Nursing Elites

1. A staff nurse is working with a patient who is on a critical pathway for education in preparation for home care. Which one of the following responsibilities would the nurse address first?

• A. Taking vital signs
• B. Answering the client's questions
• C. Evaluating client teaching
• D. Reviewing the information with the client and family

Correct answer: D

Rationale: The correct answer is D. Reviewing the information with the client and family should be addressed first. This step involves ensuring that the client and family fully understand the information provided, which is crucial before proceeding with any other responsibilities. Taking vital signs (choice A) is important but not the priority in this scenario. Answering the client's questions (choice B) and evaluating client teaching (choice C) can come after reviewing the information to ensure effective communication and understanding.

2. Which of the following best describes the concept of resilience in healthcare?

• A. Ability to recover quickly from setbacks
• B. Strict adherence to protocols
• C. Adapting to changing environments
• D. Maintaining consistent performance

Correct answer: A

Rationale: The concept of resilience in healthcare refers to the ability to bounce back and recover quickly from setbacks, such as adverse events, stress, or failures. This resilience allows healthcare professionals to navigate challenges effectively and continue providing quality care to patients. Choice B, strict adherence to protocols, though important, does not fully encompass the flexibility and adaptability required for resilience. Choice C, adapting to changing environments, is closely related to resilience but does not solely define it. Choice D, maintaining consistent performance, is valuable but does not capture the aspect of overcoming setbacks and bouncing back resiliently.

3. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

• A. Infuse dextrose 50% by slow IV push.
• B. Administer 1 mg glucagon subcutaneously.
• C. Obtain a glucose reading using a finger stick.
• D. Have the patient drink 4 ounces of orange juice.

Correct answer: C

Rationale: The correct action for the nurse to take first when a patient reports feeling lightheaded and sweaty after being weaned off an insulin drip is to obtain a glucose reading using a finger stick. This will provide crucial information on the patient's current blood glucose level, helping the nurse assess if the symptoms are due to hypoglycemia. Based on the glucose reading, appropriate interventions can be initiated, such as administering dextrose, glucagon, or oral sugars like orange juice if hypoglycemia is confirmed. However, verifying the blood glucose level is the initial step to guide subsequent actions and ensure patient safety.

4. When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery.
• B. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
• C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
• D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

Correct answer: C

Rationale: The correct answer is C because the administration of prescribed lispro (Humalog) insulin before transporting the patient to surgery is a task that can be safely delegated to a licensed practical/vocational nurse (LPN/LVN). This action is within the scope of practice of an LPN/LVN and does not require independent nursing judgment. Choices A and B involve communicating and discussing important medical information, which are higher-level nursing actions typically performed by registered nurses. Choice D involves planning strategies to manage blood glucose levels postoperatively, which requires critical thinking and assessment skills usually performed by a registered nurse.

5. A new manager is implementing an initiative with the desired outcome of having the unit run more smoothly. What quality is the manager demonstrating?

• A. Being unrealistic
• B. Being a change agent
• C. Being democratic
• D. Being authoritarian

Correct answer: B

Rationale: The correct answer is B: Being a change agent. The manager is demonstrating the quality of being a change agent by implementing an initiative aimed at improving the unit's operations. A change agent initiates and drives changes to enhance effectiveness and efficiency within the unit. Choice A is incorrect because the manager's actions are not described as unrealistic but rather proactive. Choice C, being democratic, is incorrect as it does not relate to the manager's initiative to improve unit operations. Choice D, being authoritarian, is also incorrect as the manager is not described as enforcing changes through strict control and power.

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