Nursing Elites

1. An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to

• A. give a bolus of 50% dextrose.
• B. insert a large-bore IV catheter.
• C. initiate oxygen via nasal cannula.
• D. administer glargine (Lantus) insulin.

Correct answer: B

Rationale: In a patient with hyperosmolar hyperglycemic syndrome (HHS), severe dehydration and electrolyte imbalances are common. To address these issues, the priority intervention is to insert a large-bore IV catheter for fluid resuscitation and electrolyte replacement. Giving a bolus of 50% dextrose would worsen the hyperglycemia. Initiating oxygen via nasal cannula may be beneficial for respiratory support but is not the priority in this scenario. Administering glargine (Lantus) insulin is not the initial treatment for HHS as it does not address the underlying severe dehydration and electrolyte imbalances.

2. What is the primary focus of a patient-centered care model?

• A. Cost reduction
• B. Healthcare provider satisfaction
• C. Patient satisfaction
• D. Quality assurance

Correct answer: C

Rationale: The primary focus of a patient-centered care model is on patient satisfaction. This approach emphasizes providing care that is personalized to meet the unique needs and preferences of each patient, fostering a collaborative and respectful partnership between healthcare providers and patients to achieve better health outcomes. While cost reduction (choice A) can be a byproduct of improved outcomes, it is not the primary focus. Healthcare provider satisfaction (choice B) is important but not the primary focus in patient-centered care. Quality assurance (choice D) is crucial but is secondary to patient satisfaction in a patient-centered care model.

3. Which of the following types of HMOs (Health Maintenance Organizations) contracts with two or more IPAs (Independent Practice Associations)?

• A. Staff model
• B. Point of service model
• C. Network model
• D. Group model

Correct answer: C

Rationale: The correct answer is C, the Network model. This type of HMO contracts with two or more IPAs. In a Network model, multiple IPAs work together to provide healthcare services to the members. Choice A, the Staff model, involves physicians who are employees of the HMO. Choice B, the Point of Service model, allows members to seek care outside the network at a higher cost. Choice D, the Group model, does not specifically contract with IPAs.

4. A nurse manager has two out of six staff nurses call in sick for one shift. Because of reduced availability of staff, the manager decides to manage the unit with the three remaining nurses, which keeps the unit at minimal staffing standards. What type of decision-making strategy would this be?

• A. Satisficing
• B. Routine
• C. Adaptive
• D. Rationalizing

Correct answer: A

Rationale: The correct answer is A: Satisficing. Satisficing is a decision-making strategy where the person chooses an alternative that is good enough given the circumstances. In this scenario, the nurse manager is making a satisfactory decision by managing the unit with the three remaining nurses to meet minimal staffing standards despite the reduced availability of staff. Choice B, Routine, does not apply as the decision made in the scenario is not part of a regular or standard procedure. Choice C, Adaptive, is not the best fit as the decision is more about making do with the available resources rather than adapting to a new situation. Choice D, Rationalizing, does not align with the scenario as it refers to justifying decisions rather than making a practical choice under constraints.

5. Which of the following are managerial functions, according to Mintzberg? (EXCEPT)

• A. Leading and linking at the people level
• B. Communicating and controlling at the information level
• C. Deciding pay structures
• D. Doing at the action level

Correct answer: C

Rationale: The correct answer is C. Mintzberg believed that managing involves communicating and controlling at the information level, leading and linking at the people level, and doing at the action level. Choice A is correct as it aligns with Mintzberg's concept of leading and linking at the people level. Choice B is correct as it aligns with Mintzberg's concept of communicating and controlling at the information level. Choice D is correct as it aligns with Mintzberg's concept of doing at the action level. Choice C, deciding pay structures, is not a managerial function according to Mintzberg's model, making it the exception.

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