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. An RN’s client with terminal pancreatic cancer asks questions about a do not resuscitate order. Which of the following statements should be included in the RN’s teaching to the client?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians must write do not resuscitate (DNR) orders.
• C. A DNR order can be written after the health-care provider has discussed it with the client and family.
• D. A DNR requires a court decision.

Correct answer: C

Rationale: A DNR order can be written after the health-care provider has discussed it with the client and family.

3. Your values do not coincide with your colleagues. When you report for your shift on nights and staff are not responding to patient requests for pain medication, you, as the nurse responsible for collecting data about patient quality of care, should:

• A. Explain to the nurse manager that quality problems are because of staff apathy.
• B. Issue a memo to staff to assess patients and document their response to the pain medication.
• C. Explain to staff that improving quality is one of your annual goals and you expect them to follow through.
• D. Schedule meetings to engage with staff to monitor pain management.

Correct answer: D

Rationale: As the nurse responsible for collecting data about patient quality of care, it is important to address the issue of staff not responding to patient requests for pain medication. Scheduling meetings to engage with staff to monitor pain management is the most appropriate course of action in this scenario. By enlisting support from staff, reviewing patient satisfaction data, and quality reports about pain management, you can effectively address the issue and improve patient care. Choices A, B, and C are not as effective as they do not involve actively engaging with staff, reviewing data, and working collaboratively to address the problem.

4. One of the most useful tools to determine reasons for turnover is:

• A. Questioning.
• B. Surveys.
• C. Employee forums.
• D. Telephone calls.

Correct answer: B

Rationale: Surveys are one of the most effective tools to determine reasons for turnover because they allow employees to provide feedback anonymously, leading to more truthful responses. While questioning can be part of the process, surveys provide a structured and standardized way to collect data. Employee forums may not always elicit honest responses due to peer pressure or fear of repercussions. Telephone calls may not reach all employees and do not guarantee anonymity, potentially leading to biased or incomplete information.

5. What is the main purpose of health informatics?

• A. To manage patient care
• B. To store patient records
• C. To enhance clinical decision making
• D. To improve healthcare policies

Correct answer: C

Rationale: The main purpose of health informatics is to enhance clinical decision making. While managing patient care (choice A) and storing patient records (choice B) are important functions within health informatics, the primary goal is to improve decision making processes by utilizing technology and data. Improving healthcare policies (choice D) is not the main purpose of health informatics, although it can be a byproduct of better-informed decision making.

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