Nursing Elites

1. Healthcare systems primarily have functional structures. Which of the following would be an example of this?

• A. Open communication exists between Physical Therapy and Nursing.
• B. Medicine has authority over nursing.
• C. Laboratory services have little authority.
• D. All nursing tasks fall under nursing service.

Correct answer: D

Rationale: The correct answer is D. In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group. This means that in a healthcare system with a functional structure, all nursing tasks would fall under the nursing service. Choices A, B, and C are incorrect because open communication between departments, one department having authority over another, or the level of authority of a particular department do not necessarily represent a functional structure.

2. After a violent incident, staff needs to discuss what occurred. Several actions need to be taken following the incident:

• A. Debrief the staff and complete incident reports and verify that all staff are safe
• B. Reassure the violent patient that hurting staff when ill is not cause for concern
• C. Avoid any interactions
• D. Standing close to the patient while talking

Correct answer: A

Rationale: Corrected Rationale: After a violent incident, it is crucial to debrief the staff and complete incident reports to document what occurred and ensure proper follow-up actions. Verifying that all staff are safe is essential for their well-being and security. This process allows professionals to assess the situation, learn from it, and be better prepared to handle similar incidents in the future. Choice B is incorrect because reassuring a violent patient that hurting staff is not a cause for concern may diminish the seriousness of the incident. Choice C is incorrect as avoiding interactions does not address the need for proper communication and resolution. Choice D is incorrect as standing close to a patient who has been violent may escalate the situation and compromise safety.

3. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP) working in the diabetic clinic?

• A. Measure the ankle-brachial index.
• B. Check for changes in skin pigmentation.
• C. Assess for unilateral or bilateral foot drop.
• D. Ask the patient about symptoms of depression.

Correct answer: A

Rationale: The correct answer is A: Measure the ankle-brachial index. This task involves using a Doppler ultrasound device to assess blood flow, which can be safely delegated to UAP. Choices B, C, and D require a higher level of assessment and interpretation that should be performed by licensed nursing staff. Checking for changes in skin pigmentation (B) and assessing for foot drop (C) involve more complex assessments that require nursing judgment. Asking about symptoms of depression (D) involves a psychosocial assessment, which should be performed by licensed personnel qualified to address mental health concerns.

4. A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

• A. Urine dipstick for glucose
• B. Oral glucose tolerance test
• C. Fasting blood glucose level
• D. Glycosylated hemoglobin level

Correct answer: D

Rationale: The correct answer is D: Glycosylated hemoglobin level. Glycosylated hemoglobin, also known as hemoglobin A1c, provides a long-term indicator of blood glucose control over the past 2-3 months. It is a valuable tool in assessing the effectiveness of diabetes treatment because it reflects average blood sugar levels during this period. Choices A, B, and C are not as effective for evaluating long-term glucose control. Urine dipstick for glucose only provides a snapshot of glucose levels at the time of testing, oral glucose tolerance test evaluates how the body processes glucose after drinking a sugary solution, and fasting blood glucose level gives a point-in-time measurement of glucose levels after fasting, but they do not reflect the overall glucose control over several months.

5. A nurse manager wants to implement a new policy on the unit. What is the first step in the change process according to Lewin's Change Theory?

• A. Unfreeze the system
• B. Move the system to a new level
• C. Refreeze the system
• D. Evaluate the system

Correct answer: A

Rationale: The correct answer is A: 'Unfreeze the system.' According to Lewin's Change Theory, unfreezing the system is the initial step in the change process. This step involves preparing the organization for change by creating awareness of the need for change, addressing any resistance, and establishing a sense of urgency. Choice B, 'Move the system to a new level,' is incorrect as it does not align with the first step of unfreezing. Choice C, 'Refreeze the system,' is incorrect as it pertains to the final stage of solidifying the change, not the first step. Choice D, 'Evaluate the system,' is incorrect as evaluation typically occurs after the change has been implemented, not at the beginning of the change process.

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