Nursing Elites

1. In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take?

• A. Determine what type of activities the patient enjoys.
• B. Remind the patient that exercise will improve self-esteem.
• C. Teach the patient about the effects of exercise on glucose levels.
• D. Give the patient a list of activities that are moderate in intensity.

Correct answer: A

Rationale: The correct answer is to determine what type of activities the patient enjoys. This approach is crucial as it helps in personalizing the exercise plan to the patient's preferences, making it more likely for them to adhere to it. Choice B is incorrect because focusing on self-esteem may not directly motivate the patient to engage in exercise. Choice C, although important, may not be the initial step as understanding the patient's preferences comes first. Choice D limits the patient's autonomy by not involving them in the decision-making process.

2. A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician and correcting the rate, what should be the next step in the client's care?

• A. Notify family
• B. Discipline the previous nurse
• C. Complete an incident report
• D. Obtain legal consultation

Correct answer: C

Rationale: The correct next step in the client's care after notifying the physician and correcting the rate of IVFs is to complete an incident report. This report is essential for documenting the adverse event, analyzing the cause, and implementing preventive measures to avoid similar incidents in the future. Notifying the family, disciplining the previous nurse, and obtaining legal consultation are not immediate priorities in this situation. Family notification may follow the incident report, disciplining the previous nurse is a separate administrative process, and legal consultation is usually not required for a medical error corrected promptly.

3. Which of the following indicators is viewed as important by the nurse manager in relation to a performance model?

• A. Patient outcomes
• B. Rapport with staff
• C. Daily job performance
• D. Flexibility

Correct answer: A

Rationale: The correct answer is A: Patient outcomes. In a performance model, one of the key indicators that a nurse manager would focus on is patient outcomes. Patient outcomes are a direct reflection of the quality of care provided by the staff, making it a crucial aspect of evaluating performance. Choice B, rapport with staff, though important for team dynamics, is not directly related to a performance model that primarily assesses job performance. Choice C, daily job performance, is relevant but more of an outcome rather than an indicator itself. Choice D, flexibility, is a valuable trait but not specifically highlighted in the context of a performance model.

4. Which of the following should be included in a discussion of advance directives with new nurse graduates?

• A. According to the Patient Self-Determination Act, nurses are required to inform clients of their right to create an advance directive.
• B. The advance directive designates an individual who will make financial decisions for the client if he or she is unable to do so.
• C. A living will designates who will make health-care decisions for an individual in the event the individual is unable or incompetent to make his or her own decisions.
• D. The advance directive designates a health-care surrogate who will make known the client’s wishes regarding medical treatment if the client is unable to do so.

Correct answer: D

Rationale: One function of the advance directive is to appoint a health-care surrogate who will make known the client’s wishes for medical treatment to the medical and nursing team if the client is unable to do so.

5. After receiving change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
• B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
• C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
• D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

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