Nursing Elites

1. Lippitt's phases of change are important factors in the change process. The phase that involves key people in data collection is known as:

• A. Assess the motivation.
• B. Choose a change agent.
• C. Diagnose the problem.
• D. Maintain the change.

Correct answer: C

Rationale: The correct answer is C: 'Diagnose the problem.' In Lippitt's phases of change, the first step is to diagnose the problem, which involves key people in data collection and problem-solving. This step is crucial as it helps identify the root causes of the issues that need to be addressed. Assessing the motivation (A) comes later in the change process once the problem has been diagnosed. Choosing a change agent (B) and maintaining the change (D) are also important steps in the change process but do not specifically involve key people in data collection as in the diagnosis phase.

2. A registered nurse (RN) is caring for a patient who is one of Jehovah�s Witnesses and has refused a blood transfusion even though her hemoglobin is dangerously low. After providing information about all the alternatives available and risks and benefits of each, the health-care provider allows the patient to determine which course of treatment she would prefer. The RN knows this is an example of which ethical principle?

• A. Autonomy
• B. Nonmaleficence
• C. Beneficence
• D. Distributive justice

Correct answer: A

Rationale: This is an example of the ethical principle of autonomy.

3. An RN is writing reminders for good documentation for the nurses on her staff. The purpose is to ensure nursing documentation is legally credible. Which of the following is a recommendation she should include in the reminders?

• A. Use shortcuts in documentation.
• B. Only use approved abbreviations.
• C. Documentation should be subjective.
• D. Document after care is provided.

Correct answer: B

Rationale: The correct recommendation the RN should include in the reminders is to 'Only use approved abbreviations.' Using shortcuts in documentation (choice A) may lead to errors or omissions, affecting the credibility of documentation. Documentation should be objective (choice C) rather than subjective to ensure accuracy and legal credibility. It is essential to document care promptly after providing it (choice D) to maintain the accuracy and completeness of patient records, but using approved abbreviations is a more specific recommendation to enhance legal credibility.

4. A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?

• A. The patient always carries hard candies when engaging in exercise.
• B. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
• C. The patient has a peanut butter sandwich before going for a bicycle ride.
• D. The patient increases daily exercise when ketones are present in the urine.

Correct answer: D

Rationale: The correct answer is D because increasing exercise when ketones are present in the urine is inappropriate and potentially dangerous for a patient with type 1 diabetes. This behavior can worsen the ketosis and lead to further complications. Choices A, B, and C demonstrate appropriate self-management strategies for a patient with type 1 diabetes. Carrying hard candies during exercise can help prevent hypoglycemia, going for a walk with a glucose level of 200 mg/dL can help lower blood sugar, and having a snack before physical activity can provide necessary energy.

5. After examining her client's abdomen and noting assessment of significant findings, even though the client says it doesn't hurt, the nurse says to a colleague, 'I think something is going on here; I am going to investigate further.' This nurse is using:

• A. Deductive reasoning.
• B. Intuition.
• C. Trial and error.
• D. Modified scientific method.

Correct answer: B

Rationale: The correct answer is B: Intuition. In this scenario, the nurse is relying on intuition, which refers to a 'gut feeling' or instinctive understanding without the conscious use of reasoning. Deductive reasoning (choice A) involves drawing specific conclusions from general principles. Trial and error (choice C) is a problem-solving method that involves trying various methods until the correct one is found. The modified scientific method (choice D) refers to a structured approach to conducting experiments in a scientific setting, which is not applicable in this situation where the nurse is relying on a hunch or intuition.

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