Nursing Elites

1. Nonverbal messages in communication, including body language and environmental factors, are called ___________.

• A. lateral communication
• B. upward communication
• C. metacommunications
• D. downward communication

Correct answer: C

Rationale: Nonverbal messages in communication, such as body language and environmental factors, are termed metacommunications. Choice A, lateral communication, refers to communication between individuals or groups on the same hierarchical level. Choice B, upward communication, involves the flow of information from lower levels to higher levels in an organization. Choice D, downward communication, relates to the transmission of information from higher levels to lower levels within an organization. Therefore, the correct term for nonverbal messages in communication is metacommunications.

2. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

• A. Infuse 1 liter of normal saline per hour.
• B. Give sodium bicarbonate 50 mEq IV push.
• C. Administer regular insulin 10 U by IV push.
• D. Start a regular insulin infusion at 0.1 units/kg/hr.

Correct answer: A

Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

3. 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.

4. Constant reports of inadequate pain control in clients indicate which of the following?

• A. Improper administration of medications
• B. Potential substance abuse by the healthcare provider
• C. Poorly written prescriptions
• D. Inadequate scheduling by healthcare providers

Correct answer: B

Rationale: Constant reports of inadequate pain control may suggest potential substance abuse by the healthcare provider, as they might be diverting narcotics for personal use instead of administering them to clients. The incorrect choices include: A) Improper administration of medications may cause inadequate pain control but does not necessarily involve substance abuse. C) Poorly written prescriptions could lead to medication errors but are less likely to be related to substance abuse. D) Inadequate scheduling by healthcare providers might affect pain management but does not directly suggest substance abuse.

5. What is the main purpose of a clinical audit?

• A. To measure patient satisfaction
• B. To evaluate the effectiveness of clinical practices
• C. To identify areas for improvement
• D. To standardize patient care protocols

Correct answer: C

Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.

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