Nursing Elites

1. Politics is defined as the art of influencing the allocation of scarce resources. An example of a scarce resource allocated by the manager of a patient care unit is:

• A. Raises for the staff.
• B. Patient supplies in the utility room.
• C. Staffing that minimizes overtime.
• D. Paper for the printer.

Correct answer: C

Rationale: In a healthcare setting, scarce resources can include money, time, personnel, and materials. Staffing decisions directly impact the allocation of personnel resources and can affect overtime costs, making it a critical resource managed by the unit manager. Patient supplies in the utility room and paper for the printer are important, but staffing decisions have a more direct impact on resource allocation within the unit. Raises for staff are typically granted by the institution and are not directly controlled by the unit manager.

2. Which of the following scenarios would be an example of shared governance on a nursing unit?

• A. Staff nurses delegate activities to CNAs.
• B. Procedure manuals are written by a committee of nurse managers.
• C. Staff nurses and CNAs make their own schedules.
• D. A unit manager seeks advice from her supervisor.

Correct answer: C

Rationale: The correct answer is C. Shared governance in a nursing unit involves staff nurses and CNAs having autonomy and decision-making power in aspects like scheduling, which is reflected in them making their own schedules. This scenario aligns with the philosophy of shared governance where nursing practice is best determined by nurses. Choices A, B, and D do not exemplify shared governance as they involve hierarchical delegation, managerial decision-making, and seeking advice from superiors rather than autonomous decision-making by frontline staff.

3. A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the healthcare provider?

• A. Hemoglobin A1C level is 7.9%.
• B. Last eye exam was 18 months ago.
• C. Glomerular filtration rate is decreased.
• D. Patient has questions about the prescribed diet.

Correct answer: C

Rationale: The most important finding to discuss with the healthcare provider is the decreased glomerular filtration rate. In patients on metformin therapy, monitoring kidney function is crucial as metformin is primarily excreted through the kidneys. A decreased glomerular filtration rate can lead to metformin accumulation in the body, increasing the risk of lactic acidosis, a serious adverse effect. The hemoglobin A1C level being 7.9% indicates poor diabetes control but can be addressed through medication adjustments and lifestyle modifications. The patient needing an eye exam after 18 months is important but not as urgent as discussing the decreased glomerular filtration rate. Patient questions about the prescribed diet can be addressed during the visit without the need for immediate healthcare provider intervention.

4. A healthcare professional is administering 1 L of 0.9% sodium chloride to a client who is postoperative and has fluid volume deficit. Which of the following changes should the healthcare professional identify as an indication that the treatment was successful?

• A. Increase in hematocrit
• B. Increase in respiratory rate
• C. Decrease in heart rate
• D. Decrease in capillary refill time

Correct answer: D

Rationale: The correct answer is D: Decrease in capillary refill time. In a client with fluid volume deficit, improving capillary refill time indicates that the perfusion status is improving due to the increase in fluid volume. Choices A, B, and C are incorrect. An increase in hematocrit may indicate hemoconcentration due to fluid loss, an increase in respiratory rate may suggest respiratory distress, and a decrease in heart rate may not be directly related to fluid volume status.

5. 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.

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