Nursing Elites

1. Staff are sometimes injured when a patient or visitor becomes agitated. If a staff member reports an injury, the following actions should take place: (EXCEPT)

• A. Notify security.
• B. Complete an incident report.
• C. Notify the nursing supervisor.
• D. Ensure that staff has been examined.

Correct answer: B

Rationale: When a staff member reports an injury resulting from an agitated patient or visitor, several actions should be taken. These actions include notifying security to ensure safety, notifying the nursing supervisor for appropriate follow-up, and ensuring that the injured staff member has been examined to assess the extent of the injury. Completing an incident report is not the correct action to exclude because documenting the incident is crucial for legal and healthcare purposes. Incident reports provide a detailed account of what occurred, which is essential for investigations, insurance claims, and improving safety protocols. Therefore, all other options are necessary steps to take when a staff member reports an injury, making completing an incident report the correct answer for exclusion.

2. Which statement by the patient indicates a need for additional instruction in administering insulin?

• A. 'I need to rotate injection sites among my arms, legs, and abdomen each day.'
• B. 'I can buy the 0.5 mL syringes because the line markings will be easier to see.'
• C. 'I should draw up the regular insulin first after injecting air into the NPH bottle.'
• D. 'I do not need to aspirate the plunger to check for blood before injecting insulin.'

Correct answer: A

Rationale: This statement indicates a need for additional instruction because while site rotation is essential, it's important to rotate sites within the same anatomical region (such as staying within the abdomen for several injections before moving to a different region). Rotating too frequently between different regions can cause inconsistent insulin absorption, which can affect blood sugar control.

3. 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.

4. Monitoring the number of times a medication is given utilizing the 'five rights' is an example of which phase of the Six Sigma program?

• A. Measure
• B. Management
• C. Quantitative
• D. Goal

Correct answer: A

Rationale: In the Six Sigma program, the 'Measure' phase focuses on monitoring and measuring processes to ensure they meet the desired standards. This includes tracking the number of times a medication is given correctly using the 'five rights' principle. Therefore, the correct answer is A. Choice B, 'Management,' does not specifically relate to monitoring processes or data collection, so it is not the correct answer. Choice C, 'Quantitative,' refers to the use of numerical data in decision-making, which is a broader concept and not specific to monitoring processes within the Six Sigma framework. Choice D, 'Goal,' is too general and does not capture the specific phase of Six Sigma that involves monitoring and measuring processes.

5. 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.

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