Nursing Elites

1. The healthcare provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?

• A. Avoid snacking at bedtime.
• B. Increase the rapid-acting insulin dose.
• C. Check the blood glucose during the night.
• D. Administer a larger dose of long-acting insulin.

Correct answer: C

Rationale: The Somogyi effect, also known as rebound hyperglycemia, occurs due to an excessive insulin dose at night, leading to hypoglycemia in the early morning hours. To address this, the nurse should instruct the patient to check their blood glucose during the night to determine if hypoglycemia is present, which triggers the rebound hyperglycemia. By monitoring blood glucose levels during the night, the patient can identify if adjustments are needed to prevent this phenomenon and maintain stable glucose levels. Choices A, B, and D are incorrect. Avoiding snacking at bedtime, increasing rapid-acting insulin dose, or administering a larger dose of long-acting insulin are not appropriate actions to manage the Somogyi effect. Checking blood glucose during the night is crucial to identify and prevent the rebound hyperglycemia characteristic of this phenomenon.

2. 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.

3. 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.

4. Organizations are made up of intertwined links and diversified choices that generate unanticipated consequences. This defines which of the following theories?

• A. Contingency theory
• B. Closed system theory
• C. Open system theory
• D. Chaos theory

Correct answer: D

Rationale: The correct answer is D, Chaos theory. Chaos theory is characterized by organizations that are made up of intertwined links and diversified choices that generate unanticipated consequences. Contingency theory (choice A) is based on the idea that there is no one best way to organize and manage a corporation. Closed system theory (choice B) refers to systems that are closed off from the outside environment and do not interact with it. Open system theory (choice C) views organizations as open systems that interact with their external environment.

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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