Nursing Elites

1. There are many ways to ensure that your appraisal system is nondiscriminatory. Which of the following is one way to ensure this?

• A. Giving the appraisal once per year
• B. Having no appeal process
• C. Withholding information from the employee
• D. Not allowing any input from the employee

Correct answer: A

Rationale: To ensure that an appraisal system is nondiscriminatory, one important step is to provide the appraisal once per year. This allows for ongoing evaluation and helps prevent bias. Choice B is incorrect because having no appeal process can lead to unfair treatment without a chance for review. Choice C is incorrect as withholding information from the employee can hinder transparency and objectivity. Choice D is incorrect as not allowing any input from the employee can overlook valuable insights and perspectives that could contribute to a fair evaluation process.

2. Which of the following best describes the purpose of benchmarking in healthcare?

• A. To compare performance metrics across organizations
• B. To identify best practices and implement them
• C. To ensure compliance with standards
• D. To develop new clinical guidelines

Correct answer: B

Rationale: The correct answer is B: 'To identify best practices and implement them.' Benchmarking in healthcare aims to compare performance metrics across organizations to identify the most effective practices and implement them. This helps healthcare providers improve their performance and outcomes by adopting proven successful strategies. Choices A, C, and D are incorrect because while benchmarking may involve comparing performance metrics and ensuring standards compliance, its primary purpose is to identify and implement best practices.

3. A client who is postoperative is verbalizing pain as a 2 on a pain scale of 0 to 10. Which of the following statements should the nurse identify as an indication that the client understands the preoperative teaching they received about pain management?

• A. ''I think I should take my pain medication more often, since it is not controlling my pain.''
• B. ''Breathing faster will help me keep my mind off of the pain.''
• C. ''It might help me to listen to music while I'm lying in bed.''
• D. ''I don't want to walk today because I have some pain.''

Correct answer: D

Rationale: The correct answer is D because the client is demonstrating an understanding of the preoperative teaching by acknowledging the pain and relating it to the need to rest. Walking may exacerbate the pain, and the client's decision not to walk shows an awareness of their body's signals. Choices A, B, and C are incorrect as they do not reflect a good understanding of pain management. Choice A suggests self-medicating without consulting healthcare providers, choice B focuses on distraction rather than addressing the pain, and choice C offers a coping mechanism but does not address the pain directly.

4. 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.

5. A group of physicians comes into conflict with the nursing staff of a unit over when AM vital signs are recorded. What type of technique might be used that respects the professionalism of both parties?

• A. Accommodating
• B. Collaboration
• C. Avoiding
• D. Competing

Correct answer: B

Rationale: In this scenario, the most appropriate technique to use is collaboration. Collaboration involves working together with mutual attention to the problem, utilizing the talents of all parties involved. This approach respects the professionalism of both physicians and nursing staff by valuing their input and expertise. Choice A, accommodating, involves giving in to the other party's concerns, which may not fully address the conflict. Choice C, avoiding, suggests ignoring or sidestepping the issue, which does not promote a resolution. Choice D, competing, involves pursuing one's own concerns at the expense of the other party's, leading to a win-lose situation, which is not conducive to resolving conflicts in a professional setting.

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