Nursing Elites

1. What is the primary focus of transitional care?

• A. To improve clinical outcomes
• B. To manage chronic diseases
• C. To facilitate smooth transitions between care settings
• D. To support family caregivers

Correct answer: C

Rationale: The primary focus of transitional care is to facilitate smooth transitions between care settings. While improving clinical outcomes and managing chronic diseases are important aspects of healthcare, the main goal of transitional care is to ensure patients move smoothly between different care settings such as hospitals, rehabilitation centers, and home care. Supporting family caregivers is also essential but not the primary focus of transitional care.

2. After receiving change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
• B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
• C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
• D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

3. Which level in Maslow's hierarchy is rarely met?

• A. Esteem
• B. Safety
• C. Self-actualization
• D. Belongingness

Correct answer: C

Rationale: The correct answer is C, 'Self-actualization.' Self-actualization, the highest level in Maslow's hierarchy, involves developing one's full potential and achieving personal growth. It is considered rarely met because it requires a deep understanding of oneself, a strong sense of purpose, and the ability to pursue intrinsic goals. Esteem (choice A) focuses on respect, recognition, and self-esteem, which are more commonly achieved than self-actualization. Safety (choice B) and belongingness (choice D) are also more commonly attained as they relate to basic needs for security and social connections, which are essential for overall well-being.

4. A client is admitted to a medical-surgical unit after six hours in the emergency room. He requests that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy?

• A. Continuous quality improvement
• B. Total quality management
• C. Six Sigma
• D. Quality management

Correct answer: B

Rationale: Total Quality Management (TQM) emphasizes meeting customer needs and satisfaction. In this scenario, by honoring the client's request to delay care to allow for rest, the nurse is aligning with the customer-focused approach of TQM. TQM seeks to continuously improve processes and services to enhance customer experiences and outcomes. Continuous Quality Improvement focuses on incremental improvements in processes and outcomes over time. Six Sigma is a data-driven approach to process improvement that aims to reduce defects and errors. Quality Management is a broader concept that encompasses various strategies to ensure quality standards are met.

5. What is the primary purpose of a patient-centered medical home (PCMH)?

• A. To coordinate all aspects of patient care
• B. To reduce healthcare costs
• C. To implement the latest clinical guidelines
• D. To provide financial incentives for providers

Correct answer: A

Rationale: The correct answer is A: 'To coordinate all aspects of patient care.' A patient-centered medical home (PCMH) aims to provide comprehensive and continuous care by coordinating various aspects of a patient's healthcare needs. While reducing healthcare costs and implementing clinical guidelines are important goals in healthcare, the primary focus of a PCMH is on enhancing patient care coordination to improve outcomes and patient satisfaction. Providing financial incentives for providers is not the primary purpose of a PCMH, although it can be a component of some models to encourage quality care delivery.

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