Nursing Elites

1. When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery.
• B. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
• C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
• D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

Correct answer: C

Rationale: The correct answer is C because the administration of prescribed lispro (Humalog) insulin before transporting the patient to surgery is a task that can be safely delegated to a licensed practical/vocational nurse (LPN/LVN). This action is within the scope of practice of an LPN/LVN and does not require independent nursing judgment. Choices A and B involve communicating and discussing important medical information, which are higher-level nursing actions typically performed by registered nurses. Choice D involves planning strategies to manage blood glucose levels postoperatively, which requires critical thinking and assessment skills usually performed by a registered nurse.

2. Your values do not coincide with your colleagues. When you report for your shift on nights and staff are not responding to patient requests for pain medication, you, as the nurse responsible for collecting data about patient quality of care, should:

• A. Explain to the nurse manager that quality problems are because of staff apathy.
• B. Issue a memo to staff to assess patients and document their response to the pain medication.
• C. Explain to staff that improving quality is one of your annual goals and you expect them to follow through.
• D. Schedule meetings to engage with staff to monitor pain management.

Correct answer: D

Rationale: As the nurse responsible for collecting data about patient quality of care, it is important to address the issue of staff not responding to patient requests for pain medication. Scheduling meetings to engage with staff to monitor pain management is the most appropriate course of action in this scenario. By enlisting support from staff, reviewing patient satisfaction data, and quality reports about pain management, you can effectively address the issue and improve patient care. Choices A, B, and C are not as effective as they do not involve actively engaging with staff, reviewing data, and working collaboratively to address the problem.

3. A registered nurse (RN) administered a patient�s morning insulin as the breakfast tray arrived at 0800. The RN performed a complete assessment at the same time. Then, the RN got busy with her other patients and did not check on the patient until 1400. At that time, she found the patient unresponsive with a blood glucose of 23. Both the breakfast and lunch tray were at the bedside untouched. Which of the following could the RN be charged with?

• A. Quasi-intentional tort
• B. Misdemeanor
• C. Negligence
• D. Juvenile offense

Correct answer: C

Rationale: Negligence is the failure to act in a reasonable, ordinary, and prudent manner, causing harm to someone who is owed the duty to care.

4. Which of the following types of leadership behaviors would be most useful when managing a staff of newly trained CNAs (Certified Nursing Assistants)?

• A. Achievement-oriented
• B. Supportive
• C. Participative
• D. Directive

Correct answer: D

Rationale: The most useful type of leadership behavior when managing a staff of newly trained CNAs (Certified Nursing Assistants) would be directive. Directive leadership involves giving specific guidance, ensuring adherence to rules and procedures, scheduling work efforts, and clearly telling employees what is expected. This approach is particularly beneficial for newly trained staff who may require clear instructions and guidance. - Achievement-oriented leadership focuses on setting challenging goals and encouraging employees to reach their highest potential. While this can be beneficial in some situations, it may not be the most suitable for managing newly trained CNAs who require more guidance and direction. - Supportive leadership involves providing emotional support, encouragement, and assistance to employees. While emotional support is essential in any work environment, newly trained CNAs may benefit more from clear direction and guidance. - Participative leadership involves involving employees in decision-making processes. While this can promote employee engagement and empowerment, newly trained CNAs may require more structured guidance and direction to ensure they understand their roles and responsibilities.

5. Which of the following are significant benefits to an organization that is considering adoption of a practice partnership model? (Select all that apply.)

• A. Clients express reduced satisfaction.
• B. It is less expensive to implement than other models.
• C. Continuity of care is facilitated.
• D. Leadership is well accepted.

Correct answer: C

Rationale: The correct answer is C: Continuity of care is facilitated. One of the significant benefits of a practice partnership model is that it facilitates continuity of care, which can lead to better outcomes for clients. Choice A is incorrect as clients would not express reduced satisfaction with this model; in fact, greater client satisfaction is a benefit. Choice B is incorrect because the cost-effectiveness of the model is not specified or guaranteed. Choice D is incorrect as the acceptance of leadership is not explicitly mentioned as a significant benefit of this model.

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