Nursing Elites

1. Which of the following best describes decertification?

• A. Encourage union affiliation
• B. Change union affiliation
• C. Reward union affiliation
• D. Empower union affiliation

Correct answer: B

Rationale: Decertification is the process of removing or changing union affiliation. Choosing option B, 'Change union affiliation,' correctly reflects this definition. Option A, 'Encourage union affiliation,' is incorrect as decertification is not about promoting union membership but rather altering it. Option C, 'Reward union affiliation,' is incorrect as decertification does not involve rewarding union membership. Option D, 'Empower union affiliation,' is incorrect as decertification does not empower union membership but rather modifies or eliminates it.

2. As a new graduate employed in a high-volume maternity unit that uses differentiated practice as its staffing model, what can the nurse expect?

• A. Evidence-based practice guides risk management principles.
• B. Client teaching is the responsibility of the team leader.
• C. The initial level of practice responsibility will be limited.
• D. Seniority is the main determinant of client assignments.

Correct answer: C

Rationale: In a differentiated practice model, the scope of nursing practice and responsibility are tailored to different levels of experience. As a new graduate with limited experience, the nurse can expect that the initial level of practice responsibility will be limited to match their skill level and knowledge. This allows for a gradual increase in responsibilities as the nurse gains more experience and expertise. Choice A is incorrect because evidence-based practice is related to clinical decision-making, not the staffing model. Choice B is incorrect as client teaching is typically a shared responsibility among the healthcare team, not solely the team leader's. Choice D is incorrect as differentiated practice models focus on skill level and competence rather than seniority when determining client assignments.

3. A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to

• A. use only the lispro insulin until the symptoms are resolved
• B. limit calorie intake until the glucose is less than 120 mg/dL
• C. monitor blood glucose every 4 hours and notify the clinic if it continues to rise
• D. decrease carbohydrate intake until glycosylated hemoglobin is less than 7%

Correct answer: C

Rationale: In this scenario, the nurse should advise the patient to monitor her blood glucose every 4 hours and notify the clinic if it continues to rise. This is important because the patient is experiencing symptoms of an illness (sore throat and runny nose) that can lead to fluctuations in blood glucose levels. By monitoring frequently, any significant rise in blood glucose can be detected early, enabling prompt intervention. Choice A is incorrect because abruptly stopping glargine (Lantus) insulin can lead to uncontrolled blood glucose levels. Choice B is incorrect as limiting calorie intake is not the appropriate immediate action for managing high blood glucose levels. Choice D is also incorrect as adjusting carbohydrate intake based on glycosylated hemoglobin levels is not the immediate action needed in this acute situation.

4. A nurse is planning an educational program for a group of older adults at a senior living center. Which of the following recommendations should the nurse include?

• A. You should receive a pneumococcal vaccine when you are 65 years old.
• B. You should receive a shingles vaccine when you are 70 years old.
• C. You should receive a tetanus booster every 5 years.
• D. You should have an eye examination every 2 years.

Correct answer: A

Rationale: The correct answer is A. The CDC recommends a pneumococcal vaccine for all adults aged 65 years and older. This vaccine helps protect against serious pneumococcal disease. Choice B is incorrect as the shingles vaccine is recommended for adults aged 50 years and older, not specifically at 70 years. Choice C is incorrect because a tetanus booster is recommended every 10 years, not every 5 years. Choice D is incorrect as the general recommendation for eye examinations in older adults is annually, not every 2 years.

5. Which of the following best describes the concept of shared governance?

• A. Top-down management
• B. Nurse-led committees
• C. Shared decision making
• D. Hierarchical structure

Correct answer: C

Rationale: The correct answer is C: 'Shared decision making.' Shared governance in healthcare involves empowering nurses to participate in decision-making processes that affect their practice. This model fosters collaboration, transparency, and accountability among healthcare providers. Choice A, 'Top-down management,' is incorrect because shared governance promotes a bottom-up approach. Choice B, 'Nurse-led committees,' is partially correct as it is a component of shared governance, but the core concept is broader and encompasses shared decision making beyond committee leadership. Choice D, 'Hierarchical structure,' is incorrect as shared governance aims to flatten hierarchies and distribute decision-making authority among healthcare team members.

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