Nursing Elites

1. Which of the following best describes the concept of evidence-based practice (EBP)?

• A. Clinical expertise as the primary basis for decision making
• B. Research findings as the sole basis for decision making
• C. Combining clinical expertise with the best available research evidence
• D. Following institutional guidelines for patient care

Correct answer: C

Rationale: The correct answer is C: 'Combining clinical expertise with the best available research evidence.' Evidence-based practice (EBP) emphasizes integrating clinical expertise with the most current and relevant research evidence when making decisions about patient care. Choice A is incorrect because EBP does not rely solely on clinical expertise. Choice B is incorrect as EBP considers research evidence alongside clinical expertise, not as the sole basis. Choice D is incorrect because EBP is not about blindly following institutional guidelines, but rather about integrating research evidence with clinical judgment to provide the best possible care.

2. A healthcare professional is preparing to delegate client care tasks to an assistive personnel (AP). Which of the following tasks should the healthcare professional delegate?

• A. Confirming that a client's pain has decreased after receiving an analgesic
• B. Ambulating a client who is postoperative
• C. Inserting an indwelling urinary catheter for a client
• D. Demonstrating the use of an incentive spirometer to a client

Correct answer: A

Rationale: The correct answer is option A: 'Confirming that a client's pain has decreased after receiving an analgesic.' This task involves assessing the effectiveness of the medication, which can be delegated to the assistive personnel. Options B, C, and D involve skills that should be performed by licensed healthcare professionals due to their complexity and potential risks if not done correctly. Ambulating a postoperative client requires monitoring for signs of distress or complications, inserting a urinary catheter involves an invasive procedure with infection risks, and demonstrating the use of medical devices like an incentive spirometer requires specialized knowledge to ensure correct usage.

3. What is the main purpose of a clinical audit?

• A. To measure patient satisfaction
• B. To evaluate the effectiveness of clinical practices
• C. To identify areas for improvement
• D. To standardize patient care protocols

Correct answer: C

Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.

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. Although technology has seen many advances, which two ethical principles may be in conflict because of technology?

• A. Beneficence and justice
• B. Beneficence and nonmaleficence
• C. Beneficence and veracity
• D. Beneficence and confidentiality

Correct answer: B

Rationale: The correct answer is B: Beneficence and nonmaleficence. Beneficence is the ethical principle of doing good to benefit others, while nonmaleficence is the principle of doing no harm to others. With technological advances, there can be a conflict between these two principles, as the benefits of technology may inadvertently cause harm, leading to an ethical dilemma. Choices A, C, and D are incorrect because while beneficence is involved in all options, the conflicting principle of nonmaleficence specifically addresses the avoidance of harm, making it the most relevant in the context of technology's impact on ethical principles.

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