Nursing Elites

1. Which of the following clients would most likely be selected for case management?

• A. An adolescent with a gunshot wound who is in the ER.
• B. A young adult with a fractured pelvis.
• C. An elderly client awaiting a hip replacement.
• D. A 41-year-old client admitted for outpatient tonsillectomy.

Correct answer: C

Rationale: The correct answer is C, an elderly client awaiting a hip replacement. This choice is most likely selected for case management because hip replacements are common surgical procedures with high volume in hospitals, making it appropriate for case management. Choices A, B, and D involve acute care conditions but do not typically require the same level of coordination and management that a hip replacement case would. Therefore, they are less likely to be selected for case management.

2. When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action?

• A. Collection of data
• B. Planning
• C. Analyzing data
• D. Identification

Correct answer: B

Rationale: The correct answer is B, 'Planning.' Planning is the phase where individuals reflect on current routines and explore alternative courses of action. This stage involves considering new strategies and approaches, making it the most suitable time to challenge existing norms. Choice A, 'Collection of data,' focuses on gathering information rather than actively reconsidering routines. Choice C, 'Analyzing data,' involves assessing the gathered data rather than proposing new plans. Choice D, 'Identification,' does not specifically address the process of reviewing routines and suggesting improvements, making it less relevant to the question.

3. A nurse is caring for a client who has a nasogastric (NG) tube and is receiving intermittent feedings through an open system. Which of the following actions should the nurse take first?

• A. Make sure the enteral formula is at room temperature.
• B. Wipe the top of the formula can with alcohol.
• C. Rinse the feeding bag with water between feedings.
• D. Tell the client to keep the head of the bed elevated at least 30�

Correct answer: B

Rationale:

4. A 26-year-old patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin?

• A. Thigh
• B. Buttock
• C. Abdomen
• D. Upper arm

Correct answer: C

Rationale: The correct answer is the abdomen. When a patient engages in physical activities like riding a bicycle, the abdomen is a suitable site for insulin administration due to the consistent absorption rate. The subcutaneous tissue in the abdomen allows for more predictable insulin absorption compared to other sites. The thigh is also a common site for insulin injection but may not be ideal for this patient due to the physical activity involved. The buttock and upper arm are not preferred sites for insulin injection as they can have variable absorption rates and may not be as convenient for self-administration.

5. One of the most important driving forces behind health care policy changes is which of the following?

• A. New technology
• B. Outsourcing of services
• C. Emerging role of nurse practitioners
• D. Ability to pay for health care

Correct answer: D

Rationale: The correct answer is D, 'Ability to pay for health care.' One of the primary factors influencing health care policy changes is the financial aspect, as the ability to afford healthcare services affects access, quality, and equity. While new technology, outsourcing of services, and the emerging role of nurse practitioners may also impact health care policies, the fundamental driver often revolves around individuals' and societies' financial capacity to pay for healthcare.

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