Nursing Elites

1. Which of the following describes the ability to enter into a contract with an employer?

• A. Certification to contract
• B. Certification to represent
• C. Bargaining agreement
• D. Contract agreement

Correct answer: A

Rationale: The correct answer is A, 'Certification to contract,' which refers to the process by which a union, certified by the NLRB as a bargaining agent, can enter into a contract with an employer that has been voted on by the union membership. The other choices are incorrect because 'Certification to represent' does not specifically address entering into a contract, 'Bargaining agreement' refers to the actual agreement reached through negotiation, and 'Contract agreement' is redundant, as it simply repeats the term 'contract.'

2. Construction is occurring in the Emergency Department, with equipment and sharp items being used by the contractors. As the charge nurse, you are concerned that agitated patients might use the equipment as weapons and you meet with staff to: (EXCEPT)

• A. Notify the nursing supervisor.
• B. Notify security.
• C. Have them check patients to verify safety.
• D. Ask construction workers to be responsible.

Correct answer: D

Rationale: When construction is ongoing in a healthcare setting, it is essential to address safety concerns promptly. While it is crucial to notify the nursing supervisor and security to manage potential risks, having staff check patients for safety is also a valid precautionary measure. However, asking construction workers to be responsible is not a proper action to address the safety concerns posed by the equipment. Construction workers are professionals responsible for their tasks; it is the healthcare facility's responsibility to ensure patient and staff safety in such situations.

3. Which of the following is an example of total time lost?

• A. Number of days off that an employee asks for
• B. Number of scheduled days missed
• C. Number of days missed
• D. Number of days perceived to be absent

Correct answer: B

Rationale: The correct answer is B. Total time lost refers to the number of scheduled days that an employee misses. This includes days that were planned to be worked but were not. Choice A, 'Number of days off that an employee asks for,' is not necessarily time lost as these are approved absences. Choice C, 'Number of days missed,' is vague and does not specify if they are scheduled or unscheduled. Choice D, 'Number of days perceived to be absent,' is subjective and does not clearly relate to scheduled time lost.

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. When should the nurse initiate discharge planning for a client experiencing an exacerbation of heart failure?

• A. During the admission process
• B. As soon as the client's condition is stable
• C. After consulting with the client's family
• D. During the initial team conference

Correct answer: B

Rationale: The correct time for the nurse to initiate discharge planning for a client experiencing an exacerbation of heart failure is as soon as the client's condition is stable. Discharge planning should begin early to ensure a smooth transition and continuity of care. While involving the client's family in the planning process is crucial, the primary focus should be on starting the preparations for discharge once the client's immediate health concerns are addressed and their condition is stable. Waiting for a team conference or after consulting with the family may delay the planning process, which is not ideal in ensuring a timely and effective discharge plan.

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