Nursing Elites

1. Which of the following is the preferable alternative to firing an employee?

• A. Voluntary resignation
• B. Training
• C. Confrontation
• D. Coaching

Correct answer: A

Rationale: The preferable alternative to firing an employee is voluntary resignation. When an employee voluntarily resigns, it allows them to leave on their terms, maintaining their dignity and possibly avoiding negative consequences associated with being fired. Training, confrontation, and coaching are not alternatives to firing but rather methods that can be used to address performance or behavior issues before resorting to termination.

2. Which of the following would a nurse suggest are significant benefits to an organization that is considering adoption of a practice partnership model? (Select one that does not apply.)

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

Correct answer: B

Rationale: The correct answer is B. Practice partnership models are shown to be the most cost-effective of the nursing care delivery systems, contrary to being more expensive. Clients express greater satisfaction due to the collaborative and holistic approach of this model. Continuity of care is improved when the healthcare team works together cohesively. While leadership acceptance is beneficial, it is not the most significant benefit highlighted in the context of practice partnership models.

3. A nurse manager who tells the staff to 'come to me with any problem' but then keeps the office door closed is using what type of communication?

• A. Intrasender conflict
• B. Diagonal communication
• C. Metacommunication
• D. Upward communication

Correct answer: A

Rationale: The correct answer is A: Intrasender conflict. Intrasender conflict happens when there is a discrepancy between verbal and nonverbal communication. In this scenario, the nurse manager's verbal message encourages staff to communicate openly, but the closed office door sends a conflicting nonverbal message, creating intrasender conflict. Metacommunication involves nonverbal behaviors like gestures or facial expressions that support or contradict verbal communication. Upward communication refers to the flow of information from staff to management or lower to upper management. Diagonal communication involves communication between individuals or departments at different hierarchical levels.

4. A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?

• A. Amitriptyline decreases the depression caused by your foot pain.
• B. Amitriptyline helps prevent transmission of pain impulses to the brain.
• C. Amitriptyline corrects some of the blood vessel changes that cause pain.
• D. Amitriptyline improves sleep and reduces awareness of nighttime pain.

Correct answer: B

Rationale: The correct answer is B. Amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of serotonin and norepinephrine, which helps in reducing the transmission of pain impulses to the brain. Choice A is incorrect because amitriptyline primarily works on pain transmission rather than directly on depression. Choice C is inaccurate as amitriptyline's mechanism of action is not related to correcting blood vessel changes. Choice D is partially true as amitriptyline can improve sleep, but the primary mechanism related to pain relief is by preventing pain impulses from reaching the brain.

5. When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the healthcare provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may

• A. require administration of insulin while taking prednisone
• B. develop acute hypoglycemia while taking prednisone
• C. require administration of insulin while taking prednisone
• D. have rashes caused by metformin-prednisone interactions

Correct answer: C

Rationale: When a patient taking metformin develops an allergic rash from an unknown cause and is prescribed prednisone, the nurse should anticipate that the patient may require administration of insulin while taking prednisone. Prednisone can increase blood glucose levels by antagonizing the effects of insulin, leading to hyperglycemia. Therefore, the patient may need additional insulin to manage blood sugar levels effectively. The other options are incorrect as prednisone would not directly cause a need for a higher-calorie diet, acute hypoglycemia, or rashes caused by a metformin-prednisone interaction.

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