Nursing Elites

1. Which of these tests with frequency would the nurse expect to monitor for the evaluation of clients with poor glycemic control in persons aged 18 and older?

• A. A glycosylated hemoglobin (A1c) should be performed during an initial assessment and during follow-up assessments, which should occur at no longer than 3-month intervals
• B. A glycosylated hemoglobin should be obtained at least twice a year
• C. A fasting glucose and a glycosylated hemoglobin should be obtained at 3-month intervals after the initial assessment
• D. A glucose tolerance test, a fasting glucose, and a glycosylated hemoglobin should be obtained at 6-month intervals after the initial assessment

Correct answer: A

Rationale: Glycosylated hemoglobin (A1c) testing every 3 months is recommended for clients with poor glycemic control to monitor their average blood sugar levels and adjust treatment as necessary. Choice A is correct as it aligns with the guideline of performing A1c testing every 3 months. Choice B is incorrect because testing at least twice a year may not provide adequate monitoring for clients with poor glycemic control. Choice C is incorrect as it only mentions testing at 3-month intervals without specifying the importance of A1c testing. Choice D is incorrect as it includes unnecessary tests like glucose tolerance test and does not emphasize the importance of more frequent A1c monitoring for clients with poor glycemic control.

2. Which of the following is a key component of community-based participatory research?

• A. Conducting research in a laboratory setting
• B. Involving community members in the research process
• C. Focusing solely on quantitative data
• D. Ignoring community input

Correct answer: B

Rationale: The correct answer is B: 'Involving community members in the research process.' Community-based participatory research emphasizes the active involvement of community members in all aspects of the research process, from identifying research questions to interpreting and disseminating results. Choice A is incorrect because community-based participatory research typically takes place in real-world settings, not in laboratories. Choice C is incorrect because community-based participatory research values a mix of quantitative and qualitative data. Choice D is incorrect because community input is essential in this research approach.

3. As a client who is terminally ill has been receiving high doses of an opioid analgesic for the past month and becomes unresponsive to verbal stimuli as death approaches, what orders would the nurse expect from the healthcare provider?

• A. Decrease the analgesic dosage by half
• B. Discontinue the analgesic
• C. Continue the same analgesic dosage
• D. Prescribe a less potent drug

Correct answer: C

Rationale: Continuing the same dosage of analgesic is appropriate to manage pain effectively as death nears and the client becomes unresponsive. The primary goal of palliative care in end-of-life situations is to ensure comfort, regardless of the client's level of consciousness. Decreasing the analgesic dosage or discontinuing it could lead to inadequate pain relief, which goes against the principles of palliative care. Prescribing a less potent drug may also compromise pain management in this critical stage. Therefore, maintaining the same analgesic dosage is the most appropriate action to provide comfort and alleviate suffering.

4. A community health action that focuses on reducing the frequency and severity of asthma in inner-city children by requiring a local incinerator to install particulate filters is an example of:

• A. downstream intervention
• B. risk management
• C. primary prevention
• D. upstream intervention

Correct answer: D

Rationale: The correct answer is D: upstream intervention. Upstream thinking addresses the root causes of health problems to create long-term solutions. In this scenario, requiring the incinerator to install particulate filters tackles the root cause of asthma triggers, which is pollution, rather than just managing the symptoms or risks associated with asthma. Choice A, downstream intervention, would focus more on treating asthma symptoms after they have already occurred rather than preventing them. Choice B, risk management, typically involves strategies to assess, control, or mitigate risks, which may not directly address the root cause. Choice C, primary prevention, usually refers to actions taken to prevent a disease or condition before it occurs, but in this case, the action is targeting the underlying cause rather than preventing asthma itself.

5. A nurse organizes a community action group to help resolve health problems in a low-income neighborhood with a large population of recent immigrants from Africa. What problem should the nurse address first?

• A. High rate of unemployment.
• B. Low immunization rate of children.
• C. Provision of substandard health care.
• D. Access to bilingual care providers.

Correct answer: B

Rationale: The correct answer is B: Low immunization rate of children. Addressing low immunization rates is crucial as it directly impacts the health of children and the community by preventing the spread of infectious diseases. Option A, high rate of unemployment, though important for overall well-being, is not the most immediate health concern. Option C, provision of substandard health care, is a significant issue but may not be as urgent as ensuring children are immunized. Option D, access to bilingual care providers, is important for effective communication but is not as critical as addressing low immunization rates in this scenario.

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