Nursing Elites

1. Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy?

• A. �Do you feel bloated after eating?�
• B. �Have you seen any skin changes?�
• C. �Do you need to increase your insulin dosage when you are stressed?�
• D. �Have you noticed any painful new ulcerations or sores on your feet?�

Correct answer: A

Rationale:

2. An RN�s client with terminal pancreatic cancer asks questions about a do not resuscitate order. Which of the following statements should be included in the RN�s teaching to the client?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians must write do not resuscitate (DNR) orders.
• C. A DNR order can be written after the health-care provider has discussed it with the client and family.
• D. A DNR requires a court decision.

Correct answer: C

Rationale: Clients may request a DNR order, but they need to be fully informed of all the ramifications of the decision. Therefore, the health-care provider will consult with the client and family before the order is written.

3. Several factors are considered in the calculation of the amount of FTEs. Which of the following is NOT considered when calculating the FTEs?

• A. Hours of care provided
• B. Ancillary staff
• C. Procedures to be done
• D. Types of patients

Correct answer: A

Rationale: When calculating Full-Time Equivalents (FTEs), factors such as the hours of work for the staff for two weeks, average daily census, and types of patients are considered. However, the hours of care provided are not typically included in the calculation of FTEs. Therefore, the correct answer is A. Choice B, ancillary staff, can impact FTE calculations as they contribute to the overall workload. Choice C, procedures to be done, can also influence FTE calculations, especially if they affect staffing requirements. Choice D, types of patients, play a role in determining the level of care needed and subsequently impact FTE calculations.

4. A client complains every morning that the night shift nursing staff does not answer his call light promptly to assist his elimination needs. His concerns are not shared with the Nurse Manager, and he falls while trying to walk to the bathroom. This fall could be attributed to which of the following?

• A. Breakdown in communication
• B. Lack of staff
• C. Lack of concern
• D. Breakdown in management

Correct answer: A

Rationale: The correct answer is A: Breakdown in communication. In this scenario, the client's complaints about the night shift nursing staff not responding promptly to his call light indicate a lack of effective communication. If the client's concerns were properly communicated to the Nurse Manager, steps could have been taken to address the issue and prevent the fall. Choice B, Lack of staff, is incorrect as the issue here is not related to staffing levels but rather to communication breakdown. Choice C, Lack of concern, is not the primary cause of the fall; the root cause lies in communication failure. Choice D, Breakdown in management, while related, is not as direct a cause as the breakdown in communication which led to the fall.

5. A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the healthcare provider should the nurse take first?

• A. Place the patient on a cardiac monitor
• B. Administer IV potassium supplements
• C. Obtain urine glucose and ketone levels
• D. Start an insulin infusion at 0.1 units/kg/hr

Correct answer: A

Rationale: In a patient with diabetic ketoacidosis (DKA), the initial priority is to assess for any cardiac arrhythmias due to electrolyte imbalances. Since the patient has a low serum potassium level of 3.1 mEq/L, placing the patient on a cardiac monitor is crucial to monitor for any potential cardiac complications. Administering IV potassium supplements (Choice B) may be needed, but it is not the first action to take. Obtaining urine glucose and ketone levels (Choice C) and starting an insulin infusion (Choice D) are important interventions in managing DKA, but ensuring patient safety by monitoring for arrhythmias takes precedence.

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