Nokea
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?
- A. Infuse 1 liter of normal saline per hour.
- B. Give sodium bicarbonate 50 mEq IV push.
- C. Administer regular insulin 10 U by IV push.
- D. Start a regular insulin infusion at 0.1 units/kg/hr.
Correct Answer: A
Rationale: The correct answer is A because the priority in treating diabetic ketoacidosis is fluid resuscitation to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps to restore intravascular volume and corrects electrolyte abnormalities. Choice B (sodium bicarbonate) is not recommended routinely in DKA treatment as it may worsen metabolic acidosis. Choice C (IV push insulin) can lead to hypoglycemia and should not be the initial intervention. Choice D (insulin infusion) is important but should be started after fluid resuscitation to avoid rapid drops in blood glucose levels.
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Politics is defined as the art of influencing the allocation of scarce resources. An example of a scarce resource allocated by the manager of a patient care unit is:
- A. Raises for the staff.
- B. Patient supplies in the utility room.
- C. Staffing that minimizes overtime.
- D. Paper for the printer.
Correct Answer: C
Rationale: The correct answer is C: Staffing that minimizes overtime. Politics involves influencing resource allocation, and staffing decisions directly impact the allocation of human resources, a scarce resource in healthcare settings. Minimizing overtime through effective staffing management is crucial for efficient resource utilization. Raises for the staff (A) are more related to compensation rather than resource allocation. Patient supplies (B) and paper for the printer (D) are important resources but not directly tied to influencing resource allocation in the same way as staffing decisions. In summary, the correct answer, C, directly aligns with the definition of politics and resource allocation in a healthcare setting.
The healthcare provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
- A. Avoid snacking at bedtime.
- B. Increase the rapid-acting insulin dose.
- C. Check the blood glucose during the night.
- D. Administer a larger dose of long-acting insulin.
Correct Answer: C
Rationale: The correct answer is C: Check the blood glucose during the night. The Somogyi effect is rebound hyperglycemia that occurs in response to hypoglycemia during the night. By checking blood glucose levels during the night, the patient can identify if they are experiencing nighttime hypoglycemia leading to rebound hyperglycemia in the morning. This will help determine the need for adjusting insulin doses or carbohydrate intake.
Why the other choices are incorrect:
A: Avoid snacking at bedtime - does not address the underlying issue of nighttime hypoglycemia.
B: Increase the rapid-acting insulin dose - could potentially worsen the Somogyi effect by causing further hypoglycemia.
D: Administer a larger dose of long-acting insulin - also does not address the issue of nighttime hypoglycemia and may lead to further fluctuations in blood glucose levels.
When addressing a policy violation, what is one of the initial steps to take?
- A. Terminate the employee.
- B. Confront the employee.
- C. Discipline the employee immediately.
- D. Determine whether the employee is aware of the policy.
Correct Answer: D
Rationale: The correct answer is D: Determine whether the employee is aware of the policy. This is the initial step to ensure fairness and due process. By confirming the employee's knowledge of the policy, you can address any potential misunderstandings or gaps in communication. Terminating the employee (A) without first verifying their awareness would be hasty and unfair. Confronting the employee (B) may be necessary later, but not as an initial step. Disciplining the employee immediately (C) without understanding their knowledge of the policy could lead to unnecessary conflicts and legal implications. Thus, D is the most appropriate initial step in addressing a policy violation.
One reason for conducting a comprehensive medical exam on an applicant is:
- A. It is needed to protect the organization from legal actions.
- B. It is required after a strenuous interview.
- C. It is mandated by law.
- D. It is necessary to screen for disabilities that may impact employment.
Correct Answer: A
Rationale: The correct answer is A because conducting a comprehensive medical exam helps protect the organization from potential legal actions related to discriminatory hiring practices. It ensures that the applicant meets the job's physical requirements and doesn't pose a health risk to themselves or others in the workplace. Choice B is incorrect as medical exams are not typically required after interviews. Choice C is incorrect as not all jurisdictions mandate comprehensive medical exams. Choice D is incorrect as screening for disabilities should be done through non-discriminatory means, not solely through medical exams.
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: The correct answer is D because asking construction workers to be responsible for the equipment and sharp items used is not within the charge nurse's role or authority. The responsibility for ensuring safety and security in the Emergency Department lies with the healthcare staff (including the charge nurse) and security personnel. Construction workers may not have the training or expertise to handle agitated patients or prevent potential incidents.
A: Notifying the nursing supervisor (A) can help escalate the issue and involve higher authority in addressing the safety concern.
B: Notifying security (B) is essential to ensure that trained professionals are present to handle security-related issues.
C: Having staff check patients (C) is important to verify their safety, but it does not address the primary concern of preventing patients from accessing construction equipment as weapons.