Nokea
A client with frequent tonic-clonic seizures is being admitted. What action should the nurse add to the client's plan of care?
- A. Ensure blankets are placed on all four sides of the bed.
- B. Refrain from using restraints during seizure activity.
- C. Position the client laterally during seizure activity.
- D. Have a tongue depressor available at the client's bedside.
Correct Answer: D
Rationale: The correct answer is D: Have a tongue depressor available at the client's bedside. This is important to prevent the client from biting their tongue during a seizure, which can lead to injury or airway obstruction. Placing blankets around the bed (choice A) is not a priority during a seizure. Refraining from using restraints (choice B) is correct, as restraints can cause harm during a seizure. Positioning the client laterally (choice C) is recommended after the seizure has ended, not during the seizure itself.
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The staff of a medical-surgical unit is in disagreement about holiday scheduling. The nurse manager knows that this is what type of conflict?
- A. Intragroup conflict
- B. Intergroup conflict
- C. Interpersonal conflict
- D. Intrapersonal conflict
Correct Answer: A
Rationale: The correct answer is A: Intragroup conflict. In this scenario, the conflict is happening within the staff of the medical-surgical unit, making it an intragroup conflict. The staff members belong to the same group or team, and the conflict arises within this specific group. This type of conflict typically involves disagreements, tension, or differences of opinion among members of the same group.
Summary:
B: Intergroup conflict involves conflicts between different groups or teams, not within the same group.
C: Interpersonal conflict refers to conflicts between individuals, not within a group.
D: Intrapersonal conflict involves internal conflicts within an individual, not within a group.
Which statement to a patient newly diagnosed with type 2 diabetes is correct?
- A. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
- B. Insulin is not used to control blood glucose in patients with type 2 diabetes.
- C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
- D. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
Correct Answer: C
Rationale: Step 1: In type 2 diabetes, the body either becomes resistant to insulin or doesn't produce enough insulin.
Step 2: Diet and exercise can help improve insulin sensitivity and control blood glucose levels in type 2 diabetes.
Step 3: Medications may also be prescribed if diet and exercise alone are not effective.
Step 4: Insulin therapy may be necessary in some cases but is not the first-line treatment for type 2 diabetes.
Step 5: Complications of type 2 diabetes can be serious and include cardiovascular issues, neuropathy, and kidney disease.
Step 6: Type 2 diabetes is typically diagnosed through blood tests, not by admission with a hyperglycemic coma.
Summary:
Choice A is incorrect because complications can be severe in type 2 diabetes. Choice B is incorrect as insulin may be used in some cases. Choice D is incorrect as type 2 diabetes is usually diagnosed through blood tests. Choice C is correct as diet and exercise play a
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.
12. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?
- A. 10:00 AM
- B. 12:00 PM
- C. 2:00 PM
- D. 4:00 PM
Correct Answer: A
Rationale: The correct answer is A (10:00 AM) because aspart insulin typically peaks in around 1-3 hours after administration. Given that the patient received the insulin at 8:00 AM, the peak effect would most likely occur around 10:00 AM, making it crucial for the nurse to monitor for hypoglycemia symptoms. Choice B (12:00 PM) is not the best time as the peak effect would have already passed. Choices C (2:00 PM) and D (4:00 PM) are even further away from the expected peak time, making them less critical for monitoring hypoglycemia symptoms.
A recent ethical issue has resulted in uneasiness and discomfort for several nurses on a unit. The unit manager has decided to discuss the issues at the next team meeting. The situation has resulted in which of the following for some of the nurses?
- A. Moral suffering
- B. Moral distress
- C. Ethical dilemma
- D. Veracity
Correct Answer: B
Rationale: The correct answer is B: Moral distress. Moral distress occurs when individuals know the ethically correct action to take but are constrained from doing so due to various reasons, such as organizational constraints or lack of support. In this scenario, the nurses feel unease and discomfort due to an ethical issue, indicating a conflict between their moral values and actions. The unit manager addressing the issue at the team meeting suggests that the nurses are experiencing moral distress.
A: Moral suffering is a broader term encompassing various negative emotions related to moral issues, not specifically the conflict between knowing the right action and being unable to act on it like in moral distress.
C: Ethical dilemma refers to a situation where individuals must choose between conflicting moral principles, which is not explicitly described in the scenario.
D: Veracity refers to truthfulness or honesty and is not directly related to the nurses' uneasiness and discomfort in dealing with the ethical issue.