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The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?
- A. Give the patient 4 to 6 oz more orange juice.
- B. Administer the PRN glucagon (Glucagon) 1 mg IM.
- C. Have the patient eat some peanut butter with crackers.
- D. Notify the healthcare provider about the hypoglycemia.
Correct Answer: A
Rationale: Rationale: The correct answer is A because the patient's blood glucose level has increased slightly, indicating the orange juice is working. Giving more orange juice is appropriate to continue raising the blood glucose level. Administering glucagon (B) is not necessary as the patient's glucose is improving. Eating peanut butter with crackers (C) may be too slow to raise the glucose level. Notifying the healthcare provider (D) is not needed at this point as the patient is responding to the initial intervention.
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The belief that effort will lead to a specific performance level in an individual is known as:
- A. Rewards.
- B. Expectancy.
- C. Valence.
- D. Instrumentality.
Correct Answer: B
Rationale: The correct answer is B: Expectancy. Expectancy theory posits that individuals believe that their effort will lead to a specific level of performance. This belief in the relationship between effort and performance is crucial in determining motivation. Rewards (A) refer to the outcomes of the performance, not the belief in effort-performance connection. Valence (C) is the value a person places on a specific reward, not the belief in effort-performance link. Instrumentality (D) is the belief that performance will lead to a certain outcome, not the belief in effort-performance relationship.
A group of physicians comes into conflict with the nursing staff of a unit over when AM vital signs are recorded. What type of technique might be used that respects the professionalism of both parties?
- A. Accommodating
- B. Collaboration
- C. Avoiding
- D. Competing
Correct Answer: B
Rationale: The correct answer is B: Collaboration. Collaboration involves both parties working together to find a mutually beneficial solution. In this scenario, collaborating with the physicians and nursing staff allows for open communication, respect for each other's expertise, and finding a compromise on when to record vital signs. Accommodating (A) involves giving in to one party's preferences, while avoiding (C) involves ignoring the conflict altogether. Competing (D) focuses on one party winning at the expense of the other, which does not respect the professionalism of both parties. Collaboration is the most effective technique as it values input from all parties and fosters a positive working relationship.
A nurse manager is using the nominal group technique to gather input from the staff on a new policy. What is the primary method of exchange in this technique?
- A. Oral presentations
- B. Email exchanges
- C. Written reports
- D. Group discussions
Correct Answer: C
Rationale: The correct answer is C: Written reports. In the nominal group technique, participants individually write down their ideas or suggestions on a given topic. These written reports are then collected and synthesized by the facilitator, ensuring each participant's input is considered equally. This method allows for unbiased aggregation of ideas and prevents dominant individuals from influencing the group. Oral presentations (A) may lead to groupthink, email exchanges (B) lack real-time interaction, and group discussions (D) may result in unequal participation. Written reports ensure all ideas are heard and valued, making it the primary method of exchange in this technique.
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. This is when the message sent conflicts with the nonverbal cues. In this scenario, the nurse manager's verbal message of being approachable conflicts with the nonverbal cue of keeping the office door closed. This creates confusion for the staff, leading to intrasender conflict.
B: Diagonal communication refers to communication between individuals at different levels or departments.
C: Metacommunication involves the underlying message or context of the communication.
D: Upward communication is when employees communicate with their superiors.
In this case, the closed door contradicts the verbal message, indicating intrasender conflict.
When using an open irrigation technique to irrigate a client's indwelling urinary catheter, which of the following actions should the nurse take?
- A. Position the client in a side-lying position.
- B. Perform the irrigation using a 20-mL syringe.
- C. Instill 15 mL of irrigation fluid into the catheter with each flush.
- D. Measure and record the amount of irrigant used.
Correct Answer: B
Rationale: The correct answer is B: Perform the irrigation using a 20-mL syringe. This is the correct action because using a 20-mL syringe allows for precise and controlled instillation of the irrigation fluid into the catheter. Using a smaller syringe helps prevent excessive pressure within the catheter, reducing the risk of trauma or damage to the client's urinary system.
A: Positioning the client in a side-lying position is not essential for open irrigation technique, as long as the client is comfortable and the procedure can be safely performed.
C: Instilling 15 mL of irrigation fluid with each flush may not be appropriate as the volume needed may vary based on the client's condition.
D: Although measuring and recording the amount of irrigant used is important for documentation purposes, it is not the immediate action to ensure the safe and effective irrigation of the catheter.