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When should the nurse initiate discharge planning for a client experiencing an exacerbation of heart failure?
- A. During the admission process
- B. As soon as the client's condition is stable
- C. After consulting with the client's family
- D. During the initial team conference
Correct Answer: B
Rationale: The correct time for the nurse to initiate discharge planning for a client experiencing an exacerbation of heart failure is as soon as the client's condition is stable. Discharge planning should begin early in the admission process to ensure a smooth transition and continuity of care. While involving the client's family in the planning process is crucial, the primary focus should be on starting the preparations for discharge once the client's immediate health concerns are addressed and their condition is stable. Waiting for a team conference or after consulting with the family may delay the planning process, which is not ideal in ensuring a timely and effective discharge plan.
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When is the first opportunity for a manager to reduce turnover?
- A. When the decision to hire a new employee is made
- B. After one month of employment
- C. After three months of employment
- D. After a certain tenure period
Correct Answer: C
Rationale: The manager's first opportunity to reduce turnover occurs after three months of employment. During this period, the manager can assess the employee's performance, engagement, and fit within the organization. It allows the manager to address any concerns, provide support, and intervene early to prevent turnover. Waiting until after a certain tenure period might be too late to effectively mitigate turnover risk, as issues could have already escalated. Therefore, the three-month mark is a critical point for managers to proactively manage turnover. Choices A and B are incorrect because they do not allow sufficient time for the manager to evaluate the employee and take proactive measures to reduce turnover. Choice D is incorrect as it is too vague and does not provide a specific actionable timeframe for addressing turnover concerns.
After receiving change-of-shift report, which patient should the nurse assess first?
- A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
- B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
- C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
- D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain
Correct Answer: B
Rationale: The patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention as it is an emergency situation that requires prompt intervention to prevent adverse effects. Severe hypoglycemia can lead to serious complications, such as seizures or loss of consciousness. Therefore, the nurse should prioritize assessing and managing this patient first to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. A high hemoglobin A1C level, an abnormal oral glucose tolerance test result, and acute abdominal pain, while important, do not pose an immediate threat to the patient's life compared to severe hypoglycemia.
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
- A. self-monitoring of blood glucose
- B. using low doses of regular insulin
- C. lifestyle changes to lower blood glucose
- D. effects of oral hypoglycemic medications
Correct Answer: C
Rationale: When a patient has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L), indicating prediabetes, the initial approach is focused on lifestyle modifications to lower blood glucose levels. These changes may include dietary adjustments, increased physical activity, and weight management. Self-monitoring of blood glucose, insulin therapy, and oral hypoglycemic medications are not typically the first-line interventions for patients with prediabetes. Educating the patient about lifestyle changes to lower blood glucose is the most appropriate action at this stage.
During a performance appraisal, how should the manager best provide constructive feedback to an employee?
- A. Focus only on the negative aspects of performance
- B. Provide general comments without specifics
- C. Discuss specific examples of strengths and areas for improvement
- D. Delay feedback until the next appraisal period
Correct Answer: C
Rationale: During a performance appraisal, the best approach to provide constructive feedback is by discussing specific examples of strengths and areas for improvement. This method allows the employee to understand what they are excelling at and where they need to focus on development. By highlighting both aspects, the employee can work on enhancing their performance effectively. Option A is incorrect because solely focusing on the negative aspects can demotivate the employee and hinder their growth. Option B is incorrect as providing general comments without specifics does not offer clear guidance for improvement. Option D is also incorrect as delaying feedback can prevent timely corrective actions and hinder performance progress.
When should a critical pathway be revised?
- A. When it becomes too long.
- B. When the variances show a new trend.
- C. When a member of the team retires.
- D. When the client leaves the hospital.
Correct Answer: B
Rationale: A critical pathway should be revised when variances in the patient's progress indicate a new trend or deviation from the expected course of treatment. This allows healthcare providers to adjust the pathway to ensure optimal patient care and outcomes. Changes in the critical pathway are not typically driven by its length or external factors like team member retirements or client discharges. Therefore, the correct answer is B. Choice A is incorrect because the length of the critical pathway alone does not determine the need for revision. Choices C and D are irrelevant to the patient's progress and treatment plan, making them incorrect.