In the grievance process, a nurse disagrees with statements made by a physician about performance and talks to the nurse manager. Which step in the process is this?
- A. First
- B. Second
- C. Third
- D. Fourth
Correct Answer: A
Rationale: The correct answer is A, the first step in the grievance process. When a nurse disagrees with a physician's statements, consulting the nurse manager is an initial step to address the issue informally. This step allows for clarification, communication, and resolution at a lower level before escalating to formal grievance procedures. Choices B, C, and D are incorrect because they pertain to subsequent steps in the process after the issue has become more formalized and escalated beyond the initial stage.
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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.
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.
After change-of-shift report, which patient should the nurse assess first?
- A. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
- B. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
- C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
- D. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
Correct Answer: C
Rationale: The correct answer is C because the patient with hyperosmolar hyperglycemic syndrome showing signs of poor skin turgor and dry oral mucosa is at risk for severe dehydration and potential complications. Assessing this patient first is crucial to address their immediate needs.
Choice A is incorrect as the 19-year-old with possible dawn phenomenon can be assessed after the patient with hyperosmolar hyperglycemic syndrome who is at higher risk.
Choice B is incorrect as a blood glucose reading of 230 mg/dL in a 35-year-old with type 1 diabetes is high but not indicative of an immediate life-threatening situation compared to severe dehydration.
Choice D is incorrect as the 68-year-old with peripheral neuropathy and foot pain, while in discomfort, does not present an immediate threat to their life like severe dehydration does in a patient with hyperosmolar hyperglycemic syndrome.
A ___________ manager supervises a number of first-level managers, usually within related specialties.
- A. self-directed
- B. first-level
- C. middle-level
- D. self-motivated
Correct Answer: C
Rationale: The correct answer is C: middle-level manager. Middle-level managers oversee first-level managers and coordinate activities within related specialties. They bridge the gap between top-level executives and front-line employees, ensuring organizational goals are met.
A: Self-directed managers work autonomously, not supervising other managers.
B: First-level managers supervise front-line employees, not other managers.
D: Self-motivated is a personal trait and not a managerial level.
Which of the following should be included in a discussion of advance directives with new nurse graduates?
- A. According to the Patient Self-Determination Act, nurses are required to inform clients of their right to create an advance directive.
- B. The advance directive designates an individual who will make financial decisions for the client if he or she is unable to do so.
- C. A living will designates who will make health-care decisions for an individual in the event the individual is unable or incompetent to make his or her own decisions.
- D. The advance directive designates a health-care surrogate who will make known the client’s wishes regarding medical treatment if the client is unable to do so.
Correct Answer: A
Rationale: Step 1: The Patient Self-Determination Act requires healthcare providers, including nurses, to inform clients of their right to create an advance directive.
Step 2: New nurse graduates need to understand this legal requirement to comply with ethical and legal standards.
Step 3: By discussing this requirement with new nurse graduates, they will be better equipped to provide information and support to clients regarding advance directives.
Step 4: This step is crucial in ensuring that clients' autonomy and right to self-determination are respected.
Step 5: Option A is the correct answer as it directly relates to the legal obligation of nurses in discussing advance directives with clients.
Summary: Options B, C, and D are incorrect as they do not address the specific legal requirement outlined in the Patient Self-Determination Act for informing clients about their right to create an advance directive.