Nursing Elites

1. A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the healthcare provider should the nurse take first?

• A. Place the patient on a cardiac monitor
• B. Administer IV potassium supplements
• C. Obtain urine glucose and ketone levels
• D. Start an insulin infusion at 0.1 units/kg/hr

Correct answer: A

Rationale: In a patient with diabetic ketoacidosis (DKA), the initial priority is to assess for any cardiac arrhythmias due to electrolyte imbalances. Since the patient has a low serum potassium level of 3.1 mEq/L, placing the patient on a cardiac monitor is crucial to monitor for any potential cardiac complications. Administering IV potassium supplements (Choice B) may be needed, but it is not the first action to take. Obtaining urine glucose and ketone levels (Choice C) and starting an insulin infusion (Choice D) are important interventions in managing DKA, but ensuring patient safety by monitoring for arrhythmias takes precedence.

2. A nurse is admitting a new client. Which of the following actions should the nurse take while performing medication reconciliation?

• A. Compare the client's home medications with the provider's prescriptions
• B. Place the client's home medication bottles in a secure location
• C. Call the pharmacy to determine whether the client's medications are available
• D. Verify the client's name on their identification bracelet with the medication administration record

Correct answer: A

Rationale: The correct answer is A. During medication reconciliation, the nurse should compare the client's home medications with the provider's prescriptions to ensure accurate and safe administration. This process helps identify any discrepancies or potential interactions. Choice B is incorrect because placing the client's home medication bottles in a secure location is not part of medication reconciliation. Choice C is incorrect as calling the pharmacy to determine medication availability is not related to reconciling medications. Choice D is incorrect as verifying the client's name on their identification bracelet with the medication administration record is part of the identification process, not medication reconciliation.

3. While interviewing for a position at City Hospital, the nurse asks about the organizational structure of the institution. She is told that the hospital is organized into departments based on specialty (e.g., nursing, dietary, pharmacy, etc.). Based on what you know about organizational structure, select the structure in this example.

• A. Parallel
• B. Functional
• C. Service-integrated
• D. Matrix

Correct answer: B

Rationale: The correct answer is 'Functional.' In a functional structure, organizations group employees into departments based on specialty, where similar tasks are performed by the same group. In this scenario, the hospital organizing its departments by specialty such as nursing, dietary, and pharmacy aligns with the characteristics of a functional structure. Choice A, 'Parallel,' does not fit the scenario described; parallel structures involve separate, independent units operating in parallel with little interaction. Choice C, 'Service-integrated,' does not align with the scenario either as it involves integrating services across departments. Choice D, 'Matrix,' is not the correct answer as it involves a complex organizational structure where employees report to multiple managers simultaneously, which is not the case in the scenario provided.

4. Which of the following is a leadership style that assumes individuals are motivated by internal forces and uses participation and majority rule to get work done?

• A. Autocratic leadership
• B. Laissez-faire leadership
• C. Democratic leadership
• D. Transactional leadership

Correct answer: C

Rationale: Democratic leadership is a leadership style that operates on the belief that individuals are motivated by internal forces. It involves encouraging participation and decision-making through majority rule to accomplish tasks. This leadership approach fosters collaboration, empowerment, and involvement of team members in decision-making processes. Autocratic leadership (choice A) is characterized by centralized control and little input from team members. Laissez-faire leadership (choice B) involves minimal interference and provides little guidance or direction. Transactional leadership (choice D) is based on exchanges between leaders and followers for desired outcomes, focusing on rewards and punishments rather than internal motivation and participation.

5. When planning care for a client with vision loss, which of the following interventions should the nurse include in the plan of care to assist the client with feeding?

• A. Arrange food in a consistent pattern on the client's plate
• B. Thicken liquids on the client's tray
• C. Provide small-handled utensils for the client
• D. Assign a staff member to feed the client

Correct answer: A

Rationale: When a client has vision loss, arranging food in a consistent pattern on the plate can help them locate and identify different food items more easily. This intervention promotes independence and allows the client to feed themselves with greater ease. Thicking liquids on the tray, providing small-handled utensils, or assigning a staff member to feed the client may not directly address the client's need for assistance with feeding due to vision loss. Thicking liquids is more related to swallowing difficulties, providing small-handled utensils can be helpful for clients with limited dexterity, and assigning a staff member to feed the client may not promote independence.

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