Nursing Elites

1. 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: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

2. 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.

3. What is the process of helping an employee to improve performance called?

• A. Coaching
• B. Disciplining
• C. Mentoring
• D. Peer reviewing

Correct answer: A

Rationale: The correct answer is A: Coaching. Coaching involves providing guidance and support to help an employee enhance their performance by focusing on skill development, addressing weaknesses, and achieving professional growth. Mentoring (choice C) is about guiding and nurturing a less experienced individual, not specifically aimed at improving performance. Peer reviewing (choice D) involves colleagues evaluating each other's performance, not necessarily focused on improvement. Disciplining (choice B) is taking corrective actions in response to policy violations or performance issues, which is different from the process of helping an employee improve their performance.

4. An expensive variable in salary budgets is overtime pay. Which of the following is a viable option to reduce overtime?

• A. Limiting overtime for highly paid workers
• B. Reducing the number of beds
• C. Using per diem workers
• D. Refusing to pay overtime

Correct answer: C

Rationale: The correct answer is C: Using per diem workers. By utilizing per diem workers, organizations can flexibly adjust staffing levels based on demand without incurring overtime costs. This approach helps in managing overtime budgets effectively. Choice A is incorrect because limiting overtime for highly paid workers may not address the root cause of overtime expenses. Choice B is incorrect as reducing the number of beds does not directly impact overtime costs. Choice D is not a practical solution as refusing to pay overtime can lead to legal issues and employee dissatisfaction.

5. A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician and correcting the rate, what should be the next step in the client's care?

• A. Notify family
• B. Discipline the previous nurse
• C. Complete an incident report
• D. Obtain legal consultation

Correct answer: C

Rationale: The correct next step in the client's care after notifying the physician and correcting the rate of IVFs is to complete an incident report. This report is essential for documenting the adverse event, analyzing the cause, and implementing preventive measures to avoid similar incidents in the future. Notifying the family, disciplining the previous nurse, and obtaining legal consultation are not immediate priorities in this situation. Family notification may follow the incident report, disciplining the previous nurse is a separate administrative process, and legal consultation is usually not required for a medical error corrected promptly.

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