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. A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to

• A. use only the lispro insulin until the symptoms are resolved
• B. limit calorie intake until the glucose is less than 120 mg/dL
• C. monitor blood glucose every 4 hours and notify the clinic if it continues to rise
• D. decrease carbohydrate intake until glycosylated hemoglobin is less than 7%

Correct answer: C

Rationale: In this scenario, the nurse should advise the patient to monitor her blood glucose every 4 hours and notify the clinic if it continues to rise. This is important because the patient is experiencing symptoms of an illness (sore throat and runny nose) that can lead to fluctuations in blood glucose levels. By monitoring frequently, any significant rise in blood glucose can be detected early, enabling prompt intervention. Choice A is incorrect because abruptly stopping glargine (Lantus) insulin can lead to uncontrolled blood glucose levels. Choice B is incorrect as limiting calorie intake is not the appropriate immediate action for managing high blood glucose levels. Choice D is also incorrect as adjusting carbohydrate intake based on glycosylated hemoglobin levels is not the immediate action needed in this acute situation.

3. A nurse recognizes which of the following as a primary goal of nursing?

• A. Assist patients to achieve a peaceful death.
• B. Improve personal knowledge and skills to enhance patient outcomes.
• C. Advocate for quality of life over the quantity of life.
• D. Work to control costs to enhance patients' quality of life.

Correct answer: A

Rationale: The correct answer is A: 'Assist patients to achieve a peaceful death.' One of the primary goals of nursing is to help patients experience a comfortable and peaceful passing when faced with terminal illness or at the end of life. This involves providing holistic care, managing symptoms, and ensuring that patients are as comfortable and pain-free as possible. Choices B, C, and D are incorrect because while improving knowledge and skills, advocating for quality of life, and controlling costs are important aspects of nursing care, they are not the primary goal related to end-of-life care.

4. What is the primary focus of a patient-centered care model?

• A. Cost reduction
• B. Healthcare provider satisfaction
• C. Patient satisfaction
• D. Quality assurance

Correct answer: C

Rationale: The primary focus of a patient-centered care model is on patient satisfaction. This approach emphasizes providing care that is personalized to meet the unique needs and preferences of each patient, fostering a collaborative and respectful partnership between healthcare providers and patients to achieve better health outcomes. While cost reduction (choice A) can be a byproduct of improved outcomes, it is not the primary focus. Healthcare provider satisfaction (choice B) is important but not the primary focus in patient-centered care. Quality assurance (choice D) is crucial but is secondary to patient satisfaction in a patient-centered care model.

5. When considering virtue ethics, which of the following is true?

• A. Virtue ethics attributes behaviors to moral rules.
• B. Virtue ethics attributes behaviors to knowledge of consequences.
• C. Virtue ethics focuses on moral character, rather than rules for behavior.
• D. Virtue ethics is a formal statement of rules for behavior.

Correct answer: C

Rationale: The correct answer is C: Virtue ethics focuses on moral character, rather than rules for behavior. Virtue ethics is a branch of ethical theory that emphasizes an individual's character and virtues rather than focusing on specific rules or consequences. Choice A is incorrect as virtue ethics does not attribute behaviors to moral rules; instead, it emphasizes developing virtuous character traits. Choice B is incorrect because virtue ethics does not attribute behaviors to knowledge of consequences; it looks at the moral character of the individual. Choice D is incorrect as virtue ethics is not a formal statement of rules for behavior but rather a perspective that emphasizes the importance of developing virtuous character traits.

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