Nursing Elites

1. A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the healthcare provider?

• A. Hemoglobin A1C level is 7.9%.
• B. Last eye exam was 18 months ago.
• C. Glomerular filtration rate is decreased.
• D. Patient has questions about the prescribed diet.

Correct answer: C

Rationale: The most important finding to discuss with the healthcare provider is the decreased glomerular filtration rate. In patients on metformin therapy, monitoring kidney function is crucial as metformin is primarily excreted through the kidneys. A decreased glomerular filtration rate can lead to metformin accumulation in the body, increasing the risk of lactic acidosis, a serious adverse effect. The hemoglobin A1C level being 7.9% indicates poor diabetes control but can be addressed through medication adjustments and lifestyle modifications. The patient needing an eye exam after 18 months is important but not as urgent as discussing the decreased glomerular filtration rate. Patient questions about the prescribed diet can be addressed during the visit without the need for immediate healthcare provider intervention.

2. 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: First. In the grievance process, the initial step involves the nurse talking to the nurse manager to address the issue informally. Subsequently, step two entails filing a written appeal to the director of nursing or designee. Step three involves a formal meeting with the employee, agent, grievance chairperson, nursing administrator, and director of human resources. The final step, step four, is arbitration, which is initiated when no mutually acceptable solutions can be reached by the involved parties. Therefore, the nurse talking to the nurse manager about the disagreement is the first step in the grievance process.

3. When a client who is in pain refuses to be repositioned, what should the nurse consider first in making a decision about what to do?

• A. Why a decision is needed.
• B. Who actually gets to make the decision?
• C. What are the alternatives?
• D. When a decision is needed.

Correct answer: A

Rationale: In this scenario, the nurse should first consider why a decision is needed. Understanding the underlying reason for the decision helps in selecting the best action to meet the desired goal. Who actually makes the decision is important but not the primary consideration. Exploring alternatives comes after determining the reason for the decision, who makes it, and when it is needed.

4. What is typically the first sign that a healthcare professional with a substance abuse problem will exhibit?

• A. Avoidance
• B. Bargaining
• C. Denial
• D. Regression

Correct answer: C

Rationale: The correct answer is C: Denial. When healthcare professionals have substance abuse problems, denial is often the initial sign they exhibit. Denial involves minimizing or refusing to acknowledge the issue, making it difficult to recognize and address the substance abuse problem. Choices A, B, and D are incorrect. Avoidance, bargaining, and regression are not typically the first signs displayed by healthcare professionals with substance abuse problems. By identifying denial early on, healthcare professionals can take the necessary steps to seek help and overcome substance abuse issues.

5. Which of the following best describes the concept of interprofessional collaboration in healthcare?

• A. The process by which multiple healthcare professionals work together to improve patient outcomes
• B. A method for healthcare professionals to work independently within their scope of practice
• C. The use of standardized protocols to ensure consistent care
• D. A way for healthcare professionals to share patient information electronically

Correct answer: A

Rationale: The correct answer is A. Interprofessional collaboration in healthcare refers to the coordinated efforts of multiple healthcare professionals working together to enhance patient outcomes. This collaborative approach involves professionals from different disciplines contributing their expertise to provide comprehensive care and improve the overall quality of patient treatment. Choice B is incorrect because interprofessional collaboration emphasizes teamwork and collective efforts rather than working independently. Choice C is incorrect as it refers to standardization of care protocols, not collaboration among professionals. Choice D is incorrect as sharing patient information electronically is a component of information exchange but not the primary focus of interprofessional collaboration.

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