Nursing Elites

1. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

• A. Infuse dextrose 50% by slow IV push.
• B. Administer 1 mg glucagon subcutaneously.
• C. Obtain a glucose reading using a finger stick.
• D. Have the patient drink 4 ounces of orange juice.

Correct answer: C

Rationale: The correct action for the nurse to take first when a patient reports feeling lightheaded and sweaty after being weaned off an insulin drip is to obtain a glucose reading using a finger stick. This will provide crucial information on the patient's current blood glucose level, helping the nurse assess if the symptoms are due to hypoglycemia. Based on the glucose reading, appropriate interventions can be initiated, such as administering dextrose, glucagon, or oral sugars like orange juice if hypoglycemia is confirmed. However, verifying the blood glucose level is the initial step to guide subsequent actions and ensure patient safety.

2. An RN knows that sometimes, when working through an ethical dilemma, the decision makers are unable to arrive at a mutually agreed upon decision. Which of the following is a reason why an agreement cannot be reached?

• A. One or more of the parties may be able to reconcile their values.
• B. The patient�s point of view is recognized as valuable.
• C. The dilemma involves two or more equally unpleasant choices.
• D. The institution is unable to honor the patient�s request.

Correct answer: C

Rationale: An agreement cannot be reached because the dilemma involves two or more equally unpleasant choices.

3. A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about

• A. self-monitoring of blood glucose
• B. using low doses of regular insulin
• C. lifestyle changes to lower blood glucose
• D. effects of oral hypoglycemic medications

Correct answer: C

Rationale: When a patient has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L), indicating prediabetes, the initial approach is focused on lifestyle modifications to lower blood glucose levels. These changes may include dietary adjustments, increased physical activity, and weight management. Self-monitoring of blood glucose, insulin therapy, and oral hypoglycemic medications are not typically the first-line interventions for patients with prediabetes. Educating the patient about lifestyle changes to lower blood glucose is the most appropriate action at this stage.

4. Which action by a patient indicates that the home health nurse�s teaching about glargine and regular insulin has been successful?

• A. The patient administers the glargine 30 minutes before each meal
• B. The patient�s family prefills the syringes with the mix of insulins weekly.
• C. The patient draws up the regular insulin and then the glargine in the same syringe.
• D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks

Correct answer: D

Rationale:

5. As a new nurse on a pediatric unit, you must work nights and you have minimal time to spend with your children. Your colleague observes that you speak abruptly with parents and you become easily annoyed when the patients cry or when they are demanding. You realize you are becoming increasingly more distressed and that you have no time with your children and, as a result you: (Select all that apply.)

• A. Express negative comments to colleagues about patients and parents who annoy you.
• B. Ask the nurse manager to have a schedule with an equal number of day and night shifts so that you can be with your children.
• C. Call off sick as frequently as you can without violating policies so that you have more time with your children.
• D. Minimize your communication with patients and parents so you do not offend them.

Correct answer: B

Rationale: The correct answer is B. Asking the nurse manager for a schedule with an equal number of day and night shifts is a proactive and constructive approach to address the issue of having minimal time with your children. This solution aims to balance work and personal life effectively. Choices A, C, and D are incorrect. Expressing negative comments about patients and parents (Choice A) is unprofessional and can create a negative work environment. Calling off sick frequently (Choice C) is irresponsible and violates work policies, leading to potential disciplinary actions. Minimizing communication with patients and parents (Choice D) is not a suitable approach as effective communication is essential in healthcare to provide optimal care and support to patients and their families.

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