Nursing Elites

1. After her evaluation, a staff nurse exclaims: 'I'm not sure if my manager knows much about my performance, really. He only had three specific examples to give me, two good performance examples and one to work on, and they all happened in the last month. I don't feel like he can see the whole picture.' What kind of performance appraisal rating does this statement exemplify?

• A. Recency error
• B. Leniency error
• C. Halo error
• D. Absolute judgment

Correct answer: A

Rationale: The statement exemplifies a recency error. Recency error occurs when a manager assesses an employee's performance primarily based on recent events, rather than considering the entire evaluation period. In this case, the staff nurse feels that her manager focused only on recent examples, leading to an incomplete assessment of her overall performance. Choice B, Leniency error, refers to a rater consistently giving high ratings to all employees regardless of performance, which is not evident in this scenario. Choice C, Halo error, involves allowing one positive attribute of an individual to overshadow other characteristics during appraisal, which is not the case here. Absolute judgment, Choice D, is when a rater evaluates an employee without reference to any specific criteria, which is not reflected in the staff nurse's feedback.

2. Penalties should be __________ .

• A. Determining the employee's awareness of the policy
• B. Describing the staff nurse's behavior that violated the policy
• C. Progressive
• D. Confrontation

Correct answer: C

Rationale: Penalties for policy violations should be progressive. This means that the disciplinary actions should escalate based on the severity or frequency of the violation. For minor infractions, like smoking in an unauthorized area, a progressive approach may include oral warnings, written warnings, suspension, and termination if the behavior persists. In contrast, major violations, such as theft, may warrant immediate and severe consequences like suspension or termination. Choices A, B, and D are incorrect as they do not address the concept of progressively escalating penalties based on the violation's severity or recurrence.

3. After change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
• B. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
• C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
• D. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

Correct answer: C

Rationale: The patient with hyperosmolar hyperglycemic syndrome who presents with poor skin turgor and dry oral mucosa requires immediate attention. These signs indicate severe dehydration and potential electrolyte imbalances, which can lead to serious complications. Assessing this patient first allows for prompt intervention and monitoring to stabilize their condition. Choice A is less urgent as the patient has possible dawn phenomenon, which is a common early-morning rise in blood glucose levels. Choice B, with a blood glucose reading of 230 mg/dL, indicates hyperglycemia but does not present with signs of severe dehydration like the patient in choice C. Choice D, with peripheral neuropathy and foot pain, is important but not as urgent as addressing severe dehydration and electrolyte imbalances in the patient with hyperosmolar hyperglycemic syndrome.

4. Constant reports of inadequate pain control in clients indicate which of the following?

• A. Improper administration of medications
• B. Potential substance abuse by the healthcare provider
• C. Poorly written prescriptions
• D. Inadequate scheduling by healthcare providers

Correct answer: B

Rationale: Constant reports of inadequate pain control may suggest potential substance abuse by the healthcare provider, as they might be diverting narcotics for personal use instead of administering them to clients. The incorrect choices include: A) Improper administration of medications may cause inadequate pain control but does not necessarily involve substance abuse. C) Poorly written prescriptions could lead to medication errors but are less likely to be related to substance abuse. D) Inadequate scheduling by healthcare providers might affect pain management but does not directly suggest substance abuse.

5. What is the primary role of a nurse in palliative care?

• A. To provide emotional support to patients and families
• B. To coordinate patient care and provide pain management
• C. To administer medications and treatments
• D. To conduct research on end-of-life care

Correct answer: B

Rationale: The correct answer is B. In palliative care, a nurse's primary role is to coordinate patient care and provide pain management. While emotional support (Choice A) is a crucial aspect of palliative care, it is not the primary role of a nurse in this setting. Administering medications and treatments (Choice C) is part of the nurse's responsibilities but not the primary role. Conducting research (Choice D) is important for advancing palliative care but is not the primary role of a nurse providing direct patient care in this context.

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