Nursing Elites

1. Many patient classification systems have some type of shortcoming. Among these are:

• A. The client's condition changes before the next shift.
• B. The staffing needs are predicted on a short-term basis.
• C. The potential admissions cannot be accounted for.
• D. The staffing mix changes because of illness.

Correct answer: C

Rationale: Patient classification systems have limitations in accounting for changes in a client's condition, unexpected influx of new admissions, and changes in staffing due to illness. These systems often focus on short-term staffing needs rather than utilizing demand management, which considers client outcomes to predict staffing needs over a longer period. Not being able to account for potential admissions can lead to challenges in effectively managing staff allocation and resources. Choices A, B, and D are incorrect because they do not address the specific limitation of patient classification systems related to accounting for potential admissions.

2. What are the advantages of using internal pools of nurses for staffing purposes?

• A. Familiarity with the hospital & Lower cost
• B. Centralization
• C. Staffing mix
• D. Staff satisfaction

Correct answer: A

Rationale: The correct answer is A: Familiarity with the hospital & Lower cost. Internal float pools of nurses offer advantages such as being familiar with the hospital environment and staff, which can enhance communication and collaboration. Additionally, utilizing internal nurses is more cost-effective compared to hiring agency nurses, contributing to financial savings for the healthcare facility. Choice B, Centralization, is not a direct advantage of using internal pools of nurses. Choice C, Staffing mix, is a broader concept that does not specifically address the advantages of internal nurse pools. Choice D, Staff satisfaction, is important but not directly related to the specific advantages of utilizing internal nurse pools for staffing purposes.

3. What behaviors can be observed before a person becomes violent? (EXCEPT)

• A. Wandering
• B. Tense shoulders and clenched fists
• C. Blank stare
• D. Positioned with one foot in back and an arm pulled back

Correct answer: A

Rationale: Before a person becomes violent, observable behaviors may include tense shoulders, clenched fists, a blank stare, and being positioned with one foot in back and an arm pulled back. Wandering is not typically associated with threatening behaviors signaling imminent violence. DelBel (2003) suggests that strategies such as relaxed body language, maintaining physical distance, and silence can help de-escalate an agitated individual's response.

4. A client is admitted to a medical-surgical unit after six hours in the emergency room. He requests that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy?

• A. Continuous quality improvement
• B. Total quality management
• C. Six Sigma
• D. Quality management

Correct answer: B

Rationale: Total Quality Management (TQM) emphasizes meeting customer needs and satisfaction. In this scenario, by honoring the client's request to delay care to allow for rest, the nurse is aligning with the customer-focused approach of TQM. TQM seeks to continuously improve processes and services to enhance customer experiences and outcomes. Continuous Quality Improvement focuses on incremental improvements in processes and outcomes over time. Six Sigma is a data-driven approach to process improvement that aims to reduce defects and errors. Quality Management is a broader concept that encompasses various strategies to ensure quality standards are met.

5. An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to

• A. give a bolus of 50% dextrose.
• B. insert a large-bore IV catheter.
• C. initiate oxygen via nasal cannula.
• D. administer glargine (Lantus) insulin.

Correct answer: B

Rationale: In a patient with hyperosmolar hyperglycemic syndrome (HHS), severe dehydration and electrolyte imbalances are common. To address these issues, the priority intervention is to insert a large-bore IV catheter for fluid resuscitation and electrolyte replacement. Giving a bolus of 50% dextrose would worsen the hyperglycemia. Initiating oxygen via nasal cannula may be beneficial for respiratory support but is not the priority in this scenario. Administering glargine (Lantus) insulin is not the initial treatment for HHS as it does not address the underlying severe dehydration and electrolyte imbalances.

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