Nursing Elites

1. Mrs. M has had diabetes for seven years. She has worked hard to control her blood glucose levels and watch her dietary intake. Her physician orders a hemoglobin A1C test. Which of the following best describes the action of this test?

• A. The test determines if the client is anemic and needs iron supplements
• B. The test determines if there is excess glucose building up in the urine
• C. The test determines the amount of hemoglobin reaching the liver to support gluconeogenesis
• D. The test determines the amount of hemoglobin that is coated with glucose

Correct answer: D

Rationale: A hemoglobin A1C test, also known as a glycated hemoglobin test, determines the amount of hemoglobin that is coated with glucose. Excess glucose in the bloodstream may cause it to attach to hemoglobin on red blood cells. Because the life of these cells is between 2 and 3 months, the hemoglobin A1C is an accurate measurement of a client's glucose during that time. Choices A, B, and C are incorrect. Choice A relates to anemia and iron supplements, which are not assessed by a hemoglobin A1C test. Choice B mentions excess glucose in the urine, which is typically assessed through a urine glucose test, not the hemoglobin A1C test. Choice C is incorrect as the test is not related to the amount of hemoglobin reaching the liver to support gluconeogenesis; instead, it specifically measures the amount of hemoglobin that is glycated or coated with glucose.

2. At the beginning of her shift in a long-term care facility, which of the following clients should a nurse check on first?

• A. A 91-year-old man who needs help eating breakfast
• B. An 86-year-old man who has been incontinent in his bed
• C. An 82-year-old woman who needs IV antibiotics
• D. A 75-year-old man who is recovering from an injury and needs an ice pack

Correct answer: C

Rationale: When prioritizing care in a long-term care facility, the nurse must consider tasks that require their immediate attention and cannot be delegated. Administering IV antibiotics is a critical nursing task that only the nurse can perform, ensuring the timely and correct delivery of medication to the patient. While assisting with breakfast, managing incontinence, and providing an ice pack are important, these tasks can be delegated to other healthcare team members, allowing the nurse to address the client needing IV antibiotics first to ensure effective treatment and patient safety.

3. A client in a long-term care facility tells the nurse, 'My daughter never visits me.' The nurse responds by telling the client that when her own mother was in a long-term care facility, she found it difficult to visit. This is an example of which communication technique?

• A. Empathy
• B. Self-disclosure
• C. Disapproval
• D. False reassurance

Correct answer: B

Rationale: Self-disclosure is a therapeutic communication technique that nurses use to build rapport and trust with clients. By sharing personal experiences, nurses can help clients feel understood and encourage them to open up. In this scenario, the nurse sharing her own struggle with visiting her mother demonstrates self-disclosure. Empathy (choice A) involves understanding and sharing the feelings of another, but in this case, the nurse is sharing her own experience rather than focusing solely on the client's emotions. Disapproval (choice C) and false reassurance (choice D) do not apply in this context as the nurse is not expressing disapproval or giving false hope or comfort.

4. When planning care for an uninsured diabetic patient, which strategy should be a priority?

• A. Obtain less expensive medications
• B. Follow evidence-based practice guidelines
• C. Assist with dietary changes as the first action
• D. Teach about the impact of exercise on diabetes

Correct answer: B

Rationale: The priority when planning care for an uninsured diabetic patient should be to follow evidence-based practice guidelines. By adhering to standardized evidence-based guidelines, the nurse can help reduce healthcare disparities among different socioeconomic groups. While obtaining less expensive medications and assisting with dietary changes are important, the primary concern should be providing care that aligns with established standards of practice. Teaching about the impact of exercise is also valuable but may not be the priority when immediate care planning for an uninsured patient is considered.

5. A 58-year-old client is being tested for rheumatoid arthritis. Her physician orders an erythrocyte sedimentation rate (ESR). Which of the following results is most likely to be associated with arthritis?

• A. 5 mm/hr
• B. 12 mm/hr
• C. 28 mm/hr
• D. 40 mm/hr

Correct answer: D

Rationale: The erythrocyte sedimentation rate (ESR) measures levels of inflammation in the body. Elevated ESR levels are commonly seen in autoimmune conditions like rheumatoid arthritis due to the presence of inflammation. In women over 50 years old, a normal ESR is typically below 30 mm/hr. Therefore, a result of 40 mm/hr is more indicative of arthritis in a 58-year-old individual. Choices A, B, and C are below the normal ESR range for a woman of this age and would not be as strongly associated with arthritis.

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