Nursing Elites

1. Selye's stress theory explains that a person stressed for long periods of time will:

• A. Face exhaustion and be more susceptible to illnesses.
• B. Become fatigued and become stronger.
• C. Become more assertive.
• D. Safety needs.

Correct answer: A

Rationale: Selye's stress theory posits that individuals experiencing prolonged stress are likely to face exhaustion and become more susceptible to illnesses. This is because the body's response to chronic stress can lead to physical and psychological depletion, increasing the risk of health problems. Choice B is incorrect as becoming stronger is not a typical outcome of prolonged stress according to Selye's theory. Choice C, becoming more assertive, is not directly related to the physical implications of chronic stress. Choice D, safety needs, is unrelated to Selye's stress theory and does not reflect the expected outcomes of prolonged stress.

2. As a new graduate employed in a high-volume maternity unit that uses differentiated practice as its staffing model, what can the nurse expect?

• A. Evidence-based practice guides risk management principles.
• B. Client teaching is the responsibility of the team leader.
• C. The initial level of practice responsibility will be limited.
• D. Seniority is the main determinant of client assignments.

Correct answer: C

Rationale: In a differentiated practice model, the scope of nursing practice and responsibility are tailored to different levels of experience. As a new graduate with limited experience, the nurse can expect that the initial level of practice responsibility will be limited to match their skill level and knowledge. This allows for a gradual increase in responsibilities as the nurse gains more experience and expertise. Choice A is incorrect because evidence-based practice is related to clinical decision-making, not the staffing model. Choice B is incorrect as client teaching is typically a shared responsibility among the healthcare team, not solely the team leader's. Choice D is incorrect as differentiated practice models focus on skill level and competence rather than seniority when determining client assignments.

3. The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?

• A. Ask the patient�s family to participate in the diabetes education program.
• B. Assess the patient�s perception of what it means to have diabetes mellitus.
• C. Demonstrate how to check glucose using capillary blood glucose monitoring.
• D. Discuss the need for the patient to actively participate in diabetes management.

Correct answer: B

Rationale:

4. When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the healthcare provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may

• A. require administration of insulin while taking prednisone
• B. develop acute hypoglycemia while taking prednisone
• C. require administration of insulin while taking prednisone
• D. have rashes caused by metformin-prednisone interactions

Correct answer: C

Rationale: When a patient taking metformin develops an allergic rash from an unknown cause and is prescribed prednisone, the nurse should anticipate that the patient may require administration of insulin while taking prednisone. Prednisone can increase blood glucose levels by antagonizing the effects of insulin, leading to hyperglycemia. Therefore, the patient may need additional insulin to manage blood sugar levels effectively. The other options are incorrect as prednisone would not directly cause a need for a higher-calorie diet, acute hypoglycemia, or rashes caused by a metformin-prednisone interaction.

5. The staff nurse is caring for the client with total accountability and is in continual communication with the client, the family, the physicians, and other members of the health care team. This type of nursing delivery system is known as:

• A. Total patient care
• B. Qualified nurse case managers
• C. Established critical pathways
• D. Quality management system

Correct answer: A

Rationale: The correct answer is A: Total patient care. Total patient care is the original model of nursing care delivery, in which one RN has complete responsibility for all aspects of care for one or more patients. In this system, the nurse is accountable for the client's care and maintains continuous communication with the client, their family, physicians, and other healthcare team members. Choice B, Qualified nurse case managers, refers to nurses who coordinate care but do not provide direct hands-on patient care. Choice C, Established critical pathways, involves predefined care plans for specific conditions but does not imply direct accountability as in total patient care. Choice D, Quality management system, relates to processes to ensure and enhance the quality of care but is not specifically about the direct provision of patient care.

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