Nursing Elites

1. The healthcare provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?

• A. Avoid snacking at bedtime.
• B. Increase the rapid-acting insulin dose.
• C. Check the blood glucose during the night.
• D. Administer a larger dose of long-acting insulin.

Correct answer: C

Rationale: The Somogyi effect, also known as rebound hyperglycemia, occurs due to an excessive insulin dose at night, leading to hypoglycemia in the early morning hours. To address this, the nurse should instruct the patient to check their blood glucose during the night to determine if hypoglycemia is present, which triggers the rebound hyperglycemia. By monitoring blood glucose levels during the night, the patient can identify if adjustments are needed to prevent this phenomenon and maintain stable glucose levels. Choices A, B, and D are incorrect. Avoiding snacking at bedtime, increasing rapid-acting insulin dose, or administering a larger dose of long-acting insulin are not appropriate actions to manage the Somogyi effect. Checking blood glucose during the night is crucial to identify and prevent the rebound hyperglycemia characteristic of this phenomenon.

2. The decades between the 1960s and 1980s brought about many changes in nursing. Which of the following contributed to advances in nursing?

• A. Decreased demand for health care
• B. Development of specialty care disciplines
• C. Gender discrimination
• D. Advances in technology leading to more generalized care

Correct answer: B

Rationale: The correct answer is B because the development of specialty care disciplines, such as intensive care, neurosurgical techniques, and cardiothoracic surgery, played a significant role in advancing nursing during the specified decades. Choice A is incorrect as decreased demand for health care would not drive advances in nursing. Choice C is also incorrect as gender discrimination, while an issue in the past, does not directly relate to the advancements in nursing during this period. Choice D is incorrect because advances in technology usually lead to more specialized care rather than generalized care.

3. In the grievance process, a nurse disagrees with statements made by a physician about performance and talks to the nurse manager. Which step in the process is this?

• A. First
• B. Second
• C. Third
• D. Fourth

Correct answer: A

Rationale: The correct answer is A: First. In the grievance process, the initial step involves the nurse talking to the nurse manager to address the issue informally. Subsequently, step two entails filing a written appeal to the director of nursing or designee. Step three involves a formal meeting with the employee, agent, grievance chairperson, nursing administrator, and director of human resources. The final step, step four, is arbitration, which is initiated when no mutually acceptable solutions can be reached by the involved parties. Therefore, the nurse talking to the nurse manager about the disagreement is the first step in the grievance process.

4. A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?

• A. The patient always carries hard candies when engaging in exercise.
• B. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
• C. The patient has a peanut butter sandwich before going for a bicycle ride.
• D. The patient increases daily exercise when ketones are present in the urine.

Correct answer: D

Rationale: The correct answer is D because increasing exercise when ketones are present in the urine is inappropriate and potentially dangerous for a patient with type 1 diabetes. This behavior can worsen the ketosis and lead to further complications. Choices A, B, and C demonstrate appropriate self-management strategies for a patient with type 1 diabetes. Carrying hard candies during exercise can help prevent hypoglycemia, going for a walk with a glucose level of 200 mg/dL can help lower blood sugar, and having a snack before physical activity can provide necessary energy.

5. What is the primary focus of Lean methodology in healthcare?

• A. Reduce healthcare costs
• B. Enhance patient satisfaction
• C. Increase patient throughput
• D. Standardize care processes

Correct answer: D

Rationale: The correct answer is D: Standardize care processes. Lean methodology in healthcare focuses on standardizing care processes to improve efficiency and reduce waste. While reducing healthcare costs and enhancing patient satisfaction are important goals in healthcare, the primary focus of Lean methodology is to standardize care processes to ensure consistent, high-quality care delivery. Increasing patient throughput may be a byproduct of implementing Lean principles but is not the primary focus.

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