Nursing Elites

1. The healthcare provider is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select all that apply.)

• A. Expected length of stay
• B. Assigned healthcare team
• C. Patient outcomes
• D. Medical history

Correct answer: C

Rationale: In developing a critical pathway for congestive heart failure (CHF), it is essential to include patient outcomes. Patient outcomes help guide the care plan and ensure that interventions are effective. The expected length of stay is crucial to plan for resources but is not directly related to the critical pathway components. While the assigned healthcare team is important for care delivery, it is not a standard component of a critical pathway. Medical history is valuable for understanding the patient's background but is not a core component of a critical pathway.

2. A unit director at a local hospital knows even leadership may face ethical dilemmas. Which of the following should the director take into consideration when dealing with an employee who is incompetent?

• A. The situation should be tolerated for as long as possible because of the amount of time and paperwork required to terminate an incompetent nurse.
• B. Incompetence only impacts the individual nurse.
• C. The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.
• D. Most nurse practice acts direct how to handle incompetent nurses.

Correct answer: C

Rationale: Incompetence jeopardizes patient safety. Therefore, the formal process for handling these practices should be followed.

3. Which of the following are important techniques when giving directions to subordinates? (EXCEPT)

• A. Know the context of the instructions.
• B. Use lateral communication.
• C. Verify feedback.
• D. Get positive attention.

Correct answer: B

Rationale: The correct answer is B: 'Use lateral communication.' When giving directions to subordinates, it is important to know the context of the instructions, get positive attention, verify feedback, and give follow-up communication. Lateral communication refers to communication between individuals or groups on the same organizational level, which is not directly related to giving directions to subordinates. Choices A, C, and D are important techniques that help ensure effective communication with subordinates.

4. Which of the following are considered part of the operating expenses within health care organizations? (EXCEPT)

• A. Maintenance costs
• B. Rental fees
• C. Renovation costs
• D. Supplies

Correct answer: C

Rationale: Operating expenses in health care organizations typically include costs like maintenance, rental fees, and supplies as they are necessary for the day-to-day operations. Renovation costs, on the other hand, are considered capital expenses as they involve significant improvements to facilities rather than routine operational expenses. Therefore, the correct answer is C. Choices A, B, and D are part of operating expenses in health care organizations because they directly contribute to the ongoing operational needs.

5. 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.

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