Nursing Elites

1. The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first?

• A. Teach the patient about administering regular insulin.
• B. Schedule the patient for a fasting blood glucose level.
• C. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.
• D. Provide teaching about an increased risk for fetal problems with gestational diabetes.

Correct answer: B

Rationale: The correct answer is B. Given the family history of diabetes, the initial action the nurse should take is to schedule the patient for a fasting blood glucose level. This will help in assessing if the patient has developed gestational diabetes. Choice A is incorrect because teaching about administering regular insulin is premature without confirming the diagnosis. Choice C is incorrect as an oral glucose tolerance test is typically done earlier in pregnancy. Choice D is incorrect as discussing fetal problems related to gestational diabetes should come after a confirmed diagnosis.

2. An RN is writing reminders for good documentation for the nurses on her staff. The purpose is to ensure nursing documentation is legally credible. Which of the following is a recommendation she should include in the reminders?

• A. Use shortcuts in documentation.
• B. Only use approved abbreviations.
• C. Documentation should be subjective.
• D. Document after care is provided.

Correct answer: B

Rationale: The correct recommendation that should be included in the reminders for ensuring legally credible nursing documentation is to 'Only use approved abbreviations.' Using shortcuts in documentation (Choice A) may lead to incomplete or vague information, compromising the credibility of documentation. Documentation should not be subjective (Choice C) but rather objective and based on factual information. While it is important to document after care is provided (Choice D), the immediate documentation following care provision is critical for accuracy and legal credibility.

3. Which of the following strategies is most effective for reducing medication errors on a nursing unit?

• A. Increasing the nurse-to-patient ratio
• B. Providing ongoing education on safe medication practices
• C. Using barcoding technology for medication administration
• D. Increasing the use of PRN medications

Correct answer: C

Rationale: The most effective strategy for reducing medication errors on a nursing unit is using barcoding technology for medication administration. Barcoding technology helps to ensure the right medication is given to the right patient in the right dose at the right time. Increasing the nurse-to-patient ratio (choice A) may help in preventing errors due to workload, but it may not address the root cause of medication errors. Providing ongoing education (choice B) is important but may not be as effective as implementing technology to directly prevent errors during administration. Increasing the use of PRN medications (choice D) can actually increase the risk of errors if not carefully monitored and controlled.

4. Which of the following is true regarding health care systems today?

• A. They are all managed care organizations.
• B. They are all privately owned.
• C. Only HMOs are profitable.
• D. There are multiple types of organizations.

Correct answer: D

Rationale: The correct answer is D: 'There are multiple types of organizations.' This statement is true as there are various health care delivery systems in today's world, including but not limited to managed care organizations, privately owned facilities, and other models. Choices A, B, and C are incorrect because not all health care systems are managed care organizations, privately owned, or only profitable if they are HMOs. Health care systems can vary in ownership, management, and profitability, making choice D the most accurate.

5. 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.

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