Nursing Elites

1. What is the primary focus of a patient safety program?

• A. To reduce healthcare costs
• B. To improve clinical outcomes
• C. To enhance patient satisfaction
• D. To comply with regulatory standards

Correct answer: C

Rationale: The primary focus of a patient safety program is to enhance patient satisfaction by ensuring safe practices. While reducing healthcare costs and improving clinical outcomes are important aspects influenced by patient safety programs, the main goal is to prioritize patient well-being and satisfaction. Complying with regulatory standards is essential but not the primary focus; it is a means to achieve safe practices for the benefit of patients.

2. An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to

• A. give a bolus of 50% dextrose.
• B. insert a large-bore IV catheter.
• C. initiate oxygen via nasal cannula.
• D. administer glargine (Lantus) insulin.

Correct answer: B

Rationale: In a patient with hyperosmolar hyperglycemic syndrome (HHS), severe dehydration and electrolyte imbalances are common. To address these issues, the priority intervention is to insert a large-bore IV catheter for fluid resuscitation and electrolyte replacement. Giving a bolus of 50% dextrose would worsen the hyperglycemia. Initiating oxygen via nasal cannula may be beneficial for respiratory support but is not the priority in this scenario. Administering glargine (Lantus) insulin is not the initial treatment for HHS as it does not address the underlying severe dehydration and electrolyte imbalances.

3. After change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
• B. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
• C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
• D. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

Correct answer: C

Rationale: The patient with hyperosmolar hyperglycemic syndrome who presents with poor skin turgor and dry oral mucosa requires immediate attention. These signs indicate severe dehydration and potential electrolyte imbalances, which can lead to serious complications. Assessing this patient first allows for prompt intervention and monitoring to stabilize their condition. Choice A is less urgent as the patient has possible dawn phenomenon, which is a common early-morning rise in blood glucose levels. Choice B, with a blood glucose reading of 230 mg/dL, indicates hyperglycemia but does not present with signs of severe dehydration like the patient in choice C. Choice D, with peripheral neuropathy and foot pain, is important but not as urgent as addressing severe dehydration and electrolyte imbalances in the patient with hyperosmolar hyperglycemic syndrome.

4. What is a benefit of effective delegation?

• A. It increases the manager's workload
• B. It allows the manager to make all the decisions
• C. It empowers staff to make decisions
• D. It decreases staff involvement

Correct answer: C

Rationale: The correct answer is C: 'It empowers staff to make decisions.' Effective delegation involves entrusting tasks and decisions to staff, which not only lightens the manager's load but also empowers employees, enhancing their skills and confidence. Choice A is incorrect because effective delegation should reduce the manager's workload by distributing tasks appropriately. Choice B is incorrect as effective delegation involves empowering staff to make decisions rather than the manager making all decisions. Choice D is incorrect as effective delegation actually increases staff involvement by giving them more responsibilities and decision-making power.

5. Lippitt's phases of change are important factors in the change process. The phase that involves key people in data collection is known as:

• A. Assess the motivation.
• B. Choose a change agent.
• C. Diagnose the problem.
• D. Maintain the change.

Correct answer: C

Rationale: The correct answer is C: 'Diagnose the problem.' In Lippitt's phases of change, the first step is to diagnose the problem, which involves key people in data collection and problem-solving. This step is crucial as it helps identify the root causes of the issues that need to be addressed. Assessing the motivation (A) comes later in the change process once the problem has been diagnosed. Choosing a change agent (B) and maintaining the change (D) are also important steps in the change process but do not specifically involve key people in data collection as in the diagnosis phase.

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