Nursing Elites

1. Which of the following is an example of a sentinel event in healthcare?

• A. A patient falling in the hospital without injury
• B. A near-miss medication error
• C. An unexpected patient death unrelated to the natural course of illness
• D. A patient developing an infection during a hospital stay

Correct answer: C

Rationale: The correct answer is C. A sentinel event in healthcare is an unexpected patient death unrelated to the natural course of illness. These events are serious occurrences that warrant immediate investigation and response to prevent their recurrence and ensure patient safety. Choices A, B, and D do not fit the definition of a sentinel event. While choices A, B, and D are serious incidents, they do not involve an unexpected patient death unrelated to the natural course of illness, which is the defining characteristic of a sentinel event.

2. When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action?

• A. Collection of data
• B. Planning
• C. Analyzing data
• D. Identification

Correct answer: B

Rationale: The correct answer is B, 'Planning.' Planning is the phase where individuals reflect on current routines and explore alternative courses of action. This stage involves considering new strategies and approaches, making it the most suitable time to challenge existing norms. Choice A, 'Collection of data,' focuses on gathering information rather than actively reconsidering routines. Choice C, 'Analyzing data,' involves assessing the gathered data rather than proposing new plans. Choice D, 'Identification,' does not specifically address the process of reviewing routines and suggesting improvements, making it less relevant to the question.

3. Which of the following indicators is viewed as important by the nurse manager in relation to a performance model?

• A. Patient outcomes
• B. Rapport with staff
• C. Daily job performance
• D. Flexibility

Correct answer: A

Rationale: The correct answer is A: Patient outcomes. In a performance model, one of the key indicators that a nurse manager would focus on is patient outcomes. Patient outcomes are a direct reflection of the quality of care provided by the staff, making it a crucial aspect of evaluating performance. Choice B, rapport with staff, though important for team dynamics, is not directly related to a performance model that primarily assesses job performance. Choice C, daily job performance, is relevant but more of an outcome rather than an indicator itself. Choice D, flexibility, is a valuable trait but not specifically highlighted in the context of a performance model.

4. 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.

5. When a client is receiving pain medication through a PCA pump, which of the following actions should the nurse take?

• A. Educate the family not to push the button for the client while the client is asleep.
• B. Explain to the client that vital signs will be monitored regularly due to being on a PCA pump.
• C. Instruct the client to push the button only when pain is above a 7 on a scale of 0 to 10.
• D. Adjust the basal rate and decrease the lock-out interval time if the client's pain level is too high.

Correct answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.

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