Nursing Elites

1. Which of the following is an example of an ethical dilemma in nursing?

• A. Choosing between two equally undesirable alternatives
• B. Reporting a colleague's unethical behavior
• C. Balancing patient confidentiality with the need to disclose information
• D. Deciding whether to comply with a patient's request that conflicts with professional ethics

Correct answer: D

Rationale: The correct answer is D. An ethical dilemma in nursing involves deciding whether to comply with a patient's request that conflicts with professional ethics, balancing competing values and principles. Choices A, B, and C do not directly represent ethical dilemmas in nursing. Choice A describes a general ethical dilemma, choice B involves professional conduct rather than a dilemma, and choice C refers to a confidentiality issue rather than conflicting ethical principles.

2. A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to

• A. use only the lispro insulin until the symptoms are resolved
• B. limit calorie intake until the glucose is less than 120 mg/dL
• C. monitor blood glucose every 4 hours and notify the clinic if it continues to rise
• D. decrease carbohydrate intake until glycosylated hemoglobin is less than 7%

Correct answer: C

Rationale: In this scenario, the nurse should advise the patient to monitor her blood glucose every 4 hours and notify the clinic if it continues to rise. This is important because the patient is experiencing symptoms of an illness (sore throat and runny nose) that can lead to fluctuations in blood glucose levels. By monitoring frequently, any significant rise in blood glucose can be detected early, enabling prompt intervention. Choice A is incorrect because abruptly stopping glargine (Lantus) insulin can lead to uncontrolled blood glucose levels. Choice B is incorrect as limiting calorie intake is not the appropriate immediate action for managing high blood glucose levels. Choice D is also incorrect as adjusting carbohydrate intake based on glycosylated hemoglobin levels is not the immediate action needed in this acute situation.

3. What is the main purpose of a clinical audit?

• A. To measure patient satisfaction
• B. To evaluate the effectiveness of clinical practices
• C. To identify areas for improvement
• D. To standardize patient care protocols

Correct answer: C

Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.

4. While interviewing for a position at City Hospital, the nurse asks about the organizational structure of the institution. She is told that the hospital is organized into departments based on specialty (e.g., nursing, dietary, pharmacy, etc.). Based on what you know about organizational structure, select the structure in this example.

• A. Parallel
• B. Functional
• C. Service-integrated
• D. Matrix

Correct answer: B

Rationale: The correct answer is B: Functional. In functional structures, employees are grouped into departments based on specialty, allowing individuals with similar skills and tasks to work together efficiently. In this scenario, organizing the hospital into departments such as nursing, dietary, and pharmacy based on their specialties exemplifies a functional organizational structure. Choice A, Parallel structure, involves independent units working on similar tasks, which is not the case here. Choice C, Service-integrated structure, emphasizes cross-functional teamwork across various departments, which is not the main focus in the scenario. Choice D, Matrix structure, involves employees reporting to multiple managers for different projects or tasks, which is not described in the scenario.

5. Which level in Maslow's hierarchy is rarely met?

• A. Esteem
• B. Safety
• C. Self-actualization
• D. Belongingness

Correct answer: C

Rationale: The correct answer is C, 'Self-actualization.' Self-actualization, the highest level in Maslow's hierarchy, involves developing one's full potential and achieving personal growth. It is considered rarely met because it requires a deep understanding of oneself, a strong sense of purpose, and the ability to pursue intrinsic goals. Esteem (choice A) focuses on respect, recognition, and self-esteem, which are more commonly achieved than self-actualization. Safety (choice B) and belongingness (choice D) are also more commonly attained as they relate to basic needs for security and social connections, which are essential for overall well-being.

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