Nursing Elites

1. Which of the following theories best describes current health care delivery systems?

• A. Open system theory
• B. Closed system theory
• C. Chaos theory
• D. Contingency theory

Correct answer: D

Rationale: The contingency theory best describes the current health care delivery systems. Contingency theory emphasizes that there is no one best way to organize or manage, and the effectiveness of an organization is contingent upon internal and external factors. In healthcare, the delivery systems must often adapt and be flexible in response to various factors like patient needs, technological advancements, and regulatory changes. Open system theory focuses on the interaction between a system and its environment, but it does not capture the dynamic and adaptive nature of current healthcare systems. Closed system theory suggests systems are self-contained and do not interact with the environment, which is not accurate for healthcare systems that constantly interact with patients, providers, and external factors. Chaos theory deals with complex systems and unpredictability, which while relevant to some aspects of healthcare, does not provide a comprehensive framework for understanding healthcare delivery systems.

2. Which of the following laws govern nursing practice?

• A. Statutory laws
• B. Common laws
• C. Administrative laws
• D. Constitutional laws

Correct answer: A

Rationale: Statutory laws govern nursing practice. These laws are enacted by legislative bodies and regulate various aspects of nursing practice, including licensure requirements, scope of practice, and patient care standards. Common laws, administrative laws, and constitutional laws may also impact nursing practice, but statutory laws specifically outline the legal framework for nursing professionals to follow. Common laws are based on court decisions and precedents, not specific to nursing practice. Administrative laws deal with regulations set by administrative agencies. Constitutional laws relate to the fundamental rights and principles outlined in the constitution, not specifically governing nursing practice.

3. When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the healthcare provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may

• A. require administration of insulin while taking prednisone
• B. develop acute hypoglycemia while taking prednisone
• C. require administration of insulin while taking prednisone
• D. have rashes caused by metformin-prednisone interactions

Correct answer: C

Rationale: When a patient taking metformin develops an allergic rash from an unknown cause and is prescribed prednisone, the nurse should anticipate that the patient may require administration of insulin while taking prednisone. Prednisone can increase blood glucose levels by antagonizing the effects of insulin, leading to hyperglycemia. Therefore, the patient may need additional insulin to manage blood sugar levels effectively. The other options are incorrect as prednisone would not directly cause a need for a higher-calorie diet, acute hypoglycemia, or rashes caused by a metformin-prednisone interaction.

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

• A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
• B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
• C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
• D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

5. 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 the RN should include in the reminders is to 'Only use approved abbreviations.' Using shortcuts in documentation (choice A) may lead to errors or omissions, affecting the credibility of documentation. Documentation should be objective (choice C) rather than subjective to ensure accuracy and legal credibility. It is essential to document care promptly after providing it (choice D) to maintain the accuracy and completeness of patient records, but using approved abbreviations is a more specific recommendation to enhance legal credibility.

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