A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

Correct Answer: A

Rationale: The correct answer is A because the priority in treating diabetic ketoacidosis is fluid resuscitation to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps to restore intravascular volume and corrects electrolyte abnormalities. Choice B (sodium bicarbonate) is not recommended routinely in DKA treatment as it may worsen metabolic acidosis. Choice C (IV push insulin) can lead to hypoglycemia and should not be the initial intervention. Choice D (insulin infusion) is important but should be started after fluid resuscitation to avoid rapid drops in blood glucose levels.

Correct Answer: B

Rationale: The correct answer is B: To expand access to healthcare. The primary goal of the ACA is to increase the number of Americans with access to affordable healthcare coverage. This is achieved through measures such as expanding Medicaid, creating health insurance marketplaces, and providing subsidies for low-income individuals. By increasing access to healthcare, the ACA aims to improve health outcomes and reduce disparities. Choice A (To reduce healthcare costs) is not the primary goal of the ACA, although cost containment is an important aspect. Choice C (To improve healthcare quality) is also a key goal, but not the primary focus. Choice D (To increase healthcare funding) is not the primary goal either, as the ACA aims to improve access and quality of care rather than simply increasing funding.

Correct Answer: D

Rationale: The correct answer is D because asking construction workers to be responsible for the equipment and sharp items used is not within the charge nurse's role or authority. The responsibility for ensuring safety and security in the Emergency Department lies with the healthcare staff (including the charge nurse) and security personnel. Construction workers may not have the training or expertise to handle agitated patients or prevent potential incidents. A: Notifying the nursing supervisor (A) can help escalate the issue and involve higher authority in addressing the safety concern. B: Notifying security (B) is essential to ensure that trained professionals are present to handle security-related issues. C: Having staff check patients (C) is important to verify their safety, but it does not address the primary concern of preventing patients from accessing construction equipment as weapons.

Correct Answer: B

Rationale: The correct answer is B: Moral distress. Moral distress occurs when individuals know the ethically correct action to take but are constrained from doing so due to various reasons, such as organizational constraints or lack of support. In this scenario, the nurses feel unease and discomfort due to an ethical issue, indicating a conflict between their moral values and actions. The unit manager addressing the issue at the team meeting suggests that the nurses are experiencing moral distress. A: Moral suffering is a broader term encompassing various negative emotions related to moral issues, not specifically the conflict between knowing the right action and being unable to act on it like in moral distress. C: Ethical dilemma refers to a situation where individuals must choose between conflicting moral principles, which is not explicitly described in the scenario. D: Veracity refers to truthfulness or honesty and is not directly related to the nurses' uneasiness and discomfort in dealing with the ethical issue.

Correct Answer: A

Rationale: The correct answer is A because it prioritizes client autonomy and respects their wishes. By engaging the client and asking why they want to discuss advance directives without their partner present, the nurse acknowledges the client's right to make decisions about their own healthcare. This approach promotes open communication and allows the client to express their concerns and preferences freely. Choice B is incorrect as it assumes the client only needs information and brochures without addressing their specific needs or concerns. Choice C is incorrect as it delays addressing the client's immediate questions and concerns about advance directives. Choice D is incorrect as it disregards the client's request to discuss advance directives and focuses solely on their current feelings.

Correct Answer: C

Rationale: The correct answer is C: Check the blood glucose during the night. The Somogyi effect is rebound hyperglycemia that occurs in response to hypoglycemia during the night. By checking blood glucose levels during the night, the patient can identify if they are experiencing nighttime hypoglycemia leading to rebound hyperglycemia in the morning. This will help determine the need for adjusting insulin doses or carbohydrate intake. Why the other choices are incorrect: A: Avoid snacking at bedtime - does not address the underlying issue of nighttime hypoglycemia. B: Increase the rapid-acting insulin dose - could potentially worsen the Somogyi effect by causing further hypoglycemia. D: Administer a larger dose of long-acting insulin - also does not address the issue of nighttime hypoglycemia and may lead to further fluctuations in blood glucose levels.

Correct Answer: A

Rationale: The correct answer is A: Terminate. If a staff member is not responding to discipline, it indicates a serious issue with their behavior or performance. Terminating their employment may be necessary to maintain discipline and uphold organizational standards. Confronting (B) and describing behavior (C) are initial steps in addressing the issue but may not be effective if the staff member continues to be non-responsive. Determining awareness (D) of the policy is important but does not directly address the lack of response to discipline. Terminating employment may be a last resort to maintain the integrity of the organization.

Correct Answer: A

Rationale: The correct answer is A: Autonomy. Autonomy is the ethical principle that emphasizes respecting the patient's right to make their own decisions about their healthcare. In this scenario, the RN respects the patient's autonomy by providing all necessary information and allowing the patient to choose whether or not to accept a blood transfusion, despite the potential risks. This decision-making process aligns with the patient's right to self-determination. Summary of other choices: B: Nonmaleficence - Focuses on avoiding harm to the patient, but in this case, the patient's autonomy takes precedence over nonmaleficence. C: Beneficence - Involves acting in the patient's best interest, but in this scenario, the patient's autonomy to make decisions is the primary focus. D: Distributive justice - Concerns fair distribution of resources, which is not directly relevant to the patient's right to autonomy in decision-making.

Correct Answer: A

Rationale: The correct answer is A: Twelve months. In traditional rating scales, evaluations are typically conducted over a period of twelve months to allow for a comprehensive assessment of an individual's performance over an extended period. This timeframe allows for a more accurate reflection of the individual's overall performance, taking into account various factors and performance trends throughout the year. Explanation for why the other choices are incorrect: - B: Six months: Six months is a relatively shorter timeframe compared to the traditional annual evaluation period. It may not provide a comprehensive view of the individual's performance over a longer period. - C: Three months: Three months is too short of a timeframe to evaluate performance comprehensively. It may not capture long-term performance trends and variations. - D: One month: One month is too brief to assess performance effectively. It may not account for fluctuations in performance or provide a holistic view of the individual's capabilities over time.