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

Correct Answer: C

Rationale: The correct answer is C because the patient with hyperosmolar hyperglycemic syndrome showing signs of poor skin turgor and dry oral mucosa is at risk for severe dehydration and potential complications. Assessing this patient first is crucial to address their immediate needs. Choice A is incorrect as the 19-year-old with possible dawn phenomenon can be assessed after the patient with hyperosmolar hyperglycemic syndrome who is at higher risk. Choice B is incorrect as a blood glucose reading of 230 mg/dL in a 35-year-old with type 1 diabetes is high but not indicative of an immediate life-threatening situation compared to severe dehydration. Choice D is incorrect as the 68-year-old with peripheral neuropathy and foot pain, while in discomfort, does not present an immediate threat to their life like severe dehydration does in a patient with hyperosmolar hyperglycemic syndrome.

Correct Answer: C

Rationale: The main focus of Six Sigma methodology in healthcare is enhancing clinical decision making. This is because Six Sigma aims to reduce variations and defects in processes, leading to improved quality and efficiency. By enhancing clinical decision making, healthcare providers can make more accurate and timely decisions, resulting in better patient outcomes. Incorrect choices: A: Reducing healthcare costs is a common goal in healthcare improvement initiatives but not the main focus of Six Sigma. B: Improving patient satisfaction is important but not the primary focus of Six Sigma, which aims at process improvement. D: Increasing healthcare access is crucial, but it is not the main focus of Six Sigma, which is more about quality improvement within existing processes.

Correct Answer: D

Rationale: The correct answer is D (Values and Vision & Mission statements) because they are essential components of strategic planning. Values guide decision-making and behavior, ensuring alignment with the organization's principles. Vision & Mission statements define the organization's purpose, goals, and direction, providing a roadmap for strategic decisions. Reengineering (choice C) is not a typical component of strategic planning as it focuses on process improvement rather than guiding the overall strategy. Choice A (Values) alone is not sufficient for strategic planning without a clear direction provided by Vision & Mission statements (B), making D the most comprehensive and accurate choice.

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: C

Rationale: The correct answer is C: middle-level manager. Middle-level managers oversee first-level managers and coordinate activities within related specialties. They bridge the gap between top-level executives and front-line employees, ensuring organizational goals are met. A: Self-directed managers work autonomously, not supervising other managers. B: First-level managers supervise front-line employees, not other managers. D: Self-motivated is a personal trait and not a managerial level.

Correct Answer: B

Rationale: The correct answer is B: Mentor and educator for new nurses. A nurse preceptor guides and supports new nurses in their transition to the workplace, providing mentorship and educational resources. This role involves teaching clinical skills, sharing knowledge, and offering emotional support. A: Supervisor of all nursing staff - Incorrect. A nurse preceptor focuses on mentoring new nurses, not supervising all nursing staff. C: Director of nursing services - Incorrect. The director of nursing services is a higher-level administrative position responsible for overseeing the nursing department. D: Coordinator of patient care - Incorrect. While a nurse preceptor may assist in coordinating patient care for their assigned nurse, their primary role is to mentor and educate new nurses.

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: D

Rationale: The correct answer is D: Have a tongue depressor available at the client's bedside. This is important to prevent the client from biting their tongue during a seizure, which can lead to injury or airway obstruction. Placing blankets around the bed (choice A) is not a priority during a seizure. Refraining from using restraints (choice B) is correct, as restraints can cause harm during a seizure. Positioning the client laterally (choice C) is recommended after the seizure has ended, not during the seizure itself.

Correct Answer: B

Rationale: The correct answer is B: She may lose her RN license for driving without a license. As a registered nurse, she is held to a high standard of professional conduct. Driving without a valid license is illegal and unethical, potentially endangering herself and others. This behavior could be viewed as a violation of professional ethics, leading to disciplinary action by the licensing board. Choices A, C, and D are incorrect because they do not address the legal and ethical implications of driving without a valid license for a healthcare professional. A nurse should always adhere to legal and ethical standards to maintain the trust and integrity of the profession.