An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy?

Correct Answer: B

Rationale: The correct answer is B because a blood pressure of 146/88 mmHg indicates hypertension, which is a common complication of diabetes. High blood pressure can lead to cardiovascular complications and may warrant a change in therapy. A: Hemoglobin A1C level 6.2% is within the target range for diabetes control. C: Resting heart rate of 58 beats/minute is within the normal range for an active individual. D: HDL level of 65 mg/dL is considered high and is actually beneficial for cardiovascular health.

Correct Answer: A

Rationale: The correct answer is A: Unfreeze the system. According to Lewin's Change Theory, the first step in the change process is to unfreeze the current state or system to prepare for change. This involves creating awareness of the need for change, addressing any resistance, and establishing a sense of urgency. Moving the system to a new level (choice B) and refreezing the system (choice C) are subsequent steps in the change process after unfreezing. Evaluating the system (choice D) comes later in the process to assess the effectiveness of the change implemented. Therefore, unfreezing the system is the critical initial step to facilitate successful change implementation.

Correct Answer: B

Rationale: The correct answer is B because amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of serotonin and norepinephrine, thus helping to prevent the transmission of pain impulses to the brain. This mechanism of action is effective in managing neuropathic pain, such as burning foot pain in diabetic patients. Choices A, C, and D are incorrect because amitriptyline's primary mechanism of action is related to its effects on neurotransmitter reuptake, not directly related to mood improvement, blood vessel changes, or sleep improvement.

Correct Answer: D

Rationale: The correct answer is D: Contingency theory. Contingency theory suggests that there is no one best way to organize and manage a healthcare system. It emphasizes that the effectiveness of a healthcare delivery system depends on various factors such as the environment, technology, and organizational structure. This theory acknowledges the complexity of healthcare systems and the need for flexibility and adaptation to changing circumstances. A: Open system theory focuses on the system's interaction with its environment, but it does not specifically address the best way to organize and manage a healthcare system. B: Closed system theory suggests that a system is self-contained and not influenced by external factors, which is not suitable for describing healthcare delivery systems. C: Chaos theory emphasizes the unpredictability and complexity of systems, but it does not provide a framework for organizing and managing healthcare systems effectively.

Correct Answer: C

Rationale: The correct answer is C: Shared decision making. Shared governance involves collaborative decision-making among healthcare professionals, including nurses, to improve patient care and organizational outcomes. This approach empowers frontline staff to have a voice in decisions that affect their work environment and patient care. Nurse-led committees (option B) may be a part of shared governance but do not fully encompass the concept. Top-down management (option A) and hierarchical structure (option D) are opposite to the principles of shared governance as they involve centralized decision-making and lack of employee involvement in decision-making processes.

Correct Answer: C

Rationale: Rationale: - Patient outcomes are essential in a critical pathway for CHF to track progress and effectiveness of interventions. - Expected length of stay is not a core component but can be useful for resource planning. - Assigned healthcare team is important but not a core component in the critical pathway. - Medical history is relevant but not essential in the development of a critical pathway for CHF.

Correct Answer: C

Rationale: The correct answer is C: Continual monitoring. Quality improvement programs require ongoing monitoring to assess progress, identify areas for improvement, and make data-driven decisions. Continual monitoring allows for timely adjustments to processes and interventions to ensure sustained quality improvement. Blame and punishment (A) are counterproductive in a QI program as they can create a culture of fear and hinder open communication. Employee satisfaction (B) is important but not necessarily an essential element of a QI program. Strict adherence to policies (D) is important but alone may not lead to continuous improvement without the feedback loop provided by continual monitoring.

Correct Answer: A

Rationale: The correct answer is A: Statutory laws. Nursing practice is primarily governed by statutory laws, which are laws created by legislative bodies. These laws outline the scope of practice, licensure requirements, and regulations for nursing professionals. Common laws (B) are based on court decisions and do not specifically govern nursing practice. Administrative laws (C) regulate administrative agencies and their functions, not nursing practice. Constitutional laws (D) pertain to the constitution and the rights of individuals, not the specific regulations for nursing practice.

Correct Answer: A

Rationale: The correct answer is A: Centralized. A centralized internal float pool is the most efficient because it allows for better coordination and utilization of resources. With a centralized pool, there is a single point of control and oversight, ensuring optimal allocation of staff and resources. This centralized approach minimizes redundancies and streamlines processes, leading to increased efficiency. Summary: B: Flexible - While flexibility is important, it can lead to inefficiencies if not properly managed within a float pool system. C: Mixed - A mixed pool may result in complexities and challenges in resource allocation and coordination. D: Decentralized - Decentralization can lead to fragmentation and lack of standardization, reducing overall efficiency in resource utilization.