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: Moving. In Havelock's model of change, the Moving stage involves implementing the chosen change after considering alternatives. In this scenario, the nursing staff accepted a new procedure, indicating they are moving forward with the change. This stage focuses on putting the change into action. Summary of other choices: B: Self-renewal - This choice is not applicable as self-renewal refers to personal growth and development, not organizational change stages. C: Refreezing - This choice is incorrect as refreezing involves stabilizing the change and ensuring it becomes the new norm, which comes after the Moving stage. D: Unfreezing - This choice is incorrect as unfreezing refers to preparing for change by overcoming resistance and creating readiness, which precedes the Moving stage.

Correct Answer: C

Rationale: Rationale for Correct Answer C (require administration of insulin while taking prednisone): 1. Prednisone can increase blood glucose levels by reducing insulin sensitivity. 2. Metformin alone may not control blood glucose levels adequately in the presence of prednisone. 3. Therefore, the patient may require insulin to manage blood glucose levels while on prednisone. Summary of Incorrect Choices: A: This is incorrect because insulin administration is not necessary due to the rash or the interaction between metformin and prednisone. B: This is incorrect because prednisone can actually increase blood glucose levels, leading to hyperglycemia rather than hypoglycemia. D: This is incorrect because the rash is not likely caused by an interaction between metformin and prednisone, but rather an allergic reaction to an unknown cause.

Correct Answer: B

Rationale: The correct answer is B: Assessment. The first step in resolving an ethical dilemma is to thoroughly assess the situation. This involves gathering all relevant information, understanding the perspectives of the patient and family, and identifying key ethical principles at stake. Assessment allows the RN to have a clear understanding of the dilemma and its implications before proceeding with any planning, implementation, or evaluation. Planning (A), Implementation (D), and Evaluation (C) are all important steps in the problem-solving process, but without a comprehensive assessment, the RN may not have a solid foundation to address the ethical dilemma effectively.

Correct Answer: C

Rationale: The correct answer is C because an elderly client awaiting a hip replacement typically requires ongoing support and coordination of services, making them a good candidate for case management. This client would benefit from assistance with navigating the healthcare system, coordinating appointments, and ensuring continuity of care post-surgery. Choice A is incorrect as the adolescent with a gunshot wound in the ER is likely to be in need of immediate medical intervention rather than case management. Choice B is incorrect as a young adult with a fractured pelvis may require medical treatment but may not necessarily need the level of ongoing support that case management provides. Choice D is incorrect as a 41-year-old client admitted for an outpatient tonsillectomy is a relatively straightforward procedure that may not require extensive case management services.

Correct Answer: A

Rationale: Step 1: The nurse's response should be professional and informative. Step 2: Response A provides a clear and professional explanation for the transfer. Step 3: Mentioning the provider's decision conveys expertise and reassurance to the family. Step 4: It shows respect for the provider's judgment and helps build trust with the family. Step 5: Responses B, C, and D do not directly address the family's concerns or provide a suitable explanation for the transfer.

Correct Answer: D

Rationale: The correct answer is D: Patient-focused. Developing a patient-focused atmosphere is crucial to reduce potential risks in healthcare. Patients should be at the center of care, with their needs, preferences, and safety prioritized. In a patient-focused atmosphere, communication is enhanced, leading to better understanding and adherence to treatment plans, reducing errors and adverse events. Nurses, physicians, and families play important roles in patient care, but ultimately, the patient should be the primary focus. Incorrect choices: A: Nurse-focused - Focusing solely on nurses may neglect the holistic approach to patient care and fail to address the patient's needs directly. B: Physician-focused - Similarly, focusing only on physicians may lead to a lack of patient involvement in decision-making and may not address the emotional and psychological aspects of care. C: Family-focused - While involving families in care is important, solely focusing on them may not always align with the patient's best interests and may not address the patient's autonomy and individual needs.

Correct Answer: D

Rationale: The correct answer is D: Improving patient care through technology. Informatics nurse specialists focus on utilizing technology to enhance patient outcomes and streamline healthcare processes. They analyze data, implement new technologies, and design systems to improve efficiency and quality of care. This role involves understanding both nursing practice and technology to bridge the gap between the two, ultimately benefiting patients. A: Managing electronic health records - While informatics nurse specialists may oversee EHR systems, their primary focus is on using technology to enhance patient care, not just managing records. B: Providing technical support - While they may provide some technical support, their main role is to leverage technology to improve patient outcomes, not solely to troubleshoot technical issues. C: Educating nursing staff - While education is a part of their role, the primary objective of an informatics nurse specialist is to improve patient care through technology, not just educating staff.

Correct Answer: B

Rationale: The correct answer is B because in palliative care, nurses play a crucial role in coordinating patient care and providing effective pain management. This involves working closely with patients, families, and other healthcare professionals to ensure holistic care and comfort for the patient. Nurses are responsible for assessing and addressing the physical, emotional, and psychological needs of patients in palliative care. Providing pain relief and symptom management is a key aspect of improving the quality of life for patients. Emotional support (choice A) is important but not the primary role. Administering medications (choice C) is a task within the role but not the primary focus. Conducting research (choice D) is valuable but not the primary responsibility of a nurse in palliative care.