Nursing Elites

1. A client with diabetes mellitus is scheduled for surgery. The nurse should prioritize which of the following preoperative actions?

• A. Administer a full dose of insulin before surgery
• B. Hold all oral hypoglycemic agents the day before surgery
• C. Monitor blood glucose levels closely before surgery
• D. Instruct the client to avoid all fluids the morning of surgery

Correct answer: C

Rationale: Monitoring blood glucose levels closely before surgery is the priority for a client with diabetes mellitus. This allows for early detection of any abnormalities and helps prevent hypo- or hyperglycemia complications that can arise during the perioperative period. Option A is incorrect because insulin dosing should be individualized based on the client's current blood glucose levels and the surgical plan. Option B is incorrect as abruptly holding oral hypoglycemic agents can lead to uncontrolled blood glucose levels. Option D is incorrect as adequate fluid intake is important for the client's hydration status and overall well-being before surgery.

2. A client with Cushing's syndrome is scheduled for surgery to remove an adrenal tumor. The nurse should monitor for which of the following complications postoperatively?

• A. Hyperglycemia
• B. Hypotension
• C. Hypokalemia
• D. Hyponatremia

Correct answer: B

Rationale: Postoperative hypotension is a common complication after adrenal tumor removal in a client with Cushing's syndrome. This occurs due to the sudden withdrawal of cortisol, which leads to a relative adrenal insufficiency state. Hyperglycemia (Choice A) is more common preoperatively due to excessive cortisol levels. Hypokalemia (Choice C) and Hyponatremia (Choice D) are also associated with Cushing's syndrome but are less likely to be immediate postoperative complications compared to hypotension.

3. A good relationship between a leader and a follower enables the follower to 'manage up.' Which of the following describes the best way for a follower to 'manage up'?

• A. Provide feedback to the unit manager when the manager asks for it.
• B. Assist your manager in capitalizing on his or her strengths and weaknesses.
• C. When a follower works with a manager with poor leadership skills, it is best to transfer to a different unit.
• D. Show respect and appreciation for the manager, even when speaking with coworkers.

Correct answer: D

Rationale: Managing up involves building a positive relationship with one's manager by showing respect and appreciation. Choice A is not the best way to manage up as it only focuses on providing feedback when asked, rather than proactively showing respect. Choice B is incorrect as it suggests assisting the manager in capitalizing on their strengths and weaknesses, which is more about helping the manager rather than managing up. Choice C is not the best option as transferring to a different unit should not be the first step in managing up, as it does not address the relationship with the current manager. Therefore, the best way for a follower to manage up is by showing respect and appreciation for the manager, even in conversations with coworkers.

4. A client with hypothyroidism is at risk for which of the following complications?

• A. Thyroid storm
• B. Myxedema coma
• C. Cushing's syndrome
• D. Diabetic ketoacidosis

Correct answer: B

Rationale: Myxedema coma is a severe, life-threatening complication that can occur in individuals with untreated or inadequately treated hypothyroidism. It is characterized by extreme hypothyroidism leading to decreased mental status, hypothermia, bradycardia, and respiratory depression. Thyroid storm (Choice A) is a severe complication of hyperthyroidism, not hypothyroidism. Cushing's syndrome (Choice C) results from prolonged exposure to high levels of cortisol, not related to hypothyroidism. Diabetic ketoacidosis (Choice D) is a complication of uncontrolled diabetes, not directly associated with hypothyroidism.

5. The healthcare provider is assessing a client with suspected diabetes insipidus. Which of the following clinical manifestations would support this diagnosis?

• A. Polyuria and polydipsia
• B. Hypertension and bradycardia
• C. Weight gain and edema
• D. Oliguria and thirst

Correct answer: A

Rationale: Polyuria (excessive urination) and polydipsia (excessive thirst) are classic clinical manifestations of diabetes insipidus. In this condition, there is a deficiency of antidiuretic hormone, leading to the inability of the kidneys to concentrate urine effectively, resulting in increased urine output (polyuria) and consequent thirst (polydipsia). Hypertension and bradycardia (Choice B) are not typical findings in diabetes insipidus. Weight gain and edema (Choice C) are more indicative of conditions such as heart failure or nephrotic syndrome. Oliguria (decreased urine output) and thirst (Choice D) are contradictory symptoms to what is seen in diabetes insipidus.

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