Nursing Elites

1. A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which of the following interventions should the nurse implement first?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct first intervention in the treatment of a client with diabetic ketoacidosis (DKA) is to start an intravenous line and infuse normal saline. This is essential for fluid resuscitation to restore intravascular volume and improve perfusion. Administering intravenous insulin can lead to further potassium depletion without first addressing dehydration and electrolyte imbalances. Monitoring serum potassium levels is important but should follow fluid resuscitation to avoid life-threatening hypokalemia. Obtaining an arterial blood gas (ABG) is necessary to assess the acid-base status but is not the initial priority when managing DKA.

2. A client with a nasogastric tube requires irrigation once every shift. The client's serum electrolyte results show a potassium level of 4.5 mEq/L and a sodium level of 132 mEq/L. Based on these findings, which solution should the nurse use for nasogastric tube irrigation?

• A. Tap water
• B. Sterile water
• C. Sodium chloride
• D. Normal saline

Correct answer: C

Rationale: The correct solution for nasogastric tube irrigation in this scenario is sodium chloride. The client's low sodium level of 132 mEq/L indicates the need to avoid further imbalance, making sodium chloride the most appropriate choice. Using tap water, which lacks electrolytes, or sterile water could potentially exacerbate the electrolyte imbalance. Normal saline, while similar to sodium chloride, may not be the best choice as it contains a higher concentration of sodium, which could further elevate the client's already borderline sodium level.

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. Why is it important to control blood glucose levels in type 2 DM?

• A. Hypertension and kidney disease.
• B. Weight gain and obesity.
• C. Improved wound healing.
• D. Decreased cholesterol levels.

Correct answer: A

Rationale: Controlling blood glucose levels in type 2 DM is crucial to prevent complications. High blood glucose levels can lead to hypertension and kidney disease, as seen in diabetic nephropathy and diabetic nephropathy. These are common complications of uncontrolled diabetes. Weight gain and obesity (choice B) are influenced by factors such as diet and physical activity rather than blood glucose levels. Improved wound healing (choice C) is not directly related to blood glucose control but can be affected by it indirectly. Decreased cholesterol levels (choice D) are not a direct consequence of high blood glucose levels and are more related to dietary and lifestyle factors.

5. A new nurse is working hard to follow the established procedures on the unit and is focusing on being as efficient as possible. Which of the following best describes this nurse’s behavior?

• A. The nurse is demonstrating the concept of efficiency, which involves following established procedures to complete tasks in the most effective way possible.
• B. The nurse is demonstrating the concept of task orientation, which focuses on completing tasks efficiently without necessarily considering the impact on patient care.
• C. The nurse is demonstrating the concept of patient-centered care, which focuses on providing care that is respectful of and responsive to individual patient preferences and needs.
• D. The nurse is demonstrating the concept of transformational leadership, which involves inspiring and motivating others to achieve a higher level of performance.

Correct answer: A

Rationale: The correct answer is A: The nurse is demonstrating the concept of efficiency by following established procedures to complete tasks effectively. Efficiency in healthcare involves optimizing processes and resources to achieve the best outcomes. Choice B is incorrect as task orientation refers to focusing on task completion without considering broader aspects like patient care. Choice C is incorrect as patient-centered care emphasizes individual patient needs and preferences rather than operational efficiency. Choice D is incorrect as transformational leadership involves inspiring and motivating others, not specifically related to task efficiency.

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