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 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.

3. In a male client with a history of hypertension diagnosed with primary hyperaldosteronism, the hypertension is caused by excessive hormone secretion from which of the following glands?

• A. Adrenal cortex
• B. Pancreas
• C. Adrenal medulla
• D. Parathyroid

Correct answer: A

Rationale: Primary hyperaldosteronism is characterized by excessive secretion of aldosterone from the adrenal cortex. Aldosterone, a hormone produced by the adrenal cortex, plays a crucial role in regulating blood pressure by promoting sodium and water retention in the kidneys. The adrenal medulla secretes catecholamines like epinephrine and norepinephrine, which are involved in the 'fight or flight' response, not in regulating blood pressure. The pancreas secretes insulin and glucagon, hormones involved in blood sugar regulation, not blood pressure. The parathyroid glands regulate calcium levels in the blood, not blood pressure.

4. During a physical assessment of a client with type 2 DM, a nurse notes the following findings: fasting blood glucose of 120 mg/dl, temperature of 101°F, pulse 88 bpm, respirations 22/min, and BP 140/84 mmHg. Which finding should concern the nurse the most?

• A. Pulse
• B. BP
• C. Respiration
• D. Temperature

Correct answer: D

Rationale: The correct answer is 'Temperature.' A temperature of 101°F indicates a fever, which can be a sign of infection. In individuals with diabetes, infections can lead to significant complications and affect blood glucose control. Monitoring and addressing infections promptly are crucial in individuals with diabetes to prevent worsening of their condition. Choice A, 'Pulse,' is within the normal range (60-100 bpm) and does not indicate an immediate concern. Choice B, 'BP,' while slightly elevated, is not as acutely concerning as an elevated temperature in this scenario. Choice C, 'Respiration,' falls within the normal range (12-20 breaths/min) and is not the most concerning finding among the options provided.

5. A client with hypothyroidism is being treated with levothyroxine. Which of the following symptoms would indicate that the client may be receiving too much medication?

• A. Bradycardia
• B. Weight gain
• C. Tachycardia
• D. Cold intolerance

Correct answer: C

Rationale: Tachycardia is a sign of excessive thyroid hormone replacement. Levothyroxine is used to treat hypothyroidism by supplementing thyroid hormone levels. If a client with hypothyroidism experiences symptoms of tachycardia, it suggests that they may be receiving an excessive amount of levothyroxine, causing hyperthyroidism. Bradycardia (Choice A) is more commonly associated with hypothyroidism, not excessive levothyroxine. Weight gain (Choice B) and cold intolerance (Choice D) are also typical symptoms of hypothyroidism and would not typically indicate overmedication.

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