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 nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram?

• A. Widened T wave
• B. Prominent U wave
• C. Prolonged QT interval
• D. Shortened ST segment

Correct answer: C

Rationale: In hypocalcemia, a decreased level of calcium can lead to a prolonged QT interval on the ECG due to its role in myocardial repolarization. A widened T wave (Choice A) is typically seen in hyperkalemia. A prominent U wave (Choice B) is associated with hypokalemia. A shortened ST segment (Choice D) is not a typical ECG finding in hypocalcemia.

3. The nurse is providing dietary instructions to a client with DM. The nurse instructs the client to include which item in the diet?

• A. High-fat foods
• B. Low-carbohydrate foods
• C. High-protein foods
• D. High-fiber foods

Correct answer: D

Rationale: High-fiber foods are beneficial for clients with diabetes because they help regulate blood glucose levels by slowing down the absorption of sugar. Additionally, high-fiber foods aid in maintaining satiety, supporting weight management, and preventing constipation. High-fat foods (choice A) are not recommended for clients with diabetes due to their potential negative impact on heart health and weight. While low-carbohydrate foods (choice B) can be part of a diabetes-friendly diet, high-fiber foods are more specifically beneficial for managing blood sugar levels. High-protein foods (choice C) can be included in moderation in a diabetic diet, but they are not the primary focus when it comes to improving glycemic control.

4. A psychological contract exists between staff members and nurse managers. Which of the following best describes this relationship?

• A. Nurse managers provide positive evaluations, and in turn, staff members do what managers ask of them.
• B. Nurse managers coordinate multiple departments and supervise multiple staff members.
• C. Staff members do what managers ask of them and, in turn, are rewarded through assignments, promotions, and evaluations.
• D. Nurse managers advocate for staff and support nursing roles and ethical practice.

Correct answer: C

Rationale: The correct answer is C. In a psychological contract between staff members and nurse managers, staff members are expected to fulfill the requests of managers, and in return, they are rewarded with assignments, promotions, and evaluations. This reciprocal relationship forms the basis of the psychological contract. Choices A, B, and D are incorrect because they do not accurately capture the essence of the psychological contract. While nurse managers may provide positive evaluations, coordinate departments, supervise staff, advocate for staff, and support nursing roles, these actions alone do not define the specific reciprocal nature of the psychological contract outlined in choice C.

5. A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, Nurse Tyzz notes that the client is agitated, irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

• A. Depression
• B. Neuropathy
• C. Hypoglycemia
• D. Hyperthyroidism

Correct answer: A

Rationale: The correct answer is A: Depression. Depression is a common psychological manifestation in clients with Cushing's syndrome. In this scenario, the client's symptoms of agitation, irritability, poor memory, loss of appetite, and disheveled appearance are indicative of depressive symptoms rather than neuropathy, hypoglycemia, or hyperthyroidism. Neuropathy typically presents with sensory changes and motor deficits, which are not described in the scenario. Hypoglycemia would manifest with symptoms such as diaphoresis, tremors, and confusion, which are not mentioned. Hyperthyroidism symptoms include weight loss, heat intolerance, and palpitations, which are not consistent with the client's presentation.

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