Nursing Elites

1. A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which of the following interventions should be the nurse's priority?

• 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 answer is to start an intravenous line and infuse normal saline. In diabetic ketoacidosis (DKA), the priority intervention is fluid resuscitation with normal saline to restore intravascular volume and improve perfusion. Administering insulin without first addressing dehydration and electrolyte imbalances can lead to further complications. Monitoring serum potassium levels and obtaining an arterial blood gas (ABG) are important aspects of DKA management but come after initial fluid resuscitation.

2. When implementing a new policy on the unit, what process should a nurse manager follow?

• A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
• B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
• C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
• D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.

3. A client with Addison's disease is receiving corticosteroid therapy. The nurse should monitor the client for which of the following potential side effects?

• A. Hypoglycemia
• B. Hypertension
• C. Weight loss
• D. Hyperkalemia

Correct answer: B

Rationale: When a client with Addison's disease is receiving corticosteroid therapy, the nurse should monitor for hypertension as a potential side effect. Corticosteroids can lead to hypertension by causing fluid retention and increased blood volume. Hypoglycemia (Choice A) is not a common side effect of corticosteroid therapy; instead, hyperglycemia is more likely. Weight loss (Choice C) is not a typical side effect of corticosteroid therapy; in fact, weight gain is more common due to fluid retention and increased appetite. Hyperkalemia (Choice D) is a potential side effect of Addison's disease itself due to adrenal insufficiency, but it is not directly caused by corticosteroid therapy.

4. To be effective, a nurse manager needs both managerial and leadership skills. Interpersonal activities have many concerns that overlap both leaders and managers. However, some interpersonal activities are needed by nurse managers, but are not specific duties of leaders. Which of the following is an interpersonal activity of nurse managers, but not necessarily all nurse leaders?

• A. Coaching
• B. Resource allocation
• C. Planning for the future
• D. Monitoring

Correct answer: B

Rationale: Resource allocation is an interpersonal activity specific to nurse managers because it involves managing the distribution of resources within the healthcare environment, which is not necessarily a duty for all leaders. While coaching, planning for the future, and monitoring are important skills for both leaders and managers, resource allocation is a task that is more specific to the managerial role of nurse managers.

5. A client with type 2 diabetes mellitus is taking metformin. The nurse should monitor the client for which of the following potential side effects?

• A. Lactic acidosis
• B. Hypokalemia
• C. Hyperglycemia
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A: Lactic acidosis. Metformin, a common medication for type 2 diabetes mellitus, can lead to lactic acidosis, particularly in individuals with renal impairment or other predisposing factors. Monitoring for signs and symptoms of lactic acidosis, such as muscle pain, weakness, trouble breathing, dizziness, and slow or irregular heartbeat, is crucial when a client is taking metformin. Choice B, hypokalemia, is not a common side effect of metformin. Choice C, hyperglycemia, is contrary to the intended effect of metformin, which is to lower blood glucose levels. Choice D, weight gain, is not typically associated with metformin use; in fact, metformin may even contribute to weight loss in some individuals.

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