Nursing Elites

1. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes?

• A. The 50-year-old client who does not engage in any physical exercise
• B. The 56-year-old client who drinks three glasses of wine daily
• C. The 42-year-old client who is 50 pounds overweight
• D. The 38-year-old client who smokes one pack of cigarettes daily

Correct answer: C

Rationale: The 42-year-old client who is 50 pounds overweight is at the highest risk for developing diabetes. Excess weight is a significant risk factor for diabetes as it can lead to insulin resistance and metabolic abnormalities. Choices A, B, and D are also risk factors for diabetes, but being overweight has a stronger association with the development of the condition compared to lack of exercise, excessive alcohol consumption, or smoking.

2. A nurse manager is receiving report and is faced with the following situations that require intervention. Which of the following should the nurse manager address first?

• A. No transport assistance is available to take the client to PT.
• B. A client is refusing care from an AP of the opposite gender.
• C. Three staff members have called to say they will be absent.
• D. Two nurses had a heated disagreement about a scheduling issue.

Correct answer: C

Rationale: The correct answer is C. Addressing the absence of three staff members should be the nurse manager's priority as it directly impacts staffing levels and patient care. This situation can lead to staffing shortages, affecting patient safety and workload distribution. Option A, lack of transport assistance, although important, can be addressed after ensuring adequate staffing. Option B involves a client's preference and can be addressed by assigning care appropriately. Option D, a disagreement between two nurses, is important but can be addressed after ensuring adequate staffing and patient care.

3. A client with diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to:

• A. Take insulin at 2:00 PM each day
• B. Engage in physical activity daily
• C. Increase the dose of regular insulin
• D. Eat a protein and carbohydrate snack at bedtime

Correct answer: D

Rationale: Somogyi effect, also known as rebound hyperglycemia, occurs as a response to nighttime hypoglycemia. Eating a protein and carbohydrate snack at bedtime can help prevent this by stabilizing blood sugar levels throughout the night. Instructing the client to take insulin at 2:00 PM each day (Choice A) may not directly address the nighttime hypoglycemia concern. Engaging in physical activity daily (Choice B) is generally beneficial for diabetes management but may not specifically prevent Somogyi's effect. Increasing the dose of regular insulin (Choice C) without addressing the nighttime hypoglycemia issue can exacerbate the problem.

4. A nurse is assisting with the orientation of a newly licensed nurse. The newly licensed nurse is having trouble focusing and has difficulty completing care for his assigned clients. Which of the following interventions is appropriate?

• A. Offer to provide care for his clients while he takes a break
• B. Advise him to complete less time-consuming tasks first
• C. Ask other staff members to take over some of his tasks
• D. Recommend that he take time to plan at the beginning of his shift

Correct answer: D

Rationale: The correct intervention is to recommend that the new nurse takes time to plan at the beginning of his shift. Planning ahead can help improve time management and focus. Option A is not ideal as it does not address the root cause of the issue and may not promote independence. Option B may not be effective if the nurse is struggling with time management in general. Option C involves shifting responsibilities to others without addressing the new nurse's need for improvement in managing his workload, which should be the priority.

5. What is the normal sodium level in the body?

• A. 135 to 145 milliequivalents per liter.
• B. 3 to 5 milliequivalents per liter.
• C. 135 to 145 microequivalents per liter.
• D. 3 to 5 microequivalents per liter.

Correct answer: A

Rationale: The correct answer is A: 135 to 145 milliequivalents per liter. The normal range for sodium levels in the body is expressed in milliequivalents per liter, not microequivalents. Choice B and D provide a significantly lower range which is not within the normal values for sodium. Choice C incorrectly states 'microequivalents' instead of the correct unit 'milliequivalents'. Therefore, A is the correct answer.

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