Nursing Elites

1. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

• A. The test needs to be repeated following a 12-hour fast.
• B. It appears you aren't following the prescribed diabetic diet.
• C. It tells us about your sugar control for the last 3 months.
• D. Your insulin regimen needs to be significantly altered.

Correct answer: C

Rationale: The correct answer is C. Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the past 3 months. This test is used to assess long-term blood sugar control in individuals with diabetes. Choice A is incorrect because fasting is not required for an HbA1c test. Choice B is judgmental and not supported by the information provided. Choice D is not the most accurate statement to make based on the HbA1c result; adjusting insulin would depend on a more comprehensive assessment of the client's overall diabetes management.

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. What is the approximate duration of action for intermediate-acting insulins like NPH?

• A. 6-8 hours.
• B. 10-14 hours.
• C. 16-20 hours.
• D. 24-28 hours.

Correct answer: C

Rationale: The correct answer is C: '16-20 hours.' Intermediate-acting insulins like NPH typically have a duration of action of approximately 16-20 hours. This prolonged action makes them effective in managing blood glucose levels over an extended period. Choices A, B, and D are incorrect because they do not align with the typical duration of action for intermediate-acting insulins. Choice A (6-8 hours) is too short, choice B (10-14 hours) is also shorter than the typical duration, and choice D (24-28 hours) is too long for intermediate-acting insulins like NPH.

4. Which of the following best describes the way for a follower to 'manage up'?

• A. Provide feedback to the unit manager when requested.
• B. Assist the manager in capitalizing on their strengths and weaknesses.
• C. If a follower works with a manager displaying poor leadership skills, they should transfer to a different unit.
• D. Demonstrate respect and appreciation for the manager, even when conversing with coworkers.

Correct answer: B

Rationale: The best way for a follower to 'manage up' is to assist the manager in capitalizing on their strengths and weaknesses. This approach involves supporting the manager in leveraging their strengths while helping them address and improve upon their weaknesses. Choice A is not specific enough about the context of providing feedback, which may not always be the best way to manage up. Choice C suggests avoiding the situation rather than actively managing it. Choice D, while important, does not directly address the concept of managing up by helping the manager grow and excel.

5. A client newly diagnosed with DM asks a nurse why it is necessary to monitor blood glucose levels so often. The nurse's best response would be:

• A. It helps to adjust insulin doses more precisely.
• B. It helps to prevent complications of diabetes.
• C. It helps to identify the best diet for you.
• D. It helps to reduce the need for medications.

Correct answer: B

Rationale: Monitoring blood glucose levels frequently is crucial for preventing complications in diabetes. By keeping a close eye on blood glucose levels, healthcare providers can intervene in a timely manner if levels are out of range, thus reducing the risk of long-term complications such as nerve damage, kidney disease, and vision problems. Choices A, C, and D are incorrect because while monitoring blood glucose levels may indirectly contribute to adjusting insulin doses, identifying the best diet, and reducing the need for medications, the primary purpose is to prevent complications through timely interventions.

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