Nursing Elites

1. A nurse manager has detected a potential problem with staffing and has asked staff members for their thoughts on the matter. Which of the following best describes the informational activity this manager is engaging in?

• A. Spokesperson
• B. Reporting
• C. Monitoring
• D. Job analysis and redesign

Correct answer: C

Rationale: The correct answer is C: 'Monitoring.' Monitoring involves regularly checking and observing the status of a unit or situation. In this scenario, the nurse manager is actively seeking feedback from staff members to assess and keep track of the staffing situation. Choice A, 'Spokesperson,' refers to a role where someone represents or speaks on behalf of a group or organization, which is not the primary activity in this case. Choice B, 'Reporting,' typically involves presenting information or data about a specific topic or issue but does not capture the ongoing observation and assessment aspect seen in monitoring. Choice D, 'Job analysis and redesign,' involves assessing and restructuring job roles, responsibilities, and tasks, which is not directly related to the action of monitoring staffing levels.

2. A client with diabetes mellitus visits a health care clinic. The client's diabetes was previously well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Prednisone (Deltasone)
• B. Atenolol (Tenormin)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: A

Rationale: Prednisone, a corticosteroid, can increase blood glucose levels by promoting gluconeogenesis and decreasing glucose uptake by cells. This medication can lead to hyperglycemia in patients, especially those with diabetes mellitus. Atenolol (Tenormin) is a beta-blocker and is not known to significantly affect blood glucose levels. Phenelzine (Nardil) is a monoamine oxidase inhibitor used to treat depression and anxiety disorders; it does not typically impact blood glucose levels. Allopurinol (Zyloprim) is a xanthine oxidase inhibitor used to manage gout and does not interfere with blood glucose regulation.

3. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

• A. Cool, clammy skin
• B. Distended neck veins
• C. Increased urine osmolarity
• D. Decreased serum sodium level

Correct answer: C

Rationale: Increased urine osmolarity is the best assessment finding supporting a nursing diagnosis of Deficient fluid volume in a male client with hyperglycemia. In hyperglycemia, there is increased glucose in the blood, which leads to osmotic diuresis. This results in the excretion of large amounts of urine that is concentrated (high osmolarity), leading to dehydration and fluid volume deficit. Cool, clammy skin (Choice A) is more indicative of poor perfusion, distended neck veins (Choice B) are associated with fluid volume excess, and decreased serum sodium level (Choice D) could be a result of dilutional hyponatremia due to fluid overload rather than deficient fluid volume.

4. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

• A. Elevated blood glucose level and a low plasma bicarbonate
• B. Decreased urine output
• C. Increased respirations and an increase in pH
• D. Comatose state

Correct answer: A

Rationale: The correct answer is A: Elevated blood glucose level and a low plasma bicarbonate. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, and metabolic acidosis, reflected by a low plasma bicarbonate. Elevated blood glucose levels are a hallmark of DKA due to the body's inability to use glucose properly. Choices B, C, and D are incorrect. Decreased urine output is not a specific finding associated with DKA. Increased respirations and an increase in pH are not typical in DKA; in fact, respiratory compensation for the metabolic acidosis in DKA leads to Kussmaul breathing (deep, rapid breathing). A comatose state may occur in severe cases of DKA but is not a confirming finding for the diagnosis.

5. A client with syndrome of inappropriate antidiuretic hormone (SIADH) is at risk for which of the following complications?

• A. Hypernatremia
• B. Hyponatremia
• C. Hyperkalemia
• D. Hypercalcemia

Correct answer: B

Rationale: The correct answer is B: Hyponatremia. Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by the excessive release of antidiuretic hormone (ADH), leading to water retention in the body. This causes dilutional hyponatremia, where the sodium levels in the blood become abnormally low. Option A, Hypernatremia, is incorrect because SIADH does not cause elevated sodium levels. Option C, Hyperkalemia, is incorrect as SIADH does not directly affect potassium levels. Option D, Hypercalcemia, is also incorrect as SIADH does not impact calcium levels.

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