Nursing Elites

1. 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.

2. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

• A. 2-4 hours after administration
• B. 6-14 hours after administration
• C. 16-18 hours after administration
• D. 18-24 hours after administration

Correct answer: B

Rationale: The correct answer is B: 6-14 hours after administration. NPH insulin has an onset of action within 1-2 hours, a peak action at 6-14 hours, and a duration of action of 16-24 hours. The peak action period, which is when the risk of hypoglycemia is highest, falls between 6-14 hours after administration. Choices A, C, and D are incorrect because they do not align with the typical action profile of NPH insulin.

3. The healthcare provider is assessing a client with Addison's disease. Which of the following symptoms is consistent with this condition?

• A. Hypertension
• B. Hyperglycemia
• C. Hyperpigmentation
• D. Weight gain

Correct answer: C

Rationale: Hyperpigmentation is a characteristic symptom of Addison's disease. In Addison's disease, there is a decrease in cortisol production, leading to an increase in adrenocorticotropic hormone (ACTH) secretion by the pituitary gland. Excess ACTH can stimulate melanocytes, resulting in hyperpigmentation. Choices A, B, and D are not typically associated with Addison's disease. Hypertension is more commonly associated with conditions involving excess cortisol production, such as Cushing's syndrome. Hyperglycemia may occur in diabetes mellitus but is not a hallmark of Addison's disease. Weight loss, rather than weight gain, is a common symptom of Addison's disease due to decreased cortisol levels.

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 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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