Nursing Elites

1. A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the healthcare provider should the nurse take first?

• A. Place the patient on a cardiac monitor
• B. Administer IV potassium supplements
• C. Obtain urine glucose and ketone levels
• D. Start an insulin infusion at 0.1 units/kg/hr

Correct answer: Place the patient on a cardiac monitor

Rationale: In a patient with diabetic ketoacidosis (DKA), the initial priority is to assess for any cardiac arrhythmias due to electrolyte imbalances. Since the patient has a low serum potassium level of 3.1 mEq/L, placing the patient on a cardiac monitor is crucial to monitor for any potential cardiac complications. Administering IV potassium supplements (Choice B) may be needed, but it is not the first action to take. Obtaining urine glucose and ketone levels (Choice C) and starting an insulin infusion (Choice D) are important interventions in managing DKA, but ensuring patient safety by monitoring for arrhythmias takes precedence.

2. When a Nurse Manager leaves the facility, and one of the remaining managers is given that assignment in addition to her current load without the open position being filled, this is an example of which of the following?

• A. Job enlargement
• B. Proactive management
• C. Time log
• D. Prioritizing

Correct answer: A

Rationale: The correct answer is A, job enlargement. Job enlargement involves adding more tasks to a job without changing the level of skill required. In this scenario, the manager is given additional responsibilities without the position being filled, resulting in combining positions and increasing the number of employees to supervise. Choice B, proactive management, is incorrect as it does not relate to the situation described. Choice C, time log, is not relevant to the scenario. Choice D, prioritizing, is also incorrect as it does not reflect the concept of combining positions and increasing supervisory responsibilities.

3. A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?

• A. Amitriptyline decreases the depression caused by your foot pain.
• B. Amitriptyline helps prevent transmission of pain impulses to the brain.
• C. Amitriptyline corrects some of the blood vessel changes that cause pain.
• D. Amitriptyline improves sleep and reduces awareness of nighttime pain.

Correct answer: B

Rationale: The correct answer is B. Amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of serotonin and norepinephrine, which helps in reducing the transmission of pain impulses to the brain. Choice A is incorrect because amitriptyline primarily works on pain transmission rather than directly on depression. Choice C is inaccurate as amitriptyline's mechanism of action is not related to correcting blood vessel changes. Choice D is partially true as amitriptyline can improve sleep, but the primary mechanism related to pain relief is by preventing pain impulses from reaching the brain.

4. Which level in Maslow's hierarchy is rarely met?

• A. Esteem
• B. Safety
• C. Self-actualization
• D. Belongingness

Correct answer: C

Rationale: The correct answer is C, 'Self-actualization.' Self-actualization, the highest level in Maslow's hierarchy, involves developing one's full potential and achieving personal growth. It is considered rarely met because it requires a deep understanding of oneself, a strong sense of purpose, and the ability to pursue intrinsic goals. Esteem (choice A) focuses on respect, recognition, and self-esteem, which are more commonly achieved than self-actualization. Safety (choice B) and belongingness (choice D) are also more commonly attained as they relate to basic needs for security and social connections, which are essential for overall well-being.

5. A recent nursing school graduate is preparing to take the NCLEX. The graduate knows which of the following is true?

• A. Upon graduation from nursing school, she cannot use the title RN.
• B. Because the NCLEX is a national examination, her RN license will allow her to practice in all states and territories of the United States.
• C. If her home state participates in the compact agreement, she may practice in other states participating in the agreement, but should renew her license in her home state.
• D. The RN license is a mandatory license.

Correct answer: C

Rationale: Choice C is correct because if the nurse's home state participates in the compact agreement, she can practice in other states that are part of the agreement, but she must still renew her license in her home state. This is necessary to maintain an active license in her home state. Choice A is incorrect because upon graduation, the nurse can use the title RN if licensed, but it's not automatic. Choice B is incorrect because while the NCLEX is a national exam, the nurse needs to meet individual state requirements for licensure in each state. Choice D is incorrect because an RN license is not permissive but rather a mandatory license to practice nursing.

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