Nursing Elites

1. 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.

2. A good relationship between a leader and a follower enables the follower to 'manage up.' Which of the following describes the best way for a follower to 'manage up'?

• A. Provide feedback to the unit manager when the manager asks for it.
• B. Assist your manager in capitalizing on his or her strengths and weaknesses.
• C. When a follower works with a manager with poor leadership skills, it is best to transfer to a different unit.
• D. Show respect and appreciation for the manager, even when speaking with coworkers.

Correct answer: D

Rationale: Managing up involves building a positive relationship with one's manager by showing respect and appreciation. Choice A is not the best way to manage up as it only focuses on providing feedback when asked, rather than proactively showing respect. Choice B is incorrect as it suggests assisting the manager in capitalizing on their strengths and weaknesses, which is more about helping the manager rather than managing up. Choice C is not the best option as transferring to a different unit should not be the first step in managing up, as it does not address the relationship with the current manager. Therefore, the best way for a follower to manage up is by showing respect and appreciation for the manager, even in conversations with coworkers.

3. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

• A. Hypocalcemia
• B. Hypercalcemia
• C. Hypokalemia
• D. Hyperkalemia

Correct answer: A

Rationale: Chvostek's and Trousseau's signs are clinical manifestations that suggest hypocalcemia, a common complication following thyroidectomy. Chvostek's sign is elicited by tapping the facial nerve, resulting in facial muscle contraction, while Trousseau's sign is provoked by inflating a blood pressure cuff, leading to carpal spasm. Both signs are indicative of low calcium levels in the blood. Therefore, options B, C, and D are incorrect as they do not correlate with the signs specifically associated with hypocalcemia.

4. A client with diabetes mellitus is receiving an oral antidiabetic medication. The nurse should monitor for which of the following adverse effects?

• A. Weight gain
• B. Hypoglycemia
• C. Hyperglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Hypoglycemia. When a client with diabetes mellitus is taking oral antidiabetic medication, the nurse should closely monitor for hypoglycemia, which is a common adverse effect. Hypoglycemia occurs when the blood sugar levels drop below normal range, leading to symptoms like confusion, shakiness, and sweating. Weight gain (Choice A) is not a typical adverse effect of oral antidiabetic medications. Hyperglycemia (Choice C) is the opposite of the desired effect of antidiabetic medications, which aim to lower blood sugar levels. Bradycardia (Choice D) is not directly associated with oral antidiabetic medications; it refers to a slow heart rate.

5. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?

• A. The best time for me to exercise is every afternoon.
• B. The best time for me to exercise is right after I eat.
• C. The best time for me to exercise is after breakfast.
• D. The best time for me to exercise is after my morning snack.

Correct answer: A

Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.

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