Nursing Elites

1. A client with Addison's disease is at risk for which of the following complications?

• A. Hypertension
• B. Hypovolemia
• C. Hypernatremia
• D. Hypokalemia

Correct answer: B

Rationale: A client with Addison's disease is at risk for hypovolemia. Addison's disease is characterized by adrenal insufficiency, particularly cortisol and aldosterone deficiency. Aldosterone deficiency leads to impaired sodium and water retention, resulting in decreased blood volume and hypovolemia. This condition can cause hypotension, not hypertension (Choice A), as reduced blood volume leads to decreased pressure. Hypernatremia (Choice C) is unlikely in Addison's disease because of the loss of sodium along with water in hypovolemia. Hypokalemia (Choice D) can occur due to aldosterone deficiency, but it is not the primary complication associated with Addison's disease.

2. A client with diabetes mellitus is being educated on the signs and symptoms of hypoglycemia. Which of the following symptoms should the client be instructed to report immediately?

• A. Shakiness
• B. Sweating
• C. Confusion
• D. Increased thirst

Correct answer: C

Rationale: Confusion is a critical symptom of hypoglycemia that indicates the brain is not receiving enough glucose, potentially leading to serious complications like unconsciousness or seizures. Immediate reporting of confusion is essential for prompt intervention to prevent worsening of hypoglycemia. Shakiness and sweating are early warning signs of hypoglycemia but may not always require immediate intervention. Increased thirst is a symptom commonly associated with hyperglycemia rather than hypoglycemia.

3. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:

• A. Elevated serum bicarbonate and decreased blood pH.
• B. Signs of hypoglycemia earlier than expected.
• C. Symptoms of hyperglycemia due to NPH insulin peak time.
• D. Presence of sugar in the urine.

Correct answer: B

Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.

4. How often should rotation sites for insulin injection be separated from one another?

• A. Every third day.
• B. Every week.
• C. Every 2-3 weeks.
• D. Every 2-4 weeks.

Correct answer: C

Rationale: Insulin injection sites should be rotated every 2-3 weeks to prevent lipodystrophy and ensure proper insulin absorption. Option A ('Every third day') is too frequent and does not allow enough time for the previous site to heal properly. Option B ('Every week') might not provide adequate time for the tissue to recover. Option D ('Every 2-4 weeks') could potentially lead to overuse of a single injection site, increasing the risk of lipodystrophy and inconsistent insulin absorption. Therefore, the recommended interval of every 2-3 weeks is optimal for insulin injection site rotation.

5. 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 asked for it.
• B. Assist your manager in capitalizing on his or her strengths and weaknesses.
• C. When working with a manager with poor leadership skills, transferring to a different unit is the best option.
• D. Show 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 by assisting the manager in capitalizing on his or her strengths and weaknesses. By doing so, the follower helps build a good working relationship with the manager, fostering mutual growth and development. Choice A is not the best option as it only focuses on providing feedback when asked, which may not necessarily contribute to 'managing up.' Choice C is incorrect because transferring to a different unit should not be the first solution when dealing with a manager with poor leadership skills; instead, efforts should be made to improve the current working relationship. Choice D, while important, focuses more on showing respect and appreciation rather than actively helping the manager improve, which is key to 'managing up.'

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