Nursing Elites

1. A client with Addison's disease is experiencing an Addisonian crisis. The nurse should expect to administer which of the following medication?

• A. Insulin
• B. Hydrocortisone
• C. Levothyroxine
• D. Methimazole

Correct answer: B

Rationale: During an Addisonian crisis, the adrenal glands are not producing enough cortisol, leading to a life-threatening situation. Hydrocortisone, a glucocorticoid, is the medication of choice in managing an Addisonian crisis. It helps replace deficient cortisol levels, stabilize blood pressure, and prevent further complications. Insulin (Choice A) is not indicated in Addison's disease unless specifically needed for diabetes management. Levothyroxine (Choice C) is used in hypothyroidism, not in Addison's disease. Methimazole (Choice D) is used to manage hyperthyroidism, which is not related to Addison's disease or its crisis.

2. A client with DM visits the health care clinic. The client's diabetes has been 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. Atenolol (Tenormin)
• B. Prednisone (Deltasone)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: B

Rationale: The correct answer is B. Prednisone is a corticosteroid that can cause hyperglycemia by increasing glucose production in the liver. Atenolol (Choice A) is a beta-blocker that typically does not affect blood glucose levels significantly. Phenelzine (Choice C) is a monoamine oxidase inhibitor used for depression and does not directly impact blood glucose levels. Allopurinol (Choice D) is a xanthine oxidase inhibitor used to manage gout and does not contribute to hyperglycemia.

3. A client with DM asks a nurse why it is necessary to rotate injection sites when using an insulin pen. The nurse's best response would be:

• A. To prevent scar tissue from forming under the skin.
• B. To make the injections less painful.
• C. To help the insulin absorb better.
• D. To keep the skin looking healthy.

Correct answer: C

Rationale: The correct answer is C: "To help the insulin absorb better." Rotating injection sites is important as it helps to ensure better insulin absorption and reduces the risk of developing lipodystrophy. Option A is incorrect as rotating sites primarily aims to optimize insulin absorption, not prevent scar tissue. Option B is inaccurate because rotating injection sites does not necessarily make the injections less painful. Option D is incorrect as the primary reason for rotating injection sites is not related to the aesthetics of the skin but rather to enhance insulin absorption and prevent complications.

4. Scientific management and human relations-based approach are two major theoretical management schools of thought. Which of the following best describes the scientific model of management?

• A. A nurse manager considers methods of motivating the staff to do their assigned tasks.
• B. A nurse manager commends staff for the work they do, reminding them of the importance of their work and the lives they have saved.
• C. A nurse manager analyzes the role of each staff member on the unit to determine ways to increase efficiency.
• D. A conflict between two staff nurses has impacted an entire unit. The unit manager meets with the nurses and entire staff to promote mutual understanding.

Correct answer: C

Rationale: The correct answer is C because scientific management focuses on improving efficiency through the analysis of tasks and work processes. Choice A is more aligned with a human relations-based approach, which emphasizes motivation and relationships. Choice B reflects recognition and morale boosting, which is also characteristic of the human relations approach. Choice D involves conflict resolution and promoting mutual understanding, which is related to the human relations approach rather than scientific management.

5. A client with type 2 DM is prescribed metformin (Glucophage). The nurse should include which instruction when teaching the client about this medication?

• A. Take the medication with meals.
• B. Take the medication on an empty stomach.
• C. Avoid taking the medication if you miss a meal.
• D. Take the medication before bedtime.

Correct answer: A

Rationale: The correct instruction when taking metformin (Glucophage) is to take the medication with meals. Taking metformin with meals helps to reduce gastrointestinal side effects and improve absorption. Choice B is incorrect because taking metformin on an empty stomach can increase the risk of gastrointestinal side effects. Choice C is incorrect because missing a meal does not mean the medication should be avoided; the client should still take it with the next meal. Choice D is incorrect because there is no specific recommendation to take metformin before bedtime.

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