Nursing Elites

1. A client with DM is scheduled for surgery. The nurse should plan to:

• A. Monitor the client's blood glucose level closely during the perioperative period.
• B. Give the client a regular diet as ordered.
• C. Have the client stop taking insulin 48 hours before surgery.
• D. Hold the client's insulin on the morning of surgery.

Correct answer: A

Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. For a client with diabetes mellitus (DM) scheduled for surgery, it is essential to closely monitor blood glucose levels to prevent hypo- or hyperglycemia. Choice B is incorrect because giving the client a regular diet as ordered may not address the specific needs related to managing blood glucose levels in the perioperative period. Choice C is incorrect as abruptly stopping insulin 48 hours before surgery can lead to uncontrolled blood sugar levels, which is not recommended. Choice D is incorrect because holding the client's insulin on the morning of surgery can also disrupt blood sugar control, potentially leading to complications during the perioperative period.

2. A client with type 1 DM is taught to take NPH and regular insulin every morning. The nurse should provide which instructions to the client?

• A. Take the NPH insulin first, then the regular insulin.
• B. Take the regular insulin first, then the NPH insulin.
• C. It does not matter which insulin is drawn up first.
• D. Contact the healthcare provider if the order for insulin is unclear.

Correct answer: B

Rationale: The correct answer is to take the regular insulin first, then the NPH insulin. Regular insulin should be drawn up before NPH insulin to prevent contamination of the regular insulin vial with the longer-acting insulin. Choice A is incorrect as it suggests taking the NPH insulin first, which is not the recommended practice. Choice C is incorrect because the order of drawing up insulin does matter to prevent contamination. Choice D is not the most appropriate action in this scenario, as the nurse should provide clear instructions to the client based on best practices.

3. Which of the following best defines management?

• A. A manager is someone who ensures that employees complete their work.
• B. A manager controls the work of employees.
• C. A manager organizes and controls a group of employees to get work done.
• D. A manager accomplishes tasks through planning, organizing, commanding, coordinating, and controlling work groups.

Correct answer: D

Rationale: The best definition of management encompasses the comprehensive process of planning, organizing, commanding, coordinating, and controlling work groups to achieve organizational goals. Choice A is too limited, focusing only on ensuring work completion. Choice B is overly restrictive as management involves more than mere control. Choice C is more specific than the correct answer, which encompasses a broader range of managerial functions.

4. Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

• A. 1130 and 1330.
• B. 1330 and 1930.
• C. 1530 and 2130.
• D. 1730 and 2330.

Correct answer: C

Rationale: NPH insulin typically peaks 4-12 hours after administration, so a peak between 1530 and 2130 would be expected. Choice A (1130 and 1330) is too early for the peak effect of NPH insulin. Choice B (1330 and 1930) falls within the possible peak period but is not as accurate as choice C. Choice D (1730 and 2330) is too late for the peak effect of NPH insulin based on the typical peak timing.

5. A client with hyperparathyroidism is being assessed. Which of the following symptoms is the nurse likely to find?

• A. Tetany
• B. Hypocalcemia
• C. Bone pain
• D. Hypotension

Correct answer: C

Rationale: In hyperparathyroidism, there is excessive production of parathyroid hormone, leading to increased calcium resorption from the bones. This process causes bone pain, making choice C the correct answer. Tetany (choice A) is associated with hypocalcemia, not hyperparathyroidism. Hypocalcemia (choice B) is the opposite condition of hyperparathyroidism, where blood calcium levels are elevated. Hypotension (choice D) is not a typical symptom of hyperparathyroidism.

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