Nursing Elites

1. A client with DM is taking regular and NPH insulin every morning. The nurse should provide which instruction to the client?

• A. Take the regular insulin first, then the NPH insulin.
• B. Take the NPH insulin first, then the regular insulin.
• C. Mix the insulins in a separate syringe.
• D. Take the regular insulin first and immediately follow it with the NPH insulin.

Correct answer: A

Rationale: The correct instruction for the client is to take the regular insulin first, then the NPH insulin. Regular insulin should be administered before NPH insulin to prevent contamination and maintain the potency of each insulin type. Choice B is incorrect because NPH insulin should not be taken before regular insulin. Mixing the insulins in a separate syringe, as suggested in choice C, is not recommended as it may alter the effectiveness of the insulins. Choice D is also incorrect as taking the regular insulin first and immediately following it with NPH insulin is not the recommended administration sequence.

2. A client with type 2 diabetes mellitus is being educated on foot care. Which of the following instructions should the nurse provide?

• A. Soak your feet in warm water daily.
• B. Avoid going barefoot to protect your feet.
• C. Inspect your feet daily for any cuts or sores.
• D. Avoid using a heating pad to warm your feet if they are cold.

Correct answer: C

Rationale: The correct instruction for a client with type 2 diabetes mellitus regarding foot care is to inspect their feet daily for any cuts or sores. This practice helps in early detection of potential issues like cuts, sores, or infections, which can be challenging to heal due to poor circulation in diabetes. Choice A is incorrect because soaking feet in hot water can lead to burns or skin damage, especially for individuals with diabetes who may have reduced sensation. Choice B is incorrect because going barefoot increases the risk of injuries and infections for individuals with diabetes. Choice D is incorrect because using a heating pad can also impair sensation, increasing the risk of burns or injuries for diabetic individuals.

3. A client with hypothyroidism is being treated with levothyroxine. Which of the following symptoms would indicate that the client may be receiving too much medication?

• A. Bradycardia
• B. Weight gain
• C. Tachycardia
• D. Cold intolerance

Correct answer: C

Rationale: Tachycardia is a sign of excessive thyroid hormone replacement. Levothyroxine is used to treat hypothyroidism by supplementing thyroid hormone levels. If a client with hypothyroidism experiences symptoms of tachycardia, it suggests that they may be receiving an excessive amount of levothyroxine, causing hyperthyroidism. Bradycardia (Choice A) is more commonly associated with hypothyroidism, not excessive levothyroxine. Weight gain (Choice B) and cold intolerance (Choice D) are also typical symptoms of hypothyroidism and would not typically indicate overmedication.

4. A nurse manager is working to improve patient satisfaction on the unit. Which of the following best describes the nurse manager’s role in this process?

• A. The nurse manager should set clear expectations for patient satisfaction, monitor progress, and provide feedback to staff members to continuously improve patient care.
• B. The nurse manager should gather data on patient satisfaction, identify areas for improvement, and implement strategies to enhance the patient experience.
• C. The nurse manager should develop a patient satisfaction improvement plan, set measurable goals, and track progress over time to ensure continuous improvement.
• D. The nurse manager should involve patients and families in the patient satisfaction improvement process, gather feedback, and use it to make improvements to care delivery.

Correct answer: A

Rationale: The correct answer is A. The nurse manager's role in improving patient satisfaction involves setting clear expectations for patient satisfaction, monitoring progress, and providing feedback to staff members to continuously improve patient care. Choice B is incorrect as gathering data and implementing strategies are typically part of quality improvement initiatives but do not solely define the nurse manager's role. Choice C is incorrect because the nurse manager is responsible for setting expectations and monitoring progress rather than developing the improvement plan. Choice D is incorrect as involving patients and families and gathering feedback are important aspects, but the question specifically asks about the nurse manager's role, which primarily involves setting expectations, monitoring progress, and providing feedback to staff.

5. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse the hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

• A. Phentolamine (Regitine)
• B. Methyldopa (Aldomet)
• C. Mannitol (Osmitrol)
• D. Felodipine (Plendil)

Correct answer: A

Rationale: In a hypertensive crisis due to pheochromocytoma, the appropriate medication to administer is Phentolamine (Regitine), an alpha-adrenergic blocker. Phentolamine acts quickly to block the effects of excess catecholamines that are released in pheochromocytoma, helping to rapidly lower blood pressure. Methyldopa (Aldomet) is an alpha-2 adrenergic agonist used for chronic hypertension, not for acute crises like pheochromocytoma. Mannitol (Osmitrol) is an osmotic diuretic used to reduce intracranial pressure and treat cerebral edema, not indicated for hypertensive crises. Felodipine (Plendil) is a calcium channel blocker used for chronic management of hypertension, not for acute hypertensive crises like those seen in pheochromocytoma.

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