Nursing Elites

1. 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.'

2. Which instruction about insulin administration should Nurse Kate give to a client?

• A. Always follow the same order when drawing up different insulins into the syringe.
• B. Shake the vials before withdrawing the insulin.
• C. Store unopened vials of insulin in the refrigerator at recommended temperatures.
• D. Discard the intermediate-acting insulin if it appears cloudy.

Correct answer: A

Rationale: The correct answer is A. Consistently following the same order when drawing up different insulins helps to prevent medication errors. Option B is incorrect because shaking insulin vials could cause bubbles to form, leading to inaccurate dosing. Option C is incorrect as insulin should be stored in the refrigerator, not the freezer, to maintain its effectiveness. Option D is incorrect because cloudy appearance in intermediate-acting insulin may indicate the presence of insulin crystals, which can affect its potency, but this does not necessarily mean it should be discarded without consulting a healthcare provider.

3. A client with type 2 DM is being treated with 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. Take the medication before bedtime.
• D. Avoid taking the medication if you miss a meal.

Correct answer: A

Rationale: The correct instruction for a client taking metformin (Glucophage) is to take the medication with meals. This helps reduce gastrointestinal side effects and improves absorption. Choice B is incorrect because taking metformin on an empty stomach can increase the risk of side effects. Choice C is incorrect as there is no specific recommendation to take metformin before bedtime. Choice D is incorrect as missing a meal should not lead to avoiding the medication, but the client should take it with the next meal as prescribed.

4. A client with hyperthyroidism is prescribed methimazole. The nurse should instruct the client that the purpose of this medication is to:

• A. Decrease thyroid hormone production
• B. Increase thyroid hormone production
• C. Suppress the immune system
• D. Prevent thyroid storm

Correct answer: A

Rationale: The correct answer is A: Decrease thyroid hormone production. Methimazole works by inhibiting the synthesis of thyroid hormones, specifically by blocking the enzyme responsible for this process. By reducing the production of thyroid hormones, methimazole helps to normalize the elevated levels seen in hyperthyroidism. Choices B, C, and D are incorrect. Choice B, 'Increase thyroid hormone production,' is inaccurate as methimazole actually decreases thyroid hormone production. Choice C, 'Suppress the immune system,' is unrelated to the mechanism of action of methimazole. Choice D, 'Prevent thyroid storm,' is not the primary purpose of methimazole; while it may help prevent worsening of hyperthyroidism, its main action is to reduce thyroid hormone levels.

5. A client with Cushing's syndrome is scheduled for surgery to remove an adrenal tumor. The nurse should monitor for which of the following complications postoperatively?

• A. Hyperglycemia
• B. Hypotension
• C. Hypokalemia
• D. Hyponatremia

Correct answer: B

Rationale: Postoperative hypotension is a common complication after adrenal tumor removal in a client with Cushing's syndrome. This occurs due to the sudden withdrawal of cortisol, which leads to a relative adrenal insufficiency state. Hyperglycemia (Choice A) is more common preoperatively due to excessive cortisol levels. Hypokalemia (Choice C) and Hyponatremia (Choice D) are also associated with Cushing's syndrome but are less likely to be immediate postoperative complications compared to hypotension.

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