Nursing Elites

1. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

• A. The test needs to be repeated following a 12-hour fast.
• B. It appears you aren't following the prescribed diabetic diet.
• C. It tells us about your sugar control for the last 3 months.
• D. Your insulin regimen needs to be significantly altered.

Correct answer: C

Rationale: The correct answer is C. Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the past 3 months. This test is used to assess long-term blood sugar control in individuals with diabetes. Choice A is incorrect because fasting is not required for an HbA1c test. Choice B is judgmental and not supported by the information provided. Choice D is not the most accurate statement to make based on the HbA1c result; adjusting insulin would depend on a more comprehensive assessment of the client's overall diabetes management.

2. Which of the following describes the role of the nurse in advocating for a patient?

• A. The nurse ensures that the patient has all the information needed to make an informed decision about their care.
• B. The nurse advocates for the patient by communicating their needs and preferences to the healthcare team.
• C. The nurse advocates for the patient by ensuring that they receive the care they need and by protecting their rights.
• D. The nurse advocates for the patient by helping them navigate the healthcare system and access necessary resources.

Correct answer: C

Rationale: The correct answer is C. Nurses advocate for patients by ensuring that they receive the necessary care and by protecting their rights. This involves speaking up for patients, ensuring they are treated with respect, and helping them access appropriate healthcare services. Option A, providing information for informed decision-making, is an important aspect of nursing care but not the central role of advocacy. Option B, communicating patients' needs to the healthcare team, is essential but more focused on teamwork and collaboration. Option D, helping patients navigate the healthcare system and access resources, is valuable but not the primary definition of advocacy in nursing.

3. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical manifestations should the nurse expect?

• A. Hypernatremia
• B. Hypotension
• C. Decreased urine output
• D. Polyuria

Correct answer: C

Rationale: The correct answer is C: 'Decreased urine output.' Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone, leading to water retention and decreased urine output. Therefore, the nurse should expect the client to have decreased urine output. Choices A, B, and D are incorrect. Hypernatremia (Choice A) is not typically associated with SIADH as it usually leads to dilutional hyponatremia. Hypotension (Choice B) is not a common clinical manifestation of SIADH. Polyuria (Choice D) is the opposite of what is expected in a client with SIADH, who typically presents with decreased urine output.

4. Which of the following describes an effective method of communication?

• A. A unit manager meets with a new nurse to discuss what is going well and areas for improvement.
• B. A unit manager meets with a new nurse to explain departmental policies.
• C. A unit manager meets with staff after several safety events to introduce new policies aimed at preventing further safety events.
• D. A unit manager describes safety events that have occurred on the unit to another nurse manager and discusses ideas for policy improvement with the other manager.

Correct answer: A

Rationale: Choice A is the correct answer because it describes an effective method of communication where a unit manager meets with a new nurse to discuss what is going well and areas for improvement. This approach fosters open dialogue, provides constructive feedback, and promotes professional growth. Choice B is incorrect as it only involves the explanation of departmental policies without engaging in a two-way communication process. Choice C is incorrect as it focuses on policy introduction after safety events rather than individual feedback. Choice D is incorrect as it involves discussing safety events with another manager and policy improvement, but it does not directly address individual performance feedback, which is essential for effective communication and professional development.

5. A client with DM is being taught about the importance of foot care by a nurse. Which instruction should the nurse include?

• A. Use a heating pad to warm your feet.
• B. Avoid walking barefoot.
• C. Soak your feet in hot water every night.
• D. Wear tight shoes to protect your feet.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to avoid walking barefoot. This recommendation is crucial for clients with diabetes to prevent foot injuries and infections. Walking barefoot can lead to unnoticed wounds or ulcers due to reduced sensation in the feet (neuropathy) common in diabetes. Choice A is incorrect as heating pads can cause burns and should be avoided. Choice C is incorrect because soaking feet in hot water can also lead to burns and skin damage. Choice D is incorrect as tight shoes can increase the risk of pressure sores and restrict blood flow, which is detrimental for individuals with diabetes.

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