Nursing Elites

1. A new nurse is working hard to follow the established procedures on the unit and is focusing on being as efficient as possible. Which of the following best describes this nurse’s behavior?

• A. The nurse is demonstrating the concept of efficiency, which involves following established procedures to complete tasks in the most effective way possible.
• B. The nurse is demonstrating the concept of task orientation, which focuses on completing tasks efficiently without necessarily considering the impact on patient care.
• C. The nurse is demonstrating the concept of patient-centered care, which focuses on providing care that is respectful of and responsive to individual patient preferences and needs.
• D. The nurse is demonstrating the concept of transformational leadership, which involves inspiring and motivating others to achieve a higher level of performance.

Correct answer: A

Rationale: The correct answer is A: The nurse is demonstrating the concept of efficiency by following established procedures to complete tasks effectively. Efficiency in healthcare involves optimizing processes and resources to achieve the best outcomes. Choice B is incorrect as task orientation refers to focusing on task completion without considering broader aspects like patient care. Choice C is incorrect as patient-centered care emphasizes individual patient needs and preferences rather than operational efficiency. Choice D is incorrect as transformational leadership involves inspiring and motivating others, not specifically related to task efficiency.

2. A client with hyperthyroidism is prescribed propranolol. The nurse explains that this medication is used to:

• A. Increase thyroid hormone production
• B. Decrease thyroid hormone production
• C. Relieve symptoms such as tachycardia and anxiety
• D. Prevent weight loss

Correct answer: C

Rationale: Propranolol is a beta-blocker that works by blocking the effects of adrenaline, which helps to reduce symptoms such as tachycardia (fast heart rate) and anxiety in individuals with hyperthyroidism. Choices A and B are incorrect because propranolol does not affect thyroid hormone production; it only addresses symptoms. Choice D is incorrect because propranolol does not prevent weight loss associated with hyperthyroidism.

3. A client is admitted to the ER with DKA. In the acute phase, the priority nursing action is to prepare to:

• A. Administer regular insulin intravenously
• B. Administer 5% dextrose intravenously
• C. Correct the acidosis
• D. Apply an electrocardiogram monitor

Correct answer: A

Rationale: Administering regular insulin intravenously is the priority nursing action in the acute phase of DKA. Insulin helps to lower blood glucose levels by promoting cellular uptake of glucose and inhibiting ketone production. Administering dextrose would be counterproductive as it can worsen hyperglycemia. Correcting acidosis is important but usually follows insulin administration. Applying an electrocardiogram monitor is not the priority action in the acute management of DKA.

4. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:

• A. Elevated serum bicarbonate and decreased blood pH.
• B. Signs of hypoglycemia earlier than expected.
• C. Symptoms of hyperglycemia due to NPH insulin peak time.
• D. Presence of sugar in the urine.

Correct answer: B

Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.

5. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states:

• A. If I have hypoglycemia, I should eat some sugar, not dextrose.
• B. The drug makes my pancreas release more insulin.
• C. I should never take insulin while I'm taking this drug.
• D. It's best if I take the drug with the first bite of a meal.

Correct answer: B

Rationale: The correct answer is B. Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing carbohydrate absorption in the intestine, not by stimulating insulin release. Therefore, the client would need additional teaching if they state that the drug makes their pancreas release more insulin (Choice B). Choices A, C, and D are incorrect. Choice A is incorrect because during hypoglycemia, it is recommended to consume glucose or dextrose to rapidly raise blood sugar levels. Choice C is incorrect because insulin therapy may still be needed in some cases, even when taking acarbose. Choice D is incorrect because acarbose should be taken at the start of a meal to help reduce postprandial blood glucose levels.

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