Nursing Elites

1. A new nurse is working on becoming a better follower. Which of the following recommendations should she implement?

• A. When you disagree with the manager, seek to determine the manager’s rationale.
• B. Share what you have learned only with newer nurses.
• C. Listen and reflect on your manager’s feedback.
• D. Seek to find a balance and manage your time and energy as you seek to learn about your specialty.

Correct answer: C

Rationale: Listening and reflecting on the manager’s feedback is crucial for a new nurse aiming to become a better follower. It allows the nurse to understand expectations, identify areas for improvement, and show respect for the manager's guidance. Choice A is incorrect as it focuses on resolving disagreements rather than improving followership skills. Choice B is incorrect as knowledge sharing should not be limited to specific groups. Choice D is incorrect as it addresses time management and learning about the specialty, which are important but not directly related to followership development.

2. What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?

• A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
• B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
• C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
• D. It regulates the threshold for water reabsorption in the kidneys.

Correct answer: C

Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.

3. A client with Addison's disease is being educated about managing the condition during times of stress. The nurse should instruct the client to:

• A. Double the dose of corticosteroids during periods of stress.
• B. Skip the dose of corticosteroids if you feel well.
• C. Decrease fluid intake to prevent hypertension.
• D. Avoid physical activity during stressful times.

Correct answer: A

Rationale: Clients with Addison's disease should be educated to double their corticosteroid dosage during periods of stress. This is crucial to prevent adrenal crisis, as stress can increase the body's demand for cortisol. Skipping doses when feeling well can lead to an adrenal crisis if stress occurs suddenly. Decreasing fluid intake can exacerbate dehydration and electrolyte imbalances, which are already concerns in Addison's disease. Avoiding physical activity during stressful times is not the most appropriate advice; moderate physical activity can be beneficial, as long as the client is adequately managing their corticosteroid regimen.

4. Which of the following ethical principles involves the fair and equitable distribution of resources?

• A. Justice
• B. Fidelity
• C. Autonomy
• D. Veracity

Correct answer: A

Rationale: The correct answer is A: Justice. Justice is the ethical principle that focuses on the fair and equitable distribution of resources, ensuring that all individuals receive appropriate care based on their needs. Fidelity (B) refers to being faithful or loyal to commitments and obligations. Autonomy (C) relates to respecting an individual's right to make their own decisions. Veracity (D) pertains to truthfulness and honesty in communication with patients.

5. Skillful communication is one behavior of an effective leader. 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 what improvements the new nurse can make.
• B. A unit manager meets with a new nurse to explain departmental policy.
• C. A unit manager meets with staff after several safety events to unveil new policies designed to prevent 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: Meeting with a new nurse to discuss progress and areas for improvement is an effective communication method.

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