Nursing Elites

1. A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level?

• A. The client with colitis
• B. The client with Cushing's syndrome
• C. The client who has been overusing laxatives
• D. The client who has sustained a traumatic burn

Correct answer: D

Rationale: Clients who have sustained traumatic burns are at a higher risk of developing hyperkalemia due to cell lysis. When cells are damaged in a traumatic burn, potassium can leak out from the intracellular space into the bloodstream, leading to elevated serum potassium levels. Colitis, Cushing's syndrome, and overuse of laxatives are not typically associated with the same degree of cell damage or potassium shifts seen in traumatic burns, making them less likely to result in such high potassium levels.

2. The healthcare provider is assessing a client with Addison's disease. Which of the following symptoms is consistent with this condition?

• A. Hypertension
• B. Hyperglycemia
• C. Hyperpigmentation
• D. Weight gain

Correct answer: C

Rationale: Hyperpigmentation is a characteristic symptom of Addison's disease. In Addison's disease, there is a decrease in cortisol production, leading to an increase in adrenocorticotropic hormone (ACTH) secretion by the pituitary gland. Excess ACTH can stimulate melanocytes, resulting in hyperpigmentation. Choices A, B, and D are not typically associated with Addison's disease. Hypertension is more commonly associated with conditions involving excess cortisol production, such as Cushing's syndrome. Hyperglycemia may occur in diabetes mellitus but is not a hallmark of Addison's disease. Weight loss, rather than weight gain, is a common symptom of Addison's disease due to decreased cortisol levels.

3. Which of the following is an interpersonal activity of nurse managers, but not necessarily all nurse leaders?

• A. Coaching
• B. Resource allocation
• C. Planning for the future
• D. Monitoring

Correct answer: A

Rationale: The correct answer is A: Coaching. Nurse managers are directly involved in coaching their team members, providing guidance, support, and mentorship. This is a key interpersonal activity that focuses on developing the skills and performance of individual team members. While nurse leaders may also engage in coaching activities, it is a more specific and hands-on role for nurse managers. Choice B, resource allocation, is a managerial function that involves distributing resources effectively and efficiently. Choice C, planning for the future, is a strategic activity that involves setting goals and directions for the organization. Choice D, monitoring, is a supervisory task that involves overseeing and evaluating processes and outcomes. These activities are important for nurse leaders as well as nurse managers, but coaching is a more direct interpersonal interaction typically associated with nurse managers.

4. A nurse is preparing to administer NPH insulin to a client with DM. The nurse notes that the NPH insulin vial is cloudy. The nurse should:

• A. Obtain a new vial of NPH insulin.
• B. Draw up the cloudy insulin as ordered.
• C. Shake the vial vigorously before drawing up the insulin.
• D. Warm the insulin to room temperature before administration.

Correct answer: B

Rationale: The correct answer is to draw up the cloudy insulin as ordered. NPH insulin is inherently cloudy due to its suspension of insulin crystals. Shaking the vial vigorously can lead to denaturation of the insulin molecules, altering its efficacy. Warming NPH insulin is not necessary as it can cause breakdown of insulin molecules. The nurse should gently roll the vial between hands to mix it before drawing it up to ensure an even distribution of insulin in the suspension.

5. A client with hyperparathyroidism is at risk for which of the following complications?

• A. Hypocalcemia
• B. Osteoporosis
• C. Hypokalemia
• D. Hyponatremia

Correct answer: B

Rationale: A client with hyperparathyroidism is at risk for osteoporosis, not hypocalcemia, hypokalemia, or hyponatremia. Hyperparathyroidism results in increased levels of parathyroid hormone, which causes excessive breakdown of bone tissue to release calcium into the bloodstream. This process can lead to weakened bones and an increased risk of osteoporosis. Hypocalcemia is unlikely in hyperparathyroidism as the condition is characterized by elevated calcium levels due to the abnormal activity of the parathyroid glands. Hypokalemia and hyponatremia are not directly associated with hyperparathyroidism; they are more commonly linked to other conditions affecting potassium and sodium levels in the body.

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