Nursing Elites

1. A nurse is assessing a client who received an IV fluid bolus for dehydration. Which of the following findings should the nurse identify as an indication of fluid volume excess?

• A. Hypotension
• B. Distended neck veins
• C. Slow capillary refill
• D. Weak, thready pulse

Correct answer: B

Rationale: The correct answer is B: 'Distended neck veins.' Distended neck veins are a sign of fluid volume excess, indicating an overload of fluids in the body. This can be caused by excessive fluid administration. Hypotension (choice A) is more commonly associated with fluid volume deficit. Slow capillary refill (choice C) and a weak, thready pulse (choice D) are also signs of decreased fluid volume, not fluid volume excess.

2. A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to

• A. use only the lispro insulin until the symptoms are resolved
• B. limit calorie intake until the glucose is less than 120 mg/dL
• C. monitor blood glucose every 4 hours and notify the clinic if it continues to rise
• D. decrease carbohydrate intake until glycosylated hemoglobin is less than 7%

Correct answer: C

Rationale: In this scenario, the nurse should advise the patient to monitor her blood glucose every 4 hours and notify the clinic if it continues to rise. This is important because the patient is experiencing symptoms of an illness (sore throat and runny nose) that can lead to fluctuations in blood glucose levels. By monitoring frequently, any significant rise in blood glucose can be detected early, enabling prompt intervention. Choice A is incorrect because abruptly stopping glargine (Lantus) insulin can lead to uncontrolled blood glucose levels. Choice B is incorrect as limiting calorie intake is not the appropriate immediate action for managing high blood glucose levels. Choice D is also incorrect as adjusting carbohydrate intake based on glycosylated hemoglobin levels is not the immediate action needed in this acute situation.

3. Integrated health care systems function in a variety of models. Which of the following is a common characteristic of all systems?

• A. Deliver selective care only
• B. Deliver a whole continuum of care
• C. Treat patients only in the hospital
• D. Provide care only in the primary care setting

Correct answer: B

Rationale: Integrated health care systems are designed to provide a whole continuum of care, which includes preventive, primary, specialty, hospital, and long-term care services. This integration ensures that patients receive comprehensive and coordinated care across different healthcare settings. Choice A is incorrect because integrated systems aim to provide a wide range of services, not selective care only. Choice C is incorrect as integrated systems extend care beyond hospital settings. Choice D is incorrect as these systems offer care across various settings, not limited to primary care only.

4. When planning to run for the local school board, which of the following sources of power would a nurse find important?

• A. Connection
• B. Reward
• C. Charisma
• D. Expertise

Correct answer: A

Rationale: When a nurse is planning to run for the local school board, the important source of power would be 'Connection.' In politics, building relationships and forming connections are crucial for gaining support, forming coalitions, and accessing valuable information. Being charismatic is not a necessary attribute for utilizing power effectively in this context. While expertise is valuable, especially in education-related matters, it is not specified as a primary source of power for a political candidate. Rewards are not typically within the purview of a candidate running for a position such as the local school board.

5. 12. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?

• A. 10:00 AM
• B. 12:00 PM
• C. 2:00 PM
• D. 4:00 PM

Correct answer: A

Rationale: After receiving aspart (NovoLog) insulin, which has a rapid onset, it is crucial to monitor the patient for symptoms of hypoglycemia during the peak action time. Typically, the peak action of aspart insulin occurs around 2 hours after administration. Therefore, the nurse should be most vigilant for hypoglycemia symptoms at 10:00 AM. Choice B (12:00 PM) is incorrect as it falls after the expected peak action time. Choices C (2:00 PM) and D (4:00 PM) are also incorrect because the peak action time of aspart insulin typically occurs earlier, around 2 hours post-administration.

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