Nursing Elites

1. A psychological contract exists between staff members and nurse managers. Which of the following best describes this relationship?

• A. Nurse managers provide positive evaluations, and in turn, staff members do what managers ask of them.
• B. Nurse managers coordinate multiple departments and supervise multiple staff members.
• C. Staff members do what managers ask of them and, in turn, are rewarded through assignments, promotions, and evaluations.
• D. Nurse managers advocate for staff and support nursing roles and ethical practice.

Correct answer: C

Rationale: The correct answer is C. In a psychological contract between staff members and nurse managers, staff members are expected to fulfill the requests of managers, and in return, they are rewarded with assignments, promotions, and evaluations. This reciprocal relationship forms the basis of the psychological contract. Choices A, B, and D are incorrect because they do not accurately capture the essence of the psychological contract. While nurse managers may provide positive evaluations, coordinate departments, supervise staff, advocate for staff, and support nursing roles, these actions alone do not define the specific reciprocal nature of the psychological contract outlined in choice C.

2. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

• A. I.M. or subcutaneous glucagon.
• B. I.V. bolus of dextrose 50%.
• C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
• D. 10 U of fast-acting insulin.

Correct answer: C

Rationale: For a conscious client with hypoglycemia, the initial treatment should involve administering 15 to 20 g of a fast-acting carbohydrate, such as orange juice. This helps rapidly raise the client's blood glucose levels. Choices A and D are incorrect as administering glucagon or fast-acting insulin is not the first-line treatment for hypoglycemia in a conscious client. Choice B, an I.V. bolus of dextrose 50%, is a more invasive and aggressive intervention that is not typically indicated for a conscious client with hypoglycemia.

3. Which nursing diagnosis takes the highest priority for a female client with hyperthyroidism?

• A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
• B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
• C. Body image disturbance related to weight gain and edema
• D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

Correct answer: D

Rationale: The correct answer is D: Imbalanced nutrition: Less than body requirements related to thyroid hormone excess. In hyperthyroidism, increased metabolic rate leads to increased nutritional needs, causing weight loss and muscle wasting. Therefore, addressing imbalanced nutrition due to excessive thyroid hormone is a priority. Choice A is incorrect as hyperthyroidism typically leads to weight loss, not weight gain. Choice B is less of a priority as skin issues are secondary to the metabolic disturbances caused by hyperthyroidism. Choice C, body image disturbance, is important but addressing the client's nutritional needs should take precedence to prevent further complications.

4. The client with Addison's disease is receiving education on managing the condition. Which of the following instructions should be included?

• A. Increase your sodium intake during periods of stress.
• B. Avoid all types of exercise.
• C. Decrease your fluid intake to prevent fluid overload.
• D. Stop corticosteroid therapy once symptoms improve.

Correct answer: A

Rationale: The correct instruction to include for a client with Addison's disease is to increase sodium intake during periods of stress. In Addison's disease, there is a deficiency of aldosterone leading to sodium loss. Increasing sodium intake helps to compensate for this loss and prevent complications. Choice B is incorrect as exercise is beneficial for overall health but should be done in moderation. Choice C is incorrect as fluid intake should be adequate to prevent dehydration since clients with Addison's disease are prone to electrolyte imbalances. Choice D is incorrect as corticosteroid therapy is essential for managing Addison's disease and should not be discontinued abruptly without medical guidance.

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

• A. Increase metabolism
• B. Reduce anxiety
• C. Decrease heart rate
• D. Increase blood pressure

Correct answer: C

Rationale: Propranolol is a beta-blocker commonly used in the management of hyperthyroidism. It works by blocking the effects of adrenaline, resulting in a decrease in heart rate and blood pressure. Choice A is incorrect because propranolol does not increase metabolism; instead, it may have a mild inhibitory effect. Choice B is incorrect as propranolol is not primarily used to reduce anxiety, although it may have some anxiolytic effects. Choice D is incorrect as propranolol actually decreases blood pressure by blocking the effects of adrenaline on the heart and blood vessels.

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