Nursing Elites

1. Effective leaders must communicate a vision for the future. Which of the following is the best method for communicating a vision for the future?

• A. Involve others in creating the vision and connect daily work tasks to the vision.
• B. Encourage staff nurses to openly discuss practice and possible improvements.
• C. Critically analyze and discuss advances in practice with other nurses on staff.
• D. Actively listen to the recommendations of others.

Correct answer: A

Rationale: The best method for communicating a vision for the future is to involve others in creating the vision and connect daily work tasks to the vision. This approach fosters ownership and commitment among team members, as they feel part of the vision-building process and understand how their daily tasks contribute to achieving that vision. Choice B, encouraging staff nurses to openly discuss practice and possible improvements, is important for fostering communication but doesn't directly address creating and communicating a vision. Choice C, critically analyzing and discussing advances in practice with other nurses, focuses on professional development and knowledge sharing rather than specifically communicating a future vision. Choice D, actively listening to recommendations, is valuable for gathering input but may not be sufficient on its own for effectively communicating a future vision.

2. A client with DM visits the health care clinic. The client's diabetes has been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Atenolol (Tenormin)
• B. Prednisone (Deltasone)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: B

Rationale: The correct answer is B. Prednisone is a corticosteroid that can cause hyperglycemia by increasing glucose production in the liver. Atenolol (Choice A) is a beta-blocker that typically does not affect blood glucose levels significantly. Phenelzine (Choice C) is a monoamine oxidase inhibitor used for depression and does not directly impact blood glucose levels. Allopurinol (Choice D) is a xanthine oxidase inhibitor used to manage gout and does not contribute to hyperglycemia.

3. When caring for a male client with diabetes insipidus, what does Nurse Juliet expect to administer?

• A. Vasopressin (Pitressin Synthetic)
• B. Furosemide (Lasix)
• C. Regular insulin
• D. 10% dextrose

Correct answer: A

Rationale: The correct answer is A: Vasopressin (Pitressin Synthetic). Vasopressin is the treatment of choice for diabetes insipidus as it replaces the deficient antidiuretic hormone. Furosemide (Lasix) (choice B) is a diuretic and would exacerbate fluid loss, making it inappropriate for diabetes insipidus. Regular insulin (choice C) is used for diabetes mellitus, not diabetes insipidus, which involves water balance rather than glucose regulation. 10% dextrose (choice D) is used to treat hypoglycemia, not diabetes insipidus.

4. A client newly diagnosed with DM asks a nurse why it is necessary to monitor blood glucose levels so often. The nurse's best response would be:

• A. It helps to adjust insulin doses more precisely.
• B. It helps to prevent complications of diabetes.
• C. It helps to identify the best diet for you.
• D. It helps to reduce the need for medications.

Correct answer: B

Rationale: Monitoring blood glucose levels frequently is crucial for preventing complications in diabetes. By keeping a close eye on blood glucose levels, healthcare providers can intervene in a timely manner if levels are out of range, thus reducing the risk of long-term complications such as nerve damage, kidney disease, and vision problems. Choices A, C, and D are incorrect because while monitoring blood glucose levels may indirectly contribute to adjusting insulin doses, identifying the best diet, and reducing the need for medications, the primary purpose is to prevent complications through timely interventions.

5. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, Nurse Tina assesses the client, who now has nausea, a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

• A. Diabetic ketoacidosis
• B. Thyroid crisis
• C. Hypoglycemia
• D. Tetany

Correct answer: B

Rationale: The correct answer is B: Thyroid crisis. Thyroid crisis, also known as thyroid storm, is a life-threatening condition that can occur after a thyroidectomy. Symptoms include high fever, tachycardia, extreme restlessness, and other signs of severe hyperthyroidism. Diabetic ketoacidosis (choice A) is a complication of diabetes characterized by hyperglycemia, ketosis, and acidosis, not typically seen post-thyroidectomy. Hypoglycemia (choice C) is low blood sugar levels and would not present with the symptoms described. Tetany (choice D) is a condition of involuntary muscle spasms due to low calcium levels and is not directly related to the symptoms observed in this scenario.

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