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. Which of the following clinical findings would be most concerning in a client with hypothyroidism?

• A. Bradycardia
• B. Dry skin
• C. Constipation
• D. Depression

Correct answer: A

Rationale: Bradycardia in a client with hypothyroidism is the most concerning finding as it may indicate severe hypothyroidism, leading to decreased heart rate. Bradycardia can be a sign of myxedema coma, a life-threatening condition that requires immediate medical attention. Dry skin, constipation, and depression are common symptoms associated with hypothyroidism but are not as acutely concerning as bradycardia.

3. In a male client with a history of hypertension diagnosed with primary hyperaldosteronism, the hypertension is caused by excessive hormone secretion from which of the following glands?

• A. Adrenal cortex
• B. Pancreas
• C. Adrenal medulla
• D. Parathyroid

Correct answer: A

Rationale: Primary hyperaldosteronism is characterized by excessive secretion of aldosterone from the adrenal cortex. Aldosterone, a hormone produced by the adrenal cortex, plays a crucial role in regulating blood pressure by promoting sodium and water retention in the kidneys. The adrenal medulla secretes catecholamines like epinephrine and norepinephrine, which are involved in the 'fight or flight' response, not in regulating blood pressure. The pancreas secretes insulin and glucagon, hormones involved in blood sugar regulation, not blood pressure. The parathyroid glands regulate calcium levels in the blood, not blood pressure.

4. A client is admitted to the ER with DKA. In the acute phase, the priority nursing action is to prepare to:

• A. Administer regular insulin intravenously
• B. Administer 5% dextrose intravenously
• C. Correct the acidosis
• D. Apply an electrocardiogram monitor

Correct answer: A

Rationale: Administering regular insulin intravenously is the priority nursing action in the acute phase of DKA. Insulin helps to lower blood glucose levels by promoting cellular uptake of glucose and inhibiting ketone production. Administering dextrose would be counterproductive as it can worsen hyperglycemia. Correcting acidosis is important but usually follows insulin administration. Applying an electrocardiogram monitor is not the priority action in the acute management of DKA.

5. The patient expects that a type 1 diabetic may receive ____ of their morning dose of insulin preoperatively:

• A. 10-20%.
• B. 25-40%.
• C. 50-60%.
• D. 85-90%.

Correct answer: B

Rationale: It is common practice to administer 25-40% of the morning dose of insulin preoperatively to prevent hypoglycemia during surgery. Giving a lower percentage (A) may not provide sufficient glycemic control, while higher percentages (C, D) can increase the risk of hypoglycemia during the surgical procedure.

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