Nursing Elites

1. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

• A. Encourage the client to ask questions about personal sexuality.
• B. Provide time for privacy.
• C. Provide support for the spouse or significant other.
• D. Suggest referral to a sex counselor or other appropriate professional.

Correct answer: D

Rationale: The most appropriate intervention for a postoperative male client with diabetes mellitus who reports impotence and concerns about its impact on his marriage is to suggest referral to a sex counselor or other appropriate professional. Impotence can have significant emotional and relational effects, and a sex counselor is specifically trained to address such concerns. Encouraging the client to ask questions about personal sexuality (Choice A) may not provide the specialized support needed in this situation. Providing time for privacy (Choice B) is important but may not directly address the client's concerns about impotence. Providing support for the spouse or significant other (Choice C) is valuable but may not be as effective as seeking professional help to address the client's specific issue of impotence.

2. A client with Graves' disease is prescribed propranolol. The nurse understands that the purpose of this medication is to:

• A. Treat the underlying cause of the disease
• B. Reduce thyroid hormone production
• C. Alleviate symptoms such as tachycardia and tremors
• D. Increase energy levels

Correct answer: C

Rationale: The correct answer is C: Alleviate symptoms such as tachycardia and tremors. Propranolol is a beta-blocker that helps manage symptoms like tachycardia (fast heart rate) and tremors in patients with Graves' disease. Choice A is incorrect because propranolol does not address the underlying cause of Graves' disease, which is autoimmune in nature. Choice B is incorrect because propranolol does not directly reduce thyroid hormone production; it mainly targets the symptoms. Choice D is incorrect because while propranolol may help with symptoms like tachycardia, it is not intended to increase energy levels.

3. 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.

4. Which of the following best describes the role of a nurse manager in managing conflict on the unit?

• A. The nurse manager is responsible for identifying the sources of conflict and working with staff members to resolve them in a constructive manner.
• B. The nurse manager is responsible for mediating conflicts between staff members and ensuring that they are resolved in a fair and equitable manner.
• C. The nurse manager is responsible for facilitating communication between staff members and ensuring that conflicts are addressed in a timely manner.
• D. The nurse manager is responsible for providing training and support to staff members to help them develop the skills needed to manage conflict effectively.

Correct answer: A

Rationale: The nurse manager's role in managing conflict involves identifying the sources of conflict and working with staff members to resolve them in a constructive manner. This includes addressing conflicts at their root cause and guiding staff towards effective resolution. Choice B is incorrect as the nurse manager typically does not act as a mediator but rather empowers staff to resolve conflicts themselves. Choice C is incorrect as while facilitating communication is important, it is not the sole responsibility of the nurse manager. Choice D is incorrect as providing training and support for conflict management is part of the role, but the primary responsibility lies in addressing the sources of conflict directly.

5. 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.

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