Nursing Elites

1. Nurse managers need several qualities to be effective. A nurse manager is working hard to fully understand how patient outcomes are measured on the unit and how budget changes could impact patient outcomes. Which of the following qualities does this best describe?

• A. Leadership
• B. Business sense
• C. Clinical expertise
• D. Financial management

Correct answer: B

Rationale: The correct answer is 'Business sense.' Nurse managers need to understand how financial decisions impact patient outcomes, which requires a strong understanding of business principles. Leadership (choice A) is important but doesn't specifically address understanding financial and outcome-based impacts. Clinical expertise (choice C) is essential for patient care but doesn't directly relate to understanding budget changes and their impact. Financial management (choice D) is more about managing finances directly rather than understanding the broader implications of budget changes on patient outcomes.

2. A client with DM is scheduled for surgery. The nurse should plan to:

• A. Monitor the client's blood glucose level closely during the perioperative period.
• B. Give the client a regular diet as ordered.
• C. Have the client stop taking insulin 48 hours before surgery.
• D. Hold the client's insulin on the morning of surgery.

Correct answer: A

Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. For a client with diabetes mellitus (DM) scheduled for surgery, it is essential to closely monitor blood glucose levels to prevent hypo- or hyperglycemia. Choice B is incorrect because giving the client a regular diet as ordered may not address the specific needs related to managing blood glucose levels in the perioperative period. Choice C is incorrect as abruptly stopping insulin 48 hours before surgery can lead to uncontrolled blood sugar levels, which is not recommended. Choice D is incorrect because holding the client's insulin on the morning of surgery can also disrupt blood sugar control, potentially leading to complications during the perioperative period.

3. Nurse Wayne is aware that a positive Chvostek's sign indicates:

• A. Hypocalcemia
• B. Hyponatremia
• C. Hypokalemia
• D. Hypermagnesemia

Correct answer: A

Rationale: A positive Chvostek's sign indicates hypocalcemia. This sign is elicited by tapping the facial nerve anterior to the ear, resulting in facial muscle twitching due to increased neuromuscular irritability from low calcium levels. Hyponatremia (Choice B) is characterized by low sodium levels, but it does not present with Chvostek's sign. Hypokalemia (Choice C) is low potassium levels, and hypermagnesemia (Choice D) is high magnesium levels, neither of which are associated with Chvostek's sign.

4. The client has hyperparathyroidism. Which of the following dietary instructions should the nurse provide?

• A. Increase calcium intake
• B. Limit phosphorus intake
• C. Increase fluid intake
• D. Limit vitamin D intake

Correct answer: C

Rationale: The correct answer is to 'Increase fluid intake.' This is because increasing fluid intake helps prevent kidney stones, a common complication of hyperparathyroidism. While calcium is involved in the condition, increasing calcium intake is not recommended as it can exacerbate hypercalcemia, which is commonly present in hyperparathyroidism. Limiting phosphorus intake is not directly related to managing hyperparathyroidism. Limiting vitamin D intake is also not typically necessary in managing hyperparathyroidism, as it is usually a calcium and PTH-related issue.

5. The healthcare provider is assessing a client with suspected diabetes insipidus. Which of the following clinical manifestations would support this diagnosis?

• A. Polyuria and polydipsia
• B. Hypertension and bradycardia
• C. Weight gain and edema
• D. Oliguria and thirst

Correct answer: A

Rationale: Polyuria (excessive urination) and polydipsia (excessive thirst) are classic clinical manifestations of diabetes insipidus. In this condition, there is a deficiency of antidiuretic hormone, leading to the inability of the kidneys to concentrate urine effectively, resulting in increased urine output (polyuria) and consequent thirst (polydipsia). Hypertension and bradycardia (Choice B) are not typical findings in diabetes insipidus. Weight gain and edema (Choice C) are more indicative of conditions such as heart failure or nephrotic syndrome. Oliguria (decreased urine output) and thirst (Choice D) are contradictory symptoms to what is seen in diabetes insipidus.

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