Nursing Elites

1. 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.

2. 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.

3. When implementing a new policy on the unit, what process should a nurse manager follow?

• A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
• B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
• C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
• D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.

4. The client with newly diagnosed diabetes mellitus is being taught about managing blood glucose levels. Which statement indicates a need for further teaching?

• A. I will rotate my insulin injection sites to avoid tissue damage.
• B. I will monitor my blood glucose levels before each meal.
• C. I can eat unlimited fruit as it is healthy.
• D. I should carry a fast-acting carbohydrate with me at all times.

Correct answer: C

Rationale: Choice C indicates a need for further teaching because stating 'I can eat unlimited fruit as it is healthy' is incorrect. While fruits are healthy, they also contain natural sugars that can affect blood glucose levels. Portion control is crucial to managing blood glucose levels effectively. Choices A, B, and D demonstrate correct understanding. Rotating insulin injection sites helps prevent tissue damage, monitoring blood glucose levels before meals aids in managing diabetes effectively, and carrying a fast-acting carbohydrate is essential to treat hypoglycemia promptly.

5. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse the hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

• A. Phentolamine (Regitine)
• B. Methyldopa (Aldomet)
• C. Mannitol (Osmitrol)
• D. Felodipine (Plendil)

Correct answer: A

Rationale: In a hypertensive crisis due to pheochromocytoma, the appropriate medication to administer is Phentolamine (Regitine), an alpha-adrenergic blocker. Phentolamine acts quickly to block the effects of excess catecholamines that are released in pheochromocytoma, helping to rapidly lower blood pressure. Methyldopa (Aldomet) is an alpha-2 adrenergic agonist used for chronic hypertension, not for acute crises like pheochromocytoma. Mannitol (Osmitrol) is an osmotic diuretic used to reduce intracranial pressure and treat cerebral edema, not indicated for hypertensive crises. Felodipine (Plendil) is a calcium channel blocker used for chronic management of hypertension, not for acute hypertensive crises like those seen in pheochromocytoma.

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