Nursing Elites

1. The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?

• A. Serum calcium.
• B. Serum phosphorus.
• C. Serum potassium.
• D. Serum sodium.

Correct answer: C

Rationale: During episodes of vomiting and diarrhea, there is a risk of significant potassium loss, leading to potential electrolyte imbalances. Monitoring serum potassium levels is crucial in this situation to assess and manage any abnormalities promptly. Serum calcium (Choice A) is not typically affected by vomiting and diarrhea. Serum phosphorus (Choice B) levels are not commonly altered by these symptoms. Serum sodium (Choice D) may be affected in severe cases of dehydration, but potassium monitoring is a higher priority due to its potential for rapid depletion in vomiting and diarrhea.

2. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

• A. The test needs to be repeated following a 12-hour fast.
• B. It appears you aren't following the prescribed diabetic diet.
• C. It tells us about your sugar control for the last 3 months.
• D. Your insulin regimen needs to be significantly altered.

Correct answer: C

Rationale: The correct answer is C. Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the past 3 months. This test is used to assess long-term blood sugar control in individuals with diabetes. Choice A is incorrect because fasting is not required for an HbA1c test. Choice B is judgmental and not supported by the information provided. Choice D is not the most accurate statement to make based on the HbA1c result; adjusting insulin would depend on a more comprehensive assessment of the client's overall diabetes management.

3. A client with DM is preparing for a foot care exam. The nurse should advise the client to:

• A. Wear loose-fitting shoes to protect the feet.
• B. Apply lotion to the tops and bottoms of the feet to keep the skin moist.
• C. Avoid using a heating pad to prevent burns on the feet.
• D. Avoid using sharp instruments to trim the toenails.

Correct answer: D

Rationale: The correct answer is to advise the client to avoid using sharp instruments to trim the toenails. This is crucial because using sharp instruments can lead to injuries such as cuts or wounds, increasing the risk of infections, especially in clients with diabetes who have decreased sensation in their feet. Choice A is incorrect because tight shoes can restrict circulation and increase the risk of pressure sores. Choice B is incorrect because applying lotion between the toes can create a moist environment, leading to fungal infections. Choice C is incorrect because using a heating pad can lead to burns, which can go unnoticed due to decreased sensation in diabetic feet.

4. As a nurse manager rounds on the unit, he speaks with staff, patients, and family members. Later in the day, he is in a meeting with administration. During the conversations, he considers how these interactions impact the care provided to patients on the unit. Which of the following interpersonal activities best describes this manager's actions?

• A. Networking
• B. Employee development
• C. Coaching
• D. Monitoring

Correct answer: A

Rationale: The correct answer is 'Networking.' Networking involves interacting with others to exchange information and develop professional or social contacts. In this scenario, the nurse manager engages in networking by speaking with staff, patients, family members, and administration to understand their perspectives and build relationships. This activity helps the manager gather insights that can positively impact patient care. Choice B, 'Employee development,' focuses on activities aimed at improving staff skills and performance, which is not the primary focus of the manager's actions described. Choice C, 'Coaching,' involves providing guidance and support to individuals to help them achieve specific goals, which is not explicitly depicted in the scenario. Choice D, 'Monitoring,' typically involves overseeing or supervising activities to ensure compliance with standards or objectives, which does not fully capture the manager's proactive engagement in building relationships and gathering information through interactions.

5. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states:

• A. If I have hypoglycemia, I should eat some sugar, not dextrose.
• B. The drug makes my pancreas release more insulin.
• C. I should never take insulin while I'm taking this drug.
• D. It's best if I take the drug with the first bite of a meal.

Correct answer: B

Rationale: The correct answer is B. Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing carbohydrate absorption in the intestine, not by stimulating insulin release. Therefore, the client would need additional teaching if they state that the drug makes their pancreas release more insulin (Choice B). Choices A, C, and D are incorrect. Choice A is incorrect because during hypoglycemia, it is recommended to consume glucose or dextrose to rapidly raise blood sugar levels. Choice C is incorrect because insulin therapy may still be needed in some cases, even when taking acarbose. Choice D is incorrect because acarbose should be taken at the start of a meal to help reduce postprandial blood glucose levels.

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