Nursing Elites

1. Which instruction about insulin administration should Nurse Kate give to a client?

• A. Always follow the same order when drawing up different insulins into the syringe.
• B. Shake the vials before withdrawing the insulin.
• C. Store unopened vials of insulin in the refrigerator at recommended temperatures.
• D. Discard the intermediate-acting insulin if it appears cloudy.

Correct answer: A

Rationale: The correct answer is A. Consistently following the same order when drawing up different insulins helps to prevent medication errors. Option B is incorrect because shaking insulin vials could cause bubbles to form, leading to inaccurate dosing. Option C is incorrect as insulin should be stored in the refrigerator, not the freezer, to maintain its effectiveness. Option D is incorrect because cloudy appearance in intermediate-acting insulin may indicate the presence of insulin crystals, which can affect its potency, but this does not necessarily mean it should be discarded without consulting a healthcare provider.

2. Which of the following best describes the way for a follower to 'manage up'?

• A. Provide feedback to the unit manager when requested.
• B. Assist the manager in capitalizing on their strengths and weaknesses.
• C. If a follower works with a manager displaying poor leadership skills, they should transfer to a different unit.
• D. Demonstrate respect and appreciation for the manager, even when conversing with coworkers.

Correct answer: B

Rationale: The best way for a follower to 'manage up' is to assist the manager in capitalizing on their strengths and weaknesses. This approach involves supporting the manager in leveraging their strengths while helping them address and improve upon their weaknesses. Choice A is not specific enough about the context of providing feedback, which may not always be the best way to manage up. Choice C suggests avoiding the situation rather than actively managing it. Choice D, while important, does not directly address the concept of managing up by helping the manager grow and excel.

3. Which of the following ethical principles is involved when protecting a patient's privacy and confidentiality?

• A. Fidelity
• B. Beneficence
• C. Confidentiality
• D. Justice

Correct answer: C

Rationale: Confidentiality is the ethical principle involved in protecting a patient's privacy and ensuring that personal information is not shared inappropriately. Fidelity refers to being faithful to commitments and keeping promises, not directly related to privacy and confidentiality. Beneficence involves doing good for the patient, and justice pertains to fairness and equal treatment, but they are not directly related to protecting privacy and confidentiality.

4. 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.

5. A client with type 1 diabetes mellitus presents with nausea, vomiting, and abdominal pain. The nurse suspects diabetic ketoacidosis (DKA). Which of the following lab findings would confirm this diagnosis?

• A. Serum glucose of 180 mg/dL
• B. Serum bicarbonate of 22 mEq/L
• C. Blood pH of 7.25
• D. Urine specific gravity of 1.020

Correct answer: C

Rationale: A blood pH of 7.25 is a critical finding in diabetic ketoacidosis (DKA) as it indicates metabolic acidosis, which is a hallmark of this condition. In DKA, there is an accumulation of ketones in the blood, leading to increased acidity. The serum glucose level is typically elevated in DKA, often exceeding 250 mg/dL. A serum bicarbonate level less than 18 mEq/L is usually seen in DKA due to the metabolic acidosis. Urine specific gravity is not a specific indicator for DKA and may vary depending on the individual's hydration status. Therefore, the correct lab finding that confirms DKA in this scenario is a blood pH of 7.25.

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