Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
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.
Show answer and rationale
Correct answer: A — Monitor the client's blood glucose level closely during the perioperative period.
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.
Question 2
A good relationship between a leader and a follower enables the follower to 'manage up.' Which of the following describes the best way for a follower to 'manage up'?
- A. Provide feedback to the unit manager when asked for it.
- B. Assist your manager in capitalizing on his or her strengths and weaknesses.
- C. When working with a manager with poor leadership skills, transferring to a different unit is the best option.
- D. Show respect and appreciation for the manager, even when conversing with coworkers.
Show answer and rationale
Correct answer: B — Assist your manager in capitalizing on his or her strengths and weaknesses.
The best way for a follower to 'manage up' is by assisting the manager in capitalizing on his or her strengths and weaknesses. By doing so, the follower helps build a good working relationship with the manager, fostering mutual growth and development. Choice A is not the best option as it only focuses on providing feedback when asked, which may not necessarily contribute to 'managing up.' Choice C is incorrect because transferring to a different unit should not be the first solution when dealing with a manager with poor leadership skills; instead, efforts should be made to improve the current working relationship. Choice D, while important, focuses more on showing respect and appreciation rather than actively helping the manager improve, which is key to 'managing up.'
Question 3
An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, Nurse Libby prepares to take emergency action to prevent the potential complication of:
- A. Thyroid storm.
- B. Cretinism.
- C. Myxedema coma.
- D. Hashimoto's thyroiditis.
Show answer and rationale
Correct answer: C — Myxedema coma.
The scenario described with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area is indicative of myxedema coma, a severe and life-threatening complication of hypothyroidism. Myxedema coma requires immediate emergency treatment to prevent further deterioration. Choice A, thyroid storm, is a complication of hyperthyroidism characterized by an increase in body temperature, heart rate, and blood pressure. Choice B, cretinism, refers to untreated congenital hypothyroidism leading to mental and physical growth retardation. Choice D, Hashimoto's thyroiditis, is an autoimmune condition leading to hypothyroidism but does not present with the acute, life-threatening symptoms described in the scenario.
Question 4
When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action?
- A. Collection of data
- B. Planning
- C. Analyzing data
- D. Identification
Show answer and rationale
Correct answer: B — Planning
The correct answer is B: Planning. Planning is the stage where individuals evaluate existing routines, analyze data, and consider potential alternatives for better action. During planning, people reflect on past practices, identify strengths and weaknesses, and develop strategies for improvement. Collection of data (A) is essential for informed decision-making but doesn't necessarily involve critical reflection on routines. Analyzing data (C) focuses on interpreting and drawing conclusions from data rather than directly reevaluating routines. Identification (D) involves recognizing issues but doesn't inherently lead to considering better courses of action. Therefore, planning is the most appropriate choice for prompting people to think about improving their routines.
Question 5
Which regulatory body mandates the provision of immunizations, especially for hepatitis B?
- A. American Nurses Association (ANA)
- B. Occupational Safety and Health Administration (OSHA)
- C. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- D. State board of nursing
Show answer and rationale
Correct answer: B — Occupational Safety and Health Administration (OSHA)
The correct answer is B - Occupational Safety and Health Administration (OSHA). OSHA mandates that the hepatitis B vaccine series must be offered to healthcare workers who are not immune to hepatitis. This requirement aims to protect healthcare workers from occupational exposure to bloodborne pathogens, including the hepatitis B virus. The American Nurses Association (ANA) (Choice A) is a professional organization for nurses, not a regulatory body. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (Choice C) focuses on accrediting healthcare organizations for quality and safety, not mandating immunizations. The State board of nursing (Choice D) is responsible for regulating nursing practice within a specific state, not mandating immunizations.