Nursing Elites

1. A client with a severe urinary tract infection (UTI) asks why both ciprofloxacin and phenazopyridine are needed. Which of the following responses should the nurse make?

• A. Phenazopyridine decreases adverse effects of ciprofloxacin.
• B. Combining phenazopyridine with ciprofloxacin shortens the course of therapy.
• C. The use of phenazopyridine allows for a lower dosage of ciprofloxacin.
• D. Ciprofloxacin treats the infection, and phenazopyridine treats pain.

Correct answer: D

Rationale: Ciprofloxacin is an antibiotic that treats the infection, while phenazopyridine is a urinary analgesic that relieves pain. Choice A is incorrect because phenazopyridine does not decrease adverse effects of ciprofloxacin; it primarily addresses pain. Choice B is incorrect because combining phenazopyridine with ciprofloxacin does not shorten the course of therapy; they serve different purposes. Choice C is incorrect because the use of phenazopyridine does not allow for a lower dosage of ciprofloxacin; they have independent roles in UTI management.

2. A client with a seizure disorder has a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply)

• A. PTT
• B. Aspartate aminotransferase (AST)
• C. Alanine aminotransferase (ALT)
• D. All of the Above

Correct answer: D

Rationale: The correct answer is D, 'All of the Above.' Valproic acid can impact liver function and coagulation. Monitoring the Prothrombin Time (PTT), Aspartate Aminotransferase (AST), and Alanine Aminotransferase (ALT) is crucial. PTT is monitored to assess coagulation status, while AST and ALT are liver enzymes that indicate liver function. Monitoring these values helps detect any potential adverse effects of valproic acid on the liver and blood clotting. Choices A, B, and C are incorrect because each of these laboratory values plays a critical role in evaluating the client's response to valproic acid therapy and detecting associated complications.

3. A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication?

• A. Hearing examination
• B. Glucose tolerance test
• C. Electrocardiogram
• D. Pulmonary function tests

Correct answer: C

Rationale: The correct answer is C: Electrocardiogram. Amitriptyline can cause cardiac arrhythmias, so an electrocardiogram is necessary before starting treatment. A hearing examination (choice A) is not required before initiating amitriptyline. A glucose tolerance test (choice B) is not indicated for starting this medication. Pulmonary function tests (choice D) are not necessary before initiating amitriptyline for depression.

4. A nurse is preparing to administer lactated Ringer's (LR) 1,000 mL IV to infuse over 8 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number).

• A. 21 gtt/min
• B. 20 gtt/min
• C. 25 gtt/min
• D. 18 gtt/min

Correct answer: A

Rationale: To calculate the IV infusion rate in gtt/min: 1000 mL / 480 min × 10 gtt/mL = 20.83 ≈ 21 gtt/min. Therefore, the correct answer is A. Choice B (20 gtt/min) is incorrect because the calculation results in 20.83 gtt/min, rounded to 21. Choices C (25 gtt/min) and D (18 gtt/min) are incorrect as they are not the closest whole number approximation to the calculated value.

5. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose? (Round to the nearest tenth)

• A. 2.6 mL
• B. 2.63 mL
• C. 2.7 mL
• D. 2.2 mL

Correct answer: A

Rationale: To find the dose per administration, first convert the toddler's weight to kg: 28.6 lb ÷ 2.2 = 13 kg. Then calculate the total daily dose: 20 mg/kg × 13 kg = 260 mg/day. Since it is divided into two doses, each dose is 130 mg. The concentration of the oral suspension is 250 mg/5 mL = 50 mg/mL. Therefore, to find the volume needed per dose, divide the dose by the concentration: 130 mg ÷ 50 mg/mL = 2.6 mL per dose. Hence, the nurse should administer 2.6 mL per dose. Choices B, C, and D are incorrect as they do not accurately calculate the dosage of chlorothiazide needed per dose based on the toddler's weight and the concentration of the oral suspension.

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