Nursing Elites

1. A nurse is caring for a client with end-stage osteoporosis who is experiencing severe pain and a respiratory rate of 14/min. Which medication should the nurse prioritize?

• A. Promethazine
• B. Hydromorphone
• C. Ketorolac
• D. Amitriptyline

Correct answer: B

Rationale: In this situation, the nurse should prioritize administering Hydromorphone (choice B), an opioid analgesic, to manage the severe pain effectively. Opioids are the first-line treatment for severe pain, especially in end-stage conditions like osteoporosis. Promethazine (choice A) is an antihistamine and antiemetic, not a potent analgesic. Ketorolac (choice C) is a nonsteroidal anti-inflammatory drug (NSAID) that may not provide sufficient pain relief in severe cases. Amitriptyline (choice D) is a tricyclic antidepressant used for neuropathic pain and depression, but it is not the first choice for managing severe pain in this scenario.

2. A client is receiving digoxin therapy. Which of the following should the nurse monitor?

• A. Liver function
• B. Serum electrolytes
• C. Blood pressure
• D. All of the above

Correct answer: D

Rationale: When a client is receiving digoxin therapy, it is crucial for the nurse to monitor liver function, serum electrolytes (especially potassium levels), and blood pressure. Digoxin is known to affect the heart's electrical activity and can lead to toxic effects if not managed properly. Monitoring liver function helps to assess the drug's metabolism and excretion. Checking serum electrolytes, especially potassium, is essential because digoxin toxicity can be exacerbated by electrolyte imbalances, particularly hypokalemia. Monitoring blood pressure is necessary because digoxin can influence cardiac contractility and heart rate, potentially affecting blood pressure. Therefore, monitoring all these parameters is vital to ensure the client's safety and therapeutic effectiveness of digoxin. Choices A, B, and C are incorrect because monitoring only one or two of these parameters may not provide a comprehensive assessment of the client's response to digoxin therapy.

3. A nurse is preparing to administer a dose of ampicillin. Which of the following actions should the nurse take?

• A. Administer it with food
• B. Check for penicillin allergy
• C. Monitor liver function
• D. Administer it intramuscularly

Correct answer: B

Rationale: The correct answer is to 'Check for penicillin allergy.' Before administering ampicillin, it is crucial to assess the patient for any history of penicillin allergy. This is essential to prevent an adverse allergic reaction, as ampicillin belongs to the penicillin class of antibiotics. Administering ampicillin with food (Choice A) is not a standard requirement and does not impact its effectiveness. Monitoring liver function (Choice C) is not directly related to the immediate pre-administration assessment for ampicillin. Administering ampicillin intramuscularly (Choice D) is not typically the route of administration for this antibiotic, as it is usually given intravenously or orally.

4. A nurse is caring for a client in preterm labor who is receiving magnesium sulfate. Which of the following is an indication of magnesium toxicity?

• A. Blood glucose of 160 mg/dL
• B. Urine output of 20 mL/hour
• C. Systolic BP of 140 mm Hg
• D. Respiratory rate of 20/min

Correct answer: B

Rationale: The correct answer is B: Urine output of 20 mL/hour. Urine output below 30 mL/hour is a sign of magnesium toxicity due to the risk of accumulation in the body. Choices A, C, and D are not indicative of magnesium toxicity. Elevated blood glucose, systolic blood pressure, and normal respiratory rate are not specific signs of magnesium toxicity.

5. A nurse is caring for a client who is hyperventilating and has the following ABG results: pH 7.50, PaCO2 29 mm Hg, and HCO3- 25 mEq/L. The nurse should recognize that the client has which of the following acid-base imbalances?

• A. Respiratory acidosis
• B. Respiratory alkalosis
• C. Metabolic acidosis
• D. Metabolic alkalosis

Correct answer: B

Rationale: The correct answer is B: Respiratory alkalosis. In this scenario, the client is hyperventilating, leading to excessive elimination of carbon dioxide. As a result, the PaCO2 decreases, causing a decrease in hydrogen ion concentration and an increase in pH, resulting in respiratory alkalosis. Choice A, Respiratory acidosis, is incorrect because the ABG results show a low PaCO2, not an elevated one. Choices C and D, Metabolic acidosis and Metabolic alkalosis, do not align with the ABG results provided, which point towards a respiratory, not metabolic, imbalance.

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