Nursing Elites

1. Why is the combination drug trimethoprim-sulfamethoxazole (TMP-SMX) necessary?

• A. To broaden the antibacterial spectrum.
• B. To decrease bacterial resistance.
• C. To improve the taste.
• D. To minimize toxic effects.

Correct answer: B

Rationale: The correct answer is B: To decrease bacterial resistance. Trimethoprim-sulfamethoxazole (TMP-SMX) is a combination drug used to prevent bacterial resistance to sulfonamides. It works by targeting different steps in the bacterial metabolic pathway, making it harder for bacteria to develop resistance. Choice A is incorrect because the combination does not broaden the antibacterial spectrum; instead, it enhances effectiveness against specific bacteria. Choice C is incorrect as taste improvement is not the primary reason for combining these drugs. Choice D is incorrect because while combination therapy can sometimes help minimize toxic effects, the primary purpose in this case is to address bacterial resistance.

2. A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement?

• A. Administer 20 mEq of potassium chloride.
• B. Initiate continuous cardiac monitoring.
• C. Arrange a consultation with the dietitian.
• D. Educate about the side effects of diuretics.

Correct answer: B

Rationale: Hypokalemia, defined as a serum potassium level below the normal range of 3.5 to 5 mEq/L, can lead to changes in myocardial irritability and ECG waveform, potentially causing life-threatening dysrhythmias. Therefore, the priority action for the nurse is to initiate continuous cardiac monitoring to promptly detect any abnormal heart rhythms or ventricular ectopy. This monitoring is crucial for assessing the impact of potassium replacement therapy on the cardiac rhythm and ensuring the safety of the client. While administering potassium chloride is important for correcting the hypokalemia, it should occur after cardiac monitoring is in place. Consulting with a dietitian and educating about diuretic side effects are relevant aspects of care but are not the immediate priority in this situation where cardiac monitoring takes precedence for timely intervention.

3. A client with histoplasmosis has the following arterial blood gas (ABG) results: pH 7.30, PCO2 58 mm Hg, PO2 75 mm Hg, HCO3 27 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

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

Correct answer: A

Rationale: The client's ABG results show a low pH (acidosis) and an elevated PCO2, indicating respiratory acidosis. In respiratory acidosis, there is inadequate excretion of CO2, leading to increased PCO2 levels and a decrease in pH. Therefore, the correct answer is 'Metabolic acidosis'. Choices B, C, and D are incorrect. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. Respiratory acidosis involves low pH and high PCO2 levels, as seen in this case. Respiratory alkalosis is associated with high pH and low PCO2 levels.

4. The patient is receiving acetazolamide (Diamox) for metabolic alkalosis and fluid overload. After taking the medication, the patient complains of right-sided flank pain. The nurse suspects that the patient has developed which condition?

• A. Gout
• B. Hemolytic anemia
• C. Metabolic acidosis
• D. Renal calculi

Correct answer: D

Rationale: The correct answer is D: Renal calculi. Acetazolamide, a carbonic anhydrase inhibitor, can lead to electrolyte imbalances and the formation of renal calculi. Right-sided flank pain is a classic symptom of renal calculi. Choices A, B, and C are incorrect. Gout is not typically associated with acetazolamide use. Hemolytic anemia and metabolic acidosis are not commonly linked to acetazolamide-induced side effects. Therefore, the patient's symptoms align more closely with the development of renal calculi.

5. A client who is scheduled for cardiac catheterization to rule out coronary occlusion should be informed by the nurse that:

• A. The procedure is performed in a darkened room in the radiology department
• B. It is necessary to lie quietly on a hard x-ray table for about 4 hours
• C. The room is bright and well lit, and it is best to keep the eyes closed
• D. The client may have feelings of warmth or flushing during the procedure

Correct answer: D

Rationale: Before cardiac catheterization, the nurse should inform the client that the procedure is performed in a darkened room in the radiology department, not the operating room. The client should expect to lie still on an x-ray table for the duration of the procedure, not necessarily for about 4 hours. Keeping the eyes closed is not necessary as the room is usually dimly lit. The client may experience sensations of warmth or flushing during the procedure due to catheter passage and dye injection, making choice D the correct answer.

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