Nursing Elites

1. An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer?

• A. Corticosteroids
• B. Gamma globulin
• C. Hepatitis B vaccine
• D. Fresh frozen plasma

Correct answer: B

Rationale: In this scenario, the immediate need is to provide passive immunity to the adolescent patient. Gamma globulin contains antibodies against hepatitis B, which can offer immediate protection. The hepatitis B vaccine provides active immunity over time but is not immediate. Fresh frozen plasma and corticosteroids are not indicated for immediate protection against hepatitis B infection. Therefore, the correct choice is Gamma globulin as it can provide immediate passive immunity against hepatitis B.

2. A patient with type 1 diabetes is prescribed insulin glargine. What is the primary characteristic of this insulin?

• A. Rapid-acting
• B. Intermediate-acting
• C. Long-acting
• D. Short-acting

Correct answer: C

Rationale: Insulin glargine is classified as a long-acting insulin. It is designed to provide a consistent level of insulin over approximately 24 hours, helping to keep blood glucose levels stable throughout the day. This long duration of action makes it suitable for basal insulin replacement in patients with type 1 diabetes, providing a background level of insulin to mimic the body's natural release of insulin between meals and overnight.

3. A client with a history of chronic alcohol use is admitted with confusion and an unsteady gait. Which deficiency should the nurse suspect?

• A. Thiamine (Vitamin B1)
• B. Cyanocobalamin (Vitamin B12)
• C. Folic acid
• D. Vitamin D

Correct answer: A

Rationale: The correct answer is Thiamine (Vitamin B1). Chronic alcohol use can lead to thiamine deficiency, which can result in neurological symptoms such as confusion and an unsteady gait. Thiamine is essential for proper brain function and nerve conduction, and its deficiency is common in individuals with alcohol use disorder. Cyanocobalamin (Vitamin B12) deficiency can also present with neurological symptoms, but in this case, the patient's history of chronic alcohol use points more towards thiamine deficiency. Folic acid deficiency typically presents with symptoms like fatigue and megaloblastic anemia. Vitamin D deficiency is associated with bone health issues rather than neurological symptoms.

4. A client from a nursing home is admitted with urinary sepsis and has a single-lumen, peripherally-inserted central catheter (PICC). Four medications are prescribed for 9:00 a.m. and the nurse is running behind schedule. Which medication should the nurse administer first?

• A. Piperacillin/tazobactam (Zosyn) in 100 ml D5W, IV over 30 minutes q8 hours.
• B. Vancomycin (Vancocin) 1 gm in 250 ml D5W, IV over 90 minutes q12 hours.
• C. Pantoprazole (Protonix) 40 mg PO daily.
• D. Enoxaparin (Lovenox) 40 mg subq q24 hours.

Correct answer: A

Rationale: In a patient with urinary sepsis, administering Piperacillin/tazobactam first is crucial as it is an antibiotic that directly targets the infection. Addressing the infection promptly is essential to prevent its progression and complications. Vancomycin, Pantoprazole, and Enoxaparin are important medications for the patient's overall treatment plan, but in this scenario, the antibiotic should take precedence due to the urgency of managing the sepsis.

5. What should be monitored to evaluate the effectiveness of enoxaparin in a patient with deep vein thrombosis (DVT)?

• A. Prothrombin time (PT)
• B. Partial thromboplastin time (PTT)
• C. International normalized ratio (INR)
• D. Platelet count

Correct answer: C

Rationale: The international normalized ratio (INR) is the appropriate parameter to monitor the effectiveness of enoxaparin in preventing clot formation in patients with deep vein thrombosis (DVT). INR reflects the clotting ability of the blood and is commonly used to assess the therapeutic range of anticoagulant medications, such as enoxaparin, which is crucial in managing and preventing thrombotic events like DVT.

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