Nursing Elites

1. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patient’s electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL per hour. Which action is necessary prior to administering this fluid?

• A. Evaluate the patient’s urine output.
• B. Contact the provider to order arterial blood gases.
• C. Request an order for an initial potassium bolus.
• D. Suggest a diet low in sodium and potassium.

Correct answer: A

Rationale: Prior to administering IV fluids containing potassium, it is crucial to evaluate the patient's urine output. If the urine output is less than 25 mL/hr or 600 mL/day, there is a risk of potassium accumulation. Patients with low urine output should not receive IV potassium to prevent potential complications. Contacting the provider for arterial blood gases is unnecessary in this scenario as it does not directly relate to the administration of IV fluids with potassium. Administering potassium as a bolus is not recommended due to potential adverse effects. While dietary considerations are important, suggesting a low-sodium and low-potassium diet is not the immediate action required before administering IV fluids with potassium chloride.

2. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient’s provider to order

• A. a broad-spectrum antibiotic.
• B. a narrow-spectrum antibiotic.
• C. multiple antibiotics.
• D. the pneumococcal vaccine.

Correct answer: A

Rationale: In this scenario where the offending organism causing pneumonia is unknown due to the inability to produce sputum for culture, the appropriate choice is a broad-spectrum antibiotic. Broad-spectrum antibiotics are effective against a wide range of bacteria and are commonly used when the specific pathogen is unidentified. Narrow-spectrum antibiotics target specific types of bacteria and are chosen based on culture and sensitivity results. Using multiple antibiotics without a clear indication from culture and sensitivity testing can lead to antibiotic resistance and is not recommended in this situation. Additionally, the pneumococcal vaccine is preventive and does not treat an ongoing infection like pneumonia.

3. A client is vomiting. For which acid-base imbalance does the nurse assess the client?

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

Correct answer: B

Rationale: In a client who is vomiting, the loss of gastric fluid containing hydrochloric acid can lead to metabolic alkalosis. Metabolic alkalosis is caused by the loss of acids such as hydrochloric acid from the body. Therefore, in this scenario, the nurse should assess the client for metabolic alkalosis. Choices A, C, and D are incorrect because vomiting does not typically lead to metabolic acidosis, respiratory acidosis, or respiratory alkalosis.

4. The client with deep vein thrombosis (DVT) in the left lower leg is receiving heparin therapy. Which of the following assessments is the most important for the nurse to perform?

• A. Measure the circumference of the left leg.
• B. Assess for signs of bleeding, such as bruising or hematuria.
• C. Monitor the client's vital signs.
• D. Monitor the client's respiratory status.

Correct answer: B

Rationale: The most important assessment for a client with DVT on heparin therapy is to monitor for signs of bleeding, such as bruising or hematuria. Heparin is an anticoagulant medication that can increase the risk of bleeding. Assessing for bleeding is crucial to prevent complications like hemorrhage. Measuring the circumference of the leg may be relevant for assessing for edema but is not as critical as monitoring for bleeding. Monitoring vital signs and respiratory status are important aspects of care but are not the priority when the client is on heparin therapy for DVT.

5. A patient is diagnosed with Mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Erythromycin (E-Mycin)
• D. Fidaxomicin (Dificid)

Correct answer: C

Rationale: Erythromycin is the drug of choice for treating Mycoplasma pneumonia. Mycoplasma pneumonia is typically sensitive to macrolide antibiotics, with erythromycin being one of the first-line agents. Azithromycin and clarithromycin are also effective in treating Mycoplasma pneumonia, but erythromycin is specifically mentioned as the drug of choice in this context. Fidaxomicin, on the other hand, is not indicated for the treatment of Mycoplasma pneumonia and is primarily used to treat Clostridium difficile infections.

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