Nursing Elites

1. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?

• A. Administer the drug and observe closely for hypersensitivity reactions.
• B. Ask the provider whether a cephalosporin from a different generation may be used.
• C. Contact the provider to report drug hypersensitivity.
• D. Notify the provider and suggest an oral cephalosporin.

Correct answer: A

Rationale: When a patient has a history of a rash with amoxicillin, a beta-lactam antibiotic like ceftriaxone should be administered cautiously due to a possible cross-reactivity. The nurse should still administer the drug but closely monitor the patient for any signs of hypersensitivity reactions. Asking for a different generation of cephalosporin or suggesting an oral form does not address the potential cross-reactivity issue. Contacting the provider to report drug hypersensitivity would delay care when the patient needs immediate treatment.

2. Prior to a percutaneous kidney biopsy, which actions should a nurse take? (Select all that apply.)

• A. Keep the client NPO for 4 to 6 hours.
• B. Obtain coagulation study results.
• C. Maintain strict bedrest in a supine position.
• D. A & B

Correct answer: D

Rationale: Prior to a percutaneous kidney biopsy, the nurse should ensure that the client is kept NPO for 4 to 6 hours to prevent aspiration during the procedure. Obtaining coagulation study results is crucial to assess the risk of bleeding during and after the biopsy. Strict bedrest in a supine position is not necessary before the procedure. It is important to note that blood pressure medications should be carefully managed, but it is not a pre-procedure action. Keeping the client on bedrest or assessing for blood in the urine are interventions that are more relevant post-procedure to monitor for complications.

3. Which of the following is an expected finding in a patient with hypothyroidism?

• A. Weight gain.
• B. Weight loss.
• C. Increased appetite.
• D. Diarrhea.

Correct answer: A

Rationale: Weight gain is an expected finding in hypothyroidism due to the decreased metabolic rate. Hypothyroidism leads to a slowing down of bodily functions, including metabolism, which can result in weight gain. Weight loss (Choice B) is more commonly associated with hyperthyroidism where there is an increase in metabolic rate. Increased appetite (Choice C) is also more typical of hyperthyroidism as the body is burning energy at a faster rate. Diarrhea (Choice D) is not a typical symptom of hypothyroidism; instead, constipation is more often observed due to the slowing down of the digestive system.

4. Which of the following is a common complication of hypertension?

• A. Diabetes.
• B. Heart failure.
• C. Kidney failure.
• D. Stroke.

Correct answer: D

Rationale: The correct answer is D: Stroke. Hypertension can lead to stroke due to the increased pressure on blood vessels in the brain, which can result in reduced blood flow and oxygen to the brain tissue. While choices B (Heart failure) and C (Kidney failure) can be complications of hypertension, they are not as directly associated as stroke. Choice A, Diabetes, is not a direct complication of hypertension but rather a separate condition that can be influenced by various factors. However, stroke is more commonly linked to the increased pressure on blood vessels in the brain in individuals with hypertension.

5. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient’s face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?

• A. Request an order for IV epinephrine to treat anaphylactic shock.
• B. Slow the infusion to 10 mg/min and observe the patient closely.
• C. Stop the infusion and obtain an order for a BUN and serum creatinine.
• D. Suspect Stevens-Johnson syndrome and notify the provider immediately.

Correct answer: B

Rationale: When vancomycin is infused too rapidly, “red man” syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

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