Nursing Elites

1. The healthcare professional is reviewing a patient’s chart prior to administering gentamicin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the healthcare professional take?

• A. Administer the next dose as prescribed.
• B. Obtain repeat peak and trough levels before administering the next dose.
• C. Report potential drug toxicity to the patient’s healthcare provider.
• D. Notify the patient’s healthcare provider of decreased drug therapeutic level.

Correct answer: C

Rationale: Gentamicin peak levels should ideally be between 5 to 8 mcg/mL, and trough levels should be within the range of 0.5 to 2 mcg/mL to ensure therapeutic efficacy while minimizing toxicity risk. In this case, the patient's peak level is above the recommended range, and the trough level is at the higher end, indicating potential drug toxicity. Therefore, the correct action for the healthcare professional is to report the possibility of drug toxicity to the patient’s healthcare provider. Administering the next dose as prescribed (Choice A) would exacerbate the toxicity risk. Obtaining repeat peak and trough levels (Choice B) may confirm the current levels but does not address the immediate concern of potential toxicity. Reporting a decreased drug therapeutic level (Choice D) is not the priority in this scenario, as the focus should be on addressing the potential toxicity issue.

2. Which of the following is the best indicator of long-term glycemic control in a patient with diabetes?

• A. Fasting blood glucose levels.
• B. Postprandial blood glucose levels.
• C. Hemoglobin A1c.
• D. Random blood glucose levels.

Correct answer: C

Rationale: The correct answer is C, Hemoglobin A1c. Hemoglobin A1c measures the average blood glucose level over the past 2-3 months, providing a reliable indicator of long-term glycemic control. Fasting blood glucose levels (choice A) only offer a snapshot of the current glucose level and can fluctuate throughout the day. Postprandial blood glucose levels (choice B) reflect glucose levels after meals but do not give a comprehensive view of long-term control. Random blood glucose levels (choice D) are taken at any time and lack the consistency needed to assess long-term glycemic control effectively. Therefore, Hemoglobin A1c is the superior choice for monitoring and managing diabetes over an extended period.

3. The healthcare provider provides dietary instructions about iron-rich food to a client with iron deficiency anemia. Which food selection made by the client indicates a need for additional instructions?

• A. Liver
• B. Kidney beans
• C. Oranges
• D. Leafy green vegetables

Correct answer: C

Rationale: Oranges are not a good source of iron, so selecting oranges indicates a need for additional instructions. Oranges are high in vitamin C, which can enhance iron absorption from other sources, but they are not rich in iron themselves. Liver, kidney beans, and leafy green vegetables are good sources of iron and would be beneficial for a client with iron deficiency anemia. Therefore, the correct answer is C.

4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to

• A. acquired bacterial resistance.
• B. cross-resistance.
• C. inherent bacterial resistance.
• D. transferred resistance.

Correct answer: A

Rationale: The correct answer is A: acquired bacterial resistance. Acquired resistance happens when an organism has been exposed to the antibacterial drug, making it less effective over time. Cross-resistance (B) occurs when resistance to one drug leads to resistance to another. Inherent resistance (C) happens without prior exposure to the drug, meaning the bacteria are naturally resistant. Transferred resistance (D) involves the transfer of resistant genes from one organism to another, contributing to resistance development.

5. A client has just been scheduled for endoscopic retrograde cholangiopancreatography (ERCP). What should the nurse tell the client about the procedure? Select all that apply.

• A. That informed consent is required
• B. That the test takes about 1 hour to complete
• C. That premedication for sedation may be necessary
• D. That food and fluids will be withheld before the procedure

Correct answer: B

Rationale: The correct answer is that the ERCP procedure takes about 1 hour to complete. Informed consent is required before the procedure. Premedication for sedation may be necessary as sedation is commonly used during ERCP to keep the client comfortable. Food and fluids are withheld before the procedure to prevent aspiration and ensure a clear view during the procedure. Position changes may be necessary to facilitate the passage of the tube.

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