Nursing Elites

1. You are responsible for reviewing the nursing unit's refrigerator. Which of the following drugs, if found inside the fridge, should be removed?

• A. Nadolol (Corgard)
• B. Opened (in-use) Humulin N injection
• C. Urokinase (Kinlytic)
• D. Epoetin alfa IV (Epogen)

Correct answer: A

Rationale: Nadolol (Corgard) should be removed if found inside the fridge because it is supposed to be stored at room temperature between 59 to 86 �F (15 and 30 �C) away from heat, moisture, and light. Storing it in the refrigerator can alter its effectiveness and stability. Option B, the opened Humulin N injection, should not be stored in the refrigerator as it is an in-use product and can remain at room temperature for a certain period as per manufacturer guidelines. Option C, Urokinase (Kinlytic), and Option D, Epoetin alfa IV (Epogen), do not require refrigeration and can be stored at room temperature. Therefore, Nadolol (Corgard) is the drug that should be removed from the fridge.

2. An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

• A. Arrange for a friend to administer the medication on schedule.
• B. Give the patient written instructions about how to take the medications.
• C. Teach the patient about the high risk for infecting others unless treatment is followed.
• D. Arrange for a daily noon meal at a community center where the drug will be administered

Correct answer: D

Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen for a homeless patient with active tuberculosis. By arranging a daily noon meal at a community center where the drug will be administered, the nurse ensures that the patient is available to receive the medication and can directly observe the patient taking it. This method helps address the challenges faced by homeless individuals, such as lack of a stable living situation. The other options, such as having a friend administer the medication, giving written instructions, or educating about infecting others, may not be as effective in ensuring adherence, especially in the case of a homeless individual with alcoholism.

3. A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider?

• A. Blood pressure 94/60 mm Hg
• B. Heart rate 76 bpm
• C. Urine output 50 ml/hour
• D. Respiratory rate 16 bpm

Correct answer: A

Rationale: The correct answer is 'Blood pressure 94/60 mm Hg.' Both digoxin and metoprolol decrease the heart rate. Metoprolol specifically affects blood pressure. Therefore, the heart rate and blood pressure need to be within normal range (HR 60-100 bpm; systolic BP above 100 mm Hg) to safely administer both medications. A blood pressure of 94/60 mm Hg indicates hypotension, which could be exacerbated by metoprolol, necessitating immediate reporting to the healthcare provider. Choices B, C, and D are within normal limits and do not pose immediate risks related to the administration of these medications.

4. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6�F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first?

• A. Codeine
• B. Guaifenesin (Robitussin)
• C. Acetaminophen (Tylenol)
• D. Piperacillin/tazobactam (Zosyn)

Correct answer: D

Rationale: The correct answer is Piperacillin/tazobactam (Zosyn). Early initiation of antibiotic therapy is crucial in cases of community-acquired pneumococcal pneumonia to reduce mortality. While providing symptomatic relief with medications like Codeine for cough, Guaifenesin for mucus clearance, and Acetaminophen for fever and pain is important, the priority should be to start antibiotic therapy to target the underlying infection. Piperacillin/tazobactam is an appropriate choice for treating severe community-acquired pneumonia caused by pneumococcal organisms.

5. The nurse is caring for a 10-year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is:

• A. Urinary output of 30 ml per hour
• B. No complaints of thirst
• C. Increased hematocrit
• D. Good skin turgor around burn

Correct answer: A

Rationale: For a child of this age, this is adequate output, yet does not suggest overload. Disruption of sodium-ATPase activity presumably causes an intracellular sodium shift which contributes to hypovolemia and cellular edema. Heat injury also initiates the release of inflammatory and vasoactive mediators. These mediators are responsible for local vasoconstriction, systemic vasodilation, and increased transcapillary permeability. Increase in transcapillary permeability results in a rapid transfer of water, inorganic solutes, and plasma proteins between the intravascular and interstitial spaces.

Similar Questions