Nursing Elites

1. A healthcare professional is preparing to administer the initial dose of ceftriaxone to a client who has endometritis. Which of the following statements by the client should cause the healthcare professional to hold the medication and consult the provider?

• A. I have a severe allergy to amoxicillin
• B. I get sick when I take diuretics
• C. I have a history of hearing problems
• D. I take prednisone for my asthma

Correct answer: A

Rationale: A severe allergy to amoxicillin could indicate a potential cross-reactivity with ceftriaxone, so the medication should be held. Cross-reactivity between penicillins (like amoxicillin) and cephalosporins (like ceftriaxone) is a known concern due to their similar chemical structures. Choices B, C, and D do not directly contraindicate the administration of ceftriaxone for endometritis.

2. How should a healthcare professional respond to a patient experiencing hypoglycemia?

• A. Rechecking the blood glucose level in 15 minutes
• B. Encouraging the patient to eat a high-protein snack
• C. Administering 15g of fast-acting carbohydrates
• D. Administering glucagon if the patient is unconscious

Correct answer: C

Rationale: The correct response to a patient experiencing hypoglycemia is to administer 15g of fast-acting carbohydrates. This helps quickly increase the blood glucose levels in the patient, addressing the low blood sugar. Rechecking the blood glucose level in 15 minutes (Choice A) may delay necessary intervention, encouraging a high-protein snack (Choice B) is not recommended as it does not rapidly increase blood sugar levels, and administering glucagon if the patient is unconscious (Choice D) is typically done in severe cases of hypoglycemia when the patient is unable to eat or drink.

3. A nurse is preparing to administer a high dose of morphine to a patient with terminal cancer. What is the nurse's primary consideration before administration?

• A. Ensure the family is aware of the dosage to be administered.
• B. Monitor the patient for respiratory depression.
• C. Administer the morphine in divided doses.
• D. Delay administration until the next assessment.

Correct answer: B

Rationale: The correct answer is B: Monitor the patient for respiratory depression. When administering a high dose of morphine, the nurse's primary consideration should be to monitor the patient for respiratory depression, as morphine can slow down breathing, especially in higher doses. Option A is incorrect because the primary focus should be on the patient's well-being and safety rather than family awareness at this point. Option C is not the best approach as the immediate concern is monitoring the patient closely for any adverse effects. Option D is not advisable as delaying administration without a valid reason can compromise pain management in a terminal cancer patient.

4. A nurse is evaluating care of an immobilized patient. Which action will the nurse take?

• A. Involve primarily the patient's family and healthcare team to determine goal achievement.
• B. Focus on whether the interdisciplinary team is satisfied with the care.
• C. Use objective data solely to determine whether interventions have been successful.
• D. Compare the patient's actual outcomes with the outcomes in the care plan.

Correct answer: D

Rationale: The correct answer is D because comparing the patient's actual outcomes with the outcomes in the care plan is essential in evaluating the effectiveness of care provided to an immobilized patient. This comparison helps in identifying any disparities between the planned care and the actual care received, allowing the nurse to make necessary adjustments to improve patient outcomes. Choices A, B, and C are incorrect because while involving the patient's family and healthcare team, ensuring interdisciplinary team satisfaction, and using objective data are important aspects of patient care, they do not directly address the specific action needed to evaluate care for an immobilized patient.

5. Which intervention is essential when caring for a patient with a nasogastric (NG) tube?

• A. Suction the NG tube every 4 hours.
• B. Check the placement of the NG tube before each feeding.
• C. Flush the NG tube with water before and after each medication administration.
• D. Remove the NG tube once the patient feels comfortable.

Correct answer: B

Rationale: Checking the placement of the NG tube before each feeding is crucial to ensure it is correctly positioned and safe to use. Option A is incorrect as routine suctioning can lead to complications and should only be done as needed. Option C is not necessary unless there are specific instructions for flushing. Option D is incorrect as the NG tube should only be removed by healthcare professionals based on medical criteria, not solely based on the patient's comfort.

Similar Questions