Nursing Elites

1. A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include that a severe allergy to which of the following medications is a contraindication to ceftriaxone?

• A. Gentamicin
• B. Clindamycin
• C. Piperacillin
• D. Sulfamethoxazole-trimethoprim

Correct answer: C

Rationale: The correct answer is C. Ceftriaxone, a cephalosporin antibiotic, has a cross-sensitivity with penicillin antibiotics like piperacillin. Therefore, a severe allergy to penicillin or penicillin-related antibiotics would be a contraindication to ceftriaxone. Choices A, B, and D are incorrect because they are not associated with a known cross-sensitivity with ceftriaxone.

2. A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects?

• A. Increases blood pressure
• B. Prevents esophageal bleeding
• C. Decreases heart rate
• D. Reduces ammonia levels

Correct answer: D

Rationale: The correct answer is D: Reduces ammonia levels. Lactulose is used to reduce blood ammonia levels in clients with hepatic encephalopathy. Options A, B, and C are incorrect because lactulose does not have the therapeutic effect of increasing blood pressure, preventing esophageal bleeding, or decreasing heart rate.

3. A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication?

• A. Hyperthyroidism
• B. Intestinal obstruction
• C. Glaucoma
• D. Low blood pressure

Correct answer: B

Rationale: The correct answer is B: Intestinal obstruction. Metoclopramide is contraindicated in clients with intestinal obstruction due to its prokinetic effects, which could exacerbate the condition. Choices A, C, and D are incorrect because metoclopramide is not contraindicated in hyperthyroidism, glaucoma, or low blood pressure. Hyperthyroidism, glaucoma, and low blood pressure are not specific contraindications for metoclopramide use, and this medication is commonly prescribed for conditions like gastroesophageal reflux disease and diabetic gastroparesis.

4. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose? (Round to the nearest tenth)

• A. 2.6 mL
• B. 2.63 mL
• C. 2.7 mL
• D. 2.2 mL

Correct answer: A

Rationale: To find the dose per administration, first convert the toddler's weight to kg: 28.6 lb ÷ 2.2 = 13 kg. Then calculate the total daily dose: 20 mg/kg × 13 kg = 260 mg/day. Since it is divided into two doses, each dose is 130 mg. The concentration of the oral suspension is 250 mg/5 mL = 50 mg/mL. Therefore, to find the volume needed per dose, divide the dose by the concentration: 130 mg ÷ 50 mg/mL = 2.6 mL per dose. Hence, the nurse should administer 2.6 mL per dose. Choices B, C, and D are incorrect as they do not accurately calculate the dosage of chlorothiazide needed per dose based on the toddler's weight and the concentration of the oral suspension.

5. A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching?

• A. If the phenazopyridine upsets my stomach, I can take it with meals.
• B. The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the infection.
• C. I need to drink 2 liters of fluid per day while I am taking the ciprofloxacin.
• D. I should notify my provider immediately if my urine turns an orange color.

Correct answer: D

Rationale: Phenazopyridine can turn the urine orange, which is a normal side effect and not a cause for alarm. The client's statement about notifying the provider immediately if their urine turns orange indicates a need for further teaching because it shows a misunderstanding of the medication's side effects. Choices A, B, and C demonstrate a good understanding of the prescribed medications and their effects, indicating the client has grasped the teaching provided on those aspects.

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