Nursing Elites

1. An older adult client is admitted with pneumonia and prescribed penicillin G potassium. Which factor increases the risk of an adverse reaction?

• A. Sputum culture showing Streptococcus pneumoniae.
• B. Previous treatment with penicillin.
• C. Daily use of spironolactone for hypertension.
• D. Documented allergy to sulfa drugs.

Correct answer: C

Rationale: The correct answer is C. Daily use of spironolactone for hypertension can increase the risk of hyperkalemia and interact with penicillin, leading to adverse reactions. Choice A is incorrect because the sputum culture showing Streptococcus pneumoniae is an expected finding in a patient with pneumonia and does not increase the risk of an adverse reaction to penicillin. Choice B is incorrect as previous treatment with penicillin does not necessarily increase the risk of an adverse reaction to penicillin if there was no history of allergic reactions. Choice D is also incorrect as a documented allergy to sulfa drugs does not directly increase the risk of an adverse reaction to penicillin.

2. A client who has been prescribed multiple antihypertensive medications experiences syncope and has a blood pressure of 70/40. What is the rationale for the nurse to hold the next scheduled antihypertensive dose?

• A. Increased urinary clearance of the medications has produced diuresis, lowering the blood pressure.
• B. The antagonistic interaction of the medications has reduced their effectiveness.
• C. The synergistic effect of the medications has resulted in drug toxicity, causing hypotension.
• D. The additive effect of the medications has lowered the blood pressure too much.

Correct answer: D

Rationale: The additive effect of multiple antihypertensive medications can cause hypotension, leading to dangerously low blood pressure. In this scenario, the client experiencing syncope with a blood pressure of 70/40 indicates severe hypotension, likely due to the combined action of the antihypertensive medications. Holding the next scheduled dose is essential to prevent further lowering of blood pressure and potential complications. Choices A, B, and C provide inaccurate explanations and do not align with the client's presentation and the need to manage hypotension caused by the additive effect of the medications.

3. During a thyroid storm, what is the nurse's priority intervention for a client experiencing increased heart rate and tremors?

• A. Administer antithyroid medications as prescribed.
• B. Administer a beta-blocker to control the heart rate.
• C. Monitor the client's temperature closely.
• D. Prepare the client for an emergency thyroidectomy.

Correct answer: A

Rationale: The correct answer is to administer antithyroid medications as prescribed during a thyroid storm. Antithyroid medications help control the overproduction of thyroid hormones, which is crucial in managing symptoms such as increased heart rate and tremors. These symptoms can be life-threatening if not promptly addressed. Administering a beta-blocker (Choice B) may help control the heart rate, but addressing the underlying cause with antithyroid medications is the priority. Monitoring the client's temperature (Choice C) is important but not the priority intervention during a thyroid storm. Lastly, preparing the client for an emergency thyroidectomy (Choice D) is not the initial intervention for managing symptoms of a thyroid storm.

4. A client with hypoglycemia is unresponsive. What is the nurse's priority action?

• A. Administer intravenous dextrose.
• B. Check the client's blood glucose level.
• C. Administer glucagon intramuscularly.
• D. Prepare to administer oral glucose.

Correct answer: C

Rationale: The correct answer is to administer glucagon intramuscularly. In an unresponsive hypoglycemic client, administering glucagon intramuscularly is the priority action as it helps raise blood glucose levels quickly. Intravenous dextrose may be challenging to administer in an unresponsive client. Checking the client's blood glucose level is important but not the priority when the client is unresponsive. Preparing to administer oral glucose is not ideal for an unresponsive client as they may not be able to swallow.

5. A 4-year-old child is returned to the room following a tonsillectomy and adenoidectomy. Which of the following assessments would require the nurse's immediate attention?

• A. Frequent swallowing
• B. Coughing
• C. Slow breathing
• D. Tachycardia

Correct answer: A

Rationale: In a post-tonsillectomy and adenoidectomy patient, frequent swallowing is a crucial assessment that requires immediate attention by the nurse. Frequent swallowing can indicate bleeding, a complication that needs urgent intervention. Coughing may be expected due to irritation from the surgery but is not as concerning as potential bleeding. Slow breathing and tachycardia are not typically immediate concerns following this type of surgery.

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