Nursing Elites

1. What effect can medication bound to protein have?

• A. reduced drug availability
• B. limited distribution of the drug to receptor sites
• C. less availability to produce desired medicinal effects
• D. decreased metabolism of the drug by the liver

Correct answer: C

Rationale: Medication bound to protein leads to less availability to produce desired medicinal effects because only unbound drugs can interact with active receptor sites. If a drug is bound to protein, it cannot bind with a receptor site, reducing its effectiveness. Choice A is incorrect because binding to protein reduces drug availability. Choice B is incorrect because distribution to receptor sites is ineffective if the drug is bound to protein. Choice D is incorrect because metabolism does not occur until the drug is removed from the protein molecule by the liver, allowing the protein to return to circulation.

2. Immediately after delivery, the nurse assesses the woman's uterine fundus. At what location does the nurse expect to be able to palpate the fundus?

• A. At the level of the umbilicus
• B. Two centimeters above the umbilicus
• C. Midway between the symphysis pubis and umbilicus
• D. In the pelvic cavity

Correct answer: C

Rationale: The correct answer is midway between the symphysis pubis and the umbilicus. Immediately after delivery, the uterus is about the size of a large grapefruit or softball. The fundus can be palpated at this location but then rises to a level just above the umbilicus before sinking to the level of the umbilicus, where it remains for about 24 hours. After 24 hours, the fundus starts descending gradually. By the 10th to 14th day, the fundus is in the pelvic cavity and cannot be palpated abdominally. Choices A and B are incorrect as the fundus is not initially at the level of the umbilicus or 2 centimeters above it. Choice D is also incorrect as the fundus does not remain in the pelvic cavity immediately after delivery.

3. A nurse assisting with data collection plans to perform the Romberg test. After describing the test to the client, the nurse tells the client that it will help reveal which disorder?

• A. Loss of hearing acuity
• B. A problem with balance
• C. A problem with distant hearing
• D. A problem discriminating high-pitched and low-pitched sounds

Correct answer: B

Rationale: The Romberg test is a balance assessment that evaluates cerebellar function. During the test, the client stands with feet together and eyes closed, aiming to maintain balance for about 20 seconds. This test helps identify issues related to balance and proprioception, not hearing acuity or sound discrimination. Choices C and D are incorrect as the Romberg test focuses on balance, not distant hearing or sound discrimination.

4. How often should the nurse change the intravenous tubing on total parenteral nutrition solutions?

• A. every 24 hours
• B. every 36 hours
• C. every 48 hours
• D. every 72 hours

Correct answer: A

Rationale: The correct answer is 'every 24 hours.' Changing the intravenous tubing on total parenteral nutrition solutions every 24 hours is crucial due to the high risk of bacterial growth. Bacterial contamination can lead to serious infections in patients receiving total parenteral nutrition. Choices B, C, and D are incorrect because waiting longer intervals between tubing changes increases the risk of bacterial contamination and infection, compromising patient safety. It is essential to maintain a strict 24-hour schedule to minimize the risk of complications associated with bacterial contamination.

5. Distribution of a drug to various tissues depends on the amount of cardiac output to each type of tissue. Which tissue would receive the highest amount of cardiac output and thus the highest amount of a drug?

• A. skin
• B. adipose tissue
• C. skeletal muscle
• D. myocardium

Correct answer: D

Rationale: The tissue that would receive the highest amount of cardiac output and thus the highest amount of a drug is the myocardium. Highly perfused tissues include vital organs like the brain, heart, kidneys, adrenal glands, and liver. The myocardium, being part of the heart, receives a significant amount of cardiac output. Choices A (skin) and B (adipose tissue) are poorly perfused tissues and would not receive high amounts of cardiac output. Choice C (skeletal muscle) is also less perfused compared to the myocardium.

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