Nursing Elites

1. The healthcare provider caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The healthcare provider will contact the provider to

• A. discuss giving a smaller dose of penicillin.
• B. discuss using erythromycin (E-mycin) instead of penicillin.
• C. request an order for diphenhydramine (Benadryl).
• D. suggest that the patient receive cefuroxime (Ceftin).

Correct answer: B

Rationale: When a patient reports a previous rash with amoxicillin, which is a type of penicillin, there is a concern for a penicillin allergy. In such cases, using an alternative antibiotic like erythromycin, which is not a penicillin, is the appropriate approach to avoid potential cross-reactivity and allergic reactions. Giving smaller doses of penicillin does not address the underlying allergy issue and can still lead to severe hypersensitivity reactions. Diphenhydramine (Benadryl) is used to manage allergic reactions but should not be the first choice in changing the antibiotic. While some patients allergic to penicillins may also be allergic to cephalosporins like cefuroxime, it is not the best immediate alternative in this scenario.

2. Which of the following symptoms would a healthcare provider expect to find in a patient with hyperkalemia?

• A. Muscle cramps.
• B. Hypertension.
• C. Bradycardia.
• D. Tachycardia.

Correct answer: D

Rationale: Tachycardia is the correct symptom to expect in a patient with hyperkalemia. Hyperkalemia, or high potassium levels in the blood, can affect the electrical activity of the heart. Increased potassium levels can lead to changes in the heart's rhythm, potentially causing tachycardia (rapid heart rate) or other cardiac arrhythmias. Muscle cramps (choice A) are not typically associated with hyperkalemia. Hypertension (choice B) is not a common symptom of hyperkalemia; in fact, high potassium levels can sometimes cause low blood pressure. Bradycardia (choice C), or a slow heart rate, is usually not a primary symptom of hyperkalemia; instead, hyperkalemia tends to be associated with faster heart rates or arrhythmias.

3. A client is receiving continuous ambulatory peritoneal dialysis. Which of the following statements indicates the need for more teaching by the nurse?

• A. I should take all my medications every morning.
• B. The catheter should always remain in place.
• C. The catheter should be flushed daily with sterile saline.
• D. If I gain 2 pounds, I should skip dialysis that day.

Correct answer: D

Rationale: The correct answer is D. Gaining weight is a sign that the client may be retaining fluid, indicating a need for dialysis to remove excess fluid. Skipping dialysis based on weight gain can lead to fluid overload, electrolyte imbalances, and other serious complications. Choices A, B, and C are all correct statements regarding peritoneal dialysis care: taking medications as prescribed is essential for overall health, ensuring the catheter remains in place is crucial to prevent infection, and flushing the catheter with sterile saline daily helps maintain its patency and reduce the risk of infections.

4. A client with renal calculi is being assessed by a nurse. Which question should the nurse ask?

• A. Is there a family history of this problem?
• B. Do you consume cranberry juice?
• C. Do you urinate after sexual intercourse?
• D. Do you have burning sensation during urination?

Correct answer: A

Rationale: When assessing a client with renal calculi, it is important for the nurse to inquire about a family history of the problem. There is a genetic predisposition associated with renal stone formation, making it essential to assess if other family members have experienced renal stones. Choices B, C, and D are not directly related to renal calculi. Consuming cranberry juice is more relevant to urinary tract health, urinating after sexual intercourse is related to preventing urinary tract infections, and experiencing a burning sensation during urination is a symptom commonly associated with urinary tract infections, not renal calculi.

5. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection the previous day and notes that 1000 ml of gastric secretions were collected in the last 4 hours. What condition is the client at risk for developing?

• A. Metabolic alkalosis
• B. Hyperkalemia
• C. Metabolic acidosis
• D. Hypoglycemia

Correct answer: A

Rationale: The correct answer is A: Metabolic alkalosis. Loss of gastric secretions, which contain stomach acid, can lead to metabolic alkalosis. Excessive loss of acid results in an increase in the blood pH, leading to alkalosis. Hyperkalemia (B) is an elevated potassium level and is not directly related to the loss of gastric secretions. Metabolic acidosis (C) is an acid-base imbalance characterized by low pH and bicarbonate levels, which is the opposite of what would occur with the loss of gastric secretions. Hypoglycemia (D) is low blood sugar and is not typically associated with the scenario described in the question.

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