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. The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

• A. 11 AM, shortly before lunch.
• B. 1 PM, shortly after lunch.
• C. 6 PM, shortly after dinner.
• D. 1 AM, while sleeping.

Correct answer: D

Rationale: The correct answer is D, 1 AM, while sleeping. Isophane insulin suspension NPH (Humulin N) peaks around 6-8 hours after administration, which increases the risk of hypoglycemia during the night. Choice A, 11 AM, shortly before lunch, is incorrect because the peak effect of NPH insulin occurs much later. Choice B, 1 PM, shortly after lunch, is incorrect as it is too early for the peak effect of NPH insulin. Choice C, 6 PM, shortly after dinner, is also incorrect because the peak risk of hypoglycemia with NPH insulin occurs later in the night.

3. An obese client with emphysema who smoked at least a pack of cigarettes daily is admitted after experiencing a sudden increase in dyspnea and activity intolerance. Oxygen therapy is initiated, and it is determined that the client will be discharged with oxygen. Which information is most important for the nurse to emphasize in the discharge teaching plan?

• A. Methods for weight loss
• B. Guidelines for oxygen use
• C. Approaches to conserve energy
• D. Strategies for smoking cessation

Correct answer: B

Rationale: In this scenario, the priority for the nurse to emphasize in the discharge teaching plan is the 'Guidelines for oxygen use.' As the client with emphysema is being discharged with oxygen therapy, it is crucial for the nurse to ensure that the client understands how to use oxygen properly to prevent complications and promote effective management of the condition. While weight loss, conserving energy, and smoking cessation are important aspects of care for this client, in this specific case, ensuring the safe and appropriate use of supplemental oxygen takes precedence to optimize the client's respiratory function and overall well-being.

4. A young adult is burned when wearing a shirt that was splashed with lighter fluid and caught on fire while attempting to light a charcoal grill. The client ripped off the shirt immediately, without unbuttoning the sleeves, which caused circumferential burns to both wrists. When the client is admitted, which intervention should the nurse implement first?

• A. Monitor pulse intensity.
• B. Evaluate extremity sensation.
• C. Assess range of motion.
• D. Place sterile bandage on both wrists.

Correct answer: A

Rationale: Monitoring pulse intensity is the priority to ensure circulation is not compromised due to circumferential burns.

5. A nurse contacts the healthcare provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?

• A. Intravenous fluids
• B. Hemodialysis
• C. Fluid restriction
• D. Urine culture and sensitivity

Correct answer: A

Rationale: The normal range for BUN is 10 to 20 mg/dL, and for creatinine, it is 0.6 to 1.2 mg/dL in males and 0.5 to 1.1 mg/dL in females. Creatinine is a more specific marker for kidney function compared to BUN. In this case, the client's creatinine level is within the normal range, indicating a non-renal cause for the elevated BUN. Dehydration is a common cause of increased BUN, so the appropriate action would be to recommend intravenous fluids to address the dehydration. Fluid restriction is not indicated as the client needs hydration. Hemodialysis is not appropriate for dehydration and is typically reserved for renal failure. The laboratory results do not suggest an infection, making a urine culture and sensitivity unnecessary in this scenario.

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