Nursing Elites

1. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39°C. What is the nurse’s next action?

• A. Administer the antibiotic as ordered.
• B. Contact the provider to request another culture.
• C. Discuss the need to add a second antibiotic with the provider.
• D. Review the sensitivity results from the patient’s culture.

Correct answer: D

Rationale: In this scenario, the nurse is observing signs of a possible lack of response to the current antibiotic therapy, such as increased erythema, swelling, and persistent high fever. The next appropriate action for the nurse is to review the sensitivity results from the patient’s culture. This step is crucial to determine if the current antibiotic is effective against the causative organism. If the sensitivity results indicate resistance to the current antibiotic, the antibiotic should be discontinued, and the provider should be notified for a change in therapy. Contacting the provider to request another culture is not the immediate priority, as the existing culture results need to be reviewed first. Adding a second antibiotic should only be considered after confirming the sensitivity results, as unnecessary antibiotic use can lead to antimicrobial resistance.

2. Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma?

• A. Numbness, tingling, and cramps in the extremities.
• B. Headache, diaphoresis, and palpitations.
• C. Cyanosis, fever, and classic signs of shock.
• D. Nausea, vomiting, and muscular weakness.

Correct answer: B

Rationale: Correct. Pheochromocytoma is a catecholamine-secreting non-cancerous tumor of the adrenal medulla. The classic triad of symptoms includes headache, diaphoresis (excessive sweating), and palpitations, which result from the overproduction of catecholamines like epinephrine and norepinephrine. Numbness, tingling, and cramps in the extremities (Option A) are not characteristic of pheochromocytoma. Cyanosis, fever, and classic signs of shock (Option C) are not typical symptoms of this condition. Nausea, vomiting, and muscular weakness (Option D) are not commonly associated with pheochromocytoma.

3. A client is brought to the emergency department by a neighbor. The client is lethargic and has a fruity odor on the breath. The client’s arterial blood gas (ABG) results are pH 7.25, PCO2 34 mm Hg, PO2 86 mm Hg, HCO3 14 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: The correct answer is 'Metabolic acidosis.' Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (HCO3 <22 mEq/L). In this case, the client's ABG results show a pH of 7.25 and an HCO3 level of 14 mEq/L, indicating metabolic acidosis. The PCO2 of 34 mm Hg is normal, ruling out respiratory acidosis or alkalosis. The PO2 of 86 mm Hg is also within the normal range and is not indicative of a respiratory problem. Therefore, the client is experiencing metabolic acidosis based on the ABG results provided.

4. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient’s face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?

• A. Request an order for IV epinephrine to treat anaphylactic shock.
• B. Slow the infusion to 10 mg/min and observe the patient closely.
• C. Stop the infusion and obtain an order for a BUN and serum creatinine.
• D. Suspect Stevens-Johnson syndrome and notify the provider immediately.

Correct answer: B

Rationale: When vancomycin is infused too rapidly, “red man” syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

5. The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patient’s admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?

• A. Administer the digoxin and monitor the patient’s electrocardiogram closely.
• B. Hold the digoxin dose and notify the provider of the patient’s lab values.
• C. Request an order for an intravenous bolus of potassium.
• D. Request an order for oral potassium supplements.

Correct answer: B

Rationale: In the scenario presented, the patient has a low serum potassium level, which can predispose the patient to digoxin toxicity. It is essential for the nurse to hold the digoxin dose and promptly notify the healthcare provider of the abnormal lab values. Option A is incorrect because administering digoxin without addressing the low potassium level can potentiate toxicity. Option C is inappropriate as potassium should not be given as an IV bolus, especially in the case of hypokalemia. Option D is incorrect because oral potassium supplements may not be sufficient for rapidly correcting severe hypokalemia in an acute care setting.

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