Nursing Elites

1. The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?

• A. Administer each antibiotic to infuse over 15 to 20 minutes.
• B. Order serum peak and trough levels of ampicillin.
• C. Prepare the schedule so that the drugs are given at the same time.
• D. Set up separate tubing sets for each drug labeled with the drug name and date.

Correct answer: D

Rationale: When administering intravenous aminoglycosides like gentamicin with penicillins such as ampicillin, it is crucial to avoid mixing them in the same container. Separate tubing sets labeled with the drug name and date should be used to prevent interactions between the medications. Administering each antibiotic over 15 to 20 minutes (Choice A) may not be appropriate for all medications and does not address the issue of compatibility. Ordering serum peak and trough levels of ampicillin (Choice B) is important for monitoring drug levels but does not directly address the administration process. Preparing a schedule to give drugs simultaneously (Choice C) may increase the risk of drug interactions and is not recommended when administering incompatible medications.

2. A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?

• A. Lymph node involvement is not significant.
• B. Small tumors are aggressive and indicate poor prognosis.
• C. The tumor's estrogen receptor guides treatment options.
• D. Stage I indicates metastasis.

Correct answer: C

Rationale: Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which is one of the most important prognostic factors in early-stage breast cancer.

3. Which of the following interventions is most appropriate for a patient with left-sided heart failure?

• A. Administering IV fluids.
• B. Administering oxygen.
• C. Administering diuretics.
• D. Administering antihypertensives.

Correct answer: B

Rationale: Administering oxygen is the most appropriate intervention for a patient with left-sided heart failure because it helps improve oxygenation. In left-sided heart failure, the heart struggles to pump oxygen-rich blood to the body, leading to inadequate oxygen supply to tissues. Administering oxygen can help alleviate symptoms of hypoxia and reduce the workload on the heart. IV fluids (Choice A) may exacerbate heart failure by increasing fluid volume, diuretics (Choice C) are used to reduce fluid overload in heart failure, and antihypertensives (Choice D) are more suitable for managing hypertension, which may be a comorbidity in heart failure but are not the primary intervention for left-sided heart failure.

4. A client who underwent lobectomy 24 hours ago has not had any chest tube drainage for the past hour. What should the nurse do first?

• A. Contacts the physician
• B. Checks for kinks in the drainage system
• C. Checks the client’s blood pressure and heart rate
• D. Connects a new drainage system to the client’s chest tube

Correct answer: B

Rationale: When a chest tube is not draining, the nurse's initial action should be to check for kinks or clots in the chest drainage system. This step helps to ensure the patency of the system and allows for proper drainage. Checking the client's blood pressure and heart rate is important but not the priority when addressing a lack of chest tube drainage. Contacting the physician is warranted if signs of respiratory distress or mediastinal shift are observed after ruling out kinks or clots. Connecting a new drainage system is done when the fluid chamber is full, following a specific procedure to maintain a closed system and prevent complications.

5. What is the priority intervention for a patient with a suspected myocardial infarction (MI)?

• A. Administering oxygen.
• B. Administering nitroglycerin.
• C. Administering aspirin.
• D. Administering morphine.

Correct answer: A

Rationale: Administering oxygen is the priority intervention for a patient with a suspected myocardial infarction to improve oxygenation. Oxygen helps ensure an adequate oxygen supply to the heart muscle, reducing the workload on the heart. Nitroglycerin and aspirin are important interventions in the treatment of MI; however, oxygen administration takes precedence to ensure adequate oxygenation. Morphine may be considered for pain relief, but it is not the initial priority in the treatment of a suspected MI.

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