Nursing Elites

1. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?

• A. A serum drug level greater than the MEC ensures that the drug is bacteriostatic.
• B. A serum drug level greater than the MEC broadens the spectrum of the drug.
• C. A serum drug level greater than the MEC helps eradicate bacterial infections.
• D. A serum drug level greater than the MEC increases the therapeutic index.

Correct answer: C

Rationale: The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Therefore, choice A is incorrect. Broadening the spectrum of a drug refers to its range of activity against different microorganisms, which is not directly related to MEC. Thus, choice B is incorrect. Increasing the therapeutic index involves maximizing the effectiveness of a drug while minimizing its toxicity, which is not specifically related to MEC. Therefore, choice D is also incorrect.

2. A client has a chest drainage system in place. The fluid in the water seal chamber rises and falls during inspiration and expiration. The nurse interprets this finding as an indication that:

• A. The tube is patent
• B. There is probably a kink in the tubing
• C. Suction should be added to the system
• D. The client is retaining airway secretions

Correct answer: A

Rationale: The correct answer is A: 'The tube is patent.' When the fluid in the water seal chamber rises and falls during inspiration and expiration, it indicates that the chest tube is patent, allowing for proper drainage. Choice B is incorrect because a kink in the tubing would obstruct the flow of fluid, leading to abnormal fluctuations in the water seal chamber. Choice C is incorrect as adding suction to the system is not indicated based on the described finding. Choice D is incorrect as the rising and falling of fluid in the water seal chamber is not indicative of the client retaining airway secretions.

3. A client with type 1 diabetes mellitus has a blood glucose level of 620 mg/dL. After the nurse calls the physician to report the finding and monitors the client closely for:

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

Correct answer: A

Rationale: In the scenario described, a client with a blood glucose level of 620 mg/dL and type 1 diabetes mellitus is at risk of developing metabolic acidosis. In type 1 diabetes, the lack of sufficient circulating insulin leads to an increase in blood glucose levels. As the body cells utilize all available glucose, the breakdown of fats for energy results in the production of ketones, leading to metabolic acidosis. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis are not typically associated with uncontrolled type 1 diabetes. Metabolic alkalosis is more commonly linked to conditions such as vomiting or excessive diuretic use, while respiratory acidosis and respiratory alkalosis are related to respiratory system imbalances in carbon dioxide levels.

4. A nursing assistant is measuring the blood pressure (BP) of a hypertensive client while a nurse observes. Which action on the part of the assistant would interfere with accurate measurement and prompt the nurse to intervene? Select all that apply.

• A. Measuring the BP after the client has sat quietly for 5 minutes
• B. Having the client sit with the arm bared and supported at heart level
• C. Using a cuff with a rubber bladder that encircles less than 80% of the limb
• D. Measuring the BP after the client reports that he just drank a cup of coffee

Correct answer: C

Rationale: To ensure accurate blood pressure (BP) measurement, the cuff used should have a rubber bladder that encircles at least 80% of the limb being measured. This ensures proper compression and accurate readings. Choices A and B are correct practices as it is recommended to measure BP after the client has sat quietly for 5 minutes and to have the client sit with the arm bared and supported at heart level. Choice D is also a correct reason for intervention as the client should not have consumed caffeine or smoked tobacco within 30 minutes before BP measurement, as it can affect the accuracy of the reading.

5. Which client is at greatest risk for coronary artery disease?

• A. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
• B. A 43-year-old male with a family history of CAD and a cholesterol level of 158 (8.8 mmol/L).
• C. A 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin.
• D. A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L).

Correct answer: D

Rationale: The 65-year-old female who is obese with a high LDL level of 188 (10.4 mmol/L) is at the greatest risk for coronary artery disease. Obesity and high LDL cholesterol levels are significant risk factors for developing coronary artery disease. While factors like mitral valve prolapse (choice A) and a family history of CAD (choice B) can contribute to the risk, they are not as significant as obesity and high LDL levels. Choice C, a 56-year-old male with high HDL and taking atorvastatin, is actually at lower risk due to the high HDL levels and being on statin therapy, which helps reduce cholesterol levels and lower the risk of coronary artery disease.

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