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. The patient is beginning furosemide and has started a 2-week course of a steroid medication. What should the nurse recommend?

• A. Avoid consuming licorice to prevent excess potassium loss.
• B. Report a urine output less than 600 mL/24 hours.
• C. Obtain an order for a potassium supplement.
• D. Take the furosemide in the morning.

Correct answer: C

Rationale: When a patient is taking furosemide and a steroid medication, there is an increased risk of potassium loss due to the interaction between the two drugs. Consuming licorice should be avoided as it can worsen potassium loss. Reporting a urine output less than 600 mL/24 hours is not directly related to the drug interaction and may not be necessary. Taking furosemide at bedtime is not the primary concern when a patient is concurrently on a steroid medication and furosemide. Therefore, obtaining an order for a potassium supplement is the most appropriate recommendation to counteract the potential potassium loss.

3. What most likely led to the 67-year-old woman who lives alone tripping on a rug in her home and fracturing her hip?

• A. Failing eyesight causing an unsafe environment.
• B. Renal osteodystrophy due to chronic renal failure.
• C. Osteoporosis due to hormonal changes.
• D. Cardiovascular changes leading to small strokes impairing mental acuity.

Correct answer: C

Rationale: The correct answer is C. Osteoporosis, caused by hormonal changes in later life, is the most likely predisposing factor for the fracture in the proximal end of her femur. Osteoporosis leads to reduced bone density, making bones more fragile and susceptible to fractures, especially in the elderly. Choices A, B, and D are less likely to directly lead to a hip fracture in this scenario. Failing eyesight (choice A) could contribute to the fall but is not the main predisposing factor for the fracture. Renal osteodystrophy (choice B) and cardiovascular changes (choice D) are less commonly associated with hip fractures compared to osteoporosis in elderly women.

4. An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply.

• A. Apply lanolin or petroleum jelly to intact skin.
• B. Follow a reduced-calorie, reduced-fat diet.
• C. Inspect the involved areas daily for new ulcerations.
• D. Instruct the client to limit activities of daily living (ADLs).

Correct answer: A

Rationale: To address dry skin and prevent chronic ulcers and infections in an overweight client on warfarin with decreased arterial blood flow, the nurse should instruct the client to apply lanolin or petroleum jelly to intact skin. This helps maintain skin integrity and moisture. Following a reduced-calorie, reduced-fat diet (Choice B) may be beneficial for weight management but is not directly related to skin care. Inspecting involved areas daily for new ulcerations (Choice C) is important for skin assessment and early intervention but does not specifically address dry skin. Instructing the client to limit activities of daily living (ADLs) (Choice D) is not necessary for addressing dry skin; in fact, promoting mobility and circulation through appropriate activities is crucial.

5. Which electrolyte imbalance is most likely to be seen in a patient with chronic kidney disease?

• A. Hypernatremia.
• B. Hyperkalemia.
• C. Hypocalcemia.
• D. Hypokalemia.

Correct answer: B

Rationale: In chronic kidney disease, hyperkalemia is the most common electrolyte imbalance due to the kidneys' reduced ability to excrete potassium. This impaired kidney function leads to potassium retention in the body, resulting in elevated serum potassium levels. Hypernatremia (increased sodium levels) is less likely in chronic kidney disease as the kidneys typically still function to regulate sodium levels. Hypocalcemia (low calcium levels) is not a prominent electrolyte imbalance in chronic kidney disease unless there are additional factors involved. Hypokalemia (low potassium levels) is less common in chronic kidney disease, as the primary issue is usually potassium retention rather than deficiency.

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