Nursing Elites

1. 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.

2. A healthcare professional reviews the blood gas results of a client in respiratory distress. The pH is 7.32, and the PCO2 is 50 mm Hg. Which of the following acid-base imbalances does the professional recognize in these findings?

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

Correct answer: C

Rationale: In respiratory acidosis, the pH is low (<7.35) and the PCO2 is increased (>45 mm Hg). These findings indicate that the client is experiencing respiratory acidosis, a condition where there is an excess of carbon dioxide in the blood due to inadequate ventilation, commonly seen in respiratory distress. Metabolic acidosis (Choice A) is characterized by a low pH and decreased bicarbonate levels, which is not the case in this scenario. Metabolic alkalosis (Choice B) is associated with a high pH and increased bicarbonate levels. Respiratory alkalosis (Choice D) is marked by a high pH and decreased PCO2, opposite to the values presented in the blood gas results of this client.

3. Which of the following is a key symptom of appendicitis?

• A. Right lower quadrant pain.
• B. Left lower quadrant pain.
• C. Generalized abdominal pain.
• D. Rebound tenderness.

Correct answer: A

Rationale: Corrected Choice A: Right lower quadrant pain is a classic and key symptom of appendicitis. Pain in the right lower quadrant is typically the initial symptom and is a result of inflammation and irritation of the appendix. This pain can start around the umbilicus and then migrate to the right lower quadrant. It is important to note that appendicitis rarely presents with pain in the left lower quadrant or generalized abdominal pain. Rebound tenderness, indicated in Choice D, is a sign of peritoneal irritation and is associated with appendicitis, but it is not as characteristic as the right lower quadrant pain in the initial presentation of appendicitis.

4. In a client with congestive heart failure, the nurse would be correct in withholding a dose of digoxin without specific instruction from the healthcare provider if the client's

• A. serum digoxin level is 1.5 ng/mL.
• B. blood pressure is 104/68 mmHg.
• C. serum potassium level is 3 mEq/L.
• D. apical pulse is 68/min.

Correct answer: C

Rationale: The correct answer is C. Hypokalemia can precipitate digitalis toxicity in individuals on digoxin, increasing the risk of dangerous dysrhythmias. A serum potassium level of 3 mEq/L is below the normal range (3.5 to 5.5 mEq/L) and indicates hypokalemia, which can potentiate the effects of digoxin. Choices A, B, and D are not directly related to the potential for digitalis toxicity. Serum digoxin level of 1.5 ng/mL is within the therapeutic range, blood pressure of 104/68 mmHg is not a contraindication for administering digoxin, and an apical pulse of 68/min is within the normal range and not a reason to withhold digoxin.

5. The healthcare provider is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the healthcare provider question for this patient?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Clindamycin (Cleocin)
• D. Tetracycline (Sumycin)

Correct answer: D

Rationale: The correct answer is D, Tetracycline (Sumycin). Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth. Azithromycin, Clarithromycin, and Clindamycin are antibiotics that are generally safe for use in children and do not have the same tooth discoloration side effect as Tetracycline. Therefore, these antibiotics would be more appropriate choices for a 7-year-old patient.

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