Nursing Elites

1. The physician orders the antibiotics ampicillin (Omnipen) and gentamicin (Garamycin) for a newly admitted client with an infection. The nurse should:

• A. administer both medications simultaneously.
• B. give the medications sequentially, and flush well between them.
• C. ask the physician or pharmacy which medication to give first and how long to wait before giving the other drug.
• D. start one medication now and begin the other medication in 2-4 hours.

Correct answer: B

Rationale: A client with an infection needs both antibiotics as soon as possible. However, the pH of ampicillin is 8-10, and the pH of gentamicin is 3-5.5, making them incompatible when given together. Flushing well between drugs is necessary to prevent interaction. Choice C is incorrect because the nurse, not the physician or pharmacy, should determine the correct administration sequence. Consulting with the pharmacist is appropriate if uncertain. Choice D is incorrect because delaying the second medication by several hours can slow the treatment of the client's infection, as both antibiotics are needed promptly to address the infection effectively. Therefore, the correct action is to give the medications sequentially and flush well between them to prevent any potential interactions.

2. A client is admitted with Ewing's sarcoma. Which symptoms would be expected due to this tumor's location?

• A. Hemiplegia
• B. Aphasia
• C. Nausea
• D. Bone pain

Correct answer: D

Rationale: Ewing's sarcoma is a type of bone cancer that primarily affects the bones. Therefore, bone pain would be an expected symptom due to this tumor's location. Hemiplegia, which refers to paralysis on one side of the body, Aphasia, a language disorder, and Nausea are not typical symptoms of Ewing's sarcoma. While Nausea is a common symptom in various conditions, it is not specific to bone cancer like Ewing's sarcoma. Therefore, Bone pain is the most likely symptom associated with Ewing's sarcoma.

3. Which of the following coping mechanisms protects an individual from anxiety?

• A. denial and fantasy
• B. rationalization and suppression
• C. regression and displacement
• D. reaction formation and projection

Correct answer: A

Rationale: The correct answer is 'denial and fantasy.' Denial involves blocking external events from awareness to avoid anxiety, while fantasy is escaping to a more comfortable, less threatening place. These mechanisms can protect individuals from anxiety by providing temporary relief or distraction. Choices B, C, and D are incorrect. Rationalization and suppression do not directly protect individuals from anxiety. Regression and displacement involve reverting to earlier developmental stages or redirecting emotions to a substitute target, which do not directly shield individuals from anxiety. Reaction formation and projection entail behaving in the opposite way to one's impulses or attributing one's feelings to others respectively, which do not directly protect individuals from anxiety.

4. Several clients are admitted to the emergency room following a three-car vehicle accident. Which clients can be assigned to share a room in the emergency department during the disaster?

• A. The schizophrenic client experiencing visual and auditory hallucinations and the client with ulcerative colitis
• B. The client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm
• C. A child with fixed and dilated pupils and his parents, and the client with a frontal head injury
• D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain

Correct answer: B

Rationale: The correct answer is to assign the client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm to share a room. The pregnant client needs close monitoring due to the abdominal pain, and the client with facial lacerations and a broken arm requires immediate attention for wound care and possible fracture management. Choice A should not be assigned together as the schizophrenic client experiencing visual and auditory hallucinations needs a separate room for privacy and safety, and the client with ulcerative colitis may require isolation due to the risk of infection. Choice C is incorrect because the child with fixed and dilated pupils is likely in a critical condition and should be in a private room with parents, while the client with a frontal head injury needs a separate room for focused care. Choice D is also incorrect as the client with a large puncture wound to the abdomen needs immediate attention in a separate room, and the client with chest pain requires evaluation and monitoring in a separate setting as well.

5. The primary organ for drug elimination is the:

• A. skin
• B. lung(s)
• C. kidney(s)
• D. liver

Correct answer: C

Rationale: The correct answer is the kidney(s) because most drugs are excreted in the urine, either as the parent compound or as drug metabolites. The skin is not the primary organ for drug elimination; only a few drugs are excreted in sweat. The lung(s) primarily excrete volatile gases with expiration, not drugs. While the liver metabolizes drugs, it is the kidney(s) that primarily eliminate drugs through urine, especially those with a molecular weight above 300.

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