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 corporate executive works 60-80 hours a week. The client is experiencing some physical signs of stress. The nurse teaches the client biofeedback techniques. This is an example of which of the following health-promotion interventions?

• A. structure
• B. relaxation technique
• C. time management
• D. regular exercise

Correct answer: C

Rationale: The correct answer is 'relaxation technique.' Biofeedback techniques are a form of relaxation technique that can help individuals quiet the mind, release tension, and counteract responses to stress. Teaching biofeedback techniques to the client aims to promote relaxation and stress management. Choice A, 'structure,' does not directly relate to teaching biofeedback techniques. Choice C, 'time management,' focuses on organizing tasks efficiently, not on relaxation techniques. Choice D, 'regular exercise,' although beneficial for overall health, is not specifically related to the teaching of biofeedback techniques for stress relief.

3. When assessing a client's self-expectations about weight loss, which question is most appropriate?

• A. "What makes you think you can change your eating habits?"?
• B. "How do you feel about losing weight?"?
• C. "How important is it that you lose weight?"?
• D. "What do you think is a realistic weekly weight loss for you?"?

Correct answer: D

Rationale: When assessing a client's self-expectations about weight loss, it is crucial to inquire about what the client considers a realistic weekly weight loss goal. This question helps in understanding the client's perception and expectations regarding the weight loss journey, enabling the establishment of achievable goals. Choices A, B, and C do not directly address the aspect of setting realistic goals for weight loss. While questioning about changing eating habits, feelings about losing weight, or the importance of weight loss are relevant, they do not specifically focus on setting achievable goals, which is essential for effective weight management.

4. Which information should be reported to the state Board of Nursing?

• A. The facility fails to provide literature in both Spanish and English.
• B. The narcotic count has been incorrect on the unit for the past 3 days.
• C. The client fails to receive an itemized account of his bills and services received during his hospital stay.
• D. The nursing assistant assigned to the client with hepatitis fails to feed the client and give the bath.

Correct answer: B

Rationale: The correct answer is 'The narcotic count has been incorrect on the unit for the past 3 days.' This information should be reported to the state Board of Nursing as it involves medication errors and potential drug diversion, which are serious issues that fall under the jurisdiction of the Board. Reporting medication discrepancies and errors in narcotic counts is crucial for patient safety and regulatory compliance. Choices A, C, and D involve different types of issues that are not within the direct purview of the Board of Nursing. Providing literature in multiple languages (Choice A), addressing billing practices (Choice C), and resolving staff performance issues (Choice D) should be handled internally or reported to the appropriate departments or authorities, such as the Joint Commission or the charge nurse.

5. Narrow therapeutic index medications:

• A. are drug formulations with limited pharmacokinetic variability.
• B. have limited value and require no monitoring of blood levels.
• C. have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood
• D. have limited potency and side effects.

Correct answer: C

Rationale: The therapeutic index is the ratio between the median lethal dose and median effective dose of a drug, indicating the safety margin. Narrow therapeutic index medications have a small difference between minimum toxic levels and minimum effective concentration in the blood, making them high-risk drugs that require close monitoring to avoid toxicity. Choice A is incorrect because pharmacokinetics refer to drug absorption, distribution, metabolism, and elimination, not the therapeutic index. Choice B is incorrect because narrow therapeutic index drugs necessitate monitoring due to their narrow margin of safety. Choice D is incorrect because narrow therapeutic index drugs do not necessarily have limited potency but are characterized by a small window between efficacy and toxicity.

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