Nursing Elites

1. The practical nurse is preparing to administer a prescription for cefazolin (Kefzol) 600 mg IM every six hours. The available vial is labeled, 'Cefazolin (Kefzol) 1 gram,' and the instructions for reconstitution state, 'For IM use add 2 ml sterile water for injection. Total volume after reconstitution = 2.5 ml.' When reconstituted, how many milligrams are in each milliliter of solution?

• A. 400 mg/mL
• B. 500 mg/mL
• C. 450 mg/mL
• D. 350 mg/mL

Correct answer: A

Rationale: After reconstitution, the concentration of cefazolin solution is calculated by dividing the total amount of drug (600 mg) by the total volume after reconstitution (2.5 mL). This gives 600 mg / 2.5 mL = 240 mg/mL. However, the question asks for the concentration in each milliliter of solution after reconstitution, so we need to consider the final volume of 2.5 mL. Therefore, 240 mg/mL * 2.5 mL = 600 mg, which means each milliliter contains 240 mg of cefazolin. Therefore, after reconstitution, there are 400 mg of cefazolin in each milliliter of solution. Choices B, C, and D are incorrect as they do not accurately reflect the concentration after reconstitution.

2. The client has chronic renal failure. What dietary modification is most important for this client?

• A. Increase protein intake
• B. Limit potassium-rich foods
• C. Increase sodium intake
• D. Encourage dairy products

Correct answer: B

Rationale: Limiting potassium-rich foods is crucial in chronic renal failure to prevent hyperkalemia, which can lead to cardiac complications. Excessive protein intake can increase the workload on the kidneys and may result in the accumulation of uremic toxins. Increasing sodium intake is generally discouraged in chronic renal failure due to its association with hypertension and fluid retention. Encouraging dairy products may not be suitable for all clients with chronic renal failure, as they are a significant source of phosphorus, which needs to be limited in renal failure to prevent mineral imbalances.

3. A client with a severe headache is being assessed by a nurse. What should the nurse do first?

• A. Administer pain relief medication
• B. Check the client's blood pressure
• C. Assess for associated symptoms such as nausea or photophobia
• D. Offer a quiet environment

Correct answer: B

Rationale: When a client presents with a severe headache, the initial action should be to check their blood pressure. This step is crucial as it can help determine if the headache is related to hypertension or other cardiovascular issues. Administering pain relief medication should only be done after assessing the client's vital signs and confirming the cause of the headache. While assessing for associated symptoms like nausea or photophobia is important for a comprehensive evaluation, it should follow checking the blood pressure to address immediate concerns. Offering a quiet environment is indeed beneficial for the client's comfort, but it is not the priority when dealing with a severe headache.

4. The nurse is caring for a client with cirrhosis of the liver. Which clinical finding is most concerning?

• A. Jaundice.
• B. Ascites.
• C. Spider angiomas.
• D. Asterixis.

Correct answer: D

Rationale: The correct answer is D, Asterixis. Asterixis, also known as liver flap, is a sign of hepatic encephalopathy, a severe complication of liver disease that necessitates immediate attention. While jaundice (choice A), ascites (choice B), and spider angiomas (choice C) are common clinical findings in cirrhosis, asterixis is the most concerning due to its association with hepatic encephalopathy, which can lead to altered mental status and even coma. Jaundice, ascites, and spider angiomas are also important signs in cirrhosis, but asterixis indicates a more critical condition requiring urgent intervention.

5. The nurse is caring for a client postoperatively following a hip replacement. Which intervention is most important to prevent dislocation of the prosthesis?

• A. Keep the client in a low Fowler's position
• B. Maintain hip abduction with pillows
• C. Encourage early ambulation
• D. Place the client in a prone position

Correct answer: B

Rationale: Maintaining hip abduction with pillows is crucial in preventing dislocation of the hip prosthesis postoperatively. This position helps keep the hip joint stable and reduces the risk of the prosthesis becoming displaced. Choices A, C, and D are not as effective in preventing dislocation. Keeping the client in a low Fowler's position does not provide the necessary hip support. While early ambulation is important for circulation and preventing complications, maintaining hip abduction is more specific to preventing prosthesis dislocation. Placing the client in a prone position can increase the risk of hip prosthesis dislocation due to the extreme positioning.

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