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. Before administration of a stat dose of potassium chloride IV for a client with hypokalemia, what is the most important action for the nurse?

• A. Ensure the IV is flowing freely
• B. Mix the medication thoroughly
• C. Check the client’s electrolyte levels
• D. Obtain a baseline ECG

Correct answer: A

Rationale: The most crucial action for the nurse before administering a stat dose of potassium chloride IV to a client with hypokalemia is to ensure the IV is flowing freely. A freely flowing IV is essential to safely and effectively deliver potassium chloride, helping to prevent infusion-related issues. Checking the client's electrolyte levels or obtaining a baseline ECG may be important but are not the most critical actions before administering the medication. Mixing the medication thoroughly is not applicable in this scenario as potassium chloride is typically provided ready to use.

3. Which nursing activity is within the scope of practice for the practical nurse?

• A. Complete an admission assessment in the normal newborn nursery
• B. Discontinue a central venous catheter that has become dislodged
• C. Observe a client rotate the subcutaneous site for an insulin pump
• D. Monitor a continuous narcotic epidural for a postoperative client

Correct answer: C

Rationale: The correct answer is C: 'Observe a client rotate the subcutaneous site for an insulin pump.' This activity is within the scope of practice for a practical nurse as it involves observing and ensuring proper technique for using an insulin pump, which aligns with their training and responsibilities. Choices A, B, and D are beyond the typical scope of practice for a practical nurse. Completing an admission assessment for a newborn nursery is usually performed by a registered nurse. Discontinuing a dislodged central venous catheter and monitoring a narcotic epidural require advanced skills and knowledge, usually carried out by registered nurses or advanced practice nurses.

4. A client with a diagnosis of bipolar disorder is taking lithium. What is the most important information the nurse should provide?

• A. Take the medication on an empty stomach
• B. Monitor sodium intake
• C. Report any signs of weight gain
• D. Avoid excessive caffeine intake

Correct answer: B

Rationale: The correct answer is B. Sodium levels can affect lithium levels in the body, so it is crucial to monitor sodium intake to prevent toxicity or subtherapeutic levels. Lithium is typically taken on an empty stomach to enhance absorption, making choice A more accurate than the original 'Take the medication with food.' Reporting weight gain, as mentioned in choice C, is important for monitoring side effects but is not as critical as ensuring proper lithium levels through sodium intake monitoring. Choice D, avoiding excessive caffeine intake, is not a priority concern directly related to lithium therapy.

5. A client with chronic kidney disease (CKD) is receiving erythropoietin therapy. What is the primary purpose of this medication?

• A. To lower blood pressure
• B. To improve appetite
• C. To increase red blood cell production
• D. To reduce fluid retention

Correct answer: C

Rationale: The correct answer is C: 'To increase red blood cell production.' Erythropoietin stimulates the production of red blood cells to treat anemia associated with CKD. Choices A, B, and D are incorrect because erythropoietin therapy is primarily used to address anemia by increasing the production of red blood cells rather than lowering blood pressure, improving appetite, or reducing fluid retention.

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