An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?
- A. It protects the bacteria from antibiotic and immunologic destruction.
- B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.
- C. It competes with the antibiotic for binding sites on the microbe.
- D. Glycocalyx provides nutrients for microbial growth.
Correct Answer: A
Rationale: Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes, enhancing adherence to surfaces, resisting phagocytic engulfment, and preventing antibiotics from contacting the microbe.
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The adolescent is brought to the ED with wheezing, nystagmus, ataxia, and sensorimotor neuropathy after inhaling paint thinner by “bagging.†Which nursing intervention is priority?
- A. Monitor the client's cardiac rhythm.
- B. Place the client on seizure precautions.
- C. Apply oxygen via nasal cannula at 4 liters.
- D. Notify lab to obtain a toxicology screen.
Correct Answer: C
Rationale: Applying oxygen is the priority to address wheezing and potential oxygen displacement from inhalant use.
Which spot is the safest place to administer an IM injection to an infant? Select the correct corresponding letter from the attached graphic.
- A. C
- B. B
- C. A
- D. D
Correct Answer: B
Rationale: The vastus lateralis muscle, highlighted by the letter B, should be used in infants as the muscle tends to be thickest in this area.
The client is prescribed medications on hospital admission. Four days later the client's serum creatinine level, which was normal at admission, is now 3.7 mg/dL. The nurse should contact the HCP regarding a dosage change for which medication?
- A. Ceftriaxone
- B. Insulin glargine
- C. Diltiazem
- D. Furosemide
Correct Answer: A
Rationale: A: The nurse should contact the HCP regarding ceftriaxone (Rocephin). Ceftriaxone, a third-generation cephalosporin antibiotic, is 33% to 67% excreted in the urine unchanged. Dosage reduction or increased dosing interval is recommended in renal insufficiency because ceftriaxone is nephrotoxic and can further damage the kidneys. B: Insulin glargine (Lantus) is partially metabolized at the site of injection to active insulin metabolites and partially metabolized by the liver, the spleen, the kidney, and muscle tissue; no dose reduction is necessary unless serum glucose levels fluctuate. C: Diltiazem (Cardizem) is mostly metabolized by the liver; no dose reduction is necessary. D: Furosemide (Lasix) is 30% to 40% metabolized by the liver with some nonhepatic metabolism and renal excretion as unchanged medication; no dose reduction is necessary.
The client is receiving multiple medications for treatment of PD. Which signs and symptoms should the nurse recognize as adverse effects of carbidopa-levodopa?
- A. Dystonia and akinesia
- B. Bradykinesia and agitation
- C. Muscle rigidity and cardiac dysrhythmias
- D. Orthostatic hypotension and dry mouth
Correct Answer: D
Rationale: A: Although dystonia is an adverse effect of carbidopa-levodopa, akinesia is a symptom associated with PD. B: Bradykinesia is a symptom associated with PD; agitation is an adverse effect of carbidopa-levodopa. C: Muscle rigidity is a symptom associated with PD; cardiac dysrhythmia is an adverse effect of carbidopa-levodopa. D: Orthostatic hypotension and dry mouth are common adverse effects of carbidopa-levodopa (Sinemet). These can be minimized by slow position changes and sucking on sugarless candy or chewing gum.
The nurse is developing the teaching plan for the client who is started on amitriptyline. Which information is most appropriate to include?
- A. Discuss a calorie-controlled diet plan suitable to the client's preferences.
- B. Inform about possible sexual dysfunction and be ready to provide support.
- C. Instruct to stop amitriptyline immediately if having a sudden elevation in BP.
- D. Advise to take amitriptyline upon waking up to manage the side effect of insomnia.
Correct Answer: A
Rationale: Weight gain is often a major concern for clients taking TCAs such as amitriptyline (Elavil). A calorie-controlled diet plan will assist in avoiding weight gain.
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