A nurse is reviewing the medical record of a client who has sinusitis and a new prescription for cefuroxime.
Which of the following client information is the priority for the nurse to report to the provider?

The client has a BUN level of 18 mg/dL.

The client reports a history of nausea with cefuroxime.

The client has a history of a severe penicillin allergy.

The client takes an aspirin daily.

Answer and Explanation

The Correct Answer is C

This is the priority for the nurse to report to the provider because cefuroxime is a cephalosporin antibiotic that can cause serious or life-threatening allergic reactions in people who are allergic to penicillin. The nurse should not administer cefuroxime to this client until the provider is notified and an alternative antibiotic is prescribed.

Choice A is wrong because the client has a BUN level of 18 mg/dL, which is within the normal range of 7 to 20 mg/dL.

This does not indicate any renal impairment or adverse reaction to cefuroxime.

Choice B is wrong because the client reports a history of nausea with cefuroxime, which is a common side effect of this drug.

The nurse should instruct the client to take cefuroxime with food to reduce nausea, but this is not a priority to report to the provider.

Choice D is wrong because the client takes aspirin daily, which does not interact with cefuroxime.

The nurse should monitor the client for any signs of bleeding or bruising while taking aspirin, but this is not a priority to report to the provider.

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Correct Answer is B

Explanation

This will help reduce swelling and discomfort caused by the infiltration of fluid into the tissues. Elevating the extremity also promotes venous return and prevents further fluid accumulation.

Choice A is wrong because applying pressure to the IV site can increase the risk of tissue damage and infection.

Pressure can also obstruct blood flow and cause thrombophlebitis.

Choice C is wrong because slowing the infusion rate will not stop the infiltration of fluid into the tissues.

Slowing the infusion rate can also delay the delivery of medication or fluid to the client.

Choice D is wrong because flushing the IV catheter can worsen the infiltration of fluid into the tissues.

Flushing the IV catheter can also introduce air or bacteria into the bloodstream and cause complications.

Normal ranges for peripheral IV infusion are dependent on the type and volume of fluid, the size and location of the catheter, and the condition of the client. Generally, peripheral IV infusion rates should not exceed 100 mL/hr for adults and 60 mL/hr for children.

A. The client tests negative for HIV. B. The client has a negative sputum culture. C. The client’s liver function test results are within the expected reference range. D. The client has a positive purified protein derivative test.

Correct Answer is B

Explanation

The client has a negative sputum culture. This indicates that the client is adhering to the medication regimen because a negative sputum culture means that the client is no longer infectious and has cleared the tuberculosis bacteria from their lungs.

Choice A is wrong because testing negative for HIV does not indicate that the client is adhering to the medication regimen for tuberculosis. HIV testing is not related to tuberculosis treatment.

Choice C is wrong because having a positive purified protein derivative test does not indicate that the client is adhering to the medication regimen for tuberculosis.

A positive PPD test means that the client has been exposed to tuberculosis, but it does not indicate whether the client has an active or latent infection. Choice D is wrong because having liver function test results within the expected reference range does not indicate that the client is adhering to the medication regimen for tuberculosis.

Liver function tests are used to monitor for possible adverse effects of isoniazid and rifampin, which can cause hepatotoxicity, but they do not reflect the effectiveness of the treatment.

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A nurse is reviewing the medical record of a client who has sinusitis and a new prescription for cefuroxime. Which of the following client information is the priority for the nurse to report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is receiving a peripheral IV infusion and notes infiltration of fluid into the tissues surrounding the insertion site. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is caring for a client who has tuberculosis and is taking isoniazid and rifampin. Which of the following outcomes indicates that the client is adhering to the medication regimen?

Correct Answer is B

Explanation

A nurse is assessing a client who is receiving heparin via continuous IV. The client has an aPTT of 90 seconds. The nurse should monitor the client for which of the following changes in their vital signs?

A nurse is caring for a client who has major depression and a new prescription for citalopram. Which of the following adverse effects is the priority for the nurse to report to the provider?

A nurse is preparing to administer medications to a client and discovers a medication error. The nurse should recognize that which of the following staff members is responsible for completing an incident report?

A nurse is reviewing the medical record of an adult client who has a fever and a prescription for acetaminophen. Which of the following findings should the nurse identify as a contraindication for receiving this medication?

A nurse is assessing a client who is receiving heparin via continuous IV. The client has an aPTT of 90 seconds. The nurse should monitor the client for which of the following changes in their vital signs?

A nurse is administering 4 mg of hydromorphone to a client by mouth every 4 hr. The medication is provided as hydromorphone 8 mg per tablet. Which of the following actions is appropriate for the nurse to take?

A nurse is caring for a client who is to receive potassium replacement. The provider’s prescription reads, “Potassium chloride 30 mEq in 0.9% sodium chloride 100 mL IV over 30 min.” For which of the following reasons should the nurse clarify this prescription with the provider?

A nurse is teaching a client who has active pulmonary tuberculosis about management of medication for the disease. Which of the following statements is appropriate for the nurse to make?

A nurse is reviewing the medical record of a client who has sinusitis and a new prescription for cefuroxime.
Which of the following client information is the priority for the nurse to report to the provider?