The nurse receives an order to administer cefazolin to a client diagnosed with a urinary tract infection. The nurse withholds the medication and notifies the health care provider because the client:

Has not received proper education on this medication.

Just completed a full course of an aminoglycoside antibiotic.

Is currently afebrile.

Had a prior anaphylactic reaction to penicillin.

Answer and Explanation

The Correct Answer is D

Choice A rationale

While it’s important for clients to understand their medications, not having received proper education on this medication is not a reason to withhold cefazolin.

Choice B rationale

Completing a full course of an aminoglycoside antibiotic does not contraindicate the use of cefazolin.

Choice C rationale

Being afebrile does not contraindicate the use of cefazolin. Antibiotics are used to treat bacterial infections, not just to reduce fever.

Choice D rationale

A prior anaphylactic reaction to penicillin is a contraindication for administering cefazolin. Cefazolin is a cephalosporin, and there is a risk of cross-reactivity and potential allergic reaction in clients who have a history of severe penicillin allergy.

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Correct Answer is C

Explanation

Choice A rationale

Changes to achieve low HDL and high LDL levels are not recommended. In fact, the opposite is desired. High levels of HDL (good cholesterol) and low levels of LDL (bad cholesterol) are beneficial for overall health and can help prevent cardiovascular complications associated with diabetes.

Choice B rationale

Self-monitoring of blood glucose is important for managing diabetes, but a fasting plasma glucose level of 118 mg/dL does not necessarily indicate the need for regular self-monitoring. This level is slightly elevated and may indicate prediabetes, but further testing would be needed for a definitive diagnosis.

Choice C rationale

Maintenance of a healthy weight is beneficial for everyone, but it’s particularly important for individuals with prediabetes or diabetes. Achieving and maintaining a healthy weight can help regulate blood glucose levels and prevent or delay the progression of prediabetes to diabetes.

Choice D rationale

Utilizing carbohydrate counting to match insulin intake is a strategy used in the management of diabetes. However, a fasting plasma glucose level of 118 mg/dL, while slightly elevated, does not necessarily indicate the need for insulin therapy or carbohydrate counting. Further testing would be needed to confirm a diagnosis of diabetes.

A. Urine specific gravity 1.012. B. +4 Pedal pulses. C. Respiratory rate 20/minute. D. Potassium level 3.8 mEq/L.

Correct Answer is A

Explanation

Choice A rationale

Fluid Volume Excess (FVE), or hypervolemia, refers to an isotonic expansion of the ECF due to an increase in total body sodium content and an increase in total body water. This fluid overload usually occurs from compromised regulatory mechanisms for sodium and water as seen commonly in heart failure (CHF), kidney failure, and liver failure. The key signs of hypervolemia include weight gain and swelling. One of the defining characteristics of FVE is an increase in urine specific gravity. Therefore, a urine specific gravity of 1.012 can validate the problem of Fluid Volume Excess for a patient.

Choice B rationale

+4 Pedal pulses indicate a very bounding and strong pulse, which is not directly related to Fluid Volume Excess. While it might be observed in some cases due to increased blood volume and pressure, it is not a specific or primary indicator of this condition.

Choice C rationale

A respiratory rate of 20/minute is within the normal range for an adult (12-20 breaths per minute) and does not specifically indicate Fluid Volume Excess. While respiratory changes can occur with severe or prolonged Fluid Volume Excess, a normal respiratory rate does not validate this diagnosis.

Choice D rationale

A potassium level of 3.8 mEq/L is within the normal range (3.5-5.0 mEq/L) and does not specifically indicate Fluid Volume Excess. While electrolyte imbalances can occur with Fluid Volume Excess, a normal potassium level does not validate this diagnosis.

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The nurse receives an order to administer cefazolin to a client diagnosed with a urinary tract infection. The nurse withholds the medication and notifies the health care provider because the client:

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client undergoing screening for diabetes has a fasting plasma glucose level of 118 mg/dL. What should the nurse plan to educate the client about?

Correct Answer is C

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse identifies the problem of Fluid Volume Excess for a patient. Which assessment finding validates this problem?

Correct Answer is A

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse is teaching a patient to wash their hands after using the bathroom as an attempt to break the chain of infection. Between which two links in the chain of infection does this action intervene?

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