The patient is a 75-year-old female who has been admitted to the preoperative area in preparation for pacemaker insertion.

She reports that she is undergoing this procedure because her heart rate has been consistently low, she feels constantly fatigued, and she has experienced one episode of fainting due to a low heart rate.

The patient has a history of progressively worsening symptomatic bradycardia and a history of atrial fibrillation, which is controlled by medication.

She has been off anticoagulants for four days in preparation for the procedure.

As the nurse prepares the patient’s plan of care, which four findings would indicate that it would be safe to administer the antibiotic vancomycin?

Potassium level is 4.4 mEq/L (4.4 mmol/L).

The antibiotic is being used for prophylaxis.

Blood urea nitrogen level is 17 mg/dL (6.07 mmol/L).

The dosage of the antibiotic is within the safe range.

The patient has no known allergies.

The patient has a peripheral IV in a large vein.

Answer and Explanation

Correct Answer : A,B,C,E

Choice A rationale
A potassium level of 4.4 mEq/L (4.4 mmol/L) is within the normal range. Potassium is a critical electrolyte in the body, playing key roles in cellular metabolism, protein synthesis, and electrical action potential regulation across cell membranes. Normal potassium levels typically range from 3.5 to 5.1 mmol/L1. Therefore, a potassium level of 4.4 mEq/L indicates that the patient’s potassium level is within the normal range, which is a safe condition for the administration of vancomycin.
Choice B rationale

The use of antibiotics for prophylaxis, or prevention, is a common practice in healthcare, particularly in surgical procedures such as pacemaker insertion. This is done to prevent potential infections that could occur during or after the procedure. Vancomycin is a type of antibiotic that is often used for prophylaxis against infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA)3. Therefore, if the antibiotic is being used for prophylaxis, it would be safe to administer vancomycin.
Choice C rationale
A blood urea nitrogen (BUN) level of 17 mg/dL (6.07 mmol/L) is within the normal range. The BUN test measures the amount of urea nitrogen in the blood, which can provide important information about kidney function. Urea nitrogen is a waste product that is created in the liver when protein is metabolized. It is then transported through the blood to the kidneys, which filter out most of the urea nitrogen, leaving a small amount in the blood. Normal BUN levels typically range from 6 to 20 mg/dL4. Therefore, a BUN level of 17 mg/dL indicates that the patient’s kidney function is within the normal range, which is a safe condition for the administration of vancomycin.
Choice E rationale
The absence of known allergies in a patient is a crucial factor in determining the safety of administering any medication, including vancomycin. Allergic reactions to medications can range from mild symptoms such as rash and itching to severe and life-threatening conditions such as anaphylaxis. Therefore, if a patient has no known allergies, it would be safe to administer vancomycin.
Choice D rationale

While it’s true that the dosage of the antibiotic should be within the safe range, the specific dosage of vancomycin for the patient isn’t provided in the question. Therefore, we cannot definitively say that this condition is met based on the information given.
Choice F rationale
Although vancomycin can be administered via a peripheral IV in a large vein, it’s important to note that vancomycin has a low pH and may cause venous irritation and tissue damage in cases of extravasation. Therefore, while it’s possible to administer vancomycin this way, it’s not necessarily an indicator of safety.

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Correct Answer is A

Explanation

Choice A rationale
Oxygen therapy is a crucial part of the management for patients with severe pneumonia. However, prolonged administration of high concentrations of oxygen can potentially lead to oxygen toxicity, resulting in damage to the cells of the lungs. This is due to the production of

reactive oxygen species which can damage cell structures. Therefore, it is important to avoid administering oxygen at high levels for extended periods.
Choice B rationale
While it might seem logical to increase the oxygen rate during sleep due to a slower respiratory rate, this is not typically recommended. The body’s oxygen requirements do not significantly change during sleep and increasing the oxygen rate could potentially lead to hyperoxia.
Choice C rationale
Sedatives can indeed slow the respiratory rate, but this does not decrease oxygen needs. In fact, it could potentially lead to respiratory depression and hypoxia, especially in a patient with a respiratory illness like pneumonia.
Choice D rationale
Humidification of oxygen can improve patient comfort, especially with high flow rates, by preventing dryness in the nasal passages. However, it does not make oxygen less toxic.

A. Obtain an analgesic prescription. B. Infuse an intravenous fluid bolus. C. Administer PRN oral antipyretic. D. Cover client with a cooling blanket.

Correct Answer is B

Explanation

Choice A rationale
While obtaining an analgesic prescription might help to alleviate the client’s joint pain, it is not the first intervention that should be implemented. The client’s vital signs indicate that they are in a state of shock, which is a medical emergency.

Choice B rationale
Infusing an intravenous fluid bolus is often the first step in treating shock. The client’s low blood pressure and high heart rate suggest that they may be experiencing hypovolemic shock, which can be caused by a severe fluid loss. Administering fluids can help to increase blood volume and improve blood pressure.

Choice C rationale
Administering a PRN oral antipyretic would not address the client’s immediate need. The client’s high temperature is a concern, but the low blood pressure and high heart rate are more immediate concerns.

Choice D rationale

Covering the client with a cooling blanket would address the client’s high temperature, but it would not address the more immediate concerns of low blood pressure and high heart rate.

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Naxlex Comprehensive Predictor Exams

A 10-year-old child with pneumonia is receiving oxygen at 5 L/minute via a nasal cannula. When planning care for this child, what principle of oxygen administration should the nurse keep in mind?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

A client with gout in the left great toe has received a prescription for prednisone 30 mg by mouth to be administered each day. Which symptom is most important for the client to report to the healthcare provider?

What intervention(s) should the nurse initiate if elder mistreatment is suspected? Select all that apply.

An intravenous (IV) antibiotic is prescribed for a patient with a postoperative infection. The medication is to be administered in 4 divided doses. Which schedule is best for administering this prescription?

A client with chronic kidney disease (CKD) has elevated blood urea nitrogen (BUN) and serum creatinine levels. The client reports feeling fatigued and is unable to concentrate during the morning assessments. What action should the nurse take based on these findings?

The nurse is monitoring a patient with Cushing’s disease in the post-anesthesia care unit (PACU) following a hypophysectomy. Which intervention is most important for the nurse to include in the patient’s plan of care?

A nurse is preparing a 50 mL dose of 50% dextrose IV for a patient experiencing insulin shock. What is the best method for administering the medication?

A client with influenza requires assistance in transferring to the bedside commode. The nurse observes the unlicensed assistive personnel (UAP) donning gloves and a gown to assist the client. What action should the nurse take?