You are working on a high-acuity medical surgical unit and just came on shift. You are prioritizing care for four patients who were just admitted. Which patient should you assess first?
The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
The patient with a pulse of 58 beats/min who is about to receive digoxin (Lanoxin)
The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin
The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
The Correct Answer is A
A. Vancomycin is structurally unrelated to penicillin, but cross-reactivity in severe beta-lactam allergies is rare but possible. More importantly, vancomycin carries a risk of infusion reactions, including “red man syndrome” or anaphylaxis. This patient represents the highest immediate risk for a potentially life-threatening reaction and should be assessed first. Early recognition and intervention (stopping the infusion, administering antihistamines or epinephrine if needed) are critical.
B. A pulse of 58 bpm is borderline bradycardia, which warrants caution before digoxin administration, but this is less immediately life-threatening than a potential severe allergic reaction. The nurse should withhold digoxin if below the provider’s prescribed threshold, but the patient is stable at the moment.
C. Although this patient is at risk for hypoglycemia due to NPO status after receiving insulin, a blood glucose of 80 mg/dL is within normal range, and the hypoglycemia risk develops gradually. This patient should be monitored closely, but they are not the highest priority at this exact moment.
D. This patient has mild hypertension. While headaches may indicate elevated blood pressure, this is not an immediate life-threatening condition compared with a potential anaphylactic reaction to vancomycin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["D"]
Explanation
A. Etomidate has a rapid onset of action and rapid recovery, which makes it highly useful for induction of anesthesia. After intravenous administration, its effects occur within 30–60 seconds, and patients often regain consciousness quickly after a single dose. This rapid onset and short duration help control anesthesia more precisely, especially for short proceduresor when a patient needs to regain consciousness quickly.
B. Etomidate provides sedation and hypnosis but has no analgesic properties. This means that although the patient may be unconscious, painful stimuli may still provoke physiological responses, so additional analgesics (like opioids) are often requiredduring painful procedures.
C. Etomidate is short-acting, with a duration of action of 3–5 minutesafter a single IV induction dose. Its brief effect allows for rapid adjustment of sedation depth, making it ideal for situations requiring precise control over anesthesia depth or in critically ill patients.
D. Etomidate is not an inhalation anesthetic. It is an intravenous sedative-hypnoticused primarily for induction of general anesthesiaand procedural sedation. Inhalation anesthetics, such as sevoflurane, desflurane, or halothane, are administered via the lungs, whereas etomidate is given intravenously. This makes option D the correct choice for “all of the following are correct except.”
E. Etomidate is classified as a sedative-hypnotic. It induces unconsciousness and sedationwithout significant cardiovascular or respiratory depression at induction doses, which makes it a preferred agent in patients who are hemodynamically unstable.
Correct Answer is B
Explanation
A. Antithyroid drugs, such as methimazoleand propylthiouracil (PTU), do not directly affect blood glucose levels. While thyroid hormones themselves influence metabolism, the primary effect of antithyroid medications is on thyroid hormone synthesis, not on glucose regulation.
B. One of the most serious adverse effectsof antithyroid drugs is agranulocytosis, which manifests as a significant reduction in white blood cells (particularly neutrophils). This greatly increases the risk of infection, sometimes with minimal warning signs. Patients may present with fever, sore throat, or other early infection symptoms, which should prompt immediate discontinuation of the drug and medical evaluation. Routine monitoring of WBC counts, especially early in therapy, helps detect this rare but life-threatening complication.
C. Antithyroid medications do not increase red blood cell count. Erythropoiesis is unrelated to the mechanism of these drugs. Any changes in RBCs would likely be due to unrelated conditions, not the antithyroid therapy.
D. Platelet counts are not typically affectedby antithyroid drugs. Thrombocytopenia is rare and not a standard laboratory concern for patients taking these medications.
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