Question

A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse include?

Answer 1

Correct Answers:

"Provide a sputum specimen every 2 weeks to the clinic for testing."

Rationale :

🔵 Clients receiving treatment for tuberculosis (TB) need ongoing sputum testing to evaluate the response to therapy and determine whether the infection is becoming controlled.

🔵 Serial sputum specimens help monitor for continued presence of Mycobacterium tuberculosis and help confirm when the client is becoming less infectious.

🔵 This follow-up is especially important during the early phase of treatment because medication effectiveness must be verified clinically and microbiologically.

🔵 Although schedules may vary by provider and facility, the need for regular sputum monitoring is a key teaching point during anti-TB therapy.

🔵 This option is the best answer because it reflects the need for continued evaluation during treatment, unlike the other options which contain incorrect medication instructions.

"Drink at least 8 ounces of water when you take the pyrazinamide tablet."

🔵 Drinking water with medications is generally acceptable, but this is not the most important teaching point specific to pyrazinamide therapy.

🔵 More critical teaching includes monitoring for hepatotoxicity and adherence to the full multidrug regimen.

"Expect your sputum cultures to be negative after 6 months of therapy."

🔵 Clients should not be taught to expect sputum cultures to remain positive until 6 months, because improvement and culture conversion often occur much earlier.

🔵 This statement is inaccurate and may create confusion about treatment progress and infection control.

"Take isoniazid with an antacid."

🔵 Isoniazid should not be routinely taken with antacids because antacids can interfere with its absorption.

🔵 The medication is usually given on an empty stomach for best absorption unless gastrointestinal upset requires adjustment.

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Answer 2

Correct Answers:

Methylprednisolone
Golimumab
Ciprofloxacin

Rationale :

"Methylprednisolone"

🟢 Methylprednisolone is a corticosteroid that is used to reduce intestinal inflammation during an acute ulcerative colitis flare-up.

🟢 It helps suppress the exaggerated immune response that contributes to mucosal injury and worsening diarrhea, bleeding, and abdominal pain.

🟢 Corticosteroids are commonly used for moderate to severe flares when rapid anti-inflammatory action is needed.

🟢 This medication is not intended for long-term maintenance, but it is very effective for bringing acute symptoms under control.

🟢 It is appropriate because the priority during a flare is to reduce active inflammation and stabilize the client.

"Golimumab"

🟢 Golimumab is a tumor necrosis factor (TNF) inhibitor used in clients with moderate to severe ulcerative colitis.

🟢 It works by blocking inflammatory cytokine activity, which helps reduce intestinal inflammation and promote mucosal healing.

🟢 This biologic therapy is appropriate when ulcerative colitis is not adequately controlled with more conventional therapies or when disease activity is significant.

🟢 It is part of targeted therapy aimed at controlling the immune-mediated component of the disease.

🟢 This makes it an appropriate medication choice for ulcerative colitis management.

"Ciprofloxacin"

🟢 Ciprofloxacin may be used in some clients with ulcerative colitis when there is concern for infection, severe disease, or specific complications.

🟢 Although it is not the primary anti-inflammatory treatment, it can be used as an adjunct in selected clinical situations.

🟢 Clients with acute flare-ups may have significant bowel inflammation and altered gut flora, and antibiotics may be prescribed depending on the clinical picture.

🟢 The question asks which medications are appropriate for use, and ciprofloxacin can be appropriate in certain ulcerative colitis settings.

🟢 For that reason, it is included among the correct selections.

"Aspirin"

🟢 Aspirin can irritate the gastrointestinal tract and may worsen symptoms such as bleeding and mucosal inflammation.

🟢 It is not used as a treatment for ulcerative colitis flare-ups.

"Sumatriptan"

🟢 Sumatriptan is used to treat migraine headaches, not inflammatory bowel disease.

🟢 It has no therapeutic role in reducing bowel inflammation in ulcerative colitis.

"Ibuprofen"

🟢 Ibuprofen is an NSAID, and NSAIDs can aggravate gastrointestinal inflammation and worsen ulcerative colitis symptoms.

🟢 It is not considered an appropriate medication for managing an acute ulcerative colitis flare.

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Answer 3

Correct Answers:

Start infusion of Norepinephrine 4mg/250mL D5W

Rationale :

🔴 Norepinephrine is the first-line vasopressor for clients in septic shock who remain hypotensive after aggressive fluid resuscitation.

🔴 This client has a very low blood pressure and persistent signs of shock, so immediate vasopressor support is needed to improve tissue perfusion.

🔴 Norepinephrine works primarily by causing vasoconstriction, which increases systemic vascular resistance and raises blood pressure.

🔴 It is preferred over other vasoactive agents in septic shock because it is effective for restoring perfusion without being the wrong type of vasodilator therapy.

🔴 This order is expected because the priority is to treat refractory hypotension and prevent further organ hypoperfusion.

"Start infusion of Nitroglycerin 50 mg/250 mL 0.9% NS."

🔴 Nitroglycerin is a vasodilator, which would further lower blood pressure in a client already experiencing severe hypotension.

🔴 It is not appropriate for septic shock with refractory low blood pressure.

"Start infusion of Dobutamine 500 mg/250 mL D5W."

🔴 Dobutamine can be used in some shock states when cardiac output support is needed, but it is not the first-line medication for severe hypotension in septic shock after fluids.

🔴 The immediate priority is vasoconstriction with norepinephrine, not inotropic support alone.

"Start infusion of Nitroprusside 100 mg/250 mL D5W."

🔴 Nitroprusside is another potent vasodilator and would dangerously worsen this client’s hypotension.

🔴 It is not indicated in septic shock when the blood pressure is already critically low.

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Answer 4

Correct Answers:

Wash hands with soap and water

Rationale :

🟠 Clostridium difficile forms spores, and these spores are not reliably destroyed by alcohol-based hand sanitizer.

🟠 Soap and water physically remove the spores from the hands and is the recommended method of hand hygiene after contact with a client who has C. difficile.

🟠 Because the nurse’s glove tore, there is a risk that the hands came into direct contact with infectious material.

🟠 Handwashing with soap and water is the priority action to reduce transmission and protect both the nurse and other clients.

🟠 This is the correct answer because proper hand hygiene is the most important immediate intervention after glove contamination in a spore-forming infection.

"Don a clean pair of nonsterile gloves."

🟠 Donning new gloves without first cleaning the hands traps contamination underneath the gloves.

🟠 Hand hygiene must occur before applying another pair of gloves.

"Wash hands with alcohol-based hand sanitizer."

🟠 Alcohol-based hand sanitizer is not effective against C. difficile spores.

🟠 The correct method is soap and water, not sanitizer alone.

"Wash hands with a bleach wipe from a nearby container."

🟠 Bleach wipes are used for environmental surface disinfection, not for routine handwashing.

🟠 Using them on the skin is inappropriate and does not replace handwashing with soap and water.

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Answer 5

Correct Answers:

Pantoprazole

Rationale :

🟣 Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid secretion by blocking the hydrogen-potassium ATPase pump in the stomach.

🟣 PPIs are commonly prescribed for peptic ulcer disease because they promote healing by reducing acid exposure at the ulcer site.

🟣 This makes the gastric environment less irritating and supports mucosal recovery.

🟣 Pantoprazole is correctly classified as a PPI, unlike the other options which are H2-receptor antagonists.

🟣 This medication is the expected choice when the provider specifically orders a proton pump inhibitor.

Ranitidine

🟣 Ranitidine is an H2-receptor blocker, not a proton pump inhibitor.

🟣 It reduces acid secretion differently and does not belong to the PPI class.

Famotidine

🟣 Famotidine is also an H2-receptor antagonist, not a PPI.

🟣 Although it can be used for acid-related disorders, it is not the correct answer when the provider specifies a proton pump inhibitor.

Cimetidine

🟣 Cimetidine is an H2 blocker, not a proton pump inhibitor.

🟣 It is not the medication the nurse would anticipate if the order is specifically for a PPI.

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Answer 6

Correct Answers:

10

Rationale :

✍️140 lb to kg

✍️140 ÷ 2.2 = 63.6 kg

✍️2 mg × 63.6 kg = 127.2 mg

✍️The concentration supplied is 50 mg/4 mL

✍️Which equals 12.5 mg/mL.

📍127.2 ÷ 12.5

📍10.176 mL.

📍Rounded to the nearest whole number, 10 mL.

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Answer 7

Correct Answers:

Loss of protein
Decreased plasma volume
Capillary leak

Rationale :

Loss of protein

🟡 Major burns cause increased capillary permeability, allowing protein to leak from the intravascular space into the interstitial tissues.

🟡 This protein loss contributes to edema and decreases the oncotic pressure needed to keep fluid in the vascular compartment.

🟡 Clients with extensive burns often have significant fluid shifts and loss of important plasma components.

🟡 Protein loss is a hallmark physiologic response in severe burn injury and contributes to the severity of burn shock.

🟡 This is an expected finding in a client with burns over a large body surface area.

Decreased plasma volume

🟡 Severe burns lead to large fluid shifts out of the bloodstream and into the tissues, causing decreased plasma volume.

🟡 This occurs because damaged capillaries become leaky and allow fluid to escape into the interstitial space.

🟡 Reduced plasma volume places the client at high risk for hypovolemic burn shock.

🟡 The nurse should anticipate signs such as hypotension, tachycardia, and reduced urine output as a result of this fluid loss.

🟡 Decreased plasma volume is one of the most important physiologic consequences of major burns.

Capillary leak

🟡 Capillary leak occurs after major burns because the inflammatory response damages capillary integrity.

🟡 This causes fluid, electrolytes, and proteins to move from the intravascular space into surrounding tissues.

🟡 Capillary leak is a major reason why clients with extensive burns develop edema and circulatory instability.

🟡 It begins early after the injury and is central to the pathophysiology of burn shock.

🟡 The nurse should absolutely expect this change in a client with 50% total body surface area burns.

Diuresis

🟡 In the early phase after major burns, the client is more likely to experience oliguria, not diuresis, because of decreased circulating volume.

🟡 Diuresis is not an expected initial physiologic change in severe burn injury.

Hypermagnesemia

🟡 Hypermagnesemia is not a classic physiologic response expected in major burns.

🟡 More common early concerns include fluid loss, capillary leak, electrolyte imbalance such as hyperkalemia, and decreased plasma volume.

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Answer 8

Correct Answers

Blank 1 Correct Option: patent
Blank 2 Correct Option: infiltration
Blank 3 Correct Option: absorption

Rationale :

💎 Patency of the IV line should be checked first when an IV pain medication does not relieve pain as expected, because the medication may not be entering the bloodstream properly.

💎 Infiltration occurs when IV fluid or medication leaks into the surrounding tissue instead of remaining in the vein.

💎 When infiltration occurs, the ordered IV medication is not delivered effectively into the circulation, so the client may continue to have unrelieved pain.

💎 This problem interferes with absorption of the medication into the vascular system, which delays or prevents the intended analgesic effect.

💎 For a postoperative client receiving IV morphine and ketorolac, checking whether the line is patent is a priority nursing action before assuming the medication itself is ineffective.

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Answer 9

Correct Answers

Blank 1 Correct Option: white plaque in the mouth
Blank 2 Correct Option: candidiasis
Blank 3 Correct Option: Fluconazole

Rationale :

🔷 White plaque in the mouth in a client with HIV is highly suggestive of oral candidiasis (thrush), which is a common opportunistic infection in immunocompromised patients.

🔷 This infection is caused by Candida, a fungal organism that overgrows when the immune system is weakened.

🔷 Oral thrush often appears as creamy white patches on the tongue, gums, or inner cheeks and may be painful or difficult to swallow.

🔷 Fluconazole is an appropriate antifungal medication because it is effective against Candida infections and is commonly used to treat oral candidiasis in HIV-positive clients.

🔷 The nurse should recognize this finding promptly because opportunistic infections may indicate immune suppression and the need for further evaluation of the client’s HIV status and treatment response.

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Answer 10

Correct Answers:

WBC

Rationale :

🟣 A WBC count of 13,000/mm³ on Day 2 is above the normal reference range and is one of the classic findings that can indicate systemic inflammatory response syndrome (SIRS).

🟣 An elevated white blood cell count reflects activation of the body’s inflammatory and immune response, often in the setting of infection or significant physiologic stress.

🟣 In Mary’s case, the abnormal urine findings, new confusion, and rising WBC together increase concern that she may be developing a systemic inflammatory process related to a urinary source.

🟣 SIRS criteria include abnormalities in temperature, heart rate, respiratory rate, and WBC count, making this lab value especially important.

🟣 Because the question asks which Day 2 lab value would alert the RN to possible SIRS, WBC is the most clearly correct choice.

Hematocrit

🟣 Mary’s hematocrit of 32% is low, but it is unchanged and does not specifically indicate SIRS.

🟣 A low hematocrit may reflect anemia or blood loss rather than an acute systemic inflammatory response.

Blood glucose

🟣 Mary’s blood glucose of 138 mg/dL is elevated above the normal reference range, but it is not one of the primary classic SIRS diagnostic criteria used in routine bedside assessment.

🟣 The most direct Day 2 lab clue for SIRS in this question is the elevated WBC, not the mildly increased glucose.

Platelets

🟣 Mary’s platelet count of 81,000/mm³ is abnormal and concerning, especially because it is decreasing.

🟣 However, thrombocytopenia is more suggestive of worsening illness or possible sepsis-related complications than a primary SIRS criterion itself.

INR

🟣 Mary’s INR of 4.4 is elevated and is important because she is taking Warfarin, which increases her bleeding risk.

🟣 This abnormality reflects altered coagulation status, not a defining laboratory sign of SIRS.

Potassium

🟣 Mary’s potassium of 3.9 mEq/L is within the normal reference range.

🟣 A normal potassium level does not support the presence of SIRS.

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Date	Temperature	Pulse	Respirations	Blood Pressure	Pain Scale (0-10)	Alertness
1/5 Day 1	36.7 C / 98.0 F	84 Irregular	18 Regular	146/88	3	Awake/oriented
1/6 Day 2	36.0 C / 96.8 F	96 Irregular	24 Shallow	128/78	4	Awake/disoriented to time
1/7 Day 3	38.5 C / 101.3 F	132 Irregular	26 Shallow	94/52	6	Awake/disoriented to time and place

Lab Test	1/5 0730 Day 1	1/6 0500 Day 2	1/7 0815 Day 3	Reference Range
WBC	9,400	13,000	21,000	4,500 - 10,500/mm3
Hemoglobin	12	12	12	13.8 - 17.2 g/dL
Hematocrit	32	32	32	41 - 50%
Platelets	150,000	81,000	50,000	150,000 - 450,000 mm3
INR	4.1	4.4	5.0	2.0 - 3.0
Potassium	4.0	3.9	3.5	3.5 - 5.0 meq/L
Glucose	91	138	240	70 - 100 mg/dL
Lactate			7.0	<2.0 mmol/L

QLexNursing

1 :
A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse include?

2 :
The nurse is caring for a patient with acute ulcerative colitis flare-up. The provider wants to start the patient on medication. Which medications are appropriate for use in ulcerative colitis? (Select All that Apply.)

4 :
A nurse is caring for a client with the diagnosis of clostridium difficile. While providing care to the client, the nurse's glove tears. After removing the soiled gloves, what is the priority action by the the nurse?

5 :
A provider tells the nurse that a patient with a peptic ulcer is being placed on a protein pump inhibitor. Which medication would the nurse anticipate the provider ordering?

6 :
The provider has ordered Golimumab 2mg/kg IV over 30 minutes for a patient weighing 140 pounds. The pharmacy provided a vial of Golimumab 50mg/4mL. The nurse will administer how many mL of Golimumab? (round to the nearest whole number)

7 :
A nurse is caring for a client who has burns to approximately 50% of their body. Which of the following physiological changes related to the burns should the nurse anticipate? Select all that apply.

8 :
The nurse is assigned a post-operative total hip replacement patient reporting incisional pain that is not managed with current pain medications.

Correct Answers

9 :
Complete the sentence using the drop-down selections.

Correct Answers

10 :
Patient data.

Answer Options

QLexNursing

1 : A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse include?

2 : The nurse is caring for a patient with acute ulcerative colitis flare-up. The provider wants to start the patient on medication. Which medications are appropriate for use in ulcerative colitis? (Select All that Apply.)

4 : A nurse is caring for a client with the diagnosis of clostridium difficile. While providing care to the client, the nurse's glove tears. After removing the soiled gloves, what is the priority action by the the nurse?

5 : A provider tells the nurse that a patient with a peptic ulcer is being placed on a protein pump inhibitor. Which medication would the nurse anticipate the provider ordering?

6 : The provider has ordered Golimumab 2mg/kg IV over 30 minutes for a patient weighing 140 pounds. The pharmacy provided a vial of Golimumab 50mg/4mL. The nurse will administer how many mL of Golimumab? (round to the nearest whole number)

7 : A nurse is caring for a client who has burns to approximately 50% of their body. Which of the following physiological changes related to the burns should the nurse anticipate? Select all that apply.

8 : The nurse is assigned a post-operative total hip replacement patient reporting incisional pain that is not managed with current pain medications.

Correct Answers

9 : Complete the sentence using the drop-down selections.

Correct Answers

10 : Patient data.

Answer Options

1 :
A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse include?

2 :
The nurse is caring for a patient with acute ulcerative colitis flare-up. The provider wants to start the patient on medication. Which medications are appropriate for use in ulcerative colitis? (Select All that Apply.)

4 :
A nurse is caring for a client with the diagnosis of clostridium difficile. While providing care to the client, the nurse's glove tears. After removing the soiled gloves, what is the priority action by the the nurse?

5 :
A provider tells the nurse that a patient with a peptic ulcer is being placed on a protein pump inhibitor. Which medication would the nurse anticipate the provider ordering?

6 :
The provider has ordered Golimumab 2mg/kg IV over 30 minutes for a patient weighing 140 pounds. The pharmacy provided a vial of Golimumab 50mg/4mL. The nurse will administer how many mL of Golimumab? (round to the nearest whole number)

7 :
A nurse is caring for a client who has burns to approximately 50% of their body. Which of the following physiological changes related to the burns should the nurse anticipate? Select all that apply.

8 :
The nurse is assigned a post-operative total hip replacement patient reporting incisional pain that is not managed with current pain medications.

9 :
Complete the sentence using the drop-down selections.

10 :
Patient data.