After 5 days of diuretic therapy with 20mg of furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping, and muscle weakness. These symptoms probably indicate that the patient is experiencing:

Correct Answer: A

Rationale: The symptoms of fatigue, muscle cramping, and muscle weakness in a patient after starting furosemide therapy are indicative of hypokalemia. Furosemide is a loop diuretic that can lead to potassium depletion, causing hypokalemia. Hypokalemia can manifest with muscle weakness, cramps, and fatigue due to alterations in neuromuscular function and decreased ATP production.

Correct Answer: A

Rationale: The correct answer is A (Early in the morning) because sputum accumulation is naturally highest after a night of sleep due to prolonged stasis of respiratory secretions, which allows for a more concentrated and representative sample of pulmonary flora or pathogens. Overnight, mucus pools in the airways, increasing the yield of microorganisms for culture. This timing also minimizes contamination from food particles or oral flora, which can interfere with accurate diagnostic results. Morning collection ensures optimal specimen quality for detecting infections like tuberculosis or bacterial pneumonia, where diagnostic sensitivity depends on adequate bacterial load. Choice B (After the patient eats a light breakfast) is incorrect because eating introduces food debris and oral bacteria into the mouth and throat, contaminating the sputum sample. Salivary dilution and the mechanical action of chewing/swallowing reduce the concentration of lower respiratory secretions, leading to false-negative cultures or misidentification of commensal flora as pathogens. Additionally, postprandial collection may trigger gagging or vomiting, further compromising specimen integrity. Choice C (After aerosol therapy) is incorrect because nebulized medications (e.g., bronchodilators or saline) dilute sputum and alter its composition, washing away pathogens or distorting microbial concentrations. Aerosols also increase salivary contamination, making it harder to distinguish between upper and lower respiratory tract organisms. For accurate cultures, specimens should be collected *before* aerosol treatments to avoid therapeutic interference. Choice D (After chest physiotherapy) is incorrect because percussion or postural drainage mobilizes secretions from smaller airways, but these techniques often mix sputum with saliva and oropharyngeal contaminants. While physiotherapy may increase sputum volume, it does not guarantee a representative sample from the lungs. Furthermore, the mechanical disruption can fragment bacterial colonies, reducing culture sensitivity. Early morning collection without prior intervention remains the gold standard. In summary, morning sputum collection maximizes diagnostic accuracy by leveraging physiological secretion retention, minimizing contamination, and avoiding iatrogenic interference. The other choices introduce variables that compromise specimen quality, leading to unreliable microbiological results.

Correct Answer: A

Rationale: In this scenario, the appearance of a rash after administering penicillin, even in a patient with no known allergies, is concerning for a potential allergic reaction. The appropriate action for the nurse to take is to withhold the medication and notify the physician. This precaution is necessary to prevent further administration of a medication that may be causing an adverse reaction, as allergic reactions can range from mild to severe and require immediate intervention.

Correct Answer: D

Rationale: When using the Z-track method of drug injection, it is important to prepare the injection site with alcohol to ensure cleanliness, use a needle that is at least 1" long to reach the muscle tissue, and aspirate for blood before injection to verify correct needle placement. However, rubbing the site vigorously after the injection is not recommended as it can cause medication to leak into subcutaneous tissue, compromising the medication's intended absorption and efficacy.

Correct Answer: D

Rationale: The correct answer is D because the vastus lateralis muscle is located in the anterior thigh, and the described method ensures proper localization for a safe intramuscular (I.M.) injection. The vastus lateralis is part of the quadriceps muscle group and is a common site for I.M. injections, particularly in infants and adults when other sites are contraindicated. To locate it, the clinician divides the thigh between the greater trochanter (the bony prominence at the top of the femur) and the lateral femoral condyle (the bony protrusion on the outer side of the knee) into thirds. The middle third on the anterior aspect of the thigh is the correct injection site, as it avoids major nerves and blood vessels while ensuring the medication is delivered into the muscle mass. This method is widely accepted in clinical practice and supported by anatomical studies. Choice A is incorrect because it describes the dorsogluteal site (upper outer quadrant of the buttock), which is not the vastus lateralis. The dorsogluteal site is associated with the gluteus maximus muscle and carries a higher risk of injuring the sciatic nerve or superior gluteal artery if not properly located. While it is a valid I.M. injection site, it is not the correct answer for targeting the vastus lateralis. Choice B is incorrect because it refers to the deltoid muscle site, located on the lateral aspect of the arm. The deltoid is another common I.M. injection site, particularly for vaccines, but it is not the vastus lateralis. The described landmark (acromion process) is specific to the deltoid and irrelevant to locating the vastus lateralis in the thigh. Choice C is incorrect because it describes an area on the abdomen (anterior to the umbilicus), which is not used for I.M. injections. The abdominal area is typically associated with subcutaneous injections (e.g., insulin) due to the presence of adipose tissue, not muscle mass. There is no valid anatomical basis for administering an I.M. injection in this location, making it entirely unrelated to the vastus lateralis. The correct method (D) ensures accurate placement in the vastus lateralis, minimizing complications such as nerve injury, injection into subcutaneous tissue, or accidental entry into blood vessels. The other choices either describe alternative injection sites or irrelevant anatomical locations, demonstrating a misunderstanding of the vastus lateralis's position and function. Proper identification of anatomical landmarks is critical for safe and effective I.M. injections, and the vastus lateralis is particularly advantageous due to its accessibility and reduced risk of complications compared to other sites.