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The dosage of a pediatric medication is 120mg/kg/day to be given t.i.d. The patient weighs 12 pounds. What is the correct dose for the nurse to administer?
- A. 120 mg
- B. 480 mg
- C. 218 mg
- D. 651 mg
Correct Answer: C
Rationale: The patient weighs twelve pounds, which converts to kilograms by dividing 12 by 2.2 (1 kg = 2.2 lb.). In this example, the child's weight converts to 5.4 kg. The daily dose of 120 mg is given t.i.d: each individual dose is 40 mg/kg. Then multiply the weight in kilograms by the individual dose (40mg). The individual dose is 218 mg.
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A nurse is assessing a client who has gestational diabetes and is experiencing hyperglycemia. Which of the following findings should the nurse expect?
- A. Reports increased urinary output
- B. Diaphoresis
- C. Reports blurred vision
- D. Shallow respirations
Correct Answer: A
Rationale: The correct answer is A: Reports increased urinary output. In hyperglycemia, the body tries to eliminate excess glucose through urine, leading to increased urinary output. This is known as osmotic diuresis. Diaphoresis (B) is sweating, which is not typically associated with hyperglycemia. Blurred vision (C) is a symptom of prolonged hyperglycemia affecting the eyes but not an immediate finding. Shallow respirations (D) are not directly related to hyperglycemia.
A labor and delivery nurse suspects that a client is in the transition stage of labor. Which information supports this conclusion? The client is:
- A. walking around the unit and talking with her partner.
- B. irritable and needs frequent repetition of directions.
- C. expelling feces and the fetal head is crowning.
- D. reading a magazine and talking on the phone.
Correct Answer: B
Rationale: The correct answer is B. In the transition stage of labor, the cervix dilates from 8 to 10 cm. This stage is characterized by intense contractions, increased irritability, and the need for frequent repetition of directions due to the intensity of labor pain. The client being irritable and needing frequent repetition of directions indicates that she is likely in the transition stage of labor.
A: Walking around and talking with her partner is more indicative of the early stage of labor.
C: Expelling feces and the fetal head crowning are more indicative of the second stage of labor.
D: Reading a magazine and talking on the phone are not typical behaviors during the transition stage of labor.
A nurse is monitoring a 6-month-old infant who is diagnosed with pneumonia. The nurse observes an absence of respirations and peripheral cyanosis. After determining unresponsiveness, which of the following is the next nursing action?
- A. Look listen and feel for normal breathing.
- B. Give two rescue breaths.
- C. Position the infant to open the airway.
- D. Immediately call for assistance.
Correct Answer: C
Rationale: The correct answer is C: Position the infant to open the airway. For an unresponsive infant with absent respirations and cyanosis, the priority is to open the airway to facilitate breathing. Positioning the infant with a head tilt-chin lift maneuver helps prevent airway obstruction, allowing for adequate oxygenation. This step should be taken before providing rescue breaths or calling for assistance. Choices A, B, and D are not the immediate priority in this situation. A: Looking, listening, and feeling for normal breathing is not appropriate when the infant is unresponsive with absent respirations. B: Giving rescue breaths is not effective if the airway is obstructed. D: Calling for assistance can be done after ensuring the airway is open.
A nurse is reinforcing teaching to a group of parents about preventing accidental poisoning in preschoolers. Which of the following should the nurse include?
- A. Have syrup of ipecac available in the home.
- B. Explain to preschool children that plants can be eaten only after they are cooked.
- C. Keep labels on containers of toxic substances and never remove them.
- D. Place medications in a cabinet above the sink.
Correct Answer: C
Rationale: The correct answer is C: Keep labels on containers of toxic substances and never remove them. This is important to prevent accidental poisoning in preschoolers as it helps parents and caregivers easily identify and differentiate toxic substances from safe ones. Removing labels can lead to confusion and increase the risk of accidental ingestion. Having syrup of ipecac available (choice A) is no longer recommended as a first-aid treatment for poisoning. Teaching children to cook plants before eating them (choice B) is not a practical or safe approach. Placing medications in a cabinet above the sink (choice D) may not be effective as preschoolers can still access them if the cabinet is not securely locked.
A nurse is reinforcing teaching about accidental poisoning to a parent during a routine well-child visit.
- A. "I will give my child a dose of ipecac."'
- B. "I will place my child on her back."'
- C. "I will call the Poison Control Center."'
- D. "I will get my child to drink a full glass of water."'
Correct Answer: C
Rationale: The correct answer is C: "I will call the Poison Control Center." This is the best course of action in case of accidental poisoning as they provide expert advice on managing poison exposure. Calling them ensures prompt and accurate guidance to prevent further harm. Option A (ipecac) is not recommended anymore as it can cause more harm. Option B (placing the child on her back) is irrelevant to poisoning treatment. Option D (full glass of water) is not recommended as it can dilute the poison and may worsen the situation.