Nokea
A client's central venous access device (CVAD) becomes infected. Why might the physician order antibiotics to be given through the line rather than through a peripheral IV line?
- A. to prevent infiltration of the peripheral line
- B. to reduce the pain and discomfort associated with antibiotic administration in a small vein
- C. to lessen the chance of an allergic reaction to the antibiotic
- D. to attempt to eliminate microorganisms in the catheter and prevent having to remove it
Correct Answer: D
Rationale: Microorganisms that infect CVADs are often coagulase-negative staphylococci, which can be eliminated by antibiotic administration through the catheter. If unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use lessens the need for peripheral IV lines and thus the risk of infiltration. In this case, however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use has the effect described in Choice 2, but in this case, the antibiotics are given through the CVAD to eliminate the infective agent. The route does not prevent an allergic reaction.
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When teaching a woman about possible side effects of hormone replacement therapy, the nurse should include information about all of the following except:
- A. Hypoglycemia in diabetic women.
- B. The possible return of monthly menses when taking combination hormones.
- C. Increased risk of gallbladder disease.
- D. Increased risk of breast, cervical, and ovarian cancer with long-term use.
Correct Answer: A
Rationale: When taking estrogen, there is an increased risk of diabetes or hyperglycemia due to lowered glucose tolerance. It is true that monthly menses might return when taking combination hormones. The progestin is responsible for this. There is also a risk of gallbladder disease. It is also true that there is an increased risk of breast, cervical, and ovarian cancer with long-term hormone replacement therapy.
A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:
- A. a maintenance dose.
- B. a loading dose.
- C. a medication with no first-pass effect.
- D. the medication to be given intravenously.
Correct Answer: B
Rationale: A loading or priming dose rapidly establishes a therapeutic plasma drug level. It can be calculated by multiplying the volume of distribution by the desired plasma drug concentration.
Medication bound to protein can have which of the following effects?
- A. enhancement of drug availability
- B. rapid distribution of the drug to receptor sites
- C. less availability to produce desired medicinal effects
- D. increased metabolism of the drug by the liver
Correct Answer: C
Rationale: Protein-bound drugs are inactive and less available for therapeutic effects until unbound. This does not enhance availability, speed distribution, or increase metabolism.
The parents of a 2-year-old child ask the nurse how they can teach their child to quit taking toys away from other children. Which of the following statements by the nurse offers the parents the best explanation of their child's behavior?
- A. Your child is egocentric. Egocentricity is normal for 2-year-old children. He believes other children want him to have their toys.
- B. Your child is showing negativity. He doesn't want other children to have the toys he wants.
- C. Your child is demonstrating magical thinking. He believes he can make the other children want him to play with their toys.
- D. Your child is engaging in domestic imitation. He is doing what he has seen other children do.
Correct Answer: A
Rationale: Two-year-old children are very egocentric. They believe everything and everyone is concerned about them. They believe other children want them to have their toys. This is different than believing they can make other children want them to have all the toys, as in magical thinking, which normally occurs in preschool-age children. Toddlers are very negative, but this is expressed by refusal of requests made to them. Domestic imitation does occur in preschool-age children, but it refers to the imitation of household chores and roles performed by adults, not the imitation of other children.
When medications have an additive, synergistic, or antagonistic effect on a tissue, a reaction has occurred.
- A. Pharmaceutical
- B. Pharmacodynamic
- C. Pharmacokinetic
- D. Drug incompatibility
Correct Answer: B
Rationale: Pharmacodynamic reactions involve the effect of drugs on tissue receptors, causing additive, synergistic, or antagonistic effects.