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A child weighing 20 kg has a new prescription for cefoxitin at 80 mg/kg/day administered intravenously every 6 hours. How much cefoxitin should be administered with each dose?
- A. 400 mg
- B. 200 mg
- C. 1600 mg
- D. 100 mg
Correct Answer: A
Rationale: To determine the amount of cefoxitin to be administered with each dose, first, calculate the total daily dose by multiplying the child's weight (20 kg) by the prescribed dose (80 mg/kg/day): 80 mg/kg/day 20 kg = 1600 mg/day. Since the medication is administered every 6 hours (4 doses/day), divide the total daily dose by the number of doses: 1600 mg / 4 = 400 mg. Therefore, each dose should be 400 mg. Choice B (200 mg) is incorrect because it is half the calculated dose. Choice C (1600 mg) is incorrect as it represents the total daily dose, not the dose per administration. Choice D (100 mg) is incorrect as it is a quarter of the calculated dose.
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The healthcare provider is assessing a client who has a chest tube in place following a pneumothorax. Which finding should be reported to the healthcare provider immediately?
- A. Bubbling in the water seal chamber
- B. Drainage greater than 70 ml/hour
- C. Tidaling in the water seal chamber
- D. Absence of breath sounds on the affected side
Correct Answer: D
Rationale: The absence of breath sounds on the affected side is a critical finding that may indicate a tension pneumothorax, a life-threatening condition requiring immediate intervention. This situation can lead to a shift of the mediastinum and impaired ventilation. Bubbling in the water seal chamber is an expected finding in a chest tube drainage system and indicates proper functioning. Drainage greater than 70 ml/hour is a concern but does not require immediate reporting unless it continues at a high rate or is associated with other symptoms. Tidaling in the water seal chamber is a normal fluctuation and indicates the chest tube system is patent and functioning correctly.
A client who is 3 days post-op following a cholecystectomy has yellow and thick drainage on the dressing. The nurse suspects a wound infection. The nurse identifies this type of drainage as:
- A. Purulent
- B. Serous
- C. Sanguineous
- D. Serosanguineous
Correct Answer: A
Rationale: The correct answer is A: Purulent. Purulent drainage is thick, yellow, and indicates the presence of infection. This type of drainage is typically seen in infected wounds. Choice B, Serous drainage, is thin, clear, and watery, which is normal in the initial stages of wound healing. Sanguineous drainage, choice C, is bright red and indicates fresh bleeding. Serosanguineous drainage, choice D, is pale pink to red and is a mixture of blood and serous fluid commonly seen in the early stages of wound healing.
The healthcare provider is assessing a client with acute pancreatitis. Which finding is most concerning?
- A. Pain radiating to the back
- B. Blood pressure of 95/60 mmHg
- C. Elevated serum amylase
- D. Absent bowel sounds
Correct Answer: B
Rationale: In acute pancreatitis, a low blood pressure of 95/60 mmHg is the most concerning finding as it may indicate hypovolemia or shock, which are critical conditions requiring immediate intervention. Pain radiating to the back is a common symptom of pancreatitis but is not as immediately life-threatening as hypotension. Elevated serum amylase levels and absent bowel sounds are typical findings in acute pancreatitis and may indicate pancreatic inflammation and gastrointestinal motility issues, respectively, but they are not as acutely concerning as hypotension.
What is the most important action for the LPN/LVN to take to prevent infection in a client with an indwelling urinary catheter?
- A. Ensure the catheter tubing is free of kinks.
- B. Change the catheter every 72 hours.
- C. Clean the perineal area with an antiseptic solution daily.
- D. Irrigate the catheter with normal saline every shift.
Correct Answer: A
Rationale: The most crucial action to prevent infection in a client with an indwelling urinary catheter is to ensure the catheter tubing is free of kinks. This step helps prevent obstruction in the tubing, maintaining proper urine flow and reducing the risk of infection. Changing the catheter every 72 hours is not recommended unless clinically indicated, as routine changes can increase the risk of introducing pathogens. Cleaning the perineal area with an antiseptic solution is essential for general hygiene but does not directly prevent catheter-related infections. Irrigating the catheter with normal saline every shift is not a standard practice and can introduce microorganisms into the urinary tract, increasing the risk of infection.
A client with a diagnosis of myocardial infarction (MI) is being treated. Which laboratory value would be most concerning?
- A. Troponin level of 0.5 ng/mL
- B. Creatine kinase-MB (CK-MB) of 5.0 ng/mL
- C. Serum potassium of 4.5 mEq/L
- D. Blood glucose of 180 mg/dL
Correct Answer: A
Rationale: A troponin level of 0.5 ng/mL is elevated, indicating myocardial damage, making it the most concerning finding in a client with a myocardial infarction (MI). Troponin is a highly specific marker for cardiac muscle damage, and elevated levels suggest ongoing injury to the heart muscle. While Creatine kinase-MB (CK-MB) is also a cardiac enzyme, troponin is more specific and sensitive for myocardial damage. Serum potassium and blood glucose levels are important parameters to monitor in MI patients, but in this scenario, the elevated troponin level takes precedence as it directly reflects cardiac injury.