Nokea
A client diagnosed with chronic kidney disease is prescribed epoetin alfa. When discussing measures needed to support this medication therapy, the nurse should include information regarding which supplement?
- A. Iron
- B. Zinc
- C. Calcium
- D. Magnesium
Correct Answer: A
Rationale: Epoetin alfa is a hematopoietic agent used to stimulate red blood cell production in clients with anemia, such as those with chronic kidney disease. Iron supplementation is necessary to support this therapy because adequate iron stores are required for effective erythropoiesis. Without sufficient iron, the effectiveness of epoetin alfa is reduced. Zinc, calcium, and magnesium are not directly related to supporting red blood cell production in this context.
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The nurse performing a prenatal assessment on a client in the first trimester of pregnancy discovers that the client frequently consumes beverages containing alcohol. Why should the nurse initiate interventions immediately to assist the client in avoiding alcohol consumption?
- A. To reduce the potential for fetal growth restriction in utero
- B. To promote the normal psychosocial adaptation of the mother to pregnancy
- C. To minimize the potential for placental abruptions during the intrapartum period
- D. To reduce the risk of teratogenic effects to embryo's developing fetal organs and tissue
Correct Answer: D
Rationale: Alcohol consumption during the first trimester poses a significant risk for teratogenic effects, as this is a critical period for organogenesis in the developing embryo. Exposure to alcohol can lead to fetal alcohol syndrome or other congenital anomalies, making immediate intervention essential to protect fetal development. While fetal growth restriction, psychosocial adaptation, and placental abruption are concerns, they are less directly associated with early pregnancy alcohol exposure compared to teratogenic effects.
The nurse is checking postoperative prescriptions and planning care for a 110-pound child after spinal fusion. Morphine sulfate, 8 mg subcutaneously every 4 hours PRN for pain, is prescribed. The pediatric medication reference states that the safe dose is 0.1 to 0.2 mg/kg/dose every 3 to 4 hours. From this information, the nurse determines what about the prescription?
- A. The dose is too low.
- B. The dose is too high.
- C. The dose is within the safe dosage range.
- D. There is not enough information to determine the safe dose.
Correct Answer: C
Rationale: Use the formula to determine the dosage parameters. Convert pounds to kilograms by dividing weight by 2.2. Therefore, 110 lb ÷ 2.2 = 50 kg. Dosage parameters: 0.1 mg/kg/dose × 50 kg = 5 mg; 0.2 mg/kg/dose × 50 kg = 10 mg. Dosage is within the safe dosage range.
The nurse instructs a mother of a child who had a plaster cast applied to the arm about measures that will help the cast dry. Which instructions should the nurse provide to the mother? Select all that apply.
- A. Lift the cast using the fingertips.
- B. Place the child on a firm mattress.
- C. Direct a fan toward the cast to facilitate drying.
- D. Support the cast and adjacent joints with pillows.
- E. Place the extremity with the cast in a dependent position.
- F. Reposition the extremity with the cast every 2 to 4 hours.
Correct Answer: B,C,D,F
Rationale: To help the cast dry, the child should be placed on a firm mattress. A fan may be directed toward the cast to facilitate drying. Once the cast is dry, the cast should sound hollow and be cool to touch. The cast and adjacent joints should be elevated and supported with pillows. To ensure thorough drying, the extremity with the cast should be repositioned every 2 to 4 hours. The cast is lifted by using the palms of the hands (not the fingertips) to prevent indentation in the wet cast surface. Indentations could possibly cause pressure on the skin under the cast.
The nurse instructing a client with chronic pancreatitis about measures to prevent its exacerbation should provide which information? Select all that apply.
- A. Eat bland foods.
- B. Avoid alcohol ingestion.
- C. Avoid cigarette smoking.
- D. Avoid caffeinated beverages.
- E. Eat small meals and snacks high in calories.
- F. Eat high-fat, low-protein, high-carbohydrate meals.
Correct Answer: A,B,C,D,E
Rationale: Chronic pancreatitis is a progressive, destructive disease of the pancreas, characterized by remissions and exacerbations (recurrence). Measures to prevent an exacerbation include eating bland, low-fat, high-protein, moderate-carbohydrate meals; avoiding alcohol ingestion, nicotine, and caffeinated beverages; eating small meals and snacks high in calories; and avoiding gastric stimulants such as spices.
A client at risk for respiratory failure is receiving oxygen via nasal cannula at 6 L per minute. Arterial blood gas (ABG) results indicate pH 7.29, PcO2 49 mm Hg, Po2 58 mm Hg, and HCO3 18 mEq/L. What intervention should the nurse anticipate that the primary health care provider will prescribe for respiratory support for this client?
- A. Intubating for mechanical ventilation
- B. Keeping the oxygen at 6 L per minute via nasal cannula
- C. Lowering the oxygen to 4 L per minute via nasal cannula
- D. Adding a partial rebreather mask to the current prescription
Correct Answer: A
Rationale: If respiratory failure occurs and supplemental oxygen cannot maintain acceptable PaO2 and PaCO2 levels, endotracheal intubation and mechanical ventilation are necessary. The client is exhibiting respiratory acidosis, metabolic acidosis, and hypoxemia. Lowering or keeping the oxygen at the same liter flow will not improve the client's condition. A partial rebreather mask will raise CO2 levels even further.