Nokea
A client receives a prescription for dextromethorphan 30 mg every 6 to 8 hours PO as needed for cough. The bottle is labeled 'Dextromethorphan for Oral Suspension, USP 30 mg per 15 mL.' How many tablespoons should the nurse instruct the client to take with each dose? (Enter numerical value only.)
Correct Answer: 1
Rationale: 30 mg ÷ (30 mg/15 mL) = 1 tablespoon.
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Nurse’s Notes
The client is an 81-year-old male with a history of hypertension, heart failure, and seasonal allergies. He was admitted for pneumonia 3 days ago and is currently in the intensive care unit. The client lives with his daughter and her family, who report that he is compliant with his medication regimen. The client walks every morning but has shown cognitive decline at home and has no signs of improvement. The client has been experiencing increased confusion, lethargy, and decreased appetite. He has also developed a persistent cough with greenish sputum and shortness of breath
Medical History
• Hypertension
• Heart failure
• Seasonal allergies
• Pneumonia (admitted 3 days ago)
Diagnostic Results
• White Blood Cell (WBC) count: 15,000/mm³ (4,500-11,000/mm³)
• C-reactive protein (CRP): 12 mg/L (<3 mg/L)
• Blood urea nitrogen (BUN): 25 mg/dL (7-20 mg/dL)
• Serum creatinine: 1.5 mg/dL (0.6-1.2 mg/dL)
• Chest X-ray: Bilateral infiltrates
Vital Signs
• Temperature: 38.5°C (101.3°F)
• Heart rate: 110 beats per minute
• Respiratory rate: 28 breaths per minute
• Blood pressure: 140/90 mmHg
• Oxygen saturation: 88% on room air
Provider’s Prescriptions
• Administer IV antibiotics as prescribed
• Administer oxygen therapy to maintain SpO2 > 92%
• Monitor vital signs every 4 hours
• Encourage fluid intake
• Perform chest physiotherapy
Physical Examination Results
The client appears pale and diaphoretic. He has bilateral crackles in the lower lung fields and diminished breath sounds. The client is using accessory muscles to breathe and has a productive cough with greenish sputum. His skin is warm to the touch, and he has mild peripheral edema in the lower extremities. The client is alert but disoriented to time and place.
A nurse is caring for a client in the intensive care unit. Exhibits:Complete the diagram by specifying which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.
- A. Administer diuretics as prescribed, Increase oxygen flow rate, Perform chest physiotherapy, Administer bronchodilators as prescribed, Elevate the head of the bed
- B. Acute respiratory distress syndrome (ARDS),Congestive heart failure exacerbation,Hospital-acquired pneumonia,Chronic obstructive pulmonary disease (COPD) exacerbation
- C. Oxygen saturation, Blood pressure, Respiratory rate, White blood cell count, Serum creatinine
Correct Answer:
Rationale: Hospital-acquired pneumonia fits symptoms; chest physiotherapy clears secretions; oxygen saturation and WBC monitor progress.
The nurse is teaching the client to self-administer a dose of low molecular weight heparin SUBQ. Which instruction should the nurse include?
- A. Expel the air in the prefilled syringe prior to injection.
- B. Rotate injections between the abdomen and gluteal areas.
- C. Massage the injection site to increase absorption.
- D. Inject in the abdominal area at least 2 inches from the umbilicus.
Correct Answer: D
Rationale: Abdominal site ensures absorption.
The primary nurse went on break at 1845. The covering nurse gave a second dose of insulin because of being unaware the primary nurse gave the ordered dose. Which error prevention techniques would have helped to avoid this?
- A. Double check all dosage calculations.
- B. nusually large or small doses.
- C. Compare the medication label to the order.
- D. Use at least 2 client identifiers before administering a dose.
- E. Involve and educate clients in medication administration.
- F. Document all medication in the electronic record as soon as it is given.
Correct Answer: A,C,D,E.F
Rationale: Documentation and verification prevent errors.
A nurse is reviewing a client’s laboratory results and notes a blood glucose result of 104 mg/dL (5.8 mmol/L). The reference range is 74 to 106 mg/dL (4.1 to 5.9 mmol/L). Which action should the nurse take?
- A. Place the client on contact precautions.
- B. Start a high-fiber diet.
- C. Administer an oral steroid.
- D. Make the client NPO.
Correct Answer: D
Rationale: Normal glucose requires no action.
A nurse administers an opioid analgesic to a postoperative client who also has severe obstructive sleep apnea (OSA). Which intervention is most important for the nurse to implement before leaving the client alone?
- A. Remove dentures or other oral appliance.
- B. Elevate the head of the bed to a 45-degree angle.
- C. Apply the client’s positive airway pressure device.
- D. Put and lock the side rails in place.
Correct Answer: C
Rationale: CPAP prevents airway collapse.