Nokea
An adolescent client with meningococcal meningitis is receiving a continuous IV infusion of penicillin G. How many mL/hour should the nurse program the infusion pump to deliver?
- A. 83
- B. 85
- C. 87
- D. 90
Correct Answer: A
Rationale: The correct answer is A: 83. The pharmacy provided the infusion at 10 million units per liter, which requires a rate of 83 mL/hour. To calculate this, multiply the dosage by the volume of the IV solution and divide by the concentration of the IV solution in million units: 10 million units per liter x 8.3 L = 83 mL/hour. Choices B, C, and D are incorrect as they do not align with the calculation based on the given information.
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What symptoms suggest the dosage of levothyroxine sodium is too high in a 26-year-old client with simple goiter?
- A. Bradycardia and constipation.
- B. Palpitations and shortness of breath.
- C. Lethargy and lack of appetite.
- D. Muscle cramps and dry skin.
Correct Answer: B
Rationale: The correct answer is B: Palpitations and shortness of breath. These symptoms suggest excessive thyroid hormone levels, indicating that the levothyroxine dose is too high. Bradycardia and constipation (choice A) are more indicative of hypothyroidism, which occurs when thyroid hormone levels are low. Lethargy and lack of appetite (choice C) are also common symptoms of hypothyroidism. Muscle cramps and dry skin (choice D) can be associated with various conditions but are not specific to a high dosage of levothyroxine.
The nurse is caring for a 69-year-old client with a diagnosis of hyperglycemia. Which tasks could the nurse delegate to the unlicensed assistive personnel (UAP)?
- A. Test blood sugar every 2 hours using Accu-Chek
- B. Review signs of hyperglycemia with the family and client
- C. Administer insulin if the blood sugar is elevated
- D. Measure the client's urine output
Correct Answer: D
Rationale: The correct answer is D because measuring urine output is a task that falls within the UAP's scope of practice and does not require clinical decision-making. Choice A is incorrect because testing blood sugar using Accu-Chek involves interpreting results and possible adjustments, which require a licensed healthcare provider. Choice B is incorrect as discussing signs of hyperglycemia involves education and interpretation that should be done by a nurse. Choice C is incorrect since administering insulin is a high-risk task that necessitates precise dosing and monitoring, thus should not be delegated to UAP.
A male client with a history of deep vein thrombosis (DVT) is admitted with new onset shortness of breath and a productive cough. What is the nurse's priority action?
- A. Administer prescribed anticoagulant.
- B. Notify the healthcare provider.
- C. Auscultate lung sounds.
- D. Prepare for chest physiotherapy.
Correct Answer: A
Rationale: Administering an anticoagulant is the nurse's priority action in this situation. Given the client's history of DVT and the presentation of new onset shortness of breath and a productive cough, there is a concern for a pulmonary embolism, which is a life-threatening complication of DVT. Administering an anticoagulant promptly is crucial to prevent further clot formation and to manage the existing clot, reducing the risk of pulmonary embolism. While auscultating lung sounds and preparing for chest physiotherapy are important actions in respiratory assessment and management, the priority in this case is to address the potential complication of a pulmonary embolism by administering the anticoagulant. Notifying the healthcare provider can be done after initiating the immediate intervention of anticoagulant therapy.
A client is admitted to the hospital with a diagnosis of pneumonia. The client is prescribed intravenous antibiotics and oxygen therapy. Which assessment finding indicates that the client's condition is improving?
- A. Increased white blood cell count
- B. Crackles heard on lung auscultation
- C. Productive cough with green sputum
- D. Decreased respiratory rate from 24 to 18 breaths per minute
Correct Answer: D
Rationale: A decrease in respiratory rate indicates that the client's breathing is becoming more stable, which suggests an improvement in their condition. Respiratory rate is a critical indicator of respiratory status and oxygenation. Increased white blood cell count (choice A) suggests ongoing infection, crackles on lung auscultation (choice B) indicate fluid in the lungs, and productive cough with green sputum (choice C) may indicate persistent infection or airway inflammation, which do not necessarily reflect improvement in pneumonia.
A client with Type 2 diabetes is admitted with frequent hyperglycemic episodes and glycosylated hemoglobin (A1C) of 10%. What actions should the nurse include in the client's plan of care?
- A. Mixing glargine with aspart insulin to manage glucose levels.
- B. Teaching foot care to prevent injuries.
- C. Coordinating carbohydrate-controlled meals and subcutaneous injections.
- D. Reviewing site rotation for insulin injections.
Correct Answer: C
Rationale: In managing a client with Type 2 diabetes experiencing frequent hyperglycemic episodes and with a high A1C level, it is crucial to coordinate carbohydrate-controlled meals and subcutaneous injections. This approach helps regulate blood glucose levels effectively. Mixing glargine with aspart insulin (Choice A) is not a recommended practice as these insulins have different onset and peak times. Teaching foot care (Choice B) is important in diabetes management but is not the priority in this scenario. Reviewing site rotation for insulin injections (Choice D) is important to prevent lipodystrophy but is not the immediate action needed to address the client's hyperglycemia and high A1C level.