Nokea
The 12-year-old weighing 50 kg is hospitalized with bacterial pneumonia and an upper respiratory tract infection. The nurse is reviewing the child's serum laboratory report illustrated. Based on the findings, which HCP order is most important for the nurse to question?
- A. Amikacin sulfate 375 mg IVPB q12h
- B. Guaifenesin 50-100 mg q4h prn for cough
- C. Dextrose 5% in 0.25 NaCl with 20 mEq/L KCl at 90 mL/hr
- D. Acetaminophen 325-650 mg q4-6h prn, not to exceed 3000 mg/24 hr
Correct Answer: A
Rationale: A: Amikacin (Amikin) is an aminoglycoside, which is nephrotoxic and should be questioned. The serum creatinine and BUN levels are elevated, suggesting decreased renal function. B: Guaifenesin (Robitussin) is used for cough. The dose is within the range for a child of 12 years. C: The serum osmolality is high, suggesting dehydration, and the potassium is low. D5 in 0.25 NaCl with 20 mEq/L at 90 mL/hr will treat the dehydration and hypokalemia. D: The acetaminophen (Tylenol) dose is within parameters, but it is concerning with the decreased renal function. Because acetaminophen is prn and amikacin is timed, the amikacin is more important to question.
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Which of the following actions should the LPN perform for a client with an active digoxin IV order? Select all that apply. A. Monitor ECG rhythm throughout administration., B. Administer the medication over at least 5 minutes., C. Monitor respirations during administration., D. Monitor the client's pulse for 1 minute prior to administration., E. Assess the client's blood pressure.
- A. A, D
- B. A, B, D
- C. B, C
- D. A, D, E
Correct Answer: A
Rationale: The LPN should monitor the client's heart rate and ECG with digoxin administration. Digoxin should not be given if a client's pulse is less than 60 bpm. Measuring blood pressure and respiratory rate are not indicated with digoxin administration. Administering an IV medication is outside of the LPN's scope of practice.
Which of the following are included in the Rights of Medication Administration? Select all that apply. A. right dose, B. right time, C. right explanation, D. right client, E. right route
- A. B, C, D, E
- B. A, B, D, E
- C. A, B, D
- D. B, C, E
Correct Answer: B
Rationale: The Rights of Medication Administration include right client, right drug, right dose, right route, and right time. An additional right that is sometimes included is right documentation.
The nurse completes teaching insulin administration to the parent of the toddler newly diagnosed with type 1 DM. The nurse concludes that the teaching was successful when the parent makes which statement?
- A. NPH insulin is only given at night immediately before the bedtime snack.
- B. I should use only the buttocks for the insulin injections until the child is older.
- C. Insulin lispro acts within 15 minutes and peaks 30 to 90 minutes after injection.
- D. Insulin detemir can be added to the insulin lispro pen to reduce the number of injections.
Correct Answer: C
Rationale: A: NPH (Humulin N) insulin can be given in the morning, but there is better glucose control if given at night. NPH peaks in 4 to 14 hours, so there is no need to make sure food is given immediately after administration. B: Insulin injections should always be rotated to prevent subcutaneous tissue damage from giving the injections in the same location. C: Lispro (Humalog) is rapid-acting insulin that peaks in 30 to 90 minutes and may last as long as 5 hours in the blood. This statement is correct, indicating teaching is effective. D: Detemir (Levemir) is long-acting and lispro (Humalog) is rapid-acting insulin. An insulin pen uses prefilled, multiple-use insulin cartridges; adding other types of insulins should not be attempted.
Which statement best describes electrolytes in intracellular and extracellular fluid?
- A. There is a greater concentration of sodium in extracellular fluid and potassium in intracellular fluid
- B. There is an equal concentration of sodium and potassium in extracellular fluid
- C. There is a greater concentration of potassium in extracellular fluid and sodium in intracellular fluid
- D. There is an equal concentration of sodium and potassium between intracellular and extracellular fluid
Correct Answer: A
Rationale: There is a greater concentration of sodium in extracellular fluid and potassium in intracellular fluid, maintaining cellular function and fluid balance.
The client taking tranylcypromine develops a list of possible meal plans. Which meal plans should the nurse identify as safe for the client? Select all that apply.
- A. Pepperoni pizza, Caesar salad, 16 oz iced tea
- B. Grilled pork loin, rice, green beans, 12 oz diet clear soda
- C. Grilled salmon, steamed broccoli, 12 oz lemon-lime soda
- D. Baked chicken, mashed potatoes and gravy, 8 oz 2% milk
- E. Granola with raisins and almonds, low-fat yogurt, and 8 oz coffee
- F. Beef burritos with sour cream and guacamole topping, corn chips, 12 oz beer
Correct Answer: B,C,D
Rationale: Meals without tyramine (e.g., pepperoni, raisins, yogurt, sour cream, avocados, beer) are safe for clients taking MAOIs like tranylcypromine.