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The 16-year-old, hospitalized for barbiturate overdose, is receiving low-dose dopamine at 1 mcg/kg/min. Which finding in the client's medical record illustrated should prompt the nurse to conclude that dopamine is effective?
- A. Decrease in PACs
- B. Increase in urine output
- C. Decrease in pulse pressure
- D. Increase in the diastolic BP
Correct Answer: B
Rationale: A: Dopamine (Intropin) will have no effect on decreasing the incidence of PACs. B: Low-dose dopamine, 0.5-2.0 mcg/kg/min, acts on dopaminergic receptor sites along afferent arterioles in the glomerulus, dilates the renal vasculature, and improves urine output. C: Positive inotropic effects of dopamine include an increase in systolic BP with an increase in pulse pressure. D: Positive inotropic effects of dopamine include an increase in systolic BP with little or no effect on DBP.
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The client is placed on lorazepam for short-term treatment of anxiety. Which instruction by the nurse is most important with lorazepam use?
- A. Take a second tablet if your anxiety is not being adequately relieved.
- B. If lorazepam is less effective after a few weeks, notify your provider.
- C. Avoid caffeinated foods and beverages, including tea and chocolate.
- D. If you are experiencing drowsiness or dizziness, notify your provider.
Correct Answer: B
Rationale: Lorazepam (Ativan) is a benzodiazepine anxiolytic and sedative-hypnotic medication. If it is less effective after a few weeks, the client may be developing a tolerance to lorazepam, and the HCP should be notified of this.
The client has an order for 0.45 mg Diltiazem. The medication vial has a concentration of 3 mg/mL. How many mL of the drug should be administered?
- A. 0.15 mL
- B. 6.6 mL
- C. 1.5 mL
- D. 0.65 mL
Correct Answer: A
Rationale: The correct calculation is 0.45 / 3 which equals 0.15 mL.
The LPN is about to give 100 mg Lopressor (metoprolol) to a client. Before administering the drug, he takes the patient's vitals, which are as follows: Pulse: 58, Blood Pressure: 90/62, Respirations: 18/minute. What action should the LPN take?
- A. Give the client half the prescribed dose and report the findings to the RN on duty.
- B. Give the client double the dose and report the findings to the RN on duty.
- C. Administer the drug and report the findings to the RN on duty.
- D. Hold the drug and report the findings to the RN on duty.
Correct Answer: D
Rationale: Lopressor is given to treat hypertension, and a pulse of 58 and a blood pressure of 90/62 are considered low. To prevent the client from bottoming out, the drug should be held and the findings reported to the RN, who should consult with the attending physician. LPNs should never adjust client dosing, as that is outside of their scope of practice.
While the nurse is completing the assessment of the child with Reye's syndrome, the parent states that multiple OTC medications were given before hospitalization to treat the child's influenza symptoms. Which medication stated by the parent is most important for the nurse to report to the HCP?
- A. Acetaminophen
- B. Bismuth subsalicylate
- C. Pseudoephedrine
- D. Diphenhydramine
Correct Answer: B
Rationale: A: Acetaminophen (Tylenol) is an aspirin-free analgesic and antipyretic. B: Although the etiology of Reye's syndrome is unknown, the condition typically occurs after a viral illness, such as influenza, and is associated with aspirin (acetylsalicylic acid) use during the illness. Bismuth subsalicylate (Pepto-Bismol) contains aspirin. C: Pseudoephedrine (Sudafed) is an allergy and/or cold remedy used for nasal drying and decongestion. This does not contain aspirin. D: Diphenhydramine (Benadryl) is an antihistamine. This does not contain aspirin.
The nurse is assessing the 13-year-old who has been taking somatropin recombinant. Which findings should the nurse report to an HCP?
- A. Erythematous palmar rash
- B. Blood pressure of 122/74 mm Hg
- C. Random blood glucose of 158 mg/dL
- D. X-ray report noting epiphyseal closure
Correct Answer: D
Rationale: A: Erythematous palmar rash is not associated with the use of GH. B: BP of 122/74 in a 13-year-old is considered normal. C: Although GH use may be associated with blood glucose changes, a random blood glucose of 158 mg/dL is normal. D: Somatropin (Genotropin) recombinant is an injectable GH indicated for children with a deficiency of the hormone. It cannot be given once the epiphyses have closed. The nurse should notify the HCP.