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The 16-year-old is taking acyclovir. Which statement, if made by the adolescent, should indicate to the nurse that the medication is having the desired therapeutic effect?
- A. I am having a regular menstrual cycle now.
- B. That bad odor from my vagina is now gone.
- C. All those sores on my labia are getting better.
- D. I don't have that green vaginal discharge anymore.
Correct Answer: C
Rationale: A: A side effect of acyclovir is a change in the menstrual cycle; however, having a regular menstrual cycle is not the desired therapeutic effect. B: A bad odor from the vagina is a symptom of bacterial vaginosis or trichomoniasis vaginalis, and usually not a symptom of genital herpes simplex. C: Acyclovir (Zovirax), an antiviral medication, is indicated for the treatment of genital herpes simplex virus, shingles, or chicken pox. Labial sores are associated with genital herpes simplex. Improvement of labial sores indicates that acyclovir is having the desired therapeutic effect. D: A green vaginal discharge may be a symptom of Trichomonas, which is treated with metronidazole (Flagyl), an amebicide.
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A pregnant client asks how she can prevent getting Group B Strep. What is the LPN's best response?
- A. You should have your partner wear a condom every time you have intercourse.
- B. You cannot prevent getting Group B Strep, you can only treat it.
- C. You should be extra vigilant about hand-washing, especially in the third trimester.
- D. The Group B Strep vaccine is the only proven way to prevent the disease.
Correct Answer: B
Rationale: Group B Strep lives in the vagina, rectum, and intestines of about 25% of the female population. It is considered normal flora and is not a sexually transmitted disease. The same woman can test positive in one pregnancy and negative in another, which is why testing is done every pregnancy, usually within 5 weeks of expected delivery. If a woman tests positive for Group B Strep, she will be given antibiotics during delivery to greatly reduce the risk of complications for her and her baby.
The home care nurse is observing the child with asthma self-administer a dose of albuterol via a metered-dose inhaler with a spacer. Within a short time, the child begins to wheeze loudly. What should the nurse do?
- A. Reassure the parent that this usually only occurs with the initial dose.
- B. Notify the HCP; wheezing may indicate paradoxical bronchospasms.
- C. Consult with the HCP to have the child's medication dosage increased.
- D. Reassess the technique; eye contact with albuterol can cause wheezing.
Correct Answer: B
Rationale: A: Reassuring the parent is an inappropriate action; the wheezing is not a normal reaction. There is no indication that this is an initial dose. B: The client's wheezing suggests paradoxical bronchospasms, which can occur with excessive use of adrenergic bronchodilators such as albuterol (Proventil). The medication should be withheld and the HCP notified. C: A paradoxical bronchospasm can occur from excessive use, so the dosage should not be increased. D: Contact with the eyes can cause eye irritation, not wheezing.
The 11-year-old with type 1 DM is learning to use insulin pens for basal-bolus insulin therapy with both a very-long-acting insulin and rapid-acting insulin. Which action by the child should indicate to the nurse that additional teaching is needed?
- A. The child holds the insulin glargine pen against the skin for 10 seconds after administering the correct amount of insulin.
- B. The child counts the number of carbohydrates eaten at breakfast and selects the insulin lispro pen for covering the carbohydrates eaten.
- C. The child counts the number of carbohydrates eaten at lunch and selects the insulin glargine pen for covering the carbohydrates eaten.
- D. The child determines that the blood glucose level at bedtime is within the normal range, eats a piece of turkey, and tells the nurse that coverage is not needed with insulin lispro.
Correct Answer: C
Rationale: A: To ensure that the medication is administered with the insulin pens, the pen is held in place for 10 seconds after delivery of the medication. This action is correct. B: Insulin lispro (Humalog) is rapid-acting insulin with an onset of 5 to 10 minutes. This action is correct. C: Insulin glargine (Lantus) is very-long-acting insulin administered once daily and is not used for covering the number of carbohydrates eaten. This action indicates the child needs additional teaching. D: The rapid-acting insulin lispro (Humalog) is not needed if the glucose level is WNL. Turkey does not contain carbohydrates; insulin is administered to cover only the carbohydrates eaten. This action is correct.
The client is beginning treatment with bupropion for depression. After meeting with the HCP, the client tells the nurse, “I'm also taking Zyban to help me stop smoking.†Which is the most appropriate action for the nurse?
- A. Encourage and support the client in following the smoking cessation regimen.
- B. Provide the client with the telephone number for a smoking cessation support group.
- C. Instruct the client to report any allergic-type reactions after beginning the bupropion.
- D. Inform the HCP that the client is already taking bupropion, but for smoking cessation.
Correct Answer: D
Rationale: Bupropion (Zyban) should not be used for multiple conditions simultaneously due to the risk of seizures from additive doses.
The 4-year-old with meningitis is to receive ceftriaxone 750 mg IVPB over 30 minutes. The pharmacy provided 750 mg in 50 mL D5W to be infused IVPB through a microdrip infusion system (tubing drop factor 60 gtt/min). At what rate, in gtt per min, should the nurse program the IVPB pump?
Correct Answer: 100
Rationale: Volume to be infused is 50 mL over 30 minutes. Calculate mL/min: 50 mL/ 30 min = 1.6667 mL/min. Convert to gtt/min using the drop factor: 1.6667 mL/min x 60 gtt/mL = 100 gtt/min.