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The 9-year-old with SLE is receiving large doses of prednisolone. Which laboratory finding should the nurse recognize as an untoward effect of the medication?
- A. Total bilirubin of 4 mg/dL
- B. WBC count of 18,000/mm3
- C. Serum sodium of 130 mEq/L
- D. Random glucose of 130 mg/dL
Correct Answer: B
Rationale: A: The liver is not affected by prednisolone use, so an increased total bilirubin of 4 mg/dL is not related to the use of the drug. Normal total bilirubin in a 9-year-old should be less than 2 mg/dL. B: A WBC count of 18,000/mm3 may indicate an infection, an untoward effect of prednisolone (Omnipred). Prednisolone, a corticosteroid used to reduce inflammation, may increase the risk of infection. The normal WBC in a 9-year-old is 4500-11,100/mm3. C: Prednisolone has been associated with the adverse effect of hypokalemia, but not hyponatremia. Normal serum sodium is 135-145 mEq/L. D: Although corticosteroids may have the effect of increasing blood glucose, a random glucose of 130 mg/dL is not abnormal.
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The client using latanoprost eye drops for treatment of glaucoma calls the ophthalmology clinic after noting a brown pigmentation of the iris. Which nursing action is most appropriate?
- A. Instruct the client to come to the clinic to have the eyes and medication evaluated.
- B. Schedule an appointment for the client to see an internist for liver function studies.
- C. Tell the client that the pigmentation is from the latanoprost but will eventually regress.
- D. Recommend that the client wear sunglasses when outdoors to decrease iris pigmentation.
Correct Answer: A
Rationale: A: A side effect of latanoprost (Xalatan), a prostaglandin, includes a heightened brown pigmentation of the iris, which stops progressing when latanoprost is discontinued. B: Jaundiced sclera, and not brown iris pigmentation, would suggest the need to evaluate liver function. C: The brown iris pigmentation from the latanoprost does not usually regress. D: Wearing sunglasses will have no effect on the iris pigmentation.
Which of the following is true when administering a nasal spray medication?
- A. The client should blow their nose gently before the medication is administered.
- B. The medication should be sprayed in front of the nose.
- C. The medication should be administered as the patient exhales.
- D. The client should lay flat when the medication is administered.
Correct Answer: A
Rationale: The client should blow their nose gently before the medication is administered. This is to clear the nasal passages to allow the medication to be properly administered. When administering the medication, the client should sit upright, insert the applicator into the designated nostril, and spray the medication as the patient inhales.
A 20-year-old obese female client is preparing to have gastric bypass surgery for weight loss. She says to the nurse, 'I need this surgery because nothing else I have done has helped me to lose weight.' Which response by the nurse is most appropriate?
- A. If you eat less, you can save some money.'
- B. Exercise is a healthier way to lose weight.'
- C. You should try the Atkins diet first.'
- D. I respect your decision to choose surgery.'
Correct Answer: D
Rationale: This statement is most appropriate, as it shows respect and empathy. The other statements are both insensitive and unprofessional.
The nurse notes from the child's MAR illustrated that the child is to receive the first dose of a newly prescribed medication at 0800 hours. The drug reference book recommends an initial pediatric dose of lamotrigine of 0.6 mg/kg/day in two divided doses for the first 2 weeks. Which action by the nurse is most appropriate?
- A. Administer the medication as written on the MAR.
- B. Telephone the health care provider to question the dose.
- C. Ask the parent if this is the dose the child had been taking.
- D. Consult the pharmacist to verify whether the dose is correct.
Correct Answer: B
Rationale: A: Although the medication is written on the MAR, an error still exists in the dose, and the medication should not be administered. B: The nurse should notify the HCP. The child weighs 30 kg; the recommended initial daily dose of lamotrigine (Lamictal) for this child would be 18 mg (0.6 x 30 = 18 mg). If given 18 mg bid, the child would receive a daily dose of 36 mg, twice the recommended initial pediatric dose. C: The child has a new-onset seizure disorder; it is unlikely that the child was taking this medication prior to hospitalization. D: Consulting the pharmacist is unnecessary; the nurse still needs to seek clarification from the HCP.
The new nurse is initiating TPN for four hospitalized pediatric clients. The experienced nurse should intervene when observing the new nurse attach the TPN infusion tubing to which IV line?
- A. The catheter inserted in the right external jugular vein of the 2-year-old
- B. The catheter inserted in the right subclavian vein of the 4-year-old
- C. The peripherally inserted IV catheter in a hand vein of the 12-year-old
- D. The PICC located in the right upper arm of the 6-year-old
Correct Answer: C
Rationale: A: The external jugular vein is a central IV access site. B: The subclavian vein is a central IV access site. C: TPN is a concentrated hypertonic solution containing glucose, vitamins, electrolytes, trace minerals, and protein. Because it is hypertonic, it should be administered through a central IV access site or a PICC. A major vein is used to avoid inflammatory reactions and venous thrombosis from the high-caloric and high-osmotic fluid. D: A PICC is a central IV access site.