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The child weighing 20 kg is to receive ceftriaxone 2 g IVPB q12h and dexamethasone 3 mg IV-push q6h for 4 days to treat Haemophilus influenzae type b meningitis. The drug reference states that the usual dose of ceftriaxone is 100 mg/kg/dose with a maximum daily dose of 4 g. The recommended dose of dexamethasone for treating H. influenzae type b meningitis is 0.15 mg/kg q6h for 2 to 4 days. Based on the medications prescribed and these findings, which conclusion by the nurse is correct?
- A. The dose of ceftriaxone is too high.
- B. The dose of dexamethasone is too low.
- C. Both medications are safe to administer as prescribed.
- D. The ceftriaxone should be given before the dexamethasone.
Correct Answer: C
Rationale: A: The dose for ceftriaxone is correct (100 mg x 20 kg = 2000 mg; 1000 mg = 1 g; 2000 mg = 2 g). B: The dose of dexamethasone is correct (0.15 mg x 20 kg = 3 mg). C: The doses of ceftriaxone (Rocephin) and dexamethasone (Decadron) are at the recommended doses. D: An IV-push medication takes less time to administer than an IV piggyback (IVPB) medication. The dexamethasone should be administered first.
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Which of the following should not be included in the teaching for clients who take oral iron preparations?
- A. Mix the liquid iron preparation with antacids to reduce GI distress
- B. Take the iron with meals if GI distress occurs
- C. Liquid forms should be taken with a straw to avoid discoloration of tooth enamel
- D. Oral forms should be taken with juice, not milk
Correct Answer: A
Rationale: Iron should not be mixed with antacids, as antacids can reduce iron absorption. The other options are appropriate: taking with meals can reduce GI distress, using a straw prevents tooth discoloration, and juice enhances absorption while milk can inhibit it.
The client with ulcerative colitis is started on sulfasalazine. The nurse overhears the client talking with family members about sulfasalazine and recognizes the need for more teaching when the client makes which statement?
- A. I'll be taking sulfasalazine to help control my diarrhea.
- B. Sulfasalazine will decrease the inflammation in my colon.
- C. After a year of taking sulfasalazine, I'll be cured of the disease.
- D. Sulfasalazine will help to prevent exacerbations of my disease.
Correct Answer: C
Rationale: A: Sulfasalazine reduces inflammation and thereby will reduce the number of diarrheal stools. B: Sulfasalazine, commonly used to treat ulcerative colitis, decreases inflammation in the colon. C: This statement indicates the client needs additional teaching. Ulcerative colitis is a chronic illness. Sulfasalazine (Azulfidine) does not cure ulcerative colitis; the only cure is a total proctocolectomy. D: Sulfasalazine reduces inflammation and thereby will reduce the incidence of flare-ups from ulcerative colitis.
An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?
- A. It protects the bacteria from antibiotic and immunologic destruction.
- B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.
- C. It competes with the antibiotic for binding sites on the microbe.
- D. Glycocalyx provides nutrients for microbial growth.
Correct Answer: A
Rationale: Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes, enhancing adherence to surfaces, resisting phagocytic engulfment, and preventing antibiotics from contacting the microbe.
The nurse is providing teaching to the client receiving a thiazide diuretic. Which points should the nurse plan to include? Select all that apply.
- A. Take the radial pulse before setting up the medication.
- B. Include fruits such as melons and bananas in the diet.
- C. Report side effects such as muscle cramps, nausea, or a skin rash.
- D. Take the last dose at bedtime when fluids are at the highest level.
- E. Avoid high-fat foods; thiazide diuretics increase cholesterol levels.
Correct Answer: B,C,E
Rationale: A: It is unnecessary for the client to monitor the pulse prior to taking thiazide diuretics. B: Thiazide diuretics can cause hypokalemia, and potassium-rich foods can help maintain potassium levels. C: Muscle cramps are a sign of possible medication side effects of hypokalemia and hypocalcemia. Nausea and rash are also medication side effects. D: A diuretic taken at bedtime can cause nocturia and loss of sleep. The usual timing of the last daily dose of a diuretic is at suppertime. E: Thiazide diuretics can increase serum cholesterol, LDL, and triglyceride levels, so teaching the client to avoid high-fat foods will help maintain cholesterol levels.
The client is experiencing delirium from substance withdrawal. Which medication, if prescribed prn, should the nurse administer to help calm the client?
- A. Flumazenil_1.PNG
- B. Flumazenil_2.PNG
- C. Flumazenil_3.PNG
- D. Flumazenil_4.PNG
Correct Answer: D
Rationale: Lorazepam (Ativan) depresses the CNS, reducing anxiety and calming the client during withdrawal.