Nokea
The client with CRF is receiving epoetin alfa. Which finding should indicate to the nurse that the action of the medication has been effective?
- A. Urine output increased to 30 mL per hour
- B. Hemoglobin 12 g/dL and hematocrit 36%
- C. BP 110/70 mm Hg and heart rate 68 bpm
- D. Reports an increased energy level and less fatigue
Correct Answer: B
Rationale: A: Epoetin alfa does not have an effect on urine output or BP. B: Epoetin alfa stimulates erythropoiesis, or the production of RBCs. It is used in treating anemias associated with decreased RBC production, such as in renal failure. Hgb and Hct are used to evaluate the medication's effectiveness. The target Hgb for the client with CRF is 12 g/dL. C: Epoetin alfa does not have an effect on BP or HR. D: The client may report increased energy and less fatigue because of the increased Hgb levels, but these findings are not used to evaluate the medication's action.
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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.
The nurse is preparing to administer morphine sulfate IV to the child in severe pain. The child has an IV infusion of D5W at 50 mL/hr through a PICC. Which intervention is best when administering the medication?
- A. Disconnect the infusion, inject 3 mL of normal saline, and give the morphine sulfate undiluted.
- B. Question the prescribed medication because morphine sulfate cannot be given through a PICC line.
- C. Give the morphine sulfate undiluted into the existing IV tubing's medication port closest to the child.
- D. Dilute the morphine sulfate with 5 mL of NS and give over 5 minutes into the IV tubing port closest to the child.
Correct Answer: D
Rationale: A: Unnecessary IV disconnections increase the risk for infection. Morphine sulfate is compatible with D5W. B: Morphine sulfate can be administered into a PICC access device. C: Administering undiluted morphine sulfate to a child increases the risk of adverse effects. D: The nurse should dilute the morphine sulfate before administration to prevent too-rapid administration and adverse effects. A single dose should be given over 4 to 5 minutes.
The client calls a clinic to renew the prescription for insulin being administered subcutaneously via an insulin pump. Which insulin type, if prescribed by the HCP, should the nurse question?
- A. Insulin lispro
- B. Insulin aspart
- C. Insulin glulisine
- D. Insulin glargine
Correct Answer: D
Rationale: A: Lispro (Humalog) is a rapid-acting human insulin analog that can be delivered via an insulin pump. B: Aspart (NovoLog) is a rapid-acting human insulin analog that can be delivered via an insulin pump. C: Glulisine (Apidra) is a rapid-acting human insulin analog that can be delivered via an insulin pump. D: The nurse should question if glargine (Lantus) is prescribed. Glargine is long-duration insulin not suited for delivery by an infusion pump.
The nurse is caring for an elderly client and providing education. Which of the following would be least appropriate?
- A. The nurse speaks in a loud voice.
- B. The nurse allows additional time after each instruction to allow the client to process.
- C. The nurse provides supplemental written resources.
- D. The nurse breaks up the education into multiple shorter sessions.
Correct Answer: A
Rationale: The nurse should not speak in a loud voice just because the client is elderly. The nurse should assess the client for a hearing impairment to see if additional assistance is required. However, elderly clients tend to require more time to process information, since their reaction time is slower, and they may benefit from more frequent, shorter sessions as they fatigue easily. Elderly clients are usually capable of absorbing supplemental written resources.
Oral terbutaline is prescribed for the client with bronchitis. Which comorbidity most warrants the nurse's close monitoring of the client following administration of terbutaline?
- A. Strabismus
- B. Hypertension
- C. Diabetes insipidus
- D. Hypothyroidism
Correct Answer: B
Rationale: A: Terbutaline should be used with caution in clients with glaucoma (not strabismus). B: The client's history of hypertension warrants the nurse's close monitoring of the client when terbutaline (Brethine) is administered. It should be used with caution in clients with hypertension because it can precipitate a hypertensive episode. C: Terbutaline should be used with caution in clients with DM (not DI). D: Terbutaline should be used with caution in clients with hyperthyroidism (not hypothyroidism).