Nokea
The hospitalized child who has a blood lead level of 50 mcg/dL is to receive succimer 10 mg/kg oral capsule q8h for 5 days. The child weighs 20 kg. Which intervention by the student nurse should be corrected by the observing nurse?
- A. Prepares to give the total dose of one 100-mg capsule with applesauce
- B. Sprinkles the beads of two 100-mg capsules into pudding for administration
- C. Offers fluids frequently during the shift to increase the child's urine output
- D. Explains to a parent that chelation therapy removes the lead from the blood
Correct Answer: A
Rationale: A: The 20-kg child should receive two capsules of succimer (Chemet), not one. Dose (mg) = 20 kg x 10 mg/kg = 200 mg. B: Succimer capsules can be opened and sprinkled on a small amount of food or in liquid to be swallowed; two 100-mg capsules = 200 mg, which is the correct dose. C: Fluids should be increased to prevent renal damage because succimer is excreted by the kidneys. D: Succimer forms a water-soluble compound with lead, allowing urinary elimination of excessive amounts of lead. Lead is removed from the blood, and theoretically some lead is removed from tissues and organs.
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Which of the following is not a nursing responsibility when preparing the client for central line insertion?
- A. advancing the guidewire
- B. explaining the procedure to the client
- C. maintaining sterile technique
- D. ensuring necessary consents are signed
Correct Answer: A
Rationale: The nursing responsibilities include explaining the procedure to the client, ensuring necessary consents are signed according to the facility policy, and maintaining sterile technique when preparing the equipment and supplies. The guidewire will be advanced by the practitioner inserting the central line.
The 14-year-old who has GERD is receiving lansoprazole. Which response should the nurse expect if lansoprazole is achieving the desired therapeutic effect?
- A. Increased appetite
- B. Increased GI motility
- C. Decreased epigastric pain
- D. Decreased rectal flatulence
Correct Answer: C
Rationale: A: Lansoprazole would not be expected to change appetite. B: Lansoprazole is not a gastric motility agent. C: Lansoprazole (Prevacid) is a PPI of stomach acid secretion. Decreasing the overall pH allows the gastric mucosa to heal. D: Flatulence is not affected.
A client has chronic respiratory acidosis caused by end-stage chronic obstructive pulmonary disease (COPD). Oxygen is delivered at 1 L/min per nasal cannula. The nurse teaches the family that the reason for this is to avoid respiratory depression, based on which of the following explanations?
- A. COPD clients are stimulated to breathe by hypoxia.
- B. COPD clients depend on a low carbon dioxide level.
- C. COPD clients tend to retain hydrogen ions if they are given high doses of oxygen.
- D. COPD clients thrive on a high oxygen level.
Correct Answer: A
Rationale: COPD clients are compensating for low oxygen and high carbon dioxide levels. Hypoxia is the main stimulus to breathe in persons with chronic hypercapnia. Increasing the level of oxygen decreases the stimulus to breathe.
The nurse is caring for the client with CA receiving piroxicam. Which instruction is most important for the nurse to include in the medication teaching plan?
- A. Take piroxicam with food to decrease stomach irritation.
- B. If your pain is severe, you can take another piroxicam pill.
- C. Lie down until piroxicam is effective for controlling your pain.
- D. You can take ginkgo for an energy boost when taking piroxicam.
Correct Answer: A
Rationale: A: Piroxicam (Feldene) should be taken with food and a full glass of water to prevent gastric irritation and possible bleeding. B: Piroxicam is administered in a once-daily dose, and additional doses should not be taken. C: Because of the gastric irritation and possible reflux, the client should sit upright after taking piroxicam. D: Ginkgo interacts with piroxicam, increasing the risk for bleeding.
The nurse is caring for a group of clients all in need of pain medication. The nurse has determined the most appropriate pain medication for each client based on the client's level of pain. Prioritize the order that the nurse should plan to administer the pain medications, beginning with the most potent analgesic for the client with the most severe pain.
- A. Ketorolac 10 mg oral
- B. Fentanyl 0.1 mg IV bolus per patient-controlled analgesia (PCA)
- C. Hydromorphone 5 mg oral
- D. Morphine sulfate 4 mg IV
- E. Propoxyphene 65 mg oral
Correct Answer: B,D,C,A,E
Rationale: B: Fentanyl 0.1 mg IV bolus per PCA. Fentanyl (Sublimaze), the most potent of the medications, is an opioid narcotic analgesic that binds to opiate receptors in the CNS, altering the response to and perception of pain. A dose of 0.1 to 0.2 mg is equivalent to 10 mg of morphine sulfate. D: Morphine sulfate 4 mg IV. Morphine sulfate is also an opioid analgesic. This dose is IV and would be fast-acting. C: Hydromorphone 5 mg oral. Hydromorphone (Dilaudid), another opioid analgesic, would be next in priority. The oral dosing of this medication would indicate that the client's pain is less severe than the client receiving fentanyl or morphine sulfate. Hydromorphone 7.5 mg oral is an equianalgesic dose to 30 mg of oral morphine or 10 mg parenteral morphine. A: Ketorolac 10 mg oral. Ketorolac (Toradol) is an NSAID and nonopioid analgesic that inhibits prostaglandin synthesis, producing peripherally mediated analgesia. E: Propoxyphene 65 mg oral. Propoxyphene (Darvon) should be given last. It binds to opiate receptors in the CNS but is used in treating mild to moderate pain. It has analgesic effects similar to acetaminophen's.