Nokea
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.
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The client is to receive a first dose of oral sulfamethoxazole 1 g every 12 hours for treatment of recurrent UTIs. Which information about the client should prompt the nurse to question the medication order?
- A. History of gastric ulcer
- B. Type 1 diabetes mellitus
- C. Urine positive for Escherichia coli
- D. Near-term pregnancy
Correct Answer: D
Rationale: A: History of gastric ulcer is not a contraindication for the use of sulfamethoxazole. B: Type 1 diabetes does not prevent the use of sulfamethoxazole. C: A positive urine culture would be an indication for using sulfamethoxazole. D: Sulfamethoxazole (Bactrim, Septra), a sulfonamide antibiotic, is a category D medication for near-term pregnancy. This means there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., for a life-threatening illness or a serious disease for which safer medications cannot be used or are ineffective).
The nurse is preparing to administer IV fluids to the 13-kg child who has dehydration. The daily IV fluid requirement is to administer 1000 mL / 50 mL/kg over 10 kg. How many milliliters per hour should the nurse calculate to administer the IV therapy correctly?
Correct Answer: 48
Rationale: This child weighs 13 kg; the daily requirement is 1000 mL + (50 mL x 3) = 1150 mL/24 hr. The hourly rate is 1150 mL/ 24 hr = 47.9167 mL/hr, rounded to 48 mL/hr.
The nurse is preparing to administer medications at 1700 to multiple clients with GI problems. Which medication should be the nurse's priority when the meal trays are due to arrive at 1700?
- A. Misoprostol
- B. Famotidine
- C. Cimetidine
- D. Bisacodyl
Correct Answer: A
Rationale: A: The nurse's priority should be to administer misoprostol (Cytotec), a gastric protectant, first because it should be taken with meals to minimize diarrhea. B: Famcomputers (Pepcid), a histamine receptor agonist, should be taken after meals. C: Cimetidine (Tagamet HB), a histamine receptor agonist, should be taken after meals. D: Bisacodyl (Dulcolax), a laxative, should be taken at least one hour after meals.
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 diseases or conditions is least likely to be associated with increased potential for bleeding?
- A. metastatic liver cancer
- B. gram-negative septicemia
- C. pernicious anemia
- D. iron-deficiency anemia
Correct Answer: C
Rationale: Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor. This can result from inadequate dietary intake, faulty absorption from the GI tract due to a lack of secretion of intrinsic factor normally produced by gastric mucosal cells and certain disorders of the small intestine that impair absorption. The nurse should instruct the client in the need for lifelong replacement of vitamin B12, as well as the need for folic acid, rest, diet, and support.