Nokea
The nurse has received the morning report and has the following medications due or being requested. In which order should the nurse administer the medications? List in order of priority.
- A. Administer furosemide (Lasix), a loop diuretic, IVP daily to a client diagnosed with heart failure who is dyspneic on exertion.
- B. Administer morphine, a narcotic analgesic, IVP prn to a client diagnosed with lower back pain who is complaining of pain at a '10' on a 1-to-10 scale.
- C. Administer neostigmine (Prostigmin), a cholinesterase inhibitor, PO to a client diagnosed with myasthenia gravis.
- D. Administer lidocaine, an antidysrhythmic, IVP prn to a client in normal sinus rhythm with multifocal premature ventricular contractions.
- E. Administer vancomycin, an aminoglycoside antibiotic, to a client diagnosed with a Staphylococcus infection who has a trough level of 14 mg/dL.
Correct Answer: B,D,A,C,E
Rationale: 1) Morphine for severe pain (acute, 10/10); 2) Lidocaine for PVCs (cardiac risk); 3) Furosemide for dyspnea (respiratory distress); 4) Neostigmine for myasthenia (muscle strength); 5) Vancomycin (infection, stable trough).
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A client in respiratory distress is admitted with arterial blood gas results of PH 7.30, PO2 58, PCO2 34, and HCO3 19. The nurse determines that the client is in
- A. metabolic acidosis
- B. metabolic alkalosis
- C. respiratory acidosis
- D. respiratory alkalosis
Correct Answer: A
Rationale: metabolic acidosis. These lab values indicate metabolic acidosis: the PH is low, PCO2 is normal, and bicarbonate level is low.
A 19-year-old woman has just started taking birth control pills. She calls the clinic nurse to say that her breasts are tender and she is nauseous. The nurse's response is based on which understanding?
- A. These are serious side effects.
- B. These effects usually decrease after three to six cycles.
- C. Taking the pill in the morning reduces its side effects.
- D. Taking the pills every other day reduces its side effects.
Correct Answer: B
Rationale: Breast tenderness and nausea are common initial side effects of oral contraceptives, typically resolving after a few cycles.
A pregnant woman is hospitalized for treatment of pregnancy induced hypertension (PIH) in the third trimester. She is receiving magnesium sulfate intravenously. The nurse understands that this medication is used mainly for what purpose?
- A. Maintain normal blood pressure
- B. Prevent convulsive seizures
- C. Increase the respiratory rate
- D. Increase uterine blood flow
Correct Answer: B
Rationale: Prevent convulsive seizures. Magnesium sulfate is a central nervous system depressant. While it has many systemic effects, it is used in the client with pregnancy induced hypertension (PIH) to prevent seizures.
The client with epilepsy is prescribed carbamazepine (Tegretol), an anticonvulsant. Which discharge instruction should the nurse include in the teaching?
- A. Wear SPF 15 sunscreen when outside.
- B. Obtain regular serum drug levels.
- C. Be sure to floss teeth daily.
- D. Instruct the client to take tub baths only.
Correct Answer: B
Rationale: Carbamazepine requires serum level monitoring to ensure therapeutic range and avoid toxicity. Sunscreen, flossing, or baths are less relevant.
The nurse is preparing to administer Synthroid, a thyroid hormone replacement, to the client diagnosed with hypothyroidism. Which assessment data would indicate the client is receiving too much medication?
- A. Bradypnea and weight gain.
- B. Lethargy and hypotension.
- C. Irritability and tachycardia.
- D. Normothermia and constipation.
Correct Answer: C
Rationale: Excess Synthroid causes hyperthyroidism symptoms like irritability and tachycardia. Bradypnea, lethargy, or constipation suggest hypothyroidism.