Nokea
The nurse is assessing the 13-year-old who has been taking somatropin recombinant. Which findings should the nurse report to an HCP?
- A. Erythematous palmar rash
- B. Blood pressure of 122/74 mm Hg
- C. Random blood glucose of 158 mg/dL
- D. X-ray report noting epiphyseal closure
Correct Answer: D
Rationale: A: Erythematous palmar rash is not associated with the use of GH. B: BP of 122/74 in a 13-year-old is considered normal. C: Although GH use may be associated with blood glucose changes, a random blood glucose of 158 mg/dL is normal. D: Somatropin (Genotropin) recombinant is an injectable GH indicated for children with a deficiency of the hormone. It cannot be given once the epiphyses have closed. The nurse should notify the HCP.
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The 16-year-old, hospitalized for barbiturate overdose, is receiving low-dose dopamine at 1 mcg/kg/min. Which finding in the client's medical record illustrated should prompt the nurse to conclude that dopamine is effective?
- A. Decrease in PACs
- B. Increase in urine output
- C. Decrease in pulse pressure
- D. Increase in the diastolic BP
Correct Answer: B
Rationale: A: Dopamine (Intropin) will have no effect on decreasing the incidence of PACs. B: Low-dose dopamine, 0.5-2.0 mcg/kg/min, acts on dopaminergic receptor sites along afferent arterioles in the glomerulus, dilates the renal vasculature, and improves urine output. C: Positive inotropic effects of dopamine include an increase in systolic BP with an increase in pulse pressure. D: Positive inotropic effects of dopamine include an increase in systolic BP with little or no effect on DBP.
The client with tonsillar cancer is receiving filgrastim. Prior to administering the next dose of filgrastim, the nurse notes that the client's absolute neutrophil count is 11,000/mm3. What is the nurse's best action?
- A. Administer filgrastim as prescribed.
- B. Place the client on neutropenic precautions.
- C. Notify the HCP to question giving filgrastim.
- D. Apply gown, gloves, and mask to enter the room.
Correct Answer: C
Rationale: A: Unnecessary doses can cause leukocytosis (WBCs above 100,000/mm3), an adverse effect of filgrastim. B: A normal neutrophil count is greater than 2000/mm3. Neutropenic precautions and protective wear are unnecessary because the filgrastim has been effective in increasing the neutrophil count. C: Filgrastim (Neupogen) is a granulocyte colony-stimulating factor for treatment of neutropenia. Filgrastim is usually discontinued when the absolute neutrophil count reaches 10,000/mm3. D: A high-efficiency particulate air (HEPA) or N95 mask rather than a regular mask should be worn if the client is severely neutropenic (less than 100/mm3).
The school-aged child taking guanfacine for treating ADHD is being seen by the nurse at school. The child is pale, diaphoretic, and feeling dizzy. What should the nurse do first?
- A. Take the child's blood pressure
- B. Obtain a capillary glucose level
- C. Telephone the parent about the child
- D. Put a cool cloth on the child's forehead
Correct Answer: A
Rationale: Guanfacine (Tenex) can cause hypotension, making blood pressure the first assessment priority.
The client taking sertraline for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the nurse's most appropriate response?
- A. The medication will have to be reduced gradually to prevent undesirable symptoms.
- B. You should not stop the medication without talking to your health care provider first.
- C. It appears that the medication has worked very well. It should be safe to discontinue its use.
- D. You should take this medication indefinitely to prevent recurrence of depressive symptoms.
Correct Answer: A
Rationale: Sertraline (Zoloft) is an SSRI antidepressant. Stopping these abruptly can cause withdrawal symptoms. The dose should be reduced gradually.
At discharge, the nurse documents that the client taking lithium has an accurate understanding of self-care. On which client statement should the nurse base this judgment?
- A. I need to have my blood lithium level checked every 2 weeks.
- B. I should take my lithium on an empty stomach for best absorption.
- C. I know I need to restrict foods high in sugar while I'm taking lithium.
- D. I need to eat foods containing sodium and drink 2 to 3 liters of fluid daily.
Correct Answer: D
Rationale: The client must consume adequate dietary sodium and 2500 to 3000 mL of fluid per day to prevent dehydration leading to lithium toxicity.