Nokea
The nurse is assessing the client who has begun therapy with duloxetine. Which assessment parameter should be the nurse's priority?
- A. Relief of neuropathic pain
- B. Increase in anxiety or irritability
- C. Liver function test (LFT) results
- D. Experiencing suicidal ideations
Correct Answer: D
Rationale: Duloxetine (Cymbalta) is a serotonin norepinephrine reuptake inhibitor (SSNRI) used in the treatment of major depression. Suicidal ideation is the most acute threat to life and should be assessed, especially when initiating duloxetine.
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The new nurse asks the experienced nurse why the first dose of the MMR vaccine is normally given at 12 to 15 months of age and not earlier, except with international travel. Which explanation by the experienced nurse is correct?
- A. Giving the first dose of the vaccine at 12 to 15 months of age allows the correct interval before the next booster at age 12 years.
- B. A live virus is being given; the chance of measles, mumps, or rubella developing is much higher if given at an earlier age.
- C. A first dose at this age provides passive immunity and decreases the incidence of a child developing any of the diseases.
- D. If given earlier, the vaccine may neutralize the passive immunity to measles from the child's mother and no immunity may result.
Correct Answer: D
Rationale: A: The second dose of the MMR vaccine can be given earlier, provided that at least 4 weeks has elapsed since the first dose. However, a second dose is usually not given earlier because sufficient immunity is usually present. B: The chance of developing only measles is greater if the vaccine is given at a younger age because the vaccine may neutralize the passive antibodies. C: The MMR provides active (not passive) immunity. D: Because the MMR vaccine is a live virus, a person develops a mild form of the diseases after administration, stimulating the body to develop immunity. The passively acquired antibodies to measles can interfere with the child's immune response to the vaccine, and no immunity may result.
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.
Signs of impaired breathing in infants and children include all of the following except:
- A. nasal flaring.
- B. grunting.
- C. seesaw breathing.
- D. quivering lips.
Correct Answer: D
Rationale: Lip quivering is a distracter. Signs of impaired breathing in infants and children include all the other options.
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 3-year-old with LTB is receiving aerosolized racemic epinephrine. Which assessment finding should the nurse recognize as indicating that the treatment is having an adverse effect?
- A. Heart rate of 180 beats/min
- B. Blood pressure of 60/40 mm Hg
- C. Respiratory rate of 25 breaths/min
- D. Pulse oximetry of 90% on room air
Correct Answer: A
Rationale: A: Tachycardia is an adverse effect of racemic epinephrine (AsthmaNefrin). B: Hypertension, not hypotension, is an adverse effect of racemic epinephrine; a BP of 60/40 mm Hg in a 3-year-old indicates hypotension. C: A respiratory rate of 25 breaths/min is normal for a 3-year-old. D: A pulse oximetry reading of 90% is concerning and may indicate the need for supplemental oxygen, but it is not an adverse effect from the medication.