Nokea
The nurse is caring for a client receiving IV vancomycin. The trough level is 14 mcg/mL. The next dose is now due. What is the correct response by the nurse?
- A. give the next dose as ordered
- B. wait 2 hours and redraw the trough
- C. wait 30 minutes and redraw the trough
- D. hold the dose and notify the health care provider
Correct Answer: A
Rationale: A vancomycin trough of 14 mcg/mL is within the therapeutic range (10-20 mcg/mL), so the next dose can be given as ordered.
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A client who has been diagnosed with lung cancer is starting a smoking-cessation program. Which of the following drugs would the nurse expect to be included in the program's plan?
- A. Bupropion SR (Zyban)
- B. Metoproterenol (Alupent)
- C. Oxitropium (Oxivent)
- D. Alprazolam (Xanax)
Correct Answer: A
Rationale: Bupropion SR (Zyban) is commonly used in smoking cessation programs to reduce nicotine cravings and withdrawal symptoms.
The nurse is caring for a client who is receiving mechanical ventilation. The ventilator alarms are sounding, and the nurse notes high-pressure alarms. Which of the following actions should the nurse take FIRST?
- A. Suction the client’s airway.
- B. Notify the respiratory therapist.
- C. Check the ventilator tubing for kinks.
- D. Administer a bronchodilator.
Correct Answer: C
Rationale: checking for kinks in the tubing is the first step, as it is a common cause of high-pressure alarms
A client on a mechanical ventilator begins to fight the ventilator. Which medication will be ordered for the client?
- A. Sublimaze (fentanyl)
- B. Pavulon (pancuronium bromide)
- C. Versed (midazolam)
- D. Atarax (hydroxyzine)
Correct Answer: B
Rationale: Pavulon, a neuromuscular blocker, is used to paralyze respiratory muscles in clients fighting the ventilator, ensuring effective ventilation.
The nurse is assisting in the care of a patient who is 2 days post-operative from a hemorrhoidectomy. The nurse would be correct in instructing the patient to:
- A. Avoid a high-fiber diet
- B. Continue to use ice packs
- C. Take a laxative daily to prevent constipation
- D. Use a sitz bath after each bowel movement
Correct Answer: D
Rationale: A sitz bath promotes healing and relieves pain after a hemorrhoidectomy by keeping the area clean and reducing inflammation.
A nursing instructor demonstrates to several students how to wrap an amputated limb in a bandage using a figure eight technique. Which of the following correctly states the benefits of this technique? Select all that apply.
- A. prevents blood clots from forming
- B. reduces post-operative swelling
- C. minimizes pain and discomfort
- D. prevents exposure to air
Correct Answer: B,C
Rationale: The figure-eight technique reduces swelling (B) by promoting venous return and minimizes pain (C) by stabilizing the limb. It does not prevent clots (A) or air exposure (D).