Nokea
The nurse is checking postoperative prescriptions and planning care for a 110-pound child after spinal fusion. Morphine sulfate, 8 mg subcutaneously every 4 hours PRN for pain, is prescribed. The pediatric medication reference states that the safe dose is 0.1 to 0.2 mg/kg/dose every 3 to 4 hours. From this information, the nurse determines what about the prescription?
- A. The dose is too low.
- B. The dose is too high.
- C. The dose is within the safe dosage range.
- D. There is not enough information to determine the safe dose.
Correct Answer: C
Rationale: Use the formula to determine the dosage parameters. Convert pounds to kilograms by dividing weight by 2.2. Therefore, 110 lb ÷ 2.2 = 50 kg. Dosage parameters: 0.1 mg/kg/dose × 50 kg = 5 mg; 0.2 mg/kg/dose × 50 kg = 10 mg. Dosage is within the safe dosage range.
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A client receiving total parenteral nutrition (TPN) reports nausea, polydipsia, and polyuria. To determine the cause of the client's report, the nurse should assess which client data?
- A. Rectal temperature
- B. Last serum potassium
- C. Capillary blood glucose
- D. Serum blood urea nitrogen and creatinine
Correct Answer: C
Rationale: Clients receiving TPN are at risk for hyperglycemia related to the increased glucose load of the solution. The symptoms exhibited by the client are consistent with hyperglycemia. The nurse would need to assess the client's blood glucose level to verify these data. The other options would not provide any information that would correlate with the client's symptoms.
The nurse is counseling the family of a terminally ill client about palliative care. The nurse identifies which goals as being those of palliative care? Select all that apply.
- A. The delay of the impending death
- B. Offering a caring support system
- C. Providing measure focused on pain management
- D. Introduction of interventions that enhance the quality of life
- E. Expanding the focus of care to both the client and the family
- F. Addressing the expressed spiritual needs of the client and the family
Correct Answer: B,C,D,E,F
Rationale: Palliative care is a philosophy of total care. Palliative care goals include the following: offering a support system to help the client live as actively as possible until death; providing relief from pain and other distressing symptoms; enhancing the quality of life; offering a support system to help families cope during the client's illness and their own bereavement; affirming life and regarding dying as a normal process, neither hastening nor postponing death; and integrating psychological and spiritual aspects of client care.
A client at risk for respiratory failure is receiving oxygen via nasal cannula at 6 L per minute. Arterial blood gas (ABG) results indicate pH 7.29, PcO2 49 mm Hg, Po2 58 mm Hg, and HCO3 18 mEq/L. What intervention should the nurse anticipate that the primary health care provider will prescribe for respiratory support for this client?
- A. Intubating for mechanical ventilation
- B. Keeping the oxygen at 6 L per minute via nasal cannula
- C. Lowering the oxygen to 4 L per minute via nasal cannula
- D. Adding a partial rebreather mask to the current prescription
Correct Answer: A
Rationale: If respiratory failure occurs and supplemental oxygen cannot maintain acceptable PaO2 and PaCO2 levels, endotracheal intubation and mechanical ventilation are necessary. The client is exhibiting respiratory acidosis, metabolic acidosis, and hypoxemia. Lowering or keeping the oxygen at the same liter flow will not improve the client's condition. A partial rebreather mask will raise CO2 levels even further.
The nurse hangs an intravenous (IV) bag of 1000 mL of 5% dextrose in water (D5W) at 3 pm and sets the flow rate to infuse at 75 mL/hour. At 11 pm, the nurse should expect the fluid remaining in the IV bag to be at approximately which level?
Correct Answer: 400 mL
Rationale: In an 8-hour period, 600 mL would infuse if an IV is set to infuse at 75 mL/hour. Therefore, 400 mL would remain in the IV bag.
A client who experienced repeated pleural effusions from inoperable lung cancer is to undergo pleurodesis. What intervention should the nurse plan to implement after the primary health care provider injects the sclerosing agent through the chest tube to help assure the effectiveness of the procedure?
- A. Ambulate the client.
- B. Clamp the chest tube.
- C. Ask the client to cough and deep breathe.
- D. Ask the client to remain in a side-lying position.
Correct Answer: B
Rationale: After injection of the sclerosing agent, the chest tube is clamped to prevent the agent from draining back out of the pleural space. Depending on primary health care provider preference, a repositioning schedule is used to disperse the substance. Ambulation, coughing, and deep breathing have no specific purpose in the immediate period after injection.