Nokea
The nurse is evaluating the effectiveness of lispro and glargine insulins being administered to the 2-year-old with type 1 DM. Which findings on the serum laboratory report indicate that treatment is effective?
- A. Blood glucose
- B. Hgb A1c
- C. Creatinine
- D. WBCs
Correct Answer: A, B
Rationale: The treatment goal for children with type 1 DM is blood glucose levels within the normal range (60-105 mg/dL for a 2-year-old). Hgb A1c levels are indicative of the average blood glucose levels over the past 2 to 3 months; normal A1c is 3.9% to 7.7%. Although the other laboratory values are normal, these do not indicate the effectiveness of insulin therapy.
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The nurse is assessing the child's ear with an otoscope prior to administering medications to treat persistent otitis media. Which assessment finding should the nurse expect?
- A. otoscope_1.PNG
- B. otoscope_2.PNG
- C. otoscope_3.PNG
- D. otoscope_4.PNG
Correct Answer: A
Rationale: A: This shows otitis media characterized by a bulging contour to the tympanic membrane, unclear ossicular landmarks, and yellowish middle ear effusion. B: This shows a perforated tympanic membrane, not otitis media. C: This shows a normal left ear tympanic membrane. The ossicular landmarks can be identified through the tympanic membrane. The nurse would not expect to see a normal tympanic membrane when the child has persistent otitis media. D: This shows the presence of a foreign body in the ear canal.
The LPN is caring for a client taking Lipitor (Atorvastatin). Which of these statements would indicate that the client may need reinforced teaching?
- A. I take my Lipitor with a glass of milk after my breakfast.
- B. I take my Lipitor and wait 30 minutes before taking my other medications.
- C. I take my Lipitor 30 minutes after I eat something.
- D. I take my Lipitor and my other morning medications with my grapefruit juice at breakfast.
Correct Answer: D
Rationale: Grapefruit juice should be avoided when taking Lipitor. Grapefruit juice blocks the enzymes needed to breakdown the drug, which leads to excessive amounts of the drug in the body.
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.
The nurse is reviewing the chart illustrated of the client diagnosed with stage III HF. Which conclusion should the nurse make?
- A. The medications should be administered as prescribed.
- B. The client may be experiencing toxicity from digoxin.
- C. Hyperkalemia likely caused the client's cardiac dysrhythmias.
- D. Seeing halos can result from the atrial fibrillation or anticoagulants.
Correct Answer: B
Rationale: A: The digoxin should be withheld and not given until a serum digoxin level is determined. B: Signs of digoxin (Lanoxin) toxicity include seeing yellow halos around objects and dysrhythmias. The furosemide (Lasix) diuretic increases urinary excretion of potassium and can cause hypokalemia. Hypokalemia can contribute to both cardiac dysrhythmias and digoxin toxicity. C: A serum potassium level of 2.9 mEq/L indicates hypokalemia, not hyperkalemia. D: The yellow vision is a characteristic sign of digoxin toxicity and is not a sign of cerebral damage from an infarct due to atrial fibrillation or bleeding from the anticoagulants.
The 30-year-old has been taking olanzapine for the past 5 years for the treatment of schizophrenia. The client, who has a positive family history of DM, is now overweight but is not showing signs of hyperglycemia. When the client asks about the next steps for treatment, how should the nurse respond?
- A. You'll be started on an oral hyperglycemic agent.
- B. I will be teaching you how to self-administer insulin.
- C. You'll need to have a fasting blood glucose level drawn.
- D. Olanzapine will be discontinued and another drug started.
Correct Answer: C
Rationale: Due to the risk of hyperglycemia with olanzapine (Zyprexa), blood glucose testing is needed to determine if medication therapy is indicated.