Nokea
The nurse is ready to administer a partial fill of imipenem-cilastatin (Primaxin) in the I.V. pump when a full partial fill bag of imipenem-cilastatin is found hanging at the client's bedside. Which of the following is not appropriate to do by the nurse when recognizing that the previous dose was not administered 8 hours ago to the client with pneumonia?
- A. Discard the full partial fill of imipenem-cilastatin found hanging at the client's bedside.
- B. Check the identifying information of the full partial fill of imipenem-cilastatin found hanging at the client's bedside.
- C. Follow up on the legal documentation of the client's previous administration of imipenem-cilastatin.
- D. Administer the new partial fill of imipenem-cilastatin.
Correct Answer: A
Rationale: Discarding the medication without investigation is inappropriate; the nurse should verify, document, and address the error appropriately.
You may also like to solve these questions
A client with a history of heart failure is admitted with fatigue. The nurse should monitor the client for which of the following laboratory abnormalities?
- A. Elevated B-type natriuretic peptide (BNP).
- B. Decreased creatinine.
- C. Increased albumin.
- D. Decreased sodium.
Correct Answer: A, D
Rationale: Elevated BNP indicates heart failure severity, and hyponatremia is common due to fluid overload.
A client with a history of stroke is prescribed clopidogrel (Plavix). The nurse should instruct the client to report which of the following side effects immediately?
- A. Mild headache.
- B. Bruising.
- C. Nausea.
- D. Fatigue.
Correct Answer: B
Rationale: Bruising may indicate bleeding, a serious side effect of clopidogrel, an antiplatelet medication, requiring immediate reporting.
Which of the following is an adverse effect of vancomycin (Vancocin) and needs to be reported promptly?
- A. Vertigo.
- B. Tinnitus.
- C. Muscle stiffness.
- D. Ataxia.
Correct Answer: B
Rationale: Tinnitus is a sign of ototoxicity, a serious adverse effect of vancomycin that requires prompt reporting to prevent permanent hearing damage.
The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:
- A. Decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels
- B. Decreased TSH and increased T4 levels
- C. Decreased creatine phosphokinase levels
- D. Absence of antithyroid antibodies
Correct Answer: A
Rationale: Hypothyroidism is characterized by decreased thyroxine (T4) and increased TSH as the pituitary attempts to stimulate the thyroid. Other options are inconsistent with hypothyroidism.
The nurse is caring for a client with a chest tube. Which finding indicates a potential complication?
- A. Continuous bubbling in the water seal chamber.
- B. Fluctuation in the water seal with breathing.
- C. Serosanguineous drainage.
- D. Pain at the insertion site.
Correct Answer: A
Rationale: Continuous bubbling in the water seal chamber suggests an air leak, a potential complication requiring immediate attention.