Nokea
The nurse is to administer vancomycin to the client diagnosed with sepsis. The client is to have a peak and trough level completed on this dose of vancomycin. Which action should the nurse initiate first?
- A. Determine if the trough level has already been drawn on the client.
- B. Check drug compatibilities before infusing into an existing IV line.
- C. Evaluate the client's culture and sensitivity (C&S) report results.
- D. Calculate the rate at which the vancomycin should be infused.
Correct Answer: A
Rationale: A: A trough level must be drawn before vancomycin (Vancocin) is administered. This is the first action because if the trough level has not been drawn, it will delay the vancomycin dose and could result in a medication error. B: Checking medication compatibilities is important, but this can be completed while the laboratory is obtaining the trough level. C: Checking C&S report results is important, but this can be completed while the laboratory is obtaining the trough level. D: Calculating the administration rate is important, but this can be completed while the laboratory is obtaining the trough level.
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The nurse is preparing to administer Azithromycin, and the pharmacy has provided the drug in a powder form that requires reconstitution connected to a saline piggyback. Which of the following is least concerning when preparing the medication?
- A. The expiration date on the powder vial is the same as the current date.
- B. The brand/trade name is not listed on the vial.
- C. The storage instructions on the vial says 'store at room temperature', and the vial is very cold to the touch indicating it has been taken out of a freezer.
- D. The bag of saline is leaking.
Correct Answer: B
Rationale: The brand or trade name is not required to be on the medication label if the generic name is present. The nurse should check that the medication is not expired and that it has been stored according to the storage instructions. If the saline bag is leaking, it may indicate that the container is damaged and the fluid may not be sterile.
Which of the following are included in the Rights of Medication Administration? Select all that apply. A. right dose, B. right time, C. right explanation, D. right client, E. right route
- A. B, C, D, E
- B. A, B, D, E
- C. A, B, D
- D. B, C, E
Correct Answer: B
Rationale: The Rights of Medication Administration include right client, right drug, right dose, right route, and right time. An additional right that is sometimes included is right documentation.
The nurse is developing the plan of care for the 7-year-old with encopresis who has been started on lactulose. Which outcome would be most appropriate for the nurse to establish?
- A. 2-pound weight gain
- B. Nighttime continence
- C. Blood glucose 70-110 mg/dL
- D. Normal bowel movement daily
Correct Answer: D
Rationale: A: Weight gain is not expected with an osmotic laxative. B: Nighttime continence is not expected to be altered by an osmotic laxative. C: Blood glucose is not expected to be altered by an osmotic laxative. D: Lactulose (Constulose) is an osmotic laxative used in treating encopresis to prevent constipation; the nurse should establish an outcome of a normal daily bowel movement.
The 12-year-old weighing 50 kg is hospitalized with bacterial pneumonia and an upper respiratory tract infection. The nurse is reviewing the child's serum laboratory report illustrated. Based on the findings, which HCP order is most important for the nurse to question?
- A. Amikacin sulfate 375 mg IVPB q12h
- B. Guaifenesin 50-100 mg q4h prn for cough
- C. Dextrose 5% in 0.25 NaCl with 20 mEq/L KCl at 90 mL/hr
- D. Acetaminophen 325-650 mg q4-6h prn, not to exceed 3000 mg/24 hr
Correct Answer: A
Rationale: A: Amikacin (Amikin) is an aminoglycoside, which is nephrotoxic and should be questioned. The serum creatinine and BUN levels are elevated, suggesting decreased renal function. B: Guaifenesin (Robitussin) is used for cough. The dose is within the range for a child of 12 years. C: The serum osmolality is high, suggesting dehydration, and the potassium is low. D5 in 0.25 NaCl with 20 mEq/L at 90 mL/hr will treat the dehydration and hypokalemia. D: The acetaminophen (Tylenol) dose is within parameters, but it is concerning with the decreased renal function. Because acetaminophen is prn and amikacin is timed, the amikacin is more important to question.
The unresponsive client with DM is admitted to the ED with a serum glucose level of 35 mg/dL. Which medication should the nurse plan to administer?
- A. Exenatide
- B. Pramlintide
- C. Miglitol
- D. Glucagon
Correct Answer: D
Rationale: A: Exenatide (Byetta), a synthetic incretin mimetic, is used as an adjunct in type 2 diabetes to decrease blood glucose levels. B: Pramlintide (Symlin) lowers postprandial glucose levels by slowing gastric emptying. C: Miglitol (Glyset), an alpha-glucosidase inhibitor, lowers postprandial serum glucose levels. D: The nurse should plan to administer glucagon (GlucaGen). Glucagon, administered intramuscularly, intravenously, or subcutaneously, is used in unconscious clients with diabetes to reverse severe hypoglycemia from insulin overdose. Normal serum glucose is 70 to 110 mg/dL.