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The nurse notes from the child's MAR illustrated that the child is to receive the first dose of a newly prescribed medication at 0800 hours. The drug reference book recommends an initial pediatric dose of lamotrigine of 0.6 mg/kg/day in two divided doses for the first 2 weeks. Which action by the nurse is most appropriate?
- A. Administer the medication as written on the MAR.
- B. Telephone the health care provider to question the dose.
- C. Ask the parent if this is the dose the child had been taking.
- D. Consult the pharmacist to verify whether the dose is correct.
Correct Answer: B
Rationale: A: Although the medication is written on the MAR, an error still exists in the dose, and the medication should not be administered. B: The nurse should notify the HCP. The child weighs 30 kg; the recommended initial daily dose of lamotrigine (Lamictal) for this child would be 18 mg (0.6 x 30 = 18 mg). If given 18 mg bid, the child would receive a daily dose of 36 mg, twice the recommended initial pediatric dose. C: The child has a new-onset seizure disorder; it is unlikely that the child was taking this medication prior to hospitalization. D: Consulting the pharmacist is unnecessary; the nurse still needs to seek clarification from the HCP.
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The client is to receive a first dose of oral sulfamethoxazole 1 g every 12 hours for treatment of recurrent UTIs. Which information about the client should prompt the nurse to question the medication order?
- A. History of gastric ulcer
- B. Type 1 diabetes mellitus
- C. Urine positive for Escherichia coli
- D. Near-term pregnancy
Correct Answer: D
Rationale: A: History of gastric ulcer is not a contraindication for the use of sulfamethoxazole. B: Type 1 diabetes does not prevent the use of sulfamethoxazole. C: A positive urine culture would be an indication for using sulfamethoxazole. D: Sulfamethoxazole (Bactrim, Septra), a sulfonamide antibiotic, is a category D medication for near-term pregnancy. This means there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., for a life-threatening illness or a serious disease for which safer medications cannot be used or are ineffective).
The nurse teaches the client who has lesions that have not healed and are recurring about the newly prescribed medication ganciclovir. The nurse should document that teaching about ganciclovir was completed for the client with which illustrated condition?
- A. ganeiclovir_1.PNG
- B. ganeiclovir_2.PNG
- C. ganeiclovir_3.PNG
- D. ganeiclovir_4.PNG
Correct Answer: D
Rationale: A: Client A has vitiligo, a skin disorder characterized by the patchy loss of skin pigment. Vitiligo is treated with topical steroids. B: Client B has dried herpes simplex, usually treated with the antiviral medication acyclovir. C: Client C has keloids (hypertrophic scarring), which usually are not treated with medication. D: Ganciclovir (Cytovene) is an antiviral medication used in the treatment of recurrent genital herpes.
The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client?
- A. How many grams of protein do you normally eat?
- B. What time did you eat your dinner last night?
- C. How often do you check your blood sugar level?
- D. What was your alcohol intake like this past week?
Correct Answer: D
Rationale: A: Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels. B: Glyburide once daily dose is taken with breakfast, so asking the client about dinner is not consistent with drug administration. C: Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. D: Alcohol use while taking sulfonylureas such as glyburide (DiaBeta, Micronase) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia.
The client taking rifampin brings a sample of urine that is orange in color to the clinic. Which interventions should the nurse implement? Select all that apply.
- A. Send the urine to the lab for culture and sensitivity (C&S).
- B. Reassure the client that this is normal and harmless.
- C. Teach that the urine that is orange can stain clothing.
- D. Question continuation of rifampin with the HCP.
- E. Inform that sweat and tears can also turn orange-colored.
Correct Answer: B,C,E
Rationale: A: A C&S is unnecessary because orange-colored urine is a normal finding in the client taking rifampin. B: The nurse should reassure the client that orange-colored urine is a normal finding in the client taking rifampin (Rifadin). C: The nurse should teach the client that the orange-colored urine and sweat can stain clothing and that the client should consider wearing nonwhite clothing or using undergarments if sweating is excessive. D: It is unnecessary to question continuation of rifampin if the urine is orange-colored because this is a normal finding. E: The nurse should inform the client that other body fluids, such as tears, sweat, and saliva, can also turn orange-colored with the use of rifampin (Rifadin).
The nurse is assessing the client. Which findings indicate that the client may be experiencing physical changes from long-term use of prednisone? Select all that apply.
- A. Weight gain
- B. Increased muscle mass
- C. Fragile skin
- D. Acne vulgaris
- E. Alopecia
Correct Answer: A,C,D
Rationale: A: Weight gain and muscle atrophy are body changes that may occur with long-term glucocorticoid therapy. B: Muscle wasting (not increased muscle mass) is a side effect of prednisone. C: Fragile skin is a possible body change that may occur with long-term glucocorticoid therapy. D: Acne vulgaris may occur with long-term glucocorticoid therapy. E: Hirsutism (not alopecia) is a side effect of prednisone.