Nokea
Which spot is the safest place to administer an IM injection to an infant? Select the correct corresponding letter from the attached graphic.
- A. C
- B. B
- C. A
- D. D
Correct Answer: B
Rationale: The vastus lateralis muscle, highlighted by the letter B, should be used in infants as the muscle tends to be thickest in this area.
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The nurse is preparing an educational program on immunizations for parents of children 11 to 12 years of age. To ensure the information presented is accurate for this age group, which immunizations should the nurse plan to address?
- A. Haemophilus influenza, varicella, and human papillomavirus (HPV)
- B. Mumps, measles, and rubella (MMR); pneumococcal (PPSV); and hepatitis A
- C. Diphtheria-tetanus-pertussis (DTaP), meningococcal, and haemophilus influenza
- D. Mumps, measles, and rubella (MMR); diphtheria-tetanus-pertussis (DTaP); and hepatitis B
Correct Answer: C
Rationale: A: Varicella vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years. B: The first dose of hepatitis A vaccine is administered before 1 year of age, with the second dose 6 months after the first dose. C: The recommended immunization schedule for children 11 to 12 years old includes a DTaP booster and meningococcal and haemophilus influenza vaccines. Others include HPV, PPSV, and hepatitis A series. D: MMR vaccines are administered at 12 to 15 months, with the second dose at 4 to 6 years. A hepatitis B vaccine is administered to all newborns prior to hospital discharge, with the second dose at 1 to 2 months and the third dose at 6 to 18 months.
The mother asks the nurse why the anticonvulsant valproic acid is being prescribed for her adolescent who is beginning therapy for control of aggressive behaviors. The nurse's response is based on the fact that valproic acid is helpful in reducing manic and impulsive behavior by what mechanism of action?
- A. Block the effects of dopamine at the postsynaptic neuron
- B. Enhance the reuptake of norepinephrine and serotonin in the CNS
- C. Alter sodium channels in the neurons, thus decreasing nerve impulse transmission
- D. Increase gamma-aminobutyric acid (GABA) levels to inhibit CNS neurotransmission
Correct Answer: D
Rationale: Valproic acid (Depakote) increases levels of GABA, an inhibitory neurotransmitter in the CNS.
Prior to administering filgrastim, the nurse reviews the laboratory report results for the 3-year-old who completed the second round of chemotherapy three weeks ago. Which finding indicates a therapeutic response to filgrastim?
- A. Hematocrit of 31%
- B. Eosinophil count of 6%
- C. WBC count of 6800/mm3
- D. Platelet count of 150,000/mm3
Correct Answer: C
Rationale: A: The Hct of 31% is normal but is unaffected by filgrastim, a colony-stimulating factor. B: The eosinophil count of 6% is elevated (0 to 2% is normal) but is not related to filgrastim use. C: Filgrastim (Neupogen) is a colony-stimulating factor used to increase the production of WBCs in persons who have bone marrow depression from chemotherapy. D: The platelet count of 150,000/mm3 is normal but is not used to evaluate the therapeutic effectiveness of filgrastim.
The client is receiving multiple medications for treatment of PD. Which signs and symptoms should the nurse recognize as adverse effects of carbidopa-levodopa?
- A. Dystonia and akinesia
- B. Bradykinesia and agitation
- C. Muscle rigidity and cardiac dysrhythmias
- D. Orthostatic hypotension and dry mouth
Correct Answer: D
Rationale: A: Although dystonia is an adverse effect of carbidopa-levodopa, akinesia is a symptom associated with PD. B: Bradykinesia is a symptom associated with PD; agitation is an adverse effect of carbidopa-levodopa. C: Muscle rigidity is a symptom associated with PD; cardiac dysrhythmia is an adverse effect of carbidopa-levodopa. D: Orthostatic hypotension and dry mouth are common adverse effects of carbidopa-levodopa (Sinemet). These can be minimized by slow position changes and sucking on sugarless candy or chewing gum.
The client is prescribed medications on hospital admission. Four days later the client's serum creatinine level, which was normal at admission, is now 3.7 mg/dL. The nurse should contact the HCP regarding a dosage change for which medication?
- A. Ceftriaxone
- B. Insulin glargine
- C. Diltiazem
- D. Furosemide
Correct Answer: A
Rationale: A: The nurse should contact the HCP regarding ceftriaxone (Rocephin). Ceftriaxone, a third-generation cephalosporin antibiotic, is 33% to 67% excreted in the urine unchanged. Dosage reduction or increased dosing interval is recommended in renal insufficiency because ceftriaxone is nephrotoxic and can further damage the kidneys. B: Insulin glargine (Lantus) is partially metabolized at the site of injection to active insulin metabolites and partially metabolized by the liver, the spleen, the kidney, and muscle tissue; no dose reduction is necessary unless serum glucose levels fluctuate. C: Diltiazem (Cardizem) is mostly metabolized by the liver; no dose reduction is necessary. D: Furosemide (Lasix) is 30% to 40% metabolized by the liver with some nonhepatic metabolism and renal excretion as unchanged medication; no dose reduction is necessary.