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Pharmacology math Client weight: 45 pounds Order: 225 mg by mouth TID Safe dosage range: 30 to 50 mg/kg/day How many milligrams were ordered for your client per day? What are the minimum and maximum safe dosages? Is the dose ordered safe and therapeutic?
Answer: 675 mg/day are ordered for client per day Minimum safe dose= 615 mg/day 20.5 kgx 30 mg/kg/day= 615 mg/day Maximum safe dose= 1025 mg/day 20.5 kg x 50 mg/kg/day= 1025 mg/day Yes it is a safe and therapeutic dose
Fundamentals: You assess four patients. Which patient has the greatest risk for hypomagnesemia? 1.) A 72-year-old with chronic alcoholism 2.) A 79-year-old with bone cancer 3.) A 41-year-old with hypernatremia 4.) A 46-year-old with respiratory acidosis
Answer: 1 Rationale: Patients who have chronic alcoholism are at high risk for hypomagnesemia because of decreased magnesium intake and absorption and increased magnesium excretion
Management, Prioritization and Delegation A 58-year-old patient with type 2 diabetes was admitted to the acute care unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When the RN prepares a care plan for this patient, what would he or she be sure to include? Select all that apply. 1.) Fingerstick blood glucose checks before meals and at bedtime 2.) Sliding-scale insulin dosing as prescribed 3.) Bed rest until the COPD exacerbation is resolved 4.) Teaching about the Atkins diet for weight loss 5.) Demonstration of the components of foot care 6.) Discussing the relationship between illness and glucose levels
Answer: 1, 2, 5, 6 Rationale: When a patient with diabetes is ill, glucose levels become elevated, and administration of insulin may be necessary. Administration of sliding-scale insulin is guided by fingerstick blood glucose checks. Teaching or reviewing the components of proper foot care is always a good idea with a patient with diabetes. Bed rest is not necessary, and glucose levels may be better controlled when a patient is more active. The Atkins diet recommends decreasing the consumption of carbohydrates and is not a good diet for patient with diabetes.
Maternity The nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. In anticipating the client's needs, which intervention is most appropriate? Select all that apply. 1.) Prepare the client for an ultrasound 2.) Obtain equipment for a manual pelvic examination 3.) Prepare to draw a hemoglobin and hematocrit blood sample 4.) Maintain the client on bed rest in the side-lying position as prescribed 5.) Obtain equipment for external electronic fetal heart rate monitoring
Answer: 1, 3, 4, 5 Rationale: The interventions that are most appropriate include: preparing the client for an ultrasound that could diagnose placenta previa, preparing to draw a blood sample to monitor hemoglobin and hematocrit, maintaining the client on bed rest in the side-lying position to help promote circulation, and obtaining equipment for external electronic fetal heart rate to evaluate the status of the fetus. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the third trimester until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage.
Maternity The nurse receives report on 4 maternity clients. Which clients does the nurse identify as being most at risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. 1.) A gravida III with abruptio placentae 2.) A primigravida with mild preeclampsia 3.) A primigravida who has just been diagnosed with sepsis 4.) A primigravida who delivered a 10 lb baby 3 hours ago 5.) A gravida II who has just been diagnosed with dead fetus syndrome 6.) A gravida IV who delivered 8 hours ago and has lost 500 mL of blood
Answer: 1, 3, 5 Rationale: Abruptio placentae, sepsis, and dead fetus syndrome are considered risk factors for DIC. In DIC, abnormal clumps of thickened blood (clots) form inside blood vessels and use up the blood's clotting factors leading to massive bleeding in other places. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large baby is not considered a risk factor for DIC. Hemorrhage is a risk factor with DIC; however, a loss of 500 mL is not considered hemorrhage.
Adult Health Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? 1.) Anemia 2.) Dehydration 3.) Hypertension 4.) Hypercalcemia 5.) Increased risk for fractures 6.) Elevated white blood cells
Answer: 1, 3, 5 Rationale: When the kidney fails, erythropoietin is not excreted, so anemia is expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing risk of pathological fracture. Dehydration and hypercalcemia are not expected in chronic renal disease. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.
Mental Health The nurse understands that which areas need to be explored in order to conduct a culturally sensitive assessment related to end-of-life care? Select all that apply/ 1.) Communication about death 2.) The decision-making process 3.) Financial support for client care 4.) The significance of pain and suffering 5.) The nurse's beliefs on death and dying 6.) Amount and type of accepted intervention
Answer: 1,2, 4, 5, 6 Rationale: Several areas need to be explored in order to conduct a culturally sensitive assessment. First and foremost, the nurse must explore his or her own beliefs regarding death and dying so that cultural bias can be controlled. Other areas include communication about death (who will be informed about the death); the decision-making process (who legally makes health care decisions on behalf of the client); the significance of pain and suffering so appropriate intervention can be delineated; and the amount and type of accepted intervention. The financial support for client care is irrelevant to conducting a culturally sensitive assessment.
Pharmacology math Order: 3 mcg/kg/min Client weight: 125 pounds How many micrograms should your client receive per minute?
Answer: 170.4 mcg/min Clients weight: 125 lb/2.2 lb/kg= 56.81 kg 56.8 kgx 3 mcg/kg/min= 170.4 mcg/min
Pediatrics: The nurse is caring for an 8-year-old child and notes that the child has developed social, physical, and learning skills. To which stage of psychosocial development has the child progressed? 1.) Intimacy versus isolation 2.) Industry versus inferiority 3.) Identity versus role confusion 4.) Generativity versus self-absorption or stagnation
Answer: 2 Rationale: Industry versus inferiority encompasses the task of developing social, physical, and learning skills, and the child has successfully resolved the crisis if the child is able to learn and work. Intimacy versus isolation encompasses the task of establishing intimate bonds of love and friendship. Identity versus role confusion encompasses the task of developing a sense of identity. Generativity versus self-absorption or stagnation encompasses the task of fulfilling life goals that involve family, career, and society.
Management, Prioritization and Delegation The nurse is assessing a client with a neurologic health problem and discovers a change in level of consciousness from alert to lethargic. What is the nurse's best action? 1.) Perform a complete neurologic assessment 2.) Assess cranial nerve functions 3.) Contact the Rapid Response Team 4.) Reassess the client in 30 minutes
Answer: 3 Rationale: A change in level of consciousness and orientation is the earliest and most reliable indication that central neurologic function has declined. If a decline occurs, contact the Rapid Response Team or health care provider immediately. The nurse should also perform a focused assessment to determine if there are any other changes.
Pharmacology The nurse is preparing a dose of bethanechol prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available for use if needed? 1.) Vitamin K 2.) Acetylcysteine 3.) Atropine sulfate 4.) Protamine sulfate
Answer: 3 Rationale: Administration of bethanechol cold result in cholinergic overdose. The antidote is atropine (an anticholinergic), which must be readily available for use if overdose occurs. Vitamin K is the antidote for warfarin. Protamine sulfate is the antidote for heparin. Acetylcysteine is the antidote for acetaminophen overdose.
Mental Health A client who is delusional states, "The guards in that prison across the street are coming over here to handcuff me." Which response by the nurse is therapeutic? 1.) "You believe the guards are going to handcuff you?" 2.) "The guards will only handcuff those who misbehave" 3.) "Do you feel afraid that someone is trying to hurt you?" 4.) The guards can't cross the street. So, don't worry about them"
Answer: 3 Rationale: It is therapeutic for the nurse to empathize with the client's experience while engaging in therapeutic communication to identify the true root of the client's concern. The incorrect options reinforce the delusion and do not present reality or focus on the client's feelings.
Adult Health During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? 1.) Administer hypertonic saline. 2.) Administer a blood transfusion. 3.) Decrease the rate of fluid removal. 4.) Administer antiemetic medications.
Answer: 3 Rationale: The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.
Pediatrics: The nurse is providing instructions to an adolescent regarding home care treatment for an ankle sprain. Which instruction would the nurse provide to the adolescent? 1.) Elevate the extremity, and maintain strict bedrest for 7 days 2.) Immobilize the extremity, and maintain the extremity in a dependent position 3.) Apply heat to the injured area every 4 hours for the first 48 hours, and then begin to apply ice 4.) Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours
Answer: 4 Rationale: Ice is applied to reduce the swelling and would be applied for no longer than 30 minutes every 4 to 6 hours for the first 24 to 48 hours. The injured area would be wrapped immediately to support the joint and control the swelling. The joint would be immobilized and elevated, but strict bed rest for 7 days is not required. A dependent position will cause swelling in the affected area. Applying heat to the injured area will not assist in reducing swelling to the affected extremity.
Fundamentals: When you assess pain and redness at a vascular access device (VAD) site, which action do you take first? 1.) Apply a warm, moist compress 2.) Monitor the patient's blood pressure 3.) Aspirate the infusion fluid from the VAD 4.) Stop and infusion and discontinue the intravenous infusion
Answer: 4 Rationale: Pain and redness at a VAD site are indicators of phlebitis. When phlebitis occurs, the infusion must be stopped, and the VAD removed as the highest priority.
Pharmacology The nurse prepares to administer IV potassium chloride as prescribed to a client with hypokalemia. Which action is the priority in the nurse's plan regarding the preparation and administration of the potassium chloride? 1.) Obtain a controlled IV infusion pump 2.) Monitor urine output every 30 minutes 3.) Inform the client that the medication may cause stinging along the vein 4.) Ensure the medication is diluted in an appropriate amount of normal saline
Answer: 4 Rationale: Potassium chloride administered by IV must always be diluted in IV fluid, and this is the nurse's priority action. Dilution in normal saline is recommended. Potassium chloride is never given by IV bolus (IV push), and control through an IV infusion pump facilitates a controlled rate of delivery. Therefore, the nurse next obtains an infusion pump. Urinary output is monitored during administration, and the primary health care provider is contacted if the urinary output is less than 30 mL/hour. This would occur during and after administration, which would not make monitoring output the priority. The IV site is closely because potassium chloride is very irritating to the veins, and the risk of phlebitis exists, thus informing the client is important but not the priority.
