Jackson Weber Pre/Post (Exam 4)
A pt weighing 40 lb has an order for phenobarbital 60 mg BID. The safe dose range is 3-6 mg/kg/day. Is this order safe? a) Yes the safe range is 120-240 mg/day b) no. the safe range if 54.6-109.2 mg/day c) yes the safe range is 54.6-109.2 mg/day d) no the safe range is 120-240 mg/day.
b) no. the safe range if 54.6-109.2 mg/day 1. 40 lb ---> 18.2kg 2. 3 x 18.2 = 54.6 mg/day 3. 6 x 18.2 = 109.2 mg/day 4. Dose admin per day? 60 x 2 = 120 mg/day 5. 120 >109.2 which means they are giving an unsafe dose
A nurse is reviewing lab results and notes that a 5 y/o pt's serum phenobarbital level is 8. Phenobarbital is considered therapeutic at levels between 10-40. What is the nurse's best interpretation of this data? a) the prescribed dose of phenobarbital is too low and needs to be increased to be therapeutic b) The pt has developed a tolerance to phenobarbital and another med should be ordered c) The pt hasn't been taking the phenobarbital as ordered by the provider d) Further assessment is needed regarding phenobarbital admin and compliance w/ therapy
d) Further assessment is needed regarding phenobarbital admin and compliance w/ therapy During the health hx, the nurse needs to determine what med the pt is taking, the current prescribed dose of med, the frequency of admin, and the duration of therapy as well as whether the pt is complying w/ the prescribed med regimen. There is not enough info provided in the description as it stands conclude whether any of the other answers are correct. The nurse needs to know the last time the provider changed the childs med dose, whether the child has had any recent wt changes and when the provider last assessed the childs drug levels.
The nurse is evaluating a school-aged pt brought in for a recent decline in academic performance. The parent reports the pt has been doing poorly in school and states the child "wastes time staring at the wall and daydreaming instead of working." The nurse suspects that the pt may be experiencing which type of activity? a) Absence b) Simple partial c) Myoclonic d) Atonic
a) Absence Absence seizures consist of sudden cessation of activity combined w/ a blank facial expression. This type od seizure lasts less than 30 secs and can occur multiple times during the day. B/c of the subtle changes in the pt behavior, absence seizure activity may not be recognized or may be perceived falsely as inattentiveness. Myoclonic seizures are characterized by sudden, brief, massive muscle jerks that may involve the whole body or one body part. Simple partial seizures are characterized by clonic or tonic movements involving the face, neck, and extremities and can include sensory signs such as numbness, tingling, paresthesia, or pain. Atonic seizures involve a sudden loss of muscle tone, which in children may be only a sudden drop of the head.
The nurse is admitting a peds pt w/ a known seizure hx w/ an order to implement seizure precautions. Which of the following interventions should the nurse include in the pt's plan of care? a) Keep bed in low position and remove objects from the bed b) Supervise when ambulating or bathing c) Place the pt on a ketogenic diet d) Keep O2 and suction @ bedside e) Insert a Foley catheter for incontinence
a) Keep bed in low position and remove objects from the bed b) Supervise when ambulating or bathing d) Keep O2 and suction @ bedside Basic seizure precautions should be implemented to provide a safe environment for the pt. The bed with everything removed and @ low position. O2 & suction available @ bedside. Supervision during bathing, ambulation, and other potentially unsafe activities helps to reduce the risk of an injury in the event that a seizure occurs. Although a ketogenicdiet is a nonpharmacologic tx for epilepsy, it wouldn't be appropriate for the nurse to implement this w/o an order from the provider. There is non need to insert a foley for a pt @ risk for seizures.
The role od the peds nurse has many components. Which of the following components includes the nurse's work with the interdisciplinary health care team to integrate the needs of the pt and family into a coordinated plan of care? a) Advocate b) Collaborator c) Consultant d) Educator
b) Collaborator The peds nurse serves as a collaborator by working w/ the entire interdisciplinary health care team to integrate needs of the pt and family into a coordinated plan of care. In the role of educator, the nurse instructs and counsels the pt and their family about all aspects. As an advocate, the nurse safeguards and advances the interests of its and families. The nurse ensures that the needs of the pt and family are met as a consultant through activities that include support group facilitation and working with he school nurse to plan the pt's care.
During an admission assessment, the nurse notes a sudden onset of tonic contractions of the pt's entire body followed by clonic contractions alternating w/ relaxation of all muscle groups. What actions should the nurse take? (SATA) a) administer PO maintenance dose of anticonvulsant meds b) check for a patent airway c) Raise the side rails and remove any safety hazards d) Place the pt in supine position e) Use a tongue blade to keep the tongue from obstructing the airway
b) check for a patent airway c) Raise the side rails and remove any safety hazards The nurse should ensure that the child has a patent airway and adequate oxygenation. The pt should be placed in a side-ting position, not supine, to help maintain a patent airway and decrease the risk for aspiration. Implementation of seizure precautions, including raising the side rails and removing any safety hazards, helps to keep the environment safe and reduce the risk of injury. Restraining the pt or placing anything in the mouth, such as a tongue blade, while the pt is actively seizing can cause further injury. The nurse should administer anticonvulsant meds as ordered to help stop and prevent further seizure activity, but administering PO meds during a seizure is not indicated d/t risk of aspiration.
The nurse is teaching the parent of a 5 y/o pt about home safety and injury prevention. Which of the following principles is correct regarding safety for this age group? a) Loaded firearms should be kept in a locked cabinet out of reach. b) Meds should be described as "candy" to encourage the pt to be compliant c) A forward-facing booster seat in the backseat w/ lap and shoulder belts should be used after reaching the car seat height restriction d) Bicycles should be ridden on the side of the road facing oncoming traffic.
c) A forward-facing booster seat in the backseat w/ lap and shoulder belts should be used after reaching the car seat height restriction After reaching the car seat height restriction, all 5 y/o should be in a booster seat that uses both the shoulder and lab belts. The backseat is the safest place for the child to ride. Forearms should be kept in a locked cabinet w/ the ammunition stored separately. Preschoolers are not mature enough to ride a bicycle in the street and should ride on the sidewalk; bicycles should be ridden in the same direction as traffic. To prevent accidental ingestion, parents would never describe meds as candy.
A nurse is caring for a preschool-aged pt experiencing generalized tonic-clonic seizures. This pt is at greatest risk for which of the following complications? (SATA) a) Cardia arrest b) Anaphylactic shock c) Aspiration d) Incontinence e) Head trauma
c) Aspiration d) Incontinence e) Head trauma A child w/ altered LOC may not be able to manage his or her secretions and is at risk for aspiration and ineffective airway clearance. B/c of the loss of consciousness & rhythmic clonic contractions associated w/ this type of seizure, the pt is at risk for head trauma. Loss of sphincter control, leading to incontinence, is another complication associated w/ this type of seizure. Cardiac arrest and anaphylactic shock are not complications commonly associated w/ tonic-clonic seizures.
