Passpoint -Pharmacological Therapies and Children

Which nursing action is most important to decrease the risk of postoperative complications in a child with sickle cell anemia

Increasing fluids The main surgical risk from anesthesia is hypoxia; however, emotional stress, demands of wound healing, and the potential for infection can each increase the sickling phenomenon. Increased fluids are encouraged because keeping the child well-hydrated is most important for hemodilution to prevent sickling. Preparing the child psychologically to decrease fear minimizes undue emotional stress. Deep coughing is encouraged to promote pulmonary hygiene and prevent respiratory tract infection. Analgesics are used to control wound pain and to prevent abdominal splinting and decreased ventilation.

The nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

Low serum potassium level Rationale: Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases.

Where should the nurse instill an ophthalmic medication in a 6-year-old child?

The lower conjunctival sac Explanation: Ophthalmic medication is best instilled in the lower conjunctival sac. Eyedrops are not instilled in the sclera, upper conjunctival sac, or outer canthus.

A pediatric client with iron deficiency anemia is prescribed ferrous sulfate, an oral iron supplement. When teaching the child and parent how to administer this preparation, the nurse should provide which instruction?

"Administer ferrous sulfate with fruit juice to promote absorption." Explanation: Administering an oral iron supplement such as ferrous sulfate with fruit juice or another vitamin C source enhances its absorption. Preferably, doses should be administered between meals because gastric acidity and absence of food promote iron absorption. In contrast, food, milk, and antacids impair iron absorption.

A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents:

"Has your child had strep throat recently?" Explanation: Group A beta-hemolytic streptococcal infection typically precedes rheumatic fever. An inflammatory disease, rheumatic fever affects the heart, joints, and central nervous system. It isn't infectious and can't be transmitted from one person to another. Congenital heart defects don't play a role in the development of rheumatic fever. H. influenzae vaccine doesn't prevent streptococcal infection or rheumatic fever.

The nurse is instructing a client about using the antianxiety medication lorazepam. Which statement by the client indicates a need for further education?

"I usually drink a beer every night to help me sleep." Rationale: The client shouldn't consume alcohol or any other central nervous system depressant while taking this drug. All of the other statements indicate that the client understands the nurse's instructions.

A client has been prescribed a skeletal muscle relaxant to treat a herniated nucleus pulposus. After the nurse has finished reinforcing education for the client about taking the medication, which client statement indicates that further education is needed?

"If I miss a dose of the medicine, I'll take an extra pill at the next dose." Rationale: It isn't appropriate to take more than the prescribed dosage, as serious adverse effects can occur. Changing position slowly will help avoid dizziness. Over-the-counter medications may intensify adverse effects. Skeletal muscle relaxants can cause drowsiness.

A client with Parkinson disease tells the nurse of plans to take St. John's wort for depression in addition to the prescribed carbidopa-levodopa. What is the nurse's best response

"St. John's wort can cause a toxic reaction with the Parkinsonian drugs." Rationale: Taking St. John's wort can increase in the toxic effects of levodopa, causing extremely high blood pressure, blurred vision, and muscle twitching. Although St. John's wort is an herbal remedy that can be used to treat depression, these drugs should not be taken together.

A client is prescribed haloperidol. When reinforcing the teaching plan about the drug, which instruction would the nurse emphasize?

"You should report feelings of restlessness or agitation at once. Rationale: Agitation and restlessness are adverse effects of haloperidol that can be treated with anticholinergic drugs. Using herbal supplements while taking haloperidol may interfere with the drug's effectiveness. Although the client may experience increased concentration and activity, these effects are due to a decrease in symptoms, not to the drug itself. Haloperidol isn't likely to cause essential hypertension.

A 10-year-old child is admitted with asthma. The health care provider orders an aminophylline infusion. A loading dose of 6 mg/kg is ordered. The client weighs 30 kg. How many milligrams of aminophylline is contained in the loading dose? Record your answer using a whole number.

180 Rationale: The child should receive 180 mg for the loading dose. Use the following equation: 6 mg/kg × 30 kg = 180 mg

The nurse is caring for a child with a urinary tract infection. The health care provider has ordered cephalexin 125 mg by mouth every 8 hours. Cephalexin is available 250 mg per 5 mL. How many milliliters should the nurse administer per dose? Record your answer using one decimal place.

2.5 The correct formula to calculate a drug dose is:5 mL/250 mg × 125 mg/dose = 625 mL/250 = 2.5 mL

The client is to receive an I.V. infusion of 3,000 ml of dextrose and normal saline solution over 24 hours. The nurse observes that the rate on the infusion pump is set at 150 ml/hour. If the solution runs continuously at this rate, the infusion will be completed in:

20 hours. Rationale: The total amount to be given, 3,000 ml, divided by the hourly rate, 150 ml/hour, equals the length of the infusion or, in this case, 20 hours. Therefore, the I.V. infusion pump was set at the incorrect rate.

A client is receiving isophane insulin suspension every morning. When would the nurse expect the client to possibly develop hypoglycemia?

4 to 12 hours Explanation: Isophane insulin suspension is an intermediate-acting insulin with a peak (when hypoglycemia is most likely to occur) of 4 to 12 hours. The onset of rapid-acting insulin is 15 minutes to 1 hour. The peak effect of rapid-acting insulin is 2 to 6 hours. Long-acting insulin has a peak effect of 14 to 26 hours.

The physician orders milk of magnesia, 2 teaspoons by mouth as needed, for a constipated client. What is the equivalent of 1 teaspoon in the metric system?

5 ml Rationale: One teaspoon equals 5 ml. Milligrams (mg) and grams (g) are solid measurements in the metric system, not liquid measurements.

A school-age client reports pain. After rating the pain on an age-appropriate pain scale, the nurse determines that the client's pain is minor. Which of the following drugs should the nurse administer?

Acetaminophen Explanation: Acetaminophen, when used as directed, is safe even for neonates and has the benefit of helping to reduce fever in addition to relieving mild pain. Morphine, fentanyl, and ibuprofen aren't drugs of choice for treating mild pain in children. Morphine and fentanyl are reserved for severe pain.

The parent of a preschooler with chickenpox asks the nurse about measures to make the child comfortable. Which drug would the nurse question if prescribed for this child?

Acetylsalicylic acid Explanation: Research shows a correlation between the use of aspirin during an episode of chickenpox and the development of Reye syndrome (a disorder characterized by brain and liver toxicity). Therefore, the nurse should instruct the parent to avoid administering aspirin and other products that contain salicylates and to consult a primary care provider or pharmacist before administering any medication to a child with chickenpox. Acetaminophen and ibuprofen are safe to administer for pain and control of fever in a child with chickenpox or other viral illness. Celecoxib does not correlate with the development of Reye's syndrome, but it is used for JRA in children over 2 years old.

A 10-year-old child falls, injures the left shoulder, and is taken to the emergency department. While the child waits to be seen by the primary health care provider, what is the priority nursing action?

Apply ice to the injured shoulder. Explanation: The nurse should help the child into a comfortable position and apply ice to the injured shoulder to reduce swelling and pain. Warm compresses can increase swelling and cause bleeding into the injured tissue. Demonstrating full range of motion of the left arm can cause further damage to the injured area. In the emergency department, the nurse must have a primary care provider's prescription to administer an analgesic.

The nurse is caring for a terminally ill school-age child. Which resource might be most helpful in caring for this child?

Child life specialist Explanation: A child life specialist can best help with the care of this child; these professionals have expertise in child development and the needs of hospitalized and ill children. Child protective services become involved in cases of child abuse. The CDC should be consulted for controlling infectious disease. A legal nurse consultant should be consulted to investigate malpractice.

The nurse is caring for a 10-year-old child with cystic fibrosis. The child's parents tell the nurse that they're having difficulty coping with their child's disease. Which action would be most appropriate for the nurse to take?

Consulting with the social worker to help the family find appropriate resources Explanation: The nurse can help this family by assisting them with finding appropriate financial, psychological, and social support and by providing referrals to the local community agencies and the Cystic Fibrosis Foundation. The child should be treated as much like a normal child as possible, and he should be encouraged to make friends with other children regardless of their physical condition. The nurse shouldn't encourage the parents not to visit because the child might feel abandoned.

A client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

Decreased hearing acuity Rationale: Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be prescribed. The other options aren't associated with streptomycin. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus.

A child with diabetes insipidus receives desmopressin acetate (DDAVP). When evaluating for therapeutic effectiveness, the nurse would interpret which finding as a positive response to this drug?

Decreased urine output Explanation: The primary action of DDAVP is to stimulate water reabsorption by the kidneys, thereby decreasing the urine output. DDAVP has no effect on glucose levels, blood pressure, or nausea.

A nurse is teaching newborn care to expectant parents. Which information about sleep should the nurse include in the teaching plan?

Infants should not sleep in a bed with another person. Explanation: Parents should be taught to use a firm sleep surface and to avoid loose or soft bedding that might interfere with breathing. Infants should not sleep in a bed or couch with another person. Placing the infant's bed in the parents' room is recommended. Placing infants in the prone position for sleep is associated with an increased risk of sudden infant death syndrome.

A nurse knows that a physician has ordered the liquid form of the phenothiazine chlorpromazine rather than the tablet form because the liquid:

It has a more predictable onset of action. Rationale: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset of action with tablets is unpredictable. The liquid form doesn't have fewer anticholinergic effects, fewer drug interactions, or a longer duration of action than the tablet form.

A client with lung cancer has developed an intractable, nonproductive cough that is unrelieved by nonopioid antitussive agents. The physician prescribes codeine, 10 mg by mouth every 4 hours. When discussing this medication with a nursing colleague, which statement that accurately describes codeine will the nurse include?

It is a centrally acting antitussive and can cause dependence. Rationale: As a centrally acting antitussive, codeine suppresses the cough reflex by directly affecting the sensitivity of the cough center in the medulla to incoming stimuli. Because codeine is an opioid, it can cause dependence.

An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

Kernig's sign. Explanation: In Kernig's sign, the client is in the supine position with knees flexed; a leg is flexed then at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Other common signs and symptoms include stiff neck, headache, and fever. Cullen's sign is the bluish discoloration of the periumbilical skin due to intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

After a series of tests, a 6-year-old client weighing 50 lb (22.7 kg) is diagnosed with complex partial seizures. The physician prescribes phenytoin, 125 mg by mouth twice per day. After the nurse administers phenytoin, where is the drug metabolized?

Liver Explanation: Phenytoin is metabolized in the liver. The pancreas isn't involved in the pharmacokinetic activity of phenytoin. The stomach absorbs orally administered phenytoin, which is excreted by the kidneys in the urine.

For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate therapy?

Nausea and vomiting Rationale : During the initial phase of lithium therapy, the nurse should monitor the client for GI symptoms such as nausea and vomiting, which occur most frequently in the initial stages of therapy and after dosage adjustments. GI symptoms are associated with increasing blood levels of lithium. Lithium therapy may cause leukocytosis, not anemia. The drug isn't associated with dehydration or decreased cerebral perfusion. Lithium toxicity may cause confusion, but it isn't due to decreased cerebral perfusion.

A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what severe complication of antipsychotic therapy?

Neuroleptic malignant syndrome (NMS) Explanation: A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Thrombocytopenia isn't a complication of antipsychotic medication. Anticholinergic effects include blurred vision, drowsiness, and dry mouth.

An 8-year-old client with Down syndrome is admitted to the hospital with pneumonia. Which nursing intervention is most appropriate for this child?

Performing ongoing respiratory assessments to monitor for signs of distress Explanation: The nurse should perform ongoing respiratory assessments to watch for signs of distress because the child with Down syndrome may be unable to communicate changes in his respiratory status. The nurse should instruct the client's mother, not the client, to encourage fluid intake by offering fluids frequently. A diet of high-calorie foods in small amounts is required to promote recovery. The nurse should maintain bed rest as needed to conserve the client's energy.

The nurse is planning care for a 10-year-old child in the acute phase of rheumatic fever. Which activity would be most appropriate for the nurse to schedule in the care plan?

Reading books Explanation: During the acute phase of rheumatic fever, the child should be placed on bed rest to reduce the workload of the heart and prevent heart failure. An appropriate activity for this child would be reading books. The other activities are too strenuous during the acute phase.

A client has been receiving chemotherapy to treat cancer. Which data collection finding suggests that the client has developed stomatitis (inflammation of the mouth)?

Red, open sores on the oral mucosa Rationale: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

A primigravida client with severe gestational hypertension is admitted to the labor unit. She has been receiving magnesium sulfate IV for 3 hours. The latest data reveals deep tendon reflexes (DTRs) of +1, blood pressure of 150/100 mm Hg, a pulse of 92 beats/minute, a respiratory rate of 10 breaths/minute, and urine output of 20 mL/ hour. Which action would be most appropriate?

Stop the magnesium sulfate infusion. Rationale: Magnesium sulfate should be withheld if the client's respiratory rate or urine output falls, or if reflexes are diminished or absent; all of which are true for this client. The client may also show other signs of impending toxicity, such as flushing and feeling warm. Continuing to monitor the client will not resolve suppressed DTRs and low respiratory rate and urine output. The client is already showing central nervous system depression because of excessive magnesium sulfate, so increasing the infusion rate is inappropriate. Impending toxicity indicates that the infusion should be stopped rather than just slowed.

The nurse is administering two drugs concomitantly to a client. Which interaction, recognized by the nurse, occurs when two drugs with the same qualitative effects produce a response when given together that is greater than the response either drug produces when given alone?

Synergism, Rationale: or a synergistic effect, occurs when two drugs with the same qualitative effects produce a response when given together greater than either drug produces when given alone. Tolerance is a decreased response or decreased sensitivity of the receptor to a drug. Antagonism occurs when the combined response to two drugs given together is less than the response either drug produces when given alone. Hyporeactivity is a less-than-usual response to a normal drug dose.

A school-age child is being discharged with a diagnosis of rheumatic fever. Which of the following should be included in the teaching plan for the family?

The child should stay on penicillin and return for a follow-up appointment. Explanation: A child with rheumatic fever, which is caused by group A beta-hemolytic streptococci, should stay on penicillin — either oral daily or a monthly injection — to prevent a recurrence. A follow-up appointment is needed to determine how the child is responding to treatment. Neither bed rest nor monthly blood tests will be prescribed for all children. Rheumatic fever is caused by group A beta-hemolytic streptococci, so the source of the infection is already known.

A 10-year-old child is in the hospital for the first time. The nurse has provided support and teaching to help the family and child adjust and to reduce their anxiety related to the child's hospitalization. Which of the following would the nurse view as unexpected?

The parents choose to leave to let the child build a relationship with the staff. Explanation: The parents of an adolescent might leave to help the teen maintain a fragile identity, but a 10-year-old would prefer to have his parents with him. Expected outcomes for a child and parents new to the hospital would include the parents relating readily to the staff and calmly with the child, the child accepting and responding positively to comforting measures, and the child discussing procedures and activities without evidence of anxiety.

The nurse is caring for a child who is receiving steroid therapy as a part of the cancer treatment plan. The child tearfully asks the nurse," Why does my face looks so "fat?" What information should be included in the nurse's response?

This change is temporary and will subside once the steroid medication has been discontinued. Rationale: Steroid therapy is associated with an increased roundness of the face. This may be a source of distress to the child and parents. It is important to explain that this is the result of the medication therapy and will subside.

A school-age child's family asks the nurse to describe palliative care. Which statement best describes palliative care?

Total care given when disease doesn't respond to curative treatment Explanation: The World Health Organization describes palliative care as the total care given to a client who doesn't respond to curative treatment. Intervening to hasten the death and dying process describes mercy killing. Assisting a client to end his life is assisted suicide. Euthanasia is described as the action of a person to end a client's life because he has a terminal illness.

To treat a client with acne vulgaris, the physician is most likely to prescribe which topical agent for nightly application?

Tretinoin (retinoic acid) Explanation: Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil is used to promote hair growth. Zinc oxide gelatin is used for abrasions on the lower arms or legs; the affected area must be covered with a bandage for about 1 week. Fluorouracil is an antineoplastic topical agent used to treat superficial basal cell carcinoma.

A client with hypothyroidism is prescribed levothyroxine 0.05 mg by mouth daily before breakfast. As the nurse gives the client the medication, the client states, "What dose am I getting? I've been taking 0.15 mg every day for years." Which action by the nurse is most appropriate?

Verify the dose against the health care provider's prescription in the client's medical record. Explanation: The nurse must ensure that the correct client is receiving the correct dose of the correct drug at the correct time. Therefore, before giving the medication to the client, the nurse must verify the dose against the primary health care providers order located in the client's medical record. The nurse should not tell the client that the primary health care provider must have lowered the dose without verifying the health care provider's prescription. Administering the medication "as is" does not address the client's concern and may result in a medication administration error. The nurse should not check the dose against what is written on the medication administration record because a transcription error might have occurred, which could result in administration of the wrong dose.

One hour after receiving pyridostigmine, a client reports difficulty swallowing and excessive respiratory secretions. The nurse notifies the health care provider and prepares to administer which medication?

atropine Rationale: These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors. The other drugs are acetylcholinesterase inhibitors. Edrophonium is used to diagnose myasthenia gravis; pyridostigmine is used to treat the condition and would worsen the symptoms. Acyclovir is an antiviral and would not be used to treat the client's symptoms.

A client with pulmonary edema is receiving furosemide. To determine the effectiveness of this diuretic, what data should the nurse obtain?

breath sounds Rationale: Because a diuretic is prescribed to reduce pulmonary congestion, the nurse can evaluate its effectiveness by auscultating the lungs of a client with pulmonary edema, which should show clearing of adventitious breath sounds. Heart sounds are important but are not the indicator. Bowel sound auscultation is important in a client with paralytic ileus or another diuretic effectiveness for the treatment of pulmonary edema. Neurological status is not affected by pulmonary edema or furosemide therapy, so it does not need to be evaluated. Neurovascular checks evaluate cerebrovascular function, rather than respiratory function, which is the client's immediate problem.

After a head injury, a child experiences enuresis, polydipsia, and weight loss. Based on these findings, the nurse should monitor closely for signs and symptoms of:

hypokalemia. Explanation: Enuresis, polydipsia, and weight loss suggest diabetes insipidus, a disorder that may result from a head injury that damages the neurohypophyseal structures. Diabetes insipidus places the child at risk for fluid volume depletion and hypokalemia. It doesn't cause hypercalcemia, hyperglycemia, or hyponatremia.

A 10-year-old child has been experiencing insatiable thirst and urinating excessively and the serum glucose is normal. Which condition is the child most likely experiencing?

diabetes insipidus Explanation: Polydipsia and polyuria with normal serum glucose are indicative of diabetes insipidus. Interview and laboratory results can determine whether the origin is neurogenic or nephrogenic. Type 1 or 2 diabetes mellitus present with an elevated serum glucose. A child with hyperthyroidism may present as dehydrated from the excessive sweating and rapid respirations that accompany this hypermetabolic state.

A child with asthma is receiving theophylline. The nurse knows that theophylline is administered primarily to:

dilate the bronchioles. Explanation: Methylxanthines, such as theophylline, are highly potent bronchodilators used to relieve asthma symptoms. Antihistamines typically are used to relieve a cough induced by postnasal drip; corticosteroids, to reduce airway inflammation; and antibiotics, to treat infection.

When collecting data from a 6-year-old child who has a 20% deep partial-thickness (second-degree) burn of the arms and trunk, the nurse determines that the child has damage to what layer(s) of skin?

epidermis and part of the dermis Explanation: A deep partial-thickness burn affects the epidermis and part of the dermis. A superficial partial-thickness (first-degree) burn affects the epidermis only. A full-thickness (third-degree) burn involves epidermis and all of the dermis, as well as nerves and blood vessels in the skin.

A client is receiving the drug epoetin alfa. Which findings would indicate the effectiveness of the drug?

increase in red blood cells Rationale: Epoetin alfa is a synthetic form of protein human erythropoietin. It stimulates the bone marrow to produce more red blood cells (RBC). The drug is used to treat anemia caused by chronic kidney disease, chemotherapy, and zidovudine (AZT), which is a drug used to treat HIV infection.

The nurse is administering enteric coated erythromycin to a client. What adverse reaction should the nurse monitor for?

nausea and vomiting Rationale: Erythromycin is an antibacterial antibiotic. Common adverse effects include nausea, vomiting, anorexia, diarrhea, and abdominal pain. It should be given with a full glass (8 oz [240 mL]) of water after meals or with food to lessen gastrointestinal symptoms.

A nurse working as part of a multidisciplinary team is caring for a school-age child who has cerebral palsy. The child has difficulty eating using regular utensils and requires extensive assistance. The nurse advocating for the child would seek out which team member to assist in promoting the child's independence?

occupational therapist Explanation: An occupational therapist helps clients with physical impairments adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living, thereby promoting the child's optimal level of independence. A registered dietitian would be helpful in managing and planning for the nutritional needs of children with cerebral palsy but is not trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but is not trained to assist the child in performing activities of daily living. A nurse's aide can help a child eat but is not trained in modifying utensils.

A client at the eye clinic is newly diagnosed with glaucoma. What should the nurse inform the client might occur if administration of the medication is not closely adhered to

permanent vision loss Explanation: Without proper treatment, glaucoma may progress to irreversible blindness. Treatment won't restore visual damage but will halt disease progression. Miotics, which constrict the pupil, are used in the treatment of glaucoma to permit outflow of the aqueous humor. Loss of peripheral vision and blurred or foggy vision (not diplopia) are typical in glaucoma. Loss of central vision is common in clients with macular degeneration.

Which leisure activity does the nurse include in the care plan for a school-age child with hemophilia?

swimming Explanation: Swimming is a noncontact sport with low risk of traumatic injury. Baseball, cross-country running, and football all involve a risk of trauma from falling, sliding, or contact.

The mother of a child with chickenpox (varicella) asks the nurse when her child may return to school. The nurse responds correctly by telling the mother that the child can return:

when all of the lesions are crusted over. Explanation: The period of communicability for chickenpox begins 1 to 2 days before the appearance of the body rash and continues until all skin lesions have crusted over. The child may return to school after this period.

A client has just given birth to her first child. The client is Rho(D)-negative and her baby is Rh-positive. At which time would the nurse most likely expect Rho(D) immune globulin IM to be given to the mother to reduce the risk of Rh incompatibility?

within 72 hours Rationale: When a mother is Rho(D)-negative and her baby is Rh-positive, the mother forms antibodies against the D antigen. Most of the antibodies develop within 72 hours after birth, due to the exchange of maternal and fetal blood during birth. If the mother becomes pregnant again, she will have a high antibody D level that may destroy fetal blood cells in future pregnancies. However, if the mother receives an injection of Rho(D) immune globulin within 72 hours after birth, no antibodies form. Rho(D) immune globulin may also be given to the mother during pregnancy if the baby is Rh-positive.

A physician is administering a medication by intraosseous infusion to a child. Intraosseous drug administration is typically used for a child who is:

younger than age 3 in an emergency situation when I.V. access isn't available. Rationale: In an emergency, intraosseous drug administration is typically used when a child is critically ill and younger than age 3.

An 8-year-old child is brought to the clinic with watery eyes and clear nasal drainage that has lasted more than 10 days, without fever. The nurse observes that the child has dark circles under the eyes and a crease above the tip of the nose. Which intervention should be the nurse's priority?

Collect data about potential environmental allergy triggers. Explanation: Cold symptoms that last longer than 10 days without fever, dark circles under the eyes (from increased blood flow near the sinuses), and a crease near the tip of the nose (from upward nose wiping) are all signs and symptoms of perennial allergic rhinitis. The nurse's priority is to collect data about potential indoor and outdoor environmental allergen triggers. Amoxicillin is used to treat bacterial infections, not allergies. Additionally the nurse will not prepare medication for administration without the appropriate orders from the health care provider. Influenza vaccination is indicated annually. Sinus x-rays may be necessary to check for structural abnormalities, but they are not the priority at this time.

The school nurse is examining a student at an elementary school who presents with vesicular lesions that ooze, forming crusts on the face and extremities. What is the nurse's most appropriate action?

Contact the parents; the child requires medical treatment and cannot attend school. Explanation: Impetigo starts as papulovesicular lesions surrounded by redness. The lesions become purulent and begin to ooze, forming crusts. Impetigo occurs most often on the face and extremities. Good handwashing and careful hygiene are imperative to prevent spread of the infection and should be emphasized to the child and parents. The child should not attend school or daycare for 24 hours after beginning treatment.

A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The child's parents ask the nurse whether anything could have prevented this disorder. Which intervention is most effective in preventing rheumatic fever?

Early detection and treatment of streptococcal infections Explanation: Rheumatic fever is a systemic inflammatory disease that follows a Group A streptococcal infection. Therefore, early detection and treatment of streptococcal infections helps prevent the development of rheumatic fever. Hepatitis B vaccine provides immunity against the hepatitis B virus — not streptococci. Because rheumatic fever isn't contagious, isolation measures aren't necessary. Prophylactic antibiotics are used for invasive procedures only in clients with a history of carditis to prevent bacterial endocarditis.

A client with obesity is admitted to the hospital for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client?

Identify alternative ways for the client to lose weight. Rationale: Identifying alternative ways to lose weight can help the obese client who abuses amphetamines to reach a weight loss goal safely. The nurse should encourage the client to express feelings, especially those related to obesity (e.g., concerns about control, which may be the root of the problem) and not focus on addiction. Empathizing with the client's physical reports may worsen them. Using an abrupt, firm manner discourages therapeutic communication with the obese client.

A client diagnosed with angina is being discharged from the hospital with a prescription for nitroglycerin. What should the nurse be sure to include in the discharge information?

If chest pain is experienced, take 1 tablet under the tongue every 5 minutes ×3. It is important to inform the client to take 1 tablet under the tongue every 5 minutes ×3. If the pain is not relieved at this time, the client should access the emergency medical system and go to the hospital. The client should not wait 1 hour to take the medication. The medication should not be stored in the bathroom medicine cabinet since the moisture may render the medication inactive. The client should take the nitroglycerin before immediately going to the hospital since the pain may be relieved by rest and nitroglycerin

A nurse is reviewing a client's medication blood level values for a commonly administered psychiatric medication. Which medication, prescribed in individualized dosages according to the blood levels of the drug, would the nurse expect to find in this client's medication orders?

Lithium carbonate Rationale: Dosages for lithium, a drug used to treat bipolar disorder, usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEq/L. The maximum daily dosage of thioridazine, an antipsychotic agent, is 800 mg. Dosages exceeding this amount are associated with retinitis pigmentosa, an irreversible condition that can be avoided by observing dosage limits. The recommended maintenance dosage range for thioridazine is 300 to 800 mg/day. The recommended dosage range for chlorpromazine, an antipsychotic agent, is 200 to 800 mg/day. For alprazolam, an antianxiety agent, the recommended dosage range is 0.5 to 4 mg/day.

The parents of a school-age child ask the nurse what to expect from their child during this stage of development. When developing a plan of care to address this matter, the nurse should keep in mind that this child's cognitive development is characterized by:

conservation skills. Explanation: According to Piaget, a school-age child acquires cognitive operations to understand concepts related to objects, including conservation skills, classification skills, and combinational skills. Magical thinking and transductive reasoning are characteristic of the preschooler's preoperational thought. Abstract thought is characteristic of the adolescent's period of formal operations.