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Pharmacology Math Client: 10-year-old child who weighs 80 pounds and is 48 inches tall (BSA = 1.14 m2)Order: Betamethasone 5 mg/m2/day by mouth, divided into four dosagesAvailable: syrup 0.6 mg/5 mL What is the daily dosage (mg/day) to be given? How many milligrams should be given per dosage? How many milliliters should be administered per dosage?

Answer: Daily dosage= 5.7 mg (5 mg/m2 x 1.14 m^2) = 5.7 Milligrams per dosage= 1.43 mg per dosage (5.7 mg per day / 4 dosages per day) Milliliters per dosage= 11.9 mL (0.6 mg : 5 mL= 1.43 : X mL) X= 11.91

Fundamentals A patient has not had a bowel movement for 4 days. Now she has not had a bowel movement in 4 days. Now she has nausea and severe cramping throughout her abdomen. On the basis of these findings, what should the nurse suspect? 1.) An intestinal obstruction 2.) Irritation of the intestinal mucosa 3.) Gastroenteritis 4.) A fecal impaction

Answer: 1 Rationale: Absence of bowel movement, nausea, cramping, and possibly vomiting are characteristic of an intestinal obstruction.

Maternity When reviewing laboratory results of an infant born to a woman diagnosed with gestational diabetes, the nurse anticipates which of the following hematological values? 1.) Polycythemia 2.) Neutropenia 3.) Microcytosis 4.) Thrombocytopenia

Answer: 1 Rationale: Because maternal Glycosylated hemoglobin has an impaired ability to release oxygen to the tissues. In response to decreased oxygenation, the fetus produces additional red blood cells. This is why infants of diabetic mothers (IDMs) often have polycythemia. Microcytosis is seen in iron-deficiency anemia and is not associated with maternal gestational diabetes. Maternal gestational diabetes does not adversely affect the infant's white blood cell count or platelet count.

Pharmacology Math Medication order: procaine penicillin 800,000 units IM every 12 hours Available: procaine penicillin 1,600,000 units/5 mLHow many mL will be administered?

Answer: 2.5 mL

Adult Health A client develops paroxysmal supraventricular tachycardia (PSVT). Which of the following interventions by the nurse is most appropriate? 1.) Prepare for cardioversion 2.) Continue to monitor for rhythm changes 3.) Administer the ordered atropine 4.) Defibrillate if the tachycardia is sustained

Answer: 1 Rationale: The nurse should prepare for cardioversion because sustained supraventricular tachycardia is a medical emergency requiring immediate intervention. Paroxysmal supraventricular tachycardia is not treated by defibrillation or atropine.

Fundamentals Which of the following may cause Clostridium difficile infection? Select all that apply. 1.) Chronic laxative use 2.) Contact with C. difficile bacteria 3.) Overuse of antibiotics 4.) Frequent episodes of diarrhea caused by food intolerance 5.) Inflammation of the bowel

Answer: 2, 3 Rationale: These are the two main causes of C. difficile infection.

Pharmacology A patient was brought into the emergency department with supraventricular tachycardia. The nurse is preparing to administer adenosine. What is the proper method of administering adenosine? 1.) Slow IV push over 2 minutes 2.) Diluted in 50 mL as IVPB over 30 minutes 3.) Rapid IV push as a bolus followed by saline flush 4.) Via a nebulizer

Answer: 3 Rationale: Adenosine is a first-line drug for supraventricular tachycardia. Adenosine 6 mg is given IV push as rapidly as possible followed by 20 mL of saline.

Management, Prioritization and Delegation The patient with hyperparathyroidism who is not a candidate for surgery asks the nurse why she is receiving IV normal saline and IV furosemide. What is the nurse's best response? 1.) "This therapy is to protect your kidney function." 2.) "You are receiving these therapies to prevent edema formation." 3.) "Diuretic and hydration therapies are used to reduce your serum calcium." 4.) "These therapies may help to improve your candidacy for surgery."

Answer: 3 Rationale: Diuretics and hydration help reduce serum calcium for patients with hyperparathyroidism who are not surgery candidates. Furosemide increases kidney excretion of calcium when combined with IV saline in large volumes.

Adult Health On the second postoperative day a client who is receiving PRN opioid analgesics calls the nurse asking for additional pain medication. When the nurse arrives the client is laughing and playing video games with a friend. What should the nurse do next? 1.) Check the MAR for a non-opioid pain medication 2.) Give the client warm compresses instead of the pain medication 3.) Assess the client's pain level and administer the medication 4.) Initiate a referral to the unit social worker

Answer: 3 Rationale: Judging about a client's pain experience should not be based on how the client is behaving, but on the client's rating on a pain scale. The nurse should ask the client to rate pain level on 0-10 scale and administer the medication. A client on the second postoperative day would likely need to continue taking opioid analgesics and decisions about pain management options should be based on an assessment of the client's pain. Additional pain management measures such as warm compresses may be used in addition to the pain medication if needed. If there is reason to support the client who may have an addiction problem, a social worker referral could be initiated, but there is no reason to suspect this based on the information provided in this scenario. The nurse should realize that playing video games and laughing with a friend can serve as a distraction from pain. The nurse should realize that playing video games and laughing with a friend can serve as a distraction from pain.

Maternity A woman who is at 30 weeks gestation experiences a sudden onset of bright red vaginal bleeding. The emergency room nurse documents the following assessments: Maternal heart rate = 96 beats/minute Pain = 0/10 Uterus soft, non-tender Fetal heart rate = 138 beats/minute Based on these findings, what problem should the nurse suspect? 1.) Threatened abortion 2.) Preterm labor 3.) Placenta previa 4.) Abruptio placentae

Answer: 3 Rationale: Placenta previa means "placenta first" because the placenta is abnormally implanted over the lower uterine segment. Painless bright red vaginal bleeding in the second or third trimester and a soft nontender uterus are characteristics of placenta previa. Abruptio placentae is the premature separation (partial or total) of a normally implanted placenta after 20 weeks gestation characterized by painful dark red vaginal bleeding, uterine tenderness, pain, and hypertonic uterus. Uterine contractions and changes in the cervix are characteristic of preterm labor. A threatened abortion is characterized by slight bleeding and uterine cramping.

Management, Prioritization and Delegation A 56-year-old client comes to the triage area with left-sided chest pain, diaphoresis, and dizziness. What is the priority action? 1.) Initiate continuous electrocardiographic monitoring. 2.) Notify the emergency department health care provider. 3.) Administer oxygen via nasal cannula. 4.) Draw blood and establish IV access.

Answer: 3 Rationale: The priority goal is to increase myocardial oxygenation. The other actions are also appropriate and should be performed immediately after administering oxygen.

Pediatrics The nurse is reviewing the primary health care provider's prescriptions for a child who has hospitalized with nephrotic syndrome. Which dietary prescriptions would the nurse would the nurse expect to be prescribed? 1.) A low-fat diet 2.) A full liquid diet 3.) A high-protein, high-salt diet 4.) A normal-protein, mild sodium restricted diet

Answer: 4 Rationale: A diet that is normal in protein with a mild sodium restriction is normally prescribed for the child with nephrotic syndrome. Options 1, 2, and 3 are incorrect diets for this child.

Pharmacology Diclofenac is prescribed for a client. Which medication, if noted on the client's record would alert the nurse to consult with the primary health care provider? 1.) Primidone 2.) Pyrimethamine 3.) Calcium citrate 4.) Warfarin sodium

Answer: 4 Rationale: Diclofenac is a NSAID. Interactions may occur with the use of anticoagulants, such as warfarin sodium. The nurse must consult with the primary health care provider about a potential medication interaction. Options 1, 2, and 3 are not contraindications.

Pediatrics A child is brought to the emergency department for an injury to the lower right arm that occurred after falling off a bicycle. The radiograph obtained reflects that the fracture is across the entire bone shaft with some possible displacement. What the interventions would the nurse plan to take? Select all that apply. 1.) Apply heat to the injured extremity 2.) Assess pulses proximal to the fracture site 3.) Assess for sensation proximal to the fracture site 4.) Assess the skin at the injury site for color and pallor 5.) Assess for pain ad point of tenderness of the injury 6.) Elevate the injured extremity above the level of the heart

Answer: 4, 5, 6 Rationale: The treatment plan for a child with a suspected fracture is to assess the extent of the injury. Cold would be applied to the injury considering it is a vasoconstrictor and will reduce swelling. Pulses and sensation distal (not proximal) to the injury would be assessed. Assessing the skin and pain at the site will alert the nurse to potential compartment syndrome. Elevating the injury above the heart will decrease swelling to the extremity.

Mental Health The nurse is counseling a client who is experiencing loss of appetite and problems sleeping after losing a home in a fire. What question should the nurse ask when assessing the presence of grief in the client? 1.) "Tell me what you usually like to eat". 2.) "Are you feeling anxious right now?". 3.) "How did you feel before the fire?" 4.) "Do you have problems falling asleep."

Answer: C Rationale: Anxiety, sleep problems, and appetite disturbances may be present in both grief and depression, so asking the client how they felt before the fire will help distinguish between grief and preexisting depression. Asking the client if they have problems falling asleep will assess sleep latency. Asking the client if they are feeling anxious will provide information about the presence of anxiety. Asking the client about food preferences will help the nurse assess appetite changes.

Mental Health A client report smoking 10 cigarettes per day for 20 years. How should the nurse document the client's smoking habit in pack years? 1.) 30 pack years 2.) 20 pack years 3.) 40 pack years 4.) 10 pack years

Answer: D Rationale: A pack contains 20 cigarettes. To calculate pack years, multiply the number of cigarettes smoked per day by 20, divided by the number of years the client has smoked. So, 10 multiplied by 20 divided by 20 equals 10.