Nursing Elites

1. A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child’s dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?

• A. 5 mL PO BID
• B. 5 mL PO daily
• C. 10 mL PO BID
• D. 10 mL PO daily

Correct answer: A

Rationale: The correct answer is A: '5 mL PO BID.' To calculate the child’s daily dose requirement, you multiply the child's weight (10 kg) by the prescribed dosage per kg, which is 8 mg for TMP and 40 mg for SMX. This results in a total daily requirement of 80 mg of TMP and 400 mg of SMX. To divide this into two doses, each dose should contain half of the total daily requirement, which is 40 mg TMP and 200 mg SMX. Since the liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL, the correct dose per administration is 5 mL. Therefore, 5 mL PO BID is the correct order. Choice B, '5 mL PO daily,' is incorrect as the total daily dose needs to be divided into two doses. Choices C and D, '10 mL PO BID' and '10 mL PO daily,' respectively, are incorrect as they do not align with the calculated dosage requirements based on the child's weight and the prescribed dosage per kg.

2. A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 62, PaCO2 59, and HCO3. Which statement describes the most likely cause of the simultaneous increase in both the PaO2 and the PaCO2?

• A. The hypercapnia resulted from the rapid respirations.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client had a pneumothorax which restricted ventilation.
• D. The client had a pulmonary embolism that reduced perfusion.

Correct answer: B

Rationale: In patients with COPD, oxygen therapy can reduce the hypoxic drive, which is the primary stimulus for breathing in these individuals. By providing supplemental oxygen, the hypoxic drive is diminished, resulting in decreased respiratory effort. As a consequence, the PaO2 may increase due to the supplemental oxygen, but this can lead to a decrease in the respiratory drive and subsequent retention of carbon dioxide, causing an increase in PaCO2 levels. Option A is incorrect because rapid respirations would typically lower PaCO2 levels. Option C is incorrect as a pneumothorax would lead to impaired gas exchange and decreased PaO2 levels without necessarily affecting PaCO2 levels. Option D is incorrect as a pulmonary embolism would typically result in ventilation-perfusion mismatch and decreased PaO2 levels without directly impacting PaCO2 levels.

3. When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following?

• A. Cardiac arrhythmias.
• B. Hypertension.
• C. Seizures.
• D. Hypothermia.

Correct answer: A

Rationale: The correct answer is A: Cardiac arrhythmias. Reperfusion of cardiac tissue following t-PA administration can lead to cardiac arrhythmias, necessitating resuscitation equipment. Hypertension (choice B) is a common side effect of t-PA but is not directly related to reperfusion. Seizures (choice C) and hypothermia (choice D) are not typically associated with reperfusion from t-PA administration.

4. The nurse is assessing an older adult with a pacemaker who leads a sedentary lifestyle. The client reports being unable to perform activities that require physical exertion. The nurse should further assess the client for which of the following?

• A. Left ventricular atrophy.
• B. Irregular heartbeats.
• C. Peripheral vascular occlusion.
• D. Pacemaker function.

Correct answer: A

Rationale: The correct answer is A: Left ventricular atrophy. Older adults who lead sedentary lifestyles are at risk of developing left ventricular atrophy, which can lead to decreased cardiac output during physical exertion. This condition can contribute to the client's inability to perform activities requiring physical exertion. Choice B, irregular heartbeats, may be a consideration due to the presence of a pacemaker, but the client's reported inability to perform physically exerting activities is more indicative of a structural issue like left ventricular atrophy rather than a rhythm-related problem. Peripheral vascular occlusion (Choice C) is less likely to be the cause of the client's symptoms compared to the cardiac-related issue of left ventricular atrophy. While assessing pacemaker function (Choice D) is important, the client's symptoms are more suggestive of a cardiac structural issue rather than a malfunction of the pacemaker.

5. Polyethylene glycol–electrolyte solution (GoLYTELY) is prescribed for a hospitalized client scheduled for a colonoscopy. The client begins to experience diarrhea after drinking the solution. Which action by the nurse is appropriate?

• A. Calling the physician
• B. Administering a cleansing enema
• C. Documenting the diarrhea in the medical record
• D. Giving intravenous replacement fluids in large amounts

Correct answer: C

Rationale: The correct action by the nurse in this situation is to document the diarrhea in the medical record. Polyethylene glycol–electrolyte solution (GoLYTELY) is a bowel evacuant used to cleanse the bowel before a colonoscopy. It is expected to cause mild diarrhea, which is a normal response to the medication. The diarrhea helps clear the bowel in preparation for the procedure. Calling the physician is not necessary unless there are complications. Administering a cleansing enema or giving intravenous replacement fluids in large amounts are not appropriate actions as they are not indicated for managing the expected diarrhea caused by GoLYTELY.

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