Nursing Elites

1. An 8-year-old child who weighs 60 pounds receives an order for Polycilin (Ampicillin) suspension 25 mg/kg/day divided into a dose every 8 hours. The medication is labeled '125 mg/5 ml'. How many ml should the nurse administer per dose every 8 hours?

• A. 5
• B. 10
• C. 15
• D. 20

Correct answer: A

Rationale: Calculate the daily dose first: 60 pounds x 25 mg/kg = 1500 mg/day. Divide by 3 doses = 500 mg/dose. Convert to mL: (500 mg / 125 mg) x 5 ml = 20 ml. However, the question asks for the dose per administration every 8 hours, which is 1/3 of the daily dose. So, the correct calculation should be (20 ml / 3) = 6.67 ml, which rounds to 5 ml. Therefore, the correct answer is 5 ml. Choice B (10 ml) is incorrect because it doesn't consider the frequency of dosing. Choice C (15 ml) is incorrect as it overestimates the dose. Choice D (20 ml) is incorrect as it represents the total daily dose, not the dose per administration every 8 hours.

2. Prior to surgery, written consent must be obtained. What is the nurse’s legal responsibility with regard to obtaining written consent?

• A. Validate the client's understanding of the surgical procedure to be conducted
• B. Explain the surgical procedure to the client and ensure the client comprehends before signing the consent form
• C. Ensure the client, not a family member, signs the surgical consent form
• D. Confirm that the surgical consent form is signed and included in the client's record

Correct answer: A

Rationale: The nurse's legal responsibility in obtaining written consent is to validate the client's understanding of the surgical procedure to be conducted. This process ensures that the client has been comprehensively informed about the procedure, including its risks, benefits, and alternatives. Choice B is incorrect because it does not emphasize the validation of client understanding, which is crucial for informed consent. Choice C is incorrect as the client, not a family member, should provide consent unless specific circumstances dictate otherwise. Choice D is incorrect because although ensuring the consent form is signed and filed is important, it does not address the primary responsibility of confirming the client's comprehension and ensuring informed consent.

3. A client who is newly diagnosed with type 2 diabetes mellitus (DM) receives a prescription for metformin (Glucophage) 500 mg PO twice daily. What information should the nurse include in this client’s teaching plan? (Select all that apply.)

• A. Take an additional dose for signs of hyperglycemia
• B. Recognize signs and symptoms of hypoglycemia.
• C. Report persistent polyuria to the healthcare provider.
• D. Use sliding scale insulin for finger stick glucose elevation.

Correct answer: D

Rationale: The correct answer is D. Metformin does not require additional doses for hyperglycemia, and sliding scale insulin is not typically used with metformin. It is important for the client to recognize signs and symptoms of hypoglycemia, report persistent polyuria to the healthcare provider, and take the medication with meals. Teaching the client to use sliding scale insulin for finger stick glucose elevation is not appropriate in this case because metformin is the prescribed medication, and its mechanism of action differs from insulin therapy. The client should be educated on the importance of taking metformin with meals to reduce gastrointestinal side effects and to report any persistent polyuria, which could indicate poor blood sugar control.

4. During discharge teaching, the nurse discusses the parameters for weight monitoring with a client recently diagnosed with heart failure (HF). Which information is most important for the client to acknowledge?

• A. Weigh at the same time every day
• B. Report weight gain of 2 pounds (0.9kg) in 24 hours
• C. Maintain a daily weight record
• D. Limit dietary salt intake

Correct answer: B

Rationale: The correct answer is B. Reporting a weight gain of 2 pounds in 24 hours is crucial for detecting fluid retention or worsening heart failure. This rapid weight gain indicates possible fluid overload, which can be a sign of worsening HF. Option A is not as critical as the timing of weighing can vary. Option C is important for tracking trends but does not emphasize the significance of a sudden weight gain. Option D is relevant for managing HF but does not address the immediate need for reporting rapid weight gain.

5. The nurse is caring for a laboring 22-year-old primigravida following administration of regional anesthesia. In planning care for this client, what nursing intervention has the highest priority?

• A. Raising the side rails and placing the call bell within reach
• B. Teaching the client how to push to decrease the length of the second stage of labor
• C. Timing and recording uterine contractions
• D. Positioning the client for proper distribution of anesthesia

Correct answer: D

Rationale: The highest priority nursing intervention for a laboring client following administration of regional anesthesia is to position the client for proper distribution of anesthesia. Proper positioning ensures effective pain management during labor, optimizing the effects of the regional anesthesia. While raising the side rails and placing the call bell within reach (choice A) is important for safety, teaching the client how to push (choice B) and timing and recording uterine contractions (choice C) are vital aspects of care but are not the highest priority immediately after administering regional anesthesia.

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