Question #1
A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). It would be most important for a nurse to monitor which of the following laboratory values in this patient?
Hemoglobin and hematocrit.
BUN and creatinine.
Platelet count and clotting time.
Sodium and potassium.
Answer:
The correct answer is B.
Which lab values should you monitor for a patient receiving Gentamicin?
Needed Info: Gentamicin: broad spectrum antibiotic. Side effects: neuromuscular blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss), nephrotoxic. Nursing responsibilities: monitor renal function, force fluids, monitor hearing acuity. Draw blood for peak levels 1 hr. after IM and 30 min - 1 hr. after IV infusion, draw blood for trough just before next dose.
Hemoglobin and hematocrit - can cause anemia; less common
BUN and creatinine - CORRECT: nephrotoxic; will see proteinuria, oliguria, hematuria, thirst, increased BUN, decreased creatine clearance
Platelet count and clotting time - do not usually change
Sodium and potassium - hypokalemia infrequent problem
Question #2
To enhance the percutaneous absorption of nitroglycerine ointment, it would be MOST important for the nurse to select a site that is
muscular.
near the heart.
non-hairy.
over a bony prominence.
Answer:
The correct answer is C.
What is the best site for nitroglycerine ointment? Strategy: Think about each site.
Needed Info: Nitroglycerine: used in treatment of angina pectoris to reduce ischemia and relieve pain by decreasing myocardial oxygen consumption; dilates veins and arteries. Side effects: throbbing headache, flushing, hypotension, tachycardia. Nursing responsibilities: teach appropriate administration, storage, expected pain relief, side effects. Ointment applied to skin; sites rotated to avoid skin irritation. Prolonged effect up to 24 hours
muscular - not most important
near the heart- not most important
non-hairy - CORRECT: skin site free of hair will increase absorption; avoid distal part of extremities due to less than maximal absorption
over a bony prominence - most important is that the site be non-hairy
Question #3
A man is admitted to the Telemetry Unit for evaluation of complaints of chest pain. Eight hours after admission, the patient goes into ventricular fibrillation. The physician defibrillates the patient. The nurse understands that the purpose of defibrillation is to:
increase cardiac contractility and cardiac output.
cause asystole so the normal pacemaker can recapture
reduce cardiac ischemia and acidosis.
provide energy for depleted myocardial cells.
Answer:
The correct answer is B.
Why is a patient defibrillated?
Strategy: Think about each answer choice.
Needed Info: Defibrillation: produces asystole of heart to provide opportunity for natural pacemaker (SA node) to resume as pacer of heart activity.
increase cardiac contractility and cardiac output - inaccurate
cause asystole so the normal pacemaker can recapture - CORRECT: allows SA node to resume as pacer of heart activity
reduce cardiac ischemia and acidosis - inaccurate
provide energy for depleted myocardial cells - inaccurate
Question #4
A patient is to receive 3,000 ml of 0.9% NaCl IV in 24 hours. The intravenous set delivers 15 drops per milliliter. The nurse should regulate the flow rate so that the patient receives how many drops of fluid per minute?
21
28
31
42
Answer:
The correct answer is C.
How should you regulate the IV flow rate?
Strategy: Use formula and avoid making math errors.
Needed Info: total volume x the drop factor divided by the total time in minutes.
21 - inaccurate
28 - inaccurate
31 - CORRECT: 3,000 x 15 divided by 24 x 60
42 - inaccurate
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