Question #1
An older client diagnosed with pneumonia receives intravenous (IV) gentamicin. The LPN/LVN determines which laboratory value is most important to monitor?
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
The LPN/LVN provides care for a client prescribed a dose of transdermal nitroglycerin. The LPN/LVN selects which site for the new dose?
On the lower forearm.
Over the heart.
On a non-hairy area.
On the buttocks.
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
On the lower forearm- The lower forearm has more hair and should be avoided.
Over the heart- does not need to be over chest area.
On a non-hairy area- CORRECT: this site increases absorption. This is the best choice.
On the buttocks- this area rubs with clothing and the patch can come off.
Question #3
The LPN/LVN provides care for an older client diagnosed with myocardial infarction. The client's cardiac monitor suddenly demonstrates ventricular fibrillation. The client is successfully defibrillated by the health care provider. The LPN/LVN understands which is the purpose of defibrillation?
Defibrillation increases cardiac contractility and cardiac output.
Defibrillation causes asystole, allowing the normal pacemaker of the heart to begin.
Defibrillation reduces cardiac ischemia and acidosis.
Defibrillation provides 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 client is prescribed 3000mL of 0.9% normal saline to infuse intravenously (IV). The IV infusion set delivers 15 drops per milliliter. The LPN/LVN should regulate the flow rate to deliver 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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