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A 19-year-old male client who has sustained a severe head injury is intubated and
placed on assisted mechanical ventilation. To facilitate optimal ventilation and
prevent the client from "fighting" the ventilator, the health care provider
administers pancuronium bromide IV, with adjunctive opioid analgesia. What
medication should be immediately accessible for a potential complication with this
drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine
- answer-B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the
respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D
are not antagonists to pancuronium bromide and would not be helpful in reversing
the effects of the drug compared with the use of anticholinergics.
A 2-month-old infant is scheduled to receive the first DPT immunization. What is
the preferred injection site to administer this immunization?
A. Dorsal gluteal
B. Vastus lateralis
C. Ventral gluteal
D. Deltoid
- answer-B. Vastus lateralis
The preferred intramuscular site for children younger than 2 years is the vastus
lateralis. Options A, C, and D are not preferred injection sites for the infant at 2
months of age.
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,A 26-year-old primigravida client is experiencing increasing discomfort and
anxiety during the active phase of labor. She requests something for pain. Which
analgesic should the nurse anticipate administering?
A. Butorphanol
B. Hydromorphone
C. Morphine sulfate
D. Codeine sulfate
- answer-A. Butorphanol
Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia
but with less respiratory depression, nausea, and vomiting compared with opioid
agonist analgesics.
A 3-year-old boy is admitted to the emergency department after ingesting an
unknown amount of phenobarbital elixir prescribed for his brother's seizure
disorder. Which nursing intervention should the nurse implement first?
A. Administer syrup of ipecac.
B. Take the child's vital signs.
C. Draw a blood specimen for a phenobarbital level.
D. Teach the mother safe medication storage practices.
- answer-B. Take the child's vital signs.
Phenobarbital causes respiratory depression, so the priority intervention is
assessment of vital signs. Options A, C, and D are actions that may all be used in
the treatment of this child, but they do not have the priority of option B.
A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia.
Which laboratory result should the nurse examine to assess the child's risk for
infection?
A. Neutrophil count
B. Platelet count
C. Reticulocyte count
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,D. Lymphocyte count
- answer-A. Neutrophil
During chemotherapy, granulocytes are significantly suppressed. Because
neutrophils comprise 60% to 70% of the granulocyte count, these levels are the
most useful laboratory results of the options presented to determine the child's risk
for infection. Options B, C, and D are not as useful as option A in determining risk
of infection.
A 42-year-old client is admitted to the emergency department after taking an
overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to
administer to reverse the cardiac and central nervous system effects of
amitriptyline?
A. Sodium bicarbonate
B. Naloxone
C. Phentolamine mesylate
D. Atropine sulfate
- answer-A. Sodium bicarbonate
Sodium bicarbonate is an effective treatment for an overdose of tricyclic
antidepressants such as amitriptyline to reverse QRS prolongation. Options B, C,
and D are not the preferred agents for treating this drug overdose.
A 45-year-old female client is receiving alprazolam for anxiety. Which client
behavior would indicate that the drug is effective?
A. Personal hygiene is maintained by the client for the first time in a week.
B. The client has an average resting heart rate of 120 beats/min.
C. The staff observes the client sitting in the day room reading a book.
D. The nurse records that the client lost 2 lb of body weight in the past week.
- answer-C. The staff observes the client sitting in the day room reading a book.
The ability to sit and concentrate on reading indicates decreased anxiety. Options
A, B, and D are not related to the use of alprazolam for anxiety.
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, A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous
hospitalizations have occurred since the diagnosis because of noncompliance with
the prescribed medication regimen. Which drug might work best for this particular
client?
A. Chlorpromazine HCl
B. Lithium carbonate
C. Fluphenazine decanoate
D. Diazepam
- answer-C. Fluphenazine decanoate
Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2
hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of
choice for a noncompliant psychotic client. Option A is an antipsychotic drug used
to treat schizophrenia and is usually administered PO (IM doses are short-acting).
The client must be compliant in taking this drug for it to be effective. Option B is
most effective with manic and depressive bipolar affective disorders. Option D is
an antianxiety drug and would not be effective for a psychotic disorder.
A 6-year-old child is admitted to the emergency department with status epilepticus.
His parents report that his seizure disorder has been managed with phenytoin, 50
mg PO bid, for the past year. Which drug should the nurse plan to administer in the
emergency department?
A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine
- answer-B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus. Options A, C,
and D are used for the long-term management of seizure disorders but are not as
useful in the emergency management of status epilepticus.
A 67-year-old client is discharged from the hospital with a prescription for digoxin,
0.25 mg daily. Which instruction should the nurse include in this client's discharge
teaching plan?
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