Nursing Elites

1. A child who weighs 25 kg is receiving IV ampicillin at a dose of 300 mg/kg/24 hours in equally divided doses every 4 hours. How many milligrams should the nurse administer to the child for each dose?

• A. 1875 mg
• B. 625 mg
• C. 2000 mg
• D. 1500 mg

Correct answer: A

Rationale: To calculate the correct dose for each administration, you first need to find the total daily dose: 300 mg/kg * 25 kg = 7500 mg/day. Since this total dose is divided into equally divided doses every 4 hours, there are 6 doses in 24 hours. Therefore, 7500 mg ÷ 6 doses = 1250 mg per dose. The nurse should administer 1250 mg every 4 hours, resulting in a total of 1875 mg for each dose in a 24-hour period. Choice A, 1875 mg, is the correct answer. Choice B, 625 mg, is incorrect as it does not consider the total daily dose and the frequency of administration. Choice C, 2000 mg, is incorrect as it is not the calculated dosage based on the given parameters. Choice D, 1500 mg, is also incorrect as it does not reflect the correct dosage calculation for each dose.

2. The healthcare provider is preparing to suture a 10-year-old child with a lacerated forehead. Both parents and a 12-year-old sibling are present at the child's bedside. Which instruction best supports family involvement?

• A. While waiting for the healthcare provider, only one visitor may stay with the child.
• B. All of you should leave while the healthcare provider sutures the child's forehead.
• C. It is best if the sibling goes to the waiting room until the suturing is completed.
• D. Please decide who will stay when the healthcare provider begins suturing.

Correct answer: D

Rationale: Involving the family members in deciding who will stay when the healthcare provider begins suturing supports family involvement and helps reduce anxiety for the child. This approach respects the family's dynamics and preferences, promoting a supportive environment during the procedure.

3. What intervention should the nurse implement first for a male toddler brought to the emergency center approximately three hours after swallowing tablets from his grandmother's bottle of digoxin (Lanoxin)?

• A. Administer activated charcoal
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: A

Rationale: Administering activated charcoal is the priority intervention as it binds with digoxin, preventing further absorption in the gastrointestinal tract. This helps reduce the amount of digoxin available for systemic circulation and minimizes its toxic effects. Gastric lavage is no longer recommended due to potential complications and lack of evidence of efficacy. Obtaining an electrocardiogram may help assess the effects of digoxin toxicity, but it is not the initial priority. IV digoxin immune fab (Digibind) is used in severe cases of digoxin toxicity but is not the first-line intervention.

4. The mother calls the clinic and tells the practical nurse (PN) that her child cannot swallow a prescribed tablet that was dispensed by the local pharmacy as a whole tablet. How should the PN respond?

• A. You can crush the tablet and mix it with food.
• B. You should not force the child to swallow the tablets by holding her nose closed.
• C. If a liquid form is available, the pharmacist can be contacted for a prescription change.
• D. Do not advise the child to chew the tablet if she cannot swallow it.

Correct answer: C

Rationale: When a child is unable to swallow a tablet, the appropriate response is to consider if a liquid form of the medication is available. This is a safer and more effective alternative than forcing the child to swallow or chew the tablet. Contacting the pharmacist for a prescription change can provide a suitable solution that ensures the child receives the medication in a more manageable form. Choices A, B, and D are incorrect because crushing the tablet and mixing it with food may alter the medication's effectiveness or taste, forcing the child to swallow or holding her nose closed can be distressing and ineffective, and advising the child to chew the tablet is not recommended as an alternative to swallowing it.

5. The nurse is assessing a 3-month-old infant who was brought to the clinic by the parents due to concerns about the infant’s feeding. The parents report that the infant has been vomiting after every feeding and has not gained any weight. What should the nurse assess first?

• A. Evaluate the infant’s feeding technique
• B. Check the infant’s hydration status
• C. Measure the infant’s abdominal circumference
• D. Review the infant’s growth chart

Correct answer: B

Rationale: Assessing hydration status is crucial in an infant who is vomiting frequently, as dehydration can quickly become a serious issue. In this scenario, the infant's inability to retain feeds and lack of weight gain may indicate a potential risk of dehydration, making it essential to prioritize checking the infant's hydration status to prevent complications. Evaluating the feeding technique (Choice A) could be important but is secondary to addressing potential dehydration. Measuring the abdominal circumference (Choice C) and reviewing the growth chart (Choice D) are not the priority in this situation where dehydration is a primary concern.

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