(NurseLabs)A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the ED. Which of these orders should the nurse do first?
A. Gastric lavage
B. Acetylcysteine (mucomyst) for age per pharmacy
C. Start an IV D5 1/2 NS to keep vein open
D. Activated charcoal per p...
NCLEX Practice Questions (NurseLabs)A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the ED. Which of these orders should the nurse do first? A. Gastric lavage B. Acetylcysteine (mucomyst) for age per pharmacy C. Start an IV D5 1/2 NS to kee p vein open D. Activated charcoal per pharmacy - ✔ ✔ A. Gastric lavage Removing as much of the drug as possible is the first step in treatment for this drug overdose. This is best done by gastric lavage. The next drug to give would be activated charcoal, then mucomyst, and lastly IV fluids Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure? A. Angina at rest B. Thrombus formation C. Dizziness D. Falling BP - ✔ ✔ B. Thrombus formation Thrombus formation in the coronary arteries is a potential problem in the initial 24 hours after a cardiac cath. A falling BP occurs alone with hemorrhage of the insertion site which is associated with the first 12 hours after the procedure. A client is admi tted to the ED with renal calculi and is complaining of moderate to severe flank pain and nausea. The client's temperature is 100.8 degrees F. The priority nursing goal for this client is: A. Maintain fluid and electrolyte balance B. Control nausea C. Man age pain D. Prevent UTI - ✔ ✔ C. Manage pain The immediate goal of therapy is to alleviate the client's pain What would the nurse expect to see while assessing the growth of children during their school age years? A. Decreasing amounts of body fat and muscle mass B. Little change in body appearance from year to year C. Progressive height increase of 4 inches each year D. Yearly weight gain of about 5.5lbs per year - ✔ ✔ D. Yearly weight gain of about 5.5lbs per year School age children gain about 5.5lbs per year and increase about 2 inches in height The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? A. A middle age client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia 5 days ago B. A young adult with DM Type 2 for over 10 years and admitted with abx induced diarrhea 24 hours ago C. An elderly client with a history of HTN, hypercholesterolemia, and lupus, and was admitted with Stevens -Johnson syndrome that morning D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago - ✔ ✔ A. middle aged client The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home a 3-year -old c hild comes to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling and suprasternal retractions. What should the nurs e do first? A. Prep the child for x -ray of upper airways B. Examine the child's throat C. Collect a sputum sample D, Notify the healthcare provider of the child's status - ✔ ✔ D. Notify the health care provider of the child's status These findings sugges t a medical emergency and may be due to epiglottises. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate attention in a facility equipped to perform intubation or a tracheostomy in the event of furthe r or complete obstruction. In children suspected to have a diagnosis of Diabetes, which one of the following complaints would be most likely to prompt parents to take their school age child for evaluation? A. Polyphagia B. Dehydration C. Bed wetting D. We ight loss - ✔ ✔ C. Bed wetting In children, fatigue and bed wetting are the chief complaints that prompt parents to take their children in for evaluation. When teaching a client with coronary artery disease about nutrition, the nurse should emphasize A. Eating 3 balanced meals a day B. Adding complex carbohydrates C. Avoiding very heavy meals
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