A nurse is preparing to administer vancomycin IV to an adult client. The client asks the nurse if the medication can be given 2 hr earlier. Which of the following statements should the nurse make?

“I can adjust the time and schedule for when it’s convenient for you.”.

“I can start the medication 30 minutes earlier.”.

“I have up to 2 hours after the usual schedule time to give you this medication.”.

“I can infuse the medication at a faster rate.”.

Answer and Explanation

The Correct Answer is B

The correct answer is choice b. “I can start the medication 30 minutes earlier.”.

Choice A rationale:

Adjusting the time and schedule for convenience is not appropriate for medications like vancomycin, which require precise timing to maintain therapeutic levels and avoid resistance.

Choice B rationale:

Starting the medication 30 minutes earlier is a reasonable adjustment that maintains the medication’s effectiveness and safety.

Choice C rationale:

Administering the medication up to 2 hours after the usual schedule time is incorrect because it could lead to subtherapeutic levels and reduced effectiveness.

Choice D rationale:

Infusing the medication at a faster rate is unsafe as it increases the risk of adverse reactions, such as "red man syndrome".

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Correct Answer is C

Explanation

This is because a normal FHR baseline is between 110 and 160 bpm, and anything above or below this range indicates fetal distress and should be reported to the provider. An FHR baseline of 170/min could indicate fetal tachycardia, which could be caused by maternal fever, infection, dehydration, fetal anemia, or fetal hypoxia.
Choice A is wrong because early decelerations in the FHR are normal and benign, and indicate head compression during contractions.
They do not require any intervention or reporting.
Choice B is wrong because contractions lasting 80 seconds are within the normal range for active labor, which is 40 to 90 seconds per contraction.
They do not indicate any complication or abnormality.
Choice D is wrong because a temperature of 37.4° C (99.3° F) is slightly elevated but not considered a fever. A fever is defined as a temperature of 38° C (100.4° F) or higher.
A mild increase in temperature could be due to dehydration, exertion, or environmental factors, and does not necessarily indicate infection or inflammation.

A. Potassium level. B. Temperature. C. WBC count. D. Breath sounds. E. Blood pressure.

Correct Answer is ["B","C","D"]

Explanation

B, C, and D. These findings require follow-up because they indicate possible complications of chemotherapy, such as infection, low blood cell counts, and lung damage.

Choice B is correct because a temperature of 38.6° C (101.5° F) is a sign of fever, which can indicate an infection. Chemotherapy can weaken the immune system and make the client more prone to infections.

Choice C is correct because a WBC count of 3,800/mm3 is below the normal range of 5,000 to 10,000/mm3 and indicates leukopenia, a condition of low white blood cells. Chemotherapy can cause leukopenia by damaging the bone marrow where blood cells are produced.

Choice D is correct because crackles heard at the bases of the lungs are abnormal breath sounds that can indicate fluid accumulation or inflammation in the lungs. Chemotherapy can cause lung damage by affecting the cells that line the airways or by triggering an immune response.

Choice A is wrong because a potassium level of 3.6 mEq/L is within the normal range of 3.5 to 5 mEq/L and does not require follow-up.

Choice E is wrong because a blood pressure of 114/56 mm Hg is within the normal range of less than 120/80 mm Hg and does not require follow-up.

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A nurse is preparing to administer vancomycin IV to an adult client. The client asks the nurse if the medication can be given 2 hr earlier. Which of the following statements should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is in active labor. Which of the following findings should the nurse report to the provider?

Correct Answer is C

Explanation

A nurse is caring for a client Exhibits A nurse is reviewing the client's electronic medical record. Which of the following findings requires follow-up? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

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