A patient is receiving gentamicin every 12 hours IVPB for an infection.

The nurse has administered the 0900 dose, which is prescribed to run over 1 hour. The physician prescribed peak and trough levels to be drawn.

When should the nurse expect to draw the peak level?

0930

1000

2030

2100

Answer and Explanation

The Correct Answer is B

Choice A rationale

Drawing the peak level at 0930, which is 30 minutes after the start of the infusion, would be too early. The medication would not have had enough time to reach its peak level in the blood.

Choice B rationale

The peak level of gentamicin is typically evaluated 30 minutes after the completion of the infusion. Since the infusion is administered over 1 hour, the peak level would be expected to be drawn at 10001.

Choice C rationale

Drawing the peak level at 2030, which is 12 hours after the start of the infusion, would not provide an accurate representation of the peak level of gentamicin. This is because the medication would have been metabolized and excreted over this period.

Choice D rationale

Drawing the peak level at 2100, which is 12.5 hours after the start of the infusion, would not provide an accurate representation of the peak level of gentamicin. This is because the medication would have been metabolized and excreted over this period.

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Correct Answer is D

Explanation

Choice D rationale

Hyperosmolar Hyperglycemic Syndrome (HHS) is a serious complication of diabetes that occurs when blood sugar levels are extremely high. The primary treatment for HHS is intravenous fluids and insulin. Specifically, 0.9% saline solution IV is often used initially to restore volume and correct severe dehydration.

Choice A rationale

Administration of Glucagon is not the primary treatment for HHS. Glucagon is a hormone that raises blood glucose levels and would not be beneficial in a situation where blood glucose is already extremely high.

Choice B rationale

Dextrose 50% is a concentrated glucose solution and would not be appropriate in the treatment of HHS, where blood glucose levels are already dangerously high.

Choice C rationale

While IV fluids are a crucial part of the treatment for HHS, 0.45% Normal Saline (also known as half-normal saline) is a hypotonic solution and is not typically the first choice for fluid resuscitation in HHS. The preferred initial fluid is often 0.9% saline (normal saline), which is isotonic.

A. Hold the warfarin until the next day’s dose and notify the laboratory. B. Administer the daily dose of warfarin and notify the healthcare provider so tomorrow’s dose can be adjusted. C. Administer the daily dose of warfarin as these are the expected side effects of the medication. D. Hold the warfarin until the healthcare provider is notified of the assessment findings.

Correct Answer is D

Explanation

Choice A rationale

While holding the warfarin and notifying the laboratory could be appropriate actions in some situations, they would not address the immediate concern of the large, new ecchymotic areas on the client’s extremities.

Choice B rationale

Administering the daily dose of warfarin and notifying the healthcare provider for a dose adjustment the next day could potentially exacerbate the bleeding risk, given the presence of the large, new ecchymotic areas.

Choice C rationale

Large, new ecchymotic areas are not expected side effects of warfarin. They could indicate a serious problem such as excessive anticoagulation.

Choice D rationale

The presence of large, new ecchymotic areas could indicate excessive anticoagulation, which is a serious complication of warfarin therapy. Therefore, holding the warfarin and notifying the healthcare provider of the assessment findings would be the most appropriate initial action.

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A patient is receiving gentamicin every 12 hours IVPB for an infection. The nurse has administered the 0900 dose, which is prescribed to run over 1 hour. The physician prescribed peak and trough levels to be drawn. When should the nurse expect to draw the peak level?

Choice B rationale

Choice C rationale

Choice D rationale

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Correct Answer is D

Explanation

Choice D rationale

Choice A rationale

Choice B rationale

Choice C rationale

The nurse is preparing to administer a client’s warfarin sodium 5 mg PO at 1900. Upon entering the client’s room, the nurse finds several large, new ecchymotic areas on the client’s extremities. What should be the nurse’s initial action?

Correct Answer is D

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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A patient is receiving gentamicin every 12 hours IVPB for an infection.

The nurse has administered the 0900 dose, which is prescribed to run over 1 hour. The physician prescribed peak and trough levels to be drawn.

When should the nurse expect to draw the peak level?