A 15-year-old with Hodgkin's Lymphoma is receiving Chemotherapy as an inpatient. She has vomited multiple times today despite receiving Zofran around the clock (ATC). The nurse will message the doctor and see if an order for
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Rationale for correct choices:
• Dexamethasone: This corticosteroid is often used as an adjunct antiemetic in chemotherapy-induced nausea and vomiting, particularly when standard agents like ondansetron are insufficient. It reduces inflammation and influences the chemoreceptor trigger zone to help control symptoms.\
• Begin parenteral nutrition: This supplies nutrients intravenously, bypassing the gastrointestinal tract, which is beneficial when severe vomiting prevents oral or enteral feeding. It ensures adequate caloric and nutrient intake during prolonged intolerance to GI feeding.
Rationale for incorrect choices:
• Phenergan: This antihistamine is effective for motion sickness or mild nausea but is less preferred for severe chemotherapy-induced symptoms in pediatric patients due to sedative and anticholinergic effects. It is not a first-line adjunct to ondansetron in oncology cases.
• Protonix: This proton pump inhibitor reduces gastric acid secretion and is used for GERD or ulcer prevention, not for managing chemotherapy-related nausea and vomiting. Its mechanism does not address the cause of the patient’s symptoms.
• Flagyl: This antimicrobial targets anaerobic bacterial infections and certain protozoa. It has no role in treating chemotherapy-induced nausea or vomiting and would not alleviate the patient’s acute symptoms.
• Initiate enteral feeding: This provides nutrition via a feeding tube if oral intake is insufficient, but persistent severe vomiting makes tolerance poor. Enteral feeding is avoided until nausea is controlled.
• Consult a dietitian: Involving a dietitian can help develop nutritional strategies, but it is an indirect intervention. If weight loss continues with ongoing vomiting, more immediate nutritional support is required.
• Increase caloric intake: Advising increased calories is ineffective if the patient cannot tolerate food due to persistent nausea and vomiting, making parenteral or other specialized interventions more appropriate
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. "I understand that my baby will be given multiple IV medications. Some of these medications might include opioids for pain management and antibiotics to protect her from infection.": Pain control and infection prevention are essential after open heart surgery.
B. "I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum.": Sternal precautions are critical to prevent strain on the healing sternum.
C. "I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital.": Tummy time after recent sternotomy can place pressure on the chest incision and stress the healing sternum, increasing risk of complications. It should be delayed until cleared by the surgical team.
D. "I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team.": Post-op recovery often requires extended hospitalization and long-term follow-up to monitor cardiac function and surgical healing.
Correct Answer is B
Explanation
Rationale:
A. A high-pitched "click" is heard with hip flexion or extension: A soft or high-pitched click may occur in many healthy newborns due to ligament laxity and is not specific to developmental dysplasia of the hip (DDH). It is generally considered a benign finding.
B. A distinct "clunk" is heard with Barlow and Ortolani maneuvers: This is a hallmark finding for DDH. The “clunk” indicates the femoral head is either dislocating from or relocating into the acetabulum during these maneuvers, confirming hip instability and potential dislocation.
C. The thigh and gluteal folds are symmetric: Symmetric skin folds suggest normal hip alignment. Asymmetry of these folds is more concerning for DDH, so symmetry would not confirm the diagnosis.
D. Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis): This degree of hip motion can be within normal limits, especially in the absence of instability. Restricted abduction is more consistent with DDH in older infants.
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