A nurse is planning care for a child who has a prescription for somatropin.
Which of the following interventions should the nurse include to evaluate the therapeutic effect of this medication?
Monitor the child's height monthly.
Verify the child's thyroid function is within the expected reference range.
Check the child's sodium level regularly.
Measure the child's abdominal girth.
The Correct Answer is A
Choice A rationale
Somatropin is a synthetic growth hormone used to treat growth hormone deficiency. The primary therapeutic effect of this medication is to promote linear growth in children. Therefore, monitoring the child's height monthly is a direct and quantifiable measure to evaluate the effectiveness of somatropin therapy and ensure that the child is achieving the expected growth velocity.
Choice B rationale
While thyroid function can influence growth, and growth hormone deficiency can sometimes coexist with or impact thyroid axis, evaluating the therapeutic effect of somatropin directly involves assessing growth. Monitoring thyroid function is important for overall endocrine health but is not the primary measure for the therapeutic effect of somatropin itself, assuming thyroid function is within normal limits (e.g., TSH 0.4-4.0 mIU/L, free T4 0.8-1.8 ng/dL).
Choice C rationale
Checking the child's sodium level regularly is not a direct measure of the therapeutic effect of somatropin. Growth hormone can influence fluid balance, but sodium levels (normal range 135-145 mEq/L) are primarily monitored for hydration status or potential adverse effects like fluid retention, not as an indicator of growth hormone's efficacy in promoting growth.
Choice D rationale
Measuring the child's abdominal girth is a measure of abdominal circumference, primarily used to assess abdominal distention, fluid accumulation, or changes in visceral fat. It is not a relevant parameter for evaluating the therapeutic effect of somatropin, which is specifically aimed at stimulating linear bone growth and overall somatic growth.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An INR (International Normalized Ratio) of 4.0 indicates that the client's blood is much thinner than the therapeutic range for most conditions (usually 2.0-3.0 for warfarin). This significantly increases the risk of bleeding. Vitamin K is the antidote for warfarin because it is essential for the synthesis of clotting factors (II, VII, IX, X) in the liver. Administering vitamin K reverses the anticoagulant effect of warfarin, reducing the risk of hemorrhage by promoting the production of functional clotting proteins.
Choice B rationale
Protamine sulfate is the antidote for heparin. It works by forming a stable ion pair with heparin, neutralizing its anticoagulant effects. It has no effect on the anticoagulant properties of warfarin, which acts by inhibiting vitamin K epoxide reductase, an enzyme crucial for the regeneration of active vitamin K necessary for clotting factor synthesis. Therefore, protamine is not indicated for warfarin overdose.
Choice C rationale
Calcium gluconate is used to treat hypocalcemia and magnesium toxicity. Calcium plays a vital role in numerous physiological processes, including bone health and muscle function, and is essential for blood coagulation. However, it does not directly counteract the effects of warfarin, which targets vitamin K-dependent clotting factors, and is not the appropriate antidote for an elevated INR.
Choice D rationale
Epinephrine is a potent vasoconstrictor and bronchodilator used in anaphylaxis, cardiac arrest, and severe asthma. It acts on alpha and beta-adrenergic receptors, leading to increased heart rate, blood pressure, and bronchodilation. It has no role in reversing the anticoagulant effects of warfarin and is not indicated for managing an elevated INR.
Correct Answer is C
Explanation
Choice A rationale
Urinary retention is a potential adverse effect of opioid analgesics like meperidine due to their anticholinergic effects, which can relax the detrusor muscle and increase bladder sphincter tone. While important to monitor, it is not the most immediate life-threatening concern compared to respiratory depression.
Choice B rationale
Vomiting is a common gastrointestinal adverse effect of opioid analgesics, often due to stimulation of the chemoreceptor trigger zone in the brainstem. While distressing for the client and requiring intervention, it does not pose the immediate life-threatening risk that respiratory depression does.
Choice C rationale
Meperidine is an opioid agonist that acts on mu-opioid receptors in the central nervous system, including the brainstem respiratory centers. This can lead to dose-dependent respiratory depression by decreasing the sensitivity of these centers to carbon dioxide, making a depressed respiratory rate (normal range 12-20 breaths/min) the priority assessment for client safety.
Choice D rationale
Altered level of consciousness, such as drowsiness or sedation, is a common central nervous system effect of meperidine. While a significant finding indicating opioid effect, it is secondary in priority to respiratory depression, which directly impacts vital gas exchange and can quickly become life-threatening.
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