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Exhibits

Review H and P, laboratory results, flow sheet, and orders.

The nurse notifies the health care provider of the lab values, blood pressure and pulse, and current intake and output.

Which prescriptions does the nurse expect the healthcare provider to write based on the information? Select all that apply.

Turn off the suction on the nasogastric tube

Bolus calcium

Increase the intravenous fluid rate

Add potassium to the intravenous fluids

Administer a diuretic

Flush the central line with 3% sodium chloride

Decrease the percentage of sodium in the intravenous fluids

Answer and Explanation

Correct Answer : A,C,D

A.   Turn off the suction on the nasogastric tube. The client has been experiencing continuous nasogastric (NG) suction, which can lead to fluid and electrolyte imbalances. The client's low blood pressure (86/64 mm Hg), leg cramping, and fatigue suggest volume depletion and possible electrolyte loss. Discontinuing NG suction will help prevent further fluid loss and electrolyte depletion.
B.   Bolus calcium. The client’s calcium levels (9.2 mg/dL and 9.1 mg/dL) are within normal range (8.5–10.2 mg/dL). Since there is no indication of hypocalcemia, a calcium bolus is not necessary.
C.   Increase the intravenous fluid rate. The client’s low blood pressure, tachycardia (96 bpm), and signs of fatigue suggest hypovolemia, likely due to fluid losses from NG suction and inadequate IV fluid replacement. Increasing IV fluid rate can help restore circulatory volume and improve perfusion.
D.   Add potassium to the intravenous fluids. The client’s potassium level has dropped from 3.8 mEq/L to 3.5 mEq/L, which is at the lower limit of normal (3.5–5.0 mEq/L). Prolonged NG suctioning can cause hypokalemia, leading to muscle cramps, weakness, and fatigue. Adding potassium to IV fluids can prevent further decline and correct the deficiency.
E.   Administer a diuretic. The client is already hypovolemic due to NG losses, as evidenced by low blood pressure and tachycardia. A diuretic would further exacerbate volume depletion, making it an inappropriate intervention.
F.   Flush the central line with 3% sodium chloride. The client's sodium levels are normal (139–142 mEq/L), so a hypertonic saline flush (3% NaCl) is not needed. This type of fluid is typically used for severe hyponatremia, which is not present in this case.
G.   Decrease the percentage of sodium in the intravenous fluids. The client is receiving Dextrose 5% in 0.9% sodium chloride, which provides isotonic hydration. Since the sodium level is within normal limits and the client is hypovolemic, reducing sodium concentration in IV fluids is not necessary.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

Plugged duct: A plugged duct occurs when milk is not effectively drained from the breast, leading to milk stasis and inflammation. If untreated, it can progress to mastitis, an infection caused by bacterial overgrowth in stagnant milk. The client's history of missing a feeding while shopping increases the likelihood of milk stasis, making a plugged duct the most likely cause of mastitis.
Breast abscess: A breast abscess is a collection of pus that forms when mastitis is left untreated or does not respond to antibiotics. Unlike mastitis, an abscess is typically fluctuant (soft and fluid-filled), extremely tender, and may require drainage. Since the client’s mastitis symptoms have just begun, an abscess is unlikely at this stage.
Engorgement : Breast engorgement occurs when the breasts overfill with milk, causing swelling and discomfort. While engorgement can increase the risk of mastitis, it is not an infection itself and does not directly cause mastitis unless milk stasis leads to bacterial overgrowth. Engorgement is bilateral, whereas mastitis is usually unilateral with localized redness, warmth, and fever.
Nipple trauma with cracked skin: Cracked nipples can allow bacteria to enter the breast, increasing the risk of infection. However, mastitis is primarily caused by milk stasis, not just nipple trauma. In this client, there is no mention of nipple cracks or bleeding, making this a less likely cause.
Firm, red, warm area on the right breast: A firm, red, warm, and tender area on the breast is a hallmark symptom of mastitis, indicating localized inflammation and infection. The presence of systemic symptoms (fever, chills, fatigue) further supports mastitis rather than another breast condition.
Pus draining from the nipple: Pus or fluctuance (fluid-filled swelling) suggests a breast abscess, not mastitis. While untreated mastitis can lead to an abscess, this client’s symptoms do not indicate a severe or advanced infection requiring drainage.
Generalized swelling of the entire breast: Severe engorgement can cause generalized swelling, but mastitis typically presents as a localized, inflamed area rather than affecting the entire breast. Engorgement also does not cause fever or systemic illness, which are present in mastitis.
Pain that worsens with cold compresses: Cold compresses reduce inflammation and discomfort in mastitis. If cold worsens pain, it may suggest Raynaud’s phenomenon of the nipple, which is not related to mastitis. Mastitis pain is relieved with warmth, massage, and frequent breastfeeding.

A. Avoid any smoking inside the house. B. Give infant the full course of antibiotics. C. Schedule visit for pneumococcal vaccine. D. Instill benzocaine otic drops regularly.

Correct Answer is D

Explanation

A. Avoid any smoking inside the house. Exposure to secondhand smoke increases the risk of recurrent otitis media by irritating the respiratory tract and impairing mucociliary clearance. Reducing or eliminating smoke exposure is an essential preventive measure to lower inflammation and decrease bacterial colonization in the middle ear.
B. Give infant the full course of antibiotics. Completing the full course of prescribed antibiotics ensures that the infection is fully treated, preventing bacterial resistance and reducing the likelihood of recurrent or persistent infections. Stopping antibiotics prematurely can lead to incomplete eradication of the bacteria and increase the risk of future infections.
C. Schedule visit for pneumococcal vaccine. The pneumococcal vaccine protects against Streptococcus pneumoniae, one of the leading causes of otitis media. Ensuring that the infant is up to date with routine vaccinations, including the pneumococcal and Haemophilus influenzae type B (Hib) vaccines, can significantly reduce the risk of recurrent infections.
D. Instill benzocaine otic drops regularly. Benzocaine otic drops provide temporary pain relief but do not prevent or treat infections. Using them regularly without medical guidance may mask symptoms of worsening infection, delay appropriate treatment, or cause local irritation. Pain management should be used only as needed and in conjunction with appropriate medical interventions.

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Naxlex Comprehensive Predictor Exams

Exhibits Choose the most likely options for the information missing from the statement by selecting from the list of options provided. The nurse knows that the mastitis in this scenario is most likely caused bydropdown, as evidenced bydropdown

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

The nurse is providing discharge instructions to the caregiver of an infant with recurrent otitis media. Which statement made by the caregiver should the nurse recognize as needing additional education about minimizing subsequent infections?

Correct Answer is D

Explanation

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