Med Math & Med Safety
Order: cephalexin 500 mg PO every 6 hours. Available: cephalexin 250 mg capsules. How many capsules should the nurse give per dose?
2
A child is admitted with gastroenteritis. Name one task the nurse can delegate to an unlicensed assistive personnel (UAP), and one task the nurse must keep.
Can delegate: daily weights, vital signs, intake and output, hygiene. Must keep: assessing, teaching, evaluating, giving medications.
A toddler with tetralogy of Fallot often squats down after playing. Why does this help?
Squatting raises resistance in the leg arteries, which sends more blood to the lungs to pick up oxygen
Two toddlers sit side by side, each playing with their own blocks, barely interacting. What type of play is this?
Parallel play
A child with type 1 diabetes at school is shaky, sweaty and irritable. Blood glucose is 58 mg/dL. What should the nurse do first?
Give 15 g of fast-acting carbohydrate (4 oz juice or glucose tablets), then recheck in 15 minutes
A nurse gives a scheduled antibiotic to the right child, at the right dose, route and time, but waits until the end of the shift to chart it. Which right of medication administration was not followed, and when should the nurse chart?
Documentation, immediately after administration.
A 5-year-old is 4 hours post-tonsillectomy. What behavior would make the nurse suspect bleeding at the surgical site?
Frequent swallowing (also: vomiting bright red blood, rising pulse, restlessness)
A child has coarctation of the aorta. What blood pressure and pulse pattern would the nurse expect when comparing the arms and the legs?
High BP and bounding pulses in the arms; lower BP and weak or absent pulses in the legs
A parent says their 6-month-old has never smiled at them. By about what age do most babies have a social smile, and is this a red flag?
About 2 months. Yes, no social smile by 6 months is a red flag.
What is the most accurate way to track how much fluid an infant is losing or regaining?
Daily weight, on the same scale, at the same time, with the same clothing (or none)
Order: acetaminophen 240 mg PO. The bottle reads 160 mg per 5 mL. How many mL should the nurse give? (Round to the tenth.)
7.5
The nurse's assignment includes a 2-year-old with croup. What finding in this child would move them to the top of the list, ahead of stable clients?
Stridor at rest, especially with restlessness or retractions
Name two early signs of heart failure in an infant that parents should report.
Sweating or tiring during feedings, poor weight gain, fast breathing, puffy eyelids, fewer wet diapers
A parent of a hospitalized infant says, "This is my fault. I should have brought her in sooner." Say a therapeutic response the nurse could give.
Example: "It sounds like you're feeling guilty. Tell me more about that."
An infant is going home in a Pavlik harness for developmental dysplasia of the hip (DDH). Give two key teaching points for the parents.
Don't take the harness off unless the provider says to. Put the diaper under the straps. Check the skin under the straps a few times a day. Sponge-bathe the baby.
Calculate this child's total intake in mL for the shift:
0800: 5 oz milk, 1 scrambled egg, 1 slice toast
1200: 4 oz gelatin, grilled cheese sandwich, 6 oz water
1500: 3 oz ice pop
540 mL
A toddler arrives with a fever and an itchy, blister-like rash that started on the trunk. Chickenpox is suspected. Vital signs are stable, SpO₂ 98%. What should the nurse do first?
Put on PPE and place the child on airborne and contact precautions
A child with an asthma attack had loud wheezing on admission. Now the wheezing has stopped, breath sounds are faint, and the child looks anxious. What does this mean?
A 'silent chest', a sign of severe airway obstruction and possible respiratory failure. This is an emergency.
A 16-year-old asks the nurse to promise not to tell their parents something. In which situations must the nurse share confidential information?
When there is risk of serious harm: thoughts of suicide, plans to hurt someone else, or abuse
Name three triggers of a sickle cell crisis that families should help their child avoid.
Dehydration, infection or fever, cold temperatures, high altitude or low oxygen, overexertion, emotional stress
A child weighs 44 lb. Order amoxicillin 40 mg/kg/day PO, divided every 8 hours. How many mg should the child get per dose? (Round to the nearest tenth.)
266.7 mg
An 8-year-old starts having a tonic-clonic seizure in the playroom. What is the nurse's first action?
Protect the child from injury: ease them to the floor, turn them on their side, move hard objects away, and time the seizure
What is the most serious complication of Kawasaki disease, and which test is used to watch for it?
Coronary artery aneurysm, watched for with an echocardiogram
A 2-year-old explores everything by putting it in their mouth. Which safety topic should the nurse put first when teaching the parents, and what number should they keep handy?
Poisoning prevention. Poison Control: 1-800-222-1222
A newborn has a myelomeningocele and is waiting for surgery. How should the nurse position the baby and protect the sac?
Position prone (or side-lying). Cover the sac with a sterile, moist, non-stick saline dressing. Keep stool away from it. Use latex-free supplies.