A healthcare professional is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the healthcare professional adjust the manual IV infusion to deliver?

Correct Answer: A

Rationale: In this pharmacology scenario, the correct answer is A) 22 gtt/min. To understand why this is the right choice, we need to calculate the infusion rate based on the information provided. First, we know that the total volume to be infused is 100 mL over 45 minutes. To find the rate in mL/min, we divide 100 mL by 45 minutes, which equals approximately 2.22 mL/min. Next, we need to convert mL/min to drops per minute (gtt/min) using the drop factor of 10 gtt/mL. By multiplying 2.22 mL/min by 10 gtt/mL, we get 22.2 gtt/min, which can be rounded down to 22 gtt/min since we can't administer a fraction of a drop. Now, let's discuss why the other options are incorrect: - B) 24 gtt/min: This option is close to the correct answer but is slightly higher due to a potential miscalculation or rounding error. - C) 20 gtt/min: This option is lower than the correct answer and would result in a slower infusion rate, potentially affecting the therapeutic effect of the medication. - D) 18 gtt/min: This option is significantly lower than the correct answer and would lead to an even slower infusion rate, which could be inadequate for the intended treatment. Educationally, understanding how to calculate infusion rates accurately is crucial for healthcare professionals to ensure the safe and effective administration of medications. Mastering these calculations helps prevent medication errors and ensures optimal patient outcomes.

Correct Answer: B

Rationale: The nurse should withhold the medication and inform the provider of the client's previous rash after taking penicillin. This history suggests a potential allergic reaction to penicillin, which can range from mild to severe anaphylaxis. Notifying the provider allows for an alternative antibiotic to be prescribed, considering the client's allergy to penicillin. It is crucial to avoid administering a medication that could potentially lead to a severe allergic reaction in the client.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Reduced hepatic function. The drowsiness experienced by the older adult client can be attributed to reduced hepatic function, which leads to decreased metabolism and clearance of medications from the body. Hypnotic medications, such as sedatives and sleep aids, are metabolized in the liver, and in individuals with reduced hepatic function, these drugs can accumulate in the body, leading to prolonged sedative effects. Option A) Reduced cardiac function is not directly related to the drowsiness caused by the hypnotic medication. Cardiac function primarily affects blood circulation, not the metabolism of drugs. Option B) First-pass effect refers to the initial metabolism of a drug in the liver before it reaches systemic circulation. While it is a relevant pharmacokinetic concept, it is not the primary reason for the client's drowsiness in this case. Option D) Increased gastric motility would not typically result in drowsiness. Gastric motility relates to the movement of food through the digestive system and is not directly linked to the sedative effects of hypnotic medications. Educationally, this question highlights the importance of considering age-related changes in pharmacokinetics, particularly hepatic function, when administering medications to older adults. It underscores the need for nurses to be aware of how age-related physiological changes can impact medication responses and side effects in this population.

Correct Answer: A

Rationale: Orthostatic hypotension is a known adverse effect of Phenelzine, a monoamine oxidase inhibitor (MAOI) used for depression. It is caused by a sudden drop in blood pressure when changing positions, leading to symptoms like dizziness or fainting. Monitoring for orthostatic hypotension is crucial during Phenelzine therapy to prevent complications.

Correct Answer: B

Rationale: The correct answer is B) Coarse tremors. Lithium carbonate is a mood-stabilizing medication commonly used to treat bipolar disorder. Coarse tremors are a classic sign of lithium toxicity. Tremors are one of the early signs of lithium toxicity and can progress to more severe symptoms if left untreated. Option A) Severe hypertension is not typically associated with lithium toxicity. In fact, lithium is known to cause renal side effects rather than cardiovascular effects. Option C) Constipation is not a common symptom of lithium toxicity. Gastrointestinal disturbances are not typically associated with lithium toxicity. Option D) Muscle spasm is not a specific sign of lithium toxicity. While muscle weakness can occur in severe cases of toxicity, muscle spasm is not a primary indicator. In an educational context, understanding the signs and symptoms of lithium toxicity is crucial for healthcare providers to ensure the safe and effective management of patients taking this medication. Regular monitoring of lithium levels and awareness of potential toxicities are essential components of caring for individuals with bipolar disorder.