A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis.

Ten days later, A.P.'s mother calls you and states, "I think she has lice again! We worked so hard to get rid of them and clean everything. Is there something else we can use to treat her? What do we do now?" A.P.'s pediatrician prescribes spinosad (Natroba) at this time. You will provide teaching to A.P.'s mother. Which statements are correct? Select all that apply, and correct the ones that are incorrect.

a. Apply Natroba to wet hair. b. Shake the bottle before using. c. Leave it on the scalp without rinsing for 24 hours. d. An adult needs to apply the medication to A.P.'s scalp. e. A second treatment, if needed, may be applied in 1 week. f. After the medication is washed off, use a fine-tooth comb to remove treated lice and nits from the hair and scalp.

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. What should be included in the educational plans for A.P. and her parents?

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. What will be your next steps in A.P.'s care?

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. What possible complications can occur as a result of failing to treat head lice?

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. What nursing actions would you take regarding A.P.s classmates?

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. Why would head lice occur in school-aged children?

A.P. is an 8-year-old who is sent to the nurse's office because she has had a 2-day history of scratching her head so badly that she complains that her "head hurts." You complete a general examination of A.P.'s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed-sized, silvery-white, and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis. What is pediculosis capitis?

M.R., who is 81 years old, lives alone in a senior citizens' apartment complex. After she missed several planned holiday activities, and a neighbor knocked on her door to check on her. M.R. answered the door and said that she has had a cold for 4 days and did not want to spread it to others. She said, "It happened so fast, and it just won't go away. It seems to be getting worse no matter what I do." She said she felt very achy and weak, with a headache, and has had no appetite, but did not want to bother her son, who is very busy with his job. M.R.'s neighbor convinced her to call her healthcare provider (HCP), whose office is in the same building. The nurse at the office asked M.R. to come immediately for a visit. When she arrived at the office, the HCP called for an ambulance to take M.R. to the hospital. You place a mask on M.R. in anticipation that she may have influenza. M.R. has a history of hyperlipidemia and osteoarthritis in her knees.

M.R. is admitted to a general medical unit and placed on droplet precautions. She is instructed to remain on bed rest with bathroom privileges, and "Fall Risk" measures are posted because of her weakness. An IV of $\mathrm{D}_5 1 / 2 \mathrm{NS}$ at $75 \mathrm{~mL} / \mathrm{hr}$ is started. In addition to her home medication for hyperlipidemia, other orders include acetaminophen, $650 \mathrm{mg}$ PO every 4 hours as needed for pain or for temperature over $101^{\circ} \mathrm{F}\left(38.3^{\circ} \mathrm{C}\right)$. Her vital signs are BP 110/72, P 110, R 13, T 102.4 $4^{\circ} \mathrm{F}\left(39.1^{\circ} \mathrm{C}\right)$. She is told by the admitting HCP that she most likely has the flu.

The HCP also orders oseltamivir (Tamiflu), $75 \mathrm{mg} \mathrm{PO}$ twice daily for 5 days. M.R. expresses relief that she is receiving this drug because "it will cure the flu." Which assessment findings if noted with M.R., would continue to concern you? Select all that apply.

a. Fever b. Dyspnea c. Confusion d. Sore throat e. Dry mucous membranes f. Diffuse crackles over the lung fields

T.B. is a 65 -year-old retiree who is admitted to your unit from the emergency department (ED). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but "none as bad as this." He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the ED for evaluation.

After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented $\times 3$, and he moves all extremities well. He is restless, constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear with no murmur or rub noted and with a regular rhythm. His abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for 1 week. The patient voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs are blood pressure 164/100, pulse of 132, respiration of 26, the temperature of $100^{\circ} \mathrm{F}$ (37.8 $\left.{ }^{\circ} \mathrm{C}\right), \mathrm{Spo}_2$ 96% on 2 L of oxygen by nasal cannula.

T.B.'s abdominal ultrasound demonstrates several retained stones in the common bile duct and a stone filled gallbladder. T.B. is admitted to your floor, placed on nothing by mouth (NPO) status, and scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP) that afternoon. T.B.'s other lab results are posted, and you review them.

Preoperative Laboratory Test Results:

$$\begin{array}{ll}\text { WBC } & 11,900 / \mathrm{mm}^3\left(11.9 \times 10^9 / \mathrm{L}\right) \\ \text { Hgb } & 14.3 \mathrm{~g} / \mathrm{dL}(143 \mathrm{~g} / \mathrm{L}) \\ \text { Hct } & 43 \% \\ \text { Platelets } & 250,000 / \mathrm{mm}^3\left(250 \times 10^9 / \mathrm{L}\right) \\ \text { ALT } & 200 \mathrm{units} / \mathrm{L} \\ \text { AST } & 260 \mathrm{units} / \mathrm{L} \\ \text { ALP } & 450 \mathrm{units} / \mathrm{L} \\ \text { Total bilirubin } & 4.8 \mathrm{mg} / \mathrm{dL}(82 \mathrm{mcmol} / \mathrm{L}) \\ \text { PT/INR } & 11.5 \mathrm{sec} / 1.0 \\ \text { Amylase } & 50 \text { units } / \mathrm{L} \\ \text { Lipase } & 23 \text { units } / \mathrm{L} \\ \text { Urinalysis } & \text { Negative }\end{array}$$

T.B. undergoes the ERCP, and stones and bile are released; however, imaging reveals that a stone is still retained within the cystic duct and multiple stones remain within the gallbladder itself. Surgical consultation is obtained, and laparoscopic cholecystectomy ("lap choley") is planned.

T.B. undergoes a successful laparoscopic cholecystectomy the next morning. An intraoperative cholangiogram shows that the ducts are finally cleared of stones at the conclusion of the surgery. When he returns to the nursing unit, his stomach is soft but quite distended. His wife asks you whether anything is wrong. As you review the orders, you note that Primaxin contains cilastatin. What is the purpose of cilastatin?

a. It enhances the action of the imipenem. b. It reduces the chance of an allergic reaction. c. It promotes the renal secretion of the imipenem. d. It causes the bacterial cell wall to become unstable.

Client receives a wrong medication. The nurse who made the medication error should take which of the following actions first?

A. Complete incident report

B. Call the client's provider

C. Assess the client

D. Notify the nurse manager

J.D., age 45, noticed a red spot on his calf after a day of yard work. It did not bother him at first, and he thought it may have been a spider bite. The next morning, he noticed that the spot had grown to the size of a nickel, and it was hardened and very painful. His wife asked him to get it checked, but he said he could take care of it, and tried to pierce it with a pocketknife he had sterilized with a match in an attempt to drain it. Nothing came out when he tried this, so he put some antibacterial ointment over it and covered it with a bandage. Two days later, he realized that the wound was draining yellowish fluid, and the skin around the wound was red and tender. He decides to see his healthcare provider (HCP), who told J.D. that he had developed cellulitis around the wound, which was infected.

J.D. is sent home with a prescription for doxycycline capsules. Two days later, the results from the cultures are reported to the HCP. J.D. is asked to go to the hospital for treatment for an MRSA infection.

Wound Culture and Sensitivity Report:

$$\begin{array}{ll}\text { Staphylococcus aureus (MRSA) } & \geq \mathbf{1 0 0 , 0 0 0} \text { colonies } \\ \text { Amoxicillin } & \mathrm{R} \\ \text { Ceftriaxone } & \mathrm{R} \\ \text { Ciprofloxacin } & \mathrm{R} \\ \text { Clindamycin } & \mathrm{R} \\ \text { Doxycycline } & \mathrm{R} \\ \text { Levofloxacin } & \mathrm{R} \\ \text { Linezolid } & \mathrm{S} \\ \text { Trimethoprim-sulfa } & \mathrm{R} \\ \text { Vancomycin } & \mathrm{R}\end{array}$$

Anaerobic Culture:

No growth after 2 days

Contact Precautions are implemented. In addition to intravenous linezolid antibiotic treatment, the HCP performs an incision and drainage procedure. Wound care is ordered every 12 hours with sterile normal saline wet-to-dry dressings. In addition to the antibiotic, J.D. receives methylprednisolone, $10 \mathrm{mg}$ IV every 6 hours. What is the purpose of this drug?

a. For anti-inflammatory effects b. To make the antibiotic more effective c. As a second antibiotic to fight MRSA d. To reduce pain during routine wound care

M.R., who is 81 years old, lives alone in a senior citizens' apartment complex. After she missed several planned holiday activities, and a neighbor knocked on her door to check on her. M.R. answered the door and said that she has had a cold for 4 days and did not want to spread it to others. She said, "It happened so fast, and it just won't go away. It seems to be getting worse no matter what I do." She said she felt very achy and weak, with a headache, and has had no appetite, but did not want to bother her son, who is very busy with his job. M.R.'s neighbor convinced her to call her healthcare provider (HCP), whose office is in the same building. The nurse at the office asked M.R. to come immediately for a visit. When she arrived at the office, the HCP called for an ambulance to take M.R. to the hospital. You place a mask on M.R. in anticipation that she may have influenza. M.R. has a history of hyperlipidemia and osteoarthritis in her knees.

M.R. is admitted to a general medical unit and placed on droplet precautions. She is instructed to remain on bed rest with bathroom privileges, and "Fall Risk" measures are posted because of her weakness. An IV of $\mathrm{D}_5 1 / 2 \mathrm{NS}$ at $75 \mathrm{~mL} / \mathrm{hr}$ is started. In addition to her home medication for hyperlipidemia, other orders include acetaminophen, $650 \mathrm{mg}$ PO every 4 hours as needed for pain or for temperature over $101^{\circ} \mathrm{F}\left(38.3^{\circ} \mathrm{C}\right)$. Her vital signs are BP 110/72, P 110, R 13, T 102.4 $4^{\circ} \mathrm{F}\left(39.1^{\circ} \mathrm{C}\right)$. She is told by the admitting HCP that she most likely has the flu.

The HCP also orders oseltamivir (Tamiflu), $75 \mathrm{mg} \mathrm{PO}$ twice daily for 5 days. M.R. expresses relief that she is receiving this drug because "it will cure the flu." Which measures will be part of M.R.'s treatment as she recovers from influenza? Select all that apply.

a. Rest b. Hydration c. Antibiotics d. Analgesics e. Low protein diet

Three-year-old C.E. is admitted to the emergency department fast-track clinic. Her mother tells the nurse that C.E. has had a low-grade fever for 2 days and is complaining frequently of ear pain and a sore throat. C.E.'s mother also notes that C.E. has been coughing and is a little hoarse. C.E.'s mother states that C.E.'s appetite has been "off," but she has been drinking and using the bathroom as usual. As you get C.E. settled in the exam room, you suspect C.E. may have otitis media (OM).

You continue to obtain a history from C.E.'s mother and learn C.E. has had "ear problems" and throat infections since she was a baby. She is in daycare each weekday, the father smokes outside of the house, and there is a family history of seasonal allergies. C.E. is allergic to penicillin. Her weight is $14 \mathrm{~kg}$ (31 lbs).

The primary care provider (PCP) diagnoses C.E. with bilateral AOM and strep pharyngitis. C.E. is given a prescription for Augmentin $600 \mathrm{mg}$ twice daily $P O \times 7$ days and her mother is instructed to give acetaminophen $240 \mathrm{mg}$ every 4 hours as needed for pain. She is to be discharged to home with instructions to follow up with the ear, nose, and throat (ENT) specialist. C.E.s mother is given a new prescription for azithromycin (Zithromax) PO $160 \mathrm{mg} /$ day $\times 5$ days. Azithromycin is dispensed as $200 \mathrm{mg} / 5 \mathrm{~mL}$.

C.E.'s mother takes C.E. to an ENT specialist. It is determined that her enlarged tonsils might be contributing to the frequent throat and ear infections, and a tonsillectomy and adenoidectomy (T&A) is scheduled. She is admitted postoperatively for 24-hour observation. After the surgery, the postoperative nurse receives C.E. in the short-stay unit from the postanesthesia care unit (PACU). C.E. is awake and alert, bilateral breath sounds are clear, and her $\mathrm{O}_2$ saturation is 98% on room air. She has tolerated sips of clear fluids, and her parents are with her. Which orders would you expect to see postoperatively? Select all that apply, and discuss the rationale for each choice.

a. Ice collar as tolerated b. Vital signs q4hr and prn c. Clear liquids; advance to regular toddler diet d. Home prescription for amoxicillin (Amoxil) $120 \mathrm{mg}$ PO q8hr e. Methylprednisolone (Solu-Medrol) $2.3 \mathrm{mg} \mathrm{IV} \mathrm{q} 8 \mathrm{hr} \times 3$ doses f. Aggressively gargle and swish with water after eating or drinking g. Acetaminophen (Tylenol) $210 \mathrm{mg}$ (15 mg/kg) PO q4hr prn for pain h. Maintain peripheral IV with $\mathrm{D}_5^{1 / 2} \mathrm{NS}$ at $50 \mathrm{~mL} / \mathrm{hr}$; saline lock when taking PO well

J.J., a 79-year-old woman with a history of COPD and renal insufficiency, was hospitalized for pneumonia for over a month. While hospitalized, she received intravenous clindamycin and steroids. She was discharged a week ago on oral antibiotics and steroids. This morning, she developed severe, watery diarrhea that has a strong odor and abdominal pain. This evening, her daughter took her to the emergency department because J.J. had become extremely weak and drowsy, with some confusion. Her vital signs are BP 100/68, P 118, R 24, T 100.5 F $\left(38.1^{\circ} \mathrm{C}\right)$. Her daughter stated, "All of a sudden she had terrible diarrhea, about 8 or 9 times, and she said her belly hurt. She hasn't eaten a thing all day, and I could not get her to drink anything." An IV of 0.9% normal saline at 125 mL/hr was started.

Physician's Orders:

Normal saline IV at $125 \mathrm{~mL} / \mathrm{hr}$ Obtain stool specimen for culture, O&P and C, Diff PCR assay $\mathrm{CBC}$, basic metabolic panel Admit to the medical-surgical department Clear liquids as tolerated BRP with assistance only

The Clostridium difficile PCR results are positive. The hospitalist visits J.J. and tells her daughter that JJ. has an antibiotic-associated C. difficile infection (CDI). The hospitalist orders vancomycin, $250 \mathrm{mg}$ PO 4 times a day. When the nurse comes in to give J.J. the first dose, her daughter asks, "If this was caused by an antibiotic, why is she getting another antibiotic now?" Which adverse effects are possible with oral vancomycin? Select all that apply.

a. Nausea b. Tachycardia c. Nephrotoxicity d. Mouth irritation e. Red rash on the face, neck, upper torso