Medication and I.V. Administration

Lactic acidosis

A client is prescribed metformin to control type 2 diabetes. The nurse should monitor for which life-threatening adverse reaction?

bananas and oranges.

A client is receiving furosemide, 40 mg by mouth twice per day. In the plan of care, the nurse should emphasize teaching the client about the importance of consuming:

Notifying the surgeon that the consent form hasn't been signed

A client is scheduled for surgery at 8 a.m. While completing the preoperative checklist, the nurse sees that the surgical consent form hasn't been signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation?

Check for availability of a liquid preparation.

A client reports difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take to resolve this problem?

19 mg

A client weighing 167 lb (76 kg) is brought to the emergency department in status epilepticus. The primary care provider asks the nurse to prepare diazepam 0.25 mg/kg. How many milligrams will be given to this client? Round your answer to a whole number.

Determine whether the client knows the appropriate drug dosages and administration schedules. Determine whether the client knows the correct reason for using the drug and its proper route of administration.

A client who takes over-the-counter drugs regularly is seen at a clinic. The nurse should take which actions to ascertain the client's safety when taking these drugs? Select all that apply.

Obtain another machine from central supply.

A client who underwent abdominal surgery returns from the postanesthesia care unit with a nasogastric (NG) tube in place. The client complains of nausea. While preparing to attach the client's NG tube to intermittent suction, the nurse notices that the ground on the suction machine's plug is broken. What priority action should the nurse perform first?

Directs the nurse to administer regular insulin doses according to finger-stick glucose levels without notifying the physician

A client who's admitted with new-onset diabetes mellitus is prescribed an 1,800-calorie diabetic diet. His insulin orders include regular insulin coverage using a sliding scale, and long-acting insulin every morning just before breakfast. Why was the sliding scale insulin coverage prescribed?

"It is a measure of effect, not a standard measure of weight or quantity."

A client with diabetes mellitus is receiving insulin. The nursing instructor asks the nursing student to correctly describe an insulin unit. How does the student appropriately respond?

8

A licensed practical nurse (LPN/LVN) is working with the RN in verifying a heparin IV infusion rate. The prescribed dose is 400 units of heparin per hour. The heparin is in a solution of 5,000 units/100 mL NS. How many milliliters per hour should the pump be set? Record your answer using a whole number.

metabolism of the medication

A medication nurse is preparing to administer 9 a.m. medications to a client with liver cancer. Which consideration is the nurse's highest priority?

ticarcillin

A nurse is administering medication to a client who is allergic to penicillin. Which drug is contraindicated for this client?

Hold the medication and notify the health care provider.

A nurse is administering morning medications to a client on warfarin. Upon reviewing the laboratory results, the nurse notes a prothrombin time (PT) of 27.3. What should the nurse do?

Check the roller clamp.

A nurse is monitoring a client receiving intravenous (IV) fluid via pump. The alarm of the pump starts to beep for occlusion. What should the nurse do first?

125

A nurse is monitoring a client with an IV infusion of 1000 mL of 5% dextrose in 0.45 NS to be completed in 8 hours. The IV delivery system's drop factor is 20. The nurse should verify the infusion pump is set to deliver how many mL/hour? Record your answer using a whole number.

Dilute with juice and administer through a straw.

A nurse is preparing to administer ferrous sulfate to a client. What is the nurse's appropriate action?

Synergism

The nurse is administering two drugs concomitantly to a client. Which interaction, recognized by the nurse, occurs when two drugs with the same qualitative effects produce a response when given together that is greater than the response either drug produces when given alone?

Verify the order by repeating it back to the physician over the phone.

The nurse receives a medication order from a physician over the telephone. Which nursing intervention is priority when receiving a telephone order?

Hypertonic

The nursing instructor asks the nursing student to select a type of solution, when administered intravenously (I.V.), would cause a shift of fluid from the interstitial space to the intravascular space. Which solution will the student choose?

32 drops/minute.

The physician orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V. tubing delivers 15 drops/ml. The nurse should check that the I.V. is infusing at a rate of:

Two

The physician orders nitroglycerin, 5 mg by mouth twice per day, for a client. The drug is dispensed in 2.5-mg tablets. How many tablets will the nurse administer twice per day?

½ ml

The physician prescribes 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?

Hypokalemia

The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

120 ml/hour

The physician prescribes an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, the client should receive how many milliliters of I.V. fluid per hour?

10 mL

The nurse is caring for an older adult resident with a cough. The resident has standing orders for guaifenesin syrup 200 mg, P.O., every 4 hours. The nurse has a dosage of 100-mg/5-mL. Mark on the medicine cup the amount of syrup the nurse would pour.

Check for latex allergy before applying the tourniquet.

The nurse is initiating an intravenous (IV) access for a client who needs an infusion of normal saline solution. Which nursing action should the nurse perform before the venipuncture?

Acknowledge the client's behavior, and seek clarification.

A nurse is reinforcing education with a client about three medications that the client will receive after discharge. While performing the discharge education, the nurse notices that the client suddenly becomes withdrawn and appears anxious. What action should the nurse take?

Restrict access to area of the spill.

A nurse is working on the oncology unit when a chemotherapy drug spills on the floor. What should the nurse do next?

infiltration

A client has an IV line in place for 3 days and begins to report discomfort at the insertion site. Based on the client's progress notes shown, which condition has most likely occurred?

"Use the bronchodilator first, then wait about 5 minutes before using the corticosteroid."

A client is prescribed a corticosteroid inhaler along with a bronchodilator inhaler. Which instruction about these drugs should the nurse give the client?

Obtain vital signs, and immediately notify the primary health care provider and charge nurse of the error.

A client is prescribed digoxin 0.125 mg by mouth stat. The pharmacy dispenses digoxin 0.25 mg. The nurse promptly administers the medication and then realizes the incorrect dose has been administered. How should the nurse proceed?

0.6

A client is prescribed heparin 6,000 units subcutaneously every 12 hours for deep vein thrombosis prophylaxis. The pharmacy dispenses a vial containing 10,000 units/1 mL. How many milliliter(s) of heparin should the nurse administer? Record your answer using one decimal place.

Hypokalemia

A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child?

Discontinuing the medication and notifying the physician of the error

A client admitted with bacterial pneumonia is prescribed cefuroxime axetil 550 mg I.V. every 4 hours. While assessing the client, the nurse notices that cefazolin 500 mg I.V. is infusing. Which action by the nurse is most appropriate?

"It decreases the number of ammonia-producing bacteria in the GI tract."

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. Her physician prescribes neomycin, 4 g by mouth daily in four divided doses. Her husband asks how neomycin decreases his wife's serum ammonia concentration. How should the nurse respond?

Crush the tablets and prepare a liquid form, and then insert it into the NG tube using using a syringe.

A client has a nasogastric (NG) tube. The physician prescribes an oral medication that is not available in liquid form. Which action should the nurse utilize to administer the tablet form to this client?

Perform handwashing. Check the client's medical record number and name on the identification bracelet. Check the client's allergies in the medical record, and verify them with the client.

A nurse needs to administer prescribed medications to a client with heart failure. Prior to administering the medications, what actions should the nurse take? Select all that apply.

Gently pull the auricle up and back.

A nurse prepares to administer eardrops to an adult client. Which action should the nurse take before instilling the drops?

Closely monitor prothrombin time (PT) and international normalized ratio (INR) results to determine the dose of warfarin to administer.

After being treated with heparin for a pulmonary embolism, a client is prescribed warfarin using a sliding scale. Which action should the nurse take before administering this drug?

4

The nurse is caring for a 12-month-old child with otitis media. The child weighs 11 kg and has no known drug allergies. The primary health care provider has prescribed amoxicillin 200 mg PO every 12 hours. The drug available is amoxicillin suspension 250 mg/5mL. What should the nurse administer per dose? Record your answer using a whole number.

Support the client's decision and hold all treatments.

The nurse is caring for a client on an oncology unit who is refusing further chemotherapy treatment after the rationale for the treatment has been clearly explained. What is the nurse's best action?

3-5

The nurse is caring for a client who is receiving warfarin. The nurse reinforces to the client that anticoagulant effects may not be seen for how many days?

4

The health care provider's order reads 2 g of cephalexin PO daily in equally divided doses of 500 mg each. How many times per day should the nurse administer this medication? Record your answer using a whole number.

1.25

The label of a drug package reads "hydralazine, 20 mg/ml." How many milliliters would the nurse give a client for a 25-mg dose?

The nurse can implement medication orders quickly.

The newly hired graduate nurse asks the nurse preceptor what is the only advantage of using a floor stock system. Which rationale does the preceptor give the graduate nurse?

22G, 1"

The nurse is preparing to give a 9-year-old client a preoperative I.M. injection. Which size needle should the nurse use?

Inform the pharmacy that the medication is unavailable, ask them to prepare it, and and tell them that someone will pick it up immediately.

A client reports a severe headache and blurred vision. The nurse immediately obtains vital signs, which reveals a blood pressure of 192/110 mm Hg. The nurse reviews the client's medical record and notes a prescription for clonidine 0.1 mg by mouth as needed for systolic blood pressure greater than 170 mm Hg and diastolic blood pressure greater than 100 mm Hg. The nurse checks the client's medication supply, but no clonidine is available. How should the nurse proceed?

2 mL

After laparoscopic cholecystectomy, a client reports pain and nausea. A nurse is preparing 75 mg of meperidine and 12.5 mg of promethazine to be administered IM in the same syringe. If the label on the meperidine reads 50 mg/mL and the label on the promethazine reads 25 mg/mL, how many milliliters should the nurse have in the syringe after the correct doses are drawn up? Record your answer using a whole number.

50

After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg I.V. The mixed I.V. solution contains 100 mL. The nurse is to administer the drug over 30 minutes. The drop factor of the available I.V. tubing is 15 gtt/mL. What is the drip rate in drops per minute? Record your answer using a whole number.

It can result in incomplete drug absorption.

What is one disadvantage of using the rectal route for drug administration?

Rotate the injection sites. Inject at a slow, steady pace. Insert the needle at 90 degrees. Hold the syringe like a dart.

Which actions should the nurse take to administer insulin to a client with diabetes? Select all that apply.

the nursing supervisor the prescriber

The nurse inadvertently gives a client a double dose of a prescribed medication. After discovering the error, whom should the nurse immediately notify? Select all that apply.

the prescriber

The nurse inadvertently gives a client a double dose of a prescribed medication. After discovering the error, whom should the nurse notify?

Throbbing headache or dizziness

The nurse is administering sublingual nitroglycerin to the client. Immediately after administration, the nurse observes the client for which possible sign or symptom?

cimetidine ranitidine nizatidine famotidine

A histamine (H2) receptor antagonist is prescribed for a client with recurrent gastrointestinal discomfort. The nurse is instructing the client from a medication pamphlet and highlights which medications in this classification? Select all that apply.

The cause of the error is identified through system-wide analysis.

A hospital is conducting a root cause analysis for a serious medication error made by a nurse that injured a client. What is the expected outcome of the root cause analysis?

Verify the dose against the health care provider's prescription in the client's medical record.

A client with hypothyroidism is prescribed levothyroxine 0.05 mg by mouth daily before breakfast. As the nurse gives the client the medication, the client states, "What dose am I getting? I've been taking 0.15 mg every day for years." Which action by the nurse is most appropriate?

Monitor the client's weight every day. Monitor serum protein, electrolytes, and blood glucose periodically. Monitor the client's energy levels.

A client with pancreatitis has been receiving parenteral nutrition (PN) for the past week. Which nursing interventions help determine if the client is receiving adequate nutrition? Select all that apply.

10 mL

A client with severe pain is prescribed hydromorphone 10 mg by mouth every 4 hours as needed for pain. The client rates pain as eight on a one-to-ten scale, so the nurse prepares to administer a dose. The oral liquid contained in the unit's opioid stock contains 5 mg/5 mL. How many milliliters of solution should the nurse give to the client? Record your answer using a whole number.

50-mL

The nurse is caring for an infant who is receiving I.V. therapy. The health care provider orders D5NS 400-mL to infuse in 8 hours. How much I.V. solution would the nurse place in the buretrol?

Simultaneously withdraw the needle and release the skin.

The nurse has an order to administer an intramuscular (I.M.) injection using the Z-track technique. When carrying out this order, what nursing intervention should the nurse implement?

Use the Z-track technique.

The nurse has an order to administer an iron dextran 50 mg intramuscular (I.M.) injection. When carrying out this order, which method should the nurse utilize?

rash on skin of face, chest, and arms reports severe itching all over inspiratory wheezes

The nurse is obtaining vital signs from a client who is receiving an intravenous antibiotic for the first time. Which observation made by the nurse requires immediate intervention? Select all that apply.

Withhold the drug and notify the health care provider.

The nurse is preparing to administer a dose of chlorpropamide to a client with type 2 diabetes. Before administering the drug, the nurse checks the client's allergies and notices that the client is wearing an allergy alert bracelet that indicates an allergy to sulfa drugs. Which action should the nurse take?

Using a pad, break ampoule away from the body.

The nurse is preparing to administer an injection from an ampoule. To avoid injury, how should the nurse open the ampoule?

withhold the suppository and notify the client's physician.

The nurse is to give a client a 325-mg aspirin suppository. The client has diarrhea and is in the bathroom. The best nursing approach at this time would be to:

sublingual

The nurse knows which drug administration routes provides the most rapid response in a client?

Check the tubing for kinks and reposition the client's wrist and elbow.

When checking a client's I.V. insertion site, the nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

health care provider's signature

Which information must be included in a medication order?