FA Davis

A patient undergoing testing in the radiology department developed hives and difficulty breathing after receiving contrast media. The radiologist ordered 3 mL of epinephrine 1:10,000 IV. Which of the following represents the correct number of milligrams of epinephrine per milliliter in the concentration? O0.001 mg / mL O0.01 mg/mL O 0.1 mg / mL O 1 mg/mL

0.1 mg / mL

A 5-year-old patient weighing 25 kg is prescribed oral morphine 0.2 mg/kg. The pharmacy sends a solution containing 10 mg/mL. The solution is accompanied by a dropper that measures up to 1 mL in increments of 0.25 mL. How many milliliters should be administered? O 0.25 ml O0.5 mL O00.75 mL O 1 mL

0.5 mL

A medication in a vial is labeled with the 50 mg IV over 5 minutes. The nurse draws up mg/mL. In the upper right-hand corner of the label is the expression 5 mL. The order is to administer drug name. Under the drug name is the expression 100 A. 1 mL of medication B. 5 mL of medication C. 0.5 mL of medication D. There is not enough information to answer the question.

0.5 mL of medication

46. A 3-month-pregnant patient who has acne says to you, "This acne is affecting me terribly. I feel depressed every time I look in the mirror. My friend takes tetracycline for acne. Can I?" You know that tetracycline has a pregnancy category of D. Which of the following is the best answer to her question? O "Tetracycline will be safe for you to take once you are in your second trimester. It cannot be taken in the first trimester when organs are forming." O Tetracycline is safe for pregnant women in any trimester." O Tetracycline has been shown to cause abnormalities in the fetus in animal studies. Usually, doctors weigh this risk on an individual basis. Do you want to talk with you physician about it? O "Tetracycline has been shown to cause abnormalities in the fetus and is not recommended for pregnant women."

"Tetracycline has been shown to cause abnormalities in the fetus and is not recommended for pregnant women."

Which of the following is a concern when prescribing medications for adults over 55 years of age | ODecreased activity levels ODecreased cognitive abilities OAlterations in body fat and lean muscle mass ODecreased hematopoeitic function

Alterations in body fat and lean muscle mass

The physician orders morphine 6 mg IM. The nurse administers hydromorphone 6 mg lM. The nurse's action is A. Not an error; hydromorphone is the generic form of morphine B. An error, and the patient will require more medication to obtain pain relief C. An error but will result in adequate pain relief with little potential for harm D. An error with high risk of harm

An error with high risk of harm

44. A patient ready for discharge from the hospital receives several new medication prescriptions. The nurse provides comprehensive teaching to the patient. As the nurse speaks, the patient nods indicating she has understood the instructions. Which of the following actions will be most beneficial in achieving the overall goal of informing the patient about her medications? O Ask the patient to repeat what she has been taught. O Review the medications again O Follow up with a phone call the next day O Provide written instructions.

Ask the patient to repeat what she has been taught.

53. The nurse is administering an antihypertensive medication that has been associated with orthostatic hypotension and falls in the elderly. The patient is a 70-year-old man with benign prostatic hypertrophy, hypertension, and coronary artery disease. He is awake, alert, and oriented and ambulates without an assistive device. Which nursing action is most appropriate to help this patient avoid a fall? O Make sure the side rails are elevated at all times O Have the patient use a walker until he is accustomed to the medication's effects. O Tell the patient to remove throw rugs from his home O Assess the patient's blood pressure supine and standing

Assess the patienrs blood pressure supine and standing

Expressing doses in milligrams per meter squared is based on OBody surface area OBody weight OIdeal body weight OPercentage of body fat

Body surface area

physician writes an order for digoxin for a 68-year-old fibrillation. The dose appears to be 5 mg PO now and 0.25 mg every male patient with a history of atril morning beginning tomorrow. nurse sees the prescribing physician and Knowing that 5 mg represents an unusually high dose, the asks the physician to clarify the order. The physician the order again if the nurse is not sure. The nurse's best course of action is to tells the nurse that the order is clear and to re OAdminister the 5-mg dose from available floor stock OSend the order to the pharmacy and wait to see if it sends five 1-mg tablets or one 0.5- mg tablet OCall the physician back in a half hour and ask again for clarification O Call the nursing supervisor

Call the nursing supervisor

The physician orders MSO4 4 mg IV. The nurse should A. Call the prescriber to clarify the dose B. Prepare to administer morphine sulfate 4 mg C. Call the prescriber to clarify the medication D. Prepare to administer 4 mg of magnesium sulfate INv

Call the prescriber to clarify the medication

45. The FDA has established pregnancy categories to stratify the risk of a drug to the fetus. Which of the following categories represents the lowest risk? O Category A OCategory B O Category C O Category D

Category A

Which of the following best explains why a medication is labeled "high al ert"? OThe medication should not be given to pregnant patients or those with renal or hepatic impairment. OThe medication has limited therapeutic use and should be given with caution. O The medication is associated with increased incidence of side effects . O The medication has a greater potential than most drugs to be harmful to the patient.

The medication has a greater potential than most drugs to be harmful to the patient.

A patient came to the hospital the day she was scheduled to have hip replacement therapy secondary to rheumatoid arthritis (RA). She brought with her a list of her current medications; one of her entries said "methotrexate 7.5 mg/w for RA." In writing her post-op orders, the surgeon wrote for methotrexate 7.5 mg daily. Using your drug guide, determine which of the following comments is accurate A. The post - op methotrexate dose is appropriate B. The post-op methotrexate dose is low C. The post-op methotrexate dose is high but may be necessary for a short time after urgery D. The post-op methotrexate dose is potentially fatal

The post op methotrexate dose is potentially fatal

51. A patient with sickle cell disease is in extreme pain. The only analgesic ordered is oxycodone 5 mg with acetaminophen 325 mg. The nurse calls the attending physician at home to obtain an order fora parenteral analgesic. The physician gives the nurse a verbal order for hydromorphone 2 mg IV. After receiving the verbal order, the nurse should OFind a physician on the same team to sign the verbal order O Administer the medication ORead the order back to the physician O Ask the supervisor if this dose of hydromorphone is appropriate

Read the order back to the physician

Which of the following sodium chloride solutions for injection is considered high alert? O / sodium chloride 0.45 % OSodium chloride 0.9 % O Sodium chloride 0.3 % OSodium chloride 3 %

Sodium chloride 3 %

Research has shown that medication errors are a result of A. Poor packaging B.Systems issues C. Incompetence D. Look-alike/sound-alike drug names

System issues

The Food and Drug Administration (FDA) issued a public health advisory warning practitioners and patients about the effects of heat on fentanyl transdermal patches: "Heat may increase the amount of fentanyl that reaches the blood and can cause life-threatening breathing problems and death." In explaining this to a patient, which of the following comments is accurate? A. "You will have to remove the patch before you shower." B. " Do not use an electric blanket . " C. "You can take a sauna, but you may not use a hot tub." D. "A fever will not cause this effect."

Do not use an electric blanket

dose-reduced in the presence of hepatic impairment. patient with hepatitis C is admitted to the hospital and prescribed a Which of the following statements best reflects medication that should be appropriate dosing? O Dose should be reduced ODose should be reduced if creatinine clearance is less than 40 mL/min ODosage reduction is not necessary unless the patient is jaundiced. ODosage reduction is not necessary, but liver enzymes should be assessed regularly

Dose should be reduced

Impaired renal function affects which of the following pharmacokinetic variables? O Absorption O Distribution OMetabolism OElimination

Elimination

Which of the following is not a factor in dose-related adverse drug reactions? O Patient age O Renal function O Hepatic function OElimination patterns

Elimination patterns

43. After being hospitalized for a pulmonary embolus, a patient is discharged on warfarin 2 mg every other day. The patient was on heparin for several days before being switched to warfarin. Which of the following is the most important for the nurse to do? O Teach the patient about the meaning of INR results O Explain that warfarin and heparin have similar effects but that heparin is not available in oral form. O Explain the need for blood testing. OTell the patient the expected duration of therapy

Explain the need for blood testing.

The Food and Drug Administration (FDA) issued a public health advisory warning practitioners of the potential for methadone overdose resulting in respiratory arrest. Specifically, the advisory states, "Pain relief from a dose of methadone lasts about 4 to 8 hours. However, methadone stays in the body much longer[and] patients may feel the need for more pain relief before methadone is gone from the body." What information do you need know competently explain the underlying concepts in this warning? O Protein binding and metabolism O Absorption and distribution O Half-life and duration of action O Onset and peak effects

Half- life and duration of action

Dosage calculation errors are a common cause of medication error. To minimize the risk of a dosage calculation error, the nurse should A. Double-check the calculation B. Show the calculation to the physician or pharmacist to check C. Have another nurse check the original order and then review the calculation D. Have another nurse check the original order and calculate the dose without looking the first nurse's calculation

Have another nurse check the original order and calculate the dose without looking at the firsr nurses calculations

25. A patient with a potassium level of 2.7 mEa/L is ordered the following: KCI 40 mEq IV bolus. The patient has a draws it up into a syringe, and peripheral IV line and a central IV line. The nurse administers it by direct IV into the central line over 10 minutes. This obtains a vial of KCI 40 mEq in 10 mL, action is O Correct but may result in irritation of the subclavian vein O Incorrect and will likely result in patient death O Correct and will not result in irritation of the subclavian vein because of high blood flow through the vein OIncorrect because a bolus is usually administered over 1 hour

Incorrect and will likely result in patient death

A physician writes an order for insulin glargine 25 units of insulin lispro 15 minutes before meals. The following morning, the nurse administers the morning subcutaneously every morning and 10 units doses of the insulins in the same syringe by first drawing up the insulin lispro and then drawing up the insulin glargine. This action is OCorrect because rapid- and short-acting insulins should always been drawn up first O Incorrect because insulin lispro cannot be mixed with other insulins OIncorrect because insulin glargine should not be mixed with other insulins OIncorrect because insulin glargine should only be given at bedtime

Incorrect because insulin glargine should not be mixed with other insulins

The pediatric nurse practitioner writes the following order: acetaminophen 5 cc PO q 4 hr prn pain. Which of the following best describes this order? O It is accurate and complete O It is incomplete because it does not include a description of the type of pain. O It is incomplete because it does not provide dose in metric weight OIt is incomplete because it does not indicate the duration of therapy (e.g., number of days).

It is incomplete because it does not provide dose in metric weight

52. The Beers list is a list of O Medications that should be avoided by elderly patients O Medications that should be avoided by pregnant patients OMedications that should be avoided by patients under 12 years of age O Medications that should be avoided by breast-feeding women

Medications that should be avoided by elderly patients

The nurse checks a drug reference and learns that the recommended 8-20 mg/kg/day in four divided doses. Which of the following represents the minimum and maximum dose range for clindamycin is daily dose range for an 80-pound child? O Minimum of 1408 mg; maximum of 3520 mg O Minimum of 800 mg : maximum of 2000 mg O Minimum of 324 mg; maximum of 810 mg O Minimum of 291.2 mg; maximum of 728 mg

Minimum of 291.2 mg; maximum of 728 mg

One way the pharmaceutical industry contributes to medication errors is A.Spending too little time on product development B. Packaging different products similarty C. Not alerting physicians and nurses to potential name confusion D. Offering similar products with similar actions

Packaging different products similarly

Is the ordered dose of 150 mg of clindamycin PO every 6 hours for a 10-year-old child weighing 80 pounds in an acceptable dose range if the recommended dose range is 8-20 mg/kg/day in four divided doses? O Yes, 600 mg is in the dose range. O Yes, 900 mg is in the dose range. O No, 600 mg is not in the dose range. ONo, 900 mg is not in the dose range.

Yes, 600 mg is in the dose range.

A nurse is preparing to educate a patient about two new needs to learn four names for two medicines. The nurse's best response is medications. The patient asks why he O"The better informed you are, the more likely you are to adhere to the treatment plan." O "Knowing the generic and brand name of a drug can help prevent confusion. O " The pharmacy may dispense the samedrug by a different brand name , and you will be able to recognize it by the generic name." O"Knowing the brand name will help prevent dosing errors.

"Knowing the generic and brand name of a drug can help prevent confusion.

54. The physician orders Dilantin 25 mg PO two times a day for an 18-month-old child weighing 32 pounds. You know that a safe dose for this age group is 5 mg/kg/day. On hand is Dilantin Pediatric Suspension 125 mg/5 mL. How many mL would you give per dose? O 0.5 mL O 1 mL O 1.5 mL O2 mL

1 mL

Mrs. G is 68 years old with metastatic ovarian cancer. She is 65 inches (165 cm) tall and weighs 150 pounds (68 kg). She is ordered cisplatin 100 mg/m2 for one dose. The nurse determines the patient's BSA is 1.8 m2. The nurse evaluates the dose of cisplatin and determines that the patient needs O 55.5 mg of cisplatin O 550 mg of cisplatin O 180 mg of cisplatin O 1800 mg of cisplatin

180 mg of cisplatin

Which of the following is a high-alert medication? O Oral potassium OIV propranolol O IV heparin 100 unit/ml OIM penicillin

IV propranolol

A physician writes an order for a 10-year-old child for 150 mg of clindamycin PO every 6 hours. The child weighs 80 pounds. Which of the following accurately represents the child's weight in kg? O 176 O100.5 O 40.5 O 36.4

36.4

The physician orders 20,000 units of heparin in 500 mL of DsW. After adding the 20,000 units, how many units of heparin will be in each milliter of DsW? O100 O 50 O40 O 20

40

50. A patient is admitted with thrombophlebitis. The physician orders continuous IV heparin therapy. The pharmacy delivers an IV containing 15,000 units of heparin in 500 mL of 5 % dextrose and says to run it at a rate of 20 mL per hour. You calculate the number of units per hour to determine if this will deliver the dose ordered by the physician. How many units per hour would the patient receive at this concentration and rate? O400 O600 O800 O1000

600

A nurse administers a medication to a patient for the first time. Within a few minutes, the patient began to complain of itching and difficulty breathing. These are symptoms of OAn idiosyncratic reaction O A drug-drug interaction OA hypersensitivity reaction O A food-drug interaction

A hypersensitivity reaction

A pharmacodynamic drug-drug interaction is one that involves O An impairment in drug metabolism or excretion O A hypersensitivity reaction OA known drug effect or side effect O An excessive dose of one of the drugs

A known drug effect or side effect

syrup 250 mg/5 ml to be given orally 1 hour prior to the procedure. The child weighs 20 kg. The before bringing him to the office. The dentist writes a prescription for 3 teaspoons of chloral hydrate The mother of a child undergoing a dental procedure is asked to premedicate the child at home hydrate syrup containing 15 mL of syrup and labeled 500 mg/5 pharmacy mL. The mother administers the entire dispenses a bottle of chloral bottle. This represents OA medication error because the mother gave more than 3 teaspoons O A medication error because the pharmacy dispensed the wrong concentration O A prescribing error because the dosage is excessive O An acceptable way to order, dispense, and administer the medication

A medication error because the pharmacy dispensed the wrong concentration

You are taking the history of a 62-year-old man who has been admitted to an inpatient psychiatric unit. He is depressed and says the antidepressants no longer work. He also has type 2 diabetes hypertension, and a history of atrial fibrillation. His vital signs are BP 138/84, HR 60, RR 18 temperature 99°F. He states he is having visual problems and that everything looks yellow. He has not brought his medications with him, and he tells you he takes furosemide (Lasix) 20 mg every other day, digoxin (Lanoxin) 0.125 mg twice a day, fluoxetine (Prozac) 40 mg daily, and glipizide (Glucotrol) 20 mg twice a day. Which of the following represents the appropriate nursing action? O Call the physician because his antidepressant dose is too low O Assess the patient for signs and symptoms of digoxin toxicity OAssess for signs and symptoms of dehydration. O Assess the patient's blood sugar

Assess the patient for signs and symptoms of digoxin toxicity

A patient receiving continuous heparin therapy has a PTT of 120 seconds. The nurse interprets this value as O Within therapeutic range O Subtherapeutic O Somewhat high ODangerously high

Dangerously high

Neonates require careful dosage calculations due to O Immature neurological system O Immature cardiac function O Immature immune system OImmature hepatic function

Immature hepatic function

17. After 2 days of continuous heparin discontinue the heparin. The nurse therapy, the physician writes an order for interprets this order as dalteparin (Fragmin) 1200 units once daily but does OAppropriate because the two medications improve the anticoagulant effect O Inappropriate because unfractionated and low-molecular-weight heparin cannot be combined OAppropriate because the patient willbe weaned from the heparin the following day O Inappropriate because dalteparin is the antidote for excessive anticoagulatio

Inappropriate because unfractionated and low-molecular-weight heparin cannot be combined

continuous infusion of heparin at the rate of 1000 units per hour. The physician also writes to obtaina A patient was given a bolus of heparin 5000 units IV at 10 A.M. and then was started on a PTT level at 8 A.M. the following morning. The nurse interprets the order for the PTT as any sooner OAppropriate because the dose of 1000 units per hour is low, and PT will not be affected OAppropriate because PTT should be checked once a day OInappropriate because therapeutic heparinization is demonstrated by elevations in INR O Inappropriate because PTT should be measured every 4 hours

Inappropriate because PTT should be measured every 4 hours

41. An 8-month-old infant weighing 9 kg is hospitalized with pneumonia. The nurse administers an antibiotic medication through the patient's saline lock. The nurse prepares to flush the lock after the medication and obtains a 25 - mL bottle of 23.4 % saline solution . The nurse draws up 3 mL of saline into the syringe and, using sterile technique, flushes the saline lock. These actions are OAppropriate O Inappropriate because the volume of saline is too great OInappropriate because the concentration of saline is too high and will cause harm OInappropriate because the concentration of saline is high, but it is unlikely to cause harm

Inappropriate because the concentration of saline is too high and will cause harm

patient was admitted to the hospital through the ED with severe pain "all over." The patient has breast cancer with metastasis to the bone. She has been ordered hydromorphone 2 mg by direct IV normal. Which statement isBoutof is true 10 and concerning shei the nsooimiting administration and of ovenydiaphoreic hydromorphone? OThe dose may be given over 30 seconds ORate of administration will not affect the patient's vital signs. OInitial drowsiness from the drug will diminish with continued use . O Diarrhea is a common side effect of opioids

Initial drowsiness from the drug will diminish with continued use .

One way to prevent medication errors is to A. Store multidose vials of frequently used medications as floor stock on patient-care units B. Provide a list of acceptable abbreviations that include the abbreviation I.U. for international units instead of U for units C. Limit the availability of varying concentrations of high-alert medications D. Educate staff about apothecary symbols

Limit the availability of varying concentrations of high-alert medications

Mr. B., 67 years old, sees his family doctor for leg pain when walking. The doctor explains the pathophysiology of intermittent claudication and orders him cilostazol (Pletal) 100 mg twice daily. Mr. B. has a history of type 2 diabetes, GERD (gastro-esophageal reflux disease), and heart failure (HF). He takes metformin 500 mg bid, omeprazole 20 mg once daily, and digoxin 0.125 mg once daily. Use your Drug Guide to review the medications Mr. B. takes and determine which of the following statements is accurate. A. Mr. B.'s medications are all ordered appropriately B. Mr. B. may experience an adverse reaction to the cilostazol due to his history of HF and GERD C. Mr. B. may experience an adverse reaction due to a drug interaction between metformin and cilostazol D. Mr. B. may experience an adverse reaction related to digoxin and metformin.

Mr. B may experience an adverse reaction to cilostazol due to his history of HF and GERD

Opioid analgesics are considered high-alert medications. Which of the following reasons best explains why? OOpioid analgesics have a high potential for abuse. OOpioid analgesics can cause respiratory depression O Opioid analgesics are given frequently in many health care settings O opioid analgesics are ordered too frequently in instances when less potent medications would work as well.

Opioid analgesics can cause respiratory depression

Of the following, which is not a high-alert medication monitored by the Joint Commission? O Heparin ORegular insulin OMorphine O Oral potassium

Oral potassium

The only insulin that can be given IV is O Insulin lispro O Regular insulin OLente insulin O Lantus insulin

Regular insulin

Mr. R. comes to the emergency department with a bloody nose. He cannot stop the bleeding because he is on warfarin. It is determined that his PT/INR is too high, and vitamin K (phytonadione) 10 mg is ordered IV push. The nurse quickly administers the medication through a saline lock and flushes the lock. After disposing of the needle, the nurse turns to talk to Mr. R., but he is unresponsive. A code is called but the patient cannot be resuscitated. Review the phytonadione monograph in your Drug Guide and determine which of the following explanations for what happened is accurate. A. Phytonadione 10 mg is too high a dose. B. The dose and administration were correct; the patient must have had an idiosyncratic-that is, unpredictable-adverse reaction. C. The medication was administered too quickly. D. The medication can only be given by IM (intramuscular) injection

The medication was administered too quickly

An elderly patient with a poor gag reflex aspirated food and now has aspiration pneumonia. The physician prescribes an antibiotic. The nurse, wanting to start the antibiotics as soon as possible borrows the medication from another patient and administers the first dose. Which of the following best describes the nurse's actions? O The nurse should not borrow the medication because the medication has already been charged to the other patient. OThe nurse should not borrow medication because it bypasses the pharmacist's double- check of the appropriateness of the order O The nurse should borrow the medication because it can be replaced later; starting antibiotics quickly in patients with pneumonia leads to better patient outcomes. O The nurse should borrow the medication; borrowing from other patients or using floor stock is common practice.

The nurse should not borrow medication because it bypasses the pharmacist's double- check of the appropriateness of the order

An obese 72-year-old woman with COPD was ordered (PCA) after surgery. The order was for a 2-mg loading dose, followed needed for pain (total possible hourly dose of 6 mg). The morphine by patient-controlled analgesia by 1 mg every 10 minutes as patient was agitated immediately after surgery but a ppeared to sleep deeply on the patient care floor. Nurses administered the morphine for her. The patient subsequently suffered cardiopulmonary consciousness. Analyze this scenario, and choose the statement that most accurately describes the arrest and eventually died without regaining clinical situation. O The arrest was probably not due to the morphine because doses are well within acceptable range O The arrest was probably due to the morphine because the dosage ranges are high. O The nurses should not have administered the morphine for the patient. O The nurses should have administered the morphine because the patient was unable to do so herself

The nurses should not have administered the morphine for the patient.

describes why the nurse should writes an order: clarify the order? he physician "Change SSRi to 5 usc for BS 350-399." Which of the following best A. The order contains confusing abbreviations. B. The order is incomplete . C. The dose is too low. D. The physician meant to write for a change in dosing of a selective serotonin reuptake inhibitor (usually abbreviated SSRI)

The order contains confusing abbreviations

13. A patient on a maintenance study that reported a decreased incidence of MI in patients taking baby aspirin. Which of the following dose of warfarin begins to take aspirin 200 mg daily after reading a statements is true? O The patient is at risk for an idiosyncratic reaction. O The patient is at risk for a drug-drug interaction. O The patient is at risk for a dose-related reaction OThe patient is at risk for a hypersensitivity reaction

The patient is at risk for a drug-drug interaction.

Which of the following is a frequently cited source of medications errors? A. Computerized physician order-entry systems B. Using trailing zeros in decimal expressions of dose C. Expressing doses of liquid medication in milligrams instead of milliliters D. Hand-printed orders

Using trailing zeros in decimal expressions of dose