NCLEX 10000 Pharmacological and Parenteral Therapies
A client comes to the mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. Which client statement indicates an accurate understanding of the nurse's teaching about this medication? a) "I can take over-the-counter sleeping medication if I have trouble sleeping." b) "I can drink alcohol with this medication." c) "I need to keep my appointment here at the clinic this week for a blood test." d) "I need to call my doctor in 2 weeks for a checkup."
"I need to keep my appointment here at the clinic this week for a blood test." Correct Explanation: Mandatory weekly white blood cell counts are used to detect developing agranulocytosis, which can be fatal and occurs in 1% to 2% of clients taking clozapine. This medication is associated with a risk of seizures; this risk is dose-dependent, meaning that it increases with moderate to high doses (600 to 900 mg/day).
The nurse instructs a client with coronary artery disease in the proper use of nitroglycerin. The client has had 2 previous episodes of coronary artery disease. At the onset of chest pain, what should the client do? a) Go to the emergency department if two nitroglycerin tablets taken 5 minutes apart are not effective. b) Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective. c) Call 911 when five nitroglycerin tablets taken every 5 minutes are not effective. d) Take one tablet and then immediately call 911.
Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective. Correct Explanation: Nitroglycerin tablets should be taken 5 minutes apart for three doses; if this is ineffective, 911 should be called to obtain an ambulance to take the client to the emergency department.
A client is receiving parenteral nutrition through a central venous catheter. As the nurse is changing the dressing at the catheter site, the client asks why this type of catheter is being used instead of a regular peripheral IV. Which is the best response by the nurse to explain the use of the central venous catheter? a) "The central venous catheter allows nutrients to be administered at a much greater pace." b) "The nutrients that are being administered are too concentrated for a peripheral IV." c) "The solution is hypotonic and can be given only through a central venous catheter." d) "Central venous catheters are inserted when peripheral veins can no longer be used."
"The nutrients that are being administered are too concentrated for a peripheral IV." Correct Explanation: Parenteral nutrition solutions have five to six times the concentration of nutrients of blood. They would be very irritating to the vascular intima if delivered via a peripheral vein. When administered via a central venous catheter, concentrated solutions are rapidly diluted to isotonic levels.
Which of the following instructions should the nurse give to the parents of an 8-year-old child with asthma who is being switched from parenteral steroid therapy to a daily dose of oral prednisone? a) "Make sure to give the pill intact to maintain the enteric coating." b) "Have the child take the dose with meals to prevent gastric irritation." c) "Administer the dose before bedtime to minimize adverse effects." d) "Give the medication according to the child's response."
"Have the child take the dose with meals to prevent gastric irritation." Explanation: Prednisone causes severe gastric upset. Therefore, it should be given with food. It is recommended that the daily dose be given in the morning before 9 a.m. (0900) Given at this time, the medication will suppress adrenal cortex activity less, which may reduce the risk of hypothalamic-pituitary-adrenal--axis suppression.
The in-take nurse is assessing a client who has just arrived at the emergency department and is taking phenelzine, an MAO inhibitor, for treatment-resistant depression. Which of the following statements by this client should be given top priority? a) "I have a throbbing headache." b) "What was my temperature? I'm feeling warm." c) "My legs feel stiff after I sit in the chair for awhile." d) "My bowels haven't moved in the last 2 days."
"I have a throbbing headache." Correct Explanation: A serious, life-threatening reaction to MAO inhibitors is hypertensive crisis. Although this medication usually reduces blood pressure, it can, in combination with too much tyramine (present in other drugs and foods), cause blood pressure to rise to a dangerous level. A throbbing headache could be a significant indicator of an impending crisis.
A client taking disulfiram during alcohol rehabilitation therapy reports to the nurse that he has a mild cold and plans to use a cough medicine. Which statement made by the client indicates understanding of the nurse's teaching? a) "As long as the physician is aware, its okay." b) "I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." c) "I realize that taking cough syrup with this medication might cause me to be depressed." d) "Small doses of cough syrup might make me crave alcohol."
"I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." Correct Explanation: Disulfiram provokes a violent reaction in the presence of alcohol; the client may not realize that cough medicine may contain an alcohol base.
A client has been receiving an I.V. solution. What is an appropriate expected outcome for this client? a) "Edema and warmth are noted at I.V. insertion site." b) "There is a risk for infection related to I.V. insertion." c) "Monitor fluid intake and output every 4 hours." d) "The client remains free of signs and symptoms of phlebitis."
"The client remains free of signs and symptoms of phlebitis." Correct Explanation: "The client remains free of signs and symptoms of phlebitis" is an appropriate expected outcome.
The client with glaucoma is scheduled for a hip replacement. Which prescription would require clarification before the nurse carries it out? a) Administer morphine sulfate. b) Administer atropine sulfate. c) Teach leg lifts and muscle-setting exercises. d) Teach deep-breathing exercises.
Administer atropine sulfate. Correct Explanation: Atropine sulfate causes pupil dilation. This action is contraindicated for the client with glaucoma because it increases intraocular pressure. The drug does not have this effect on intraocular pressure in people who do not have glaucoma.
A nurse is assigned to a client who, after a medication teaching session with her, began receiving amitriptyline hydrochloride to treat depression. One week after starting this drug, the client refuses to take the medication. He says it has caused blurred vision, dry mouth, and constipation, but it hasn't improved his mood. Which nursing diagnosis is appropriate for this client? a) Deficient knowledge (treatment regimen) related to inadequate understanding of teaching b) Ineffective coping related to personal vulnerability c) Anxiety related to unconscious conflict d) Noncompliance (treatment regimen) related to treatment resistance
Deficient knowledge (treatment regimen) related to inadequate understanding of teaching Correct Explanation: The nurse should understand that this client doesn't have the information necessary to make an informed decision about using the medication. The therapeutic effects of amitriptyline aren't seen for 2 to 3 weeks after starting therapy, and the client may develop a tolerance to the adverse effects of the medication if he continues taking it. Therefore, Deficient knowledge related to inadequate understanding of teaching is the most appropriate nursing diagnosis.
A normal, healthy infant is brought to the clinic for the first diptheria, tetanus, acellular pertussis (Dtap) immunization. Which route is appropriate to administer this vaccine? a) intradermal b) IM c) subcutaneous d) oral
IM Correct Explanation: Dtap vaccine is given intramuscularly, usually with other vaccines. As a killed virus it can be given to immunocompromised children.
A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. What complication of antipsychotic therapy does the nurse suspect? a) Neuroleptic malignant syndrome b) Agranulocytosis c) Anticholinergic effects d) Extrapyramidal effects
Neuroleptic malignant syndrome Correct Explanation: Neuroleptic malignant syndrome is a rare but potentially fatal effect of antipsychotic medication. This condition generally begins with an elevated temperature and severe extrapyramidal effects.
The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on the leg. What should the nurse do first? a) Notify the surgeon of the poison ivy. b) Notify the anesthesiologist of the prednisone administration. c) Document the prednisone with current medications. d) Send the client to surgery.
Notify the anesthesiologist of the prednisone administration. Correct Explanation: The nurse should notify the anesthesiologist because supplemental prednisone suppresses the adrenal cortex's natural ability to produce increased corticosteroids in times of stress such as surgery. The anesthesiologist may need to prescribe supplemental steroid coverage during the perioperative period.
A nurse should assess the maturity of enzyme systems (kidney and liver) in which pediatric population before administering medications? a) Neonates b) Premature infants c) Adolescents d) Toddlers
Premature infants Explanation: Factors related to growth and maturation significantly alter an individual's capacity to metabolize and excrete drugs. Thus, the premature infant is at risk for problems because of immaturity. Deficiencies associated with immaturity become more important with decreasing age. Enzyme systems develop quickly, with most increasing to adult levels within 1 to 8 weeks after birth. Within the first year of life, all are probably as active as they will ever be.
The client is taking 50 mg of lamotrigine daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? a) Report the rash to the health care provider (HCP). b) Question the client about recent sun exposure. c) Explain that the rash is a temporary adverse effect. d) Give the client an ice pack for his arm.
Report the rash to the health care provider (HCP). Correct Explanation: The nurse should immediately report the rash to the HCP because lamotrigine can cause Stevens-Johnson syndrome, a toxic epidermal necrolysis.
A nurse is monitoring a client for adverse reactions to atropine eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? a) Increased salivation b) Apnea c) Tachycardia d) Hypotension
Tachycardia Correct Explanation: Systemic absorption of atropine can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. To minimize systemic absorption, the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops. The drug also may cause dry mouth. It isn't known to cause hypotension or apnea.
A 36-month-old child weighing 20 kg (44 lbs) is to receive ceftriaxone 2 g I.V. every 12 hours. The recommended dose is 50 to 75 mg/kg/day in divided doses. The nurse should: a) Call the laboratory to check the therapeutic serum level of ceftriaxone. b) Administer the medication as ordered. c) Administer half the ordered dose. d) Withhold administering ceftriaxone and notify the child's physician.
Withhold administering ceftriaxone and notify the child's physician. Correct Explanation: The child's physician should be notified because the maximum daily recommended dosage for ceftriaxone for this child's weight would be 3.3 g/day and giving this dose would administer 4 g/day.
A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a) Within 12 hours b) Within 5 to 7 days c) Within 6 hours d) Within 24 to 48 hours
Within 6 hours Correct Explanation: For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI.
A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs? a) legs b) abdomen c) arms d) iliac crest
abdomen Correct Explanation: If the client engages in an activity or exercise that focuses on one area of the body, that area may cause inconsistent absorption of insulin. A good regimen for a jogger is to inject the abdomen for 1 week and then rotate to the buttock.
A nurse is administering sublingual nitroglycerin to a client. Immediately after administering nitroglycerin, the nurse should expect to administer: a) acetaminophen. b) prednisone. c) insulin. d) alprazolam.
acetaminophen. Correct Explanation: In the early stages of therapy, nitoglycerin commonly causes headache and dizziness. Acetaminophen usually helps decrease nitroglycerin-induced headache
A nurse is developing a drug therapy regimen that won't interfere with a client's lifestyle. When doing this, the nurse must consider the drug's: a) peak concentration time. b) adverse effects. c) route of excretion. d) steady-state duration of action.
adverse effects. Correct Explanation: When developing a drug therapy regimen that won't interfere with a client's lifestyle, the nurse must consider the drug's adverse effects because these may result in noncompliance.
A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL (80 g/L), and the health care provider (HCP) prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19-gauge needle. To administer the packed red blood cells, the nurse should: a) start an additional IV access device with a 22G intravenous cannulation device. b) attach the packed blood cells to the existing 22G IV of 5% dextrose using Y tubing. c) attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. d) start an additional 22G IV site because the packed blood cells must be given in a separate line.
attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. Explanation: The packed cells should be administered using a central catheter or 19G needle. Y tubing and the normal saline solution are used to keep the vein open when the blood transfusion is complete.
Nursing responsibilities for the client with a patient-controlled analgesia (PCA) system include: a) documenting the client's response to pain medication. b) titrating the client's pain medication until the client is free from pain. c) reassuring the client that pain will be relieved. d) instructing the client to continue pressing the system's button whenever pain occurs.
documenting the client's response to pain medication. Explanation: It is essential that the nurse document the client's response to pain medication on a routine, systematic basis.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a) They decrease the need for insulin. b) They cause wide fluctuations in the need for insulin. c) They increase the need for insulin. d) They have no effect
hey increase the need for insulin. Correct Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for: a) decrease in bronchial secretions. b) thinning of tenacious, purulent sputum. c) less difficulty breathing d) suppression of the client's respiratory infection.
less difficulty breathing Correct Explanation: Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.
Important teaching for a client receiving risperidone should include advising the client to: a) notify the physician if he notices an increase in bruising. b) discontinue the drug if he gains weight. c) maintain a therapeutic level by doubling a dose if he misses a dose. d) be sure to take the drug with a meal because it can severely irritate the stomach.
notify the physician if he notices an increase in bruising. Correct Explanation: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important.
Which should the nurse closely assess in a client who is reversing from general anesthesia and receiving clindamycin? a) hypotension b) renal failure c) respiratory depression d) tachycardia
respiratory depression Correct Explanation: The client who has received general anesthesia with neuromuscular blocking agents must be carefully monitored when given clindamycin. A serious interaction could be enhanced, neuromuscular blockage, skeletal muscle weakness, or respiratory depression, if this combination is used during or immediately after surgery. Concurrent use should be avoided.
A newly pregnant woman tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to: a) switch brands. b) take the vitamin on a full stomach. c) take the vitamin with orange juice for better absorption. d) take the vitamin first thing in the morning.
take the vitamin on a full stomach. Correct Explanation: Prenatal vitamins commonly cause nausea and taking them on a full stomach may curb this adverse effect.
A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used: a) to provide long-term access to central veins. b) for 2 weeks without being replaced. c) in clients with infections in the blood. d) to administer only blood products and I.V. fluids.
to provide long-term access to central veins. Correct Explanation: A PICC provides long-term access (longer than 2 weeks) to central veins. It can be used to administer blood products, medications, I.V. fluids, and total parenteral nutrition. Moreover, the PICC can be used to obtain blood specimens.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: a) insulin. b) furosemide. c) potassium chloride. d) vasopressin.
vasopressin. Correct Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus.
A nurse receives a report that a client has had an overdose of heparin. Which of the following actions by the nurse is most important in managing the overdose? a) Obtain an order to give protamine sulfate. b) Have the client remain on bed rest to prevent injury. c) Inform the client that nosebleeds may occur. d) Review the client's coagulation studies.
Obtain an order to give protamine sulfate. Explanation: Protamine sulfate is the reversal agent for heparin. Administering this would be the best way to treat the client.
A nurse teaches a client experiencing heartburn to take 1.5 oz of aluminum hydroxide when symptoms appear. How many milliliters should the client take? Record your answer using a whole number.
45 Correct Explanation: 1 oz = 30 mL 1 oz/1.5 oz = 30 mL/x mL 1x = 1.5 X 30 x = 45
To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole. The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect? a) Dizziness b) Headache c) Anxiety d) Diarrhea
Diarrhea Correct Explanation: Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects.
A nurse administers digoxin 0.125 mg to a client at 1400 instead of the prescribed dose of digoxin 0.25 mg. Which of the following statements should the nurse record in the medical record? a) Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg. b) At 1400, wrong dose of digoxin given due to heavy workload. c) Digoxin 0.25 mg administered at 1400, physician notified. d) Nurse accidentally gave digoxin 0.125 mg to the client at 1400.
Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg. Correct Explanation: The nurse should not include judgment statements, opinion, assumptions, or conclusions about what happened. The nurse should simply state the occurrence. The other options present judgment, blame, and conclusion.
A client has a patient a controlled analgesia (PCA) infusion to manage postoperative pain. In spite of receiving a dose of pain medication, the client rates the pain at 8 on a 0 to 10 pain scale. What should the nurse do first? a) Notify the health care provider (HCP). b) Inspect the infusion site. c) Assess vital signs. d) Check the patient-controlled analgesia (PCA) pump function.
Inspect the infusion site. Explanation: The nurse should first check the infusion site to be sure the site has not infiltrated. Next, the nurse should check the PCA pump to determine if it is functioning properly. Assessing vital signs would be important to provide additional data about the possible cause of pain, but is not the first action at this time
A client continually reports of pain after the administration of an oral analgesic. The physician writes an order for the nurse to administer a placebo to the client the next time the client reports of pain. The doctor states, "Tell the client it is a stronger analgesic." What would be the appropriate action by the nurse? a) Consult with the pharmacist to discuss the dosage of the placebo. b) Refuse to administer the placebo to the client. c) Give the placebo but do not tell the client it is a stronger medication. d) Give the placebo as ordered by the physician.
Refuse to administer the placebo to the client. Correct Explanation: The nurse should refuse to give the placebo and should also refuse to misinform the client. The nurse has a responsibility to explain the client's medications to the client. The client can then make an informed decision about accepting or refusing the medication.
A nurse has been asked to insert peripheral IV lines in several clients on the nursing unit. Which of the following sites would the nurse need to avoid in order to maintain client safety? a) A sunburned arm of a teenager admitted for hydration therapy b) The unaffected arm of a woman who has had a radical mastectomy c) The arm of a client where an arteriovenous shunt has been inserted d) A tattooed arm of a motorcycle rider diagnosed with kidney failure
The arm of a client where an arteriovenous shunt has been inserted Correct Explanation: The nurse should avoid the arm with an arteriovenous shunt so the shunt is not jeopardized if the IV infiltrates, if the area becomes infected or inflamed, or if a thrombosis develops.
The nurse assesses a client who has just received morphine sulfate. The client's blood pressure is 90/50 mm Hg; pulse rate, 58 bpm; respiration rate, 4 breaths/min. The nurse should check the client's chart for a prescription to administer: a) naloxone hydrochloride. b) doxacurium. c) remifentanil. d) flumazenil.
naloxone hydrochloride. Correct Explanation: Naloxone hydrochloride is the antidote for morphine sulfate. The signs of overdose on morphine sulfate are a respiration rate of 2 to 4 breaths/min, bradycardia, and hypotension.
Cross-tolerance to a drug is defined as: a) one drug increases another drug's potency. b) one drug reduces response to another drug. c) one drug that can prevent withdrawal symptoms from another drug. d) an allergic reaction to a class of drugs.
one drug reduces response to another drug. Correct Explanation: Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug.
A child with iron deficiency anemia was prescribed ferrous sulfate. Which statement by the parent would indicate a need for further instruction on proper administration? a) "I mix the medication in milk to make it taste better." b) "I encourage my child to drink lots of fluids." c) "I give the ferrous sulfate at a different time than my child's other medications." d) "I give the medication in the morning before breakfast."
"I mix the medication in milk to make it taste better." Correct Explanation: Ferrous sulfate absorbs better with juices containing vitamin C. However, food containing calcium will decrease the medication's absorption. Ferrous sulfate should be given on an empty stomach if tolerated. Many medications alter the absorption of ferrous sulfate and they should be administered at least 1-2 hours apart. Drinking lots of fluid will help with constipation, a common side effect of ferrous sulfate.
A client with shock brought on by hemorrhage has a temperature of 97.6° F (36.4° C), a heart rate of 140 beats/minute, a respiratory rate of 28 breaths/minute, and a blood pressure of 60/30 mm Hg. For this client, the nurse should question which physician order? a) "Monitor urine output every hour." b) "Administer oxygen by nasal cannula at 3 L/minute." c) "Infuse I.V. fluids at 83 ml/hour." d) "Draw samples for hemoglobin and hematocrit every 6 hours."
"Infuse I.V. fluids at 83 ml/hour." Correct Explanation: Because shock signals a severe fluid volume loss of (750 to 1,300 ml), its treatment includes rapid I.V. fluid replacement to sustain homeostasis and prevent death. The nurse should expect to administer three times the estimated fluid loss to increase the circulating volume. An I.V. infusion rate of 83 ml/hour wouldn't begin to replace the necessary fluids and reverse the problem. Monitoring urine output every hour, administering oxygen by nasal cannula at 3 L/minute, and drawing samples for hemoglobin and hematocrit every 6 hours are appropriate orders for this client.
The client with chronic renal failure tells the nurse he takes magnesium hydroxide at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid because: a) Magnesium hydroxide is high in sodium. b) Psyllium hydrophilic mucilloid is more palatable. c) Magnesium hydroxide is too harsh on the bowel. d) Magnesium hydroxide can cause magnesium intoxication.
Magnesium hydroxide can cause magnesium intoxication. Correct Explanation: Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems.
A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. What complication of antipsychotic therapy does the nurse suspect? a) Neuroleptic malignant syndrome b) Extrapyramidal effects c) Anticholinergic effects d) Agranulocytosis
Neuroleptic malignant syndrome Correct Explanation: Neuroleptic malignant syndrome is a rare but potentially fatal effect of antipsychotic medication. This condition generally begins with an elevated temperature and severe extrapyramidal effects.
The nurse teaches the client with cirrhosis that the expected outcome of taking lactulose is: a) five to six loose stools per day. b) one regular bowel movement a day. c) two to three soft stools per day. d) four to five loose stools per day.
two to three soft stools per day. Explanation: The expected effect of lactulose is for the client to have two to three soft stools a day to help reduce the pH and serum ammonia levels, which will prevent hepatic encephalopathy.
When observing the parent instilling prescribed ear drops prescribed twice a day for a two-year-old toddler, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddler's pinna in which direction? a) up and forward b) down and backward c) up and backward d) down and forward
down and backward Correct Explanation: In a child younger than 3 years of age, the pinna is pulled back and down because the auditory canals are almost straight in children
The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for: a) less difficulty breathing b) thinning of tenacious, purulent sputum. c) suppression of the client's respiratory infection. d) decrease in bronchial secretions.
ess difficulty breathing Correct Explanation: Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea.
The expected outcome for using thiamine for a client being treated for an alcohol addiction is to: a) prevent the development of Wernicke's encephalopathy. b) decrease the client's withdrawal symptoms. c) promote elimination of alcohol from the body faster. d) aid the client in regaining strength sooner.
prevent the development of Wernicke's encephalopathy. Correct Explanation: Thiamine specifically prevents the development of Wernicke's encephalopathy, a reversible amnestic disorder caused by a diet deficient in thiamine secondary to poor nutritional intake that commonly accompanies chronic alcoholism. It is characterized by nystagmus, ataxia, and mental status changes. Because the client would rather drink alcohol than eat, the client is depleted of vitamins and nutrients
Which oral contraceptive is considered safe for use while breastfeeding because it will not affect the breast milk supply once breastfeeding has been well established? a) progestin b) estrogen and progestin c) estrogen d) testosterone
progestin Correct Explanation: Progestin alone has no effect on breast milk or breastfeeding once the milk supply is well established.
The nurse is preparing to give an IM injection. to an underweight client. Which site is the safest because it has the fewest amount of blood vessels and major nerves located in the area? a) triceps b) deltoid c) dorsogluteal d) vastus lateralis
vastus lateralis Explanation: The vastus lateralis site is the preferred IM site for all ages because it does not have any major nerves or blood vessels located near it. The deltoid and dorsogluteal muscles have major nerves and blood vessels located nearby.
A nurse is administering vitamin K to a neonate. The medication comes in a concentration of 2 mg/ml and the ordered dose is 0.5 mg to be given subcutaneously. How many milliliters should the nurse administer? Record your answer using two decimal places.
0.25 Correct Explanation: The nurse should use the following formula to calculate drug dosages: Dose on hand/Quantity on hand = Dose desired/X Plug in the values and the equation is as follows: 2 mg/ml = 0.5 mg/X X = 0.25 ml.
An 8-month-old infant is admitted with a febrile seizure. The infant weighs 17 lb (7.7 kg). The physician orders ceftriaxone, 270 mg I.M. every 12 hours. (The safe dosage range is 50 to 75 mg/kg daily.) The pharmacy sends a vial containing 500 mg, to which the nurse adds 2 ml of preservative-free normal saline solution. The nurse should administer how many milliliters? a) 1.8 ml b) None because this isn't a safe dosage c) 0.08 ml d) 1.08 ml
1.08 ml Correct Explanation: Because the infant weighs 17 lb (7.7 kg), the safe dosage range is 385 to 578 mg daily. The ordered dosage, 540 mg daily, is safe.
A physician orders normal saline solution to infuse at a rate of 150 ml/hour for a client admitted with dehydration and pneumonia. How many liters of solution will the client receive during an 8-hour shift? Record your answer using one decimal place.
1.2 Correct Explanation: The client is to receive the solution at an infusion rate of 150 ml/hour. 150 ml X 8 hours = 1,200 ml, the total volume in milliliters the client will receive during an 8-hour shift. Next, convert milliliters to liters by dividing by 1,000. The total volume in liters of normal saline solution that the client will receive in 8 hours is 1.2 L
The nurse is preparing a client's preoperative medication. The order reads atropine 0.6 mg and meperidine hydrochloride 50 mg I.M. The dosage of available atropine is 0.8 mg/ml and the dosage of available meperidine is 100 mg/ml. What will be the total volume of medication the nurse will administer? Record your answer using two decimal places.
1.25 Correct Explanation: The atropine dosage is calculated as follows: 0.6 mg/x ml = 0.8 mg/ml x = 0.75 ml The meperidine dosage is calculated as follows: 50 mg/x ml = 100 mg/ml x = 0.5 ml The total volume to be administered is 1.25 ml.
A client receives an IV dose of gentamicin sulfate. How long after the completion of the dose should the peak serum concentration level be measured? a) 20 minutes b) 40 minutes c) 10 minutes d) 30 minutes
30 minutes Correct Explanation: The peak serum dose of an antibiotic is drawn 30 minutes after the completion of the IV dose of the antibiotic.
A client who is experiencing an exacerbation of ulcerative colitis is receiving IV fluids that are to be infused at 125 mL/h. The IV tubing delivers 15 gtt/mL. How quickly should the nurse infuse the fluids in drops per minute to infuse the fluids at the prescribed rate? Record your answer using a whole number.
31 Correct Explanation: To administer I.V. fluids at 125 mL/h using tubing that has a drip factor of 15 gtt/mL, the nurse should use the following formula: 125 mL/60 min × 15 gtt/1 mL = 31 gtt/min.
Two days after a client undergoes repair of a ruptured cerebral aneurysm, a physician orders mannitol, 0.5 g/kg to be infused over 60 minutes. The client weighs 175 lb. The nurse should administer how many grams of mannitol? Record your answer using a whole number.
40 Correct Explanation: To determine the number of grams to administer, the nurse first must convert the client's weight from pounds to kilograms using the following conversion factor: 1 kg = 2.2 lb 175 lb x 1 kg / 2.2 lb = 79.55 kg (pounds cancel out in this equation) 175 lb / 2.2 lb = 79.55 kg Next multiply the client's weight by the ordered amount (0.5 mg / kg). 79.55 kg x 0.5 g/kg = 39.775 g (kilograms cancel out) Round this number to the nearest whole number to determine the dose to be administered equals 40 grams.
A woman who is Rh-negative has given birth to an Rh-positive infant. The nurse explains to the client that she will receive Rho(D) immune globulin (RhoGAM). The nurse determines that the client understands the purpose of RhoGAM when she states: a) "RhoGAM will be used to prevent bleeding in my newborn." b) "RhoGAM will prevent antibody formation in my blood." c) "RhoGAM will protect my next baby if it is Rh-negative." d) "RhoGAM will be given to prevent antigen formation in my baby's blood."
"RhoGAM will prevent antibody formation in my blood." Correct Explanation: RhoGAM is given to new mothers who are Rh-negative and not previously sensitized and who have given birth to an Rh-positive infant. RhoGAM must be given within 72 hours of the birth of the infant because antibody formation begins at that time. The vaccine is used only when the mother has borne an Rh-positive infant—not an Rh-negative infant.
A child with nephrosis is placed on prednisone. The dose is 2 mg/kg/day to be administered twice a day. The child weighs 25 lb (11.3 kg). How many milligrams will the child receive at each dose? Record your answer using one decimal place.
11.3 Correct Explanation: 11.3 kg X 2 mg = 22.6 mg each day. The child is to receive two doses, so 22.6 mg/day ÷ 2 doses/day = 11.3 mg/dose
The health care provider (HCP) changes a client's current dose of IM meperidine hydrochloride to an oral dosage. The current IM dosage is 75 mg every 4 hours as needed. What dosage of oral meperidine will be required to provide an equivalent analgesic dose? a) 150 to 300 mg every 4 hours b) 75 to 100 mg every 4 hours c) 25 to 50 mg every 4 hours d) 125 to 140 mg every 4 hours
150 to 300 mg every 4 hours Correct Explanation: The equianalgesic dose of oral meperidine hydrochloride is up to four times the IM dose.
A physician orders the following preoperative medications to be administered to a client by the I.M. route: meperidine, 50 mg; hydroxyzine pamoate, 25 mg; and glycopyrrolate, 0.3 mg. The medications are dispensed as follows: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer? a) 3.8 ml b) 5 ml c) 2.5 ml d) 2 ml
2.5 ml Correct Explanation: Using the proportion method, the nurse solves for X and then adds the total number of milliliters together.
Intraosseous infusion of a medication would be most appropriate for which child? a) A 4-year-old child with celiac disease b) A 5-year-old child with status asthmaticus c) A 2-year-old child with a ruptured spleen and hypovolemia d) An 18-month-old child with cystic fibrosis
A 2-year-old child with a ruptured spleen and hypovolemia Correct Explanation: In an emergency, intraosseous drug administration is typically used when a child is critically ill and younger than age 3. The 2-year-old child with a ruptured spleen and hypovolemia meets these criteria
Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration? a) Altered onset of action b) Altered duration c) Altered drug absorption d) Altered drug dose
Altered drug dose Correct Explanation: Although not harmful to the client when injected, small air bubbles can actually change the dose of medication administered; therefore, the nurse should remove the air bubbles
A nurse is teaching a client how to administer subcutaneous (subQ) insulin injections. Which injection site should the client use? a) Deltoid b) Vastus lateralis c) Rectus femoris d) Anterior aspect of the thigh
Anterior aspect of the thigh Correct Explanation: SubQ injection sites, which are relatively distant from bones and major blood vessels, include the lateral aspects of the upper arm, the anterior aspects of the thigh, and the abdomen.
The nurse should teach the client who is receiving warfarin sodium that: a) warfarin sodium will facilitate clotting of the blood. b) International Normalized Ratio (INR) is used to assess effectiveness. c) partial thromboplastin time values determine the dosage of warfarin sodium. d) protamine sulfate is used to reverse the effects of warfarin sodium.
International Normalized Ratio (INR) is used to assess effectiveness. Correct Explanation: INR is the value used to assess effectiveness of the warfarin sodium therapy. INR is the prothrombin time ratio that would be obtained if the thromboplastin reagent from the World Health Organization was used for the plasma test. It is now the recommended method to monitor effectiveness of warfarin sodium. Generally, the INR for clients administered warfarin sodium should range from 2 to 3.
Before the nurse administers IV replacement of 5% dextrose in water with potassium chloride, what nursing intervention must be completed first? a) adding potassium chloride to the bag at the bedside b) evaluating laboratory results for electrolytes c) checking the rate for IV push administration. d) priming tubing using sterile technique
evaluating laboratory results for electrolytes Correct Explanation: IV solutions are prescribed based upon the fluid and electrolyte status of the client, so laboratory results should be monitored first
A client with impaired cardiac functioning is at risk during anesthesia induction with thiopental sodium because this drug causes: a) complete muscle relaxation. b) bradycardia. c) hypotension. d) tachypnea.
hypotension. Explanation: Sodium pentothal, a short-acting barbiturate, can cause hypotension, which may be especially problematic for the client with impaired cardiac functioning.
Which food should the nurse tell the client to avoid while taking phenelzine? a) fresh fish b) hamburger c) salami d) roasted chicken
salami Correct Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). MAOIs block the enzyme monoamine oxidase, which is involved in the decomposition and inactivation of norepinephrine, serotonin, dopamine, and tyramine (a precursor to the previously stated neurotransmitters). Foods high in tyramine—those that are fermented, pickled, aged, or smoked—must be avoided because, when they are ingested in combination with MAOIs, a hypertensive crisis occurs. Some examples include salami, bologna, dried fish, sour cream, yogurt, aged cheese, bananas, pickled herring, caffeinated beverages, chocolate, licorice, beer, red wine, and alcohol-free beer.
A child brought to the hospital with ketoacidosis is to receive regular insulin via an I.V. infusion. Which of the following I.V. solutions should the nurse expect the primary care provider to order initially? a) 5% dextrose. b) 0.9% saline. c) 2.5% dextrose. d) 0.45% saline.
0.9% saline. Correct Explanation: A child with ketoacidosis should receive normal saline solution because it is isotonic and does not contain glucose. The child receives this solution until the blood glucose level approaches the normal range. The rate, or units given per hour, is based on the child's weight. A child with ketoacidosis has elevated blood glucose levels.
A physician orders a single dose of trimethoprim/sulfamethoxazole by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next? a) Give one tablet, three times per day. b) Call the physician to verify the order. c) Administer the three tablets as the single dose. d) Call the hospital pharmacist and question the medication supplied.
Call the hospital pharmacist and question the medication supplied. Correct Explanation: The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error
The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. Teaching regarding the use of these medications is effective if the client will take: a) the levothyroxine with breakfast and the other medications after breakfast. b) all medications before going to bed. c) all medications together 1 hour after eating breakfast. d) the levothyroxine before breakfast and the other medications 4 hours later.
the levothyroxine before breakfast and the other medications 4 hours later. Correct Explanation: Levothyroxine) must be given at the same time each day on an empty stomach, preferably ½ to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.
A 25-year-old client taking hydroxychloroquine for rheumatoid arthritis reports difficulty seeing out of the left eye. What does this finding indicate? a) possible retinal degeneration b) part of the disease process c) development of a cataract d) a coincidental occurrence
possible retinal degeneration Correct Explanation: Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals.
The antidote for heparin is: a) thrombin. b) vitamin K. c) protamine sulfate. d) warfarin.
protamine sulfate. Correct Explanation: The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant.
Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin should include which information? Select all that apply. a) Give the medication at regular intervals. b) Notify the health care provider (HCP) of poor feeding or vomiting. c) Notify the HCP if more than two consecutive doses are missed. d) Make up any missed doses as soon as realized. e) Repeat the dose one time if the child vomits immediately after administration. f) Mix the medication with a small volume of breast milk or formula.
• Notify the health care provider (HCP) of poor feeding or vomiting. • Notify the HCP if more than two consecutive doses are missed. • Give the medication at regular intervals. Correct Explanation: To achieve optimal therapeutic levels, digoxin should be given at regular intervals without variation, usually every 12 hours. Vomiting and poor feeding are signs of toxicity. If more than two consecutive doses are missed, interventions may be needed to assure therapeutic drug levels. The medication should not be mixed with any other fluid as refusal may result in inaccurate intake of the medication. Taking make-up doses, or taking the medication at times other than scheduled, may adversely affect serum levels
A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication? a) "I'll call my physician if I have ringing in the ears." b) "I'll call my physician if I have difficulty voiding." c) "I know this medication may cause constipation so I will take a daily stool softener." d) "I know this mediation may cause bleeding so I will take it on an empty stomach."
"I'll call my physician if I have ringing in the ears." Correct Explanation: The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears).
A client who is being discharged from the hospital with bacterial pneumonia discusses not completing all medication in antibiotic regimens in the past. Which of the following statements should be a priority by the nurse? a) "Complete the medication unless you are not coughing any sputum." b) "You are infectious with the bacteria until all antibiotics are completed." c) "Taking the medication until you feel better is usually okay." d) "Taking only part of the prescription medication will result in antibiotic-resistant microbes."
"Taking only part of the prescription medication will result in antibiotic-resistant microbes." Explanation: Taking medication until completed will lessen antibiotic-resistant strains of bacteria.
Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate? a) diastolic blood pressure greater than 90 mm Hg b) respiratory rate of 20 breaths/minute c) systolic blood pressure greater than 110 mm Hg d) urine output greater than 30 ml/hour
urine output greater than 30 ml/hour Correct Explanation: Urine output provides the most sensitive indication of the client's response to therapy for hypovolemic shock. Urine output should be consistently greater than 35 mL/h. Blood pressure is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. Respiratory rate is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock.
