Med Concepts - Medication and I.V. Administration - ML6

During a shift report, a nurse is told that a postoperative client with diabetes is on "sliding scale" insulin coverage. The primary health care provider has prescribed the following sliding scale. Insulin aspart SC, before meals based on the following blood glucose (BG) levels: BG level less than 110 mg/dL 0 units BG level between 110 and 130 mg/dL 3 units BG level between 131 and 150 mg/dL 4 units BG level between 151 and 200 mg/dL 6 units BG level greater than 200 mg/dL Call provider The nurse obtains a fingerstick blood glucose level just before breakfast. It is 207 mg/dL. What is the nurse's action? Administer 4 units of insulin aspart. Administer 6 units of insulin aspart, and then call the provider. Administer 6 units of insulin aspart. Call the provider for further prescriptions.

Call the provider for further prescriptions. Explanation: With sliding scale insulin coverage, the glucose level of capillary blood is checked on a regular basis, and short-acting regular insulin is administered based on the glucose levels. This treatment is used for short-term glucose management after surgery. According to the prescribed sliding scale, the BG level of 207 mg/dL exceeds the range of the sliding scale coverage, so the provider should be called for further instruction. The nurse would not administer the 6 units prior to calling the primary health care provider.

The nurse is using the Z-track method of intramuscular (IM) injection to administer iron dextran to a client with iron-deficiency anemia. What nursing intervention should be performed when administering this medication? Select all that apply. Inject the iron dextran after aspirating for a blood return. Change the needle after drawing up the iron dextran. After removing the needle, massage the injection site. Confirm the client's identity before administering the iron dextran. Inject the iron dextran into the deltoid muscle. Before inserting the needle, displace the skin laterally by pulling it away from the injection site.

Confirm the client's identity before administering the iron dextran. Change the needle after drawing up the iron dextran. Before inserting the needle, displace the skin laterally by pulling it away from the injection site. Inject the iron dextran after aspirating for a blood return. Explanation: Before administering any medication, the nurse must confirm the client's identity. After drawing up the iron dextran, the nurse should remove the first needle and attach a second needle to prevent tracking the medication through the subcutaneous tissue when the second needle is inserted. To administer the injection by the Z-track method, the nurse should first displace the skin laterally by pulling it away from the injection site. The nurse should aspirate for blood return before administering iron dextran; if no blood appears, the medication may be injected. Iron dextran should be administered into the large dorsogluteal muscle only. After injecting iron dextran, the nurse should not massage the site because this could force the medication into the subcutaneous tissue.

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. Determine whether the drugs are expensive Determine whether the client knows that these drugs are available in the hospital Determine whether the drugs are generic Determine whether the client knows the correct reason for using the drug and its proper route of administration Determine whether the client knows the appropriate drug dosages and administration schedules

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 Explanation: The nurse should determine whether the client knows the appropriate dosages and administration schedules for any over-the-counter drugs taken regularly. The nurse also should determine whether the client knows the correct reason for using the drug and its proper route of administration. Neither the drug's cost nor its generic classification is as important unless a problem arises with either of these two factors. Availability of drugs in the hospital isn't a high-priority issue unless the client wants to purchase them from an outpatient pharmacy.

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? Increasing the infusion rate of the medication and notifying the physician of the error Decreasing the infusion rate of the medication and notifying the physician of the error Discontinuing the medication and documenting assessment findings Discontinuing the medication and notifying the physician of the error

Discontinuing the medication and notifying the physician of the error Explanation: The nurse should discontinue the medication and notify the physician of the medication error. The nurse shouldn't allow the wrong medication infusion to continue. She should document her assessment findings but she must first stop the infusion and then notify the physician of the error.

A nurse is administering 500 mg of ampicillin IM every 6 hours to a 122-lb (55-kg) client with a respiratory tract infection. The drug label reads, "The recommended dose for a client weighing more than 40 kg is 250 mg to 500 mg IM or IV at 6-hour intervals." The drug concentration is 250 mg/2 mL. Which nursing interventions are appropriate at this time? Select all that apply. Draw up 10 mL ampicillin to administer. Administer the medication at 10:00 a.m. (1000), 2:00 p.m. (1400), and 10:00 p.m. (2200). Evaluate the client for allergies to penicillin. Administer the medication because it is within the dosing recommendations. Question the primary care provider about the prescription because the amount is more than recommended. Obtain a sputum culture before administering the first dose of the medication.

Evaluate the client for allergies to penicillin. Administer the medication because it is within the dosing recommendations. Obtain a sputum culture before administering the first dose of the medication. Explanation: Because ampicillin is a penicillin antibiotic, the client should be evaluated for allergy to penicillin before the medication is administered. The dose of ampicillin is within the recommended range for an adult client. Cultures should be obtained before antibiotics are given. The nurse should draw up 5 mL to administer the correct dose, according to the concentration on the label. The recommended dosing schedule is 6 hour intervals.

A nurse is caring for a client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/μl. The client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour. He reports severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, the nurse should avoid which route? Oral I.V. I.M. Subcutaneous

I.M. Explanation: With a platelet count of 22,000/μl, the client bleeds easily. Therefore, the nurse should avoid using the I.M. route because the area is highly vascular and can bleed readily when penetrated by a needle. The bleeding can be difficult to stop. The client already has an I.V. access, so it would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subcutaneous routes are preferred over I.M., but they're less effective for acute pain management than I.V.

The nurse is educating a client on how to take a sublingual tablet. Which instruction should the nurse give to the client? Instruct the client to place the tablet between the gum and the cheek. Place the tablet between the upper lip and gum. Instruct the client to place the tablet under the tongue and leave until fully dissolved. Swallow but do not chew the tablet.

Instruct the client to place the tablet under the tongue and leave until fully dissolved. Explanation: The nurse should instruct the client to touch the tip of the tongue to the roof of the mouth and then place the sublingual tablet on the floor of the mouth under the tongue. Sublingual medications are absorbed directly into the bloodstream from the oral mucosa, bypassing the GI and hepatic systems. No drug is administered on top of the tongue or on the roof of the mouth. With the buccal route, the tablet is placed between the gum and the cheek.

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? 1.25 1.0 1.5 0.5

1.25 : The nurse would administer 1.25 ml. The ratio to determine this answer is 25 mg : X ml :: 20 mg : 1 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.

10 Explanation: The following formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the equation is as follows: 5 mg/5 mL = 10 mg/X; so X = 10 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? 150-mL 100-mL 50-mL 30-mL

50-mL Explanation: When calculating the mL/hour, divide 400-mL by 8 hours to get 50-mL/hour. When caring for an infant, only place one hour's worth of fluid into the buretrol to be infused.

A nurse is preparing to administer oral doxycycline to a client. What is the nurse's appropriate action? Administer with full glass of water. Administer with an antacid. Administer with food. Administer with milk.

Administer with full glass of water. Explanation: Doxycycline should be given with a full glass of water on an empty stomach. It should not be taken with milk or within 2 hours of antacid administration.

A client is prescribed a corticosteroid inhaler along with a bronchodilator inhaler. Which instruction about these drugs should the nurse give the client? "Use the bronchodilator first, then wait about 5 minutes before using the corticosteroid." "You should be able to take almost any over-the-counter medication you feel you need." "Notify your physician if your heart rate increases by more than 50 beats/minute after after using these medications." "Use the bronchodilator whenever you feel you need it."

"Use the bronchodilator first, then wait about 5 minutes before using the corticosteroid." Explanation: The nurse should tell the client to use the bronchodilator first, then wait 5 minutes before using the corticosteroid. Doing so allows the bronchodilator to open air passages for maximum effectiveness. The nurse should also show the client how to check his pulse, and should instruct him to do so before and after using the bronchodilator. The client should call the physician if his pulse rate increases by more than 20 beats/minute (not 50 beats/minute). The nurse should tell the client to take the drugs exactly as prescribed, around the clock. The client should check with the physician before taking over-the-counter preparations.

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.

0.6 Explanation: The dose dispensed by the pharmacy is 10,000 units/1 mL, and the desired dose is 6,000 units. The nurse should use the following equations to determine the amount of heparin to administer: Dose on hand/quantity on hand = dose desired/X 10,000 units/1 mL = 6,000 units/X 10,000 units X X = 6,000 units X 1 mL X = 6,000 units X 1 mL/10,000 units X = 0.6 mL.

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.

19 Explanation: 0.25 mg/kg x (1 kg/2.2 lb) x 167 lb = 19 mg.

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.

4 Explanation: The nurse would administer the medication four times per day. Two grams is equivalent to 2,000 mg. To give equally divided doses of 500 mg, divide the desired dose of 500 mg into the total daily dose of 2,000 mg. This gives an answer of four times per day. The nurse would give 500 mg every 6 hours for a total of four times per day.

A nurse is preparing to administer ferrous sulfate to a client. What is the nurse's appropriate action? Dilute with juice and administer through a straw. Mix the drug with pudding. Administer undiluted with a small snack. Mix with cola to disguise the taste.

Dilute with juice and administer through a straw. Explanation: Ferrous sulfate is offered in a diluted form through a straw to prevent staining of the teeth. Avoid administering iron with milk, dairy products, or caffeine because it inhibits drug absorption.

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

Hypokalemia Explanation: Insulin administration causes glucose and potassium to move into the cells, causing hypokalemia. Calcium levels aren't directly affected by insulin administration. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus also enters the cells with insulin and potassium. Sodium levels aren't directly affected by insulin administration.

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? Notifying the surgeon that the consent form hasn't been signed Giving the preoperative analgesic at the scheduled time Canceling the surgery Asking the client to sign the consent form

Notifying the surgeon that the consent form hasn't been signed Explanation: Notifying the surgeon takes priority because informed consent must be obtained before the client receives drugs that can alter cognition. Giving the preoperative analgesic at the scheduled time would alter the client's ability to give informed consent. Obtaining consent for surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery also isn't within the scope of nursing practice.

A nurse is working on the oncology unit when a chemotherapy drug spills on the floor. What should the nurse do next? Clean the area with soap and water. Restrict access to area of the spill. Use nonabsorbent material to clean the floor. Dispose of all supplies used in cleaning in a regular garbage bag.

Restrict access to area of the spill. Explanation: Restricting access to the area of the spill limits exposure to the chemotherapeutic agent and injury. An absorbent material should be used to absorb the spill. The area is cleaned with a designated material, not water and soap. All materials should be disposed of in an approved container.

The nurse is teaching a client how to rotate insulin injection sites. What is the purpose of rotating injection sites? To prevent the formation of hard nodules To prevent erratic drug distribution To prevent medication leakage from the tissue or muscle To prevent bruising

To prevent the formation of hard nodules Explanation: Rotating injection sites promotes adequate drug absorption and prevents the formation of hard nodules caused by repeated injections into the same site. Nodules may impede drug absorption with future injections. Rotating sites doesn't prevent bruising, medication leakage, or erratic drug distribution.

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? metabolism of the medication necessity of the medication frequency of the medication purpose of the medication

metabolism of the medication Explanation: The rate and ability of the liver to metabolize medications will be altered in a client with liver cancer. Therefore, it is essential to understand how each medication is metabolized. The other considerations are important but not as vital.

A client is to be discharged on daily medication delivered by a transdermal disk. Which statement, given to the nurse by the client, indicates the need for further medication teaching? "I'll wash my hands after applying the disk." "I'll place the disk on the same spot every time." "I'll avoid touching the gel in the disk." "I'll change the disk at the same time every day."

"I'll place the disk on the same spot every time." Explanation: A transdermal disk should be applied to a different site each time. The client should avoid placing it on uneven, damaged, or irritated skin, or on areas below the knee or elbow. The other options indicate an understanding of transdermal disk use.

The nurse is preparing a client who has been newly diagnosed with asthma for discharge. As part of his discharge orders, the client is prescribed albuterol via nebulizer every 8 hours for 3 days, followed by one dose daily thereafter. Which instruction should the nurse include when teaching the client about nebulizer use? "You can be flexible with scheduling your albuterol treatments." "You should take your pulse before and after treatment; if your pulse rate increases by more than 30 beats/minute you should notify your physician." "You might develop nervousness and palpitations during your treatment; this is normal and will subside." "If you feel short of breath you can use your nebulizer more frequently than prescribed."

"You should take your pulse before and after treatment; if your pulse rate increases by more than 30 beats/minute you should notify your physician." Explanation: The nurse should show the client how to check his pulse rate. The client should be instructed to check his pulse rate before and after using his nebulizer and to call the physician if his pulse rate increases by more than 30 beats/minute. The nurse should instruct the client to use his nebulizer exactly as prescribed. Using the nebulizer more often than prescribed can cause the drug to lose effectiveness, or to produce uncomfortable adverse effects. The client should also be instructed to notify his physician if his shortness of breath worsens, the drug becomes less effective, or he develops palpitations, nervousness, or a hypersensitivity reaction such as a rash.

When giving an intramuscular (IM) injection, which angle should the nurse insert the needle into the muscle? 15 degrees 90 degrees 45 degrees 30 degrees

90 degrees Explanation: When giving an IM injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering an intradermal injection. A 30-degree angle isn't used for any type of injection. A 45- or 90-degree angle can be used when giving a subcutaneous injection.

The physician orders ampicillin, 500 mg by mouth every 6 hours. The nurse recognizes this as an example of which type of order? An as-needed order A stat order A standard written order A single order

A standard written order Explanation: A standard written order is an order that applies until the prescriber writes another order to alter or discontinue the first one. Many health care facilities have established policies dictating how long orders for certain classes of drugs, such as opioids or antibiotics, are to remain valid. A single order allows for a one-time dose only. An as-needed order allows for drug administration when the client needs it. A stat order includes such words as now, immediately, or stat.

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? Acknowledge the client's behavior, and seek clarification. Notify the primary health care provider, and request a change in the prescriptions. Request that the primary health care provider prescribe generic alternatives. Explore with the client whether the client can purchase the medications over an extended period.

Acknowledge the client's behavior, and seek clarification. Explanation: The nurse should clarify the client's behavior to determine the appropriate cause of the action. The nurse should not request to have the prescriptions changed or that generic alternatives be prescribed. Treatment should not be delayed while the nurse explores the possibility of purchasing medications over an extended period.

A nurse prepares to administer eardrops to an adult client. Which action should the nurse take before instilling the drops? Direct the medication toward the base of the ear canal. Gently pull the auricle up and back. Warm the eardrops in tepid water. Identify the client by calling the client's name.

Gently pull the auricle up and back. Explanation: In order to instill the drops in an adult client's ear, the nurse should straighten the ear canal by gently pulling the auricle up and back. Two client specific identifiers should be used to identify the client. The eardrops should be room temperature (not warmed). When instilling the drops, the flow of the medication is directed toward the top of the ear canal not the base of the ear canal.

A client is prescribed metformin to control type 2 diabetes. The nurse should monitor for which life-threatening adverse reaction? Nausea Megaloblastic anemia Vomiting Lactic acidosis

Lactic acidosis Explanation: The nurse should monitor the client for signs of lactic acidosis, a life-threatening adverse reaction associated with metformin. Nausea, vomiting, and megaloblastic anemia are adverse reactions associated with metformin, but they aren't considered life-threatening.

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. Ask the client if there are any medications that will be refused. Check the client's medical record number and name on the identification bracelet. Hold all the medications until the primary health care provider has examined the client. Perform handwashing. Check the client's allergies in the medical record, and verify them with the 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. Explanation: To verify a client's identity, the nurse should read the identification bracelet and check at least two client identifiers, such as the name and medical record number. Handwashing is always performed prior to preparing medications for administration. The primary health care provider does not need to have examined the client before administration of previously prescribed medications. While clients have the right to refuse a medication, this is not something the nurse would ask the client in advance.

The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, which action should the nurse perform next? Roll the vial gently between the palms Invert the vial and let it stand for 2 to 3 minutes Do nothing Shake the vial vigorously

Roll the vial gently between the palms Explanation: Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Doing nothing or inverting the vial wouldn't help dissolve the medication. Shaking the vial vigorously could cause the medication to break down, altering its action.

A nurse is teaching a client about a newly prescribed drug. What physiological changes does the nurse recognize that could cause a geriatric client to have difficulty learning about prescribed medications? Lack of family support Decreased drug excretion Fixed income Sensory deficits

Sensory deficits Explanation: Sensory deficits could cause a geriatric client to have difficulty retaining knowledge about prescribed medications. Decreased drug excretion doesn't alter the client's knowledge about the drug. A lack of family support or limited finances may affect compliance, not knowledge retention.

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? The cause of the error is identified through system-wide analysis. The pharmacist that processed the order is terminated. The nurse is terminated for making such an error. The client's family sues the hospital.

The cause of the error is identified through system-wide analysis. Explanation: The purpose of root cause analysis is to analyze and identify the root cause of the error from a system perspective and plan interventions to a prevent future occurrence. Terminating the nurse and the pharmacist does not prevent the client from suing the hospital and does nothing to prevent future occurrence. The family suing the hospital is not an expected outcome of a root cause analysis.

The nurse is preparing to administer an injection from an ampoule. To avoid injury, how should the nurse open the ampoule? Use a syringe without the needle attached to withdraw the medication. Wearing gloves, break ampoule toward the body. Ask the patient care technician to open the ampoule. Using a pad, break ampoule away from the body.

Using a pad, break ampoule away from the body. Explanation: Using a pad and breaking the ampoule away from the nurse protects the nurse from cutting from the sharp edge of the broken ampoule. Gloves are thin and can easily be cut by a broken glass. Using a syringe without a needle puts the nurse's fingers in direct contact with the broken glass. Asking the technician to open the ampoule without the proper technique puts the technician at risk of injury.

A nurse is assisting with developing an education plan for a client diagnosed with type 1 diabetes. Which method is most effective for educating the client about self-administration of insulin? a short videotape that provides useful information and demonstrations a list of instructions written at a sixth-grade reading level an audiotape version of discharge instructions a discussion and demonstration between the nurse and the client

a discussion and demonstration between the nurse and the client Explanation: The discussion and demonstration method provides the client with the opportunity to observe the procedure and then perform a return demonstration. Additionally, the direct contact with the nurse provides an opportunity for the client to ask questions. This education method is most effective. Videotape, audiotape, and a list of instructions are effective methods of reinforcing education after the discussion and demonstration have taken place.

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. famotidine cimetidine nizatidine esomeprazole ranitidine

cimetidine ranitidine nizatidine famotidine Explanation: H2 receptor antagonists suppress secretion of gastric action, alleviate symptoms of heartburn, and help to prevent peptic ulcer disease. Esomeprazole is a proton pump inhibitor.

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

infiltration Explanation: The assessment findings of pallor, swelling, skin that is cool to the touch at the I.V. insertion site, and a normal WBC count all indicate infiltration. The infusion should be discontinued and restarted in a different site. Phlebitis would be evidenced by redness at the cannula tip and along the vein. Infection would be evidenced by an elevated WBC count.

Which symptoms reported by a client indicate adverse effects of a drug? Select all that apply. occasional constipation or diarrhea skin blisters accompanied by intense itching achy joints and a temperature of 101° F (38.3° C) nausea and occasional vomiting after taking the drug double vision and difficulty hearing tight feeling in the throat and difficulty breathing

tight feeling in the throat and difficulty breathing achy joints and a temperature of 101° F (38.3° C) skin blisters accompanied by intense itching double vision and difficulty hearing Explanation: Difficulty breathing along with a sensation that the throat is closing up is a type I allergic reaction (anaphylactic shock). Achy joints and temperature elevation are type II allergic reactions (cytotoxic). An itchy rash with blisters is a type IV allergic reaction (cell-mediated hypersensitivity). Double vision and difficulty hearing are indicators of neurotoxic effects of a drug. Nausea, vomiting, and occasional constipation or diarrhea are common drug side effects. Increasing fluid or food intake may alleviate this effect.

The physician prescribes 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give? ¼ ml 2 ml ½ ml 1 ml

½ ml Explanation: The nurse should give ½ ml of the drug. The dosage is calculated as follows:250 mg/X = 500 mg/1 ml500X = 250X = ½ ml

Milk of magnesia does not relieve a client's constipation. The physician orders a soap suds enema, 500 mL. How many liters will the nurse administer? 0.5 L 0.75 L 2 L 1 L

0.5 L Explanation: 1,000 mL is equal to 1 liter, therefore 500 mL equals 0.5 L.

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? Notify the physician of PT and INR results before administering the next dose of warfarin. Closely monitor prothrombin time (PT) and international normalized ratio (INR) results to determine the dose of warfarin to administer. Administer the next dose of warfarin and then notify the physician if PT and INR results are abnormally high. Administer the next dose of warfarin and then notify the physician if PT and INR results are abnormally low.

Closely monitor prothrombin time (PT) and international normalized ratio (INR) results to determine the dose of warfarin to administer. Explanation: Sliding scales are written orders from the physician that allow the nurse to independently manage medications with varied dosages. To administer warfarin safely, the nurse must closely monitor PT and INR results. She should notify the physician of any abnormal results, whether they're abnormally low or abnormally high. Abnormally high results place the client at risk for bleeding; abnormally low results place the client at risk for recurrent pulmonary emboli. If the PT and INR fall within the ranges indicated on the sliding scale, the nurse can independently administer the dose according to the order.

A client who is recovering one day after an extensive abdominal surgery is having incisional pain. When should the nurse plan to administer analgesics for this client? When requested by the client Four times a day Every 3-4 hours Three times a day

Every 3-4 hours Explanation: The physiological consequences of postoperative pain can delay or impair postoperative recovery and result in a longer period of hospitalization. The aim of effective postoperative pain management are to improve the comfort and satisfaction of the client, facilitate recovery and functional ability, reduce morbidity, and promote rapid discharge from hospital. Pain should be assessed minimally every 4 hours around the clock as well as after any treatments. It is best for the nurse to use a preventive approach for this client's pain management because it is predictable and major. Adequate postoperative pain assessment can lead to more effective pain control and fewer postoperative complications.

A geriatric client has experienced several adverse drug reactions. What does the nurse recognize that this client may benefit from? Increased drug doses at longer intervals Frequent visits to the physician Nursing home placement Reduced drug dosages

Reduced drug dosages Explanation: Older clients commonly have diminished hepatic and renal function that reduces drug metabolism and excretion. Adverse reactions tend to be related to blood level; therefore, the client may benefit from reduced drug dosages. Adverse drug reactions aren't a cause for nursing home placement. Increased drug doses at longer intervals may increase adverse reactions rather than decrease them. Although frequent visits to the physician may benefit the client, the visits themselves won't alter how the drug reacts in the client's body.

A health care provider prescribes amonamine oxidase inhibitor (MAOI) for a client. What should the nurse include when reinforcing discharge teaching? Select all that apply eat pepperoni in limited amounts eat refrigerated meat within 1 month of purchase avoid eating cottage cheese avoid taking St. John's wort avoid eating blue aged cheese

avoid eating blue aged cheese avoid taking St. John's wort Explanation: When taking monoamine oxidase inhibitors (MAOI) it is important that clients avoid products containing tyrpamine as this can potentially cause severe hypertension, headaches, heart problems, nausea and vomiting, visual disturbances and confusion. Clients should avoid aged St. John's wort and pepperoni. Refrigerated meats should be consumed within 3-4 days of purchase. The nurse should focus on reinforcing that aged and mature cheese such as blue cheese should be avoided; but cottage cheese may be consumed.

For which rationale, when administering a Z-track injection, the nurse measures the correct medication dose and then draws a small amount of air into the syringe? Adding air ensures that the client receives the entire dose. Adding air prevents the drug from flowing back into the needle track. Adding air decreases pain caused by the injection. Adding air prevents the solution from entering a blood vessel.

Adding air prevents the drug from flowing back into the needle track. Explanation: The added air flushes the drug from the syringe, ensuring that the drug goes into the muscle tissue, and preventing it from flowing back into the needle track, which could cause skin staining. Adding air doesn't decrease pain (which results from the drug's chemical composition), and it has no bearing on whether the drug enters a blood vessel. Adding air isn't necessary to ensure that the client receives the entire dose.

Which nursing action is appropriate when administering a glycerin suppository to a client? Removing the suppository from the refrigerator 30 minutes before insertion Assisting the client to a right-side lying position with the left leg flexed upward Applying a lubricant to the suppository Instructing the client to bear down during insertion

Applying a lubricant to the suppository Explanation: A suppository should be lubricated before insertion to ease insertion and reduce discomfort. The nurse should assist the client in a left-side lying position (not right-side lying) to ease insertion. Because suppositories melt at body temperature, they usually require refrigeration until administration. Instructing the client to bear down would cause the anal sphincter to contract, making insertion difficult.

A client with left hemiparesis is having difficulty swallowing a potassium chloride 20 meq tablet. What should the nurse do? Crush the pill and administer with a small amount of liquid. Break the pill into small pieces and administer with apple sauce. Administer the medication with a large amount of liquid. Ask the health care provider for an order to administer a different consistency through a different route.

Ask the health care provider for an order to administer a different consistency through a different route. Explanation: Potassium chloride cannot be crushed; therefore, crushing the pill and breaking it into small pieces are wrong choices. Administering the medication with a large volume of water does not remove the risk of aspiration/choking. Potassium has liquid and IV forms; therefore, notifying the health care provider to change the order is the correct response.

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? Withhold the morning dose of warfarin and give it later in the day. Repeat the laboratory result. Give warfarin as prescribed. Hold the medication and notify the health care provider.

Hold the medication and notify the health care provider. Explanation: The nurse should notify the health care provider because the report is outside the normal range. The nurse cannot independently hold a medication without orders. Giving the warfarin with levels of 27.3 increases the risk of bleeding. Repeating the laboratory result requires a doctor's order.

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

Hypokalemia Explanation: A loop diuretic removes water and, along with it, sodium and potassium. This may result in hypokalemia, hypovolemia, and hyponatremia.

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: creamed corn. fresh green vegetables. low-fat milk. bananas and oranges.

bananas and oranges. Explanation: Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the client to increase intake of potassium-rich foods, such as bananas and oranges. Fresh green vegetables, milk, and creamed corn aren't good sources of potassium.

The nurse is preparing to discharge a child who has rheumatic fever. Which medication would the nurse expect to be prescribed to prevent recurrence of rheumatic fever? Digoxin Glucocorticoids Anti-inflammatory medications Antibiotics

bananas and oranges. Explanation: Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the client to increase intake of potassium-rich foods, such as bananas and oranges. Fresh green vegetables, milk, and creamed corn aren't good sources of potassium.