Medication and IV administration

After knee replacement surgery, patient discharged with acetaminophen & codeine tablets, 30 mg, for pain. The nurse should include which instruction during discharge?

"Avoid driving a car while taking this medication."

Physican writes order for client that says: "Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should nurse transcribe the order onto medication administration record.

"Digoxin 0.125 mg P.O. once daily."

Nurse is to administer I.M. injection into a client's left Vastus lateralis muscle. How should nurse position patient?

Lying supine

Client comes to emergency department after taking an overdose of amitriptyline (Evavil). Immediate care for this client should include:

Administering activated charcoal every 4 hours for 24 hours. (Charcoal binds with amtriptyline and inactivates it)

What statement by student nurse demonstrates further instruction about cytotoxic drugs is needed?

"Nurses who are pregnant must wear gloves during administration of cytotoxic drugs." (Pregnant nurses cannot administer cytotoxic drugs because exposure may be associated with teratogenic effects)

Order digoxin (Lanoxin) 0.125 mg by mouth every morning for client with heart failure. Pharmacy dispenses tablets that contain 0.25 mg each. How many tablets should the nurse administer in each dose?

0.5

Client ordered heparin 6,000 units every 12 hours. Pharmacy dispenses a vial containing 10,000 units/ml. How many ml of heparin should nurse administer?

0.6 ml

Drug package reads "(Demerol), 50mg/ml" How many ml should a nurse give a client for a 30 mg dose?

0.6 ml

Order heparin, 7,500 units administered subcutaneously every 12 hours. The vial reads 10,000 units per milliliter. Nurse should anticipate giving how much heparin for each dose?

3/4 ml

The maximum transfusion time for a unit of packed red blood cells (RBCs) is:

4 hours ( Beyond four hours of transfusion there is increased risk for bacterial contamination of the blood)

Client is to receive a glycerin suppository. When administering suppository, nurse should insert it how far into client's rectum?

4" (10cm) - Far enough to pass the internal anal sphincter.

After receiving an I.M. injection, client complains of burning at injection site. Which nursing action would be most appropriate at this time?

Apply a warm compress to dilate the blood vessels. (Heat increases blood flow in area, which increases medication absorption)

Client is to receive a glycerin suppository. Which nursing action is appropriate when administering a suppository?

Applying a lubricant to the suppository.

Nurse caring for a client taking an oral anticoagulant. The nurse should teach the client to:

Avoid foods high in vitamin K. (K can interfere with anti-coagulation.)

A nurse must verify a client's identity before administering medication. The safest way to verify identity is to:

Check the clients identification band.

Which detail of patient's drug therapy is a nurse legally required to document?

Client's reaction to the drug.

Client with a deficient fluid volume receiving an I.V. infusion of dextrose 5% in water & lactated Ringer's solution at 125 mL/hour, Which assessment finding indicated need for additional fluids?

Dark amber urine

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength (Bactrim-DS)?

Drink 6 to 8 glasses of fluid daily while taking this medication. (To prevent renal problems)

Patient being discharged after surgery. After providing medication teaching, nurse ask patient to repeat instructions. This approach is an example of which professional role?

Educator

Nurse regularly inspects a client's IV site to ensure patency & prevent extravasation during dopamine (Intropin) therapy. What is the treatment for dopamine extravasation?

Elevating the limb, applying warm compresses, & administering phentolamine (Regitine) as ordered.

Physician orders activated charcoal for client who intentionally took overdose of hydrocodone (Vicodin). Before administering the drug, nurse should ensure that client:

Has audible bowel sounds.

Progesterone

Hormone used to treat amenorrhea or dysfunctional uterine bleeding.

Which type of solution raises serum osmolarity & pulls fluid from the intracellular & interstitial compartments into the intravascular compartment?

Hypertonic

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

Hypokalemia (Insulin administration causes glucose & potassium to move into the cells)

If a manual end-of-shift count of controlled substances isn't correct, the nurses best action is to:

Immediately report the discrepancy to the nurse-manager, nursing supervisor, & pharmacy.

Dopamine

Is a vasconstrictor used to treat hypotension.

Before administering packed red blood cells, nurse must flush a client's I.V. line. Which solution should nurse use to flush the line?

Normal saline solution

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

Notify the surgeon that the client has not signed the consent form.

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet:

On the floor of the mouth.

Nitrates

Reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) & systemic vascular resistance (afterload).

Opioids

Reduce myocardial oxygen demand, promote vasodilation, & decrease anxiety.

Calcium channel blockers

Reduce the hearts workload by decreasing the heart rate.

Which safeguard should the nurse take to ensure accuracy of a telephone order?

Repeat the order to the prescriber.

After reconstituting a multidose vial of medication, a nurse writes date and time of reconstitution on vial label. What else should the nurse write on the label?

Strength of the medication

Nurse is administering two drugs to a client at the same time. The nurse knows the most probable reason for giving the drugs together is:

Synergism

For client who takes over-the-counter drugs regularly, nurse should ascertain"

Whether the client knows the drug dosages & administration schedules.

When administering I.M. injection, nurse notices there is not a sharps-disposal container handy. Which action should the nurse take?

With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the nearest sharps disposal container.

Physician orders 1 liter dextrose 5% in water at 150 ml/hr. The drip factor of the I.V. tubing is 15 gtt/ml. What is the drip rate for this I.V. infusion in drops per minute?

150/60 min= 2.5 2.5x15= 37.5 37.5 gtt/minute

A physician orders morphine, 3mg I.V. every 2 hours as needed, to control pain. Insert reads "Morphine, 4mg/ml." How many milliliter of morphine should client receive?

0.75

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

120 ml/hour

physician orders dextrose 5% in water, 1000ml to be infused over 8 hours. I.V. tubing delivers 15 drops/ml.. the nurse should run the I.V. infusion at a rate of:

125/60 minutes=x/1 minute 60min=125=2.1 ml/minute 32 drops/minute

When administering an intradermal injection the appropriate angle is:

15 degree

When giving a subcutaneous injection the nurse may use what angle?

45 or 90 degree angle

When giving an I.M. injection, nurse should insert the needle into the muscle at an angle of:

90 degrees

The main advantage of using a floor stock system?

A nurse can implement medication orders quickly.

Physician orders amipicillin (Omnipen), 500 mg by mouth every 6 hours. This medication order is an example of:

A standing order.

Client admitted into emergency department after intentionally taking overdose of amitriptyline (Elavil). A nurse knows giving activated charcoal will:

Bind with the ingested drug so that the body does not absorb it.

Client taking hormonal contraceptives, nurse should ensure the client knows she must have which vial sign monitored regularly?

Blood pressure

Nurse is calculating proper dosage of medication for a child. What parameter should influence this calculation?

Body surface area in relation to weight

Most common cause of medication errors among non-institutionalized elderly clients?

Deficient knowledge

After administering an I.M injection, a nurse should:

Discard the uncapped needle in a puncture proof container.

A nurse notes client's I.V. insertion site is red, swollen, & warm to the touch. Which action should nurse take first?

Discontinue the I.V. infusion.

Tamoxifen

Estrogen blocker used to treat premenopausal & postmenopausal breast cancer & to prevent breast cancer in certain women who are at high risk.

A drug must enter the bloodstream before it can act within the body. Which parental administration route places drug directly into the circulation, requiring no absorption?

I.V.

When preparing to administer a drug dose to patient, nurse examines drug label. Nurse understands the Food, Drug, & Cosmetic act requires that drug labels state the:

Presence, quantities, & portions of active ingredients.

Physician orders an infusion of whole blood for a patient. When planning car, nurse should include which intervention?

Staying with the patient for 15 minutes after starting the infusion.

When a central venous catheter becomes moist or loose, what should a nurse do first?

Remove the dressing, clean the site, & apply a new dressing. (dressing should be changed every 72 hours or when it becomes soiled, moist, or loose.

Client is in the bathroom when nurse enters to give prescribed medications. What should the nurse do?

Return to the client's room a few minutes later & remain there until the client take the medication.

Nurse is reconstituting a powdered medication in vial. After adding the solution to the powder, the nurse should:

Roll the vial gently between her palms

Nurse caring for a patient with central venous catheter. Which assessment finding would indicate possible infection?

Tachypnea (Signs of infection tachypnea, dizziness, & lethargy)

Nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation?

Terll the client the name and action or use of each medication before administering it.

Physician orders nitroglycerin, 5mg by mouth twice a day. The drug is dispensed in 2.5 mg tablets. How many tablets will the nurse administer with each dose?

Two

A nurse has a order to administer iron dextran (INFeD) 50 mg I.M. injection. When carrying out this order, the nurse should:

Use the Z-track technique

When administering an I.M. injection, which action puts the nurse at risk for a needle-stick injury?

Using the one-handed needle-recapping technique after administering all injections.

Which I.M. injection site is appropriate for a six month old infant.

Vastus lateralis muscle

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

Withhold the suppository & notify the client's physician.

Client discharged with prescription for an analgesic that is a controlled substance. During discharge teaching, nurse should explain that client must fill the prescription how soon after the date on which the physician wrote it?

Within 6 months

Beta-adrenergic blockers

Work by blocking beta receptors in myocardium, reducing response to catecholamines & sympathetic nerve stimulation. Protect myocardium, helping reduce risk of another infarction by decreasing myocardial oxygen demand.

Physician orders normal saline infused at rate of 150 ml/hour. How many liters will the client receive during an 8 hour shift.

150x8 = 1,200 ml 1.2 liters