Medication and I.V. Administration PrepU Questions

A cardiologist prescribes digoxin 125 mcg by mouth every morning for a client diagnosed with heart failure. The pharmacy dispenses tablets that contain 0.25 mg each. How many tablet(s) would the nurse administer in each dose? Record your answer using one decimal place. (For example: 6.2)

Correct response: 0.5 Explanation: The nurse would begin by converting 125 mcg to milligrams: 125 mcg/1,000 = 0.125 mg Then the nurse would use the following formula to calculate the drug dosage: Dose on hand/Quantity on hand = Dose desired/X 0.25 mg/1 tablet = 0.125 mg/X 0.25X = 0.125 x 1 tablet X = 0.5 tablets

The healthcare provider prescribes meperidine hydrochloride 1.5 mg/kg intramuscularly to a school-age client. The pharmacy supplies meperidine hydrochloride injection as 50 mg/mL. The client weighs 25 kg. How many milliliters will the nurse administer? Record your answer using two decimal places.

Correct response: 0.75 Explanation: 1.5 mg/kg × 25 kg = 37.5 mg per dose 37.5 mg / 50 mg x 1ml = 0.75 ml for injection

The nurse teaches a client taking desmopressin nasal spray about how to manage treatment. The nurse determines that the client needs additional instruction when the client makes which comment? "I should check for sores in my nose while taking this medication." "I should use the same nostril each time I take the medicine." "I should report nasal congestion." "I should report any signs of respiratory infection."

Correct response: "I should use the same nostril each time I take the medicine." Explanation: The client who is taking desmopressin nasal spray should not use the same nares for administration each time. The client should alternate nares every dose. The client should observe for and report promptly signs and symptoms of nasal ulceration, congestion, or respiratory infection.

A nurse has been asked to insert peripheral I.V. lines in several clients on the nursing unit. Which site would the nurse need to avoid in order to maintain client safety? the unaffected arm of a woman who has had a radical mastectomy the sunburned arm of a teenager admitted for hydration therapy the tattooed arm of a motorcycle rider diagnosed with kidney failure the arm of a client where an arteriovenous shunt has been inserted

Correct response: the arm of a client where an arteriovenous shunt has been inserted Explanation: The nurse should avoid the arm with an arteriovenous shunt so the shunt is not jeopardized if the I.V. infiltrates, if the area becomes infected or inflamed, or if a thrombosis develops. The other options are incorrect because they could be used without risk to the client. It would be unsafe to use the affected side of a client who has had a mastectomy, but the unaffected side would be appropriate. The nurse should avoid broken or inflamed skin, but a sunburn without blisters could be considered.

The mother of a 28-year-old client who is taking clozapine states, "Something's wrong. My son is drooling like a baby." What response by the nurse would be most helpful? "I wonder if he's having an adverse reaction to the medicine." "Don't worry about it; this is only a minor inconvenience compared to its benefits." "I've seen this happen to other clients who are taking clozapine." "Excess saliva is common with this drug; here's a paper cup for him to spit into."

Correct response: "Excess saliva is common with this drug; here's a paper cup for him to spit into." Explanation: Telling the mother that excess saliva is a common adverse effect of the drug is most helpful because it gives her information about the problem, thereby helping to decrease her anxiety about what is occurring with her son. By offering the paper cup, the nurse also demonstrates concern for the client, thereby leading to increased trust. Saying "I wonder if he is having an adverse reaction to the medicine" shows the nurse's lack of knowledge about the drug, decreases confidence in the nurse, and indicates poor judgment. Saying "Don't worry about it, it's only a minor inconvenience compared to its benefits" or telling the mother that the nurse has seen this happening to other clients is insensitive and does not assuage the mother's anxiety.

What is the priority action that a nurse should take after omitting an ordered medication? Notify the nursing supervisor. Write an incident report. Document the omission and the reason for it. Notify the prescriber.

Correct response: Notify the prescriber. Explanation: A nurse who has omitted an ordered medication should prioritize the notification of the prescriber. The nurse should then document the omission and the reason it occurred in the client's chart and, depending on facility policy, write an incident report. Depending on the facility's policy, the nursing supervisor may need to be notified but this would be done after the prescriber has been notified.

When the nurse is preparing a teaching plan for an adult client about general anesthesia induction, which explanation by the nurse would be most appropriate? "Your premedication will put you to sleep." "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy." "You will breathe in medication through a facial mask to make you sleepy." "You will receive intravenous medication to make you sleepy."

Correct response: "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy." Explanation: Adult clients are induced for general anesthesia by breathing in an inhalant anesthetic mixed with oxygen through a facial mask and receiving intravenous medication to make them sleepy. Clients are not induced with the premedication. Clients usually are not induced with the intravenous infusion or the mask alone.

The nurse is to administer 1,200 mg of an antibiotic. The drug is prepared with 6 g of the drug in 2 mL of solution. The nurse should administer how many milliliters of the drug? Record your answer using one decimal place.

Correct response: 0.4 Explanation: First, convert grams to milligram: 6 g = 6,000 mg.Next, set up a proportion:6,000 mg/2 mL = 1,200 mg/XX = (1,200/6,000) x 2 mLX = 0.4 mL.

A client who weighs 187 lb (85 kg) has an order to receive enoxaparin 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? Record your answer using two decimal places.

Correct response: 0.85 Explanation: The physician's order is for the client to receive enoxaparin 1 mg/kg. Therefore, the client is to receive 85 mg. The desired dose in milliliters then can be calculated by using the formula of desired dose (D) divided by dose or strength of dose on hand (H) times volume (V). 85 (mg) × 0.3 mL = 25.5 mg/mL 25.5 mg divided by 30 = 0.85 mL.

A pediatric nurse is caring for a 12-year-old client with gonorrhea who is to receive penicillin G 0.6 million units IM as an initial dose. The pharmacy supplies the medication, which is labeled 2.4 million units/4 mL. How many milliliters would the nurse safely administer to this client? Record your answer as a whole number.

Correct response: 1 Explanation: The ANA Code of Ethics for Nurses provision 3 states that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the client. This is crucial during the medicating of a pediatric client. The initial dose ordered is 0.6 million units which is an appropriate dose for this age client. The dose available is 2.4 million units. Using (dose ordered/units) x quantity, the correct quantity is 4 mL. (0.6 million units / 2.4 million units) x 4 mL = 1 mL.

A child is to receive dexamethasone intravenously at the ordered dosage of 7.6 mg. The drug concentration in the vial is 4 mg/ml. How many milliliters should the nurse administer? Record the answer using one decimal place.

Correct response: 1.9 Explanation: Using the ratio-proportion method, the equations are as follows: 4 mg/1 ml = 7.6 mg/X ml; 4X = 7.6; X = 7.6/4 = 1.9 ml.

The nurse must administer ferrous sulfate to an infant who weighs 8 lb 13 oz (4.00 kg). The dosage prescribed is 6 mg/kg/day to be given in three doses. What would be the correct amount to be administered for each dose? Record your answer using a whole number.

Correct response: 8 Explanation: The client must receive 6 mg/kg/day over 3 doses/day. Therefore, divide 6 by 3 to find the per-dose rate: 2 mg/kg. Now multiply the medication per kilogram by the weight in kilograms: 2 mg/kg × 4 kg = 8 mg. The client should receive 8 mg of ferrous sulfate with each dose.

A client is prescribed an intravenous solution of 1,000 ml to be infused from 0800 to 2000. The nurse will use an infusion pump that delivers the solution in milliliters per hour. At what rate would the nurse set the pump to deliver the solution? Record your answer using a whole number. (For example: 62)

Correct response: 83 Explanation: First, determine how many hours the infusion needs to run. The elapsed time between 0800 and 2000 is 20 - 8 = 12 hours. Because 1,000 ml must be infused over 12 hours, set up a proportion of ml to hours to find the rate per 1 hour: 1,000 ml / 12 hr = x ml / 1 hr Solve for x, rounding to the nearest whole number: 12x = 1,000 x = 83 The pump should be set to deliver 83 ml/hour.

The health care provider has prescribed a saline lock for a client. In which order from first to last should the nurse implement this prescription? All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Apply clean gloves, and locate and clean the venipuncture site. 2Use the nondominant hand to stabilize the vein by pulling the skin taut. 3Insert an over-the-needle catheter, advancing the catheter once flashback is observed. 4Stabilize the catheter and apply dressing to secure the saline lock.

Correct response: Apply clean gloves, and locate and clean the venipuncture site. Use the nondominant hand to stabilize the vein by pulling the skin taut. Insert an over-the-needle catheter, advancing the catheter once flashback is observed. Stabilize the catheter and apply dressing to secure the saline lock. Explanation: Clean gloves must be donned prior to any invasive procedure in order to protect both the client and the nurse from encountering bodily fluids. The vein is stabilized prior to needle insertion so the vein is less likely to "roll" and the catheter may be more easily threaded into the vein. Flashback signifies that the needle is in the vein, and the catheter is advanced into the vein, using the needle as a guide. Once the catheter is in the vein and connected to the saline lock, they must be stabilized and secured with a transparent dressing so the nurse can monitor the site.

A client reports pain in the right heel and is requesting medication. The nurse assesses the client and administers an analgesic. The client experiences no pain relief and states that the heel pain is worse. What is an appropriate intervention by the nurse? Massage the client's foot in a circular motion. Repeat the dose of analgesic every hour. Apply warm, moist heat to the right ankle area. Call the physician to report the finding.

Correct response: Call the physician to report the finding. Explanation: The best response would be to notify the physician. The nurse cannot repeat the dose of analgesic without an order. Massaging the ankle and applying moist heat would be inappropriate for a number of reasons. The client could be developing a deep vein thrombosis, which may dislodge an embolus. Unrelieved pain indicates that an adverse event is developing, and the physician should be made aware of the situation.

A client who is 1 day postoperative is using a morphine patient-controlled analgesia (PCA) pump. The client is confused and disoriented. What is the priority intervention by the nurse? Check for shortness of breath, signifying a pulmonary embolism. Check whether the client is self-administering a bolus too frequently. Check respiratory rate and depth as well as oxygen saturation levels. Check the pulse rate and blood pressure.

Correct response: Check respiratory rate and depth as well as oxygen saturation levels. Explanation: Morphine depresses respiration, so the nurse should assess the client's respiratory rate and depth. If the rate is below 12 breaths/min, morphine can be withheld. Checking oxygen saturation levels will also indicate whether there is effective oxygenation of the blood. Morphine's effect is not usually significant on the cardiovascular system. The calculation of effective morphine dose includes that administered via the bolus. Pulmonary embolism is not a problem in the initial postoperative period.

A nurse working on a new unit is required to administer an unfamiliar medication to a client. How would the nurse proceed with the medication administration? Administer the medication to the client as ordered. Consult a formulary or drug handbook to learn about the medication. Ask an experienced nurse about the medication. Ask another nurse to administer the medication to the client.

Correct response: Consult a formulary or drug handbook to learn about the medication. Explanation: Before administering a medication, the nurse must be knowledgeable of the indication for this specific client, the appropriate dosing, and the basic pharmacology of the drug. The nurse needs to know of contraindications or adverse effects that would need to be assessed for. A formulary guide or drug handbook can provide the necessary information, although the nurse may have to seek additional client-specific information. The nurse should not administer a drug without being familiar with it and should not delegate the responsibility unless the nurse is unable to obtain information that allows for safe administration. If the nurse does not feel qualified to administer the drug, then it is appropriate to ask another nurse to perform the task, but the nurse should not simply accept another nurse's information about the drug prior to administering it themselves.

The health care provider (HCP) prescribes IV cefazolin 1 g for a client. In preparing to administer the cefazolin, the nurse notes that the client is allergic to penicillin. Based on this information, what is an appropriate action for the nurse to take? Call the pharmacist to verify that the cefazolin should be administered as prescribed. Administer the cefazolin, staying at the client's bedside during the infusion. Continue to prepare to administer the cefazolin as prescribed. Notify the HCP of the client's allergy to penicillin.

Correct response: Notify the HCP of the client's allergy to penicillin. Explanation: The nurse should notify the HCP that the client is allergic to penicillin before giving the cefazolin. Cephalosporins are contraindicated in clients who are allergic to penicillin. Clients who are allergic to penicillin may have a cross-allergy to cephalosporins.

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? Give the placebo but do not tell the client it is a stronger medication. Consult with the pharmacist to discuss the dosage of the placebo. Refuse to administer the placebo to the client. Give the placebo as ordered by the physician.

Correct response: Refuse to administer the placebo to the client. 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. The other options are incorrect because the nurse would be misinforming the client about the medication that is being administered. The client would not be able to provide informed consent.

Which principle should a nurse consider when administering pain medication to a client? Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain. Morphine and hydromorphone shouldn't be used to treat severe pain. I.V. pain medications may take as long as 2 hours to relieve pain. Use opioid combination drugs or nonopioid analgesics only for severe pain.

Correct response: Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain. Explanation: Administering sustained-release oral formulations around the clock provides better relief of chronic pain by keeping blood levels within therapeutic range. Opioid combination drugs and nonopioid medications are most effective in the treatment of mild to moderate pain. I.V. medications usually act within 1 hour of administration. Morphine and hydromorphone are drugs of choice for severe pain.

The nurse is preparing to administer ear drops to a 2-year-old client with an infection of the external auditory canal. The order reads, "2 drops in the right ear three times per day." Which steps should the nurse take to administer this medication? Select all that apply. Wash hands and arrange supplies at the bedside. Examine the ear canal for drainage. Warm the medication to the body temperature. Lie the child on the right side with the left ear facing up. Gently pull the pinna up and back and instill the drops into the external ear canal.

Correct response: Wash hands and arrange supplies at the bedside. Warm the medication to the body temperature. Examine the ear canal for drainage. Explanation: The nurse should prepare to instill the eardrops by washing hands, gathering supplies, and arranging the supplies at the bedside. To avoid adverse effects resulting from eardrops that are too cold (such as vertigo, nausea, and pain), the medication should be warmed to body temperature in a bowl of warm water. Temperature of the drops should be tested by placing a drop on the wrist. Before instilling the drops, the ear canal should be examined for drainage that may reduce the medication's effectiveness. Because the dose is to be given in the right ear, the child should be placed on the left side with the right ear facing up. For an infant or a child younger than 3 years, gently pull the auricle down and back because the ear canal is straighter in children of this age-group.

Which assessment findings indicates that epoetin alfa is having a therapeutic effect? neutrophil count 8.0 × 109/L platelet count 150 × 109/L white blood cell count 7.0 × 109/L hemoglobin 12 g/dL

Correct response: hemoglobin 12 g/dL Explanation: Epoetin alfa is a colony-stimulating factor used help boost red blood cell count. Indications for use are a hemoglobin level < 10 g/dL. It will not improve white blood cells or components (neutrophils) or platelet counts.

The client has come to the hospital emergency room reporting lethargy and vomiting. The healthcare provider makes a tentative diagnosis of Reye's syndrome. The client's history reveals a recent acute viral infection and the use of several medications. The nurse suspects which medication to be implicated in the development of Reye's syndrome? haloperidol phenytoin ketoprofen aspirin

Correct response: aspirin Explanation: Aspirin is implicated in the development of Reye's syndrome in children with a history of recent acute viral infection. The other medications listed would not be implicated. Haloperidol is an antipsychotic, ketoprofen is an NSAID, and phenytoin is used for seizures.

Which adverse effect occurs when there is too rapid an infusion of TPN solution? negative nitrogen balance circulatory overload hypoglycemia hypokalemia

Correct response: circulatory overload Explanation: Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fluid volume. A negative nitrogen balance occurs in nutritionally depleted individuals, not when TPN fluids are administered in excess. When TPN is administered too rapidly, the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.

A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively? wrapping the arm in an elastic bandage from wrist to elbow elevating the hand and wrapping it in a warm towel administering an as-needed analgesic placing an ice pack on the hand

Correct response: elevating the hand and wrapping it in a warm towel Explanation: Elevating the arm promotes venous drainage and reduces edema; applying warmth increases circulation and eases pain and edema. Ice application would relieve pain but not edema. An analgesic wouldn't correct the primary cause of the discomfort. Wrapping the arm above the hand would slow venous return and is contraindicated.

Which assessment findings indicates that epoetin alfa is having a therapeutic effect? neutrophil count 8.0 × 109/L hemoglobin 12 g/dL platelet count 150 × 109/L white blood cell count 7.0 × 109/L

Correct response: hemoglobin 12 g/dL Explanation: Epoetin alfa is a colony-stimulating factor used help boost red blood cell count. Indications for use are a hemoglobin level < 10 g/dL. It will not improve white blood cells or components (neutrophils) or platelet counts.

Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment? hypotonic isotonic hypertonic electrotonic

Correct response: hypertonic Explanation: The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and interstitial compartments. A hypotonic solution's osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect.

What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking beta-adrenergic blocker? irregular pulse increased respiratory rate decreased respiratory rate abnormally low blood pressure

Correct response: irregular pulse Explanation: Abrupt withdrawal of a beta-adrenergic blocker results in rebound cardiac excitation, which causes ventricular arrhythmias and an irregular pulse. Abnormally low blood pressure would be unlikely because beta-adrenergic blockers are used to treat hypertension. Abrupt withdrawal of this medication wouldn't directly affect a client's respiratory rate.

A client with major depressive disorder is receiving phenelzine. The nurse intervenes when the client orders which food for lunch? green beans pepperoni pizza Salisbury steak yogurt with fruit

Correct response: pepperoni pizza Explanation: Clients taking phenelzine, a monoamine oxidase inhibitor, cannot take foods with high tyramine content. Pepperoni is a sausage with a high tyramine content. Yogurt with fruit, Salisbury steak, and green beans have little or no tyramine.

A client is taking acetylsalicylic acid (ASA) for pain control. Which finding should the nurse report to the healthcare provider immediately? muscle aches ringing in the ears GI upset constipation

Correct response: ringing in the ears Explanation: A symptom of ASA toxicity is tinnitus and must be reported to the healthcare provider. Constipation, muscle aches, and GI upset are not adverse effects or indicators of toxicity of ASA.

During gentamicin therapy, the nurse should monitor a client's serum potassium level. serum glucose level. partial thromboplastin time (PTT). serum creatinine level.

Correct response: serum creatinine level. Explanation: During gentamicin therapy, the nurse should monitor a client's serum creatinine level because the most notable adverse reactions to aminoglycoside therapy are nephrotoxicity and ototoxicity. The drug doesn't appear to affect serum potassium or glucose levels or PTT.

The client in preterm labor is admitted to the hospital. To stop the client's uterine contractions, the nurse anticipates administering which medication? ergovine maleate dinoprostone misoprostol terbutaline

Correct response: terbutaline Explanation: Terbutaline is used to inhibit preterm uterine contractions. Dinoprostone and misoprostol are used to induce fetal expulsion and promote cervical dilation and effacement. Ergonovine maleate stops blood flow to the uterus and is used for hemorrhage.

The client in preterm labor is admitted to the hospital. To stop the client's uterine contractions, the nurse anticipates administering which medication? misoprostol ergovine maleate terbutaline dinoprostone SUBMIT ANSWER

Correct response: terbutaline Explanation: Terbutaline is used to inhibit preterm uterine contractions. Dinoprostone and misoprostol are used to induce fetal expulsion and promote cervical dilation and effacement. Ergonovine maleate stops blood flow to the uterus and is used for hemorrhage.

The health care provider (HCP) has prescribed guaifenesin 300 mg four times a day. The dosage strength of the liquid is 200 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using one decimal place.

Correct response: 7.5 Explanation: 300 mg/X = 200 mg/5 mL X = 7.5 mL.

Which statement indicates that a client understands discharge instructions about propranolol? "I will assess my heart rate before I take my medication." "I will take this medication whenever I feel anxious." "I will take this medication in the morning." "I will not take this medication if I see yellow halos around lights."

Correct response: 42 Explanation: The IV flow rate is determined by the rate of infusion and the number of drops/mL of the fluid being administered. 15 gtt/mL × 1,000 mL/6 h x 1 h/60 min = 42 gtt/min.

A nurse overhears this conversation between coworkers: "Older people have lost many friends and family and also have health problems. Their anxiety and worries can be so severe that they need higher doses of benzodiazepines than most people." What is the most appropriate response for the nurse to make to the coworkers? "You're wrong. It's not safe to use benzodiazepines at all in older adults because of the side effects." "You're right. Many older adults have had anxiety for so long that it's more difficult to treat." "Older people should get the same dose as any other adult. It doesn't make any difference." "That's not right. Older people need lower doses than most people because of reduced liver and kidney function."

Correct response: "That's not right. Older people need lower doses than most people because of reduced liver and kidney function." Explanation: Reduced liver and kidney function are expected in older adults; benzodiazepines and many other medications should be administered cautiously to the elderly. Older adults are also at increased risk for falls because of oversedation that can occur with benzodiazepines. While benzodiazepines may be prescribed in lower doses, they can still be used in older adults with monitoring for safety.

A client undergoing cancer chemotherapy has been prescribed epoetin alfa. The client is to receive 150 units/kg subcutaneously three times per week. The client weighs 90 kg. How many units will the nurse administer at each dose? Record your answer using a whole number.

Correct response: 13500 Explanation: Each dose is 150 units/kg. Multiply: 150 units/kg × 90 kg = 13,500 units. The client receives 13,500 units subcutaneously 3 times a week.

Nitrofurantoin, 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using a whole number

Correct response: 15 Explanation: The following formula is used to calculate the correct dosage:25 mg/5 mL = 75 mg/XX = (5 x 75/25) mL = 15 mL.

The physician prescribes acetaminophen 650 mg by mouth every 4 hours for a client with a temperature of 102° F (38.8° C) who has a feeding tube in place. The nurse has acetaminophen solution on hand containing 160 mg/5 ml. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

Correct response: 20.3 Explanation: This formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the equation is as follows: 160 mg/5 ml = 650 mg/X. Therefore, X = 20.3 ml.

The emergency department nurse is caring for a client having a STEMI. The health care provider has prescribed a weight-based heparin bolus of 40 units/kg, with a maximum dose of 4000 units. The client weighs 250 lb (113.64 kg). How many units of heparin will the nurse give?

Correct response: 4000 Explanation: To calculate a weight-based medication prescription, you must multiply the client's weight in kilograms by the prescribed dosage. 113.64 kg x 40 units/kg = 4545.6 units However, for this problem, the maximum heparin bolus allowed is 4000 units, so this client should be given 4000 units of heparin. More than the maximum dose should never be given. Heparin is a high-risk medication and giving too much could have serious consequences, such as uncontrolled hemorrhage.

The nurse is preparing 1,000 mL D5/N5 to deliver over 6 hours. If the infusion set administers 15 gtt/mL, what is the required flow rate in gtt/min? (Round to the nearest whole number.)

Correct response: 42 Explanation: The IV flow rate is determined by the rate of infusion and the number of drops/mL of the fluid being administered. 15 gtt/mL × 1,000 mL/6 h x 1 h/60 min = 42 gtt/min.

Elderly clients may be concerned about taking too many medications and can be unsure of the reasons for some of the medications. What is the best action by the nurse? Set up an appointment to review each medication, actions, and side effects with each client. Consult with a pharmacist to discuss the medications, effects, side effects, and interactions; initiate physician referrals as needed. Give a general presentation on common groupings of medications and indications. Ask each client to research the individually prescribed medications and problem solve the reasons they were prescribed.

Correct response: Consult with a pharmacist to discuss the medications, effects, side effects, and interactions; initiate physician referrals as needed. Explanation: Have the pharmacist review the importance of medications, their effects and side effects. It is also important to assess for possible interactions. If changes are needed, then it is important to initiate a physician referral. The nurse would spend an inordinate amount of time reviewing medications with each client; a better resource would be the pharmacist. Giving a general presentation does not individualize what is needed by each person.

A nurse is caring for a client who has several medications ordered to treat the diagnosed condition. The client is refusing the medications, stating that the benefits do not outweigh the side effects. What is the nurse's best response to this situation? Consult with the prescribing physician. Document the client's decision in the health record. Tell the client that the medications are important to take. Disguise the medication in the client's food.

Correct response: Consult with the prescribing physician. Explanation: The nurse is aware of the reasons for the client declining the medication. The nurse should discuss with the physician ways to alleviate the side effects the client is experiencing. The other options do not respect client choice and do not demonstrate advocacy on behalf of the client's well-being.

A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with the preceptor. Which planned action by the graduate nurse should the preceptor correct? Flushing the PICC with 0.9% sodium chloride before removing it Measuring the length of the removed catheter and comparing it with the documented length of the inserted catheter Discarding the catheter in a trash container Applying a dressing over the site and leaving it in place for 24 hours

Correct response: Discarding the catheter in a trash container Explanation: To prevent injury to others, the graduate nurse should discard the catheter in a sharps-disposal container rather than a trash container. The graduate nurse should measure the length of the catheter to ensure that the entire catheter has been removed. Flushing the line ensures that there are no problems with the line. Applying a dressing and leaving it in place for 24 hours helps ensure hemostasis.

The nurse is admitting a client with glaucoma. The client brings prescribed eye drops from home and insists on using them in the hospital. What should the nurse do? Allow the client to keep the eye drops at the bedside and use as prescribed on the bottle. Ask the client's wife to assist the client in administering the eye drops while the client is in the hospital. Place the eye drops in the hospital medication drawer and administer as labeled on the bottle. Explain to the client that the health care provider (HCP) will write a prescription for the eye drops to be used at the hospital.

Correct response: Explain to the client that the health care provider (HCP) will write a prescription for the eye drops to be used at the hospital. Explanation: In order to prevent medication errors, clients may not use medications they bring from home; the HCP will prescribe the eye drops as required. It is not safe to place the eye drops in the client's medication box or to permit the client to use them at the bedside. The nurse should ask the wife to take the eye drops home.

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus? Insert a second I.V. line into the opposite arm. Gently aspirate the I.V. catheter to check for a blood return. Place a tourniquet on the arm in which the injection will be administered. Warm the I.V. medication to room temperature.

Correct response: Gently aspirate the I.V. catheter to check for a blood return. Explanation: Before administering an I.V. bolus, the nurse should gently aspirate the I.V. catheter for a small amount of blood to ensure correct placement of the I.V. catheter. Then the nurse may inject the medication over the recommended time interval. The nurse doesn't need to insert another I.V. line unless the ordered medication is incompatible with the medication in the I.V. solution. Warming the medication could alter the drug's action. Placing a tourniquet on the arm would close off the venous system and prevent drug injection.

When checking a client's medication profile, a nurse notes that the client is receiving a drug contraindicated for clients with glaucoma. The nurse knows that this client, who has a history of glaucoma, has been taking the medication for the past 3 days. What should the nurse do first? Hold the medication and report the information to the physician to ensure client safety. File an incident report because several other staff members have given the medication to the client. Find out whether there are extenuating reasons for giving the drug to this client. Continue to give the medication because the client has been taking it for 3 days.

Correct response: Hold the medication and report the information to the physician to ensure client safety. Explanation: The nurse should report the information to the physician because the client's safety may be endangered. The nurse shouldn't give the drug until clarifying the order with the physician. The fact that the client has taken the drug for several days doesn't guarantee that giving another dose is safe. Filing an incident report and finding out whether there are extenuating reasons for giving the drug wouldn't address client safety.

A client with cancer of the stomach tells the nurse, "I cannot bear the pain anymore. Please give me some poison to free myself from this agonizing pain." The nurse faces a value conflict. Which is true in such a condition? The nurse should solely consider the values of the client. Human need may affect the values conflict. Value conflict has no effect on the client's compliance. Values conflict is always destructive in nature.

Correct response: Human need may affect the values conflict. Explanation: Human need may affect values conflict. Though the client is refusing further treatment, the nurse should be aware that the client needs the treatment. The nurse should not consider only the values of the client. When faced with a values conflict, nurses should examine their own values regarding the conflict. Value conflict may affect the client's compliance. Values conflict is not always destructive in nature. At times, it may even be constructive.

A client with cancer of the stomach tells the nurse, "I cannot bear the pain anymore. Please give me some poison to free myself from this agonizing pain." The nurse faces a value conflict. Which is true in such a condition? Values conflict is always destructive in nature. Value conflict has no effect on the client's compliance. Human need may affect the values conflict. The nurse should solely consider the values of the client.

Correct response: Human need may affect the values conflict. Explanation: Human need may affect values conflict. Though the client is refusing further treatment, the nurse should be aware that the client needs the treatment. The nurse should not consider only the values of the client. When faced with a values conflict, nurses should examine their own values regarding the conflict. Value conflict may affect the client's compliance. Values conflict is not always destructive in nature. At times, it may even be constructive.

Which action is a priority for the nurse when finding medications at a client's bedside? Leave the medications, as the client will take them after the next meal. Leave the medications and seek the nurse who left them in the room. Remove the medications from the room and discard them into an appropriate disposal bin. Label the medications and place them back in the medication room.

Correct response: Remove the medications from the room and discard them into an appropriate disposal bin. Explanation: Disposing of the medications in the appropriate manner reflects best practice of nursing and medication administration. Leaving the medications by the client's bed would create a risk for another client to take them, for this client to take them inappropriately, or for them to get lost. It would be incorrect and unsafe to label medications that were taken out by another nurse.

The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply. Increases nerve pain. Reverses blood pressure of 90/58. Reverses decreased respiratory rate of 10. Increases inflammation. Reverses decreased level of consciousness.

Correct response: Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Reverses blood pressure of 90/58. Explanation: Therapeutic effect includes reversal of respiratory depression, sedation, and hypotension. Therapeutic effect does not include increasing nerve pain or increasing inflammation.

The nurse received an order to administer intravenous fluids with potassium for a client receiving intravenous fluids. What step(s) are included in the process? Select all that apply. Review the client's laboratory values. Review the label of the intravenous tubing. Identify client with two methods. Assist the client with ambulation. Obtain correct ordered intravenous fluids.

Correct response: Review the client's laboratory values. Obtain correct ordered intravenous fluids. Identify client with two methods. Review the label of the intravenous tubing. Explanation: The nurse will review the client's laboratory values, obtain correct ordered intravenous fluids, and identify client with two methods. The intravenous tubing should already have been labeled from the previous fluids so the nurse should review the label. Assisting the client with ambulation is not part of the intravenous fluid procedure.

A female client is treated for trichomoniasis with metronidazole. What should the nurse tell the client about this medication? Her partner does not need treatment. The medication should not alter the color of the urine. She should discontinue oral contraceptive use during this treatment. She should avoid alcohol during treatment and for 24 hours after completion of the drug.

Correct response: She should avoid alcohol during treatment and for 24 hours after completion of the drug. Explanation: Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection.

The nurse is caring for a client with a blood pressure of 210/94 mm Hg. The health care provider prescribes enalapril 20 mg b.i.d. Which nursing action is best when instructing on the new medication regimen? Teach the client the name and frequency of the new medication. Use the package insert for medication instruction. State the new medication, including name, use, and reason for the new medication. Inform the client about the new medication and provide a handout on the use.

Correct response: State the new medication, including name, use, and reason for the new medication. Explanation: Medication administration and teaching is in the nurse's scope of practice and a common nursing action. It is important for the nurse to inform the client about the medication, including its name, use, and the reason for the medication change, because teaching the client about treatment regimen promotes compliance. The other responses are not as specific and inclusive.

The health care provider (HCP) is calling in a prescription for ampicillin for a neonate. What should the nurse do? Select all that apply. Write down the prescription. Ask the HCP to confirm that the prescription is correct. Ask the nursing supervisor to cosign the telephone prescription as transcribed by the nurse. Ask the HCP to come to the hospital and write the prescription on the medical record. Repeat the prescription to the HCP over the telephone.

Correct response: Write down the prescription. Repeat the prescription to the HCP over the telephone. Ask the HCP to confirm that the prescription is correct. Explanation: The nurse should write down the prescription, read the prescription back to the HCP, and receive confirmation from the provider that the prescription is correct as understood by the nurse. It is not necessary for the HCP to come to the hospital to write the prescription on the medical record or to have the nursing supervisor cosign the telephone prescription.

A client has been taking intravenous furosemide for congestive heart failure. The client is ordered to start intravenous gentamicin. What intervention is the priority for the nurse? assess the I.V. site for phlebitis monitor serum furosemide level assess urine hourly output monitor serum BUN and creatinine levels

Correct response: monitor serum BUN and creatinine levels Explanation: Concurrent furosemide and gentamicin administration have a potential to increase both drugs' toxicity. This increases the risk of ototoxicity and nephrotoxicity. The nurse should monitor renal labs including BUN and creatinine, tinnitus, and balance/gait. Urine output should be monitored, however, the BUN and creatinine will be impacted before there is a change in urine output. The I.V. site should be assessed regularly as part of routine nursing care, not as a priority for the administration of these drugs. A serum furosemide is not a routine lab during the administration of these medications.

The sudden onset of which sign indicates a potentially serious complication for the client receiving an IV infusion? noisy respirations pupillary constriction halitosis moist skin

Correct response: noisy respirations Explanation: A serious complication of IV therapy is fluid overload. Noisy respirations can develop as a result of pulmonary congestion. Additional symptoms of fluid overload include dyspnea, crackles, hypertension, bounding pulse, and distended neck veins.

A client is scheduled for surgery at 8 a.m.(0800). While completing the preoperative checklist, the nurse sees that the surgical consent form isn't signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation? canceling the surgery asking the client to sign the consent form notifying the surgeon that the client hasn't signed the consent form giving the client the preoperative analgesic at the scheduled time

Correct response: notifying the surgeon that the client hasn't signed the consent form Explanation: Notifying the surgeon takes priority because the physician must obtain informed consent 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 to surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery isn't within the scope of nursing practice.

Gentamicin IV has been prescribed to treat a client's infection. The nurse should monitor the client for: ototoxicity. ascites. cardiac arrhythmias. confusion.

Correct response: ototoxicity. Explanation: Ototoxicity is a serious side effect of gentamicin. Tinnitus and dizziness are common; irreversible deafness can develop if the onset of ototoxicity is not detected early. Gentamicin is also known to be nephrotoxic and hepatotoxic.

For a client with rib fractures and a pneumothorax, the health care provider (HCP) prescribes morphine sulfate, 1 to 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which finding indicates the goal has been met? decreased client anxiety pain rating of 0 on a scale of 0 to 10 by the client PaO2 of 70 mm Hg (9.31 kPa) respiratory rate of 26 breaths/min

Correct response: pain rating of 0 on a scale of 0 to 10 by the client Explanation: If the client reports no pain, then the objective of adequate pain relief has been met. Decreased anxiety is not related only to pain control; it could also be related to other factors. A respiratory rate of 26 breaths/min is not within normal limits, nor is the PaO2 of 70 mm Hg (9.31 kPa), but these values are not measures of pain relief.