Saunders question

Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 3. Prepare the medication for bolus administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 4. Monitor the IV site for signs of infiltration or phlebitis. Potassium chloride administered intravenously must always be diluted in IVfluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IVbag con- taining the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the health care provider if the uri- nary output is less than 30 mL/hour.

A client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 1500. The nurse making rounds at 1545 finds that the client is complaining of a pounding headache and is dyspneic, experiencing chills, and apprehensive, with an increased pulse rate. The intravenous (IV) bag has 400 remaining. The nurse should take which action mL first? 1. Slow the IV infusion. 2. Sit the client up in bed. 3. Remove the IV catheter. 4. Call the primary health care provider (PHCP)

1. Slow the IV infusion. the client's symptoms are compatible with circula- tory overload. This may be verified by noting that 600 mL has infused in the course of 45 minutes. The first action of the nurse is to slow the infusion. Other actions may follow in rapid sequence. The nurse may elevate the head of the bed to aid the client's breathing, if necessary. The nurse also notifies the HCP. The IV catheter is not removed; it may be needed for the administration of medications to resolve the complication.

The nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

1. Withdraws the NPH insulin first Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 iden- tify correct actions for preparing NPH and short-acting insulin. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect action. Remember RN—draw up the Regular (short-acting) insulin before the NPH insulin.

A prescription reads potassium chloride 30 mEq to be added to 1000 mL normal saline (NS) and to be administered over a 10-hour period. The label on the medication bottle reads 40 mEq/20 mL. The nurse prepares how many milliliters (mL) of potassium chloride to administer the correct dose of medication? Fill in the blank.

15 ml

Sulfisoxazole, 1 g orally twice daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1. ½ tablet 2. 1 tablet 3. 2 tablets 4. 3 tablets

2 tablets

The nurse provides medication instructions to a client about digoxin. Which statement by the client indicates an understanding of its adverse effects? 1. "Blurred vision is expected." 2. "If my pulse rate drops below 60 beats per minute, I should let my cardiologist know." 3. "This medication may cause headache and weakness but that is nothing to worry about." 4. "If I am nauseated or vomiting, I should stay on liquids and take some liquid antacids."

2. "If my pulse rate drops below 60 beats per minute, I should let my cardiologist know." This question is an example of a positive event queryquestion. Note the words indicatesan understanding, and focus on the subject, adverse effects. Additionally, focus on the data provided in the options. Digoxin is a cardiac glycoside and works by increasing contractility of the heart. This medica- tion has a narrow therapeutic range and a major concern is tox- icity. Currently, it is considered second-line treatment for heart failure because of its narrow therapeutic range and potential for adverse effects. Adverse effects that indicate toxicity include gastrointestinal disturbances, neurological abnormalities, bra- dycardia or other cardiac irregularities, and ocular disturbances. If any of these occur, the health care provider (HCP) is notified. Additionally, the client should notify the HCP if the pulse rate drops below60 beats per minute because serious dysrhythmias are another potential adverse effect of digoxin therapy.

The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? 1. Report of infrequent insomnia 2. Development of expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after 2 doses of the medication 4. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication

2. Development of expiratory wheezes Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pul- monary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.Test-Taking Strategy: Focus on the subject, a potential adverse complication. Eliminate options indicating a decrease in blood pressure and a decrease in heart rate first, because these are expected effects from the medication. Next, focusing on the subject will direct you to the correct option.

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pads on the client's chest and before discharging the device, which intervention is a priority? 1. Ensure that the client has been intubated. 2. Set the defibrillator to the "synchronize" mode. 3. Administer an amiodarone bolus intravenously. 4. Confirm that the rhythm is ventricular fibrillation.

4. Confirm that the rhythm is ventricular fibrillation. Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch, if present, is removed. The client does not have to be intubated to be defi- brillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchro- nize. Amiodarone may be given subsequently but is not required before defibrillation

Sub Q routes and IM route implications

Sub q- 45 or 90 if short Im- 90

About IV Flow Rate

· Intravenous administration errors, such as incorrect flow rates or failure to monitor a flow rate, that result in injury

Milliliters to units.

1. Unit measures a medication in terms of itsaction, not its physical weight. 2. For example, penicillin, heparin sodium, and insulin are measured in units.

The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the client's medication history and determines it is necessary to contact the primary health care provider (PHCP) if the client is also taking which medications? Select all that apply. 1. Warfarin 2. Glimepiride 3. Amlodipine 4. Simvastatin 5. Atorvastatin

1. Warfarin 2. Glimepiride 3. Amlodipine Nonsteroidal antiinflammatory drugs (NSAIDs) can amplify the effects of anticoagulants; therefore, these med- ications should not be taken together. Hypoglycemia may result for the client taking ibuprofen if the client is concurrently taking an oral hypoglycemic agent such as glimepiride; these medications should not be combined. A high risk of toxicity exists if the client is taking ibuprofen concurrently with a cal- cium channel blocker such as amlodipine; therefore, this com- bination should be avoided. There is no known interaction between ibuprofen and simvastatin or hydrochlorothiazide

A health care provider prescribes 1000 mL of normal saline 0.9% to infuse over 8 hours. The dropfactor is 15 drops (gtt)/1 mL. The nurse sets theflow rate at how many drops per minute?

31 drops/min

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? 1. "I should notify my cardiologist if my feet or legs start to swell." 2. "I am supposed to report to my cardiologist if my pulse rate decreases below 60." 3. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." 4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning." variant angina, or Prinzmetal's angina, is pro- longed and severe and occurs at the same time each day, most often at rest. The pain is a result of coronary artery spasm. The treatment of choice is usually a calcium channel blocker, which relaxes and dilates the vascular smooth muscle, thus relieving the coronary artery spasm in variant angina. Adverse effects can include peripheral edema, hypotension, bradycardia, and heart failure. Grapefruit juice interacts with calcium channel blockers and should be avoided. If bradycardia occurs, the cli- ent should contact the health care provider. Clients should also be taught to change positions slowly to prevent orthostatic hypotension. Physical exertion does not cause this type of angina; therefore, the client should be able to continue morn- ing walks with his or her spouse.

Quinapril hydrochloride is prescribed as adjunctive therapy in the treatment of heart failure. After administering the first dose, the nurse should monitor which item as the priority? 1. Weight 2. Urine output 3. Lung sounds 4. Blood pressure

4. Blood pressure

A client brought to the emergency department states that he has accidentally been taking 2 times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action? 1. Prepare to administer an antidote. 2. Draw a sample for type and crossmatch and transfuse the client. 3. Draw a sample for an activated partial thromboplastin time (aPTT) level. 4. Draw a sample for prothrombin time (PT) and international normalized ratio (INR).

4. Draw a sample for prothrombin time (PT) and international normalized ratio (INR). The action that the nurse should take is to draw a sample for PT and INR level to determine the client's anti- coagulation status and risk for bleeding. These results will provide information as to how to best treat this client (e.g., if an antidote such as vitamin K or a blood transfusion is needed). The aPTT monitors the effects of heparin therapy.

A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. The nurse anticipates that which action is needed? 1. Discontinuing the heparin infusion 2. Increasing the rate of the heparin infusion 3. Decreasing the rate of the heparin infusion 4. Leaving the rate of the heparin infusion as is

4. Leaving the rate of the heparin infusion as is Rationale: The normal aPTTvaries between 28 and 35 seconds (28 and 35 seconds), depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 (42 to 52.5) and 2.5 (70 to 87.5) times normal. This means that the client's value should not be less than 42 seconds or greater than 87.5seconds. Thus the client's aPTT is within the therapeutic range and the dose should remain unchanged. Test-Taking Strategy: Focus on the subject, the expected aPTT for a client receiving a heparin sodium infusion. Remember that the normal range is 28 to 35 seconds and that the aPTT should be between 1.5 and 2.5 times normal when the client is receiving heparin therapy. Simple multiplication of 1.5 and 2.5 by 28 and 35 will yield a range of 42 to 87.5 seconds). This client's value is 65 seconds

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

4. Serum magnesium level Electrolyte normal values: K--> 3.5 to 4.5 Ca--> 9 to 10.5 Mg-->1.3 to 2.1 Na--> 135-145 Creatinine >1.3 toxic

A prescription reads regular insulin, 8 units/hr by continuous intravenous (IV) infusion. The pharmacy prepares the medication and then delivers an IV bag labeled 100 units of regular insulin in 100 mL normal saline (NS). An infusion pump must be used to administer the medication. The nurse sets the infusion pump at how many milliliters (mL) per hour to deliver 8 units/hr? Fill in the blank.

8 ml/hr Steps: Formula: unit/ml x hr 1. unit=1ml 100 units=100ml 100 units/100 ml=1 unit 2. 1 unit x 8hr= 8 ml/hr

The primary health care provider prescribes erythromycin suspension 800 mg by mouth. After reconstitution, how many milliliters should the nurse pour into the medicine cup to deliver the prescribed dose? Refer to figure. Fill in the blank. ***Medication stock: 200mg per 5ml*** Answer: _____ mL

Answer: 20mL

The nurse checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is the most appropriate action for the nurse to take?

Hold the feeding and reinstill the residual amount.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range? 1. 0.5 ng/mL (0.63 nmol/L) 2. 0.8 ng/mL (1.02 nmol/L) 3. 0.9 ng/mL (1.14 nmol/L) 4. 2.2 ng/mL (2.8 nmol/L)

1. 0.5 ng/mL (0.63 nmol/L) The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL. If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and an elevated level.

The nurse monitors a for which digoxin receiving client early manifestation of digoxin toxicity? 1. Anorexia 2. Facial pain 3. Photophobia 4. Yellow color perception

1. Anorexia This question addresses the subcategory Pharmacological and Parenteral Therapies in the Client Needs category Physiological Integrity. Note the strategic word, early. Digoxin is a cardiac gly- coside that is used to manage and treat heart failure and to con- trol ventricular rates in clients with atrial fibrillation. The most common early manifestations of toxicity include gastrointesti- nal disturbances such as anorexia, nausea, and vomiting. Neu- rological abnormalities can also occur earlyand include fatigue, headache, depression, weakness, drowsiness, confusion, and nightmares. Facial pain, personality changes, and ocular distur- bances (photophobia, diplopia, light flashes, halos around bright objects, yellow or green color perception) are also signs of toxicity, but are not early signs.

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic digoxin toxicity? of Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2. Diarrhea 4. Blurred vision 5. Nausea and vomiting Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 28 seconds 3. Activated partial thromboplastin time of 60 seconds 4. Activated partial thromboplastin time longer than 120 seconds

3. Activated partial thromboplastin time of 60 seconds Common laboratory ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds. Because the aPTT should be 1.5 to 2.5 times the normal value, the cli- e n t 's a P TT w o u l d b e c o n s i d e r e d t h e r a p e u t i c i f i t w a s 6 0 s e c o n d s . Prothrombin time assesses response to warfarin therapy. Test-Taking Strategy: Focus on the subject, the therapeutic effect of heparin. Prothrombin time is eliminated because it assesses response to warfarin therapy. The aPTT of 28 seconds is eliminated because this result indicates that the client is receiving no therapeutic effect from the continuous heparin infusion. Finally, the aPTT greater than 120 seconds can be eliminated because this value is beyond the therapeutic range and the client is at risk for bleeding.

The nurse reviews the eesults of a client with chronic kidney disease and notes that potassl is 5.7 lyte rium lectrothe levethe cardiac moitor as a resut of the laboratory value? n5.7 mmo/L). Which patterns would the nurse watch for on (L/mEqllSelect all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexe

3. Tall peaked T waves 5. Widened QRS complexe the normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level greater than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. ST depression and a prominent U wave occurs in hypokalemia. A prolonged ST segment occurs in hypocalcemia.

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously

4. Administer short-duration insulin intravenously Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitor- ing is important due to alterations in potassium levels associ- ated with DKA and its treatment, but apply

A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 1. Obtains a weight 2. Takes the temperature 3. Takes the blood pressure 4. Checks the amount of urine output

4. Checks the amount of urine output In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potas- sium chloride intravenously would be to assess the status of the urine output. Potassium chloride should never be adminis- tered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hour, potassium chloride should not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride.

The nurse determines that a client is having a trans- fusion reaction. After the nurse stops the transfusion, which action should be taken next?

Run normal saline at a keep-vein-open rate If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further health care provider pre- scriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume. The nurse would not remove the IV line because then there would be no IV access route. Obtaining a culture of the tip of the catheter device removed from the client is incorrect. First, the catheter should not be removed. Second, cultures are performed when infection, not transfusion reaction, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump. Test-Taking Strategy: Note the strategic word, next. Knowing that the IVline should not be removed assists in eliminating the options directing the nurse to discontinue the device. Recalling that normal saline, not dextrose, is used when administering a unit of blood will direct you to the correct option.