NCLEX PN - Fluids/Electrolytes and Medication Questions
The medication prescribed is atropine sulfate, 0.4 mg. The medication label states atropine sulfate, 0.5 mg / 0.5 mL. How many milliliters will the nurse prepare to administer to the client?
0.4 mL rationale: (0.4 mg / 0.5 mg) x 0.5 mL = 0.4 mL
Atropine sulfate, 0.2 mg given intramuscularly, is prescribed for a child. The medication label reads as follows: "0.4 mg / mL" The nurse has determined that the prescribed dose is safe. How many milliliters should the nurse administer to the child?
0.5 mL
The medication prescribed is prochlorperazine 5 mg intramuscularly, every 4 hours as needed. The medication label states prochlorperazine 10 mg/mL The nurse prepares how much medication to administer the dose?
0.5 mL
The medication prescribed is heparin sodium 650 units subcutaneously, every 12 hours. The medication vial reads heparin sodium 1000 units/mL The nurse prepares how many mililiters to administer one dose?
0.65 mL rationale: (desired / available) x mL = mL per dose 650 units / 1000 units x 1 mL = .65 mL
The medication prescribed is meperidine hydrochloride (Demerol), 35 mg intramuscularly. The medication label states meperidine hydrochloride (Demerol), 50 mg/mL. The nurse plans to prepare how much medication to administer the dose?
0.7 mL
The medication is an intramuscular dose of 400,000 units of penicillin G benzathine (Bicillin). The medication label reads penicillin G benzathine (Bicillin) 300,00 units / mL. The nurse prepares how much medication to administer the correct dose?
1.3 mL
the health care provider's prescription reads "levothyroxine (Synthroid), 150 mcg orally daily." The medication label reads "levothyroxine, 0.1 mg / tablet. The nurse prepares to administer how many tablet(s) to the client?
1.5 tablets
a health care provider prescribes potassium chloride (KCl) elixir, 20 mEq orally daily. The medication label states potassium chloride (KCl), 30 mEq / 15 mL How many milliliters should the nurse prepare to administer the dose?
10 mL
the nurse is asked to regulate the flow rate of an intravenous (IV) solution being administered to a client. The IV bag contains 50 mL of solution and the solution is to be administered over 30 minutes. The administration set has a drop factor of 10 drops (gtts) / mL. The nurse should regulate the roller clamp on the infusion set to deliver how many drops per minute?
17 gtts / min rationale: 50 mL / 30 minutes x 10 gtts / min = 16.667 or 17 gtts / min
The medication prescription reads phenytoin (Dilantin), 0.2 g orally, twice daily. The medication label states 100-mg capsules. The nurse prepares how many capsule(s) to administer one dose?
2 capsules
The medication prescribed is levodopa 1 g orally, daily. The medication label states levodopa, 500-mg tablets. The nurse prepares to administer how many tablets at the evening dose?
2 tablets rationale: 1 g = 1000mg 1000 mg / 500 mg = 2 tablets
the health care provider prescribes 1000 mL of 0.45% normal saline to run over 8 hours. The drop factor is 15 gtts / mL. The nurse plans to adjust the flow rate to how many gtts / min
31 gtt / min
the health care provider's prescription reads "phenytoin (Dilantin) 0.2 g orally, twice daily" The medication label states 100-mg capsules. How many capsule(s) should the nurse plan to administer over a 24-hour period
4 capsules convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0.2 g = 200 mg 200 mg / 100 mg x 1 capsule = 2 capsules per dose The question asks for the number of capsules for a 24 hour period. Since the medication is administered twice daily then the total daily number of capsules is 4.
The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. Which should the nurse observe for on the cardiac monitor as a result of this laboratory value? A) ST elevation B) Peaked P waves C) Prominent U waves D) Narrow, peaked T waves
D) Narrow, peaked T waves rationale: a serum potassium level of 5.4 mEq/L is indicative of hyperkalemia. Cardiac changes include a wide, flat P wave; a prolonged PR interval; a widened QRS complex; and narrow, peaked T waves
The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom is an indication of this electrolyte imbalance? A) twitching B) positive trousseau's sign C) hyperactive bowel sounds D) generalized muscle weakness
D) generalized muscle weakness rationale: generalized muscle weakness is seen in clients with hypercalcemia. Twitching, positive Trousseau's sign, and hyperactive bowel sounds are signs of hypocalcemia.
the nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which additional signs/symptoms should the nurse expect to note in this client if hyponatremia is present? A) intense thirst B) slow-bounding pulse C) dry mucous membranes D) postural blood pressure changes
D) postural blood pressure changes rationale: postural blood pressure changes occur in the client with hyponatremia. Intense thirst and dry mucous membranes are seen in clients with hypernatremia. A slow, bounding pulse is not indicative of hyponatremia. In a client with hyponatremia, a rapid, thready pulse is noted.
the nurse is told in a report that the client has hypocalcemia and a postive Chvostek's sign. Which signs should the nurse expect to note during the data collection? Select all that apply Coma Tetany Diarrhea Hypoactive bowel sounds A positive Trousseau's sign
tetany // diarrhea // a positive trousseau's sign rationale: a positive Chvostek's sign is indicative of hypocalcemia. Other signs and symptoms include tachycardia, hypotension, paresthesias, twitching, cramps, tetany, a positive Trousseau's sign, diarrhea, seizures, hyperactive bowel sounds, and a prolonged QT interval
the nurse is preparing to administer 35 mg of a prescribed intramuscular (IM) dose of medication to a client. The medication label reads 50 mg / mL. How many milliliters should the nurse administer to the client?
0.7 mL
The medication prescribed is atropine sulfate, 0.4 mg intramuscularly, immediately. The medication label states atropine sulfate 0.3 mg/ 0.5 mL. The nurse prepares how much medication to administer the dose?
0.7 mL rationale: (0.4 mg / 0.3 mg) x 0.5 mL = 0.667 or 0.7 mL
The medication prescribed is hydromorphone hydrochloride (Dilaudid), 3 mg intramuscularly, every 4 hours as needed. The medication label reads hydromorphone hydrochloride (Dilaudid) 4 mg/1 mL. The nurse should prepare to administer how many mL to the client?
0.75 mL rationale (desired / available) x mL = mL per dose 3mg / 4 mg x 1 mL = 0.75 mL
the medication prescribed is digoxin (Lanoxin), 0.25 mg orally, daily. The medication label reads digoxin (Lanoxin) 0.125 mg/ tablet. The nurse should prepare how many tablet(s) to administer the dose?
2 tablets rationale (desired / available) x tablet(s) = tablet(s) per dose .25 mg / .125 mg = 2 tablets
The intravenous prescription is 3000 mL of 5% dextrose (D5W) to run over a 24-hour period. The drop factor is 10 gtts/ 1 mL. The nurse plans to adjust the flow rate to how many gtts / minute?
21 gtts / minute
The intravenous prescription is 1000 mL of 0.9% NaCl (normal saline) to run over 12 hours. The drop factor is 15 gtts/ 1 mL. The nurse plans to adjust the flow rate to how many gtts/ min?
21 gtts / minute rationale: total volume x drop factor / time in minutes 1000 mL x 15 gtt / 720 minutes 15,000 / 720 = 20.8 or 21 drops per minute
a postoperative client has a prescription to receive an IV infusion of 1000 mL normal saline solution over a period of 10 hours. The drop factor for the IV infusion set is 15 gtts / mL The nurse sets the flow rate at how many drops per minute?
25 gtts / min
the nurse is calculating a client's 24-hour fluid intake. The client consumed coffee (8 oz), water (8 oz), and orange juice (6 oz) for breakfast; soup (4 oz) and iced tea (8 oz) for lunch; and milk (10 oz), tea (8 oz), and water (8 oz) for dinner. The client also consumed 24 oz of water during the day. How many milliliters of fluid did the client consume in the 24-hour period?
2520 mL rationale: the client consumed a total of 84 oz of fluid. Because 1 oz is equal to 30 mL, multiply 84 oz by 30 mL / oz This yields 2520 mL
The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse should tell the client that which food item is least likely to contain calcium? A) milk B) butter C) spinach D) collard greens
B) butter rationale butter comes from milk fat and does not contain significant amounts of calcium. Milk, spinach, and collard greens are calcium-containing foods and should be avoided by the client on a calcium-restricted diet
The nurse reviews the client's serum level and notes that the level is 8.0 mg/dL. The nurse understands which condition causes this serum calcium level? A) prolonged bed rest B) adrenal insufficiency C) Hyperparathyroidism D) Excessive ingestion of vitamin D
A) prolonged bed rest rationale: the normal serum calcium level is 8.6 to 10.0 mg/dL. A client with a serum calcium level of 8.0 mg/dL is experiencing hypocalcemia. The excesive ingestion of vitamin D, adrenal insufficiency, and hyperparathyroidism are causative factors associated with hypercalcemia. Although immobilization can initially cause hypercalcemia, the long-term effect of prolonged bedrest is hypocalcemia.
Sulfisoxazole (Gantrisin), 1 g orally four times daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads, "500-mg tablets." The nurse has determined that the prescribed dose is safe. How many tablets per dose should the nurse administer to the adolescent? A) 0.5 B) 1 C) 2 D) 3
C) 2 tablets rationale 1 g = 1000 mg 1000 mg / 500 mg = 2 tablets
the nurse is caring for a client with kidney failure. The laboratory results reveal a magnesium level of 3.6 mg /dL Which sign does the nurse expect to note in the client, based on this magnesium level? A) Twitching B) Irritability C) Hyperactive reflexes D) loss of deep tendon reflexes
D) loss of deep tendon reflexes rationale: the normal magnesium level is 1.6 to 2.6 mg/dL A client with a magnesium level of 3.6 mg/dL is experiencing hypermagnesia. Loss of deep tendon reflexes is characteristic of this condition. Twitching, irritability and hyperactive reflexes should be noted in a client with hypomagnesia.
the nurse reviews electrolyte values and notes a sodium level of 130 mEq/L. The nurse expects that this sodium level would be noted in a client with which condition? A) the client with watery diarrhea B) the client with diabetes insipidus (DI) C) the client with an inadequate daily water intake D) the client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
D) the client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) rationale: Hyponatremia is a serum sodium level less than 135 mEq/L. Hyponatremia can occur secondary to SIADH. The client with an inadequate daily water intake, watery diarrhea, or diabetes insipidus is at risk for hypernatremia.
A health care provider has prescribed phenobarbital sodium (luminal sodium), 25 mg orally twice daily, for a child with febrile seizures. The medication label reads as follows: "Phenobarbital sodium, 20 mg/ 5mL" The nurse is determined that the dose prescribed is a safe dose for the child. How many milliliters per dose should the nurse administer to the child? A) 2 mL B) 4.5 mL C) 6.25 mL D) 7 mL
C) 6.25 mL rationale 25 mg / 20 mg x 5 mL = 5.25 mL / dose
the nurse is caring for a group of clients. Which client is most likely to have a serum phosphorus level of 2.0 mg/dL A) a client receiving chemotherapy B) a client with hypoparathyroidism C) a client with a history of alcoholism D) a client admitted with vitamin D intoxication
C) a client with a history of alcoholism rationale: the normal serum phosphorus level is 2.7 to 4.5 mg/dL, so a value of 2.0 mg/dL is indicative of hypophosphatemia. Causative factors include decreased nutritional intake and malnutrition. A poor nutritional state is associated with alcoholism. Hypoparathyroidism, chemotherapy, and vitamin D intoxication are causative factors of hyperphosphatemia.
The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for a potassium deficit? A) the client with Addison's disease B) The client with metabolic acidosis C) the client with intestinal obstruction D) the client receiving nasogastric suction
D) the client receiving nasogastric suction rationale: Potassium-rich gastrointestinal (GI) fluids are lost through GI suction, which places the client at risk for hypokalemia. The client with intestinal obstruction, Addison's disease, and metabolic acidosis is at risk for hyperkalemia.
a health care provider's prescription reads as follows: "Ampicillin, 125 mg intramuscular every 6 hours." The medication label reads, "1 gram when reconstituted with 7.4 mL of bacteriostatic water." How many milliliters should the nurse draw up for one dose? A) 0.54 mL B) 0.92 mL C) 1.1 mL D) 7.4 mL
B) 0.92 mL rationale: convert grams to milligrams. with the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Then, use the medication calculation formula. 1 g = 1000 mg 125 mg / 1000 mg x 7.4 mL = 0.925 mL / dose
The nurse reviews a clients electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level should be noted with which condition? A) Diarrhea B) Traumatic burn C) Cushing's Syndrome D) Overuse of laxatives
B) Traumatic Burn rationale: a serum potassium level that exceeds 5.0 mEq/L is indicative of hyperkalemia. Clients who experience the cellular shifting of potassium, as in the early stages of massive cell destruction (ie with trauma, burns, sepsis, or metabolic or respiratory acidosis), are at risk for hyperkalemia. The client with Cushing's syndrome or diarrhea and the client who has been overusing laxatives are at risk for hypokalemia.
The nurse is caring for a client with a diagnosis of hyperparathyroidism. Laboratory studies are performed, and the serum calcium level is 12.0 mg/dL. Based on this laboratory value, the nurse should take which action? A) document the value in the client's record. B) Inform the registered nurse of the laboratory value C) place the laboratory result form in the client's record D) Reassure the client that the laboratory result is normal
B) inform the registered nurse of the laboratory value rationale: the normal serum calcium level ranges from 8.6 to 10.0 mg/dL. The client is experiencing hpercalcemia, and the nurse would inform the registered nurse of the laboratory value. Because the client is experiencing hypercalcemia, the remaining options are incorrect actions
The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for fluid volume deficit? A) the client with cirrhosis B) the client with a colostomy C) the client with heart failure D) the client with decreased kidney function
B) the client with a colostomy rationale: causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, ileostomy, and colostomy. A client with cirrhosis, HF, or decreased kidney function is at risk for fluid volume excess.
Which of these clients are most likely to develop fluid (circulatory) overload? Select all that apply A premature infant a 101 year old man A client on renal dialysis A client with diabetes mellitus A 29 year old client with pneumonia
A premature infant// a 101 year old man// a client on renal dialysis// a client with heart failure rationale: clients with cardiac, respiratory, renal, or liver diseases and older and very young clients cannot tolerate an excessive fluid volume. The risk of fluid (circulatory) overload exists with these clients.
The medication prescription states to administer acetaminophen (Tylenol), 650 mg orally for a temperature of more than 38 C. The medication bottle states Tylenol (acetaminophen), 325 mg tablets. The nurse takes the client's temperature and notes that it is 101 F. The nurse plans to take which action? A) administer 2 Tylenol tablets B) administer 3 Tylenol tablets C) do not administer the Tylenol at this time D) check the client's temperature in 30 minutes
A) Administer 2 Tylenol tablets rationale: convert Fahrenheit to Celsius, and then calculate the dose to be administered. to convert Fahrenheit to Celsius, subtract 32 and divide the result by 1.8 C = (101-32) = 69 / 1.8 = 38.3 C 650 mg / 325 mg x 1 tablet = 2 tablets
The nurse is reading the HCPs progress notes in the client's records and sees that the HCP has documented "insensible fluid loss of approximately 800 mL daily" Which client is at risk for this loss? A) client with a draining wound B) client with a urinary catheter C) client with a fast respiratory rate D) client with a nasogastric tube to low suction
C) client with a fast respiratory rate rationale: sensible losses are those that the person is aware of, such as those that occur through wound drainage, GI tract losses, and urination. Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs.
Morphine sulfate, 2.5 mg, is prescribed for a child. The safe pediatric dose is 0.05 to 0.1 mg/kg/dose. The child weighs 50 kg. Which statement describes the prescribed dosage for this child? A) the dose is too low B) the dose is too high C) the dose is within the safe dosage range D) there is not enough information to determine the safe dosage range
C) the dose is within the safe dosage range rationale: 0.5 mg/kg/dose x 50 kg = 2.5 mg/dose 0.1 mg/kg/dose x 50 kg = 5 mg/dose the dose is within the safe dosage range
The nurse who is caring for a client with kidney failure notes that the client is dyspneic, and crackles are heard on auscultation. Which additional signs/symptoms should the nurse expect to note in this client? A) Rapid weight loss B) Flat hand and neck veins C) A weak and thready pulse D) An increase in blood pressure
D) an increase in blood pressure rationale: impaired cardiac or kidney function can result in fluid volume excess. Findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, an elevated blood pressure, a bounding pulse, an elevated central venous pressure, weight gain, edema, neck and hand vein distention, an altered level of consciousness, and a decreased hematocrit level.
The medication prescribed is metoclopramide hydrochloride (Reglan) 10 mg intramuscularly times one dose. The medication label reads metoclopramide hydrochloride (Reglan), 5 mg/mL. The nurse prepares how much medication to administer the dose?
2 mL
The medication prescribed is zidovudine (Retrovir), 0.2 g orally, three times daily. The medication label states zidovudine, 100-mg tablets. The nurse prepares to administer how many tablets for one dose?
2 tablets
The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which prescribed medication should the nurse prepare to assist in administering to the client? A) calcium chloride B) calcium gluconate C) calcitonin (Miacalcin) D) large doses of vitamin D
C) Calcitonin (Miacalcin) rationale the normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration
A client enters the emergency department confused, twitching, and having seizures. His family states he recently was placed on corticosteriods for arthritis and was feeling better and exercising daily. Upon assessment, he has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. His serum sodium level is 172 mEq/ L. Which interventions would the health care provider likely prescribe? Select all that apply Monitor vital signs Monitor intake and output Increase water intake only Monitor electrolyte levels Provide a sodium-reduced diet Administer sodium replacements
Monitor vital signs // monitor intake and output // increase water intake only // monitor electrolyte levels // provide a sodium-reduced diet rationale: hypernatremia is described as having a serum sodium level that exceeds 145 mEq / L. Signs and symptoms would include dry mucous membranes, loss of skin turgor, thirst, flushed skin, elevated temperature, oliguria, muscle twitching, fatigue, confusion, and seizures. Interventions include, monitoring fluid balance, monitoring vital signs, reducing dietary intake of sodium, monitoring electrolyte levels, and increasing oral intake of water. Sodium replacement therapy would not be prescribed for a client with hypernatremia
Which electrocardiogram changes would the nurse note on the cardiac monitor with a client whose potassium (K+) level is 2.7 mEq/L? A) U waves B) Flat P waves C) Elevated T waves D) Prolonged PR interval
A) U waves rationale A serum potassium level of less than 3.5 mEq/L is indicative of hypokalemia. Potassium deficit is the most common electrolyte imbalance and is potentially life threatening. Cardiac changes with hypokalemia may induce peaked P waves, flattened T waves, depressed ST segment, and the presence of U waves.
The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding should the nurse expect to note as a result of this long-term use? A) gurgling respirations B) increased blood pressure C) decreased hematocrit level D) increased specific gravity of the urine
D) increased specific gravity of the urine rationale: clients taking diuretics on a long-term basis are at risk for fluid volume deficit. Findings of fluid volume deficit include increased respirations and heart rate, decreased central venous pressure, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, dark-colored and odorous urine, an increased hematorcrit level, and an altered LOC. Gurgling respirations, increased blood pressure, and decreased hematocrit as a result of hemodilution are seen in a client with fluid volume excess
The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at the least likely risk for the development of third-spacing? A) the client with sepsis B) the client with cirrhosis C) the client with kidney failure D) the client with diabetes mellitus
D) the client with diabetes mellitus rationale: fluid that shifts into the interstitial spaces and remains there is referred to as third-space fluid. Common sites for third-spacing include the abdomen, pleural cavity, peritoneal cavity, and pericardial sac. Third-space fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Risk factors include liver or kidney disease, major trauma, burns, sepsis, wound healing, major surgery, malignancy, malabsorption syndrome, malnutrition, alcoholism, and older age
