Pharm Unit 3

Which parenteral route has the longest absorption time? a. Intradermal b. Subcut c. IM d. Intravenous (IV)

a. Intradermal

The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the patient require to evaluate therapeutic effects of the drug? A) Activated partial thromboplastin time (APTT) only B) International normalized ratio (INR) only C) Prothrombin time (PT) and INR D) PT and APTT

C) Prothrombin time (PT) and INR

A patient has high blood pressure and penile erectile dysfunction. He asks the nurse if he could try tadalafil (Cialis)after seeing an advertisement on television. What medications, if taken by the patient, would the nurse recognize as increasing the risk associated with taking tadalafil? A) Beta-blockers B) Angiotensin-converting enzyme (ACE) inhibitors C) Alpha-adrenergic blockers D) Calcium channel blockers

C) Alpha-adrenergic blockers

A patient has a continuous IV infusion at 60 mL/hr. The right hand IV has infiltrated and the nurse has started a new IV on the left forearm. Which intervention should the nurse also perform? 1) Elevate the patient's left forearm. 2) Schedule daily dressing changes to the new IV site. 3) Change the administration set. 4) Place the patient in Fowler's position.

3) Change the administration set. Rationale: Reusing an IV set from a previous site increases the risk of contamination.

The nurse suspects that a patient's intravenous solution has infiltrated into the tissues. What action should the nurse take first? 1) Aspirate, then inject 0.5 mL normal saline. 2) Restart the IV line in a different vein. 3) Stop the infusion immediately. 4) Notify the primary care provider.

3) Stop the infusion immediately.

A patient has been diagnosed with hypovolemia. Which hydration prescription should the nurse question? *Select all that apply* 1) 0.9% (normal) saline at 100 mL/hr 2) Lactated Ringer's solution at 100 mL/hr 3) Total parenteral nutrition solution at 100 mL/hr 4) D5W solution at 100 mL/hr 5) D5 0.9% NaCl at 100 mL/hr

3) Total parenteral nutrition solution at 100 mL/hr 4) D5W solution at 100 mL/hr 5) D5 0.9% NaCl at 100 mL/hr

When performing a central venous catheter dressing change, which step is correct? 1) Wear sterile gloves while removing and discarding the soiled dressing. 2) Apply pressure on the catheter-hub junction when removing the soiled dressing. 3) Place a sterile transparent dressing over the site and the catheter-hub junction. 4) Have the patient wear a mask or turn his head away from the site.

4) Have the patient wear a mask or turn his head away from the site. Rationale: Aseptic technique should be used with approaching the insertion site. Therefore, both nurse and patient should wear a mask. If the patient cannot wear a mask, have him turn his head away from the insertion site during the procedure.

The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this morning. What actions will the nurse take? (Select all that apply.) A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). C) Expect to administer protamine sulfate. D) Expect to administer vitamin K. E) Assess partial thromboplastin time (PTT)

A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). D) Expect to administer vitamin K.

A pregnant woman is admitted to the high-risk OB unit and started on an IV of magnesium sulfate. What assessment by the nurse is most important? A. Deep tendon reflexes B. Fetal heart tones C. Serum calcium level D. Temperature

A. Deep tendon reflexes

The nurse improves patient compliance with the drug regimen of epoetin alfa by providing what? A) An appointment card for each drug administration day B) A calendar to mark the days of the week the drug is to be administered C) A referral for community transportation D) The telephone number of the pharmacy where the medication can be purchased

B) A calendar to mark the days of the week the drug is to be administered Rationale: The nurse should provide the patient with a calendar with the days the drug is to be administered marked clearly to remind her when the dose is due. The patient can be taught to self-administer the drug so there is no need for an appointment or arranging transportation. The patient can use her choice of pharmacy and would not need the telephone number.

A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin alfa therapy for iron replacement. What will the nurse assess before initiating therapy? A) Weight B) Last menstrual period C) Intake and output (I & O) for a 24-hour period D) Blood type

B) Last menstrual period Rationale: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the patient is not pregnant before drug therapy has started so the nurse would assess when the patient last menstruated. The patients weight, I & O, and blood type are not important factors in determining whether the drug can be used.

A nurse working in a PCP's office is collecting history information from a client who reports experiencing erectile dysfunction and is seeking treatment with Tadalafil. This medication would be contraindicated if the client is currently taking which of the following? A. Atorvastatin B. Nitroglycerin patch C. Albuterol D. Metoprolol

B. Nitroglycerin patch

The nurse is providing care for a client with a urinary tract infection. The nurse understands the client is receiving phenazopyridine for which of the following reasons? A. To reduce the frequency and severity of bladder spasms. B. To provide local anesthetic effects to the bladder mucosa. C. To kill E. coli bacteria commonly associated with urinary tract infection. D. To promote diuresis and subsequently prevent stone formation.

B. To provide local anesthetic effects to the bladder mucosa.

The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication? A) Reduced risk of endometriosis B) Reduced risk of dysfunctional uterine bleeding C) Reduced risk of osteoporosis D) Reduced risk of uterine cancer

C) Reduced risk of osteoporosis

The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient? A) Skin condition B) Cardiac arrhythmia C) Vision changes D) Mental status

C) Vision changes

A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, what is the nurses priority action? A) Wash his or her hands. B) Identify the child by checking the arm band and asking him or her to state his or her name. C) Ensure a quiet environment so the patient can sleep during administration of the drug. D) Check laboratory studies to determine most recent measures of bone marrow function.

D) Check laboratory studies to determine most recent measures of bone marrow function.

What may become discolored by phenazopyridine (Pyridium) in addition to the urine? a. Feces b. Sclera c. Sputum d. Saliva

b. Sclera

When preparing parenteral medications, the nurse should perform which intervention(s)? (Select all that apply.) a. Check the expiration date. b. Use sterile technique throughout the entire procedure. c. Check the drug dose form ordered against the source available. d. Prepare the drug in a clean well lighted area. e. Check calculations.

a. Check the expiration date. c. Check the drug dose form ordered against the source available. d. Prepare the drug in a clean well lighted area. e. Check calculations.

Which risk factor(s) should be considered when administering medications by injection? (Select all that apply.) a. Trauma at the site of the needle puncture b. Possibility of infection c. Irretrievability of the medication once administered d. Delayed absorption e. Delayed onset of action f. Chance of allergic reaction

a. Trauma at the site of the needle puncture b. Possibility of infection c. Irretrievability of the medication once administered f. Chance of allergic reaction

An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of dyspnea. The nurse notes shallow rapid respirations and a cough that produces frothy sputum. Which is the priority nursing action? a. Assess the urine output. b. Elevate the head of the bed. c. Encourage the patient to cough. d. Maintain the IV rate.

b. Elevate the head of the bed.

Which condition would the nurse expect to be treated with an isotonic solution? a. Fluid overload b. Hemorrhagic shock c. Cellular dehydration d. Cerebral edema

b. Hemorrhagic shock

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? a. It takes at least 3 days for the symptoms to resolve once the clot dissolves. b. Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body. c. I will report this to your health care provider because there may be a need to look at alternative treatments. d. You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge.

b. Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body.

Which technique by the nurse is accurate when administering heparin to a thin, older adult patient? a. Aspirate before injecting the medication. b. Inject at a 45-degree angle. c. Inject at a 90-degree angle. d. Massage site following injection.

b. Inject at a 45-degree angle.

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? a. Bradycardia b. Petechiae c. Increased urinary output d. Dry skin

b. Petechiae

Which is the most potent of the natural estrogenic hormones produced in the ovaries? a. Estradiol b. Estrone c. Estriol d. Estrogen

a. Estradiol

Which technique by the nurse accurately maintains asepsis of a peripheral IV access device? a. Wear gloves when hanging all IV solutions. b. Apply a topical antibiotic ointment to the insertion site. c. Change fluid administration sets according to institutional policy. d. Flush with heparin before use.

c. Change fluid administration sets according to institutional policy.

The nurse is preparing to administer kindergarten immunizations at the local health clinic. Which anatomic site would be best for the injection of the immunizations containing 0.5 mL? a. Rectus femoris b. Dorsogluteal c. Deltoid d. Ventrogluteal

c. Deltoid

An adult patient is to receive two medications IM. Which action by the nurse is most important in order to mix the medications in one syringe? a. Assess for the presence of adequate muscle mass. b. Ensure that the combined medication amount is less than 2 mL. c. Determine the compatibility of the medications. d. Use a needle that is 25 gauge.

c. Determine the compatibility of the medications.

Which potential complication will the nurse expect in patients with a venous access device? a. Circulatory overload b. Extravasation c. Infection d. Pain

c. Infection

A patient is complaining of moderate bladder pain and spasms secondary to a UTI. Which drug would assist in relieving symptoms? a. Tolterodine (Detrol) b. Nitrofurantoin (Furadantin) c. Phenazopyridine hydrochloride (Pyridium) d. Oxybutynin chloride (Ditropan)

c. Phenazopyridine hydrochloride (Pyridium)

A patient has a peripherally inserted central catheter (PICC) line inserted to continue IV antibiotic therapy at home. With proper care, how long can this type of venous access device remain in place? a. 2 months b. 4 months c. 6 months d. 12 months

d. 12 months Rationale: PICC lines routinely remain in place for 1 to 3 months, but can last for a year or more if cared for properly.

Which gauge needles are used for subcut injections? a. 14 to 16 gauge b. 18 to 21 gauge c. 22 to 24 gauge d. 25 to 27 gauge

d. 25 to 27 gauge

The nurse notes that a patient with cardiac disease has IV heparin infusing and that it is behind by 2 hours. What is the best nursing action? a. Increase the IV rate and recheck in 1 hour. b. Change the infusion rate to TKO. c. Discontinue the solution using aseptic technique. d. Contact the health care provider for consultation.

d. Contact the health care provider for consultation.

A patient diagnosed with benign prostatic hypertrophy asks why tamsulosin (Flomax), an alpha1 adrenergic blocking agent, has been prescribed. Which explanation by the nurse is most accurate? a. It inhibits the action of testosterone. b. It improves sexual function. c. It reduces the size of the prostate. d. It increases urinary flow.

d. It increases urinary flow.

What is the mechanism of action of drugs used to treat thromboembolic disease? a. Dissolving clots and preventing formation of new clots b. Making platelets more flexible and preventing formation of new clots c. Causing vasodilation and increased blood flow d. Preventing platelet aggregation and inhibiting clot formation

d. Preventing platelet aggregation and inhibiting clot formation

What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin? A) Avoiding intramuscular injections B) Assessing for symptoms of respiratory depression C) Measuring hourly urinary outputs D) Monitoring BP hourly

A) Avoiding intramuscular injections

When assisting with bedside central venous catheter (CVC) placement, which nursing intervention is appropriate? *Select all that apply.* 1) Apply sterile gloves and mask (and possibly gown). 2) Scrub the insertion site with antibacterial soap for 1 min. 3) Verify that informed consent has been obtained. 4) Place the patient in low Fowler's position. 5) Prepare an infusion bag with dextrose 10% and water.

1) Apply sterile gloves and mask (and possibly gown). 3) Verify that informed consent has been obtained.

The nurse needs to relocate an intravenous site in a patient with an infiltrated IV in the right forearm. In which site is it appropriate for the nurse to insert the new IV line? *Select all that apply.* 1) Left hand 2) Right wrist 3) Right antecubital area 4) Right saphenous vein 5) Left jugular vein

1) Left hand 3) Right antecubital area

The nurse notes that a patient's intravenous catheter site is painful, edematous, red, and warm to the touch. There is a palpable cord along the vein and the fluid infusion is sluggish. What should the nurse suspect is occurring with this patient? 1) Infiltration 2) Extravasation 3) Hematoma 4) Phlebitis

4) Phlebitis Rationale: Phlebitis is an inflammation of the vein. It may be caused by the infusion of solutions that are irritating to the vein. Patients receiving IV solutions with potassium chloride are at a higher risk for phlebitis, as it is irritating to the vein.

When the nurse administers warfarin it is expected that the drug will have what effect on the body? A) Decrease in production of vitamin K dependent clotting factors B) Increase in prothrombin C) Increase in vitamin Kdependent factors in the liver D) Increase in procoagulation factors

A) Decrease in production of vitamin K dependent clotting factors

A nurse is caring for a client who has an order for oxytocin (Pitocin) to stimulate uterine contractions. Which of the following actions are appropriate for the nurse to take? Select all that apply. A. Assess frequency of uterine contractions. B. Monitor vital signs of client and fetal heart rate. C. Place the client prone to prevent dizziness. D. Draw labs to ensure adequate peak and trough. E. Administer via an electronic infusion device.

A. Assess frequency of uterine contractions. B. Monitor vital signs of client and fetal heart rate. E. Administer via an electronic infusion device.

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patients history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Penile implant C) Hypotension D) Lung cancer

B) Penile implant

A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color? A) Bluish-green B) Reddish-orange C) Brown D) Black

B) Reddish-orange

A patient has been prescribed epoetin alfa. The nurse determines the drug is contraindicated as a result of what finding in the patient history? A) Asthma B) Irritable bowel syndrome C) Hypertension D) Shortness of breath

C) Hypertension Rationale: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for patients with asthma, irritable bowel syndrome, or shortness of breath.

The student nurse is caring for a client who currently takes oxybutynin. The student should include which of the following statements in the client's teaching? A. "This medication will help reduce your pain." B. "Some people who take this develop ringing in their ears." C. "This medication helps you control your bladder." D. "Some people complain of night sweats with this medication."

C. "This medication helps you control your bladder."

The nurse caring for a client with a 42-pack-per-year history of smoking taking estradiol. Which of the following assessment findings in the client should the nurse be most concerned about? A. Bilateral breast tenderness B. Total calcium level of 9.2 mg/dL C. Unilateral swelling of the right calf D. Platelet count of 167,000 cells/mm3

C. Unilateral swelling of the right calf

The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurse instruct the patient to do prior to starting heparin to treat venous thrombosis? A) Wait an hour after taking the anticoagulant before feeding the infant. B) Push fluids to clear the drug from her system before feeding the infant. C) Find another method of feeding the infant while taking this drug. D) Continue breast-feeding because heparin does not enter breast milk.

D) Continue breast-feeding because heparin does not enter breast milk. Rationale: Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, push fluids, or find another method of feeding the baby.

The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose his or her hair. Why would the nurse suggest that he or she get a wig or use appropriate head cover? A) People may be uncomfortable seeing his or her bald head. B) The hair will likely grow back if the head is covered at all times. C) His or her self-esteem will be better if the head is covered. D) Heat is lost through the head and it is important to cover it during extremes in temperature.

D) Heat is lost through the head and it is important to cover it during extremes in temperature.

In assessing a patient with a central venous access device, which sign or symptom indicates that the patient is experiencing an air embolism? a. Chest pain b. Erythema c. Frothy sputum d. Sweating

a. Chest pain

Which patient assessment finding(s) suggest(s) extravasation of an IV solution? (Select all that apply.) a. Coolness b. Edema c. Fever d. Pain at venipuncture site e. Redness at the site f.Shortness of breath

a. Coolness b. Edema d. Pain at venipuncture site e. Redness at the site

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.) a. Do not make any major changes to your diet without discussing it with your health care provider. b. Keep outpatient laboratory appointments for monitoring of therapy. c. Take the medication after meals. d. Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium. e. Avoid aspirin products.

a. Do not make any major changes to your diet without discussing it with your health care provider. b. Keep outpatient laboratory appointments for monitoring of therapy. d. Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium. e. Avoid aspirin products.

What is the composition of hypotonic intravenous solutions such as 0.45% NaCl? a. Fewer dissolved particles than blood b. Approximately the same number of dissolved particles as blood c. Higher concentrations of dissolved particles than blood d. Electrolytes and dextrose

a. Fewer dissolved particles than blood

Which action by the nurse is accurate when withdrawing medication into a syringe from a vial? a. Inject an amount of air equal to the medication into the vial. b. Break the thin neck of the vial container. c. Remove the rubber stopper on the top of the vial. d. Discard the initial 0.5 mL of medication to ensure sterility.

a. Inject an amount of air equal to the medication into the vial.

Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered? a. Oxytocin (Pitocin) b. Magnesium sulfate c. Vitamin K d. Dopamine

a. Oxytocin (Pitocin)

Following the insertion of a central venous access device, the nurse notes a weak, thready pulse and decreased blood pressure. The patient complains of shortness of breath and palpitations. Which action will the nurse take first? a. Place the patient on the left side. b. Reassess vital signs. c. Stop the infusion. d. Verify placement of the device.

a. Place the patient on the left side. Rationale: Signs and symptoms indicate an air embolism. The nurses immediate action will be to place the patient onto his or her left side. The nurse has determined change in pulse and blood pressure already, and although it is appropriate to reassess, it is not the first action the nurse will take. There is no indication that anything is infusing into this venous access device. Verifying the placement of the device is not the first action the nurse would take.

What will the nurse explain when teaching a patient about a PICC line? (Select all that apply.) a. The catheter may have a single or double lumen. b. There is greater risk of clotting and infiltration with this type of catheter. c. The patient will be receiving infusions continuously to ensure patency. d. The tip of the catheter may be open or valved. e. The catheter may be used for drawing blood.

a. The catheter may have a single or double lumen. d. The tip of the catheter may be open or valved.

Anticoagulant therapy may be used for which situation(s)? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients f. Peptic ulcer disease

a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients Rationale: Anticoagulant therapy is used to treat patients at high risk for stroke; patients with thromboembolic diseases, such as myocardial infarction; those at risk of developing thrombus resulting from underlying medical conditions or disease; and patients with thromboembolic diseases, such as DVT. Anticoagulant therapy is not used to treat patients with peptic ulcer disease.

Which site is identified by the anterior superior iliac spine and greater trochanter? a. Ventrogluteal b. Dorsogluteal c. Vastus lateralis d. Rectus femoris

a. Ventrogluteal

A patient at 33 weeks gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.) a. Vital signs hourly b. Administration of IV pitocin c. Administration of magnesium sulfate IV d. Fetal stress test e. Assessment of deep tendon reflexes

a. Vital signs hourly c. Administration of magnesium sulfate IV d. Fetal stress test e. Assessment of deep tendon reflexes

The nurse assesses a patients right hand IV site to be infiltrated. Appropriate nursing actions include: (Select all that apply.) a. stopping the infusion. b. attempting to aspirate the medication. c. elevating the affected limb. d. checking capillary refill. e. removing the catheter as directed by policy.

a. stopping the infusion. c. elevating the affected limb. d. checking capillary refill. e. removing the catheter as directed by policy.

Which syringe will the nurse use to administer insulin subcutaneously to a patient? a. A syringe calibrated in minims b. A syringe calibrated in units c. A syringe calibrated in tenths of mL d. A syringe calibrated in mL

b. A syringe calibrated in units

Which emergency drug must be available when caring for a patient receiving magnesium sulfate? a. Naloxone b. Calcium gluconate c. Dextrose d. Dopamine

b. Calcium gluconate

The nurse is educating a patient about diabetes. Based on recommendations from the American Diabetes Association, which statement by the nurse is best regarding site rotation? a. Insulin injection sites should always be in the abdomen to ensure absorption into the stomach. b. It is important to rotate injection sites systematically within one area before progressing to a new site for injection. c. Following exercise, site rotation is not indicated because the circulation in the muscles will absorb the medication efficiently. d. If you aspirate, site rotation can be done every other day to avoid developing problems with absorption.

b. It is important to rotate injection sites systematically within one area before progressing to a new site for injection.

Which action by the nurse is most accurate when drawing up medication from an ampule? a. Consider the rim of the ampule as sterile. b. Use a filter needle to withdraw the medication. c. Wrap a paper towel around the neck of the ampule before breaking it. d. Inject 0.5 mL of air into the ampule before withdrawing the medication.

b. Use a filter needle to withdraw the medication.

The nurse is caring for a patient taking Pyridium for the diagnosis of UTI. What should the nurse report to the health care provider? (Select all that apply.) a. Orange colored urine b. Yellow sclera c. Flushing of the skin d. Headache e. Increased pain and burning

b. Yellow sclera e. Increased pain and burning

A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by intramuscular (IM) injection. Which needle and syringe will be used? a. 5/8 inch, 25-gauge needle with 5 mL syringe b. 1 inch, 28-gauge needle with 4 mL syringe c. 1 1/2 inch, 21-gauge needle with 3 mL syringe d. 3 inch, 16-gauge needle with 1.5 mL syringe

c. 1 1/2 inch, 21-gauge needle with 3 mL syringe

A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order? a. Nifedipine (Procardia) b. Furosemide (Lasix) c. Magnesium sulfate d. Terbutaline (Brethine)

c. Magnesium sulfate

The nurse assesses erythema, warmth, and burning pain along the patients IV site. Which complication is this patient most likely experiencing? a. Air embolism b. Extravasation c. Phlebitis d. Pulmonary edema

c. Phlebitis

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? a. Warfarin sodium (Coumadin) b. Enoxaparin (Lovenox) c. Protamine sulfate d. Vitamin K

c. Protamine sulfate

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? a. Document in the nursing notes that these results are within therapeutic range. b. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. c. Stop the heparin drip. d. Assess the patient for signs and symptoms of decreased sensorium.

c. Stop the heparin drip. Rationale: Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value. The patients aPTT value is above the therapeutic range, which puts her at risk for hemorrhage. The most appropriate nursing action would be to stop the heparin drip. These results cannot be documented as being within the normal therapeutic range. RBC count and mental status are not relevant in assessing therapeutic response to anticoagulation.

Which is the preferred IM site for injecting a 6-month-old child? a. Dorsogluteal b. Abdominal c. Vastus lateralis d. Deltoid muscle

c. Vastus lateralis

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? a. Bolus the patient with an additional 5000 units of heparin. b. Stop the heparin immediately and notify the health care provider that the patients blood level is toxic. c. Administer protamine sulfate stat. d. Continue with the prescribed rate.

d. Continue with the prescribed rate. Rationale: Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour. A time of 54 is within the therapeutic range. An increase of heparin is not indicated because the patient is in the therapeutic range. The range is not toxic. An antidote to the anticoagulant is not indicated because the patient is within the therapeutic range.

Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.) a. Assessment of recent aPTT levels b. Massaging the site after injection of medication c. Aspirating after needle insertion d. Documenting ecchymotic areas e. Monitoring of vital signs

d. Documenting ecchymotic areas e. Monitoring of vital signs Rationale: Ecchymosis, or bruising, indicates bleeding below the dermis and should be assessed closely. Patients on heparin therapy are prone to bleeding, which would lead to hemorrhagic shock. Vital sign alterations would alert the nurse to internal bleeding. aPTT levels are required to be monitored for the intravenous route, but not for subcutaneous injections. The injection site should not be massaged to reduce local bleeding. Aspiration may cause bruising when administering heparin subcutaneously.

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching? a. I will always wear a medical alert bracelet. b. I will check with my health care provider before I take any OTC medications. c. I will be careful when I use a knife or other sharp objects. d. I will rinse my mouth with mouthwash instead of brushing my teeth.

d. I will rinse my mouth with mouthwash instead of brushing my teeth.

A patient is diagnosed with cancer and requires 6 months of chemotherapy infusions. Which type of intravenous (IV) access device will likely be used? a. Peripheral venous access device b. Midline catheter c. Winged needle venous access device d. Implantable venous infusion port

d. Implantable venous infusion port

What is the purpose of administering filgrastim (Neupogen) to a patient who is postbowel resection resulting from cancer? a. Decrease the gastrointestinal (GI) toxicity resulting from chemotherapeutic agents b. Suppress the immune response c. Work as an antiemetic and stimulate his appetite d. Increase the white blood cell (WBC) counts

d. Increase the white blood cell (WBC) counts

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K? a. Fruit b. Pasta c. Potato d. Spinach

d. Spinach

A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min; urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action? a. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. b. Stop the IV magnesium sulfate and contact the health care provider. c. Place the patient on her left side and administer oxygen. d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

5. After undergoing prostate surgery, a patient is discharged on the medication phenazopyridine hydrochloride (Pyridium) to assist with urinary catheter discomfort. What information will the nurse include in the discharge teaching? a. Urine will have a foul smell while taking this medication. b. Diarrhea and abdominal cramping are expected adverse effects. c. The sclera of the eye is yellow while on therapy. d. Urine will appear reddish orange.

d. Urine will appear reddish orange.

Which nursing action is accurate when administering parenteral medication? a. Adjust the route of the medication, if needed. b. Document the response to PRN medications at the end of the shift. c. Request the pharmacist to provide education about the medication to the patient. d. Use clinical judgment when rescheduling missed doses of a medication.

d. Use clinical judgment when rescheduling missed doses of a medication.

The nurse cleansing the skin surface of a patient prior to injection will start at the: a. periphery and work inward in a back and forth motion. b. periphery and work inward in a cyclical motion. c. injection site and work outward in a straight line. d. injection site and work outward in a circular motion.

d. injection site and work outward in a circular motion.