PrepU PassPoint Medication and I.V. Administration

A nurse is caring for a client with deep vein thrombosis who is scheduled to receive an injection of enoxaparin 75 mg subcutaneously daily. On hand is enoxaparin 100 mg per milliliter (ml). How many milliliter(s) should the nurse administer to the client? Record your answer using two decimal places.

0.75 Explanation: D/H X Q = 75/100 x 1 = 0.75 ml

A nurse administers digoxin 0.125 mg to a client at 1400 instead of the prescribed dose of digoxin 0.25 mg. Which statement should the nurse record in the medical record?

Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg. Explanation: The nurse should not include judgment statements, opinion, assumptions, or conclusions about what happened. The nurse should simply state the occurrence. The other options present judgment, blame, and conclusion.

The nurse is caring for a 12-month-old child with otitis media. The child weighs 11 kg and has no known drug allergies. The primary health care provider has prescribed amoxicillin 200 mg PO every 12 hours. The drug available is amoxicillin suspension 250 mg/5mL. What should the nurse administer per dose? Record your answer using a whole number.

4 Explanation: (5 mL/250 mg) x 200 mg/dose = 4 mL/dose.

The nurse is administering medications to a client when the client indicates that the name of the medication does not sound familiar. What should the nurse do?

Hold the medication and verify that the client should receive the medication. Explanation: The nurse should listen to the client's concern and verify that the client can indeed receive the medication. The nurse should not encourage the client to take the medication without verifying the client's concern. Crushing and disguising the medication is equal to lying and tricking the client. This is not acceptable. Informing the client that he or she probably knows the medication by a different name does not address the concern of the client. The nurse should verify and then notify the client if the medication is known by a different name.

A client with pancreatitis has been receiving parenteral nutrition (PN) for the past week. Which nursing interventions help determine if the client is receiving adequate nutrition? Select all that apply.

Monitor the client's weight every day. Monitor serum protein, electrolytes, and blood glucose periodically. Monitor the client's energy levels. Explanation: By weighing the client with pancreatitis who has been receiving PN every day, the nurse helps the team evaluate the client's response to PN. Maintenance of present weight is one indicator of adequate nutrition. Weight loss may indicate inadequate nutrition, whereas weight gain may indicate adequate nutrition or fluid retention. Decreased nausea and vomiting do not indicate adequate nutrition. Clients with pancreatitis have restrictions on oral intake, so encouraging increased caloric intake is not appropriate. The nurse should record intake and output to evaluate fluid replacement, not the nutritional adequacy of PN. Serum protein levels, electrolyte levels, and blood sugar levels at intervals will indicate an overall improvement in nutritional and metabolic status. Increased energy levels and feelings of well-being can be indicative of improved nutritional status as well.

The nurse is administering two drugs concomitantly to a client. Which interaction, recognized by the nurse, occurs when two drugs with the same qualitative effects produce a response when given together that is greater than the response either drug produces when given alone?

Synergism Explanation: Synergism, or a synergistic effect, occurs when two drugs with the same qualitative effects produce a response when given together greater than either drug produces when given alone. Tolerance is a decreased response or decreased sensitivity of the receptor to a drug. Antagonism occurs when the combined response to two drugs given together is less than the response either drug produces when given alone. Hyporeactivity is a less-than-usual response to a normal drug dose.

The nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should expect the health care practitioner to prescribe which medication?

Tamoxifen Explanation: Tamoxifen is an estrogen-blocker used to treat premenopausal and postmenopausal breast cancer and to prevent breast cancer in certain women who are at high risk. Acetaminophen is a nonopioid analgesic antipyretic. Dopamine is a vasoconstrictor used to treat hypotension. Progesterone is a hormone used to treat amenorrhea or dysfunctional uterine bleeding.

A client reports difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take to resolve this problem?

Check for availability of a liquid preparation. Explanation: The nurse should find out whether the medication is available in liquid form. Dissolving or breaking the capsule may interfere with drug action or absorption. The nurse shouldn't withhold any medication without first notifying the physician.

The physician prescribes 20 units of U-100 regular insulin for a client. The only syringe available is a 1-ml tuberculin syringe. How many milliliters of insulin should the nurse administer?

0.2 Explanation: The nurse should calculate the does as follows:100 units/1 ml = 20 units/X. So then, X = 0.2 ml.

Milk of magnesia does not relieve a client's constipation. The physician orders a soap suds enema, 500 mL. How many liters will the nurse administer?

0.5 L Explanation: 1,000 mL is equal to 1 liter, therefore 500 mL equals 0.5 L.

A hospital is conducting a root cause analysis for a serious medication error made by a nurse that injured a client. What is the expected outcome of the root cause analysis?

The cause of the error is identified through system-wide analysis. Explanation: The purpose of root cause analysis is to analyze and identify the root cause of the error from a system perspective and plan interventions to a prevent future occurrence. Terminating the nurse and the pharmacist does not prevent the client from suing the hospital and does nothing to prevent future occurrence. The family suing the hospital is not an expected outcome of a root cause analysis.

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.

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 client weighing 167 lb (76 kg) is brought to the emergency department in status epilepticus. The primary care provider asks the nurse to prepare diazepam 0.25 mg/kg. How many milligrams will be given to this client? Round your answer to a whole number.

19 Explanation: 0.25 mg/kg x (1 kg/2.2 lb) x 167 lb = 19 mg.

A nurse is reinforcing education with a client about three medications that the client will receive after discharge. While performing the discharge education, the nurse notices that the client suddenly becomes withdrawn and appears anxious. What action should the nurse take?

Acknowledge the client's behavior, and seek clarification. Explanation: The nurse should clarify the client's behavior to determine the appropriate cause of the action. The nurse should not request to have the prescriptions changed or that generic alternatives be prescribed. Treatment should not be delayed while the nurse explores the possibility of purchasing medications over an extended period.

A nurse is preparing to administer ferrous sulfate to a client. What is the nurse's appropriate action?

Dilute with juice and administer through a straw. Explanation: Ferrous sulfate is offered in a diluted form through a straw to prevent staining of the teeth. Avoid administering iron with milk, dairy products, or caffeine because it inhibits drug absorption.

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?

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

Hypokalemia Explanation: Insulin administration causes glucose and potassium to move into the cells, causing hypokalemia. Calcium levels aren't directly affected by insulin administration. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus also enters the cells with insulin and potassium. Sodium levels aren't directly affected by insulin administration.

A student nurse is reviewing physician orders written on a client's chart. Which entry is written incorrectly because it contains material from the "do not use" list of the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission)?

epoetin alfa 6500 U SQ daily. Explanation: The order written as "Epoetin alfa 6500 U SQ daily" is incorrect according to the Joint Commission's "do not use" list. "U" should not be used because it may be mistaken as zero (0), 4 (four), or cc. The healthcare professional should write "unit" instead. The other medication orders are written correctly. The order for diazepam does not include a trailing zero in the dosage. The order for levothyroxine sodium includes a leading zero prior to the dose. The acetaminophen order is correct in the use of the word "every" instead of Q.D., QD, q.d., or qd.

A client is prescribed heparin 6,000 units subcutaneously every 12 hours for deep vein thrombosis prophylaxis. The pharmacy dispenses a vial containing 10,000 units/1 mL. How many milliliter(s) of heparin should the nurse administer? Record your answer using one decimal place.

0.6 Explanation: The dose dispensed by the pharmacy is 10,000 units/1 mL, and the desired dose is 6,000 units. The nurse should use the following equations to determine the amount of heparin to administer: Dose on hand/quantity on hand = dose desired/X 10,000 units/1 mL = 6,000 units/X 10,000 units X x X = 6,000 units X 1 mL X = 6,000 units X 1 mL/10,000 units X = 0.6 mL.

A client with severe pain is prescribed hydromorphone 10 mg by mouth every 4 hours as needed for pain. The client rates pain as eight on a one-to-ten scale, so the nurse prepares to administer a dose. The oral liquid contained in the unit's opioid stock contains 5 mg/5 mL. How many milliliters of solution should the nurse give to the client? Record your answer using a whole number.

10 Explanation: The following formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the equation is as follows: 5 mg/5 mL = 10 mg/X; so X = 10 mL.

The health care provider's order reads 2 g of cephalexin PO daily in equally divided doses of 500 mg each. How many times per day should the nurse administer this medication? Record your answer using a whole number.

4 Explanation: The nurse would administer the medication four times per day. Two grams is equivalent to 2,000 mg. To give equally divided doses of 500 mg, divide the desired dose of 500 mg into the total daily dose of 2,000 mg. This gives an answer of four times per day. The nurse would give 500 mg every 6 hours for a total of four times per day.

A nurse is preparing to administer oral doxycycline to a client. What is the nurse's appropriate action?

Administer with full glass of water. Explanation: Doxycycline should be given with a full glass of water on an empty stomach. It should not be taken with milk or within 2 hours of antacid administration.

When drawing up a medication, the nurse notes there are small air bubbles adhering to the interior surface of the syringe. The nurse knows which effect the bubbles might have on parenteral administration?

Altered drug dose Explanation: Although not harmful to the client when injected, small air bubbles can change the dose of medication actually administered; therefore, the nurse should remove the air bubbles. The drug's onset of action, duration, and absorption won't be affected. Air bubbles may actually be helpful in some situations but should be added only after the dose of the drug has been withdrawn accurately. For example, with iron dextran, an air bubble and the Z-track method of injection help prevent permanent staining of the client's skin if the solution leaks into the subcutaneous tissue.

A client is upset to learn that corticosteroids need to be taken to control symptoms of systemic lupus erythematosus (SLE). While the nurse is preparing to administer medication, the client refuses to take it, stating, "This is turning me into an old woman before my time." What is the best response by the nurse?

Ask about the medication side effects that are a concern and explain why suddenly stopping the drug can cause problems. Explanation: It is important to explore the client's concerns regarding the side effects. As a follow-up, it is important to reinforce what is the desired effect of the drug. It is critical to explain the importance of not suddenly discontinuing its use. Explaining the symptoms of the disease does not identify the reasons for the client's concern. Encouraging the client to take the medication or documenting the refusal does not identify the concerns.

A nurse inadvertently transcribes a client's medication order that was written as "Ampicillin 250 mg four times a day" as "Ampicillin 2500 mg four times a day." The nurse gives two doses as transcribed to the client. Another nurse gives one dose before the pharmacist questions the reorder of the medication. What should the two nurses do in this situation?

Both nurses must acknowledge making the medication error. Explanation: The correct answer is that both nurses are responsible for this error. The first nurse transcribed the order incorrectly and did not recognize that the dose was too high when administering the medication. The second nurse should have known the dose was too high. Both nurses must admit to the error. The other options do not reflect a nurse's responsibility in admitting to an error and preventing injury to clients.

The nurse is initiating an intravenous (IV) access for a client who needs an infusion of normal saline solution. Which nursing action should the nurse perform before the venipuncture?

Check for latex allergy before applying the tourniquet. Explanation: Priming the IV tubing is done after the access has been secured. Verifying that the client does not have latex allergy ensures the safety of the client. Laboratory values for electrolytes have no impact on IV access; however, checking platelets can indicate a tendency for bleeding during venipuncture. Using the biggest size needle is inaccurate information. Colloids require large-bore needles, but regular fluids do not.

A nurse is supervising a student during medication administration to a client. Which action by the student would cause the nurse to intervene during the med pass at the bedside?

Check the room number and the client's name on the bed. Explanation: Checking the client's identification band is the safest way to verify a client's identity because the band is assigned on admission and should not be removed at any time. Asking the client's name would be also be appropriate. Checking the room number isn't appropriate because clients may be transferred from another room and the paperwork may not be correct. Checking the client's name on the bed is not appropriate because names on beds are also not always correct.

When checking a client's I.V. insertion site, the nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

Check the tubing for kinks and reposition the client's wrist and elbow. Explanation: The nurse should first check for common causes of a decreased I.V. flow rate, such as kinks in the tubing and poor positioning of the affected arm. The nurse should discontinue the I.V. infusion only if other measures fail to solve the problem. Irrigating I.V. tubing may dislodge clots, if present. Elevating the I.V. fluid bag may help if no kinks are found and if repositioning doesn't resolve the problem.

The nurse is providing care to a client with asthma. The healthcare provider orders albuterol sulfate INH 2 puffs q 6 hours for maintenance dosing. What should the nurse do Select all that apply.

Clarify the order with the healthcare provider. Hold the medication. Explanation: This medication should be held and clarified with the healthcare provider. Albuterol sulfate is a rescue inhaler, meant to be used for the quick-relief of wheezing, coughing, and chest tightness, it should not be used as a maintenance inhaler. The supervisor and the pharmacy should not be called, the healthcare provider should be called to clarify the order.

A client with a fluid volume deficit is receiving an I.V. infusion of dextrose 5% in water and lactated Ringer's solution at 125 ml/hour. Which data collection finding indicates the need for additional I.V. fluids?

Dark amber urine Explanation: Normally, urine appears light yellow; dark amber urine is concentrated and suggests decreased fluid intake. The serum sodium level normally ranges from 136 to 145 mEq/L. A temperature of 99.6° F (37.6° C) is only slightly elevated and doesn't indicate a fluid volume deficit. Neck vein distention is a sign of fluid volume overload.

The health care provider prescribes a digoxin elixir for a toddler with heart failure. What action should the nurse take first before administering this drug?

Determine the apical pulse. Explanation: Because digoxin may reduce the heart rate the nurse should measure the apical pulse for 60 seconds before administering the drug to prevent further slowing of the heart rate. The serum potassium level doesn't affect digoxin's action. This would be important if an arrhythmia was present or the child was on a loop diuretic. The child's weight and blood pressure should be checked regularly but not necessarily before digoxin administration.

Before administering the evening dose of a prescribed medication, the nurse on the evening shift finds an unlabeled, filled syringe in the client's medication drawer. What priority action should the nurse implement?

Discard the syringe to avoid a medication error. Explanation: As a safety precaution, the nurse should discard an unlabeled syringe that contains medication. The other options are considered unsafe because they promote error. While it may be appropriate to speak to the day nurse about the presence and contents of the syringe (and to reinforce that unlabeled, filled syringes present a safety risk), the syringe should first be disposed of to ensure that it does not become the source of a medication error.

A nurse is administering morning medications to a client on warfarin. Upon reviewing the laboratory results, the nurse notes a prothrombin time (PT) of 27.3. What should the nurse do?

Hold the medication and notify the health care provider. Explanation: The nurse should notify the health care provider because the report is outside the normal range. The nurse cannot independently hold a medication without orders. Giving the warfarin with levels of 27.3 increases the risk of bleeding. Repeating the laboratory result requires a doctor's order.

The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

Hypokalemia Explanation: A loop diuretic removes water and, along with it, sodium and potassium. This may result in hypokalemia, hypovolemia, and hyponatremia.

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion?

Instructing the client to report any itching, swelling, or dyspnea Explanation: Because administration of blood or blood products may cause serious adverse effects such as allergic reactions, the nurse must monitor the client for these effects. Signs and symptoms of life-threatening allergic reactions include itching, swelling, and dyspnea. Although the nurse should inform the client of the duration of the transfusion and should document its administration, these actions are less critical to the client's immediate health. The nurse should monitor vital signs 5 minutes after the transfusion is started, again in 15 minutes, and then at least hourly depending on the client's condition.

A client is prescribed metformin to control type 2 diabetes. The nurse should monitor for which life-threatening adverse reaction?

Lactic acidosis Explanation: The nurse should monitor the client for signs of lactic acidosis, a life-threatening adverse reaction associated with metformin. Nausea, vomiting, and megaloblastic anemia are adverse reactions associated with metformin, but they aren't considered life-threatening.

A client newly diagnosed with diabetes mellitus is experiencing difficulty with self-administration of insulin. Despite further teaching, the client shows little improvement. What action by the nurse is most appropriate?

Notify the physician of the client's lack of progress and request a diabetes education department consult. Explanation: The nurse should notify the physician of the client's lack of progress and request a consult with the diabetes education department. The nurse can't consult the diabetes department without a physician's order. There's no need to delay the client's discharge if his condition is stable and he's physically ready for discharge. The client should be encouraged to be as independent as possible, and it isn't appropriate to consult with the family without the client's permission.

A nurse is administering eye drops to a client. Which technique is correct?

Pull the lower lid down, press the tear duct, and drop medication into the conjunctival sac. Explanation: Eye drops should be dropped into the lower lid and the nurse should press the tear duct to slow systemic absorption. Administration in other locations of the eye will allow the medication to run out of the eye and prevent the full dose from being applied.

The newly hired graduate nurse asks the nurse preceptor what is the only advantage of using a floor stock system. Which rationale does the preceptor give the graduate nurse?

The nurse can implement medication orders quickly. Explanation: A floor stock system enables the nurse to implement medication orders quickly. However, this method is considered unsafe because it doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

The nurse inadvertently gives a client a double dose of a prescribed medication. After discovering the error, whom should the nurse notify?

The prescriber Explanation: After discovering a medication error, the nurse should immediately notify only those persons who can do something to rectify the error, such as the prescriber, the nursing supervisor, or the pharmacist.

The nurse is teaching a client how to rotate insulin injection sites. What is the purpose of rotating injection sites?

To prevent the formation of hard nodules Explanation: Rotating injection sites promotes adequate drug absorption and prevents the formation of hard nodules caused by repeated injections into the same site. Nodules may impede drug absorption with future injections. Rotating sites doesn't prevent bruising, medication leakage, or erratic drug distribution.

The health care provider orders nitroglycerin, 5 mg by mouth twice per day, for a client. The drug is dispensed in 2.5-mg tablets. How many tablets will the nurse administer twice per day?

Two Explanation: The nurse will administer two tablets twice per day. Using the ratio method, the equation to solve for X is: 5 mg : X tab :: 2.5 mg : 1 tab. Solving for X determines the quantity of the dosage is two tablets.

A client is receiving furosemide, 40 mg by mouth twice per day. In the plan of care, the nurse should emphasize teaching the client about the importance of consuming:

bananas and oranges. Explanation: Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the client to increase intake of potassium-rich foods, such as bananas and oranges. Fresh green vegetables, milk, and creamed corn aren't good sources of potassium.

Which information must be included in a medication order?

health care provider's signature Explanation: The health care provider's signature must be included in a medication order. Other components of a medication order include the client's full name, drug name, dosage form, dose amount, administration route, time schedule, and the date and time of the order. The drug class and possible adverse reactions aren't components of a medication order. Client allergies should be recorded in the client's chart, not on the medication order.

A medication nurse is preparing to administer 9 a.m. medications to a client with liver cancer. Which consideration is the nurse's highest priority?

metabolism of the medication Explanation: The rate and ability of the liver to metabolize medications will be altered in a client with liver cancer. Therefore, it is essential to understand how each medication is metabolized. The other considerations are important but not as vital.

A facility has a system for transcribing medication orders to a Kardex as well as a computerized medication administration record (MAR). A physician writes the following order for a client: "Prednisone 5 mg by mouth daily for 3 days." The order is correctly transcribed on the Kardex. However, the nurse who transcribes the order onto the MAR neglects to place the limitation of 3 days on the prescription. On the 4th day after the order was instituted, a nurse administers prednisone 5 mg by mouth. During an audit of the chart, the error is identified. The person most responsible for the error is the:

nurse who administered the erroneous dose. Explanation: The nurse administering the dose should have compared the MAR with the Kardex and noted the discrepancy. The transcribing nurse and pharmacist aren't void of responsibility; however, the nurse administering the dose is most responsible. The facility's policy does provide for a system of checks and balances. Therefore, the facility isn't responsible for the error.

The nurse is obtaining vital signs from a client who is receiving an intravenous antibiotic for the first time. Which observation made by the nurse requires immediate intervention? Select all that apply.

rash on skin of face, chest, and arms reports severe itching all over inspiratory wheezes Explanation: Rash, inspiratory wheezes, and reports of severe itching indicate that the client is having an allergic reaction to the antibiotic. A heart rate of 86 is within normal limits and reports of mouth being dry is not indicative of an allergic reaction.

A healthcare provider writes a prescription for "digoxin .125mg PO once daily" and "nitroglycerin patch 0.4 mg/hour topically to be worn 0800-2000 daily." What does the nurse clarify with the healthcare provider?

the dose of digoxin Explanation: The prescription for digoxin is improperly written because there is no zero (0) before the decimal point. The nurse clarifies this order to ensure it is not meant to be 1.25mg. The other aspects of proper prescription are addressed, including route and frequency. The nitroglycerin patch prescription includes route (topical), dose, and frequency and does not require clarification.

A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first?

the prescriber Explanation: After discovering a medication error, the safety of the patient is top priority. The nurse should immediately check the client and observe for any adverse effects which may develop. The first person the nurse needs to notify is the prescriber, followed by the nursing manager (or the nursing supervisor). Then pharmacist and risk manager should also be notified.

The nurse is preparing to administer medications to the client. Which identifiers will the nurse use? Select all that apply.

wristband birthdate name Explanation: Clients in the hospital setting wear identification bands, and are also asked to state their name and birth date. Client room number and medication record number are not used to identify the client.

The nursing instructor informs the student nurse about proper procedures for administering medications. Which statement made by the student demonstrates that education provided by the instructor was understood? Select all that apply.

"I will be sure to check for the right dose of medication." "I will ask the client's name and date of birth while checking the name bracelet." "I will check to ensure that the medication is the right one." "I need to be sure I am giving the medication for the right reason." Explanation: Before administering medication, the nurse should make sure they have the right client by checking the identification band, checking the health care provider's order for dosage and frequency, checking that the medication is ordered for the right route, and making sure the medication is administered at the right time for the right reason. The right health care provider and right quantity aren't part of the medication administration process.

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

Notifying the surgeon that the consent form hasn't been signed Explanation: Notifying the surgeon takes priority because informed consent must be obtained 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 for surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery also isn't within the scope of nursing practice.

A nurse needs to administer prescribed medications to a client with heart failure. Prior to administering the medications, what actions should the nurse take? Select all that apply.

Perform handwashing. Check the client's medical record number and name on the identification bracelet. Check the client's allergies in the medical record, and verify them with the client. Explanation: To verify a client's identity, the nurse should read the identification bracelet and check at least two client identifiers, such as the name and medical record number. Handwashing is always performed prior to preparing medications for administration. The primary health care provider does not need to have examined the client before administration of previously prescribed medications. While clients have the right to refuse a medication, this is not something the nurse would ask the client in advance.

The nurse administers nalbuphine hydrochloride to a postoperative client. Which finding indicates to the nurse that the client is responding as expected to the medication?

blood pressure 115/72 mm Hg Explanation: After the administration of an opioid analgesic, the client's vital signs should remain within normal parameters. The blood pressure is the only normal finding for this client. Nalbuphine hydrochloride can cause cardiovascular and respiratory adverse effects such as hypertension, hypotension, bradycardia, tachycardia, respiratory depression, dyspnea, and asthma. Therefore, the nurse should evaluate the vital signs before and after administering the medication.

A histamine (H2) receptor antagonist is prescribed for a client with recurrent gastrointestinal discomfort. The nurse is instructing the client from a medication pamphlet and highlights which medications in this classification? Select all that apply.

cimetidine ranitidine nizatidine famotidine Explanation: H2 receptor antagonists suppress secretion of gastric action, alleviate symptoms of heartburn, and help to prevent peptic ulcer disease. Esomeprazole is a proton pump inhibitor.

The nurse is reviewing the content of a prescription before giving it to a client. The nurse determines that the prescription is accurately written when which information is included on the prescription? Select all that apply.

healthcare provider signature frequency dose Explanation: Information needed on the prescription includes: the date, client name, medication (trade and generic name), dose, route, frequency, quantity, and signature of prescriber. The pharmacy name and telephone number of the client are not required.

A client develops hepatic encephalopathy 1 week after portacaval shunt surgery. Her physician prescribes neomycin, 4 g by mouth daily in four divided doses. Her husband asks how neomycin decreases his wife's serum ammonia concentration. How should the nurse respond?

"It decreases the number of ammonia-producing bacteria in the GI tract." Explanation: Neomycin lowers the blood ammonia level by reducing the number of ammonia-producing bacteria in the GI tract. The drug also exerts its antibacterial activity directly on the ribosomes of susceptible organisms, among them E. coli, by inhibiting protein synthesis via direct action on ribosomal subunits. When these bacteria are present, they convert urea to ammonia. Neomycin is bactericidal in high concentrations and bacteriostatic in low concentrations. Thus, it doesn't trap or bind with ammonia in the GI tract.

After laparoscopic cholecystectomy, a client reports pain and nausea. A nurse is preparing 75 mg of meperidine and 12.5 mg of promethazine to be administered IM in the same syringe. If the label on the meperidine reads 50 mg/mL and the label on the promethazine reads 25 mg/mL, how many milliliters should the nurse have in the syringe after the correct doses are drawn up? Record your answer using a whole number.

2 Explanation: This formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the formula for calculating the amount of meperidine is as follows: 50 mg/mL = 75 mg/X; X = 1.5 mL. The formula for calculating the amount of promethazine is as follows: 25 mg/mL = 12.5 mg/X; X = 0.5 mL. To calculate the total milliliters to draw up in the syringe, add the quantity of meperidine and the quantity of promethazine, as follows: 1.5 mL + 0.5 mL = 2 mL.

The nurse is preparing to give a 9-year-old client a preoperative I.M. injection. Which size needle should the nurse use?

22G, 1" Explanation: The nurse should first evaluate the muscle mass and amount of subcutaneous fat and then select the correct size needle. Without more information, the nurse would select the 22G, 1" needle, appropriate for an average-sized school-age child. The 20G, 1" needle would be unnecessarily large. The 22G, 1½" needle would be too long. The 20G, 1½" needle would be both too long and unnecessarily large.

The nurse is caring for a client who is receiving warfarin. The nurse reinforces to the client that anticoagulant effects may not be seen for how many days?

3-5 Explanation: Anticoagulant effects do not occur for approximately 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination.

The health care provider prescribes 60 mEq of potassium chloride liquid as a one-time dose. The pharmacy supplies a liquid containing 20 mEq/15 ml. How many milliliters will the nurse administer? Record your answer using a whole number.

45 Explanation: The nurse can calculate the dose by setting up the following equation:60 mEq/20 mEq = X ml/15 mlThen cross multiply the fractions:X x 20 mEq = 15 ml x 60 mEqThen solve for X:X = 45 ml

The nurse is caring for an infant who is receiving I.V. therapy. The health care provider orders D5NS 400-mL to infuse in 8 hours. How much I.V. solution would the nurse place in the Buretrol?

50-mL Explanation: When calculating the mL/hour, divide 400-mL by 8 hours to get 50-mL/hour. When caring for an infant, only place one hour's worth of fluid into the Buretrol to be infused.

Which nursing action is appropriate when administering a glycerin suppository to a client?

Applying a lubricant to the suppository Explanation: A suppository should be lubricated before insertion to ease insertion and reduce discomfort. The nurse should assist the client in a left-side lying position (not right-side lying) to ease insertion. Because suppositories melt at body temperature, they usually require refrigeration until administration. Instructing the client to bear down would cause the anal sphincter to contract, making insertion difficult.

After being treated with heparin for a pulmonary embolism, a client is prescribed warfarin using a sliding scale. Which action should the nurse take before administering this drug?

Closely monitor prothrombin time (PT) and international normalized ratio (INR) results to determine the dose of warfarin to administer. Explanation: Sliding scales are written orders from the physician that allow the nurse to independently manage medications with varied dosages. To administer warfarin safely, the nurse must closely monitor PT and INR results. She should notify the physician of any abnormal results, whether they're abnormally low or abnormally high. Abnormally high results place the client at risk for bleeding; abnormally low results place the client at risk for recurrent pulmonary emboli. If the PT and INR fall within the ranges indicated on the sliding scale, the nurse can independently administer the dose according to the order.

A client has a nasogastric (NG) tube. The physician prescribes an oral medication that is not available in liquid form. Which action should the nurse utilize to administer the tablet form to this client?

Crush the tablets and prepare a liquid form, and then insert it into the NG tube using a syringe. Explanation: To administer oral medications in tablet form through an NG tube, the nurse must reproduce the disintegration and dissolution processes by crushing the tablets and preparing a liquid form, if appropriate for that medication. After confirming NG tube placement, the nurse then inserts the liquid into the NG tube using a syringe. Washing cut tablets or crushed powder down the tube may cause the medication to stick to the sides of the tube, possibly providing inaccurate dosing and causing the tube to clog.

A client admitted with bacterial pneumonia is prescribed cefuroxime axetil 550 mg I.V. every 4 hours. While assessing the client, the nurse notices that cefazolin 500 mg I.V. is infusing. Which action by the nurse is most appropriate?

Discontinuing the medication and notifying the physician of the error Explanation: The nurse should discontinue the medication and notify the physician of the medication error. The nurse shouldn't allow the wrong medication infusion to continue. She should document her assessment findings but she must first stop the infusion and then notify the physician of the error.

A client reports a severe headache and blurred vision. The nurse immediately obtains vital signs, which reveals a blood pressure of 192/110 mm Hg. The nurse reviews the client's medical record and notes a prescription for clonidine 0.1 mg by mouth as needed for systolic blood pressure greater than 170 mm Hg and diastolic blood pressure greater than 100 mm Hg. The nurse checks the client's medication supply, but no clonidine is available. How should the nurse proceed?

Inform the pharmacy that the medication is unavailable, ask them to prepare it, and tell them that someone will pick it up immediately. Explanation: The nurse must notify the pharmacy that the medication is unavailable and that an immediate dose is needed. The nurse should make sure that the nurse communicates the importance of dispensing the medication immediately and explain that someone will come to the pharmacy to get the drug so treatment is not delayed. Simply notifying the primary health care provider and documenting that the drug is unavailable delays treatment. The client's blood pressure is severely elevated, so the client cannot wait for the next scheduled pharmacy delivery.

A nurse is teaching a client about a newly prescribed drug. What physiological changes does the nurse recognize that could cause a geriatric client to have difficulty learning about prescribed medications?

Sensory deficits Explanation: Sensory deficits could cause a geriatric client to have difficulty retaining knowledge about prescribed medications. Decreased drug excretion doesn't alter the client's knowledge about the drug. A lack of family support or limited finances may affect compliance, not knowledge retention.

A client who underwent abdominal surgery returns from the postanesthesia care unit with a nasogastric (NG) tube in place. The client complains of nausea. While preparing to attach the client's NG tube to intermittent suction, the nurse notices that the ground on the suction machine's plug is broken. What priority action should the nurse perform first?

Obtain another machine from central supply. Explanation: Because safety is imperative for both the nurse and client, the nurse should obtain another machine. Using the machine as is could lead to electric shock. The nurse should never use damaged equipment, even after performing a temporary repair. Damaged equipment should be labeled "Broken" and be reported to the appropriate department for repair.

A client who has received an IM injection of ceftriaxone sodium calls the clinic and states "I think I am allergic to this medicine, there is a bump and it hurts at the injection site." What is the nurse's best response?

Place a warm compress on the area for 10 minutes. Explanation: The nurse should advise the client that a warm compress may be applied to the area to help decrease the pain. This is an expected result of the injection and is not an allergic reaction there is no need to go to the immediate care or take diphenhydramine. Continuously moving the extremity will not relieve the pain and may increase the edema.

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. 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.

The nurse has an order to administer an intramuscular (I.M.) injection using the Z-track technique. When carrying out this order, what nursing intervention should the nurse implement?

Simultaneously withdraw the needle and release the skin. Explanation: When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication, and then simultaneously withdraws the needle and releases the skin.

The nurse is caring for a client on an oncology unit who is refusing further chemotherapy treatment after the rationale for the treatment has been clearly explained. What is the nurse's best action?

Support the client's decision and hold all treatments. Explanation: Supporting the client's decision is in concert with the ethical principle of autonomy. The other options violate autonomy and privacy of the client.

The nurse has an order to administer an iron dextran 50 mg intramuscular (I.M.) injection. When carrying out this order, which method should the nurse utilize?

Use the Z-track technique. Explanation: Iron dextran is an iron preparation given using the Z-track technique to prevent leakage into the subcutaneous tissue and staining of the skin. When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site to seal the drug in the muscle, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication to ensure drug dispersion, and then simultaneously withdraws the needle and releases the skin to seal the needle track. Wiping the needle immediately after injection poses the risk of a needle stick.

The nurse is reviewing laboratory values on a client with heart failure and atrial fibrillation. The client has a potassium level of 2.8 mEq/L (2.8 mmol/L). The client is scheduled to receive their 0900 dose of digoxin. What is the nurse's best action?

Withhold the dose of digoxin and notify the healthcare provider. Explanation: Administering the dose of digoxin should not be done. The effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. Drawing a stat potassium level and comparing the earlier result with the current result does not address the low potassium level. The level could be lower, putting the client at risk for a cardiac event. Offering the client a banana with breakfast will not raise the potassium level because the banana does not contain enough potassium. Withholding the dose of digoxin should be done to prevent digoxin toxicity. The nurse should notify the healthcare provider to let them know about the low potassium level. The healthcare provider can order a potassium supplement orally or intravenously and another potassium level laboratory value to be drawn after treatment to evaluate if the level is within normal limits after treatment. Giving half of the digoxin may cause digoxin toxicity because of the low potassium level. Offering potassium-rich foods all day will not do much to increase the potassium level. Reviewing the dietary needs of the client and consulting the dietitian is not warranted at this time.

The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?

deferoxamine Explanation: Deferoxamine is used for the treatment of iron overload by ridding the body of the extra iron. Montelukast is a bronchodilator used for chronic asthma. Ramipril is a antihypertensive used to treat hypertension. Flurazepam is a sedative/hypnotic that is used for insomnia.

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

discard the uncapped needle and syringe in a puncture-proof container. Explanation: The appropriate procedure is to discard uncapped needles in a puncture-proof, leak-proof container. To reduce the risk of accidental needle sticks, the nurse should never recap a needle. The nurse should never place a used needle in a garbage can or in a medical waste container that isn't puncture-proof and leak-proof. The nurse should never break or bend a needle before discarding it. Doing so increases the risk of a needle stick.

A nurse is teaching a client regarding his or her medication schedule. What is the best nursing intervention to improve this client's compliance with the prescribed medication schedule?

Devise the simplest medication schedule possible. Explanation: To improve client compliance, nurses should simplify the medication schedule as much as possible. Compliance drops sharply when more than three medications are prescribed; geriatric clients tend to use more than one medication concurrently. It's too costly and impractical to hire a visiting nurse in most instances. Although instructions may need to be repeated, giving all instructions at least three times doesn't necessarily ensure compliance. Moreover, a physician, not the nurse, must decide how often a medication should be given.

A client is scheduled for a computed tomography (CT) of the chest with contrast media. Which finding should the nurse report immediately to the healthcare provider?

The client is allergic to shellfish. Explanation: Allergy to shellfish can indicate an allergy to contrast media and needs to be reported to the healthcare provider. A CT scan is open; therefore, claustrophobia should not be an issue. There is no caution with metal in a CT scan. Use of the inhaler is not contraindicated since the medication is rapidly absorbed.

A client is prescribed a corticosteroid inhaler along with a bronchodilator inhaler. Which instruction about these drugs should the nurse give the client?

"Use the bronchodilator first, then wait about 5 minutes before using the corticosteroid." Explanation: The nurse should tell the client to use the bronchodilator first, then wait 5 minutes before using the corticosteroid. Doing so allows the bronchodilator to open air passages for maximum effectiveness. The nurse should also show the client how to check his pulse, and should instruct him to do so before and after using the bronchodilator. The client should call the physician if his pulse rate increases by more than 20 beats/minute (not 50 beats/minute). The nurse should tell the client to take the drugs exactly as prescribed, around the clock. The client should check with the physician before taking over-the-counter preparations.

A child experiences nausea and vomiting after receiving cancer chemotherapy drugs. What should the nurse do to help prevent these problems from recurring?

Administer ondansetron 30 to 60 minutes before the next chemotherapy session. Explanation: Antiemetics such as ondansetron counteract nausea most effectively when given before administration of the agent that causes nausea. Buspirone is an antianxiety medication and would not help reduce or prevent nausea due to chemotherapy. Increasing fluid intake before the next chemotherapy session would only worsen nausea and could cause more vomiting. Keeping the patient NPO may contribute to dehydration.

The nurse is using a scanner with medication administration and client identification. The scanner rejects the barcode of the client's name band. What alternative(s) does the nurse use to follow hospital policy for scanning medications? Select all that apply.

Obtain a new client identification name band. Ask the supervisor for a new scanner. Explanation: The nurse should obtain a new client identification name band and ask the supervisor for a new scanner. The nurse should not hold the medications, override the system, or use a new computer. The scanner and client name band are not working.

The client is to receive an I.V. infusion of 3,000 ml of dextrose and normal saline solution over 24 hours. The nurse observes that the rate on the infusion pump is set at 150 ml/hour. If the solution runs continuously at this rate, the infusion will be completed in:

20 hours. Explanation: The total amount to be given, 3,000 ml, divided by the hourly rate, 150 ml/hour, equals the length of the infusion or, in this case, 20 hours. Therefore, the I.V. infusion pump was set at the incorrect rate.

While preparing to start a stat I.V. infusion, a nurse notices a broken ground wire on the infusion pump's plug. What would the nurse do first?

Obtain another pump from central supply. Explanation: Because safety is imperative for both the nurse and the client, the nurse should obtain another pump from central supply. Using the pump as is could lead to electric shock. The nurse should never use damaged equipment, even after performing a temporary repair. The nurse should pull the pump out of service by labelling it as damaged equipment as directed by facility policy and by reporting it to the appropriate department for repair, but this should be done after the client's treatment needs are addressed.

Which human element should be considered by the nurse during planning of home drug administration?

The client's cognitive abilities Explanation: The nurse must consider the client's cognitive abilities to understand drug instructions. If the client can't understand the instructions, the nurse must find a family member or significant other to take on the responsibility of administering medications in the home setting. The client's ability to recover, occupational hazards, and socioeconomic status don't affect drug administration.

When a nurse tries to administer medication, the client refuses it, saying, "I don't have to take those pills if I don't want to." What intervention by the nurse would have the highest priority?

exploring how the client's feelings affect the decision to refuse medication Explanation: By helping the client explore their feelings about the change in health status, the nurse can determine how these feelings affect the decision to refuse medication. Then the nurse can help the client develop new ways to satisfy self-care, esteem, and other needs and, ultimately, participate fully in the therapeutic regimen. Insisting that the client take the medication, reporting the client's comments to the physician, and explaining the consequences of not taking the medication are inappropriate because these actions do not explore the client's feelings.

The nurse is administering medications to a client with advanced Alzheimer's dementia who is confused to person, place, and time. Prior to administering the medication, what action should the nurse perform to verify the client's identity?

Compare the name and ID number on the client's wristband to the medication administration record. Explanation: The nurse should compare the name and ID number on the client's wristband to the medication administration record. As the client is not oriented to person, place, or time, it is not appropriate to verify identity by asking the client to state his or her name and birthdate. Checking the name listed on the unit board for the room does not ensure that the client in the room is the correct client. Asking another staff member the name of the client in that room does not ensure adequate verification of identity. Add a Note

A client who's aphasic and has left-sided paralysis after sustaining a stroke is scheduled for debridement of a left leg ulcer. Whenever passive range-of-motion (ROM) exercises are performed on the left leg, the client grimaces and moans. Which action should the nurse take before the physician performs the debridement?

Check the client's medication administration record to see when he last received pain medication and administer a dose, if appropriate, before debridement. Explanation: The nurse should check the administration record to see when the client last received pain medication and administer a dose, if appropriate, before the debridement procedure. Doing so will minimize the client's discomfort during the procedure. The nurse can notify the physical therapist of the discomfort when she accompanies the client to a physical therapy session. It isn't necessary to report the finding at this time. The nurse should continue to move the client's leg to prevent complications of immobility. It isn't necessary to reschedule the debridement; doing so might increase the risk of infection.

A nurse is administering iron dextran IM. A client asks why the skin is pulled to the side before the needle is inserted. Which statements are appropriate for the nurse to make? Select all that apply.

It prevents medication leaking into subcutaneous tissue. It prevents staining of the skin. Explanation: The Z-track method of IM administration is used to prevent tracking (leakage) of the medication into the subcutaneous tissue (underneath the skin). The Z-track method is particularly useful with medication that must be absorbed by muscle to work, or when using a dark-colored drug that can cause staining of the skin. Because it prevents medication from seeping into the subcutaneous tissue, it ensures a full dosage is administered. Z-track injection may be less painful than a traditional IM injection, but all injections will cause some discomfort. Multiple injections are rarely given at same site.

A client receives a short-acting insulin and an intermediate-acting insulin before breakfast at 0800. Using the chart shown, when should the nurse expect the onset of the intermediate-acting insulin to take effect?

1000 Explanation: The timing of insulin's effects varies according to the type. Referring to the chart, the nurse would note that the onset of action for the intermediate-acting insulin (Humulin NPH) is 1 to 2 hours. Because the administration time was 0800, the effects should begin 1 to 2 hours after administration, at approximately 1000.

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse report?

blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL Explanation: Nonsteroidal anti-inflammatory drugs can decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors and predispose clients to the development of acute renal failure as indicated by the increased levels of BUN and serum creatinine. The other lab values do not reflect damage to the kidneys.

The nurse is providing education to a client who has received a new prescription for oral contraceptives. What would the nurse instruct the client to report to her primary health care provider related to the medication?

blurred vision and severe headache Explanation: Some adverse effects of oral contraceptives, such as blurred vision and severe headaches, require a report to the health care provider. Because these two effects in particular may be associated with an increased risk for stroke, the client may need to change to another form of birth control. Breast tenderness, cramps associated with menstruation, and decreased menstrual flow may occur as a normal response to the use of oral contraceptives.

A licensed practical nurse (LPN/LVN) is working with the RN in verifying a heparin IV infusion rate. The prescribed dose is 400 units of heparin per hour. The heparin is in a solution of 5,000 units/100 mL NS. How many milliliters per hour should the pump be set? Record your answer using a whole number.

8 Explanation: mL/hour = 100 mL/5,000 U x 400 U/1 hour = 8 mL/hr (Dimensional Analysis) 5,000 units divided by 100 mL NS = 50 units/mL. 400 units divided by 50 units/mL = 8 mL. 50 units of heparin in each milliliter of the solution; 8 mL/hour delivers 400 units.

A client diagnosed with pneumonia refuses the prescribed oral antibiotic. The client is alert and oriented, vital signs are within normal range, and crackles are scattered throughout the posterior left lower lobe of the client's lung. Which actions should the nurse perform? Select all that apply.

Document that the client refused to take the medication. Address the client's concern about the medication by clarifying its purpose. Notify the physician. Explanation: The nurse should try to address the client's concern by clarifying the medication's purpose. If the client still refuses the medication, the nurse should notify the physician. It is also necessary to document the client's refusal. The client is alert and oriented, so the nurse may not mix the medication into the food without the client's knowledge. The nurse needs to witness the client swallowing the medication and cannot leave the medication at the client's bedside.