Medication and I.V. Administration - RN NCLEX

The mother of a 28-year-old client who is taking clozapine states, "Something's wrong. My son is drooling like a baby." What response by the nurse would be most helpful?

"Excess saliva is common with this drug; here's a paper cup for him to spit into."

A client is taking phenelzine 15 mg PO three times a day. The nurse is about to administer the next dose when the client tells the nurse about having a throbbing headache. Which action should the nurse do first?

Obtain the client's vital signs.

An older adult is taking eight medications to manage hypertension, diabetes, and arthritis and reports having nausea, diarrhea, tremors, and unusual thoughts. When investigating the cause of these symptoms, the nurse should consider which reason for underestimating adverse drug reactions in older adults?

Physical or psychological symptoms are attributed to the effects of aging.

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

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

A physician orders a soap suds enema, 500 ml. What does this amount equal in liters?

0.5 L 500 ml equals 0.5 L.

While receiving disulfiram therapy, the client becomes nauseated and vomits severely. Which question should the nurse ask first?

"How much alcohol did you drink today?"

A nurse overhears this conversation between coworkers: "Older people have lost many friends and family and also have health problems. Their anxiety and worries can be so severe that they need higher doses of benzodiazepines than most people." What is the most appropriate response for the nurse to make to the coworkers?

"That's not right. Older people need lower doses than most people because of reduced liver and kidney function."

Which statement by the client indicates an understanding of teaching regarding use of corticosteroids during preterm labor?

"The corticosteroids may help my baby's lungs mature."

A client with chronic heart failure has atrial fibrillation and is taking warfarin. What should the nurse tell the client about the expected outcome of this drug?

"This medication will prevent a clot from forming."

While providing palliative care to a client in the home setting, the client's family expresses concern that the client is receiving "too much narcotic medication." Which statement is the mosttherapeutic response by the nurse?

"You are concerned that the client is receiving too much narcotic medication?"

Which adverse effect occurs when there is too rapid an infusion of TPN solution?

circulatory overload

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

discard the uncapped needle and syringe in a puncture-proof container.

A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign?

hyperglycemia

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

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

The maximum transfusion time for a unit of packed red blood cells (RBCs) is

4 hours. A unit of packed RBCs may be transfused over a period of 1 to 4 hours. It shouldn't infuse for longer than 4 hours because the risk of contamination and sepsis increases after that time. The nurse should discard any blood not given within this time, or return it to the blood bank, in accordance with facility policy.

The nurse is to administer an antibiotic to a client with burns, but there is no medication in the client's medication box. What should the nurse do first?

Call the pharmacy department.

What assessment findings would lead the nurse to suspect that the client has an addiction to a pain medication? Select all that apply.

Client compulsively uses the pain medication. Client loses control of use of pain medication. Client continues use of pain medication despite of risk of harm.

The nurse starts an infusion of tissue plasminogen alteplase (tPA) for a client with a cerebrovascular accident (CVA). What are the priority nursing interventions during treatment with this medication?

Conduct frequent neurologic assessments to determine whether the stroke is evolving or acute complications are developing. Because tPA dissolves clots--clots that are anywhere in the body, not specific to the thrombosed area--neurologic checks are essential. Lowering the head of the bed is incorrect because the nurse wants slight head elevation to promote cerebral drainage of fluid. The pressure should be maintained to avoid further bleeding and/or swelling. The urine output would need frequent monitoring after administration of this medication to assess for any bleeding.

The nurse is developing a teaching plan with a client who is taking warfarin sodium. What should the nurse include in the plan?

Consult the health care provider (HCP) before undergoing a tooth extraction.

A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client?

Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube. To administer oral medication through an NG tube, the nurse must reproduce the disintegration and dissolution processes by crushing the tablets and preparing a liquid form. Making sure not to crush sustained-release tablets or empty capsules, the nurse then inserts the liquid into the NG tube. Heating the tablets may destroy or alter the drug's action. 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 clogging the tube.

A client is receiving chemotherapy and tells the nurse about also taking herbal therapy. What should the nurse do next?

Determine what substances the client is using, and make sure that the health care provider (HCP) is aware of all therapies the client is using.

The nurse is preparing to administer a controlled substance to a client who was admitted to an inpatient unit after being injured during a manic episode. The single-dose vial contains more than is needed for the prescribed dose. Which nursing action is appropriate?

Document wasting of the excess medication with a second witness.

A nurse practitioner (NP) orders an antibiotic to which the client is allergic. The nurse preparing the medication notices the allergy alert and contacts the NP by phone. The NP does not return the call and the first dose is due to be given. Which action by the nurse is the best solution?

Hold the medication until speaking with the NP. The nurse must speak to the NP and review the order. The other answers are incorrect because the nurse is aware of a stated allergy and must not give a medication that can cause an allergic reaction. The pharmacist cannot prescribe a new medication.

The student nurse is planning to care for a peripheral intravenous (I.V.) site for a client receiving chemotherapy. Which outcome would demonstrate that the student understands the concepts of I.V. care?

If extravasation is suspected, stop the infusion. Peripheral venous access devices are commonly used for clients receiving long-term chemotherapy, total parenteral nutrition, or frequent medication or fluids. These devices may remain in place for several weeks to more than 1 year if no complications develop. Extravasation, or infiltration of the drug into surrounding tissue, is an emergency, and the priority action is to stop the infusion. The site could be cleaned and dressing changed more often than every 72 hours depending on the type of dressing, patient's condition, and other factors. Heparin is not used to flush peripheral sites. Nurses monitor I.V. sites more frequently than every 24 hours; the site should be checked at least every 4 hours.

When a nurse brings prescribed medication to a client, the client says they usually take a white tablet, not the yellow tablet that the nurse has brought. What should the nurse do first?

Recheck the name and strength of the medication.

A female client is treated for trichomoniasis with metronidazole. What should the nurse tell the client about this medication?

She should avoid alcohol during treatment and for 24 hours after completion of the drug. Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur.

A client has been taking furosemide for 2 days. The nurse should review the laboratory record for changes in which blood level?

a decreased potassium Furosemide is a loop diuretic and inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle. Furosemide promotes sodium diuresis, resulting in a loss of potassium and serious electrolyte imbalances. Furosemide does not affect the BUN level.

A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief?

intravenous (IV) The nurse would want the client to receive the benefit of the medication as quickly a possible to help alleviate the migraine. A drug placed directly into intravenous system enters the client's bloodstream more quickly than oral, IM, or buccal, thereby avoiding the barriers of food and the destructive effects of stomach acid. With oral, IM, and buccal administration, the client's response to the drug is slower.

The nurse is caring for a client with an I.V. line. During care of the I.V. line, the nurse would be required to wear protective gloves in which situations? Select all that apply.

when inserting the I.V. When discontinuing the I.V. When changing the I.V. site The nurse should wear protective gloves when inserting the I.V., when discontinuing the I.V., and when changing the I.V. site due to the risk of exposure to blood and bodily fluids. The nurse would not be required to wear protective gloves while spiking or hanging a new bag of solution.

The nurse should advise which client who is taking lithium to consult with the health care provider regarding a potential adjustment in lithium dosage?

a client who is beginning training for a tennis team A client who is beginning training for a tennis team would most likely require an adjustment in lithium dosage because excessive sweating can increase the serum lithium level, possibly leading to toxicity. Adjustments in lithium dosage would also be necessary when other medications have been added, when an illness with high fever occurs, and when a new diet begins.

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

aspirin Aspirin is implicated in the development of Reye's syndrome in children with a history of recent acute viral infection.

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

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

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

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

A client has sustained a head injury and is to receive mannitol by I.V. push. In evaluating the effectiveness of the drug, the nurse should expect to find:

decreased cerebral edema. Mannitol, an osmotic diuretic, is used to decrease cerebral edema in clients with head injuries. The other choices are not correct results of mannitol.