Medication and IV Administration

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number.

33

A client with a deep vein thrombosis has heparin sodium infusing at 1,500 units/hour. The concentration of heparin is 25,000 units/500 mL. If the infusion remains at the same rate for a full 12 hour shift, how many milliliters of fluid will infuse? Record your answer using a whole number.

360

The health care provider (HCP) has prescribed guaifenesin 300 mg four times a day. The dosage strength of the liquid is 200 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using one decimal place.

7.5

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

Gently aspirate the I.V. catheter to check for a blood return.

A child diagnosed with tinea is being treated with griseofulvin. What instructions should the nurse give the parents?

Have the child avoid intense sunlight.

When administering an I.V. medication through a central line, the nurse notes that a client's central line gauze dressing was last changed 24 hours previously. What is the appropriate action by the nurse?

Proceed to administer the I.V. medication.

The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next?

Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.

A client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. What should the nurse tell the client to do?

Take the medication immediately.

During a bedside shift report, the nurse finds that the client is receiving the wrong I.V. solution. Which action by the nurse is indicated?

Write up an incident report describing the error.

Which class of medication protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

beta-adrenergic blockers

A nurse must monitor a client receiving chloramphenicol for adverse drug reactions. What is a toxic reaction to chloramphenicol?

bone marrow suppression

Clients who are receiving parenteral nutrition (PN) are at risk for development of which complication?

fluid imbalances

The nurse should instruct a client who is taking dexamethasone and furosemide to report which symptom?

muscle weakness

While monitoring a client following moderate sedation, the nurse administers pain medication for a pain score of 8 out of 10. The client becomes hard to rouse with a respiratory rate of 7 breaths/minute. Which medication should the nurse be prepared to administer?

naloxone

An outpatient client who has been receiving haloperidol for two days develops muscular rigidity, altered consciousness, a temperature of 103° F (39.4° C), and trouble breathing on day 3. The nurse interprets these findings as indicating which complication?

neuroleptic malignant syndrome

After administering naloxone, an opioid antagonist, the nurse should monitor the client carefully for which problem?

respiratory depression

During gentamicin therapy, the nurse should monitor a client's

serum creatinine level.

A client has been prescribed digoxin. Which symptom should the nurse tell the client to report as a potential indication of digoxin toxicity?

visual disturbances

The nurse should teach the client that signs of digoxin toxicity include:

visual disturbances such as seeing yellow spots.

The physician orders 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?

½ ml

A nurse is preparing to administer digoxin elixir to a client. Which principle regarding this medication is correct?

Liquid digoxin should be measured with a calibrated dropper or syringe.

The nurse is changing the subclavian dressing of a client who is receiving total parenteral nutrition. When assessing the catheter insertion site, the nurse notes the presence of yellow drainage from around the sutures that are anchoring the catheter. What should the nurse do first?

Obtain a culture specimen of the drainage.

The healthcare provider has ordered chlorpromazine for a client diagnosed with schizophrenia. What should the nurse include in the client's teaching concerning the administration of chlorpromazine?

"Chlorpromazine can cause involuntary movements of the face and jaw."

The nurse has an order to administer 1200 mg of an antibiotic. The drug is prepared as 6 grams of the drug in 2 ml of solution. The nurse should administer how many ml of the drug? Record your answer using one decimal place.

0.4

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 of the following statements is the most therapeutic response by the nurse?

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

The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply.

"Clonidine may cause low blood pressure when you stand up." "Clonidine may cause fatigue." "Clonidine may cause dry mouth."

A client with chronic pancreatitis is discharged with a prescription for pancrelipase. Which instruction must the nurse include when providing discharge instructions regarding this medication?

"Swallow this medication whole. Do not chew it."

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?"

The nurse needs to administer verapamil 0.3 mg/kg I.V. once a day to a pediatric client who weighs 20 lb (9.07 kg). The dose on hand is 5 mg/2 ml. How many milliliters will the nurse administer to the pediatric client? Round to the nearest tenth

1.1

The healthcare provider orders carbamazepine 200 mg orally three times a day for a client who has epilepsy. The dose on hand is 100 mg/5 mL. How many teaspoons will the nurse give the client at each dose?

2

The nurse is taking a health history of a pediatric client that is taking half a teaspoon of cetirizine every day at home. The medication the parents bring to the office has a concentration of 1 mg/mL solution. How many mg is this client receiving per day? Round the answer to the nearest tenth place.

2.5

A client is to receive 1 unit of packed red blood cells over 2 hours. There are 250 mL in the infusion bag. The IV administration infusion set delivers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse run the infusion? Record your answer using a whole number.

21

The physician has ordered an I.V. of 3000 mL of 0.9% sodium chloride to be infused over the next 24 hours. The nurse uses I.V. tubing that has a drip factor of 10. Calculate the drops per minute needed to deliver the correct amount of I.V. fluid. Record your answer using a whole number.

21

A nurse administers morphine sulfate to a client in the recovery room. Within 15 minutes after receiving the dose of morphine, the client is very lethargic; respiratory rate is 7 breaths per minute and shallow. What is the appropriate action of the nurse?

Administer naloxone.

Two days after a client undergoes repair of a ruptured cerebral aneurysm, a physician orders mannitol, 0.5 g/kg to be infused over 60 minutes. The client weighs 175 lb. The nurse should administer how many grams of mannitol? Record your answer using a whole number.

40

A client who takes ibuprofen for pain tells the nurse, "I have frequent indigestion." Which action should the nurse take?

Ask the client to describe the indigestion.

A client reports pain in the right heel and is requesting medication. The nurse assesses the client and administers an analgesic. The client experiences no pain relief and states that the heel pain is worse. What is an appropriate intervention by the nurse?

Call the physician to report the finding.

A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next?

Check for availability of a liquid preparation.

A client's caretaker calls the home care nurse and states accidentally puncturing the central venous catheter after discontinuing the total parenteral nutrition. What instructions should the nurse provide to the caretaker?

Clamp the catheter.

A new nurse is preparing to dispense medications to the assigned clients. The medications are provided by the pharmacy in individualized single-dose packaging. Which step is most important to ensure that each client receives the correct medication?

Compare the prescriber's original order with the label on the pharmacy package.

When making rounds on the pediatric neurology unit, the nurse manager notes that, when giving IV medications, many of the staff nurses are disconnecting the flush syringe first and then clamping the intermittent infusion device. The nurse manager is concerned that the nurses do not understand the benefits of positive pressure technique and turbulence flow flush in preventing clots. After the nurse manager discusses the problem with the staff educator, which intervention would be the most effective way to improve the nursing practice?

Create a poster presentation on the topic with a required posttest.

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.

The nurse is admitting a client with glaucoma. The client brings prescribed eye drops from home and insists on using them in the hospital. What should the nurse do?

Explain to the client that the health care provider (HCP) will write a prescription for the eye drops to be used at the hospital.

The nurse is preparing to administer a preoperative medication that includes a sedative to a client who is having abdominal surgery. What should the nurse do first?

Have the client empty the bladder.

The nurse is administering a tuberculin skin test. Place the steps for administering the tuberculin skin test in the correct order. All options must be used.

Obtain a tuberculin syringe, a half-inch, 26-gauge needle, and purified protein derivative. Draw up intermediate-strength purified protein derivative. Clean forearm area with alcohol. Inject 0.1 ml of the purified protein derivative. Create a wheal that is 6 to 10 mm in diameter. Remove the tuberculin syringe and dispose of the tuberculin syringe

A client is to receive glargine insulin in addition to a dose of aspart. When the nurse checks the blood glucose level at the bedside, it is greater than 200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins?

Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then, with a different insulin syringe, put air into the aspart vial, and draw up the correct dose.

The health care provider has prescribed phenytoin sodium therapy for a client with seizures. What should the nurse explain to the client about stopping the drug suddenly?

Status epilepticus may occur.

To prevent development of peripheral neuropathies associated with isoniazid administration, what should the nurse teach the client to do?

Supplement the diet with pyridoxine (vitamin B6).

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery?

methylprednisolone sodium succinate intravenously

The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client?

walking

A client with chronic obstructive pulmonary disease has a new prescription for theophylline. Which information obtained from the client would prompt the nurse to consult with the healthcare provider?

The client takes cimetidine 150 mg daily.

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.

The postoperative nursing assessment of a client's ability to swallow fluids before providing oral fluids is based on the type of anesthesia given. Which client would not have delayed fluid restrictions?

a repair of carpal tunnel syndrome under local anesthesia.

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength?

"Drink 6 to 8 glasses of fluid daily while taking this medication."

The nurse is preparing a client's preoperative medication. The prescription reads atropine 0.6 mg and meperidine hydrochloride 50 mg IM. The dosage of available atropine is 0.8 mg/mL, and the dosage of available meperidine is 100 mg/mL. What will be the total volume of medication the nurse will administer? Record your answer using two decimal places.

1.25

An infusion of lidocaine hydrochloride is running at 30 mL/hour. The dilution is 1,000 mg/250 mL. What dosage is the client receiving per minute? Record your answer using a whole number.

2

The nurse is preparing to administer a chemotherapy infusion to a client with esophageal cancer. The client has an implanted port that was last accessed 7 days ago. The insertion site is clean and dry and without erythema. Which is the appropriate action by the nurse?

Access the port using a Huber needle.

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

Applying a lubricant to the suppository

Which instruction is most important for the nurse to include in the teaching plan for a client who is taking phenelzine?

Avoid foods high in tyramine.

The nurse is teaching a client with hypertension about taking atenolol. What should the nurse instruct the client to do?

Avoid sudden discontinuation of the drug.

When assessing a client's I.V. insertion site, a 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.

The nurse in the emergency department is administering a prescription for 20 mg intravenous furosemide, which is to be given immediately. The nurse scans the client's identification band and the medication barcode. The medication administration system does not verify that furosemide is prescribed for this client; however, the furosemide is prepared in the accurate unit dose for intravenous infusion. What should the nurse do next?

Contact the pharmacist immediately to check the order and the barcode label for accuracy.

The nurse is admitting a client directly from a healthcare clinic. The healthcare provider's orders are illegible. What should the nurse do next? Select all that apply.

Hold all orders. Call the healthcare provider to clarify orders.

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.

A nurse is delivering a client's 10 a.m. (1000) medications. The client is away from their room for a diagnostic study. Which action is most appropriate for the nurse to take?

Lock the medications in the medicine cabinet until the client returns.

The nurse on the surgical unit is passing 0900 medications to a client using an electronic medication administration record (eMAR). Place the medication steps in the correct sequential order (from first to last) for safe medication administration by the nurse. All options must be used.

Open the computer program and enter the user ID and password. Select the correct client from the list of clients. Access the client's eMAR and select/prepare the medication(s) for 0900. Verify the client's name, birthday, and armband against the eMAR. Administer and document the medications in the eMAR. Log out of the client's eMAR and monitor the client for any reactions.

The nurse is preparing to administer a flu shot to an adult client. How would the nurse proceed? Place the steps in sequential order. All options must be used.

Put gloves on. Locate the deltoid muscle. Clean the injection site with an alcohol pad. Gently stretch the skin taut at the site. Inject it into the muscle at a 90-degree angle. Wait 10 seconds before removing needle.

A physician writes an order for a nurse to administer an I.V. medication which, according to hospital policy, is not a nursing protocol. The nurse informs the physician that it is not a nursing protocol, and the physician states, "Give it, and I will cover you." What should the nurse do in this situation?

Refuse to administer the medication.

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.

A client is taking iron supplements. What information should the nurse give the client?

The stools will become darker.

The nurse establishes the goal of preventing the development of a stress ulcer in a burn client. Which would most likely contribute to the achievement of this goal?

administering famotidine as ordered

Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration?

altered drug dose

A client will receive IV midazolam hydrochloride during surgery. Which finding indicates a therapeutic effect?

amnesia

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

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

circulatory overload

The nurse must administer medication to a 4-year-old child. Which methods are appropriate for the nurse to use to administer the medication? Select all that apply.

crushing the medication and mixing it with food play acting to give a sick doll some medication having the child's parents present in the room

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.

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

In a client with a urine specific gravity of 1.040, a subnormal serum osmolality, and a serum sodium level of 128 mEq/L, the nurse should question an order for which I.V. fluid?

dextrose 5% in water (D5W)

A nurse regularly inspects a client's I.V. site to ensure patency and prevent extravasation during dopamine therapy. What is the treatment for dopamine extravasation?

elevating the affected limb, applying warm compresses, and administering phentolamine as ordered

The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site has which appearance?

evidence of a bleb

A client's serum ammonia level is elevated, and the health care provider (HCP) prescribes 30 mL of lactulose. Which effect is common for this drug?

increased bowel movements

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids?

the importance of watching for signs of hyperglycemia

A client who underwent surgery had the following intake on the day of surgery: Day shift: 500 mL packed blood cells; 236 mL platelets; 750 mL normal saline solution; 1 L dextrose 5% in normal saline solution Evening shift: 250 mL normal saline solution; 1 L dextrose 5% in normal saline solution Night shift: 1 L dextrose 5% in normal saline solution. How many milliliters of solution should the nurse document as the client's 24-hour intake? Record your answer using a whole number.

4736

After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg intravenously. The mixed solution is 100 ml. The nurse is to administer the drug over 30 minutes. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Record your answer using a whole number. (For example: 62)

50

A physician prescribes intravenous heparin 25,000 units in 250 ml of normal saline solution to infuse at 600 units/hour for a client who suffered an acute myocardial infarction (MI). After 6 hours of heparin therapy, the client's partial thromboplastin time is subtherapeutic. The healthcare provider orders the infusion to be increased to 800 units/hour. The nurse would set the infusion pump to deliver how many milliliters per hour? Record your answer using a whole number.

8

A client is prescribed warfarin sodium. The nurse has prepared 1 tablet of 5 mg, 1 tablet of 2 mg, and 1/2 tablet of 3 mg. What is the dose that the nurse will be administering? Record your answer using one decimal place.

8.5

A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are as follows: heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first?

Administer 1 liter 0.9% saline IV.

The nurse used a secure access code to obtain a morphine 2 mg/ml vial from the computerized automated dispensing cabinet (ADC). Before exiting the system, the nurse is prompted to count the remaining vials. The nurse counts 10 remaining vials, but the system reads 9 remaining vials. What is the next action by the nurse?

Ask another nurse to assist with following the procedure to resolve the discrepancy.

The nurse is verifying the identity of a client prior to administering medication. The client has had a stroke and has ataxia. What is the best action by the nurse?

Ask the client to state name and birthdate.

A client has not had a bowel movement for 2 days and is feeling uncomfortable. The physician writes an order that states, "laxative of choice." How should the nurse proceed with this order?

Ask the physician to prescribe a specific laxative.

Immediately after receiving an injection of bupivacaine, the client becomes restless and nervous and reports a feeling of impending doom. What should the nurse do next?

Assess the client's vital signs.

Upon initial assessment of a postoperative client, the nurse identifies that the I.V. infusion is different from the solution ordered by the physician. What is the first action the nurse should take?

Assess the client, call the physician, and then hang the ordered solution.

The nurse is changing intravenous fluids for a client who has hypokalemia. Place in order the steps the nurse will use to change intravenous fluids. All options must be used.

Review the new intravenous order. Obtain the correct intravenous fluids. Identify client with two methods. Begin the intravenous fluids. Document the start of the fluids. Monitor the next potassium level.

The client has just undergone abdominal surgery and returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which interventions should the nurse implement? Select all that apply.

Tell the client to push the button when in pain. Check the patient-controlled analgesia (PCA) settings with another nurse. Assess the IV insertion site

A nurse is teaching a client how to administer subcutaneous (subQ) insulin injections. Which injection site should the client use?

anterior aspect of the thigh

Which clinical manifestation is a typical reaction to long-term phenytoin sodium therapy?

excessive growth of gum tissue

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream?

hypertonic

A client has been taking intravenous furosemide for congestive heart failure. The client is ordered to start intravenous gentamicin. What intervention is the priority for the nurse?

monitor serum BUN and creatinine levels

A client is scheduled for surgery at 8 a.m.(0800). While completing the preoperative checklist, the nurse sees that the surgical consent form isn't signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation?

notifying the surgeon that the client hasn't signed the consent form

A nurse is administering two drugs to a client at the same time. The nurse knows the most probable reason for giving the drugs together is

synergism.

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

The nurse is administering 5,000 units heparin subcutaneously to a client (see the accompanying image). The nurse should:

use a shorter needle.

A client is being switched from levodopa (L-dopa) to carbidopa-levodopa. The nurse should monitor for which possible complication during medication changes and dosage adjustment?

vital sign fluctuation

Methylphenidate hydrochloride has been prescribed for a child with attention deficit hyperactivity disorder. The nurse should make which of the following statements to the child's parents? Select all that apply.

"If discontinued, methylphenidate hydrochloride must be tapered off slowly." "If the symptoms do not improve, the medication may need to be adjusted."

Which statement indicates that a new graduate nurse understands central venous pressure (CVP) measurement when used on a client?

"The test will assess pressure and volume changes in the right atrium."

A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection. Which instruction should the nurse include in the teaching plan?

"Use a barrier method of birth control for the rest of your cycle."

Three days after surgery, a client continues to take hydrocodone 7.5 mg and acetaminophen 500 mg for postoperative pain. What should the nurse ask the client before administering the pain medication?

"When did you last have a bowel movement?"

The physician prescribes furosemide, 2 mg/kg P.O., as a one-time dose for an infant with fluid overload. The infant's documented weight is 14 lb (6.4 kg). The oral solution contains 10 mg/mL. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

1.3

A client has been ordered vancomycin 1400 mg I.V. The medication is placed in 250 mL of normal saline. At which rate should the nurse set the pump to infuse the medication over 90 minutes? Record your answer using a whole number.

167

Because of a shortage of I.V. infusion pumps, a nurse must regulate a client's I.V. by gravity flow. The client has an order for 1000 mL of 0.9 NSS to infuse at 100 mL/hr. The tubing drip factor is 10 drops/mL. What is the appropriate rate for the nurse to set the I.V. infusion?

17 drops per minute

A client is to be discharged on prednisone. Which statement indicates that the client understands how to take the medication?

"I need to wear or carry identification that I am taking prednisone."

The nurse is preparing a client for a cardiac catheterization. Which client statement would the nurse need to report to the healthcare provider immediately?

"I took my metformin this morning."

Propranolol is ordered for a client that has Type 1 diabetes mellitus. Which client statement indicates understanding of a common side effect of this therapy?

"I will check my blood glucose at least twice a day."

The physician has prescribed amiodarone for a client with cardiomyopathy. The nurse should monitor the client's rhythm to determine the effectiveness of the medication in controlling:

Life-threatening ventricular dysrhythmias.

Ear drops have been prescribed to be instilled in the adult client's left ear to soften cerumen. To position the client, what should the nurse do?

Pull the auricle lobe up and back.

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

4 hours.

At what time should the blood be drawn in relation to the administration of the IV dose of gentamicin sulfate?

just before the administration of the next IV dose

The nurse should instruct the client to avoid taking which drug while taking metoclopramide hydrochloride?

central nervous system depressants

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.

A client who is 1 day postoperative is using a morphine patient-controlled analgesia (PCA) pump. The client is confused and disoriented. What is the priority intervention by the nurse?

Check respiratory rate and depth as well as oxygen saturation levels.

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.

After the discharge of a client from a surgical unit, the housekeeper brings a blue pill to the nurse. The pill was found in the sheets when the linens were removed from the client's bed. The nurse reviews the client's medication administration record, which shows that the client received this medication at 0800. What would be the nurse's priority action?

Complete an incident form and notify the physician.

The nurse is administering a medication to a client with myeloid leukemia and does not know the use, dose, or side effects. To obtain the most up-to-date information about this drug, what should the nurse do?

Consult the drug guide provided by the clinical agency.

The physician's order reads "digoxin 0.075 mg." The pharmacy packaging contains three digoxin tablets labeled as 0.25 mg each. The packaging states to administer all 3 tablets to the client. What should the nurse do next?

Contact the pharmacist because the dose is too high.

The nurse reads the new medication prescriptions for a 4-year-old child with nephrotic syndrome (see exhibit). What action should the nurse take?

Contact the prescriber for clarification.

The nurse is caring for a client with a double lumen tunneled central catheter with ordered bloodwork and intermittent I.V. medications. What is the correct action by the nurse?

Dedicate the largest lumen for blood draws.

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.

When administering flumazenil intravenously for reversal of sedation, what should the nurse do? Select all that apply.

Give the medication undiluted in incremental doses. Be alert for shivering and hypotension. Use only a free-flowing IV line in a large vein. Monitor the client's level of consciousness

A client is prescribed a bisacodyl suppository. When administering the suppository, the nurse will include what actions?

Insert the suppository approximately 1 inch (2.5 cm) into the rectum, or just past the internal anal sphincter.

The nurse is preparing to administer 4 units of regular insulin to a client with type 1 diabetes mellitus. Which of the following equipment does the nurse need to perform the injection? Select all that apply.

Medication administration record 27-gauge, ½" needle

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how neomycin decreases the serum ammonia concentration. How should the nurse respond?

Neomycin decreases the amount of ammonia-producing bacteria in the GI tract.

The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on the leg. What should the nurse do first?

Notify the anesthesiologist of the prednisone administration

A nurse receives a report that a client has had an overdose of heparin. Which action by the nurse is most important in managing the overdose?

Obtain an order to give protamine sulfate.

The nurse is caring for a client with a blood pressure of 210/94 mm Hg. The health care provider prescribes enalapril 20 mg b.i.d. Which nursing action is best when instructing on the new medication regimen?

State the new medication, including name, use, and reason for the new medication.

The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply.

Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Reverses blood pressure of 90/58

A client is to receive an IM injection using a Z-track injection technique. The nurse holds the gauze pledget against an IM injection site while removing the needle from the muscle. What is the intended outcome of this technique?

Seal off the track left by the needle in the tissue

A nurse is assessing a postsurgical client who has been receiving nasogastric suctioning for 3 days. The client is restless, confused, and has generalized edema. What is the nurse's best intervention?

Stop the infusion of 5% dextrose in water (D5W) at 100 mL/hr.

Twenty minutes after a transfusion of packed red blood cells is initiated, a client reports shivering, headache, and lower back pain. The vital signs show a normal temperature and increased pulse and respiratory rate. What should be the first nursing actions?

Stop the transfusion, continue with saline infusion, and notify the physician regarding a suspected hemolytic reaction.

A nurse is teaching a parent of a toddler diagnosed with conjunctivitis to administer the ophthalmic ointment. Which action by the mother indicates that further instruction is necessary?

The mother holds the eyelids open with her fingers.

The nurse is observing a new graduate nurse instill eyedrops into a client's eyes. The nurse evaluates that the new graduate is using appropriate technique when which of the following steps is incorporated into the procedure?

The nurse's hand is stabilized on the client's forehead while instilling the drops.

A client has developed a hospital-acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the pharmacy sent cefazolin. What should the nurse do? Select all that apply.

Verify the medication order as written by the by the health care provider. (HCP). Contact the pharmacy and speak to a pharmacist. Request that cephalexin be sent promptly. Return the cefazolin to the pharmacy

A nurse has an order to administer an I.M. injection of iron dextran to a client. Which action is correct for an I.M. injection?

Withdraw the needle and release the skin.

A client is to be discharged on daily medication delivered by a transdermal disk. Which statement indicates the need for further medication teaching?

"I'll place the disk on the same spot each day."

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be:

10 to 14 days after the initial medication regime is implemented.

A nurse is preparing to administer intravenous cefazolin 1 gram in 50 mL of normal saline over 30 minutes. How many mLs per hour will the client receive? Record your answer using a whole number.

100

A physician orders an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, a client should receive how many milliliters of I.V. fluid per hour?

120 ml/hour

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms?

hypertension

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

hypertonic

If a manual end-of-shift count of controlled substances isn't correct, the nurse's best action is to

immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy.

Sodium polystyrene sulfonate is prescribed for a client following crush injury. Which finding indicates the drug has been effective?

The serum potassium is 4.0 mEq/L (4.0 mmol/L).

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect?

ovarian cancer

For a client with rib fractures and a pneumothorax, the health care provider (HCP) prescribes morphine sulfate, 1 to 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which finding indicates the goal has been met?

pain rating of 0 on a scale of 0 to 10 by the client

What information must a medication order include?

physician's signature

A client has been on long-term prednisone therapy. What should the nurse instruct the client to include in the diet? Select all that apply.

protein potassium calcium vitamin D

Which laboratory test should the nurse monitor when the client is receiving warfarin sodium therapy?

prothrombin time (PT)

A nurse is caring for a client receiving lidocaine I.V. Which factor is most relevant to administration of this medication?

runs of ventricular tachycardia on a cardiac monitor

A client is refusing to take the prescribed oral medication. Which measure by the nurse can be used to get the client to take the medication? Select all that apply.

suggesting a liquid form of the medication instead of a pill asking the client the reason for not taking the medication explaining the purpose of the medication to the client

The client is started on simvastatin to lower cholesterol. The nurse should explain to the client that which laboratory test will be monitored to detect potential side effects while the client is taking this drug?

liver function tests

When the nurse administers IV midazolam hydrochloride, the client demonstrates signs of an overdose. What should the nurse do next?

Ventilate with an oxygenated bag-valve mask.

A client comes to the clinic for diagnostic allergy testing. The nurse understands that intradermal injections are used for such testing based on which principle?

Intradermal drugs diffuse more slowly.

The nurse is caring for a client on a patient-controlled analgesia (PCA) pump. What additional interventions by the nurse would be effective for pain relief? Select all that apply.

gentle massage of the area with positioning encouraging relaxing of inflamed muscles and performing distraction exercises