blood nclex

Sulfisoxazole, 1 g orally four times daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the prescribed dose is safe. How many tablets per dose should the nurse administer to the adolescent?

1. 0.5 tablet 2. 1 tablet 3. 2 tablets 4. 3 tablets Answer: 3 Rationale: Change grams to milligrams, knowing that 1000 mg = 1 g. When converting from grams to milligrams (larger to smaller), move the decimal point three places to the right; thus, 1.0 g = 1000 mg. Then, use the medication calculation formula.

A client has a prescription to receive purified protein derivative (PPD) 0.1 mL intradermally (Mantoux test). The nurse prepares to administer the PPD and obtains a tuberculin syringe with a 26-gauge, 5/8-inch needle, knowing that the needle will be inserted:

1. Almost parallel to the skin with bevel side up 2. At a 45-degree angle with bevel side down 3. Almost parallel to the skin with bevel side down 4. At a 30-degree angle with bevel side down Answer: 1 Rationale: A Mantoux skin test is administered by giving 0.1 mL of PPD intradermally. This involves drawing the medication into a tuberculin syringe with a 25- to 27-gauge, 5/8-inch needle. The injection is given by inserting the needle as close as possible to a parallel position with the skin and with the needle bevel facing up. This results in formation of a wheal, when administered correctly.

A nurse is assisting with caring for a client who has received a transfusion of platelets. The nurse determines that the client is benefiting most from this therapy if the client exhibits which of the following?

1. An increased hematocrit level 2. An increased hemoglobin level 3. A decline of the temperature to normal 4. A decrease in oozing from puncture sites and gums Answer: 4 Rationale: Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or the oozing of blood from puncture sites, wounds, and mucous membranes. The client's temperature would decline to normal after the infusion of granulocytes if those transfused cells were then instrumental in fighting infection in the body. Increased hemoglobin and hematocrit levels would be seen when the client has received a transfusion of red blood cells.

A health care provider prescribes a parenteral nutrition solution to start at 50 mL/hr by infusion pump via an established subclavian central line. After 2 hours of initiating the parenteral nutrition infusion, the client suddenly complains of difficulty in breathing and chest pain. Which action would the nurse prepare to do first?

1. Auscultate the client's lung sounds. 2. Clamp the parenteral nutrition infusion. 3. Obtain the client's blood glucose level. 4. Perform an electrocardiogram (ECG). Answer: 2 Rationale: A complication of a subclavian central line can be an embolism resulting from air or thrombus. A sudden onset of chest pain shortly after the initiation of parenteral nutrition may mean that this complication has developed. The central line is clamped, not discontinued, and the health care provider is notified immediately. Option 1 is an appropriate action but not the first action. Option 3 is not a priority because the client's symptoms do not indicate the presence of hypoglycemia or hyperglycemia. The health care provider will probably prescribe an ECG, but this action would not be the initial action in this situation.

A nurse is preparing an IV solution and tubing for a client who requires IV fluids. While preparing to prime the tubing, the tubing drops and hits the top of the medication cart. The nurse should plan to do which of the following?

1. Change the IV tubing. 2. Wipe the tubing with Betadine. 3. Scrub the tubing with an alcohol swab. 4. Scrub the tubing before attaching it to the IV bag. Answer: 1 Rationale: The nurse should change the IV tubing. The tubing has become contaminated, and, if used, it could result in a systemic infection in the client. Wiping or scrubbing the tubing is insufficient to prevent systemic infection.

A nurse notes blanching, coolness, and edema at the peripheral intravenous (IV) site. Which of the following is the most appropriate action?

1. Check for a blood return. 2. Remove the IV. 3. Apply a warm compress. 4. Measure the area of infiltration. Answer: 2 Rationale: Blanching, coolness, and edema of the IV site are signs of infiltration. Because infiltration can be damaging to the surrounding tissue, the most appropriate action is to remove the IV to prevent any further damage. The nurse should not depend solely on the blood return for assurance that the cannula is in the vein because a blood return may be present even if the cannula is only partially in the vein. Warm compresses may be applied to the infiltrated area only after the IV is removed and only if the infiltrated solution is not damaging to the surrounding tissues. Measuring the area of infiltration should only be done after the IV has been removed so that further tissue damage is assessed.

A nurse is assisting in the preparation of a client for a blood transfusion. Which item is the most important for the completion of the identification process?

1. Identification bracelet 2. Social Security number 3. Client's current address 4. Medical record number Answer: 1 Rationale: The identification bracelet that is placed on the client at admission is the most important item for proper client identification. The ID bracelet contains the client's name, age, health care provider's name, room number, and a hospital and/or medical record identification number. It contains the same information that is present on the client's addressograph card, which is stamped on all client requisitions. The Social Security number and address are irrelevant for the procedure described. The medical record number would most likely be present on the client ID bracelet.

The nurse notes the appearance of skin breakdown on a client's hand at the site of an intravenous catheter that had medication infusing. The nurse determines that which adverse effect occurred? Refer to figure.

1. Phlebitis 2. Infiltration 3. Thrombosis 4. Extravasation Answer: 4 Rationale: Extravasation refers to the tissue injury that occurs from leakage of medication into surrounding skin and subcutaneous tissue; it can also cause tissue necrosis. Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection. Phlebitis can cause the development of a clot (thrombophlebitis). Infiltration is seepage of the intravenous fluid out of the vein and into the surrounding interstitial spaces. It is a form of tissue injury but the injury is not to the extent that occurs with extravasation.

A nurse is checking the insertion site of a peripheral IV catheter. The nurse notes the site to be reddened, warm, painful, and slightly edematous in the area of the vein proximal to the IV catheter. The nurse interprets that this is likely the result of:

1. Phlebitis of the vein 2. Infiltration of the IV line 3. Hypersensitivity to the IV solution 4. An allergic reaction to the IV catheter material Answer: 1 Rationale: Phlebitis at an IV site results in discomfort at the site and redness, warmth, and swelling proximal to the IV catheter. The IV catheter should be removed, and a new IV line should be inserted at a different site. The remaining options are incorrect; the signs and symptoms in the question are not associated with these conditions.

A nurse is preparing to administer medication through a nasogastric (NG) tube that is connected to suction. Which of the following indicates the accurate procedure for medication administration?

1. Position the client supine to assist with medication absorption. 2. Clamp the NG tube for 30 minutes after medication administration. 3. Aspirate the NG tube after medication administration to maintain patency. 4. Change the suction setting to low intermittent suction for 30 minutes after medication administration. Answer: 2 Rationale: If a client has an NG tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the NG tube will remove the medication that has just been administered. Low intermittent suction will also remove the medication. The client should not be placed in the supine position because of the risk for aspiration.

A nurse notes that the site of a client's peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. Based on these findings, the initial nursing action is to:

1. Remove the IV. 2. Slow the rate of infusion. 3. Check for loose catheter connections. 4. Notify the health care provider. Answer: 1 Rationale: Phlebitis at an IV site can be determined by client discomfort at the site, as well as by redness, warmth, and swelling proximal to the catheter. The line should be removed, and a new line should be inserted at a different site. Options 2 and 3 are incorrect. The health care provider should be notified if phlebitis occurred, but this is not the initial action.

A client who is receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure and a bounding pulse. The nurse reports the findings, knowing that these signs are indicative of which complication of this therapy?

1. Sepsis 2. Air embolism 3. Fluid overload 4. Hyperglycemia Answer: 3 Rationale: The client's signs and symptoms are consistent with fluid overload. The increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. A fever would be present in a client with sepsis. Signs and symptoms of an air embolus include confusion, pallor, lightheadedness, tachycardia, tachypnea, hypotension, anxiety, and unresponsiveness. Polyuria, polydipsia, and polyphagia are manifestations of hyperglycemia.

A nurse is assisting with caring for a client who will receive a unit of blood. Just before the infusion, it is most important for the nurse to check the client's:

1. Vital signs 2. Skin color 3. Oxygen saturation 4. Latest hematocrit level Answer: 1 Rationale: A change in the vital signs may indicate that a transfusion reaction is occurring. The nurse assesses the client's vital signs before the procedure to obtain a baseline, every 15 minutes for the first half hour after beginning the transfusion, and every half hour thereafter. Options 2, 3, and 4 may be checked but are not the most important.

A nurse has just been told by the health care provider that a prescription has been written to administer an iron injection to a client. The nurse anticipates giving the medication by which method?

1. Z-track 2. Subcutaneous using a ⅝-inch needle 3. Intramuscular using a 1-inch needle 4. Direct intravenous push after dilution Answer: 1 Rationale: The correct technique for administering parenteral iron is deep in the gluteal muscle using the Z-track technique. Usually a 1½-inch needle is used to administer the injection, depending on the size of the client. This method minimizes the possibility that the injection will stain the skin a dark color. The medication is not given by the subcutaneous route or by direct intravenous push.

A health care provider's prescription reads ciprofloxacin (Cipro) 0.5 g orally twice daily. The medication label reads ciprofloxacin 500 mg tablets. The nurse prepares how many tablet(s) to administer one dose?

Answer: 1 Rationale: Convert 0.5 g to milligrams (mg). In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0.5 g = 500 mg. The nurse would administer one tablet.

A health care provider's prescription reads triazolam (Halcion), 125 mcg orally at bedtime daily. The medication bottle is labeled triazolam, 0.125-mg tablets. The nurse prepares how many tablet(s) to administer one dose?

Answer: 1 Rationale: Convert 125 mcg to mg. In the metric system, to convert smaller to larger, divide by 1000 or move the decimal three places to the left. Therefore, 125 mcg = 0.125 mg. One tablet is administered.

A health care provider's prescription reads "cyanocobalamin (vitamin B12) 100 mcg intramuscular." The medication label reads "cyanocobalamin (vitamin B12), 0.5 mg/mL." The nurse administers how many milliliters to the client?

Answer: 0.2 Rationale: Convert 100 mcg to mg. In the metric system, to convert smaller to larger, divide by 1000 or move the decimal three places to the left. Therefore, 100 mcg = 0.1 mg. Then follow the formula:

A health care provider has prescribed phytonadione (vitamin K) 2.5 mg intramuscularly. The nurse reads the label on the medication vial and administers how many mL to the client? Refer to figure.

Answer: 0.25 Rationale: Use the formula for calculating medication doses.

The medication prescribed is atropine sulfate, 0.4 mg. The medication label states atropine sulfate, 0.5 mg/0.5 mL. How many milliliters will the nurse prepare to administer to the client?

Answer: 0.4 Rationale: Follow the formula for dosage calculation.

A health care provider's prescription reads atenolol (Tenormin), 0.025 g orally daily. The medication bottle reads atenolol, 50-mg tablets. The nurse prepares how many tablet(s) to administer the dose?

Answer: 0.5 Rationale: Convert 0.025 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore 0.025 g = 25 mg. Next use the medication formula to calculate the correct dose.

A health care provider's prescription reads atenolol (Tenormin) 0.025 grams orally daily. The medication bottle reads atenolol (Tenormin), 50-mg tablets. The nurse prepares how many tablet(s) to administer the dose?

Answer: 0.5 Rationale: Convert 0.025 grams to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0.025 g = 25 mg, which is equal to ½ or 0.5 tablet.

The medication is an intramuscular dose of 400,000 units of penicillin G benzathine (Bicillin). The label on the 10-mL ampule sent from the pharmacy reads penicillin G benzathine (Bicillin) 300,000 units/mL. The nurse prepares how much medication to administer the correct dose? (Round answer to the nearest tenth position.)

Answer: 1.3 Rationale: Follow the formula for dosage calculation.

A health care provider's prescription reads "levothyroxine (Synthroid), 150 mcg orally daily." The medication label reads "levothyroxine, 0.1 mg/tablet." The nurse prepares to administer how many tablet(s) to the client?

Answer: 1.5 Rationale: Convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000, or move the decimal three places to the left. Therefore 150 mcg = 0.15 mg.

A health care provider's prescription reads theophylline timed-release capsules (Slo-Bid), 100 mg orally every 6 hours. The medication label reads 50-mg capsules. How many capsules will the nurse give to administer one dose?

Answer: 2 Rationale: Use the formula for calculating the appropriate medication dosage.

A health care provider's prescription reads "ketorolac (Toradol), 30 mg intramuscular every 6 hours as needed." The medication label reads "ketorolac (Toradol), 15 mg/mL." The nurse prepares to administer how many milliliters to the client?

Answer: 2 Rationale: Use the medication calculation formula to answer the question.

The medication prescription reads phenytoin (Dilantin) 0.2 g orally twice daily. The medication label states 100-mg capsules. A nurse prepares how many capsule(s) to administer one dose?

Answer: 2 Rationale: You must convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0.2 g equals 200 mg. After conversion from grams to milligrams, use the formula to calculate the correct dose.

A health care provider prescribes 2000 mL of 5% dextrose in water to run over 24 hours. The drop (gtt) factor is 15 gtt/mL. The nurse plans to adjust the flow rate at how many gtts per minute? (Round answer to the nearest whole number.)

Answer: 21 Rationale: The prescribed 2000 mL is to be infused over 24 hours. Follow the formula and multiply 2000 mL by 15 (gtt factor). Then divide the result by 1440 minutes (24 hours × 60 minutes). The infusion is to run at 20.8, or 21 gtt/minute.

The intravenous prescription is 1000 mL of 0.9% NaCl (normal saline) to run over 12 hours. The drop factor is 15 gtt/1 mL. The nurse plans to adjust the flow rate to how many gtt/minute? (Round answer to the nearest whole number.)

Answer: 21 Rationale: Use the intravenous (IV) flow rate formula.

The intravenous prescription is 3000 mL of 5% dextrose (D5W) to run over a 24-hour period. The drop factor is 10 gtt/1 mL. The nurse plans to adjust the flow rate to how many gtt/minute? (Round answer to the nearest whole number.)

Answer: 21 Rationale: Use the intravenous (IV) flow rate formula.

A nurse is asked to regulate the flow rate of an intravenous (IV) solution being administered to a client. The IV bag contains 50 mL of solution and the solution is to be administered over 30 minutes. The administration set has a drop factor of 10 drops (gtt)/mL. The nurse should regulate the roller clamp on the infusion set to deliver how many drops per minute? Round to the nearest whole number.

Answer: 17 Rationale: The formula and calculation for this IV flow rate is:

A health care provider prescribes 1000 mL of normal saline to be infused over a period of 12 hours. The drop (gtt) factor is 15 drops (gtt)/mL. The nurse sets the flow rate at how many gtt per minute? (Round answer to the nearest whole number.)

Answer: 21 Rationale: Use the formula for calculating IV infusion rates. Convert 12 hours to minutes (12 hours × 60 minutes = 720 minutes).

A health care provider prescribes a bolus of 500 mL of 0.9% normal saline (NS) to run over 4 hours. The drop (gtt) factor is 10 drops (gtt) per 1 mL. The nurse plans to adjust the flow rate at how many gtt per minute? Round answer to the nearest whole number.

Answer: 21 Rationale: The prescribed 500 mL is to be infused over 4 hours. Follow the formula and multiply 500 mL by 10 (gt factor). Then, divide the result by 240 minutes (4 hours X 60 minutes). The infusion is to run at 20.8 or 21 gtt/minute.

A client is going to be transfused with a unit of packed red blood cells. The nurse understands that it is necessary to remain with the client for what time period after the transfusion is started?

1. 5 minutes 2. 15 minutes 3. 30 minutes 4. 45 minutes Answer: 2 Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is the most likely time that a transfusion reaction will occur. This enables the nurse to detect a reaction and intervene quickly. The nurse engages in safe nursing practice by obtaining coverage for the other clients during this time. Options 1 is too short of a time period. Options 3 and 4 are lengthy time periods.

A nurse is monitoring a client receiving a blood transfusion for circulatory overload. The nurse understands that which of the following is a clinical indication of circulatory overload?

1. Fatigue 2. Flat neck veins 3. Moist, productive cough 4. Decreasing blood pressure Answer: 3 Rationale: Chest or lumbar pain, cyanosis, dyspnea, moist productive cough, crackles in the lung bases, distended neck veins, and an increase in blood pressure are clinical indications of circulatory overload caused by excessive infusion amounts or too rapid an infusion rate. Options 1, 2, and 4 are incorrect.

A registered nurse has just hung a 250-mL bag of packed red blood cells (PRBCs) on a client. The licensed practical nurse assisting in caring for the client plans to remain with the client for at least how many minutes following the start of the infusion?

1. 5 minutes 2. 15 minutes 3. 30 minutes 4. 60 minutes Answer: 2 Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is the most frequent period during which a transfusion reaction may occur. This enables the nurse to quickly detect a reaction and intervene quickly. Option 1 is not ample time to remain with the client. The time frames in options 3 and 4 are unnecessary.

Atropine sulfate, 0.2 mg given intramuscularly, is prescribed for a child. The medication label reads as follows: "0.4 mg/mL." The nurse has determined that the prescribed dose is safe. How many milliliters should the nurse administer to the child?

Answer: 0.5 Rationale: Use the formula for calculating medication dosage.

Morphine sulfate, 2.5 mg subcutaneously, is prescribed for a client postoperatively. The medication label reads "1/15 grains/mL." How many milliliters should the nurse administer? Round answer to the nearest tenth position.

Answer: 0.6 Rationale: Convert grains (gr) to milligrams (mg) and then use the medication calculation formula.

Which of these clients are most likely to develop fluid (circulatory) overload? Select all that apply.

1. A premature infant 2. A 101-year-old man 3. A client on renal dialysis 4. A client with diabetes mellitus 5. A 29-year-old woman with pneumonia 6. A client with congestive heart failure Answer: 1 2 3 6 Rationale: Clients with cardiac, respiratory, renal, or liver diseases and older and very young clients cannot tolerate an excessive fluid volume. The risk of fluid (circulatory) overload exists with these clients.

A health care provider prescribes meperidine hydrochloride (Demerol) 15 mg intramuscularly for a client in pain. The medication label states, meperidine hydrochloride (Demerol) 25 mg per mL. How many milliliters will the nurse administer to the client?

Answer: 0.6 Rationale: Use the formula for calculating medication dosages.

The medication prescribed is heparin sodium 650 units subcutaneously every 12 hours. The medication vial reads heparin sodium (Liquaemin), 1000 units/mL. The nurse prepares how many milliliters to administer one dose?

Answer: 0.65 Rationale: Follow the formula for dosage calculation.

A nurse is administering intramuscular iron to an assigned client. The nurse should take which action to avoid skin staining around the injection site?

1. Administer the injection in the thigh. 2. Massage the site after injection. 3. Use a Z-track method for administration. 4. Administer the injection in the nondominant arm. Answer: 3 Rationale: Proper technique for administering iron by the intramuscular route includes using a Z-track technique and changing the needle after drawing it up, but before the medication is given. The medication should be given in the upper outer quadrant of the buttock, and not in an exposed area such as the arms or thighs. The site should not be massaged after injection.

A health care provider has prescribed phenobarbital sodium (Luminal Sodium), 25 mg orally twice daily, for a child with febrile seizures. The medication label reads as follows: "Phenobarbital sodium, 20 mg/5 mL." The nurse has determined that the dose prescribed is a safe dose for the child. How many milliliters per dose should the nurse administer to the child?

1. 2 mL 2. 4.5 mL 3. 6.25 mL 4. 7 mL Answer: 3 Rationale: Use the medication calculation formula.

The medication prescribed is atropine sulfate, 0.4 mg intramuscularly, immediately. The medication label states atropine sulfate, 0.3 mg/0.5 mL. The nurse prepares how much medication to administer the dose? Round to the nearest tenth position.

Answer: 0.7 Rationale: Follow the formula for dosage calculation.

The medication prescribed is meperidine hydrochloride (Demerol), 35 mg intramuscularly. The medication label states meperidine hydrochloride (Demerol), 50 mg/mL. The nurse plans to prepare how much medication to administer the dose?

Answer: 0.7 Rationale: Follow the formula for dosage calculations.

A nurse is preparing to administer a prescribed intramuscular (IM) dose of meperidine hydrochloride (Demerol), 35 mg, to a client. The medication label reads meperidine hydrochloride, 50 mg/mL. How many milliliters will the nurse administer to the client?

Answer: 0.7 Rationale: Use the medication calculation formula and note the prescribed (35 mg) and available doses (50 mg/mL).

A nurse is checking the IV dressing of a client with a peripheral intravenous solution infusing. The date on the dressing is 2/9 (February 9). The nurse calculates that the dressing should be changed on which of the following dates?

1. 2/10 2. 2/12 3. 2/14 4. 2/16 Answer: 2 Rationale: The IV site dressing should be changed every 48 to 72 hours, which is every 2 to 3 days. With an insertion date of 2/9, the due date for change, depending on agency policy, would be either 2/11 or 2/12. Changing the dressing every 5 to 7 days (options 3 and 4) would place the client at risk for infection. Changing the dressing on a daily basis is not necessary unless the dressing becomes wet.

A hospitalized child with leukemia has received chemotherapy by the intravenous (IV) route, and a discharge to home is being planned. Laboratory values indicate that the child is neutropenic. During the course of the chemotherapy, the IV infiltrated and the child has a small open area at the site of infiltration that is being treated daily by cleansing and the application of a topical antibiotic. The nurse instructs the mother regarding the signs of infection at this affected site. Which statement by the mother indicates that the mother understands the instructions?

1. "Pus at the site means that an infection is present." 2. "If I see redness at the site, I don't need to worry as long as there is no pus." 3. "I will clean the site and apply the topical ointment every day." 4. "If the temperature is elevated, I don't need to be concerned, because this is normal with affected white blood cells." Answer: 3 Rationale: Some neutropenic children will not produce purulent drainage. Because pus is made of white blood cells, drainage cannot be used as a sign of infection. Redness may be the only sign. An elevated temperature is a sign of infection. Option 3 is the only correct statement.

A pediatric client with a ventricular septal defect repair is placed on a maintenance dose of digoxin (Lanoxin). The safe dose is 0.03 mg/kg/day, and the client's weight is 7.2 kg. The health care provider (HCP) prescribes the digoxin to be given twice daily. How much digoxin should the nurse administer to the client at each dose?

1. 0.1 mg 2. 0.37 mg 3. 0.5 mg 4. 2.5 mg Answer: 1 Rationale: Calculate the dosage by weight first: therefore 0.03 mg/day × 7.2 kg = 0.21 mg/day. Next, note that the HCP prescribes digoxin to be given twice daily; therefore two doses in 24 hours will be administered, and 0.21 mg/day divided by two doses = 0.1 mg for each dose.

A registered nurse (RN) tells a licensed practical nurse (LPN) that the health care provider has prescribed a hypotonic IV solution for a client. Which IV solution should the LPN obtain for administration to the client?

1. 0.45% saline 2. 5% dextrose in water 3. 10% dextrose in water 4. 5% dextrose in 0.9% saline Answer: 1 Rationale: 5% dextrose in water is an isotonic solution; 10% dextrose in water and 5% dextrose in 0.9% saline are hypertonic solutions; 0.45% saline is hypotonic and is probably the only hypotonic solution used in clinical situations. Distilled water is another example of a hypotonic solution. Hypotonic solutions contain a lower concentration of salt or more water than an isotonic solution.

A health care provider's prescription reads as follows: "Ampicillin, 125 mg intramuscular every 6 hours." The medication label reads "1 gram and reconstitute with 7.4 mL of bacteriostatic water." How many milliliters should the nurse draw up for one dose?

1. 0.54 mL 2. 0.92 mL 3. 1.1 mL 4. 7.4 mL Answer: 2 Rationale: Convert grams to milligrams. With the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Then, use the medication calculation formula: 1 g = 1000 mg Formula:

Penicillin G procaine (Wycillin), 1,000,000 units given intramuscularly, is prescribed for an adolescent with an infection. The medication label reads as follows: "1,200,000 units/2 mL." The nurse has determined that the prescribed dose is safe. How many milliliters per dose should the nurse administer to the adolescent?

1. 0.8 mL 2. 1.2 mL 3. 1.44 mL 4. 1.66 mL Answer: 4 Rationale: Use the medication calculation formula.

A health care provider has prescribed prochlorperazine 4 mg intramuscularly for a client who is vomiting. The nurse reads the label on the medication vial and administers how many milliliters (mL) to the client? Refer to the figure.

1. 0.8 mL 2. 1.2 mL 3. 4 mL 4. 5 mL Answer: 1 Rationale: Use the formula for calculating medication doses.

Which of the following laboratory results indicate a therapeutic drug level? Refer to the figure. Select all that apply.

1. 1 2. 2 3. 3 4. 4 5. 5 Answer: 1 3 5 Rationale: Options 1, 3, and 5 are the only therapeutic drug levels; all the rest are abnormal (too high). Therapeutic drug levels are as follows: carbamazepine (Tegretol) is 5 to 12 mcg/mL; digoxin (Lanoxin) is 0.5 to 2 ng/mL; gentamicin is 5 to 10 mcg/mL; phenytoin (Dilantin) is 10 to 20 mcg/mL; theophylline is 10 to 20 mcg/mL; and tobramycin is 5 to 10 mcg/mL.

A nurse is reading a health care provider's prescription and notes that a client is to receive a medication at 1:00 ᴘᴍ. Using the military time clock, the nurse administers the medication at which time? Refer to figure.

1. 1 2. 2 3. 3 4. 4 Answer: 1 Rationale: According to the National Patient Safety goals, health care agencies are mandated to use military time, which is a 24-hour system that avoids misinterpretation of ᴀᴍ and ᴘᴍ times. Instead of two 12-hour cycles in standard time, the military clock is one 24-hour time cycle. 1:00 ᴘᴍ is 1300 military time.

A nurse hangs a 1000-mL intravenous (IV) bag of 5% dextrose in water (D5W) at 0700. The IV is to infuse at 100 mL/hr, and the nurse places a time tape on the IV bag. At noon the nurse would expect that the infusion line on the IV bag would be at which point? Refer to figure.

1. 1 2. 2 3. 3 4. 4 Answer: 2 Rationale: If an IV is to infuse at 100 mL/hr, in a 5-hour period (0700 to 1200 [noon]) a total of 500 mL would have infused. Therefore the infusion line would be at the 500-mL point.

A nurse is preparing a small dose of a medication for administration to an infant. The nurse selects which syringe for preparing the medication? Refer to figure.

1. 1 2. 2 3. 3 4. 4 Answer: 2 Rationale: The tuberculin syringe has a long, thin barrel. The syringe, calibrated in sixteenths of a minim and hundredths of a milliliter, has a capacity of 1 mL. It is used to prepare small amounts of medication such as small, precise doses for infants or young children. Option 1 is a 3-mL syringe that is used to administer intramuscular and subcutaneous injections. Option 3 is a 5-mL syringe and option 4 is an insulin syringe. Insulin syringes are used to administer insulin.

A nurse is making a worksheet and listing the tasks that need to be performed for assigned adult clients during the shift. The nurse writes on the plan to check the IV of an assigned client who is receiving fluid replacement therapy at least every:

1. 1 hour 2. 2 hours 3. 3 hours 4. 4 hours Answer: 1 Rationale: Safe nursing practice includes monitoring an IV infusion at least once per hour for an adult client. Options 2, 3, and 4 do not provide time frames that are safe or acceptable.

A nurse is preparing to hang an intravenous (IV) solution of 1000 mL 5% dextrose in lactated Ringer's to flow at 80 mL/hour. The nurse time-tapes the bag with a start time of 07:00. After making hourly marks on the time-tape, the nurse notes that the completion time for the bag is:

1. 17:00 2. 17:30 3. 19:30 4. 21:00 Answer: 3 Rationale: At a rate of 80 mL/hour, the 1000-mL bag will be finished infusing in 12.5 hours. This brings the end time to 19:30, using military time.

The medication prescription states to administer Tylenol (acetaminophen) 650 mg orally for a temperature of more than 38° C. The medication bottle states Tylenol (acetaminophen), 325 mg tablets. The nurse takes the client's temperature and notes that it is 101° F. The nurse plans to take which of the following actions?

1. Administer two Tylenol tablets. 2. Administer three Tylenol tablets. 3. Do not administer the Tylenol at this time. 4. Check the client's temperature in 30 minutes. Answer: 1 Rationale: Convert Fahrenheit to Celsius, and then calculate the dose to be administered. Step 1: Conversion of Fahrenheit to Celsius: To convert Fahrenheit to Celsius, subtract 32, and divide the result by 1.8: C = (101 - 32) = 69, divided by 1.8 = 38.3° Step 2: Dosage Calculation: Therefore option 1 is the correct answer.

A client who is receiving a blood transfusion rings the call bell for the nurse. When entering the room, the nurse notes that the client is flushed, dyspneic, and complaining of generalized itching. The nurse interprets that the client is experiencing:

1. Bacteremia 2. Fluid overload 3. Hypovolemic shock 4. A transfusion reaction Answer: 4 Rationale: The signs and symptoms exhibited by the client are consistent with a transfusion reaction. With bacteremia, the client would have a fever, which is not part of the clinical picture presented. With fluid (circulatory) overload, the client would have crackles in addition to dyspnea. There is no correlation between the signs mentioned in the question and hypovolemic shock. The signs identified in the question are indicative of an allergic reaction, which is one type of blood transfusion reaction.

A nurse has been instructed to discontinue an IV line. The nurse removes the catheter by withdrawing the catheter while applying pressure to the site with a(n):

1. Band-Aid 2. Alcohol swab 3. Betadine swab 4. Sterile 2 × 2 gauze Answer: 4 Rationale: A dry, sterile dressing such as a sterile 2 × 2 gauze is used to apply pressure to the site while the catheter is discontinued and removed. This material is absorbent, sterile, and nonirritating to the site. A Band-Aid may be used to cover the site after hemostasis has occurred. An alcohol swab or Betadine would irritate the opened puncture site and would not stop the blood flow.

A nurse is caring for a client with a multilumen catheter and is monitoring for signs of an air embolism. Which clinical manifestations that would be noted in this complication? Select all that apply.

1. Cyanosis 2. Chest pain 3. Coughing 4. Hypertension 5. Crackles heard in the lung bases on auscultation 6. A churning "windmill" sound heard over the right ventricle on auscultation Answer: 1 2 3 6 Rationale: All clients with intravenous lines are at risk for air embolism. Because an air embolism can be life threatening, it is essential that the nurse monitor for the presence of chest pain, coughing, hypotension, cyanosis, and hypoxia. In addition, if the client does have an air embolism, auscultation over the right ventricle may reveal a churning "windmill" sound.

A client has been on parenteral nutrition for 8 weeks. The health care provider prescribes that the parenteral nutrition be weaned down by 50 mL/hr/day until discontinued. The client asks the nurse, "Why doesn't the doctor just stop the parenteral nutrition instead of dragging it on for 3 days?" The nursing response would be to explain that the health care provider is concerned about which phenomenon?

1. Dehydration 2. Hypokalemia 3. Hypernatremia 4. Rebound hypoglycemia Answer: 4 Rationale: Clients receiving parenteral nutrition are receiving high concentrations of glucose. To give the pancreas time to adjust to decreasing glucose loads, the infusion rates are tapered down. Before discontinuing the parenteral nutrition, the body must adjust to the lowered glucose levels. If the parenteral nutrition were suddenly withdrawn, the client would probably have rebound hypoglycemia. Options 1, 2, and 3 are not concerns when the parenteral nutrition is discontinued.

A nurse is monitoring a client who is receiving a unit of packed red blood cells. Within an hour after the initiation of a transfusion, the nurse finds the client to be restless, with reports of chills and back pain. The nurse notes that there is dark urine in the Foley catheter drainage bag. The nurse interprets that the client is experiencing which reaction?

1. Delayed hemolytic 2. Acute hemolytic 3. Hyperkalemic 4. Allergic Answer: 2 Rationale: The client is experiencing an acute hemolytic reaction to the transfusion. The nurse in this instance would immediately stop the infusion and notify the health care provider. A delayed hemolytic reaction typically occurs from 2 to 14 days after transfusion. A hyperkalemic reaction occurs when blood is transfused that has been stored for too long, resulting in red blood cell hemolysis. The client experiencing a hyperkalemic reaction would exhibit nausea, muscle weakness or paresthesias, apprehension, bradycardia, electrocardiogram (ECG) changes, and possibly cardiac arrest. An allergic reaction is characterized by flushing, nausea and vomiting, respiratory stridor, hypotension, and other signs of anaphylaxis.

A nurse is preparing to administer an intramuscular injection to a 1-year-old child. Which of the following locations would the nurse select to administer the medication?

1. Deltoid muscle 2. Dorsogluteal muscle 3. Ventrogluteal muscle 4. Vastus lateralis muscle Answer: 4 Rationale: The vastus lateralis muscle is the best choice for all age groups and should always be used in children younger than 3 years of age. The ventrogluteal muscle is safe for children older than 18 months because it is free of major blood vessels and nerves. The dorsogluteal muscle develops with walking, so it should not be used until the child has been walking for at least 1 year. The deltoid muscle is not used for children because the small muscle mass cannot hold large volumes of medication or medications that must be injected deep into the muscle mass.

A client wishes to donate blood for a family member and asks the nurse about the procedure for identifying compatibility. The nurse tells the client that which test will be done to test compatibility?

1. Eosinophil count 2. Monocyte count 3. Indirect Coombs' 4. Red blood cell count Answer: 3 Rationale: The indirect Coombs' test detects circulating antibodies against red blood cells (RBCs) and is the "screening" component of the prescription to "type and screen" a client's blood. This test is used in addition to the ABO typing, which is normally done to determine blood type. The direct Coombs' test is used to detect idiopathic hemolytic anemia, by detecting the presence of autoantibodies against the client's RBCs. Eosinophil and monocyte counts are part of a complete blood count, a routine hematological screening test. A red blood cell count is also part of a complete blood count and determines the number of circulating red blood cells but does not determine compatibility.

A nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells. Before leaving the room, the nurse tells the client that it is most important to immediately report which of the following signs if they occur?

1. Fatigue 2. Nausea 3. Headache 4. Backache Answer: 4 Rationale: The nurse should instruct the client to immediately report signs of a transfusion reaction, which can include a backache among other signs such as chills, itching, or rash. These signs of transfusion reaction would require the nurse to stop the transfusion. Fatigue, headache, and nausea are not specifically related to transfusion reaction; however, if these occur, the nurse should investigate their cause.

When assisting in the identification process required before a blood transfusion, which action will the nurse take when it is noted that all of the necessary information is correct, except for the client's name?

1. Hang the unit of blood because the blood information matches. 2. Notify the health care provider that the client will not receive any blood. 3. Re-label the transfusion with the correct name. 4. Call the blood bank about the discrepancy. Answer: 4 Rationale: The nurse should call the blood bank and notify the personnel about the discrepancy. The unit should not be hung, and information on the requisition or bag should not be altered in any way. The nurse assigned to the client may choose to call the health care provider, but the nature of that communication would be to report a delay in the transfusion because of the problem, not to report that there would be no transfusion.

A nurse enters a client's room to check the client who began receiving a blood transfusion 45 minutes earlier. The client is flushed and dyspneic. The nurse listens to the client's lung sounds and notes the presence of crackles in the lung bases. The client states that she was just going to ring the call bell for the nurse. The nurse determines that this client is most likely experiencing which of the following complications of blood transfusion therapy?

1. Hypovolemic shock 2. Transfusion reaction 3. Fluid (circulatory) overload 4. Bacteremia Answer: 3 Rationale: With fluid (circulatory) overload, the client has the presence of crackles in the lungs in addition to dyspnea. Hypovolemic shock (restlessness, increased pulse, decreased blood pressure) is not likely to occur in a client receiving fluids. An allergic reaction, which is one type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. With bacteremia, the client would have a fever, which is not part of the clinical picture presented.

A client with a peripheral intravenous (IV) site calls the nurse to the room and tells the nurse that the IV site is swollen. The nurse checks the IV site and notes that it is also cool and pale and that the IV has stopped running. The nurse documents that which has probably occurred?

1. Infection 2. Phlebitis 3. Infiltration 4. Thrombosis Answer: 3 Rationale: An infiltrated IV is one that has dislodged from the vein, and is lying in subcutaneous tissue. The pallor, coolness, and swelling are the result of IV fluid being deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The corrective action is to remove the catheter and start a new IV line. The other three options are likely to be accompanied by warmth at the site, not coolness.

A client receiving intravenous (IV) fluid therapy complains of burning and a feeling of tightness at the IV insertion site. On assessment, the nurse detects coolness and swelling at the site and notes that the IV rate has slowed. The nurse determines that which of the following has occurred?

1. Infection 2. Phlebitis 3. Infiltration 4. Thrombosis Answer: 3 Rationale: An infiltrated IV line is one that has dislodged from the vein and is lying in subcutaneous tissue. Pallor, coolness, and swelling at the IV site result when IV fluid is deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of IV solution will slow down or stop. The corrective action is to remove the catheter and start a new IV line at another site. Options 1, 2, and 4 are likely to be accompanied by warmth at the site, not coolness.

A nurse notes redness, warmth, and a yellowish drainage at the insertion site of a central venous catheter in a client receiving parenteral nutrition. The nurse immediately reports these findings, knowing that:

1. Infections of a central catheter site can lead to septicemia. 2. The client is allergic to the dressing material covering the site. 3. The parenteral nutrition solution has infiltrated and must be stopped. 4. The client is experiencing an allergy to the parenteral nutrition solution. Answer: 1 Rationale: Redness, warmth, and purulent drainage are signs of an infection, not an allergic reaction. Infiltration causes the surrounding tissue to become cool and pale.

A nurse is preparing to administer an acetaminophen (Tylenol) suppository to a child. The nurse plans to:

1. Insert the suppository 1 to 2 cm into the rectum. 2. Position the child on the right side with the left leg flexed. 3. Ask the child to expel the suppository after it has been inserted. 4. Ask the child to hold the breath during insertion of the suppository. Answer: 1 Rationale: When administering a suppository to a child, the child should be positioned on the left side with the right leg flexed. The child should be asked to take a deep breath to further relax the sphincter. The suppository is gently inserted past the internal sphincter; the distance required to place the medication is approximately 1 to 2 cm. After insertion, the buttocks should be held together until the urge to expel the suppository has passed.

The medication prescribed is hydromorphone hydrochloride (Dilaudid), 3 mg intramuscular every 4 hours as needed. The medication label reads hydromorphone hydrochloride (Dilaudid), 4 mg/1 mL. The nurse prepares to administer how many mL to the client?

Answer: 0.75 Rationale: Follow the formula for dosage calculation.

A normal saline 0.9% intravenous (IV) solution is prescribed for a client. The IV is to run at 100 mL/hr. The nurse prepares the solution, understanding that which of the following is a characteristic of this type of solution?

1. Is hypertonic with the plasma and other body fluids 2. Is hypotonic with the plasma and other body fluids 3. Affects the plasma osmolarity 4. Is the same solution as sodium chloride 0.9% Answer: 4 Rationale: Sodium chloride 0.9% is the same solution as normal saline 0.9%. This solution is isotonic, and isotonic solutions frequently are used for intravenous infusion because they do not affect the plasma osmolarity.

Intravenous (IV) lactated Ringer's solution is prescribed for a postoperative client. A nursing student is caring for the client, and the nursing instructor asks the student about the tonicity of the prescribed IV solution. The student responds by telling the instructor that the solution is:

1. Isotonic 2. Hypotonic 3. Hypertonic 4. Normotonic Answer: 1 Rationale: Lactated Ringer's solution is an isotonic solution. Other isotonic solutions include 5% dextrose in water, 0.9% normal saline, and 5% dextrose in 0.225% normal saline. 0.45% normal saline is hypotonic; 10% dextrose in water, 5% dextrose in 0.9% normal saline, and 5% dextrose in 0.45% normal saline are hypertonic solutions.

A nurse is instructed to complete a medication reconciliation form on a newly admitted client. Why is it important for the nurse to ensure that this process is completed accurately?

1. It makes sure that the client's medical insurance will pay the cost of the medications. 2. It educates the client about the reason why medications are being given. 3. It notifies the client's pharmacy about the medications the client is taking in the hospital. 4. It helps to make sure that the health care provider is aware of all of the medications the client is taking and has been taking at home. Answer: 4 Rationale: Medication reconciliation is an organized process to avoid medication errors by comparing the client's medication prescriptions to all of the medications that the client has been taking. Health care providers must review this list and prescribe appropriate medications. This process is not used to educate clients and families on current medications or to determine if the client's insurance will pay the cost of the medications. Notifying the pharmacy of what medications the client is taking while in the hospital is not a specific purpose of the medication reconciliation process.

A nurse is assigned to care for a client receiving parenteral nutrition via the subclavian vein. The nurse would identify which intervention in the plan of care for the client as the priority?

1. Monitoring the insertion site for signs of infection 2. Maintaining the client in a semi-Fowler's position on his back at all times 3. Encouraging the client to cough and deep breathe 4. Taking the blood pressure hourly Answer: 1 Rationale: Parenteral nutrition that is infusing via a central line, such as through the subclavian vein, is more likely to become infected than a standard peripheral intravenous line. Infection may quickly lead to sepsis. At least every 4 to 6 hours, the insertion site should be inspected. It is not necessary to place the client in the semi-Fowler's position on his back at all times. It is advisable to encourage a client to cough and deep breathe, but this action does not relate to the subject of the question. It is not necessary to take the blood pressure hourly.

A nurse is caring for a client who had a small bowel resection the previous day and has continuous gastric suction attached to the nasogastric tube. Which intravenous solution should the nurse anticipate to be prescribed for the client?

1. Normal saline 2. 25% albumin 3. 5% dextrose in water 4. Lactated Ringer's solution Answer: 4 Rationale: Electrolyte solutions such as lactated Ringer's are used to replace fluid from gastrointestinal (GI) tract losses. Albumin is used for shock and protein replacement; 5% dextrose in water contains only glucose and no electrolytes to replace gastrointestinal losses. Normal saline contains no glucose, and glucose is essential for calories when a client takes nothing per mouth (NPO).

A client has been receiving parenteral nutrition at 125 mL/hr for 5 days. On data collection, the LPN notes bilateral crackles and 2+ pedal edema and that the client has gained 3 pounds in 5 days. Which nursing action would be appropriate as the initial action?

1. Notify the registered nurse of the findings. 2. Encourage the client to cough and deep breathe. 3. Check the client's medication prescriptions for a diuretic. 4. Slow the parenteral nutrition infusion rate to 100 mL/hr. Answer: 1 Rationale: The client is showing signs of fluid retention and possible excess fluid intake. Crackles, edema, and weight gain signify fluid shifts from intravascular spaces to the interstitial spaces. The problem may or may not be related to the parenteral nutrition. Other possible causes of fluid retention include impaired respiratory and cardiovascular function, impaired kidney function, or a combination of factors. The nurse needs to notify the registered nurse of the findings. The registered nurse will then notify the health care provider for further prescriptions. Option 2 will have little, if any, effect on peripheral edema and weight gain. Option 3 infers that a diuretic will help the situation, and it is possible that the health care provider will prescribe a diuretic; however, the health care provider needs to be aware of the change in the physical condition of the client. The nurse should not increase or decrease the rate of parenteral nutrition infusions without a health care provider's prescription to do so.

A health care provider's prescription reads: tobramycin sulfate, 7.5 mg intramuscularly twice daily. The medication label states 10 mg/mL. How many mL will the nurse give to administer one dose?

Answer: 0.75 Rationale: Use the formula for calculating the appropriate medication dosage.

A nurse is doing a routine assessment of a client's peripheral IV site. The nurse notes that the site is cool, pale, and swollen and that the IV has stopped running. The nurse determines that which of the following has probably occurred?

1. Phlebitis 2. Infection 3. Infiltration 4. Thrombosis Answer: 3 Rationale: An infiltrated IV is one that has dislodged from the vein and is lying in subcutaneous tissue. The pallor, coolness, and swelling are the result of IV fluid being deposited into the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The other three options identify complications that are likely to be accompanied by warmth at the site rather than coolness.

A client rings the call bell and complains of pain at the site of an intravenous (IV) infusion. The licensed practical nurse (LPN) inspects the site and determines that the client has developed phlebitis. The LPN would plan to avoid which of the following actions in the care of this client?

1. Prepare to apply warm moist packs to the site. 2. Prepare to start a new line in a proximal portion of the same vein. 3. Prepare to discontinue the IV catheter at that site. 4. Notify the registered nurse (RN). Answer: 2 Rationale: As directed, the LPN should discontinue the IV at the phlebitic site and apply warm, moist compresses to the area to speed resolution of the inflammation. Because phlebitis has occurred, the LPN also notifies the RN, who will contact the health care provider about the IV complication. The LPN should prepare for restarting the IV in a vein other than the one that has developed phlebitis.

One unit of packed red blood cells has been prescribed for a client postoperatively because the client's hemoglobin level is low. The health care provider prescribes diphenhydramine (Benadryl) to be administered before the administration of the transfusion. The nurse determines that this medication has been prescribed to:

1. Prevent a fever. 2. Promote sedation. 3. Prevent a rash and pruritus. 4. Promote bone marrow absorption. Answer: 3 Rationale: An urticarial reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine, such as diphenhydramine. Options 1, 2, and 4 are incorrect statements. Acetaminophen (Tylenol), however, may be prescribed before the administration to assist in preventing an elevated temperature.

A client is complaining of pain at the site of the intravenous (IV) infusion device. The nurse checks the IV site and determines that the client has developed phlebitis. Which action should the nurse take?

1. Remove the IV. 2. Apply ice packs to the site. 3. Slow the rate of the IV infusion. 4. Change the dressing on the IV site. Answer: 1 Rationale: The nurse should plan to remove the IV and apply warm moist compresses to the area to speed resolution of the inflammation. Ice packs should not be applied, and slowing the rate and changing the dressing are interventions that delay removing the IV.

A nurse is checking a peripheral intravenous (IV) site and notes blanching, coolness, and edema at the site. The nurse should do which first?

1. Remove the IV. 2. Check for a blood return. 3. Apply a warm compress. 4. Measure the area of infiltration. Answer: 1 Rationale: Blanching, coolness, and edema of the IV site are all classic signs of infiltration. Because infiltration can be damaging to the surrounding tissue, the first action by the nurse is to remove the IV to prevent any further damage. The nurse should not depend solely on the blood return for assurance that the cannula is in the vein because a blood return may be present even if the cannula is only partially in the vein. Warm compresses may be applied to the infiltrated area only after the IV is removed and only if the infiltrated solution is not damaging to the surrounding tissues. Measuring the area of infiltration should be done only after the IV has been removed so that tissue damage is thoroughly assessed.

A client who has been receiving parenteral nutrition by way of a central venous access device complains of chest pain and dyspnea. The nurse quickly assesses the client's vital signs and notes that the pulse rate has increased and that the blood pressure has dropped. The nurse determines that the client is likely experiencing:

1. Sepsis 2. Air embolism 3. Fluid overload 4. Fluid imbalance Answer: 2 Rationale: The signs and symptoms of air embolism include chest pain, dyspnea, hypoxia, anxiety, tachycardia, and hypotension. The nurse also would hear a loud churning sound over the pericardium on auscultation of the chest. The signs and symptoms of sepsis include fever, chills, and general malaise. The signs and symptoms of a fluid imbalance depend on the type of imbalance that the client is experiencing. Fluid overload causes increased intravascular volume, which increases the blood pressure and the pulse rate as the heart tries to pump the extra fluid volume. Fluid overload also causes neck vein distention and the shifting of fluid into the alveoli, resulting in lung crackles. Complications would be reported to the registered nurse and/or the health care provider immediately.

A client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 15:00. The nurse, making rounds at 15:45, finds that the client is complaining of a pounding headache, is dyspneic with chills, is apprehensive, and has an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse should take which of the following actions first?

1. Sit the client up in bed. 2. Place the client in Trendelenburg's position. 3. Shut off the infusion. 4. Discontinue the angiocatheter and IV. Answer: 3 Rationale: The client's symptoms are compatible with speed shock. This may be verified by noting that 600 mL has infused in the course of 45 minutes. The first action of the nurse from the options presented is to shut off the infusion. The nurse may elevate the head of the bed to aid the client's breathing. Placing the client in Trendelenburg's position is not an appropriate action. The registered nurse is notified immediately, who then contacts the health care provider. The angiocatheter does not need to be removed. It may be needed to treat this complication.

A nurse hangs a 1000-mL bag of intravenous (IV) fluid on an assigned client. Forty-five minutes later, the nurse notes that the client is complaining of a pounding headache, is dyspneic, is apprehensive, and has an increased pulse rate. The IV bag has 500 mL remaining. The nurse should take which of the following actions first?

1. Sit the client up in bed. 2. Slow the rate of infusion. 3. Shut off the IV infusion. 4. Remove the IV. Answer: 3 Rationale: The client's symptoms are compatible with speed shock. This may be verified by noting that 500 mL has infused in the course of 45 minutes. The first action of the nurse is to shut off the IV infusion. Other actions may follow in rapid sequence. The nurse may elevate the head of the bed to aid the client's breathing. The health care provider is notified immediately. Slowing the infusion rate is inappropriate because the client will continue receiving fluid. The IV does not have to be removed; it may be needed to manage the complication.

A nurse is assisting with caring for a client who is receiving a unit of packed red blood cells. The nurse tells the client that it is most important to report which of the following signs immediately?

1. Sore throat or earache 2. Chills, itching, or rash 3. Unusual sleepiness or fatigue 4. Mild discomfort at the catheter site Answer: 2 Rationale: The client is told to report chills, itching, or rash immediately, because these could be signs of a possible transfusion reaction. Mild discomfort at the catheter site may be indicative of a problem, or it could result from the size of the IV catheter required to infuse the blood product. Sore throat, earache, sleepiness, and fatigue, are unrelated to a transfusion reaction.

A nurse checks the peripheral intravenous (IV) site dressing and notes that it is damp and that the tape is loose. The nurse would first:

1. Stop the infusion immediately. 2. Check that the tubing is securely attached. 3. Increase the IV flow rate to assess for further leaking. 4. Prepare to restart the IV at a site medial to the original site. Answer: 2 Rationale: If there is leakage at the IV site, the nurse should first locate the source. The nurse should assess the site further to be certain that all connections are secure. The nurse should not increase the IV flow rate. Although it is true that it may leak more, it may also cause more tissue damage if the IV was infiltrating. Information about the IV must first be gathered so that the cause of the leaking can be determined before interventions can be planned.

A nursing student is assisting the clinic nurse with the administration of immunizations in the well-baby clinic. The student is asked to administer a measles, mumps, and rubella (MMR) vaccine to a child and prepares to administer the vaccine:

1. Subcutaneously in the gluteal muscle 2. Subcutaneously in the upper arm 3. Intramuscularly in the deltoid muscle 4. Intramuscularly in the thigh Answer: 2 Rationale: MMR is administered subcutaneously into the outer aspect of the upper arm. Each child should receive two vaccinations, the first between 12 and 15 months of age and the second between 4 and 6 years or 11 and 12 years. Options 1, 3, and 4 are incorrect.

A client requiring upcoming surgery is extremely anxious about the need for possible blood transfusion and is concerned about the risk of infection from contaminated blood. The nurse suggests that the client consider which option as an effective method to minimize this risk?

1. Take iron supplements before surgery to boost hemoglobin levels. 2. Request that any donated blood be screened twice by the blood bank. 3. Ask a friend or family member to donate blood ahead of time. 4. Arrange an autologous blood donation before the planned surgery. Answer: 4 Rationale: Donating autologous blood to be reinfused as needed during or after surgery minimizes the risk of cross-infection from contaminated blood. The next most effective way is to ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are helpful for iron deficiency anemia but are not helpful in affecting the possibility of infection.

Cloxacillin sodium (Tegopen) 100 mg orally every 8 hours is prescribed for a child with an elevated temperature who is suspected of having a respiratory tract infection. The child weighs 17 pounds. The safe pediatric dosage is 50 mg/kg/day. Which statement most accurately describes the prescribed dosage for this child?

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe dosage range. 4. There is not enough information to determine the safe dosage. Answer: 1 Rationale: Convert pounds to kilograms by dividing by 2.2. Pounds to kilograms: 17 lb divided by 2.2 lb/kg = 7.72 kg Safe dosage parameter: 50 mg/kg/day × 7.72 kg = 386 mg/day Dosage frequency: 100 mg × 3 doses (every 8 hours) = 300 mg/day The dosage is within the safe dosage range.

Penicillin V (Pen-VK), 250 mg orally every 8 hours, is prescribed for a child with a respiratory infection. The child's weight is 45 pounds. The safe pediatric dosage is 25 to 50 mg/kg/day. Which statement most accurately describes the prescribed dosage for this child?

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe dosage range. 4. There is not enough information to determine the safe dosage. Answer: 3 Rationale: Convert pounds to kilograms by dividing by 2.2 and then determine the dosage frequency. Pounds to kilograms: 45 lb divided by 2.2 lb/kg = 20.45 kg Dosage parameters: 25 mg/kg/day × 20.45 kg = 511.25 mg/day 50 mg/kg/day × 20.45 kg = 1022.5 mg/day Dosage frequency: 250 mg × 3 doses (every 8 hours) = 750 mg/day The dosage is within the safe dosage range.

A health care provider has prescribed phenobarbital sodium (Luminal Sodium), 25 mg orally twice daily for a child with febrile seizures. The child's weight is 7.2 kg. The safe pediatric dosage is 1 to 6 mg/kg/day. The nurse determines that:

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe range. 4. There is not enough information to determine the safe dosage. Answer: 2 Rationale: Calculate the dosage parameters, using the safe dosage range identified in the question and the child's weight in kilograms. Next determine the total daily dosage. Dosage parameters: 1 mg/kg/day × 7.2 kg = 7.2 mg/day 6 mg/ kg/day × 7.2 kg = 43.2 mg/day Dosage frequency: 25 mg × 2 doses = 50 mg/day The dosage is too high.

Diphenhydramine hydrochloride (Benadryl) 25 mg orally every 6 hours is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse determines that:

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe range. 4. There is not enough information to determine the safe dosage. Answer: 3 Rationale: Calculate the dosage parameters, using the safe dosage range identified in the question and the child's weight in kilograms. Next, determine the total daily dosage. Dosage parameters: 5 mg/kg × 25 kg = 125 mg/day Dosage frequency: 25 mg × 4 doses = 100 mg/day The dosage is safe.

A nurse is checking postoperative prescriptions and planning care for a 110-pound child after spinal fusion. Morphine sulfate, 8 mg subcutaneously every 4 hours as needed (PRN) for pain, is prescribed. The pediatric drug reference states that the safe dosage is 0.1 to 0.2 mg/kg/dose every 2 to 4 hours. From this information, the nurse determines that:

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe range. 4. There is not enough information to determine the safe dosage. Answer: 3 Rationale: Convert pounds to kilograms by dividing by 2.2, because 1 kg = 2.2 pounds. Therefore, 110 lb divided by 2.2 = 50 kg. Then determine the dosage parameters. Dosage parameters: 0.1 mg/kg × 50 kg = 5 mg 0.2 mg/kg × 50 kg = 10 mg The dosage is safe.

Penicillin G procaine (Wycillin), 1 million units intramuscularly, has been prescribed for the child with a throat infection. The child's weight is 62 pounds. The safe pediatric dosage for a child that weighs greater than 60 pounds is 600,000 to 1,200,000 units daily. The nurse determines that:

1. The dosage is too low. 2. The dosage is too high. 3. The dosage is within the safe range. 4. There is not enough information to determine the safe dosage. Answer: 3 Rationale: The child's weight is 62 pounds, which falls within the safe pediatric dosage range of 600,000 to 1,200,000 units daily. The dosage is safe.

Morphine sulfate, 2.5 mg, is prescribed for a child. The safe pediatric dose is 0.05 to 0.1 mg/kg/dose. The child weighs 50 kg. Which statement most accurately describes the prescribed dosage for this child?

1. The dose is too low. 2. The dose is too high. 3. The dose is within the safe dosage range. 4. There is not enough information to determine the safe dosage range. Answer: 3 Rationale: Use the formula for calculating a safe dosage range. Dosage parameters: 0.05 mg/kg/dose × 50 kg = 2.5 mg/dose 0.1 mg/kg/dose × 50 kg = 5 mg/dose The dose is within the safe dosage range.

Diphenhydramine hydrochloride (Benadryl), 25 mg orally every 6 hours, is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse determines that:

1. The dose is too low. 2. The dose is too high. 3. The dose is within the safe dosage range. 4. There is not enough information to determine the safe dose. Answer: 3 Rationale: Use the formula for calculating a safe dosage range. Safe dose parameter: 5 mg/kg/day × 25 kg = 125 mg/day Dosage frequency: 25 mg × 4 doses (every 6 hours) = 100 mg/day The dose is within the safe dosage range.

A client who was receiving a blood transfusion has experienced a transfusion reaction. The nurse sends the blood bag that was used for the client to which of the following areas?

1. The pharmacy 2. The laboratory 3. The blood bank 4. The risk-management department Answer: 3 Rationale: The nurse prepares to return the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures that are needed after a transfusion reaction has been documented. Options 1, 2, and 4 are incorrect.

A nurse takes a client's temperature before giving a blood transfusion. The temperature is 100° F orally. The nurse reports the finding to the registered nurse and anticipates that which of the following actions will take place?

1. The transfusion will begin as prescribed. 2. The blood will be held, and the health care provider will be notified. 3. The transfusion will begin after the administration of an antihistamine. 4. The transfusion will begin after the administration of 600 mg of acetaminophen (Tylenol). Answer: 2 Rationale: If the client has a temperature of 100° F or more, the unit of blood should be held until the health care provider is notified and has the opportunity to give further prescriptions. The other options are incorrect actions.

A client is scheduled for insertion of a peripherally inserted central catheter (PICC), and the nurse explains the advantages of this catheter. Which statement by the client indicates a lack of understanding about this type of catheter?

1. There is less pain and discomfort. 2. This type of catheter is very reliable. 3. It is reasonable in cost. 4. It is specifically designed for short-term use. Answer: 4 Rationale: PICC catheters are intended to be used for clients who need long-term catheter placement. It is reasonable in cost because the catheter does not need routine replacement, as do traditional peripheral IV catheters. The catheter is more comfortable for the client because there is no repeated venipuncture with catheter change. The catheter is also very reliable. It is less likely to infiltrate and can be used for administration of a number of different types of medications.

A client has a prescription to receive 1000 mL of 5% dextrose in 0.45% sodium chloride. After gathering the appropriate equipment, the nurse takes which action first before spiking the IV bag with the tubing?

1. Uncaps the distal end of the tubing 2. Uncaps the spike portion of the tubing 3. Opens the roller clamp on the IV tubing 4. Closes the roller clamp on the IV tubing Answer: 4 Rationale: The nurse should first clamp the tubing to prevent the solution from running freely through the tubing after it is attached to the IV bag. The nurse should next uncap the proximal (spike) portion of the tubing and attach it to the IV bag. The roller clamp is then opened slowly, and the fluid is allowed to flow through the tubing in a controlled fashion to prevent air from remaining in parts of the tubing.

A nurse teaches a client how to administer enoxaparin (Lovenox) subcutaneously. The nurse determines that the client understands the correct procedure if the client does which on a return demonstration?

1. Uses a 1-inch needle 2. Massages after injection 3. Aspirates before injection 4. Bunches the skin before injection Answer: 4 Rationale: With subcutaneous injection of enoxaparin, the administration technique is the same as for heparin. The smallest-gauge needle available (25- to 27-gauge) is used to prevent injection site hematoma, a "bunching" technique is used, and the medication is injected deep into fatty abdominal tissue. Aspiration before injecting is not done, and the injection site is not massaged. The needle is withdrawn gently to minimize bleeding, and injection sites are rotated systematically.

A nurse is assigned to care for a client with a peripheral IV infusion. The nurse is providing hygiene care to the client and would avoid which of the following while changing the client's hospital gown?

1. Using a hospital gown with snaps at the sleeves 2. Disconnecting the IV tubing from the catheter in the vein 3. Checking the IV flow rate immediately after changing the hospital gown 4. Putting the bag and tubing through the sleeve, followed by the client's arm Answer: 2 Rationale: The tubing should not be removed from the IV catheter. With each break in the system, there is an increased chance of introducing bacteria into the system, which can lead to infection. Options 1 and 4 are appropriate. The flow rate should be checked immediately after changing the hospital gown, because the position of the roller clamp may have been affected during the change.

A client with an indwelling intravenous (IV) catheter has a prescription for an IV solution to be changed to 1000 mL 0.9% sodium chloride to infuse at 100 mL/hr. When determining the rationale for the change in fluid, the nurse interprets that the client probably needs this type of solution because it:

1. Will increase the plasma osmolarity 2. Will decrease the plasma osmolarity 3. Is isotonic with the plasma and other body fluids 4. Is hypotonic with the plasma and other body fluids Answer: 3 Rationale: Sodium chloride 0.9% is isotonic and is frequently used for intravenous infusion because it does not affect the plasma osmolarity. Options 1, 2, and 4 are incorrect regarding this type of solution.

A nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to attach the distal end of the IV tubing to a needleless device, the tubing drops and hits the top of the medication cart. Which of the following is the appropriate action by the nurse?

1. Wipe the tubing port with povidone-iodine. 2. Scrub the needleless device with an alcohol swab. 3. Attach a new needleless device. 4. Change the IV tubing. Answer: 4 Rationale: The nurse should change the IV tubing because it has become contaminated and could cause systemic infection to the client. Wiping the port with povidone-iodine is insufficient and would be contraindicated regardless, because the catheter will be attached directly to an angiocatheter in the client's vein. The needleless device has not been contaminated and does not need replacement or cleansing.

A client with sickle cell anemia is being treated for sickle cell crisis. The health care provider prescribes morphine sulfate 2 mg. The concentration of the vial is 10 mg/mL of solution. How many milliliters of solution should the nurse administer?

Answer: 0.2 Rationale: Use the formula for calculating medication doses.

A client has just delivered an 8 lb 8 oz infant boy after a prolonged labor. The pediatrician prescribes ampicillin 50 mg to be given by the intramuscular route to the newborn every 8 hours. The nurse is initiating the first dose. Ampicillin is available in powder form for injection. The directions on the bottle indicate reconstitution with 0.9 mL of sterile diluent for a concentration of 125 mg/mL. How many mL would the nurse prepare to administer the first dose?

Answer: 0.4 Rationale: Use the dosage calculation formula.

A health care provider prescribes an intramuscular (IM) dose of 250,000 units of penicillin G benzathine (Bicillin). The label on the 10-mL ampule sent from the pharmacy reads penicillin G benzathine 300,000 units/mL. How much medication will the nurse prepare to administer the correct dose? Round to the nearest tenth position.

Answer: 0.8 Rationale: Use the formula for calculating the appropriate medication dosage. In this question, it is not necessary to perform a conversion. The data needed to perform this calculation are the health care provider's prescription (250,000 units of penicillin G benzathine) and the available amount of 300,000 units/mL.

A health care provider prescribes meperidine hydrochloride (Demerol), 40 mg intramuscularly stat, for a postoperative client in pain. The medication label states meperidine hydrochloride, 50 mg/mL. How many mL will the nurse prepare to administer to the client?

Answer: 0.8 Rationale: Use the formula for calculating the medication dosage. In this question, it is not necessary to perform a conversion.

A health care provider prescribes atenolol (Tenormin) 0.05 g orally daily. The label on the medication bottle states, atenolol 50-mg tablets. How many tablet(s) will the nurse administer to the client?

Answer: 1 Rationale: Convert 0.05 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore 0.05 g = 50 mg. The nurse will administer one tablet.

A health care provider's prescription reads "meperidine hydrochloride (Demerol) 125 mg by the intramuscular route stat." The medication vial reads 100 mg/mL. How many milliliters of the medication would the nurse draw into the syringe for injection?

Answer: 1.25 Rationale: Use the formula for calculating the appropriate medication dose. In this question, it is not necessary to perform a conversion.

A health care provider prescribes levothyroxine (Synthroid) 150 mcg orally daily for a client with hypothyroidism. The medication label states, 0.1 mg per tablet. The home care nurse will instruct the client to take how many tablet(s)?

Answer: 1.5 Rationale: Convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000 or move the decimal three places to the left. Therefore 150 mcg = 0.15 mg. Next, use the formula for determining the correct dosage.

A health care provider has prescribed a liquid oral suspension of amoxicillin (Amoxil). The prescription reads 0.25 gram (g) orally three times daily. How many milliliters (mL) should the nurse administer to the client per dose? Refer to figure.

Answer: 10 Rationale: Convert grams to milligrams first before using the formula. To convert larger to smaller, move the decimal point three places to the right. Therefore, 0.25 gram = 250 mg.

A health care provider prescribes potassium chloride (KCl) elixir, 20 mEq orally twice daily. The medication label states potassium chloride (KCl), 30 mEq/15 mL. The nurse prepares to administer the morning dose. How many milliliters will the nurse prepare to administer one dose?

Answer: 10 Rationale: Follow the formula for dosage calculation.

A health care provider prescribes one unit of packed red blood cells to infuse over 4 hours. One unit of blood contains 250 mL, and the drop factor is 10 gtt/1 mL. The registered nurse asks the licensed practical nurse (LPN) to assist with monitoring the flow rate during the infusion. The LPN monitors the flow rate, knowing that how many gtt/min should infuse? Round the answer to the nearest whole number.

Answer: 10 Rationale: The prescribed 250 mL is to be infused over 4 hours. Follow the formula, and multiply 250 mL by 10 (gtt factor). Then divide the result by 240 minutes (4 hours × 60 minutes). The infusion is to run at 10.4 or 10 gtt/min.

Penicillin V potassium 250 mg orally every 8 hours is prescribed for a child with a respiratory infection. The medication label reads: Penicillin, 125 mg per 5 mL. The nurse has determined that the dosage prescribed is a safe dose for the child. How many milliliters (mL) will the nurse administer to the child per dose?

Answer: 10 Rationale: Use the formula for calculating the appropriate medication dose.

A nurse is preparing to administer 30 mEq of liquid potassium chloride (KCl) to an adult client. The label on the medication bottle reads 40 mEq of KCl/15 mL. The nurse prepares how many milliliters of KCl to administer the correct dose of medication? Round answer to the nearest whole number.

Answer: 11 Rationale: Use the formula to calculate medication dosages.

A health care provider prescribes 3000 mL of 5% dextrose to be administered over a 24-hour period. The nurse prepares to set the infusion rate knowing that how many milliliters per hour are to be administered?

Answer: 125 Rationale: To determine how many milliliters per hour are to be administered, simply divide the total prescribed amount of IV solution by the prescribed time period for infusion. Therefore, 3000 mL divided by 24 hours is 125 mL.

One unit of packed red blood cells is infusing into a client over a 4-hour period. The unit of blood contains 250 mL. The drop factor is 15 drops (gtt) per 1 mL. The nurse determines that the flow rate should be set at how many drops per minute? Round answer to the nearest whole number.

Answer: 16 Rationale: Use the formula to calculate the infusion rate.

A client is to receive 1000 mL of 5% dextrose in water (D5W) at a rate of 100 mL/hr. The drop (gtt) factor is 10 drops (gtt) per mL. The nurse adjusts the flow rate to deliver how many gtt per minute? Round to the nearest whole number.

Answer: 17 Rationale: The first step is to determine how many hours the intravenous (IV) infusion will last. This requires simple division of the total volume of milliliters (mL) to be infused (1000 mL) by the total milliliters per hour (100 mL), which is 10 hours. Then convert hours to minutes, which is 600 minutes. Next use the formula to calculate the flow rate.

Ampicillin sodium 250 mg in 50 mL of normal saline (NS) is being administered over a period of 30 minutes. The drop (gtt) factor is 10 drops (gtt) per mL. The nurse is asked to check the flow rate of the infusion. The nurse determines that the infusion is running at the prescribed rate if the infusion is delivering how many gtt per minute? (Round answer to the nearest whole number.)

Answer: 17 Rationale: The prescribed 50 mL is to be infused over 30 minutes. Follow the formula and multiply 50 mL by 10 (gtt factor). Then divide the result by 30 minutes. Round answer to the nearest whole number. The infusion is to run at 17 gtt/minute.

The medication prescribed is zidovudine (AZT), 0.2 g orally every 4 hours. The medication label states zidovudine (AZT), 100-mg tablets. The nurse prepares to administer how many tablets for one dose?

Answer: 2 Rationale: Convert 0.2 g to mg. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right; therefore 0.2 g = 200 mg.

A health care provider prescribes phenytoin (Dilantin) 0.2 g orally twice daily. The medication label states, 100-mg capsules. How many capsule(s) will the nurse prepare to administer the dose?

Answer: 2 Rationale: Convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore 0.2 g = 200 mg. The nurse will administer two capsules.

A health care provider's prescription reads "phenytoin (Dilantin) 0.2 g orally, twice daily." The medication label states 100-mg capsules. How many capsule(s) will the nurse prepare to administer one dose?

Answer: 2 Rationale: Convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right. Therefore 0.2 g = 200 mg.

A health care provider prescribes tetracycline hydrochloride (Sumycin) 0.5 g orally four times daily. The medication label on the bottle of medication reads tetracycline hydrochloride 250 mg tablets. The nurse prepares how many tablet(s) to administer one dose?

Answer: 2 Rationale: Convert 0.5 g to mg. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0.5 g = 500 mg. Next use the medication calculation formula to determine the correct dose.

The medication prescribed is levodopa (Larodopa), 1 g orally, twice daily. The medication label states levodopa, 500-mg tablets. The nurse prepares to administer how many tablets at the evening dose?

Answer: 2 Rationale: Convert 1 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right; therefore 1 g = 1000 mg.

The medication prescribed is digoxin (Lanoxin), 0.25 mg orally daily. The medication label reads digoxin (Lanoxin), 0.125 mg/tablet. The nurse prepares how many tablet(s) to administer the dose?

Answer: 2 Rationale: Follow the formula for dosage calculation.

The medication prescribed is metoclopramide hydrochloride (Reglan) 10 mg intramuscularly times one dose. The medication label reads metoclopramide hydrochloride (Reglan), 5 mg/mL. The nurse plans to prepare how much medication to administer the dose?

Answer: 2 Rationale: Follow the formula for dosage calculation.

The medication prescribed is prochlorperazine (Compazine), 20 mg intramuscular every 4 hours as needed. The medication label states prochlorperazine 10 mg/mL. The nurse prepares how much medication to administer the dose?

Answer: 2 Rationale: Follow the formula for dosage calculation.

A health care provider prescribes digoxin (Lanoxin) 0.5 mg PO daily for a client with congestive heart failure. The medication label states, 0.25 mg per tablet. How many tablet(s) will the nurse administer to the client?

Answer: 2 Rationale: Follow the formula for the calculation of the correct dose.

A health care provider prescribes atenolol (Tenormin) 0.05 g by mouth daily. The label on the medication bottle states atenolol 25-mg tablets. How many tablets will the nurse administer to the client?

Answer: 2 Rationale: Formula: Convert 0.05 g to mg. In the metric system, to convert the larger unit of measure to the smaller unit of measure, multiply by 1000 or move the decimal three places to the right. Therefore 0.05 g = 50 mg. The nurse will administer two tablets.

A client diagnosed with bipolar disorder is prescribed oral lorazepam (Ativan) 4 mg daily to help manage his manic behavior. The medication label reads 2 mg/mL. To ensure the correct dose, the nurse administers how many milliliters per dose?

Answer: 2 Rationale: Use the formula for calculating medication dosages.

A health care provider prescribes digoxin (Lanoxin), 0.25 mg by mouth (PO) daily, for a client with congestive heart failure. The medication label states 0.125 mg per tablet. How many tablet(s) will the nurse administer to the client?

Answer: 2 Rationale: Use the formula for calculating the appropriate medication dosage. In this question, it is not necessary to perform a conversion.

A health care provider's prescription reads potassium chloride 20 mEq in 1000 mL normal saline and infuse at 100 mL/hr. The nurse assisting in caring for the client determines that the client will receive how many mEq of potassium every hour?

Answer: 2 Rationale: Use the ratio and proportion formula to solve this problem, and then solve for x. 20 mEq: 1000 mL :: x mg: 100 mL Multiply means and extremes then divide to solve for x. 1000x = 2000 x = 2 mEq

A client is to receive 1000 mL of 5% dextrose in water over a period of 125 mL/hr. The drop (gtt) factor is 10 drops (gtt)/mL. The nurse sets the flow rate at how many gtt per minute? (Round answer to the nearest whole number.)

Answer: 21 Rationale: The first step is to determine how many hours the IV administration will infuse. This requires simple division of the total volume of milliliters to be infused (1000 mL) by the total milliliters per hour (125 mL). This calculates to 8 hours and is then converted to minutes, which is 480 minutes (8 hours × 60 minutes). Next, use the formula to calculate the flow rate.

A health care provider prescribes 1000 mL of 0.9% normal saline (NS) to run over 8 hours. The drop (gtt) factor is 10 drops (gtt) per 1 mL. The nurse adjusts the flow rate to run at how many gtt per minute? Round to the nearest whole number.

Answer: 21 Rationale: The prescribed 1000 mL is to be infused over 8 hours. Follow the formula and multiply 1000 mL by 10 (gtt factor). Then divide the result by 480 minutes (8 hours X 60 minutes). The infusion is to run at 20.8 or 21 gtt/minute.

A health care provider prescribes 1000 mL of normal saline (NS) to be infused over a period of 10 hours. The drop (gtt) factor is 15 drops (gtt) per mL. The nurse adjusts the flow rate at how many gtt per minute?

Answer: 25 Rationale: The prescribed 1000 mL is to be infused over 10 hours. Follow the formula and multiply 1000 mL by 15 (gtt factor). Then divide the result by 600 minutes (10 hours x 60 minutes). The infusion is to run at 25 gtt/minute.

A postoperative client has a prescription to receive an intravenous (IV) infusion of 1000 mL normal saline solution over a period of 10 hours. The drop (gtt) factor for the IV infusion set is 15 gtt/mL. The nurse sets the flow rate at how many drops per minute?

Answer: 25 Rationale: Use the formula for calculating IV flow rates.

A client diagnosed with schizophrenia who is being prepared for discharge has been prescribed oral risperidone (Risperdal) 6 mg daily. The medication label reads 2 mg/tablet. To ensure the correct dose, the nurse instructs the client to take how many tablets once daily?

Answer: 3 Rationale: Use the formula for calculating medication dosages.

A client originally was prescribed oral sertraline (Zoloft) 25 mg daily for depression. The dose was been gradually increased in an effort to control the symptoms. The current dose is 75 mg daily. The medication label reads 25 mg/tablet. To receive the correct dose, the nurse instructs the client to take how many tablets once daily?

Answer: 3 Rationale: Use the formula for calculating medication dosages.

A health care provider prescribes phenobarbital (Luminal), 10 mg by mouth daily. The medication bottle is labeled 15 mg/5 mL. How many milliliters will the nurse administer? Round the answer to the nearest tenth.

Answer: 3.3 Rationale: Follow the formula for the calculation of the medication dose.

A health care provider prescribes 1000 mL of 0.45% NaCl (half-normal saline) to run over 8 hours. The drop (gtt) factor is 15 gtt/1 mL. The nurse plans to adjust the flow rate to how many gtt/min? Round the answer to the nearest whole number.

Answer: 31 Rationale: The prescribed 1000 mL is to be infused over 8 hours. Follow the formula, and multiply 1000 mL by 15 (gtt factor). Then divide the result by 480 minutes (8 hours × 60 minutes). The infusion is to run at 31.2 or 31 gtt/min.

A health care provider prescribes 3000 mL of 5% dextrose in water (D5W) to run over a 24-hour period. The drop (gtt) factor is 15 drops (gtt) per 1 mL. The nurse adjusts the flow rate to run at how many gtt per minute? (Round answer to the nearest whole number.)

Answer: 31 Rationale: The prescribed 3000 mL is to be infused over 24 hours. Follow the formula and multiply 3000 mL by 15 (gtt factor). Then divide the result by 1440 minutes (24 hours x 60 minutes). The infusion is to run at 31 gtt/minute.

A health care provider prescribes 3000 mL of 0.9% normal saline to run over 24 hours. The drop (gtt) factor is 15 gtts/mL. The nurse plans to adjust the flow rate at how many gtts per minute? (Round answer to the nearest whole number.)

Answer: 31 Rationale: The prescribed 3000 mL is to be infused over 24 hours. Follow the formula and multiply 3000 mL by 15 (gtt factor). Then divide the result by 1440 minutes (24 hours × 60 minutes). The infusion is to run at 31.2 or 31 gtts/minute.

A nurse is checking the remaining volume in a 1000-mL IV bag that is scheduled to infuse over 8 hours. The nurse has just noted that at 11:00 ᴀᴍ the remaining IV fluid is at the 500-mL level. When she returns at 12:00 noon at which numerical level (mL) should the IV fluid be?

Answer: 375 Rationale: If the IV is scheduled to run over 8 hours, then the hourly rate is 125 mL/hr. Using 500 mL as the reference point, the next hourly marking would be at 375 mL, which is 125 mL less than 500.

The prescription reads to infuse an insulin drip at 12 mL/hr. There are 100 units regular insulin in 250 mL of normal saline. How many units of insulin will the client receive per hour?

Answer: 4.8 Rationale: Use ratio and proportion method of calculation. 100 units: 250 mL = X: 12 mL 250X = 1200 X = 4.8

A health care provider prescribes 1000 mL of 5% dextrose (D5W) to run at 125 mL/hr. The nurse calculates the infusion rate, knowing that it will take how many hours for 1 L to infuse?

Answer: 8 Rationale: To determine how many hours it will take for 1 L to infuse, first recall that 1 L is equal to 1000 mL. Next, divide the 1000 mL by the amount being delivered in 1 hour.

The prescription reads to give ondansetron hydrochloride 0.15 mg/kg of body weight 30 minutes before receiving chemotherapy for the treatment of cancer. The client weighs 132 pounds. How many mg of ondansetron hydrochloride will the nurse administer?

Answer: 9 Rationale: First convert pounds to kilograms 1 pound = 2.2 kg. Divide 132 pounds by 2.2 to yield 60 kg. Therefore the client weighs 60 kg. Then use ratio and proportion to calculate the milligrams: 0.15 mg : 1 kg :: x : 60 kg Multiply means and extremes then divide to solve for x. Therefore, 1x = 9