Medication and I.V. Administration

A 64-year-old client has just had total hip replacement surgery. The physician orders heparin 8,000 units to be administered subcutaneously. The label on the heparin vial reads: "Heparin 10,000 units/ml." How many milliliters of heparin should the nurse draw up in the syringe to administer the correct dose?

0.8 ml RATIONALES: The following formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the equation is as follows: 10,000 units/ml = 8,000 units/X; X = 0.8 ml.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 1. 100 units of regular insulin in normal saline solution 2. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline 3. 100 units of regular insulin in dextrose 5% in water 4. 100 units of NPH insulin in dextrose 5% in water

1. 100 units of regular insulin in normal insulin solution RATIONALE: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in therapy, a dextrose solution is administered to prevent hypoglycemia.

A nurse is developing a drug therapy regimen that won't interfere with a client's lifestyle. When doing this, the nurse must consider the drug's: 1. adverse effects. 2. route of excretion. 3. peak concentration time. 4. steady-state duration of action.

1. adverse effects. RATIONALE: When developing a drug therapy regimen that won't interfere with a client's lifestyle, the nurse must consider the drug's adverse effects because these may result in noncompliance. A drug's excretion route, peak concentration time, and steady-state duration of action are important considerations when developing a drug therapy regimen; however, they're related to the drug's physiologic effects and don't affect the client's lifestyle.

A client with an I.V. line in place complains of pain at the insertion site. Assessment of the site reveals a vein that is red, warm, and hard. Which of the following actions should the nurse take? Select all that apply: 1. Slow the infusion rate. 2. Discontinue the infusion. 3. Restart the infusion distal to the discontinued I.V. site. 4. Have the registered nurse restart the infusion in the opposite arm. 5. Apply warm soaks to the I.V. site. 6. Document assessment of the I.V. site, the nurse's actions, and the client's response to the situation.

2. Discontinue the infusion. 4. Have the registered nurse restart the infusion in the opposite arm. 5. Apply warm soaks to the I.V. site. 6. Document assessment of the I.V. site, the nurse's actions, and the client's response to the situation. RATIONALES: Redness, warmth, pain, and a hard, cordlike vein at the I.V. insertion site suggest that the client has phlebitis. The nurse should discontinue the I.V. line and have the registered nurse insert a new I.V. catheter proximal to or above the discontinued I.V. site or in the other arm. Applying warm soaks to the site reduces inflammation. The nurse should document assessment of the I.V. site, actions taken, and the client's response to the situation. Slowing the infusion rate won't reduce the phlebitis. Restarting the infusion at a site distal to the phlebitis may contribute to the inflammation.

A client who underwent abdominal surgery returns from the postanesthesia care unit with a nasogastric (NG) tube in place. The client complains of nausea. While preparing to attach the client's NG tube to intermittent suction, the nurse notices that the ground on the suction machine's plug is broken. What should the nurse do first? 1. Use the machine as is because the client is nauseous. 2. Obtain another machine from central supply. 3. Tape the broken ground to the plug and use the machine. 4. Report the problem to the supervisor.

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

If a manual end-of-shif count of controlled substances isn't correct, the nurse's best action is to: 1. investigate and correct the discrepancy, if possible, before proceeding. 2. immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy. 3. document the discrepancy on an incident report. 4. document the discrepancy on a opioid-inventory form.

2. immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy. RATIONALE: Reporting a noted discrepancy to the nurse-manager, nursing supervisor, and pharmacy should be the nurse's first step. Although the discrepancy may be easily corrected if investigated, the investigation isn't a nurse's responsibility. Documenting discrepancy on an incident report or opioid-inventory form doesn't address the problem.

A client is to receive a glycerin suppository. When inserting the suppository, the nurse should advance it approximately how far into the client's rectum? 1. 1" (2.5 cm) 2. 2" (5 cm) 3. 3" (7.5 cm) 4. 4" (10 cm)

3. 3" (7.5 cm) RATIONALES: The nurse should advance a rectal suppository far enough into the rectum to pass the internal anal sphincter. In an adult, this distance is approximately 3".

The physician orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V. tubing delivers 15 drops/ml. The nurse should check that the I.V. is infusing at a rate of: 1. 15 drops/minute. 2. 21 drops/minute. 3. 32 drops/minute. 4. 125 drops/minute.

3. 32 drops/minute. RATIONALES: Giving 1,000 ml over 8 hours is the same as giving 125 ml over 1 hour (60 minutes). Find the number of milliliters per minute as follows: 125/60 minutes = X/1 minute 60X = 125 = 2.1 ml/minute To find the number of drops per minute: 2.1 ml/X gtt = 1 ml/15 gtt X = 32 gtt/minute, or 32 drops/minute

While performing rounds, a nurse finds the a client is receiving the wrong I.V. solution. The nurse's initial response should be to: 1. Remove the I.V. catheter and call the physician. 2. write up an incident report describing the mistake. 3. slow the I.V. flow rate and hang the appropriate solution. 4. wait until the next bottle is due and then change to the proper solution.

3. slow the I.V. flow rate and hang the appropriate solution. RATIONALE: When a client is getting the wrong I.V. solution, the nurse should maintain access and start the proper solution. She doesn't have to remove the catheter. Doing so would subject the client to unnecessary needle sticks. Waiting until the next bottle is due is inappropriate and places the client at risk for problems and the nurse in legal jeopardy. After starting the correct solution, the nurse should complete an incident report describing the specific error.

As a result of a serious motorcycle accident, a client suffers paraplegia. When the nurse tries to administer medication, the client refuses it, saying, "I don't have to take those pills if I don't want to. What good will they do?" Which action by the nurse would be most appropriate? 1. Insisting that the client take the medication 2. Reporting the client's comments to the physician 3. Explaining the consequences of not taking the medication 4. Exploring how the client's feelings affect the decision to refuse medication

4. Exploring how the client's feelings affect the decision to refuse medication RATIONALES: After helping the client explore feelings about the change in health status, the nurse can determine how these feelings affect the decision to refuse medication. Then the nurse can help the client develop new ways to satisfy self-care, enhance self-esteem, and meet other needs and, ultimately, participate fully in the therapeutic regimen. The other options are inappropriate because they fail to explore the client's feelings.

A nurse has an order to administer an I.M. injection using Z-track technique. When carrying out this order, what should the nurse do? 1. Insert the needle at a 45-degree angle. 2. Wipe the needle immediately after injection. 3. Pull the skin toward the injection site. 4. Simultaneously withdraw the needle and release the skin.

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

Which type of medication order might read "Vitamin K 10 mg I.M. daily × 3 days?" 1. Single order 2. Stat order 3. Standing order 4. Standard written order

4. Standard written order RATIONALES: This is a standard written order. Prescribers write a single order for medications given only once. A stat order is written for medications given immediately for an urgent client problem. A standing order, also known as a protocol, establishes guidelines for treating a particular disease or set of symptoms in special care areas such as the coronary care unit. Facilities also may institute medication protocols that specifically designate drugs that a nurse may not give.