Pharmacological and Parenteral Therapies Part 1
The nurse reviews the electronic health record (EHR) of a 16-year-old client admitted to the pediatric unit for treatment following an overdose of acetaminophen. In what order should the nurse perform these prescriptions, from first to last?
First, the nurse should insert the peripheral venous access device. The normal saline bolus should be administered before N-acetylcysteine because that medication will be delivered continuously over a longer period. A clear liquid diet is the lowest priority after treatment of the client's condition has been initiated. The nurse should also obtain acetaminophen level now and every eight hours.
Review the client's health information in the electronic medical record (EHR) and then complete the sentences using the drop-down choices. The nurse completing the medication reconciliation recognizes that a medication attributing to the client's current problem is _________ and was prescribed for _______.
prednisone reducing inflammation
The nurse checks on the client at 1030 and notes the client is sleeping soundly. The client does not arouse to name but arouses to touch. Indicate whether each client finding requires follow-up by the nurse or if no action is needed. Each row should include a single choice. Respirations Heart rate Pulse oximetry Pain level Blood pressure Level of consciousness
Requires Follow Up No Action Needed Requires Follow Up No Action Needed Requires Follow Up Requires Follow Up
The nurse has an IV pump that can be programmed to run rates in whole numbers. The available heparin from the pharmacy is shown in the image. (Heparin Sodium for Injection IV or Subcut use 10,000 units per mL) (Heparin in 0.9% Sodium Chloride 25,000 units in 500 mL) Verify the client's weight, allergies, and health history. Request that the licensed practical/vocational nurse (LPN/LVN) perform a second check of the medications prior to administration. Label the tubing with the medication name and date the tubing needs to be changed. Program the pump to run the bolus first and then start the heparin infusion. Program the IV pump to run the heparin infusion at 34 mL/hr. Set the volume to be infused (VTBI) on the pump to 500 mL. Schedule the lab to draw the anti-Xa level 6 hours after starting the heparin infusion. Ensure protamine sulfate is available on the unit.
Appropriate Not appropriate Appropriate Not appropriate Appropriate Not Appropriate Appropriate Appropriate
The nurse prepares to administer an intravenous push (IVP) medication to a client via a saline locked (capped) peripheral IV site. Which actions should the nurse take to safely administer the IVP? Select all that apply. Determine the rate of administration in mL/hour. Confirm two client identifiers. Confirm the medication is compatible with the fluids infusing. Assess the IV site for redness and pain. Compare the medication name to the provider's prescription. Start a second IV line to administer the medication. Hang a gravity bag of normal saline for infusion.
Confirm two client identifiers. Assess the IV site for redness and pain. Compare the medication name to the provider's prescription.
Review the client's health information in the electronic health record (EHR) and then identify the correct nursing actions. Select all that apply. Initiate new IV site for potassium chloride to run as primary infusion Delegate blood glucose monitoring to unlicensed assistive personnel (UAP) Titrate insulin infusion to 6 units/hr Verify insulin titration with another nurse Maintain IV fluids at current rate Infuse potassium chloride at a rate of 200 mL/hr
Delegate blood glucose monitoring to unlicensed assistive personnel (UAP) Titrate insulin infusion to 6 units/hr Verify insulin titration with another nurse Maintain IV fluids at current rate
Review the client's health information in the electronic health record (EHR) and then identify the condition, associated findings, and parameters to monitor for this client. Select the correct answers from the provided drop-down boxes.
Findings: Ketones Acetone breath Condition: DKA Parameters: Blood glucose Potassium levels
The nurse cares for a client receiving chemotherapy for leukemia. What actions should the nurse take when preparing and administering a vesicant agent? Select all that apply. Have a second qualified nurse verify the medication with the primary nurse. Infuse an antiemetic medication through the same line as the chemotherapy. Place absorbent pads underneath the lines when initiating the infusion. Wear personal protective equipment when handling the lines. Check for blood return prior to administration. Place used supplies and protective equipment in the regular trash. Use a central line instead of a peripheral line. Monitor for erythema, pus, red streaks, or bruising at the line site.
Have a second qualified nurse verify the medication with the primary nurse. Place absorbent pads underneath the lines when initiating the infusion. Wear personal protective equipment when handling the lines. Check for blood return prior to administration. Use a central line instead of a peripheral line. Monitor for erythema, pus, red streaks, or bruising at the line site.
The nurse receives a hand-off report for a client scheduled for dialysis in two hours. After reviewing the electronic health record (EHR), which actions should the nurse take? Select all that apply. Hold the prescribed dose of lisinopril 20 mg by mouth daily. Deliver the prescribed dose of NPH insulin 5 units subcutaneously. Administer the first of 2 units of prescribed packed red blood cells. Hold the prescribed IV antibiotic ordered every 6 hours, due now. Hold the prescribed dose of sodium polystyrene sulfonate by mouth daily.
Hold the prescribed dose of lisinopril 20 mg by mouth daily. Deliver the prescribed dose of NPH insulin 5 units subcutaneously. Hold the prescribed IV antibiotic ordered every 6 hours, due now. Hold the prescribed dose of sodium polystyrene sulfonate by mouth daily.
The nurse receives a client as a new admission. The client is experiencing a sickle cell crisis. After reviewing the provider's prescriptions, select the row from the provider's prescription that indicates the need to contact the healthcare provider for clarification.
Morphine 1 mg by mouth every 4 hours as needed for pain greater than 5/10
Review the client's health information in the electronic health record (EHR) and then identify the assessment that requires nursing action. Select one option in each row. Blood glucose Respiratory assessment Gastrointestinal assessment Heart rate Mucous membranes
Requires No Action Take Action Requires No Action Requires No Action Requires No Action
A nurse is floated to a different medical-surgical unit for the day. Another nurse on the unit asks the floated nurse to witness a wasting of an opioid medication that is due for a client at 1200 today. The floated nurse is still involved in another client's room at 1200 but comes to the medication room at 1215. The other nurse tells the floated nurse, "You're too late. I already prepared the medication and wasted the excess. Just go into the chart and sign off that it was wasted. A pharmacy tech was here in the med room when I did it but left a few minutes ago." For each potential nursing action, click to specify whether the action is appropriate or not appropriate by the floated nurse at this time. Sign off the waste in the chart, but make a note that it was witnessed by the pharmacy tech. Call the pharmacy and ask if the tech is still in the building. Notify the charge nurse of the situation. Contact hospital security since the nurse may have stolen the excess opioid. Review the policies and procedures for the unit regarding wasting of medications. Explain to the nurse the reason for not signing off the waste since it was not personally witnessed.
Not appropriate Not appropriate Appropriate Not appropriate Appropriate Appropriate
For each potential nursing action, click to specify whether the intervention is indicated or not indicated for the care of the client at this time. Bolus the client with 4000 units of heparin Turn off the IV pump Instruct the lab to draw an anti-Xa level in 6 hours Reprogram the pump to run at 17 mL/hour Assess the client for petechiae and bruising Administer protamine sulfate as an antidote Ask the client if unilateral leg pain is present Assess the integrity of the IV site
Not indicated Not indicated Indicated Indicated Indicated Not indicated Not indicated Indicated
Review the client's health information in the electronic health record (EHR) and then highlight the prescriptions that should be clarified by the nurse. Select to highlight. Admission Prescriptions 0.9% NS continuous infusion - 100 mL/hr Ondansetron 4 mg intravenous push PRN nausea Morphine 2 mg intravenous push every 4 hours as needed for severe pain CBC, CMP daily Bedside blood glucose every 1 hour with insulin infusion Regular insulin 100 units/100 mL - infuse per insulin infusion protocol Notify provider of blood glucose >400 mg/dL New Prescriptions Potassium chloride 20 mEq/100 mL D5W now
Regular insulin 100 units/100 mL - infuse per insulin protocol
The chemo-certified nurse is caring for clients in the outpatient infusion center. The client is a newly diagnosed cancer client who has not undergone a port placement yet. The nurse starts a new intravenous (IV) catheter on the client's forearm with an 18 gauge. The client had no complaints with flushing of normal saline, nor the initial normal saline fluids. The nurse starts the client on the dose of chemotherapy via intravenous catheter infusion. The client has no complaints with the initiation of this therapy. When the nurse checks on the client one hour later, the nurse notices that extravasation has occurred. After reviewing the client's information, determine what actions the nurse should complete immediately. Select all that apply. Explain this is expected with this medication. Stop the running infusion of medication. Alert the healthcare provider to what has occurred. Disconnect the main line tubing. Infuse normal saline through the IV line. Remove the peripheral IV.
Stop the running infusion of medication. Alert the healthcare provider to what has occurred. Disconnect the main line tubing.
Based on the client's reported pain and request for pain medication at 1530, the nurse will suggest ________ for pain relief because this medication works best for _______.
oral oxycodone severe pain
Review the client's health information in the electronic health record (EHR) and then identify the statements by the client that indicate a need for additional education. Select one option in each row. "My pancreas has stopped being able to make insulin on its own." "If I start to get shaky, I need to give myself insulin." "I can use the back of my arm or stomach to give myself insulin." "I can reuse my insulin needles up to 3 times." "The glucagon kit that I was prescribed is given when I cannot safely eat to bring my sugar up."
Understanding Needs education Understanding Needs education Understanding
The nurse admits a client into the emergency department with shortness of breath, chest tightness, and wheezing. The client is barely able to complete a sentence, but the nurse learns that the client has a history of asthma. The client tried a rescue inhaler but "it did not work." The client was coughing a lot but then struggled to cough. The nurse initiates the prescribed albuterol nebulizer. For each potential assessment finding, click to specify whether the finding indicates a potential improvement, signals a worsening condition, or is unrelated to the condition of the client after completion of the nebulizer treatment. No audible breath sounds Lower pitch to expiratory wheeze Mist stops coming from the nebulizer after 10 minutes Client able to complete sentences Increased coughing with nebulizer treatment Client is restless Client reports increased thirst
Worsening condition Potential improvement Unrelated Potential improvement Potential improvement Worsening condition Unrelated
After reviewing the electronic health record (EHR), drag each word choice to fill in the blank in each sentence. The nurse knows that __________ is the priority concern for the client. The nurse should administer ________ first. The nurse will question the healthcare provider about the _______ prescription.
dehydration 0.9% NaCl ampicillin 500 mg
The nurse reviews discharge medications with a client. While explaining the new medications, the client asks if they can have one glass of wine at a wedding in the coming week. After reviewing the client's information, highlight the priority medication in the electronic health record (EHR) that indicates the client needs to avoid alcohol consumption. Discharge Instructions3/19 1030 Discharge medications include fluticasone for environmental allergies. For infection, take metronidazole 1 tablet twice a day for 7 days. Also, take amoxicillin 1 capsule three times a day for 14 days.
metronidazole
