Medication And I.V. Administration (Part 2)

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  • 1/85 Questions

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

    • Tolerance.
    • Antagonism.
    • Hyporeactivity.
    • Synergism.
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About This Quiz

Explore key aspects of medication and IV administration in 'Medication and I. V. Administration (Part 2)'. This quiz assesses understanding of opioid scheduling, medication reconstitution, telephone order accuracy, injection site reactions, drug cross-tolerance, and drug synergism, essential for nursing professionals.

Medication And I.V. Administration (Part 2) - Quiz

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  • 2. 

    For a client who takes over-the-counter drugs regularly, the nurse should ascertain:

    • Whether the drugs are expensive.

    • Whether the drugs are generic.

    • Whether the client knows the drug dosages and administration schedules.

    • Whether the client knows that these drugs are available in the hospital.

    Correct Answer
    A. Whether the client knows the drug dosages and administration schedules.
    Explanation
    RATIONALE: The nurse should determine whether the client knows dosages and administration schedules for any over-the-counter drugs he takes regularly. The nurse also should determine whether the client knows why he takes each drug and the proper way to administer it. Neither the drug's cost nor its generic classification are as important as these factors unless a problem arises with either of them. Availability of drugs in the hospital isn't a high-priority item unless the client wants to purchase drugs from an outpatient pharmacy.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 559.

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  • 3. 

    A nurse must verify a client's identity before administering medication. The safest way to verify identity is to:

    • Ask the client his name.

    • Check the client's identification band.

    • State the client's name aloud and have the client repeat it.

    • Check the room number and the client's name on the bed.

    Correct Answer
    A. Check the client's identification band.
    Explanation
    RATIONALE: Checking the client's identification band is the safest way to verify a client's identity because the band is assigned on admission and should not be removed at any time. (If the band is removed, it must be replaced.) Asking the client's name or having the client repeat his name would be appropriate only for a client who's alert, oriented, and able to understand what the nurse is saying, but it isn't the safe standard of practice. Checking the room number isn't appropriate because clients may be transferred from another room and the paperwork may not be correct. Checking the client's name on the bed isn't appropriate because names on beds aren't always correct.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 821.

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  • 4. 

    Which safeguard should the nurse take to ensure accuracy of a telephone order?

    • Repeat the order to the prescriber.

    • Repeat the order to the nursing supervisor.

    • Wait for the physician to sign the order before administering the drug.

    • Insist that the nursing supervisor monitor the call.

    Correct Answer
    A. Repeat the order to the prescriber.
    Explanation
    RATIONALE: When taking a telephone order, the nurse should repeat the order to the prescriber to ensure that she clearly understands it. She needn't repeat the order to a nursing supervisor. The nurse may administer the drug before the physician signs the order, but the physician must sign the order within the time period the facility policy dictates. Although it's a good idea to have a second nurse monitor the call, the second nurse doesn't have to be the nursing supervisor.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 254.

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  • 5. 

    A client diagnosed with pneumonia refuses his oral antibiotic. The client is alert and oriented, vital signs are within normal range, and crackles are scattered throughout the posterior left lower lobe of his lung. The nurse's most appropriate action would be to:

    • Mix the medication into the client's food without his knowledge.

    • Document that the client refused his medication.

    • Address the client's concern about the medication by clarifying its purpose.

    • Leave the medication with the client in case he decides to take it at a later time.

    Correct Answer
    A. Address the client's concern about the medication by clarifying its purpose.
    Explanation
    RATIONALE: The nurse should try to address the client's concern by clarifying its purpose. If the client still refuses the medication, the nurse should notify the physician. Because the client is alert and oriented, the nurse may not mix the medication in food without his knowledge. Documenting the client's refusal doesn't address the client's concerns or notify the physician.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Analysis

    REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 565.

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  • 6. 

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

    • Recap the needle and discard it in any medical waste container.

    • Recap the needle and discard it in a puncture-proof container.

    • Discard the uncapped needle in a puncture-proof container.

    • Break the needle and discard the needle and syringe in any medical waste container.

    Correct Answer
    A. Discard the uncapped needle in a puncture-proof container.
    Explanation
    RATIONALE: The appropriate procedure is to discard uncapped needles in a puncture-proof, leak-proof container. To reduce the risk of accidental needle sticks, the nurse should never recap a needle. She should never place a used needle in a garbage can or in a medical waste container that isn't puncture-proof and leak-proof. She should never break or bend a needle before discarding it. Doing so increases the risk of a needle stick.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 841.

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  • 7. 

    A nurse is working in a clinic where a family member's spouse is treated for a sexually transmitted disease. The nurse is concerned about the risk to her family member. What is the most appropriate action for the nurse to take?

    • Anonymously inform her family member of the spouse's diagnosis so that he or she may seek necessary treatment.

    • As legally required, inform the family member of the client's diagnosis.

    • Encourage the client to speak with the family member about the diagnosis if he or she hasn't already done so.

    • Provide the local Board of Health with the family member's name so they can contact him or her with information about the client's diagnosis.

    Correct Answer
    A. Encourage the client to speak with the family member about the diagnosis if he or she hasn't already done so.
    Explanation
    RATIONALE: Encouraging the client to talk with his spouse is the nurse's only option. According to the Health Insurance Portability and Accountability Act, a client's diagnosis is confidential information that shouldn't be shared with anyone, including a spouse, without the client's permission. Telling a family member about the diagnosis is a violation of the client's confidentiality. The nurse isn't legally obligated to report the diagnosis to her family member. It isn't appropriate for the nurse to provide information that would allow other agencies to contact the client's spouse.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 256.

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  • 8. 

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

    • Giving the client the preoperative analgesic at the scheduled time

    • Asking the client to sign the consent form

    • Notifying the surgeon that the client hasn't signed the consent form

    • Canceling the surgery

    Correct Answer
    A. Notifying the surgeon that the client hasn't signed the consent form
    Explanation
    RATIONALE: Notifying the surgeon takes priority because the physician must obtain informed consent before the client receives drugs that can alter cognition. Giving the preoperative analgesic at the scheduled time would alter the client's ability to give informed consent. Obtaining consent to surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery isn't within the scope of nursing practice.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 133.

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  • 9. 

    A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first?

    • The client

    • The prescriber

    • The nurse's lawyer

    • The risk manager

    Correct Answer
    A. The prescriber
    Explanation
    RATIONALE: After discovering a medication error, the nurse should immediately notify only those persons who can do something to rectify the error, such as the prescriber, the nursing supervisor, and the pharmacist.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 811.

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  • 10. 

    A physician orders an infusion of whole blood for a client. When planning the client's care, a nurse should include which intervention?

    • Staying with the client for 15 minutes after starting the infusion

    • Starting an I.V. infusion of 5% dextrose in saline solution before hanging the blood bag

    • Starting the infusion through a 22G I.V. catheter

    • Allowing the blood to warm to room temperature before infusing

    Correct Answer
    A. Staying with the client for 15 minutes after starting the infusion
    Explanation
    RATIONALE: Because most hemolytic reactions occur during the first 15 minutes of a blood transfusion, the nurse should plan to stay with the client for this length of time. During this time, the nurse should monitor the client's vital signs frequently, in accordance with facility policy. The nurse should start the infusion with normal saline solution only and should use at least a 19G catheter to prevent hemolysis of red blood cells. The nurse shouldn't warm the blood because refrigerating blood until infusion prevents bacterial growth.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1737.

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  • 11. 

    The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should:

    • Stir the liquid with a sterile applicator.

    • Invert the vial and let it stand for 2 to 3 minutes.

    • Shake the vial vigorously.

    • Roll the vial gently between her palms.

    Correct Answer
    A. Roll the vial gently between her palms.
    Explanation
    RATIONALE: Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Stirring the medication with a sterile applicator isn't accepted practice. Inverting the vial wouldn't help dissolve the medication. Shaking the vial vigorously could cause the medication to break down, altering its action.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 794.

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  • 12. 

    A nurse has an order to administer an I.M. injection using the Z-track technique. When carrying out this order, what should the nurse do?

    • Insert the needle at a 45-degree angle.

    • Wipe the needle immediately after injection.

    • Pull the skin laterally toward the injection site.

    • Simultaneously withdraw the needle and release the skin.

    Correct Answer
    A. Simultaneously withdraw the needle and release the skin.
    Explanation
    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.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 591.

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  • 13. 

    A nurse has an order to administer iron dextran (INFeD) 50 mg I.M. injection. When carrying out this order, the nurse should:

    • Insert the needle at a 45-degree angle.

    • Wipe the needle immediately after injection.

    • Pull the skin laterally toward the injection site.

    • Use the Z-track technique.

    Correct Answer
    A. Use the Z-track technique.
    Explanation
    RATIONALE: Iron dextran is an iron preparation given using the Z-track technique to prevent leakage into the subcutaneous tissue and staining of the skin. When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site to seal the drug in the muscle, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication to ensure drug dispersion, then simultaneously withdraws the needle and releases the skin to seal the needle track. Wiping the needle immediately after injection poses the risk of a needle stick.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 814.

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  • 14. 

    A physician orders nitroglycerin, 5 mg by mouth twice a day, for a client. The drug is dispensed in 2.5-mg tablets. How many tablets will the nurse administer with each dose?

    • Two

    • Four

    • Six

    • Eight

    Correct Answer
    A. Two
    Explanation
    RATIONALE: The nurse will administer two tablets with each dose. Using the ratio method, the equation to solve for X is: 5 mg : X tab :: 2.5 mg : 1 tab. Solving for X determines the quantity of the dosage form (two tablets, in this example).

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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  • 15. 

    A client is receiving furosemide (Lasix), 40 mg by mouth twice per day. In the care plan, the nurse should emphasize teaching the client about the importance of consuming:

    • Fresh green vegetables.

    • Bananas and oranges.

    • Low-fat milk.

    • Creamed corn.

    Correct Answer
    A. Bananas and oranges.
    Explanation
    RATIONALE: Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the client to increase his intake of potassium-rich foods, such as bananas and oranges. Fresh green vegetables, milk, and creamed corn aren't good sources of potassium.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 870.

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  • 16. 

    A physician writes an order for a client that says: "Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should the nurse transcribe this order onto the medication administration record?

    • Digoxin .125 mg P.O. once daily

    • Digoxin 0.125 mg P.O. once daily

    • Digoxin 0.1250 mg P.O. once daily

    • Digoxin .1250 mg P.O. once daily

    Correct Answer
    A. Digoxin 0.125 mg P.O. once daily
    Explanation
    RATIONALE: The nurse should always place a zero (0) before a decimal point so that no one misreads the figure, which could result in a dosage error. The nurse should never insert a zero at the end of a dosage that includes a decimal point because this could be misread, possibly leading to a 10-fold increase in the dosage.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 780.

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  • 17. 

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

    • Investigate and correct the discrepancy, if possible, before proceeding.

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

    • Document the discrepancy on an incident report.

    • Document the discrepancy on a opioid-inventory form.

    Correct Answer
    A. Immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy.
    Explanation
    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 the discrepancy on an incident report or opioid-inventory form doesn't address the problem.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Analysis

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 778.

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  • 18. 

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

    • ¼ ml

    • ½ ml

    • 1 ml

    • 2 ml

    Correct Answer
    A. ½ ml
    Explanation
    RATIONALE: The nurse should give the client ½ ml of the drug. The dosage is calculated as follows:
    250 mg/X = 500 mg/1 ml
    500X = 250
    X = ½ ml.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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  • 19. 

    A nurse is to give a client a 325-mg aspirin suppository. The client has diarrhea and is in the bathroom. The best nursing approach at this time would be to:

    • Administer the suppository 15 minutes after the diarrhea stops.

    • Withhold the suppository and notify the client's physician.

    • Tell the client you'll give him the suppository when he's finished in the bathroom.

    • Substitute 325-mg aspirin by mouth.

    Correct Answer
    A. Withhold the suppository and notify the client's physician.
    Explanation
    RATIONALE: Because the client has diarrhea, the nurse should hold the medication and talk with the physician. She should never give a suppository to a client with diarrhea because the client would expel the suppository. Waiting 15 minutes or until the client is finished in the bathroom is inappropriate because the client will most likely have another urge to defecate and will expel the suppository. Substituting the oral form is inappropriate; only the physician can change the administration route of an ordered drug.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Basic care and comfort
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 808.

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  • 20. 

    A drug must enter the bloodstream before it can act within the body. Which parenteral administration route places a drug directly into the circulation, requiring no absorption?

    • I.M.

    • Subcutaneous (subQ)

    • Intradermal

    • I.V.

    Correct Answer
    A. I.V.
    Explanation
    RATIONALE: The I.V. route bypasses absorption barriers and results in an immediate systemic response. The body must absorb drugs that are administered I.M., subQ, or intradermally before the system can respond.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 14.

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  • 21. 

    Which principle should a nurse consider when administering pain medication to a client?

    • Use opioid combination drugs or nonopioid analgesics only for severe pain.

    • I.V. pain medications may take as long as 2 hours to relieve pain.

    • Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain.

    • Morphine (Duramorph) and hydromorphone shouldn't be used to treat severe pain.

    Correct Answer
    A. Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain.
    Explanation
    RATIONALE: Administering sustained-release oral formulations around the clock provides better relief of chronic pain by keeping blood levels within therapeutic range. Opioid combination drugs and nonopioid medications are most effective in the treatment of mild to moderate pain. I.V. medications usually act within 1 hour of administration. Morphine and hydromorphone are drugs of choice for severe pain.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Basic care and comfort
    COGNITIVE LEVEL: Analysis

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1394.

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  • 22. 

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

    • 0.5 L

    • 0.75 L

    • 1 L

    • 2 L

    Correct Answer
    A. 0.5 L
    Explanation
    RATIONALE: 500 ml equals 0.5 L.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 55.

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  • 23. 

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

    • Isotonic

    • Hypertonic

    • Electrotonic

    • Hypotonic

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

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, p. 1432.

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  • 24. 

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

    • 1 hour.

    • 2 hours.

    • 4 hours.

    • 6 hours.

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

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1739.

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  • 25. 

    A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child?

    • Hypercalcemia

    • Hyperphosphatemia

    • Hypokalemia

    • Hypernatremia

    Correct Answer
    A. Hypokalemia
    Explanation
    RATIONALE: Hypokalemia occurs when insulin administration causes glucose and potassium to move into the cells. Insulin administration doesn't directly affect calcium levels. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus enters the cells with insulin and potassium. Insulin administration doesn't directly affect sodium levels.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Analysis

    REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 384.

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  • 26. 

    A physician orders a blood transfusion for a client who has a 21G I.V. in place. What should the nurse do?

    • Tell the physician the client needs a central line placed.

    • Insert an 18G I.V. in addition to the 21G I.V.

    • Start the blood transfusion immediately.

    • Hang a bag of dextrose 5% and water and attach it to the I.V.

    Correct Answer
    A. Insert an 18G I.V. in addition to the 21G I.V.
    Explanation
    RATIONALE: Because molecules of blood and blood products are larger than molecules of I.V. fluids, the nurse should plan to use a large I.V. access device, such as an 18G or a 19G needle, so blood can flow through it. Using a large-gauge needle also prevents red blood cell hemolysis. There is no indication that the client needs to have a central line placed. If the nurse is unable to place a larger gauge I.V., she should discuss the situation with the physician. She should hang blood only with normal saline solution. Any other solution is incompatible with the blood.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1737.

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  • 27. 

    A nurse is working on an oncology unit that uses a computerized medication access system to minimize medication errors. Which action is the best way for her to identify a client before administering medication?

    • Stating the client's name when entering the room and asking if the name is correct

    • Matching the client's identification bracelet to the medication-administration record

    • Asking the client's roommate to identify the client

    • Asking the client to state his name

    Correct Answer
    A. Matching the client's identification bracelet to the medication-administration record
    Explanation
    RATIONALE: The best way to assess a client's identity is by comparing his identification bracelet with the medication record. Although asking the client to state his name is a way to identify an alert client, a confused client may not give the correct name. It isn't appropriate for the nurse to state the client's name because a client who is hard of hearing may respond affirmatively to avoid embarrassment. A client's roommate isn't a reliable source of information.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 564.

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  • 28. 

    What is the best way for a nurse to improve a client's compliance with the ordered medication schedule?

    • Encourage the client to hire a visiting nurse.

    • Give all instructions at least three times.

    • Lengthen the intervals in the administration schedule.

    • Devise the simplest possible medication schedule.

    Correct Answer
    A. Devise the simplest possible medication schedule.
    Explanation
    RATIONALE: To improve client compliance, the nurse should simplify the medication schedule as much as she can. Compliance drops sharply when more than three medications are ordered; elderly clients tend to use more than one medication concurrently. Hiring a visiting nurse is too costly and impractical in most instances. Although the nurse may need to repeat instructions, giving all instructions at least three times doesn't necessarily ensure compliance. A physician, not the nurse, must decide how often a client should take a medication.

    CLIENT NEEDS CATEGORY: Psychosocial integrity
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 791.

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  • 29. 

    A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with her preceptor. Which planned action by the graduate nurse should the preceptor correct?

    • Measuring the length of the removed catheter and comparing it with the documented length of the inserted catheter

    • Discarding the catheter in a trash container

    • Flushing the PICC with 0.9% sodium chloride before removing it

    • Applying a dressing over the site and leaving it in place for 24 hours

    Correct Answer
    A. Discarding the catheter in a trash container
    Explanation
    RATIONALE: To prevent injury to others, the graduate nurse should discard the catheter in a sharps-disposal container rather than a trash container. She should measure the length of the catheter to ensure that the entire catheter has been removed. Flushing the line ensures that there are no problems with the line. Applying a dressing and leaving it in place for 24 hours helps ensure hemostasis.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 627.

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  • 30. 

    A client requests his medication at 9 p.m. instead of 10 p.m. so that he can go to sleep earlier. Which type of nursing intervention is required?

    • Intradependent

    • Interdependent

    • Dependent

    • Independent

    Correct Answer
    A. Independent
    Explanation
    RATIONALE: Nursing interventions are classified as independent, interdependent, or dependent. Altering the drug schedule to coincide with the client's daily routine represents an independent intervention, whereas consulting with the physician and pharmacist to change a client's medication because of adverse reactions represents an interdependent intervention. Administering an already ordered drug on time is a dependent intervention. There's no such thing as an intradependent nursing intervention.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 315.

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  • 31. 

    A nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation?

    • Tell the client to take all the medications at once.

    • Advise the client to take each medication with 8 oz of water.

    • Leave the medications at the bedside for the client to take when he wishes.

    • Tell the client the name and action or use of each medication before administering it.

    Correct Answer
    A. Tell the client the name and action or use of each medication before administering it.
    Explanation
    RATIONALE: When administering several oral medications at the same time, the nurse should tell the client the name of each medication and its action or use before administering it. The client may take the medications all at once or one at a time with any amount of fluid. Leaving medications at the bedside may lead to errors such as the client not taking them. To ensure that the client takes his medication, the nurse should always observe the client taking it.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 821.

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  • 32. 

    A nurse is instructing a client with asthma on the use of an inhaler with a spacer. The client asks what the purpose of the spacer is. The nurse's best response is:

    • The spacer traps medicine from the inhaler, then breaks up and slows down the medication particles, so you get more medication.

    • The physician has ordered the spacer and wants me to show you how to use it.

    • The spacer is a better way for you to receive the medication from the inhaler and you don't have to inhale when using it.

    • You should ask your physician to explain the purpose of the spacer.

    Correct Answer
    A. The spacer traps medicine from the inhaler, then breaks up and slows down the medication particles, so you get more medication.
    Explanation
    RATIONALE: Describing how the spacer works accurately explains the purpose and benefit of an inhaler. Telling the client that the physician has ordered the spacer and instructed the nurse to explain its use doesn't answer the client's question. The nurse isn't correct in saying the client doesn't have to inhale when using a spacer; during administration, the client should inhale deeply and slowly for 3 to 5 seconds. The client doesn't need to ask the physician about the spacer; the nurse should be familiar with its purpose and proper use.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Analysis

    REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 574.

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  • 33. 

    A nurse is administering sublingual nitroglycerin (Nitrostat) to a client. Immediately after administering nitroglycerin, the nurse should expect to administer:

    • Lorazepam (Xanax).

    • Acetaminophen (Tylenol).

    • Insulin.

    • Prednisone (Deltasone).

    Correct Answer
    A. Acetaminophen (Tylenol).
    Explanation
    RATIONALE: In the early stages of therapy, nitoglycerin commonly causes headache and dizziness. Acetaminophen usually helps decrease nitroglycerin-induced headaches. Although the client may be anxious, lorazepam usually isn't given after nitroglycerin. There is no indication that the client would need insulin or prednisone.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 751.

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  • 34. 

    A nurse notes that a client's I.V. insertion site is red, swollen, and warm to the touch. Which action should the nurse take first?

    • Discontinue the I.V. infusion.

    • Apply a warm, moist compress to the I.V. site.

    • Check the I.V. infusion for patency.

    • Apply an ice pack to the I.V. site.

    Correct Answer
    A. Discontinue the I.V. infusion.
    Explanation
    RATIONALE: Because redness, swelling, and warmth at an I.V. site are signs of infection, the nurse should discontinue the infusion immediately and restart it at another site. After doing this, the nurse should apply warmth to the original site. Checking infusion patency isn't warranted because assessment findings suggest infection and inflammation, not infiltration. Heat, not cold, is the appropriate treatment for inflammation.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 626.

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  • 35. 

    What is the most common cause of medication errors among noninstitutionalized elderly clients?

    • Deficient knowledge

    • Poor vision

    • Dementia

    • Confusion

    Correct Answer
    A. Deficient knowledge
    Explanation
    RATIONALE: Deficient knowledge is the most common cause of medication errors among noninstitutionalized elderly clients. Poor vision, dementia, and confusion can contribute to medication errors in this group, but they're less common causes of medication errors.

    CLIENT NEEDS CATEGORY: Health promotion and maintenance
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 772.

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  • 36. 

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

    • Serum potassium level.

    • Serum glucose level.

    • Partial thromboplastin time (PTT).

    • Serum creatine level.

    Correct Answer
    A. Serum creatine level.
    Explanation
    RATIONALE: During gentamicin therapy, the nurse should monitor a client's serum creatine level because the most notable adverse reactions to aminoglycoside therapy are nephrotoxicity and ototoxicity. The drug doesn't appear to affect serum potassium or glucose levels or PTT.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 698.

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  • 37. 

    What is the main advantage of using a floor stock system?

    • A nurse can implement medication orders quickly.

    • A nurse receives input from the pharmacist.

    • The system minimizes transcription errors.

    • The system reinforces accurate calculations.

    Correct Answer
    A. A nurse can implement medication orders quickly.
    Explanation
    RATIONALE: A floor stock system enables a nurse to implement medication orders quickly. It doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 781.

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  • 38. 

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

    • Deltoid

    • Rectus femoris

    • Vastus lateralis

    • Anterior aspect of the thigh

    Correct Answer
    A. Anterior aspect of the thigh
    Explanation
    RATIONALE: SubQ injection sites, which are relatively distant from bones and major blood vessels, include the lateral aspects of the upper arm, the anterior aspects of the thigh, and the abdomen. The deltoid, rectus femoris, and vastus lateralis are I.M. injection sites.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 32.

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  • 39. 

    A client with a deficient fluid volume is receiving an I.V. infusion of dextrose 5% in water and lactated Ringer's solution at 125 ml/hour. Which assessment finding indicates the need for additional I.V. fluids?

    • Serum sodium level of 135 mEq/L

    • Temperature of 99.6° F (37.6° C)

    • Jugular vein distention

    • Dark amber urine

    Correct Answer
    A. Dark amber urine
    Explanation
    RATIONALE: Normally, urine appears light yellow; dark amber urine is concentrated and suggests decreased fluid intake. The serum sodium level normally ranges from 135 to 145 mEq/L. A temperature of 99.6° F (37.6° C) is only slightly elevated and doesn't indicate a fluid volume deficit. Neck vein distention is a sign of fluid volume overload, not deficient fluid volume.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Analysis

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 931.

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  • 40. 

    Which moral principle is a nurse applying when she decides what is best for a client and acting without consulting the individual?

    • Beneficence

    • Paternalism

    • Fidelity

    • Autonomy

    Correct Answer
    A. Paternalism
    Explanation
    RATIONALE: Nurses and other health care workers employ paternalism when a client's loss of consciousness or other circumstances compel them to decide what is best for the client and to act without consulting the individual. Beneficence means that nurses should act in the client's interests always. Fidelity requires the nurse to be faithful and truthful and to keep promises to clients, families, coworkers, and employers. Autonomy refers to every individual's right to make rational decisions about his life. The nurse's belief in autonomy leads to a respect for the client's decisions.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 111.

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  • 41. 

    After receiving an I.M. injection, a client complains of burning pain at the injection site. Which nursing action would be most appropriate at this time?

    • Applying a cold compress to decrease swelling

    • Applying a warm compress to dilate the blood vessels

    • Massaging the area to promote absorption of the drug

    • Instructing the client to tighten his gluteal muscles to promote better absorption of the drug

    Correct Answer
    A. Applying a warm compress to dilate the blood vessels
    Explanation
    RATIONALE: Applying heat increases blood flow to the area, which, in turn, increases medication absorption. Cold decreases pain but allows the medication to remain in the muscle longer. Massage is a good intervention, but applying a warm compress is better. Tightening the gluteal muscles may cause additional burning if the drug irritates muscular tissues.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Basic care and comfort
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1222.

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  • 42. 

    Cross-tolerance to a drug is defined as:

    • One drug that can prevent withdrawal symptoms from another drug.

    • An allergic reaction to a class of drugs.

    • One drug reduces response to another drug.

    • One drug increases another drug's potency.

    Correct Answer
    A. One drug reduces response to another drug.
    Explanation
    RATIONALE: Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a class of drugs. A drug's ability to increase the potency of another drug describes potentiating effects.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1200.

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  • 43. 

    The label of a drug package reads "meperidine hydrochloride (Demerol), 50 mg/ml." How many milliliters should a nurse give a client for a 30-mg dose?

    • 0.5 ml

    • 0.6 ml

    • 1 ml

    • 1.6 ml

    Correct Answer
    A. 0.6 ml
    Explanation
    RATIONALE: A measure of 0.6 ml equals 30 mg when the ratio is 50 mg/ml. The ratio to determine this answer is 30 mg : X ml :: 50 mg : 1 ml.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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  • 44. 

    When developing a teaching plan for a client taking hormonal contraceptives, a nurse should ensure that the client knows she must have which vital sign monitored regularly?

    • Pulse

    • Respirations

    • Temperature

    • Blood pressure

    Correct Answer
    A. Blood pressure
    Explanation
    RATIONALE: The incidence of hypertension is three to six times greater in clients using hormonal contraceptives than in women who don't use these drugs. Age and duration of the drug's use increase this incidence. Hormonal contraceptives don't directly affect pulse, respirations, or temperature.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 598.

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  • 45. 

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

    • Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter

    • Increase in systemic blood pressure

    • Runs of ventricular tachycardia on a cardiac monitor

    • Increase in intracranial pressure (ICP)

    Correct Answer
    A. Runs of ventricular tachycardia on a cardiac monitor
    Explanation
    RATIONALE: Physicians sometimes use lidocaine drips to treat clients whose arrhythmias haven't been controlled with oral medication and whose runs of ventricular tachycardia are visible on the cardiac monitor. SaO2, blood pressure, and ICP are important factors but aren't as significant as ventricular tachycardia in this situation.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 733.

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  • 46. 

    A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?

    • Hypercalcemia

    • Hypernatremia

    • Hyperglycemia

    • Hyperkalemia

    Correct Answer
    A. Hyperkalemia
    Explanation
    RATIONALE: Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., and Bare, B. Brunner & Suddarth's Textbook of Medical Surgical-Nursing, 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 324.

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  • 47. 

    A nurse may delegate adding medications to I.V. fluid containers to a:

    • Nursing assistant.

    • Pharmacy technician.

    • Pharmacist.

    • Student nurse.

    Correct Answer
    A. Pharmacist.
    Explanation
    RATIONALE: A nurse should delegate the task of adding medications to primary fluid containers to a pharmacist. Other assistive personnel aren't qualified to perform this task.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 161.

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  • 48. 

    A physician orders the following preoperative medications to be administered to a client by the I.M. route: meperidine (Demerol), 50 mg; hydroxyzine pamoate (Vistaril), 25 mg; and glycopyrrolate (Robinul), 0.3 mg. The medications are dispensed as follows: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer?

    • 5 ml

    • 2 ml

    • 2.5 ml

    • 3.8 ml

    Correct Answer
    A. 2.5 ml
    Explanation
    RATIONALE: Using the proportion method, the nurse solves for X in the following equations and then adds the total number of milliliters together, as shown:
    1 ml/100 mg = X ml/50 mg
    X = 0.5 ml of meperidine
    2 ml/100 mg = X ml/25 mg
    X = 0.5 ml of hydroxyzine pamoate
    1 ml/0.2 mg = X ml/0.3 mg
    X = 1.5 ml of glycopyrrolate
    0.5 ml + 0.5 ml + 1.5 ml = 2.5 ml of all preoperative medications.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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  • 49. 

    A physician orders heparin, 7,500 units, to be administered subcutaneously every 12 hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much heparin for each dose?

    • ¼ ml

    • ½ ml

    • ¾ ml

    • 1¼ ml

    Correct Answer
    A. ¾ ml
    Explanation
    RATIONALE: The nurse solves the problem as follows:
    10,000 units/7,500 units = 1 ml/X
    10,000X = 7,500
    X = 7,500/10,000 or ¾ ml.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Analysis

    REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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