Medication And I.V. Administration (Part 2)

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Quizzes Created: 12 | Total Attempts: 15,212

Questions: 85 | Attempts: 396 | Updated: Mar 21, 2023

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

Questions and Answers

1.

The physician orders morphine, 4 mg I.V. every hour, as needed to relieve a client's pain. The nurse knows that morphine belongs to which schedule of opioids?
- A.
  
  Schedule I
- B.
  
  Schedule II
- C.
  
  Schedule III
- D.
  
  Schedule IV
Correct Answer
B. Schedule II

Explanation
RATIONALE: Morphine is a Schedule II opioid with a high potential for abuse and possible severe psychological and physical dependence. Schedule I drugs such as heroin aren't accepted for medical use. Schedule III drugs such as paregoric have lower abuse potential. Schedule IV drugs such as chloral hydrate (Noctec) have even less potential for abuse.

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

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 6.

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2.

After reconstituting a multidose vial of medication, a nurse writes the date and time of reconstitution on the vial label. What else should the nurse write on the label?
- A.
  
  Expiration date of the order
- B.
  
  Strength of the medication
- C.
  
  Route of administration
- D.
  
  Prescriber's name
Correct Answer
B. Strength of the medication

Explanation
RATIONALE: After reconstituting a medication, the nurse should label any unused medication with the strength of the medication and her initials or signature, as well as the date and time of reconstitution. The expiration date on the order is usually written on the medication record. She should write the administration route and prescriber's name on the order sheet, not on the label.

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, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 784.

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3.

Which safeguard should the nurse take to ensure accuracy of a telephone order?
- A.
  
  Repeat the order to the prescriber.
- B.
  
  Repeat the order to the nursing supervisor.
- C.
  
  Wait for the physician to sign the order before administering the drug.
- D.
  
  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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4.

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?
- A.
  
  Applying a cold compress to decrease swelling
- B.
  
  Applying a warm compress to dilate the blood vessels
- C.
  
  Massaging the area to promote absorption of the drug
- D.
  
  Instructing the client to tighten his gluteal muscles to promote better absorption of the drug
Correct Answer
B. 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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5.

Cross-tolerance to a drug is defined as:
- A.
  
  One drug that can prevent withdrawal symptoms from another drug.
- B.
  
  An allergic reaction to a class of drugs.
- C.
  
  One drug reduces response to another drug.
- D.
  
  One drug increases another drug's potency.
Correct Answer
C. 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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6.

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:
- A.
  
  Tolerance.
- B.
  
  Antagonism.
- C.
  
  Hyporeactivity.
- D.
  
  Synergism.
Correct Answer
D. Synergism.

Explanation
RATIONALE: Synergism, or a synergistic effect, occurs when two drugs with the same qualitative effects produce, when given together, a response greater than either drug produces when given alone. Tolerance is a person's decreased response or decreased sensitivity to a drug. Antagonism occurs when the combined response to two drugs given together is less than the response either drug produces when given alone. Hyporeactivity is a less-than-usual response to a normal drug dose.

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. 59.

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7.

Which signs and symptoms might a nurse observe in a client having an adverse reaction to a loop diuretic? Select all that apply.
- A.
  
  Weakness
- B.
  
  Irregular pulse
- C.
  
  Hyperactive bowel sounds
- D.
  
  Decreased muscle tone
- E.
  
  Potassium level of 3.1 mEq/L
- F.
  
  Ventricular arrhythmias
Correct Answer(s)
A. Weakness
B. Irregular pulse
D. Decreased muscle tone
E. Potassium level of 3.1 mEq/L
F. Ventricular arrhythmias

Explanation
RATIONALE: Signs and symptoms of an adverse reaction to a loop diuretic include weakness, irregular pulse, hyperactive (not hypoactive) bowel sounds, decreased muscle tone, hypokalemia (indicated by a potassium level below 3.5 mEq/L), and ventricular arrhythmias. Bowel sounds are hypoactive rather than hyperactive.

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

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 791.

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8.

To determine the I.V. drip rate, a nurse must know the drip factor, which is:
- A.
  
  The number of milliliters in one drop.
- B.
  
  The number of drops in one milliliter.
- C.
  
  The number of drops per minute to be infused.
- D.
  
  The number of drops per hour to be infused.
Correct Answer
B. The number of drops in one milliliter.

Explanation
RATIONALE: The drip factor is the number of drops in one milliliter, not the number of milliliters in one drop. The drip rate refers to the number of drops infused per minute. The flow rate is the number of milliliters, not the number of drops, infused per hour.

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. 42.

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9.

A client comes to the emergency department after taking an overdose of amitriptyline (Elavil). Immediate care for this client should include:
- A.
  
  Giving syrup of ipecac to induce vomiting.
- B.
  
  Administering activated charcoal every 4 hours for 24 hours.
- C.
  
  Giving large boluses of enteral saline.
- D.
  
  Lavaging the stomach with a small-gauge gastric tube.
Correct Answer
B. Administering activated charcoal every 4 hours for 24 hours.

Explanation
RATIONALE: After administering appropriate stomach lavage, the nurse should give the client activated charcoal every 4 hours for 24 hours. The charcoal binds with amitriptyline and inactivates it. The nurse shouldn't induce vomiting because the client's mental status may rapidly deteriorate and pose the risk of aspiration. Large boluses of enteral saline can force the drug into the small intestine, where it will be absorbed. The nurse should use a large tube for gastric lavage so she can remove intact pills.

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

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 382.

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10.

A nurse is administering sublingual nitroglycerin (Nitrostat) to a client. Immediately after administering nitroglycerin, the nurse should expect to administer:
- A.
  
  Lorazepam (Xanax).
- B.
  
  Acetaminophen (Tylenol).
- C.
  
  Insulin.
- D.
  
  Prednisone (Deltasone).
Correct Answer
B. 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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11.

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?
- A.
  
  Discontinue the I.V. infusion.
- B.
  
  Apply a warm, moist compress to the I.V. site.
- C.
  
  Check the I.V. infusion for patency.
- D.
  
  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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12.

After having a total hip replacement, a client receives morphine sulfate (Duramorph) by patient-controlled analgesia (PCA) pump. The client says, "This pump doesn't help my pain at all." What should the nurse do in response to this statement?
- A.
  
  Assess the client's understanding of the PCA pump.
- B.
  
  Tell the physician that the ordered dose isn't sufficient for pain control.
- C.
  
  Press the dose delivery button to give the client an immediate dose of the drug.
- D.
  
  Push the "Flush" button on the PCA pump to make sure the I.V. line isn't infiltrated.
Correct Answer
A. Assess the client's understanding of the PCA pump.

Explanation
RATIONALE: The nurse should assess the client's understanding of the PCA pump because the client may not correctly understand how to use it. If the client can be taught how to properly use the PCA, other measures may not be necessay. The nurse needs to assess the situation further before notifying the physician. Pressing the dose delivery button can help alleviate the client's pain, but it won't ultimately help if the client doesn't know how to use the pump independently for pain control. Pushing the "Flush" button on the PCA pump will give the client a bolus of the opioid and isn't an appropriate method of assessing the I.V. line's patency.

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. 407.

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13.

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?
- A.
  
  0.5 ml
- B.
  
  0.6 ml
- C.
  
  1 ml
- D.
  
  1.6 ml
Correct Answer
B. 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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14.

Why would a nurse be interested in a client's dietary history when administering drugs?
- A.
  
  Vegetarian diets can cause more adverse drug reactions than diets containing meat.
- B.
  
  The number of calories a client consumes can alter a drug's metabolism.
- C.
  
  Dietary intake can alter the effectiveness of some drugs.
- D.
  
  High-sodium diets can increase the half-life of some drugs.
Correct Answer
C. Dietary intake can alter the effectiveness of some drugs.

Explanation
RATIONALE: Dietary intake can alter the effectiveness of some drugs; for example, dairy products bind certain antibiotics and make them ineffective. A vegetarian diet doesn't cause more adverse drug reactions than a diet containing meat. Although excessive calorie consumption may alter a drug's distribution, caloric intake doesn't affect a drug's metabolism. Dietary intake, including sodium, doesn't affect the half-life of any drug.

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. 112.

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15.

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:
- A.
  
  Mix the medication into the client's food without his knowledge.
- B.
  
  Document that the client refused his medication.
- C.
  
  Address the client's concern about the medication by clarifying its purpose.
- D.
  
  Leave the medication with the client in case he decides to take it at a later time.
Correct Answer
C. 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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16.

What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking his beta-adrenergic blocker?
- A.
  
  Abnormally low blood pressure
- B.
  
  Irregular pulse
- C.
  
  Increased respiratory rate
- D.
  
  Decreased respiratory rate
Correct Answer
B. Irregular pulse

Explanation
RATIONALE: Abrupt withdrawal of a beta-adrenergic blocker results in rebound cardiac excitation, which causes ventricular arrhythmias and an irregular pulse. Abnormally low blood pressure would be unlikely because beta-adrenergic blockers are used to treat hypertension. Abrupt withdrawal of this medication wouldn't directly affect a client's respiratory rate.

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

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 467.

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17.

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?
- A.
  
  Pulse
- B.
  
  Respirations
- C.
  
  Temperature
- D.
  
  Blood pressure
Correct Answer
D. 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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18.

If a manual end-of-shift count of controlled substances isn't correct, the nurse's best action is to:
- A.
  
  Investigate and correct the discrepancy, if possible, before proceeding.
- B.
  
  Immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy.
- C.
  
  Document the discrepancy on an incident report.
- D.
  
  Document the discrepancy on a opioid-inventory form.
Correct Answer
B. 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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19.

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?
- A.
  
  Stating the client's name when entering the room and asking if the name is correct
- B.
  
  Matching the client's identification bracelet to the medication-administration record
- C.
  
  Asking the client's roommate to identify the client
- D.
  
  Asking the client to state his name
Correct Answer
B. 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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20.

After administering an I.M. injection, a nurse should:
- A.
  
  Recap the needle and discard it in any medical waste container.
- B.
  
  Recap the needle and discard it in a puncture-proof container.
- C.
  
  Discard the uncapped needle in a puncture-proof container.
- D.
  
  Break the needle and discard the needle and syringe in any medical waste container.
Correct Answer
C. 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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21.

A client is admitted to the emergency department after intentionally taking an overdose of amitriptyline (Elavil). A nurse knows that giving the client activated charcoal will:
- A.
  
  Cause him to vomit the ingested drug.
- B.
  
  Stimulate bowel motility so he excretes the drug rapidly.
- C.
  
  Bind with the ingested drug.
- D.
  
  Neutralize the ingested drug.
Correct Answer
C. Bind with the ingested drug.

Explanation
RATIONALE: Activated charcoal binds with the drug so that the body doesn't absorb it. Giving a client activated charcoal won't promote vomiting or stimulate bowel motility, and it doesn't neutralize the drug.

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

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 382.

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22.

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?
- A.
  
  Anonymously inform her family member of the spouse's diagnosis so that he or she may seek necessary treatment.
- B.
  
  As legally required, inform the family member of the client's diagnosis.
- C.
  
  Encourage the client to speak with the family member about the diagnosis if he or she hasn't already done so.
- D.
  
  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
C. 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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23.

The physician orders 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?
- A.
  
  ¼ ml
- B.
  
  ½ ml
- C.
  
  1 ml
- D.
  
  2 ml
Correct Answer
B. 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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24.

A nurse is caring for a client receiving lidocaine (Xylocaine) I.V. Which factor is most relevant to administration of this medication?
- A.
  
  Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter
- B.
  
  Increase in systemic blood pressure
- C.
  
  Runs of ventricular tachycardia on a cardiac monitor
- D.
  
  Increase in intracranial pressure (ICP)
Correct Answer
C. 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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25.

An emergency department nurse is caring for a child diagnosed with croup. The nebulizer treatment of choice for a child with croup is:
- A.
  
  Albuterol (Ventolin).
- B.
  
  Metaproterenol (Alupent).
- C.
  
  Racemic epinephrine (Racepinephrine).
- D.
  
  Ipratropium bromide (Atrovent).
Correct Answer
C. Racemic epinephrine (Racepinephrine).

Explanation
RATIONALE: Racemic epinephrine is an adrenergic that reduces inflammation and edema of the tissue surrounding the trachea in a client with croup. Albuterol, metaproterenol, and other beta2-adrenergic drugs are used to treat asthma. Ipratropium is an anticholinergic used to treat severe asthma.

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

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 262.

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26.

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:
- A.
  
  Adverse effects.
- B.
  
  Route of excretion.
- C.
  
  Peak concentration time.
- D.
  
  Steady-state duration of action.
Correct Answer
A. Adverse effects.

Explanation
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.

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. 34.

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27.

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?
- A.
  
  Hypercalcemia
- B.
  
  Hypernatremia
- C.
  
  Hyperglycemia
- D.
  
  Hyperkalemia
Correct Answer
D. 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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28.

A nurse may delegate adding medications to I.V. fluid containers to a:
- A.
  
  Nursing assistant.
- B.
  
  Pharmacy technician.
- C.
  
  Pharmacist.
- D.
  
  Student nurse.
Correct Answer
C. 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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29.

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?
- A.
  
  100 units of regular insulin in normal saline solution
- B.
  
  100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution
- C.
  
  100 units of regular insulin in dextrose 5% in water
- D.
  
  100 units of NPH insulin in dextrose 5% in water
Correct Answer
A. 100 units of regular insulin in normal saline solution

Explanation
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 the therapy, a dextrose solution is administered to prevent hypoglycemia.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
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. 1414.

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30.

A physician orders codeine, ½ grain every 4 hours, for a client experiencing pain. How many milligrams of codeine should the nurse administer?
- A.
  
  15 mg
- B.
  
  30 mg
- C.
  
  60 mg
- D.
  
  120 mg
Correct Answer
B. 30 mg

Explanation
RATIONALE: The nurse should administer 30 mg of codeine. The dosage is calculated as follows:
1 gr/0.5 grain = 60 mg/X
X = 60 × 0.5 = 30 mg.

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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31.

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:
- A.
  
  Administer the suppository 15 minutes after the diarrhea stops.
- B.
  
  Withhold the suppository and notify the client's physician.
- C.
  
  Tell the client you'll give him the suppository when he's finished in the bathroom.
- D.
  
  Substitute 325-mg aspirin by mouth.
Correct Answer
B. 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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32.

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?
- A.
  
  5 ml
- B.
  
  2 ml
- C.
  
  2.5 ml
- D.
  
  3.8 ml
Correct Answer
C. 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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33.

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?
- A.
  
  ¼ ml
- B.
  
  ½ ml
- C.
  
  ¾ ml
- D.
  
  1¼ ml
Correct Answer
C. 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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34.

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?
- A.
  
  Giving the client the preoperative analgesic at the scheduled time
- B.
  
  Asking the client to sign the consent form
- C.
  
  Notifying the surgeon that the client hasn't signed the consent form
- D.
  
  Canceling the surgery
Correct Answer
C. 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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35.

A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use?
- A.
  
  20G, 1″
- B.
  
  20G, 1½″
- C.
  
  22G, 1″
- D.
  
  22G, 1½″
Correct Answer
C. 22G, 1″

Explanation
RATIONALE: The nurse should evaluate the muscle mass and amount of subcutaneous fat and then select the correct needle size. Without more information, the nurse would select the 22G, 1″ needle, appropriate for an average-size school-age child. The 20G, 1″ needle would be unnecessarily large. The 22G, 1½″ needle would be too long. The 20G, 1½″ needle would be too long and unnecessarily large.

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

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 100.

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36.

A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first?
- A.
  
  The client
- B.
  
  The prescriber
- C.
  
  The nurse's lawyer
- D.
  
  The risk manager
Correct Answer
B. 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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37.

A physician orders an infusion of whole blood for a client. When planning the client's care, a nurse should include which intervention?
- A.
  
  Staying with the client for 15 minutes after starting the infusion
- B.
  
  Starting an I.V. infusion of 5% dextrose in saline solution before hanging the blood bag
- C.
  
  Starting the infusion through a 22G I.V. catheter
- D.
  
  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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38.

A client who has severe thermal burns and is on mechanical ventilation becomes delusional and attempts to extubate himself. The nurse gives him propofol (Diprivan), a sedative. As a result, it's most important that the client receive a supplementation of:
- A.
  
  Zinc.
- B.
  
  Sodium.
- C.
  
  Potassium.
- D.
  
  Magnesium.
Correct Answer
A. Zinc.

Explanation
RATIONALE: Propofol causes urinary zinc losses. Clients with burns are particularly susceptible to zinc deficiency; therefore, this client may need zinc supplementation. Burn clients are prone to electrolyte imbalances, including elevated or depressed sodium and potassium levels; however, these aren't specifically related to propofol therapy. The client may need magnesium supplementation, but not as a result of propofol therapy.

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

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 195.

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39.

A client is to receive a glycerin suppository. Which nursing action is appropriate when administering a suppository?
- A.
  
  Removing the suppository from the refrigerator 30 minutes before insertion
- B.
  
  Applying a lubricant to the suppository
- C.
  
  Dissolving the suppository in 3 ml of warm water
- D.
  
  Instructing the client to bear down during insertion
Correct Answer
B. Applying a lubricant to the suppository

Explanation
RATIONALE: A suppository must be lubricated before insertion. Because suppositories melt at body temperature, they usually require refrigeration until administration. It isn't appropriate to dissolve a suppository in warm water. It should remain in a solid state. Instructing the client to bear down would cause the anal sphincter to contract, making insertion difficult.

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

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 48.

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40.

The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should:
- A.
  
  Stir the liquid with a sterile applicator.
- B.
  
  Invert the vial and let it stand for 2 to 3 minutes.
- C.
  
  Shake the vial vigorously.
- D.
  
  Roll the vial gently between her palms.
Correct Answer
D. 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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41.

A nurse administering medications is unfamiliar with ropinirole (Requip), the medication ordered for a client with Parkinson's disease. Which action should the nurse perform first?
- A.
  
  Check the client's medication-administration record for clarification of the medication.
- B.
  
  Contact the pharmacist for information about this medication.
- C.
  
  Refer to a reliable nursing drug handbook to verify the action, usual dosage, adverse effects, and nursing considerations for this medication.
- D.
  
  Ask another nurse on the unit who is familiar with the medication for information about it.
Correct Answer
C. Refer to a reliable nursing drug handbook to verify the action, usual dosage, adverse effects, and nursing considerations for this medication.

Explanation
RATIONALE: A nurse must be knowledgeable about a medication before she administers it to a client. A reliable nursing drug handbook will include information about the drug's expected action, usual dosage, adverse effects, and nursing considerations. The client's medication-administration record won't include this information. Because nurses are responsible for their own actions, it isn't necessary to consult a pharmacist or another nurse if the medication is listed in a reliable nursing drug handbook.

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. 563.

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42.

A nurse is preparing to administer digoxin (Lanoxin) elixir to a client. Which principle regarding this medication is correct?
- A.
  
  The adult therapeutic level for digoxin is 2 to 3 mg/ml.
- B.
  
  Although serious, digoxin toxicity isn't life-threatening.
- C.
  
  Digoxin shouldn't be administered if the client's heart rate is below 100 beats/minute.
- D.
  
  Liquid digoxin should be carefully measured with a calibrated dropper or syringe.
Correct Answer
D. Liquid digoxin should be carefully measured with a calibrated dropper or syringe.

Explanation
RATIONALE: The adult therapeutic level for digoxin is 0.5 to 2 mg/ml. This narrow therapeutic range makes digoxin toxicity likely, so the nurse must measure liquid preparations with calibrated droppers or syringes. Digoxin toxicity commonly causes life-threatening cardiac arrhythmias. The nurse should hold digoxin for heart rates below 60 beats/minute.

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. 673.

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43.

What is the best way for a nurse to improve a client's compliance with the ordered medication schedule?
- A.
  
  Encourage the client to hire a visiting nurse.
- B.
  
  Give all instructions at least three times.
- C.
  
  Lengthen the intervals in the administration schedule.
- D.
  
  Devise the simplest possible medication schedule.
Correct Answer
D. 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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44.

What is the most common cause of medication errors among noninstitutionalized elderly clients?
- A.
  
  Deficient knowledge
- B.
  
  Poor vision
- C.
  
  Dementia
- D.
  
  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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45.

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?
- A.
  
  Insert the needle at a 45-degree angle.
- B.
  
  Wipe the needle immediately after injection.
- C.
  
  Pull the skin laterally toward the injection site.
- D.
  
  Simultaneously withdraw the needle and release the skin.
Correct Answer
D. 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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46.

A nurse has an order to administer iron dextran (INFeD) 50 mg I.M. injection. When carrying out this order, the nurse should:
- A.
  
  Insert the needle at a 45-degree angle.
- B.
  
  Wipe the needle immediately after injection.
- C.
  
  Pull the skin laterally toward the injection site.
- D.
  
  Use the Z-track technique.
Correct Answer
D. 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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47.

Which drug delivery system most effectively reduces the likelihood of medication errors?
- A.
  
  Floor stock
- B.
  
  Unit-dose
- C.
  
  Individual prescription
- D.
  
  Automated
Correct Answer
D. Automated

Explanation
RATIONALE: An automated drug delivery system most effectively reduces the likelihood of medication errors by automatically dispensing the drug. Medication errors can still occur with this method but are less likely than with floor stock, unit-dose, and individual prescription methods.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
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. 549.

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48.

A client is to be discharged with a prescription for an analgesic that is a controlled substance. During discharge teaching, the nurse should explain that the client must fill this prescription how soon after the date on which the physician wrote it?
- A.
  
  Within 1 month
- B.
  
  Within 3 months
- C.
  
  Within 6 months
- D.
  
  Within 12 months
Correct Answer
C. Within 6 months

Explanation
RATIONALE: In most cases, an outpatient must fill a prescription for a controlled substance within 6 months of the prescription date.

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. 555.

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49.

During gentamicin therapy, the nurse should monitor a client's:
- A.
  
  Serum potassium level.
- B.
  
  Serum glucose level.
- C.
  
  Partial thromboplastin time (PTT).
- D.
  
  Serum creatine level.
Correct Answer
D. 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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50.

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?
- A.
  
  I.M.
- B.
  
  Subcutaneous (subQ)
- C.
  
  Intradermal
- D.
  
  I.V.
Correct Answer
D. 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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Medication And I.V. Administration (Part 2)

The physician orders morphine, 4 mg I.V. every hour, as needed to relieve a client's pain. The nurse knows that morphine belongs to which schedule of opioids?

After reconstituting a multidose vial of medication, a nurse writes the date and time of reconstitution on the vial label. What else should the nurse write on the label?

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

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?

Cross-tolerance to a drug is defined as:

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:

Which signs and symptoms might a nurse observe in a client having an adverse reaction to a loop diuretic? Select all that apply.

To determine the I.V. drip rate, a nurse must know the drip factor, which is:

A client comes to the emergency department after taking an overdose of amitriptyline (Elavil). Immediate care for this client should include:

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

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?

After having a total hip replacement, a client receives morphine sulfate (Duramorph) by patient-controlled analgesia (PCA) pump. The client says, "This pump doesn't help my pain at all." What should the nurse do in response to this statement?

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?

Why would a nurse be interested in a client's dietary history when administering drugs?

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:

What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking his beta-adrenergic blocker?

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?

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

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?

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

A client is admitted to the emergency department after intentionally taking an overdose of amitriptyline (Elavil). A nurse knows that giving the client activated charcoal will:

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?

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

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

An emergency department nurse is caring for a child diagnosed with croup. The nebulizer treatment of choice for a child with croup is:

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:

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?

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

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?

A physician orders codeine, ½ grain every 4 hours, for a client experiencing pain. How many milligrams of codeine should the nurse administer?

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:

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?

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?

A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use?

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

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

A client who has severe thermal burns and is on mechanical ventilation becomes delusional and attempts to extubate himself. The nurse gives him propofol (Diprivan), a sedative. As a result, it's most important that the client receive a supplementation of:

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

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

A nurse administering medications is unfamiliar with ropinirole (Requip), the medication ordered for a client with Parkinson's disease. Which action should the nurse perform first?

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

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

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

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?

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

Which drug delivery system most effectively reduces the likelihood of medication errors?

A client is to be discharged with a prescription for an analgesic that is a controlled substance. During discharge teaching, the nurse should explain that the client must fill this prescription how soon after the date on which the physician wrote it?

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

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?