Next Generation NCLEX Practice Questions

Next Generation NCLEX Practice Questions Module 8: Pharmacology and Intravenous Therapies Question. The nurse is preparing to administer 30 milliliters (mL) of a liquid medication to an assigned client. What should the nurse do when preparing this medication? Choose the most likely option for the missing information in the statements below by choosing from the lists of options. The nurse should use a medicine cup, pouring liquid into it after placing it on a flat surface. The nurse is preparing to administer 30 milliliters (mL) of a liquid medication to an assigned client. What should the nurse do when preparing this medication? Choose the most likely option for the missing information in the statements below by choosing from the lists of options. If too much is poured, the nurse should discard the medication per policy. Question: A topical glucocorticoid preparation has been prescribed for a client in whom local dermatitis has developed as a result of an insect bite. What should the nurse include when teaching the client about the medication? Rub the cream gently into the skin Cover the site with plastic wrap after applying the cream Apply an occlusive dressing over the site after applying the cream Apply the cream in a thick layer over the site of the bite and on 2 inches of surrounding skin. RATIONALE: Topical glucocorticoids can be absorbed into the systemic circulation. Therefore they should be applied in a thin layer and gently rubbed into the skin. The client is told not to use occlusive dressings (e.g., bandages, plastic wrap) unless instructed to do so by the health care provider. Question: A client with breast cancer who has undergone a mastectomy will be receiving chemotherapy. The oncologist prescribes allopurinol, 100 mg orally daily, to be started before the initiation of chemotherapy. The nurse should tell the client that this medication is used for which purpose? To prevent nausea To prevent diarrhea To reduce postoperative incision pain To minimize an increase in the plasma uric acid level contact: Q. A client with Hodgkin's disease will be receiving chemotherapy with doxorubicin. Which action should the nurse plan to take as a means of monitoring the client for toxicity specific to this medication? Checking the client's temperature Attaching a cardiac monitor to the client Assessing the client for peripheral edema Drawing a blood specimen to check the client's platelet count Q. A client has been given instructions regarding the recently prescribed levothyroxine. The nurse determines the teaching was effective if the client states the medication should be taken in which manner? With food At bedtime With a snack at 3 p.m. In the morning, on an empty stomach Q. Oral prednisone, 10 mg/day, has been prescribed for a hospitalized client with a history of type 1 diabetes mellitus for the treatment of an acute exacerbation of asthma. The nurse should monitor the client closely for which occurrence? Signs of hypoglycemia Signs of hyperglycemia The need to decrease the prescribed daily insulin dose Q. The need to change the prescribed daily insulin to an oral hypoglycemic medication A nurse has taught a client with type 1 diabetes mellitus how to draw up and mix the prescribed dose of NPH insulin 20 units and regular insulin 6 units. The nurse realizes the teaching has been effective if the client draws up the insulins in which order? Arrange the sequence options in the correct order by assigning each option a number  Putting 20 units of air into the NPH insulin bottle 1  Putting 6 units of air into the regular insulin bottle 2  Drawing up the regular insulin 3  Drawing up the NPH insulin 4  Rectally administered lactulose is prescribed for a client with hepatic encephalopathy. Which parameter should the nurse monitor to evaluate the effectiveness of the medication?  Blood pressure  Ammonia level  Electrolyte levels  Looseness of stools Q. The nurse provides medication instructions to a client. Which statements by the client indicate the need for follow-up and additional teaching? Select all that apply.  "I need to check my pulse before taking my heart medication."  "I need to stop taking the medication if I have any side effects."  "I can take herbal medications if I want, because they come from plants."  "I should wear a Medic-Alert bracelet for as long as I’m taking this blood thinner."  "I need to take this antibiotic until all of the capsules are all gone, even if I’m feeling better." Q. A nurse is preparing to administer enteric-coated acetylsalicylic acid tablets orally to a client. When the nurse brings the medication to the client, the client tells the nurse that she has difficulty swallowing and will not be able to swallow the pills. Which action is most appropriate for the nurse to take?  Contacting the health care provider  Administering an elixir form of the medication  Crushing the pills and mixing them into applesauce  Administering the suppository form of the medication Q. A nurse is observing a new nurse employee who is preparing to administer 1 inch (2.5 cm) of topical nitroglycerin ointment to a client with angina pectoris. Which actions indicate the new nurse employee needs further education? Select all that apply. Wearing gloves Applying the ointment to skin with hair Removing previously applied ointment Rubbing the ointment into the client’s skin Measuring out the correct amount of ointment on the paper applicator Taping the paper applicator in place once the ointment has been applied RATIONALE: To promote medication absorption as intended, the nurse would avoid applying the ointment to skin with hair and would also avoid rubbing the ointment into the skin. The nurse always wears gloves when applying topical medications to a client; in this case, gloves are especially important because the nurse could be subject to the effects of the medication if it were to come into contact with the nurse’s skin. Before applying nitroglycerin ointment, the nurse would remove the previously applied ointment and cleanse the skin. The correct amount of medication is measured out on the appropriate paper applicator, after which the applicator is taped in place on the client’s body. Q. A client’s dinner intake includes a glass of milk (8 oz), a cup of tea (6 oz), a glass of water (8 oz), and gelatin (4 oz). How many milliliters of fluid has the client consumed? (Type your answer in the space provided, then select Submit.) Solution: 8 oz X 30 mL= 240 mL 6 oz X 30 mL= 180 mL 8 oz X 30 mL= 240 mL 4 oz X 30 mL = 120 mL add everything 780 mL Q. A newborn is to receive intramuscular vitamin K immediately after birth. On the basis of the health care providers prescription, the nurse determines that the newborn should be given 0.25 mL of medication. Which syringe should the nurse select to draw up the correct dose?    Correct      Formula for Calculating a Pediatric Dose from the Adult Dose    Example: The average adult dose of a medication is 250 mg and the child has a BSA of 0.41 m2 .   Calculating a child's drug dosage in this manner is very unusual. Most chemotherapy drugs for children are prescribed according to the BSA.   Four-month-old Caryn Badger has been prescribed amoxicillin 60 mg orally every 8 hours for the treatment of a respiratory infection. Caryn weighs 12.5 lb. The drug literature indicates that in children weighing less than 20 kg, the safe dose is 40 mg/kg/day, divided into three doses. Caryn's nurse prepares to administer the first dose of the medication.   Caryn weighs 12.5 lb. The nurse, determining whether the dosage prescribed for Caryn is safe, calculates Caryn’s weight in kilograms. How many kilograms does Caryn weigh? (Round your answer to the nearest tenth.) 5.7 kg   SOLUTION: 12.5 LBS / 2.2 LBS = 5.68 kg ROUND THE TO THE NEAREST TENTH 5.7 kg  Q. The safe dose of the prescribed medication is 40 mg/kg/day, divided into three doses. Using Caryn's weight in kilograms, the nurse determines the maximal daily dose of the medication that Caryn can safely be given. What is the maximal daily dose in milligrams? 228 mg/day RATIONALE: To determine the maximal daily dose of medication for Caryn, multiply her weight in kilograms by the safe dose parameter. In this situation, the safe dose is 40 mg/kg/day, so multiply 40 mg by 5.7 kg. This yields 228 mg/day. Q. The nurse reads the medication label and rechecks the prescription (60 mg orally every 8 hours) to determine the amount of medication to be given. How many milliliters will the nurse give per dose to Caryn? 2.4 mL RATIONALE: Use the dose calculation formula: Desired _______ × milliliters = Milliliters per dose Available 60 mg ______ × 5 mL = 2.4 mL 125 mg Q. Caryn’s condition worsens. The health care provider has changed the amoxicillin prescription to nafcillin 200 mg intramuscularly every 6 hours. The drug literature indicates that this medication can be safely given at a dosage of 100 mg/kg/day, divided into 4 to 6 doses. The vial is labeled "1 g" and will be reconstituted with 3.4 mL of diluent, which equals 4 mL in the vial. How will the nurse respond to this prescription? Arrange the actions in the order that they should be performed. All options must be used. Arrange the sequence options in the correct order by assigning each option a number. Nafcillin Sodium  Calculate the safe dose. 1  Call the health care provider to clarify the prescription.2  Select the appropriate medication vial.3  Calculate the amount of medication to draw up.4  Wash hands.5 Q. Which guidelines are appropriate for use by the nurse administering the intramuscular injection to Caryn? Select all that apply. Inject into the vastus lateralis muscle. Use the ventrogluteal muscle for the injection. Use a 1½-inch (3.8 cm) 20-gauge needle and 3-mL syringe. Ask someone else to hold the infant while you give the injection. Use a ½-inch (1.25 cm) 25-gauge needle to administer the medication. RATIONALE: The only muscle large enough for intramuscular injections in the infant is the vastus lateralis. The nurse should ask someone else to hold the infant to help prevent damage resulting from movement during the injection. Another nurse or a parent may help hold the child. The needle should be ½ inch long, 25 gauge, because of the infant’s small muscle mass. The ventrogluteal muscle is used in children older than 18 months and in adults. A 1½-inch 20-gauge needle is too long and too large. The registered nurse is a case manager for the emergency department. A client is brought to the emergency department by emergency medical services after sustaining a gunshot wound to the abdomen. The client, bleeding profusely, requires an immediate transfusion of whole blood, but his blood type is unknown. When conducting a case review, the case manager determines appropriate action was taken if which type of blood was requested from the blood bank?  O-positive  O-negative  AB-positive  AB-negative The nurse is caring for a client with breast cancer who has been undergoing chemotherapy. Blood tests indicate a low platelet count. A platelet transfusion is prescribed, and the nurse obtains the platelets from the blood bank. After carrying out the pretransfusion protocol, the nurse should administer the transfusion over what period of time? 2 hours 4 hours 6 hours 15 to 30 minutes RATIONALE: The volume of a unit of platelets may vary from 200 mL for single-donor platelets to 300 mL per unit for pooled platelets. Because the platelet is a fragile cell, platelet transfusions are administered rapidly once they have been brought to the client’s room, usually over the course of 15 to 30 minutes. The other options are time frames that are too long for the administration of a platelet transfusion.  The nurse has obtained a unit of packed RBCs from the blood bank for administration to a client. While preparing to administer the transfusion, the nurse is called to attend to an emergency involving another client. Before leaving to go to the other client, what should the nurse ask another staff member to do?  Return the blood to the blood bank  Place the blood in the nursing unit’s refrigerator  Attach the blood to the client’s IV line because the client’s identity and the identifying information on the unit of blood have already been matched  Bring the unit of blood to the client’s bedside and explain to the client that the blood will be infused once the emergency situation has been taken care of RATIONALE: Blood bank safety protocol dictates that refrigerated blood components not be returned to inventory if they have been warmed to more than 10° C (50° F). Therefore the maximal amount of time for which a unit of blood can be out of storage is 30 minutes. Thus, the nurse would not leave the unit of blood at the client’s bedside or attach it to the client’s IV line. Blood is not placed in the nursing unit refrigerator, because its temperature may not be adequate for blood storage. The appropriate nursing action is to have the unit of blood returned to the blood bank.  Two registered nurses confirming blood product compatibility and verifying client identity for a client who is to receive a unit of packed RBCs are comparing the name and number on the client’s identification band with the name and number on the unit of blood. The nurses note that the numbers are not identical. What should the nurses do?  Hang the unit of blood  Contact the blood bank  Continue verifying client identity, then notify the health care provider  Ask the unit secretary to prepare another identification band for the client that contains the number noted on the unit of blood RATIONALE: Two licensed nurses must check the health care provider's prescription, the client's identity, and the client’s identification band and number, verifying that the name and number are identical to those on the blood component tag. At the bedside, the client is asked to state his or her name, which the nurse compares with the name on the client’s ID band. The blood bag tag and label and the blood requisition form are assessed to ensure that ABO and Rh types are compatible, and the blood bag label is also checked to ensure that the correct components have been issued. If an inconsistency is found, the blood bank is notified immediately. Hanging the unit of blood, continuing to verify the client’s identity, notifying the health care provider, and asking the unit secretary to prepare another identification band for the client that contains the number noted on the unit of blood are all incorrect choices. Additionally, there is no useful reason to notify the health care provider. The nurse is working with a new nurse employee who is hanging a unit of packed RBCs. The nurse realizes the new nurse employee has taken correct action if the nurse takes which step once the nurse has hung the blood and adjusted the flow rate? Taking the client’s vital signs Staying with the client and monitoring him closely for 15 minutes Asking the client whether he has ever had a reaction to a blood transfusion Placing the call bell next to the client and instructing him to call if he experiences anything unusual RATIONALE: The first 10 to 15 minutes of any transfusion is the most critical period. If a major ABO incompatibility exists or a severe allergic reaction such as anaphylaxis is going to occur, it is usually evident within the first 50 mL of the transfusion. Therefore the transfusion should be started at a slow rate and the client monitored closely for the first 15 minutes. If no reaction is noted during the first 15 minutes, the infusion may be increased to the prescribed rate. The client is asked about previous reactions to blood transfusions before the blood is infused. Vital signs are taken before the transfusion is begun, after the first 15 minutes, and every hour until 1 hour has elapsed since the transfusion was completed. Before leaving the client, the nurse places the call bell next to him and instructs him to call if he experiences any unusual feelings or emotions.  The nurse is monitoring a client receiving a blood transfusion. One hour after the transfusion is started, the client complains that her skin is extremely itchy. On assessing the client’s skin, the nurse notes a rash and suspects a transfusion reaction. Which action should the nurse take after immediately stopping the transfusion?  Removing the IV catheter  Contacting the health care provider  Completing a transfusion reaction report  Rechecking the blood bag tags against the client’s identification band RATIONALE: When a transfusion reaction occurs, the nurse first stops the blood transfusion, then maintains a patent IV line with normal saline solution and immediately notifies the health care provider and blood bank. After taking these actions, the nurse would recheck the blood bag tags against the client’s identification band, check the client’s vital signs and urine output, treat the client’s symptoms in accordance with the health care provider’s prescriptions, send the blood bag and tubing to the blood bank, complete a transfusion reaction report and document the reaction in the client’s record, and collect required blood and urine samples in accordance with agency protocol and health care provider’s prescriptions. Helena Farentano, 79 years old, is being admitted to the hospital for evaluation of weakness and lightheadedness. While gathering subjective data, the nurse discovers that Helena has experienced frequent episodes of weakness and lightheadedness over the past 3 weeks. Helena tells the nurse that she was brought to the hospital by her son after such an episode this morning, during which she fell. She tells the nurse that she is a widow and lives alone but that her son lives close by and helps her with whatever she needs. Helena's temperature is 99° F (37.2° C), apical pulse is 92 beats/min, respiratory rate is 22 breaths/min, and blood pressure is 100/58 mm Hg. Helena tells the nurse that she has generally been in good health and usually eats a balanced diet but that over the past 3 months or so her appetite has been poor. Laboratory studies and diagnostic tests have been prescribed. While reviewing the results of Helena’s laboratory studies, the nurse notes that Helena’s hemoglobin is 6.8 g/dL (68 mmol/L) and her hematocrit is 24%. The nurse reports the results to the health care provider, who prescribes a transfusion of 1 unit of packed red blood cells (RBCs). Which are part of the correct procedures for administering the blood? Select all that apply. Using a 22-gauge needle to infuse the blood Monitoring Helena for circulatory overload during the infusion Planning to ensure that the infusion will be complete in 4 hours Monitoring Helena closely for a transfusion reaction, especially during the first 50 mL of the transfusion Ensuring that the transfusion is started within 1 hour of the blood bag’s delivery to the nursing unit from the blood bank. RATIONALE: The normal hemo