NCLEX-RN QUESTION AND ANSWERS WITH RATIONALES 2023

NCLEX-RN QUESTION AND ANSWERS WITH RATIONALES 2023 Physiological Integrity: Pharmacological & Parenteral Therapies Questions 1. When you are monitoring your client who is now started on an intravenous antibiotic for an infection, you notice that the client is exhibiting signs of anaphylaxis. What is your first priority intervention? A. Stop the intravenous flow B. Slow down the intravenous flow C. Notify the doctor D. Begin CPR Correct Response: A Your first priority intervention is to immediately stop the flow of the intravenous antibiotic because it is highly likely that the signs of anaphylaxis have occurred as the result of the client’s adverse effect to this antibiotic. The next thing that you would do is assess the client to determine their physical status and to provide necessary emergency measures, including CPR, if it is indicated. Later, you would notify the doctor about this adverse reaction. 2. The best way to determine whether or not a medication is compatible with a particular intravenous fluid is to: A. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for color changes B. Refer to a compatibility chart C. Call the doctor and ask if the medication is compatible with the particular intravenous fluid D. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for any precipitates Correct Response: B The best way to determine whether or not a medication is compatible for a particular intravenous fluid is to refer to a compatibility chart. Although, at times, incompatibility can be evidenced with changes such as those related to color changes and the formation of a cloudy solution or obvious precipitate, at other times incompatibility may not be noticeable. For this reason, nurses must refer to a compatibility or incompatibility chart before they mix medications or medications and solutions. Lastly, there is no need to call the doctor for compatibilities when you have, and should use, a compatibility chart. 3. One of the primary purposes of a formal medication reconciliation is to: A. Prevent polypharmacy B. Conserve financial resources C. Prevent interactions D. Prevent allergies Correct Response: C The medication reconciliation process to insure that the nurse is aware of all medications that the client is taking, some of which may have been ordered by a physician other than the client’s primary care doctor and some of which are over the counter or alternative therapies that the client has added. The complete and current list of medications is then reviewed by the nurse and possible interactions are identified and addressed with the client. Although this medication reconciliation process can also save costs by eliminating unnecessary medications, particularly when the client is taking multiple medications (polypharmacy), this is not a primary purpose. Lastly, medications that the client is allergic to should never be given, therefore, these medications should not appear during the medication reconciliation process; they should never have been given to or taken by the client. 4. Your pregnant client has a new order for a medication. What principle should you apply to this new medication? A. The fact that drugs classified as categories C, D and X are contraindicated for women who are pregnant. B. The fact that drugs classified as categories A, B and C are contraindicated for women who are pregnant. C. The fact that drugs classified as categories C, D and E are contraindicated for women who are pregnant. D. The fact that drugs classified as categories C, D and Z are contraindicated for women who are pregnant. Correct Response: A Drugs classified as categories C, D and X are contraindicated for women who are pregnant because of the risks associated with these categories in terms of the developing fetus when these medications cross the placental barrier. 5. What are the nursing implications associated with administering blood and blood products to a client who has a blood type of B negative? A. The nurse must be knowledgeable about the fact that this client has A and B agglutinins and lacks the Rh factor B. The nurse must be knowledgeable about the fact that this client has B and O agglutinins and lacks the Rh factor C. The nurse must be knowledgeable about the fact that this client has B agglutinins and lacks the Rh factor D. The nurse must be knowledgeable about the fact that this client has A agglutinins and lacks the Rh factor Correct Response: D The nurse must be knowledgeable about the fact that this client has A agglutinins and they lack the Rh factor. Type A blood has B agglutinins; type B blood has A agglutinins, type AB blood has no antibodies, or agglutinins, and type O blood has both A and B agglutinins. People also have a rhesus, or Rh, factor antigen or the lack of it. Clients with an Rh positive blood, which is the vast majority of people, have Rh positive blood and people without the Rh factor antigen have Rh negative blood. 6. Select the complication of a blood transfusion that is accurately paired with its preventive measure. A. Hemolysis: Typing and cross matching the blood and checking for ABO compatibility prior to administration B. Hemolysis: Insuring that the client does not have a prior history of hemolysis in the past C. Febrile reactions: Insuring that the client does not have a prior history of hemolysis in the past D. Febrile reactions: Typing and cross matching the blood and checking for ABO compatibility prior to administration Correct Response: A Hemolysis can be prevented by typing and cross matching the blood and checking for ABO compatibility prior to administration. This incompatibility can occur as the result of a laboratory error in terms of typing and cross matching and a practitioner error in terms of checking the blood and matching it to the client’s blood type. Febrile reactions are the most commonly occurring reaction to blood and blood products administration. Although a febrile reaction can occur with all blood transfusions, it is most frequently associated with packed red blood cells and this reaction is not accompanied with hemolysis nor is it associated with its occurrence. 7. You will be administering packed red blood cells to your client. Which of the following principles should you apply to this blood administration? A. You must insure that the client has a patent intravenous catheter that is at least 20 gauge. B. You will need the help of another nurse prior to the administration of these packed red blood cells. C. The unit of packed red blood cells should start no more than 1 hour after it is picked up. D. You must remain with and monitor the client for at least 30 minutes after the transfusion begins. Correct Response: B You will need the help of another nurse prior to the administration of these packed red blood cells. Two nurses must check the blood, the doctor’s order, the ABO compatibility and the client’s identity using at least two unique identifiers prior to the administration of this blood. You must insure that the client has a patent intravenous catheter that is at least 18 gauge and not 20 gauge; you will be using normal saline and a Y infusion set for the administration of the blood because Ringer’s lactate and other intravenous solutions are not compatible with blood; blood should not remain in the client care area for more than 30 minutes so it is important that the nurse is prepared to begin the transfusion shortly after the blood is delivered to the patient care area; and, lastly, the nurse should remain with and monitor the client for at least 15 minutes after the transfusion begins at a slow rate since most serious blood reactions and complications occur shortly after the transfusion begins. 8. You are caring for a multiple trauma client who has just arrived at the emergency room with a number of other external disaster victims. This client has multiple blast injuries and hypovolemic shock; it is anticipated that this unstable critically injured and unconscious client will have long term intravenous therapy, blood products and possibly hyperalimentation as well. Which type of venous access would you most likely anticipate for this client? A. A percutaneous, non tunneled subclavian catheter B. A peripheral intravenous catheter that is 20 gauge C. A multi lumen implanted tunneled and cuffed central venous catheter D. A peripherally inserted central venous catheter Correct Response: C You would most likely anticipate that this client will be given a multi lumen implanted tunneled and cuffed central venous catheter because this multi trauma client is in need of multiple intravenous therapies such as blood, medications and total parenteral nutrition over an extended period of time. A percutaneous, non tunneled subclavian catheter would not be the device of preference because percutaneous, non tunneled subclavian catheters are used when short term treatments are anticipated; a peripheral intravenous catheter that is at least 18 gauge is necessary for the administration of blood; and a peripherally inserted central venous catheter would also not be the venous access device of choice for this seriously ill client who will require long term treatments and care. 9. How many tablets should be administered daily using the below information? Doctor’s order: 200 mg of medication once a day Medication label: 1 tablet = 150 mg A. 1.5 tablets B. 1.25 tablets C. 1.33 tablets D. 1 tablet Correct Response: C You have to determine how many tablets the patient will take if the doctor has ordered 200 mg a day and the tablets are manufactured as 150 mg per tablet. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 200 mg: X tablets = 150 mg: 1 tablet Or as 200 mg = 150 mg X tablets 1 tab You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 200 x 1 = 150 X 200/150 = 1.33 tabs rounded off to 1 1/3 tabs 10. How many mL of a liquid medication would you administer intramuscularly using the below information? Doctor’s order: 10 mg of medication BID Medication label: 1 mL = 12 mg A. 0.8 mL B. 0.9 mL C. 0.75 mL D. 0.125 mL Correct Response: A You have to determine how many mLs the patient will take if the doctor has ordered 10 mg twice a day and there are 12 mg in each mL. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 10 mg: X mL = 12 mg: 1 mL Or as 10 mg = 12 mg X mL 1 mL You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 10 x 1 = 10 X 10/12 = 0.833 mL rounded off to 0.8 mL 11. How many units of heparin would you administer subcutaneously using the below information? Doctor’s order: 6,500 units of heparin subcutaneously Medication label: 4,500 units in one mL A. 1.4 mL B. 1.5 mL C. 1.475 mL D. 1.425 mL E. 1.375 mL Correct Response: A You have to determine how many mLs the patient will take if the doctor has ordered 6,500 units of heparin subcutaneously and there are 4,500 units in one mL. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 6,500 units: X mL = 4,500 units: 1 mL Or as 6,500 units = 4,500 units X mL 1 mL You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 6,500 x 1 = 6,500 6,500/4,500 = 1.44 mL which is rounded off to 1.4 mL 12. Your pediatric client weighs 48 pounds. How many mg of a medication would you administer to this client with each dose when the doctor has ordered 5 mg/kg/day in two equally divided doses? A. 45 mg B. 60 mg C. 52 mg D. 55 mg Correct Response: D To calculate the number of mg that this pediatric client will receive in each dose, you will have to calculate the client’s weight in kg and then determine the total mg for the day after which you will divide the daily dosage by 2 because the order is for two equally divided doses each day. The steps for this calculation are shown below: This is how to determine the client’s weight in terms of kg: 48 pounds: x kg = 2.2 pounds: 1 kg Or as 48 pounds = 2.2 pounds x kg 1 kg You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 48 x 1 = 48 48/2.2 = 21.81 or 21.81 kg This is how to determine the client’s total daily dosage when the doctor has ordered has ordered 5 mg/kg/day: 21.81 kg x 5 = 109.05 mg per day This is how to determine the client’s dose for each of the two divided doses: 109.05/2 = 54.53 mg which is rounded off to 55 mg for each of two divided doses. 13. How many drops per minute would you administer when the doctor’s order states that the client should receive 1 liter of fluid over 8 hours and the intravenous set delivers 20 gtts per cc? A. 31 gtts B. 42 gtts C. 48 gtts D. 51 gtts Correct Response: B The first step of this calculation is to calculate the number of mLs, or cc s, per hour and then determine the number of drops per minute. This calculation is done as follows: 1000 ml = 125 mL per hour 8 hrs The next step is done using this rule that reflects the fact that there are 60 minutes per hour in order to determine the number of mLs per minute . 1 hour = The ordered mL per hour 125 mLs X min 60 min 1 hour = 125 mL X min 60 min 60 x 1 = 60 88/60 = 2.08 mL per minute Finally, the number of drops per minute is calculated by using the intravenous infusion set’s drop factor by using this rule. Volume per minute x Drop factor 2.08 x 20 = 41.6 gtts per minute which is rounded off to 42 gtts per minute 14. How many mLs will you administer to the client after you use 3.3 mL of normal saline to reconstitute a medication that will yield 12 mg per mL and the doctor’s order is as follows. Doctor’s order: 25 mg of medication BID A. 1.9 mL B. 2.0 mL C. 2.5 mL D. 2.1 mL Correct Response: D With this type of calculation, the amount of normal saline that will be added to a powder in a vial to reconstitute the medication is important, instead, it is the amount of medication that results after the addition of the normal saline. For example, this reconstituted medication yields it is the yield of 12 mg in an mL that is relevant. It is this that will be used in the calculation. This calculation is done as shown below: 12 mg = 25 mg 1 mL X mL 25 x 1 = 25 25/12 = 2.08 mL which is 2.1 mL rounded off 15. You are caring for a client who has a doctor’s order for 1200 mLs of intravenous fluid every 8 hours. Your shift began at 8 am and there were 600 mLs remaining in the intravenous fluid bag. How many mLs would you expect to see at 12 noon? A. 0 mL B. 5 mL C. 10 mL D. 7.5 mL Correct Response: A When the doctor has ordered 1200 mLs of intravenous fluid every 8 hours, you would calculate the number of mLs per hour, as below. 1200/8 = 150 mLs per hour From 8 am to 12 noon there are 4 hours so: 150 mLs x 4 = 600 mLs Because you had 600 mLs at 8 am, you should be prepared to hand another intravenous bag because this 600 mLs should all be infused at 12 noon. 16. Your client has a doctor’s order for the antihistamine medication diphenhydramine for sleep. What should you do? A. Question the order because Benadryl is an antihistamine and not a sleeping medication. B. Refuse to give the Benadryl because this medication is a stimulant. C. Question the order because Benadryl is contraindicated when the client has a sleep inducement disorder. D. Give the Benadryl because sleep inducement is an accepted off label use of this medication. Correct Response: D You would administer this Benadryl because sleep inducement is an accepted off label use of this medication. When a medication is used for any other than these established and approved uses, this usage is referred to as an “off label use”. 17. Which of the following is not considered one of the “Ten Rights of Medication Administration”? A. The “right” verification B. The “right” to refuse C. The “right” documentation D. The “right” client education