ATI MEDICATIONADMINISTRATION FINAL EXAM

ATI MEDICATIONADMINISTRATION FINAL EXAM 1. The nurse is checking newly prescribed medications. Which medications require the nurse to contact the HCP to clarify what has been prescribed? Select all that apply. A. Aspirin 325 mg orally qd B. MS 4 mg IV q 1 hr pm C. Furosemide 40 mg IV now D. DSW with 20 mEq KCL IV at 125 1nL/hr E. Heparin 5000 u subcutaneously bid ANSWER: A, B, E A. The nurse should clarify aspirin with the HCP because the abbreviation “qd” is disallowed by the Joint Commission. The “qd” can be mistaken for every other day rather than daily. B. The nurse should clarify “MS” with the HCP. The use of MS is disallowed by the Joint Commission because it can be mistaken for magnesium sulfate rather than morphine sulfate. C. Furosemide (Lasix) has the essential components of a medication order—medication name, close, frequency, and route—and uses acceptable abbreviations. D. D5W with 20 mEq KCL has the essential components of a medication order—medication name, dose, frequency, and route—and uses acceptable abbreviations. E. The nurse should clarify heparin with the HCP because the abbreviation “u” is disallowed by the Joint Commission. The “11” can be mistaken for “0”(zero), the number “4” (four), or “cc”. 2. The client is prescribed ferrous sulfate 300 mg PO bid. Which action should be taken by the nurse? A. Administer ferrous sulfate as prescribed to the client. B. Contact the HCP to clarify the route of the medication. C. Contact the HCP to question twice-daily administration. D. Withhold the medication; the dose is beyond the usual range. ANSWER: A A. The nurse should administer ferrous sulfate (Feosol) as prescribed. All essential information is included using approved abbreviations. B. The abbreviation “PO” is an acceptable abbreviation for the oral route and does not need to be clarified with the HCP. C. The abbreviation “bid” is acceptable for twice- daily administration, and at this dose. D. The dose of ferrous sulfate is within the acceptable range and should not be withheld3. The nurse is reviewing the client’s prescribed medications. Which medications should the nurse plan to clarify with the HCP? Select all that apply. A. Digoxin 25 mg IV B. D5NS with 20 mEq KCL now C. Aspirin 325 mg tablet oral every am. D. Lisinopril 5 mg oral bid E. Hydromorphone 1 mg qlh as needed ANSWER: A. B. E A. Digoxin (Lanoxin) is missing the frequency and should be clarified with the HCP; the dosage also is too large and will result in a medication error. B. The IV solution is missing the rate and should be clarified with the HCP. C. The prescribed aspirin contains the name of the medication, the dose, the route, and the frequency and is correct. D. The pre5cribed lisinOpril (Zestril) Contains the name of the medication, the dose, the route, and the frequency and is correct. The abbreviation bid means twice daily and is an accepted abbreviation. E. The prescribed hydromorphone (Dilaudid) is missing the route. The abbreviation q1h is an acceptable medication-related abbreviation indicating that hydromorphone may be administered every hour if needed. 4. The client provides a handwritten medication list that includes bupropion XL 150 mg daily. The client also shows the nurse the medication bottle labeled bupropion XL 300 mg tablets. Which questions should the nurse ask the client? Select all that apply. A. “Has your dosage of bupropion increased or decreased recently?” B. “Did you cut the tablets in half to give yourself the correct dose?" C. “Are you taking bupropion to stop smoking or to treat depression?” D. “When was the last time you took medication from this bottle?” E. “Have you had headaches, tremors, or dry mouth while taking bupropion?” ANSWER: A. C. D. E A. The handwritten medication list is half the strength of the tablets in the bottle. Either the dose was increased and this is the correct bottle, or the dose was decreased and the handwritten medication list is correct and this is the wrong bottle. B. Bupropion is sustained release; tablets should not be halved for safe administration. This is the wrong question to ask. C. Bupropion (Wellbutrin) is commonly used for smoking cessation or treating depression. It can also be used for treating ADHD in adults, or to increase sexual desire in women. D. The last time a dose was taken from the bottle will help determine the amount the client is taking and to verify if it is the correct amount. E. Major side effects of bupropion include headaches, tremors, and dry mouth. If the client is taking a higher dose than prescribed, the client could be experiencing side effects. 5. Before a child’s hospital discharge, the nurse is teaching the parents how to administer an oral medication to the child. Which nurse instruction would be most appropriate? A. Administer the medication and then give a small glass of milk. B. Give the child a flavored ice pop just before giving the medication. C. Use play to show and tell the child that the medication will taste good. D. pour out capsule contents, crush pills, and give these with applesauce. ANSWER: B A. Essential foods, such as milk, should not be given with medications. The child may later associate the food with the medicine and refuse the food. Some medications should not be taken with milk. B. The cold from the ice pop will help to numb the taste buds and weaken the taste of the medication. C. Providing potentially false information about the taste may affect the child’s trust. If the child is old enough, warn the child that the medication is objectionable, but then praise the child after the medication is swallowed. D. Some capsules are extended release and should not be opened 6 . The nurse is administering oral medications to the client. Which steps should be taken by the nurse to safely administer oral medications? Prioritize the nurse’s actions by placing each step in the correct order. A. Document on the client’s MAR administering the medication B. Check the label after preparing the medication C. Check the client’s name band and another agency- approved identifier D. Review the medication prescribed on the medication administration record (MAR) E. Check the label on the medication against the MAR F. Give the medication to the client with a glass of water G. Check the medication at the bedside ANSWER: D. E. B. C. G. F. A D. Review the medication prescribed on the MAR. E. Check the label on the medication against the MAR. B. Check the label after preparing the medication. C. Check the client’s name band and another agency—approved identifier. G. Check the medication at the bedside. F. Give the medication to the client with a glass of water. A. Document on the client’s MAR administering the medication. The medication should be reviewed three times before administering it to the client: when obtaining the medication, after preparing the medication, and at the bedside after the client’s name band has been checked. This sequence is necessary so that the right client receives the right medication and dose, at the right time. 7. The nurse is evaluating whether the client on multiple oral medications is taking the medications correctly. Which finding should be most concerning to the nurse because the absorption rate of medications can be increased? A. Takes afternoon oral medications with a carbonated soft drink B. Drinks a glass of milk with the tetracycline antibiotic oral medication C. Takes morning oral medications with water and consumes 2500 mL of water daily D. Takes mealtime oral medications with a meal low in fiber and high in fatty foods ANSWER: A A. Carbonated beverages can cause oral medications to dissolve faster, be neutralized, or experience a change in absorption rate in the stomach. B. When dairy products are taken with an antibiotic, such as tetracycline, there is decreased drug absorption in the stomach. C. Medications should be taken with a full glass of water. D. Foods low in fiber and high in fat will delay stomach emptying and medication absorption by up to 2 hours. 8. The nurse observes a nursing student prepare and administer medications to adult clients. Which action by the nursing student warrants intervention by the nurse? A. Injects air into a vial before withdrawing 20 mg furosemide from a vial labeled 20 mg/mL B. Selects a 1-mL syringe and 5/8-inch needle for giving 0.5 mL of heparin subcutaneously C. Instructs the client to place a medication to be taken buccal under the client’s tongue D. Pours the prescribed “Robitussin 2 tsp now” to the 10 mL mark on a medication cup ANSWER: C A. Air should be injected into a vial before withdrawing the furosemide (Lasix). B. A needle size of ‘A to 5/8 inch in length should be used for adult subcutaneous injections. C. Buccal medications should be held in the cheek rather than under the tongue. The rate of absorption may be affected. D. A teaspoon is equivalent to 5 mL; thus, 2 teaspoons is 10 mL. 9. The client with minimal adipose tissue is prescribed to receive insulin subcutaneously. Which approach should the nurse plan to use to administer the medication? ANSWER: C A. An 1M and not a subcutaneous injection is given by the Z-track method. B. The triangle identifies the site for giving an IM and not a subcutaneous injection. C. A subcutaneous injection can be given in the abdomen. Pulling the skin to pinch a large skin- fold between the thumb and fingers lifts the subcutaneous layer off the muscle. A 90-degree angle is used for someone who has a lot of subcutaneous tissue. A 45-degree angle is used if the person has a small amount of subcutaneous tissue. D. A 15-degree needle angle is used for an intradermal and not a subcutaneous injection. 10. The nurse is planning to administer medications through the client’s NG tube. Which interventions should the nurse plan after checking the medications, checking client identification, and verifying tube placement? Select all that apply. A. Crush together all medications that are acceptable for crushing. B. Pour crushed medications into one medication cup, mix with water, and administer. C. Pour each individual crushed medication into individual medication cups and mix with water. D. Use a syringe to withdraw one prepared medication from the medication cup and administer. E. Using a syringe, flush the client’s NG tubing with water between each medication. ANSWER: C, D. E A. Medications should not be combined for crushing to prevent compatibility issues, tube occlusions, and altering the effects of the medications. Medications should be given one at a time and the tube flushed between medications. B. Pouring crushed medications into one medication cup combines the medications. C. Medications to be administered NG should be crushed, mixed with water, and administered separately to prevent altering the effects of the medications, compatibility issues, and tube occlusions. D. A syringe with the appropriate-sized tip that fits into the NG tube should be used for withdrawing the medication from the med cup and for administration. E. The NC tube should be flushed with water between each medication to prevent occlusion of the NG tube. 11. The nurse is teaching the client to self administer a medication dose through an MDI. After having the client sit upright, which instructions should be provided? Prioritize the nurse’s instructions by placing each step in the correct order. A. Press the top of the canister. B. Shake the canister several times. C. Close your teeth and lips tightly around the mouthpiece. D. Exhale slowly through pursed lips. E. Take a deep breath and exhale until you cannot exhale any more air. F. Insert the mouthpiece into the mouth over the tongue. G. Inhale deeply and hold the breath for 10 seconds. ANSWER: B, F, C, E, A, G, D B. Shake the canister several times. This will ensure mixing of the contents. F. Insert the mouthpiece into the mouth over the tongue. C. Close your teeth and lips tightly around the mouthpiece. This ensures that the medication will be delivered. E. Take a deep breath and exhale until you cannot exhale any more air. A. Press the top of the canister. G. Inhale deeply and hold the breath for 10 seconds. D. Exhale slowly through pursed lips. 12. The client who inhales a corticosteroid medication through a metered-dose inhaler states, “I have a foul taste in my mouth after I use the inhaler.” Which is the nurse’s best response? A. “You will get used to the foul taste and not notice it.” B. “Be sure that you shake the canister before using it.” C. “Suck on hard candy before you use the inhaler.” D. “Attach an aerosol spacer before using the inhaler.” ANSWER: D A. Stating that the client will get used to the taste does not acknowledge the client’s concern and is not helpful- The foul taste is from large particles of medication on the client’s tongue. B. Shaking the canister does not change the taste of the medication; it ensures that the medication is dispersed within the canister. C. Sucking on hard candy may alter the taste and make it worse; it is not the best response. D. Using a spacer delivers the medication in smaller particles; fewer particles fall onto the tongue. The spacer promotes deeper delivery of the medication into the lungs. 13. The student nurse is administering a clonidine transdennal patch to the client with hypertension. Which action requires the observing nurse to intervene? A. Dons nonsterile gloves before removing the medication from the package. B. Checks the client’s armband for name and medical record number. C. Applies the patch, rubs it against the skin, and then secures it in place. D. Folds the old patch with medication to the inside in preparation for discarding. ANSWER: C A. Nonsterile gloves should be worn to avoid contact with the medication. B. The client should be identified using two unique identifiers. C. The clonidine (Catapres) should not be rubbed into the skin. Patches are designed to allow constant, controlled amounts of medication to be released over 24 hours or more. D. Folding the patch with the medication to the inside avoids inadvertent contact with the medication. 14. The experienced nurse is observing the student nurse provide care to the client. Which action by the student nurse most definitely requires the observing nurse to intervene? A. Places a medication that requires assessment of the client’s heart rate in its own cup. B. Places eye drops prescribed 0D. in the middle of the client’s right eye conjunctiva] sac. C. Flushes an injection port with saline before administering the medication by IV push. D. Opens a sustained-release capsule at the request of the client to mix its contents with food. ANSWER: D A. A medication that requires special assessments should be separated from other medications in case it needs to be held. It is best not to open the medication until the assessments are complete. B. The abbreviation O.D. means right eye. Eye drops should be placed in the right eye conjunctival sac, where they are absorbed. C. Saline (0.9% NaCl) should be used to check the patency of the IV site before administering an IV medication. D. A sustained-release medication is meant to be absorbed over 24 hours; the capsule should not be opened and mixed with food. 15. The nurse administers a prochlorperazine suppository to the adult client. Which action best ensures the nurse that the medication is correctly administered? A. Positions the client on the left side B. Lubricates the suppository prior to insertion C. Feels the suppository being pulled away after insertion D. Notes soft, formed stool 30 minutes after insertion ANSWER: C A. Although the client should be positioned on the left side, this does not indicate whether the medication is in the correct position. B. Lubrication makes passage easier but does not ensure the correct placement against the rectal wall and past the sphincter. C. Rectal suppositories should be inserted past the internal anal sphincter and against the rectal wall. Stimulation of the bowel, once past the internal anal sphincter, will draw the medication inward. Stool in the bowel could cause incorrect placement of the suppository. D. Prochlorperazine (Compazine) is an antiemetic medication. It does not produce bowel peristalsis and elimination. Digital stimulation may cause passage of stool that is in the bowel, but this does not ensure correct administration. 16 . The inexperienced nurse used a child’s ear illustration to teach the child’s mother how to administer eardrops. While pointing to the illustration, the nurse stated, “Warm the solution and clean your 2-year—old’s ear. Then pull the child’s ear up and back, instill the medication, and depress on the tragus of the ear. Keep the child side-lying for about 5 minutes and then insert a small cotton fluff loosely in the auditory canal for about 20 minutes.” Which action is best for the observing nurse to take during or following the teaching? A. Suggest to the nurse that the mother return demonstrate instilling eardrops. B. Confirm with the nurse and mother that the procedure was correctly taught. C. Kindly interrupt to state that the child’s ear should be pulled down and back. D. Praise the nurse for the thorough teaching to the mother about instilling eardrops. ANSWER: C A. Suggesting a return demonstration would be appropriate, but it is not the bestoption because the procedure was taught incorrectly and the mother would demonstrate it incorrectly. B. The observing nurse cannot confirm an incorrectly taught procedure. C. For children under 3 years of age, the ear canal should be gently pulled down and back because the ear canal is directed upward. The observing nurse should kindly interrupt so that the mother is not taught an incorrect procedure. D. Praise should be given for selecting an illustration for learning enhancement, but praise should not be given for an incorrectly taught procedure. 17. An LPN is administering medications to adult clients. Which action requires the RN to intervene? A. Withdraws 1 mL of purified protein derivative (PPD) from a vial for intradermal injection B. Holds an insulin pen for 10 seconds on the client’s abdomen after administering insulin C. Measures three finger-breadths below the acromion process for an intramuscular injection D. Injects 5000 units heparin subcutaneously in the abdomen without first aspirating for blood ANSWER: A A. The RN should intervene because 1 mL is too much for an intradermal injection. Only small amounts are administered intradermally, usually no more than 0.1 mL. B. Holding an insulin pen at the site for 10 seconds will ensure that the insulin is administered. C. The deltoid muscle is located three finger-breadths below the acromion process. D. The nurse should not aspirate for blood when giving heparin subcutaneously. 18. The nurse, working the evening shift, is planning to administer insulin subcutaneously to a child. Which statement made by the nurse to the mother would be inappropriate? A. “It is okay for your child to say ‘ouch,’ cry, or even scream when receiving an injection.” B. “I can give the injection while your child is sleeping; then the injection won’t be noticed.” C. “I will apply a topical analgesic 1 hour before administering the injection to reduce pain.” D. “The child will need to be lying, but after the injection you can hold and comfort your child.” ANSWER: B A. Giving approval for the child to vent his or her feelings provides the child with a better sense of control. B. Injections should never be administered to a sleeping child because the injection is painful, and the child will wake up and be terrified. C. A topical analgesic such as lidocaine/prilocaine (EMLA) cream can reduce the pain with insertion, but pain may still be felt as the medication is injected. D. The child can be lying flat during the injection. 19. The client hospitalized with MS provides a handwritten medication list. Interferon betalb 25 mg subcutaneously daily is on the list. Which nursing actions are correct related to the client’s medication list? Select all that apply. A. Rewrite the medications on official facility documents as written and file per agency policy. B. Inquire about vitamins, herbals, and over-the- counter medications that may not be on the list. C. Verify the dose of interferon beta-lb with the prescribing health care provider. D. Have pharmacy verify the interferon beta-lb with the pharmacy where it was last filled. E. Photocopy or scan the handwritten list and insert a copy into the client’s medical record. F. Ask a family member to bring the container with the prescription noted for verification. ANSWER: B, C, D, F A. Rewriting the medications into the client’s medical record without verifying the dose and frequency can result in a medication overdose. B. Vitamins, herbals, and OTC medications can affect the action of other medications. C. The usual dose and frequency of interferon beta-1b (Betaseron) is 0.25 mg (8 million IU) every other day, so the dose and frequency should be verified. Medications can be verified by contacting the prescribing physician. D. The nurse can ask pharmacy to contact the pharmacy where the medication was last filled to verify the dose. E. Inserting an unaltered copy into the client’s medical record without verifying the dose and frequency can result in a medication overdose. F. Medications can be verified by asking a family member to bring the container that has the prescribing information noted. 20. The nurse plans to administer an IM injection into the left dorsogluteal muscle for the client positioned prone. On the illustration, place an X on the area where the nurse should administer the injection. The left dorsogluteal muscle is best located above and outside a line drawn from the left posterior superior iliac Spine to the left greater trochanter of the femur. An alternative method is to divide the buttock into four quadrants and make the injection in the upper outer quadrant, about 2 to 3 inches (5—7.6 cm) below the iliac crest. A combination of these methods is often used to identify the correct location and avoid the sciatic nerve. 21. The client is to receive hydroxyzine 25 mg IM. Before injecting the medication, which statements should the nurse make to the client? Select all that apply. A. “You will feel minimal pain as I administer the medication.” B. “Expect to experience relief from nausea within about 10 minutes.” C. “You will feel me pull the skin to the side at the site before I give the medication.” D. “Tense your muscle as I make the injection to avoid focusing on the injection itself.” E. “I will use the deltoid muscle; use of the arm muscles will increase absorption.” F. “You will feel a cold sensation as I cleanse your skin with the alcohol swab.” ANSWER: C, F A. Hydroxyzine injected IM can be extremely painful, so the nurse should not give the client false information. B. Medications administered by the IM route generally take 20 to 30 minutes to become effective. C. Hydroxyzine is an antiemetic and sedative/ hypnotic. The injection can be extremely painful, so it is administered by the Z-track IM method. In the Z-track method, the skin is pulled away from the injection site, the injection made, the medication is administered, and the nurse waits 10 seconds before the needle is withdrawn and the skin is released. D. Tensing the muscles increases pain and should be avoided. E. A large muscle such as the ventrogluteal, not the deltoid muscle, should be used for the injection. Literature suggests the ventrogluteal site is safer than the dorsogluteal site for IM injections. F. The skin is disinfected with alcohol prior to administration, which will feel cool when applied. 22. The experienced nurse instructs the new nurse to give an IM injection into the dorsogluteal muscle of the older adult client. Which is the new nurse’s best action? A. Position the client onto his or her abdomen and identify the landmarks for injection. B. Administer the injection using the Z-track method to avoid leakage of medication. C. Inform the experienced nurse that the ventrogluteal muscle is the preferred IM site. D. Select a 1-inch needle for administering the medication into the dorsogluteal muscle. ANSWER: C A. Positioning the client prone may help to identify landmarks for an IM injection into the dorsogluteal muscle, but this site is not recommended for older adults due to difficulty in identifying the land- marks and the proximity of the sciatic nerve and superior gluteal artery. B. All IM injections should be administered by a 2-track method regardless of site. The dorsogluteal muscle should not be used for injection in an older adult. C. The new nurse should inform the experienced nurse that the preferred site for an IM injection is the ventrogluteal muscle. It is the safest and least painful site for an IM injection because it is located away from major blood vessels and nerves. D. The needle size should be based on the site, the muscle size, and the amount of medication; no information is provided to determine if a 1-inch needle is appropriate. 23. The clinic nurse is preparing to administer monovalent HepB (hepatitis B vaccine) IM to a newbom. Which site is best for the nurse to select? A. Deltoid B. Ventrogluteal C. Dorsogluteal D. Vastus lateralis ANSWER: D A. The deltoid muscle is not well developed in neonates. B. Although 0.5 mL of medication can be administered into the ventrogluteal muscle of neonates, it is not a recommended site because the muscle is not bulky enough to absorb medications. C. Dorsogluteal muscles are not well developed in neonates and not bulky enough to absorb medications. D. The vastus lateralis muscle on the anterolateral thigh is recommended as the site for IM injections for neonates less than 1 month old. It has a larger muscle mass than other IM injection sites, which is needed for adequate medication absorption. Using this site avoids the risk of sciatic nerve damage. 24. Before administering digoxin orally, the nurse determines that the client’s serum digoxin level is 2.6 ng/mL. Which actions should be taken by the nurse knowing that the therapeutic range is 0.5 to 2.0 ng/mL? Select all that apply. A. Administer the oral dose as prescribed. B. Withhold the prescribed dose ofdigoxin. C. Have the client’s digoxin level rechecked. D. Notify the HCP of the laboratory results. E. Call pharmacy to discontinue the digoxin. ANSWER: B, D A. Digoxin should not be administered; the serum digoxin level is higher than the therapeutic range. B. Digoxin should be withheld; the serum digoxin level is higher than the therapeutic range. C. There is no indication that the digoxin level is inaccurate; a recheck is costly and unnecessary. D. The HCP should be informed of the digoxin results; also, the nurse should address that the digoxin was withheld and obtain an order for this. E. Only the HCP can discontinue the digoxin order. Once written, the paper or electronic record is received by pharmacy; the nurse does not need to call pharmacy. 25. The nurse is caring for the client who has 0.9% NaCl infusing intravenously. The HCP wrote an order the previous day to change the IV solution to 0.9% NaCl with 10 mEq KCL. Which action should the nurse initiate first? A. Notify the client’s health care provider (HCP). B. Complete an agency variance/incident report. C. Check the client’s serum potassium level. D. Replace 0.9% NACl with the correct solution. ANSWER: C A. The current serum potassium level should be known before notifying the HCP. The HCP may decide to change the amount of potassium based on the client’s level. B. An agency incident report should be completed by the nurse after caring for the client. C. Because the order was written the previous day and not implemented, the nurse should first check the client’s serum potassium level and then notify the HCP. D. The nurse should determine if there are order changes before replacing the solution. 26 . The client has a low serum potassium level. What should the nurse consider when preparing to administer potassium replacement intravenously? A. The potassium concentration should not exceed 20 mEq/L. B. Ice or warm packs may be needed to reduce vein irritation. C. The potassium should be administered by the IV push route. D. The potassium should be added to the IV solution that is infusing. ANSWER: B A. Although the usual replacement dose is 20 mEq/ 100 mL with administration of 10 to 20 mEq/hour, IV concentrations can safely range from 10 to 40 mEq/L. B. Potassium can be irritating to the vein, and the client may experience burning. Strategies to minimize pain and inflammation include applying ice or warm packs. C. Potassium is never administered as an IV push; it will cause cardiac dysrhythmias. D. Adding medication to an already-infusing IV solution is unsafe and can result in a faster or slower rate of administration depending on the volume of solution remaining. 27. The nurse plans to administer an antibiotic IVPB to the client who is on a fluid restriction and strict 1&0. On the illustration, which port on the 0.9% NaCl IV line would be best for the nurse to add a secondary line for the antibiotic? A. A B. B C. C D. D ANSWER: B A. Placing the secondary line into the existing IV solution bag will cause mixing of the antibiotic with the IV solution. B. The IVPB secondary line should be inserted at the port immediately distal to the backcheck valve on the tubing and before the pump (line B). The antibiotic should run through the IV infusion pump to control the rate and ensure that the medicationis delivered. C. Placing the IVPB secondary line into a port after the infusion pump (line C) would allow an uncontrolled rate for the antibiotic; the IV solution will also be infusing, increasing the volume that the client should receive. D. Line D is the port closest to the client and after the pump. The rate of administration of the antibiotic would not be controlled by the pump. 28. The client has DSW/20 mEq KCL infusing at 75 mL/hr. An antibiotic newly prescribed for the client is to be administered by an IVPB infusion. Which actions should be taken by the nurse? Select all that apply. A. Verify compatibilities between the IV infiision and antibiotic. B. Check for client allergies to the newly prescribed antibiotic. C. Initiate a peripherally inserted central catheter for the antibiotic. D. Ask the HCP if the IV solution and IVPB can be infused together. E. Detemiine the infusion rate for administering the antibiotic. ANSWER: A, B, E A. Although most antibiotics are compatible at the injection site with DSW/20 mEq KCL, the nurse should check for compatibilities. If incompatible, the nurse must stopthe infusion and flush the line before administering the antibiotic. B. Because this is a newly prescribed medication, it is especially important for the nurse to check for allergies. C. Antibiotics can be administered in hand and arm veins; initiating a PICC is unnecessary. D. The nurse would not ask the HCP about administering both the IV infusion and IVPB together; if unfamiliar with how to administer an IVPB, the nurse should consult an experienced nurse or consult the agency procedure manual. E. The rate for administering antibiotics varies by the type of antibiotic and the amount of solution in the IVPB. The nurse should determine the rate by checking the recommended rate noted on the IVPB and, if not noted, consult a medication book or pharmacy and then calculate the correct rate if necessary. 29. The experienced nurse is supervising the new nurse caring for a hospitalized child. Which action indicates that the new nurse needs additional orientation regarding IV therapyfor children? A. Detemiines that the current solution has been infusing for 24 hours and should be changed B. Selects a 1000-mL bag of the prescribed IV solution and checks it against the child’s chart C. Prepares new tubing and the prescribed IV solution 1 hour before it is due to be changed D. Removes the cover from the tubing spike, spikes the bag, and squeezes the drip chamber ANSWER: B A. IV solutions that are open longer than 24 hours are no longer considered sterile. B. IV solutions in 250- and 500-mL containers should be selected to guard against circulatory overload. IV solutions are considered medications, and errors in administration can have negative consequences. C. Tubing is changed every 72 to 96 hours, depending on agency policy. D. The procedure for spiking the bag is correct. The bag could either be hung first or after being spiked. 30. The HCP prescribed intermittent flushing of an infant’s peripheral [V access device to maintain patency. Which action should be taken by the nurse? A. Request a continuous infusion at “to keep open rate” B. Flush the IV access device with 5 mL 0.9% NaCl C. Verify the type and amount of solution for flushing D. Flush the 1V access device with 10 units heparin ANSWER: C A. A continuous infusion is unnecessary to maintain patency of the peripheral IV device. B. Although saline is the typical flush solution, 5 Ml is too much. C. The standard of practice is to verify the amount and type of solution, either by consulting the HCP or agency protocols. D. Heparin may be used to maintain patency of central lines but is usually not used for a peripheral IV access device. 31. The nurse starts cefazolin sodium 500 mg intravenously for the client. Five minutes later, the nurse stops the infusion when the client states, “My throat feels like it is closing shut.” Which intervention should the nurse implement next? A. Call the HCP for possible tracheotomy. B. Call the HCP to request a new antibiotic. C. Obtain and place a medic alert bracelet. D. Give epinephrine and an antihistamine. ANSWER: D A. A tracheotomy may not be necessary. and time is wasted calling the HCP. B. A new antibiotic of a different drug classification may be prescribed, but this is not the next action. C. Some facilities place a medic alert bracelet on the client listing all of the client’s allergies, but this is not the next action. The client’s allergy should be noted in the client’s chart. D. The airway closure indicates anaphylaxis, a life-threatening allergic reaction. Immediate treatment includes giving epinephrine and an antihistamine to relax the bronchioles and reverse the inflammation. 32. The nurse is preparing to administer cefotaxime. Which action is most appropriate when the nurse notes that the client has an allergy to ceftriaxone? A. Give the cefotaxime as prescribed by the health care provider. B. Call phannacy to verify that the medication prescribed is a cephalosporin. C. Ask the client whether cefotaxime had been received in the past. D. Verify that the IICP is aware that the client has an allergy to cephalosporins. ANSWER: D A. Both cefotaxime (Claforan) and ceftriaxone (Roccphin) are third-generation cephaloSporins; there could be cross allergies between the medications. If the nurse administers the medication without verifying that the HCP is aware of the allergy to cephalosporins, the nurse would deviate from the standard of care owed to the client. B. Although the nurse may call pharmacy to verify that the prescribed medication is a cephalosporin and to confirm the risks associated with administering it based on the client’s allergy, the most important action is to notify the HCP. C. The nurse could question the client about receiving the medication previously, but the most important action is for the nurse to verify that the HCP is aware of the allergy. D. The nurse should call the HCP to verify that the allergy was known and that the allergy was considered when cefotaxime was prescribed. Even though the medications are different, they are from the same drug classifications. 33. The nurse receives new orders for multiple clients. Which order should be the nurse’s priority? A. Nitroglycerin 0.4 mg sublingually (SL) STAT for the client experiencing chest pain B. Morphine sulfate 4 mg intravenously (IV) now for the client experiencing incisional pain C. Lorazepam 2 mg lV now for the client experiencing restlessness and picking at tubing D. One unit packed red blood cells S'l’A’l' for the client with a hemoglobin of 9.5 g ANSWER: A A. Administering SL nitroglycerin is priority. This can be performed more quickly than the other orders and has the greatest potential of changing client outcomes. Nitroglycerin increases coronary blood flow, reducing angina] pain and the potential of MI. B. Morphine is a controlled substance requiring the nurse to retrieve it and sign it out from a secure location. Administering IV medications takes longer than SL medications. C. Lorazepam is a controlled substance requiring the nurse to retrieve it and sign it out from a secure location. Administering IV medications takes longer than SL medications. D. Obtaining blood from the blood bank will take longer than administering an SL medication. 34. The client’s assessment findings at 0800 hours include BP 180/88 mm Hg, HR 96 bpm, RR 24 breaths per minute, and T 102.6°F (392°C). The client’s last bowel movement was 6 days ago. The client prefers to take medications one at a time due to difficulty swallowing. Currently the client is lying flat in bed. In which order should the nurse administer the medications to this client? A. Timolol 2 gtt right eye B. Labetalol 20 mg IV push for systolic BP > 160 mm Hg C. Ramipril 2.5 mg oral daily D. Docusate sodium rectal suppository this am. E. Cefazolin sodium l g N syringe pump (lVSlP) ANSWER: B. E. A. C. D B. Labetalol (Normodyne) 20 mg IV push for systolic BP >160 mm Hg. Labetalol is a beta blocker that will lower the BP. This should be administered first because the client’s BP is elevated and the onset of action is 2 to 5 minutes. E. Cefazolin sodium (Anccf) 1 g IVSP should be next. The nurse is working with the IV lines and the client’s temperature is also elevated, suggesting an infection. Cefazolin sodium is a cephalosporin antibiotic. A. Timolol (Timoptic) 2 gtt right eye should be third. The client is lying flat in bed. Timolol is used for treating glaucoma. It is easier to administer into the conjunctiva] sac if given while lying in bed. C. Ramipril (Altace) 2.5 mg oral daily should be next. It is an ace inhibitor with an onset of 1 to 2 hours, and the client’s BP is already elevated. D. Docusate sodium (Docusate) rectal suppository this am. should be last. The client needs to assume a side-lying position for the rectal suppository to be administered. It is used to soften stool and promote defecation. It should be retained as long as possible. 35. The nurse notes that a hospital coworker omits treatments for clients, has mood swings, makes frequent requests for help with assignments, and has numerous requests to witness the waste ofcontrolled substances. Which nursing action is most appropriate? A. Report the findings to the nurse’s immediate SIIDCTVISOF B. Tell the coworker that drug abuse is suspected and offer support C. Notify the police, who will investigate because drug abuse is a legal offense D. Complete an incident report, noting the times the coworker wasted controlled substances ANSWER: A A. The findings should be reported to the coworker’s supervisor, who should collect additional information and approach the coworker with the concern. B. Telling the coworker of suspicions may cause the coworker to hide the problem, if one exists, and could jeopardize client safety. C. The immediate supervisor, and not the police, should be collecting additional data to either support or refute the nurse’s suspicions. D. The nurse should document suspicions, but completing an incident report is unnecessary because there are no data to support that an incident has occurred. 36 . The client is to receive oxycodone 5 mg with acetaminophen 325 mg. two tablets orally for pain relief. Which actions by the nurse should be corrected by an observing nurse? Select all that apply. A. Obtains apple juice for the client to drink with the medication B. Unlocks the med box in the client’s room to retrieve the medication C. Identifies the client by name, birth date, and medical record number D. lnforms the client to expect some pain relief within 10 to 15 minutes E. Tells the client to place the tablets under the tongue for faster pain relief ANSWER: B. E A. Oxycodone with acetaminophen can be taken with apple juice. B. Oxycodone with acetaminophen (Percocet) is a schedule 11 controlled substance. The Controlled Substances Aet requires facilities to keep controlled substances in a locked drawer, box, or automated dispensing machine in a location that is inaccessible to clients. C. Two unique client identifiers should be used to administer medications safely, usually the name and medical record number. D. The time of onset for analgesic effect from oxycodone with acetaminophen is 10 to 15 minutes. E. A medication is to be administered by the route it was ordered. 37. The client’s son asks the hospice nurse to administer larger doses of pain medication. Despite having pain, the client, who is Hispanic, adamantly refuses increased doses. The client states, “I believe that accepting pain is God’s will for me.” By withholding larger analgesic doses, the nurse best demonstrates ethical practice guided by which principle? A. Nonmaleficence B. Autonomy C. Beneficence D. Veracity ANSWER: B A. Nonmaleficence is to do no harm. Withholding larger doses should not cause harm. B. Autonomy refers to the client’s right to make individual choices and to have those choices honored by the nurse. C. Beneficence is the promotion of good. The good actions must be weighed against any possible harm. D. Veracity means truthfirlness. No statement was made by the nurse. 38. The client experiences nausea atter an oral dose of cephalexin, and interventions for nausea are unsuccessful. When the nurse attempts to administer the next dose of cephalexin, the client adamantly refuses to take it. Which nursing intervention is best? A. Administer the cephalexin dose 1 hour after repeating the dose ofantiemetic. B. Have the client suck on ice chips for several minutes before taking cephalexin. C. Crush the cephalexin tablet and mix it with applesauce for administration. D. Report the information to the client’s HCP and request a different medication. ANSWER: D A. Giving cephalexin (Keflex) 1 hour after a repeat dose of antiemetic involves administering the medication against the client’s wishes. B. Sucking on ice chips many increase the client’s nausea. The stem indicates that the nurse has already tried to manage the client’s nausea and that interventions were unsuccessful. C. Applesauce could increase the client’s nausea, and administering cephalexin is against the client’s wishes. D. In this situation, the client has the right to refuse medications and treatments regardless of the reasons and the consequences. 39. The nurse is administering mctoclopramide 10 mg IV to the client with decreased peristalsis. Which action would result in a medication error? A. Gives metoclopramide intravenously over 1 minute B. Administers the metoclopramide 30 minutes after meals C. Notes a Y-site incompatibility of metoclopramide and furoscmide D. Holds the infusing DSW and injects metocloprarnide at the most distal port ANSWER: B A. It is safe to administer 10 mg of metoclopramide IV over 1 minute. B. Metoclopramide (Reglan) should be administered 30 minutes before (not after)meals to increase GI motility and prevent nausea at mealtime. C. The nurse should note any medication incompatibilities and select an IV line with compatible solution, flush the IV line with saline before and after administration, or start another IV access for administering IV medications. D. Metoclopramide is compatible with D5W, and the most distal port would be the one closest to the client’s insertion site. 40. The client with cellular dehydration is to receive an IV solution that will rehydrate cells. Which solution, if prescribed by the HCP, should the nurse proceed to administer? A. Lactated Ringer’s B. 0.9% sodium chloride C. 0.45% sodium chloride D. DSW 0.9% sodium chloride ANSWER: C A. Laetated Ringer’s is isotonic. It expands vascular volume and does not enter the cells to treat cellular dehydration. B. NS (0.9% sodium chloride) is isotonic. It expands vascular volume and does not enter the cells to treat cellular dehydration. C. 0.45% sodium chloride is hypotonic. It will expand vascular volume and enter cells to rehydrate them and treat cellular dehydration. D. DSW 0.9% sodium chloride is hypertonic. Once dextrose is metabolized, it leaves isotonic 0.9% sodium chloride, which remains in the vascular compartment and does not enter cells. 41. The client with a central venous access device suddenly develops dyspnea, chest pain, tachycardia, and hypotension after the nurse attaches new injection caps during a central line dressing change. Which action should be taken by the nurse first? A. Apply oxygen via a face mask at 4 liters per minute. B. Turn the client onto the left side with the head lowered. C. Call for another nurse to notify the health care provider. D. Cleanse the injection caps and flush the catheter with saline. ANSWER: B A. Although oxygen should be applied because the client has dyspnea, it should be administered by nasal cannula, not a mask. Applying oxygen is not the first action. B. The symptoms suggest air embolism. Turning the client onto the left side with the head lower than the feet will trap the embolism in the right atrium. C. Although the HCP should be notified, the first action is to turn the client onto the left side. D. Air likely entered the vascular system when the injection caps were changed. Injecting saline increases the risk of additional air entering the vascular system. Blood should be aspirated to remove air from the injection caps and central line catheter. 42. The client has a vesicant solution infiising intravenously in a large peripheral vein. Which assessment findings should prompt the nurse to explore whether extravasation has occurred? Select all that apply. A. The IV solution bag is empty. B. The IV pump is malfunctioning. C. Swelling at the IV insertion site. D. Blistering at the IV insertion site. E. The client is having chest pain. ANSWER: C. D A. An empty solution bag indicates the need for a new bag. It is not a sign of extravasation. B. A malfimctioning IV pump could cause the vesicant to infuse too rapidly and lead to extravasation, but it is not a sign of extravasation. C. Swelling surrounding the 1V site is a sign of infiltration from fluid leaking into the tissues and not infusing into the vein. A vesicant solution can cause extravasation. D. Blistering at the IV site is a sign of extravasation from leakage of vesicant solution into the tissues. E. Chest pain is unrelated to extravasation at a peripheral IV site. 43. The nurse is assessing the veins of the client’s hand and arm prior to inserting an IV catheter for a transfusion of RBCs. Which vein would be best for the nurse to select? A. The basic vein that has a bifurcation B. A vein on the client’s nondominant hand C. The distal cephalic vein above the wrist D. A dorsal metacarpal vein that is straight ANSWER: C A. It is difficult to advance the catheter in a vein with a bifurcation (point where two veins meet) due to the presence of valves in the veins. B. A vein in the client’s nondominant hand may not be large enough to insert a largersized needle for a blood transfusion. Too small a catheter may destroy RBCs being infused. C. The cephalic vein is a larger vein located on the thumb side of the arm. Selecting the vein above the wrist will allow movement of the wrist and minimize possible displacement of the catheter. D. The dorsal metacarpal veins are in the hand. Hand veins may not be large enough to insert a larger- sized needle for a blood transfusion. Too small a catheter maydestroy RBCs being infused. 44. The nurse is preparing to administer a transfusion of RBCs to the client with blood type AB negative. The blood bank does not have any units of AB negative PRBCs so provides a unit of 0 negative RBCs. What should the nurse do? A. Return the unit to the blood bank because it is incompatible. B. Continue to prepare to administer the unit; it is compatible. C. Verifyr with the HCP that the client can receive 0 negative RBCs. D. Obtain the client’s consent before administering the 0 negative RBCS. ANSWER: B A. The nurse should not return the blood to the blood bank. The client with AB negative blood type can receive type 0 negative RBCs. Type 0 negative has no antigens on the RBC to react with the A and B antigens on the type AB negative RBC. B. The nurse should continue to prepare the blood because it is compatible. A person with type AB blood has A and B antigens on the RBC, but type 0 has none. C. It is unnecessary to verify compatible RBCs with the HCP; this will delay administering the transfusion. D. The client’s consent for blood administration should have been received before obtaining the blood. Blood must be started within 30 minutes of obtaining it from the blood bank. 45. The nurse is to administer chlordiazepoxide HCL 25 mg intramuscularly (IM) to the client. The medication package contains 100 mg of sterile, powdered chlordiazepoxide HCL that must be reconstituted with 2 mL of diluent. After reconstitution, how many mL of medication should the nurse with- draw into the syringe illustrated to administer the correctdose? ANSWER: A The line is pointing to the ½ mL or 0.5 mL mark on the syringe. Use a proportion formula to calculate the correct dose. 100mg:2mL::25mg:XmL Multiply the extremes and then the means. 100X = 50 X=50 / 100 or0.5 mL 46 . A mother calls a clinic wanting to use a tea- spoon to administer a medication to her child. For the child’s age,the bottle states to give 5 mL using the dropper provided. The nurseshould tell the mother to administer how many teaspoon(s)? teaspoon(s) (Record your answer as a whole number.) ANSWER: 1 5 mL = 1 teaspoon 47. The nurse is to administer promethazine 12.5 mg IM STAT to the client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client? mL (Record your answer rounded to hundredths.) ANSWER: 0.25 Use a proportion formula: 50mg:lmL::12.5mg:XmL Multiple the extremes (outside values) and then the means (inside values) and solve for X: 50X = 12.5 mg X = 12.5 / 50 = 0.25 Medication dosing less than 1 is always expressed with a 0 preceding the decimal. 48. PHARE The client is to receive esomeprazole 40 mg oral daily. The medication is supplied in 20-mg capsules. In order to give the correct dose, the nurse should administer how many capsules? capsules(Record your answer as a whole number.) ANSWER: 2 Use a proportion formula, multiply the extremes (outside values) by the means (inside values), and solve for X. 20 mg : 1 capsule :: 40 mg :X capsules 20X = 40 X = 2 capsules 49. PHAEE Allopurinol 400 mg IV is prescribed for the client with tumor lysis syndrome. The medication vial contains 500 mg per 25 mL. How many milli- liters of medication should the nurse prepare? mL (Record your answer as a whole number.) ANSWER: 20 50. The client is to receive cefazolin 500 mg in 50 ml. of NS IVPB. The medication is to be infused over 20 minutes. The nurse should set the infusion pump to deliver how many milliliters per hour? mL/hr (Record your answer as a whole number.) ANSWER: 150 50 mL : 20 min :: XmL/h: 60 min/h Multiply the means (inside values) and then the extremes (outside values) to solve for X. 20X = 3000 X = 150 mL/h The nurse should set the infusion pump to deliver cefazolin (Ancei) at 150 mL/h.