A patient with a diagnosis of hepatic coma is admitted to the ICU.

The provider orders neomycin 300mg

q6h to be administered via the NG tube. The nurse knows the rationale for this drug order is
to prevent further liver damage.
to prevent fulminate sepsis.
to decrease the pH level in the small intestine.
to decrease the serum ammonia level.
Although neomycin is generally prescribed to treat infection, it is also prescribed for patients with liver
disease to kill intestinal bacteria. The bacteria produce ammonia when breaking down protein. The
diseased liver is unable to clear the ammonia, so serum levels build and lead to hepatic encephalopathy.
Neomycin does not affect pH or prevent further liver damage.
The pediatrician prescribes amoxicillin suspension 200 mg PO q 8 hr for a 3-year-old client with acute otitis
media. The child weighs 38 pounds (17.2 kg). The recommended daily dose range for children up to 40 kg is
20-40 mg/kg/day in divided doses every 8 hours. Following the 10 Rights of Medication Administration,
what is the nurse's BEST action?
Contact the pediatrician to clarify the dose.
Administer the medication as prescribed.
Withhold the dose because it is too low.
Refuse to give because it is not the drug of choice.

The nurse should administer the dose, since it is within appropriate guidelines. The child may safely receive
344-688 mg/day, in divided doses of 115-230 mg each. Amoxicillin (20-40/kg/day) is the antibiotic of choice
for treating acute otitis media in clients older than 2 years who are not allergic to penicillin. Approximately
80% of children will have at least one episode of acute otitis media. The 10 Rights of Medication
Administration that are applicable here: Right patient, right medication, right dose, right route, right time,
and right assessment.
The nurse hangs an IV piggyback (IVPB) of vancomycin for a client who had a total knee replacement.
When the nurse returns a few minutes later, which of the following indicates that the client is experiencing
a serious reaction to the vancomycin?
Rash on the face and neck
Hypertension and bradycardia
Sudden shortness of breath
Cyanosis around the face and lips
Vancomycin flushing syndrome (VFS) [previously called red man syndrome (RMS)] is a common allergic
reaction to vancomycin that typically presents with a rash on the face, neck, and upper torso after
intravenous administration of vancomycin. VFS is related to a rapid rate of infusion; it should not be
administered faster than 1 gram/hour. Other symptoms are hypotension, itching, nausea/vomiting,
fever/chills, weakness, dizziness, and tachycardia. VFS most often begins 4-10 minutes after the start of the
first dose of vancomycin, although it can occur with doses as late as 7 days later. The nurse should
immediately stop the infusion and notify the HCP. Treatment is with steroids and antihistamines. Future
doses are given at slower rates. Sudden shortness of breath is indicative of anaphylaxis. Cyanosis is not
related to VFS.

While a healthcare provider is caring for a patient following a laryngectomy, the patient suddenly becomes
pale and nonresponsive with a BP of 90/40. What should be done first?
Move the emergency cart to the patient's bedside.
Administer atropine intravenously.
Increase the infusion of dextrose in normal saline (D5NS).
Place the client in the Trendelenburg position.
D5NS infusion is hypertonic, so it will draw fluid into the circulation. Trendelenburg position could
compromise the airway in a patient who has had head or neck surgery. Atropine could cause hyponatremia
and further hypotension. It is not necessary to move the emergency cart to the patient's bedside at this
time.
The nurse is preparing to administer procedural morphine sulfate as an analgesic to a 4-year-old child who
weighs 40 pounds. The health care provider (HCP) has prescribed 4 mg morphine sulfate IV. What is the
nurse's BEST action?
Contact the pharmacy for advice.
Verify the dosage for the child.
Administer the dose as ordered.
Give half the prescribed dose.
The nurse should verify the dosage strength (Right Dose) for the child before administering. For this child
(40 lbs = 18.2 kg) the dosage should be 1.5-1.8 mg/dose. For procedural analgesia and sedation in children,
morphine sulfate is given 0.08-0.1 mg/kg/dose IV, IM, or SC before the procedure and every 5-10 minutes
as needed. Peak effect is 15-30 minutes after IV administration and 30-60 minutes after IM administration.
Morphine sulfate is indicated for procedural analgesia because it is reliable, predictable, and easily
reversed with naloxone. NOTE: An average 4-year-old weighs 40 pounds and is 40 inches tall.

The purpose of holding a sterile gauze pad on the site of an IM injection while removing the needle is to
increase the absorption of the medication.
seal off the track left by the needle.
decrease the discomfort of the needle pulling on the skin.
prevent pathogens from entering through the puncture.
Pressing the gauze pad against the skin while removing the needle reduces the discomfort of the pulling
sensation. Once the medication has been completely injected, remove the needle using a smooth, steady
motion. Remove the needle at the same angle at which it was inserted.
At 6:00 a.m., the healthcare provider administers NPH insulin to a patient with diabetes. How soon may
the patient show any signs of hypoglycemia?
10:00 a.m.
9:00 a.m.
8:00 a.m.
7:00 a.m.
NPH insulin is an intermediate-acting insulin, usually given once or twice a day. The peak effect of NPH
insulin occurs 4–12 hours after administration, so the nurse should start to monitor for signs of
hypoglycemia at 10:00 a.m. Hypoglycemia (blood glucose below 70 mg/dl) can have a rapid onset. Signs
include shakiness, dizziness, anxiety, confusion, sweating, chills, and clammy skin. The patient's pulse may
increase. The patient may complain of blurred vision, headache, fatigue, hunger, or nausea.
A patient receiving vancomycin has an order for a trough level to be drawn. When should the lab collect
the blood sample?
30 minutes after the infusion
1 hour before the infusion
1 hour after the infusion
30 minutes before the infusion

A trough level should be drawn 30 minutes before the third or fourth dose. The other answers are incorrect
times to draw blood levels. Vancomycin is indicated for serious gram–positive bacterial infections, so it is
important to monitor dosage levels. The typical trough level range for vancomycin is 10–20 µg/mL. The
reference range for peak levels is 25–50 µg/mL.
A health care provider (HCP) prescribes an intravenous medication to be administered 25 mcg/kg/min. The
client weighs 52 kg. How many milligrams (mg) will the client receive in one hour?
780 mg
78 mg
7.8 mg
0.78 mg
1 mcg = 0.001 mg. To convert 25 mcg, set up a proportion: 1/0.001 = 25/x. Cross-multiply (0.001 × 25 =
0.025 mg) and then multiply by 52 kg = 1.3 mg per minute. In one hour (60 min × 1.3 mg), the client should
receive 78 mg.
The nurse is preparing to administer intravenous procainamide to a client with stable ventricular
tachycardia. Which of the following is MOST important to monitor during the infusion?
Serum potassium
Continuous ECG
Glasgow Coma Scale
Urine specific gravity
Procainamide is well-tolerated and is a first-line agent for the treatment of acute, undiagnosed, wide-
complex tachycardia. Procainamide blocks sodium channels and also has an effect on potassium channels
and so prolongs the effective refractory period, decreases automaticity and slows conduction. The client's
ECG should be constantly monitored for cardiotoxicity: widening of QRS (> 50%) and prolonged QT interval,
as well as hypotension.
A client with deep vein thrombosis (DVT) is receiving heparin therapy by continuous intravenous infusion.
Prior to initiating the heparin infusion, the client's activated partial thromboplastin time (aPTT) was 32
seconds. The nurse notes that the most recent aPTT result is 70 seconds. What is the nurse's BEST action?
Maintain the heparin infusion rate.
Decrease the heparin infusion rate.
Increase the heparin infusion rate.
Administer protamine sulfate stat.

The nurse should maintain the current heparin infusion rate. The reference range of aPTT is 30-40 seconds.
To obtain an aPTT result, an activator is added that speeds up the clotting time and results in a narrower
reference range. The aPTT is considered a more sensitive version of the PTT and is used to monitor the
patient’s response to heparin therapy. Decreasing or increasing the infusion rate is not appropriate.
Protamine sulfate is a heparin antagonist, used to immediately reverse the action of heparin. It is not
indicated for this situation.

The purpose of medication reconciliation is to

create an accurate list of all medications that a client is taking at home and during hospitalization.
document all doses of each medication that a client receives during their inpatient stay.
compare pharmacy charges with actual doses administered during hospitalization.
ensure that the inpatient unit's narcotic count is correct at the start and end of every shift.

Medication reconciliation is the process of creating the most accurate list possible of all medications that a
patient is taking — including drug name, dosage, frequency, and route — and comparing that list against
the physician’s admission, transfer, or discharge orders. The goal is to provide correct medications to the
patient at all transition points within the hospital.

When a drug's effect is increased after a second drug is administered, this interaction is called
antagonism.
potentiation.
absolution.
synergism.
Potentiation is a type of drug interaction. Potentiation occurs when two drugs are taken together and the
action of one drug increases the action of the other, causing the pharmacologic response to be greater for
one of the drugs.
Which of the following drugs should not be refrigerated?
Opened (in-use) Humulin N injection
Epoetin alfa IV (Epogen)
Ampicillin Oral Suspension
Nadolol (Corgard)

Nadolol (Corgard) is a beta blocker used to treat hypertension and chest pain. It is stored tightly closed at
room temperature from 59 °F to 86 °F (15 °C to 30 °C), away from heat, moisture, and light. Humulin N is a
form of insulin. After it has been opened, it is stored in the refrigerator or at room temperature below 86
°F. Humulin N must be discarded within 31 days after opening. Ampicillin is a penicillin antibiotic. The
liquid suspension form should be stored in the refrigerator for up to 7 days. Epoetin alfa IV is used with
patients undergoing chemotherapy or suffering from anemia from serious chronic diseases. It is stored in
the refrigerator and should be protected from light.

Following a client's intentional benzodiazepine overdose, the Emergency Department physician prescribes
flumazenil 200 mcg IV push STAT. The stock vial contains 0.5 mg flumazenil in 5 mL solution. How many mL
should the nurse draw up and administer? Provide an answer to one decimal place.
2.0 mL
0.5 mL
4.0 mL
2.5 mL

The nurse will draw up and administer 2.0 mL. To calculate: 1. Convert mg to mcg: 0.5 mg x 1000 = 500
mcg. 2. Known: 5 mL = 500 mcg. 3. 1 mL = 100 mcg. 4. 2 mL = 200 mcg. 5. You. can also set up an equation:
(5 mL x 200 mcg ÷ 500 mcg = 2.0 mL. Flumazenil, a specific benzodiazepine antagonist, is used as an
antidote for intentional benzodiazepine overdose, as well as reversing the sedation and respiratory
depression from anesthesia.
A client with a history of ulcers is starting on propantheline. When the nurse provides instructions with the
client, which instruction is CORRECT?
"Follow the special diet."
"Maintain good oral hygiene."
"Limit your fluid intake."
"Avoid using any laxatives."
One of the most common side effects of propantheline is a dry mouth, so good oral hygiene is important.
Because propantheline reduces stomach acid, it has a "drying" effect that can also result in constipation
and urinary retention. The client should be instructed to report side effects. Fluids are not restricted and
there is no special diet. Laxatives may be appropriate.
When a provider prescribes an IV infusion medication to be titrated, which of the following elements is
NOT required to be part of the order?
Frequency for increasing or decreasing incremental dose
Initial or starting rate of the infusion (dose/minute)
Objective clinical endpoint or patient response
Ability of the nurse to determine the units of incremental rate

According to the Joint Commission, required elements for medication titration orders include the
following: 1. medication name; 2. medication route; 3. initial or starting rate of infusion (dose/min); 4.
incremental units the rate can be increased or decreased; 5. frequency for incremental doses (how often
the dose (rate) can be increased or decreased); 6. maximum rate (dose) of infusion; 7. objective clinical
endpoint or patient response. The nurse follows the titration prescription and does not make independent
determinations regarding the infusion.
While monitoring a client receiving fresh frozen plasma (FFP) the nurse notes that the client suddenly
complains of shortness of breath. Vital signs indicate elevated heart rate and blood pressure. The nurse
auscultates crackles at the base of the client's lungs. What complication is the client MOST likely
experiencing?
Circulatory overload
Pulmonary embolism
Myocardial infarction
Transfusion reaction
Circulatory overload occurs when blood or plasma enters the blood stream too quickly. It is evidenced by
respiratory distress, tachycardia, hypertension, and the presence of pulmonary edema (crackles). The
client may also display neck vein distention. Pulmonary embolism signs also include respiratory distress,
tachycardia and hypertension, as well as hemoptysis, fever, chest pain, diaphoresis, and fainting. The most
common signs of a transfusion reaction are chills, back pain, fever, itching, hives, and shortness of breath.
Signs of a myocardial infarction include pressure or tightness in the chest; pain in the chest, jaw, and upper
body; shortness of breath; diaphoresis; nausea; vomiting; and anxiety.

A healthcare provider is caring for a patient receiving intravenous chemotherapy for cancer. The healthcare
provider will plan to administer the prescribed antiemetic to the patient
one hour after the infusion is complete.
before starting the infusion.
if the patient complains of nausea.
one half hour after the infusion has started.
Most chemotherapeutic agents have a high potential for causing nausea and vomiting. Up to 80% of
patients experience chemotherapy-induced nausea and vomiting, which occur when the vomiting center in
the brain is stimulated during the chemotherapy infusion. Administering an antiemetic prior to starting the
infusion can prevent or minimize nausea and vomiting.

A patient is admitted to the medical unit with a diagnosis of hepatitis. When preparing to administer
intravenous medications, the healthcare provider understands that the patient's diagnosis primarily affects
which phase of pharmacokinetics?
Excretion
Absorption
Metabolism
Distribution
The liver is the primary site of drug metabolism, so alterations in liver function can affect the metabolism
of medications. Liver disease can make drug metabolism unpredictable, with serious consequences. Liver
function can also affect excretion to a lesser degree, if the liver's ability to make medications water soluble
is compromised.
The physician orders an IV theophylline drip at 40 mg/hr. The pharmacy sends a 250 mL bag of D5W mixed
with 500 mg theophylline. What should the infusion rate on the pump be?
80 mL/hr
40 mL/hr
60 mL/hr
20 mL/hr
To calculate the infusion rate: 1. Divide the dose that was ordered by the available dose. (40 mg ÷ 500 mg =
0.08) 2. Multiply that value by the quantity (250 mL) to be infused. ANSWER: 20 mL/hr.

If a drug is 50% protein-bound, it means that

50% of the drug is available.
50% of the drug destroys protein.
50% will pass through the intestines.
50% less protein should be eaten.
The percentage of the drug that is NOT protein bound is the amount of the drug that is free to work as
expected. In this case, 50% of the drug is unable to be effective because it is protein-bound. Protein binding
has nothing to do with drug excretion, protein in the diet, or the destruction of protein.
A client with a diagnosis of depression is prescribed phenelzine sulfate (Nardil). When he returns to the
clinic a week later, he reports that he doesn't feel any better. The nurse explains that when starting a
monoamine oxidase inhibitor (MAOI), the client won't experience relief of symptoms for how long?
2 months
3–4 weeks
2 weeks
3–4 months

A client should be taught that MAOI inhibitors, such as Nardil, require about a month to achieve
therapeutic blood levels and demonstrate relief of symptoms. Clients should also be instructed never to
discontinue an MAOI drug abruptly without first consulting with their provider.

The doctor orders Zofran 8 mg PO t.i.d. The pharmacy sends a 100 mL bottle, labeled 4 mg/tsp. How many
mL should be given for each dose?
10 mL
2 mL
5 mL
8 mL

1 tsp = 5 mL and 4 mg. Multiply 4 mg × 2 to reach the ordered dose of 8 mg. It will take 10 mL (2 tsp) to give
8 mg of Zofran.

Before administering a dose of furosemide (Lasix) to a 2-year-old with a congenital heart defect, the nurse
should confirm the child's identity by checking the hospital ID band and
asking the parent for the child's name.
verifying the child's identity with a second nurse.
asking the child to state their name.
verifying the child's room number.
Standards of safe medication administration require obtaining two patient identifiers before proceeding.
For a child, a parent can give the child's name. Many young children do not know their full name or are
accustomed to being called by a nickname. Adults can be asked the child's name and birth date. Room
numbers are not a reliable means of verifying identification.

A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient
about the medication, which of the following will the healthcare provider include?
"Be sure to include a number of foods in your diet that are rich in potassium."
"I'll teach you how to take your radial pulse before taking the medication."
"Take this medication every day with a large glass of water after your evening meal."
"Stop taking this medication if you notice changes in how much you urinate."
Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the
medication in the evening so that sleep is not interrupted. Potassium is lost in the urine along with sodium
and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid
hypokalemia. Examples of potassium-rich foods include avocados, spinach, sweet potatoes, yogurt, and
bananas.
A patient who has a history of chronic back pain requires a higher dose of an opioid medication to achieve
adequate pain relief. The healthcare provider suspects that these findings are a result of which of the
following?
Addiction
Pseudoaddiction
Tolerance
Dependence
Tolerance is a decrease in sensitivity to a medication. It is a common occurrence when opioids are taken
for an extended period time, and leads to the patient requiring a progressively larger dose to achieve the
same degree of pain management. When a patient seeks assistance to manage their pain, the patient's
behavior is sometimes referred to as pseudoaddiction. Addiction is characterized by behaviors that include
impaired control over substance use, cravings, compulsive use, and continued use despite harm.

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient
about the medication, which of these foods will the healthcare provider advise the patient to avoid?
Grapefruit
Bananas
Milk
Eggs
Grapefruit and its juice contain furanocoumarins, which inhibit the cytochrome P450 enzyme CYP3A4.
CYP3A4 is involved in metabolizing many drugs, including calcium channel blockers. Medication blood
levels can increase, becoming toxic. The levels of calcium channel blockers are increased when grapefruit
or grapefruit juice is consumed, potentially causing hypotension. Grapefruit can interfere with other drugs
too, including statins (atorvastatin, lovastatin, simvastatin), some antibiotics, and some cancer drugs.

A client with a history of severe alcohol abuse is admitted to the medical unit for alcohol withdrawal and
detoxification. The client admits to having a drink 2 hours before their admission. Which of the following
medications will the health care provider (HCP) prescribe for this client?
Disulfiram
Haloperidol
Naloxone hydrochloride
Diazepam
A hospital provides the safest for an anticipated severe alcohol withdrawal. All clients should be given
thiamine 100 mg as soon as possible, and then daily during the withdrawal period. Benzodiazepines (such
as diazepam, alprazolam, chlordiazepoxide, or lorazepam) are prescribed to minimize agitation and
anxiety, as well as treat possible seizures. Naloxone hydrochloride is used to reverse the effects of an
opioid overdose. Disulfiram is taken to support alcohol abuse treatment by producing an acute sensitivity
to drinking alcohol. Haloperidol is an anti-psychotic drug, prescribed for schizophrenia and other
psychoses.

A provider has prescribed isotretinoin (Accutane) for a 22-year-old female with a diagnosis of severe cystic
acne. Before the nurse gives the client instructions for taking the medication, which of the following is the
MOST important question that the nurse should ask the client?
"Are you able to swallow capsules easily?"
"What date was your last menstrual period?"
"Does your insurance cover prescriptions?"
"Can you tolerate some slight weight gain?"

A teratogen is an agent that can disturb the development of the embryo or fetus. Taking isotretinoin
(Accutane) during pregnancy can cause birth defects of the brain and heart as well as facial deformities.
Before providing the client any instructions on taking this medication, the nurse should determine whether
the client might be pregnant. The client should have a reliable birth control method. The capsules are
swallowed whole with a full glass of water. Unusual weight gain or weight loss are listed as rare or
unknown adverse reactions.
A health care provider (HCP) prescribes metronidazole PO bid x 7 days for a client with a diagnosis of
bacterial vaginosis (BV). When the nurse reviews information about the medication with the client, which
statement by the client indicates a need for FURTHER instruction?
"I will take this with a full glass of water."
"If I miss a dose, I will take two to catch up."
"I may get a metallic taste in my mouth."
"If I drink alcohol, I could get really sick."
Metronidazole is a broad-spectrum antibiotic that is used to treat a variety of infections, including bacterial
vaginosis. If a dose is missed, the client should NOT take a double dose. The client should take the
medication at prescribed intervals with a meal or a full glass of water or milk. The client should avoid
alcohol while taking metronidazole and for 72 hours after finishing all doses. Drinking can cause nausea,
abdominal cramps, vomiting, and headaches. Loss of appetite and a metallic taste in the mouth are
possible side-effects that go away when the medication is finished.\
Before a patient can receive a transfusion of whole blood, the laboratory and blood bank require a sample
of the patient's blood. Which tests will be run?
Blood type and antigen screen
Blood type and crossmatch
Complete blood count (CBC) and differential
Blood culture and sensitivity analysis
A blood type and crossmatch is necessary to ensure a match between the blood donor and the patient who
is receiving the blood. An incompatible match could result in severe adverse events and possible death.
CBC, differential, culture, and sensitivity are unnecessary. Blood type and antigen screen is incorrect; the
proper test is blood type and antibody screen, which will be performed as part of the crossmatch.
A healthcare provider is performing an assessment of a patient who is taking propranolol (Inderal) for
supraventricular tachycardia. Which assessment finding is an indication that the patient is experiencing an
adverse effect of this drug?
Bradycardia
Paresthesia
Urinary retention
Dry mouth
Beta-1 receptors are found in the cardiac conduction system and myocytes. Beta-1 blockade will slow
discharge from the SA node and decrease speed through the AV node, slowing the heart rate. Propranolol
(Inderal) decreases the strength of heart contractions as well as the heart rate, resulting in less cardiac
oxygen consumption.

During an arteriogram (angiogram), the patient suddenly says, “I’m feeling really hot.” Which is the best
response?
"You are having an allergic reaction to the dye. I will get an order for Benadryl."
"The heat indicates that the clots in the coronary vessels are dissolving."
"That feeling of warmth is normal when the dye is injected. It will last up to 20 seconds."
"Let me get your doctor to explain this sensation to you."
Patients should be instructed that it is normal to experience a warm sensation when IV contrast is injected.
The feeling lasts 5–20 seconds.

The healthcare provider prepares to administer a corticosteroid to a patient with a diagnosis of asthma.
What is the rationale for administering this drug to this patient?
To promote bronchodilation
To decrease airway swelling
To promote expectoration of mucus
To prevent respiratory infections
Corticosteroids and other anti-inflammatory drugs work by reducing inflammation, swelling, and mucus
production in the airways of a person with asthma. As a result, the airways are less inflamed and less likely
to react to asthma triggers. Inhaled corticosteroids are the primary treatment for asthma.
The health care provider (HCP) prescribes aluminum hydroxide suspension tid between meals and at
bedtime for a client with severe heartburn. When the client returns for a follow-up appointment, which
side effect is MOST important for the nurse to ask about?
Insomnia
Constipation
Palpitations
Dizziness

Aluminum hydroxide is an antacid that quickly neutralizes gastric acid. It is used to treat heartburn, acid
indigestion, and upset stomach. It can also reduce phosphate levels in certain kidney conditions.
Constipation is the main side effect, which can lead to worsening hemorrhoids or bowel obstruction. Other
side effects include loss of appetite, pain on urination, drowsiness, and muscle weakness. The other
options are not related to the use of aluminum hydroxide.

A clinician is teaching inhaled corticosteroid technique. Which of the following should be included in
teaching?
"You should inhale as quickly and deeply as possible when you take a puff from the inhaler."
"Press the canister down, breathe in slowly and deeply, hold your breath for a few seconds, and then
slowly exhale."
"Spacers are not necessary. They are mostly for convenience and ease of handling the inhaler."
"It is not necessary to rinse your mouth after using your inhaler."
Breathing in slowly and deeply and then holding one's breath allows for the medication to move farther
down the patient's airway. If possible, the patient should count to ten before exhaling. Spacers are
typically suggested because they prevent the medication from collecting on the tongue and the back of the
throat. Because inhalers leave a residue in the mouth, they can increase the risk of developing Candida
infections. The patient should always rinse their mouth after use.

The health care provider (HCP) prescribes "250 mg/5 mL amoxicillin PO q8h for 10 days" for a child's ear
infection. The child's parent asks the nurse how much amoxicillin to give the child in each dose. Which of
the following is the equivalent of 5 mL?
1 teaspoon
1/2 teaspoon
1/2 tablespoon
1 tablespoon
5 mL = 1 teaspoon. The parent should give the child 1 teaspoon of amoxicillin every 8 hours. The parent
should use a medication spoon or dropper to measure the dose, not a household spoon. The nurse should
educate the parent about completing the prescription even if the child starts to feel better. 1 tablespoon =
3 teaspoons (15 mL), which would be a triple dose.
Following an allergic reaction during a blood transfusion, the health care provider (HCP) prescribes
diphenhydramine injection 30 mg IM stat. The vial containing the medication has 50 mg/mL. How much
solution will the nurse draw into the syringe for administration?
1.6 mL
0.6 mL
1.2 mL
0.2 mL
The nurse should draw up and administer 0.6 mL of solution. Using the Desired Dose over Available
formula 1. Desired dose (30 mg) ÷ Available dose (1 mL) = 50 g ÷ x mL. 2. x mL = 30 mg ÷ 50 mg = 0.6 mL.
Diphenhydramine hydrochloride injection solution is an antihistamine that treats allergic reactions to
blood or plasma transfusions.. The injectable form has a rapid onset of action, within 20-30 minutes.

A patient diagnosed with type 2 diabetes mellitus is admitted to the medical unit with pneumonia. The
patient's oral antidiabetic medication has been discontinued, and the patient is now receiving insulin for
glucose control. Which of the following statements best explains this change in medication?
The infection has compromised beta cell function, so the patient will need insulin from now on.
Stress-related states such as infections increase the risk of hyperglycemia.
Acute illnesses like pneumonia will cause increased insulin resistance.
Insulin administration will help prevent hypoglycemia during the illness.

Infections cause a stress response in the body by increasing the amounts of such hormones as
glucocorticoids and epinephrine, which suppress the natural immune response. These stress hormones
work against insulin and cause an increase in blood glucose levels. With high glucose levels, white cells are
slowed and take longer to fight the infection. Type 2 diabetics may temporarily require insulin during acute
illnesses and hospitalizations, but they often return to their normal medication regimen after they recover.
Insulin injections also permit more accurate control of glucose levels than oral medications.

All of the following are equivalent to 25% EXCEPT

1/4
one-quarter
25.0
0.25
A percentage is a number that is expressed as a fraction of 100, or parts per 100. Percentages are used in
medicine in several ways, including IV solutions (such as Sodium Chloride 0.9%), injectable medications
(such as lidocaine hydrochloride 2%), and calculations of an infant's weight loss or gain.
Before administering penicillin IM to a client with"NKDA" on his medical record, the nurse asks the client if
he has any drug allergies. The client responds, "I'm not sure. I may have had a rash one time after I had a
shot when I was sick." Which is the appropriate action for the nurse?
Hold the penicillin and contact the prescribing provider.
Administer the penicillin and observe for 60 minutes.
Contact the hospital pharmacist for oral penicillin.
Ask the client for more details before giving the penicillin.
The nurse should hold the penicillin and contact the provider who ordered the medication. Even a mild
reaction in the past puts the client at risk for an anaphylactic reaction, which typically occurs within an
hour of administration. Common adverse effects of penicillin include rash; hives; itching; and swelling of
the face, lips, and tongue.

During an acute exacerbation of inflammatory bowel disease, a patient is to receive total parenteral
nutrition (TPN) and lipids. Which of these interventions is the priority when caring for this patient?
Infuse the solution in a large peripheral vein.
Monitor the patient's blood glucose per protocol.
Change the administration set every 72 hours.
Monitor urine specific gravity every shift.

Total parenteral nutrition (TPN) can cause hyperglycemia, so blood glucose levels should be closely
monitored. Because of the hypertonicity of the TPN solution, it must be administered via a central venous
catheter. The high concentrations of glucose and lipids make TPN an excellent medium for bacterial
growth. Therefore, administration sets should be changed every 24 hours if the TPN contains lipids.

A client asks the nurse why their health care provider (HCP) has prescribed phenazopyridine for their
urinary tract infection. What is the nurse's BEST response?
"It kills the bacteria that causes the infection."
"It increases urine output to flush out the bacteria."
"It relieves the pain and itching caused by the infection."
"It makes the urine more acidic so the bacteria can't survive."
Phenazopyridine does not treat the cause of the urinary irritation, but it can help relieve the symptoms
while other treatments take effect. Phenazopyridine is a dye that works as an analgesic to soothe the lining
of the urinary tract. It relieves the itching and burning, as well as urinary urgency and frequency. It is both
a prescription and an over-the-counter (OTC) medication.
During a routine visit to the clinic, a client tells the nurse that they feel lightheaded after taking nifedipine
for hypertension. Which question is MOST important for the nurse to ask the client?
"Do you take a nap every day?"
"When do you take this medication?"
"Are you drinking grapefruit juice?"
"How much potassium are you taking?"
The nurse should ask the client when they take the medication. Nifedipine (Procardia, Adalat) is a calcium
channel blocker. One of the common side effects is lightheadedness or dizziness. Other side effects include
headache, fatigue, and shortness of breath. Calcium channel blockers may be taken at any time during the
day, as long as the schedule is consistent. Taking it in the evening may minimize side effects. Grapefruit
and grapefruit juice should not be taken with calcium channel blockers, but this is not related to
lightheadedness. Potassium intake does not cause lightheadedness. Naps or rest periods are not related to
dizziness.

A patient presents to the emergency department with a complaint of watery diarrhea for the past three
days. Assessment findings include blood pressure 100/60, pulse 98, and dry mucous membranes. The
healthcare provider would anticipate intravenous therapy administration with which of the following
fluids?
Colloid solution
Isotonic crystalloid
Hypotonic crystalloid
Hypertonic crystalloid
Hypovolemia is corrected by expanding the intravascular compartment. An isotonic IV solution will expand
the intravascular compartment without affecting cells and tissues of other fluid compartments. Hypertonic
and colloid solutions would pull fluid into the intravascular space but at the expense of other fluid
compartments.

Before administering two units of whole blood, what type of intravenous (IV) device should a healthcare
provider use?
A large bore catheter to allow blood cells to pass easily into the patient.
Whatever the doctor has ordered. Consult the patient's chart.
The smallest possible catheter to prevent pain on insertion.
The same IV device as previously used. Consult the patient's chart.
Large bore catheters are necessary to prevent damage to blood cells. This also decreases development of
clots from hemolysis. An 18-gauge needle is often the standard for blood administration.

A 12-year-old male is admitted to the hospital several days after stepping on a sharp object that punctured
his shoe and penetrated the bottom of his foot. Concerned about possible osteomyelitis, the doctor has
ordered parenteral antibiotics. Which of the following is done immediately before the antibiotic is
started?
A complete blood count (CBC) with differential is drawn.
A blood culture test is drawn.
The first antibiotic dose is held until the parents are present.
The admission orders are entered into the system.
Antibiotics must not be started until a blood culture test is drawn, because administering antibiotics may
interfere with identifying the bacteria and the appropriate therapy. The blood count will reveal the
presence of infection but will not help identify the causative organism or guide antibiotic treatment.
Parental presence is important for the adjustment of the child but not for the administration of
medication.

A patient with a history of atrial fibrillation is scheduled for a left hip hemiarthroplasty at 09:00. A health
professional is administering medications at 08:00. Which of these medication orders should the health
professional question?
Low molecular weight heparin anticoagulant subcutaneously
Opioid analgesic intravenously
Beta blocker orally
Cephalosporin antibiotic intravenously
Heparin and low-molecular-weight heparins are normally held 12 hours before surgery because of the
increased risk of perioperative bleeding. Patients with a history of atrial fibrillation are often on
anticoagulation therapy to prevent the formation of blood clots. The health professional should contact
the appropriate physician to clarify whether the heparin should be administered.
The healthcare provider would anticipate which of the following as a treatment option for pneumonitis?
Albuterol nebulization
Emergency thoracotomy
Chest tube insertion
Corticosteroid administration
Corticosteroids are often recommended to treat inflammatory conditions such as pneumonitis. The other
options are not appropriate. Chest tubes are used for drainage. Albuterol is a drug for rapid
bronchodilation. A thoracotomy is a surgical procedure in which a cut is made between the ribs to see and
reach the lungs or other organs in the chest or thorax.