Pharmacology and Intravenous Therapies

Module 8 Questions 1. 1.ID: 383694396 A physician’s prescription reads, “Phenytoin (Dilantin) 0.1 g by mouth twice daily.” The medication label indicates that the bottle contains 100-mg capsules. How many capsules does the nurse prepare for administration of one dose? Correct 2. Correct Responses: "1" Rationale: Convert 0.1 g to milligrams: 1000 mg = 1 g; therefore 0.1 g = 100 mg. Next use the medication formula:
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Test-Taking Strategy: First, convert 0.1 g to mg. Next. follow the formula for the calculation of the correct dose. Recheck your work and ensure that the answer makes sense. If you had difficulty with this question, review medication calculation problems.

Level of Cognitive Ability: Applying
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Client Needs: Physiological Integrity
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Integrat ed Process: Nursing Process/Implementation

Content Area: Medication Calculations

Refe rence: Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 695-699). St. Louis: Mosby. Awarded 1.0 out of 1.0 possible points. 2.ID: 383694320 A client has a prescription for short-term therapy with enoxaparin (Lovenox). The nurse explains to the client that this medication is being prescribed to: Prevent pain A. Relieve back spasms B. Increase the client’s energy level C. Reduce the risk of deep vein thrombosis Correct D. Rationale: Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in selected at-risk clients. It is not used to prevent pain, relieve back spasms, or increase the energy level. Test-Taking Strategy: To answer this question accurately, it is necessary to be familiar with this medication and its intended effects. Recalling that this medication is an anticoagulant will direct you to the correct option. Review the action of this medication if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology 3. Reference: Lehne, R. (2010). Pharmacology for nursing care (7th ed., p. 602). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 3.ID: 383695637 A client receiving parenteral nutrition (PN) requires fat emulsion (lipids), which will be piggybacked to the PN solution. On obtaining a bottle of fat emulsion, the nurse notes that fat globules are floating at the top of the solution. Which of these actions should the nurse take? Shaking the bottle vigorously A. Requesting a new bottle from the pharmacy Correct B. Rotating the bottle gently back and forth to mix the globules C. Running the bottle under warm water until the globules disappear D. Rationale: The nurse should not hang a fat emulsion that contains visible fat globules. Another bottle of solution should be obtained and used in its place. When PN is combined with fat emulsion, the solution should not be used if there is a visible “ring” noted in the container of solution. The actions in the other options are incorrect. Test-Taking Strategy: Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate rotating the bag and shaking the bottle first. To select from the remaining options, think about the significance of seeing fat globules in the solution and imagine the potential adverse effect of fat globules in the client’s bloodstream. This will direct you to the correct option. Review the procedures for administration of fat emulsion if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Parenteral Nutrition 4. Reference: Gahart, B., & Nazareno, A. (2010). 2010 intravenous medications (26th ed., p. 576). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 4.ID: 383695130 Risperidone (Risperdal) is prescribed for a client with a diagnosis of schizophrenia. Which laboratory study does the nurse expect to see among the physician’s prescriptions? Platelet count Correct A. Creatinine level B. Sedimentation rate C. D. Red blood cell count Rationale: Baseline assessment includes renal and liver function parameters. Risperidone is used with caution — often at a reduced dosage — in clients with renal or hepatic impairment, clients with underlying cardiovascular disorders, and in older or debilitated clients. The laboratory tests identified in the other options are not necessary. Test-Taking Strategy: Use the process of elimination. Recalling that this medication is used with caution in clients with renal or hepatic failure will direct you to the correct option. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Pharmacology 5. Reference: Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: A nursing process approach (6th ed., p. 402). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 5.ID: 383695122 The serum theophylline level of a client who is taking the medication (Theo-24) is 16 mcg/mL. On the basis of this result, the nurse will initially: Document the normal value on the chart Correct A. Call the healthcare provider immediately B. Call the rapid response team to help with the emergency C. Call the pharmacy to alert the pharmacist regarding the client’s D. theophylline level Rationale: The normal therapeutic range for theophylline is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. A value of 16 mcg/mL is within the therapeutic range. Test-Taking Strategy: Specific knowledge regarding the therapeutic range for this medication is necessary to answer this question. Recalling that the normal therapeutic range for theophylline levels is 10 to 20 mcg/mL will direct you to the correct option. Review the nursing considerations related to this medication if you had difficulty with this question. Level of Cognitive Ability: Understanding Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology 6. Reference: Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: A nursing process approach (6th ed., p. 608). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 6.ID: 383695614 A nurse has obtained a unit of blood from the blood bank and properly checked the blood bag with another nurse. Which of the following parameters does the nurse assess just before hanging the transfusion? Skin color A. B. Vital signs Correct Latest platelet count C. D. Urine output over the last 24 hours Rationale: A change in vital signs may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs before the procedure, every 15 minutes for the first half-hour, and every half-hour thereafter. The other options do not need to be assessed just before the start of a transfusion. The nurse should be aware of fluid volume status, as well as weight. to help identify fluid volume overload, but this is not the priority before start of a blood infusion. Test-Taking Strategy: The strategic words in the question are “just before,” which tell you that the correct option must be assessed for possible comparison during the transfusion. Use the ABCs (airway, breathing, and circulation) to find the correct option. Review the procedure for administering blood if you had difficulty with this question. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Blood administration 7. Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 918). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 7.ID: 383694391 At 1300, the nurse is documenting the receipt of a unit of packed blood cells at the hospital blood bank. The nurse calculates that the transfusion must be started by: 1315 A. B. 1330 Correct 1345 C. D. 1400 Rationale: Blood must be hung within 30 minutes after obtaining it from the blood bank. After that time, the temperature of the blood becomes warm and could be unsafe for use. Therefore 1345 and 1400 are incorrect. It is not necessary to hang the blood within 15 minutes of receiving it from the blood bank. Test-Taking Strategy: Knowledge of the standard procedures related to blood administration is needed to answer this question correctly. Remember that blood must be hung within 30 minutes after obtaining it from the blood bank. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Blood Administration 8. References: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 918). St. Louis: Saunders. Perry, A., & Potter, P. (2010). Clinical nursing skills & techniques (7th ed., p. 792). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 8.ID: 383697107 A nurse hangs a 500-mL bag of intravenous (IV) fluid for an assigned client. One hour later the client complains of chest tightness, is dyspneic and apprehensive, and has an irregular pulse. The IV bag has 100 mL remaining. Which of the following actions should the nurse take first? Removing the IV A. Sitting the client up in bed B. C. Shutting off the IV infusion Correct Slowing the rate of infusion D. Rationale: The client’s symptoms are indicative of speed shock, which results from the rapid infusion of drugs or a bolus infusion. In this case, the nurse would note that 400 mL has infused over 60 minutes. The first action on the part of the nurse is shutting off the IV infusion. Other actions may follow in rapid sequence: The nurse may elevate the head of the bed to aid the client’s breathing and then immediately notify the healthcare provider. Slowing the infusion rate is inappropriate because the client will continue to receive fluid. The IV does not need to be removed. It may be needed to manage the complication. Test-Taking Strategy: Use the process of elimination, focusing on the data in the question. Note the question contains the strategic word “first.” Recognizing the signs of speed shock and recalling the appropriate interventions should also direct you to the option of shutting off the IV infusion. Review the initial nursing actions for speed shock if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Intravenous Therapy Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 230). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 9. 9.ID: 383694370 A client taking hydrochlorothiazide reports to the clinic for follow-up blood tests. For which side effect of the medication does the nurse monitor the client’s laboratory results? A. Hypokalemia Correct B. Hypocalcemia C. Hypernatremia D. Hypermagnesemia Rationale: The client taking a potassium-wasting diuretic such as hydrochlorothiazide must be monitored for reductions in the potassium level. Other fluid and electrolyte imbalances that may occur with use of this medication are hyponatremia, hypercalcemia, hypomagnesemia, and hypophosphatemia. The nurse should also educate the client about foods that are rich in potassium. Test-Taking Strategy: Use the process of elimination, recalling that most thiazide diuretics names end with -zide. Remembering that hypokalemia is a concern when a client is taking a potassium-wasting diuretic will direct you to the correct option. If this question was difficult for you, review the side effects of this medication. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Pharmacology 10. Reference: Edmunds, M. (2010). Introduction to clinical pharmacology (6th ed., p. 236). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 10.ID: 383697122 A nurse is caring for a client with a diagnosis of chronic renal failure who is receiving dialysis. Epoetin alfa (Epogen), to be administered subcutaneously, has been prescribed, and the nurse is drawing the medication from a single-use vial. The nurse should prepare the medication by: A. Shaking the vial before drawing up the medication B. Drawing up the medication and discarding the unused portion Correct C. Obtaining the medication from the medication freezer and allowing it to thaw D. Mixing the medication with 0.1 mL of heparin before administration to prevent clotting Rationale: Epoetin alfa is dispensed in a 1-mL vial for subcutaneous or IV injection. The vial should not be shaken, because epoetin alfa is a protein that can be denatured with agitation. The nurse should use only one dose per single-dose vial and discard the unused portion. Epoetin alfa is not to be mixed with other medications. The medication should be stored at 2° to 8 °C (35° to 46° F) and should not be frozen. Test-Taking Strategy: Use the process of elimination and your knowledge regarding the storage and administration of epoetin alfa to answer this question. Noting the words “single-use vial” in the question will direct you to the correct option. If you are unfamiliar with this medication, review this content. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology 11. Reference: Lehne, R. (2010). Pharmacology for nursing care (7th ed., pp. 649, 654). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 11.ID: 383694332 A nurse answers a call bell and finds that the parenteral nutrition (PN) solution bag of an assigned client is empty. The new prescription was written for a new bag at the beginning of the shift, but it has not yet arrived from the pharmacy. Which of the following actions should the nurse take first? A. Calling the healthcare provider B. Calling the pharmacy for further instructions C. Hanging a solution of 10% dextrose in water Correct D. Hanging a solution of 5% dextrose in 0.9% sodium chloride Rationale: The solution containing the highest amount of dextrose should be hung until the new bag of PN becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose solution is the best solution to infuse because it will minimize the risk of hypoglycemia. The pharmacy and physician should also be called, but care of the client is the immediate priority of the nurse. Test-Taking Strategy: Note the strategic word “first” in the query of the question and focus on the data in the question. Eliminate calling the pharmacy or healthcare provider first, because these options do not directly address the client. To select from the remaining options, recall the concentration of a PN solution and remember that this client is at risk for hypoglycemia; this will direct you to the correct option. Review care of the client receiving PN if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Parenteral Nutrition 12. Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 1401). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 12.ID: 383697163 Disulfiram (Antabuse) is prescribed for a client. Which questions does the nurse make a priority of asking the client before administering this medication? Select all that apply. A. “When did you have your last full meal?” B. “Do you have a history of diabetes insipidus?” C. “When was your last drink of alcohol?” Correct D. “Do you have a history of thyroid problems?” Correct E. “Do you have a history of cancer in your family?” Rationale: Disulfiram (Antabuse) is used as an adjunct treatment for selected clients with alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important question is when the client had his last drink of alcohol. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in cases of severe heart disease, psychosis, or hypersensitivity to the medication. Test-Taking Strategy: Use the process of elimination. Recalling that the medication is used as an adjunct treatment for selected clients with alcoholism will help direct you to the option in which the client is asked when he consumed his last alcoholic drink. To find the other correct options, it is necessary to know the contraindications to the use of disulfiram. If you are unfamiliar with this medication and its use, review this content. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Pharmacology 13. Reference: Lehne, R. (2010). Pharmacology for nursing care (7th ed., pp. 417, 418, 420). St. Louis: Saunders Awarded 1.0 points out of 1.0 possible points. 13.ID: 383695126 A client is receiving heparin sodium by way of continuous IV infusion. For which adverse effects of the therapy does the nurse assess the client? Select all that apply. Tinnitus A. Tarry stools Correct B. Slowed pulse C. D. Bleeding from the gums Correct Increased blood pressure E. Rationale: Heparin is an anticoagulant, and the client who receives continuous IV heparin is at risk for bleeding. The nurse must be alert for signs of bleeding: bleeding from the gums, ecchymoses on the skin, cloudy or pink-tinged urine, tarry stools, and body fluids that test positive for occult blood. Test-Taking Strategy: Use the process of elimination. Recalling that this medication is an anticoagulant will direct you to the correct options. If this question was difficult for you, review the adverse effects of this medication. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Pharmacology References: Gahart, B., & Nazareno, A. (2010). 2010 Intravenous medications (26th ed., p. 682). St. Louis: Mosby. Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: A nursing process approach (6th ed., p. 683). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points.