Pharm-ageddon
A nurse has been administering a drug to a client intramuscularly (IM). The health care provider discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:
a. Passive diffusion
b. Glomerular filtration
c. Active transport
d. First-pass effect
d. First-pass effect
The nurse is caring for a 5-year-old client in the pediatric clinic. The client's parent reports that the client has been tired lately and has lost 3 lb (1.4 kg) over the past month despite having a good appetite and drinking water constantly. The client has also had frequent urination, and the parent is concerned that the client may have a urinary tract infection. In planning care, what action(s) should the nurse take? Select all that apply.
a. Obtain blood glucose testing
b. Obtain an order for straight catheterization
c. Perform a dipstick urine test
d. Perform a bladder scan
e. Inform the healthcare provider of the client’s symptoms
a. Obtain blood glucose testing
c. Perform a dipstick urine test
e. Inform the healthcare provider of the client’s symptoms
An example of a curative surgical procedure is:
a. Tumor excision
b. Face-lift
c. Biopsy
d. Placement of an NG tube
a. Tumor excision
A patient is scheduled for surgery. According to evidence-based guidelines for preventing surgical site infections, (SSI) when should prophylactic antibiotics be administered?
a. Exactly four hours prior to scheduled surgery time
b. Immediately upon arrival at the hospital
c. Within 60 minutes before the first incision is made
d. One the patient is moved to the Post-Anesthesia Care UnitPACU
c. Within 60 minutes before the first incision is made
The pediatric nurse is caring for a child who weighs 44 pounds. The health care provider has prescribed methylprednisolone sodium succinate, 0.03 mg/kg/d IV in normal saline. How many milligrams of medication will the nurse prepare?
0.6 mg
When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will:
a. Be released fairly quickly
b. Have a long duration of action
c. Be excreted quickly
d. Lead to toxicity when given
b. Have a long duration of action
A nurse is caring for a 55 year old client diagnosed with deep vein thrombosis (DVT). The health care provider orders anticoagulant therapy to prevent further clot formation. The client's lab results indicate a platelet count of 68,000 mm3 (68 x 109/L). What is the priority action the nurse should take in this scenario?
a. Consult the healthcare provider to discuss alternative anticoagulant options
b. Increase the dose of the prescribed anticoagulant to compensate for the low platelet count
c. Administer the prescribed anticoagulant therapy as ordered
d. Suspend all anticoagulant therapy and initiate antiplatelet medications
a. Consult the healthcare provider to discuss alternative anticoagulant options
A fractured skull would be classified under which category of surgery based on urgency?
a. Elective
b. Emergent
c. Required
d. Urgent
b. Emergent
The hospital is evaluating the percentage of post-surgical patients who developed a wound infection during their stay. What type of quality improvement evaluation is this?
a. Process evaluation
b. Root cause analysis (RCA)
c. Outcome evaluation
d. Structural evaluation
c. Outcome evaluation
A child weighs 44lbs. The provider orders ibuprofen 10 mg/kg/dose. The medication is available in 100 mg/5mL. How many mL should the child receive?
10mL
the nurse has administered an opioid drug to a client. Which action would be most appropriate for the nurse to do immediately after administering the drug?
a. Monitor the vital signs of the patient
b. Document administration of the drug
c. Reassess the patient's pain level
d. Update the healthcare provider regarding the patient's status
b. Document administration of the drug
Which laboratory value is most indicative of a chronic inflammatory process rather than an acute reaction?
a. White Blood Cell count (WBC)
b. C-Reactive Protein (CRP)
c. Procalcitonin
d. Erythrocyte Sedimentation Rate (ESR)
d. Erythrocyte Sedimentation Rate (ESR)
A nurse is caring for a patient who experienced blood loss during emergent surgery. During the postoperative assessment, the nurse notes that the core temperature is 35.2, the pH is 7.21, and there is continuous wheezing from the surgical incision despite pressure dressings. Which interpretation by the nurse is more accurate?
a. The client is experiencing expected postoperative findings and requires only routine monitoring
b. The client is demonstrating signs of the Triad of Death, which can lead to uncontrolled bleeding and worsening organ dysfunction
c. The patient is showing evidence of fluid overload resulting in delusional anemia
d. The patient is experiencing adverse side effects of postoperative opioid administration
b. The client is demonstrating signs of the Triad of Death, which can lead to uncontrolled bleeding and worsening organ dysfunction
Which of the following is an example of a structural evaluation standard in healthcare quality?
a. The percentage of nurses on a unit who hold a specialty certification
b. The successful administration of a PRN medication based on a nursing assessment
c. The number of patient falls recorded in the last quarter
d. The adherence rate to a specific hand-hygiene protocol
a. The percentage of nurses on a unit who hold a specialty certification
A child weighs 55 lbs. The provider orders clindamycin 30 mg/kg/day divided into three equal doses. The medication comes as 75 mg/5mL. How many mg/dose? How many mL per dose?
250 mg/dose
16.7 mL/dose
What is the primary rationale for requiring a patient to remain upright for at least 30 minutes after taking a bisphosphonate such as Alendronate (Fosamax)?
a. To prevent the development of the first-pass effect
b. To prevent serious esophageal irritation or ulceration
c. To ensure the drug is metabolized by the liver before it reaches the kidneys
d. To increase the rate of absorption in the small intestines
b. To prevent serious esophageal irritation or ulceration
A patient has been vomiting for 12 hours. The nurse notes the patient is lethargic and the heart rate is 112 bpm. Which lab result would be most critical to report to the provider?
a. WBC 12.0 x10^9/L
b. Potassium 2.4 mEq/L
c. Hematocrit of 54%
d. C-reactive protein 0.8 mg/dL
b. Potassium 2.4 mEq/L
The circulating nurse is monitoring aseptic technique in the operating room during an appendectomy for an adult client. Which action(s) would require intervention? Select all that apply.
a. The surgical technician adjusts their mask while scrubbed in.
b. The surgical technician reaches over the sterile field to reposition an instrument.
c. The surgeon places their gloved hands below the sterile field.
d. The anesthesiologist administers medication while standing outside the sterile field
e. The scrub nurse touches a non-sterile surface and continues working
a. The surgical technician adjusts their mask while scrubbed in.
b. The surgical technician reaches over the sterile field to reposition an instrument.
c. The surgeon places their gloved hands below the sterile field.
e. The scrub nurse touches a non-sterile surface and continues working
A nurse is using the SBAR tool to communicate a change in patient status to a provider. This intervention is an example of which quality evaluation type?
a. Process
b. Benchmark
c. Structural
d. Outcome
a. Process
A patient weighs 198lbs. The provider orders metoprolol 1.5 mg/kg/day PO divided into 2 equal doses. Available in 50 mg tablets. How many tablets should the nurse administer per dose?
a. 1 tablet
b. 1.5 tablets
c. 2 tablets
d. 2.5 tablets
b. 1.5 tablets
The nurse instructs a client with a history of A-Fib on Warfarin. Which client statement indicates that teaching about the medication has been effective?
a. “I will avoid walking barefoot in the house and outdoors.”
b. “I will take a dose when I begin to feel fatigued.”
c. “I will use a regular razor when shaving.”
d. “I will have the blood level of the drug checked twice a year.”
“I will avoid walking barefoot in the house and outdoors.”
The nurse reviews morning labs: Hbg: 7.2 g/dL, Hct: 22%, Platelets: 280,000 mm^3, WBC 8000/mm^3. Which assessment finding is most concerning?
a. Increased risk for infection
b. Decreased oxygen-carrying capacity
c. Increased bleeding risk
d. Fluid overload
b. Decreased oxygen-carrying capacity
A nurse is assessing a patient with a leg fracture and a new cast. The patient reports severe pain that is not relieved by the prescribed opioid and increases when the nurse flexes the patient’s toes. What is the priority nursing action?
a. Administer an additional dose of pain medication and reassess in 1 hour
b. Elevate the limb above the level of the heart and apply ice to reduce swelling
c. Apply a warm compress to the area to improve circulation
d. Notify the provider of your assessment findings
d. Notify the provider of your assessment findings
When documenting a clinical event in the medical record, which of the following is considered a best practice for a nurse?
a. Summarizing the patient behavior to save space in the record
b. Providing a clear, descriptive story that can be understood without outside context
c. Including personal and professional opinions about errors made
d. Mentioning that the Risk Manager was notified to ensure comprehensive note taking
b. Providing a clear, descriptive story that can be understood without outside context
The physician orders 1.5 liters of Lactated Ringer’s solution to be administered over 12 hours. The IV tubing delivers 20 gtt/mL. What is the flow rate in gtt/min?
42 gtts