Blood Administration
A nurse is preparing to administer a transfusion of 300 ml of pooled platelets for a client who has thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames?
A. Within 30 minutes/unit
B. Within 60 minutes/unit
C. Within 2 hours/unit
D. Within 4 hours/unit
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ANSWER: A. Within 30 minutes/unit:
Platelets are fragile and should be infused as quickly as possible to reduce clumping. The nurse should administer the platelets within 15 to 30 minutes
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B. The nurse should administer Fresh frozen plasma within 30-60 min/unit.
C. / D. The nurse should administer a unit of whole blood or PRBC’s within 2 to 4 hours
How will the nurse describe the action of proton pump inhibitors (PPIs)?
A.They compete with histamine for binding sites on the parietal cells.
B.They form a protective barrier that can be thought of as a liquid bandage.
C.They irreversibly bind to the hydrogen-potassium-ATPase pump.
D.They help to neutralize acid secretions to promote gastric mucosal defensive mechanisms.
Answer: C. They irreversibly bind to the hydrogen-potassium-ATPase pump.
PPIs work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to the ATPase pump, H+/K+ ATPase, the enzyme for this step.
PPI Example: Esomeprazole, omeprazole, pantoprazole, lansoprazole.
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D. = Antacids = calcium carbonate, magnesium oxide
A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider?
A. Serum sodium 144 mEq/L
B. Urine output 120 mL in 4 hr
C. Serum potassium 5.2 mEq/L
D. Blood pressure 140/90 mm Hg
ANSWER: C. CORRECT: Serum potassium of 5.2 mEq/L indicates hyperkalemia.
Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider.
Spironolactone = K+ Sparing diuretic = other examples: Triamterene & Amiloride
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A. Serum sodium of 144 mEq/L is within the expected reference range.
B. Urine output of 30 mL/hr or 120 mL in 4 hr is within the expected reference range.
D. A blood pressure of 140/90 mm Hg is within the expected reference range.
A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take?
A. Expel the air bubble from the prefilled syringe before injecting.
B. Insert the needle completely into the client’s tissue.
C. Administer the injection in the client’s thigh.
D. Aspirate carefully after inserting the needle into the client’s skin
ANSWER: B
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A. The nurse should not expel the air bubble in the prefilled syringe prior to injection because the medication has been premeasured, and expelling the air could cause medication to be lost. An exception would be if the dosage needed to be adjusted prior to the injection.
B. CORRECT: The nurse should inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection.
C. A deep subcutaneous injection should be administered into the subcutaneous tissue of the abdomen, at least 2 inches away from the umbilicus.
D. The nurse should not aspirate when administering enoxaparin or other heparin products subcutaneously.
A nurse is caring for a client who is taking propylthiouracil. For which of the following adverse effects of this medication should the nurse monitor?
A. Bradycardia
B. Insomnia
C. Heat intolerance
D. Weight loss
ANSWER: A. Bradycardia
propylthiouracil = aka = PTU = Class: Thionamides = to manage hyperthyroidism, graves disease...methimazole is another example
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A. CORRECT: Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia.
B. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil.
C. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil.
D. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil.
A nurse is preparing to transfuse a unit of red packed cells (RPCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?
A. Ensure that the client has a patent IV line before obtaining the blood product from the refrigerator.
B. Obtain another nurse to confirm the correct client and the correct blood product with you.
C. Take a complete set of vital signs before beginning the transfusion and periodically during the transfusion.
D. Stay with the client for the first 15 to 30 minutes of the transfusion.
ANSWER: B. Obtain another nurse to confirm the correct client and the correct blood product with you.
Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reactions from occurring because the reaction is caused by ABO and Rh incompatibility.
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A. Ensuring the client has a patent IV line before obtaining the blood product is important, but will not prevent the client from having a hemolytic reaction.
C. Taking vital signs before and during the blood transfusion will identify a potential hemolytic reaction, but will not prevent one.
D. Staying with the client for the first 15 to 20 minutes of the transfusion can ensure prompt identification and treatment of a hemolytic reaction, but will not prevent one.
What is the mechanism of action for Famotidine?
A.It causes a decrease in stomach pH, reducing stomach acidity.
B.It competes with histamine for binding sites on the parietal cells.
C.It forms a protective coating against gastric acid, pepsin, and bile salts.
D.It irreversibly binds to the hydroge–potassium–adenosine triphosphatase (ATPase) pump.
Answer: B. It competes with histamine for binding sites on the parietal cells.
Histamine receptor–blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.
Examples of Histamine H2 Antagonists: Famotidine, nizatidine, ranitidine,
A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol?
A. Asthma
B. Glaucoma
C. Hypertension
D. Tachycardia
ANSWER: A. Asthma
propranolol = Beta adrenergic blockers(sympatholytics) = "lol"
- Cardioselective: Beta1 (affects only the heart) = Metoprolol, Atenolol, Esmolol
- Nonselective: Beta1 and beta2 (affecting both the heart and lungs) = Propranolol, Nadolol
- Alpha and beta blockers =Carvedilol, Labetalol
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A. CORRECT: Propranolol is a nonselective beta‑adrenergic blocker that blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma.
B. Propranolol is not contraindicated in clients who have glaucoma.
C. Propranolol is prescribed to treat hypertension. It is not contraindicated for clients who have this disorder.
D. Propranolol is prescribed to treat tachy dysrhythmias, such as tachycardia. It is contraindicated in clients who have bradycardia and heart block.
A nurse is caring for a hospitalized client who is receiving IV heparin for a deep‑vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer?
A. Vitamin K1
B. Atropine
C. Protamine
D. Calcium gluconate
ANSWER: C. Protamine
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A. Vitamin K1 is used to reverse the effects of warfarin.
B. Atropine is used to reverse bradycardia caused by beta adrenergic blockers.
C. CORRECT: Protamine reverses the anticoagulant effect of heparin.
D. Calcium gluconate is used to treat magnesium sulfate toxicity.
A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication?
A. “I’ll take this medicine with my meals.”
B. “I’ll take this medicine 30 minutes before I eat.”
C. “I’ll take this medicine just before I go to bed.”
D. “I’ll take this medicine as soon as I wake up in the morning.”
ANSWER: B.
AN ORAL ANTIDIABETIC MED = CLASS: Meglitinides (glinides)
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A. Repaglinide should not be taken with a meal.
B. CORRECT: Repaglinide causes a rapid, short‑lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested.
C. Repaglinide should not be taken just before bedtime.
D. Repaglinide is not taken upon awakening in the morning.
A nurse is assessing a client during a transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications?
A. Epinephrine
B. Lorazepam
C. Furosemide
D. Diphenhydramine
ANSWER: C. Furosemide:
a loop diuretic, may be prescribed to relieve manifestations of circulatory overload.
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A. Epinephrine may be prescribed for a client who has an anaphylactic shock caused by a severe allergic reaction, but is not indicated for manifestations assessed in this client.
B. Lorazepam, a benzodiazepine, may be prescribed for a client who has severe anxiety, but is not indicated for the manifestations assessed in this client.
D. Diphenhydramine, a histamine blocker, may be prescribed to treat mild allergic reactions, but is not indicated for manifestations assessed in this client.
A nurse is caring for four clients who have peptic ulcer disease. The nurse should recognize misoprostol is contraindicated for which of the following clients?
A. A client who is pregnant
B. A client who has osteoarthritis
C. A client who has a kidney stone
D. A client who has a urinary tract infection
ANSWER: A
A. CORRECT: Misoprostol can induce labor and is contraindicated in pregnancy.
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B. There are no contraindications for use in clients who have osteoarthritis.
C. There are no contraindications for use in clients who have kidney stones.
D. There are no contraindications for use in clients who have urinary tract infections.
A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity?
A. Phenytoin
B. Verapamil
C. Warfarin
D. Aluminum hydroxide
ANSWER: B. Verapamil (a class IV antidysrhythmic)
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A. Phenytoin, an antiseizure and antidysrhythmic medication, does not increase a client’s risk for digoxin toxicity. When given as an antidysrhythmic, phenytoin can treat dysrhythmias caused by digoxin toxicity.
B. CORRECT: Verapamil, a calcium‑channel blocker, can increase digoxin levels. If these medications are given concurrently, the digoxin dosage might be decreased and the nurse should monitor digoxin levels carefully.
C. Warfarin does not interact with digoxin to increase digoxin levels.
D. Antacids, such as aluminum hydroxide, decrease absorption of digoxin and can decrease digoxin levels and effectiveness.
A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran?
A. Vitamin K1
B. Protamine
C. Omeprazole
D. Probenecid
ANSWER: C. Omeprazole
Dabigatran = Direct thrombin inhibitor = directly inhibits thrombin, thus preventing a thrombus from developing
prevents stroke or embolism in clients who have atrial fibrillation not caused by valvular heart disease. It is also used to treat DVT and to prevent pulmonary embolism....
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A. Vitamin K1 is used to treat hemorrhage or overdose of warfarin, but it is not an antidote for dabigatran.
B. Protamine is used to treat severe hemorrhage or overdose of heparin, but is not an antidote for dabigatran.
C. CORRECT: Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food.
D. Probenecid is used to treat gout and gouty arthritis, and is not indicated to treat an adverse effect of dabigatran.
A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider?
A. Somnolence
B. Constipation
C. Fluid retention
D. Weight gain
ANSWER: A. Somnolence
Metformin Med Class: Biguanides
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A. CORRECT: Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider.
B. Diarrhea is an adverse effect of metformin.
C. Fluid retention is not an adverse effect caused by metformin.
D. Anorexia and weight loss are adverse effects of metformin.
A nurse is caring for a hospitalized patient who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the reference range. Which of the following blood products should the nurse prepare to infuse?
A. Whole blood
B. Platelets
C. Fresh frozen plasma
D. Packed red blood cells
ANSWER: C. Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can prevent bleeding.
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A. Whole blood is infused in clients who have experienced acute blood loss or who require volume expansion in addition to replacement of red blood cells.
B. Platelets are infused for clients who have severe thrombocytopenia and are not indicated for clients who have an elevated aPTT.
D. PRBC’s are transfused for clients who are severely anemic who do not require extra plasma volume
A nurse is teaching a client who is taking sucralfate PO for peptic ulcer disease has a new prescription for phenytoin to control seizures. Which of the following instructions should the nurse include?
A. Take an antacid with the sucralfate.
B. Take sucralfate with a glass of milk.
C. Allow a 2‑hr interval between these medications.
D. Chew the sucralfate thoroughly before swallowing.
ANSWER: C
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A. Antacids can interfere with the effects of sucralfate, so the client should allow a 30 min interval between the sucralfate and the antacid.
B. Sucralfate should be taken on an empty stomach, 1 hr before meals.
C. CORRECT: Sucralfate can interfere with the absorption of phenytoin, so the client should allow a 2‑hr interval between the sucralfate and phenytoin.
D. The client should swallow the sucralfate whole.
A nurse is planning caring for a client who is has a new prescription for torsemide. The nurse should plan to monitor for which of the following adverse reactions of this medications? (Select all that apply.)
A. Respiratory acidosis
B. Hypokalemia
C. Hypotension
D. Ototoxicity
E. Ventricular dysrhythmias
ANSWER: B, C, D, E
Torsemide = Loop Diuretic (aka High-ceiling Loop Diuretic) = other examples" Furosemide, Bumetanide, Ethacrynic acid.
B. CORRECT: The nurse should plan to monitor for hypokalemia, which is an adverse effect of a loop diuretic.
C. CORRECT: The nurse should plan to monitor for hypotension.
D. CORRECT: The nurse should plan to monitor the client for ototoxicity.
E. CORRECT: The nurse should plan to monitor for ventricular dysrhythmias, which is a manifestation of hypokalemia, an adverse effect of torsemide.
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A. The nurse should plan to monitor for metabolic alkalosis.
A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take?
A. Administer IM enoxaparin along with the alteplase dose.
B. Hold direct pressure on puncture sites for up to 30 min.
C. Administer aminocaproic acid IV prior to alteplase infusion.
D. Prepare to administer alteplase within 8 hr of manifestation onset.
ANSWER: B
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A. Enoxaparin is only available in a subcutaneous form. Subcutaneous and IM injections and other punctures should be avoided due to bleeding risk when alteplase is administered.
B. CORRECT: The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing of blood stops.
C. Aminocaproic acid is an antidote to alteplase and should only be administered in the event of serious bleeding that does not stop after blood products are administered or other remedies are tried. It would not be given prior to alteplase administration.
D. Alteplase must be administered as soon as possible after manifestations of myocardial infarction, pulmonary embolism, or cerebral vascular accident begin. Three hours is often the limit; client outcomes would be decreased if 8 hr elapsed before beginning alteplase.
A nurse is caring for a client in an outpatient facility who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor?
A. WBC
B. Serum potassium
C. Platelet count
D. Liver function tests
ANSWER: D. Liver function test
Med Class: Alpha‑glucosidase inhibitors
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A. Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication.
B. Acarbose does not affect potassium levels. It is not necessary to monitor serum potassium while the client is taking this medication.
C. Acarbose does not affect the platelet levels. It is not necessary to monitor the platelet count while the client is taking this medication.
D. CORRECT: Acarbose can cause liver toxicity when taken long‑term. Liver function tests should be monitored periodically while the client takes this medication.
A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client’s temperature is 2 degrees F higher than baseline. In addition to notifying the provider, which of the following actions should the nurse take? Select all that apply.
A. Stop the infusion.
B. Place the client in an upright position with feet down.
C. Remove the blood bag and tubing from the IV catheter.
D. Obtain a urine specimen.
E. Infuse dextrose 5% in water through the IV.
ANSWER: A, C, D
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A. The nurse should stop the infusion for a rise in temperature of 2 degrees F and reports of chills. The client could be having a hemolytic reaction.
B. The nurse should place the client with potential circulatory overload in the upright position with feet down. This client’s manifestations do not indicate circulatory overload.
C. The nurse should ovoid infusing more PRBC’s and should remove the PRBC’s and tubing from the client’s IV catheter.
D. Obtaining a urine specimen to check for hemolysis is standard procedure for a client who has a blood transfusion reaction.
E. The nurse should only infuse 0.9% sodium chloride until a new prescription is received.
A nurse is providing a client who has peptic ulcer disease with instructions about managing his condition. Which of the following instructions should the nurse include? (Select all that apply.)
A. “Eat a bedtime snack.”
B. “Drink decaffeinated coffee”
C. “Low‑dose aspirin therapy should be avoided.”
D. “Seek measures to reduce stress.”
E. “Avoid smoking.”
ANSWER: D, E
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A. The client should avoid a bedtime snack to reduce gastric acid secretion.
B. The client should avoid caffeinated and decaffeinated coffee to reduce gastrin release.
C. Although frequent use of NSAIDs can decrease prostaglandin production resulting in injury to gastric tissue, low‑dose aspirin therapy is permitted.
D. CORRECT: Reducing stress is beneficial for healing of the ulcer and prevention of complications.
E. CORRECT: Smoking inhibits healing of the ulcer.
A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply.)
A. Simvastatin
B. Hydrochlorothiazide
C. Phenytoin
D. Clonidine
E. Aliskiren
ANSWER: B, D, E
captopril = ACE (Angiotensin‑converting enzyme inhibitors) = "pril" i.e. Enalapril, Enalaprilat, Fosinopril, Lisinopril, Ramipril, Moexipril, Benazepril
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A. Simvastatin, an antilipemic medication that lowers cholesterol, does not interact with captopril and does not intensify first‑dose hypotension.
B. CORRECT: Hydrochlorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics can intensify first‑dose orthostatic hypotension caused by captopril and can continue to interact with antihypertensive medications to cause hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril and keep the client safe from injury.
C. Phenytoin, an antiseizure medication, does not interact with captopril and does not intensify first dose hypotension.
D. CORRECT: Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify first‑dose orthostatic hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril, and keep the client safe from injury.
E. CORRECT: Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its first‑dose orthostatic hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril, and keep the client safe from injury.
A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.)
A. Hypertension
B. Coffee‑ground emesis
C. Tinnitus
D. Paresthesias of the extremities
E. Nausea
ANSWER: B, C, E
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A. H ypotension and shock can result if severe aspirin allergy occurs, but hypertension is not an adverse effect of aspirin therapy.
B. CORRECT: GI bleeding with dark stools or coffee‑ground emesis can be an adverse effect of aspirin therapy.
C. CORRECT: Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy
D. Paresthesias of the extremities are not adverse effects of aspirin therapy.
E. CORRECT: Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy.
A nurse is providing teaching for a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? (Select all that apply.)
A. Stomatitis
B. Insomnia
C. Nausea
D. Rash
E. Increased gout pain
ANSWER: C, D, E
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A. Stomatitis occurs with medications that increase the risk of infection, such as many of the DMARDs used to treat rheumatoid arthritis. Allopurinol does not increase a client’s risk for infection.
B. Insomnia is not an adverse effect caused by allopurinol.
C. CORRECT: Nausea and vomiting are adverse effects that can be caused by allopurinol.
D. CORRECT: Rash and other hypersensitivity reactions can be caused by allopurinol. The client should be taught to contact the provider for any manifestation of hypersensitivity so that the medication can be discontinued.
E. CORRECT: An increase in gout attacks can occur during the first few months in a client who is taking allopurinol.