Physiological integrity: Pharmacological and parenteral therapies

Adverse Effects & Expected Outcomes

100

A 5-year-old is being treated for an acute attack of asthma using racemic epinephrine (epinephrine hyrochloride) nebulizer state. Which finding indicates an adverse effect of this medication? A. Excitability B. Tremors C. Heart rate 150 D. Nausea

C. Adverse Effects of epinephrine include hypertension and tachycardia. Answers A, B, and D are expected side effects of racemic epinephrine.

200

A client with renal failure has an order for erythropoietin (Epogen) to be given subcutaneously. The nurse should teach the client to report which of the following? A. Severe headache B. Slight nausea C. Decreased urination D. Itching

A. Severe headache can indicate impending seizure activity. Slight nausea is expected when beginning the therapy, so answer B is incorrect. A client with renal failure already has itching and decreased urination, so answers C and D are incorrect.

300

Because a client is receiving fresh frozen plasma, the nurse should evaluate which of the following laboratory results for the effectiveness of therapy? A. Hemoglobin and hematocrit B. Platelets C. Prothrombin (PT) and partial thromboplastin (PTT) D. White blood cells

C. PT and PTT laboratory tests should be evaluated to determine the effectiveness of receiving fresh plasma. Answer A is evaluated to indicate successful red blood cell therapy. Answer B should be monitored to evaluate successful platelet therapy. Answer D would be evaluated to determine effective granulocyte therapy.

400

The nurse is caring for a client with an IV who is experiencing dyspnea, hypotension, a weak, rapid pulse, a decreased level of consciousness, and who is becoming cyanotic. The priority nursing intervention is to A. Notify the physician. B. Place the client in a Trendelenburg position. C. Administer oxygen. D. Discontinue the IV.

D. The client is experiencing an air embolism. The other interventions are appropriate, but this condition is fatal, so the priority is to discontinue the IV.

500

The client is being treated with intravenous Vancomycin for MRSA when the nurse notes redness of the client’s neck and chest. Place in ordered sequence the actions to be taken by the nurse: A. Call the doctor B. Stop the IV infusion of Vancomycin C. Administer Benadryl as ordered D. Take the vital signs

B, D, A, C. The client is experiencing red mans syndrome. The priority is to stop the infusion first and obtain necessary assessment data before calling the physician to receive an order for Benadryl.

Blood Products, TPN, & IV/Parenteral Therapies

100

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that the rationale for transfusing fresh frozen plasma in this client is A. To treat platelet loss. B. To promote rapid volume expansion. C. That the transfusion must be done slowly. D. That is will increase the hemoglobin and hematocrit levels.

B. Fresh frozen plasma is often used for volume expansion as a result of fluid and blood loss. It does not contain platelets so it is not used to treat any type of low platelet count disorder. It is rich in clotting factor and can be thawed and transfused quickly. It will not specifically increase the hemoglobin and hematocrit levels

200

The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should immediately be taken next? A. Remove the intravenous (IV) line. B. Run a solution of 5% dextrose in water. C. Run normal saline at a keep-vein-open rate. D. Obtain a culture of the tip of the catheter device removed from the client.

C. If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further physician prescriptions. This maintains a patent IV access line and aids in maintaining the client’s intravascular volume. The nurse would not remove the IV line because then there would be no IV access route. Obtaining a culture are the tip of the catheter should not be removed. Second, cultures are performed when infection, not transfusion reaction, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump.

300

The nurse is preparing to change the parenteral nutrition (PN) bag and tubing. The client’s central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during tubing change? A. Breathe normally B. Turn the head to the right C. Exhale slowly and evenly D. Take a deep breath, hold it, and bear down.

D. The client should be asked to perform the Valsalva maneuver during the tubing change. This helps avoid air embolism during tubing changes. The nurse asks the client to take a deep breath, hold it, and bear down. If the intravenous line is on the right, the client turns his or her head to the left. This position increases intrathoracic pressure. Options A and C are inappropriate and could cause the potential for an air embolism during the tubing change.

400

A client with a recent diagnosis of myocardial infarction and impaired renal function is recuperating on the step-down cardiac unit. The client’s blood pressure had been borderline low and intravenous (IV) fluids have been infusing at 100 mL/hr via a central line catheter in the right internal jugular for approximately 24 hours in increase renal output and maintain the blood pressure. Upon entering the client’s room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likely experiencing which complication of IV therapy? A. Hematoma B. Air embolism C. Systemic infection D. Circulatory overload

D. Circulatory overload is a complication of IV therapy. Signs include tachypnea, dyspnea, a moist cough, crackles and hypertension. Hematoma is characterized by eccymosis, swelling, and leakage at the IV insertion site, and hard and painful lumps at the site. Air embolism is characterized by tachycardia, dyspnea, hypotension, cyanosis, and decreased level of consciousness. Systemic infection is characterized by chills, fever, malaise, headache, nausea, vomiting, backache, and tachycardia.

500

A client is involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which intravenous (IV) solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure? A. 5% dextrose in Lactated Ringer’s B. 0.33% sodium chloride (1/3 normal saline) C. 0.225% sodium chloride (1/4 normal saline) D. 0.45% sodium chloride (1/2 normal saline)

The goal of therapy with this client is to expand intravascular volume as quickly as possible. The 5% dextrose in Lactated Ringer’s (hypertonic solution) would increase intravascular volume and immediately replace lost fluid volume until a transfusion could be administered, resulting in an increase in the client’s blood pressure. The solutions in options 2, 3, and 4 would not be given to this client because they are hypotonic solutions and , instead of increasing intravascular space, the solution would move into the cells via osmosis.

Central Venous Access Devices

100

Which of the following should the nurse include when caring for a client with a peripherally inserted central venous catheter (PICC)? A. Weigh the client daily B. Avoid taking the blood pressure in the arm on the side of the PICC C. Take the temperature every four hours D. Monitor the client’s response to fluid and electrolyte therapy

B. You should always avoid taking the blood pressure on the arm with the PICC line.

200

Which of the following evaluations does the nurse make when the venipuncture site has an observable swelling and is tender and cool to touch? A. An infection has developed B. Bleeding into the surrounding tissue has occurred C. The IV site has infiltrated D. A phlebitis is developing

C. Infiltration causes noticeable swelling and is tender and cool to touch. Infiltration may be caused by using the wrong gauge catheter, the wrong type of device, or dislodgement of the device from the vein.

300

The nurse should monitor a client with a central venous catheter for which of the following manifestations of a pneumothorax? Select all that apply. A. Hypertension B. Shortness of breath C. Flushing D. Lethargy E. Chest pain F. Weak, rapid pulse

B, E, & F. Clinical manifestations of a pneumothorax include sudden shortness of breath, sharp chest pain, hypotension, pallor, cyanosis, and a weak, rapid pulse, which may indicate the pleural membrane has been punctured.

400

The nurse assesses which of the following clients to be most appropriate for the selection of the central venous catheter? A. A client who is dehydrated with hypokalemia requiring fluid and electrolyte replacement. B. A client who has cancer of the esophagus and is receiving chemotherapy. C. A client who has an infection and needs short-term antibiotics. D. A client who had gallbladder surgery and is experiencing post-op nausea.

B. A central venous catheter is generally inserted into the internal jugular and subclavian veins. It is used for long-term therapy, such as those receiving chemotherapy.

500

The nurse is caring for a client with a central venous access device. Which of the following clinical manifestations does the nurse interpret as indicative of a dislodged catheter. Select all that apply. A. Pain in the neck B. Bleeding from the site C. Gurgling sounds D. Skin that is pale and cool to touch E. Palpitations F. Chills

A, C, & E. These are clinical manifestations of a dislodged central venous access device.

Calculations & Medication Administration

100

A post-chemotherapy client is experiencing hypokalemia and has an order for IV potassium chloride 10 mEq in 100 mL of normal saline. Which does the nurse select as the most appropriate means to deliver this medication? A. The largest anticubital vein B. The vein in the back of the dominant hand C. The cephalic vein D. A vascular access device

D. Potassium chloride is irritating to the veins. Using the largest vein possible, via a venous access device, is best. The anticubital would restrict movement. Answers B and C are smaller peripheral veins.

200

The doctor’s orders reads: Vitamin B12 injection 1000 mcg once a month. The nurse has injectable vitamin B12 available in a concentration of 0.5 mg/mL. What volume should the nurse administer? A. 7 mL B. 2 mL D. 20 mL E. 1 mL

B. 1 mg = 1000 mcg 0.5 mg: 1 mL:: 1 mg: x 0.5 x = 1 = 2 mL 0.5 0.5

300

The clients mother contacts the clinic regarding medication administration stating, “My daughter can’t swallow this capsule. It’s too large.” Investigation reveals that the medication is a capsule marked SR. The nurse should instruct the mother to” A. Open the capsule and mix the medication with ice cream. B. Crush the medication and administer it with 8 oz. of liquid. C. Call the pharmacist and request an alternative preparation of the medication. D. Stop the medication and inform the physician at the follow-up visit.

C. SR means sustained release. This medication cannot be altered because of the pharmacokinetics.

400

A physician prescribes 100 mL of ½% NS solution to run over 8 hour. The drop factor is 15 drops/mL. The nurse plans to adjust the flow rate to how many drops per minute to safely administer this IV solution. (Round answer to the nearest whole number.) A. 31 gtt/min B. 48 gtt/min C. 60 gtt/min D. 15 gtt/min

A. Tidal volume in mL x Drop = Flow rate in gtt/min Time in minutes 1000mL x 15 gtt/mL = 15,000 gtt = 31.2 or 31 gtt/min 8 hours x 60 mins/hr 480 mins

500

The physician has ordered morphine sulfate (Duramorph) 10 mg s.q. q 4 hours PRN. The child weighs 80 lbs. The recommended maximum dose of morphine sulfate (Duramorph) is 0.1 mg to 0.2 mg/kg/dose. To determine the safety of this dose, what is the safe dose range for this child? A. 4.2-8.6 mg B. 1.5-4.2 mg C. 3.6-7.3 mg D. 5.9-10 mg

C. 80lbs=36.4 kg Lower Threshold:0.1mg/kgx36.4kg=3.6 mg 2.2 Upper Threshold: 0.2 mg/kg x 36.4 kg = 7.3 mg So, 10 mg/dose is not within the safe dose range for this child.

Pharmacological Pain Management

100

Which of the following is a priority in the plan of care for a client who has had abdominal surgery and complains of pain in the immediate postoperative period? A. Monitor the client’s blood pressure B. Teach the client to splint the abdomen C. Reposition the client for comfort D. Ask the client to describe the pain

D. A priority assessment includes description and severity of the pain as expressed by the client.

200

The nurse is teaching a class on controlled substances. Which of the following should the nurse include in the class? A. There is no accepted medical use for Schedule I controlled substances. B. Examples of Schedule II drugs include glutethimide (Doriden), secobarbital (Seconal), and hydrocodone with acetaminophen (Vicoden). C. Schedule III controlled substances have a high potential for abuse. D. Schedule IV controlled substances are over-the-counter narcotics that must be sold by a registered pharmacist.

A. Schedule I controlled substances have no acceptable medical use and are for research purpose only.

300

Which of the following should the nurse include in the medication instructions for an older adult who has back pain and a mild opioid with codeine has been prescribed? A. Assess the respirations 3 times a day B. Increase daily fiber and fluids C. Limit the administration of the medication to severe pain D. Avoid taking the medication more that two times a day

B. It is difficult for clients to count their own respirations accurately and not and is not appropriate for codeine. Dosing should be “round the clock.” Older clients are more prone to constipation than younger clients so fluids and fiber should be increased in their diet.

400

Which of the following is the appropriate assessment for respiratory depression in the older adult after the administration of an opioid for analgesia? Respiratory depression is A. More likely after several doses of the same drug. B. Most likely after the first dose. C. Unlikely because the opioid is not prescribed for the older adult in large doses. D. Unlikely if the drug is given orally.

B. If the client is very sensitive to an opioid, the resulting respiratory depression is most likely to occur after the first dose.

500

The nurse assesses which of the following physiological manifestations as indicating that the client is experiencing acute pain? Select all that apply. A. Verbalization of pain B. Crying C. Hypertension D. Flushing E. Tachycardia F. Moist skin

C & E. Hypertension and tachycardia are physiological manifestations of acute pain. Crying and verbalization of pain are psychological or emotional manifestations of pain. When a client is in acute pain, the skin is more likely to be cool and pale.