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Pharmacological and Parenteral Therapies
1.
A client in ICU is given procainamide HCI (Pronestyl) slow IV push. The nurse should withhold the next dose forwhich indication?a.
Presence of premature ventricular contractionsb.
Occurrence of severe hypotensionc.
Recurring paroxysmal atrial tachycardiad.
A sedimentation rate of 10
Severe hypotension or bradycardia are signs of adverse reaction with this medication. Options #1 and #3 are notordinarily side effects of this drug. Option #4 is within normal limits.
2.
An anxious adult client has been ordered the following preoperative medications IM:
• meperidine HCI (Demerol)
• promethazine (Phenergan)
• diazepam (Valium)
Which technique should be used in the administration of these medications?a.
The diazepam (Valium) should be placed in a separate syringe.b.
All the medications should be placed in one syringe to avoid the discomfort of several injections.c.
Each medication should be placed in a separate syringe for safety.d.
The physician should be notified because these drugs are incompatible.
Diazepam (Valium) is not compatible with most other medications and should be administered separately. Option #2is incorrect because the two drugs are incompatible. Option #3 is unnecessary. Option #4 is inappropriate as the nurseshould be knowledgeable about drug interactions and compatibility.
3.
Which instruction should be given to a client taking tetracycline HCL (Achromycin)?a.
Take with a full stomach or a glass of milk.b.
Avoid exposure to direct sunlight.c.
Continue taking the medication until client feels better.d.
Avoid the use of soaps or detergents for two weeks.
Photosensitivity occurs with the use of this medication. Option #1 is incorrect because this medication should betaken on an empty stomach. Option #3 is incorrect because the full prescription should be taken. Option #4 isirrelevant.
4.
A client has taken levothyroxine sodium (Synthroid) 0.4 mg daily for 4 days. Which symptoms suggest that thenurse should recommend a change in the clients medication?a.
Nervousness and difficulty sleepingb.
Tired with no energyc.
Coarse hair and skind.
Persistent weight gain
Nervousness and insomnia suggest an overdose of thyroid hormone replacement therapy. Options #2, #3, and #4 aresymptoms of hypothyroidism the reason for giving this medication.
5.
Which medication would be a priority for the diabetic client to avoid if possible?a.
Steroidsb.
Narcoticsc.
Major tranquilizersd.
NSAIDs
Steroids increase the blood glucose requiring an increase in the insulin intake. Options #2, #3, and #4 are usually safefor diabetic clients.
6.
What action should a nurse take for an adult client taking lithium carbonate (Lithane) who has a serum lithiumlevel of 2.0 mEq/L?a.
Administer the next dose on timeb.
Increase the clients fluid intake.c.
Notify the physician.d.
Encourage the client to rest.
The therapeutic level of lithium is 0.5-1.2 mEq/L. Toxic manifestations may occur at levels about 1.5 mEq/L so thephysician should be notified. Option #1 will not occur since the clients level is out of the therapeutic range. Options #2and #4 will not decrease the lithium level.
7.
During the administration of amphotericin B, what would be the priority of nursing care?a.
Observe for signs of hyperkalemiab.
Monitor serum glucose.
c.
Encourage a diet low in calories and protein.d.
Evaluate the IV site for phlebitis.
This anti-fungal is very irritating to the vein. The IV site must be evaluated frequently for phlebitis. Option #1 isincorrect since the problem that can occur is hypokalemia. Option #2 is incorrect. Option #3 should be a diet high incalories and protein.
8.
Your COPD clients order reads theophylline (Aminophylline) 300 mg in 100 cc D;W at 36 mg/hr. To deliver thecorrect dose, the nurse sets the infusion control device at:a.
12 cc/hr.b.
25 cc/hr.c.
36 cc/hr.d.
100 cc/hr.
300mg = 36mg100cc x300x = 3600 x=12
9.
A client presents in respiratory acidosis and pulmonary edema. What would be the desired outcome afteradministering furosemide (Lasix) for this client?a.
Blood pressure change from 160/92 to 148/88.b.
Respiratory rate change from 52 to 48c.
Urine output 100 cc/hr.d.
Breath sounds present with less rales and rhonchi.
Lasix is administered to diurese the extra fluid. As the fluid decreases, the breath sounds will have less rales andrhonchi. Option #1 is not specific for this client. It would be an outcome, but not specific for pulmonary edema.Option #2 is insignificant. Option #3 is expected, but the priority is to improve the breath sounds.
10.
A male nurse is 58 tall and weighs 175 pounds. The nurse has selected the gluteus medius muscle for anintramuscular injection. Which size needle should be used?a.
20 gauge, 3-inch needleb.
22 gauge, 1 to 1-1/2 inch needlec.
25 gauge, 3-inch needled.
25 gauge, 5/8 inch needle
An intramuscular injection at the gluteus medius calls for a needle length of 1 to 1-1/2 inches, and gauge #20 to #22.Option #1 is incorrect because the needle is too long. Option #4 is incorrect because the needle gauge is too small andthe needle is too short.
11.
Which medication has an adverse reaction on extra-pyramidal effects?a.
Lithium (Lithane)b.
Haloperidol (Haldol)c.
Chlordiazepoxide (Librium)d.
Nortriptyline (Aventyl)
This medication produces extrapyramidal reactions. Options #1, #3, and #4 do not include extrapyramidal reactions asa possible adverse reaction.
12.
A client is given morphine 6 mg IV push for postoperative pain. Following administration of this drug, the nurseobserves:
• P
-68
• R
-8
• BP
-100/68
• Client sleeping quietly
Which nursing action is most appropriate?a.
Allow the client to sleep undisturbed.b.
Administer oxygen via face mask or nasal prongs.c.
Administer naloxone (Narcan).d.
Keep epinephrine 1:1000 at the bedside.
IV naloxone (Narcan) should be given to reverse respiratory depression. Option #1 is incorrect because the respiratoryrate of 8 is too low and necessitates a nursing action. Option #2 is secondary and may not be needed. Option #4 isirrelevant to the situation.
13.
During administration of oral medications to an elderly confused client, the client states, "These pills look funny.They belong to the lady down the hall." How should the nurse respond to the client?a.
"Your physician has ordered new medications for you. They will help you get well."b.
"Remember yesterday when I brought your medications? They look the same."
c.
"I'll explain the purpose of medications."d.
"I'll be back after I check your medications again."
Even the confused client should have medications rechecked when there is any possibility of an error. Always observethe five Rs of medication administration. Options #1, #2, and #3 are incorrect.
14.
What would be the priority care before pushing a medication via a heparin lock?a.
Change the angiocath every 48 hours.b.
Change the dressing every 24 hours.c.
Check for a flashback prior to administering the medication.d.
Flush the heparin lock with 25 cc fluid prior to administering the medication.
Checking for a flashback is a priority before administering any medication via a heparin lock. Another alternativewould be to flush the lock, but 25 cc is too much fluid. Options #1 and #2 are inappropriate.
15.
Which observation of a client receiving theophylline (Aminophylline) IVPB for an acute respiratory problemwould alert the nurse to withhold the medication and notify the physician?a.
Hypertensionb.
Unresponsivenessc.
Polyuriad.
Tachycardia
Option #4 is a side effect of Aminophylline. Levels about 20 ug/1 are considered toxic. Clients with long-term use of this drug may tolerate higher blood concentration levels. Other side effects which can develop are hypotension,nausea, vomiting, and headache. These must be monitored to minimize the potential problems associated withseizures. Options #1, #2, and #3 are not due to an Aminophylline overdose.
16.
Which action would be appropriate for a client receiving a continuous infusion of heparin with a PTT greaterthan 150 seconds?a.
Slow the heparin dripb.
Stop the heparin and notify the physician.c.
Maintain the heparin at the current infusion rate.d.
Increase the infusion rate and notify the physician.
The client is excessively anticoagulated. The heparin should be stopped immediately and the physician notified forfurther action. Option #1 is incorrect because the client is still receiving the drug, and it should be stopped. Options #3and #4 are inappropriate actions.
17.
Which medication may be contraindicated for hypertensive clients with COPD?a.
Beta blockersb.
Ace inhibitorsc.
Diureticsd.
Bronchodilators
Beta blockers can have the adverse reaction of bronchial spasm which would lead to further complications for a clientwith COPD. Option #2 is incorrect because though a cough may develop from ace inhibitors, it is not contraindicatedin COPD clients. Option #3 is beneficial for these clients as it facilitates diuresing. Option #4 is also beneficial for theseclients because it is a respiratory smooth muscle relaxant.
18.
A client discharged with sublingual nitroglycerin (Nitrostat) should be taught to:a.
take the medication 5 minutes after the pain has started.b.
stop taking the medication if a burning sensation is present.c.
take the medication on an empty stomach.d.
avoid abrupt changes in posture.
Nitroglycerin can cause hypotension. The client should avoid changing positions quickly to decrease the chances of falling. Option #1 is incorrect because the client should be taught to take medication with the onset of pain. Option #2is incorrect because a burning or stinging sensation indicates the medication is working. Option #3 is incorrectbecause the client should be taught to place the medication under the tongue and let it melt, not swallow it.
19.
While monitoring a client receiving pain relief from client-controlled analgesia (PCA), what would be the prioritycare for this client?a.
Set the pumps hourly infusion rate to equal total cc/hour needed to control pain.b.
Evaluate the client for orthostatic hypotension.c.
Monitor the respiratory rate for tachypnea.d.
Inform the client that he can control all of his pain by simply pushing a button.
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