Question 1 1 

/ 1 pts

The nurse is noting an order for a medication to be given TID. Which

times will the nurse plan to administer the medication to the patient?

  9 A.M. and 9 P.M.

Correct!   9 A.M., 1 P.M. and 5 P.M.

  Nightly before the patient goes to sleep

  9 A.M., 1 P.M., 5 P.M. and 10 P.M.

TID indicates that the medication is to be administered three times

daily. Common times for TID medications are 9 A.M., 1 P.M. and 5
P.M.

Question 2 1 / 1 pts

The nurse is to administer 1 mL of prochlorperazine (Compazine) 10 mg

IM to an adult patient. Which syringe will the nurse select to administer the
medication?

  1 mL syringe with 27 gauge,   inch needle

  3 mL syringe with 18 gauge, 1 inch needle

Correct!   3 mL syringe with 23 gauge,   inch needle

  1 mL tuberculin syringe with 27 gauge,   inch needle

 Tuberculin syringes are typically used for subcutaneous injections.
The   and   inch needles are too short for intramuscular
injections into adults. The 18 and 27 gauge needles are too small
for adult intramuscular injections. A 3 mL syringe with a 23 gauge, 
 inch needle should be used to administer the medication to the
adult patient.

Question 3 1 / 1 pts

The nurse is caring for a patient who takes 6 tablets of methotrexate once
every week on Fridays. How many mg of methotrexate does the patient
take per dose?
Trexall

Methotrexate tablets,
USP

2.5 mg tablets
only

Correct!   15 mg

  10 mg

  20 mg

  25 mg

2.5 mg tablets x 6 = 15 mg

Question 4 1 / 1 pts

The nurse is to administer 45 mg of phenobarbital to the patient. How

many tablets will the patient receive?
Phenobarbital tablets, USP

 15 mg
CIV   only

  2 tablets

  1 tablet

Correct!   3 tablets

  4 tablets

45 mg x 1 tablet = 3 tablets

              Dose    15 mg

Question 5 1 / 1 pts

The nurse is reviewing the patient’s laboratory results. Which result must
be communicated to the physician immediately?

Correct!   Serum potassium level 6.8 mEq/L

  Serum chloride level 85 mEq/L

  Serum sodium level 134 mEq/L

  Serum magnesium level 2.3 mEq/L

Normal serum potassium level is 3.5 to 5.0 mEq/L. A serum

potassium level of 6.8 mEq/L is very high and puts the patient at
risk for cardiac arrhythmias. The potassium level should be
reported to the physician immediately.

Question 6 1 / 1 pts

 The nurse is caring for a patient whose ABG results reveal the following:
pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm Hg. Which
condition will the nurse expect to see in the patient’s chart as the
underlying cause of these results?

Correct!   Gastroenteritis with severe nausea, vomiting, and diarrhea

  Widespread tissue ischemia caused by cardiogenic shock

  Hyperventilation after a panic attack

  
Respiratory failure caused by pneumonia with pleural effusions

Gastroenteritis with nausea, vomiting, and diarrhea will lead to a

metabolic alkalosis resulting from loss of electrolytes and acids
through emesis and loose stools. Metabolic alkalosis features the
elevated pH of 7.56, elevated HCO3 42 mEq/L and normal
PaCO2 of 32 mm Hg. Widespread tissue ischemia would lead to
metabolic acidosis with low pH resulting from release of lactic acid
from the tissues. Respiratory failure leads to a respiratory acidosis
with a low pH and elevated PaCO2 level. Hyperventilation leads to
respiratory alkalosis with an elevated pH and elevated HCO3 level.

Question 7 1 / 1 pts

The nurse is caring for a patient who has a 1200 mL daily fluid restriction.
The patient has consumed 250 mL with each of her three meals and had
another 150 mL with her medications. The patient has received 150 mL of
IV fluids during the day. How many mL of fluid may the patient still
consume in order to stay within the prescribed fluid restriction?

  250 mL

Correct!   150 mL

  300 mL
   100 mL

The patient has had an oral fluid intake of 900 mL and an IV fluid
intake of 150 mL, giving a total of 1050 mL. This leaves 150 mL
that the patient may consume for the rest of the evening to stay
within the prescribed fluid restriction.

Question 8 1 / 1 pts

The nurse is caring for a patient who has a history of congestive heart
failure. The nurse includes the diagnosis fluid volume excess in the
patient’s care plan. Which goal statement has the highest priority for the
patient and nurse?

  The patient will verbalize understanding of fluid restrictions.

  The patient’s pitting pedal edema will resolve within 72 hours.

  The patient will have urine output of at least 30 mL/hr.

Correct!   The patient’s lung sounds will remain clear.

Oxygenation is the highest priority for the patient with congestive

heart failure and fluid volume excess. Keeping the patient’s lungs
clear is the most important goal for the nurse to consider when
caring for this patient.

Question 9 1 / 1 pts

The nurse is caring for a patient who is to receive intermittent bolus doses
of phenytoin (Dilantin) through the IV line. Which intervention has the
highest priority when administering this medication?
Correct!   
Check for blood return and compatibility prior to administration.

  
Use a new IV tubing set each time the medication is
administered.

  
Use sterile gloves when drawing up and administering the
medication.

  
Document the date, time, and nurse’s initials after each dose is
administered.

Phenytoin (Dilantin) can cause significant irritation to blood vessels

and tissues when administered via IV. For this reason, the nurse
must ensure that the IV catheter is located correctly in the vein by
checking for a blood return prior to administration. Dilantin may not
be given with IV fluids that contain dextrose as precipitation and
crystallization, so the nurse must also check compatibility with the
patient’s prescribed IV fluids.

Question 10 1 / 1 pts

The nurse is caring for a patient who is very dehydrated. Which goal best
indicates that the nursing diagnosis of Deficient fluid volume has been
corrected and that the patient’s fluid balance has been restored?

Correct!   
The patient had 1300 mL of light yellow urine in the last 24 hours.

  The patient has no jugular venous distention.

  The patient’s lung sounds are clear bilaterally.

  The patient verbalizes need for adequate daily fluid intake.

 The goal that best indicates that the patient’s dehydration has been
corrected is output of 1300 mL of clear yellow urine in the last 24
hours. Dark concentrated urine is a symptom of dehydration.
Jugular venous distention and presence of crackles in the lungs
are both indicative of fluid volume overload.

Question 11 1 / 1 pts

The nurse is caring for a patient who has a history of congestive heart
failure and takes once-daily furosemide (Lasix) in order to prevent fluid
overload and pulmonary edema. The patient tells the nurse that she has
stopped taking the medication because she has to urinate frequently
during the night. What is the nurse’s best response?

  “Eat foods high in potassium and limit your salt intake.”

  “Restrict your fluid intake after dinner and in the evening.”

  “You should ask your doctor to decrease the dose.”

Correct!   “Take the diuretic early in the morning before breakfast.”

The patient should be instructed to take the diuretic early in the

morning so that the effects will wear off before the patient goes to
bed at night. Decreasing the dose could lead to fluid overload and
pulmonary edema.

Question 12 1 / 1 pts

The nurse is caring for a patient with a history of hyperparathyroidism who

presents with a serum calcium level of 14.5 mg/dL. What is the highest
priority nursing diagnosis for this patient?
   
Deficient knowledge related to need for supplemental calcium in
diet

  
Risk for constipation caused by decreased gastrointestinal
motility

  Activity intolerance related to muscle cramping and spasms

Correct!   
Risk for injury related to weakened bones that may easily fracture

Chronic hypercalcemia can lead to weakened bones as

strengthening calcium is removed over time. Pathologic fractures
can easily result, so risk for injury is a high priority nursing
diagnosis for this patient. The other nursing diagnoses apply but
are less important than the safety of the patient.

Question 13 1 / 1 pts

The nurse is caring for a patient who has a serum magnesium level of 0.8
mEq/L. Which is the highest priority goal to include in the patient’s plan of
care?

  
The patient will verbalize the importance of sufficient dietary
intake of magnesium.

  The patient will maintain urine output of at least 30 mL/hr.

Correct!   
The patient will remain alert and oriented x3 with no confusion or
seizure activity.

  
The patient’s oral mucous membranes will remain free of
ulceration and pain.
 A patient with low serum magnesium is at risk for neurologic
symptoms including confusion, disorientation, and seizures. The
highest priority goal for this patient is to avoid neurologic problems
that could lead to injury. The other goals are applicable to the
patient with low magnesium but are less important.

Question 14 1 / 1 pts

The nurse is caring for a hospitalized patient with hyperparathyroid

disease and a serum calcium level of 14.2 mg/dL. What is the priority
intervention of the nurse?

  
Teach stress-relieving techniques, including progressive muscle
relaxation.

Correct!   
Instruct the patient to always call for assistance before getting out
of bed.

  
Assist the patient to change into dry clothing after episodes of
diaphoresis.

  
Measure urine output hourly and notify physician if urine output is
less than 30 mL/hr.

The patient with hypercalcemia should always call for assistance

before getting out of bed because of the risk of falling as a result of
muscle weakness, soft bones, and lethargy. Diaphoresis and
decreased urine output are not common symptoms of
hypercalcemia. Teaching stress-relieving techniques is not a
priority, especially since lethargy and stupor are symptoms of
hypercalcemia.

Question 15 1 / 1 pts

 Which medication has the highest potential for abuse?

  Diphenoxylate & atropine (Lomotil) – schedule V

Correct!   Methylphenidate (Ritalin) – schedule II

  Alprazolam (Xanax) – schedule IV

  Acetaminophen & codeine (Tylenol #3) – schedule III

According to the Controlled Substances Act, drugs that have the

potential for abuse/dependency are classified as schedule I-V.
Schedule I drugs have no approved medical applications in the
United States. Schedule II drugs have high potential for
abuse/dependency and have multiple restrictions for prescriptions.
Schedule III, IV, and V have lower risks of dependency/abuse and
fewer restrictions for prescriptions

Question 16 1 / 1 pts

Which of the following medication orders is to be administered PRN?

  
Humulin R 10 units subcutaneously before each meal and at
bedtime

  
Prednisone 10 mg PO today, then taper down 1 mg each day for
the next 10 days

Correct!   
Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep

  Kefzol (Ancef) 1 g IVPB 30 minutes prior to surgery

 The nurse is to give the Ambien if the patient cannot sleep. The
nurse uses discretion when deciding when to administer the
medication PRN.

Question 17 1 / 1 pts

After administering an antibiotic to the patient, the patient complains of

feeling very ill. The nurse notes that the patient is scratching and has
hives. The patient soon starts having difficulty breathing and his blood
pressure drops. What is the nurse’s assessment of the situation?

  
The patient is having a mild allergic reaction and an antihistamine
will make the patient feel better.

Correct!   
The patient is having an anaphylactic reaction and epinephrine
should be administered right away.

  
The patient’s infection is worsening and progressing to septic
shock so blood cultures should be drawn.

  
The patient has developed toxic shock syndrome and the
antibiotic orders must be changed right away.

The patient's symptoms are indicative of anaphylaxis: a severe,

life-threatening allergic reaction. the airways close up, the throat
swells closed, and the blood pressure drops dangerously low. The
patient may go into shock and die. Patients may have very mild
allergic reactions to medications and experience a rash or itching.

Question 18 0 / 1 pts

 The nurse makes a medication error. Which action will the nurse take
first?

  
Document the medication given, how the patient responded, and
the corrective actions taken.

orrect Answer   
Assess the patient for any adverse reactions and notify the
prescriber.

  
Explain to the patient that a medication error has occurred, and
notify the nurse manager.

ou Answered   
Prepare an incident report so that the facility can determine the
cause of the error.

When a medication error occurs, the nurse’s first priority is to make

sure that the patient is okay. If the patient shows any signs of
adverse reaction to the medication error, the doctor/prescriber
should be notified right away. Documentation, filling out the facility
incident report, and explaining the error to the patient can take
place later after the patient’s condition is determined to be stable.

Question 19 1 / 1 pts

The nurse begins a shift on a busy medical-surgical unit. The nurse will be
caring for multiple patients. Which patient will the nurse assess first?

  A patient who has a question about her daily medications

Correct!   A patient who just received nitroglycerin for chest pain

  
A patient who would like some acetaminophen (Tylenol) for a mild
headache
   A patient who needs discharge teaching about an antibiotic

The nurse’s first priority is always: ABCs- Airway, Breathing, and

Circulation. This includes any patients who are having chest pain
and/or difficulty breathing. The nurse needs to see this patient first
to determine if the chest pain has been relieved or not. An
assessment should be done right away to determine if the patient
is now stable or if additional interventions need to be done. The
other patients’ needs are less critical and can be met after this
patient is assessed.

Question 20 1 / 1 pts

The nurse is caring for a patient who is at risk for fluid overload as a result
of a history of congestive heart failure. Which intervention will the nurse
teach the patient to perform at home to monitor fluid balance?

Correct!   “Weigh yourself every morning before breakfast.”

  “Drink plain water rather than soda, coffee, or fruit juice.”

  “Count your heart rate every evening before you go to bed.”

  “Check to make sure that your urine is a bright yellow color.”

Checking the weight every morning before breakfast is a sensitive

indicator of the patient’s fluid volume status. Weight gain of 2 to 3
lb over 1 to 2 days generally indicates fluid retention and should be
reported to the physician.

Question 21 1 / 1 pts

The nurse is caring for a patient who is admitted with a serum sodium
level of 120 mEq/L. Which is the most important intervention for the nurse
 to perform?

  Assess for signs and symptoms of digoxin (Lanoxin) toxicity.

  Administer hypotonic IV solutions as ordered by the physician.

Correct!   
Perform regular neurologic checks and institute seizure
precautions.

  Encourage the patient to eat foods that are high in sodium.

A serum sodium level of 124 mEq/L is dangerously low and may

cause neurologic problems including seizures, confusion, and
weakness. Regular neurologic checks should be performed and
the patient should be placed on seizure precautions until the
sodium level is corrected. Encouraging the patient to eat high-
sodium foods is fine, but it is not as important as the patient’s
safety. A hypotonic saline solution will further lower the patient’s
sodium level. Lanoxin toxicity is seen with hypokalemia rather than
hyponatremia.

Question 22 1 / 1 pts

The nurse is caring for a patient who is prescribed diphenoxylate-atropine

(Lomotil). Which assessment finding by the nurse indicates a need to
contact the prescriber and question the order?

  the patient has bleeding hemorrhoids 

Correct!   the patient is constipated with last BM 3 days ago 

  patient is on a low fiber gluten free diet 

  the patient has skin breakdown in the rectal area 

 Question 23 1 / 1 pts

The nurse is caring for a patient who is taking narcotic pain medication
after surgery. Which breakfast choices will help prevent constipation and
promote return to regular bowel function?

  Pancakes with maple syrup, bacon, and coffee with cream 

  Omelet with cheddar cheese, green pepper, and onions 

Correct!   Raisin bran with skim milk, fresh fruit, and wheat toast 

  Bagel with cream cheese, and strawberry nonfat yogurt 

Question 24 1 / 1 pts

During discharge teaching, the nurse is to give the patient a signed,

dated, and timed prescription from the physician for medications to be
taken at home. Which prescription drug order needs to be corrected
before it is given to the patient?

  Warfarin (Coumadin) 5 mg PO daily before dinner

  Zolpidem (Ambien) 5 mg PO at bedtime as needed for sleep

Correct!   Methotrexate (Trexall) 8 tablets PO once weekly on Saturdays

  Levothyroxine (Synthroid) 137 mcg PO daily before breakfast

All prescriptions must have the name of the drug to be

administered along with dosage, route, and frequency. The
methotrexate order does not contain a dosage for the drug, just the
number of pills to be taken.
 Question 25 1 / 1 pts

The nurse is caring for a patient who is admitted to the hospital with
diabetic ketoacidosis. Which assessment finding indicates an attempt
made by the patient’s body to correct the pH?

  The patient is sleepy and difficult to arouse.

Correct!   The patient’s respirations are very deep and rapid.

  The patient’s urine is dark and concentrated.

  The patient’s skin is pale, cool, and diaphoretic.

The patient with diabetic ketoacidosis is in a state of metabolic

acidosis. The body will attempt to compensate for the acidosis by
blowing off extra amounts of carbon dioxide through deep, rapid
respirations. Since carbon dioxide is converted to carbonic acid,
removal of carbon dioxide will help shift the body’s pH to a less
acidotic state.

Question 26 1 / 1 pts

The nurse is caring for a patient who was brought to the ER after
overdosing on narcotic pain medication. The patient was found
unresponsive with no respirations. Arterial blood gases were drawn
shortly after the patient’s arrival to the hospital. Which results will the
nurse expect to see?

  pH 7.45, PaCO2 38 mm Hg, HCO3 28 mEq/L, PaO2 80 mm Hg

  pH 7.35, PaCO2 45 mm Hg, HCO3 26 mEq/L, PaO2 70 mm Hg

  pH 7.56, PaCO2 32 mm Hg, HCO3 32 mEq/L, PaO2 90 mm Hg

Correct!   pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60 mm Hg

The patient who overdosed on narcotic pain medication will be in
respiratory acidosis as a result of respiratory suppression. Low pH
of 7.27 and elevated PaCO2 are consistent with respiratory
acidosis as insufficient carbon dioxide is removed from the blood.
The low 60 mm Hg PaO2 is due to insufficient oxygen intake.