Medication And I.V. Administration (Part 2)

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1. A nurse is administering two drugs to a client at the same time. The nurse knows the most probable reason for giving the drugs together is:

Explanation

RATIONALE: Synergism, or a synergistic effect, occurs when two drugs with the same qualitative effects produce, when given together, a response greater than either drug produces when given alone. Tolerance is a person's decreased response or decreased sensitivity to a drug. Antagonism occurs when the combined response to two drugs given together is less than the response either drug produces when given alone. Hyporeactivity is a less-than-usual response to a normal drug dose.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 59.

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Medication And I.V. Administration (Part 2) - Quiz

Explore key aspects of medication and IV administration in 'Medication and I. V. Administration (Part 2)'. This quiz assesses understanding of opioid scheduling, medication reconstitution, telephone order accuracy, injection site reactions, drug cross-tolerance, and drug synergism, essential for nursing professionals.

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2. A nurse must verify a client's identity before administering medication. The safest way to verify identity is to:

Explanation

RATIONALE: Checking the client's identification band is the safest way to verify a client's identity because the band is assigned on admission and should not be removed at any time. (If the band is removed, it must be replaced.) Asking the client's name or having the client repeat his name would be appropriate only for a client who's alert, oriented, and able to understand what the nurse is saying, but it isn't the safe standard of practice. Checking the room number isn't appropriate because clients may be transferred from another room and the paperwork may not be correct. Checking the client's name on the bed isn't appropriate because names on beds aren't always correct.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 821.

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3. For a client who takes over-the-counter drugs regularly, the nurse should ascertain:

Explanation

RATIONALE: The nurse should determine whether the client knows dosages and administration schedules for any over-the-counter drugs he takes regularly. The nurse also should determine whether the client knows why he takes each drug and the proper way to administer it. Neither the drug's cost nor its generic classification are as important as these factors unless a problem arises with either of them. Availability of drugs in the hospital isn't a high-priority item unless the client wants to purchase drugs from an outpatient pharmacy.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 559.

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4. A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first?

Explanation

RATIONALE: After discovering a medication error, the nurse should immediately notify only those persons who can do something to rectify the error, such as the prescriber, the nursing supervisor, and the pharmacist.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 811.

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5. A physician orders an infusion of whole blood for a client. When planning the client's care, a nurse should include which intervention?

Explanation

RATIONALE: Because most hemolytic reactions occur during the first 15 minutes of a blood transfusion, the nurse should plan to stay with the client for this length of time. During this time, the nurse should monitor the client's vital signs frequently, in accordance with facility policy. The nurse should start the infusion with normal saline solution only and should use at least a 19G catheter to prevent hemolysis of red blood cells. The nurse shouldn't warm the blood because refrigerating blood until infusion prevents bacterial growth.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1737.

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6. A client is scheduled for surgery at 8 a.m. While completing the preoperative checklist, the nurse sees that the surgical consent form isn't signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation?

Explanation

RATIONALE: Notifying the surgeon takes priority because the physician must obtain informed consent before the client receives drugs that can alter cognition. Giving the preoperative analgesic at the scheduled time would alter the client's ability to give informed consent. Obtaining consent to surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery isn't within the scope of nursing practice.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 133.

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7. The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should:

Explanation

RATIONALE: Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Stirring the medication with a sterile applicator isn't accepted practice. Inverting the vial wouldn't help dissolve the medication. Shaking the vial vigorously could cause the medication to break down, altering its action.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 794.

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8. A client diagnosed with pneumonia refuses his oral antibiotic. The client is alert and oriented, vital signs are within normal range, and crackles are scattered throughout the posterior left lower lobe of his lung. The nurse's most appropriate action would be to:

Explanation

RATIONALE: The nurse should try to address the client's concern by clarifying its purpose. If the client still refuses the medication, the nurse should notify the physician. Because the client is alert and oriented, the nurse may not mix the medication in food without his knowledge. Documenting the client's refusal doesn't address the client's concerns or notify the physician.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Analysis

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 565.

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9. A nurse has an order to administer an I.M. injection using the Z-track technique. When carrying out this order, what should the nurse do?

Explanation

RATIONALE: When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication, and then simultaneously withdraws the needle and releases the skin.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 591.

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10. A nurse has an order to administer iron dextran (INFeD) 50 mg I.M. injection. When carrying out this order, the nurse should:

Explanation

RATIONALE: Iron dextran is an iron preparation given using the Z-track technique to prevent leakage into the subcutaneous tissue and staining of the skin. When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site to seal the drug in the muscle, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication to ensure drug dispersion, then simultaneously withdraws the needle and releases the skin to seal the needle track. Wiping the needle immediately after injection poses the risk of a needle stick.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 814.

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11. After administering an I.M. injection, a nurse should:

Explanation

RATIONALE: The appropriate procedure is to discard uncapped needles in a puncture-proof, leak-proof container. To reduce the risk of accidental needle sticks, the nurse should never recap a needle. She should never place a used needle in a garbage can or in a medical waste container that isn't puncture-proof and leak-proof. She should never break or bend a needle before discarding it. Doing so increases the risk of a needle stick.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 841.

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12. Which safeguard should the nurse take to ensure accuracy of a telephone order?

Explanation

RATIONALE: When taking a telephone order, the nurse should repeat the order to the prescriber to ensure that she clearly understands it. She needn't repeat the order to a nursing supervisor. The nurse may administer the drug before the physician signs the order, but the physician must sign the order within the time period the facility policy dictates. Although it's a good idea to have a second nurse monitor the call, the second nurse doesn't have to be the nursing supervisor.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Knowledge

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 254.

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13. A nurse is working in a clinic where a family member's spouse is treated for a sexually transmitted disease. The nurse is concerned about the risk to her family member. What is the most appropriate action for the nurse to take?

Explanation

RATIONALE: Encouraging the client to talk with his spouse is the nurse's only option. According to the Health Insurance Portability and Accountability Act, a client's diagnosis is confidential information that shouldn't be shared with anyone, including a spouse, without the client's permission. Telling a family member about the diagnosis is a violation of the client's confidentiality. The nurse isn't legally obligated to report the diagnosis to her family member. It isn't appropriate for the nurse to provide information that would allow other agencies to contact the client's spouse.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 256.

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14. A client is receiving furosemide (Lasix), 40 mg by mouth twice per day. In the care plan, the nurse should emphasize teaching the client about the importance of consuming:

Explanation

RATIONALE: Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the client to increase his intake of potassium-rich foods, such as bananas and oranges. Fresh green vegetables, milk, and creamed corn aren't good sources of potassium.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 870.

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15. A physician orders nitroglycerin, 5 mg by mouth twice a day, for a client. The drug is dispensed in 2.5-mg tablets. How many tablets will the nurse administer with each dose?

Explanation

RATIONALE: The nurse will administer two tablets with each dose. Using the ratio method, the equation to solve for X is: 5 mg : X tab :: 2.5 mg : 1 tab. Solving for X determines the quantity of the dosage form (two tablets, in this example).

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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16. A physician writes an order for a client that says: "Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should the nurse transcribe this order onto the medication administration record?

Explanation

RATIONALE: The nurse should always place a zero (0) before a decimal point so that no one misreads the figure, which could result in a dosage error. The nurse should never insert a zero at the end of a dosage that includes a decimal point because this could be misread, possibly leading to a 10-fold increase in the dosage.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 780.

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17. A physician orders a blood transfusion for a client who has a 21G I.V. in place. What should the nurse do?

Explanation

RATIONALE: Because molecules of blood and blood products are larger than molecules of I.V. fluids, the nurse should plan to use a large I.V. access device, such as an 18G or a 19G needle, so blood can flow through it. Using a large-gauge needle also prevents red blood cell hemolysis. There is no indication that the client needs to have a central line placed. If the nurse is unable to place a larger gauge I.V., she should discuss the situation with the physician. She should hang blood only with normal saline solution. Any other solution is incompatible with the blood.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1737.

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18. A nurse is to give a client a 325-mg aspirin suppository. The client has diarrhea and is in the bathroom. The best nursing approach at this time would be to:

Explanation

RATIONALE: Because the client has diarrhea, the nurse should hold the medication and talk with the physician. She should never give a suppository to a client with diarrhea because the client would expel the suppository. Waiting 15 minutes or until the client is finished in the bathroom is inappropriate because the client will most likely have another urge to defecate and will expel the suppository. Substituting the oral form is inappropriate; only the physician can change the administration route of an ordered drug.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 808.

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19. The maximum transfusion time for a unit of packed red blood cells (RBCs) is:

Explanation

RATIONALE: A unit of packed RBCs may be transfused over a period of between 1 and 4 hours. It shouldn't infuse for longer than 4 hours because the risk of contamination and sepsis increases after that time. The nurse should discard any blood not given within this time, or return it to the blood bank, in accordance with facility policy.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1739.

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20. A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child?

Explanation

RATIONALE: Hypokalemia occurs when insulin administration causes glucose and potassium to move into the cells. Insulin administration doesn't directly affect calcium levels. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus enters the cells with insulin and potassium. Insulin administration doesn't directly affect sodium levels.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 384.

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21. A drug must enter the bloodstream before it can act within the body. Which parenteral administration route places a drug directly into the circulation, requiring no absorption?

Explanation

RATIONALE: The I.V. route bypasses absorption barriers and results in an immediate systemic response. The body must absorb drugs that are administered I.M., subQ, or intradermally before the system can respond.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 14.

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22. Which principle should a nurse consider when administering pain medication to a client?

Explanation

RATIONALE: Administering sustained-release oral formulations around the clock provides better relief of chronic pain by keeping blood levels within therapeutic range. Opioid combination drugs and nonopioid medications are most effective in the treatment of mild to moderate pain. I.V. medications usually act within 1 hour of administration. Morphine and hydromorphone are drugs of choice for severe pain.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Analysis

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1394.

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23. If a manual end-of-shift count of controlled substances isn't correct, the nurse's best action is to:

Explanation

RATIONALE: Reporting a noted discrepancy to the nurse-manager, nursing supervisor, and pharmacy should be the nurse's first step. Although the discrepancy may be easily corrected if investigated, the investigation isn't a nurse's responsibility. Documenting the discrepancy on an incident report or opioid-inventory form doesn't address the problem.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Analysis

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 778.

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24. A physician orders a soap suds enema, 500 ml. What does this amount equal in liters?

Explanation

RATIONALE: 500 ml equals 0.5 L.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 55.

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25. The physician orders 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?

Explanation

RATIONALE: The nurse should give the client ½ ml of the drug. The dosage is calculated as follows:
250 mg/X = 500 mg/1 ml
500X = 250
X = ½ ml.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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26. Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment?

Explanation

RATIONALE: The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and interstitial compartments. A hypotonic solution's osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, p. 1432.

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27. A nurse is instructing a client with asthma on the use of an inhaler with a spacer. The client asks what the purpose of the spacer is. The nurse's best response is:

Explanation

RATIONALE: Describing how the spacer works accurately explains the purpose and benefit of an inhaler. Telling the client that the physician has ordered the spacer and instructed the nurse to explain its use doesn't answer the client's question. The nurse isn't correct in saying the client doesn't have to inhale when using a spacer; during administration, the client should inhale deeply and slowly for 3 to 5 seconds. The client doesn't need to ask the physician about the spacer; the nurse should be familiar with its purpose and proper use.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Analysis

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 574.

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28. A client requests his medication at 9 p.m. instead of 10 p.m. so that he can go to sleep earlier. Which type of nursing intervention is required?

Explanation

RATIONALE: Nursing interventions are classified as independent, interdependent, or dependent. Altering the drug schedule to coincide with the client's daily routine represents an independent intervention, whereas consulting with the physician and pharmacist to change a client's medication because of adverse reactions represents an interdependent intervention. Administering an already ordered drug on time is a dependent intervention. There's no such thing as an intradependent nursing intervention.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 315.

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29. A nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation?

Explanation

RATIONALE: When administering several oral medications at the same time, the nurse should tell the client the name of each medication and its action or use before administering it. The client may take the medications all at once or one at a time with any amount of fluid. Leaving medications at the bedside may lead to errors such as the client not taking them. To ensure that the client takes his medication, the nurse should always observe the client taking it.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 821.

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30. What is the best way for a nurse to improve a client's compliance with the ordered medication schedule?

Explanation

RATIONALE: To improve client compliance, the nurse should simplify the medication schedule as much as she can. Compliance drops sharply when more than three medications are ordered; elderly clients tend to use more than one medication concurrently. Hiring a visiting nurse is too costly and impractical in most instances. Although the nurse may need to repeat instructions, giving all instructions at least three times doesn't necessarily ensure compliance. A physician, not the nurse, must decide how often a client should take a medication.

CLIENT NEEDS CATEGORY: Psychosocial integrity
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 791.

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31. A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with her preceptor. Which planned action by the graduate nurse should the preceptor correct?

Explanation

RATIONALE: To prevent injury to others, the graduate nurse should discard the catheter in a sharps-disposal container rather than a trash container. She should measure the length of the catheter to ensure that the entire catheter has been removed. Flushing the line ensures that there are no problems with the line. Applying a dressing and leaving it in place for 24 hours helps ensure hemostasis.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 627.

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32. A nurse is working on an oncology unit that uses a computerized medication access system to minimize medication errors. Which action is the best way for her to identify a client before administering medication?

Explanation

RATIONALE: The best way to assess a client's identity is by comparing his identification bracelet with the medication record. Although asking the client to state his name is a way to identify an alert client, a confused client may not give the correct name. It isn't appropriate for the nurse to state the client's name because a client who is hard of hearing may respond affirmatively to avoid embarrassment. A client's roommate isn't a reliable source of information.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 564.

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33. A client with a deficient fluid volume is receiving an I.V. infusion of dextrose 5% in water and lactated Ringer's solution at 125 ml/hour. Which assessment finding indicates the need for additional I.V. fluids?

Explanation

RATIONALE: Normally, urine appears light yellow; dark amber urine is concentrated and suggests decreased fluid intake. The serum sodium level normally ranges from 135 to 145 mEq/L. A temperature of 99.6° F (37.6° C) is only slightly elevated and doesn't indicate a fluid volume deficit. Neck vein distention is a sign of fluid volume overload, not deficient fluid volume.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 931.

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34. What is the most common cause of medication errors among noninstitutionalized elderly clients?

Explanation

RATIONALE: Deficient knowledge is the most common cause of medication errors among noninstitutionalized elderly clients. Poor vision, dementia, and confusion can contribute to medication errors in this group, but they're less common causes of medication errors.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 772.

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35. During gentamicin therapy, the nurse should monitor a client's:

Explanation

RATIONALE: During gentamicin therapy, the nurse should monitor a client's serum creatine level because the most notable adverse reactions to aminoglycoside therapy are nephrotoxicity and ototoxicity. The drug doesn't appear to affect serum potassium or glucose levels or PTT.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 698.

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36. What is the main advantage of using a floor stock system?

Explanation

RATIONALE: A floor stock system enables a nurse to implement medication orders quickly. It doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 781.

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37. A nurse is administering sublingual nitroglycerin (Nitrostat) to a client. Immediately after administering nitroglycerin, the nurse should expect to administer:

Explanation

RATIONALE: In the early stages of therapy, nitoglycerin commonly causes headache and dizziness. Acetaminophen usually helps decrease nitroglycerin-induced headaches. Although the client may be anxious, lorazepam usually isn't given after nitroglycerin. There is no indication that the client would need insulin or prednisone.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 751.

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38. A nurse is teaching a client how to administer subcutaneous (subQ) insulin injections. Which injection site should the client use?

Explanation

RATIONALE: SubQ injection sites, which are relatively distant from bones and major blood vessels, include the lateral aspects of the upper arm, the anterior aspects of the thigh, and the abdomen. The deltoid, rectus femoris, and vastus lateralis are I.M. injection sites.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 32.

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39. A nurse notes that a client's I.V. insertion site is red, swollen, and warm to the touch. Which action should the nurse take first?

Explanation

RATIONALE: Because redness, swelling, and warmth at an I.V. site are signs of infection, the nurse should discontinue the infusion immediately and restart it at another site. After doing this, the nurse should apply warmth to the original site. Checking infusion patency isn't warranted because assessment findings suggest infection and inflammation, not infiltration. Heat, not cold, is the appropriate treatment for inflammation.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 626.

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40. Which moral principle is a nurse applying when she decides what is best for a client and acting without consulting the individual?

Explanation

RATIONALE: Nurses and other health care workers employ paternalism when a client's loss of consciousness or other circumstances compel them to decide what is best for the client and to act without consulting the individual. Beneficence means that nurses should act in the client's interests always. Fidelity requires the nurse to be faithful and truthful and to keep promises to clients, families, coworkers, and employers. Autonomy refers to every individual's right to make rational decisions about his life. The nurse's belief in autonomy leads to a respect for the client's decisions.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 111.

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41. A physician orders the following preoperative medications to be administered to a client by the I.M. route: meperidine (Demerol), 50 mg; hydroxyzine pamoate (Vistaril), 25 mg; and glycopyrrolate (Robinul), 0.3 mg. The medications are dispensed as follows: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer?

Explanation

RATIONALE: Using the proportion method, the nurse solves for X in the following equations and then adds the total number of milliliters together, as shown:
1 ml/100 mg = X ml/50 mg
X = 0.5 ml of meperidine
2 ml/100 mg = X ml/25 mg
X = 0.5 ml of hydroxyzine pamoate
1 ml/0.2 mg = X ml/0.3 mg
X = 1.5 ml of glycopyrrolate
0.5 ml + 0.5 ml + 1.5 ml = 2.5 ml of all preoperative medications.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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42. A physician orders heparin, 7,500 units, to be administered subcutaneously every 12 hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much heparin for each dose?

Explanation

RATIONALE: The nurse solves the problem as follows:
10,000 units/7,500 units = 1 ml/X
10,000X = 7,500
X = 7,500/10,000 or ¾ ml.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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43. A client is to receive a glycerin suppository. Which nursing action is appropriate when administering a suppository?

Explanation

RATIONALE: A suppository must be lubricated before insertion. Because suppositories melt at body temperature, they usually require refrigeration until administration. It isn't appropriate to dissolve a suppository in warm water. It should remain in a solid state. Instructing the client to bear down would cause the anal sphincter to contract, making insertion difficult.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 48.

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44. When developing a teaching plan for a client taking hormonal contraceptives, a nurse should ensure that the client knows she must have which vital sign monitored regularly?

Explanation

RATIONALE: The incidence of hypertension is three to six times greater in clients using hormonal contraceptives than in women who don't use these drugs. Age and duration of the drug's use increase this incidence. Hormonal contraceptives don't directly affect pulse, respirations, or temperature.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 598.

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45. If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first?

Explanation

RATIONALE: If a central venous catheter becomes disconnected, the nurse should immediately apply a catheter clamp. If a clamp isn't available, the nurse may place a sterile syringe or catheter plug in the catheter hub. After cleaning the hub with alcohol or povidone-iodine solution, the nurse must replace the I.V. extension set and restart the infusion. Calling the physician, applying a dry sterile dressing to the site, and telling the client to take a deep breath aren't appropriate interventions at this time.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., and Bare, B. Brunner & Suddarth's Textbook of Medical Surgical-Nursing, 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1197.

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46. After receiving an I.M. injection, a client complains of burning pain at the injection site. Which nursing action would be most appropriate at this time?

Explanation

RATIONALE: Applying heat increases blood flow to the area, which, in turn, increases medication absorption. Cold decreases pain but allows the medication to remain in the muscle longer. Massage is a good intervention, but applying a warm compress is better. Tightening the gluteal muscles may cause additional burning if the drug irritates muscular tissues.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1222.

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47. The label of a drug package reads "meperidine hydrochloride (Demerol), 50 mg/ml." How many milliliters should a nurse give a client for a 30-mg dose?

Explanation

RATIONALE: A measure of 0.6 ml equals 30 mg when the ratio is 50 mg/ml. The ratio to determine this answer is 30 mg : X ml :: 50 mg : 1 ml.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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48. Cross-tolerance to a drug is defined as:

Explanation

RATIONALE: Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a class of drugs. A drug's ability to increase the potency of another drug describes potentiating effects.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1200.

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49. A nurse is caring for a client receiving lidocaine (Xylocaine) I.V. Which factor is most relevant to administration of this medication?

Explanation

RATIONALE: Physicians sometimes use lidocaine drips to treat clients whose arrhythmias haven't been controlled with oral medication and whose runs of ventricular tachycardia are visible on the cardiac monitor. SaO2, blood pressure, and ICP are important factors but aren't as significant as ventricular tachycardia in this situation.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 733.

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50. A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?

Explanation

RATIONALE: Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., and Bare, B. Brunner & Suddarth's Textbook of Medical Surgical-Nursing, 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 324.

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51. A nurse may delegate adding medications to I.V. fluid containers to a:

Explanation

RATIONALE: A nurse should delegate the task of adding medications to primary fluid containers to a pharmacist. Other assistive personnel aren't qualified to perform this task.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 161.

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52. When preparing to give a client an ordered drug, a nurse realizes that the drug is one she has never administered before. No drug references on the nursing unit contain information about the drug in question. What should the nurse do?

Explanation

RATIONALE: When print resources aren't available, pharmacists are the best resources for drug information, which they can provide quickly and reliably. Pharmacists have more up-to-date and accurate drug information than physicians or other nurses do. The nurse should refuse to give a drug only if she can't find any information about it.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 548.

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53. Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration?

Explanation

RATIONALE: Although not harmful to the client when injected, small air bubbles can actually change the dose of medication administered; therefore, the nurse should remove the air bubbles. Small air bubbles won't affect the drug's onset of action, duration, or absorption. Air bubbles may be helpful in some situations but should be added only after the dose of the drug has been withdrawn accurately. For example, with iron dextran, an air bubble and the Z-track method of injection help prevent permanent staining of the client's skin if the solution leaks into the subcutaneous tissue.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 829.

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54. A client is admitted to the emergency department after intentionally taking an overdose of amitriptyline (Elavil). A nurse knows that giving the client activated charcoal will:

Explanation

RATIONALE: Activated charcoal binds with the drug so that the body doesn't absorb it. Giving a client activated charcoal won't promote vomiting or stimulate bowel motility, and it doesn't neutralize the drug.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 382.

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55. Why would a nurse be interested in a client's dietary history when administering drugs?

Explanation

RATIONALE: Dietary intake can alter the effectiveness of some drugs; for example, dairy products bind certain antibiotics and make them ineffective. A vegetarian diet doesn't cause more adverse drug reactions than a diet containing meat. Although excessive calorie consumption may alter a drug's distribution, caloric intake doesn't affect a drug's metabolism. Dietary intake, including sodium, doesn't affect the half-life of any drug.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 112.

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56. A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use?

Explanation

RATIONALE: The nurse should evaluate the muscle mass and amount of subcutaneous fat and then select the correct needle size. Without more information, the nurse would select the 22G, 1″ needle, appropriate for an average-size school-age child. The 20G, 1″ needle would be unnecessarily large. The 22G, 1½″ needle would be too long. The 20G, 1½″ needle would be too long and unnecessarily large.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 100.

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57. A nurse is preparing to administer digoxin (Lanoxin) elixir to a client. Which principle regarding this medication is correct?

Explanation

RATIONALE: The adult therapeutic level for digoxin is 0.5 to 2 mg/ml. This narrow therapeutic range makes digoxin toxicity likely, so the nurse must measure liquid preparations with calibrated droppers or syringes. Digoxin toxicity commonly causes life-threatening cardiac arrhythmias. The nurse should hold digoxin for heart rates below 60 beats/minute.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 673.

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58. The physician orders morphine, 4 mg I.V. every hour, as needed to relieve a client's pain. The nurse knows that morphine belongs to which schedule of opioids?

Explanation

RATIONALE: Morphine is a Schedule II opioid with a high potential for abuse and possible severe psychological and physical dependence. Schedule I drugs such as heroin aren't accepted for medical use. Schedule III drugs such as paregoric have lower abuse potential. Schedule IV drugs such as chloral hydrate (Noctec) have even less potential for abuse.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 6.

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59. Which drug delivery system most effectively reduces the likelihood of medication errors?

Explanation

RATIONALE: An automated drug delivery system most effectively reduces the likelihood of medication errors by automatically dispensing the drug. Medication errors can still occur with this method but are less likely than with floor stock, unit-dose, and individual prescription methods.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 549.

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60. After having a total hip replacement, a client receives morphine sulfate (Duramorph) by patient-controlled analgesia (PCA) pump. The client says, "This pump doesn't help my pain at all." What should the nurse do in response to this statement?

Explanation

RATIONALE: The nurse should assess the client's understanding of the PCA pump because the client may not correctly understand how to use it. If the client can be taught how to properly use the PCA, other measures may not be necessay. The nurse needs to assess the situation further before notifying the physician. Pressing the dose delivery button can help alleviate the client's pain, but it won't ultimately help if the client doesn't know how to use the pump independently for pain control. Pushing the "Flush" button on the PCA pump will give the client a bolus of the opioid and isn't an appropriate method of assessing the I.V. line's patency.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 407.

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61. A physician orders an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, a client should receive how many milliliters of I.V. fluid per hour?

Explanation

RATIONALE: First, the nurse determines how many milliliters (half of the total) to administer over the first 10 hours: 2,400 ml ÷ 2 = 1,200 ml. Then she determines how many of these milliliters to deliver per hour: 1,200 ml ÷ 10 hours = 120 ml/hour.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56.

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62. An emergency department nurse is caring for a child diagnosed with croup. The nebulizer treatment of choice for a child with croup is:

Explanation

RATIONALE: Racemic epinephrine is an adrenergic that reduces inflammation and edema of the tissue surrounding the trachea in a client with croup. Albuterol, metaproterenol, and other beta2-adrenergic drugs are used to treat asthma. Ipratropium is an anticholinergic used to treat severe asthma.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 262.

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63. What is one disadvantage of using the rectal route?

Explanation

RATIONALE: Incomplete drug absorption is a disadvantage of rectal drug administration. The drug itself, not the way in which it is administered, may cause orthostatic hypotension or hypersensitivity reactions. If inserted properly, drugs administered rectally won't cause rectal tears.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 807.

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64. A nurse is preparing to discharge a child who has rheumatic fever. Which medication will the physician order to prevent recurrence of rheumatic fever?

Explanation

RATIONALE: A child with rheumatic fever is at risk for a recurrence, especially if carditis complicates the condition. He will need long-term antibiotic therapy into adulthood, maybe even for life. A physician may order digoxin to treat heart failure but digoxin doesn't prevent recurrence of rheumatic fever. Corticosteroids and anti-inflammatory medications reduce inflammation in rheumatic fever but won't prevent a recurrence.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Comprehension

REFERENCE: Hatfield, N. Broadribb's Introductory Pediatric Nursing, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003, p. 381.

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65. A nurse administering medications is unfamiliar with ropinirole (Requip), the medication ordered for a client with Parkinson's disease. Which action should the nurse perform first?

Explanation

RATIONALE: A nurse must be knowledgeable about a medication before she administers it to a client. A reliable nursing drug handbook will include information about the drug's expected action, usual dosage, adverse effects, and nursing considerations. The client's medication-administration record won't include this information. Because nurses are responsible for their own actions, it isn't necessary to consult a pharmacist or another nurse if the medication is listed in a reliable nursing drug handbook.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R., and Hirnle, C. Fundamentals of Nursing: Human Health and Function, 5th ed. Lippincott Williams & Wilkins, 2007, p. 563.

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66. A physician orders codeine, ½ grain every 4 hours, for a client experiencing pain. How many milligrams of codeine should the nurse administer?

Explanation

RATIONALE: The nurse should administer 30 mg of codeine. The dosage is calculated as follows:
1 gr/0.5 grain = 60 mg/X
X = 60 × 0.5 = 30 mg.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 56

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67. A nurse must monitor a client receiving chloramphenicol (Chloromycetin) for adverse drug reactions. What is a toxic reaction to chloramphenicol?

Explanation

RATIONALE: The most toxic reaction to chloramphenicol is bone marrow suppression. Chloramphenicol isn't known to cause lethal arrhythmias, malignant hypertension, or status epilepticus.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 718.

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68. Which statement about concurrent administration of ticarcillin (Ticar) and gentamicin (Garamycin) is correct?

Explanation

RATIONALE: High doses of extended-spectrum penicillins such as ticarcillin inactivate aminoglycosides. This interaction is clinically relevant in clients with poor renal function because elevated blood concentrations of both agents may exist simultaneously. Doses of both agents should be separated by at least 1 hour. Penicillins shouldn't be mixed in the same I.V. fluid with aminoglycosides.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 697.

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69. A client who has severe thermal burns and is on mechanical ventilation becomes delusional and attempts to extubate himself. The nurse gives him propofol (Diprivan), a sedative. As a result, it's most important that the client receive a supplementation of:

Explanation

RATIONALE: Propofol causes urinary zinc losses. Clients with burns are particularly susceptible to zinc deficiency; therefore, this client may need zinc supplementation. Burn clients are prone to electrolyte imbalances, including elevated or depressed sodium and potassium levels; however, these aren't specifically related to propofol therapy. The client may need magnesium supplementation, but not as a result of propofol therapy.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 195.

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70. What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking his beta-adrenergic blocker?

Explanation

RATIONALE: Abrupt withdrawal of a beta-adrenergic blocker results in rebound cardiac excitation, which causes ventricular arrhythmias and an irregular pulse. Abnormally low blood pressure would be unlikely because beta-adrenergic blockers are used to treat hypertension. Abrupt withdrawal of this medication wouldn't directly affect a client's respiratory rate.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 467.

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71. A client comes to the emergency department complaining of a fast and irregular heartbeat. After examining the client, a physician gives a verbal order for digoxin (Lanoxin), 1 mg I.V. in four divided doses over the next 24 hours, with the first dose administered stat. How should the nurse respond to this order?

Explanation

RATIONALE: In urgent situations, such as the one described here, the nurse should write and sign a verbal order as dictated by the prescriber and then repeat the order aloud for the prescriber's verification. She should ask the prescriber to spell the drug name if necessary. Although verbally repeating the order for verification is appropriate, the nurse must write the order to prevent errors. In an urgent situation, insisting that the physician write the order would take valuable time away from crucial interventions and client evaluation. Refusing to carry out the order would be appropriate only if the nurse felt the order was unsafe.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 254.

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72. A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?

Explanation

RATIONALE: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., and Bare, B. Brunner & Suddarth's Textbook of Medical Surgical-Nursing, 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1414.

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73. Which signs and symptoms might a nurse observe in a client having an adverse reaction to a loop diuretic? Select all that apply.

Explanation

RATIONALE: Signs and symptoms of an adverse reaction to a loop diuretic include weakness, irregular pulse, hyperactive (not hypoactive) bowel sounds, decreased muscle tone, hypokalemia (indicated by a potassium level below 3.5 mEq/L), and ventricular arrhythmias. Bowel sounds are hypoactive rather than hyperactive.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 791.

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74. In a client with a urine specific gravity of 1.040, a subnormal serum osmolality, and a serum sodium level of 128 mEq/L, the nurse should question an order for which I.V. fluid?

Explanation

RATIONALE: An elevated urine specific gravity, a subnormal serum osmolality, and a subnormal serum sodium level indicate that the client is excreting too many solutes. Because the client is in a hypotonic state, the nurse shouldn't give him a hypotonic I.V. solution. D5W, also referred to as free water, is hypotonic when given I.V. and can further hemodilute the client. Dextrose 5% in half-normal saline solution is hypertonic, normal saline solution is isotonic, and lactated Ringer's solution is isotonic. For this client, each of these three choices are more acceptable than D5W.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1705.

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75. To determine the I.V. drip rate, a nurse must know the drip factor, which is:

Explanation

RATIONALE: The drip factor is the number of drops in one milliliter, not the number of milliliters in one drop. The drip rate refers to the number of drops infused per minute. The flow rate is the number of milliliters, not the number of drops, infused per hour.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 42.

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76. A physician orders an I.M. injection for a client. Which factor at the I.M. injection site may affect the absorption rate of a drug?

Explanation

RATIONALE: Blood flow to the I.M. injection site affects the drug absorption rate. Muscle tone and strength have no effect on drug absorption. The amount of body fat at the injection site may help determine the size of needle and the technique the nurse uses to localize the site; however, it doesn't affect drug absorption (unless the nurse inadvertently injects the medication into the subcutaneous tissue instead of the muscle).

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 798.

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77. A client comes to the emergency department after taking an overdose of amitriptyline (Elavil). Immediate care for this client should include:

Explanation

RATIONALE: After administering appropriate stomach lavage, the nurse should give the client activated charcoal every 4 hours for 24 hours. The charcoal binds with amitriptyline and inactivates it. The nurse shouldn't induce vomiting because the client's mental status may rapidly deteriorate and pose the risk of aspiration. Large boluses of enteral saline can force the drug into the small intestine, where it will be absorbed. The nurse should use a large tube for gastric lavage so she can remove intact pills.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 382.

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78. After reconstituting a multidose vial of medication, a nurse writes the date and time of reconstitution on the vial label. What else should the nurse write on the label?

Explanation

RATIONALE: After reconstituting a medication, the nurse should label any unused medication with the strength of the medication and her initials or signature, as well as the date and time of reconstitution. The expiration date on the order is usually written on the medication record. She should write the administration route and prescriber's name on the order sheet, not on the label.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 784.

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79. A client is to be discharged with a prescription for an analgesic that is a controlled substance. During discharge teaching, the nurse should explain that the client must fill this prescription how soon after the date on which the physician wrote it?

Explanation

RATIONALE: In most cases, an outpatient must fill a prescription for a controlled substance within 6 months of the prescription date.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 555.

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80. A physician orders activated charcoal for a client admitted to the emergency department after intentionally taking an overdose of hydrocodone (Vicodin). Before administering the drug, a nurse should ensure that the client:

Explanation

RATIONALE: Because activated charcoal binds to the ingested drug and is eliminated in the stool, the client should have audible bowel sounds before the nurse administers the drug. He needn't be able to follow commands and may not be fully responsive. An NG tube should be in place but isn't necessary because the client can drink the activated charcoal. This treatment doesn't require an advance directive.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 382.

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81. A nurse is developing a drug therapy regimen that won't interfere with a client's lifestyle. When doing this, the nurse must consider the drug's:

Explanation

RATIONALE: When developing a drug therapy regimen that won't interfere with a client's lifestyle, the nurse must consider the drug's adverse effects because these may result in noncompliance. A drug's excretion route, peak concentration time, and steady-state duration of action are important considerations when developing a drug therapy regimen; however, they're related to the drug's physiologic effects and don't affect the client's lifestyle.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology, 4th ed. Philadelphia: Lippincott Williams Wilkins, 2008, p. 34.

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82. A client is scheduled for an excretory urography at 10 a.m. An order directs the nurse to insert a saline lock I.V. device at 9:30 a.m.. The client requests a local anesthetic for the I.V. procedure and the physician orders lidocaine-prilocaine cream (EMLA cream). The nurse should apply the cream at:

Explanation

RATIONALE: It takes up to 2 hours for lidocaine-prilocaine cream (EMLA cream) to anesthetize an insertion site. Therefore, if the insertion is scheduled for 9:30 a.m., EMLA cream should be applied at 7:30 a.m. The local anesthetic wouldn't be effective if the nurse administered it at the later times.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Abrams, A.C., et al. Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed. Lippincott Williams & Wilkins, 2007, p. 1099.

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83. A nurse is caring for a client with a central venous catheter. Which assessment finding would indicate possible systemic infection?

Explanation

RATIONALE: Signs and symptoms of systemic infection may include central nervous system involvement, such as tachypnea, dizziness, and lethargy. Fever and the infectious process associated with systemic infection would most likely cause tachycardia rather than bradycardia.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 706.

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84. To prepare for insulin administration, the nurse disinfects the injection site. Before giving the injection, the nurse should allow the disinfected area to dry for:

Explanation

RATIONALE: Before administering an injection, the nurse should allow the disinfected area to dry for about 1 minute. Doing so prevents introducing the potentially irritating disinfectant into the client's tissues.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 585.

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85. A nurse is caring for a client who complains of a migraine. Which route is best for the nurse administering the client's migraine medication?

Explanation

RATIONALE: The nurse would want the client to receive the benefit of the medication as quickly a possible to help alleviate the migraine. A drug dissolved in the mouth enters the client's bloodstream more quickly than oral, I.M., or subQ forms, thereby avoiding the barriers of food and the destructive effects of stomach acid. With oral, I.M., or subQ administration, the client's response to the drug is slower.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Aschenbrenner, D.S., and Venable, S.J. Drug Therapy in Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 29.

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