NCLEX Practice Questions — Set 21
How to use this set
Run it as a timed block rather than dipping in and out. 100 items at roughly a minute each is close to the pace the real exam asks for, and pacing is a skill that only improves under a clock. Answer every item before you open a single rationale — checking as you go turns a test into a reading exercise and hides the questions you were unsure about.
These sets are numbered rather than sorted by subject. The questions come from a general NCLEX bank that carries no topic field, and labelling them by eye would put a share of them under the wrong heading, so they are presented as mixed sets — which is how the exam itself arrives.
The 100 questions
Which of the following should the nurse include when teaching a client about an upcoming outpatient surgery?
Show answer and rationale
Correct answer: B. Postoperative nursing interventions
Preoperative teaching involves educating the client about anticipated postoperative nursing interventions, including turning, coughing, deep breathing, and leg exercises. Risks of complications, proposed surgical procedures, and anesthetic choices are primarily discussed with the client by the surgical and anesthetic team.
In reviewing the chart of a client about to undergo general anesthesia, which of the following is the greatest risk factor? The client who
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Correct answer: D. ate a snack within the last three hours.
Aspiration poses a risk during general anesthesia. Clients are instructed not to eat or drink anything prior to general anesthesia in order to reduce the risk of aspiration. Although cigarette smoking and controlled hypertension may increase risks of complications postoperatively, aspiration poses a more significant risk in this situation. Anxiety does not pose a risk factor for general anesthesia
Which of the following is a priority in the nursing assessment of a client preoperatively?
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Correct answer: D. Verification of client identification
Prior to completing any assessment of a client preoperatively, it is imperative to correctly verify the client’s identity. After verification of client identity, the nursing assessment can continue; this would include assessing the client’s allergies, nutritional status, and neurological status.
The nurse is obtaining a nursing history from a client suspected to be at risk for malignant hyperthermia. Which of the following should the nurse assess first to elicit the most accurate risk assessment?
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Correct answer: A. Previous history of complications associated with surgery
An integral part of the preoperative nursing assessment is the determination of previous complications associated with surgery. Drug allergies, over-the-counter medication usage, and a history of unexplained fevers are not associated with malignant hyperthermia. Malignant hyperthermia is a potentially life-threatening syndrome characterized by a hypermetabolic state caused by certain anesthetic agents, such as succinylcholine.
The nurse is concerned about a client’s risk for impaired gas exchange related to ineffective airway clearance. Which of the following would be a priority assessment?
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Correct answer: B. Decreased air movement
Decreased air movement may indicate a significant respiratory compromise. Assessing the client’s ability to move air is a priority nursing assessment. The number of respirations per minute, number of liters of oxygen inspired, and capillary refill are important assessment data, but are not priority assessments.
The nurse is caring for a postoperative client who has received a general anesthetic. Which of the following observations is the priority to be immediately reported?
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Correct answer: B. Rising body temperature
A rising body temperature can indicate malignant hyperthermia, a rare but lifethreatening complication of general anesthesia. Complaints of nausea, mild hypertension, and decreased urine output would need to be conveyed to the anesthesia or surgical team, but are not emergent complaints.
The nurse is caring for a client who is perioperative. Which of the following is a priority nursing intervention utilized to prevent infection in this client?
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Correct answer: A. Preparation of the skin overlying the surgical site
Preparation of the skin is a priority nursing intervention utilized to prevent infection. Maintenance of hemodynamic status, temperature, and estimated blood loss do not impact on a client’s risk for infection.
When caring for a client receiving conscious sedation, which of the following should the perioperative nurse routinely monitor?
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Correct answer: A. Level of consciousness
Level of consciousness is routinely monitored in the provision of conscious sedation. Temperature and urine output are monitored in the postoperative phase. Dermatome level is monitored postoperatively after the provision of regional anesthesia.
Which of the following should the perioperative nurse monitor when evaluating the presence of ineffective thermoregulation in a client?
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Correct answer: B. Temperature
Body temperature is the primary method of assessment utilized by nurses to determine the client’s thermoregulation. Cardiac rhythm, blood pressure, and oxygen saturation levels are all monitored, but give little indication of the client’s risk for altered body temperature.
Which of the following is the priority nursing intervention that the nurse should perform for a client in the postoperative period after surgery?
Show answer and rationale
Correct answer: A. Establish a patent airway
The first priority in caring for a client in the postoperative period is the establishment of a patent airway. Maintenance of hemodynamic stability, determination of level of consciousness, and assessment of pain are all important aspects in postoperative care, but are not the priorities.
The nurse is caring for a client postoperatively. Which of the following would indicate that the client has a compromised airway? The client
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Correct answer: D. complains of anxiety.
Hypoxemia is often associated with complaints of anxiety. A complaint of pain is a common postoperative complaint but is not associated with airway compromise. Normal pulse oximetry levels are above 90%. The assessment finding of coolness and clamminess is a nonspecific assessment finding that may indicate a wide variety of problems.
The nurse is caring for a client who developed a compromised airway. Which of the following interventions is the priority to perform first?
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Correct answer: D. Open the airway with a chin lift or jaw thrust
The initial priority nursing intervention for a client experiencing a compromised airway is the reestablishment of the airway. The client may need to be repositioned but often to a Fowler’s or lateral position. The client may need to be reintubated and the surgeon should be notified, but these are not the priority interventions.
The nurse is caring for a client in the immediate postoperative period. Which of the following would indicate that the client is becoming hypovolemic?
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Correct answer: C. Blood loss of 500 ml
Blood loss and resulting low fluid volume may result in hypovolemia in the postoperative period. Anxiety and pain may cause hypertension in the perioperative client, but would not cause hypovolemia. An elevated diastolic blood pressure is not indicative of hypovolemia.
The nurse is caring for a client postoperatively who develops sinus tachycardia. Which of the following interventions should the nurse perform?
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Correct answer: A. Manage the client’s anxiety
Treatment of sinus tachycardia involves treating the underlying cause. Sinus tachycardia is a common dysrhythmia often caused by anxiety. Atropine is a drug commonly used to treat sinus bradycardia. Applying warmed blankets and positioning a client in the left lateral position would not be performed for sinus tachycardia.
The nurse is caring for a client postoperatively who has become hypothermic. The nurse’s best action would be to
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Correct answer: D. remove clothing saturated with blood.
The nurse removes clothing saturated with blood and reapplies clean and dry clothing in order to maintain a client’s body temperature. Repositioning a client, medicating a client for pain, or monitoring intake and output do not treat a client’s low body temperature.
A client is experiencing confusion in the immediate postoperative period. Which of the following assessments is essential to determine the reason for the confusion?
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Correct answer: B. Airway status
The nurse must first rule out hypoxemia as being the cause of a client’s confusion. A client with an impaired airway may be experiencing confusion due to hypoxemia. Cardiac rhythm, level of consciousness, and anxiety are all important assessments in the postoperative period, but are not the initial assessment in a client presenting with confusion.
The nurse admits a client scheduled for surgery. Which of the following findings should the nurse report as a risk factor for aspiration?
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Correct answer: C. Obesity
Obesity increases a client’s risk for aspiration due to increased pressure of abdominal contents on the lower esophageal sphincter. Cigarette smoking, an elevated serum sodium level, or a history of sleep apnea do not increase the risk of aspiration.
Which of the following is a priority in the plan of care for a client who has had abdominal surgery and complains of pain in the immediate postoperative period?
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Correct answer: B. Ask the client to describe the pain
A priority assessment for a client’s pain includes a description of the severity and nature of the pain as experienced by the client. Monitoring blood pressure, repositioning of the client, and teaching the client to splint the abdomen are all important postoperative nursing interventions, but are not priority interventions in the management of the client’s postoperative pain.
A 16-year-old client has a medical history of anorexia nervosa. The nurse is preparing the client for abdominal surgery. The nurse is most concerned about the client’s risk for
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Correct answer: C. infection.
Clients who have experienced anorexia nervosa are at risk for malnutrition and lowered immune function, and may experience an increased risk of infection and tissue healing. A history of anorexia nervosa does not pose a greater-than-average risk for aspiration, hypovolemia, or altered tissue perfusion.
A client is scheduled for an operative procedure to rule out cancer. When the nurse assesses the client, the nurse observes tears in the client’s eyes. Which of the following would be the most therapeutic nursing intervention?
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Correct answer: B. Ask the client to describe his or her feelings
Assessing what the client is actually experiencing will assist the nurse in selecting the most appropriate nursing intervention. Supporting and advocating for the client are nursing responsibilities. The surgeon may be contacted if the client has specific concerns, but would not be contacted prior to an initial assessment. Medicating the client with a preoperative analgesic would be inappropriate without first addressing the client’s concerns or questions.
A client is admitted for emergency surgery for a bowel obstruction. The perioperative nurse understands that the client is at greatest risk during the perioperative period for
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Correct answer: B. aspiration.
Clients who have bowel obstructions are at increased risk of aspiration because the intestinal contents can be vomited and aspirated during induction of anesthesia. Clients who have bowel obstructions are references Daniels, R., & Nicoll, L. (2012). Contemporary medicalsurgical nursing. Clifton Park, NY: Delmar Cengage Learning. DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standard and practice (4th ed.). Clifton Park, NY: Delmar Cengage Learning. Spratto, G. R., & Woods, A. L. (2012). PDR nurse’s drug handbook 2012. Clifton Park, NY: Delmar Cengage Learning. not at an increased risk during the perioperative period for infection or airway obstruction. Fluid shifts may occur in the client with a bowel obstruction, but aspiration presents a greater risk for the client.
A client has a PCA (patient-controlled analgesia) machine ordered to manage postoperative pain. The PACU (postanesthesia care unit) nurse determines that the best time to initiate the PCA machine is
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Correct answer: A. when the client arrives at the PACU.
PCA (patient-controlled analgesia) is an effective mechanism for the management of client pain. It is initiated upon arrival to the postanesthesia care unit (PACU) and client education is reinforced during the client’s stay in the PACU. A delay in initiation of the PCA device may cause an increase in client pain.
The registered nurse is preparing the clinical assignments for the day. Which of the following may the nurse delegate to a licensed practical nurse?
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Correct answer: D. Administer the preoperative intramuscular medication
A licensed practical nurse may administer a preoperative intramuscular medication to a client scheduled for surgery. Informing a client scheduled for surgery on the surgical procedure and instructing a client scheduled for surgery on the preoperative preparation are job tasks reserved for the registered nurse. A licensed practical nurse may not obtain an informed consent because the surgeon must inform the client about the surgical procedure and obtain the informed consent.
The nurse is preparing to administer insulin to a client with diabetes mellitus for which of the following purposes?
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Correct answer: A. Health maintenance
Health maintenance drugs, such as insulin, vitamins, and minerals, are used to keep the body healthy. Relief of disease manifestations, such as with antihistamines, is the most common use of drugs used in treatment. Preventive drugs, such as a hepatitis vaccine, are used to prevent disease. Curative drugs, such as antibiotics, are used to cure disease.
Which of the following should the nurse include in the oral drug administration procedure?
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Correct answer: C. Administer a carbonated beverage over ice following a drug
Pouring a carbonated beverage over ice and administering it after a drug will decrease nausea. Drugs should be administered in liquid form to children under the age of�5�years. Administering one drug at a time is recommended for an older adult client because of a possibility of impaired swallowing. A buccal drug is a drug to be placed inside the mouth or cheek.
Which of the following should the nurse include when administering drugs by a nasogastric tube?
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Correct answer: B. Administer one drug with 30 ml of water
One drug should be administered at a time through a nasogastric tube, but it is better to avoid administering drugs through a feeding tube because the lumen is much smaller than a nasogastric tube. Administer each drug with 5 to 30 ml of water and flush with 5 to 30 ml of water between drugs. The client should be placed in an upright position for at least 30 minutes following drug administration.
Which of the following principles of parenteral drug administration is a priority for the nurse to consider before administering a parenteral injection to a 2-year-old child?
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Correct answer: D. Select the vastus lateralis for the administration of the drug
The priority of any intramuscular injection is the selection of the appropriate site. The vastus lateralis is the preferred site of drug administration in children under the age of 3. EMLA (lidocaine 2.5% and prilocaine 2.5%) may be applied to an intramuscular injection site one to two hours before administering an injection to a child, but the priority is site selection. Tapping the injection site before administering an injection to a child is helpful because it distracts the child (who then focuses on the tap and not the injection). No more than 1 ml should be administered to a child.
The nurse selects which of the following isotonic intravenous solutions for the primary purpose of promoting rehydration and elimination, while providing a good vehicle for potassium replacement?
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Correct answer: B. Dextrose 5% in water
Dextrose 5% in water is an isotonic intravenous solution with the primary purpose of promoting rehydration and elimination, while providing a good vehicle for potassium replacement. Sodium chloride 0.45% is a hypotonic solution that moves fluids into the cells. It is used to provide daily maintenance of body fluid and establishment of renal function. The client should be monitored for water intoxication. Dextrose 5% in 0.45% saline is a hypertonic solution that draws fluids from the cells. The client should be monitored for dehydration. Ringer’s lactate is an isotonic solution that resembles the normal composition of blood serum and plasma. It contains sodium, potassium, calcium, chloride, and lactate, but no dextrose.
The nurse prepares to hang which of the following for a client with thrombocytopenia?
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Correct answer: B. Platelets
Platelets are administered in the treatment of bleeding disorders, such as thrombocytopenia. Whole blood is not used as much as packed red blood cells but may be used in cases of hemorrhage. Red blood cells are used to replace erythrocytes in conditions such as anemia or blood loss. Albumin is used to restore intravascular volume in the treatment of shock and hypoproteinemia.
The nurse is caring for a client with an IV who is experiencing dyspnea, hypotension, a weak and rapid pulse, and a decreased level of consciousness, and who is becoming cyanotic. The priority nursing intervention is to
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Correct answer: A. discontinue the IV.
A client who is dyspneic; has hypotension; has a weak, rapid pulse; has a decreased level of consciousness; and is cyanotic is experiencing an air embolism. Administering oxygen, notifying the physician, and placing the client in a Trendelenburg position are all appropriate interventions, but the priority intervention is to immediately stop the entrance of air into the vein. As little as 10 ml of air may be fatal. An air embolism may result from a loose connection, tubing change, or inappropriately primed tubing. To assure that the entrance of air is stopped from entering the vein, it is safest and quickest to discontinue the IV instead of risking further air entering the vein.
Because a client is receiving fresh plasma, the nurse should evaluate which of the following laboratory results for the effectiveness of therapy?
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Correct answer: B. Prothrombin (PT) and partial thromboplastin (PTT)
The prothrombin (PT) and partial thromboplastin (PTT) laboratory tests should be evaluated to determine the effectiveness of receiving fresh plasma. The hematocrit and hemoglobin are evaluated to indicate successful red blood cell therapy. The platelets should be monitored to evaluate successful platelet therapy. The white blood cell count would be evaluated to determine effective granulocyte therapy.
The nurse is teaching a class on controlled substances. Which of the following should the nurse include in the class?
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Correct answer: D. There is no accepted medical use for Schedule I controlled substances
Schedule I controlled substances have no acceptable medical use and are used for research purposes only. Glutethimide (Doriden), secobarbital (Seconal), and hydrocodone with acetaminophen (Vicodin) are examples of Schedule III drugs. Schedule II controlled substances have a high potential for abuse, and Schedule III drugs have a moderate potential for abuse. Schedule V controlled substances are over-the-counter narcotics that must be sold by a registered pharmacist.
The nurse prepares to administer meperidine (Demerol) intramuscularly to an adult client by selecting which of the following needles?
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Correct answer: B. 23 gauge
The appropriate gauge needle to administer an intramuscular injection to an adult client is 21 to 23 gauge.
When administering intravenous therapy to a client, it would be essential for the nurse to include which of the following aspects of the procedure?
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Correct answer: B. Avoid letting the intravenous solution hang more than 24 hours
An intravenous solution should not hang more than 24 to 72 hours. Intravenous tubing should be changed every 48 to 72 hours. The IV solution to be hung should always be checked against the current doctor’s order. It is unsafe practice to just hang the solution running out, because the order may have been changed. A time strip should never be made with a felt-tip marker because the ink from the marker may leech through the plastic bag and contaminate the solution.
After initiating intravenous therapy, a client experiences chills, headaches, backache, and a temperature of 38.3�C, or 101�F. The nurse should report this as which of the following types of intravenous reactions?
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Correct answer: A. Pyrogenic reaction
Clinical manifestations of a pyrogenic reaction include a sudden increased temperature, chills, backache, headache, general malaise, and nausea and vomiting.
Which of the following is a priority for the nurse to perform on a client who has a thrombophlebitis?
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Correct answer: B. Discontinue the IV
Discontinuing the IV is the priority nursing intervention when a thrombophlebitis is present. After discontinuing an intravenous solution, warm, moist compresses are applied to the area, the physician is notified, the incident is documented, and the IV is restarted at another site.
The nurse is observing another nurse start an intravenous infusion. Which of the following would indicate the nurse starting the IV does not understand the procedure?
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Correct answer: A. Cleanse the selected IV site with Betadine followed by alcohol
Cleansing the selected IV with Betadine followed by alcohol may form a toxic material that may be absorbed through the skin. It is appropriate to select a butterfly needle for an endoscopy procedure, use the scalp vein for an infant, or find a difficult vein with a venoscope.
A client receiving a blood transfusion complains of chills, headache, backache, and sudden spikes in temperature. The priority nursing action is to
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Correct answer: B. discontinue the transfusion.
Blood administration reactions generally occur within the first 15 minutes. Chills, headache, backache, and a sudden spike in temperature indicate a reaction. The priority nursing action is to discontinue the transfusion and notify the physician immediately.
The nurse identifies which of the following orders as an intermittent intravenous infusion?
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Correct answer: B. Ranitidine (Zantac) 0.5 mg in 50 ml 0.9% NaCl over 20 minutes every 6 hours
An intermittent intravenous infusion is the administration of an IV drug without the infusion of solution. These infusions are administered at regularly scheduled times. An example of an intermittent intravenous infusion is ranitidine (Zantac) 0.5 mg in 50 ml 0.9% NaCl over 20 minutes every 6 hours.
Which of the following principles of intravenous push does the nurse consider before administering a drug by this route?
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Correct answer: B. The rate of IV push administration must be verified in a drug book
Administering a drug by the IV push rate is a way to administer a small amount of a drug in a short period of time. The rate of any IV drug must be verified in a drug book before administration. Because this is a rapid way of administering drugs to a client, there is a high risk of adverse reactions. If the drug is given too quickly, such as in 1 minute or less, there is no opportunity to discontinue the drug should a reaction occur.
The nurse is observing another nurse administer blood. Which of the following indicates to the observing nurse that the administering nurse does not understand blood administration?
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Correct answer: D. Infuse the transfusion slowly over 6 hours
Blood should not hang for more than 4 hours. If it hangs for more than 4 hours, there is a risk of bacterial growth. Blood should be run slowly for the first 15 minutes at 20 drops per minute. If no reaction occurs after 15 minutes, the flow rate may be established. The vital signs should be assessed every 30 minutes until 1 hour after transfusion to make sure that no reaction is occurring.
The nurse assesses which of the following clients to be most appropriate for the selection of the central venous catheter?
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Correct answer: C. A client who has cancer of the esophagus and is receiving chemotherapy
A central venous catheter is generally inserted into the internal jugular and subclavian veins with the distal tip located in the superior vena cava to minimize vessel irritation and sclerosis. It is used for long-term therapy, such as for a client who has cancer of the esophagus and is receiving chemotherapy.
Which of the following should the nurse include when caring for a client with a peripherally inserted central venous catheter (PICC)?
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Correct answer: A. Avoid taking the blood pressure in the arm on the side of the PICC
The taking of blood pressure should be avoided in the arm on the side of a peripherally inserted central catheter (PICC).
The nurse is caring for a client with a central venous catheter who is experiencing chest pain, dyspnea, coughing, and apprehension. The nurse reports this as indicative of a(n)
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Correct answer: D. air embolism.
Clinical manifestations of an air embolism in a client with a central venous catheter include chest pain, dyspnea, coughing, and apprehension.
A student nurse asks the nurse where a peripherally inserted central catheter is inserted. Which of the following is the appropriate response by the nurse?
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Correct answer: A. Antecubital area of the basilic vein
A peripherally inserted central catheter is inserted into the antecubital area of the basilic�vein.
The nurse selects which of the following intravenous fluids to administer to a client who is very dehydrated with a serum potassium of 2.2 mEq/L, sodium of 129 mEq/L, and calcium of 7.5 mg/dl?
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Correct answer: D. Ringer’s lactate
A client who has a serum potassium of 2.2 mEq/L, sodium of 129 mEq/L, and a calcium of 7.5 mg/dl would benefit from an intravenous solution that resembles the normal composition of the blood serum and plasma with a potassium level below the daily requirement. Ringer’s lactate is an isotonic solution that provides sodium, potassium, calcium, chloride, and lactate. Sodium chloride 0.45% is an isotonic solution that may be used for daily maintenance of body fluid and establishment of renal function. Dextrose 5% in water is an isotonic solution that promotes rehydration and elimination. Administering D5W may cause a sodium loss but does provide a good medium for administration of potassium. Dextrose 10% in water also contains a higher percentage of�dextrose.
Which of the following evaluations does the nurse make when the venipuncture site has an observable swelling and is tender and cool to touch?
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Correct answer: B. The IV site has infiltrated
An intravenous solution that has infiltrated develops a noticeable swelling and is tender and cool to touch. Infiltration may be caused by using a catheter of the wrong gauge, using the wrong type of device, or by dislodgement of the device from the vein. A phlebitis results from a mechanical or chemical trauma. Tenderness is the first indication. Other clinical manifestations include a reddened area or pink or red stripe along the vein, warmth, and swelling. If the IV site develops an infection, the area becomes red and warm to the touch, and may have an observable drainage. Bleeding into the surrounding tissue around an IV site may cause the area to become swollen and red.
A client receiving continuous intravenous therapy is complaining of dyspnea, cough, and tachycardia. The nurse auscultates crackles bilaterally. In determining what action to take next, which of the following factors should the nurse consider?
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Correct answer: B. The client is exhibiting signs of hypervolemia
A client receiving a continuous intravenous solution who is complaining of dyspnea, cough, and tachycardia and who has crackles auscultated bilaterally is exhibiting clinical manifestations of hypervolemia, or an increased circulating volume. This may cause cardiac overload that can lead to pulmonary edema and cardiac failure. Hypervolemia may be caused by an intravenous solution running at too rapid a rate. Upon detection, the IV should be slowed to a keep-open rate and the physician should be notified.
Which of the following solutions should the nurse administer to correct an excessive fluid loss and provide sodium chloride to a client?
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Correct answer: A. Dextrose 5% in 0.45% normal saline
Dextrose 5% in 0.45% normal saline promotes renal function and urinary output while providing calories and sodium to a client. It also corrects an excessive fluid loss. Although sodium chloride 0.45% establishes renal function while providing daily maintenance of body fluids, it does not provide a source of calories. Ringer’s lactate resembles the normal composition of blood and serum while replacing potassium in a client who is hypokalemic. Ringer’s lactate contains sodium, potassium, calcium, chloride, and lactate. Dextrose 5% in water promotes rehydration and elimination, and serves as a good medium for the administration of potassium. It may also cause a loss of urinary sodium. D5W is a source of calories, but does not provide a source of sodium.
The nurse should perform which of the following Centers for Disease Control and Prevention (CDC) guidelines to decrease intravascular infection resulting from intravenous therapy in adult clients?
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Correct answer: B. Replace short peripheral venous catheter and rotate sites every 48 to 72 hours
In an adult client, short peripheral venous catheters should be replaced and the site rotated every 48 to 72 hours. Topical antimicrobial ointment should not be applied to the insertion site of a peripheral or central venous catheter. Prior to insertion, the insertion site should be cleansed with 70% alcohol or 10% povidone-iodine. IV tubing, including secondary tubing, and stopcocks should not be changed more frequently than every 72 hours.
Which of the following should the nurse consider when selecting a site for venipuncture?
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Correct answer: A. Use the same finger to palpate a vein by pressing downward
The nurse should use the same finger to palpate the vein by pressing downward to determine resilience of the vein. The insertion site should not be shaved, because shaving may cause abrasions that predispose the site to infection. The tourniquet should be applied 4 to 5 inches above the proposed insertion site. An insertion site should not be selected if it is distal to a previous insertion site. This may cause the new IV to infiltrate.
Which of the following gerontological considerations should the nurse include when selecting a venipuncture site and initiating intravenous therapy for an older adult client?
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Correct answer: B. Use a 22- to 24-gauge needle for the venipuncture
When initiating an intravenous solution in an older adult client, a 22- to 24-gauge needle is the best. A 22- to 24-gauge needle is used for the delivery of fluid and drugs. The dorsal metacarpal veins are the best veins. Because the veins of an older adult client are fragile, a loosely applied tourniquet or no tourniquet should be used. Adhesive tape should be avoided because the older adult client has fragile skin that can be easily torn. Paper tape is recommended.
A physician has ordered acetylsalicylic acid (aspirin) 10 gr every 4 hours p.r.n. The available dose for aspirin is 325 mg per tablet. What will the nurse administer?
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Correct answer: B. 2 tabs
Find the number of tablets to be administered: 1 gr 5 60 mg and 1 tablet 5 325 mg First convert grains to milligrams: 1 gr 5 60 mg, 10 gr 5 600 mg 660 mg is the desired dose. Set up the ratio: 325 mg 1 tab 660 mg x � x 660 325 x 2.03 � � Because conversions between apothecary and�metric systems are not exact, two 325-mg tablets may be administered for the 600-mg grains. The nurse will administer 2�tablets.
The physician has ordered guaifenesin (Robitussin) expectorant syrup 1� ounces p.o. every 4 hours. One 90-ml bottle of guaifenesin (Robitussin) syrup is available. What will the nurse administer?
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Correct answer: B. 45 ml
Find the amount of expectorant that should be administered. 1 ounce 5 30 ml Convert ounces to milliliters: 1 ounce 5 30 ml, 1� ounces 5 45 ml, x5 45 ml The nurse will administer 45 ml.
The physician’s order reads phenytoin sodium (Dilantin) 0.1 g p.o. now. On hand are phenytoin sodium (Dilantin) capsules, 100 mg per capsule. The nurse will give
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Correct answer: D. 1 capsule.
Find the number of capsules to be administered. The order is for 0.1 g and each capsule 5 100 mg. Convert grams to milligrams: 1 gram 5 1000 mg, 0.1 g 5 100 mg, x 5 1 capsule The nurse will administer 1 capsule.
The order reads levodopa (Dopar) 1.5 g p.o. b.i.d. On hand are levodopa (Dopar) tablets in a 500-mg strength. The nurse will give
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Correct answer: D. 3 tablets.
Find the number of tablets to be administered. The order is for 1.5 g, and the tablets on hand are 500 mg. First convert 1.5 g to milligrams: 1 gram 5 1000 mg, 1.5 g 5 1500 mg Determine the number of tablets to be administered: 500 mg 1 tablet 1500 mg x � � � x 1500 mg 500 mg tablets x 3 tablets The nurse will administer 3 tablets of levodopa (Dopar).
The doctor’s order states glipizide (Glucotrol) 5000 mcg daily. On hand the nurse has glipizide (Glucotrol) 2.5 mg tablets. How many tablets will the nurse administer?
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Correct answer: A. 2 tablets
Find the number of tablets to be administered. The order is for 5000 mcg, and the tablets on hand are 2.5 mg. Convert 5000 mcg to milligrams: 1000 mcg 5 1 mg, then 5000 mcg 5 5 mg Set up the ratio to determine the number of tablets to deliver: 2.5 mg 1 tab 5 mg x � � � x 5 mg 2.5 mg tablets x 2 tablets The nurse will administer 2 tablets of glipizide (Glucotrol).
The nurse reads a physician’s order, which states atropine sulfate 0.5 mg IM stat. The nurse has atropine sulfate 0.3 mg/0.5 ml for injection available. What volume of the atropine solution should the nurse administer�IM?
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Correct answer: C. 0.8 ml
Find the volume for this injection. Set up a ratio: 0.3 mg 5 ml 5.0 mg x � � ? � � x 5 ml 0.5 mg 3.0 mg x 2.5 0.3 ml, x 0.8 ml The nurse will administer 0.8 ml of the injectable solution intramuscularly.
The order reads hydromorphone HCl (Dilaudid) 1.5 mg s.q. every 4 to 6 hours p.r.n. The nurse has injectable hydromorphone HCl (Dilaudid) ampules gr 1/30 per ml. What volume will the nurse administer?
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Correct answer: D. 0.75 ml
Find the volume to inject. Conversion: 1 gr 5 60 mg, and the drug has 1/30 grain per ml. Convert 1/30 grain and 1.5 mg to the same units. Note: It is generally easier to convert grains to milligrams. 1 gr 5 60 mg, 1/30 gr 5 60 30 mg The medicine has a strength of 2 mg/ml. Then set up the ratio: � � � 2 mg/ml 1.5 mg x x 1.2 mg 2 mg ml .75 ml The nurse will administer 0.75 ml of the injectable solution.
The doctor’s order reads vitamin B12 injection 1000 mcg once a month. The nurse has injectable vitamin B12 available in a concentration of 0.5 mg/ml. What volume should the nurse administer?
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Correct answer: A. 2 ml
Find the volume for this injection. The concentration available is 0.5 mg/ml. Convert mcg to mg: 1 mg 5 1000 mcg Then set up the ratio: 0.5 mg 1 ml 1 mg x � � � x 1 mg 0.5 mg ml x 2 ml The nurse will administer 2 ml injectable vitamin B12.
The doctor has ordered furosemide (Lasix) 40-mg IV push. The nurse has injectable furosemide (Lasix) 20 mg in 2 ml available. What should the nurse administer?
Show answer and rationale
Correct answer: B. 4 ml
Find the volume to inject. The order is for 40 mg; available is 20 mg/2 ml. Set up the ratio: 20 mg 2 ml 40 mg x � x 40 2 20 ml x 4 ml � ? � The nurse will administer 4 ml of injectable furosemide (Lasix) IV push.
The doctor has ordered diazepam (Valium) 2.5-mg IV push stat. Available is injectable diazepam (Valium) 5 mg/ml. How much will�the nurse administer?
Show answer and rationale
Correct answer: A. 0.5 ml
Find the volume to be injected. The order is for 2.5 mg; the available solution is�5 mg/ml. Set up a ratio: 5 mg 1 ml 2.5 mg x � � � x 2.5 mg 5 mg ml x 0.5 ml The nurse will administer 0.5 ml of the injectable furosemide (Valium) solution.
The order reads ceftriaxone (Rocephin) 1.4 g IM b.i.d. Available is a ceftriaxone (Rocephin) 1-vial; when reconstituted with 2.1 ml, it results in a concentration of 350 mg per ml. What volume will the nurse administer?
Show answer and rationale
Correct answer: C. 4 ml/2 vials
Find the volume to be administered. The order is for 1.4 g; the available solution is 350 mg/ml. Convert the grams to mg: 1 g 5 1000 mg, 1.4 g 5 1400 mg Convert 1.4 g to milligrams (move the decimal point three places) to equal 1400 mg. Set up a ratio: 350 mg/ml 1400 mg x � , � � x 1400 mg 350 mg ml, x 4 ml The nurse will need to administer 4 ml of the ceftriaxone (Rocephin). There is not enough medication in 1 vial to administer 4 ml. Therefore the nurse will need to reconstitute 2�vials for the prescribed dose.
Amoxicillin with clavulanic acid (Augmentin) powder reconstituted with 69 ml water results in a 75-ml suspension with a 200-mg/5-ml concentration. The doctor’s order reads Augmentin 600-mg oral suspension p.o. every 12 hours. What volume of the suspension will the nurse administer?
Show answer and rationale
Correct answer: D. 15 ml
Determine the volume to be administered. The order is for 600 mg; available is 200 mg/5 ml. Set up a ratio: 200 mg 5 ml 600 mg x � � ? � x 5 600 mg 200 mg ml x 15 ml The nurse will administer 15 ml of the reconstituted Augmentin suspension.
Administer 800 ml IV D5W at 75 ml/hour. The�drop factor is 10 gtt/ml. What is the drops-per-minute rate?
Show answer and rationale
Correct answer: A. 13
Determine the drip rate per minute in gtt. The order is for a rate of 75 ml/hr; the drop factor is 10 gtt/ml. Convert the order to ml/minute: 1 hour 5 60 minutes, 1/60 3 75 ml/hr 5 1.25 ml/minute Determine the drip rate: x 5 order 3 drop factor x 5 1.25 ml/min 3 10 gtt/ml x 5 12.5 gtt/min, rounded to 13 The nurse will administer 13 gtt/minute.
Infuse heparin 40,000 units in 1000 ml of normal saline IV over 24 hours. The administration set has a drop factor of 10 gtt/ml. The nurse will set the gtt per minute at what rate?
Show answer and rationale
Correct answer: A. 7 gtt
Determine the gtt/minute rate. The order is for a rate of 1000 ml/day; the drop factor is 10 gtt/ml. Convert the order to ml/minute: 1 day 5 24 hours/day 3 60 minutes/hour � ? 1000 ml/ day � 1000 24 60 0.69 ml/ minute minutes/day Determine the drip rate: x 5 order 3 drop factor x 5 0.69 ml/minute 3 10 gtt/ml x 5 6.9 gtt/minute, rounded to 7 The nurse will administer 7 gtt/minute.
The order reads heparin 2000 units s.q. The nurse has on hand heparin 2500 units/ml. How�much will the nurse administer?
Show answer and rationale
Correct answer: D. 0.8 ml
What volume will the nurse administer? The order is for 2000 units and available is a 2500-units/ml solution. Set up a ratio: 2500 units 1 ml 2000 units x � x 2000 2500 x 4/5 or 0.8 ml � � The nurse will administer 0.8 ml.
Heparin 30,000 units in 1000 ml of normal saline is to be administered IV over 24 hours via microdrip. How many units of heparin is the client receiving per hour?
Show answer and rationale
Correct answer: C. 635
Determine the units to be administered per�hour. The rate is 30,000 units over 24 hours. Note: The mention of "microdrip" does not enter into this calculation at all; you only need to convert units per day to units per hour. The microdrip calculation is only a factor when determining the setting for delivery of the order. The order is for 30,000 units 24 hours x 1 hour � x 30,000 units 24 hours x 1249.9 units per hour, or 1250 units per hour � � The nurse will administer 1250 units per hour.
Infuse 2000 ml of lactated Ringer’s over 12�hours. The drop factor is 15 gtt/ml. The nurse will regulate the IV to how many gtt per minute?
Show answer and rationale
Correct answer: C. 42
Determine the drip rate in gtt/minute. The order is for 2000 ml/12 hours; the drop factor is 15 gtt/minute. Convert the prescription to a rate per minute: 2000 ml 12 hours 167ml/hours 167 ml 60 minutes 2.78 ml/hours � � Now calculate the drip rate: 2.78 ml/minute 3 15 gtt/ml 5 41.7 gtt/minute or 42 gtt/minute The nurse will administer 42 gtt/minute.
Use an electronic regulator to administer 1500�ml of D5W in 6 hours. The nurse will set the machine for
Show answer and rationale
Correct answer: C. 250 ml/hour.
Determine the setting in ml/hour for an electronic regulator. The order is for 1500 ml/6 hours. x 1500 ml 6 hours � �250 ml/hour The nurse will set the machine to administer 250 ml/hour.
The recommended dosage for cefaclor (Ceclor)�suspension is 20 to 40 mg/kg/day divided into 2�or 3 doses. The child receiving�the cefaclor (Ceclor) weighs 22 kg. What is the recommended range for the individual dose ordered as twice daily for this�child?
Show answer and rationale
Correct answer: A. 220 to 440 mg
Determine the recommended safety range of this drug. The recommended dosage is from 20 mg/kg/ day to 40 mg/kg/day. The child’s weight is 22 kg; the drug will be administered 2 times per day. Calculate the recommended upper and lower thresholds for this child. Lower threshold: 20 mg/kg/day 3 22 kg 5 440 mg/day 2 doses per day, lower threshold per dose 5 1/2 3 440 mg 5 220 mg Upper threshold: 40 mg/kg/day 3 22 kg 5 880 mg/day 2 doses per day, upper threshold per dose 5 1/2 3 880 mg 5 440 mg The range for this child is 220 mg to 440 mg.
The recommended dosage for furosemide (Lasix) oral solution is a single dose of 2 mg/kg, and subsequent doses of 1 to 2 mg/kg every 6�hours until suitable response, up to a maximum of 6 mg/kg/day. What is the minimum to maximum 24-hour dose range for a child weighing 26 kg?
Show answer and rationale
Correct answer: A. 52 mg to 156 mg/24 hours
Determine the range of daily safe dosages for a 26-kg child. The safe dosage range has a minimum of 2 mg/kg as a single application, and a maximum of 6 mg/kg/day Determine the lower threshold for this child: If the first 2 mg/kg shows results, there would be no further application. For a child of 26 kg, the lower threshold is 26 kg 3 2 mg/kg 5 52 mg. Determine the upper threshold: The daily upper limit is given as 6 mg/kg/day. For a child of 26 kg, the upper threshold is 26 kg 3 6 mg/kg 5 156 mg. The range for this child is 52 mg to 156 mg.
Using the child’s weight, determine what the pediatric dose for digoxin (Lanoxin) would be if the usual adult dose is 0.15 mg p.o. every day. The child weighs 13 kg. The nurse will administer
Show answer and rationale
Correct answer: B. 0.05 mg.
Find the amount of digoxin the nurse should administer based on BSA. The usual adult dose is for 0.15 mg, and the child weighs 13 kg. S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564, where S is in cm2 ; W is in kg; and H is in cm. Determine the child’s BSA using weight:( ) 4 13 7 13 90 52 7 103 59 103 0.57 m BSA 2 Determine the child’s dose based on BSA: � ? � ? 0.57 m 1.7 0.15 mg 0.34 0.15 0.05 mg 2 The nurse will administer a 0.05-mg dose.
An adult dose of doxycycline (Vibramycin) is 100 mg b.i.d. The child who is to take doxycycline (Vibramycin) is 32 inches tall and weighs 48�pounds. Determine the child’s dose based on BSA.
Show answer and rationale
Correct answer: A. 40 mg/dose
Determine a child’s dose of Vibramycin using�BSA. An adult dose is 100 mg; the child is 32 inches tall and weighs 48�pounds. S 5 log W 3 0.425 1 log H 3 0.725 1 1.8564, S is in cm2 ; W is in kg; and H is in cm. Determine the child’s BSA: 48 32 3131 1536 3131 0.49 0.70 m2 Determine the child’s dose based on the BSA: � ? 0.70 m 1.7 100 mg 41 mg/dose 2 The nurse will administer 40 mg per dose.
The recommended adult dose of acyclovir is 200 mg every 4 hours. What would an appropriate dose be for a child weighing 8 kg and standing 57 cm tall?
Show answer and rationale
Correct answer: A. 40 mg
Determine a child’s dose of acyclovir using BSA. The adult dose is 200 mg; the child is 57 cm tall and weighs 8 kg. Determine the child’s BSA: � ? ? ? 8 kg 57 cm 3600 456 3600 0.12 0.35 m2 Determine the child’s dose: � ? � ? 0.35 m 1.7 200 mg child’s dose 0.21 200 42 mg 2 The nurse will administer 40 mg every 4 hours.
The nurse should question which of the following drugs for use in a client who has glaucoma?
Show answer and rationale
Correct answer: B. Atropine sulfate
Atropine sulfate is an anticholinergic drug that is used as a mydriatic to dilate the pupil. This blocks the drainage of aqueous humor. If used by a client who has glaucoma, it could cause an acute attack by increasing the intraocular pressure. Glaucoma is treated by drugs that constrict the pupil to allow for the escape of aqueous humor and that reduce intraocular pressure. Acetazolamide (Diamox) is a carbonic anhydrase inhibitor that decreases the aqueous fluid. Pilocarpine is a cholinergic agonist used in the treatment of glaucoma. Mannitol is an osmotic diuretic that draws the aqueous fluid from the eye by osmosis.
The nurse is administering an adrenergic blocking agent, such as a beta blocker, to a client with glaucoma. Which of the following would the nurse interpret as indicative of a serious adverse reaction?
Show answer and rationale
Correct answer: B. Exacerbation of asthma
Adrenergic blocking agents (beta blockers) are miotics used in the treatment of glaucoma. They decrease the aqueous production and intraocular pressure. Adverse reactions include stinging, photophobia, burning, tearing, and blurred vision. Although a decrease in blood pressure may occur, the most serious adverse reaction is an exacerbation in a client’s asthma.
The nurse administers which of the following drugs to a client who has keratitis?
Show answer and rationale
Correct answer: D. Idoxuridine (Stoxil)
Keratitis is inflammation of the cornea that is treated with topical idoxuridine (Stoxil), which is an anti-infective. Acyclovir (Zovirax) is an antiviral used in the treatment of herpes zoster ophthalmicus. Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used for a client who has glaucoma to decrease the aqueous fluid. Scopolamine (Isopto Hyoscine) is a mydriatic that is used for cycloplegic refractions and uveitis.
The nurse is to administer timolol (Timoptic) 1 drop in each eye. Which of the following comments by the client indicates the need for further teaching?
Show answer and rationale
Correct answer: D. "I’ll need to take this until my eye pressure is normal."
Timolol (Timoptic) is an antiglaucoma agent. This is required daily for the rest of the client’s life unless surgical intervention is performed. It will decrease the aqueous fluid and decrease the intraocular pressure. Hand washing is an aseptic measure to prevent microorganism transfer. Adverse reactions include dizziness, double vision, and other visual changes.
The nurse instructs the client that the best position for instilling nose spray is to
Show answer and rationale
Correct answer: D. tilt the head backward.
Tilting the head backward can facilitate movement of the drug into the nasal passages.
The nurse is assigned to administer eyedrops to a client being prepared for cataract surgery. Which of the following types of eyedrop does the nurse expect to administer?
Show answer and rationale
Correct answer: C. A thiazide diuretic
A mydriatic agent produces dilation of the pupil. Mydriatic eyedrops are used preoperatively for cataract surgery. They not only dilate the pupil, but also constrict blood vessels. A miotic agent constricts the pupil. An osmotic diuretic will decrease intraocular pressure. A thiazide diuretic promotes the excretion of body fluid and is not prescribed for cataract surgery
A client with M�ni�re’s disease asks the nurse why meclizine hydrochloride (Antivert) is being administered. The most appropriate response by the nurse is which of the following?
Show answer and rationale
Correct answer: D. "It will alleviate your nausea."
Meclizine hydrochloride (Antivert) is an antiemetic used to alleviate the nausea that occurs in M�ni�re’s disease from the violent vertigo. It does not directly stop the vertigo.
The nurse is collecting a medication history from a client with herpes simplex 1 of the eye. The nurse should ask the client if which of the following drugs are taken?
Show answer and rationale
Correct answer: C. Trifluridine (Viroptic)
Trifluridine (Viroptic) is an antiviral drug used to treat herpes simplex 1. Cromolyn is an antiallergic drug used to treat conjunctivitis by reducing the itching and redness. Idoxuridine (Stoxil) is an anti-infective used topically to treat keratitis. Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used in the treatment of glaucoma to decrease aqueous fluid.
The nurse should understand that a client is to receive which of the following drugs to paralyze the ciliary body muscles?
Show answer and rationale
Correct answer: D. Homatropine
Homatropine is a cycloplegic mydriatic administered for ciliary muscle paralysis. Phenylephrine HCl (Neo-Synephrine) and hydroxyamphetamine-hydrobromide (Paredrine) are mydriatics used to dilate the pupil. Cromolyn is used to treat conjunctivitis by reducing itching and redness.
The nurse should question which of the following drugs that is ordered to be given prior to an eye refraction?
Show answer and rationale
Correct answer: A. Scopolamine
Pilocarpine (Pilocar) is a cholinergic used in the treatment of glaucoma. It should be questioned because it stimulates the iris to contract. Scopolamine is a cycloplegic and phenylephrine HCl (Neo-Synephrine) is a mydriatic used for eye refraction. Hydroxyamphetamine (Paredrine) is a mydriatic used diagnostically to differentiate among postganglionic, central, or preganglionic Horner’s syndrome.
The nurse understands that a client is to receive prednisolone (Pred Forte) for which of the following purposes?
Show answer and rationale
Correct answer: D. Is an anti-inflammatory
Prednisolone (Pred Forte) is a topical corticosteroid used to treat postoperative eye inflammation.
Which of the following interventions is a priority for the nurse to implement when a client with glaucoma receiving betaxolol (Betoptic) experiences bradycardia, headache, and depression?
Show answer and rationale
Correct answer: D. Report these adverse reactions as systemic
Betaxolol (Betoptic) is a beta-adrenergic blocker given for glaucoma. The adverse reactions are generally considered as being transient discomfort. Adverse reactions, although rare, may include bradycardia, pulmonary distress, headache, depression, and heart block. These indicate a systemic reaction and must be reported.
The nurse is caring for a client with allergic rhinitis and evaluates which of the following drugs to act as a mast cell stabilizer?
Show answer and rationale
Correct answer: D. Cromolyn (Nasalcrom)
Cromolyn (Nasalcrom) is the only mast cell stabilizer. Diphenhydramine (Benadryl), brompheniramine (Dimetane), and loratidine (Claritin) are all antihistamines.
Which of the following drugs should the nurse question in a client with cardiovascular disease and hypertension?
Show answer and rationale
Correct answer: B. Pseudoephedrine (Sudafed)
Pseudoephedrine (Sudafed) is a nasal decongestant used for temporary relief of nasal congestion from the common cold, hay fever, or other respiratory allergies. Decongestants such as pseudoephedrine (Sudafed) are contraindicated in clients with cardiovascular disease and hypertension. Diphenhydramine (Benadryl), loratidine (Claritin), and cetirizine (Zyrtec) are all antihistamines and are not contraindicated.
A client on diazepam (Valium) asks the nurse why the physician said to avoid drinking alcohol while taking this medication. Which of the following responses by the nurse appropriately explains what alcohol will do?
Show answer and rationale
Correct answer: B. Increase the sedative effect
Alcohol is a central nervous system depressant and, when taken with Valium, will give an additive effect and increase the sedative value of the Valium. Alcohol causes vasoconstriction, not vasodilation. Alcohol will serve as an additive effect when taken with Valium, yielding an increased sensitivity to the Valium.
When admitting a new client with glaucoma, the nurse notes an order for atropine. The nurse should question this order because atropine
Show answer and rationale
Correct answer: A. causes an increase in intraocular pressure.
Atropine is a cycloplegic mydriatic. It blocks the effects of acetylcholine on the sphincter muscle of the iris and the accommodative muscle of the ciliary body. Atropine causes an increase in intraocular pressure. In the treatment of glaucoma, the goal is to decrease intraocular pressure in order to avoid damage to the optic nerve. Adverse reactions of atropine include a decrease in secretions and urinary hesitancy or retention, but not diuresis.
Prior to discharge, the nurse instructs the client who is receiving dipivefrin (Propine) to notify the physician if which of the following occurs?
Show answer and rationale
Correct answer: C. Tachycardia
Dipivefrin (Propine) is a sympathomimetic that can cause tachycardia. An increase in urinary frequency, fatigue, and weight gain are not adverse reactions.
The nurse should administer dipivefrin (Propine) at which of the following times?
Show answer and rationale
Correct answer: A. Every 12 hours
Dipivefrin (Propine) is a sympathomimetic drug used in the treatment of glaucoma. Treatment includes regular administration of the eyedrops every 12 hours. The objective of the treatment is to reduce the intraocular pressure.
Which of the following is essential that the nurse include in the assessment of a client who works evenings and takes pilocarpine (Pilocar)?
Show answer and rationale
Correct answer: B. Decreased dark adaptation
Pilocarpine (Pilocar) is a cholinergic agonist used in the treatment of glaucoma. Due to the contraction of the iris, it causes a decreased adaptation to dark. Other adverse reactions include hypertension, urinary frequency, and diarrhea.
The nurse is collecting a health history from a client who is to begin taking acetazolamide (Diamox). Which of the following questions should the nurse ask to determine the safety of this drug?
Show answer and rationale
Correct answer: B. "Have you ever had an allergy to sulfa?"
Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used in the treatment of glaucoma. It should not be used if a prior history to a sulfa allergy is known. It inhibits carbonic anhydrase in the kidney, which decreases the formation of bicarbonate and hydrogen ions from carbon dioxide, thus decreasing the availability of the ions for transport.
The nurse instructs a client who is prescribed a topical ear medication to
Show answer and rationale
Correct answer: B. administer at room temperature.
Topical ear medications should be administered at room temperature because the cold can cause dizziness. Earplugs are not used to retain drops. Treatment of a fungal infection requires application once or twice daily. Topical ear medication has no sedative effect.
The registered nurse is planning to delegate nursing tasks for the day. Which of the following tasks may be delegated to a licensed practical nurse?
Show answer and rationale
Correct answer: C. Cleanse a client’s eyelid with plain water to soften and remove crusting
A registered nurse may delegate the cleansing of a client’s eyelid with plain water to soften and remove crusting to a licensed practical nurse. A licensed practical nurse may not instruct a client taking antihistamines on the adverse reactions, assess a client for cardiovascular disease before administering a nasal decongestant, or review the electrolyte panel of a client taking a diuretic ear medication. These nursing tasks require the knowledge level of a registered nurse.
A client has been receiving intravenous theophylline and the physician writes new orders to discontinue the IV medication and begin an immediate-release oral form of the medication. When should the nurse schedule the first dose of the oral medication to be administered?
Show answer and rationale
Correct answer: A. Begin 4 to 6 hours after stopping the intravenous infusion of theophylline
After stopping IV therapy, a period of 4 to 6�hours should elapse before initiating oral therapy. The half-life of the drug is 3 to 15 hours in nonsmoking adults, and 4 to 5 hours in adult heavy smokers. If the oral dose is initiated too soon it could lead to adverse reactions, such as nausea, vomiting, diarrhea, irritability, insomnia, or headache. More serious theophylline toxicity is manifested by cardiac arrhythmias, hypotension and peripheral vascular collapse, tachycardia,�hyperglycemia, or seizures. The therapeutic serum level for theophylline is 10 to 20 mcg/ml.
A client with acute asthma is treated for inspiratory and expiratory wheezes and a decreased forced expiratory volume. Which class of prescribed drugs should the nurse administer first to this client?
Show answer and rationale
Correct answer: C. Bronchodilators
The most immediate need of a client with inspiratory and expiratory wheezes and a decreased forced expiratory volume is to dilate the bronchioles and improve air exchange. Steroids (inhaled or oral) may follow the emergent treatment to reduce the inflammation, but would not be first-line drugs. Mucolytics are not appropriate for the client with asthma, as there is little mucus production associated with asthma.
The nurse is admitting a client with asthma who is to be started on theophylline. Which of the following questions would be appropriate to ask this client?
Show answer and rationale
Correct answer: C. "Do you take cimetidine (Tagamet)?"
Cimetidine (Tagamet) will decrease theophylline clearance and may increase serum drug levels. The dose may have to be reduced for this client. Insulin and aspirin do not affect drug clearance.
What to do with your score
Score the set, then spend longer on the review than you did on the questions. For every item you missed, decide which of three things went wrong: you did not know the fact, you misread what the item was asking, or you knew the fact and still chose second-best. Those need three different fixes — content review, slower reading, and priority-framework practice — and lumping them together is why question banks stop working for people.
Read the rationale on the items you got right as well. Arriving at the correct option for the wrong reason is common, and it does not survive a harder version of the same question.
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