Pharmacological and Parenteral Therapies NCLEX Questions with Rationale

NCLEX Pharmacological and Parenteral Therapies Questions

Pharmacological and Parenteral Therapies NCLEX Practice Questions

Question 1. 
The nurse is caring for an elderly client who has been taking cimetidine (Tagamet) for a year. The nurse should monitor for which central nervous system side effects? Select all that apply.
(a) tetany
(b) agitation
(c) confusion
(d) constipation
(e) disorientation
Answer:
(b) agitation
(c) confusion
(e) disorientation

Rationale:
Older clients are more susceptible to CNS side effects of cimetidine, including agitation, confusion, and disorientation. Tetany is a neuromuscular side effect of hypomagnesemia. Constipation is a side effect of cimetidine in the Gl system.

Question 2.  
The nurse is caring for a client scheduled to receive cyclopentolate HCI preoperatively.
Which finding in the client's history would prompt the nurse to notify the health care provider?
(a) osteoporosis
(b) hypothyroidism
(c) renal insufficiency
(d) cardiac dysrhythmias
Answer:
(d) cardiac dysrhythmias

Rationale:
Cyclopentolate HCI is a mydriatic medication used to dilate the pupils preoperatively and for eye examinations. Use of mydriatics is contraindicated in clients with cardiac dysrhythmias, as this increases the risk of serious side effects such as tachycardia and hypertension due to systemic absorption. This can lead to stroke, myocardial infarction, and cardiac ischemia, especially in the elderly or those with pre-existing myocardial disease. Osteoporosis, hypothyroidism, and renal insufficiency are not conditions that would contraindicate use of mydriatics.

Question 3. 
The nurse is providing discharge teaching to a client who has been prescribed prednisone. The nurse instructs the client to report which symptom to the health care provider?
(a) increased appetite
(b) anxiety or confusion
(c) strong, bounding pulses
(d) weight gain of 3 pounds
Answer:
(b) anxiety or confusion

Rationale:
Side effects of prednisone include hypokalemia. Anxiety, confusion, and lethargy are signs of hypokalemia and should be reported. Increased appetite and slight weight gain are common side effects that do not need to be reported; weight gain greater than 5 pounds per week or continued weight gain should be reported. A strong, bounding pulse would not be an expected finding in hypokalemia. 

Question 4.
A client with asthma has orders for terbutaline. Which finding in the medical history would the nurse be most concerned about?
(a) diabetes
(b) migraines
(c) osteoarthritis
(d) coronary artery disease
Answer:
(d) coronary artery disease

Rationale:
Terbutaline is contraindicated with coronary artery disease. It may increase blood glucose levels and should be used with caution in diabetes. Migraines and osteoarthritis are not contraindications for this medication.

Question 5.
The nurse is caring for a client with multiple IV medications. Which of the following drugs are compatible?
(a) vancomycin and heparin
(b) nitroglycerin and dopamine
(c) sodium bicarbonate and dobutamine
(d) furosemide (Lasix) and ondansetron (Zofran)
Answer:
(b) nitroglycerin and dopamine

Rationale:
Nitroglycerin and dopamine are compatible. The other drug combinations listed are not compatible.

Question 6.
The nurse is preparing to administer pilocarpine hydrochloride eye drops to a client with glaucoma. Which is the correct technique to administer eye drops? Select all that apply.
(a) instruct the client to tilt the head back and look up
(b) pull the upper lid up and place the drops just above the pupil
(c) pull the lower lid down and place the drop into the conjunctival sac
(d) to instill multiple drops, wait 3 to 5 minutes between drops to allow maximum absorption
(e) instruct the client to close the eyes and gently rub the eyelids to ensure maximum absorption
Answer:
(a) instruct the client to tilt the head back and look up
(c) pull the lower lid down and place the drop into the conjunctival sac
(d) to instill multiple drops, wait 3 to 5 minutes between drops to allow maximum absorption

Rationale:
The client should tilt the head back and look up. The nurse then gently pulls the lower lid down and places the drop into the conjunctival sac without touching the applicator to the eye or any other surface. The nurse should wait 3 to 5 minutes between drops to allow maximum absorption. Pulling the upper lid up and placing drops just above the pupil is not correct technique. The client should not squeeze the eyes or rub them after the drops have been administered.

Question 7. 
The nurse is teaching a client about alendronate sodium (Fosamax). Which statement by the client indicates a need for further teaching?
(a) "I should take this with a meal."
(b) "I will call my doctor if I develop a fever."
(c) "I should not lie down for at least 30 minutes."
(d) "Dairy products reduce the absorption of this medicine."
Answer:
(a) "I should take this with a meal."

Rationale:
Fosamax should be taken with water at least 30 minutes before breakfast or other medications. Clients should report fever and not lie down for at least 30 minutes after taking Fosamax. Food, especially dairy, interferes with absorption.

Question 8. 
The ED nurse admits a client with second-degree burns to the arms and third-degree burns to the legs. Based on the Parkland formula, which IV fluid would the nurse anticipate for this client during the first 24 hours?
(a) D5W
(b) colloid solutions
(c) crystalloid solutions
(d) 5% albumin in isotonic saline
Answer:
(c) crystalloid solutions

Rationale:
The Parkland formula calls for crystalloid only (Lactated Ringer's) solution for initial fluid replacement. D5W and colloid solutions are not used in the Parkland formula. The Modified Brooke formula prescribes 5% albumin in isotonic saline for the first 24 hours.

Question 9.
A 12-year-old client has new orders for amphetamine and dextroamphetamine (Adderall) for attention-deficit/hyperactivity disorder. The nurse should alert the client's caregivers about which adverse effect?
(a) nausea
(b) seizures
(c) weight gain
(d) constipation
Answer:
(b) seizures

Rationale:
Seizures are a serious, adverse drug effect that may occur when taking Adderall. Nausea and constipation are common side effects but are not considered adverse drug effects. Adderall normally decreases appetite, causing weight loss instead of weight gain.

Question 10.
A client with suspected vitamin C toxicity presents to the ED. Which manifestations of toxicity would the nurse expect in this client? Select all that apply.
(a) muscle weakness
(b) halos around objects
(c) occult rectal bleeding
(d) dry mucous membranes
(e) increased estrogen levels
Answer:
(c) occult rectal bleeding
(e) increased estrogen levels

Rationale:
Vitamin C toxicity causes occult rectal bleeding and increased estrogen levels. Muscle weakness is a sign of vitamin D toxicity. Halos around objects do not occur with vitamin C toxicity. Dry mucous membranes may occur with vitamin A toxicity.

Question 11. 
The nurse is working in the mental health unit and is educating a group of student nurses about atypical antipsychotics. Which statement by one of the student nurses requires further teaching about this class of drugs?
(a) "These drugs can cause bradycardia."
(b) "This class of drugs can cause diabetes."
(c) "Weight gain and obesity are side effects of these drugs."
(d) "Rarely, neuroleptic malignant syndrome can occur and may be fatal."
Answer:
(a) "These drugs can cause bradycardia."

Rationale:
Atypical antipsychotics can cause tachycardia, not bradycardia. Diabetes can occur due to changes in glucose metabolism. These drugs can cause weight gain and obesity. Although rare, neuroleptic malignant syndrome can occur and cause death. Signs and symptoms include muscle rigidity, fever, confusion, and elevated creatinine levels.

Question 12.
The nurse is preparing to administer a calcium channel blocker to a client with hypertension. The nurse understands that the mechanism of action of these drugs is to
(a) cause vasodilation and increase total peripheral resistance.
(b) cause vasodilation and decrease total peripheral resistance.
(c) cause vasoconstriction and decrease total peripheral resistance.
(d) cause vasoconstriction and increase total peripheral resistance.
Answer:
(b) cause vasodilation and decrease total peripheral resistance.

Rationale:
Calcium channel blockers cause vasodilation and decrease total peripheral resistance, which leads to a decrease in blood pressure. The other options do not correctly describe the mechanism of action of calcium channel blockers. Vasoconstriction coupled with increased total peripheral resistance would raise, not lower, blood pressure. Increasing the pressure on one component results in overall blood pressure increase, even if the other component is decreased. 

Question 13.
The charge nurse is working with a student nurse who reports that her assigned client has severe flushing of the upper body following an IV antibiotic infusion. The charge nurse understands that the antibiotic likely responsible for this "red man syndrome" is which medication?
(a) cephalexin
(b) amoxicillin
(c) gentamicin
(d) vancomycin
Answer:
(d) vancomycin

Rationale:
Upper body flushing, often called "red man syndrome," is a side effect of vancomycin that can occur especially if the drug is infused too rapidly. Side effects of cephalexin include diarrhea, easy bruising, dark urine, and joint pain. Side effects of amoxicillin include black or "hairy" tongue, stomach pain, nausea and vomiting, and pale or yellowed skin. Side effects of gentamicin include loss of appetite, rash, increased thirst, and muscle twitching. Side effects of antibiotics may be minor, severe, or life- threatening.

Question 14. 
The nurse is educating a client who is newly diagnosed with angina about his newly prescribed nitroglycerin. The nurse understands that teaching is effective when the client makes which statement?
(a) "It is safe to take one dose of nitroglycerin if I am taking sildenafil."
(b) "I should chew up three tablets at once, and then call 9-1-1 if I still have chest pain in 15 minutes." '
(c) "I can take up to three tablets, 5 minutes apart, under my tongue as needed for chest pain."
(d) "I can keep the pills in a glass cup on my nightstand so I can reach them easily in an emergency."
Answer:
(c) "I can take up to three tablets, 5 minutes apart, under my tongue as needed for chest pain."

Rationale:
Nitroglycerin should be taken one tablet at a time, sublingually every 5 minutes up to three doses over 15 minutes as needed for chest pain. If pain relief does not occur, 9-1 -1 should be called. It is not safe to take nitroglycerin if taking sildenafil unless approved by the health care provider. Nitroglycerin should be taken one tablet at a time and never chewed or crushed. The pills must be kept in a dark container to prevent loss of effectiveness of the medication.

Question 15. 
A client is ordered to receive 1,000 ml of D5W over 6 hours. The infusion set administers 10 gtt/mL. At what rate (gtt/min) should the nurse set the flow?
(a) 24gtt/min
(b) 26gtt/min
(c) 28gtt/min
(d) 30 gtt/min
Answer:
(c) 28gtt/min
Solution:
table

Question 16. 
The nurse is caring for a client who presents with increased ammonia levels, elevated BUN, and altered mental status. Which medication would the nurse anticipate the health care provider ordering for this client?
(a) lactulose
(b) sucralfate
(c) lamotrigine
(d) gabapentin
Answer:
(a) lactulose

Rationale:
Lactulose is a laxative given to lower ammonia levels in clients with hepatic encephalopathy. Elevated BUN indicates a dysfunction in the body's ability to convert protein to nitrogen; this coupled with elevated ammonia levels would present as confusion. Sucralfate is an anti-ulcer medication used in the management of Gl ulcers. Lamotrigine is an antiepileptic medication used to control seizures. Gabapentin is an anticonvulsant and mood stabilizer.

Question 17. 
The nurse is caring for a client with AIDS who is diagnosed with thrush. Which instruction should the nurse give to the client's caretaker, who will be administering nystatin (Mycostatin) oral solution?
(a) take the medication before meals
(b) take the medication after meals
(c) mix the medication with orange juice
(d) take the medication at bedtime
Answer:
(b) take the medication after meals

Rationale:
Oral thrush (candidiasis) occurs when the fungus Candida albicans accumulates on the lining of the mouth. While more likely to occur in babies, this condition also appears in persons with a suppressed immune system. The medication should be swished in the mouth, then either spit out or swallowed. To make the best contact with the oral mucosa, the medication should be taken after meals. The solution should not be diluted with other liquids. The standard frequency of nystatin is four times a day.

Question 18. 
An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is associated with acetaminophen overdose?
(a) metabolic alkalosis
(b) increased blood urea nitrogen level
(c) decreased hemoglobin and hematocrit
(d) elevated liver enzyme levels
Answer:
(d) elevated liver enzyme levels

Rationale:
Metabolism of acetaminophen occurs primarily in the liver, causing an elevation of liver enzyme levels. Metabolic alkalosis is not associated with acetaminophen overdose. Blood urea nitrogen level results from metabolism of protein by the liver and is not associated with acetaminophen overdose. A decrease of hemoglobin and hematocrit is consistent with anemia.

Question 19. 
A client diagnosed with bipolar disease is receiving a maintenance dosage of lithium carbonate. His wife calls the community mental health nurse to report that her husband is displaying mild aggression and poor judgment. Which intervention is appropriate?
(a) administer an extra dose of lithium carbonate
(b) take client to the closest emergency department
(c) measure lithium blood level
(d) arrange for hemodialysis
Answer:
(c) measure lithium blood level

Rationale:
Assessment of the therapeutic level of lithium in the blood is required to determine the next course of action. An extra dose of lithium carbonate may make the symptoms more pronounced. The client's behavior does not warrant a trip to the emergency department, although he should seek medical attention. There is not enough information yet to determine whether hemodialysis is necessary.

Question 20.
Which instruction is correct for a client receiving lithium carbonate for bipolar disorder?
(a) breastfeeding may be done
(b) driving or using machinery is acceptable
(c) drugs containing ibuprofen should be avoided
(d) fluid intake should be limited to eight 8-oz glasses per day 
Answer:
(c) drugs containing ibuprofen should be avoided

Rationale:
Ibuprofen will alter the effect of lithium and should be avoided. Breastfeeding is not recommended as lithium passes into breast milk and may have undesirable effects on a nursing infant. Driving, using machinery, or performing any activity that requires alertness or clear vision should be avoided until the patient is sure she can perform such activities safely. The patient should also drink extra fluids to prevent dehydration, a common side effect of taking lithium.

Question 21. 
The mental health unit nurse is precepting a student nurse. Together they are caring for a client with schizophrenia. The nurse asks the student nurse to select the atypical antipsychotic from the client's medication list. The nurse anticipates the student nurse to select which medication?
(a) loxapine
(b) thioridazine
(c) risperidone
(d) haloperidol
Answer:
(c) risperidone

Rationale:
Risperidone is the only atypical antipsychotic medication listed. Atypical antipsychotics treat the negative symptoms of schizophrenia, such as alogia (poverty of speech). Loxapine, thioridazine, and haloperidol are used to treat the positive symptoms of schizophrenia, such as hallucinations.

Question 22. 
The nurse is educating a client about MAOI and diet. Which dietary selection by the client indicates that the nurse's teaching was effective?
(a) egg-white omelet with a cup of yogurt
(b) baked chicken breast with green beans
(c) scrambled eggs with sausage and toast
(d) hot dog with sauerkraut, beans, and a fruit cup
Answer:
(b) baked chicken breast with green beans

Rationale:
A baked chicken breast with green beans is an acceptable diet choice for the client on MAOI. Clients on MAOI should avoid all foods containing tyramine, which can cause hypertensive crisis. Yogurt, sausage, and sauerkraut are high in tyramine.

Question 23. 
The clinic nurse is seeing a client who is taking duloxetine hydrochloride. When updating the client's medical history, for which condition mentioned by the client would the nurse notify the health care provider?
(a) recent worsening of insomnia
(b) unplanned weight loss of 6 pounds
(c) uncontrolled narrow-angle glaucoma
(d) removal of a benign skin cancer on the leg
Answer:
(c) uncontrolled narrow-angle glaucoma

Rationale:
Uncontrolled narrow-angle glaucoma is a contraindication for duloxetine hydrochloride therapy, as it can further increase pressure in the eye. The nurse should notify the health care provider so that an alternative medication may be considered, along with treatment of glaucoma. Insomnia is a common side effect of duloxetine hydrochloride.

The nurse can educate the client about nonpharmacologic methods to improve sleep. Decreased appetite and weight loss are side effects of the medication. If the weight loss is too fast or too much, the health care provider should be notified; otherwise, small fluctuations in weight over a long period of time should not be a concern. Removal of a skin cancer, while important, is not an anticipated side effect of duloxetine hydrochloride.

Question 24. 
The ED nurse has admitted a client with suspected overdose of tricyclic antidepressants.
Which signs and symptoms does the nurse expect to find in this client? Select all that apply.
(a) confusion
(b) dry mouth
(c) bradycardia
(d) dysrhythmias
(e) constricted pupils
(f) flushing of the skin
Answer:
(a) confusion
(b) dry mouth
(d) dysrhythmias
(f) flushing of the skin

Rationale:
Signs and symptoms of overdose with tricyclic antidepressants include confusion, dry mouth, dysrhythmias, and flushing of the skin. Tachycardia and dilated pupils are other signs. Cardiac rhythm may progress to intraventricular blocks, complete atrioventricular blocks, and ventricular fibrillation. The nurse should prepare for gastric lavage to avoid further absorption of the medication.

Question 25.
The nurse is training persons enrolled at a community center information session on administering naloxone (Narcan) to opioid overdose victims. Which information should the nurse include when teaching this group? Select all that apply.
(a) is administered by subcutaneous injection in the abdomen, thigh, or arm
(b) works instantly
(c) lasts 30 minutes
(d) can be administered by lay persons, provided they have had training
Answer:
(c) lasts 30 minutes
(d) can be administered by lay persons, provided they have had training

Rationale:
A single dose starts to wear off within 30 minutes and is essentially gone after 90 minutes. Bystanders, with education and training, are able to successfully administer naloxone (Narcan) to persons experiencing an opioid overdose. Naloxone (Narcan) is administered by intramuscular (IM) injection in the muscle of the arm, thigh, or buttocks. Alternately, the medication may be administered by nasal spray. The medication typically works within 5 minutes.

Question 26. 
The nurse is caring for a client receiving total parenteral nutrition (TPN). During the assessment, the nurse notes absence of breath sounds on the right side, where the central catheter is placed. Which of the following does the nurse suspect is responsible for this abnormal assessment finding?
(a) air embolism
(b) fluid overload
(c) pneumothorax
(d) refeeding syndrome
Answer:
(c) pneumothorax

Rationale:
A pneumothorax is one of the complications of TPN. It is caused by improper central catheter placement or by a catheter that has migrated. Absence of breath sounds on the affected side, chest or shoulder pain, tachycardia, cyanosis, and sudden shortness of breath are indications of pneumothorax. The nurse should notify the health care provider and prepare the client for a portable chest X-ray. An air embolism is another complication of TPN. Signs and symptoms of air embolism include respiratory distress; a weak, rapid pulse; chest pain; dyspnea; hypotension; and a loud churning sound auscultated over the pericardium. 

Fluid overload would not present as absence of breath sounds; instead, expected findings include hypertension, bounding pulses, increased respiratory rate, distended veins in the hands and neck, and moist crackles. Signs of refeeding syndrome include arrhythmias, vomiting, shortness of breath, weakness, ataxia, and seizures. It occurs in severely malnourished clients who are undergoing nutritional replacement therapy.

Question 27. 
The nurse is reviewing a client's morning medication orders. Which of the following orders would prompt the nurse to call the health care provider for order clarification?
(a) famotidine 20 mg PO BID
(b) haloperidol 15 mg IM q4h prn
(c) lithium carbonate 300 mg PO TID
(d) amoxicillin 500 mg PO ql2h * 7 days
Answer:
(b) haloperidol 15 mg IM q4h prn

Rationale:
The typical dosage for haloperidol is 2 - 5 mg IM. This dose is three times the normal dose and should be questioned by the nurse. Options 1, 3, and 4 reflect average dosing ranges for those medications.

Question 28. 
A client with hypertension asks the nurse to explain how amlodipine besylate (Norvasc) lowers her blood pressure. The nurse gives which explanation to the client?
(a) "It prevents calcium from entering the smooth muscle, which relaxes the blood vessels to lower heart rate and blood pressure."
(b) "It is a diuretic that works by removing extra sodium and water from the body through the kidneys, which helps lower blood pressure."
(c) "It causes the body to produce less angiotensin, which allows blood vessels to relax and open up, therefore reducing blood pressure."
(d) "It lowers blood pressure by lowering the heart rate and the workload of the heart, and decreases the amount of blood pumped out of the heart."
Answer:
(a) "It prevents calcium from entering the smooth muscle, which relaxes the blood vessels to lower heart rate and blood pressure."

Rationale:
Norvasc is a calcium channel blocker. Calcium causes the heart to beat stronger and harder, so by blocking it, the blood pressure is lowered. Option 2 describes the action of diuretics, such as furosemide. Option 3 describes ACE (angiotensin-converting enzyme) inhibitors, such as lisinopril. Option 4 describes the action of beta-blockers, such as metoprolol tartrate.

Question 29. 
The nurse is caring for a client who is taking bethanechol chloride (Urecholine) for neurogenic bladder. Which of the following does the nurse understand is correct concerning this medication?
(a) This is the primary treatment for clients with a urinary obstruction.
(b) If the client cannot swallow pills, the medication may be given by the IV or IM route.
(c) Urecholine should be given with food to prevent nausea and vomiting.
(d) Atropine sulfate should be readily available when a client receives this medication. 
Answer:
(d) Atropine sulfate should be readily available when a client receives this medication. 

Rationale:
Atropine sulfate is the antidote for Urecholine, which can cause transient complete heart block. Urecholine is contraindicated in clients with urinary obstructions or strictures. It should never be given by IV or IM routes. It should be given on an empty stomach to decrease the risk of nausea and vomiting.

Question 30. 
The nurse is caring for a client taking sulfonamides to treat a urinary tract infection. Which of the following should the nurse monitor for in this client? Select all that apply.
(a) fever or sore throat
(b) reddish-pink urine
(c) side effects such as dyspnea, chest pains, chills, and cough
(d) urinary output of 1200 mL daily to minimize the risk of renal damage
(e) the need to decrease the dosage if the client takes warfarin sodium (Coumadin) or phenytoin (Dilantin)
Answer:
(a) fever or sore throat
(d) urinary output of 1200 mL daily to minimize the risk of renal damage
(e) the need to decrease the dosage if the client takes warfarin sodium (Coumadin) or phenytoin (Dilantin)

Rationale:
The nurse should monitor for fever or sore throat, as sulfonamides can cause leukopenia, hemolytic anemia, thrombocytopenia, and agranulocytosis. If the client develops a fever or sore throat, the health care provider should be notified. The client should drink 8-10 glasses of water daily to maintain daily urinary output of 1200 mL to minimize the risk of renal damage.

If the client takes warfarin sodium, phenytoin, or oral hypoglycemics, it may be necessary to reduce the dosage of the medication: sulfonamides potentiate the effects of those drugs. Sulfonamides can cause the urine to turn dark brown or red when taken with some combination sulfonamide medications. Dyspnea, chest pains, chills, and cough are side effects of urinary tract antiseptics such as Macrodantin and Macrobid.

Question 31. 
The nurse is caring for a client diagnosed with tuberculosis. The physician plans to treat the client with a first-line medication. Which medication should the nurse prepare to administer?
(a) rifampin
(b) ciprofloxacin
(c) levofloxacin
(d) streptomycin
Answer:
(a) rifampin

Rationale:
Rifampin is one of the first-line agents for tuberculosis. Ciprofloxacin, levofloxacin, and streptomycin are second-line medications for tuberculosis.

Question 32. 
The nurse is caring for a client who complains of a headache with a pain level of 5 on a scale of 1 to 10, Which PRN pain medication order is most appropriate for the nurse to administer?
(a) morphine 2 mg IV q6h PRN
(b) aspirin 325 mg PO q6h PRN
(c) acetaminophen 650 mg PO q6h PRN
(d) nitroglycerin 0.4 mg sublingually every 5 minutes, up to 3 doses over 15 minutes
Answer:
(c) acetaminophen 650 mg PO q6h PRN

Rationale:
Acetaminophen is commonly given to relieve mild headache pain, and this is a typical dose. Morphine is an opioid and would not be the first choice, due to the risk of dependency and/or abuse. It may also make the client drowsy, which increases the risk of falls. Aspirin increases the risk of bleeding, especially at doses greater than 81 mg, so this would not be a first choice. Nitroglycerin is given for angina pain, not headaches.

Question 33. 
The nurse is preparing to administer 1(b)4 mL of liquid medication via oral syringe. Which of the following actions by the nurse indicate an understanding of how to give oral medications via syringe?
(a) The nurse uses either an oral or parenteral syringe to administer the medication.
(b) The nurse pours 10 mL of the medication into a 30 mL medicine cup, then adds (b)4 mL with a 3 mL syringe.
(c) The nurse pours 10 mL of the medication into a 30 mL medicine cup, then adds (b)4 mL with a 5 mL syringe.
(d) The nurse pours 10 mL of the medication into a 30 mL medicine cup, then slowly adds the remainder until it is almost halfway between the 10 mL mark and 15 mL mark.
Answer:
(b) The nurse pours 10 mL of the medication into a 30 mL medicine cup, then adds (b)4 mL with a 3 mL syringe.

Rationale:
Administering 12.4 ml of liquid medication requires using a 3 mL syringe to most accurately draw up the 2.4 mL to add to the 10 mL in the medicine cup. A 5 mL syringe is less accurate and increases the risk of an incorrect dosage. Only oral syringes should be used to administer oral medications. In option 4, the nurse is essentially estimating the amount to add to the cup, increasing the risk of an incorrect dosage.

Question 34.
The nurse is caring for a client with a staph infection. The client has orders for vancomycin 15 mg/kg per 12 hours. The client weighs 136 pounds. How much of this medication will the client receive every 12 hours? 
Answer:

\(\frac { 136 lbs }{ 2.2 kg }\)	Convert pounds to kilograms.
= 61.8 kg = 62 kg.	Round up to find patient's weight in kilograms.
15 mg x 62 kg	Multiply milligrams of vancomycin by client's weight in kilograms.
= 930 mg	Solve for dose per 12 hours.

Question 35. 
The nurse is teaching a group of student nurses about drug safety. Keeping in mind Joint Commission guidelines, which of the following does the nurse teach the students? Select all that apply.
(a) "Do not abbreviate drug names."
(b) "Use daily instead of QD, Q.D., or q.d."
(c) "Rectum can be abbreviated PR, R, or Per Rec."
(d) "Use OD to indicate right eye for eye medications."
(e) "Use the letter u to indicate units, such as with insulin."
Answer:
(a) "Do not abbreviate drug names."
(b) "Use daily instead of QD, Q.D., or q.d."

Rationale:
Joint Commission guidelines dictate which abbreviations can or cannot be used. Drug names should be spelled out fully. For example, MS can be magnesium sulfate or morphine sulfate; therefore, drug abbreviations should be avoided. The word daily should no longer be abbreviated, but spelled out in full. The rectal route should not be abbreviated, but should be spelled out as per rectum. The designation of right eye or left eye should be spelled out and not abbreviated. The word units should notbe abbreviated, since it can be confused with a zero, the number 4, or the term cc.

Question 36. 
The night nurse is preparing to pull night medications for a client. Levofloxacin is scheduled to be given at 0030. The nurse will give this medication at which time?
(a) 1:30a.m.
(b) 1:30 p.m.
(c) 11:30 p.m.
(d) 12:30 a.m.
(e) 12:30 p.m.
Answer:
(d) 12:30 a.m.

Rationale:
Medication times are given in military times, based on a 24-hour clock. Midnight is 2400 hours, at which time the clock resets to 0000. Medications due at 0030 are then due at 12:30 a.m. Using a 24-hour clock instead of a 12-hour clock eliminates the need to designate a.m. or p.m. for medication times.

Question 37. 
The nurse has an order to administer enoxaparin (Lovenox) 40 mg subcutaneously. When the automatic medication dispenser opens, however, the nurse finds enoxaparin 80 mg in the pocket. Which is the correct action by the nurse?
(a) notify the pharmacy to correct the error
(b) skip the morning dose of the medication
(c) call the health care provider for order clarification
(d) waste half of the enoxaparin and give the remaining 40 mg
Answer:
(a) notify the pharmacy to correct the error

Rationale:
The nurse should notify the pharmacy to correct the error. A pharmacy tech should come and place the proper dose of the medication in the dispenser pocket. Not reporting the error to the pharmacy may lead to a client receiving double the ordered dose if the nurse administering it is not paying close attention. Skipping the medication increases the risk of clots. There is no need for an order clarification from the health care provider. Wasting half of the medication does not solve the problem; it leaves others vulnerable to a dosing error and still allows room for error if the amount wasted is not precise. The nurse should never try to adapt an incorrect dosing pack by wasting it.

Question 38.
The nurse is caring for a client who has an order for ceftriaxone IV. The client is awake and alert and has been taking PO medications and eating. The IV ceftriaxone is not available in the automatic medication dispenser. What should the nurse do next?
(a) hold the medication since the client is afebrile
(b) call the pharmacy to send up the missing IV medication
(c) obtain the PO ceftriaxone from the medication dispenser and administer it
(d) call the health care provider and see if the client can be switched over to oral ceftriaxone
Answer:
(d) call the health care provider and see if the client can be switched over to oral ceftriaxone

Rationale:
If the client is eating and tolerating meals, the nurse should ask the health care provider if f    the client can take the medication in PO form. The oral form is more convenient for the client and lessens the need to repeatedly access the IV, which increases the risk of infection. If the health care provider declines to change the form of the medication, the nurse would then contact the pharmacy for the missing medication. The nurse should not hold medication without notifying the health care provider, nor should the nurse administer medication in a form different from what was ordered.

Question 39.  
The nurse is preparing to administer furosemide IM to a 6-month-old client with edema.
Which location is the preferred injection site for this client?
(a) the gluteus medius
(b) the vastus lateralis
(c) the dorsogluteal site
(d) the ventrogluteal muscle 
Answer:
(b) the vastus lateralis

Rationale:
The vastus lateralis is the preferred injection site for babies under 7 months of age. It may be used from birth to adulthood. The gluteus medius and the ventrogluteal site should be used only in infants older than 7 months. The dorsogluteal site should not be used for injections due to the risk of damaging the sciatic nerve and puncturing blood vessels.

Question 40.
The nurse is caring for a client with breast cancer who has an order for doxorubicin IV. The nurse anticipates which common side effect of this medication?
(a) permanent hair loss
(b) halos around objects and blurred vision
(c) red urine for 1 - 2 days after administration
(d) facial flushing and red streaking along the vein 
Answer:
(c) red urine for 1 - 2 days after administration

Rationale:
Doxorubicin causes red urine for 1 - 2 days after administration. Hair loss is temporary; regrowth begins 2-3 months after treatment is completed. Visual changes are not a side effect of this medication. Facial flushing and red streaking along the vein only occur when infused too rapidly; therefore, this should not be an expected side effect.