Medication and Blood Products

The nurse educates the patient taking atorvastatin that she may need to return to the clinic for which laboratory test?

The patient has consistently reported 8/10 pain levels despite large doses of morphine being supplied. The nurse brings the patient’s IV morphine dose to the room to administer it. The patient states, “That is way more medication than the nurse gave me all night.” The nurse verifies the dose and amount and finds it consistent with the order and the amount that has been removed from the Pyxis. Which action by the nurse is appropriate?

The provider orders hypertonic saline for a patient. The patient’s wife wants to know why this therapy is being given. Which of the following is the best statement regarding the rationale for this therapy?

A 15-year-old patient has been diagnosed with non-mosaic Turner syndrome. The nurse prepares to educate the patient on which medication?

A young adult patient with phenylketonuria who is taking tyrosine supplements complains of severe headaches. Which of the following responses by the nurse is most appropriate?

The nurse is caring for a patient with bacterial meningitis. The provider has prescribed mannitol to this patient. The patient’s mother asks why this medication has been prescribed. Which of the following responses by the nurse is most appropriate?

The nurse is assigned to a patient with acute lymphocytic leukemia (ALL) about to undergo his first round of chemotherapy. The patient’s WBC is 120,000/uL and his LDH is 3 times the upper limit of normal. Which intervention is most important?

The nurse is assigned a patient with long-standing type 1 diabetes mellitus who has severe pneumonia. Before dinner, the patient receives a larger than normal dose of her insulin NPH by mistake. The following morning, the patient is hyperglycemic. How does the nurse explain this phenomenon to the patient?

The nurse is caring for a patient with unilateral left renal artery stenosis secondary to atherosclerotic disease. The patient is placed on an angiotensin converting enzyme (ACE) inhibitor and serum creatinine rises by 3 mg/dL. What is the most likely explanation for this reaction to this medication?

The nurse is asked to assist with a 38-year-old woman who desires oral birth control pills. The patient decides on an estrogen-progesterone formulation because she still desires to get her monthly periods. The patient states she is a heavy smoker. Which of the following is the most accurate statement about the smoking and this medication?

The nurse is assigned to care for a patient with a history of pulmonary embolism who is on anticoagulation therapy. The patient takes warfarin and her last INR check was therapeutic. Which of the following statements about warfarin is most accurate?

A young patient presents to the ER after consuming a full bottle of acetaminophen about 12 hours ago. She has nausea, vomiting, and malaise. Within hours, she develops right upper quadrant (RUQ) pain. Exam is significant for severe RUQ tenderness and a positive Murphy’s sign. The nurse anticipates administering which medication?

The patient is receiving high-dose prednisone for an acute flare up of rheumatoid arthritis. Which adverse event is associated with high-dose prednisone? Select all that apply.

A patient with moderate asthma is being treated for a recent myocardial infarction. Which of following statements most accurately describes the use of cardioselective beta-blockers in this patient?

The nurse is caring for a patient with a bleeding gastric ulcer. The patient calls the nurse asking for ibuprofen for a tension headache. Which response by the nurse is most appropriate?

The nurse is caring for a patient with a suspected methicillin resistant staphylococcal aureus (MRSA) skin infection. While awaiting wound cultures and sensitivities, the patient is empirically given vancomycin. When the nurse starts the IV infusion of vancomycin, the patient acutely develops a pruritic, erythematous rash that involves the face, neck and upper torso. Which action does the nurse take first?

The nurse is assigned to care for a patient with a history of thromboembolism but in whom conventional anticoagulant therapy is contraindicated due a recent spinal injury. The nurse adds which preventative measure to the patient’s plan of care to prevent thromboembolism?

The nurse is on the treatment team for an African American patient who is being hospitalized for a recent hypertensive emergency. The nurse anticipates administering which medication?

The nurse has been caring for a patient who will be discharged home today. Patient has an open wound in his left thigh that has been treated under vacuum. He has advanced COPD and has been requiring oxygen to maintain his oxygen saturation. Patient has been undergoing intravenous antibiotic therapy with vancomycin and piperacillin/tazobactam for a wound infection and has no mobility in his left leg. Which of the following statements is correct concerning the discharge needs of this patient? Select all that apply.

The patient presents to the emergency department and states, "I don't remember being bitten, but it looks like I have a spider bite on my foot." Upon assessment, the nurse notes cellulitis and a large boil that is subsequently lanced and drained. The nurse anticipates administering which antibiotic?

A patient is receiving IV vancomycin for gram-positive sepsis. The nurse notes the patient’s vancomycin trough is 28 mcg/mL. The patient is due for a dose. Which action by the nurse is most appropriate?

A patient’s vancomycin trough, which was drawn 30 minutes after the dose, was 32 μg/mL. Which action by the nurse is most appropriate?

The patient with pneumonia who has been taking PO azithromycin for four days contacts the clinic to report itching and burning in her vagina. Which response by the nurse is most appropriate?

A patient recently diagnosed with type 2 diabetes mellitus has been unable to control blood glucose levels with diet and exercise. Which medication does the nurse anticipate the provider to order?

The nurse is caring for a patient recently diagnosed with type 2 diabetes mellitus. The provider has prescribed metformin. Which lab value, if present in the patient’s chart, prompts the nurse to hold the dose and contact the provider?

A patient with type 2 diabetes mellitus has been prescribed insulin detemir. When does the nurse administer the first dose?

A pregnant woman is diagnosed with an ischemic stroke and alteplase is discussed. The nurse is aware alteplase is in which pregnancy category?

A patient has been diagnosed with toxic megacolon. Which interventions are appropriate for this patient? Select all that apply.

The patient with heart failure has been prescribed an angiotensin-converting enzyme inhibitor (ACEI). The patient reports to the nurse, “I can’t take this medication anymore. This cough is so annoying! It keeps me awake at night.” Which response by the nurse is most appropriate?

The patient with signs of sepsis was started on a broad spectrum antibiotic. The patient's blood culture has grown gram-positive cocci in clusters resistant to penicillin but susceptible to methicillin. Which antibiotic is appropriate?

A patient with heart failure has been prescribed a dobutamine infusion. The nurse is aware this drug will most strongly affect which of the patient’s receptors?

A patient presents in acute decompensated heart failure (ADHF) with a blood pressure of 75/42 mmHg. The nurse starts a continuous dopamine infusion as ordered at 0952. When does the nurse expect the peak effect to be achieved?

A patient with plaque psoriasis has plaques over 15% of the body. Which therapy is appropriate for this patient?

A toddler has been diagnosed with atopic dermatitis in a pediatric clinic. Which treatment will likely be started first?

A 10-year-old patient presents to the school nurse following a class party complaining of pain, arm swelling, and a swollen mouth after a bee sting. Lungs are clear with good air movement. Which action does the nurse take first?

A patient presents to the emergency department complaining of intractable epistaxis. Upon assessment, the nurse notes petechiae and ecchymosis covering the patient’s chest and arms. The patient is otherwise well. Laboratory results are normal with exception of the patient’s platelet count, which is abnormally low (29,000/microL). The nurse anticipates an order for which medication?

A pregnant patient with pre-eclampsia is receiving a magnesium sulfate infusion. Which early symptom, if present in the patient, indicates the patient’s magnesium level is becoming toxic?

The nurse is caring for a patient who develops severe hyperkalemia accompanied by ECG changes. Which medication(s) does the nurse anticipate administering? Select all that apply.

The 30-year-old female patient presents to the emergency department complaining of double vision, bilateral facial drooping, diffuse muscle weakness, difficulty swallowing, and shallow respirations. The nurse anticipates administering which medication to confirm this patient’s diagnosis?

Which characteristic, if found in the patient’s chart, would prompt the nurse to hold the ordered bumetanide and contact the provider?

The 48-pound patient is in the intensive care unit with hypovolemic shock. Intravenous norepinephrine has been ordered to run continuously at 0.05 mcg/kg/min. The pharmacy dispenses the medication in a 1 mg/mL concentration. What is the rate in milliliters per hour that the patient will receive? Enter your answer to the hundredth decimal.

The infant who weighs 3.8 kg has a total fluid order of 120 ml/kg/day. Continuous infusions include dexmedetomidine running at 0.38 mL/h, morphine running at 0.2 mL/h, dopamine at 0.4 mL/h, and midazolam at 1.2 mL/h. At what rate will the nurse program the patient’s total parenteral nutrition to meet the total fluid goal? Enter your rate in mL/h to the tenth decimal place.

Which blood pressure is an indication the 34-year-old patient requires an increase in norepinephrine infusion dosage?

Which adverse effect of gabapentin is of greatest concern for the 85-year-old patient?

Which order does the nurse complete first in the patient with acute respiratory failure?

The nurse is assigned to care for a patient who has long-standing type 1 diabetes mellitus. Which of the following orders for subcutaneous insulin is most appropriate?

The nurse is assigned to care for a 65-year-old male patient who is diagnosed with atrial fibrillation. The nurse realizes during the shift report that six hours ago she administered 0.6 mg of this patient’s antiarrhythmic medication instead of 6.0 mg. Which action does the nurse perform first?

An unconscious patient presents to the emergency department following a benzodiazepine overdose and is noted to have the words, “Do Not Resuscitate,” tattooed across the chest. Which action by the medical team is most appropriate?

The nurse is assigned to care for a 45-year-old G2P1 female at 35 weeks estimated gestational age who is admitted with preeclampsia. On morning rounds, the patient says she is having considerable abdominal pain, so the provider writes multiple medication orders for her. Which medication order can the nurse carry out without clarification?

A 12-year-old male patient has received the first dose of the human papillomavirus vaccine in May of this year. When will the nurse schedule an appointment for him to come back to receive his second and third doses?