Medication and Blood Products

The nurse is caring for a patient receiving total parenteral nutrition (TPN). After morning rounds, the nurse notices the rate of TPN infusion is slower than what is ordered for the patient and is three hours behind schedule. There are no nursing notes, and the rate was not mentioned on sign-out. Which initial action is most appropriate?

The 4-hour-old neonate in the nursery begins making rhythmic movements with the hands and smacking of the lips. An electroencephalogram is performed, and seizures are observed. The nurse prepares to administer which medication?

The nurse is assigned to a 4-year-old patient admitted with a vaso-occlusive crisis secondary to sickle cell anemia. The boy is in agonizing pain. He has apparently taken off his hospital wristband. Before administering the pain medication, the nurse should perform which of the following actions?

The nurse is caring for a patient admitted for nephrolithiasis. The patient is experiencing severe pain and the provider writes the following order: “5 mg MSO4.” Which action by the nurse is most appropriate?

The nurse is assigned to a 55-year-old patient admitted for diabetic ketoacidosis. The provider writes the patient’s insulin regimen on the admission orders as follows, - “insulin NPH 25 IU.” Which action by the nurse is most appropriate? 

The nurse is assigned to a 52-year-old patient who is admitted for elective cholecystectomy. While undergoing preoperative evaluation, the patient mentions to the nurse an allergy that is not documented in the health record. Which action by the nurse is most appropriate?

The 29-year-old female patient who presents at six weeks postpartum for a routine checkup requests to start taking oral contraceptives again. The patient reports successful breastfeeding and a desire to continue for the next year. Which oral contraceptive is recommended for this patient?

The nurse is providing disease management education to the parents of a 10-year-old patient newly diagnosed with type 1 diabetes mellitus. Which instruction is appropriate to give the family? 

The nurse is assigned to a 32-year-old G1P0 female at 30 weeks estimated gestational age who presents with pre-eclampsia. On physical assessment, the patient’s blood pressure is 180/125 mm Hg. The patient is prescribed magnesium sulfate by the provider. Which of the following is the most indicative that magnesium sulfate has been effective?

The patient with major depressive disorder who has been off medication for a couple of years has been prescribed fluoxetine (Zoloft) again. The patient states, "I'm concerned about starting this medication again. I'm a taxi driver and it always used to make me so sleepy." Which instruction from the nurse is appropriate?

The older adult patient is brought to the emergency department with sudden onset confusion, agitation, and hallucinations. The patient's past medical history is significant for type 2 diabetes managed with glyburide, anxiety managed with lorazepam, and insomnia managed with zolpidem. Upon assessment, the patient's heart rate and rhythm are regular, lungs are clear to auscultation, and bowel sounds are present. Vital signs are normal, with exception of a slightly elevated heart rate. Which is the most likely cause of the patient's symptoms?

A confused, minimally arousable patient is brought to the emergency department via ambulance. The patient is hypotensive and bradypneic. Paramedics report finding an empty bottle of diazepam next to the patient. The nurse prepares which therapy?

The elderly patient is at risk for falls related to urinary incontinence. Which intervention is appropriate?

The patient has a peripherally inserted central catheter (PICC) for the long-term administration of parenteral nutrition, oxacillin, and gentamicin. Which assessment findings, if present in the patient, indicate the patient is experiencing a complication of the PICC line? Select all that apply.

The patient presents to the emergency room complaining that his heart is racing and he feels dizzy. His heart rate is 220 bpm, his blood pressure is 80/40 mmHg, and his capillary refill is 5 seconds. He is diaphoretic and is becoming increasingly lethargic. The nurse anticipates which order first?

The patient with a heart rate of 233 bpm has been diagnosed with supraventricular tachycardia on electrocardiogram (ECG). The nurse prepares to administer which medication?

The 4-year-old child is admitted with measles. Which medication does the nurse prepare to administer initially?

The 32-year-old patient presents to the emergency department complaining of difficulty breathing, cough, and chills. Vital signs are notable for a temperature of 38.4°C, heart rate 118 bpm, respiratory rate 24, oxygen saturation 87% on room air, and blood pressure of 98/62 mmHg. Upon assessment, the nurse notes nasal flaring, diminished breath sounds in the right upper lobe, and subcostal retractions. Capillary refill time is 4 seconds. The patient admits waking up in a pool of vomit after binge drinking 3 nights ago. Which orders does the nurse anticipate? Select all that apply.

The 25-week-gestation neonate is ordered to receive ampicillin 100 mg/kg/day intravenously divided into doses every 12 hours immediately after birth. The neonate weighs 745 grams. The pharmacy dispenses ampicillin in a 5 mL vial that contains 125 mg. How many milliliters will the nurse administer with each dose? Round your answer to the nearest tenth decimal.

The 32-week-gestation, 1.9 kg neonate has been prescribed intravenous ampicillin for concerns for sepsis. The dose is 150 mg/kg/d divided into 2 doses administered over 15 minutes. The pharmacy dispenses the medication in a 5 mL vial that contains 250 mg of medication. At what rate will the nurse program the medication to infuse? Round your answer to the nearest tenth decimal.

The nurse is providing education to the patient who is starting warfarin for treatment of a deep vein thrombosis (DVT). Which statements are included in teaching? Select all that apply.

The nurse instructs the patient with diabetes mellitus to store prefilled insulin syringes in which location?

A child with “staring fits” is diagnosed with absence seizures. The nurse prepares patient education materials on which medication?

The patient is undergoing placement of an antibiotic-impregnated central line catheter for vancomycin infusions. Which statements are true about this type of catheter? Select all that apply.

The nurse is performing an assessment of an infant born 8 hours ago. The infant’s POC blood glucose level is 25 mg/dL. Which action does the nurse take first?

The nurse must reconstitute a medication for intravenous administration. Using a syringe, the nurse draws up an appropriate amount of diluent. Which action does the nurse should take next?

The nurse anticipates administering which medication to the patient with osteomyelitis? 

A patient with longstanding alcohol abuse problems is admitted for COPD exacerbation. After reaching the floor, the patient becomes disoriented, anxious, tachycardic, diaphoretic, and tremulous. His oxygen saturation is 95% on 2 L supplemental oxygen via nasal cannula. Which intervention is most appropriate for this patient?

The provider orders an infusion of 10mL/kg/hr for the patient who weighs 154 lbs. The nurse arranges the IV infusion pump to dispense which flow rate?

The nurse is caring for the patient with fever, chills, and a cough productive of green sputum. The chest X-ray shows a hazy opacity. The nurse checks the patient's medical history for sensitivity to which medication? 

The nurse is providing medication teaching to the patient who was just prescribed warfarin. Which statements does the nurse include in teaching? Select all that apply. 

The nurse is caring for the woman in labor whose body temperature is 102.8°F and heart rate is 114 bpm. Which order does the nurse carry out first?

The nurse is caring for the patient with intestinal obstruction who is receiving total parenteral nutrition (TPN). The nurse reviews which lab results to ensure the patient is tolerating the infusion? Select all that apply. 

The pediatric patient is hospitalized for fever, nausea, vomiting, and diarrhea. Capillary refill is >2 seconds. The nurse anticipates an order for which intravenous infusion?

The patient with angina and claudication with walking is prescribed isosorbide dinitrate (Isordil). The nurse bases medication teaching on which understanding of the drug's mechanism of action?

The patient with diabetes is brought to the emergency department with severe confusion and is unable to follow commands. A point-of-care (POC) glucose measurement reveals a blood sugar of 44 g/dL. The nurse begins a 50 mL infusion of D50W. Which action does the nurse take next?

The patient with an ileus is on bed rest after abdominal surgery. A nasogastric tube (NG) is in place because of severe vomiting and significant abdominal distention. Which statement is true regarding management of this patient? 

The day after administering a blood product to the anemic patient, the nurse learns it was contaminated with a fungal pathogen due to improper processing. The nurse is vigilant for which symptom(s)?

The patient is scheduled for bariatric surgery in one month. During the preoperative physical, the nurse notes the patient takes St. John's wort. The nurse instructs the patient to stop taking St. John's wort 5 days prior to the surgery for which reason?  

The patient with advanced liver disease is being evaluated for moderate hematemesis, tachycardia, and hypotension. An esophagogastroduodenoscopy (EGD) confirms the patient has esophageal varices. Which is the priority action by the nurse?

Which medication is considered to be a first-generation antipsychotic?

The nurse is preparing for an infant’s two-month well-baby check-up. Which immunizations does the nurse prepare? Select all that apply.

The nurse prepares a diphtheria, tetanus, and pertussis (DTaP) vaccination for a 6-year-old patient. The patient’s mother states, “Wait! He’s already gotten that vaccine, several times when he was younger. I have it written down in his records.” Which response by the nurse is appropriate?

The nurse is preparing a Haemophilus influenzae type b (Hib) immunization for the 2-month-old patient. The baby’s mother states, “I recently read the influenza vaccine isn’t given until at least a year. Are you sure he should be getting this now?” Which response by the nurse is most appropriate?

The nurse reviewing the vaccination record of a 12-month-old infant expects the infant to have completed which vaccine series?

The nurse is preparing for the well-baby visit of the 6-month-old who is up-to-date on vaccines. Which vaccinations does the nurse prepare for the visit? Select all that apply.

The 13-year-old female patient presents to the clinic in January to begin the vaccine series for human papillomavirus. The nurse instructs the patient’s mother to schedule an appointment for the next vaccine in the series during which month at the earliest?

The baby born at 32 weeks’ gestation to a mother who is hepatitis B surface antigen negative (HBsAg-negative) is taken to the Neonatal Intensive Care Unit (NICU) for care. The neonate, who weighs 1.8 kg, requires continuous positive airway pressure of 7 cm H20, intravenous fluids containing dextrose, and intravenous caffeine. After getting consent from the mother, when is the most appropriate time to administer the hepatitis B vaccine to the baby?

The 34-week-gestation neonate is born weighing 1.7 kg to a mother who is hepatitis B surface antigen (HBsAg) positive; all other infectious disease serologies are negative. Which orders are appropriate for this patient? Select all that apply.

The 1.9 kg neonate is born precipitously via vaginal delivery to a 32-year-old mother who received no prenatal care or infectious disease serology testing before delivery. The mother has a history of intravenous drug use. Which intervention does the nurse perform first?