Routes of Administration

The nurse most anticipates administering total parenteral nutrition (TPN) to the patient with which condition?

After receiving a dose of antibiotics, a 34-year-old man develops an itchy rash, throat swelling, shortness of breath, lightheadedness, and hypotension. Which of the following is the best next step?

An 18-year-old patient asks the nurse for assistance in choosing a birth control method. She tells the nurse that she smokes infrequently and has trouble remembering to take her daily vitamins. Which method does the nurse recommend to the patient?

The nurse is providing pre-procedure education to a patient prior to surgery requiring general anesthesia. Which question by the patient indicates a need for further teaching?

A nurse is taking care of a patient on continuous heparin sodium by IV at 1500 units per hour. Pharmacy dispenses the IV bags of 500 mL D5W with 15,000 units of heparin sodium. At which rate does the nurse set the infusion pump for this patient?

The 35-year-old patient presents to the emergency department with nausea, vomiting, and diarrhea for the past week. Vital signs are significant for a heart rate of 135 bpm and a blood pressure of 75/40 mmHg. The nurse anticipates which order?

The patient presents to the urgent care clinic with a hand laceration sustained while using pruning shears in the garden. Which vaccine is most important for this patient?

The patient presents to the clinic following being bitten by a bat while cleaning out a barn. The nurse anticipates administering which vaccine?

A 35-year-old client with a three-day history of vomiting is admitted with dehydration. The provider prescribes 1 liter of normal saline solution to infuse over 4 hours. As the nurse prepares to insert an intravenous (IV) catheter, she’s unable to palpate the vein at the intended insertion site. How does the nurse proceed?

Which central venous access site is preferred in an adult with normal kidney function to reduce the risk for central line-associated bloodstream infection?

The provider tells the nurse that the goal of therapy for a patient with congestive heart failure (CHF) and acute pulmonary edema is preload reduction. To accomplish this, the nurse anticipates administering which of the following medications?

The nurse is caring for a patient with blood type A+, who requires a transfusion of packed red blood cells. The nurse receives a unit of blood from the blood bank that is labeled AB -. Which of the following is the best course of action for the nurse to take?

An alert patient requires a nasogastric (NG) tube for abdominal decompression. The tube is placed to the appropriate depth, but the nurse is unable to hear a rush of air when auscultating over the patient’s stomach and cannot aspirate gastric contents for pH testing. Which of the following is the most appropriate next course of action?

The nurse is inserting a nasogastric (NG) tube into a patient, when the patient begins to cough, wheeze, and have difficulty breathing. Which of the following is the next most appropriate intervention?

The nurse is assessing a patient with a 20-gauge intravenous catheter is the right hand through which vancomycin is infusing. The nurse notes the IV insertion site is edematous and erythematous. Which of the following is the most appropriate next course of action?

The nurse assesses the insertion site of an intravenous catheter through which the patient is receiving amphotericin. The nurse notes erythema, edema, and tenderness immediately proximal to the insertion site. Which of the following terms is most appropriate for the nurse to use to document this finding?

The nurse is preparing to administer hyaluronidase to a patient who experienced an IV extravasation. Which of the following statements should the nurse use to describe the rationale for using this drug to the patient?

The nurse is caring for a patient who requires four intravenous drugs with four different pHs to be infused through an intravenous catheter that was just placed. In which order must they be administered to help prevent extravasation? Place the answers in the correct order.

A 5-year-old boy presents with recent ingestion of an entire bottle of chewable pediatric acetaminophen. The child’s mother learned of the ingestion two hours after it occurred and immediately brought the child to the closest emergency department an hour away. The patient weighs 41 pounds. Which of the following prescriptions should the nurse most likely anticipate initially?

The patient is receiving intravenous gentamicin to treat a gram-negative infection. The nurse draws a gentamicin trough level immediately prior to the 4th dose; the result is 2.2 µg/mL. Which of the following conclusions would be most appropriate given this result?

The nurse is a first responder to the scene of a motor vehicle accident in which the patient experienced burns to 35% of her body. Which action does the nurse take first?

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 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 educating a patient with a recent esophagectomy how to perform percutaneous endoscopic gastrostomy (PEG) feedings. Which of the following statements is correct regarding PEG feedings?

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 multiple continuous infusions for the treatment of acute decompensated heart failure (ADHF). The nurse notes the patient’s central line, through which the drips are being infused, has cracked. After an alternate vascular access has been established, which drug should the nurse restart first?

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?

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.

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 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?

A 6-day-old neonate in the newborn intensive care unit has been prescribed oxacillin for a suspected central line-associated bloodstream infection. The nurse receives the following order: oxacillin IV 50 mg/kg/day, divided q12h. The neonate weighs 2 lb. 11 oz and the pharmacy dispenses the medication in a concentration of 20 mg/mL. How many milliliters will the nurse administer for each dose? Round your answer to the nearest tenth decimal place.

The nurse receives an order to administer digoxin 0.125 mg intramuscularly each morning to a patient in heart failure. Which part of the order does the nurse question?

The client presents to the emergency department following a blow to the abdomen during a baseball game. He is unresponsive with a blood pressure of 82/48 mmHg, heart rate of 118 bpm, a respiratory rate of 18, and an oxygen saturation of 95% on room air. The nurse anticipates taking which action first to treat this patient?

The nurse anticipates seeing the effect of which medication most quickly? 

The adult patient with type 1 diabetes mellitus and Parkinson’s disease lives alone. Which patient statement would prompt the nurse to advocate for a delay in discharge from the hospital?

Which patient is appropriate to assign to a licensed practical/vocational nurse (LPN/LVN)?

The patient with advanced dementia accuses the nurse of trying to poison him with his scheduled medications. Which nursing intervention is most appropriate?

The patient with cervical cancer has an implanted sealed internal radiation device. The nurse provides which instruction to the patient?

The nurse is supervising the care of a diabetic patient with stomach cancer. After surgery, the patient is placed on total parenteral nutrition (TPN). Which information does the nurse provide the nursing student about the TPN?

To which patient does the nurse most likely anticipate administering total parenteral nutrition (TPN)?

The nurse is caring for a patient receiving total parenteral nutrition (TPN). The nurse most closely assesses for which complication in this patient? 

The nurse is most vigilant for signs of which complication in a patient receiving total parenteral nutrition (TPN)?

The patient has a 20 gauge IV in the left antecubital fossa and is receiving D5W at 150 mL/h. Upon assessment, the nurse notes the site is swollen and cool to the touch; there is no erythema. Which term does the nurse use to document this finding? 

The patient is pale and dizzy following a gunshot wound to the groin. Minimal bleeding is noted at the site. Vital signs are notable for a heart rate of 125 bpm and a blood pressure of 73/39 mm Hg. Two unsuccessful attempts have been made to establish an IV site. He loses consciousness. Which action does the nurse take next?

The 50-year-old patient receiving chemotherapy for breast cancer has developed a fungal bloodstream infection. Which intervention is the nurse’s first consideration?

The patient with persistent shoulder pain with associated numbness of the hand is scheduled for a magnetic resonance imaging (MRI) scan. The patient tells the nurse, "I'm terrified of enclosed spaces. I just don't know if I'll survive this test." After relaying the patient's concerns to the provider, which response does the nurse expect from the provider? 

The nurse is assigned to a 45-year-old HIV-positive male patient who is admitted with a MRSA skin infection on his right arm secondary to intravenous drug use. The patient is prescribed intravenous vancomycin. Twenty minutes after starting the vancomycin infusion, the patient develops a mild erythematous macular rash on the face, trunk and extremities. Which action is performed first?

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?