Routes of Administration

The patient is receiving a continuous heparin infusion that started at 0000 for the treatment of a deep vein thrombosis in the leg. Prior to the initiation of therapy, the patient’s activated partial thromboplastin time (aPTT) level was 35 seconds. The aPTT level drawn at 0800 was found to be 70 seconds. The nurse reports this information to the provider and advocates for which intervention?  

The patient who was started on warfarin sodium for the treatment of atrial fibrillation has reached steady state with the current dose. Which instruction is most important to give the patient?

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

The patient with chronic alcoholism begins parenteral nutrition (PN) at a rate of 50 mL/h for treatment of severe malnutrition. Four hours after the infusion begins, the patient’s urine output increases from 40 mL/h to 200 mL/h. The nurse contacts the provider to request which order?  

The nurse is supervising the student nurse in performing a cap change for a peripherally inserted central catheter (PICC) in a patient who recently sustained a traumatic brain injury. Which action by the student nurse best indicates effective learning?

At the beginning of the shift, the nurse assesses the patient receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter and notes a crack in the tubing with TPN leaking. The nurse notifies the provider and anticipates receiving which order first? 

The patient receiving total parenteral nutrition (TPN) is found to have received 24 hours’ worth of TPN in 4 hours. Which intervention does the nurse perform first? 

The nurse is supervising the graduate nurse in caring for intravenous lines. Which actions by the graduate nurse require intervention and further education? Select all that apply.  

The patient had an unsealed radiation source instilled into the uterus on Tuesday. On Friday, the patient has an episode of incontinence and requires a full linen change. How does the nurse dispose of the soiled linens? 

The nurse is caring for the patient who is at the nadir for bone marrow suppression. Which order does the nurse clarify with the provider?  

Which intervention is most important for the 38-week-gestation neonate who was antenatally diagnosed with hypoplastic left heart syndrome and born 2 hours ago?  

The nurse in a tertiary medical center with attached pediatric hospital is caring for the 28-year-old gravida 3 para 2 woman who is 40-weeks pregnant and presents to the labor and delivery unit 1 hour after spontaneous rupture of membranes. Patient had good prenatal care, an amniotic fluid index of 12, and pregnancy is complicated only by the antenatal diagnosis of fetal single ventricle anatomy.  Labor is progressing well and the fetus is tolerating contractions well with moderate variability in fetal heart tones. The nurse is most concerned with having which item in the delivery room? 

The nurse overhears a colleague preparing a dose of naltrexone. The nurse offers to assist and ensures the colleague takes which actions? Select all that apply.  

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8°C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider? 

The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient’s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54 mmHg. The nurse contacts the provider to report these findings and advocate for which initial order?  

The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient’s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54mmHg. The patient received maintenance fluids during the procedure and no blood transfusions. How many liters of isotonic fluid does the nurse anticipate administering to the patient during the postoperative period? Enter your response using a whole number. 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 32-year-old patient presents complaining of severe itching on the arms that has gotten worse as her job has gotten more stressful. Upon assessment, the nurse observes erythematous lichen patches on the arms and in the antecubital fossa, where it is fissured and weeping. The nurse anticipates providing education about which medication?  

The 48-year-old patient is brought via ambulance to the emergency room after being found unresponsive by her son. She has a prescription for transdermal fentanyl patches for treatment of cancer pain related to her breast cancer that has metastasized to her pelvis. The patient’s heart rate is 72 bpm, respiratory rate is 4 breaths per minute, and her oxygen saturation is 88%. Her arterial blood gas results are: pH 7.21, PaCO₂ 72 mmHg, PaO₂ 74, HCO₃¯ 23. A thorough assessment reveals 2 fentanyl patches on the patient’s skin. The nurse advocates for which initial action?  

The 75-year-old patient presents to the emergency department complaining of a severe headache that is localized behind the right eye. The patient is nauseous and vomits upon standing. While wearing glasses, the visual acuity is 20/25 in the left eye and 20/110 in the right (records show it is normally also 20/25 corrected). Her left pupil is equal, round, and reactive to light and accommodation; it is measured at 3 mm. Her right pupil reacts only minimally to light and measures at 5 mm; it is round. The provider palpates the eye and reports that it is tense. Her heart rate is 102 bpm and blood pressure is 118/84 mmHg. The nurse anticipates providing which intervention first?  

The 31-year-old patient G2P1 woman presents to the clinic for 30 week appointment. She was diagnosed at 24 weeks with gestational diabetes. For 6 weeks, she changed her diet and exercised more regularly while checking her blood sugars. She logged fasting glucose levels of 108-135 mg/dL. She has no proteinuria or glycosuria. The nurse provides which information to the patient?  

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count reveals a megaloblastic anemia. Which statement by the nurse is most appropriate? 

The 20-year-old patient with asthma presents to the emergency department with increased work of breathing and severe wheezing after exposure to household dust and mold. The patient used the albuterol inhaler 6 times in the previous 4 hours with minimal relief. Upon inspection, the nurse notes extensive accessory respiratory muscle use with moderate supraclavicular retractions and nasal flaring. The nurse auscultates expiratory wheezing in all lung fields. The patient is afebrile, normotensive, significantly tachypneic, and mildly tachycardic. The chest x-ray is clear. The nurse prepares to administer which medication first? 

The nurse clarifies which order for the patient admitted with cellulitis caused by methicillin-resistant staphylococcus aureus?   

The 24-year-old patient presents with flu-like symptoms and a diffuse maculopapular rash across her chest, trunk, and palms of the hands. Upon palpation, cervical lymph nodes are enlarged. The patient uses intravenous drugs and reports having unprotected sex. The patient’s labs are notable for negative HIV test, positive human chorionic gonadotropin test, and positive rapid plasma reagin test. The patient reports a history of anaphylaxis with penicillin administration. The nurse educates the patient about which treatment? 

The nurse is preparing to insert an intravenous catheter into the patient with a BMI of 39. Which angle of insertion does the nurse utilize in order to most likely maximize the chance of successfully entering the vessel? 

Upon insertion of an intravenous catheter, bright red blood is noted prior to attaching the tubing. Which initial action is appropriate?

The nurse is observing the student nurse preparing a 6-year-old for the insertion of an intravenous catheter. Which statement by the student nurse prompts the nurse to intervene? 

The nurse is caring for the patient with prostate cancer that has metastasized to the bone. The physician has prescribed extended-release oxycodone to treat severe bone pain. The patient expresses to the nurse he is concerned he will become addicted to the opioid pain medication given what you see on television. Which response from the nurse is most appropriate?