What this section covers: Pharmacological and Parenteral Therapies (13-19% of items), part of Physiological Integrity.
12 free practice questions
Click an answer: you see at once whether it is right, with the explanation.
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Question 1A client has been receiving a continuous heparin infusion for 6 days. The platelet count has dropped from 240,000/mm3 at baseline to 105,000/mm3. What is the nurse's priority action?
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Answer: C — Stop the heparin infusion and notify the health care provider.
A drop in platelets of 50% or more during heparin therapy suggests heparin-induced thrombocytopenia (HIT), an immune reaction that puts the client in a highly clotting state. Heparin must be stopped immediately and a non-heparin anticoagulant used, so continuing heparin by any route or at any rate is unsafe.
Checked against: OpenStax Pharmacology for Nurses, 20.2 Anticoagulants, Heparin and Clinical Tip: Assess for HIT; DailyMed Heparin Sodium Injection, 5.3 HIT and HITT
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Question 2A client receiving a heparin infusion develops bleeding from the gums and a very prolonged aPTT. Which medication should the nurse anticipate the provider will prescribe to reverse the heparin?
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Answer: B — Protamine sulfate.
Protamine binds heparin and neutralizes it; the label calls for very slow IV injection, no more than 50 mg over 10 minutes, because rapid injection can cause severe hypotension. Vitamin K reverses warfarin, naloxone reverses opioids and flumazenil reverses benzodiazepines.
Checked against: OpenStax Pharmacology for Nurses, 20.2 Anticoagulants, Anticoagulant Reversal Agents: Protamine; DailyMed Protamine Sulfate Injection, Dosage and Administration
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Question 3A client is being discharged on warfarin. Which statement by the client shows correct understanding of diet teaching?
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Answer: A — "I will keep the amount of leafy green vegetables I eat about the same from week to week.".
Vitamin K opposes the effect of warfarin, so the goal is a consistent vitamin K intake, not total avoidance; a sudden increase can lower the INR and a sudden stop can over-anticoagulate the client. Grapefruit juice is listed as a food interaction, not a helper.
Checked against: OpenStax Pharmacology for Nurses, 20.2 Anticoagulants, Warfarin (client education) and Table 20.3 Drug Prototype Table: Warfarin
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Question 4A client who was unresponsive with slow breathing after an opioid overdose is now awake and breathing 16 times per minute after IV naloxone. Why does the nurse keep monitoring the client closely?
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Answer: D — The effect of naloxone may wear off before the effect of the opioid, so sedation and respiratory depression can return.
The duration of action of some opioids exceeds that of naloxone, so the client must stay under continued surveillance and repeat doses are given as needed. Naloxone does not cause respiratory depression; its main adverse effect in opioid-dependent clients is acute withdrawal.
Checked against: DailyMed Naloxone Hydrochloride Injection, Clinical Pharmacology and Warnings (repeat administration); OpenStax Pharmacology for Nurses, 14.3 Opioid Antagonists
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Question 5A postoperative client has a prescription for IV morphine as needed for pain. Which finding should lead the nurse to withhold the dose and notify the provider?
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Answer: C — Respiratory rate of 8 breaths/min and the client is difficult to arouse.
Slow, shallow breathing with heavy sedation signals opioid-induced respiratory and CNS depression, which can be fatal; another dose would deepen it, and naloxone should be readily available. Pain of 7/10 is the reason to give the drug, and constipation is an expected effect to manage, not a reason to withhold analgesia.
Checked against: OpenStax Pharmacology for Nurses, 14.3 Opioid Agonists, Nursing Implications and FDA Black Box Warning; DailyMed Morphine Sulfate Injection, 5.2 Life-Threatening Respiratory Depression
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Question 6Twenty minutes into an IV vancomycin infusion, the client develops flushing and itching of the face, neck and upper chest. The infusion was set to run over 30 minutes. What should the nurse do first?
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Answer: B — Stop the infusion and notify the provider; vancomycin should be infused over at least 60 minutes.
Flushing during a fast vancomycin infusion is the rapid-infusion reaction (vancomycin flushing syndrome); stopping the infusion usually ends it, and the drug is given over not less than 60 minutes. It is often mistaken for an allergy, but it is managed by slowing the rate rather than labeling the client allergic.
Checked against: DailyMed Vancomycin Hydrochloride for Injection, Warnings: Infusion Reactions; OpenStax Pharmacology for Nurses, 7.2 Adverse Effects (vancomycin flushing syndrome)
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Question 7A client taking lithium for bipolar disorder has had vomiting and diarrhea for 2 days and now has a coarse hand tremor and lethargy. The serum lithium level is 2.0 mEq/L. What should the nurse do?
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Answer: A — Hold the next lithium dose and notify the provider of possible lithium toxicity.
The usual goal level is 0.6 to 1.2 mEq/L, and a level of 1.5 to 2.5 mEq/L is linked with lethargy, tremors, nausea and vomiting, so this client shows toxicity. Vomiting and diarrhea cause fluid and sodium loss, which raises lithium levels; restricting fluids would make it worse.
Checked against: OpenStax Pharmacology for Nurses, 13.3 Mood Stabilizers, Lithium and Table 13.16 Adverse Reactions Related to Serum Levels of Lithium
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Question 8A client is starting levothyroxine. Which instruction should the nurse include?
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Answer: D — Take it once daily on an empty stomach, one-half to one hour before breakfast.
Levothyroxine is taken once daily on an empty stomach 30 to 60 minutes before breakfast, and at least 4 hours apart from iron, calcium and antacids, which reduce its absorption. It is a daily, usually lifelong, replacement, not an as-needed drug.
Checked against: DailyMed Levothyroxine Sodium Tablets, 2.1 Administration Instructions and 17 Patient Counseling Information
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Question 9A provider prescribes ketorolac 15 mg IV now for an adult client. The vial is labeled ketorolac 30 mg/mL. How many mL should the nurse give?
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Answer: C — 0.5 mL.
Using desired over have times quantity: 15 mg / 30 mg x 1 mL = 0.5 mL. The ordered dose is half of the strength in 1 mL, so the volume must be less than 1 mL; 2 mL comes from dividing the strength by the dose (30 / 15) instead of the dose by the strength.
Checked against: OpenStax Pharmacology for Nurses, 2.4 Dosage Calculations, Basic Formula Method
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Question 10A child who weighs 22 lb is prescribed amoxicillin 15 mg/kg per dose. The suspension contains 250 mg per 5 mL. How many mL should the nurse give per dose?
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Answer: B — 3 mL.
Convert weight: 22 lb / 2.2 = 10 kg. Dose: 15 mg x 10 kg = 150 mg. Volume: 150 mg / 250 mg x 5 mL = 3 mL. Using 22 as kilograms instead of converting gives the 6.6 mL error.
Checked against: OpenStax Pharmacology for Nurses, 2.4 Dosage Calculations, Body Weight Method
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Question 11A liter (1,000 mL) of 0.9% sodium chloride is to infuse over 8 hours by gravity. The tubing drop factor is 15 gtt/mL. At how many drops per minute should the nurse set the infusion?
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Answer: A — 31 gtt/min.
First find the hourly rate: 1,000 mL / 8 h = 125 mL/h. Then gtt/min = 125 mL x 15 gtt/mL / 60 min = 31.25, rounded to 31 because only whole drops can be counted. 125 is the mL/h rate, not drops per minute.
Checked against: OpenStax Clinical Nursing Skills, 13.3 Intravenous Infusion, Gravity Infusion
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Question 12Ten minutes after a unit of packed red blood cells is started, the client reports new low back pain and chills. The heart rate has risen and the blood pressure has dropped from baseline. What should the nurse do first?
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Answer: D — Stop the transfusion.
New low back pain, chills, tachycardia and falling blood pressure early in a transfusion point to an acute hemolytic reaction. Whenever a reaction is suspected, the nurse stops the transfusion immediately and notifies the provider, then keeps the vein open with normal saline through new tubing.
Checked against: OpenStax Clinical Nursing Skills, 13.4 Blood Transfusions, Transfusion Reactions and Hemolytic Transfusion Reaction
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