WEEK 1
The nurse identifies the primary purpose of federal legislation in drug standards as
A. preventing overcharging for drugs.
B. controlling efforts in drug research.
C. ensuring public safety.
D. moderating effective drug usage.
Which situation regarding controlled substances requires the supervising RN to intervene?
A. The staff keeps a separate controlled-substances record for all required information.
B. Controlled substances are locked away from patients, and all staff members have keys
for necessary access.
C. Opioids are kept under double lock to limit access to them.
D. All discarded or wasted controlled substances are countersigned.
A nurse is to administer a dose of furosemide (Lasix). The nurse is aware that Lasix is the
________ for the drug.
A. generic name
B. chemical name
C. nonproprietary name
D. brand name
A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours.
What is the expected duration of this medication?
A. increase.
B. decrease.
C. remain unchanged.
D. dissipate.
A patient sustains significant burns to the skin and is experiencing fluid shift associated with
edema in the fluid overload phase. The nurse would anticipate that this will interfere most
with which phase of pharmacodynamics?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Which nursing actions would be most appropriate for ensuring patient safety with a
medication that has a low therapeutic index?
A. Monitoring a patient’s urine output
B. Assessing vital signs hourly
C. Maintaining strict isolation precautions
D. Monitoring serum peak and trough levels
What is the primary site of metabolism for most drugs?
A. kidney.
B. small intestine.
C. liver.
D. brain.
The nurse is required to chart the patient’s response to all of the following groups of
medications except
A. opioids.
B. antiemetics.
C. sedatives.
D. antihyperlipidemics.
What is the primary purpose of self-medication administration?
A. To cut down on the amount of staff needed in the health care facility
B. To empower the patient to be more effective in management of the therapeutic
regimen
C. To decrease medication errors
D. To decrease the time the patient needs to wait for the medication
A nurse reads the following order: “Take one multivitamin qod.” The nurse will
A. administer 1 multivitamin every morning.
B. give the patient 1 multivitamin every other day.
C. call the prescriber to clarify the order.
D. refuse to administer the multivitamin and document it as not administered.
The patient’s culture may influence the patient’s attentiveness to time. This may be of special
concern to nurses when they teach patient about
A. the routes of medication administration.
B. the schedule of medication dosing.
C. the anticipated side effects.
D. the anticipated therapeutic effects.
The patient, who is Jamaican, is currently 4 months pregnant and informs the nurse during a
prenatal visit that she eats red clay to provide nutrients to the fetus. She states that this a
practice her grandmother told her would ensure a healthy pregnancy. What is the best action
by the nurse?
a) Contact Child Protective Services
b) Insist that the patient stop the practice immediately.
c) Determine the amount of clay she eats daily
d) Discuss the research about dietary intake of clay.
Which is a correctly written goal by the nurse?
A. Patient will administer the prescribed dose.
B. Patient will learn to administer insulin.
C. Patient will know how to take insulin correctly.
D. Patient will independently administer the prescribed dose of insulin at the end of 1 hour
of instruction.
Which information will the nurse include in the patient teaching? (Select all that apply.)
A. Cost of drugs
B. Administration technique
C. Instructions regarding drug discontinuation
D. Foods to avoid when taking a certain drug
E. Side effects to report to health care provider
What is the first step of the nursing process when working with patients receiving drug
therapy?
A. Assessment
B. Planning
C. Implementation
D. Evaluation
Before information about drug therapy is presented to a patient, it is most important for the
nurse to
A. determine the patient’s reading level.
B. plan the number of teaching sessions.
C. assess the patient’s readiness to learn.
D. tell the patient that he or she must comply with the drug therapy.
WEEK 2
You call the physician to alert her that, despite the correct use of the PCA morphine, Mr. Ross
is having persistent, uncontrolled pain at a level of 8 out of 10. She gives you new orders to
increase the PCA settings. Before hanging up, you need to do what three things?
1. Write the order
2. Read it back to the physician
3. Receive confirmation that the order is correct
You review the new order you have just received for Mr. Ross’s pain. Before sending the
order to the pharmacy, you make sure it has what seven essential components?
1. Client’s full name
2. Date and time written
3. Name of medication
4.
5.
6.
7.
Dosage
Route
Time and frequency
Signature of prescriber or proxy
You have new orders to discontinue the NGT and advance Mr. Ross’s diet from NPO status to
clear liquids as tolerated. The physician writes the order: Phenergan Supp 12.5 mg PR q4h
prn nausea. After pharmacy transcribes the order, you compare the MAR with the order to
verify. What components do you expect to see when reviewing the MAR?
1. Mr. Ross’s full Name, DOB, medical record #, ALLERGIES
2. Today’s date
3. Medication information
4. Time of administration
5. Initials (transcriber, person giving med)
6. Special instructions
7. Legends—describe abbreviations
8. MED ALERT! Avoid giving Phenergan IV because it may cause severe tissue injury
Mr. Ross is feeling nauseous after a popsicle and apple juice. You decide to medicate per MD
order. (Phenergan Supp 12.5 mg PR q4h prn nausea) The facility where you work uses an
eMAR with Bar-Code Medication Delivery system. What are the 6 rights you will check when
scanning bar codes on Mr. Ross’ wristband and on the medication?
1. Client—2 identifiers
Mr. Jared Ross, DOB 01/02/1951
1. Medication—Phenergan Suppository
2. Dosage—12.5 mg
3. Route—PR (rectal)
4. Time—now
5. Documentation
List three uses for the MAR.
1. Check the med order, Prepare the correct dosage, Record the medication administered
What types of systems are the Pyxis and Omnicel?
1. Computer-Controlled Dispensing or Automated dispensing system (ADS)
What does CPOE stand for?
1. Computerized Prescriber Order Entry
What do the following scheduling abbreviations mean?
1. p.c. after meals
2. a.c. before meals
3. qh every hour
Mr. Ross is 2 days post-op and currently tolerating a clear liquid diet with no nausea. His pain
is adequately controlled with PCA morphine. The physician orders to continue Mr. Ross’s
home meds, one of which is simvastatin 40 mg p.o. daily. As you look at the label you
distinguish which names as trade and generic?
Zocor is the trade name.
Simvastatin is the generic name.
Order: lactulose 30 g p.o. t.i.d. Available: lactulose 10 g per 15 mL. How many mL will you
administer per dose? 45 mL
Order: ibuprofen 600 mg p.o. t.i.d. prn pain. Available: ibuprofen 200 mg tablets. How many
tablets will you administer per dose? 3 Tabs
Order: metformin 500 mg p.o. b.i.d. Available: metformin 1 g tablets. How many tablets will
you administer per dose? ½ tab
Mr. Ross is 3 days post-op and the plan is to advance the diet to full liquid and ambulate q2h
while awake. The following meds are scheduled for 0900: aspirin 162 mg p.o. daily,
simvastatin 40 mg p.o. daily, and atenolol 50 mg p.o. daily hold if SBP < 120 or HR < 60.
How many tablets of each med will you pull from the Pyxis?
aspirin 162 mg p.o. daily Available: aspirin 81 mg tablets
simvastatin 40 mg p.o. daily Available: simvastatin 80 mg tablets
atenolol 50 mg p.o. daily Available: atenolol 50 mg tablets
Aspirin—2 tabs
Simvastatin—½ tab
Atenolol—1 tab
Before you administer the 0900 meds to Mr. Ross, you review his vital signs. They are as
follows: T—98.9° F P—52 R—18 BP—112/74. What is your next course of action?
Hold atenolol per MD order and parameters on MAR.
“hold if SBP < 120 or HR < 60”
Order: dilaudid 1000 mcg IV q4h prn pain. Available: dilaudid 2mg per 1mL. How many mL
will you administer per dose? 0.5 mL
Order: lisinopril 5 mg p.o. daily. Available: lisinopril 10 mg tablets. How many tablets will you
administer per dose? ½ tablet
Order: synthroid 0.075 mg p.o. daily. Available: synthroid 25 mcg tablets. How many tablets
will you administer per dose? 3 tablets
While Mr. Ross is ambulating, you notice that he looks flushed and feels warm to the touch.
You check his temperature orally and you find that it is 101.2° F. You check the chart and find
an order for: Tylenol 650 mg p.o. q6h prn temp greater than 37.8° C. You go to the Pyxis and
find that you have acetaminophen 325 mg tablets. What is your next course of action?
Implement the “six rights of med administration” to administer two tablets.
Order: Potassium Chloride 40 mEq p.o. b.i.d. Available: KCl 20 mEq tablets. How many tablets
will you administer per dose? 2 tabs
Order: Cleocin 300 mg IV q6h. Available: Cleocin 0.6 g per 4 mL. How many mL will you
administer per dose? 2 mL
Order: Kefzol 0.5 g IV q6h. Available: Kefzol 225 mg per mL. How many mL will you administer
per dose? 2.22 mL
Mr. Ross’s fever has subsided and he has no other s/s of infection. The doctor has added
Flagyl 500 mg IV q6h and has discontinued the PCA morphine. She also wrote an order for
Percocet 5/325 2 tab p.o. q6h prn pain. Mr. Ross is now complaining of 7/10 pain. It is also
time to hang the Flagyl. At the Pyxis, you have available: Flagyl 0.5 g in 100 mL & Percocet
5/325 tablets. How much medication will you pull?
Pull 2 tabs of Percocet and 100 mL of Flagyl from the Pyxis.
As long as Mr. Ross remains in stable condition throughout the night, he will be discharged
tomorrow.
WEEK 3
Problem 1
How many grams of dextrose in 500 mL of D5W?
Problem 2
How many grams of NaCl are in 1,000 mL of NS?
Mr. Flint is a 63-year-old male who presents to the emergency department with chest pain
and shortness of breath on exertion. His vital signs are stable at this time. The physician on
duty orders an electrocardiogram, 1 L NS IV to run at 100 mL/hr, lab work, and cardiac
monitoring. You know that in 3 hours, 300 mL will have infused. How many mg NaCl will be
left in the bag?
6,300 mg NaCl left in 700 mL
A 20-gauge IV is placed in Mr. Flint’s right forearm. You prime the tubing and begin to infuse
the NS at the prescribed rate using an IV pump. This IV is a:
a. Central line
b. Secondary line
c. Peripheral line
Calculate how much of each component is in the 2-L following solution: D5 ½NS + 20 mEq KCl
How many milligrams of dextrose? 100,000 mg Dextrose
How many grams of NS? 9 g NS
How many milliequivalents of KCl? 40 mEq KCI
Problem: Infuse 3,000 mL over 24 hr
Order: 4.5 g Zosyn in 100 mL NS IVPB in 30 min BID. What is the rate in mL/hr?
200 mL/hr
Problem: Infuse NS at 100 mL per hr. The drop factor on tubing is 10 gtt/mL. How many
gtt/min?
Problem: Infuse D5W at 100 mL per hr. What is rate in gtt/min? DF = 10 gtt/mL
Problem: IV of 1,000 mL NS to infuse in 8 hr. IV tubing has drop factor of 20 gtt/mL
The IV pump you were using to infuse Mr. Flint’s IVF is necessary for another patient and you
must calculate the rate in gtt/min. You check the tubing package and find a drop factor of 20
gtt/ml. You recall the order: 1 L NS IV at 100 mL/hr now. What is the rate?
Run the NS at 33 gtt/min. Remember to count the drops for a whole minute in order to
accurately set the rate.
Order: Administer the following IVs for 24 hr:
a. 1,000 mL D5W with 10 mEq KCl (potassium chloride)
b. 500 mL D5NS with 1 amp MVI (multivitamin)
c. 500 mL D5W
Order: Mix solution of 20 mEq KCl in 1,000 mL of NS. Administer at 2 mEq per hour.
Mr. Flint’s labwork is back and his potassium level is slightly decreased at 3.1 mEq/L. The
physician changes the IV fluid to 1 L of D5 NS + 20 mEq KCl at a rate of 2.25 mEq/hr. You add
the potassium to the D5 NS and calculate the new rate. Using the same drop factor of 20
gtt/mL, what is the rate in gtt/min?
38 gtt/min
Problem: An IV is regulated at 20 microgtt/min. How many hours will it take to infuse 100
mL?
Before you can administer the new IVF, you must place a label. You just finished adding 20
mEq of potassium chloride to 1,000 mL dextrose 5% in 0.9 % sodium chloride. What will your
label look like?
Mr. Flint is diagnosed with new-onset atrial fibrillation and is started on a heparin drip in
order to prevent clots from being formed. What are some things that need to be done when
preparing to administer this medication?
• Obtain an electronic IV pump.
• Weigh the client and convert to kg.
• Have another nurse independently check the dosage.
• Make sure anticoagulation labs (aPTT) are ordered.
Order: Heparin 7,500 units subcut now. Available: Heparin labeled 10,000 units per mL
Order: Infuse solution of 1 L D5W with 20,000 units of heparin at 30 mL per hour. Calculate
the dosage of heparin the client receives per hour.
Order: Infuse heparin 850 units per hr from a solution containing D5W 500 mL with heparin
25,000 units IV.
A client weighs 160 lb. Administer heparin sodium IV 80 units per kg. How many units should
be administered?
Calculate weight in kg (CF: 1 kg = 2.2 lb)
160 lb/2.2 = 72.72 = 72.7 kg
Calculate the heparin bolus dosage
80 units/kg x 72.7 kg = 5,816 units
Client weighs 165 lb .
Order requires heparin bolus of 80 units per kg and then initiate drip at 18 units per kg per hr
Heparin infusion is 25,000 units in 1,000 mL of 0.9% sodium chloride.
What is the infusion rate to achieve 18 units per kg per hr?
Mr. Flint weighs 264 lb. You have on hand 25,000 units in 1,000 mL of 0.9% sodium chloride.
You review the order for Mr. Flint’s heparin drip. Heparin bolus 70 units/kg then initiate drip
at 16 units/kg/hr. How many mL will you administer as a bolus? What will the infusion rate
be in mL/hr?
Bolus: 336 mL
Drip: 76.8 mL/hr
Mr. Flint’s aPTT level is 44 sec 6 hours after the infusion has been initiated. His weight is 264
lb. The protocol reads: aPTT 33-45 sec Bolus 40 units/kg, then increase rate by 2 units/kg/hr.
You recall the original order and concentration strength of the heparin: Heparin drip at 16
units/kg/hr. Available: Heparin 25,000 units in 1L NS. How many mL will you administer for
the bolus and what will be the new rate?
Bolus: 192 mL
Rate: 86.4 mL/hr
Order: Infuse solution of 1 L NS with 30,000 units of heparin at 24 mL per hr. Calculate the
dosage of heparin the client receives per hour. 720 units per hour
Client weighs 147 lb. Order: heparin bolus of 70 units per kg and then initiate drip at 14 units
per kg per hr. Available: 25,000 units in 1,000 mL of 0.9% sodium chloride.
How many mL will you bolus? 187.09 mL
What is the infusion rate? 37.42 mL per hr
A solution of labetelol (Trandate) 100 mg per 100 mL of D5W is to infuse at a rate of 25 mg
per hr. Calculate the rate to infuse the solution in mL per hr
Isuprel 2 mg per 250 mL D5W. Infuse at 5 mcg per min
Order: Infuse dopamine 400 mg in 500 mL of D5W at 30 mL per hr. Calculate dosage in mcg
per min and mcg per hr.
2. Convert 24 mg to mcg to find mcg per min and mcg per hr:
1,000 mcg = 1 mg, so …
24 mg (1,000) = 24,000 mcg
3. Change mcg per hr to mcg per min:
60 min = 1 hr, so…
24,000  60 min = 400 mcg/min
Client is receiving Pronestyl at 60 mL/hr. The solution is available as 2 g in 500 mL D5W.
Calculate the mg per hr and mg per min the client will receive.
1. Convert g to mg (1 g = 1,000 mg)
2 g (1,000) = 2,000 mg in 500 mL
2. Determine mg/hr via ratio and proportion:
3. Convert mg/hr to mg/min (60 min = 1 hr)
240 mg/hr  60 min = 4 mg/min
The physician decides that cardioversion should be done to treat Mr. Flint’s new-onset atrial
fibrillation. The consent form is signed, and Mr. Flint is cardioverted into sinus rhythm. After
cardioversion, Mr. Flint has decreased cardiac output evidenced by hypotension and the
physician orders: Levophed 1 mcg/min for 1 hour, monitoring BP every 5 minutes. Available:
2 mg/250 mL D5W. What will be the rate? 7.5 mL/hr
Order: Dopamine 2 mcg per kg per min. Available solution is 400 mg in 250 mL D5W. Client
weighs 150 lb.
1. Convert 150 lb to kg (2.2 lb = 1 kg ): 150  2.2 = 68.18 kg rounds to … 68.2 kg
2. Determine dosage per minute: 68.2 kg  2 mcg/kg/min = 136.4 mcg/min
Convert mcg/min to mL/hr (1,000 mcg = 1 mg)
1. Make conversion:
136.4 mcg per min  60 min = 8,184 mcg/hr
2. Convert to mcg per hr to mg per hr:
8,184  1,000 = 8.18 = 8.2 mg/hr
3. Determine flow rate:
400 mg : 250 mL = 8.2 mg:x mL
x = 5.1 = 5 mL/hr
Nipride has been ordered to titrate at 3 to 6 mcg per kg per min to maintain a client’s systolic
BP below 140 mm Hg. The solution contains 50 mg Nipride in 250 mL D5W. The client weighs
56 kg. Determine the flow rate setting for the volumetric pump.
1. Calculate dosage range:
(Lower dosage) 3 mcg/kg/min  56 kg = 168 mcg/min
(Higher dosage) 6 mcg/kg/min  56 kg = 336 mcg/min
2. Calculate IV rate in mL/hr for lower dose:
3. Calculate IV rate for upper dose:
Mr. Flint’s blood pressure has not risen above 78/40 throughout the Levophed infusion.
Although he is alert, he is complaining of dizziness. The physician changes the dosage:
Levophed titrated at 2 mcg/min to 6 mcg/min, increasing the rate by 1 mcg/min every 2
hours to maintain SBP > 100 mm Hg. Available: 2 mg/250 mL D5W. Determine the new rate
and develop a titration table rounding to the nearest tenth.
Dosage Rate (mcg/min)
Flow Rate (mL/hr)
2 mcg/min (minimum)
15 mL/hr
3 mcg/min
22.5 mL/hr
4 mcg/min
30 mL/hr
5 mcg/min
37.5 mL/hr
6 mcg/min (maximum)
45 mL/hr
After 2 days in the ICU, Mr. Flint’s BP normalizes and he is transferred to the medical surgical
unit.
Order Dopamine 5 to 10 mcg/kg/min for a client weighing 184 lb. Titrate dosage to maintain
client’s SBP > 110 mm Hg. Available: 400 mg/250 mL NS. Develop a titration table to
determine the flow rates. Min rate: 15.68 mL/hr Max rate: 31.36 mL/hr
Tara Bates is your 4-year-old patient admitted to the pediatric unit with MRSA infection to
the right inner thigh with plans for I and D tomorrow morning. You weigh Tara and find she is
32 lb and 9 oz. You must convert the weight to kg when filling out the surgical checklist.
What is Tara’s weight in kg? 15.1 kg
You continue with your assessment of Tara and notice that she feels warm to the touch and
her cheeks are flushed. An oral temperature reveals a fever of 101.5° F. You review the chart
and find the following order:
Tylenol Elixir (160 mg/5 mL) 150 mg PO q4h prn fever greater than 99° F
The safe dose range reads:
10-15 mg/kg/dose q4-6hr as needed.
Is the dose safe? (Tara weighs 15.1 kg) If so, how much will you administer?
The dose is safe, administer 4.7 mL AFTER checking calculations and dosage with another
nurse.
You are to administer a preop antibiotic to Tara (14.8 kg). The order reads:
Vancomycin 148 mg IV over 2 hr q6h
The safe dose range is
40 mg/kg/day in 6-8 divided dosages.
Is the dose safe?
The dose is within safe range.
You have available 500 mg vials that must be reconstituted with 10 mL sterile water for a
concentration of 50 mg/mL. This must be further diluted with NS to ≥ 5 mg/mL and
administered over at least 60 min.
How much of the reconstituted medication will you draw up and how much will you further
dilute with? Draw up 3 mL (2.96 rounded) and further dilute with 30 mL NS.
You are to administer the medication over 2 hr. Your facility policy requires you to use a
Burette with microdrip tubing and a pump.
Calculate the rate in gtt/min and mL/hr. Run the infusion at 15 microgtt/min and 15 mL/hr.
You also remember to flush the tubing at the same rate with an additional 15 mL NS.
Tara tolerates the medication well and sleeps through the night without pain or fever.
Tara has been NPO after midnight and the physician orders maintenance IV fluids. Based on
her weight, 32 lb 9 oz, what rate do you anticipate to program into the pump?
52 ml/hr
Tara tolerates the fluid well and is dressed in a clean gown before she is taken to surgery at
0700. Her mother thanks you for all your help.
A child weighing 42 lb 5 oz is prescribed Rocephin 800 mg IV B.I.D. The recommended dosage
is 50–75 mg/kg/day.
1. Convert the weight to kg. 19.2 kg
2. Determine the safe dose range for the child. 960-1440 mg/day
3. Is the ordered dose safe? If not, what is your next step? Alert the prescriber, do not
administer the dose.
The prescriber changes the order to Rocephin
500 mg IV over 1 hr B.I.D. You have on hand Rocephin 2 g per 50 mL.
4. How much will you administer? 12.5 mL
5. What will be the rate mL/hr? 12.5 mL/hr
6. What is the rate in gtt/min with microdrip tubing? 13 gtt/hr
WEEK 5
Before administering lithium to a patient, it is most important for the nurse to assess which
laboratory value?
• Blood sugar
• Sodium
• Urine osmolality
• Hematocrit
When patients are taking selective SSRIs for the first time for depression, which is most
important to monitor for during the first few weeks of therapy?
A. Hypertensive crisis
B. Suicidal thoughts
C. Convulsions
D. Orthostatic hypotension
When providing teaching for a patient who is prescribed a selective SSRI, which statement
will the nurse include?
A. The SSRI will work faster than the older tricyclic antidepressants.
B. The SSRI will have an immediate beneficial effect on the patient’s depression symptoms.
C. The SSRI will not work well for severe cases of depression.
D. The SSRI may take several weeks to have a beneficial effect.
Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine
overdose?
A. Flumazenil
B. Naltrexone
C. Vivitrol
D. Flunitrazepam
A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which
finding does the nurse expect upon assessment of the patient?
A. Hyperthermia
B. Hypotension
C. Bradycardia
D. Somnalence
Which statement does the nurse include when teaching a patient about disulfiram (Antabuse)
therapy?
A. “Disulfiram (Antabuse) will cure your alcoholism if you take it as directed.”
B. “If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very
high.”
C. “You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”
D. “If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due.”
The nurse is explaining the differences between transdermal nicotine and nicotine gum
programs. Which statement by the nurse is correct?
A. “The nicotine patch will give you quick relief from cravings.”
B. “Chewing the gum rapidly will release an immediate dose of nicotine.”
C. “It seems that patients have better treatment compliance with the gum than the
patch.”
D. “The dose of nicotine in the gum is approximately twice the dose the average
smoker receives in one cigarette.”
WEEK 6
The number of people with hypertension in the United States is estimated to be
• 10 million.
• 25 million.
• 50 million.
• 70 million.
When administering an alpha-adrenergic drug for hypertension, it is most important for the
nurse to assess the patient for the development of what response?
• Hypotension
• Hyperkalemia
• Oliguria
• Respiratory distress
A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions
this order because her physician has never told her that she has hypertension. What is the
best explanation for this order?
A. The doctor knows best.
B. The patient is confused.
C. This medication has cardioprotective properties.
D. This medication has a protective effect on the kidneys for patients with diabetes.
Which statement about ARBs does the nurse identify as being true?
• Hyperkalemia is more likely to occur than when using ACE inhibitors.
• Cough is more likely to occur than when using ACE inhibitors.
• Chest pain is a common adverse effect.
• Overdose is usually manifested by hypertension and bradycardia.
Which location is the area where the highest percentage of sodium and water are resorbed
back into the bloodstream?
A. Glomerulus
B. Proximal tubule
C. Ascending loop of Henle
D. Distal tubule
While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV
tubing. What is the most appropriate action by the nurse?
A. Administer the infusion slowly.
B. Discard the solution and obtain another bag of medication.
C. Obtain a filter and then infuse the solution.
D. Return the fluid to the IV bag to dissolve the crystals.
A patient with a creatinine clearance of 20 mL/min is admitted to the medical-surgical unit.
The patient is in need of rapid diuresis.
1. Which class of diuretic does the nurse anticipate administering?
A. Potassium sparing
B. Thiazide
C. Osmotic
D. Loop
Two days after admission, the nurse is reviewing laboratory results of the patient.
2. Which is the most common electrolyte finding resulting from the administration of
furosemide (Lasix)?
A. Hypocalcemia
B. Hypophosphatemia
C. Hypokalemia
D. Hypomagnesemia
The patient is being discharged home with furosemide (Lasix).
3. When providing discharge teaching, which instruction will the nurse include?
A. Avoid prolonged exposure to the sun.
B. Avoid foods high in potassium content.
C. Stop taking the medication if you feel dizzy.
D. Weigh yourself once a week and report a gain or loss of more than 1 lb.
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the
medication with the evening meal or at bedtime. The patient asks why it must be taken at
this time of day. What is the nurses’ best response?
A. “The medication is better absorbed at this time.”
B. “This timeframe correlates better with the natural diurnal rhythm of cholesterol
production.”
C. “There will be fewer adverse effects if taken at night instead of with the morning meal.”
D. “This timing reduces the incidence of myopathy.”
A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which
of the following does the nurse identify as true?
• The nurse should have the patient swallow the dose of the colestipol powder one
teaspoonful at a time.
• The powder should be dissolved and immediately administered.
• The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral
medication.
•
The colestipol should be administered with meals.
A patient will be taking niacin as part of antilipemic therapy. What is the best way to avoid
problems with flushing or pruritus?
A. Take the medication at bedtime.
B. Take the medication with a small dose of a steroid.
C. Take the medication with a full glass of water on an empty stomach.
D. Start with a low initial dose and then increase it gradually.
A patient wants to take garlic tablets to improve his cholesterol levels. Which condition
would be a contraindication?
A. Hypertension
B. Bowel obstruction
C. Sinus infection
D. Scheduled surgery
WEEK 7
A patient has received an IV dose of adenosine, and almost immediately the heart monitor
shows asystole. What should the nurse do next?
A. Check the patient’s pulse.
B. Prepare to administer cardiopulmonary resuscitation.
C. Set up for defibrillation.
D. Continue to monitor the patient.
A patient is in the emergency department with an unspecified supraventricular dysrhythmia.
The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the
medication through the IV lock, the patient says she feels something wet spilling on her arm.
Her heart rate was unchanged. What will the nurse do next?
A. Assess the patient for diaphoresis.
B. Check the IV lock to see if it is functioning properly.
C. Repeat the dose of diltiazem (Cardizem).
D. Restart the IV in another location.
A patient is receiving oral quinidine. Which assessment finding is of most concern?
A. Nausea
B. Prolonged QT interval
C. Diarrhea
D. Occasional palpitations
A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain.
What should his first action be?
A. Take his nitroglycerin tablet.
B. Stop mowing and sit or lie down.
C. Go inside the house to cool off and get a drink of water.
D. Call 911.
A patient with extremely high blood pressure (BP) is in the emergency department. The
physician will order therapy with nitroglycerin to manage the patient’s BP. Which form of
nitroglycerin is most appropriate?
A. Sublingual spray
B. Transdermal patch
C. Oral capsule
D. IV infusion
The nurse is obtaining a medication history on a patient presenting with chest pain. What
drug classification would necessitate the nurse informing the provider before beginning the
prescribed nitroglycerin?
A. Proton pump inhibitor
B. Phosphodiesterase inhibitors (Erectile Dysfunction medications)
C. Inhaled beta blocker
D. Acetylsalicylic acid (aspirin)
A patient with a known history of angina was walking his dog and developed chest pain. The
patient immediately stops walking and sits down. He continues to experience chest pain
when sitting down. When should he call 911?
A. Immediately
B. If the pain becomes more severe
C. If one sublingual tablet does not relieve the pain after 5 minutes
D. If the pain is not relieved after three sublingual tablets, taken 5 minutes apart
A patient who has had an MI is taking a beta blocker. What is the main benefit of beta
blocker therapy for this patient?
A. Vasodilation of the coronary arteries
B. Increased force of cardiac contraction
C. Slowing of the heart rate
D. Maintaining adequate BP
The nurse is preparing to educate a group of patients on the management of angina.
1. Which drug groups are most often used to treat patients with angina?
The nitrates and nitrites, the beta blockers, and the CCBs are the drugs most often used
to treat patients with angina pectoris.
A patient asks the nurse to tell her more about a new drug the patient has been prescribed
called ranolazine (Ranexa).
2. Which response by the nurse is accurate?
A. “We do not know how Ranexa works.”
B. “This drug is the first medication your health care provider will use to treat your
angina.”
C. “This drug must be given intravenously.”
D. “Ranexa is safe to use in patients with liver failure.”
What information will the nurse include when teaching the patients about taking beta 2blocking drugs for the treatment of angina?
A. “Call your health care provider if you heart rate is 64 beats/min.”
B. “These drugs are safe to use in patients who have asthma.”
C. “Call your health care provider if you experience a weight gain of 2 lb or more in 24
hours or 5 lb or more in 1 week.”
D. “Avoid taking these medications with grapefruit juice.”
A patient asks how to apply transdermal nitroglycerin.
4. What is the nurse’s best response?
A. “Always apply the transdermal patch over the area of your chest where your heart is.”
B. “Keep the previous patch on for 1 full day so you always have two patches on at a time.”
C. “Apply the patch to hairless areas of the body.”
D. “First apply Vaseline to your body; then apply the transdermal patch.”
A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night
before. Which statement is most correct?
A. The patient is receiving a double dose of anticoagulants.
B. The heparin therapy was ineffective, so the warfarin was started.
C. The heparin provides anticoagulation until therapeutic levels of warfarin are reached.
D. The heparin and warfarin work together synergistically to provide anticoagulation.
A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI.
The nurse notices that there is a slight amount of bleeding from the antecubital area where
venous lab work was drawn. What will the nurse do first?
A. Monitor the site for further bleeding.
B. Apply pressure to the site with a gauze pad.
C. Slow the rate of infusion of the thrombolytic drug.
D. Stop the infusion of the thrombolytic drug.
A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI.
The nurse notices that there is a slight amount of bleeding from the antecubital area where
venous lab work was drawn. What will the nurse do first?
A. Monitor the site for further bleeding.
B. Apply pressure to the site with a gauze pad.
C. Slow the rate of infusion of the thrombolytic drug.
D. Stop the infusion of the thrombolytic drug.
A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her
physician has recommended that she start taking low-dose aspirin therapy as part of her
treatment for transient ischemic attacks. What is the concern with taking these two drugs
together?
A. Increased risk of gastric ulcer
B. Decreased action of the aspirin because of the interaction with the ginkgo
C. Increased risk of bleeding because of the ginkgo
D. Antagonism of the action of the aspirin because of the multivitamins
The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary
embolus. The patient is being converted to warfarin (Coumadin) therapy. The following
questions relate nursing considerations when caring for this patient.
1. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy
will include
A. immediate discontinuation of IV heparin and administration of oral warfarin
(Coumadin) therapy only.
B. overlapping therapy of IV heparin and warfarin are for at least 5 days.
C. monitoring the INR and stopping the IV heparin when the INR is 1.0.
2. When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber
monitors which of the following to determine the next appropriate dose of warfarin?
A. Platelet levels
B. aPTT
C. Red blood cell count
D. PT/INR
3. Which of the following should the nurse include when providing dietary teaching for the
patient receiving warfarin (Coumadin) therapy?
A. Avoid drinking large amounts of green tea.
B. Cranberry juice will provide you with needed nutrients while taking Coumadin.
C. You must never eat spinach.
D. You can only eat lettuce once a month.
4. The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is
readmitted to the hospital with bleeding. Which drug can the nurse anticipates
administrating?
A. Protamine sulfate
B. Alteplase (Activase, Cathflo Activase)
C. Reteplase (Retavase)
D. Vitamin K