Ans:
A
Feedback:
If a diagnosis requires medical intervention, such as hyperlipidemia, which
can only be diagnosed through laboratory studies, there is no point in
making the drug an OTC medication. Most, if not all, OTC drugs have the
capacity to mask signs and symptoms of an underlying disease so this is not
a factor in deciding if a drug can be sold OTC. All drugs have the potential
for toxic effects if not taken as directed and virtually all drugs have the
potential for adverse effects.
35.
The nurse needs to ask what specific questions when collecting a drug
history? (Select all that apply.)
A)
Do you take any over-the-counter medications?
B)
Do you take any herbal supplements?
C)
Do you use any alternative therapies?
D)
Do you take any natural supplements or vitamins?
E)
What unusual therapies do you take?
Ans:
A, B, D
Feedback:
The nurse needs to specifically question the patients use of over-the-counter
drugs, herbal supplements, natural supplements, and vitamins. Use of terms
like alternative therapies or unusual therapies is too vague and may not elicit
the kind of information needed.
Chapter 5.- Chapter 8 Prescriptions and LabelsChapter 6. Basic Review of MathematicsChapter
7. Measurement SystemsChapter 8. Dosage Calculations
1.
The nurse is calculating a drug dosage and converting from milligrams to
grams. What measurement system is the nurse using?
A)
Metric system
B)
Apothecary system
C)
Household system
D)
Avoirdupois system
Ans:
A
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Feedback:
The metric system is the most widely used system of measurement in the
world; it is based on the decimal system. The gram is the basic unit of solid
measure, and the liter unit of liquid measure. The apothecary system uses the
grain as the basic unit of solid measure. The household system uses the
pound as the basic unit of measure. The avoirdupois system uses ounces and
grains, but it is mostly used by drug manufacturers for bulk medications.
2.
The nurse teaches a young mother the importance of administering
appropriate dosages of acetaminophen (Tylenol) and determines further
teaching is needed when the mother makes what statement?
A)
The childrens dosage will change with time as they grow.
B)
My babys dose of Tylenol is about 1 half an adult dose.
C)
It is important to give the right dose to prevent toxic effects of the
medication.
D)
My childrens dose of Tylenol should be based on their weight or age.
Ans:
B
Feedback:
A childs dose is never based on an adults dose. A childs dosage is based on
weight and age and will change with age as they grow. Larger than directed
dosages can result in toxic effects of this medication.
3.
A nurse calculates the pediatric patients medication dosage using Clarks rule
and uses what formula?
A)
Infants age in months/150 months times the average adult dose
B)
Childs age in years/childs age in years plus 12 times the average adult
dose
C)
Weight of child in pounds/150 pounds times the average adult dose
D)
Surface area in square meters/1.73 times the average adult dose
Ans:
C
Feedback:
Clarks rule uses the childs weight to calculate the dose and assumes the
adult dose is based on a 150-pound person. Frieds rule applies to a child
younger than 1 year of age and assumes that an adult dose would be
appropriate for a child who is 12.5 years (150 months) old. Youngs rule
applies to children 1 to 12 years of age. Surface area calculation of a childs
dose is determined with the use of a nomogram including the childs height
and weight.
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4.
Ans:
The nurse receives a new medication order for a patient to administer 240
mg of medication per day in equally divided doses every 6 hours. How many
mg of the drug should the nurse administer for each dose?
60 mg
Feedback:
Because there are 24 hours in a day, giving a drug every 6 hours would
mean giving the drug 4 times a day. Because the total daily dose is 240 mg,
dividing that dose by 4 would mean each dose should be 60 mg.
5.
A physician orders 500 mL of IV solution be administered over 8 hours. If
the IV infusion set delivers 15 drops per mL, how many drops per minute
should the nurse administer to the patient?
A)
15 drops/min
B)
20 drops/min
C)
32 drops/min
D)
64 drops/min
Ans:
A
Feedback:
If a patient was to receive 500 mL in 8 hours, dividing 500 by 8 would mean
that the patient would receive 62.5 mL in 1 hour, or 60 min. Setting up the
equation, 15 drops/mL/X equals 62.5 mL/60 min; cross-multiplying, the
answer will be 15 drops/min.
6.
The nurse is teaching a diabetic patient to self-administer Humulin insulin,
supplied in a vial labeled 100 units/mL. The provider has ordered 32 units of
Humulin insulin to be taken each morning. How many mL of insulin would
the patient prepare for one dose?
A)
0.032 mL
B)
0.32 mL
C)
3.2 mL
D)
0.64 mL
Ans:
B
Feedback:
There are 100 units in each mL. Divide that amount by 32 units for the
answer (0.32 mL).
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7.
Ans:
The provider orders a maintenance dose of oral aminophylline, 3 mg/kg
every 6 hour. The patient weighs 50 kg. How many mg should the nurse
administer to the patient in a 24-hour period?
600 milligram
Feedback:
The patients weight times the number of milligram/kilogram will provide
daily dosage of medication: 50 kg 3 mg/kg = 150 mg per dose. The patient is
to receive a dose every 6 hours. The number of hours in a day divided by the
number of hours separating each dose supplies the number of dosages the
patient receives per day: 24 hours 6 hours between doses = 4 doses per day.
If each dose is 150 mg and the patient receives 4 of these doses a day, the
total amount of medication received is 150 mg 4 daily doses = 600 mg.
8.
The physician writes an order for oxazepam for a 6-year-old child. The
nurse verifies that there is no established dosage for children 6 to 12 years of
age for oxazepam. The nurse knows that the usual adult dose is 10 mg tid.
What would the nurse calculate the appropriate dose to be?
A)
0.03 mg tid
B)
0.3 mg tid
C)
1.8 mg tid
D)
3.3 mg tid
Ans:
D
Feedback:
Because the nurse knows only the childs age, the nurse would need to use
Youngs rule to determine the appropriate dosage. The formula for Youngs
rule is: Childs dose = childs age in years (childs age + 12) average adult
dose. Using the information provided in the question: Dose = 6 (6 + 12) 10
mg = 6 18 10 = 0.33 10 = 3.3.
9.
A newly admitted patient has orders to receive 1,000 mL of normal saline IV
over 8 hours. If the IV infusion set is a microdrip set that delivers 60 drops
per mL, how many drops per minute should the nurse administer to the
patient?
A)
60 drops/min
B)
125 drops/min
C)
240 drops/min
D)
480 drops/min
Ans:
B
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Feedback:
If a patient was to receive 1,000 mL in 8 hours, dividing 1000 by 8 would
mean that the patient would receive 125 mL in 1 hour, or 60 minutes. Setting
up the equation, 60 drops/mL X = 125 mL/60 minutes; cross-multiplying,
the answer is 125 drops/min.
10.
The nurse is preparing to administer cefadroxil 1 g PO. The medication is
supplied in 500-mg tablets. How many tablets will the nurse administer?
A)
0.5 tablet
B)
1 tablet
C)
2 tablets
D)
3 tablets
Ans:
C
Feedback:
Convert 1 g to mg by multiplying 1 g times 1,000 mg. There are 500-mg in
each tablet. Dividing the 1000 mg prescribed dosage by 500-mg available
dosage, the answer is two tablets.
11.
The nurse begins administering 500 mL of 5% dextrose and water solution
at 01:00 to run over 4 hours. At 02:00, the nurse administers 80 mg
gentamicin in 50 cc normal saline to infuse over 30 minutes. How many mL
of fluid will the nurse administer to the patient between 02:00 and 03:00?
A)
175 mL
B)
150 mL
C)
125 mL
D)
100 mL
Ans:
A
Feedback:
The patient is receiving 500 mL over 4 hours. To determine how much fluid
is infusing per hour = 500 mL 4 = 125. In addition to the 125 mL of IV
solution, the patient also receives 50 mL of gentamicin during the 02:00 to
03:00 hour. 125 mL + 50 mL = 175 total mL of fluid received during this
hour.
12.
An adult patient with renal cancer, weighing 95 kg, is to receive vincristine
25 mcg/kg/day IV. What is the dosage of vincristine that the nurse should
administer to the patient daily in mg?
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Ans:
2.375 mg
Feedback:
This order requires 25 mcg of medication for every 1 kg of body weight.
The patient weighs 95 kg. To determine total dosage multiply weight times
mcg of medication: 25 95 = 2,375 mcg. Convert mcg to mg by moving the
decimal three places to the left, or you can divide 2,375 by 1,000 because
there are 1,000 mcg per mg.
13.
Ans:
The nurse is preparing medication for a 30-month-old child with otitis media
in the right ear. The child weighs 33 pounds. The physician has ordered
Keflex, 50 mg/kg/d in equally divided doses every 8 hours. The medication
concentration is 250 mg/5 mL. How many milliliters should the nurse give
the toddler for each dose?
5 mL
Feedback:
To calculate the correct dosage, the nurse first converts the childs weight
from pounds to kilograms by dividing weight in pounds by 2.2 (2.2 lb = 1
kg). 33 pounds 2.2 pounds/kg = 15 kg. The child is to receive 50 mg for
every kilogram. To determine this childs dosage multiply weight times daily
dose (15 kg 50 mg/kg = 750 mg). Thus, 750 mg is to be administered in
equally divided dosages every 8 hours, or 3 times a day. 750 mg 3 = 250
mg/dose. There is 250 mg in 5 mL of medication so the patient would be
given 5 mL.
14.
An adolescent is admitted to the intensive care unit with diabetic
ketoacidosis. The nurse prepares a continuous insulin infusion of 100 units
(U) regular insulin in 500 milligram normal saline. When documenting this
medication, how many units of regular insulin will this patient receive per
milligram of IV solution?
A)
0.175 U/milligram
B)
0.2 U/milligram
C)
0.25 U/milligram
D)
0.5 U/milligram
Ans:
B
Feedback:
The problem tells us there is 100 U/500 milligram. To determine how many
units are in each milligram, divide both numbers by 500: 100 U 500/500
milligram 500 = 0.2 U/1 milligram.
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15.
The patient drinks 18 ounces of fluid at lunchtime. How many milliliters of
intake will the nurse document?
A)
1.7 mL
B)
0.6 mL
C)
540 mL
D)
54 mL
Ans:
C
Feedback:
1 ounce = 30 mL. Using the ratio-and-proportion method: 1 oz/30 mL = 18
oz/X. Cross-multiply to determine the patient drank 540 mL of fluid.
16.
The pediatric nurse is caring for a child who weighs 44 pounds. The
physician has ordered methylprednisolone sodium succinate (Solu-Medrol),
0.03 mg/kg/d IV in normal saline. How many milligrams of medication will
the nurse prepare?
A)
6.5
B)
6
C)
0.65
D)
0.6
Ans:
D
Feedback:
First convert the childs weight to kilograms by dividing 44 pounds by 2.2
kg/1 pound = 20 kg. Multiply the dosage times the childs weight: 20 kg 0.03
mg/kg/d = 0.6 mg/d
17.
The nurse is to infuse 100 mL of 5% dextrose and water solution containing
an IV antibiotic over 30 minutes. The infusion set delivers 10 gtt/mL. How
many drops per minute will the nurse administer?
A)
33 gtt/min
B)
30.3 gtt/min
C)
30 gtt/min
D)
3 gtt/min
Ans:
A
Feedback:
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Use the following ratio to determine how many drops of fluid to administer
per minute:
Using the information from this problem:
Because it is not possible to deliver 0.3 drops, round 33.3 to 33 gtt/min.
18.
An 80-year-old patient with internal bleeding is admitted through the
emergency room after a motor vehicle accident. The physician has ordered 2
units of packed red blood cells (1 unit is 250 mL) to infuse over 1 hour each.
The drip rate on the blood administration set is10 gtt/mL. The nurse
administers how many drops per minute to infuse the blood as ordered?
A)
47
B)
42
C)
37
D)
32
Ans:
B
Feedback:
Use the following ratio to determine how many drops of fluid to administer
per minute:
Using the information from this problem:
Because it is not possible to deliver 0.7 of a drop, round 41.7 to 42 minutes
19.
The physician prescribes 250 mg of a drug. The information on the drug vial
says the concentration is 500 mg/mL. How much of the drug will the nurse
prepare?
A)
0.25 mL
B)
0.33 mL
C)
0.5 mL
D)
0.75 mL
Ans:
C
Feedback:
To determine amount to prepare: 500 mg/1 mL = 250 mg/X. Cross-multiply
to determine the nurse will prepare 0.5 mL.
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20.
An 81-year-old patient with congestive heart failure has been sent to a
cardiologist who prescribes digoxin (Lanoxin) 0.125 mg PO every morning.
The pharmacy dispenses pills that contain 0.25 mg of Lanoxin. How many
pills should the nurse teach the patient to take every morning?
A)
2
B)
1.5
C)
1
D)
0.5
Ans:
D
Feedback:
0.25 mg/1 tablet = 0.125 mg dose/X. Cross-multiply to determine 0.5 or 1/2
of a tablet is to be taken daily. The nurse may request the pharmacy dispense
a different concentration to prevent the patient from having to cut the tablet
in half.
21.
A patient with diabetic ketoacidosis is to receive a continuous infusion of
regular insulin. The physician orders 1 L of 5% dextrose and water solution
to run at 150 mL/h once the patients blood glucose has reached 250 mg/dL.
The drip factor of the tubing is 15 gtt/mL. How many drops per minute will
the nurse deliver?
A)
0.25 gtt/min
B)
62 gtt/min
C)
37 gtt/min
D)
250 gtt/min
Ans:
C
Feedback:
Use the following ratio to determine how many drops of fluid to administer
per minute:
Using the information from this problem:
37.5 can be rounded to 37 or 38 gtt/min.
22.
A)
A patient has orders to receive 2 L of IV fluid over a 24-hour period with
this amount to be infused in the first 10 hours of treatment. How many
milliliters per hour will the nurse administer during the first 10 hours of the
infusion?
50 mL/h
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B)
100 mL/h
C)
83 mL/h
D)
200 mL/h
Ans:
B
Feedback:
of the 2 liters is to infuse in the first 10 hours. of 2 = 1 L; 1 L = 1,000 mL to
infuse over 10 hours = 100 mL/L.
23.
A)
A patient is going to have bowel surgery in the morning. The physician
orders 500 mL of GoLytely PO to be administered at 5 PM this evening.
How many liters will the nurse administer?
1
B)
C)
D)
Ans:
C
Feedback:
Cross-multiply to learn 500 mL = or 0.5 L.
24.
The patient returns from the postanesthesia care unit (PACU) with the
following order: morphine 3 mg IV every 2 hours as needed for relief of
pain. The vial reads morphine, 4 mg/mL. How many milliliters of morphine
will the nurse administer?
A)
1 mL
B)
0.75 mL
C)
0.5 mL
D)
0.25 mL
Ans:
B
Feedback:
Using the figures from this problem: 4 mg/1 mL = 3 mg/X. Cross-multiply
yielding 0.75 mL.
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25.
A patient is admitted with a deep vein thrombosis in his or her left calf. The
physician orders Heparin, 7,500 units subcutaneously every 12 hours. The
medication vial reads Heparin, 10,000 units/mL. How many milliliters does
the nurse administer?
A)
0.5 mL
B)
0.75 mL
C)
1 mL
D)
1.25 mL
Ans:
A
Feedback:
Using the information supplied by the problem: 10,000 units/1 mL = 7,500/
X. Cross-multiplying yields X = 0.75 mL for each dose.
26.
A patient with an acute myocardial infarction is admitted to the coronary
care unit. The physician has ordered heparin 25,000 units in 250 mL normal
saline to infuse at a rate of 600 units/h. The nurse sets the infusion pump to
deliver how many milliliters in an hour?
A)
8
B)
7
C)
6
D)
5
Ans:
C
Feedback:
First determine the number of units per mL = 25,000 units/250 mL = 100
units/1 mL. Next use the ratio and proportion method to determine the
number of milliliters needed to supply 600 units/h. 100 units/1 mL = 600
units/X. Cross-multiplying yields 6 mL needed every hour to supply the
required dose.
27.
The physician has ordered 30 mg of Demerol IM for relief of a severe
migraine headache. The package insert reads meperidine hydrochloride
(Demerol) 50 mg/mL. How many milliliters would the nurse administer?
A)
1.6
B)
1
C)
0.6
D)
0.5
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Ans:
C
Feedback:
Filling in the information from the problem: 50 mg/1 mL = 30 mg/X mL.
Cross-multiply yielding 0.6 mL required to administer a 30-mg dosage.
28.
A patient is experiencing pain, so the physician orders codeine grain every 4
hours. How many milligrams of codeine would the nurse administer?
A)
15 mg
B)
30 mg
C)
60 mg
D)
120 mg
Ans:
B
Feedback:
The simplest way to convert measurements from one system to another is to
set up a ratio and proportion equation. The ratio containing two known
equivalent amounts is placed on one side of an equation, and the ratio
containing the amount you wish to convert and its unknown equivalent is
placed on the other side.
60 mg/1 grain = flexion range of motion. Cross-multiplying yields 30 mg.
29.
A 79-year-old female patient presents at the clinic complaining of
constipation for 1 week. The nurse practitioner prescribes Milk of Magnesia
2 teaspoons by mouth as needed for relief of constipation. How many
milliliter will the nurse administer?
A)
30 mL
B)
7.5 mL
C)
10 mL
D)
15 mL
Ans:
C
Feedback:
Use the ratio and proportion method to convert from household system to
metric system. 5 mL/1 tsp = X mL/2 tsp. Cross-multiplying yields 10 mL =
2 tsp.
30.
A patient has orders to receive 3,000 mL of IV fluid at a rate of 150 mL/h. If
the infusion starts at 08:00, when would it be finished?
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A)
20:00
B)
23:00
C)
01:00
D)
04:00
Ans:
D
Feedback:
Amount of fluid to infuse = 3,000 mL; rate of infusion = 150 mL. 3,000 150
mL = 20 hours to infuse. There are 24 hours in a day 20 hours = 4 hours.
The infusion will complete in 4 hours before 08:00 (08:00 04:00 = 04:00
hour) so the infusion completes at 04:00.
31.
The nurse recognizes that what system is being used when seeing a
medication ordered in minims?
A)
Apothecary
B)
Metric
C)
Household
D)
Avoirdupois
Ans:
A
Feedback:
The apothecary system used minims as the basic measure of liquid and is
rarely used today. The metric system uses liters as the basic unit of
measurement for fluid, while the household system uses ounces and the
avoirdupois system uses ounces with a different conversion amount.
32.
The nurse is calculating the patients intake and output record and converts
ounces to milliliters. What systems is this nurse converting from and to?
A)
From household to metric
B)
From metric to household
C)
From household to apothecary
D)
From apothecary to Avoirdupois
Ans:
A
Feedback:
Ounces can be either household or Avoirdupois, although they are not equal
measurements and milliliters is a metric measurement. Since Avoirdupois to
metric is not an available choice, the correct answer is household to metric.
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33.
What is the most accurate method for the nurse to use when determining a
pediatric dosage?
A)
A nomogram using body surface area
B)
Youngs rule
C)
Frieds rule
D)
Clarks rule
Ans:
A
Feedback:
The most accurate means of determining a pediatric drug dosage is a
nomogram using body surface area because the weight and body surface
area of two children who are of the same age can be significantly different.
Youngs rule, Frieds rule, and Clarks rule are based on the childs age and the
usual adult dosage and are rarely used today unless no other method will
suffice for a specific drug.
34.
The nurse determines a childs body surface area is 0.4 m2 and the average
adult dosage of the medication is 500 mg. The medication is supplied in
liquid form with 500mg/5 mL. How many milliliter will the nurse
administer?
A)
3.46 mL
B)
1.73 mL
C)
0.5 mL
D)
12 mL
Ans:
A
Feedback:
The formula for calculating the childs dose using body surface area is
surface area in m2 divided by 1.73 and then multiplied by adult dosage.
Using the information supplied in this problem (0.4 1.73) 500 mg = 346 mg.
Using the ratio and proportion method, 500 mg/5 mL = 346 mg/X mL;
cross-multiplying yields 3.46 mL for the nurse to administer.
35.
The physician orders acetaminophen (Tylenol) 15 mg/kg q4 hours PRN (as
needed) for pain. The drug is supplied with 160 mg/5 mL. The infant weighs
12 pounds. How many milliliter of medication will the nurse administer?
A)
2.5 mL
B)
5.6 mL
C)
12.4 mL
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D)
10.7 mL
Ans:
A
Feedback:
Begin by converting the infants weight to kilograms (12 pounds 2.2 pounds/
kg = 5.45 kg). The order says to give 15 mg/kg. To determine this childs
dosage multiply weight and 15 mg/kg (5.45 kg 15 mg/kg = 81.75 mg/dose).
Finally, use the ratio and proportion method to calculate how to prepare the
medication: 160 mg/5 mL = 81.75 mg/X mL; cross-multiplying yields 2.5
mL.
Chapter 9. Enteral Medications and Administration
MULTIPLE CHOICE
1. In which position would the nurse place a patient before the administration of an enteral
feeding?
a
.
Supine
b
.
Semi-Fowlers
c
.
Left lateral
d
.
Prone
ANS: B
To facilitate gastric emptying, the patient should be placed in a semi-Fowlers position (30 degree
head of bed [HOB] elevation) for 30 minutes before the start of the feeding. Aspiration is a risk
during enteral feedings in the supine position and in the left lateral position. The prone position
would prevent gastric emptying and increase the risk of aspiration.
DIF: Cognitive Level: Application REF: p. 134 OBJ: 4
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
2. Which type of lubricant would the nurse use to administer a rectal suppository?
a
.
Petroleum jelly
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