Free Registered Nurse: Pharmacological & Parenteral Therapies Questions and Answers — Questions and Answers
Question 1: A patient is admitted to the medical unit for alcohol withdrawal and detoxification who has a history of serious alcohol misuse. The individual acknowledges consuming alcohol two hours prior to admission. Which drug from the list below will the healthcare professional (HCP) recommend for this patient?
- Diazepam (Correct answer)
- Haloperidol
- Naloxone hydrochloride
- Disulfiram
Correct answer: Diazepam
Diazepam, a benzodiazepine, is the drug of choice for managing acute alcohol withdrawal syndrome. It helps to reduce central nervous system hyperexcitability, alleviate symptoms like tremors, agitation, and anxiety, and prevent seizures, which are common and dangerous during alcohol detoxification.
Question 2: Total parenteral nutrition (TPN) and lipids should be administered to a patient with an acute aggravation of inflammatory bowel disease. Which of these treatments should be given top priority while treating this patient?
- Infuse the solution in a large peripheral vein
- Monitor urine specific gravity every shift
- Monitor the patient's blood glucose per protocol (Correct answer)
- Change the administration set every 72 hours
Correct answer: Monitor the patient's blood glucose per protocol
TPN solutions are highly concentrated with dextrose, which can cause significant fluctuations in blood glucose levels, leading to hyperglycemia. Monitoring blood glucose per protocol is crucial to prevent complications like osmotic diuresis, dehydration, and electrolyte imbalances, making it a top priority.
Question 3: A 3-year-old patient with acute otitis media is given the medication amoxicillin suspension 200 mg PO every 8 hours by the pediatrician. The youngster is 38 pounds (17.2 kg). For kids up to 40 kg, the suggested dose range is 20–40 mg/kg/day, divided into eight-hour intervals. What is the nurse's BEST course of action when following the 10 Rights of Medication Administration?
- Contact the pediatrician to clarify the dose
- Administer the medication as prescribed (Correct answer)
- Refuse to give because it is not the drug of choice
- Withhold the dose because it is too low
Correct answer: Administer the medication as prescribed
First, calculate the child's weight in kg (38 lbs / 2.2 lbs/kg = 17.2 kg). Then, calculate the recommended daily dose range: 17.2 kg * 20 mg/kg/day = 344 mg/day to 17.2 kg * 40 mg/kg/day = 688 mg/day. The prescribed dose is 200 mg every 8 hours, which totals 600 mg/day (200 mg x 3 doses). Since 600 mg/day falls within the safe range of 344-688 mg/day, the nurse should administer the medication as prescribed.
Question 4: The healthcare professional gives NPH insulin to a diabetic patient at 6:00 a.m. How soon might the patient exhibit hypoglycemic symptoms?
- 8:00 AM
- 7:00 AM
- 9:00 AM
- 10:00 AM (Correct answer)
Correct answer: 10:00 AM
NPH insulin is an intermediate-acting insulin with an onset of action typically 1-2 hours after administration and a peak effect occurring 4-12 hours later. If administered at 6:00 AM, the patient is most likely to experience hypoglycemic symptoms around the peak time, which would be 10:00 AM (4 hours after administration).
Question 5: To treat primary hypertension, a patient is given a prescription for a calcium channel blocker. Which of these foods will the healthcare professional advise the patient to avoid while explaining the medication?
- Eggs
- Milk
- Bananas
- Grapefruit (Correct answer)
Correct answer: Grapefruit
Grapefruit and grapefruit juice are known to interact with many medications, including calcium channel blockers, by inhibiting the CYP3A4 enzyme in the gut. This inhibition can lead to increased blood levels of the medication, potentially causing enhanced effects and adverse reactions, making it crucial to avoid.
Question 6: A patient complains of having watery diarrhea for the last three days when they arrive at the emergency room. Blood pressure readings of 100/60, a pulse of 98, and dry mucous membranes are other assessment findings. Which of the following fluids would the healthcare provider expect to provide intravenous treatment with?
- Hypotonic crystalloid
- Hypertonic crystalloid
- Isotonic crystalloid (Correct answer)
- Colloid solution
Correct answer: Isotonic crystalloid
The patient's symptoms (watery diarrhea, low blood pressure, high pulse, dry mucous membranes) indicate significant fluid volume deficit and dehydration. Isotonic crystalloid solutions, such as 0.9% Normal Saline or Lactated Ringer's, are the most appropriate choice for initial fluid resuscitation as they expand the intravascular volume without causing fluid shifts into or out of cells.
Question 7: The nurse checks with the patient to see if there are any drug sensitivities before giving penicillin intramuscularly to a patient with "NKDA" on his medical record. The customer replies, "I'm not certain. One time, when I was ill and received a shot, I might have developed a rash." Which course of action is best for the nurse?
- Ask the client for more details before giving the penicillin
- Hold the penicillin and contact the prescribing provider (Correct answer)
- Administer the penicillin and observe for 60 minutes
- Contact the hospital pharmacist for oral penicillin
Correct answer: Hold the penicillin and contact the prescribing provider
Even an uncertain history of a rash after an injection warrants caution, especially with a medication like penicillin, which is a common allergen. To ensure patient safety and adhere to the 'Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation, Right Reason, Right Response, Right to Refuse, Right Assessment' principles, the nurse must clarify the allergy status with the provider before administering the medication.
Question 8: Holding a sterile gauze pad over the injection site while removing the needle serves to
- seal off the track left by the needle
- increase the absorption of the medication
- prevent pathogens from entering through the puncture
- decrease the discomfort of the needle pulling on the skin (Correct answer)
Correct answer: decrease the discomfort of the needle pulling on the skin
Holding a sterile gauze pad over the injection site while removing the needle helps to stabilize the skin and apply gentle counter-pressure. This action reduces the pulling sensation on the skin as the needle is withdrawn, thereby decreasing the patient's discomfort during the procedure.
Question 9: The lab and blood bank need a sample of the patient's blood before the patient can receive a transfusion of whole blood. What tests will be conducted?
- Blood type and crossmatch (Correct answer)
- Blood type and antigen screen
- Complete blood count (CBC) and differential
- Blood culture and sensitivity analysis
Correct answer: Blood type and crossmatch
Before any blood transfusion, it is absolutely essential to perform a blood type (ABO and Rh factor) and crossmatch. This ensures that the donor blood is compatible with the recipient's blood, preventing potentially life-threatening transfusion reactions caused by antigen-antibody incompatibilities.
Question 10: For a patient with severe heartburn, the healthcare professional (HCP) recommends taking aluminum hydroxide suspension every two hours between meals and before bed. Which side effect should the nurse bring up when the patient returns for a follow-up appointment?
- Insomnia
- Constipation (Correct answer)
- Palpitations
- Dizziness
Correct answer: Constipation
Aluminum hydroxide is an antacid commonly used to treat heartburn. A well-known side effect of aluminum-containing antacids is constipation, as aluminum can slow intestinal motility. The nurse should inquire about changes in bowel habits during the follow-up appointment to assess for this common adverse effect.
Question 11: Hepatitis is the patient's diagnosis upon admission to the medical facility. Which phase of pharmacokinetics is most affected by the patient's diagnosis when the healthcare professional is getting ready to administer intravenous medications?
- Distribution
- Excretion
- Metabolism (Correct answer)
- Absorption
Correct answer: Metabolism
The liver is the primary organ responsible for drug metabolism, which is the process of chemically altering drugs into metabolites for excretion or activation. In a patient with hepatitis, liver function is impaired, significantly affecting the body's ability to metabolize medications. This impairment can lead to altered drug levels, increased toxicity, or reduced therapeutic effect, especially with intravenous medications that bypass initial absorption and go directly into systemic circulation.
Question 12: The doctor prescribes Zofran 8 mg PO once daily. A 100 mL bottle with the label "4 mg/tsp" is sent by the pharmacy. How many milliliters should each dose contain?
- 2 mL
- 10 mL (Correct answer)
- 5 mL
- 8 mL
Correct answer: 10 mL
To calculate the correct dose, first determine the concentration in mg/mL. Since 1 tsp equals 5 mL, the concentration is 4 mg/5 mL. The doctor prescribed 8 mg. To find the volume, set up a proportion: (4 mg / 5 mL) = (8 mg / X mL). Solving for X, (8 mg * 5 mL) / 4 mg = 10 mL. Therefore, each dose should contain 10 mL.
Question 13: 50% protein binding indicates that a medication is
- 50% of the drug is available (Correct answer)
- 50% less protein should be eaten
- 50% will pass through the intestines
- 50% of the drug destroys protein
Correct answer: 50% of the drug is available
When a medication is 50% protein-bound, it means that half of the drug molecules are attached to plasma proteins, primarily albumin, and are inactive. The remaining 50% of the drug is 'free' or unbound, meaning it is pharmacologically active and available to exert its therapeutic effect. Only the unbound drug can distribute to tissues, bind to receptors, and be metabolized or excreted.
Question 14: The medical professional is ready to provide a corticosteroid to a patient who has been diagnosed with asthma. What justification exists for giving this medication to this patient?
- To prevent respiratory infections
- To promote bronchodilation
- To promote expectoration of mucus
- To decrease airway swelling (Correct answer)
Correct answer: To decrease airway swelling
Corticosteroids are potent anti-inflammatory medications. In asthma, the primary problem is inflammation and swelling of the airways, leading to bronchoconstriction and increased mucus production. By decreasing airway swelling and inflammation, corticosteroids reduce airway hyperresponsiveness and improve airflow, making them crucial for long-term control of asthma symptoms.
Question 15: A client intentionally overdosed on benzodiazepines, prompting the emergency department doctor to order flumazenil 200 mcg IV push STAT. Flumazenil is present as a 0.5 mg/5 mL solution in the stock vial. How many milliliters should the nurse prepare and give? Give a response with one decimal place.
- 0.5 mL
- 2.0 mL (Correct answer)
- 2.5 mL
- 4.0 mL
Correct answer: 2.0 mL
First, convert the order from mcg to mg: 200 mcg = 0.2 mg. Next, use the concentration of the stock vial (0.5 mg/5 mL) to calculate the volume needed. Set up a proportion: (0.5 mg / 5 mL) = (0.2 mg / X mL). Solving for X, (0.2 mg * 5 mL) / 0.5 mg = 2 mL. Therefore, the nurse should prepare and give 2.0 mL.
Question 16: Which of the following is NOT required to be a part of the order when a practitioner prescribes an IV infusion drug to be titrated?
- Initial or starting rate of the infusion (dose/minute)
- Frequency for increasing or decreasing the incremental dose
- Ability of the nurse to determine the units of incremental rate (Correct answer)
- Objective clinical endpoint or patient response
Correct answer: Ability of the nurse to determine the units of incremental rate
When an IV infusion drug is ordered to be titrated, the practitioner must specify the initial rate, the frequency for incremental changes, and the objective clinical endpoint for titration. The nurse needs clear parameters to adjust the dose safely and effectively. It is the prescriber's responsibility to define the units of incremental rate, not the nurse's to determine them, ensuring consistency and patient safety.
Free Registered Nurse: Pharmacological & Parenteral Therapies Questions and Answers
A patient is admitted to the medical unit for alcohol withdrawal and detoxification who has a history of serious alcohol misuse.
The individual acknowledges consuming alcohol two hours prior to admission.
Which drug from the list below will the healthcare professional (HCP) recommend for this patient?