NACE Pharmacological and Parenteral Therapies 2 — Questions and Answers
Question 1: A patient is prescribed heparin 5,000 units subcutaneously. The vial contains 10,000 units/mL. How many mL should the nurse administer?
- 0.25 mL
- 0.5 mL (Correct answer)
- 1 mL
- 2 mL
Correct answer: 0.5 mL
Using the formula: 5,000 units divided by 10,000 units/mL = 0.5 mL.
Dose calculation: Desired dose / Available concentration = Volume to administer. 5,000 units / 10,000 units/mL = 0.5 mL. Heparin is a high-alert medication requiring independent double verification by two nurses before administration.
Question 2: Which assessment is most important before administering digoxin?
- Blood pressure
- Apical heart rate for one full minute (Correct answer)
- Respiratory rate
- Temperature
Correct answer: Apical heart rate for one full minute
The apical heart rate must be assessed for one full minute before administering digoxin. The medication should be held if the rate is below 60 bpm in adults.
Digoxin is a cardiac glycoside that slows the heart rate and increases contractility. Before each dose, the nurse must auscultate the apical pulse for a full 60 seconds to detect irregularities. Hold if heart rate is below 60 bpm (adult). Therapeutic level is 0.5-2.0 ng/mL.
Question 3: A patient receiving IV vancomycin develops flushing of the face, neck, and upper body. What is the nurse's priority action?
- Administer epinephrine for anaphylaxis
- Slow the infusion rate (Correct answer)
- Stop the infusion permanently and notify the provider
- Apply cold compresses to the flushed areas
Correct answer: Slow the infusion rate
This presentation is consistent with Red Man Syndrome, a histamine-mediated reaction to rapid vancomycin infusion. Slowing the infusion rate typically resolves the symptoms.
Red Man Syndrome is a histamine-mediated reaction caused by rapid vancomycin infusion, not a true allergic reaction. The primary intervention is to slow or temporarily stop the infusion, then restart at a slower rate. Vancomycin should be infused over at least 60 minutes.
Question 4: Which medication requires the nurse to monitor potassium levels closely due to the risk of hyperkalemia?
- Furosemide
- Spironolactone (Correct answer)
- Hydrochlorothiazide
- Mannitol
Correct answer: Spironolactone
Spironolactone is a potassium-sparing diuretic that blocks aldosterone, leading to potassium retention and risk of hyperkalemia.
Spironolactone is an aldosterone antagonist (potassium-sparing diuretic) that blocks sodium reabsorption and potassium excretion in the distal tubule. This mechanism causes potassium retention, creating hyperkalemia risk.
Question 5: A nurse is administering total parenteral nutrition (TPN) through a central line. Which nursing action is essential?
- Administer TPN through a peripheral IV line for convenience
- Monitor blood glucose levels regularly (Correct answer)
- Run TPN at a rapid rate to complete it within 12 hours
- Add medications directly into the TPN bag
Correct answer: Monitor blood glucose levels regularly
TPN contains high concentrations of dextrose that can cause hyperglycemia. Blood glucose monitoring every 4-6 hours is essential during TPN administration.
TPN is a hypertonic solution containing dextrose (15-25%), amino acids, lipids, electrolytes, vitamins, and trace elements administered through a central venous catheter. The nurse should monitor blood glucose every 4-6 hours and never abruptly discontinue TPN due to rebound hypoglycemia risk.
Question 6: A patient with diabetes is prescribed NPH insulin and regular insulin. In which order should the nurse draw up the insulins?
- NPH first, then regular
- Regular first, then NPH (Correct answer)
- Either order is acceptable
- They must be given in separate syringes
Correct answer: Regular first, then NPH
The clear (regular) insulin is always drawn up first to prevent contamination of the regular insulin vial with the cloudy (NPH) insulin.
When mixing insulins in one syringe, always draw up regular (clear) insulin first, then NPH (cloudy). The mnemonic 'clear before cloudy' or 'RN' (Regular then NPH) helps remember the sequence. Contaminating the regular insulin vial with NPH would alter the onset and duration of regular insulin.
NACE Pharmacological and Parenteral Therapies 2
A patient is prescribed heparin 5,000 units subcutaneously.
The vial contains 10,000 units/mL.
How many mL should the nurse administer?