DOH Nursing Medication Management 3 — Questions and Answers
Question 1: A patient's blood glucose is 58 mg/dL. They are unconscious and unable to take oral glucose. What medication should be administered?
- IV dextrose 50% (D50W) or IM glucagon 1 mg (Correct answer)
- Oral glucose gel placed under the tongue of the unconscious patient
- Insulin to stabilize blood glucose levels
- IV normal saline alone
Correct answer: IV dextrose 50% (D50W) or IM glucagon 1 mg
Unconscious hypoglycemia requires IV dextrose (D50W, 25–50 mL) for rapid correction when IV access exists, or IM/SC glucagon 1 mg if no IV access is available. Glucagon stimulates hepatic glycogenolysis, raising blood glucose within 10–15 minutes. Never give oral glucose to unconscious patients — aspiration risk.
Question 2: A patient prescribed fluoxetine (SSRI) and tramadol concurrently is at risk for which condition?
- Serotonin syndrome (Correct answer)
- Malignant hyperthermia
- Neuroleptic malignant syndrome
- Anticholinergic syndrome
Correct answer: Serotonin syndrome
Both fluoxetine (increases serotonin via reuptake inhibition) and tramadol (weak serotonin reuptake inhibitor + mu-opioid agonist) increase serotonergic activity. The combination increases risk of serotonin syndrome: tremor, clonus, hyperthermia, agitation, and tachycardia. MAOIs with serotonergic drugs carry the highest risk.
Question 3: A nurse is administering IV phenytoin. Which solution should NOT be used to dilute it?
- Dextrose (5% D5W) — phenytoin precipitates in dextrose solutions (Correct answer)
- Normal saline (0.9% NaCl)
- Lactated Ringer's solution
- Sterile water for injection
Correct answer: Dextrose (5% D5W) — phenytoin precipitates in dextrose solutions
Phenytoin precipitates in dextrose (glucose) solutions because the acidic pH of D5W alters solubility. It must be diluted ONLY in normal saline (0.9% NaCl). Additionally, IV phenytoin must be administered slowly (≤50 mg/min in adults) to prevent cardiac arrhythmias and hypotension.
Question 4: A patient taking an aminoglycoside antibiotic reports ringing in the ears (tinnitus). What does this indicate?
- Ototoxicity — the drug should be reported to the physician immediately (Correct answer)
- A normal expected side effect requiring no action
- Hypersensitivity reaction requiring antihistamine
- Pseudomembranous colitis from antibiotic use
Correct answer: Ototoxicity — the drug should be reported to the physician immediately
Tinnitus and hearing loss are early signs of aminoglycoside ototoxicity (cochlear damage), which can progress to permanent sensorineural hearing loss. The drug must be reviewed immediately. Risk factors include prolonged use, high doses, renal impairment, and concurrent loop diuretics.
Question 5: A patient is to receive ampicillin 500 mg IV. The vial contains 1 g of ampicillin in 10 mL of diluent. How many mL should be administered?
- 5 mL (Correct answer)
- 10 mL
- 2.5 mL
- 7.5 mL
Correct answer: 5 mL
Concentration: 1,000 mg/10 mL = 100 mg/mL. Required dose: 500 mg. Volume = 500 mg ÷ 100 mg/mL = 5 mL. Always use the formula: Volume = Desired dose ÷ Available concentration. Double-check with dimensional analysis.
Question 6: What is the antidote for benzodiazepine overdose?
- Flumazenil (Correct answer)
- Naloxone
- N-acetylcysteine
- Protamine sulfate
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly reverses sedation and respiratory depression from benzodiazepine overdose. It has a shorter half-life than most benzodiazepines, so re-sedation can occur and repeat dosing or infusion may be needed. Naloxone reverses opioids.
DOH Nursing Medication Management 3
A patient's blood glucose is 58 mg/dL.
They are unconscious and unable to take oral glucose.
What medication should be administered?