NACE Pharmacological and Parenteral Therapies 4 — Questions and Answers
Question 1: A patient receiving total parenteral nutrition (TPN) develops sudden shortness of breath and chest pain after the central line is repositioned. What should the nurse suspect first?
- Air embolism (Correct answer)
- Hyperglycemia
- Catheter occlusion
- Fluid overload
Correct answer: Air embolism
Sudden dyspnea and chest pain after central line manipulation are classic signs of air embolism, a life-threatening complication.
Question 2: Which electrolyte imbalance is most commonly associated with prolonged loop diuretic therapy such as furosemide?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Loop diuretics inhibit potassium reabsorption in the loop of Henle, making hypokalemia the most common electrolyte complication.
Question 3: A nurse is preparing to administer heparin 5,000 units subcutaneously. Which action is correct?
- Aspirate before injecting to confirm no blood return
- Inject into the deltoid muscle
- Do not rub the injection site after administration (Correct answer)
- Use a 21-gauge, 1.5-inch needle
Correct answer: Do not rub the injection site after administration
Rubbing a subcutaneous heparin injection site can cause bruising and hematoma formation, so it should be avoided.
Question 4: A patient is receiving IV vancomycin and develops flushing, erythema, and hypotension during the infusion. What is the most likely cause?
- Anaphylactic reaction
- Red man syndrome (Correct answer)
- Septic shock
- Phlebitis
Correct answer: Red man syndrome
Red man syndrome is a rate-related reaction to rapid vancomycin infusion causing histamine release, resulting in flushing, erythema, and hypotension.
Question 5: Which assessment finding in a patient taking lithium carbonate requires immediate intervention?
- Mild hand tremor
- Polyuria
- Serum lithium level of 2.5 mEq/L (Correct answer)
- Slight nausea after doses
Correct answer: Serum lithium level of 2.5 mEq/L
A serum lithium level of 2.5 mEq/L indicates severe toxicity (therapeutic range 0.6–1.2 mEq/L) and requires immediate intervention.
Question 6: A nurse is teaching a patient about warfarin therapy. Which food should the patient be instructed to consume consistently rather than avoid entirely?
- Grapefruit juice
- Green leafy vegetables (Correct answer)
- Alcohol
- Aged cheese
Correct answer: Green leafy vegetables
Patients on warfarin should keep vitamin K intake (from green leafy vegetables) consistent rather than eliminating it, as abrupt changes alter INR.
Question 7: When administering a peripheral IV infusion, the nurse notices the site is cool, pale, and swollen. What is the priority action?
- Slow the infusion rate and reassess in 30 minutes
- Apply a warm compress over the site
- Discontinue the IV and restart at a new site (Correct answer)
- Elevate the extremity and continue the infusion
Correct answer: Discontinue the IV and restart at a new site
Coolness, pallor, and swelling indicate infiltration; the IV must be discontinued immediately and restarted at a new site to prevent tissue damage.
NACE Pharmacological and Parenteral Therapies 4
A patient receiving total parenteral nutrition (TPN) develops sudden shortness of breath and chest pain after the central line is repositioned.
What should the nurse suspect first?