Pharmacological and Parenteral Therapies 2

Question 1

A nurse is preparing to administer digoxin (Lanoxin) 0.125 mg PO to a client with heart failure. Before administering the medication, which assessment is most critical?

Accepted Answer

Assess the client's apical heart rate for one full minute

Answer

Digoxin slows the heart rate by increasing vagal tone. Before administration, the nurse must count the apical pulse for one full minute. If the heart rate is below 60 bpm in adults, digoxin is withheld and the provider is notified.

Question 2

A nurse is administering heparin as a continuous IV infusion. The order reads: Heparin 25,000 units in 250 mL D5W, infuse at 1,000 units/hour. At what rate should the nurse set the infusion pump (mL/hour)?

Accepted Answer

10 mL/hour

Answer

To calculate: concentration = 25,000 units / 250 mL = 100 units/mL. Rate = desired dose / concentration = 1,000 units/hour ÷ 100 units/mL = 10 mL/hour.

Question 3

A nurse is caring for a client receiving morphine via patient-controlled analgesia (PCA). Which assessment finding requires immediate intervention?

Accepted Answer

Respiratory rate of 8 breaths per minute with pinpoint pupils

Answer

A respiratory rate of 8 breaths per minute with pinpoint pupils indicates opioid-induced respiratory depression and miosis — signs of opioid overdose. This requires immediate intervention including assessment, stopping the PCA, and administering naloxone (Narcan) per order.

Question 4

A nurse is administering a peripheral IV infusion of potassium chloride (KCl) 40 mEq in 100 mL normal saline. The client reports burning and pain at the IV site. Which action should the nurse take first?

Accepted Answer

Assess the IV site for signs of infiltration

Answer

Before taking any corrective action, the nurse must first assess the IV site to determine whether the burning is due to normal vein irritation from the potassium or due to infiltration/extravasation, which requires the IV to be stopped immediately.

Question 5

A nurse is preparing to administer insulin. The physician order reads: Regular insulin 10 units subcutaneously and NPH insulin 20 units subcutaneously. How should the nurse prepare this combined dose?

Accepted Answer

Draw up regular insulin first, then NPH insulin into the same syringe

Answer

When mixing regular and NPH insulin, the nurse draws regular (clear) insulin first, then NPH (cloudy) insulin. The mnemonic 'Clear before Cloudy' helps remember this sequence. Drawing regular insulin first prevents contamination with NPH.

NCLEX Practice Test

NCLEX Practice Test

Pharmacological and Parenteral Therapies 2