Pharmacological and Parenteral Therapies 3

Question 1

A nurse is administering metformin to a client scheduled for a contrast CT scan later today. Which action should the nurse take?

Accepted Answer

Hold the metformin and notify the provider before administering the contrast

Answer

Metformin should be held before and after contrast dye administration due to the risk of contrast-induced nephropathy, which can reduce metformin clearance and lead to lactic acidosis — a potentially fatal complication.

Question 2

A nurse is caring for a client who received an overdose of acetaminophen (Tylenol) 6 hours ago. Which medication should the nurse anticipate administering?

Accepted Answer

N-acetylcysteine (Mucomyst)

Answer

N-acetylcysteine (NAC) is the specific antidote for acetaminophen overdose. It replenishes glutathione stores to detoxify the hepatotoxic metabolite NAPQI, preventing liver failure. It is most effective when given within 8-10 hours of ingestion.

Question 3

A nurse is teaching a client about warfarin therapy. The client asks what to do if bleeding symptoms develop at home. Which instruction is most appropriate?

Accepted Answer

'Contact your provider immediately or go to the emergency department if you experience unusual or significant bleeding.'

Answer

Clients on warfarin must know that unusual or significant bleeding requires immediate medical evaluation. The provider may need to check the INR, temporarily hold warfarin, and potentially administer vitamin K or fresh frozen plasma.

Question 4

A nurse is reviewing medication orders for a client with renal failure. Which medication requires the most careful dose adjustment or avoidance in this population?

Accepted Answer

Metformin (Glucophage)

Answer

Metformin is contraindicated in significant renal failure (eGFR <30 mL/min/1.73m²) because it is renally cleared and accumulation causes lactic acidosis, a potentially fatal complication.

Question 5

A nurse is preparing to start a peripheral IV infusion of dextrose 10% in water (D10W). The infusion is a vesicant. The nurse assesses the current IV site and notes it is in the antecubital fossa of the right arm, patent with good blood return. Which action is most appropriate?

Accepted Answer

Request a central venous catheter before administering the infusion

Answer

D10W (Dextrose 10%) is considered a vesicant — it causes significant tissue damage if it infiltrates. High-concentration dextrose solutions (>10%) should ideally be administered through a central venous catheter to avoid peripheral vein damage and infiltration risk.

NCLEX Practice Test

NCLEX Practice Test

Pharmacological and Parenteral Therapies 3