Nursing Acceleration Challenge Exam I PN-RN Pharmacological and Parenteral Therapies Questions and Answers

Question 1

A nurse is monitoring a client receiving an IV infusion of 0.9% sodium chloride. The client complains of pain and swelling at the IV site, and the surrounding skin appears cool and blanched. Which action should the nurse take first?

Accepted Answer

Stop the infusion and remove the IV catheter.

Answer

The client's signs and symptoms (pain, swelling, coolness, blanching) are classic indicators of IV infiltration, where the IV fluid leaks into the surrounding subcutaneous tissue. The immediate priority is to stop the infusion to prevent further fluid from entering the tissue and causing more damage. After stopping the infusion, the catheter should be removed.

Question 2

A nurse is preparing to administer a continuous intravenous infusion of heparin. Which of the following laboratory values is essential for the nurse to review immediately before initiating the infusion?

Accepted Answer

Activated Partial Thromboplastin Time (aPTT)

Answer

The therapeutic effect of a continuous unfractionated heparin (UFH) infusion is monitored by the aPTT. The nurse must know the baseline aPTT and the desired therapeutic range before starting the infusion to ensure patient safety and effective anticoagulation. PT and INR are used to monitor warfarin therapy. While hemoglobin and hematocrit are important to monitor for bleeding, the aPTT is the primary lab value used for titrating the heparin infusion.

Question 3

A nurse is caring for a client receiving Total Parenteral Nutrition (TPN) via a central venous catheter. Which of the following is a priority nursing intervention to prevent a metabolic complication?

Accepted Answer

Monitoring blood glucose levels every 4 to 6 hours.

Answer

TPN solutions have a high dextrose concentration, which places the client at high risk for hyperglycemia. Frequent blood glucose monitoring (typically every 4-6 hours) is essential to detect and manage this common and serious metabolic complication. Central line dressings are changed using sterile technique, but typically not every 24 hours (usually every 7 days or per protocol). The TPN line should be dedicated to the TPN infusion to prevent infection. TPN rates should never be increased to 'catch up' as this can cause severe metabolic disturbances like hyperglycemia and fluid overload.

Question 4

A nurse is initiating a transfusion of packed red blood cells (PRBCs). Fifteen minutes into the transfusion, the client develops shortness of breath, chills, and lower back pain. What is the nurse's priority action?

Accepted Answer

Stop the transfusion immediately.

Answer

The client's symptoms of chills, shortness of breath, and lower back pain are classic signs of an acute hemolytic transfusion reaction, a life-threatening emergency. The absolute first and most critical action is to stop the transfusion immediately to prevent any more incompatible blood from entering the client's system. After stopping the transfusion, the nurse would then notify the provider and perform other supportive interventions, such as maintaining IV access with normal saline.

Question 5

A client is admitted with severe dehydration secondary to gastroenteritis. The healthcare provider orders an intravenous fluid to rapidly expand intravascular volume. Which type of IV solution would the nurse anticipate being ordered?

Accepted Answer

0.9% Sodium Chloride (Normal Saline)

Answer

0.9% Sodium Chloride (Normal Saline) is an isotonic solution, meaning it has a similar osmolarity to body fluids. It is the fluid of choice for rapid intravascular volume expansion in cases of dehydration or hypovolemia because it primarily stays within the vascular space. 0.45% NaCl is hypotonic and would shift fluid into cells. D5W is isotonic in the bag but becomes hypotonic in the body as dextrose is metabolized. 3% NaCl is a hypertonic solution used for specific electrolyte imbalances like severe hyponatremia, not for general volume expansion.

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

Nursing Acceleration Challenge Exam I PN-RN Pharmacological and Parenteral Therapies Questions and Answers