Pharmacological and Parenteral Therapies 1 — Questions and Answers
Question 1: A nurse is preparing to administer IV potassium chloride (KCl) 40 mEq to a client with hypokalemia. Which action is essential before administration?
- Administer the KCl as an IV push over 2 minutes for rapid correction
- Confirm the client has adequate urine output and dilute KCl in IV fluid before infusing (Correct answer)
- Administer KCl undiluted to avoid fluid overload in the client
- Give the KCl intramuscularly if IV access is not available
Correct answer: Confirm the client has adequate urine output and dilute KCl in IV fluid before infusing
IV potassium must always be diluted (never given undiluted or as IV push — it causes cardiac arrest). Adequate urine output (at least 0.5 mL/kg/hr) must be confirmed before administration to prevent hyperkalemia. IV KCl is administered slowly with cardiac monitoring.
Question 2: A client receiving heparin infusion has an aPTT result of 180 seconds (therapeutic range 60-100 seconds). The nurse's priority action is to:
- Continue the infusion at the current rate and recheck aPTT in 6 hours
- Increase the infusion rate because the client's aPTT needs to be higher
- Stop the heparin infusion and notify the provider immediately (Correct answer)
- Administer vitamin K as the antidote for heparin toxicity
Correct answer: Stop the heparin infusion and notify the provider immediately
An aPTT of 180 seconds is supratherapeutic and indicates a serious bleeding risk. The nurse must stop the infusion and immediately notify the provider. The antidote for heparin is protamine sulfate (not vitamin K, which reverses warfarin).
Question 3: A nurse is teaching a client who is newly prescribed metformin for type 2 diabetes. Which instruction is most important?
- Take metformin only when blood glucose exceeds 200 mg/dL
- Avoid alcohol and contact the provider if you experience persistent nausea, vomiting, or muscle pain (Correct answer)
- Metformin commonly causes hypoglycemia — always carry glucose tablets
- Double the dose if a dose is missed to maintain blood glucose control
Correct answer: Avoid alcohol and contact the provider if you experience persistent nausea, vomiting, or muscle pain
Persistent GI symptoms and muscle pain with metformin can signal lactic acidosis, a rare but life-threatening adverse effect. Alcohol increases this risk. Metformin alone does not cause hypoglycemia. Missing a dose should result in taking the next scheduled dose, never doubling.
Question 4: A nurse is inserting a peripheral IV in a client's forearm. After successful venipuncture, blood is visible in the flash chamber. The nurse's next step is to:
- Remove the needle and catheter and apply pressure to the site
- Advance the catheter while withdrawing the needle stylet, then connect tubing (Correct answer)
- Pull the needle back slightly and advance the catheter over the bevel
- Tape the needle in place and begin the infusion immediately
Correct answer: Advance the catheter while withdrawing the needle stylet, then connect tubing
Once blood flashes into the chamber, the nurse advances the plastic catheter fully into the vein while withdrawing the needle stylet. The catheter (not the needle) remains in the vein. Attempting to readvance the needle after withdrawal risks catheter shear.
Question 5: A nurse is administering a blood transfusion. Fifteen minutes after starting, the client reports chills, back pain, and has developed a fever of 39.2°C (102.6°F). Which action should the nurse take first?
- Slow the infusion rate and continue monitoring for symptom resolution
- Administer diphenhydramine and acetaminophen and resume the transfusion
- Stop the transfusion, maintain IV access with normal saline, and notify the provider (Correct answer)
- Increase the infusion rate to complete the transfusion before symptoms worsen
Correct answer: Stop the transfusion, maintain IV access with normal saline, and notify the provider
Chills, back pain, and fever during a transfusion are signs of a hemolytic transfusion reaction, a potentially fatal emergency. The nurse must immediately stop the transfusion, keep the IV line open with normal saline (not the blood tubing), and notify the provider and blood bank.
Question 6: A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart failure. Before giving the dose, the nurse assesses an apical pulse of 52 beats per minute. The nurse should:
- Administer the dose because the pulse is within 10 beats of normal
- Hold the dose and notify the provider, as the pulse is below 60 beats per minute (Correct answer)
- Give half the dose and reassess the pulse in 30 minutes
- Administer the medication and document the pulse rate in the chart
Correct answer: Hold the dose and notify the provider, as the pulse is below 60 beats per minute
Digoxin is held if the apical pulse is below 60 bpm in adults, as it slows the heart rate. Administering digoxin to a bradycardic client can cause dangerous arrhythmias. The nurse must withhold the dose and immediately report the finding to the prescribing provider.
Pharmacological and Parenteral Therapies 1
A nurse is preparing to administer IV potassium chloride (KCl) 40 mEq to a client with hypokalemia.
Which action is essential before administration?