Pharmacological and Parenteral Therapies

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?

Accepted Answer

Confirm the client has adequate urine output and dilute KCl in IV fluid before infusing

Answer

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:

Accepted Answer

Stop the heparin infusion and notify the provider immediately

Answer

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?

Accepted Answer

Avoid alcohol and contact the provider if you experience persistent nausea, vomiting, or muscle pain

Answer

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:

Accepted Answer

Advance the catheter while withdrawing the needle stylet, then connect tubing

Answer

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?

Accepted Answer

Stop the transfusion, maintain IV access with normal saline, and notify the provider

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

Pharmacological and Parenteral Therapies