RN Registered Nurse: Pharmacological & Parenteral Therapies 3 — Questions and Answers
Question 1: A patient receiving IV morphine shows a respiratory rate of 8 breaths/min and is difficult to arouse. The priority action is:
- Administer naloxone (Narcan) as ordered (Correct answer)
- Reposition the patient and elevate the head of bed
- Increase IV fluid rate to flush the medication
- Reassess in 15 minutes
Correct answer: Administer naloxone (Narcan) as ordered
Respiratory depression from opioid overdose requires immediate reversal with naloxone.
Question 2: Which assessment finding is an early sign of digoxin toxicity?
- Bradycardia and visual disturbances (yellow-green halos) (Correct answer)
- Hypertension and tachycardia
- Urinary retention and dry mouth
- Hyperkalemia and tremors
Correct answer: Bradycardia and visual disturbances (yellow-green halos)
Classic early signs of digoxin toxicity include bradycardia, nausea, and yellow-green visual halos.
Question 3: A patient with a penicillin allergy is prescribed cephalexin. The nurse should:
- Administer it without concern as there is no cross-reactivity
- Hold the medication and notify the prescriber about the allergy history (Correct answer)
- Administer a test dose first and observe for 30 minutes
- Substitute with azithromycin on nursing judgment
Correct answer: Hold the medication and notify the prescriber about the allergy history
There is a potential cross-reactivity between penicillins and cephalosporins; the prescriber must be notified to reassess.
Question 4: Which route of medication administration has the fastest onset of action?
- Sublingual
- Intramuscular
- Intravenous (Correct answer)
- Transdermal
Correct answer: Intravenous
Intravenous administration delivers medication directly into the bloodstream, providing the fastest onset.
Question 5: A nurse is caring for a patient on heparin infusion. The aPTT result is 3 times the control. The nurse should:
- Increase the heparin rate per protocol
- Hold the infusion and notify the provider (Correct answer)
- Continue the infusion and recheck in 6 hours
- Administer protamine sulfate immediately without an order
Correct answer: Hold the infusion and notify the provider
An aPTT three times the control indicates excessive anticoagulation; the infusion should be held and the provider notified.
Question 6: Before administering an intramuscular injection into the ventrogluteal site, the nurse should:
- Aspirate for 10 seconds to check for blood return
- Locate the site using landmarks (iliac crest and greater trochanter) (Correct answer)
- Use a 5/8-inch needle for an average adult
- Inject the medication at a 45-degree angle
Correct answer: Locate the site using landmarks (iliac crest and greater trochanter)
The ventrogluteal site is identified by placing the palm on the greater trochanter and fingers toward the iliac crest.
Question 7: A patient is prescribed phenytoin (Dilantin) for seizure control. Which finding requires immediate intervention?
- Mild drowsiness after first dose
- Gingival hyperplasia noted at dental visit
- Nystagmus, ataxia, and confusion (Correct answer)
- Urine turning pinkish-red
Correct answer: Nystagmus, ataxia, and confusion
Nystagmus, ataxia, and confusion indicate phenytoin toxicity and require immediate provider notification.
RN Registered Nurse: Pharmacological & Parenteral Therapies 3
A patient receiving IV morphine shows a respiratory rate of 8 breaths/min and is difficult to arouse.
The priority action is: