RN Registered Nurse: Pharmacological & Parenteral Therapies 4 — Questions and Answers
Question 1: A patient is receiving total parenteral nutrition (TPN) via a central line. The nurse should assess for which complication?
- Hypoglycemia from too much insulin
- Hyperglycemia and infection at insertion site (Correct answer)
- Peripheral edema from fluid overload
- Bradycardia from lipid infusion
Correct answer: Hyperglycemia and infection at insertion site
TPN's high dextrose content can cause hyperglycemia, and the central line is a significant infection risk.
Question 2: Which medication classification requires the nurse to assess the patient's apical pulse for one full minute before administration?
- ACE inhibitors
- Cardiac glycosides (digoxin) (Correct answer)
- Proton pump inhibitors
- Thiazide diuretics
Correct answer: Cardiac glycosides (digoxin)
Digoxin slows conduction through the AV node; it is withheld if the apical pulse is below 60 beats per minute.
Question 3: A nurse is caring for a patient receiving IV aminophylline. Which finding indicates toxicity?
- Constipation and urinary retention
- Tachycardia, tremors, and seizures (Correct answer)
- Bradycardia and hypotension
- Peripheral edema and weight gain
Correct answer: Tachycardia, tremors, and seizures
Aminophylline (theophylline) toxicity manifests as tachycardia, tremors, seizures, and arrhythmias.
Question 4: A patient prescribed a fentanyl transdermal patch needs to be educated that the patch should be:
- Placed over a bony prominence for best absorption
- Changed every 24 hours to a new site
- Placed on non-irritated, non-hairy skin and changed every 72 hours (Correct answer)
- Heated with a warm blanket to increase absorption
Correct answer: Placed on non-irritated, non-hairy skin and changed every 72 hours
Fentanyl patches are applied to intact, non-hairy skin and replaced every 72 hours; heat increases absorption dangerously.
Question 5: Which lab value is the priority to check before administering an aminoglycoside antibiotic?
- Liver enzymes (AST/ALT)
- Serum creatinine and BUN (Correct answer)
- Complete blood count (CBC)
- Serum glucose
Correct answer: Serum creatinine and BUN
Aminoglycosides are nephrotoxic; baseline and ongoing renal function tests (creatinine, BUN) are essential.
Question 6: A nurse is preparing to hang a peripheral IV solution of dextrose 10% in water (D10W). This solution is classified as:
- Isotonic
- Hypotonic
- Hypertonic (Correct answer)
- Colloid
Correct answer: Hypertonic
D10W has an osmolarity of approximately 505 mOsm/L, making it hypertonic compared to plasma.
Question 7: A patient with myasthenia gravis is being treated with pyridostigmine. The nurse understands this drug works by:
- Blocking acetylcholine receptors at the neuromuscular junction
- Inhibiting acetylcholinesterase to increase acetylcholine availability (Correct answer)
- Stimulating beta-2 adrenergic receptors in muscle
- Reducing autoantibody production
Correct answer: Inhibiting acetylcholinesterase to increase acetylcholine availability
Pyridostigmine inhibits acetylcholinesterase, increasing available acetylcholine at the neuromuscular junction to improve muscle strength.
RN Registered Nurse: Pharmacological & Parenteral Therapies 4
A patient is receiving total parenteral nutrition (TPN) via a central line.
The nurse should assess for which complication?