RN Registered Nurse: Pharmacological & Parenteral Therapies 5 — Questions and Answers
Question 1: A nurse is reviewing a medication order that reads 'morphine sulfate 4 mg IV q4h PRN pain.' The nurse should clarify which missing element?
- Route of administration
- Frequency of administration
- Pain scale threshold or indication for use (Correct answer)
- Name of the prescribing provider
Correct answer: Pain scale threshold or indication for use
A complete PRN order requires a specific indication or pain threshold (e.g., 'for pain >5/10') to guide administration.
Question 2: Which action is correct when administering a subcutaneous heparin injection?
- Aspirate to verify no blood return before injecting
- Massage the site vigorously after injection to aid absorption
- Inject into the abdomen 2 inches from the umbilicus without aspiration (Correct answer)
- Use the deltoid muscle for the injection site
Correct answer: Inject into the abdomen 2 inches from the umbilicus without aspiration
Subcutaneous heparin is injected into the abdomen without aspiration; massaging increases bruising risk.
Question 3: A patient on lithium therapy complains of tremors, confusion, and has a serum level of 2.1 mEq/L. The nurse anticipates:
- Increasing the lithium dose to achieve therapeutic levels
- Holding the dose and preparing for supportive treatment of toxicity (Correct answer)
- Encouraging high fluid intake to raise the level further
- Administering activated charcoal without consulting the provider
Correct answer: Holding the dose and preparing for supportive treatment of toxicity
The therapeutic lithium range is 0.6–1.2 mEq/L; a level of 2.1 indicates severe toxicity requiring the dose to be held.
Question 4: A patient is started on lisinopril for hypertension and calls reporting a new persistent dry cough. The nurse should:
- Advise the patient to continue the medication; this will resolve
- Tell the patient to double the dose to overcome the cough reflex
- Document and notify the provider, as this is a common ACE inhibitor side effect (Correct answer)
- Instruct the patient to take an antihistamine with each dose
Correct answer: Document and notify the provider, as this is a common ACE inhibitor side effect
A persistent dry cough is a common ACE inhibitor side effect caused by bradykinin accumulation and should be reported.
Question 5: When reconstituting a powdered medication for IV administration, the nurse should:
- Shake the vial vigorously for 60 seconds to dissolve the powder
- Use the diluent specified on the package insert and gently swirl until dissolved (Correct answer)
- Always use sterile water for injection regardless of the package insert
- Mix the drug directly in the patient's IV bag without a separate vial
Correct answer: Use the diluent specified on the package insert and gently swirl until dissolved
Package insert instructions specify the correct diluent and volume; gentle swirling prevents foaming or degradation.
Question 6: A patient receiving chemotherapy is prescribed ondansetron (Zofran) and dexamethasone. The nurse understands the dexamethasone is given to:
- Treat bone marrow suppression
- Enhance the antiemetic effect of ondansetron (Correct answer)
- Prevent peripheral neuropathy
- Increase white blood cell production
Correct answer: Enhance the antiemetic effect of ondansetron
Dexamethasone has antiemetic properties that act synergistically with serotonin antagonists like ondansetron to prevent chemotherapy-induced nausea.
Question 7: A nurse is double-checking a high-alert medication with another RN before administration. This practice is designed to prevent harm from:
- Medications with a low therapeutic index (Correct answer)
- Any medication given orally
- All OTC medications dispensed at the bedside
- Medications given only during night shift
Correct answer: Medications with a low therapeutic index
High-alert medications (e.g., insulin, anticoagulants, chemotherapy) have a narrow therapeutic index and can cause significant harm if errors occur.
RN Registered Nurse: Pharmacological & Parenteral Therapies 5
A nurse is reviewing a medication order that reads 'morphine sulfate 4 mg IV q4h PRN pain.' The nurse should clarify which missing element?