Pharmacological Therapies

393 questions

All types393 Multiple choice194 Multiple select64 Numeric68 Ordering67

A practical nurse is reviewing the medication administration record for a client who is 24 hours postoperative following a bowel resection. The client is scheduled to receive oral metoprolol. Current vital signs are: blood pressure 92/58 mm Hg, apical pulse 116 beats/min, and respirations 22 breaths/min. The client's urine output for the last 4 hours was 85 mL. Which action should the practical nurse take first?

Withhold the metoprolol and immediately report the assessment findings to the registered nurse.

Administer the scheduled metoprolol because the client's heart rate is elevated.

Initiate a prescribed as-needed rapid intravenous fluid bolus of normal saline.

Delay the metoprolol and prioritize administering a prescribed oral opioid for incisional pain.

Show answer & explanation

Answer: Withhold the metoprolol and immediately report the assessment findings to the registered nurse.

Answer

The practical nurse should withhold the metoprolol and immediately report the assessment findings to the registered nurse.

The client is exhibiting signs of compensatory shock (hypotension, tachycardia, and oliguria) 24 hours after major abdominal surgery. Metoprolol, a beta-blocker, lowers both blood pressure and heart rate. Administering this medication would eliminate the client's compensatory tachycardia and exacerbate the hypotension. Within the scope of practice, the practical nurse must withhold the unsafe medication and immediately notify the registered nurse of the client's deteriorating condition.

Step-by-Step Solution

Analyze the client's vital signs and clinical data.

Blood pressure is low (92/58 mm Hg), heart rate is high (116 beats/min), and urine output is low (85 mL over 4 hours, which is approximately 21 mL/hr).

To identify any physiological instability or contraindications to the scheduled medication.

Evaluate the scheduled medication against the clinical data.

Metoprolol is a beta-blocker that lowers both heart rate and blood pressure.

Administering a beta-blocker to a hypotensive, hypovolemic client will block their compensatory tachycardia and dangerously worsen the hypotension.

Determine the appropriate nursing action within the practical nurse scope of practice.

The medication must be withheld and the client's unstable condition must be reported to the registered nurse immediately.

Practical nurses must recognize deteriorating conditions, withhold unsafe medications, and escalate care to the registered nurse for advanced assessment.

Key Concept

Pharmacological Therapies

Question 2Question →

A practical nurse (PN) is caring for a 78-year-old client who was admitted with a fractured femur and is receiving scheduled doses of oral oxycodone for pain management. During the night shift, the PN finds the client newly agitated, picking at the bedsheets, and unable to recognize family members. The client's vital signs are blood pressure 102/68 mm Hg, heart rate 94 beats/min, respiratory rate 11 breaths/min, and oxygen saturation 89% on room air. The client's family requests the next dose of pain medication to calm the client. Which action should the PN take first?

Withhold the oxycodone, apply supplemental oxygen, and promptly report the findings to the registered nurse (RN).

Administer the prescribed oxycodone to manage the pain that is likely causing the client's severe agitation.

Explain to the family that nighttime confusion is an expected response in older adults and administer the medication.

Accept a verbal order from the on-call provider to administer an intravenous push dose of lorazepam to ensure safety.

Show answer & explanation

Answer: Withhold the oxycodone, apply supplemental oxygen, and promptly report the findings to the registered nurse (RN).

Answer

The correct action is to withhold the oxycodone, apply supplemental oxygen, and promptly report the findings to the registered nurse (RN).

The client is demonstrating signs of significant respiratory depression (11 breaths/min) and resulting hypoxia (89% oxygen saturation), which are life-threatening adverse effects of opioid analgesics like oxycodone. Acute confusion and restlessness in an older adult are frequently the primary, early signs of hypoxia. The safest and most appropriate action within the PN scope of practice is to withhold the respiratory depressant, intervene by applying oxygen to address the immediate breathing compromise, and escalate the critical situation to the RN immediately.

Step-by-Step Solution

Analyze the client's clinical presentation and vital signs.

The client has a low respiratory rate (11 breaths/min), hypoxia (89% oxygen saturation), and acute neurological changes (agitation, confusion).

To identify any immediate life-threatening conditions or contraindications to scheduled medications.

Correlate the assessment findings with the prescribed pharmacological therapy.

The findings represent adverse effects of oxycodone (respiratory depression) and the resulting hypoxia (manifesting as acute confusion).

To determine if the medication is safe to administer or if it is contributing to the client's deterioration.

Determine the priority nursing intervention within the PN scope of practice.

The priority is to withhold the offending medication, support the respiratory system with oxygen, and escalate the findings to the RN.

Airway and breathing are the highest priorities. PNs must recognize critical changes, intervene safely within their scope, and communicate urgently with the supervising RN.

Key Concept

Opioid safety, recognition of hypoxia-induced delirium, and PN scope of practice.

Question 3Question →

A practical nurse (PN) is preparing to administer scheduled morning medications, including oral pantoprazole and oral metoprolol, to a client admitted $24\text{ hours}$ ago with an upper gastrointestinal bleed. The client states, "My stomach hurts a little, but I am mostly just very dizzy." The client's current vital signs are: blood pressure $86/52\text{ mm Hg}$ , heart rate $118\text{ beats/min}$ , respirations $22\text{/min}$ , and oxygen saturation $96\%$ on room air. Based on this data, which action should the PN take first?

Withhold the scheduled medications and immediately notify the registered nurse (RN) of the client's condition.

Administer the pantoprazole to address the abdominal pain, but withhold the metoprolol due to the low blood pressure.

Administer both medications as prescribed and instruct the client to remain in a supine position to manage the dizziness.

Perform a comprehensive cardiovascular assessment to determine the cause of the vital sign changes before intervening.

Show answer & explanation

Answer: Withhold the scheduled medications and immediately notify the registered nurse (RN) of the client's condition.

Answer

The PN should withhold all scheduled medications and immediately notify the RN of the client's vital signs and symptoms.

The correct action is to withhold the medications and notify the RN. The client's hypotension, marked tachycardia, and dizziness

24\text{ hours}

after a gastrointestinal bleed are classic indicators of active hemorrhage and hypovolemic shock. In this state, administering oral medications is unsafe due to decreased gastrointestinal perfusion and the risk of aspiration. Furthermore, a beta-blocker like metoprolol would suppress the client's compensatory tachycardia and dangerously lower the blood pressure further. The PN's scope of practice dictates the immediate escalation of these critical, unstable findings to the RN.

Step-by-Step Solution

Analyze the client's clinical data.

The client presents with significant hypotension (

86/52\text{ mm Hg}

), marked tachycardia (

118\text{ beats/min}

), and dizziness.

Identifying abnormal assessment findings is the first step in determining safe medication administration.

Interpret the clinical significance of the findings in the context of the client's history.

These findings in a client with a recent gastrointestinal bleed strongly indicate active internal hemorrhage and hypovolemic shock.

Connecting current vital signs to the admitting diagnosis helps identify physiological instability.

Determine the pharmacological implications for the scheduled medications.

Administering metoprolol (a beta-blocker) would suppress the compensatory tachycardia and further lower blood pressure, worsening the shock. Administering any oral medication is contraindicated due to poor perfusion and potential need for emergency procedures.

Administering medications without considering physiological status can cause severe patient harm.

Apply the PN scope of practice to select the priority action.

The PN must withhold the medications and immediately escalate these critical findings to the RN for comprehensive evaluation and emergency intervention.

The PN role requires recognizing unstable conditions and communicating them promptly to the RN or provider.

Key Concept

Prioritization of ABCs and LPN/LVN Scope of Practice in Medication Administration

Question 4Question →

During the morning shift on a cardiac step-down unit, a client recovering from an acute myocardial infarction requires several pharmacological interventions. The client's active electronic health record includes orders for a continuous intravenous heparin infusion, an annual influenza immunization, oral metoprolol, and oral digoxin $0.125\text{ mg}$ (supplied as a liquid concentration of $50\text{ mcg/mL}$ ). Which intervention demonstrates the appropriate application of pharmacological safety and the practical nursing scope of practice?

Evaluating the client's apical pulse for one full minute and confirming two distinct client identifiers before administering the oral metoprolol

Adjusting the rate of the continuous intravenous heparin infusion independently based on the morning activated partial thromboplastin time (aPTT) protocol

Administering the influenza immunization prior to discharge without verifying the client's current temperature or checking for a history of severe allergic reactions

Administering

0.25\text{ mL}

of the oral digoxin solution to deliver the prescribed

0.125\text{ mg}

dose using the supplied

50\text{ mcg/mL}

concentration

Show answer & explanation

Answer: Evaluating the client's apical pulse for one full minute and confirming two distinct client identifiers before administering the oral metoprolol

Answer

The correct action is to evaluate the client's apical pulse for a full minute and confirm two distinct patient identifiers before administering the oral metoprolol.

Evaluating the client's apical pulse for one full minute and verifying two distinct client identifiers before administering metoprolol demonstrates adherence to the 'rights' of medication administration. Furthermore, checking the pulse is a critical pre-administration parameter for beta-blockers, and administering oral medications is well within the practical nurse's scope of practice.

Step-by-Step Solution

Evaluate the scope of practice regarding intravenous infusions.

Determine that titrating continuous IV heparin is strictly a registered nurse (RN) responsibility.

Practical nurses cannot independently adjust high-alert continuous IV drips.

Analyze the requirements for safe vaccine administration.

Identify that screening for acute fever and allergies is mandatory before giving the influenza vaccine.

Failing to check contraindications compromises client safety and violates medication administration protocols.

Calculate the correct volume for the prescribed digoxin dose.

Convert

0.125\text{ mg}

125\text{ mcg}

. Divide by the concentration of

50\text{ mcg/mL}

to get

2.5\text{ mL}

The option suggesting

0.25\text{ mL}

is mathematically incorrect and would result in significant underdosing.

Evaluate the safety checks for oral metoprolol.

Confirm that checking the apical pulse and using two client identifiers is correct.

Beta-blockers affect heart rate, and patient identification is a universal medication safety right within the PN scope.

Key Concept

Safe Medication Administration and PN Scope of Practice

Question 5Question →

A practical nurse (PN) is preparing to administer a prescribed intramuscular medication that is supplied in a single-dose glass ampule. Arrange the following preparation steps in the correct chronological order to ensure safe medication handling and administration.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence begins with clearing the upper stem of medication, followed by protecting the hands with gauze, snapping the ampule away from the body, attaching a filter needle, withdrawing the medication, and finally replacing the filter needle with an appropriate injection needle.

Safe medication preparation from a glass ampule requires a specific sequence to protect both the nurse and the client. The nurse must first ensure all medication is in the lower chamber (flicking the stem) to prevent dose loss. Next, the nurse protects themselves by wrapping the neck and breaking the glass away from their body. Because breaking the glass can introduce microscopic shards into the liquid, the nurse must attach a filter needle to draw up the medication safely. Once the medication is withdrawn without contaminating the needle on the rim, the filter needle must be discarded and replaced with an injection-appropriate needle, as filter needles are not meant for client administration.

Step-by-Step Solution

Flick the upper stem of the ampule lightly to ensure all medication moves into the lower chamber.

All medication is contained within the base of the ampule.

Prevents loss of the prescribed dose when the ampule is opened.

Wrap a sterile gauze pad or an unopened alcohol swab around the narrow neck of the ampule.

A protective barrier is established around the break point.

Protects the nurse's fingers from glass cuts.

Snap the ampule neck quickly and firmly in a direction pointing away from the body.

The ampule is opened safely.

Directs potential glass shards away from the nurse's face and body.

Attach a filter needle to the sterile syringe.

The syringe is equipped to filter out particulate matter.

Essential to prevent drawing up microscopic glass shards that fell into the medication when the ampule was broken.

Withdraw the prescribed amount of medication while avoiding contact with the outer rim of the ampule.

The correct dose is drawn into the syringe while maintaining sterility.

Touching the unsterile outer rim of the ampule would contaminate the needle.

Remove the filter needle and attach the appropriate size needle for intramuscular injection.

The syringe is ready for safe client administration.

Filter needles are strictly for drawing up medication and are contraindicated for injecting into tissue.

Key Concept

Safe Preparation of Parenteral Medications from an Ampule

Estimated Time:1m 30s

Question 6Question →

A practical nurse (PN) is reviewing the medication administration record (MAR) and morning laboratory results for assigned clients. Identify the actions that represent safe and appropriate practice for the PN. Select all that apply.

Select all that apply

Withhold scheduled subcutaneous enoxaparin for a client with a morning platelet count of

75,000\text{/mm}^3

and notify the registered nurse.

Accept a delegated task from the registered nurse to administer an initial intravenous (IV) push dose of hydromorphone for a client experiencing severe pain.

Reinforce teaching for a client starting oral rifampin that their urine, sweat, and tears may turn a harmless red-orange color.

Administer a scheduled dose of oral metoprolol to a client who has an asymptomatic resting heart rate of

54\text{ beats/min}

Administer a prescribed oral potassium chloride supplement to a client with a morning serum potassium level of

3.2\text{ mEq/L}

Bypass the barcode medication administration scanner during a temporary system outage and identify the client using only their room number.

Show answer & explanation

Answer: Withhold scheduled subcutaneous enoxaparin for a client with a morning platelet count of $75,000\text{/mm}^3$ and notify the registered nurse.; Reinforce teaching for a client starting oral rifampin that their urine, sweat, and tears may turn a harmless red-orange color.; Administer a prescribed oral potassium chloride supplement to a client with a morning serum potassium level of $3.2\text{ mEq/L}$ .

Answer

The correct actions are withholding enoxaparin for thrombocytopenia, reinforcing teaching about expected side effects of rifampin, and administering potassium chloride for hypokalemia.

Safe pharmacological practice for the practical nurse involves withholding enoxaparin when the platelet count is critically low to prevent hemorrhage, educating clients on harmless but startling medication side effects (like rifampin causing red-orange secretions), and appropriately treating documented electrolyte deficits (such as administering potassium for hypokalemia).

Step-by-Step Solution

Evaluate the clinical data and prescribed medication for each client scenario.

Identify therapeutic indications, potential contraindications, and required monitoring for the specific drug classes (anticoagulants, antimicrobials, electrolytes, beta-blockers, opioids).

To ensure clinical safety and prevent adverse pharmacological events.

Analyze each proposed nursing action against the established LPN/PN scope of practice.

Differentiate between tasks that are safe to perform (administering oral/subcutaneous medications, reinforcing teaching) and tasks that must be refused or escalated (IV push medications, ignoring critical safety parameters).

To maintain legal practice boundaries and ensure the highest level of client safety.

Key Concept

The practical nurse must integrate pharmacological knowledge with strict adherence to scope of practice, ensuring safe medication administration, accurate monitoring of laboratory values, and appropriate client teaching reinforcement.

Question 7Question →

A practical nurse is preparing to administer an oral suspension to a client who weighs $154\text{ lb}$ . The healthcare provider has prescribed $15\text{ mg/kg/day}$ to be administered in two equally divided doses. The pharmacy dispenses the medication with a concentration of $0.25\text{ g/5 mL}$ . How many $\text{mL}$ should the practical nurse administer for each dose? Record your answer to the nearest tenth. Do not include units in your answer.

Show answer & explanation

Answer: 10.5

Answer

10.5

To arrive at the correct answer of

10.5

, the practical nurse must systematically process multiple conversions. First, the client's weight is converted to kilograms (

154 \div 2.2 = 70\text{ kg}

). Next, the total daily dose is calculated (

70 \times 15 = 1050\text{ mg/day}

). Because the medication is divided into two equal doses, the single dose requirement is

525\text{ mg}

. Before calculating the volume, the dispensed concentration of

0.25\text{ g/5 mL}

must be converted to milligrams (

0.25 \times 1000 = 250\text{ mg/5 mL}

). Finally, using the desired over have formula:

(525\text{ mg} \div 250\text{ mg}) \times 5\text{ mL}

equals exactly

10.5\text{ mL}

Step-by-Step Solution

Convert the client's weight from pounds to kilograms.

154\text{ lb} \div 2.2\text{ lb/kg} = 70\text{ kg}

Weight-based dosing requires the client's weight in kilograms.

Calculate the total daily dose in milligrams.

70\text{ kg} \times 15\text{ mg/kg/day} = 1050\text{ mg/day}

This establishes the total amount of medication the client needs over a 24-hour period.

Determine the amount required for a single dose.

1050\text{ mg/day} \div 2\text{ doses} = 525\text{ mg/dose}

The prescription specifies two equally divided doses per day.

Convert the supplied medication concentration from grams to milligrams.

0.25\text{ g} \times 1000\text{ mg/g} = 250\text{ mg}

. The available concentration is

250\text{ mg}

per

5\text{ mL}

Units of measurement must match between the desired dose (mg) and the available medication supply (g) before calculating volume.

Calculate the volume to administer for a single dose.

(525\text{ mg} \div 250\text{ mg}) \times 5\text{ mL} = 2.1 \times 5\text{ mL} = 10.5\text{ mL}

Applying the standard dimensional analysis or 'Desired over Have times Volume' formula yields the exact volume to administer.

Key Concept

Multi-step dosage calculation involving weight conversion, frequency division, and unit conversion.

Question 8Question →

A practical nurse (PN) is preparing to administer the measles, mumps, and rubella (MMR) live vaccine to an adult female client in a community health clinic. Which of the following actions should the PN take to ensure safe practice? Select all that apply.

Select all that apply

Inquire if the client is currently pregnant or plans to become pregnant within the next four weeks.

Withhold the vaccine and notify the registered nurse if the client is currently receiving immunosuppressive therapy.

Proceed with the immunization without assessing for gelatin or neomycin allergies if the client has received previous vaccines.

Bypass the barcode scanning process because the vaccine is administered as a standard, prepackaged dose.

Calculate the required medication volume to administer by converting the client's current weight from pounds to kilograms.

Accept a delegated task to administer a newly prescribed intravenous (IV) push antibiotic to the client during the same visit.

Show answer & explanation

Answer: Inquire if the client is currently pregnant or plans to become pregnant within the next four weeks.; Withhold the vaccine and notify the registered nurse if the client is currently receiving immunosuppressive therapy.

Answer

The correct actions are to inquire if the client is pregnant or plans to become pregnant, and to withhold the vaccine if the client is receiving immunosuppressive therapy.

The MMR vaccine is a live attenuated virus. It is strictly contraindicated during pregnancy due to the risk of fetal harm, and clients should be advised to avoid pregnancy for at least four weeks after vaccination. Additionally, live vaccines are contraindicated in clients who are severely immunocompromised (such as those receiving immunosuppressive therapy), as they can cause severe or fatal infections. Therefore, the practical nurse must actively screen for these conditions before administration.

Step-by-Step Solution

Identify the medication classification and properties.

The MMR vaccine is a live attenuated viral vaccine.

Understanding that the vaccine contains live viruses helps identify absolute contraindications related to immune function and fetal safety.

Evaluate the client's current health status against known contraindications.

Pregnancy and severe immunosuppression are absolute contraindications for live vaccines.

Live vaccines can cross the placenta or cause severe systemic infection in clients lacking an adequate immune response.

Review the practical nurse (PN) scope of practice and medication safety standards.

The PN must perform all medication rights verification, recognize that adult MMR doses are standardized rather than weight-based, and refuse tasks outside their scope, such as IV push administration.

Adhering to strict safety standards and scope of practice prevents patient harm and professional liability.

Key Concept

Safe administration of live attenuated vaccines and adherence to the practical nurse scope of practice.

Question 9Question →

The practical nurse (PN) is reviewing the morning assessment data and medication administration record (MAR) for a $65$ -year-old client admitted with chronic kidney disease and hypertension.

Assessment Data	Current Finding
Blood pressure	$142/88$ mmHg
Heart rate	$64$ beats/minute
Respiratory rate	$18$ breaths/minute
Oxygen saturation	$96\%$ on room air
Serum potassium	$5.9$ mEq/L ( $5.9$ mmol/L)

Scheduled Medications:
* Lisinopril $20$ mg PO daily
* Sodium polystyrene sulfonate $15$ g PO stat
* Metoprolol $5$ mg IV push stat
* Influenza virus vaccine (inactivated) $0.5$ mL IM once

Based on this data, which actions by the PN are appropriate? Select all that apply.

Select all that apply

Withhold the scheduled oral lisinopril and immediately report the hyperkalemia to the registered nurse (RN).

Administer the oral sodium polystyrene sulfonate after verifying the client's full name and date of birth.

Notify the charge nurse that the stat IV push metoprolol requires administration by an RN.

Administer the stat IV push metoprolol slowly over

2

minutes while observing the client for hypotension.

Verify the client's identity using their room number and physical location before administering the influenza vaccine.

Withhold the influenza vaccine because the client reports experiencing a mild, localized rash at the injection site after last year's dose.

Show answer & explanation

Answer: Withhold the scheduled oral lisinopril and immediately report the hyperkalemia to the registered nurse (RN).; Administer the oral sodium polystyrene sulfonate after verifying the client's full name and date of birth.; Notify the charge nurse that the stat IV push metoprolol requires administration by an RN.

Answer

The practical nurse should withhold the oral lisinopril and notify the RN, safely administer the oral sodium polystyrene sulfonate using proper client identifiers, and notify the charge nurse that the IV push metoprolol requires RN administration.

The client's serum potassium level of

5.9

mEq/L indicates hyperkalemia. Because ACE inhibitors like lisinopril cause potassium retention, the scheduled dose must be withheld and the registered nurse (RN) notified to prevent cardiac complications. Administering oral sodium polystyrene sulfonate is an appropriate action to treat hyperkalemia, provided the PN verifies the client's identity using two client-specific identifiers (such as full name and date of birth). Furthermore, because administering medications via direct intravenous (IV) push typically exceeds the PN scope of practice, the PN must advocate for client safety by notifying the charge nurse that an RN is required to administer the IV metoprolol.

Step-by-Step Solution

Analyze the client's laboratory results in relation to the prescribed medications.

The serum potassium level is

5.9

mEq/L, indicating hyperkalemia. Lisinopril is an ACE inhibitor that can cause further potassium retention, whereas sodium polystyrene sulfonate is prescribed to lower potassium levels.

Identifying contraindications based on current laboratory data prevents potentially life-threatening adverse events.

Determine the legal boundaries of the practical nurse (PN) scope of practice.

The PN can safely administer oral (PO) and intramuscular (IM) medications, but administering intravenous (IV) push medications must be deferred to the RN.

Nurses must practice strictly within their legal scope to ensure safe, competent client care.

Evaluate the safety principles for medication identification and vaccine contraindications.

Safe administration requires two client-specific identifiers (excluding room numbers). Additionally, a mild localized reaction to a previous vaccine is not a valid contraindication for current administration.

Adhering strictly to medication safety rights and evidence-based immunization guidelines minimizes the risk of clinical errors.

Key Concept

Safe pharmacological therapy requires integrating client laboratory data to withhold contraindicated medications, adhering strictly to the PN scope of practice, and applying evidence-based medication safety standards.

Question 10Question →

A practical nurse is preparing to administer amoxicillin oral suspension to a pediatric client diagnosed with acute otitis media. The client weighs $44$ lb. The healthcare provider has prescribed $45\text{ mg/kg/day}$ to be divided into three equal doses administered every $8$ hours. The pharmacy supplies amoxicillin suspension at a concentration of $250\text{ mg}/5\text{ mL}$ . How many milliliters (mL) should the nurse administer for a single dose? (Record answer to the nearest whole number. Do not include units in answer.)

Show answer & explanation

Answer: 6

Answer

To determine the correct dose, the nurse must first convert the weight from pounds to kilograms by dividing by

2.2

(

44 \div 2.2 = 20\text{ kg}

). Next, calculate the total daily dose by multiplying the weight by the prescribed dose (

20\text{ kg} \times 45\text{ mg/kg} = 900\text{ mg/day}

). Since the medication is divided into three equal doses (every 8 hours), each individual dose is

300\text{ mg}

(

900 \div 3

). Finally, using the supplied concentration of

250\text{ mg}/5\text{ mL}

, calculate the required volume:

(300\text{ mg} \div 250\text{ mg}) \times 5\text{ mL} = 6\text{ mL}

Step-by-Step Solution

Convert the client's weight from pounds to kilograms.

44\text{ lb} \div 2.2\text{ lb/kg} = 20\text{ kg}

Weight-based medication dosages require the client's weight to be in kilograms.

Calculate the total daily dose prescribed.

20\text{ kg} \times 45\text{ mg/kg} = 900\text{ mg/day}

This establishes the total amount of medication the client should receive over a 24-hour period.

Determine the amount required for a single dose.

900\text{ mg} \div 3\text{ doses} = 300\text{ mg/dose}

The prescription states the daily dose must be divided into three equal doses (every 8 hours).

Calculate the volume of liquid to administer per dose.

\frac{300\text{ mg}}{250\text{ mg}} \times 5\text{ mL} = 6\text{ mL}

This uses the supplied concentration (

250\text{ mg}

per

5\text{ mL}

) to find the correct liquid volume to administer.

Key Concept

Pediatric weight-based dosage calculation and safe medication administration

Question 11Question →

A practical nurse (PN) is reviewing the medication administration record (MAR) and current vital signs for a client who is 24 hours postoperative following a bowel resection. The client is scheduled to receive a dose of oral metoprolol. The client's vital signs are: temperature 98.6°F (37.0°C), heart rate 118 beats/minute, respiratory rate 22 breaths/minute, and blood pressure 88/54 mm Hg. The client reports mild dizziness. Which action is the priority for the PN?

Administer the metoprolol as prescribed to help reduce the client's elevated heart rate.

Administer the medication with a small sip of water and instruct the client to remain in bed to prevent falls.

Withhold the metoprolol and immediately report the client's vital signs to the registered nurse.

Verify the client using two distinct identifiers and the barcode scanner before giving the medication.

Show answer & explanation

Answer: Withhold the metoprolol and immediately report the client's vital signs to the registered nurse.

Answer

The priority action is to withhold the metoprolol and immediately report the client's vital signs to the registered nurse.

The client is exhibiting signs of potential hypovolemic shock (hypotension, compensatory tachycardia, dizziness) following major surgery. Metoprolol is a beta-blocker that lowers both heart rate and blood pressure. Administering this medication would eliminate the body's compensatory mechanism (tachycardia) and further decrease the blood pressure, potentially leading to cardiovascular collapse. Within the practical nursing scope of practice, the nurse must withhold the medication and immediately escalate these critical findings to the registered nurse for urgent assessment and intervention.

Step-by-Step Solution

Analyze the client's vital signs and postoperative status.

The client is 24 hours post-op with tachycardia (118 bpm), hypotension (88/54 mm Hg), and dizziness, indicating possible hypovolemia, bleeding, or early shock.

Identifying physiological instability is the first step in safe medication administration.

Evaluate the pharmacological action of the scheduled medication.

Metoprolol is a beta-adrenergic blocker that decreases heart rate, blood pressure, and myocardial contractility.

Understanding the drug's mechanism is essential to predict its effect on the current clinical picture.

Synthesize the data to determine the appropriate nursing action.

Administering metoprolol will block the client's compensatory tachycardia and worsen the hypotension. The medication must be withheld and the RN notified.

The practical nursing scope of practice requires withholding contraindicated medications and escalating critical findings to the RN for comprehensive assessment.

Key Concept

Safe Medication Administration: Recognizing Contraindications and Scope of Practice

Estimated Time:1m 15s

Question 12Question →

A practical nurse (PN) is reviewing the morning data for an older adult client who takes scheduled oral atorvastatin for hyperlipidemia. Three days ago, the client was started on a course of oral clarithromycin for a respiratory infection. During the morning assessment, the client reports profound, generalized muscle aching. The PN observes that the client's urine in the collection device is dark and tea-colored. The morning laboratory results reveal a blood urea nitrogen (BUN) of $35\text{ mg/dL}$ ( $12.5\text{ mmol/L}$ ) and a serum creatinine of $2.4\text{ mg/dL}$ ( $212\text{ \mu mol/L}$ ). Which of the following is the priority action for the PN?

Withhold the atorvastatin and clarithromycin, and immediately report the clinical findings and laboratory results to the registered nurse (RN).

Administer the scheduled medications and encourage the client to drink additional fluids to help lower the elevated serum creatinine.

Administer a prescribed PRN analgesic for the muscle pain and reposition the client for comfort, delaying the scheduled medications.

Bypass routine barcode scanning to expedite the administration of the clarithromycin, as treating the acute infection is the priority.

Show answer & explanation

Answer: Withhold the atorvastatin and clarithromycin, and immediately report the clinical findings and laboratory results to the registered nurse (RN).

Answer

The priority action is to withhold both the atorvastatin and clarithromycin and immediately escalate the clinical findings and laboratory results to the supervising registered nurse (RN).

The correct action demonstrates an understanding of a severe drug-drug interaction. Clarithromycin inhibits the metabolism of atorvastatin, leading to toxic accumulation. The client's symptoms (muscle pain, dark urine) and laboratory values (elevated BUN and creatinine) indicate rhabdomyolysis and acute kidney injury. Within the PN scope of practice, the immediate priority is to ensure safety by withholding the medications and escalating the critical findings to the RN for medical intervention.

Step-by-Step Solution

Analyze the client's medication regimen for potential interactions.

The client is taking atorvastatin (a statin) and clarithromycin (a macrolide antibiotic). Clarithromycin strongly inhibits the CYP3A4 enzyme, which metabolizes atorvastatin. This leads to toxic levels of the statin.

Identifying drug-drug interactions is a critical step before administering any medication.

Evaluate the client's clinical symptoms and laboratory findings against known adverse effects.

Severe muscle aching, dark tea-colored urine (myoglobinuria), elevated BUN, and elevated serum creatinine indicate rhabdomyolysis and resulting acute kidney injury.

Recognizing severe adverse reactions ensures the nurse does not administer a medication that will cause further harm.

Determine the priority nursing intervention within the practical nurse (PN) scope of practice.

The PN must withhold the offending medications and immediately notify the RN and healthcare provider so that emergent medical interventions can be initiated.

The PN's primary responsibility in an adverse event is to maintain client safety by stopping the harm and escalating to the RN or provider for advanced clinical judgment.

Key Concept

Recognizing severe drug interactions leading to rhabdomyolysis, and executing the PN role to withhold medications and report critical findings.

Question 13Question →

During a routine morning assessment, a client receiving pharmacological therapy for heart failure states, "I feel sick to my stomach, and all the lights have a strange yellow glow around them." The client's medication profile includes daily oral digoxin and furosemide. A review of today's laboratory results reveals a serum digoxin level of $2.8\text{ ng/mL}$ . Which action should the practical nurse implement?

Administer the scheduled digoxin dose as prescribed, recognizing that the serum level is within the expected therapeutic range.

Bypass the medication barcode scan to quickly administer an as-needed antiemetic to relieve the client's nausea.

Withhold the upcoming dose of digoxin and immediately notify the registered nurse of the clinical findings.

Accept a delegated task from the registered nurse to administer an intravenous push medication to manage potential dysrhythmias.

Show answer & explanation

Answer: Withhold the upcoming dose of digoxin and immediately notify the registered nurse of the clinical findings.

Answer

The correct action is to withhold the upcoming dose of digoxin and immediately notify the registered nurse of the clinical findings.

The client is exhibiting both subjective symptoms (nausea, visual halos) and objective data (a serum digoxin level of

2.8\text{ ng/mL}

) that clearly indicate severe digoxin toxicity. The normal therapeutic range is

0.8

2.0\text{ ng/mL}

. Safe nursing practice dictates that the practical nurse must hold the offending medication to prevent further toxicity and immediately alert the supervising registered nurse or healthcare provider to initiate corrective treatment.

Step-by-Step Solution

Evaluate the subjective clinical manifestations reported by the client.

The client reports nausea and seeing yellow halos around lights.

Gastrointestinal distress and visual disturbances are classic early signs of digoxin toxicity.

Analyze the objective laboratory data provided in the electronic health record.

The serum digoxin level is

2.8\text{ ng/mL}

Comparing the client's level against the normal therapeutic range (

0.8

2.0\text{ ng/mL}

) confirms that the level is toxic.

Determine the safest and most appropriate nursing intervention within the PN scope of practice.

The medication administration must be halted and the supervising nurse notified.

Preventing further harm by holding the toxic medication and escalating critical labs ensures patient safety and adheres to the chain of command.

Key Concept

Digoxin Toxicity Recognition and Management

Question 14Question →

While monitoring an older adult client who is being treated with a continuous intravenous heparin infusion for a pulmonary embolism, a practical nurse (PN) reviews the trend of the client's vital signs. Over the past four hours, the client's heart rate has climbed from $78\text{ bpm}$ to $112\text{ bpm}$ , and the blood pressure has trended downward from $134/82\text{ mmHg}$ to $104/68\text{ mmHg}$ . The client currently reports feeling faint. What is the priority action for the PN?

Escalate the clinical findings immediately to the primary registered nurse.

Record the data in the client's chart and reassess the blood pressure in one hour.

Adjust the heparin infusion rate downward according to the facility's titration protocol.

Assist the client to a seated position at the edge of the bed to manage the faintness.

Show answer & explanation

Answer: Escalate the clinical findings immediately to the primary registered nurse.

Answer

The priority action is to escalate the clinical findings immediately to the primary registered nurse.

The client's presentation of a climbing heart rate, dropping blood pressure, and faintness while receiving a continuous heparin infusion strongly points to internal hemorrhage and early hypovolemic shock. Because the client is experiencing a critical, life-threatening adverse effect that requires complex assessment and potential medical intervention (such as stopping the infusion or administering fluids), the practical nurse must prioritize immediately notifying the registered nurse to initiate a rapid response.

Step-by-Step Solution

Analyze the client's medication and current symptoms.

The client is on a continuous heparin infusion (high risk for bleeding) and presents with new-onset tachycardia, decreasing blood pressure, and faintness.

Identifying the relationship between the pharmacological therapy and new physical symptoms is essential for recognizing adverse drug events.

Interpret the vital sign trends and prioritize care.

The shift from normal baseline vital signs to tachycardia and borderline hypotension indicates early hypovolemic shock, likely due to internal hemorrhage.

Early recognition of shock requires prioritizing Circulation and immediate medical intervention to prevent cardiovascular collapse.

Determine the appropriate action within the practical nurse's scope of practice.

The PN must immediately notify the registered nurse rather than independently altering intravenous medications or delaying care.

Managing a hemodynamically unstable client and titrating intravenous anticoagulants fall outside the PN scope of practice.

Key Concept

Monitoring for adverse effects of anticoagulant therapy and adhering to the practical nurse scope of practice.

Question 15Question →

A practical nurse is caring for a client who is 4 hours postoperative following an open cholecystectomy. The registered nurse (RN) is managing the client's continuous intravenous (IV) fluids and delegates the administration of scheduled oral metoprolol, oral oxycodone, and a PRN dose of IV push ondansetron to the practical nurse. The client's current vital signs are blood pressure 86/52 mmHg, heart rate 118 bpm, and respiratory rate 16 breaths/min. The client reports a pain level of 7 on a 0 to 10 scale. Which action should the practical nurse take first?

Refuse the delegated intravenous push medication, withhold the oral medications, and immediately report the vital signs to the registered nurse.

Accept the delegation to administer both the oral and intravenous medications to ensure timely pain and nausea relief for the postoperative client.

Inform the registered nurse that intravenous push medications are out of scope, but proceed with administering the scheduled oral metoprolol.

Prioritize pain management by administering the oral oxycodone immediately, then request the registered nurse to administer the antiemetic.

Show answer & explanation

Answer: Refuse the delegated intravenous push medication, withhold the oral medications, and immediately report the vital signs to the registered nurse.

Answer

The practical nurse must refuse the out-of-scope intravenous push medication, withhold the oral antihypertensive and opioid medications due to the client's hemodynamic instability, and immediately report the findings to the supervising registered nurse.

The client's vital signs (blood pressure 86/52 mmHg, heart rate 118 bpm) indicate potential hypovolemic shock or hemorrhage, which is a circulation (ABC) priority. Metoprolol (a beta-blocker) and oxycodone (an opioid) both lower blood pressure and must be withheld to prevent cardiovascular collapse. Additionally, administering IV push medications like ondansetron is outside the practical nurse's scope of practice. The nurse must refuse the unsafe delegation and escalate the critical clinical findings to the registered nurse immediately.

Step-by-Step Solution

Analyze the delegated tasks against the practical nurse scope of practice.

Administration of intravenous push medications (ondansetron) is identified as out of scope and must be refused.

Nursing practice acts generally prohibit practical nurses from administering medications via the intravenous push route.

Evaluate the client's current vital signs in the context of their postoperative status.

Blood pressure of 86/52 mmHg and a heart rate of 118 bpm are identified as critical abnormalities.

These vital signs in a 4-hour postoperative client strongly suggest early hypovolemic or hemorrhagic shock, requiring immediate attention.

Analyze the pharmacological effects of the scheduled oral medications on the client's current physiological state.

Both metoprolol (a beta-blocker) and oxycodone (an opioid) are identified as contraindicated.

Metoprolol lowers blood pressure and heart rate, while oxycodone causes vasodilation and lowers blood pressure; both would exacerbate the client's cardiovascular compromise.

Determine the priority nursing action based on scope and safety.

Withhold the oral medications, refuse the IV push task, and escalate immediately to the registered nurse.

Immediate RN assessment and intervention (such as IV fluid boluses) are required to manage the hemodynamic instability.

Key Concept

The practical nurse must strictly adhere to their scope of practice by refusing IV push delegations, while concurrently utilizing clinical judgment to withhold medications (like beta-blockers and opioids) that would exacerbate early signs of shock.

Estimated Time:1m 30s

Question 16Question →

A practical nurse (PN) is reviewing the morning clinical data for a client who is $2$ days postoperative following a total hip arthroplasty. The client is scheduled to receive subcutaneous enoxaparin, oral celecoxib, and oral pantoprazole.

Morning clinical data:
- Blood pressure: $96/58\text{ mmHg}$
- Heart rate: $112\text{ beats/min}$
- Hemoglobin: $10.4\text{ g/dL}$
- Platelet count: $85,000/\text{mm}^3$

Which action should the PN take FIRST?

Withhold the scheduled enoxaparin and celecoxib, and immediately notify the registered nurse.

Withhold the enoxaparin due to the platelet count, but proceed with administering the celecoxib and pantoprazole.

Document the vital signs as expected postoperative fluid shifts and administer the scheduled medications.

Administer the celecoxib immediately to ensure adequate pain management before addressing the laboratory results.

Show answer & explanation

Answer: Withhold the scheduled enoxaparin and celecoxib, and immediately notify the registered nurse.

Answer

Withhold the scheduled enoxaparin and celecoxib, and immediately notify the registered nurse.

The correct action demonstrates safe pharmacological practice and clinical judgment. The client has a critically low platelet count (

85,000/\text{mm}^3

) alongside early signs of shock (tachycardia and hypotension). Enoxaparin (an anticoagulant) and celecoxib (an NSAID) both impair the body's ability to clot. Administering them would place the client at extreme risk for severe hemorrhage. The practical nurse must withhold these medications and immediately escalate the situation to the registered nurse for prompt medical intervention.

Step-by-Step Solution

Analyze the laboratory results and recognize abnormalities.

The platelet count is

85,000/\text{mm}^3

, which indicates critical thrombocytopenia (normal is

150,000 - 400,000/\text{mm}^3

Identifying thrombocytopenia is crucial because it significantly increases the client's risk for spontaneous or medication-induced hemorrhage.

Correlate laboratory findings with the current vital signs.

The client is exhibiting tachycardia (

112\text{ beats/min}

) and mild hypotension (

96/58\text{ mmHg}

These borderline vital signs, combined with low platelets in a postoperative client, are early physiological indicators of internal bleeding or shock.

Evaluate the scheduled pharmacological therapies against the clinical data.

Enoxaparin is an anticoagulant and celecoxib is an NSAID; both impair clotting and are contraindicated given the client's thrombocytopenia and signs of shock.

Administering either medication could precipitate or exacerbate a life-threatening hemorrhage.

Determine the most appropriate nursing action within the PN scope of practice.

The medications must be withheld and the registered nurse must be notified immediately.

The PN scope of practice requires safeguarding the client from contraindicated treatments and escalating critical clinical deterioration to the supervising RN for advanced assessment.

Key Concept

Recognizing early signs of shock and withholding anticoagulant and NSAID therapies in the presence of thrombocytopenia.

Question 17Question →

A practical nurse (PN) is assigned to a client in a neurological rehabilitation unit. The client has a new prescription for phenytoin $5\text{ mg/kg/day}$ by mouth, to be given in two equally divided doses. The client's current weight is $176\text{ lb}$ . The facility pharmacy provides phenytoin oral suspension at a concentration of $125\text{ mg}/5\text{ mL}$ . Which of the following actions represents safe nursing practice by the PN?

Verify the client's identity using two distinct identifiers and administer

8\text{ mL}

of the oral medication per dose.

Bypass scanning the client's identification band prior to administration because the PN has cared for the client all week.

Calculate the individual dose using the client's weight in pounds, resulting in an administration of

17.6\text{ mL}

per dose.

Accept a delegated task from the registered nurse to administer a supplemental dose of the medication via intravenous (IV) push.

Show answer & explanation

Answer: Verify the client's identity using two distinct identifiers and administer $8\text{ mL}$ of the oral medication per dose.

Answer

The correct action is to verify the client's identity using two distinct identifiers and to administer

8\text{ mL}

of the oral medication per dose.

The practical nurse must verify the client's identity using two distinct identifiers prior to administration to ensure patient safety. Furthermore, the dose is accurately derived by converting the weight to kilograms (

176\text{ lb} \div 2.2 = 80\text{ kg}

), finding the single dose (

400\text{ mg/day} \div 2 = 200\text{ mg/dose}

), and calculating the required liquid volume (

(200\text{ mg} \div 125\text{ mg}) \times 5\text{ mL} = 8\text{ mL}

Step-by-Step Solution

Convert the client's weight from pounds to kilograms.

176\text{ lb} \div 2.2 = 80\text{ kg}

Standard medical dosages are calculated using the metric system.

Calculate the total daily dose based on the client's weight in kilograms.

80\text{ kg} \times 5\text{ mg/kg} = 400\text{ mg/day}

The provider's prescription specifies the total amount to be given over 24 hours.

Determine the amount of medication required for a single dose.

400\text{ mg} \div 2 = 200\text{ mg/dose}

The total daily medication is prescribed to be given in two equally divided doses.

Calculate the liquid volume to administer per dose using the pharmacy concentration.

(200\text{ mg} \div 125\text{ mg}) \times 5\text{ mL} = 8\text{ mL}

Using the 'Desired over Have times Volume' formula determines the exact milliliters needed for administration.

Identify the proper safety procedure for medication administration.

Verify two distinct patient identifiers.

Standard safety protocols mandate verifying identity before giving any medication to prevent administration errors.

Key Concept

Safe medication administration encompasses accurate weight-based dosage calculation, strict adherence to medication rights, and practicing within the established legal scope.

Estimated Time:1m 30s

Question 18Question →

An LPN/LVN is caring for a client with chronic pain who has a new prescription for a fentanyl transdermal patch. The client currently has an older patch in place on their right upper chest. Arrange the following actions in the correct chronological order to safely administer this medication.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence is to first remove the old patch, dispose of it safely, prepare the new site by cleansing it, label the new patch, and finally apply it with firm pressure.

Safe application of a transdermal patch requires a strict sequence to prevent overdose and ensure proper absorption. Removing the old patch first is the most critical safety step. Disposing of it immediately prevents accidental exposure. Cleansing a new site rotates the location to protect skin integrity. Labeling the patch before application prevents discomfort or tissue damage from writing on the patient, and firm application ensures the patch remains secure.

Step-by-Step Solution

Remove the old patch.

Prevents double-dosing.

Leaving the old patch on while applying a new one can cause a fatal opioid overdose due to cumulative medication absorption.

Dispose of the old patch securely.

Secures the narcotic medication.

Folding it adhesive-to-adhesive neutralizes remaining medication and prevents diversion or accidental exposure to unintended individuals.

Prepare a new application site.

Ensures clean, dry skin on a new location.

Rotating sites prevents irritation. A clean, dry surface ensures the new patch sticks properly without chemicals altering its absorption rate.

Label the new patch.

Documentation is visible on the patch.

Marking the date, time, and initials ensures the next healthcare provider knows exactly when it was applied and when it is due for a change.

Apply the new patch.

Medication delivery begins.

Pressing firmly with the palm for 30 seconds activates the adhesive securely against the skin.

Key Concept

Safe Administration of Transdermal Medications

Question 19Question →

A client who is experiencing a productive cough has a prescription for guaifenesin $400\text{ mg}$ by mouth every $4\text{ hours}$ . The facility pharmacy dispenses guaifenesin liquid with a labeled concentration of $200\text{ mg}$ per $10\text{ mL}$ . How many milliliters $(\text{mL})$ should the nurse administer for a single dose?

2\text{ mL}

10\text{ mL}

20\text{ mL}

40\text{ mL}

Show answer & explanation

Answer: $20\text{ mL}$

Answer

The nurse should administer

20\text{ mL}

for a single dose.

To calculate the correct liquid medication dose, use the standard formula:

\frac{\text{Desired}}{\text{Have}} \times \text{Volume}

. The desired dose is

400\text{ mg}

, the dose on hand is

200\text{ mg}

, and the supplied volume is

10\text{ mL}

. Calculating

\left(\frac{400\text{ mg}}{200\text{ mg}}\right) \times 10\text{ mL}

results in exactly

20\text{ mL}

Step-by-Step Solution

Identify the prescribed dose (Desired).

The prescribed dose is

400\text{ mg}

This is the target amount of medication the client needs to receive.

Identify the concentration of the medication supplied (Have and Volume).

The medication available is

200\text{ mg}

in every

10\text{ mL}

This determines the ratio of medication mass to liquid volume.

Apply the dosage calculation formula:

\frac{\text{Desired}}{\text{Have}} \times \text{Volume}

\frac{400\text{ mg}}{200\text{ mg}} \times 10\text{ mL} = 2 \times 10\text{ mL} = 20\text{ mL}

Using the standard formula ensures the correct volumetric dose is prepared.

Key Concept

Medication Dosage Calculation

Question 20Question →

A practical nurse (PN) is preparing to administer a scheduled dose of oral amoxicillin to a 3-year-old toddler weighing $15\text{ kg}$ who was admitted with a severe respiratory infection. Which of the following actions demonstrate safe pharmacological practice by the PN? Select all that apply.

Select all that apply

Verifying the toddler's identity by having the parent state the child's full name and date of birth.

Scanning the medication barcode and the toddler's identification band prior to dispensing the dose.

Converting the toddler's weight from kilograms to pounds prior to calculating the prescribed dosage.

Accepting a verbal order from the healthcare provider to administer the medication via intravenous (IV) push.

Leaving the oral medication syringe at the bedside for the parent to administer once the toddler is awake.

Withholding the scheduled dose and notifying the registered nurse (RN) after observing a new urticarial rash.

Show answer & explanation

Answer: Verifying the toddler's identity by having the parent state the child's full name and date of birth.; Scanning the medication barcode and the toddler's identification band prior to dispensing the dose.; Withholding the scheduled dose and notifying the registered nurse (RN) after observing a new urticarial rash.

Answer

The correct actions include verifying the child's identity with the parent, utilizing barcode scanning for the medication and ID band, and withholding the medication if an allergic rash is noted.

Safe pharmacological practice requires strict adherence to the rights of medication administration and practicing within the legal scope. Verifying a pediatric client's identity through a parent and utilizing barcode scanning prevent identification errors. Furthermore, recognizing signs of a hypersensitivity reaction, such as an urticarial rash, and properly withholding the drug while notifying the RN demonstrates sound clinical judgment.

Step-by-Step Solution

Evaluate each action against the standard rights of medication administration.

Verifying identity with the parent and scanning barcodes directly support the 'right client' and 'right medication' checks.

Ensuring proper identification prevents medication errors, especially in pediatric populations.

Assess the clinical findings and the practical nurse (PN) scope of practice for each scenario.

Withholding the drug for a rash is a safe, necessary action. Administering an IV push medication is out of scope.

The PN must recognize signs of adverse reactions and operate strictly within defined legal boundaries.

Analyze the procedural and calculation methods described in the distractors.

Converting kilograms to pounds for a weight-based dose is incorrect, and leaving medications at the bedside violates administration protocols.

Standard pediatric dosing relies on kilogram measurements, and direct observation of ingestion is mandatory for safety.

Key Concept

Medication Administration Safety and PN Scope of Practice

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