Blood Administration NCLEX Practice Questions, NUR 211 Blood Transfusion NCLEX Questions,, Exams of Medicine

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Blood Administration NCLEX Practice

Questions, NUR 211 Blood Transfusion

NCLEX Questions, 1- blood nclex, 6-NCLEX

Medication IV Calculations, 5-Part 1

Medications Blood IV therapy PN NCLEX

Oct, 4-Module 8 Pharmacology and

Intravenous Therapies

Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6 F orally. Which action should the nurse take?

1. Begin the transfusion as prescribed.
2. Administer an antihistamine and begin the transfusion.
3. Delay hanging the blood and notify the health care provider.
4. Administer two tablets of acetaminophen (Tylenol) and begin the transfusion. - ANS;
5. Delay hanging the blood and notify the health care provider. Rationale: If the client has a temperature higher than 100 F, the unit of blood should not be hung until the HCP is notified and has the opportunity to give further prescriptions. The HCP likely will prescribe that the blood be administered regardless of the temperature, but the decision is not within the nurse's scope of practice to make. The nurse needs an HCP's prescription to administer medications to the client. The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse should ask which INITIAL question?
6. "Have you ever had a transfusion before?"
7. "Why do you think that you need the transfusion?"
8. "Have you ever gone into shock for any reason in the past?"
9. "Do you know the complications and risks of a transfusion?" - ANS; 1) "Have you ever had a transfusion before?" Rationale:

Asking the client about personal experience with transfusion therapy provides a good starting point for client teaching about this procedure. Questioning about previous history of shock and knowledge of complications and risks of transfusion are not helpful because they may elicit a fearful response from the client. Although determining whether the client knows the reason for the transfusion is important, it is not an appropriate statement in terms of eliciting information from the client regarding an understanding of the need for the transfusion. A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The client's blood pressure is 90/50 from a baseline of 125/78. The client's temperature is 100.8F orally from a baseline of 99.2F orally. The nurse determines that the client may be experiencing which complication of a blood transfusion?

1. Septicemia
2. Hyperkalemia
3. Circulatory overload
4. Delayed transfusion reaction - ANS; 1) Septicemia Rationale: Septicemia occurs with the transfusion of blood contaminated with microorganisms. Signs include CHILLS, FEVER, VOMITING, DIARRHEA, HYPOTENSION, and the development of SHOCK. Hyperkalemia causes weakness, paresthesias, abdominal cramps, diarrhea, and dysrhythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. A delayed transfusion reaction can occur days to years after a transfusion. Signs include fever, mild jaundice, and a decreased hematocrit level. The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken NEXT?
5. Remove the intravenous (IV) line.
6. Run a solution of 5% dextrose in water.
7. Run normal saline at a keep-vein-open rate.
8. Obtain a culture of the tip of the catheter device removed from the client. - ANS; 3) Run normal saline at a keep-vein-open rate. Rationale: If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further health care provider prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume.

The nurse would NOT remove the IV line because then there would be no IV access route. Obtaining a culture of the tip of the catheter device removed from the client is incorrect. First, the catheter should NOT be removed. Second, cultures are performed when infection, NOT transfusion reactions, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump. The nurse has just received a unit of packed red blood cells from the blood bank for transfusion to an assigned client. The nurse is careful to select tubing especially made for blood products, knowing that this tubing is manufactured with which item?

1. An air vent
2. Tinted tubing
3. An in-line filter
4. A microdrip chamber - ANS; 3) An in-line filter Rationale: The tubing used for blood administration has an in-line filter. The filter helps ensure that any particles larger than the size of the filter are caught in the filter and are not infused into the client. Tinted tubing is incorrect because blood does not need to be protected from light. The tubing should be macrodrip, not microdrip, to allow blood to flow freely through the drip chamber. An air vent is unnecessary because the blood bag is not made of glass. The client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding?
5. Increased hematocrit level
6. Increased hemoglobin level
7. Decline of elevated temperature to normal
8. Decreased oozing of blood from puncture sites and gums - ANS; 4) Decreased oozing of blood from puncture sites and gums Rationale: Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes.

Increased hemoglobin and hematocrit levels would occur when the client has received a transfusion of red blood cells. An elevated temperature would decline to normal after infusion of granulocytes if those cells were instrumental in fighting infection in the body. The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse should assess which PRIORITY item?

1. Vital signs
2. Skin color
3. Urine output
4. Latest hematocrit level - ANS; 1) Vital signs Rationale: A change in vital signs during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs BEFORE the procedure and again after the first 15 minutes. The other options do not identify assessments that are a priority just before beginning a transfusion. The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. Approximately how long will the nurse need to stay with the client to ensure that a transfusion reaction is not occurring?
5. 5 minutes
6. 15 mintues
7. 30 minutes
8. 45 mintues - ANS; 2) 15 mintues Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is usually when a transfusion reaction may occur. This enables the nurse to detect a reaction and intervene quickly. Following infusion of a unit of packed red blood cells, the client has developed new onset of tachycardia, bounding pulses, crackles, and wheezes. Which action should the nurse implement FIRST?
9. Maintain bed rest with legs elevated
10. Place the client in high-Fowler's position
11. Increase the rate of infusion of intravenous fluids
12. Consult with the HCP regarding initiation of oxygen therapy. - ANS; 2) Place the client in high-Fowler's position Rationale:

New onset of tachycardia, bounding pulses, crackles and wheezes post-transfusion are evidence of fluid overload, a complication associated with blood transfusions. Placing the client in a high-Fowler's (upright) position will facilitate breathing. Measures that increase blood return to the heart, such as leg elevation and administration of intravenous fluids, should be avoided at this time. In addition, administration of fluids cannot be initiated without a prescription. Consulting with the HCP regarding administration of oxygen may be necessary, but positional changes take a short amount of time to do and should be initiated first. The nurse, listening to the morning report, learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which daily serum laboratory studies to assess the effectiveness of the transfusion?

1. Hematocrit level
2. Erythrocyte count
3. Hemoglobin level
4. White blood cell count - ANS; 4) White blood cell count Rationale: The client who has neutropenia may receive a transfusion of granulocytes, or white blood cells. These clients often have severe infections and are unresponsive to antibiotic therapy. The nurse notes the results of follow-up white blood cell counts and differential to evaluate the effectiveness of the therapy. The nurse also continues to monitor the client for signs and symptoms of infection. Erythrocyte count and hemoglobin and hematocrit levels are determined after transfusion of packed red blood cells. A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that which is the rationale for transfusing fresh-frozen plasma to this client?
5. To treat the loss of platelets
6. To promote rapid volume expansion
7. Because a transfusion must be done slowly
8. Because it will increase the hemoglobin and hematocrit levels - ANS; 2) To promote rapid volume expansion Rationale: Fresh-frozen plasma is often used for volume expansion as a results of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level.

The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which item is important to check regarding the age of blood cells before the transfusion is begun?

1. Expiration date
2. Presence of clots
3. Blood group and type
4. Blood identification number - ANS; 1) Expiration date Rationale: The nurse notes the expiration date on the unit of blood to ensure that the blood is fresh. Blood cells begin to deteriorate over time, so safe storage is usually limited to 35 days. Careful notation of the expiration date by the nurse is an essential part of the verification process before hanging a unit of blood. The nurse also notes the blood identification (unit) number, blood group and type, and client's name. The nurse also inspects the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted. A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to take which action(s) to reduce the risk of possible transfusion complications? SELECT ALL THAT APPLY.
5. Ask a family member to donate blood ahead of time.
6. Give an autologous blood donation before the surgery.
7. Take iron supplements before surgery to boost hemoglobin levels.
8. Request that any donated blood be screened twice by the blood bank.
9. Take adequate amounts of vitamin C several days prior to the surgery date. - ANS;
10. Ask a family member to donate blood ahead of time.
11. Give an autologous blood donation before the surgery. Rationale: A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is to ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are helpful for iron deficiency anemia but are not helpful in replacing blood lost during the surgery. Vitamin C enhances iron absorption, but also is not helpful in replacing blood lost during surgery. A client with severe blood loss resulting from multiple trauma requires rapid transfusion of several units of blood. The nurse asks another health team member to obtain which

device for use during the transfusion procedure to help reduce the risk of cardiac dysrhythmias?

1. Infusion pump
2. Pulse oximeter
3. Cardiac monitor
4. Blood-warming device - ANS; 4) Blood-warming device Rationale: If several units of blood are to be administered, a blood warmer should be used. Rapid transfusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device. Pulse oximetry and cardiac monitoring equipment are useful for the early assessment of complications but do not reduce the occurrence of cardiac dysrhythmias. Electronic infusion devices are not helpful in this case because the infusion must be rapid, and infusion devices generally are used to control the flow rate. In addition, not all infusion devices are made to handle blood or blood products. A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which intravenous (IV) solution from the IV storage area to hang with the blood product at the client's bedside?
5. Lactated Ringer's
6. 0.9% sodium chloride
7. 5% dextrose in 0.9% sodium chloride
8. 5% dextrose in 0.45% sodium chloride - ANS; 2) 0.9% sodium chloride Rationale: Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells. Lactated Ringer's is not the solution of choice with this procedure. The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse assesses which priority item? a. Vital signs b. Skin color c. Urine output D. Latest hematocrit level - ANS; A. vital signs

A change in VS during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs before the procedure and again after the first 15 minutes. The nurse has discontinued a unit of blood that was infusing into a client because the client experienced a transfusion reaction. After documenting the incident appropriately, the nurse sends the blood bag and tubing to which of the following departments? a. Blood bank b. Risk management c. Environmental services d. Infection control - ANS; A. blood bank The nurse returns the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures needed once a transfusion reaction has been documented. The other option identify incorrect departments. Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6F orally. Which of the following is the appropriate nursing action? a. Begin the transfusion as prescribed b. Delay hanging the blood and notify the physician c. Administer an antihistamine and begin the transfusion d. Administer two tablets of acetaminophen (Tylenol) and begin the transfusion - ANS; b. Delay hanging the blood and notify the physician If the client's temperature is higher than 100F the unit of blood should not be hung until the physician is notified and has the opportunity to give further prescriptions. The physician will likely prescribe that the blood be administered regardless of the temperature, but the decision is not within the nurse's scope of practice to make. A nurse is preparing medication for administration. In addition to the right medication, the nurse adheres to which of the following additional rights of medication administration. Select all that apply. a. The right route b. The right staff member c. The right time d. The right client e. The right documentation f. The right dose - ANS; A, C, D, E, F There are six rights to administering medications: The right medication, the right client, the right dose, the right route, the right time, and the right documentation. A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that the rationale for transfusing fresh- frozen plasma in this client is:

A. to treat the loss of platelets B. to promote rapid volume expansion C. That the transfusion must be done slowly D. That it will increase the hemoglobin and hematocrit levels. - ANS; B. to promote rapid volume expansion Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level. A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The client's blood pressure is 90/50 from a baseline of 125/78. The client's temperature is 100.8F orally from a baseline of 99.2F orally. The nurse determines that the client may be experiencing which complication of a blood transfusion? a. Septicemia b. Hyperkalemia c. Circulatory overload d. Delayed transfusion reaction - ANS; A. Septicemia Septicemia occurs with the transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and the development of shock. Hyperkalemia causes weakness, paresthesias, abdominal cramps, diarrhea, and dysrythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. A delayed transfusion reaction can occur days or weeks after a tranfusion. Signs include fever, mild jaundice, and a decreased hematocrit level. The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse asks which initial question? a. "have you ever had a transfusion before?" b. "why do you think that you need the transfusion?" c. "have you ever gone into shock for any reason in the past?" e. "do you know the complications and risks of a transfusion?" - ANS; a. "have you ever had a transfusion before?" Asking the client about personal experience with transfusion therapy provides a good starting point for client teaching about this procedure. Options C and E are not helpful because they may elicit a fearful response from the client. Although determining whether the client knows the reason for the transfusion is important, option B is not an appropriate statement in terms of eliciting information from the client regarding an understanding of the need for the transfusion A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which of the following? a. Increased hematocrit level b. Increased hemoglobin level c. Decline of elevated temperature to normal

d. Decreased oozing of blood from puncture sites and gums - ANS; d. Decreased oozing of blood from puncture sites and gums Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes. Increased hemoglobin and hematocrit levels would occur when the client has received a transfusion of red blood cells. An elevated temperature would decline to normal after infusion of granulocytes if those cells were instrumental in fighting infection in the body. The nurse is picking up a unit of packed red blood cells at the hospital blood bank. After putting the pen down, the nurse glances at the clock, which reads 1:00. The nurse calculates that the transfusion must be started by: a. 1: b. 2: c. 2: d. 3:00 - ANS; a. 1: Blood must be hung as soon as possible within 30 mintues after it is obtained from the blood bank. A client has experienced a rash with pruritus during previous blood transfusions. The client asks the nurse whether it is safe to receive another transfusion. In formulating a response, the nurse incorporates the understanding that which medication will most likely be prescribed before the transfusion is begun? a. Ibuprofen (Motrin) b. Acetaminophen (Tylenol) c. Diphenhydramine (Benadryl) d. Acetylsalicylic Acid (ASA Aspirin) - ANS; c. Diphenhydramine (Benadryl) An urticarial reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine such as diphenhydramine. Acetaminophen and ASA are analgesics and ibuprofen is a NSAID A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which of the following IV solutions form the IV storage area to hang with the blood product at the client's bedside? a. Lactated Ringer's b. 0.9% sodium chloride c. 5% dextrose in 0.9% sodium chloride d. 5% dextrose in 0.45% sodium chloride - ANS; c. 0.9% sodium chloride Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells. Lactated ringer's is not the solution of choice with this procedure. A nurse has an order to transfuse a unit of packed red blood cells to a client who does not currently have an IV line inserted. When obtaining supplies to start the IV infusion the nurse selects an angiocatheter with a size of:

a. 18 gauge b. 21 gauge c. 22 gauge d. 24 gauge - ANS; a. 18 gauge The IV catheter used for a blood transfusion should be at least 18 or 19 gauge. Compared with IV solutions, blood has a thicker and stickier consistency, and use of an 18 or 19 gauge catheter will ensure that the bore of the catheter is large enough to prevent damage to the blood cells. A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to do which of the following to reduce the risk of possible transfusion complications? a. give an autologous blood donation before the surgery b. ask a friend or family member to donate blood ahead of time c. take iron supplements before surgery to boost hemoglobin levels d. request that any donated blood be screened twice by the blood bank. - ANS; a. give an autologous blood donation before the surgery A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are not helpful in replacing blood lost during the surgery. A nurse is assisting with caring for a client who will receive a unit of blood. Just before the infusion, it is most important for the nurse to check the client's: - ANS; 1. Vital signs

2. Skin color
3. Oxygen saturation
4. Latest hematocrit level Answer: 1 Rationale: A change in the vital signs may indicate that a transfusion reaction is occurring. The nurse assesses the client's vital signs before the procedure to obtain a baseline, every 15 minutes for the first half hour after beginning the transfusion, and every half hour thereafter. Options 2, 3, and 4 may be checked but are not the most important. A client who is receiving a blood transfusion rings the call bell for the nurse. When entering the room, the nurse notes that the client is flushed, dyspneic, and complaining of generalized itching. The nurse interprets that the client is experiencing: - ANS; 1. Bacteremia
5. Fluid overload
6. Hypovolemic shock
7. A transfusion reaction Answer: 4 Rationale: The signs and symptoms exhibited by the client are consistent with a transfusion reaction. With bacteremia, the client would have a fever, which is not part of

the clinical picture presented. With fluid (circulatory) overload, the client would have crackles in addition to dyspnea. There is no correlation between the signs mentioned in the question and hypovolemic shock. The signs identified in the question are indicative of an allergic reaction, which is one type of blood transfusion reaction. A client who was receiving a blood transfusion has experienced a transfusion reaction. The nurse sends the blood bag that was used for the client to which of the following areas? - ANS; 1. The pharmacy

2. The laboratory
3. The blood bank
4. The risk-management department Answer: 3 Rationale: The nurse prepares to return the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow- up testing procedures that are needed after a transfusion reaction has been documented. Options 1, 2, and 4 are incorrect. A nurse takes a client's temperature before giving a blood transfusion. The temperature is 100° F orally. The nurse reports the finding to the registered nurse and anticipates that which of the following actions will take place? - ANS; 1. The transfusion will begin as prescribed.
5. The blood will be held, and the health care provider will be notified.
6. The transfusion will begin after the administration of an antihistamine.
7. The transfusion will begin after the administration of 600 mg of acetaminophen (Tylenol). Answer: 2 Rationale: If the client has a temperature of 100° F or more, the unit of blood should be held until the health care provider is notified and has the opportunity to give further prescriptions. The other options are incorrect actions. A nurse is assisting with caring for a client who has received a transfusion of platelets. The nurse determines that the client is benefiting most from this therapy if the client exhibits which of the following? - ANS; 1. An increased hematocrit level
8. An increased hemoglobin level
9. A decline of the temperature to normal
10. A decrease in oozing from puncture sites and gums Answer: 4 Rationale: Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or the oozing of blood from puncture sites, wounds, and mucous membranes. The client's temperature would decline to normal after the infusion of granulocytes if those transfused cells were then instrumental in fighting infection in the body. Increased hemoglobin and hematocrit levels would be seen when the client has received a transfusion of red blood cells.

A client has a prescription to receive 1000 mL of 5% dextrose in 0.45% sodium chloride. After gathering the appropriate equipment, the nurse takes which action first before spiking the IV bag with the tubing? - ANS; 1. Uncaps the distal end of the tubing

2. Uncaps the spike portion of the tubing
3. Opens the roller clamp on the IV tubing
4. Closes the roller clamp on the IV tubing Answer: 4 Rationale: The nurse should first clamp the tubing to prevent the solution from running freely through the tubing after it is attached to the IV bag. The nurse should next uncap the proximal (spike) portion of the tubing and attach it to the IV bag. The roller clamp is then opened slowly, and the fluid is allowed to flow through the tubing in a controlled fashion to prevent air from remaining in parts of the tubing. A nurse is doing a routine assessment of a client's peripheral IV site. The nurse notes that the site is cool, pale, and swollen and that the IV has stopped running. The nurse determines that which of the following has probably occurred? - ANS; 1. Phlebitis
5. Infection
6. Infiltration
7. Thrombosis Answer: 3 Rationale: An infiltrated IV is one that has dislodged from the vein and is lying in subcutaneous tissue. The pallor, coolness, and swelling are the result of IV fluid being deposited into the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The other three options identify complications that are likely to be accompanied by warmth at the site rather than coolness. A nurse is assigned to care for a client with a peripheral IV infusion. The nurse is providing hygiene care to the client and would avoid which of the following while changing the client's hospital gown? - ANS; 1. Using a hospital gown with snaps at the sleeves
8. Disconnecting the IV tubing from the catheter in the vein
9. Checking the IV flow rate immediately after changing the hospital gown
10. Putting the bag and tubing through the sleeve, followed by the client's arm Answer: 2 Rationale: The tubing should not be removed from the IV catheter. With each break in the system, there is an increased chance of introducing bacteria into the system, which can lead to infection. Options 1 and 4 are appropriate. The flow rate should be checked immediately after changing the hospital gown, because the position of the roller clamp may have been affected during the change. A nurse is making a worksheet and listing the tasks that need to be performed for assigned adult clients during the shift. The nurse writes on the plan to check the IV of an assigned client who is receiving fluid replacement therapy at least every: - ANS; 1. 1 hour
11. 2 hours

3. 3 hours
4. 4 hours Answer: 1 Rationale: Safe nursing practice includes monitoring an IV infusion at least once per hour for an adult client. Options 2, 3, and 4 do not provide time frames that are safe or acceptable. A nurse is checking the insertion site of a peripheral IV catheter. The nurse notes the site to be reddened, warm, painful, and slightly edematous in the area of the vein proximal to the IV catheter. The nurse interprets that this is likely the result of: - ANS; 1. Phlebitis of the vein
5. Infiltration of the IV line
6. Hypersensitivity to the IV solution
7. An allergic reaction to the IV catheter material Answer: 1 Rationale: Phlebitis at an IV site results in discomfort at the site and redness, warmth, and swelling proximal to the IV catheter. The IV catheter should be removed, and a new IV line should be inserted at a different site. The remaining options are incorrect; the signs and symptoms in the question are not associated with these conditions. A nurse has been instructed to discontinue an IV line. The nurse removes the catheter by withdrawing the catheter while applying pressure to the site with a(n): - ANS; 1. Band-Aid
8. Alcohol swab
9. Betadine swab
10. Sterile 2 × 2 gauze Answer: 4 Rationale: A dry, sterile dressing such as a sterile 2 × 2 gauze is used to apply pressure to the site while the catheter is discontinued and removed. This material is absorbent, sterile, and nonirritating to the site. A Band-Aid may be used to cover the site after hemostasis has occurred. An alcohol swab or Betadine would irritate the opened puncture site and would not stop the blood flow. A nurse is preparing an IV solution and tubing for a client who requires IV fluids. While preparing to prime the tubing, the tubing drops and hits the top of the medication cart. The nurse should plan to do which of the following? - ANS; 1. Change the IV tubing.
11. Wipe the tubing with Betadine.
12. Scrub the tubing with an alcohol swab.
13. Scrub the tubing before attaching it to the IV bag. Answer: 1 Rationale: The nurse should change the IV tubing. The tubing has become contaminated, and, if used, it could result in a systemic infection in the client. Wiping or scrubbing the tubing is insufficient to prevent systemic infection.

A client is going to be transfused with a unit of packed red blood cells. The nurse understands that it is necessary to remain with the client for what time period after the transfusion is started? - ANS; 1. 5 minutes

2. 15 minutes
3. 30 minutes
4. 45 minutes Answer: 2 Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is the most likely time that a transfusion reaction will occur. This enables the nurse to detect a reaction and intervene quickly. The nurse engages in safe nursing practice by obtaining coverage for the other clients during this time. Options 1 is too short of a time period. Options 3 and 4 are lengthy time periods. A nurse is assisting with caring for a client who is receiving a unit of packed red blood cells. The nurse tells the client that it is most important to report which of the following signs immediately? - ANS; 1. Sore throat or earache
5. Chills, itching, or rash
6. Unusual sleepiness or fatigue
7. Mild discomfort at the catheter site Answer: 2 Rationale: The client is told to report chills, itching, or rash immediately, because these could be signs of a possible transfusion reaction. Mild discomfort at the catheter site may be indicative of a problem, or it could result from the size of the IV catheter required to infuse the blood product. Sore throat, earache, sleepiness, and fatigue, are unrelated to a transfusion reaction. Which of these clients are most likely to develop fluid (circulatory) overload? Select all that apply. - ANS; 1. A premature infant
8. A 101-year-old man
9. A client on renal dialysis
10. A client with diabetes mellitus
11. A 29-year-old woman with pneumonia
12. A client with congestive heart failure Answer: 1 2 3 6 Rationale: Clients with cardiac, respiratory, renal, or liver diseases and older and very young clients cannot tolerate an excessive fluid volume. The risk of fluid (circulatory) overload exists with these clients. The medication prescribed is hydromorphone hydrochloride (Dilaudid), 3 mg intramuscular every 4 hours as needed. The medication label reads hydromorphone hydrochloride (Dilaudid), 4 mg/1 mL. The nurse prepares to administer how many mL to the client? - ANS; Answer: 0. Rationale: Follow the formula for dosage calculation.

The medication prescribed is digoxin (Lanoxin), 0.25 mg orally daily. The medication label reads digoxin (Lanoxin), 0.125 mg/tablet. The nurse prepares how many tablet(s) to administer the dose? - ANS; Answer: 2 Rationale: Follow the formula for dosage calculation. The medication prescribed is heparin sodium 650 units subcutaneously every 12 hours. The medication vial reads heparin sodium (Liquaemin), 1000 units/mL. The nurse prepares how many milliliters to administer one dose? - ANS; Answer: 0. Rationale: Follow the formula for dosage calculation. The medication prescribed is metoclopramide hydrochloride (Reglan) 10 mg intramuscularly times one dose. The medication label reads metoclopramide hydrochloride (Reglan), 5 mg/mL. The nurse plans to prepare how much medication to administer the dose? - ANS; Answer: 2 Rationale: Follow the formula for dosage calculation. The medication prescribed is meperidine hydrochloride (Demerol), 35 mg intramuscularly. The medication label states meperidine hydrochloride (Demerol), 50 mg/mL. The nurse plans to prepare how much medication to administer the dose? - ANS; Answer: 0. Rationale: Follow the formula for dosage calculations. The medication prescribed is prochlorperazine (Compazine), 20 mg intramuscular every 4 hours as needed. The medication label states prochlorperazine 10 mg/mL. The nurse prepares how much medication to administer the dose? - ANS; Answer: 2 Rationale: Follow the formula for dosage calculation. The medication prescribed is atropine sulfate, 0.4 mg intramuscularly, immediately. The medication label states atropine sulfate, 0.3 mg/0.5 mL. The nurse prepares how much medication to administer the dose? Round to the nearest tenth position. - ANS; Answer: 0. Rationale: Follow the formula for dosage calculation. The medication prescribed is levodopa (Larodopa), 1 g orally, twice daily. The medication label states levodopa, 500-mg tablets. The nurse prepares to administer how many tablets at the evening dose? - ANS; Answer: 2 Rationale: Convert 1 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right; therefore 1 g = 1000 mg. The medication prescribed is zidovudine (AZT), 0.2 g orally every 4 hours. The medication label states zidovudine (AZT), 100-mg tablets. The nurse prepares to administer how many tablets for one dose? - ANS; Answer: 2 Rationale: Convert 0.2 g to mg. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right; therefore 0.2 g = 200 mg.

The medication prescribed is atropine sulfate, 0.4 mg. The medication label states atropine sulfate, 0.5 mg/0.5 mL. How many milliliters will the nurse prepare to administer to the client? - ANS; Answer: 0. Rationale: Follow the formula for dosage calculation. The medication prescription states to administer Tylenol (acetaminophen) 650 mg orally for a temperature of more than 38° C. The medication bottle states Tylenol (acetaminophen), 325 mg tablets. The nurse takes the client's temperature and notes that it is 101° F. The nurse plans to take which of the following actions? - ANS; 1. Administer two Tylenol tablets.

2. Administer three Tylenol tablets.
3. Do not administer the Tylenol at this time.
4. Check the client's temperature in 30 minutes. Answer: 1 Rationale: Convert Fahrenheit to Celsius, and then calculate the dose to be administered. Step 1: Conversion of Fahrenheit to Celsius: To convert Fahrenheit to Celsius, subtract 32, and divide the result by 1.8: C = (101 - 32) = 69, divided by 1.8 = 38.3° Step 2: Dosage Calculation: Therefore option 1 is the correct answer. The medication prescription reads phenytoin (Dilantin) 0.2 g orally twice daily. The medication label states 100-mg capsules. A nurse prepares how many capsule(s) to administer one dose? - ANS; Answer: 2 Rationale: You must convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Therefore, 0. g equals 200 mg. After conversion from grams to milligrams, use the formula to calculate the correct dose. The intravenous prescription is 1000 mL of 0.9% NaCl (normal saline) to run over 12 hours. The drop factor is 15 gtt/1 mL. The nurse plans to adjust the flow rate to how many gtt/minute? (Round answer to the nearest whole number.) - ANS; Answer: 21 Rationale: Use the intravenous (IV) flow rate formula. The medication is an intramuscular dose of 400,000 units of penicillin G benzathine (Bicillin). The label on the 10-mL ampule sent from the pharmacy reads penicillin G benzathine (Bicillin) 300,000 units/mL. The nurse prepares how much medication to administer the correct dose? (Round answer to the nearest tenth position.) - ANS; Answer: 1. Rationale: Follow the formula for dosage calculation. The intravenous prescription is 3000 mL of 5% dextrose (D5W) to run over a 24-hour period. The drop factor is 10 gtt/1 mL. The nurse plans to adjust the flow rate to how many gtt/minute? (Round answer to the nearest whole number.) - ANS; Answer: 21

Rationale: Use the intravenous (IV) flow rate formula. A nurse is preparing to administer medication through a nasogastric (NG) tube that is connected to suction. Which of the following indicates the accurate procedure for medication administration? - ANS; 1. Position the client supine to assist with medication absorption.

2. Clamp the NG tube for 30 minutes after medication administration.
3. Aspirate the NG tube after medication administration to maintain patency.
4. Change the suction setting to low intermittent suction for 30 minutes after medication administration. Answer: 2 Rationale: If a client has an NG tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the NG tube will remove the medication that has just been administered. Low intermittent suction will also remove the medication. The client should not be placed in the supine position because of the risk for aspiration. Morphine sulfate, 2.5 mg, is prescribed for a child. The safe pediatric dose is 0.05 to 0.1 mg/kg/dose. The child weighs 50 kg. Which statement most accurately describes the prescribed dosage for this child? - ANS; 1. The dose is too low.
5. The dose is too high.
6. The dose is within the safe dosage range.
7. There is not enough information to determine the safe dosage range. Answer: 3 Rationale: Use the formula for calculating a safe dosage range. Dosage parameters: 0.05 mg/kg/dose × 50 kg = 2.5 mg/dose 0.1 mg/kg/dose × 50 kg = 5 mg/dose The dose is within the safe dosage range. A health care provider's prescription reads as follows: "Ampicillin, 125 mg intramuscular every 6 hours." The medication label reads "1 gram and reconstitute with 7.4 mL of bacteriostatic water." How many milliliters should the nurse draw up for one dose? - ANS; 1. 0.54 mL
8. 0.92 mL
9. 1.1 mL
10. 7.4 mL Answer: 2 Rationale: Convert grams to milligrams. With the metric system, to convert larger to smaller, multiply by 1000 or move the decimal three places to the right. Then, use the medication calculation formula: 1 g = 1000 mg Formula: A health care provider has prescribed phenobarbital sodium (Luminal Sodium), 25 mg orally twice daily, for a child with febrile seizures. The medication label reads as follows:

"Phenobarbital sodium, 20 mg/5 mL." The nurse has determined that the dose prescribed is a safe dose for the child. How many milliliters per dose should the nurse administer to the child? - ANS; 1. 2 mL

2. 4.5 mL
3. 6.25 mL
4. 7 mL Answer: 3 Rationale: Use the medication calculation formula. Sulfisoxazole, 1 g orally four times daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the prescribed dose is safe. How many tablets per dose should the nurse administer to the adolescent? - ANS; 1. 0.5 tablet
5. 1 tablet
6. 2 tablets
7. 3 tablets Answer: 3 Rationale: Change grams to milligrams, knowing that 1000 mg = 1 g. When converting from grams to milligrams (larger to smaller), move the decimal point three places to the right; thus, 1.0 g = 1000 mg. Then, use the medication calculation formula. Atropine sulfate, 0.2 mg given intramuscularly, is prescribed for a child. The medication label reads as follows: "0.4 mg/mL." The nurse has determined that the prescribed dose is safe. How many milliliters should the nurse administer to the child? - ANS; Answer:

Rationale: Use the formula for calculating medication dosage. A nurse is preparing to administer a prescribed intramuscular (IM) dose of meperidine hydrochloride (Demerol), 35 mg, to a client. The medication label reads meperidine hydrochloride, 50 mg/mL. How many milliliters will the nurse administer to the client? - ANS; Answer: 0. Rationale: Use the medication calculation formula and note the prescribed (35 mg) and available doses (50 mg/mL). A nurse is asked to regulate the flow rate of an intravenous (IV) solution being administered to a client. The IV bag contains 50 mL of solution and the solution is to be administered over 30 minutes. The administration set has a drop factor of 10 drops (gtt)/mL. The nurse should regulate the roller clamp on the infusion set to deliver how many drops per minute? Round to the nearest whole number. - ANS; Answer: 17 Rationale: The formula and calculation for this IV flow rate is: A health care provider prescribes potassium chloride (KCl) elixir, 20 mEq orally twice daily. The medication label states potassium chloride (KCl), 30 mEq/15 mL. The nurse prepares to administer the morning dose. How many milliliters will the nurse prepare to administer one dose? - ANS; Answer: 10 Rationale: Follow the formula for dosage calculation.

The nurse notes the appearance of skin breakdown on a client's hand at the site of an intravenous catheter that had medication infusing. The nurse determines that which adverse effect occurred? Refer to figure. - ANS; 1. Phlebitis

2. Infiltration
3. Thrombosis
4. Extravasation Answer: 4 Rationale: Extravasation refers to the tissue injury that occurs from leakage of medication into surrounding skin and subcutaneous tissue; it can also cause tissue necrosis. Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection. Phlebitis can cause the development of a clot (thrombophlebitis). Infiltration is seepage of the intravenous fluid out of the vein and into the surrounding interstitial spaces. It is a form of tissue injury but the injury is not to the extent that occurs with extravasation. A postoperative client has a prescription to receive an intravenous (IV) infusion of 1000 mL normal saline solution over a period of 10 hours. The drop (gtt) factor for the IV infusion set is 15 gtt/mL. The nurse sets the flow rate at how many drops per minute? - ANS; Answer: 25 Rationale: Use the formula for calculating IV flow rates. A client who is receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure and a bounding pulse. The nurse reports the findings, knowing that these signs are indicative of which complication of this therapy? - ANS; 1. Sepsis
5. Air embolism
6. Fluid overload
7. Hyperglycemia Answer: 3 Rationale: The client's signs and symptoms are consistent with fluid overload. The increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. A fever would be present in a client with sepsis. Signs and symptoms of an air embolus include confusion, pallor, lightheadedness, tachycardia, tachypnea, hypotension, anxiety, and unresponsiveness. Polyuria, polydipsia, and polyphagia are manifestations of hyperglycemia. A health care provider's prescription reads "phenytoin (Dilantin) 0.2 g orally, twice daily." The medication label states 100-mg capsules. How many capsule(s) will the nurse prepare to administer one dose? - ANS; Answer: 2 Rationale: Convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right. Therefore 0.2 g = 200 mg. A health care provider prescribes 1000 mL of 0.45% NaCl (half-normal saline) to run over 8 hours. The drop (gtt) factor is 15 gtt/1 mL. The nurse plans to adjust the flow rate

to how many gtt/min? Round the answer to the nearest whole number. - ANS; Answer: 31 Rationale: The prescribed 1000 mL is to be infused over 8 hours. Follow the formula, and multiply 1000 mL by 15 (gtt factor). Then divide the result by 480 minutes (8 hours × 60 minutes). The infusion is to run at 31.2 or 31 gtt/min. A health care provider's prescription reads "levothyroxine (Synthroid), 150 mcg orally daily." The medication label reads "levothyroxine, 0.1 mg/tablet." The nurse prepares to administer how many tablet(s) to the client? - ANS; Answer: 1.5 Rationale: Convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000, or move the decimal three places to the left. Therefore 150 mcg = 0.15 mg. A health care provider prescribes 1000 mL of 5% dextrose (D5W) to run at 125 mL/hr. The nurse calculates the infusion rate, knowing that it will take how many hours for 1 L to infuse? - ANS; Answer: 8 Rationale: To determine how many hours it will take for 1 L to infuse, first recall that 1 L is equal to 1000 mL. Next, divide the 1000 mL by the amount being delivered in 1 hour. A health care provider prescribes one unit of packed red blood cells to infuse over 4 hours. One unit of blood contains 250 mL, and the drop factor is 10 gtt/1 mL. The registered nurse asks the licensed practical nurse (LPN) to assist with monitoring the flow rate during the infusion. The LPN monitors the flow rate, knowing that how many gtt/min should infuse? Round the answer to the nearest whole number. - ANS; Answer: 10 Rationale: The prescribed 250 mL is to be infused over 4 hours. Follow the formula, and multiply 250 mL by 10 (gtt factor). Then divide the result by 240 minutes (4 hours × 60 minutes). The infusion is to run at 10.4 or 10 gtt/min. Diphenhydramine hydrochloride (Benadryl), 25 mg orally every 6 hours, is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse determines that: - ANS; 1. The dose is too low.

2. The dose is too high.
3. The dose is within the safe dosage range.
4. There is not enough information to determine the safe dose. Answer: 3 Rationale: Use the formula for calculating a safe dosage range. Safe dose parameter: 5 mg/kg/day × 25 kg = 125 mg/day Dosage frequency: 25 mg × 4 doses (every 6 hours) = 100 mg/day The dose is within the safe dosage range. Penicillin G procaine (Wycillin), 1,000,000 units given intramuscularly, is prescribed for an adolescent with an infection. The medication label reads as follows: "1,200,000

units/2 mL." The nurse has determined that the prescribed dose is safe. How many milliliters per dose should the nurse administer to the adolescent? - ANS; 1. 0.8 mL

2. 1.2 mL
3. 1.44 mL
4. 1.66 mL Answer: 4 Rationale: Use the medication calculation formula. A pediatric client with a ventricular septal defect repair is placed on a maintenance dose of digoxin (Lanoxin). The safe dose is 0.03 mg/kg/day, and the client's weight is 7.2 kg. The health care provider (HCP) prescribes the digoxin to be given twice daily. How much digoxin should the nurse administer to the client at each dose? - ANS; 1. 0.1 mg
5. 0.37 mg
6. 0.5 mg
7. 2.5 mg Answer: 1 Rationale: Calculate the dosage by weight first: therefore 0.03 mg/day × 7.2 kg = 0.21 mg/day. Next, note that the HCP prescribes digoxin to be given twice daily; therefore two doses in 24 hours will be administered, and 0.21 mg/day divided by two doses = 0.1 mg for each dose. A client who has been receiving parenteral nutrition by way of a central venous access device complains of chest pain and dyspnea. The nurse quickly assesses the client's vital signs and notes that the pulse rate has increased and that the blood pressure has dropped. The nurse determines that the client is likely experiencing: - ANS; 1. Sepsis
8. Air embolism
9. Fluid overload
10. Fluid imbalance Answer: 2 Rationale: The signs and symptoms of air embolism include chest pain, dyspnea, hypoxia, anxiety, tachycardia, and hypotension. The nurse also would hear a loud churning sound over the pericardium on auscultation of the chest. The signs and symptoms of sepsis include fever, chills, and general malaise. The signs and symptoms of a fluid imbalance depend on the type of imbalance that the client is experiencing. Fluid overload causes increased intravascular volume, which increases the blood pressure and the pulse rate as the heart tries to pump the extra fluid volume. Fluid overload also causes neck vein distention and the shifting of fluid into the alveoli, resulting in lung crackles. Complications would be reported to the registered nurse and/or the health care provider immediately. A client receiving intravenous (IV) fluid therapy complains of burning and a feeling of tightness at the IV insertion site. On assessment, the nurse detects coolness and swelling at the site and notes that the IV rate has slowed. The nurse determines that which of the following has occurred? - ANS; 1. Infection
11. Phlebitis

3. Infiltration
4. Thrombosis Answer: 3 Rationale: An infiltrated IV line is one that has dislodged from the vein and is lying in subcutaneous tissue. Pallor, coolness, and swelling at the IV site result when IV fluid is deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of IV solution will slow down or stop. The corrective action is to remove the catheter and start a new IV line at another site. Options 1, 2, and 4 are likely to be accompanied by warmth at the site, not coolness. One unit of packed red blood cells is infusing into a client over a 4-hour period. The unit of blood contains 250 mL. The drop factor is 15 drops (gtt) per 1 mL. The nurse determines that the flow rate should be set at how many drops per minute? Round answer to the nearest whole number. - ANS; Answer: 16 Rationale: Use the formula to calculate the infusion rate. A nurse is preparing to administer 30 mEq of liquid potassium chloride (KCl) to an adult client. The label on the medication bottle reads 40 mEq of KCl/15 mL. The nurse prepares how many milliliters of KCl to administer the correct dose of medication? Round answer to the nearest whole number. - ANS; Answer: 11 Rationale: Use the formula to calculate medication dosages. A registered nurse (RN) tells a licensed practical nurse (LPN) that the health care provider has prescribed a hypotonic IV solution for a client. Which IV solution should the LPN obtain for administration to the client? - ANS; 1. 0.45% saline
5. 5% dextrose in water
6. 10% dextrose in water
7. 5% dextrose in 0.9% saline Answer: 1 Rationale: 5% dextrose in water is an isotonic solution; 10% dextrose in water and 5% dextrose in 0.9% saline are hypertonic solutions; 0.45% saline is hypotonic and is probably the only hypotonic solution used in clinical situations. Distilled water is another example of a hypotonic solution. Hypotonic solutions contain a lower concentration of salt or more water than an isotonic solution. Intravenous (IV) lactated Ringer's solution is prescribed for a postoperative client. A nursing student is caring for the client, and the nursing instructor asks the student about the tonicity of the prescribed IV solution. The student responds by telling the instructor that the solution is: - ANS; 1. Isotonic
8. Hypotonic
9. Hypertonic
10. Normotonic Answer: 1 Rationale: Lactated Ringer's solution is an isotonic solution. Other isotonic solutions include 5% dextrose in water, 0.9% normal saline, and 5% dextrose in 0.225% normal

saline. 0.45% normal saline is hypotonic; 10% dextrose in water, 5% dextrose in 0.9% normal saline, and 5% dextrose in 0.45% normal saline are hypertonic solutions. A nurse is checking the IV dressing of a client with a peripheral intravenous solution infusing. The date on the dressing is 2/9 (February 9). The nurse calculates that the dressing should be changed on which of the following dates? - ANS; 1. 2/10

2. 2/12
3. 2/14
4. 2/16 Answer: 2 Rationale: The IV site dressing should be changed every 48 to 72 hours, which is every 2 to 3 days. With an insertion date of 2/9, the due date for change, depending on agency policy, would be either 2/11 or 2/12. Changing the dressing every 5 to 7 days (options 3 and 4) would place the client at risk for infection. Changing the dressing on a daily basis is not necessary unless the dressing becomes wet. A nurse is checking the remaining volume in a 1000-mL IV bag that is scheduled to infuse over 8 hours. The nurse has just noted that at 11:00 ᴀᴍ the remaining IV fluid is at the 500-mL level. When she returns at 12:00 noon at which numerical level (mL) should the IV fluid be? - ANS; Answer: 375 Rationale: If the IV is scheduled to run over 8 hours, then the hourly rate is 125 mL/hr. Using 500 mL as the reference point, the next hourly marking would be at 375 mL, which is 125 mL less than 500. Cloxacillin sodium (Tegopen) 100 mg orally every 8 hours is prescribed for a child with an elevated temperature who is suspected of having a respiratory tract infection. The child weighs 17 pounds. The safe pediatric dosage is 50 mg/kg/day. Which statement most accurately describes the prescribed dosage for this child? - ANS; 1. The dosage is too low.
5. The dosage is too high.
6. The dosage is within the safe dosage range.
7. There is not enough information to determine the safe dosage. Answer: 1 Rationale: Convert pounds to kilograms by dividing by 2.2. Pounds to kilograms: 17 lb divided by 2.2 lb/kg = 7.72 kg Safe dosage parameter: 50 mg/kg/day × 7.72 kg = 386 mg/day Dosage frequency: 100 mg × 3 doses (every 8 hours) = 300 mg/day The dosage is within the safe dosage range. Penicillin V (Pen-VK), 250 mg orally every 8 hours, is prescribed for a child with a respiratory infection. The child's weight is 45 pounds. The safe pediatric dosage is 25 to 50 mg/kg/day. Which statement most accurately describes the prescribed dosage for this child? - ANS; 1. The dosage is too low.

2. The dosage is too high.
3. The dosage is within the safe dosage range.
4. There is not enough information to determine the safe dosage. Answer: 3 Rationale: Convert pounds to kilograms by dividing by 2.2 and then determine the dosage frequency. Pounds to kilograms: 45 lb divided by 2.2 lb/kg = 20.45 kg Dosage parameters: 25 mg/kg/day × 20.45 kg = 511.25 mg/day 50 mg/kg/day × 20.45 kg = 1022.5 mg/day Dosage frequency: 250 mg × 3 doses (every 8 hours) = 750 mg/day The dosage is within the safe dosage range. Morphine sulfate, 2.5 mg subcutaneously, is prescribed for a client postoperatively. The medication label reads "1/15 grains/mL." How many milliliters should the nurse administer? Round answer to the nearest tenth position. - ANS; Answer: 0.6 Rationale: Convert grains (gr) to milligrams (mg) and then use the medication calculation formula. Penicillin V potassium 250 mg orally every 8 hours is prescribed for a child with a respiratory infection. The medication label reads: Penicillin, 125 mg per 5 mL. The nurse has determined that the dosage prescribed is a safe dose for the child. How many milliliters (mL) will the nurse administer to the child per dose? - ANS; Answer: 10 Rationale: Use the formula for calculating the appropriate medication dose. A health care provider has prescribed phenobarbital sodium (Luminal Sodium), 25 mg orally twice daily for a child with febrile seizures. The child's weight is 7.2 kg. The safe pediatric dosage is 1 to 6 mg/kg/day. The nurse determines that: - ANS; 1. The dosage is too low.
5. The dosage is too high.
6. The dosage is within the safe range.
7. There is not enough information to determine the safe dosage. Answer: 2 Rationale: Calculate the dosage parameters, using the safe dosage range identified in the question and the child's weight in kilograms. Next determine the total daily dosage. Dosage parameters: 1 mg/kg/day × 7.2 kg = 7.2 mg/day 6 mg/ kg/day × 7.2 kg = 43.2 mg/day Dosage frequency: 25 mg × 2 doses = 50 mg/day The dosage is too high. Diphenhydramine hydrochloride (Benadryl) 25 mg orally every 6 hours is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse determines that: - ANS; 1. The dosage is too low.