Medication Administration and Blood Transfusion Practices, Exams of Nursing

Download Medication Administration and Blood Transfusion Practices and more Exams Nursing in PDF only on Docsity! NCLEX PHARMACOLOGY EXAM 2025 LATEST TEST WITH COMPLETE QUESTIONS AND CORRECT ANSWERS RATED A+ A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting? a. A small catheter to decrease patient discomfort b. The type of IV device the patient has had in the past, which worked well c. A large bore catheter d. The type of device the physician prefers Correct Answer C. Large bore catheters prevent damage to blood components and are less likely to develop clotting problems than a small bore catheter. The nurse should determine the correct device without asking the patient what type has been used before or asking the physician which type he prefers and start the IV. Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50 milliliter vial with a concentration of 25 percent. What dosage will the nurse administer? a. The nurse should use the entire 50 milliliter vial. b. The nurse should determine the volume to administer from the physician. c. This concentration of product should not be used. d. The nurse will administer 4 milliliters. Correct Answer D. A 25 percent solution contains one quarter of a gram per milliliter. Thus, the nurse will administer 4 milliliters to provide a complete gram of albumin. The volume in option 1 would provide 12.5 grams of albumin. The nurse should determine the volume. It is unnecessary to seek the answer from the physician. A 25 percent solution is an acceptable product and can safely be used. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration? a. CVADs are less expensive than a peripheral IV. b. Once a week administration is possible. c. Caustic agents in small veins can be avoided. d. The patient or his family can administer the drug at home. Correct Answer C. Many chemotherapeutic drugs are vesicants (highly active corrosive materials that can produce tissue damage even in low concentrations). Extravasations of a vesicant can result in significant tissue necrosis. Administration into a large vein is optimal. CVADs are more expensive than a peripheral IV. Dosing depends on the drug. IV chemotherapeutic agents are not administered at home. They are given in an outpatient or clinic setting if not given during hospitalization. A female patient's central venous access device (CVAD) becomes infected. Why would the physician order antibiotics to be given through the line rather than through a peripheral IV line? a. To prevent infiltration of the peripheral line b. To reduce the pain and discomfort associated with antibiotic administration in a small vein c. To lessen the chance of an allergic reaction to the antibiotic d. To attempt to sterilize the catheter and prevent having to remove it Correct Answer D. Microorganisms that infect CVADs are often coagulase-negative staphylococci, which can be eliminated by antibiotic administration through the catheter. If unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use lessens the need for peripheral IV lines and, thus, the risk of infiltration. In this case however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use has this effect, but in this case, the antibiotics are given through essential fatty acids. It is recommended that approximately 4 percent of daily calories be EFAs. A deficiency can quickly develop. Daily essential fatty acids are necessary for constant prostaglandin production. Lipids are almost isotonic with blood. A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, "at least the doctor won't be wearing surgical garb, will he?" How will the nurse answer the patient? a. "You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire." b. "To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves." c. "It depends on the doctor's preference." d. "Most doctors only wear sterile gloves, not a cap, mask, or sterile gown." Correct Answer C. Strict aseptic technique including the use of cap, mask, and sterile gown and gloves is require when placing a central venous line including a PICC. Options A, B, and D are incorrect statements. They increase the risk of infection. A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? a. "You will have general anesthesia so you won't feel anything." b. "It will be inserted rapidly, and any discomfort is fleeting." c. "The insertion site will be anesthetized. Threading the catheter through the vein is not painful." d. "You will receive sedation prior to the procedure." Correct Answer C. Pain related to PICC insertion occurs with puncture of the skin. When inserting PICC lines, the insertion site is anesthetized so no pain is felt. The patient will not receive general anesthesia or sedation. Statement 2 is false. Unnecessary pain should be prevented. What volume of air can safely be infused into a patient with a central venous access device (CVAD)? a. It is dependent on the patient's weight and height. b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. c. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. d. None. Correct Answer B. Any air entering the right heart can lead to a pulmonary embolus. All air should be purged from central venous lines none should enter the patient. Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse: a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer. b. Portacath devices are not used to obtain blood samples because of the risk of clot formation. c. The vacutainer will be attached to the portacath needle to obtain a direct sample. d. Any needle and syringe may be utilized to obtain the sample. Correct Answer A. A special portacath needle is used to access the portacath device. A syringe is attached and the sample is obtained. One of the primary reasons for insertion of a portacath device is the need for frequent or long-term blood sampling. A vacutainer will exert too much suction on the central line resulting in collapse of the line. Only special portacath needles should be used to access the portacath device. What is the purpose of "tunneling" (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling: a. Increases the patient's comfort level. b. Decreases the risk of infection. c. Prevents the patient's clothes from having contact with the catheter d. Makes the catheter less visible to other people. Correct Answer B. The actual access to the subclavian vein is still just under the clavicle, but by tunneling the distal portion of the catheter several inches under the skin the risk of migratory infection is reduces compared to a catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent infection. The primary complication of a central venous access device (CVAD) is: a. Thrombus formation in the vein. b. Pain and discomfort. c. Infection. d. Occlusion of the catheter as the result of an intra-lumen clot. Correct Answer C. A foreign body in a blood vessel increases the risk of infection. Catheters that come outside the body have an even higher risk of infection. Most infections are caused by skin bacteria. Other infective organisms include yeasts and fungi. Options 1 and 4 are complications of a CVAD but are not the primary problem. Once placed, these lines do not cause pain and discomfort. Nurse Blessy is doing some patient education related to a patient's central venous access device. Which of the following statements will the nurse make to the patient? a. "These type of devices are essentially risk free." b. "These devices seldom work for more than a week or two necessitating replacement." c. "The dressing should only the changed by your doctor." d. "Heparin in instilled into the lumen of the catheter to decrease the risk of clotting." Correct Answer D. A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin used depends on the patient's age, comorbidities, and the frequency of catheter access/flushing. Glucagon is a pancreatic alpha cell hormone, which cause glycogenolysis and gluconeogenesis. Fenofibrate (Tricor) is an antihyperlipidemic agent that lowers plasma triglycerides. Lamotrigine (Lamictal) is an anticonvulsant. Estrogen antagonists are used to treat estrogen hormone- dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be: a. Prostate cancer. b. Thyroid cancer. c. Renal carcinoma. d. neuroblastoma. Correct Answer A. Prostate tissue is stimulated by androgens and suppressed by estrogens. Androgen antagonists will block testosterone stimulation of prostate carcinoma cells. The types of cancer in options 2-4 are not androgen dependent. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of the following products? a. Eggs b. Shellfish c. Soy d. acidic fruits Correct Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish also contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These products do not contain iodine. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? a. Hepatitis B b. inactivated polio c. diphtheria, acellular pertussis, tetanus (DTaP) d. mumps, measles, rubella (MMR) Correct Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options a,b and c do not contain egg protein. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by: a. immunoglobulin E (IgE). b. immunoglobulin G (IgG). c. immunoglobulin A (IgA). d. immunoglobulin M (IgM). Correct Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms. Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract: a. Human immunodeficiency disease (HIV). b. Hepatitis C infection. c. Hepatitis B infection. d. West Nile viral disease. Correct Answer C. Hepatitis B is the most common infection spread via blood transfusion. Donors are screened by a questionnaire that includes symptoms. The donated blood is also tested for infection. The risk of infection with the agents in options 2 and 3 has decreased to approximately 1 in 2 million secondary to donor questioning and donor blood testing. The incidence of West Nile viral transmission is unknown, but donor infection is still relatively rare. A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that: a. This donor blood is incompatible with the patient's blood. b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects. c. This is a compatible match. d. The patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood. Correct Answer C. Type O, Rh negative blood has none of the major antigens and is safely administered to patients of all blood types. It is also known as the universal donor. Premedicating with these agents will not prevent a major d. Rescue therapy. Correct Answer B. Leucovorin is used to save or "rescue" normal cells from the damaging effects of chemotherapy allowing them to survive while the cancer cells die. Therapy to rapidly reduce the number of cancerous cells is the induction phase. Consolidation therapy seeks to complete or extend the initial remission and often uses a different combination of drugs than that used for induction. Chemotherapy is often administered in intermittent courses called pulse therapy. Pulse therapy allows the bone marrow to recover function before another course of chemotherapy is given. A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: a. Myelosuppression. b. Gout and hyperuricemia. c. Pancytopenia. d. Cancer cell growth and replication Correct Answer B. Prevent uric acid nephropathy, uric acid lithiasis, and gout during cancer therapy since chemotherapy causes the rapid destruction of cancer cells leading to excessive purine catabolism and uric acid formation. Allopurinol can induce myelosuppression and pancytopenia. Allopurinol does not have this function. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: a. Intraventricular administration. b. Intravesical administration. c. Intravascular administration. d. Intrathecal administration. Correct Answer B. Medications administered intravesically are instilled into the bladder. Intraventricular administration involves the ventricles of the brain. Intravascular administration involves blood vessels. Intrathecal administration involves the fluid surrounding the brain and spinal cord. The most common dose-limiting toxicity of chemotherapy is: a. Nausea and vomiting. b. Bloody stools. c. Myelosuppression. d. Inability to ingest food orally due to stomatitis and mucositis. Correct Answer C. The overall goal of cancer chemotherapy is to give a dose large enough to be lethal to the cancer cells, but small enough to be tolerable for normal cells. Unfortunately, some normal cells are affected including the bone marrow. Myelosuppression limits the body's ability to prevent and fight infection, produce platelets for clotting, and manufacture red blood cells for oxygen portage. Even though the effects in options a, b, and d are uncomfortable and distressing to the patient, they do not have the potential for lethal outcomes that myelosuppression has. Chemotherapy induces vomiting by: a. Stimulating neuroreceptors in the medulla. b. Inhibiting the release of catecholamines. c. Autonomic instability. d. Irritating the gastric mucosa. Correct Answer A. Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that lead to expulsion of gastric contents. Catecholamine inhibition does not induce vomiting. Chemotherapy does not induce vomiting from autonomic instability. Chemotherapy, especially oral agents, may have an irritating effect on the gastric mucosa, which could result in afferent messages to the solitary tract nucleus, but these pathways do not project to the vomiting center. Myeloablation using chemotherapeutic agents is useful in cancer treatment because: a. It destroys the myelocytes (muscle cells). b. It reduces the size of the cancer tumor. c. After surgery, it reduces the amount of chemotherapy needed. d. It destroys the bone marrow prior to transplant. Correct Answer A. Myelo comes from the Greek word myelos, which means marrow. Ablation comes from the Latin word ablatio, which means removal. Thus, myeloablative chemotherapeurtic agents destroy the bone marrow. This procedure destroys normal bone marrow as well as the cancerous marrow. The patient's bone marrow will be replaced with a bone marrow transplant. Myelocytes are not muscle cells Tumors are solid masses typically located in organs. Surgery may be performed to reduce tumor burden and require less chemotherapy afterward. Medications bound to protein have the following effect: a. Enhancement of drug availability. b. Rapid distribution of the drug to receptor sites. c. The more drug bound to protein, the less available for desired effect. d. Increased metabolism of the drug by the liver. Correct Answer C. Only an unbound drug can be distributed to active receptor sites. Therefore, the more of a drug that is bound to protein, the less it is available for the desired drug effect. Less drug is available if bound to protein. Distribution to receptor sites is irrelevant since the drug bound to protein cannot bind with a receptor site. Metabolism would not be increased. The liver will first have to remove the drug from the protein molecule before metabolism can occur. The protein is then free to return to circulation and be used again. The nursery nurse is putting erythromycin ointment in the newborn's eyes to prevent infection. She places it in the following area of the eye: d. Phenytoin (Dilantin), 100 mg TID Correct Answer B. Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti- seizure drugs. Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to a. give her the next ordered dose of MS. b. give her a back rub, put on some light music, and dim the lights in the room. c. report your findings to the RN, requesting an alternate medication order be obtained from the physician. d. call her daughter to come and sit with her. Correct Answer C. Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified. When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as: a. Roquefort, cheddar, or Camembert cheese. b. grape juice, orange juice, or raisins. c. onions, garlic, or scallions. d. ground beef, turkey, or pork. Correct Answer A. Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid the other foods are not. The physician orders an intramuscular injection of Demerol for the postoperativepatient's pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled a. simethicone. b. albuterol. c. meperidine. d. ibuprofen. Correct Answer C. The generic name for Demerol is meperidine. The nurse is administering an antibiotic to her pediatric patient. She checks the patient's armband and verifies the correct medication by checking the physician's order, medication kardex, and vial. Which of the following is not considered one of the five "rights" of drug administration? a. Right dose b. Right route c. Right frequency d. Right time Correct Answer C. The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included. A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should: a. draw up and administer the dose b. shake the vial in an attempt to disperse the clumps c. draw the dose from a new vial d. warm the bottle under running water to dissolve the clump Correct Answer C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication? a. take the medication on an empty stomach b. take the medication with an antacid c. avoid exposure to sunlight d. limit alcohol to 2 ounces per day Correct Answer C. The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is 1) only the nurse's—she should have checked the allergies before administering the medication. 2) only the physician's—she gave the order, the nurse is obligated to follow it. 3) only the pharmacist's—he should alert the floor to possible allergic reactions. 4) the pharmacist, physician, and nurse are all liable for the mistake. Correct Answer The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors. The nurse is administering Augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient?