A nurse is caring for a patient who is receiving DSW with 20 mEq of KCL at 75 mL/hr. The provider has prescribed 1 g of ceftriaxone IV. When preparing to administer this medication by IV piggyback, which of the following data is the highest priority for the nurse to consider before administration?
The patient's vital signs<br>
The medication's compatibility with the primary IV solution
The patient's level of consciousness
The amount of IV solution in the primary bag
The Correct Answer is B
B. This is the highest priority. Before administering ceftriaxone via IV piggyback, the nurse must ensure compatibility with the primary IV solution (D5W with KCl). Certain medications can interact chemically or physically with other IV solutions or medications, leading to precipitation, inactivation, or other adverse effects. Compatibility should be verified through appropriate resources or pharmacy guidelines.
A. Vital signs provide crucial information about the patient's overall condition, but they do not directly impact the administration of the IV medication ceftriaxone. However, if there are significant changes in vital signs (e.g., fever, hypotension), these could influence the decision to administer ceftriaxone or any medication.
C. Important, but not directly related to medication administration. The patient's level of consciousness is crucial for assessing their neurological status and response to treatment, but it does not affect the administration of ceftriaxone IV piggyback specifically.
D. Important, but not the highest priority in this context. Monitoring the amount of IV solution in the primary bag is essential to ensure continuous fluid delivery and prevent interruptions in therapy.
However, for the immediate preparation and administration of ceftriaxone IV piggyback, ensuring compatibility with the primary IV solution takes precedence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["D","E"]
Explanation
D. Persistent headache can occur with elevated levels of gentamicin, as it may indicate neurotoxicity. Gentamicin can cause neurotoxic effects, including headaches, especially when levels are elevated.
E. Tinnitus (ringing in the ears) is a classic symptom of gentamicin toxicity. Elevated gentamicin levels can lead to ototoxicity, which manifests as tinnitus among other auditory symptoms.
A. Insomnia is not typically associated with elevated levels of gentamicin. Elevated gentamicin levels are not known to cause insomnia.
B. Constipation is not typically associated with elevated levels of gentamicin. Elevated gentamicin levels are not known to cause constipation.
C. Xerostomia (dry mouth) is not typically associated with elevated levels of gentamicin. Elevated gentamicin levels are not known to cause xerostomia.
Correct Answer is B
Explanation
B When drawing medication from an ampule, especially if it's a solution that may contain particulate matter or to ensure sterility, using a filter needle is recommended. A filter needle has a membrane filter that prevents particles from being drawn into the syringe while allowing the medication to pass through.
A. Shaking a glass ampule is not recommended because it can lead to the introduction of glass particles or cause the solution to foam or become contaminated. Instead, gently flicking the ampule with a finger can help move any solution that may be adhering to the neck downward, but shaking should be avoided.
C. While wearing gloves is important for infection control, sterile gloves are not typically required for withdrawing medication from a single-dose glass ampule. Standard aseptic technique and hand hygiene are usually sufficient.
D. Ampules are designed to be opened by snapping the top away from the body to avoid potential injury from glass shards. The nurse should use a gauze pad or an ampule opener to break the ampule open safely, directing any breakage away from themselves and others.
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