Another nurse on the unit meets you as you leave the medication room and states ' really need to go to break now or I will not get one, can you administer this morphine that I have ready for you?" The nurse hands you an empty vial of morphine and a syringe containing 2 mL of clear fluid. What is your best response?

"I know it is really busy but I do not have time to help you either. I have my own clients."

"Are you sure the doctor ordered that much morphine? It seems like a lot to give all at once.":

"I can give your client their pain medications, but I need to draw up and prepare it myself."

"Sure thing, give me that syringe and I will give it for you while you are on break.":

Answer and Explanation

The Correct Answer is C

A) "I know it is really busy but I do not have time to help you either. I have my own clients.": While it may be tempting to express frustration due to being busy, this response lacks professionalism and does not address the situation appropriately. As healthcare professionals, it is important to communicate effectively and collaborate with colleagues to ensure safe patient care, even when busy. Instead, the nurse should express the need to follow protocols while offering help in a safe manner.

B) "Are you sure the doctor ordered that much morphine? It seems like a lot to give all at once.": Although questioning the dosage is part of safe nursing practice, this response is unnecessary in this situation. If there is a concern about the prescribed amount of morphine, it should be verified with the healthcare provider. However, this question does not directly address the issue of administering the medication safely. It also does not ensure that the nurse is following correct protocols for preparing and administering medication.

C) "I can give your client their pain medications, but I need to draw up and prepare it myself.": This response is the most appropriate because it ensures the nurse is adhering to safe medication administration practices. The nurse should always prepare and administer medications themselves to verify the correct dosage, route, and patient. Allowing another nurse to prepare medication and administering it without proper verification can lead to medication errors. This response also shows willingness to help while maintaining safety standards.

D) "Sure thing, give me that syringe and I will give it for you while you are on break.": This response is inappropriate because it involves accepting medication from another nurse without verifying that the correct drug, dose, and preparation have been followed. It is unsafe to administer medications prepared by others without reviewing the medication and ensuring that everything is accurate. Nurses must always prepare and administer their own medications to prevent potential medication errors.

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Correct Answer is ["12"]

Explanation

1. Convert the child's weight from pounds to kilograms:

There are approximately 2.2 pounds in 1 kilogram.

33 pounds / 2.2 pounds/kg = 15 kg (approximately)

2. Calculate the total milligrams of amoxicillin needed per dose:

The order is for 20 mg/kg/dose.

The child weighs 15 kg.

20 mg/kg * 15 kg = 300 mg

3. Determine the concentration of the amoxicillin suspension:

The label shows the concentration is 125 mg/5 mL.

4. Set up a proportion to find the volume (in mL) needed:

125 mg / 5 mL = 300 mg / x mL

5. Solve for x:

Cross-multiply: 125x = 300 * 5

125x = 1500

x = 1500 / 125

x = 12 mL

Answer: You will administer 12 mL per dose.

A. The client will remain free from visible bleeding, bruising, and signs of internal bleeding (tachycardia and hypotension) during this shift. B. The client will verbalize understanding of dietary restrictions while on warfarin and provide examples of foods that contain vitamin K during this shift C. The client will state their pain level is less than 4 on a 0-10 pain scale during aspirin therapy. D. The client will remain free from any signs and symptoms of deep vein thrombosis,

Correct Answer is A

Explanation

A) The client will remain free from visible bleeding, bruising, and signs of internal bleeding (tachycardia and hypotension) during this shift: This is the most appropriate outcome for the "Risk for bleeding" nursing diagnosis. Since both aspirin and warfarin are anticoagulants, they increase the client's risk of bleeding. The priority is to monitor for and prevent any signs of visible bleeding, bruising, or more serious internal bleeding, which could manifest as tachycardia or hypotension. This outcome directly addresses the client's safety by focusing on detecting and preventing bleeding complications.

B) The client will verbalize understanding of dietary restrictions while on warfarin and provide examples of foods that contain vitamin K during this shift: While this is an important goal for clients on warfarin (because vitamin K can interfere with the effectiveness of warfarin), it is not the most immediate concern in the context of the "Risk for bleeding" diagnosis. Dietary restrictions should be discussed but are not as time-sensitive or directly related to the prevention of bleeding in the short term, especially during this shift.

C) The client will state their pain level is less than 4 on a 0-10 pain scale during aspirin therapy: While managing pain is important, this outcome does not directly address the risk for bleeding associated with both aspirin and warfarin therapy. The priority nursing concern here is preventing bleeding, not pain management during aspirin therapy.

D) The client will remain free from any signs and symptoms of deep vein thrombosis (DVT): While preventing DVT is important for patients on anticoagulant therapy, the focus of this nursing diagnosis is on the risk of bleeding, not thrombosis. Therefore, this outcome is not as relevant to the immediate concerns related to the prescribed medications (aspirin and warfarin).

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The order reads "amoxicillin 20mg/kg/dose PO every 8 hours." The child weighs 33 pounds. Using the label below, how many mL will you administer per dose? (Enter a number only, answer to the nearest tenths place)

Correct Answer is ["12"]

Explanation

The client is prescribed aspirin and warfarin. Based on side effects of both medications, the nurse identifies "Risk for bleeding" as a nursing diagnosis for this client. What outcome is appropriate for this nursing diagnosis?

Correct Answer is A

Explanation

A client is prescribed propranolol a systemically acting ophthalmic drop. What additional step must be included in the administration process?

The prescription reads for diphenhydramine 10 mg PO every 4-6 hours as needed for runny nose and allergy symptoms. Using the label below, how many mL will the nurse teach the parent to administer? Enter a numeric value only. Answer to the nearest whole mL

The client is ordered to receive 40 mg of atorvastatin PO daily. In the medication cabinet, you find 10 mg tablets. How many tablets will you administer to the client? (Enter a numerical value only)

The nurse is providing discharge instructions to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medications while breast feeding?

The nurse is caring for client with liver failure admitted with hepatic encephalopathy, Lactulose is ordered Q2 hours. What assessment finding should the nurse use to best evaluate therapeutic response of the medication?

A nurse assesses the client and determines the client is at risk for infection. Which activity best reflects the planning phase of the nursing process?

A client with active GERD presents to clinic. Which statement by the client indicates they need additional education?

A client is to be started on a heparin intravenous infusion at 2,000 units per hour. On hand is an IV bag labeled 25,000 units/ 250 mL. At what rate (mL/hour) will the nurse set the pump? (Answer to the nearest whole number)