TEST BANK for Henke's Med-Math _ Dosage Calculation, Preparation, & Administration 9th Edition. ISBN

Henkes Med-math Dosage Calculation Preparation And Administration 9th Edition Buchholz Test Bank Chapter 1, Arithmetic Needed for Dosage Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Page and Header: 2, Dividing Whole Numbers; 3, Fractions Integrated Process: Teaching/Learning Objective: 1, 2 1.

A patient/client was instructed to drink 25 oz of water within 2 hours but was

only able to drink 15 oz. What portion of the water remained?

A)

2/5

B)

3/5

C)

2/25

D)

25/25

Ans: A Feedback: Subtract the quantity of water the client drank (15 oz) from the total available quantity (25 oz): 10 oz remain. To determine the portion of the water that remains, create a fraction by dividing 10 oz (remaining portion) by 25 oz (total portion). Therefore, 10 divided by 25 = 10/25. To reduce fractions, find the largest number that can be divided evenly into the numerator and the denominator (5). Ten divided by 5 (10/5) = 2; 25/5 = 5. The fraction 10/25 can be reduced to its lowest terms of 2/5.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Page and Header: 2, Dividing Whole Numbers; 3, Fractions

Integrated Process: Teaching/Learning Objective: 1, 2 2.

A patient/client was prescribed 240 mL of Ensure by mouth as a supplement

but consumed only 100 mL. What portion of the Ensure remained?

A)

5/12

B)

7/12

C)

100/240

D)

240/240

Ans: B Feedback: Subtract the quantity of Ensure the client consumed (100 mL) from the total available quantity (240 mL): 140 mL remain. To determine the portion of the Ensure that remains, create a fraction by dividing 140 mL (remaining portion) by 240 mL (total portion). Therefore, 140 divided by 240 = 7/12. To reduce fractions, find the largest number that can be divided evenly into the numerator and the denominator (20); 140 divided by 20 (140/20) = 7; 240/20 = 12. The fraction 140/240 can be reduced to its lowest terms of 7/12.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Difficulty: Difficult Page and Header: 2, Multiplying Whole Numbers; 3, Fractions Integrated Process: Communication and Documentation Objective: 1, 2 3.

1

A patient/client consumed 2 4 oz. of coffee, 2/3 oz. of ice cream, and 1

of beef broth. What is the total number of ounces consumed that should be documented for the patient/client?

A)

3 3/4

B)

4 5/12

C)

4 2/3

D)

4 4/9

1

2

oz.

Ans: B Feedback: Add the amount of ounces consumed. First, change any mixed number to a fraction by multiplying the whole number by the denominator and then adding that total to the numerator. For the coffee, 4

2 = 8 + 1 = 9/4; for the beef broth, 2

1

= 2 + 1 = 3/2. Then add: 9/4 + 2/3 (ice cream) + 3/2. When fractions have different denominators, find the least common denominator (LCD). For 2, 3, and 4, the LCD = 12. Rewrite each fraction using the LCD; divide the LCD by the denominator of each fraction and then multiply that result by the numerator of the fraction. The new fractions to be added are 27/12 (coffee), 8/12 (ice cream), and 18/12 (beef broth).

After conversion of the fractions, the numerators are added together and the fraction is reduced to the lowest terms.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Difficulty: Difficult Page and Header: 2, Multiplying Whole Numbers; 3, Fractions Integrated Process: Communication and Documentation Objective: 1, 2 4.

A coffee cup holds 180 mL. The patient/client drank 2⅓ cups of coffee. How

many milliliters would the nurse document as consumed?

A)

360

B)

420

C)

510

D)

600

Ans: B Feedback: The coffee cup holds 180 mL. The client drank 2⅓ cups. To estimate the total number of milliliters consumed, multiply 180

7/3 (2⅓). When a mixed number

is present, change it to an improper fraction by multiplying the whole number by the denominator and then adding that total to the numerator: 2

3 = 6 + 1 = 7/3.

Therefore, 180 mL × 7/3 = 420 mL (180 ÷ 3 = 60 × 7 = 420).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals Integrated Process: Nursing Process Objective: 3, 5 5.

A patient/client weighed 48.52 kg on admission and now weighs 50.4 kg. How

many kilograms were gained since admission?

A)

0.78

B)

0.88

C)

1.88

D)

1.98

Ans: C

ToEuSnTt BoA Feedback: To estimate the am f kNilKoS grEaL mLsEgRa. inCeO dM , subtract weight on admission (48.52) from current weight (50.4 kg) = 1.88 kg (weight gained). To subtract decimals, decimals are stacked lined up. Starting at the far right of the stack, the numbers are subtracted. In the answer, make sure the decimal point lines up exactly with the points above it.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals Integrated Process: Teaching/Learning Objective: 3, 5, 6 6.

A patient/client's sodium intake for one meal was 0.004 g and 0.152 g. How

many grams, to the nearest hundredths, of sodium were consumed?

A)

0.15

B)

0.156

C)

0.16

D)

0.166

Ans: C Feedback: To add decimals, stack vertically, making sure that all of the decimal points exactly line up. Starting at the far right of the stack, add each vertical column of numbers. In the answer, make sure the decimal point lines up exactly with the points above it. To round off a decimal, the final number is dropped. Add 0.004 g + 0.152 g = 0.156 g (thousandths place) to determine the total number of grams the client consumed. When the final number (6) is 5 or greater, drop that number and increase the adjacent number (5) by 1. When you want a number rounded off to the nearest hundredth, look at the number in the thousandth place and follow the rounding off rule. Therefore, 0.156 = 0.16 g.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals; 15, Percents; 19, Fractions, Ratio, and Proportion.

Integrated Process: Teaching/Learning Objective: 5, 7, 8 7.

A patient/client reports drinking 30% of a 16-oz bottle of orange juice. How

many ounces did the patient/client drink?

A)

0.18

B)

3.2

C)

4.8

D)

5.3

Ans: C Feedback: Percent means "parts per hundred." Percent is a fraction, containing a variable numerator and a denominator that always equals 100. Therefore, 30% =

30/100 (fraction), 30:100 (ratio), and 0.3 (decimal). To determine the percent of the orange juice the client drank, multiply 30%

16 oz. Using the decimal format (0.3

16), line up the numbers on the right. Do not align the decimal points. Starting at the right, multiply each digit in the top number by each digit in the bottom number, just as is done with whole numbers. Add the products. Place the decimal point in the answer by starting at the right and moving the point the same number of places that you totaled earlier. When blank spaces are present, fill each one with a zero. The answer is 4.8 oz (0.3

16).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals; 15, Percents; 19, Fractions, Ratio, and Proportion.

Integrated Process: Communication and Documentation Objective: 5, 7, 8 8.

A patient/client reports drinking 45% of a 12-oz can of soda. How many ounces

are documented?

A)

4.4

B)

5.7

C)

5.4

D)

4.7

Ans: C Feedback: Percent means "parts per hundred." Percent is a fraction, containing a variable numerator and a denominator that always equals 100. Therefore, 45% = 45/100 (fraction), 45:100 (ratio), and 0.45 (decimal). To determine the percent of the soda that the client drank, multiply 45%

12 oz. Using the decimal format (0.45

12), line up the numbers on the right. Do not align the decimal points. Starting at the right, multiply each digit in the top number by each digit in the bottom number, just as is done with whole numbers. Add the products. Place the decimal point in the answer by starting at the right and moving the point the same number of places that

you totaled earlier. When blank spaces are present, fill each one with a zero. The answer is 5.4 oz (0.45

12).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 3, Fractions Integrated Process: Teaching/Learning Objective: 1 9.

A patient/client is on a 1200 mL fluid restriction for 24 hours. At breakfast and

lunch, the patient/client consumed 3/5 of the fluid allowance. How many milliliters were consumed?

A)

280

B)

360

C)

540

D)

720

Ans: D Feedback: To estimate 3/5 of 1200 mL, set up the fraction: 3/5 × 1200/1 = 3600/5 = 720 mL. Multiply the numerators across and then multiply the denominators across.

Reduce the answer to its lowest terms.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Page and Header: 3, Fractions Integrated Process: Communication and Documentation Objective: 1

10.

A patient/client is on a 1500 mL fluid restriction for 24 hours. At 3 PM, the client

consumed 2/3 of the fluid allowance for 24 hours. What are the maximum milliliters of fluid remaining that the patient/client can consume during the evening shift?

A)

400

B)

450

C)

500

D)

550

Ans: C Feedback: To estimate 2/3 of 1500 mL, multiply 2/3 × 1500. Set up the fraction: 2/3 1500/1 = 3000/3 = 1000 mL (amount of fluid consumed in milliliters). Multiply the fraction by multiplying the numerators across and then multiplying denominators across. Reduce the answer to its lowest terms. To determine the amount of fluid left to be consumed, subtract 1000 (amount of fluid consumed) from 1500 mL (total amount of fluid for 24 hours), which equals 500 mL (maximum fluid to be administered during evening shift).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 3, Fractions; 10, Decimals Integrated Process: Teaching/Learning Objective: 1, 5 11.

A patient/client drank 0.375 mL of a medication that was available as 0.75 mL.

List the amount of medication consumed as a fraction of the whole.

A)

1/5

B)

1/4

C)

1/3

D)

1/2

Ans: D

Feedback: The patient/client consumed 0.375 mL of 0.75 mL of a medication. To estimate the amount consumed, as a fraction of the whole, set up the problem as division: 0.375/0.750. Clear the decimal points in both the numerator and the denominator by moving each decimal point three places to the right. Therefore, 375/750 = 0.5 (or 1/2).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals Integrated Process: Teaching/Learning Objective: 3 12.

A laboratory report listed the following four results: bilirubin (0.2), creatinine

(1.46), creatinine (0.09), and albumin (0.75). Identify the smallest amount.

A)

0.2

B)

1.46

C)

0.09

D)

0.75

Ans: C Feedback: The correct order from smallest to largest is 0.09, 0.2, 0.75, and 1.46. Size is determined by the number of places that come after the decimal point. One place is “tenths,” two places is “hundredths,” and three places is “thousandths.” Therefore, 0.09, read as nine hundredths, is smaller than two tenths, seventy-five hundredths, and one and forty-six hundredths.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate

Page and Header: 10, Decimals Integrated Process: Teaching/Learning Objective: 3 13.

The laboratory report included these four numbers: 0.355, 0.3, 0.03, and

0.035. Which decimal is the largest?

A)

0.3

B)

0.03

C)

0.035

D)

0.355

Ans: A Feedback: The correct sequence from smallest to largest is 0.355, 0.035, 0.03, and 0.3. Size is determined by the number of places that come after the decimal point.

One place is “tenths,” two places is “hundredths,” and three places is “thousandths.”

Therefore, three tenths is larger than three hundredths, thirty-five thousandths, and three hundred and fifty-five thousandths.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 10, Decimals; 15, Percents Integrated Process: Teaching/Learning Objective: 4, 5, 6, 7 14.

A patient/client's oral ibuprofen suspension dose contains 325 mg per

teaspoon. A dose of 100 mg represents what percentage of this dosage?

A)

29.7

B)

30.8

C)

31.7

D)

32.8

Ans: B

Feedback: To estimate what percent 100 mg represents of 325 mg, divide 100/325.

To change a fraction into a decimal, divide the numerator by the denominator. Add decimal points in the dividend and quotient as needed: 100/325 = 20/65 = 0.3076.

Carry out to the thousandths place. To round off a decimal, the final number is dropped. When the final number is 5 or greater, drop the number and increase the adjacent number by 1. Therefore, 0.3076 = 0.308. Next, change a decimal to a percent by moving the decimal point two places to the right, then write the percent sign: 0.308 = 30.8%.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 10, Decimals; 15, Percents Integrated Process: Teaching/Learning Objective: 3, 4, 6, 7 15.

A patient/client's medication contains 650 mg per ounce. What percentage of

this dosage does 375 mg represent?

A)

56.7

B)

57.7

C)

59.8

D)

60.6

Ans: B Feedback: To estimate what percent 375 mg represents of 650 mg, divide 375/650.

To change a fraction into a decimal, divide the numerator by the denominator. Add decimal points in the dividend and quotient as needed: 375/650 = 15/26 = 0.5769.

Carry out to the thousandths place. To round off a decimal, the final number is dropped. When the final number is 5 or greater, drop the number and increase the adjacent number by 1. Therefore, 0.5769 = 0.577. Next, change a decimal to a percent by moving the decimal point two places to the right, then write the percent sign: 0.577 = 57.7%.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 5, 8 16.

The physician prescribed 7.5 mg of a medication that is available in 5-mg

tablets. How many tablets would the nurse administer?

A)

1

2

B) 1 C) 1

1

2

D) 2

Ans: C Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 tablet : 5 mg :: x tablets : 7.5 mg; 5x = 7.5 mg/5 mg = 1.5 tablets. Proportion (Fractions): 1 tablet/5 mg = x tablets/7.5 mg; 5x = 7.5 mg/5 mg = 1.5 tablets.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 3, 8

17.

The physician prescribed 5000 units of a medication that is available in 10,000

units per milliliter. How many milliliters would the nurse administer?

A)

0.5 mL

B)

1 mL

C)

1.5 mL

D)

2 mL

Ans: A Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 mL : 10,000 units :: x mL : 5000 units; 10,000x = 5000/10,000 = 0.5 mL. Proportion (Fractions): 1 mL/10,000 units = x/5000 units. 10,000x = 5000/10,000 = 0.5 mL. Format: Multiple Choice Chapter: 1

LaLcEoR Client Needs: Physiological ITnE teSgT riB tyA:NPKhS arEm lo. gC icO alMand Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Page and Header: 3, Fractions; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 1, 8 18.

The physician prescribed 20 mg of a medication that is available 10 mg per 15

milliliters. How many milliliters would the nurse administer?

A)

10

B)

15

C)

20

D)

30

Ans: D Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 15 mL : 10 mg :: x mL : 20 mg; 10x = 300/10 = 30 mL. Proportion (Fractions): 15 mL/10 mg = x mL/20 mg; 10x = 300/10 = 30 mL. Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 3, Fractions; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 1, 8 19.

The physician prescribed 50 mg of a medication that is available as 80 mg per

milliliter. How many milliliters would the nurse administer?

A)

0.16

B)

0.6

C)

1.6

D)

16

Ans: B Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 mL : 80 mg :: x mL : 50 mg; 80x = 50/80 = 5/8 = 0.625 mL. Round off to the nearest tenths: 0.625 mL = 0.6 mL. Proportion (Fractions): 1 mL/80 mg = x mL/50 mg; 80x = 50/80 = 5/8 = 0.625 mL = 0.6 mL. Note: 0.625 mL carried out to the hundredths = 0.63 mL; carried out to tenths = 0.6 mL. Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 3, Fractions; 10, Decimals; 19, Fractions, Ratio, and Proportion

Integrated Process: Nursing Process Objective: 1, 2, 8 20.

The physician prescribed 0.25 g of a medication that is available in 0.5-g

tablets. How many tablets would the nurse give?

A)

1

2

B) 1 1

C) 1

2

D) 2

Ans: A Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 tablet : 0.5 g :: x tablet : 0.25 g; 0.5x = 0.25/0.5 =

1

Proportion (Fractions): 1 tablet/0.5 g = x tablet/0.5 g; 0.5x = 0.25/0.5 =

1

2

tablet.

2

tablet.

(Note: Clear the decimal points before the final division).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Page and Header: 3, Fractions; 10, Decimals; 15, Percents Integrated Process: Nursing Process Objective: 4, 5, 6, 7 21.

A nurse measured the circumference of an edematous leg and documented

“15.5 inches at mid-calf, left leg” on the client's electronic medical record. For comparison, she measured the right calf and documented “12 inches at mid-calf, right leg.” The left calf is what percent larger than the right calf?

A)

20

B)

22

C)

23

D)

25

Ans: C Feedback: This is a multiple-step problem. To estimate the difference between the measurements of the left calf compared to the right calf, subtract 12 inches from 15.5 inches, which equals 3.5 inches. To determine the percent, create a fraction by dividing the difference (3.5 inches) by the largest or total number (15.5 inches). Clear the decimal points before final division. Divide: 3.5/15.5 = 7/31. To change a fraction into a decimal, divide the numerator by the denominator. Add decimal points in the dividend and quotient as needed: 7/31 = 0.225. Carry out to the hundredths place. To round off a decimal, the final number is dropped. When the final number is 5 or greater, drop that number and increase the adjacent number by 1. Therefore, 0.225 = 0.23. Next, change the decimal to a percent by moving the decimal point two places to the right, then write the percent sign: 0.23 = 23%.

Format: Multiple Choice Chapter: 1

EiR Client Needs: Physiological ITnE teSgT riB tyA:NPKhS ysEiL olL og ca.l CAO dM aptation Cognitive Level: Analyze Difficulty: Difficult Page and Header: 3, Fractions; 10, Decimals; 15, Percents Integrated Process: Teaching/Learning Objective: 2, 4, 7 22.

The physician prescribed taking blood pressure assessments on a patient, lying

and standing, every 4 hours, for 24 hours. Determine the percentage difference between the first two systolic readings (140 mm Hg lying and 125 mm Hg standing).

A)

7

B)

9

C)

11

D)

13

Ans: C Feedback: To estimate the difference between the two systolic readings (140 mm Hg lying and 125 mm Hg standing), subtract 125 mm Hg from 140 mm Hg. To determine

the percent, create a fraction by dividing the difference (15 mm Hg) by the larger number or total (140 mm Hg). Divide: 15/140 = 3/28. To change a fraction into a decimal, divide the numerator by the denominator. Add decimal points in the dividend and quotient as needed: 3/28 = 0.107. Carry out to the hundredths place. To round off a decimal, the final number is dropped. When the final number is 5 or greater, drop the number and increase the adjacent number by 1. Therefore, 0.107 = 0.11. Next, change the decimal to a percent by moving the decimal point two places to the right, then write the percent sign: 0.11 = 11%.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 3, Fractions; 10, Decimals; 15, Percents Integrated Process: Teaching/Learning Objective: 4, 5, 7 23.

A physician prescribed an IV solution, 500 mL of 0.9% NS with 25 g of an

antibiotic, to run over 8 hours. What percent of the IV fluids would be given each hour?

A)

10

B)

12.5

C)

15

D)

18.5

Ans: B Feedback: To estimate what percent of the IV fluid is given each hour, first determine the amount of IV solution that would be given hourly: divide 500 mL/8 hours = 62.5 mL/hour. Next, divide the hourly amount by the total amount = 62.5/500 = 0.125 mL/hour/500 mL. Change the decimal to a percent by moving the decimal point two places to the right and then writing the percent sign. Therefore, 0.125 = 12.5%.

Format: Multiple Choice

Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 10, Decimals; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 2, 8, 9 24.

A physician prescribed 35 mg of a medication, IM, q4h, prn. The drug is

available as 50 mg/mL. How many milliliters would the nurse give for each dose? If the patient/client received six doses over 24 hours, how many total milliliters would the nurse give?

A)

0.5; 3

B)

0.6; 3.6

C)

0.7; 4.2

D)

0.8; 4.8

Ans: C

LdER Feedback: When the amountToEf S dT ruBgApNrK esScE riL be is.dC ifO feMrent from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 mL : 50 mg :: x mL : 35 mg; 50x = 35/50 = 0.7 mL. Proportion (Fractions): 1 mL/50 mg = x mL/ 35 mg; 50x = 35/50 = 0.7 mL. To estimate the total milliliters given over 24 hours, multiply 0.7 mL

6 doses (24 hours ÷ 4 hours) = 4.2

mL. Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 10, Decimals; 19, Fractions, Ratio, and Proportion Integrated Process: Teaching/Learning Objective: 1, 5, 8

25.

The physician ordered 20 mg of a drug by IV push, to be given over 5 minutes,

q12h. The medication is available as 25 mg/5 mL. How many milliliters would the nurse give for each dose? How many milliliters of medication would be given over each minute?

A)

4; 0.8

B)

4; 1

C)

5; 0.8

D)

5; 1

Ans: A Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 5 mL : 25 mg :: x mL : 20 mg; 25x = 100/25 = 4 mL. Proportion (Fractions): 5 mL/25 mg = x mL/20 mg; 25x = 100/25 = 4 mL. To estimate the milliliters given over each minute, divide the total milliliters by the total minutes (4 ÷ 5 = 0.8 mL/minute).

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Page and Header: 10, Decimals; 15, Percents Integrated Process: Communication and Documentation Objective: 5, 7 26. An elderly patient/client takes her morning medications with 4 ounces of Boost®. The doctor wants her to increase her Boost® intake by 50%. How many additional ounces would the patient/client take with her morning dose of medications?

Use the decimal format to estimate the percent increase.

A) 1 B) 1 ½ C) 2

D) 2 ½

Ans: C Feedback: Percent means "parts per hundred." Percent is a fraction, containing a variable numerator and a denominator that always equals 100. Therefore, 50% = 50/100 (fraction), 50:100 (ratio), and 0.5 (decimal). To determine the additional Boost® the patient/client should drink, multiply 50% (0.5

4 oz. Using the decimal format

4), line up the numbers on the right. Do not align the decimal points. Starting

at the right, multiply each digit in the top number by each digit in the bottom number, just as is done with whole numbers. Add the products. Place the decimal point in the answer by starting at the right and moving the point the same number of places that you totaled earlier. The answer is that the patient/client would take 2 additional ounces of Boost® with her medications.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Page and Header: 2, Dividing Whole Numbers; 7, Dividing Fractions Integrated Process: Teaching/Learning Objective: 1, 2, 8 27. The physician prescribed 60 mg of Klonopin (clonazepam) available as a 40 mg scored tablet. The patient/client was advised to take how many tablets for each dose?

Use Proportion (Ratios and Fractions) to solve this problem.

A) ½ B) 1 C) 1 ½ D) 2 Ans: C

Feedback: When the amount of drug prescribed is different from the supply, you can solve the dosage problem with proportion, either using ratios or fractions. When one of the numbers is unknown, the letter x substitutes for the missing number.

Proportion (Ratios): 1 tab : 40 mg :: x tab : 60 mg; 40x = 60/40 = 1.5 tablets.

Proportion (Fractions): 60 mg/40 mg = x /1 tab; 40x = 60/40 = 1.5 tablets.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Page and Header: 12, Multiplying Decimals Integrated Process: Teaching/Learning Objective: 5 28. A patient/client takes 0.125 mg of a medication, three times daily. How many milligrams would the patient/client take in four days?

A)

0.375

B)

0.75

C)

1.125

D)

1.5

Ans: D Feedback: First determine the total amount of medication taken in one day. Multiply 0.125 mg x 3 times per day. To multiply a decimal (0.125) by a whole number (3), place the decimal point in the answer by starting at the right and moving the decimal point the same number of places equal to the sum of the decimal points. Therefore, 0.125 mg x 3 = 0.375 mg ( the decimal point in the answer is moved three points to the left). This is the amount of medication in one day. Then multiply 0.375 mg x 4 days = 1500. Move the decimal point three places to the left; 1500 = 1.5 mg.

Format: Multiple Choice Chapter:

1

Client Needs:

Physiological Integrity: Basic Care and Comfort

Cognitive Level: Analyze Difficulty: Difficult Page and Header:

3, Multiplying Fractions

Integrated Process: Communication and Documentation Objective: 2 29. A patient/client in a nursing home is weighed weekly. Her initial weight on admission was 174 ½ pounds. After three weeks, she weighed 156 ¼ pounds. How many pounds did the patient/client lose in three weeks? Subtract the mixed numbers after determining the least common denominator (LCD).

A) 12 ½ B) 14 ¾ C) 16 ½ D) 18 ¼

Ans: D

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Feedback: Subtract the patient/client’s current weight (156 ¼) from her initial weight (174 ½). To subtract mixed numbers, one method is to find the least common denominator (LCD) for ½ and ¼ and leave the fractions as mixed numbers. For 2 and 4, the LCD = 4. Rewrite each fraction using the LCD; divide the LCD by the denominator of each fraction and then multiply that result by the numerator of the fraction. After conversion of the fractions (174 2/4 − 156 ¼ ), the numerators of the fractions are subtracted and the whole numbers are subtracted = 18 ¼ .

Format: Multiple Choice Chapter:

1

Client Needs:

Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level:

Analyze

Difficulty: Difficult Page and Header: 15, Percents; 19, Fractions, Ratio, and Proportion Integrated Process: Communication and Documentation Objective: 7, 8

30. A diabetic patient/client was prescribed an 1800 calorie ADA diet. The patient/client can have 35% of her calories (630) in the form of carbohydrate (CHO).

To maintain this same ratio, how many carbohydrate calories would she be allowed if the ADA diet was reduced to 1500 calories? Use a proportion (ratios) to solve the problem.

A)

525

B)

475

C)

425

D)

375

Ans: A Feedback: A ratio indicates the relationship between two numbers. A proportion is the relationship between two ratios. When one of the numbers in the proportion is unknown, the letter x substitutes for that number. Set up the ratio/proportion: 630 CHO calories: 1800 ADA calories = x CHO calories : 1500 ADA calories; 1800 x = 630 × 1500/1800; x = 945,000/1800 = 525 CHO calories.

Chapter 2, Metric and Household Systems of Measurement Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 1.

The patient/client is to receive Colace (docusate sodium) 100 mg po bid. What is this dose of medication in grams?

A)

10

B)

1

C)

0.1

D)

0.01

Ans: C Feedback: When you move from a smaller quantity (milligrams) to a larger quantity (grams), divide or move the decimal three places to the left. To convert 100 mg to grams, move the decimal point three places to the left, which equals 0.1 g. The Quick Method for changing milligrams to grams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 g = 1000 mg; the gram is the larger measure (100 mg < x g). The arrow directs moving the decimal point three places to the left (100 mg = 0.1 mg).

Format: Multiple Choice Chapter: 2

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 2.

The patient/client is to receive Kantrex (kanamycin sulfate) 1 g po q6h for 5 days. What is this dose of medication in milligrams?

A)

1

B)

10

C)

100

D)

1000

Ans: D

ST KrSqEuLaL Feedback: When you move fT roEm a BlaArN ge ntEitR y.(C grOaM ms) to a smaller quantity (milligrams), multiply or move the decimal three places to the right. To convert 1 g to milligrams, move the decimal point three places to the right, which equals 1000 mg.

The Quick Method for changing grams to milligrams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 g = 1000 milligrams; the gram is the larger measure (1 g > x mg). The arrow directs moving the decimal point three places to the right (1 g = 1000 mg).

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning

Objective: 1, 2 3.

The patient/client is to receive Lanoxin (digoxin) 125 mcg po every day. What is the dose of this medication in milligrams?

A)

0.00125

B)

0.0125

C)

0.125

D)

1.25

Ans: C Feedback: When you move from a smaller quantity (micrograms) to a larger quantity (milligrams), divide or move the decimal three places to the left. To convert 125 mcg to milligrams, move the decimal point three places to the left, which equals 0.125 mg.

The Quick Method for changing micrograms to milligrams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 mg = 1000 mcg; the milligram is the larger measure (125 mcg < x mg). The arrow directs moving the decimal point three places to the left (125 mcg = 0.125 mg).

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 4.

The patient/client is to receive Synthroid (levothyroxine sodium) 0.175 mg every day. The available medication is 175-mcg tablets. How many tablets should the patient/client receive?

A)

1

2

B)

1

C)

1 2

D)

2

1

Ans: B Feedback: When you move from a larger quantity (milligrams) to a smaller quantity (micrograms), multiply or move the decimal three places to the right. To convert 0.175 mg to micrograms, move the decimal point three places to the right, which equals 175 mcg. The Quick Method for changing milligrams to micrograms is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 mg = 1000 mcg; the milligram is the larger measure (0.175 mg > x mcg). The arrow directs moving the decimal point three places to the right (0.175 mg = 175 mcg). If the desired amount of 175 mcg is the same as the available amount of 0.175 mg per tablet, then give 1 tablet.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System Integrated Process: Communication and Documentation Objective: 1, 2 5.

The patient/client had 240 mL of milk, 180 mL of apple juice, and 120 mL of water with the 10 AM medications. What is the total intake the nurse should document in liters on the intake and output form?

A)

54

B)

5.4

C)

0.54

D)

0.054

Ans: C Feedback: When you move from a smaller quantity (milliliters) to a larger quantity (liters), divide or move the decimal three places to the left. To convert 540 mL to liters, move the decimal point three places to the left, which equals 0.54 L. The Quick Method for changing milliliters to liters is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 L = 1000 mL; the liter is the larger measure (240 mL + 180 mL + 120 mL) = 540 mL < x L. The arrow directs moving the decimal point three places to the left: 540 mL = 0.54 L.

Format: Multiple Choice Chapter: 2 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Page and Header: 40, Household System

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Integrated Process: Teaching/Learning Objective: 3 6.

A nursing faculty member asks a nursing student to talk to a patient/client about common household liquid measures. What are considered household liquid measures?

A)

Gram, pint, tablespoon, teaspoon

B)

Liter, gram, pint, quart

C)

Pint, quart, tablespoon, teaspoon

D)

Quart, liter, teaspoon, tablespoon

Ans: C Feedback: A gram is a solid metric measure. A liter is a liquid metric measure. The terms pint, quart, tablespoon, and teaspoon are considered household liquid measures.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 40, Household System Integrated Process: Communication and Documentation Objective: 1, 3, 4 7.

A client had the following clear liquid dinner: 4 tbsp of apple juice, 8 oz of beef 1

broth, 4 oz of orange gelatin, and 2 pint of tea. What is the total intake the nurse should document in milliliters on the intake and output form?

A)

520

B)

590

C)

640

D)

670

Ans: D Feedback: To estimate the total intake, convert the available amounts to the same liquid measure. In this case, use milliliters. The following equivalents are needed in order to solve this problem: 1 tbsp = 15 mL, 1 oz = 30 mL, and 1 pint = 500 mL. Therefore, 4 tbsp of apple juice  15 mL = 60 mL, 8 oz of beef broth  30 mL = 240 mL, 1

4 oz of orange gelatin  30 mL = 120 mL, and 2 pint of tea  500 mL = 250 mL. Add all quantities in milliliters: 60 + 240 + 120 + 250 = 670 mL.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult

Page and Header: 32, Metric System; 41, Liquid Measures Integrated Process: Communication and Documentation Objective: 1, 4 8.

How many milliliters would the nurse document on the intake and output form as being absorbed from a 1-liter bag if 550 mL was left in the bag?

A)

400

B)

450

C)

500

D)

550

Ans: B Feedback: To estimate the amount of liquid that was absorbed, subtract the amount left in the bag (550 mL) from the total amount. Use the following equivalent (1 L = 1000 mL) to work in the same liquid measure. Therefore, 1000 mL (amount in a 1-L bag) − 550 mL (amount left in IV bag) = 450 mL (amount of IV fluid absorbed).

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 41, Liquid Measures Integrated Process: Communication and Documentation Objective: 1, 4 9.

How many milliliters would the nurse document on the intake and output form as being absorbed from a 1-L bag if the 125 mL was left in the bag?

A)

800

B)

825

C)

850

D)

875

Ans: D Feedback: To estimate the amount of liquid that was absorbed, subtract the amount left in the bag from the total amount. Use the following equivalent (1 L = 1000 mL) to work in the same liquid measure. Therefore, 1000 mL (amount in a 1-L bag) − 125 mL (amount left in IV bag) = 875 mL (amount of IV fluid absorbed).

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 41, Liquid Measures

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Integrated Process: Communication and Documentation Objective: 1, 2 10.

The nurse documented that the patient/client voided 725 mL during the day shift. How many liters is this?

A)

0.0725

B)

0.725

C)

7.25

D)

72.5

Ans: B Feedback: The Quick Method for changing milliliters to liters is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 L = 1000 mL; the liter is the larger measure (725 mL < x L). The arrow indicates moving the decimal point three places to the left. Therefore, 725 mL = 0.725 L.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 3, 4 11.

The patient/client has been measuring urine at home with a quart milk carton

and states voiding 1 is this?

A)

1.5

B)

2.25

C)

3.7

D)

3.75

1

2

quarts 2 days ago and 2

1

4

quarts yesterday. How many liters

Ans: D 1

1

Feedback: To estimate the total amount of liquid in liters, add 1 2 quarts and 2 4 quarts and then convert quarts to liters using the equivalent: 1 quart = 1 L. Therefore, 1.5 quarts + 2.25 quarts = 3.75 quarts. Since 1 quart = 1 L, 3.75 quarts = 3.75 L.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning

Objective: 1, 3, 4 12.

What household measure is equivalent to 5 mL of cough syrup?

A)

1 tablespoon

B)

1 teaspoon

C)

½ ounce

D)

¼ cup

Ans: B Feedback: Equivalents between the household system and the metric system are not exact. A teaspoon = 5 mL. A tablespoon = 15 mL. An ounce = 30 mL so ½ ounce = 15 mL. A cup = 8 oz. so ¼ cup = 2 ounces.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 3, 4 13.

What household measure might be useful to give 1/6 oz of a liquid medication?

A)

1 tsp

B)

1 tbsp

C)

5 drops

D)

5 mL

Ans: A Feedback: Use two equivalents: 1 oz = 30 mL and 1 tsp = 5 mL. Therefore, 1/6 oz × 30 mL = 5 mL = 1 tsp; 1 tbsp = 15 mL and 5 drops = 1 minim.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 3, 4 14.

A patient/client has an order for 1200 mL of water by mouth every 24 hours.

How many ounces does the patient/client have to drink?

A)

30

B)

40

C)

50

D)

60

Ans: B Feedback: Use the equivalent: 1 oz = 30 mL. To estimate the number of ounces in 1200 mL, divide 1200 mL by 30 mL, which equals 40 oz.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 40, Household System Integrated Process: Communication and Documentation

Objective: 4 15.

A patient/client weighs 130 lb. How many kilograms should the nurse document on the chart? Round to the nearest tenth.

A)

58.1

B)

59.1

C)

285

D)

286

Ans: B Feedback: Use the equivalent: 1 kg = 2.2 lb. To convert pounds to kilograms, divide by 2.2 and round to the nearest tenth. Therefore, 130 lb  2.2 = 59.09. Round off to 59.1 kg.

Format: Multiple Choice Chapter: 2

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 40, Household System Integrated Process: Communication and Documentation Objective: 4 16.

A patient/client weighs 4.5 kg. How many pounds should the nurse document on the chart? Round to the nearest tenth.

A)

2.4

B)

2.9

C)

9.4

D)

9.9

Ans: D

Feedback: Use the equivalent: 1 kg = 2.2 lb. To convert kilograms to pounds, multiply by 2.2 and round to the nearest tenth. Therefore, 4.5 kg × 2.2 = 9.9 lb.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 17.

The patient/client is to receive Nitrostat 0.4-mg tablet. How many grams of medication are in this tablet?

A)

0.0004

B)

0.004

C)

0.04

D)

400

Ans: A Feedback: When you move from a smaller quantity (milligrams) to a larger quantity (grams), divide or move the decimal three places to the left. To convert 0.4 mg to grams, move the decimal point three places to the left, which equals 0.0004 g. The Quick Method for changing milligrams to grams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 g = 1000 mg; the gram is the larger measure (100 mg < x g). The arrow directs moving the decimal point three places to the left (0.4 mg = 0.0004 g).

Format: Multiple Choice Chapter: 2

Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Communication and Documentation Objective: 4 1

18.

A newborn is 22 4 inches long. How many centimeters should the nurse document on the chart?

A)

8.9

B)

9.9

C)

55.6

D)

56.5

Ans: C Feedback: Use the equivalent: 1 inch = 2.5 cm. Convert 22.25 inches to centimeters by multiplying: 22.25 inches  2.5 cm = 55.6 cm.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 42, Other Conversions Integrated Process: Communication and Documentation Objective: 5 19.

The nurse documented a temperature of 104.9° Fahrenheit. What is this temperature reading in Centigrade? Round to the nearest tenth.

A)

38.9

B)

39.8

C)

40.5

D)

41.2

Ans: C Feedback: To convert from 104.9° Fahrenheit to Centigrade, use this formula: °C = (°F − 32)  5/9. Therefore, 104.9 − 32 = 72.9  5/9 = 40.49. Round to the nearest tenth: 40.49 = 40.5.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 20.

A patient/client was prescribed Serevent (salmeterol), 50 mcg per inhalation, for prevention of bronchospasm. How many milligrams would the patient/client take with each inhalation?

A)

0.05

B)

0.5

C)

5

D)

500

Ans: A Feedback: The Quick Method for changing micrograms to milligrams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and

remember that 1 mg = 1000 mcg. The milligram is the larger measure (50 mcg < x mg). The arrow directs moving the decimal point three places to the left (50 mcg = 0.05 mg).

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 4 21.

A physician ordered 1 L of dialysate solution, per each cycle or exchange of

peritoneal dialysis. After the prescribed “dwell” time,

3

4

of the solution (fluid plus

TEmSaTnByAmNiKlliSlitEeLrsLoEfRs.oCluOtiMon remained in the patient's waste products) drained. How abdomen?

A)

125

B)

250

C)

500

D)

750

Ans: B Feedback: Use the following equivalent, 1 L = 1000 mL, to work in the same liquid measure. Therefore, 1 L = 1000 mL (amount in 1 L of solution) and 3

3

4

L = 750 mL (

× 1000 mL) amount drained. To estimate the amount of liquid remaining in the abdomen, subtract the amount of solution that drained from the total amount administered. Therefore, 1000 mL − 750 mL = 250 mL (amount of dialysate solution remaining in the abdomen).

4

Format: Multiple Choice

Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 3, 4 22.

A patient/client was directed to take 8 oz of MiraLAX solution as bowel prep for a colonoscopy. The MiraLAX powder was mixed in 64 oz of Gatorade. The client drank 8 oz every 15 minutes for six doses. Two doses remained. How many milliliters of MiraLAX solution remained?

A)

240

B)

300

C)

360

D)

480

Ans: D Feedback: Use the following equivalent, 1 oz = 30 mL, to work in the same liquid measure. The patient/client drank 48 oz of MiraLAX (8 oz × 6 doses) from a 64-oz container. To estimate the amount of solution remaining, subtract the amount of solution already taken (48 oz) from the total amount available (64 oz), which equals 16 oz. Then, multiply the remaining ounces by the equivalent: 30 mL = 1 oz.

Therefore, 30 mL × 16 oz = 480 mL.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures

Integrated Process: Teaching/Learning Objective: 1, 2, 3, 4 23.

A physician prescribed 10 mg of an antibiotic per kilogram of body weight for a patient/client who weighs 165 lb. How many kilograms does the patient/client weigh?

How many grams per kilogram would the nurse give?

A)

70; 0.001

B)

75; 0.01

C)

80; 0.1

D)

85; 1

Ans: B Feedback: Use two equivalents: 1 kg = 2.2 lb and 1 g = 1000 mg. To convert pounds to kilograms, divide by 2.2 and round to the nearest tenth. Therefore, 165 lb  2.2 = 75 kg. When you move from a smaller quantity (milligrams) to a larger quantity (grams), divide or move the decimal three places to the left. To convert 10 mg to grams, move the decimal point three places to the left: 0.01 g. The Quick Method for changing milligrams to grams is to write the equivalent that you need, show which TESTBANKSELLER.COM way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 g = 1000 mg; the gram is the larger measure (1000 mg < x g). The arrow directs moving the decimal point three places to the left (10 mg = 0.01 g).

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 2, 3, 4

24.

A physician prescribed 15 mL of a drug per kilogram for a 66-lb child. How many kilograms should the nurse use to estimate dosage? How many ounces per kilogram would the nurse give?

A)

30; 0.5

B)

35; 1

C)

40; 1.5

D)

45; 2

Ans: A Feedback: Use two equivalents: 1 kg = 2.2 lb and 30 mL = 1 oz. To convert pounds to kilograms, divide by 2.2 and round to the nearest tenth. Therefore, 66 lb ÷ 2.2 = 30 kg. To convert milliliters to ounces, divide by 30. Therefore, 15 mL ÷ 30 mL = 0.5 oz.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological ITnE teSgT riB tyA:NPK hS arEm lo. gC icO alMand Parenteral Therapies LaLcEoR Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 3, 4 25.

A patient/client was told to take 2 tablespoons of Robitussin (dextromethorphan) syrup, twice daily, to relieve his cough. The patient/client was told that this dosage was equivalent to how many ounces?

A)

0.5

B)

1

C)

1.5

D)

2

Ans: B

Feedback: Use the equivalent: 1 tablespoon = 15 mL. Multiple 2 tablespoons × 15 mL = 30 mL. Use the equivalent: 30 mL = 1 ounce.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1,2 26. The patient/client is to receive 0.05 mg of liquid Lanoxin (Digoxin) once daily.

What is the dosage of this medication in micrograms?

A)

0.5 mcg

B)

5 mcg

C)

50 mcg

D)

500 mcg

Ans: C Feedback: When you move from a larger quantity (milligrams) to a smaller quantity (micrograms), multiply or move the decimal three places to the right. To convert 0.05 mg to micrograms, move the decimal point three places to the right, which equals 50 mcg. The Quick Method for changing milligrams to micrograms is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 mg = 1000 micrograms; the milligram is the larger measure (1 mg > x mcg). The arrow directs moving the decimal point three places to the right (0.05 mg = 50 mcg).

Format: Multiple Choice

Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header:

32, Metric System; 40, Household System; 41, Liquid Measures

Integrated Process: Teaching/Learning Objective: 1, 3, 4 27. The patient/client is to receive 250 mg of Augmentin (amoxicillin/clavulanate potassium) po, twice daily. Augmentin (amoxicillin/clavulanate potassium) is available as 125 mg/ 5 mL. How many teaspoons of the medication would the patient/client take for one dose?

A) 0.5 teaspoon B) 1 teaspoon C) 1.5 teaspoons D) 2 teaspoons Ans: D Feedback: The patient/client took 250 mg of Augmentin. If 125 mg = 5 mL then 250 mg = 10 mL. The patient/client took 10 mL of Augmentin. Use the following equivalent: 5 mL = 1 teaspoon; 10 mL = 2 teaspoons.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Page and Header: 32, Metric System Integrated Process: Communication and Documentation

Objective: 4 28. A patient/client weighed 50 kg on day seven of his hospitalization. The nurse noted that this was a loss of five pounds since admission. The nurse would document a current patient/client weight of how many pounds? What was the patient/client’s weight, in kilograms, on admission?

A) 103; 44.5 B) 110; 52.3 C) 113; 49.1 D) 120; 52.3 Ans: B Feedback: Use the equivalent: 1 kg = 2.2 lb. To convert kilograms to pounds, multiply by 2.2 and round to the nearest tenth: 50 kg × 2.2 = 110 lbs. Next, add 5 lb to current weight of 110 lb = 115 lb as admission weight. . To convert pounds to kilograms, divide by 2.2 and round to the nearest tenth: 115 ÷ 2.2 = 52.3 kg.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System Integrated Process: Teaching/Learning Objective: 1, 2 29. A patient/client was prescribed Vitamin B12, 2500 mcg, sublingually, daily. At the end of seven days, the patient will have taken how many milligrams of Vitamin B12?

A) 7.5 B) 12.5 C) 17.5

D) 22.5 Ans: C Feedback: The Quick Method for changing micrograms to milligrams is to write the equivalent that you need, show which way the decimal point should move by drawing an arrow, make sure the open part of the arrow always faces the larger measure, and remember that 1 mg = 1000 mcg. The milligram is the larger measure (2500 mcg < x mg). The arrow directs moving the decimal point three places to the left (2500 mcg = 2.5 mg). Next, multiply 2.5 mg × 7 days = 17.5 mg.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Page and Header: 32, Metric System; 40, Household System; 41, Liquid Measures Integrated Process: Teaching/Learning Objective: 1, 3, 4 30. A patient/client, on a fluid-restricted diet, is directed to take his daily medications with 120 mL of water. The patient/client will use a measuring cup and pour how many ounces of water?

A) 2 B) 3 C) 4 D) 5 Ans: C Feedback: Use the equivalent: 1 oz = 30 mL. To estimate the number of ounces in 120 mL: 120 mL ÷ 30 mL, = 4 ounces.

Chapter 3, Drug Abbreviations, Labels, and Packaging Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 1 1.

The patient/client is to receive Xanax (alprazolam) 0.5 mg po at bedtime. What time would be appropriate to administer this medication?

A)

2 PM

B)

4 PM

C)

6 PM

D)

10 PM

Ans: D Feedback: “At bedtime” means hour of sleep. A sample time for hour of sleep is 10 PM.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation

Page 1

Objective: 1 2.

The patient/client is to receive Pepcid (famotidine) 10 mg po AC for heartburn.

When should this medication be administered?

A)

Before meals

B)

After meals

C)

Every hour

D)

Immediately

Ans: A Feedback: The abbreviation for before meals is AC, and the abbreviation for after meals is PC. The abbreviation for every hour is qh, and the abbreviation for immediately is STAT.

Format: Multiple Choice Chapter: 3

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 57, Routes of Administration Integrated Process: Teaching/Learning Objective: 1 3.

The patient/client is to receive Maxipime (cefepime hydrochloride) 1 g IVPB q12h for 7 days. What is the route of administration for this medication?

A)

IM

B)IV C)

IVP

D)

IVPB

Ans: D

Page 2

Feedback: The abbreviations for parenteral routes are IM (intramuscularly), IV (intravenously), IVP (intravenous push), and IVPB (intravenous piggyback).

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Page and Header: 57, Routes of Administration Integrated Process: Communication and Documentation Objective: 1 4.

In 2004, the Joint Commission issued a list of “Do Not Use" abbreviations.

Which abbreviation is prohibited in all documentation?

A)

HHN

B)

MDI

C)

OU

D)

SL

Ans: C Feedback: OU is a prohibited abbreviation for both eyes. The Joint Commission’s goal regarding "prohibited abbreviations" was created in response to errors that occur due to misinterpretation of abbreviations in documentation in the medical record. HHN is the abbreviation for handheld nebulizer, MDI is the abbreviation for metered-dose inhaler, and SL is the abbreviation for sublingual or under the tongue.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 3

Difficulty: Moderate Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 2 5.

The patient/client is to receive Lasix (furosemide) 20 mg po daily at 10 AM. Which entry on the medication administration record is transcribed correctly in military time?

A)

Lasix (furosemide) 20 mg po daily at 10 AM

B)

Lasix (furosemide) 20 mg po daily at 10 PM

C)

Lasix (furosemide) 20 mg po daily at 1000

D)

Lasix (furosemide) 20 mg po daily at 2200

Ans: C Feedback: For military time, the 24-hour clock begins at midnight as 0000. The hours from 1 AM to 12 noon are the same as traditional time; colons and the terms AM and PM are omitted. Lasix (furosemid oE dL aiL lyEaRt.1C0OAMM is in traditional time. Lasix TeE)S2T0Bm AgNKpS (furosemide) 20 mg po daily at 10 PM is at 10 at night. Lasix (furosemide) 20 mg po daily at 2200 is at 10 PM.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 2 6.

The patient/client is to receive Coumadin (warfarin sodium) 5 mg po at 1900.

Which entry on the medication administration record is transcribed correctly in traditional time?

Page 4

A)

Coumadin (warfarin sodium) 5 mg po at 7 AM

B)

Coumadin (warfarin sodium) 5 mg po at 9 AM

C)

Coumadin (warfarin sodium) 5 mg po at 7 PM

D)

Coumadin (warfarin sodium) 5 mg po at 9 PM

Ans: C Feedback: To change military time to traditional time, from 1300 forward, subtract 12. To change traditional time to military time, from 1 PM forward, add 12. Therefore, 7 AM = 0700, 9 AM = 0900, 7 PM = 1900, and 9 PM = 2100.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 2 7.

The patient/client's IV therapy for 10 hours stopped at 10:30 PM. What is the correct military time that the nurse should document in the chart that the IV therapy was started?

A)

10:30 PM

B)

1:30 PM

C)

1030

D)

1230

Ans: D Feedback: To change military time to traditional time, from 1300 forward, subtract 12. To change traditional time to military time, from 1 PM forward, add 12. Therefore,

Page 5

the IV stopped at 2230. Since the IV infused for 10 hours, it was started at 12:30 (traditional time).

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 2 8.

The patient/client, whose IV therapy lasted for 6 hours, was started at 3 AM. What is the correct military time that the nurse should document in the chart that the IV therapy was stopped?

A)

0300

B)

0900

C)

3 AM

D)

9 AM

Ans: B Feedback: The hours from 1 AM to 12 noon are the same as traditional time; colons and the terms AM and PM are omitted. Since the IV was started at 3 AM (0300) and infused for 6 hours, it was stopped at 0900.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 6

Difficulty: Moderate Page and Header: 59, Metric and SI Abbreviations; 62, Drug Labels Integrated Process: Communication and Documentation Objective: 3, 6 9.

The patient/client is to receive Lasix (furosemide) 20 mg po daily at 10 AM. What is the meaning of “mg” on the medication label?

A)

Microgram

B)

Milliequivalent

C)

Milligram

D)

Milliliter

Ans: C Feedback: The abbreviations are mcg (microgram), mEq (milliequivalent), mg (milligram), and mL (milliliter).

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Page and Header: 59, Metric and SI Abbreviations; 62, Drug Labels Integrated Process: Communication and Documentation Objective: 3, 6 10.

The patient/client is to receive 125 micrograms of Lanoxin (Digoxin). What is the abbreviation for microgram that will be found on the medication label?

A)

mg

B)

gm

C)

mcg

Page 7

D)

mEq

Ans: C Feedback: The abbreviation mcg refers to microgram. The abbreviation ug should not be used.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Page and Header: 59, Metric and SI Abbreviations Integrated Process: Communication and Documentation Objective: 3

.nC3O2M5 mg per tbsp. What does the 11.

The patient/client is toTrE ecSeT ivBeAaN cK etS aE mLinLoEpR he abbreviation “tbsp” on the medication administration record mean?

A)

Double teaspoon

B)

Ounce

C)

Teaspoon

D)

Tablespoon

Ans: D Feedback: The abbreviation tbsp refers to tablespoon, DSSP is used for double teaspoon, oz is used for ounce, and tsp for teaspoon.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

Page 8

Difficulty: Moderate Page and Header: 59, Metric and SI Abbreviations Integrated Process: Teaching/Learning Objective: 3 12.

Which statement is true about abbreviations for the International System of Units (SI)?

A)

The International System of Units was adopted from the apothecary measures.

B)

Differences between metric and SI systems occur in dosage.

C)

Weight measures in the SI system are based on the teaspoon.

D)

Volume measures in the SI system are based on the liter.

Ans: D Feedback: The International System of Units was adopted from the metric system.

Differences between metric and SI systems do not occur in dosage. Weight measures in the SI system are based on the gram, and volume measures in the SI system are based on the liter.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Page and Header: 59, Metric and SI Abbreviations; 60, Terms and Abbreviations for Drug Preparations; 62, Drug Labels Integrated Process: Teaching/Learning Objective: 4, 5, 6 The patient/client is to receive vitamin B12 1000 mcg IM three times a week.

13.

Select the prescription that reflects this order.

A)

Administer vitamin B12 1000 micrograms intramuscularly three times a week.

Page 9

B)

Administer vitamin B12 1000 milligrams intravenously three times a week.

C)

Administer vitamin B12 1000 milliliters intramuscularly every other day.

D)

Administer vitamin B12 1000 milliequivalents intravenously every other day.

Ans: A Feedback: The abbreviation for microgram is mcg; for milligram, mg; for milliliter, mL; and for milliequivalent, mEq. The abbreviation for intramuscularly is IM, and the abbreviation for intravenously is IV.

Format: Short Answer Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 59, Metric and SI Abbreviations; 60, Terms and Abbreviations for Drug Preparations; 62, Drug Labels Integrated Process: Communication and Documentation Objective: 4, 5, 6 14.

The patient/client is to receive Carafate 1 g via NGT qid. Write out the correct prescription order in longhand.

Ans: Carafate 1 gram via nasogastric tube four times a day Feedback: The abbreviation g is for gram, NGT for nasogastric tube, and qid for four times a day.

Format: Short Answer Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 10

Difficulty: Difficult Page and Header: 59, Metric and SI Abbreviations; 60, Terms and Abbreviations for Drug Preparations; 62, Drug Labels Integrated Process: Communication and Documentation Objective: 4, 5, 6 15.

The patient/client is to receive Dilantin 100 mg po tid. Write out the correct prescription order in longhand.

Ans: Dilantin 100 milligrams by mouth three times a day Feedback: The abbreviation mg is for milligrams; po for by mouth; and tid for three times a day.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 59, Metric and SI Abbreviations; 60, Terms and Abbreviations for Drug Preparations; 62, Drug Labels; 65, Drug Packaging Integrated Process: Teaching/Learning Objective: 1, 3, 4, 5, 6 16.

Using the medication administration record below, what medications should be administered at 10 AM on September 2, 2015?

Medication Enalaprilat 5 mg po daily; hold for blood pressure less than 100 Docusate sodium 200 mg po, ac Heparin 5000 units subcutaneously bid

Stop Date September 4, 2015

Hour 10 AM

September 4, 2015 September 1, 2015

9 AM 9 PM 10 AM 10 PM

Page 11

9/2/15 Blood pressure 130/74

Medication Furosemide 20 mg po daily Diphenhydramine 50 mg po every HS A)

Vasotec, Heparin

B)

Vasotec, Lasix

C)

Heparin, Lasix, Benadryl

D)

Colace, Vasotec, Lasix

Stop Date September 3, 2015 September 4, 2015

Hour 10 AM

9/2/15

10 PM

Ans: B Feedback: Vasotec and Lasix should be administered. Colace is to be administered AC, which is before 10 AM. The heparin order expired on September 1, 2015, and Benadryl is ordered at nighttime, not in the morning.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 62, Drug Labels; 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 5, 6, 7 17.

The nurse has to administer Neupogen 175 mcg subcutaneously every day for 2 weeks. The medication is available as 480 mcg/1.6 mL. How many milliliters of medication would the nurse draw up in the precision syringe? Round to the nearest hundredths.

A)

0.5

B)

0.58

Page 12

C)

0.6

D)

0.68

Ans: B Feedback: There are four types of syringes (3 mL, 1-mL precision, insulin U-100, and insulin U-50). The 1-mL precision syringe is used for subcutaneous and intradermal injections. When this syringe is used, carry out decimals three places and round off to the nearest hundredths for milliliters. To determine how many milliliters to give, use this formula: Desired amount/Available amount × Quantity. Therefore, 175 mcg/480 mcg × 1.6 mL = 0.583 mL. In rounding off numbers, when the last number is 5 or more, add 1 to the previous number; when the number is 4 or less, drop the number.

Therefore, 0.583 = 0.58. Since the amount of medication to give (0.58 mL) is less than 1 mL, use the 1-mL precision syringe.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 62, Drug Labels; 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 5, 6, 7 18.

The nurse has to administer Sublimaze (fentanyl citrate) 60 mcg IM 30 minutes prior to surgery. The medication is available as Sublimaze (fentanyl citrate) 50 mcg/mL. How many milliliters of medication would the nurse draw up in the syringe?

A)

1

B)

1.1

C)

1.15

D)

1.2

Ans: D

Page 13

Feedback: To determine how many milliliters to give, use this formula: Desired amount/Available amount × Quantity. Therefore, 60 mcg/50 mcg × 1 mL = 1.2 mL. The correct syringe to select for this injection is 3 mL because the amount to give is greater than 1 mL. The markings on a 3-mL syringe are to the nearest tenth. When this syringe is used, carry out the decimals two places and round off to the nearest tenth for milliliters. In rounding off numbers, when the last number is 5 or more, add 1 to the previous number, and when the number is 4 or less, drop the number.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 62, Drug Labels; 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning

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Objective: 5, 6, 7 19.

The nurse has to administer Decadron (dexamethasone sodium phosphate) 9 mg IV daily for 2 days. The medication is available as Decadron (dexamethasone sodium phosphate) 4 mg per milliliter. How many milliliters of medication would the nurse draw up in the syringe? Round to the nearest tenth.

A)

2.2

B)

2.3

C)

2.4

D)

2.5

Ans: B Feedback: To determine how many milliliters to give, use this formula: Desired amount/Available amount × Quantity. Therefore, 9 mg/4 mg × 1 mL = 2.25 mL. The correct syringe to select for this injection is a 3 mL. The markings on a 3-mL syringe are to the nearest tenth. When this syringe is used, carry out the decimals two places and round off to the nearest tenth for milliliters. In rounding off numbers, when the

Page 14

last number is 5 or more, add 1 to the previous number, and when the last number is 4 or less, drop that number. Therefore, 2.25 = 2.3 mL.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 62, Drug Labels Integrated Process: Communication and Documentation Objective: 6 20.

What is the lot number mean on a drug label?

A)

Batch of drug from which the stock came

B)

TiE KtSaEsLinLgEleR. How much drug is adm niS stTeB reAdNa tiC mO eM

C)

Used by the pharmacist to identify the drug

D)

Used to identify the method of packaging

Ans: A Feedback: The lot number indicates the batch of drug from which the stock came. The usual dosage is the dosage information that states how much drug is administered at a single time or during a 24-hour period. The NDC number is the National Drug Code used by the pharmacist to identify the drug and the method of packaging.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

Page 15

Page and Header: 65, Drug Packaging Integrated Process: Teaching/Learning Objective: 6 21.

Which form of multidose medication begins to lose it potency once dissolved?

A)

Capsule

B)

Liquid

C)

Powder

D)

Tablet

Ans: C Feedback: Powders begin losing their potency as soon as they begin to dissolve.

Format: Choice Multiple Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Page and Header: 62, Drug Labels Integrated Process: Communication and Documentation Objective: 7 22.

When the nurse prepares a medication from a multidose vial, what information must be included on the vial? Select all that apply.

A)

Date of preparation

B)

Expiration date

C)

Nurse's name

D)

Storage

E)

Time of preparation

Page 16

Ans: A, B, D, E Feedback: The nurse must write the date and time of preparation on the label and must note the expiration date and storage for a multidose vial. It is not required that the nurse's name or initials be put on the vial.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 7 23.

Skilled care nursing facilities often use a medication system that dispenses unit-dose medication for what period of time?

A)

One dose

B)

One day

C)

One week

D)

One month

Ans: D Feedback: Skilled care nursing facilities often use a system that dispenses unit-dose medication for 1 month.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

Page 17

Difficulty: Moderate Page and Header: 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 6, 7 24.

What form of medication will the nurse find in a sealed medication cup?

A)

Capsule

B)

Liquid

C)

Powder

D)

Tablet

Ans: B Feedback: A sealed medication cup contains a liquid preparation. Plastic bubble, foil, or paper wrappers contain tablets or capsules. Plastic or glass containers hold a single dose of a liquid or powder drug.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 7 25.

What must the nurse do when administering topical multidose medications to prevent contamination of a medication? Select the best example.

A) Use a clean tongue blade to remove medication from a jar containing an ointment.

Page 18

B) When using a dropper bottle for ear medication, label the container with the patient's name.

C) Metered-dose inhalers can be shared between clients as long as they are cleaned between uses.

D) Mucous membranes can be touched with the dropper when administering topical ear drops.

Ans: B Feedback: To prevent cross-contamination, a container needs to be labeled with the patient's name, and use must be restricted to only that patient. To avoid contamination of medication creams, ointments, and pastes in jars, a sterile tongue blade or sterile glove is used to remove the medication. Metered-dose inhalers are aerosol devices with two parts: a canister under pressure and a mouthpiece; they cannot be shared. Mucous membranes cannot be touched with a dropper because contamination of the dropper can cause pathogens to grow.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 62, Drug Labels; 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 5, 6, 7 26. The nurse has to administer Demerol (meperidine hydrochloride) 75 mg IM q 4-6 hrs, prn The medication is available as Demerol (meperidine hydrochloride) 50 mg/mL. How many milliliters of medication would the nurse draw up in the syringe?

A)

1

B)

1.5

C)

2

Page 19

D)

2.5

Ans: B Feedback: To determine how many milliliters to give, use this formula: Desired amount/Available amount × Quantity. Therefore, 75 mg/50 mg × 1 mL = 1.5 mL. The correct syringe to select for this injection is 3 mL because the amount to give is greater than 1 mL. The markings on a 3-mL syringe are to the nearest tenth. When this syringe is used, carry out the decimals two places and round off to the nearest tenth for milliliters.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 1 27. The patient/client is to receive Milk of Magnesium, 30 mL every night. What is the time abbreviation that the nurse would find on the medication order.

A) pc B) qn C) ac D) qh Ans: B Feedback: The abbreviation for “every night” is qn. The abbreviation for “after meals” is pc, the abbreviation for “before meals” is ac and qh is used for “every hour.”

Format: Multiple Choice

Page 20

Chapter: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Page and Header: 53, Time of Administration of Drugs Integrated Process: Communication and Documentation Objective: 2 28. The patient/client is to receive Dilantin (phenytoin) 100 mg, q8h. What is the correct military time that the nurse should document in the chart for the last dose of the day? The first dose was given at 0600.

A)

1430

B)

1640

C)

1830

D)

2200

Ans: D Feedback: The hours from 1 AM to 12 noon are the same as traditional time; colons and the terms AM and PM are omitted. Since the medicine was started at 6 AM (0600) and the third dose would be given at 10 PM (2200).

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Page and Header: 60, Terms and Abbreviations for Drug Preparations Integrated Process: Teaching/Learning Objective: 4

Page 21

29. Select the statement that is true about the definition for a drug preparation.

A) An elixir is a drug dissolved in a hydroalcoholic sweetened base.

B) A suspension is a drug contained in a clear liquid preparation.

C) An ointment is a liquid alcoholic solution of a drug.

D) A solution is an alcoholic solution of a volatile solution Ans: A Feedback: An elixir is a drug dissolved in a hydroalcoholic sweetened base. A suspension consists of small particles of drug that are dispersed in a liquid base and must be shaken before being poured. An ointment is a semisolid drug preparation that is applied to the skin for external use only. A solution is a drug that is contained in a clear liquid preparation.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological In grTitB yA :N Ph mLaL coElo TtEeS KaSrE Rg.icCaOl Mand Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 62, Drug Labels; 65, Drug Packaging; 73, Equipment to Measure Doses Integrated Process: Teaching/Learning Objective: 5, 6, 7 30. The nurse has to administer Solu-Cortef (hydrocortisone sodium succinate) 450 mg IV daily for 7 days. The medication is available as Solu-Cortef (hydrocortisone sodium succinate) 250 mg per milliliter. How many milliliters of medication would the nurse draw up in the syringe? Round to the nearest tenth.

A)

1.6

B)

1.8

C)

2

D)

2.2

Page 22

Ans: B Feedback: To determine how many milliliters to give, use this formula: Desired amount/Available amount × Quantity. Therefore, 450 mg/250 mg × 1 mL = 1.8 mL. The correct syringe to select for this injection is a 3 mL. The markings on a 3-mL syringe are to the nearest tenth. When this syringe is used, carry out the decimals two places and round off to the nearest tenth for milliliters.

Page 23

Chapter 4, Calculation of Oral Medications—Solids and Liquids Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids Integrated Process: Teaching/Learning Objective: 1 1.

Which is the correct equation to use when solving dosage calculations using the method

where the proportion is expressed using two fractions?

A)

Desire/Have  Supply = x

B)

Supply : Have :: x : Desire

C)

Supply/Have = x/Desire

D)

Desire/Supply  Have = x

Ans:

C

Feedback: There are four methods that can be used for dosage calculations. Formula Method: Desire/Have  Supply = x. Proportion (Ratios): Supply : Have :: x : Desire. Proportion (Fractions): Supply/Have = x/Desire. Dimensional Analysis: Supply/Have  Desired dose = x. Dimensional analysis uses a horizontal line, similar to a fraction, to set up the equation. Vertical lines are used to separate what you have, what you desire, and the conversion factor(s), when used. Refer to page 84 to in the textbook to view the setup for dimensional analysis.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids

Page 1

Integrated Process: Teaching/Learning Objective: 1 2.

The patient/client is to receive Paxil (paroxetine hydrochloride) 40 mg po daily. Each

tablet contains 20 mg. Select the correct equation to use when solving this medication problem using the formula method.

A)

40 mg/20 mg  tablet = x

B)

1 tablet : 20 mg : : x : 40 mg

C)

1 tablet/20 mg = x/40 mg x

D)

40 mg/1 tablet  20 mg = x

Ans:

A

Feedback: The formula method uses Desire/Have  Supply = x (40 mg/20 mg  1 tablet = x).

Choice B represents Proportion (Ratios): Choice C represents Supply: Have :: x : Desire.

Proportion (Fractions): and Choice D represents Supply/Have = x/Desire. Dimensional Analysis: Supply/Have  Desired dose = x.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids Integrated Process: Teaching/Learning Objective: 1 3.

What is the correct equation name for "Supply : Have :: x : Desire"?

A)

Formula method

B)

Dimensional analysis

C)

Proportion expressed as two ratios

D)

Proportion expressed as two fractions

Ans:

C

Page 2

Feedback: Formula Method: Desire/Have  Supply = x. Proportion (Ratios): Supply : Have :: x : Desire. Proportion (Fractions): Supply/Have = x/Desire. Dimensional Analysis: Supply/Have  Desired Dose = x.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 87, Oral Solids Integrated Process: Teaching/Learning Objective: 1 4.

The patient/client is to receive Zyprexa (olanzapine) 10 mg po twice a day. Each tablet

contains 2.5 mg. How many tablets would the patient/client receive for each dose?

A)

3

B)

3.5

C)

4

D)

4.5

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 10 mg/2.5 mg  1 tablet = 10/2.5 = 4 tablets. Proportion (Ratios): 1 tablet : 2.5 mg :: x tablets : 10 mg; 2.5x = 10/2.5 = 4 tablets. Proportion (Fractions): 1 tablet/2.5 mg = x tablets/10 mg; 2.5x = 10/2.5 = 4 tablets. Dimensional Analysis: 1 tablet/2.5 mg  10 mg = 10  1 tablet/2.5 = 4 tablets.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

Page 3

Page and Header: 87, Oral Solids; 98, Clearing Decimals Integrated Process: Teaching/Learning Objective: 1, 3 5.

The patient/client is to receive Synthroid (levothyroxine sodium) 0.05 mg po daily. Each

tablet contains 0.025 mg. How many tablets would the patient/client receive?

A) B)

1

1

4

2

C)

1

D)

2

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.05 mg/0.025 mg  1 tablet = 0.05/0.025 = 50/25 = 2 tablets. Proportion (Ratios): 1 tablet : 0.025 mg :: x tablets : 0.05 mg; 0.025x = 0.05/0.025 = 50/25 = 2 tablets.

Proportion (Fractions): 1 tablet/0.025 mg = x tablets/0.05 mg; 0.025x = 0.05/0.025 = 50/25 = 2 tablets. Dimensional Analysis: 1 tablet/0.025 mg  0.05 mg = 1 tablet  0.05/0.025 = 50/25 = 2 tablets. When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (three spaces in this example). Then clear the decimal point.

Therefore, 0.05 mg = 50 mg and 0.025 mg = 25 mg. It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 98, Clearing Decimals Integrated Process: Teaching/Learning Objective: 1, 3

Page 4

6.

The patient/client is to receive Tagamet (cimetidine) 0.8 g po three times a day. Each tablet

contains 0.4 g. How many tablets would the patient/client receive for each dose?

A)

2

B)

3

C)

4

D)

5

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.8 g/0.4 g  1 tablet = 2 tablets. Proportion (Ratios): 1 tablet : 0.4 g :: x tablets : 0.8 g; 0.4x = 0.8/0.4 = 8/4 = 2 tablets. Proportion (Fractions): 1 tablet/0.4 g = x tablets/0.8 g; 0.4x = 0.8/0.4 = 8/4 = 2 tablets. Dimensional Analysis: 1 tablet/0.4 g  0.8 g = 1 tablet  0.8/0.4 = 8/4 = 2 tablets. When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (one space in this example). Then clear the decimal point.

Therefore, 0.8 g = 8 g and 0.4 g =T4EgS.TItBisAsNuK ggSeE stL edLtE haRt.thCeOdM ecimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 98, Clearing Decimals Integrated Process: Teaching/Learning Objective: 1, 3 7.

The patient/client is to receive Hydrodiuril (hydrochlorothiazide) 12.5 mg po daily. Each

scored tablet contains 25 mg. How many tablets would the patient/client receive?

A) B)

1

1

4

2

Page 5

C)

1

D)

2

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 12.5 mg/25 mg  1 tablet = 12.5/25 = 125/250 =

1

2

(Ratios): 1 tablet : 25 mg :: x tablets : 12.5 mg; 25x = 12.5/25 = 125/250 = (Fractions): 1 tablet/25 mg = x tablet/12.5 mg; 25x = 12.5/25 = 125/250 =

tablet. Proportion 1

1

2

tablet. Proportion

2

tablet.

Dimensional Analysis: 1 tablet/25 mg  12.5 mg = 12.5  1 tablet/25 = 125/250 =

1

2

tablet.

When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (one space in this example). Then clear the decimal point. Therefore, 12.5 mg = 125 mg and 25 mg = 250 mg. It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 98, Clearing Decimals When Using the Formula Method Integrated Process: Teaching/Learning Objective: 1, 3 8.

The patient/client is to receive digoxin 0.1 mg po daily. Each scored tablet contains 0.05

mg. How many tablets would the patient/client receive?

A) B)

1

1

C)

1

D)

2

4

2

Page 6

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.1 mg/0.05 mg  1 tablet = 0.1/0.05 = 10/5 = 2 tablets. Proportion (Ratios): 1 tablet : 0.05 mg :: x tablets : 0.1 mg; 0.05x = 0.1/0.05 = 10/5 = 2 tablets. Proportion (Fractions): 1 tablet/0.05 mg = x tablets/0.1 mg; 0.05x = 0.1/0.05 = 10/5 = 2 tablets. Dimensional Analysis: 1 tablet/0.05 mg  0.1 mg = 1 tablet  0.1/0.05 = 10/5 = 2 tablets. When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (two spaces in this example). Then clear the decimal point. Therefore, 0.1 mg = 10 mg and 0.05 mg = 5 mg. It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological InteT grE itS y:TPBhA arN mK acSoE loLgL icE alRa. ndCPOaMrenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure Integrated Process: Teaching/Learning Objective: 1, 2 9.

The patient/client is to receive Zyloprim (allopurinol) 0.25 g po every day. Each scored

tablet contains 100 mg. How many tablets would the patient/client receive?

A)

1.5

B)

2

C)

2.5

D)

3

Ans:

C

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to change 0.25 g to 250 mg.

To convert 0.25 g to milligrams, move the decimal point three places to the right: 250 mg. Estimate

Page 7

the amount to give. Formula Method: 250 mg/100 mg  1 tablet = 250/100 = 2.5 tablets.

Proportion (Ratios): 1 tablet : 100 mg :: x tablets : 250 mg; 100x = 250/100 = 2.5 tablets.

Proportion (Fractions): 1 tablet/100 mg = x tablets/250 mg; 100x = 250/100 = 2.5 tablets. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 tablet/100 mg  0.25 g  1000 mg/1 g = 1 tablet  0.25  1000/100  1 = 250/100 = 2.5 tablets.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure Integrated Process: Teaching/Learning Objective: 1, 2 10.

The patient/client is to receive Lopressor (metoprolol tartrate) 0.05 g po every day. Each

scored tablet contains 50 mg. How nyBtAabNlK etS sw ouLldEtRh. eC paOtiM ent/client receive?

TEmSaT EL 1

A) 2 B)

1

C)

112

D)

2

Ans:

B

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to change 0.05 g to 50 mg.

To convert 0.05 g to 50 mg, move the decimal point three points to the right. Estimate the amount to give. Formula Method: 50 mg/50 mg  1 tablet = 50/50 = 1 tablet. Proportion (Ratios): 1 tablet : 50 mg :: x tablets : 50 mg; 50x = 50/50 = 1 tablet. Proportion (Fractions): 1 tablet/50 mg = x tablets/50 mg; 50x = 50/50 = 1 tablet. Use a conversion factor for dimensional analysis.

Dimensional Analysis: 1 tablet/50 mg  0.05 g  1000 mg/1g = 1 tablet  0.05  1000/50  1 = 50/50 = 1 tablet.

Page 8

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 98, Clearing Decimals Integrated Process: Teaching/Learning Objective: 1, 3 11.

The patient/client is to be given Cymbalta (duloxetine hydrochloride) 0.04 g po twice a

day. Each scored tablet contains 0.02 g. How many tablets would the patient/client receive?

1

A) 2 B)

1

C)

112

D)

2

Ans:

D

S,TfB Feedback: When solving any proT blE em irsAt N chKeS ckEtLhL atEthRe.oCrdOeM r and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.04 g/0.02 g  1 tablet = 0.04/0.02 = 4/2 = 2 tablets. Proportion (Ratios): 1 tablet : 0.02 g :: x tablets : 0.04 g; 0.02x = 0.04/0.02 = 4/2 = 2 tablets. Proportion (Fractions): 1 tablet/0.02 g = x tablets/0.04 g; 0.02x = 0.04/0.02 = 4/2 = 2 tablets. Dimensional Analysis: 1 tablet/0.02 g  0.04 g = 1 tablet  0.04/0.02 = 4/2 = 2 tablets. When the numerator and denominator are decimals, move the decimal point the same number of spaces to the right in both decimals (two spaces in this example). Then clear the decimal point. Therefore, 0.04 g = 4 g and 0.02 g = 2 g. It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 9

Difficulty: Difficult Page and Header: 87, Oral Solids; 98, Clearing Decimals When Using the Formula Method Integrated Process: Teaching/Learning Objective: 1, 3 12.

The patient/client is to receive Ery-Tab (erythromycin) 0.666 g po every 6 hours. Each

tablet contains 333 mg. How many tablets would the patient/client receive?

1

A) 2 B)

1

C)

112

D)

2

Ans:

D

Feedback: When solving any problem, first check that the order and supply to the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to change 0.666 g to 666 mg (0.666 g  1000 mg). To convert 0.666 g to milligrams, move the decimal point three places to the right: 666 mg. Estimate the amount to give. Formula Method: 666 mg/333 mg  1 tablet = 666/333

TESTBANKSELLER.COM

= 2 tablets. Proportion (Ratios): 1 tablet : 333 mg :: x tablets : 666 mg; 333 mg x = 666/333 = 2 tablets. Proportion (Fractions): 1 tablet/333 mg = x tablets/666 mg; 333x = 666/333 = 2 tablets.

Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 tablet/333 mg  0.666 g  1000 mg/1 g = 1 tablet  0.666  1000/333  1 = 666/333 = 2 tablets.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 4

Page 10

13.

The patient/client is to receive Prozac (fluoxetine hydrochloride) oral solution 40 mg po

every day. The medication is available as Prozac (fluoxetine hydrochloride) oral solution 20 mg per 5 mL. How many milliliters of medication would the patient/client receive?

A)

5

B)

10

C)

15

D)

20

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 40 mg/20 mg  5 mL = 200/20 = 10 mL. Proportion (Ratios): 5 mL : 20 mg :: x mL : 40 mg; 20x = 200/20 = 10 mL. Proportion (Fractions): 5 mL/20 mg = x mL/40 mg; 20x = 200/20 = 10 mL. Dimensional Analysis: 5 mL/20 mg  40 mg = 5 mL  40/20 = 200/20 = 10 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 4 14.

The patient/client is to receive Dilantin (phenytoin) oral solution 100 mg po three times a

day. The medication is available as Dilantin (phenytoin) oral solution 125 mg per 5 mL. How many milliliters of medication would the patient/client receive?

A)

3

B)

3.5

C)

4

D)

4.5

Page 11

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 100 mg/125 mg  5 mL = 500/125 = 4 mL. Proportion (Ratios): 5 mL : 125 mg :: x mL : 100 mg; 125x = 500 mg/125 = 4 mL. Proportion (Fractions): 5 mL/125 mg = x mL/100 mg; 125x = 500 mg/125 = 4 mL. Dimensional Analysis: 5 mL/125 mg  100 mg = 5 mL  100/125 = 500/125 = 4 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/LeT arE niS ngTBANKSELLER.COM Objective: 1, 4 15.

The patient/client is to receive theophylline elixir 120 mg po twice a day. The medication is

available as theophylline elixir 80 mg per 15 mL. How many milliliters of medication would the patient/client receive?

A)

20

B)

22.5

C)

25

D)

27.5

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 120 mg/80 mg  15 mL = 1800/80 = 45/2 = 22.5 mL. Proportion (Ratios): 15 mL : 80 mg :: x mL : 120 mg; 80x = 1800/80 = 45/2 = 22.5 mL. Proportion (Fractions): 15 mL/80 mg = x mL/120 mg; 80x = 1800/80 = 45/2 = 22.5 mL. Dimensional Analysis: 15 mL/80 mg  120 mg

Page 12

= 15 mL  120/80 = 1800/80 = 45/2 = 22.5 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 2, 4 16.

The patient/client is to receive Mellaril (thioridazine) 150 mg po twice a day. The

medication is available as Mellaril (thioridazine) 30 mg per milliliter. How many teaspoons should the nurse instruct the patient/client to take for each dose?

A)

1

B)

2

C)

3

D)

4

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, the use of an equivalent is necessary (1 tsp = 5 mL) to change 5 mL to teaspoons. Estimate the amount to give. Formula Method: 150 mg/30 mg  1 mL = 150/30 = 5 mL = 1 tsp. Proportion (Ratios): 1 mL : 30 mg :: x mL = 150 mg; 30 mg x = 150/30 = 5 mL = 1 tsp. Proportion (Fractions): 1 mL/30 mg = x mL/150 mg; 30x = 150/30 = 5 mL = 1 tsp. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 mL/30 mg  150 mg  1 tsp/5 mL = 1  150  1 tsp/30  5 = 150/150 = 1 tsp. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4

Page 13

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 995, Converting Order and Supply to the Same Weight Measure; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 2, 4 17.

The patient/client is to receive Tagamet (cimetidine) 300 mg po every 6 hours. The

medication is available as Tagamet (cimetidine) 300 mg per 5 mL. How many teaspoons should the nurse instruct the patient/client to take?

1

A) 2 B)

1

C)

112

D)

2

Ans:

B

S,TfB Feedback: When solving any proT blE em irsAt N chKeS ckEtLhL atEthRe.oCrdOeM r and the supply are in the same weight measure. For this problem, the use of an equivalent is necessary (1 tsp = 5 mL) to change 5 mL to teaspoons. Estimate the amount to give. Formula Method: 300 mg/300 mg  5 mL = 1500/300 = 5 mL = 1 teaspoon. Proportion (Ratios): 5 mL : 300 mg :: x mL : 300 mg; 300x = 1500/300 = 5 mL = 1 teaspoon. Proportion (Fractions): 5 mL/300 mg = x mL/300 mg; 300x = 1500/300 = 5 mL = 1 tsp. Use a conversion factor for dimensional analysis. Dimensional Analysis: 5 mL/300 mg  300 mg  1 tsp/5 mL = 5  300  1 tsp/300  5 = 1500/1500 = 1 tsp. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

Page 14

Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 2, 4 18.

The patient/client is to receive Augmentin (amoxicillin/clavulanate potassium) 0.25 g po

every 8 hours. The medication Augmentin (amoxicillin/clavulanate potassium) is available as an oral suspension 125 mg per 5 mL. How many teaspoons should the nurse instruct the patient/client to take?

A)

1

B)

2

C)

3

D)

4

Ans:

B

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, two equivalents are necessary (5 mL = 1 tsp and 1 g = 1000 mg). To convert 0.25 g to milligrams, movTeEthSeTdBeci mK alSpE oiLnL t tE hrRe. e pClO acMes to the right: 250 mg. Therefore, AN 0.25 g = 250 mg (0.25 g  1000) and 5 mL = 1 tsp. Estimate the amount to give. Formula Method: 250 mg/125 mg  5 mL = 1250/125 = 10 mL = 2 tsp. Proportion (Ratios): 5 mL : 125 mg :: x mL : 250 mg; 125x = 1250/125 = 10 mL = 2 tsp. Proportion (Fractions): 5 mL/125 mg = x mL/250 mg; 125x = 1250/125 = 10 mL = 2 tsp. Use two conversion factors for dimensional analysis.

Dimensional Analysis: 5 mL/125 mg  0.25 g  1000 mg/1 g  1 tsp/5 mL = 5  0.25  1000  1 tsp/125  1  5 = 1250/625 = 2 tsp. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning

Page 15

Objective: 1, 4 19.

The patient/client is to receive Zantac (ranitidine hydrochloride) 150 mg bid via

nasogastric tube. The medication is available as Zantac (ranitidine hydrochloride) 15 mg per milliliter. How many milliliters does the nurse need to administer?

A)

5

B)

10

C)

15

D)

20

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. In this problem, no equivalent is necessary. Estimate the amount to give. Formula Method: 150 mg/15 mg  1 mL = 150/15 = 10 mL. Proportion (Ratios): 1 mL : 15 mg :: x mL : 150 mg; 15x = 150/15 = 10 mL. Proportion (Fractions): 1 mL/15 mg = x mL/150 mg; 15x = 150/15 = 10 mL. Dimensional Analysis: 1 mL/15 mg  150 mg = 150  1/15 = 10 mL. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 102; Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 4 20.

The patient/client is to receive Aldomet (methyldopa) 300 mg bid via nasogastric tube. The

medication is available as Aldomet (methyldopa) 250 mg per 5 mL. How many milliliters does the nurse need to administer?

A)

6

B)

6.5

C)

7

D)

7.5

Page 16

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. In this problem, no equivalent is necessary. Estimate the amount to give. Formula Method: 300 mg/250  5 mL = 1500/250 = 6 mL. Proportion (Ratios): 5 mL : 250 mg :: x mL : 300 mg; 250 mg x = 1500 mg/250 mg = 6 mL. Proportion (Fractions): 5 mL/250 mg = x mL/300 mg; 250 mg x = 1500/250 = 6 mL. Dimensional Analysis: 5 mL/250 mg  300 mg = 5 mL  300/250 = 1500/250 = 6 mL. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids Integrated Process: Teaching/LeT arE niS ngTBANKSELLER.COM Objective: 1 21.

When the medication dosage ordered is different from the supply, it is necessary to make

sure that both are in the same weight measure. You can either convert one or the other amount to its equivalent or use a conversion factor. Select the calculation method that uses a conversion factor to set up the problem.

A)

Desire/Have  Supply = x

B)

Supply/Have = x/Desire

C)

Supply: Have :: x : Desire

D)

Supply/Have  Desire = x

Ans:

D

Feedback: When solving any dosage problem where the order and the supply are not in the same weight measure, it is necessary to convert one or the other amount to the same weight measure.

Always convert to the measure that you “have on hand” since that is the supply that you are working with. You can either use an equivalent value or a conversion factor. When you use an equivalent value, you need to do a calculation prior to setting up your problem. Dimensional

Page 17

analysis allows you to use a conversion factor within the fraction setup, thereby eliminating a step and the chance for an error.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure; 98, Clearing Decimals When Using the Formula Method Integrated Process: Teaching/Learning Objective: 1, 2, 3 22.

The patient/client is to receive Catapres (clonidine) 600 mcg po daily. The medication is

available as Catapres (clonidine) 0.2 mg per tablet. How many tablets should the patient/client receive daily?

A)

1

2

B)

1

C)

2

D)

3

Ans:

D

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 mg = 1000 mcg) to change 600 mcg to 0.6 mg. To convert 600 mcg to milligrams, move the decimal point three places to the left. Therefore, 600 mcg = 0.6 mg. Estimate the amount to give. Formula Method: 0.6 mg/0.2 mg  1 tablet = 0.6/0.2 = 6/2 = 3 tablets. Proportion (Ratios): 1 tablet : 0.2 mg :: x tablets : 0.6 mg; 0.2x = 0.6/0.2 = 6/2 = 3 tablets. Proportion (Fractions): 1 tablet/0.2 mg  x tablets/0.6 mg; 0.2x = 0.6/0.2 = 6/2 = 3 tablets. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 tablet/0.2 mg  600 mcg  1 mg/1000 mcg = 1 tablet  600  1/0.2  1000 = 600/200 = 6/2 = 3 tablets. When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the

Page 18

right in both decimals (three spaces in this example). It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure Integrated Process: Teaching/Learning Objective: 1, 2 23.

The patient/client is to receive Keflex (cephalexin) 2 g, twice daily. The medication is

available as Keflex (cephalexin) 500 mg per capsule. How many capsules would the patient/client receive at each dose?

A)

1

B)

2

C)

3

D)

4

Ans:

D

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to change 2 g to 2000 mg (2  1000). To convert 2 g to milligrams, move the decimal point three places to the right (2000 mg).

Estimate the amount to give. Formula Method: 2000 mg/500 mg  1 capsule = 2000/500 = 4 capsules. Proportion (Ratios): 1 capsule : 500 mg :: x capsules : 2000 mg; 500x = 2000/500 = 4 capsules. Proportion (Fractions): 1 tablet/500 mg = x tablets/2000 mg; 500x = 2000/500 = 4 capsules. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 capsule/500 mg  2 g  1000 mg/1 g = 1 capsule  2  1000/500  1 = 2000/500 = 4 capsules.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Page 19

Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 4 24.

The patient/client is to receive Vistaril (hydroxyzine) 40 mg po twice daily. The

medication is available as Vistaril (hydroxyzine) 10 mg per 5 mL. How many milliliters would the patient/client receive for each dose?

A)

5 mL

B)

10 mL

C)

15 mL

D)

20 mL

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 40 mg/10 mg T5Em =A 20N0K/1S0E=L2L0EmRL.. C PrOoM portion (Ratios): 5 mL : 10 mg :: x SLTB mL : 40 mg; 10x = 200/10 = 20 mL. Proportion (Fractions): 5 mL/10 mg = x mL/40 mg; 10x = 200/10 = 20 mL. Dimensional Analysis: 5 mL/10 mg  40 mg = 5 mL  40/10 = 200/10 = 20 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 111, Oral Solid and Liquid Problems Without Written Calculations/“Common Sense” Calculations Integrated Process: Teaching/Learning Objective: 1, 5

Page 20

25.

The patient/client is to receive Lasix (furosemide) 20 mg po four times a day. The

medication is available in liquid form as Lasix (furosemide) 10 mg per milliliter. The patient/client should receive how many milliliters per dose?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. This is a common sense calculation where the problem can be solved based on whether or not the answer seems logical. For example, if the patient/client is to receive 20 mg and the drug is available as 10 mg per milliliter, it is common sense that 2 mL should be given. The answer can be checked by asking the question, “Does it seem correct?” Common sense is loosely defined as “sound, practical judgment.”

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids 98, Clearing Decimals When Using the Formula Method Integrated Process: Teaching/Learning Objective: 1, 3 26. The patient/client is to receive Ativan (lorazepam)) 0.25 mg po three times a day. Each tablet contains 0.5 mg. How many tablets would the patient/client receive for each dose?

A)

1/2

B)

1

C)

1 1/2

D)

2

Ans:

A

Page 21

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.25 mg/0.5 mg  1 tablet = 1/2 tablet. Proportion (Ratios): 1 tablet: 0.5 mg:: x tablets : 0.25mg; 0.5x = 0.25 mg/0.5 mg  1 tablet = 1/2 tablet. Proportion (Fractions): 1 tablet/0.5 mg = x tablet/0.25 mg; 0.5x = 0.25 mg/0.5 mg  1 tablet = 1/2 tablet. Dimensional Analysis: 1 tablet/0.5 mg × 0.25 mg = 1 tablet × 0.25/0.5  1 tablet = 1/2 tablet When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (one space in this example). Then clear the decimal point. Therefore, 0.25 mg = 25 mg and 0.5 g = 50 mg. It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 2, 4 27.

The patient/client is to receive Prozac Liquid ( fluoxetine hydrochloride) 450 mg po every

8 hours. The medication is available as Prozac Liquid ( fluoxetine hydrochloride) 300 mg per 5 mL. How many teaspoons should the nurse instruct the patient/client to take?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, the use of an equivalent is necessary (1 tsp = 5 mL) to change 5

Page 22

mL to teaspoons. Estimate the amount to give. Formula Method: 450 mg/300 mg  5 mL = 2250/300 = 7.5 mL = 1.5 teaspoons. Proportion (Ratios): 5 mL: 300 mg :: x mL : 450 mg; 300x = 2250/300 = 7.5 mL = 1.5 teaspoons Proportion (Fractions): 5 mL/300 mg = x mL/450 mg; 300x = 2250/300 = 7.5 mL = 1.5 teaspoons. Use a conversion factor for dimensional analysis.

Dimensional Analysis: 5 mL/300 mg  450 mg  1 tsp/5 mL = 5  450  1 tsp/300  5 = 2250/1500 = 1.5 teaspoons. For liquids, the four methods are set up just as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure Integrated Process: Teaching/Learning Objective: 1, 2 28.

The patient/client is to receive Nexium (esomeprazole magnesium) 0.04 g po every day.

Each capsule contains 20 mg. How many capsules would the patient/client receive?

A)

1

B)

2

C)

3

D)

4

Ans:

B

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to change 0.04 g to 40 mg.

To convert 0.04 g to milligrams, move the decimal point three places to the right: 40 mg. Estimate the amount to give. Formula Method: 40 mg/20 mg  1 capsule = 40/20 = 2 capsules. Proportion (Ratios): 1 capsule: 20 mg :: x capsules : 40 mg; 20x = 40/20 = 2 capsules. Proportion (Fractions): 1 capsule/20 mg = x tablets/40 mg; 20x = 40/20 = 2 capsules Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 capsule/20 mg  0.04 g  1000 mg/1 g = 1 capsule  0.04  1000/20  1 = 40/20 = 2 capsules.

Page 23

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 87, Oral Solids; 102, Special Types of Oral Solid Orders Integrated Process: Teaching/Learning Objective: 1, 4 29.

The patient/client is to receive Amoxil (amoxicillin) oral suspension 500 mg po two times

a day. The medication is available as Amoxil (amoxicillin) oral suspension 250 mg per 5 mL. How many milliliters of medication would the patient/client receive for each dose?

A)

5

B)

10

C)

20

D)

30

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 500 mg/250 mg  5 mL = 2500/250 = 10 mL. Proportion (Ratios): 5 mL : 250 mg :: x mL : 500 mg; 250x = 2500/250 = 10 mL. Proportion (Fractions): 5 mL/250 mg = x mL/500 mg; 250x = 2500/250 = 10 mL. Dimensional Analysis: 5 mL/250 mg  500 mg = 5 mL  500/250 =2500/250 = 10 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

Page 24

Page and Header: 87, Oral Solids; 95, Converting Order and Supply to the Same Weight Measure; 98, Clearing Decimals When Using the Formula Method Integrated Process: Teaching/Learning Objective: 1, 2, 3 30.

The patient/client is to receive Lanoxin (digoxin) 500 mcg po daily. The medication

is available as Lanoxin (digoxin) 0.25 mg per tablet. How many tablets should the patient/clientreceive daily?

A)

1

2

B)

1

C)

2

D)

4

Ans:

C

Feedback: When solving any problem, first check that the order and supply are in the same weight measure. For this problem, an equivalent is necessary (1 mg = 1000 mcg) to change 500 mcg to 0.5 mg. To convert 500 mcg to milligrams, move the decimal point three places to the left. Therefore, 500 mcg = 0.5 mg. Estimate the aTmEoS unTtBtoAgNiK veS. E FoLrL mE ulR a.

MCeO thMod: 0.5 mg/0.25 mg  1 tablet = 0.5/0.25 = 2/1 = 2 tablets. Proportion (Ratios): 1 tablet : 0.25 mg :: x tablets : 0.5 mg; 0.25x = 0.5/0.25 = 2/1 = 2 tablets. Proportion (Fractions): 1 tablet/0.25 mg  x tablets/0.5 mg; 0.25x = 0.5/0.25 = 2/1 = 2 tablets. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1 tablet/0.25 mg  500 mcg  1 mg/1000 mcg = 1 tablet  500  1/0.25  1000 = 500/250 = 2/1 = 2 tablets. When the numerator and denominator are decimals, add zeros to each decimal to make the number of decimal places the same in both. Then move the decimal point the same number of spaces to the right in both decimals (three spaces in this example). It is suggested that the decimal points be moved prior to setting up the problem to reduce calculation errors.

Page 25

Chapter 5, Liquids for Injection Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1 1.

The physician ordered 100 mg of Cleocin (clindamycin) IM q6h. The drug is available in a

vial labeled 300 mg/2 mL. Using a 1-mL syringe and rounding off to the nearest tenth, how many milliliters of Cleocin would the nurse give for each dose? Use the formula method to calculate the dosage.

A)

0.4

B)

0.5

C)

0.6

D)

0.7

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Formula Method: 100 mg/300 mg  2 mL = 200/300 = 0.66 mL. To round to the nearest tenth, drop the final number. If that number is 5 or higher, drop it and increase the adjacent number by 1. If the final number is less than 5, then drop that number. Therefore, for 0.66, drop (6) and change 0.6 to 0.7. Draw up 0.7 mL in the 1-mL syringe.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 1

Difficulty: Moderate Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1 2.

The physician ordered 50 mg of gentamicin IM three times daily. The drug is available in a

vial labeled 40 mg/mL. Using a 3-mL syringe and rounding off to the nearest tenth, how many milliliters of gentamicin would the nurse give for each dose? Use proportion (ratios) to calculate the dosage.

A)

1.1

B)

1.2

C)

1.3

D)

1.5

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Proportion (Ratios): 40 mg : 1 mL :: S 50TB mA gN : xKS mE LL ; 4L0E xR =.5C 0/O 40M= 5/4 = 1.25 mL. To round to the TE nearest tenth, drop the final number. If that number is 5 or higher, drop it and increase the adjacent number by 1. If the final number is less than 5, then drop that number. Therefore, for 1.25, drop (5) and change 1.2 to 1.3. Draw up 1.3 mL in the 3-mL syringe.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1 3.

The patient/client is to receive Sandostatin 0.05 mg subcutaneously daily. The medication

is available as Sandostatin 100 mcg/1 mL. Which syringe should the nurse use to administer the medication? Use proportion (fractions) to calculate the dosage.

Page 2

A)

3 mL

B)

Insulin U-50

C)

Insulin U-100

D)

1-mL precision

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary (1 mg = 1000 mcg) to change 0.05 mg to 50 mcg (0.05 mg  1000 = 50 mcg). Estimate the amount to give. Proportion (Fractions): 1 mL/100 mcg  x mL/50 mcg; 100x = 50/100 =

1

2

= 0.5 mL. The correct syringe to select for this

injection is the 1 mL. Draw up 0.5 mL. The 3-mL syringe is used for a maximum volume of 3 mL of medication. Insulin syringes are used only for insulin administration, and the markings are in units. (Note: The 1-mL syringe is also called a precision and a tuberculin syringe. It is marked in milliliters to the nearest hundredth and in minims to the nearest half-minim.)

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1 4.

The patient/client is to receive Valium (diazepam) 8 mg IM every 4 hours prn for agitation.

The medication is available as Valium (diazepam) 5 mg/mL. Which syringe should the nurse use to administer the medication? Use dimensional analysis to calculate the dosage.

A)

3 mL

B)

Insulin U-50

C)

Insulin U-100

D)

1-mL precision

Ans:

A

Page 3

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Dimensional Analysis: 1 mL/5 mg  8 mg = 1 mL  8/5 = 8/5 = 1.6 mL. The correct syringe to select for this injection is a 3 mL. The markings are to the nearest tenth. The 1-mL syringe is used for a maximum volume of 1 mL of medication. Insulin syringes are used only for insulin administration. The markings are in units.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1 5.

The physician ordered heparin sodium 3000 units subcutaneously every 12 hours. The

Select the syringe to us medication is available as 5000 units/mL. e and the amount of heparin to give. Use the formula method to calculate the dosage.

A)

0.3 mL; 1-mL syringe

B)

0.6 mL; 1-mL syringe

C)

0.3 mL; Insulin U-50

D)

0.6 mL; Insulin U-100

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 3000 units/5000 units  1 mL = 3/5 = 0.6 mL. The 1-mL syringe is used for a maximum volume of 1 mL of medication. Although heparin is ordered in units, an insulin syringe is not used because insulin syringes are used only for insulin administration.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Page 4

Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 6.

The physician ordered 1.5 mg of subcutaneous epinephrine stat. The medication is

available in an ampule labeled 1:1000. How many milliliters should the nurse give?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. When a medication is supplied as a ratio, the ratio indicates the strength of the drug as grams per milliliters. Therefore, a ratio of 1:1000 means 1 g/1000 mL. SinceT1EgST is BalAsoNeKqS uiEvL alL enEt R to.1C0O 00Mmg, you can interpret the solution as 1000 mg/1000 mL. This question should be solved using a supply of 1000 mg/1000 mL. Estimate the amount to give. Formula Method: 1.5 mg/1000 mg  1000 mL = 1500/1000 = 3/2 = 1.5 mL. Proportion (Ratios): 1000 mL : 1000 mg :: x : 1.5 mg; 1000x = 1500/1000 = 3/2 = 1.5 mL. Proportion (Fractions): 1000 mL/1000 mg  x/1.5 mg; 1000x = 1500/1000 = 3/2 = 1.5 mL. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1000 mL/1 g  1.5 mg  1 g/1000 mg = 1000 mL  1.5  1/1000 = 1500/1000 = 3/2 = 1.5 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2

Page 5

7.

The physician ordered 10 mg of subcutaneous lidocaine. The medication is available in a

multidose vial labeled lidocaine 2%. How many milliliters should the nurse prepare?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. When a medication label states the strength of a drug as a percent, the percent means “parts per hundred.” Therefore, lidocaine 2% means 2 g of lidocaine in 100 mL. Since 1 g is also equivalent to 1000 mg, you can interpret the solution as 2000 mg in 100 mL. Estimate the amount to give. Formula Method: 10 mg/2000 mg  100 mL = 1000/2000 = 0.5 mL. Proportion (Ratios): 100 mL : 2000 mg :: x : 10 mg; 2000x = 1000/2000 = 0.5 mL. Proportion (Fractions): 100 mL/2000 mg  x/10 mg; 2000x = 1000/2000 = 0.5 mL. Use a conversion factor for dimensional analysis. Dimensional Analysis: 100 mL/2 g  10 mg  1 g/1000 mg = 100 mL  10TE S 1/T 2BA1N 00K0S=E1L0L0E 0/R 20.0C 0O=M0.5 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 8.

The patient/client is to receive morphine sulfate 4 mg IV stat. The medication is available

as morphine sulfate 10 mg/mL. How many milliliters of medication would the patient/client receive?

A)

0.04

B)

0.4

C)

0.45

Page 6

D)

0.5

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 4 mg/10 mg  1 mL = 4/10 = 0.4 mL. Proportion (Ratios): 1 mL : 10 mg :: x mL : 4 mg; 10x = 4/10 = 0.4 mL. Proportion (Fractions): 1 mL/10 mg = x/4 mg; 10x = 4/10 = 0.4 mL. Dimensional Analysis: 1 mL/10 mg  4 mg = 4/10 = 0.4 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 9.

The patient/client is to receive Dilantin (phenytoin sodium) 300 mg IV daily. The

medication is available as Dilantin (phenytoin sodium) 250 mg/5 mL. How many milliliters of medication would the patient/client receive?

A)

5.5

B)

6

C)

6.5

D)

7

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 300 mg/250 mg  5 mL = 1500/250 = 6 mL. Proportion (Ratios): 5 mL : 250 mg :: x mL : 300 mg; 250x = 1500/250 = 6 mL. Proportion (Fractions): 5 mL/250 mg = x mL/300 mg; 250x = 1500/250 = 6 mL. Dimensional Analysis: 5 mL/250 mg  300 mg = 1500/250 = 6 mL. Format: Multiple Choice Chapter: 5 Page 7

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 10.

The patient/client is to receive Tigan (trimethobenzamide hydrochloride) 150 mg IM stat.

The medication is available as Tigan (trimethobenzamide hydrochloride) 100 mg/mL. How many milliliters of medication would the patient/client receive?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problemT, E noSeTqB uiAvN alK enSt E isLnL ecEeR ss. arCyO . EMstimate the amount to give.

Formula Method: 150 mg/100 mg  1 mL = 150/100 = 1.5 mL. Proportion (Ratios): 1 mL : 100 mg :: x mL : 150 mg; 100x = 150/100 = 1.5 mL. Proportion (Fractions): 1 mL/100 mg = x/150 mg; 100x = 150/100 = 1.5 mL. Dimensional Analysis: 1 mL/100 mg  150 mg = 1 mL  150/100 = 1.5 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2

Page 8

11.

The patient/client is to receive Nembutal sodium (pentobarbital sodium) 120 mg IM at

bedtime prn. The medication is available as Nembutal sodium (pentobarbital sodium) 50 mg/mL. How many milliliters of medication would the patient/client receive?

A)

1.2

B)

1.4

C)

2.4

D)

2.8

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 120 mg/50 mg  1 mL = 120/50 = 2.4 mL. Proportion (Ratios): 1 mL : 50 mg :: x mL : 120 mg; 50x = 120/50 = 2.4 mL. Proportion (Fractions): 1 mL/50 mg = x mL/120 mg; 50x =120/50 = 2.4 mL. Dimensional Analysis: 1 mL/50 mg  120 mg = 1 mL  120/50 = 2.4 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 12.

The patient/client is to receive AquaMEPHYTON (phytonadione) 5 mg subcutaneously

every day for 3 days. The medication is available as AquaMEPHYTON (phytonadione) 10 mg/mL. How many milliliters should the nurse give each day?

A)

0.25

B)

0.5

C)

0.75

D)

1

Ans:

B

Page 9

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 5 mg/10 mg  1 mL = 5/10 = 0.5 mL. Proportion (Ratios): 1 mL : 10 mg :: x mL : 5 mg; 10x = 5/10 = 0.5 mL. Proportion (Fractions): 1 mL/10 mg = x mL/5 mg; 10x = 5/10 = 0.5 mL. Dimensional Analysis: 1 mL/10 mg  5 mg = 5/10 = 0.5 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 13.

The patient/client is to receive Compazine (prochlorperazine) 10 mg IM every 4 hours prn

for nausea and vomiting. The medication is available as Compazine (prochlorperazine) 5 mg/mL. How many milliliters should the nurse administer?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 10 mg/5 mg  1 mL = 10/5 = 2 mL. Proportion (Ratios): 1 mL : 5 mg :: x mL : 10 mg; 5x = 10/5 = 2 mL. Proportion (Fractions): 1 mL/5 mg = x mL/10 mg; 5x = 10/5 = 2 mL. Dimensional Analysis: 1 mL/5 mg  10 mg = 1 mL  10/5 = 10/5 = 2 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Page 10

Difficulty: Moderate Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 14.

The directions for reconstitution of ampicillin sodium for injection are on the drug label.

Directions read: “For IM use, add 3.5 mL sterile water for injection. Resulting solution contains 250 mg ampicillin sodium per mL. The vial contains ampicillin sodium equivalent to 1 gram.

Usual adult dosage of ampicillin is 250 mg–500 mg IM every 6 hours.” How much diluent is added to the vial to prepare the medication for IM use?

A)

1 mL

B)

3.5 mL

C)

250 mg/mL

D)

500 mg/mL

Ans:

B

Feedback: Refer to the directions on the label. The label reads, “Add 3.5 mL sterile water for injection. The resulting solution cToE ntS aiT nsB2A5N0KmSgE /m LLL.”ETRh.eCuOsuMal adult dosage is 250 mg to 500 mg.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 15.

The directions for reconstitution of oxacillin sodium for injection are on the drug label.

Directions read: “For IM use, add 5.7 mL sterile water for injection. Resulting solution contains 250 mg oxacillin sodium per 1.5 mL. The vial contains oxacillin sodium equivalent to 1 gram.

Usual adult dosage of oxacillin sodium is 250 mg–500 mg IM every 4 to 6 hours.” What is the final concentration of the prepared oxacillin solution for IM administration?

Page 11

A)

50 mg/1.5 mL

B)

125 mg/5.7 mL

C)

250 mg/1.5 mL

D)

500 mg/1.5 mL

Ans:

C

Feedback: Refer to the directions on the label. The label reads, “Add 5.7 mL sterile water for injection. The resulting solution contains 250 mg/1.5 mL.” The usual adult dosage is 250 mg to 500 mg.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 164, Injections From Powders Integrated Process: Teaching/LeT arE niS ngTBANKSELLER.COM Objective: 3 16.

The directions for reconstitution of oxacillin sodium for injection are on the drug label.

Directions read: “For IM use, add 5.7 mL sterile water for injection. Resulting solution contains 250 mg oxacillin sodium per 1.5 mL. The vial contains oxacillin sodium equivalent to 1 gram.

Usual adult dosage of oxacillin sodium is 250 mg–500 mg IM every 4 to 6 hours.” The patient/client is to receive 400 mg IM every 6 hours. How many milliliters would the nurse administer?

A)

1.7

B)

2.1

C)

2.4

D)

5.7

Ans:

C

Feedback: Refer to the directions on the label, which reads, “Add 5.7 mL of sterile water for injection. The resulting solution contains 250 mg/1.5 mL.” When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is

Page 12

necessary. Estimate the amount to give. Formula Method: 400 mg/250 mg  1.5 mL = 600/250 = 2.4 mL. Proportion (Ratios): 1.5 mL : 250 mg :: x mL : 400 mg; 250x = 600 mg/250 mg = 2.4 mL. Proportion (Fractions): 1.5 mL/250 mg = x mL/400 mg; 250x = 600 mg/250 mg = 2.4 mL. Dimensional Analysis: 1.5 mL/250 mg  400 mg = 1.5 mL  400/250 = 600 mg/250 mg = 2.4 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 17.

The directions for reconstitution of mezlocillin IV injection read: “For IV use, reconstitute

with 30 mL sterile water for injection. Each 30 mL of reconstituted solution will contain 3 grams of mezlocillin.” The patient/client is to receive 1.5 g of mezlocillin IV every 6 hours. How many milliliters would the nurse administer?

A)

1.5

B)

3

C)

15

D)

30

Ans:

C

Feedback: Refer to directions on the label. The label reads, “Add 30 mL sterile water for injection.

The resulting solution will contain 3 grams of mezlocillin.” When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give. Formula Method: 1.5 g/3 g  30 mL = 45/3 = 15 mL. Proportion (Ratios): 30 mL : 3 g :: x mL : 1.5 g; 3x = 45/3 = 15 mL. Proportion (Fractions): 30 mL/3 g  x mL/1/5 g; 3x = 45/3 = 15 mL. Dimensional Analysis: 30 mL/3 g  1.5 g = 30 mL  1.5/3 = 45/3 = 1.5 mL. Format: Multiple Choice Chapter: 5 Page 13

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 18.

The directions for reconstitution of a 5,000,000 unit vial of Pfizerpen (penicillin G

potassium) reads: “For IM reconstitution, add sterile water for injection using these mL diluent units, per mL of solution: 18 mL/250,000 8 mL/500,000 3 mL/1,000,000” The patient/client is to receive Pfizerpen (penicillin G potassium) 500,000 units IM now. What would be the best amount of diluent to add to the powder for reconstitution for IM use?

A)

3

B)

8

C)

18

D)

23

Ans:

B

Feedback: Adding 8 mL results in a dilution of 500,000 units per milliliter.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4 19.

The patient/client is to receive Humulin R 15 units subcutaneously daily at 7:30 AM. Which

syringe should the nurse use to administer the medication?

Page 14

A)

3 mL

B)

Insulin 50 unit

C)

Insulin 100 unit

D)

1-mL precision

Ans:

B

Feedback: Insulin syringes, which are marked in units, are used only for insulin. The low-dose 50-unit syringe should be used for injections of 50 units or less. The U-100 syringe is used for injections of 51 to 100 units. Use a U-50 syringe for this problem because the patient/client is receiving 15 units of insulin.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 176, Insulin Injections

TESTBANKSELLER.COM

Integrated Process: Teaching/Learning Objective: 4 20.

The patient/client is to receive Humulin NPH 56 units subcutaneously every morning

hour before breakfast. Which dosage and syringe is correct for the nurse to administer the medication?

A)

1-mL syringe drawn up with Humulin NPH at the 0.56-mL mark

B)

3-mL syringe drawn up with Humulin NPH at the 0.56-mL mark

C)

Insulin 100-unit syringe drawn up with Humulin NPH at the 56-unit mark

D)

Insulin 50-unit syringe drawn up with Humulin NPH at the 50-unit mark

Ans:

C

Feedback: Insulin syringes, which are marked in units, are used only for insulin administration.

The low-dose 50-unit syringe should be used for injections of 50 units or less. The insulin should be used for injections of 50 units or less. The U-100 syringe is used for injections of 51 to 100 units. The U-100 unit syringe would be used for this patient/client for 56 units of NPH. Format: Multiple Choice

Page 15

Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4 21.

A patient/client receives Humalog 7 units subcutaneously daily at 7:30 AM. The nurse

knows that this type of insulin will reach its peak effectiveness at which time?

A)

8:30 AM

B)

9:30 AM

C)

10:30 AM

D)

12:30 PM

Ans:

A

Feedback: Humalog is a rapid-acting insulin that has an onset of action in 5 minutes. It reaches its peak effectiveness in 1 hour and lTaE stsS2TtBoA4NhK ouSrE s.LTL heErR ef. orCe,Ow Mhen given at 7:30 AM, Humalog reaches its peak effectiveness at 8:30 AM. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4 22.

The healthcare provider has ordered the patient/client to receive insulin IV. Which insulin

would the nurse have to use?

A)

Humalog

B)

Lantus

C)

NPH

Page 16

D)

Regular

Ans:

D

Feedback: Regular insulin is the only insulin that may be given IV. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4 23.

The nurse has to administer Humulin R 18 units and NPH 35 units subcutaneous daily at

7:30 AM. What is the correct order for drawing up these medications?

1) Inject into the Humulin R vial 18 units of air 2) Inject into the NPH vial 35 units of air

TESTBANKSELLER.COM

3) Withdraw 18 units of Humulin R insulin 4) Withdraw 35 units of NPH insulin A)

1, 2, 3, 4

B)

1, 2, 4, 3

C)

2, 1, 3, 4

D)

2, 1, 4, 3

Ans:

C

Feedback: Inject into the NPH vial the amount of air equal to the amount of NPH insulin. Second, inject into the regular vial the amount of air equal to the amount of regular insulin. Third, withdraw the correct amount of regular insulin (clear insulin). Fourth, withdraw the correct amount of NPH insulin (cloudy insulin).

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 17

Difficulty: Difficult Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4 24.

A patient/client has a sliding scale for insulin dosage. The order is for Humulin R every 6

hours as follows. (Note: “BG” is used for blood glucose.) The physician's order reads: Accucheck every 6 hours BG 0–180 mg/dL no coverage BG 181 mg/dL–240 mg/dL 2 units subcutaneously BG 241 mg/dL–300 mg/dL 4 units subcutaneously BG 301 mg/dL–400 mg/dL 6 units subcutaneously BG >400 mg 8 units subcutaneously and call the physician

At 11 AM, the patient/client's Accucheck reading was 242 mg/dL. How many units of Humulin R insulin would the patient/client receive?

A)

2 units subcutaneously

B)

4 units subcutaneously

C)

6 units subcutaneously

D)

8 units subcutaneously and call the physician

Ans:

B

Feedback: The nurse gives the ordered insulin according to the results of the Accucheck. The Accucheck was 242 mg/dL. Therefore, the nurse would “cover” the patient/client with 4 units of Humulin R insulin.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning

Page 18

Objective: 4 25.

A patient/client has a sliding scale for insulin dosage. The order is for Humulin R every 6

hours as follows. (Note: “BG” is used for blood glucose.) The physician's order reads: Accucheck every 6 hours BG 0–80 mg/dL give 1 amp of D50 and call healthcare provider BG 81–100 mg/dL 0 units subcutaneously BG 101–150 mg/dL 2 units subcutaneously BG 151–200 mg/dL 3 units subcutaneously BG 201–250 mg/dL 5 units subcutaneously BG 251–300 mg/dL 8 units subcutaneously and call healthcare provider BG >300, call healthcare provider At 6 AM, the patient/client's Accucheck reading was 79 mg/dL. What would be the correct actions by the nurse?

A)

Call the healthcare provider first

B)

Give 1 amp of D50 and call the healthcare provider

C)

Give 2 units of Humulin R inS suTliB nANKSELLER.COM TE

D)

Give 8 units of Humulin R insulin and call the healthcare provider

Ans:

B

Feedback: The Accucheck was 79 mg/dL, which indicates a blood glucose level lower than recommended by the physician. The nurse should follow the protocol established by the sliding-scale orders.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 142, Syringes and Rounding Integrated Process: Teaching/Learning Objective: 1

Page 19

26.

The patient/client is to receive Stelazine (trifluoperazine HCL) 3 mg IM every 6 hours prn.

The medication is available as Stelazine (trifluoperazine HCL) 2 mg/mL. Which syringe should the nurse use to administer the medication? Use dimensional analysis to calculate the dosage.

A)

3 mL

B)

Insulin U-50

C)

Insulin U-100

D)

1-mL precision

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Dimensional Analysis: 1 mL/2 mg  3 mg = 1 mL  3/2 = 3/2 = 1.5 mL. The correct syringe to select for this injection is a 3 mL. The markings are to the nearest tenth. The 1-mL syringe is used for a maximum volume of 1 mL of medication. Insulin syringes are used only for insulin administration. The markings are in units.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 156, Special Types of Problems in Injections From a Liquid Integrated Process: Teaching/Learning Objective: 2 27.

The patient/client is to receive Demerol (meperidine) 50 mg IM stat. The medication is

available as Demerol (meperidine) 100 mg/mL. How many milliliters of medication would the patient/client receive?

A)

0.5

B)

1

C)

1.5

D)

2

Ans:

A

Page 20

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 50 mg/100 mg  1 mL = 50/100 = 0.5 mL. Proportion (Ratios): 1 mL : 100 mg :: x mL : 50 mg; 100 x = 50/100 = 0.5 mL Proportion ( Fractions): 1 mL/100mg = x/50 mg; 50/100 = 0.5 mL. Dimensional Analysis: 1 mL/100 mg  50 mg = 1 mL  50/100 = 0.5 mL Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 28.

The patient/client is to receive 250 mg of Ancef, IM, every 12 hours. The directions for

reconstitution of Ancef (cefazolin) for injection are on the drug label in the form of a table.

Directions read: “Use 2 mL of sterile water as a diluent. Resulting solution contains approximately 125 mg/mL with an approximate available volume of 2 mL.” What is the final concentration of the prepared cefazolin solution for IM administration?

A)

50 mg/1.5 mL

B)

100 mg/1.5 mL

C)

125 mg/ mL

D)

150 mg/ mL

Ans:

C

Feedback: Refer to the directions on the label. The label reads, “Add 2 mL sterile water for injection. The resulting solution contains 125 mg/ mL.” The usual adult daily dosage is 250 mg to 500 mg.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 21

Difficulty: Difficult Page and Header: 164, Injections From Powders Integrated Process: Teaching/Learning Objective: 3 29.

The directions for reconstitution of a 500 mg vial of Omnipen (ampicillin sodium) in

powder format for injection reads: “Reconstitute with 1.8 mL of sterile water for 500 mg. Each mL of reconstituted solution will contain 250 mg of Omnipen.” The patient/client is to receive 500 mg of Omnipen every 6 hours. How many milliliters would the nurse administer?

A)

0.5

B)

1

C)

15

D)

2

Ans:

D

Feedback: Refer to directions on the label. The label reads, “Add 1.8 mL sterile water diluent for injection. The resulting solution will contain 250mg/mL of Omnipen.” When solving any problem, first check that the order and the T suE ppl yB arA eN inKtS heEsLaL mE eR w. eiC ghOtMmeasure. For this problem, no ST equivalent is necessary. Estimate the amount to give. Formula Method: 500 mg/250 mg  1 mL = 500/250 = 2 mL. Proportion (Ratios): 1 mL : 250 mg :: x mL : 500 mg; 250x = 500/250 = 2 mL. Proportion (Fractions): 1 mL/250 mg  x mL/500 mg; 250x = 500/250 = 2 mL. Dimensional Analysis: 1 mL/250 mg  500 mg = 1 mL  500/250 = 2 mL. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 176, Insulin Injections Integrated Process: Teaching/Learning Objective: 4

Page 22

30.

A patient/client receives a combination of 18 units of Regular insulin and 20 units of NPH

or Lente insulin, subcutaneously daily at 8:00 AM. The nurse knows that this combination of insulin will have an onset at what time?

A)

8:30 AM

B)

9:00 AM

C)

9:30 AM

D)

10:00 AM

Ans:

B

Feedback: Regular insulin is short-acting insulin that has an onset of action in 60 minutes. It reaches its peak effectiveness in 2 to 4 hours and last 5 to 7 hours. NPH or Lente insulin is intermediate-acting insulin. It also has an onset of 1 to 2.5 hours and can last from 18 to 24 hours.

Therefore, when these insulins are given together at 8:00 AM, the onset will occur within the hour by 9:00 AM.

Page 23

Chapter 6, Calculation of Basic IV Drip Rates Format: Multiple Choice

Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 216, Types of IV Fluids Integrated Process: Communication and Documentation Objective: 1 1.

1

The physician ordered a patient/client to receive 1000 mL D5 2 NS to infuse over 24 hours.

Which solution should the nurse obtain from the supply cart?

A)

D5%W

B)

D5% 0.9 NS

C)

D5% 0.45 NS

D)

0.9% NS

Ans:

C 1

Feedback: D5W = D5%W; D5 NS = D5% 0.9 NS; D5 2 NS = D5% 0.45 NS; NS = 0.9% NS. The 0.45% is considered

1

2

because the NS solution is 0.9%.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 218, Kinds of IV Drip Factors Integrated Process: Communication and Documentation Objective: 2

Page 1

2.

The faculty member tells the nursing student to obtain an IV microdrip tubing set. What is

the drop factor on an IV microdrip?

A)

10 gtt/mL

B)

15 gtt/mL

C)

20 gtt/mL

D)

60 gtt/mL

Ans:

D

Feedback: There are three standard macrodrip IV tubing sets that deliver either 10 gtt/mL, 15 gtt/mL, or 20 gtt/mL. Microdrip IV tubing sets deliver 60 gtt/mL.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 214, Infusion P TuEmSpTs BANKSELLER.COM Integrated Process: Communication and Documentation Objective: 4 3.

The physician has ordered 1000 mL D5W, IV to run at 75 mL/hour. What is the correct

volume for infusion and rate for infusion on the infusion pump?

A)

Rate for infusion: 1000 mL; Volume for infusion: 75 mL

B)

Rate for infusion: 75 mL; Volume for infusion: 1000 mL

C)

Rate for infusion: 75 mL; Volume for infusion: 75 mL

D)

Rate for infusion: 1000 mL; Volume for infusion: 1000 mL

Ans:

B

Feedback: When an order reads 1000 mL D5W to run at 75 mL/hour, the volume for infusion is 1000 mL, and the rate for infusion is 75 mL. The order would read 75 mL to run at 1000 mL/hour for a rate of infusion at 1000 mL and volume for infusion of 75 mL. The order would read 75 mL to run at 75 mL/hour for a rate of infusion at 75 mL and volume for infusion of 75 mL. The order would read 1000 mL at 1000 mL for a rate of infusion at 1000 mL and volume for infusion of 1000 mL.

Page 2

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 219, Infusion Pumps Integrated Process: Teaching/Learning Objective: 4, 6 4.

The physician ordered Vancomycin (vancomycin hydrochloride) 500 mg IVPB every 24

hours. The medication was placed in 100 mL of D5W to infuse over 60 minutes. What is the correct volume for infusion and rate for infusion on the infusion pump that has a microdrip tubing?

A)

Secondary volume: 100 mL; Secondary rate: 100 mL

B)

Secondary volume: 500 mL; Secondary rate: 10 gtt/mL

C)

Secondary volume: 100 mL; Secondary rate: 60 minutes

D)

Secondary volume: 500 mTLE; S SeTcB onAdNarKySraEtL e:L6E 0R m.inCuO teM s

Ans:

A

Feedback: An infusion pump can be used for intravenous piggyback (IVPB). The order reads “medication was placed in 100 mL of D5W to infuse over 60 minutes.” The nurse would enter two pieces of information into the pump: the total number of milliliters to be infused (100 mL) and the number of milliliters per hour. The infusion pump always uses a microdrip tubing (60 gtt/mL).

Therefore, the pump will deliver 100 mL/hour. You can also use this formula to estimate milliliters per hour: total number of milliliters ordered/Number of hours to run. Therefore, 100 mL/1 hour (60 minutes) = 100 mL/hour. The secondary volume is 100 mL, and the secondary rate is 100 mL/hour. The pump interrupts the primary IV to administer the IVPB over 1 hour and then resumes the primary flow. The other choices are not correctly written orders or settings.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

Page 3

Difficulty: Moderate Page and Header: 220, Labeling IVs Integrated Process: Teaching/Learning Objective: 5 5.

What information is missing from this IV label?

10:00 AM, Jane Doe, 1000 mL D5W at 100 mL/hr or 17 gtt/min, AB (initials).

A)

Date and time

B)

Date and patient/client name

C)

Time, room, and bed number

D)

Date, room, and bed number

Ans:

D

Feedback: The missing information is date, room, and bed number. Every IV must be identified so that any professional can check both the fluid that is hanging and the drip rate. A typical order includes the following information: patient/client name, order, room and bed number, date and time, rate of infusion, and initials of the nurse who hung the IV.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6 6.

The physician ordered D5 NS to run at 125 mL/hour with a drop factor of 20 gtt/mL.

Calculate the IV flow rate in gtt/minute. Round off to the nearest whole number.

A)

41

B)

42

C)

43

D)

44

Ans:

B

Page 4

Feedback: Use this formula: Number of milliliters to infuse  TF/Number of minutes to infuse = Drops per minute or gtt/minute. Therefore, 125 mL  20 gtt/mL ÷ 60 minutes = 2500/60 = 41.66 gtt/minute. Round off to the nearest whole number: 42 gtt/minute.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 219, Infusion Pumps; 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 4, 6 7.

The physician ordered 500 mL NS to run over 6 hours with a drop factor of 20 gtt/mL.

Calculate the correct IV flow rate to set on the infusion pump.

A)

27 gtt/minute

B)

28 gtt/minute

C)

83 mL/hour

D)

84 mL/hour

Ans:

C

Feedback: Infusion pumps are always calculated in milliliters per hour. Use this formula: Total number of milliliters ordered/Number of hours to run = mL/hour. Therefore, 500 mL/6 hours = 83.33 mL/hour. Round off to the nearest whole number: 83 mL/hour.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6

Page 5

8.

The physician ordered a unit of 250 mL packed red blood cells to infuse over 4 hours with

a drop factor of 10 gtt/mL. Calculate the correct IV flow rate in milliliters per hour. Round off to the nearest whole number.

A)

42

B)

63

C)

83

D)

120

Ans:

B

Feedback: This IV order for packed red blood cells specifies the total amount of fluid to be infused and the duration of administration. To calculate milliliters per hour, simply divide the total volume (250 mL) by the number of hours (4 hours). Therefore, 250 mL/4 hours = 62.5 mL. Round off to the nearest whole number: 63 mL/hour.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological InteT grE itS y:TPBhA arN mK acSoE loLgL icE alRa. ndCPOaMrenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6 9.

The physician ordered 1000 mL NS to infuse over 10 hours with a drop factor of 15 gtt/mL.

Calculate the correct IV flow rate in drops per minute. Round off to the nearest whole number.

A)

24

B)

25

C)

100

D)

150

Ans:

B

Feedback: Use this formula: Number of milliliters to infuse  TF/Number of minutes to infuse = Drops per minute or gtt/minute. Therefore, 1000 mL  15 gtt/mL ÷ 600 minutes (10 hours  60 minutes) = 15,000/600 = 24.9 gtt/minute. Round off to the nearest whole number: 25 gtt/minute.

Page 6

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates; 226, Determining Hours an IV Will Run Integrated Process: Teaching/Learning Objective: 6, 7 10.

The physician ordered 1000 mL of D5W to infuse at 125 mL/hour with a drop factor of 10

gtt/mL. How many hours will this IV run?

A)

6

B)

7

C)

8

D)

9

Ans:

C

Feedback: This IV order specifies the total amount of fluid to be infused and the amount to be given per hour (milliliters per hour). To calculate the duration of infusion (number of hours), simply divide the total volume (1000 mL) by the volume per hour (125 mL). Therefore, 1000 mL ÷ 125 mL/hour = 8 hours to infuse.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 226, Determining Hours an IV Will Run Integrated Process: Teaching/Learning Objective: 6, 7 11.

The physician ordered a total of 1500 mL of NS to infuse at 75 mL/hour with a drop factor

of 15 gtt/mL. How many hours will this IV run?

Page 7

A)

10

B)

15

C)

20

D)

25

Ans:

C

Feedback: This IV order specifies the total amount of fluid to be infused and the amount to be given per hour (milliliters per hour). To calculate the duration of infusion (number of hours), simply divide the total volume (1500 mL) by the volume per hour (75 mL). Therefore, 1500 mL ÷ 75 mL/hour = 20 hours to infuse.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, CalculatinTgEB pL RL atE esR.COM SaTsiBc AIVNKDSriE Integrated Process: Teaching/Learning Objective: 6 12.

The physician ordered 1000 mL of D5W to infuse over 16 hours with a drop factor of 20

gtt/mL. Calculate the correct IV flow rate in drops per minute. Round off to the nearest whole number.

A)

21

B)

28

C)

32

D)

46

Ans:

A

Feedback: Use this formula: Number of milliliters to infuse  TF/Number of minutes to infuse = Drops per minute or gtt/minute. Therefore, 1000 mL  20 gtt/mL ÷ 960 minutes (16 hours  60 minutes) = 20,000/960 = 20.8 gtt/minute. Round off to the nearest whole number: 21 gtt/minute.

Format: Multiple Choice

Page 8

Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 226, Determining Hours an IV Will Run Integrated Process: Teaching/Learning Objective: 6, 7 13.

The physician ordered 2500 mL of NS to infuse in 150 mL/hour with a drop factor of 15

gtt/mL. How long will this IV run?

A)

14 hours

B)

15 hours and 30 minutes

C)

16 hours and 36 minutes

D)

17 hours

Ans:

C

Feedback: A routine IV order specifies the total amount of fluid to be infused and the amount to be given per hour (milliliters per houTrE ). S TT oB caAlcNuK laS teEtL heLdEuR ra. tiC onOoMf infusion (number of hours), simply divide the total volume (2500 mL) by the volume per hour (150 mL). Therefore, 2500 mL ÷ 150 mL/hour = 16.6 hours to infuse. The next step requires that you convert the 0.6 hour to minutes. Multiply: 0.6  60 minutes = 36 minutes. Therefore, the answer is 16 hours and 36 minutes.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 223, Choosing the Infusion Set Integrated Process: Teaching/Learning Objective: 3 14.

An IV infusion pump is not available. The nurse would use a macrodrip for the IV infusion

in which instance?

Page 9

A)

The order specifies a large amount of fluid over a short time

B)

A small amount of IV fluid is to be infused to a child

C)

The IV infusion is to be administered over a long period

D)

Microdrips per minute are too few to count accurately

Ans:

A

Feedback: A macrodrip is used when the order specifies a large amount of fluid over a short time.

A microdrip is used when the IV is to be administered over a long period, a small amount of fluid is to be infused, or the macrodrops per minute are too few.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 229, Adding Medications to IVs Integrated Process: Teaching/LeT arE niS ngTBANKSELLER.COM Objective: 6, 9 15.

1

The physician ordered 1000 mL, D5 2 NS with KCL 10 mEq IV over 8 hours. The nurse

located a vial of potassium chloride 40 mEq/20 mL. How many milliliters of KCL should the nurse add to the IV bag?

A)

5

B)

10

C)

15

D)

20

Ans:

A

Feedback: To add medications to a continuous IV, estimate the amount to give using calculations for preparing liquids for injection in Chapter 5. When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary.

Estimate the amount to give. Formula Method: 10 mEq/40 mEq  20 mL = 200/40 = 5 mL. Proportion (Ratios): 20 mEq : 40 mg :: x mL : 10 mEq; 40x = 200/40 = 5 mL. Proportion (Fractions): 20 mL/40 mEq = x mL/10 mEq; 40x = 200/40 = 5 mL. Dimensional Analysis: 20

Page 10

mL/40 mEq  10 mEq = 20 mL 10/40 = 200/40 = 5 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 229, Adding Medications to IVs Integrated Process: Teaching/Learning Objective: 6, 9 16.

1

The physician ordered 250 mL D5 2 NS with aminophylline 0.25 g added for

administration over 1 hour, every 6 hours. The nurse located a vial of aminophylline 500 mg/20 mL. How many milliliters of medication should be added to the IV bag?

A)

5

B)

10

C)

15

D)

20

Ans:

B

Feedback: To add medications to a continuous IV, estimate the amount to give using calculations for preparing liquids for injection in Chapter 5. When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary (1 g = 1000 mg) to convert 0.25 g to 250 mg. When you move from a larger quantity (gram) to a smaller quantity (milligrams), multiply or move the decimal three places to the right. Therefore, 0.25 g = 250 mg. Estimate the amount to give. Formula Method: 250 mg/500 mg  20 mL = 5000/500 = 10 mL. Proportion (Ratios): 20 mL : 500 mg :: x mL : 250 mg; 500x = 5000/500 = 10 mL. Proportion (Fractions): 20 mL/500 mg = x mL/250 mg; 500x = 5000/500 = 10 mL. Use a conversion factor for dimensional analysis. Dimensional Analysis: 20 mL/500 mg  0.25 g  1000 mg/1 g = 20 mL  0.25  1000/500  1 = 5000/500 = 10 mL. For liquids, the four calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Page 11

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates; 231, Medications for Intermittent IV Administration Integrated Process: Teaching/Learning Objective: 6, 10 17.

The physician ordered clindamycin (Cleocin) 900 mg in 75 mL over 30 minutes with a

drop factor of 15 gtt/mL. What is the correct IV flow rate in drops per minute? Use both the standard formula and dimensional analysis to solve this problem. Round off to the nearest whole number.

A)

37

B)

38

C)

75

D)

150

Ans:

B

Feedback: For IV piggyback problems, use the standard calculation formula used for IVs: Milliliters  TF/Minutes = gtt/minute. Therefore, 75 mL  15 gtt/mL ÷ 30 minutes = 1125/30 = 37.5 gtt/minute; round off to 38 gtt/minute. Use this formula for dimensional analysis: gtt/mL  mL/minute. Therefore, 15 gtt/1 mL  75 mL/30 minutes = 15 gtt  75/1  30 = 1125 gtt/30 minutes = 37.5 gtt/minute; round off to 38 gtt/minute.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 231, Medications for Intermittent IV Administration

Page 12

Integrated Process: Teaching/Learning Objective: 6, 10 18.

The physician has ordered Tagamet (cimetidine) 300 mg in 50 mL D5W over 30 minutes

with a drop factor of 10 gtt/mL. What is the correct IV flow rate in drops per minute? Use both the standard formula and dimensional analysis to solve this problem. Round off to the nearest whole number.

A)

16

B)

17

C)

50

D)

100

Ans:

B

Feedback: For IV piggyback problems, use the standard calculation formula used for IVs: Milliliters  TF/Minutes = gtt/minute. Therefore, 50 mL  10 gtt/mL ÷ 30 minutes = 500/30 = 16.6 gtt/minute; round off to 17 gtt/minute. Use this formula for dimensional analysis: gtt/mL  mL/minute. Therefore, 10 gtt/1mL  50 mL/30 minutes = 10 gtt  50/1  30 minutes = 500/30 =16.6 gtt/minute; round off to 17TgE tt/SmTinBuA teN. KSELLER.COM Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 236, Enteral Nutrition Integrated Process: Teaching/Learning Objective: 11 19.

The physician ordered

3

4 -strength Ensure. The total volume is 240 mL. How many

milliliters of Ensure should be mixed with the water?

A)

150

B)

160

C)

170

D)

180

Page 13

Ans:

D

Feedback: Begin with the total volume of 240 mL. If a then

3

4

3

4 -strength solution of Ensure is desired,

of 240 mL is 180 mL. The difference in volume is 60 mL of water that is needed to be

mixed with the Ensure.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 236, Enteral Nutrition Integrated Process: Teaching/Learning Objective: 11 20.

The physician has ordered

1

4 -strength Isocal. The total volume is 100 mL. How many

milliliters of water need to be mixed with the Isocal?

A)

25

B)

50

C)

75

D)

100

Ans:

C

Feedback: Begin with the total volume of 100 mL. If a then

1

4

1

4 -strength solution of Isocal is desired,

of 100 mL is 25 mL. The difference in volume is 75 mL of water that is needed to be

mixed with Isocal.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 216, Types of IV Fluids; 219, Infusion Pumps

Page 14

Integrated Process: Teaching/Learning Objective: 3, 4 21.

The patient/client is ordered 500 mL of an IV solution to run over 10 hours via an infusion

pump. The nurse understands that the rate will be stated and programmed as milliliters per hour.

What will be the tubing factor for the infusion pump? Round off to the nearest whole number.

A)

10

B)

15

C)

20

D)

60

Ans:

D

Feedback: With an infusion pump, the infusion rate is set in milliliters per hour, and the pump automatically calculates the dose in milligrams, micrograms, and so forth. Some pumps use regular IV tubing; others use tubing specific to the pump. The tubing factor for an IV infusion pump is 60 gtt/mL.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6 22.

The physician ordered 500 mL of D5W to run over 6 hours. How many milliliters per hour

would the patient/client receive? Round off to the nearest whole number.

A)

71

B)

83

C)

100

D)

125

Ans:

B

Page 15

Feedback: This IV order specifies the total amount of fluid to be infused and the duration of administration. To calculate milliliters per hour, simply divide the total volume (500 mL) by the number of hours (6 hours). Therefore, 500 mL/6 hours = 83.3 mL. Round off to 83 mL (nearest whole number).

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates; 226, Determining Hours an IV Will Run Integrated Process: Teaching/Learning Objective: 6, 7 23.

The physician ordered 1000 mL of NS to run at 167 mL/hour. How many hours should it

take for the IV to infuse? Round off to the nearest whole number.

A)

4

B)

6

C)

8

D)

10

Ans:

B

Feedback: This IV order specifies the total amount of fluid to be infused and the amount to be given per hour (milliliters per hour). To calculate the duration of infusion (number of hours), simply divide the total volume (1000 mL) by the volume per hour (167 mL). Therefore, 1000 mL ÷ 167 mL/hour = 5.98 hours. Round off to 6 hours.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates

Page 16

Integrated Process: Teaching/Learning Objective: 6 24.

The patient/client is to receive 1000 mL of NSS over a 10-hour period of time. Use a

macrodrip of 15 gtt/mL and determine the drops per minute. Use dimensional analysis to calculate the answer.

A)

17

B)

25

C)

32

D)

43

Ans:

B

Feedback: This IV order specifies the total amount of fluid to be infused and the duration of administration. To calculate drops per minute using dimensional analysis, use this formula: gtt/mL  Total mL/Minutes. Therefore, 15 gtt/1 mL  1000 mL/10 hours  1 hour/60 minutes = 15 gtt  1000  1/1  10  60 minutes = 1500/600 = 25 gtt/minute.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 231, Medications for Intermittent IV Administration Integrated Process: Teaching/Learning Objective: 6, 10 25.

The physician ordered Timentin (ticarcillin) 500 mg in 50 mL to infuse over 30 minutes.

The drop factor is 15 gtt/mL. Calculate the flow rate in drops per minute.

A)

18

B)

25

C)

38

D)

42

Ans:

B

Page 17

Feedback: For IV piggyback problems, use the standard calculation formula used for IVs: Milliliters  TF/Minutes = gtt/minute. Therefore, 50 mL  15 gtt/mL ÷ 30 minutes = 750/30 = 25 gtt/minute. You can also use the dimensional analysis formula: gtt/mL  Total mL/Minutes: 15 gtt/1 mL  50 mL/30 minutes; 15 gtt  50/1  30 minutes = 750 gtt/30 minutes = 25 gtt/minute.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6 26.

The physician ordered 500 mL D5 ½ NS to run at 100 mL/hour with a drop factor of 60

gtt/mL. Calculate the IV flow rate in gtt/minute. Round off to the nearest whole number.

A)

25

B)

50

C)

75

D)

100

Ans:

D

Feedback: Use this formula: Number of milliliters to infuse  DF/Number of minutes to infuse = Drops per minute or gtt/minute. Therefore, 100 mL  60 gtt/mL ÷ 60 minutes = 100 × 60/60 = 100 gtt/min.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates; 226, Determining Hours an IV Will Run Integrated Process: Teaching/Learning

Page 18

Objective: 6, 7 27.

The physician ordered 1000 mL of LR to infuse at 83 mL/hour with a drop factor of 20

gtt/mL. How many hours will this IV run?

A)

6

B)

8

C)

10

D)

12

Ans:

D

Feedback: This IV order specifies the total amount of fluid to be infused and the amount to be given per hour (milliliters per hour). To calculate the duration of infusion (number of hours), simply divide the total volume (1000 mL) by the volume per hour (83 mL). Therefore, 1000 mL ÷ 83 mL/hour = 12 hours to infuse (round off to the nearest whole number).

Format: Multiple Choice Chapter: 6 Client Needs: Physiological InteT grE itS y:TPBhA arN mK acSoE loLgL icE alRa. ndCPOaMrenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates Integrated Process: Teaching/Learning Objective: 6 28.

The physician ordered 500 mL of D5W to infuse over 8 hours with a drop factor of 20

gtt/mL. Calculate the correct IV flow rate in drops per minute. Round off to the nearest whole number.

A)

15

B)

18

C)

21

D)

25

Ans:

C

Page 19

Feedback: Use this formula: Number of milliliters to infuse  DF/Number of minutes to infuse = Drops per minute or gtt/minute. Therefore, 500 mL  20 gtt/mL ÷ 480 minutes (8 hours  60 minutes) = 10,000/480 = 20.8 gtt/minute. Round off to the nearest whole number: 21 gtt/minute.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 221, Calculating Basic IV Drip Rates; 229, Adding Medications to IVs Integrated Process: Teaching/Learning Objective: 6, 9 1

29.

The physician ordered 500 mL D5 2 NS with 60 mEq of KCL (potassium chloride) for

administration over 5 hours. The nurse located a vial of KCL, 40 mEq/20 mL. How many milliliters of medication should be added to the IV bag?

A)

10

B)

20

C)

30

D)

40

Ans:

C

Feedback: To add medications to a continuous IV, estimate the amount to give using calculations for preparing liquids for injection in Chapter 5. When solving any problem, first check that the order and the supply are in the same weight measure. Estimate the amount to give. Use Proportion, both ratios and fractions. Proportion (Ratios): 20 mL : 40 mEq :: x mL : 60 mEq; 40x =1200/40 = 30 mL Proportion (Fractions): 20 mL/40 mEq = x mL/60 mEq; 40x =. 1200/40 = 30 mL. For liquids, the two calculation methods are set up the same as for oral solids, except the supply includes a liquid measurement.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Page 20

Cognitive Level: Apply Difficulty: Moderate Page and Header: 221, Calculating Basic IV Drip Rates; 231, Medications for Intermittent IV Administration Integrated Process: Teaching/Learning Objective: 6, 10 30. The physician ordered Solu-Cortef (hydrocortisone sodium succinate) 250 mg in 1000 mL over 10 hours with a drop factor of 10 gtt/mL. What is the correct IV flow rate in drops per minute?

Use the standard formula to solve this problem. Round off to the nearest whole number.

A)

15

B)

17

C)

19

D)

21

Ans:

B

Feedback: For IV piggyback problems, use the standard calculation formula used for IVs: Total milliliters  TF/minutes = gtt/minT utEeS . TThB erAefNoK reS , 1E0L0L 0E mR L.C1O 0M gtt/mL ÷ 600 minutes ( 10 hrs × 60 minutes) = 10,000/600 = 16.66 gtt/minute; round off to 17 gtt/minute.

Page 21

Chapter 7, Special Types of IV Calculations Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 261, Amount of Drug in a Solution Integrated Process: Teaching/Learning Objective: 1 1.

Select the correct formula to use to identify the amount of drug in 1 mL of solution.

A)

Amount of drug (mL)/Amount of fluid  Supply = 1 mL

B)

Supply : Have :: 1 mL : Desire

C)

Supply/Have = 1 mL/Desire

D)

Amount of drug (mL)/AmToE unStToB f fAluNidKS =E AL mLoE unRt . ofCdOruMg in 1 mL

Ans:

D

Feedback: The four methods of calculation (formula method, proportion [ratios], proportion [fractions] and dimensional analysis) can be used to determine the amount of drug in 1 mL of a solution. These calculations can be complicated. It is suggested that a simple reduction be done using the following formula: Amount of drug/Amount of fluid (mL) = Amount of drug in 1 mL. Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2

Page 1

2.

The physician ordered heparin 850 units/hour. There are 25,000 units of heparin in 500 mL

of D5W. Calculate the correct IV flow rate in milliliters per hour.

A)

17

B)

18

C)

19

D)

20

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 850 units/25,000 units  500 mL = 425,000/25,000 = 17 mL/hour. Proportion (Ratios): 500 mL : 25,000 units :: x mL : 850 units; 25,000x = 425,000/25,000 = 17 mL/hour.

Proportion (Fractions): x mL/850 units = 500 mL/25,000 units; 25,000x = 425,000/25,000 = 17 mL/hour. Dimensional Analysis: 500 mL/25,000 units  850 units/1 hour = 500 mL  850/25,000  1 hour = 425,000/25,000 = 17 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 3.

The physician ordered aminophylline 250 mg in 500 mL of D5W. It is to infuse at 20

mg/hour per infusion pump. Calculate the correct IV flow rate in milliliters per hour.

A)

30

B)

35

C)

40

D)

45

Ans:

C

Page 2

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 20 mg/250 mg  500 mL = 10,000/250 = 40 mL/hour. Proportion (Ratios): 500 mL : 250 mg :: x mL : 20 mg; 250x = 10,000/250 = 40 mL/hour. Proportion (Fractions): 500 mL/250 mg = x mL/20 mg; 250x = 10,000/250 = 40 mL/hour. Dimensional Analysis: 500 mL/250 mg  20 mg/1 hour = 500 mL  20/250  1 hour = 10,000/250 = 40 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 4.

The physician ordered aminophylline 250 mg in 500 mL of D5W. It is to infuse at 30

mg/hour per infusion pump. How many hours will the IV run? Round to the nearest hour.

A)

8

B)

10

C)

12

D)

14

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. This is a two-part problem. First, calculate milliliters per hour, then calculate the number of hours by using this formula: Number of milliliters/Number of milliliters per hour = Hours. Estimate the amount to give. Formula Method: 30 mg/250 mg  500 mL = 15,000/250 = 60 mL/hour. Proportion (Ratios): 500 mL : 250 mg :: x mL : 30 mg; 250x = 15,000/250 = 60 mL/hour. Proportion (Fractions): 500 mL/250 mg = x mL/ 30 mg; 250x = 15,000/250 = 60 mL/hour. Dimensional Analysis: 500 mL/250 mg  30 mg/1 hour = 500 mL  30/250  1 hour = 15,000/250 = 60 mL/hour. Now calculate the number of hours.

Page 3

Number of milliliters/Number of milliliters per hour = Hours. Therefore, 500 mL/60 mL/hour = 8.3 hours. Round to the nearest hour: 8 hours.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 5.

The physician ordered Pronestyl (procainamide) 2 g in 250 mL of D5W. It is to infuse at

0.24 g/hour per infusion pump. Calculate the correct IV flow rate in milliliters per hour.

A)

30

B)

35

C)

40

D)

45

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give.

Formula Method: 0.24 g/hour ÷ 2 g  250 mL = 60/2 = 30 mL/hour. Proportion (Ratios): 250 mL : 2 g :: x mL : 0.24 g; 2x = 60 mL/2 = 30 mL. Proportion (Fractions): 250 mL/2 g = x mL/0.24 g; 2x = 60 mL/2 = 30 mL. Dimensional Analysis: 250 mL/2 g  0.24 g/1 hour = 250 mL  0.24/2  1 hour = 60 mL/2 hours = 30 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning

Page 4

Objective: 2 6.

The physician ordered Pronestyl (procainamide) 2 g in 500 mL of D5W. It is to infuse at

0.24 g/hour per infusion pump. How many hours will the IV run? Round to the nearest hour.

A)

7

B)

8

C)

9

D)

10

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give. This is a two-part question. First, calculate milliliters per hour, then calculate the hours by using this formula: Number of milliliters/Number of milliliters per hour = Hours. Estimate the amount to give. Formula Method: 0.24 g/hour ÷ 2 g  500 mL = 120/2 = 60 mL/hour. Proportion (Ratios): 500 mL : 2 g :: x mL : 0.24 g; 2x = 120/2 = 60 mL. Proportion (Fractions): 500 mL/2 g = x mL/0.24 g; 2x = 120/2 = 60 mL/2. Dimensional Analysis: 500 mL/2 g  0.24 g/1 hour = 500 mL  0.24/2  1 hour = 120 mL/2 = 60 mL. NowTcEalc ulB atA eN thK eS nuEm r oRf.hC ouOrsM: Number of milliliters/Number of ST LbLeE milliliters per hour = Hours. Therefore, 500 mL ÷ 60 mL/hour = 8.3 hours. Round to the nearest hour: 8 hours.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 7.

The physician ordered lidocaine 2 g in 500 mL of D5W. It is to infuse at 1 mg/minute per

infusion pump. What is the correct IV flow rate in milliliters per hour?

A)

5

B)

10

Page 5

C)

15

D)

20

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a two-part problem. Begin by changing 1 mg/minute to 60 mg/hour (60 minutes = 1 hour) and 2 g to 2000 mg (1 mg = 1000 mg).

Estimate the amount to give. Formula Method: 60 mg/hour ÷ 2000 mg  500 mL = 30,000/2000 = 15 mL/hour. Proportion (Ratios): 500 mL : 2000 mg :: x mL : 60 mg; 2000x = 30,000/2000 = 15 mL/hour. Proportion (Fractions): 500 mL/2000 mg = x mL/60 mg; 2000x = 30,000/2000 = 15 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 500 mL/2 g  1 mg/1 minute  1 g/1000 mg  60 minutes/1 hour = 500 mL  1  1  60/2  1  1000  1 = 30,000 mL/2000 hours = 15 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 8.

The physician ordered lidocaine 2 g in 500 mL of D5W. It is to infuse at 1 mg/minute per

infusion pump. How many hours will the IV run? Round to the nearest hour.

A)

30

B)

31

C)

32

D)

33

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, calculate milliliters per hour, then calculate number of hours. Begin by changing 1 mg/minute to

Page 6

60 mg/hour (60 minutes = 1 hour) and converting 2 g to 2000 mg (1 mg = 1000 mg). Estimate the amount to give. Formula Method: 60 mg/hour ÷ 2000 mg  500 mL = 30,000/2000 = 15 mL/hour.

Proportion (Ratios): 500 mL : 2000 mg :: x mL : 60 mg; 2000x = 30,000/2000 = 15 mL/hour.

Proportion (Fractions): 500 mL/2000 mg = x mL/60 mg; 2000x = 30,000/2000 = 15 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 500 mL/2 g  1 mg/1 minute  1 g/1000 mg  60 minutes/1 hour = 500 mL  1  1  60/2  1  1000  1 = 30,000/2000 hours = 15 mL/hour. To calculate the number of hours, use this formula: Number of milliliters/Number of milliliters per hour = Hours. Therefore, 500 mL ÷ 15 mL/hour = 33.33 hours.

Round to the nearest hour: 33 hours.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 9.

The physician ordered Intropin (dopamine) 400 mg in 250 mL of D5W. It is to infuse at

100 mcg/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

4

B)

6

C)

8

D)

10

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to milligrams per milliliter: 400 mg/250 mL = 1.6 mg/mL. Next, change 1.6 mg to 1600 mcg. Divide by 60 minutes to get micrograms per minute:

Page 7

1600 mcg/60 minutes = 26.67 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 100 mcg/minute ÷ 26.67 mcg/minute  1 mL = 3.749 mL/hour; round to 4 mL/hour. Proportion (Ratios): 1 mL : 26.67 mcg :: x mL : 100 mcg; 26.67x = 100 mcg/26.67 mcg = 4 mL/hour. Proportion (Fractions): 1 mL/26.67 mcg = x mL/100 mg; 26.67x = 100 mcg/26.67 mcg = 4 mL/hour. Use two conversion factors for dimensional analysis.

Dimensional Analysis: 250 mL/400 mg  100 mcg/1 minute  60 minutes/1 hour  1 mg/1000 mcg; 250 mL  100  60  1/400  1  1 hour  1000 = 1,500,000 mL/400,000 = 4 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 10.

The physician ordered 2 mg of epinephrine in 250 mL of D5W. It is to infuse at 4

mcg/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

28

B)

29

C)

30

D)

31

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to milligrams per milliliter: 2 mg/250 mL = 0.008 mg/mL. Next, change milligrams to micrograms: 0.008 mg = 8 mcg/mL (1 mg = 1000 mcg).

Divide by 60 to get micrograms per minute: 8 mcg/60 minutes = 0.133 mcg/minute. Estimate the amount to give. Formula Method: 4 mcg/minute ÷ 0.133 mcg/minute  1 mL = 30.07 mL/hour;

Page 8

round to 30 mL/hour. Proportion (Ratios): 1 mL : 0.133 mcg :: x mL : 4 mcg; 0.133x = 4 mcg/0.133 mcg = 30 mL/hour. Proportion (Fractions): 1 mL/0.133 mcg = x mL/4 mcg; 0.133x = 4 mcg/0.133 mcg = 30 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/2 mg  4 mcg/minute  60 minutes/1 hour  1 mg/1000 mcg = 250  4  60  1/2  1  1 hour  1000 = 60,000/2000 = 30 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 11.

The physician ordered 50 mg of nitroglycerin in 250 mL of D5W. It is to infuse at 10

mcg/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

2

B)

3

C)

4

D)

5

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to milligrams per milliliter: 50 mg/250 mL = 0.2 mg/1 mL. Next, change milligrams to micrograms: 0.2 mg/mL = 200 mcg/mL (1 mg = 1000 mcg).

Divide by 60 to get micrograms per minute: 200 mcg/60 minutes = 3.33 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 10 mcg/minute ÷ 3.33 mcg/minute  1 mL = 3 mL/hour. Proportion (Ratios): 1 mL : 3.33 mcg :: x mL : 10 mcg; 3.33x = 10 mcg/3.33 = 3 mL/hour. Proportion (Fractions): 1 mL/3.33 mcg = x mL/10 mcg; 3.33x = 10

Page 9

mcg/3.33 = 3 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/50 mg  10 mcg/minute ÷ 1 minute  60 minutes/1 hour  1 mg/1000 mcg = 250 mL  10  60  1/50  1  1 hour  1000 = 150,000/50,000 = 3 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 12.

The physician ordered 50 mg of Nipride (nitroprusside sodium) in 250 mL of D5W. It is to

infuse at 3 mcg/kg/minute per infusion pump. The patient/client weighs 60 kg. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

52

B)

53

C)

54

D)

55

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, determine how many micrograms per minute to infuse based on the patient/client's weight.

Multiply: 60 kg  3 mcg/minute = 180 mcg/minute. Next, reduce the numbers in the standard solution to milligrams per milliliter: 50 mg/250 mL = 0.2 mg/1 mL. Then, change milligrams to micrograms: 0.2 mg/mL = 200 mcg/mL (1 mg = 1000 mcg). Divide by 60 to get micrograms per minute: 200 mcg/60 minutes = 3.33 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 180 mcg/minute ÷ 3.33 mcg/minute  1 mL = 54.05 = 54 mL/hour; Proportion (Ratios): 1 mL : 3.33 mcg :: x mL : 180 mcg; 3.33x = 180/3.33 = 54 mL. Proportion (Fractions): 1 mL/3.33 mcg = x mL/180 mcg; 3.33x = 180/3.33 = 54 mL. Use two

Page 10

conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/50 mg  180 mcg/1 minute  60 minutes/1 hour  1 mg/1000 mcg = 250 mL  180  60  1/50  1 hour  1000 = 2,700,000/50,000 = 54 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 13.

The physician ordered 250 mg of Dobutrex (dobutamine) in 500 mL of D5W. It is to infuse

at 3 mcg/kg/minute per infusion pump. The patient/client weighs 80 kg. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

26

B)

27

C)

28

D)

29

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, determine how many micrograms per minute to infuse based on the patient/client's weight.

Multiply: 80 kg  3 mcg/minute = 240 mcg/minute. Next, reduce the numbers in the standard solution to milligrams per milliliter: 250 mg/500 mL = 0.5 mg/1 mL. Then, change milligrams to micrograms: 0.5 mg/mL = 500 mcg/mL (1 mg = 1000 mcg). Divide by 60 to get micrograms per minute: 500 mcg/60 minutes = 8.33 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 240 mcg/minute ÷ 8.33 mcg/minute  1 mL = 28.81 mL/hour = 29 mL/hour. Proportion (Ratios): 1 mL : 8.33 mcg :: x mL : 240 mcg; 8.33x = 240/8.33 = 29 mL. Proportion (Fractions): 1 mL/8.33 mcg = x mL/240 mcg; 8.33x = 240/8.33 = 29 mL. Use

Page 11

two conversion factors for dimensional analysis. Dimensional Analysis: 500 mL/250 mg  240 mcg/1 minute  60 minutes/1 hour  1 mg/1000 mcg = 500 mL  240  60  1/ 250  1 hour  1000 = 7,200,000/250,000 = 29 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 14.

The physician ordered 1 g of aminophylline in 1000 mL of D5W. It is to infuse at 12

mcg/kg/minute per infusion pump. The patient/client weighs 110 lb. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

35

B)

36

C)

37

D)

38

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, convert 110 lb to kilograms (1 kg = 2.2 lb): 110 lb/2.2 = 50 kg. Then determine how many micrograms per minute to infuse based on the patient/client's weight. Multiply: 50 kg  12 mcg/kg/minute = 600 mcg/minute. Next, reduce the numbers in the standard solution to milligrams per milliliter: 1000 mg/1000 mL = 1 mg/1 mL. Then change milligrams to micrograms: 1 mg = 1000 mcg (1 mg = 1000 mcg). Divide by 60 to get micrograms per minute: 1000 mcg/60 minutes = 16.66 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 600 mcg/minute ÷ 16.66 mcg/minute  1 mL = 36.01 mL/hour = 36 mL/hour. Proportion (Ratios): 1 mL : 16.66 mcg :: x mL : 600 mcg; 16.66 mcg x = 600 mcg/16.66 mcg = 36 mL.

Page 12

Proportion (Fractions): 1 mL/16.66 mcg = x mL/600 mcg; 16.66 mcg x = 600 mcg/16.66 mcg = 36 mL. Be careful when using dimensional analysis. You need four conversion factors: 1 kg = 2.2 lb; 60 minutes = 1 hour; 1 g = 1000 mg; and 1 mg = 1000 mcg. Dimensional Analysis: 1000 mL/1 g  12 mcg/kg/hour  1 g/1000 mg  1 mg/1000 mcg  60 minutes/1 hour  110 lb  1 kg/2.2 lb = 1000 mL  12  1  1  60  110  1/1  1000  1000  1  2.2 = 79,200,000/2,200,000 = 36 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 15.

The physician ordered 10 units of Pitocin in 1000 mL of D5W. It is to infuse at 3

milliunits/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

16

B)

17

C)

18

D)

19

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to units per milliliter: 10 units/1000 mL = 0.01 units/1 mL. Then, change units to milliunits: 0.01 units/mL  1000 = 10 milliunits/mL. Next, divide by 60 to get milliunits per minute: 10 milliunits/mL ÷ 60 minutes = 0.166 milliunits/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 3 milliunits/minute ÷ 0.166 milliunits/minute  1 mL = 18.07 mL/hour = 18 mL/hour. Proportion (Ratios): 1 mL : 0.166

Page 13

milliunits :: x mL : 3 milliunits; 0.166x = 3/0.166 = 18 mL/hour. Proportion (Fractions): 1 mL/0.166 milliunits = x mL/3 milliunits; 0.166x = 3/0.166 = 18 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 1000 mL/10 units  3 milliunits/minute  60 minutes/1 hour  1 unit/1000 milliunits = 1000 mL  3  1  60/10  1000  1 hour  1 = 180,000/10,000 = 18 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 281, Body Surface Nomogram Integrated Process: Teaching/Learning Objective: 3 16.

A child's weight is 20 lb, and his height is 30 inches. Determine the body surface area (BSA) in square meters. Use the nomogram in the textbook (p. 282).

A)

0.35 m2

B)

0.4 m2

C)

0.45 m2

D)

0.5 m2

Ans:

C

Feedback: BSA is critical when calculating dosages for pediatric patients or for drugs that are extremely potent and need to be given in precise amounts. The nomogram lets you plot the patient/client's height and weight to determine the BSA. 1. Locate the patient/client's height in the left column of the nomogram and the weight in the right column.

2. Use a ruler to draw a straight line connecting the two points. The point where the line intersects the surface area column indicates the patient's BSA in square meters.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Page 14

Cognitive Level: Analyze Difficulty: Moderate Page and Header: 284, Patient-Controlled Analgesia Integrated Process: Teaching/Learning Objective: 4 17.

The patient/client is on patient-controlled analgesia for pain medication. The physician

wrote orders for the basal rate. What is the basal rate?

A)

Maximum of medication the patient/client can receive in an hour

B)

Amount of medication infused continuously each hour

C)

Amount of medication infused when the patient/client activates the button control

D)

Interval during which the patient/client cannot initiate another dose after giving a self-dose

Ans:

B

Feedback: Basal rate is the amount of medication that is infused continuously each hour. Total hourly dose is the maximum of medication the patient/client can receive in an hour.

Patient-controlled analgesia (PCA) dose is the amount of medication infused when the patient/client activates the button T coEnS trT olB .L koSuE t iLnL teE rvR al.oC rO deMlay is the interval during which the AoNcK patient/client cannot initiate another dose after giving a self-dose.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning Objective: 5 18.

A patient/client weighs 200 lb. Available is 25,000 units of heparin in 1000 mL of D5W.

The physician orders the following: heparin sodium IV bolus of 80 units/kg and start the drip at 14 units/kg/hour. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

51

Page 15

B)

52

C)

53

D)

54

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, begin by converting pounds to kilograms (1 kg = 2.2 lb): 200 lb/2.2 = 90.9 kg. Determine the bolus dose: 90.9 kg  14 units/kg/hour = 1272.73 units/hour.

Estimate the amount to give. Round to the nearest whole number. Formula Method: 1272.73 units/hour ÷ 25,000 units  1000 mL = 50.9 mL/hour = 51 mL/hour. Proportion (Ratios): 1000 mL : 25,000 units :: x mL : 1272.73 units; 25,000x = 1,272,730/25,000 = 51 mL/hour. Proportion (Fractions): 1000 mL/25,000 units = x mL/1272.73 units; 25,000 units x = 1,272,730/25,000 = 51 mL/hour. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1000 mL/25,000 units  14 units/kg/hour  90.9 kg  200 lb  1 kg/2.2 lb = 1000 mL  14  2000  1/25,000  1  2.2 = 2,800,000/55,000 = 51 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning Objective: 5 19.

A patient/client weighs 110 lb. Available is 25,000 units of heparin in 1000 mL of D5W.

The physician orders a heparin sodium IV bolus of 80 units/kg and a starting dose at 18 units/kg/hour. What is the heparin bolus dosage?

A)

900 units/hour

B)

1000 units/hour

C)

3900 units

D)

4000 units

Ans:

D

Page 16

Feedback: Begin by converting pounds to kilograms (1 kg = 2.2 lb): 110 lb/2.2 = 50 kg. Determine the bolus dose: 50 kg  80 units/kg bolus = 4000 units.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning Objective: 5 20.

The physician ordered 100 units of regular insulin in 250 mL of NS. It is to infuse at 8

units/hour per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

16

B)

18

C)

20

D)

22

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give. Round to the nearest whole number. Formula Method: 8 units/100 units  250 mL = 20 mL/hour.

Proportion (Ratios): 250 mL : 100 units :: x mL : 8 units; 100x = 2000/100 = 20 mL/hour.

Proportion (Fractions): 250 mL/100 units = 20 mL/8 units; 100x = 250 mL  8/100 hours = 2000/100 = 20 mL/hour. Dimensional Analysis: 250 mL/100 units  8 units/1 hour = 2000 mL/100 hours = 20 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page 17

Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 21.

The physician ordered heparin 1200 units/hour. Heparin is available as 40,000 units in

1000 mL D5W. What is the correct IV flow rate in milliliters per hour?

A)

10

B)

20

C)

30

D)

40

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. To add medications to a continuous IV, you would estimate the amount to give using the same calculation methods that are used for preparing liquids for injection as covered in Chapter 5. Estimate the amount to give. Formula Method: 1200 units/40,000 units  1000 mL = 1,200,000/40,000 = 30 mL/hour. Proportion (Ratios): 1000 mL : 40,000 units T ::ExSmTLB:A1N 20K0SuEnL itsL; E 40R,0.0C0O xM = 1,200,000/40,000 = 30 mL/hour.

Proportion (Fractions): x mL/1200 units = 1000 mL/40,000 units; 40,000x = 1,200,000/40,000 = 30 mL/hour. Dimensional Analysis: 1000 mL/40,000 units  1200 units/1 hr = 1000 mL  1200/40,000  1 hour = 1,200,000/40,000 = 30 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2

Page 18

22.

The physician ordered 15 units of Pitocin in 500 mL of D5W. It is to infuse at 2

milliunits/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

1

B)

2

C)

3

D)

4

Ans:

D

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to units per milliliter: 15 units/500 mL = 0.03 units/1 mL. Then, change units to milliunits: 0.03 units/mL  1000 = 30 milliunits/mL (1 unit = 1000 milliunits). Next, divide by 60 to get milliunits per minute: 30 milliunits/mL ÷ 60 minutes = 0.5 milliunits/minute. Round to the nearest whole number. Solve for milliliters per hour. Estimate the amount to give. Formula Method: 2 milliunits/minute ÷ 0.5 milliunits/minute  1 mL = 2/0.5 = 20/5 = 4 mL/hour. Proportion (RaTtiEoS s)T : 1Bm LK :S 0.E 5L mL ilE liuRn.itC s :: x mL : 2 milliunits; 0.5x = 2/0.5 = AN OM 20/5 = 4 mL/hour. Proportion (Fractions): 1 mL/0.5 milliunits = x mL/2 milliunits; 0.5x = 2/0.5 = 20/5 = 4 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 500 mL/15 units  2 milliunits/minute  60 minutes/1 hour  1 unit/1000 milliunits = 500 mL  2  60  1/15  1 hour  1000 = 60,000/15,000 = 4 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 281, Body Surface Nomogram Integrated Process: Teaching/Learning Objective: 3

Page 19

23.

A physician ordered Cerubidine (daunorubicin), 40 mg/m2, in 100 mL D5W, over 1 hour.

The patient/client's height is 140 cm, and he weighs 100 lb. How many milligrams should be added to the IV piggyback line?

A)

52

B)

56

C)

62

D)

66

Ans:

B

Feedback: Calculate the body surface area (BSA) using the nomogram on page 277 in the textbook. Using a ruler, draw a line from the patient/client's height of 140 cm to his weight of 100 lb. This gives a BSA of 1.4 m2. Estimate the amount to give by multiplying: 40 mg/m2  1.4 m2 = 56 mg. Label the IV solution of D5W with 56 mg of Cerubidine. Set the infusion pump at 100 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning Objective: 5 24.

A patient/client weighs 152 lb. Available is 20,000 units of heparin in 1000 mL of D5W.

The physician orders the following: heparin sodium IV bolus of 40 units/kg and start the drip at 10 units/kg/hour. What is the correct IV rate in milliliter per hour? Round to the nearest whole number.

A)

20

B)

25

C)

30

D)

35

Ans:

D

Page 20

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. Begin by converting pounds to kilograms (1 kg = 2.2 lb): 152 lb/2.2 = 69 kg.

Determine the bolus dose: 69 kg  10 units/kg/hour = 690 units/hour. Estimate the amount to give.

Round to the nearest whole number. Formula Method: 690 units/hour/20,000 units  1000 mL = 34.5 mL/hour = 35 mL/hour. Proportion (Ratios): 1000 mL : 20,000 units :: x mL : 690 units; 20,000x = 690,000/20,000 = 35 mL/hour. Proportion (Fractions): 1000 mL/20,000 units = x mL/690 units; 20,000x = 690,000/20,000 = 35 mL/hour. Use a conversion factor for dimensional analysis. Dimensional Analysis: 1000 mL/20,000 units  10 units/kg/hour  152 lb  1 kg/2.2 lb = 1,520,000/44,000 = 35 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning Objective: 5 25.

The physician ordered 80 units of regular insulin in 250 mL of NS. It is to infuse at 10

units/hour per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

21

B)

28

C)

31

D)

38

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give. Round to the nearest whole number. Formula Method: 10 units/hour/80 units  250 mL = 31.25 mL/hour = 31 mL/hour. Proportion (Ratios): 250 mL : 80 units :: x mL : 10 units; 80x = 2500/80 = 31

Page 21

mL/hour. Proportion (Fractions): 250 mL/80 units = x mL/10 units; 80x = 2500/80 = 31 mL/hour.

Dimensional Analysis: 250 mL/80 units  10 units/1 hour = 250 mL  10/80 = 31 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in units/hour or mg/hour Integrated Process: Teaching/Learning Objective: 2 26.

The physician ordered Lasix (furosemide) 100 mg in 250 mL of D5W. It is to infuse at 6

mg/hour per infusion pump. How many hours will the IV run? Round to the nearest hour.

A)

17

B)

4

C)

8

D)

10

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. This is a two-part problem. First, calculate milliliters per hour, then calculate the number of hours using this formula: Number of milliliters/Number of milliliters per hour = Hours. Estimate the amount to give. Formula Method: 6 mg/100 mg × 250 mL = 1,500/100 = 15 mL/hour. Proportion (Ratios): 250 mL : 100 mg :: x mL : 6 mg; 100x = 1,500/100 = 15 mL/hour. Proportion (Fractions): 250 mL/100 mg = x mL/6 mg; 100x =1,500/100 = 15 mL/hour. Dimensional Analysis: 250 mL/100 mg × 6 mg/1 hour = 250 mL × 6/100 × 1 hour = 1500/100 = 15 mL/hour. Now calculate the number of hours. Number of milliliters/Number of milliliters per hour = Hours. Therefore, 250 mL/15 mL/hour = 16.67 hours.

Round to the nearest hour: 17 hours.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

Page 22

Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 27.

The physician ordered Aramine (metaraminol) 50 mg in 250 mL of D5W. It is to infuse at

50 mcg/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

10

B)

15

C)

20

D)

25

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standarTdEsS olT utB ioAnNtoKm illL igLraEmRs.pC erOm SE Milliliter: 50 mg/250 mL = 0.2 mg/mL. Next, change 0.2 mg to 200 mcg. Divide by 60 minutes to get micrograms per minute: 200 mcg/60 minutes = 3.33 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 50 mcg/minute ÷ 3.33 mcg/minute  1 mL = 15 mL/hour. Proportion (Ratios): 1 mL : 3.33 mcg :: x mL : 50 mcg; 3.33x = 50 mcg/3.33 mcg = 15 mL/hour. Proportion (Fractions): 1 mL/3.33 mcg = x mL/50 mg; 3.33x = 50 mcg/3.33 mcg = 15 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/50 mg  50 mcg/1 minute  60 minutes/1 hour  1 mg/1000 mcg; 250 mL  50  60  1/50  1  1 hour  1000 = 750,000/50,000 = 15 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

Page 23

Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate Integrated Process: Teaching/Learning Objective: 2 28.

The physician ordered 100 mg of nitroglycerin in 250 mL of D5W. It is to infuse at 15

mcg/minute per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

2

B)

3

C)

4

D)

5

Ans:

A

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, reduce the numbers in the standard solution to milligrams per milliliter: 100 mg/250 mL = 0.4 mg/1 mL. Next, change milligramTsEtoSm grKam s:L0L .4EmRg. /m TiBcrAoN SE CLO=M 400 mcg/mL (1 mg = 1000 mcg).

Divide by 60 to get micrograms per minute: 400 mcg/60 minutes = 6.66 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 15 mcg/minute ÷ 6.66 mcg/minute  1 mL = 2 mL/hour. Proportion (Ratios): 1 mL : 6.66 mcg :: x mL : 15 mcg; 6.66x = 15 mcg/6.66 = 2 mL/hour. Proportion (Fractions): 1 mL/6.66 mcg = x mL/15 mcg; 6.66x = 15 mcg/6.66 = 2 mL/hour. Use two conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/100 mg  15 mcg/minute ÷ 1 minute  60 minutes/1 hour  1 mg/1000 mcg = 250 mL x 15  60  1/100  1  1 hour  1000 = 225,000/100,000 = 2 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 261, Medications Ordered in mcg/minute, mcg/kg/minute, or milliunits/minute—Calculation of Rate

Page 24

Integrated Process: Teaching/Learning Objective: 2 29

The physician ordered 400 mg of Dobutrex (dobutamine) in 250 mL of D5W. It is to infuse

at 4mcg/kg/minute per infusion pump. The patient/client weighs 70 kg. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

9

B)

11

C)

13

D)

15

Ans:

B

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, an equivalent is necessary. This is a multi-step problem. First, determine how many micrograms per minute to infuse based on the patient/client's weight.

Multiply: 70 kg  4mcg/minute = 280 mcg/minute. Next, reduce the numbers in the standard solution to milligrams per milliliter: 400 mg/250 mL = 1.6 mg/1 mL. Then, change milligrams to micrograms: 1.6 mg/mL = 1600 m cgC).ODMivide by 60 to get micrograms per TcEgS/mTLB(A1NmKgS=E1L0L00Em R. minute: 1600 mcg/60 minutes = 26.66 mcg/minute. Estimate the amount to give. Round to the nearest whole number. Formula Method: 280 mcg/minute ÷ 26.66 mcg/minute  1 mL = 10.5 mL/hour = 11 mL/hour. Proportion (Ratios): 1 mL : 26.66 mcg :: x mL : 280 mcg; 26.66x = 280/26.66 = 11 mL. Proportion (Fractions): 1 mL/26.66 mcg = x mL/280 mcg; 26.66x = 280/26.66 = 11 mL. Use two conversion factors for dimensional analysis. Dimensional Analysis: 250 mL/400 mg  280 mcg/1 minute  60 minutes/1 hour  1 mg/1000 mcg = 250 mL  280  60  1/ 400  1 hour  1000 = 4,200,000/400,000 = 11 mL/hour.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Page and Header: 285, Heparin and Insulin Protocols Integrated Process: Teaching/Learning

Page 25

Objective: 5 30. The physician ordered 60 units of regular insulin in 100 mL of NS. It is to infuse at 15 units/hour per infusion pump. What is the correct IV rate in milliliters per hour? Round to the nearest whole number.

A)

18

B)

21

C)

25

D)

31

Ans:

C

Feedback: When solving any problem, first check that the order and the supply are in the same weight measure. For this problem, no equivalent is necessary. Estimate the amount to give. Round to the nearest whole number. Formula Method: 15 units/hour/60 units 100 mL = 25 mL/hour.

Proportion (Ratios): 100 mL : 60 units :: x mL : 15 units; 60x = 1500/60 = 25 mL/hour. Proportion (Fractions): 100 mL/60 units = x mL/15 units; 60x = 1500/60 = 25 mL/hour. Dimensional Analysis: 100 mL/60 units  15 units/1 hour = 100 mL  15/60 = 25 mL/hour.

Page 26

Chapter 8, Dosage Problems for Infants and Children Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 1.

An infant weighs 12 lb 6 oz. How many pounds does this infant weigh?

A)

12

B)

12.375

C)

12.475

D)

13

Ans:

B

Feedback: Use the equivalent: 16 oz = 1 lb. First, divide 6 oz by 16 oz to get 0.375 lb. Then add the answer to the pounds to get the total number of pounds: 12 lb + 0.375 lb = 12.375 lb.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 2.

An infant weighs 98 ounces. How many pounds does the infant weigh?

A)

6.125

B)

6.225

Page 1

C)

6.335

D)

6.456

Ans:

A

Feedback: Use the equivalent: 16 oz = 1 lb. Divide 98 oz by 16 to get 6.125 lb.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 3.

A child weighs 30 lb. How many kilograms does this child weigh? Round to the nearest

hundredth.

A)

13.64

B)

13.73

C)

13.84

D)

13.93

Ans:

A

Feedback: Use the equivalent: 1 kg = 2.2 lb. Divide 30 lb by 2.2 and round off to the nearest hundredth: 30/2.2 = 13.636 = 13.64 kg.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning

Page 2

Objective: 1 4.

A child weighs 14 lb 8 oz. How many kilograms does this child weigh?

A)

6.48

B)

6.59

C)

14.4

D)

14.5

Ans:

B

Feedback: Use the equivalent: 16 oz = 1 lb. First, divide 8 oz by 16 oz = 0.5 lb. Then add the answer to the pounds to get the total number of pounds: 0.5 lb + 14 lb = 14.5 lb. Next, use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms and round off to the nearest hundredth: 14.5 lb/2.2 = 6.59 kg.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 5.

A child weighs 35 lb and has an order for Keflex (cephalexin) 150 mg po every 6 hours.

The literature states the usual children's dose is 25 to 50 mg/kg a day in four divided doses. The drug label reads 125 mg/5 mL. What is the safe dosage range per day for this medication?

A)

197.75 to 695.75

B)

297.75 to 725.5

C)

397.75 to 795.5

D)

400.25 to 810.75

Ans: C Feedback: First, use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms by dividing the number of pounds by 2.2: 35/2.2 = 15.909. Round to the nearest hundredths: 15.91 kg. Determine the safe dosage range. The literature states that the dose should range from 25 to 50 mg/kg, given

Page 3

in four divided doses. Lower range: 25 mg  15.91 kg = 397.75 mg per day/4 doses = 99.44 mg per dose. Higher range: 50 mg  15.91 kg = 795.5 mg/4 doses = 198.88 mg per dose. The dosage ordered falls within the range that is safe: 150 mg  4 doses (24 hours ÷ 6 = 4 doses) = 600 mg.

Therefore, 600 mg falls within the daily range of 397.75 to 795.5 mg. This order is in the safe range per dose and per day.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 6.

A child weighs 3 kg and has an order for phenobarbital sodium 10 mg po per day. The

ER literature states that the usual chilTdE reS n'T sB doAsN eK isS3EtoL5Lm g/. kgC/O daMy. The drug label reads phenobarbital elixir 20 mg/5 mL. How many milliliters should the nurse administer? Use the formula method to calculate the amount to give.

A)

1.5

B)

2

C)

2.5

D)

3

Ans:

C

Feedback: Determine the safe dosage range. The literature states that the usual children's dose is 3 to 5 mg/kg/day. Lower range: 3 mg  3 kg = 9 mg. Higher range: 5 mg  3 kg = 15 mg. The safe dosage range for this child per day is 9 to 15 mg. This dose is safe at 10 mg. The nurse should administer 2.5 mL. Use the formula method: 10 mg/20 mg  5 mL = 50/20 = 2.5 mL.

Format: Multiple Choice Chapter: 8

Page 4

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg, 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 1, 3 7.

An infant who weighs 9 pounds has an order for Kantrex (kanamycin sulfate) 30 mg IV

every 12 hours. The literature states that the recommended dosage is 15/kg/day in two divided doses. The vial is labeled 75 mg/2 mL. How many milliliters should the nurse administer per dose?

Use the proportion (fractions) method to calculate the amount to give.

A)

0.8

B)

0.9

C)

1

D)

1.1

Ans:

A

Feedback: Use the equivalent: 1 kTgE=S2T.2BlA b.NCKoSnE veLrtLpEoR un.dC sO toMkilograms by dividing the number of pounds by 2.2: 9/2.2 = 4.09 kg. Round to the nearest hundredths. Determine the safe dosage range. The literature states that the recommended dosage range is 15 mg/kg/day in two equally divided doses: 15 mg  4.09 kg = 61.35 mg/day or 30.67 mg per dose. Therefore, 30 mg, q12h, is within the safe dosage range. Use proportion (fractions): 2 mL/75 mg  x mL/30 mg; 75x = 60/75 = 0.8 mL.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 5

Page 5

8.

A child weighs 40 kg, and the recommended dosage of Cleocin (clindamycin palmitate

hydrochloride) oral suspension is 8 to 25 mg/kg/day in four divided doses. What is the maximum dosage for this child in 24 hours?

A)

320

B)

500

C)

640

D)

1000

Ans:

D

Feedback: Determine the safe dosage range. Lower range: 8 mg  40 kg = 320 mg/day. Higher range: 25 mg  40 kg = 1000 mg/day. Therefore, the maximum dosage for this child is 1000 mg/day.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 9.

A child weighs 88 lb and has an order for morphine sulfate 7.5 mg subcutaneously every 8

hours prn. The recommended maximum dose for a child is 0.1 to 0.2 mg/kg/dose. What is the safe dosage range for this child?

A)

2 to 4

B)

3 to 5

C)

5 to 7

D)

4 to 8

Ans:

D

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms: 88 lb/2.2 = 40 kg.

Determine the safe dosage range. Lower range: 0.1 mg  40 kg = 4 mg. Higher range: 0.2 mg  40 kg = 8 mg. The safe dosage range for this child is 4 to 8 mg/dose.

Page 6

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 10.

A child weighs 18 kg and has an order for Zithromax 10 mg/kg po stat. The recommended

dosage is 10 mg/kg/day. The oral suspension is dispensed as 200 mg in 5 mL. How many milliliters should the nurse administer in one dose? Use the proportion (ratios) method to calculate the amount to give.

A)

4.3

B)

4.4

C)

4.5

D)

4.6

Ans:

C

Feedback: The recommended dosage is 10 mg/kg/day. A child who weighs 18 kg would have a maximum daily dose of 180 mg (18 kg  10 mg/kg). The physician ordered 180 mg (10 mg/kg) stat. The medicine is available as 200 mg/5 mL. Use proportion (ratios): 200 mg : 5 mL :: 180 mg : x mL; 200x = 900/200 = 4.5 mL.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Page and Header: 334, Determining Body Surface Area in Meters Squared Integrated Process: Teaching/Learning

Page 7

Objective: 2 11.

Using the nomogram in the textbook (Fig. 8-10), what is the body surface area (BSA) for a

child who weighs 60 lb and is 39 inches tall?

A)

0.6 m2

B)

0.7 m2

C)

0.8 m2

D)

0.9 m2

Ans:

D

Feedback: To determine the body surface area, draw a straight line between the points representing the patient's height on the left vertical scale to the point representing the patient's weight on the right vertical scale. The point at which this line intersects the middle vertical scale represents the body surface area in meters squared. Refer to Figure 8-10 on page 334 in the textbook.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological InteT grE itS y:TPBhA arN mK acSoE loLgL icE alRa. ndCPOaMrenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 334, Determining Body Surface Area in Meters Squared Integrated Process: Teaching/Learning Objective: 2 12.

A child has a body surface area (BSA) of 0.75 m2 and a medication order for Cosmegen

(dactinomycin) 0.5 mg/m2 daily for 5 days IV push. How many milligrams should the nurse administer daily?

A)

0.27

B)

0.36

C)

0.375

D)

0.45

Ans:

C

Feedback: Multiply the medication order (0.5 mg/m2) by the body surface area (0.75 m2), which equals 0.375 mg that the nurse should administer daily.

Page 8

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 334, Determining Body Surface Area in Meters Squared Integrated Process: Teaching/Learning Objective: 2 13.

A child weighs 20 lb and is 30 inches tall. The dosage for the medication is 20 mg/m2/dose

four times a day. How many milligrams of medication are administered per dose?

A)

8

B)

9

C)

10

D)

11

Ans:

B

Feedback: Use Figure 8-10 on page 334 of the textbook to determine the body surface area (BSA).

Draw a straight line between the points representing the patient/client's height on the left vertical scale to the point representing the patient/client's weight on the right vertical scale. The point at which this line intersects the middle vertical scale represents the BSA in meters squared––in this case, 0.45 m2. Calculate the dose to be administered. Multiply the medication order (20 mg/m2/dose) by the BSA (0.45 m2), which equals 9 mg that should be given for each dose.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg; 339, Administering IV Medications Integrated Process: Teaching/Learning

Page 9

Objective: 1, 3 14.

A child weighs 44 lb and has an order for IV methylprednisolone sodium succinate

(Solu-Medrol). The order is for 0.03 mg/kg/day. How many milligrams of medication should be administered?

A)

0.4

B)

0.5

C)

0.6

D)

0.7

Ans:

C

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms: 44 lb/2.2 = 20 kg. Next, calculate the dose by multiplying the prescribed dose (0.3 mg/kg/day)  the number of kilograms (20 kg), which equals 0.6 mg to be administered.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological InteT grE itS y:TPBhA arN mK acSoE loLgL icE alRa. ndCPOaMrenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg; 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 1, 3 15.

A child weighs 95 lb and has an order for IV tobramycin (Nebcin). The order is for 3

mg/kg/day in three divided doses. How many milligrams of medication should be administered per dose?

A)

43.18

B)

86.42

C)

129.60

D)

172.83

Ans:

A

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms: 95 lb/2.2 = 43.18 kg.

Round to the nearest hundredths. The order is for 3 mg/kg/day. Therefore, 43.18 kg  3

Page 10

mg/kg/daily = 129.54 mg/day. Divide the daily dose into three doses: 129.54 mg/3 doses = 43.18 mg/dose.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 334, Determining Body Surface Area in Meters Squared Integrated Process: Teaching/Learning Objective: 2 16.

A child's weight is 50 lb and his height is 36 inches. The dosage for his medication is 25

mg/m2/dose four times a day. What is the child's body surface area (BSA)?

A)

0.8

B)

0.9

C)

1

D)

1.1

Ans:

A

Feedback: Use Figure 8-10 in the textbook to determine the body surface area. Draw a straight line between the points representing the patient's height on the left vertical scale to the point representing the patient's weight on the right vertical scale. The point at which this line intersects the middle vertical scale represents the surface area in square meters. The surface area in square meters is 0.8 m2.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage Based on mg/kg; 339, Administering IV Medications

Page 11

Integrated Process: Teaching/Learning Objective: 1, 3 17.

A child weighs 20 kg and has an order for Garamycin (gentamicin) 40 mg IV piggyback

every 8 hours. The recommended dosage range is 2 to 2.5 mg/kg every 8 hours. The medication is supplied in 20-mg vials with a strength of 10 mg/mL. How many milliliters would the nurse withdraw from the vial? Use dimensional analysis to calculate the amount to give.

A)

2.5

B)

3

C)

3.5

D)

4

Ans:

D

Feedback: First, determine the safe dosage range. Lower range: 2 mg  20 kg = 40 mg/kg/every 8 hours. Higher range: 2.5 mg  20 kg = 50 mg/kg/every 8 hours. The safe dosage range is 40 mg to 50 mg/kg/8 hours. The prescribed dose of 40 mg, q8h, is within the safe range. To determine the amount of milliliters to give, consider the available amount (10 mg/mL). Use dimensional analysis: 1 mL/10 mg  40 mg = T 1 EmSLTB4A0N /1K0S=E4L 0/L1E 0R =.4CmOLM.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 3 18.

The nurse has administered a parenteral IV piggyback to a child. At the completion of the

IV, how many milliliters of flush are added to the Buretrol to clear the tubing of the medication?

A)

10

B)

15

C)

20

D)

25

Page 12

Ans:

C

Feedback: When a parenteral IV piggyback pediatric medication is completed, a flush of 20 mL is added to the Buretrol to clear the tubing of the medication.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Page and Header: 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 3 19.

The dose of continuous IV dosages is based on which measurement of weight?

A)

Kilograms

B)

Milligrams

C)

Ounces

D)

Pounds

Ans:

A

Feedback: Continuous IV dosages are based on weight in kilograms. The dose of most pediatric drugs is based on mg/kg/body weight or body surface area in meters squared (m2). Pounds are converted to kilograms in order to determine medication dosages.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 3

Page 13

20.

An infant weighs 22 lb and has an order for NS to be infused at 5 mL/kg/hour. How many

milliliters per hour should the nurse infuse the IV solution?

A)

40

B)

45

C)

50

D)

55

Ans:

C

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms: 22 lb/2.2 = 10 kg.

Multiply the infant's weight (10 kg) by the ordered rate (5 mL/kg/hour) = 10  5 = 50 mL/hour.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 321, Dosage BTaE seS dToB nA mN g/KkS g ELLER.COM Integrated Process: Teaching/Learning Objective: 1 21.

The physician ordered 5 mg/kg of a medication for a toddler who weighed 26 pounds. How

many milligrams of the medication would the nurse prepare?

A)

52.27

B)

54.54

C)

56.81

D)

59.1

Ans:

B

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms and round to the nearest hundredth: 26 lb/2.2 = 11.82 kg. Next, multiply the milligrams per kilogram: 5 mg  11.82 = 59.1 mg to be given. Prior to administration, the safe dosage range would be calculated.

Format: Multiple Choice

Page 14

Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 22.

The physician ordered Aldactone (spironolactone) 15 mg twice daily for a child who

weighs 42 lb. The safe dosage range is 1 to 2 mg/kg/day. What is the safe dosage range, per dose, for this child?

A)

18.63 to 37.27

B)

9.55 to 19.09

C)

19.54 to 39.09

D)

20 to 40

Ans:

B

Feedback: Use the equivalent: 1 kTgE=S2T.2BlA b.NCKoS nvEeL rtLpE ouRn. dsCtO oM kilograms and round to the nearest hundredth: 42/2.2 = 19.09 kg. Determine the safe dosage range. The literature states that the recommended dosage range is 1 to 2 mg/kg/day. Lower range: 19.09 kg  1 = 19.09 mg. Higher range: 19.09 kg  2 = 38.18 mg. Therefore, the child's safe dosage range is 19.09 mg to 38.18 mg.

Since this total is ordered divided into two doses, the safe dosage range/dose is which equals 9.55 mg, and

1

2

1

of 38.18 mg, which equals 19.09 mg.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1

Page 15

2

of 19.09 mg,

23.

The physician prescribed Vancocin (vancomycin) 25 mg/kg/day po. The child weighed 54

pounds. The safe dosage for this drug is 40 mg/kg/24 hours, in four equal doses, not to exceed 2 g/day. How many milligrams per day is the safe dosage for this child?

A)

907.98

B)

932.52

C)

957.06

D)

982

Ans:

D

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms by dividing the number of pounds by 2.2: 54/2.2 = 24.545 kg. Round to the nearest hundredth (24.55). Determine the safe dosage range. The literature states the recommended daily dosage range is 40 mg/kg/day, divided into four equal doses, not to exceed 2 g/day. Therefore, the child's safe daily dosage is 981.6 mg (24.54 kg  40 mg). The physician ordered 25 mg/kg/day. Therefore, 24.55 kg  25 mg = 613.75 mg/day, which is safe to give.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 24.

The physician ordered Lasix (furosemide) 2.5 mg/kg q 8 hours for a child who weighs 28

lb. The safe dosage range is 3 to 6 mg/kg/q8h. What is the safe dosage range for this child?

A)

25.46 to 50.92

B)

31.82 to 63.65

C)

38.19 to 76.38

D)

76.38 to 84.68

Ans:

C

Page 16

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms by dividing the number of pounds by 2.2: 28/2.2 = 12.727 kg. Round to the nearest hundredth (12.727 = 12.73 kg).

Determine the safe dosage range. The literature states the recommended daily dosage range is 3 to 6 mg/kg/day, not to exceed 6 mg/kg, q6–8h. Lower range: 12.73 kg  3 mg = 38.19 mg. Higher range: 12.73 kg  6 mg = 76.38 mg. Therefore, the child's safe daily dosage range is 38.19 mg to 76.38 mg. The q 8 hour dose is not to exceed 6 mg/kg: 12.73 kg  6 = 76.38 mg, which is safe.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 25.

ER The physician ordered LaT siE xS (fT urB osAeN mK idSeE ) 2L.5Lm g/. kgC,OqM8 hours for a child who weighs 28

pounds. The safe dosage range is 3 to 6 mg/kg/q8h. How many milligrams of Lasix should the nurse administer for each dose? Round to the nearest whole number.

A)

25

B)

32

C)

38

D)

45

Ans:

B

Feedback: Based on the previous question, you know that the child weighs 12.73 kg and has a safe dosage range of 38.19 mg (3 mg/kg  12.73 kg) to 76.38 mg (6 mg/kg  12.73 kg). The physician ordered 2.5 mg/kg q8h. Therefore, the nurse would prepare 31.82 mg to give (2.5 mg  12.73 kg).

Round to the nearest whole number: 31.82 rounds to 32 mg to be given q8h.

Format: Multiple Choice Chapter: 8

Page 17

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 26.

A child weighs 44 lb and has an order for Augmentin (amoxicillin clavulanate potassium)

100 mg po every 8 hours. The literature states the safe dose should range from 6.7 to 13.3 mg/kg/q8h. The Augmentin label reads 125 mg/5 mL. How many milliliters would be given for each dose? Is it within the daily safe dosage? Use the Formula Method to solve this problem.

A)

2; safe

B)

4; safe

C)

6; not safe

D)

8; not safe

Ans:

B

Feedback: First, use the equivalenTtE : 1SkTgB=A2N.2KlSbE .C LoLnEveRrt.pCoOunMds to kilograms by dividing the number of pounds by 2.2: 44/2.2 = 20 kg. Determine the safe range of dosage. Low dose: 6.7 mg × 20 kg = 134 mg; high dose: 13.3 mg × 20 kg = 266 mg. The safe range is 134 to 266 mg, q8h. The dose ordered (100 mg, q8h) is safe. Use the Formula Method to determine milliliters to be given for each dose: 100 mg/125 mg × 5 mL: 500/125 = 4 mL.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1 27.

A child weighs 50 lb and has an order for Valium (diazepam) 2 mg, PO, tid. The safe

dosage for children is 1 to 2.5 mg, tid or qid. What is the total daily dosage for this child? Is it safe?

Page 18

A)

4; safe

B)

6; safe

C)

8; not safe

D)

10; not safe

Ans: B The safe dosage range for this drug is 1 to 2.5 mg. tid or qid. Therefore, the safe dosage range is a low of 3-4 mg (1mg × 3 or 4 ×/day) and a high of 7.5 to 10 mg (2.5 × 3 or 4 ×/day). Giving this child 2 mg tid = 6 mg daily which is within the safe dosage range.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 334, Determining Body Surface Area in Meters Squared Integrated Process: Teaching/LeT arE niS ngTBANKSELLER.COM Objective: 2

28.

A child weighs 40 lb and is 32 inches tall. The dosage for the medication is 30 mg/m2/dose

two times a day. How many milligrams of medication are administered per dose?

A)

18

B)

19

C)

20

D)

21

Ans:

A

Feedback: Use Figure 8-11 on page 335 of the textbook to determine the body surface area (BSA).

Draw a straight line between the points representing the patient/client's height on the left vertical scale to the point representing the patient/client's weight on the right vertical scale. The point at which this line intersects the middle vertical scale represents the BSA in meters squared––in this

Page 19

case, 0.6 m2. Calculate the dose to be administered. Multiply the medication order (30 mg/m2/dose) by the BSA (0.6 m2), which equals 18 mg that should be given for each dose.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 339, Administering IV Medications Integrated Process: Teaching/Learning Objective: 3 29.

A child weighs 33 lb and has an order for D5 ½ NS to be infused at 8 mL/kg/hour. How

many milliliters per hour should the nurse infuse the IV solution?

A)

80

B)

100

C)

120

D)

140

Ans:

C

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms: 33 lb/2.2 = 15 kg.

Multiply the child’s weight (15 kg) by the ordered rate (8 mL/kg/hour) = 15  8 = 120 mL/hour.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 321, Dosage Based on mg/kg Integrated Process: Teaching/Learning Objective: 1

Page 20

30.

The physician ordered Lasix (furosemide) 20 mg q 8 hours as a single dose for a child who

weighs 22 lb. The safe dosage range is 2 mg/kg. Is this dose safe? Lasix is available as an oral solution 10 mg/mL. How many mL should the child receive? Use the Formula Method for your calculations.

A)

1; safe

B)

1; not safe

C)

2; safe

D)

2; not safe

Ans:

C

Feedback: Use the equivalent: 1 kg = 2.2 lb. Convert pounds to kilograms by dividing the number of pounds by 2.2: 22/2.2 = 10 kg. Determine the safe dosage. The literature states the recommended single dose of 2 mg/kg. A 10 kg child would receive 20 mg (2 mg × 10 kg). Formula Method: 20mg/10 mg × 1 mL; 20/10 = 2 mL. Give 2 mL of a single dose of 20 mg.

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Chapter 9, Information Basic to Administering Drugs Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 1.

Which of the following statements is true about the trade name for a

medication?

A)

It is the official name given to the drug.

B)

The name is not capT itE alS izTeB dA . NKSELLER.COM

C)

It may have several different names.

D)

Consumer groups advocate that drugs are prescribed only by this name.

Ans: C Feedback: A trade name is the brand name under which a company manufactures a generic drug. The trade name is capitalized. The generic name is the official name given to a drug and is not capitalized. Consumer groups have advocated that drugs be prescribed by generic name only.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Page 1

Integrated Process: Teaching/Learning Objective: 1 2.

What does the classification drug category refer to?

A)

The way a drug works at the molecular, tissue, or body system level

B)

The way a drug acts against diseases or disorders

C)

A quick reference to a drug's therapeutic actions, uses, and adverse

effects D)

A reference for the nurse that provides information about the drug's

indications, precautions, and nursing implications Ans: A Feedback: A drug category refers to the way a drug works at the molecular, tissue, or body system level. Drug classifications are a way to categorize drugs by the way they act against diseases or disorders, especially by their effect on a particular area of the body or on a particular condition. Drug classifications are a quick reference to the drug's therapeutic actions, uses, and adverse effects that provide the nurse with information on indications, precautions, and nursing implications.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 3.

What does the term side effect of a drug refer to?

A)

Nontherapeutic effect that may be harmful to the patient/client

Page 2

B)

Medical interventions necessary because the drug is life threatening

C)

Mandated lowering of the drug's dosage or the discontinuance of the

drug D)

Consequence of drug administration

Ans: D Feedback: Side effects are nontherapeutic and transient reactions to drugs that may not require any nursing intervention. Side effects occur as a consequence of drug administration. Adverse effects are nontherapeutic effects that may be harmful to the patient/client and thus require lowering the dosage or discontinuing the drug. Because these effects can be life threatening, they may require medical intervention.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 4.

According to the U.S. Food and Drug Administration, pregnancy category

B for a drug means: A)

No risk to the fetus in any trimester.

B)

No adverse effect demonstrated in animals; no human studies available.

C)

Studies with animals have shown adverse reaction; no human studies

are available.

D)

Definite fetal risk exists; may be given despite risk to the fetus if needed

for a life-threatening condition.

Page 3

Ans: B Feedback: Pregnancy categories are classified as follows: A, no risk to the fetus in any trimester; B, no adverse effect demonstrated in animals, no human studies available; C, studies with animals have shown adverse reaction, no human studies are available; and D, definite fetal risk exists, may be given despite risk to the fetus if needed for a life-threatening condition.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 5.

What does the heading Indications for a drug refer to?

A)

Explains how the drug works

B)

Gives the reasons for using the drug

C)

Describes conditions in which a drug should be given with caution

D)

Provides information that is crucial to protect against medication error

Ans: B Feedback: Indications is a heading used to explain why a drug is used. The heading Action explains how the drug works; Precautions refers to conditions in which a drug should be given with caution, and information about the Dosage and route of administration is crucial to protect against medication error.

Format: Multiple Choice

Page 4

Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 6.

Which statement is true about the heading Interactions and

Incompatibilities of a drug?

A)

It is not important to consider drug herbal interactions.

B)

Chemical incompatibility may not give a visible sign of a precipitation.

C)

Physical incompatibility usually produces a visible sign of a color change.

D)

Incompatibilities are important when medications are combined for an

injection in IV administration.

Ans: D Feedback: Incompatibilities are important when medications are combined for an injection in IV administration. It is important to consider drug herbal interactions. Chemical incompatibility usually produces a visible sign, such as precipitation or color change. Physical incompatibility may not give a visible precipitation or color change.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 377, Pharmacokinetics

Page 5

Integrated Process: Teaching/Learning Objective: 2 7.

What is the major organ of excretion for a drug?

A)

Kidney

B)

Large intestine

C)

Liver

D)

Stomach

Ans: A Feedback: The major organ of excretion is the kidney. Most biotransformation occurs in the liver. The large intestine and stomach are involved in drug absorption.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 377, Pharmacokinetics Integrated Process: Teaching/Learning Objective: 2 8.

Select the pharmacokinetic term that refers to the chemical change of a

drug into a form that can be excreted.

A)

Absorption

B)

Distribution

C)

Biotransformation

D)

Excretion

Ans: C Feedback: Biotransformation refers to the chemical change of a drug into a

Page 6

form that can be excreted. Absorption of a drug depends on several conditions: the degree of stomach acidity; the time required for the stomach to empty; whether food is present; the amount of contact with villi in the small intestine, and the flow of blood to the villi. Distribution describes the drug's movement through body fluids. Excretion is the process by which the body removes a drug.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 377, Pharmacokinetics Integrated Process: Teaching/Learning Objective: 2 9.

What does the term half-life of a drug refer to?

A)

Its tolerance level when the drug is used frequently

B)

Its biotransformation as it accumulates in the body

C)

Its duration of action, indicating how much drug is effective at different

times as the percent of concentration decreases over time D)

Its concentration in the patient/client's blood or serum through the use

of lab tests to measure the therapeutic level Ans: C Feedback: The half-life of a drug, which correlates roughly with its duration of action, indicates how often the drug may be given to continue therapeutic effect. Tolerance occurs when the patient/client requires more of a drug when it is used frequently. Cumulation occurs when a condition inhibits biotransformation or excretion and the drug accumulates in the body. The

Page 7

therapeutic range evaluates the effects of drug therapy in the patient/client's blood or serum through the use of laboratory tests that measure the therapeutic level.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Page and Header: 382, Legal Considerations Integrated Process: Nursing Process Objective: 3 10.

Select a statement that is consistent with the concept of criminal law.

A)

It is concerned with the legal rights of private persons.

B)

An individual can sue for damages in the form of money.

C)

A claim of harm or injury to an individual can be used because the nurse

did not meet the required standard.

D)

It includes offenses against the general public that are detrimental to

society as a whole and are prosecuted by government authorities.

Ans: D Feedback: Criminal law relates to offenses against the general public that are detrimental to society as a whole, and actions considered criminal are prosecuted by government authorities.

Civil law is concerned with the legal rights and duties of private persons. When an individual believes that a wrong has been committed, he or she can sue for damages in the form of money. One of the four elements of malpractice is a claim that harm or injury resulted because the nurse did not meet the required standard of care.

Page 8

Format: Choice Multiple Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Page and Header: 382, Legal Considerations Integrated Process: Nursing Process Objective: 3 11.

A nurse was sued for malpractice. Which four elements must be present

for the case to be considered malpractice? Select all that apply.

A)

A claim that an error, not injury, occurred for several days

B)

A claim that the nurse owed the patient/client a special care of duty

C)

A claim that the nurse failed to meet the required standard

D)

A claim that harm or injury resulted because the nurse did not meet the

required standard E)

A claim of damages for which compensation is sought

Ans: B, C, D, E Feedback: Malpractice or negligence on the part of the nurse involves four elements: a claim that the nurse owed the patient/client a special care of duty; a claim that the nurse failed to meet the required standard; a claim that harm or injury resulted because the nurse did not meet the required standard; and a claim of damages for which compensation is sought. Errors without injury don't meet the standard of the four elements needed to support malpractice.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate

Page 9

Page and Header: 382, Legal Considerations Integrated Process: Nursing Process Objective: 3 12.

The nurse carries out a medication order that was incorrectly written by

the healthcare provider and subsequently filled by the pharmacist. Who is liable for administering the incorrect dose?

A)

Healthcare agency

B)

Healthcare provider

C)

Nurse

D)

Pharmacist

Ans: C Feedback: Mistakes in administering medication are among the most common causes of malpractice. Liability may result from administering the wrong dose, giving a medication to the wrong patient/client, giving a drug at the wrong time, or failing to administer a drug in the proper manner. For administration of medications, a nurse is required by law to exercise the degree of skill and care that a reasonably prudent nurse with similar training and experience would exercise under the same or similar circumstances. The physician is liable for writing the wrong script, the pharmacist is liable for filling the wrong order, and the nurse is liable for administering the wrong dose. All three can be sued if harm results. Additionally, the healthcare agency can be named in the lawsuit.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Difficulty: Moderate Page and Header: 387, Ethical Principles in Drug Administration

Page 10

Integrated Process: Nursing Process Objective: 4 13.

Which situation illustrates the ethical principle of autonomy being

applied in drug administration?

A)

The patient/client has the right to refuse medication.

B)

In drug research, the patient/client has a right to informed consent.

C)

A nurse anticipates the untoward effects of drugs that may occur and

acts to minimize them.

D)

The patient/client's drug therapy and responses are discussed only with

people who have the right to know.

Ans: A Feedback: Autonomy or self-determination is a form of personal liberty in which a person has the right to decide; know the facts and understand them; and acts without outside force, deceit, or constraints. For the patient/client, this implies a right to be informed about drug therapy and a right to refuse medication. The nurse has an obligation not to lie. In drug research, the patient/client has a right to informed consent. The principle of nonmaleficence holds that the nurse must not inflict harm on the patient/client and must prevent harm whenever possible. The nurse anticipates the untoward effects of drugs that may occur and acts to minimize them. Confidentiality is respect for the information that a nurse learns from professional involvement with patients/clients. A patient/client's drug therapy and responses should be discussed only with people who have a right to know.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply

Page 11

Difficulty: Moderate Page and Header: 387, Ethical Principles in Drug Administration Integrated Process: Nursing Process Objective: 4 14.

Which situation illustrates the ethical principle of justice being applied to

drug administration?

A)

The nurse will be right back with the patient/client's pain medication.

B)

The nurse checks the chart to see when the pain medication was last

administered to the patient/client and lets the patient/client know the information.

C)

The nurse decides it is best for the patient/client to receive pain

medication and overrides the patient/client's wishes not to take the pain medication.

D)

The patient/client receives the right dose of the correct pain medication

by the right route at the right time.

Ans: D Feedback: Justice refers to the patient/client's right to receive the right drug, the right dose, by the right route, at the right time. Fidelity is when the nurse should keep a promise made to the patient/client. Statements such as “'ll be right back” and “I'll check the chart and let you know” create a covenant that should be respected. The principle of beneficence holds that the nurse should act in the patient/client's best interests. If the nurse overrides a patient/client's wishes, deciding what is best for the patient/client, the nurse is violating the patient/client's rights.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control

Page 12

Cognitive Level: Understand Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Nursing Process Objective: 1 15.

An example of a nontherapeutic or adverse reaction to an

antihypertensive drug would be: A)

Lower systolic blood pressure

B)

Drowsiness

C)

Decreased sense of anxiety

D)

Tachycardia

Ans: D Feedback:

Side effects are non-therapeutic reactions to a drug. Because

these reactions are transient, they may not require any nursing intervention.

Side effects occur as a consequence of drug administration; often they are unrelated to the desired action of the drug. Adverse effects are nontherapeutic effects that may be harmful to the patient/client and thus require lowering the dosage or discontinuing the drug. Because these effects can be life threatening, they may require medical intervention. Idiosyncratic effects are effects from drugs that are not expected.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Nursing Process

Page 13

Objective: 1 16.

On admission, a patient tells a nurse that he has had an anaphylactic

reaction to penicillin. The nurse documents that penicillin: A)

Should only be given with another drug.

B)

Can be safely administered 90 days after the reaction.

C)

Can be given with caution.

D)

Is contraindicated.

Ans: D Feedback: A drug is contraindicated if an anaphylactic reaction occurs.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Nursing Process Objective: 1 17.

Select the medication order that is considered complete.

A)

3/30/08: Fran Jones Room 212 Keflex (cephalexin) 500 mg every 6

hours for 7 days Dr. James Brown B)

3/30/08: Fran Jones Room 212 Digoxin (Lanoxin) 0.5 mg po every day

Dr. James Brown C)

3/30/08: Fran Jones Room 212 Demerol (meperidine) 50 mg IM for pain

Dr. James Brown D)

3/30/08: Fran Jones Room 212 morphine sulfate 4 IV stat Dr. James

Brown Ans: B

Page 14

Feedback: A correct medication order bears the patient/client's name and room number, the date, the name of the drug, the dose of the drug, the route of administration, and the times to administer the drug. Therefore: 3/30/08: Fran Jones Room 212 Digoxin (Lanoxin) 0.5 mg po every day Dr. James Brown is a complete medication order.

3/30/08: Fran Jones Room 212 Keflex (cephalexin) 500 mg every 6 hours for 7 days Dr. James Brown is missing the route of administration.

3/30/08: Fran Jones Room 212 Demerol (meperidine) 50 mg IM for pain Dr. James Brown is missing the times to administer the drug.

3/30/08: Fran Jones Room 212 morphine sulfate 4 IV stat Dr. James Brown is missing the dose of the drug.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Difficulty: Difficult Page and Header: 372, Drug Knowledge Integrated Process: Nursing Process Objective: 1 18.

Choose the best nursing action for administering liquid medications.

A)

When measuring a liquid medication from a stock solution, pour a little

excess and then return any unused amount to the stock bottle.

B)

When a liquid medication requires dilution, add sufficient sterile water

equal to the total amount of solution ordered.

C)

Before the patient/client has to take a liquid antacid, have him or her

drink 5 to 10 mL of water to help in swallowing the thick antacid.

D)

Pour liquid medications at eye level using a medicine cup. It is important

Page 15

to measure at the level of the center of the meniscus.

Ans: D Feedback: It is important to never return any poured drug to a stock bottle.

Some liquid medications require dilution. It is important to check references for directions. After, not before, the patient/client has taken a liquid antacid, add 5 to 10 mL of water to the cup to mix because antacids are thick and some medication often remains in the cup. It is important to pour liquid medications at eye level using a medicine cup. It is important to measure at the center of the meniscus.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Page and Header: 377, Pharmacokinetics Integrated Process: Nursing Process Objective: 2 19.

Select the best nursing action when administering irritating oral drugs.

A)

Withhold the medication and notify the healthcare provider.

B)

Break the oral medication in half and have the patient/client take two

halves separately.

C)

Obtain the liquid form of the medication and add 5 to 10 mL of water to

the cup.

D)

Administer the medication with a meal or snack.

Ans: D Feedback: Administer irritating oral drugs along with meals or a snack to decrease gastric irritation. Only a scored tablet can be broken in half. When a

Page 16

patient/client cannot swallow capsules or tablets, the physician should be notified to order a liquid medication or the nurse should check with the pharmacist. After the patient/client has taken a liquid antacid, add 5 to 10 mL water to the cup, mix, and have the patient/client drink it.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Page and Header: 377, Pharmacokinetics Integrated Process: Nursing Process Objective: 2 20.

Explain the meaning of a synergistic effect when two drugs are given.

A)

The first drug offsets the effectiveness of the second drug.

B)

The second drug increases the intensity of the first drug.

C)

The first drug and second drug action are not affected.

D)

Neither the first drug nor second drug work at all.

Ans: B Feedback: Synergism describes what happens when the second drug increases the intensity or prolongs the effect of the first drug. The reversal action is termed antagonism.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

Page 17

Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 21.

A patient/client who took an opioid analgesic for pain experienced the

following side effects. Which effect would be considered adverse?

A)

Drowsiness

B)

Constipation

C)

Euphoria

D)

Urinary retention

Ans: D Feedback: Side effects are nontherapeutic reactions to a drug that are usually transient and may not require any nursing intervention. Adverse side effects are also nontherapeutic, but they may be harmful or life threatening, require nursing documentation, and may require medical intervention. Drowsiness, constipation, and euphoria are side effects that are not life threatening but do require that the nurse document their occurrence because the physician may wish to change the dosage. Urinary retention is considered an adverse effect that requires medical intervention.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1

Page 18

22.

The patient/client took one 500-mg tablet of Glucophage (metformin)

daily. Select the statement that describes the drug's classification.

A)

It is an oral antidiabetic agent.

B)

It inhibits hepatic glucose production.

C)

It is excreted unchanged by the kidneys.

D)

It increases tissue sensitivity to insulin.

Ans: A Feedback: A drug's classification is a way to categorize drugs by the way they act against diseases or disorders. Glucophage (metformin) is an oral antidiabetic. Its inhibition of hepatic glucose and its ability to increase tissue sensitivity to insulin refers to its actions. Its excretion, unchanged by the kidneys, refers to pharmacokinetics.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 2 23.

In infants, body systems are different relative to drug absorption;

distribution, metabolism, and elimination. Identify an expected change for absorption.

A)

Decreased stomach acidity

B)

Increased blood flow to the gastrointestinal tract

C)

Increased gastrointestinal motility

D)

Smaller body surface area

Page 19

Ans: A Feedback: Changes in absorption for infants include decreased stomach acidity, slower peripheral circulation and greater body surface area.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 377, Pharmacokinetics Integrated Process: Teaching/Learning Objective: 2 24.

A patent/client is given 500 mg of an oral antibiotic at 12 noon. The

physician prescribes the drug, every 6 hours, based on the drug's half-life of 30 minutes. What percent of the drug would be available in the patient/client's bloodstream at 2:00 PM? A)

50%

B)

25%

C)

12.5%

D)

6.25%

Ans: D Feedback: The half-life is the time required for half of the drug to be excreted.

If a drug's half-life is 30 minutes, then after 30 minutes, only half of the dose is still therapeutic. After 30 more minutes, only half of the prior dose is therapeutic. Therefore, if a drug with a half-life of 30 minutes is given at 12 noon, then 30 minutes later at 12:30 PM, 50% is available. At 1:00 PM, 25% is available; at 1:30 PM, 12.5% is available; and at 2:00 PM, only 6.25% of the drug remains.

Page 20

Format: Choice Multiple Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Page and Header: 382, Legal Considerations Integrated Process: Nursing Process Objective: 3 25.

A regional medical center recently experienced a large number of

lawsuits regarding negligence due to medication errors. Although preventable, which are the common actions associated with the most frequent medication administration errors? Select all that apply.

A)

The wrong patient/client is given the medication.

B)

The incorrect dose is administered.

C)

The drug is given on the wrong schedule, resulting in ineffectiveness.

D)

The wrong drug is given.

E)

The wrong route of administration is used.

F)

The drug is not monitored and complications result.

Ans: A, B, C Feedback: All activities can result in negligence and patient/client harm. The three most common errors are administering an incorrect dose, administering the wrong drug, and using the wrong route of administration.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

Page 21

Difficulty: Moderate Page and Header: 372, Drug Knowledge Integrated Process: Teaching/Learning Objective: 1 26. Which of the following statements is true about the generic name for a medication?

A) Manufacturers of generic drugs are required to use the same fillers and dyes for consistency.

B) Generic drugs, because they are manufactured by different companies, are not exactly the same.

C) The active ingredient(s) in different generic drug preparations is (are) different depending on the manufacturer.

D) Generic drugs tend to be more expensive because of the variety of preparations for each medication.

Ans: B Feedback: Generic drug preparations tend to be the least expensive drug preparation available. Generic drugs are not exactly the same because they are manufactured by different companies, using different fillers and dyes. The active ingredient in the drug must meet standards of uniformity and purity.

Format: Multiple Choice Chapter:

9

Client Needs:

Physiological Integrity: Pharmacological and Parenteral

Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header:

377, Pharmacokinetics

Integrated Process: Teaching/Learning Objective: 2

Page 22

27. Age-related changes affect the pharmacokinetics of medications. Identify an example of bodily changes occurring with an older adult.

A) Decreased stomach acidity B) Increased body surface area C) Increased body fat D) Increased liver function Ans: C Feedback: Pharmacokinetic changes that occur with older adults include: increased stomach acidity and body fat and decreased body surface area and liver function.

Format: Multiple Choice Chapter:

9

Client Needs:

Safe and Effective Care Environment: Management of Care

Cognitive Level: Difficulty:

UnderstaTnEdSTBANKSELLER.COM

Moderate

Page and Header:

382, Legal Considerations

Integrated Process: Nursing Process Objective: 3 28. The most common causes of liability due to a nursing error are related to mistakes that occurred when: A) documenting patient care B) transferring the patient C) administering medications D) changing surgical dressings.

Ans: C Feedback: Mistakes in administering medications are among the most common causes of liability, which may result from the following:

Page 23

•

administering the wrong dose

•

giving a medication to the wrong patient/client

•

giving a drug at the wrong time

•

failing to administer a drug at the right time or in the proper manner

•

failing to withhold a medication when indicated

Format: Multiple Choice Chapter:

9

Client Needs:

Physiological Integrity: Basic Care and Comfort

Cognitive Level:

Understand

Difficulty: Moderate Page and Header:

387, Ethical Principles in Drug Administration

Integrated Process: Nursing Process Objective: 4 29. A nurse tells a patient/client “I’ll be right back.” The nurse fails to return for ESoTf BthAeNK two hours. This is a violatiT on etShEicLaLl E pR ri. nC ciO pM le of: A) Autonomy B) Confidentiality C) Justice D) Fidelity Ans: D Feedback: Autonomy refers to self-determination. Confidentiality is respect for information obtained from professional interaction with the patient/client.

Justice refers to the patient/client’s rights to safe care. Fidelity refers to the nurse’s responsibility to keep promises made to the patient/client.

Format: Multiple Choice Chapter:

9

Client Needs:

Physiological Integrity: Pharmacological and Parenteral

Page 24

Therapies Cognitive Level: Difficulty:

Apply

Moderate

Page and Header:

377, Pharmacokinetics

Integrated Process: Teaching/Learning Objective: 2 30. A drug’s effectiveness is influenced by its metabolism and biotransformation. Some drugs are less effective because of the “Patient-pass” effect. Which route of drug administration is influenced by this effect?

A) Oral B) Subcutaneous C) Intramuscular D) Intravenous Ans: A Feedback: Most metabolism TEoSrTbBiA otNrK an SsEfL orLm EaRt.ioCnOM o ccurs in the liver. The first-pass effect occurs with medications taken by mouth (enteral route). After ingestion, the drug is absorbed by the gastrointestinal system and then first passes through the liver, where some of the drug may be metabolized. Thus, the drug may not be as effective as it continues through the pharmacokinetic phases. The parenteral route (subcutaneous, IM, IV) bypasses the first-pass effect, so more of the drug is available to the body tissues and cells.

Page 25

Chapter 10, Administration Procedures Format: Choice Multiple Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Page and Header: 409, Standard Precautions Applied to Administration of Medications Integrated Process: Teaching/Learning Objective: 4 1.

When administering injections, which general safeguards in administering

medications must be followed? Select all that apply.

A)

Wash hands.

B)

Wear gloves.

C)

Recap needle after useT.ESTBANKSELLER.COM

D)

Disposal of used sharps in a puncture-proof container.

E)

Wear protective eyewear.

Ans: A, B, D, E Feedback: Do not recap when administering injections. Handwashing and gloves are required. Carefully dispose of used sharps in a puncture-proof container or use a needleguard device. Protective eyewear must be worn when a medication procedure is known to cause aerosolization of fluids that contain chemicals or body fluids.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Page and Header: 409, Standard Precautions Applied to Administration of Medications Integrated Process: Teaching/Learning Objective: 4

2.

A nursing faculty member is reviewing general standards, precautions, and

safeguards used to administer medications to nursing students. Which statement is correct and should be included in the presentation she is preparing?

A)

Bend the needle off a syringe after using it to administer an injection to a

patient/client.

B)

Gowns must be worn to administer medications to mucous membranes.

C)

Wear gloves for any direct contact with a patient/client's blood, body fluids, or

secretions.

D)

A mask is required when administering oral medications with patients/clients

on any isolation procedure.

Ans: C Feedback: When administering medications, gloves are worn for any direct contact with a patient/client's blood, body fluids, or secretions. Used needles are not to be broken, bent, or recapped after use. Gowns are worn only when there is a risk that clothing may become contaminated with a patient/client's blood or body fluids. A mask is required when caring for a patient/client on strict or respiratory isolation procedures.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Page and Header: 409, Standard Precautions Applied to Administration of Medications Integrated Process: Teaching/Learning Objective: 4 3.

A nurse was stuck with a used needle while dropping it into a full

puncture-proof container. What would the nurse do first?

A)

Apply an acceptable antiseptic.

B)

Follow protocol for accidental exposure to blood or body fluids.

C)

Squeeze the area of contact.

D)

Wash the area with soap and copious amounts of water.

Ans: C Feedback: When a needlestick occurs that causes contact with the blood or blood-streaked body fluids of any patient/client, it is important to act immediately.

Squeeze the area of contact, then wash the area with soap and copious amounts of water, and apply an acceptable antiseptic. It is important to follow the protocol established by the healthcare institution for management of needlestick injury or accidental exposure to blood or body fluids.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Page and Header: 405, Systems of Administration Integrated Process: Teaching/Learning Objective: 3 4.

Choose the most widely used system of medication administration.

A)

Mobile cart

B)

Scanner device

C)

Tickets

D)

Unit-dose packaging

Ans: D Feedback: Unit-dose packaging is the most widely used system. Institutions establish their own systems for administering medication. Tickets, mobile carts, locked medication cabinets near the patient/client's bedside, and/or computer printouts may be used. A newer system uses a scanner device, scanning the patient/client's ID band, the nurse's ID, the medication administration record, and the medication in unit-dose packaging. If the scan reveals any discrepancy, the device alerts the nurse. The ticket system is rarely used.

Format: Multiple Choice

Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 405, Systems of Administration Integrated Process: Teaching/Learning Objective: 3 5.

A patient/client refused to take an ordered stool softener. What is the correct

procedure to document the refused medication?

A)

Circle the time and document a reason the medication was not given.

B)

Circle the time and initial and document a reason the medication was refused.

C)

Draw a line through the time and document a reason the medication was not

given.

D)

Draw a line through the time and initial and document a reason the medication

was refused.

Ans: B

TE EeLtLim ER Feedback: When a medication isSrT efBuA seNdK, S th e. isCcO irM cled and initialed and a reason given for why the medication was not given. When a nurse administers a medication, a line is drawn through the time and initialed.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Difficulty: Difficult Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 6.

Select the correct sequence of steps for the administration of oral medications.

1) Administer oral tablets first.

2) Administer oral capsules second.

3) Administer oral liquid medications first.

4) Administer oral liquid medications second.

A) 1, 4 B)

2, 3

C)

It does not matter what order the medications are administered.

D)

Capsules have to be administered first, then tablets and oral liquid

medications._ Ans: A Feedback: Oral solid medications are administered first, along with a full glass of water whenever possible unless contraindicated. Then oral liquid medications are given. Oral tablets and capsules are both considered solid medications.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate

Am NK Page and Header: 411, RoutTeE s SoT fB Ad inS isE trL aL tiE onR.COM Integrated Process: Teaching/Learning Objective: 5 7.

What type of precaution must the nurse use to break a scored tablet?

A)

Clean technique

B)

Respiratory technique

C)

Strict asepsis

D)

Standard asepsis

Ans: A Feedback: To break a scored tablet, use clean technique. A mask is required when administering medications for a patient/client on strict or respiratory isolation procedures.

Format: Choice Multiple Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level: Understand Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 8.

Select all correct statements about the administration of oral medications.

A)

Check expiration dates on all labels.

B)

Check patients/clients for allergies to drugs.

C)

Be aware that some drugs are best taken on an empty stomach.

D)

When a patient/client is NPO, he or she cannot receive any drugs.

E)

Use one primary method of verifying the identity of the patient/client.

Ans: A, B, C Feedback: It is recommended that two patient/client identifiers are sufficient for patient/client identification. Even if the patient/client is NPO, he or she may need to receive certain drugs. Always check expiration dates on all labels. It should be a routine procedure to check patients/clients for allergies to drugs. Some drugs are best

TrBs AmNaKySbEeLtLaE CiOthM food. taken on an empty stomach;ToEtS he keRn.w Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 9.

The nurse has to give an intramuscular injection to an adult. What is the correct

gauge needle that should be used?

A)

21

B)

23

C)

25

D)

28

Ans: B Feedback: The higher the gauge number, the finer the needle. The finest needle currently available for routine injections is the 28-gauge needle on the insulin syringe.

Gauge numbers 25, 26, and 28 are used in subcutaneous injections for adults and in intramuscular (IM) injections for children and emaciated patients/clients. Numbers 23 and 22 are used for IM injections; 20 and 21 are for IV therapy.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 10.

The nurse had to prepare an injection of regular and NPH insulin. What is the

TaBrA EL correct sequence of steps forTpErS ep inN gKtS he inL sE ulR in.iC nO jeM ction?

1) Draw up into the syringe an amount of air equivalent to the amount of regular insulin and expel the air into the vial.

2) Draw up into the syringe an amount of air equivalent to the amount of NPH insulin and expel the air into the vial.

3) Draw up the ordered amount of regular insulin.

4) Draw up the ordered amount of NPH insulin.

A)

1, 2, 3, 4

B)

1, 2, 4, 3

C)

2, 1, 3, 4

D)

2, 1, 4, 3

Ans: C Feedback: Choose one vial as the primary. With two insulins, regular insulin is the primary. Inject air into the second vial, which is the NPH insulin, in an amount equaling the medication to be withdrawn. Inject air into the primary vial, which is the regular insulin, in an amount equaling the medication to be withdrawn and then

withdraw the medication in the usual way. Insert the needle into the second vial, which is the NPH insulin, and slowly withdraw the needed amount of drug from the second vial. When preparing two types of insulin in one syringe, first draw into the syringe the vial containing the regular insulin.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 11.

The nurse had to administer 2.25 mL of an intramuscular medication to an

adult patient/client. According to the medication administration record, the previous injection was administered in the right dorsogluteal site. In which site should the

TsEcS L?LER.COM nurse administer this intramu ulT aB rA inN jeKcS tiE on A)

Deltoid

B)

Lower abdomen

C)

Left ventrogluteal site

D)

Thigh

Ans: C Feedback: The left ventrogluteal site will accept a medication volume of 2.25 mL and is on the opposite side and a different injection site from the previous injection. The ventrogluteal site is located in the ventral part of the gluteal muscle and has no large nerves or blood vessels. The deltoid site is used for intramuscular injections only if specifically ordered and no more than 2 mL of medication can be injected. This injection volume is 2.25 mL. The lower abdomen and thigh are used for subcutaneous injections, not intramuscular sites.

Format: Multiple Choice Chapter: 10

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 12.

The nurse has to administer an intradermal injection for skin testing for

allergies. Which action is correct for intradermal injections?

1

A)

Insert the needle

B)

Hold the syringe in four fingers and thumb, with the bevel of the needle down.

C)

Inject the solution so that it raises a small wheal, raised bump, or blister.

D)

Massage the skin for 10 seconds after removal of the needle.

4

inch, almost parallel to the skin.

Ans: C Feedback: The correct method for intradermal injections is to hold the syringe in four fingers and thumb, with the bevel of the needle up. Insert the needle about 1/8 inches, almost parallel to the skin. The needle will be seen under the skin. Inject the solution so that it raises a small wheal, raised bump, or a blister. Do not massage the skin.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration; 440, Special Considerations Integrated Process: Teaching/Learning Objective: 5, 6 13.

A 6-month-old infant is to receive 0.5 mL of a preoperative injection,

intramuscularly, prior to going to surgery to have tubes inserted in the ears. What site should the nurse select to administer the medication?

A)

Deltoid

B)

Dorsogluteal

C)

Ventrogluteal

D)

Vastus lateralis

Ans: D Feedback: The site for an intramuscular injection in a child depends on the child's age, the child's size, and the volume and density of medication being administered. Infants cannot tolerate volumes greater than 0.5 mL in a single site. The preferred site for infants is the vastus lateralis muscle. After the child has been walking for more than a year, the dorsogluteal site can be used. However, that site is not recommended for children younger than 5 years. For the older child and adolescent, the same injection sites used for adults are appropriate.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

Am NK Page and Header: 411, RoutTeE s SoT fB Ad inS isE trL aL tiE onR.COM Integrated Process: Teaching/Learning Objective: 5 14.

While administering the flu vaccine via the intramuscular route, the nurse sees

a blood return in the syringe barrel after aspirating 0.1 mL. What is the nurse's next step?

A)

Inject the medication slowly.

B)

Remove the needle quickly and reinsert in a new site.

C)

Press down on the area with an alcohol pad.

D)

Withdraw the needle and prepare another injection.

Ans: D Feedback: When blood enters the syringe, withdraw the needle, discard both the needle and the syringe into a sharps container, and prepare another injection.

Format: Multiple Choice Chapter: 10

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 15.

Which statement is true about Z-track technique for intramuscular injections?

A)

The ventrogluteal site is used to prevent medication from seeping into the

needle tract and onto the skin.

B)

Inject the needle at a 90-degree angle. After giving the injection, count to 10

prior to removal of the needle.

C)

After preparing the medication, use the same needle to prevent leakage along

the tract of the injection.

D)

Add 0.1 mL of air to the syringe to seal off the medication and prevent it from

leaking onto the skin.

Ans: B

T0B-AdN EL LgEleR..ACftOeMr giving the medication, count Feedback: Insert the needle T atEaS9 egKrS ee an to 10 to seal the medication into the tract. The Z-track method used at the dorsogluteal site can prevent medication from seeping into the needle tract and onto the skin. After the medication is prepared, the needle is changed to prevent leakage along the tract. Air (0.2 mL) is added to the syringe. As the medication is injected, the air will rise to the top of the syringe and will be administered last, thus sealing off the medication and preventing it from leaking onto the skin.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5

16.

The patient/client has a 1000 mL bag of NS running at 30 mL/hour. In how

many hours would the nurse anticipate having to change the IV bag?

A)

16

B)

24

C)

72

D)

96

Ans: B Feedback: Generally, IV fluids are changed every 24 hours. A peripheral IV site is changed every 72 hours and IV tubing every 72 to 96 hours. It would take 33

1

2

hours

for 1000 mL of NS to infuse at 30 mL/hour.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration; 440, Special Considerations Integrated Process: Teaching/Learning Objective: 5, 6 17.

The nurse has to administer a bitter-tasting oral medication to a 5-year-old

patient/client. What is the best strategy to administer this drug to the child?

A)

Before administering the medication, offer a popsicle.

B)

Administer the medication in a cup of milk.

C)

Have the child keep his nostrils open and drink the medication through a straw.

D)

Use a specially manufactured medication nipple or pacifier.

Ans: A Feedback: Before administering an oral medication, offer the child a popsicle, which will numb the taste buds. Mix the drug with a teaspoon of puréed fruit, ice cream, or syrup. Using essential foodstuffs such as milk is not a good idea because the child may refuse those foods later. Have the child pinch his or her nostrils and drink the medication through a straw. This technique interferes with the ability to smell and

keeps the child from tasting the medication. For infants, not a 5-year-old child, use a specially manufactured nipple or pacifier.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration; 440, Special Considerations Integrated Process: Teaching/Learning Objective: 5, 6 18.

A geriatric patient/client has had a cerebrovascular accident and has a feeding

tube in place. Which statement is correct about the administration of drugs through a feeding tube?

A)

Dilute medications with normal saline at room temperature.

B)

Elevate the head of the bed to 30 degrees prior to administering.

C)

TbBeAiNnKthSeEL M inserting 60 mL of air.

Check the position of tThE eStu stL oE mR a. chCO by

D)

Flush the tube with 15 mL of warm water to ensure patency.

Ans: B Feedback: Dilute the medication with water. The fluid mixture should be at room temperature. Elevate the head of the bed to 30 degrees. To check the position of the tube in the stomach, place a stethoscope on the stomach and insert about 15 mL of air. Flush the tube with at least 30 mL of warm water to ensure patency.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration; 440, Special Considerations Integrated Process: Teaching/Learning Objective: 5, 6

19.

A geriatric patient/client has to administer frequent eye drops in both eyes prior

to cataract surgery. Which action is most important for the patient/client to consider when administering eye drops?

A)

The patient/client should gently draw the lower eyelid down to create a sac to

instill the medication.

B)

The medication should be inserted into the outer canthus of the eye.

C)

The patient/client should look down when instilling the eye drops into his eye.

D)

The medication should touch the eye membrane to ensure proper placement.

Ans: A Feedback: The patient/client should gently draw the lower eyelid down to create a sac. He or she should then look up and instill the liquid medication into the lower conjunctival sac, taking care not to touch the membrane. When administering ophthalmic ointment, the ointment should be spread from the inner to the outer canthus of the eye.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 411, Routes of Administration; 440, Special Considerations Integrated Process: Teaching/Learning Objective: 5, 6 20.

A 2-year-old patient/client has to have ear drops administered. What is the

correct procedure for the nurse to administer the ear drops?

A)

Straighten the ear canal by pulling the pinna up and back.

B)

Straighten the ear canal by pulling the pinna down and back.

C)

The patient/client should rest on the affected side for 10 to 15 minutes.

D)

The patient/client should rest on the unaffected side for 5 to 10 minutes.

Ans: B Feedback: The ear canal is straightened on a child 3 years and younger by pulling the pinna down and back and on an adult by pulling the pinna up and back. The

patient/client should rest on the unaffected side for 10 to 15 minutes after administration of ear drops.

Format: Choice Multiple Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Page and Header: 399, Three Checks and the Rights of Medication Administration Integrated Process: Teaching/Learning Objective: 1 21.

There are six standard rights that a nurse must adhere to before administering

medications. Select all that apply. The right to the: A)

Right medication

B)

Right assessment

C)

Right drug preparation

D)

Right documentation

E)

Right time

Ans: A, D, E Feedback: The six standard rights for a patient/client for medication administration are the right medication, right patient/client, right dosage, right route, right time, and right documentation. Assessment and drug preparation are important and necessary, but they are not part of the standard six rights.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Page and Header: 400, Medication Orders Integrated Process: Teaching/Learning Objective: 2

22.

Select the type of medication order that is labeled as a “single-dose” order.

A)

Synthroid 0.05 mg, po, daily.

B)

Morphine sulfate, 3 mg, q4h, prn for chest pain.

C)

Zithromax (“Z-Pak”), 6,250 mg tablets; take 2 tablets on the first day and then

one tablet daily for the next four days.

D)

Valium 5 mg, po, daily prior to a bone biopsy.

Ans: D Feedback: The medication order for Valium is an example of a single-dose order.

Zithromax is a standing order with a termination date; morphine is a prn order; and Synthroid is an example of a standing order without a termination date.

Format: Choice Multiple Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate

ArNdKeS Page and Header: 400, MedT icE atSioTnBO rsELLER.COM Integrated Process: Teaching/Learning Objective: 2 23.

Medication orders in an institution can be written by approved practitioners.

Select all categories of personnel that can write medication orders.

A)

Physicians

B)

Medical students

C)

Registered nurses

D)

Emergency medical technicians

E)

Nurse practitioners

Ans: A, B, E Feedback: Only licensed physicians or healthcare providers such as medical students and nurse practitioners can write medication orders. Medical students and nurse practitioners must have the order countersigned by a physician or work from an approved list of orders that can be written. Registered nurses and emergency medical

technicians cannot independently write medication orders but can administer them, in an emergency situation, using an approved protocol.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Page and Header: 403, Medication Administration Record (MAR ), Computerized Medication Administration Records (CMAR ), and Electronic Medical Administration Record (eMAR ) Integrated Process: Teaching/Learning Objective: 2 24.

A physician ordered a medication to be given four times a day. The dosage

administration schedule was 10:00 AM, 2:00 PM, 6:00 PM, and 10:00 PM. The nurse recorded the drug's administration, in military time, on the medication administration

AeNnKcS LrEuR OMinistration using military time. record (MAR). Select the corrT eE ctSsTeB qu eE oL fd g. aC dm A)

1000, 1200, 1500, 2000

B)

1000, 1300, 1600, 2100

C)

1000, 1500, 1900, 2300

D)

1000, 1400, 1800, 2200

Ans: D Feedback: When using military time (24-hour clock) rather than the 12-hour clock used commonly in the United States, the day begins at midnight (0000) and ends the following midnight (2400). For example, 12:30 AM is written as 0030, 2:00 AM (0200), 8:00 AM (0800), 3:00 PM (1500), and 7:00 PM (1900). Therefore, the correct answer is 1000 (10:00 AM), 1400 (2:00 PM), 1800 (6:00 PM), and 2200 (10:00 PM).

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

Difficulty: Moderate Page and Header: 411, Routes of Administration Integrated Process: Teaching/Learning Objective: 5 25.

The nurse is aware that some patients/clients have difficulty swallowing solid

preparations of medications. Therefore, special considerations can be used. Choose the best approach to help a geriatric patient/client take a solid form of a medication.

A)

Open a sustained-release capsule and mix the contents with applesauce.

B)

Crush a prolonged-release tablet into fine particles.

C)

Crush an enteric-coated tablet and give with milk.

D)

Break a scored tablet in half and give

1

2

first and then

1

2

about 1 minute

later.

Ans: D Feedback: When applying special considerations for oral administration, it is important to remember to never crush enteric- or prolonged-release tablets or open time- or sustained-released capsules. Scored tablets (a line in the center) can be broken. It is recommended to place the tablet in a paper towel folded over the tablet and, using both

thumbs and index fingers, apply even and light pressure and break

the tablet.

Format: Multiple Choice Chapter:

10

Client Needs:

Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level:

Apply

Difficulty: Moderate Page and Header:

400, Medication Orders

Integrated Process: Teaching/Learning Objective: 2 26. Select the example of a medication order that is written without termination.

A)

Mevacor (lovastatin) 10 mg, po, every 12 hours for 7 days

B)

Motrin (ibuprofen) 400 mg, po, daily

C)

Demerol (meperidine HCL) 50 mg, IM, prior to surgery

D) Lasix (furosemide) 40 mg, IV, stat Ans: B Feedback: Mevacor is a standing order with a termination time. Motrin is a standing order without a termination time. Demerol is a single-dose order and Lasix is a stat order.

Format: Multiple Choice Chapter:

10

Client Needs:

Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level:

Understand

Difficulty: Moderate Page and Header:

400, Medication Orders

Integrated Process:

Teaching/Learning

Objective: 2 27. Hospital guidelines provT idEeSaTnBaA uN toKm icLsE toRp.tC im SaEtL OeMfor some drug classifications.

Select the drug classification that would most likely have a 10-day automatic stop time.

A)

Narcotic

B)

Anticoagulant

C)

Antibiotic

D) Antihypertensive Ans: C Feedback: Narcotic medication orders are usually valid for 48 to 72 hours.

Anticoagulants are usually valid for long-term use with the dosage adjusted based on laboratory blood values. Antibiotics are usually valid for 10 days. Antihypertensives are usually valid for long-term use depending on their effectiveness and the patient’s therapeutic response.

Format: Choice Multiple Chapter:

10

Client Needs:

Safe and Effective Care Environment: Safety and Infection Control

Cognitive Level:

Understand

Difficulty: Moderate Page and Header:

411, Routes of Administration

Integrated Process:

Teaching/Learning

Objective: 5 28. When administering medications by the oral route a number of safeguards are required. Select all that apply: A) Break unscored tablets by placing the tablet in a paper towel and, using your thumb and index finger, break the tablet.

B)

Crush enteric-coated tablets to facilitate rapid absorption.

C)

Shake liquid medications thoroughly before pouring.

D)

Pour liquids at eye level, using a medicine cup.

E)

Lozenges should dissolve slowly in the mouth.

Ans: C, D, E Feedback: Do not break unscored tablets because you can’t be certain that the drug will be evenly distributed. Never crush enteric-coated tablets because they are meant to dissolve in the alkaline secretions of the intestines rather than the highly acidic stomach juices. You should always shake liquid medications to mix the contents.

When pouring liquids at eye level measure the correct dose at the center of the liquid which is called the meniscus, the lower curve of the liquid in a cup container. Lozenges are solid tablets with medication that dissolves slowly in the mouth.

Format: Multiple Choice Chapter:

10

Client Needs:

Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level:

Apply

Difficulty: Moderate Page and Header: Integrated Process: Objective: 5

411, Routes of Administration Teaching/Learning

29. The most common syringe used for injections is a standard 3-mL size, marked in milliliters to the nearest tenth. Select the standard gauge of the injection needle for the 3-mL syringe.

A)

25 -28

B)

25-26

C)

20-28

D)

20-23

Ans: D Feedback: The term gauge indicates the needle’s diameter and width. The higher the gauge number, the finer or smaller the needle’s diameter. A 25 -28 gauge is standard for a ½ mL, low-dose insulin syringe. A 25-26 gauge is used for a 1-mL insulin syringe. A standard 1-mL syringe would use a 20-28 gauge needle and the standard 3-mL syringe would use a 20-23 gauge needle.

Format: Multiple Choice Chapter:

10

Client Needs:

Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level:

Apply

Difficulty: Difficult Page and Header: Integrated Process:

411, Routes of Administration Teaching/Learning

Objective: 5 30. There are four common sites for intramuscular injections for adults: dorsogluteal, ventrogluteal, the vastus lateralis and the deltoid muscles. Select the landmarks to use to correctly identify the exact site for the dorsogluteal site.

A) The crest of the posterior ileum as the superior boundary and the inferior gluteal fold as the lower boundary.

B)

The greater trochanter, the anterior superior iliac spine and the iliac crest

C) One hand’s width below the greater trochanter and one hand’s width above the knee.

D)

The lower edge of the acromion process and the axilla are boundaries.

Ans: A Feedback: Dorsogluteal Site. The thick gluteal muscles of the buttocks (the dorsogluteal site has been associated with possible injury due to the proximity of the sciatic nerve. Also extensive subcutaneous tissue at this site may cause the IM injection to actually be in the subcutaneous tissue. The ventrogluteal site refers to the ventral part of the gluteal muscle. The vastus lateralis refers to the lateral thigh. The deltoid site refers to the upper arm, at the deltoid, a small muscle close to the radial and brachial arteries