General Concepts - NCLEX-PN

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Question

The nurse is preparing to administer 250,000 units of medication to a patient. The ampule sent from the pharmacy contains 500,000 units/mL. How many mL should the nurse administer?

Answer

The medication dose formula is as follows: Milliliters to be administered = (Dose to be administered)/(Available solution). Thus, the calculation for this problem is (250,000 units)/(500,000 units/mL) = 0.5 mL

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Question

The nurse is preparing to administer 100,000 units of medication to a patient. The ampule sent from the pharmacy contains 600,000 units/mL. How many mL should the nurse administer?

Answer

The medication dose formula is as follows: Milliliters to be administered = (Dose to be administered)/(Available solution). Thus, the calculation for this problem is (100,000 units)/(600,000 units/mL) = 0 mL mL

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Question

The nurse is preparing a bag of heparin sodium solution with a mix of 120,000 units/400 mL intravenously. At what rate should the nurse set the infusion pump if intending to deliver 1800 units/hr?

Answer

The required rate can be calculated as follows: (Delivered units/hr x mL)/units. Thus, the answer can be calculated as (1800 units/hr x 400 mL)/120,000 units = 6.0 mL/hr

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Question

Which of the following is the preferred location of intramuscular (IM) injection in infants?

Answer

The vastus lateralis is the preferred site of injection in infants. Rectus femoris injections may be preformed as a second choice. The dorsogluteal site should not be used in infants as the muscle is not developed and there is risk associated with the location of the sciatic nerve. Deltoid injections may be given to older children when the muscle becomes larger.

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Question

The nurse is preparing to administer an intramuscular (IM) injection to a 4.8 pound infant. The nurse should position the needle at which angle?

Answer

The preferred angle for intramuscular (IM) injections is 90 degrees. However, very small infants may require that the injection be given at a 45 degree angle. Based on patient condition, it is the nurse's responsibility to assess the needs of the patient and adjust care as appropriate.

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Question

The new pediatric nurse has just given a suppository to a 5-year-old boy. He has a bowel movement 7 minutes post administration. Which action should the nurse take next?

Answer

First, examine the stool for the suppository. Based on the findings, inform the physician. If the suppository was fully present in the stool, the physician may want to prescribe another dose. If not, he may choose to re-order half of the prescribed dose or none at all.

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Question

The nurse has just administered the first doses of the following medications. Which is most likely the cause of a new-onset headache?

Answer

The development of a headache is most likely a side effect of pantoprazole (a proton-pump inhibitor). Sumatriptan is a medication that is commonly used to relieve migraine headaches. Metoclopromide may cause restlessness and anxiety. Sucralfate may cause constipation. Side effects are rarely seen with magnesium hydroxide, they include nausea, constipation, and aluminum deficiency due to overexcretion via binding phosphate in the stomach.

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Question

The pediatric nurse must convince a 4-year-old boy to take his medication. Which phrase is the most acceptable?

Answer

When convincing a child to take medicine, be straightforward and clear. Try not to offer the child a choice, as they likely won't take it. Stay away from using bribery, punishment, or comparing medicine to candy. Be honest about the taste of the medicine or risk losing the trust of the child.

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Question

The pediatric nurse is summoned to a room by the parents of a 2-year-old child. The peripheral IV line has been removed by the patient. When starting a new line, the nurse carefully chooses placement. The nurse should attempt to start the IV __________.

Answer

Most peripheral IV's are started in the right or left arm. Distal to the arm would mean closest to the fingertips. When starting an IV, always start looking for potential sites closest to the fingertips and work upwards. If a vein is punctured and becomes unusable, it is possible to move above the previous attempt and start a successful IV.

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Question

Jane is a 49-year-old woman who has recently had a peripherally inserted central catheter (PICC) placed. The nurse is teaching Jane how to flush her PICC. She knows that the teaching was effective when Jane states which of the following?

Answer

One should always use a 10mL syringe or larger to flush a PICC line. Smaller syringes place greater pressure on the line which could result in damage. For example, a 3mL syringe places greater pressure on a PICC line than a 5mL syringe.

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Question

Which of the following is an appropriate reason to delay antibiotic administration in a stable patient?

Answer

Obtaining a set of blood cultures before treating a bacterial infection helps to individualize care and reduce antibiotic resistance (using a narrow-spectrum antibiotic doesn't work against so many types of bacteria). By identifying specific bacteria in the blood, a narrow-spectrum antibiotic may be chosen. A physician may prescribe a broad-spectrum antibiotic initially and change treatment later based on the results of the blood cultures.

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Question

A nurse is teaching a mother how to administer nystatin to her 2-month-old child in the treatment of oral candidiasis. Which of the following is an appropriate instruction given by the nurse to the mother?

Answer

Apply medication to the mouth using a cotton-tipped applicator. Give the medication after meals and avoid rinsing the mouth. The medication should have contact with the mucosa without being washed away. Do not place the medication in a child's bottle, they may refuse to eat due to the bitter taste of the medication. Do not use a syringe to squirt the liquid to the back of the mouth since the child will likely spit it out.

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Question

When performing a blood transfusion, which of the following procedures should not be adhered to in order to ensure safe delivery of blood product to the patient?

Answer

All are true except for the use of lactated Ringer's this may cause a hemolytic reaction, only normal saline 0.9% is utilized.

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Question

You are taking care of a patient undergoing chemotherapy for breast cancer and she complains of nausea. Her physician prescribes her ondansetron for nausea relief. What is the mechanism of action of ondansetron?

Answer

The correct answer is "Serotonin 5HT-3 receptor antagonist."

Ondansetron functions by antagonizing the serotonergic 5HT-3 receptors both centrally in the brain and peripherally at vagal nerve endings. It is frequently given as an anti-nausea and anti-emetic agent for patients with cancer undergoing chemotherapy and/or radiation therapy, as well as in post-operative patients, and for patients with gastroenteritis, among other uses.

Ondansetron is neither a full nor a partial agonist of the 5HT-3 receptors, making those answer choices incorrect.

Metaclopramide, which is another anti-nausea agent, is an anatagonist of the dopamine D2 receptor, but ondansetron is not, so this choice is incorrect. Neither metaclopramide nor ondansetron is an agonist of the dopamine D2 receptor.

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Question

You start a patient in the intensive care unit on a drip of phenylephrine, as the patient is persistently hypotensive. You think that this will raise the patient's blood pressure because phenylephrine's primary mechanism of action is which of the following?

Answer

The correct answer is "alpha-1 adrenergic agonist."

Phenylephrine is frequently administered in the intensive care unit setting for patients with hypotension that is refractory to simple fluid resuscitation. It is a vasopressor, as its mechanism of action is to serve as an alpha-1 adrenergic agonist.

The other choices are incorrect, as they represent the primary mechanisms of action of a handful of medications other than phenylephrine.

An example of an alpha-2 adrenergic agonist would be methyldopa.

An example of a beta-1 adrenergic agonist would be dobutamine.

An example of a beta-2 adrenergic agonist would be albuterol.

An example of a beta-1 adrenergic antagonist would be atenolol.

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Question

You are the nurse taking care of a patient with asthma. The patient reports using his albuterol inhaler about once a month for wheezing and shortness of breath. Albuterol functions by which of the following mechanisms of action?

Answer

The correct answer is "Beta-2 adrenergic receptor agonist."

This question tests your knowledge of the mechanism of action of albuterol, a short-acting medication, frequently used in the treatment of acute asthma flares. Albuterol is an agonist of the Beta-2 adrenergic receptor in the bronchial smooth muscle, which helps to dilate the bronchioles, often providing relief to patients who are suffering from asthma flares, as bronchospasm plays a large role in causing their symptoms. Additional effects of albuterol include increased heart rate, increased insulin release, and vasodilation among others.

An example of a beta-1 adrenergic agonist would be dobutamine.

An example of a beta-1 adrenergic antagonist would be atenolol.

An example of a beta-2 adrenergic antagonist would be butoxamine.

An example of an alpha-1 adrenergic agonist would be phenylephrine.

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Question

You are a nurse at a gastroenterology practice and your patient is being started on ranitidine for gastroesophageal reflux disease (GERD). Which of the following describes the mechanism of action of ranitidine?

Answer

The correct answer is "Histamine-2 receptor antagonist."

This question tests your knowledge of the mechanism of action of the commonly prescribed antacid medication, ranitidine. Ranitidine functions by antagonizing the histamine-2 receptors within the parietal cells (acid-producing cells) of the stomach. This helps to reduce acid production, which can provide symptomatic relief to patients who suffer from epigastric burning, discomfort, and pain due to gastroesophageal reflux disease and peptic ulcer disease, among other conditions.

An example of a histamine-1 receptor antagonist would be diphenhydramine.

An example of a beta-2 adrenergic receptor agonist would be albuterol.

An example of a proton pump inhibitor would be omeprazole.

An example of a direct acid neutralizer would be calcium carbonate.

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Question

Which of the following is considered a schedule II drug?

Answer

Schedule II drugs are monitored drugs that have an accepted medical use and are highly addictive (both physically and psychologically). Schedule II drugs include oxycodone/acetaminophen, fentanyl, and hydromorphone.

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Question

Hayden is a 9-year-old boy who has been admitted to the emergency room with a fever. He weighs 71lbs. If the dosing guideline for acetaminophen is at 4 hour intervals, how many milligrams of acetaminophen should the nurse administer?

Answer

First convert Hayden's weight from pounds to kilograms. This is done by dividing Hayden's weight by 2.2 because 1 pound is 2.2 kilograms.

Next set up the equation as follows:

Solve for :

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Question

Evelynn is a 3-year-old girl who has been bitten by her family's dog. She has had an incision and drainage (I&D) of her left hand to prevent infection and she has been prescribed cefazolin. The guidelines for cefazolin are . Evelynn weighs 42 lbs. How many milligrams of cefazolin should the nurse administer daily?

Answer

First convert Evelynn's weight from pounds to kilograms. This is done by dividing Evelynn's weight by 2.2 because 1 pound is 2.2 kilograms.

Set up the equation as follows:

Solve for

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