Drug Administration and Distribution
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NCLEX-PN › Drug Administration and Distribution
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?
The blood should be administered with isotonic solutions such as lactated Ringers
The preferred gauge of the needle should be between 18 to 20 gauge to allow for improved flow
The tubing should be of a "Y type" to allow for fluid and blood product simultaneous infusion.
Positively identify the patient identification.
Blood must be used within the first 30 minutes of arrival to the unit.
Explanation
All are true except for the use of lactated Ringer's this may cause a hemolytic reaction, only normal saline 0.9% is utilized.
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?
"I will use a 10mL syringe or larger to flush my PICC line."
"I will use a 3mL syringe or larger to flush my PICC line."
"I will use a 1mL syringe or larger to flush my PICC line."
"I will use a 20mL syringe or larger to flush my PICC line."
"I will use a 30mL syringe or larger to flush my PICC line."
Explanation
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.
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?
45 degrees
90 degrees
30 degrees
15 degrees
60 degrees
Explanation
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.
Which of the following is the preferred location of intramuscular (IM) injection in infants?
Vastus lateralis
Rectus femoris
Dorsogluteal region
Deltoid
Biceps brachii
Explanation
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.
The nurse is teaching a patient who has just been prescribed antibiotics. The nurse knows that teaching has been effective when the patient states which of the following?
"I should use a back-up method of birth control if I use oral contraceptives while taking antibiotics."
"An antibiotic will help me get over my case of the flu."
"My mother was previously prescribed the same antibiotic. I may take some of her leftover pills if my symptoms return."
"I can stop taking the antibiotics when I feel better."
"An antibiotic might help prevent me from getting sick in the future."
Explanation
Antibiotics may interfere with the function of oral contraceptives. A woman who is on oral contraceptives must use a back-up method of birth control to prevent pregnancy. Antibiotics should only be taken as prescribed. They should be taken continuously until all pills are gone. It is dangerous to take leftover antibiotics. Antibiotics will not prevent illness and do not work against viruses such as influenza. Misuse of antibiotics may contribute to antibiotic resistance and the rise of antibiotic resistant bacteria.
Ethel is an 80-year-old woman who was admitted for dehydration. The nurse reports that she is not making 
Explanation
The minimum urine requirement per hour for most adults is 
Calculate drip rate in minutes using the following formula:
Ethel's equation looks as follows:
The pediatric nurse must convince a 4-year-old boy to take his medication. Which phrase is the most acceptable?
"Your mother and I need you to take your medicine now."
"Will you please take your medication for us?"
"It is time to take your medicine. It tastes just like candy!"
"If you take your medicine, I will give you a soda pop!"
"If you don't take your medicine now, you will need to take a time-out."
Explanation
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.
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?
Examine the stool for the suppository
Give another full dose of the suppository
Give an additional half of the prescribed dose
Consult pharmacy
Inform the physician that the child has had a bowel movement
Explanation
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.
The geriatric nurse is administering nightly medications to a 65-year-old woman with dysphagia. The patient is able to swallow crushed medications with thickened liquids. Which of the following medications should the nurse not crush?
Pantoprazole ER
Acetaminophen
Sertraline HCl
Potassium chloride
Multivitamins
Explanation
Pantoprazole ER should not be crushed. "ER" is an abbreviation for extended release. Extended release medications dissolve over a delayed period of time. Crushing the medication results in a faster rate of absorption by body tissues due to disruption of the coating that allows it's extended release.
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 __________.
as distal as possible
as medial as possible
as proximal as possible
as lateral as possible
as ipsilateral as possible
Explanation
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.