Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is administering 4 mg of hydromorphone to a client by mouth every 4 hr. The medication is provided as hydromorphone 8 mg per tablet. Which of the following actions is appropriate for the nurse to take?
A. Store the remaining half of the pill in the automated medication dispensing system.
Choice A is wrong because storing the remaining half of the pill in the automated medication dispensing system could lead to errors in dosage or diversion of the drug.
B. Dispose of the remaining medication while another nurse observes.
This is because hydromorphone is a controlled substance and any unused portion should be discarded in the presence of a witness. Some possible explanations for the other choices are:
C. Return the remaining medication to the facility’s pharmacy.
Choice C is wrong because returning the remaining medication to the facility’s pharmacy is not a recommended practice for controlled substances and could also result in errors or diversion.
D. Place the remaining half of the pill in the unit-dose package.
Choice D is wrong because placing the remaining half of the pill in the unit-dose package could compromise the integrity and stability of the medication and expose it to environmental factors. Normal ranges for hydromorphone are not applicable as it is a synthetic opioid analgesic that does not have a therapeutic level. However, some factors that may affect its pharmacokinetics and pharmacodynamics are age, weight, renal function, liver function, genetic polymorphisms, and drug interactions.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
This is because hydromorphone is a controlled substance and any unused portion should be discarded in the presence of a witness. Some possible explanations for the other choices are:
Choice A is wrong because storing the remaining half of the pill in the automated medication dispensing system could lead to errors in dosage or diversion of the drug.
Choice C is wrong because returning the remaining medication to the facility’s pharmacy is not a recommended practice for controlled substances and could also result in errors or diversion.
Choice D is wrong because placing the remaining half of the pill in the unit-dose package could compromise the integrity and stability of the medication and expose it to environmental factors.
Normal ranges for hydromorphone are not applicable as it is a synthetic opioid analgesic that does not have a therapeutic level.
However, some factors that may affect its pharmacokinetics and pharmacodynamics are age, weight, renal function, liver function, genetic polymorphisms, and drug interactions.
Similar Questions
A nurse is planning teaching for a client who is trying to quit smoking. Which of the following instructions about nicotine replacement options should the nurse include?
A. Do not drink beverages while sucking on a nicotine lozenge.
The nurse should instruct the client to avoid drinking beverages while sucking on a nicotine lozenge because this can interfere with the absorption of nicotine and reduce its effectiveness. Some possible explanations for the other choices are: Choice B is wrong because chewing nicotine gum for 10 minutes before spitting it out is too short.
B. Chew nicotine gum for 10 min before spitting it out.
Choice B is wrong because chewing nicotine gum for 10 minutes before spitting it out is too short. The recommended duration is at least 30 minutes to allow enough nicotine to be released and absorbed through the lining of the mouth.
C. Change the nicotine patch every other day.
Choice C is wrong because changing the nicotine patch every other day is not frequent enough. The patch should be changed daily and applied to a different skin site to prevent irritation and ensure a steady dose of nicotine.
D. Administer 2 sprays of nicotine nasal spray in each nostril with each
Choice D is wrong because administering 2 sprays of nicotine nasal spray in each nostril with each dose is too much. The recommended dose is one spray per nostril, up to five times per hour or 40 times per day. Using too much nasal spray can cause side effects such as nasal irritation, sneezing, coughing, headache, or nausea.
Full Explanation
The nurse should instruct the client to avoid drinking beverages while sucking on a nicotine lozenge because this can interfere with the absorption of nicotine and reduce its effectiveness. Some possible explanations for the other choices are:
Choice B is wrong because chewing nicotine gum for 10 minutes before spitting it out is too short.
The recommended duration is at least 30 minutes to allow enough nicotine to be released and absorbed through the lining of the mouth.
Choice C is wrong because changing the nicotine patch every other day is not frequent enough.
The patch should be changed daily and applied to a different skin site to prevent irritation and ensure a steady dose of nicotine.
Choice D is wrong because administering 2 sprays of nicotine nasal spray in each nostril with each dose is too much.
The recommended dose is one spray per nostril, up to five times per hour or 40 times per day.
Using too much nasal spray can cause side effects such as nasal irritation, sneezing, coughing, headache, or nausea.
A nurse is caring for a client who has hyponatremia and is receiving an infusion of a prescribed hypertonic solution.
Which of the following findings should indicate to the nurse that the treatment is effective?
A. Improved cognition.
Hyponatremia is a condition where the sodium level in the blood is too low, which can cause confusion, lethargy, seizures, and coma. A hypertonic solution is a fluid that has a higher concentration of solutes than the blood, which can help raise the sodium level and reduce the brain swelling caused by hyponatremia. Therefore, improved cognition indicates that the treatment is effective.
B. Cardiac arrhythmias absent.
Cardiac arrhythmias are not a common symptom of hyponatremia unless it is severe or rapid in onset. Therefore, their absence does not necessarily indicate that the treatment is effective.
C. Decreased vomiting.
Vomiting can be a cause or a consequence of hyponatremia, depending on the underlying condition. Decreased vomiting may indicate that the patient is less nauseated, but it does not reflect the sodium level or the brain status.
D. Absent Chvostek’s sign.
Chvostek’s sign is a facial twitching that occurs when tapping on the cheek, which indicates hypocalcemia (low calcium level). It is not related to hyponatremia or hypertonic solution. Normal ranges for sodium are 135 to 145 mEq/L and for calcium are 8.5 to 10.5 mg/dL.
Full Explanation
Hyponatremia is a condition where the sodium level in the blood is too low, which can cause confusion, lethargy, seizures, and coma. A hypertonic solution is a fluid that has a higher concentration of solutes than the blood, which can help raise the sodium level and reduce the brain swelling caused by hyponatremia. Therefore, improved cognition indicates that the treatment is effective.
Choice B. Cardiac arrhythmias absent.
Cardiac arrhythmias are not a common symptom of hyponatremia unless it is severe or rapid in onset.
Therefore, their absence does not necessarily indicate that the treatment is effective.
Choice C. Decreased vomiting.
Vomiting can be a cause or a consequence of hyponatremia, depending on the underlying condition.
Decreased vomiting may indicate that the patient is less nauseated, but it does not reflect the sodium level or the brain status.
Choice D. Absent Chvostek’s sign.
Chvostek’s sign is a facial twitching that occurs when tapping on the cheek, which indicates hypocalcemia (low calcium level).
It is not related to hyponatremia or hypertonic solution.
Normal ranges for sodium are 135 to 145 mEq/L and for calcium are 8.5 to 10.5 mg/dL.
A nurse is preparing to administer medications to a client and discovers a medication error.
The nurse should recognize that which of the following staff members is responsible for completing an incident report?
A. The quality improvement committee.
The quality improvement committee is not directly involved in the incident and does not complete the report. The committee may review the report later to identify trends and areas for improvement.
B. The charge nurse.
The charge nurse is not responsible for completing the report, although they may assist or supervise the nurse who caused the error. The charge nurse may also notify the provider and other relevant staff members about the incident.
C. The nurse who caused the error.
The nurse who caused the error may be involved in providing details and information about the incident, but the nurse who discovers the error is the one responsible for completing the incident report to ensure that all relevant information is accurately documented.
D. The nurse who identifies the error.
It is crucial for the nurse who discovers the error to complete the incident report to ensure that all relevant details are accurately documented. This allows for a thorough investigation and implementation of corrective actions to prevent future errors.
Full Explanation
The nurse who caused the error is responsible for completing an incident report. An incident report is a tool for documenting any event that deviates from the standard of care or causes harm to a client, staff member, or visitor. The purpose of an incident report is to improve quality and safety, not to assign blame or punish anyone. The nurse who caused the error should fill out the report as soon as possible after the event, providing factual and objective information.
A. The quality improvement committee is not directly involved in the incident and does not complete the report. The committee may review the report later to identify trends and areas for improvement.
B. The charge nurse is not responsible for completing the report, although they may assist or supervise the nurse who caused the error. The charge nurse may also notify the provider and other relevant staff members about the incident.
C. The nurse who caused the error may be involved in providing details and information about the incident, but the nurse who discovers the error is the one responsible for completing the incident report to ensure that all relevant information is accurately documented.
D. It is crucial for the nurse who discovers the error to complete the incident report to ensure that all relevant details are accurately documented. This allows for a thorough investigation and implementation of corrective actions to prevent future errors.