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The best way to determine whether or not a medication is compatible with a particular intravenous fluid is to:
- A. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for color changes
- B. Refer to a compatibility chart
- C. Call the doctor and ask if the medication is compatible with the particular intravenous fluid
- D. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for any precipitates
Correct Answer: B
Rationale: A compatibility chart provides standardized, evidence-based information on medication and IV fluid compatibility, ensuring safety.
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An infant with increased intracranial pressure (ICP) on a regular diet vomits while eating dinner. Which of the following should the nurse do next?
- A. Put the child on nothing-by-mouth (NPO) status.
- B. Call to report this event to the physician.
- C. Wait a few minutes, then refeed the child.
- D. Administer the prescribed antiemetic.
Correct Answer: B
Rationale: Vomiting in an infant with increased ICP may indicate worsening pressure, requiring immediate physician notification.
Which of the following conditions is a potential consequence of a prolonged QT interval?
- A. Serious electrolyte imbalance.
- B. Ventricular dysrhythmias.
- C. Heart block.
- D. Atrial dysrhythmias.
Correct Answer: B
Rationale: A prolonged QT interval increases the risk of ventricular dysrhythmias, such as torsades de pointes, which can be life-threatening.
The nurse is teaching a client how to mix regular and NPH insulins in the same syringe. Which action should the nurse instruct the client to take?
- A. Draw up the NPH insulin into the syringe first.
- B. Keep both bottles in the refrigerator at all times.
- C. Rotate the NPH insulin bottle in the hands before mixing.
- D. Take all of the air out of the insulin bottles before mixing.
Correct Answer: C
Rationale: The NPH insulin bottle needs to be rotated for at least 1 minute between both hands. This resuspends the insulin. The nurse should not shake the bottles. Shaking causes foaming and bubbles to form, which may trap particles of insulin and alter the dosage. Regular insulin is drawn up before NPH insulin. Insulin may be maintained at room temperature. Additional bottles of insulin for future use should be stored in the refrigerator. Air does not need to be removed from the insulin bottles.
An I.V. infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure?
- A. It may be necessary to remove a small amount of hair from the infant's scalp.
- B. A sedative will be given to help keep the infant quiet.
- C. Administering the infant will be delayed until the infusion has been completed.
- D. Holding the infant will be contraindicated while the infusion is being administered.
Correct Answer: A
Rationale: Removing a small amount of hair may be necessary to secure the I.V. site on the scalp.
Which of the following statements best explains why the nurse should evaluate gastric residual in administering the client's next enteral feeding?
- A. To determine how well nutrients are being absorbed
- B. To determine if the client is receiving enough feeding
- C. To prevent overdistention of the stomach
- D. To prevent mixing undigested formula with partially digested formula
Correct Answer: C
Rationale: Evaluating gastric residual prevents overdistention of the stomach, which can lead to aspiration or discomfort. It does not directly assess nutrient absorption or feeding adequacy.