D 441: Medical Dosage Calculations and Pharmacology

Question 15

The healthcare provider prescribes a secondary infusion of cefazolin 0.7 gram in 50 mL of D5W to infuse over 30 minutes. The drop factor is 10 gtt/mL. The nurse should regulate the IV to deliver how many drops/minute? (Round to the nearest whole number.)

Answer: 17 gtts/min   ✓

Rationale: (50 mL × 10 gtt/mL) ÷ 30 min = 16.67, rounds to 17. The drug dose does not affect the rate.

Question 16

Azithromycin is prescribed for a client with Chlamydia trachomatis. In providing client teaching about the medication, the nurse should emphasize the importance of reporting the onset of which symptom to the healthcare provider (HCP)?

A.  Urinary frequency.

B.  Flatulence and nausea.

C.  Yellow sclera.   ✓

D.  Headache.

Correct answer: C

Rationale: Yellow sclera (jaundice) can signal hepatotoxicity.

Question 17

A client with cystitis receives a prescription for phenazopyridine. Which information should the nurse educate the client on about its therapeutic effect?

A.  Provides an analgesic effect for irritated bladder mucosa.   ✓

B.  Calms spasms in the urinary tract.

C.  Use the medication after voiding after sexual intercourse.

D.  Eliminates urinary bacteria.

Correct answer: A

Rationale: Phenazopyridine is a urinary analgesic; it does not treat the infection. It turns urine reddish-orange.

Question 18

A client with a skin rash that is causing localized itching and pain is likely to receive a prescription that is administered via which route?

A.  Transdermal.

B.  Epidural.

C.  Topical.   ✓

D.  Intradermal.

Correct answer: C

Rationale: A localized rash is treated by applying medication directly to the skin.

Question 19

When preparing to apply a scheduled fentanyl transdermal patch, the nurse notes that the previously applied patch is intact on the client’s upper back and the client denies pain. Which action should the nurse take?

A.  Administer an oral analgesic and evaluate its effectiveness before applying the new patch.

B.  Place the patch on the client’s shoulder and leave both patches in place for 12 hours.

C.  Apply the new patch in a different location after removing the original patch.   ✓

D.  Remove the patch and consult with the healthcare provider (HCP) about the client’s pain resolution.

Correct answer: C

Rationale: Remove the old patch and apply the new one at the scheduled time in a different site. Two patches at once risks respiratory depression.

Question 20

The nurse obtains an oral temperature of 40° C for a client with an infection. What temperature in Fahrenheit should the nurse document? (Round to the nearest tenth.)

Answer: 104 °F   ✓

Rationale: (40 × 9/5) + 32 = 104.0 °F.

Question 21

Which is the best method for the nurse to use to prepare the skin prior to administration of a topical ointment?

A.  Shave off any excess hair.

B.  Wash with soap and water.   ✓

C.  Gently massage the area.

D.  Cleanse with an alcohol prep pad.

Correct answer: B

Rationale: Soap and water removes debris and old medication; pat dry before applying.

Question 22

A client who is receiving pregabalin for fibromyalgia reports experiencing tremors in the hands. Which action should the nurse implement?

A.  Administer a PRN dose of an antianxiety drug.

B.  Obtain orthostatic blood pressure readings.

C.  Collect a capillary glucose level.

D.  Notify the healthcare provider (HCP).   ✓

Correct answer: D

Rationale: Tremor is a CNS adverse effect of pregabalin; the HCP must evaluate.

Question 23

A young adult female client who is planning to become pregnant asks the nurse if she can continue taking isotretinoin for cystic acne. Which information is most important for the nurse to provide this client?

A.  Baseline liver function results must be obtained during therapy.

B.  Discontinue this medication one month before attempting to conceive.   ✓

C.  Breast feeding is not recommended while taking this medication.

D.  Do not take multiple vitamins that contain vitamin A while taking this drug.

Correct answer: B

Rationale: Isotretinoin is a severe teratogen (boxed warning).

Question 24

A client is admitted with reports of shortness of breath, dyspnea on exertion, and chest pressure. The healthcare provider (HCP) prescribes a medication that is unfamiliar to the nurse. When checking the drug handbook, the nurse reads that the prescribed amount is an unusually large dose. Which action should the nurse take?

A.  Verify the prescribed dosage with the HCP.   ✓

B.  Administer the medication as prescribed.

C.  Consult pharmacist for dose clarification.

D.  Give the dosage recommended in the drug handbook.

Correct answer: A

Rationale: The prescriber must clarify or confirm the order before it is given.

Question 25

A peak and trough level was obtained from a client receiving an aminoglycoside IV every 8 hours. Which finding presents the highest risk for the client and should be reported immediately to the healthcare provider?

A.  Increased peak, increased trough.   ✓

B.  Decreased trough only.

C.  Decreased peak, decreased trough.

D.  Decreased peak only.

Correct answer: A

Rationale: Elevated levels mean accumulation, raising risk of nephrotoxicity and ototoxicity.

Question 26

A client receives a prescription for a fluid bolus of 0.9% sodium chloride, USP 250 mL to be infused in 30 minutes. How many mL/hr should the nurse program the infusion pump to deliver?

Answer: 500 mL/hr   ✓

Rationale: 250 mL ÷ 30 min × 60 min/hr = 500 mL/hr.

Question 27

Which client’s laboratory value should the nurse review prior to administering the initial dose of a statin medication?

A.  Serum electrolytes.

B.  Serum liver enzymes.   ✓

C.  Capillary blood glucose.

D.  Complete blood count.

Correct answer: B

Rationale: Statins can cause liver injury; baseline ALT/AST are needed.

Question 28

The healthcare provider prescribes penicillin 800,000 units intramuscularly (IM) for a client with a streptococcal infection. The available vial is labeled, Penicillin 500,000 units/mL. How many mL should the nurse administer? (Round to the nearest tenth.)

Answer: 1.6 mL   ✓

Rationale: 800,000 ÷ 500,000 = 1.6 mL.

Question 29

Magnesium hydroxide 1.5 ounces PO is prescribed for a client troubled with heartburn. After taking the prescribed dose 3 times today, how many mL of magnesium hydroxide has the client ingested?

Answer: 135 mL   ✓

Rationale: 1.5 oz × 30 mL/oz = 45 mL per dose; 45 × 3 = 135 mL.

Question 30

The healthcare provider prescribes filgrastim 410 mcg SUBQ every day for a client post bone marrow transplant. The medication available is “Filgrastim 600 mcg/mL.” How many mL should the nurse administer? (Round to the nearest tenth.)

Answer: 0.7 mL   ✓

Rationale: 410 ÷ 600 = 0.683, rounds to 0.7 mL.

Question 31

An older adult female client comes to the clinic for a regular check up. The client tells the nurse that she has increased her daily doses of acetaminophen for the past month to control joint pain. Based on this client’s comment, which previous laboratory results should the nurse compare with today’s laboratory report?

A.  Look for an increase in today’s lactic dehydrogenase (LDH) compared to the previous one to assess for possible liver damage.   ✓

B.  Expect to find an increase in today’s activated partial thromboplastin time (APTT) as compared to last quarter’s due to bleeding.

C.  Determine if there is a decrease in serum potassium due to renal compromise.

D.  Look at last quarter’s hemoglobin and hematocrit, expecting an increase today due to dehydration.

Correct answer: A

Rationale: Acetaminophen overuse is hepatotoxic; compare liver-related values.

Question 32

A 16-year-old male is admitted after a motor vehicle collision with 50% burns over his body. One liter of normal saline is prescribed to infuse over 4 hours. The drop factor is 60 drops per mL. The nurse should regulate the infusion to administer how many drops per minute?

Answer: 250 gtts/min   ✓

Rationale: (1000 × 60) ÷ (4 × 60) = 250.

Question 33

The spouse of a client diagnosed with Parkinson’s disease calls the clinic and tells the nurse the client is having involuntary jerky movements of the legs and arms and is confused. Which action should the clinic nurse implement first?

A.  Determine how long the client has been diagnosed with Parkinson’s disease.

B.  Ask the client’s spouse to list all medications the client is currently taking.   ✓

C.  Advise the client’s spouse to call an ambulance to take the client to the emergency department (ED).

D.  Request that the client’s spouse bring the client to the clinic as soon as possible.

Correct answer: B

Rationale: Dyskinesia and confusion suggest levodopa/carbidopa toxicity; gather medication data first.

Question 34

A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigued and dizzy. Which instruction should the nurse provide?

A.  Stop taking the medication immediately.

B.  Obtain transportation to the emergency department.

C.  Increase intake of fluids and high protein foods.

D.  Avoid hazardous activities until symptoms subside.   ✓

Correct answer: D

Rationale: Drowsiness and dizziness are common early effects; stopping baclofen abruptly can cause seizures and withdrawal.

Question 35

The nurse is teaching a 12-year-old girl how to use an applicator to administer vaginal ointment for a yeast infection. While discussing use of the applicator, which information is most useful for the nurse to learn about the girl?

A.  Ability to insert a tampon.   ✓

B.  Use of birth control.

C.  History of sexual intercourse.

D.  Onset of menarche.

Correct answer: A

Rationale: Tampon use shows the anatomical understanding and comfort needed for an applicator.

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