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Question 1 of 5.

Which of the following medication orders requires clarification before the nurse can administer the order?

A. epinephrine (EpiPen) 0.25 mg IM STAT

B. heparin 30 units/kg/hr IV infusion for 24 hours

C. ampicillin (Omnipen) 500 mg PO bid

D. lorazepam (Ativan) 1.0 mg PO prn

Explanation: Heparin dosing (30 units/kg/hr) is unusually low for anticoagulation (typically 10-20 units/kg/hr). This requires clarification to ensure safety.

Question 2 of 5.

Prochlorperazine maleate (Compazine) 10 mg IM has been ordered for a client. The client is also to receive Stadol 2 mg IM. Before administering these medications, the nurse should

A. obtain respirations and temperature.

B. dilute with 9 ml of NS.

C. draw the medications in separate syringes.

D. verify the route of administration.

Explanation: Compazine should be considered incompatible in a syringe with all other medications

Question 3 of 5.

When using restraints for an agitated/aggressive patient, which of the following statements should NOT influence the nurse’s actions during this intervention?

A. The restraints/seclusion policies set forth by the institution.

B. The patient’s competence.

C. The patient’s voluntary/involuntary status.

D. The patient’s nursing care plan.

Explanation: the need for restraints is based on patient’s behavioral status and condition, not the patient’s voluntary/involuntary status

Question 4 of 5.

A client has been taking perphenazine (Trilafon) by mouth for two days and now displays the following: head turned to the side, neck arched at an angle, stiffness and muscle spasms in neck. The nurse would expect to give which of the following as a PRN medication?

A. Promazine (Sparine).

B. Biperiden (Akineton).

C. Thiothixene (Navane).

D. Haloperidol (Haldol).

Explanation: is an antiparkinsonian agent, used to counteract extrapyramidal side effects the client is experiencing

Question 5 of 5.

A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an acute exacerbation. The nurse notes that the client has a respiratory rate of 28 breaths per minute, is using accessory muscles, and has oxygen saturation of 88% on 2 L/min of oxygen via nasal cannula. Which of the following actions should the nurse take FIRST?

A. Increase the oxygen flow to 4 L/min.

B. Administer a bronchodilator as ordered.

C. Place the client in a high Fowler’s position.

D. Obtain an arterial blood gas (ABG) sample.

Explanation: positioning in high Fowler’s facilitates breathing and improves oxygenation immediately; other actions may follow based on further assessment

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