RN/LPN/GN Orientation Medication Exam

Directions: There are 43 questions. Each question is worth 1 point. You have 75 minutes to complete this exam. Medication formulas are provided in your orientation folder to assist you with calculations. Select the best answer. Passing score is 36/43 or a 85%!

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* 1. Name:

Part I: Calculation Section

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* 2. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV push
Stock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter

How many milliliters (ml) will you give?

0.25

2.5

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* 3. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV push
Stock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter

Would you need to monitor vital signs (i.e. respiratory rate and blood pressure) after giving a dose of Morphine Sulfate?

Yes

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* 4. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

How many tablets will you give?

0.5

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* 5. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

Safe Dose - is this a safe/normal dose for a patient?

Yes

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* 6. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

Can you give this patient Tylenol for PAIN when the PRN order indicates Tylenol use for TEMPERATURE above 101 F?

Yes

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* 7. Order: Lovenox (Enoxaparin Sodium) 40 milligrams (mg), SQ (subcutaneous), every day
Stock: Lovenox (Enoxaparin Sodium) 80 milligrams (mg)/0.8 milliliter (ml) pre-filled syringe

How much Lovenox will you give?

1 ml

0.5 ml

0.2 ml

0.4 ml

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* 8. Order: 1200ml of IV NSS to infuse over 6 hours
Drip factor: 10 gtts/ml

How many gtts/min will this infusion run?

0.33 gtts/min

3.3 gtts/min

33 gtts/min

None of these

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* 9. Order: 1000ml of IV NSS to run at 80 ml/hr

How many hours will this infusion run?

5 hours

12.5 hours

10 hours

7.5 hours

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* 10. Order: 1000ml of IV LR to run over 8 hours

What is the rate of this infusion?

125 ml/hr

250 ml/hr

100 ml/hr

75 ml/hr

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* 11. Order: Flagyl (Metronidazole) 500 milligrams (mg) PO Q8H
Stock: Flagyl (Metronidazole) 250 milligrams (mg)/tablet

How many tablet(s) will you give?

0.5 tabs

1 tabs

2 tabs

None of these

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* 12. 20mg of Lasix (Furosemide) is ordered to be given after the first unit of PRBCs has infused. The vial of medication contains Lasix 80mg/2ml. How many mls will the nurse administer?

0.25ml

0.5ml

1ml

2ml

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* 13. The physician orders 75mg PO Q4H PRN for cough. If the patient requires cough syrup every 4 hours, how many mg would the patient receive in a 24-hour period?

150mg

300mg

450mg

225mg

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* 14. The physician ordered a unit (300mls) of PRBCs to be infused over 4 hours. What rate would you set the IV pump to run?

75 ml/hr

150 ml/hr

50 ml/hr

None of these

Part II - Intranet Resources Section

To answer the following questions, use the Excela Health Intranet Resources listed:

Policies - Administrative

Nursing Manual

Clinical Pharmacology

Open the Excela Health Intranet and follow the directional path listed in RED BOLD to locate the specified document.

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* 15. Policies - Administrative - Latrobe Policies - Set drop down menu to 1500-Patient Care/Visitor Services - Click on 1519 Positive Identification of all hospital patients - Scroll up to "Open Your Policy Here" at top left of screen.

Which of the following is the correct patient identification verification process?

the care provider will verify the patient name and birthdate using the ID bracelet for only the initial interaction with the patient

the care provider will verify the patient name and birthdate by asking the patient to state their name

the care provider will verify the patient name and birthdate by asking the patient to state their name and birthdate

the care provider will verify the patient name and birthdate using only information from the electronic medical record

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* 16. An additional red bracelet is applied to the patient's extremity. At Excela Health, this red bracelet represents:

Fall Alert

Allergies

Isolation

Do Not Use This Extremity

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* 17. Department L-Z - Nursing - Nursing Manual - Search for "Heparin" - Select Heparin DVT Afib Protocol.

The Heparin protocol indicates which of the following laboratory values is monitored every six hours after each Heparin dosage adjustment for patients NOT receiving a DOAC?

Anti-Xa

Bleeding Time

INR

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* 18. Department L-Z - Nursing - Nursing Manual - Search for Hydromorphone (Dilaudid) - Click on Medication Administration: IV Hydromorphone (Dilaudid) & Morphine.

When administering IV Push Hydromorphone (Dilaudid) to a patient who is NOT high risk for opioid-induced respiratory depression, what criteria must be followed?
1. The Glasgow Coma Scale is used to assess sedation.
2. Assess patient for: respirations, oxygen saturation, Pasero Sedation Scale and pain level.
3. Assessments are done prior to administration, within 30 minutes after administration, every 4 hours and prn.
4. HOLD the dose and notify physician for respirations less than 12/min, pulse ox < 91% and a Pasero Sedation Scale of 3 or 4.

1, 2, 3

2, 3, 4

1, 3, 4

All of the above

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* 19. Department L-Z - Nursing - Nursing Manual - Search for PCA - Click on PCA: Patient Management

Your patient is ordered a Patient Controlled Analgesic (PCA) pump and your patient is NOT high risk for Opioid-Induced Respiratory Depression. The PCA procedure states that with initiation, the nurse must:
1. Assess: BP, pulse, respirations, pulse oximetry, pain score, sedation scale, patient satisfaction, number of PCA delivered dose and attempts (at initiation and each loading dose/bolus then every 30 min x 2, every 2 hrs x 2 and every 4 hrs for the duration of therapy).
2. Manage: If sedation is severe (Pasero Scale 3 or 4) and respirations are less than 12/min, STOP all opioids, apply oxygen via face mask STAT, notify physician and give Naloxone (Narcan) as per the PCA Power Plan.
3. Education: Emphasize with the family/significant other that the patient is the ONLY one to push the button for analgesia administration.
4. Safety: PCA tubing should never be changed.

1, 2, 3

1, 3, 4

2, 3, 4

1, 2, 4

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* 20. According to the PCA Patient Management procedure, when does the nurse double check the PCA order with the PCA cassette and pump to assure accuracy?

Prior to initiating PCA therapy

Each time changes are made, including administration of a bolus or prescription changes

When medication cassette is changed

At shift change with oncoming nurse

At shift change with off going nurse

At transfer (transferring nurse and receiving nurse)

All of the above

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* 21. Department L-Z - Nursing - Nursing Manual - Search for Medication Administration: Medication Pens - Click on Medication Administration: Medication Pens.

When using an insulin pen to administer Lantus insulin to your patient, what procedural steps are to be followed?

Safety needles aren't available for medication pens

Prime the needle using 5 units of insulin prior to dialing the dose

Rotate injection sites

Medication pens can be used for more than one patient

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* 22. Department L-Z - Nursing - Nursing Manual - Search for Blood - Click on Blood and Blood Products Administration.

Your patient has been receiving a unit of PRBCs for the last hour. The patient begins to complain of sudden difficulty breathing and chills. What are your immediate steps?

Stop the transfusion

Monitor the patient's vital signs closely

Report the reaction to the physician and notify the blood bank

All of the above

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* 23. Department L-Z - Nursing - Nursing Manual - Search for TPN - Click on Total Parenteral Nutrition (TPN) Protocol.

If a new TPN infusion is interrupted, what action would the nurse take to avoid hypoglycemia in the patient?

Start IV Dextrose 10%/Water at the same infusion rate for 2 hours

Start IV Lactated Ringers at a faster than ordered rate to catch up

Start IV 0.9 NSS at the same infusion rate

Start the TPN at a faster than ordered rate to catch up

Department L-Z - Nursing - Nursing Manual - Search for "Medication - Procedures for Administration" Procedure. **Use this procedure for the next 2 questions.

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* 24. In accordance with the PA State Board of Nursing, the Excela Health LPN is prohibited from administering:

Oral medications

Topical ointments and sprays

Transdermal applications

IV push medications (except IV flush solutions e.g. saline and flush-strength Heparin)

For the next 10 questions, utilize the following path to find the answer: Department L-Z - Pharmacy - Online Resources - Clinical Pharmacology - Enter drug name in the search field - Select the correct medication when it pops up - Select Indications/Dosage.

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* 25. Protonix

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* 26. Lovenox

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* 27. Dilantin

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* 28. Atrovent

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* 29. Morphine

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* 30. Zocor

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* 31. Lasix

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* 32. Ativan

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* 33. Metformin

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* 34. Avapro

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* 35. Department L-Z - Pharmacy - Online Resources - Clinical Pharmacology - Reports - IV Compatibility Report.

Using the IV Compatibility Report function, enter the given drug names, click on "Add" and then "Run Report" to determine compatibility.

Are Heparin and Protonix compatible at the Y-Site on an IV?

Compatible

Incompatible

Results Uncertain

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* 36. Department L-Z - Pharmacy - Online Resources - Hazardous Drugs -Excretion Precaution Duration (2019 NIOSH List)

You are admitting a patient who reports he has taken his last dose of Zytiga, for prostate cancer 2 days ago. Use the table to determine how many more days of excretion precautions must be observed for this patient

3 days

No precautions necessary

1 day

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* 37. Department L-Z - Pharmacy - Online Resources - Hazardous Drugs -Excretion Precaution Duration (2019 NIOSH List)

You are admitting a patient who states he has received a dose of cisplatin at Arnold Palmer pavilion 3 days age? Does the patient need to be on excretion precautions for the next 4 days?

No precautions necessary

yes

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* 38. Department L-Z - Pharmacy - Online Resources - Hazardous Drugs -Excela Health Formulary Hazardous Drugs

Zinecard (Dexrazoxane) is contained in Group 2 of Hazardous Drugs and is a non-neoplastic drug that meets one or more NIOSH criteria to be considered a hazardous drug.

False

No precautions necessary for this drug

True

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* 39. Are Heparin and Ancef compatible at the Y-Site on an IV?

Compatible

Incompatible

Results Uncertain

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* 40. Are Heparin and Cardizem compatible at the Y-Site on an IV?

Compatible

Incompatible

Results Uncertain

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* 41. Department L-Z - Pharmacy - Online Resources - Clinical Pharmacology - Under Reports choose Drug Interaction Report.

Type Zocor in the Search box and press enter to add it to your Drug List. Click the boxes next to Food and Grapefruit Juice and click Run Report.

Identify potential food interactions found in the Zocor report:

All Vitamin K foods

Grapefruit juice

Cheese and wine

Green leafy vegetables

Part III - EH Medication Dispensing Cabinet & eMAR (HERO) Use

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Below is a screen shot of the OmniCell device found on each nursing unit. At EH, the OmniCell device contains the patient's ordered "PRN" medications, floor stock and emergency medications. Daily medications are kept in the patient's room and/or on the medication cart/WOW. Use this picture to answer the next question.

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* 42. Georgia, Dalton has requested pain medication and is ordered Tylenol #3. Referring to the AcuDose dispensing screen, what time was the last Tylenol #3 dispensed?

11/05/2003 15:07:52

Unable to determine

11/12/2003 11:06:18

None of the above

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Below is a picture taken from an eMAR in Cerner. Use this picture to answer the next question.

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* 43. What does the red colored box represent for the medication Lasix?

Daily medication obtained via a verbal order

Pharmacy has not checked the medication order

Medication is "on hold"

Stat medication that has not been given

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* 1. Name:

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* 2. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV pushStock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter How many milliliters (ml) will you give?

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* 3. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV pushStock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter Would you need to monitor vital signs (i.e. respiratory rate and blood pressure) after giving a dose of Morphine Sulfate?

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* 4. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 FStock: Tylenol (Acetaminophen) 325 milligrams (mg)/tabletHow many tablets will you give?

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* 5. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 FStock: Tylenol (Acetaminophen) 325 milligrams (mg)/tabletSafe Dose - is this a safe/normal dose for a patient?

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* 6. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 FStock: Tylenol (Acetaminophen) 325 milligrams (mg)/tabletCan you give this patient Tylenol for PAIN when the PRN order indicates Tylenol use for TEMPERATURE above 101 F?

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* 7. Order: Lovenox (Enoxaparin Sodium) 40 milligrams (mg), SQ (subcutaneous), every dayStock: Lovenox (Enoxaparin Sodium) 80 milligrams (mg)/0.8 milliliter (ml) pre-filled syringeHow much Lovenox will you give?

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* 8. Order: 1200ml of IV NSS to infuse over 6 hoursDrip factor: 10 gtts/mlHow many gtts/min will this infusion run?

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* 9. Order: 1000ml of IV NSS to run at 80 ml/hrHow many hours will this infusion run?

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* 10. Order: 1000ml of IV LR to run over 8 hoursWhat is the rate of this infusion?

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* 11. Order: Flagyl (Metronidazole) 500 milligrams (mg) PO Q8HStock: Flagyl (Metronidazole) 250 milligrams (mg)/tabletHow many tablet(s) will you give?

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* 12. 20mg of Lasix (Furosemide) is ordered to be given after the first unit of PRBCs has infused. The vial of medication contains Lasix 80mg/2ml. How many mls will the nurse administer?

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* 13. The physician orders 75mg PO Q4H PRN for cough. If the patient requires cough syrup every 4 hours, how many mg would the patient receive in a 24-hour period?

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* 14. The physician ordered a unit (300mls) of PRBCs to be infused over 4 hours. What rate would you set the IV pump to run?

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* 16. An additional red bracelet is applied to the patient's extremity. At Excela Health, this red bracelet represents:

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* 17. Department L-Z - Nursing - Nursing Manual - Search for "Heparin" - Select Heparin DVT Afib Protocol.The Heparin protocol indicates which of the following laboratory values is monitored every six hours after each Heparin dosage adjustment for patients NOT receiving a DOAC?

Question Title

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* 20. According to the PCA Patient Management procedure, when does the nurse double check the PCA order with the PCA cassette and pump to assure accuracy?

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* 21. Department L-Z - Nursing - Nursing Manual - Search for Medication Administration: Medication Pens - Click on Medication Administration: Medication Pens.When using an insulin pen to administer Lantus insulin to your patient, what procedural steps are to be followed?

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* 22. Department L-Z - Nursing - Nursing Manual - Search for Blood - Click on Blood and Blood Products Administration.Your patient has been receiving a unit of PRBCs for the last hour. The patient begins to complain of sudden difficulty breathing and chills. What are your immediate steps?

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* 23. Department L-Z - Nursing - Nursing Manual - Search for TPN - Click on Total Parenteral Nutrition (TPN) Protocol.If a new TPN infusion is interrupted, what action would the nurse take to avoid hypoglycemia in the patient?

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* 24. In accordance with the PA State Board of Nursing, the Excela Health LPN is prohibited from administering:

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* 25. Protonix

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* 26. Lovenox

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* 27. Dilantin

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* 28. Atrovent

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* 29. Morphine

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* 30. Zocor

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* 31. Lasix

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* 32. Ativan

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* 33. Metformin

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* 34. Avapro

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* 38. Department L-Z - Pharmacy - Online Resources - Hazardous Drugs -Excela Health Formulary Hazardous DrugsZinecard (Dexrazoxane) is contained in Group 2 of Hazardous Drugs and is a non-neoplastic drug that meets one or more NIOSH criteria to be considered a hazardous drug.

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* 39. Are Heparin and Ancef compatible at the Y-Site on an IV?

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* 40. Are Heparin and Cardizem compatible at the Y-Site on an IV?

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* 42. Georgia, Dalton has requested pain medication and is ordered Tylenol #3. Referring to the AcuDose dispensing screen, what time was the last Tylenol #3 dispensed?

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Below is a picture taken from an eMAR in Cerner. Use this picture to answer the next question.

* 2. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV push
Stock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter

How many milliliters (ml) will you give?

* 3. Order: Morphine (Morphine Sulfate) 2.5 milligrams (mg) IV push
Stock: Morphine (Morphine Sulfate) 10 milligrams (mg)/milliliter

Would you need to monitor vital signs (i.e. respiratory rate and blood pressure) after giving a dose of Morphine Sulfate?

* 4. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

How many tablets will you give?

* 5. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

Safe Dose - is this a safe/normal dose for a patient?

* 6. Order: Tylenol (Acetaminophen) 650mg PO every 4 hours PRN not to exceed 4000mg/24 hours for TEMPERATURE above 101 F
Stock: Tylenol (Acetaminophen) 325 milligrams (mg)/tablet

Can you give this patient Tylenol for PAIN when the PRN order indicates Tylenol use for TEMPERATURE above 101 F?

* 7. Order: Lovenox (Enoxaparin Sodium) 40 milligrams (mg), SQ (subcutaneous), every day
Stock: Lovenox (Enoxaparin Sodium) 80 milligrams (mg)/0.8 milliliter (ml) pre-filled syringe

How much Lovenox will you give?

* 8. Order: 1200ml of IV NSS to infuse over 6 hours
Drip factor: 10 gtts/ml

How many gtts/min will this infusion run?

* 9. Order: 1000ml of IV NSS to run at 80 ml/hr

How many hours will this infusion run?

* 10. Order: 1000ml of IV LR to run over 8 hours

What is the rate of this infusion?

* 11. Order: Flagyl (Metronidazole) 500 milligrams (mg) PO Q8H
Stock: Flagyl (Metronidazole) 250 milligrams (mg)/tablet

How many tablet(s) will you give?

* 17. Department L-Z - Nursing - Nursing Manual - Search for "Heparin" - Select Heparin DVT Afib Protocol.

The Heparin protocol indicates which of the following laboratory values is monitored every six hours after each Heparin dosage adjustment for patients NOT receiving a DOAC?

* 21. Department L-Z - Nursing - Nursing Manual - Search for Medication Administration: Medication Pens - Click on Medication Administration: Medication Pens.

When using an insulin pen to administer Lantus insulin to your patient, what procedural steps are to be followed?

* 22. Department L-Z - Nursing - Nursing Manual - Search for Blood - Click on Blood and Blood Products Administration.

Your patient has been receiving a unit of PRBCs for the last hour. The patient begins to complain of sudden difficulty breathing and chills. What are your immediate steps?

* 23. Department L-Z - Nursing - Nursing Manual - Search for TPN - Click on Total Parenteral Nutrition (TPN) Protocol.

If a new TPN infusion is interrupted, what action would the nurse take to avoid hypoglycemia in the patient?

* 38. Department L-Z - Pharmacy - Online Resources - Hazardous Drugs -Excela Health Formulary Hazardous Drugs

Zinecard (Dexrazoxane) is contained in Group 2 of Hazardous Drugs and is a non-neoplastic drug that meets one or more NIOSH criteria to be considered a hazardous drug.