Dosage Calculation RN Adult Medical Surgical Proctored Assessment 3.2 Retake 1

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Sample questions from Dosage Calculation RN Adult Medical Surgical Proctored Assessment 3.2 Retake 1

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the cardiac step-down unit, a client weighing 82 kg is prescribed an unfractionated heparin infusion at 18 units/kg/hr. The prepared solution contains 25,000 units in 250 mL. At how many mL/hr should the nurse program the infusion pump?

   • A.18.0 mL/hr
   • B.29.5 mL/hr
   • C.147.6 mL/hr
   • D.14.8 mL/hr

   Rationale: The prescribed dose is 82 kg x 18 units/kg/hr = 1,476 units/hr, and the solution contains 100 units/mL, so the pump rate is 14.76 mL/hr, rounded to 14.8 mL/hr. Programming 18.0 mL/hr treats the ordered weight-based dose as a volume rate, while 29.5 mL/hr doubles the required dose. A rate of 147.6 mL/hr reflects a tenfold conversion error; verify the concentration and use the facility's independent double-check process for heparin.

2. 2.A client's apical pulse is 54/min before the scheduled morning medications. The prescription is digoxin 0.125 mg PO daily, and the client reports new nausea and yellow-tinted vision. Which action should the nurse take?

   • A.Give half the dose and document the client's symptoms.
   • B.Hold the dose and notify the provider of the findings.
   • C.Administer the dose with food and reassess the pulse in 1 hour.
   • D.Give the dose and request a serum digoxin level with the next routine blood draw.

   Rationale: Bradycardia together with nausea and altered color vision suggests possible digoxin toxicity, so the nurse should hold the dose and promptly notify the provider. Giving the full dose with food does not address the concerning pulse or toxicity cues. Independently reducing the dose is not within the nurse's authority, and administering digoxin before waiting for a routine level could worsen toxicity.

3. 3.The provider prescribes nitroprusside at 0.5 mcg/kg/min for a client weighing 70 kg. The solution contains 50 mg in 250 mL of D5W. Which rate should the nurse set on the infusion pump?

   • A.1.05 mL/hr
   • B.21 mL/hr
   • C.10.5 mL/hr
   • D.0.21 mL/hr

   Rationale: The ordered dose is 0.5 mcg/kg/min x 70 kg = 35 mcg/min, or 2,100 mcg/hr. The solution concentration is 50,000 mcg/250 mL = 200 mcg/mL, so the rate is 2,100/200 = 10.5 mL/hr. A rate of 1.05 mL/hr is tenfold too low, while 21 mL/hr doubles the ordered dose; 0.21 mL/hr results from an incorrect conversion of minutes to hours.

4. 4.During a home visit, a client with heart failure says, "I took an extra water pill yesterday because my ankles looked puffy." The medication list includes furosemide 40 mg PO daily. Which information is most important for the nurse to obtain first?

   • A.The client's current weight and whether it has changed from the usual morning weight
   • B.The client's preferred pharmacy for updating the prescription label
   • C.Whether the client has noticed increased urinary frequency after the dose
   • D.Whether the client takes furosemide with breakfast or later in the day

   Answer and rationale are in the full material.

5. 5.A client with atrial fibrillation is prescribed warfarin. The INR is 5.2, and the client reports no bleeding. Which action should the nurse take?

   • A.Administer vitamin K immediately without consulting the provider.
   • B.Administer the scheduled dose because there is no visible bleeding.
   • C.Give the dose with a serving of spinach to lower the INR.
   • D.Hold the dose and notify the provider for further instructions.

   Answer and rationale are in the full material.