A nurse is reconciling the medications for a client who was newly admitted for management of mania. Which of the following prescriptions should the nurse clarify with the provider?

Risperidone 3.0 mg PO daily

Clonazepam 0.5 mg PO three times daily

Lithium 300 mg PO three times daily

Divalproex sodium 0.5 g PO daily

Answer and Explanation

The Correct Answer is A

The pharmacological management of acute mania involves mood stabilizers and antipsychotics to achieve rapid symptomatic control. Safety standards prohibit the use of trailing zeros in medication orders to prevent ten-fold dosing errors. A decimal point followed by a zero can be easily misread in a clinical environment, leading to iatrogenic harm and severe medication toxicity.

Rationale:

A. Risperidone 3.0 mg contains a trailing zero, which is a dangerous notation that must be clarified and corrected to 3 mg. If the decimal point is not clearly visible, a clinician might mistakenly administer 30 mg, which could lead to severe extrapyramidal symptoms or neuroleptic malignant syndrome. Following the "Do Not Use" list from The Joint Commission is essential for patient safety.

B. Clonazepam 0.5 mg is a correctly formatted prescription for a benzodiazepine often used as an adjunct in mania to promote sedation and reduce agitation. The leading zero before the decimal point is required to prevent the dose from being read as 5 mg. Since this order follows safe labeling practices and falls within therapeutic ranges, it does not require clarification.

C. Lithium 300 mg is a standard starting dose for a primary mood stabilizer used in the treatment of bipolar disorder. The order is written clearly without dangerous abbreviations or incorrect decimal placements. Because the dose is typical for achieving a therapeutic serum concentration between 0.8 and 1.2 mEq/L, the nurse can proceed with administration and monitoring.

D. Divalproex sodium 0.5 g is an anticonvulsant mood stabilizer written using a leading zero, which is the correct safety format for decimal values. While often prescribed in milligrams (500 mg), the use of grams is clear and follows standard metric notation. There is no ambiguity in this order that would increase the risk of a significant medication error for the patient.

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Free Nursing Study Resources

Correct Answer is D,A,C,B

Explanation

Inject 5 units of air into the NPH insulin vial.

Inject 15 units of air into the regular insulin vial.

Withdraw 15 units of medication from the regular insulin vial.

Withdraw 5 units of medication from the NPH insulin vial.

Brief Introduction:

Insulin mixturepreparation requires a specific sequence to prevent cross-contamination of vials and ensure dosage accuracy. Regular insulinis a short-acting, clear solution, while NPH insulinis an intermediate-acting, cloudy suspension. Maintaining the "clear before cloudy" withdrawal rule is a critical safety standard in clinical pharmacology to avoid contaminating the fast-acting clear vial with the protein-binding agents found in the NPH suspension.

Rationale:

A. Injecting 15 units of air into the regular insulinvial is the second step in the sequence. After the NPH vial has been pressurized with air, the needle is withdrawn and inserted into the clear vial. This ensures that the clear insulin vial is ready for immediate withdrawal without needing to re-enter the cloudy vial later, which maintains the chemical purityof the short-acting insulin.

B. Withdrawing 5 units of medication from the NPH insulinvial is the final step of the procedure. Because NPH contains protamine, any accidental backflow into the regular vial would alter the clear insulin's pharmacokinetic properties. By withdrawing the cloudy insulin last, the nurse ensures the integrity of the fast-acting dose, which is essential for managing postprandial glucose spikes.

C. Withdrawing 15 units of medication from the regular insulinvial occurs after air has been injected into both vials. The clear insulin is always drawn up first into the syringe to ensure that no cloudy suspensionenters the clear vial. This order is a standard nursing competency designed to prevent the modification of the onset and peak action of the clear insulin dose.

D. Injecting 5 units of air into the NPH insulinvial is the initial step in preparing a mixed dose. Vials are sealed vacuum environments; therefore, air equal to the dose must be injected to allow for the easy displacement of fluid. Starting with the cloudy vialfor air injection (without the needle touching the solution) allows the nurse to then move to the clear vial for the withdrawal phase.

A. Date, time, digoxin 0.25 PO QD, VO, provider, nurse B. Date, time, digoxin 0.25 mg by mouth daily, VO, provider, nurse C. Date, time, digoxin .25 mg by mouth daily, provider, nurse D. Date, time, digoxin .25 mg PO daily, VO, provider, nurse

Correct Answer is B

Explanation

Safe medical documentation requires the use of standardized terminologyand the avoidance of dangerous abbreviations to prevent medication errors. The Joint Commission maintains a "Do Not Use" list, which prohibits notations that are easily misinterpreted, such as trailing zeros or missing leading zeros.

Rationale:

A.This entry is incorrect because it uses the abbreviation "QD" for daily, which is on the prohibited list as it can be mistaken for "QID" (four times daily). Additionally, it fails to include the unit of measurement "mg" after the dosage, which is a critical safety component. Standardized documentation requires writing out the word "daily" and including full units to ensure there is no ambiguity in the medical record.

B.This is the correct entry because it follows all safety protocols, including the use of a leading zero (0.25 mg) and writing out "daily" and "by mouth." It also correctly documents that it was a verbal order (VO) and identifies both the prescribing provider and the receiving nurse. This level of detail ensures the order is legally sound and minimizes the risk of a ten-fold dosing error or route confusion.

C.This entry is unsafe because it lacks a leading zero (.25 mg), which could result in the patient receiving 25 mg instead of 0.25 mg if the decimal point is missed. Such a massive overdose of digoxin would likely be fatal due to its narrow therapeutic index and cardiac toxicity. Furthermore, it fails to document that the order was a verbal order, which is necessary for legal and clinical accountability.

D.Similar to choice C, this entry is incorrect due to the omission of the leading zero before the decimal point (.25 mg). While it correctly uses "VO" and "daily," the lack of a leading zero is a high-risk charting error that directly violates patient safety standards. Proper notation must always place a zero before a decimal to highlight the fractional nature of the dose to all clinical staff.

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A nurse is reconciling the medications for a client who was newly admitted for management of mania. Which of the following prescriptions should the nurse clarify with the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D,A,C,B

Explanation

A nurse receives a verbal order for a client for digoxin. Which of the following entries should the nurse document in the client's medical record?

Correct Answer is B

Explanation

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