🩺 NR 217 Exam 3 Remediation Infographic
Remediation for exam 3 topicsKatie Mills
50%
Topics to review
🩺 Medication Safety & Error Reduction
🩺 NR 217 Exam 3 Remediation Infographic
IV therapy & Blood administration
Actions to Take for a Continuous IV Infusion
Actions to Take when Administering a Unit of PRBCs
Caring for a Client Who Is Undergoing a Blood Transfusion
Actions to Take for a Warm and Painful Catheter Site
Respiratory & Chronic Conditions
Info
magnetic Whiteboard INFOGRAPHIC
Write a great headline.
Step 1
We are visual beings. We are capable of understanding images from millions of years ago, even from other cultures.
Step 2
We tell thousands and thousands of stories. ⅔ of ourconversations are stories.
Step 3
We need to interact with each other.We learn collaboratively.
Graphic + text
Graphics are very shareable, making them ideal for social media, and as if that weren't enough: they often generate quality traffic for the content we create.
‘Your content is liked, but it engages much more if it is interactive.’
Always cite the author.
magnetic Whiteboard INFOGRAPHIC
A catchy title
Do you feel like your text is still missing something? Add animation to capture your audience.
80%
WOW Effect
Write a catchy headline
90%
Write acatchy headline
Write a catchy headline
Bring life to the elements of your creation with animation. It's impossible not to pay attention to moving content!
Write a catchy headline
What you read: interactivity and animation can make the dullest content become something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Attention! At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds valueand engages.
Write a great headline
Do you need more reasons to create dynamic content? Well: 90% of the information we assimilate comes through sight, and we retain 42% more information when the content is moving.
Did you know that... In Genially you will find more than 1,000 ready-made templates to showcase your content and 100% customizable, which will help you tell your stories?
Demonstrate review and improvement in lower-scoring content areas
After reviewing pharmacology, medication safety, and nursing planning strategies, I can now identify early signs of complications, apply evidence-based practices to medication administration, and use structured decision-making to ensure safe patient care.
Write a catchy headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Tip: Interactivity is the key piece to capturing the interest and attention of your audience. A Genially is interactive because your audience explores and engages with it.
With this feature...
You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whateveryou want!
Did you know that Genially allows you to share your creation directly, without the need for downloads? Ready for your audience to view it on any device and promote it anywhere.
Write a great headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Write a catchy headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
With this feature...You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whatever you want!
Write a great headline
When giving a presentation, there are two objectives to pursue: to convey information and to avoid yawns. To achieve this, it may be good practice to create an outline and use words that will be etched in your audience's minds.
This is another question I don't fully remember, I believe this one was about monitoring the continuous IV. I honestly wasn't sure about any of the time frames. I remember Rachel's powerpoint about IV's but none of the timeframes looked familiar to me.
Tubing sets and solution bags can also be a source of infection. Nurses should follow facility policy regarding how often tubing should be changed. Standards established by the Infusion Nurses Society (INS) state that tubing sets should be changed every 96 hours or according to facility policy for continuous infusions and every 24 hours for intermittent infusions. However, the IV tubing set should be changed immediately if contamination is suspected or the integrity of the closed system has been disrupted. Another exception to this standard involves tubing sets used for the administration of blood or blood products and lipids: They should be changed more frequently because of the high risk of bacterial growth. INS standards indicate that the tubing for lipids should be changed every 12 hours and with each new container. Blood administration sets should be changed after every unit or every 4 hours according to INS standards. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
With this feature...
You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whateveryou want!
Did you know that Genially allows you to share your creation directly, without the need for downloads? Ready for your audience to view it on any device and promote it anywhere.
Action to take following medication refusal Safe Medication Administration and Error Reduction: Client’s Refusal of Medications
I believe when I saw these questions there was one that I initally thought to ask the client why they were refusing because I had remembered a previous test question of figuring out why. I'm still not sure what the correct answer was but it does make sense that after education and investigating that you would then tell the provider.
Although the client has the right to refuse any medication or treatment, the nurse is responsible for investigating the reasons for refusal and attempting to dispel any fears or misconceptions. The nurse should notify the health care provider whenever a client refuses medication and make the appropriate documentation in the client’s medical record. (ATI: Medication Administration)
Safe Medication Administration and Error Reduction: An Interruption During Medication Preparation
While I still couldn't really find a good answer for it in ATI, my thinking for this question was to discard the medication in an emergency because leaving it wouldn't be right because what if someone tampered with it, asking someone else to take over wouldn't be right because then you'd have to teach them what to do and by that time the emergency would be handled, and then I didn't think asking someone to watch it made sense because it's your license and if I don't know this person or trust them I wouldn't want to put my license on the line because I alllowed someone else to watch my medications when I could just start over.
Interruption occurs when the nurse is preparing or administering a medication and is interrupted during the process. Interruptions during the medication process impact client safety, quality of care, and workload. Strategies to prevent interruptions include marking the area where medication preparation occurs to prevent people from conversing with a nurse working in the labeled area, limiting excess noises, decreasing the use of cellphones by the nurse, and educating staff not to disturb those preparing medications unless the need is critical in nature. (ATI: Medication Management)
Priority Action Following a Medication Administration Error
I believe for this question I was thinking the correct thing would either be to notify the provider or document the error but looking it up now, it does make sense to check vitals and make sure the client is okay first.
When it has been determined that a medication error has occurred, the client must be assessed for any change in medical condition.Notify the health care provider as soon as possible to remedy any potentially harmful effects of the error. The organizational protocols will dictate the steps to complete following a medication error, which typically involve notifying the nursing supervisor and completing an incident report once the health care provider has been notified. (ATI: Medication Administration)
Teaching about Incident Reports
I believe this question was which scenario should an incident report be made. I think I chose the wrong route scenario but I was between choosing the hour later because I knew that that was also a medication error, I guess it was a matter of which one was more correct.
When completing the incident report, the nurse explains the situation surrounding the error, including what happened, which actions were taken, other people involved, and circumstances that may have played a role in the error. It is important to state only the facts in the incident report, while avoiding any personal opinions or excuses, omitting facts, or trying to place the responsibility on someone else. Although the incident report is considered a legal document, it is not placed or mentioned in the client’s medical record. Following health care facility’s policy, the erroneous medication administered, or scheduled medication omitted, should be documented in the client’s medical record, along with the client assessment, interventions provided, and notification of the health care provider. (ATI: Medication Administration)
Teaching About Pharmacodynamics
For this question I wasn't sure. I know I had heard of half-life before but I wasn't entirely sure so I guessed. But now I know and it's trough, I'm pretty sure!
Peak and trough blood levels will guide the health care provider in maintaining therapeutic medication levels. The peak blood level occurs when the medication is at its highest concentration, but below the toxic level. Peak medication levels occur when absorption is complete. The concentration of a medication is considered to be within the therapeutic range when the medication produces the desired effects. The trough blood level is the lowest level of concentration of a medication that correlates to the rate of elimination. It is measured before administering the next scheduled dose. All medications have a half-life, which is the time it takes for the medication to fall to half its strength through excretion. Medications with longer half-lives may be administered only once daily to maintain a therapeutic level. (ATI:Medication Administration)
Safe Medication and Error Reduction: Actions for Potassium Chloride Administration
Honestly, I don't even remember this question but I found information in ATI and it was good for me to review it as I didn't remember the question.
Choose a site proximal to a recently discontinued IV site. When possible, avoid the dominant hand and antecubital space and other joints, as flexion can affect the rate flow of IV fluids. Avoid an extremity with lymphema or trauma. For pediatrics clients, the hand or foot may be the preferred site, and for infants, a scalp vein may be preferred. When determining the site at which to initiate IV access, the nurse should select a vein that feels pliable and smooth. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I believe this question was about transfusion rate for PRBCs which I wasn't exactly sure about. I don't remember what the options were but it does make sense to wait 15 minutes with the client and then checking vitals every 15 minutes after the transfusion has started.
Prior to administering transfusions, the client must sign a consent form to receive a blood product. Pre-infusion vital signs should be obtained, and all required supplies should be gathered prior to obtaining the blood from the laboratory, as blood should remain appropriately stored until it is ready to be transfused. The client should have an 18 to 20-gauge IV access that is patent and already in place before the nurse retrieves the blood product. At the bedside, two nurses must check and compare the blood unit label with the client’s identification information and ensure compatibility of the unit with the client’s blood type. Transfusion should be completed within 4 hours of leaving controlled temperature storage. Blood should be transfused by an RN. A nurse should remain with the client during the first 15 minutes of the transfusion, as most transfusion reactions occur within this time frame. Vital signs should be routinely checked 15 minutes after starting the transfusion and then according to facility policy. Close attention should be paid to the client for the first fifteen minutes, as this is when most transfusion reactions may occur. The nurse should take and document vital signs after fifteen minutes and monitor the client for any signs of a transfusion reaction. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I don't remember the specifics of the question but it was good to review the information because regardless I wasn't sure about my answers for the IVs.
It is critical to recognize when a transfusion reaction is occurring, as prompt clinical management can prevent serious injury to a client. If a reaction is suspected, the priority is to stop the transfusion while keeping IV access open using an infusion of 0.9% sodium chloride. In some cases, it is necessary to replace the administration set because a significant amount of blood may still be present within the tubing. The blood unit label and client identification should be compared again to verify that the blood product was administered to the correct client. The blood unit should be returned to the blood bank with a sample of blood from the client for investigation of the reaction. The nurse should remain with the client, continue to monitor the client’s status, support respirations if needed, and notify the provider. The most common acute transfusion reactions include acute hemolytic reactions, which occur when the blood transfused is not compatible with the blood of the client; febrile non-hemolytic transfusion reactions; allergic reactions, which can range from mild to anaphylactic; transfusion-related acute lung injury (TRALI), which results in edema of the lung tissues and airways; and transfusion-associated circulatory overload (TACO), which is often the result of too-rapid administration of blood products. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I do remember this question and for some reason I thought you weren't supposed to add warmth to something that was already warm, so I thought the best action would be to slow the infusion but I believe that was only for potassium.
Should phlebitis occur, the nurse should notify the provider and plan to discontinue the IV access. Comfort measures such as the application of warm compresses, elevation of the affected area, and the administration of prescribed analgesics should be anticipated. Additionally, the nurse should utilize clinical judgment in attempting to identify the cause of the phlebitis (mechanical, chemical, or bacterial) and integrate these findings into planning for the insertion of a new IV site. Documentation should include a description of the IV site, the objective and subjective manifestations, the phlebitis rating score, notification of the provider, and interventions implemented. If a new IV site is initiated, its location should also be included in the documentation. When caring for an older adult who requires IV therapy, note that aging can cause this client’s skin to become thinner and more fragile. This makes it more difficult to carry out IV insertion and therapy. In addition, the veins in older adults become thicker, valves become rigid and sclerotic. and veins are more prone to rupture. Care should be used when applying a tourniquet to avoid causing vein rupture or the development of a hematoma. Instead of a tourniquet, a blood pressure cuff or a warm compress may be used to ensure venous distention. When preparing to initiate an IV access, it may be necessary to pull the skin taut and stabilize the vein, then decrease the angle of insertion, because the older adult client often has a loss of subcutaneous tissues needed to support the vein and the vein is closer to the surface of the skin. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
Caring for a Client Who Has COPD
This question I do remember. I knew it was either respiratory alkalosis or acidosis and unfortunately I chose the wrong one but now I will remember which one is which.
As these causes indicate, respiratory acidosis can be an acute or a chronic condition. In chronic conditions, such as chronic obstructive pulmonary disorder (COPD), the body adjusts over time. In contrast, acute episodes of respiratory acidosis occur quickly and require intervention. The body will attempt to regain homeostasis by retaining HCO3– (a base); however, it takes the kidneys hours to days to regain homeostasis. Exacerbations of chronic respiratory conditions are often due to a respiratory virus infection and will result in respiratory acidosis.
Manifestations of respiratory acidosis can include anxiety and confusion, fatigue, shortness of breath, lethargy, and sleepiness. Treatment depends on identifying the underlying cause and can include supplemental oxygen administration and medications such as bronchodilators and corticosteroids. Nursing interventions for a client who is experiencing respiratory acidosis include monitoring respiratory effort, lung sounds, and the airway; monitoring vital signs, I&O, and subsequent ABGs or other laboratory results; and administering treatments as prescribed. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
Chronic Neurologic Disorders: Phenytoin Administration
This question really threw me off because I don't remember any specifics for medications like Phenytoin. So since I wasn't sure I just chose the rate one. 100mg/hour I think it was. I couldn't find anything in ATI for it so I looked online and found some information on it.
Chronic Neurologic Disorders: Phenytoin Administration
Preparation and dilution
Diluent: Phenytoin must be diluted only in 0.9% sodium chloride (normal saline).
Do not dilute with dextrose: Mixing with dextrose solutions will cause the phenytoin to precipitate.
Concentration: The final concentration of the solution should be no less than 5 mg/mL and ideally not exceed 10 mg/mL to reduce the risk of precipitation.
Administration time: The diluted solution is unstable and must be prepared immediately before use and administered within 1 to 4 hours.
In-line filter: An in-line filter (0.22 to 0.5 microns) must be used during administration to catch any crystals that may form and prevent them from entering the patient's bloodstream.
Infusion rate and technique
Slow administration is critical: Rapid IV administration of phenytoin can cause severe hypotension, cardiac arrhythmias (including bradycardia, heart block, and ventricular fibrillation), and cardiovascular collapse.
Maximum rate (adults): The infusion rate should not exceed 50 mg per minute.
Lower rates for high-risk patients: In elderly patients or those with pre-existing heart conditions, the rate should be reduced to 25 mg per minute or lower.
Administration site: Administer the drug into a large peripheral or central vein through a large-gauge catheter to reduce the risk of venous irritation. Flush the line: The IV line should be thoroughly flushed with normal saline before and after the infusion to clear the catheter and prevent local venous irritation and precipitation.
Avoid continuous infusion: Phenytoin should be administered as an intermittent slow infusion, not as a continuous one.
Monitor the site: The catheter site must be closely monitored throughout the infusion for any signs of irritation or a purple-colored discoloration.
Patient monitoring
Cardiac monitoring: Continuous cardiac monitoring is essential during and after the infusion to watch for any changes in heart rate or rhythm.
Blood pressure: Blood pressure should be monitored frequently, such as every 15 minutes during the infusion.
Therapeutic drug monitoring: Serum phenytoin levels should be monitored to ensure they are within the therapeutic range (typically 10 to 20 mcg/mL total phenytoin).
Watch for respiratory depression: Monitor for signs of respiratory depression, especially in critically ill patients.
Potential complications
Purple glove syndrome: A rare but severe complication, especially with infusions into small veins or after massive doses. It involves swelling, pain, and purplish discoloration of the limb, and in severe cases, can lead to skin necrosis and limb ischemia.
Cardiotoxicity: Rapid administration can cause life-threatening heart problems, including severe hypotension and various arrhythmias.
Injection site reactions: Local venous irritation, pain, and phlebitis can occur, especially if the IV is administered too quickly or into a small vein.
Precipitation: If the solution is not prepared correctly (e.g., diluted in dextrose) or infused too slowly, it can form crystals that can lead to vascular complications.
Reflection
Now that I've taken the test and completed my remediation, I feel that there were a few that I should have gotten right but chose wrong and then there were quite a few that I just wasn't sure about. I always feel like I'm studying enough and I know the information well enough but when I start to take the test I begin to feel like whatever studying I had done wasn't enough. I'm going to have to look for different ways to study and make sure that I'm confident on my knowledge level because I know that my style of learning doesn't work well with reading and trying to take in the knowledge so I need to find a different way to study. I think some of the most powerful learning moments during this exercise was realizing how much I wasn't sure of and how much I wanted to change it. I tend to have a very laid-back personality and sometimes it feels like I might not care but doing this remediation really made me see how much I want to do better and succeed and prove to myself that I can do it because I know I can. As a nurse, I feel I will always be learning and as a human being we're bound to make mistakes. Not that I would want to but this remediation really put into perspective the importance of safe medication administration and if you do make an error the proper way to handle it.
🩺 NR 217 Exam 3 Remediation Infographic
Katie Mills
Created on October 29, 2025
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Transcript
🩺 NR 217 Exam 3 Remediation Infographic
Remediation for exam 3 topicsKatie Mills
50%
Topics to review
🩺 Medication Safety & Error Reduction
🩺 NR 217 Exam 3 Remediation Infographic
IV therapy & Blood administration
Actions to Take for a Continuous IV Infusion
Actions to Take when Administering a Unit of PRBCs
Caring for a Client Who Is Undergoing a Blood Transfusion
Actions to Take for a Warm and Painful Catheter Site
Respiratory & Chronic Conditions
Info
magnetic Whiteboard INFOGRAPHIC
Write a great headline.
Step 1
We are visual beings. We are capable of understanding images from millions of years ago, even from other cultures.
Step 2
We tell thousands and thousands of stories. ⅔ of ourconversations are stories.
Step 3
We need to interact with each other.We learn collaboratively.
Graphic + text
Graphics are very shareable, making them ideal for social media, and as if that weren't enough: they often generate quality traffic for the content we create.
‘Your content is liked, but it engages much more if it is interactive.’
Always cite the author.
magnetic Whiteboard INFOGRAPHIC
A catchy title
Do you feel like your text is still missing something? Add animation to capture your audience.
80%
WOW Effect
Write a catchy headline
90%
Write acatchy headline
Write a catchy headline
Bring life to the elements of your creation with animation. It's impossible not to pay attention to moving content!
Write a catchy headline
What you read: interactivity and animation can make the dullest content become something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Attention! At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds valueand engages.
Write a great headline
Do you need more reasons to create dynamic content? Well: 90% of the information we assimilate comes through sight, and we retain 42% more information when the content is moving.
Did you know that... In Genially you will find more than 1,000 ready-made templates to showcase your content and 100% customizable, which will help you tell your stories?
Demonstrate review and improvement in lower-scoring content areas
After reviewing pharmacology, medication safety, and nursing planning strategies, I can now identify early signs of complications, apply evidence-based practices to medication administration, and use structured decision-making to ensure safe patient care.
Write a catchy headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Tip: Interactivity is the key piece to capturing the interest and attention of your audience. A Genially is interactive because your audience explores and engages with it.
With this feature...
You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whateveryou want!
Did you know that Genially allows you to share your creation directly, without the need for downloads? Ready for your audience to view it on any device and promote it anywhere.
Write a great headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
Write a catchy headline
What you read: interactivity and animation can turn the most boring content into something fun. At Genially, we use AI (Awesome Interactivity) in all our designs, so you can level up with interactivity and turn your content into something that adds value and engages.
With this feature...You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whatever you want!
Write a great headline
When giving a presentation, there are two objectives to pursue: to convey information and to avoid yawns. To achieve this, it may be good practice to create an outline and use words that will be etched in your audience's minds.
This is another question I don't fully remember, I believe this one was about monitoring the continuous IV. I honestly wasn't sure about any of the time frames. I remember Rachel's powerpoint about IV's but none of the timeframes looked familiar to me.
Tubing sets and solution bags can also be a source of infection. Nurses should follow facility policy regarding how often tubing should be changed. Standards established by the Infusion Nurses Society (INS) state that tubing sets should be changed every 96 hours or according to facility policy for continuous infusions and every 24 hours for intermittent infusions. However, the IV tubing set should be changed immediately if contamination is suspected or the integrity of the closed system has been disrupted. Another exception to this standard involves tubing sets used for the administration of blood or blood products and lipids: They should be changed more frequently because of the high risk of bacterial growth. INS standards indicate that the tubing for lipids should be changed every 12 hours and with each new container. Blood administration sets should be changed after every unit or every 4 hours according to INS standards. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
With this feature...
You can add additional content that excites your audience's brain: videos, images, links, interactivity... Whateveryou want!
Did you know that Genially allows you to share your creation directly, without the need for downloads? Ready for your audience to view it on any device and promote it anywhere.
Action to take following medication refusal Safe Medication Administration and Error Reduction: Client’s Refusal of Medications
I believe when I saw these questions there was one that I initally thought to ask the client why they were refusing because I had remembered a previous test question of figuring out why. I'm still not sure what the correct answer was but it does make sense that after education and investigating that you would then tell the provider.
Although the client has the right to refuse any medication or treatment, the nurse is responsible for investigating the reasons for refusal and attempting to dispel any fears or misconceptions. The nurse should notify the health care provider whenever a client refuses medication and make the appropriate documentation in the client’s medical record. (ATI: Medication Administration)
Safe Medication Administration and Error Reduction: An Interruption During Medication Preparation
While I still couldn't really find a good answer for it in ATI, my thinking for this question was to discard the medication in an emergency because leaving it wouldn't be right because what if someone tampered with it, asking someone else to take over wouldn't be right because then you'd have to teach them what to do and by that time the emergency would be handled, and then I didn't think asking someone to watch it made sense because it's your license and if I don't know this person or trust them I wouldn't want to put my license on the line because I alllowed someone else to watch my medications when I could just start over.
Interruption occurs when the nurse is preparing or administering a medication and is interrupted during the process. Interruptions during the medication process impact client safety, quality of care, and workload. Strategies to prevent interruptions include marking the area where medication preparation occurs to prevent people from conversing with a nurse working in the labeled area, limiting excess noises, decreasing the use of cellphones by the nurse, and educating staff not to disturb those preparing medications unless the need is critical in nature. (ATI: Medication Management)
Priority Action Following a Medication Administration Error
I believe for this question I was thinking the correct thing would either be to notify the provider or document the error but looking it up now, it does make sense to check vitals and make sure the client is okay first.
When it has been determined that a medication error has occurred, the client must be assessed for any change in medical condition.Notify the health care provider as soon as possible to remedy any potentially harmful effects of the error. The organizational protocols will dictate the steps to complete following a medication error, which typically involve notifying the nursing supervisor and completing an incident report once the health care provider has been notified. (ATI: Medication Administration)
Teaching about Incident Reports
I believe this question was which scenario should an incident report be made. I think I chose the wrong route scenario but I was between choosing the hour later because I knew that that was also a medication error, I guess it was a matter of which one was more correct.
When completing the incident report, the nurse explains the situation surrounding the error, including what happened, which actions were taken, other people involved, and circumstances that may have played a role in the error. It is important to state only the facts in the incident report, while avoiding any personal opinions or excuses, omitting facts, or trying to place the responsibility on someone else. Although the incident report is considered a legal document, it is not placed or mentioned in the client’s medical record. Following health care facility’s policy, the erroneous medication administered, or scheduled medication omitted, should be documented in the client’s medical record, along with the client assessment, interventions provided, and notification of the health care provider. (ATI: Medication Administration)
Teaching About Pharmacodynamics
For this question I wasn't sure. I know I had heard of half-life before but I wasn't entirely sure so I guessed. But now I know and it's trough, I'm pretty sure!
Peak and trough blood levels will guide the health care provider in maintaining therapeutic medication levels. The peak blood level occurs when the medication is at its highest concentration, but below the toxic level. Peak medication levels occur when absorption is complete. The concentration of a medication is considered to be within the therapeutic range when the medication produces the desired effects. The trough blood level is the lowest level of concentration of a medication that correlates to the rate of elimination. It is measured before administering the next scheduled dose. All medications have a half-life, which is the time it takes for the medication to fall to half its strength through excretion. Medications with longer half-lives may be administered only once daily to maintain a therapeutic level. (ATI:Medication Administration)
Safe Medication and Error Reduction: Actions for Potassium Chloride Administration
Honestly, I don't even remember this question but I found information in ATI and it was good for me to review it as I didn't remember the question.
Choose a site proximal to a recently discontinued IV site. When possible, avoid the dominant hand and antecubital space and other joints, as flexion can affect the rate flow of IV fluids. Avoid an extremity with lymphema or trauma. For pediatrics clients, the hand or foot may be the preferred site, and for infants, a scalp vein may be preferred. When determining the site at which to initiate IV access, the nurse should select a vein that feels pliable and smooth. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I believe this question was about transfusion rate for PRBCs which I wasn't exactly sure about. I don't remember what the options were but it does make sense to wait 15 minutes with the client and then checking vitals every 15 minutes after the transfusion has started.
Prior to administering transfusions, the client must sign a consent form to receive a blood product. Pre-infusion vital signs should be obtained, and all required supplies should be gathered prior to obtaining the blood from the laboratory, as blood should remain appropriately stored until it is ready to be transfused. The client should have an 18 to 20-gauge IV access that is patent and already in place before the nurse retrieves the blood product. At the bedside, two nurses must check and compare the blood unit label with the client’s identification information and ensure compatibility of the unit with the client’s blood type. Transfusion should be completed within 4 hours of leaving controlled temperature storage. Blood should be transfused by an RN. A nurse should remain with the client during the first 15 minutes of the transfusion, as most transfusion reactions occur within this time frame. Vital signs should be routinely checked 15 minutes after starting the transfusion and then according to facility policy. Close attention should be paid to the client for the first fifteen minutes, as this is when most transfusion reactions may occur. The nurse should take and document vital signs after fifteen minutes and monitor the client for any signs of a transfusion reaction. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I don't remember the specifics of the question but it was good to review the information because regardless I wasn't sure about my answers for the IVs.
It is critical to recognize when a transfusion reaction is occurring, as prompt clinical management can prevent serious injury to a client. If a reaction is suspected, the priority is to stop the transfusion while keeping IV access open using an infusion of 0.9% sodium chloride. In some cases, it is necessary to replace the administration set because a significant amount of blood may still be present within the tubing. The blood unit label and client identification should be compared again to verify that the blood product was administered to the correct client. The blood unit should be returned to the blood bank with a sample of blood from the client for investigation of the reaction. The nurse should remain with the client, continue to monitor the client’s status, support respirations if needed, and notify the provider. The most common acute transfusion reactions include acute hemolytic reactions, which occur when the blood transfused is not compatible with the blood of the client; febrile non-hemolytic transfusion reactions; allergic reactions, which can range from mild to anaphylactic; transfusion-related acute lung injury (TRALI), which results in edema of the lung tissues and airways; and transfusion-associated circulatory overload (TACO), which is often the result of too-rapid administration of blood products. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
I do remember this question and for some reason I thought you weren't supposed to add warmth to something that was already warm, so I thought the best action would be to slow the infusion but I believe that was only for potassium.
Should phlebitis occur, the nurse should notify the provider and plan to discontinue the IV access. Comfort measures such as the application of warm compresses, elevation of the affected area, and the administration of prescribed analgesics should be anticipated. Additionally, the nurse should utilize clinical judgment in attempting to identify the cause of the phlebitis (mechanical, chemical, or bacterial) and integrate these findings into planning for the insertion of a new IV site. Documentation should include a description of the IV site, the objective and subjective manifestations, the phlebitis rating score, notification of the provider, and interventions implemented. If a new IV site is initiated, its location should also be included in the documentation. When caring for an older adult who requires IV therapy, note that aging can cause this client’s skin to become thinner and more fragile. This makes it more difficult to carry out IV insertion and therapy. In addition, the veins in older adults become thicker, valves become rigid and sclerotic. and veins are more prone to rupture. Care should be used when applying a tourniquet to avoid causing vein rupture or the development of a hematoma. Instead of a tourniquet, a blood pressure cuff or a warm compress may be used to ensure venous distention. When preparing to initiate an IV access, it may be necessary to pull the skin taut and stabilize the vein, then decrease the angle of insertion, because the older adult client often has a loss of subcutaneous tissues needed to support the vein and the vein is closer to the surface of the skin. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
Caring for a Client Who Has COPD
This question I do remember. I knew it was either respiratory alkalosis or acidosis and unfortunately I chose the wrong one but now I will remember which one is which.
As these causes indicate, respiratory acidosis can be an acute or a chronic condition. In chronic conditions, such as chronic obstructive pulmonary disorder (COPD), the body adjusts over time. In contrast, acute episodes of respiratory acidosis occur quickly and require intervention. The body will attempt to regain homeostasis by retaining HCO3– (a base); however, it takes the kidneys hours to days to regain homeostasis. Exacerbations of chronic respiratory conditions are often due to a respiratory virus infection and will result in respiratory acidosis. Manifestations of respiratory acidosis can include anxiety and confusion, fatigue, shortness of breath, lethargy, and sleepiness. Treatment depends on identifying the underlying cause and can include supplemental oxygen administration and medications such as bronchodilators and corticosteroids. Nursing interventions for a client who is experiencing respiratory acidosis include monitoring respiratory effort, lung sounds, and the airway; monitoring vital signs, I&O, and subsequent ABGs or other laboratory results; and administering treatments as prescribed. (ATI: Fluid, Electrolyte, and Acid-Base Regulation)
Chronic Neurologic Disorders: Phenytoin Administration
This question really threw me off because I don't remember any specifics for medications like Phenytoin. So since I wasn't sure I just chose the rate one. 100mg/hour I think it was. I couldn't find anything in ATI for it so I looked online and found some information on it.
Chronic Neurologic Disorders: Phenytoin Administration
Preparation and dilution Diluent: Phenytoin must be diluted only in 0.9% sodium chloride (normal saline). Do not dilute with dextrose: Mixing with dextrose solutions will cause the phenytoin to precipitate. Concentration: The final concentration of the solution should be no less than 5 mg/mL and ideally not exceed 10 mg/mL to reduce the risk of precipitation. Administration time: The diluted solution is unstable and must be prepared immediately before use and administered within 1 to 4 hours. In-line filter: An in-line filter (0.22 to 0.5 microns) must be used during administration to catch any crystals that may form and prevent them from entering the patient's bloodstream. Infusion rate and technique Slow administration is critical: Rapid IV administration of phenytoin can cause severe hypotension, cardiac arrhythmias (including bradycardia, heart block, and ventricular fibrillation), and cardiovascular collapse. Maximum rate (adults): The infusion rate should not exceed 50 mg per minute. Lower rates for high-risk patients: In elderly patients or those with pre-existing heart conditions, the rate should be reduced to 25 mg per minute or lower.
Administration site: Administer the drug into a large peripheral or central vein through a large-gauge catheter to reduce the risk of venous irritation. Flush the line: The IV line should be thoroughly flushed with normal saline before and after the infusion to clear the catheter and prevent local venous irritation and precipitation. Avoid continuous infusion: Phenytoin should be administered as an intermittent slow infusion, not as a continuous one. Monitor the site: The catheter site must be closely monitored throughout the infusion for any signs of irritation or a purple-colored discoloration. Patient monitoring Cardiac monitoring: Continuous cardiac monitoring is essential during and after the infusion to watch for any changes in heart rate or rhythm. Blood pressure: Blood pressure should be monitored frequently, such as every 15 minutes during the infusion. Therapeutic drug monitoring: Serum phenytoin levels should be monitored to ensure they are within the therapeutic range (typically 10 to 20 mcg/mL total phenytoin). Watch for respiratory depression: Monitor for signs of respiratory depression, especially in critically ill patients. Potential complications Purple glove syndrome: A rare but severe complication, especially with infusions into small veins or after massive doses. It involves swelling, pain, and purplish discoloration of the limb, and in severe cases, can lead to skin necrosis and limb ischemia. Cardiotoxicity: Rapid administration can cause life-threatening heart problems, including severe hypotension and various arrhythmias. Injection site reactions: Local venous irritation, pain, and phlebitis can occur, especially if the IV is administered too quickly or into a small vein. Precipitation: If the solution is not prepared correctly (e.g., diluted in dextrose) or infused too slowly, it can form crystals that can lead to vascular complications.
Reflection
Now that I've taken the test and completed my remediation, I feel that there were a few that I should have gotten right but chose wrong and then there were quite a few that I just wasn't sure about. I always feel like I'm studying enough and I know the information well enough but when I start to take the test I begin to feel like whatever studying I had done wasn't enough. I'm going to have to look for different ways to study and make sure that I'm confident on my knowledge level because I know that my style of learning doesn't work well with reading and trying to take in the knowledge so I need to find a different way to study. I think some of the most powerful learning moments during this exercise was realizing how much I wasn't sure of and how much I wanted to change it. I tend to have a very laid-back personality and sometimes it feels like I might not care but doing this remediation really made me see how much I want to do better and succeed and prove to myself that I can do it because I know I can. As a nurse, I feel I will always be learning and as a human being we're bound to make mistakes. Not that I would want to but this remediation really put into perspective the importance of safe medication administration and if you do make an error the proper way to handle it.