141 Taylor Chapter 30 Questions

15. A nurse is teaching an older adult about taking newly prescribed medications at home. Which information would be included? A. "You can identify your medications by their color." B. "I have written the names of your drugs with times to take them." C. "You won't forget a medication if you count them every day." D. "Don't worry if the label comes off, just look at the shapes."

B Rationale: A nurse should teach clients the names of drugs and the times they should be administered rather than distinguishing drugs by color. Manufacturers may vary the color of generic drugs, and the visual changes associated with aging may make it more difficult to identify medications by color. Medications should not be identified by counting or by shapes and should remain in their original containers with the label intact for the client to correctly identify the name of the medication. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 939

14. A nurse is administering a liquid medication to an infant. Where will the nurse place the medication to prevent aspiration? A. Between the gum and the cheek B. In front of the teeth and gums C. On the front of the tongue D. Under the tongue

A Rationale: A dropper is used to give infants or very young children liquid medications while holding them in a sitting or semi-sitting position. The medication is placed between the gum and the cheek to prevent aspiration. If the medication is given in the front of the mouth, the infant or child may spit it out. If the medication is given under the tongue, the infant or child may push the medication to the front of the mouth. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 939

2. The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? A. Withhold the medication until the potential drug allergy has been addressed by the care team. B. Administer the medication and increase the frequency of assessments in the hours that follow. C. Substitute an antibiotic with similar action, but one that is from a different drug family. D. Discuss the severity, signs, and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

A Rationale: Client safety is paramount, and the nurse has a responsibility to ensure that a potential threat of harm is identified and dealt with promptly. It is beyond the nurse's scope of practice to independently substitute another drug, and it would be unsafe to administer the drug in light of this revelation. The nurse would not administer the drug even if the client stated that his allergy is mild. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 929

1. The nurse is preparing to administer a medication via a nasogastric tube. Which guideline is appropriate for the nurse to follow when administering a drug via this route? A. Flush the tube with water between each drug administered. B. Position the client supine prior to administering the drug. C. Administer the medication at a cold temperature. D. If connected to suction, do not reconnect to suction for 5 minutes after drug administration.

A Rationale: Guidelines to consider when administering a drug via nasogastric tube include positioning the client with the head of the bed elevated, administering the medication at room temperature for the client's comfort, flushing the tube with water between each drug administered, and avoiding the use of suction for 20 to 30 minutes after the drug is administered. The temperature of the medication should be room temperature but can also be given cold. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 940

36. A client diagnosed with anemia is receiving a blood transfusion. The client develops urticaria accompanied by wheezing and dyspnea not long after the transfusion starts. The nurse interprets this as indicative of: A. allergic reaction. B. side effect. C. toxicity. D. antagonism.

A Rationale: In a client with urticaria, the symptoms of severe allergic reaction are hives, wheezing, and dyspnea, which is due to an anaphylactic reaction. Minor adverse effects are called side effects. Many side effects are essentially harmless and can be ignored. Toxicity results from overdosage or buildup of medication in the blood due to impaired metabolism and excretion. Antagonism is a drug interaction by which drug effects decrease. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 919

43. A client reports postoperative pain of 9 on a scale of 10 and asks the nurse whether a shot or a pill will provide the fastest pain relief. Which is the best response from the nurse? A. Intravenous medication provides the fastest pain relief until you can take pills by mouth. B. Oral medication will take effect more slowly but will provide longer lasting pain relief. C. Injectable pain medication acts quickly but is only administered when pain cannot be controlled. D. Oral pain medication will take effect in about the same amount of time as injectable medication.

A Rationale: Injected medications, especially by the intravenous route, are usually absorbed more rapidly than oral medications. Oral medications have to combine with the liquid in the stomach then get absorbed into the blood and the rate of absorption from stomach to blood is slower than through the intravenous route. Injectable medications are not only used for times when pain cannot be controlled so this would not accurately address the question. Oral pain medication does not take effect in the time amount of time as injectable medication, it is slower. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 952

42. A client asks the nurse whether the generic acetaminophen is as effective as the brand name product. Which is the nurse's best response? A. Generic medication performs the same as the corresponding brand-name product. B. Generic medication often has different active ingredients, dosages and route of administration from the brand-name version. C. Dyes, fillers and coatings may be similar, so the generic medication often looks like branded version. D. Generic medication performs a little differently than the corresponding brand-name product.

A Rationale: The generic name of a drug is the name assigned by the manufacturer that first developed the drug. The drug company that sells the drug selects the trade name. Drug manufacturers must prove to the Federal Drug Administration (FDA) that a generic medication performs the same as the corresponding brand-name product. Generic medications must have the same, not different, active ingredients, dosages and routes of administration as the brand-name versions. Inactive ingredients such as dyes, fillers and coatings may be different, so generic drugs often look different from, not the same as, branded versions. Generic drugs do not perform a little differently than the corresponding brand-name product. The FDA requires that generic medications perform the same as the corresponding brand-name medication. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 913

24. A nurse is preparing to administer a medication by intravenous piggyback. Where will the piggyback container be placed? A. higher than the primary solution container B. lower than the primary solution container C. at an equal height with the primary solution container D. below the level of the client's heart

A Rationale: The intravenous piggyback delivery system requires the intermittent or additive solution to be placed higher than the primary solution container. The primary solution container is placed on an extension hook to lower it when the piggyback container is hung. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 952

33. A nurse at a health care facility has to instill ear drops in a client. The nurse knows that which technique varies for an adult and child client? A. manipulation of the client's ear to straighten the auditory canal B. dilution of the medication drops before instilling in the client's ear C. position in which the client remains until medication reaches the eardrum D. amount of time before instilling medication in the client's opposite ear

A Rationale: The nurse should be aware that the method of manipulation of the client's ear to straighten the auditory canal varies between an adult and child. In a young client, the nurse pulls the ear down, in an adult client, the nurse pulls the ear up and back. The medication is not diluted, the number of medication drops instilled is as per the physician's prescription, and does not depend on the client's age. The position in which the client remains until the medication reaches the eardrum, and the amount of time before instilling medication in the client's opposite ear, does not differ with the age of the client. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 955

30. A nurse needs to administer a prescribed dose of an opioid medication to a client with acute neck pain. These medications should be stored in a: A. double-locked drawer. B. single container. C. self-contained packet. D. disguised container.

A Rationale: The nurse should place opioid drugs in a double-locked drawer. Opioids are controlled substances, meaning that federal laws regulate their possession and administration. Health care facilities keep opioids in a double-locked drawer, box, or room on the nursing unit. An opioid drug may not be placed in a single container, self-contained packet, or in disguised containers. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 934

3. Which client receives a drug that requires a parenteral route? A. client who has been prescribed intravenous antibiotics B. client who takes a diuretic pill each morning C. client with emphysema who uses nebulized bronchodilators D. client who has an antifungal ointment applied to their skin rash daily

A Rationale: The parenteral route includes such methods as intravenous administration and injections. Pills are given by an oral route, and a nebulizer is administered by the pulmonary route. An ointment is a topical medication. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 941

8. A nurse is converting the dosage of a medication to a different unit in the metric system. The medication label specifies the drug as being 0.5 g per tablet. The order is for 500 mg. How many tablets will the nurse give? A. 1 B. 2 C. 5 D. 10

A Rationale: To convert in the metric system from a smaller unit to a larger unit, move the decimal point three places to the right. As 0.5 g = 500 mg, the nurse would administer one tablet. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 930

20. A nurse is preparing an injection by withdrawing the solution from a multidose vial. What is necessary to facilitate withdrawing a medication from the vial? A. First, inject an equal amount of air into the vial. B. Withdraw the liquid and then inject an equal amount of air. C. Insert the needle and slowly withdraw the liquid. D. Insert a separate needle to equalize the pressure.

A Rationale: To facilitate removal of medication from a multidose vial, first inject an amount of air equal to the amount of the desired quantity of the medication. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 943

44. When the nurse administers the client's amlodipine, the client states that usually only one pill is taken instead of three pills. Which right of medication should now be triple checked before allowing the client to take the medication? A. Right dose B. Right client C. Right medication D. Right time

A Rationale: When a client states that the dose he or she is used to taking is different from the dose the nurse is administering, it is suggestive of an incorrect medication dosage and should cue the nurse to triple-check medication dosages. The client's identity should be checked before the medication is handed to the client, and the client's statement is directed toward the medication dose, not whether he or she has medication prescribed. The client's statement does not involve the name or the type of medication, only the dose. The client is not questioning the medication administration time, only the dose. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 932

27. A nurse at the health care facility is preparing the medication dosage for a client. Why should the nurse read and compare the label on the medication with the MAR at least three times (before, during, and after) while preparing the medication for administration? A. Ensure that the right medication is given at the right time by the right route B. Comply with the medical order and ensures that the right dose is given C. Ensure that the medication has been administered to the right client D. Demonstrate timely administration and compliance with the medical order

A Rationale: When preparing the medications for administration, the nurse reads and compares the label on the medication with the MAR at least three times. This is to ensure that the right medication is given at the correct time and by the correct route. The nurse calculates the doses to comply with the medical order and ensure that the right dose is given. Before administration, the nurse identifies the client by checking the wristband or asking the client's name. This is to ensure that the medication is given to the right person. The nurse should plan to administer the medications within 30 to 60 minutes of their scheduled time, which demonstrates timely administration and compliance with the medical order. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 932

40. A client who has been taking no medications has just been diagnosed as having diabetes. The client is prescribed an injectable medication once a day and an oral medication twice a day for blood glucose control. What would the nurse teach the client about taking these medications? Select all that apply. A. Take the medications at the same time each day. B. Do not abruptly stop the medication or alter the dosage. C. The intended effects and adverse effects of the medications D. Keep the medications in a lighted, warm, and dry place. E. The appropriate timing of the medications in relation to food

A, B, C, E Rationale: The nurse, when teaching a client about medications, would include in the instructions to take the medications at the same time each day, to not abruptly stop the medications or alter the dosage of the medications, and would teach about the intended/adverse effects of each medication. For diabetic medications, it is important for the nurse to teach the client when to take these medications in relation to ingestion of food. These medications would make the client's blood glucose drop to critically low levels if food is not also ingested. Medications should not be exposed to light. Medications should be kept in a cool, dry place. Light, temperature, and humidity can inactivate the medications. Question format: Multiple Select Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 966

39. The "rights" of medication administration help to ensure accuracy when administering medications. What are some of these rights? Select all that apply. A. medication B. client C. prescribing physician D. pharmacy E. dosage F. route

A, B, E, F Rationale: To prevent medication errors, always ensure that the right medication is given to the right client in the right dosage through the right route at the right time, followed by the right documentation. The physician and pharmacy are not part of the "rights" of medication administration for nurses. Question format: Multiple Select Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 933

19. A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A. Recap the needle, place it in a puncture-resistant container. B. Do not recap the needle, place it in a puncture-resistant container. C. Break off the needle, place it in the barrel, and throw it in the trash. D. Take off the needle and throw the syringe in the client's trash can.

B Rationale: After use, needles and syringes are placed in a puncture-resistant container without being recapped. This prevents needlestick injuries because most occur during recapping. The needle does not need to be removed or broken to place it in a puncture-resistant container. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 941

6. A client who is taking an oral opioid for pain relief tells the nurse they are constipated. What is this common response to opioids called? A. therapeutic effect B. adverse effect C. toxic effect D. idiosyncratic effect

B Rationale: Although therapeutic effect is the desired outcome of medication administration, sometimes adverse effects occur. Adverse effects (such as constipation from opioids) often are predictable and can usually be tolerated. Toxic effects (toxicities) are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death. An idiosyncratic effect (sometimes called paradoxical effect) is any unusual or peculiar response to a drug that may manifest itself by over-response, under-response, or even the opposite of the expected response. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 918

17. What would a nurse instruct a client to do after administration of a sublingual medication? A. "Take a big drink of water and swallow the pill." B. "Try not to swallow while the pill dissolves." C. "Swallow frequently to get the best benefit." D. "Chew the pill so it will dissolve faster."

B Rationale: Sublingual and buccal medications should not be swallowed, but rather held in place so that complete absorption takes place. The client should be instructed not to swallow, drink a liquid, or chew the pill. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 941

11. What type of prescription would the health care provider most likely write to treat a client whose pain levels vary widely throughout the day? A. Stat B. PRN C. standing D. one-time

B Rationale: The prescriber may write a PRN prescription ("as needed") for medication. The client receives medication when it is requested or required. These prescriptions are commonly written for treatment of symptoms. For example, medications used for pain relief, to relieve nausea, and for sleep aids are often written as a PRN order. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 926

37. Which medication system allows for client independence? A. Unit dose system B. Self-administered medication system C. Automated medication-dispensing system D. Bar Code Medication Administration (BCMA)

B Rationale: The self-administered system allows the client independence and responsibility. It also allows nursing supervision, education, and evaluation for client compliance and safety medication management prior to facility discharge. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 926

41. The nurse is administering an oral opioid medication to a client who reported pain. The client dropped the medication on the floor. What actions would the nurse take now? Select all that apply. A. Wipe off the pill with dry gauze and administer to the client. B. Search for the pill on the floor until the pill is found. C. Discard the pill in an appropriate container with a witnessing nurse present. D. Obtain another dose of the medication for the client. E. Ask the physician to prescribe the opioid medication in a liquid form.

B, C, D Rationale: If an oral medication falls to the floor, the nurse searches for the pill until the pill is found. This is particularly important for an opioid medication, which the nurse must account for according to federal law. The pill is to be discarded in an appropriate container with a witness, also according to federal law. The nurse obtains another dose of the medication to administer to the client. The nurse does not wipe the pill and try to administer the pill to the client. This is to prevent contamination and transmission of microorganisms. Only if the client drops multiple dosages of opioid medications on the floor would the nurse ask for a liquid form of the medication. Question format: Multiple Select Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 936

10. A nurse is conducting an interview with a client to collect a medication history. Which question would be used to ensure safe medication administration? A. "Have you noticed any change in your bowel habits?" B. "How do you feel about taking medications?" C. "Do you have any allergies to medications?" D. "At what times do you take your medications?"

C Rationale: Drug allergies can occur in a person who has previously been exposed to a medication and developed a drug allergy. The reactions range from minor to life threatening. Serious drug reactions must be documented according to agency policy and reported to the FDA MedWatch program. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 935

32. A client with dry skin has been prescribed inunction. What should the nurse do to promote absorption of the ointment? A. shake the contents of the ointment B. apply inunction with a cotton ball C. rub the ointment into the skin D. warm the inunction before application

C Rationale: In order to promote absorption, the nurse should rub the ointment into the client's skin. Shaking the contents would mix the contents uniformly, whereas applying the ointment with a cotton ball would distribute the substance over a wide area. Warming the ointment before application would provide comfort. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 928

28. A client with allergies has been advised to have an allergy test. The nurse needs to administer an injection to the client for allergy testing. Which injection route is most suitable for allergy testing? A. subcutaneous B. intramuscular C. intradermal D. intravenous

C Rationale: Intradermal injection routes are commonly used for tuberculin tests and allergy testing because they are administered between the layers of the skin. A subcutaneous injection is not suitable because it is administered more deeply than an intradermal injection, whereas an intramuscular injection is administered in one muscle or muscle group. Intravenous injection is also not suitable because it is instilled into veins. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 944

31. A nurse at a health care facility administers a prescribed drug to a client and does not record doing so in the medical administration record. The nurse who comes during the next shift, assuming that the medication has not been administered, administers the same drug to the client again. The nurse on the previous shift calls to inform the health care facility that the administration of the drug to this client in the earlier shift was not recorded. What should the nurse on duty do immediately upon detection of the medication error? A. Report the incident to the physician. B. Report the incident to the supervising nurse. C. Check the client's condition. D. Fill in the accident report sheet.

C Rationale: On detection of the medication error, the nurse should immediately check the client's condition. When medication errors occur, nurses have an ethical and legal responsibility to report them to maintain the client's safety. As soon as the nurse recognizes an error, he or she should check the client's condition, then report the mistake to the prescriber and supervising nurse. Health care agencies have a form for reporting medication errors called an incident sheet or accident sheet. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Communication and Documentation Reference: p. 934

38. What is the name of the process by which a drug moves through the body and is eventually eliminated? A. Pharmacology B. Pharmacotherapeutics C. Pharmacokinetics D. Pharmacodynamics

C Rationale: Pharmacokinetics is the process by which a drug moves through the body and is eventually eliminated. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 916

25. A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step? A. to keep the inside of the needle or catheter sterile B. to facilitate client comfort and decrease anxiety C. to clear medication and prevent clot formation D. to dilute the infusion and maintain homeostasis

C Rationale: The intravenous lock is flushed before and after the infusion is completed to clear the vein of any medication and to prevent clot formation in the needle. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 953

46. The health care provider writes a prescription for ampicillin 1 gram every 6 hours for a client. What would cause the nurse to question this medication prescription? A. The time is missing. B. The amount is missing. C. The route is missing. D. The frequency is missing.

C Rationale: The rights of medication administration include client, drug, route, dose, time, reason, and documentation. This medication prescription does not identify a route. Ampicillin can be administered intravenously, intramuscularly, or orally. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 927

4. A physician has ordered peak and trough levels of a medication. When would the nurse schedule the trough level specimen? A. Before administering the first dose B. Immediately after the first dose C. 30 minutes before the next dose D. 24 hours after the last dose

C Rationale: The trough level is the point at which the drug is at its lowest concentration, and the specimen is usually drawn in the 30-minute interval before the next dose. The peak level, in contrast, is the highest plasma concentration of the drug, and is usually drawn one hour after administration of the medication. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 923

23. Which anatomic site is recommended for intramuscular injections for adults? A. vastus lateralis B. epidermis of inner forearm C. ventrogluteal muscles D. subcutaneous fat

C Rationale: The ventrogluteal site involves the gluteus medius and gluteus minimus muscles in the hip area. This site is recommended for adults because there are no large nerves or blood vessels, it is removed from bone tissue, it is clean, and the client may lie on the back, abdomen, or side for the injection. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 949

16. A nurse is administering medications through a nasogastric tube connected to continuous suction. How will the nurse do this accurately? A. Briefly disconnect tubing from the suction to administer medications, then reconnect. B. Realize this can't be done, and document information. C. Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D. Leave the suction alone and give medications orally or rectally.

C Rationale: To administer medications to clients with a nasogastric tube connected to continuous suction, disconnect the tubing from the suction, administer the medications one at a time, and then clamp the tubing for 20 to 30 minutes after administration to allow absorption. It is not necessary to give the medications orally or rectally. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 940

5. A client taking insulin has the levels adjusted to ensure that the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A. peak level B. trough level C. half-life D. therapeutic range

D Rationale: A drug's therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. The peak level, or highest plasma concentration, of the drug should be measured when absorption is complete. The peak level may be affected by factors that affect drug absorption as well as the route of administration. The trough level is the point when the drug is at its lowest concentration, and this specimen is usually drawn in the 30-minute interval before the next dose. A drug's half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 923

13. A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A. to prevent absorption in the mouth B. to prevent absorption in the esophagus C. to facilitate absorption in the stomach D. to prevent gastric irritation

D Rationale: Enteric-coated tablets are covered with a hard surface to impede absorption until the tablet has left the stomach. Enteric-coated tablets should not be chewed or crushed because the active ingredient of the drug is irritating to the gastric mucosa. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 937

22. A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A. 10-mL syringe, 3-inch (8-cm) 18-gauge needle B. 5-mL syringe, 2-inch (5-cm) 20-gauge needle C. insulin syringe, 1-inch (2.5-cm) 16-gauge needle D. tuberculin syringe, 1/2-inch (1.25-cm) 26-gauge needle

D Rationale: Equipment used for an intradermal injection includes a tuberculin syringe calibrated in tenths and hundredths of a milliliter. A quarter-inch to half-inch (0.626-cm to 1.25-cm) 26- or 27-gauge needle is used. Insulin syringes are used for insulin. The 18- and 20-gauge needles are too large for an intradermal injection. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 944

7. A nurse is conducting an interview for a health history. In addition to asking the client about medications being taken, what else should be asked to assess the risk for drug interactions? A. the effects of prescribed medications B. type and amount of foods eaten C. daily amount of intake and output D. use of herbal supplements

D Rationale: Herbal remedies can interact with prescribed medications. When asking a client if he is taking any medications, the nurse should specifically ask if herbal supplements are also being used. Foods usually do not interfere with most medications. Fluids are important for hydration and keeping circulation so that the medication can reach the sites of action. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 936

21. An adult with diabetes receives 20 units of insulin each morning and evening. How will the nurse teach the client to administer the insulin? A. "Use a 1-mL syringe and give 0.4 mL." B. "Use a 5-mL syringe and give 0.40 mL." C. "Use a tuberculin syringe and give 4/10 mL." D. "Use an insulin syringe and give 20 units."

D Rationale: Insulin dosages are calculated in units. The scale commonly used is U100, based on 100 units of insulin contained in 1 mL of solution. The adult client is taught to measure by units, not mL. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 946

45. A hospitalized client asks the nurse for "some aspirin for my headache." There is no prescription for aspirin for this client. Which assessment information should the nurse obtain prior to requesting a prescription for aspirin? A. previous use of aspirin B. tolerance to aspirin C. other medications currently taken D. allergy to aspirin

D Rationale: It is important to check the medication history, which should include a history of any allergies and medication intolerances, the client's medical history, and the client's pregnancy and lactation status. Previous use of aspirin, side effects and other medications taken may at some point be relevant to requesting from the heath care provider. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 929

35. A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. What is the reason for bunching when injecting subcutaneously? A. to prevent needlestick injuries B. to ensure the accuracy of landmarking C. to facilitate blood circulation at the injection site D. to avoid instilling medication within the muscle

D Rationale: Nurses bunch tissue between the thumb and fingers before administering the injection to avoid instilling medication within the muscle. Bunching does not prevent needlestick injuries, it does not facilitate blood circulation at the injection site, nor does it ensure the accuracy of landmarking. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 945

9. A medication is prescribed for a pediatric client. The nurse is ensuring the dosage is correct. What factor would the nurse use to calculate the dosage is correct for this client? A. Age B. Developmental level C. Ethnicity D. Body surface area (BSA)

D Rationale: Pediatric doses are calculated according to the infant's or child's weight in kilograms or the BSA. The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 920

12. What must a nurse do each time medications are administered to ensure that medication errors do not occur? A. Verify the number of medications to be administered. B. Review information about classification of drugs. C. Ask another nurse to double-check the medications. D. Observe the three checks and rights of administration.

D Rationale: Safety is of the utmost when preparing and administering drugs. The nurse observes the three checks and rights of medication administration each time medications are administered. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 932

18. A nurse is administering an intramuscular injection of a viscous medication using the appropriate-gauge needle. What does the nurse need to know about needle gauges? A. All needles for parenteral injection are the same gauge. B. The gauge will depend on the length of the needle. C. Ask the client what size needle is preferred. D. Gauges range from 14 to 29, with 14 being the largest.

D Rationale: The gauge is determined by the diameter of the needle and ranges from 14 to 29. As the diameter of the needle increases, the gauge number decreases (a 14-gauge needle is, therefore, larger than a 29-gauge needle). A viscous medication requires a larger-gauge needle for injection. Asking the client is not appropriate, as they will not have the knowledge to determine what size gauge is appropriate. The gauge is different from the length of the needle. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 941

26. A nurse is caring for a client in the nursing unit when the physician, during the rounds, verbalizes a prescription for a medication. What appropriate action should the nurse take to ensure the accuracy of the verbal medication order? A. Ask the physician to repeat the dosage. B. Ask the physician to spell out the medication name. C. Ask a second nurse to listen for accuracy. D. Ask the physician to write out the order.

D Rationale: To maintain the accuracy of a verbal order, the nurse should tactfully ask the physician for a written order. When obtaining phone orders, it is important to repeat the dosages of medications and to spell medication names for confirmation of accuracy. Some nurses may ask a second nurse to listen to a telephone order on an extension. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 926

29. A nurse needs to administer an intradermal tuberculin skin test injection to a client. What is the most suitable angle when administering an intradermal injection? A. 180-degree angle B. 90-degree angle C. 45-degree angle D. 10-degree angle

D Rationale: When administering an intradermal injection, the nurse should hold the syringe almost parallel to the skin at a 5-15-degree angle with the bevel pointing upward. This facilitates delivering the medication between the layers of the skin and advances the needle to the desired depth. A nurse administers a subcutaneous injection at a 45-degree angle or a 90-degree angle to reach the subcutaneous level of tissue, depending on the length of the needle. The nurse will not be able to insert the injection if it is held at a 180-degree angle. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 944

34. A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which instructions are stated on the label of a vial container? A. type of needle to be used for withdrawal B. directions for administering the drug C. best site for administering the drug D. amount of diluent to be added

D Rationale: When reconstitution is necessary, the drug label lists instructions such as the amount of diluent to be added and the type of diluent to be used, but not the type of needle. The label states the dosage per volume after reconstitution, not the best site for administering the drug after the reconstitution. It also states the directions for storing the drug, not the directions for administering the drug to a client. Question format: Multiple Choice Chapter 30: Medications Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 944