Ch 3: Medication Administration and the Nursing Process of Drug Therapy

c) "My baby's dose of acetaminophen is based on a healthy adult male" Pg. 37 A child's dose is never based on an adult's dose. However, on rare occasions a child's dose might be higher than normal if a critical concentration cannot be reached with a smaller dose and a higher dose would not be harmful. Benefits from the increased dosage would have to out weight the risk for adverse or toxic effects. A child's organs may not be mature enough to handle drugs causing drug metabolism to be altered. A child's dosages are determined by the age, weight, or body surface.

1. A young mother asks the nurse why she cannot give her 2-year-old child an adult dose of acetaminophen. The nurse explains why this is unsafe. What statement would indicate that the mother needs further education? a) "My child's dose of acetaminophen should be based on her weight or age" b) "There could be a time when my child may need a higher dose than normal" c) "My baby's dose of acetaminophen is based on a healthy adult male" d) "My baby can't handle a high dose of acetaminophen because her liver may be damaged"

a) 1 gram = 1000 milligrams c) 1 milligram = 1000 micrograms e) 1 kilogram = 1000 grams Pg. 46 In the metric system the unit of weight is the gram. The following indicates the correct conversions: 1 kilogram = 1000 grams; 1 gram = 1000 milligrams; 1 milligram = 1000 micrograms. The conversion that 1 gram equals 100 milligrams is incorrect, as is that 1 gram equals 10 milligrams.

10. The nurse must use the metric system in dosage calculations. Which conversions are correct? (Select all that apply.) a) 1 gram = 1000 milligrams b) 1 gram = 10 milligrams c) 1 milligram = 1000 micrograms d) 1 gram = 100 milligrams e) 1 kilogram = 1000 grams

b) 1.5 inches (3.8 cm), 22 gauge Pg. 51 A 22-gauge needle that is 1.5 inches (3.8 cm) long is most often used for IM injections. The remaining options are either too short or of an inappropriate gauge.

11. The nurse should use which needle when administering a nonviscous solution by the intramuscular (IM) route for an adult? a) 0.5 inches (1.3 cm), 25 gauge b) 1.5 inches (3.8 cm), 22 gauge c) 1.5 inches (3.8 cm), 18 gauge d) 1 inch (2.5 cm), 25 gauge

c) "What kind of reactions have you had to medications?" Pg. 53 Open-ended questions cannot be logically answered with a "yes" or "no" response. They allow the nurse to elicit far greater detail than yes/no questions.

12. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency department. Which of the following is an open-ended assessment question? a) "Does anyone in your immediate family have a history of drug allergies?" b) "Have you ever had a bad response to a drug that you've taken?" c) "What kind of reactions have you had to medications?" d) "Are you comfortable with receiving needles?"

d) Obtain a medication history Pg. 43 History and physical examination are completed during assessment, the first step of the nursing process. Problem identification is completed during the nursing diagnosis step, the second step of the nursing process. Education is a form of intervention. Confirming or ruling out nursing diagnoses would be part of the diagnosis stage.

13. A nurse is beginning to apply the nursing process during a new client interaction. What activity should the nurse perform? a) Educate the client about basic medication safety b) Identify potential client problems related to drug therapy c) Confirm or rule out nursing diagnoses d) Obtain a medication history

1 tablet Pg. 46 1 g = 1,000 mg; 0.5 g = 500 mg

14. The nurse is preparing to administer a 500-mg dose of medication. It is available as 0.5 g per tablet. How many tablets will the nurse administer to a client to achieve the prescribed dose?

0.8 mL Pg. 46 8 mg/10 mg = X/1 mL

15. The health care provider ordered 8 mg of morphine sulfate IM. Morphine sulfate is available as 10 mg in a 1-mL vial. How many milliliters will the nurse administer to this client?

d) 0.5 Pg. 46 12.5 (desired dose) ÷ 25 (available dose) = 0.5 tablets.

16. A client is prescribed a 12.5-mg dose of metoprolol for the treatment of high blood pressure. The nurse should administer how many 25-mg tablets? a) 1 b) 1.25 c) 2 d) 0.5

2.2 mg Pg. 47 Using the mg/kg method, the nurse would set up this calculation: 0.2 mg/1 kg = X mg/11 kg; Cross multiplying and solving for X: X = 0.2 × 11; X = 2.2 mg.

17. A child weighs 11 kilograms. The health care provider orders a drug as follows: 0.2 mg/kg intravenously. What dose should the nurse administer?

d) 5 mL Pg. 46 In liquid drugs, a specific amount of drug is in a given volume of solution. In this example, there is 125 mg/5 mL, so 5 mL is the volume (quantity) in which there is 125 mg of drug. The other calculations are incorrect and if given would be a drug error.

18. The nursing student is studying drug dosing with liquids. The student knows that a specific amount of drug will be in a given volume. A particular drug label reads "Augmentin 125 mg/5 mL." Which is the correct volume? a) 125 mg b) 2.5 mL c) 725 mg d) 5 mL

b) Read the order back to the health care provider d) Write down the order exactly as the health care provider said it e) Request verbal confirmation that the order is correct as written Pg. 44 When a nurse receives a verbal order over the telephone, it is the nurse's responsibility to write down the order, repeat back the information exactly as written, and then ask for verbal confirmation that it is correct. It is not necessary to contact the pharmacist and request confirmation on the order. The medication may be new to the client, so verifying that the client has taken it previously is not required.

19. The nurse receives a verbal order from a health care provider. To ensure safe medication administration, what steps are completed? Select all that apply. a) Verify that the client has previously taken the medication b) Read the order back to the health care provider c) Call the pharmacist to confirm that this medication is ordered correctly d) Write down the order exactly as the health care provider said it e) Request verbal confirmation that the order is correct as written

a) Providing client teaching about a drug therapy regimen Pg. 55 Implementation involves planning client care and intervention. Providing client teaching would be a part of implementation. Developing a problem statement is done during the nursing diagnosis step. Obtaining baseline information about the client's health patterns and identifying the client's social support system would be completed during assessment.

2. Which nursing intervention would the nurse expect to do during implementation? a) Providing client teaching about a drug therapy regimen b) Obtaining baseline information about the client's pattern of health care c) Developing statements about a client's actual problem d) Identifying the client's social support network

d) Ensure that care is safe and effective Pg. 53 Nurses use the nursing process as a decision-making, problem-solving process to improve the safety and effectiveness of care. The main purposes of the nursing process do not involve giving clients a voice, collaborating or giving a framework for documentation.

20. What is the nurse's main rationale for applying the nursing process in medication therapy? a) Provide opportunities for clients to express their preferences b) Promote interprofessional collaboration c) Provide a framework for documenting nursing actions d) Ensure that care is safe and effective

c) Compare the outcome expected with the actual client outcome Pg. 61 In the evaluation phase, a nurse would compare the expected outcome goals of the treatment with the client's progress, thereby judging the effectiveness of nursing management. Questions are generally asked initially at the onset of drug therapy and compiled. These questions serve as a basis for preparing the client's education program. During the assessment phase of core client variables, the nurse physically examines the client and establishes all baselines. The evaluation phase is not the right time to reconsider core client variables and core drug knowledge because such critical information is essentially compiled in the assessment phase.

21. Which activity would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy? a) Ask questions to prepare an effective client education program b) Reconsider core drug knowledge and core client variables c) Compare the outcome expected with the actual client outcome d) Establish a baseline for the client's treatment and care

d) "When are you taking your medication?" Pg. 54 The client's statement suggests that the drug's peak effect is occurring during sleep, which would lead the nurse to suspect that the client is taking the medication before bedtime. The nurse would need to confirm that this is true before questioning the client further about the dosage, fluid intake or other issues. Asking about herbal medicines is appropriate with any drug therapy but is not the priority in this situation.

22. The nurse is providing care for a client who has been prescribed a diuretic to treat hypertension. The client states that the effects of the drug are problematic, causing the client to wake up numerous times during the night to urinate. What assessment question should the nurse prioritize? a) "Have you increased your fluid intake since starting the drug?" b) "Are you taking any herbal medicines?" c) "What is the dosage of your medication?" d) "When are you taking your medication?"

d) 1 kg equals 2.2 pounds Pg. 46 The dosage of a drug may be based on the client's weight. In many instances, references give the dosage based on the weight in kilograms rather than pounds. There are 2.2 lbs in 1 kg.

23. Medication doses given to children are usually smaller than those given to adults. Doses for children can also be calculated based on the child's weight. Which would be correct when calculating a dose based on weight? a) 1 kg equals 4 pounds b) 1 pound equals 4 kg c) 1 pound equals 2.2 kg d) 1 kg equals 2.2 pounds

d) Administer the drug as instructed by the health care provider Pg. 44 The nurse should administer the drug as instructed without a written order as it is an emergency. The nurse should, however, ensure that the provider's order is obtained after drug has been administered. Waiting for a written order during an emergency may exacerbate the provider's condition. The nurse should complete the documentation immediately after the administration of the drug and not wait until the provider's order is received.

24. A health care provider instructs a nurse to administer a drug to a client STAT. What should the nurse perform in this situation? a) Document the administration of the drug only after receiving the provider's order b) Insist on obtaining a written report before administering any drug c) Forgo obtaining the provider's order after the drug has been administered d) Administer the drug as instructed by the health care provider

d) Review laboratory values indicative of kidney function Pg. 53-54 The client's renal status will indicate the ability to excrete the drug. Liver function is needed to assess metabolism. Weight, hydration and fluid balance are less significant than renal function in determining the client's ability to excrete drugs.

30. When assessing a client before starting a drug regimen, how should the nurse best assess the client's ability to excrete medications? a) Weight the client and measure the client's abdominal girth b) Review the client's AST, ALT, bilirubin and albumin levels c) Assess the client's nutritional and hydration status d) Review laboratory values indicative of kidney function

d) Drug administration method Pg. 36 In addition to all the drug details, the nurse needs to include the best method to self-administer a drug, the drug; food or drug; drug interactions, any dietary restrictions, and the time and duration of the treatment. The nurse is expected to possess core drug knowledge, but is not supposed to transfer the entire core drug knowledge to clients. Diagnosis and outcome identification is a method to identify and label interactions between core drug knowledge and core client variables; this exercise is generally done by nurses to help them identify adverse effects and their causes quickly and reliably. The vital signs of a client do not need to be included in the education materials. Client education materials essentially help a client to administer drugs safely.

25. A nurse has been assigned the task of preparing educational materials for clients with diabetes. The nurse has included the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or the health care provider. Which information is essential to include in the educational materials? a) Vital signs of the client b) Diagnosis and outcome identification mechanism c) Core drug knowledge d) Drug administration method

b) Documenting the medication after administration Pg. 36 Documentation is known as the 6th right. The other five rights are right client, right drug, right dose, right route, and right time. Verification of the MAR with the provider's order should be done when the orders are entered and verified into the electronic record. Double checking the client's allergies to the medication record should be done before administering medications.

26. The nurse is preparing to administer medications and demonstrates knowledge of the 6th right by: a) Ensuring that the MAR matches the provider's order b) Documenting the medication after administration c) Identifying the client prior to administering the medication d) Double checking the medication with the allergies listed on the clients chart

a) Any adverse reaction is a cause to discontinue a therapy regimen Pg. 56 The benefit of the therapy must be weighed against the drug's adverse or side effects in order to make a decision regarding the discontinuation of the therapy. Expected benefits should outweigh potential adverse effects. Thus, drugs usually should not be prescribed for trivial problems or problems for which nondrug measures are effective. Drug therapy should be individualized. Many variables influence a drug's effects on the human body. Failure to consider these variables may decrease therapeutic effects or increase the risks of adverse effects. Drug effects on quality of life should be considered in designing a drug therapy regimen. Quality-of-life issues are also being emphasized in research studies, with expectations of measurable improvement because of drug therapy.

27. Which statement represents an action that would interfere with providing effective drug therapy? a) Any adverse reaction is a cause to discontinue a therapy regimen b) Expected benefits should outweigh potential adverse effects c) Quality of life should be considered in designing a drug therapy regimen d) Drug therapy should be individualized for each client

a) The nurse should question the order with the primary care provider Pg. 39 Any order that is unclear, particularly due to illegible handwriting, should be questioned. The nurse should not try to interpret the handwriting as it may lead to a misinterpretation. The nurse should also not confirm the order with any other health care provider who is nearby. Administering drugs based on verbal orders is permissible only during emergencies.

28. The nurse assigned to take care of a client is unable to read the primary care provider's handwriting. Which intervention is the most appropriate in this situation? a) The nurse should question the order with the primary care provider b) The nurse should obtain a verbal order c) The nurse should try to interpret the handwriting d) The nurse should confirm the order with a nearby care provider

a) A nurse must possess a basic understanding of mathematics Pg. 46 The nurse should have a basic understanding of several mathematical principles in order to do metric conversions in the event that a drug is ordered in a unit of measurement that is different from what is available. Strictly following the medication order and having a good knowledge about pharmacology ensures proper administration of drugs but does not help in metric conversions. Safe administration of drug dosage is a primary nursing function and not the health care provider's function.

29. According to protocol, a nursing student is required to complete metric conversions to ensure accurate administration of medication dosage. What does this indicate? a) A nurse must possess a basic understanding of mathematics b) A nurse must strictly follow the given medication orders c) A nurse must ask for the primary care provider's assistance d) A nurse must possess a good understanding of pharmacology

a) Intravenous infusion Pg. 48 Intravenous infusion is the preferred method for use in emergency situations when rapid drug effects are desired. Absorption is considered to be instantaneous, as the drug is placed directly into the bloodstream. The subcutaneous and intramuscular routes could be used but would not ensure rapid drug effects. Intrathecal administration is usually done by a specially trained health care provider.

3. An unconscious client has been brought to the hospital, and the client has prescribed a life-saving drug to be administered parenterally. Which method would be the most appropriate for the nurse to use when administering the medication? a) Intravenous infusion b) Subcutaneous administration c) Intramuscular administration d) Intrathecal administration

d) NPH insulin Pg. 47 Insulin is administered subcutaneously. The influenza and tetanus vaccines are administered by intramuscular injection and the PPD skin test is an intradermal injection.

31. Which of the following should be administered via subcutaneous injection? a) Influenza vaccine b) Tetanus vaccine c) PPD skin test d) NPH insulin

b) 2 Pg. A nurse should use two methods to identify the client before administering the medication. One form of identification is not enough, such as asking "Are you Mr. Jones?" If the client is confused, the client may say yes, when they are not indeed Mr. Jones, or the client may be in the wrong room. If verified by two methods there is no need for three or four methods.

32. A nurse should use how many methods to identify the client before administering the medication? a) 4 b) 2 c) 1 d) 3

d) Eye drops Pg. 49 Eye drops are instillations—liquids for topical use. Liquid medication when used to flush out or irrigate a wound is also topical administration. Mouthwash, syrups, and tinctures are not used for topical administration.

33. A student nurse is administering medications at a long-term care facility. Which of the following liquid medications is for topical administration? a) Mouthwash b) Syrup c) Tincture d) Eye drops

a) Drug name b) Dosage strength c) Dosage form Pg. 41 Although drug labels contain a great amount of information about the drug being given, three specific items are needed to administer a drug: the name, form, and dosage strength.

34. Which of the following are the three specific items found on a drug label needed to administer a drug? Select all that apply. a) Drug name b) Dosage strength c) Dosage form d) Monitoring parameters e) Side effects

c) 0.32 Pg. 46 100 units/1 mL = 32 units/X X = (32/100) mL = 0.32 mL

35. The nurse is conducting client education for a newly diagnosed diabetic. The order is for 32 units of insulin. The insulin is supplied in a multidose vial that is labeled 100 units/mL. How many mL of insulin would be needed to treat this client? a) 3.2 b) 32 c) 0.32 d) 0.032

a) 1500 (3 PM) Pg. 44 At 125 mL/hr, the client will need another liter (1000 mL) of IV fluid in 8 hours. The infusion was begun at 7 AM and the next liter will be hung at 3 PM.

36. At 0700 (7 AM) the health care provider has ordered the nurse to begin an IV infusion and has ordered the client to receive 125 mL/hr of IV fluid. At what time will the nurse be prepared to hang the next liter of IV fluid? a) 1500 (3 PM) b) 1400 (2 PM) c) 1300 (1 PM) d) 1600 (4 PM)

c) The trade name is the same as the brand name Pg. 3-4 Drug labels contain two names: trade (brand) name and generic (official) name. The trade name is usually capitalized, written first on the label, and identified by the registration symbol. The generic name is written in smaller print, often in parentheses, and usually located under the trade name. Often the generic drug is less expensive than the brand name drug.

37. The nursing student has learned that drug labels contain two names: trade name and generic name. The student demonstrates an understanding of the differences between the two when stating which of the following? a) The generic name is the same as the brand name b) The generic name is usually capitalized on the label and the trade name is written in a smaller print c) The trade name is the same as the brand name d) Often the trade drug is less expensive than the generic

b) Apply next dose to a new site Pg. 44 An important nursing intervention when administrating drugs through the transdermal route is to apply the next dose to a new site. It is important to check the infusion rate every 15 to 30 minutes in patients using infusion controllers or infusion pumps. When using the intradermal route, the inner part of the forearm should be used as the injection site and small volumes of doses should be administered.

38. A nurse is required to administer a drug through the transdermal route. Which of the following responsibilities should the nurse follow for the patient? a) Give small volumes of doses b) Apply next dose to a new site c) Inject only the inner part of the forearm d) Check the infusion rate

b) 8 Pg. 46 The client can take up to four doses in any 24-hour period. Each dose of 650 mg is two tablets (650 mg ÷ 325 mg/tablet = 2). 2 tablets X 4 doses = 8 tablets.

39. A client with mild postoperative pain has been prescribed 650 mg acetaminophen q6h PO PRN. The medication is available in 325 mg tablets. How many tablets can the client safely take in any 24-hour period? a) 12 b) 8 c) 2 d) 4

a) "Tell me the name of your prescription please" Pg. The nurse should be aware of the potential name mix-up between the antihistamine Zyrtec (commonly prescribed for allergies) and the antipsychotic Zyprexa. Asking the client for the name of the prescription gives the nurse information to conclude whether the client has received the correct prescription. Telling the client that depression is being treated or asking about hallucinations or allergy symptoms does not address the most likely occurrence that the wrong medication has been filled by the pharmacy.

4. A client who just picked up a prescription at the pharmacy asks the nurse why the client was prescribed a medication for mental health issues when the client sought treatment for allergies. What is the nurse's best response? a) "Tell me the name of your prescription please" b) "Have you been experiencing any hallucinations lately?" c) "What symptoms of allergies do you have?" d) "The prescriber probably wanted to treat any anticipated depression you may experience"

c) 0.6 Pg. 46 This method of prescribing takes into consideration the varying weights of children and the need for a higher dose of the drug when the weight increases. In this example, the nurse must first convert the child's weight from lbs to kg [42lbs x .45 kg = 18.9kg] and then calculate the daily dosage [18.9kg x .03mg = .57mg/day].

5. A pediatric nurse is caring for a child who weighs 42 lbs. The health care provider has ordered methylprednisolone sodium succinate (Solu-Medrol), 0.03mg/kg/day IV in normal saline. How many milligrams should the nurse prepare to give? a) 6.5 b) 6 c) 0.6 d) 0.65

a) Milliliter b) Kilogram d) Gram Pg. 46 The metric system uses the gram, liter, and meter. Gram, milliliter, and kilogram are metric units.

6. A nurse should recognize what as a metric system unit? (Select all that apply.) a) Milliliter b) Kilogram c) Dram d) Gram e) Teaspoon

a) Consult with the nursing supervisor, refuse to administer the medication, and notify the provider Pg. 37 The nurse may be held liable for not giving a drug or for giving a wrong drug or a wrong dose. In addition, the nurse is expected to have sufficient drug knowledge to recognize and question erroneous orders. If, after questioning the prescriber and seeking information from other authoritative sources, the nurse considers that giving a drug is unsafe, the nurse must refuse to give the drug. The fact that a health care provider wrote an erroneous order does not excuse the nurse from legal liability if he or she carries out that order.

7. During a medication pass, the nurse notices that the health care provider ordered a dose of medication that appears to be excessive based on the nurse's knowledge of the medication. The nurse calls the provider, and the provider instructs the nurse to administer the medication anyway. What should the nurse do? a) Consult with the nursing supervisor, refuse to administer the medication, and notify the provider b) Refuse to administer the medication, and notify the provider c) Ask the provider on-call for a new order d) Administer the medication

c) Interpreting the prescriber's prescriptions accurately Pg. 55 The nurse is responsible for interpreting the prescriber's prescription accurately. Dosage adjustments and the choice of medications are normally beyond the nurse's scope of practice. Medication administration is not usually delegated.

8. To safely administer medications to clients, a nurse's responsibilities include what intervention? a) Delegating the administration of medications efficiently b) Making dosage adjustments safely and in a timely fashion c) Interpreting the prescriber's prescriptions accurately d) Identifying the most appropriate medication for a client's health problem

a) Annually Pg. The Joint Commissions updates the NPSG on a yearly basis. These goals are established to help accredited organizations address specific areas of concern with regard to client safety. Facilities accredited by the Joint Commission are required to be in compliance with the National Patient Safety Standards. Several of these goals directly affect medication administration. This allows the facilities to see data for a year to trend falls, medication errors, etc. Less time would not give a true picture for evaluation purposes for corrective action.

9. After teaching a group of nursing students about the Joint Commission and National Patient Safety Goals (NPSG), the instructor determines that the teaching was successful when the group identifies that the NPSG is updated at which frequency? a) Annually b) Monthly c) Quarterly d) Semiannually