Chapter 29: Medications

Which medication interaction illustrates a synergism?

A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy.

A nurse is applying a vaginal cream to a client with a fungal infection. Which guideline is recommended for this application?

Cleanse area at vaginal orifice with washcloth and warm water.

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long-term use of nasal sprays can cause rebound nasal congestion."

During a teaching session, the client asks the nurse to explain the features of inhalers. Which statements by the nurse describe an inhaler? Select all that apply.

"Inhalers are handheld devices for delivering medications into the respiratory passage." "Inhalers consist of a container of medication and a holder with a mouthpiece." "Drugs for inhalation may be administered by a hand atomizer or a nebulizer."

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

"I am taking tadalafil in addition to nitroglycerin."

Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response?

"I will get the hospital's information system's phone number for you."

Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients?

"The cylinder of the insulin pen contains a prefilled reservoir of insulin." "The dose of insulin in an insulin pen is displayed in a window of the syringe." "The insulin pen automatically resets the dose window to zero, following the injection."

The nurse is teaching a client about metformin SA. When the client asks, "What does the SA mean?" what is the appropriate nursing response?

"sustained action"

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication?

73-year-old client diagnosed with liver disease

The charge nurse on the medical/surgical unit is reviewing physician orders for a client with a diagnosis of congestive heart failure. Which infusion orders would the nurse question?

1000 D5W to run in 30 minutes

The nurse has a prescription to administer 25 mg of furosemide IV to a client. The drug is supplied in a vial 40 mg/4 ml. How many milliliters will the nurse administer of the medication? Record your answer using one decimal place.

2.5

The health care provider prescribes ciprofloxacin 500 mg PO q12h for a pediatric client with bronchial pneumonia. The nurse has liquid ciprofloxacin 250 mg/10 mL on hand. How many milliliters would the nurse dispense? Record your answer using a whole number.

20

A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client?

30 mL

The nurse is preparing a medication from a vial and contaminates the plunger after the medication is drawn into the syringe. What should the nurse do next?

Administer the medication as prescribed

When the client demonstrates a rash 30 minutes after taking a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction?

Allergy

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that it is to be applied topically. Which instructions should the nurse provide?

Apply the medication to clean, dry skin of the affected area using gloves.

The nurse has inadvertently administered medication ordered for Client A to Client B. What is the appropriate nursing action? Select all that apply.

Assess Client B thoroughly. Complete an incident report. Contact the provider to report the error.

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

Assess the vaginal area.

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Avoid crushing sustained-release pellets.

The nurse observes a prescription written for a client for a medication that does not correlate with the client's diagnosis or comorbid factors. What is the best action for the nurse to take?

Call the provider to obtain a rationale for the use of the medication for the client

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatibility.

A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?

Deltoid

A nurse needs to administer an injection to a client in the deltoid site. Which action should the nurse perform to avoid the risk of damaging the radial nerve and artery?

Draw an imaginary line at the axilla between the acromion and brachial vessels.

A client with a new diagnosis of glaucoma (increased pressure within the eye) has been prescribed a medication that is to be administered by an eye drop. Which action should the nurse perform?

Ensure that drops of the medication fall onto the client's conjunctival sac.

Which actions would the nurse perform when administering a subcutaneous injection correctly? Select all that apply.

Grasp and bunch the area surrounding the injection site or spread the skin taut at the site. Inject the needle quickly at an angle of 45 to 90 degrees. After removing the needle, do not massage the area to prevent hematoma formation.

A client is being started on total parenteral nutrition (TPN). When initiating the therapy, the nurse gradually tapers up the infusion rate as ordered to prevent which potential complication?

Hyperglycemia

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick?

Immediately activate the safety needle and place the syringe and needle into a Sharps container.

A nurse is administering a client's analgesic by the subcutaneous route. What should guide the nurse's action?

Inject into the adipose tissue layer just below the epidermis and dermis

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse?

Insert a new IV medication lock and remove the old one.

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler?

It is a canister that contains pressurized medication.

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order.

Which contains all the components of a valid order?

John Smith, atenolol 50 mg, twice a day, by mouth

If the dosage is inappropriate for a client, who is responsible?

Nurse

When administering oral medications, which practices should the nurse follow? Select all that apply.

Perform hand hygiene before and after medication administration. Stay at the bedside until the client has swallowed all the medications. Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug.

The nurse has received a telephone order for a client from a health care provider. How will the nurse indicate in the documentation that the order was received via telephone?

Record "T.O." at the end of the order.

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

Report the needlestick to the nurse manager.

A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case?

Return the medication to the medication cart or medication room.

The nurse has confirmed the client's identity and provided a client with oral medications to take. What is the next appropriate nursing intervention?

Stay with the client while medications are taken

A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection?

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse's appropriate response?

Tactfully request the provider to input the order into the computerized provider order system.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements

Which parts of the syringe and needle must be kept sterile when preparing and administering an injection? Select all that apply.

The needle hub The needle Inside the barrel

Which nursing action best exemplifies proper drug-diversion prevention of client medications?

The nurse does not share the personal automated medication-dispensing system password

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication.

A nurse is administering medication to a client via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation?

Use a syringe to plunge the tube to try to dislodge the medication.

The client states "I think my IV dressing needs to be changed." In which instance should the nurse change the dressing?

When the dressing is loose, bloody or wet.

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?

to determine the extent to which the client responded to the drugs

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered?

all at once

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?

bolus administration

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

bolus administration

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to food or drugs

The nurse has given medications to four clients. Which client will the nurse monitor most closely for a possible reaction to occur?

client with infection who received a bolus of Lactated Ringer's solution

The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe?

decreased irritation and pain in subcutaneous tissue

The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?

intradermal

The nurse has provided a client with a sublingual medication. Which is the most appropriate nursing intervention to ensure proper administration of this medication?

looking under the client's tongue to verify administration

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

miconazole

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication?

review the client's medication, allergy, and medical history

The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client?

spacer

A client with an infection is receiving intravenous antibiotic therapy. The client has an intermittent infusion device in place. The nurse flushes the device with normal saline solution before administering the antibiotic based on which rationale?

to prevent blood clot formation

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation?

when the client has disorders that affect the absorption of medications