Chapter 29: Medications

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat? "Place a rolled towel beneath the neck if you are unable to sit." "Aim the tip of the container toward the nasal passage." "Breathe through your mouth as the drops are instilled." "Remain in the sitting position for 5 minutes."

"Aim the tip of the container toward the nasal passage." Explanation: Aiming the tip of the container toward the nasal passage will deposit the drugs within the nose rather than into the throat. Place a rolled towel beneath the neck if the client cannot sit will provide support and aid in positioning. Breathing through the mouth as the drops are instilled is not the correct action for nasal drop administration. Remaining in the sitting position for 5 minutes will promote local absorption.

The nurse is caring for a client who is receiving a prescribed intravenous (IV) infusion of an antibiotic to treat an infection. The client asks the nurse, "Can I just take a pill?" What is the best response by the nurse? -"The health care provider can control the dose of medication you receive through IV." -"The IV infusion will treat your infection slower." -"An IV infusion maintains a therapeutic level of the medication in your blood." -"Oral antibiotics are not as effective as IV infusions."

"An IV infusion maintains a therapeutic level of the medication in your blood." Explanation: When treating certain infections, blood levels of the medication are needed to maintain a consistent therapeutic level. IV infusion does not necessarily treat the infection faster, but provides a consistent blood level. Oral antibiotics can be effective in treating infections. The dose can be controlled through IV infusion, but this is not the reason the client is receiving the medication via IV infusion.

The nurse is to start providing care for an older adult client who sees several different health care providers and specialists. Which question should the nurse prioritize on assessment? "Why do you see so many different providers?" "Which provider seems to take the best care of you?" "Do you get all of your medications filled at the same pharmacy?" "How long have you been seeing a variety of providers?"

"Do you get all of your medications filled at the same pharmacy?" Explanation: The nurse is aware that this client has a high potential for being prescribed medications by more than one provider. Polypharmacy is a concern in the older adult population. The nurse will want to know if medications are filled at the same pharmacy, as this is often where pharmacists will note discrepancies in medications prescribed or duplicate orders written by different providers. The other questions posed are not a priority or helpful.

The nurse is teaching a client about the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate XR. When the client asks, "What does the XR mean?" what is the appropriate nursing response? "Sustained release." "Continuous release." "Extended release." "Sustained action."

"Extended release." Explanation: The nurse will clarify that XR means "extended release." SR means "sustained release;" CR means "continuous release;" SA means "sustained action."

The nurse is administering the first dose of an intravenous infusion of an antibiotic. Which statement made by the client is cause for concern? "I feel hungry." "I feel like I need to urinate." "I feel like my back and arms are itching." "I feel very tired."

"I feel like my back and arms are itching." Explanation: IV infusions have an immediate effect. The nurse should instruct the client to report any difficulty in breathing or signs of reaction such as itching. If the client has adverse reactions, the treatment is stopped immediately. Feeling tired or hungry is not a cause for alarm in IV infusion. Feeling tired could indicate another issue and is not related to infusion reactions.

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the client indicates teaching was effective? "I will decrease the amount of potassium in my diet." "If my pulse is higher than 100 beats/min, I will hold the dose." "I will call the health care provider if I develop dizziness, blurred vision, or nausea." "I will store this medication in the refrigerator."

"I will call the health care provider if I develop dizziness, blurred vision, or nausea." Explanation: Digoxin is a cardiac glycoside that slows the heart rate and strengthens myocardial contraction. It is imperative to keep therapeutic blood levels of this medication. As such, teaching the client to report signs and symptoms of digitalis toxicity such as dizziness, blurred vision, nausea, and vomiting is imperative. Usually, dietary potassium is increased, not decreased, while taking this medication. Digitalis slows myocardial conduction and should be taken if the heart rate is higher than 100 beats/min. If the heart rate is lower than 60 beats/min, the dose should be held, and the health care provider should be notified. Digitalis is stored at room temperature, not in the refrigerator.

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 log in so that you can proceed with medication delivery." "I am giving you my password so you can log in." "I will get the hospital's information system's phone number for you." "I can log in and give the medications for you."

"I will get the hospital's information system's phone number for you." Explanation: Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue.

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 difficulty in coordinating breathing." "Long-term use of nasal sprays can cause rebound nasal congestion." "Long-term use of nasal sprays can repair the nasal passage." "Long-term use of nasal sprays can cause an unpleasant taste."

"Long-term use of nasal sprays can cause rebound nasal congestion." Explanation: Saying that long-term use of nasal sprays can cause rebound nasal congestion is correct, as this usually occurs when nasal sprays are used repeatedly by clients. Long-term use of nasal sprays cannot cause difficulty in coordinating breathing; this is more applicable with inhalers than with nasal sprays. Long-term use of nasal sprays do not repair the nasal passage; instead, they damage the nasal passage. Long-term use of nasal sprays does not cause an unpleasant taste; this is more appropriate with inhalers and not nasal sprays.

A client has been prescribed a new medication that is costly and not fully covered by the client's insurance plan. What can the nurse suggest to the client to address the concern? -"Ask the provider if they will prescribe a less expensive drug even if it is not as effective." -"I know that the medication is expensive, but your health care provider knows what is best for you." -"See if you can call a family member to borrow the money for the prescription." -"Request that the pharmacy partially fill the prescription to evaluate the drug's effectiveness before full purchase."

"Request that the pharmacy partially fill the prescription to evaluate the drug's effectiveness before full purchase." Explanation: Medication can be very costly, especially if the client is prescribed several types. When a medication is new, the client may hesitate to purchase the entire 30-day supply for the expense, since medication may not be returned even if it is ineffective. The nurse may suggest that the client purchase a partial prescription to determine whether it is suitable and without adverse effects. This will also give the client time to come up with the remaining amount for the rest of the prescription. It is not helpful for the nurse to instruct the client to fill the entire prescription or to state that the health care provider knows best. Asking the client to borrow money from family members is non-therapeutic as well as intrusive.

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals? -"This is because food and some drinks can affect the way your medicine works." -"This is because gastric acid is decreased after meals, which can affect the way your medicine works." -"This is because decreased blood flow occurs after meals, which can affect the way your medicine works." -"This is because your medication can cause nausea and that can affect the way it works."

"This is because food and some drinks can affect the way your medicine works." Explanation: Some medicines need to be taken "before food" or "on an empty stomach." This is because food and some drinks can affect the way these medicines work. For example, taking some medicines at the same time as eating may prevent the stomach and intestines from absorbing the medicine, making it less effective. Blood flow to the stomach increases after eating a meal. Gastric acid increases after a meal to help digestive food eaten. Nausea does not affect the absorption of a medication.

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear? 5 minutes 10 minutes 15 minutes 20 minutes

5 minutes Explanation: When ear drops are to be administered in both ears, the nurse would wait 5 minutes after giving the ear drops in the first ear before administering the ear drops into the second ear. This avoids causing the medication to run out immediately after administration. Other times are longer than are needed between ears.

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide? -"Rest the eye dropper on the inner canthus to make it easier to instill the drops." -"Wait 5 minutes between instillation of different types of eye drops." -"If you cannot instill these drops from the bottle, you will be unable to have surgery." -"Dispose of these medications every 7 days due to possible bacterial contamination."

"Wait 5 minutes between instillation of different types of eye drops." Explanation: The nurse will teach the client to wait 5 minutes between instillation of different types of eye drops to facilitate best absorption. The dropper should not touch the eye, as this increases the possibility of contamination. Devices are available to facilitate administration if a client has trouble using the bottle. These types of drugs should be discarded after 28 days to prevent bacterial contamination.

The nurse is caring for a client who has a history of asthma. The client has been admitted to a hospital unit for treatment of shortness of breath related to asthma exacerbation. The client tells the nurse, "I have been using my metered-dose inhalers but I still feel tightness in my chest." Which action(s) will the nurse take in response to the client's statement? Select all that apply. -Inform the client that the inhaled medications may require re-evaluation by the provider as they may no longer be -effective. -Assure the client that using inhaled medications can be challenging and provide a demonstration of proper inhaled medication use. -Assess the client's SpO2 levels before and after the inhaled medications have been properly administered. -Contact the client's provider and recommend the use of a spacer to aid effective administration of inhaled medications. -Conduct a thorough review of effective breathing techniques with the client and encourage the client to practice.

-Assure the client that using inhaled medications can be challenging and provide a demonstration of proper inhaled medication use. -Assess the client's SpO2 levels before and after the inhaled medications have been properly administered. -Contact the client's provider and recommend the use of a spacer to aid effective administration of inhaled medications. -Conduct a thorough review of effective breathing techniques with the client and encourage the client to practice. Explanation: Ineffective breathing patterns can be related to an improper technique using a metered-dose inhaler to manage shortness of breath and mild hypoxemia associated with underlying lung disease, such as asthma. Coordinating the work of effectively self-administering inhaled medications and doing so effectively can be challenging for clients. The nurse will reassure the client of this and provide a demonstration of proper medication administration to the client. Assessing the client's oxygen saturation levels before and after proper administration of the inhaled medications provides objective data to both the nurse and the client about the importance of good technique when using inhaled medications. A spacer facilitates a continuous inhalation of medication for clients who have difficulty inhaling while depressing the canister in the inhaler. Reviewing deep breathing techniques with the client can help to promote more effective use of inhaled medications. While the client may require a review of the current medications by the provider, the nurse will first assess if current medication use practices are effective.

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client? 10 to15 degrees 20 to 30 degrees 45 degrees 90 degrees

90 degrees Explanation: Insulin injections are given subcutaneously to clients with obesity at a 90-degree angle. Other answers are incorrect.

A new prescription has been noted in the medical record for an adult client with chest pain to receive a medication that comes in the form of a transdermal patch. The nurse will consider which precaution(s) to ensure safety with this form of drug use? Select all that apply. -May cause injury with defibrillation. -Fold the patch in half before disposal. -Dispose of transdermal patches in the trash. -Assess for fever prior to application. -Apply patches at the same location for consistency. -Remove the patch prior to magnetic resonance imaging (MRI). -Monitor the client for early identification of adverse effects. -Use a heating pad to increase absorption.

-May cause injury with defibrillation. -Fold the patch in half before disposal. -Assess for fever prior to application. -Remove the patch prior to magnetic resonance imaging (MRI). -Monitor the client for early identification of adverse effects. Explanation: Burns to the skin and smoke may occur if a patch is in place during defibrillation. A transdermal patch should be folded in half after removal to prevent nurse making contact with the medication or inadvertently transferring the medication onto another surface. A fever higher than 102°F (39°C) may be a contraindication to use, because the heat may increase the rate of absorption. A transdermal patch may cause burning to the skin, if the patch is in place while the client is undergoing magnetic resonance imaging (MRI). The use of a transdermal patch carries the same risk as the medication given in other forms. The client should be evaluated accordingly for potential adverse effects. The nurse will follow facility protocols to dispose of a transdermal patch, often in facility-approved containers and sometimes with a second nusre as a witness. Application sites should be rotated with each application to prevent local skin irritation. Direct heat, such as that provided by a heating pad or a sun lamp, should be avoided. Local heat provided by the palm of the hand may be used initially to help facilitate adhesion.

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? 0.5 2 4 1.5

0.5 Explanation: 1.0 mg = 1000 mcg. 0.125 mg =125 mcg. 0.0625 mg is exactly one half of 0.125 mg. If the digoxin tablet is 0.125 mg or 125 mcg, then the nurse would administer 0.5 tablet which is 0.0625mg, or 65.5mcg.

The nurse is working the night shift in the ER when an ambulance arrives carrying a man s/p motor vehicle accident (MVA). His initial BP is 100/56 and the nurse notes that he is bleeding heavily from a laceration on the forehead. Fifteen minutes later, the nurse reassesses the client and finds that his BP is 95/58. What IV fluid would the nurse expect to be ordered? 0.45% NS 0.9% NS 3% NS D5 ¼ NS

0.9% NS Explanation: Isotonic fluids are used to increase blood pressure secondary to hypovolemia.

A pediatric client has a fever for which the provider has prescribed ibuprofen 200 mg orally every 6 hours. The instructions on the bottle indicate there is 100 mg/5ml. How many milliliters should the nurse give? Record your answer using a whole number.

10 Explanation: Using the desired over dose on hand calculation, the desired dose of 200 mg is divided by the dose on hand of 100 mg and multiplied by the quantity on hand of 5ml 200/100 X 5mL = 10mL

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client? 10 to 15 degrees 20 to 30 degrees 45 degrees 90 degrees

10 to 15 degrees Explanation: Intradermal injections are given at a 10- to 15-degree angle. Other answers are incorrect.

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood? 1500 1200 2000 Wait until day 5 of treatment.

1500 Explanation: Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest.

The nurse is administering morphine oral solution 5 mg to a client requesting medication for pain. The preparation is delivered as morphine solution 10 mg/5 ml. Calculate the amount, in milliliters, the will nurse administer. Record your answer to one decimal place.

2.5 The desired dose is 5 mg. The dose on hand or supplied dose is 10 mg. Quantitiy is 5 ml. The nurse would administer 2.5 ml. 5 mg/10 mg × 5 ml = 2.5 ml

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 Explanation: Dose on hand = Dose desired ÷ X 40 mg/4 ml = 25 mg ÷ X 40X = 100 X = 100/40 = 2.5 mg

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? 15 mL 22.5 mL 67.5 mL 30 mL

30 mL Explanation: The formula to calculate the correct medication amount is:(Dose on hand/Quantity on hand = Dose desired/X).If you use this for this scenario, you would have 30 g/45 mL = 20 g/X, where X = 30 mL.

The nurse is preparing to insert an intravenous needle in a 1-year-old child for a one-time administration of fluids due to dehydration. Which needle would the nurse likely select? A 22-gauge intravenous catheter A 19-gauge winged infusion set A 23-gauge winged infusion set An 18-gauge intravenous catheter

A 23-gauge winged infusion set Explanation: Winged infusion or small vein needles may be used for short-term or one-time infusion therapies or may be used with infants and small children. These are short, beveled needles with plastic flaps or wings.

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 client is taking doxycycline, an antibiotic, for rosacea. She takes this with her morning vitamins, which includes calcium carbonate. She has not noticed a change in her symptoms. -A client is taking metoprolol for her blood pressure and metformin for her diabetes. Her provider has told her that these are safe to take together. -A client was told not to take tretinoin topical if she is pregnant because it may be teratogenic.

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. Explanation: A synergistic reaction is one in which one drug increases the effect of another drug. Acetaminophen and oxycodone have a synergistic relationship. Doxycycline and calcium carbonate have an antagonistic relationship.

A client presents in the emergency department with signs and symptoms of venous thromboembolism. What type of medication administration would most likely be ordered to infuse a large dose of heparin for this client? -Administer heparin by intravenous bolus or push through an intravenous infusion. -Administer a piggyback intermittent intravenous infusion of heparin. -Administer an intermittent intravenous infusion of heparin via a volume-control administration set. -Administer heparin via a continuous infusion.

Administer heparin by intravenous bolus or push through an intravenous infusion. Explanation: A bolus push involves a single injection of a concentrated solution directly into an intravenous line and is frequently used to treat emergencies. In continuous infusion, the client receives the medication slowly, over a long period. With intermittent intravenous infusion and a volume-control administration set, the drug is mixed with a small amount of the intravenous solution and administered over a short period at the prescribed interval. Heparin is not administered via a piggyback.

A nurse has administered an injection to a client. Which intervention should the nurse perform to reduce discomfort and provide quick relief? Massage the site following injection. Numb the skin with an ice pack after the injection. Apply pressure to the site during needle withdrawal. Apply a eutectic mixture of local anesthetic to the site.

Apply pressure to the site during needle withdrawal. Explanation: To reduce the discomfort associated with an injection, the nurse should apply pressure to the site during needle withdrawal. Applying a eutectic mixture of local anesthetic to the site will not help because it only provides relief after 1 or 2 hours. The nurse should numb the skin with an ice pack not after the injection, but before it. The nurse should not massage the site following an injection because, in some clients, it could lead to further complications and discomfort.

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 a small amount of the medication to the affected area then repeat after initial dose has dried. -Apply the medication to clean, dry skin of the affected area using gloves. -Clean the area with alcohol and apply a quarter size of medication to the affected area. -Using sterile gauze, apply to the affected area with gloves and cover with a bandage.

Apply the medication to clean, dry skin of the affected area using gloves. Explanation: The nurse should instruct the client about the transdermal route for medication administration, which is used for topical agents (agents applied to the skin surface or mucous membranes). Whenever applying topical medications, the hands should be protected from inadvertent absorption through the skin by wearing clean gloves. Being the condition is below the skin, there is no need to clean the area or use sterile gauze to apply the medication. Repeating application of medication after drying of initial dose is not needed.

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss? -A larger syringe is required when giving an intramuscular injection on an obese person. -As the gauge number becomes larger, the diameter of the needle and the lumen become smaller. -When giving an injection, the amount of the medication directs the choice of gauge. -The size of the syringe is directed by the viscosity of the medication to be given.

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller. Explanation: The larger the gauge, the smaller the needle. An obese person requires a longer needle to reach muscle tissue than does a thin person. When giving an injection, the viscosity of the medication directs the choice of needle gauge. The size of the syringe is directed by the amount of the medication to be given.

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear? Place a cotton ball in the ear to absorb excess medication. Instill the medication in the opposite ear if prescribed. Ask the client to maintain the position for some time. Briefly postpone the application in the second ear.

Ask the client to maintain the position for some time. Explanation: After instilling the prescribed number of drops in the client's ear, the nurse should ask the client to maintain the position briefly until the solution travels toward the eardrum. When instilling the medication in the client's ear, the nurse first manipulates the client's ear to straighten the auditory canal. Tilting the client's head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client.

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear? Clean the external ear of drainage with cotton balls moistened with water or normal saline solution. Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back. Ask the client to remain lying down for at least 5 minutes. Immediately repeat the application in the second ear if prescribed.

Ask the client to remain lying down for at least 5 minutes. Explanation: Tilt the client's head away from the ear into which the medication will be instilled. Compress the container and instill the prescribed number of drops on the side of the ear canal rather than directly onto the tympanic membrane. Press and release the tragus, the projection of skin-covered cartilage at the opening of the external ear, to facilitate moving the medication toward the eardrum. Place a small cotton ball loosely in the ear to absorb excess medication. If a bilateral administration is prescribed, wait at least 5 minutes before instilling medication in the opposite ear. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client.

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. Notify the health care provider. Explain that this is expected effect of the medication. Hold the second dose until the discomfort is relieved.

Assess the vaginal area. Explanation: When a client reports discomfort, further assessment is needed. The nurse should assess the vagina and vaginal canal for erythema, edema, drainage, or tenderness, and then notify the health care provider after the assessment is completed. The nurse does not know if the discomfort is expected until after assessment, and the nurse should assess the discomfort before deciding to hold the dose.

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client? Prepare the exact dosage of medication in front of the client. Avoid administering medication prepared by another nurse. Bring the prescribed medication in a ceramic cup or glass container. Check the label of the medication container three times at the bedside.

Avoid administering medication prepared by another nurse. Explanation: A nurse should never administer medications prepared by another nurse. The nurse administers only those medications that she has prepared. The nurse should prepare and bring oral medications to the client's bedside in a paper or plastic cup, not in a glass container or ceramic cup, in order to avoid accidents and spills. The nurse checks the label of the medication container three times when preparing it, not when administering it to the client.

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? Add medications to the formula. Mix all the medications together in 15 mL of water. Use cold water when mixing powdered medications. Avoid crushing sustained-release pellets.

Avoid crushing sustained-release pellets. Explanation: When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.

A medication order has ac written after the medication dosage. What does ac stand for? Before meals After meals Before After

Before meals Explanation: The abbreviation 'ac' means before meals.

The nurse opens the multidose container of oxycodone. The nurse needs 1.5 tablets to deliver the as needed dose, and the tablets in the container are not scored. What action by the nurse is best? Document the medication dose as not administered. Call the pharmacy to request a supply change. Cut the second tablet in half using a pill splitter. Administer one tablet until the issue is resolved.

Call the pharmacy to request a supply change. Explanation: The best action by the nurse is to request scored tablets or the correct dose from the pharmacy. If this is not possible, the nurse considers cutting the unscored tablet with the pill splitter, recognizing that this could result in an inaccurate dose. The nurse could choose not to give the medication, but this leaves the client in needless pain. The nurse could choose to administer two-thirds of the dose by giving one tablet, but this leaves the client underdosed for pain relief.

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency? Determine if there is an odor from the medication. Prepare the medication with good lighting. Return the medication if the label is unclear. Check the expiration date.

Check the expiration date. Explanation: Checking the expiration date on liquid medication can ensure the medication is at the desired potency, because liquid medications may become stronger or weaker with the passing of time. Administering an expired medication could have a deleterious effect on the client. Determining an odor does not ensure the potency of the medication, because many liquid medications have an odor that is not pleasant. Returning the medication if the label is unclear is a step to take to ensure safe administration, but this action does not determine the potency of the medication.

A nurse is applying a vaginal cream to a client with a fungal infection. Which guideline is recommended for this application? -Position the client in a left side-lying position. -Cleanse area at vaginal orifice with washcloth and warm water. -Wipe from the sacrum to the vaginal orifice upward (back to front). -Spread the labia with dominant hand and introduce the applicator gently with the nondominant hand.

Cleanse area at vaginal orifice with washcloth and warm water. Explanation: The procedure for applying a vaginal cream is as follows: Position the client so that she is lying on her back with the knees flexed. Spread labia with fingers, and cleanse area at vaginal orifice with washcloth and warm water, using a different corner of the washcloth with each stroke. Wipe from above the vaginal orifice downward toward the sacrum (front to back). Spread the labia with the nondominant hand and introduce the applicator with the dominant hand gently, in a rolling manner.

The nurse administered 0900 medications to the team of clients. The nurse notes that a medication error was made. One client received a medication that was prescribed for the roommate. What action(s) does the nurse perform? Complete an incident report. Write "incident report completed" in the nurse's notes. Document the error in the nurse's notes. Notify the health care provider. Perform an assessment of the client.

Complete an incident report. Document the error in the nurse's notes. Notify the health care provider. Perform an assessment of the client. Explanation: If a medication error is made, the nurse assesses and monitors the client for any adverse reactions. The nurse notifies the health care provider. The nurse documents the error and follow-up actions in the nurse's notes. The nurse also completes an incident report. The nurse does not document the incident report in the nurse's notes. This is an internal document. The incident report asks for more details and allows the agency to investigate the root cause and prevention of this type of error for the future.

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action? Administer the drug as ordered. Ask another nurse to verify the order. Assume that the provider meant to order buspirone. Contact the health care provider for order clarification.

Contact the health care provider for order clarification. Explanation: The nurse should contact the health care provider to verify the order. Bupropion and buspirone are drugs that have look-alike and sound-alike properties but are different in indication. The nurse should not automatically administer the drug, nor ask another nurse to verify an order, nor assume what is meant by an order.

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

Deltoid Explanation: The deltoid and ventrogluteal sites are more appropriate for adults than the vastus lateralis. The scapula is a site for an intradermal injection. The biceps brachii muscle is not used for intramuscular injections.

A nurse is administering a hepatitis B immunization injection to an adult client. Which site would the nurse choose for this injection? Vastus lateralis site Deltoid muscle site Ventrogluteal site Dorsogluteal site

Deltoid muscle site Explanation: Hepatitis B virus vaccine is one medication that should be given in the deltoid muscle in adults to induce adequate levels of the antibody. The vastus lateralis muscle and the ventrogluteal muscle can be used for other intramuscular injections. The dorsogluteal muscle is no longer a preferred site for intramuscular injections.

The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse? Determine compatibility of the insulins by checking a drug compatibility table. Inject air into each vial equal to the amount of insulin prescribed. Check the expiration date on each vial. Roll the modified insulin vial to mix it well.

Determine compatibility of the insulins by checking a drug compatibility table. Explanation: The first step in mixing two types of insulin in one syringe is verifying compatibility. Some insulins cannot be mixed together. The other steps are appropriate but should be completed after determining compatibility.

A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action? Recognize that it is not safe to mix two medications in one syringe. Page the health care provider to determine whether the drugs can be mixed. Determine the compatibility of the two drugs by consulting clinical resources. Collaborate with the pharmacy to have one of the times changed.

Determine the compatibility of the two drugs by consulting clinical resources. Explanation: The nurse must determine the compatibility of the two drugs; some drugs can be safely combined in a single syringe. However, this is not determined by paging the health care provider. There is no need to change the times of administration.

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues? Absorption Synergism Distribution Metabolism

Distribution Explanation: The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver.

When administering a subcutaneous injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation? Pull out and discard the needle. Discard the equipment and start the procedure from the beginning. Engage safety shield on needle guard and discard needle appropriately. Document the incident and inform the primary care provider.

Engage safety shield on needle guard and discard needle appropriately. Explanation: The needle needs to be disposed of properly after engaging the safety guard because the needle cannot be reinserted due to contamination. A new needle can be attached to the syringe and the remainder of the medication administered after cleansing the site again. The incident does warrant notifying the primary care provider.

The nurse plans discharge teaching for a client leaving the medical center with new medication prescriptions. Which action(s) does the nurse include in the discharge teaching? Select all that apply. -Explain the benefit in placing medications in a place that links to normal events in the client's life such as brushing teeth or going to bed -Provide client with a list of medications and directions for taking them -Confirm that the client understands the reason for the medications -Teach client and caregivers how to fill a pill box using the medicine list as a guide -Tell client to always choose brand name over-the-counter medications to ensure consistency in color, shape, and size of pills

Explain the benefit in placing medications in a place that links to normal events in the client's life such as brushing teeth or going to bed Provide client with a list of medications and directions for taking them Confirm that the client understands the reason for the medications Teach client and caregivers how to fill a pill box using the medicine list as a guide Explanation: An important aspect of accurate home medication administration is ensuring a schedule that is easy to remember and suits the client's lifestyle by arranging administration of medications by linking it with normal events in the client's life (e.g., meals, bedtime) which promotes adherence and accuracy.

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action? Provide discharge paperwork to the client. Request another nurse to reteach the material. Give written instructions to the client and caregivers. Arrange for home health to see the client.

Give written instructions to the client and caregivers. Explanation: Older adults may not be able to remember instructions in order to repeat them back clearly. It is appropriate to provide written instructions so the client and caregivers have a quick reference to use for medication administration.

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 Infection Air embolism Pneumothorax

Hyperglycemia Explanation: Metabolic complications also may present a problem for the client receiving TPN. Most commonly, clients experience hyperglycemia if they are unable to tolerate the high glucose content of the TPN solution. When therapy is initiated, the infusion rate is usually tapered up over a period of a day or two. Using strict aseptic technique during catheter manipulations, dressing changes, and tubing and bottle changes helps to reduce the risk for infection. Air embolism and pneumothorax are potential complications that are associated with central line placement, not TPN administration.

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation? IV Infusion Oral powder Subcutaneous injection Inhalation

IV Infusion Explanation: Intravenous infusion is the fastest route of administration because the medication goes into the bloodstream immediately and is dispensed over a period of time which is needed in pulmonary hypertension. The second fastest route is an injection because they are quickly absorbed into vessels. Oral medication is a slow route and should not be used in an emergency situation. Medication via patches would not administer the medication quickly enough in an emergency situation. Inhalation medications are specifically given for respiratory issues.

A nurse is administering a client's analgesic by the subcutaneous route. What should guide the nurse's action? Select a site on the inner surface of the forearm or the deltoid muscle. Inject into the adipose tissue layer just below the epidermis and dermis. Inject at a 30- to 45-degree angle based on the amount of subcutaneous tissue present. Pinch firmly if the client is obese.

Inject into the adipose tissue layer just below the epidermis and dermis. Explanation: Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Subcutaneous injections do not enter muscle tissue. Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventrogluteal area. Subcutaneous injections are administered at a 45- to 90-degree angle, based on the amount of subcutaneous tissue present and the length of the needle. Pinching is advised for thinner clients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation? Inner surface of the forearm Shoulder Abdomen Anterior aspect of the thigh

Inner surface of the forearm Explanation: Sites commonly used for intradermal injections are the inner surface of the forearm and the upper back, under the scapula. The deltoid muscle of the shoulder is a common injection site for intramuscular injections. The abdomen and anterior aspect of the thigh are common injection sites for subcutaneous injections.

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? Call the health care provider to request oral antibiotics. Flush the lock with heparin solution. Administer the prescribed antibiotics as prescribed. Insert a new IV medication lock and remove the old one.

Insert a new IV medication lock and remove the old one. Explanation: The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the health care provider to change the order is not appropriate.

The nurse prepares to administer an intravenous medication. Which action should the nurse perform when administering a medication from an ampule? Break the ampule toward the nurse's body. Wrap a sterile alcohol pad around the neck of the ampule before breaking it. Attach the filter needle to the syringe before administering the medication. Insert the tip of the filter needle into the center of the ampule and invert the ampule

Insert the tip of the filter needle into the center of the ampule and invert the ampule. Explanation: The ampule should be broken away from the nurse's body to prevent being cut by the broken glass. The nurse should wrap sterile gauze pad around the neck to make a sufficient barrier so broken glass particles don't easily cut the nurse. An alcohol pad may slip and does not provide adequate padding. The filter needle is attached when drawing up the medication from the ampule to prevent small glass particles in the syringe. The nurse would change the needle to the needless system to inject it intravenously. The nurse should insert the tip of the filter needle into the center of the ampule and invert the ampule to draw up the medication.

Which parenteral route of administration has the longest absorption time? Intradermal Intravenous Subcutaneous Intramuscular

Intradermal Explanation: Medicines are absorbed the fastest in areas of the body that contain the greatest blood supply. Intradermal injections are administered into the dermis, just below the epidermis, and this route of administration has the longest absorption time. Intravenous drugs are absorbed immediately because they are administered directly into the bloodstream. Intramuscular injections are faster than subcutaneous because muscle has more blood flow.

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 battery-operated device that spins. It suspends finely powdered medication. It is a canister that contains pressurized medication. It has propellers that get activated during inhalation

It is a canister that contains pressurized medication. Explanation: A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do? Have another nurse guard the preparations. Put the medications back in the containers. Have another nurse finish preparing and administering the medications. Lock the medications in a cart and finish them upon return.

Lock the medications in a cart and finish them upon return. Explanation: Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

To convert 0.8 grams to milligrams, the nurse should do which of the following? Move the decimal point 2 places to the right. Move the decimal point 3 places to the right. Move the decimal point 2 places to the left. Move the decimal point 3 places to the left.

Move the decimal point 3 places to the right. Explanation: To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). 1000 milligrams (mg) is equal to 1 gram (g); therefore 0.8 g is multiplied by 1000 (which is equivalent to moving the decimal point 3 places to the right) to determine how many mg it is equivalent to.

The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission? -Add the route to the prescription and administer the medication since the nurse is familiar with the drug. -Notify the health care provider to add the route and then administer the medication when complete. -Call to ask the pharmacy how the drug should be administered. -Omit the administration of the medication since it was written incorrectly.

Notify the health care provider to add the route and then administer the medication when complete. Explanation: The nurse should notify the health care provider and should refrain from administering the medication until the missing information is obtained. The nurse should not implement a questionable medication prescription until after consulting with the person who has written the prescription. The nurse should not omit the medication without consulting with the provider that prescribed it, because the client will not receive the therapeutic benefits. The pharmacy cannot determine the correct route, because the prescription must come from the prescriber.

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered? standing order PRN order one-time order stat order

PRN order Explanation: A PRN order is one that is given to a client on an "as needed" basis.

When administering oral medications, which practices should the nurse follow? Select all that apply. Dispense multiple liquid medications into a single cup to reduce the number of containers the client must handle. Perform hand hygiene before and after medication administration. Stay at the bedside until the client has swallowed all the medications. Store the client's MAR at the bedside at all times to ensure safe identification. Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug.

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. Explanation: When administering oral medications, it is important to perform hand hygiene before and after administration and to stay with the client until all medications have been swallowed. The nurse should also assess the effect of the medication at a reasonable time after administration. The MAR should be brought to the bedside to verify the client, but it is not left at the bedside. It would be inaccurate and unsafe to dispense multiple liquid medications into a single cup, as this may result in dosage errors.

The nurse is caring for a client with visual impairment who has been prescribed two different types of eye drops. Which nursing intervention will best assist the client in differentiating between the bottles of drops? -Write the names of the medications on the bottle. -Place a rubber band snugly around one of the bottles. -Color code the bottles with different colors of pens. -Teach the client to place bottles on different ends of the table.

Place a rubber band snugly around one of the bottles. Explanation: The client with visual impairment will best benefit from a tactile difference between bottles; therefore, placing a rubber band snugly around one bottle is the best approach. Names written on the bottles may be difficult for the client with visual impairment to read, and color-coding may not work if the client is colorblind. Placing bottles on different ends of the table can be confusing if the client forgets which medication is which.

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, "I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it." What would the nurse do to address this situation? -Instruct the client to return to taking the current prescribed medication until it is all gone -Offer to speak to the provider for different treatment options -Provide education on taking all antibiotics for effective treatment -Instruct the client to take both the current antibiotic along with a new prescribed antibiotic to avoid antibiotic resistance

Provide education on taking all antibiotics for effective treatment Explanation: Although benefits of antibiotics may be felt in a few days after starting therapy, the nurse will teach the client that the entire course of medication must be taken to rid the body of infection. Discontinuing the antibiotic prematurely may cause the infection to reoccur. The incomplete use of an antibiotic is one factor that contributes to the evolution of resistant microbial organisms so the nurse would not instruct the client to returning to the previous regimen. Consulting the health care provider for alternate treatment options may or may not be applicable and also is not particularly the most important. The mixture of antibiotics would typically not be prescribed in this client.

Which technique should the nurse employ when instilling otic medication in an adult ear? Tilt the client's head toward the ear in which the medication is being instilled. Tilt the client's head back with face upward. Pull the client's ear down and back. Pull the client's ear up and back.

Pull the client's ear up and back. Explanation: Pulling the client's ear up and back is correct, as this will straighten the auditory canal of the adult client. Tilting the client's head towards the ear in which the medication is being instilled and tilting the client's head back with face upward are incorrect, as these techniques will allow the medication to drain outside the ear. Pulling the ear down and back is incorrect, as this technique is used to straighten the auditory canal of a child, not an adult.

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? No extra documentation is necessary. Have another nurse cosign the order input. Tell the provider to sign the order as soon as possible. Record "T.O." at the end of the order

Record "T.O." at the end of the order. Explanation: Recording "T.O." at the end of the order indicates that this was a telephone order. Another nurse should not cosign the order. Reminding the provider to sign the order as soon as possible is helpful, but it does not indicate that this was a telephone 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? Request counseling on the potential for infection. Document the injury. Report the needlestick to the nurse manager. Obtain the client's blood to be tested for HIV and HBV.

Report the needlestick to the nurse manager. Explanation: Upon encountering a needlestick, the nurse's priority action is to report the injury. Other actions can take place after the injury has been reported.

The nurse is caring for a client who has had a stroke. Prior to administering oral medications, what is the appropriate nursing action? Change the medication route to intramuscular. Mix the drug with pudding. Request that the provider obtain a speech therapist's evaluation. Administer the medication with water to drink.

Request that the provider obtain a speech therapist's evaluation. Explanation: To prevent aspiration, the nurse will ask the provider to consult with a speech therapist for evaluation of dysphagia. The nurse cannot convert orders for medications to a different route. Water or pudding may increase the risk for aspiration if a dysphagia evaluation has not been completed.

Which nursing action(s) promotes safety in the preparation of medication? Select all that apply. -Ensure a second nurse cosigns all medications. -Take verbal prescriptions for medications whenever possible. -Return medications with obscured labels to the pharmacy. -Note the expiration dates on liquid medications. -Prepare medications in well-lit conditions

Return medications with obscured labels to the pharmacy. Note the expiration dates on liquid medications. Prepare medications in well-lit conditions. Explanation: Agency policy differs slightly on which medications require cosignage and which do not. Typically, opioids and controlled substances require that the dose be double-checked by another nurse and cosigned. All other medications can be signed for and administered by one nurse independently. If the nurse is not able to read the label of a drug, it is not safe to administer. Even if it means the drug may be administered late, the nurse must return it to the pharmacy and request that it is appropriately labeled so the nurse is able to complete all the rights of administration. Noting expiration dates on liquid medications is important because they are not safe to administer once past the expiry date. By preparing medications in well-lit conditions, the nurse is safeguarding from giving the medication to the wrong client or giving the wrong drug at the wrong time. The environment in which medications are prepared for administration is a critical aspect of safety. Medication prescriptions should be written in legible writing on a health care provider prescription sheet whenever possible. If the prescribing health care provider is present when the prescription is made, a verbal prescription should not be taken. Verbal prescriptions have been found to lead to serious errors and should be used sparingly.

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? -Inform the health care provider about the client's absence. -Leave the medication on the client's bedside table. -Return the medication to the medication cart or medication room. -Inform the head nurse about the client's absence.

Return the medication to the medication cart or medication room. Explanation: If the client is not present at the time when the medication needs to be administered, the nurse should return the medication to the medication cart or medication room. Leaving medications on the client's bedside table may result in their loss or accidental ingestion by someone else. The nurse need not inform the health care provider or the head nurse about the client's absence.

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this upcoming dose of scheduled unit-dose packaged antihypertensive medication? Place the dose in the medication cup with other medications. Set the antihypertensive dose aside pending assessment. Ask the client to report any dizziness and lightheadedness. Teach the client to use the call bell whenever getting out of bed.

Set the antihypertensive dose aside pending assessment. Explanation: Knowing that the previous dose was held, the nurse sets the antihypertensive aside until an assessment of current blood pressure is performed or verified. The nurse scans and administers all the regularly scheduled medications at one time, except for those requiring additional assessment. Those unit-dose packages are set to the side until the nurse is sure that administration is the correct action. The client should already know to call for assistance, if needed, and to report new or worsening symptoms, such as feeling dizzy.

The client has continuous enteral feedings through a nasointestinal tube. The client has a thyroid medication that is to be taken on an empty stomach. What action does the nurse perform? Mix the medication in the tube feeding and administer the tube feeding and medication together. Ask the health care provider to prescribe bolus feedings. Stop the infusion for 30 minutes before and after administration of the thyroid medication. Withhold the thyroid medication.

Stop the infusion for 30 minutes before and after administration of the thyroid medication. Explanation: When the client receives a medication that is to be given on an empty stomach, the nurse will stop the tube feeding for 15 to 30 minutes before and after administration of the medication. This will aid in absorption of the medication or improve its absorption. The nurse does not mix the medication in the tube feeding. Mixing the medication with the tube feeding will impair absorption or the action of the drug. The nurse does not ask for a change to bolus feeding. The client has a nasointestinal tube, and bolus feedings are not recommended for nasointestinal tubes, due to risk of dumping syndrome. The nurse does not withhold the medication without proper notification of the health care provider.

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention? Assess skin for rash. Open the airway. Activate the Rapid Response Team. Stop the infusion of the antibiotic.

Stop the infusion of the antibiotic. Explanation: The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life-threatening reactions can also occur quickly. The first nursing action is to stop the infusion. The nurse will proceed to assure that there is an open airway, assess the skin for rash, and activate the Rapid Response Team if needed.

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? -Sites commonly used for a subcutaneous injection are the inner surface of the forearm and the upper back, under the scapula. -Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. -Subcutaneous injections are administered at a 30- to 45-degree angle based on the amount of subcutaneous tissue present. -Pinching is advised for obese clients to lift the adipose tissue away from underlying muscle and tissue.

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Explanation: Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Sites commonly used for an intradermal injection are the inner surface of the forearm and the upper back, under the scapula. Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventrogluteal area. Subcutaneous injections are administered at a 45- to 90-degree angle, based on the amount of subcutaneous tissue present and the length of the needle. Pinching is advised for thinner clients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue.

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason? The site is in close proximity to the sciatic nerve. The area is free of major blood vessels and fat. There is a high possibility of injecting into subcutaneous fat. The site lies close to the radial nerve.

The area is free of major blood vessels and fat. Explanation: The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. The deltoid region for an intramuscular injection has little overlying subcutaneous fat and lies close to the radial nerve

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 It uses a system based on household measurements which are easily understood and measured It prevents errors by never using leading zeros for doses less than one measurement unit It ensures accuracy by expressing quantities in fractions and Arabic numbers

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements Explanation: The metric system is the most widely accepted and convenient system of measurement for drug administration and the strength and frequency of the dose also are indicated (e.g., digoxin 0.125 mg daily). The system is measured by 10s and can easily be consistently converted to other increments; i.e. .25 m = 25 cm = 250 mm. A recommended mistake-proofing practice when administering medications using the metric system is never to use trailing zeros (e.g., 5 mg, never 5.0 mg); using trailing zeros increases the likelihood of an error. A mistake-proofing practice is to always use leading zeros for doses less than one measurement unit (e.g., 0.3 mg, never .3 mg); it does not prevent errors by omitting leading zeros. The metric system does not utilize fractions and Arabic numbers and is not based on commonly used household measurements.

The nurse is creating a professional development presentation about medication orders. Which teaching will the nurse include? Select all that apply. -Use abbreviations as much as possible. -The health care providers must sign all orders. -Be extra cautious with look-alike and sound-alike drugs. -U and IU are acceptable abbreviations to use. -The prescribing provider is the only person accountable for drug orders.

The health care providers must sign all orders. Be extra cautious with look-alike and sound-alike drugs Explanation: The nurse's teaching will include that health care providers must sign all orders, and care must be taken with look-alike and sound-alike drugs. Abbreviations should not be used. The nurse is held accountable for making sure that all components of a medication order are present and for clarifying any portion that is not understood.

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 instruct the child to prolong his/her inhalation. The nurse should use a nebulizer to administer the medication. The nurse should assess the child's mucous membranes. The nurse should provide simple written instructions.

The nurse should use a nebulizer to administer the medication. Explanation: The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Assessing the child's mucous membranes is incorrect, as this action is used to identify any break in the continuity of the membranes and will not assist with the coordination of inspiration. Providing simple written instructions is incorrect, as this will enhance the teaching/learning process of the child and not the coordination of the child's inspiration.

Regarding medication administration, what must occur at the change of shifts? The client's medications must be drawn up. The medications for the division are counted. The opioids for the division are counted. Only the LPNs on the division count medications

The opioids for the division are counted. Explanation: Health care facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection? -The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug. -The ventrogluteal site determines whether or not the needle is in a blood vessel. -The ventrogluteal site prevents tissue contact with the irritating drug. -The ventrogluteal site reduces the transmission of microorganisms.

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug. Explanation: The ventrogluteal site is a large muscular injection site that provides a location with the capacity for depositing and absorbing the drug and is therefore correct. The nurse will reduce the transmission of microorganisms by hand washing and not by selecting the ventrogluteal site. The nurse will aspirate for a blood return to determines whether or not the needle is in a blood vessel. Changing the needle will prevent tissue contact with the irritating drug, not the usage of the ventrogluteal site.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity? Therapeutic range Peak level Trough level Half-life

Therapeutic range Explanation: Therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. Peak level is the highest plasma concentration. Trough level is the point when the drug is at the lowest concentration. Half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body.

The nurse has begun caring for a surgical client who has been ordered preoperative antibiotics prior to bowel surgery. While the nurse will adhere to all the principles of safe medication administration, which domain will the nurse pay particular attention toroute in this situation? Dose Route Time Client

Time Explanation: The rights of medication administration include right client, right drug, right route, right dose, right time, right reason, and right documentation. While the nurse will adhere to all of these, timing is particularly important for preoperative medications, since these must be times so that peak efficacy aligns with the time of peak risk.

A client with chronic obstructive pulmonary disease (COPD) has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in order to ensure safe and complete delivery of the prescribed medication? Use a spacer or extender with the metered-dose inhaler. Provide oxygen therapy 30 minutes prior to administration. Provide multiple puffs of the medication in rapid sequence. Place the inhaler as deeply into the client's mouth as is comfortable.

Use a spacer or extender with the metered-dose inhaler. Explanation: The use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible. MDIs are placed 1 or 2 inches (2.5 or 5 cm) in front of the mouth, not deeply into the mouth. Oxygen therapy prior to administration does not aid in delivery. Multiple puffs, if ordered, are given after 1 to 5 minutes.

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? Remove the tube and replace it with a new tube. Use a syringe to plunge the tube to try to dislodge the medication. Call the physician before instituting any corrective interventions. Wait the prescribed amount of time and attempt to administer the medication again before calling the physician.

Use a syringe to plunge the tube to try to dislodge the medication. Explanation: When medication becomes clogged in the tube, the nurse should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified. The nurse should not remove the tube nor wait for a prescribed amount of time to attempt to readminister the medication.

A client requests more medication for pain at the surgical site rated 8 out of 10. There is a PRN prescription for 10 mg PO of oxycodone for pain greater than 6 out of 10 on the pain scale. Which action should the nurse take first? -Verify clients name and date of birth -Administer the prescribed amount of oxycodone. -Review file for adverse effects -Determine if the prescription is appropriate.

Verify clients name and date of birth Explanation: The nurse administers prn prescriptions "as needed," based on the time frame and directions prescribed by the provider. However, the first step is to have the client verify their name and date of birth. Determining if the prescription is appropriate as well as reviewing for adverse effects are done prior to initiating therapy of the drug, not when the client has been taking the medication.

Which client would most likely require placement of an implantable port? -a 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy -an 18-year-old man s/p gunshot wound in the ICU requiring multiple blood transfusions -a 12-year-old girl with sickle cell anemia requiring frequent pain medication administration -a 45-year-old man with a history of colon cancer that is currently in remission

a 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy Explanation: This client needs frequent IV access. A central port is easily accessed for chemotherapy sessions, then the access is discontinued even though the port remains in place subcutaneously. A central port also allows for the infusion of chemotherapy into a central vessel; this is important because chemotherapy is caustic and severely damages peripheral vessels.

To which client would the nurse be most likely to administer a PRN medication? a client who is reporting pain near the surgical site a client who requires daily medication to control hypertension a client who is experiencing severe and unprecedented chest pain a client whose asthma is treated with inhaled corticosteroids

a client who is reporting pain near the surgical site Explanation: A report of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications.

The rapid response team is present while a client is receiving cardiopulmonary resuscitation (CPR). The health care provider informs the nurse to administer a dose of epinephrine IV. Which method of medication will the nurse obtain? an individual supply a unit dose supply a stock supply an automated medication dispensing system

a stock supply Explanation: The nurse will need to obtain the medication rapidly because this is an emergency situation. The fastest method in this scenario is the stock supply, which is a large number of stored drugs that remain on the unit for emergency use. A unit dose supply is a packet that has one pill or capsule for client consumption. An individual supply is a container with enough of the prescribed drug for several days or weeks, which is common in long-term care facilities such as nursing homes. The automated medication dispensing system requires the nurse to access the machine with a specific code and withdraw the one item that is needed. This is a time consuming procedure that is not appropriate for an emergency situation.

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered? all at once over 3 hours in tandem with another medication over the duration of a 12-hour shift

all at once Explanation: Bolus administration is given into a vein all at one time. All other answers are incorrect.

A client reports itching and shortness of breath 15 minutes after receiving ceftriaxone 500 mg intravenously. The nurse recognizes that the client is experiencing which type of reaction? adverse drug reaction allergic reaction toxic effect idiosyncratic effect

allergic reaction Explanation: Itching and shortness of breath are signs of an allergic reaction and a possible anaphylactic reaction. An adverse drug reaction is when a client experiences nausea or other side effects, but not an allergic effect. Toxic effect is when too much medication affects an organ or the body as a whole. Idiosyncratic effect is any unusual or peculiar response to a drug. It may manifest by overresponse, underresponse, or even the opposite of the expected response.

A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency? before and after each medication administration at least every 8 hours once daily every 72 hours

before and after each medication administration Explanation: Peripheral intermittent lines are usually flushed with preservative-free 0.9% NaCl before and after each medication administration and every 8 hours when medications are not being given. Most agencies recommend changing intermittent devices every 72 hours to ensure patency and prevent common complications of IV therapy.

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 electronic infusion device continuous administration secondary administration

bolus administration Explanation: Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. An electronic infusion device, continuous administration, and secondary administration do have the potential to cause life-threatening changes, but not to the same degree as a bolus administration, since the rate at which medication is administered is not as fast as during a bolus.

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection? checking for documented allergies to food or drugs preparing the syringe with the medication cleaning the area with an alcohol swab gathering all the equipment needed

checking for documented allergies to food or drugs Explanation: Checking for documented allergies to food or drugs is done to ensure safety and is therefore correct. Preparing the syringe with the medication is incorrect because this is considered planning, not assessment. Cleaning the area with an alcohol swab is implementing, not assessing. Gathering all the equipment needed is also considered planning.

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration? -client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination -client who is beginning treatment with chemotherapy following a diagnosis of ovarian cancer -client who is diagnosed as having sepsis and is prescribed antibiotic therapy -client who is in the emergent phase of a 50% partial-thickness (second-degree) burn and requiring medication for pain

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination Explanation: The hepatitis B vaccine is administered intramuscularly. Recombivax HB, a form of the hepatitis B vaccine, may be administered subcutaneously to clients who are at high risk for hemorrhage. This client is low risk. Medications for the clients experiencing the situations listed would be administered intravenously.

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle? intradermal subcutaneous intramuscular intravenous

intradermal Explanation: When giving an intradermal injection, the nurse instills the medication shallowly at a 10- to 15-degree angle of entry. When the nurse administers a subcutaneous injection, the angle of entry is either 45 degrees or 90 degrees, whereas for intramuscular injections, the angle is 90 degrees. Intravenous injections are instilled into the veins of the client at an angle of around 15 degrees, but only if no venous access port is in place.

The Z-track technique is utilized during drug administration by which route? intramuscular subcutaneous intradermal intravenous

intramuscular Explanation: The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort.

A nurse is using an 18-gauge needle to administer medication to a client. The nurse knows that, when compared with a 27-gauge needle, an 18-gauge needle has which feature? shorter length greater length larger diameter smaller diameter

larger diameter Explanation: For most injections, 18- to 27-gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. The needle gauge, or the diameter, refers to its width.

When administering heparin subcutaneously, the nurse should: aspirate after the injection. aspirate before the injection. vigorously massage the site. never aspirate.

never aspirate. Explanation: When administering heparin subcutaneously, never aspirate before administration.

The client cannot swallow and just had an enteral tube placed for feeding and medications. Medications will have to be in liquid form or crushed for administration. The client has the following medications prescribed. Which medication will the nurse withhold and consult with the health care provider? furosemide liquid oxycodone extended release tablet acetaminophen tablet aspirin chewable tablet

oxycodone extended release tablet Explanation: The nurse would withhold the oxycodone extended release tablet. The extended release tablet is meant for delivery of the drug over an extended period of time, such as 12 hours. If crushed, the client would get an immediate release of the medication and could experience an adverse reaction. The other medications can be administered through an enteral tube: liquid, tablet that is crushed, chewable tablet that is crushed.

The nurse is administering a rectal suppository. How far will the nurse insert the suppository? past the internal sphincter just past the opening of the anus far enough to still visualize the end of the suppository until the client reports feelings of discomfort

past the internal sphincter Explanation: To be effective, a suppository must be inserted past the internal sphincter, which is about the distance of the finger of insertion.

Which action describes buccal medication administration? -placing a medication under the tongue and allowing it to dissolve -placing a medication underneath the upper lip or in the side of the mouth -placing a medication through a nasogastric tube -placing a medication that is designed to be absorbed -through the skin for systemic effects on the skin

placing a medication underneath the upper lip or in the side of the mouth Explanation: Buccal medication is not chewed, swallowed, or placed under the tongue. Sublingual medications are placed under the tongue. Medications that are given through a nasogastric tube are oral. A medication that is designed to produce systemic effects and is absorbed through the skin is called transdermal.

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity? placing the secondary and primary infusion at equal height placing the primary solution higher than the secondary solution stopping the primary solution until the secondary infusion is completed placing the secondary infusion higher than the primary solution

placing the secondary infusion higher than the primary solution Explanation: The nurse should place the secondary infusion higher than the primary infusion. This will allow the secondary infusion to infuse first. When completed, the primary infusion will continue to infuse. The other options are not correct.

When preparing to start an intravenous infusion on an adult, the nurse should: prepare the skin with 70% alcohol and povidone-iodine. apply sterile gloves before inserting the intravenous device. place a cold cloth over the intended site for greater access. place a tourniquet 2 inch (5 cm) below the selected site

prepare the skin with 70% alcohol and povidone-iodine. Explanation: Prepare the site using a vigorous circular motion, with 70% alcohol as a defatting agent; work from the center outward to a diameter of 2 to 3 inches (5 to 7.5 cm); follow with an application of povidone-iodine.

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? -read and compare labels on the medication with the medical record -review the client's medication, allergy, and medical history -administer medication within 30 to 60 minutes of the scheduled time -allow sufficient time to prepare the medication with minimal distraction

review the client's medication, allergy, and medical history Explanation: To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least 3 times (before, during, and after preparing the medication) to ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications.

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client? prone supine oblique lithotomy

supine Explanation: To best facilitate instillation of nasal medication via a dropper, and to ensure that the drug is administered into the place where its effects are desired, the nurse will place the client in supine position. The other positions are not appropriate.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug? swallowing the medication taking the medication on an empty stomach talking when taking the medication performing physical activities

swallowing the medication Explanation: When administering medication by sublingual application, the client should avoid swallowing or chewing the medication. Eating or smoking during administration is also contraindicated. Taking the medication on an empty stomach, talking, or performing physical activities may not be contraindicated when administering drugs sublingually.

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 to administer timely emergency treatment to implement measures to reduce the transmission of microorganisms to prevent interfering with test results

to determine the extent to which the client responded to the drugs Explanation: Determining the extent to which the client has responded to the drugs is correct, as this allows the nurse to observe the area for signs of local reaction in which the standard time is 24-48 hours. Ensuring that emergency treatment is quickly administered is incorrect since the nurse is to observe the client for allergy to the test in the first 30 minutes. Reducing the risk for the transmission of microorganisms is incorrect since this could be achieved by the nurse removing gloves and performing hand hygiene immediately after administering the drug. Preventing interference with test results is incorrect, as the nurse could instruct the client not to rub the area.

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? side of buttock upper arm lower abdomen upper back

upper back Explanation: The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily.

The nurse is preparing to withdraw liquid medication from an ampule for injection into an IV. What is the appropriate action for the nurse to take when withdrawing the medication? -use a needleless IV injector -withdraw the medication and then squirt some of the medication out before injecting -choose a smaller needle for injection so no particles will enter the syringe -use a filter needle to withdraw the medication

use a filter needle to withdraw the medication Explanation: Filter needles should be used whenever withdrawing medication for injection from an ampule, due to the risk of glass particles being aspirated into the syringe. The filter needle contains a membrane that acts as a barrier by blocking the entrance of glass shards. A needleless injector will not protect the client from inadvertent glass shards in the solution. Squirting out some of the solution will not eliminate the potential for glass shards and may cause the client to receive a lower dose of medication than is required. A smaller needle will not filter out the glass particles that may be present.

The nurse is preparing to give a vaccination to an infant. At which site should the nurse plan to administer the injection? vastus lateralis deltoid rectus femoris dorsogluteal

vastus lateralis Explanation: The vastus lateralis site is particularly desirable for infants and children, whose gluteal muscles are poorly developed.

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 when the drug needs to act on the client very slowly when the client wants to avoid the discomfort of an intradermal injection when the drug needs to be administered only once

when the client has disorders that affect the absorption of medications Explanation: Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections. A single administration of a drug does not indicate the need for intravenous administration.