Exam 1: Medication Administration and Safety Questions

How should a nurse prepare an intravenous piggyback (IVPB) medication for administration to a client receiving an IV infusion? Select all that apply. 1. wear clean gloves to check the IV site 2. rotate the bag after adding the medication to mix 3. use 100 mL of fluid to mix the medication 4. flush the IV insertion site with 2 mL saline 5. place the IVPB at a lower level than the existing IV 6. use a sterile technique when preparing the medication

1, 2, 6 rationale: Clean gloves should be worn to check the IV site because there is a risk of coming into contact with the client's blood. Ensuring that the medication is mixed is important. Rotating the bag is one way, although there are others. Because IV solutions enter the body's internal environment, all solutions and medications using this route must be sterile to prevent the introduction of microbes. The amount and type of solution depend on the medication. The insertion site does not have to be flushed with an infusing IV. The IVPB should be hung higher, not lower, than the existing bag.

A child is admitted to the hospital with diarrhea and is prescribed antidiarrheal medications. Which nursing actions indicate that the nurse is skilled in safe drug administration to pediatric clients? Select all that apply. 1. the nurse calculates the drug dose according to the age 2. the nurse recommends long-term use of the medication 3. the nurse promotes fluid and electrolyte balance 4. the nurse assesses the child for presence of any eating disorders 5. the nurse assesses the severity of diarrhea by counting the number of stools every 48 hours

1, 3, 4 rationale: The nurse should calculate the dose according to the age of the child to ensure accurate dosing. Diarrhea causes rapid loss of fluid volume and electrolytes through the stools; therefore, the nurse should promote fluid and electrolyte balance by ensuring the appropriate intake of fluids. The nurse should assess the child for the presence of eating disorders such as bulimia and anorexia to check for the abuse of laxatives. The nurse should not recommend the long-term use of antidiarrheal medications because they cause toxic effects. The nurse should measure the amount of diarrhea by the number of stools every 24 hours and not for 48 hours.

Which nursing care interventions are beneficial for medication administration in toddlers? Select all that apply. 1. providing comfort measures to the child 2. encouraging self-expression and self-care 3. helping the child understand the treatment 4. holding the child securely while administering the medication 5. accepting aggressive behavior as a healthy response to medication administration

1, 3, 4, 5 rationale: Measures such as touching or holding the child should be performed immediately after medication administration because they may provide comfort. Helping the child understand the treatment gives the child a feeling of having both his or her body and the situation under control. The child should be held securely to allow for steady control of the limb in question during injection. Aggressive behavior by the child may be accepted, but only to a reasonable limit. Adolescents should be encouraged to engage in self-care, but toddlers are not capable of self-care.

A client has received instructions to take 650 mg aspirin every 6 hours as needed for arthritic pain. What should the nurse include in the client's medication teaching? Select all that apply. 1. take the aspirin with meals or a snack 2. make an appointment with a dentist if bleeding gums develop 3. do not chew enteric-coated tablets 4. switch to acetaminophen if tinnitus occurs 5. report persistent abdominal pain

1, 3, 5 rationale: Aspirin is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Enteric-coated tablets must not be crushed or chewed. Aspirin therapy may lead to gastrointestinal bleeding, which may be manifested by abdominal pain; if present, the prescriber must be notified immediately. Bleeding gums should be reported to the practitioner, not the dentist. Acetaminophen does not contain the antiinflammatory properties present in aspirin; tinnitus should be reported to the practitioner.

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. 1. urinary output 2. deep tendon reflexes 3. last bowel movement 4. arterial blood gas results 5. last serum potassium level 6. patency of the intravenous access

1, 5, 6 rationale: Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate. A patent IV access is essential because potassium is very irritating and painful to subcutaneous tissue. The infusion of KCL 40 mEq in 100 mL of 5% dextrose and water has no direct effect on deep tendon reflexes, bowel movement patterns, or arterial blood gases. Therefore these items are not required to be assessed before administration of this medication.

A client has been taking lithium carbonate for 3 days. The nurse has the client's lithium level checked before administering the medication and finds it to be 0.3 mEq/L (0.3 mmol/L). What action will the nurse take? 1. notify the PCP 2. administer the medication 3. watch for adverse side effects 4. withhold the next dose of the medication

2 rationale: A level 0.3 mEq/L (0.3 mmol/L) is below the therapeutic range of 0.5 to 1.5 mEq/L (0.5 to 1.5 mmol/L); therefore the medication should be administered as prescribed to increase the serum drug level. There is no need to notify the primary healthcare provider, because the level is still subtherapeutic. Adverse side effects are not expected until the level exceeds the therapeutic range of 0.5 to 1.5 mEq/L (0.5 to 1.5 mmol/L).

A nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? 1. height 2. allergies 3. vital signs 4. body weight

2 rationale: Allergies should be listed on all MARs to prevent the administration of drugs to which the client is allergic. Height is part of the initial health history/physical assessment data. Weight is part of the initial health history/physical assessment data. The vital signs are part of the initial health history/physical assessment data.

A nurse is preparing to administer an intravenous piggyback medication to a client who is receiving a continuous infusion of intravenous (IV) fluids. What is the priority nursing intervention? 1. get an additional IV infusion pump for the medication 2. check the compatibility of the medication and the continuous IV solution 3. disconnect the continuous IV solution while administering the piggyback medication 4. flush the client's venous access device to ensure patency

2 rationale: Compatibility of the ordered IV medication and infusing IV solution needs to be verified to prevent harm to the client because incompatible solutions may increase, decrease, or neutralize effects of the medication. An additional IV infusion pump is not necessary because IV medication will be administered through a piggyback infusion. The nurse needs to stop IV fluids and disconnect the tubing only if the ordered IV medication is not compatible with IV fluids and there is an order to hold the continuous infusion. The client has a continuous infusion of IV; therefore patency of the IV access device is already determined

A healthcare provider prescribes enoxaparin 30 mg subcutaneously daily. Which measure would the nurse take when administering this medication? 1. push over 2 minutes 2. administer in the abdomen 3. rub site after administration 4. remove air pocket from prepackaged syringe before administration

2 rationale: Enoxaparin specifically targets blood clots throughout the body and carries a lower risk of hemorrhage than that associated with the drugs heparin and warfarin. Enoxaparin is administered once a day through a subcutaneous injection site around the naval. Enoxaparin should be injected into the fatty tissue only, which is why the abdomen is the recommended injection site. Avoid administering in a muscle. Manufacturer recommendations indicate the air pocket from prepackaged syringes not be removed before administration. Rubbing the site is contraindicated, as it can cause bruising. There are no recommendations to push this subcutaneous medication over 2 minutes.

When a client has gluteal edema, why should the nurse avoid using the gluteus maximus muscle for administration of intramuscular medications? 1. deposition of an injected drug causes pain 2. blood supply is likely insufficient for adequate absorption 3. fluid leaks from the site for a long time after the injection 4. tissue fluid dilutes the drug before it enters the circulation

2 rationale: Fluid in interstitial spaces impairs circulation, leading to slowed absorption of drugs,as well as an increased risk for skin breakdown. The pain caused by an injection will be influenced by the type and volume of the drug, not by edema at the site. Interstitial fluid may leak from edematous tissue, but this is not the rationale for altering sites. The dilution of the drug does not significantly affect absorption.

A nurse is teaching an older client about proper medication use. Which statement made by the client indicates the need for further education? 1. i will ask the pharmacist to give generic medications 2. i will use over-the-counter medications along with prescribed drugs 3. i will continue my treatment by consulting a single healthcare provider 4. i will know the names and times of administration of the medications i am taking

2 rationale: Over-the-counter medicines should not be used along with prescription drugs because of the risk of negative drug-drug interactions. Low-cost generic drugs can be used because they have similar potency and will not cause adverse effects. Consulting a single healthcare provider will reduce the risk of polypharmacy because the healthcare provider can easily check for potentially negative drug interactions. The client should know about the names, uses, and times of administration of the medicines he or she is taking to aid in medication compliance.

A nurse reviews a list of medications that have been prescribed for a client. The nurse is aware that it is unsafe to administer which medication as an intravenous (IV) bolus? 1. saline flush 2. potassium chloride 3. naloxone 4. adenosine

2 rationale: Potassium chloride given as an IV bolus can cause cardiac arrest. It should never be administered intravenously without being diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response? 1. stating you must take your medicine now 2. saying ill be back in a few minutes so we can talk 3. explaining why it is necessary to take the medication 4. withholding the medication before notifying the PHP

2 rationale: Saying, "I'll be back in a few minutes so we can talk" allows the angry client time to regain self-control; announcing a plan to return will ease fears of abandonment or retribution. Staying and insisting that the client take the medication may provoke increased anger and further loss of control. Clients will not accept logical explanations when angry. Alternative nursing interventions should be attempted before withholding the medication and notifying the primary healthcare provider, although these may become necessary.

A registered nurse teaches a nursing student about considerations for administering medication in infants. Which statement of the nursing student indicates a need for additional learning? 1. i should administer nasal drops 20-30 minutes before a feeding 2. i should pull the ear pinna up and back while administering ear drops 3. i should wait until the infant stops crying for administering oral medication 4. i should restrain the head and place an eye drop at the corner near the nose if the infant is uncooperative

2 rationale: The ear pinna should be pulled down and back while administering eardrops in infants. Pulling the pinna up and back is recommended for an adult or a child older than 3 years of age. Nasal drops should be administered 20 to 30 minutes before a feeding because potential congestion caused by nasal medications may make it difficult for the infants to suck. If the infant is crying, wait until he or she calms to prevent medication aspiration. Infants often squeeze their eyes tightly shut to avoid eye drops. Therefore to administer drops in an uncooperative infant, the infant's head should be gently restrained and the drops should be placed at the corner nearest the nose.

What is the maximum recommended intramuscular dose for medications in preschoolers? 1. 0.5 mL 2. 1.0 mL 3. 1.5 mL 4. 2.0 mL

2 rationale: The maximum recommended intramuscular dose in preschoolers should not exceed 1 mL.

What nursing interventions should be performed when medications are administered to a 10-year-old child? Select all that apply. 1. allowing the child to bite 2. explaining the procedure 3. explaining the need to take the medication 4. providing activities to relieve the child's aggression 5. providing a pacifier after medication administration

2, 3, 4 rationale: Explaining the procedure to the child helps promote the child's cooperation. A 10-year-old is mature enough to understand the importance of taking medication. Providing activities to relieve aggression will help to soothe the child. The child may be allowed to scream and cry but not to bite. Pacifiers are given to infants; pacifier use is not appropriate in a 10-year-old.

What primary nursing actions are used to prevent pediatric medication errors? Select all that apply. 1. carefully decipher illegibly written orders 2. have full knowledge of the medication, including its on- and off-label uses 3. assume that the prescriber is correct and administer the medications as ordered 4. always confirm information about the client before delivering a dose 5. make sure all the orders are clear and well understood during a shift change

2, 4, 5 rationale: The nurse should know the label and off-label use of any drug prescribed to the client. The nurse should confirm information about the client every time before administering medication to ensure that the client receives the correct medication. The nurse should make sure all the orders are clear and well understood during shift changes to avoid miscommunication. The nurse should not try to decipher illegibly written orders. The nurse should never assume that the prescriber is correct; instead, the nurse should investigate until all ambiguities are resolved.

For a client with difficulty swallowing, the nurse should crush which medication? 1. metoprolol extended release 2. felodipine sustained release 3. acetaminophen extra strength 4. potassium chloride extended release

3 rationale: Acetaminophen extra strength (Tylenol ES [extra strength]) is not coated or intended to be released slowly; crushing this medication will not cause a bolus to be administered to the client. Crushing of extended- or sustained-release drugs such as potassium chloride extended release will cause a bolus of medication to be given at once rather than slowly; if crushing is necessary, another form of the medication or another medication should be requested from the health care provider. Crushing an SR (sustained-release) medication will cause a bolus to be administered at once rather than slowly as intended; if crushing is necessary, another form of the medication or another medication should be requested of the health care provider. Crushing of an XL (extended-release) medication will cause a bolus to be given; if crushing is necessary, another form of the medication or another medication should be requested of the health care provider.

Which healthcare team member would the registered nurse state is most suitable to provide oral medication to a client? 1. nurse manager 2. patient care associate 3. licensed practical nurse 4. unlicensed assistive personnel

3 rationale: Activities such as providing oral medication to the client is the responsibility of the licensed practical nurse. The nurse manager is not most suitable to provide oral medication to the client because the nurse manager is mainly involved in delegating tasks and managing other emergency conditions. Patient care associates and unlicensed assistive personnel are unlicensed practitioners who are primarily responsible for providing hygienic care to the clients.

While supervising the LPN's technique with medication administration, the nurse manager sees the LPN beginning to dispense an incorrect dose. How should the nurse manager respond initially? 1. by telling the LPN that an error has been made 2. by informing the nursing supervisor that the LPN is unsafe 3. by questioning the dosage in the hope that the LPN will identify the error 4. by pointing out the error just before the LPN begins to administer the medication

3 rationale: Because the nurse is supervising, not evaluating, the LPN, questioning the dosage rather than pointing out the error is a positive approach that will allow the LPN to grow and help foster a supportive working relationship. Telling the LPN that an error has been made is not the initial intervention; this may become necessary if the LPN does not identify the error without being told. Informing the nursing supervisor is inappropriate and premature. Waiting until just before administration of the incorrect dose puts the client at risk.

Which of these programs is least likely to focus on medication delivery process modification? 1. evaluation research 2. quality improvement 3. experimental research 4. performance improvement

3 rationale: Experimental research is least likely to focus on medication delivery process modification. Quality improvement, evaluation research, and performance improvement are all likely to focus on medication delivery process modification in order to make the process better for the client.

A client reported being administered the wrong dose of medication by the wrong route, which may lead to serious complications. The nurse leader is gathering information to determine what happened. Which phase of client care management is the nurse leader following? 1. validation 2. translation 3. preparation 4. comparative evaluation

3 rationale: Medication errors may occur due to the administration of the wrong dose through the wrong route, which may lead to serious complications in the client. According to Stetler's model, the nurse leader is in the preparatory phase, which involves searching, sorting, and selecting sources of evidence. The validation phase focuses on utilization with an appraisal of study findings rather than the critique of a study's design. The transactional, or application, phase involves practical aspects of implementing the plan for translating the research into practice at the individual, group, department, or organizational level. Comparative evaluation is also known as the decision-making phase and involves making a decision about the applicability of the study by synthesizing cumulative findings.

Which medication requires the nurse to monitor the client for signs of hyperkalemia? 1. furosemide 2. metolazone 3. spironolactone 4. hydrochlorothiazide

3 rationale: Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect. Furosemide, metolazone, and hydrochlorothiazide generally cause hypokalemia.

On the first day of the month a primary healthcare provider prescribes an antipsychotic medication for a client with schizophrenia. The initial dosage is 25 mg once a day, to be titrated in increments of 25 mg every other day to a desired dosage of 175 mg daily. On what day of the month will the client reach the desired daily dose of 175 mg? 1. day 7 2. day 9 3. day 13 4. day 15

3 rationale: The client will reach the desired dosage of 175 mg on the thirteenth day of the month; on the first day it is 25 mg, on the third day it is 50 mg, on the fifth day it is 75 mg, on the seventh day it is 100 mg, on the ninth day it is 125 mg, on the eleventh day it is 150 mg, and on the thirteenth day it is 175 mg.

Which healthcare team member would the nurse expect can be delegated with the task of administering oral medication to a client per the functional model? 1. registered nurse 2. patient care associate 3. licensed practical nurse 4. unlicensed assistive personnel

3 rationale: The licensed practical nurse can give oral medication to a client. The registered nurse gives IV medication to a client. Patient care associates assist and monitor vital signs. Unlicensed assistive personnel perform all hygienic tasks.

A healthcare team is caring for clients after a fire. The charge nurse delegates different tasks to the healthcare team according to the functional model of nursing. Which team member is eligible and accessible to provide oral medications to any clients? 1. nursing manager 2. chief nursing officer 3. licensed practical nurse 4. unlicensed nursing professional

3 rationale: The licensed practical nurse is eligible and accessible to provide oral medications to clients. The nursing manager is responsible for more than one unit and has other managerial responsibilities and may not be available for providing oral medications to the clients. The chief nursing officer is busy assessing, monitoring, and verifying requirements. The unlicensed nursing professional is not eligible to provide oral medications; they can only monitor and assist the clients.

An 18-month-old toddler requires an intramuscular injection. As the nurse enters the room with the medication, the child begins to scream and flail about on the bed. The father is sitting at the child's bedside and gets up to leave. What action should the nurse take to best handle this situation? 1. Allow the child to say good-bye to the father and then give the injection. 2. Tell the father to return and comfort the child after the injection is given. 3. Ask the father to stay to comfort the child while the injection is being given. 4. Leave the room and ask another nurse to come in to hold the child during the injection.

3 rationale: Toddlers are extremely fearful of separation, as well as of intrusive procedures; if the parents are present, they should be encouraged to stay and give comfort. Toddlers depend on their parents for comfort and control. Toddlers are dependent on their parents; the parent should be encouraged to participate in care.

The nursing manager is preparing a schedule for delegating appropriate tasks to different health care team members. Which health care team member can be delegated the task of administering oral medications? Select all that apply. 1. certified technician 2. patient care associate 3. licensed practical nurse 4. licensed vocational nurse 5. unlicensed nursing professional

3, 4 rationale: Delegation of tasks is different for different health care team members, based on their position, skills, and capabilities. Provision of prescribed treatments, such as administering oral medications, are tasks delegated to licensed professionals, such as licensed practical nurses and licensed vocational nurses. A certified technician is an unlicensed nursing personnel and therefore should not be delegated tasks such as administering oral medications.

Which nursing intervention helps to prevent medication errors in children? Select all that apply. 1. encouraging the use of brand names 2. promoting the use of abbreviations and acronyms 3. minimizing the use of verbal and telephone orders 4. carefully reading all labels for accuracy 5. recording the client's weight before carrying out the medication order

3, 4, 5 rationale: All labels and warnings should be read carefully to avoid the administration of expired medications. The client's weight should be recorded to help decrease errors in dosage. The use of generic names should be encouraged to avoid medication errors. Brand names may cause confusion and may lead to medication errors. The use of abbreviations and acronyms should be avoided because of the risk of confusion. Minimizing the use of verbal and telephone orders will also help prevent medication errors in children. Verbal and telephone orders should be read back to the healthcare provider prescribing the medication(s), but this is not always done, so errors are made.

A nurse notes that a famous client has received an incorrect dose of medication due to the malfunction of the intravenous (IV) device, but does not inform the primary healthcare provider. Instead the nurse tells a colleague that the medication could not be given due to the client's inappropriate behavior. The nurse then updates media personnel about the client's health status. What legal charges may be brought up against the nurse? Select all that apply. 1. libel 2. assault 3. slander 4. malpractice 5. invasion of privacy

3, 4, 5 rationale: Speaking falsely about a person is known as slander. In the given situation, the nurse misinforms the colleague about the client's behavior. This action may damage the client's reputation. Malpractice occurs when nursing care falls below the professional standards of care due to negligent acts. Because the nurse does not inform the primary health care provider about the incorrect medication dosage, the nurse may be charged with malpractice. Because the nurse informs media personnel about the client's health status, the nurse may be charged with invasion of privacy. The nurse will not be charged with libel because he or she did not document false information in the client's records. Because the nurse did not threaten the client or place him or her in physical or psychological danger, charges of assault will not be brought up.

Which precautions should the nurse follow to minimize medication errors in children? Select all that apply. 1. report all medication errors 2. receive verbal orders over the telephone 3. use authoritative resources such as drug handbooks 4. communicate with the parents or caregivers 5. confirming information about the client every time a dose is given

3, 4, 5 rationale: Using authoritative resources such as drug handbooks and confirming information about the client every time a dose is given helps to minimize medication errors. Communicating with the parents and caregivers would also help to decrease any medication errors. Reporting any medication errors helps to identify the cause of such errors. Receiving verbal orders over the telephone is not recommended because there may be a bad connection and important information may be lost.

After delegating the task of administering oral medications to a licensed practical nurse (LPN), the registered nurse (RN) ensures that the LPN is supervised until the task is accomplished. Which right of delegation does the scenario reflect? 1. the right task 2. the right person 3. the right direction 4. the right circumstance

4 rationale: The right circumstance is indicated by the appropriate supervision, availability of equipment and resources, and appropriateness of the given situation. If the task is appropriate to the delegate based on institutional policies and is legal then it represents the right task of delegation. If the delegatee has adequate knowledge and experience to perform a task safely and effectively, it represents the right person of delegation. The right direction is indicated by the clear and concise directions provided for the task.

A nurse must administer a medication by means of injection to a 2-year-old whose parent is not present. What is the most therapeutic approach for the nurse to use? 1. Avoiding telling the child beforehand, giving the injection, and then cuddling the child 2. Demonstrating how an injection is given, telling the child why it is needed, and then gathering the equipment 3. Giving a doll the injection, encouraging the child to give the doll an injection, and then giving the injection 4. Warning the child about the injection just before administering it, saying that it is OK to cry, and then comforting the child

4 rationale: Toddlers have not yet developed a concept of time. The child should be warned just before the injection is given, then shown acceptance when he or she cries and is comforted. Children are sensitive to a dishonest approach; this results in their losing trust in the caregiver. Toddlers' attention span is too short and their cognitive ability too limited for them to watch a demonstration and listen to an explanation. Toddlers are too young to participate in therapeutic play; this approach is more appropriate for the preschooler.

The nurse is administering medication through an implanted port. What nursing safety priority should the nurse follow in this scenario? 1. The nurse should use barrel syringes to flush any central line. 2. The nurse should use 20 mL of sterile saline to flush the port after drawing blood. 3. The nurse should use 10 mL of sterile saline to flush the port before and after medication administration. 4. The nurse should withhold the drug until patency and adequate noncoring needle placement of the port are established.

4 rationale: When administering medication through implanted ports, the nurse should withhold the drug until patency and adequate noncoring needle placement of the port are established. In case of a peripherally inserted central catheter (PICC), the nurse should use barrel syringes to flush any central line. The nurse should use 20 mL of sterile saline to flush the port after drawing blood as a nursing safety priority in case of PICC. The nurse should use 10 mL of sterile saline to flush the PICC before after and medication administration.

The healthcare provider prescribes ziprasidone 15 mg intramuscularly stat. The medication package is labeled 20 mg/mL. How many milliliters of ziprasidone solution will the nurse administer? Record your answer using two decimal places, including leading zero if applicable. ___ mL

0.75 mL

A nonviolent client on the psychiatric unit suddenly refuses to take the prescribed antipsychotic medication. What should the nurse do? 1. Honor the client's decision and document the behavior and all interventions. 2. Use an authoritarian approach to induce the client to take the prescribed medication. 3. Call the primary healthcare provider and request that the client be discharged against medical advice. 4. Start proceedings to have the client declared incompetent and seek a court order permitting medication.

1 rationale: A client has the right to refuse treatment and should not be forcibly medicated unless the client is deemed dangerous to self or others. An authoritarian approach is not therapeutic and may compromise the nurse-client relationship. Calling the primary healthcare provider is premature; first the nurse should attempt therapeutic interventions to meet the client's needs. Starting proceedings to have the client declared incompetent is appropriate for a client who is considered to be dangerous to self or others or incompetent to evaluate necessary treatment.

The nursing leader is teaching the newly hired nurse about the use of an electronic medication administration record. Which statement of the newly hired nurse indicates effective learning? 1. "It will identify medication errors." 2. "It will be accessible to a single user." 3. "It will decrease the accuracy of charge capture." 4. "It will decrease the accuracy of pharmacokinetic monitoring."

1 rationale: An electronic medication administration record will generate reports to track medication errors with the visibility of near misses. The electronic medication administration record will be accessible to multiple users. It will increase the accuracy of charge capture between administration time and the time when the drug is dispensed. It will improve the accuracy of pharmacokinetic monitoring.

A nurse reviews the medication charts of four clients. Which medication prescription will cause the nurse to notify the primary healthcare provider? 1. Client A 2. Client B 3. Client C 4. Client D

1 rationale: Client A has acromegaly, which is a result of increased growth hormone production. This condition should be treated with octreotide and lanreotide instead of conivaptan; conivaptan is used to treat SIADH. The treatment of Cushing's syndrome involves the administration of aminoglutethimide. SIADH is treated with vasopressin receptor antagonists such as tolvaptan. Pheochromocytoma is treated with adrenergic blockers such as phenoxybenzamine.

Which first line medication would the nurse state is used to treat anaphylactic reactions? 1. Epinephrine 2. Norepinephrine 3. Dexamethasone 4. Diphenhydramine

1 rationale: Epinephrine is the first line drug for treating anaphylactic reactions. Norepinephrine is also used in treating anaphylactic reactions as a supportive drug. Diphenhydramine and dexamethasone are second line drugs for treating anaphylactic reactions.

A nurse is administering an intradermal skin test injection to a client. What is the next action the nurse needs to do after the medication has been injected? 1. Withdraw the needle and place a piece of gauze over the injection site. 2. Withdraw the needle and scrub the site with Betadine solution. 3. Withdraw the needle and vigorously wipe the area with an alcohol wipe. 4. Withdraw the needle and circle the area with a skin pen.

1 rationale: Gently placing a piece of gauze at the injection site is necessary to prevent the intradermal medication from leaking out of the injection site. Scrubbing the site with Betadine or vigorously wiping with alcohol can cause the medication to leak into the surrounding tissue and prevent the accuracy of the test. Circling the area with a skin pen needs to be done after the gauze has been applied to the area and then removed.

The medication prescribed for an infant is to be given intramuscularly. Which site will the nurse select for administration of the medication? 1. Vastus lateralis 2. Ventrogluteal 3. Dorsogluteal 4. Deltoid

1 rationale: Intramuscular injections are given in the vastus lateralis muscle of the thigh in infants. The ventrogluteal site is not used until children have been walking. The dorsogluteal site is considered high risk for damage to the sciatic nerve or a major blood vessel. The deltoid site in the arm has a small muscle mass that limits the amount of medication that can be injected.

The charge nurse delegates the task to the healthcare team to provide medication to a group of people who were diagnosed with gastroenteritis due to food poisoning. Which healthcare team member is suitable to provide medication in this situation? 1. Registered nurse 2. Healthcare provider 3. Licensed practical nurse 4. Unlicensed assistive personnel

1 rationale: Intravenous medications are provided in case of gastroenteritis due to food poisoning for immediate relief in the clients. The registered nurse is eligible to provide intravenous medications to clients. The healthcare provider prescribes the medication for the clients. Licensed practical nurses are not eligible to provide intravenous medications; they can provide oral and intramuscular medications. Unlicensed assistive personnel are eligible to provide assistance and monitoring.

Which medication should be immediately started when a client has an anaphylactic attack? 1. isoproterenol 2. diphenhydramine HCl 3. hydrocortisone sodium succinate 4. methylprednisolone sodium sucinate

1 rationale: Isoproterenol is a beta-adrenergic, sympathomimetic drug that is considered to be a first-line of medication for the management of anaphylaxis. Diphenhydramine HCl is a second-line antihistamine to be used after the client is stabilized. Hydrocortisone sodium succinate and methylprednisolone sodium succinate are second-line corticosteroid medications that inhibit inflammatory mediators.

A nurse is a preceptor for a new graduate nurse. The new graduate is providing care for a client who requests pain medication. The new graduate discovers that the prescribed dose is higher than the safe range listed in the hospital formulary and informs the preceptor of this discovery. The preceptor instructs the new graduate to go ahead and give the prescribed dose. Which action is best for the new graduate to take? 1. Contact the primary healthcare provider to discuss the dose. 2. Contact a hospital pharmacist to verify the dose prescribed. 3. Give the medication as prescribed to decrease the client's pain. 4. Check the dose with another nurse on the unit to see if it is correct.

1 rationale: The new nurse should discuss the dose with the primary healthcare provider who prescribed the medication. Although talking to the pharmacist may elicit additional information, this is not the best action since the new nurse will have to notify the prescribing primary healthcare provider. Giving the medication as prescribed may place the client at risk. Although checking the dose with another nurse may elicit additional information, this is not the best course of action.

The home health care nurse discards outdated and leftover medications from previous prescriptions at the home of an elderly client. Which Quality and Safety Education for Nurses (QSEN) competency does this intervention involve? 1. Safety 2. Quality Improvement 3. Evidence-based practice 4. Teamwork and collaboration

1 rationale: The nurse ensures the safety of the client by discarding medications that are outdated. It is important to prevent harm to the client who may unintentionally take a medication that is no longer required. Quality improvement requires the nurse to use data to monitor the outcomes of care processes. The nurse ensures evidence-based practice by integrating the best current evidence with clinical expertise, client, and family values for delivery of optimal health care. The nurse functions effectively within nursing and interprofessional teams to promote open communication and mutual respect while applying teamwork and collaboration competency.

The hospital administration has recently introduced bar coding and radio frequency identification (RFID) scanning for reducing medication errors. After a few days, the scanner is giving false reports and the hospital management gathered all the staff members to discuss ways to solve this issue and find alternatives. What type of decision-making strategy does the nurse manger most likely think to be useful in this situation? 1. Focus groups 2. Brainstorming 3. Delphi technique 4. Nominal group technique

1 rationale: The purpose of the focus groups is to explore issues, generate information, and to identify problems or to evaluate the effects of an intervention. The groups meet face-to-face to discuss issues and under the direction of a moderator participators are able to validate or disagree with ideas expressed. Brainstorming can be an effective method for generating a large volume of creative options by listing all idea as stated without critique or discussion. Delphi technique involves systematically collecting and summarizing opinions and judgments on a particular issue through interview, surveys, or questionnaires. In nominal group technique, participants are asked not to talk to each other as they write down their ideas to solve a predefined problem or issue.

While caring for a client with diabetes, the registered nurse delegates the task of administering oral medications to the licensed practitioner nurse (LPN), but the LPN is reluctant to take the assignment. What should be the most appropriate response of the registered nurse in this situation? 1. Evaluate the reason for the behavior. 2. Engage more actively in the delegated task. 3. Require the delegatee to complete the task. 4. Report the LPN's reluctance to higher authorities.

1 rationale: The registered nurse (RN) should first evaluate the reason for the behavior of the LPN and try to determine if the LPN has insufficient knowledge, a psychomotor deficit, or any other reason for the reluctance. If the LPN is unwilling to perform in a specific situation, the RN should engage more actively. Requiring the delegatee to complete the task despite reluctance may not be safe. Reporting the issue to higher authorities should not be the initial intervention.

A young woman tells the nurse, "My partner prevents me from taking my medications." What should the nurse do to deal with the situation? 1. Conduct an interview with the client alone, when the partner is not around. 2. Notify the primary healthcare provider to conduct an interview with the client. 3. Collaborate with multiple community resources to obtain adequate health care. 4. Evaluate the client's and the family's cultural beliefs, values, and practices to determine their specific needs.

1 rationale: The statement provided by the young woman indicates that the individual may be a victim of abuse, so the nurse should interview the client alone when the client has privacy and the individual suspected of being the abuser is not present. Discussing the problems with the primary healthcare provider might cause fear of retribution in the abused client. When dealing with people with mental illness, the nurse should collaborate with multiple community resources to obtain adequate health care. When dealing with vulnerable populations, the nurse should evaluate their cultural beliefs, values, and practices to determine their specific needs.

A mother complains that her child's teeth have become yellow in color. With prolonged use, which medication may be responsible for the child's condition? 1. Tetracycline 2. Promethazine 3. Chloramphenicol 4. Fluoroquinolones

1 rationale: When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients.

In what ways can a nurse promote medication adherence in children? Select all that apply. 1. by mixing oral medications with food or juice 2. by communicating with parents to ensure active participation 3. by selecting a convenient route of dosage and dosage schedule 4. by measuring liquid formulations with a calibrated spoon or syringe 5. by refraining from readministering the drug if the child spills it or spits it out

1, 2, 3, 4 rationale: Oral medications may be mixed with food or fruit juice to improve their palatability. Communication with parents helps to ensures conscientious and skilled participation. The most convenient dosage form and dosing schedule should be selected to help ensure easy administration. Liquid formulations should be measured with the use of a calibrated spoon or syringe to help prevent inappropriate dosing. If the child spits out or spills the drug, the amount of drug spilled should be readministered.

Which nursing interventions would help to prevent medication errors in pediatrics? Select all that apply. 1. knowing information about the drug 2. avoiding verbal telephone orders 3. using abbreviations and acronyms 4. checking the drug label and client's information three times before giving the drug 5. using authoritative resources as references

1, 2, 4, 5 rationale: The nurse should know all about the information of the drug (such as the action, dosage, route, uses, and adverse effects) to avoid medication errors. The nurse should avoid the use of verbal telephone orders because of the high risk of miscommunication. The nurse should check the drug label and the client's information three times before administering the drug. The nurse should use the authoritative resources such as the drug handbooks as a reference. The nurse should avoid the use of abbreviations and acronyms because they lead to confusion.

Which information should a nurse provide to a child's caregivers to ensure safe, proper handling and use of medication? Select all that apply. 1. drug storage 2. written instructions 3. calculation of the dosage based on symptoms 4. nature and duration of the adverse response 5. demonstration of the techniques of administration

1, 2, 4, 5 rationale: The nurse should provide the child's caregiver with adequate information about the child's medication and the way to properly store the medication. The nurse should write down the instructions for administering the drug and demonstrate the techniques of administration. The nature and duration of any adverse responses should be explained to the caregivers. It is unsafe for the nurse to teach the child's caregiving how to calculate dosage based on symptoms. The caregiver is not educated on how to calculate dosage based on symptoms and this poses a risk for toxicity to the child.

Which factors should the nurse consider when administering medications to adolescents? Select all that apply. 1. Explanation of the medication administration procedure by the nurse to the client 2. Interactive communication regarding the procedure of medication administration 3. Implementation of comfort measures like holding 4. Acceptance of aggressive behavior with certain limitations 5. Encouragement of self-expression, individuality, and self-care

1, 2, 5 rationale: During administration of medication to the children of all age groups, the nurse should consider certain points. For adolescents, the nurse should provide a description regarding the procedure being conducted. The adolescent must be allowed to express fears and experiences regarding the administration, and self-expression, individuality, and self-care should be allowed and encouraged. Implementing comfort measures like holding are more appropriate for a younger age group, and accepting aggressive behavior with certain limitations is appropriate only for toddlers.

In what ways can a nurse prevent medication errors? Select all that apply. 1. avoid using abbreviations and acronyms 2. minimize the use of verbal and telephone orders 3. try to guess what the client is saying if the language is not understood 4. document each dose of the drug using trailing zeros when recording the dose 5. check three times before giving a drug by comparing the drug order and medication profile

1, 2, 5 rationale: The use of abbreviations is avoided because this action may cause confusion and increase the risk of error. The use of verbal and telephone orders should be minimized to avoid confusion over drugs that have similar names. Before a drug is administered, the dosage order should be checked three times to verify the five rights: right drug, right dose, right time, right route, and right client. The use of trailing zeros should be avoided because it increases the risk of overdose. If the client's language is not understood, a translator's help should be enlisted.

A client will be receiving monthly intramuscular doses of cyanocobalamin (vitamin B 12), 200 mcg. The medication is available as 100 mcg/mL. Which syringe contains the correct amount of medication for the ordered dose? 1. 1/2 2. 1 3. 1 1/2 4. 2

Set up the problem and solve. Using the ratio and proportion method: 100 mcg : 1 mL = 200 mg : x mL (100)( x) = 200; divide both sides by 100. x = 200/100 = 2 mL. Choose the syringe that is shaded to the 2-mL mark.

Famotidine 20 mg intravenous piggyback (IVPB) is prescribed for a client with a duodenal ulcer. The medication is diluted in 50 mL of 5% dextrose and is infused over 15 minutes. At what rate should the infusion control device (ICD) be set? Record your answer using a whole number. ___ mL/hr

The amount of D5W to be infused is 50 mL. The time of infusion is 15 minutes. The infusion control device requires the rate to be entered in mL/hr. Therefore, the time of infusion must be converted from minutes to hours.

The healthcare provider has prescribed enoxaparin 1 mg/kg for a client who had a total knee replacement. The client weighs 187 pounds (85 kg). This medication is available in a concentration of 30 mg/0.3 mL. What dose will the nurse administer in milliliters? 1. 0.8 mL 2. 0.85 mL 3. 0.9 mL 4. 0.95 mL

The answer is calculated as follows: 1 kg = 2.2 lb (187 divided by 2.2 = 85 kg) 85 mg × 0.3 mL = 25.5 mg/mL25.5 mg divided by 30 = 0.85 mL

A practitioner prescribes penicillin G benzathine suspension 2.4 million units for a client with a sexually transmitted infection. The medication is available in a multidose vial of 10 mL in which 1 mL = 300,000 units. How many milliliters should the nurse administer? Record your answer using a whole number. ___ mL

The prescribed dose is 2.4 million units. The available concentration 300,000 u/mL. Use dimensional analysis and/or ratio and proportion methods to determine the appropriate amount.

A client presents with a severe stiff neck, shuffling gate, and other extrapyramidal symptoms. Benztropine 2.5 mg by mouth is prescribed. The medication is available in 1-mg scored tablets. How many tablets should the nurse administer? Record your answer using one decimal place. _____ tablet(s)

The prescribed dose is 2.5 mg. The available medication is 1 mg tablets. Use the dimensional analysis and/or ratio and proportion methods to determine how many tablets the nurse should administer.

A healthcare provider prescribes 250 mg of a medication. The vial reads 500 mg/mL. How much medication should the nurse administer? Include a leading zero if applicable. Record your answer using one decimal place. _____ mL

The prescribed dose is 250 mg. The available concentration is 500 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine the number of milliliters the nurse should administer.

A healthcare provider prescribes 250 mg of an antibiotic intravenous piggyback (IVPB). A vial containing 1 gram of the powdered form of the medication must be reconstituted with 2.8 mL of diluent to form a volume of 3 mL. How many mL of the solution should the nurse administer? Record your answer using one decimal place and leading zero if applicable. __mL

The prescribed dose is 250 mg. The available concentration of medication is 1 gram in 3 mL. First, the prescribed medication (250 mg) should be converted to the available concentration (grams). The use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A child is to receive 60 mg of phenytoin. The medication is available as an oral suspension that contains 125 mg/5 mL. How many milliliters should the nurse administer? Record your answer using one decimal place. ____ mL

The prescribed dose is 60 mg. The available concentration is 125 mg/5 mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

Azithromycin 0.45 g intravenous piggyback (IVPB) is prescribed for a client who is unable to tolerate oral medications. The medication is available in powdered form in a vial containing 500 mg. Instructions indicate that the medication must be reconstituted with 4.8 mL of sterile water and that the powdered medication displaces 0.2 mL. What volume of reconstituted medication should the nurse add to the intravenous piggyback solution? Record your answer using one decimal place. ___ mL

The prescribed medication is 0.45 g. This should be converted to milligrams to match the available medication. The available concentration is 500 mg/5 mL. After the prescribed medication is converted to milligrams, use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A healthcare provider prescribes cefazolin sodium 375 mg intravenous piggyback (IVPB) every 8 hours. The vial of powder contains 500 mg of the medication. This must be reconstituted with 2 mL of 0.9% sodium chloride. In the resulting solution 1 mL contains 225 mg of cefazolin. How many mL of cefazolin solution should the nurse administer? Record your answer using one decimal place. ____mL

The prescribed medication is 375 mg. The available concentration is 225 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A nurse receives an order to give amoxicillin/clavulanate 50 mg/kg q4h to a 4-year-old child who weighs 35 pounds (16 kg). The medication label says that there is 200 mg of amoxicillin/clavulanate in 1 mL of normal saline. How much amoxicillin/clavulanate should the nurse give? Record your answer using a whole number. _____mL

The prescribed medication is 50 mg/kg. The child's weight is 16 kg. The available concentration of the medication is 200 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

The order reads: "Give calcitonin 50 international units subcutaneous daily." The medication is available in a vial that contains 200 international units/mL. How many milliliters will the nurse draw up in the syringe for this dose? Include a leading zero if applicable. Record your answer using two decimal places. _____mL

The primary healthcare provider instructs the nurse on the administration of calcitonin. The available dosage of the drug is 200 international units/mL (IU/mL); the required administering dose is 50 international units (IU). Each 1 mL of the injection delivers 50 IU of calcitonin, so 50 IU = 1 mL. Therefore, the nurse should draw up to 0.25 mL of the drug (50 × 1 ÷ 200 = 0.25) in the syringe.

A healthcare provider prescribes an initial loading dose of 75 mcg of oral digoxin for a school-aged child. The medication is supplied as an elixir, 50 mcg/mL. How many milliliters of solution will the nurse administer? Record your answer using one decimal place. ___ mL.

Use ratio and proportion to solve the problem. 1.5 mL