med review questions

A physician has ordered Morphine (an opioid) and Vistaril (antianxiety medication) to be administered together to produce pain relief for a patient. When smaller doses of each are administered together, the effect is greater than if they were given separately. This effect is an example of: a. A synergistic effect b. A therapeutic effect c. An adverse effect d. An idiosyncratic effect

Correct answer: A

An alert patient has refused to take her prescribed medications, stating, "The medication isn't doing me any good!" What should you do? a. Crush the patient's medications and disguise them in some of the patient's food. b. Assess further as to why the patient feels this way and notify the physician of the patient's refusal. c. Instruct the patient that the physician may refuse to treat her if she is nonadherent. d. Leave the medications at the patient's bedside in case she changes her mind.

B Rationale: Any withheld medication should be reported to the prescriber. Assessment may allow you to determine whether the patient requires further instruction regarding the medication regimen. You should also document the patient's refusal. The patient has the right to refuse medication. Medications should never be left at the patient's bedside. The physician should be notified of any withheld medication. If a patient refuses medication, never return unwrapped medication to a container; discard it. If the medication wrapper remains intact, the medication may be returned to the patient's unit-dose drawer. Refusal of mediation must be documented and the prescriber notified within 24 hours.

If a physician's handwriting is difficult to read and as a result the nurse administers a wrong medication or incorrect dosage, then who is legally responsible for the error? a. The physician b. The nurse who gave the medication c. The pharmacist who filled the medication order d. The hospital

B Rationale: The nurse who gives the wrong medication or an incorrect dosage is legally responsible for the error. If the physician's handwriting is illegible, you should verify the order with the physician.

Which term refers to the movement of a drug from the site of administration to the bloodstream? a. Distribution b. Metabolism c. Excretion d. Absorption

Correct answer D Rationale: Absorption refers to the movement of drug from the site of administration into the bloodstream. Distribution involves the transport of the drug in body fluids, such as blood, to the tissues and organs. Metabolism is the biotransformation of the drug into a more water-soluble form or into metabolites that can be excreted from the body. Excretion, or the removal of drugs from the body, takes place in the kidneys, liver and gastrointestinal tract, lungs, and exocrine glands.

Which of the following is most important to check prior to administering a medication to a patient? a. Medical condition b. Vital signs c. Other prescription medications d. Allergy status

Correct answer D Rationale: Check the patient's chart to see if any allergy status is recorded. If not, be sure to ask the patient. Also remember to check the drug's generic and brand names to avoid inadvertent administration.

An 81-year-old cachectic woman (weighing 40 kg) requires iron dextran 1 mL intramuscularly. How will you administer this injection? a. Choose a 21-gauge, 0.5- to 1-inch needle, and administer the injection with the Z-track technique at a 90-degree angle. b. Choose a 21-gauge, 1.5-inch needle, and administer the injection at a 90-degree angle. c. Avoid aspirating, because this will increase tissue irritation. d. Choose a 21-gauge, 1-inch needle, and administer the injection with the Z-track technique at a 45-degree angle.

Correct answer: A Rationale: A thin patient may require only a 0.5- to 1-inch needle. A larger gauge is chosen because iron dextran is viscous. The angle of insertion for an IM injection is 90 degrees. All IM injections should be given with the Z-track technique. All IM injections should be aspirated to avoid administering medication directly into a blood vessel.

The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? a. Ask the prescriber to change the order b. Crush the pill with a mortar and pestle c. Hide the capsule in a piece of solid food d. Open the capsule and sprinkle it over pudding

Correct answer: A Rationale: Enteric-coated or sustained-release capsules should not be crushed; the nurse needs to contact the prescriber to change the medication to a form that is liquid or can be crushed.

Which of the following patients should you observe the closest for a toxic effect? a .The patient who has a history of urticaria, pruritus, and wheezing after taking an antibiotic b. The patient who has liver and kidney problems and takes high doses of aspirin to relieve her pain c. The patient who appears more agitated after receiving a sleep aid d. The patient who experiences constipation and nausea while taking pain medication

Correct answer: B Rationale: Many medications are metabolized in the liver and excreted in the kidney. In a patient with liver and kidney disease, the medication may not be metabolized or excreted and the patient will build up toxic levels in their body.

Which of the following are contraindications to oral medication administration? (Select all that apply.) a. Confusion b. Inability to swallow c. Nausea/vomiting d. Postop for gastrointestinal surgery e. Continuous gastric suction f. Fluid restriction

Correct answer: B, C, D, E Rationale: Alterations in gastrointestinal function can interfere with drug absorption, distribution, and excretion. Giving oral medication to patients with impaired swallowing increases their risk of aspiration. The following are contraindications to oral medication administration: inability to swallow, nausea/vomiting, bowel inflammation, reduced peristalsis, gastrointestinal surgery, and gastric suction.

The correct way to administer ear drops to an adult client is to pull the pinna: a. Straight back b. Down and back c. Upward and outward d. Straight down

Correct answer: C

A nurse is administering medications to a 4-year-old patient. After he or she explains which medications are being given, the mother states, "I don't remember my child having that medication before." What is the nurse's next action? a. Give the medications b. Identify the patient using two patient identifiers c. Withhold the medications and verify the medication orders d. Provide medication education to the mother to help her better understand her child's medications

Correct answer: C Rationale: Do not ignore patient or caregiver concerns; always verify orders whenever a medication is questioned before administering it.

What should a nurse do if he or she thinks that the prescribed medication may be wrong for a particular patient? a. Administer it since it is unlikely that the doctor and/or pharmacist made a mistake b. Administer it as there likely won't be any adverse side effects c. Don't administer it and make a note in the patient's chart as to reasons why d. Notify the doctor to get clarification and confirmation of the prescribed medication before administering it

Correct answer: D Rationale: If unsure, always question the order before administering the medication.