Medication

The nurse is teaching a nursing student regarding safety of chemotherapeutic medication. Which statement by the nurse is correct?

"Antineoplastic drugs can be absorbed through the skin."

The nurse is caring for an older adult client who sees several different health care providers and specialists. Which question will the nurse ask?

"Do you get all of your medications filled at the same pharmacy?"

The nurse is beginning to administer oral medications to a client. The client states, "I haven't taken that pill before. Are you sure it's correct?" The nurse rechecks the CMAR/MAR and finds that the medication is scheduled to be administered. Which response is most appropriate?

"Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." Explanation: This nurse should verify the medication with the prescriber. By this action, the nurse is adhering to the five "rights" of medication administration. A nurse and client should both be aware of medications that are prescribed and why they are prescribed. A nurse should not tell a client they should take a medication just because it is listed on the CMAR/MAR, nor should the nurse tell them to take it and they will follow up later. This could be a medication error.

The charge nurse has just completed an inservice with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?

"Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes." Explanation: The administration of medications to clients is a core nursing function that involves skillful technique and consideration of the client's development, health status, and safety. Also, the nursing process is often applicable to the skills of medication administration. Informing the new nurse that this profession may not be the one for them is not professional and does not foster respect for the person or the question raised. Professionalism is expected with each interaction with clients, family members and other health care members, including nursing students.

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

"I am taking tadalafil in addition to nitroglycerin." Explanation: Clients taking nitroglycerin in any form should not take drugs or herbs for erectile dysfunction. This may cause severe hypotension due to the combined vasodilation effect. Other client statements are appropriate and do not require further nursing teaching.

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

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

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance."

Which statement by a client indicates to the nurse that teaching was effective regarding the different parts of a syringe?

"The plunger is the part of the syringe that moves back and forth to withdraw and instill medication." Explanation: The plunger is that part of the syringe that moves back and forth to withdraw and instill the medication. Therefore, this statement is correct. The barrel not resetting the dose window to zero following an injection is one of the characteristics of an insulin pen and is therefore incorrect. It is the tip of the syringe to which the needle is attached, not the barrel. The plunger does not hold the medication; the barrel does.

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide?

"Wait 5 minutes between instillation of different types of eye drops."

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

-Rapid-acting insulin and short-acting insulin are often combined with intermediate-acting insulin.

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?

0.5 125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets

The nurse is teaching a client with diabetes about insulin pen injection. The nurse will teach that the insulin in prefilled pens is stable for how long?

1 month

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle Explanation: A 15-degree angle is correct, as this allows the drug to be injected between the layers of the skin. A 45-degree angle is incorrect, as this will allow the drug to be injected beneath the skin but above the muscle. A 90-degree angle is incorrect, as this will allow the drug to be injected in the muscle. A 120-degree angle is incorrect, as this will be more suitable for intravenous injections.

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 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 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

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?

90 degrees

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. 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 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?

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 is administering a piggyback infusion to a client with partial-thickness or second-degree burns. Which describes the most important feature of a piggyback infusion?

A parenteral drug is given in tandem with an IV solution. Explanation: In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency. IV medication or fluid is given all at one time as quickly as possible in a bolus administration, not in piggyback infusion. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution.

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?

As the gauge number becomes larger, the size of the needle becomes smaller. Explanation: The larger the gauge, the smaller the needle. The first number on a needle package is the gauge or diameter of the needle; the second number is the length in inches. When giving an injection, the viscosity of the medication directs the choice of 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?

Ask the client to maintain the position for some time 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.

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

Avoid crushing sustained-release pellets 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. Besides, 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

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 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 because the rate at which medication is administered is not as fast as during a bolus.

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration?

Check the tube placement before administration. Explanation: The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children). The nurse should never have the client swallow the pills if the client has an nasogastric tube.

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

Cleanse area at vaginal orifice with washcloth and warm water. 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 is caring for a client who has had a cerebrovascular accident. Prior to administering oral medications, what is the nurse's appropriate action?

Consult with a speech therapist for dysphagia.

The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate 40 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for clarification of the prescription. Explanation: Before administering the medication, the nurse should immediately contact the health care provider to verify the prescription; no one else can verify the prescription. The combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate and the drug propranolol are medications that have look-alike and sound-alike properties, but are very different in indication and dosage.

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?

Contact the health care provider for order clarification.

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. 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.

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location.

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?

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.

The nurse prepares to administer an antihypertensive medication at 0900 for a client who has problems swallowing and has a blood pressure of 88/50 mm Hg. Which action should the nurse perform when administering the medication?

Do not administer the medication with blood pressure 88/50 mm Hg. Explanation: The nurse should provide medications on time and follow facility guidelines, which may allow 30 minutes before or after the prescribed time. The medication is an antihypertensive and will lower blood pressure; since this client is hypotensive, the nurse should not give the medication and should call the primary care provider (PCP) to discuss the action taken. The PCP will decide if the dosage needs to be reduced or written parameters placed into the medication administration record. The client has problems swallowing, but a slow-release medication cannot be crushed because it would speed up its absorption and make the drug more readily available at one time, which could drastically lower the blood pressure. The nurse should stay with the client as the client takes medications for the safety of the client. Never leave medications unattended or on a tray of food.

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client?

Each unit of insulin is accompanied by a clicking sound in the pen.

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?

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 has an order to administer 80 mg of furosemide orally to a client. The drug is supplied in 40-mg white, round tablets. How will the nurse administer the medication?

Give 2 tablets

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?

Give written instructions to the client and caregivers.

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

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

A nurse is 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 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.

Which parenteral route of administration has the longest absorption time?

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 preparing medication for a client is called away to an emergency. What should the nurse do?

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.

A nurse is caring for a client who has been prescribed codeine, a narcotic medication to relieve severe postoperative pain. Which responsibility does the nurse have to complete when handling narcotic medications? Select all that apply.

Maintain an accurate account of the use of the medication. Record each medication used from the stock supply. Count each narcotic medication at the change of each shift. Explanation: When handling narcotic medications, the nurse should have an accurate account of the use of the medications and a record of each medication used from the stock supply, and the nurse should count each narcotic at the change of each shift. Narcotic medications are controlled substances, meaning that federal laws regulate their possession and administration. The nurse should not place the medication in the container with other prescribed medications or place the medication along with other medications on the nursing unit. An individual supply is placed in a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay.

To convert 0.8 grams to milligrams, the nurse should do which of the following?

Move the decimal point 3 places to the right.

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

Nurse Explanation: Whereas physicians and other healthcare providers prescribe and pharmacists dispense therapeutic agents, it is the nurse's legal domain to administer medications in a safe and timely manner.

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

Place the date on the vial and retain for future use.

The chemotherapy client has been admitted for thrombocytopenia. Which blood product will the nurse anticipate administering?

Platelets

Which technique should the nurse employ when instilling otic medication in an adult ear?

Pull the client's ear up and back.

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

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

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

Return the medication to the medication cart or medication room. 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 physician or the head nurse about the client's absence.

What would be considered a "right" of drug administration? Select all that apply.

Right drug Right documentation Right dose Right client

A nurse is preparing to administer a scheduled dose of enteric-coated ASA to a client who has a history of angina. When preparing the medication, the nurse is careful to check the five rights of medication administration. The five rights include which of the following?

Right time

A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point would the nurse include in the education plan?

Rotate the injection site. Explanation: Insulin may be administered subcutaneously in the upper arm, anterior or lateral aspects of the thigh, buttocks, or abdomen (avoiding a 2-inch radius around the umbilicus). Rotate the site for each injection systematically about 1 inch from the previous injection site. Rotation within one area is preferred to rotation to a new body area with each injection (in order to minimize daily variability in absorption associated with different sites, according to the ADA).

A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate?

Select another site.

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

Stay with the client while medications are taken. Explanation: The nurse must wait with the client to personally acknowledge that medications have been taken (or refused). Other actions are taken after the client has taken the medication.

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?

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

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

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

Tactfully request the provider to input the order into the computerized provider order system. Explanation: Providers are to enter their own orders when they are physically present. It is appropriate for the nurse to tactfully request that the provider do so. The nurse should not input the order, nor refuse to implement it.

A nurse needs to withdraw a prescribed medication from an ampule and administer it to a client. Which action should the nurse perform to ensure that all the medication is equally distributed when withdrawing?

Tap the top of the ampule before withdrawing the medicine. Explanation: Tapping the top of the ampule distributes all the medication to the lower portion of the ampule. Tapping the barrel of the syringe near the hub does not distribute medication equally, but moves the air toward the needle. Inserting the filter needle in the ampule ensures sterility of the needle. Using a smaller- or larger-gauge needle does not ensure that all the medication is equally distributed when withdrawing.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation?

The most common site for an intradermal injection is the inner aspect of the forearm. Intradermal injections are commonly used for diagnostic purposes. Examples include tuberculin tests and allergy testing. Small volumes, usually 0.01 to 0.05 mL, are injected because of the small tissue space. Other areas that may be used are the back and upper chest, not the stomach.

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

The nurse should use a nebulizer to administer the medication. 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.

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

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

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 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.

A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler?

a canister containing medication that is released when the container is compressed

To which client would the nurse be most likely to administer a p.r.n. medication?

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 p.r.n. 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 nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not?

aspirating for a blood return

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

bolus administration

A client with chronic obstructive pulmonary disease has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client:

breathes through his or her mouth until all the medication has been inhaled. Explanation: The client should breathe through his or her mouth rather than through the nose. It is not necessary to rinse before administration or to cough during administration. Deep breathing is preferable to shallow breathing because this improves absorption.

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 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 caring for a client with typhoid at a health care facility. The nurse checks the medication order in the client's chart for the drugs prescribed to the client. Which component is a required component of the medication order?

client's name Explanation: The client's name is an important component of the medication order; without it, the nurse should withhold the administration of the drug. The client's age, diagnosis, and signature are not components of the medication order. Other components of the medication order include the date and time the order is written, the drug name, the dose to be administered, the route of administration, the frequency of administration, and the signature of the person ordering the drug.

A client's eMAR 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?

decreased irritation and pain in subcutaneous tissue Explanation: This technique is Z-tracking. The Z-track technique allows the medication to be administered into the muscle tissue with no tracking of medication in the subcutaneous tissues as the needle is removed, resulting in less pain and irritation.

A client at a health care facility has been prescribed scopolamine, to be administered transdermally. Which statement describes transdermal application?

drugs bonded to an adhesive and applied to the skin Explanation: Transdermal applications are drugs that are bonded to an adhesive and applied to the skin. After application, the drug migrates through the skin and eventually is absorbed into the bloodstream. Pastes are drugs within a thick base that are applied, but not rubbed, into the skin. Sublingual applications are drugs that are placed under the tongue and left to dissolve slowly. Buccal applications are drugs that are placed against the mucous membrane of the inner cheek.

Which component of a syringe's needle does the nurse recognize that refers to width?

gauge

The nurse is preparing to attach a label to an intravenous medication that is being administered by continuous infusion. Which component will the nurse include on the label? Select all that apply.

initials of nurse time drug was added dose identification of drug

A nurse is using the Z-track technique to administer an injection to a client. Which injection route utilizes the Z-track technique?

intramuscular Explanation: When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique. Clients report slightly less pain during (and the day after) a Z-track injection compared with the usual intramuscular injection technique. The Z-track technique is not suitable for intravenous injections, as they are administered into the veins, nor is it used for intradermal or subcutaneous injections.

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

medications that need to be infused over 20 to 60 minutes Explanation: Intermittent infusions are used for medications that need to be administered for an intermediate length of time, usually 20 to 60 minutes. The intravenous push technique is used for medications that can be given over 1 minute for rapid therapeutic effect, and may be given into a continuously infusing IV set or into a capped IV port. The continuous infusion technique is used for medications that are toxic if given over short periods.

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

miconazole (vaginal cream) Oxymetazoline is a nasal decongestant used to alleviate congestion; bisacodyl is a rectal suppository used for softening stool; timolol is an eye drop used to treat glaucoma.

When administering heparin subcutaneously, the nurse should:

never aspirate.

A nurse is administering a prescribed intramuscular injection to a client by the Z-track method. Which action ensures that the medicine remains sealed?

pulling the tissue laterally until the tissue is taut Explanation: To ensure that the medication remains sealed within the muscle, the nurse should pull the tissue laterally until the tissue is taut. This tissue should be held in place until the needle is removed. Inserting the needle at a 90-degree angle does not ensure that the medication remains sealed, but directs the tip of the needle well within the muscle. Withdrawing the needle and instantly releasing taut skin prevents leaking of the medicine into the subcutaneous and dermal layers of tissue. Applying pressure but not massaging the injection site ensures that the medication remains sealed.

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

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

An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method?

self-contained packets that hold one tablet or capsule for individual clients Explanation: The nurse should understand that a unit dose supply method is a method in which self-contained packets hold one tablet or capsule for an individual client. An individual supply is a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay. Some facilities use automated medication-dispensing systems, which contain frequently used medications for that unit, any as-needed (p.r.n.) medications, controlled medications, and emergency medications.

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

spacer Explanation: A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption, because it prevents drug loss. A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. Nasal drops are liquid medication sprayed or dropped into the client's nose. These, however, would not help in maximizing the absorption of the medication.

Drugs known to cause birth defects are called:

teratogenic.

A graduate nurse is administering several medications to a newly admitted client. Who is legally responsible for the drugs administered by this nurse?

the nurse administering the drugs Nurses are legally responsible for the drugs they administer and any drug order suspected to be in error written by a prescriber such as a physician, nurse practioner, doctor of osteopathic medicine (DO) should be questioned. The pharmacist would check the dosing of the medication and dispenses the medication as written. The nurse manager is responsible for hiring and managerial functions of the unit.

The primary reason for the Controlled Substances Act is:

to prevent drug use and dependence. Explanation: The primary reason for the Controlled Substances Act is to prevent drug use and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug use laws.

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

• Perform hand hygiene before and after medication administration. • Stay at the bedside until the patient has swallowed all the medications. • Verify the patient'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.