Module 1

The serum half-life of a drug is: - The time required after absorption for half of the drug to be eliminated from the body - The time required for the drug to become effective in the body. - The time required for half of a drug dose to be absorbed into the systemic circulation. - The time required for the drug to have peak effects.

- The time required after absorption for half of the drug to be eliminated from the body

Effectiveness of health teaching and drug therapy is associated with which of the following phases of the nursing process? -Implementation - Assessment - Planning - Evaluation

- Evaluation

Trough level is the: - Highest plasma concentration of a drug. - Lowest plasma concentration of a drug. - Minimum effective concentration of a drug. - Rate of absorption of a drug.

- Lowest plasma concentration of a drug.

The term used when elderly clients are on many different drugs to treat various illnesses is known as: - Pharmaceutics. - Pharmacodynamics. - Pharmacognosy. - Polypharmacy.

- Polypharmacy.

250mcg = ___mg

0.25

1.25 L = ___ mL

1250

5 ounces = ___ mL

150

2 Tbsp = ___ mL

30

3gm=___ mg

3000

When preparing to administer heparin or insulin subcutaneously, which site is preferred? A. Abdomen B. Scapula C. Deltoid muscle D. Back of the upper arm

A. Abdomen Rationale: The abdomen is the preferred site for subcutaneous heparin or insulin injection. The scapula, deltoid muscle, and upper arm are not the preferred sites for subcutaneous heparin or insulin injections.

What is the best way for the nurse to ensure that a patient receives the correct dose of a medication? A. Compare the prescriber's order with the MAR before dispensing the medication. B. Ask the patient if he would like a larger dose of pain medication. C. Assess the patient's ability to swallow oral medications without difficulty. D. Check the name of the medication three times against the MAR.

A. Compare the prescriber's order with the MAR before dispensing the medication. Rationale: Reconciling the order with the MAR at the point of delivery ensures that the correct dose is selected. Assessing the effectiveness of pain medication is important, but the patient cannot increase the amount of medication he receives. Although it is appropriate to assess swallowing ability, doing so does not ensure the correct medication dose is give. Checking the name of the medication is required, but it will not ensure that the dose is correct. Medications come in a variety of strengths, and name and dose must be checked three times.

When is a patient at a higher risk for a medication administration error? A. During a care transition point, such as transfer to another unit B. While on a hospital unit for an extended length of time C. On the third postoperative day D. When taking an active role in self-administration of insulin

A. During a care transition point, such as transfer to another unit Rationale: Medication errors are more likely to occur during care transition points, such as at admission or discharge or just after transfer to a new unit. The length of time a patient is on a floor does not increase the risk for medication errors. Having had a surgery three days ago does not increase the risk for medication errors. Self-administration of insulin injections should be encouraged and does not increase the risk for medication errors.

While reviewing a new medication order, the nurse notes that the frequency of administration has been omitted. What is the nurse's best response? A. Immediately contact the prescriber to complete the order. B. Refer to a current drug book for the most commonly prescribed dosage. C. Call the pharmacy to determine the frequency. D. Ask a registered nurse who is familiar with the prescriber to identify the usual frequency ordered.

A. Immediately contact the prescriber to complete the order. Rationale: The prescriber is required to include all pertinent information on the prescription. Referring to a current drug book is not an appropriate means of addressing an omission in a medication order. Calling the pharmacy to determine the frequency is not an appropriate means of addressing an omission in a medication order. Asking another nurse is not an appropriate means of addressing an omission in a medication order.

When preparing to administer a new medication, what would the nurse do first to ensure the patient's safety? A. Perform hand hygiene. B. Compare the written order with the medication administration record (MAR). C. Inform the patient about the medication. D. Review appropriate nursing considerations.

A. Perform hand hygiene. Rationale: The first step in preparing to administer a new medication would be to perform hand hygiene. Although it is appropriate to compare the written order with the medication administration record (MAR), to inform the patient about the medication, and to review applicable nursing considerations, doing so would not be the nurse's first step in preparing to administer a new medication.

Which site is most commonly used for intramuscular injections? A. Ventrogluteal B. Abdominal C. Deltoid D. Dorsogluteal

A. Ventrogluteal Rationale: The ventrogluteal site is the preferred IM injection site for adults and children, but not for infants and toddlers. The abdomen is used for subcutaneous injections. The deltoid site is an appropriate choice for small volumes, but it is not the preferred site for intramuscular injections. The dorsogluteal site is contraindicated for intramuscular injections.

Three weeks after delivery of her baby, a patient started a diet of 800 calories per day and started jogging 2 miles twice per day. The nurse recognizes that the patient's behavior may be most influenced by which motivating factor? a. Body image b. Environment c. Illness behavior d. Chronic illness

Answer: a Body image is a self-ascribed attribute that influences a person's ability and desire to change, and it may be a motivating factor to maintain the change. Self-concept is a general and broader factor that motivates less specific responses. The environment is not an influencing factor because this is a personal and possibly self-destructive behavior pattern for weight loss. Pregnancy is not a chronic illness.

The nurse is developing a plan of care for a patient. What is the most appropriate goal for a patient related to medications? a. The patient will administer all medications correctly by discharge. b. The patient will be taught common side effects of prescribed medications. c. The patient will have a good understanding of prescribed medications. d. The patient will have all medications administered by staff as prescribed.

Answer: a Evaluating the patient's ability to correctly administer medications is a patient-centered and measurable goal. Teaching side effects and administering medications by staff are nursing goals. Desiring a "good understanding" is not a measurable goal.

A teenage girl faces a long hospitalization after surgery. How can the girl's continued development be fostered? a. Encourage her to write her feelings in a journal. b. Divert her attention by playing video games. c. Encourage her to work on craft projects. d. Make sure her parents are constantly by her side.

Answer: a Teenagers are capable of abstract thought and often find it helpful to verbalize their feelings either by talking or by journaling. Diverting her attention by playing video games and encouraging her to work on craft projects are measures that may be used to help her pass the time but are not methods of fostering teen development. Teens usually do not wish parents to be at their side constantly and may want some private time away from them.

Which activity best illustrates the use of the Health Promotion Model (HPM) by the nurse to increase the level of well-being for a patient immediately after surgery? a. Holding a pillow across his chest when coughing and deep breathing b. Encouraging the patient to eat his entire evening meal c. Changing his surgical dressing daily as ordered by the physician d. Asking his family to step out of the room during dressing changes Answer: a The HPM describes an individual's interaction with his environment as he engages in behaviors that promote health. The patient using a pillow as a splint is interacting with his environment to prevent atelectasis and infection.

Answer: a The HPM describes an individual's interaction with his environment as he engages in behaviors that promote health. The patient using a pillow as a splint is interacting with his environment to prevent atelectasis and infection.

Which action by a 3-month-old infant would the nurse interpret as an example of Piaget's sensorimotor stage of primary circular reaction? a. Deliberately placing the thumb into the mouth b. Accidentally kicking a ball c. Searching for an object under a blanket d. Shaking a rattle

Answer: a The deliberate action of placing the thumb in the mouth elicits a pleasurable effect. Accidentally kicking a ball is not a deliberate action. Searching for objects and shaking a rattle occur at later stages.

A nurse providing preventive care to an overweight female with a family history of diabetes should engage in which priority care-planning activity for this patient? a. Calculating the patient's waist-to-hip ratio and recommending a daily exercise routine b. Instructing the patient to perform blood glucose monitoring once daily c. Giving the patient a month's supply of insulin needles and syringes d. Suggesting the patient participate in diabetes education classes offered at a local health facility

Answer: a The female patient does not have diabetes but is overweight and at risk due to a family history of diabetes. The best way to prevent diabetes is to keep her waist-to-hip ratio in the low-risk range (0.80 or lower). Beginning an exercise program with walking and progressing as tolerated increases muscle mass, improves depression, and strengthens the heart.

The nurse is in a patient room ready to administer a new medication to the patient. Which action best demonstrates awareness of safe, skilled nursing practice? a. Identify the patient by comparing the patient's name and birth date to the medication administration record (MAR). b. Determine whether the medication and dose are appropriate for the patient. c. Make sure that the medication is in the medication cart. d. Check the accuracy of the dose with another nurse.

Answer: a The right patient is one of the six rights to ensure safe administration of the medication. At least two patient identifiers should be used and compared with the armband or MAR. Determining the appropriateness of a medication for a patient should be completed prior to entering the patient room. Not all medications require another nurse to check the accuracy of the dose. Determining whether the medication is available is a time management issue.

The nurse is caring for a critically ill patient. What are the contraindications for administering medications by the oral route for this type of patient? (Select all that apply.) a. Vomiting b. Unconsciousness c. Diarrhea d. Penicillin allergy e. Intubation

Answer: a, b, e Nothing that needs to be swallowed should be administered to an unconscious patient due to the risk of aspiration. Medications are unlikely to be absorbed in the patient who is vomiting. An endotracheal tube makes it impossible for a patient to swallow oral medication. A penicillin allergy affects the type of medication to administer but not the route. A patient with diarrhea may have decreased absorption, but it does not affect the ability to swallow medications safely.

A patient has been using herbal medication as part of her daily routine. Which actions should the nurse take? (Select all that apply.) a. Document the herbs as part of the medication history. b. Recommend a reputable company from which to buy herbs. c. Allow the patient to self-administer the herbs with her morning medications. d. Inform the primary care provider of the findings. e. Identify possible adverse effects of the herbal medications.

Answer: a, d, e It is important to include the herbal medications that the patient reports using in the medication history because there is the possibility of interactions among herbals and prescribed medications. The primary care provider should always be informed about the herbs being used by the patient. It is essential for the nurse to identify potential adverse effects of the herbal medications to prevent harmful drug interactions. It is inappropriate for the nurse to recommend a company for the patient to purchase herbal preparations and to allow the patient to self-administer the herbs while in the hospital without a specific physician order.

While assessing a patient for domestic violence, the nurse knows that which statement is true regarding domestic violence? a. It is a health risk factor only during young adulthood. b. It occurs across age, socioeconomic levels, and cultural boundaries. c. Young women aged 20 to 24 have the lowest incidence of rape and sexual assaults. d. Women are the only victims of domestic violence.

Answer: b All socioeconomic levels and cultures are affected by domestic violence. It is a health risk for adults of all ages—from young to older adulthood. Young women have the highest rate of rape and sexual assault. Women are not the only victims of domestic violence. Men also may be victims of domestic violence and sexual assaults, although they are less likely to report it or to seek care.

What action should be taken by the nurse first when preparing to administer medications to a patient? a. Check the medication expiration date. b. Check the medication administration record (MAR). c. Call the pharmacy for administration instructions. d. Check the patient's name band.

Answer: b Checking the MAR is the first step in administering medications. Checking the expiration date and administration instructions is done only after the order is verified. Checking the patient's name band is one of the six rights of medication administration, but it is done after the MAR has been checked and the drug, dose, route, and time of administration have been verified.

Which behavior by the young adult patient indicates an understanding of patient education aimed at reducing the health risks for that age group? a. Smoking only one pack of cigarettes per day b. Limiting alcohol use to an occasional drink c. Using drugs found in a roommate's drawer for anxiety d. Having a relationship with a partner who was threatening in the past

Answer: b Having an occasional drink shows control and moderation. Smoking any amount is damaging to the lungs, and education for cessation is needed. Using any drugs that are not directly prescribed for the person shows a lack of understanding of the risks of drugs. Staying in a relationship that has been dangerous in the past increases the risk of intimate partner violence.

A patient is seeking information about leading indicators that show the importance of health promotion and illness prevention in the United States. To which government-sponsored resource would the nurse refer the patient for the best comprehensive source of information? a. The American Cancer Society website b. The Healthy People 2030 website c. The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report d. The American Association of Hospitals home page

Answer: b Healthy People 2030 is the most up-to-date site for health indicators in the United States, and it is presented in an easy-to-understand format. The CDC Morbidity and Mortality Weekly Report does not cover all of the indicators, and it may be overly technical for the patient. The same holds true for the American Association of Hospitals home page. The American Cancer Society website would supply the consumer with information specific to cancers as opposed to the comprehensive health information found in the Healthy People 2030 document.

The nurse is performing a health assessment on a 15-year-old female patient. Which is the best way to obtain accurate information regarding her sexual activity? a. Ask the mother about the girl's sexual activity. b. Privately ask the girl about her sexual activity. c. Warn the girl about the dangers of sexual activity. d. Ask the girl if she wants birth control.

Answer: b Privately asking the girl about her sexual activity in an open and nonjudgmental fashion is the best way to obtain accurate information. Asking the mother about the girl's sexual activity may be embarrassing for the teen and her mother and may not provide accurate information. Warning the girl about the dangers of sexual activity is making a judgment. It is important to provide a nonjudgmental approach with teens. The teen may have additional questions about sexuality beyond the topic of birth control; thus, it is important to approach the teen in a manner that encourages open discussion.

A 2-year-old child insists on having a drink of water and having a story read to him and says, "Good night, sleep tight" at bedtime every night. The nurse knows the child is exhibiting which type of behavior? a. Controlling b. Ritualism c. Obsession d. Compulsion

Answer: b Ritualism offers the toddler a sense of security and comfort. The child is not trying to control his behavior with the ritual. Obsession and compulsion are terms commonly used in patients in older age groups and describe maladaptive behaviors.

An active older patient has been frequently evaluated for minor problems at the clinic since the death of her husband 3 months earlier. During one of her visits, she states that she is tired from not sleeping well, feels restless, and is nervous about attending her Tuesday night bridge club. Which type of holistic health model intervention should the nurse employ to help the patient cope with the loss of her husband? a. Encouraging prn use of antianxiety medication ordered by her provider b. Sharing the value of music therapy to address anxiety about her loss c. Explaining that she will be over the loss of her husband in a few months d. Encouraging a gradual reentry into social interaction and activities with friends

Answer: b Sharing the value of using music therapy to reduce anxiety surrounding her loss is the most holistic health model intervention listed. This type of distraction is a holistic technique that works well in the form of music, painting, and expressive dance. Instructing the patient to use drugs is not part of the holistic approach. The patient may not be ready to re-engage in a full activity schedule, and it is unlikely that her feelings of loss will ever totally resolve.

The nurse enters a patient's room and notices that the patient has not been out of bed since the previous day. The patient states that his condition has made him bedridden, although the nurse knows that he is capable of independent ambulation. Which type of reaction is the patient exhibiting? a. Ambivalence to symptoms b. Illness behavior c. Diminished functional ability d. Overreaction to illness

Answer: b The patient is defining and interpreting his disease symptoms according to his beliefs about illness and how to respond to it. The patient's ability to ambulate is intact. Overreaction to illness is a subjective anomaly, and the patient is not ambivalent about his diagnosis.

Which term indicates a mental health disorder that is frequently seen in older adults? a. Schizophrenia b. Bipolar disorder c. Depression d. Posttraumatic stress disorder (PTSD)

Answer: c Depression is one of the psychiatric illnesses appearing frequently in the older adult population. Schizophrenia typically is seen in younger adult populations. Bipolar disorder is usually identified before age 65 years. PTSD can be seen in any age group and usually is related to previous experience of a traumatic event.

For which person seen at the primary care provider's (PCP's) office appointment would patient and family education be most critical? a. A 24-year-old male patient with a cold virus and on no medications b. A 45-year-old male patient on metformin for type 2 diabetes for the past 3 years c. A 75-year-old female patient just prescribed the anticoagulant warfarin d. A 40-year-old male asthmatic patient diagnosed 10 years ago and on albuterol

Answer: c Educating the patient and family members to the side effects of the anticoagulant warfarin and its potential for bleeding is a critical part of care for the 75-year-old female patient who has just started taking this medication. A 25-year-old male patient is young, and his immune system has the potential to fight off a cold virus. Education about a cold versus the flu would be helpful but is not critical. A middle adult who has had diabetes and has been maintained on this medication for 3 years would have had education when he was first started on the medication. A patient who has been using asthmatic medication for the past 10 years is likely to be knowledgeable about the medication from previous use.

An 8-year-old girl is newly diagnosed with type 1 diabetes. The nurse may expect fear and crying when teaching the child how to self-administer insulin injections due to which influencing factor? a. Self-concept b. Self-esteem c. Developmental level d. Hierarchy of needs

Answer: c Even when the child understands about having the disease, she is less likely to understand the need for insulin therapy due to her emotional and comprehension level of development. A child's self-concept is not well established at this point, and self-esteem is not a major factor. Hierarchy of needs is not yet fully developed because the child depends on her parents for the basic level of needs.

The health care provider prescribes a transdermal medication. The nurse understands what feature of the transdermal route? a. It is inhaled into the respiratory tract. b. It is dissolved inside the cheek. c. It is absorbed through the skin. d. It is inserted into the vaginal cavity.

Answer: c Medicated patches or disks can be applied directly to the skin. The transdermal route of administration allows release and absorption of the medication through the skin over time, producing a steady drug level. Medications that are inhaled are aerosolized and not absorbed through the skin. The buccal route (inside the cheek) is a form of topical administration, but it is through the mucous membranes of the mouth, not transdermal (through the skin). Medications administered vaginally are topical, but they are applied to the mucous membrane of the vaginal wall, not to the skin.

Which group is referred to as the sandwich generation? a. Older adults who are caretakers for their elderly parents b. Younger adults who are reexamining their life choices c. Middle adults who are caretakers for multiple generations of their family d. Younger adults who are changing employment constantly

Answer: c Middle adults who are caretakers for multiple generations of their family tend to be sandwiched in between the needs of children, grandchildren, and elderly parents, all of whom need their attention and care. This situation can lead to many health and financial problems for the middle adult. Although older adults caring for their elderly parent also may experience significant stresses, they would not be called the sandwich generation unless they also were caring for younger members of their family. Younger adults may change jobs or middle adults may reexamine choices they have made, but these factors do not reflect the concept of the sandwich generation.

A patient diagnosed with an aggressive cancer is estimated to have 6 months to live. Two months later, the patient's wife calls the nurse's office because she is upset that her husband has taken up motorcycle racing and has already been injured twice. The nurse knows that the patient is experiencing a behavioral change in which factor due to the prognosis of his illness? a. Spirituality b. Physical attributes c. Self-concept d. Personal affect Answer: c Self-concept is profoundly affected by the diagnosis of a terminal disease. People often try to reinvent themselves and behave in an uncharacteristic manner in the face of such a diagnosis.

Answer: c Self-concept is profoundly affected by the diagnosis of a terminal disease. People often try to reinvent themselves and behave in an uncharacteristic manner in the face of such a diagnosis.

The nurse is teaching a patient about how to take a sublingual nitroglycerin tablet. Which statement by the patient best demonstrates understanding of the teaching? a. "I will take the tablet with plenty of water." b. "I will place the tablet inside my cheek." c. "I will put the tablet under my tongue." d. "I will take the tablet while I am eating."

Answer: c Sublingual medications are placed under the tongue, where they are absorbed quickly into systemic circulation. Medications placed in the cheek are delivered by the buccal route. Sublingual medications should be taken without water or food.

The nurse is caring for a patient who is unable to hold a cup or spoon. How should the nurse administer oral medications to the patient? a. Crush the pills and mix them in pudding before administering. b. Ask the pharmacist to change all of the medications to a liquid form. c. Use a small paper cup to place the pills into the patient's mouth. d. Place the pills on the table and have the patient take the pills by hand.

Answer: c The nurse assists the patient by using a small cup to place the medications into the patient's mouth. Using a cup rather than the nurse touching the pills maintains medical asepsis. Crushing the pills with food is appropriate for a patient with dysphagia, not for a person who is unable to hold objects. Liquid medications may be used for some swallowing difficulties or to replace very large pills. It is not safe to leave medications on a table, because they can be contaminated, lost among other items, dissolve in spilled liquids, or be missed. Leaving the pills on a table does not address this patient's difficulty in holding objects and is not aseptic.

The nurse reviews a primary care provider's order and finds that the medication amount is greater than the standard dose. What action should the nurse take? a. Give the standard dose rather than the one that is ordered. b. Consult with the nursing supervisor to get a second opinion. c. Call the primary care provider to discuss the order in question. d. Administer the medication as ordered by the primary care provider.

Answer: c The nurse is responsible for understanding and further investigating a medication order that falls outside an acceptable standard. Ultimately, nurses are responsible for their own actions despite a PCP's written order. It is not within the nurse's scope of practice to alter a medication order. However, the nurse has the right to refuse to give a medication and the responsibility to question orders, as necessary, to ensure patient safety. Consulting with the nursing supervisor for a second opinion is unnecessary.

What is the best activity for a hospitalized school-age child to encourage continued appropriate development? a. Watching favorite television shows for 2 hours per day b. Keeping a journal of feelings while in the hospital c. Working on a paint-by-number project that can be completed in an afternoon d. Playing a favorite video game each afternoon

Answer: c The school-age child is in Erikson's stage of industry. He needs to work on projects that build a sense of accomplishment. A painting project that can be completed in one afternoon gives a sense of accomplishment. Although the other options are activities, they do not contribute to the primary developmental task of the school-age child—developing a sense of industry.

How is the toddler's need for autonomy best met? a. The parents' consistently meeting the child's needs b. Encouraging imaginative play c. Allowing the child limited choices d. Promoting experimentation to determine cause and effect

Answer: c The toddler's need for autonomy can best be supported by allowing the child choices within limits. Parents consistently meet the child's needs during the infant period. In later developmental stages, imaginative play is encouraged, and experimentation is promoted to determine cause and effect.

A 65-year-old male patient has been a one-pack-per-day smoker for 40 years. He was recently diagnosed with chronic obstructive pulmonary disease (COPD) and would like to attend a smoking cessation class. The nurse recognizes smoking cessation as which level of prevention for this patient? a. Primary prevention b. Secondary prevention c. Statutory prevention d. Tertiary prevention

Answer: d According to the stages for disease prevention, primary prevention is implemented for the absence of disease, secondary prevention applies to the early stages of disease or recently diagnosed risk factors, and tertiary preventive care is offered for permanent and irreversible disease. In this case, even though the patient's COPD was recently diagnosed, the care would be considered tertiary prevention because his condition is permanent.

Which of the listed basic needs identified by Maslow must be addressed first when providing nursing care? a. Self-esteem b. Love and belonging c. Self-actualization d. Nutrition and elimination

Answer: d Nutrition and elimination must be addressed first before concerns about self-esteem, love and belonging, and self-actualization, according to Maslow's hierarchy of needs. According to Maslow, the lower-level needs must be fulfilled and maintained before the higher-level needs can be met.

A preschooler's mother is concerned because her child behaves in a mean fashion toward her younger brother. The mother states, "She acts like she has no sympathy for him!" What is the nurse's best response? a. "She is very young to exhibit sibling rivalry." b. "What does her brother do to her to make her act this way?" c. "Do you fight at home? She is probably imitating you." d. "Preschoolers are not capable of putting themselves in another's place."

Answer: d One characteristic of preschool thought is that it is egocentric. That is, preschoolers are not yet able to see a situation from another's point of view. Sibling rivalry commonly appears in the preschool period. The brother's behavior has no bearing on the mother's expressed concern. The child is not necessarily imitating adult behavior but is displaying appropriate developmental characteristics.

Match the infant reflex name with the behavior observed. a. Sucking reflex b. Moro reflex c. Rooting reflex d. Tonic neck reflex e. Babinski reflex i. In response to a loud sound, babies will extend their arms, throw back their head, and often cry. ii. When the sole of the infant's foot is stroked, the infant's big toe moves upward, while the remaining toes fan outward. iii. When an infant is lying in a supine position and the head is turned to the side, the infant will extend the arm on the side the head is facing. The opposite arm will be bent. iv. When the corner of a baby's mouth is touched, the baby will turn the head toward the touch and open the mouth. v. When the roof of a baby's mouth is touched, the baby will begin to suck

Answers: Reflex Name Behavior Observed a. Sucking reflex v. When the roof of a baby's mouth is touched, the baby will begin to suck. b. Moro reflex i. In response to a loud sound, babies will extend their arms, throw back their head, and often cry. c. Rooting reflex iv. When the corner of a baby's mouth is touched, the baby will turn the head toward the touch and open the mouth. d. Tonic neck reflex iii. When an infant is lying in a supine position and the head is turned to the side, the infant will extend the arm on the side the head is facing. The opposite arm will be bent. e. Babinski reflex ii. When the sole of the infant's foot is stroked, the infant's big toe moves upward, while the remaining toes fan outward.

Which of the following would be examples of positive reinforcers? (Select all that apply.) a. Clapping for a child who successfully used the toilet b. Offering praise for a child who behaved in a store c. Taking a child to the playground after a positive teacher report d. Placing a child in time-out for misbehavior. e. Stickers for positive play with peers.

Answers: a, b, c, e Clapping, offering praise, and giving rewards are all positive reinforcements that are likely to increase desired behavior(s). Time-out is a type of negative punishment used to discourage unwanted behavior.

Which factor(s) is/are likely to influence the transition from adolescence to adulthood? (Select all that apply.) a. Cultural beliefs b. Societal values c. Personal beliefs and expectations d. Governmental rules e. Peer influences

Answers: a, b, c, e Cultural beliefs, societal values, personal beliefs and expectations, and peer influences are all factors that influence an individual's transition into adulthood. Although governmental rules may influence certain societal values and beliefs, they are not directly responsible for the transition through adulthood.

When an injury to a child is suspicious for abuse, which is/are important to document? (Select all that apply.) a. Size and location of bruising b. Distinguishing characteristics of injuries c. Height and weight of the child d. Time of last meal e. General state of health of the child

Answers: a, b, c, e The size and location of the bruising, distinguishing characteristics of injuries, height and weight of the child, and the general state of health of the child all are considerations in determining possible child abuse or neglect. The exact location and the nature of the injury are important to document. A child who has been abused over time may be small and have other health problems stemming from the abuse. The time of the last meal may be important information but usually is not related to suspected abuse.

The nurse is assessing data for a group of older adults. Which patient(s) in this group is/are exhibiting normal signs of aging? (Select all that apply.) a. The patient with knee pain and wrinkles around the eyes b. The patient who needs reading glasses and states that the food tastes bland c. The patient who is confused and does not know the current year d. The patient who states that constipation is an increasing problem e. The patient who is showing signs of depression and hopelessness

Answers: a, b, d Normal aging includes signs of decline in many organ systems. Knee pain, skin wrinkles, need for reading glasses, decline in taste buds, and constipation all can occur with aging. Normal aging does not include dementia or depression, even though these can both be diagnosed in the older adult population.

Which step(s) can nurses and health care providers take to remove barriers to identifying and treating victims of domestic violence? (Select all that apply.) a. Call the police. b. Ask about abuse. c. Ask for proof of domestic violence. d. Screen for domestic violence with all patients. e. Disregard reported abuse in spouses.

Answers: b, d Screening for domestic violence with all patients and asking about abuse will help identify patients who may be victims. Calling the police is a step that may be taken when abuse is confirmed but is not a step in identifying victims. Taking this step will be decided on with the involvement of both health care providers and the patient. Asking for proof may cause the victim to mistrust the health care provider. Never disregard a report of abuse. Abusers often are related to or married to the victim.

Which statement or question best illustrates the nurse's understanding of the role of nursing assistive personnel (NAP) in medication administration? A. "Does the patient need her pain medication?" B. "Let me know if she complains of any nausea." C. "What is the quality of her pain now?" D. "Tell her she doesn't have an order for the drug she's asking for."

B. "Let me know if she complains of any nausea." Rationale: The nurse may delegate to NAP the task of reporting a patient's symptoms. Patient assessment regarding pain medication and quality of pain may not be delegated to NAP. NAP are not responsible for delivering this kind of information to a patient, since doing so would require educating the patient about his or her medication regimen. Patient education may not be delegated to NAP.

Which statement best illustrates the nurse's understanding of the role of nursing assistive personnel (NAP) in documenting medication administration? A. "Make a note that the patient just received her PM dose of pain medication." B. "Let me know if the patient says her nausea is getting worse." C. "Can you check the MAR and see when this patient had her pain medication last?" D. "Ask the patient if I need to get another order from the provider."

B. "Let me know if the patient says her nausea is getting worse." Rationale: The nurse may delegate to NAP the task of reporting a patient's symptoms. Documentation of medication administration may not be delegated to NAP. Reviewing medication documentation cannot be delegated to NAP. Neither the patient nor the NAP is responsible for making this clinical judgment. The skill of patient assessment is a nursing responsibility.

What is the most appropriate way for the nurse to split an unscored tablet? A. Use a pill-splitting device to split the unscored pill in half. B. Ask the pharmacy if it is appropriate to split the pill and if so, ask them to split and repackage it with the adjusted dose given on the label. C. Use scissors to cut the pill in half. D. Administer a whole pill every other day instead of every day.

B. Ask the pharmacy if it is appropriate to split the pill and if so, ask them to split and repackage it with the adjusted dose given on the label. Rationale: Unscored tablets may not be appropriate to split. Asking the pharmacy to split the medication is the safest way to ensure accurate dosing when administering a pill that has not been scored by the manufacturer. Using a pill-splitting device will not guarantee accuracy, since the tablets are not scored. Cutting a pill with a scissors will not ensure accurate dosing and should not be done. The nurse may not change the dose or frequency of administration of a medication.

What is the nurse's best response after noticing that the route of administration has been omitted from a medication order? A. Ask which route the patient prefers. B. Immediately notify the prescriber to request that the order be completed. C. Refer to a current drug book to determine the most commonly prescribed route. D. Contact the pharmacy to determine the most appropriate route for this patient.

B. Immediately notify the prescriber to request that the order be completed. Rationale: The prescriber is required to include all pertinent information on the prescription and should be notified immediately if it is incomplete. Asking which route the patient would prefer is not a safe way of addressing such an omission. Referring to a current drug book for the most commonly prescribed route is not a safe way of addressing such an omission. Contacting the pharmacy is not an appropriate means of addressing an omission in a medication order.

Which action would the nurse take to diminish tissue irritation when administering a subcutaneous injection to a patient of average size? A. Massage the site after administration. B. Make sure the volume of the medication is less than 2 mL. C. Administer the injection at a 45- to 90-degree angle. D. Wear clean gloves while administering the injection.

B. Make sure the volume of the medication is less than 2 mL. Rationale: Delivering a volume of less than 2 mL by subcutaneous injection will reduce the likelihood of tissue irritation. Massaging the site after giving a subcutaneous injection is not recommended because doing so can damage tissue. Although administering a subcutaneous injection at a 45- to 90-degree angle is the correct technique, doing so will not prevent tissue irritation. Wearing clean gloves will protect the nurse from exposure to bloodborne pathogens, but doing so will not prevent tissue irritation.

The patient refuses a scheduled dose of an antibiotic, saying that the medication makes him feel nauseated. What it the nurse's best response? A. Inform the patient why the medication is necessary. B. Notify the prescriber of the patient's reason for refusing the medication. C. Offer to administer the medication with the patient's favorite snack food. D. Note the patient's refusal in the MAR.

B. Notify the prescriber of the patient's reason for refusing the medication. Rationale: The provider must treat the infectious process for which the antibiotic was ordered. The provider may, for example, offer the patient an agent to alleviate the nausea associated with the medication or order a different agent that produces less nausea, such as an extended-release antibiotic. Informing the patient that the medication is necessary does not alleviate the nausea he feels when he takes it. Offering to administer the medication with the patient's favorite snack food might not alleviate the patient's nausea, in which case the patient is unlikely to be persuaded by this offer a second time. In addition, some antibiotics must be taken on an empty stomach. Noting the patient's refusal in the MAR is appropriate, but the nurse must also notify the provider so that the infectious process for which the antibiotic was ordered can be treated.

Which action by the nurse ensures patient safety when administering an intramuscular injection? A. Putting on clean gloves before administration B. Rotating injection sites C. Aspirating for blood return when administering a vaccine D. Injecting the medication quickly

B. Rotating injection sites Rationale: Rotating injection sites is important in order to prevent hypertrophy of tissue. Wearing clean gloves will protect the nurse from exposure to bloodborne pathogens, but doing so will not affect patient safety. It is unnecessary to aspirate when giving an IM vaccine. Intramuscular medications must be injected slowly, at a rate no faster than 10 sec/ml.

Which of the following nursing actions will reduce the risk of "wrong route" when administering a medication? A. Only splitting pills or tablets that have been prescored by the manufacturer B. Using an oral dosing syringe when administering oral liquid medication C. Transcribing a fractional dose of less than one with a leading zero (e.g., 0.5 mg) D. Crushing an oral medication that is difficult to swallow

B. Using an oral dosing syringe when administering oral liquid medication Rationale: Using a parenteral syringe to administer an oral medication may result in an oral medication being given parenterally, as an injection. Such a mistake would indeed be a "wrong route" medication error. Splitting pills or tablets incorrectly may result in an altered dose, not an incorrect route. Inaccurate transcription of a fractional dose would result in a dosing error, not a route error. Crushing an oral medication to facilitate swallowing will not result in a route error.

Which needle would be most appropriate for the nurse to use when giving a subcutaneous injection to a patient of average height and weight? A. 20-gauge, ½-inch B. 22-gauge, 1-inch C. 25-gauge, ⅜-inch D. 27-gauge, 1-inch

C. 25-gauge, ⅜-inch Rationale: The 25-gauge, ⅜-inch needle is the correct gauge and length for a subcutaneous injection. The 20-gauge, ½-inch needle diameter is too large for a subcutaneous injection. The 22-gauge, 1-inch needle and the 27-gauge, 1-inch needle are too long for a subcutaneous injection.

When preparing an intramuscular injection, what can the nurse do to reduce the patient's risk for infection? A. Wear clean gloves. B. Use a 3-ml syringe. C. Clean the injection site with an alcohol swab. D. Massage the injection site.

C. Clean the injection site with an alcohol swab. Rationale: Cleaning the injection site with an alcohol swab before administering an intramuscular injection will reduce the patient's risk for infection. Wearing clean gloves will protect the nurse from exposure to bloodborne pathogens, but doing so will not reduce the patient's risk for infection. Selecting an appropriate syringe size will not affect the patient's risk for infection. Massaging the site after an injection is not appropriate technique and will not reduce the patient's risk for infection.

What is the most important step the nurse can take to ensure that the patient is getting the correct medication? A. Assess the patient's ability to swallow oral medications without difficulty. B. Question the patient about his or her experience with this or similar medications. C. Compare the medication label with the MAR three times. D. Evaluate the patient's understanding of the safety issues related to the specific drug.

C. Compare the medication label with the MAR three times. Rationale: Comparing the medication label with the MAR three times helps protect the patient from medication administration errors. Although it is appropriate to assess the patient's swallowing ability, this precaution applies only to oral medications. Although it is appropriate to ask if the patient has had any experience taking the agent or a similar drug, this precaution would not be helpful if the medication were new to the patient. Although it is appropriate to evaluate the patient's understanding of the safety issues related to the specific drug, doing so is not the most effective way for the nurse to protect the patient.

What can the nurse do to minimize the discomfort of a subcutaneous injection? A. Inject the medication rapidly. B. Massage the injection site. C. Cover the injection site with gauze pad after withdrawing the needle. D. Inject the medication without pinching the skin.

C. Cover the injection site with gauze pad after withdrawing the needle. Rationale: Covering the nonintact skin of a subcutaneous injection site with a gauze pad, rather than with an alcohol swab, will reduce discomfort. Rapid injection of medication will increase discomfort. Massaging the injection site can cause discomfort and tissue damage. Injecting the medication without pinching the skin will not reduce discomfort.

What can the nurse do to minimize the patient's risk for injury when delivering an intramuscular injection? A. Instruct the patient to relax. B. Insert the needle at a 45-degree angle. C. Pull back on the plunger after inserting the needle. D. Pull the skin taut at the injection site when inserting the needle.

C. Pull back on the plunger after inserting the needle. Rationale: Pulling back on the plunger will allow the nurse to determine if the needle is in a blood vessel, rather than in muscle tissue. Encouraging the patient to relax may decrease discomfort, but will not reduce the patient's risk for injury. For an intramuscular injection, the needle must be inserted at a 90-degree angle. Pulling the skin taut when inserting the needle will not reduce the patient's risk for injury.

As the nurse is administering medication to a patient, the patient states, "I've never seen that pill before." What is the nurse's most appropriate response? A. Reassure the patient that the pharmacy sent the right medication. B. Tell the patient that it is probably a different brand than what he takes at home and not to worry. C. Tell the patient that you will review the physician's order to clarify any discrepancies. D. Tell the patient that the doctor probably ordered a new medication.

C. Tell the patient that you will review the physician's order to clarify any discrepancies. Rationale: If a patient questions a medication, it is important to review the medication orders and revisit the six rights of medication administration. An alert patient will know whether a medication is different from those he or she has received before.

As the nurse is giving a patient his medications, he remarks, "I've never seen this blue pill before." What is the nurse's correct response? A. "I'm sure the doctor knows what he's doing. Don't worry." B. "Our pharmacy probably sent a generic form of what you're used to taking." C. "What color pill are you used to seeing?" D. "Don't take it. Let me double-check the doctor's order to make sure this is the correct medication for you."

D. "Don't take it. Let me double-check the doctor's order to make sure this is the correct medication for you." Rationale: An alert patient or family caregiver will know whether a medication is different from those he or she has received before. To prevent a possible error, such a concern should be explored, not simply dismissed. Although it may be true that the pharmacy has sent a generic form of the correct medication, the nurse must verify this assumption. Overlooking a patient's concern could result in a medication error.

What is the best way for the nurse to ensure that the patient does not receive the wrong dose because of a calculation error? A. Ask the pharmacy to calculate the correct dosage. B. Consult a current drug book to determine the new dosage. C. Defer the calculation process to the provider. D. Ask another registered nurse (RN) to verify the calculation.

D. Ask another registered nurse (RN) to verify the calculation. Rationale: Having another RN double-check and verify the dosage calculation is the best way to avoid making a medication error. Although it is appropriate to use the pharmacy as a resource and to review dosing information in a current drug book, doing so is not the best way for the nurse to avoid making a dosage calculation error. Except in unusual circumstances, relying on the provider to make the calculation is both impractical and unnecessary.

Which action by the nurse helps to ensure that the medication is delivered into the muscle when administering an intramuscular injection? A. Using a 1-inch needle B. Inserting the needle at a 45- to 60-degree angle C. Withdrawing the needle immediately after delivering the medication D. Aspirating for blood return before injecting the medication

D. Aspirating for blood return before injecting the medication Rationale: Aspirating for blood return ensures that the medication will be delivered into muscle tissue, and not into a blood vessel. Selection of needle length will vary, depending on the age and size of the patient. For an intramuscular injection, the needle must be inserted at a 90-degree angle. To prevent medication from leaking out of the muscle tissue, the needle is left in place for about 10 seconds once the medication has been delivered

Which example reflects effective documentation of medication administration by a nurse? A. Comparing the written order with the medication administration record (MAR) three times B. Providing patient education regarding a medication C. Obtaining a BP before giving a blood pressure medication D. Including the location of an injection site on the MAR

D. Including the location of an injection site on the MAR Rationale: Including the location of an injection is required when documenting the administration of injected medication. Comparing the written order with the MAR helps the nurse ensure that the medication order has been correctly transcribed into the dispensing system; however, this activity occurs before the documentation of medication administration. Although providing patient education is appropriate and should be included in patient documentation, this activity does not specifically address documentation of medication administration. Obtaining pre-assessments is important, but the nurse would do so before documenting medication administration.

What can the nurse do to ensure proper site selection for subcutaneous insulin injection? A. Insert the needle at a 30-degree angle. B. Select a different anatomical region for each injection. C. Ask the patient to relax before inserting the needle. D. Systematically rotate sites within the same anatomical location or area.

D. Systematically rotate sites within the same anatomical location or area. Rationale: Systematic rotation within one anatomical location will allow consistent insulin absorption. The correct needle angle for a subcutaneous injection is 45 to 90 degrees. Administering the injection at a 30-degree angle will not deliver medication to the subcutaneous tissue. Furthermore, injection technique has no bearing on site selection. Changing anatomical regions for each insulin injection is not recommended. Asking the patient to relax will help decrease discomfort during the injection, but doing so will not ensure proper site selection.

In kidney disease, drug excretion is: - Unaffected. - Increased. - Slowed. - Enhanced.

Slowed