Module 4: Safe Medication Preparation

The patient who is to receive a medication BID will receive the medication: A. Twice a day B. Four times a day C. After meals D. Three times a day

a

A nurse is administering daily medications when a patient states, "I never took a little yellow pill before." What is the nurse's best action? A. Stop and recheck the medication that it is correct according to the health care provider's order. B. Reassure the patient that these are the medications his health care provider prescribed. C. Inform the patient this is probably because the agency uses a different brand of medication than what he takes at home. D. Return the unopened unit dose and document that the patient refused the medication.

a If a patient questions the medication, stop and recheck to be certain there is no mistake.

The health care provider ordered levothyroxine (Levothroid) 0.1 mg PO daily. The drug available states 100 mcg per tab. How many tablets should the nurse administer? 0.5 tab. 1 tab. 2 tabs. 10 tabs.

1 tab 0.1 mg is equivalent to 100 mcg. 0.1 mg x 1000 mcg/mg = 100 mg.

The nurse is reviewing a patient's prescribed medications. The patient states that she quit taking her blood pressure medication because it made her "too weak and tired." What type of medication action was the patient most likely experiencing? A. Side effect. B. Synergistic effect. C. Drug dependence. D. Idiosyncratic reaction.

a Side effects are usually predictable and often unavoidable secondary effects produced by a medication at the usual therapeutic medication dose. Patients may stop taking medications because of side effects. For example, some cardiac and antihypertensive medications may initially worsen the patient's fatigue, and because the patient feels worse on the medication, the patient stops taking it. An idiosyncratic reaction is that in which a patient overreacts or underreacts to a medication or has a reaction different from normal. With a synergistic reaction, the physiologic action of the two medications in combination is greater than the effect of the medications when given separately. In psychological dependence, the patient desires the medication for some benefit other than the intended effect. Physical dependence involves a physiologic adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn.

The following medications are to be administered. Which patient receives medication the most often? The patient who: A. Receives antibiotics q4h. B. Receives cardiac medication qid. C. Receives an antihypertensive bid. D. Receives a sedative at bedtime. E. Receives an iron supplement AC.

a The patient who receives medication every 4 hours would receive the drug six times in 24 hours, making this the most often. The patient who receives a bedtime sedative would receive medication one time daily. The patient who receives medication AC receives medication three times a day before meals. A patient who receives a medication bid receives medication twice a day. A patient who receives a medication qid receives medication four times a day.

A health care provider has ordered Astramorph (morphine sulfate), a narcotic opioid, and Vistaril (hydroxyzine), an antianxiety medication, to be administered together to produce pain relief for a patient. When smaller doses of each are administered together, the effect is greater than if they were given separately. This effect is an example of which of the following? A. A synergistic effect. B. An idiosyncratic effect. C. Drug tolerance. D. Drug dependence.

a With a synergistic effect, the two medications are working together cooperatively and produce a greater result. Medication tolerance occurs when patients receive the same medication for long periods and require higher doses to produce the same desired effect. In psychological dependence, the patient desires the medication for some benefit other than the intended effect. Physical dependence involves a physiologic adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn. An idiosyncratic reaction is that in which a patient overreacts or underreacts to a medication or has a reaction different from normal.

The nurse administered a routine scheduled medication of Prozac (fluoxetine hydrochloride), an antidepressant, 20 mg PO to a patient. The nurse checked the medication label against the MAR when getting it out of the automatic dispensing system, again when placing the medication in a cup, and once more at the patient's bedside prior to administration. The label read 20 mg and contained a single capsule. The nurse asked the patient to state her name and administered the medication, offering the patient a drink of water. The nurse documented the administration of the medication. Which of the six rights of medication administration did the nurse violate? A. The nurse did not use two patient identifiers. B. The nurse did not make the appropriate number of checks for the right drug. C. The nurse administered the medication correctly. D. The nurse did not have a second nurse verify the dose.

a a) Incorrect. The nurse failed to use two patient identifiers prior to medication administration which could have resulted in giving medication to the wrong patient. b) Incorrect. No calculations were involved and this was not a high-risk drug such as insulin or anticoagulants, therefore a second nurse's verification would be unnecessary. c) Incorrect. The nurse made three appropriate checks for the right drug. *d) Correct! The nurse failed to use two patient identifiers prior to medication administration which could have resulted in giving medication to the wrong patient. The nurse must consistently follow the 6 rights of medication administration to avoid medication errors.

The nurse finished administering medications to a patient when she realized she gave the medications to the wrong patient. What should the nurse do first? A. Assess the patient's condition. B. Notify the health care provider. C. Report the incident to the supervisor. D. Fill out an incident report.

a Correct When an error occurs, the nurse should assess and examine the patient's condition and notify the health care provider of the incident as soon as possible. The nurse should follow any health care provider's orders for corrective action and continue to monitor the patient. Once the patient is stable, the nurse should report the incident to the appropriate person in the agency (e.g., manager or supervisor). The nurse is also responsible for preparing a written incident report, which usually must be filed within 24 hours of the incident.

How can the nurse determine a patient's history of allergies? (Select all that apply.) a. By looking at the patient's allergy bracelet b. By looking at the MAR c. By administering a dose and monitoring the patient's response d. By asking the patient e. By looking at the front of the chart or in the patient's electronic health record (EHR)

a b d e Allergies are listed in at least three places: the patient's allergy bracelet, the MAR, and conspicuously on the front of the chart or in the patient s electronic health record. The nurse may also ask the patient about allergies before medication administration. Administering a dose and monitoring the patient's response will not determine a history of allergies. Prevention of administering medications to which the patient is allergic is an important safety measure.

Identify the 6 rights of medication administration. a. The right time b. The right dose c. The right MAR d. The right medication e. The right conversion factor f. The right route g. The right documentation h. The right health care provider i. The right expiration date j. The right patient

a b d f g j The 6 rights of medication administration are the right patient, the right medication, the right dose, the right route, the right time, and the right documentation.

Identify the 6 rights of medication administration. A. The right time B. The right dose C. The right MAR D. The right medication E. The right conversion factor F. The right route G. The right documentation H. The right health care provider I. The right expiration date J. The right patient

a b d f g j The 6 rights of medication administration are the right patient, the right medication, the right dose, the right route, the right time, and the right documentation.

The health care provider has ordered amoxicillin 250 mg PO q8h. The drug label states 125 mg amoxicillin per 5 mL. Based on this information, which of the following would be correct actions by the nurse? (Select all that apply.) a. Compare the patient's name and date of birth on the armband with the MAR. b. Administer 2.5 mL of amoxicillin per dose. c. Administer 10 mL of amoxicillin per dose. d. Administer the medication by the parenteral route. e. Administer the amoxicillin at 0800, 1200, and 1800.

a c

Which of the following patients are at risk for developing drug toxicity? (Select all that apply.) A. 43-year-old male, who has liver failure Correct B. 16-year-old female, who has had vomiting and diarrhea Incorrect C. 82-year-old male, who has renal disease Correct D. 65-year-old male, who has been on high doses of antibiotics for 3 weeks Correct E. 75-year-old female, who swallowed Caladryl lotion

a c d e A toxic medication effect develops after prolonged intake of high doses of a medication, after ingestion of medications intended for external application, or when a medication accumulates in the blood because of impaired metabolism (e.g., liver disease) or excretion (e.g., renal disease). Vomiting and diarrhea do not place a patient at risk for drug toxicity.

Which of the following patients are at risk for developing drug toxicity? (Select all that apply.) a. 43-year-old male, who has liver failure b. 16-year-old female, who has had vomiting and diarrhea c. 82-year-old male, who has renal disease d. 65-year-old male, who has been on high doses of antibiotics for 3 weeks e. 75-year-old female, who swallowed Caladryl lotion

a c d e A toxic medication effect develops after prolonged intake of high doses of a medication, after ingestion of medications intended for external application, or when a medication accumulates in the blood because of impaired metabolism (e.g., liver disease) or excretion (e.g., renal disease). Vomiting and diarrhea do not place a patient at risk for drug toxicity.

The nurse is caring for a 76-year-old patient being treated for depression, elevated cholesterol levels, and renal failure. She is placed on a new medication to lower her cholesterol as well as a low-fat diet. She takes nine different medications in the morning, and she complains that it ruins her appetite. Her personal habits include taking over-the-counter (OTC) sleep aids, taking herbal remedies, and smoking a pack of cigarettes per day. Which eight of the following are factors that place this patient at an increased risk for experiencing an adverse drug effect? (Select all that apply.) A. Taking a new medication. B. Being on a low-fat diet. C. Having a diagnosis of depression. D. Taking OTC medications and herbal remedies. E. Her poor appetite. F. The number of medications she takes. G. Having a high cholesterol level. H. Having a diagnosis of renal failure. I. Her age. J. Her smoking habit. K. Her gender.

a c d f h i j k This patient has several factors that place her at risk for experiencing an adverse drug reaction, including the following: her gender (women are at increased risk for adverse drug reactions), her age (she is elderly), taking more than four to five medications (polypharmacy), having a diagnosis of depression (or anxiety), having a diagnosis of renal disease (or hepatic disease), having a smoking habit (or other substance abuse such as alcohol or street drugs), her use of OTC medications, and taking a medication for the first time.

The patient is to receive 120 mg of IV Lasix (furosemide). You calculate that this will be 12 mL (10 mg/mL). The drug book states that the usual dosage is 20 to 40 mg. What steps should the nurse take to avoid medication errors in this situation? (Select all that apply.) a. Question unusually large or small doses. b. Only administer 4 mL (40 mg). c. Read labels at least two times to make sure it is the correct medication. d. Use at least two patient identifiers whenever administering a medication. e. Double-check all calculations.

a e In this instance, the medication ordered is an unusually large amount. The nurse should question the amount by verifying the order with the health care provider. The nurse should not alter the order without talking to the healthcare provider and receiving orders to do so. The nurse should also double-check all calculations. Reading the label and using two patient identifiers are steps that help prevent medication errors, but in this instance, they will not prevent administering too much medication. Labels should be checked three times before administration.

The home care nurse is reviewing the patient's prescribed medications. The patient reports he doesn't take his antihypertensive (blood pressure) medication anymore. What is the best response by the nurse? A. "You could create problems for your family if you don't manage your health." B. "What is the reason you are no longer taking the blood pressure medication?" C. "Have you had your blood pressure checked since discontinuing this medication?" D. "You could possibly suffer a stroke if you don't manage your blood pressure"

b

The home care nurse is reviewing the patient's prescribed medications. The patient reports he doesn't take his antihypertensive (blood pressure) medication anymore. What is the best response by the nurse? a. "You could create problems for your family if you don't manage your health." b. "What is the reason you are no longer taking the blood pressure medication?" c. "Have you had your blood pressure checked since discontinuing this medication?" d. "You could possibly suffer a stroke if you don't manage your blood pressure"

b

1. Which of the following patients is at highest risk for a toxic medication effect? A. The patient who appears more agitated after receiving a sleep aid. B. The patient who has liver and kidney problems and takes high doses of aspirin to relieve pain. C. The patient who experiences constipation and nausea while taking pain medication. D. The patient who has a history of urticaria, pruritis, and wheezing after taking an antibiotic.

b A toxic medication effect develops after prolonged intake of high doses of medication, after ingestion of medications intended for external application, or when a medication accumulates in the blood because of impaired metabolism and/or excretion. Urticaria, pruritis, and wheezing are symptoms of an allergic reaction rather than a toxic effect. Becoming more agitated after taking a sleep aid is an example of an idiosyncratic effect. The patient with nausea and constipation while taking pain medication is experiencing side effects of the pain medication.

Look at the image and then answer the following:According to the medication label, the trade name is: A. zidovudine. B. Retrovir. C. Glaxo Wellcome. D. capsules.

b Retrovir is the trade name. Zidovudine is the generic name. Glaxo Wellcome is the name of the manufacturer. Capsules is the drug form.

When should the nurse document medication administration? A. When the medication is in the medication cup. B. Immediately after the medication is given. C. Before the next scheduled dose. D. Before the end-of-shift report.

b Correct All medications should be documented immediately after they are given to prevent accidental duplication.

1. An alert patient has refused to take her prescribed medications, stating, "The medication isn't doing me any good!" What should the nurse do? A. Crush the patient's medications and disguise them in some of the patient's food. B. Assess further as to why the patient feels this way and notify the health care provider of the patient's refusal. C. Instruct the patient that the health care provider may refuse to treat her if she is noncompliant. D. Leave the medications at the patient's bedside in case she changes her mind.

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

If the patient refuses a medication, what should the nurse do? (Select all that apply.) A. Administer the dose when the next dose is due. B. Notify the health care provider. C. Document the reason for refusal in the patient's health record. D. Mix it in a small amount of their food. E. Determine the reason for refusal.

b c e When medication is refused, determine the reason for it and take action accordingly. Refusal of medications must be documented and the health care provider notified. The MAR may require a special symbol that indicates that the patient refused the medication. The patient has the right to refuse.

The nurse brings the patient's medications but the patient refuses to take them, stating, "I'll take them later. Right now my stomach feels a little upset. Could you please bring me some crackers?" What is the best action the nurse should take? (Select all that apply.) a. Document the patient is noncompliant in following the medication regimen. b. Lock the patient's medications up temporarily and document the incident. c. Leave the medications at the patient's bedside and check on him later. d. Offer the patient some crackers and see if the patient has any medications that could help relieve nausea. e. Have the patient take the medications at this scheduled time with a small sip of water.

b d The nurse should never leave the medications at the patient's bedside unless there is an order to do so. If the medication is left unattended, the patient may forget to take it, drop it, or intentionally avoid taking the dose without the nurse's awareness. The nurse is responsible for ensuring that the patient receives the ordered dose. The nurse should temporarily lock the medications up and document the incident. If the patient is unable to take the medications later, the health care provider should be notified within 24 hours of the refusal. The nurse may also see if there are medications available to treat the patient's nausea, or at least provide crackers as requested. The nurse should avoid labeling the patient as noncompliant. The patient has the right to refuse medication.

The health care provider's order states to feed the infant 2 ounces every 4 hours. How many mL should the nurse prepare to feed the infant each time? A. 15 mL. B. 30 mL. C. 60 mL. D. 210 mL.

c 1 ounce = 30 mL; 2 ounces = 60 mL.

1. A patient has an order to receive nystatin oral suspension PC. When will the nurse administer this medication? A. Before meals. B. At bedtime. C. After meals. D. As requested by the patient.

c The abbreviation "PC" indicates that the patient will receive the medication after meals

The nurse selects a medication according to the MAR for the correct drug name, dosage, and route. The nurse goes to the patient's room and compares the name and date of birth on the patient's ID bracelet to that information on the MAR. The nurse administers the medication orally because it is a pill and then returns to the MAR and documents the medication administration. Which of the following six rights did the nurse violate? A. The right route. B. The right documentation. C. The right time. D. The right medication. E. The right patient. F. The nurse followed all of the six rights of medication administration. G. The right dose.

c The nurse forgot to identify the right time of medication administration

1. Look at the image and then answer the question.The health care provider has ordered 250 mg of cefprozil (Cefzil). The nurse is preparing to calculate the amount needed by using the following formula:Which number should the nurse place in the formula as the "dose on hand"? A. 50. B. 5. C. 125. D. 250.

c Correct The dose on hand is 125 mg. The amount of medication in the bottle is 50 mL. The vehicle or amount of the medication on hand is 5 mL. The dose ordered is 250 mg.

A nurse manager is reviewing with the nurse measures used to prevent medication errors. Which of the following statements indicate a correct understanding of steps used to prevent medication errors? A. "I will check the label once against the MAR as I remove the medication from the container." B. "I will ask the patient if he or she has the name that I will read off of the MAR." C. "I will shut the door of the medication room when I am preparing medications." E. "I will do my best to interpret illegible handwriting to administer the medication on time and then clarify the order the next time the health care provider makes rounds."

c Correct The nurse is correct when identifying the following steps used to prevent medication errors: Not allowing any other activity to interrupt administration of medication to a patient, such as by shutting the door of the medication room to reduce distractions and/or to deter interruptions. The other statements are inaccurate. The nurse should read and compare the label to the MAR at least 3 times. The nurse should use at least two patient identifiers whenever administering a medication, and the nurse should ask the patient to state his or her name rather than asking the patient to answer "yes" or "no." The nurse should calculate the dosage required and double-check the calculation. The nurse should know how to calculate drug dosages without assistance because a pharmacist or another nurse may not always be readily available. The nurse should not interpret illegible handwriting but should clarify the order with the health care provider before administering the medication. D. "I will have the pharmacist calculate all drug dosages."

The health care provider has ordered a peak level to be drawn for a patient receiving vancomycin (Vancocin). The nurse reads the following in a drug book: Vancomycin Route: IV Onset: Rapid Peak: end of infusion Duration: 12-24 hr The nurse plans to start the IV infusion of vancomycin as ordered at 1000, setting the IV pump so it will infuse over 60 minutes. At what time should the nurse have the peak level drawn? a. 1000 the next day b. 2200 c. 955 d. 1100

d

What is the best way for nurses to prevent medication errors? A. Only give medications to patients who are alert and oriented. B. Use an automated medication dispensing system. C. Avoid distractions and take time to prepare medications. D. Adhere to the 6 rights of medication administration.

d a) Correct! All medication errors can be linked, in some way, to an inconsistency in adhering to the 6 rights of medication administration. b) Incorrect. Although avoiding distractions and taking sufficient time to prepare medications may help reduce the likelihood of a medication error, following the 6 rights of medication administration will potentially prevent a variety of errors. All medication errors can be linked, in some way, to an inconsistency in adhering to the 6 rights of medication administration. c) Incorrect. All medication errors can be linked, in some way, to an inconsistency in adhering to the 6 rights of medication administration. Not all patients requiring medication will be alert and oriented. d) Incorrect. Errors can still occur with an automated medication dispensing system. All medication errors can be linked, in some way, to an inconsistency in adhering to the 6 rights of medication administration.

The health care provider has ordered an antibiotic to be given 3 times in a 24-hour period. Which would be the best dosing schedule for this medication in order to maintain a therapeutic blood level? A. AC. B. qid. C. tid. D. q8h.

d To maintain therapeutic blood levels of the antibiotic, it should be administered every 8 hours. The abbreviation "tid" indicates 3 times a day but refers to during waking hours. The abbreviation "AC" refers to before meals. The abbreviation "qid" refers to 4 times a day but not at equal intervals to ensure a therapeutic blood level.

A patient has been taking vancomycin (Vancomycin HCl) for an infection. The health care provider has ordered a peak and trough level to be drawn. When should the nurse expect the phlebotomist to draw the patient's blood for the trough level? A. 2 hours after administering the vancomycin. B. 30 minutes after administering the vancomycin. C. Exactly halfway between doses. D. 30 minutes before administering the vancomycin.

d Trough levels are drawn 30 minutes before administration of the drug. Peak levels are drawn according toterm-2 the expected time for the drug to reach its peak concentration after administration

The patient has been taking 3 teaspoons of cough syrup. How many mL would this be? A. 3 mL. B. 5 mL. C. 10 mL. D. 15 mL.

d Correct 1 teaspoon = 5 mL; 3 teaspoons = 15 mL.

Mrs. Star in room 129-1 requests a prn pain medication. The nurse administered Mrs. Star's pain medication to Mrs. Start in room 138-2. After the nurse assessed Mrs. Start and reported the incident to the health care provider, the nurse reviewed the patients' MAR and determined that both Mrs. Star and Mrs. Start had orders for the same prn pain medication. Fortunately, Mrs. Start's order stated she could receive pain medication every 4 hours, and 5 hours had elapsed since her last dose. Since neither patient was harmed by the error, why should the nurse complete an incident report? A. In this case, it would be unnecessary to complete an incident report. B. The nurse should complete the report so the agency can keep track of which nurses are making the most errors. C. The nurse should do so to provide documentation should legal action be taken. D. The nurse should do so to determine why the mistake occurred and what can be done to avoid similar errors in the future.

d Correct It is good risk management to report all medication errors regardless of patient outcome. The agency can still learn why the mistake occurred and what can be done to avoid similar errors in the future. Agencies can use incident reports to initiate quality improvement programs as needed.

The nurse finished administering medications at 1030 when the nurse realized that she gave a patient all of his medications at 1000, including some medications that should have been administered at 1200 and some at 1400. Which of the six rights of medication administration did the nurse violate? A. The right route. B. The right dose. C. The right patient. D. The right time. E. The right documentation. F. The right medication.

d Correct The nurse forgot to follow the right time of medication administration.

How can the nurse determine a patient's history of allergies? (Select all that apply.) A. By looking at the patient's allergy bracelet Correct B. By looking at the MAR Correct C. By administering a dose and monitoring the patient's response D. By asking the patient Correct E. By looking at the front of the chart or in the patient's electronic health record (EHR)

e Allergies are listed in at least three places: the patient's allergy bracelet, the MAR, and conspicuously on the front of the chart or in the patient s electronic health record. The nurse may also ask the patient about allergies before medication administration. Administering a dose and monitoring the patient's response will not determine a history of allergies. Prevention of administering medications to which the patient is allergic is an important safety measure.