Nursing Chapter 35

The nurse prepares to administer the following medication to the patient. Which instruction will the nurse be sure to give before the patient takes the medication? MS Contin Morphine sulfate Extended release tablets, USP 15 mg CII only a."Be sure to swallow the pill whole." b."Crush the medication and place the powder in applesauce." c."Place the pill under your tongue." d."Let the pill slowly dissolve in your mouth."

a."Be sure to swallow the pill whole." Rationale: Extended release medications must always be swallowed whole without crushing or dissolving the tablet. They are not given sublingually or allowed to dissolve in the mouth.

The nurse identifies which medication that has the highest potential for abuse? a.Methylphenidate (Ritalin)—schedule II b.Alprazolam (Xanax)—schedule IV c.Acetaminophen & codeine (Tylenol #3)—schedule III d.Diphenoxylate & atropine (Lomotil)—schedule V

a.Methylphenidate (Ritalin)—schedule II Rationale: According to the Controlled Substances Act, drugs that have the potential for abuse/dependency are classified as schedule I-V. Schedule I drugs have no approved medical applications in the United States. Schedule II drugs have high potential for abuse/dependency and have multiple restrictions for prescriptions. Schedule III, IV, and V have lower risks of dependency/abuse and fewer restrictions for prescriptions. Methylphenidate has the highest risk of abuse in this selection.

The nurse identifies which medication order to be administered PRN? a.Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep b.Prednisone 10 mg PO today, then taper down 1 mg each day for the next 10 days c.Humulin R 10 units subcutaneously before each meal and at bedtime d.Kefzol (Ancef) 1 g IVPB 30 minutes prior to surgery

a.Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep Rationale: The nurse is to give the zolpidine (Ambien) if the patient cannot sleep. Therefore, this is the PRN (as needed) medication order. The other orders have specific time frames.

The nurse suspects that the patient is experiencing a drug toxicity rather than a side effect. Which question will the nurse ask to help confirm this suspicion? a."When did you take your last dose of the medication?" b."Have you been taking extra doses of the medication?" c."Are you taking any other medications?" d."Have you ever taken this medication in the past?"

b."Have you been taking extra doses of the medication?" Rationale: Asking if the patient has been taking extra doses of the medication will allow the nurse to determine if the patient has been taking too much of the drug or more than was prescribed. Toxicity occurs when the patient receives/takes excessive amounts of the drug.

The nurse is to administer 15 mg of morphine liquid to the patient. How much morphine liquid will the nurse draw up to administer to the patient? Morphine sulfate oral solution (CONCENTRATE) 100 mg/5 mL (20 mg/mL) CII only a.0.5 mL b.0.75 mL c.1.3 mL d.1.5 mL

b.0.75 mL

The nurse is caring for a patient who takes 6 tablets of methotrexate once every week on Fridays. How many mg of methotrexate does the patient take per dose? Trexall Methotrexate tablets, USP 2.5 mg tablets only a.10 mg b.15 mg c.20 mg d.25 mg

b.15 mg Rationale: 2.5 mg tablets × 6 = 15 mg.

The nurse is to administer 1 mL of prochlorperazine (Compazine) 10 mg IM to an adult patient. Which syringe will the nurse select to administer the medication? a.1 mL tuberculin syringe with 27 gauge, 1/2 inch needle b.3 mL syringe with 23 gauge, 1 1/2 inch needle c.1 mL syringe with 27 gauge, 5/8 inch needle d.3 mL syringe with 18 gauge, 1 inch needle

b.3 mL syringe with 23 gauge, 1 1/2 inch needle Rationale: Intramuscular injections for adults are usually administered with a 3 mL syringe and a 1 to 3 inch, 19 to 25 gauge needle. Tuberculin syringes are typically used for subcutaneous injections. The inch needles are too short for intramuscular injections into adults. The 18 and 27 gauge needles are too small for adult intramuscular injections.

The nurse is caring for a patient who is receiving vancomycin (Vancocin) to treat a severe infection. The next dose is due to be administered at 10:00 a.m. What time will the nurse draw the vancomycin serum trough level? a.7:30 a.m. b.9:30 a.m. c.11:30 a.m. d.1:30 p.m.

b.9:30 a.m. Rationale: The trough is the lowest serum level of the medication. Serum trough levels are to be drawn just prior to the administration of the medication.

The nurse administers a medication to a patient. Shortly afterward, the patient develops an itchy rash over the entire body and reports feeling very unwell. What is the priority action of the nurse? a.Leave the patient to notify the provider and the pharmacist. b.Determine if the patient is having any difficulty breathing. c.Document the reaction in the patient's chart. d.Obtain an order for hydrocortisone cream to relieve the itching.

b.Determine if the patient is having any difficulty breathing. Rationale: The nurse must first determine if the patient is having any difficulty breathing, since the patient may be starting to have an anaphylactic reaction to the medication, which can lead to shortness of breath and airway swelling. After assuring that the patient is stable, the nurse can notify the appropriate personnel and request any treatments for the reaction.

The nurse is caring for a patient who is taking many prescription medications for various health problems. Which direction from the nurse will help the patient avoid dangerous drug interactions? a.Only take over-the-counter medications. b.Have all of the prescriptions filled at the same pharmacy. c.Avoid taking generic preparations of prescribed medications. d.Only take the medications that the patient feels are necessary.

b.Have all of the prescriptions filled at the same pharmacy. Rationale: The patient's risk for dangerous drug interactions is increased when many medications are taken. Filling all the prescriptions at the same pharmacy will allow the pharmacist to check for possible interactions.

The nurse is caring for a patient who is in agonizing pain. All the following options are listed on the patient's medication order sheet to relive pain. The nurse knows which option that will provide the most rapid pain relief for the patient? a.Morphine (MSContin) 10 mg PO b.Hydromorphone (Dilaudid) 1 mg IV push c.Meperidine (Demerol) 75 mg IM d.Fentanyl (Duragesic) 50 mcg transdermal patch

b.Hydromorphone (Dilaudid) 1 mg IV push Rationale: IV administration has the most rapid onset of action and will provide the patient with the quickest pain relief.

The nurse is caring for a patient with multiple chronic illnesses who is having difficulty remembering to take multiple medications at the correct times. Which is the appropriate Nursing diagnosis for this patient? a.Activity intolerance related to inability to take medications on time b.Impaired health maintenance related to complexity of medication schedule c.Risk for aspiration related to need to swallow many pills during day d.Powerlessness related to inability to figure out medication dose times

b.Impaired health maintenance related to complexity of medication schedule Rationale: The patient is not able to manage the prescribed medication regimen because of the complexity of the schedule, so Impaired health maintenance is an appropriate diagnosis. Activity intolerance does not relate to the ability to take multiple medications at once and manage medication times. The patient does not state any difficulty swallowing pills, so risk for aspiration is not applicable. Inability to figure out medication dose times does not constitute powerlessness.

During discharge teaching, the nurse is to give the patient a signed, dated, and timed prescription from the physician for medications to be taken at home. Which prescription drug order needs to be corrected before it is given to the patient? a.Warfarin (Coumadin) 5 mg PO daily before dinner b.Methotrexate (Trexall) 8 tablets PO once weekly on Saturdays c.Levothyroxine (Synthroid) 137 mcg PO daily before breakfast d.Zolpidem (Ambien) 5 mg PO at bedtime as needed for sleep

b.Methotrexate (Trexall) 8 tablets PO once weekly on Saturdays Rationale: All prescriptions must have the name of the drug to be administered along with dosage, route, and frequency. The methotrexate order does not contain a dosage for the drug, just the number of pills to be taken. The other orders are complete.

The nurse identifies which medications that are to be administered via parenteral routes? (Select all that apply.) a.Bisacodyl (Dulcolax) 10 mg suppository daily PRN constipation b.Prochlroperazine (Compazine) 10 mg IM q 6 hours PRN nausea c.Brimonidine (Alphagan) 0.1% solution 2 drops to each eye daily d.Proventil (Ventolin) inhaler 2 puffs as needed for shortness of breath e.Fentanyl (Duragesic) 50 mcg transdermal patch apply every 72 hours f.Insulin lispro (Humalog) insulin 15 units subcutaneously ac meals

b.Prochlroperazine (Compazine) 10 mg IM q 6 hours PRN nausea f.Insulin lispro (Humalog) insulin 15 units subcutaneously ac meals Rationale: Parenteral medications are administered by injection into tissue, muscle, or a vein rather than through the gastrointestinal or respiratory route.

After administering an antibiotic to the patient, the nurse notes the patient complaining of feeling ill, is scratching and has hives. The patient soon starts having difficulty breathing and is hypotensive. What is the nurse's assessment of the situation? a.The patient is having a mild allergic reaction and an antihistamine will make the patient feel better. b.The patient is having an anaphylactic reaction and epinephrine should be administered right away. c.The patient's infection is worsening and progressing to septic shock so blood cultures should be drawn. d.The patient has developed toxic shock syndrome and the antibiotic orders must be changed right away.

b.The patient is having an anaphylactic reaction and epinephrine should be administered right away. Rationale: The patient's symptoms are indicative of anaphylaxis: a severe, life-threatening allergic reaction. The airways close, the throat swells closed, and the blood pressure drops dangerously low. The patient may go into shock and die. This is a medical emergency. Anaphylaxis can occur immediately after the administration of medication and can be fatal. Treatment includes immediate discontinuation of the drug and administration of epinephrine (an antagonist), intravenous (IV) fluids, steroids, and antihistamines while providing respiratory support. Patients may have very mild allergic reactions to medications and experience a rash or itching. This patient is not developing septic shock or toxic shock syndrome.

The nurse carefully reviews the patient's medication list. Which observation about the list indicates the highest risk for serious drug-drug interactions? a.The patient has been taking the same medications for a long time. b.The patient is taking a large number of medications. c.Most of the drugs on the list are prescribed at high doses. d.The patient takes oral, injected, and inhaled medications.

b.The patient is taking a large number of medications. Rationale: The risk of drug-drug interactions increases when a patient takes many drugs. One of the most important ways to prevent adverse drug interactions is to minimize the number of drugs that the patient is taking. The other options do not show a high likelihood of drug-drug interactions.

The nurse is caring for a patient who will self-administer medication injections at home after discharge. How can the nurse best determine that the patient understands the technique and can administer the injections correctly? a.Provide written instructions about how to administer the injections. b.Watch the patient self-administer an injection. c.Call the patient the next day to ask if there is any difficulty with administering the injections. d.Ask the patient to express understanding as to how to administer the injections.

b.Watch the patient self-administer an injection. Rationale: The nurse should watch the patient self-administer an injection to make sure that the patient is doing it correctly. This will give the nurse an opportunity to point out and correct any mistakes and offer the patient reassurance about the technique.

The nurse is to administer 45 mg of phenobarbital to the patient. How many tablets will the patient receive? Phenobarbital tablets, USP 15 mg CIV only a.1 tablet b.2 tablets c.3 tablets d.4 tablets

c.3 tablets

The nurse is noting an order for a medication to be given TID. Which times will the nurse plan to administer the medication to the patient? a.9 a.m., 1 p.m., 5 p.m., and 10 p.m. b.9 a.m. and 9 p.m. c.9 a.m., 1 p.m., and 5 p.m. d.Nightly before the patient goes to sleep

c.9 a.m., 1 p.m., and 5 p.m. Rationale: TID indicates that the medication is to be administered three times daily. Common times for TID medications are 9 a.m., 1 p.m., and 5 p.m.

The nurse makes a medication error. Which action will the nurse take first? a.Prepare an incident report. b.Explain to the patient that a medication error has occurred. c.Assess the patient for any adverse reactions. d.Document the medication given, the response, and corrective actions taken.

c.Assess the patient for any adverse reactions. Rationale: When a medication error occurs, the nurse's priorities are to determine the effect on the patient and intervene to offset any adverse effects of the error. Actions include immediate and ongoing assessment, notification of the prescribing health care provider, initiation of interventions as prescribed to offset any adverse effects, and documentation related to the event. Error reporting is an essential component of patient safety and should be completed as soon as the patient is assessed and stable. The nurse should follow facility guidelines for medication error reporting.

The nurse is caring for a patient who is NPO with a new PEG (percutaneous endoscopic gastrostomy) tube. Which of the patient's medications can the nurse administer through the tube? (Select all that apply.) a.Zolpidem tartrate (Edluar) sublingual tablet 5 mg nightly at bedtime b.Ondansetron (Zofran) oral disintegrating tablet 8 mg q 8 hours PRN nausea c.Cefaclor (Ceclor) for oral suspension 250 mg q 6 hours d.Oxymorphone hydrochloride extended release (Opana ER) 40 mg q 12 hours e.Phenytoin (Dilantin) chewable tablet 100 mg q 12 hours f.Potassium chloride oral solution 20 mEq daily

c.Cefaclor (Ceclor) for oral suspension 250 mg q 6 hours e.Phenytoin (Dilantin) chewable tablet 100 mg q 12 hours f.Potassium chloride oral solution 20 mEq daily Rationale: Extended-release, oral disintegrating, and sublingual tablets may not be administered through feeding tubes. Suspensions and oral solutions are ideal for feeding tube administration. Chewable tablets may be crushed and dissolved in liquid for administration through feeding tubes.

The nurse is caring for a patient who was just made NPO. The nurse is to administer carvedilol (Coreg) 25 mg PO to the patient for control of high blood pressure. What is the best action of the nurse? a.Crush the medication and administer it to the patient mixed with applesauce. b.Administer the medication to the patient with a small sip of water. c.Contact the patient's provider to clarify the order. d.Administer the equivalent medication dose through the patient's IV.

c.Contact the patient's provider to clarify the order. Rationale: The nurse should contact the patient's provider to clarify the order. Oral medications should never be administered to NPO patients without specific orders to do so from the provider. Not all medications can be administered intravenously.

The nurse begins a shift on a busy medical-surgical unit and will be caring for multiple patients. Which patient does the nurse assess first? a.A patient who would like some acetaminophen (Tylenol) for a mild headache. b.A patient who has a question about her daily medications. c.A patient who needs discharge teaching about an antibiotic. d.A patient who just received nitroglycerin for chest pain.

d.A patient who just received nitroglycerin for chest pain. Rationale: The nurse's first priority is always: ABCs—Airway, Breathing, and Circulation. This includes any patients who are having chest pain and/or difficulty breathing. The nurse needs to see this patient first to determine if the chest pain has been relieved or not and to determine if the patient is now stable or if additional interventions need to be done. The other patients' needs are less critical and can be met after this patient is assessed.

When administering phenytoin (Dilantin) through the patient's IV line, the nurse carefully flushes the IV with normal saline before and afterward to avoid crystal formation of the medication that occurs when it mixes with dextrose in water (D5W) solution. Which type of drug interaction is the nurse being careful to avoid? a.Antagonism b.Potentiation c.Synergism d.Incompatibility

d.Incompatibility Rationale: When medications combine to form crystals or adverse chemical reactions, the result is a drug incompatibility. Compatibility must be assessed prior to medication preparation and administration.

The nurse administers a medication to the patient. Which symptoms indicate to the nurse that the patient is having an allergic reaction rather than a side effect? a.Hair loss and sweaty skin b.Nausea and constipation c.Heartburn and nasty taste in the mouth d.Itchy rash and difficulty breathing

d.Itchy rash and difficulty breathing Rationale: Itchy rash and difficulty breathing are indicative of an allergic reaction to a medication. The other symptoms are common side effects of medications.