Potter & Perry Ch 32 - Medication Administration (Practice Questions)

*A health care provider ordered enalapril (Vasotec) 2 mg IV push for a patient with hypertension. The pharmacy sent vials marked 1.25 mg enalapril/mL. How many mL does the nurse administer? ______ mL*

*Answer: 1.6 mL *

*A child is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 64 puffs. The dose is 2 puffs every 6 hours. How many days will the pMDI last? ___________ days.*

*Answer: 8 days* Rationale: The patient is taking 2 puffs every 6 hours which is 8 puffs a day. The inhaler has 64 puffs in it. To determine how many days the inhaler will last, divide the number of puffs by the number of doses per day that the patient takes; 64 puffs/8 puffs per day = 8 days

*A pediatric nurse takes a medication to a 12-year-old female patient. The patient tells the nurse to take it away because she is not going to take it. What is the nurse's next action?* A. Ask the patient's reason for refusal B. Consult with the patient's parents for advice C. Take the medication away and chart the patient's refusal D. Tell the patient that her health care provider knows what is best for her

*Answer: A* Rationale: Whenever a patient refuses a medication, the first step is to talk with the patient to gather the patient's insights and possible reasons for not taking the medication.

*You are a new graduate nurse completing your orientation on a very busy intensive care unit. You cannot read a health care provider's order for one of your patient's medications. You have heard from more experienced nurses that this health care provider does not like to be called, and you know that another of the health care provider's patients is very unstable. What is the most appropriate next step for you to take?* A. Call the health care provider to clarify the order B. Talk with your preceptor to help you interpret the order C. Refer to a medication manual before giving the medication D. Use your best judgment and critical thinking and administer the dose you think the health care provider ordered

*Answer: A* Rationale: Whenever you are unable to read a patient's order, you must consult with the health care provider to clarify the order before giving the medication.

*After receiving an intramuscular (IM) injection in the deltoid, a patient states, "My arm really hurts. It's burning and tingling where I got my injection. What should the nurse do next? (Select all that apply.)* A. Assess the injection site B. Administer an oral medication for pain C. Notify the patient's health care provider of assessment findings D. Document assessment findings and related interventions in the patient's medical record E. This is a normal finding so nothing needs to be done F. Apply ice to the site for relief of burning pain

*Answer: A, C, D* Rationale: If a patient describes localized pain, numbness, burning or tingling at an IM injection site, you need to suspect possible injury to nerve or tissues. Appropriate nursing actions include assessing the site, notifying the patient's health care provider, and documenting your findings.

*After seeing a patient, the health care provider starts to give a nursing student a verbal order for a new medication. The nursing student first needs to:* A. Follow ISMP guidelines for safe medication abbreviations. B. Explain to the health care provider that the order needs to be given to a registered nurse. C. Write down the order on the patient's order sheet and read it back to the health care provider. D. Ensure that the six rights of medication administration are followed when giving the medication.

*Answer: B* Rationale: Nursing students cannot take medication orders.

*A nursing student is administering ampicillin PO. The expiration date on the medication wrapper was yesterday. What is the appropriate action for the nursing student to take next?* A. Ask the nursing professor for advice B. Return the medication to pharmacy and get another tablet C. Call the health care provider after discussing this situation with the charge nurse D. Administer the medication since medications are good for 30 days after their expiration date

*Answer: B* Rationale: The nurse needs to return the medication to the pharmacy and get a tablet that is not expired because expired medications should not be administered.

*What statement made by a 4-year-old patient's mother indicates that she understands how to administer her son's eardrops?* A. "To straighten his ear canal, I need to pull the outside part of his ear down and back." B. "I need to straighten his ear canal before administering the medication by pulling his ear upward and outward." C. "I need to put my son in a chair and make sure that he's sitting up with his head tilted back before I give him the eardrops." D. "After I'm done giving him his eardrops, I need to make sure that my son remains sitting straight up for at least 10 minutes."

*Answer: B* Rationale: When administering medications to people 3 years of age and older, you need to pull the auricle upward and outward to straighten the ear canal when giving eardrops.

*You are working in a health clinic on a college campus. You need to administer medroxyprogesterone acetate intramuscularly (IM) to a female patient for birth control. You look up this medication in a reference manual and determine that it is viscous and injections can be painful. On the basis of this information, you plan which of the following when administering this medication? (Select all that apply.)* A. Inject the medication over 3 minutes to reduce pain associated with the injection B. Administer the medication in the ventral gluteal site C. Use the z-track method when administering the medication D. Use the deltoid site for medication administration E. Ask the patient questions about her major and which classes she is taking during the injection to provide distraction

*Answer: B, C, E* Rationale: When giving viscous medications intramuscularly, a patient typically experiences pain. Giving the medication in the ventral gluteal site using the z-track method and distracting the patient during medication administration will help to decrease pain associated with the medication.

*A nurse admits a 72-year-old patient with a medical history of hypertension, heart failure, renal failure, and depression to a general medical patient care unit. The nurse reviews the patient's medication orders and notes that the patient has three health care providers who have ordered a total of 13 medications. What is the most appropriate action for the nurse to take next?* A. Give the medications after identifying the patient using two patient identifiers B. Provide medication education to the patient to help with adherence to the medical plan C. Review the list of medications with the health care providers to ensure that the patient needs all 13 medications D. Set up a medication schedule for the patient that is least disruptive to the expected treatment schedule in the hospital

*Answer: C* Rationale: This patient most likely is experiencing polypharmacy. To minimize risks associated with polypharmacy, frequent communication among health care providers is essential to make sure that the patients' medication regimen is as simple as possible.

*A nursing student is administering medications to a patient through a gastric tube (G-tube). Which of the following actions taken by the nursing student requires the nursing instructor to intervene?* A. The nursing student places all the patient's medications in different medicine cups. B. The nursing student evaluates each medication and holds the tube feeding before administering a medication that needs to be administered on an empty stomach. C. The nursing student flushes the tube with 30 mL of water between each medication. D The nursing student crushes a nifedipine extended-release tablet and mixes it with water before administering it.

*Answer: D* Rationale: Extended-release tablets should not be crushed; the nursing student needs to question this order and investigate alternative medications while the patient is receiving medications through the gastric tube.

*A toddler is to receive 2.5 mL of an antipyretic by mouth. Which equipment is the most appropriate for medication administration for this child?* A. A medication cup B. A teaspoon C. A 5-mL syringe D. An oral-dosing syringe

*Answer: D* Rationale: Syringes for oral dosing are adapted for accurate administration of medication to pediatric patients. They do not have a syringe or needle cap and cannot accidentally be used to administer parenteral medications.

*The nurse is administering an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in the appropriate order. 1. Release tubing and inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. Use watch to time administration. 2. Select injection port of intravenous (IV) tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy. 3. After injecting medication, release tubing, withdraw syringe, and recheck fluid infusion rate. 4. Connect syringe to port of intravenous (IV) line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port. 5. Clean injection port with antiseptic swab. Allow to dry. 6. Occlude intravenous (IV) line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return.* A. 2, 5, 4, 1, 3, 6 B. 2, 5, 6, 4, 1, 3 C. 5, 4, 2, 6, 1, 3 D. 2, 5, 4, 6, 1, 3

*Answer: D* Rationale: This is the appropriate order for a nurse to administer an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing.

*A nurse accidently gives a patient the medications that were ordered for the patient's roommate. What is the nurse's first priority?* A. Complete an occurrence report. B. Notify the health care provider. C. Inform the charge nurse of the error. D. Assess the patient for adverse effects.

*Answer: D* Rationale: Whenever a medication error occurs, the first action of the nurse is to assess the patient.

*A nurse caring for a patient on a general surgical unit notes the following medication order in the patient's medical record: 3 March 2016 1415 Administer 25 mg hydrochlorothiazide PO BID D.Anderson, MD What should the nurse do next?*

*Answer: The nurse should administer the medication after reviewing the order.* Rationale: This order contains all the requirements for a medication order, including the patient's name, date and time the order is written, medication name, dose, route, frequency of administration, and provider's signature.

1, 4, 5 Insulin is given as a subcutaneous injection for slower absorption. The rate of absorption of insulin differs in various sites. The abdomen has the quickest absorption. The recommended sites of insulin injection include the upper arms, anterior and lateral part of the thighs, buttocks, and abdomen. These sites have the appropriate amount of subcutaneous tissue for absorption of insulin. The injection site should not be chosen again for a month. The injection site should be rotated with each injection. Repeated injection at the same site may lead to lipodystrophy.

A diabetic patient has been switched from oral antidiabetic drugs to insulin. Which information would help the patient to ensure correct self-administration of insulin? Select all that apply. 1 The recommended sites of injection include the upper arm, thigh, abdomen, and buttocks. 2 Once a site is chosen for injection, the same site should be used for further injections. 3 The site of injection should be changed monthly. 4 The insulin is absorbed more quickly when injected into the abdomen. 5 Insulin is given as a subcutaneous injection.

2, 3, 4, 5 Self-administration of insulin requires proper visual acuity to ensure drawing the appropriate amount of insulin. Insulin must be stored as directed by the manufacturer to maintain vitality. The site of insulin injection must be rotated to prevent local changes of the skin. The nurse should demonstrate the proper preparation of a single insulin preparation. Insulin doses may be adjusted based on home-based blood glucose estimation of capillary blood or per the health care provider's instructions.

A diabetic patient is prescribed insulin. Which interventions should the nurse perform to teach the patient how to self-administer insulin? Select all that apply. 1 Instruct the patient not to titrate the insulin dose based on glucose monitoring. 2 Demonstrate the preparation of a single insulin preparation. 3 Demonstrate rotation of insulin site injections. 4 Instruct the patient about the appropriate storage of insulin. 5 Check the visual acuity of the patient.

100 The highest reading of a therapeutic range corresponds to the toxic range of plasma concentration. Any drug levels above this concentration are toxic. The highest value of the therapeutic range of the drug in question is 100 mg/dL, so plasma concentration of the drug above 100 mg/dL is toxic.

A medication has a minimum effective concentration of 25 mg/dL and the therapeutic range is 25 to 100 mg/dL. What is the plasma concentration above which the toxic effects of the drug may appear? Record your answer using a whole number. ___ mg/dL

2 A patient who underwent appendectomy (surgical removal of appendix) may not be contraindicated for oral route of drug administration because the appendix is not a major part of the gastrointestinal (GI) tract. Oral medication is generally avoided in patients with a surgical resection of the GI tract. A patient with reduced GI motility after general anesthesia or bowel inflammation is contraindicated for oral medication administration. Oral administration is contraindicated in patients with esophageal strictures because of the difficulty in swallowing. The oral route is also avoided when patients have alterations in GI function. Therefore, a patient with nausea and vomiting is contraindicated for oral route of drug administration.

A nurse reviews the clinical data of four patients. Which patient is suitable for oral medication administration? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

1, 2 Aspiration is a serious problem encountered while administering oral medications. While administering oral medications, the patient should not use a straw because it decreases the patient's control over volume intake, thereby increasing the risk of aspiration. The patient should be positioned in an upright sitting position while administering medications to prevent aspiration. A single pill should be administered at one time, because it helps to swallow easily, which prevents the risk for aspiration. The patient can safely drink the medication from a cup; it will prevent the risk for aspiration. Allowing the patient to self-administer the medication decreases the risk of aspiration.

A nursing student prepares to administer medication to a patient through the oral route. Which actions made by the nursing student may cause the patient to experience aspiration? Select all that apply. 1 Positioning the patient in a relaxed sleeping position during administration 2 Instructing the patient to use straws while taking liquid medication 3 Allowing the patient to self-administer the medication 4 Instructing the patient to drink the medication from a cup 5 Administering one pill at a time

3 Patients need to know information about their medications so they can take them correctly and safely. The nursing student can provide the name of the medication and a description of its desired effect. The student should not dismiss the patient's concerns by telling the patient that he should speak with the physician or assigned nurse.

A nursing student takes a patient's antibiotic to his room. The patient asks the nursing student what it is and why he should take it. How should the nursing student respond to the patient? 1 Tell the patient he has to speak with his assigned nurse about this. 2 State that information about medications is confidential and cannot be shared. 3 Provide the name of the medication and a description of its desired effect. 4 Explain that only the patient's physician can give this information

50 The daily requirement for this patient is 2 X 2 puffs—that is, 4 puffs a day. The canister has a total of 200 puffs; therefore, using 4 puffs daily will empty the canister in (200/4) = 50 days, so the patient should come in for a canister replacement after 50 days.

A patient has been advised to use a metered dose inhaler (MDI) two puffs two times a day. The canister has a total of 200 puffs of medicine. When should the nurse ask the patient to come in for a new canister? Record your answer using a whole number. ___ days

2, 5 Enoxaparin is a low-molecular-weight heparin that is administered in subcutaneous tissue of the abdomen, at least 2 inches away from the umbilicus. The injection site has to be pinched as the needle is inserted. This helps ensure that the medicine is injected into the subcutaneous tissue. Subcutaneous injections are not to be given over bony prominences, because doing so can cause injury. When administering enoxaparin, air within the syringe should not be expelled, because doing so can affect the dosing. Subcutaneous injections should not be given over large underlying muscles, because the medicine can be accidently injected into the muscles. Medication injected into a muscle is absorbed more quickly than from the subcutaneous tissue.

A patient has been prescribed enoxaparin. Which points should the nurse keep in mind when administering enoxaparin? Select all that apply. 1 The injection should be given over large underlying muscles. 2 The injection site should be pinched while the needle is being inserted. 3 Air should be expulsed from the syringe before administration. 4 The injection should be given over a bony prominence. 5 The injection should be given in the abdomen.

2 The patient with unilateral weakness may have an increased risk of aspiration due to impaired swallowing. To prevent aspiration, the medication should be placed on the stronger side of the mouth. This action improves swallowing of the medication. Providing medication as a solution increases the risk of aspiration. Placing the medication in the weaker side of the mouth may lead to inappropriate swallowing. Grinding the medication before administration does not reduce the incidence of aspiration.

A patient has unilateral weakness due to a medical disorder. How can the nurse administer medication to this patient without causing aspiration? 1 Crush the medication before administration. 2 Place the medication in the stronger side of mouth. 3 Place the medication in the weaker side of mouth. 4 Provide the medication as a solution.

4 A STAT order indicates that the single dose of medication should be given immediately and only once. When a patient with high blood pressure is admitted to an emergency unit, then a STAT order is used by the primary health care provider. A now order is used when the patient requires the medication within the next 90 minutes, but not immediately. A single order is used for preoperative medications or medications given before diagnostic examinations; these medications are given at once in a specified time. A standing order is an order that is carried out until the primary health care provider cancels it.

A patient is admitted to the emergency unit with hypertension. Which prescription order would the primary health care provider use in this situation? 1 Standing order 2 Single order 3 Now order 4 STAT order

4 While using a breath-activated metered-dose inhaler, the inhaler should not be shaken. The mouthpiece should be positioned between the lips for medication administration. The patient should inhale deeply and forcefully through the mouth to create an aerosol. The patient should hold his or her breath for 5 to 10 seconds during inhalation to ensure full medication administration.

A patient is inhaling using a breath-activated metered-dose inhaler. Which action made by the patient indicates a need for correction? 1 Holding the breath for 5 to 10 seconds during inhalation 2 Inhaling deeply and forcefully through the mouth 3 Positioning the mouthpiece between the lips 4 Shaking the inhaler vigorously

25 Two puffs of a medication four times a day indicates eight puffs per day. 200 puffs divided by eight puffs per day equal 25 days.

A patient is instructed to use two puffs of salbutamol (Ventolin) four times a day. The canister has 200 puffs. Calculate how long the metered-dose inhaler will last. Record your answer using a whole number. ____________ days

4, 5 A patient is prescribed a sublingual nitroglycerin drug. Which instructions should the nurse provide to the patient? Select all that apply. 1 Place the drug between your tongue and cheeks. 2 Take the medication with water. 3 Spit out the drug in case of irritation. 4 Place the medication under the tongue. 5 Do not swallow the medication

A patient is prescribed a sublingual nitroglycerin drug. Which instructions should the nurse provide to the patient? Select all that apply. 1 Place the drug between your tongue and cheeks. 2 Take the medication with water. 3 Spit out the drug in case of irritation. 4 Place the medication under the tongue. 5 Do not swallow the medication

2, 4 Lozenges are slowly absorbed through the buccal mucosa; therefore, they should be kept in the mouth an adequate time to allow dissolution. Lozenges should not be ingested quickly because they are more effective when absorbed through the buccal mucosa and not the gastric mucosa. The lozenges should not be crushed or dissolved in water or juice, because this can make them ineffective.

A patient is prescribed lozenges for a cough. Which instructions should the nurse give to this patient regarding the use of lozenges? Select all that apply. 1 Dissolve in juice before swallowing. 2 Do not ingest the medication quickly. 3 Dissolve in water before swallowing. 4 Allow the medication to dissolve in the mouth. 5 Crush the lozenge before swallowing.

2 A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications. Setting up follow-up appointments, ensuring that someone will provide housekeeping for the patient, and making sure the patient's family knows how to safely bathe the patient are not the priority for the discharge nurse in relation to medication administration.

A patient is transitioning from the hospital to the home environment and obtains a home care referral. Which is priority for the discharge nurse in relation to safe medication administration? 1 Make sure the patient's family knows how to safely bathe the patient and provide mouth care. 2 Ensure that the home care agency is aware of medication and health teaching needs. 3 Ensure that someone will provide housekeeping for the patient at home. 4 Set up the follow-up appointments with the physician for the patient.

1 While using a breath-activated metered-dose inhaler, holding the breath for 5 to 10 seconds ensures full medication distribution. Positioning the mouthpiece between the lips prevents medication from escaping through the mouth. Exhaling away from the inhaler before inhalation prevents a loss of powder. Inhaling deeply and forcefully through the mouth creates an aerosol.

A patient is using a breath-activated metered-dose inhaler. Which action made by the patient ensures full medication distribution? 1 Holding the breath for 5 to 10 seconds during inhalation 2 Inhaling deeply and forcefully through the mouth 3 Exhaling away from the inhaler before inhalation 4 Positioning the mouthpiece between the lips

1 Vomiting, diarrhea, and abdominal cramps are suggestive of the disturbed gastrointestinal tract. The oral route of drug administration is contraindicated in patients with gastrointestinal disturbance, because there will not be effective drug absorption. The astopial route, intravenous route, and transdermal route do not require gastrointestinal system for drug metabolism, so these routes of drug administration are safe for this patient.

A patient reports severe vomiting, diarrhea, and abdominal cramps to the nurse. Which form of medication is contraindicated in the patient? 1 Tablet administered through the oral route 2 Transdermal medicine administered through the skin surface 3 Solution administered through an intravenous line 4 Lotion applied to the topical surface

3 One household cup is approximately equivalent to 240 mL. . Therefore the patient would require 2 cups of oral rehydration solution (2 X 240 mL). Three cups are equivalent to 240 X 3 = 720 mL of the solution. Four cups would be equivalent to 240 x 4 = 960 mL of the solution.

A patient who has diarrhea is dehydrated and needs 480 mL of oral rehydration solution. How can the nurse show the patient what 480 mL is using a household measurement? 1 Four cups are approximately equivalent to 480 mL. 2 Three cups are approximately equivalent to 480 mL. 3 Two cups are approximately equivalent to 480 mL. 4 One cup is approximately equivalent to 480 mL.

1 Household measurement is most familiar and includes drops, teaspoons, tablespoons, and cups for volume, pints, and quarts for weight. The prescription order containing 30 mL indicates that 2 tablespoons of the medication should be taken. 240 mL indicates 1 cup of the medication. 960 mL indicates 1 quart of the medication. 5 mL indicates 1 teaspoon of the medication.

A patient's prescription order calls for 30 mL of the medication to be taken. What should the nurse instruct the patient regarding the administration of the medication according to household measurement? 1 "You should take 2 tablespoons of the medication." 2 "You should take 1 teaspoon of the medication." 3 "You should take 1 quart of the medication." 4 "You should take 1 cup of the medication."

2 Maintenance medications are inhaled; their effects lasts for long periods of time. Rescue medications are short acting and provide immediate relief. Maintenance medications are used on a daily basis to prevent acute respiratory distress.

A primary health care provider prescribes maintenance medication to a patient with respiratory distress. What does the nurse teach the patient about maintenance medication? 1 A dose of maintenance medication is administered monthly. 2 The effects of maintenance medication last for a long time. 3 Maintenance medication provides immediate relief. 4 Maintenance medication is short acting.

2, 4, 5 Oral disintegrating tablets begin to dissolve immediately. Therefore, they should not be pushed through the foil. Oral disintegrating medications should be placed on the patient's tongue and should not be chewed. Because these tablets dissolve when placed on the tongue, water is not necessary. Oral disintegrating medications should be placed on top of the patient's tongue. Oral disintegrating medications should be removed from the blister packet just before use.

A registered nurse evaluates the actions of a nursing student who is administering oral disintegrating tablets to a patient. Which actions made by the nursing student indicate a need for correction? Select all that apply. 1 Removing the medication from the blister packet just before use 2 Offering water to the patient to help swallow the tablet 3 Placing the medication on top of the patient's tongue 4 Instructing the patient to chew the medication 5 Pushing the tablet through the foil

1, 3 Most of the drugs undergo biotransformation in the liver before they are excreted through kidneys. Enema, which increases the rate of peristalsis, will accelerate the excretion of medication through feces. Renal failure may result in drug toxicity due to improper excretion of the drug from the body. Adequate fluid intake promotes proper elimination of medications through kidneys. Drug doses should be minimized in patients with renal disease to avoid the risk of drug toxicity.

A registered nurse is teaching a nursing student about medications in patients with renal disease. Which statements, if made by the nursing student, indicate a need for further teaching? Select all that apply. 1 "Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure." 2 "Health care providers should decrease the medication dose in patients with renal disease." 3 "Most drugs undergo biotransformation in the kidney before they are excreted." 4 "Adequate fluid intake promotes proper elimination of medications through the kidneys." 5 "Renal failure may lead to drug toxicity in the body."

4 A troche is a flat, round tablet that should be dissolved in the mouth for medication release. Therefore, a patient who is prescribed a troche form of medication should be instructed to dissolve the medication slowly in the mouth. A caplet is a solid dosage form of medication, which is available in coated form and meant to be swallowed whole. A capsule is a form of medication that is encased in a gelatin shell; this medication is meant to be swallowed whole. A tablet is a powdered medication compressed into a hard disk or cylinder; this medication is also meant to be swallowed whole.

A registered nurse prepares to administer medications to four patients through the oral route. Which patient is instructed to dissolve the medication slowly in the mouth? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

1 Only oral syringes should be used when preparing medications for the enteral route to prevent accidental parenteral administration. If liquid medications are not available, the nurse can crush simple tablets or open capsules and dilute them in water before administering them. Enteral tubes should be flushed with at least 30 mL of water before and after giving medications. The incompatibility of the location of the tube with the medication being administered may lead to poor bioavailability of the drug administered.

A registered nurse teaches a nursing student about the precautionary measures to be taken while caring for a patient with enteral tubes. Which statement made by the nursing student indicates the need for further teaching? 1 "I will use regular syringes while preparing medications for a patient." 2 "I will verify the compatibility of the location of the tube with the medication being administered." 3 "I will flush tubes with at least 30 mL of water before and after administering medications." 4 "I will crush tablets and dilute them with water before administering them to the patient."

3 AD in the prescription order indicates that the medication should be administered in the right ear. AS in the prescription order indicates that the medication should be administered in the left ear. OD indicates that the medication should be administered in the right eye. OS indicates that the medication should be administered in the left eye.

After reading the prescription order of a patient, the nurse prepares to administer the medication in the patient's right ear. Which abbreviation in the prescription reflects the nurse's action? 1 OS 2 OD 3 AD 4 AS

3 Nursing students cannot take orders from physicians. Thus, there is no need to refer to the ISMP for abbreviation guidelines, write down the order, and ensure the six rights of medication administration are followed in this instance.

After seeing a patient, the physician gives the nursing student a verbal order for a new medication. What should the nursing student do first? 1 Ensure that the six rights of medication administration are followed when giving the medication. 2 Write down the order on the patient's order sheet and read it back to the physician. 3 Explain to the physician that the order should be given to a registered nurse. 4 Follow Institute for Safe Medication Practices (ISMP) guidelines for abbreviations.

3, 2, 1, 4, 5, 6 First, remove the cover from the mouthpiece. Then, hold the inhaler upright and turn the wheel to the right. Then, turn the wheel to the left until a click is heard. Next, load the medication pellet and exhale away from the inhaler before inhalation. Then, position the mouthpiece between the lips. Finally, inhale deeply and forcefully through the mouth.

Arrange the steps in administering a breath-activated metered-dose inhaler in sequential order. 1. Load the medication pellet 2. Hold the inhaler upright and turn the wheel to the right and left until a click is heard 3. Remove the cover from the mouthpiece 4. Exhale away from the inhaler before inhalation 5. Position the mouthpiece between the lips 6. Inhale deeplyand forcefully through the mouth

0.4 The volume required is calculated by the formula: (Dose ordered/dose on hand) x Amount on hand = Amount to administer. (4 mg/10 mg) x 1 mL = Amount to administer = 0.4 mL. Therefore, the patient requires 0.4 mL of morphine to be administered.

The healthcare provider has instructed the nurse to administer 4 mg of morphine sulfate intravenously to a patient. The ampule of morphine contains 1 mL of the solution with a concentration of 10 mg/mL. What volume of the medication should the nurse administer to this patient? Record your answer to one decimal place. ___ mL

125 The amount of drug to be administered to the patient is calculated as: Dose ordered/dose on hand × amount on hand. Here, the amount of medication administered to the patient is 0.25 L, and the dose on hand is 500 mg/L. The amount on hand is 1 L. Therefore, the calculation is 0.25/500 x 1 = 125. Therefore, the prescribed dose is 125 mg/L.

The nurse administers 0.25 L of 500 mg/L paracetamol (over-the-counter analgesic) to a pediatric patient through intravenous route. What is the actual dose prescribed to the patient? Record your answer in the whole number _____ mg/L

3 Acidic medications cause gastric irritation. Nonfat snacks should be offered to reduce gastric irritation, because snacks that are rich in fat can delay the medication absorption. Lozenges are absorbed slowly through the oral mucosa. Therefore, a patient taking a lozenge is cautioned against chewing or swallowing the lozenge. Powdered medications should be mixed with liquid just before administration because when prepared in advance, powdered medications often thicken, which makes swallowing difficult. Effervescent medications should be dissolved in water and given immediately after dissolving.

The nurse administers different forms of medications to a patient. Which action made by the nurse indicates a need for correction? 1 Giving effervescent medications to a patient immediately after dissolving them in water 2 Mixing powdered medications with liquid just before administration 3 Offering a snack rich in fats after administering acidic medication 4 Cautioning the patient against chewing or swallowing a lozenge

1 While using a metered-dose inhaler using a spacer, the small exhalation slots should not be covered because it prevents the air from moving out of the inhaler. The spacer mouthpiece should be placed into the mouth and the lips should be closed. Before exhaling, the metered-dose inhaler should be removed from the mouth. The medication canister should be depressed and one puff should be sprayed in the spacer.

The nurse evaluates the actions of a patient who is self-administering medication through a metered-dose inhaler using a spacer. Which action made by the patient indicates a need for correction? 1 Covering the small exhalation slots with the lips 2 Depressing the medication canister and spraying one puff in the spacer 3 Removing the metered-dose inhaler and spacer before exhaling 4 Placing a spacer mouthpiece into the mouth and closing the lips

26 mL One teaspoon is equal to 5 mL in the metric system. Therefore, 5 teaspoons of magnesium hydroxide is equal to 25 mL (5 x 5 = 25 mL). Fifteen drops of medication is equal to 1 mL. Therefore, 25 mL + 1 mL = 26 mL.

The nurse finds an order for 5 teaspoons of magnesium hydroxide and 15 drops of diphenhydramine hydrochloride in a patient's prescription. How much medication (in volume) should the nurse administer in total? Record your answer using a whole number.

4 For rectal administration of a suppository, the patient should be placed in the Sims' position. Neither the patient nor the nurse would be comfortable if the patient were placed in the prone position, lateral position, or dorsal recumbent position.

The nurse has been asked to administer a rectal suppository to a patient. In what position should the nurse place the patient? 1 Doral recumbent 2 Lateral position 3 Prone position 4 Sims' position

3 A rectal suppository for an adult should be placed against the rectal wall about 10 cm into the rectum. For children and infants, the suppository should be placed 5 cm deep into the rectum against the rectal wall. The inner aspect of the anal orifice is not the right position for suppository administration. The suppository has to be placed past the internal anal sphincter.

The nurse has been asked to administer a rectal suppository to an adult patient. Where should the nurse place the medication? 1 Just prior to the internal anal sphincter 2 Inner aspect of the anal orifice 3 Rectal wall 10 cm into the rectum 4 Rectal wall 5 cm into the rectum

2 The use of opioid drugs is carefully controlled through federal and state guidelines. Violation of these guidelines is punishable under the controlled substance law. State Nurse Practice Acts (NPAs) define the scope of nurses' professional functions and responsibilities. The Pure Food and Drug Act is the first American law to regulate medications. The Food and Drug Administration is the current monitoring body for maintaining the standards of medication, through its medication law.

The nurse in the palliative care unit is administering a higher-than-prescribed dose of opioid analgesic to a patient with terminal stage cancer to relieve pain. Which act or law should discipline the nurse? 1 Medication law of Food and Drug Administration 2 Controlled Substance Act 3 Pure Food and Drug Act 4 Nurse Practice Act

2, 4, 5 A full prescription of the antibiotics should be completed to ensure the therapeutic effect. An incomplete course of antibiotics may worsen the condition being treated and also lead to development of resistance to the antibiotic. Full treatment must be taken even if the patient attains early symptomatic relief. If the patient's condition does not improve with full treatment, then treatment should be discontinued.

The nurse is attending to a patient with a pulmonary infection. The healthcare provider prescribes antibiotics for the patient. Which instructions should the nurse give to the patient regarding antibiotic treatment? Select all that apply. 1 Emphasize continuation if the condition does not improve with a full course of medication 2 Explain that improper treatment may cause development of bacterial resistance. 3 Emphasize discontinuing the treatment once the patient attains symptomatic relief. 4 Explain that improper treatment may worsen the patient's condition. 5 Emphasize taking the full prescription.

0.5 By using the formula method: (Dose ordered/Dose on hand) x amount on hand = Amount to administer. (250 mg/1000 mg) x 2 mL = ½ mL = 0.5 mL.

The nurse is preparing a medication ordered by the physician. The physician ordered 250 mg of Tylenol to be given to the patient. The medication comes from the pharmacy in dosage strength of 1 gram of Tylenol in 2 mL. How many mL should the nurse administer? Record your answer using one decimal place. ____________ mL

1, 2, 5 The interventions for safe insulin administration include teaching the patient how to determine the expiration date of insulin. The nurse should help the patient to determine the amount of insulin required based on the home capillary glucose monitoring results. Insulin should be administered as a subcutaneous injection. The nurse should instruct the patient to refrigerate the medication whenever needed. Insulin should be self-administered; however, when necessary, a caregiver can assist in rotating injection sites.

The nurse is preparing a teaching plan for safe insulin administration. Which interventions included in the plan is appropriate for the patient? Select all that apply. 1 Helping the patient determine the insulin required based on the home capillary glucose monitoring 2 When necessary, instructing the patient to accept help from the caregiver for rotating injection sites 3 Instructing the patient to avoid refrigeration of the medication 4 Teaching the steps of administering intramuscular injection 5 Teaching the patient to determine the expiration date of insulin

1 The capacity of the tuberculin syringe is 1 mL and is used to prepare small amounts of medications (e.g., intradermal or subcutaneous injections).

The nurse is preparing an intravenous medication for an infant in the pediatric unit and is using a tuberculin syringe for precise medication measurement. The tuberculin syringe is calibrated in hundredths of a milliliter. What is the capacity of the syringe? Record your answer using a whole number. __ mL

1, 3, 5 All narcotics should be stored in a locked, secure cabinet or container to ensure safe storage. The narcotics should be counted with the opening of narcotic drawers and/or at shift change to ensure that narcotics are not missing. The patient's name, date, time of medication administration, name of medication, dose, and signature of the nurse dispensing the medication should be recorded. Documentation is necessary to keep a proper count of drug usage. Discrepancies in narcotic counts should be immediately reported, because they may be a result of theft or illegal drug use. Any unused portion should be disposed of to prevent abuse.

The nurse is responsible for the storage and safe usage of drugs. Which guidelines should the nurse follow for the safe use of narcotics? Select all that apply. 1 Document and record patient details. 2 Do not report discrepancies in narcotic count. 3 Frequently count narcotics, especially during shift change. 4 Preserve unused portion of the drug. 5 Store narcotics in locked containers.

2, 3, 5 The components of a medication order include dose and frequency of the medication, route of administration, and generic name of the medication. The dose and frequency are decided based on the patient's weight and the amount of medication required to obtain the therapeutic effect. The route of administration depends on the types of medication and the condition of the patient. The medication can be given via enteral or parenteral route. The generic name of the drug is an important component of the medication order and is used to identify the drug. The chemical name of the medication and the name of the nurse in charge are not components of the medication order.

The nurse is reviewing a medication order for a patient. What are the components of medication orders? Select all that apply. 1 Chemical name of medication 2 Generic name of medication 3 Route of administration 4 Specific nurse in charge 5 Dose and frequency

1 The intraosseous route of administration is common in toddlers who have poor access to intravascular space. Insulin is administered through the intraperitoneal route. Epidural medication is administered in the spinal canal in the epidural space. Intraarterial medication administration is managed by the nurse who continuously infuses the clot-dissolving agent and carefully monitors the integrity of the infusion.

The nurse is teaching a nursing student about parenteral routes. Which statement made by the nursing student indicates a need for correction? 1 "Intrapleural administration is common in toddlers who have poor access to intravascular space." 2 "Epidural medication is used to administered medicine in the spinal canal." 3 "Intraarterial medication administration is managed by the nurse." 4 "The intraperitoneal route is used to administer insulin."

2, 3, 5 In a hospital setting, whenever a verbal order is given, the nurse should read back the order to the prescriber to confirm it. The order should be entered in the computer. The nurse should receive confirmation of the order from the prescriber for validation. The nurse should enter the time and the prescriber's name and then sign the order, indicating that it was read back. The prescriber should countersign the order within 24 hours, not 48 hours.

The nurse on night shift explains a patient's condition to the healthcare provider, who in turn provides the verbal order of medication over the phone. Which accurately describe the roles of nurse and health care provider in executing telephone orders? Select all that apply. 1 The prescriber should countersign within 48 hours. 2 The nurse should receive confirmation from the prescriber. 3 The nurse has to enter the order in the computer. 4 The nurse should not sign the order. 5 The nurse should read back the order.

4 Splitting tablets in half, even if they are prescored with a line down the middle, leads to medication errors. If a pill must be split within inpatient settings, the pharmacist splits the pill with a splitting device, repackages and labels it, and sends it to the nurse for administration. Nurses should not split pills. When using a blister pack, the nurse should pop medications through the foil or paper backing into a medication cup. To prepare tablets or capsules from a floor stock bottle, the nurse should pour the required amount into a bottle cap and transfer the medication to the medication cup without touching the medication with his or her fingers. To prepare unit-dose tablets or capsules, place the packaged tablet or capsule directly into the medicine cup without removing the wrapper.

The nurse prepares to administer a solid form of oral medications. Which action made by the nurse indicates a need for correction? 1 Placing the tablet into a cup without removing the wrapper while preparing unit dose tablets 2 Pouring the required tablet into a bottle cap 3 Popping medications through the file into the cup when using a blister pack 4 Splitting the tablet in half when it is necessary to give half of a pill

3 The order from the prescriber should indicate the route of administration, rather than hospital policy, type of mediation, or size of the patient.

The nurse receives an order to start giving a loop diuretic to a patient to help lower blood pressure. Which will help the nurse determine the appropriate route for administering the diuretic? 1 The patient's size and muscle mass 2 The type of medication ordered 3 The prescriber's orders 4 Hospital policy

3 Asthma is primarily an inflammatory disease; therefore a patient with asthma may require anti-inflammatory agents through inhalational route. Patients with chronic obstructive pulmonary disease (COPD) receive bronchodilators because they usually have problems with bronchoconstriction. A patient with emphysema may receive a bronchodilator because emphysema causes bronchoconstriction. A patient with pneumonia may not receive anti-inflammatory agents through the inhalational route because pneumonia is treated with antibiotics. A patient with bronchitis may not receive anti-inflammatory agents through the inhalational route because bronchitis causes bronchoconstriction.

The nurse reviews the clinical data of four patients. Which patient is suitable to receive anti-inflammatory agents through the inhalational route? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

1 When there is a prn order, the nurse may use his or her own discretion for administering or withholding medication based on a subjective or objective assessment. Stat orders refer to single doses of medication to be given immediately or only once. Standing orders and routine medication orders are the same; in either case, the nurse continues the medication as directed by the prescriber until the prescriber asks the nurse to stop the medication.

The nurse works in a postoperative unit. Under which order should the nurse perform an assessment to determine whether the patient needs medication? 1 Prn order 2 Routine medication order 3 Standing order 4 Stat order

4, 5 The unit-dose system uses a cart with drawers with a 24-hour supply of medications for each patient. The drawers are labeled with the patient's name. Controlled substances are not kept in the patient's drawer; they are kept separately in locked drawers. The cart also has prn and stock medications. The carts have the ordered dose of medication for each patient for 24 hours, which may not be the full course.

The nursing instructor is talking to nursing students about the unit-dose system used in medication distribution. Which statements accurately describe the unit-dose system? Select all that apply. 1 It includes ordered doses of medication for a full course. 2 It does not contain prn and stock medication. 3 It has controlled substances kept in foil. 4 It has labeled drawers. 5 It uses carts for distribution.

1 The amount to be given is half the amount that is provided in the solution. Therefore, the answer is 1 mL. The nurse will calculate the answer using the proportion method. Because the ampule has 40 mg/2 mL, and the nurse has to administer only 20 mg, use the formula 40 mg/2 mL = 20 mg/x mL, 40x = 40, x = 1 mL.

The order is for 20 mg of a medication to a pediatric patient. The ampule of the medication has 40 mg/2 mL of the medication. What is the correct volume to be administered? Record your answer using a whole number. ______ mL

2 Morphine sulfate 2 mg IV q2h prn indicates a prn order. A prn order of prescription by the primary health care provider indicates that the medication should be administered whenever the patient requires it. A STAT order indicates that the medication should be given immediately. A now order indicates that the medication should be given within 90 minutes. A single order indicates that the medication should be given once at a specified time before the diagnostic examination.

The prescription order of a patient contains morphine sulfate 2 mg IV q2h prn for incisional pain. Which intervention made by the nurse would be appropriate for this patient? 1 Administering the medication before the diagnostic examination 2 Administering the medication only when the patient requires it 3 Administering the medication within 90 minutes 4 Administering the medication immediately

4, 5 It is always advisable to awaken a sleeping child before giving an injection. Parents or other nurses may help restrain unpredictable and uncooperative children. Infants and children have underdeveloped muscles, so intramuscular injections must be done with caution and in accordance with the agency's policies. It helps if the child is distracted with bubbles, toys, and other fun stimuli to reduce the pain perception. Application of lidocaine gel is safe and appropriate for reducing pain perception to a certain extent.

The primary health care provider instructs the nurse to administer a booster dose of tetanus toxoid to a 7-year-old patient. Which nursing actions are appropriate? Select all that apply. 1 Avoiding the application of topical lidocaine ointment before injecting the vaccine 2 Avoiding distracting the concentration of child while injecting the vaccine 3 Always look for a muscular site for injection 4 Having a parent help restrain the patient if he or she is unpredictable or uncooperative 5 Avoiding injections when the patient is asleep

1 When the medication, to which the patient is allergic, is modified before reaching the patient, it is called a near miss. When such an error occurs in a health care setting, it should be reported to the hospital administration. Even though it did not harm the patient, it should be reported so as to prevent such errors in the future. Reporting it to the patient is not appropriate, because it may create a negative impression about the hospital. The nurse should not consider it a common error, because it could have harmed the patient. Writing it in the patient's medical record is not an appropriate intervention.

The primary health care provider prescribed sulfamethoxazole (Bactrim) to a patient with a urinary tract infection. The nurse finds that the patient is allergic to sulfa drugs and obtains an order for another medication. What is the nurse's responsibility in this situation to prevent such medication error in future? 1 Reporting it to the hospital administration 2 Writing it in the patient's medical record 3 Considering it as a common error 4 Reporting it to the patient

2, 4 The suppository form of medication involves the insertion of pellets of medications in body cavities such as the vagina and rectum. The oral route, topical route, and intravenous route of drug administration do not use the suppository form of medications.

The primary health care provider prescribes a suppository form of medication to a patient. What are the probable routes of administration advised for the patient? Select all that apply. 1 Intravenous route 2 Vaginal route 3 Topical route 4 Rectal route 5 Oral route

0.4 The amount of drug to be administered to the patient is calculated as: Dose ordered/Dose on hand × Amount on hand. Here, the dose ordered is 200 mg and the dose on hand is 500 mg. The amount on hand is 1 L. The calculation is: 200/500 x 1= 0.4 L. Therefore, 0.4 L, or 400 mL of 500 mg/L conc. of amoxicillin should be administered to the patient, to meet the requirement of the primary health care provider.

The primary health care provider prescribes intravenous administration of 200 mg of amoxicillin to a pediatric patient with acute gastritis. However, the pharmacy has intravenous drips of only 500 mg/L. How much volume of 500 mg/L dose should the nurse administer to the patient to ensure that the dosage suffices the primary health care provider's prescription? Record your answer to one decimal. ____ L.

4 The notation "prn" in the prescription indicates that the medication can be taken as and when required, maintaining a specific time interval between doses. The notation "qh" indicates that the medication should be taken every hour. The notation "ac" indicates that the medication should be taken before meals. "bid" indicates that the medication should be taken twice a day.

The primary health care provider prescribes pain medication to a patient with the notation "prn" in the prescription. What should the nurse interpret from the prescription? 1 The medication should be taken twice each day. 2 The medication should be taken before meals. 3 The medication should be taken every hour. 4 The medication should be taken as needed.

3, 4 Hydralazine is an emergency drug that should be administered as per the STAT order of prescription that is written in emergencies when a patient's condition changes suddenly. Lorazepam is an example of a drug that is administered following a one-time prescription order. A single order prescription necessitates the administration of medication at one specific time. A prn order prescription necessitates the administration of medication only when a patient requires it.

The registered nurse is teaching a nursing student about prescription orders. Which statement if made by the nursing student indicates the need for further teaching? 1 "A prn order is prescribed when the drug should be administered to the patient as and when required." 2 "A single order prescription necessitates the administration of medication at one specific time." 3 "Administration of lorazepam is an example of a prn order of prescription." 4 "Administration of hydralazine is an example of a now order prescription." 5 "Only emergency medications are prescribed in STAT prescription orders."

1 Most pediatric medications are not rounded to the nearest thousandth decimal. They are rounded to the nearest tenth, to prevent drug overdose. Ototoxicity is the reported adverse effect of vancomycin. Therefore, it is challenging to administer this drug to infants who cannot talk. Unlike the adult drug regimen, most pediatric medications are ordered in milligrams per kilogram (mg/kg) of body weight. A child's age, weight, and maturity of body systems affect the ability to metabolize and excrete medications.

The registered nurse is teaching pediatric drug dosages to a nursing student. Which statement if made by the nursing student indicates a need for further teaching? 1 "After the dose calculation as per the age, most of the doses are rounded to the nearest thousandth." 2 "A child's age, weight, and maturity of body systems affect the drug dosage. " 3 "Most pediatric medications are ordered in milligrams per kilogram dosage." 4 "Drugs such as vancomycin should be administered to infants with caution."

3 Mixing the medication in the pediatric patient's favorite drink should be avoided, because the child may later refuse the same drink. A pediatric patient may accidentally aspirate a pill, which could be fatal. Therefore, liquids or elixirs are safer in children. Offering the child juice after he or she has swallowed the medication will help get rid of any bad taste in the child's mouth and incentivize the child to take the next dose if he or she is promised juice afterward. Droppers are indicated for the administration of tablet solution to infants.

The registered nurse is teaching the nursing student about the administration of oral analgesic medications in the pediatric patients. Which of the student's actions indicates the need for further teaching? 1 Using droppers to administer tablet solution to infants 2 Offering the child juice after he or she has swallowed the medication 3 Mixing the medication in the child's favorite drink 4 Administering an elixir or liquid rather than pills

2, 3, 4, 1 When performing vaginal administration of a suppository, the index finger of the dominant hand is lubricated with a water-soluble lubricant jelly. Then the vaginal orifice is exposed with the nondominant hand by retracting the labial folds. The rounded end of the suppository is then inserted along the posterior wall of the vagina to ensure uniform distribution of medication along the walls of the vaginal cavity. Last, wipe off the remaining lubricant around the orifice and labia.

The various steps involved in vaginal administration of a suppository are listed. Arrange the steps in the correct sequence. 1. Wipe away remaining lubricant around orifice. 2. Lubricate index finger of dominant hand. 3. Expose vaginal orifice with nondominant hand. 4. Insert suppository along posterior wall of vagina.

3, 4, 5 The advantages of the oral route of medication administration are that the medications are easy to administer, this method rarely causes anxiety, and this method is convenient and comfortable. The disadvantages of the oral route are that it cannot be used when a patient has gastric suction or reduced gastric mobility.

What are the advantages of administering medications by the oral route? Select all that apply. 1 The oral route is effective when a patient has reduced gastric mobility. 2 The oral route can be used when a patient has gastric suction. 3 The oral route is convenient and comfortable. 4 The oral route rarely causes anxiety. 5 The oral route is easy to administer.

1 An idiosyncratic reaction is an unpredictable effect that involves over-reaction or under-reaction to a medication. A side effect is a predictable and unavoidable adverse effect that is produced at a usual therapeutic dose. A toxic effect is an effect that occurs after prolonged intake of medications. An allergic reaction is an unpredictable response of medications that occurs with repeated administration.

Which adverse effect involves overreaction or under-reaction to a medication effect? 1 Idiosyncratic reaction 2 Allergic reaction 3 Toxic effect 4 Side effect

4 Propofol, used for anesthesia and sedation, includes egg lecithin and soybean oil as inactive ingredients. Therefore, patients who have an egg or soy allergy should not receive propofol. Lorazepam is an anti-anxiety drug administered to patients with anxiety. Hydralazine is a muscle relaxant, indicated in emergency conditions. Vancomycin is an antibiotic medication.

Which anesthetic drug is contraindicated in patients with allergy to soy products? 1 Vancomycin 2 Hydralazine 3 Lorazepam 4 Propofol

2 The use of opioid drugs is carefully controlled through federal and state guidelines. Violation of these guidelines is punishable under the controlled substance law. Antiemetics, antihistamines, and nonsteroidal anti-inflammatory drugs are not controlled substances.

Which class of drugs, if administered to the patient without a prescription, is punishable under the Controlled Substance law? 1 Nonsteroidal anti-inflammatory drugs 2 Opioid analgesics 3 Antihistamines 4 Antiemetics

1, 2 Powder and solution are medication forms that are commonly prepared for administration by parenteral routes. Elixir is a clear fluid containing water and or alcohol that is given orally. Troche is a lozenge that is given orally. Extract is a concentrated form of medication that is made by removing the active part of medication from its other components. It is given orally.

Which medication forms are commonly prepared for administration by parenteral routes? Select all that apply. 1 Solution 2 Powder 3 Extract 4 Troche 5 Elixir

4 Every route of administration has different rates of absorption. The physical makeup of the skin makes the absorption slow for medications placed on the skin. Medications placed under the tongue have quick absorption. Respiratory airways and mucous membranes have many blood vessels. Therefore, medications placed in the oral mucosa, on the respiratory airways, and on the mucous membranes are absorbed most quickly after administration.

Which medication route is absorbed slowly after administration? 1 Medications placed on the respiratory airways 2 Medications placed in the oral mucosa 3 Medications placed under the tongue 4 Medications placed on the skin

4 Administrating medications in liquid form rather than pill form will help to avoid aspiration in children. Using a straw for medication administration will help in ease of administration. Offering juice after medication administration and avoid mixing a large amount of medication into foods will not help prevent aspiration.

Which nursing intervention avoids aspiration in children? 1 Avoid mixing a large amount of medication into foods 2 Offering juice after medication administration 3 Using a straw for medication administration 4 Using liquid medication form

1 A spacer is a 10- to 20-cm (4- to 8-inch) long tube that attaches to the pressurized metered-dose inhaler and allows the medication particles to slow down and separate into smaller pieces. This action improves drug absorption in a patient's airway. A canister is a container that consists of the drug and the propellant. Propellant is used to for effective dispersion of the drug in the canister. Spacers have face masks for children less than 4 years of age. They are especially helpful when a patient has difficulty coordinating the steps involved in self-administering inhaled medications.

Which part of a pressurized metered-dose inhaler is used to improve drug absorption in a patient's airway? 1 Spacer 2 Face mask 3 Propellant 4 Canister

2 The inhalational route of administration uses aerosol sprays, mists, or powders that penetrate lung airways. The oral route of administration generally uses medication in the form of solids and liquids. The buccal route of administration also uses medications in the form of solids and liquids. The transdermal route generally uses medication in the form of transdermal patches.

Which route of administration mainly uses medication in the form of aerosol sprays? 1 Transdermal 2 Inhalational 3 Buccal 4 Oral

4 The easiest and most desirable route for administering medications is oral. Rectal and vaginal routes may cause discomfort. The intravenous route of medication administration may be painful to the patient.

Which route of medication administration is easiest and most desirable? 1 Intravenous 2 Vaginal 3 Rectal 4 Oral

1, 2, 4 Timing medications with meals reduces the risk of aspiration, because the medications are consumed with food. If the risk of aspiration increases, the nurse may choose different routes of drug administration. The nurse should encourage the patient to take medications on his or her own if possible. Medications should be administered one after the other, not all at once. The use of straws should be discouraged, because straws affect patient control of volume intake and increase the risk of aspiration.

Which safety measures should the nurse implement to prevent aspiration when administering oral medications? Select all that apply. 1 Recommend self-administration if possible. 2 Choose a different route if the risk of aspiration increases. 3 Encourage the use of straws whenever possible. 4 Time the medications with meals. 5 Administer all medications at the same time.

2 The nurse should inform the patient about the nature of a drug being administered if it is an experimental drug or a standard drug. Labeled medications should be administered to patients. Any patient of consenting age has the right to refuse medicine; the nurse should not forcefully administer medication to the patient in such situations. Transparency should be maintained regarding the medication administration.

Which statement about a patient's rights of medication is incorrect? 1 The nurse should maintain transparency of the standard drugs being administered to the patient. 2 The nurse should maintain confidentiality of the experimental drugs administered to the patient. 3 The nurse cannot forcefully administer any medication to a patient of consenting age. 4 The nurse should always administer labeled medications to the patient.

1 First exposure to an allergen will sensitize the immune system. When the patient is exposed to the same allergens for the second time, an anaphylactic reaction may occur. Pharyngeal edema, constriction of bronchiolar muscles, and severe wheezing are the signs of an anaphylactic reaction. It is a life-threatening condition and is a type of allergic reaction.

Which statement about anaphylactic reaction requires correction? 1 Occurs when a patient is exposed to the allergens for the first time. 2 Anaphylactic reactions are a type of allergic reactions. 3 Anaphylactic reactions may be life threatening. 4 Anaphylactic reactions may cause pharyngeal edema.

2 Some dry powder inhalers are unit dosed. These inhalers require patients to load a single dose of medication into the inhaler with each use. Other dry powder inhalers hold enough medication for 1 month. The medication inside a dry powder inhaler can clump if the patient is in a humid climate, because dry powders generally clump when exposed to humidity. Some patients cannot inspire fast enough to administer the entire dose of the medication. Dry powder inhalers require less manual dexterity. Because the device is activated with the patient's breath, there is no need to coordinate puffs with inhalation.

Which statement about dry powder inhalers indicates a need for correction? 1 A dry powder inhaler is activated with the patient's breath so there is no need to coordinate puffs with inhalation. 2 All dry powder inhalers require patients to load a single dose of medication into the inhaler with each use. 3 Few patients cannot inspire fast enough to administer the entire dose of the medication. 4 The medication inside a dry powder inhaler can clump if exposed to humid climate.

1 The Food and Drug Administration enforces medication laws that ensure all medications on market undergo vigorous testing before they are sold. The Pure Food and Drug Act is the first American law to regulate medications. The Food and Drug Administration is the current monitoring body for maintaining the standards of medications. MedWatch is a voluntary program that enables health care personnel to report any adverse events of medicines.

Which statement about medical legislation and standards requires correction? 1 MedWatch ensures all medications on market undergo vigorous testing before they are sold. 2 MedWatch enables healthcare personnel to report any adverse events of medicines. 3 The current monitoring body for maintaining the standards of medications is the Food and Drug Administration. 4 The first American law to regulate medications was the Pure Food and Drug Act.

1 Chemotherapeutic agents are the most common medications administered through intrapleural injection. Subcutaneous injection deposits the medication just below the dermis of the skin. The intraosseous method of medication administration involves the infusion of medication directly into the bone marrow. It is used most commonly in infants and toddlers who have poor access to their intravascular space. Patients taking medication through the sublingual route are instructed not to swallow or drink water until the tablet dissolves.

Which statement about various routes of drug administration requires correction? 1 Intradermal injection deposits the medication just below the dermis of the skin. 2 Patients taking medication through sublingual route are instructed not to drink water until the tablet dissolves. 3 Intraosseous administration of drugs is most commonly used in infants and toddlers. 4 Chemotherapeutic agents are administered through the intrapleural route.

3 Inhalers that contain rescue medications are used to provide immediate relief for acute respiratory distress. Rescue medications are short-acting. Maintenance medications last for a long period of time and are used on a daily schedule.

Which statement is true regarding an inhaler containing rescue medication? 1 Rescue medication is used on a daily schedule. 2 The effects of rescue medication last for a longer period. 3 Rescue medication provides immediate relief. 4 Rescue medication is long acting.

3 The apothecary system of measurement is used infrequently today. Household measurement is most familiar to people. Household measurement does not allow the use of teaspoons and cups. The metric system of measurement is not officially adopted by the U.S. Congress but is used by most health professionals in the United States.

Which statement is true regarding systems of medication measurement? 1 The metric system of measurement is officially adopted by the U.S. Congress. 2 Household measurements allow the use of teaspoons and cups. 3 The apothecary system is used infrequently today. 4 The metric system is most familiar to people.

4 Positioning a patient in a seated position at a 90-degree angle when administering oral medications reduces the risk of aspiration, but this is not the case during enteral feeding. Special consideration is needed while administering medication to patients with enteral feeding tubes to help avoid increased risk of medication toxicity. Failing to follow recommendations may lead to reduced medication effectiveness and tube obstruction.

Which statement related to enteral feeding needs correction? 1 Following the recommendations during medication administration may help avoid tube obstruction. 2 Reduced medication effectiveness is due to a failure of precautionary measures while administering. 3 Special consideration while administering medication helps to avoid the risk of medication toxicity. 4 Positioning a patient at a 90-degree angle while administering enteral feeding reduces the risk of aspiration.

2, 3 Medications are absorbed slowly through the skin due to the makeup of the skin. The oral route of administration is contraindicated in patients with gastrointestinal disorders. The administration of medications through the parenteral route often causes anxiety in patients, especially in children. The intramuscular and intravenous routes have higher absorption rates. The oral route is contraindicated in patients with reduced gastrointestinal motility.

Which statements are true regarding routes of medication administration? Select all that apply. 1 Oral route is used in patients with reduced gastrointestinal motility. 2 Oral route is avoided in patients with gastrointestinal disorders. 3 Medications are absorbed slowly through the skin. 4 Inhalational routes have higher absorption rates. 5 Parenteral route causes anxiety in patients.

1, 3, 5 Nursing students cannot take medication orders of any kind, and so their initials do not have to appear on the order because they won't have taken it. The primary health care provider must countersign the telephone order given by that provider at a later time, usually within 24 hours after giving it. This type of prescription order given by the primary health care provider is referred to as a telephone order. The nurse should sign on the telephone order and indicate the time and the name of the health care provider who gave the order. The nurse should document the telephone order given by the primary health care provider.

Which statements regarding the guidelines to be followed for telephone and verbal order require correction? Select all that apply. 1 It is not mandatory for the primary health care provider to sign on the telephone prescription order, because the nurse signs it. 2 The nurse should document the telephone order given by the primary health care provider. 3 The telephone order should contain the initials of the nurse who received the order. 4 The type of prescription order involved in this condition is the telephone order. 5 Nursing students can take telephone orders.

3 A liniment is a semisolid preparation containing alcohol, oil, or soapy emollient that is applied to the skin. Capsules are taken through the oral route. However, a capsule is a medication encased in a gelatin shell. A clear fluid containing water and/or alcohol is an elixir. However, the route of administration of elixirs is oral, not parenteral. A suppository is a solid dosage mixed with gelatin and shaped in the form of a pellet for insertion into a body cavity (rectum or vagina). It is not dissolved in a sterile fluid.

Which student nurse's assessment sheet is accurate regarding various forms of medication? 1 Student nurse 4 2 Student nurse 3 3 Student nurse 2 4 Student nurse 1

1, 3 Children are in a special age group and require special consideration during medication administration, such as using straws for children will help them to swallow medication. The nurse should mix a small amount of medication with other foods or liquids, because children might refuse to take a larger mixture. The nurse should avoid mixing medications with the child's favorite foods, because the child may refuse those foods later. Juice should be offered only if it is allowed. A plastic, disposable syringe should be used while preparing liquid doses.

Which tips are appropriate for the safe administration of medications in children? Select all that apply. 1 Mixing a small amount of medication with other foods or liquids 2 Using a glass disposable syringe to prepare liquid doses 3 Using straws to help the child swallow the medication 4 Offering juice after the child swallows the medication 5 Mixing medications with the child's favorite foods

1 When an older patient has a difficult time swallowing a medication and a physical problem has been ruled out, the nurse should report the situation to the primary health provider in order to have him or her change the medication form. The nurse should be patient and should not insist the patient to take the tablet by explaining its benefits. Holding onto the tablet until the patient is ready to swallow the tablet is not an appropriate intervention, because the medication may be required immediately. If a physical problem has not been ruled out, the patient should be taught to keep the tablet on the front of the tongue, and he or she may be able to swallow by washing it back off the throat.

While administering medication to an older patient, the nurse finds that the patient has difficulty in swallowing a tablet; however, after assessment, a physical problem is ruled out. Which nursing intervention is appropriate in this condition? 1 Reporting the situation to the primary health care provider and changing the medication form 2 Instructing the patient to keep the tablet on the front of the tongue and swallow 3 Holding onto the tablet until the patient is ready to swallow the tablet 4 Encouraging the patient to take the tablet by explaining its benefits

3 Rhinitis is characterized by the inflammation of mucous membranes lining the nose. This inflammation causes swelling along with clear, watery discharge. Rashes are small, raised vesicles that are usually reddened and are distributed over the entire body. Pruritus is itching of the skin. It is accompanied with red rashes that are distributed over the entire body. The patient with urticaria shows raised, irregularly shaped skin eruptions of varying sizes and shapes. These eruptions have reddened margins and pale centers. Inflammation of the nasal mucous membranes is seen in a patient with urticaria.

While assessing a patient who experienced a mild allergic reaction, the nurse observes swelling and a clear, watery discharge from the nose. Upon nasal mucosal biopsy, the nurse finds inflammation of the mucous membranes. Which allergic reaction should the nurse suspect in the patient? 1 Urticaria 2 Pruritus 3 Rhinitis 4 Rash

1 Hives, or urticaria, is a mild allergic reaction that is characterized by raised, irregularly shaped skin eruptions with red margins. Rash is a mild allergic reaction that is characterized by small, raised vesicles that are usually reddened all over the body. Inflammation of the mucous membrane lining the nose mucosa is referred to as rhinitis. Pruritus is a mild allergic reaction that involves itching of the skin that accompanies rashes.

While assessing a patient, the nurse observes raised, irregularly shaped skin eruptions with red margins. Which mild allergic reaction does the nurse document in the medical record? 1 Hives 2 Pruritus 3 Rhinitis 4 Rash