prep-u: chapter 30: medications

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat?

"Aim the tip of the container toward the nasal passage."

The nurse is teaching a client about venlafaxine XR. When the client asks, "What does the XR mean?" what is the appropriate nursing response?

"It means extended release."

The nurse is caring for a 70-year-old client who reports seeing a number of different health care providers. Which follow-up assessment question will the nurse ask?

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

Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response?

"I will get the hospital's information system's phone number for you."

An older adult client has been prescribed a transdermal patch. Which client statement demonstrates the need for further teaching by the nurse?

"This medication is likely to work slower on me than on a younger person."

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

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

The nurse plans discharge teaching for a client leaving the medical center with new medication prescriptions. Which action(s) does the nurse include in the discharge teaching? Select all that apply.

- Explain the benefit in placing medications in a place that links to normal events in the client's life such as brushing teeth or going to bed - Provide client with a list of medications and directions for taking them - Confirm that the client understands the reason for the medications - Teach client and caregivers how to fill a pill box using the medicine list as a guide

A nurse needs to administer a subcutaneous injection to a client. Which techniques should the nurse use to reduce discomfort? Select all that apply.

- Support the client's tissue when withdrawing the needle. - Numb the skin with an ice pack before the injection. - Insert and withdraw the needle without hesitation. - Instill the medication slowly but steadily.

A nurse who is administering an injection to a client has an accidental needlestick injury after withdrawing the needle from the client's tissue. Which action(s) will the nurse take? Select all that apply.

- report the injury to a supervisor immediately - perform hand hygiene per agency protocol - document the injury per agency protocol in a timely manner - seek a medical assessment and follow up as needed

A new prescription has been noted in the medical record for an adult client with chest pain to receive a medication that comes in the form of a transdermal patch. The nurse will consider which precaution(s) to ensure safety with this form of drug use?

-May cause injury with defibrillation. -Fold the patch in half before disposal. -Assess for fever prior to application. -Remove the patch prior to magnetic resonance imaging (MRI). -Monitor the client for early identification of adverse effects.

A nurse is preparing to administer several prescribed medications to a client. The medications ordered are to be given by the following routes: oral, subcutaneous, intramuscular and intravenous. Place the routes in the proper order from slowest to fastest absorption.

-Oral -Subcutaneous -Intramuscular -Intravenous

In which order should the nurse instruct the client to use an inhaler?

-Shake the canister to distribute the drug in the pressurized chamber. -Place the inhaler in your mouth and close your lips around the mouthpiece. -Press down on the canister once to release the medication. -As the medication is released, breathe in slowly through your mouth for 3-5 seconds. -Hold your breath for 10 seconds. -Clean the inhaler daily by rinsing it in warm water daily.

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

-right documentation -right dose -right client -right drug

A pediatric client has a fever for which the provider has prescribed ibuprofen 200 mg orally every 6 hours. The instructions on the bottle indicate there is 100 mg/5ml. How many milliliters should the nurse give? Record your answer using a whole number.

10

A nurse is in the process of converting a continuous IV infusion to an intermittent infusion device. The nurse has clamped off the primary IV tubing, donned clean gloves, clamped the extension tubing and disconnected the primary IV tubing. The nurse is now cleansing the port on the extension tubing with an antiseptic swab. The nurse cleanses the port for which duration of time?

15 seconds (AND 15 SECONDS TO DRY!!)

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?

1500

The nurse is administering morphine oral solution 5 mg to a client requesting medication for pain. The preparation is delivered as morphine solution 10 mg/5 ml. Calculate the amount, in milliliters, the will nurse administer. Record your answer to one decimal place.

2.5

The health care provider prescribes ciprofloxacin 500 mg PO q12h for a pediatric client with bronchial pneumonia. The nurse has liquid ciprofloxacin 250 mg/10 mL on hand. How many milliliters would the nurse dispense? Record your answer using a whole number.

20

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

90 degrees

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that it is to be applied topically. Which instructions should the nurse provide?

Apply the medication to clean, dry skin of the affected area using gloves.

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear?

Ask the client to remain lying down for at least 5 minutes. (REMAIN IN POSITION FOR SOME TIME)

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

Assess the vaginal area.

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client?

Avoid administering medication prepared by another nurse.

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

Avoid crushing sustained-release pellets.

A nurse is caring for a client with conjunctivitis. The health care provider prescribes eyedrops to be administered stat. Which action by the nurse demonstrates safe instillation?

Avoid dropping the drops directly on the cornea.

The nurse observes an order for a client to receive furosemide, 20 mg once daily, and records the specific date and time of the order. What is the appropriate nursing action?

Call the health care provider for order clarification.

A nurse receives orders from the health care provider to mix a client's insulin in a syringe with two other medications. What is the recommended guideline in this situation?

Call the pharmacist to determine compatibility of the drugs.

After inserting an intravenous catheter into a client's vein, the nurse does not obtain blood return. What is the appropriate nursing action?

Change the catheter insertion site.

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Check the expiration date.

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatibility.

The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action?

Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription.

The nurse is reading a medication prescription for a drug that is routinely administered every 12 hours. The prescription does not state the frequency of administration. What is the appropriate nursing action and accompanying rationale that guides the nurse's action?

Contact the health care provider to clarify the prescription. Assumptions cannot be made about medication administration and the nurse must practice within the state's nurse practice act and the organization's policies and procedures concerning medication administration.

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid

The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse?

Determine compatibility of the insulins by checking a drug compatibility table.

A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action?

Determine the compatibility of the two drugs by consulting clinical resources.

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

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

A nurse needs to administer an injection to a client in the deltoid site. Which action should the nurse perform to avoid the risk of damaging the radial nerve and artery?

Draw an imaginary line at the axilla between the acromion and brachial vessels.

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers.

Which situation accurately describes a recommended guideline when administering oral medications to clients?

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.

A nurse is administering a client's analgesic by the subcutaneous route. What should guide the nurse's action?

Inject into the adipose tissue layer just below the epidermis and dermis.

Which parenteral route of administration has the longest absorption time?

Intradermal

The nurse is caring for a client who just returned from the postanesthesia care unit and rates current pain as "9 out of 10." Which prescribed medication would provide the fastest relief from pain?

Intravenous morphine sulfate

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler?

It is a canister that contains pressurized medication.

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the health care provider's order.

A nurse is caring for a client on IV therapy. The IV tubing has a volume-control set. Which of the following is a function of the volume-control set?

It is used to administer small volumes of IV medication.

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

Lock the medications in a cart and finish them upon return.

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered?

PRN order

The physiologic and biochemical effects of a drug on the body defines:

Pharmacodynamics

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

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

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

Return the medication to the medication cart or medication room.

The nurse is administering the first dose of an intravenous infusion of an antibiotic. What action would the nurse take next?

Stay with the client during the first 15 minutes of infusion.

A client is receiving a secondary infusion of a new antibiotic. After 5 minutes of administration, the client reports itching and appears flushed. What is the first nursing intervention?

Stop the infusion. (ASAP!!)

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?

The area is free of major blood vessels and fat.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?

Therapeutic range

The nurse has begun caring for a surgical client who has been ordered preoperative antibiotics prior to bowel surgery. While the nurse will adhere to all the principles of safe medication administration, which of the six rights will the nurse pay particular attention to in this situation?

Time (RIGHT OUT OF PREOP)

A client has been ordered nasal drops, which the nurse will administer. How should the nurse best position the client?

Upright, with head tilted back

A nurse is caring for a client with scabies for which a topical medication has been prescribed. When educating the client on how to use the medication, which should the nurse tell the client regarding the application?

Use gloves to apply.

The nurse is preparing to administer a medication to a client when the client states, "Last time I took that medication, I broke out in hives." What is the priority action by the nurse?

Withhold the medication and notify the health care provider that ordered the medication

To which client would the nurse be most likely to administer a PRN medication?

a client who is reporting pain near the surgical site

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered?

all at once (SINGLE DOSE)

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?

bolus administration

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to food or drugs

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration?

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination

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

gauge

The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication?

in the anterolateral aspect of the thigh

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

intradermal

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

medications that need to be infused over 20 to 60 minutes

When administering heparin subcutaneously, the nurse should:

never aspirate.

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity?

placing the secondary infusion higher than the primary solution

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

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

The nurse is administering medications to the team of clients. It is 0730 levothyroxine 25 mcg po daily scheduled for 0600 but not administered, pantoprazole 40 mg po daily scheduled for 0800, metformin 500 mg po two times a day scheduled for 0800 aNd 1700 The nurse identified the client by asking name and client identifier while looking at the client identification band, The nurse verified the medications for drug name, dose, and route with three checks. Which right did the nurse make an error?

right time

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

spacer

The primary reason for the Controlled Substances Act is:

to prevent drug use and dependence.

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch?

upper back (HARDER TO BE REMOVED)

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client?

vastus lateralis site

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients?

ventrogluteal