Unit 7 (PHARMACOLOGY) Questions-Adams Chapters 6,7,8,9 and K & E Ch.35

The client has required 2 sublingual nitroglycerine tablets that are gr 1/150 per tablet. How many mg of nitroglycerine did the client receive?

Correct Answer: 0.8 mg or 800 mcg Rationale: The client received gr 2/150 of NTG. There are 60 mg in 1 grain. To convert, multiply 2/150 x 60 = 120/150 = 0.8 mg or 800 mcg.

Chapter 8 The nurse teaches a class about medication used during pregnancy to pregnant women. The nurse determines that additional instruction is required when a patient makes which response? 1. The baby can only be harmed by medications during the first trimester. 2. It is important to not take over-the-counter (OTC) drugs during my pregnancy. 3. Exposure to teratogens can result in my babys death or in malformations. 4. If I breastfeed my baby, drugs can come through my breast milk.

Correct Answer: 1 Rationale 1: A baby can be harmed by medication used throughout the period of gestation. Over-the-counter (OTC) drugs should be avoided during pregnancy. Many drugs are transferred through breast milk. Teratogens can cause fetal demise and congenital malformations

Which of the following is an example of a medication error? 1. The wrong dose of a medication is drawn up, but is caught and corrected prior to administration. 2. A medication is administered to a patient with no allergies, yet an anaphylactic response occurs. 3. A medication is administered in liquid form instead of tablet form due to the patients difficulty swallowing. 4. A patient experiences unexpected hypotension as a result of medication administration.

Correct Answer: 1 Rationale 1: A medication error can occur even when it does not reach the patient. Unexpected reactions to medications are not preventable, and would be considered adverse effects, not medication errors. Altering the form from a tablet to a liquid does not constitute a medication error.

A client has a new order for a medication that does not have a termination date. The nurse would place this medication order under which classification on the clients medication administration record? 1. Standing 2. PRN 3. STAT 4. Single

Correct Answer: 1 Rationale 1: A standing order might not have a termination date. This medication may be provided to the client indefinitely. Rationale 2: A PRN order or an as-needed order permits the nurse to provide the client with the medication when, in the nurses judgment, the client needs it. Rationale 3: A STAT order indicates that the medication is to be provided immediately and only once. Rationale 4: A single order or a one-time order indicates that the medication is to be provided only once.

Which of the following best represents adherence to a standard of care? 1. Administering a medication within the time frame specified by hospital policy 2. Administering a medication intramuscularly when a patient refuses to take it orally 3. Using abbreviations while charting to save time 4. Discontinuing a medication at the request of a patient

Correct Answer: 1 Rationale 1: Administering medications as specified by agency policy is meeting the standard of care. Discontinuing medications is outside the scope of nursing. Changing the route of medication administration requires an order, and would not be appropriate, since the patient is refusing it. Using abbreviations might save time, but is not generally considered meeting a standard of care.

The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurses understanding of this situation? 1. The adolescent is embarrassed in front of his peers. 2. The adolescent does not understand the need for the medication. 3. The adolescent forgets that he is supposed to take the medication. 4. The adolescent has made a conscious decision not to take the medication.

Correct Answer: 1 Rationale 1: Adolescents relate strongly to peers and are easily embarrassed; the adolescent does not want to be made fun of. The adolescent is most likely not forgetting the medication. Most adolescents receiving attention-deficit hyperactivity disorder (ADHD) medication recognize that it helps them. Most adolescents know why they are receiving medication.

The nurse assesses an adverse effect of a medication that has been administered. No medication error was committed. What is the best plan of the nurse at this time? 1. Report the adverse effect to the Food and Drug Administrations (FDA) MedWatch Website. 2. Report the adverse effect to the Food and Drug Administrations (FDA) Adverse Event Website. 3. Report the adverse effect to the Food and Drug Administrations (FDA) Safe Medicine Website. 4. Report the adverse effect to the Food and Drug Administrations (FDA) Med MARX Website.

Correct Answer: 1 Rationale 1: Adverse events with medication should be reported to the FDAs Med Watch Website. There isnt any Food and Drug Administrations (FDA) Safe Medicine Website. There isnt any Food and Drug Administrations (FDA) Med MARX Website. There isnt any Food and Drug Administrations (FDA) Adverse Event Website.

The nurse is providing medications to a client. After identifying the client, the nurse should take which action? 1. Inform the client as to the intended action of the medication. 2. Administer the drug. 3. Document that the drug was provided. 4. Evaluate the effectiveness of the drug.

Correct Answer: 1 Rationale 1: After identifying the client, the nurse should next instruct the client as to the intended action of the medication. Rationale 2: The medication is administered after the client has been instructed about the medication. Rationale 3: Documentation occurs after the medication has been given. Rationale 4: The medication is evaluated for effectiveness after a period of time has elapsed after administering the medication.

The nurse commits a medication error. The nurse documents the error in the patients record and completes the incident report. What does the nurse recognize as the primary reason for doing this? 1. To verify that the patients safety was protected 2. To protect the patient from further harm 3. To protect the health care facility from litigation 4. To protect the nurse from liability

Correct Answer: 1 Rationale 1: Documentation in the patients medical record and completion of an incident report verify that the patients safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability.

Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy? 1. Genetic differences 2. Diet 3. Health beliefs 4. Alternative therapies

Correct Answer: 1 Rationale 1: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

The pregnant patient tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. What is the best response by the nurse? 1. This is because your blood volume has increased. 2. Tell me how you have been taking your medication. 3. This is because your baby is receiving part of the medication. 4. Maybe the medication has expired; check the label.

Correct Answer: 1 Rationale 1: Increased blood volume results in hemodilution and increased excretion of the medication. The medication effectiveness is not reduced because of the baby. Asking the patient how she is taking the medication is a good idea, but in this case, increased blood volume is responsible for decreased drug effect. The medication has most likely not expired; most patients have it refilled monthly.

Which statement is the most accurate regarding medication use in pregnant women? 1. Inhaled drugs are absorbed more quickly. 2. Drug excretion rates are lowered. 3. Oral drugs absorption rate is lowered. 4. Drug use should be avoided during pregnancy.

Correct Answer: 1 Rationale 1: Increases in tidal volume and pulmonary vasodilation during pregnancy lead to quicker absorption rates. Gastric emptying is delayed, leading to prolonged oral drug absorption rates. Renal blood flow is increased, leading to higher excretion rates. Some circumstances call for drug administration during pregnancy. (p. 64)

During administration of an intradermal injection, the nurse notices that the outline of the needle bevel is visible under the clients skin. How should the nurse proceed? 1. Recognize that this is an expected finding in a properly administered intradermal injection. 2. Withdraw the needle, prepare a new injection, and start again. 3. Insert the needle further into the skin at a deeper angle. 4. Turn the needle so that the bevel is down and inject the medication slowly, looking for development of a bleb.

Correct Answer: 1 Rationale 1: Intradermal injections are given at a very shallow angle so that the medication is delivered into the area between the dermal layers. When properly given, the outline of the needle bevel will be visible prior to injection of the fluid. Rationale 2: There is no need to withdraw the needle and start again. Rationale 3: Inserting the needle further into the skin and at a deeper angle would result in delivery of the fluid into the subcutaneous tissues. Rationale 4: The needle is inserted with the bevel up.

The nurse teaches a class to patients about how to help prevent medication errors when in the hospital. What is a priority question for the nurse to ask the patients? 1. Do you know the names of all the medications you take? 2. Do you trust your physician to order the correct medication? 3. Do you have a friend to verify that you are receiving the correct medication? 4. Do you know what your illness is, and if you will need surgery?

Correct Answer: 1 Rationale 1: Knowing the names of all medications taken can reduce drug errors when a patient is admitted to the hospital. Knowing the illness and anticipating surgery do not necessarily help prevent medication errors. Asking the patients if they trust their physicians to order the correct medication is inappropriate. It is inappropriate for friends of patients to verify medications prior to administration.

The patient is receiving albuterol (Proventil) for treatment of bronchospasm related to asthma. What is the initial nursing intervention as it relates to this medication? 1. Monitor the patient for relief of bronchospasms. 2. Monitor the patient for nausea and headache. 3. Monitor the patients serum drug levels. 4. Provide the patient with age-appropriate education about albuterol (Proventil).

Correct Answer: 1 Rationale 1: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform. Nausea and headache are expected side effects, but monitoring for these side effects is not part of the initial intervention. Education about medication is important, but is not part of the initial intervention. Monitoring of serum drug levels for albuterol (Proventil) is not indicated.

Kozier & Erbs Fundamentals of Nursing, 10/E Chapter 35 The nurse is preparing to administer a medication that the agency designates as high alert. What action should the nurse take? 1. Ask another registered nurse to verify the medication. 2. Call the pharmacist to check the efficacy of the medication. 3. Decline to administer the medication unless there is a physician present. 4. Request that the nursing supervisor administer the medication.

Correct Answer: 1 Rationale 1: Most health care agencies maintain a list of high-alert medications, including controlled substances, which require the verification of two registered nurses. Rationale 2: Although the pharmacy is a valuable resource for nurses, the high-alert designation does not require pharmacy intervention. Rationale 3: High-alert medications do not require the presence of a physician for administration. Rationale 4: High-alert medications do not require the presence of a nursing supervisor for administration.

A client who has been prescribed a narcotic for chronic back pain is demonstrating signs of withdrawal. The nurse identifies these symptoms as being 1. physical dependence. 2. psychological dependence. 3. plateau. 4. drug allergy.

Correct Answer: 1 Rationale 1: Physiological dependence is due to biochemical changes in body tissues, especially the nervous system. These tissues come to require the substance for normal functioning. A dependent person who stops using the drug experiences withdrawal symptoms. Rationale 2: Psychological dependence is emotional reliance on a drug to maintain a sense of well-being, accompanied by feelings of need or cravings for that drug. There are varying degrees of psychological dependence, ranging from mild desire to craving and compulsive use of the drug. Rationale 3: Plateau is a maintained concentration of a drug in the plasma during a series of scheduled doses. Rationale 4: A drug allergy is an immunologic reaction to a drug. When a client is first exposed to a foreign substance, the body might react by producing antibodies. A client can react to a drug in the same manner as an antigen and thus develop symptoms of an allergic reaction.

All of the patients have cancer and are receiving chemotherapy. Which patient does the nurse evaluate as having the highest probability for a remission? 1. The patient with a support group of cancer survivors 2. The patient who is also seeing a psychiatrist for treatment of depression 3. The wealthy patient who can afford the best medical care available 4. The patient who is a former physician

Correct Answer: 1 Rationale 1: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support, and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient would not have as high a probability for remission as the patient with a support group. A former physician may have a sound knowledge base about cancer, but this patient would not have as high a probability for remission as the patient with a support group. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with a support group.

Which of the following best describes spirituality? 1. The capacity to love 2. Objective viewpoints 3. Logical thinking 4. Critical deliberation

Correct Answer: 1 Rationale 1: Spirituality is described as the capacity to love. Rationale 2: Objective viewpoints do not capture the capacity to love. Rationale 3: Logical thinking does not always include the capacity to love. Rationale 4: Critical deliberation does not include the capacity to love or spirituality.

Which statement is accurate regarding the Institute for Safe Medication Practices (ISMP)? 1. It publishes a consumer newsletter regarding medication errors. 2. It is a governmental agency. 3. It accepts reports from anyone for a nominal fee. 4. It only accepts reports from health care professionals.

Correct Answer: 1 Rationale 1: The ISMP is a non-profit organization that accepts reports from consumer and health care providers. It also publishes a newsletter titled Safe Medicine

An adolescent patient comes to the school nurse with complaints of vague abdominal pain. What assessment data would help to confirm the nurses suspicion that the adolescent has body image concerns? 1. The adolescent says, Everyone makes a big deal about what I eat, so dont ask. 2. The adolescent tells the nurse, I have been sexually active with my boyfriend. 3. The adolescent reports, My periods are irregular. Should I see a doctor? 4. The adolescent tells the nurse, I just cant seem to get along with my parents.

Correct Answer: 1 Rationale 1: The adolescent could have an eating disorder, which may result from altered body image. Being sexually active with her boyfriend does not necessarily indicate an altered body image. Irregular menses do not necessarily indicate an altered body image. Arguments with parents do not necessarily indicate an altered body image.

Nurses should implement strategies to prevent medication errors. Which strategies would be the most beneficial for reducing common errors? 1. Strategies to prevent wrong dosage errors 2. Strategies to prevent wrong route errors 3. Strategies to prevent wrong medication errors 4. Strategies to prevent wrong patient errors

Correct Answer: 1 Rationale 1: The most common reported medication errors involve errors related to the wrong dose.

The nurse is adding medication to an existing intravenous setup. Which nursing action is indicated? 1. Close the infusion clamp. 2. Ensure that the IV bag is full prior to adding medication. 3. Do not remove the IV bag from the pole. 4. Briskly shake the IV bag after injecting the medication.

Correct Answer: 1 Rationale 1: The nurse must close the infusion clamp prior to adding medication to an existing IV bag. Closing the clamp prevents the medication from inadvertently going directly down the tubing and into the client. Rationale 2: Medication is frequently added to IV bags that are less than completely full. The nurse must make a determination of whether the bag contains enough fluid to dilute the medication to the desired strength. Rationale 3: The bag can be taken from the IV pole for mixing. Rationale 4: The bag should receive a gentle rotation, not brisk shaking, to mix the medication and the fluid.

While preparing to administer an eye ointment, the nurse inadvertently squeezes the tube, discarding the first bead of medication. What action should the nurse take at this point? 1. Administer the eye ointment as ordered, as the first bead of ointment should be discarded anyway. 2. Notify the pharmacy and request a new, unopened tube of ointment. 3. Have a second licensed nurse witness the waste and sign the chart. 4. Continue to squeeze the tube until a clear line of ointment has been discarded from the tip.

Correct Answer: 1 Rationale 1: The nurse should administer the eye ointment as ordered, as the first bead of ointment is considered contaminated and should always be discarded. Rationale 2: There is no need to notify the pharmacy for a new tube of ointment. Rationale 3: There is no need to have the wastage witnessed by another nurse. Rationale 4: It is necessary to discard only the first bead of ointment, not an entire line.

The patient is an American Indian admitted to the hospital for chemotherapy. At any given time, five family members are in the patients room, which is private. The nurse tells the patient that according to hospital policy; only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurses action? 1. The nurse should have assessed the patients preferences about how many family members she wanted to be present. 2. The nurse should have called the physician and obtained an order for additional family members to be present. 3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy. 4. The nurse should have allowed the patient to have as many family members as she wanted to be present.

Correct Answer: 1 Rationale 1: The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

The nurse manager plans to teach the graduate nurse the reason why the nursing unit has policies and procedures. What best describes the reason for policies and procedures? 1. The policies and procedures establish standards of care for the institution. 2. The policies and procedures indicate how nursing personnel are to perform skills. 3. The policies and procedures establish how the health care facility is to be run. 4. The policies and procedures indicate the steps that must be taken when a medication error occurs.

Correct Answer: 1 Rationale 1: The reason health care facilities have policies and procedures is to establish standards of care for the facility; the performance of skills is included under standards of care. Steps to be taken when a medication error occurs are included under standards of care. Health care facilities have policies and procedures in place to establish standards of care for the facility, not to establish how the facility is to be run.

Which group of people would be most likely to use spices for maintaining the balance of hot and cold? 1. Hispanic 2. European 3. Native American 4. African American

Correct Answer: 1 Rationale 1: Those from the Hispanic culture will most likely use spices for maintaining the balance of hot and cold. Rationale 2: Those from the European culture will not likely use spices for balancing hot and cold. Rationale 3: Those from the Native American culture will not likely use spices for balancing hot and cold. Rationale 4: Those from the African American culture will not likely use spices for balancing hot and cold.

Which statement is accurate regarding gender and pharmacology? 1. Women tend to seek medical care earlier than men do. 2. Currently, it is not considered sexual discrimination for health plans to exclude covering oral contraceptives. 3. Since the 1980s, the FDA has mandated that research studies include both male and female subjects. 4. Studies indicate that men and women suffer from Alzheimers disease in equal numbers.

Correct Answer: 1 Rationale 1: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

The nurse is preparing medications for a client. What should the nurse do to ensure that the correct medication is provided to the client? Standard Text: Select all that apply. 1. Make sure it is the right client. 2. Make sure it is the right medication. 3. Make sure it is the right dose. 4. Make sure it is the right route. 5. Make sure it is for the right diagnosis.

Correct Answer: 1, 2, 3, 4 Rationale 1: The right client is one of the rights of medication administration. Rationale 2: The right medication is one of the rights of medication administration. Rationale 3: The right dose is one of the rights of medication administration. Rationale 4: The right route is one of the rights of medication administration. Rationale 5: The right diagnosis is not one of the rights of medication administration.

A client is prescribed a medication to be administered through the parenteral route. The nurse would expect that this medication will be provided through which method? Standard Text: Select all that apply. 1. Subcutaneous injection 2. Intramuscular injection 3. The oral route 4. Intradermal injection 5. Intravenous infusion

Correct Answer: 1, 2, 4, 5 Rationale 1: Subcutaneous injection is considered a parenteral route of administration. Rationale 2: Intramuscular injection is considered a parenteral route of administration. Rationale 3: The oral route is not a parenteral route of administration. Rationale 4: Intradermal injection is considered a parenteral route of administration. Rationale 5: Intravenous injection is considered a parenteral route of administration.

The nurse has provided an otic medication to a client. What should the nurse document about this medications administration? Standard Text: Select all that apply. 1. Name of the drug 2. The strength 3. The appetite of the client 4. The number of drops 5. The response of the client

Correct Answer: 1, 2, 4, 5 Rationale 1: When documenting after providing an otic medication, the nurse should include the name of the drug. Rationale 2: When documenting after providing an otic medication, the nurse should include the strength. Rationale 3: When documenting after providing an otic medication, the nurse does not need to include the clients appetite. Rationale 4: When documenting after providing an otic medication, the nurse should include the number of drops. Rationale 5: When documenting after providing an otic medication, the nurse should include the response of the client.

A client is prescribed an oral medication. When reviewing this medication, the nurse realizes it might not be the route of choice for this client because the client is experiencing Standard Text: Select all that apply. 1. nausea. 2. anxiety. 3. vomiting. 4. pain from cuts and abrasions. 5. irritated gastric mucosa.

Correct Answer: 1, 3, 5 Rationale 1: Oral medications are inappropriate for a client who is nauseated. Rationale 2: Oral medications are appropriate for the client experiencing anxiety. Rationale 3: Oral medications are inappropriate for a client who is vomiting Rationale 4: Oral medications are appropriate for the client experiencing pain from cuts and abrasions. Rationale 5: Oral medications are inappropriate for a client with irritated gastric mucosa.

A client tells the nurse that the pharmacy will not fill a prescription that was written by the physician. Upon closer examination, what should the nurse determine is missing from the prescription? Standard Text: Select all that apply. 1. Rx symbol 2. Clients diagnosis 3. Clients Social Security number 4. Dispensing instructions for the pharmacist 5. Number of refills

Correct Answer: 1, 4, 5 Rationale 1: The Rx symbol is to be written on a prescription. Rationale 2: The clients diagnosis is not part of a prescription. Rationale 3: The clients Social Security number is not part of a prescription. Rationale 4: The dispensing instructions for the pharmacist are part of a prescription. Rationale 5: The number of refills must be provided on a prescription.

A patient asks the nurse why a medication prescribed by the provider didnt do anything at all. Which statement by the nurse accurately describes how genetics influence drug action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Genetic differences can result in significant differences in how each patients body handles the same medication. 2. Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs. 3. Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect. 4. Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs. 5. Genetic differences in patients who are biracial result in an allergic response to medications.

Correct Answer: 1,2,3 Rationale 1: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in peoples ability to handle medications. Rationale 2: The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. Rationale 3: When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. Rationale 4: Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. Rationale 5: Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

When teaching the patient about a new medication, the nurse should include which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Adverse effects that can be expected 2. Which adverse effect to report to the health care provider 3. The drugs therapeutic action 4. Chemical composition of the drug 5. Name of the drug manufacturer

Correct Answer: 1,2,3 Rationale 1: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects. Rationale 2: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects. Rationale 3: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects. Rationale 4: It is not necessary to teach the patient the chemical makeup of the drug. Rationale 5: It is not necessary to teach the patient the name of the drug manufacturer.

A home health nurses patient caseload is ethnically diverse. Which interventions show understanding of cultural variables? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible 2. Assessing the patients response to acupuncture for pain 3. Discussing the patients beliefs regarding treatment 4. Notifying the health care provider of the patients intentions to consult with a medicine man for spiritual guidance 5. Removing the patients collection of herbs to decrease the risk of an adverse effect when taken with Western medicine

Correct Answer: 1,2,3 Rationale 1: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications. Rationale 2: The nurse can assess the patients response to acupuncture and interpret the effects on prescribed treatment with respect for the patients culture. Rationale 3: Cultures view health and wellness in different ways. An understanding of the patients cultural beliefs allows the nurse to provide better support and guidance. Rationale 4: As long as the medicine man does not prescribe any herbs, the nurse does not have to discuss this with the provider. Rationale 5: The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications.

A pregnant patient suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the patient about which complications associated with drug use during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Preterm birth 2. Low birth weight 3. Birth defects 4. Allergies to narcotics 5. Increased labor

Correct Answer: 1,2,3 Rationale 1: Many illicit drugs can cause preterm birth. Rationale 2: Many illicit drugs can cause low birth weight. Rationale 3: Many illicit drugs can cause birth defects. Rationale 4: No research suggests that drug use can cause allergies to narcotics. Rationale 5: No research suggests that drug use can cause increased labor.

The nurse is planning care for a pregnant patient prone to substance abuse. When the patient states, My baby isnt getting my drugs, I am, how does the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most illicit drugs will cross the placenta and hurt the baby. 2. Even drugs that do not cross the placenta can hurt your baby by preventing nutrients from getting across the placenta. 3. Research shows taking drugs can cause your baby to be born too early. 4. You are correct. You are far enough along in your pregnancy that drugs will not harm your baby. 5. If you continue to take drugs, it will make you have a very irritable infant.

Correct Answer: 1,2,3 Rationale 1: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Rationale 2: Certain drugs can cause constriction of placental blood vessels, resulting in decreased nutrient exchange. Rationale 3: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Rationale 4: The effect the drug has on the fetus will depend on the stage of fetal development. There is a greater potential for harm during the first trimester but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy. Rationale 5: While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy.

For which patient would the nurse expect the health care provider to continue prescribed medications during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient recently diagnosed with gonorrhea 2. The patient with a history of frequent asthma attacks 3. The patient with hypertension 4. The patient with frequent insomnia 5. The patient with a family history of stroke

Correct Answer: 1,2,3 Rationale 1: Sexually transmitted infections are treated during pregnancy. Rationale 2: Asthma is treated during pregnancy. Rationale 3: Hypertension is treated during pregnancy. Rationale 4: Insomnia would not be treated during pregnancy. Rationale 5: This patient would not be treated unless she has a history of stroke.

The nurse preparing a teaching plan for an adolescent postpartum mother includes which topics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most medications are secreted into breast milk. 2. The new mothers insulin will not be secreted into her breast milk. 3. Over-the-counter (OTC) drugs and herbal products are secreted into breast milk and have the potential to cause harm to the infant. 4. Topical medications must be avoided as these also are secreted into breast milk. 5. Most drugs are safe to take right after breastfeeding because they have not reached the blood stream yet.

Correct Answer: 1,2,3 Rationale 1: The majority of drugs are secreted into breast milk. Rationale 2: Insulin molecules are too large to be secreted into breast milk. Rationale 3: OTC drugs and herbal products can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use. Rationale 4: Topical medications are not secreted into breast milk and are safe to use during breastfeeding. Topical medications could be ingested by the infant if applied to the nipple or breast. Rationale 5: Drugs should only be taken during breastfeeding if the benefits to the mother outweigh the risks to the infant.

The nurse in charge of a clinical study welcomes the participants in an open forum. One patient is surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for what reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Clinical trials failed to include ethnically diverse subjects. 2. Clinical trials comprised mostly Caucasian males. 3. Little attention was focused on identifying the different effects drugs had on various ethnic groups. 4. Research proved there were no differences among ethnic groups. 5. The large majority of clinical trials included Caucasian females.

Correct Answer: 1,2,3 Rationale 1: There was a lack of ethnic diversity in early clinical trials. Rationale 2: Until recently, clinical trials comprised mostly Caucasian males. Rationale 3: Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups. Rationale 4: There was insufficient research to show differences because little attention was focused on these differences. Rationale 5: The large majority of clinical trials excluded females.

The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patients outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home 2. Middle-aged patient with Down syndrome living in a group home 3. Recently divorced mother of three children with breast cancer 4. Sixteen-year-old requesting birth control without parental consent 5. Seven-year-old with asthma in a foster care home

Correct Answer: 1,2,3 Rationale 1: This patient may not be able to return to a home that requires climbing stairs. Rationale 2: A patient with Down syndrome needs additional care to ensure that treatment outcome is successful. Rationale 3: This patient may be the familys sole provider and may have financial concerns. Rationale 4: Many teens seek contraception without their parents consent. This should not have a negative impact on outcome. Rationale 5: Residing in foster care should not have a negative impact on outcome.

The nurse in the emergency department is caring for several patients from diverse cultures. Which statement shows the nurses ability to provide culturally competent care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives? 2. I just want to make sure you and your spouse understand the risks as you consider the options. 3. I dont really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear? 4. I really dont understand why you wont consider an abortion. Your admission papers say you are an atheist. 5. Im not quite sure why the health care provider is giving you these prescriptions. You didnt get them filled the last time you were here.

Correct Answer: 1,2,3 Rationale 1: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment. Rationale 2: This statement shows the nurse is accepting of patients beliefs. Rationale 3: This statement may encourage the patient to open up to the nurse about fears. Rationale 4: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the patients spiritual beliefs or lack thereof. Rationale 5: This statement does not consider social factors that may contribute to nonadherence.

The nurse is working very hard to prevent medication errors. What plan(s) will assist the nurse in preventing most errors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Plan to always check the patients identification band prior to administration of medications. 2. Plan to open all of the medications immediately prior to administration. 3. Plan to tell physicians that verbal orders will not be accepted. 4. Plan to record the medication on the medication administration record (MAR) immediately prior to administration. 5. Plan to validate all orders with another nurse prior to administration of medications.

Correct Answer: 1,2,3 Rationale 1: Ways to reduce medication errors include checking the patients identification band prior to administration of medications, telling physicians that verbal orders will not be accepted, and opening all of the medications immediately prior to administration. Medications should be documented on the medication administration record (MAR) after they have been administered. All orders do not need to be validated with another nurse, only the orders that the nurse is unsure about.

A new nurse on the orthopedic floor makes a medication error. Which statements by the nurse manager foster a safe environment in which nurses will report medication errors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred. 2. I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again. 3. Its really good that your patient is OK and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future. 4. Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error. 5. We need to sit down as soon as possible and write up an incident report describing everything you did incorrectly that caused this error.

Correct Answer: 1,2,3,4 Rationale 1: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 2: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 3: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 4: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 5: An incident report will need to be written, but the nurse who made the error should feel the report will identify factors contributing to the error rather than place blame.

A nurse is caring for a patient who is exhibiting signs of an adverse reaction to warfarin (Coumadin). Which statements made by the patient would lead the nurse to suspect that this is the case? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Im from the South, and we have buttermilk almost every meal. 2. I was suffering so much from hot flashes until my friend told me to try an herb called St. Johns wort. I dont seem to have as many symptoms as before. 3. My husband makes me put garlic in everything! He heard it helps keep our blood pressure normal. 4. I heard ginkgo was really good for improving memory so I started taking it a couple of months ago. 5. I was having difficulty sleeping a couple months ago, and my neighbor recommended I try kava. It seems to calm my nerves.

Correct Answer: 1,2,3,4 Rationale 1: Calcium products do not affect the action of warfarin. Rationale 2: St. Johns wort may increase the risk for bleeding when taken with warfarin. Rationale 3: Garlic may increase the risk for bleeding when taken with warfarin. Rationale 4: Ginkgo may increase the risk for bleeding when taken with warfarin. Rationale 5: Kava can increase drowsiness and sedation when taken with CNS depressants. It does not interact with warfarin.

A nurse is caring for a patient diagnosed with acute asthma who is taking several medications. The nurse would suspect a common adverse drug effect with which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Headache 2. Nausea 3. Vomiting 4. Changes in blood pressure 5. Loss of hearing

Correct Answer: 1,2,3,4 Rationale 1: Headache is a common adverse effect of some medications. Rationale 2: Nausea is a common adverse effect of some medications. Rationale 3: Vomiting is a common adverse effect of some medications. Rationale 4: Changes in blood pressure is a common adverse effect of some medications. Rationale 5: Loss of hearing would be considered a serious adverse effect, not a common one.

A nurse is preparing care for a newly admitted diabetic patient. Which information would be critical for the nurse to assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Medical history 2. Current lab results 3. Medication allergies 4. Use of dietary supplements 5. Number of previous hospitalizations

Correct Answer: 1,2,3,4 Rationale 1: Medical history may reveal conditions that contraindicate the use of certain drugs. Rationale 2: Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. Rationale 3: Allergies to one drug may cross over to another drug and would need to be avoided. Rationale 4: Some dietary supplements can interact with drugs. Rationale 5: While this is good information, it is not critical to this admission.

A community health nurse is preparing a teaching plan regarding medications and safety for a new parent class. Which topics should be addressed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Parents should maintain a list of current medications for each child. 2. Parents should be aware of each childs medication allergies. 3. Parents should know what the childs prescribed medication is for, how it should be administered, and when to expect the child to feel better. 4. Parents should be aware that any leftover medication should be appropriately disposed of, not saved for future use. 5. Parents should read the drug label for any foods the child should avoid while taking the medication and for possible adverse effects to watch out for.

Correct Answer: 1,2,3,4 Rationale 1: Parents should make a complete list of all prescribed medications, over-the-counter drugs, and any vitamins the child takes. Rationale 2: It is very important that parents be aware of a childs allergies in order to prevent an unnecessary allergic response. Rationale 3: Parents should know what condition the childs medication is prescribed for, and how, when, and how much to administer. It is also important for parents to know when to expect the child to feel better so a follow-up visit can be made if the child is not feeling better. Rationale 4: Parents should be aware that it is not safe to self-diagnose and treat with leftover medication. Rationale 5: Parents should be aware the label often describes food and drinks to avoid. The label will not describe possible adverse effects; the nurse will need to describe these to the parents.

A patient returns to the clinic for follow up after taking a newly prescribed medication for a month. The nurse recognizes medication teaching was successful when the patient makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ive been taking my medication on an empty stomach like the prescription label said to. 2. I always take my medication with a full glass of water. 3. Im not drinking any alcohol close to the time that I take my medication. 4. I switched all my medications to one pharmacy like you suggested. 5. I was glad I could take my medications and supplements together. I dont really like to take a lot of pills during the day.

Correct Answer: 1,2,3,4 Rationale 1: Some medications must be taken on an empty stomach. It is important to know if the medication should be taken with food or on an empty stomach. Rationale 2: Taking medications with water will decrease the chance of an interaction that can occur with other juices or fluids. Rationale 3: Alcohol can cause adverse interactions with medications. Rationale 4: Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing current and new medications for interactions. Rationale 5: It is best not to take herbal supplements and vitamins with prescribed medications to avoid interactions.

A nurse is reinforcing discharge instructions concerning food?drug interactions. The nurse determines that the patient understands when the patient makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I should take my medications with water to avoid any problems with my medications being absorbed. 2. I cannot take one of my medications with grapefruit juice because it will decrease the absorption of the medication. 3. I need to be sure to read the prescription label because the pharmacist will indicate if I need to take my medication with food or without food. 4. I should take my daily vitamin 2 hours after my medication so they do not affect each other. 5. If I take my medication with hot tea, it will not affect absorption.

Correct Answer: 1,2,3,4 Rationale 1: The safest fluid to take with medications is water. Rationale 2: Grapefruit juice can increase absorption of certain drugs and should be avoided. Rationale 3: The pharmacist will indicate on the medication label if the medication should be taken with or without food. Rationale 4: Herbal supplements and vitamins can cause adverse effects when taken with medication. Rationale 5: Taking medication with caffeine or a hot drink can affect absorption and the effectiveness of medication.

The nurse has made a medication error. The nurse manager determines the error was based on a common misinterpretation of which abbreviation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. IU 2. SQ 3. Q.O.D. 4. U 5. mcg

Correct Answer: 1,2,3,4 Rationale 1: This is the abbreviation for international unit but can be mistaken for IV or 10. The prescriber should write out international unit. Rationale 2: This is the abbreviation for subcutaneous but can be mistaken for 5q or 5 every. The prescriber should write out subcutaneous. Rationale 3: This is the abbreviation for every other day but can be mistaken for every day or four times a day. The prescriber should write out every other day. Rationale 4: This is the abbreviation for unit but can be mistaken for 4. The prescriber should write out unit. Rationale 5: This abbreviation for microgram is not commonly misinterpreted.

The nurse makes a medication error, but the patient is not harmed. The patients family asks the nurse manager what is considered a medication error. Which of the following are potential responses by the nurse manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Failure to follow health care providers orders 2. Failure to give the right medication 3. Failure to give a medication at the ordered time 4. Failure to call the pharmacy and report that the medication has been given 5. Failure to give the right dose of the medication

Correct Answer: 1,2,3,5 Rationale 1: In this medication error, the patient does not receive the drug as the health care provider intended it to be given. Rationale 2: In this medication error, the patient does not receive the drug the health care provider intended to be given. Rationale 3: In this medication error, the patient does not receive the drug at the time the health care provider intended it to be given. Rationale 4: The delivery of the medication is recorded on the medical administration record (MAR); the nurse does not report to the pharmacy each time a medication has been given. Rationale 5: In this medication error, the patient does not receive the dose of the drug the health care provider intended to be given.

The nurse is preparing a teaching plan for an older patient who is taking multiple medications. Which principles should the nurse keep in mind during the planning phase? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient should use only one pharmacy to fill prescriptions. 2. The patient should keep a list of all medications for easy accessibility. 3. Polypharmacy is a common cause of medication errors in older patients. 4. Polypharmacy is unique to older patients and is the most common cause of medication errors. 5. The patient should be aware of each prescribed medication, the dose, and possible side effects.

Correct Answer: 1,2,3,5 Rationale 1: It is common for older patients to have medical conditions requiring the use of multiple medications that could have possible interactions. Using one pharmacy will ensure the pharmacist will discover any problematic interactions between multiple drugs. Rationale 2: Keeping a list available is important for unexpected trips to a health care facility. Rationale 3: The use of multiple drugs for multiple chronic conditions is a common cause for medications errors in older patients. Rationale 4: Polypharmacy is not unique to older patients, although it is most often seen in this group. Rationale 5: Knowing the names, dose, and possible side effects of medications will reduce the risk for medication errors.

A nurse on the medical-surgical unit is caring for several very ill patients. One patient says, I was supposed to get my medications an hour ago. The nurse recognizes that medication errors can have what repercussions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Medication errors can potentially extend the patients length of hospital stay. 2. Medication errors can result in expensive legal costs to the facility. 3. Medication errors can damage the facilitys reputation. 4. Medication errors can be physically devastating to nurse and patient. 5. Medication errors cause preventable deaths during hospitalizations.

Correct Answer: 1,2,3,5 Rationale 1: Medication errors can cause harm, which can extend the patients length of stay. Rationale 2: If a medication error causes a patient harm, it can result in expensive legal fees for hospital defense. Rationale 3: If the incidence of medication errors is publicized, it can cause the facility to be seen as unsafe or to be delivering substandard care. Rationale 4: Medication errors can be physically devastating to patients but would be emotionally devastating to the nurse. Rationale 5: Medication errors are the most common cause of morbidity and preventable death within hospitals.

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fifty-year-old recently remarried male taking antihypertensive medication 2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive 3. Sixty-eight-year-old male recently started on antidepressants known to cause gynecomastia 4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth 5. Seventy-eight-year-old male taking estrogen as therapy for prostate cancer

Correct Answer: 1,2,4 Rationale 1: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect. Rationale 2: Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history. Rationale 3: Men at this age usually already have some degree of enlargement of breast tissue due to decreasing testosterone and would not necessarily need additional education to prevent medication nonadherence. Rationale 4: Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth. Rationale 5: Although estrogen therapy can result in breast enlargement, men at this age usually already have some degree of breast enlargement due to decreased testosterone levels.

Chapter 7 The nursing instructor teaches the student nurses about how medication errors can occur. What information will the nursing instructor include in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse miscalculates the medication dose. 2. The nurse does not check the patients identification band. 3. The nurse does not validate an order with the physician. 4. The nurse misinterprets a physicians order. 5. The nurse administers the incorrect drug.

Correct Answer: 1,2,4,5 Rationale 1: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patients identification band. As long as the nurse understands the physicians order, there is no need to validate the order with the physician.

The nurse assesses the patient with diabetes mellitus prior to administering medications. Which questions are important to ask the patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Are you allergic to any medications? 2. Are you taking any herbal or over-the-counter medications? 3. How difficult is it for you to maintain your ideal body weight? 4. Will you please tell me about the kind of diet you follow? 5. What other medications are you currently taking?

Correct Answer: 1,2,5 Rationale 1: These questions refer specifically to medications. Diet and ideal body weight are important questions, but do not refer specifically to medication administration.

The physician has prescribed quetiapine (Seroquel) for the patient with chronic auditory hallucinations. The patient has stopped taking the medication. The nurse incorrectly uses the diagnosis of noncompliance. What is essential for the nurse to assess prior to using this nursing diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Do cultural or religious issues have an impact on taking the medication? 2. Has the patient made an informed decision not to take the medication? 3. Is the noncompliance related to a lack of finances? 4. Did the patient understand why the medication had been prescribed? 5. Are side effects causing the patient to refuse the medication?

Correct Answer: 1,3,4,5 Rationale 1: A lack of understanding of the reason the medication was prescribed, the occurrence of side effects, cultural or religious issues, and a lack of finances, can all contribute to noncompliance with medications. Noncompliance assumes that the patient has been properly educated about the medication and has made an informed decision not to take it. The nursing diagnosis of noncompliance would not be appropriate in this case.

When possible, drug therapy is postponed until after pregnancy and lactation. However, certain acute and chronic conditions must be managed during pregnancy, including Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. epilepsy. 2. serious cystic acne. 3. sexually transmitted infections. 4. gestational diabetes. 5. hypertension.

Correct Answer: 1,3,4,5 Rationale 1: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. Rationale 2: Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy. Rationale 3: Sexually transmitted infections can harm the fetus. Rationale 4: Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. Rationale 5: If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation.

Chapter 9 The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood pressure 2. The cause of the hypertension 3. Mood 4. Level of education 5. Belief in a higher power

Correct Answer: 1,3,4,5 Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. How is drinking alcohol viewed by your culture? 2. Have you ever attended Alcoholic Anonymous meetings? 3. Did you see your parents drinking alcohol when you were growing up? 4. Have you been in alcohol rehabilitation before now? 5. What blood relatives of yours are addicted to alcohol?

Correct Answer: 1,3,5 Rationale 1: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

A drug for which research has shown an adverse effects in animals but not in pregnant women would be categorized as Category 1. A. 2. B. 3. D. 4. C.

Correct Answer: 2 Rationale 1: A drug that has adverse effects in animals but not in pregnant women is a Category B drug.

At which point of preparing medication from an ampule does the nurse anticipate using a filter needle? 1. Filter needles are not used for this preparation. 2. When drawing the medication from the ampule. 3. When administering the medication to the client. 4. Both for drawing up the medication and for administering the medication.

Correct Answer: 2 Rationale 1: A filter needle is used to draw medication from an ampule. Rationale 2: The nurse uses a filter needle to draw medication up from an ampule to remove any possible shards of glass from the liquid. Rationale 3: If the filter needle was used to inject the client, the trapped shards of glass would be injected into the muscle. Rationale 4: The nurse uses a filter needle to draw medication up from an ampule to remove any possible shards of glass from the liquid. The filter needle is then changed to a regular needle prior to administering the liquid to the client. If the filter needle was used to inject the client, the trapped shards of glass would be injected into the muscle.

The nurse is concerned that an older client is experiencing an adverse effect from a prescribed medication. What did the nurse assess to make this clinical decision? 1. Altered memory 2. Altered organ responsiveness 3. Decreased manual dexterity 4. Decreased visual acuity

Correct Answer: 2 Rationale 1: Altered memory will not cause an adverse drug effect. Rationale 2: Altered quality of organ responsiveness, resulting in adverse effects becoming pronounced before therapeutic effects are achieved, is one effect of medications on the older client. Rationale 3: Decreased manual dexterity will not cause an adverse drug effect. Rationale 4: Decreased visual acuity will not cause an adverse drug effect.

Which nursing intervention would take priority following administration of a new medication? 1. Monitoring lab values 2. Monitoring the patients respiratory status 3. Prescribing additional medications if side effects occur 4. Measuring patient weight

Correct Answer: 2 Rationale 1: Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing. Monitoring lab values and measuring weight might be appropriate nursing interventions with some medications, but would not be the priority. Nurses do not prescribe medications.

Which of the following kinds of drugs would be most likely to enter breast milk? 1. Ionized 2. Lipid-soluble 3. Water-soluble 4. Bound to plasma protein

Correct Answer: 2 Rationale 1: As with the placenta, drugs that are ionized, water-soluble, and bound to plasma protein are less likely to enter breast milk.

A patient with hypertension is receiving medication to lower his blood pressure. Which of the following demonstrates the evaluation process related to medication administration? 1. Asking the patient whether he is compliant in taking his medications 2. Determining that goals were not met 3 days following medication administration 3. Administration of IV antihypertensive agents 4. Determination of the patients baseline blood pressure

Correct Answer: 2 Rationale 1: Evaluation is the final step in the nursing process where goal attainment is determined. Administering medications is the intervention step. Determining the patients baseline blood pressure and asking him about compliance would be the assessment step.

The nurse administers an evening medication to the patient in the morning. The medication did go to the correct patient. What is the nurses best course of action at this time? 1. Change the medication administration time to the morning. 2. Notify the physician about the error and complete an incident report. 3. Tell the evening nurse to hold the evening dose just for tonight. 4. Notify the physician and ask if any further action needs to be taken.

Correct Answer: 2 Rationale 1: Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed.

The African American patient had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse caring for the patient is Caucasian. The nurse assesses the patients diet to be very high in fat. What is the best plan by the nurse to improve the patients diet and reduce the risk for additional medications? 1. With the patients permission, plan to ask an African American nurse to speak to him about a low-fat diet. 2. With the patients permission, plan to discuss his diet with whomever prepares meals for his family. 3. Plan to give the patient information specific to African Americans about low-fat diets. 4. Plan to ask the physician for a consult by dietary services so a dietician can teach the patient about low-fat diets.

Correct Answer: 2 Rationale 1: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

The nurse provides care for elders in an assisted living facility. What does the nurse assess as a primary contributing factor for medication complications in the elderly? 1. The elderly often abuse alcohol. 2. The elderly are frequently dehydrated. 3. The elderly are frequently constipated. 4. The elderly have decreased stomach acid.

Correct Answer: 2 Rationale 1: Fluid deficit is a critical factor in the older adult that can contribute to medication complications. Decreased stomach acid is not a critical factor with medication complications in the elderly. Frequent constipation is not a critical factor with medication complications in the elderly. Alcohol abuse could be a factor in medication complications with the elderly, but is not as critical as fluid volume deficit.

The hospitalized client has an order for Tylenol 325 mg 2 tablets every 4 hours prn temperature over 101F. The client complains of a headache. Can the nurse legally administer Tylenol to treat the headache? 1. Yes, as Tylenol is used both for fever and headache. 2. No, not unless the client also has a temperature over 101F. 3. Yes, but the nurse should document the reason why the medication was administered as a temperature elevation. 4. Yes, because the medication is available over the counter, an order is not required.

Correct Answer: 2 Rationale 1: In the hospital setting, the nurse can only administer medications that are prescribed for the client and can only administer those medications according to the specifics of the prescription. In this case, the medication was ordered for temperature elevation, not pain, so the nurse cannot legally administer the Tylenol to treat the clients headache. Rationale 2: In the hospital setting, the nurse can only administer medications that are prescribed for the client and can only administer those medications according to the specifics of the prescription. In this case, the medication was ordered for temperature elevation, not pain, so the nurse cannot legally administer the Tylenol to treat the clients headache. Rationale 3: The nurse should never document false information in regard to medication administration. Rationale 4: The fact that this is an over-the-counter medication and is used both for fever and headache is not pertinent to the nurses decision.

The nurse is managing care for several patients at a diabetic treatment center. What is the primary intervention for the nurse? 1. To administer the correct medicine to the correct patient at the correct dose and the correct time via the correct route 2. To return the patient to an optimum level of wellness while limiting adverse effects related to the patients medical diagnosis 3. To include any cultural or ethnic preferences in the administration of the medication 4. To answer any questions the patient may have about the medicine, or any possible side effect of the medication

Correct Answer: 2 Rationale 1: Interventions are aimed at returning the patient to an optimum level of wellness and limiting adverse effects related to the patients medical diagnosis or condition. The correct patient, dose, and time refer to the five rights of medication administration and, while important, is not the best, overall nursing intervention. Answering questions the patient may have is an appropriate intervention, but is not the best overall intervention. While important to include cultural and ethnic preferences, this is not the best overall intervention.

The pregnant patient plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. What is the best response by the nurse? 1. Be sure to check the label to see if the herbal product could be used during breastfeeding. 2. Most drugs can be transferred to the infant during breastfeeding, so this is not recommended. 3. Herbal products are considered natural, so it should be fine to use them during breastfeeding . 4. This should be fine, as long as there is at least 12 hours between the time you use the product and when you breastfeed.

Correct Answer: 2 Rationale 1: It is best to avoid as many drugs as possible during breastfeeding. The bottle may not be labeled for breastfeeding, so the patient should check with the nurse. There is no safety time limit established between the use of the product and breastfeeding. Herbal products are drugs.

The nurse has just injected insulin subcutaneously into the clients abdomen. What action should the nurse take at this point? 1. Massage the site to encourage absorption. 2. Leave the needle embedded in the clients skin for 5 seconds after administration. 3. Remove the needle rapidly by pulling it quickly from the skin. 4. Cover the injection site with a pressure dressing for at least 15 minutes or until the bleb disappears.

Correct Answer: 2 Rationale 1: Massage is contraindicated for most medications because it alters the delivery rate from the tissues. Rationale 2: The American Diabetes Association recommends leaving the needle embedded in the clients skin for 5 seconds after injection of medication, particularly insulin. This allows for complete delivery of the dose. Rationale 3: The needle should be removed slowly and smoothly to minimize pain for the client. Rationale 4: Bleeding rarely occurs after subcutaneous injection, but short application of manual pressure (13 minutes) should cause bleeding to stop. There is no need for a pressure dressing for 15 minutes. Subcutaneous injections do not result in bleb formation.

The nurse in the emergency department administers an adult dose of an antibiotic to a 3-month-old baby. As a result, the baby suffers permanent brain damage. What best describes the effect of this error on the health care facility? 1. The professional license of the nurse will be lost. 2. The morale of the staff involved will be depleted. 3. The reputation of the health care facility will suffer. 4. The health care facility will pay a very large settlement.

Correct Answer: 2 Rationale 1: Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale.

The toddler refuses to take his oral medication. What is the best suggestion to the mother from the nurse for ensuring the toddler receives his medication? 1. Tell him you will buy him a toy if he takes the medication. 2. Crush the tablet and mix it with a small amount of jam. 3. Crush the tablet and mix it with milk. 4. Tell him he will be punished if he does not take the medicine.

Correct Answer: 2 Rationale 1: Mixing the medication in jam will disguise the taste. The parent should not buy the childs compliance with a toy. Punishment will alienate the child and decrease compliance. Parents should avoid placing medication in milk as this may cause the toddler to avoid healthy foods.

The nurse is teaching a caregivers support group for caretakers of elderly patients. The focus is medication compliance. The nurse determines that learning has occurred when the caregivers make which response? 1. We should crush their medicine and put it in applesauce so they will swallow it. 2. We should use a medication management box so they wont forget to take it. 3. We should ask the doctor if all the medication is really necessary. 4. We should give them more education about the medicine so they will take it.

Correct Answer: 2 Rationale 1: Most elderly patients will be medication compliant if they have a way to remember to take the medication; a medication management box is an excellent idea. Many elderly can swallow pills just fine, and many medications cannot be crushed. The problem is not the education; it is that the elderly often forget what medication to take at what time. Asking the physician about medications is fine, but this will not help the elderly patient to remember when to take it.

The African American patient has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The patient refuses the drugs; he requests to have herbs and African objects in his room to remove the curse. What is the priority action by the nurse? 1. Allow the request without seeking further information from the patient. 2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients. 3. Allow the request after the patient signs a release of responsibility to avoid litigation. 4. Allow the request after all members of the treatment team agree to it.

Correct Answer: 2 Rationale 1: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

The nurse was very busy and unfamiliar with a new medication, but administered it anyway. Later the nurse looked up the medication. How does the nurse manager evaluate this behavior? 1. This was acceptable as long as the nurse looked up the action and side effects of the drug later. 2. An error could have occurred because the nurse was unfamiliar with the medication. 3. The nurse manager was partially at fault because the nursing unit was understaffed and the nurse was too busy. 4. An error did occur because the nurse could have administered the medication via the incorrect route.

Correct Answer: 2 Rationale 1: Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault.

The nurse is assessing a newly admitted patients current medications. What does the best objective data include? 1. The patients wife tells the nurse what medications the patient has been receiving. 2. The nurse checks the prescription bottles the patient has brought to the hospital. 3. The nurse asks the physician what medications the patient was currently taking. 4. The patient lists the medications that have been prescribed.

Correct Answer: 2 Rationale 1: Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patients prescription medication bottles. A list of medications provided by the patient and the patients wife is subjective, not objective data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

About which of the following patient assessment data sets would the nurse be most concerned prior to medication administration? 1. White blood cell count, ability to speak, and temperature 2. Age, allergies, and level of consciousness 3. Hair color, gender, and body mass index 4. Weight, height, and blood type

Correct Answer: 2 Rationale 1: Of the data sets listed, age, allergies, and level of consciousness includes the most concerning data, with allergies and level of consciousness being the most concerning. In every situation, the nurse should know whether the patient is allergic to a medication prior to administering. If a patient has an impaired level of consciousness, the route of drug administration needs to be addressed. Hair color is not concerning, while the other listed data are of concern only in certain situations with certain drugs.

The nurse is preparing for medication administration to a group of patients. What is the best overall outcome for the patients? 1. Patients will take the medications after receiving medication instruction. 2. Patients will receive the best therapeutic outcome from the medications. 3. Patients will state the reason they are receiving the medications. 4. Patients will experience minimal side effects after taking the medications.

Correct Answer: 2 Rationale 1: Outcomes should focus first on the therapeutic outcome of the medications. The fact that the patient takes the medication is not the best overall outcome for the patients. The treatment of side effects is not the best overall outcome for the patients. Having the patients state the reason they are receiving the medications is the best overall outcome for the patients.

Patients who are discharged from the hospital on new medications should 1. be advised that their local pharmacy will provide them with the drug information and instructions they need. 2. be provided with oral and written drug information and instructions. 3. be provided oral drug information and instructions as opposed to written. 4. be provided with written drug information and instructions only.

Correct Answer: 2 Rationale 1: Patients should be provided with oral and written drug information and instructions prior to discharge. Patients may receive these oral and written materials from their pharmacy, but should be supplied initially by the hospital.

A patient presents with hypotension and bradycardia. The patient indicates that one of her physicians recently prescribed three new medications to her current list of 10 medications per day. Based on this information, which statement would be the most accurate? 1. The patient is having an allergic reaction to one of the new medications. 2. The patient is experiencing adverse reactions as a result of polypharmacy. 3. The patient is not in compliance with her prescribed medications. 4. The patient is experiencing an adverse effect that will go away in time.

Correct Answer: 2 Rationale 1: Polypharmacy increases the risk of drug interactions and side effects. It is not appropriate to assume the side effects will go away. The information provided does not reveal anything about patient compliance. Bradycardia and hypotension do not necessarily indicate an allergic reaction.

The nurse is administering medications to an elderly patient. Which laboratory tests are important for the nurse to assess prior to the administration of medication? 1. Complete blood count (CBC) and electrolytes 2. Kidney and liver function tests 3. Arterial blood gases (ABGs) and basic metabolic panel 4. Lipid panel and thyroid function tests

Correct Answer: 2 Rationale 1: Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage. Complete blood count (CBC) and electrolytes will not help to determine the proper drug dosage. Lipid panel and thyroid function tests will not help to determine the proper drug dosage. Arterial blood gases (ABGs) and a basic metabolic panel will not help to determine the proper drug dosage.

Which method is the most appropriate for administering medications to school-age children? 1. Allowing the child to make decisions regarding the time the medications are taken 2. Providing a brief explanation 3. Administering drugs while holding the child down 4. Providing a lengthy explanation followed by quick drug administration

Correct Answer: 2 Rationale 1: School-age children should be provided a brief explanation followed by quick drug administration. Children should not be held down. Lengthy explanations and allowing for choices are more appropriate for adolescents.

Upon aspirating a saline lock prior to administering intravenous medication, the nurse notes that there is no blood return. What nursing action should be taken? 1. Discontinue this infiltrated lock and restart another site for medication administration. 2. Slowly infuse 1 mL of saline into the lock, assessing for infiltration. 3. Reinsert the needle into the lock and aspirate using more pressure. 4. Pull the intravenous catheter out 1/8 inch and attempt aspiration.

Correct Answer: 2 Rationale 1: Simple lack of blood upon aspiration does not indicate infiltration, so there is no need to discontinue the site. Rationale 2: Although the presence of blood upon aspiration confirms that the catheter is in a vein, the absence of blood does not rule out correct placement. If no blood returns, the nurse should slowly infuse 1 mL of saline into the lock while assessing the site for infiltration. If there is no infiltration present, the nurse should administer the medication. Rationale 3: Often the reason for absence of blood return is that the vessel has collapsed around the catheter from the pressure of aspiration. Increasing the pressure will not increase the likelihood of blood return. Rationale 4: Pulling the intravenous catheter out 1/8 inch will not increase the likelihood of blood return and may make the site more unstable.

What is the most significant role for nurses as defined by state nurse practice acts and by regulating bodies such as The Joint Commission (TJC)? 1. Planning care 2. Teaching 3. Assessment 4. Evaluating care

Correct Answer: 2 Rationale 1: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses, giving it the weight of law and key important accreditation standards. Assessment, planning, and evaluation are important, but not the most significant roles of the nurse according to state nurse practice acts and Joint Commission.

The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, I dont deserve them. The nurse providing care has anti-abortion beliefs. What is the best response by the nurse? 1. I think you need to do what is best for you. 2. You have a serious infection and really need the drug. 3. Do you think you should be punished because you had an abortion? 4. Ill call your physician and let him know about your decision.

Correct Answer: 2 Rationale 1: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

The nurse is providing discharge teaching for a client who is being dismissed with prescriptions for a bronchodilator inhaler and a corticosteroid inhaler. What information should the nurse provide regarding the dosage schedule for these two medications? 1. Always use the corticosteroid inhaler first. 2. Use the bronchodilator first. 3. It makes no difference which inhaler is used first. 4. Use the inhalers on alternate days, not on the same day.

Correct Answer: 2 Rationale 1: The bronchodilator should be used first in order to open the airways so the corticosteroid medication can move deeply into the lungs. Rationale 2: These two types of inhalers are frequently prescribed to be used together. The bronchodilator should be used first in order to open the airways so the corticosteroid medication can move deeply into the lungs. Rationale 3: The bronchodilator should be used first in order to open the airways so the corticosteroid medication can move deeply into the lungs. Rationale 4: These two types of inhalers are frequently prescribed to be used together. The bronchodilator should be used first in order to open the airways so the corticosteroid medication can move deeply into the lungs.

A trauma patient in the emergency department has a low hemoglobin and hematocrit, and has an order to receive normal saline IV solution. Which nursing diagnosis would be most appropriate regarding the need for administering the IV solution? 1. Activity intolerance 2. Fluid volume deficit 3. Decreased cardiac output 4. Risk for Infection

Correct Answer: 2 Rationale 1: The drop in hemoglobin and hematocrit signify blood loss following trauma. Fluid volume deficit would be the best nursing diagnosis. The patients activity might be altered, and he might be at risk for infection following the trauma, but these do not relate to administering the IV normal saline. It is more likely that the patient has a drop in hemoglobin and hematocrit as a result of the trauma than a cardiac problem.

A client is prescribed a new medication. The pharmacy notifies the nurse that the dosage is outside of route prescribing limits. The nurse is unable to reach the prescribing physician about the order. What should the nurse do? 1. Give the medication to the client as prescribed. 2. Withhold the medication. 3. Give one-half of the medication dose prescribed. 4. Administer the medication through the oral route.

Correct Answer: 2 Rationale 1: The nurse should not give the medication as prescribed, as the pharmacy has identified that the dose prescribed is outside of dosing limits. Rationale 2: If the primary care provider cannot be reached, document all attempts to contact the primary care provider and the reason for withholding the medication. Rationale 3: The nurse should not give the client one-half of the medication dose prescribed, as this is outside of the nurses licensure. Rationale 4: The nurse should not administer the medication through the oral route, as this might not be the best route for the medication and changing the route is outside of the nurses licensure.

Before administering a medication to a client, the nurse checks the clients pulse, blood pressure, and laboratory values. The nurse is performing which right of medication administration? 1. Medication 2. Assessment 3. Route 4. Dose

Correct Answer: 2 Rationale 1: The nurse would not need to assess blood pressure, pulse, or laboratory values to determine the right medication. Rationale 2: Some medications require specific assessments prior to administration, such as blood pressure, pulse, or laboratory values. Medication orders can include specific parameters for administration, so these assessments must be done before administering. Rationale 3: The nurse would not need to assess blood pressure, pulse, or laboratory values to determine the right route. Rationale 4: The nurse would not need to assess blood pressure, pulse, or laboratory values to determine the right dose.

The client who regularly uses a metered-dose inhaler four times a day tells the nurse that it is difficult to tell when the canister is empty. What instruction should the nurse give this client? 1. Place the canister in a bowl of water. If the canister floats, it is not empty. 2. When you get a new canister, divide the number of puffs that is listed on the label by four. That will tell you how many days the canister will last. 3. You can tell that the canister is empty when you can no longer smell the medication when you activate the plunger. 4. When you feel like you are no longer getting maximum effect from the medication, your canister is empty.

Correct Answer: 2 Rationale 1: The old method of floating the canister in water is not accurate, as there may be propellant left in the canister after the medication is all dispensed. Rationale 2: The best way to track the number of puffs left in a canister is to start with the new canister, dividing the number of puffs listed on the label by the number of puffs taken each day. Rationale 3: Being able to smell the medication is not an indication of the amount left in the canister. Rationale 4: Waiting until there is lack of maximum effect from the medication may put the client at risk for respirator illness exacerbation.

The nurse is planning to administer medications to a new client. What is the nurses greatest priority in administering these medications? 1. Be certain the medications are given within 15 minutes of the time they are scheduled. 2. Before giving the medications, know what the intended effects are for this client. 3. Assess the clients knowledge of the action of the medications. 4. Document the administration accurately so the reimbursement is correct.

Correct Answer: 2 Rationale 1: This is important but not the greatest priority. Rationale 2: The greatest priority is to understand the intended effects of the medication for this client. The nurse should never do anything to or for a client without knowing the intended effect. Rationale 3: This is important but not the greatest priority. Rationale 4: This is important but not the greatest priority.

The nurse is concerned that an older client will have difficulty self-administering medications. What did the nurse assess that caused this concern? Standard Text: Select all that apply. 1. Eats several servings of fruits and vegetables each day 2. Altered memory 3. Decreased visual acuity 4. Decreased manual dexterity 5. Limits red meat in the diet

Correct Answer: 2, 3, 4 Rationale 1: Eating several servings of fruits and vegetables each day will not influence the older clients ability to self-administer medications. Rationale 2: Altered memory is one physiological change associated with aging that influences medication administration. Rationale 3: Decreased visual acuity is one physiological change associated with aging that influences medication administration. Rationale 4: Decreased manual dexterity is one physiological change associated with aging that influences medication administration. Rationale 5: Limiting red meat in the diet will not influence the older clients ability to self-administer medications.

The nurse is instructing a new mother on the method to provide a newly prescribed medication to her 2-month-old infant. What should the nurse include in this teaching? Standard Text: Select all that apply. 1. Mix the medication into the babys formula. 2. Use a nipple so the baby can suck the medication. 3. Use a syringe or dropper to provide the medication. 4. Place a small amount of the medication along the side of the babys cheek. 5. Prepare twice the amount of medication prescribed because the baby will spit out half of it.

Correct Answer: 2, 3, 4 Rationale 1: Never mix medications into foods that are essential, as the infant may associate the food with an unpleasant taste and refuse that food in the future. Never mix medications with formula. Rationale 2: Oral medications can be provided to a baby with the use of a nipple so that the baby sucks the medication. Rationale 3: Oral medications can be provided to a baby with a syringe or dropper. Rationale 4: Oral medications can be provided to a baby by placing a small amount of liquid medication along the inside of the babys cheek and waiting for the infant to swallow. Rationale 5: The mother should never be instructed to provide the baby with twice the amount of medication that is prescribed.

The nurse determines that the effectiveness of a medication is not as great when provided to female clients as it is with male clients. The nurse suspects that this difference in effectiveness is because of which factor? Standard Text: Select all that apply. 1. Occupation 2. Hormones 3. Fat amount 4. Physical activity status 5. Fluid level

Correct Answer: 2, 3, 5 Rationale 1: Differences in the way men and women respond to drugs are not chiefly related to occupation. Rationale 2: Differences in the way men and women respond to drugs are chiefly related to hormone levels. Rationale 3: Differences in the way men and women respond to drugs are chiefly related to the distribution of body fat. Rationale 4: Differences in the way men and women respond to drugs are not chiefly related to physical activity status. Rationale 5: Differences in the way men and women respond to drugs are chiefly related to the distribution of body fluid.

The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Keep the toddler awake and observe for side effects of the medication. 2. Keep all medications locked up and stored out of reach of the toddler. 3. Use syrup of ipecac immediately if the toddler has ingested medication. 4. Call the Poison Control Center for guidance with any medication ingested. 5. Teach the toddler that medications are for adult use only.

Correct Answer: 2,4 Rationale 1: Locking up medications is the safest way to childproof the home. The Poison Control Center should be contacted for any type of medication the toddler has ingested. Syrup of ipecac should only be used if recommended by the Poison Control Center. The Poison Control Center should be contacted, and they will advise if the child is to be kept awake. It is unrealistic to expect a toddler to understand that medications are for adult use only.

The nursing instructor teaches student nurses about the Food and Drug Administration (FDA) Pregnancy Categories. What is the best information to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during pregnancy. 2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women. 3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom change once they are established. 4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using clinical human research trials. 5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects.

Correct Answer: 2,5 Rationale 1: Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe use of drugs in pregnant women. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies. Pregnancy Category C is not necessarily safe, it just means that animal studies have shown an adverse effect, but well-controlled studies in pregnant women have not been done. Food and Drug Administration (FDA) Pregnancy categories for individual drugs do change based on reported effects on fetuses.

A clients status is deteriorating, and the physician prescribes a medication to be administered immediately one time. The nurse would contact the pharmacy and identify this medication order as being of which type? 1. Standing 2. PRN 3. STAT 4. Single order

Correct Answer: 3 Rationale 1: A standing order might not have a termination date. This medication may be provided to the client indefinitely. Rationale 2: A PRN order or an as-needed order permits the nurse to provide the client with the medication when, in the nurses judgment, the client needs it. Rationale 3: A STAT order indicates that the medication is to be provided immediately and only once. Rationale 4: A single order or a one-time order indicates that the medication is to be provided only once.

A client is diagnosed with liver disease. The nurse realizes that which element of pharmacokinetics will be affected in this client? 1. Absorption 2. Distribution 3. Biotransformation 4. Excretion

Correct Answer: 3 Rationale 1: Absorption is the process by which a drug passes into the bloodstream. Rationale 2: Distribution is the transportation of a drug from its site of absorption to its site of action. Rationale 3: Biotransformation, also called detoxification or metabolism, is a process by which a drug is converted to a less active form. Most biotransformation takes place in the liver. Biotransformation can be altered if a person has an unhealthy liver. Rationale 4: Excretion is the process by which metabolites and drugs are eliminated from the body. Most drug metabolites are eliminated by the kidneys via the urine.

The nurse identifies that the ordered dose for a medication is twice the amount generally administered. What action should the nurse take? 1. Administer the medication as it was ordered. 2. Check to see if previous shift nurses gave the medication. 3. Collaborate with the prescriber about the order. 4. Administer only the standard dose of the medication.

Correct Answer: 3 Rationale 1: Administering the dose as ordered may harm the client. Rationale 2: The fact that previous nurses gave the medication as ordered does not make it the correct action. Rationale 3: When the nurse has doubts about the correctness of a medication or medication dose for a specific client, collaboration with the prescriber is necessary. The nurse is legally and ethically responsible for all actions taken, including medication administration. Rationale 4: The nurse cannot change the amount of medication to give without collaborating with the prescriber.

Why is the nurse writing out the name of the drug morphine sulfate instead of using the abbreviation MS? 1. The hospital has placed MS on its list of do-not-use abbreviations. 2. The Joint Commission requires that the abbreviation MS not be used. 3. Using the abbreviation MS puts the client at risk of medication error. 4. Computerized charting systems will not accept the abbreviation MS.

Correct Answer: 3 Rationale 1: Although the hospital has probably placed MS on its list of do-not-use abbreviations, The Joint Commission does require that the abbreviation not be used. Rationale 2: The Joint Commission does require that the abbreviation not be used; however ,client safety is the primary reason. Rationale 3: The best answer is that using the abbreviation MS puts the client at risk of medication error. Rationale 4: Although some computerized charting systems will not accept the abbreviation MS, the best reason is for client safety.

The Joint Commission (TJC) documented that patient education was deficient on several medical-surgical units of a local hospital. A nursing committee was formed to address this problem and focused on what likely nursing intervention? 1. Providing educational pamphlets about medications to the patients. 2. Asking the physicians to provide medication education to the patients. 3. Discussing medications each time they are administered to patients. 4. Requesting more frequent pharmacy consults for the patients.

Correct Answer: 3 Rationale 1: Discussing medications each time they are administered is an effective way to increase the amount of education provided. Medication education is considered to be a responsibility of the nurse, not the physician or pharmacist. Educational pamphlets can be effective, but are not as effective as the nurse providing education to the patient.

The nurse has several educational pamphlets for the patient about medications the patient is receiving. Prior to giving the patient these pamphlets, what is a primary assessment for the nurse? 1. Assess the patients readiness to learn new information. 2. Assess the patients religious attitudes toward medicine. 3. Assess the patients reading level. 4. Assess the patients cultural bias toward taking medicine.

Correct Answer: 3 Rationale 1: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patients readiness to learn, cultural bias, and religious attitudes are important, but not as important as the patients reading level.

The client is to receive an intramuscular injection of a medication that is supplied in a 2-mL cartridge and a second medication that is supplied in a vial. The total amount to be administered of these medications exceeds the volume of the cartridge by 0.5 mL. How should the nurse proceed? 1. Administer the cartridge medication in one injection and the vial medication in a separate injection. 2. Call the pharmacy for advice on administering these medications. 3. Draw both of the medications up into a syringe for administration. 4. Add as much of the vial medication to the cartridge as possible prior to injection, giving the balance in a separate injection.

Correct Answer: 3 Rationale 1: Giving two separate injections, no matter how the medication is divided, should be avoided if possible. Rationale 2: There is no need for the nurse to consult the pharmacy for this standard technique. Rationale 3: When the total amount of medication to administer exceeds the volume of the cartridge, the medication is drawn up into a syringe and is administered. Rationale 4: Giving two separate injections, no matter how the medication is divided, should be avoided if possible.

Which of the following statements correctly identifies factors that contribute to medication errors? 1. A nurse who observes the five rights will prevent all medication errors from occurring. 2. Nurses are always liable when a medication error occurs. 3. Handwritten orders are more frequently associated with medication errors than are typed orders. 4. An incorrect dose (based on weight) is ordered, dispensed, and administered to a patient. The administering nurse and ordering clinician would be the only parties held accountable.

Correct Answer: 3 Rationale 1: Handwritten orders can be illegible, leading to higher medication error rates. Although the nurse is a major player in medication safety, there are instances when medication errors occur that do not involve the nurse, such as when patients take medications at home. Observing the five rights is essential to avoiding medication errors, but will not prevent all medication errors from occurring. The clinician ordering the medication, the nurse administering the medication, and the pharmacist dispensing the medication would be held accountable.

Which statement regarding human DNA sequences is accurate? 1. Only 2% of human DNA is different among the different ethnicities. 2. Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine. 3. Even though human genetic differences are small, significant differences can be seen with drug metabolism. 4. Asian Americans are the ethnic group known to be slow acetylators.

Correct Answer: 3 Rationale 1: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

The nurse is preparing a small amount of medication for oral administration. Which nursing action is essential? 1. Draw up the medication in a syringe with a large-gauge needle. 2. Measure the medication at the top of the meniscus. 3. Label the syringe with the medication name, amount, and route. 4. Dilute the medication with water before measuring.

Correct Answer: 3 Rationale 1: If a regular syringe is used to draw up the medication, the needle should be discarded. A syringe with a needle might also indicate that the medication is to be given parenterally and cause a medication route error. Rationale 2: If medications are measured in a cup, the correct measurement is at the bottom of the meniscus. Rationale 3: When measuring medication in a syringe, a label must be attached indicating the name of the medication, the amount, and the route. This labeling is essential to prevent the medication from being given via the wrong route. Rationale 4: Medication might be diluted after measuring, but dilution before measuring would impact the dosage of the medication.

The nurse is planning to administer a bitter-tasting oral medication to a 4-year-old client. What strategy should this nurse plan? 1. Give the medication in orange juice or milk to mask the taste. 2. Tell the child that the medication tastes good. 3. Ask the parents how they give medications at home. 4. Get another nurse to assist by holding the client down.

Correct Answer: 3 Rationale 1: Medication should not be placed in essential foods such as orange juice or milk, as the child may develop an aversion to the food related to the taste of the medication. Rationale 2: Being untruthful about any interventions may cause the client to lose trust in the nurse. Rationale 3: Parents are a very good source of ideas for caring for their child, and their input should be sought when performing tasks such as medication administration. Rationale 4: Having a second nurse hold the client down to administer the medication is an unnecessary use of force and will frighten the child.

The nurse is preparing to administer a subcutaneous injection to a client. When selecting the needle, the nurse should choose one with a 1. small gauge number. 2. long shaft. 3. long bevel. 4. short bevel.

Correct Answer: 3 Rationale 1: Needles with small gauge numbers are used for viscous medications. For subcutaneous injections, a larger gauge number should be used. Rationale 2: Long shafts are used for intramuscular injections. Rationale 3: Longer bevels provide the sharpest needles, and cause less discomfort. They are commonly used for subcutaneous and intramuscular injections. Rationale 4: Short bevels are used for intradermal and IV injections because a long bevel can become occluded if it rests against the side of a blood vessel.

Which of the following identifies the collection of objective data? 1. The patient rates her pain a 5 on a 010 pain scale. 2. The patient states she is anxious. 3. The patient has a wound measured at 5 centimeters in length. 4. The patient informs the nurse that she weighs 150 pounds.

Correct Answer: 3 Rationale 1: Objective data are gathered through physical assessment, laboratory tests, and other diagnostic sources. Subjective data consist of what the patient says or perceives.

The nurse will administer medication to a school-age child. What is the preferred action by the nurse? 1. Teach the child the action and expected side effects of the medication. 2. Tell the child he will not be allowed to go to recess if the medication is not taken. 3. Offer the child a choice of beverage with which to take the medication. 4. Offer to play with the child prior to medication administration.

Correct Answer: 3 Rationale 1: Offering the child a choice fosters cooperation and compliance. Playing with the child is a preschool child activity. Teaching the child the action and expected side effects of the medication is too advanced for the school-age child. Threatening a school-age child will antagonize him; he will most likely not take the medication.

The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients? 1. Does your religion allow the use of high blood pressure medication? 2. Do you think your high blood pressure is a problem? 3. Can you afford the high blood pressure medication? 4. Does your culture use herbs to treat high blood pressure?

Correct Answer: 3 Rationale 1: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Which statement about the nursing process is accurate? 1. Generally, goals are more measurable than outcomes. 2. Goals involve very specific criteria that evaluate interventions. 3. Obtaining the outcomes is essential for goal attainment. 4. After selecting the nursing diagnosis, interventions are completed.

Correct Answer: 3 Rationale 1: Outcomes are specific, measurable criteria that are used to measure goal attainment. The planning phase (including outcomes and goals) follows nursing diagnosis. Goals are more general than specific.

The nurse recognizes that agency system checks are in place to decrease medication errors. Who commonly collaborates with the nurse on checking the accuracy of the medication prior to administration? 1. The nursing supervisor 2. The nursing unit manager 3. The pharmacist 4. The physician

Correct Answer: 3 Rationale 1: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration.

The patient is receiving an oral antibiotic as treatment for cellulitis of the lower extremity. The patients outcome is Patient will state a key point about antibiotic treatment for cellulitis. Which statement by the patient provides the best evaluation by the nurse at this time? 1. If the pain gets too bad, I can take my prescribed pain medication. 2. If the swelling continues, I can apply an ice pack. 3. I need to take all the pills even if my leg looks better. 4. I must keep my leg elevated until the swelling goes down.

Correct Answer: 3 Rationale 1: Taking all the medication even if the leg looks better is a key point about antibiotic therapy and meets the patients outcome. Keeping the leg elevated does not address the outcome for antibiotic treatment. Applying an ice pack does not address the outcome for antibiotic treatment. Taking pain medication does not address the outcome for antibiotic treatment.

Which of the following statements regarding medication error rates is ethically accurate? 1. Error rates are acceptable when well below the national average. 2. Error rates are acceptable when associated costs exceed the costs necessary for preventative actions. 3. Error rates are never acceptable. 4. Error rates are only acceptable when associated costs are less than 5% of the facilitys yearly profit.

Correct Answer: 3 Rationale 1: The incidence of medication errors is never acceptable.

The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, Will all of my hair fall out? What is the most therapeutic response by the nurse? 1. We are not really sure; applying an ice bag to your head may help. 2. Dont worry, we can recommend an excellent wig company if need be. 3. Yes, that is one of the expected side effects of this medication. 4. It might. Have you discussed this with your physician?

Correct Answer: 3 Rationale 1: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

The nurse is caring for an adolescent with depression and suicidal thoughts. The nursing diagnosis is Risk for Suicide related to depression. What is the best outcome for this adolescent? 1. The patient will discuss his feelings in group therapy today. 2. The patient will list five reasons why he should not harm himself today. 3. The patient will not commit any acts of self-harm today. 4. The patient will take the antidepressant medication as prescribed today.

Correct Answer: 3 Rationale 1: The patient not committing any acts of self-harm relates to the problem statement in the nursing diagnosis and is measurable. Listing five reasons why the patient should not harm himself will not prevent him from committing an act of self-harm. Taking antidepressant medication will not prevent the patient from committing an act of self-harm. Discussion of feelings will not prevent the patient from committing an act of self-harm.

Which of the following correctly identifies and orders the primary steps of the nursing process? 1. Establish nursing diagnosis, assessment, intervene, collaborate, evaluation 2. Establish goals, assessment, intervention, planning, communication 3. Assessment, establish nursing diagnosis, planning, interventions, evaluation 4. Assessment, planning, establish objectives, communication, evaluation

Correct Answer: 3 Rationale 1: The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation. Although some steps might not be in this precise order, assessment is done first. The establishment of goals and objectives is generally considered part of planning. Communication is important, but is not a primary step of the nursing process.

The nurse who is to administer 2.5 mL of intramuscular pain medication to an adult client notes that the previous injection was administered in the right ventrogluteal site. In which site should the nurse plan to administer this injection? 1. The same site 2. The deltoid 3. The left ventrogluteal 4. The rectus femoris

Correct Answer: 3 Rationale 1: The same site should not be used because this is not enough time for tissue recovery. Rationale 2: The deltoid site will not accept 2.5 mL of medication. Rationale 3: Of the options given, the best choice is the left ventrogluteal. This is a site that will accept 2.5 mL of medication, and using the opposite site from the last injection will allow the first site time for recovery. Rationale 4: The rectus femoris site is generally used only for self-injection of medication and is a painful site for medication administration.

The nurse is preparing to administer a medication to a 6-year-old client. What is the nurses priority action? 1. Administer the exact dosage as ordered. 2. Give the dosage supplied by the pharmacy. 3. Verify that the dosage is within the safe range for this child. 4. Administer no more than one-half of the safe adult dosage.

Correct Answer: 3 Rationale 1: This dose should be compared to the standard dose listed in a reputable drug reference book. Rationale 2: Although prescribers and pharmacists are also responsible to figure the correct dose, the nurse who administers the dose is the last possible person to prevent a medication error. The nurse has the final responsibility to ensure that the dose ordered and dose supplied are correct for the client. Rationale 3: The priority action is to verify that the dosage is within the safe range for this child. This verification can be done by figuring the dose per kilogram of body weight or by use of a nomogram. Rationale 4: This dose may be more or less than one-half the adult dosage.

During the process of administering medications, the nurse checks the name band for the clients name. What should be this nurses next action? 1. Administer the medication as ordered. 2. Initial the MAR that the medication will be given. 3. Double check the clients identification using a second method. 4. Educate the client regarding the medication to be given.

Correct Answer: 3 Rationale 1: This nurse should employ a second method to verify the clients identification. Rationale 2: The MAR will be initialed after the medication has been given. Rationale 3: The Joint Commissions National Safety Goals require a two-step check of client identification prior to the administration of medications. This nurse should employ a second method to verify the clients identification. Rationale 4: Once the nurse has verified client identification, the nurse should educate the client regarding the medication to be given.

The nurse is on a committee to reduce medication errors in a large health care facility. What is a recommendation the nurse proposes that will most likely help to reduce medication errors? 1. Train medication technicians to administer medications. 2. Use robots to prepare all medications for administration by the nurse. 3. Use automated, computerized cabinets on all nursing units. 4. Designate nurses whose only function is to administer medication.

Correct Answer: 3 Rationale 1: To help reduce medication errors, many health care agencies are using automated, computerized, locked cabinets for medication storage on patient-care units. Health care agencies are not planning to designate nurses who just do medication administration. Health care agencies are not planning to have medication technicians administer medications. Health care agencies are not planning to have robots prepare all medications for administration by the nurse.

The patient is receiving a beta-blocker medication. The nurse has done medication education and provided the patient with printed information to take home. During the next appointment, the nurse notes that the patient is not taking the medication properly. What is a therapeutic assessment question to ask this patient? 1. Do I have to inform your physician about your noncompliance? 2. Why didnt you take your medicine as we talked about? 3. Are you able to read and comprehend the printed information? 4. Dont you understand how important it is to take the medicine?

Correct Answer: 3 Rationale 1: Up to 48% of English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking why questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a dont you understand question is as demeaning as asking a why question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance; and this question is threatening.

A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patients life. The patient tells the nurse, This is punishment from God for sins I have committed; some women at my church say so. What will the best plan of the nurse include? 1. With the patients permission, plan to involve a hospital minister to discuss the patients perspective about cancer. 2. With the patients permission, plan to bring the case before the hospitals board of ethics. 3. With the patients permission, plan to contact the patients minister to discuss the patients perspective about cancer. 4. With the patients permission, plan to meet with family members to discuss the patients perspective about cancer.

Correct Answer: 3 Rationale 1: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

The nurse is reviewing a new medication order for a client, and determines that the order is incomplete when which element is missing? Standard Text: Select all that apply. 1. Clients address 2. Dispensing instructions for the pharmacist 3. Name of the medication 4. Dosage 5. Route of administration

Correct Answer: 3, 4, 5 Rationale 1: The clients address is part of a prescription but not of a medication order. Rationale 2: Dispensing instructions for the pharmacist are a part of a prescription but not of a medication order. Rationale 3: The name of the medication is an essential part of the medication order. Rationale 4: The dosage is an essential part of the medication order. Rationale 5: The route of administration is an essential part of the medication order.

While reviewing a medication order, the nurse determines that it is written using the metric system. What did the nurse observe to come to this conclusion about the medication order? Standard Text: Select all that apply. 1. Number of ounces 2. Number of drams of the solution 3. Number of milligrams of the medication 4. Number of grains of the medication 5. Number of milliliters of the solution

Correct Answer: 3, 5 Rationale 1: Ounces are a measurement in the household system. Rationale 2: Drams are a measurement in the apothecaries system. Rationale 3: Milligrams are a measurement in the metric system. Rationale 4: Grains are a measurement in the apothecaries system. Rationale 5: Milliliters are a measurement in the metric system.

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Tetracycline 2. ACE inhibitor antihypertensive medication 3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives

Correct Answer: 3,4,5 Rationale 1: Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider. Rationale 2: ACE inhibitor antihypertensive drugs are in category C and are considered safe during pregnancy. Rationale 3: Methotrexate is in category X and should be avoided during pregnancy. Rationale 4: Isotretinoin is in category X and should be avoided during pregnancy. Rationale 5: Oral contraceptives are in category X and should be avoided during pregnancy.

The nurse plans to administer medication to the preschool child. Which approach indicates the nurse has an understanding of growth and development? 1. The child is often more cooperative if the parent is not in the room. 2. The child does better with verbal instruction than with play instruction. 3. There should be no need to restrain a child of this age. 4. Use a brief rationale, followed by quick administration of the medication.

Correct Answer: 4 Rationale 1: A brief rationale, followed by quick administration, decreases the childs anxiety and promotes cooperation with the medication process. It may be necessary to restrain a preschool child for medication administration. Having a parent in the room usually promotes more cooperation from the preschool child. Preschool children do better with play instruction.

The nurse is preparing to administer eardrops to a 6-year-old client. What nursing action is correct? 1. Pull the earlobe down and back to straighten the ear canal. 2. Insert the tip of the applicator into the ear canal. 3. Put the eardrops in the refrigerator for 10 minutes prior to administration. 4. Press gently on the tragus of the ear a few times after administration.

Correct Answer: 4 Rationale 1: After age 3, the pinna of the ear should be pulled up and back to straighten the ear canal. Rationale 2: The tip of the eardrop applicator should not be placed into the ear canal, but should be held just above the canal so that the drops can fall onto the side of the canal. Rationale 3: Eardrops should be warmed prior to administration, not cooled. Rationale 4: The nurse should press gently but firmly on the tragus of the ear after eardrops are administered in order to direct the drops into the ear canal.

The nurse is providing group education about warfarin (Coumadin) to minority patients who have experienced strokes (brain attacks). The nurse determines that learning has occurred when the patients make which statement? 1. We may need to have more frequent blood tests. 2. We may need to have less frequent blood tests. 3. We may need more medication than other ethnic groups. 4. We may need less medication than other ethnic groups.

Correct Answer: 4 Rationale 1: Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients. Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower, not higher, dosages. There is no need for Asian and African American patients to have less frequent blood tests than Caucasian patients.

A drug that is known to cause birth defects is known as 1. category A. 2. category C. 3. cautionary. 4. teratogenic.

Correct Answer: 4 Rationale 1: Drugs that are known to cause birth defects are called teratogenic, or classified as category D or category X.

While preparing to administer a transdermal estrogen patch, the nurse finds the previously applied patch in the clients bed linens. How can the nurse avoid this situation with the patch now being applied? 1. Shave the area where the patch is being applied. 2. Place a heating pad over the area where the patch is applied for 10 minutes after application. 3. Run a finger around the adhesive edges of the new patch before placing it on the clients skin. 4. Press firmly over the patch with the palm of the hand for about 10 seconds after applying it to the skin.

Correct Answer: 4 Rationale 1: If hair is a problem in keeping the patch on, choose a less hairy site for application or clip (do not shave) the hair. Rationale 2: Placement of a heating pad is contraindicated, as the heat could increase circulation and the rate of absorption. Rationale 3: Avoid touching the adhesive edges of the patch prior to placing it on the skin. Rationale 4: In order to affix the patch firmly to the clients skin, press firmly over the patch with the palm of the hand for about 10 seconds after application.

While hospitalized, a client was receiving 15 ml of an oral medication three times a day. When providing discharge instructions, the nurse should teach the client to take how much of this medication at home? 1. 2 teaspoons 2. 1 teaspoon 3. 2 tablespoons 4. 1 tablespoon

Correct Answer: 4 Rationale 1: In the household measurement system, 2 teaspoons is equivalent to 810 ml in the metric system. Rationale 2: In the household measurement system, 1 teaspoon is equivalent to 45 ml in the metric system. Rationale 3: In the household measurement system, 2 tablespoons is equivalent to 30 ml in the metric system. Rationale 4: In the metric system, 15 ml is equal to 1 tablespoon in the household measurement system.

The physician has prescribed a nitroglycerine (Nitrodur) patch for the patient. What is the best outcome for this patient as it relates to use of the medication? 1. Patient will be able to identify the expiration date of the medication prior to discharge. 2. Patient will verbalize three side effects of the medication prior to discharge. 3. Patient will state the reason for receiving the medication prior to discharge. 4. Patient will demonstrate correct application of the patch prior to discharge.

Correct Answer: 4 Rationale 1: It is important for the patient using a transdermal medication to be able to correctly apply the patch. The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

The nurse is to administer four oral medications to the client via a nasogastric tube. One of the medications is a tablet that has been crushed, one is a capsule that has been opened and the powder removed, and two are supplied in liquid form. How should the nurse administer these medications? 1. Flush the tube, mix the crushed tablet and the capsule powder into the two liquids for administration, and follow by flushing the tube. 2. Mix the crushed tablet and capsule powder in warm water and administer. Flush the tube and administer the mixed liquids. 3. Flush the tube with the mixed liquids first, then administer the crushed tablet and capsule powder mixed in cold water. 4. Mix the crushed tablet and capsule powder individually in warm water. Administer each medication separately, flushing the tube before and after each administration.

Correct Answer: 4 Rationale 1: Mixing medications together may result in a chemical reaction that occludes the tube. Rationale 2: Mixing medications together may result in a chemical reaction that occludes the tube. Rationale 3: Mixing medications together may result in a chemical reaction that occludes the tube. Rationale 4: When giving medication via a nasogastric or gastric tube, the nurse should individually prepare and administer the medications, flushing the tube before and after each administration. Failure to flush the tube adequately is the leading cause of tube occlusion.

The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her, and will not allow her to receive any analgesia during the experience. What is the best action by the nurse? 1. Inform the husband that it is his wifes choice whether or not to receive analgesia. 2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital. 3. Allow the request, but inform the husband that the physician will make the final decision about analgesia. 4. Allow this request, and be available in the event the request changes.

Correct Answer: 4 Rationale 1: Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

The nurse is administering a medication to a client as prescribed in order to maintain a specific amount of the medication in the clients bloodstream at all times. The nurse is ensuring that which action is being maintained for this client? 1. Peak plasma level 2. Drug half-life 3. Onset of action 4. Plateau

Correct Answer: 4 Rationale 1: Peak plasma level is the highest plasma level achieved by a single dose when the elimination rate of the drug equals the absorption rate. Rationale 2: Drug half-life is the time required for the elimination process to reduce the concentration of the drug to one-half of what it was at initial administration. Rationale 3: Onset of action is the time after administration when the body initially responds to the drug. Rationale 4: Plateau is when a concentration of a drug is maintained in the clients plasma through a series of scheduled doses.

While administering an intramuscular injection, the nurse notes blood return in the syringe barrel after aspirating. What action should the nurse take? 1. Pull the needle out 1/4 inch and inject the medication. 2. Inject the medication as planned. 3. Notify the physician immediately. 4. Discard the medication and start over.

Correct Answer: 4 Rationale 1: Simply pulling out the needle 1/4 inch does not guarantee that the needle point is not in a vessel, and the presence of blood in the syringe prevents checking the new site. Rationale 2: Blood return in the syringe barrel after aspiration indicates a strong probability that the needle tip is in a blood vessel. Injection of medication would then be intravenous, not intramuscular. Rationale 3: There is no need to notify the physician of this event. Rationale 4: The nurse should discard the medication and start over with new medication and a new syringe.

The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurses evaluation? 1. The adolescent has developed alternative coping mechanisms to increase his focus during classes. 2. The adolescent is fearful that this drug may be a gateway drug and he will abuse other substances. 3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school. 4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

Correct Answer: 4 Rationale 1: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

The nurse makes a medication error and a patient dies. In court, the attorney for the family of the deceased patient asks the nurse if she followed standards of care in administering the medication. How would the attorney phrase this question? 1. Did you follow agency guidelines as in previous circumstances? 2. Did you follow the physicians orders and double-check them before administration? 3. Did you do the three checks and follow the five rights as taught in school? 4. Did you do what another nurse would have done under similar circumstances?

Correct Answer: 4 Rationale 1: Standards of care refer to the actions that a reasonable and prudent nurse with equivalent preparation would do under similar circumstances. Standards of care do not refer to following physician orders. Standards of care do not refer to following agency guidelines. Standards of care do not refer to doing three checks or five rights.

The nurse is caring for a team of four clients who are seriously ill. One of the clients has just received a new cardiac medication. How should the nurse instruct the unlicensed assistive personnel (UAP) who is also caring for this client? 1. Have the UAP assess for any unexpected effects from the medication. 2. Tell the UAP to teach the clients family what to expect from the medication. 3. Have the UAP look the medication up in a drug reference book to read about drug actions and possible side effects. 4. Give the UAP specific instructions regarding what drug actions or side effects to report to the nurse.

Correct Answer: 4 Rationale 1: The UAP does not have the skills or legal responsibility to assess the client. Rationale 2: It is the nurses responsibility to teach the client or family about the medications. Rationale 3: The nurse should not expect that the UAP can determine from the drug reference book what drug actions and possible side effects are pertinent to this client. Rationale 4: The nurse should give the UAP specific instructions about what drug actions or side effects should be reported to the nurse. The UAP does not have the skills or legal responsibility to assess the client, but can collect data to report to the nurse.

Which statement is accurate regarding pharmacotherapy in the older adult? 1. Increased body water can lead to a higher risk of drug toxicity. 2. Plasma levels are increased, leading to a heightened drug response. 3. Generally, drug doses should be increased due to prolonged drug metabolism. 4. Drug absorption is slower due to increased gastric pH.

Correct Answer: 4 Rationale 1: The elderly have an increase in gastric pH, which slows absorption. Plasma levels are lower, causing a diminished drug response. Body water is reduced, leading to a higher risk of drug toxicity. Generally, drug doses are reduced because of prolonged drug metabolism.

Which stage of fetal development poses the greatest risk to the fetus related to medication administration? 1. Each stage is equal in risk. 2. Pre-implantation period 3. Third trimester 4. Embryonic

Correct Answer: 4 Rationale 1: The embryonic phase poses the greatest risk to fetal development.

The nurse follows the nursing process when conducting medication education about insulin. The step of evaluation is best demonstrated by which question? 1. Is your abdomen the best place to inject insulin? 2. What questions do you have about insulin? 3. Can you recognize when you are experiencing hypoglycemia? 4. Can you tell me four points you remember about how to take your insulin?

Correct Answer: 4 Rationale 1: The nurse is evaluating the effectiveness of medication education by asking the patient for feedback from the education provided. Asking the patient what questions she has about insulin is an assessment question. Asking the patient if her abdomen is the best place to inject insulin is an assessment question. Asking the patient if she can recognize when she is experiencing hypoglycemia is an assessment question.

Which of the following demonstrates ethical reporting of a medication error? 1. The nurse does not report the error, because the error was caught and corrected prior to drug administration. 2. The nurse does not report or document the error, since the error did not result in any harm to the patient. 3. The nurse reports the error to the physician and the charge nurse but does not document the error due to possible legal action. 4. The nurse informs the patient, documents the error as per hospital policy, and notifies the physician.

Correct Answer: 4 Rationale 1: The nurse should report and document all medication errors whether the patient was harmed or not. It is essential to report and document medication errors to identify possible system failures, even when the error is caught prior to administration or has potential for legal action.

A client diagnosed with diabetes asks the nurse about reusing insulin syringes. Assessment reveals that the client has poor personal hygiene and difficulty with fine motor skills. The nurse also knows the client has financial difficulties. What instruction should the nurse give this client? 1. The American Diabetes Association advises that syringes are for single use only. 2. In order to save money, I advise you to reuse syringes up to three times or until the needle feels dull. 3. Only people who practice good personal hygiene can reuse syringes. 4. All clients are different, but I advise you to use a new syringe for each injection.

Correct Answer: 4 Rationale 1: This is not true; the American Diabetes Association indicates that syringes can be reused. Rationale 2: This client does not meet the criteria for suggesting the reuse of syringes. Rationale 3: The nurse should not directly confront the client with the statement about personal hygiene, as that would damage the nurseclient relationship. Rationale 4: Although the American Diabetes Association does indicate that syringes can be reused, that suggestion is not made to people who have poor personal hygiene, acute concurrent illness, open wounds on the hands, or decreased resistance to infection. In this case, the nurse has assessed that this client has poor hygiene and has difficulty with fine motor skills. The best answer is to suggest that this client use a new syringe for each injection.

An adult client is prescribed the hepatitis B vaccination. The nurse will administer this medication through which site? 1. Dorsogluteal 2. Rectus femoris 3. Vastus lateralis 4. Deltoid

Correct Answer: 4 Rationale 1: Using the dorsogluteal site can lead to nerve damage, and is not recommended as a site for intramuscular injections. Rationale 2: The rectus femoris muscle is used only occasionally for intramuscular injections because it is painful. Rationale 3: The vastus lateralis muscle is recommended for infants younger than 1 year of age, although it can be used for clients of all ages. Rationale 4: The deltoid muscle is not used often for intramuscular injections because it is a relatively small muscle and is very close to the radial nerve and radial artery. It is sometimes considered for use in adults because of rapid absorption from the deltoid area, but no more than 1 mL of solution can be administered. This site is recommended for the administration of hepatitis B vaccine in adults.

The nurse is preparing medications for a group of patients. Another nurse begins telling the nurse about her recent engagement. What is the best action by the first nurse? 1. Ask the second nurse to help with administering medications so they can have more time to talk. 2. Continue to prepare the medications for administration and pretend to listen to the first nurse. 3. Stop preparing medications until the first nurse has finished talking about her engagement. 4. Tell the second nurse that the conversation is distracting and must cease while medications are being prepared.

Correct Answer: 4 Rationale 1: When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurses conversation will also be distracting.

A client weighing 220 lbs. is prescribed to receive 25 mg/kg of a medication, divided over 4 equal doses. How many mg of the medication should the nurse provide for each dose?

Correct Answer: 625 mg Global Rationale: First determine the clients weight in kg by dividing the weight in lbs. by 2.2, or 220/2.2 = 100 kg. Then multiply the prescribed dose of 25 mg x 100 kg = 2500 mg. Then divide the total mg dose by 4, or 2500/4 = 625 mg. The nurse should provide 625 mg of the medication for each dose.