Administration of Medications
1. 1. This is the correct way to administer a metered-dose inhaler. 2. The client should wait 2 minutes before taking a second dose of medication. 3. The client should monitor the pulse rate, not the respiratory rate, because this medication causes tachycardia. 4. The breath should be held as long as possible and then exhaled through pursed lips.
1. The nurse is teaching the client the correct use of a metered-dose inhaler. Which intervention should the nurse implement? 1. Instruct the client to push the top of the medication canister while taking a deep breath. 2. Explain the need to wait 30 seconds before taking a second dose of medication. 3. Teach the client to monitor the respiratory rate for 1 full minute after taking medication. 4. Tell the client to exhale the breath immediately after inhaling the medication.
19. 11/2 tablets. To set up this problem convert grams to milligrams. There are 1000 mg in 1 g, so 1.5 g equals 1500 mg. Then set up the problem: 1000 : 1 = 1500 : X Then cross-multiply 1000 X = 1500 To solve for X divide each side of the equation by 1000 1000X/1000 = 1500/1000 X = 1.5
19. The client is to receive 1.5 g of a medication every morning. The medication comes 1000 mg per tablet. How many tablets would the nurse administer?
10. 1. If the nurse drew up this much medication, then the dose would be 10 times less than the prescribed dose. 2. This is the correct amount of medication to administer to the client intradermally. This is the prescribed dose when administering a PPD intradermal injection to a client who is being tested for possible exposure to tuberculosis. 3. This is five times the prescribed dose of medication. 4. If the nurse drew up this much medication, then the dose would be 10 times too much medication. This much medication intradermally would cause damage to the intradermal layer of the skin.
10. The nurse is preparing to administer 0.1 mL of medication intradermally to the client. How much medication would the nurse draw up in the tuberculin (1.0-mL) syringe? 1. A 2. B 3. C 4. D
11. 25 gtt/minutes. The nurse should divide 150 mL/hour by 60 minutes to get 2.5 mL/minute. Then multiply 2.5 mL/minute by 10 gtt/mL to get 25 gtt/minute as the rate to set the infusion set.
11. The client who has had abdominal surgery has an IV of Ringer's lactate infusing at 150 mL/hour. The nurse is hanging a new bag of fluid. The IV administration set delivers 10 gtt/mL. At what rate would the nurse set the infusion?
12. 250 mL/hour. Vancomycin is administered over a minimum of 1 hour. Pumps deliver fluids at an hourly rate. The nurse should set the pump to deliver the 250 mL of fluid over 1 hour.
12. The nurse is preparing to administer vancomycin, an aminoglycoside antibiotic, IVPB via an infusion pump. The IVPB is delivered in 250 mL of normal saline. At which rate should the nurse set the pump?
13. 1.4 mL will be administered intramuscularly. To set up this equation the nurse would write the equation: 5,000,000 units: 3.5 mL = 2,000,000 units: X mL Cross-multiply to get: 7,000,000 = 5,000,000 X To solve for X, divide both sides of the equation by 5,000,000 X = 1.4 mL
13. The order is penicillin 2.0 million units IM. The medication comes in a powder form of 5 million units per vial with directions to reconstitute with 3.2 mL of sterile diluent to produce 3.5 mL of solution. How many milliliters will the nurse administer?
14. 900 mg/24-hour time period. The nurse must first determine the infant's weight in kilograms. To do this, divide 33 pounds by 2.2 conversion factor = 15 kg of body weight. Then multiply 15 kg times 15 mg per kg to equal 225 mg per dose. The medication can be administered every 6 hours. The question asks how many milligrams could be administered within 24 hours. To find out the number of potential dosing times, divide 24 by 6, which equals 4. Multiply 225 mg per dose times 4 doses to obtain 900 mg of Tylenol administered in a 24-hour time period.
14. The order is to administer acetaminophen 15 mg/kg PRN every 6 hours to an infant weighing 33 pounds. How many milligrams of acetaminophen could the infant receive in a 24-hour time period?
15. 1360 units of heparin per hour. The heparin mixture is 40,000 per 500 mL of fluid. The first step in solving this problem is to find out how many units of heparin are in each mL of fluid. Divide 40,000 by 500 = 80 units of heparin per milliliter of IV fluid. The current rate is 15 mL per hour, but the client should have the IV infusion rate increased by 2 mL per hour per the protocol = 17 units per hour. Multiply 80 units per mL times 17 = 1360 units of heparin per hour for the next 6 hours.
15. The client's MAR reads: At 0800 the client's PTT result is 58. How many units per hour will the client receive for the next 6 hours?
16. 14,400 units of heparin per 12-hour shift. The first step in solving this problem is to find out how many units are in each milliliter of IV fluid. To do this divide 25,000 units by 500 mL of IV fluid = 50 units per milliliter of IV fluid. The next step is to multiply the number of units per milliliter times the number of milliliters per hour the client is receiving: 15 × 24 = 1200 units of heparin infusing per hour. Many math problems will ask for the number of units per hour. If this is the question, then 1200 units is the answer, but this question is asking the cumulative shift total of medication. Multiply 1200 times 12 = 14,400 units per 12-hour shift.
16. The client is receiving a heparin infusion at 24 mL/hour via an infusion pump. The medication comes 25,000 units in 500 mL of D5W. How much heparin is the client receiving during a 12-hour shift?
17. 1.67 mL. To find out how many milliliters of morphine should be administered: 15 : 1 = 10 : X Then cross-multiply: 10 = 15 X To solve for X, divide both sides of the equation by 15 10/15 = 15X/15 10 divided by 15 = 0.666 or 0.67 mL of morphine For Phenergan, the dose is 25 mg. Phenergan comes as 25 mg/mL, so 1 mL contains the dose prescribed. Then add the two: 1 mL + 0.67 mL = 1.67 mL
17. The client is to receive a preoperative medication of morphine 10 mg and Phenergan 25 mg IM on call to the operating room. The medication comes as morphine 15 mg/mL and Phenergan 25 mg/mL. How many milliliters of medication will the nurse administer?
18. 50 mL per hour. The nurse would divide the amount of fluid—200 mL—by the number of hours—4—to infuse the medication. 200 ÷ 4 = 50 mL per hour. Pumps are always set at the rate per hour to infuse.
18. The nurse is preparing to administer an IVPB of 40 mEq of potassium in 200 mL of IV solution over 4 hours. At what rate would the nurse set the pump?
2. 1. This is not the acceptable standard of practice. The ventrogluteal muscle (on the side of the hip between the trochanter and ischium) is the injection site of choice because it is a large muscle mass that is free of major nerves and adipose tissue to ensure the medication goes in the muscle. 2. This is the correct action to take because the charge nurse should not correct the primary nurse in front of the client. The deltoid muscle (in the upper arm) should not be used to administer 3 mL of medication intramuscularly because the muscle is small and can only accommodate small doses of medications, no more than 1-2 mL of medication. 3. The charge nurse should not correct the primary nurse at the bedside in front of the client. This embarrasses the primary nurse and will make the client lose confidence in the primary nurse. 4. An occurrence report should not be completed because the charge nurse stopped the action before the client received the injection in the incorrect muscle. The charge nurse would want to discuss the correct site for administering intramuscular medication with the primary nurse.
2. The primary nurse is at the bedside and is preparing to administer 3 mL of medication into the deltoid muscle. Which intervention should the charge nurse implement? 1. Take no action because this is acceptable standard of practice. 2. Ask the primary nurse to come to the nurse's station. 3. Tell the nurse not to inject the medication into the deltoid muscle. 4. Complete an occurrence report documenting the behavior.
20. 3.4 mL per hour. This is a multistep problem. The first step is to find out how many kg the client weighs. Divide 165 pounds by 2.2 conversion factor to equal 75 kg of body weight. Then multiply 3 times 75 = 225 mcg/minute infusion rate. Multiply 225 times 60 equals 13,500 mcg per hour to infuse. Pumps are set at an hourly rate in mL/hour. Next convert the mg of medication to mcg: multiply 2 g times 1000 = 2000 mg, and then multiply 2000 times 1000 = 2,000,000 μg (or 2 g times 1,000,000). 13500 : X = 2,000,000 : 500 2,000,000 X = 6,750,000 2,000,000X/2,000,000 = 6,750,000/2,000,000 3.375 or 3.4 mL per hour. Most pumps in an intensive care unit can be set in increments of tenths of a milliliter.
20. The HCP has ordered 3 mcg/kg per minute of dopamine 2 G/500 mL of D5W to be administered to a client in the intensive care unit. The client weighs 165 pounds. At which rate would the nurse set the IV pump in mL/hour?
21. 1. The medication should be placed under the tongue, not between the gumline and the cheek (buccal). 2. The medication should be placed under the tongue, not swallowed. 3. Sublingual medication is placed under the tongue and should be kept there until the tablet is totally dissolved before swallowing the saliva. 4. The nurse does not need to don gloves when administering this medication. It will not absorb into the nurse's skin.
21. Which intervention should the nurse implement when administering sublingual medication? 1. Place the medication between the gum line and the cheek. 2. Assess the client's ability to swallow the medication. 3. Instruct the client to allow the tablet to dissolve completely. 4. Wear gloves when administering sublingual medication.
22. 1. Assessment is the first intervention, and verifying that the tube is in the stomach is priority when administering medications via the nasogastric tube. 2. If the residual is greater than 100 mL for an adult, the medication should not be administered because this indicates the client is not digesting the feedings. 3. The head of the client's bed should be elevated to prevent aspiration. The foot of the bed should not be elevated. 4. The medication should not be poured into the syringe until the placement of the tube is verified, the residual is checked, and the head of the bed is elevated.
22. The nurse is preparing to administer medication via a nasogastric tube. Which intervention should the nurse implement first? 1. Assess and verify tube placement. 2. Check the residual volume. 3. Elevate the foot of the client's bed. 4. Pour medication into the syringe barrel.
23. 4, 2, 3, 1, 5 4. The nurse must first check to make sure the right client is getting the right medication. 2. The nurse should determine if the client can swallow the medication. 3. The nurse should check the medication against the Medication Administration Record, open the medication package, and place it in the medication cup at the bedside. If the client cannot swallow or refuses the medication, the package can be sent back to the pharmacy if it has not been opened, preventing an unnecessary charge to the client. 1. The nurse should offer water so that the client can swallow the medication. 5. The nurse should remain with the client until the medication is swallowed.
23. Which interventions should the nurse implement when administering a tablet to the client? Rank in order of performance. 1. Offer a glass of water to facilitate swallowing the medication. 2. Assess that the client is alert and has the ability to swallow. 3. Open the medication and place in the medication cup. 4. Check the client's identification band and date of birth. 5. Remain with the client until all medication is swallowed.
24. 1. The charge nurse cannot administer these medications without verifying the medications against the Medication Administration Record. 2. The nurse should take the medication cup back to the medication room and discuss this situation with the primary nurse. Medications should never be left at the bedside. 3. The charge nurse should not correct the primary nurse in front of the client; therefore, this would not be an appropriate intervention. 4. The charge nurse should not leave the medications at the bedside. Medication should never be left at the bedside.
24. The charge nurse is making rounds and notices that the primary nurse left a medication cup with three tablets at the client's bedside. Which intervention should the charge nurse implement? 1. Administer the client's medications. 2. Remove the medication cup from the room. 3. Request the primary nurse come to the room. 4. Leave the cup at the bedside and talk to the primary nurse.
25. 1. Inserting the suppository beyond the anal-rectal ridge will ensure the suppository is retained. 2. The client should lie on the left side (Sims' position). 3. A water-soluble lubricant will ensure the suppository is inserted without trauma to the rectal area and will allow the suppository to dissolve. 4. The nurse should wear nonsterile gloves on both hands, not just on the dominant hand. 5. Thirty minutes will allow absorption of the medication.
25. The nurse is preparing to administer a rectal suppository to a client. Which interventions should the nurse implement? Select all that apply. 1. Insert the suppository beyond the anal-rectal ridge. 2. Instruct the client to lie in the supine position. 3. Lubricate the suppository with a water-soluble lubricant. 4. Apply a sterile glove on the dominant hand. 5. Encourage the client to retain the suppository for 30 minutes.
26. 1. Rotating the sites prevents skin irritation. The nurse understands the correct way to apply a transdermal patch and does not need more teaching. 2. The old patch must be removed and the area must be cleansed to prevent further medication absorption. The nurse does not need more teaching. 3. The nurse should use nonsterile gloves to prevent absorption of the medication through the nurse's hands. The nurse does not need more teaching. 4. The patch should be applied to a clean, dry, hairless area to ensure adherence and proper absorption of the medication. Because the nurse is applying the medication to a hairy area, the nurse needs more teaching.
26. Which action indicates the nurse needs more teaching when administering a transdermal medication to a client? 1. The nurse rotates the site when administering the transdermal patch. 2. The nurse removes the previous transdermal patch and cleans the area. 3. The nurse applies the transdermal patch using nonsterile gloves. 4. The nurse applies the transdermal patch to a dry, hairy area.
27. 1. The nurse should prepare the medication using a 25-gauge, 3/8- to 5/8-inch needle. 2. For heparin, do not aspirate for blood because this can damage surrounding tissue and cause bruising. 3. Do not massage after injecting heparin because this may cause bruising or bleeding. 4. The nurse should not administer the heparin in the same site because this may cause tissue necrosis or other damage to the tissue.
27. The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? 1. Prepare the medication using a 20-gauge, 1.5-inch needle. 2. After injecting the needle, aspirate and observe for blood. 3. After removing the needle, massage the area gently. 4. Check previous injection sites and administer in another area.
28. 1. This is the correct way to administer an intradermal medication. 2. The medication should be administered in a tuberculin or 1-mL syringe using a 25-27-gauge, 3/8- to 5/8-inch needle. 3. The nurse should use the thumb and index finger of the nondominant hand to spread the skin taut, not bunch the skin. 4. The medication should be injected slowly to form a small wheal or bleb.
28. Which intervention should the nurse implement when administering a medication via the intradermal route? 1. Insert the needle with the bevel up at a 10-degree angle in the skin. 2. Prepare the medication in a 3-mL syringe using a 23-gauge, 1-inch needle. 3. Bunch the skin between the thumb and index finger of the nondominant hand. 4. Quickly inject the medication as to not form a wheal or bleb.
29. 1. The nurse should gently press on the lacrimal duct for 1-2 minutes to prevent systemic absorption through the lacrimal canal. 2. The nurse should remove any discharge by gently wiping out from the inner canthus, using a separate cloth for each eye. 3. The nurse should wash hands prior to administering eye drops, but the nurse does not need to wear gloves when administering ophthalmic drops. 4. Medication placed directly on the cornea can cause discomfort or damage, which is why the medication is placed in the lower conjunctival sac.
29. The nurse is administering ophthalmic drops to the client. Which intervention should the nurse implement? 1. Firmly press the lacrimal duct for 5 minutes after instilling drops. 2. Do not remove any discharge from the eye prior to instilling drops. 3. Apply nonsterile gloves prior to administering ophthalmic drops. 4. Administer the ophthalmic drops in the lower conjunctival sac.
3. 1. The medication should be diluted with normal saline to increase the longevity of the vein for intravenous medication and fluids. Diluting decreases the client's pain secondary to the IV push. A 5-mL or 10-mL amount allows the nurse to inject the medication over a 5-minute time frame better than a 0.5-mL amount. 2. Using the closest port ensures the least resistance to the flow of medication into the client and helps to control the rate at which the medication reaches the client's bloodstream. 3. The nurse should pinch off the tubing above the port, not below, to ensure that the medication flows into the client's vein and not upward into the IV tubing. 4. The medication should be injected slowly over 5 minutes (2 minutes for most IV medications) and at a steady rate because a rapid injection could cause speed shock. Speed shock is a sudden adverse physiological reaction secondary to an IVP medication where the client develops a flushed face, headache, a tight feeling in the chest, irregular pulse, loss of consciousness, and possible cardiac arrest.
3. The nurse is administering digoxin (Lanoxin) 0.25 mg intravenous push medication to the client. Which intervention should the nurse implement? 1. Administer the medication undiluted in a 1-mL syringe. 2. Insert the needle in the port closest to the client's IV site. 3. Pinch off the intravenous tubing below the port. 4. Inject the medication quickly and at a steady rate.
30. 1. The nurse is administering the eardrops correctly so there is no reason to stop the nurse from administering the eardrops. 2. This is the correct way to administer eardrops to an adult, but not to a young child. 3. The nurse should administer eardrops to a child younger than age 3 in this manner. This is done because of the short eustachian tube of a child. The charge nurse need take no action. 4. This is the correct way to administer the eardrops to a 2-year-old child. Therefore, the charge nurse does not need to discuss the administration technique with the primary nurse.
30. The charge nurse is observing the primary nurse administering otic drops to a 2-year-old child by pulling down and back on the auricle. Which action should the charge nurse take? 1. Stop the primary nurse and ask the nurse to step out of the room. 2. Demonstrate inserting the otic drops by pulling up and back on the auricle. 3. Take no action because this is the correct way to administer the eye drops. 4. Allow the nurse to administer the otic drops and then discuss the technique with the nurse.
31. 1. The nurse should have the client blow the nose prior to instilling nasal drops to clear the nasal passage. Instructing the client to blow the nose indicates the nurse does not need more teaching. 2. This action allows the drops to have time to work effectively. The nurse does not need more teaching. 3. The client should tilt the head back for the drops to reach the frontal sinus and tilt the head to the affected side to reach the ethmoid sinus. This action indicates the nurse knows the correct administration of nasal drops and does not need more teaching 4. Some nasal drops require the client to close one nostril and tilt the head to the closed side or to hold the breath or breathe through the nose for 1 minute. None of the nasal drops requires a sterile cotton ball to be inserted into the nostril. The nurse needs more teaching.
31. Which action indicates the nurse needs more teaching when administering nasal drops to the client? 1. Instruct the client to blow the nose prior to administering the nasal drops. 2. Have the client keep the head tilted back for 5 minutes after instilling drops. 3. During the administration have the client tilt the head back and to the affected side. 4. Place a sterile cotton ball into the nostril where the nasal spray was administered.
32. 1. The client has the right to refuse medication; therefore, the nurse cannot force the client to take the medication. 2. This nurse must have a witness when wasting a narcotic. 3. Legally the nurse must have someone witness the narcotic being wasted. 4. The pharmacy does not need to be notified that a narcotic was wasted; it must be witnessed and documented on the narcotics log.
32. The nurse prepared 2 mg of morphine with 9 mL normal saline for a client who is complaining of pain. When the nurse enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain pill." Which action should the nurse take? 1. Explain that the medication must be administered because it has been drawn up. 2. Ask another nurse to watch the medication being wasted into the sink. 3. Place the syringe in the sharps container in the client's room. 4. Notify the pharmacy that a narcotic was not administered to the client.
33. 1. The nurse must compare the medication with the MAR to make sure it is the right medication, but this is not the nurse's first intervention. 2. The nurse must take the MAR to the bedside with the medication to make sure the medication is being administered to the correct client, but this is not the nurse's first intervention. 3. The nurse must check the MAR with at least two forms of identification, one of which can be the client's identification band, but this is not the nurse's first intervention. 4. Washing the hands is essential to avoid contaminating the medication. Although it seems like an obvious step, it is often neglected by the nurse as a result of being busy and in a hurry.
33. The nurse is preparing to administer the morning medications to a group of clients in a medical department. Which intervention should the nurse implement first? 1. Compare the medication with the Medication Administration Record. 2. Take the medication and the Medication Administration Record to the bedside. 3. Check the client's identification band with the Medication Administration Record. 4. Wash the hands with soap and warm water for at least 30 seconds.
34. 1. Only crushed or liquid medication should be administered through the GT tube, but this is not the first intervention the nurse should implement. 2. The nurse should first flush the GT with tap water to ensure that it is patent before putting any medication into the gastrostomy tube. 3. The medication can be administered via gravity or a plunger can be used, if needed, but this is not the nurse's first intervention. 4. After the medication is administered, the nurse should flush the GT with tap water to make sure all the medication is in the stomach and not in the tubing.
34. The nurse is administering medications through a gastrostomy tube (GT). Which intervention should the nurse implement first? 1. Place the crushed pills in the gastrostomy tube. 2. Flush the gastrostomy with at least 30 mL of tap water. 3. Use the plunger to push the medication into the GT. 4. Clamp the gastrostomy tube closed.
35. 1. A volume-controlled chamber (Buretrol) along with an intravenous administration pump should be used when administering intravenous fluids to children to ensure that the child does not experience fluid-volume overload. Fluid-volume overload in a child could cause death. 2. The IV catheter should be secured, but this is not the most important intervention because even if it is not secured the child would not experience fluid-volume overload, which is a potentially life-threatening complication of IV fluid therapy. 3. Having the mother or father at the bedside is an appropriate intervention because the child will be frightened, but it is not the most important intervention. 4. Double-checking a routine intravenous fluid is not necessary, but the nurse should double-check medication according to the child's weight.
35. The nurse is preparing to administer intravenous fluids to a 2-year-old child. Which intervention is most important for the nurse to implement? 1. Use a volume-controlled chamber to administer the intravenous fluids. 2. Ensure that the intravenous catheter is securely taped to the child's skin. 3. Request that an adult hold the child's hand when hanging the IV fluid. 4. Check the intravenous solution type with another nurse before administering.
36. 1. The deltoid muscle (in the upper arm) should not be used to administer 3 mL of medication intramuscularly because the muscle is small and can only accommodate small doses, no more than 1 to 2 mL, of medications. 2. The dorsogluteal (the buttocks) is not recommended for intramuscular injections because the sciatic nerve may be injured if the nurse fails to identify the proper landmarks to ensure missing it. 3. The ventrogluteal muscle on the side of the hip between the trochanter and ischium is the injection site of choice because it is a large muscle mass that is free of major nerves and adipose tissue to ensure the medication goes in the muscle. 4. The vastus lateralis muscle (lateral side of the thigh) can be used for administering intramuscular injections, but the client often complains that this is more painful than other areas.
36. The nurse is preparing to administer 3 mL of a medication intramuscularly. Which muscle is the best site to administer the medication? 1. The deltoid muscle. 2. The dorsogluteal muscle. 3. The ventrogluteal muscle. 4. The vastus lateralis muscle.
37. 1. The client should lie down for 10 to 15 minutes so that all the medication can melt and coat the vaginal walls. 2. The client may need to use a perineal pad to catch any drainage or prevent staining of the undergarments. 3. The filled vaginal applicator should be inserted as far into the vaginal canal as possible, and then the client should push the plunger, depositing the medication in the vagina 4. The client should not douche prior to administering vaginal cream because douching removes the normal flora of the vagina.
37. The client is prescribed vaginal cream. Which information should the nurse discuss with the client? 1. Instruct the client to lie down for 10 to 15 minutes after inserting medication. 2. Tell the client not to use a perineal pad after administering the medication. 3. Teach the client not to insert the vaginal applicator very far into the vagina. 4. Discuss the need to douche 30 minutes prior to inserting the vaginal cream.
38. 1. The lid should be placed with the lid upside down so that the outer surface is down. This protects the inside of the lid from dirt or contamination. 2. Many liquids or medications in a solution must be shaken before they are poured. Make sure the lid is tightly closed before shaking. 3. The medication should be held at eye level when reading the proper dose. Often the medication in the cup is not level—it is higher on the sides than in the middle. Read the level at the lowest point in the medication cup. 4. Holding the medication label against the hand prevents the medicine from running down onto the label so that it cannot be read.
38. The nurse is preparing to administer a liquid-form oral medication. Which intervention should the nurse implement? 1. Place the lid of the bottle right side up so the outer surface is up. 2. Do not shake the medication before pouring it into the medication cup. 3. Hold the medication cup at chest level when reading the proper dose. 4. Pour the liquid into the bottle with the label against the hand.
39. 1. The use of a spacing device increases the amount of medication reaching the lungs with less of the medication being deposited in the mouth and throat. This is the correct procedure, and the nurse would not have to correct the information. 2. The site of action for inhalers is the lungs. The client should not hold the medication in the mouth because this will increase the likelihood of the client developing a fungal infection of the mouth. The client should inhale deeply and hold the breath after the medication is in the lung. The nurse should correct this misinformation. 3. Pausing between puffs allows the lungs to absorb more of the medication. This is correct information. 4. Mouth sores may indicate a fungal mouth infection as a result of the medication and the HCP should be notified. This is correct information
39. The nurse on a medical unit is providing discharge instructions to a client who is prescribed fluticasone (AeroBid), a glucocorticoid, and a metered-dose inhaler. Which statement by the client warrants intervention? 1. "I will use a spacer when using my inhaler." 2. "I will hold the medication in my mouth for 10 seconds." 3. "I will wait a few minutes between puffs." 4. "I will notify my HCP if I get mouth sores."
4. 1. The roller clamp should be closed on the tubing to prevent fluid loss from the IV bag. The nurse does not need more teaching. 2. The medication should be inserted into the center of the port to prevent accidental puncture of the sides of the port or the IV bag. The nurse does not need more teaching. 3. This indicates the nurse needs more teaching because the IV bag should be gently rotated to distribute the medication evenly throughout the IV solution. 4. The label must clearly identify what the nurse added to the IV solution. The nurse does not need more teaching.
4. The nurse is adding a medication to an intravenous bag. Which action indicates the nurse needs more teaching in performing this procedure? 1. The nurse clamps the roller clamp on the tubing attached to the IV solution. 2. The nurse inserts the needle into the center of the medication port. 3. The nurse avoids rotating the solution after administering the medication. 4. The nurse writes the name and dose of the medication on the medication label.
40. 1. This point indicates the amount of regular insulin only—14 units. 2. This point indicates the amount of intermediate insulin only—28 units. 3. This point is 32 units, which is the incorrect dosage. 4. The nurse would first draw up 14 units of regular-acting insulin and have another RN check the dosage. Then the nurse should draw up 28 units of intermediate-acting insulin to total 42 units of insulin and verify the dosage with another RN. Drawing up regular insulin first ensures that the intermediate- acting insulin does not accidentally get inserted into the regular insulin, thereby altering the peak time of the regular insulin. MEDICATION MEMORY JOGGER: Remember "clear to cloudy" when combining regular-acting and intermediate-acting insulin.
40. The nurse is preparing to administer 14 units of regular insulin and 28 units of intermediate insulin. How much insulin would the nurse draw up on the insulin syringe? 1. A 2. B 3. C 4. D
5. 1. This is appropriate when withdrawing medication from a vial. An ampule is a one-time use container. 2. All of the medication should be in the lower chamber of the ampule; the nurse should tap the upper chamber to make sure all of the medication is in the lower chamber. 3. The ampule should be snapped away from the nurse so that any glass fragments are directed away from the nurse, not toward the nurse. 4. The nurse should not allow the needle to touch the rim of the ampule because the rim is considered contaminated. The correct procedure is to insert the needle in the center of the opening of the ampule.
5. Which intervention should the nurse implement when withdrawing medication from an ampule? 1. Do not use if the ampule was opened more than 30 days ago. 2. Ensure that all the medication is in the upper chamber of the ampule. 3. Snap the neck of the ampule so that it opens toward the nurse. 4. Insert the needle into the center of the opening of the ampule.
6. 1. The primary nurse must discard the used needle in the sharps container in the client's room and, according to OSHA, cannot remove a used or "dirty" needle from the client's room. This action would require intervention from the charge nurse. 2. The Joint Commission mandates that the nurse use two forms of identification when administering medications to a client to ensure that the correct client is given the prescribed medication. This action would not warrant intervention by the charge nurse. 3. Air should be injected into a vial to create a positive pressure inside the vial to ease the medication withdrawal and prevent a vacuum when withdrawing the medication. This action would not warrant intervention by the charge nurse. 4. Narcotics must be documented and accounted for when removed from the narcotics box or container. This action would not warrant intervention by the charge nurse.
6. Which action by the primary nurse warrants intervention by the charge nurse? 1. The charge nurse observes the primary nurse carrying a used needle to the medication room. 2. The charge nurse observes the primary nurse using two methods to identify the client who is receiving medications. 3. The charge nurse observes the primary nurse injecting air into a vial when preparing an intramuscular injection. 4. The charge nurse observes the primary nurse documenting the removal of meperidine (Demerol) from the narcotics box.
7. 1. Do not use a favorite food or essential dietary item when administering a medication because the child may refuse the food in the future. The medication will cause the favorite food to taste bad or "funny." 2. The nurse should be honest with the child and the parent or guardian and tell the truth. Not telling the truth will damage the parent's trust in the nurse. Even if a 2-year-old does not understand, the child gagging or spitting out the medication indicates it is unpleasant tasting, and the parent will know the nurse lied about the medication. 3. The nurse should not use large volumes of fluid because if the child does not drink the entire amount, then the nurse cannot determine if the entire dose has been taken. 4. This action promotes swallowing and prevents the medication from being aspirated or spit out.
7. The nurse is administering an unpleasant-tasting liquid medication to a 2-year-old child. Which intervention should the nurse implement? 1. Prepare the medication in the child's favorite food. 2. Tell the child the medication will not taste bad. 3. Put the medication in 4 ounces of apple juice. 4. Use a dropper to place the medication between the gum and cheek.
8. 1. The client appears to be having an anaphylactic reaction and bringing the crash cart to the bedside is an appropriate intervention, but it is not the first intervention. 2. The client is in distress, and taking the vital signs will not help an allergic reaction. 3. The HCP should be notified so that the order for a medication to counteract the anaphylactic reaction can be obtained. Therefore, this is the first intervention. 4. The nurse can prepare to administer the medication, but the HCP determines if in fact the client is having an allergic reaction and then orders the appropriate medication. Very few clients have a PRN order in place from the HCP for a possible allergic reaction, so this is not the first intervention.
8. The nurse administers a medication to a client, and 30 minutes later the client tells the nurse that he/she is starting to itch. The nurse notes a red rash over the client's body. Which intervention should the nurse implement first? 1. Have the crash cart brought to the room. 2. Assess the client's apical pulse and blood pressure. 3. Notify the health-care provider immediately. 4. Prepare to administer diphenhydramine (Benadryl), an antihistamine.
9. 1. This is not the correct way to determine the prescribed amount when using a calibrated measuring cup. 2. The liquid aluminium hydroxide/ magnesium hydroxide (Maalox) must be poured into a calibrated measuring cup and measured at the base of the meniscus to ensure the correct dose. 3. The aluminium hydroxide/magnesium hydroxide (Maalox) bottle must be shaken vigorously to ensure the medication is well dispersed in the bottle. 4. A syringe is primarily used to give liquid medications to children to ensure accurate dosing. It is not used to administer antacids to an adult.
9. The nurse is preparing to administer 15 mL of the antacid aluminium hydroxide / magnesium hydroxide (Maalox) from a bottle to a client. Which intervention should the nurse implement? 1. Determine the correct amount at the sides of the cup. 2. Measure the medication at the base of the meniscus. 3. Avoid shaking the bottle of Maalox. 4. Draw the medication into a 20-mL syringe.