Chapter 28: Medications
The physician has ordered an IV of 3000 mL of 0.9% sodium chloride to be infused over the next 24 hours. The nurse uses IV tubing that has a drip factor of 10. Calculate the drops per minute needed to deliver the correct amount of IV fluid. Record your answer using a whole number.
21 *Formula for calculating drops per minute: mL/hr x drop factor = gtts/minute 60 minutes 3000 mL/24 hr = 125 mL/hr 125 mL/hr x 10 = 20.8 or 21 gtts/min 60
A patient with a complex cardiac history has been prescribed digoxin (Lanoxin) 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? a) 0.5 b) 4 c) 1.5 d) 2
a) 0.5 *125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets
A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which of the following describes the mechanism of a metered-dose inhaler? a) A canister containing medication that is released when the container is compressed b) A device that forces liquid drug through a narrow channel using pressurized air c) A device that forces medication through a narrow channel with the help of inert gas d) A propeller-driven device that spins and suspends a finely powdered medication
a) A canister containing medication that is released when the container is compressed *A metered-dose-inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas.
A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are as follows: heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first? a) Administer 1 liter 0.9% saline IV. b) Draw a complete blood count (CBC) with hematocrit and hemoglobin. c) Obtain an abdominal x-ray. d) Insert an indwelling urinary catheter.
a) Administer 1 liter 0.9% saline IV. The client is demonstrating vital signs consistent with fluid volume deficit, likely due to bleeding and/or hypovolemic shock as a result of the automobile accident. The client will need intravenous fluid volume replacement using an isotonic fluid (e.g., 0.9% normal saline) to expand or replace blood volume and normalize vital signs. The other prescriptions can be implemented once the intravenous fluids have been initiated.
A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client? a) Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube. b) Heat the tablets until they liquefy; then pour the liquid down the NG tube. c) Cut the tablets in half and wash them down the NG tube, using a water-filled syringe. d) Crush the tablets and wash the powder down the NG tube, using a syringe filled with saline solution.
a) Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube. To administer oral medication through an NG tube, the nurse must reproduce the disintegration and dissolution processes by crushing the tablets and preparing a liquid form. Making sure not to crush sustained-release tablets or empty capsules, she then inserts the liquid into the NG tube. Heating the tablets may destroy or alter the drug's action. Washing cut tablets or crushed powder down the tube may cause the medication to stick to the sides of the tube, possibly providing inaccurate dosing and clogging the tube.
Which parenteral route of administration has the longest absorption time? a) Intramuscular b) Subcutaneous c) Intradermal d) Intravenous
c) Intradermal *Intradermal injections are administered into the dermis, just below the epidermis, and this route of administration has the longest absorption time. Intravenous drugs are absorbed immediately because they are administered directly into the bloodstream.
A nurse needs to administer an injection to a client in the deltoid site. Which of the following actions should the nurse perform to avoid the risk of damaging the radial nerve and artery? a) Draw an imaginary line at the axilla between the acromion and brachial vessels. b) Pull the tissue laterally until it is taut. c) Avoid asking the client to lie down or sit. d) Aspirate for blood return from the tissue.
a) Draw an imaginary line at the axilla between the acromion and brachial vessels. *To avoid the risk of damaging the radial nerve and artery in the deltoid site, the nurse should draw an imaginary line at the axilla first and then inject between the acromion and brachial vessels. The nurse should ask the client to lie down, sit, or stand with the shoulder well exposed. Pulling the tissue until it is taut and aspirating blood return from the tissue is part of the Z-track method, not part of the technique used to avoid the risk of damaging the radial nerve and artery.
Which of the following accurately describes a recommended guideline when administering oral medications to patients? a) If a child refuses to take medication, the medication can be crushed and added to a small amount of food. b) If a patient vomits immediately after receiving oral medications, readminister the medication. c) If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. d) Assume that the patient is the authority on whether or not the medication was swallowed.
a) If a child refuses to take medication, the medication can be crushed and added to a small amount of food. *Medication can be added to small amounts of food, but should not be added to liquids. If it is questionable whether the medication was swallowed, check the patient's mouth and cheeks. If a pill is dropped, it should be discarded, and if a patient vomits, notify the physician to see if the medication should be readministered.
A nurse preparing medication for a patient is called away to an emergency. What should the nurse do? a) Lock the medications in a cart and finish them upon return. b) Have another nurse finish preparing and administering the medications. c) Have another nurse guard the preparations. d) Put the medications back in the containers.
a) Lock the medications in a cart and finish them upon return. *Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.
A nurse is preparing an injection by withdrawing the solution from a multidose vial. What is necessary to facilitate withdrawing a medication from the vial? a) first inject an equal amount of air into the vial b) withdraw the liquid and then inject an equal amount of air c) insert a separate needle to equalize the pressure d) insert the needle and slowly withdraw the liquid
a) first inject an equal amount of air into the vial * To facilitate removal of medication from a multidose vial, first inject an amount of air in the same amount as the desired quantity of the medication.
The nurse is administering an intradermal injection, . The nurse should: a) withdraw the needle. b) instruct the client to massage the area for 1 minute. c) aspirate the medication and administer the medication at another site. d) report an adverse reaction to the medication.
a) withdraw the needle. *The nurse observes a wheal indicating that the medication has been deposited in the dermis; the nurse can now withdraw the needle. The wheal is an expected outcome of an intradermal injection. The area should not be massaged; massaging will cause the medication to move into the subcutaneous tissue. The medication has been administered correctly, and the nurse should not aspirate the medication or attempt to administer it again.
When preparing to give a client an ordered drug, a nurse realizes that the drug is one she has never administered before. No drug references on the nursing unit contain information about the drug in question. What should the nurse do? a) Ask other nurses on the unit for information about the drug. b) Contact a pharmacist to obtain information about the drug. c) Refuse to give the drug because she can't find any written information about it. d) Consult the physician for information about the drug.
b) Contact a pharmacist to obtain information about the drug. *When print resources aren't available, pharmacists are the best resources for drug information, which they can provide quickly and reliably. Pharmacists have more up-to-date and accurate drug information than physicians or other nurses do. The nurse should refuse to give a drug only if she can't find any information about it.
When administering a subcutaneous injection to a patient, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation? a) Discard the equipment and start the procedure from the beginning. b) Engage safety shield on needle guard and discard needle appropriately. c) Document the incident and inform the primary care provider d) Pull out and discard the needle.
b) Engage safety shield on needle guard and discard needle appropriately. * The needle needs to be disposed of properly after engaging the safety guard because the needle cannot be re-inserted due to contamination. A new needle can be attached to the syringe and the remainder of the medication administered after cleansing the site again. The incident does warrant notifying the primary care provider.
The physiologic and biochemical effects of a drug on the body defines a) Pharmacology b) Pharmacodynamics c) Pharmacokinetics d) Pharmacotherapeutics
b) Pharmacodynamics *Pharmacodynamics refers to the physiologic and biochemical effects of a drug on the body.
You are preparing to administer a transdermal medication. How should this be accomplished? a) You should inject the medication just below the dermis of the skin. b) You should apply the medication directly to the skin. c) You should ask the patient to swallow the medication. d) You should inject the medication into a body cavity.
b) You should apply the medication directly to the skin. *Transdermal medications are adsorbed through the skin.
The nurse should advise which client who is taking lithium to consult with the health care provider (HCP) regarding a potential adjustment in lithium dosage? a) a client who attends college classes b) a client who is beginning training for a tennis team c) a client who can now care for her children d) a client who continues work as a computer programmer
b) a client who is beginning training for a tennis team A client who is beginning training for a tennis team would most likely require an adjustment in lithium dosage because excessive sweating can increase the serum lithium level, possibly leading to toxicity. Adjustments in lithium dosage would also be necessary when other medications have been added, when an illness with high fever occurs, and when a new diet begins.
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: a) increases norepinephrine secretion and thus decreases blood pressure and heart rate. b) blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. c) is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d) is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.
b) blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. *Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction. Propranolol does not increase norepinephrine secretion, cause vasodilation, or block conversion of angiotensin I to angiotensin II.
The client states to the nurse, "I take citalopram 40 mg every day as my health care provider prescribed. I have also been taking St. John's wort 750 mg daily for the past 2 weeks." Which findings would indicate that the client is developing serotonin syndrome? Select all that apply. a) constipation b) confusion c) diaphoresis d) ataxia e) restlessness
b) confusion c) diaphoresis d) ataxia e) restlessness *Serotonin syndrome can occur if a selective serotonin reuptake inhibitor is combined with a monoamine oxidase inhibitor, a tryptophan-serotonin precursor, or St. John's wort. Signs and symptoms of serotonin syndrome include mental status changes (such as confusion, restlessness, or agitation) headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia. Constipation is not associated with serotonin syndrome.
Sodium polystyrene sulfonate is prescribed for a client following crush injury. The drug is effective if: a) the pulse is weak and irregular. b) the serum potassium is 4.0 mEq/L (4.0 mmol/L). c) the ECG is showing tall, peaked T waves. d) there is muscle weakness on physical examination.
b) the serum potassium is 4.0 mEq/L (4.0 mmol/L). *Following crush injury, serum potassium rises to high levels. Sodium polystyrene sulfonate is a potassium binding resin. The resin combines with potassium in the colon and is then eliminated, and serum potassium levels should come back to normal. Normal serum potassium is 3.5 to 5.3. Weak, irregular pulse and tall peaked T waves on ECG are signs of hyperkalemia, and muscle weakness is a sign of hypokalemia.
You are beginning to administer oral medications to a patient. The patient states, "I haven't taken that pill before. Are you sure it's correct?" You recheck the CMAR/MAR and find that the medication is scheduled to be administered. Which of the following responses is most appropriate? a) "It wouldn't be listed on this CMAR/MAR if it wasn't prescribed for you." b) "Go ahead and take it, and then I'll check with your primary care provider about it." c) "Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." d) "It's listed here on the CMAR/MAR, so you should take it."
c) "Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." *This action indicates adherence to the five rights of medication administration.
The nurse is preparing to administer meperidine (Demerol) as an intramuscular injection in an adult patient's deltoid site. Which of the following needles should the nurse select for this injection? a) 2"; 18 gauge b) 1 1/2"; 18 gauge c) 1"; 22 gauge d) 5/8"; 24 gauge
c) 1"; 22 gauge *IM injections using the deltoid site require a 20- to 25-gauge needle that is between 1" and 1 1/2" in length.
A nurse is administering medication to a 78-year-old female patient who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this patient has an increased possibility of drug toxicity due to which of the following age-related factors? a) Decreased adipose tissue and increased total body fluid in proportion to total body mass b) Increased kidney function, resulting in excessive filtration and excretion c) Decline in liver function and productio n of enzymes needed for drug metabolism d) Increased number of protein-binding sites
c) Decline in liver function and productio n of enzymes needed for drug metabolism *Older patients are at risk for experiencing a cumulative effect, related to a decreased rate of drug metabolism, higher drug plasma concentrations, leading to prolonged action and increased possibility of drug toxicity if the liver function and production of enzymes for metabolism is decreased. Adipose tissue and total body fluid in proportion to body mass is not a factor indicated in this scenario. A decreased number of protein-binding sites could lead to drug toxicity. Decreased, rather than increased, kidney function leads to drug toxicity due to decreased secretion of the drug.
Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream? a) Hypotonic b) Isotonic c) Hypertonic d) Sodium chloride
c) Hypertonic A hypertonic solution causes the bloodstream to absorb fluids until pressure on both sides of the blood vessel is equal. A hypotonic solution causes fluids to move from the bloodstream into the tissues. An isotonic solution has no effect on the cell. Depending on the concentration of sodium, a sodium chloride solution can be isotonic, hypertonic, or hypotonic.
A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child? a) Hypernatremia b) Hypercalcemia c) Hypokalemia d) Hyperphosphatemia
c) Hypokalemia Hypokalemia occurs when insulin administration causes glucose and potassium to move into the cells. Insulin administration doesn't directly affect calcium levels. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus enters the cells with insulin and potassium. Insulin administration doesn't directly affect sodium levels.
A client's blood pressure is elevated at 160/90 mm Hg. The health care provider (HCP) prescribed "clonidine 1 mg by mouth now." The nurse sent the prescription to pharmacy at 0710, but the medication still has not arrived at 0800. The nurse should do all except: a) call the pharmacy. b) check the client's blood pressure. c) go to the pharmacy to obtain the drug. d) check all appropriate places on the unit to which the drug could have been delivered.
c) go to the pharmacy to obtain the drug. *Although the nurse needs to obtain and administer the medication as soon as possible, it is inappropriate for the nurse to go to the pharmacy and request the drug without first calling the pharmacy and checking to see whether the medication was delivered. The drug may have been delivered to several appropriate spots on the unit, such as the client's drug bin, the transport system, or the delivery box. The nurse should assess the client's blood pressure to determine the immediacy of the condition for which the medication was prescribed.
A client with peripheral vascular disease, coronary artery disease, and chronic obstructive pulmonary disease takes theophylline 200 mg twice daily every day, and digoxin 0.5 mg once a day. The health care provider (HCP) now prescribes pentoxifylline. To prevent adverse effects, the nurse should monitor the client's: a) partial thromboplastin time (PTT). b) digoxin level. c) theophylline level. d) serum cholesterol level.
c) theophylline level. * Pentoxifylline can potentiate the effects of theophylline and increase the risk of theophylline toxicity. Therefore, the nurse should monitor the client's theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the client's PTT would need to be monitored closely if the client were taking heparin. It does not affect cholesterol levels.
A client states, "I have never taken a yellow pill before for my blood pressure. Why are you giving me this pill?" After verifying that the nurse has prepared the correct medication, which of the following would be an accurate statement by the nurse? a) "I think you must be confused; this is the right medication." b) "You can refuse to take this medication if you wish." c) "We use all kinds of brands at the hospital so I am sure it is correct." d) "This is the same medication that you take at home but in generic form."
d) "This is the same medication that you take at home but in generic form."
To which of the following patients would the nurse be most likely to administer a PRN medication? a) A patient who requires daily medication to control hypertension b) A patient who is experiencing severe and unprecedented chest pain c) A patient whose asthma is treated with inhaled corticosteroids d) A patient who is complaining of pain near her surgical site
d) A patient who is complaining of pain near her surgical site *A complaint of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications
A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube? a) Add medications to the formula b) Use cold water when mixing powdered medications c) Mix all the medications together in 15 mL of water d) Avoid crushing sustained-release pellets
d) Avoid crushing sustained-release pellets *When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Besides, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.
When developing a teaching plan for a client taking hormonal contraceptives, a nurse should ensure that the client knows she must have which vital sign monitored regularly? a) Temperature b) Pulse c) Respirations d) Blood pressure
d) Blood pressure *The incidence of hypertension is three to six times greater in clients using hormonal contraceptives than in women who don't use these drugs. Age and duration of the drug's use increase this incidence. Hormonal contraceptives don't directly affect pulse, respirations, or temperature.
What factor is used to calculate drug dosages for a child? a) Developmental level b) Age c) Ethnicity d) Body surface area (BSA)
d) Body surface area (BSA) *Pediatric doses are calculated according to the child's weight or BSA. The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height.
A nurse needs to administer a prescribed medication to a client using IV push. In which of the following ways is the medication being administered to the client? a) Gravity infusion b) Continuous drip c) Electronic infusion device d) Bolus administration
d) Bolus administration *A bolus is a relatively large amount of medication given all at once; bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration. A continuous infusion, also called continuous drip, is instillation of a parenteral drug over several hours. It involves adding medication to a large volume of IV solution. After the medication is added, the solution is administered by gravity infusion or, more commonly, with an electronic infusion device such as a controller or pump.
A nurse is applying a nitroglycerine transdermal patch to a patient. Which of the following is the preferred site to use? a) Lower leg b) Any hairless surface c) Bicep d) Chest
d) Chest *Nitroglycerin (Minitran) may be placed on any hairless surface except on extremities below the knees or elbows, with the chest being the preferred site. It is reapplied every 12 to 14 hours, and patients should have a nitrate-free interval of 10 to 12 hours each day to ensure tolerance does not develop (Ball & Smith)
Which one of the following medications would most likely be administered via a transdermal patch? a) Epinephrine b) Antibiotics c) Antidepressants d) Hormonal medications
d) Hormonal medications *Transdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiac medications, and nicotine.
A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? a) Allow sufficient time to prepare the medication with minimal distraction b) Administer medication within 30 to 60 minutes of the scheduled time c) Read and compare labels on the medication with the medical record d) Review the client's medication, allergy, and medical history
d) Review the client's medication, allergy, and medical history *To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least three times before, during, and after preparing the medication to ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications.
