Chapter 29: Medications
The charge nurse on the medical/surgical unit is reviewing health care provider orders for a client with a diagnosis of congestive heart failure. Which infusion orders would the nurse question? Select all that apply. - 20 mL 0.9 NaCl to run in 20 minutes - 1000 D5W to run in 30 minutes - 50 mL D5W to run in 60 minutes - 250 mL 0.9 NaCl to run in 60 minutes
-1000 D5W to run in 30 minutes Explanation: Medications administered by intermittent infusion are supplied either in bags that contain 50 to 250 mL of IV fluid (0.9 normal saline or 5% dextrose in water) or in 20- to 60-mL syringes to be used with an infusion pump. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 856.
A nurse is preparing to administer several prescribed medications to a client. The medications ordered are to be given by the following routes: oral, subcutaneous, intramuscular and intravenous. Place the routes in the proper order from slowest to fastest absorption. 1 Intravenous 2 Oral 3 Subcutaneous 4 Intramuscular
2 Oral 3 Subcutaneous 4 Intramuscular 1 Intravenous Explanation: Absorption is the process by which a medication enters the bloodstream. The route of administration affects how quickly and completely a medication is absorbed. Intravenous (IV) administration offers the quickest rate of absorption, followed in descending order by intramuscular (IM), subcutaneous, and oral (PO) routes. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 823.
It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client? A.) A 40-year-old client diagnosed with breast cancer prescribed fulvestrant B.) A 70-year-old demonstrating muscle wasting prescribed chlorpromazine
A 70-year-old demonstrating muscle wasting prescribed chlorpromazine Explanation: The Z-track method is suggested for older adults who have decreased muscle mass. While some agents, such as iron, are best given via the Z-track method due to the irritation and discoloration associated with this agent, none of the other clients demonstrate specific characteristics that suggest the need for Z-tracking. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Skill 29-7: Administrating an Intramuscular Injection, p. 902.
The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse? A.) Determine compatibility of the insulins by checking a drug compatibility table. B.) Inject air into each vial equal to the amount of insulin prescribed. C.) Check the expiration date on each vial. D.) Roll the modified insulin vial to mix it well.
A,) Determine compatibility of the insulins by checking a drug compatibility table. Explanation: The first step in mixing two types of insulin in one syringe is verifying compatibility. Some insulins cannot be mixed together. The other steps are appropriate but should be completed after determining compatibility. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 886-890.
The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client? A.) spacer B.) nasal drops C.) metered-dose inhaler D.) turbo-inhaler
A.) spacer Explanation: A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption, because it prevents drug loss. 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. Nasal drops are liquid medication sprayed or dropped into the client's nose. These, however, would not help in maximizing the absorption of the medication. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 864-865.
The nurse is preparing to insert an intravenous needle in a 1-year-old child for a one-time administration of fluids due to dehydration. Which needle would the nurse likely select? A.) An 18-gauge intravenous catheter B.) A 23-gauge winged infusion set C.) A 19-gauge winged infusion set D.) A 22-gauge intravenous catheter
B.) A 23-gauge winged infusion set Explanation: Winged infusion or small vein needles may be used for short-term or one-time infusion therapies or may be used with infants and small children. These are short, beveled needles with plastic flaps or wings. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 910.
The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed? A.) bisacodyl B.) miconazole C.) timolol D.) oxymetazoline
B.) miconazole Explanation: The nurse anticipates that miconazole, a vaginal cream, will be prescribed for a yeast infection. Oxymetazoline is a nasal decongestant used to alleviate congestion; bisacodyl is a rectal suppository used for softening stool; timolol is an eye drop used to treat glaucoma. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 862.
The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client? A.) prone B.) lithotomy C.) supine D.) oblique
C.) supine Explanation: To best facilitate instillation of nasal medication via a dropper, and to ensure that the drug is administered into the place where its effects are desired, the nurse will place the client in supine position. The other positions are not appropriate. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 863.
At what point should the nurse perform the first of the three checks of medication administration? A.) when reviewing the client's medication administration record (MAR) B.) after retrieving the drug from the drawer of a drug cart C.) at the beginning of a shift D.) as the nurse reaches for the drug package or container
D.) as the nurse reaches for the drug package or container Explanation: The first of the three checks associated with safe medication administration takes place when the nurse reaches for the container or unit dose package. The three checks are: 1. when the nurse reaches for the unit dose package or container; 2. after retrieval from the drawer and compared with the eMAR/MAR, or compared with the eMAR/MAR immediately before pouring from a multidose container; 3. before giving the unit dose medication to the client, or when replacing the multidose container in the drawer or shelf. At the beginning of a shift is too early to complete the first of three safe medication checks. A nurse reviews the client's medication administration record (MAR) as a part of the morning assessment to identify when medications are due. This is part of the second check of frequency with the MAR. After retrieving the drug from the drawer of a drug cart is part of the third check of frequency. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 837.
The nurse is creating a professional development presentation about medication orders. Which teaching will the nurse include? Select all that apply. -The health care providers must sign all orders. -The prescribing provider is the only person accountable for drug orders. -U and IU are acceptable abbreviations to use. -Be extra cautious with look-alike and sound-alike drugs. -Use abbreviations as much as possible.
-The health care providers must sign all orders. -Be extra cautious with look-alike and sound-alike drugs. Explanation: The nurse's teaching will include that health care providers must sign all orders, and care must be taken with look-alike and sound-alike drugs. Abbreviations should not be used. The nurse is held accountable for making sure that all components of a medication order are present and for clarifying any portion that is not understood. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 833.
A new prescription has been noted in the medical record for an adult client with chest pain to receive a medication that comes in the form of a transdermal patch. The nurse will consider which precaution(s) to ensure safety with this form of drug use? Select all that apply. 1-Dispose of transdermal patches in the trash. 2-Apply patches at the same location for consistency. 3-May cause injury with defibrillation. 4-Use a heating pad to increase absorption. 5-Remove the patch prior to magnetic resonance imaging (MRI). 6-Fold the patch in half before disposal. 7-Assess for fever prior to application. 8-Monitor the client for early identification of adverse effects.
3-May cause injury with defibrillation. 6-Fold the patch in half before disposal. 7-Assess for fever prior to application. 5-Remove the patch prior to magnetic resonance imaging (MRI). 8-Monitor the client for early identification of adverse effects. Burns to the skin and smoke may occur if a patch is in place during defibrillation. A transdermal patch should be folded in half after removal to prevent nurse making contact with the medication or inadvertently transferring the medication onto another surface. A fever higher than 102°F (39°C) may be a contraindication to use, because the heat may increase the rate of absorption. A transdermal patch may cause burning to the skin, if the patch is in place while the client is undergoing magnetic resonance imaging (MRI). The use of a transdermal patch carries the same risk as the medication given in other forms. The client should be evaluated accordingly for potential adverse effects. The nurse will follow facility protocols to dispose of a transdermal patch, often in facility-approved containers and sometimes with a second nusre as a witness. Application sites should be rotated with each application to prevent local skin irritation. Direct heat, such as that provided by a heating pad or a sun lamp, should be avoided. Local heat provided by the palm of the hand may be used initially to help facilitate adhesion. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Guidelines for Nursing Care 29-2: Applying Transdermal Patches, p. 859.
The nurse is caring for a client who is receiving a prescribed intravenous (IV) infusion of an antibiotic to treat an infection. The client asks the nurse, "Can I just take a pill?" What is the best response by the nurse? A.) "An IV infusion maintains a therapeutic level of the medication in your blood." B.) "The health care provider can control the dose of medication you receive through IV." C.) "The IV infusion will treat your infection slower." D.) "Oral antibiotics are not as effective as IV infusions."
A.) "An IV infusion maintains a therapeutic level of the medication in your blood." Explanation: When treating certain infections, blood levels of the medication are needed to maintain a consistent therapeutic level. IV infusion does not necessarily treat the infection faster, but provides a consistent blood level. Oral antibiotics can be effective in treating infections. The dose can be controlled through IV infusion, but this is not the reason the client is receiving the medication via IV infusion. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 824.
The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective? A.) "Reconstitution is the process of adding liquid, known as diluent, to a powdered substance." B.) "Reconstitution is a sealed glass drug container that must be broken to withdraw the medication." C.) "Reconstitution is a sealed glass cylinder of parenteral medication with an attached needle." D.) "Reconstitution is a glass or plastic container of parental medication with a self-sealing rubber stopper.
A.) "Reconstitution is the process of adding liquid, known as diluent, to a powdered substance." Explanation: Reconstitution is the process of adding liquid, known as diluent, to a powdered substance. A sealed glass cylinder of parenteral medication with an attached needle is a refilled cartridge, not reconstitution. A glass or plastic container of parental medication with a self-sealing rubber stopper is a vial, not reconstitution. A sealed glass drug container that must be broken to withdraw the medication is an ampoule, not reconstitution. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 845.
A nurse is administering a piggyback infusion to a client with partial-thickness or second-degree burns. Which describes the most important feature of a piggyback infusion? A.) A parenteral drug is given in tandem with an IV solution. B.) Medication locks are changed every 72 hours. C.) Medication is given all at one time as quickly as possible. D.) The primary IV solution is infused by gravity.
A.) A parenteral drug is given in tandem with an IV solution. Explanation: In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency. IV medication or fluid is given all at one time as quickly as possible in a bolus administration, not in piggyback infusion. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 856-910.
A nurse is caring for a client with pancreatic cancer who is receiving continuous morphine for pain. Which intervention would be the most effective method to administer this medication? A.) Administer a continuous subcutaneous infusion of morphine. B.) Administer morphine by intravenous bolus or push through an intravenous infusion. C.) Administer orally. D.) Administer a piggyback intermittent intravenous infusion of morphine.
A.) Administer a continuous subcutaneous infusion of morphine. Explanation: Some medications, such as insulin and morphine, may be administered continuously via the subcutaneous route. Advantages of continuous subcutaneous medication infusion include the longer rate of absorption via the subcutaneous route and convenience for the client. A client with cancer may be experiencing nausea and vomiting and the oral route may not be effective. If the client has an IV, then the intravenous bolus (push) or by piggyback is appropriate. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 851.
A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action? A.) Determine the compatibility of the two drugs by consulting clinical resources. B.) Collaborate with the pharmacy to have one of the times changed. C.) Page the health care provider to determine whether the drugs can be mixed. D.) Recognize that it is not safe to mix two medications in one syringe.
A.) Determine the compatibility of the two drugs by consulting clinical resources. Explanation: The nurse must determine the compatibility of the two drugs; some drugs can be safely combined in a single syringe. However, this is not determined by paging the health care provider. There is no need to change the times of administration. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 886-889.
While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse? A.) Discontinue the IV site and restart IV in a new location. B.) Slow the rate of infusion until client reports relief. C.) Apply a cool, moist compress for 20 minutes. D.) Monitor the site closely for any signs of complications.
A.) Discontinue the IV site and restart IV in a new location. Explanation: The assessment reveals the IV has infiltrated. The nurse should stop the IV fluid and remove the IV from the extremity, then restart the IV in a different location. Applying a cool, moist compress or slowing the rate will not address the problem of the IV fluid going into the surrounding tissue instead of the vein. Monitoring the site is not appropriate, because there is already a complication present that requires action by the nurse. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 910-915.
The nurse is preparing to administer oral medication to a client. Which is the first action the nurse will take? A.) Read and compare labels on the drug with the MAR. B.) Compare the medication administration record (MAR) with the written medical order. C.) Wash hands or perform an alcohol-based hand rub. D.) Pour liquids with the drug label toward the palm of the hand.
B.) Compare the medication administration record (MAR) with the written medical order. Explanation: The nurse will first compare the MAR with written orders, then wash hands, read and compare labels, and prepare medications. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 821.
A client is prescribed an HMO-CoA reductase inhibitor for the treatment of elevated cholesterol and triglyceride levels. Which education will the nurse provide to the client regarding the medication prescribed? A.) Liver function and glucose levels will be checked periodically. B.) Muscle pain and weakness is a common side effect of the medication. C.) The medication will lower the high-density lipoproteins. D.) Eliminate fats in the diet and substitute with carbohydrates.
A.) Liver function and glucose levels will be checked periodically. Explanation: "Statins" will require the monitoring of glucose levels and liver enzymes periodically since they may cause an elevation of liver enzymes. Glucose levels may also rise when taking these medications, although the mechanism of action is unclear. The medication occasionally and not commonly will cause muscle aches and pains and is a reason that individuals stop taking the medication. The client should inform the health care provider if this occurs and the medication may be switched to another form of cholesterol lowering medication. The outcome is to increase the high-density lipoprotein or the "good cholesterol" and not lower it. Fat should not be eliminated in the diet, but modified to include healthier fats. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications.
The nurse is caring for a client with visual impairment who has been prescribed two different types of eye drops. Which nursing intervention will best assist the client in differentiating between the bottles of drops? A.) Place a rubber band snugly around one of the bottles. B.) Teach the client to place bottles on different ends of the table. C.) Write the names of the medications on the bottle. D.) Color code the bottles with different colors of pens.
A.) Place a rubber band snugly around one of the bottles. Explanation: The client with visual impairment will best benefit from a tactile difference between bottles; therefore, placing a rubber band snugly around one bottle is the best approach. Names written on the bottles may be difficult for the client with visual impairment to read, and color-coding may not work if the client is colorblind. Placing bottles on different ends of the table can be confusing if the client forgets which medication is which. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 879.
Which teaching will the nurse provide to a client with the NANDA-I nursing diagnosis of "Ineffective Protection related to cancer and chemotherapy treatment"? A.) Refrain from using aspirin while undergoing chemo treatment. B.) Chemotherapy will be given on schedule regardless of other health conditions. C.) Test urine and stool for occult blood every week. D.) Brush teeth with a hard-bristle brush to effectively clean oral cavity.
A.) Refrain from using aspirin while undergoing chemo treatment. Explanation: The nurse will teach that aspirin and products containing salicylates should be avoided during chemo treatment, since these interfere with clotting. Teeth should be brushed with a soft-bristle brush; chemotherapy may be delayed if platelets are low or for other reasons; urine and stool should be tested daily for occult blood. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 841.
A nurse is administering medication to a client via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation? A.) Use a syringe to plunge the tube to try to dislodge the medication. B.) Wait the prescribed amount of time and attempt to administer the medication again before calling the physician. C.) Remove the tube and replace it with a new tube. D.) Call the physician before instituting any corrective interventions.
A.) Use a syringe to plunge the tube to try to dislodge the medication. Explanation: When medication becomes clogged in the tube, the nurse should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified. The nurse should not remove the tube nor wait for a prescribed amount of time to attempt to readminister the medication. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 882-883.
The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered? A.) all at once B.) over 3 hours C.) in tandem with another medication D.) over the duration of a 12-hour shift
A.) all at once Explanation: Bolus administration is given into a vein all at one time. All other answers are incorrect. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 857.
A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes? A.) bolus administration B.) secondary administration C.) electronic infusion device D.) continuous administration
A.) bolus administration Explanation: Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. An electronic infusion device, continuous administration, and secondary administration do have the potential to cause life-threatening changes, but not to the same degree as a bolus administration, since the rate at which medication is administered is not as fast as during a bolus. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 905.
A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC) suddenly reports itching and flushing. Which action should the nurse prioritize for this client? A.) clamp the antibiotic infusion B.) remove the PICC line C.) flush the PICC line D.) slow the infusion rate
A.) clamp the antibiotic infusion Explanation: The client may be experiencing a life-threatening reaction to the antibiotic. The nurse should clamp the secondary infusion line which is infusing the antibiotic and notify the primary care provider immediately. It would be inappropriate for the nurse to flush the PICC line as this will increase the amount of antibiotic getting into the client's body. Slowing the infusion rate will also not correct or prevent further adverse effects. The nurse should not remove the PICC line as this may be outside the nurse's scope of practice as it requires special training and certification to do that. The nurse should leave the PICC line open, however, unless otherwise instructed. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Medications vis Intermittent Intravenous Infusion, p. 856
The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication? A.) in the anterolateral aspect of the thigh B.) in the lateral aspect of the upper arm C.) in the lower abdomen D.) in the gluteus maximus muscle in the buttocks
A.) in the anterolateral aspect of the thigh Explanation: The vastus lateralis site is in the anterior aspect of the thigh, in which the nurse places the injection in the middle third of the thigh and is often used for infants. Therefore, this description is correct. The deltoid site is located in the lateral aspect of the upper arm. The dorsogluteal site is located in the gluteus maximus muscle in the buttocks. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 853.
A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle? A.) intradermal B.) subcutaneous C.) intramuscular D.) intravenous
A.) intradermal Explanation: When giving an intradermal injection, the nurse instills the medication shallowly at a 10- to 15-degree angle of entry. When the nurse administers a subcutaneous injection, the angle of entry is either 45 degrees or 90 degrees, whereas for intramuscular injections, the angle is 90 degrees. Intravenous injections are instilled into the veins of the client at an angle of around 15 degrees, but only if no venous access port is in place. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 849.
A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients? A.) ventrogluteal B.) upper chest C.) rectus femoris D.) gluteus maximus
A.) ventrogluteal Explanation: The ventrogluteal or deltoid muscles may be the preferred intramuscular sites for older adult clients experiencing impaired mobility. This site has the potential of retaining greater muscle mass longer than other sites. It is also usually less painful for the client. The dorsogluteal site, which has the gluteus maximus, should be avoided because of the risk of damage to the sciatic nerve with diminished musculature. The rectus femoris site is most suitable for infants. The upper chest muscle is part of intradermal injections, not intramuscular injections. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Table 29-4 Intramuscular Site Selection, p. 853.
The nurse beginning a shift has received a report from the previous nurse, who reports that a client has a catheter inserted into the subclavian vein. The oncoming nurse will plan to assess which type of catheter? A.) Broviac catheter B.) peripherally inserted cutaneous catheter C.) Groshong catheter D.) Hickman catheter
B.) peripherally inserted cutaneous catheter Explanation: A peripherally inserted cutaneous catheter is a type of nontunneled percutaneous catheter that is inserted into a peripheral vein with the distal end terminating in the axillary vein, subclavian vein, or superior vena cava. Hickman, Broviac, and Groshong catheters are types of tunneled catheters that are inserted into a central vein with part of the catheter secured in the subcutaneous tissue. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 921.
A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals? A.) "This is because your medication can cause nausea and that can affect the way it works." B.) "This is because food and some drinks can affect the way your medicine works." C.) "This is because gastric acid is decreased after meals, which can affect the way your medicine works." D.) "This is because decreased blood flow occurs after meals, which can affect the way your medicine works."
B.) "This is because food and some drinks can affect the way your medicine works." Explanation: Some medicines need to be taken "before food" or "on an empty stomach." This is because food and some drinks can affect the way these medicines work. For example, taking some medicines at the same time as eating may prevent the stomach and intestines from absorbing the medicine, making it less effective. Blood flow to the stomach increases after eating a meal. Gastric acid increases after a meal to help digestive food eaten. Nausea does not affect the absorption of a medication. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 856.
A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client? A.) Prepare the exact dosage of medication in front of the client. B.) Avoid administering medication prepared by another nurse. C.) Bring the prescribed medication in a ceramic cup or glass container. D.) Check the label of the medication container three times at the bedside
B.) Avoid administering medication prepared by another nurse. Explanation: A nurse should never administer medications prepared by another nurse. The nurse administers only those medications that she has prepared. The nurse should prepare and bring oral medications to the client's bedside in a paper or plastic cup, not in a glass container or ceramic cup, in order to avoid accidents and spills. The nurse checks the label of the medication container three times when preparing it, not when administering it to the client. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 834.
What action should the nurse take when giving an intramuscular injection using the Z-track method? A.) Inject the medication quickly, and steadily withdraw the needle. B.) Do not massage the site because it may cause irritation. C.) Withdraw the needle within 5 seconds of injecting the medication. D.) Use a needle at least 1 inch (2.5 cm) long.
B.) Do not massage the site because it may cause irritation. Explanation: The nurse should use the Z-track technique for intramuscular injections that are irritating to the subcutaneous tissues in order to prevent leakage of medication into the needle track, thus minimizing discomfort. The needle size will depend on the size of the client and muscle being used. The medication should be injected slowly rather than quickly in order to minimize discomfort. After the medication has been instilled, the nurse will wait 10 seconds before withdrawing the needle, which give enough time for all the medication to diffuse into the tissue. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 855.
The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action? A.) Request another nurse to reteach the material. B.) Give written instructions to the client and caregivers. C.) Provide discharge paperwork to the client. D.) Arrange for home health to see the client.
B.) Give written instructions to the client and caregivers. Explanation: Older adults may not be able to remember instructions in order to repeat them back clearly. It is appropriate to provide written instructions so the client and caregivers have a quick reference to use for medication administration. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 843.
While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action? A.) Request counseling on the potential for infection. B.) Report the needlestick to the nurse manager. C.) Obtain the client's blood to be tested for HIV and HBV. D.) Document the injury.
B.) Report the needlestick to the nurse manager. Explanation: Upon encountering a needlestick, the nurse's priority action is to report the injury. Other actions can take place after the injury has been reported. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 868.
A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection? A.) Subcutaneous injections are administered at a 30- to 45-degree angle based on the amount of subcutaneous tissue present. B.) Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. C.) Pinching is advised for obese clients to lift the adipose tissue away from underlying muscle and tissue. D.) Sites commonly used for a subcutaneous injection are the inner surface of the forearm and the upper back, under the scapula.
B.) Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Explanation: Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Sites commonly used for an intradermal injection are the inner surface of the forearm and the upper back, under the scapula. Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventrogluteal area. Subcutaneous injections are administered at a 45- to 90-degree angle, based on the amount of subcutaneous tissue present and the length of the needle. Pinching is advised for thinner clients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 849.
A health care provider at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler? A.) a device that forces medication through a narrow channel with the help of inert gas B.) a canister containing medication that is released when the container is compressed C.) a device that forces liquid drug through a narrow channel using pressurized air D.) a propeller-driven device that spins and suspends a finely powdered medication
B.) a canister containing medication that is released when the container is compressed Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 865-866.
Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration? A.) client who is in the emergent phase of a 50% partial-thickness (second-degree) burn and requiring medication for pain B.) client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination C.) client who is diagnosed as having sepsis and is prescribed antibiotic therapy D.) client who is beginning treatment with chemotherapy following a diagnosis of ovarian cancer
B.) client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination Explanation: The hepatitis B vaccine is administered intramuscularly. Recombivax HB, a form of the hepatitis B vaccine, may be administered subcutaneously to clients who are at high risk for hemorrhage. This client is low risk. Medications for the clients experiencing the situations listed would be administered intravenously. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 856.
The nurse is administering a rectal suppository. How far will the nurse insert the suppository? A.) far enough to still visualize the end of the suppository B.) past the internal sphincter C.) until the client reports feelings of discomfort D.) just past the opening of the anus
B.) past the internal sphincter Explanation: To be effective, a suppository must be inserted past the internal sphincter, which is about the distance of the finger of insertion. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Inserting a Rectal Suppository, p. 864.
The nurse is to start providing care for an older adult client who sees several different health care providers and specialists. Which question should the nurse prioritize on assessment? A.) "Why do you see so many different providers?" B.) "Which provider seems to take the best care of you?" C.) "Do you get all of your medications filled at the same pharmacy?" D.) "How long have you been seeing a variety of providers?"
C.) "Do you get all of your medications filled at the same pharmacy?" Explanation: The nurse is aware that this client has a high potential for being prescribed medications by more than one provider. Polypharmacy is a concern in the older adult population. The nurse will want to know if medications are filled at the same pharmacy, as this is often where pharmacists will note discrepancies in medications prescribed or duplicate orders written by different providers. The other questions posed are not a priority or helpful. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Administering Oral Medications: Special Techniques, Older Adults, p. 844.
The nurse is performing the admissions assessment for a client admitted with right hip pain. When performing the assessment, the client stated all of the prescribed medications they take from the previous admission. Which question is the priority for the nurse to ask the client? A.) "What time do you take your medications?" B.) "Do you have someone to help you at home?" C.) "Do you take any over-the-counter medications?" D.) "Do you use cold therapy for your hip pain?"
C.) "Do you take any over-the-counter medications?" Explanation: Assessing whether the client takes any over-the-counter medications is the priority because the nurse will need to identify any medication interactions that can occur while the client is in the hospital. Knowing what time the client takes their medications is important but does it not take priority over knowing drug-drug interactions. Discussions about help at home and about alternative pain management therapies are not a priority in the admission assessment; correct medication reconciliation is the priority here. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 830.
A nursing student is teaching the client regarding insertion of a central line catheter. Which statement by the student would cause the nurse to intervene? A.) "Central lines can prevent multiple sticks to gain intravenous access." B.) "A central line can stay in longer than a peripheral catheter." C.) "The risks are the same for a central line as they are for peripheral lines." D.) "Multiple medications can be infused through a central line catheter."
C.) "The risks are the same for a central line as they are for peripheral lines." Explanation: Clot formation, pneumothorax, and bacteremia risks are higher with a central line. As a result, the risks associated with central line placement are higher than those associated with a peripheral IV. Other options are correct regarding central lines. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 828.
A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood? A.) Wait until day 5 of treatment. B.) 2000 C.) 1500 D.) 1200
C.) 1500 Explanation: Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 830.
Which medication interaction illustrates a synergism? A.) A client is taking doxycycline, an antibiotic, for rosacea. She takes this with her morning vitamins, which includes calcium carbonate. She has not noticed a change in her symptoms. B.) A client is taking metoprolol for her blood pressure and metformin for her diabetes. Her provider has told her that these are safe to take together. C.) A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy. D.) A client was told not to take tretinoin topical if she is pregnant because it may be teratogenic
C.) A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy. Explanation: A synergistic reaction is one in which one drug increases the effect of another drug. Acetaminophen and oxycodone have a synergistic relationship. Doxycycline and calcium carbonate have an antagonistic relationship. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 826.
The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse? A.) Administer the prescribed antibiotics as prescribed. B.) Call the health care provider to request oral antibiotics. C.) Insert a new IV medication lock and remove the old one. D.) Flush the lock with heparin solution.
C.) Insert a new IV medication lock and remove the old one. Explanation: The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the health care provider to change the order is not appropriate. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 919.
A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered? A.) stat order B.) one-time order C.) PRN order D.) standing order
C.) PRN order Explanation: A PRN order is one that is given to a client on an "as needed" basis. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 1257.
A nurse needs to instill eye medication in a client with conjunctivitis. Which action is best to distribute the medication over the surface of the eye? A.) The nurse should gently rub the client's eyelids. B.) The nurse should make a pouch in the lower eyelid. C.) The client should blink the eye. D.) The nurse should instill medication drops in the upper eyelid.
C.) The client should blink the eye. Explanation: To distribute the eye medication over the surface of the eye, the client should blink the eyes rather than rubbing them. In order to provide a natural reservoir for liquid medication, the nurse makes a pouch in the lower lid by pulling the skin downward over the bony orbit. To prevent injury and blink reflexes, the nurse should not instill medication in the upper eyelid but should steady the medication container and move it from below the client's line of vision or from the side of the eye instead. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 860.
The nurse has provided a client with oral medications in a small plastic cup. What is the best nursing action to ensure the rights of safe medication administration are implemented? A.) Have the unlicensed assistive personnel (UAP) to monitor the client until medication is taken. B.) Ask the client's family to confirm that the client has swallowed the medication. C.) Wait with the client until the medications are taken. D.) Allow the client to sign for the medication and keep the medications on a bedside table until ready to take them.
C.) Wait with the client until the medications are taken. Explanation: The nurse must wait with the client to personally acknowledge that medications have been taken (or refused). This action ensures that the medication was administered to the right client, right route, and at the right time. It is not appropriate to leave medications with a client, to ask family to confirm administration, or to leave the room without knowing that the client has taken (or refused) the medications. Therefore, leaving the UAP to monitor medication administration is not safe practice. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Administering Oral Medications, p. 843.
The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? A.) side of buttock B.) lower abdomen C.) upper back D.) upper arm
C.) upper back Explanation: The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 859.
The nurse opens the multidose container of oxycodone. The nurse needs 1.5 tablets to deliver the as needed dose, and the tablets in the container are not scored. What action by the nurse is best? A.) Administer one tablet until the issue is resolved. B.) Document the medication dose as not administered. C.) Cut the second tablet in half using a pill splitter. D.) Call the pharmacy to request a supply change.
D.) Call the pharmacy to request a supply change. Explanation: The best action by the nurse is to request scored tablets or the correct dose from the pharmacy. If this is not possible, the nurse considers cutting the unscored tablet with the pill splitter, recognizing that this could result in an inaccurate dose. The nurse could choose not to give the medication, but this leaves the client in needless pain. The nurse could choose to administer two-thirds of the dose by giving one tablet, but this leaves the client underdosed for pain relief. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 874-880.
Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat? A.) "Remain in the sitting position for 5 minutes." B.) "Place a rolled towel beneath the neck if you are unable to sit." C.) "Breathe through your mouth as the drops are instilled." D.) "Aim the tip of the container toward the nasal passage."
D.) "Aim the tip of the container toward the nasal passage." Explanation: Aiming the tip of the container toward the nasal passage will deposit the drugs within the nose rather than into the throat. Place a rolled towel beneath the neck if the client cannot sit will provide support and aid in positioning. Breathing through the mouth as the drops are instilled is not the correct action for nasal drop administration. Remaining in the sitting position for 5 minutes will promote local absorption. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 862.
An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration? A.) Have the client swallow the pills around the tube. B.) Bring the liquids to room temperature before administration. C.) Flush the tube with 30 to 40 mL saline before medication administration. D.) Check the tube placement before administration.
D.) Check the tube placement before administration. Explanation: The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children). The nurse should never have the client swallow the pills if the client has an nasogastric tube. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, ADMINISTERING MEDICATIONS THROUGH AN ENTERAL FEEDING TUBE, p. 844.
An older adult client tells the nurse about taking a popular, over-the-counter nonsteroidal anti-inflammatory drug (NSAID) daily for arthritic pain. Which question could the nurse ask the client to identify a complication associated with chronic use of this medication? A.) Do you have frequent colds or sinus problems? B.) Do you ever pass dark, tarry bowel movements? C.) Do your feet swell at the end of the day? D.) Do you feel dizzy or lightheaded when you stand up?
D.) Do you ever pass dark, tarry bowel movements? Explanation: NSAIDs are commonly used for the treatment of pain. NSAIDs are the leading cause of gastrointestinal side effects such as stomach ulcers and bleeding. As such, the nurse asks the client about the presence of dark, tarry stools as this indicates upper gastrointestinal bleeding. NSAIDs do not cause postural hypotension which would result in dizziness or lightheadedness upon rising. NSAIDs are not known to cause peripheral edema or fluid retention. NSAIDs do not decrease immunity, however; NSAID use may mask a fever. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Focus on the Older Adult, p. 828.
When administering a subcutaneous injection to a client, 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.) Pull out and discard the needle. B.) Document the incident and inform the primary care provider. C.) Discard the equipment and start the procedure from the beginning. D.) Engage safety shield on needle guard and discard needle appropriately.
D.) Engage safety shield on needle guard and discard needle appropriately. Explanation: The needle needs to be disposed of properly after engaging the safety guard because the needle cannot be reinserted 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 851-893.
To convert 0.8 grams to milligrams, the nurse should do which of the following? A.) Move the decimal point 3 places to the left. B.) Move the decimal point 2 places to the left. C.) Move the decimal point 2 places to the right. D.) Move the decimal point 3 places to the right.
D.) Move the decimal point 3 places to the right. Explanation: To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). 1000 milligrams (mg) is equal to 1 gram (g); therefore 0.8 g is multiplied by 1000 (which is equivalent to moving the decimal point 3 places to the right) to determine how many mg it is equivalent to. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, pp. 834-835.
In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action? A.) Draw up the remaining medication to give at the next time of administration. B.) Send the vial with the remaining drug back to the pharmacy. C.) Discard the remaining drug. D.) Place the date on the vial and retain for future use.
D.) Place the date on the vial and retain for future use. Explanation: The nurse will place the date on the vial and retain it for future use since the vial is indicated for multiple uses. Other actions are incorrect. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 885.
Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler? A.) The nurse should instruct the child to prolong his/her inhalation. B.) The nurse should provide simple written instructions. C.) The nurse should assess the child's mucous membranes. D.) The nurse should use a nebulizer to administer the medication.
D.) The nurse should use a nebulizer to administer the medication. Explanation: The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Assessing the child's mucous membranes is incorrect, as this action is used to identify any break in the continuity of the membranes and will not assist with the coordination of inspiration. Providing simple written instructions is incorrect, as this will enhance the teaching/learning process of the child and not the coordination of the child's inspiration. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 865.
A client asks the nurse what action clients should take in ensuring that medications are instilled appropriately. What is the best response by the nurse? A.) Place the medication directly on the cornea. B.) Apply pressure on the outer canthus to prevent drops from entering the tear duct. C.) Look down while instilling the drops. D.) Turn the head slightly to the affected side to prevent solution or tears from flowing toward the opposite eye.
D.) Turn the head slightly to the affected side to prevent solution or tears from flowing toward the opposite eye. Explanation: When instilling the drops, turn the head slightly to the affected side so that the solution will not flow into the opposite eye. Gentle pressure should be applied to the inner canthus so that the drops don't enter the tear ducts. The medication should never be placed directly onto the cornea since that may damage the cornea. The client should look up when instilling drops. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 860.
The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe? A.) more rapid administration of the medication B.) less frequent administration of the medication C.) decreased risk for infection D.) decreased irritation and pain in subcutaneous tissue
D.) decreased irritation and pain in subcutaneous tissue Explanation: This technique is Z-tracking. The Z-track technique allows the medication to be administered into the muscle tissue with no tracking of medication in the subcutaneous tissues as the needle is removed, resulting in less pain and irritation. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, Skill 29-7 Administering an Intramuscular Injection, p. 902.
After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues? A.) Absorption B.) Metabolism C.) Synergism D.) Distribution
Distribution Explanation: The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 29: Medications, p. 823.
