Chapter 30 Medications PrepU

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

"I am taking tadalafil in addition to nitroglycerin."

A client is newly prescribed a nitroglycerin transdermal patch daily. Which should the nurse include when educating a client on how to administer this drug? Select all that apply.

"Rotate the location of the patch daily." "Clean the area when removing the old patch." "Wrap removed patch in plastic and dispose."

A client with gastritis who is taking aspirin for cardiovascular prophylaxis asks the nurse whether there is benefit in buying the enteric-coated product. What is the appropriate nursing response?

"The enteric coating will protect your stomach."

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer?

0.5 Explanation: 1.0 mg = 1000 mcg. 0.125 mg =125 mcg. 0.0625 mg is exactly one half of 0.125 mg. If the digoxin tablet is 0.125 mg or 125 mcg, then the nurse would administer 0.5 tablet which is 0.0625mg, or 65.5mcg.

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long-term use of nasal sprays can cause rebound nasal congestion."

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

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

A client has been prescribed 300 mg of metronidazole. The supply is metronidazole 200 mg tablets. How many tablets will the nurse administer? Record your answer using one decimal place.

1.5

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

2.5 mL

A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client?

30 mL

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 minutes

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 23-gauge winged infusion set

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

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

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller.

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

As the gauge number becomes larger, the size of the needle becomes smaller.

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

Ask the client to maintain the position for some time.

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

Bolus administration

A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration?

Check the client's identification band.

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?

Check the tube placement before administration.

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

Consult a current drug reference book for IV compatibility.

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

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

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation?

IV infusion

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

Give written instructions to the client and caregivers.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation?

Inner surface of the forearm

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?

Insert a new IV medication lock and remove the old one.

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

It is a canister that contains pressurized medication.

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

Medication stays in the chamber so you can continue to inhale it.

The nurse is administering morphine 5 mg oral solution, which is located in a locked drawer in the medication room. The medication is provided in a unit-dose container that is labeled 10 mg/5 ml. What action(s) are required for the nurse to perform?

Provide written documentation for the removal of the medication dose. Obtain another nurse to witness the waste of the unused medication. Count the number of the morphine unit-dose containers prior to removal. Document each shift by two nurses that an opioid count was performed.

Which technique should the nurse employ when instilling otic medication in an adult ear?

Pull the client's ear up and back.

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

Report the needlestick to the nurse manager.

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

Stop the infusion

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

The area is free of major blood vessels and fat

A client with chronic obstructive pulmonary disease (COPD) has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in order to ensure safe and complete delivery of the prescribed medication?

Use of a spacer

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

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

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

a client who is reporting pain near the surgical site

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

all at once

A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency?

before and after each medication administration

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

check expiration date

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

deltoid

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

in the anterolateral aspect of the thigh 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.

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

medications that need to be infused over 20 to 60 minutes

Which action describes buccal medication administration?

placing a medication underneath the upper lip or in the side of the mouth

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

time

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation?

when the client has disorders that affect the absorption of medications

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15 degree angle

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle Explanation: A 15-degree angle is correct, as this allows the drug to be injected between the layers of the skin. A 45-degree angle is incorrect, as this will allow the drug to be injected beneath the skin but above the muscle. A 90-degree angle is incorrect, as this will allow the drug to be injected in the muscle. A 120-degree angle is incorrect, as this will be more suitable for intravenous injections.

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

2.5 ml

It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client?

A 70-year-old demonstrating muscle wasting prescribed chlorpromazine

The nurse has inadvertently administered medication ordered for Client A to Client B. What is the appropriate nursing action? Select all that apply.

Assess Client B thoroughly. Complete an incident report. Contact the provider to report the error.

A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the first assessment the nurse should make?

Assess the IV site for redness.

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

Assess the vaginal area.

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

It is a canister that contains pressurized medication.

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

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

The nurse is educating a client on how to self-administer subcutaneous insulin injections. The client asks why the needle must be removed at the same angle as that of insertion. How will the nurse respond?

It minimizes tissue trauma.

What action should the nurse take when giving an intramuscular injection using the Z-track method?

Do not massage the site because it may cause irritation.

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?

Do you take any over-the-counter medications

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

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

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

Medication stays in the chamber so you can continue to inhale it."

The client has continuous enteral feedings through a nasointestinal tube. The client has a thyroid medication that is to be taken on an empty stomach. What action does the nurse perform?

Stop the infusion for 30 minutes before and after administration of the thyroid medication.

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

ask the client to maintain the position until the solution travels toward the eardrum. When instilling the medication in the client's ear, the nurse first manipulates the client's ear to straighten the auditory canal. Tilting the client's head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed

The client cannot swallow and just had an enteral tube placed for feeding and medications. Medications will have to be in liquid form or crushed for administration. The client has the following medications prescribed. Which medication will the nurse withhold and consult with the health care provider?

oxycodone extended release tablet

A client with chronic obstructive pulmonary disease has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client:

breathes through his or her mouth until all the medication has been inhaled.

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

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

placing the secondary infusion higher than the primary solution

The primary reason for the Controlled Substances Act is:

to prevent drug use and dependence.

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

upper back

Which actions by the nurse will prevent injury while withdrawing medication from an ampule? Select all that apply.

using a gauze square to hold the ampule while breaking it snapping the neck of the ampule away from his/her body discarding the ampule in a puncture-resistant container

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

vastus lateralis site

A nuse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation?

when the client has disorders that affect the absorption of medications

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10-15 degrees

A client reports itching and shortness of breath 15 minutes after receiving ceftriaxone 500 mg intravenously. The nurse recognizes that the client is experiencing which type of reaction

allergic reaction

A client reports itching and shortness of breath 15 minutes after receiving ceftriaxone 500 mg intravenously. The nurse recognizes that the client is experiencing which type of reaction?

allergic reaction

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

therapeutic range

A nurse is assessing the reading on a volume-control set when administering an IV drug to a client. Which of the following functions is performed by a volume-control set?

eliminates the need for an additional bag of fluid

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse?

"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole."

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?

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

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance."

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer

0.5

The nurse is preparing to administer meperidine as an intramuscular injection in an adult client's deltoid site. Which needle should the nurse select for this injection?

1 inch, 22 gauge

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?

1 mL

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication?

73-year-old client diagnosed with liver disease

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 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

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

Check the expiration date. Explanation: Checking the expiration date on liquid medication can ensure the medication is at the desired potency, because liquid medications may become stronger or weaker with the passing of time. Administering an expired medication could have a deleterious effect on the client. Determining an odor does not ensure the potency of the medication, because many liquid medications have an odor that is not pleasant. Returning the medication if the label is unclear is a step to take to ensure safe administration, but this action does not determine the potency of the medication.

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

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

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

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

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick?

Immediately activate the safety needle and place the syringe and needle into a Sharps container.

The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action?

Notify the health care provider.

Which nursing action(s) promotes safety in the preparation of medication? Select all that apply.

Return medications with obscured labels to the pharmacy. Note the expiration dates on liquid medications. Prepare medications in well-lit conditions.

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

Return the medication to the medication cart or medication room.

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention?

Stop the infusion of antibiotic. The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life threatening reactions can also occur quickly. The first nursing action is to stop the infusion. The nurse will proceed to assure that there is an open airway, assess the skin for rash, and activate the Rapid Response Team if needed.

Regarding medication administration, what must occur at the change of shifts?

The narcotics for the division are counted.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication.

Regarding medication administration, what must occur at the change of shifts?

The opioids for the division are counted.

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

The vastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles

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

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

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

checking for documented allergies to food or drugs

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

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

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?

to determine the extent to which the client responded to the drugs

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?

decreased irritation and pain in subcutaneous tissue

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?

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.

A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?

deltoid

The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?

intradermal

The Z-track technique is utilized during drug administration by which route?

intramuscular

A nurse is using an 18-gauge needle to administer medication to a client. The nurse knows that, when compared with a 27-gauge needle, an 18-gauge needle has which feature?

larger diameter

A nurse is administering a prescribed intramuscular injection to a client by the Z-track method. Which action ensures that the medicine remains sealed?

pulling the tissue laterally until the tissue is taut

The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?

removing prior application and any remaining residue from skin

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

return the medication to the medication cart of medicine room

An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method?

self-contained packets that hold one tablet or capsule for individual clients

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?

supine