foundations exam 2 pt 4

therapeutic range

A client taking insulin has his levels adjusted to ensure that the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A) Peak level B) Trough level C) Half-life D) Therapeutic range

B) Adverse effect

A client who is taking an oral narcotic for pain relief tells the nurse he is constipated. What is this common response to narcotics called? A) Therapeutic effect B) Adverse effect C) Toxic effect D) Idiosyncratic effect

D) Tuberculin syringe, 1/2-inch 26-gauge needle

A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A) 10-mL syringe, 3-inch 18-gauge needle B) 5-mL syringe, 2-inch 20-gauge needle C) Insulin syringe, 1-inch 16-gauge needle D) Tuberculin syringe, 1/2-inch 26-gauge needle

A) Ensures that the right medication is given at the right time by the right route

A nurse at the health care facility is preparing the medication dosage for a client. Why should the nurse read and compare the label on the medication with the MAR at least three times (before, during, and after) while preparing the medication for administration? A) Ensures that the right medication is given at the right time by the right route B) Complies with the medical order and ensures that the right dose is given C) Ensures that the medication has been administered to the right client D) Demonstrates timely administration and compliance with the medical order

D) Gauges range from 18 to 30, with 18 being the largest.

A nurse is administering an intramuscular injection of a viscous medication using the appropriate-gauge needle. What does the nurse need to know about needle gauges? A) All needles for parenteral injection are the same gauge. B) The gauge will depend on the length of the needle. C) Ask the client what size needle is preferred. D) Gauges range from 18 to 30, with 18 being the largest.

D) Ask the physician to write out the order.

A nurse is caring for a client in the nursing unit when the physician, during the rounds, prescribes a medication for the client. What appropriate action should the nurse take to ensure the accuracy of the verbal medication order? A) Ask the physician to repeat the dosage. B) Ask the physician to spell out the medication name. C) Ask a second nurse to listen for accuracy. D) Ask the physician to write out the order.

B) Rotate the site with each injection.

A nurse is showing an older adult client the correct method of self-administering an insulin injection at home. Which of the following points should the nurse tell the client in order to avoid lipoatrophy and lipohypertrophy? A) Change the needle daily with each injection. B) Rotate the site with each injection. C) Apply local anesthetic to the injection site. D) Massage the injection site for 10 minutes.

"I have written the names of your drugs with times to take them."

A nurse is teaching an older adult at home about taking newly prescribed medications. Which information would be included? A) "You can identify your medications by their color." B) "I have written the names of your drugs with times to take them." C) "You won't forget a medication if you count them every day." D) "Don't worry if the label comes off; just look at the shapes."

C) Route

A physician writes an order for ampicillin 1 gram every 6 hours for a client. What is missing in this order? A) Time B) Amount C) Route D) Frequency

telephone order

An order for a medication or medical treatment made over the telephone is called a

verbal order

If the order is given verbally to the nurse, it is called a

B) BUN and creatinine

Medications administered that are renal toxic should have frequent assessments of which blood values? A) AST and ALT B) BUN and creatinine C) WBC and platelets D) RBC and differential

A, B, E, F

The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply. A) Medication B) Client C) Prescribing physician D) Pharmacy E) Dosage F) Route

A) Withhold the medication until the potential drug allergy has been addressed by the care team.

The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? A) Withhold the medication until the potential drug allergy has been addressed by the care team. B) Administer the medication and increase the frequency of assessments in the hours that follow. C) Substitute an antibiotic with similar action, but which is from a different drug family. D) Discuss the severity, signs and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

A)Flush the tube with water between each drug administered.

The nurse is preparing to administer a medication via a nasogastric tube. What guideline is appropriate for the nurse to follow when administering a drug via this route? A)Flush the tube with water between each drug administered. B) Position the client supine prior to administering the drug. C) Administer the medication at a cold temperature. D) If connected to suction, do not reconnect to suction for five minutes after drug administration.

A) Compare it with the original physician's order

What does the nurse do to verify an order for a medication listed on a medication administration record (MAR)? A) Compare it with the original physician's order. B) Ask another nurse what the drug is. C) Look up the drug in a textbook. D) Call the pharmacist for verification.

intrasite rotation

rotating injections within the same body part for example, if a patient receives morning insulin in the right arm, give the next injection in a different place in the same arm.

the upper arm and the anterior and lateral parts of the thigh, buttocks, and abdomen.

what are the recommended sites for insulin injection?

discard it rather than returning it to the original container.

what to do when a patient refuses medication

D) Amount of diluent to be added

A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which of the following instructions are stated on the label of a vial container? A) Type of needle to be used for withdrawal B) Directions for administering the drug C) Best site for administering the drug D) Amount of diluent to be added

Immediately after the order is noted

A physician has ordered that a medication be given "stat" for a client who is having an anaphylactic drug reaction. At what time would the nurse administer the medication? A) At the next scheduled medication time B) Immediately after the order is noted C) Not until verifying it with the client D) Whenever the client asks for it

C) Check the client's condition.

A nurse at a health care facility administers a prescribed drug to a client and does not record doing so in the medical administration record. The nurse who comes during the next shift, assuming that the medication has not been administered, administers the same drug to the client again. The nurse on the previous shift calls to inform the health care facility that the administration of the drug to this client in the earlier shift was not recorded. What should the nurse on duty do immediately upon detection of the medication error? A) Report the incident to the physician. B) Report the incident to the supervising nurse. C) Check the client's condition. D) Fill in the accident report sheet.

B) Do not recap the needle; place it in a puncture-resistant container.

A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A) Recap the needle; place it in a puncture-resistant container. B) Do not recap the needle; place it in a puncture-resistant container. C) Break off the needle, place it in the barrel, and throw it in the trash. D) Take off the needle and throw the syringe in the client's trash can.

D) To prevent gastric irritation

A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A) To prevent absorption in the mouth B) To prevent absorption in the esophagus C) To facilitate absorption in the stomach D) To prevent gastric irritation

C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes.

A student nurse is administering medications through a nasogastric tube connected to continuous suction. How will the student do this accurately? A) Briefly disconnect tubing from the suction to administer medications, then reconnect. B) Realize this can't be done, and document information. C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D) Leave the suction alone and give medications orally or rectally.

a technique for pulling the skin during an injection, is recommended for IM injections xiv) It prevents leakage of medication into subcutaneous tissues, seals medication in the muscle, and minimizes irritation.

What is the Z track method

C) Pharmacokinetics

What is the name of the process by which a drug moves through the body and is eventually eliminated? A) Pharmacology B) Pharmacotherapeutics C) Pharmacokinetics D) Pharmacodynamics

A) A woman who has been ordered intravenous antibiotics

Which of the following clients receives a drug that requires parenteral route? A) A woman who has been ordered intravenous antibiotics B) A woman who takes a diuretic pill each morning C) A man with emphysema who uses nebulized bronchodilators D) A man who has an antifungal ointment applied to his skin rash daily

b. report the discrepancy immediately

a nurse finds an open vial of morphine lying on top of the cabinet in a client's room. which of the following actions should the nurse take ? a. return the medication to the unit's stock for future use b. report the discrepancy immediately c. administer the medication to other clients to avoid waste d. independently dispose of the remaining medication

specific characteristics of the medications

a nurse is reviewing a client's admission record. the nurse notes that there are prescriptions for several medications. which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration? a. institutional policies regarding routine medication administration times b. specific characteristics of the medications c. schedule of administration that the client follows at home

d." I will continue taking my Coumadin as prescribed"

a nurse is teaching a client how to do fecal occult blood testing, which of the following statements by the client indicates a need for further teaching ? a. "I will continue my low-dose aspirin therapy regimen: b. "I will refrain from eating raw fruits and vegetables" c. " I will avoid steak and other red meats" d." I will continue taking my Coumadin as prescribed"

TB skin test

a simple skin test to determine the presence of a tuberculosis infection, is performed by an intradermal injection of 0.1 mL of tuberculin purified protein derivative (PPD) on the inner surface of the forearm ii) The injection produces a pale elevation of the skin (a wheal) 6 to 10 mm in diameter iii) Afterward the injection site is circled, and the patient is instructed not to wash the circle off.

Prepare medications for only one patient at a time Follow the 6 rights of medication administration (1) The right medication (2) The right dose (3) The right patient (4) The right route (5) The right time (6) The right documentation (7) The right indication Be sure to read labels at least 3 times (comparing medication administration record (MAR) with label before administering the medication Use at least 2 patient identifiers and review the patient's allergies whenever administering a medication Do not allow any other activity to interrupt administration of medication to a patient.(no phones , no pager, no discussion with any other staff) Double check all calculations and other high risk medication administration processes and verify with another nurse Do not interpret illegible handwriting, clarify with health care provider Question unusually large or small doses Document all medications as soon as they are given When you have made an error, reflect on what went wrong and ask how you could have prevented the error. Complete an occurrence report per agency policy. Evaluate the context or situation in which a medication error occurred. This helps to determine nurses have the necessary resources for safe medication administration. Attend in-service programs that focus on medications commonly administered. Ensure that you are well rested when caring for patients . nurses tend to make more errors when they are tired Involve and educate patients when administering medications. Address patients' concerns about medications before administering them. (concerns about their appearance or side effects)

avoiding medication errors

Another nurse has to witness the narcotic administration (from ampule into syringe to make sure adequate amount is being used and nothing is being kept from the patient or stolen by the administering nurse If a patient refuses opioids or any controlled substance, follow proper agency procedure by having someone else witness the "wasted" medication. iv) AMDSs control the dispensing of all medications, including narcotics. (1) E

wasting narcotics

It is important to instruct them to avoid eating red meat for 3 days before testing. iv) If there are no contraindications and it is approved by the health care provider, instruct your patient to stop taking aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs for 7 days because these could cause a false-positive test result. Patients also need to avoid vitamin C supplements and citrus fruits and juices for 3 days before the test because they can cause a false-negative result

fecal occult testing -patient education

A palpable elevated, hardened area around the injection site, caused by edema and inflammation from the antigen- antibody reaction, measured in millimeters.

what is the positive results of the TB skin test ?

To use the Z-track method, apply the appropriate-size needle to the syringe and select an IM site, preferably in a large, deep muscle such as the ventrogluteal. Pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm (1 to 1 ½ inches) laterally to the side with the ulnar side of the nondominant hand. (2) Hold the skin in this position until you have administered the injection (Fig. 31.24A). (3) After cleaning a site, inject the needle deeply into the muscle. (4) To reduce injection site discomfort, there is no longer any need to aspirate after the needle is injected when administering vaccines ii) It is the nurse's responsibility to follow agency policy for aspirating vaccines after injecting the needle. iii) Keep the needle inserted for 10 seconds to allow the medication to disperse evenly. iv) Release the skin after withdrawing the needle. v) This leaves a zigzag path that seals the needle track wherever tissue planes slide across one another. The medication is sealed in the muscle tissue.

how to use the Z track method

the patient must have another skin test

if the site is not read within 72 hours after the test , what happens?

Non-time critical medications

medication that is given 1-2 hours before or after its scheduled time

safety syringes have a sheath or guard that covers a needle immediately after it is withdrawn from the skin (1) This eliminates the chance for a needlestick injury. (2) The syringe and sheath are disposed of together in a receptacle. (a) Use needleless devices whenever possible to reduce the risk of needlestick and sharps injuries v) Always dispose of needles and other instruments considered sharps into clearly marked, appropriate containers (1) Containers need to be puncture proof and leak proof. Never force a needle into a full needle disposal receptacle. Never place used needles and syringes in a wastebasket, in your pocket, on a patient's meal tray, or at the patient's bedside

prevention of needle-sticks

Only authorized staff receive and record telephone or verbal orders. ii) The health care agency identifies in writing the staff who are authorized. (1) Clearly identify patient's name, room number, and diagnosis. (2) Read back all orders to health care provider (3) Use clarification questions to avoid misunderstandings. (4) Write "TO" (telephone order) or "VO" (verbal order), including date and time, name of patient, and complete order; sign the name of the health care provider and nurse. (5) Follow agency policies; some agencies require documentation of the "read-back" or require two nurses to review and sign telephone or verbal orders. (6) The health care provider co-signs the order within the time frame required by the agency (usually 24 hours; verify agency policy).

receiving order from physcian

Assess a muscle before giving an injection. (1) Properly identify the site for the IM injection by palpating bony landmarks, and be aware of the potential complications associated with each site. (2) The site needs to be free of tenderness because repeated injections in the same muscle cause severe discomfort. (3) With the patient relaxed, palpate the muscle to rule out any hardened lesions. (4) Minimize discomfort during an injection by helping a patient assume a position that helps to reduce muscle strain. x) Other interventions such as distraction and applying pressure to an IM site decrease pain during an injection. xi) Rotate IM injection sites to decrease the risk for tissue hypertrophy. xii) Emaciated or atrophied muscles absorb medication poorly; thus, avoid their use when possible.

what is the proper placement of IM injection

they cannot take medication orders of any kind . they only Give newly ordered medications only after a registered nurse has written and verified the order

what is the role of nursing students for a physician order >?

needles of ³⁄₁₆ inch (4 to 5 mm) administered at a 90-degree angle to reduce pain and achieve adequate control of blood sugars with minimal adverse effects for people of all BMIs, including children

when administering insulin you should use

between 48 and 72 hours after the test

when to read the tuberculin test ?