Fundamentals PrepU Chapter 28: Medications

When the client demonstrates a rash 30 minutes after taking a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction? -Anaphylaxis -Allergy -Idiosyncratic -Antagonistic

Allergy

A nurse is reviewing information about a prescribed drug in a drug handbook in preparation for administration to a client. When reading about the drug, the nurse identifies which name as the generic name? -Polycillin-N -Ampicillin sodium -SK Ampicillin-N -Omnipen-N

Ampicillin sodium

A nurse is applying a vaginal cream to a client with a vaginal infection. What is a recommended guideline for this application? -Cleanse area at vaginal orifice with washcloth and warm water. -Spread the labia with dominant hand and introduce the applicator with the nondominant hand gently, using a pushing motion. -Wipe from the sacrum to the vaginal orifice upward (back to front). - Position the client in the prone position.

Cleanse area at vaginal orifice with washcloth and warm water.

The nurse is caring for a 70-year-old client who reports seeing a number of different health care providers. Which follow-up assessment question will the nurse ask? -"When did you start seeing different providers?" -"Which provider do you prefer?" -"Why are you seeing so many different providers?" -"Do you get all of your medications filled at the same pharmacy?"

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

The nurse is caring for a client with diabetes. Which client statement reflects that nursing teaching has been effective? -"I will eat meals whenever I feel hungry." -"I will test my blood glucose levels immediately after I eat." -"I will eat a meal within a half hour of taking my morning insulin." -"I will drink orange juice if I experience high blood glucose levels."

"I will eat a meal within a half hour of taking my morning insulin."

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 can log in and give the medications for you." -"I will log in so that you can proceed with medication delivery." -"I will get the hospital's information systems' phone number for you." -"I am giving you my password so you can log in."

"I will get the hospital's information systems' phone number for you."

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? -"The risks are the same for a central line as they are for peripheral lines." -"Central lines can prevent multiple sticks to gain intravenous access." -"A central line can stay in longer than a peripheral catheter." -"Multiple medications can be infused through a central line catheter."

"The risks are the same for a central line as they are for peripheral lines."

The nurse is providing discharge teaching about multiple medications to a client with mild dementia. Which nursing intervention is appropriate? Select all that apply. -Refrain from teaching client since information will not be retained. -Obtain referral for skilled nursing visits at home. -Tell client that taking medication is a personal responsibility. -Recommend use of a medication dispenser. -Teach family members about medication administration.

-Obtain referral for skilled nursing visits at home. -Teach family members about medication administration. -Recommend use of a medication dispenser.

The nurse is preparing to administer an oral medication to a client with xerostomia. Which nursing action is appropriate? -Refuse to give the medication due to safety reasons. -Offer a sip of water before administering medication. -Call the provider to change the order to the intramuscular route. -Administer the medication as usual and document.

-Offer a sip of water before administering medication.

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. -Intravenous -Intramuscular -Oral -Subcutaneous

-Oral -Subcutaneous -Intramuscular -Intravenous

When administering oral medications, which practices should the nurse follow? Select all that apply. -Dispense multiple liquid medications into a single cup to reduce the number of containers the client must handle. -Store the client's MAR at the bedside at all times to ensure safe identification. -Perform hand hygiene before and after medication administration. -Verify the client's response to the medication 30 minutes after administration, or as appropriate for the drug. -Stay at the bedside until the client has swallowed all the medications.

-Perform hand hygiene before and after medication administration. -Stay at the bedside until the client has swallowed all the medications. -Verify the client's response to the medication 30 minutes after administration, or as appropriate for the drug.

The nurse manager is reviewing medication order protocols with staff nurses. Which teaching will the nurse include? Select all that apply. -Orders can be carried out without provider signatures. -Refrain from using abbreviations. -Nurses and health care providers are accountable for drug safety. -IU and U are acceptable abbreviations to use. -Be mindful of look-alike and sound-alike drugs.

-Refrain from using abbreviations. -Be mindful of look-alike and sound-alike drugs. -Nurses and health care providers are accountable for drug safety.

Which medication dosage is properly written? - 0.25 mg - .125 mcg - .8 mg - 00.125 mg

0.25 mg

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 -2 -1.5 -4

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 -2 inch; 18 gauge -1½ inch; 18 gauge -5/8 inch; 24 gauge

1 inch; 22 gauge

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection? -0.05 mL -1 mL -3 mL -0.01 mL

1 mL

The nurse is teaching a client with diabetes about insulin pen injection. The nurse will teach that the insulin in prefilled pens is stable for how long? -1 year -14 days -1 month -indefinitely

1 month

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 -45 degrees -90 degrees -20-30 degrees

10-15 degrees

A client has been ordered 500 mg of acetaminophen. It is available in 250 mg tablets. How much will the nurse plan to administer? -1 1/2 tablets -1 tablet -2 tablets -1/2 tablet

2 tablets

The nurse is preparing to administer insulin to an older client who is frail and has failure to thrive. At what angle will the nurse plan to insert the needle into the client? -20-30 degrees -45 degrees -90 degrees -10-15 degrees

45 degrees

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client? -20-30 degrees -90 degrees -10-15 degrees -45 degrees

90 degrees

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? -An 18-gauge intravenous catheter -A 19-gauge winged infusion set -A 23-gauge winged infusion set -A 22-gauge intravenous catheter

A 23-gauge winged infusion set

A physician 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 device that forces liquid drug through a narrow channel using pressurized air -A device that forces medication through a narrow channel with the help of inert gas -A propeller-driven device that spins and suspends a finely powdered medication -A canister containing medication that is released when the container is compressed

A canister containing medication that is released when the container is compressed

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? -Medication locks are changed every 72 hours. -Primary IV solution is infused by gravity. -A parenteral drug is given in tandem with IV solution. -Medication is given all at one time as quickly as possible.

A parenteral drug is given in tandem with IV solution.

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? -Administer morphine by intravenous bolus or push through an intravenous infusion. -Administer a continuous subcutaneous infusion of morphine. -Administer a piggyback intermittent intravenous infusion of morphine. -Administer orally.

Administer a continuous subcutaneous infusion of morphine.

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? -Briefly postpone the application in the second ear. -Instill the medication in the opposite ear if prescribed. -Place a cotton ball in the ear to absorb excess medication. -Ask the client to maintain the position for some time.

Ask the client to maintain the position for some time.

The nurse is preparing medications and is notified that a health care provider is on the phone. What is the nurse's appropriate response? -Leave medication preparation and take the call. -Ask the unit clerk to take a message from the provider. -Ask another nurse to finish gathering medications and take the call. -Speak to the provider while finishing medication preparation.

Ask the unit clerk to take a message from the provider.

Which is a recommended guideline for the nurse who is administering a piggyback intermittent intravenous infusion of medication? -Ask the physician to calculate and regulate the infusion with an infusion pump. -Place the additive solution lower than the primary solution container. -Attach infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion. -Using clean technique, remove the cap on the tubing spike and the cap on the port of the medication container.

Attach infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion.

A medication is prescribed for a pediatric client. The nurse is ensuring the dosage is correct. What factor would the nurse use to calculate the dosage is correct for this client? -Age -Developmental level -Ethnicity -Body surface area (BSA)

Body surface area (BSA)

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? -Continuous administration -Bolus administration -Secondary administration -Electronic infusion device

Bolus administration

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 -Gravity infusion -Continuous drip -Electronic infusion device

Bolus administration

The nurse has inserted a peripheral intravenous catheter into a client. What is the appropriate action when a blood return is not obtained? -Pinch IV tubing to prohibit initial infusion. -Change the site of catheter insertion. -Insert the IV catheter further. -Begin infusing the IV fluid.

Change the site of catheter insertion.

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? -Have the client swallow the pills around the tube. -Check the tube placement before administration. -Flush the tube with 30 to 40 mL saline before medication administration. -Bring the liquids to room temperature before administration.

Check the tube placement before administration.

A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC). After 5 minutes of administration, the client reports itching and appears flushed. What is the most appropriate nursing intervention? -Clamp the PICC line. -Remove the PICC line. -Slow the rate through the PICC line. -Flush the PICC line.

Clamp PICC line

A client with a central venous catheter develops signs of air embolism. Which action would the nurse do first? -Place the client on his left side. -Check the client's vital signs. -Notify the physician immediately. -Clamp the existing catheter.

Clamp the existing catheter.

A nurse is caring for a client with typhoid at a health care facility. The nurse checks the medication order in the client's chart for the drugs prescribed to the client. Which component is a required component of the medication order? -Client's age -Client's signature -Client's name -Client's diagnosis

Client's name

The nurse is caring for a client who has a newly written order for "fluoxetine 20 mg by mouth daily for treatment of depression." The nurse is unfamiliar with this medication. Which action is most appropriate? -Ask a more experienced colleague about the medication. -Consult a professional medication reference before preparing to administer the medication. -Trust that the primary care provider practices safely and administer the medication as ordered. -Inform the primary care provider about being uncomfortable administering the medication.

Consult a professional medication reference before preparing to administer the medication.

The nurse is preparing to administer two IV medications. What is the appropriate nursing action? -Consult current drug reference book for IV compatibility. -Prepare to administer through two separate tubes. -Hold one medication for an hour and administer it after the first medication. -Administer the drugs through the same tubing.

Consult current drug reference book for IV compatibility.

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action? -Assume that provider meant to order buspirone. -Contact health care provider for order clarification. -Ask another nurse to verify the order. -Administer drug as ordered.

Contact health care provider for order clarification.

The hospital nurse is using barcode medication administration software when preparing to administer medication to a client. When the scanning system cannot identify the client's identity, what is the appropriate nursing action? -Hold the medication until the next day until the system updates. -Contact the pharmacy and information technology department for assistance. -Administer the medication and override the software system. -Complete an incident report.

Contact the pharmacy and information technology department for assistance.

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? -Metabolism -Distribution -Synergism -Absorption

Distribution

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? -Document the incident and inform the primary care provider. -Engage safety shield on needle guard and discard needle appropriately. -Pull out and discard the needle. -Discard the equipment and start the procedure from the beginning.

Engage safety shield on needle guard and discard needle appropriately.

A severe allergic reaction from a medication requires: -Atarax -Asprin -Epinephrine -Dopamine

Epinephrine

A nurse is caring for a client who has a PICC line. Which nursing action is recommended? -Use clean technique when changing dressing. -Keep external portion of catheter coiled on top of dressing. -Flush using normal saline and/or heparin solution according to facility policy. -Change catheter caps every 10 days or as per facility policy.

Flush using normal saline and/or heparin solution according to facility policy.

A nurse needs to administer an intradermal injection to a client. What is the most common site for administering an intradermal injection? -Stomach -Forearm -Chest -Back

Forearm

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented, but unable to articulate teaching back to the nurse. What is the appropriate nursing action? -Give written instructions to the client and caregivers. -Arrange for home health to see the client. -Provide discharge paperwork to the client. -Request another nurse to re-teach material.

Give written instructions to the client and caregivers.

The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangements does the nurse anticipate in the discharge plan of care? -home nursing visits -long-term care facility admission -continued inpatient admission -assisted living arrangements

Home nursing visits

A client is being started on total parenteral nutrition (TPN). When initiating the therapy, the nurse gradually tapers up the infusion rate as ordered to prevent which potential complication? -Infection -Hyperglycemia -Air embolism -Pneumothorax

Hyperglycemia

A nurse instills eardrops into a client's ear to soften a wax buildup. What is a guideline the nurse should follow? -Pull the pinna down and back for a child over 3 years of age, and straight back for an infant or a child younger than 3 years. -The dropper should be held with its tip resting on the ear. -Eardrops should not be considered if the ear canal has swollen to the point that medication cannot pass. -If both ears are to be treated, wait 5 minutes before instilling drops in the second ear.

If both ears are to be treated, wait 5 minutes before instilling drops in the second ear.

A client has been prescribed a drug that will be administered by buccal application. What should the nurse tell the client regarding buccal application of the drug? -It is placed under the tongue to dissolve slowly. -It is bonded to an adhesive bandage applied to the skin. -It is placed against the mucous membrane of the inner cheek. -It is administered by rubbing into the skin.

It is placed against the mucous membrane of the inner cheek.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do? -Have another nurse guard the preparations. -Lock the medications in a cart and finish them upon return. -Put the medications back in the containers. -Have another nurse finish preparing and administering the medications.

Lock the medications in a cart and finish them upon return.

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 -medications that can be given through a capped intravenous port -medications that are toxic if given over short periods -medications that are given over 1 minute for rapid therapeutic effect

Medications that need to be infused over 20 to 60 minutes

To convert 0.8 grams to milligrams, the nurse should do which of the following? -Move the decimal point 2 places to the right. -Move the decimal point 3 places to the right. -Move the decimal point 3 places to the left. -Move the decimal point 2 places to the left.

Move the decimal point 3 places to the right.

A nurse is preparing to administer a transfusion of packed red blood cells to a client. Which solution would the nurse expect to use to administer the transfusion? -Lactated Ringer's -Normal saline -Dextrose 5% and water -Dextrose 50%

Normal Saline

Which route of medication administration is most commonly prescribed? -Subcutaneous -Topical -Intravenous -Oral

Oral

What is the name of the process by which a drug moves through the body and is eventually eliminated? -Pharmacotherapeutics -Pharmacodynamics -Pharmacokinetics -Pharmacology

Pharmacokinetics

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? -Write the names of the medications on the bottle. -Place a rubber band snugly around one of the bottles. -Color code the bottles with different colors of pens. -Teach the client to place bottles on different ends of the table.

Place a rubber band snugly around one of the bottles.

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for an antibiotic secondary infusion. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity? -Placing the secondary and primary infusion at equal height -Stopping the primary solution until the secondary infusion is completed -Placing the secondary infusion higher than the primary solution -Placing the primary solution higher than the secondary solution

Placing the secondary infusion higher than the primary solution

The nurse has received a telephone order for a client from a health care provider. How will the nurse indicate in the documentation that the order was received via telephone? -Have another nurse cosign the order input. -Tell the provider to sign the order as soon as possible. -No extra documentation is necessary. -Record "T.O." at the end of the order.

Record "T.O." at the end of the order.

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action? -Request counseling on the potential for infection. -Document the injury. -Report the needlestick to the nurse manager. -Obtain client's blood to be tested for HIV and HBV.

Report the needlestick to the nurse manager.

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? -Leave the medication on the client's bedside table. -Inform the physician about the client's absence. -Inform the head nurse about the client's absence. -Return the medication to the medication cart or medication room.

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? -Activate the Rapid Response Team. -Assess skin for rash. -Stop the infusion of antibiotic. -Open the airway.

Stop the infusion of antibiotic.

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? -Review the client's medication, allergy, and medical history. -Allow sufficient time to prepare the medication with minimal distraction. -Administer medication within 30 to 60 minutes of the scheduled time. -Read and compare labels on the medication with the medical record.

Review the client's medication, allergy, and medical history.

A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate? -Select another site. -Apply a topical anesthetic. -Loosen the tourniquet slightly. -Apply a warm compress for 5 minutes.

Select another site.

Which medication system allows for client independence? -Self-administered medication system -Unit dose system -Automated medication-dispensing system -Bar Code Medication Administration (BCMA)

Self-administered medication system

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? -Nasal drops -Metered-dose inhaler -Turbo-inhaler -Spacer

Spacer

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? -Subcutaneous injections are administered at a 30- to 45-degree angle based on the amount of subcutaneous tissue present. -Sites commonly used for a subcutaneous injection are the inner surface of the forearm and the upper back, under the scapula. -Pinching is advised for obese clients to lift the adipose tissue away from underlying muscle and tissue. -Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

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 site lies close to the radial nerve. -The site is in close proximity to the sciatic nerve. -The area is free of major blood vessels and fat. -There is a high possibility of injecting into subcutaneous fat.

The area is free of major blood vessels and fat.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity? -Peak level -Half-life -Therapeutic range -Trough level

Therapeutic range

Which anatomic site is recommended for intramuscular injections for adults? -ventrogluteal muscles -vastus lateralis -epidermis of inner forearm -subcutaneous fat

Ventrogluteal Muscles

The nurse has withdrawn opioid pain medication into a syringe. When preparing to administer the medication, the client refuses, stating that pain is controlled currently at a level of 2 on a scale of 1 to 10. What is the appropriate nursing action? -Waste the medication with another nurse witness present. -Squirt the medication down the client's sink while the client watches. -Hold the medication in cargo pocket to give later. -Administer the medication to control future pain.

Waste the medication with another nurse witness present.

A client with a central venous catheter develops a catheter-related bloodstream infection (CRBSI). The nurse understands that this infection is most commonly due to: Catheter contamination from infection found in other areas of the body. Colonization of the catheter tip from migration of skin organisms at the insertion site. Direct contamination of the catheter or hub. Contamination of the infusion solution.

colonization of the catheter tip from migration of skin organisms at the insertion site.

What type of order would a physician most likely write to treat a client whose pain levels vary widely throughout the day? -One-time -Stat -p.r.n. -Standing

prn

The nurse is providing discharge teaching for an older adult with arthritis who also has an implanted catheter. Which care does the nurse anticipate the client will need to provide catheter care? -long-term care facility -home care -inpatient admission -assisted living

home care

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 can be given through a capped intravenous port -medications that are given over 1 minute for rapid therapeutic effect -medications that need to be infused over 20 to 60 minutes -medications that are toxic if given over short periods

medications that need to be infused over 20 to 60 minutes

When administering heparin subcutaneously, the nurse should: -aspirate before the injection. -aspirate after the injection. -vigorously massage the site. -never aspirate.

never aspirate

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? -a supply that remains on the nursing unit for use in emergency -a container with enough prescribed medications for several days for a client -systems that contain frequently used medication for that unit -self-contained packets that hold one tablet or capsule for individual clients

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

The nurse is reviewing the plan of care for a client who has a newly placed implanted catheter and is to be discharged home. What is a priority for the nurse to include in the plan of care? -how to access the port -signs of infection -to keep a dressing over the port -flushing the port with heparin

signs of infection

A client with an infection is receiving intravenous antibiotic therapy. The client has an intermittent infusion device in place. The nurse flushes the device with normal saline solution before administering the antibiotic based on which rationale? -to allow increased mobility for the client -to facilitate cannulation of the central vein -to prevent blood clot formation -to minimize the danger of fluid overload

to prevent blood clot formation

The primary reason for the Controlled Substances Act is: -to prevent drug use and dependence. -to prevent overuse of antibiotics. -to regulate the purchase of narcotics. -to regulate the purchase of antibiotics.

to prevent drug use and dependence.