Med Admin

1. Which medication has the highest potential for abuse? a. Methylphenidate (Ritalin) - schedule II b. Alprazolam (Xanax) - schedule IV c. Acetaminophen & codeine (Tylenol #3) - schedule III d. Diphenoxylate & atropine (Lomotil) - schedule V

ANS: A According to the Controlled Substances Act, drugs that have the potential for abuse/dependency are classified as schedule I-V. Schedule I drugs have no approved medical applications in the United States. Schedule II drugs have high potential for abuse/dependency and have multiple restrictions for prescriptions. Schedule III, IV, and V have lower risks of dependency/abuse and fewer restrictions for prescriptions DIF: Applying REF: p. 814 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Addiction

12. A nurse has opened and used part of a new multidose vial. The nurse should ______ the vial. a. write the current date on b. wipe the top of c. check the expiration date of d. replace the plastic top that covered

ANS: A Before replacing a newly opened multidose vial in the medication storage area, the nurse should write the date the vial was opened, because out-of-date medication can chemically change. DIF: Cognitive Level: Application REF: p. 679, Steps 35-3 OBJ: Clinical Practice #3 TOP: Multidose Vial Tips KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment

8. The nurse prepares to administer the following medication to the patient. Which instruction will the nurse be sure to give before the patient takes the medication? MS Contin Morphine sulfate Extended release tablets, USP 15 mg CII only a. "Be sure to swallow the pill whole." b. "Crush the medication and place the powder in applesauce." c. "Place the pill under your tongue." d. "Let the pill slowly dissolve in your mouth."

ANS: A Extended release medications must always be swallowed whole without crushing or dissolving the tablet. MS Contin is always to be administered orally rather than sublingually. DIF: Remembering REF: p. 834 | p. 847 TOP: Teaching/Learning MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Patient Education

25. The nurse is teaching a patient who weighs 325 pounds on how to administer a subcutaneous would suggest that the patient would: a. require a longer needle because of his weight. b. experience a faster response to the medication. c. use a 15-degree angle to inject the medication. d. need extra pressure at the injection site to prevent bleeding.

ANS: A For the obese patient, the needle length should be longer than the needle length for a thin person because of excess fatty layers. DIF: Cognitive Level: Application REF: p. 674, Clinical Cues OBJ: Clinical Practice #1 TOP: Subcutaneous Injection KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: basic care and comfort

10. A patient has an order to receive two intramuscular injections in the same syringe. The nurse should initially: a. determine if the two medications are compatible in the same syringe. b. obtain a larger syringe that will accommodate both medications. c. select two syringes to give the medications separately. d. ask the patient whether he would prefer one or two injections.

ANS: A The first step is to determine whether the two medications are compatible in the same syringe. DIF: Cognitive Level: Analysis REF: p. 679, Clinical Cues OBJ: Clinical Practice #5 TOP: Compatibility of Medications KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

14. The nurse has an order to administer an injection of purified protein derivative (PPD) by the intradermal route. The maximum amount of medication that can be given using this route is _____ mL. a. 0.1 b. 0.75 c. 0.50 d. 0.2

ANS: A The maximum dose that can be given via the intradermal route is 0.1 mL. DIF: Cognitive Level: Knowledge REF: p. 682, Skill 35-1 OBJ: Theory #7 TOP: Mantoux Test KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment

3. The best angle to insert the needle to administration an subcutaneous injection is at an angle of _____ degrees. a. 45 to 90 b. 30 to 45 c. 15 to 30 d. 5 to 15

ANS: A The needle is inserted at a 45- or 90-degree angle depending on the needle length and the size of the patient. DIF: Cognitive Level: Comprehension REF: p. 672, 686, Skill 35-2 OBJ: Theory #1 TOP: Medication Administration: Subcutaneous KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

5. Which of the following medication orders is to be administered PRN? a. Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep b. Prednisone 10 mg PO today, then taper down 1 mg each day for the next 10 days c. Humulin R 10 units subcutaneously before each meal and at bedtime d. Kefzol (Ancef) 1 g IVPB 30 minutes prior to surgery

ANS: A The nurse is to give the Ambien if the patient cannot sleep. The nurse uses discretion when deciding when to administer the medication PRN. DIF: Applying REF: pp. 819-820 TOP: Documentation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration

20. A patient has a medication order for iron dextran (Imferon) to be given using the Z- track technique. The rationale for using this method is to: a. avoid medication irritation. b. avoid tissue scarring. c. cause less painful method. d. protect the sciatic nerve.

ANS: A Z-track technique should be used with injection of this medication, because it creates a slanted needle track and avoids seepage of the medication back into subcutaneous or skin layers. DIF: Cognitive Level: Comprehension REF: p. 694, Skill 35-5 OBJ: Theory #2 TOP: Z Track Technique KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

30. When reconstituting a drug from a powder, the nurse will: (Select all that apply.) a. confirm the type of diluent required. b. use only a 23-gauge needle to inject a reconstituted drug. c. thoroughly mix solute with diluent. d. roll the solute between hands to warm powder. e. label the drug as to the amount of medication per volume after dilution.

ANS: A, C, E After confirming the type of diluent required, the solute must be mixed thoroughly with the recommended diluent, then labeled as to the amount of medication per volume after dilution. DIF: Cognitive Level: Application REF: p. 678 OBJ: Clinical Practice #4 TOP: Mixing Drug from Powder KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

23. Which medication order should be documented in the MAR and in the nurses' notes after it is given? a. Digoxin 0.25 mg PO at 9:00 AM b. Demerol 75 mg IM PRN pain c. Lasix 40 mg PO twice daily d. KCl 20 mEq PO daily

ANS: B PRN and STAT orders are recorded in both the MAR and nurses' notes along with the reason why the medication was given, the result, and the duration of effect of medication. DIF: Cognitive Level: Application REF: p. 695 OBJ: Clinical Practice #11 TOP: Documentation KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

20. The nurse is to administer 15 mg of morphine liquid to the patient. How much morphine liquid will the nurse draw up to administer to the patient? Morphine sulfate oral solution (CONCENTRATE) 100 mg/5 mL (20 mg/mL) CII only a. 0.5 mL b. 0.75 mL c. 1.3 mL d. 1.5 mL

ANS: B 15 mg x 1 mL = 0.75 mL Dose 20 mg DIF: Applying REF: p. 828 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Dosage Calculation NOT: Concepts: Safety

22. The nurse is caring for a patient who takes 6 tablets of methotrexate once every week on Fridays. How many mg of methotrexate does the patient take per dose? Trexall Methotrexate tablets, USP 2.5 mg tablets only a. 10 mg b. 15 mg c. 20 mg d. 25 mg

ANS: B 2.5 mg tablets x 6 = 15 mg DIF: Applying REF: p. 828 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Dosage Calculation NOT: Concepts: Assessment

12. During discharge teaching, the nurse is to give the patient a signed, dated, and timed prescription from the physician for medications to be taken at home. Which prescription drug order needs to be corrected before it is given to the patient? a. Warfarin (Coumadin) 5 mg PO daily before dinner b. Methotrexate (Trexall) 8 tablets PO once weekly on Saturdays c. Levothyroxine (Synthroid) 137 mcg PO daily before breakfast d. Zolpidem (Ambien) 5 mg PO at bedtime as needed for sleep

ANS: B All prescriptions must have the name of the drug to be administered along with dosage, route, and frequency. The methotrexate order does not contain a dosage for the drug, just the number of pills to be taken. DIF: Applying REF: p. 819 TOP: Documentation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Interactions NOT: Concepts: Care Coordination

14. The nurse suspects that the patient is experiencing a drug toxicity rather than a side effect. Which question will the nurse ask to help confirm this suspicion? a. "When did you take your last dose of the medication?" b. "Have you been taking extra doses of the medication?" c. "Are you taking any other medications?" d. "Have you ever taken this medication in the past? "

ANS: B Asking if the patient has been taking extra doses of the medication will allow the nurse to determine if the patient has been taking too much of the drug or more than was prescribed. Toxicity occurs when the patient receives/takes excessive amounts of the drug. DIF: Applying REF: p. 816 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Adverse Effects NOT: Concepts: Safety

3. The nurse is caring for a patient who is in agonizing pain. All of the following options are listed on the patient's medication order sheet to relive pain. Which will provide the most rapid pain relief for the patient? a. Morphine 10 mg PO b. Dilaudid 1 mg IV push c. Demerol 75 mg IM d. Duragesic 50 mcg transdermal patch

ANS: B IV administration has the most rapid onset of action and will provide the patient with the quickest pain relief. DIF: Remembering REF: p. 815 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Pharmacological Pain

15. The nurse is caring for a patient who is receiving vancomycin (Vancocin) to treat a severe infection. The next vancomycin dose is due to be administered at 10:00 A.M. What time will the nurse draw the vancomycin serum trough level? a. 7:30 A.M. b. 9:30 A.M. c. 11:30 A.M. d. 1:30 P.M.

ANS: B Serum trough levels are to be drawn just prior to the administration of the medication in order to determine the lowest blood level of the drug within the patient's system. DIF: Applying REF: p. 816 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Care Coordination

7. When the nurse is preparing to draw medication from an ampule, the proper procedure is to: a. allow medication to float freely in the body, neck, and stem. b. wrap the neck with a gauze or alcohol sponge to the open ampule. c. break the ampule so that it opens toward her. d. inject air into the ampule to ease the withdrawal of the medication.

ANS: B The medication should rest in the body of the ampule before being withdrawn, and the neck should be wrapped to protect the nurse from glass cuts when the ampule is snapped open. DIF: Cognitive Level: Application REF: p. 677, Clinical Cues OBJ: Clinical Practice #3 TOP: Using Ampules KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe Effective Care Environment: safety and infection control

5. The nurse understands that the only part of the syringe that can be touched and not contaminated is the: a. needle. b. outside of the barrel. c. sides of the plunger. d. tip of the syringe.

ANS: B The needle, inside of the barrel, sides of the plunger, and tip of the syringe must be kept sterile. DIF: Cognitive Level: Knowledge REF: p. 673 OBJ: Clinical Practice #2 TOP: Injection Equipment KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: safety and infection control

4. The nurse administers a medication to a patient. Shortly afterward, the patient develops an itchy rash all of his body and reports feeling very unwell. What is the priority action of the nurse? a. Leave the patient to notify the physician and the pharmacist. b. Determine if the patient is having any difficulty breathing. c. Document the reaction in the patient's chart. d. Obtain an order for hydrocortisone cream to relieve the itching.

ANS: B The nurse must first determine if the patient is having any difficulty breathing, since the patient may be starting to have an anaphylactic reaction to the medication. Anaphylaxis is life threatening and requires immediate treatment; the nurse must recognize this potential and plan to initiate emergency interventions right away. DIF: Applying REF: p. 816 | p. 838 | p. 846 | p. 853 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration

2. The nurse is caring for a patient who will give himself medication injections at home after discharge. How can the nurse best determine that the patient understands the technique and can administer the injections correctly? a. Provide written instructions about how to administer the injections. b. Watch the patient give himself an injection. c. Call the patient the next day to ask if he is having difficulty with the injections. d. Ask the patient if he understands how to administer the injections.

ANS: B The nurse should watch the patient give himself an injection to make sure that he is doing it correctly. This will give the nurse an opportunity to point out and correct any mistakes and offer the patient reassurance about his technique. DIF: Remembering REF: p. 845 TOP: Assessment MSC: NCLEX Client Needs Category: Health Promotion: Self-care NOT: Concepts: Patient Education

1. When the 8-year-old child complains that he does not want to have a "shot," the nurse explains that the use of a parenteral route: a. is the best way to give medicine. b. will hasten the action of the drug. c. will take less medicine to make him well. d. will be painless because the needles are so sharp.

ANS: B The parenteral route will hasten the action of the drug. Although the equipment is better, there is still some pain involved in a parenteral application. The parenteral method is not always the best way to administer a drug. DIF: Cognitive Level: Application REF: p. 671 OBJ: Theory #2 TOP: Medication Administration: Parenteral KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

21. The nurse is caring for a patient with multiple chronic illnesses who is having difficulty remembering to take all of her many medications at the correct times. Which is the appropriate nursing diagnosis for this patient? a. Activity intolerance related to inability to take medications on time b. Ineffective therapeutic regimen management related to complexity of medication schedule c. Risk for aspiration related to need to swallow many pills during day d. Acute confusion related to inability to figure out medication dose times

ANS: B The patient is not able to manage her prescribed medication regimen because of the complexity of the schedule, so Ineffective therapeutic regimen management is an appropriate diagnosis. Activity intolerance does not relate to the ability to take multiple medications at once and manage medication times. The patient does not state any difficulty swallowing pills, so risk for aspiration is not applicable. Inability to figure out medication dose times does not constitute acute confusion. DIF: Applying REF: p. 845 TOP: Diagnosis MSC: NCLEX Client Needs Category: Health Maintenance: Self Care NOT: Concepts: Adherence Behavior

13. When reinforcing instructions to a patient who will self-administer insulin injections at home, it is important to remind the patient to: a. always use a new insulin vial with each dose. b. rotate injection sites systematically. c. use a tuberculin syringe to draw up insulin. d. aspirate before injecting the insulin.

ANS: B The patient should rotate injection sites systematically to promote absorption and to decrease tissue irritation. DIF: Cognitive Level: Application REF: p. 684 OBJ: Clinical Practice #11 TOP: Self Administering Insulin KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance

11. The nurse is caring for a patient who is taking many prescription medications for various health problems. Which direction from the nurse will help the patient avoid dangerous drug interactions? a. Only take over-the-counter medications. b. Have all of the prescriptions filled at the same pharmacy. c. Avoid taking generic preparations of prescribed medications. d. Only take the medications that the patient feels are necessary.

ANS: B The patient's risk for dangerous drug interactions is increased when many medications are taken. Filling all of the prescriptions at the same pharmacy will allow the pharmacist to check for possible interactions. DIF: Applying REF: p. 812 | p. 817 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Interactions

18. The nurse is caring for a patient who was just made NPO. The nurse is to administer carvedilol (Coreg) 25 mg PO to the patient for control of high blood pressure. What is the best action of the nurse? a. Crush the medication and administer it to the patient mixed with applesauce. b. Administer the medication to the patient with a small sip of water. c. Contact the patient's physician to clarify the order. d. Administer the equivalent medication dose through the patient's IV.

ANS: C The nurse should contact the patient's physician to clarify the order. Oral medications should never be administered to NPO patients without specific orders to do so from the physician. Coreg may not be administered intravenously. DIF: Applying REF: p. 833 | pp. 848-849 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Clinical Judgment

6. After administering an antibiotic to the patient, the patient complains of feeling very ill. The nurse notes that the patient is scratching and has hives. The patient soon starts having difficulty breathing and his blood pressure drops. What is the nurse's assessment of the situation? a. The patient is having a mild allergic reaction and an antihistamine will make the patient feel better. b. The patient is having an anaphylactic reaction and epinephrine should be administered right away. c. The patient's infection is worsening and progressing to septic shock so blood cultures should be drawn. d. The patient has developed toxic shock syndrome and the antibiotic orders must be changed right away.

ANS: B The patient's symptoms are indicative of anaphylaxis: a severe, life-threatening allergic reaction. the airways close up, the throat swells closed, and the blood pressure drops dangerously low. The patient may go into shock and die. Patients may have very mild allergic reactions to medications and experience a rash or itching. DIF: Applying REF: p. 816 | p. 846 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Adverse Effects NOT: Concepts: Clinical Judgment

10. The nurse carefully reviews the patient's medication list. Which observation about the list indicates the highest risk for serious drug-drug interactions? a. The patient has been taking the same medications for a long time. b. The patient is taking a large number of medications. c. Most of the drugs on the list are prescribed at high doses. d. The patient takes oral, injected, and inhaled medications.

ANS: B The risk of drug-drug interactions increases when many drugs are taken by the patient. One of the most important ways to prevent adverse drug interactions is to minimize the number of drugs that the patient is taking. DIF: Applying REF: pp. 817-818 | p. 832 | p. 845 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Interactions NOT: Concepts: Safety

18. When administering an intramuscular injection for a 4-year-old child, the best site to use is the: a. gluteus medius. b. vastus lateralis. c. ventrogluteal. d. dorsogluteal.

ANS: B The vastus lateralis is the best choice for children younger than 5 years old, because the gluteal muscle is not well developed. DIF: Cognitive Level: Comprehension REF: p. 692 OBJ: Clinical Practice #7 TOP: Vastus Lateralis Site KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: reduction of risk

19. The nurse is to administer 1 mL of prochlorperazine (Compazine) 10 mg IM to an adult patient. Which syringe will the nurse select to administer the medication? a. 1 mL tuberculin syringe with 27 gauge, inch needle b. 3 mL syringe with 23 gauge, inch needle c. 1 mL syringe with 27 gauge, inch needle d. 3 mL syringe with 18 gauge, 1 inch needle

ANS: B Tuberculin syringes are typically used for subcutaneous injections. The and inch needles are too short for intramuscular injections into adults. The 18 and 27 gauge needles are too small for adult intramuscular injections. A 3 mL syringe with a 23 gauge, inch needle should be used to administer the medication to the adult patient. DIF: Remembering REF: pp. 824-825 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Safety

2. Which medications are to be administered via parenteral routes? (Select all that apply.) a. Bisacodyl (Dulcolax) 10 mg suppository daily PRN constipation b. Prochlroperazine (Compazine) 10 mg IM q 6 hours PRN nausea c. Brimonidine (Alphagan) 0.1% solution 2 drops to each eye daily d. Proventil (Ventolin) inhaler 2 puffs as needed for shortness of breath e. Fentanyl (Duragesic) 50 mcg transdermal patch apply every 72 hours f. Insulin lispro (Humalog) insulin 15 units subcutaneously ac meals

ANS: B, F Parenteral medications are given through a needle under the skin (subcutaneous, intradermal, or intramuscular) or through a vein (intravenous) rather than through the gastrointestinal or respiratory route. DIF: Applying REF: pp. 822-824 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Safety

23. The nurse is to administer 45 mg of phenobarbital to the patient. How many tablets will the patient receive? Phenobarbital tablets, USP 15 mg CIV only a. 1 tablet b. 2 tablets c. 3 tablets d. 4 tablets

ANS: C 45 mg x 1 tablet = 3 tablets Dose 15 mg DIF: Applying REF: p. 828 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Dosage Calculation NOT: Concepts: Safety

24. A nurse giving a subcutaneous injection will select a: a. 3-mL syringe and 22-gauge, 1 -inch needle. b. 3-mL syringe and 18-gauge, 1 -inch needle. c. 3-mL syringe and 25-gauge, 5/8-inch needle. d. 3-mL syringe and 20-gauge, 1-inch needle.

ANS: C For subcutaneous injection, it is best to use a 25-gauge, 5/8-inch needle. DIF: Cognitive Level: Application REF: p. 672 OBJ: Clinical Practice #1 TOP: Needle and Syringe Size KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: basic care and comfort

22. When preparing to reconstitute a drug from a powder form, the nurse should first: a. use sterile water. b. vigorously shake the powder prior to reconstituting drug. c. follow directions on label for diluent to use. d. discard the vial and the unused medication.

ANS: C Instructions for the diluent should be followed from the directions on the label. DIF: Cognitive Level: Application REF: p. 678 OBJ: Clinical Practice #4 TOP: Reconstitution KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: pharmacological therapies

17. The nurse is noting an order for a medication to be given TID. Which times will the nurse plan to administer the medication to the patient? a. 9 A.M., 1 P.M., 5 P.M. and 10 P.M. b. 9 A.M. and 9 P.M. c. 9 A.M., 1 P.M. and 5 P.M. d. Nightly before the patient goes to sleep

ANS: C TID indicates that the medication is to be administered three times daily. Common times for TID medications are 9 A.M., 1 P.M. and 5 P.M. DIF: Applying REF: p. 827 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Care Coordination

4. The nurse computes the dose of medication as 2.4 million units of penicillin to be delivered in 4 mL. The nurse should: a. give the 4 mL using a 5-mL syringe. b. inform the charge nurse that the dose is too large to be given IM. c. divide the dose into two 3-mL syringes and give as a divided dose. d. ask the physician if another drug can be used.

ANS: C The maximum number of milliliters that can be injected into the dorsogluteal muscle is 3 mL. If the person has small muscle mass, or if the dose exceeds 3 mL, the dose should be divided into two doses. DIF: Cognitive Level: Analysis REF: p. 688 OBJ: Theory #1 TOP: Intramuscular Medication Administration KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

15. A nurse has administered a Mantoux skin test to a patient in the outpatient clinic at 9:00 AM on Monday. The patient should be scheduled to return to the clinic to have the result read: a. late Monday afternoon. b. late Tuesday afternoon. c. any time on Wednesday. d. any time on Friday.

ANS: C The results of the Mantoux skin test should be read within 48 to 72 hours after injection. DIF: Cognitive Level: Comprehension REF: p. 682, Skill 35-1 OBJ: Clinical Practice #8 TOP: Tuberculosis Testing KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

9. The nurse performs the proper technique when withdrawing medication from the vial by: a. wiping the rubber stopper with a povidone-iodine swab. b. inserting the needle into the vial at a 90-degree angle. c. injecting into the vial an amount of air that is equal to the dose. d. keeping the needle above the level of solution while withdrawing into the syringe.

ANS: C The vial should be wiped with an alcohol swab before use, the needle should be inserted at a slight lateral angle to avoid coring the rubber stopper, and an amount of air equal to the dose should be injected into the vial, while the needle is kept below the level of the solution to withdraw the dose. DIF: Cognitive Level: Application REF: p. 679, Steps 35-5 OBJ: Clinical Practice #3 TOP: Withdrawing Medication from a Vial KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

19. The most effective nursing actions to decrease discomfort to the patient during a parenteral injection would be: a. inserting the needle while the skin is still wet from the alcohol wipe. b. asking the patient to look at the injection site for learning purposes. c. using the smallest gauge needle that is appropriate for the site. d. removing the needle slowly to avoid damaging the tissue.

ANS: C Using the smallest gauge needle that is appropriate for the site is one way to decrease patient discomfort. DIF: Cognitive Level: Comprehension REF: p. 693, Box 35-4 OBJ: Clinical Practice #9 TOP: Parenteral Injection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: basic care and comfort

7. The nurse makes a medication error. Which action will the nurse take first? a. Prepare an incident report so that the facility can determine the cause of the error. b. Explain to the patient that a medication error has occurred, and notify the nurse manager. c. Assess the patient for any adverse reactions and notify the prescriber. d. Document the medication given, how the patient responded, and the corrective actions taken.

ANS: C When a medication error occurs, the nurse's first priority is to make sure that the patient is okay. If the patient shows any signs of adverse reaction to the medication error, the doctor/prescriber should be notified right away. Documentation, filling out the facility incident report, and explaining the error to the patient can take place later after the patient's condition is determined to be stable. DIF: Remembering REF: p. 827 | p. 846 TOP: Implementation MSC: NCLEX Client Needs Category: Safety: Reporting of Incident NOT: Concepts: Safety

1. The nurse is caring for a patient who is NPO with a new PEG (percutaneous endoscopic gastrostomy) tube. Which of the patient's medications can the nurse administer through the tube? (Select all that apply.) a. Edluar (zolpidem tartrate) sublingual tablet 5 mg nightly at bedtime b. Ondansetron (Zofran) oral disintegrating tablet 8 mg q 8 hours PRN nausea c. Ceclor (cefaclor for oral suspension) 250 mg q 6 hours d. Oxymorphone hydrochloride extended release (Opana ER) 40 mg q 12 hours e. Phenytoin (Dilantin) chewable tablet 100 mg q 12 hours f. Potassium chloride oral solution 20 mEq daily

ANS: C, E, F Extended-release, oral disintegrating, and sublingual tablets may not be administered through feeding tubes. Suspensions and oral solutions are ideal for feeding tube administration. Chewable tablets may be crushed and dissolved in liquid for administration through feeding tubes. DIF: Applying REF: p. 823 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Safety

27. When administering heparin, the nurse will avoid: a. using the lower abdomen as an injection site. b. rotating sites. c. massaging area for more than 3 seconds. d. aspirating after injection.

ANS: D After the insertion of heparin, the nurse should not aspirate because this practice tends to increase bruising. DIF: Cognitive Level: Application REF: p. 688, Box 35-5 OBJ: Theory #1 TOP: Heparin Injection KEY: Nursing Process Step: Application MSC: NCLEX: Physiological Integrity: pharmacological therapies COMPLETION

2. To ensure the proper administration of a tuberculin test, the nurse will: a. use a 3-mL syringe. b. choose a 21-gauge, 1-inch needle. c. insert the needle at a 30-degree angle. d. inject slowly to form a bleb.

ANS: D An intradermal injection should be done using a 1-mL syringe with a 25-, 27-, or 29- gauge needle that is 5/8-inch long. The needle is inserted at a 15-degree angle, and medication is injected slowly to form a bump or a bleb underneath the skin. DIF: Cognitive Level: Application REF: p. 682, Skill 35-1 OBJ: Theory #1 TOP: Medication Administration: Intradermal KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

13. The nurse administers a medication to the patient. Which symptoms indicate that the patient is having an allergic reaction rather than a side effect? a. Hair loss and sweaty skin b. Nausea and constipation c. Heartburn and nasty taste in the mouth d. Itchy rash and difficulty breathing

ANS: D Itchy rash and difficulty breathing are indicative of an allergic reaction to a medication. The other symptoms are common side effects of medications. DIF: Applying REF: p. 816 TOP: Assessment MSC: NCLEX Client Needs Category: Pharmacological Therapies: Adverse Effects NOT: Concepts: Clinical Judgment

8. When withdrawing medication from an ampule, the best needle to use is a _____ needle. a. beveled b. 1-inch c. 1 -inch d. filter

ANS: D Medication should be withdrawn from an ampule using a filter needle, which prevents small glass fragments from being drawn into the syringe. DIF: Cognitive Level: Application REF: p. 677 OBJ: Clinical Practice #3 TOP: Medication via Ampule KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment: safety and infection control

6. A nurse has just administered a medication to a patient using a syringe that is not a safety syringe. To dispose of the needle and syringe safely, the nurse should: a. recap the needle and dispose of it in the trash receptacle. b. recap the needle and dispose of it in the sharps container. c. leave the needle uncapped and dispose of it in the trash receptacle. d. leave the needle uncapped and dispose of it in the sharps container.

ANS: D Needles are not to be recapped and should be deposited in the sharps container. DIF: Cognitive Level: Application REF: p. 675, Safety Alert OBJ: Clinical Practice #2 TOP: Preventing Needle Sticks KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe Effective Care Environment: safety and infection control

17. When administering an intramuscular injection to an adult patient using the ventrogluteal site, the nurse should use which landmark to locate the area for injection? a. The lower end of the trochanter and the knee b. The upper end of the trochanter and the knee c. The head of the trochanter and the posterior iliac spine d. The head of the trochanter and the anterior iliac spine

ANS: D The head of the trochanter and the anterior iliac spine are the landmarks used to give an injection in the ventrogluteal site. The ventrogluteal site is the safest in regard to possible injury to the patient's sciatic nerve. DIF: Cognitive Level: Comprehension REF: p. 690, Skill 35-3 OBJ: Theory #10 TOP: Landmarks for Injection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: reduction of risk

26. The nurse may refuse to carry out an order for a placebo if the: a. medication is labeled as a placebo. b. nurse has religious grounds for refusing. c. placebo is to be delivered by a parenteral route. d. patient is unaware that the medication is a placebo.

ANS: D The nurse is ethically obligated to refuse to give a placebo if the patient has not been informed that the medication is a placebo. DIF: Cognitive Level: Comprehension REF: p. 672, Legal/Ethical OBJ: Theory #1 TOP: Placebo KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

21. A patient asks why the clinic nurse asked him to remain in the clinic for 30 minutes after the injection of penicillin. The nurse explains that it is part of the standards of care to monitor for: a. any pain reaction. b. bleeding at the site. c. infection at the site. d. any allergic reaction.

ANS: D The nurse should plan to monitor this patient for allergic response for 30 minutes after giving the first dose of a medication. DIF: Cognitive Level: Application REF: p. 694, Safety Alert OBJ: Clinical Practice #6 TOP: Allergic Reaction to Parenteral Injection KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. The nurse begins a shift on a busy medical-surgical unit. The nurse will be caring for multiple patients. Which patient will the nurse assess first? a. A patient who would like some acetaminophen (Tylenol) for a mild headache b. A patient who has a question about her daily medications c. A patient who needs discharge teaching about an antibiotic d. A patient who just received nitroglycerin for chest pain

ANS: D The nurse's first priority is always: ABCs- Airway, Breathing, and Circulation. This includes any patients who are having chest pain and/or difficulty breathing. The nurse needs to see this patient first to determine if the chest pain has been relieved or not. An assessment should be done right away to determine if the patient is now stable or if additional interventions need to be done. The other patients' needs are less critical and can be met after this patient is assessed. DIF: Applying REF: p. 822 | p. 834 TOP: Assessment MSC: NCLEX Client Needs Category: Management of Care: Establishing Priorities NOT: Concepts: Clinical Judgment

16. A hospitalized patient has an order for subcutaneous heparin. The best location to administer this medication is the: a. upper arm. b. anterior thigh. c. buttock. d. abdomen.

ANS: D The optimal site for heparin injection is the abdomen, because this area is not involved in muscular activity, as are the arms, buttocks, and legs. DIF: Cognitive Level: Knowledge REF: p. 688, Box 35-3 OBJ: Clinical Practice #8 TOP: Heparin Subcutaneous Injection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

11. A patient has an order to receive a mixture of short- and long-acting insulin. The first step to properly draw them up in the same syringe is to: a. shake both vials vigorously before use. b. inject air into the short acting clear insulin. c. withdraw the short acting clear insulin. d. inject air into the long acting cloudy insulin.

ANS: D The vials should be rolled gently to mix the insulin suspension evenly, but they should not be shaken. Air is injected first into the long-acting cloudy insulin vial and then into the short-acting clear insulin vial. DIF: Cognitive Level: Analysis REF: p. 680, Steps 35-4 OBJ: Clinical Practice #5 TOP: Combining Short- and Long-Acting Insulin KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: pharmacological therapies

16. When administering phenytoin (Dilantin) through the patient's IV line, the nurse carefully flushes the IV with normal saline before and afterward to avoid crystal formation of the medication that occurs when it mixes with dextrose in water (D5W) solution. Which type of drug interaction is the nurse being careful to avoid? a. Antagonism b. Potentiation c. Synergism d. Incompatibility

ANS: D When medications combine to form crystals or adverse chemical reactions, the result is a drug incompatibility. Compatibility must be assessed prior to medication preparation and administration. DIF: Remembering REF: p. 817 | p. 829 | p. 840 | p. 878 TOP: Implementation MSC: NCLEX Client Needs Category: Pharmacological Therapies: Medication Administration NOT: Concepts: Safety