Medication Administration

Which measurement system is most accurate for drug administration?

Metric

A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which instructions are stated on the label of a vial container?

Amount of diluent to be added It also states the directions for storing the drug, NOT directions for administering the drug to a client

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 who has been prescribed an inhaler asks what the spacer is used for. What is the appropriate nursing response?

"Medication stays in the chamber so you can continue to inhale it." Rationale: A spacer provides a reservoir for aerosol medication. The client can take additional breaths (after the initial breath) to continue inhaling the medication held in the reservoir. The spacer does not decrease the amount of medication received, make the medication move faster, or serve as a holding device.

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? to prevent absorption in the mouth to prevent absorption in the esophagus to prevent gastric irritation to facilitate absorption in the stomach

to prevent gastric irritation

The nurse is preparing to administer a transdermal medication. How should this be accomplished? The nurse should ask the client to swallow the medication. The nurse should apply the medication directly to the skin. The nurse should inject the medication into a body cavity. The nurse should inject the medication just below the dermis of the skin.

The nurse should apply the medication directly to the skin.

A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident. Which action should the nurse perform to prevent gastric reflux?

Help the client into a Fowler position

During a teaching session on self-administration of insulin, the client asks the nurse why it is necessary to bunch the skin before inserting the needle. What is the nurse's best response?

"Bunching your skin facilitates the placement of the needle in the subcutaneous tissue."

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide? "Rest the eye dropper on the inner canthus to make it easier to instill the drops." "Wait 5 minutes between instillation of different types of eye drops." "If you cannot instill these drops from the bottle, you will be unable to have surgery." "Dispose of these medications every 7 days due to possible bacterial contamination."

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

A nurse needs to administer a subcutaneous heparin injection to a client. Which injection site is most suitable for heparin?

Abdomen (less pain)

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

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

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? Synergism Distribution Metabolism Absorption

Distribution

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?

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

The nurse is preparing supplies for a tuberculosis screening. The nurse should choose which syringes and needles?

1 mL syringe; ½-inch (1.25-cm), 26-gauge needle

The nurse is teaching a client about using two inhalers. Which client statement reflects that nursing teaching has been effective? "I should be careful to refrain from shaking the canisters of medication." "I must wait at least 1 full minute between inhalers." "I will breathe in for about 10 seconds and exhale quickly." "I will wash the holder in warm water mixed with some bleach."

"I must wait at least 1 full minute between inhalers." Rationale: The canisters must be shaken after being placed in the holder. After breathing the medication in over 10 seconds, the client should exhale slowly through pursed lips. Holders should be rinsed in warm water daily and cleaned weekly with mild soap and water.

The nurse is caring for a client with diabetes. Which client statement reflects that nursing teaching has been effective?

"I will eat a meal within a half hour of taking my morning insulin." Further teaching is needed when the client knows that orange juice should be consumed when experiencing low blood glucose levels, that blood glucose levels should be tested before and 2 hours after meals, and that meals should be consumed three times daily (with appropriate snacks in between) at approximately the same time day to day.

A client who is receiving medication via a metered-dose inhaler asks the nurse, "Why don't I put the inhaler mouthpiece in my mouth when I use the medication?" Which response by the nurse would be most appropriate? "The medication is more easily trapped in the oropharynx." "The mist that forms is better inhaled into your airways." "This helps you to ensure that you swallow the medication." "Your mouth would contaminate the inhaler and medication."

"The mist that forms is better inhaled into your airways." Rationale: Positioning the mouthpiece 1 to 2 inches (2.5 to 5 cm) from an open mouth allows the medication to be released and form a mist that is delivered more accurately by inhalation to the bronchial airways, rather than being trapped in the oropharynx and then swallowed. Contamination of the inhaler is not a consideration, since inhalers are intended for single-client use.

Which statement by a client indicates to the nurse that teaching was effective regarding the different parts of a syringe?

"The plunger is the part of the syringe that moves back and forth to withdraw and instill medication." Rationale: The needle is attached to the tip of the syringe, the barrel holds the medication, not the plunger. The barrel not resetting the dose window to 0 after injection is a characteristic of an insulin pen

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?

1. Check the client's ID band.

Steps to draw medication supplied in a glass ampule

1. Wrap a small gauze pad around the neck of the ampule. 2. Break off the top of the ampule. 3. Attach the filter needle to the syringe. 4. Withdraw the medication. 5. Discard the filter needle. 6. Attach a sterile administration device to the syringe.

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?

20/30 x 45= 30 mL Rationale: Dose on hand/Quantity on hand = Dose desired/X

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?

90 degrees

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

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

A nurse is reviewing information about a prescribed drug in a drug handbook. The nurse identifies which name as the generic name?

Ampicillin sodium Omnipen-N, Polycillin-N, and SK Ampicillin-N are trade names

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 Ethnicity Body surface area (BSA) Developmental level

Body surface area (BSA)

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? The size of the syringe is directed by the viscosity of the medication to be given. As the gauge number becomes larger, the size of the needle becomes smaller. When giving an injection, the amount of the medication directs the choice of gauge. When looking at a needle package, the first number is the length in inches and the second number is the gauge or diameter of the needle.

As the gauge number becomes larger, the size of the needle becomes smaller. Rationale: The size of the syringe is directed by the amount of the medication to be given. 1st # on a needle package is the gauge or diameter of the needle 2nd # is the length in inches. Viscosity of the medication directs the choice of gauge

The nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not? inserting the needle at a 90-degree angle waiting 10 seconds with the needle still in place and the skin held taut aspirating for a blood return withdrawing the needle and immediately releasing the taut skin

Aspirating for a blood return

The nurse is administering an IM injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not?

Aspirating for a blood return Rationale: Withdrawing the needle and immediately releasing the taut skin is incorrect, as this creates a diagonal path to prevent leaking in the subcutaneous layer of the tissue. Waiting 10 seconds with the needle still in place and the skin held taut is incorrect, as this provides time to distribute the medication in a larger area.

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

Assess Client B thoroughly. Complete an incident report. Contact provider to report the error. Rationale: Telling Client A about the error violates HIPAA.

A nurse needs to administer a subcutaneous injection to a client. How far from the previous injection site to the area should the nurse administer the injection?

At least 1 inch (2.5 cm) Injection sites are rotated a finger's width apart, or about 1 inch (2.5 cm), from a previous site to avoid tissue injury.

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications via an enteral tube? Avoid crushing sustained-release pellets. Mix all the medications together in 15 mL of water. Use cold water when mixing powdered medications. Add medications to the formula.

Avoid crushing sustained-release pellets Rationale: The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. A slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection? checking for documented allergies to food or drugs gathering all the equipment needed cleaning the area with an alcohol swab preparing the syringe with the medication

Checking for documented allergies to food or drugs Rationale: Preparing the syringe with the medication and gathering equipment is considered planning, not assessment. Cleaning the area with an alcohol swab is implementing, not assessing

The nurse is teaching a client about the proper use of transdermal patches. Which locations apply?

Chest, abdomen, upper arms, buttock

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?

Contact the health care provider for order clarification.

A nurse is administering medication to a 78-year-old female client who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this client has an increased possibility of drug toxicity due to which age-related factor?

Decline in liver function and production of enzymes needed for drug metabolism

A nurse has administered an IM injection. What will the nurse do with the syringe and needle?

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

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client? The insulin pen is easily transported on the client. It is easier to learn how to use an insulin pen than a syringe and vial. Each unit of insulin is accompanied by a clicking sound in the pen. With an insulin pen, a large variety of insulin types are available.

Each unit of insulin is accompanied by a clicking sound in the pen.

A nurse is preparing an injection by withdrawing the solution from a multidose vial. What is necessary to facilitate withdrawing a medication from the vial?

First, inject an equal amount of air into the vial.

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

A nurse is preparing to administer an ID injection. What would be most appropriate for the nurse to do?

Hold the syringe at a 10- to 15-degree angle.

A nurse is performing a sensitivity test on a client. What would be the best type of injection to use for this procedure?

Intradermal Rationale: Used for allergy tests since it has the longest absorption time of all parenteral routes.

The Z-track technique is used during which administration route?

Intramuscular Rationale: Used to prevent leakage of medication into the needle track, minimizing discomfort.

When educating an older adult client about the administration of medication during discharge, the nurse notes that the client is having difficulty comprehending the instructions. What intervention should the nurse follow in this case to ensure the client's safety? Ask a second nurse to repeat the instructions. Involve a second responsible person in the instructions. Ask the client's physician to provide instructions. Write discharge instructions on the medication containers.

Involve a second responsible person in the instructions. Rationale: A referral for skilled nurse visits is appropriate for homebound older adults who need additional instructions about medication routines after discharge. However, the nurse would not ask a second nurse to simply repeat the instructions or delegate the teaching to somebody else. The nurse will also not write all the discharge instructions on the various medication containers, but instead will write all the instructions in detail on the discharge sheet for the client's convenience.

Which contains all the components of a valid order?

John Smith, atenolol 50 mg, twice a day, by mouth

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. Have another nurse finish preparing and administering the medications. Put the medications back in the containers.

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

1. The nurse is preparing to give the 2nd dose of ordered antibiotics to a client and notes that no one has documented that the 1st dose was given. What is the appropriate nursing action? 2. The nurse is preparing to give the 2nd dose of ordered antibiotics to a client and notes that the 1st dose of medication is still in the automated medication-dispensing system. The MAR does not show that the initial dose was given. What is the appropriate action?

Notify the health care provider first 2. Follow internal policies regarding incident reporting. 3. The nurse will receive information from the health care provider about new orders to make sure the client gets both doses of medication. The pharmacy may be notified later, but it is not appropriate to initially notify them without clarifying with the health care provider.

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

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

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

Offer a sip of water before administering medication Rationale: To prevent oral medications from sticking to the tongue, administer with a sip of water prior to taking the drug, or mix with a soft food such as applesauce.

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action? Draw up the remaining medication to give at the next time of administration. Place the date on the vial and retain for future use. Discard the remaining drug. Send the vial with the remaining drug back to the pharmacy.

Place the date on the vial and retain for future use.

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

Report the needlestick to the nurse manager.

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 read and compare labels on the medication with the medical record allow sufficient time to prepare the medication with minimal distraction administer medication within 30 to 60 minutes of the scheduled time

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

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 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 a supply that remains on the nursing unit for use in an emergency

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

A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse's appropriate response?

Tactfully request the provider to input the order into the computerized provider order system.

A client is ordered to receive an IM 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. There is a high possibility of injecting into subcutaneous fat. The area is free of major blood vessels and fat.

The area is free of major blood vessels and fat. Rationale: Considered the safest and least painful site. Dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. Deltoid region has little overlying subcutaneous fat and lies close to the radial nerve

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.

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

Vastus lateralis site Dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed. The Deltoid site is the least-used IM injection site because it is a smaller muscle than the others.

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

Therapeutic range Peak level- the highest plasma concentration of the drug- should be measured when absorption is complete. Trough level- when the drug is at its lowest concentration- this specimen is drawn in the 30-minute interval before the next dose. Half-life- the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body.

A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. What is the reason for bunching when injecting subcutaneously? to facilitate blood circulation at the injection site to avoid instilling medication within the muscle to ensure the accuracy of landmarking to prevent needlestick injuries

To avoid instilling medication within the muscle Rationale: Bunching does not prevent needlestick injuries, it does not facilitate blood circulation at the injection site, nor does it ensure the accuracy of landmarking.

To which client would the nurse be most likely to administer a p.r.n. medication? a client who requires daily medication to control hypertension a client who is experiencing severe and unprecedented chest pain a client who is reporting pain near the surgical site a client whose asthma is treated with inhaled corticosteroids

a client who is reporting pain near the surgical site Rationale: A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications.

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? smaller diameter greater length larger diameter shorter length

larger diameter

Which action describes buccal medication administration? placing a medication underneath the upper lip or in the side of the mouth placing a medication through a nasogastric tube placing a medication that is designed to be absorbed through the skin for systemic effects on the skin placing a medication under the tongue and allowing it to dissolve

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

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? covering application paper with plastic with transparent semipermeable dressing squeezing prescribed amount of paste from tube onto application paper removing prior application and any remaining residue from skin using wooden applicator to spread paste over the paper

removing prior application and any remaining residue from skin Rationale: The nurse will remove one application and residue before applying another to prevent excessive drug levels 2. Squeeze the paste onto the paper 3. Spread the paste over the paper, apply the paper, and cover it with a transparent semipermeable dressing.

A client with dry skin has been prescribed inunction. What should the nurse do to promote absorption of the ointment? shake the contents of the ointment warm the inunction before application rub the ointment into the skin apply inunction with a cotton ball

rub the ointment into the skin Rationale: Shaking the contents would mix the contents uniformly, whereas applying the ointment with a cotton ball would distribute the substance over a wide area. Warming the ointment before application would provide comfort.

Which actions by the nurse will prevent injury while withdrawing medication from an ampule? Select all that apply. discarding the ampule in a puncture-resistant container using a gauze square to hold the ampule while breaking it tapping the barrel of the syringe near the hub snapping the neck of the ampule away from his/her body inverting the ampule

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

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

ventrogluteal muscles Rationale: Recommended for adults because there are no large nerves or blood vessels, it is removed from bone tissue, it is clean, and the client may lie on the back, abdomen, or side for the injection.