N104 Pharm Ch 05 Medication

4 The nurse should discuss this with the provider and request an order to give the medication that the patient already has in the correct dose. It is not correct for the nurse to alter a prescription. Asking the patient to discard a new prescription is wasteful if it is possible to use what is on hand. The nurse would not call the pharmacist to request relabelling of the patient's previous prescription.

A patient who has hypertension is prescribed diltiazem hydrochloride 240 mg QD upon discharge. The nurse notes that the patient has a recently filled prescription for diltiazem hydrochloride 120-mg capsules at home. What action will the nurse take? 1 Instruct the patient to take two 120-mg capsules of the medication. 2 Call the pharmacist to request relabeling the patient's previous prescription. 3 Instruct the patient to discard the medication on hand and refill the new prescription. 4 Notify the provider and discuss a written order for two 120-mg capsules of diltiazem hydrochloride.

2 Patients with depression are prescribed paroxetine (Paxil), which is an antidepressant medication. Plavix is the brand name of clopidogrel, which is an antiplatelet medication. Plavix sounds similar to Paxil. Antiplatelet drugs decrease the viscosity of the blood and increase the chances of bleeding; therefore, the patient may develop hemorrhage. Jaundice is caused by increased bilirubin in the blood, so the administration of antiplatelet drugs will not raise the blood level of bilirubin. Hypertension is caused by vasoconstriction. Antiplatelet drugs do not cause vasoconstriction and do not increase the risk of hypertension. Hypoglycemia is associated with a decrease in blood glucose levels. Antiplatelet drugs do not cause a drop in blood glucose levels.

A patient with depression has been prescribed paroxetine (Paxil). During the follow-up visit, the nurse finds that the patient has been taking Plavix instead of paroxetine (Paxil). What does the nurse expect from this finding? 1 The patient is at risk of jaundice. 2 The patient is at risk of hemorrhage. 3 The patient is at risk of hypertension. 4 The patient is at risk of hypoglycemia.

3, 4, 5 According to the National Coordinating Council for Medication Error Reporting and Prevention, medication errors can be classified as those that cause patient harm, those that cause death, and those that cause no patient harm. A category of medication errors that is nobody's fault does not exist. Medication errors that are not reported are still medication errors.

According to the National Coordinating Council for Medication Error Reporting and Prevention, what are the categories of medication errors? Select all that apply. 1 Those that are nobody's fault 2 Those that are never reported 3 Those that cause patient harm 4 Those that cause patient death 5 Those that cause no patient harm

2 Drugs that can cause severe harm, such as death or unconsciousness, to patients when administered in high concentrations are categorized under high alert. An oral hypoglycemic is a high-alert drug. The drug must be prescribed while giving caution to the patient. Drugs that cause less harm, such as mild headache and fever, can be categorized under low alert. Substances such as poisons that are fatal in the smallest of doses are placed in the highly toxic category. Substances that are fatal when consumed in high concentrations are categorized as low-toxicity drugs. Substances with either high or low toxicities are not usually prescribed as medications.

An oral hypoglycemic medication is in which category of medications? 1 Low alert 2 High alert 3 Highly toxic 4 Low toxicity

4 Using inappropriate language while speaking to the nurse indicates that the patient may have disruptive behavior. Disruptive behavior includes personal verbal or physical behavior that interferes with patient care. Impaired cognition is not associated with disruptive behavior. Impaired cognition occurs in patients with dementia and Alzheimer's disease. The stem of the question does not provide any information that the patient is expressing feelings or describe what they are. There is not enough information to determine if the behavior is disruptive. A patient experiencing an emotional outburst while speaking to the nurse is not indicative of disruptive behavior. The outburst could conceivably be part of a crying or violent episode. There is not enough information to make this judgment. This behavior does not indicate that the patient is trying to harm the nurse.

Following an assessment of a patient, the nurse concludes that the patient's behavior is disruptive. Which observation might lead the nurse to arrive at this conclusion? 1 The patient demonstrates impaired cognition. 2 The patient does not express feelings to the nurse. 3 The patient has an emotional outburst while speaking to the nurse. 4 The patient uses inappropriate language while speaking to the nurse.

1, 3, 4, 5 Medication errors can occur at any point in the medication process: prescribing, procuring, transcribing, dispensing, and administration. Verification is a step in the medication reconciliation process.

In which step of the medication process can a medication error occur? Select all that apply. 1 Prescribing 2 Verification 3 Procurement 4 Transcribing 5 Administration

3 There are multiple steps involved in the medication process. These include procuring, prescribing, transcribing, dispensing, administering, and monitoring. The majority of preventable adverse drug events begin at the prescribing step. However, most prescribing errors can be caught by the pharmacist before order entry and by nurses before administration. In procuring, dispensing, and transcribing steps, fewer chances of error exist as compared to the prescribing step.

In which step of the medication process do the majority of preventable adverse drug events begin? 1 Procuring 2 Dispensing 3 Prescribing 4 Transcribing

4 While doing the medication reconciliation, the nurse should instruct the patient to carry a current and complete list of medications in his wallet. In case of emergency or any mishap, it is helpful for the health care provider to know which medications the patient is taking. The nurse should initially ask the patient open-ended questions. It prevents the patient from simply answering yes or no and allows the patient to elaborate and give more information. The nurse should encourage the patient to learn the names and current doses of his medications. The nurse should avoid medical jargon because the patient may not understand some of the medical terms.

The nurse assesses a male patient who has renal failure. Which action should the nurse take during medication reconciliation of the patient? 1 The nurse initially asks the patient closed-ended questions. 2 The nurse uses medical jargon while interacting with the patient. 3 The nurse encourages the patient to remember a few medications. 4 The nurse instructs the patient to keep a list of medications in his wallet.

2 The most common medication errors in pediatrics occur because of incorrect dose calculations. These are called dosing errors. Mathematical dosage calculations for pediatric patients are problematic because of their smaller body size. Less immunity does not increase the chances of medication errors. Not all pediatric patients are susceptible to allergic reactions. The route of administration is clearly mentioned in the prescription, so there is less chance of this error.

The nurse in a pediatric facility notes that medication errors are more prevalent in the pediatric population than in the adult population. What is the probable reason for this difference? 1 Pediatric patients have weaker immune systems. 2 Pediatric patients have incorrect dose calculations. 3 Children have a higher susceptibility to allergic reactions. 4 An incorrect route of administration is used with children.

1 The nurse should immediately prepare a document regarding the medication error and submit it to the nurse manager. Errors made by students and professionals must be reported promptly. It helps to take precautions in the future and to provide effective care to patients. The nurse should report all medication errors regardless of the severity. The student nurse may be depressed because of the error. The student nurse must not be excused for the medication error. Advising students immediately regarding their responsibility and the necessity of being cautious can make them feel criticized and helpless.

The nurse instructs a nursing student to administer 40 mg of furosemide to a patient who has liver cirrhosis. The patient develops sweating and hypotension after receiving the medication. The nurse learns that the student nurse has administered an 80-mg tablet of furosemide. What is the most appropriate response by the nurse? 1 "I need to complete an incident report on the error you made." 2 "As the patient had a very minor side effect, I will not report it." 3 "I consider this to be your first mistake, and I excuse you this time." 4 "It is the nurse's responsibility to be cautious while caring for the patient."

2 The abbreviation D/C means discharge, so the nurse should prepare the discharge papers for the patient. The abbreviation p.c. indicates that the medications must be given after meals. The abbreviation TID indicates that the medications must be administered twice a day. To discontinue medication, STOP must be written under the list of medications.

The nurse is assigned to care for a patient who has schizophrenia. The nurse notes an order by the provider to D/C the medications. To avoid a possible error, what should have been written on the order instead of the abbreviation? 1 Administer the medications after every meal. 2 Prepare discharge instructions for the patient. 3 Administer the medications three times a day. 4 Discontinue administering the medications to the patient.

4 Medication errors usually occur with look-alike or sound-alike drugs. In this case, the nurse could have administered MiraLax, a laxative drug, instead of Mirapex, an antiparkinson drug, as a result of which the patient experienced diarrhea. Duragesic and Sufenta are anesthetic drugs and are not used for treatment of parkinsonism. Celebrex is an antiinflammatory drug, and Celexa is an antidepressant drug. These drugs are not used for the treatment of parkinsonism. Lamictal is an anticonvulsant drug, and Lamisil is an antifungal drug. These drugs are not used for the treatment of Parkinson disease.

The nurse is caring for a patient who has Parkinson disease. The nurse observes that even after a prescribed drug is administered, the patient's condition remains the same and that the patient also develops diarrhea. What is the probable reason for the drug's ineffectiveness? 1 The nurse administered fentanyl (Duragesic) instead of sufentanil (Sufenta). 2 The nurse administered celecoxib (Celebrex) instead of citalopram (Celexa). 3 The nurse administered lamotrigine (Lamictal) instead of terbinafine (Lamisil). 4 The nurse administered polyethylene glycol (MiraLax) instead of pramipexole (Mirapex).

1 Large numbers of drugs are similar in spelling or pronunciation, which can lead to medication errors. Plavix and Paxil are drug names that sound alike. The nurse administered Plavix, an antiplatelet drug, instead of Paxil, an antidepressant drug. This error may have occurred because the nurse did not hear or read the prescription properly. As the nurse administered antiplatelet drug to the patient, the patient is at a high risk of bleeding. Antiplatelet drugs are usually prescribed for preventing stroke, pulmonary embolism, and myocardial infarction.

The nurse is caring for a patient who has depression. While reviewing the nurse's medication administration record (MAR), the nurse manager finds that the nurse has administered clopidogrel (Plavix) instead of paroxetine (Paxil). What is the most likely consequence of this medication error? 1 The patient is at a high risk of bleeding. 2 The patient is at a high risk of developing a stroke. 3 The patient is at a high risk of pulmonary embolism. 4 The patient is at a high risk of myocardial infarction.

1 The nurse should properly represent the dosage of the medication to prevent medication errors. The appropriate method of representation is "5 mg" or "five mg." The nurse should not use decimals because they can be misread, for example, as 5 g, which can cause a drug overdose. The nurse should avoid using trailing zeros while writing the prescription; 5.0 mg can be misinterpreted as 50 mg, so it is not an appropriate method. Writing "1mgX5" can be interpreted as administering a 1-mg tablet 5 times a day, so it should not be done.

The nurse is caring for a patient who is diagnosed with borderline personality disorder. The primary health care provider orders 5 mg of diazepam to treat anxiety in the patient. How will the nurse transcribe this prescription? 1 5 mg of diazepam 2 005 g of diazepam 3 5.0 mg of diazepam 4 1mgX5 of diazepam

2 Serotonin syndrome is caused by overdose of antidepressants such as fluoxetine. The abbreviation "QD" is from the Latin words quaque die, which mean "every day." The prescription orders that the medication be taken every day, but the patient took the medication four times a day. Therefore, this action led to the development of serotonin syndrome. Taking medication after meals will not increase the risk of drug toxicity and does not cause serotonin syndrome. Administration of the drug every alternate day will not cause serotonin syndrome. Drinking water with the medication will not cause serotonin syndrome. Abbreviations should be avoided whenever possible to avoid this type of error.

The nurse is caring for a patient with depression who has been prescribed fluoxetine QD. During the follow-up visit, the nurse finds that the patient has developed serotonin syndrome. Which action could have resulted in this complication? 1 Taking fluoxetine after meals 2 Taking fluoxetine four times a day 3 Taking fluoxetine every alternate day 4 Taking fluoxetine with a glass of water

1 The nurse should arrange for an interpreter. The nurse should not interpret what the patient is trying to say, because the patient's concern may not be the same as what the nurse assumes it to be. The nurse should not request that the patient speak English, because the patient does not speak English. The nurse should not contact the primary health care provider unless there are concerns regarding medication administration, adverse reactions, or complications.

The nurse is caring for a patient with multiple fractures who does not speak English. The patient is trying to express her feelings to the nurse, but the nurse does not understand. What is the nurse's best action? 1 Arrange for an interpreter 2 Interpret what the patient is saying 3 Contact the primary health care provider 4 Request the patient to try speaking English

3 The nurse should take special precautions while administering drugs to the patient. Checking prescriptions for look-alike and sound-alike drugs helps to reduce medication errors. It is easy to administer the wrong medication when the medications sound alike (e.g., Zantac and Xanax). If the nurse has any doubt regarding a medication, the nurse should consult with the primary health care provider to check whether the medicine needs to be replaced. The nurse should avoid giving a low dose of a drug during the first administration because only an accurate dose will give the desired therapeutic effect. If the nurse has doubt, the drug should be cleared before administration. If the route of administration is not mentioned, it should be confirmed and only then should the drug be administered to the patient. The nurse should not administer a drug by the intravenous route if the route is not mentioned in the prescription. The nurse who is in doubt about the route should clarify it with the health care provider.

The nurse is preparing two medications for a patient who has peptic ulcer disease and notes that ranitidine (Zantac) is prescribed but alprazolam (Xanax) is in the patient's medication drawer. Which strategy will the nurse incorporate to prevent a medication error? 1 Replace the prescribed medicine if there are any questions. 2 Give low doses of the medication during the first administration. 3 Double-check prescriptions for drugs that look alike or sound alike. 4 Use an intravenous route of administration if the route is not mentioned.

4 The nurse should recalculate the dose before administration. Medications in the digitalis category have a narrow margin between therapeutic serum drug level and toxic level. A dosing error will lead to severe adverse effects in the patient. If the prescription mentions that the drug should be administered in elixir form, the nurse should not administer the drug in tablet form. Administering drugs in high doses will lead to severe adverse reactions for the patient; thus it should be avoided. Administering correct doses to the patient does not require the nurse to replace the drug.

The primary health care provider prescribes digoxin elixir for a patient. What precaution should the nurse take before administering the drug? 1 Administer the drug in tablet form. 2 Administer a high dose of the drug. 3 Replace the drug with the generic form. 4 Recalculate the dose before administration.

2 Speak Up is a patient public awareness program started to encourage patients to take a more active role in their health care by speaking up and asking questions whenever they feel the need to do so. The nurse encourages the patient to ask any questions related to the health care provided. Expressing gratitude to the hospital staff is not the motive of the Speak Up program. This forum encourages asking questions about the health care, but it is not associated with the patients' complaints about the hospital. Patients are always free to talk and discuss issues with other patients in the hospital. This, however, is not the purpose of the Speak Up program.

The nurse is teaching a patient about the Speak Up awareness program. What information should the nurse give the patient? 1 "You are free to express your gratitude to the hospital staff." 2 "You are free to ask any questions about the health care provided." 3 "You are free to report the problems that you have with the hospital." 4 "You are free to talk to other patients and discuss your issues with them."

1 The nurse should arrange for a translator while interacting with the patient who has a language barrier. It helps the patient to effectively understand all teaching regarding precautions and the frequency of drug administration. The nurse should clearly explain the instructions before asking the patient to read the black box warning, as patients may not understand some of the instructions. The nurse should arrange for a translator rather than asking the patient to call her caregiver. The caregivers may not be able to properly convey the instructions given by the nurse. Nurse teaching techniques such as how to provide a self-injection of insulin therapy will not help the patient understand the complete drug information. The nurse should demonstrate the technique in the presence of a translator so the patient can follow the instructions of the nurse.

The nurse is teaching a patient with diabetes mellitus about medications. The patient is prescribed an oral hypoglycemic and insulin twice a day. The nurse notes that the patient has difficulty understanding instructions because of a language barrier. Which action will help the patient understand the instructions? 1 The nurse will obtain a translator to assist with teaching. 2 The nurse will instruct the patient to read the black box warnings. 3 The nurse will advise the patient to call the health care provider for more information. 4 The nurse will demonstrate how to administer the medication and will provide written information.

3 The student nurse who commits a medication error should immediately report it to the clinical instructor. This helps to provide appropriate treatment and care to the patient. The student nurse should not decide on his or her own what needs to be done and administer the glucose to the patient without consulting the clinical instructor. After giving immediate care to the patient, it is the responsibility of the clinical instructor to inform the nurse manager. The student nurse should not change the dose without consulting the primary health care provider.

The nursing student administers 40 units of insulin to a patient and then realizes that the patient should have received 35 units of insulin. What is the most appropriate action? 1 Administer glucose to the patient 2 Immediately inform the nurse manager 3 Immediately inform the clinical instructor 4 Administer 30 units of insulin in the next dose

35 mL The nurse should be able to appropriately administer medications to patients to avoid medication errors. If the nurse has to administer 350 mg of a medication to a patient from a vial containing 1 g/100 mL concentration of a drug, then the nurse should withdraw 35 mL of medication from the vial and give it to the patient. 1 g = 1000 mg, so the amount of drug in the vial per milliliter = 1000 mg/100 mL = 10 mg/mL. If 1 mL of the medication contains 10 mg of the drug, then for 350 mg the nurse should administer 35 mL of the medication intravenously. If the nurse administers 0.35 mL it may not help to relieve pain because it is too low a dose; 3.5 mL is 35 mg, which is again a low dose; and 350 mL of medication constitutes 35 g, which can be fatal and can cause hepatotoxicity because it is an extremely high dose.

The primary health care provider prescribes acetaminophen 350 mg intravenously for pain. A concentration of 1 g/100 mL of acetaminophen is available. How many milliliters will the nurse administer? Record your answer using a whole number. _____

1, 2, 3, 4, 5 The five rights of medication administration include right time, right drug, right dose, right route, and right patient. These rights help in prevention of medication errors by ensuring that the right patient gets the right drug in the prescribed safe dose, through the most effective route and at the right time. Right disease is not a right of medication administration.

What are five basic rights of medication administration that the nurse should keep in mind? Select all that apply. 1 Right time 2 Right drug 3 Right dose 4 Right route 5 Right patient 6 Right disease

3 In February 2004, the FDA passed legislation requiring bar codes for all prescription and over-the-counter medications.

What organization announced new regulations requiring bar codes for all prescription and over-the-counter medications? 1 Drug Enforcement Agency (DEA) 2 Federal Bureau of Investigation (FBI) 3 U.S. Food and Drug Administration (FDA) 4 Department of Health and Human Services (DHHS)

1, 4, 5 Special care should be taken while administering medications to the pediatric patient. The nurse should know the drug thoroughly. That is, the nurse should know the label claim, drug action, adverse effects, safe dosage ranges, routes of administration, high-alert drug status cautions, and contraindications. The nurse should avoid distractions while giving medications to decrease the risk of medication errors. The nurse should verify information in handwritten prescriptions. Use authoritative resources such as drug handbooks to clarify how to use the drug. The nurse should avoid verbal and telephone prescriptions. When this is unavoidable, the nurse should repeat the information back to the prescriber.

What precautions will the nurse take to prevent pediatric medication errors? Select all that apply. 1 Know the drug thoroughly. 2 Avoid the use of drug handbooks. 3 Use verbal telephone prescriptions. 4 Avoid distractions while giving medications. 5 Verify information in handwritten prescriptions.

4 Medication reconciliation is the process of reviewing the patient's medications any time the patient is admitted, transferred, or discharged. The nurse should perform medication reconciliation before transferring the patient to the intensive care unit. This is because changes could have been made to the original medication list. Medication reconciliation must be done before the patient is discharged, before the patient is in surgery, and before the patient undergoes a radiologic test. It helps to avoid medication errors that can occur as a result of drug interaction.

When should the nurse perform medication reconciliation for a patient? 1 After the patient is discharged 2 While the patient is in surgery 3 While the patient is undergoing a radiologic test 4 Before the patient is transferred to the intensive care unit

2, 3, 5 Pediatric patients and older adults are at a greater risk of having medication errors. Among pediatric patients, those in an intensive care unit are more susceptible to medication errors because of drug interactions. Chemotherapeutic agents are high-alert drugs, and inappropriate dosage can cause adverse effects. In the emergency department on the weekend, patients may be misdiagnosed because of the lack of staff. Patients younger than the age of 2 years are more susceptible to medication errors because of inaccurate dosage adjustments. Determining a patient's weight helps in the prescription of the appropriate dose.

Which groups of pediatric patients are at a higher risk of medication errors? Select all that apply. 1 Patient who are 5 years old or older 2 Patients admitted in an intensive care unit 3 Patients receiving chemotherapeutic agents 4 Patients whose weight is accurately determined 5 Patients in the emergency department on the weekend

2, 4, 5 Medications that can cause severe adverse effects in patients are categorized as high-alert medications. The nurse should carefully monitor patients who are prescribed high-alert medications. Inotropic drugs, radiocontrast agents, and chemotherapeutic agents are included in the category of high alert. These drugs have low therapeutic indices. Diuretics and antiemetic drugs are not included in the high-alert category because they do not have narrow therapeutic indices.

Which medications fall within the high-alert category? Select all that apply. 1 Diuretic agents 2 Inotropic drugs 3 Antiemetic agents 4 Radiocontrast agents 5 Chemotherapeutic agents

3 Computerized order entry helps to standardize prescribing functions because it avoids errors caused by abbreviations and handwriting. It also helps as a backup source in case the patient loses the prescription. Frequent monitoring helps the nurse to document the patient's response to the medications. Bar coding helps to check whether the patient is receiving the correct medication that was prescribed by the primary health care provider. Standardizing guidelines helps to provide effective care but does not help to completely minimize errors in prescription caused by poor handwriting.

Which method helps to standardize medication prescription? 1 Frequent monitoring 2 Bar coding of medication 3 Computerized order entry 4 Standardization of guidelines

3 Medications on the high-alert list have been identified as such because of their potentially toxic nature and the need for special care when prescribing, dispensing, and administering them. High-alert medications are not necessarily involved in more errors than other drugs; however, the potential for patient harm is higher.

Why are specific medications classified as "high-alert" medications? 1 Medications always cause certain adverse effects. 2 Only RNs are allowed to administer these medications. 3 Potential for patient harm is higher with these medications. 4 States require these medications to be on the high-alert list.