chapter 29 medications

Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: The nurse is preparing to draw up a medication that is supplied in a glass ampule. Arrange the following steps in the correct order. 1. Attach sterile administration device to the syringe. 2. Wrap a small gauze pad around neck of ampule. 3. Discard filter needle. 4. Withdraw medication. 5. Attach filter needle to the syringe. 6. Break off top of the ampule.

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

A nurse needs to administer a prescribed injection to an elderly client with impaired mobility. Which of the following intramuscular sites is preferred for administering an injection to elderly clients? a) Vastus lateralis b) Upper chest c) Ventrogluteal d) Gluteus maximus

The ventrogluteal or deltoid muscles may be the preferred intramuscular sites for older adults experiencing impaired mobility. The dorsogluteal site, which has the gluteus maximus, should be avoided because of the risk of damage to the sciatic nerve with diminished musculature. The vastus lateralis muscle site is most suitable for small children and infants or clients who are extremely thin. The upper chest muscle is part of intradermal injections, not intramuscular injections. p.730

Choice Multiple question - Select all answer choices that apply. Which of the following actions are included in the required "checks" for safe medication administration? Select all that apply. a) Read the medication label when reaching for the unit dose package. b) Read the medication label after retrieving the medication from the drawer. c) Read the medication label after observing the patient take the medication. d) Read the medication label just before administering a unit dose medication to the patient. e) Read the label whenever the patient questions the appearance of the medication.

a. Read the medication label when reaching for the unit dose package. d. Read the medication label just before administering a unit dose medication to the patient. b. Read the medication label after retrieving the medication from the drawer. Although this action is correct, it is not one of the "three checks" (it does routinely occur). p.738

When the client demonstrates a rash 30 minutes after she has taken a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction? a) Allergy b) Antagonistic c) Anaphylaxis d) Idiosyncratic

a. allergy Allergic reactions result from an immunologic response to a substance to which the client is sensitized. p.728

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which of the following guidelines for needle selection might they discuss? a) As the gauge number becomes larger, the size of the needle becomes smaller. b) When giving an injection, the amount of the medication directs the choice of gauge. c) 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. d) The size of the syringe is directed by the viscosity of the medication to be given.

a. as the gauge number becomes larger, the size of the needle becomes smaller The larger the gauge, the smaller the needle. The first number on a needle package is the gauge or diameter of the needle and the second number is the length in inches. When giving an injection, the viscosity of the medication directs the choice of gauge. The size of the syringe is directed by the amount of the medication to be given. p.745

At what point should the nurse perform the first of the three checks of medication administration? a) As the nurse reaches for the drug package or container b) When reviewing the client's medication administration record (MAR) c) After retrieving the drug from the drawer of a drug cart d) At the beginning of a shift

a. as the nurses reaches for the drug package or container The first of the three checks associated with safe medication administration takes place when the nurse reaches for the container or unit dose package. p. 767

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear? a) Ask the client to maintain the position for some time b) Instill the medication in the opposite ear if prescribed c) Place a cotton ball in the ear to absorb excess medication d) Briefly postpone the application in the second ear

a. ask the client to maintain the position for some time. After instilling the prescribed number of drops in the client's ear, the nurse should ask the client to maintain the position briefly until the solution travels toward the eardrum. When instilling the medication in the client's ear, the nurse first manipulates the client's ear to straighten the auditory canal. Tilting the client's head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client. p.761

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

a. ask the physician to write out the order. rationale: To maintain the accuracy of a verbal order, the nurse should tactfully ask the physician for a written order. When obtaining phone orders, it is important to repeat the dosages of medications and to spell medication names for confirmation of accuracy. Some nurses may ask a second nurse to listen to a telephone order on an extension. p. 732

A nurse is providing care for a patient who has a history of dementia. Which of the following methods should the nurse use in order to determine the patient's identity prior to medication administration? a) Check the patient's identification band. b) Cross-reference the MAR with the patient's medical record. c) Enlist the help of a colleague who is familiar with the patient. d) Ask the patient his or her name prior to giving the drug.

a. check the patient's identification band. For all patients, the preferred method of confirming identity is to read the patient's identification band. p. 739

Choice Multiple question - Select all answer choices that apply. The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply. a) Client b) Prescribing physician c) Dosage d) Route e) Medication f) Pharmacy

a. client c. dosage d. route e. medication To prevent medication errors, always ensure that the: (1) Right medication is given to the (2) right client in the (3) right dosage through the (4) right route at the (5) right time. p. 738

A nurse educator is reviewing information related to medication administration documentation with a group of graduate nurses. Which guideline for documenting will the nurse discuss with the group? a) Document administration of the medication immediately after administering the drug. b) Document administration of the medication at the end of your nursing shift. c) Document administration of the medication after you determine it caused no side effects. d) Document administration of the medication immediately prior to giving the drug.

a. document administration of the medication immediately after administering the drug Record each dose of medication as soon as possible after it is given and do not record medications before they are given. Documenting immediately after administering a drug provides a documented record that can be consulted if there are any questions about whether the patient received the medication. p. 742

Choice Multiple question - Select all answer choices that apply. The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply. a) Dosage b) Pharmacy c) Route d) Medication e) Prescribing physician f) Client

a. dosage c. route d. medication f. client To prevent medication errors, always ensure that the: (1) Right medication is given to the (2) right client in the (3) right dosage through the (4) right route at the (5) right time. p.738

Which of the following clients is likely to have altered metabolism of medications? a) Elderly b) School-age children c) Adolescents d) Middle adults

a. elderly Metabolism is the process of chemically changing the drug in the body. Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized. p.730

A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which of the following actions should the nurse perform to prevent gastric reflux? a) Help the client into a Fowler's position. b) Administer the medication over several minutes. c) Check for drug allergies in the client's history. d) Add diluted medication to the syringe.

a. help the client into a Fowler's position Assuming Fowler's position can help prevent gastric reflux when medications are administered through an enteral tube. The nurse checks the client's medical history for drug allergies to avoid potential complications. Adding diluted medication to the syringe as it becomes nearly empty prevents instilling air into the syringe. Administering the medication over several minutes has no effect on reflux. p.744

Which of the following accurately describes a recommended guideline when administering oral medications to patients? a) If a child refuses to take medication, the medication can be crushed and added to a small amount of food. b) If a patient vomits immediately after receiving oral medications, readminister the medication. c) If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. d) Assume that the patient is the authority on whether or not the medication was swallowed.

a. if a child refuses to take medication, the medication can be crushed and added to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If it is questionable whether the medication was swallowed, check the patient's mouth and cheeks. If a pill is dropped, it should be discarded, and if a patient vomits, notify the physician to see if the medication should be readministered. p. 744

A nurse is performing a sensitivity test on a patient. What would be the best type of injection to use for this procedure? a) Intradermal b) Intramuscular c) Subcutaneous d) None of the above

a. intradermal Intradermal injections are administered into the dermis, just below the epidermis. The intradermal route has the longest absorption time of all parenteral routes. For this reason, intradermal injections are used for sensitivity tests, such as tuberculin and allergy tests, and local anesthesia. The advantage of the intradermal route for these tests is that the body's reaction to substances is easily visible, and degrees of reaction are discernible by comparative study. p. 749

The Z-track technique is utilized during drug administration by which of the following routes? a) Intramuscular b) Intravenous c) Subcutaneous d) Intradermal

a. intramuscular The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. p. 754

A post-surgical patient's MAR provides for PRN administration of a number of analgesics by various routes. Which of the following routes will likely provide the most rapid pain relief for the patient? a) Intravenous b) Subcutaneous c) Intramuscular d) Oral

a. intravenous Intravenous drugs, because they are introduced directly into the circulatory system, have an onset that is faster than that of IM, SC, or PO routes. p. 755

Which of the following factors is associated with rapid absorption of a drug? a) Intravenous route of administration b) Basic environment in the stomach c) Oral route of administration d) Decreased blood flow

a. intravenous route of administration Drugs administered intravenously are placed directly into the bloodstream, and thus technically are not absorbed and take effect quickly. Other factors that increase drug absorption are an acid stomach environment and increased blood flow. p.755

Choice Multiple question - Select all answer choices that apply. A nurse is caring for a client who has been prescribed codeine, a narcotic medication to relieve severe postoperative pain. Which of the following responsibilities does the nurse have to complete when handling narcotic medications? Select all that apply. a) Maintain an accurate account of the use of the medication b) Count each narcotic medication at the change of each shift c) Place the medication with other medications on the nursing unit d) Place the medication in the container with other prescribed medications e) Record each medication used from the stock supply

a. maintain an accurate account of the use of the medication b. count each narcotic medication at the change of each shift e. record each medication used from the stock supply When handling narcotic medications, the nurse should have an accurate account of the use of the medications, a record of each medication used from the stock supply, and the nurse should count each narcotic at the change of each shift. Narcotic medications are controlled substances, meaning that federal laws regulate their possession and administration. The nurse should not place the medication in the container with other prescribed medications or place the medication along with other medications on the nursing unit. An individual supply is placed in a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay. p. 739

What is involved in the absorption, distribution, metabolism, and excretion of medication? a) Pharmacokinetics b) Pharmacology c) Pharmacotherapeutics d) Pharmacodynamics

a. pharmacokinetics Pharmacokinetics involves the absorption, distribution, metabolism, and excretion of a medication. p. 725

A nurse uses a nitroglycerin paste to dilate the coronary arteries of a client at the health care facility. What should the nurse do facilitate the medication absorption? a) Place application paper on a non-hairy area of skin b) Rotate the site of medication placement c) Avoid touching the application with bare fingers d) Remove one application before applying another

a. place application paper on a non-hairy area of skin When applying a nitroglycerin paste to dilate the client's coronary artery, the nurse should place an application paper on a clean, non-hairy area of skin to facilitate medication absorption. Rotating the site of medication placement helps reduce potential skin irritation. The nurse should avoid touching the paste with bare fingers because it could cause self-absorption of the medication. To prevent excessive medication levels in the client, the nurse should remove the application before applying another and remove any residue remaining on the skin. p. 758

Regarding medication administration, what must occur at the change of shifts? a) The narcotics for the division are counted b) The LPNs only on the division count medications c) The client's medications must be drawn up d) The medications for the division are counted

a. the narcotics for the division are counted Healthcare facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine). p. 739

A nurse needs to administer a prescribed injection to a toddler. Which of the following injection sites is most suitable for the client? a) Vastus lateralis site b) Dorsogluteal site c) Ventrogluteal site d) Deltoid site

a. vastus lateralis site The vastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles. The dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed; whereas, the ventrogluteal site is safe for children. The deltoid site is the least-used intramuscular injection site because it is a smaller muscle than the others. It is used only for adults because the muscle is not sufficiently developed in infants and children. p. 752

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which of the following situations? a) When the client has disorders that affect the absorption of medications b) When the drug needs to be administered only once c) When the drug needs to act on the client very slowly d) When the client wants to avoid the discomfort of an intradermal injection

a. when the client has disorders that affect the absorption of medications Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections. A single administration of a drug does not indicate the need for intravenous administration. p. 755

A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client with influenza. Which of the following precautions should the nurse take when combining drugs? a) Withdraw exact amounts of each drug from each container. b) Shake the two drug containers before withdrawing. c) Expel both the drugs separately in a vial before use. d) Mix the two drugs together thoroughly before administering.

a. withdraw exact amounts of each drug from each container. When combining more than one drug in a single syringe, the nurse should take exact amounts from each drug container because, once the drugs are in the barrel of the syringe, there is no way to expel one without expelling the other. Mixing the two drugs before administering or shaking the drug containers before withdrawing is not suitable because it can cause chemical reactions and precipitates. Expelling both the drugs separately in a vial before use could also lead to a chemical reaction, which often causes a precipitate to form. p. 748

The nurse is beginning to administer oral medications to a client. The client states, "I haven't taken that pill before. Are you sure it's correct?" You recheck the CMAR/MAR and find that the medication is scheduled to be administered. Which of the following responses is most appropriate? a) "Go ahead and take it, and then I'll check with your primary care provider about it." b) "Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." c) "It's listed here on the CMAR/MAR, so you should take it." d) "It wouldn't be listed on this CMAR/MAR if it wasn't prescribed for you."

b. "don't take that pill yet. I will verify that the medications was ordered by your primary care provider." This action indicates adherence to the five rights of medication administration. p. 735

A physician at the health care facility orders 500 mg of a medication to be administered by the oral route, four times a day for a client. The medication is available in a form of 250 mg per 5 mL. What quantity of the medication should the nurse administer to the client? a) 15 mL b) 10 mL c) 20 mL d) 30 mL

b. 10 mL The nurse needs to administer 10 mL of the medication as per the physician's prescription in the medication order. The nurse uses the following formula in order to calculate the amount of medication to administer: Desired Dose/Dose on Hand (supplied dose) Quantity. Applying the formula to the information provided in the medication order: 500 mg/250 mg 5 mL = 10mL. p.737

A nurse needs to administer an intradermal tuberculin skin test injection to a client. Which of the following is the most suitable angle when administering an intradermal injection? a) 45-degree angle b) 10-degree angle c) 180-degree angle d) 90-degree angle

b. 10-degree angle When administering an intradermal injection, the nurse should hold the syringe almost parallel to the skin at a 10-degree angle with the bevel pointing upward. This facilitates delivering the medication between the layers of the skin and advances the needle to the desired depth. A nurse administers a subcutaneous injection at a 45-degree angle or a 90-degree angle to reach the subcutaneous level of tissue, depending on the length of the needle. The nurse will not be able to insert the injection if it is held at a 180-degree angle. p. 788

A nurse is caring for a patient with pancreatic cancer who is receiving continuous morphine for pain. Which of the following would be the most effective method to administer this medication? a) Administer morphine by intravenous bolus or push through an intravenous infusion. b) Administer a continuous subcutaneous infusion of morphine. c) Administer an intermittent intravenous infusion of morphine via a volume-control administration set. d) Administer a piggyback intermittent intravenous infusion of morphine.

b. Administer a continuous subcutaneous infusion of morphine. Some medications, such as insulin and morphine, may be administered continuously via the subcutaneous route. Advantages of continuous subcutaneous medication infusion include the longer rate of absorption via the subcutaneous route and convenience for the patient. p. 750

A nurse is administering a prescribed dose of medication to a client through a medication lock. How often should the nurse flush the medication lock to maintain patency? a) Every 72 to 96 hours b) Every 8 to 12 hours c) Every 36 to 48 hours d) Every one or two hours

b. Every 8 to 12 hours To maintain patency, nurses usually flush medication locks every 8 to 12 hours with saline or heparin. Nurses do not flush medication locks every one or two hours, 36 to 48 hours, or every 72 to 96 hours to maintain patency. In fact, nurses change medication locks either when they change the IV site or at least every 72 hours. p.810

You are caring for a patient who just returned from the postanesthesia care unit (PACU) and rates current pain as "9 out of 10." Which of the following prescribed medications will provide the fastest relief from pain? a) Intramuscular ketorolac tromethamine (Toradol) b) Oral acetaminophen and oxycodone (Percocet) c) Intravenous morphine sulfate d) Oral acetaminophen with codeine (Tylenol #3)

c. intravenous morphine sulfate The intravenous route has the most rapid onset. p.755

A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client with influenza. Which of the following precautions should the nurse take when combining drugs? a) Mix the two drugs together thoroughly before administering. b) Withdraw exact amounts of each drug from each container. c) Shake the two drug containers before withdrawing. d) Expel both the drugs separately in a vial before use.

b. Withdraw exact amounts of each drug from each container. When combining more than one drug in a single syringe, the nurse should take exact amounts from each drug container because, once the drugs are in the barrel of the syringe, there is no way to expel one without expelling the other. Mixing the two drugs before administering or shaking the drug containers before withdrawing is not suitable because it can cause chemical reactions and precipitates. Expelling both the drugs separately in a vial before use could also lead to a chemical reaction, which often causes a precipitate to form. p.748

A nurse is administering an intramuscular injection to a client using the zig-zag technique. Which of the following actions should the nurse perform to prevent leaking and ensure sealing of medication in the subcutaneous and dermal layers of tissue? a) Manipulate the plunger with the help of the thumb. b) Withdraw the needle and release taut skin immediately after injection. c) Insert the needle at a 90-degree angle into the tissue. d) Apply pressure and massage the site immediately.

b. Withdraw the needle and release taut skin immediately after injection. Withdrawing the needle and immediately releasing the taut skin creates a diagonal path that prevents the medication from leaking into the subcutaneous and dermal layers of tissue. Manipulating the plunger with the help of the thumb avoids releasing the tissue held taut by the non-dominant hand. Applying pressure, but not massaging the site, ensures that the medication remains sealed. Inserting the needle at a 90-degree angle directs the tip of the needle within the muscle. p.797

A nurse is administering a piggyback infusion to a client with second-degree burns. Which of the following describes the most important feature of a piggyback infusion? a) Primary IV solution is infused by gravity b) A parenteral drug is given in tandem with IV solution c) Medication locks are changed every 72 hours d) Medication is given all at one time as quickly as possible

b. a parenteral drug is given in tandem with IV solution In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency. IV medication or fluid is given all at one time as quickly as possible in a bolus administration, not in piggyback infusion. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution. p.756-757

A client diagnosed with anemia is receiving a blood transfusion. The client develops urticaria accompanied by wheezing and dyspnea not long after the transfusion starts. The nurse interprets this as indicative of which of the following? a) Antagonism b) Allergic reaction c) Side effect d) Toxicity

b. allergic reaction With urticaria, hives, wheezing, and dyspnea are the symptoms of severe allergic reaction, which is due to an anaphylactic reaction. Minor adverse effects are called side effects. Many side effects are essentially harmless and can be ignored. Toxicity results from overdosage or buildup of medication in the blood due to impaired metabolism and excretion. Antagonism is a drug interaction by which drug effects decrease. p. 728

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which of the following actions should the nurse perform when administering oral medication to the client? a) Bring the prescribed medication in a ceramic cup or glass container. b) Avoid administering medication prepared by another nurse. c) Prepare the exact dosage of medication in front of the client. d) Check the label of the medication container three times at the bedside.

b. avoid administering medication prepared by another nurse. A nurse should never administer medications prepared by another nurse. The nurse administers only those medications that he or she has prepared. The nurse should prepare and bring oral medications to the client's bedside in a paper or plastic cup, not in a glass container or ceramic cup, in order to avoid accidents and spills. The nurse checks the label of the medication container three times when preparing it, not when administering it to the client. p.738-739

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

b. avoid crushing sustained-release pellets. When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. 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. Additionally, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, 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. p. 743

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

b. cleanse area at the vaginal orifice with washcloth and warm water The following is the procedure for applying a vaginal cream: Position the patient so that she is lying on her back with the knees flexed. Spread labia with fingers, and cleanse area at vaginal orifice with washcloth and warm water, using a different corner of the washcloth with each stroke. Wipe from above the vaginal orifice downward toward the sacrum (front to back). Spread the labia with the nondominant hand and introduce the applicator with the dominant hand gently, in a rolling manner. p. 763

A nurse is administering medication to a patient with a gastrointestinal tube. Which of the following is a recommended guideline for medication administration using this route? a) Use solid medications whenever possible. b) Crush medications to a fine powder and mix with 15 to 30 mL of water. c) Do not open capsules to empty into liquid. d) Follow medication administration with a 30- to 60-mL water flush between medication doses.

b. crush medications to a fine powder and mix with 15 to 30 mL of water Medications should be crushed to a fine powder and mixed with 15 to 30 mL of water before delivery through the tube. Use liquid medications when possible, because they are readily absorbed and less likely to cause tube occlusions. Certain solid dosage medications can be crushed and combined with liquid. Certain capsules may be opened, emptied into liquid, and administered through the tube (Toedter Williams, 2008). Administer the first dose of medication by pouring it into the syringe and following with a 5- to 10-mL water flush between medication doses. Follow the last dose of medication with 30 to 60 mL of water flush. p. 744

A nurse needs to use a moisturizer for an older adult client with dry skin. Why is the onset of the medication action atypical in an older adult client? a) Decreased appetite b) Diminished subcutaneous fat c) Diminished physical mobility d) Decreased body temperature

b. diminished subcutaneous fat The onset of medication action is atypical for topical medications due to diminished subcutaneous fat, resulting in quicker absorption. Decreased appetite, diminished physical mobility, and decreased body temperature may not lead to atypical action with relation to the application of topical medication. p. 730

A severe allergic reaction from a medication requires a) Dopamine b) Epinephrine c) Asprin d) Atarax

b. epinephrine A severe allergic reaction, called an anaphylactic reaction, requires immediate medical intervention because it can be fatal. Treatment includes discontinuing the medication and administering epinephrine, IV fluids, and antihistamines. p. 728

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

b. flush the tube with water between each drug administered. Guidelines to consider when administering a drug via nasogastric tube include positioning the client with the head of the bed elevated, administering the medication at room temperature for the client's comfort, flushing the tube with water between each drug administered, and avoiding the use of suction for 20 to 30 minutes after the drug is administered. p.744

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. Which of the following is a feature of a metered-dose inhaler? a) It has propellers that get activated during inhalation. b) It is a canister that contains pressurized medication. c) It suspends finely powdered medication. d) It is a battery-operated device that spins.

b. it is a canister that contains pressurized medication A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation. p. 763

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understand that this type of infusion is used for which situation? a) Medications that are toxic if given over short periods b) Medications that need to be infused over 20 to 60 minutes c) Medications that can be given through a capped intravenous port d) Medications that are given over 1 minute for rapid therapeutic effect

b. medications that need to be infused over 20 to 60 minutes Intermittent infusions are used for medications that need to be administered for an intermediate length of time, usually 20 to 60 minutes. The intravenous push technique is used for medications that can be given over 1 minute for rapid therapeutic effect and may be given into a continuously infusing IV set or into a capped IV port. The continuous infusion technique is used for medications that are toxic if given over short periods. p. 756

Which of the following routes of medication administration is most commonly prescribed? a) Topical b) Oral c) Subcutaneous d) Intravenous

b. oral Oral administration is the most commonly used route of administration. It is usually the route most convenient and comfortable for the patient. p.741

The physiologic and biochemical effects of a drug on the body defines a) Pharmacology b) Pharmacodynamics c) Pharmacotherapeutics d) Pharmacokinetics

b. pharmacodynamics Pharmacodynamics refers to the physiologic and biochemical effects of a drug on the body. p. 727

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

b. pharmacokinetics Pharmacokinetics is the process by which a drug moves through the body and is eventually eliminated. p. 725

A nurse is using a volume control set to administer a dose of prescribed medication to a client. The nurse opens the lower clamp until the tubing is filled with fluid and then reclamps it. Which of the following statements explains the nurse's action? a) Provides diluent for the medication b) Purges air from the tubing c) Removes colonizing microorganisms d) Mixes the drug throughout the fluid

b. purges air from the tubing The nurse opens the lower clamp until the tubing is filled with fluid and then reclamps it because doing so purges air from the tubing. In order to provide diluent for the medication, the nurse opens the clamp above the calibrated container, fills the chamber with desired volume of fluid, and reclamps. To remove colonizing microorganisms, the nurse swabs the injection port on the calibrated container. To mix the medication thoroughly with the fluid, the nurse rotates the fluid chamber back and forth. p. 804

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) A supply that remains on the nursing unit for use in emergency b) Self-contained packets that hold one tablet or capsule for individual clients c) Systems that contain frequently used medication for that unit d) A container with enough prescribed medications for several days for a client

b. self-contained packets that hold one tablet or capsule for individual clients. The nurse should understand that a unit dose supply method is a method in which self-contained packets hold one tablet or capsule for an individual client. An individual supply is a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay. Some facilities use automated medication-dispensing systems, which contain frequently used medications for that unit, any as-needed (PRN) medications, controlled medications, and emergency medications. p. 773

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason? a) The site is in close proximity to the sciatic nerve. b) The area is free of major blood vessels and fat. c) There is a high possibility of injecting into subcutaneous fat. d) The site lies close to the radial nerve.

b. the area is free of major blood vessels and fat. The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. The deltoid region for an intramuscular injection has little overlying subcutaneous fat and lies close to the radial nerve. p. 752

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

b. therapeutic range Therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. Peak level is the highest plasma concentration. Trough level is the point when the drug is at the lowest concentration. Half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body. p. 732

When the nurse administers the morning dose of a medication during the evening, which of the rights of medication administration has she failed to follow? a) Client b) Time c) Dose d) Medication

b. time When the nurse administers the right medication to the right client at the wrong time, the nurse has failed to follow the right time. p. 738

A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. The nurse knows that which of the following is the reason for bunching when injecting subcutaneously? a) To ensure the accuracy of landmarking b) To avoid instilling medication within the muscle c) To prevent needle-stick injuries d) To facilitate blood circulation at injection site

b. to avoid instilling medication within the muscle Nurses bunch tissue between the thumb and fingers before administering the injection to avoid instilling medication within the muscle. Bunching does not prevent needle-stick injuries, it does not facilitate blood circulation at the injection site, nor does it ensure the accuracy of landmarking. p. 750

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

b. to prevent blood clot formation The intermittent infusion devices are irrigated or flushed with a small quantity of sterile saline to prevent blood clot formation and thus maintain patency. Irrigating the device with a small quantity of sterile saline does not facilitate cannulation of the central vein. The intermittent infusion device itself maintains venous access without requiring the client to receive continuous infusion, thus allowing increased mobility for the client and minimizing danger of fluid overload. o.756

The primary reason for the Controlled Substances Act is a) To regulate the purchase of narcotics b) To prevent drug abuse c) To prevent overuse of antibiotics d) To regulate the purchase of antibiotics

b. to prevent drug abuse The primary reason for the Controlled Substances Act is to prevent drug abuse and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug abuse laws. p. 739

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

c. 1 mL The volume of a subcutaneous injection is usually up to 1 mL. An intramuscular injection is the administration of up to 3 mL of medication into one muscle or muscle group. Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01 to 0.05 mL. p. 749

A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which of the following describes the mechanism of a metered-dose inhaler? a) A device that forces liquid drug through a narrow channel using pressurized air b) A propeller-driven device that spins and suspends a finely powdered medication c) A canister containing medication that is released when the container is compressed d) A device that forces medication through a narrow channel with the help of inert gas

c. A canister containing medication that is released when the container is compressed A metered-dose-inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas. p. 763

A nurse is administering medication to a patient via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation? a) Remove the tube and replace it with a new tube. b) Call the physician before instituting any corrective interventions. c) Use a syringe to plunge the tube to try to dislodge the medication. d) Wait the prescribed amount of time and attempt to administer the medication again before calling the physician.

c. Use a syringe to plunge the tube to try to dislodge the medication. When medication becomes clogged in the tube, you should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified. p.744

A nurse needs to administer a subcutaneous heparin injection to a client. Which of the following injection sites is most suitable for heparin? a) Back b) Upper chest c) Abdomen d) Forearm

c. abdomen The abdomen area is the preferred site for a subcutaneous heparin injection because of less pain intensity. The forearm, back, and upper chest are common sites for an intradermal injection, not a subcutaneous injection. p. 749-750

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

c. ampicillin sodium Ampicillin sodium is a generic name. Each drug has only one generic name, which is often simpler than the chemical name from which it was derived. Omnipen-N, Polycillin-N, and SK Ampicillin-N are trade names. The brand name, or trade name, is a registered name assigned by the manufacturer. p. 725

The maintenance of client safety with medication administration is of primary importance in healthcare. The most commonly used system for billing and record keeping is the a) Unit dose system b) Administration for an entire client team c) Automated medication-dispensing system d) Self-administered medication system

c. automated medication-dispensing system Nurses access the system by using a password or by scanning a finger to identify the fingerprint. The medication is delivered in a unit-dose package. The automated dispensing system keeps an account of all medication used for billing and controlled substance record keeping. p.736

When treating a client at a health care facility with nitroglycerin paste, how can the nurse prevent contamination in the client during application? a) Rotate the site of medication placement. b) Remove one application before applying another. c) Avoid touching the application with bare fingers. d) Place an application paper on a clean area of skin.

c. avoid touching the application with bare fingers In order to prevent self-absorption and contamination, the nurse should avoid touching the application with bare fingers. When applying the nitroglycerin paste, the nurse should remove one application before applying another and remove any residue remaining on the skin in order to prevent excessive drug levels in the client during application. The nurse should place the application paper on a clean, non-hairy area of skin as it facilitates drug absorption. The nurse rotates the site of medication to prevent potential skin irritation. p. 758

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which of the following as the process by which the medication is delivered to the target cells and tissues? a) Metabolism b) Absorption c) Distribution d) Synergism

c. distribution The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver. p.727

A nurse caring for a client with diarrhea needs to establish an intravenous (IV) access to administer fluids and medication. When explaining intravenous access to the client, which of the following would the nurse most likely incorporate into the description? a) Placement of a flexible catheter in the right atrium b) Insertion of a catheter tip into the superior vena cava c) Insertion of a needle into a peripheral vein d) Placement of a flexible catheter into a large vein

c. insertion of a needle into a peripheral vein The most common method of accessing the venous system is through percutaneous insertion of a needle or flexible catheter into a peripheral vein. Thus the nurse would include this in the description. The peripheral veins usually provide the quickest and easiest approach to establishing IV access for administration of solutions and medications. This process differs from central venous therapy, which involves placement of a flexible catheter into one of the client's large veins, with the catheter tip placed in either the superior vena cava or the right atrium. p. 755

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which of the following injections can be administered at this angle? a) Intravenous b) Intramuscular c) Intradermal d) Subcutaneous

c. intradermal When giving an intradermal injection, the nurse instills the medication shallowly at a 10- to 15-degree angle of entry. When the nurse administers a subcutaneous injection, the angle of entry is either 45 degrees or 90 degrees, whereas for intramuscular injections, the angle is 90 degrees. Intravenous injections are instilled into the veins of the client at an angle of around 15 degrees, but only if no venous access port is in place. p. 789

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

c. involve a second responsible person in the instruction If an elderly client is having difficulty comprehending the discharge instruction, the nurse should involve a second responsible person in the instruction in order to ensure client safety. 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. p.744

A nurse is using an 18-gauge needle to administer a medication to a client. The nurse knows that when compared to a 27-gauge needle, an 18-gauge needle has which of the following features? a) Greater length b) Shorter length c) Larger diameter d) Smaller diameter

c. larger diameter For most injections, 18- to 27-gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. The needle gauge or the diameter refers to its width. p. 745

When administering heparin subcutaneously, the nurse should a) Aspirate before the injection b) Vigorously massage the site c) Never aspirate d) Aspirate after injection

c. never aspirate When administering heparin subcutaneously, never aspirate before administration p. 750

A nurse needs to administer medications to a client through an intravenous port. Which of the following actions should the nurse perform to ascertain that the IV catheter is in the vein? a) Pinch the tubing above the access port b) Instill a few tenths of a milliliter of medication c) Observe the tubing near the insertion device d) Check the client's pulse rate near the port

c. observe the tubing near the insertion device The nurse should observe for blood in the tubing near the IV catheter or insertion device because blood validates that the IV catheter is in the vein. Pinching the tubing above the access port does not ascertain the presence of IV catheter in the vein but stops the flow of IV fluid; whereas, instilling a few tenths of a milliliter of medication initiates the bolus administration. Nurses do not assess the client's pulse rate near the IV port to ascertain that the IV catheter is in the vein. p. 800

A nurse is administering intermittent IV medication to an active adolescent. Which of the following IV systems could be used to allow the patient more freedom? a) Intravenous infusion b) Peripheral venous access device c) Continuous intravenous infusion d) Volume-control administration set

c. peripheral venous access device A peripheral venous access device allows the patient more freedom than a continuous IV infusion. The patient is connected to the IV line when it is time to receive the medication and disconnected when the medication is completed. The device is kept patent (working) by flushing with small amounts of saline pushed through the device on a routine basis. Using saline eliminates any possible systemic effects on coagulation, development of a heparin allergy, and drug incompatibility, which may occur when a heparin solution is used. p.757

A nurse needs to administer an intramuscular injection to a thin and frail elderly client. Which of the following actions should the nurse perform to avoid striking the bone when injecting? a) Inject using subcutaneous rather than intramuscular technique. b) Obtain an x-ray of the injection site. c) Pinch the muscular tissue. d) Massage the injection site.

c. pinch the muscular tissue The muscular tissue should be pinched together to avoid striking the bone when administering an intramuscular injection if the older person has decreased subcutaneous fat. Massaging the injection site will not help avoid the possibility of striking the bone. Performing the injection using a subcutaneous rather than intramuscular technique is not done because injection techniques are not interchangeable. It is not common practice to obtain an x-ray for administering an injection. p. 799

A nurse is administering a prescribed intramuscular injection to a client by the Z-track technique. Which of the following actions ensures that the medicine remains sealed? a) Avoiding applying pressure, but massaging the injection site b) Inserting the needle at 90-degree angle c) Pulling the tissue laterally until the tissue is taut d) Withdrawing the needle and instantly releasing taut skin

c. pulling the tissue laterally until the tissue is taut To ensure that the medication remains sealed within the muscle, the nurse should pull the tissue laterally until the tissue is taut. Inserting the needle at a 90-degree angle does not ensure that the medication remains sealed but directs the tip of the needle well within the muscle. Withdrawing the needle and instantly releasing taut skin prevents leaking of the medicine into the subcutaneous and dermal layers of tissue. Applying pressure but not massaging the injection site ensures that the medication remains sealed. p. 797

A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case? a) Leave the medication on the client's bedside table. b) Inform the head nurse about the client's absence. c) Return the medication to the medication cart or medication room. d) Inform the physician about the client's absence.

c. return the medication to the medication cart or medication room If the client is not present at the time when the medication needs to be administered, the nurse should return the medication to the medication cart or medication room. Leaving medications on the client's bedside table may result in their loss or accidental ingestion by someone else. The nurse need not inform the physician or the head nurse about the client's absence. p. 739

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

c. review the client's medication, allergy, and medical history To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least three timesbefore, during, and after preparing the medicationto ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications. p. 735

Choice Multiple question - Select all answer choices that apply. Which of the following are included in the "five rights for medication administration"? Select all that apply. a) Right route b) Right medication c) Right dose d) Right diagnosis e) Right room f) Right time

c. right dose f. right time a. right route b. right medication You should observe the patient take medications and should not leave them at the bedside. p. 738

The nurse is preparing a patient for discharge, and this patient has been prescribed an eye medication disk for use at home. Which statement is factual and important to discuss with the patient? a) The disk will be completely covered by the upper eyelid. b) The disk should be removed nightly and reinserted each morning. c) The disk will be effective for up to 1 week. d) The disk should be removed prior to showers or swimming.

c. the disk will be effective for up to 1 week. When properly placed, the eye medication disk is completely covered by the lower eyelid, allowing the patient to wear contact lenses, swim, and sleep with the disk in place. Once applied, the disk remains in place for up to a week before being removed and discarded. p. 759

The nurse enters a client's room to administer medications, and the client calls out from the bathroom, "Just leave the medicines on my bedside table. I promise I'll take them as soon as I'm finished." Which of the following responses is most appropriate? a) "I need to wait right here until you are finished. Please hurry." b) "I'll need to let your primary care provider know that you won't take your medications." c) "I will withhold the dose until the next administration time." d) "I will return with the medications when you are finished in the bathroom."

d. "I will return with the medications when you are finished in the bathroom." You should observe the client take medications and should not leave them at the bedside. p. 741

A patient with a complex cardiac history has been prescribed digoxin (Lanoxin) 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? a) 1.5 b) 4 c) 2 d) 0.5

d. 0.5 125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets p. 737

The nurse is preparing the dosage for a client as per the medication administration record. Which of the following precautions should the nurse take when preparing medications? a) Transfer medications from large containers to small containers. b) Ask another nurse to assist in preparing the medication. c) Check the label of the drug container once before administration. d) Avoid relabeling containers with missing labels.

d. Avoid relabeling containers with missing labels. The nurse should avoid using medication from containers with missing labels because this eliminates speculating on the drug name or dosage. The nurse should work alone without interruptions and distractions to promote concentration, rather than asking another nurse to assist with preparing the medication. The nurse should check the label of the drug container three times before administration at various stages of preparing the dosage in order to ensure accuracy. Medication should not be transferred between containers in order to prevent mismatching contents. p. 738

A nurse at the health care facility needs to instill eye medication in a client with conjunctivitis. What care should the nurse take to avoid injury when instilling the medication? a) Move the medication container below the client's line of vision b) Ask the client to sleep with the head tilted back c) Make a pouch in the lower lid by pulling the skin downward d) Steady the container above the location for instillation

d. Steady the container above the location for instillation To avoid injury when instilling the eye medication, the nurse should steady the container above the location of instillation without touching the eye surface. Asking the client to sit or lie supine with the head tilted back prevents the medication from passing into the nasolacrimal duct or being blinked onto the cheek. Moving the medication container below the client's line of vision prevents blink reflexes. Making a pouch in the lower eyelid by pulling the skin downward provides a natural reservoir for depositing the liquid medication. p.759

To which of the following patients would the nurse be most likely to administer a PRN medication? a) A patient whose asthma is treated with inhaled corticosteroids b) A patient who requires daily medication to control hypertension c) A patient who is experiencing severe and unprecedented chest pain d) A patient who is complaining of pain near her surgical site

d. a patient who is complaining of pain near her surgical site A complaint of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. 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. p. 733

A patient presents in the ER with signs and symptoms of VTE. What type of medication administration would most likely be ordered to infuse a large dose of heparin for this patient? a) Administer heparin via a continuous infusion. b) Administer an intermittent intravenous infusion of heparin via a volume-control administration set. c) Administer a piggyback intermittent intravenous infusion of heparin. d) Administer heparin by intravenous bolus or push through an intravenous infusion.

d. administer heparin by intravenous bolus or push through an intravenous infusion A bolus push involves a single injection of a concentrated solution directly into an intravenous line and is frequently used to treat emergencies. In continuous infusion, the patient receives the medication slowly, over a long period. With intermittent intravenous infusion and a volume-control administration set, the drug is mixed with a small amount of the intravenous solution and administered over a short period at the prescribed interval. p. 756

A client suffers from infectious diarrhea. Based on her loss of fluid, her protein level is below normal. What blood product will the physician order to restore intravascular volume? a) Packed red cells b) Platelets c) Whole blood d) Albumin

d. albumin Albumin is a plasma protein contained within the plasma. It is used to restore intravascular volume and to maintain cardiac output in clients with hypoproteinemia. p. 730

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

d. amount of diluent to be added When reconstitution is necessary, the drug label lists instructions such as the amount of diluent to be added and the type of diluent to be used, but not the type of needle. The label states the dosage per volume after reconstitution, not the best site for administering the drug after the reconstitution. It also states the directions for storing the drug, not the directions for administering the drug to a client. p. 749

Which of the following medication-administration systems protects the client by identifying the rights of medication administration? a) Automated medication-dispensing system b) Unit dose system c) Self-administered medication system d) Barcode Medication Administration

d. barcode medication administration The Barcode Medication Administration system will warn of a potential error if the action does not meet the rights of medication administration. p. 736

A nurse needs to administer a prescribed medication to a client using IV push. In which of the following ways is the medication being administered to the client? a) Electronic infusion device b) Continuous drip c) Gravity infusion d) Bolus administration

d. bolus administration A bolus is a relatively large amount of medication given all at once; bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration. A continuous infusion, also called continuous drip, is instillation of a parenteral drug over several hours. It involves adding medication to a large volume of IV solution. After the medication is added, the solution is administered by gravity infusion or, more commonly, with an electronic infusion device such as a controller or pump. p.756

A nurse is using an IV port when administering medication to a client. Which of the following IV administrations has the greatest potential to cause life-threatening changes? a) Secondary administration b) Electronic infusion device c) Continuous administration d) Bolus administration

d. bolus administration Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. An electronic infusion device, continuous administration, and secondary administration do have the potential to cause life-threatening changes, but not to the same degree as a bolus administration because the rate at which medication is administered is not as fast as during a bolus. p. 756

Choice Multiple question - Select all answer choices that apply. A nurse needs to administer an insulin injection to a client with diabetes. Which of the following actions should the nurse perform to prevent bruising of the injection site? Select all that apply. a) Massage the site before administering the injection b) Stretch the injection site taut before administering the injection c) Rotate the injection sites with each injection d) Change the needle before injecting e) Avoid aspirating the plunger after placing the needle

d. change the needle before injecting c. rotate the injection sites with each injection e. avoid aspirating the plunger after placing the needle To prevent bruising in the area of the injection, the nurse should change the needle before injecting the client. Nurses rotate the sites with each injection to avoid a previous area where there has been local bleeding. The nurse does not aspirate the plunger once the needle is in place. Massaging the site is contraindicated because this can increase the tendency for local bleeding. Stretching the injection site taut before administering the injection does not prevent bruising of the injection site. p. 750

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

d. check the client's condition On detection of the medication error, the nurse should immediately check the client's condition. When medication errors occur, nurses have an ethical and legal responsibility to report them to maintain the client's safety. As soon as the nurse recognizes an error, he or she should check the client's condition and report the mistake to the prescriber and supervising nurse immediately. Health care agencies have a form for reporting medication errors called an incident sheet or accident sheet. p. 767

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

d. ensures that the right medication is given at the right time by the right route When preparing the medications for administration, the nurse reads and compares the label on the medication with the MAR at least three times. This is to ensure that the right medication is given at the correct time, and by the correct route. The nurse calculates the doses to comply with the medical order and ensure that the right dose is given. Before administration, the nurse identifies the client by checking the wristband or asking the client's name. This is to ensure that the medication is given to the right person. The nurse should plan to administer the medications within 30 to 60 minutes of their scheduled time, which demonstrates timely administration and compliance with the medical order. p. 738

An elderly client with pneumonia has been prescribed the use of a bronchodilator by the physician. What should the nurse monitor in a client taking an inhaled bronchodilator? a) Pupil dilation b) Physical mobility c) Body temperature d) Heart rate

d. heart rate The nurse should monitor the heart rate and blood pressure of the elderly client who uses inhaled bronchodilators. It is important to monitor the vital signs because these medications commonly cause tachycardia and hypertension. Either or both of these effects increase the risks of complications, especially in elderly clients with underlying cardiovascular disease. The nurse need not monitor the client's body temperature, pupil dilation, or physical mobility because these are not related to the administration of bronchodilators. p. 763-764

Choice Multiple question - Select all answer choices that apply. A nurse is caring for a client who refuses to take the prescribed medication, stating that she is allergic to it. What should the nurse do when the client refuses to take the medication? Select all that apply. a) Circle the scheduled time on the MAR b) Report the situation to the prescriber c) Discuss the reason for refusal with the client d) Identify the reason for not administering e) Inform the nurse manager about the situation

d. identify the reason for not adminstering a. circle the scheduled time on the MAR b. report the situation to the prescriber When a client refuses the administration of a medication, the nurse needs to mention the reason why he or she did not administer the medication, circle the scheduled time on the MAR, and report the situation to the prescriber. The nurse should inform the prescriber, not the nurse manager, about the situation. The nurse also need not discuss the situation with the client; instead, the nurse should document the reason for not administering the medication. p. 767

Which of the following is an accurate guideline for patient teaching regarding the use of a DPI? a) Instruct the patient not to inhale into the mouthpiece. b) Instruct the patient to breathe in slowly with shallow breaths, over 2 to 3 seconds. c) Remind the patient that it is not necessary to count doses because a DPI has dosage counters. d) Instruct the patient that if mist can be seen from the mouth or nose, the DPI is being used incorrectly.

d. instruct the patient that if mist can be seen from the mouth or nose, the DPI is being used incorrectly A mist should not be seen coming from the patient's mouth or nose. The patient should be instructed not to exhale into the mouthpiece. Only some DPI have dosage counters to keep track of remaining doses. The patient should breathe in quickly and deeply through the mouth, over 2 to 3 seconds. p. 764

Which parenteral route of administration has the longest absorption time? a) Intramuscular b) Subcutaneous c) Intravenous d) Intradermal

d. intradermal Intradermal injections are administered into the dermis, just below the epidermis, and this route of administration has the longest absorption time. Intravenous drugs are absorbed immediately because they are administered directly into the bloodstream. p. 749

If the dosage is inappropriate for a client, who is responsible? a) Pharmacist b) Physician c) Medical technician d) Nurse

d. nurse Whereas physicians and other healthcare providers prescribe and pharmacists dispense therapeutic agents, it is the nurse's legal domain to administer medications in a safe and timely manner. p. 735

A client with common cold, difficulty in breathing, and a stuffy nose is prescribed a nasal medication. When administering the medication, how can the nurse provide support and aid in positioning? a) Place the tip of the container just inside the nostril b) Instruct the client to breathe through the mouth c) Help the client into a sitting position with the head tilted backward d) Place a rolled towel or pillow behind the client's neck

d. place a rolled towel or pillow behind the client's neck In order to provide support and aid in positioning, the nurse should place a rolled towel or a pillow behind the neck of the client. Instructing the client to breathe through the mouth prevents inhaling large droplets. Placing the tip of the container just inside the nostril confines the spray within the nasal passage. Helping the client into a sitting position with the head tilted backward facilitates depositing the medication where its effects are desired. p.762

The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which of the following would help maximize drug absorption in this client? a) Metered-dose inhaler b) Turbo-inhaler c) Nasal drops d) Spacer

d. spacer A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption because it prevents drug loss. A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. Nasal drops are liquid medication sprayed or dropped into the client's nose. These, however, would not help in maximizing the absorption of the medication. p. 764

A nurse is administering enoxaparin, (blood thinner) to a patient with DVT, via the subcutaneous route. Which of the following is a recommended guideline when administering a subcutaneous injection? a) Pinching is advised for obese patients to lift the adipose tissue away from underlying muscle and tissue. b) Subcutaneous injections are administered at a 30- to 45-degree angle based on the amount of subcutaneous tissue present. c) Sites commonly used for a subcutaneous injection are the inner surface of the forearm and the upper back, under the scapula. d) Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

d. subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Sites commonly used for an intradermal injection are the inner surface of the forearm and the upper back, under the scapula. Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventral gluteal area. Subcutaneous injections are administered at a 45- to 90-degree angle, based on the amount of subcutaneous tissue present and the length of the needle. Pinching is advised for thinner patients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue. p. 750

A client with chronic obstructive pulmonary disease has been prescribed an inhaled bronchodilator. Which of the following techniques should the nurse implement in order to ensure safe and complete delivery of the prescribed medication? a) Place the inhaler as deeply into the client's mouth as is comfortable. b) Provide multiple puffs of the medication in rapid sequence. c) Provide oxygen therapy 30 minutes prior to administration. d) Use a spacer or extender with the metered-dose inhaler.

d. use a spacer or extender with the metered-dose inhaler The use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible. MDIs are placed one to two inches in front of the mouth, not deeply into the mouth. Oxygen therapy prior to administration does not aid in delivery. Multiple puffs, if ordered, are given after 1 to 5 minutes.