MED ADMIN AND NURSING PROCESS

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? A. "Crushing the medication might cause you to have a stomachache or indigestion." B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you." C. "Crushing the medication would release all the medication at once, rather than over time." D. "Crushing is unsafe, as it destroys the ingredients in the medication."

"Crushing the medication might cause you to have a stomachache or indigestion." The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.

A nurse is preparing to administer a medication to a client who states, "That looks different from the pill I usually take." Which of the following responses should the nurse make? A. "Describe what the pill looks like." B. "This is the medication prescribed by your provider." C. "This pill is probably from a different lot number than yours at home." D. "This hospital might use a different manufacturer, but the medication is the same."

"Describe what the pill looks like." The nurse must collect more data prior to administering the medication. There is a chance that this is not the correct dose or medication. The nurse should clarify the prescription with the provider in order to ensure safe and effective administration of therapy.

A nurse is preparing a client's evening dose of risperidone when the tablet falls on the countertop. Which of the following actions should the nurse take? A. Use the tablet's packaging to pick it up from the counter. B. Wash the tablet off with alcohol and place it in a clean medication cup. C. Discard the tablet and obtain another dose of medication. D. Place the tablet directly into a medication cup.

Discard the tablet and obtain another dose of medication. The nurse must adhere to medical asepsis when preparing and administering medications. If the nurse drops a tablet, she cannot be sure that the tablet is not contaminated; therefore, she must discard it.

A client receives a wrong medication. The nurse who made the medication error should take which of the following actions first? A. Call the client's provider. B. Assess the client. C. Notify the nurse manager. D. Complete an incident report.

Assess the client. The first action the nurse should take using the nursing process is to assess the client. The nurse must first determine whether or not the error has caused the client any harm and also provide any relevant interventions.

A nurse is preparing to administer a pre-packaged oral medication to a client and complete the final medication check. At which of the following times or places should the nurse perform this final check? A. At the client's bedside before administration B. In the area where the nurse obtained the medication C. At the time of documentation D. At the nurses' station while reviewing the provider's prescription

At the client's bedside before administration The nurse should perform the final medication check at the client's bedside while reviewing the package's label.

A nurse is having difficulty reading the provider's writing when transcribing a prescription for a client's medication. Which of the following actions should the nurse take? A. Clarify the type of medication with the family. B. Review the medication history on the admission record. C. Send the prescription to the pharmacist to clarify. D. Contact the provider to clarify the prescription.

Contact the provider to clarify the prescription. To prevent a medication error, the nurse should clarify the unclear prescription with the provider.

When reviewing the admitting prescriptions for a client, the nurse notes that the dose of one medication is three times the usual dose of this medication. Which of the following actions should the nurse take? A. Contact the pharmacy and confirm that the dosage is safe to administer. B. Ask another nurse to verify that the dosage is appropriate for the client C. Contact the provider to question the dosage. D. Inform the charge nurse and administer the dose of the medication the provider prescribed.

Contact the provider to question the dosage. When a nurse believes there is an error in a prescription, the nurse must question the provider.

A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take? A. Tell the client the physician wants him to take the medications. B. Ask the client why he is refusing to take the medications. C. Explain the purpose for the medications. D. Document that the client refuses the medications

Document that the client refuses the medications. The client has the right to refuse the medication. It is appropriate for the nurse to document the client's refusal of the medications. The nurse should then inform the provider of the client's refusal.

A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene? A. Verifies the medication against the prescription and medication label. B. Scans the bar code on the medication administration record and the client's arm band. C. Checks the provider's orders and confirmed dosage in a medication reference guide. D. Documents medication administration prior to administering it.

Documents medication administration prior to administering it. The nurse should document administering medications after they are given to reduce the risk of error.

A nurse withdraws morphine 2mg from a 4-mg/mL vial to inject IM for a client. Which of the following actions should the nurse take for wasting the excess medications? A. Place the excess medication in the sharps container. B. Save the excess medication for the next administration. C. Return the excess medication to the secure cabinet. D. Have a second nurse witness the disposal of the excess medication.

Have a second nurse witness the disposal of the excess medication. Morphine is a controlled substance. Policies vary with the facility, but the nurse must have another nurse witness the disposal of unused portions of doses of controlled substances.

A nurse is administering 1 mg hydromorphone IV to a client. The available dose is 2mg/1mL. What should the nurse do with the remaining medication? A. Send the medication back to the pharmacy. B. Store the medication in a locked drawer for later use. C. Dispose the medication in the sharps container prior to leaving the room. D. Waste the medication in the presence of another nurse.

Waste the medication in the presence of another nurse. Immediately following administration, the nurse should ask another nurse to witness the disposal of the unused medication. If paper records are used, each nurse should sign his/her name. If computerized systems are used, each nurse should sign his/her name electronically.

A nurse is administering an oral medication to an older adult client. The client states, "The pill I always take is green. I don't take an orange pill." Which of the following responses should the nurse make? A. "Sometimes the same pill comes in a different color." B. "Let me explain the purpose of the medication." C. "I will check your medication order again." D. "This is the medication that your doctor wants you to take."

"I will check your medication order again." The appropriate nursing response is to check the provider's original medication order to avoid a medication error.

A nurse is orienting a newly licensed nurse about receiving telephone prescriptions. Which of the following statements by the newly licensed nurse should indicate a need for further teaching? A. "I will repeat the prescription back to the provider after receiving it." B. "I will ask the provider for clarification when I do not understand." C. "Telephone prescriptions are transcribed into the nurse's notes." D. "The provider should sign the telephone prescription as soon as possible."

"Telephone prescriptions are transcribed into the nurse's notes." The nurse should transcribe the prescription to the provider's prescription form on the client's medical record. It is important for the nurse to transcribe the prescription promptly and in the correct place in the medical record.

A nurse is reviewing the medication administration records from the previous shift. Which of the following findings should indicate to the nurse a need for an incident report? A. A client received gentamicin intermittent IV bolus over 1 hr. B. A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection. C. A nurse injected Demerol IM into the vastus lateralis site of adult. D. A client received a crushed bupropion XL tablet mixed with applesauce

A client received a crushed bupropion XL tablet mixed with applesauce Extended or sustained release medications are intended to release medication levels over a long period of time to sustain therapeutic relief. Crushing, breaking, or chewing an extended release medication releases the medication at once into the bloodstream and could be life-threatening. Mixing this medication in applesauce deviates from standard of care and requires the nurse to complete an incident report.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertenly administered to another client. Which of the following actions should the nurse take first? A.Notify the client's provider. B. Check the client's vital signs. C. Fill out an occurrence form. D. Administer the medication to the correct client.

Check the client's vital signs The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions.

A nurse is preparing to administer oral medications to a client. Which of the following should the nurse recognize as an acceptable client identifier? SATA A. Client's full name B. Facility room number C. Partner's full name D. Provider's name E. Facility-assigned identification number

Client's full name. To prevent medication errors, it is essential to perform the six rights of medication administration which includes the "correct client." The Joint Commission requires the use of two separate client identifiers to identify the correct client. Facility-assigned identification number. To prevent medication errors, it is essential to perform the six rights of medication administration which includes the "correct client." The Joint Commission requires the use of two separate client identifiers to identify the correct client.

A nurse is preparing medication for a client when another client has an emergency. Which of the following actions should the nurse take? A. Have another nurse guard the medication preparations until the nurse returns. B. Have another nurse finish preparing the medications. C. Lock the medication in a room and finish preparing it after returning from the emergency. D. Discard the prepared medications and begin again after returning.

Lock the medication in a room and finish preparing it after returning from the emergency. No one else should have access to or administer medications the nurse has prepared. Securing them and returning later to finishing preparing and administering them decreases the risk of medication errors

A nurse is teaching a newly licensed nurse about transcribing prescriptions. Which of the following examples should the nurse include in the instructions? A. Losartan 50.0 mg, PO, QD B. Metformin 500mg,1 tablet, PO, daily C. Desmopressin .1 mL, intranasal, qd D. Zolpidem, 5 mg PO, HS

Metformin 500mg,1 tablet, PO, daily This prescription is written correctly.

A nurse manager is presenting to a group of unit nurses the categories regulated under the Controlled Substances Act. Which of the following medication prescriptions should the nurse include under Schedule II? A. Buprenorphine hydrochloride B. Morphine C. Hydrocodone bitartrate D. Diazepam

Morphine The charge nurse should include in the teaching that morphine is under Schedule II prescription medications, which requires the provider to complete a written prescription with a signature.

A nurse is assessing for the presence of extrapyramidal side effects EPS) in client who is taking chlorpromazine. Which of the following findings should the nurse recognize as EPS? SATA A. Muscle spasms of the neck B. Fidgeting behavior C. Blurred vision D. Tremors of the hands E. Sexual dysfunction

Muscle spasms of the neck. Muscle spasms of the neck are an example of EPS associated with conventional antipsychotics. Fidgeting behavior. Fidgeting behavior, or akathisia, consists of behaviors such as pacing or fidgeting, which are distressing and uncomfortable for the client. Tremors of the hands. Hand tremors are Parkinsonian manifestations which are part of EPS.

A nurse is teaching a class about medication reconciliation. Which of the following information should the nurse include in the teaching? A. Do not include over-the-counter medications in the medication reconciliation report. B. Provide a list of the client's current medications during the change of shift report. C. Do not perform reconciliation for a client at discharge from a health care facility. D. Provide a list of the client's current medications during admission to a health care facility.

Provide a list of the client's current medications during admission to a health care facility. The nurse should create a list of current medications including the name, indication, route, dosage, and dosing interval upon admission to a health care facility. The list consists of all medications, including vitamins, herbal products, and prescription and nonprescription medications.

A nurse is teaching a class about safe medication administration. The nurse should include in the teaching that which of the following references are acceptable for safe medication administration? SATA A. A website that ends in .com B. Published journals C. Pharmacists D. Physicians' Desk Reference E. Pharmaceutical sales representatives

Published journals. Published journals and reputable newsletters, such as The Medical Letter on Drugs and Therapeutics, and the Prescriber's Letter, are bimonthly and monthly publications that present current information on medications. Pharmacists Pharmacists provide expert information about medications, expected versus unexpected side effects, contraindications, compatibilities, and indications for use. Physicians' Desk Reference. The Physicians' Desk Reference (PDR) is a reference work financed by the pharmaceutical industry. The information on each drug is identical to the information on the package insert. The PDR is updated annually to reflect current recommendations.

A nurse finds an open vial of morphine lying on top of the cabinet in a client's room. Which of the following actions should the nurse take? A. Return the medication to the unit's stock for future use. B. Report the discrepancy immediately. C. Administer the medication to other clients to avoid waste. D. Independently dispose of the remaining medication.

Report the discrepancy immediately Because this medication is a controlled substance, the nurse should remove the medication from the client's bedside and report the incident according to the facility's policy. After that, she may dispose of it with another nurse witnessing the discard.

A nurse is preparing to administer an IM injection meperidine to a client. Which of the following is the priority assessment the nurse should complete? A. Apical pulse rate B. Blood pressure C. Level of consciousness D. Respiratory rate

Respiratory rate Airway, breathing, and circulation are the priority focus of the nurse at this time. Meperidine can cause respiratory depression and the client's respiratory rate should be monitored prior to administering this medication.

A nurse is documenting in a client's medical record. Which of the following abbreviations is appropriate for the nurse to use? SATA A. MSO4 B. bid C. 30 mL D. .2 mg E. Q.D.

bid , 30mL