PREPU CH29

Regarding medication administration, what must occur at the change of shifts?

The narcotics for the division are counted.

Which pharmacological consideration should the nurse consider when applying a medication patch to a client?

The nurse is to use gloves to apply and wash hands after.

The nurse is preparing to administer a transdermal medication. How should this be accomplished?

The nurse should apply the medication directly to the skin.

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?

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

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 would help maximize drug absorption in this client?

spacer

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?

to determine the extent to which the client responded to the drugs

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch?

upper back

There have been an increase of needlestick injuries in the intensive care unit. When preparing to address this occurrence in a staff meeting, what should the nurse manager include in an education presentation to prevent needlestick injuries? Select all that apply.

using self-retracting safety needles disposing of used needles in sharps container Using needleless adapters for medication administration

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse?

"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole."

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide?

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

The nurse receives a medication prescription for amoxicillin 250 mg QID. by mouth for a client with an infection. What approximate scheduled times will the nurse document the client requires the medication?

0800, 1200, 1600, 2000

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

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

The nurse is teaching a client with diabetes about insulin pen injection. The nurse will teach that the insulin in prefilled pens is stable for how long?

1 month

A client has been prescribed 300 mg of an oral antibiotic. It is available in 200 mg tablets. How many tablets will the nurse administer? Record your answer using one decimal place.

1.5

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle

Which client would most likely require placement of an implantable port?

A 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy.

It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client?

A 70-year-old demonstrating muscle wasting prescribed chlorpromazine

A nurse is caring for a client with pancreatic cancer who is receiving continuous morphine for pain. Which intervention would be the most effective method to administer this medication?

Administer a continuous subcutaneous infusion of morphine.

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller.

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?

Ask the client to remain lying down for at least 5 minutes.

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

Assess the vaginal area.

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?

Avoid crushing sustained-release pellets.

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?

Bolus administration

After inserting an intravenous catheter into a client's vein, the nurse does not obtain blood return. What is the appropriate nursing action?

Change catheter insertion site.

A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration?

Check the client's identification band.

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Check the expiration date.

The nurse reviews the following prescription in the client's medical record: Morphine sulfate (MS) 3 mg every four hours as needed for postoperative pain. Which action by the nurse is correct?

Clarify the prescription with the health care prescriber

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatibility.

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for order clarification.

A nurse is administering an intradermal injection to a client for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at the site of injection. What is the nurse's best action in this situation?

Document the administration and inform the primary care provider.

A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point should the nurse include in the education plan?

Each time you give the injection rotate the injection site.

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client?

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

Which situation accurately describes a recommended guideline when administering oral medications to clients?

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.

A nurse is administering a client's analgesic by the subcutaneous route. What should guide the nurse's action?

Inject into the adipose tissue layer just below the epidermis and dermis.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation?

Inner surface of the forearm

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse?

Insert a new IV medication lock and remove the old one.

The nurse prepares to administer an intravenous medication. Which action should the nurse perform when administering a medication from an ampule?

Insert the tip of the filter needle into the center of the ampule and invert the ampule.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

intradermal

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

medications that need to be infused over 20 to 60 minutes

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

miconazole

The charge nurse has just completed an inservice with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?

"Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes."

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

"I am taking tadalafil in addition to nitroglycerin."

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the client indicates teaching was effective?

"I will call the health care provider if I develop dizziness, blurred vision, or nausea."

Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response?

"I will get the hospital's information system's phone number for you."

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long-term use of nasal sprays can cause rebound nasal congestion."

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

"Medication stays in the chamber so you can continue to inhale it."

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance."

Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply.

"The dose of insulin in an insulin pen is displayed in a window of the syringe." "The cylinder of the insulin pen contains a prefilled reservoir of insulin." "The insulin pen automatically resets the dose window to zero, following the injection."

The health care provider prescribes ciprofloxacin 500 mg PO q12h for a pediatric client with bronchial pneumonia. The nurse has liquid ciprofloxacin 250 mg/10 mL on hand. How many milliliters would the nurse dispense? Record your answer using a whole number.

20 (Dosages are in the numerator of the proportion, quantities in the denominator. After the numbers are placed in the proportion, cross-multiply to find the desired quantity. (250 mg)/(10 mL) = (500 mg)/(X mL); 500 = 250 X; X = 20 mL.)

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 minutes

A nurse is administering intramuscular injections to clients. What needle size(s) has the nurse used correctly? Select all that apply.

5/8-inch (2-cm) needle for the vastus lateralis site 1 1/2-inch (3.75-cm) needle for an adult in the deltoid site 5/8-inch (2-cm) needle for a child in the deltoid site

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication?

73-year-old client diagnosed with liver disease

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

90 degrees

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid

A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?

Deltoid

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location.

When administering a subcutaneous injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation?

Engage safety shield on needle guard and discard needle appropriately.

A client with a new diagnosis of glaucoma (increased pressure within the eye) has been prescribed a medication that is to be administered by an eye drop. Which action should the nurse perform?

Ensure that drops of the medication fall onto the client's conjunctival sac.

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers.

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation?

IV infusion

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order.

Which organ is the primary site for drug metabolism?

Liver

A client is prescribed an HMO-CoA reductase inhibitor for the treatment of elevated cholesterol and triglyceride levels. Which education will the nurse provide to the client regarding the medication prescribed?

Liver function and glucose levels will be checked periodically.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do?

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

To convert 0.8 grams to milligrams, the nurse should do which of the following?

Move the decimal point 3 places to the right.

The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action?

Notify the health care provider.

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

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

Which technique should the nurse employ when instilling otic medication in an adult ear?

Pull the client's ear up and back.

A nurse who is administering an injection to a client has an accidental needlestick injury after withdrawing the needle from the client's tissue. Which action(s) will the nurse take? Select all that apply.

Report the injury to a supervisor immediately. Perform hand hygiene per agency protocol. Document the injury per agency protocol in a timely manner. Seek a medical assessment and follow up as needed.

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?

Return the medication to the medication cart or medication room.

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention?

Stop the infusion of the antibiotic.

A nurse is caring for a 6-year-old client on the hematology-oncology floor. During a packed red blood cell (PRBC) transfusion, the client reports of pain at the peripheral IV site. The nurse assesses the site and notices that the site is purple. What is the nurse's best course of action?

Stop the transfusion and insert peripheral IV at a new site.

A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection?

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

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

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

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?

The area is free of major blood vessels and fat.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication.

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug.

When administering oral medications, which practices should the nurse follow? Select all that apply.

Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug. Stay at the bedside until the client has swallowed all the medications. Perform hand hygiene before and after medication administration.

A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler?

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

To which client would the nurse be most likely to administer a PRN medication?

a client who is reporting pain near the surgical site

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered?

all at once

At what point should the nurse perform the first of the three checks of medication administration?

as the nurse reaches for the drug package or container

A medication order has ac written after the medication dosage. What does ac stand for?

before meals

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

bolus administration

A client with chronic obstructive pulmonary disease has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client:

breathes through his or her mouth until all the medication has been inhaled.

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to food or drugs

The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe?

decreased irritation and pain in subcutaneous tissue

The nurse is preparing to attach a label to an intravenous medication that is being administered by continuous infusion. Which component will the nurse include on the label? Select all that apply.

dose initials of nurse identification of drug time drug was added

If the dosage is inappropriate for a client, who is responsible?

nurse

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity?

placing the secondary infusion higher than the primary solution

The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?

removing prior application and any remaining residue from skin

What would be considered a "right" of drug administration? Select all that apply.

right documentation right client right dose right drug