PrepU- Chapter 30 Medications

The nurse is to administer levothyroxine 0.125 mg PO at 0600. The package is labeled levothyroxine 125 mcg. Calculate the number of tablets the nurse will administer. Record your answer as a whole number.

1 The nurse converts mg to mcg. 0.125 mg is equal to 125 mcg. The nurse will administer 1 tablet. Desired dose is 125 mcg. Dose on hand or supplied dose is 125 mcg. Quantity is 1 tablet.

A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action? A. Recognize that it is not safe to mix two medications in one syringe. B. Page the health care provider to determine whether the drugs can be mixed. C. Determine the compatibility of the two drugs by consulting clinical resources. D. Collaborate with the pharmacy to have one of the times changed.

C. Determine the compatibility of the two drugs by consulting clinical resources. The nurse must determine the compatibility of the two drugs; some drugs can be safely combined in a single syringe. However, this is not determined by paging the health care provider. There is no need to change the times of administration.

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues? A. Absorption B. Synergism C. Distribution D. Metabolism

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.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do? A. Have another nurse guard the preparations. B. Put the medications back in the containers. C. Have another nurse finish preparing and administering the medications. D. Lock the medications in a cart and finish them upon return.

D. Lock the medications in a cart and finish them upon return. Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

In which order should the nurse instruct the client to use an inhaler?

1 Shake the canister to distribute the drug in the pressurized chamber. 2 Place the inhaler in your mouth and close your lips around the mouthpiece. 3 Press down on the canister once to release the medication. 4 As the medication is released, breathe in slowly through your mouth for 3-5 seconds. 5 Hold your breath for 10 seconds. 6 Clean the inhaler daily by rinsing it in warm water daily. The nurse should instruct the client to shake the canister to distribute the drug in the pressurized chamber before placing the inhaler in his/her mouth and closing his/her lips around the mouthpiece. The client will then press down on the canister once to release the medication, and as the medication is released, the client will breathe in slowly through his/her mouth for 3-5 seconds. The client will then hold his/her breath for 10 seconds. The client is to clean the inhaler daily by rising it in warm water.

The nurse is educating a client on how to self-administer subcutaneous insulin injections. The client asks why the needle must be removed at the same angle as that of insertion. How will the nurse respond? A. This verifies correct injection of the drug. B. It minimizes tissue trauma. C. It prevents needlestick injuries. D. This helps to control placement of the needle.

B. It minimizes tissue trauma. Removing the needle at the same angle at which it was inserted to administer medication minimizes tissue trauma and discomfort to the client. To verify correct injection of the drug, the client will push the plunger and watch for a small wheal. To prevent needlestick injuries, the client will cover the needle with a protective cap. Holding the arm still and stretching the skin taut helps to control placement of the needle.

A nurse is preparing to administer several prescribed medications to a client. The medications prescribed are to be given by the following routes: oral, subcutaneous, intramuscular and intravenous. Place the routes in the proper order from slowest to fastest absorption. Use all options. A nurse is preparing to administer several prescribed medications to a client. The medications prescribed are to be given by the following routes: oral, subcutaneous, intramuscular and intravenous. Place the routes in the proper order from slowest to fastest absorption. Use all options.

1 oral 2 subcutaneous 3 intramuscular 4 intravenous Absorption is the process by which a medication enters the bloodstream. The route of administration affects how quickly and completely a medication is absorbed. Intravenous (IV) administration offers the quickest rate of absorption, followed in descending order by intramuscular (IM), subcutaneous, and oral (PO) routes.

The nurse is preparing to administer a nasal spray. Place the nurse's actions in order, from first to last. Use all options.

1. Identify the client using two identifiers and verify any allergies. 2. Offer the client a tissue and ask the client to blow the nose. 3. Insert the tip of the nasal spray into one nostril and close the other nostril with a finger. 4. Compress the nasal spray while the client breathes in through the nose. 5. Remove the tip of the spray from the client's nostril and release the compression. 6. Instruct the client to not blow the nose for 5 to 10 minutes. The nurse should first identify the client and verify any allergies, then explain the procedure to the client. Next, the nurse would assist the client to a comfortable sitting position, offer the client a tissue, and request the client blow the nose to clear the nasal passageway. The nurse should then agitate the spray gently if required and insert the tip of the nasal spray into one nostril while closing the other nostril with a finger. Then the nurse should compress the bottle and release the spray at the same time the client breathes in through the nose. The nurse should keep the bottle compressed until it is removed from the client's nostril. Request the client hold the breath for a few seconds to allow absorption into the mucous membranes, and instruct the client to not blow the nose for 5 to 10 minutes.

Which component of a syringe's needle does the nurse recognize that refers to width? A. lumen B. shaft C. bevel D. gauge

D. gauge The gauge of a needle refers to width. The lumen is the opening of the needle; the shaft is the length of the needle; the bevel is the slanted portion of the needle that provides access into the vein.

The nurse has a prescription to administer 25 mg of furosemide IV to a client. The drug is supplied in a vial 40 mg/4 ml. How many milliliters will the nurse administer of the medication? Record your answer using one decimal place.

2.5 Dose on hand = Dose desired ÷ X 40 mg/4 ml = 25 mg ÷ X 40X = 100 X = 100/40 = 2.5 mg

A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration? A. Deltoid B. Vastus lateralis C. Biceps brachii D. Scapula

A. Deltoid The deltoid and ventrogluteal sites are more appropriate for adults than the vastus lateralis. The scapula is a site for an intradermal injection. The biceps brachii muscle is not used for intramuscular injections.

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration? A. Deltoid B. Vastus lateralis C. Ventrogluteal D. Scapula

A. Deltoid The deltoid is the best site for this medication. Biologicals for infants and young children are administered at the vastus lateralis. The ventrogluteal site is used for depot formulations and irritating medications. The scapula is a site for an intradermal injection.

The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse? A. Determine compatibility of the insulins by checking a drug compatibility table. B. Inject air into each vial equal to the amount of insulin prescribed. C. Check the expiration date on each vial. D. Roll the modified insulin vial to mix it well.

A. Determine compatibility of the insulins by checking a drug compatibility table. The first step in mixing two types of insulin in one syringe is verifying compatibility. Some insulins cannot be mixed together. The other steps are appropriate but should be completed after determining compatibility.

During the discharge process the client states "I am confused about how to store my insulin." Which statement is the best response by the nurse? A. Extra vials of insulin should be kept in the refrigerator, but the vial you are currently drawing from should be kept at room temperature. B. Extra vials insulin should be kept at room temperature, but the vial you are currently drawing from should be refrigerated. C. All insulin vials should be kept at room temperature. D. All insulin vials should be refrigerated.

A. Extra vials of insulin should be kept in the refrigerator, but the vial you are currently drawing from should be kept at room temperature. The client, by stating he or she was unclear about storage of insulin, provided an opportunity for client teaching. The best response by the nurse is that insulin vials not being used should be refrigerated, but insulin currently being used for injection should be at room temperature.

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

A. checking for documented allergies to food or drugs Checking for documented allergies to food or drugs is done to ensure safety and is therefore correct. Preparing the syringe with the medication is incorrect because this is considered planning, not assessment. Cleaning the area with an alcohol swab is implementing, not assessing. Gathering all the equipment needed is also considered planning.

The nurse is performing the admissions assessment for a client admitted with right hip pain. When performing the assessment, the client stated all of the prescribed medications they take from the previous admission. Which question is the priority for the nurse to ask the client? A. "Do you take any over-the-counter medications?" B. "Do you use cold therapy for your hip pain?" C. "What time do you take your medications?" D. "Do you have someone to help you at home?"

A. "Do you take any over-the-counter medications?" Assessing whether the client takes any over-the-counter medications is the priority because the nurse will need to identify any medication interactions that can occur while the client is in the hospital. Knowing what time the client takes their medications is important but does it not take priority over knowing drug-drug interactions. Discussions about help at home and about alternative pain management therapies are not a priority in the admission assessment; correct medication reconciliation is the priority here.

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? A. 0.5 B. 2 C. 4 D. 1.5

A. 0.5 1.0 mg = 1000 mcg. 0.125 mg =125 mcg. 0.0625 mg is exactly one half of 0.125 mg. If the digoxin tablet is 0.125 mg or 125 mcg, then the nurse would administer 0.5 tablet which is 0.0625mg, or 65.5mcg.

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood? A. 1500 B. 1200 C. 2000 D. Wait until day 5 of treatment.

A. 1500 Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest.

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? A. 5 minutes B. 10 minutes C. 15 minutes D. 20 minutes

A. 5 minutes When ear drops are to be administered in both ears, the nurse would wait 5 minutes after giving the ear drops in the first ear before administering the ear drops into the second ear. This avoids causing the medication to run out immediately after administration. Other times are longer than are needed between ears.

A nurse is administering intramuscular injections to clients. What needle size(s) has the nurse used correctly? Select all that apply. A. 5/8-inch (2-cm) needle for the vastus lateralis site B. 5/8-inch (2-cm) needle for an adult in the ventrogluteal site C. 1 1/2-inch (3.75-cm) needle for a child in the deltoid site D. 1 1/2-inch (3.75-cm) needle for an adult in the deltoid site E. 5/8-inch (2-cm) needle for a child in the deltoid site F. 5/8-inch (2-cm) needle for an adult in the ventrogluteal site

A. 5/8-inch (2-cm) needle for the vastus lateralis site D. 1 1/2-inch (3.75-cm) needle for an adult in the deltoid site E. 5/8-inch (2-cm) needle for a child in the deltoid site The acceptable size for needles based on the muscle being used for the injection is: Vastus lateralis 5/8-inch to 1-inch (2 to 2.5 cm) Deltoid (children) 5/8-inch to 1-inch (2 to 2.5 cm) Deltoid (adults) 5/8-inch to 1 1/2-inch (2 to 3.75 cm) Ventrogluteal (adults) 1 1/2-inch (3.75 cm)

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? A. Assess the vaginal area. B. Notify the health care provider. C. Explain that this is expected effect of the medication. D. Hold the second dose until the discomfort is relieved.

A. Assess the vaginal area. When a client reports discomfort, further assessment is needed. The nurse should assess the vagina and vaginal canal for erythema, edema, drainage, or tenderness, and then notify the health care provider after the assessment is completed. The nurse does not know if the discomfort is expected until after assessment, and the nurse should assess the discomfort before deciding to hold the dose.

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration? A. Check the tube placement before administration. B. Have the client swallow the pills around the tube. C. Flush the tube with 30 to 40 mL saline before medication administration. D. Bring the liquids to room temperature before administration.

A. Check the tube placement before administration. The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children). The nurse should never have the client swallow the pills if the client has an nasogastric tube.

The nurse is caring for a client receiving D5 ½ NS + 20 mEq KCl/L infusing per pump at 125 mL/hr. The nurse prepares to administer 40-mg furosemide IVP. Which actions should the nurse take? Select all that apply. A. Stop the infusion pump and clamp the line. B. Cleanse the infusion port closest to the pump. C. The first flush is at the same rate as the drug. D. Provide the medication at the recommended rate. E. The second flush is at the same rate as the drug.

A. Stop the infusion pump and clamp the line. D. Provide the medication at the recommended rate. E. The second flush is at the same rate as the drug. The nurse should stop the infusion pump and clamp the line. The infusion port closest to the client's IV site should be cleaned with alcohol or antimicrobial swab. There is no timing for the first normal saline flush. The nurse should make sure to follow the guidelines when administering IVP meds at the recommended rate. When furosemide is pushed faster than its recommended rate, it can cause hearing loss. The normal saline flush after the IVP is administered at the same rate as the medication to prevent untoward effects.

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

A. The nurse should apply the medication directly to the skin. Transdermal medications are adsorbed through the skin. Injectable medications are either delivered intramuscularly (in the muscle) or subcutaneously (or below the dermis). By mouth medications are taken by swallowing. Medications can also be given in the vagina, rectum, eyes, and ears.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity? A. Therapeutic range B. Peak level C. Trough level D. Half-life

A. 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.

The nurse is preparing to administer a medication to a client when the client states, "Last time I took that medication, I broke out in hives." What is the priority action by the nurse? A. Withhold the medication and notify the health care provider that ordered the medication B. Administer the medication, the reaction may not occur again C. Administer the medication and monitor the client for 30 minutes after administration D. Substitute another medication with the same action

A. Withhold the medication and notify the health care provider that ordered the medication Whenever a client reports being allergic to a medication, the nurse should withhold the medication and notify the provider so that something else may be ordered. The medication should never be administered due to the risk of a potential anaphylactic reaction. The nurse may not substitute any medication without a providers order

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

A. 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.

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

A. a client who is reporting pain near the surgical site A report 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.

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. at the beginning of a shift C. when reviewing the client's medication administration record (MAR) D. after retrieving the drug from the drawer of a drug cart

A. as the nurse 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. The three checks are: 1. when the nurse reaches for the unit dose package or container; 2. after retrieval from the drawer and compared with the eMAR/MAR, or compared with the eMAR/MAR immediately before pouring from a multidose container; 3. before giving the unit dose medication to the client, or when replacing the multidose container in the drawer or shelf. At the beginning of a shift is too early to complete the first of three safe medication checks. A nurse reviews the client's medication administration record (MAR) as a part of the morning assessment to identify when medications are due. This is part of the second check of frequency with the MAR. After retrieving the drug from the drawer of a drug cart is part of the third check of frequency.

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? A. bolus administration B. electronic infusion device C. continuous administration D. secondary administration

A. 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, since the rate at which medication is administered is not as fast as during a bolus.

A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC) suddenly reports itching and flushing. Which action should the nurse prioiritize for this client? A. clamp the antibiotic infusion B. flush the PICC line C. remove the PICC line D. slow the infusion rate

A. clamp the antibiotic infusion The client may be experiencing a life-threatening reaction to the antibiotic. The nurse should clamp the secondary infusion line which is infusing the antibiotic and notify the primary care provider immediately. It would be inappropriate for the nurse to flush the PICC line as this will increase the amount of antibiotic getting into the client's body. Slowing the infusion rate will also not correct or prevent further adverse effects. The nurse should not remove the PICC line as this may be outside the nurse's scope of practice as it requires special training and certification to do that. The nurse should leave the PICC line open, however, unless otherwise instructed.

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration? A. client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination B. client who is beginning treatment with chemotherapy following a diagnosis of ovarian cancer C. client who is diagnosed as having sepsis and is prescribed antibiotic therapy D. client who is in the emergent phase of a 50% partial-thickness (second-degree) burn and requiring medication for pain

A. client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination The hepatitis B vaccine is administered intramuscularly. Recombivax HB, a form of the hepatitis B vaccine, may be administered subcutaneously to clients who are at high risk for hemorrhage. This client is low risk. Medications for the clients experiencing the situations listed would be administered intravenously.

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? A. decreased irritation and pain in subcutaneous tissue B. less frequent administration of the medication C. more rapid administration of the medication D. decreased risk for infection

A. decreased irritation and pain in subcutaneous tissue This technique is Z-tracking. The Z-track technique allows the medication to be administered into the muscle tissue with no tracking of medication in the subcutaneous tissues as the needle is removed, resulting in less pain and irritation.

The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication? A. in the anterolateral aspect of the thigh B. in the lateral aspect of the upper arm C. in the lower abdomen D. in the gluteus maximus muscle in the buttocks

A. in the anterolateral aspect of the thigh The vastus lateralis site is in the anterior aspect of the thigh, in which the nurse places the injection in the middle third of the thigh and is often used for infants. Therefore, this description is correct. The deltoid site is located in the lateral aspect of the upper arm. The dorsogluteal site is located in the gluteus maximus muscle in the buttocks.

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? A. medications that need to be infused over 20 to 60 minutes B. medications that are given over 1 minute for rapid therapeutic effect C. medications that can be given through a capped intravenous port D. medications that are toxic if given over short periods

A. 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.

The nurse is administering a rectal suppository. How far will the nurse insert the suppository? A. past the internal sphincter B. just past the opening of the anus C. far enough to still visualize the end of the suppository D. until the client reports feelings of discomfort

A. past the internal sphincter To be effective, a suppository must be inserted past the internal sphincter, which is about the distance of the finger of insertion.

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

A. removing prior application and any remaining residue from skin The nurse will remove one application and residue before applying another, as this prevents excessive drug levels when a new application is placed. The nurse will then proceed to squeeze the paste onto the paper, spread the paste over the paper, apply the paper, and cover it with a transparent semipermeable dressing.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug? A. swallowing the medication B. taking the medication on an empty stomach C. talking when taking the medication D. performing physical activities

A. swallowing the medication When administering medication by sublingual application, the client should avoid swallowing or chewing the medication. Eating or smoking during administration is also contraindicated. Taking the medication on an empty stomach, talking, or performing physical activities may not be contraindicated when administering drugs sublingually.

A client is prescribed an opioid analgesic. The nurse is teaching the client about the need to avoid ingesting alcohol with the drug to prevent an interaction which would potentiate the effects of the analgesic. The nurse is describing which event? A. synergism B. antagonism C. incompatibility D. tolerance

A. synergism When one drug potentiates the effect of another drug when taken together, synergism occurs. Antagonism occurs when the effects of one drug are decreased by another drug. Incompatibility occurs when a drug precipitates from solutions, or becomes chemically inactive, if mixed with other medications. Tolerance to a medication occurs when a client develops a decreased response to the drug, requiring an increased dosage to achieve the therapeutic effects.

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation? A. when the client has disorders that affect the absorption of medications B. when the drug needs to act on the client very slowly C. when the client wants to avoid the discomfort of an intradermal injection D. when the drug needs to be administered only once

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.

A nurse is caring for a client on IV therapy. The IV tubing has a volume-control set. Which of the following is a function of the volume-control set? A. It is used to administer medication only to older adult clients. B. It is used to administer small volumes of IV medication. C. It is used to administer medication in a large volume of blood. D. It is used when IV medications are irritating to peripheral veins.

B. It is used to administer small volumes of IV medication. A volume-control set is used to administer a small volume of IV medication at intermittent intervals to avoid accidentally overloading the circulatory system. A volume-control set is used to administer IV medication at intermittent intervals, not continuously. It is not a volume-control set but a central venous catheter that is used to administer medication in a large volume of blood and when IV medications are irritating to peripheral veins.

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat? A. "Place a rolled towel beneath the neck if you are unable to sit." B. "Aim the tip of the container toward the nasal passage." C. "Breathe through your mouth as the drops are instilled." D. "Remain in the sitting position for 5 minutes."

B. "Aim the tip of the container toward the nasal passage." Aiming the tip of the container toward the nasal passage will deposit the drugs within the nose rather than into the throat. Place a rolled towel beneath the neck if the client cannot sit will provide support and aid in positioning. Breathing through the mouth as the drops are instilled is not the correct action for nasal drop administration. Remaining in the sitting position for 5 minutes will promote local absorption.

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response? A. "This is to decrease the amount of drug that you receive." B. "Medication stays in the chamber so you can continue to inhale it." C. "You will receive the medication faster as it goes through this device." D. "It makes the inhaler easier to hold in case you have arthritis."

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

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals? A. "This is because gastric acid is decreased after meals, which can affect the way your medicine works." B. "This is because food and some drinks can affect the way your medicine works." C. "This is because decreased blood flow occurs after meals, which can affect the way your medicine works." D. "This is because your medication can cause nausea and that can affect the way it works."

B. "This is because food and some drinks can affect the way your medicine works." Some medicines need to be taken "before food" or "on an empty stomach." This is because food and some drinks can affect the way these medicines work. For example, taking some medicines at the same time as eating may prevent the stomach and intestines from absorbing the medicine, making it less effective. Blood flow to the stomach increases after eating a meal. Gastric acid increases after a meal to help digestive food eaten. Nausea does not affect the absorption of a medication.

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

B. "Wait 5 minutes between instillation of different types of eye drops." The nurse will teach the client to wait 5 minutes between instillation of different types of eye drops to facilitate best absorption. The dropper should not touch the eye, as this increases the possibility of contamination. Devices are available to facilitate administration if a client has trouble using the bottle. These types of drugs should be discarded after 28 days to prevent bacterial contamination.

The nurse is teaching a client about zolpidem CR for sleep. When the client asks, "What does the CR mean?" what is the appropriate nursing response? A. "sustained release" B. "continuous release" C. "extended release" D. "sustained action"

B. "continuous release" The nurse will clarify that CR means "continuous release." XR means "extended release;" SR means "sustained release;" SA means "sustained action."

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick? A. Immediately activate the safety needle and remove the needle from the syringe. Place the needle in the Sharps container and the syringe in the trash. B. Immediately activate the safety needle and place the syringe and needle into a Sharps container. C. Immediately activate the safety needle and have a colleague hold the Sharps container within reach for disposing of the syringe and needle. D. Immediately activate the safety needle and hold it close to the body until disposing it into the Sharps container.

B. Immediately activate the safety needle and place the syringe and needle into a Sharps container. The nurse will immediately activate the safety needle and place the syringe and needle into a Sharps container. Removing the needle from the syringe or holding it close to the body puts the nurse at risk for a needle stick. Safety needles are not failproof. Thus, having a colleague hold the Sharps container puts the colleague at risk if the safety needle falls and the nurse misses the opening of the container.

A nurse is caring for a client who has been prescribed codeine, an opioid medication to relieve severe postoperative pain. Which responsibility does the nurse have to complete when handling opioid medications? Select all that apply. A. Place the medication in the container with other prescribed medications. B. Maintain an accurate account of the use of the medication. C. Record each medication used from the stock supply. D. Count each opioid medication at the change of each shift. E. Place the medication with other medications on the nursing unit.

B. Maintain an accurate account of the use of the medication. C. Record each medication used from the stock supply. D. Count each opioid medication at the change of each shift. When handling opioid medications, the nurse should have an accurate account of the use of the medications and a record of each medication used from the stock supply, and the nurse should count each opioid at the change of each shift. Opioid 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.

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered? A. standing order B. PRN order C. one-time order D. stat order

B. PRN order A PRN order is one that is given to a client on an "as needed" basis.

When administering oral medications, which practices should the nurse follow? Select all that apply. A. Dispense multiple liquid medications into a single cup to reduce the number of containers the client must handle. B. Perform hand hygiene before and after medication administration. C. Stay at the bedside until the client has swallowed all the medications. D. Store the client's MAR at the bedside at all times to ensure safe identification. E. Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug.

B. Perform hand hygiene before and after medication administration. C. Stay at the bedside until the client has swallowed all the medications. E. Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug. When administering oral medications, it is important to perform hand hygiene before and after administration and to stay with the client until all medications have been swallowed. The nurse should also assess the effect of the medication at a reasonable time after administration. The MAR should be brought to the bedside to verify the client, but it is not left at the bedside. It would be inaccurate and unsafe to dispense multiple liquid medications into a single cup, as this may result in dosage errors.

A nurse who is administering a piggyback intermittent intravenous infusion of medication to a client observes that there is a cloudy, white substance forming in the IV tubing. Which actions should the nurse take in this situation? Select all that apply. A. Assess the IV site for signs of infiltration or phlebitis. B. Stop the IV from flowing and stop administering the medication. C. Prime the secondary tubing by "backfilling" it. D. Clamp the IV at the site nearest to the client. E. Replace tubing on primary and secondary infusions. F. Check literature regarding incompatibilities of medications after administering.

B. Stop the IV from flowing and stop administering the medication. D. Clamp the IV at the site nearest to the client. E. Replace tubing on primary and secondary infusions. The nurse must stop the IV from flowing and stop administering the medication, then clamp the IV at site nearest to the client. The administration tubing must be changed and then the infusion can be restarted. The nurse should check literature or consult the pharmacist regarding compatibility of the medication and IV fluid before, not after, administration. Priming the secondary tubing by backfilling it will not correct the drug incompatibility.

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? A. Input the order into the computerized provider order system. B. Tactfully request the provider to input the order into the computerized provider order system. C. Refuse to implement the order and notify the nurse manager. D. Have another nurse witness and record the order into the medication administration record (MAR).

B. Tactfully request the provider to input the order into the computerized provider order system. Providers are to enter their own orders when they are physically present. It is appropriate for the nurse to tactfully request that the provider do so. The nurse should not input the order, nor refuse to implement it.

A nurse needs to withdraw a prescribed medication from an ampule and administer it to a client. Which action should the nurse perform to ensure that all the medication is equally distributed when withdrawing? A. Tap the barrel of the syringe near the hub. B. Tap the top of the ampule before withdrawing the medicine. C. Insert the filter needle completely in the ampule. D. Use a smaller-gauge needle to withdraw the medication.

B. Tap the top of the ampule before withdrawing the medicine. Tapping the top of the ampule distributes all the medication to the lower portion of the ampule. Tapping the barrel of the syringe near the hub does not distribute medication equally, but moves the air toward the needle. Inserting the filter needle in the ampule ensures sterility of the needle. Using a smaller- or larger-gauge needle does not ensure that all the medication is equally distributed when withdrawing.

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.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler? A. The nurse should instruct the child to prolong his/her inhalation. B. The nurse should use a nebulizer to administer the medication. C. The nurse should assess the child's mucous membranes. D. The nurse should provide simple written instructions.

B. The nurse should use a nebulizer to administer the medication. The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Assessing the child's mucous membranes is incorrect, as this action is used to identify any break in the continuity of the membranes and will not assist with the coordination of inspiration. Providing simple written instructions is incorrect, as this will enhance the teaching/learning process of the child and not the coordination of the child's inspiration.

A client reports itching and shortness of breath 15 minutes after receiving ceftriaxone 500 mg intravenously. The nurse recognizes that the client is experiencing which type of reaction? A. synergistic reaction B. allergic reaction C. toxic effect D. idiosyncratic effect

B. allergic reaction Itching and shortness of breath are signs of an allergic reaction and a possible anaphylactic reaction. Toxic effect is when too much medication affects an organ or the body as a whole. Idiosyncratic effect is any unusual or peculiar response to a drug. It may manifest by overresponse, underresponse, or even the opposite of the expected response. A synergistic effect exists when an exaggerated response to the medication takes place.

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? A. continuous drip B. bolus administration C. gravity infusion D. electronic infusion device

B. 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.

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: A. takes rapid, shallow breaths until the medication is complete. B. breathes through his or her mouth until all the medication has been inhaled. C. coughs intermittently while the medication is being administered. C. rinses his or her mouth with water before the medication is administered.

B. breathes through his or her mouth until all the medication has been inhaled. The client should breathe through his or her mouth rather than through the nose. It is not necessary to rinse before administration or to cough during administration. Deep breathing is preferable to shallow breathing because this improves absorption.

The client cannot swallow and just had an enteral tube placed for feeding and medications. Medications will have to be in liquid form or crushed for administration. The client has the following medications prescribed. Which medication will the nurse withhold and consult with the health care provider? A. furosemide liquid B. oxycodone extended release tablet C. acetaminophen tablet D. aspirin chewable tablet

B. oxycodone extended release tablet The nurse would withhold the oxycodone extended release tablet. The extended release tablet is meant for delivery of the drug over an extended period of time, such as 12 hours. If crushed, the client would get an immediate release of the medication and could experience an adverse reaction. The other medications can be administered through an enteral tube: liquid, tablet that is crushed, chewable tablet that is crushed.

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

B. placing a medication underneath the upper lip or in the side of the mouth Buccal medication is not chewed, swallowed, or placed under the tongue. Sublingual medications are placed under the tongue. Medications that are given through a nasogastric tube are oral. A medication that is designed to produce systemic effects and is absorbed through the skin is called transdermal.

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. review the client's medication, allergy, and medical history C. administer medication within 30 to 60 minutes of the scheduled time D. allow sufficient time to prepare the medication with minimal distraction

B. 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 3 times (before, during, and after preparing the medication) to 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.

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients? A. gluteus maximus B. ventrogluteal C. rectus femoris D. upper chest

B. ventrogluteal The ventrogluteal or deltoid muscles may be the preferred intramuscular sites for older adult clients experiencing impaired mobility. This site has the potential of retaining greater muscle mass longer than other sites. It is also usually less painful for the client. 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 rectus femoris site is most suitable for infants. The upper chest muscle is part of intradermal injections, not intramuscular injections.

The nurse is caring for a client who is receiving a prescribed intravenous (IV) infusion of an antibiotic to treat an infection. The client asks the nurse, "Can I just take a pill?" What is the bestresponse by the nurse? A. "The health care provider can control the dose of medication you receive through IV." B. "The IV infusion will treat your infection slower." C. "An IV infusion maintains a therapeutic level of the medication in your blood." C. "Oral antibiotics are not as effective as IV infusions."

C. "An IV infusion maintains a therapeutic level of the medication in your blood." When treating certain infections, blood levels of the medication are needed to maintain a consistent therapeutic level. IV infusion does not necessarily treat the infection faster, but provides a consistent blood level. Oral antibiotics can be effective in treating infections. The dose can be controlled through IV infusion, but this is not the reason the client is receiving the medication via IV infusion.

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention? A. "I will wear gloves when applying this." B. "I will apply this as frequently as prescribed." C. "I am taking tadalafil in addition to nitroglycerin." D. "I understand that this drug may lower my blood pressure."

C. "I am taking tadalafil in addition to nitroglycerin." Clients taking nitroglycerin in any form should not take drugs or herbs for erectile dysfunction. This may cause severe hypotension due to the combined vasodilation effect. Other client statements are appropriate and do not require further nursing teaching.

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? A. "I will log in so that you can proceed with medication delivery." B. "I am giving you my password so you can log in." C. "I will get the hospital's information system's phone number for you." D. "I can log in and give the medications for you."

C. "I will get the hospital's information system's phone number for you." Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue.

Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply. A. "The plastic cylinders of insulin pens are softer." B. "Insulin pens are less expensive than insulin vials." C. "The cylinder of the insulin pen contains a prefilled reservoir of insulin." D. "The dose of insulin in an insulin pen is displayed in a window of the syringe." E. "The insulin pen automatically resets the dose window to zero, following the injection."

C. "The cylinder of the insulin pen contains a prefilled reservoir of insulin." D. "The dose of insulin in an insulin pen is displayed in a window of the syringe." E. "The insulin pen automatically resets the dose window to zero, following the injection." The cylinder of an insulin pen contains a prefilled reservoir of insulin because insulin comes prepared. The dose of insulin in an insulin pen is displayed in a window of the syringe, making it easier for the client see the remaining dose. Insulin pens automatically reset the dose window to zero following the injection; this minimizes client error. The cylinder of the insulin pen is made out of hard plastic, not soft plastic, to allow the client to grasp it like a pen. Insulin pens are more expensive, not less expensive, than insulin vials.

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection? A. 3 mL B. 0.01 mL C. 1 mL D. 0.05 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.

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? A. 16-year-old client diagnosed with left radial fracture B. 35-year-old client diagnosed with migraines C. 73-year-old client diagnosed with liver disease D. 45-year-old client diagnosed with lung cancer

C. 73-year-old client diagnosed with liver disease Older adults have a decrease in plasma protein, which is needed to bind and inactivate the medication in the bloodstream. The decrease in plasma proteins can increase the amount of medication circulating, which increases the effects. Decreased liver and kidney function also increases the amount of medication in the blood. The other options can have a risk, but they are not the highest.

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. Place a cotton ball in the ear to absorb excess medication. B. Instill the medication in the opposite ear if prescribed. C. Ask the client to maintain the position for some time. D. Briefly postpone the application in the second ear.

C. 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.

A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the firstassessment the nurse should make? A. Monitor the IV infusion rate. B. Assess the vaginal mucosa. C. Assess the IV site for redness. D. Assess the client's blood pressure.

C. Assess the IV site for redness. If tenderness, fever without obvious source, or symptoms of local or bloodstream infection are present, remove the dressing and inspect the site directly.

A nurse receives orders from the health care provider to mix a client's insulin in a syringe with two other medications. What is the recommended guideline in this situation? A. It cannot be done because it is not possible to mix more than two medications in one syringe. B. Call the health care provider to determine the necessity of mixing the three drugs or to see if they are compatible. C. Call the pharmacist to determine compatibility of the drugs. D. Check with the nursing team before mixing and administering the drugs.

C. Call the pharmacist to determine compatibility of the drugs. Mixing three drugs is not recommended, but if it must be done, contact the pharmacist and not the health care provider to determine the compatibility of the drugs, the compatibility of their pH values, and the preservatives that may be present in each drug. A drug compatibility table should be available to nurses who are preparing medications.

The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action? A. Ask the nursing supervisor to validate the frequency as every 8 hours and update the electronic medical record (EMR). B. Input the prescription into the electronic medical record (EMR) to reflect that the drug is given every 8 hours, after verifying with the pharmacy. C. Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. D. Ask another nurse to validate the frequency as every 8 hours, update the electron

C. Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. The nurse should always have the health care provider clarify the prescription. The nurse cannot assume that a medication is to be given at certain times, nor should another nurse verify the frequency or clarify the prescription. The nurse should remain on the phone with the provider and read back the entire prescription for verification. Documentation should reflect that it is a phone prescription. Usually the phone prescription has to be reviewed and cosigned by the provider within 24 hours.

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? A. Pull out and discard the needle. B. Discard the equipment and start the procedure from the beginning. C. Engage safety shield on needle guard and discard needle appropriately. D. Document the incident and inform the primary care provider.

C. Engage safety shield on needle guard and discard needle appropriately. The needle needs to be disposed of properly after engaging the safety guard because the needle cannot be reinserted due to contamination. A new needle can be attached to the syringe and the remainder of the medication administered after cleansing the site again. The incident does warrant notifying the primary care provider.

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, "I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it." What would the nurse do to address this situation? A. Instruct the client to return to taking the current prescribed medication until it is all gone B. Offer to speak to the provider for different treatment options C. Provide education on taking all antibiotics for effective treatment D. Instruct the client to take both the current antibiotic along with a new prescribed antibiotic to avoid antibiotic resistance

C. Provide education on taking all antibiotics for effective treatment Although benefits of antibiotics may be felt in a few days after starting therapy, the nurse will teach the client that the entire course of medication must be taken to rid the body of infection. Discontinuing the antibiotic prematurely may cause the infection to reoccur. The incomplete use of an antibiotic is one factor that contributes to the evolution of resistant microbial organisms so the nurse would not instruct the client to returning to the previous regimen. Consulting the health care provider for alternate treatment options may or may not be applicable and also is not particularly the most important. The mixture of antibiotics would typically not be prescribed in this client.

Which nursing action(s) promotes safety in the preparation of medication? Select all that apply. A. Ensure a second nurse cosigns all medications. B. Take verbal prescriptions for medications whenever possible. C. Return medications with obscured labels to the pharmacy. D. Note the expiration dates on liquid medications. E. Prepare medications in well-lit conditions.

C. Return medications with obscured labels to the pharmacy. D. Note the expiration dates on liquid medications. E. Prepare medications in well-lit conditions. Agency policy differs slightly on which medications require cosignage and which do not. Typically, opioids and controlled substances require that the dose be double-checked by another nurse and cosigned. All other medications can be signed for and administered by one nurse independently. If the nurse is not able to read the label of a drug, it is not safe to administer. Even if it means the drug may be administered late, the nurse must return it to the pharmacy and request that it is appropriately labeled so the nurse is able to complete all the rights of administration. Noting expiration dates on liquid medications is important because they are not safe to administer once past the expiry date. By preparing medications in well-lit conditions, the nurse is safeguarding from giving the medication to the wrong client or giving the wrong drug at the wrong time. The environment in which medications are prepared for administration is a critical aspect of safety. Medication prescriptions should be written in legible writing on a health care provider prescription sheet whenever possible. If the prescribing health care provider is present when the prescription is made, a verbal prescription should not be taken. Verbal prescriptions have been found to lead to serious errors and should be used sparingly.

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. Inform the health care provider about the client's absence. B. Leave the medication on the client's bedside table. C. Return the medication to the medication cart or medication room. D. Inform the head nurse 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 health care provider or the head nurse about the client's absence.

The client has continuous enteral feedings through a nasointestinal tube. The client has a thyroid medication that is to be taken on an empty stomach. What action does the nurse perform? A. Mix the medication in the tube feeding and administer the tube feeding and medication together. B. Ask the health care provider to prescribe bolus feedings. C. Stop the infusion for 30 minutes before and after administration of the thyroid medication. D. Withhold the thyroid medication.

C. Stop the infusion for 30 minutes before and after administration of the thyroid medication. When the client receives a medication that is to be given on an empty stomach, the nurse will stop the tube feeding for 15 to 30 minutes before and after administration of the medication. This will aid in absorption of the medication or improve its absorption. The nurse does not mix the medication in the tube feeding. Mixing the medication with the tube feeding will impair absorption or the action of the drug. The nurse does not ask for a change to bolus feeding. The client has a nasointestinal tube, and bolus feedings are not recommended for nasointestinal tubes, due to risk of dumping syndrome. The nurse does not withhold the medication without proper notification of the health care provider.

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? A. Call the health care provider to request oral antibiotics. B. Flush the lock with heparin solution. C. Administer the prescribed antibiotics as prescribed. D. Insert a new IV medication lock and remove the old one.

D. Insert a new IV medication lock and remove the old one. The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the health care provider to change the order is not appropriate.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason? A. It uses a system based on household measurements which are easily understood and measured B. It prevents errors by never using leading zeros for doses less than one measurement unit C. The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements D. It ensures accuracy by expressing quantities in fractions and Arabic numbers

C. The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements The metric system is the most widely accepted and convenient system of measurement for drug administration and the strength and frequency of the dose also are indicated (e.g., digoxin 0.125 mg daily). The system is measured by 10s and can easily be consistently converted to other increments; i.e. .25 m = 25 cm = 250 mm. A recommended mistake-proofing practice when administering medications using the metric system is never to use trailing zeros (e.g., 5 mg, never 5.0 mg); using trailing zeros increases the likelihood of an error. A mistake-proofing practice is to always use leading zeros for doses less than one measurement unit (e.g., 0.3 mg, never .3 mg); it does not prevent errors by omitting leading zeros. The metric system does not utilize fractions and Arabic numbers and is not based on commonly used household measurements.

An automated medication-dispensing system has been introduced at health care facility, eliminating the need for two nurses to count controlled substances at the end of each shift. Which practice should the nurses on the unit perform to ensure accurate inventory of controlled substances? A. Participate in a manual count of the inventory at least once every 48 hours. B. Place any rejected or wasted medications back into system promptly. C. Verify the count each time a medication is removed from the system. D. Delegate inventory control to properly trained unlicensed assistive personnel.

C. Verify the count each time a medication is removed from the system. Each time a medication is removed from an automated system, the count must be verified and any discrepancies accounted for. Manual counts are not mandated every 48 hours. Inventory control cannot be delegated to unlicensed assistive personnel. Wasted medications are documented and accounted for but not placed back into the system.

A client has been prescribed an opioid, and the nurse is convinced that the dose prescribed will create a serious risk for respiratory depression, What set of actions should the nurse take next? A. Administer the medication as prescribed, and document the concerns in the client's record. B. Administer the medication, and monitor the client's respiratory status continually. C. Withhold the medication. and speak with the health care provider. D. Do not administer the medication, and complete an incident report.

C. Withhold the medication. and speak with the health care provider. Nurses have the right and responsibility to decline to administer a medication if they believe it jeopardizes client safety. A logical follow up to withholding a scheduled dose would be to dialogue with the health care provider before choosing subsequent actions such as an incident report.

What does the nurse expect to be included in the directions for reconstitution on a drug label? Select all that apply. A. size of the client B. type of diluent not to use C. directions for storing the drug D. amount of diluent to be added E. dosage per volume after reconstitution

C. directions for storing the drug D. amount of diluent to be added E. dosage per volume after reconstitution Directions for storing the drug, the amount of diluent to be added, and the dosage per volume after reconstitution are necessary for adding diluent to a powdered substance for injectable drugs, as these ensure the maximum potency. Therefore, the nurse would expect to find these in the directions. The size of the client will determine the size of the needle selected to inject the client and will not be found on the drug label. The type of diluent will be included on the drug label, but not in the directions for reconstitution.

The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangement does the nurse anticipate in the discharge plan of care? A. assisted living arrangement B. long-term care facility admission C. home nursing visits D. continued inpatient admission

C. home nursing visits The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. Other answers are incorrect, as the client does not need assisted living, long-term care, or continued admission.

When administering heparin subcutaneously, the nurse should: A. aspirate after the injection. B. aspirate before the injection. C. never aspirate. D. gently massage the site.

C. never aspirate. When administering heparin subcutaneously, the nurse should never aspirate, due to the anticoagulant effects and the consequent risk for bleeding.

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client? A. dorsogluteal site B. ventrogluteal site C. vastus lateralis site D. deltoid site

C. 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. The ventrogluteal site, however, 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.

A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client? A. 15 mL B. 22.5 mL C. 67.5 mL D. 30 mL

D. 30 mL The formula to calculate the correct medication amount is:(Dose on hand/Quantity on hand = Dose desired/X).If you use this for this scenario, you would have 30 g/45 mL = 20 g/X, where X = 30 mL.

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? A. 10 to15 degrees B. 20 to 30 degrees C. 45 degrees D. 90 degrees

D. 90 degrees Insulin injections are given subcutaneously to clients with obesity at a 90-degree angle. Other answers are incorrect.

It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client? A. A 30-year-old client diagnosed with Tourette syndrome prescribed haloperidol B. A 40-year-old client diagnosed with breast cancer prescribed fulvestrant C. A 50-year-old client demonstrating delirium tremors prescribed lorazepam D. A 70-year-old demonstrating muscle wasting prescribed chlorpromazine

D. A 70-year-old demonstrating muscle wasting prescribed chlorpromazine The Z-track method is suggested for older adults who have decreased muscle mass. While some agents, such as iron, are best given via the Z-track method due to the irritation and discoloration associated with this agent, none of the other clients demonstrate specific characteristics that suggest the need for Z-tracking.

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. Add medications to the formula. B. Mix all the medications together in 15 mL of water. C. Use cold water when mixing powdered medications. D. Avoid crushing sustained-release pellets.

D. 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.

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? A. Administer the drug as ordered. B. Ask another nurse to verify the order. C. Assume that the provider meant to order buspirone. D. Contact the health care provider for order clarification.

D. Contact the health care provider for order clarification. The nurse should contact the health care provider to verify the order. Bupropion and buspirone are drugs that have look-alike and sound-alike properties but are different in indication. The nurse should not automatically administer the drug, nor ask another nurse to verify an order, nor assume what is meant by an order.

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 bestaction in this situation? A. Choose another site and reinject the medication. B. Prepare another syringe and administer it to the client at the same site. C. Document the administration as correctly administered. D. Document the administration and inform the primary care provider.

D. Document the administration and inform the primary care provider. A wheal or blister indicates that the medication has been injected into the dermis. If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be reinjected into another site. The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.

Which situation accurately describes a recommended guideline when administering oral medications to clients? A. Assume that the client is the authority on whether or not the medication was swallowed. B. If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. C. If a client vomits immediately after receiving oral medications, readminister the medication. D. If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.

D. If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If unsure whether the medication was swallowed, check the client's mouth and cheeks. If a pill is dropped, it should be discarded. If a client vomits, notify the health care provider to see if the medication should be readministered.

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? A. placing the secondary and primary infusion at equal height B. placing the primary solution higher than the secondary solution C. stopping the primary solution until the secondary infusion is completed D. placing the secondary infusion higher than the primary solution

D. placing the secondary infusion higher than the primary solution The nurse should place the secondary infusion higher than the primary infusion. This will allow the secondary infusion to infuse first. When completed, the primary infusion will continue to infuse. The other options are not correct.

The nurse has begun caring for a surgical client who has been prescribed preoperative antibiotics prior to bowel surgery. While the nurse will adhere to all the principles of safe medication administration, which of the rights of administration will the nurse pay special attention to in this situation? A. dose B. route D. time D. client

D. time The rights of medication administration include right client, right drug, right route, right dose, right time, right reason, and right documentation. While the nurse will adhere to all of these, timing is particularly important for preoperative medications, because these must be times so that peak efficacy aligns with the time of peak risk.

The primary reason for the Controlled Substances Act is: A. to regulate the purchase of antibiotics. B. to regulate the purchase of opioids. C. to prevent overuse of antibiotics. D. to prevent drug use and dependence.

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

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? A. side of buttock B. upper arm C. lower abdomen D. upper back

D. upper back The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily.

A 2-year-old child has been injured in a motor vehicle collision and is in immediate need of a blood transfusion for profuse bleeding. Which access site does the nurse expect to use for the infusion? A. carotid B. dorsalis pedis C. great saphenous vein D. scalp vein E. intraosseous

E. intraosseous Intraosseous access with a large-bore rigid needle inserted into the medullary cavity of a long bone may be required for the child with a critical injury who needs emergency fluid, medication, or blood administration (if adequate venous access is not accessible).