CH 3,15,16,18

The physician orders a patient to receive 1000 mL of intravenous fluid over the next 12 hours. The intravenous delivery system is a microdrip system. The nurse would set the infusion to run at which rate? a) 83 gtts/minute b) 32 gtts/minute c) 120 gtts/minute d) 42 gtts/minute

Answer: 83 gtts/minute Rationale: The nurse would set up the following ratio: X = 1000 mL/12 hours x 60 gtts/min 60 min/hour Solving for X equals: 83 gtts/min

Most tablets and capsules dissolve in the acidic fluids of the stomach and are absorbed in: a) The rectum. b) The descending colon. c) The liver. d) The upper small intestine.

Answer: the upper small intestine Rationale: The small intestine is the portion of the digestive system most responsible for absorption of drugs into the bloodstream.

The right route of the drug is usually determined by the drug's formulation. a) True b) False

Answer: True

A patient is administered a third-generation cephalosporin. Which of the following microorganisms are cephalosporins most effective in treating? A) Gram-positive B) Gram-negative C) Fungi D) Virus

Ans: B Feedback: Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. Compared with penicillins, they are, in general, less active against gram-positive organisms but more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.

A nurse has established intravenous access in a patient whose infection necessitates treatment with IV cefazolin. What potential adverse reaction is most likely during this patient's course of treat? A) Gastrointestinal upset B) Dry skin and pruritus C) Drowsiness D) Orthostatic hypotension

Ans: A Feedback: Adverse effects to cefazolin and the other cephalosporins are similar to those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting. Integumentary, neurological, and blood pressure changes are atypical.

A patient is administered acetylsalicylic acid (aspirin) for fever and headache. What is the action of acetylsalicylic acid (aspirin)? A) Inhibiting prostaglandin synthesis in the central and peripheral nervous system B) Providing selective action by inhibiting prostaglandin synthesis in the CNS C) Inhibiting the release of norepinephrine to increase blood pressure D) Suppressing the function of the hypothalamus to decrease inflammation

Ans: A Feedback: Aspirin inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation.

A patient has been prescribed an oral penicillin for an infection caused by gram-negative bacilli. When conducting health education for this patient, the nurse should emphasize which of the following? A) The need to take the medication on an empty stomach B) The fact that a mild rash frequently follows the first few doses C) The need to increase fluid intake for the duration of treatment D) The fact that the drug should be discontinued once symptoms subside

Ans: A Feedback: Most penicillins should be best taken on an empty stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The patient should take the full course of antibiotics.

A 69-year-old female responded well to inpatient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this patient's current clinical presentation? A) The patient may be infected with microorganisms that were resistant to the cephalosporin. B) The patient may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin. C) The patient may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin. D) The cephalosporin may have initially caused leukopenia and made the patient susceptible to secondary infection.

Ans: A Feedback: Patients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier). Delayed hypersensitivity and renal involvement are highly unlikely. Antibiotics do not cause leukopenia.

A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees and elbows with pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process? A) Prostaglandin inhibition is limited to the central nervous system. B) Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. C) Acetaminophen has an antiplatelet effect to decrease edema. D) Prostaglandins decrease the gastric acid secretion.

Ans: A Feedback: The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A) 80 mg B) 180 mg C) 325 mg D) 650 mg

Ans: A Feedback: The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 80 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.

A patient is administered Augmentin (amoxicillin and clavulanate potassium) to treat otitis media. How does a beta-lactamase inhibitor agent achieve a therapeutic effect? A) It extends the spectrum of antibacterial activity of penicillin. B) It extends the spectrum of the beta-lactamase inhibitor. C) It decreases the side effects of high-dose penicillin. D) It increases the absorption of the penicillin.

Ans: A Feedback: When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillin's spectrum of antimicrobial activity. Augmentin does not extend the spectrum of beta-lactamase inhibitor. Augmentin does not decrease the side effects of high-dose penicillin. Augmentin does not increase the absorption of penicillin.

An older adult patient has just been diagnosed with community-acquired pneumonia and aztreonam (Azactam) has been ordered. What action should the nurse perform before administering the first dose? A) Administer a 500 mL bolus of normal saline. B) Confirm the patient's allergy status. C) Swab the patient's nares for the presence of MRSA. D) Teach the patient to expect discolored urine during treatment.

Ans: B Feedback: As with all antibiotics, it is important to assess the patient's allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.

A patient is scheduled for a vaginal hysterectomy. Which of the following medications is the drug of choice for surgical prophylaxis? A) Cefadroxil (Duricef) B) Cefazolin sodium (Ancef) C) Cephalexin (Keflex) D) Cephradine (Velosef)

Ans: B Feedback: Cefazolin sodium (Ancef) is the drug of choice for surgical prophylaxis in most surgical procedures. Cefadroxil, cephalexin, and cephradine are all first-generation cephalosporins, but they are not utilized as the drug of choice for surgical prophylaxis.

A patient is administered imipenem-cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose? A) To eliminate adverse effects of imipenem administration B) To inhibit the destruction of imipenem C) To potentiate the therapeutic effects of imipenem D) To allow imipenem to cross the blood-brain barrier

Ans: B Feedback: Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration of imipenem and reducing its potential renal toxicity. It does not allow the drug to cross the blood-brain barrier, and cilastatin does not eliminate all adverse effects.

A patient is diagnosed with infective endocarditis. Which of the following medications is most effective in treating this patient? A) Dicloxacillin B) Ampicillin C) Nafcillin D) Oxacillin

Ans: B Feedback: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillinresistant Staphylococcus aureus.

A patient suffers from pain in the elbow related to inflammation. What are the chemical mediators of inflammation? A) Insulin, thyroid hormone, and calcitonin B) Bradykinin, histamine, and leukotrienes C) Phospholipids, arachidonic acid, and platelets D) Red blood cells, lymph, and serosa

Ans: B Feedback: Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes. Insulin, thyroid hormone, and calcitonin are not chemical mediators of inflammation. Phospholipids, arachidonic acid, and platelets are not chemical mediators of inflammation. Red blood cells, lymph, and serosa are not chemical mediators of inflammation.

Unasyn is being administered to a patient with an infection caused by Staphylococcus aureus. What type of anti-infective is Unasyn? A) Extended-spectrum antipseudomonal penicillin B) Penicillin-beta-lactamase inhibitor combination C) Cephalosporin D) Aminopenicillin

Ans: B Feedback: Unasyn is a penicillin-beta-lactamase inhibitor combination. It is ampicillin and sulbactam. Unasyn is not classified as an extended-spectrum antipseudomonal penicillin, cephalosporin, or aminopenicillin.

A patient with septicemia is administered cefotaxime sodium (Claforan), a secondgeneration cephalosporin. How is this medication excreted? A) It is excreted by the lungs. B) It is excreted by the liver. C) It is excreted by the kidneys. D) It is excreted through the GI tract.

Ans: C Feedback: Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.

A patient is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism? A) Cefaclor (Ceclor) B) Cefamandole nafate (Mandol) C) Cefoxitin (Mefoxin) D) Cefuroxime sodium (Zinacef)

Ans: C Feedback: Cefoxitin (Mefoxin) is active against B. fragilis, an anaerobic organism resistant to most drugs. Cefaclor, cefamandole nafate, and cefuroxime sodium are all second-generation cephalosporins but not the drug of choice for B. fragilis.

Oral ampicillin has been ordered for a female patient whose urinary tract infection will be treated in a home setting. When teaching this patient about her antibiotic, the nurse should instruct the patient to do which of the following? A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction. B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat. C) Drink a full glass of water when taking a dose of the drug. D) Taper off the drug rather than abruptly stopping it.

Ans: C Feedback: Patients taking penicillins should take oral doses with a full glass of water. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

A patient is to receive imipenem-cilastatin (Primaxin) IM to treat P. aeruginosa. What should imipenem-cilastatin be mixed with prior to administering intramuscularly? A) Meropenem (Merrem) B) Gentamicin (Garamycin) C) Lidocaine D) Epinephrine

Ans: C Feedback: When preparing imipenem-cilastatin for IM injection, lidocaine is added to decrease pain. Meropenem, gentamicin, and epinephrine are not added to imipenem-cilastatin.

When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A) Inflammation is relieved. B) Core body temperature is reduced. C) Pain is relieved. D) Platelet aggregation is inhibited.

Ans: D Feedback: At low doses, aspirin blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet.

A patient is administered aztreonam (Azactam). What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa? A) It is a lower-cost medication. B) It is administered orally. C) It causes less GI distress. D) It has lower risk for hearing loss.

Ans: D Feedback: Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, but the drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-cost medication. Aztreonam is not administered orally. Aztreonam does not cause less GI upset.

A patient is administered penicillin V orally for a strep throat. What is the mechanism of action of this medication? A) It inhibits protein synthesis. B) It lowers the pH of cellular contents. C) It causes mutations. D) It inhibits cell wall synthesis.

Ans: D Feedback: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.

A patient previously experienced an anaphylactic reaction to penicillin G. Which of the following medications should not be administered to this patient due to the potential for cross-sensitivity? A) Lactulose (Chronulac) B) Ketoconazole (Nizoral) C) Kanamycin (Kantrex) D) Cefadroxil (Duricef)

Ans: D Feedback: Cefadroxil (Duricef) is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.

A 71-year-old man with a history of osteoarthritis is scheduled for hip replacement surgery, and the surgeon has ordered a first-generation cephalosporin to be administered before and after surgery as prophylaxis. Which of the following drugs is a firstgeneration cephalosporin? A) Cefotetan (Cefotan) B) Cefoxitin (Mefoxin) C) Ceftriaxone (Rocephin) D) Cefazolin (Ancef)

Ans: D Feedback: Cefazolin (Ancef) is a first-generation cephalosporin. Cefotetan (Cefotan) and cefoxitin (Mefoxin) belong to the second generation, and ceftriaxone (Rocephin) is a thirdgeneration cephalosporin.

An intensive care unit (ICU) nurse is preparing to administer an intravenous dose of imipenem-cilastatin to a patient who is being treated for sepsis. What aspect of this patient's history would contraindicate the use of this drug? A) The patient has a history of type 1 diabetes mellitus. B) The patient is showing signs and symptoms of fluid volume excess. C) The patient's most recent creatinine level was 140 mol/L (high). D) The patient has a documented allergy to penicillin.

Ans: D Feedback: It is important to avoid administering imipenem-cilastatin and the other carbapenems to people with life-threatening allergic reactions to penicillin. Diabetes, slightly increased creatinine levels, and fluid overload do not necessarily contraindicate the use of imipenem-cilastatin.

An adult patient has a history of rheumatic fever. Which of the following medications should be administered as prophylaxis for rheumatic fever? A) Cyclacillin (Cyclapen) B) Amoxicillin (Augmentin) C) Dicloxacillin D) Penicillin G benzathine (Bicillin LA)

Ans: D Feedback: Penicillin G benzathine (Bicillin LA) is administered as prophylaxis for rheumatic fever. Cyclacillin, amoxicillin, and dicloxacillin are not routinely administered for prophylaxis of rheumatic fever.

A young mother asks the nurse why she cannot give her 2-year-old child an adult dose of Tylenol. The nurse explains. What statement would indicate that the mother needs further education? a) "My child's dose of Tylenol should be based on her weight or age." b) "My baby's dose of Tylenol is based on a healthy adult male." c) "My baby can't handle a high dose of Tylenol because her liver may be damaged." d) "There could be a time when my child may need a higher dose than normal."

Answer: "My baby's dose of Tylenol is based on a healthy adult male."

A client who just picked up her prescription at the pharmacy asks the nurse why she was prescribed a medication for mental health issues when she sought treatment for allergies. What is the nurse's best response? a) "Have you been experiencing any hallucinations lately?" b) "What symptoms of allergies do you have?" c) "The prescriber probably wanted to treat any anticipated depression you may experience." d) "Tell me the name of your prescription please."

Answer: "Tell me the name of your prescription please." Rationale: The nurse should be aware of the potential name mix-up between the antihistamine Zyrtec (commonly prescribed for allergies) and the antipsychotic Zyprexa. Asking the client for the name of the prescription gives the nurse information to conclude whether the client has received the correct prescription. Telling the client that depression is being treated or asking about hallucinations or allergy symptoms does not address the most likely occurrence that the wrong medication has been filled by the pharmacy

The nurse is preparing to administer a transdermal medication and the client asks why the medication is being delivered in this manner. What is the nurse's best response? a) "This method keeps a steady amount of medicine in your body at all times." b) "There are no side effects when medications are given this way." c) "This type of medicine administration means the client can take it on and off at will." d) "This allows the health care provider to prescribe a high dose of medicine."

Answer: "This method keeps a steady amount of medicine in your body at all times."

After teaching the parents of a child who is receiving drug therapy, which statement indicates the need for additional teaching? a) "When measuring a liquid medication, we should use a measured device or spoon rather than a kitchen tablespoon or teaspoon." b) "Some over-the-counter drugs contain the same ingredients, so we need to read each label closely before giving the medication." c) "We need to tell each health care provider about all the medications that our child is taking, even nonprescription ones." d) "We can use the same medications that we use for similar problems in our child, but we might need to adjust the dosage."

Answer: "We can use the same medications that we use for similar problems in our child, but we might need to adjust the dosage."

A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency department. Which of the following is an open-ended assessment question? a) "Are you comfortable with receiving needles?" b) "Does anyone in your immediate family have a history of drug allergies?" c) "Have you ever had a bad response to a drug that you've taken?" d) "What kind of reactions have you had to medications?"

Answer: "What kind of reactions have you had to medications?"

A patient receiving drug therapy that increases urinary elimination comes to the clinic complaining of waking up numerous times during the night to urinate. Which question would be most appropriate for the nurse to ask? a) "Are you taking any herbal medicines?" b) "What is the dosage of your medication?" c) "When are you taking your medication?" d) "Have you had any other complaints?"

Answer: "When are you taking you medication?" Rationale: The patient's complaints suggest that the drug's peak effect is occurring during sleep, which would lead the nurse to suspect that the patient is taking the medication before bedtime. The nurse would need to confirm that this is true before questioning the patient further about the dosage or other complaints. Asking about herbal medicines is appropriate with any drug therapy.

A patient has orders to receive 3,000 mL of IV fluid at a rate of 150 mL/hr. If the infusion starts at 0800, when would it be finished? a) 0400 b) 0100 c) 2000 d) 2300

Answer: 0400 3,000 mL/150 mL = 20 hours. Therefore, 20 hours after 0800 is 0400.

A nurse is to administer 150 mg of a drug intramuscularly. The label on the multidose vials reads 100 mg/mL. How much would the nurse give? a) 2.5 mL b) 1.5 mL c) 1 mL d) 2 mL

Answer: 1.5 mL

A patient is going to have bowel surgery in the morning. The physician orders 500 mL of GoLytly PO starting at 5 PM this evening. What would this amount be in liters? a) 1 b) ¾ c) ¼ d) ½

Answer: 1/2 500 mL/1000 mL = 0.5 L or 1/2 L

The nurse multiplies and divides simple fractions when calculating drug doses for clients. Which of the following fractions occur when multiplying 2/5 by 5/8? a) 4 b) 16/25 c) 2/5 d) 1/4

Answer: 1/4

A patient has orders to receive 2 liters of IV fluid over a 24-hour period with ½ this amount to be infused in the first 10 hours of treatment. How many milliliters per hour would the patient receive during the first 10 hours of the infusion? a) 100 mL/hr b) 120 mL/hr c) 240 mL/hr d) 50 mL/hr

Answer: 100 mLl/hr Rationale: Use the following ratio to determine how many drops of fluid to administer per minute: drops/minute = mL of solution prescribed per hour X drops delivered per mL 60 minutes/1 hour

A nurse is preparing to give a client an extended-release medication. For how long will the effects of this type of drug typically last? a) 12 to 24 hours b) 3 to 6 hours c) 24 to 36 hours d) 6 to 12 hours

Answer: 12 to 24 hours Rationale: Extended-release drugs have effects that typically last 12 to 24 hours

A newly admitted patient has orders to receive 1000 mL of normal saline IV over 8 hours. If the IV infusion set is a microdrip set that delivers 60 drops per mL how many drops per minute should the patient be receiving? a) 480 drops/minute b) 60 drops/minute c) 120 drops/minute d) 240 drops/minute

Answer: 120 drops/minute Rationale: If a patient were to receive 1000 mL in 8 hours, dividing 1000 by 8 would mean that the patient would receive 125 mL in 1 hour, or 60 minutes. Setting up the equation, 60 drops/mL times X equals 125 mL/60 minutes, and cross-multiplying, the answer is 120 drops/min.

The nurse is required to administer 2 mL of a subcutaneous (SC) injection to the patient. The injection should be given in _____ sites, with separate needles and syringes. a) 4 b) 2 c) 3 d) 1

Answer: 2 Rationale: A volume of 0.5 to 1 mL is used for SC injection. If a volume of 2 mL is ordered through the SC route, then the injection is given in two sites with separate needles and syringes.

A patient is to receive 0.05 g of a diuretic. The patient has 25 mg tablets on hand. The nurse would instruct the patient to take how many tablets? a) 1.5 b) ½ c) 1 d) 2

Answer: 2 order = 0.05 g available = 25 mg or 0.025 mg O/A or 0.05 g/0.025 g = 2 tablets

A clinic patient needs to take 1 g PO of cefadroxil. The nurse explains to the patient that the drug comes in 500 mg tablets. How many tablets would the nurse tell the patient to take? a) 3 tablets b) 1 tablet c) 2 tablets d) 0.5 tablet

Answer: 2 tablets Rationale: Convert 1 g to mg by multiplying 1 g times 1000mg. There are 500 mg in each tablet. Dividing 1000 mg prescribed dosage by 500 mg available dosage, the answer is 2 tablets.

The nurse is converting grams to milligrams. How would the nurse move the decimal point? a) 2 places to the right b) 3 places to the left c) 2 places to the left d) 3 places to the right

Answer: 3 places to the right Rationale: To convert from large to small, the nurse would move the decimal point to the right. In this case 1 g = 1,000 mg; therefore, the decimal point would move three places to the right.

Which of the following correctly expresses the ratio 3:100 in a fraction? (Choose one) a) 1/33.3 b) 33.3/1 c) 100/3 d) 3/100

Answer: 3/100

A patient is experiencing pain, so their physician orders codeine ½ grain every 4 hours. How many milligrams of codeine would the nurse administer? a) 120 mg b) 30 mg c) 15 mg d) 60 mg

Answer: 30 mg Rationale: The simplest way to convert measurements from one system to another is to set up a ratio and proportion equation. The ratio containing two known equivalent amounts is placed on one side of an equation, and the ratio containing the amount you wish to convert and its unknown equivalent is placed on the other side

You are a pediatric nurse caring for a child who weighs 42 lbs. The physician has ordered methylprednisolone sodium succinate (Solu-Medrol), 0.03mg/kg/day IV in normal saline. How many milligrams should the nurse prepare to give? a) 6.5 b) 6 c) 0.6 d) 0.65

Answer: 6 Rationale: This method of prescribing takes into consideration the varying weights of children and the need for a higher dose of the drug when the weight increases. For example, if a child with postoperative nausea is to be treated with Vistaril (hydroxyzine), the recommended dose is 1.1 mg/kg by intramuscular injection. If the child weighs 22 kg, the dosage for this child would be 1.1 mg times 22 kg or 24.2 mg, rounded down to 24 mg. If a child weighed only 6 kg, the recommended dose would be 1.1mg times 6 kg or 6.6 mg.

A nurse needs to convert 3 fluid ounces to the metric system equivalent. The nurse performs the calculation to find which result? a) 90 mL b) 180 mL c) 240 mL d) 360 mL

Answer: 90 mL

Which of the following is scanned during administration of a drug using a bar code point-of-care medication system? Select all that apply. a) Client's identification band b) Drug unit dose package c) Nurse's identification badge d) Client's medication administration record e) Client's hospital chart

Answer: A, B, C Rationale: The bar code point-of-care medication system requires that the client's identification band, the drug unit dose package, and the nurse's identification badge are all scanned prior to drug administration.

Which of the following must occur prior to initiating an effective therapeutic regimen? Select all that apply. a) Nurse's assessment of the client's ability to understand medication regimen. b) Client verbalizes desire to manage the medication regimen. c) Assessment of client's educational level. d) Client's compliance with other tasks of daily living. e) Client must demonstrate ability to read.

Answer: A, B, C, D Rationale: Prior to initiating a teaching plan for the client to administer an effective therapeutic treatment regimen, the nurse must assess the client's compliance with other tasks of daily living, the client's desire and willingness to manage the regimen, the client's ability to understand the regimen, and the client's basic educational level.

Which of the following factual knowledge should the nurse have prior to administering a drug? Select all that apply. a) Reason for use of the drug b) Drug's general action c) Drug's most common adverse effects d) Special precautions in administration e) Normal dosage range

Answer: A, B, C, D, E

A nurse, who is required to administer a drug twice a day to a patient, forgets to administer the first dose. What are the nursing interventions that the nurse should perform in this situation? Select all that apply. a) Complete an incident report regarding the error b) Notify the primary care provider immediately c) Increase dosage to compensate for the first dose d) Report the drug error immediately e) Take no action if client doesn't show any adverse reaction

Answer: A, B, D

An instructor is describing the units of measure associated with household system. Which of the following would the nurse include? Select all that apply. a) Quart b) Cup c) Dram d) Teaspoon e) Ounce f) Milliliter

Answer: A, B, D, E Rationale: Units in the household system of measurement include pint, quart, gallon, ounces, cups, tablespoons, teaspoons, drops, and pounds. Dram is a unit of measure in the apothecary system. Milliliter is a unit of measure in the metric system.

What aspects of self-administration of drugs show that the client is deficient in knowledge of the subject? Select all that apply. a) Lack of interest in learning b) Inability to remember c) Not having a college degree d) Not having a high school degree e) Cognitive limitation

Answer: A, B, E

Which of the following are the three specific items found on a drug label needed to administer a drug? Select all that apply. a) Drug name b) Monitoring parameters c) Dosage form d) Dosage strength e) Side effects

Answer: A, C, D Rationale: Although drug labels contain a great amount of information about the drug being given, three specific items are needed to administer a drug: the name, form, and dosage strength.

The goals of drug therapy are to maximize beneficial effects and minimize adverse effects. To help meet these goals, general guidelines include all of the following EXCEPT: a) Expected benefits should outweigh potential adverse effects. b) Drug therapy should be individualized. c) Any adverse reaction is cause to discontinue a therapy regimen. d) Drug effects on quality of life should be considered in designing a drug therapy regimen.

Answer: Any adverse reaction is cause to discontinue a therapy regimen. Rationale: Expected benefits should outweigh potential adverse effects. Thus, drugs usually should not be prescribed for trivial problems or problems for which nondrug measures are effective. Drug therapy should be individualized. Many variables influence a drug's effects on the human body. Failure to consider these variables may decrease therapeutic effects or increase the risks of adverse effects. Drug effects on quality of life should be considered in designing a drug therapy regimen. Quality-of-life issues are also being emphasized in research studies, with expectations of measurable improvement as a result of drug therapy.

A nurse is required to administer a drug through the transdermal route. Which of the following responsibilities should the nurse follow for the patient? a) Apply next dose to a new site. b) Give small volumes of doses. c) Check the infusion rate. d) Inject only the inner part of the forearm.

Answer: Apply next dose to a new site. Rationale: An important nursing intervention when administrating drugs through the transdermal route is to apply the next dose to a new site. It is important to check the infusion rate every 15 to 30 minutes in patients using infusion controllers or infusion pumps. When using the intradermal route, the inner part of the forearm should be used as the injection site and small volumes of doses should be administered

The nurse demonstrates an understanding of the metric system when she identifies which of the following to be correct? (Select all that apply.) a) 1 gram = 100 milligrams b) 1 gram = 1000 milligrams c) 1 milligram = 1000 micrograms d) 1 kilogram = 1000 grams e) 1 gram = 10 milligrams

Answer: B, C, D

Which of the following are steps of the nursing process? Select all that apply. a) Documentation b) Planning c) Evaluation d) Assessment e) Reporting

Answer: B, C, D

The physician has ordered intravenous pain medication for your patient. Why are medications given intravenously? Select all that apply. a) It provides slower onset and longer duration of the medication. b) A smaller dose of the medication is needed to cause the desired effect. c) There is less irritation to the tissues. d) It is effective when the patient has impaired circulation.

Answer: B, C, D Rationale: IV medications cause less irritation to the tissues, have a rapid onset and shorter duration of action, and can be given even when the patient has compromised circulation. Smaller dosage of the medication is needed to produce the same effect as compared to the intramuscular, subcutaneous or oral routes of medication administration due to the direct action of the medication. IV medications can cause the same amount or additional adverse effects related to the route of administration and the onset of action.

Which of the following is part of the concept known as the five + 1 rights of drug administration? Select all that apply. a) Right prescriber b) Right drug c) Right documentation d) Right patient e) Right route

Answer: B, C, D, E

Which of the following are systems of measurement associated with drug dosing? (Select all that apply) a) Nursing system b) Hospital measurements c) Metric system d) Apothecary system e) Household measurements

Answer: C, D, E Rationale: There are three systems of measurement associated with drug dosing: the metric system, the apothecary system, and household measurements.

A group of students are practicing pediatric dosage calculation using Clark's rule. Which information would the student's need? a) Child's body surface area b) Child's weight in pounds c) Child's age in months d) Child's height in centimeters

Answer: Child's weight in pounds Rationale: Clark's rule requires knowledge of the child's weight in pounds, and the average adult dose. A child's height in centimeters is used to determine body surface area. Fried's rule requires that the infant's age in months be known. Child's body surface area is not used with Clark's rule.

The charge nurse on the unit transcribes a physician's order onto the medication administration record. She writes, "Digoxin 0.25 mg PO qod ×3d" on the MAR. How should the order be written to prevent medication error? a) Digoxin 0.25 mg PO every other day ×3d b) Digoxin 0.25 mg PO qod for three doses c) Digoxin 0.25 mg by mouth every other day for three doses d) Digoxin 0.25 mg PO qod ×3d

Answer: Digoxin 0.25 mg by mouth every other day for three doses

A nurse in a nutrition clinic is to give 2 cups of organic prune juice to a client every night. The nurse is to document this on the nursing chart. What unit will the nurse use to document the amount of juice according to the metric system of measurement? a) Unit b) Gram c) Milliliter d) Ounce

Answer: Milliliter Rationale: The nurse should document the amount of prune juice in milliliters or increments of milliliters. The measure of liquid volume in the metric system is based on the milliliter. Gram is a measurement of weight. An ounce is an apothecary term used formerly; it is equivalent to 30 mL. The term unit does not belong to the metric system of measurement.

Mr. Jones is self-administering garlic, St. John's wort, and echinacea. What does the anesthesiologist ask the client to do? a) Continue only the garlic and echinacea according to his current medication regimen. b) Maintain his current regimen regardless of the herbal supplements taken. c) Discontinue the herbal medications 2 to 3 weeks prior to surgery. d) Discontinue the herbal medications 1 week prior to surgery.

Answer: Discontinue the herbal medications 2 to 3 weeks prior to surgery. Rationale: The American Society of Anesthesiologists recommends that all herbal products be discontinued 2 to 3 weeks before any surgical procedure. Some products (e.g., echinacea, feverfew, garlic, gingko biloba, ginseng, valerian, St. John's wort) can interfere with or increase the effects of some drugs, affect blood pressure or heart rhythm, or increase risks of bleeding; some have unknown effects when combined with anesthetics, other perioperative medications, and surgical procedures.

A nurse has administered narcotics to a patient. Which of the following interventions should the nurse perform immediately after administration? a) Inform the patient about the type of drug. b) Document administration of the drug. c) Update the physician regarding the patient's condition. d) Monitor the vital signs of the patient.

Answer: Document administration of the drug. Rationale: After administration of any drug, the nurse should immediately document the administration. After the documentation is complete, the nurse can record the patient's vital signs. The patient needs to be informed about the drug before the administration. The physician need not be immediately informed, unless the client develops severe adverse reactions.

The nurse is preparing to administer medications and demonstrates knowledge of the 6th right by doing what procedure? a) Ensuring that the medication is administered at the correct time b) Documenting the medication after administration c) Checking the medication to make sure that the correct dose of medication is given d) Identifying the client immediately prior to administering the medication

Answer: Documenting the medication after administration

Many patients who the nurse cares for in the hospital are also taking over-the-counter (OTC) medications. Which core patient variable is needed to assess the patient's OTC medication use? a) Environment b) Lifestyle c) Life span d) Health status

Answer: Health Status Rationale: Health status not only is needed to assess the patient for acute and chronic illness but also must comprise a comprehensive drug history that includes OTC medications. This information is essential for determining the appropriate plan of care for the patient.

A nurse has been caring for a patient in a health care facility. Under what circumstances should the nurse consider the evaluation of a patient to be positive? a) If subjective and objective data are successfully obtained. b) If the patient does not experience anxiety during therapy. c) If the expected outcomes are accomplished. d) If the patient is better able to communicate with the nurse.

Answer: If the expected outcomes are accomplished

Assessment of a client receiving drug therapy reveals that the client has been experiencing gastrointestinal upset related to the drug. The client states, "My stomach has been so upset that all I've been able to eat is soup and dry crackers." Which nursing diagnosis would be most likely? a) Risk for imbalanced fluid volume b) Feeding self-care deficit c) Imbalanced nutrition: Less than body requirements d) Noncompliance

Answer: Imbalanced nutrition: Less than body requirements Rationale: The client is reporting a problem with ingesting adequate food and nutrients. Therefore, imbalanced nutrition: Less than body requirements would be most appropriate. Risk for imbalanced fluid volume may be a problem if the client were experiencing vomiting or diarrhea that could lead to excess fluid loss. The client is not verbalizing a problem with feeding himself. Rather, he is reporting difficulty in eating or consuming adequate food. The client is taking the medication, so he is not noncompliant

The nurse checks a client's temperature before administering a standing order for Tylenol for temperatures over 100°F. The client's temperature is 98.9°F, so the nurse decides to withhold the dose of Tylenol. Withholding the dose represents which phase of the nursing process? (Choose one) a) Implementation/intervention b) Planning c) Analysis/diagnosis d) Evaluation

Answer: Implementation/intervention

The nursing student learns that the apothecary system was at one time used for weight but was recently eliminated for which of the following reasons? a) It produced a high rate of errors. b) It was used only for volume and thus was limited. c) It was used for only large doses. d) It was too hard to memorize.

Answer: It produced a high rate of errors.

During assessment, a nurse asks a client about any chronic conditions that might have an impact on the client's prescribed drug therapy. Which of the following, if reported by the client, would alert the nurse to a possible problem? a) Two episodes of pneumonia over the last 5 years b) Episode of gastroenteritis last month c) Nearsightedness for the past 10 years d) Kidney disease diagnosed 2 years ago

Answer: Kidney disease diagnosed 2 years ago Rationale:

When taking a medication history on a patient why should the nurse ask about the use of alternative therapies? a) Natural products may be more effective and the drug may not be needed. b) The cost of the drug and the alternative therapy may be too great for the patient to handle. c) Patients who use new drugs are usually not compliant with medical regimens. d) Many drug-alternative therapy interactions can cause serious problems and should be avoided.

Answer: Many drug-alternative therapy interactions can cause serious problems and should be avoided. Rationale: Alternative therapies often involve the use of herbal products, which contain natural chemicals that affect the body. Many drug-alternative therapy interactions have been reported that could cause serious side effects. The health care provider needs to be alert to these possible interactions and to adjust treatment appropriately. Cost and effectiveness may be factors, but the balancing of these therapies in the drug regimen to prevent interactions is the main concern of the nurse.

A nurse in a nutrition clinic is to give 2 cups of organic prune juice to a client every night. The nurse is to document this on the nursing chart. What unit will the nurse use to document the amount of juice according to the metric system of measurement? a) Ounce b) Gram c) Unit d) Milliliter

Answer: Milliliter Rationale: The nurse should document the amount of prune juice in milliliters or increments of milliliters. The measure of liquid volume in the metric system is based on the milliliter. Gram is a measurement of weight. An ounce is an apothecary term used formerly; it is equivalent to 30 mL. The term unit does not belong to the metric system of measurement.

A 35-year-old male patient is admitted to the hospital with pneumonia. He was originally being treated at home, but became worse when he quit taking his medicine. What would be an appropriate nursing diagnoses for this patient? a) Deficient knowledge: monitoring temperature b) Noncompliance c) Risk for injury related to office visits d) Non-adherence: overuse

Answer: Noncompliance

A nurse identifies the following: Risk for injury related to central nervous system effects of the prescribed drug therapy. The nurse is engaged in which step of the nursing process? a) Implementation b) Nursing diagnosis c) Assessment d) Evaluation

Answer: Nursing diagnosis

Identification of problems that can be solved or prevented by the nurse without involvement of the physician is known as which of the following? (Choose one) a) Nursing diagnosis b) Nursing evaluation c) Nursing Assessment d) Nursing documentation

Answer: Nursing diagnosis

A nursing diagnosis provides the framework for which of the following? a) Medical interventions b) Outcome statements c) Evaluation d) Nursing interventions

Answer: Nursing interventions

A nurse is completing the first step of the nursing process. Which of the following activities would the nurse perform? a) Administering the prescribed drug b) Obtaining a medication history c) Determining the therapeutic response to the drug d) Identifying actual patient problems

Answer: Obtaining a medication history

Which of the following is essential for the nurse to obtain before administering a medication to the client? a) Physician's order b) Prescription of the drug c) Medical history of the client d) Primary care provider's verbal order

Answer: Physicians' order Rationale: The nurse should have a physician's order before administering a medication. A nurse should not administer drugs on the primary care provider's verbal order unless there is an emergency. The drug prescription and medical history of the client provide information about the dosage schedule and the client's history, but these documentations alone do not allow the nurse to administer a medication.

After the formulation of nursing diagnoses what is the next step in the nursing process? (Choose one) a) Evaluation b) Implementation c) Planning d) Assessment

Answer: Planning

The nurse is establishing goals for a client related to a new medication administration. Which phase of the nursing process is characterized by goal setting? a) Planning b) Analysis c) Evaluation d) Implementation

Answer: Planning

A nurse caring for a patient is describing steps for carrying out nursing activities that will assist in achieving patient goals. At which step of the nursing process is the nurse? a) Evaluation b) Assessment c) Planning d) Implementation

Answer: Planning Rationale: The planning step of the nursing process involves describing steps for carrying out nursing activities that will assist in achieving patient goals or expected outcomes. The assessment step involves collecting facts by means of a physical examination and through information supplied by the patient or the patient's family. During the implementation step, the nurse carries out a defined plan of action. Evaluation is a decision-making process that involves determining the effectiveness of the nursing interventions in meeting the expected outcomes.

A nurse is administering IV acyclovir to a client. The pharmacy sent the correct dose in an IV bag with the instructions to give over one hour. The nurse realizes that the dose was ordered for 1 PM and it is now 1:45 PM. What should the nurse do? a) So that the medication is administered completely by the normal finishing time, start the infusion and set the pump so that the total amount will be given by 2 PM. b) Run the infusion as directed (over one hour) and note the time that it was started in the chart. Fill out any medication discrepancy reports that the institution requires when a medication is given late. c) Run the infusion at the normal rate but stop the pump and infusion at 2 PM so that the client does not get too much of the medication too close to the next dose. d) Run the infusion as directed (over one hour) and document in the chart the time that it should have been started instead of the actual time.

Answer: Run the infusion as directed (over one hour) and note the time that it was started in the chart. Fill out any medication discrepancy reports that the institution requires when a medication is given late.

Which organization is responsible for the continuation of defining, explaining, classifying, and researching summary statements about health problems related to nursing? a) The National Council of State Boards of Nursing b) The North American Nursing Diagnosis Association-International (NANDA-I) c) The Joint Commission d) The individual states' nursing board

Answer: The North American Nursing Diagnosis Association-International (NANDA-I) Rationale: NANDA-I was formed to standardize the terminology used for nursing diagnoses and continues to define, explain, classify, and research summary statements about health problems related to nursing. The Joint Commission is responsible for accreditation. The state board of nursing and National Council of State Boards of Nursing affect licensing."Dose desired / dose on hand = dose administered" is the formula for calculating the dose to be administered. Under which of the following circumstances is this to be used?

What is a safety feature inherent in using the bar code method to administer drugs? a) The bar code on the client's identification band contains the MAR. b) The bar code on the drug label contains the client's name. c) A wireless computer network processes the scanned information and gives an error d) When administering medications, the nurse is only required to scan the bar code on the drug label.

Answer: The bar code on the client's identification band contains the MAR.

The nurse is teaching a client about the medications prescribed by the physician. Which of the following should the nurse state as the reason for not crushing an enteric-coated tablet into a powder? a) The medication tastes unpleasant. b) The medication melts when in contact with moisture. c) The medication irritates the stomach mucosa. d) The medication dissolves in the client's mouth.

Answer: The medication irritates the stomach mucosa.

The nurse assigned to take care of a patient is unable to read the primary-care provider's handwriting. Which of the following interventions is the most appropriate in this situation? a) The nurse should question the order with the primary-care provider. b) The nurse should try to interpret the handwriting. c) The nurse should obtain a verbal order. d) The nurse should confirm the order with a nearby care provider.

Answer: The nurse should question the order with the primary-care provider. Rationale:

Which of the following is not a client right regarding his or her prescribed medication? a) The right to refuse a court ordered medication b) The right to know the name and action of a medication c) The right to know the possible side effects of a medication d) The right to request the generic form of medications

Answer: The right to refuse a court ordered medication Rationale: Clients have the right to know the name, action, and possible side effects of medications administered to them. They also have the right to refuse to take medications, unless a court order gives healthcare workers the right to administer medications without the client's consent. (If clients are endangering themselves or others, medications may be given against their will.) Clients also have the right to request the generic form of prescribed medications, if available. Generic forms of medications are often less expensive than their brand name counterparts.

A nurse should teach parents to call their child's health care provider if the child seems to be getting worse even with drug therapy. a) True b) False

Answer: True

All prescriptions are required to list the metric measure for quantity and strength of the drug. a) False b) True

Answer: True

The nurse knows that household measurements are used for volume only and are not commonly used in health care settings. Sometimes for convenience the physician will order a drug in a household measurement. Which of the following is an example of a drug ordered this way? a) Ampicillin 250 mg b) Tylenol 200 mg c) Tylenol 1 tsp d) Tylenol 5 ml

Answer: Tylenol 1 tsp

You are caring for a patient who takes several drugs. You know that those patients most likely to have adverse drug reactions are who? a) Patients with coronary artery disease b) Non-compliant patients c) Patients who are on the recommended dose d) Very young and very old patients

Answer: Very young and very old patients

A nurse must give two ophthalmic medications to the same client. What step should the nurse take? a) Wait 1 to 5 minutes after administering the first drug before delivering the second. b) Check with the physician to see if a single medication to treat both problems is available instead. c) Instill both in one eye and then both in the other. d) Put both medications in the dropper at once.

Answer: Wait 1 to 5 minutes after administering the first drug before delivering the second.

A nurse is caring for a hospitalized pediatric patient. The child has medications ordered that the nurse wants to verify the dosage of. The nurse decides to calculate the child's medication dose by using Clark's Rule. Which calculation represents the application of Clark's Rule? a) Infant's age in months/150 months times the average adult dose b) Surface area in square meters/1.73 times the average adult dose c) Weight of child in pounds/150 pounds times the average adult dose d) Child's age in years/child's age in years plus 12 times the average adult dose

Answer: Weight of child in pounds/150 pounds times the average adult dose Rationale: Clark's Rule uses the child's weight to calculate the dose and assumes the adult dose is based on a 150-pound person. Fried's Rule applies to a child younger than 1 year of age and assumes than an adult dose would be appropriate for a child who is 12.5 years (150 months) old. Young's Rule applies to children 1 to 12 years of age. Surface area calculation of a child's dose is determined with the use of a nomogram including the child's height and weight.

"Dose desired / dose on hand = dose administered" is the formula for calculating the dose to be administered. Under which of the following circumstances is this to be used? a) When the dosage is written in the apothecary system. b) When the physician is not available to calculate the dosage. c) When the label of the drug is in the metric system. d) When the dose desired and dose on hand are in the same system.

Answer: When the dose desired and dose on hand are in the same system.

A nurse has received an order to administer a drug intravenously over a 60-minute period in a patient with NS running at TKO. The nurse should gather supplies and prepare to administer the drug by a) intravenous piggyback (IVPB). b) intravenous push (IVP). c) peripherally inserted central line (PIC). d) continuous IV infusion.

Answer: intravenous piggyback (IVPB)