Chapter 34 and 35 Pharmacology

The nurse is preparing to obtain a blood specimen from an older adult patient who is occasionally confused. Which method of patient identification will the nurse avoid? Ask the patient who they are and check the room number. Scan the bar code located on the patient's arm band. Ask the patient to state their full name and birthdate. Compare the laboratory label with the information on the patient's arm band.

1

The nurse manager in a long-term care facility is concerned about the increase in medication errors at the facility. Which feedback from the nurses indicate the most likely cause? 1.)Clients want to be social and gather around the medication cart. 2.)The Medication Administration Record (MAR) lists the medications by generic and brand-names. 3.)Photos of each client are attached to the MAR are used for identification. 4.)Clients need to be located before medications are given.

1

The cardiac care nurse is assessing a client for signs of digoxin toxicity. Which symptoms are concerning? Select all that apply. Loss of appetite Nausea and vomiting Blurred vision Yellow cast to objects Halos of light around objects

2 3 4 5

The nurse is performing phlebotomy using an evacuated tube set and has inserted the needle into the selected vein location. Which actions will the nurse take if a blood sample cannot be obtained? Select all that apply. Palpate the vein distal to the needle and redirect the needle. Switch the method of specimen collection. Pull back or rotate the needle slightly. Change the evacuation tube for another. Use the index finger and thumb to anchor the vein in place.

2 3 4 5

The nurse has researched the high incidence of nurses who become dependent on drugs or alcohol. Which is the greatest contributor to substance abuse among nurses? High-stress level jobs Shift rotations Easy access to drugs Twelve-hour shifts

3

The nurse manager in a long-term care facility is concerned about the increase in medication errors at the facility. Which feedback from the nurses indicate the most likely cause? Clients want to be social and gather around the medication cart. The Medication Administration Record (MAR) lists the medications by generic and brand-names. Photos of each client are attached to the MAR are used for identification. Clients need to be located before medications are given.

1

The nurse receives a hand-written prescription order from a health-care provider in which the dose is not clearly written. Which priority action does the nurse take? Call the health-care provider for verification of the order. Call the pharmacist for dosage parameters. Look the drug up in a current, Physician's Desk Reference. Administer the lowest dose in the range given by the drug handbook.

1

The nurse recognizes that sometimes a tourniquet must be applied tighter than usual when obtaining a blood specimen. Which additional action will the nurse take under these circumstances? 1.)Apply the tourniquet over a gown or shirt sleeve. 2.)Use a narrower tourniquet width. 3.)Hang the patient's arm in a dependent position first. 4.)Ask the patient to pump the hand several times.

1

The nurse prepares to draw blood from multiple patients and begins to label the tubes at the nurses' station to expedite the process. The charge nurse stops the nurse and explains this is not best practice. Which potential error may occur when labeling specimens before entering the patient's room? Select all that apply. 1.)Wrong patient 2.)Wrong time 3.)Wrong color tubes 4.)Wrong method of venipuncture 5.)Risk of hemoconcentration

1 2

The nurse is preparing to administer medication to a client. Which actions by the nurse are focused on the rights of medication administration? Select all that apply. Ascertain why the medication is ordered and if it addresses the client's condition. Use two methods of identification before administering medication to a client. Check for changes in the client's ordered medications. Validate that the method of administration is clearly indicated. Identify the medication by its color before administration

1 2 3 4

The nurse is working in an acute care setting and administering medications to multiple patients. Which patient is assessed as being a high risk for an allergic reaction? Select all that apply. A patient receiving multiple injections for a possible exposure to rabies A patient being treated aggressively for septicemia A patient with a transient ischemic attack who is started on blood pressure drugs A patient scheduled for a thyroid scan that requires a contrast medium A patient with new-onset seizure activity being treated to control convulsions

1 2 4 5

The nurse is preparing to perform phlebotomy on a patient for the collection of blood specimens. The nurse notices that previous needle puncture sites on this patient have resulted in the formation of a hematoma. Which actions will the nurse take to prevent additional hematomas? Select all that apply. 1.)Remove the tourniquet prior to removing the needle from the vein. 3.)Hold pressure over the puncture site for at least 1 to 2 min. 3.)Place a cold pack immediately on the puncture site after the needle is withdrawn. 4.)Use warm compresses prior to the blood draw so the procedure is less traumatic. 5.)Put a sterile dressing over the site and have the patient tightly flex the elbow.

1,2

The nurse is preparing to administer medication to a client. Which actions by the nurse are focused on the rights of medication administration? Select all that apply. 1.)Ascertain why the medication is ordered and if it addresses the client's condition. 2.) Use two methods of identification before administering medication to a client. 3.)Check for changes in the client's ordered medications. 4.)Validate that the method of administration is clearly indicated. 5.)Identify the medication by its color before administration

1,2,3,4

When learning to draw blood samples, the nurse is taught how to recognize an appropriate vein. Which characteristic will the nurse identify as an indicator of a good blood sample site? 1.)The vein feels elastic and bouncy when palpated. 2.)The vein feels firm when a tourniquet is applied. 3.)There are small whitened areas along the vein. 4.)There are many branches off the main vein.

1- A good healthy vein should feel elastic and bouncy when it is palpated.

The nurse is providing care for multiple patients in the clinic setting who are receiving medications. Which patient has the lowest risk for an anaphylactic reaction? 1.)A patient who experienced vomiting and diarrhea after receiving an antibiotic 2.)A patient with known allergies who just received an allergy injection 3.)A patient receiving an anticonvulsant medication for seizures 4.)A patient with a shellfish allergy who is being prepped with povidone for stitches.

1- Patients treated with antibiotics may experience the side effects of nausea, and diarrhea. However these side effects are not indicative of anaphylaxis

A nurse realizes they have administered the wrong medication to a client. Which action will the nurse take immediately? 1.)Call the client's health-care provider to report a medication error. 2.)Check the vital signs and monitor the status of the client who received the wrong medications. 3.)Fill out an incident report, providing the details of the error and the client's condition. 4.)Check vital signs of the client and then administer the medications to the correct client.

2

The nurse is preparing for a 0900 medication to be given to a patient at 0930. The nurse reads the medication administration record (MAR), knows that the capsule is red, and retrieves a red capsule from the patient's medication drawer. Later, the nurse discovers the wrong drug was given because there were two different, red-colored drugs. Which medication right did the nurse violate? 1.)Validation of the drug's action 2.)Verification of the drug name 3.)Confirmation of the patient 4.)Recognition of the time

2

The nurse is preparing to administer medication to an older adult client. Which best describes the need to assess the client for signs of toxicity? 1.)An older adult may not be able to voice the effects of toxicity. 2.)Older adults have a decrease in liver and kidney function. 3.)It is difficult to distinguish the causes of toxicity in an older adult. 4.)Older adults have a decreased ability to experience or describe pain.

2

The nurse is preparing to administer medication to an older adult client. Which best describes the need to assess the client for signs of toxicity? An older adult may not be able to voice the effects of toxicity. Older adults have a decrease in liver and kidney function. It is difficult to distinguish the causes of toxicity in an older adult. Older adults have a decreased ability to experience or describe pain.

2

The nurse is preparing to obtain a blood specimen from a patient who is thin. The patient states, "I am told that my veins roll badly." Which technique will the nurse use to successfully perform a blood draw on this patient? 1.)Increase the dilation of the vein prior to the procedure. 2.)Anchor the vein in place by pulling the skin taut. 3.)Use a blood pressure cuff as a tourniquet. 4.)Use a smaller-size needle.

2

The nurse needs to obtain a blood specimen for glucose monitoring from a patient. The patient works as a carpenter and has callouses on both hands. Which site will the nurse use to obtain the blood specimen? 1.) The index finger 2.)The pinkie finger 3.)The tip of any finger 4.)The side of any finger

2

The nurse provides instructions to a patient who will be discharged from the emergency department (ED). The patient is prescribed an analgesic and asks, "Why do I need a prescription for a medication I can get without one?" Which response by the nurse is appropriate? " The pharmaceutical company lost its patent." "The prescribed dosage is higher than what can be obtained over the counter." "Your insurance will cover only the cost of a prescribed medication." "Your health care provider avoids prescribing habit-forming medications."

2

The nurse reviews prescribed medications for a patient who is admitted for the treatment of a bacterial respiratory infection. Which factor places the patient at risk for a potential adverse medication reaction? A history of seasonal allergies A previous reaction to antibiotic therapy A history of smoking A diagnosis of type 2 diabetes mellitus

2

The nurse works in a pediatric clinic. When the nurse needs to obtain blood specimens from young patients, a needle-and-syringe method is used. For which reason is the decision made to use this method of specimen collection? 1.)The risk of an accidental needle stick to staff is decreased. 2.)The evacuated tube system is too strong for patients in this age group. 3.)Using the needle-and-syringe method is more cost effective. 4.)It is easier to transfer blood into the required specimen tubes.

2

The nurse works in the neonate nursery and is required to obtain blood specimens. The nurse is aware that dermal punctures are routinely performed. Which reason supports the practice of dermal punctures on neonates? Dermal punctures to the heel area cause less pain for neonates. To avoid causing damage to nerves and bone that are located close to the skin surface. Needle sticks to the scalp veins are likely to leave bruising. The use of umbilical cord vessels occurs only with serious conditions.

2

The nurse selects a butterfly infusion set to obtain a blood specimen on a patient with fragile veins. Which is a benefit to using a butterfly set? Select all that apply. The needle gauge Easy handling of the needle during venipuncture Easy maneuvering of the collection tubes Stabilization of the needle Shorter collection time

2 3 4

The nurse is preparing to perform phlebotomy using an evacuated tube system. The nurse understands certain advantages to using this system. Which advantages does the nurse recognize? Select all that apply. The system works for all ages of patients. The risk for accidental needle sticks is decreased. The initial stick is less painful for patients. The evacuated tube system is easy to use. The contaminated needle is left uncapped.

2 4 5

The nurse is reviewing the Schedule classifications for medications. Which drugs does the nurse identify as Schedule II drug(s)? Select all that apply. Mescaline Methadone Paregoric Fentanyl Codeine

2 4 5

The nurse uses a medicine cart to pass medications to clients on an in-client unit. Which actions should be taken by the nurse assures safety during medication administration? Select all that apply. 1.)The client is asked to identify the drug and explain its use before it is administered. 2.)All aspects of the medication order are checked when the drug is removed from the client's bin. 3.)The Medication Administration Record (MAR) is filled in with the client's response to the medication. 4.)The medication is checked against the information on the MAR for that drug. 5.)Information about the client and drug are checked at the bedside prior to opening the medication.

2 4 5

The nurse uses a medicine cart to pass medications to clients on an in-client unit. Which actions should be taken by the nurse assures safety during medication administration? Select all that apply. The client is asked to identify the drug and explain its use before it is administered. All aspects of the medication order are checked when the drug is removed from the client's bin. The Medication Administration Record (MAR) is filled in with the client's response to the medication. The medication is checked against the information on the MAR for that drug. Information about the client and drug are checked at the bedside prior to opening the medication.

2 4 5

The nurse is providing care for an adult client admitted with a lower respiratory infection. The client manifests a severe cough with little or no sputum production. Which medication order does the nurse anticipate? An antitussive An expectorant A bronchodilator An antihistamine

2 expectorant thins respiratory mucus so that it can be coughed out

The nurse is performing phlebotomy using an evacuated tube set and has inserted the needle into the selected vein location. Which actions will the nurse take if a blood sample cannot be obtained? Select all that apply. 1.)Palpate the vein distal to the needle and redirect the needle. 2.)Switch the method of specimen collection. 3.)Pull back or rotate the needle slightly. 4.)Change the evacuation tube for another. 5.)Use the index finger and thumb to anchor the vein in place.

2,3,4,5

The nurse is preparing to administer a prescribed dose of digoxin to a patient. Which action will the nurse take if the most recent blood level of digoxin reveals a level of 1.9 ng/mL? 1.)Call to repeat the lab test. 2.)Administer the drug as prescribed. 3.)Hold the dose and call the health care provider. 4.)Screen the patient for signs of toxicity.

2- Digoxin is given as long as the blood level is not greater than 2.0 ng/mL

The nurse is caring for a client who is being treated with tetracycline for an infection. The client states, "I take the pills with milk because they make me nauseous." What is the nurse's best response? 1.)Contact the health-care provider for anti-nausea medication. 2.)Take the medication with nondairy foods. 3.)Suggest dividing the dose to decrease the nausea. 4.)Take an antacid prior to taking the antibiotic.

2- this medication should not be taken with dairy products because the proteins in these foods decrease absorption off the medication. It should be taken with a full glass of water to prevent irritation of esophagus and stomach.

The nurse applies a nonlatex tourniquet on a patient to perform venipuncture for the collection of blood specimens. Which will the nurse monitor for during the procedure to ensure the tourniquet is not applied too tightly? 1.)Check for areas of pinpoint hemorrhage in the area where the tourniquet is applied. 2.)Monitor the area for the development of a hematoma. 3.)Assess for the presence of a radial pulse in the extremity where the tourniquet is applied. 4.)Inspect the skin under the tourniquet for any skin tears.

3

The nurse has researched the high incidence of nurses who become dependent on drugs or alcohol. Which is the greatest contributor to substance abuse among nurses? 1.)High-stress level jobs 2.)Shift rotations 3.)Easy access to drugs 4.)Twelve-hour shifts

3

The nurse is obtaining blood specimens from a patient. For which reason does the nurse don gloves before beginning the procedure? To maintain a sterile field and prevent the patient from developing an infection To cover the nurse's fingertips with a smooth surface to enhance palpation To decrease the risk of the nurse coming into contact with the patient's blood To prevent the nurse from needing to disinfect hands after the procedure

3

The primary care clinic nurse reviews a patient's medications during a scheduled office visit. Which is the primary rationale for the medication review? To determine whether a trade medication can be replaced with a generic medication To decide if over-the-counter medications can be used To evaluate for the possibility of drug-drug interactions To assess if medication costs can be reduced

3

The nurse is performing phlebotomy using the dermal puncture technique. Which actions will the nurse include in the process? Select all that apply. 1.) Hold the capillary tube perpendicular to the blood drop. 2.)Massage or milk the puncture site if bleeding is slow. 3.)Wipe away the first drop of blood with sterile gauze. 4.)Scrape the capillary tube against the site to obtain the sample. 5.)Squeeze and release pressure on the fingertip.

3 5

The nurse is performing phlebotomy using the dermal puncture technique. Which actions will the nurse include in the process? Select all that apply. 1.)Hold the capillary tube perpendicular to the blood drop. 2.)Massage or milk the puncture site if bleeding is slow. 3.)Wipe away the first drop of blood with sterile gauze. 4,)Scrape the capillary tube against the site to obtain the sample. 5.)Squeeze and release pressure on the fingertip.

3, 5

The nurse is obtaining blood culture specimens from a patient suspected to have septicemia. In which order will the nurse perform this procedure? Place the options in the correct order. All options must be used. Obtain the anaerobic blood specimen. Cleanse the site with povidone-iodine if there is no allergy. Apply a tourniquet and identify the puncture site. Obtain the aerobic blood specimen. Cleanse a 2-in. site vigorously with two alcohol pads.

3,5,2,14

The nurse prepares to perform a venipuncture on an older adult patient with tiny, fragile veins. Which nursing action will help to distend distal veins while preventing the vein from rupturing? 1.) Apply the tourniquet tightly around the upper arm. 2.)Perform the venipuncture without occluding the veins 3.)Apply a blood pressure cuff inflated to 40 mm Hg 4.)Utilize a dermal puncture technique instead

3- The nurse will want the distal veins to dilate.

The nurse is monitoring the laboratory results for a patient who is taking warfarin. The patient's results have shown a wide fluctuation in clotting times. Which is the best question for the nurse to ask the patient? 1.)"What time each day do you take your warfarin?" 2.)"Can you share with me how you were instructed to take your medication?" 3.)"Can you tell me about your dietary intake of green, leafy vegetables?" 4.)"Do you find that you are bruising more easily from minor bumps?"

3- green leafy vegetables are a high source of vitamin K which counteracts the anticoagulant action of warfarin. Pg 758

The licensed practical nurse/licensed vocational nurse (LPN/LVN) notes that a patient experiences respiratory distress after the registered nurse (RN) leaves the room following the initiation a new, intravenous piggy-back infusion. Which is the priority action for the LPN/LVN? 1.)Page the RN who initiated the medication infusion stat. 2.)Obtain a set of vital signs and report to the RN immediately. 3.)Raise the head of the bed into a high-Fowler position. 4.)Stop the flow of the IV piggy-back medication.

4

The licensed practical nurse/licensed vocational nurse (LPN/LVN) notes that a patient experiences respiratory distress after the registered nurse (RN) leaves the room following the initiation a new, intravenous piggy-back infusion. Which is the priority action for the LPN/LVN? Page the RN who initiated the medication infusion stat. Obtain a set of vital signs and report to the RN immediately. Raise the head of the bed into a high-Fowler position. Stop the flow of the IV piggy-back medication.

4

The nurse administers a prescribed antipyretic drug to a patient. Which outcome would be expected? The patient's pain decreases The patient's blood pressure stabilizes The patient's breathing improves The patient's fever is reduced

4

The nurse interviews a patient who recently began warfarin therapy for the treatment of pulmonary emboli. The patient states, "I have noticed that my gums bleed when I brush my teeth." Which is the priority action for the nurse? 1.)Ask if the patient has a history of gum disease. 2.)Inquire if the patient uses a regular toothbrush or an electric toothbrush. 3.)Ask if the patient takes over-the-counter medication for headaches or muscles aches 4.)Inquire if the patient has consumed crunchy foods, which can cause gum irritation

4

The nurse is attempting to administer medications to a client but the client refuses. "This pill looks different than the pill that I take at home" states the client. What is the nurse's best action? Explain to the client that the medication is a different brand but does the same thing. Call the pharmacy to see if the brand the client takes can be ordered. Tell the client about the unwanted symptoms that will occur if the medication is not taken. Place the medication back into the client's bin and mark "refused" on the Medication Administration Record (MAR). Next

4

The nurse is caring for a patient admitted to the hospital for a suspected infection. The health-care provider orders blood cultures to be drawn. The nurse anticipates drawing two evacuated tube samples. For what reason are two samples drawn? 1.)One tube is to check for septicemia and the other is to perform a culture for antibiotic therapy. 2,)Two tubes are drawn in case one is contaminated or broken during testing. 3.)So that an adequate sample is available to perform sensitivities for a variety of antibiotics. 4.)One tube is to check for the presence of aerobic pathogens and the other is for anaerobic pathogens.

4

The nurse is preparing to administer medication to a preschool client. The health-care provider's order reads in part, "5 mg/kg." After weighing the client in pounds, which conversion will the nurse use to determine the correct dosage? Multiply the client's weight in pounds by 2.2 to get the weight in kilograms. Convert the number of the client's weight in pounds to the same number in kilograms. Take the client's weight in pounds and divide the number by 2.0 to get kilograms. Divide the client's weight in pounds by 2.2 to get the weight in kilograms.

4

The nurse is preparing to draw blood specimens on three different patients. The nurse wants to expedite the process as much as possible. Which action by the nurse increases the chance for error? The specific specimen needed from each patient is reviewed prior to the draw. The patients are each identified by two identifiers before the specimen is drawn. The time of the blood draw is written on the label after the specimen is acquired. The specimen tubes are labeled prior to starting the blood draws.

4

The nurse is to administer a medication that will melt between the client's cheek and gums. What best describes this route of administration? 1.)Oral route 2.)Sublingual route 3.)Mucosal route 4.)Buccal route

4

The nurse needs to draw a blood specimen on a patient who is obese. The nurse anticipates difficulty with the procedure. For which reason does the nurse expect problems? 1.)The walls of the veins are likely to be thicker than in a patient who is thinner. 2.)Pain is worse because of the need to insert the needle at a deeper angle. 3.)A history of difficult needle sticks will cause the veins to constrict. 4.)It will be difficult to palpate a vein through the extra adipose tissue.

4

The nurse prepares to administer the prescribed dose of amoxicillin 250 mg orally. In the patient's medication box is a 500-mg capsule. Which action by the nurse is appropriate? Cut in half and administer. Administer two capsules. Give one capsule. Call the pharmacy.

4

While administering nighttime medications, the nurse discovers that a dose of atenolol should have been given to a new patient at 1600 but was not administered. The current time is now 2300. Which is the priority action by the nurse? 1.)Give the medication now and document the reason it was given late. 2.)Double the atenolol dosage at the next administration time. 3.)Hold the medication until the morning, then contact the health care provider for orders. 4.)Obtain vital signs, monitor the patient, and contact the health care provider for further instructions.

4- Atenolol should be given 10 to 12 hours apart for twice daily dosages and should not be stropped suddenly.

The nurse is teaching a client on a newly prescribed drug for the treatment of high cholesterol. What is the reason for instructing grapefruit is to be avoided? 1.)Grapefruit enhances the action of the drug and decreases cholesterol too quickly. 2.) Grapefruit blocks the action of the drug and causes an increase in cholesterol. 3.)Grapefruit is a high-cholesterol food source and counteracts the drug. 4.)Grapefruit interferes with the enzymes that break down the drug.

4- Grapefruit interferes with enzymes that break down the drug and cause the blood levels of of the drug to become too high

The nurse is reviewing discharge medications with a client. One of the medications is liquid and the instructions state in part, "take 1 ounce daily." What best describes the measurement to the client? One ounce is equal to two measuring-set tablespoons. Two standard tableware tablespoons will equal one ounce. Eight measuring-set teaspoons will equal one ounce. One-sixteenth of a cup equals one ounce.

One ounce is equal to two measuring-set tablespoons.

The nurse in a health-care provider's office is planning on obtaining a blood specimen from a patient. The patient states, "I hate the sight of needles." Which action by the nurse is appropriate? Take the patient where a supine position is possible. Instruct the patient to look away during the procedure. Inform the patient of the nurse's competency. Assure that patient that the procedure is painless.

Take the patient where a supine position is possible.

The nurse is reviewing the ordered medications for a client who is being discharged. Which item(s) should be included in prescription order? Select all that apply. The generic and brand-name of the medication The frequency of when the medication is to taken The name and hospital identification number of the client The specific reason the medication is prescribed The dosage of the medication to be taken

The specific reason the medication is prescribed The dosage of the medication to be taken

The nurse is providing care for a client who suddenly experiences chest pain. The health-care provider orders sublingual nitroglycerine STAT. When will the nurse give the medication? Upon pharmacy delivery of the drug Within 30 min of the order Within 15 min of the order As needed

Within 15 min of the order

The nurse has received orders to collect laboratory tests by phlebotomy for a patient and has gathered the following tubes in preparation for the procedure. Which color cap in the evacuating tube set does the nurse use first?

Yellow- is for culture and is used first