Chapter 4: The Nursing Process in Drug Therapy and Patient Safety PrepUs

A nurse is beginning the apply the nursing process during a new client interaction. What activity should the nurse perform? Obtain a medication history. Identify potential client problems related to drug therapy. Educate the client about basic medication safety. Confirm or rule out nursing diagnoses.

Obtain a medication history. History and physical examination are completed during assessment, the first step of the nursing process. Problem identification is completed during the nursing diagnosis step, the second step of the nursing process. Education is a form of intervention. Confirming or ruling out nursing diagnoses would be part of the diagnosis stage.

The client has a daily antihypertensive medication ordered. Taking the blood pressure prior to administration of the medication is which step of the nursing process? Implementing Assessing Planning Diagnosing

Assessing The nurse is collecting data by taking a blood pressure. Once assessment occurs, diagnosis, planning and implementation occur.

The nurse is preparing a teaching plan for a client who will be discharged home with several new medications. When preparing the teaching session, what is the nurse's best action? Determine the client's level of education. Make copies of medication package inserts for the client. Ask the client if he or she would like to receive information on the new medications. Administer the medications as a way of prompting discussion.

Determine the client's level of education. Gathering information about the client's level of understanding about his or her condition, illness, or drug therapy helps the nurse determine where the client is in terms of his or her status and the level of explanation that will be required. It also provides additional baseline information for developing a client education program. Medication inserts are too detailed for consumer use. The nurse should assess how much information to provide, but giving no information to the client is not an option. Medication administration would not be part of the preparation.

The nurse is preparing a teaching plan for a client who will be discharged home with several new medications. When preparing the teaching session, what is the nurse's best action? Determine the client's level of education. Make copies of medication package inserts for the client. Ask the client if he or she would like to receive information on the new medications. Administer the medications as a way of prompting discussion.

Determine the client's level of education. Gathering information about the client's level of understanding about his or her condition, illness, or drug therapy helps the nurse determine where the client is in terms of his or her status and the level of explanation that will be required. It also provides additional baseline information for developing a client education program. Medication inserts are too detailed for consumer use. The nurse should assess how much information to provide, but giving no information to the client is not an option. Medication administration would not be part of the preparation.

"Evaluation" of the client's response to drug therapy relates most closely to which phase of the nursing process? Problem Goal Plan Cause

Goal The effectiveness of the interventions to address the goal occurs in the evaluation phase of the nursing process. Once the problem is identified, the goal and plan are established.

Which medication order by the health care provider will require the nurse to seek clarification of that order? Furosemide (Lasix) 20 mg. IV every 8 hours. Warfarin (Coumadin) 5 mg. PO every evening at 6 PM. Heparin 5,000 u SC every day Meperedine (Demerol) 25 mg. IM every 4-6 hours PRN

Heparin 5,000 u SC every day The abbreviation "u" should not be used alone because it can be mistaken for a zero, a 4 or "cc". The word "unit" should be written out to avoid confusion. All of the other orders are written correctly.

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? Imbalanced nutrition: Less than body requirements Risk for imbalanced fluid volume Feeding self-care deficit Noncompliance

Imbalanced nutrition: Less than body requirements 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, the client is reporting difficulty in eating or consuming adequate food. The client is taking the medication so the client is not noncompliant.

A client is being evaluated for reports of alteration in sleep patterb. When asking a client about current medications and supplements being taken, what is the nurse's best approach? Ask the client to list all dosages of prescription medications in alphabetical order. Inquire about all prescription medications, over the counter drugs, herbs and supplements. Ask the client if any new medications have been prescribed since the last office visit. Inquire if the client ingests large amounts of coffee through out the day.

Inquire about all prescription medications, over the counter drugs, herbs and supplements. Over-the-counter (OTC) sleep aids are abundant, and clients may not volunteer information regarding their use of these alternative or complementary remedies. Always inquire about use of herbal or OTC products. Although lab testing is not conclusive, medical reports indicate a possible interaction with eucalyptus products, causing increased sedation. Clients who drink coffee all day long and have for years, don't usually have sleep pattern alterations due to the normal ingestion. They will however, complain of severe headache from lack of caffeine, if they don't.

A nurse is assigned to care for a client with a respiratory problem in a health care facility. What should a nurse consider in an expected outcome for a client undergoing drug therapy? Amount of time the client will take to recover fully Amount of drugs the client will require during the treatment Possible adverse reactions that could occur during the therapy Maximum level of wellness that is reasonably attainable for the client

Maximum level of wellness that is reasonably attainable for the client The nurse should know that the expected outcome describes the maximum level of wellness that is reasonably attainable for the client and that the therapeutic effect is achieved. The expected outcome for a client does not include the amount of time the client will take to recover fully, the amount of drugs the client will require during the treatment, or the possible adverse reactions that could occur during the therapy.

When learning about the medications the client takes during admission, it would be important to do what regarding herbal supplements? Research them for possible interactions with other medications. Discontinue them if the client is taking prescription medications. Make sure that the client takes them one hour before prescription medications. Notify the healthcare provider to see if he wants them continued or held.

Notify the healthcare provider to see if he wants them continued or held. The healthcare provider must be aware of all herbal and over- the- counter medications taken when prescribing medications. Some herbals may or may not have any affect on prescription drugs, so it is the healthcare provider that must make the decision to continue or to hold them. A major concern related to the use of herbal supplements is the potential for interactions with prescription medications, even though the nurse can research them, it is the healthcare provider who must make the decision. Health care providers should identify potential interactions and advise the client accordingly.

What statement is true concerning nursing diagnoses? Nursing diagnoses can be actual or potential. Nursing diagnoses are treatable. Nursing diagnoses are never serious. Nursing diagnoses are based on medical diagnoses.

Nursing diagnoses can be actual or potential. Nursing diagnoses can be actual or potential. The other statements are not correct.

Which statement is true about a nursing diagnosis? This is done first in the nursing process. The nursing diagnosis relates the client's status. The nursing diagnosis cannot be verified. Nursing diagnoses are made up as the client needs them.

The nursing diagnosis relates the client's status. The nursing diagnosis relates the client's status from the nursing perspective and is done after assessment in the nursing process. The diagnosis is verified from assessment data. The diagnosis is verified through the NANDA criteria and is not "made up."

What is true concerning the "placebo effect" in drug administration? Thinking that the drug will help the patient creates the placebo effect. The administration of pretend medications creates the placebo effect. The illegal administration of medication creates the placebo effect. The improper dosing of medication creates the placebo effect.

Thinking that the drug will help the patient creates the placebo effect. The placebo effect is the thought that the drug will be helpful and can have a large impact on the success of drug therapy. The nurse's attitude helps with this.

A client recently discovered that she is pregnant. She currently takes herbal medications to control her diabetes and the symptoms related to pregnancy. She asks the nurse if it is safe to take herbal medications while she is pregnant. What would the nurse tell this client? "Most herbal and dietary supplements should be avoided during pregnancy or lactation." "Most herbal and dietary supplements are safe during pregnancy and are used by many cultures to control the symptoms of nausea." "Dietary supplements are high in fat and protein; they are safe to take during pregnancy and help to maintain health during lactation." "Herbal and dietary supplements will cause premature labor."

"Most herbal and dietary supplements should be avoided during pregnancy or lactation." Most herbal and dietary supplements should be avoided during pregnancy or lactation.

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

"Tell me the name of your prescription please." The nurse should be aware of the potential name mixup 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 teaching the parents of a school-aged child who is to receive medication therapy. What instructions should the nurse include? "Tell your health care provider about all the medicines that your child is taking." "Carefully use a common household teaspoon or tablespoon to administer the liquid medication." "Teach your child to take the medication independently in order to promote autonomy." "Over-the-counter medicines are usually safe, but make sure not to exceed the recommended dose."

"Tell your health care provider about all the medicines that your child is taking." Health care providers don't always know what a child is taking if multiple providers are involved or over-the-counter medications are administered, so parents need to keep a list of all medications given to a child including prescription, over-the-counter, and herbal medicines. Liquid medications should be measured with appropriate measuring devices such as a measured dosing device or spoon from a measuring set. A household teaspoon or tablespoon should not be used because the amounts are highly variable. The body organs and systems of children are very different from those of an adult. Most children require supervision in order to ensure safety. Parents should not be encouraged to take OTC medications without checking with the provider first.

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

"We can use the same medications that we use for similar problems in our child, but we might need to adjust the dosage." Adult medications should never be used to treat a child. The body organs and systems of children are very different from those of an adult. Parents should read all labels before giving a child a drug, especially over-the-counter products because many of these may contain the same ingredients, thereby accidently overdosing the child. Liquid medications should be measured with appropriate measuring devices such as a measured dosing device or spoon from a measuring set. The parents should never use a flatware teaspoon or tablespoon to measure a child's drugs. Health care providers do not always know what a child is taking, so parents need to keep a list of all medications given to a child, including prescription, over-the-counter, and herbal medicines.

The nurse is providing care for a client who has been prescribed a diuretic to treat hypertension. The client states that the effects of the drug are problematic, causing the client to wake up numerous times during the night to urinate. What assessment question should the nurse prioritize? "When are you taking your medication?" "What is the dosage of your medication?" "Have you increased your fluid intake since starting the drug?" "Are you taking any herbal medicines?"

"When are you taking your medication?" The client's statement suggests that the drug's peak effect is occurring during sleep, which would lead the nurse to suspect that the client is taking the medication before bedtime. The nurse would need to confirm that this is true before questioning the client further about the dosage, fluid intake or other issues. Asking about herbal medicines is appropriate with any drug therapy but is not the priority in this situation.

A nurse is preparing to give client education about medication therapy. The nurse should plan to address what topics? (Select all that apply.) Drug toxicity warning signs Alternative therapies to avoid Drug administration scheduling Steps for reporting a drug error OTC alternatives to prescriptions

-Drug toxicity warning signs -Alternative therapies to avoid -Drug administration scheduling Clients are not responsible for reporting medication errors and that would be inappropriate to include in client teaching plan. Warning signs would be an important aspect to include in a client education plan. Information about possible interactions with alternative therapies and those to avoid would be an important aspect of a client teaching plan. Information about the administration schedule would be an important aspect of a client teaching plan. A nurse should not counsel a client to replace prescription drugs with anything else.

In discussing the drug regimen with the client, what factors should be included? (Select all that apply.) Cut the tablet in half if the client does not have enough. Call the physician only after two unexpected reactions occur. Length of time before desired therapeutic effect will occur Steps to minimize adverse reactions Adverse reactions to expect

-Length of time before desired therapeutic effect will occur -Steps to minimize adverse reactions -Adverse reactions to expect The following factors should be included when discussing the drug regimen with the client: length of time before desired therapeutic effect will occur, steps to minimize adverse reactions, and adverse reactions to expect.

To correctly administer a medication, when should the nurse compare the medication with the medication administration record (MAR)? (Select all that apply.) after administering the medication immediately prior to medication administration when removing the medication from the medication cart when initially looking at the medication label after documenting the medication

-immediately prior to medication administration -when removing the medication from the medication cart -when initially looking at the medication label The nurse ensures that the right drug is being administered by comparing the medication to the MAR with the container label; as the item is removed from the cart; and before the actual administration of the drug.

What is part of the assessment phase of the nursing process? (Select all that apply.) obtaining a medication history obtaining vital signs formulating nursing diagnoses asking about chief reason for seeking medical attention determining therapeutic response

-obtaining a medication history -obtaining vital signs -asking about chief reason for seeking medical attention -determining therapeutic response The assessment phase of the nursing process involves collecting subjective and objective data, as well as initial and ongoing assessment. Examples of this include taking medication history and vital signs, asking about the chief issue, and determining therapeutic response.

Drug studies generally base the recommended adult dose of a drug needed to reach a critical concentration on what measure? A 60-year-old man An average-sized woman A 150-pound adult male An obese adult

A 150-pound adult male Drug studies base the therapeutic dosage, or that dose needed to reach a critical concentration, on the physiology of a 150-pound healthy adult male. Testing is not routinely done in women because of the potential for unknown effects on the ova. Testing would not be done on an obese adult or older adult because of the potential of underlying disease, altered metabolism, or reactions to the drug.

Which client is most likely to experience the placebo effect of a new medication? A client who states, "I'm certain this new drug is going to work for me." A client who states, "I'm very organized, so I'm sure I'll stick to the drug schedule closely." A client who states, "I'm in agony. Can you please give me something for my pain?" A client who states, " I have a preference for herbal remedies and alternative therapies."

A client who states, "I'm certain this new drug is going to work for me." Clients who expect a drug is going to work well are far more likely to have their expectations met according to the placebo effect. Adherence and the need for medication do not necessarily suggest the presence of the placebo effect. A preference for herbal remedies and alternative therapies does not indicate the placebo effect.

What action should the nurse perform during the implementation step of the nursing process? Administrations and documentation of medications. Obtain information about the client's chronic condition. Determine the client's level of understanding. Question the client about financial resources.

Administrations and documentation of medications. Administration of medication and documentation occurs during the implementation phase. Information about the client's chronic condition would be obtained during assessment. Information about the client's level of understanding would be obtained during the evaluation phase of the nursing process. Information about the client's financial resources would be obtained during assessment.

A nurse has identified the following: Risk for injury related to central nervous system (CNS) effects of the prescribed drug therapy. What event should the nurse have performed immediately before this during the nursing process? Analyzed the data gathered during assessment Taught the client about safety measures related to CNS effects Planned relevant interventions Created a plan of care that include medication safety

Analyzed the data gathered during assessment In the nursing diagnosis step, the nurse identifies actual and potential problems, such as a risk for injury. Assessment is the first step of the nursing process that involves information gathering via a history and physical examination. Teaching and other interventions should occur subsequent to this. The plan of care should integrate all of the client's relevant nursing diagnoses.

The physician orders NPH U100 insulin 16 units SC every AM for a client. The nurse prepares the insulin dose. To ensure safety, what does the nurse do? Provide information about the need for insulin Bring the vial to the bedside. Ask another nurse to double-check the measurement. Encourage the client to administer the insulin.

Ask another nurse to double-check the measurement. Measure doses accurately. Ask a colleague to double-check measurements of insulin and heparin, unusual doses (i.e., large or small), and any drugs to be given intravenously.

The collection of subjective and objective data is completed during which step of the nursing process? Assessment Analysis Implementation Planning

Assessment Assessment involves collecting objective and subjective data.

Place these steps in the nursing process in the proper sequence from beginning to end. Assessment Nursing diagnosis Implementation Evaluation

Assessment Nursing diagnosis Implementation Evaluation The nursing process consists of four major steps in this order: assessment, nursing diagnosis, implementation, and evaluation. The steps overlap and are continuous and dynamic.

Which activity would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy? Compare the outcome expected with the actual client outcome. Reconsider core drug knowledge and core client variables. Ask questions to prepare an effective client education program. Establish a baseline for the client's treatment and care.

Compare the outcome expected with the actual client outcome. In the evaluation phase, a nurse would compare the expected outcome goals of the treatment with the client's progress, thereby judging the effectiveness of nursing management. Questions are generally asked initially at the onset of drug therapy and compiled. These questions serve as a basis for preparing the client's education program. During the assessment phase of core client variables, the nurse physically examines the client and establishes all baselines. The evaluation phase is not the right time to reconsider core client variables and core drug knowledge because such critical information is essentially compiled in the assessment phase.

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? ) Implementation/intervention Analysis/diagnosis Evaluation Planning

Implementation/intervention Giving or withholding a drug is a nursing activity related to the Implementation or Intervention phase of the nursing process.

Which would the nurse expect to do during implementation? Develop statements about a client's actual problem. Obtain baseline information about the client's pattern of health care. Identify the client's social support network. Provide client teaching about a drug therapy regimen.

Provide client teaching about a drug therapy regimen. Implementation involves planning client care and intervention. Providing client teaching would be a part of implementation. Developing a problem statement is done during the nursing diagnosis step. Obtaining baseline information about the client's health patterns and identifying the client's social support system would be completed during assessment.

A nurse has committed a medication error. After ensuring the client's safety, the nurse should perform what action? Report the event according to the health care facility's policies. Submit a drug error report to the National League for Nursing. Report the event to the Institute for Safe Medication Practices. Ensure that each of the nurse's colleagues knows about the event.

Report the event according to the health care facility's policies. If a nurse sees or participates in a medication error, the nurse first reports the error to the institution and then to the national reporting program. Drug errors are not reported to the NLN. It is not necessary for each of the nurse's colleagues to know about the error, though information should be shared in a way that promotes safety.

A nurse has committed a medication error. After ensuring the client's safety, the nurse should perform what action? Report the event according to the health care facility's policies. Submit a drug error report to the National League for Nursing. Report the event to the Institute for Safe Medication Practices. Ensure that each of the nurse's colleagues knows about the event.

Report the event according to the health care facility's policies. If a nurse sees or participates in a medication error, the nurse first reports the error to the institution and then to the national reporting program. Drug errors are not reported to the NLN. It is not necessary for each of the nurse's colleagues to know about the error, though information should be shared in a way that promotes safety.

A client has informed the nurse that he has begun supplementing his medication regimen with a series of herbal remedies recommended by his sister-in-law. Which is the most important nursing intervention regarding the safe use of herbal supplements? Research for potential interactions with medications. Instruct the client to discontinue them if taking prescription medications. Instruct the client to take the supplements 1 hour before prescription medications. Instruct the client to take the supplements 3 hours after prescription medications.

Research for potential interactions with medications. Two major concerns are that the use of supplements may keep clients from seeking treatment from a health care provider and that products may interact with prescription drugs. Not all herbal supplements should be discontinued in combination with prescription medications. The herbal supplements should be administered in varying quantities and at varying times based on the medication regime. They are not always administered 1 hour before prescription medications or 3 hours after prescription medications.

What is the primary purpose of the use of the nursing process in medication therapy? That the drug is given at the right time That holistic, evidence-informed care is given That the right dose is given to the patient That the drug is given to the right patient

That holistic, evidence-informed care is given The nursing process provides a means of ensuring holistic, evidence-informed care. The other options describe three of the seven "rights" of medication administration.

The right route of the drug is determined by the drug's formulation. True False

True The formulation of the drug determines by what route it should be given. For example, insulin is destroyed by stomach acids and cannot be given orally so it must be given parenterally.

A nurse is caring for a 49-year-old client with acute gout and arthritis. The nurse interviews the client and checks the medical records. Which additional assessment should the nurse consider before medication administration teaching? examining the client physically asking closed-ended and precise questions determining what medication information the client needs observing the client for at least 24 hours

examining the client physically In addition to the interview and the medical records, the nurse should physically examine a client to gain an insight into his or her characteristics. During the interview, it is not a good practice to ask closed-ended questions; therefore, the nurse should always ask open-ended questions during the client interview. Open-ended questions evoke clear and adequate information that clarifies doubts and helps in decisions regarding drug therapy. While interviewing the client, the nurse can observe any peculiar or specific attributes. Determining information to be included in medication education occurs during the planning phase of the nursing process.

During assessment, a nurse asks a client about any chronic conditions that might have an impact on the client's prescribed drug therapy. What issue, if reported by the client, would alert the nurse to a possible problem?\ two episodes of pneumonia over the last 5 years kidney disease diagnosed 2 years ago nearsightedness for the past 10 years episode of gastroenteritis last month

kidney disease diagnosed 2 years ago Chronic conditions, such as renal disease, heart disease, diabetes, or chronic lung disease, can affect the pharmacokinetics and pharmacodynamics of a drug and may be contraindications to the use of a drug. These conditions may also require cautious use or dosage adjustment when administering a certain drug. Pneumonia, nearsightedness, or an episode of gastroenteritis would not be as significant as a history of kidney disease.

Before teaching a client about diagnosis and therapy, what information is essential for the nurse to evaluate in the client? level of education social support systems discharge plans physician consent

level of education The nurse needs to know the client's level of education to come up with a teaching plan that is appropriate for the client. Social support systems are good to have but not with teaching when the client is able to understand. Physician consent is not necessary, it is a nurses responsibility to teach the client. Discharge plans can be made with the support of social support systems.

A group of students are reviewing information about the nursing process and drug therapy in preparation for an examination on the material. The students demonstrate understanding of the material when they state that the nursing process is a: continuous linear approach to problem solving. set of sequential steps that are dynamic in nature. method for determining a client's priority needs. means to gather information about a client's current status.

set of sequential steps that are dynamic in nature. The nursing process is a continual dynamic cyclical process of problem solving that occurs as series of steps to ensure that a client receives the best, safest, most efficient, scientifically based, holistic care. It is not static or linear. Assessment, one step of the nursing process, allows information to be obtained to determine the client's current status, priority needs, and problems.

The nurse is planning to educate a client about medication therapy. What is an essential part of the nursing process? that the nurse perform all teaching and evaluation the delegation of teaching to licensed personnel the delegation of teaching to students informing the physician about who has taught the client

that the nurse perform all teaching and evaluation The nurse is responsible for teaching the client about all medication therapy. The nurse cannot delegate this responsibility and does not have to inform the physician who taught the client, but does have to document that the teaching was performed.

A nurse has been caring for a client in a health care facility. The nurse should consider the evaluation of a client to be positive if: the expected outcomes are accomplished. the client does not experience anxiety during therapy. the client is better able to communicate with the nurse. subjective and objective data are successfully obtained.

the expected outcomes are accomplished. The nurse should consider an evaluation for a client as positive if the expected outcomes are accomplished or if progress has occurred. If the client does not experience anxiety during therapy, then the nurse is better able to implement the care planned for the client and expect maximum effectiveness during evaluation. However, evaluation of the care plan is not considered complete if the client does not experience anxiety during therapy, although it facilitates receiving a positive response during evaluation. Similarly, if the client is able to effectively communicate his feelings to the nurse, the nurse can implement the care plan in a better way to yield maximum therapeutic results for the client, but good communication alone should not be considered a factor that completes the evaluation for the client. Obtaining subjective and objective data is important for accurate drug administration and therapy implementation. Evaluation for a client cannot be considered complete only on the basis of subjective and objective data.