Clinical chapter 28-questions
The nurse is beginning to administer oral medications to a client. The client states, "I haven't taken that pill before. Are you sure it's correct?" You recheck the CMAR/MAR and find that the medication is scheduled to be administered. Which of the following responses is most appropriate?
"Don't take that pill yet. I will verify that the medication was ordered by your primary care provider."
A patient with a complex cardiac history has been prescribed digoxin (Lanoxin) 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer?
0.5 125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets
A nurse is administering insulin to a diabetic patient. Which of the following are three recommended times to check the label before administration? Select all that apply.
1-When reaching for the container or unit dose package 2-After retrieval from the drawer and compared with the CMAR 3-When replacing the container to the drawer or shelf (or before giving the unit dose medication to the patient)
To which of the following patients would the nurse be most likely to administer a PRN medication?
A patient who is complaining of pain near her surgical site A complaint of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications
A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation?
Assess the vomit, looking for the pill. patient vomits after oral pill --> assess vomit for pill or fragments --> notify doctor to see if another dose is necessary
. A medication order reads: "K-Dur, 20 mEq po b.i.d." When and how does the nurse correctly give this drug?
BID=2x a day PO=oral route
Ms. Hall has an order for hydromorphone (Dilaudid), 2 mg, intravenously, q 4 hours PRN pain. The nurse notes that according to Ms. Hall's chart, she is allergic to Dilaudid. The order for medication was signed by Dr. Long. What would be the correct procedure for the nurse to follow in this situation?
Call Dr. Long and ask that she change the medication. The nurse is responsible for any medications he or she gives and must contact the doctor to inform her of the patient's allergy to the drug. The nurse should not give the medication and might speak with the supervisor only if uncomfortable with the physician's answer once she is notified. The nurse is legally unable to order a replacement medication, as is the pharmacist.
A nurse discovers that she made a medication error. What should be the nurse's first response?
Check the patient's condition to note any possible effect of the error FIRST (patient is most important)
A nurse is administering heparin subcutaneously to a patient. What is the correct technique for this procedure?
Do not aspirate before or massage after the injection.
A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which of the following actions should the nurse perform to prevent gastric reflux?
Help the client into a Fowler's position. fowlers position helps with gastric reflux
Which of the following accurately describes a recommended guideline when administering oral medications to patients?
If a child refuses to take medication, the medication can be crushed and added to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If it is questionable whether the medication was swallowed, check the patient's mouth and cheeks. If a pill is dropped, it should be discarded, and if a patient vomits, notify the physician to see if the medication should be readministered.
A nurse instills eardrops into a patient's ear to soften a wax buildup. Which of the following is a guideline the nurse should follow?
If both ears are to be treated, wait 5 minutes before instilling drops in the second ear. 3 yrs old --> pulled straight back < 3 yrs old --> down and back > 3 yrs old --> up and back swollen ear canal --> wick can be inserted for med delivery dropper should NOT touch the ear
When educating an elderly client about the administration of medication during discharge teaching, the nurse notes that the client is having difficulty comprehending the instruction. What intervention should the nurse follow in this case to ensure the client's safety?
Involve a second responsible person in the instruction. If an elderly client is having difficulty comprehending the discharge instruction, the nurse should involve a second responsible person in the instruction in order to ensure client safety. A referral for skilled nurse visits is appropriate for homebound older adults who need additional instructions about medication routines after discharge. However, the nurse would not ask a second nurse to simply repeat the instructions or delegate the teaching to somebody else. The nurse will also not write all the discharge instructions on the various medication containers, but instead will write all the instructions in detail on the discharge sheet for the client's convenience.
To convert 0.8 grams to milligrams, the nurse should do which of the following?
Move the decimal point 3 places to the right. To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). 1000 milligrams (mg) is equal to 1 gram (g); therefore 0.8 g is multiplied by 1000 (which is equivalent to moving the decimal point 3 places to the right) to determine how many mg it is equivalent to
The nurse transcribes an order that reads: Colace 100 mg PO daily. This is an example of which type of order?
PO=mouth standing order=carried out as specified until cancelled by a new order
A physician orders a pain medication for a postoperative patient that is a PRN order. When would the nurse administer this medication?
PRN=as needed (requested or required) single/one time=only once at time specified by prescriber stat=single order carried out immediately standing order/routine order=carried out until cancelled by another order
A 17-year-old girl is admitted to pediatrics with a diagnosis of diabetic ketoacidosis. She requires intravenous therapy to
Provide access for the administration of insulin A client with acute diabetic ketoacidosis requires intravenous access for the administration of insulin.
A nurse is administering medication to a patient via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation?
Use a syringe to plunge the tube to try to dislodge the medication. When medication becomes clogged in the tube, you should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified.
When administering heparin subcutaneously, the nurse should
When administering heparin subcutaneously, never aspirate before administration
When the client demonstrates a rash 30 minutes after she has taken a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction?
allergy allergic reactions from an immunologic response to a substance to which the client is sensitized
A nurse has administered an injection to a client. Which of the following interventions should the nurse perform to reduce discomfort and provide quick relief?
apply pressure to the site during needle withdrawal eutectic mixture --> pain relief for only 2 hrs ice pack to numb skin --> before injection NOT after massaging --> DONT DO bc could lead to discomfort and complications The nurse should not massage the site following an injection because in some clients it could lead to further complications and discomfort
A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear?
ask the client to maintain the position for some time After instilling the prescribed number of drops in the client's ear, the nurse should ask the client to maintain the position briefly until the solution travels toward the eardrum. When instilling the medication in the client's ear, the nurse first manipulates the client's ear to straighten the auditory canal. Tilting the client's head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client.
Which of the following are recommended guidelines for the nurse who is administering a piggyback intermittent intravenous infusion of medication?
attach infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion Attach the infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion, taking care to avoid contaminating either end. The IV piggyback delivery system requires the intermittent or additive solution to be placed higher than the primary solution container. The nurse is responsible for calculating and regulating the infusion with an infusion pump. Using aseptic technique, remove the cap on the tubing spike and the cap on the port of the medication container.
A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?
avoid crushing sustained release pellets When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.
A nurse is administering medication to a 78-year-old female patient who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this patient has an increased possibility of drug toxicity due to which of the following age-related factors?
decline in liver function and production of enzymes needed for drug metabolism older patients: @ risk for cumulative effect bc..... decreased rate of drug metabolism higher drug plasma concentrations--> prolonged action and increased possibility of drug toxicity (if liver function and production of enzymes for metabolism is decreased decreased # of protein binding sites --> toxicity decreased (not increased) kidney function --> toxicity (bc amount of secretion is decreased)
A nurse is administering a hepatitis B immunization injection to an adult patient. Which site would the nurse choose for this injection?
deltoid muscle site for hep B --> induces adequate levels of the antibody intramusclar injection locations: vastus lateralis muscle ventrogluteal muscle DONT USE DORSOGLUTEAL MUSCLE
After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which of the following as the process by which the medication is delivered to the target cells and tissues?
distribution The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver.
A nurse is administering an intradermal injection to a patient for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at the site of injection. What is the nurse's best action in this situation?
document the administration and inform the primary care provider A wheal or blister indicates that the medication has been injected into the dermis. If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be re-injected into another site. The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.
Which of the following clients is likely to have altered metabolism of medications?
elderly Metabolism is the process of chemically changing the drug in the body. Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized.
A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step?
flush IV lock before and after administering meds --> clears medication and prevents clots
A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which of the following guidelines for needle selection might they discuss?
gauge # inc --> needle size dec The larger the gauge, the smaller the needle. #1 --> gauge/diameter of needle #2 --> length in inches viscosity --> directs the choice of gauge when giving an injection size of syringe --> based on amount of meds you're administering
A nurse who is administering a piggyback intermittent intravenous infusion of medication to a patient observes that there is a cloudy, white substance forming in the IV tubing. What actions should the nurse take in this situation? (Select all that apply.)
giving IV infusion and see cloudy white substance in the IV tube: stop IV flow, stop med administration --> clamp the IV at site nearest to the patient --> change administration tubing --> restart infusion BEFORE ALL ADMINISTRATIONS check compatibility of meds with IV fluid
A nurse is providing care for a patient who has a history of dementia. Which of the following methods should the nurse use in order to determine the patient's identity prior to medication administration?
if patient has dementia--> check the patient's identification band
A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case?
if patient not in room for med --> return meds to cart/room don't need to inform physician or head nurse about patient's absence
A nurse needs to administer a subcutaneous heparin injection to a client. Which of the following injection sites is most suitable for heparin?
injecting subcutaneous heparin: use abdomen area --> bc less painful intradermal injection: forearm, back, upper chest
A nurse is ordered to administer epinephrine to a child who was stung by a bee and is allergic to insect bites. Which means of drug administration would the nurse use to achieve rapid absorption and quicker results in this emergency situation?
injection Intravenous is the fastest route of administration because the medication goes into the bloodstream immediately. The second fastest route is an injection because they are quickly absorbed into vessels. Oral medication is a slow route and should not be used in an emergency situation. Medication via patches would not administer the medication quickly enough in an emergency situation. Inhalation medications are specifically given for respiratory issues.
Which of the following parts of the syringe and needle must be kept sterile when preparing and administering an injection? Select all that apply.
inside the barrel the needle the needle hub The outside of the cap and barrel do not need to be kept sterile.
A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which of the following injections can be administered at this angle?
intradermal injection: 10-15 angle of entry subcutaneous injection: 45 angle 90 angle (most typical) intramuscular injection: 90 angle intravenous injection: 15 angle only if no venous access port is in place
A nurse is using the Z-track technique to administer an injection to a client. Which of the following injection routes utilizes the Z-track technique?
intramuscular=z track intramuscular injection irritate upper levels of tissue --> z track method causes less pain to this tissue z track isn't used for any other type of injection
A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. Which of the following is a feature of a metered-dose inhaler?
it is a canister that contains pressurized medication A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.
A nurse is using an 18-gauge needle to administer a medication to a client. The nurse knows that when compared to a 27-gauge needle, an 18-gauge needle has which of the following features?
larger diameter the smaller the number, the larger the diameter 18 gauge > 27 gauge in diameter gauge/diamete/width (all synonyms)
a nurse preparing medication for a patient is called away to an emergency. what should the nurse do?
lock the medication in a cart --> finish them when you return nurse must stay with medications once they have been prepared OR lock them in med cart DO NOT leave meds unattended or placed back in their containers once you prepare meds, you have to be the one to administer
A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?
max subcutaneous injection=1mL. max intramuscular injection=3mL max intradermal injections=0.01-0.05mL
A nurse is administering an oral medication to a patient via a gastric tube. The nurse observes the medication enter the tube, and then the tube becomes clogged. What would be the appropriate initial action of the nurse in this situation?
meds clogged in gastric tube --> attack 10 ml syringe --> pull back then apply pressure to plunger multiple times to try to clear out the meds meds clogged and won't move through tube --> tell doctor --> may request to replace the tube
A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which of the following describes the mechanism of a metered-dose inhaler?
metered dose inhaler=a canister containing medication that is released when the container is compressed turbo-inhaler=propelled driven device that spins and suspends ad finely powdered medication An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas.
A patient requires 40 units of NPH insulin and 10 units of regular insulin daily subcutaneously. What is the correct sequence when mixing insulins?
mixing insulins: air into NPH insulin vial --> air into regular insulin --> take out correct amount of insulin --> go back to NPH insulin and withdrawn 40 units placing air in the NPH insulin and don't touching the needle to the insulin makes sure that the needle is contaminated and therefore there is no chance to contaminate the regular (short acting) insulin
A client is to take Demerol 35 mg IM. You have Demerol 50 mg per cc. How many cc will you administer?
o.7 cc
A nurse is administering a pain medication to a patient. In addition to checking his identification bracelet, the nurse correctly verifies his identity by:
patient identification: ask patient to state name
what is involved in the absorption, distribution, metabolism, and exertion of medication
pharmacokinetics --> absorption, distribution, metabolism, and exertion of medication
A nurse is reconstituting powdered medication in a vial. Which action is a recommended step in this process?
reconstituting powdered medication: draw up needed amount of liquid into the syringe --> stick needle into top of powdered med vial --> inject liquid portion into the powder --> remove needle & recap --> agitate vial to completely mix giving the dose: draw up prescribed amount of meds while holding syringe vertically @ eye level
A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication?
review the client's medication, allergy, and medical history To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least three timesbefore, during, and after preparing the medicationto ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications
The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which of the following would help maximize drug absorption in this client?
spacer A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption because it prevents drug loss. A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. Nasal drops are liquid medication sprayed or dropped into the client's nose. These, however, would not help in maximizing the absorption of the medication.
When instructing a client regarding sublingual application, the nurse should inform the client that which of the following is contraindicated when administering the drug? sublingual application is when something is put under the tongue that is then supposed to be dissolved into the body and SHOULD NOT be swallowed
swallowing the medication (patient should not do this) sublingual application --> don't chew, swallow, eat, smoke doesn't matter if you take the meds on empty stomach, are talking, or performing physical activities
Drugs known to cause birth defects are called
teratogenic
drugs known to cause birth defects are called
teratogenic=drugs that cause birth defects
Regarding medication administration, what must occur at the change of shifts?
the narcotics for the division are counted Healthcare facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).
What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?
therapeutic range therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. peak level is the highest plasma concentration. Trough level is the point when the drug is at its lowest concentration. half life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body
You are preparing to administer a rectal suppository to an adult patient. How far should you plan to insert the suppository?
three inches A rectal suppository must make contact with the rectal mucosa for absorption to occur so it should be inserted about 3 to 4 inches.
A client at a health care facility has been prescribed scopolamine, to be administered transdermally. Which of the following statements describes transdermal application?
transdermal application --> drugs bonded to an adhesive and applied to the skin After application, the drug migrates through the skin and eventually is absorbed into the blood stream. Pastes are drugs within a thick base that are applied, but not rubbed, into the skin. Sublingual applications are drugs that are placed under the tongue and left to dissolve slowly. Buccal applications are drugs that are placed against the mucous membrane of the inner cheek. pastes=drugs in thick base that are applied but not rubbed into the skin
You are preparing to administer a transdermal medication. How should this be accomplished?
transdermal medication --> apply the medication directly to the skin transdermal medications=absorbed through the skin
An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method?
unit does supply=one serving, one tablet/capsule for individual client, individual packets individual supply=container with enough meds for multiple doses; long term car; nursing homes stock supply=emergency use that stays on nursing unit automate medication systems=have frequently used meds for that unit, PRN meds, controlled meds, emergency meds
A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which of the following situations?
using IV administration when: -client has disorders that affect the absorption of medications (burns as an example) -quick response is needed -when client was to avoid the discomfort of REPEATED intramuscular injections
A nurse needs to administer a prescribed injection to a toddler. Which of the following injection sites is most suitable for the client?
vastus lateralis site The vastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles. The dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed; whereas, the ventrogluteal site is safe for children. The deltoid site is the least-used intramuscular injection site because it is a smaller muscle than the others. It is used only for adults because the muscle is not sufficiently developed in infants and children.
Which anatomic site is recommended for intramuscular injections for adults?
ventrogluteal muscles The ventrogluteal site involves the gluteus medius and gluteus minimus muscles in the hip area. This site is recommended for adults because there are no large nerves or blood vessels, it is removed from bone tissue, it is clean, and the patient may lie on the back, abdomen, or side for the injection.
A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?
ventrogluteal site for intramuscular: good bc the area is free of major blood vessels and fat safest place least painful don't use dosogluteal bc near sciatic nerves and you could also inject into subcutaneous fat could use deltoid region for intramuscular since there is only a little bit of fat but it lies close to radial nerve (don't want to hit this nerve)
Children's medication dosages are most often calculated using the child's body surface area and
weight child meds: based on body surface and weight
A medication order reads: "Hydromorphone, 2 mg IV every 3 to 4 hours PRN pain." The prefilled cartridge is available with a label reading "Hydromorphone 2 mg/1 mL." The cartridge contains 1.2 mL of hydromorphone. Which nursing action is correct?
when vials have more in it than you need: compare dose needed to the amount of meds you have and dispose correctly of what is not needed (don't need to notify anyone or get re-prescribed)
A nurse needs to administer a subcutaneous injection to a client. Which of the following techniques should the nurse use to reduce discomfort? Select all that apply.
• Support the client's tissue when withdrawing the needle • Numb the skin with an ice pack before the injection • Insert and withdraw the needle without hesitation • Instill the medication slowly but steadily The nurse can reduce discomfort associated with injections by using alternative techniques such as numbing the skin with an ice pack before the injection, inserting and withdrawing the needle without hesitation, and instilling the medication slowly and steadily. Nurses use the Z-track method for intramuscular injections, not for any other injection. Supporting the tissue during withdrawal reduces discomfort.
