EAQ Medication Administration

To prevent excessive bruising when administering subcutaneous heparin, what technique will the nurse employ? - Administer the injection via the Z-track technique - Avoid massaging the injection site after the injection - Use 2 mL of sterile normal saline to dilute the heparin - Inject the drug into the vastus lateralis muscle in the thigh

Avoid massaging the injection site after the injection

Which information may be (i.e., is not required) transcribed into a medication administration record (MAR) as per individual hospital policy? A. Date of admission of the patient B. Name of any medication withheld C. Time of medication administration D. Signature of the nurse administering the medication

B.

Which term represents a powdered or liquid medication concentrate that must be diluted or dissolved? A. Solvent B. Diluent C. Solute D. Solution

C.

Which nursing intervention helps to prevent medication errors in children? . - Encouraging the use of brand names - Promoting the use of abbreviations and acronyms - Minimizing the use of verbal and telephone orders - Carefully reading all labels for accuracy and checking expiration dates - Recording the client's weight before carrying out the medication order

C,D,E

A nurse gives a patient two tablets of acetaminophen instead of the prescribed one tablet of acetaminophen-codeine. Which is the priority nursing action after the medication error is identified? A. Informing the physician B. Notifying the nursing supervisor C. Assessing the patient for side effects D. Documenting the problem on an incident report

C.

The nurse is preparing to give a subcutaneous injection. Which is the appropriately sized needle for this type of injection? A. 3-in B. 1- to 2-in C. ½- to ⅝-in D. ⅜- to ½-in

C.

The nurse receives the medication order morphine 2 cc q6h IV prn pain. Which portion of the order has an identified error-prone abbreviation? A. The name of the medication B. The route to be given C. The dosage ordered D. The frequency of the medication administration

C.

What is an advantage of the unit-dose method of drug dispensing? A. More drugs are available for selection. B. Drugs are always available for administration. C. Nurses save time preparing drugs for administration. D. The availability of large quantities of a drug enhances the cost efficiency.

C.

When drawing up medication from an ampule, what does the nurse understand about ampules? A. An ampule is considered a closed system. B. An ampule can be used for multiple doses. C. An ampule requires a filter needle to draw up medication. D. An ampule contains the exact amount of medication printed on it.

C.

Which is true of routine medication orders given verbally? A. They should be written by the nurse. B. They must be signed by the prescriber within 72 hours. C. They will not be accepted. D. They must be written on a medication administration record.

C.

Which statement about the distribution of controlled substances by a computer-controlled dispensing system is correct? A. It does not distribute Schedule I and II controlled substances. B. It distributes controlled substances only when the pharmacy gives the system access. C. It provides a detailed record regarding the usage and the user of the controlled substances. D. It cannot monitor the distribution of controlled substances after 48 hours of a physician's order.

C.

The nurse is having difficulty reading a health care provider's prescription for a medication. Which step is most appropriate for the nurse to take next?

Call a pharmacist to interpret the prescription. Call the health care provider to clarify the prescription. Consult the unit manager to help interpret the prescription. Ask the unit secretary to interpret the health care provider's handwriting.

What are common negligent acts of nurses found in the hospital setting? - Failure to notify the healthcare provider of problems - Failure to follow the six rights of medication administration - Failure to ensure the safety of a client with disequilibrium problems - Failure to notify a family member about the client's current status - Failure to administer medication during an emergency without consulting with the nursing manager

A,B,C

An order written by which of the following people will need to be cosigned? A. Medical intern B. Student nurse C. Anesthesiologist D. Charge nurse

A.

A patient has elevated cholesterol levels and wishes to use an herbal preparation. Which herbal preparation does the nurse encourage the patient to use to decrease the elevated cholesterol levels?

Garlic Licorice Ginkgo biloba Saw palmetto

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. What is the preferred mode of medication administration for this client? - Oral - Rectal - Intravenous - Intramuscular

Intravenous

The advantages of computerized physician order entry include which of the following abilities of the computer? Recognizing medication incompatibilities Interpreting medication abbreviations Identifying safe dosage ranges Interpreting symbols Preventing incorrect transcription Identifying allergies

Recognizing medication incompatibilities Identifying safe dosage ranges Preventing incorrect transcription Identifying allergies

The registered nurse is teaching pediatric drug dosages to a nursing student. Which statement if made by the nursing student indicates a need for further teaching? "Drugs such as vancomycin should be administered to infants with caution." "Most pediatric medications are ordered in milligrams per kilogram dosage." "A child's age, weight, and maturity of body systems affect the drug dosage. " "After the dose calculation as per the age, most of the doses are rounded to the nearest tenth."

"After the dose calculation as per the age, most of the doses are rounded to the nearest tenth." Most pediatric medications are not rounded to the nearest tenth decimal. They are rounded to the nearest thousandth, to prevent drug overdose. Ototoxicity is the reported adverse effect of vancomycin. Therefore, it is challenging to administer this drug to infants who cannot talk. Unlike the adult drug regimen, most pediatric medications are ordered in milligrams per kilogram (mg/kg) of body weight. A child's age, weight, and maturity of body systems affect the ability to metabolize and excrete medications.

A registered nurse is teaching a nursing student about medications in patients with renal disease. Which statements, if made by the nursing student, indicate a need for further teaching? "Renal failure may lead to drug toxicity in the body." "Adequate fluid intake promotes proper elimination of medications through the kidneys." "Most drugs undergo biotransformation in the kidney before they are excreted." "Health care providers should decrease the medication dose in patients with renal disease." "Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure."

"Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure." "Most drugs undergo biotransformation in the kidney before they are excreted." Most of the drugs undergo biotransformation in the liver before they are excreted through kidneys. Enema, which increases the rate of peristalsis, will accelerate the excretion of medication through feces. Renal failure may result in drug toxicity due to improper excretion of the drug from the body. Adequate fluid intake promotes proper elimination of medications through kidneys. Drug doses should be minimized in patients with renal disease to avoid the risk of drug toxicity.

The nurse has been asked to prepare a 1% solution of medication in distilled water. How much of the medication should the nurse dissolve in 100 mL of distilled water? Record your answer using a whole number, and, please note, no comma is needed.

1000mg A 1% solution contains 1 gram of the medication dissolved in 100 mL of the solution. Because the unit is mg, and 1 gram is 1000 mg, the nurse should dissolve 1000 mg of the medication in 100 mL of water.

A patient is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 200 puffs. The patient takes two puffs every 4 hours. How many days will the pMDI last?

16 days Rationale Two puffs × six times a day = 12 puffs per day; 200 puffs/12 puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a total of 17 days.

In what ways can a nurse prevent medication errors? - Avoid using abbreviations and acronyms - Minimize the use of verbal and telephone orders - Try to guess what the client is saying if the language is not understood - Document each dose of the drug using trailing zeros when recording the dose - Check three times before giving a drug by comparing the drug order and medication profile

A,B,E

A nurse is taking care of a client who has chronic back pain. What nursing considerations should be made when determining the client's plan of care? - Ask the client about the acceptable level of pain. - Eliminate all activities that precipitate the pain. - Administer the pain medications regularly around the clock. - Use a different pain scale each time to promote patient education. - Assess the client's pain every 15 minutes.

A,C

A nurse is using dimensional analysis to calculate the correct dose of medication for a patient. The prescription is for meperidine 50 mg IM. The nurse has 25 mg/mL available. Using the dimensional analysis calculation method, which is on the left side of the equation? A. x B. 50 mg C. 25 mg D. 1 mL

A.

What should the nurse understand when accepting a verbal order? A. The nurse can be responsible for a medication error. B. The nurse is the originator of the order. C. The nurse has 24 hours to sign the order. D. The nurse needs a prescriber's signature before processing the order.

A.

When utilizing the insulin syringe safely, what is important for the nurse to know? A. Subcutaneous injections can be given with the insulin syringe. B. Insulin syringes have attachable needles. C. After drawing up the insulin, the needle must be changed before administration. D. The scale on the Lo-Dose syringe is small and may be difficult to read.

A.

Which statement regarding a unit-dose medication cabinet is correct? A. It has patient-specific drawers to store medications. B. The nurse calculates the dose and uses medications from it. C. Its drawers are filled by the pharmacist and verified by the nurse. D. It is filled with medications 12 hours before administration.

A.

A medication label reads: 100 sublingual nitroglycerin tablets 0.3 mg (1/200 gr). What is the proper way to administer this medication? A. Have the patient chew the tablet. B. Place the tablet under the patient's tongue. C. Place the tablet between the patient's cheek and gum. D. Have the patient swallow the tablet whole

B.

After verifying the correct medication and dosage, what is the nurse's next step in administering medication from a prefilled syringe? A. Withdraw the medication from the plunger at the end of the syringe. B. Add normal saline solution to the syringe to mix the medication properly. C. Apply the appropriately sized safety needle to the end of the syringe. D. Administer the medication into the oral cavity.

B.

The nursing instructor asks the nursing student to retrieve 0.9% normal saline to reconstitute a powdered medication. Which term would refer to the normal saline in this situation? A. Solute B. Solvent C. Solution D. Stabilizer

B.

What is the definition of unit-dose packaging? A. Average dose ordered for the desired therapeutic effect for a target population B. Non-reusable packaged and labeled single serving of a drug dose ordered for a patient C. Allowance of different doses to be drawn as needed for a particular patient and condition D. The intentional use of a drug or medicine packaged in an amount that is higher than is normally used

B.

Which organization established a National Patient Safety Goals to prevent medication errors and created the official Do Not Use list? A. The Institute for Safe Medication Practices (ISMP) B. The Joint Commission (TJC) C. Quality and Safety Education for Nurses (QSEN) D. United States Pharmacopeia (USP)

B.

A patient is ordered diphenhydramine hydrochloride (Benadryl) elixir 50 mg stat and 25 mg every 6 hours for itching. The diphenhydramine is dispensed as 12.5 mg per 5 mL. How many milliliters will the nurse administer for the stat dose? How many milliliters total will the nurse administer after administering the stat dose and the first two following that dose? _____ mL A. 25 for the stat dose; 50 total for the first two doses B. 25 for the stat dose; 25 total for the first two doses C. 20 for the stat dose; 40 total for the first two doses D. 20 for the stat dose; 20 total for the first two doses

D.

The nurse is preparing to give a subcutaneous injection. Which is the appropriate needle for this type of injection? A. 18-gauge B. 20-gauge C. 25-gauge D. 28-gauge

D.

What would the nurse expect to find on the medication label for an enteric-coated tablet? A. The tablet may be crushed. B. The tablet may be diluted. C. The tablet is extra strength. D. The tablet may have "EC" after the name.

D.

Which organization has developed guidelines that include 12 interdisciplinary core processes for safe use of computer-controlled dispensing systems? A. The Joint Commission (TJC) B. The American Health Care Association (AHCA) C. Centers for Disease Control and Prevention (CDC) D. The Institute for Safe Medication Practices (ISMP)

D.

Which statement regarding a unit-dose drug dispensing system (UDDS) is correct? A. Unit-dose packages are reusable. B. Unit-dose medications are placed at the patient's bedside. C. Unit-dose packages are labeled only with generic names of the drug. D. Unit-dose medications are prepared daily in the pharmacy and sent to the unit.

D.

Which student nurse statement regarding computer-controlled dispensing systems indicates the need for further learning? A. "The pharmacy supplies this system daily with stock medications." B. "Controlled substances are kept in this system with a detailed record." C. "The nurse uses a security code and password or biometric fingerprint scan to access this system." D. "The nurse cannot access this system in an emergency and needs to notify the pharmacy for access."

D.

The nurse is explaining to a patient about the side effects of a prescribed drug. Which terms describe side effects? Predictable Often unavoidable Occur after prolonged intake Occur at usual therapeutic dose Caused by defective drug excretion

Occur at usual therapeutic dose Predictable Often unavoidable

The nurse receives a medication order from the primary care provider. Which components must be present for the medication order to be considered valid? Patient's full name The generic and trade names of the medication Full credentials of the primary care provider Frequency of medication administration Signature of person writing the order

Patient's full name Frequency of medication administration Signature of person writing the order

Which organizations provide direction for the use of approved abbreviations? American Nurses Association (ANA) The Joint Commission (TJC) American Hospital Association (AHA) Institute of Medicine (IOM) Health care institutional policies Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS)

The Joint Commission (TJC) Institute of Medicine (IOM) Health care institutional policies

When calculating a dosage from an order, with what is the nurse concerned? Date the order was written Time and frequency of administration Medication name Signature of the prescriber The name of the patient

Time and frequency of administration Medication name

A prescription states that a patient is to take a medication by mouth bid pc. Which dosing instruction does pc elicit from this prescription?

Two times a day After meals Before meals Three times a day

The nurse is reviewing error-prone abbreviations with nursing students. Which abbreviations would the instructor correctly identify as error-prone? q1d mcg hs t.i.d. subcut OD

q1d hs OD

After administering a medication, the nurse finds that a medication error has occurred. Which action by the nurse is most appropriate in this situation? Preparing and filing an incident report Reporting the incident to the manager Reporting the incident to the supervisor Assessing and examining the patient's condition

Assessing and examining the patient's condition

Which statement is true regarding systems of medication measurement? The metric system is most familiar to people. The apothecary system is used infrequently today. Household measurements allow the use of teaspoons and cups. The metric system of measurement is officially adopted by the U.S. Congress.

The apothecary system is used infrequently today.

The primary health care provider prescribes pain medication to a patient with the notation "prn" in the prescription. What should the nurse interpret from the prescription? The medication should be taken as needed. The medication should be taken every hour. The medication should be taken before meals. The medication should be taken twice each day.

The medication should be taken as needed.

A nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? - Height - Allergies - Vital signs - Body weight

allergies

The registered nurse is teaching the right route of drug administration to nursing students. Which of a nursing student's statements indicates a need for further teaching? "The medication should be labeled after preparation." "Enteral syringes should not be used to prepare oral medications." "Failure to remove the cap before administering the oral medication may result in aspiration." "Administration of oral products through intravenous route may result in the formation of a sterile abscess."

"Enteral syringes should not be used to prepare oral medications." Enteral syringes can be used for preparing oral medications, because they have a different color from the parenteral syringe and will be clearly labeled for oral or enteral use. Any prepared medication should be labeled soon after its preparation to prevent any adverse effects of the unlabeled drug. Removing any caps from the tip of an oral syringe before administering the medication will help in preventing aspiration. Administration of oral preparations through parenteral route may result in the formation of a sterile abscess and may also result in fatal consequences.

The registered nurse is teaching a nursing student about the safety guidelines for nursing skills. Which statement by the student nurse indicates the need for further education? - "I should set up and prepare medications in distraction-free areas." - "I should advise the certified medical assistant to administer intravenous medication." - "I should be vigilant during the entire process of medication administration." - "I should identify each client using at least two identifiers before administrating medications."

"I should advise the certified medical assistant to administer intravenous medication."

The registered nurse is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a healthcare setting. Which statement made by the nursing student indicates a need for further education? - "I should check the new medication order against the current list of medicines." - "I should avoid asking about the over-the counter medications." - "I should obtain a comprehensive and current list of the client's medications." - "I should avoid distractions and go slowly when reconciling the client's medications."

"I should avoid asking about the over-the counter medications."

A nurse is teaching an older client about proper medication use. Which statement made by the client indicates the need for further education? - "I will ask the pharmacist to give generic medications." - "I will use over-the-counter medicines along with prescribed drugs." - "I will continue my treatment by consulting a single healthcare provider." - "I will know the names and times of administration of the medications I am taking."

"I will use over-the-counter medicines along with prescribed drugs."

The nurse is teaching a nursing student about parenteral routes. Which statement made by the nursing student indicates a need for correction? "The intraperitoneal route is used to administer insulin." "Intraarterial medication administration is managed by the nurse." "Epidural medication is used to administered medicine in the spinal canal." "Intrapleural administration is common in toddlers who have poor access to intravascular space."

"Intrapleural administration is common in toddlers who have poor access to intravascular space."

The registered nurse is teaching a nursing student about the various factors that affect drug absorption. Which statement if made by the nursing student indicates a need for further teaching? "Patients with malnutrition and liver disease are at risk of drug toxicity." "The larger the surface of drug absorption, the less the drug is absorbed." "Drugs given through the intravenous route are absorbed faster than the oral route." "The tablet form of medication is more readily absorbed than the solution form." "The greater the blood supply to the site of administration, the faster the drug is absorbed."

"The tablet form of medication is more readily absorbed than the solution form." "The larger the surface of drug absorption, the less the drug is absorbed." The larger the surface of drug absorption, the more the drug is absorbed. The solution form of medication is more readily absorbed by the body than the tablet form of medications. Patients with malnutrition and liver disease are at risk of drug toxicity. Drug absorption is faster through the intravenous route (IV) than the oral route, as the IV route facilitates the direct infusion of medication into the blood. The greater the blood supply to the site of administration, the faster the absorption of the drug is.

The registered nurse is teaching a nursing student about time-critical medications. Which statement if made by the nursing student indicates effective learning? "The Institute for Safe Medication Practices (ISMP) determines time-critical medications." "Time-critical medications should be administered within 1 hour of the scheduled time." "Time-critical medications should be administered within 30 minutes of the scheduled time." "Subtherapeutic responses do not occur with delayed administration of time-critical medications."

"Time-critical medications should be administered within 30 minutes of the scheduled time." Time-critical medications are medications that should be administered within 30 minutes before and after the scheduled time. Hospitals have the responsibility of deciding time-critical medications. Non-time-critical medications should be administered within 1 hour of the scheduled time. Delayed administration of time-critical medications cause harm or subtherapeutic responses.

The registered nurse is teaching a nursing student about prescription orders. Which statement if made by the nursing student indicates the need for further teaching? "Only emergency medications are prescribed in STAT prescription orders." "Administration of hydralazine is an example of a now order prescription." "Administration of lorazepam is an example of a prn order of prescription." "A single order prescription necessitates the administration of medication at one specific time." "A prn order is prescribed when the drug should be administered to the patient as and when required."

"administration of hydralazine is an example of a now order prescription." "Administration of lorazepam is an example of a prn order of prescription." Hydralazine is an emergency drug that should be administered as per the STAT order of prescription that is written in emergencies when a patient's condition changes suddenly. Lorazepam is an example of a drug that is administered following a one-time prescription order. A single order prescription necessitates the administration of medication at one specific time. A prn order prescription necessitates the administration of medication only when a patient requires it.

The nurse is preparing a medication ordered by the physician. The physician ordered 250 mg of Tylenol to be given to the patient. The medication comes from the pharmacy in dosage strength of 1 gram of Tylenol in 2 mL. How many mL should the nurse administer? Record your answer using one decimal place.

0.5

A patient has to be given a bladder irrigation with 100 mL of medicated solution with 1/1000 dilution. How much of the medication should the nurse dissolve in 100 mL of solvent? Record your answer using a whole number.

1/1000 solution indicates the presence of 1 gram of medication in 1000 mL of solution. This means that each mL of the solution contains 1 mg of the medication. Because the nurse has to prepare 100 mL of the solution, the nurse should dissolve 100 mg of medication in 100 mL of solvent.

A medication has a minimum effective concentration of 25 mg/dL, and the therapeutic range is 25─100 mg/dL. Which plasma concentration may cause toxic effects of the drug?

100 Rationale The highest reading of a therapeutic range corresponds to the toxic range of plasma concentration. Any drug levels above this concentration are toxic. The highest value of the therapeutic range of the drug in question is 100 mg/dL, so plasma concentration of the drug above 100 mg/dL is toxic. p. 784

A patient has been advised to use a metered-dose inhaler (MDI) two puffs two times a day. The canister has total of 200 puffs of medicine. When would the nurse ask the patient to come in for a new canister?

50 days Rationale The daily requirement of the patient is 2 × 2 puffs; that is, four puffs a day. The canister has total of 200 puffs; therefore using four puffs daily will empty the canister in (200/4) = 50 days. So the patient should come in for a canister replacement after 50 days.

The nurse is preparing to administer ear drops to a client who has impacted cerumen. Before administering the drops, the nurse will assess the client for which contraindications? - Allergy to the medication - Itching in the ear canal - Drainage from the ear canal - Tympanic membrane rupture - Partial hearing loss in the affected ear

A,C,D

A nurse is preparing to administer an ophthalmic medication to a client. What techniques should the nurse use for this procedure? - Clean the eyelid and eyelashes. - Place the dropper against the eyelid. - Apply clean gloves before beginning the procedure. - Instill the solution directly onto the cornea. - Press on the nasolacrimal duct after instilling the solution.

A,C,E

A nurse is teaching about near-miss events to a group of nursing students. What is appropriate for the nurse to include in the education? - They do not cause actual harm to the patient. - They may cause moderate harm to the patient. - They are caused by a variation in standard care. - They are caused by impaired immune functioning. - Their cause can be analyzed by failure mode effective analysis

A,C,E

An older client asks, "How do I know that all the medications that I take are safe?" What information should the nurse include in response to this client's question? - "Ask your healthcare provider how and when you should be taking your medications." - "Stop taking a prescribed medication if you are not feeling better in a few days." - "Discard medications into the toilet that have exceeded the expiration date on the bottle." - "Check the name, dose, and instructions about administration of drugs each time before leaving the pharmacy." - "Inform your healthcare provider of the over-the-counter drugs, recreational drugs, and amount of alcohol you ingest."

A,D,E

The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? Ask the prescriber to change the order. Crush the pill with a mortar and pestle. Hide the capsule in a piece of solid food. Open the capsule and sprinkle it over pudding.

Ask the prescriber to change the order. Enteric-coated or sustained-release capsules should not be crushed or opened; the nurse should contact the prescriber to change the medication to a form that is liquid or can be crushed. The nurse should not hide the capsule in a piece of solid food, because it could put the patient at risk for choking.

For a client with difficulty swallowing, the nurse should crush which medication? - Metoprolol extended release - Felodipine sustained release - Acetaminophen extra strength - Potassium chloride extended release

Acetaminophen extra strength

What is the most important nursing action involved in caring for a client using medications to manage disease? - Administering the medications - Teaching about the medications - Ensuring adherence to the medication regimen - Evaluating the client's ability to self-administer medications

Administering the medications

A patient develops skin rashes and hives after administration of penicillin. Which phenomenon is this known as?

Aggravation Amelioration Adverse reaction Therapeutic effect Rationale An adverse reaction is any unintended harmful action of any medication or therapeutic procedure. The development of hives is an adverse reaction to penicillin. Aggravation is an increase in the severity of existing symptoms. Amelioration is a decrease in the severity of existing symptoms. A therapeutic effect is the expected and wanted outcome of relief of symptoms. p. 786

A patient develops sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath following administration of a medication. Which type of allergic reaction is the patient experiencing? Rhinitis Medication allergy Anaphylactic reaction Idiosyncratic reaction

Anaphylactic reaction The sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath indicate the severe form of allergic reaction called anaphylactic reaction. Rhinitis is a minor form of allergic reaction that manifests as sneezing, swelling, and clear nasal discharge. Medication allergy is a nonspecific term and encompasses rhinitis, rash, urticaria, and pruritus. Idiosyncratic reaction is the onset of an unpredictable response in a patient.

A client requests information about the prescribed medication regimen. What is the best response by the nurse? - Give a computer printout about the medication to the client. - Ask the client to state what is already known about the medication. - Advise talking to the primary healthcare provider to seek information about the medication. - Delegate the task of sharing information about the medication to the licensed practical nurse.

Ask the client to state what is already known about the medication.

The nurse takes a medication to a patient, and the patient refuses to take it and tells the nurse to take it away. What is the nurse's next action? Ask the patient's reason for refusal. Explain that she must take the medication. Take the medication away and chart the patient's refusal. Tell the patient that her physician knows what is best for her.

Ask the patient's reason for refusal.

A 15-year-old adolescent is admitted with partial- and full-thickness burns of the arms and upper torso. What are the purposes of administering pain medication by way of the intravenous route rather than the intramuscular route? - Adolescents are afraid of injections. - It decreases the risk of tissue irritation. - Severe pain is reduced more effectively. - Impaired peripheral circulation is bypassed. - It provides for more prolonged relief of pain.

B,C,D

A client is being admitted for a total hip replacement. When is it necessary for the nurse to ensure that a medication reconciliation is completed? - After reporting severe pain - On admission to the hospital - Upon entering the operating room - Before transfer to a rehabilitation facility - At time of scheduling for the surgical procedure

B,D

A nurse is reviewing the different names for a drug. Which medication designation is assigned by the U.S. Adopted Names Council?

Brand name Official name Trade name Chemical name Rationale Medications can have a maximum of four designations. The official name is assigned by the U.S. Adopted Names Council to ensure safety, consistency, and logic in the choice of names. The brand/trade name is a registered name assigned by the drug manufacturer to distinguish the product from those of other manufacturers. The chemical name is an accurate description of the substance composition. bag 783

A patient develops buccal irritation following the administration of a buccal medication for 3 days. Which nursing instruction may have prevented the patient's buccal irritation?

Chew the medication. Swallow the medication. Take the medication with water. Alternate the cheeks with each dose. Rationale Buccal administration of medication may lead to buccal irritation by erosion of the mucus membrane. This may be very uncomfortable for the patient. Buccal irritation may be minimized by alternating the placement of the medication with each subsequent dose so that a single area is not affected. Buccal medications are not to be chewed, swallowed, or taken with any liquids, as the rate of absorption may be affected. p. 804

A nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun caring for the client. What is the best nursing intervention in preparing for the client's discharge? - Contact the client's healthcare provider to ask to substitute a liquid form of medications for the pill form. - Teach the client and family members to crush the pills and administer them with applesauce. - Contact the client's healthcare provider to discuss use of transdermal medications for pain control. - Teach the client and family members about addiction that may occur as a result of regular opioid use.

Contact the client's healthcare provider to discuss use of transdermal medications for pain control.

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer dementia. The client lives alone. The client's adult children live nearby. According to the prescribed medication regimen, the client is to take medications six times throughout the day. What is the priority nursing intervention to assist the client with taking the medication? - Contact the client's children and ask them to hire a private duty aide who will provide round-the-clock care. - Develop a chart for the client, listing the times the medication should be taken. - Contact the primary healthcare provider and discuss the possibility of simplifying the medication regimen. - Instruct the client and client's children to put medications in a weekly pill organizer.

Contact the primary healthcare provider and discuss the possibility of simplifying the medication regimen.

Which nursing actions are appropriate for safe narcotic administration? Making a note of a discrepancy in the record Obtaining the signature of the witness nurse in the paper record Storing the medication in the drawer near the patient Disposing of the unused part in the presence of another nurse Dispensing wasted parts of medications in sharps containers

Disposing of the unused part in the presence of another nurse Obtaining the signature of the witness nurse in the paper record

Which interventions should the nurse perform when administering medications to a patient through a nasogastric tube? Dissolve the different medications separately. Draw all the medications together in a syringe. Use a pigtail vent after connecting the syringe to the tube. Flush the tube before and after administration of the medication. Contact the health care provider if the patient resists the administration.

Dissolve the different medications separately. Flush the tube before and after administration of the medication. Contact the health care provider if the patient resists the administration. When administering medication through a nasogastric tube, all the medications should be dissolved separately in suitable solvents. The nasogastric tube should be flushed prior to drug administration and following administration of each drug to prevent blockage. If the nurse encounters resistance while administering the medication, the health care provider should be notified. Each medication should be separately dissolved and administered to prevent mixing of medications. The nurse should not use a pigtail vent after connecting the tube to the syringe, because it can cause air to escape into the digestive tract.

The nurse is responsible for the storage and safe usage of drugs. Which guidelines should the nurse follow for the safe use of narcotics? Store narcotics in locked containers. Preserve unused portion of the drug. Frequently count narcotics, especially during shift change. Do not report discrepancies in narcotic count. Document and record patient details.

Document and record patient details. Frequently count narcotics, especially during shift change. Store narcotics in locked containers.

A patient is transitioning from the hospital to the home environment and obtains a home care referral. Which is priority for the discharge nurse in relation to safe medication administration? Set up the follow-up appointments with the physician for the patient. Ensure that someone will provide housekeeping for the patient at home. Ensure that the home care agency is aware of medication and health teaching needs. Make sure the patient's family knows how to safely bathe the patient and provide mouth care.

Ensure that the home care agency is aware of medication and health teaching needs. A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications. Setting up follow-up appointments, ensuring that someone will provide housekeeping for the patient, and making sure the patient's family knows how to safely bathe the patient are not the priority for the discharge nurse in relation to medication administration.

Which route is used for the administration of regional analgesia for surgical procedures? Epidural Intrapleural Intraosseous Intraperitoneal

Epidural

To ensure the safety of a client who is receiving a continuous intravenous normal saline infusion, the nurse should change the administration set how often? - Every 4 to 8 hours - Every 12 to 24 hours - Every 24 to 48 hours - Every 72 to 96 hours

Every 72 to 96 hours

The nurse is attending to a patient with a pulmonary infection. The healthcare provider prescribes antibiotics for the patient. Which instructions should the nurse give to the patient regarding antibiotic treatment? Emphasize taking the full prescription. Explain that improper treatment may worsen the patient's condition. Emphasize discontinuing the treatment once the patient attains symptomatic relief. Explain that improper treatment may cause development of bacterial resistance. Emphasize continuation if the condition does not improve with a full course of medication

Explain that improper treatment may cause development of bacterial resistance. Emphasize taking the full prescription. Explain that improper treatment may worsen the patient's condition.

A nurse is administering an eye medication that removes secretions and cleanses and soothes a patient's eye. Which type of ophthalmic medication is the nurse administering?

Extraocular disks Eyedrops Eye ointments Eye irrigation Rationale Eye irrigation or eyewash gently cleanses, removes secretions or foreign bodies, and refreshes (soothes) the eye. For continuous administration of medication, the health care provider may prescribe an extraocular disk, which is similar to a contact lens. The health care provider may prescribe eyedrops for the treatment of eye diseases or irritations. The health care provider may prescribe eye ointments if the patient has an eye infection or irritation. p. 806

Medications undergo vigorous testing before they are made available to the public. Which regulatory agency is responsible for ensuring this process? Medicare program National Formulary United States Pharmacopeia Food and Drug Administration

Food and Drug Administration The Food and Drug Administration ensures that all medications available in the market undergo vigorous testing to ensure their safety and efficacy. The Medicare program does not ensure testing of drugs. The United States Pharmacopeia and the National Formulary set standards for medication strength, quality, purity, packaging, safety, and dose form.

A patient with end-stage prostate cancer has developed a urinary tract infection. Which dietary intervention would a nurse propose to provide additional comfort to the patient?

Garlic Echinacea Ginkgo biloba Saw palmetto Rationale Saw palmetto is helpful for prostatic enlargement, urinary inflammation, and chronic pelvic pain. Garlic lowers serum cholesterol and blood pressure; hence it is useful in the management of angina. Echinacea is helpful for respiratory infections. Ginkgo biloba improves memory and mental alertness. page 788

A primary nurse receives prescriptions for a newly admitted client and has difficulty reading the healthcare provider's writing. Who should the nurse ask for clarification of this prescription? - Nurse practitioner - House healthcare provider who is on call - Healthcare provider who wrote the prescription - Nurse manager familiar with the healthcare provider's writing

Healthcare provider who wrote the prescription

When a patient asks the nurse about the use of therapeutic herbs, which response by the nurse is best?

Herbs have many qualities; some effects are good, and some are not." "I have heard many people have used some herbal remedies and had good results." "Herbs are not regulated in the same way as prescribed medications, and some herbs can have health risks, especially if used with prescribed drugs." "If you are getting relief from an herbal remedy, there is probably no harm in it."

While assessing a patient, the nurse observes raised, irregularly shaped skin eruptions with red margins. Which mild allergic reaction does the nurse document in the medical record? Rash Hives Rhinitis Pruritus

Hives Hives, or urticaria, is a mild allergic reaction that is characterized by raised, irregularly shaped skin eruptions with red margins. Rash is a mild allergic reaction that is characterized by small, raised vesicles that are usually reddened all over the body. Inflammation of the mucous membrane lining the nose mucosa is referred to as rhinitis. Pruritus is a mild allergic reaction that involves itching of the skin that accompanies rashes.

Which drug is administered with the STAT order of prescription? Cetrizine Hydroalazine Vancomycin Paracetamol (over-the-counter analgesic)

Hydroalazine

A primary health care provider prescribed an antihistamine to a pediatric patient and informed the caretakers that the child may become drowsy after taking this medication. However, on the contrary, the child became extremely agitated and excited after taking the medication. What is this reaction called? Toxic effect Allergic reaction Therapeutic effect Idiosyncratic reaction

Idiosyncratic reaction Idiosyncratic reaction is any unpredictable drug reaction. Therefore, the child exhibits an idiosyncratic reaction. The toxic effect often develops after prolonged intake of medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Allergic reactions are sudden onset immunological reactions seen after a drug intake. The therapeutic effect is a reaction that is the expected or predicted physiological response caused by a medication.

A patient has asthma and receives an inhaled medication. Which local effect of this medication is desired?

Inflammation Rebound effect Bronchodilation Increased heart rate

A nurse is preparing medications. Which form of medication is absorbed very rapidly?

Inhalers Eardrops Eyedrops Coated tablets Rationale When an inhaler is used, the medication enters through the nose and mouth into the lower respiratory system, and the medication is absorbed very quickly. Eardrops and eyedrops are absorbed more slowly than inhaled medications. Coated tablets are absorbed from the colon, which means they have a delayed onset of action as they must pass through the digestive system first. p. 821

The nurse is educating a diabetic patient about how to administer insulin. Which statements pertaining to use of insulin are appropriate? The insulin vial should be shaken well before drawing the injection. Insulin should not be mixed with any other medication. Insulin detemir should not be mixed with any insulin. Insulin glargine should be mixed only with regular insulin. Rapid-acting insulin mixed with NPH insulin should be given along with meals.

Insulin should not be mixed with any other medication. Insulin detemir should not be mixed with any insulin Insulin should never be mixed with any other medication, because it can hamper the effectiveness of the insulin. Mixing insulin detemir with any other insulin can make it ineffective. Shaking an insulin vial can form bubbles that can interfere with correct dosage. Insulin glargine should not be mixed with any other insulin. Rapid-acting insulin mixed with NPH insulin must be given 15 minutes before meals for maximum benefit.

The nursing instructor is talking to nursing students about the unit-dose system used in medication distribution. Which statements accurately describe the unit-dose system? It uses carts for distribution. It has labeled drawers. It has controlled substances kept in foil. It does not contain prn and stock medication. It includes ordered doses of medication for a full course.

It uses carts for distribution. It has labeled drawers. he unit-dose system uses a cart with drawers with a 24-hour supply of medications for each patient. The drawers are labeled with the patient's name. Controlled substances are not kept in the patient's drawer; they are kept separately in locked drawers. The cart also has prn and stock medications. The carts have the ordered dose of medication for each patient for 24 hours, which may not be the full course.

While undergoing a soapsuds enema, the client reports abdominal cramping. What action should the nurse take? - Immediately stop the infusion. - Lower the height of the enema bag. - Advance the enema tubing 2 to 3 inches (5 to 7.5 cm). - Clamp the tube for 2 minutes and then restart the infusion.

Lower the height of the enema bag.

When reviewing a drug to be administered, the nurse identifies that the package insert indicates that the Z-track injection technique should be used. Under what circumstance does the nurse expect that this technique will be necessary? - Volume of medication to be administered is large. - Medication is irritating to subcutaneous tissue and skin. - Injection site must be massaged after it is administered. - Procedure requires an air bubble to be drawn into the syringe.

Medication is irritating to subcutaneous tissue and skin.

Which statements are true regarding routes of medication administration? Parenteral route causes anxiety in patients. Inhalational routes have higher absorption rates. Medications are absorbed slowly through the skin. Oral route is avoided in patients with gastrointestinal disorders. Oral route is used in patients with reduced gastrointestinal motility.

Medications are absorbed slowly through the skin. Oral route is avoided in patients with gastrointestinal disorders. Parenteral route causes anxiety in patients. Medications are absorbed slowly through the skin due to the makeup of the skin. The oral route of administration is contraindicated in patients with gastrointestinal disorders. The administration of medications through the parenteral route often causes anxiety in patients, especially in children. The intramuscular and intravenous routes have higher absorption rates. The oral route is contraindicated in patients with reduced gastrointestinal motility.

Which statement about anaphylactic reaction requires correction? Anaphylactic reactions may cause pharyngeal edema. Anaphylactic reactions may be life threatening. Anaphylactic reactions are a type of allergic reactions. Occurs when a patient is exposed to the allergens for the first time.

Occurs when a patient is exposed to the allergens for the first time. First exposure to an allergen will sensitize the immune system. When the patient is exposed to the same allergens for the second time, an anaphylactic reaction may occur. Pharyngeal edema, constriction of bronchiolar muscles, and severe wheezing are the signs of an anaphylactic reaction. It is a life-threatening condition and is a type of allergic reaction.

The nursing student is preparing to administer an antibiotic to a patient. The patient asks the nursing student what the medication is and why he should take it. Which information would the nursing student include when replying to the patient?

Only the patient's health care provider can give this information. The student provides the name of the medication and a description of its desired effect. Information about medications is confidential and cannot be shared. The patient has to speak with his assigned nurse about this. Rationale If the student nurse is administering the patient's medications, it is his or her responsibility to be familiar with the patient's medications and their desired effects. The student nurse should be knowledgeable and comfortable addressing the patient's questions and concerns; however, the student nurse's clinical instructor should be present as well. The patient's health care provider is not the only one who can provide this information to the patient. A patient's medication is confidential and should not be shared with anyone other than the patient and others who are providing direct patient care. The patient does not have to speak with his assigned nurse. The student nurse was assigned to care for the patient, under the supervision of a clinical instructor or staff nurse; therefore he or she should be qualified to answer the patient's questions regarding his medications. p. 814

The nurse plans to administer a medication that can give immediate relief to a patient. Which parameter of the drug should the nurse check for to find if the drug can provide immediate relief to the patient?

Peak concentration Plateau concentration Duration of action Onset of action Rationale For providing immediate relief to the patient, a drug should have a faster onset of action. A drug with a slow onset of action may show a delayed effect. Peak concentration refers to the time taken to attain the highest effective concentration and does not provide information related to the onset of action. Plateau concentration is the plasma concentration attained and maintained after repeated fixed doses. Duration is the amount of time for which the drug produces its effect and does not provide information regarding onset of action.

A client has an order for a sublingual nitroglycerin tablet. The nurse should teach the client to use what technique when self-administering this medication? - Place the pill inside the cheek and let it dissolve. - Place the pill under the tongue and let it dissolve. - Chew the pill thoroughly and then swallow it. - Swallow the pill with a full glass of water.

Place the pill under the tongue and let it dissolve.

The primary health care provider prescribed sulfamethoxazole (Bactrim) to a patient with a urinary tract infection. The nurse finds that the patient is allergic to sulfa drugs and obtains an order for another medication. What is the nurse's responsibility in this situation to prevent such medication error in future? Reporting it to the patient Considering it as a common error Writing it in the patient's medical record Reporting it to the hospital administration

Reporting it to the hospital administration When the medication, to which the patient is allergic, is modified before reaching the patient, it is called a near miss. When such an error occurs in a health care setting, it should be reported to the hospital administration. Even though it did not harm the patient, it should be reported so as to prevent such errors in the future. Reporting it to the patient is not appropriate, because it may create a negative impression about the hospital. The nurse should not consider it a common error, because it could have harmed the patient. Writing it in the patient's medical record is not an appropriate intervention.

A patient develops sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath following administration of a medication. Which type of allergic reaction is the patient experiencing?

Rhinitis Medication allergy Anaphylactic reaction Idiosyncratic reaction Rationale The sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath indicate the severe form of allergic reaction called anaphylactic reaction. Rhinitis is a minor form of allergic reaction that manifests as sneezing, swelling, and clear nasal discharge. Medication allergy is a nonspecific term and encompasses rhinitis, rash, urticaria, and pruritus. Idiosyncratic reaction is the onset of an unpredictable response in a patient. page 786

The nurse who is responsible for dispensing medications understands that every patient requires a different dosage for a given drug. Various factors affect the absorption of drugs. Which factors influence absorption? Total body weight Body temperature Route of administration Lipid solubility of the drug Blood flow to the site of administration

Route of administration Lipid solubility of the drug Blood flow to the site of administration Factors that influence absorption are the route of administration, ability of the medication to dissolve, blood flow to the site of administration, body surface area (BSA), and lipid solubility of medication. The absorption of drugs depends on the route of administration; oral route has the least absorption, and the intravenous route has the highest absorption. The human body absorbs medications in a liquid state more readily than tablets and capsules. Higher blood flow to the site of administration favors faster absorption of drugs. Because the cell membrane has a lipid layer, highly lipid-soluble medications cross cell membranes easily and are absorbed quickly. Absorption of drugs depends on body surface area, not on body weight. Body temperature does not affect the absorption of drugs.

A patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site. Which condition would the nurse suspect?

Sepsis Phlebitis Infiltration Fluid overload Rationale Redness, warmth, and tenderness at the IV site are signs of phlebitis. Sepsis is an infection in the blood stream. Infiltration occurs when an intravenous catheter becomes dislodged (no longer in the vein) and the medication leaks into the surrounding tissue. Fluid overload occurs when a patient receives too much fluid intravenously.

A nurse is teaching self-administration of insulin to a patient. Which instruction would the nurse include in the teaching?

Shake the vial before drawing insulin. Administer regular insulin intramuscularly. Roll the insulin between your palms if the preparation is cloudy. Administer insulin after having meals.

The nurse observes that a patient has a rash, itchy skin, inflammation and swelling of the nasal passages, and raised skin eruptions after intravenous drug administration. Which type of drug effect is the patient experiencing?

Side effect Toxic effect Allergic effect Adverse effect Rationale Allergic reactions are unpredictable immune responses caused by antibody reactions to antigens. These include rashes, itching, inflammation and swelling of the nasal passages, and raised skin eruptions. Severe allergic reactions are also referred to as anaphylactic reactions. Side effects are predictable but unwanted and sometimes unavoidable reactions to medications. These side effects may be minor, harmless, or harmful. Toxic effects are serious physiologic effects caused by medication overdose or long-term use that may impair metabolism and excretion. Adverse effects are severe, unintended, and unwanted reactions that occur when one drug interacts with another or when a drug interacts with food or after one dose of a single drug. page 786

The primary health care provider prescribes lorazepam (Ativan) 1 mg IV to a patient who is about to undergo an MRI scan. Which type of prescription order has been given by the primary health care provider? Prn order Now order STAT order Single order

Single order

The nurse is caring for a client who got discharged from the hospital. The nurse finds that the client is having difficulty in determining which medications to take. What would be the best nursing intervention in this situation? - The nurse fills and labels the medication bottles. - The nurse advises the caregiver to support the client in taking medication. - The nurse recommends the client's pharmacy to re-label the medication in large letters. - The nurse shows the client examples of pill organizers that will help the client to sort the medication.

The nurse recommends the client's pharmacy to re-label the medication in large letters.

Which statement about medication names requires correction? The trademark for generic names is indicated by the superscript "TM." United States Adopted Names Council approves generic names of drugs. The nonproprietary name of a medication is the generic name given to the drug. The Institute for Safe Medication Practices publishes a list of medications that are frequently confused with another.

The trademark for generic names is indicated by the superscript "TM." Brand names of any drug are indicated by the trademark of superscript "TM." The United States Adopted Names Council approves the generic name of the drug released into the market as the first trade name. The nonproprietary name of a medication is the generic name given to the drug. The Institute for Safe Medication Practices publishes a list of medications that are frequently confused with another medications.

A geriatric patient with hypertension and diabetes mellitus is taking propranolol (Inderal) and insulin (Humulin N) therapy. Which interventions by health care professionals help prevent patient medication errors according to the Leapfrog Group? - Scheduling regular follow-up visits - Prescribing low dosage of medication - Using computer physician order entry - Closely monitoring the patient for 24 hours

Using computer physician order entry

Which nursing intervention avoids aspiration in children? Using liquid medication form Using a straw for medication administration Offering juice after medication administration Avoid mixing a large amount of medication into foods

Using liquid medication form

After 3 months of supplemental oral iron therapy, there is no significant increase in an adolescent's hemoglobin level. Iron dextran is prescribed. What is the best way for the nurse to administer this medication? - With a transdermal needle - By massaging the injection site - With the use of the Z-track method - By administering a local anesthetic first

With the use of the Z-track method

A nurse is administering an intradermal skin test injection to a client. What is the next action the nurse needs to do after the medication has been injected? - Withdraw the needle and place a piece of gauze over the injection site. - Withdraw the needle and scrub the site with Betadine solution. - Withdraw the needle and vigorously wipe the area with an alcohol wipe. - Withdraw the needle and circle the area with a skin pen.

Withdraw the needle and place a piece of gauze over the injection site.