Nurse 202: Quiz 4 Medications

The nurse transcribes an order that reads: Colace 100 mg PO daily. This is an example of which type of order?

a) Standing order b) Stat order c) Single order d) "As needed" order --> Standing order Explanation: This is an example of a standing order, which is to be carried out as specified until it is cancelled by another order.

What type of order would a physician most likely write to treat a client whose pain levels vary widely throughout the day?

a) Stat b) Standing c) p.r.n. d) One-time --> as needed for pain

A severe allergic reaction from a medication requires:

Epinephrine

A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step?

Correct response: to clear medication and prevent clot formation Explanation: The intravenous lock is flushed before and after the infusion is completed to clear the vein of any medication and to prevent clot formation in the needle.

A nurse is administering a piggyback infusion to a client with second-degree burns. Which of the following describes the most important feature of a piggyback infusion?

Correct: A parenteral drug is given in tandem with IV solution. Explanation: In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency.

When educating an older adult client about the administration of medication during discharge, 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. Explanation: If an older adult 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.

Which medications are dropped into the ear to treat ear infections or to soften and remove ear wax?

Otic Explanation: Otic medications are administered in the ear. Ophthalmic medications are administered in the eyes. Parenteral medications are given by injection or infusion.

The nurse is providing care to a client who has a Groshong catheter inserted. When irrigating the catheter, the nurse would use which solution?

a) Sterile water b) Diluted heparin c) Normal saline d) 5% dextrose --> Normal saline Explanation: Catheter patency is usually maintained by periodically flushing the catheter with diluted heparin. However, because of its unique design, the Groshong catheter requires irrigation with normal saline rather than heparin.

A nurse is conducting an interview with a patient to collect a medication history. Which of the following questions would be used to ensure safe medication administration?

a) "Have you noticed any change in your bowel habits?" b) "How do you feel about taking medications?" c) "At what times do you take your medications?" d) "Do you have any allergies to medications?" --> "Do you have any allergies to medications?" Explanation: Drug allergies can occur in a person who has previously been exposed to a medication and developed a drug allergy. The reactions range from minor to life threatening. Serious drug reactions must be documented according to agency policy and reported to the FDA MEDWATCH program.

An adult with diabetes receives 20 units of insulin each morning and evening. How will the nurse teach the client to administer the insulin?

a) "Use a 5-mL syringe and give 0.40 mL." b) "Use a tuberculin syringe and give 4/10 mL." c) "Use a 1-mL syringe and give 0.4 mL." d) "Use an insulin syringe and give 20 units." --> "Use an insulin syringe and give 20 units." Explanation: Insulin doses are calculated in units. The scale commonly used is U100, based on 100 units of insulin contained in 1 mL of solution. The adult client is taught to measure by units, not mL.

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?

a) 0.05 mL b) 0.01 mL c) 3 mL d) 1 mL --> 1 mL Explanation: The volume of a subcutaneous injection is usually up to 1 mL. An intramuscular injection is the administration of up to 3 mL of medication into one muscle or muscle group. Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01 to 0.05 mL.

A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose which have 30 g in 45 mL. How many milliliters is the nurse going to administer every 6 hours to the client?

a) 15 mL b) 67.5 mL c) 22.5 mL d) 30 mL --> 30 mL Explanation: The formula to calculate the correct medication amount is: (Dose on hand/Quantity on hand = Dose desired/X). If you use this for this scenario you would have 30 g/45 mL = 20 g/X

A nurse needs to administer a continuous medication drip to a client. The nurse knows that, for a continuous infusion, she will likely need to add medication to which volume of IV solution?

a) 15 to 50 mL b) 150 to 250 mL c) 50 to 100 mL d) 500 to 1,000 mL --> 500 to 1,000 mL Explanation: A continuous infusion is the instillation of a parenteral drug over several hours. It is also called a continuous drip, which involves adding medication to a large volume of IV solution—approximately 500 to 1,000 mL

A nurse is preparing to administer IV therapy to a client and selects a catheter with a large lumen. Which catheter would have the largest lumen?

a) 22 gauge b) 20 gauge c) 18 gauge d) 21 gauge --> 18 gauge Explanation: IV catheters are available in various sizes. The lumen size is measured in gauges; odd numbers designate winged infusion needles (19, 21, 23), whereas even numbers designate catheter sizes. The most common adult catheter sizes are 22, 20, and 18.

A client has an order for chloramphenicol, 500 mg every 6 hours. The drug comes in 250 mg capsules. What would the nurse administer?

a) 3 tabs b) 4 tabs c) 1 tab d) 2 tabs --> 2 tablets

The nurse is preparing to administer meperidine as an intramuscular injection in an adult client's deltoid site. Which needle should the nurse select for this injection?

a) 5/8"; 24 gauge b) 1"; 22 gauge c) 1½"; 18 gauge d) 2"; 18 gauge --> 1"; 22 gauge Explanation: IM injections using the deltoid site require a 20- to 25-gauge needle that is between 1" and 1½" in length.

Which medication would most likely be administered via a transdermal patch?

a) Antidepressants b) Hormonal medications c) Antibiotics d) Epinephrine --> Hormonal medications Explanation: Transdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiac medications, and nicotine.

A nurse gives a client 0.25 mg of digoxin instead of the prescribed dose of 0.125 mg. What should the nurse do next?

a) Assess the client and notify the client's physician. b) Give another 0.125 mg as soon as possible. c) Nothing; the dose will not make a significant difference. d) Hold the next dose to make sure the total amount balances. --> This is a medication error. The priority is to assess the client and then call the physician to advise him or her of the error and seek further direction. The other options do not describe the steps the nurse should take to ensure client safety following a medication error.

The nurse is working on a medical unit when an unlicensed assistive personnel (UAP) approaches and states that Mrs. G.'s IV dressing is curling at the edges and appears wet. What is the nurse's best approach to this situation?

a) Assess the dressing and redress it if the dressing is not intact. b) Leave the dressing change for the next shift. c) Assess the dressing and delegate the dressing change to the UAP if the dressing is not intact. d) Reinforce the dressing with a tegaderm. --> Assess the dressing and redress it if the dressing is not intact. Explanation: Under current regulations an IV dressing change is not a task that can be delegated.

What factor is used to calculate drug dosages for a child?

a) Body surface area (BSA) b) Ethnicity c) Age d) Developmental level --> Body surface area (BSA) Explanation: Pediatric doses are calculated according to the child's weight or BSA. The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height.

Which actions would the nurse take when instilling eyedrops correctly? Select all that apply.

a) Clean the eyelids and eyelashes of any drainage with cotton balls soaked in clean water. b) Wash hands and put on gloves. c) Place the thumb near the margin of the lower eyelid and exert pressure upward over the bony prominence of the cheek. d) Have the client look up and focus on something on the ceiling. e) Tilt the client's head back slightly if sitting, or place the head on a pillow if lying down. f) Squeeze the container and allow the prescribed number of drops to fall into the cornea. --> • Wash hands and put on gloves. • Tilt the client's head back slightly if sitting, or place the head on a pillow if lying down. • Have the client look up and focus on something on the ceiling. Explanation: The nurse's hands should be washed and gloves worn to prevent introduction of microorganisms into the client's eye. The eyes should be cleaned with normal saline rather than water because debris can be carried into the eye when the conjunctival sac is exposed. Tilting the client's head backward and having him focus on the ceiling allows for the drops to be dropped into the conjunctival sac (not the cornea). The thumb or two fingers are placed near the margin of the lower eyelid immediately below the eyelashes, and pressure is exerted downward over the bony prominence of the cheek to expose the lower conjunctival sac as the lid is pulled down.

A nurse is caring for a client with typhoid at a health care facility. The nurse checks the medication order in the client's chart for the drugs prescribed to the client. Which component is a required component of the medication order?

a) Client's age b) Client's diagnosis c) Client's name d) Client's signature --> Client's name Explanation: The client's name is an important component of the medication order; without it, the nurse should withhold the administration of the drug. The client's age, diagnosis, and signature are not components of the medication order.

A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration?

a) Enlist the help of a colleague who is familiar with the client. b) Ask the client his name prior to giving the drug. c) Cross-reference the MAR with the client's medical record. d) Check the client's identification band. --> Check the client's identification band.

A client is to receive a blood transfusion. Immediately after initiating the transfusion, the nurse suspects that the client is experiencing a hemolytic reaction based on which finding? Select all that apply.

a) Facial flushing b) Fever c) Urticaria d) Low back pain e) Hematuria --> • Fever • Facial flushing • Low back pain • Hematuria Explanation: Symptoms of a hemolytic reaction, which are immediate, include facial flushing, fever, chills, headache, low back pain, tachycardia, dyspnea, hypotension, and blood in the urine. Urticaria is seen with an allergic reaction.

A nurse is caring for a client who has a PICC line. Which nursing action is recommended?

a) Flush using normal saline and/or heparin solution according to facility policy. b) Keep external portion of catheter coiled on top of dressing. c) Use clean technique when changing dressing. d) Change catheter caps every 10 days or as per facility policy. --> Flush using normal saline and/or heparin solution according to facility policy. Explanation: PICC lines are flushed with normal saline and/or heparin in order to maintain patency by preventing clot formation in the line. Sterile technique should be used for dressing changes for at least 24 hours after insertion and 3 to 7 days thereafter. The external part of the catheter should be kept under the dressing to prevent the introduction of microorganisms, leading to infection.

A nurse needs to administer an intradermal injection to a client. What is the most common site for administering an intradermal injection?

a) Forearm b) Stomach c) Back d) Chest --> Forearm Explanation: The most common site for an intradermal injection is the inner aspect of the forearm. Intradermal injections are commonly used for diagnostic purposes.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do?

a) Have another nurse finish preparing and administering the medications. b) Put the medications back in the containers. c) Have another nurse guard the preparations. d) Lock the medications in a cart and finish them upon return. --> Lock the medications in a cart and finish them upon return. Explanation: Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers.

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration?

a) Have the client swallow the pills around the tube. b) Flush the tube with 30 to 40 mL saline before medication administration. c) Check the tube placement before administration. d) Bring the liquids to room temperature before administration. --> Check the tube placement before administration. Explanation: The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children).

A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which action should the nurse perform to prevent gastric reflux?

a) Help the client into a Fowler's position. b) Add diluted medication to the syringe. c) Administer the medication over several minutes. d) Check for drug allergies in the client's history. --> Help the client into a Fowler's position. Explanation: Assuming Fowler's position can help prevent gastric reflux when medications are administered through an enteral tube.

Which situation accurately describes a recommended guideline when administering oral medications to clients?

a) If a client vomits immediately after receiving oral medications, re-administer the medication. b) If a child refuses to take medication, the medication can be crushed and added to a small amount of food. c) If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. d) Assume that the client is the authority on whether or not the medication was swallowed. --> If a child refuses to take medication, the medication can be crushed and added to a small amount of food. Explanation: 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 client's mouth and cheeks. If a pill is dropped, it should be discarded. If a client vomits, notify the physician to see if the medication should be re-administered.

A nurse has to administer a subcutaneous injection to a client. For which client can the nurse administer a subcutaneous injection at a 90-degree angle?

a) Infants b) Thin clients c) Obese clients d) Children --> The nurse inserts the needle at a 90-degree angle to reach the subcutaneous tissue in a normal-size or obese client who has a 2-inch tissue fold when it is bunched. For thin clients who have a 1-inch fold of tissue, the nurse inserts the needle at a 45-degree angle.

A nurse needs to instill eye medication in a client with conjunctivitis. Which action should the nurse take to distribute the medication over the surface of the eye?

a) Instill medication drops in the upper eyelid. b) Make a pouch in the lower eyelid. c) Ask the client to blink the eye. d) Gently rub the client's eyelids. --> Ask the client to blink the eye. Explanation: To distribute the eye medication over the surface of the eye, the nurse should ask the client to blink the eyes, rather than rubbing them. In order to provide a natural reservoir for liquid medication, the nurse makes a pouch in the lower lid by pulling the skin downward over the bony orbit.

On a home visit to a client, the client shows the nurse a medication that he purchased over-the-counter for relief of his arthritis pain. The client asks the nurse how it should be administered. The nurse reviews the medication and determines that it is to be applied to the skin. The nurse would instruct the client to most likely use which route of medication administration for this medication?

a) Intradermal b) Sublingual c) Buccal d) Transdermal --> Transdermal Explanation: The nurse should instruct the client about the transdermal route for medication administration, which is used for topical agents (agents applied to the skin surface or mucous membranes). The intradermal route is a type of parenteral administration, while sublingual and buccal routes are for oral administration.

A nurse is using the Z-track technique to administer an injection to a client. Which injection route utilizes the Z-track technique?

a) Intramuscular b) Intravenous c) Subcutaneous d) Intradermal --> Intramuscular Explanation: When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique.

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler?

a) It is a battery-operated device that spins. b) It suspends finely powdered medication. c) It is a canister that contains pressurized medication. d) It has propellers that get activated during inhalation. --> It is a canister that contains pressurized medication. Explanation: 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.

Which contains all the components of a valid order?

a) John Smith, Warfarin, once a day, by mouth b) John Smith, 70 units, BID, SL c) John Smith, Enoxaparin Sodium 120 mg, subcutaneously, periumbilical d) John Smith, Atenolol 50 mg, twice a day, by mouth --> John Smith, Atenolol 50 mg, twice a day, by mouth Explanation: The components of an order include the client's name, the medication's name, the amount and frequency of the dose, and the route of administration.

A client has a central venous catheter inserted. The nurse understands that the tip of the catheter would be found at which location? Select all that apply.

a) Median cubital vein b) Left ventricle c) Right atrium d) Basilic vein e) Superior vena cava --> • Superior vena cava • Right atrium Explanation: Central venous therapy involves placement of a flexible catheter into one of the client's large veins, with the tip of the catheter placed in either the superior vena cava or the right atrium.

If the dosage is inappropriate for a client, who is responsible?

a) Medical technician b) Physician c) Pharmacist d) Nurse --> Nurse

Which system of measurement is most accurate and precise for drug administration?

a) Metric system b) Natural system c) Apothecary system d) Household system --> Metric system Explanation: The metric system is the most widely accepted and convenient system of measurement for drug administration.

To convert 0.8 grams to milligrams, the nurse should do which of the following?

a) Move the decimal point 2 places to the left. b) Move the decimal point 3 places to the left. c) Move the decimal point 2 places to the right. d) Move the decimal point 3 places to the right. --> Move the decimal point 3 places to the right.

Regarding medication administration, what must occur at the change of shifts?

a) Only the LPNs on the division count medications. b) The client's medications must be drawn up. c) The narcotics for the division are counted. d) The medications for the division are counted. --> The narcotics for the division are counted.

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?

a) Use cold water when mixing powdered medications. b) Avoid crushing sustained-release pellets. c) Mix all the medications together in 15 mL of water. d) Add medications to the formula. --> Avoid crushing sustained-release pellets. Explanation: 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.

When administering oral medications, which practices should the nurse follow? Select all that apply.

a) Perform hand hygiene before and after medication administration. b) Verify the client's response to the medication 30 minutes after administration, or as appropriate for the drug. c) Dispense multiple liquid medications into a single cup to reduce the number of containers the client must handle. d) Stay at the bedside until the client has swallowed all the medications. e) Store the client's MAR at the bedside at all times to ensure safe identification. --> • Perform hand hygiene before and after medication administration. • Stay at the bedside until the client has swallowed all the medications. • Verify the client's response to the medication 30 minutes after administration, or as appropriate for the drug. Explanation: When administering oral medications, it is important to perform hand hygiene before and after administration and to stay with the client until all medications have been swallowed. The nurse should also assess the effect of the medication at a reasonable time after administration. The MAR should be brought to the bedside to verify the client, but it is not left at the bedside. It would be inaccurate and unsafe to dispense multiple liquid medications into a single cup, as this may result in dosage errors.

The National Formulary (NF) is a list of medications which are regulated by the U.S. government. It describes medications based on certain categories. Which category does the National Formulary not describe?

a) Physical properties b) Source c) Purity d) Side effects --> Side Effects

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?

a) Place a cotton ball in the ear to absorb excess medication. b) Instill the medication in the opposite ear if prescribed. c) Ask the client to maintain the position for some time. d) Briefly postpone the application in the second ear. --> Ask the client to maintain the position for some time. Explanation: 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.

A client with chronic obstructive pulmonary disease (COPD) has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in order to ensure safe and complete delivery of the prescribed medication?

a) Place the inhaler as deeply into the client's mouth as is comfortable. b) Provide oxygen therapy 30 minutes prior to administration. c) Use a spacer or extender with the metered-dose inhaler. d) Provide multiple puffs of the medication in rapid sequence. --> Use a spacer or extender with the metered-dose inhaler. Explanation: The use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible. MDIs are placed 1 or 2 inches in front of the mouth, not deeply into the mouth. Oxygen therapy prior to administration does not aid in delivery. Multiple puffs, if ordered, are given after 1 to 5 minutes.

A nurse is reviewing information about a prescribed drug in a drug handbook in preparation for administration to a client. When reading about the drug, the nurse identifies which name as the generic name?

a) Polycillin-N b) Omnipen-N c) Ampicillin sodium d) SK Ampicillin-N --> Ampicillin sodium Explanation: Ampicillin sodium is a generic name. Each drug has only one generic name, which is often simpler than the chemical name from which it was derived. Omnipen-N, Polycillin-N, and SK Ampicillin-N are trade names. The brand name, or trade name, is a registered name assigned by the manufacturer.

A child brought to the emergency department is exhibiting significant signs of hypovolemic shock for which intravenous therapy is prescribed. The physician is unable to obtain intravenous access and decides to use intraosseous access. The nurse would prepare which site to be used?

a) Proximal tibia b) Patella c) Distal radius d) Femur --> Proximal tibia Explanation: The proximal tibia is the most acceptable insertion site for the intraosseous (IO) needle.

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?

a) Return the medication to the medication cart or medication room. b) Inform the physician about the client's absence. c) Leave the medication on the client's bedside table. d) Inform the head nurse about the client's absence. --> Return the medication to the medication cart or medication room. Explanation: If the client is not present at the time when the medication needs to be administered, the nurse should return the medication to the medication cart or medication room. Leaving medications on the client's bedside table may result in their loss or accidental ingestion by someone else. The nurse need not inform the physician or the head nurse about the client's absence.

A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point would the nurse include in the education plan?

a) Reuse syringes and needles up to three times. b) Store needles and syringes in a glass container. c) Rotate the injection site. d) Use the same site on the body for each injection. --> Rotate the injection site. Explanation: Insulin may be administered subcutaneously in the upper arm, anterior or lateral aspects of the thigh, buttocks, or abdomen (avoiding a 2-inch radius around the umbilicus). Rotate the site for each injection systematically about 1 inch from the previous injection site.

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication?

a) Review the client's medication, allergy, and medical history. b) Administer medication within 30 to 60 minutes of the scheduled time. c) Read and compare labels on the medication with the medical record. d) Allow sufficient time to prepare the medication with minimal distraction. --> Review the client's medication, allergy, and medical history. Explanation: 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 3 times (before, during, and after preparing the medication) to ensure that the right medication is given at the right time by the right route.

Which "rights" are included in the "six rights for medication administration"? Select all that apply.

a) Right route b) Right time c) Right room d) Right dose e) Right diagnosis f) Right medication --> To prevent medication errors, always ensure that the: (1) Right medication is given to the (2) right client in the (3) right dosage through the (4) right route at the (5) right time, followed by the (6) right documentation.

A nurse enters a client's room to check on his intravenous infusion. An electronic infusion device is not being used. When checking the solution container and rate, the nurse notes that that fluid is infusing at a rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion?

a) The client is resting his arm with the IV on his head. b) The fluid, although running slow, is infusing. c) The client is using his non-IV hand to push the IV pole when ambulating. d) The tubing is visible, running freely from the solution to the access site. --> The client is resting his arm with the IV on his head. Explanation: When the extremity is elevated, such as the client resting his arm on his head, the fluid will infuse more slowly. Kinked or obstructed tubing (not visible and running freely), a patent catheter (such that the fluid is infusing), and the height of the solution container (such as when the client gets up and walks in the hall pushing the IV pole with the hand containing the IV) are factors that would contribute to a slowed rate.

A nurse enters a client's room to check on his intravenous infusion. An electronic infusion device is not being used. When checking the solution container and rate, the nurse notes that that fluid is infusing at a rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion?

a) The client is using his non-IV hand to push the IV pole when ambulating. b) The client is resting his arm with the IV on his head. c) The tubing is visible, running freely from the solution to the access site. d) The fluid, although running slow, is infusing. --> The client is resting his arm with the IV on his head. Explanation: When the extremity is elevated, such as the client resting his arm on his head, the fluid will infuse more slowly. Kinked or obstructed tubing (not visible and running freely), a patent catheter (such that the fluid is infusing), and the height of the solution container (such as when the client gets up and walks in the hall pushing the IV pole with the hand containing the IV) are factors that would contribute to a slowed rate.

A nurse is caring for a client at a health care facility who is undergoing nicotine withdrawal therapy and has been prescribed a nicotine patch. Which is true with regard to the application of a transdermal patch?

a) The drug becomes inactive immediately after the patch is removed. b) The patch is mostly applied to lower parts of the body. c) A new patch is placed in exactly the same location as the previous one. d) The patch is applied to a skin area with adequate circulation. --> Ask the client to maintain the position for some time. Explanation: 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.

A nurse enters a client's room to check on his intravenous infusion. An electronic infusion device is not being used. When checking the solution container and rate, the nurse notes that that fluid is infusing at a rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion?

a) The fluid, although running slow, is infusing. b) The client is resting his arm with the IV on his head. c) The client is using his non-IV hand to push the IV pole when ambulating. d) The tubing is visible, running freely from the solution to the access site. --> B

The nurse is preparing to administer a transdermal medication. How should this be accomplished?

a) The nurse should inject the medication just below the dermis of the skin. b) The nurse should apply the medication directly to the skin. c) The nurse should inject the medication into a body cavity. d) The nurse should ask the client to swallow the medication. --> Transdermal medications are adsorbed through the skin.

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?

a) The site lies close to the radial nerve. b) The area is free of major blood vessels and fat. c) There is a high possibility of injecting into subcutaneous fat. d) The site is in close proximity to the sciatic nerve. --> The area is free of major blood vessels and fat. Explanation: The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. The deltoid region for an intramuscular injection has little overlying subcutaneous fat and lies close to the radial nerve.

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?

a) There is a high possibility of injecting into subcutaneous fat. b) The site is in close proximity to the sciatic nerve. c) The site lies close to the radial nerve. d) The area is free of major blood vessels and fat. --> The area is free of major blood vessels and fat. Explanation: The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat.

Which is not true regarding Nurse Practice Acts?

a) They describe what medications nurses can prescribe. b) They vary among states. c) They define the boundaries of the functions of a nurse. d) They were established to describe legitimate nursing function. --> They describe what medications nurses can prescribe. Explanation: Prescribing and dispensing medications are not legal practices for registered nurses, with the exception of nurses in advance practice roles.

A client is scheduled to receive total parenteral nutrition over the next 6 to 9 months. When preparing the client for IV access, the nurse would anticipate which type of device to be used? Select all that apply.

a) Tunneled catheter b) Midline infusion device c) Implanted vascular access port. d) Multilumen central catheter e) Peripherally inserted central catheter --> • Peripherally inserted central catheter • Tunneled catheter • Implanted vascular access port. Explanation: When TPN is anticipated for an extended period (greater than 4 weeks), a long-term catheter (PICC line, tunneled catheter, or an implanted vascular access device) may be placed. A midline infusion device is suitable for clients who need moderate-term parenteral therapy (1 to 4 weeks). A multilumen central catheter is used in the hospital for short-term therapy.

A nurse is administering a hepatitis B immunization injection to an adult patient. Which site would the nurse choose for this injection?

a) Vastus lateralis site b) Ventrogluteal site c) Deltoid muscle site d) Dorsogluteal site --> Deltoid muscle site Explanation: Hepatitis B virus vaccine is one medication that should be given in the deltoid muscle in adults to induce adequate levels of the antibody. The vastus lateralis muscle and the ventrogluteal muscle can be used for other intramuscular injections.

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client?

a) Ventrogluteal site b) Dorsogluteal site c) Deltoid site d) Vastus lateralis site --> The area is free of major blood vessels and fat. Explanation: The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. The deltoid region for an intramuscular injection has little overlying subcutaneous fat and lies close to the radial nerve.

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

a) When looking at a needle package, the first number is the length in inches and the second number is the gauge or diameter of the needle. b) When giving an injection, the amount of the medication directs the choice of gauge. c) The size of the syringe is directed by the viscosity of the medication to be given. d) As the gauge number becomes larger, the size of the needle becomes smaller. --> As the gauge number becomes larger, the size of the needle becomes smaller. Explanation: The larger the gauge, the smaller the needle. The first number on a needle package is the gauge or diameter of the needle; the second number is the length in inches.

A nurse is preparing an injection by withdrawing the solution from a multidose vial. What is necessary to facilitate withdrawing a medication from the vial?

a) Withdraw the liquid and then inject an equal amount of air. b) Insert a separate needle to equalize the pressure. c) First, inject an equal amount of air into the vial. d) Insert the needle and slowly withdraw the liquid. --> when the client has disorders that affect the absorption of medications Explanation: Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections.

To which client would the nurse be most likely to administer a p.r.n. medication?

a) a client whose asthma is treated with inhaled corticosteroids b) a client who is reporting pain near the surgical site c) a client who requires daily medication to control hypertension d) a client who is experiencing severe and unprecedented chest pain --> a client who is reporting pain near the surgical site Explanation: A report of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a p.r.n. 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 client with a central venous catheter develops a catheter-related bloodstream infection (CRBSI). The nurse understands that which route is the most common for causing this type of infection?

a) contamination of the infusion solution being used b) irregularities in the catheter's material c) an infection in another part of the body traveling to the catheter tip d) catheter tip contamination due to skin organisms encountered during insertion --> catheter tip contamination due to skin organisms encountered during insertion Explanation: There are four recognized routes for catheter contamination. The most common route of infection is colonization of the catheter tip due to migration of skin organisms from insertion site.

A nurse is administering medication to a 78-year-old female client who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this client has an increased possibility of drug toxicity due to which age-related factor?

a) decline in liver function and production of enzymes needed for drug metabolism b) increased number of protein-binding sites c) decreased adipose tissue and increased total body fluid in proportion to total body mass d) increased kidney function, resulting in excessive filtration and excretion --> decline in liver function and production of enzymes needed for drug metabolism Explanation: Older clients are at risk for experiencing a cumulative effect, related to a decreased rate of drug metabolism, higher drug plasma concentrations. This leads to prolonged action and an increased possibility of drug toxicity if the liver function and production of enzymes for metabolism are decreased.

A client at a health care facility has been prescribed scopolamine, to be administered transdermally. Which statement describes transdermal application?

a) drugs bonded to an adhesive and applied to the skin b) drugs placed against the mucous membrane of the inner cheek c) drugs placed under the tongue and allowed to dissolve slowly d) drugs within a thick base applied, not rubbed, into the skin --> drugs bonded to an adhesive and applied to the skin Explanation: Transdermal applications are drugs that are bonded to an adhesive and applied to the skin.

After administering medication to a client subcutaneously, the nurse removes the needle at the same angle at which it was inserted. Which explains the nurse's action?

a) helps to control placement of the needle b) verifies correct injection of the drug c) minimizes tissue trauma to the client d) prevents needlestick injuries --> minimizes tissue trauma to the client Explanation: Removing the needle at the same angle at which it was inserted to administer medication minimizes tissue trauma and discomfort to the client. To verify correct injection of the drug, the nurse pushes the plunger and watches for a small wheal. To prevent needlestick injuries, the nurse covers the needle with a protective cap. Holding the client's arm and stretching the skin taut helps to control placement of the needle.

A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency?

a) once daily b) every 72 hours c) at least every 8 hours d) before and after each medication administration -->

Which action describes buccal medication administration?

a) placing a medication through a nasogastric tube b) placing a medication, which is designed to be absorbed through the skin for systemic effects, on the skin c) placing a medication under the tongue and allowing it to dissolve d) placing a medication underneath the upper lip or in the side of the mouth --> placing a medication underneath the upper lip or in the side of the mouth Explanation: Buccal medication is not chewed, swallowed, or placed under the tongue. Sublingual medications are placed under the tongue. Medications that are given through a nasogastric tube are oral. A medication that is designed to produce systemic effects and is absorbed through the skin is called transdermal.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug?

a) swallowing the medication b) performing physical activities c) talking when taking the medication d) taking the medication on an empty stomach --> swallowing the medication Explanation: When administering medication by sublingual application, the client should avoid swallowing or chewing the medication. Eating or smoking during administration is also contraindicated.

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?

a) systems that contain frequently used medication for that unit b) a supply that remains on the nursing unit for use in emergency c) a container with enough prescribed medications for several days for a client d) self-contained packets that hold one tablet or capsule for individual clients --> self-contained packets that hold one tablet or capsule for individual clients Explanation: The nurse should understand that a unit dose supply method is a method in which self-contained packets hold one tablet or capsule for an individual client. An individual supply is a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay.

The primary reason for the Controlled Substances Act is:

a) to regulate the purchase of antibiotics. b) to prevent drug abuse. c) to regulate the purchase of narcotics. d) to prevent overuse of antibiotics. --> To prevent drug abuse

Drugs known to cause birth defects are called:

a) umbilical cross. b) teratogenic. c) nosocomial. d) pregnancy sensitivity. --> teratogenic. Explanation: Drugs know to cause birth defects are called teratogenic.

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation?

a) when the client wants to avoid the discomfort of an intradermal injection b) when the drug needs to act on the client very slowly c) when the drug needs to be administered only once d) when the client has disorders that affect the absorption of medications --> when the client has disorders that affect the absorption of medications Explanation: Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections.