Pharm 678

For patient who are receiving enteral nutrition via intermittent tube feeding :

1. check the residual volume before each feeding 2. check to ensure the presence of bowel sounds. The absence of bowel sounds indicated the need to contact the healthcare provider for order before proceeding. 3. Check the position of the tube to ensure that it is still in the stomach. 4. During the initiation of enteral feeding by intermittent or continuous methods, blood glucose testing may be ordered.

Why is the oral route the preferred route for medications? (Select all that apply.) 1. It is convenient. 2.It is safe. 3. The rate of absorption is dependable. 4.It is relatively economical. 5.Most medications are readily available in oral dose forms.

1 , 2, 4, 5 The oral form of a medication is usually cheaper than other forms. Most medications (or a comparable medication) are available in oral form. It is more convenient to give medications orally when available. The oral route is one of the safest routes of drug administration. However, the oral route has the slowest and least dependable rate of absorption due to frequent changes in the gastrointestinal environment.

Which type of drug preparation requires that the patient be instructed to "shake well" before self-administration? 1.Suspension 2.Emulsion 3. Elixir 4. Syrup

1. A suspension is a liquid dose form that contains solid, insoluble drug particles dispersed in a liquid base. These particles settle to the bottom of the container on standing, so all suspensions must be shaken well before administration to ensure thorough mixing. Syrups, elixirs, and emulsions do not require shaking.

Why is it important not to crush medications that considered long acting? 1. Medications that crushed are harder to swallow, making it harder to activate the effect. 2. Medications that are crush release the drug immediately , inactivating the long-acting effect and potentially causing an overdose. 3. Medication that are crushed will not be absorbed properly, inactivating the long- acting effect. 4. Medications that are crushed will become powder and lose all the effectiveness of the drug.

2

Oral drug administration includes which principle(s)? (Select all that apply.) 1. Dependable rate of absorption 2. Most economical 3.Insulin able to be administered via this route 4. Drugs delivered directly by the oral, rectal, or nasogastric (NG) methods 5. Dosage forms are convenient and readily available

2, 5 Oral administration is the most economical, convenient, and readily available. Absorption from oral medications can vary depending on many factors. Insulin cannot be administered via the oral route. In oral drug administration, drugs are only delivered via the oral route.

Which is a disadvantage of rectal administration of medications? 1.Risk of damage to the rectal sphincter 2.Variability in absorption 3.Resulting irritation of the large bowel 4.Slow onset of action

2. The presence of stool in the rectum and the risk of the patient expelling the drug before absorption can cause variability in medication absorption. Absorption through the mucous membrane of the rectum is rapid if the drug is in contact with it, and therefore the onset of action is not necessarily slow. Preparations designed for rectal administration do not enter the large bowel. No significant risk of damage to the rectal sphincter occurs.

The prescriber has changed the route of the patient's medication form an intravenous route to an oral route. What effect in (general ) does the change in route have on the drug dosage and the absorption time? 1. Decreased dosage and increased absorption time. 2. Increase dosage and increased absorption time. 3. Increase dosage and decreased absorption time. 4. Decrease dosage and decreased absorption time.

3

The nurse is assessing the patient's pH of aspirate after inserting an NG tube. Which value would the nurse expect if the NG tube is correctly placed? 1.Greater than 7 2.4 to 5 3.Less than 3 4.6 to 7

3. LESS THAN 3 If an NG tube is correctly placed in the stomach, the stomach pH would measure less than 3. A pH reading of 4 to 5 is acidic but is usually not a low enough reading for stomach contents unless the patient is receiving H2 antagonists, which would affect the aspirated fluid pH. Intestinal pH is typically 6 to 7. Respiratory pH is typically greater than 7.

Which scale is labeled on a medicine cup? 1.Centimeter 2.Millimeter 3.Kilogram 4.Metric

4. METRIC

In preparing to administer medications to a patient with an NG tube, which would be appropriate to give through that route? (Select all that apply.) a.Liquid medication b.Tablets crushed and diluted in 30 mL of water c.Enteric coated tablets crushed and diluted in 30 mL of water d.Capsules emptied into 30 mL of water e.Timed release capsules emptied into 30 mL of water f.Suppositories

A , B , D Liquid forms of medications are preferable. Tablets may be crushed and diluted in water. Capsules may be opened and the contents added to approximately 1 ounce of water. Enteric coated medications and timed release capsules should never be broken for administration. Suppositories are not given via NG route.

Which data will the nurse document when administering a PRN oral pain medication to a patient? (Select all that apply.) a.Date, time, drug name, dosage, and route of administration b.Essential patient education about the drug completed c.Administration receptacle used d.Signs and symptoms of adverse drug effects e.Evaluation of therapeutic effectiveness

A , B, D, E

NG medication administration includes which principle(s)? (Select all that apply.) a.The tube must be assessed for correct placement. b.All medications can be combined into one syringe. c.Tablets and capsules should be dissolved in water. d.The suction source should be immediately reconnected. e.Flush the tube with 30 mL of water after drug administration.

A , C ,E

Which nursing action(s) would be appropriate when administering a disposable enema? (Select all that apply.) a.Position the patient on the left side. b.Allow the solution to flow in by gravity. c.Instruct the patient to hold the solution 30 minutes before defecating. d.Maintain the six rights of medication administration. e. Lubricate the rectal tube.

A , C, D , E To facilitate flow into the large intestine, patients should be positioned on the left side. The solution should be held for 30 minutes before defecating. Enemas are medications, so the seven rights of medication administration should be followed. Lubrication of the rectal tube will facilitate insertion into the rectum. Gravity will not facilitate the administration of a small volume of enema solution administered from a bottle.

Which receptacle(s) is/are commonly used in the hospital with pediatric oral medications? (Select all that apply.) a.Oral syringe b.Baby bottle full of formula c.Infant feeding nipple d.Teaspoon e.Medicine dropper

A , C, E

What must the nurse have before administering any medication?(select all that apply)

A current license to practice A medication order signed by practitioner license with prescription privileges Knowledge of the medication Knowledge of client diagnosis

Which dressings would be appropriate to use for treating wounds with exudates? (Select all that apply) A) AlgiDERM B) Telfa C) Kaltostat D) Sorbsan E) OpSite

A) AlgiDERM C) Kaltostat D) Sorbsan

What is the appropriate nursing action when administering a vaginal suppository? A) Ask the patient to urinate prior to insertion. B) Assist the patient to a side-lying position. C) Keep suppository refrigerated prior to insertion. D) Insert the suppository 1 inch into the vagina.

A) Ask the patient to urinate prior to insertion.

Which effect would be important for the nurse to address when teaching a patient about the overuse of nose drops? A) Rebound B) Ceiling C) Idiosyncratic D) Measured

A) Rebound

Which order(s) would be examples of percutaneous medication administration? (Select all that apply) A) Timolol 0.5% 1 drop to each eye daily B) Albuterol nebulizer 2.5 mg qid C) Heparin 5000 units IV D) Lasix 20 mg PO every AM E) Silvadene 1% topically to affected area

A) Timolol 0.5% 1 drop to each eye daily B) Albuterol nebulizer 2.5 mg qid E) Silvadene 1% topically to affected area

Which action(s) will the nurse perform when preparing to administer a topical medication? (Select all that apply) A) Wash hands before and after administration. B) Maintain a dry environment to encourage wound healing. C) Wear gloves during the application process. D) Use sterile dressing for all wounds.

A) Wash hands before and after administration. C) Wear gloves during the application process.

Which example best demonstrates safe drug administration by the nurse?

Administer an oral medication with the patient sitting upright

When applying nitroglycerin topically, which nursing intervention is correct? A) Secure the paper on two sides with tape. B) Shave the area prior to application of the paper. C) Wear gloves while placing the new paper. D) Remind the patient to discontinue use of the medication if chest pain is relieved.

C) Wear gloves while placing the new paper.

A 2-year-old child is hospitalized with the diagnosis of tonsillitis and bilateral otitis media. The nurse is preparing to administer ear drops. When instilling the eardrops, the nurse will pull the earlobe: A) Upward and back. B) Sideways and down. C) Downward and back. D) Sideways and up.

C) Downward and back.

Which medications must be sterile? A) Topical B) Vaginal C) Ophthalmic D) Nasal

C) Ophthalmic

What is the rationale for the nurse applying the gentle pressure to the inner corner of the eyelid after instilling eyedrops? A) Decreases the risk of infection. B) Maintains intraocular pressure. C) Prevents systemic effects. D) Provides comfort to the patient.

C) Prevents systemic effects.

The nurse is preparing to administer Lanoxin to a patient on the telemetry unit.In addition to understanding the patient's diagnosis,the nurse must also know which characteristic of the medication?select all that apply

Adverse effect Expected actions Contraindications for use Usual dosing

Why does the nurse clamp an NG tube for at least 30 minutes?

Answer : Clamping an NG tube for at least 30 minutes following medication administration will prevent the medication from being removed from the stomach. Twenty minutes is not enough time to allow for medication absorption before applying the NG tube to suction. If the person requires suction, allowing the NG tube to be clamped for 60 or 90 minutes may cause nausea and vomiting.

Which nursing assessment accurately describes the results of an intradermal skin test? A) Itching and weeping B) Erythema and induration C) Swelling and coolness D) Pallor and drainage

B) Erythema and induration

Where does the nurse correctly administer ophthalmic medication? A) At the inner cants of the eye B) In the lower conjunctival sac C) Directly onto the eyeball D) To the outer corner of the eyelid

B) In the lower conjunctival sac

What is the most reliable method to calculate a pediatric patient's medication

Body surface area(BSA)

The nurse is instructing a patient to use a corticosteroid inhaler. Which statement by the patient indicates the need for further teaching? A) "I will shake the inhaler before I use it." B) "I need to rinse my mouth after I use the inhaler." C) "I will use this when I'm lying in bed in the morning." D) "After I inhale, I will hold my breath and then breathe out slowly."

C) "I will use this when I'm lying in bed in the morning."

Where would the nurse apply nitroglycerin ointment on a male patient? A) The same site that was previously used B) A hairy area of the chest C) The upper arm D) The back of the knee

C) The upper arm

Where will the nurse administer a medication that was ordered to give sublingually? A) Between the molar teeth and cheek B) Below the skin surface C) Under the tongue D) Into the conjunctival sac

C) Under the tongue

Which action will the nurse perform when doing a wet to dry dressing every 4 hours on a patient with a deep wound? A) Pack the wound tightly with gauze. B) Saturate the dressing with as much liquid as possible. C) Use Montgomery tapes or a binder to secure the dressing. D) Apply the new moist dressing over the existing one.

C) Use Montgomery tapes or a binder to secure the dressing.

An older patient who is prescribed acetaminophen (Tylenol) caplets for knee pain asks how the caplets differ from the tablets. Which explanation does the nurse provide to the patient?

Caplets are more easily swallowed. A caplet is a tablet that has an elongated shape and a smooth coating like a capsule. The smooth coating facilitates swallowing. A capsule is designed to hide unpleasant taste. Rate of dissolution and dosage are unrelated to the characteristics of a caplet.

What is medication reconciliation?

Comparing the patient's current medication orders to all of the medications actually being taken

The nurse determines that a prescribed medication has not been administered as ordered on the previous shift.What action will the nurse take?

Complete an incidence report

Which action will the nurse take if a dosage is unclear on health care provider's order?

Contact the health care provider to verify the correct dosage

A patient has an infected wound with large amounts of drainage. Which type of dressing would the nurse use? A) Telfa B) OpSite C) DuoDerm D) AlgiDERM

D) AlgiDERM

The nurse is preparing an otic solution. When instructing the patient in regard to area of administration, the nurse will explain that the solution will be placed: A) Into the eye. B) Under the tongue. C) Topically. D) Into the ear.

D) Into the ear.

The nurse is teaching a patient about nitroglycerin ointment. Which is an advantage of this form of the medication? A) It does not give patient a bad taste in the mouth. B) The amount of ointment does not matter in obtaining a therapeutic response. C) It does not cause headaches as an adverse effect. D) It proves relief of anginas pain for several hours longer than sublingual.

D) It proves relief of anginas pain for several hours longer than sublingual.

A patient with metastatic cancer is being admitted for pain control. Which action will the nurse perform in administering a transdermal patch? A) After removal, dispose of the old patch in a receptacle in the patient's room. B) Change the fentanyl patch every day, either in the morning or at bedtime. C) Hold the short-acting oral pain medication when a fentanyl patch is initiated. D) Label the patch with date, time, dosage, and initials after patch placement.

D) Label the patch with date, time, dosage, and initials after patch placement.

Which is an accurate nursing action when treating a patient's rash with a lotion? A) Avoid shaking the container prior to treatment. B) Cleanse area with alcohol prior to treatment. C) Cover the area with gauze because of the oil base. D) Pat on the area with a gloved hand.

D) Pat the area with a gloved hand.

Why are sublingual and buccal medications rapidly absorbed? A) Their action is localized to the mouth B) They are metabolized in the liver C) Blood flow is diminished in these areas D) These drugs pass directly into systemic circulation

D) These drugs pass directly into systemic circulation

Which medication route provides the most rapid onset of a medication but also poses the greatest risk for adverse effects?

Intravenous

The nurse transcribes an order to administer valium 10mg IV stat.This order is correctly interpreted by the nurse to mean it should be provided how?select all that apply

Immediately one time only intravenously

Which statements is/are true regarding computerized prescriber order entry(CPOE)?select all that apply

Intergrates the ordering system with the pharmacy,laboratory, and nurses stations Provides instant access to online information to facilitate patient care needs facilitate review of drugs of ordered medication for potential drug interaction Facilitate review of drugs for appropraiteness of dosages

The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally.Which is true regarding the substitution of this medication to suppository form?

It is contraindicated without an order from the health care provider

Which lab tests would be used to assess liver and/or renal function before administering medication?select all that apply

LDH ALT Crs BUN

Which medication order requires nursing judgement and means "administer if needed"?

Morphine 4mg IV every 4 hours PRN

Which is known as the fifth vital sign

Pain

Where would the procedure and treatments directed by health care provider be found?

Physician's order form

Which action will the nurse take when it is determined that the narcotic count is incorrect while obtaining a medication from the narcotic area?

Report the discrepancy to the charge nurse immediately.

Which statements is/are true regarding the types of medication orders?(select all that apply)

Standing orders indicate the number of specified medication to be given Renewal orders facilitate physician review before continuance of high risk medications

Who defines the standard of care for practice of nursing?(select all that apply)

State of boards of nursing Federal laws regulating health care facilities The joint Commission Professional nursing association

Which advantages does the unit dose drug distribution system include?(select all that apply)

The pharmacist is able to analyze prescribed medication for each client for drug interactions and contarindications Credit is given to the patient for unused medication

Which is true regarding the unit dose drug distribution system?

The use of single dose packages of drugs dispensed to fill each dose requirement as it is ordered

The nurse is administering an oral medication to a 90 year old patient who has difficulty swallowing pills. One of the medications to be administered is a spansule type capsule. What nursing consideration(s) should be applied in this case? (Select all that apply.) a.Wash hands before preparing medications and before administration. b.Crush medications and administer with a soft food, such as applesauce. c.Check the patients ID band with the MAR to ensure patient rights are followed. d.Have an 8 ounce glass of water available. e. Check with the pharmacist to see if the spansule medication comes in a liquid form.

a, c, d, e

Why we cannot use petroleum jelly or mineral oil for rectal suppositories

it may reduce the absorption of the medicine.

A patient's liquid cough medicine has been discontinued with one half of the bottle remaining.The home health nurse is aware that according to the U.S. Food and Drug Administration guidelines on prescription medication disposal, The next step should be to

read the drug label specific disposal instructions