(PrepU) Chapter 29: Medications

A code is called and Nurse A hands several drugs to Nurse B, stating while rushing off, "Give these to my client while I help with the code." What is Nurse B's appropriate response?

State, "I cannot give medications for other nurses." Nurses must never administer medications prepared by another nurse. Nurse B will professionally reply, "I cannot give medications for you." Nurse B should not hold the medications or ask another nurse to give the medications.

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat?

"Aim the tip of the container toward the nasal passage." Aiming the tip of the container toward the nasal passage will deposit the drugs within the nose rather than into the throat. Place a rolled towel beneath the neck if the client cannot sit will provide support and aid in positioning. Breathing through the mouth as the drops are instilled is not the correct action for nasal drop administration. Remaining in the sitting position for 5 minutes will promote local absorption.

The nurse is teaching a nursing student regarding safety of chemotherapeutic medication. Which statement by the nurse is correct?

"Antineoplastic drugs can be absorbed through the skin." Antineoplastic drugs are absorbed through the skin and should always be handled with caution. All other options are incorrect.

During a teaching session on self-administration of insulin, the client asks the nurse why it is necessary to bunch the skin before inserting the needle. What is the nurse's best response?

"Bunching your skin facilitates the placement of the needle in the subcutaneous tissue." Facilitating the placement of the needle in the subcutaneous tissue is correct, as this action enables the skin to accommodate the length of the needle better. Controlling bleeding, steadying the syringe, and ensuring complete delivery of the insulin are incorrect, as these actions are not why it is necessary to bunch the skin.

The nurse is beginning to administer oral medications to a client. The client states, "I haven't taken that pill before. Are you sure it's correct?" The nurse rechecks the CMAR/MAR and finds that the medication is scheduled to be administered. Which response is most appropriate?

"Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." This nurse should verify the medication with the prescriber. By this action, the nurse is adhering to the five "rights" of medication administration. A nurse and client should both be aware of medications that are prescribed and why they are prescribed. A nurse should not tell a client they should take a medication just because it is listed on the CMAR/MAR, nor should the nurse tell them to take it and they will follow up later. This could be a medication error.

The charge nurse has just completed an inservice with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?

"Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes." The administration of medications to clients is a core nursing function that involves skillful technique and consideration of the client's development, health status, and safety. Also, the nursing process is often applicable to the skills of medication administration. Informing the new nurse that this profession may not be the one for them is not professional and does not foster respect for the person or the question raised. Professionalism is expected with each interaction with clients, family members and other health care members, including nursing students.

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

"I am taking tadalafil in addition to nitroglycerin." Clients taking nitroglycerin in any form should not take drugs or herbs for erectile dysfunction. This may cause severe hypotension due to the combined vasodilation effect. Other client statements are appropriate and do not require further nursing teaching.

The nurse is teaching a client about using two inhalers. Which client statement reflects that nursing teaching has been effective?

"I must wait at least 1 full minute between inhalers." Teaching has been effective when the client states that a full minute must elapse between taking doses of medication from different inhalers. The canisters must be shaken after being placed in the holder. After breathing the medication in over 10 seconds, the client should exhale slowly through pursed lips. Holders should be rinsed in warm water daily and cleaned weekly with mild soap and water.

Which statement by a relative indicates to the nurse that the teaching on the application of paste was effective?

"I will not apply the paste on hairy skin." It is correct for the relative not to apply the paste on hairy skin, because doing so could delay the absorption of the drugs. Not removing the last application before applying another is incorrect, as this could lead to excessive drug levels. Not rotating the sites of medication placement is incorrect, as this could lead to irritation of the skin. It is incorrect for the relative to not use gloves when applying the paste, as this could lead to self-contact and absorption of the paste.

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

"Medication stays in the chamber so you can continue to inhale it." A spacer provides a reservoir for aerosol medication. The client can take additional breaths (after the initial breath) to continue inhaling the medication held in the reservoir. The spacer does not decrease the amount of medication received, make the medication move faster, or serve as a holding device.

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance." Reconstitution is the process of adding liquid, known as diluent, to a powdered substance. A sealed glass cylinder of parenteral medication with an attached needle is a refilled cartridge, not reconstitution. A glass or plastic container of parental medication with a self-sealing rubber stopper is a vial, not reconstitution. A sealed glass drug container that must be broken to withdraw the medication is an ampoule, not reconstitution.

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?

18 gauge 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. As the numbers increase, the lumen size decreases; thus, a 22-gauge needle is smaller in diameter than an 18-gauge needle. Of the catheter gauges listed, 18 would be the largest.

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 minutes When ear drops are to be administered in both ears, the nurse would wait 5 minutes after giving the ear drops in the first ear before administering the ear drops into the second ear. This avoids causing the medication to run out immediately after administration. Other times are longer than are needed between ears.

Which medication interaction illustrates a synergism?

A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy. A synergistic reaction is one in which one drug increases the effect of another drug. Acetaminophen and oxycodone have a synergistic relationship. Doxycycline and calcium carbonate have an antagonistic relationship.

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?

Ampicillin sodium 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 nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear?

Ask the client to maintain the position for some time. After instilling the prescribed number of drops in the client's ear, the nurse should ask the client to maintain the position briefly until the solution travels toward the eardrum. When instilling the medication in the client's ear, the nurse first manipulates the client's ear to straighten the auditory canal. Tilting the client's head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client.

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

Assess the vaginal area. When a client reports discomfort, further assessment is needed. The nurse should assess the vagina and vaginal canal for erythema, edema, drainage, or tenderness, and then notify the health care provider after the assessment is completed. The nurse does not know if the discomfort is expected until after assessment, and the nurse should assess the discomfort before deciding to hold the dose.

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Avoid crushing sustained-release pellets. When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.

A medication is prescribed for a pediatric client. The nurse is ensuring the dosage is correct. What factor would the nurse use to calculate the dosage is correct for this client?

Body surface area (BSA) Pediatric doses are calculated according to the infant's or child's weight in kilograms or the BSA. The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height.

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?

Check the client's identification band. For all clients, the preferred method of confirming identity is to read the client's identification band. The next step, if possible, is for the nurse to state their name. Cross-referencing with the MAR and the client's medical record does not allow for any interaction with the actual client. Enlisting the help of a colleague who is familiar with the client is not appropriate.

A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC). After 5 minutes of administration, the client reports itching and appears flushed. What is the most appropriate nursing intervention?

Clamp the PICC line. The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life-threatening reactions can also occur quickly. The first nursing action is to stop the infusion. Clamping the PICC line will stop the infusion. Slowing the rate is inappropriate, as this will not solve the problem if the client is having a reaction. Removing the PICC is unnecessary, and flushing the line may introduce more of the medication to the client.

The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate 40 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for clarification of the prescription. Before administering the medication, the nurse should immediately contact the health care provider to verify the prescription; no one else can verify the prescription. The combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate and the drug propranolol are medications that have look-alike and sound-alike properties, but are very different in indication and dosage.

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for order clarification. The nurse should contact the health care provider to verify the order. Bupropion and buspirone are drugs that have look-alike and sound-alike properties but are different in indication. The nurse should not automatically administer the drug, nor ask another nurse to verify an order, nor assume what is meant by an order.

A nurse is administering an intradermal injection to a client for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at the site of injection. What is the nurse's best action in this situation?

Document the administration and inform the primary care provider. A wheal or blister indicates that the medication has been injected into the dermis. If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be reinjected into another site. The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.

The experienced nurse is teaching a new nurse about chemotherapy administration. What teaching will the experienced nurse include? Select all that apply.

Double-glove when administering these drugs. Pharmacists must be specifically trained to prepare chemotherapy agents. Central venous catheters (CVCs) are often used to administer antineoplastic drugs. The experienced nurse will teach that a nurse should double-glove when administering chemotherapy agents to protect form exposure; that toxic effects can occur after skin contact, inhalation of tiny fluid droplets, or oral absorption of drug residue during hand-to-mouth contact; that pharmacists must be specifically trained to prepare chemo; that exposure can affect sperm, ova, or fetal tissue; and that CVCs are often used to administer chemo.

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client?

Each unit of insulin is accompanied by a clicking sound in the pen. Each unit of insulin is accompanied by a clicking sound in the pen. This is a beneficial feature for the client who has poor vision, as the sound will alert the client to count when selecting the prescribed dose. Being easily transported, being easier to learn, and having a variety of types available are all advantages for using insulin pens, but they do speak specifically to this client.

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers. Older adults may not be able to remember instructions in order to repeat them back clearly. It is appropriate to provide written instructions so the client and caregivers have a quick reference to use for medication administration.

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?

Help the client into a Fowler position. Assuming a Fowler position can help prevent gastric reflux when medications are administered through an enteral tube. The nurse checks the client's medical history for drug allergies to avoid potential complications. Adding diluted medication to the syringe as it becomes nearly empty prevents instilling air into the syringe. Administering the medication over several minutes has no effect on reflux.

The nurse is educating a client on how to use an insulin pen. Which steps reflect recommended procedure? Select all that apply.

Hold the pen upright and tap to force any air bubbles to the top. Dial the dose selector to 2 units to perform an "air shot" to get rid of bubbles. Dial the dose selector to 2 units to perform an "air shot" to get rid of bubbles. The client should hold the pen upright and tap to force any air bubbles to the top, then dial the dose selector to 2 units to perform an "air shot" to get rid of bubbles. The client should clean the injection site and administer the injection by holding the pen like a dart. The client must check that the dose selector is at "0," then dial the units of insulin for the dose. When administering the injection, the client must push the button all the way in and count to "6" before removing the needle.

The nurse is caring for a client who just returned from the postanesthesia care unit (PACU) and rates current pain as 9 out of 10. Which is the most appropriate postoperative prescription for this client?

IV morphine sulfate The intravenous route has the most rapid onset and is considered the best for a client, especially with a pain rating of 9 out of 10. Oral routes of medications start to work in 45 minutes. Intramuscular medications start to work within 30 minutes.

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

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If unsure 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 health care provider to see if the medication should be readministered.

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick?

Immediately activate the safety needle and place the syringe and needle into a Sharps container. The nurse will immediately activate the safety needle and place the syringe and needle into a Sharps container. Removing the needle from the syringe or holding it close to the body puts the nurse at risk for a needle stick. Safety needles are not failproof. Thus, having a colleague hold the Sharps container puts the colleague at risk if the safety needle falls and the nurse misses the opening of the container.

A 2-year-old child has been injured in a motor vehicle accident and is in immediate need of a blood transfusion for profuse bleeding. Which access site might the nurse expect to use for the infusion?

Intraosseous access Intraosseous access with a large-bore rigid needle inserted into the medullary cavity of a long bone may be required for the critically injured child who needs emergency fluid, medication, or blood administration (if adequate venous access is not accessible).

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?

It is a canister that contains pressurized medication. A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.

Which contains all the components of a valid order?

John Smith, atenolol 50 mg, twice a day, by mouth The components of an order include the client's name, the medication name, the amount and frequency of the dose, and the route of administration.

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

Lock the medications in a cart and finish them upon return. 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. Another nurse cannot administer medications that have been prepared by the first nurse.

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

Move the decimal point 3 places to the right. To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). 1000 milligrams (mg) is equal to 1 gram (g); therefore 0.8 g is multiplied by 1000 (which is equivalent to moving the decimal point 3 places to the right) to determine how many mg it is equivalent to.

The nurse is preparing to administer an oral medication to a client with xerostomia. Which nursing action is appropriate?

Offer a sip of water before administering medication. Xerostomia, a condition of dry mouth, affects some older adults and clients taking certain kinds of medications. To prevent oral medications from sticking to the tongue, administer with a sip of water prior to taking the drug, or mix with a soft food such as applesauce. Other answers are incorrect.

What type of prescription would the health care provider most likely write to treat a client whose pain levels vary widely throughout the day?

PRN The prescriber may write a PRN prescription ("as needed") for medication. The client receives medication when it is requested or required. These prescriptions are commonly written for treatment of symptoms. For example, medications used for pain relief, to relieve nausea, and for sleep aids are often written as a PRN order.

What is the name of the process by which a drug moves through the body and is eventually eliminated?

Pharmacokinetics Pharmacokinetics is the process by which a drug moves through the body and is eventually eliminated.

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

Place the date on the vial and retain for future use. The nurse will place the date on the vial and retain it for future use since the vial is indicated for multiple uses. Other actions are incorrect.

The chemotherapy client has been admitted for thrombocytopenia. Which blood product will the nurse anticipate administering?

Platelets One common indication for platelet transfusion is thrombocytopenia following chemotherapy.

The nurse has received a telephone order for a client from a health care provider. How will the nurse indicate in the documentation that the order was received via telephone?

Record "T.O." at the end of the order. Recording "T.O." at the end of the order indicates that this was a telephone order. Another nurse should not cosign the order. Reminding the provider to sign the order as soon as possible is helpful, but it does not indicate that this was a telephone order.

When the nurse administers the client's amlodipine, the client states that usually only one pill is taken instead of three pills. Which right of medication should now be triple checked before allowing the client to take the medication?

Right dose When a client states that the dose he or she is used to taking is different from the dose the nurse is administering, it is suggestive of an incorrect medication dosage and should cue the nurse to triple-check medication dosages. The client's identity should be checked before the medication is handed to the client, and the client's statement is directed toward the medication dose, not whether he or she has medication prescribed. The client's statement does not involve the name or the type of medication, only the dose. The client is not questioning the medication administration time, only the dose.

The nurse is administering an oral opioid medication to a client who reported pain. The client dropped the medication on the floor. What actions would the nurse take now? Select all that apply.

Search for the pill on the floor until the pill is found. Discard the pill in an appropriate container with a witnessing nurse present. Obtain another dose of the medication for the client. If an oral medication falls to the floor, the nurse searches for the pill until the pill is found. This is particularly important for an opioid medication, which the nurse must account for according to federal law. The pill is to be discarded in an appropriate container with a witness, also according to federal law. The nurse obtains another dose of the medication to administer to the client. The nurse does not wipe the pill and try to administer the pill to the client. This is to prevent contamination and transmission of microorganisms. Only if the client drops multiple dosages of opioid medications on the floor would the nurse ask for a liquid form of the medication.

A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate?

Select another site. If a vein appears hard or ropelike, the nurse should select another spot for the venipuncture. Applying a warm compress would be used to help dilate the vein. Loosening the tourniquet would have no effect on the "hardness" of the vein. The vein should not be used. Applying a topical anesthetic is appropriate to reduce the pain associated with insertion. However, a vein that feels hard should not be used.

The nurse is teaching a client with diabetes how to withdraw insulin from a vial. In which order should the nurse explain the steps to the client?

Select appropriate syringe and needle. Remove the metal cover from the rubber stopper. Fill the syringe with a volume of air equal to the volume that will be withdrawn from the vial. Pierce the rubber stopper with the needle and instill the air. Invert the vial, hold, and brace it while pulling on the plunger. Date and initial the vial for future use. The nurse should instruct the client to first select the appropriate syringe and needle, followed by removing the metal cover from the rubber stopper and then filling the syringe with a volume of air equal to the volume that will be withdrawn from the vial. After piercing the rubber stopper with the needle and instilling the air, invert the vial, hold, and brace it while pulling on the plunger. Finally, date and initial the vial for future use.

Which medication system allows for client independence?

Self-administered medication system The self-administered system allows the client independence and responsibility. It also allows nursing supervision, education, and evaluation for client compliance and safety medication management prior to facility discharge.

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this scheduled unit-dose packaged antihypertensive medication?

Set the antihypertensive dose aside pending assessment. Knowing that the previous dose was held, the nurse sets the antihypertensive aside until an assessment of current blood pressure is performed or verified. The nurse scans and administers all the regularly scheduled medications at one time, except for those requiring additional assessment. Those unit-dose packages are set to the side until the nurse is sure that administration is the correct action. The client should already know to call for assistance, if needed, and to report new or worsening symptoms, such as feeling dizzy.

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this upcoming dose of scheduled unit-dose packaged antihypertensive medication?

Set the antihypertensive dose aside pending assessment. Knowing that the previous dose was held, the nurse sets the antihypertensive aside until an assessment of current blood pressure is performed or verified. The nurse scans and administers all the regularly scheduled medications at one time, except for those requiring additional assessment. Those unit-dose packages are set to the side until the nurse is sure that administration is the correct action. The client should already know to call for assistance, if needed, and to report new or worsening symptoms, such as feeling dizzy.

The nurse is administering medication to a client through a drug-infusion lock using the saline flush. During the process, the client complains of pain at the site. Which interventions are appropriate in this situation? Select all that apply.

Stop the medication and assess the site for signs of infiltration and phlebitis. Flush the medication lock with normal saline again to recheck patency. If site is within normal limits, resume medication administration at a slower rate. The nurse should stop administering the medication and assess the medication lock site for signs of infiltration and phlebitis. Next, the nurse should flush the medication lock with normal saline again to recheck patency. If the IV site appears within normal limits, the nurse resumes the medication administration at a slower rate. If pain persists, the medication administration is stopped, and the medication lock is removed and restarted in a different location. Infiltration without complications does not warrant notifying the physician. The medication should not be administered as this can cause tissue damage and will be painful.

What signs of complications and their probable causes may occur when administering an IV solution to a client? Select all that apply.

Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV. Redness, swelling, heat, and pain at the site may indicate phlebitis. Local or systemic manifestations may indicate an infection is present at the site. If the IV catheter has become dislodged and IV fluid is flowing into the tissues, then infiltration has occurred. Infiltration is indicated with swelling, pain, coolness, or pallor at the insertion site. Redness, swelling, heat, and pain at the site may indicate phlebitis of the vein. If the site has become infected, it may be contained as a localized infection, or it can spread throughout the bloodstream as a systemic infection. A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when fluids are administered too rapidly (speed shock). Bleeding at the IV site indicates the need for additional pressure to be applied to the site. This can occur if the client is taking anticoagulants or has a bleeding disorder. Engorged neck veins, increased blood pressure, and dyspnea occur when fluid overload has occurred.

A client who has been taking no medications has just been diagnosed as having diabetes. The client is prescribed an injectable medication once a day and an oral medication twice a day for blood glucose control. What would the nurse teach the client about taking these medications? Select all that apply.

Take the medications at the same time each day. Do not abruptly stop the medication or alter the dosage. The intended effects and adverse effects of the medications The appropriate timing of the medications in relation to food The nurse, when teaching a client about medications, would include in the instructions to take the medications at the same time each day, to not abruptly stop the medications or alter the dosage of the medications, and would teach about the intended/adverse effects of each medication. For diabetic medications, it is important for the nurse to teach the client when to take these medications in relation to ingestion of food. These medications would make the client's blood glucose drop to critically low levels if food is not also ingested. Medications should not be exposed to light. Medications should be kept in a cool, dry place. Light, temperature, and humidity can inactivate the medications.

The nurse is preparing a packed red blood cell transfusion for a client. The nurse checks the client's blood type in the electronic medical record (EMR) and notes that it is blood type B. What does this mean?

The client has anti-A antibodies. Clients with type B blood have anti-A antibodies. This means they would attack any type A blood they receive, prompting a transfusion reaction. Clients with type O blood are universal donors.

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?

The client is resting his arm with the IV on his head. 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.

The nurse is creating a professional development presentation about medication orders. Which teaching will the nurse include? Select all that apply.

The health care providers must sign all orders. Be extra cautious with look-alike and sound-alike drugs. The nurse's teaching will include that health care providers must sign all orders, and care must be taken with look-alike and sound-alike drugs. Abbreviations should not be used. The nurse is held accountable for making sure that all components of a medication order are present and for clarifying any portion that is not understood.

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

The narcotics for the division are counted. Health care facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).

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

The nurse should apply the medication directly to the skin. Transdermal medications are adsorbed through the skin. Injectable medications are either delivered intramuscularly (in the muscle) or subcutaneously (or below the dermis). By mouth medications are taken by swallowing. Medications can also be given in the vagina, rectum, eyes, and ears.

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug. The ventrogluteal site is a large muscular injection site that provides a location with the capacity for depositing and absorbing the drug and is therefore correct. The nurse will reduce the transmission of microorganisms by hand washing and not by selecting the ventrogluteal site. The nurse will aspirate for a blood return to determines whether or not the needle is in a blood vessel. Changing the needle will prevent tissue contact with the irritating drug, not the usage of the ventrogluteal site.

To which client would the nurse be most likely to administer a PRN medication?

a client who is reporting pain near the surgical site A report of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications.

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

a client who is reporting pain near the surgical site 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.

The nurse is caring for a client with pneumonia who requires administration of medications. When does the nurse document administration in the medication administration record (MAR)?

after completion of administration of each drug The nurse documents administration after giving medications each time. The nurse never documents administration of medications ahead of delivery, nor does the nurse document during the actual delivery time. Nurses do not wait until the end of the shift to document medication administration.

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?

catheter tip contamination due to skin organisms encountered during insertion 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. Direct contamination of the catheter or catheter hub is also a contributing factor (O'Grady, N.P., et al, 2011). Less common, the catheters may be contaminated by organisms that migrate from infections in other areas of the client. Rarely, the infusion itself may be contaminated. Additionally, the material the catheter is made from may contribute to CRBSI. Silastic catheters are associated with higher risk of catheter infections due to surface irregularities that allow development of a biofilm formation along the catheter's inner lumen.

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to food or drugs Checking for documented allergies to food or drugs is done to ensure safety and is therefore correct. Preparing the syringe with the medication is incorrect because this is considered planning, not assessment. Cleaning the area with an alcohol swab is implementing, not assessing. Gathering all the equipment needed is also considered planning.

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?

decline in liver function and production of enzymes needed for drug metabolism 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. Adipose tissue and total body fluid in proportion to body mass are not factors indicated in this scenario. A decreased number of protein-binding sites could lead to drug toxicity. Decreased, rather than increased, kidney function leads to drug toxicity due to decreased secretion of the drug.

The nurse is providing discharge teaching for an older adult with arthritis who also has an implanted catheter. Which care does the nurse anticipate the client will need to provide catheter care?

home care The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. The scenario presented does not indicate that the client needs long-term care or assisted living. An inpatient admission is not anticipated to be needed for the sole purpose of catheter care.

The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?

intradermal The nurse will use the intradermal route, which is injecting the drug between the layers of the skin. The subcutaneous route is reserved for drugs to be injected beneath the skin but above the muscle. The intramuscular route is reserved for drugs to be injected in the muscle. The intravenous route is reserved for drugs to be instilled into veins.

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

intramuscular When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique. Clients report slightly less pain during (and the day after) a Z-track injection compared with the usual intramuscular injection technique. The Z-track technique is not suitable for intravenous injections, as they are administered into the veins, nor is it used for intradermal or subcutaneous injections.

A nurse is using an 18-gauge needle to administer medication to a client. The nurse knows that, when compared with a 27-gauge needle, an 18-gauge needle has which feature?

larger diameter For most injections, 18- to 27-gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. The needle gauge, or the diameter, refers to its width.

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

miconazole The nurse anticipates that miconazole, a vaginal cream, will be prescribed for a yeast infection. Oxymetazoline is a nasal decongestant used to alleviate congestion; bisacodyl is a rectal suppository used for softening stool; timolol is an eye drop used to treat glaucoma.

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter To be effective, a suppository must be inserted past the internal sphincter, which is about the distance of the finger of insertion.

The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?

removing prior application and any remaining residue from skin The nurse will remove one application and residue before applying another, as this prevents excessive drug levels when a new application is placed. The nurse will then proceed to squeeze the paste onto the paper, spread the paste over the paper, apply the paper, and cover it with a transparent semipermeable dressing.

What would be considered a "right" of drug administration? Select all that apply.

right drug right documentation right dose right client Clients have the right to expect safe and appropriate drug administration. Nurses must observe each of these rights to ensure that the administration is done accurately.

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

to clear medication and prevent clot formation 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.

The primary reason for the Controlled Substances Act is:

to prevent drug use and dependence. The primary reason for the Controlled Substances Act is to prevent drug use and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug use laws.

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

when the client has disorders that affect the absorption of medications 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. A single administration of a drug does not indicate the need for intravenous administration.