Chapter 29: Medications

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes? bolus administration electronic infusion device continuous administration secondary administration

bolus administration Explanation: Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. An electronic infusion device, continuous administration, and secondary administration do have the potential to cause life-threatening changes, but not to the same degree as a bolus administration, since the rate at which medication is administered is not as fast as during a bolus. Chapter 29: Medications - Page 905

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? side of buttock upper arm lower abdomen upper back

upper back Explanation: The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily. Chapter 29: Medications - Page 859

10. A nurse is converting the dosage of a medication to a different unit in the metric system. The medication label specifies the drug as being 0.5 g per tablet. The order is for 500 mg. How many tablets will the nurse give? A) 1 B) 2 C) 5 D) 10

A) 1

4. A nurse is administering a medication to a patient for acute pain. Of the various routes for drug administration, which would be chosen because it is absorbed more rapidly? A) injected medications B) liquid oral medications C) topical skin medications D) oral-coated medications

A) injected medications

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse? "The nurse should not have crushed this medication. It could have caused an allergic reaction." "I can crush the medication but will not be able to mix it in the applesauce, because it will limit the effectiveness." "Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole." "I will ask the health care provider to cancel the prescription for aspirin since you are unable to take it." TAKE ANOTHER QUIZ

"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole." Explanation: An enteric-coated medication should never be crushed since it disrupts the integrity of the pill and may cause irritation. The drug will dissolve prematurely in the gastric secretions and irritate the lining of the stomach. Crushing the medication does not cause an allergic reaction unless the client is already allergic to the medication. It is not appropriate for the nurse to make disparaging comments about other nurses to the client. The prescription should not be canceled. If needed, the nurse may contact the prescriber for a different form of the medication. Chapter 29: Medications - Page 841-843

Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response? "I will log in so that you can proceed with medication delivery." "I am giving you my password so you can log in." "I will get the hospital's information system's phone number for you." "I can log in and give the medications for you."

"I will get the hospital's information system's phone number for you." Explanation: Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue. Chapter 29: Medications - Page 833-834

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection? 3 mL 0.01 mL 1 mL 0.05 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. Chapter 29: Medications - Page 849

A client has been prescribed 300 mg of metronidazole. The supply is metronidazole 200 mg tablets. How many tablets will the nurse administer? Record your answer using one decimal place.

1.5 Explanation: The nurse will plan to administer one and one-half tablets, which totals the 300 mg dose. Dose on hand = Dose desired ÷ X 200 mg/1 tablet = 300 mg ÷ X 200X = 300 X = 300/200 = 1.5 tablets Chapter 29: Medications - Page 836

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood? 1500 1200 2000 Wait until day 5 of treatment.

1500 Explanation: Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest. Chapter 29: Medications - Page 830

The nurse is administering morphine oral solution 5 mg to a client requesting medication for pain. The preparation is delivered as morphine solution 10 mg/5 ml. Calculate the amount, in milliliters, the will nurse administer. Record your answer to one decimal place.

2.5 Explanation: The desired dose is 5 mg. The dose on hand or supplied dose is 10 mg. Quantitiy is 5 ml. The nurse would administer 2.5 ml. 5 mg/10 mg × 5 ml = 2.5 ml Chapter 29: Medications - Page 836

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 that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client? 15 mL 22.5 mL 67.5 mL 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, where X = 30 mL. Chapter 29: Medications - Page 836

A nurse is administering intramuscular injections to clients. What needle size(s) has the nurse used correctly? Select all that apply. 5/8-inch (2-cm) needle for the vastus lateralis site 5/8-inch (2-cm) needle for an adult in the ventrogluteal site 1 1/2-inch (3.75-cm) needle for a child in the deltoid site 1 1/2-inch (3.75-cm) needle for an adult in the deltoid site 5/8-inch (2-cm) needle for a child in the deltoid site 5/8-inch (2-cm) needle for an adult in the ventrogluteal site

5/8-inch (2-cm) needle for the vastus lateralis site 1 1/2-inch (3.75-cm) needle for an adult in the deltoid site 5/8-inch (2-cm) needle for a child in the deltoid site The acceptable size for needles based on the muscle being used for the injection is:Vastus lateralis 5/8-inch to 1-inch (2 to 2.5 cm)Deltoid (children) 5/8-inch to 1-inch (2 to 2.5 cm)Deltoid (adults) 5/8-inch to 1 1/2-inch (2 to 3.75 cm)Ventrogluteal (adults) 1 1/2-inch (3.75 cm) Chapter 29: Medications - Page 855

It is particularly important for the nurse to use this technique (Z-track method) when administering intramuscular (IM) medication to which client? A 30-year-old client diagnosed with Tourette syndrome prescribed haloperidol A 40-year-old client diagnosed with breast cancer prescribed fulvestrant A 50-year-old client demonstrating delirium tremors prescribed lorazepam A 70-year-old demonstrating muscle wasting prescribed chlorpromazine

A 70-year-old demonstrating muscle wasting prescribed chlorpromazine Explanation: The Z-track method is suggested for older adults who have decreased muscle mass. While some agents, such as iron, are best given via the Z-track method due to the irritation and discoloration associated with this agent, none of the other clients demonstrate specific characteristics that suggest the need for Z-tracking. Chapter 29: Medications - Page 902

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 client is taking doxycycline, an antibiotic, for rosacea. She takes this with her morning vitamins, which includes calcium carbonate. She has not noticed a change in her symptoms. A client is taking metoprolol for her blood pressure and metformin for her diabetes. Her provider has told her that these are safe to take together. A client was told not to take tretinoin topical if she is pregnant because it may be teratogenic.

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. Explanation: 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. Chapter 29: Medications - Page 826

17. What does the nurse do to verify an order for a medication listed on a medication administration record (MAR)? A) Compare it with the original physicians order. B) Ask another nurse what the drug is. C) Look up the drug in a textbook. D) Call the pharmacist for verification.

A) Compare it with the original physicians order.

20. A nurse is administering a liquid medication to an infant. Where will the nurse place the medication to prevent aspiration? A) between the gum and the cheek B) in front of the teeth and gums C) on the front of the tongue D) under the tongue

A) between the gum and the cheek

9. A nurse is administering lithium to a Japanese patient. What cultural factor should the nurse consider regarding the effects of the medications? A) elevated serum levels may occur causing symptoms of drug toxicity B) expected side effects should be no different than in other patients C) the patient may require a larger-than-normal dose of a drug D) more rapid metabolism may interfere with drug absorption

A) elevated serum levels may occur causing symptoms of drug toxicity

27. 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) first inject an equal amount of air into the vial B) withdraw the liquid and then inject an equal amount of air C) insert the needle and slowly withdraw the liquid D) insert a separate needle to equalize the pressure

A) first inject an equal amount of air into the vial

31. A nurse is preparing to administer a medication by intravenous piggyback. Where will the piggyback container be placed? A) higher than the primary solution container B) lower than the primary solution container C) at an equal height with the primary solution container D) below the level of the patients heart

A) higher than the primary solution container

The nurse has inadvertently administered medication ordered for Client A to Client B. What is the appropriate nursing action? Select all that apply. Do nothing as long as Client B has no reaction. Tell Client A that the wrong drugs were given to Client B. Assess Client B thoroughly. Complete an incident report. Contact the provider to report the error.

Assess Client B thoroughly. Complete an incident report. Contact the provider to report the error. The nurse will assess and monitor Client B, complete an incident report, and notify the provider in case other orders may need to be given. It is ethically and legally inappropriate to refrain from taking action. Telling Client A about the error violates HIPAA. Chapter 29: Medications - Page 869

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that it is to be applied topically. Which instructions should the nurse provide? Apply a small amount of the medication to the affected area then repeat after initial dose has dried. Apply the medication to clean, dry skin of the affected area using gloves. Clean the area with alcohol and apply a quarter size of medication to the affected area. Using sterile gauze, apply to the affected area with gloves and cover with a bandage.

Apply the medication to clean, dry skin of the affected area using gloves. 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). Whenever applying topical medications, the hands should be protected from inadvertent absorption through the skin by wearing clean gloves. Being the condition is below the skin, there is no need to clean the area or use sterile gauze to apply the medication. Repeating application of medication after drying of initial dose is not needed. Chapter 29: Medications - Page 858

A nurse is administering a pain medication to a patient. In addition to checking his identification bracelet, the nurse correctly verifies the patient's identity by performing which action? Asking the patient his name and birthdate Reading the patient's name on the sign over the bed Asking the patient's roommate to verify his name Asking, "Are you Mr. Brown?"

Asking the patient his name and birthdate The nurse should ask the patient to state his name and birthdate based on facility policy. A sign over the patient's bed may not always be current. The roommate is an unsafe source of information. The patient may not hear his name but may reply in the affirmative anyway (e.g., a person with a hearing deficit).

A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation? Readminister the medication and notify the primary care provider. Readminister the pill in a liquid form if possible. Assess the vomit, looking for the pill. Notify the primary care provider.

Assess the vomit, looking for the pill. If a patient vomits immediately after swallowing an oral pill, the nurse should assess the vomit for the pill or fragments of it. The nurse should then notify the primary care provider to see if another dosage should be administered.

26. A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A) Recap the needle and place it in a puncture-resistant container. B) Do not recap the needle and place it in a puncture-resistant container. C) Break off the needle, place it in the barrel, and throw it in the trash. D) Take off the needle and throw the syringe in the patients trash can.

B) Do not recap the needle and place it in a puncture-resistant container.

21. A nurse is teaching an older adult at home about taking newly prescribed medications. Which of the following would be included? A) You can identify your medications by their color. B) I have written the names of your drugs with times to take them. C) You wont forget a medication if you count them every day. D) Dont worry if the label comes off

B) I have written the names of your drugs with times to take them.

23. What would a nurse instruct a patient to do after administration of a sublingual medication? A) Take a big drink of water and swallow the pill. B) Try not to swallow while the pill dissolves. C) Swallow frequently to get the best benefit. D) Chew the pill so it will dissolve faster.

B) Try not to swallow while the pill dissolves.

7. A patient who is taking an oral narcotic for pain relief tells the nurse he is constipated. What is this common response to narcotics called? A) therapeutic effect B) adverse effect C) toxic effect D) idiosyncratic effect

B) adverse effect

15. A physician has ordered that a medication be given stat for a patient who is having an anaphylactic drug reaction. At what time would the nurse administer the medication? A) at the next scheduled medication time B) immediately after the order is noted C) not until verifying it with the patient D) whenever the patient asks for it

B) immediately after the order is noted

16. What type of order would a physician most likely write to treat the symptoms of a disease? A) stat B) p.r.n. C) standing D) single

B) p.r.n.

11. A physician orders Cipro 500 mg, PO q12h for a patient with bronchial pneumonia. The nurse has Cipro 250 mg on hand. How many tablets would the nurse dispense? A) 1/2 tablet B) 1 tablet C) 2 tablets D) 2 1/2 tablets

C) 2 tablets

5. A physician has ordered peak and trough levels of a medication. When would the nurse schedule the trough level specimen? A) before administering the first dose B) immediately after the first dose C) 30 minutes before the next dose D) 24 hours after the last dose

C) 30 minutes before the next dose

22. A student nurse is administering medications through a nasogastric tube connected to continuous suction. How will the student do this accurately? A) Briefly disconnect tubing from the suction to administer medications, then reconnect. B) Realize this cant be done, and document information. C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D) Leave the suction alone and give medications orally or rectally.

C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes.

13. 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) Do you have any allergies to medications? D) At what times do you take your medications?

C) Do you have any allergies to medications?

3. A patient who is taking Tylenol for a fever asks a nurse if there is a generic form that is less expensive. What would the nurse tell him? A) No, Tylenol is all that is available. B) No, not that I am aware of. C) Yes, and it is acetaminophen. D) Yes, and it is also called Tylenol.

C) Yes, and it is acetaminophen.

Which of the following healthcare providers have prescriptive authority? Select all that apply. A) licensed practical nurse B) pharmacist C) physician D) social worker E) dentist F) advance practice nurses

C) physician E) dentist F) advance practice nurses

32. A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step? A) to keep the inside of the needle or catheter sterile B) to facilitate patient comfort and decrease anxiety C) to clear medication and prevent clot formation D) to dilute the infusion and maintain homeostasis

C) to clear medication and prevent clot formation

30. Which anatomic site is recommended for intramuscular injections for adults? A) vastus lateralis B) epidermis of inner forearm C) ventrogluteal muscles D) subcutaneous fat

C) ventrogluteal muscles

Ms. Hall has an order for hydromorphone, 2 mg, intravenously, q 4 hours PRN pain. The nurse notes that according to Ms. Hall's chart, she is allergic to hydromorphone. The order for medication was signed by Dr. Long. What would be the correct procedure for the nurse to follow in this situation? Administer the medication, the doctor is responsible for medication administration. Call Dr. Long and ask that the medication be changed. Ask the supervisor to administer the medication. Ask the pharmacist to provide a medication to take the place of hydromorphone.

Call Dr. Long and ask that the medication be changed. The nurse is responsible for any medications given and must inform the doctor of the patient's allergy to the drug. The nurse should not give the medication and might speak with the supervisor only if uncomfortable with the health care provider's answer when notified. The nurse is legally unable to order a replacement medication, as is the pharmacist.

A nurse discovers that a medication error occurred. What should be the nurse's first response? Record the error on the medication sheet. Notify the physician regarding course of action. Check the patient's condition to note any possible effect of the error. Complete an incident report, explaining how the mistake was made.

Check the patient's condition to note any possible effect of the error. The nurse's first responsibility is the patient—careful observation is necessary to assess for any effect of the medication error. The other nursing actions are pertinent, but only after checking the patient's welfare.

The nurse is preparing to administer two IV medications. What is the appropriate nursing action? Prepare to administer through two separate tubes. Administer the drugs through the same tubing. Consult a current drug reference book for IV compatibility. Hold one medication for an hour and administer it after the first medication.

Consult a current drug reference book for IV compatibility. Explanation: The nurse should consult a current drug reference book for compatibility before administering two IV medications. Other answers are incorrect. Chapter 29: Medications - Page 848

The nurse is caring for a client who has had a cerebrovascular accident. Prior to administering oral medications, what is the nurse's appropriate action? Give the client water to drink. Consult with a speech therapist for dysphagia. Mix medications in applesauce or pudding. Convert orders for oral medications to intravenous or intramuscular.

Consult with a speech therapist for dysphagia. Explanation: To prevent aspiration, the nurse will not administer oral medications, but will ask the provider to consult with a speech therapist who can evaluate dysphagia and recommend safe methods of medication administration. The nurse cannot automatically convert an order for medications to a different route; this would have to be considered by the health care provider. Chapter 29: Medications - Page 84

The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have Klonopin 10 mg by mouth twice daily. What is the appropriate nursing action? Administer the drug as prescribed. Ask another nurse to verify the prescription. Assume that the provider meant to prescribe clonidine. Contact the health care provider for clarification of the prescription.

Contact the health care provider for clarification of the prescription. Explanation: Before administering the medication, the nurse should immediately contact the health care provider to verify the prescription due to suspected wrong medication prescription. The medications Klonopin and clonidine are medications that have look-alike and sound-alike properties but are very different in indication and dosage. Klonopin is the trade name for clonazepam, which is a benzodiazepine for the treatment of seizures, whereas clonidine is an alpha 2 receptor agonist used in the treatment of hypertension. Administering the drug as prescribed could harm the client because it is not intended for hypertension. Assuming the provider meant to prescribe clonidine does not allow for correction of the problem, because there is no order to change the medication and another nurse will not be able to verify the prescription. Chapter 29: Medications - Page 879

33. Which of the following accurately describes a step in this procedure? A) The medication is injected just below the dermis of the skin. B) Transdermal patches that contain estrogen should be applied to breast tissue. C) When indicated, apply a cold pack to the area to promote absorption. D) The nurse would wear gloves while massaging in the medication.

D) The nurse would wear gloves while massaging in the medication.

2. What federal agency enforces the official standards for drugs in the United States? A) Centers for Disease Control and Prevention B) Judicial branch of the administration C) Controlled Substance Act D) Food and Drug Administration

D) Food and Drug Administration

24. A nurse is administering an intramuscular injection of a viscous medication using the appropriate- gauge needle. What does the nurse need to know about needle gauges? A) All needles for parenteral injection are the same gauge. B) The gauge will depend on the length of the needle. C) Ask the patient what size needle is preferred. D) Gauges range from 18 to 30, with 18 being the largest.

D) Gauges range from 18 to 30, with 18 being the largest.

18. What must a nurse do each time medications are administered to ensure that medication errors do not occur? A) Verify the number of medications to be administered. B) Review information about classification of drugs. C) Ask another nurse to double-check the medications. D) Observe the three checks and five rights.

D) Observe the three checks and five rights.

14. A hospitalized patient asks the nurse for some aspirin for my headache. There is no order for aspirin for this patient. What will the nurse do? A) Go ahead and give the patient aspirin, a common self-prescribed drug. B) Ask the patients visitors if they have any aspirin for the patient. C) Ask the patients family to bring some aspirin from home. D) State that an order from the doctor is legally required and check with the doctor.

D) State that an order from the doctor is legally required and check with the doctor.

28. An adult with diabetes receives 20 units of insulin each morning and evening. How will the nurse teach the patient to administer the insulin? A) Use a 1-mL syringe and give 0.4 mL. B) Use a 5-mL syringe and give 0.40 mL. C) Use a tuberculin syringe and give 4/10 mL. D) Use an insulin syringe and give 20 units.

D) Use an insulin syringe and give 20 units.

12. What factor is used to most accurately calculate drug dosages for a child? A) age B) developmental level C) weight D) body surface area (BSA)

D) body surface area (BSA)

25. Which of the following parts of the syringe and needle must be kept sterile when preparing and administering an injection? Select all that apply. A) the outside of the cap B) the outside of the barrel C) the needle hub D) the needle E) inside the barrel F) part of plunder entering barrel

D) the needle E) inside the barrel F) part of plunder entering barrel

6. A patient taking insulin has his levels adjusted to ensure the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A) peak level B) trough level C) half-life D) therapeutic range

D) therapeutic range

19. A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A) to prevent absorption in the mouth B) to prevent absorption in the esophagus C) to facilitate absorption in the stomach D) to prevent gastric irritation

D) to prevent gastric irritation

29. A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A) 10-mL syringe, 3-inch 18-gauge needle B) 5-mL syringe, 2-inch 20-gauge needle C) insulin syringe, 1-inch 16-gauge needle D) tuberculin syringe, 1/2-inch 26-gauge needle

D) tuberculin syringe, 1/2-inch 26-gauge needle

8. A nurse is conducting an interview for a health history. In addition to asking the patient about medications being taken, what else should be asked to assess the risk for drug interactions? A) the effects of prescribed medications B) type and amount of foods eaten C) daily amount of intake and output D) use of herbal supplements

D) use of herbal supplements

A nurse is administering phenytoin via a gastric tube to a patient who is receiving tube feedings. What would be an appropriate action of the nurse in this situation? Discontinue the tube feeding and leave the tube clamped for required period of time before and after medication administration. Notify the primary care provider that medication cannot be given to the patient at this time via the gastric tube. Remove the tube in place and replace it with another tube prior to administering the medication. Flush the tube with 60 mL of water prior to administering the medication.

Discontinue the tube feeding and leave the tube clamped for required period of time before and after medication administration. If the patient is receiving tube feedings, the nurse should review information about the drugs to be administered. Absorption of some drugs, such as phenytoin, is affected by tube-feeding formulas. The nurse should discontinue a continuous tube feeding and leave the tube clamped for the required period of time before and after the medication has been given, according to the reference and facility protocol.

A medication order reads: "Hydromorphone, 2 mg IV every 3 to 4 hours PRN pain." The prefilled cartridge is available with a label reading "Hydromorphone 2 mg/1 mL." The cartridge contains 1.2 mL of hydromorphone. What should the nurse do? Give all the medication in the cartridge because it expanded when it was mixed and this is what the pharmacy sent. Call the pharmacy and request the proper dose. Refuse to give the medication and document refusal in the EHR. Dispose of 0.2 mL before administering the drug, verify the waste with another nurse.

Dispose of 0.2 mL before administering the drug, verify the waste with another nurse. Many cartridges are overfilled, and some of the medication needs to be discarded. Always check the volume needed to provide the correct dose with the volume in the syringe. Giving the excess medication in the cartridge may result in adverse effects for the patient. For this dose, it is not necessary to call the pharmacy or refuse to give the medication, provided the order is written correctly. Wasting narcotics typically requires a second RN to witness the waste and verify the amount of narcotic discarded.

A nurse who is administering medications to patients in an acute care setting studies the pharmacokinetics of the drugs being administered. Which statements accurately describe these mechanisms of action? Select all that apply. Distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues. Metabolism is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Absorption is the change of a drug from its original form to a new form, usually occurring in the liver. During first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the system's circulation. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug absorption. Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body.

Distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues. During first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the system's circulation. Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body. Distribution occurs after a drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues. Some drugs move from the intestinal lumen to the liver by way of the portal vein and do not go directly into the systemic circulation following oral absorption. This is called the first-pass effect, or hepatic first pass. Excretion is the process of removing a drug or its metabolites (products of metabolism) from the body. Absorption is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Metabolism, or biotransformation, is the change of a drug from its original form to a new form. The liver is the primary site for drug metabolism. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug excretion.

A nurse is administering heparin subcutaneously to a patient. What is the correct technique for this procedure? Aspirate before giving and gently massage after the injection. Do not aspirate massage the site for 1 minute. Do not aspirate before or massage after the injection. Massage the site of the injection aspiration is not necessary but will do no harm.

Do not aspirate before or massage after the injection. When giving heparin subcutaneously, the nurse should not aspirate or massage, so as not to cause trauma or bleeding in the tissues.

A health care provider orders a pain medication for a postoperative patient that is a PRN order. When would the nurse administer this medication? A single dose during the postoperative period Doses administered as needed for pain relief One dose administered immediately Doses routinely administered as a standing order

Doses administered as needed for pain relief When the prescriber writes a PRN order ("as needed") for medication, the patient receives medication when it is requested or required. With a single or one-time order, the directive is carried out only once, at a time specified by the prescriber. A stat order is a single order carried out immediately. A standing order (or routine order) is carried out as specified until it is canceled by another order.

A client with a new diagnosis of glaucoma (increased pressure within the eye) has been prescribed a medication that is to be administered by an eye drop. Which action should the nurse perform? Apply a few drops of normal saline to the eye to irrigate the eye. Ask the client to close his eyes for 15 to 30 seconds prior to administration. Cleanse the tip of the container with an alcohol swab. Ensure that drops of the medication fall onto the client's conjunctival sac.

Ensure that drops of the medication fall onto the client's conjunctival sac. Explanation: Eye drops should be applied to the conjunctival sac. Irrigation is not necessary prior to administration, nor does the client need to close his or her eyes. The tip of the container must be sterile, but it is not routinely swabbed with alcohol. Chapter 29: Medications - Page 860

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? Provide discharge paperwork to the client. Request another nurse to reteach the material. Give written instructions to the client and caregivers. Arrange for home health to see the client.

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. Chapter 29: Medications - Page 843

A patient requires 40 units of NPH insulin and 10 units of regular insulin daily subcutaneously. What is the correct sequence when mixing insulins? Inject air into the regular insulin vial and withdraw 10 units; then, using the same syringe, inject air into the NPH vial and withdraw 40 units of NPH insulin. Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin. Inject air into the regular insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the NPH insulin vial and withdraw 40 units; then, withdraw 10 units of regular insulin. Inject air into the NPH insulin vial and withdraw 40 units; then, using the same syringe, inject air into the regular insulin vial and withdraw 10 units of regular insulin.

Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin. Regular or short-acting insulin (unmodified insulin) should never be contaminated with NPH or any insulin modified with added protein. Placing air in the NPH vial first without allowing the needle to contact the solution ensures that the regular insulin will not be contaminated. page 886 - scale 29.4 insulin implementation.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation? Inner surface of the forearm Shoulder Abdomen Anterior aspect of the thigh

Inner surface of the forearm Explanation: Sites commonly used for intradermal injections are the inner surface of the forearm and the upper back, under the scapula. The deltoid muscle of the shoulder is a common injection site for intramuscular injections. The abdomen and anterior aspect of the thigh are common injection sites for subcutaneous injections. Chapter 29: Medications - Page 890-894

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse? Call the physician to request oral antibiotics. Flush the lock with heparin solution. Administer the prescribed antibiotics as prescribed. Insert a new IV medication lock and remove the old one.

Insert a new IV medication lock and remove the old one. Explanation: The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the physician to change the order is not appropriate. Chapter 29: Medications - Page 919

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 battery-operated device that spins. It suspends finely powdered medication. It is a canister that contains pressurized medication. 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. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation. Chapter 29: Medications - Page 864

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. Superior vena cava Right atrium Left ventricle Median cubital vein Basilic vein

Median cubital vein Basilic vein 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. No IV catheter is placed in the left ventricle. The median cubital vein and basilic vein would be used for peripheral IV therapy or for the insertion of peripheral central venous catheters. Chapter 29: Medications - Page 857

A nurse is preparing medications for patients in the ICU. The nurse is aware that there are patient variables that may affect the absorption of these medications. Which statements accurately describe these variables? Select all that apply. Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed. Some people experience the same response with a placebo as with the active drug used in studies. People with liver disease metabolize drugs more quickly than people with normal liver functioning. A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication's effects. Oral medications should not be given with food as the food may delay the absorption of the medications. Circadian rhythms and cycles may influence drug action.

Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed. Some people experience the same response with a placebo as with the active drug used in studies. A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication's effects. Circadian rhythms and cycles may influence drug action. Nurses need to know about medications that may produce varied responses in patients from different ethnic groups. The patient's expectations of the medication may affect the response to the medication, for example, when a placebo is given and a patient has a therapeutic effect. The patient's environment may also influence the patient's response to medications, for example, sensory deprivation and overload may affect drug responses. Circadian rhythms and cycles may also influence drug action. The liver is the primary organ for drug breakdown, thus pathologic conditions that involve the liver may slow metabolism and alter the dosage of the drug needed to reach a therapeutic level. The presence of food in the stomach can delay the absorption of orally administered medications. Alternately, some medications should be given with food to prevent gastric irritation, and the nurse should consider this when establishing a patient's medication schedule. Other medications may have enhanced absorption if taken with certain foods.

Which technique should the nurse employ when instilling otic medication in an adult ear? Tilt the client's head toward the ear in which the medication is being instilled. Tilt the client's head back with face upward. Pull the client's ear down and back. Pull the client's ear up and back.

Pull the client's ear up and back. Pulling the client's ear up and back is correct, as this will straighten the auditory canal of the adult client. Tilting the client's head towards the ear in which the medication is being instilled and tilting the client's head back with face upward are incorrect, as these techniques will allow the medication to drain outside the ear. Pulling the ear down and back is incorrect, as this technique is used to straighten the auditory canal of a child, not an adult. Chapter 29: Medications - Page 861

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? No extra documentation is necessary. Have another nurse cosign the order input. Tell the provider to sign the order as soon as possible. Record "T.O." at the end of the order.

Record "T.O." at the end of the order. Explanation: 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. Chapter 29: Medications - Page 842

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler? The nurse should instruct the child to prolong his/her inhalation. The nurse should use a nebulizer to administer the medication. The nurse should assess the child's mucous membranes. The nurse should provide simple written instructions.

The nurse should use a nebulizer to administer the medication. Explanation: The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Assessing the child's mucous membranes is incorrect, as this action is used to identify any break in the continuity of the membranes and will not assist with the coordination of inspiration. Providing simple written instructions is incorrect, as this will enhance the teaching/learning process of the child and not the coordination of the child's inspiration. Chapter 29: Medications - Page 865

The nurse is caring for an adult client who is receiving medication transdermally. What action by the nurse is most important to ensure the safety of the client? Donning gloves prior to administration of the patch Applying the patch to a clean, dry, hairless, and intact area of skin Writing the date, time, and nurse's initials on the new patch Removing or ensuring the removal of the previous patch

Removing or ensuring the removal of the previous patch Explanation: Removing or ensuring the removal of the patch is most important to ensure the safety of the client. Leaving the prior patch on the skin could cause an overdose of the medication since the old patch still contains medication. Donning gloves protects the safety of the nurse by preventing exposure to the medication. Applying the patch to clean, dry, and hairless skin ensures proper uptake of the medication. Applying the patch to unbroken skin is a safety concern, but not at the same urgency as a medication overdose. Writing the date, time, and who applied the medication directly on the patch helps to easily identify the patch and is good practice. Chapter 29: Medications - Page 859

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? Inform the physician about the client's absence. Leave the medication on the client's bedside table. Return the medication to the medication cart or medication room. 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. Chapter 29: Medications - Page 841

The nurse is preparing to administer a bolus of furosemide 0.8 mg to a client with congestive heart failure and kidney disease. Which right of drug administration would the nurse question and confirm in this client? Right route Right drug Right client Right dose

Right drug Explanation: To ensure safe medication preparation and administration, the nurse should practice the rights of medication administration. Right client, right drug, right dose, and right route are rights of medication administration. In this client who has kidney disease, furosemide is contraindicated. Therefore, confirming the correct medication would be crucial. Chapter 29: Medications - Page 842

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. Apply a warm compress for 5 minutes. Loosen the tourniquet slightly. Apply a topical anesthetic.

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. Chapter 29: Medications - Page 857

A nurse is teaching a patient how to use a meter-dosed inhaler to control asthma. What are appropriate guidelines for this procedure? Select all that apply. Shake the inhaler well and remove the mouthpiece covers from the MDI and spacer. Take shallow breaths when breathing through the spacer. Depress the canister releasing one puff into the spacer and inhale slowly and deeply. After inhaling, exhale quickly through pursed lips. Wait 1 to 5 minutes as prescribed before administering the next puff. Gargle and rinse with salt water after using the MDI.

Shake the inhaler well and remove the mouthpiece covers from the MDI and spacer. Depress the canister releasing one puff into the spacer and inhale slowly and deeply. Wait 1 to 5 minutes as prescribed before administering the next puff. The correct procedure for using a meter-dosed inhaler is: Shake the inhaler well and remove the mouthpiece cover; breathe normally through the spacer; depress the canister releasing one puff into the spacer and inhale slowly and deeply; after inhaling, hold breath for 5 to 10 seconds, or as long as possible, and then exhale slowly through pursed lips; wait 1 to 5 minutes as prescribed before administering the next puff; and gargle and rinse with tap water after using the MDI.

A client is receiving a secondary infusion of a new antibiotic. After 5 minutes of administration, the client reports itching and appears flushed. What is the first nursing intervention? Stop the infusion. Slow the rate of infusion. Assess the characteristics of the itching. Contact the health care provider.

Stop the infusion. Explanation: 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. Slowing the rate is inappropriate, as this will not solve the problem if the client is having a reaction. Assessing the itching and contacting the health care provider can occur after the infusion is stopped. Chapter 29: Medications - Page 908

The nurse is preparing to administer a transdermal medication. How should this be accomplished? The nurse should apply the medication directly to the skin. The nurse should inject the medication just below the dermis of the skin. The nurse should ask the client to swallow the medication. The nurse should inject the medication into a body cavity.

The nurse should apply the medication directly to the skin. Explanation: 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. Chapter 29: Medications - Page 823

A nurse who gives subcutaneous and intramuscular injections to patients in a hospital setting attempts to reduce discomfort for the patients receiving the injections. Which technique is recommended? The nurse selects a needle of the largest gauge that is appropriate for the site and solution to be injected. The nurse injects the medication into contracted muscles to reduce pressure and discomfort at the site. The nurse uses the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track. The nurse applies vigorous pressure in a circular motion after the injection to distribute the medication to the intended site.

The nurse uses the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track. The nurse should use the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. The nurse should select a needle of the smallest gauge that is appropriate for the site and solution to be injected, and select the correct needle length. The nurse should also inject the medication into relaxed muscles since there is more pressure and discomfort if medication is injected into contracted muscles. The nurse should apply gentle pressure after injection, unless this technique is contraindicated.

A medication order reads: "K-Dur, 20 mEq po BID." When and how does the nurse correctly give this drug? Daily at bedtime by subcutaneous route Every other day by mouth Twice a day by the oral route Once a week by transdermal patch

Twice a day by the oral route The abbreviation BID refers to twice-a-day administration; "po" (by mouth) refers to administration by the oral route.

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? Use a spacer or extender with the metered-dose inhaler. Provide oxygen therapy 30 minutes prior to administration. Provide multiple puffs of the medication in rapid sequence. Place the inhaler as deeply into the client's mouth as is comfortable.

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 (2.5 or 5 cm) 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. Chapter 29: Medications - Page 864

A nurse is administering medication to a client via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation? Remove the tube and replace it with a new tube. Use a syringe to plunge the tube to try to dislodge the medication. Call the physician before instituting any corrective interventions. Wait the prescribed amount of time and attempt to administer the medication again before calling the physician.

Use a syringe to plunge the tube to try to dislodge the medication. Explanation: When medication becomes clogged in the tube, the nurse should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified. The nurse should not remove the tube nor wait for a prescribed amount of time to attempt to readminister the medication. Chapter 29: Medications - Page 882-883

The nurse is administering a medication to a patient via an enteral feeding tube. Which are accurate guidelines related to this procedure? Select all that apply. Crush the enteric-coated pill for mixing in a liquid. Flush open the tube with 60 mL of very warm water. Use the recommended procedure for checking tube placement in the stomach or intestine. Give each medication separately and flush with water between each drug. Lower the head of the bed to prevent reflux. Adjust the amount of water used if patient's fluid intake is restricted.

Use the recommended procedure for checking tube placement in the stomach or intestine. Give each medication separately and flush with water between each drug. Adjust the amount of water used if patient's fluid intake is restricted. The nurse should use the recommended procedure for checking tube placement prior to administering medications. The nurse should also give each medication separately and flush with water between each drug and adjust the amount of water used if fluids are restricted. Enteric-coated medications should not be crushed, the tube should be flushed with 15 to 30 mL of water, and the head of the bed should be elevated to prevent reflux

Which client would most likely require placement of an implantable port? a 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy an 18-year-old man s/p gunshot wound in the ICU requiring multiple blood transfusions a 12-year-old girl with sickle cell anemia requiring frequent pain medication administration a 45-year-old man with a history of colon cancer that is currently in remission

a 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy This client needs frequent IV access. A central port is easily accessed for chemotherapy sessions, then the access is discontinued even though the port remains in place subcutaneously. A central port also allows for the infusion of chemotherapy into a central vessel; this is important because chemotherapy is caustic and severely damages peripheral vessels. Chapter 29: Medications - Page 833

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 client who requires daily medication to control hypertension a client who is experiencing severe and unprecedented chest pain a client whose asthma is treated with inhaled corticosteroids

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 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. Chapter 29: Medications - Page 831-832

A client reports itching and shortness of breath 15 minutes after receiving ceftriaxone 500 mg intravenously. The nurse recognizes that the client is experiencing which type of reaction? adverse drug reaction allergic reaction toxic effect idiosyncratic effect

allergic reaction Explanation: Itching and shortness of breath are signs of an allergic reaction and a possible anaphylactic reaction. An adverse drug reaction is when a client experiences nausea or other side effects, but not an allergic effect. Toxic effect is when too much medication affects an organ or the body as a whole. Idiosyncratic effect is any unusual or peculiar response to a drug. It may manifest by overresponse, underresponse, or even the opposite of the expected response. Chapter 29: Medications - Page 834

A client with chronic obstructive pulmonary disease has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client: takes rapid, shallow breaths until the medication is complete. breathes through his or her mouth until all the medication has been inhaled. coughs intermittently while the medication is being administered. rinses his or her mouth with water before the medication is administered.

breathes through his or her mouth until all the medication has been inhaled. The client should breathe through his or her mouth rather than through the nose. It is not necessary to rinse before administration or to cough during administration. Deep breathing is preferable to shallow breathing because this improves absorption. Chapter 29: Medications - Page 865-866

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection? checking for documented allergies to food or drugs preparing the syringe with the medication cleaning the area with an alcohol swab gathering all the equipment needed

checking for documented allergies to food or drugs Explanation: 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. Chapter 29: Medications - Page 849

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration? client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination client who is beginning treatment with chemotherapy following a diagnosis of ovarian cancer client who is diagnosed as having sepsis and is prescribed antibiotic therapy client who is in the emergent phase of a 50% partial-thickness (second-degree) burn and requiring medication for pain

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination Explanation: The hepatitis B vaccine is administered intramuscularly. Recombivax HB, a form of the hepatitis B vaccine, may be administered subcutaneously to clients who are at high risk for hemorrhage. This client is low risk. Medications for the clients experiencing the situations listed would be administered intravenously. Chapter 29: Medications - Page 856

The nurse is administering a rectal suppository. How far will the nurse insert the suppository? past the internal sphincter just past the opening of the anus far enough to still visualize the end of the suppository until the client reports feelings of discomfort

past the internal sphincter Explanation: To be effective, a suppository must be inserted past the internal sphincter, which is about the distance of the finger of insertion. Chapter 29: Medications - Page 864

The nurse beginning a shift has received a report from the previous nurse, who reports that a client has a catheter inserted into the subclavian vein. The oncoming nurse will plan to assess which type of catheter? Hickman catheter Broviac catheter Groshong catheter peripherally inserted cutaneous catheter

peripherally inserted cutaneous catheter Explanation: A peripherally inserted cutaneous catheter is a type of nontunneled percutaneous catheter that is inserted into a peripheral vein with the distal end terminating in the axillary vein, subclavian vein, or superior vena cava. Hickman, Broviac, and Groshong catheters are types of tunneled catheters that are inserted into a central vein with part of the catheter secured in the subcutaneous tissue. Chapter 29: Medications - Page 921

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 container with enough prescribed medications for several days for a client self-contained packets that hold one tablet or capsule for individual clients a supply that remains on the nursing unit for use in an emergency systems that contain frequently used medication for that unit

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. Some facilities use automated medication-dispensing systems, which contain frequently used medications for that unit, any as-needed (PRN) medications, controlled medications, and emergency medications. Chapter 29: Medications - Page 834

The nurse is preparing to withdraw liquid medication from an ampule for injection into an IV. What is the appropriate action for the nurse to take when withdrawing the medication? use a needleless IV injector withdraw the medication and then squirt some of the medication out before injecting choose a smaller needle for injection so no particles will enter the syringe use a filter needle to withdraw the medication

use a filter needle to withdraw the medication Explanation: Filter needles should be used whenever withdrawing medication for injection from an ampule, due to the risk of glass particles being aspirated into the syringe. The filter needle contains a membrane that acts as a barrier by blocking the entrance of glass shards. A needleless injector will not protect the client from inadvertent glass shards in the solution. Squirting out some of the solution will not eliminate the potential for glass shards and may cause the client to receive a lower dose of medication than is required. A smaller needle will not filter out the glass particles that may be present. Chapter 29: Medications - Page 847

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client? dorsogluteal site ventrogluteal site vastus lateralis site deltoid site

vastus lateralis site Explanation: The vastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles. The dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed. The ventrogluteal site, however, is safe for children. The deltoid site is the least-used intramuscular injection site because it is a smaller muscle than the others. It is used only for adults because the muscle is not sufficiently developed in infants and children. Chapter 29: Medications - Page 853

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients? gluteus maximus ventrogluteal rectus femoris upper chest

ventrogluteal The ventrogluteal or deltoid muscles may be the preferred intramuscular sites for older adult clients experiencing impaired mobility. This site has the potential of retaining greater muscle mass longer than other sites. It is also usually less painful for the client. The dorsogluteal site, which has the gluteus maximus, should be avoided because of the risk of damage to the sciatic nerve with diminished musculature. The rectus femoris site is most suitable for infants. The upper chest muscle is part of intradermal injections, not intramuscular injections. Chapter 29: Medications - Page 853