Chapter 29: Medications

Drugs known to cause birth defects are called:

nosocomial. pregnancy sensitivity. umbilical cross. **teratogenic.

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?

shorter length greater length **larger diameter smaller diameter

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

10 to15 degrees 20 to 30 degrees 45 degrees **90 degrees

A pediatric client has a fever for which the provider has prescribed ibuprofen 200 mg orally every 6 hours. The instructions on the bottle indicate there is 100 mg/5ml. How many milliliters should the nurse give? Record your answer using a whole number.

10mL

The nurse is teaching a client about the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate XR. When the client asks, "What does the XR mean?" what is the appropriate nursing response?

"Continuous release." "Sustained action." "Sustained release." **"Extended release."

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?

"I will ask the health care provider to cancel the prescription for aspirin since you are unable to take it." "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."

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

"Reconstitution is a sealed glass drug container that must be broken to withdraw the medication." **"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance." "Reconstitution is a sealed glass cylinder of parenteral medication with an attached needle." "Reconstitution is a glass or plastic container of parental medication with a self-sealing rubber stopper."

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." "I will apply this as frequently as prescribed." "I understand that this drug may lower my blood pressure." "I will wear gloves when applying this."

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 get the hospital's information system's phone number for you." "I will log in so that you can proceed with medication delivery." "I am giving you my password so you can log in." "I can log in and give the medications for you."

A client with gastritis who is taking aspirin for cardiovascular prophylaxis asks the nurse whether there is benefit in buying the enteric-coated product. What is the appropriate nursing response?

**"The enteric coating will protect your stomach." "There is no difference between the enteric-coated product and the regular one." "Enteric coated products are significantly more expensive." "That is the only way that aspirin is sold."

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer?

**0.5 1.5 2 4

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

**1 mL 0.05 mL 3 mL 0.01 mL

A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the first assessment the nurse should make?

**Assess the IV site for redness. Assess the client's blood pressure. Monitor the IV infusion rate. Assess the vaginal mucosa.

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. How will the nurse respond?

**Bunching your skin facilitates the placement of the needle in the subcutaneous tissue." "Bunching your skin ensures complete delivery of the insulin." "Bunching your skin steadies the syringe." "Bunching your skin controls bleeding."

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

**Check the expiration date. Determine if there is an odor from the medication. Prepare the medication with good lighting. Return the medication if the label is unclear.

A nurse is applying a vaginal cream to a client with a fungal infection. Which guideline is recommended for this application?

**Cleanse area at vaginal orifice with washcloth and warm water. Spread the labia with dominant hand and introduce the applicator gently with the nondominant hand. Position the client in a left side-lying position. Wipe from the sacrum to the vaginal orifice upward (back to front).

A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action?

**Determine the compatibility of the two drugs by consulting clinical resources. Page the health care provider to determine whether the drugs can be mixed. Collaborate with the pharmacy to have one of the times changed. Recognize that it is not safe to mix two medications in one syringe.

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 Anterior aspect of the thigh Abdomen Shoulder

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered?

**PRN order standing order stat order one-time order

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. Tell the provider to sign the order as soon as possible. No extra documentation is necessary. Have another nurse cosign the order input.

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?

**Return the medication to the medication cart or medication room. Inform the head nurse about the client's absence. Inform the health care provider about the client's absence. Leave the medication on the client's bedside table.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

**The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements It ensures accuracy by expressing quantities in fractions and Arabic numbers It prevents errors by never using leading zeros for doses less than one measurement unit It uses a system based on household measurements which are easily understood and measured

The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication?

**in the anterolateral aspect of the thigh in the gluteus maximus muscle in the buttocks in the lower abdomen in the lateral aspect of the upper arm

Which action describes buccal medication administration?

**placing a medication underneath the upper lip or in the side of the mouth placing a medication under the tongue and allowing it to dissolve placing a medication through a nasogastric tube placing a medication that is designed to be absorbed through the skin for systemic effects on the skin

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity?

**placing the secondary infusion higher than the primary solution stopping the primary solution until the secondary infusion is completed placing the secondary and primary infusion at equal height placing the primary solution higher than the secondary solution

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 squeezing prescribed amount of paste from tube onto application paper using wooden applicator to spread paste over the paper covering application paper with plastic with transparent semipermeable dressing

The nurse is to administer levothyroxine 0.125 mg PO at 0600. The package is labeled levothyroxine 125 mcg. Calculate the number of tablets the nurse will administer. Record your answer as a whole number.

1 Tablet

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication?

35-year-old client diagnosed with migraines 45-year-old client diagnosed with lung cancer **73-year-old client diagnosed with liver disease 16-year-old client diagnosed with left radial fracture

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Administer the drugs through the same tubing. **Consult a current drug reference book for IV compatibility. Prepare to administer through two separate tubes. Hold one medication for an hour and administer it after the first medication.

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?

Assess the characteristics of the itching. **Stop the infusion. Contact the health care provider. Slow the rate of infusion.

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

Assume that the client is the authority on whether or not the medication was swallowed. If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. **If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. If a client vomits immediately after receiving oral medications, readminister the medication.

The nurse is preparing a client newly prescribed digoxin for discharge. Which safety consideration should the nurse include in the client teaching?

Check your radial pulse before taking the medication each day.

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?

Cleanse the tip of the container with an alcohol swab. Ask the client to close his eyes for 15 to 30 seconds prior to administration. **Ensure that drops of the medication fall onto the client's conjunctival sac. Apply a few drops of normal saline to the eye to irrigate the eye.

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?

Discard the remaining drug. Draw up the remaining medication to give at the next time of administration. Send the vial with the remaining drug back to the pharmacy. **Place the date on the vial and retain for future use.

A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse's appropriate response?

Have another nurse witness and record the order into the medication administration record (MAR). **Tactfully request the provider to input the order into the computerized provider order system. Refuse to implement the order and notify the nurse manager. Input the order into the computerized provider order system.

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the client indicates teaching was effective?

I will decrease the amount of potassium in my diet." "If my pulse is higher than 100 beats/min, I will hold the dose." "I will store this medication in the refrigerator." **"I will call the health care provider if I develop dizziness, blurred vision, or nausea."

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?

Immediately repeat the application in the second ear if prescribed. Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back. Clean the external ear of drainage with cotton balls moistened with water or normal saline solution. **Ask the client to remain lying down for at least 5 minutes.

The nurse is administering the first dose of an intravenous infusion of an antibiotic. What action would the nurse take next?

Instruct the client to report any difficulty breathing. Document the total volume infused. Assess the client after completion of infusion. **Stay with the client during the first 15 minutes of infusion.

Which parenteral route of administration has the longest absorption time?

Intravenous Intramuscular **Intradermal Subcutaneous

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 has propellers that get activated during inhalation. **It is a canister that contains pressurized medication. It is a battery-operated device that spins. It suspends finely powdered medication.

The nurse is preparing to administer an intramuscular (IM) injection into a client. Which procedure should the nurse use to administer the injection?

Pull the skin taut between two fingers while injecting. Pinch the skin up between two fingers while injecting. **Pull skin and subcutaneous tissue 1 to 1.5 in (2.5 to 3.75 cm) to one side of the injection site while injecting. Insert the needle until the entire bevel lies immediately under the skin while injecting.

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

Request counseling on the potential for infection. Obtain the client's blood to be tested for HIV and HBV. **Report the needlestick to the nurse manager. Document the injury.

The nurse is preparing to withdraw medication from an unbroken glass ampule. Which nursing actions are appropriate? Select all that apply.

Snap the neck of the ampule while holding it close to the nurse's body. **Invert the ampule to withdraw medication. **Avoid allowing the needle to touch the outside of the ampule. **Tap the top of the ampule. Don sterile gloves before opening the ampule.

The nurse is preparing to administer a medication to a client when the client states, "Last time I took that medication, I broke out in hives." What is the priority action by the nurse?

Substitute another medication with the same action Administer the medication and monitor the client for 30 minutes after administration **Withhold the medication and notify the health care provider that ordered the medication Administer the medication, the reaction may not occur again

The nurse is caring for a client receiving D5 ½ NS + 20 mEq KCl/L infusing per pump at 125 mL/hr. The nurse prepares to administer 40-mg furosemide IVP. Which actions should the nurse take? Select all that apply.

The second flush is at the same rate as the drug. Cleanse the infusion port closest to the pump. **Stop the infusion pump and clamp the line. **Provide the medication at the recommended rate. **The first flush is at the same rate as the drug.

The nurse is educating a client on how to self-administer subcutaneous insulin injections. The client asks why the needle must be removed at the same angle as that of insertion. How will the nurse respond?

This verifies correct injection of the drug. It prevents needlestick injuries. **It minimizes tissue trauma. This helps to control placement of the needle.

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?

Use cold water when mixing powdered medications. **Avoid crushing sustained-release pellets. Add medications to the formula. Mix all the medications together in 15 mL of water.

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?

Wait the prescribed amount of time and attempt to administer the medication again before calling the physician. Call the physician before instituting any corrective interventions. **Use a syringe to plunge the tube to try to dislodge the medication. Remove the tube and replace it with a new tube.

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?

Wait until day 5 of treatment. 1200 **1500 2000

A health care provider at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler?

a device that forces medication through a narrow channel with the help of inert gas a device that forces liquid drug through a narrow channel using pressurized air a propeller-driven device that spins and suspends a finely powdered medication **a canister containing medication that is released when the container is compressed

The rapid response team is present while a client is receiving cardiopulmonary resuscitation (CPR). The health care provider informs the nurse to administer a dose of epinephrine IV. Which method of medication will the nurse obtain?

an automated medication dispensing system a unit dose supply **a stock supply an individual supply

The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangement does the nurse anticipate in the discharge plan of care?

assisted living arrangement long-term care facility admission continued inpatient admission **home nursing visits

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

deltoid site **vastus lateralis site ventrogluteal site dorsogluteal site

The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe?

less frequent administration of the medication decreased risk for infection more rapid administration of the medication **decreased irritation and pain in subcutaneous tissue

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?

electronic infusion device **bolus administration secondary administration continuous administration

The client cannot swallow and just had an enteral tube placed for feeding and medications. Medications will have to be in liquid form or crushed for administration. The client has the following medications prescribed. Which medication will the nurse withhold and consult with the health care provider?

furosemide liquid **oxycodone extended release tablet acetaminophen tablet aspirin chewable tablet

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 upper chest rectus femoris **ventrogluteal (deltoid muscles)

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

intravenous intramuscular **intradermal subcutaneous

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

once daily at least every 8 hours every 72 hours **before and after each medication administration

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered?

over 3 hours **all at once in tandem with another medication over the duration of a 12-hour shift

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?

toxic effect adverse drug reaction idiosyncratic effect **allergic reaction