Chapter 29- 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." Explanation: 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 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?

"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.

The nurse is caring for an older adult client who sees several different health care providers and specialists. Which question will the nurse ask?

"Do you get all of your medications filled at the same pharmacy?" Explanation: Polypharmacy is a concern in the older adult population. The nurse will want to know if medications are filled at the same pharmacy, as this is often where pharmacists will note discrepancies in medications prescribed or duplicate orders written by different providers. The other questions posed are not helpful.

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

"I will call the health care provider if I develop dizziness, blurred vision, or nausea." Explanation: Digoxin is a cardiac glycoside that slows the heart rate and strengthens myocardial contraction. It is imperative to keep therapeutic blood levels of this medication. As such, teaching the client to report signs and symptoms of digitalis toxicity such as dizziness, blurred vision, nausea, and vomiting is imperative. Usually, dietary potassium is increased, not decreased, while taking this medication. Digitalis slows myocardial conduction and should be taken if the heart rate is higher than 100 beats/min. If the heart rate is lower than 60 beats/min, the dose should be held, and the health care provider should be notified. Digitalis is stored at room temperature, not in the refrigerator.

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long-term use of nasal sprays can cause rebound nasal congestion." Explanation: Saying that long-term use of nasal sprays can cause rebound nasal congestion is correct, as this usually occurs when nasal sprays are used repeatedly by clients. Long-term use of nasal sprays cannot cause difficulty in coordinating breathing; this is more applicable with inhalers than with nasal sprays. Long-term use of nasal sprays do not repair the nasal passage; instead, they damage the nasal passage. Long-term use of nasal sprays does not cause an unpleasant taste; this is more appropriate with inhalers and not nasal sprays.

Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply.

"The cylinder of the insulin pen contains a prefilled reservoir of insulin." "The dose of insulin in an insulin pen is displayed in a window of the syringe." "The insulin pen automatically resets the dose window to zero, following the injection." Explanation: The cylinder of an insulin pen contains a prefilled reservoir of insulin because insulin comes prepared. The dose of insulin in an insulin pen is displayed in a window of the syringe, making it easier for the client see the remaining dose. Insulin pens automatically reset the dose window to zero following the injection; this minimizes client error. The cylinder of the insulin pen is made out of hard plastic, not soft plastic, to allow the client to grasp it like a pen. Insulin pens are more expensive, not less expensive, than insulin vials.

A nursing student is teaching the client regarding insertion of a central line catheter. Which statement by the student would cause the nurse to intervene?

"The risks are the same for a central line as they are for peripheral lines." Explanation: Clot formation, pneumothorax, and bacteremia risks are higher with a central line. As a result, the risks associated with central line placement are higher than those associated with a peripheral IV. Other options are correct regarding central lines.

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide?

"Wait 5 minutes between instillation of different types of eye drops." Explanation: The nurse will teach the patient to wait 5 minutes between instillation of different types of eye drops to facilitate best absorption. The dropper should not touch the eye, as this increases the possibility of contamination. Devices are available to facilitate administration if a client has trouble using the bottle. These types of drugs should be discarded after 28 days to prevent bacterial contamination.

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees Explanation: Intradermal injections are given at a 10- to 15-degree angle. Other answers are incorrect.

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle Explanation: A 15-degree angle is correct, as this allows the drug to be injected between the layers of the skin. A 45-degree angle is incorrect, as this will allow the drug to be injected beneath the skin but above the muscle. A 90-degree angle is incorrect, as this will allow the drug to be injected in the muscle. A 120-degree angle is incorrect, as this will be more suitable for intravenous injections.

The nurse has a prescription to administer 25 mg of furosemide IV to a client. The drug is supplied in a vial 40 mg/4 ml. How many milliliters will the nurse administer of the medication? Record your answer using one decimal place.

2.5 Explanation: Dose on hand = Dose desired ÷ X 40 mg/4 ml = 25 mg ÷ X 40X = 100 X = 100/40 = 2.5 mg

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?

90 degrees Explanation: Insulin injections are given subcutaneously to clients with obesity at a 90-degree angle. Other answers are incorrect.

It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client?

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.

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. 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.

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

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller. Explanation: The larger the gauge, the smaller the needle. An obese person requires a longer needle to reach muscle tissue than does a thin person. When giving an injection, the viscosity of the medication directs the choice of needle gauge. The size of the syringe is directed by the amount of the medication to be given.

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. Explanation: If tenderness, fever without obvious source, or symptoms of local or bloodstream infection are present, remove the dressing and inspect the site directly.

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. Explanation: When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. 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.

The nurse observes a prescription written for a client for a medication that does not correlate with the client's diagnosis or comorbid factors. What is the best action for the nurse to take?

Call the provider to obtain a rationale for the use of the medication for the client Explanation: If the nurse is unsure of the medication or the reason for administration, it is best to ask to avoid improper medication administration. Human error is not unusual, and it would be in the best interest of the client and nurse to clarify any prescriptions that are unclear.

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. Explanation: 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.

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. Explanation: Checking the expiration date on liquid medication can ensure the medication is at the desired potency, because liquid medications may become stronger or weaker with the passing of time. Administering an expired medication could have a deleterious effect on the client. Determining an odor does not ensure the potency of the medication, because many liquid medications have an odor that is not pleasant. Returning the medication if the label is unclear is a step to take to ensure safe administration, but this action does not determine the potency of the medication.

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

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.

The nurse is preparing to administer eye drops to a client with glaucoma. A discrepancy is noted between dosage recorded on the medication administration record (MAR) and what the client states he or she takes daily at home. Which action should the nurse take?

Contact the health care provider for clarity. Explanation: Anytime a discrepancy is noted between what is prescribed and what the client states, the nurse should pause to contact the health care provider for clarity. It should not be assumed that the client or the MAR is correct, nor should the nurse simply skip the current dose of medication.

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. Explanation: 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 a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid Explanation: The deltoid is the best site for this medication. Biologicals for infants and young children are administered at the vastus lateralis. The ventrogluteal site is used for depot formulations and irritating medications. The scapula is a site for an intradermal injection.

The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse?

Determine compatibility of the insulins by checking a drug compatibility table. Explanation: The first step in mixing two types of insulin in one syringe is verifying compatibility. Some insulins cannot be mixed together. The other steps are appropriate but should be completed after determining compatibility.

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. Explanation: The nurse must determine the compatibility of the two drugs; some drugs can be safely combined in a single syringe. However, this is not determined by paging the health care provider. There is no need to change the times of administration.

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location. Explanation: The assessment reveals the IV has infiltrated. The nurse should stop the IV fluid and remove the IV from the extremity, then restart the IV in a different location. Applying a cool, moist compress or slowing the rate will not address the problem of the IV fluid going into the surrounding tissue instead of the vein. Monitoring the site is not appropriate, because there is already a complication present that requires action by the nurse.

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues?

Distribution Explanation: The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver.

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?

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.

A client is being started on total parenteral nutrition (TPN). When initiating the therapy, the nurse gradually tapers up the infusion rate as ordered to prevent which potential complication?

Hyperglycemia Explanation: Metabolic complications also may present a problem for the client receiving TPN. Most commonly, clients experience hyperglycemia if they are unable to tolerate the high glucose content of the TPN solution. When therapy is initiated, the infusion rate is usually tapered up over a period of a day or two. Using strict aseptic technique during catheter manipulations, dressing changes, and tubing and bottle changes helps to reduce the risk for infection. Air embolism and pneumothorax are potential complications that are associated with central line placement, not TPN administration

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation?

IV Infusion Explanation: Intravenous infusion is the fastest route of administration because the medication goes into the bloodstream immediately and is dispensed over a period of time which is needed in pulmonary hypertension. The second fastest route is an injection because they are quickly absorbed into vessels. Oral medication is a slow route and should not be used in an emergency situation. Medication via patches would not administer the medication quickly enough in an emergency situation. Inhalation medications are specifically given for respiratory issues.

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. Explanation: 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.

A nurse is administering a client's analgesic by the subcutaneous route. What should guide the nurse's action?

Inject into the adipose tissue layer just below the epidermis and dermis. Explanation: Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. Subcutaneous injections do not enter muscle tissue. Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventrogluteal area. Subcutaneous injections are administered at a 45- to 90-degree angle, based on the amount of subcutaneous tissue present and the length of the needle. Pinching is advised for thinner clients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue.

Which parenteral route of administration has the longest absorption time?

Intradermal Explanation: Medicines are absorbed the fastest in areas of the body that contain the greatest blood supply. Intradermal injections are administered into the dermis, just below the epidermis, and this route of administration has the longest absorption time. Intravenous drugs are absorbed immediately because they are administered directly into the bloodstream. Intramuscular injections are faster than subcutaneous because muscle has more blood flow.

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. 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.

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. Explanation: The nurse's ongoing verification of the IV solution and the infusion rate with the physician's order is essential. If more than one IV solution or medication is ordered, the nurse should make sure the additional IV solution can be attached to the existing tubing. As one bag is infusing, the nurse should prepare the next bag so it is ready for a change when less than 50 mL of fluid remains in the original container. Every 72 hours is recommended for changing the administration sets of simple IV solutions.

A nurse is caring for a client on IV therapy. The IV tubing has a volume-control set. Which of the following is a function of the volume-control set?

It is used to administer small volumes of IV medication. Explanation: A volume-control set is used to administer a small volume of IV medication at intermittent intervals to avoid accidentally overloading the circulatory system. A volume-control set is used to administer IV medication at intermittent intervals, not continuously. It is not a volume-control set but a central venous catheter that is used to administer medication in a large volume of blood and when IV medications are irritating to peripheral veins.

The nurse is caring for a client who has been prescribed an enteric-coated drug. Which should the nurse include when teaching the client proper administration of this drug?

It should not be chewed or crushed. Explanation: The nurse should inform the client that enteric-coated drugs should not be chewed, crushed, or cut because if the integrity of the coating is impaired, it dissolves prematurely in the gastric secretions and can irritate the lining of the stomach (or be absorbed too quickly). Solid oral drugs that are not enteric-coated may have a groove so that they can be cut into pieces. Capsules, not enteric tablets, can but should not be opened. Enteric drugs are not available in liquid form.

Which contains all the components of a valid order?

John Smith, atenolol 50 mg, twice a day, by mouth Explanation: 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. Explanation: Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

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 Explanation: A PRN order is one that is given to a client on an "as needed" basis.

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

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

After administering ear drops to a client, how does the nurse ensure the medication is delivered completely?

Place gentle pressure on the tragus after administration. Explanation: The nurse applies gentle pressure to the tragus after administering ear drops to move the medication from the canal toward the tympanic membrane. A cotton ball, if inserted, would also help prevent the medication from leaking out of the ear. Pulling the pinna up and back and positioning the client's head correctly is proper technique but does not assist the medication in getting to the eardrum. Not allowing the dropper to touch the ear reduces the risk of contamination of the dropper but has nothing to do with the tragus.

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, "I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it." What would the nurse do to address this situation?

Provide education on taking all antibiotics for effective treatment Explanation: Although benefits of antibiotics may be felt in a few days after starting therapy, the nurse will teach the client that the entire course of medication must be taken to rid the body of infection. Discontinuing the antibiotic prematurely may cause the infection to reoccur. The incomplete use of an antibiotic is one factor that contributes to the evolution of resistant microbial organisms so the nurse would not instruct the client to returning to the previous regimen. Consulting the health care provider for alternate treatment options may or may not be applicable and also is not particularly the most important. The mixture of antibiotics would typically not be prescribed in this client.

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

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. Explanation: The nurse should use the Z-track technique. It is generally used with medications that are irritating to the tissues, and it can be used routinely for all IM injections, provided that the overlying tissue at the chosen site can be displaced by at least 1 in (2.5 cm). The procedure includes pulling the skin and subcutaneous tissue 1 to 1.5 in (2.5 to 3.75 cm) to one side of the injection site while injecting. The intramuscular method is performed by pulling the skin taut between two fingers while injecting. The subcutaneous method of injection is performed while the skin is pinched up between two fingers. The intradermal method of injection is performed by placing the needle, bevel up just under the skin.

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. 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.

Which nursing action(s) promotes safety in preparation of medication? Select all that apply.

Return medications with obscured labels to the pharmacy. Note the expiration dates on liquid medications. Prepare medications in well-lit conditions. Explanation: Agency policy differs slightly on which medications require cosignage and which do not. Typically, narcotics and controlled substances require that the dose be double-checked by another nurse and cosigned. All other medications can be signed for and administered by one nurse independently. If the nurse is not able to read the label of a drug, it is not safe to administer. Even if it means the drug may be administered late, the nurse must return it to pharmacy and request that it is appropriately labelled so the nurse is able to complete all the rights of administration. Noting expiration dates on liquid medications is important because they are not safe to administer once past the expiry date. By preparing medications in well-lit conditions, the nurse is safeguarding from giving the a medication to the wrong client or giving the wrong drug at the wrong time. The environment in which medications are prepared for administration is a critical aspect of safety. Medication prescriptions should be written in legible writing on a health care provider prescription sheet whenever possible. If the prescribing health care provider is present when the prescription is made, a verbal prescription should not be taken. Verbal prescriptions have been found to lead to serious errors and should be used sparingly.

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. Explanation: 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

A nurse who is administering a piggyback intermittent intravenous infusion of medication to a client observes that there is a cloudy, white substance forming in the IV tubing. Which actions should the nurse take in this situation? Select all that apply.

Stop the IV from flowing and stop administering the medication. Clamp the IV at the site nearest to the client. Replace tubing on primary and secondary infusions. Explanation: The nurse must stop the IV from flowing and stop administering the medication, then clamp the IV at site nearest to the client. The administration tubing must be changed and then the infusion can be restarted. The nurse should check literature or consult the pharmacist regarding compatibility of the medication and IV fluid before, not after, administration. Priming the secondary tubing by backfilling it will not correct the drug incompatibility.

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention?

Stop the infusion of the antibiotic. 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. The nurse will proceed to assure that there is an open airway, assess the skin for rash, and activate the Rapid Response Team if needed.

A nurse needs to administer a subcutaneous injection to a client. Which techniques should the nurse use to reduce discomfort? Select all that apply.

Support the client's tissue when withdrawing the needle. Numb the skin with an ice pack before the injection. Insert and withdraw the needle without hesitation. Instill the medication slowly but steadily. Explanation: The nurse can reduce discomfort associated with injections by using alternative techniques such as numbing the skin with an ice pack before the injection, inserting and withdrawing the needle without hesitation, and instilling the medication slowly and steadily. Nurses use the Z-track method for intramuscular injections, not for any other injection. Supporting the tissue during withdrawal reduces discomfort.

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?

Tactfully request the provider to input the order into the computerized provider order system. Explanation: Providers are to enter their own orders when they are physically present. It is appropriate for the nurse to tactfully request that the provider do so. The nurse should not input the order, nor refuse to implement it.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?

Therapeutic range Explanation: Therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. Peak level is the highest plasma concentration. Trough level is the point when the drug is at the lowest concentration. Half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body.

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 Explanation: The metric system is the most widely accepted and convenient system of measurement for drug administration and the strength and frequency of the dose also are indicated (e.g., digoxin 0.125 mg daily). The system is measured by 10s and can easily be consistently converted to other increments; i.e. .25 m = 25 cm = 250 mm. A recommended mistake-proofing practice when administering medications using the metric system is never to use trailing zeros (e.g., 5 mg, never 5.0 mg); using trailing zeros increases the likelihood of an error. A mistake-proofing practice is to always use leading zeros for doses less than one measurement unit (e.g., 0.3 mg, never .3 mg); it does not prevent errors by omitting leading zeros. The metric system does not utilize fractions and Arabic numbers and is not based on commonly used household measurements.

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. Explanation: 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. Explanation: 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. 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.

A postoperative client's medication administration record (MAR) provides for PRN administration of a number of analgesics by various routes. Which action should the nurse take to assess the client's pain to determine the appropriate analgesic to administer?

The nurse will have the client rate pain on the pain scale of 1 to 10 and proceed accordingly. Explanation: By assessing the client's pain using the pain scale the nurse can determine how severe the pain is and act accordingly. Intravenous drugs, because they are introduced directly into the circulatory system, have an onset that is faster than that of intramuscular (IM), subcutaneous (SC), or by mouth (PO) routes. IM and SC injections have to penetrate the muscles and tissues to be circulated in the body, which takes about 30 to 45 minutes. PO takes about 45 to 60 minutes for onset of action, as the drug needs to be digested in the stomach and then get into the circulation via the portal or hepatic vein.

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. Explanation: 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.

The primary reason for the Controlled Substances Act is:

to prevent drug use and dependence. Explanation: 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.

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

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.

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

all at once Explanation: Bolus administration is given into a vein all at one time. All other answers are incorrect.

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

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.

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?

decreased irritation and pain in subcutaneous tissue Explanation: This technique is Z-tracking. The Z-track technique allows the medication to be administered into the muscle tissue with no tracking of medication in the subcutaneous tissues as the needle is removed, resulting in less pain and irritation.

There have been an increase of needlestick injuries in the intensive care unit. When preparing to address this occurrence in a staff meeting, what should the nurse manager include in an education presentation to prevent needlestick injuries? Select all that apply.

disposing of used needles in sharps container using self-retracting safety needles Using needleless adapters for medication administration Explanation: To avoid needlestick injuries, the nurse should dispose of needles in appropriate sharps containers, should not attempt to recap needles, and should utilize self-retracting safety needles when performing venipuncture. Use needleless adapters whenever possible for all other IV maintenance and medication administration. Although observing Standard Precautions limits provider exposure to bloodborne pathogens, especially hepatitis B and HIV, gloves do not help to avoid needlestick injuries.

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch?

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.

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

medications that need to be infused over 20 to 60 minutes Explanation: Intermittent infusions are used for medications that need to be administered for an intermediate length of time, usually 20 to 60 minutes. The intravenous push technique is used for medications that can be given over 1 minute for rapid therapeutic effect, and may be given into a continuously infusing IV set or into a capped IV port. The continuous infusion technique is used for medications that are toxic if given over short periods.

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

miconazole Explanation: 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.

When administering heparin subcutaneously, the nurse should:

never aspirate. Explanation: When administering heparin subcutaneously, never aspirate before administration.

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

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.

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 Explanation: The nurse should place the secondary infusion higher than the primary infusion. This will allow the secondary infusion to infuse first. When completed, the primary infusion will continue to infuse. The other options are not correct.

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 Explanation: 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.

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

review the client's medication, allergy, and medical history Explanation: To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least 3 times (before, during, and after preparing the medication) to ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications.

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?

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.

The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client?

spacer Explanation: A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption, because it prevents drug loss. A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. Nasal drops are liquid medication sprayed or dropped into the client's nose. These, however, would not help in maximizing the absorption of the medication.

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client?

supine Explanation: To best facilitate instillation of nasal medication via a dropper, and to ensure that the drug is administered into the place where its effects are desired, the nurse will place the client in supine position. The other positions are not appropriate.

Drugs known to cause birth defects are called:

teratogenic. Explanation: Drugs know to cause birth defects are called teratogenic.

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?

to determine the extent to which the client responded to the drugs Explanation: Determining the extent to which the client has responded to the drugs is correct, as this allows the nurse to observe the area for signs of local reaction in which the standard time is 24-48 hours. Ensuring that emergency treatment is quickly administered is incorrect since the nurse is to observe the client for allergy to the test in the first 30 minutes. Reducing the risk for the transmission of microorganisms is incorrect since this could be achieved by the nurse removing gloves and performing hand hygiene immediately after administering the drug. Preventing interference with test results is incorrect, as the nurse could instruct the client not to rub the area

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 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.

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

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.