CNF Exam 2: Medications (28)

The nurse is teaching a client about using two inhalers. Which client statement reflects that nursing teaching has been effective? - "I should be careful to refrain from shaking the canisters of medication." - "I will breathe in for about 10 seconds, and exhale quickly." - "I must wait at least 1 full minute between inhalers." - "I will wash the holder in warm water mixed with some bleach."

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

Which statement by a client indicates to the nurse that teaching was effective regarding the different parts of a syringe? - "The plunger is the part of the syringe that moves back and forth to withdraw and instill medication." - "The barrel is the part of the syringe that resets the dose window to zero following an injection" - "The barrel is the part of the syringe to which the needle is attached." - "The plunger is the part of the syringe that holds the medication."

"The plunger is the part of the syringe that moves back and forth to withdraw and instill medication." The plunger is that part of the syringe that moves back and forth to withdraw and instill the medication. Therefore, this statement is correct. The barrel not resetting the dose window to zero following an injection is one of the characteristics of an insulin pen, and is therefore incorrect. It is the tip the syringe to which the needle is attached, and not the barrel. The plunger does not hold the medication; the barrel does.

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

"Use an insulin syringe and give 20 units." Insulin doses are calculated in units. The scale commonly used is U100, based on 100 units of insulin contained in 1 mL of solution. The adult client is taught to measure by units, not mL.

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.

- Contact the provider to report the error. - Assess Client B thoroughly. - Complete an incident report. 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.

Which actions would a nurse perform after selecting a site and palpating accessible veins in order to start an IV infusion? Select all that apply. - Clean the entry site with saline, followed by an alcohol swab according to agency policy. - Place the dominant hand about 4 in (10 cm) below the entry site to hold the skin taut against the vein. - Enter the skin gently with the catheter held by the hub in the non-dominant hand, bevel side down, at a 10- to 30-degree angle. - Advance the needle or catheter into the vein. A sensation of "give" can be felt when the needle enters the vein. - When blood returns through the lumen of the needle or the flashback chamber of the catheter, advance device into the vein until the hub is at the venipuncture site. - Release the tourniquet, quickly remove the protective cap from the IV tubing, and attach the tubing to the catheter or needle.

- Release the tourniquet, quickly remove the protective cap from the IV tubing, and attach the tubing to the catheter or needle. - When blood returns through the lumen of the needle or the flashback chamber of the catheter, advance device into the vein until the hub is at the venipuncture site. - Advance the needle or catheter into the vein. A sensation of "give" can be felt when the needle enters the vein. The needle or catheter is advanced into the vein once the sensation of "give" can be felt when the needle enters the vein. This allows the needle or catheter to enter the vein with minimal trauma and deters passage of the needle through the vein. The tourniquet is released once there is a flashback of blood because the tourniquet causes increased venous pressure, resulting in automatic backflow. Placing the access device well into the vein helps to prevent dislodgement. The site is cleansed with an antiseptic solution such as chlorhexidine, or according to facility policy. The nurse should use the non-dominant hand placed about 1 or 2 inches (2.5 or 5 cm) below the entry site, holding the skin taut against the vein to allow for easier insertion of the IV needle/catheter.

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?

A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication.

A severe allergic reaction from a medication requires:

A severe allergic reaction, called an anaphylactic reaction, requires immediate medical intervention because it can be fatal. Treatment includes discontinuing the medication and administering epinephrine, IV fluids, and antihistamines.

A client has a central venous catheter inserted. The nurse understands that the tip of the catheter would be found at which location?

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.

A patient was admitted to the hospital's obstetrical unit yesterday afternoon and the nurse is now administering the patient's scheduled 8 AM medications. The patient asks the nurse why she is not receiving a dose of levothyroxine (Synthroid) stating, "I've been taking it at home for my whole pregnancy." Which of the nurse's following actions is most appropriate? - Assess the patient for signs and symptoms of hypothyroidism. - Consult the medication reconciliation that was performed on admission. - Educate the patient about differences between outpatient and inpatient drug regimens. - Document the patient's query in the narrative notes of the patient's chart.

Consult the medication reconciliation that was performed on admission. Medication reconciliations allow the institution's care team to track and cross-reference the medications that the patient was taking in the community. The patient would be unlikely to show signs of hypothyroidism after one missed dose, and this assessment is not a wholly sufficient response to a medication order than may have been overlooked. Similarly, documenting the patient's question in the narrative notes does not guarantee a timely resolution. Educating the patient about the differences between outpatient and inpatient drug regimens may be construed as downplaying the patient's concerns.

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

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

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

Insulin injections are given subcutaneously to clients with obesity at a 90 degree angle.

When educating an older adult client about the administration of medication during discharge, the nurse notes that the client is having difficulty comprehending the instruction. What intervention should the nurse follow in this case to ensure the client's safety? - Ask a second nurse to repeat the instruction. - Ask the client's physician to provide instruction. - Involve a second responsible person in the instruction. - Write discharge instructions on the medication containers.

Involve a second responsible person in the instruction. If an older adult client is having difficulty comprehending the discharge instruction, the nurse should involve a second responsible person in the instruction in order to ensure client safety. A referral for skilled nurse visits is appropriate for homebound older adults who need additional instructions about medication routines after discharge. However, the nurse would not ask a second nurse to simply repeat the instructions or delegate the teaching to somebody else. The nurse will also not write all the discharge instructions on the various medication containers, but instead will write all the instructions in detail on the discharge sheet for the client's convenience.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do? - Have another nurse guard the preparations. - Put the medications back in the containers. - Have another nurse finish preparing and administering the medications. - Lock the medications in a cart and finish them upon return.

Lock the medications in a cart and finish them upon return. Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

The nurse just completed a refresher course on parental drug administration. Which statement by the nurse indicates that teaching was effective? - "Reconstitution is the process of adding liquid, known as diluent, to a powered 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 self-sealing rubber stopper." - "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 powered substance. A sealed glass cylinder of parenteral medication with an attached needle is a refilled cartridge, not reconstitution. A glass or plastic container of parental medication with self-sealing rubber stopper is a vial, not reconstitution. A sealed glass drug container that must be broken to withdraw the medication is an ampoule, not reconstitution.

The nurse has received a telephone order for a client from a healthcare 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. Recording "T.O." at the end of the order indicates that this was a telephone order. Another nurse should not cosign. Reminding the provider to sign the order as soon as possible is helpful, but does not indicate that this was a telephone order.

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? Read and compare labels on the medication with the medical record. Review the client's medication, allergy, and medical history. Administer medication within 30 to 60 minutes of the scheduled time. Allow sufficient time to prepare the medication with minimal distraction.

Review the client's medication, allergy, and medical history. 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.

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 difficulty in coordinating breathing." - "Long-term use of nasal sprays can cause rebound nasal congestion." - "Long-term use of nasal sprays can repair the nasal passage." - "Long-term use of nasal sprays can cause an unpleasant taste."

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, as this more applicable with inhalers and not 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 do not cause an unpleasant taste; this is more appropriate with inhalers and not nasal sprays.

Nurse A receives an urgent phone call and hands several medications to Nurse B, stating, "Please give these to my client. I will be right back." What is Nurse B's appropriate response? - Proceed to give the medications. - Place the medications in pocket until Nurse A returns. - State, "I cannot give medications for you." - Inform the healthcare provider.

State, "I cannot give medications for you." Nurses must never administer medications prepared by another nurse. Nurse B will professionally reply, "I cannot give medications for you." Nurse B should not hold the medication in a pocket. Informing the healthcare provider does not address Nurse A's action.

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 healthcare provider.

Stop the infusion. 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 healthcare provider can occur after the infusion is stopped.

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on what reason?

The area is free of major blood vessels and fat. The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility of injecting into subcutaneous fat. The deltoid region for an intramuscular injection has little overlying subcutaneous fat and lies close to the radial nerve.

A nurse enters a client's room to check on his intravenous infusion. An electronic infusion device is not being used. When checking the solution container and rate, the nurse notes that that fluid is infusing at a rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion? - The client is resting his arm with the IV on his head. - The tubing is visible, running freely from the solution to the access site. - The fluid, although running slow, is infusing. - The client is using his non-IV hand to push the IV pole when ambulating.

The client is resting his arm with the IV on his head. When the extremity is elevated, such as the client resting his arm on his head, the fluid will infuse more slowly. Kinked or obstructed tubing (not visible and running freely), a patent catheter (such that the fluid is infusing), and the height of the solution container (such as when the client gets up and walks in the hall pushing the IV pole with the hand containing the IV) are factors that would contribute to a slowed rate.

The nurse is teaching a client about zolpidem CR (Ambien CR) for sleep. When the client asks, "What does the CR mean?" what is the appropriate nursing response?

The nurse will clarify that CR means "continuous release." XR means "extended release;" SR means "sustained release;" SA means "sustained action."

The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action?

The nurse will notify the healthcare provider before administering medication, and follow internal policies regarding incident reporting. The nurse will receive information from the healthcare provider about new orders to make sure the client gets the right amount of medication. The pharmacy may be notified later.

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?

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.

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 drug. - The ventrogluteal site determines whether or not the needle is in a blood vessel. - The ventrogluteal site prevents tissue contact with the irritating drug. - The ventrogluteal site reduces the transmission of microorganisms.

The ventrogluteal site is a large muscular injection site that provides a location with the capacity for depositing and absorbing 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, and not the usage of the ventrogluteal site.

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?

To facilitate removal of medication from a multidose vial, first inject an amount of air equal to the amount of the desired quantity of the medication.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug?

When administering medication by sublingual application, the client should avoid swallowing or chewing the medication. Eating or smoking during administration is also contraindicated. Taking the medication on an empty stomach, talking, or performing physical activities may not be contraindicated when administering drugs sublingually.

The nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not? aspirating for a blood return inserting the needle at a 90-degree angle withdrawing the needle and immediately releasing the taut skin waiting 10 seconds with the needle still in place and the skin held taut

aspirating for a blood return Aspirating for a blood return is correct, as this will determine if the needle is in the blood vessel. Inserting the needle at a 90-degree angle is incorrect, as this directs the needle in the muscles. Withdrawing the needle and immediately releasing the taut skin is incorrect, as this creates a diagonal path to prevent leaking in the subcutaneous layer of the tissue. Waiting 10 seconds with the needle still in place and the skin held taut is incorrect, as this provides time to distribute the medication in a larger area.

The nurse is talking with the caregiver of a pediatric client who is fearful of receiving allergy shots. What teaching will the nurse provide regarding the eutectic mixture of local anesthestics (EMLA)? - must be applied at least 30 minutes prior to injections - best suited for multiple administrations such as weekly injections - is only effective when used on adult clients - numbs all layers of the skin so nothing regarding the injection is felt

best suited for multiple administrations such as weekly injections EMLA is best suited for multiple administrations such as weekly injections. It must be applied 1-2 hours prior to injection, and is effective on any type of client. It is a local anesthetic that reduces or eliminates local discomfort via the initial piercing of the skin.

The nurse is providing discharge teaching for an older adult with arthritis who also has an implanted catheter. Which care does the nurse anticipate the client will need to provide catheter care? - home care - long-term care facility - inpatient admission - assisted living

home care The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. The scenario presented does not indicate that the client needs long-term care, nor assisted living. An inpatient admission is not anticipated to be needed for the sole purpose of catheter care.

When administering heparin subcutaneously, the nurse should:

never aspirate

The primary reason for the Controlled Substances Act is:

to prevent drug abuse and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug abuse laws.