Medication Administration
A nurse is teaching a client how to administer medication through a jejunostomy tube. Which of the following instructions should the nurse include? A. "Flush the tube before and after each medication." B. "Mix your medications with your enteral feeding." C. "Push tablets through the tube slowly." D. "Mix all the crushed medications prior to dissolving them in water."
A. "Flush the tube before and after each medication." Rationale: A. Correct: The client should flush the tubing before and after each medication with 15 to 30 mL water to prevent clogging of the tube. B. To maximize the therapeutic effect of a medication, the client should not mix medications with enteral formula. In addition, if the client does not receive the entire feeding, he does not receive the entire medication. This can also delay the client receiving the medication. C. The client should not administer tablets or undissolved medications through a jejunostomy tube because they can clog the tube. D. The client should self-administer each medication separately.
A nurse in an outpatient clinic is caring for a client who has a new prescription for an antihypertensive medication. Which of the following instructions should the nurse give the client? A. "Get up and change positions slowly." B. "Avoid eating aged cheese and smoked meat." C. "Report any usual bruising or bleeding to the doctor immediately." D. "Eat the same amount of foods that contain vitamin K every day."
A. "Get up and change positions slowly." Rationale: A. Correct: Antihypertensive medications can cause orthostatic hypotension. The nurse should instruct the client to change positions slowly and to sit or lie down when feeling dizzy or lightheaded to prevent injury. B. Consuming foods that contain tyramine (avocados, figs, aged cheese, yeast extracts, beer, smoked meats) while taking monoamine oxidase inhibitors, not antihypertensives, can lead to hypertensive crisis. C. Clients taking an anticoagulant, not an antihypertensive, should report bruising, discolored urine or stool, petechiae, bleeding gums, and any other manifestations of bleeding to the provider immediately. D. Clients taking anticoagulants, not antihypertensives, should maintain a consistent intake of dietary vitamin K to avoid sudden fluctuations that could affect the action of the anticoagulant.
A nurse educator is teaching a module about safe medication administration to newly licensed nurses. Which of the following statements should the nurse identify as an indication that one of the group understands how to implement medication therapy? (Select all that apply.) A. "I will observe for side effects." B. "I will monitor for therapeutic effects." C. "I will prescribe the appropriate dose." D. "I will change the dose if adverse effects occur." E. "I will refuse to give a medication if I believe it is unsafe."
A. "I will observe for side effects."; B. "I will monitor for therapeutic effects."; E. "I will refuse to give a medication if I believe it is unsafe." Rationale: A. Correct: The nurse is responsible for observing for side effects. This is within a nurse's scope of practice. B. Correct: The nurse is responsible for monitoring therapeutic effects. This is within a nurse's scope of practice. C. The provider is responsible for prescribing the appropriate dose. This is outside of the nurse's scope of practice. D. The provider is responsible for changing the dose if adverse effects occur. This is outside of the nurse's scope of practice. E. Correct: The nurse is responsible for identifying when a medication could harm a client. It is within the nurse's scope of practice to refuse to administer the medication and contact the provider.
A nurse is preparing to administer a 0900 medication to a client. Which of the following are acceptable administration times for this medication? (Select all that apply). A. 0905 B. 0825 C. 1000 D. 0840 E. 0935
A. 0905; D. 0840 Rationale: A. Correct: The nurse should administer medications within 30 min of the time it is due. 0905 is within 30 min of the time the medication is due. B. 0825 is not within 30 min of the time the medication is due. C. 1000 is not within 30 min of the time the medication is due. D. Correct: 0840 is within 30 min of the time the medication is due. E. 0935 is not within 30 min of the time the medication is due.
A nurse prepares an injection of morphine to administer to a client who reports pain. Prior to administering the medication, the nurse assists another client onto a bedpan. She asks a second nurse to give the injection. Which of the following actions should the second nurse take? A. Offer to assist the client who needs the bedpan. B. Administer the injection the other nurse prepared. C. Prepare another syringe and administer the injection. D. tell the client who needs the bedpan she will have to wait for her nurse.
A. Offer to assist the client who needs the bedpan. Rationale: A. Correct: The second nurse should offer to assist the client who needs the bedpan. This will allow the nurse who prepared the injection to administer it. B. A nurse should only administer medications that she prepared. C. Preparing another syringe will delay the administration of the pain medication. D. Telling the client to wait is not an acceptable option for a client who needs a bedpan .
A nurse is teaching a client who has a new prescription for oxybutynin about managing the medication's anticholinergic effects. Which of the following instructions should the nurse include? (Select all that apply.) A. Take sips of water frequently. B. Wear sunglasses when outdoors in sunlight. C. Use a soft toothbrush when brushing teeth. D. Take the medication with an antacid. E. Urinate prior to taking the medication.
A. Take sips of water frequently; B. Wear sunglasses when outdoors in sunlight; E. Urinate prior to taking the medication Rationale: A. Correct: Taking sips of water frequently will help relieve the anticholinergic effect of dry mouth. B. Correct: Wearing sunglasses will help relieve the anticholinergic effect of photophobia. C. Anticholinergic effects do not increase the client's risk for bleeding. Constipation is an example of an anticholinergic effect. D. Taking the medication with an antacid will not decrease anticholinergic effects. Constipation is an example of an anticholinergic effect. E. Correct: Urinating prior to taking the medication will help relieve the anticholinergic effect of urinary retention.
A nurse is teaching an adult client how to administer ear drops. Which of the following statements should the nurse identify as an indication that the client understands the proper technique? A. "I will straighten my ear canal by pulling my ear down and back." B. "I will gently apply pressure with my finger to the front part of my ear after putting in the drops." C. "I will insert the nozzle of the ear drop bottle snug into my ear before squeezing the drops in." D. "After the drops are in, I will place a cotton ball all the way into my ear canal."
B. "I will gently apply pressure with my finger to the front part of my ear after putting in the drops." Rationale: A. The client should straighten his ear canal by pulling the auricle upward and outward to open up the ear canal and allow the medication to reach the eardrum. B. Correct: The client should gently apply pressure with the finger to the tragus of the ear after administering the drops to help the drops go into the ear canal. C. The client should never occlude the ear canal with the dropper when instilling ear drops because this can cause pressure that could injure the eardrum. D. The client should not place a cotton ball past the outermost part of the ear canal because it could introduce bacteria to the inner or middle ear.
A nurse is working with a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as an indication that the newly hired nurse understands medication error prevention? A. Taking all medications out of the unit-dose wrappers before entering the client's room B. Checking with the provider when a single dose requires administration of multiple tablets C. Administering a medication, then looking up the usual dosage range D. Relying on another nurse to clarify a medication prescription
B. Checking with the provider when a single dose requires administration of multiple tablets Rationale: A. To prevent errors, the nurse should not take unit-dose medications out of wrappers until at the bedside when preforming the third check of medication administration. The nurse can encourage clients' involvement and provide teaching at this time. B. Correct: If a single dose requires multiple tablets, it is possible that an error has occurred in the prescription or transcription of the medication. This action could prevent a medication error. C. Reviewing the usual dosage range prior to administration can help the nurse identify an inaccurate dosage. D. If the prescription is unclear, the nurse should contact the provider, not another nurse, for clarification.
A nurse is reviewing a client's medications. They include cimetidine and imipramine. Knowing that cimetidine decreases the metabolism of imipramine, the nurse should identify that this combination is likely to result in which of the following effects? A. Decreased therapeutic effects of cimetidine B. Increased risk of imipramine toxicity C. Decreased risk of adverse effects of cimetidine D. Increased therapeutic effects of imipramine
B. Increased risk of imipramine toxicity Rationale: A. A medication that increases the metabolism of another medication can decrease the effectiveness of that medication. B. Correct: A medication that decreases the metabolism of another medication increases the serum level of that medication, increasing the risk for toxicity. C. A medication that decreases the metabolism of another medication does not decrease the risk for adverse effects. D. A medication that decreases the metabolism of another medication does not increase the medication's therapeutic effects.
A young adult client in a provider's office tells the nurse that she uses fasting for several days each week to help control her weight. The client takes several medications for various chronic issues. The nurse should explain to the client that which of the following mechanisms that results from fasting puts her at risk for medication toxicity? A. Increasing the metabolism of the medications over time B. Increasing the protein-binding response C. Increasing medications' transit time through the intestines D. Decreasing the excretion of medications
B. Increasing the protein-binding response Rationale: A. Some medications, not fasting, cause metabolic tolerance as metabolism of the medication increases over time and the effectiveness of the medication declines. B. Correct: Inadequate nutrition, such as starvation, can affect the protein-binding response of medications. It increases their response and thus increases the risk for medication toxicity. C. Disorders that cause diarrhea, not fasting, cause oral medications to pass through the gastrointestinal tract too quickly for adequate absorption. This mechanism does not cause toxicity. D. Kidney disease or failure, not fasting, prevents or delays medication excretion, which can cause toxicity.
A nurse is preparing medications for a preschooler. Which of the following factors should the nurse identify as altering how a medication affects children? (Select all that apply.) A. Increased gastric acid production B. Lower blood pressure C. Higher body water content D. Increased absorption of topical medications E. Increased gastric emptying time
B. Lower blood pressure; C. Higher body water content; D. Increased absorption of topical medications Rationale: A. Children have decreased gastric acid production. B. Correct: Children have a lower blood pressure. C. Correct: Children have a higher body water content. D. Correct: Children have increased absorption of topical medications. E. Children have a slower gastric emptying time.
To promote adherence with medication self-administration, a nurse is making recommendations for an older adult client. Which of the following instructions should the nurse include? (Select all that apply.) A. Adjust dosages according to daily weight. B. Place pills in daily pill holders. C. Ask for liquid forms if the client has difficulty swallowing pills. D. Ask a relative to assist periodically. E. Request child-resistant caps on medication containers.
B. Place pills in daily pill holders; C. Ask for liquid forms if the client has difficulty swallowing pills; D. Ask a relative to assist periodically Rationale: A. The provider adjusts the client's dosages. Instructing the client to base dosages on daily weight increases the risk for error in medication self-administration. B. Correct: Organizing medications in daily pill holders promotes medication adherence. C. Correct: Providing a form of medication that is easier for the client to swallow promotes medication adherence. D. Correct: Including the client's support system promotes medication adherence. E. Some older adult clients have difficulty opening child-resistant caps. Request easy-open containers from the pharmacy.
A nurse is preparing to inject heparin subcutaneously for a client who is postoperative. Which of the following actions should the nurse take? A. Use a 22-gauge needle. B. Select a site on the client's abdomen. C. Spread the skin with the thumb and finger. D. Observe for bleb formation to confirm proper placement.
B. Select a site on the client's abdomen. Rationale: A. For a subcutaneous injection, the nurse should use a 25- to 27-gauge needle. B. Correct: For a subcutaneous injection, the nurse should select a site that has an adequate fat-pad size (abdomen, upper hips, lateral upper arms, thighs). C. For a subcutaneous injection, the nurse should pinch the skin with her thumb and index finger. D. Bleb formation confirms injection into the dermis, not into subcutaneous tissue.
A nurse is collecting data from a client who takes haloperidol to treat schizophrenia. Which of the following findings should the nurse document as extrapyramidal symptoms (EPSs)? (Select all that apply.) A. Orthostatic hypotension B. Tremors C. Acute dystonia D. Decreased level of consciousness E. Restlessness
B. Tremors; C. Acute dystonia; E. Restlessness Rationale: A. Orthostatic hypotension is an adverse effect, but it is not an EPS. B. Correct: Tremors are an EPS. Others are rigidity, drooling, agitation, and a shuffling gait. C. Correct: Acute dystonia is an EPS. It includes spastic movements of the back, neck, tongue, and face. D. Decreased level of consciousness is an adverse effect, but it is not an EPS. E. Correct: Restlessness is an EPS. Others are rigidity, drooling, agitation, and a shuffling gait.
A nurse in an outpatient surgical center is admitting a client for a laparoscopic procedure. The client has a prescription for preoperative diazepam. Prior to administering the medication, which of the following actions is the nurse's priority? A. Teaching the client about the purpose of the medication B. Giving the medication at the administration time the provider prescribed C. Identifying the client's medication allergies D. Documenting the client's anxiety level
C. Identifying the client's medication allergies Rationale: A. The nurse should teach the client about the purpose of the medication to make sure the client understands why the provider prescribed it. However, another action is the priority. B. The nurse should administer the medication at the time the provider prescribed that the client receive it to help prepare the client for the surgical procedure. However, another action is the priority. C. Correct: The greatest risk to this client is injury form an allergic reaction. The priority action is to identify the client's allergies prior to medication administration. D. The nurse should document the client's anxiety level to have a baseline against which to measure the effectiveness of the medication. However, another action is the priority.
A nurse is caring for a client who is 1 day postoperative following a total knee arthroplasty. The client states his pain level is 10 on a scale of 0 to 10. After reviewing the client's medication administration record, which of the following medications should the nurse administer? A. Meperidine 75 mg IM B. Fentanyl 50 mcg/hr transdermal patch C. Morphine 2 mg IV D. Oxycodone 10 mg PO
C. Morphine 2 mg IV Rationale: A. Although meperidine is a strong analgesic, the IM route of administration can allow for slow absorption, delaying the onset of pain relief. The IM route also can cause additional pain from the injection. B. Although fentanyl is a strong analgesic, the transdermal route of administration can allow for slow absorption, delaying the onset of pain relief. C. Correct: The nurse should administer IV morphine because the onset is rapid, and absorption of the medication into the blood is immediate, which provides the optimal response for a client who is reporting pain at a level of 10. D. Although oxycodone is a strong analgesic, the oral route of administration of this medication can allow for onset of pain relief in 10 to 15 min, which can be a long time for a client who is reporting pain at a level of 10.
A nurse is teaching a client who is lactating about taking medications. Which of the following actions should the nurse recommend to minimize in the entry of medication into breast milk? A. Drink 8 oz milk with each dose of medication. B. Use medications that have an extended half-life. C. Take each dose right after breastfeeding. D. Pump breast milk and freeze it prior to feeding to the newborn.
C. Take each dose right after breastfeeding Rationale: A. The intake of food or fluid with medication does not affect entry of medications into breast milk. B. The client should avoid medications that have an extended half-life due to their increased entry into breast milk. C. Correct: Taking medication immediately after breastfeeding helps minimize medication concentration in the next feeding. D. Pumping and freezing breast milk does not affect entry of medications into breast milk.
A nurse is teaching a client about taking multiple oral medications at home to include time-release capsules, liquid medications, enteric-coated pills, and opioids. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I can open the capsule with the beads in it and sprinkle them on my oatmeal." B. "If I am having difficulty swallowing, I will add the liquid medication to a batch of pudding." C. "I can crush the pills with the coating on them." D. "I will eat two crackers with the pain pills."
D. "I will eat two crackers with the pain pills." Rationale: A. Although this might help a client who has swallowing issues, it is essential for the client to swallow enteric-coated or time-release medications whole. B. Although adding a liquid medication to food is helpful if the client is having difficulty swallowing, he should not mix the medication with large amounts of food or beverages in case he cannot consume the entire quantity. C. The client must not crush enteric-coated or time-release preparations. He must swallow them whole. D. Correct: The client should take irritating medications, such as analgesics, with small amounts of food. It can help prevent nausea and vomiting.
A nurse is preparing to administer digoxin to a client who states, "I don't want to take that medication. I do not want one more pill." Which of the following responses should the nurse make? A. "Your physician prescribed it for you, so you really should take it." B. "Well, let's just get it over quickly then." C. "Okay, I'll give you your other medications." D. "Tell me your concerns about taking this medication."
D. "Tell me your concerns about taking this medication." Rationale: A. This response dismisses the client's concerns. B. The nurse is dismissing the client's concerns about taking the medication by continuing with medication administration. C. Although clients have the right to refuse a medication, the nurse should provide information about the risk of refusal instead of proceeding with medication administration. D. Correct: Although clients have the right to refuse a medication, the nurse is correct in determining the refusal by asking the client his concerns. Then the nurse can provide information about the risk of refusal and facilitate an informed decision. At that point, if the client still exercises his right to refuse a medication, the nurse should notify and the provider and document the refusal and the actions the nurse took.
A nurse in an outpatient clinic is teaching a client who is in her first trimester of pregnancy. Which of the following statements should the nurse make? A. "You will need to get a rubella immunization if you haven't had one prior to pregnancy." B. "You can safely take over-the-counter medications." C. "You should avoid any vitamin preparations containing iron." D. "Your provider can prescribe medication for nausea if you need it."
D. "Your provider can prescribe medication for nausea if you need it." Rationale: A. Pregnancy is a contraindication for live-virus vaccines, including rubella, due to possible teratogenic effects. B. Most medications, including over-the-counter, are potentially harmful to the fetus. The client should avoid any medications unless her provider prescribes them. C. Nutritional supplements that include iron are common recommendations during pregnancy to support the health of the mother and fetus. D. Correct: Providers can prescribe medications to treat nausea and other discomforts of pregnancy.
