Medication Administration

3. Which route is unrelated to the parenteral administration of medications? 1. Buccal 2. Z-track 3. Intravenous 4. Intradermal

*1. A parenteral route is one that is outside the gastrointestinal tract. A medication administered by the buccal route dissolves between the cheeks and gums, where it acts on the oral mucous membranes or is swallowed with saliva. Most troches are used for local effect. 2. Z-track is a method of administering an intramuscular injection. The intramuscular route is a parenteral route. 3. The intravenous route, a parenteral route, instills medication directly into the venous circulation. 4. The intradermal route, a parenteral route, injects medication just under the epidermis.

45. The practitioner prescribes 18 units of Novolog R and 26 units of Novolog N to be given at 0730 AM in the same syringe. Indicate on the syringe, by shading in the appropriate area, how many total units of Novolog R and Novolog N are to be drawn into the syringe.

Answer: 44 units total. A total of 44 units of insulin should be drawn into the syringe. Eighteen units of Novolog R are drawn into the syringe first and then the 26 units of Novolog N are drawn into the syringe. It is done in this order to ensure that the Novolog N insulin, which is longer acting, does not dilute the Novolog R insulin in the vial, which is fast acting.

16. What route is inappropriate for a topical medication? 1. Intradermal 2. Bladder 3. Rectum 4. Vagina

*1. An intradermal injection is inserted below, not on top of, the epidermis. 2. Medications in the form of solutions can be instilled into the bladder. They are designed to work locally and are considered a topical medication. 3. Medications in the form of a suppository can be inserted into the rectum and are considered topical medications. Most are designed to work locally, although some are absorbed systemically. 4. Medications in the form of a suppository, tablet, cream, foam, or jelly can be instilled into the vagina. They are designed to work locally and are considered topical medications.

21. A nurse must administer a medication into the ear of an adult. What should the nurse do to limit patient discomfort when administering ear drops? 1. Warm the solution to body temperature 2. Place the patient in a comfortable position 3. Pull the pinna of the ear upward and backward 4. Instill the fluid in the center of the auditory canal

*1. Instilling cold medication into the ear canal is uncomfortable and can cause vertigo and nausea. Holding the bottle of medication in the hand for several minutes warms the solution to body temperature. 2. The side-lying position with the involved ear upward must be maintained for 2 to 3 minutes while the instilled medication disperses throughout the ear canal. 3. This straightens the ear canal and facilitates the flow of medication toward the eardrum in an adult; it does not limit discomfort. 4. This is contraindicated because the force of the fluid may injure the eardrum. The drops should be directed along the side of the ear canal.

35. A practitioner prescribes a rectal suppository for an adult patient. What should the nurse do when administering the rectal suppository? 1. Lubricate the medication before insertion 2. Warm the medication to body temperature 3. Insert the medication just inside the rectum's external sphincter 4. Place the patient in the prone position to administer the medication

*1. Lubrication eases insertion by reducing friction, which limits tissue trauma and discomfort. 2. Warming the medication causes it to melt, making it impossible to insert. Most rectal suppositories are kept refrigerated until used. 3. Rectal suppositories should be inserted 3 inches into the rectal canal of an adult. 4. The patient should be placed in the leftlateral or left-Sims position to take advantage of the anatomical curve of the rectum and sigmoid colon.

24. Where is medication absorbed when the nurse administers a suppository? 1. Ear 2. Nose 3. Mouth 4. Rectum

1. Medicated solutions are administered via drops in the ear. 2. Medicated solutions are dropped or sprayed in the nose. 3. Tablets, lozenges, and troches are administered in the mouth. *4. Suppositories—semisolid, cone-shaped, or oval-shaped masses that melt at body temperature—are inserted into the rectum.

28. A nurse must reconstitute a powdered medication. What should the nurse do? 1. Keep the needle below the initial fluid level as the rest of the fluid is injected 2. Instill the solvent that is consistent with the manufacturer's directions 3. Score the neck of the ampule before breaking it 4. Shake the vial to dissolve the powder

1. This will create excessive bubbles that can interfere with complete reconstitution or result in bubbles being drawn into the syringe. Both occurrences can result in an inaccurate dose. *2. Compatibility is necessary so that a compound or precipitate that is harmful to a patient does not result. 3. Reconstitution occurs in a vial (a closed system), not an ampule (an open system). 4. Shaking the vial will create excessive bubbles. The vial should be rotated between the hands to facilitate reconstitution.

23. Which abbreviation indicates that the practitioner wants a medication administered before meals? 1. pc 2. qh 3. po 4. ac

1. The abbreviation for after meals is p.c. (post cibum). 2. The abbreviation for every hour is q.h. 3. The abbreviation for by mouth is PO (per os). *4. The abbreviation for before meals is a.c. (ante cibum).

37. A nurse plans to administer a 3-mL intramuscular injection. Which muscle is the least desirable to use for the administration of this medication? 1. Deltoid 2. Dorsogluteal 3. Ventrogluteal 4. Vastus lateralis

*1. The deltoid, on the lateral aspect of the upper arm, is a small muscle that is incapable of absorbing a large medication volume. This site is more appropriate for 1 mL of solution. 2. The dorsogluteal site uses the gluteus maximus muscles in the buttocks, which can absorb larger medication volumes. 3. The ventrogluteal site uses the gluteus medius and minimus muscles in the area of the hip, which can absorb larger medication volumes. 4. The vastus lateralis muscle is located on the anterolateral aspect of the thigh, which can absorb larger medication volumes.

15. A nurse teaches a patient how to self-administer a corticosteroid via a metered-dose inhaler with an extender. Which behavior indicates to the nurse that the patient understands the teaching? 1. Rinses the mouth with water after the treatment 2. Rolls the canister between the hands slowly before using the inhaler 3. Positions the mouthpiece directly in front of the mouth while inhaling 4. Assumes the semi-Fowler position with the head supported on a pillow

*1. Rinsing the mouth removes any remaining medication. This prevents irritation to the oral mucosa and tongue and prevents oral fungal infections. 2. This may not mix the medication adequately and result in an inadequate dose. The canister should be shaken several times before use. 3. When an extender (spacer) is used with a metered-dose inhaler the mouthpiece of the extender should be placed in the mouth over the tongue with the teeth and lips tightly around the mouthpiece. 4. The patient should be in an upright (standing, sitting, or high-Fowler) position to promote lung expansion when inhaling.

6. A nurse is preparing to reconstitute a medication in a multiple-dose vial. What is the most essential step in the preparation of this medication? 1. Instilling an accurate amount of diluent into the vial 2. Using a filtered needle when drawing up the medication from the vial 3. Instilling air into the vial before withdrawing the reconstituted solution 4. Wiping the rubber seal of the vial with alcohol before and after each needle insertion

*1. The required amount of diluent must be followed exactly in a multiple-dose formulation to ensure accurate dosage preparation. The diluent for a singledose formulation also must be exact so that the medication is diluted enough not to injure body tissues. 2. A filtered needle should be used when drawing up fluid from an ampule, not a vial. A filter prevents shards of glass from entering the syringe. 3. Although this is an advisable practice, it is not as important as administering an accurate dose. 4. The rubber seal must be wiped with alcohol before, not after, needle insertion.

32. A patient has a prescription for 2 puffs of a bronchodilator via a metered-dose inhaler. What should the nurse teach the patient to do when self-administering the medication? 1. Start breathing in while compressing the canister 2. Hold the inspired breath for several seconds 3. Deliver 2 puffs with each inspiration 4. Inhale slowly for 8 to 10 seconds

*1. This ensures that a maximum amount of the drug is inhaled while the medication is still aerosolized. 2. The breath should be held for 10 seconds, or longer, to promote distribution and absorption of the medication. 3. One puff, not 2, should be delivered with each inhalation. 4. The inhalation should start with compression of the canister and continue for another 3 to 5, not 8 to 10, seconds to ensure distribution of the medication.

13. A practitioner prescribes nose drops to be administered twice a day. What should the nurse do when instilling nose drops? 1. Place the patient in the supine position with the head tilted backward 2. Pinch the nares of the nose together briefly after the drops are instilled 3. Instruct the patient to blow the nose 5 minutes after the drops are instilled 4. Insert the drop applicator 1/8 inch into the nose toward the base of the nasal cavity

*1. This ensures that gravity will promote the flow of medication to the posterior pharynx. 2. This is unnecessary and can frighten the patient, who already may be having difficulty breathing. 3. Blowing the nose should be avoided because it may remove medication from the nose. Five minutes is the length of time the patient should remain in the supine position with the head tilted backward. 4. Nose drops should be directed toward the midline of the ethmoid bone with the dropper held 1/2 inch above the nares.

26. A nurse is to administer an eye irrigation to a patient's right eye. What should the nurse do? 1. Direct the flow of solution from the inner to the outer canthus 2. Irrigate with an asepto syringe several inches from the eye 3. Don sterile gloves before beginning the procedure 4. Position the patient in a right lateral position

*1. This prevents secretions and fluid from entering and irritating the lacrimal ducts. 2. An asepto syringe produces a flow of fluid that is forceful and difficult to control. An IV bag of solution is preferred to provide a flow of fluid by gravity that is gentle and controllable. 3. Medical, not surgical, asepsis is required for this procedure. 4. The patient should be placed in a sitting or back-lying position with the head tilted toward the affected eye.

42. A nurse is preparing to draw up medication from a vial. What should the nurse do first? 1. Ensure that the needle is firmly attached to the syringe 2. Rub vigorously back and forth over the rubber cap with an alcohol swab 3. Inject air into the vial with the needle bevel below the surface of the medication 4. Draw up slightly more air than the volume of medication to be withdrawn from the via

*1. This will ensure a tight seal and a closed system. If not firmly connected, the hub of the needle may disengage from the barrel of the syringe during preparation or administration of the medication when internal and external pressures are exerted on the needle and syringe. 2. The top just needs to be swiped. Rubbing back and forth is a violation of surgical asepsis because it reintroduces microorganisms to the area being cleaned. 3. This should be avoided because it causes bubbles that may interfere with the drawing up of an accurate volume of solution. 4. Excess air in the closed system raises pressure in the vial which may cause bubbles when withdrawing the fluid and result in an inaccurate volume of solution.

43. A nurse is interviewing a newly admitted client in the process of completing a nursing admission history and physical. What information should be included in a medication reconciliation. Select all that apply. 1. _____ Vitamins 2. _____ Drug allergies 3. _____ Food supplements 4. _____ Over-the-counter herbs 5. _____ Prescribed medications

*1. Vitamins are a medication and should be included on a medication reconciliation form. An accurate list of all the drugs that a client is taking (e.g., name, dose, route, frequency) should be reconciled on admission and during transitions (e.g., transfer between units, shift reports, when new medication administration records are implemented, and at discharge). This list needs to be compared with new medications prescribed and education provided to the client about each medication. 2. Generally drug allergies are documented on a health history, not the drug reconciliation form. *3. Food supplements are considered medications because they often contain ingredients that may interact with medicinal products. *4. Over-the-counter herbs are considered medications because they contain ingredients that may unfavorably interact with medicinal products. *5. Prescribed medications should be included on a medication reconciliation form.

44. What equipment and technique should the nurse use to administer most intramuscular injections? Select all that apply. 1. _____ Use a 1-inch needle 2. _____ Use a 25-gauge needle 3. _____ Insert the needle at a 45-degree angle 4. _____ Aspirate before instilling the medication 5. _____ Massage the insertion site after needle removal

1. A 1.5-inch needle is required to reach muscular tissue. 2. A 22-gauge needle usually is used for an intramuscular injection; a 25-gauge needle usually is used for a subcutaneous injection. 3. The needle should be inserted at a 90-degree angle; a 45-degree angle is used for a subcutaneous injection. 4. Aspiration is done before instilling the medication to ensure that a blood return does not occur, which indicates that the needle is in a blood vessel. *5. Massage promotes dispersion of the medication.

40. A practitioner prescribes a medication that must be administered transdermally. The nurse determines that a drug administered transdermally is: 1. Inhaled into the respiratory tract 2. Dissolved under the tongue 3. Absorbed through the skin 4. Inserted into the rectum

1. A medication that is aerosolized is inhaled. 2. A tablet, such as nitroglycerine (Nitrostat), is dissolved under the tongue. *3. A medicated patch or disk can be applied directly to the skin where the medication is released and absorbed over time. This method ensures a continuous therapeutic drug level and reduces fluctuations in circulating drug levels. 4. Medications in the form of a suppository are inserted into the rectum.

27. A medication is delivered by the Z-track method when the nurse: 1. Uses a special syringe designed for Z-track injections 2. Pulls laterally and downward on the skin before inserting the needle 3. Administers the injection in the muscle on the anterolateral aspect of the thigh 4. Injects the needle in a separate spot for each dose on a Z-shaped grid on the abdomen

1. A special syringe is not needed for administering a medication via Z-track. The barrel of the syringe must be large enough to accommodate the volume of solution to be injected (usually 1 to 3 mL) and the needle long enough to enter a muscle (usually 11/2 inches). *2. This creates a zigzag track through the various tissue layers that prevents backflow of medication up the needle track when simultaneously removing the needle and releasing the traction on the skin. 3. The use of the vastus lateralis muscle for a Z-track injection may cause discomfort for the patient. Z-track injections are tolerated more when the well-developed gluteal muscles are used. 4. The needle is inserted into the muscle once for a Z-track injection. The Z represents the zigzag pattern of the needle track that results when the skin traction and the needle are simultaneously removed.

12. What should the nurse use when administering a subcutaneous injection? 1. 5-mL syringe 2. 25-gauge needle 3. Tuberculin syringe 4. 11/2-inch long needle

1. A subcutaneous injection should not exceed 1 mL. A 3-mL, not a 5-mL, syringe is acceptable for a subcutaneous injection. *2. A subcutaneous injection should use a 25- to 29-gauge needle, which minimizes tissue trauma. The diameter of a needle is referred to as its gauge, which ranges from 28 (small) to 14 (large). 3. The volume of a tuberculin syringe is only 1 mL. For most subcutaneous injections, a syringe that can accommodate up to 3 mL is preferred to facilitate handling of the syringe. 4. This length is appropriate for an intramuscular, not subcutaneous, injection.

38. A nurse is preparing to administer a subcutaneous injection of insulin. What site should the nurse use to best promote its absorption? 1. Upper lateral arms 2. Anterior thighs 3. Upper chest 4. Abdomen

1. Although insulin can be administered at the deltoid site, it is a small area that is not conducive to injection rotation within the site. The rate of absorption at this site is slower than at the preferred site for insulin administration. 2. Although insulin can be administered in this site, the tissue of the thighs and buttocks have the slowest absorption rate. 3. This site is not acceptable for the administration of insulin because of the lack of adequate subcutaneous tissue. *4. The abdomen is the preferred site for administration of insulin because it is a large area that promotes a systematic rotation of injections and it has the fastest rate of absorption.

18. A nurse holds a bottle with the label next to the palm of the hand when pouring a liquid medication. What is the rationale for this action? 1. Conceal the label from the curiosity of others 2. Prevent the soiling of the label by spilled liquid 3. Ensure the accuracy of the measurement of the dose 4. Guarantee the label is read before pouring the liquid

1. Although patient confidentiality should always be maintained, this is not the reason for holding the label toward the palm of the hand. *2. Liquid medication may drip down the side of the bottle and soil the label, which may interfere with the ability to read the label accurately. 3. Accuracy of the dose is ensured by using a calibrated cup and measuring the liquid at the base of the meniscus while positioning the cup at eye level. 4. The label should be read before holding it against the palm of the hand.

17. A nurse adds a medication to an intravenous fluid bag. Which nursing action is the priority? 1. Attaching a completed IV additive label to the bag 2. Mixing the medication and solution by rotating the bag 3. Maintaining sterile technique throughout the procedure 4. Ensuring that the drug and the IV solution are compatible

1. Although this is important for safe administration of a medication administered intravenously, it is not the priority. 2. Although this should be done to ensure distribution of the medication throughout the IV solution, it is not the priority. 3. Although this is important to prevent infection, it is not the priority. *4. An incompatibility can increase, decrease, or neutralize the effect of the medication. Also, it may cause a compound or precipitate that can harm the patient. This must be done before proceeding with subsequent steps of the procedure.

39. What should a nurse use when placing a cream into a patient's vaginal canal? 1. A finger 2. A gauze pad 3. An applicator 4. An irrigation kit

1. Either a gloved finger or an applicator is used to insert a vaginal suppository, not a cream. 2. It is impossible to insert a cream into the vaginal canal with a gauze pad. If attempted, it would traumatize the mucous membranes of the vagina. *3. The consistency of a cream requires that an applicator be used to ensure that the medication is deposited along the full length of the vaginal canal. 4. The consistency of a cream is too thick to be inserted into the vagina with an irrigating kit.

2. A nurse instructs a patient to close the eyes after the administration of eye drops. What rationale for this instruction should the nurse explain to the patient? 1. Limits corneal irritation 2. Squeezes excess medication from the eyes 3. Disperses the medication over the eyeballs 4. Prevents medication from entering the lacrimal duct

1. Instilling medication into the conjunctival sac prevents the trauma of drops falling on the cornea. 2. Closing the eyes gently, rather than squeezing the lids shut, prevents the loss of medication from the conjunctival sac. *3. Closing the eyes moves the medication over the conjunctiva and eyeball and helps ensure an even distribution of medication. 4. Gentle pressure over the inner canthus for 1 minute after administration prevents medication from entering the lacrimal duct.

9. A home care nurse observes the spouse of a patient inserting a rectal suppository. What behavior indicates that the nurse must provide teaching about suppository administration? 1. Lubricates the tip of the suppository 2. Inserts the suppository while wearing a glove 3. Inserts the suppository while the patient bears down 4. Places the suppository a finger length into the rectum

1. Lubrication is required to limit tissue trauma and ease insertion. 2. Standard precautions should be employed when there is exposure to patients' body fluids. 3. Bearing down increases intra-abdominal pressure, which impedes the insertion of the suppository. The patient should be instructed to relax and breathe deeply and slowly while the suppository is inserted. *4. In an adult, a suppository should be inserted 4 inches to ensure it is beyond the internal sphincter.

31. The practitioner prescribes a troche. The nurse should administer it by placing it in the patient's: 1. Ear 2. Eye 3. Mouth 4. Rectum

1. Medications in the form of a solution are instilled into the ear. 2. Ophthalmic medications in the form of a solution or an ointment are administered in the eye. *3. A troche, a lozenge-like tablet, is dissolved slowly in the mouth in the buccal cavity to provide a localized effect. 4. Medications in the form of suppositories are inserted into the rectum.

7. Which characteristic is associated with a subcutaneous injection of 5000 units of heparin? 1. 3-mL syringe 2. 22-gauge needle 3. 11/2-inch needle length 4. 90-degree angle of insertion

1. Most doses of heparin are less than 1 mL. Three milliliters of heparin is excessive and may result in bleeding. 2. This gauge needle is too large and can cause unnecessary trauma and bleeding at the insertion site. A 25- or 26-gauge needle is adequate. 3. This length needle is unnecessarily long and may enter a muscle rather than subcutaneous tissue. *4. A 1/2-inch needle inserted at a 90-degree angle will ensure that the heparin is inserted into subcutaneous tissue

11. It is most important for the nurse to use a filtered needle when preparing a parenteral medication that: 1. Has to be reconstituted 2. Is supplied in an ampule 3. Appears cloudy in the vial 4. Is to be mixed with another medication

1. Reconstitution occurs within a closed vial and does not require a filtered needle. *2. The top of an ampule must be snapped off at its neck to access the fluid. A filtered needle prevents glass particles from being drawn into the syringe. 3. The majority of medications in vials are clear solutions. Cloudy fluid usually indicates contamination. Additional information from a drug guide or pharmacist is necessary to determine if the cloudiness is an expected characteristic of the drug or it indicates contamination. 4. It is not necessary to use a filtered needle when mixing medications.

41. What should the nurse do to limit discomfort when administering an injection? 1. Pull back on the plunger before injecting the medication 2. Apply ice to the area before the injection 3. Pinch the area while inserting the needle 4. Inject the medication slowly

1. Testing for a blood return prevents injecting medication directly into the circulatory system rather than limiting the discomfort of an injection. 2. This is contraindicated because it causes vasoconstriction, which limits absorption of the medication. 3. Pinching the skin aids in needle insertion when administering a subcutaneous injection. It does not limit the discomfort of an injection. *4. Injecting slowly allows the fluid to be dispersed gradually, which limits tissue trauma and discomfort.

4. How often should "docusate sodium (Colace) 100 mg b.i.d." be given? 1. Three times a day 2. Two times a day 3. Every other day 4. At bedtime

1. The abbreviation for three times a day is t.i.d. (ter in die). *2. The abbreviation b.i.d. (bis in die) represents twice a day. 3. B.i.d. does not mean every other day. Every other day must be written out; an abbreviation should not be used. 4. B.i.d. does not mean at bed time. Formerly the abbreviation for bed time (hour of sleep) was h.s. (hora somni); however, the Joint Commission disallows the use of the abbreviation of h.s. because of the frequency of errors with its use.

5. Which intervention is uniquely related to the administration of an intradermal injection? 1. Using the air-bubble technique 2. Pinching the skin during needle insertion 3. Inserting the needle with the bevel upward 4. Massaging the area after the fluid is instilled

1. The air-bubble or air-lock technique can be used with intramuscular, not intradermal, injections. Its use is controversial, particularly with disposable plastic syringes. 2. Pinching or bunching up tissue is appropriate with subcutaneous, not intradermal, injections. *3. When medication is injected with the bevel up, a small wheal will form under the skin. This technique is used only with intradermal injections. 4. Massaging the site of an intradermal injection will disperse the medication beyond the intended injection site and is contraindicated.

30. Which nursing action is most appropriate when administering an analgesic? 1. Reassess drug effectiveness every 8 hours 2. Follow the prescription exactly for the first 24 hours 3. Ask the practitioner to include a medication prescription for breakthrough pain 4. Seek a new prescription after two doses that do not achieve a tolerable level of relief

1. The patient should be assessed every 1 to 2 hours to ensure effectiveness of the drug. 2. The prescription should be followed exactly if it is a safe dose; however, if the medication is not effective, 24 hours is too long a period not to intervene. 3. This is unnecessary if the drug is the appropriate dose. *4. Two doses is enough time to evaluate the effectiveness of a medication for pain. Patients should not have to endure intolerable levels of pain.

10. A practitioner prescribes a medication that must be administered via the intramuscular route. Which site should the nurse eliminate from consideration because it has the highest potential for injury when administering an intramuscular injection? 1. Vastus lateralis 2. Rectus femoris 3. Ventrogluteal 4. Dorsogluteal

1. The vastus lateralis site is not near large nerves or blood vessels, and the muscle does not lie over a joint. It is a preferred site for infants 7 months of age and younger. 2. The rectus femoris site is not near major nerves, blood vessels, or bones. It is a preferred site for adults. 3. The ventrogluteal site is not near large nerves or blood vessels. It is a preferred site in adults and children. *4. The dorsogluteal site has the highest risk for injury because of the close proximity of the sciatic nerve, blood vessels, and bone.

34. A nurse plans to administer a bolus dose of a medication via a currently running intravenous infusion. What should the nurse do first? 1. Use a volume-control infusion set with microdrip tubing 2. Ensure that it is compatible with the IV solution being infused 3. Pinch the tubing above the infusion port while instilling the bolus 4. Instill it into a 50-mL bag of normal saline and infuse it via a secondary line

1. The volume of fluid of a bolus dose is too small to necessitate a volume-control infusion set. *2. An incompatible solution can increase, decrease, or neutralize the effects of the medication. In addition, an incompatibility may result in a compound or cause a precipitate that is harmful to the patient. 3. This is not the initial action. This is done immediately before and while instilling the medication to ensure that the medication flows toward the patient rather than in the opposite direction up the tubing. 4. This is done for a medication administered via an intermittent intravenous infusion over a 30- to 90-minute period rather than an intravenous bolus (IV push) dose that is administered over 1 to 5 minutes.

22. A nurse instructs a patient to inhale deeply and hold each breath for a second when using a hand-held nebulizer. The patient asks, "Why do I have to hold by breath?" The nurse responds, "This technique will: 1. Prolong treatment." 2. Limit hyperventilation." 3. Disperse the medication." 4. Prevent bronchial spasms."

1. There is no advantage in prolonging the treatment. 2. Slow, deep breathing will limit hyperventilation. *3. A pause at the height of inspiration will promote distribution and absorption of the medication before exhalation begins. 4. Slow inhalations and exhalations with pursed lips help prevent bronchial spasms.

36. A nurse is administering an intradermal injection. At what angle should the nurse insert the needle? 1. 90-degree angle 2. 45-degree angle 3. 30-degree angle 4. 15-degree angle

1. This angle is appropriate for an intramuscular, not an intradermal, injection. 2. This angle is appropriate for a subcutaneous, not an intradermal, injection. 3. This is too steep an angle for an intradermal injection and a wheal will not form. *4. An intradermal injection is administered by inserting a needle at a 10- to 15-degree angle through the skin with the bevel of the needle facing upward toward the skin. The small volume of medication instilled just below the epidermis causes the formation of a wheal (localized area of swelling that appears like a small bubble).

14. When the nurse brings pills to a patient, the patient is unable to hold the paper cup with the medications. What should the nurse do? 1. Crush the pills and mix it with applesauce 2. Have the practitioner prescribe the liquid form of the drug 3. Use the paper cup to introduce the pills into the patient's mouth 4. Put the pills into the patient's hand and have the patient self-administer the pills

1. This is done if the patient has dysphagia. 2. This is done if the patient still has difficulty swallowing a pill after it is crushed and mixed with applesauce. *3. The patient needs assistance. Keeping medication in the cup, rather than touching it with the hands, maintains medical asepsis. 4. This is unrealistic and unsafe. The patient has demonstrated the need for assistance.

20. A nurse must administer a medication that is supplied in an ampule. What should the nurse do first to access the ampule? 1. Inject the same amount of air as the fluid to be removed 2. Wipe the constricted neck with an alcohol swab 3. Break the constricted neck using a barrier 4. Insert the needle into the rubber seal

1. This is done with a vial, not an ampule. 2. The rubber seal of a vial, not the neck of an ampule, should be wiped with alcohol. *3. A barrier, such as a commercially manufactured ampule opener, gauze, or an alcohol swab, should be used to protect the hands from broken glass. 4. This is done with a vial, not an ampule.

19. A practitioner prescribes a medicated powder to be applied to a patient's skin. What is most essential for the nurse to do when applying the medicated powder? 1. Apply a thin layer in the direction of hair growth 2. Protect the patient's face with a towel 3. Dress the area with dry sterile gauze 4. Ensure that the skin surface is dry

1. This is done with lotions, creams, or ointments. 2. This is unnecessary. When the powder is sprinkled gently on the site, the powder should not become aerosolized. 3. This is not a universal requirement. When necessary, a dressing is applied with a practitioner's order. *4. Moisture harbors microorganisms and when mixed with a powder will result in a paste-like substance. The site should be clean and dry before medication administration to ensure effective action of the drug.

25. A home care nurse is helping a patient with short-term memory loss how to remember to take multiple drugs throughout the day. What should the nurse do when teaching this patient? 1. Suggest that the patient wear a watch with an alarm 2. Ask a family member to call the patient when medications are to be taken 3. Design a chart of the medications the patient takes each day during the week 4. Instruct the patient to put medications in a weekly organizational pill container

1. This is unrealistic. When the alarm goes off, the patient may not remember why it is ringing. 2. This is unrealistic and puts an excessive burden on family members. 3. This is unrealistic. The chart may be complex, confusing, and require repeated cognitive decisions throughout the day that may be beyond the patient's ability. *4. Pill distribution can be set up once a week. After the medication is taken, the empty section reminds the patient that the medication was taken, which prevents excessive doses. This is a major issue for patients with shortterm memory loss.

29. A nurse is preparing to administer a tablet to a patient. When should the nurse remove the medication from its unit dose package? 1. Outside the door to the patient's room 2. At the patient's bedside 3. In the medication room 4. At the medication cart

1. This is unsafe. This exposes the medication to the environment where it may become contaminated or grouped with other medications being administered to the patient, thus interfering with safe administration of one or more of the medications. *2. The medication should be opened and administered immediately to the patient, limiting the potential for contamination. Reading the label immediately before opening the package is an additional safety check. Immediate administration prevents accidental disarrangement of medications that may result in a medication error. 3. This is unsafe. It unnecessarily exposes the medication to the environment because it requires the nurse to carry the medication through the unit to the patient's room. In addition, it can become confused with the medications for other patients. 4. This is unsafe. The medication is exposed unnecessarily to the environment and it can be inadvertently confused with the medications for other patients.

33. A nurse teaches a patient about taking a sublingual nitroglycerin tablet. The nurse evaluates that the patient understands the teaching when the patient states, "I should place it: 1. On my skin." 2. Inside my cheek." 3. Under my tongue." 4. In my eye on the lower lid."

1. Topical medications are applied on the skin. 2. A troche or lozenge given by the buccal route is placed between the cheek and gums. *3. A sublingual medication is placed under the tongue. It is absorbed quickly through the mucous membranes into the systemic circulation. 4. A medication placed in the lower conjunctival sac of the eye is administered for its local effect and is considered a topical medication.

8. A nurse is assessing a patient for the appropriateness of administering a medication via the oral route. What clinical manifestation indicates that the nurse should ask the practitioner for a change in route? 1. Nausea 2. Unconsciousness 3. Gastric suctioning 4. Difficulty swallowing

1. Vomiting, not nausea, is a contraindication for oral medications. *2. Nothing that needs to be swallowed should ever be placed into the mouth of an unconscious patient because of the risk for aspiration. 3. Gastric suctioning can be interrupted for 20 to 30 minutes after medication has been instilled via a nasogastric tube. 4. Nursing interventions, such as positioning, mixing a crushed medication in applesauce, and dissolving a medication in a small amount of fluid, can be employed to facilitate the ingestion of medication.

1. The instructions with a medication states to use the Z-track method. What should the nurse do that is specific to this procedure? 1. Pinch the site throughout the procedure 2. Massage the site after the needle is removed 3. Remove the needle immediately after the medication is injected 4. Change the needle after the medication is drawn into the syringe

1. When the Z-track method is used during an intramuscular injection, the skin and subcutaneous tissue are pulled 1 to 11/2 inches to one side, not pinched. 2. Massage is contraindicated because it will force medication back up the needle track, which may result in tissue irritation or staining. 3. Removal of the needle should be delayed 10 seconds to allow the medication to begin to be dispersed and absorbed. *4. The Z-track method is used with viscid or caustic solutions. Changing the needle ensures that medication is not on the outside of the needle, which prevents tracking of the medication into subcutaneous tissue during needle insertion.