prep u chapter 29
During a teaching session on self-administration of insulin, the client asks the nurse why it is necessary to bunch the skin before inserting the needle. What is the nurse's bestresponse? "Bunching your skin steadies the syringe." "Bunching your skin ensures complete delivery of the insulin." "Bunching your skin facilitates the placement of the needle in the subcutaneous tissue." "Bunching your skin controls bleeding."
"Bunching your skin facilitates the placement of the needle in the subcutaneous tissue."
The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse? "I can crush the medication but will not be able to mix it in the applesauce, because it will limit the effectiveness." "The nurse should not have crushed this medication. It could have caused an allergic reaction." "Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole." "I will ask the health care provider to cancel the prescription for aspirin since you are unable to take it."
"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole."
Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response? "I will get the hospital's information system's phone number for you." "I will log in so that you can proceed with medication delivery." "I am giving you my password so you can log in." "I can log in and give the medications for you."
"I will get the hospital's information system's phone number for you."
The nurse is instructing a client with xerostomia (dry mouth) about taking several pills and capsules that have been prescribed. What statement made by the client indicates to the nurse that the client understood the instructions? "I will have to get a speech therapy appointment before taking the pills." "I will take a sip or two of water prior to taking my pills." "The best time to take my medications is first thing in the morning before eating." "If I cannot swallow the pills, I will hold the dose and take both doses later in the day."
"I will take a sip or two of water prior to taking my pills."
Which statement by a client indicates to the nurse that teaching was effective regarding the different parts of a syringe? "The barrel is the part of the syringe to which the needle is attached." "The plunger is the part of the syringe that moves back and forth to withdraw and instill medication." "The plunger is the part of the syringe that holds the medication." "The barrel is the part of the syringe that resets the dose window to zero following an injection."
"The plunger is the part of the syringe that moves back and forth to withdraw and instill medication."
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." "Rest the eye dropper on the inner canthus to make it easier to instill the drops." "If you cannot instill these drops from the bottle, you will be unable to have surgery." "Dispose of these medications every 7 days due to possible bacterial contamination."
"Wait 5 minutes between instillation of different types of eye drops."
A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client? 15 mL 30 mL 22.5 mL 67.5 mL
30 mL
The client is prescribed a medication that needs to be taken on an empty stomach. The nurse inadvertently administers this medication with food. What are the ramifications of this error? The client may experience abdominal pain. Absorption of the medication will be impaired. The medication schedule will have to be changed. The medication will be more effective.
Absorption of the medication will be impaired.
A nurse has administered an injection to a client. Which intervention should the nurse perform to reduce discomfort and provide quick relief? Apply a eutectic mixture of local anesthetic to the site. Apply pressure to the site during needle withdrawal. Numb the skin with an ice pack after the injection. Massage the site following injection.
Apply pressure to the site during needle withdrawal.
When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next? Hold the second dose until the discomfort is relieved. Explain that this is expected effect of the medication. Assess the vaginal area. Notify the health care provider.
Assess the vaginal area.
Regarding medication administration, what must occur at the change of shifts? Only the LPNs on the division count medications. The client's medications must be drawn up. The medications for the division are counted. The narcotics for the division are counted.
The narcotics for the division are counted.
A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration? Vastus lateralis Scapula Deltoid Ventrogluteal
Deltoid
A severe allergic reaction from a medication requires: Aspirin Atarax Dopamine Epinephrine
Epinephrine
Which situation accurately describes a recommended guideline when administering oral medications to clients? If a client vomits immediately after receiving oral medications, readminister the medication. If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. Assume that the client is the authority on whether or not the medication was swallowed
If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.
The charge nurse is observing a new nurse administer an intramuscular (IM) medication to an adult client for the first time. After reviewing the image, what should the charge nurse do next? Stop the new nurse from administering the medication Inform the new nurse to spread the fingers outward to visualize landmarks for the injection Instruct the new nurse to continue with the medication administration using the current technique Tell the new nurse to move aside, so another nurse can safely administer the medication using this route
Inform the new nurse to spread the fingers outward to visualize landmarks for the injection
The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission? Call to ask the pharmacy how the drug should be administered. Omit the administration of the medication since it was written incorrectly. Notify the health care provider to add the route and then administer the medication when complete. Add the route to the prescription and administer the medication since the nurse is familiar with the drug.
Notify the health care provider to add the route and then administer the medication when complete.
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? Instruct the client to take both the current antibiotic along with a new prescribed antibiotic to avoid antibiotic resistance Offer to speak to the provider for different treatment options Instruct the client to return to taking the current prescribed medication until it is all gone Provide education on taking all antibiotics for effective treatment
Provide education on taking all antibiotics for effective treatment
The nurse is preparing to administer a tuberculin test to a client. Which instructions should the nurse provide to the client? Call the nurse in 72 hours for results. Return in 48 to 72 hours for results. We will contact you with the results. Wait here for 60 minutes for results.
Return in 48 to 72 hours for results.
A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case? Return the medication to the medication cart or medication room. Inform the head nurse about the client's absence. Leave the medication on the client's bedside table. Inform the physician about the client's absence.
Return the medication to the medication cart or medication room.
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? Teach the client to use the call bell whenever getting out of bed. Ask the client to report any dizziness and lightheadedness. Set the antihypertensive dose aside pending assessment. Place the dose in the medication cup with other medications.
Set the antihypertensive dose aside pending assessment.
A client has a central venous catheter inserted. The nurse understands that the tip of the catheter would be found at which location? Select all that apply. Basilic vein Median cubital vein Superior vena cava Right atrium Left ventricle
Superior vena cava Right atrium
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? Input the order into the computerized provider order system. Have another nurse witness and record the order into the medication administration record (MAR). Refuse to implement the order and notify the nurse manager. Tactfully request the provider to input the order into the computerized provider order system.
Tactfully request the provider to input the order into the computerized provider order system.
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 which reason? The site lies close to the radial nerve. The site is in close proximity to the sciatic nerve. The area is free of major blood vessels and fat. There is a high possibility of injecting into subcutaneous fat.
The area is free of major blood vessels and fat.
The client states "I think my IV dressing needs to be changed." In which instance should the nurse change the dressing? Never; changing the dressing can dislodge the catheter. When the dressing is loose, bloody or wet. When the dressing is curling up at the edges. When the client requests it.
When the dressing is loose, bloody or wet.
A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency? at least every 8 hours every 72 hours before and after each medication administration once daily
before and after each medication administration
A nurse is administering medication to a 78-year-old female client who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this client has an increased possibility of drug toxicity due to which age-related factor? decline in liver function and production of enzymes needed for drug metabolism increased number of protein-binding sites decreased adipose tissue and increased total body fluid in proportion to total body mass increased kidney function, resulting in excessive filtration and excretion
decline in liver function and production of enzymes needed for drug metabolism
The Z-track technique is utilized during drug administration by which route? intravenous intramuscular intradermal subcutaneous
intramuscular
What would be considered a "right" of drug administration? Select all that apply. right class right dose right drug right client right documentation
right dose right drug right client right documentation
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 implement measures to reduce the transmission of microorganisms to prevent interfering with test results to determine the extent to which the client responded to the drugs to administer timely emergency treatment
to determine the extent to which the client responded to the drugs
A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation? when the drug needs to act on the client very slowly when the drug needs to be administered only once when the client has disorders that affect the absorption of medications when the client wants to avoid the discomfort of an intradermal injection
when the client has disorders that affect the absorption of medications