2 Administration of Drugs

A primary health care provider orders a transdermal drug. When administering this drug, which action by the nurse would be most appropriate? A) Apply next dose to a new site. B) Check the infusion rate. C) Inject only the inner part of the forearm. D) Give small volumes of doses.

Ans: A Feedback: An important nursing intervention when administrating drugs through the transdermal route is to apply the next dose to a new site. It is important to check the infusion rate every 15 to 30 minutes in patients using infusion controllers or infusion pumps. When using the intradermal route, the inner part of the forearm should be used as the injection site and small volumes of doses should be administered.

The nurse is preparing to administer an intradermal injection. The nurse would insert the needle at which angle? A) 15 degrees B) 30 degrees C) 45 degrees D) 90 degrees

Ans: A Feedback: When giving an intradermal injection, the needle is inserted bevel up at a 15-degree angle. The nurse would insert the needle at a 90-degree angle for an intramuscular injection or for a patient who is obese and requires a subcutaneous injection. Typically a subcutaneous injection is given at a 45-degree angle.

The nurse is checking the medical record of an assigned patient for medication orders. The nurse is unable to read the primary health care provider's handwriting. Which action would be most appropriate? A) The nurse should question the order with the primary health care provider. B) The nurse should try to interpret the handwriting. C) The nurse should confirm the order with a nearby health care provider. D) The nurse should obtain a verbal order.

Ans: A Feedback: Any order that is unclear, particularly due to illegible handwriting, should be questioned. The nurse should not try to interpret the handwriting as it may lead to a misinterpretation. The nurse should also not confirm the order with any other physician who is nearby. Administering drugs based on verbal orders is permissible only during emergencies.

A nurse is preparing to administer an intramuscular injection to a patient for the first time. Which of the following would be most important for the nurse to do? A) Obtain the patient's allergy history. B) Obtain information about the drug. C) Inquire if the patient has any objections to syringes. D) Discuss the dosage with other nurses.

Ans: A Feedback: Before giving any drug for the first time, the nurse should ask the patient about any known allergies as well as any family history of allergies. The nurse need not particularly obtain information about the drug as it has been prescribed by the physician, but needs to be aware of the adverse effects it may cause. There is also no need to discuss the dosage with other nurses or to find out if the client has any objections to syringes. However, the nurse should help allay the patient's fears by reassuring him or her about the administration.

A nurse is preparing to administer a prescribed drug by the oral route. Which of the following would be most important for the nurse to do? Select all that apply. A) Making sure the client is in an upright position prior to administration B) Ensuring that a full glass of water is readily available C) Leaving PRN drugs at the bedside for ready access if needed D) Instructing the client to tilt his or her head back to swallow a capsule E) Having the client refrain from sipping on the water before placing the tablet in the mouth

Ans: A, B Feedback: Clients should always be in an upright position when receiving oral drugs and a glass of water should be readily available. They should be encouraged to take a few sips of water before placing the tablet or capsule in the mouth. Drugs should never be left at the client's bedside. Instruct clients to tilt their head back to swallow a tablet and slightly forward to swallow a capsule.

After teaching a group of students about the different routes of medication administration, the nursing instructor determines that the teaching was successful when the students identify which of the following as a topical drug? Select all that apply. A) Eyedrops B) Suppository C) Nebulized bronchodilator D) Nicotine patch E) Capsule

Ans: A, B Feedback: Topical drugs are drugs that are applied to the outer layer of the skin but not absorbed through the skin, such as eyedrops and suppositories. A nebulized bronchodilator is an inhaled medication. A nicotine patch delivers the medication transdermally; that is, it is readily absorbed from the skin. A capsule is a form of oral medication.

A group of nursing students are reviewing the concept known as the five + 1 rights of drug administration. The group demonstrates understanding of this concept when they identify which of the following as being included? Select all that apply. A) Right documentation B) Right patient C) Right route D) Right drug E) Right prescriber

Ans: A, B, C, D Feedback: The five + 1 rights of drug administration include the following: right patient, right drug, right dose, right route, right time, and right documentation.

When completing the check to ensure that the right drug is being administered to the client, which of the following should the nurse compare? Select all that apply. A) Medication B) Container label C) Medication record D) MAR E) Nursing notes

Ans: A, B, C, D Feedback: The nurse compares the medication, container label, and medication record and then the MAR as the item is removed from the cart and before the actual administration of the drug.

A nurse is reviewing the order for a medication. Which of the following must be included? Select all that apply. A) Client's name B) Drug name C) Dosage form D) Route of administration E) Frequency of administration

Ans: A, B, C, D, E Feedback: A primary health care provider's order must include the client's name, the drug name, the dosage form and route, the dosage to be administered, and the frequency of administration.

A nurse is preparing to administer a prescribed drug. Which information about the drug would be most important for the nurse to know? Select all that apply. A) Normal dosage range B) Special precautions in administration C) Drug's most common adverse effects D) Drug's general action E) Reason for use of the drug

Ans: A, B, C, D, E Feedback: The nurse must have factual knowledge of each drug given, the reason for use of the drug, the drug's general action, the more common adverse reactions associated with the drug, special precautions in administration (if any), and the normal dose ranges.

A nurse is reviewing the medical record of a client and notes the various orders for drug therapy. Which of the following would the nurse most likely expect to find? Select all that apply. A) Standing order B) STAT order C) Single order D) Alternate order E) PRN order

Ans: A, B, C, E Feedback: Common orders given by health care providers for drug therapy include the standing order, the single order, the PRN order, and the STAT order.

A nurse is preparing to administer a prescribed drug via an intramuscular injection. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Always wear gloves. B) Cleanse skin at injection site. C) Place pressure on the area after removing the needle. D) Recap the needle before disposal. E) Aspirate after inserting the needle.

Ans: A, B, C, E Feedback: When administering an intramuscular injection, the nurse should always wear gloves, cleanse the skin at the injection site prior to administration, aspirate for 5 to 10 seconds after inserting the needle, apply pressure to the area after removing the needle, and never recap the needle.

When administering parenteral drugs, which of the following routes would the nurse use? Select all that apply. A) Subcutaneous B) Intramuscular C) Intradural D) Intravenous E) Intradermal

Ans: A, B, D, E Feedback: A nurse can administer parenteral drugs via subcutaneous, intramuscular, intravenous, intradermal, and, in some instances, intra-arterial routes by means of a catheter placed by a physician in an artery. The primary health care provider can administer a drug via the intradural route.

1. Which of the following reflects a nurse's responsibility when a drug is prescribed for a client? Select all that apply. A) Administering the drug to the client B) Monitoring for therapeutic response C) Checking for drug-drug interactions D) Reporting adverse reactions E) Teaching the client information needed to administer drugs safely at home

Ans: A, B, D, E Feedback: When a drug is prescribed to a client, the nurse is responsible for the administration of the drug, monitoring for therapeutic effects, reporting adverse drug reactions, and teaching the client information needed to administer the drug safely at home. A pharmacist checks for drug-drug interactions prior to dispensing a drug for administration.

When a primary health care provider phones in a medication order for a client, the nurse should do which of the following? Select all that apply. A) Write down the order. B) Record the order as soon as the MAR is retrieved. C) Repeat back the information exactly as written. D) Clarify any unclear information. E) Obtain verbal confirmation that the information is correct.

Ans: A, C, D, E Feedback: If a verbal order is given over the telephone, the nurse writes down the order immediately, repeats back the information exactly as written, and then asks for a verbal confirmation that it is correct. Any order that is unclear should be questioned and clarified.

A nurse is preparing a presentation for a group of nurses about actions that nurses can do to help prevent drug errors. Which of the following would the nurse include? Select all that apply. A) Rechecking all calculations B) Always administering the drug before answering any of the client's questions C) Avoiding distractions and concentrating on only one task at a time D) Confirming any questionable orders E) Practicing the five + 1 rights of drug administration

Ans: A, C, D, E Feedback: In addition to following the five + 1 rights of drug administration, a nurse can employ the following strategies to aid in the prevention of drug errors: confirm any questionable orders; when calculations are necessary, verify them with another nurse; listen to the client when he or she questions a drug, the dosage, or the drug regimen; never administer the drug until the client's questions have been adequately researched; and avoid distractions and concentrate on only one task at a time.

Prior to administering a prescribed drug, the nurse correctly identifies the client by which method? Select all that apply. A) Checking a client's name on his or her wristband B) Checking a client's chart C) Asking the client to identify himself or herself and give his or her birth date D) Asking a client if he or she is the correct client E) Using a current picture of the client if available

Ans: A, C, E Feedback: Client identifiers can include visual and verbal methods. Visual methods include use of a recent picture of the client or client wristband. Verbal methods include asking the client for his or her name and another unique identifier, such as his or her birth date. Never ask a client, are you Mr. Jones? because some clients may respond by answering yes even though that is not their name due to confusion or difficulty hearing. Checking the client's chart would be inappropriate to use for identifying the client.

Drug errors are most likely to occur at which time? Select all that apply. A) When transcribing the drug order B) When verifying the client C) When dispensing the drug D) When charting after drug administration E) When administering the drug

Ans: A, C, E Feedback: Drug errors may occur in transcribing drug orders, when the drug is dispensed, or in administration of the drug. Nurses, as the drug administrators, serve as the last defense against drug errors. Verifying the client and charting after administration are two important areas to help prevent medication errors.

A client has an order to receive 10 units of intermediate-acting insulin at bedtime via subcutaneous injection. The nurse would expect to administer the injection at which site? Select all that apply. A) Upper arm B) Inner forearm C) Upper abdomen D) Gluteus maximus E) Upper thigh

Ans: A, C, E Feedback: The sites for subcutaneous injection are the upper arms, the upper abdomen, and the upper thighs.

When administering an intradermal injection, the nurse would use a 1-mL syringe with which gauge of needle? Select all that apply. A) 26 gauge B) 28 gauge C) 29 gauge D) 25 gauge E) 27 gauge

Ans: A, D, E Feedback: A 1-mL syringe with a 25- to 27-gauge needle that is 1/4 to 5/8 inches long is best suited for intradermal injections.

A nurse has administered an opioid drug to a patient. Which action would be most appropriate for the nurse to do immediately after administering the drug? A) Monitoring the vital signs of the patient B) Documenting administration of the drug C) Informing the patient about the type of drug D) Updating the physician regarding the patient's condition

Ans: B Feedback: After administration of any drug, the nurse should immediately document the administration. After the documentation is complete, the nurse can record the patient's vital signs. The patient needs to be informed about the drug before the administration. The physician need not be immediately informed, unless the client develops severe adverse reactions.

A patient is prescribed a buccal medication. The nurse would instruct the patient to place the drug at which location? A) Under the tongue B) Against the cheek mucous membrane C) Inside the rectum D) At the back of the tongue

Ans: B Feedback: Buccal drugs are placed in the mouth against the mucous membranes of the cheek in either the upper or lower jaw. Sublingual medications are placed under the tongue. Rectal suppositories are inserted into the rectum. Oral medications are placed at the back of the tongue.

A primary health care provider instructs a nurse to administer a medication to a patient STAT. Which action by the nurse would be most appropriate? A) Insist on obtaining a written report before administering any drug. B) Administer the drug as ordered by the physician. C) Forgo obtaining the physician's order after the drug has been administered. D) Document the administration of the drug only after receiving the physician's order.

Ans: B Feedback: The nurse should administer the drug as instructed without a written order as it is an emergency. The nurse should, however, ensure that the physician's order is obtained after the drug has been administered. Waiting for a written order during an emergency may exacerbate the patient's condition. The nurse should complete the documentation immediately after the administration of the drug and not wait until the physician's order is received.

A nursing instructor is observing a nursing student prepare an oral drug for administration. The instructor determines that the student is performing the procedure correctly when the student compares the label of the drug with the MAR how many times? A) 2 B) 3 C) 4 D) 5

Ans: B Feedback: The proper procedure is to compare the drug label with the MAR three times: (a) when the drug is taken from its storage area, (b) immediately before removing the drug from the container, and (c) before administering the drug to the patient.

The nurse is caring for a client who has a nasogastric tube in place. The client is to receive an oral medication through the tube. Which action by the nurse would be most appropriate? Select all that apply. A) Not diluting liquids prior to administration B) Checking the tube for placement C) Dissolving crushed tablets in water prior to administration D) Flushing the tube with water after drugs are administered E) Clearing the tube with air prior to administration

Ans: B, C, D Feedback: Before administration of an oral drug through an NG tube or gastrostomy tube, the nurse should check the tube for placement, dilute and flush liquid drugs through the tube, crush tablets and dissolve them in water before administering them through the tube, and flush the tube with water after the drugs are placed in the tube to clear the tubing completely.

When using a bar-code point-of-care medication system, the nurse would scan which of the following prior to drug administration? Select all that apply. A) Client's hospital chart B) Client's identification band C) Drug unit dose package D) Nurse's identification badge E) Client's medication administration record

Ans: B, C, D Feedback: The bar-code point-of-care medication system requires that the client's identification band, the drug unit dose package, and the nurse's identification badge are all scanned prior to drug administration.

When administering a prescribed drug to a client, which action would be completely inappropriate? Select all that apply. A) Charting immediately on the MAR after drug administration B) Removing a drug from an unlabeled container C) Giving a drug that someone else prepared D) Crushing tablets or opening capsules E) Removing the drug's unit dose wrapper at the client's bedside

Ans: B, C, D Feedback: The nurse should always record immediately on the MAR after drug administration. The nurse should never remove a drug from an unlabeled container, give a drug that someone else prepared, or crush tablets or open capsules without consulting a pharmacist. The drug's unit dose wrapper should remain on until the nurse arrives at the client's bedside.

Which of the following is considered a unit dose system? Select all that apply. A) Floor stock bottle of aspirin 81 mg B) A prefilled Lovenox syringe C) One Phenergan suppository D) Floor stock bottle of ibuprofen suspension E) Single-dose cup of Maalox

Ans: B, C, E Feedback: Examples of unit dose medications include a package that contains one tablet or capsule, a premeasured amount of a liquid drug, a prefilled syringe, or one suppository.

The physician has asked a nurse to administer a drug intravenously to a patient who is unresponsive. How can the nurse ensure that the drug is administered to the right patient? A) By waking him up to ask him his name B) By identifying the patient's room number C) By checking the patient's wristband D) By asking the nursing assistant for the patient's location

Ans: C Feedback: The nurse should identify a patient by checking his wristband, which has the patient's name. The nurse should not ask the patient to confirm his name, because some patients, particularly those who are confused or have difficulty hearing, may respond by answering yes. Additionally, this patient is unresponsive. The nurse can obtain the patient's location by asking any other member of the health care staff, but should verify the patient's identity by checking the wristband. The nurse should not rely on the patient's room number alone.

A nurse is required to give an intramuscular (IM) injection to an 18-month-old toddler. The nurse would prepare which site for administration? A) Dorsogluteal site B) Deltoid muscle C) Vastus lateralis D) Ventrogluteal site

Ans: C Feedback: The vastus lateralis site is frequently used for infants and small children because it is more developed than the other intramuscular sites such as the dorsogluteal and deltoid muscle. Ventrogluteal sites may be used in children who have been ambulating for more than 2 years.

When documenting, which of the following would be appropriate for the nurse to use at accredited health care organizations? Select all that apply. A) IU B) QD C) 0.2 mg D) Units E) 2.0 mg

Ans: C, D Feedback: Always use a leading zero when writing decimals (i.e., 0.2 mg, not .2 mg) and leave off the trailing zero (i.e., 2 mg, not 2.0 mg). Always write out units, international units, and daily; do not use U, IU, or QD.

The nurse is preparing to administer a prescribed drug to a patient. The patient looks at the tablet and says, This doesn't look like my usual pill. Which response by the nurse would be most appropriate? A) This is the same pill your doctor has been ordering. B) It must be from a different manufacturer. C) It looks different? Are you sure? D) Let me double check with your doctor and the order.

Ans: D Feedback: If the patient makes any statement about the drug, the nurse needs to hold the drug and investigate the patient's statement, double checking the chart and the order and obtaining clarification and/or confirmation from the prescriber. It may be that the dosage or manufacturer has changed and that is what makes the pill look different. It is always important to err on the side of caution. Telling the patient that the pill is the same or that it is from a different manufacturer may be true, but the nurse needs to confirm that before giving it to the patient. Repeating the patient's statement and then asking him if he is sure is inappropriate because it implies that the patient is incorrect.

A patient is ordered to receive a subcutaneous injection of heparin twice a day. When administering this drug to the patient, which of the following would be most important for the nurse to do to minimize tissue damage? A) Insert the needle at the appropriate angle. B) Select the needle length based on the patient's weight. C) Ensure that there is no hair on the injection site. D) Rotate the injection site regularly.

Ans: D Feedback: The nurse should rotate the injection sites to minimize the damage caused to the tissue. Inserting the needle at the proper angle and selecting the needle length based on the patient's weight will not significantly help in minimizing tissue damage if the same site is repeatedly injected. It is not necessary to avoid injection sites that have hair as long as the drug is administered in the upper arms, the upper abdomen, and the upper back.