Ch. 32

A nurse is teaching a group of student nurses about the different types of medication orders seen in the acute care setting. Which statements made by the students indicate an understanding of the information? "A standing order is carried out until the health care provider cancels it by another order or until a prescribed number of days elapses." ""Subjective and objective assessment findings are used to determine when to administer a prn medication." "A single order prescription means that a medication is given only once, but the nurse can choose the time that it is given." "A STAT order can be repeated as often as needed in an emergency situation, based on the patient's condition." "A standing order must include a frequency of administration."

"A standing order is carried out until the health care provider cancels it by another order or until a prescribed number of days elapses." ""Subjective and objective assessment findings are used to determine when to administer a prn medication." "A standing order must include a frequency of administration."

The nurse is preparing a counseling plan for a patient on insulin treatment. Which instruction should the nurse first specify to the patient? "Rotate the insulin injection site regularly." "Take insulin subcutaneously before food." "Keep a daily administration log for insulin injection." "Eat candy while experiencing hypoglycemia after taking insulin."

"Eat candy while experiencing hypoglycemia after taking insulin."

The registered nurse is teaching the right route of drug administration to nursing students. Which of a nursing student's statements indicates a need for further teaching? "The medication should be labeled after preparation." "Enteral syringes should not be used to prepare oral medications." "Failure to remove the cap before administering the oral medication may result in aspiration." "Administration of oral products through intravenous route may result in the formation of a sterile abscess."

"Enteral syringes should not be used to prepare oral medications."

The registered nurse is teaching correct documentation of medications to a nursing student. Which statement if made by the nursing student indicates a need for further teaching? "I should ensure that I use a standard terminology in the medical documentation." "I should consult the health care provider if there are any issues in the documentation." "I should ensure that the medical record of the patient contains the patient's full name." "I should ensure that the abbreviation of the prescribed medication is mentioned in the medical documentation."

"I should ensure that the abbreviation of the prescribed medication is mentioned in the medical documentation."

What is a disadvantage of the parenteral route of medication administration? The parenteral route causes discoloration of the teeth. The parenteral route can only be given to unconscious patients. The parenteral route is contraindicated before some tests or surgery. The parenteral route may place the patient at a higher risk of reactions.

The parenteral route may place the patient at a higher risk of reactions.

Which nursing intervention avoids aspiration in children? Using liquid medication form Using a straw for medication administration Offering juice after medication administration Avoid mixing a large amount of medication into foods

Using liquid medication form

Which tips are appropriate for the safe administration of medications in children? Mixing medications with the child's favorite foods Offering juice after the child swallows the medication Using straws to help the child swallow the medication Using a glass disposable syringe to prepare liquid doses Mixing a small amount of medication with other foods or liquids

Using straws to help the child swallow the medication Mixing a small amount of medication with other foods or liquids

Which nursing measures are helpful in minimizing medication errors? Using two patient identifiers Concealing medication errors Ensuring adequate rest for the nurse Properly interpreting illegible prescriptions Preparing medications for one person at a time

Using two patient identifiers Ensuring adequate rest for the nurse Preparing medications for one person at a time

A registered nurse is teaching a nursing student about medications in patients with renal disease. Which statements, if made by the nursing student, indicate a need for further teaching? "Renal failure may lead to drug toxicity in the body." "Adequate fluid intake promotes proper elimination of medications through the kidneys." "Most drugs undergo biotransformation in the kidney before they are excreted." "Health care providers should decrease the medication dose in patients with renal disease." "Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure."

"Most drugs undergo biotransformation in the kidney before they are excreted." "Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure."

The registered nurse is teaching a nursing student about the various factors that affect drug absorption. Which statement if made by the nursing student indicates a need for further teaching? "Patients with malnutrition and liver disease are at risk of drug toxicity." "The larger the surface of drug absorption, the less the drug is absorbed." "Drugs given through the intravenous route are absorbed faster than the oral route." "The tablet form of medication is more readily absorbed than the solution form." "The greater the blood supply to the site of administration, the faster the drug is absorbed."

"The larger the surface of drug absorption, the less the drug is absorbed." "The tablet form of medication is more readily absorbed than the solution form."

Upon grasping the patient's skin, the nurse can hold about 2.5 cm (1 inch) of tissue with the fingers. At which angle should the nurse inject enoxaparin to the patient? 15 degrees 45 degrees 60 degrees 90 degrees

45

solution

a given mass of solid substance dissolved in a known volume of fluid or given volume of liquid dissolved in a known volume of another fluid

standing or routine med order

administered until the dosage is changed or another medication is prescribed

Why is insulin administered by injection?

because the Gi tract breaks down and destroys an oral form of insulin

what determines the organ of excretion?

chemical makeup of medicine

irrigations

cleanse an area, install medication, or apply hot or cold to injured tissue

Pharmacokinetics is the study of how medications:

enter the body are absorbed and distributed reach their site of action alter physiological functions are metabolized exit the body

what insulins should you never mix with other insulins?

insulin glargine or insulin detemir

Which injection is most preferred for allergy skin testing? Intradermal injection Intravenous injection Intramuscular injection Subcutaneous injection

intradermal

An infant who has recently undergone cardiac surgery is prescribed intravenous medications; however, the nurse finds that the infant has poor intravascular access. Which route of administration may the primary health care provider prescribe in this situation? Intrathecal Intrapleural Intraosseous Intraperitoneal

intraosseous

Intraveneous bolus

introduces a concentrated dose of medication directly into the systemic ciruclation

before injecting medication:

know the volume the characteristics and viscosity and location of anatomical structures under injection site

medication reconciliation

nurses, pharmacists, and other health care providers compare the medication that a pharmacist and other health care providers compare the medication that a patient is taking currently with what the patient should be taking and any newly ordered medications

Distribution depends on:

physical and chemical properties of meds physiology of patient

Insuline is classified by rate of Action:

rapid, short, intermediate, and long lasting

Luer lok:

screw

irrigations most commonly use:

sterile water, saline, or antiseptic solutions

After reading the prescription order of a patient, the nurse prepares to administer the medication in the patient's right ear. Which abbreviation in the prescription reflects the nurse's action? AS AD OD OS

AD

Where are the best subcutaneous injection sites? Upper ventral gluteal areas Anterior aspects of the thighs Scapular areas of the upper back Outer posterior aspect of the upper arms Abdomen from below the costal margins to the iliac crests

Anterior aspects of the thighs Outer posterior aspect of the upper arms Abdomen from below the costal margins to the iliac crests

The primary health care provider instructs the nurse to administer a booster dose of tetanus toxoid to a 7-year-old patient. Which nursing actions are appropriate? Avoiding injections when the patient is asleep Having a parent hold the child in a position of comfort Always look for a muscular site for injection Avoiding distracting the concentration of child while injecting the vaccine Avoiding the application of topical lidocaine ointment before injecting the vaccine

Avoiding injections when the patient is asleep Having a parent hold the child in a position of comfort

A diabetic patient is prescribed insulin. Which interventions should the nurse perform to teach the patient how to self-administer insulin? Check the visual acuity of the patient. Instruct the patient about the appropriate storage of insulin. Demonstrate rotation of insulin site injections. Demonstrate the preparation of a single insulin preparation. Instruct the patient not to titrate the insulin dose based on glucose monitoring.

Check the visual acuity of the patient. Instruct the patient about the appropriate storage of insulin. Demonstrate rotation of insulin site injections. Demonstrate the preparation of a single insulin preparation.

What is the role of state's Nurse Practice Act (NPA) in nursing? Controlling sales and distribution of medicines Defining the scope of nurse's professional function Ensuring safe and effective medications to the general population Establishing the individual policies to meet federal, state, and local regulations

Defining the scope of nurse's professional function

Nurses role in med adm.

Determines medications ordered are correct assessing patients ability to self-administer determining whether patient should receive meds at a given time administering medications correctly closely monitoring effects

Which interventions should the nurse perform when administering medications to a patient through a nasogastric tube? Dissolve the different medications separately. Draw all the medications together in a syringe. Use a pigtail vent after connecting the syringe to the tube. Flush the tube before and after administration of the medication. Contact the health care provider if the patient resists the administration.

Dissolve the different medications separately. Flush the tube before and after administration of the medication. Contact the health care provider if the patient resists the administration.

The nurse prepares to administer a multivitamin from an ampule to a patient. Which nursing action indicates a need for correction? Drawing the medication quickly from the ampule Cleaning the patient's site of injection with an antiseptic cotton swab Applying friction in a circular motion up to 5 cm (2 inch) while cleaning the site Extracting the medication from a previously opened ampule first followed by the new ampule

Extracting the medication from a previously opened ampule first followed by the new ampule

Which drug is administered with the STAT order of prescription? Cetirizine Hydralazine Vancomycin Acetaminophen

Hydralazine

The nurse has to administer a subcutaneous injection to a patient. Which precautions should the nurse follow when administering the subcutaneous injection? Inject medication slowly. Pinch skin with the nondominant hand. Aspirate when administering the injection. Inject the needle slowly at a 45- to 90-degree angle. Insert the needle with bevel up at a 5- to 15-degree angle.

Inject medication slowly. Pinch skin with the nondominant hand

What is the hormone used to treat diabetes?

Insulin

A diabetic patient has been switched from oral antidiabetic drugs to insulin. Which information would help the patient to ensure correct self-administration of insulin? Insulin is given as a subcutaneous injection. The insulin is absorbed more quickly when injected into the abdomen. The site of injection should be changed monthly. Once a site is chosen for injection, the same site should be used for further injections. The recommended sites of injection include the upper arm, thigh, abdomen, and buttocks.

Insulin is given as a subcutaneous injection. The insulin is absorbed more quickly when injected into the abdomen. The recommended sites of injection include the upper arm, thigh, abdomen, and buttocks.

Four major sites of parenteral injection

Intramuscular Intraveneous subcutaneous intradermal

Which routes of administration are most commonly used to administer chemotherapeutic agents? Epidural Intracardiac Intrapleural Intraarticular Intraperitoneal

Intrapleural Intraperitoneal

The nurse administers a medication in the subarachnoid space. Which route of administration did the nurse use? Epidural Intrathecal Intrapleural Intraperitoneal

Intrathecal

The nursing instructor is talking to nursing students about the unit-dose system used in medication distribution. Which statements accurately describe the unit-dose system? It uses carts for distribution. It has labeled drawers. It has controlled substances kept in foil. It does not contain prn and stock medication. It includes ordered doses of medication for a full course.

It uses carts for distribution. It has labeled drawers.

Which class of drugs, if administered to the patient without a prescription, is punishable under the Controlled Substance law? Antiemetics Antihistamines Opioid analgesics Nonsteroidal anti-inflammatory drugs

Opioid analgesics

An elderly obese patient who has undergone total hip replacement surgery has been put on low-molecular-weight heparin (LMWH) enoxaparin. For which complications of subcutaneous injections should the nurse monitor? Phlebitis Pain Infiltration Hypertrophy of the skin Sterile abscess

Pain Hypertrophy of the skin Sterile abscess

Which statements are true regarding routes of medication administration? Parenteral route causes anxiety in patients. Inhalational routes have higher absorption rates. Medications are absorbed slowly through the skin. Oral route is avoided in patients with gastrointestinal disorders. Oral route is used in patients with reduced gastrointestinal motility.

Parenteral route causes anxiety in patients. Medications are absorbed slowly through the skin. Oral route is avoided in patients with gastrointestinal disorders.

Which medication forms are commonly prepared for administration by parenteral routes? Elixir Troche Extract Powder Solution

Powder Solution

pharmacists role in medi adm.

Prepares and distributes medication

Factors that influence absorption

Route ability of meds to dissolve blood flow to site of adm. body surface area lipid solubility

A patient is admitted to the emergency unit with hypertension. Which prescription order would the primary health care provider use in this situation? STAT order Now order Single order Standing order

STAT order

The nurse is preparing a teaching plan for safe insulin administration. Which interventions included in the plan is appropriate for the patient? Teaching the patient to determine the expiration date of insulin Teaching the steps of administering intramuscular injection Instructing the patient to avoid refrigeration of the medication When necessary, instructing the patient to accept help from the caregiver for rotating injection sites Helping the patient determine the insulin required based on the home capillary glucose monitoring

Teaching the patient to determine the expiration date of insulin When necessary, instructing the patient to accept help from the caregiver for rotating injection sites Helping the patient determine the insulin required based on the home capillary glucose monitoring

What is the significance of the deltoid muscle site in parenteral administration? The deltoid muscle site is used to administer heparin The deltoid muscle site is used to administer hepatitis B vaccine The deltoid muscle site is used to administer medications that have larger volumes The deltoid muscle site is used to administer medications that are viscous and irritating

The deltoid muscle site is used to administer hepatitis B vaccine

Therapeutic effect

the expected or predicted physiological response caused by a medication

Biotransformation occurs under:

the influence of enzymes that detoxify, break down, and remove active chemicals

The nurse applies lidocaine to a site before injecting the medication. What is the purpose of this nursing intervention? To reduce pain To minimize tissue pulling To minimize muscular tension To provide more consistency in the medication absorption

to reduce pain

Wha types of needles to use for skin testing?

tuberculin or small hypodermic syringe

adverse effects

undesired, unintended, and often unpredictable responses to medication

three types of containers for volume-controlled infusions

volume-control administration sets piggyback sets syringe pumps

toxic effects

when a medication accumulates in blood because of impaired metabolism or excretion

medication interaction

when one medication modifies the action of another