Chapter 26 Medicating Patients

Which would be an appropriate technique and preparation for administration of subcutaneous injection in a morbidly obese person? Select all that apply. - 25- to 27-gauge needle. - 18- to 20-gauge needle. - Inject substance at a 45-degree angle. - Inject at a 90-degree angle. - Pull skin taut when administering.

- 25- to 27-gauge needle. - Inject at a 90-degree angle. - Pull skin taut when administering.

Which characteristics of a drug are part of pharmacokinetics? Select all that apply. - Absorption - Packaging - Dosage - Distribution - Excretion

- Absorption - Distribution - Excretion

After delivering the medication, Cynthia begins the documentation process and realizes that a medication error has been made. What actions should be taken? Select all that apply. - Tell the client about the mistake. - Pretend the error did not happen. - Assess the client for changes in assessment or vital signs. - Induce vomiting. - Complete an incident report per the agency policy.

- Assess the client for changes in assessment or vital signs. - Complete an incident report per the agency policy. Explanation: If an error is made, it is important for the nurse to quickly admit the error occurred and assess the client. The nurse should then follow the agency policy and complete an incident report. There is no need to notify the client of the error unless there is a reason, such as additional tests being ordered. In most cases, the healthcare provider will need to be notified. Having the client vomit is uncommon, although this action may be considered in children.

When should the three checks take place? Select all that apply. - Before leaving the pharmacy - Before preparing the medication - At the client's bedside - After preparing the medication - After the client has taken the medication

- Before preparing the medication - At the client's bedside - After preparing the medication

What should the nurse confirm as two identifiers? Select all that apply. - Birthdate - Medical record number - Name - Social Security number - Home address

- Birthdate - Medical record number - Name

Cynthia begins the medication administration process. Which safety protocol should take place before the medications are removed from the package? Select all that apply. - Confirm the medication label with the medication administration record (MAR). - Check the client's allergies. - Check the expiration date of the medication. - Confirm the correct dose. - Verbally check the client's identifier.

- Confirm the medication label with the medication administration record (MAR). - Check the client's allergies. - Check the expiration date of the medication. - Confirm the correct dose. Explanation: Before opening the medication package, the nurse should begin the process of "three checks" and "six rights." The two identifiers should take place at the client's bedside. Allergies must be verified as the medication record is reviewed and again at the bedside. The medication's expiration date should also be confirmed before removal of the medication.

In order to safely measure quantity desired, what does the nurse need to know? Select all that apply. - Dose preferred - Desired dose - Quantity on hand - Volume on hand - Dose on hand

- Desired dose - Dose on hand - Quantity on hand

During the administration of a metered-dose inhaler, when should the nurse instruct the client to rinse her mouth? Select all that apply. - An hour after the dose has been administered - Directly after the dose has been administered for certain medicines - During the administration of the dose - Directly before the dose is administered - An hour before the dose is administered

- Directly after the dose has been administered for certain medicines - Directly before the dose is administered

Medication errors are common in healthcare. What are some frequently reported reasons for errors to occur? Select all that apply. - Fatigue - Inadequate staffing - Lack of knowledge - Poor handwriting - Labeling errors

- Fatigue - Inadequate staffing - Lack of knowledge - Poor handwriting - Labeling errors

The nursing outcome for a client with a nursing diagnosis of Risk for constipation r/t analgesic is as follows: Client will not experience constipation as evidenced by usual frequency of bowel movements; passage of soft, formed stool. Constipation is a common side effect of analgesics, so what is an appropriate nursing intervention to help address this? Select all that apply. - Instruct the client to increase intake of foods high in fiber. - Instruct the client to maintain a minimum fluid intake of 2500 mL/day unless contraindicated. - Administer laxatives or cathartics and/or enemas if ordered. - Report a pattern of decreasing bowel sounds. - Expect an absence of abdominal distention and pain.

- Instruct the client to increase intake of foods high in fiber. - Instruct the client to maintain a minimum fluid intake of 2500 mL/day unless contraindicated. - Administer laxatives or cathartics and/or enemas if ordered.

Which are examples of parenteral administration of medication? Select all that apply. - Intramuscular - Intravascular - Inhaled - Oral suspension - Topical application

- Intramuscular - Intravascular

The nurse is preparing medications in solid form. How should the nurse anticipate they are measured? Select all that apply. - Kiloliters - Liters - Milliliters - Milligrams - Grams

- Milligrams - Grams

What are some advantages to computerized safety methods in medication administration? Select all that apply. - Monitor for safe dosing - Perform medication calculations - Alert for errors - Confirm compatibilities - Minimize cost

- Monitor for safe dosing - Perform medication calculations - Alert for errors - Confirm compatibilities

When documenting, what should Cynthia include? Select all that apply. - Name of medication - Dose of medication - Route of administration - Date and time of administration - Initials and name

- Name of medication - Dose of medication - Route of administration - Date and time of administration - Initials and name Explanation: All of these items are important to include in the documentation process.

As Cynthia talks to Mrs. Steinhart about the medications to be delivered, what information should the nurse share? Select all that apply. - Name of medication - Reason for medication - Pharmacokinetics of the medication - Who ordered the medication - Dose of medication

- Name of medication - Reason for medication - Who ordered the medication - Dose of medication Explanation: Educating the client about the medication can be the last "double check" for accuracy. By stating, "Hi, Mrs. Steinhart, I have your furosemide 20 mg that Dr. Jones ordered. It's your water pill," errors can be discovered. Sometimes the client will say, "That's not my normal dose" or "I usually take spironolactone for my water pill," which provides the nurse with another confirmation of accuracy.

Which are safety challenges related to medication self-administration in older adults? Select all that apply. - Opening medication containers - Remembering to take medications - Studying labels for correct dosing - Asking doctors for medications - Thinking medications are not needed

- Opening medication containers - Remembering to take medications - Studying labels for correct dosing

Which are examples of the "rights of medication" administration? Select all that apply. - Right client - Right room - Right nurse assigned to administer - Right dose - Right time - Right route

- Right client - Right dose - Right time - Right route

Which are sources of discomfort associated with injections? Select all that apply. - The needle itself. - Anxiety of the client. - Movement of the client. - Chemical irritation caused by certain drugs. - Pressure of the volume of medication in the tissue.

- The needle itself. - Chemical irritation caused by certain drugs. - Pressure of the volume of medication in the tissue.

Which statements are true about parenteral medications? Select all that apply. - The results are predictable. - It is less painful for the client. - The body absorbs the drugs faster and more completely. - The medication lasts longer. - Dosage measuring is accurate.

- The results are predictable. - The body absorbs the drugs faster and more completely. - Dosage measuring is accurate.

Cynthia safely prepares the medication and takes it to Mrs. Steinhart's room. What final checks need to take place in the client's room? Select all that apply. - Two identifiers - Third confirmation of the medication - Right patient - Right documentation - Right room

- Two identifiers - Third confirmation of the medication - Right patient Explanation: At the client's bedside, the two identifiers are checked verbally as the medical identification band is compared for name/birthday or name/medical record number. In doing this, the nurse has again confirmed the "right patient." The third of the "three checks" takes place at the bedside by comparing the medication with the MAR. The right documentation will take place after the medication is administered.

Martha now prepares Mr. Matthew's blood pressure medication. She makes a mental note to reassess his blood pressure prior to the delivery of this medication. Prescribed to be delivered is metoprolol 25 mg PO daily. Available from the pharmacy is metoprolol 50 mg tablets. How many tablets should Martha administer? a. 0.5 tab b. 1 tab c. 2 tabs d. 3 tabs e. 4 tabs

0.5 tab

The physician has prescribed furosemide, 10 mg PO daily. The pharmacy has furosemide, 20 mg tablet available. How many tablets should the nurse administer daily? a. 10 tabs b. 0.5 tab c. 2 tabs d. 1 tab

0.5 tab

Which is a safe volume of medication to be administered through the subcutaneous route? a. 3 to 5 mL b. 2 to 4 mL c. 0.5 to 1 mL d. 1.5 to 3 mL

0.5 to 1mL

The next client for medication preparation is Mr. Sampson, a client with heart disease. He is to receive furosemide 40 mg IV. After evaluating the client's fluid status and potassium level, Martha begins to draw up the medication. Available from the pharmacy is 80 mg in a 1 mL vial. How many milliliters of medication will Martha administer? a. 0.5 mL b. 1 mL c. 1.5 mL d. 2 mL e. 2.5 mL

0.5mL

The physician has prescribed meperidine, 50 mg. The pharmacy has meperidine 75 mg/mL available. How many milliliters should the nurse deliver? a. 6.7 mL b. 1.5 mL c. 2 mL d. 0.67 mL

0.67 mL

Mr. Sampson also has a prescription for clopidogrel 75 mg PO daily. Available from the pharmacy is clopidogrel 75 mg tablets. How many tablets will Martha administer? a. 0.5 tab b. 1 tab c. 2 tabs d. 3 tabs e. 4 tabs

1 tab

The next medication for preparation is Mr. Matthew's diabetes medication. Martha confirms that his morning glucose was 134 g/dL and the dose is safe to give. The prescription is for metformin hydrochloride 500 mg PO twice daily. The pharmacy sent metformin hydrochloride 500 mg tablets. How many tablets should Martha prepare for a single dose (one scheduled administration)? a. 0.5 tab b. 1 tab c. 2 tabs d. 3 tabs e. 4 tabs

1 tab Explanation: Martha will prepare 1 tablet. Do not be fooled by "twice daily." The client will receive 1 tablet in the morning and one in the evening for 2 total tablets for the day, not at a time.

Martha is preparing to administer meperidine 75 mg to Ms. Fiore. Available from the pharmacy is 50 mg/mL. How many mL of medication will Martha deliver? a. 0.67 mL b. 1 mL c. 1.5 mL d. 2 mL e. 3,750 mL

1.5mL

The physician has prescribed methylprednisolone, 60 mg IV bid. The pharmacy has methylprednisolone, 40 mg/mL available. How many milliliters should the nurse administer? a. 1.5 mL b. 1 mL c. 0.67 mL d. 0.33 mL

1.5mL

The last client for Martha to deliver medications to is Teddy Thompson, a 19 year old with a history of seizures from cerebral palsy. He has an order for phenytoin 100 mg liquid to be delivered through a percutaneous endoscopic gastrostomy tube into his stomach. The pharmacy has sent phenytoin 30 mg/5 mL. After confirming the latest serum phenytoin level, how much medication should Martha deliver? a. 0.6 mL b. 1 mL c. 3.3 mL d. 16.7 mL e. 100 mL

16.7mL

The physician prescribed atropine sulfate, 0.1 mg subcutaneous now, prior to surgery. The pharmacy has atropine sulfate, 0.05 mg per mL available. How many milliliters should the nurse administer? a. 0.2 mL b. 0.5 mL c. 5 mL d. 2 mL

2 mL

Martha recently graduated nursing school, passed the NCLEX, and started working at a local hospital. After receiving a hand-off report for a group of clients, she is preparing for the day. As she looks over the medication record, Martha begins to consider the dosage calculations she will need to make for the safe delivery of medications. At 0830 she begins to prepare for the delivery of morning medications. Her first client, Donovan Matthews has a history of peptic ulcer disease, diabetes, and hypertension. The first medication to deliver is omeprazole 20 mg PO once daily. Available from the pharmacy is omeprazole 10 mg tablets. How many tablets will Martha deliver? a. 0.5 tab b. 1 tab c. 2 tabs d. 3 tabs e. 4 tabs

2 tabs Explanation: Dose on Hand/Quantity on Hand = Desired Dose/Quantity Desired

The physician has prescribed morphine sulfate, 12 mg IV q2h, prn for pain. The pharmacy has morphine sulfate, 5 mg/mL available. How many milliliters should the nurse administer? a. 0.42 mL b. 2.4 mL c. 0.84 mL d. 1.2 mL

2.4 mL

The physician has prescribed acetaminophen, ½ teaspoon. The pharmacy has acetaminophen, 160 mg/5 mL available. How many milliliters should the nurse administer if 1 teaspoon = 5 mL? a. 1 mL b. 2.5 mL c. 0.5 mL d. 5 mL

2.5mL

After safely delivering Mr. Matthew's medications, Martha receives a call that her client, Suzanna Fiore has a serum potassium level of 3.2 mEq/L. She contacts the health care provider and receives an order for potassium chloride 40 mEq PO now. The pharmacy provides potassium chloride 10 mEq/tablet. How many tablets should Martha deliver? a. 0.5 tab b. 1 tab c. 2 tabs d. 3 tabs e. 4 tabs

4 tabs

During the administration of a subcutaneous medication, at what angle should the nurse insert the needle? a. 15 to 45 degrees b. 90 to 120 degrees c. 45 to 120 degrees d. 45 to 90 degrees

45 to 90 degrees

While delivering Ms. Fiore's medications, the charge nurse comes into the room to tell Martha that her post-surgical client, Kenny Randall is asking for his intramuscular pain medication. Martha notes that the order is for meperidine 75 mg IM. Available from the pharmacy is 50 mg/mL vials. What is the dose on hand? a. 50 mg b. 75 mg c. 1 mL d. 2 mL e. 3 mL

50mg Explanation: The dose on hand is the amount sent from pharmacy. 50 mg is the dose on hand. 1 mL is the volume (quantity) on hand. 75 mg is the dose order (or desired dose).

When administering eye ointment, why does the nurse pull the lower lid down to expose the conjunctival sac?

Allows for better visualization Explanation: When administering eye ointment, the nurse uses her nondominant hand to pull the lower lid down to expose the conjunctival sac to allow for better visualization of the area where the nurse will administer the medication. It is important to tell the client that his or her vision will be blurred for a short time because of the viscosity of the ointment.

A nurse is preparing oral medications. A client is concerned that the blood pressure pill is a different color than the one he or she takes at home. How should the nurse respond? a. Return the medication to the pharmacy, as it is the wrong medication. b. Reassure the client that this is what the doctor has prescribed. c. Check the label and dosage and confirm that the medication and dosage is correct. Reassure the client that this is a different manufacturer. d. Ask the client to bring his medications from home and he can take those.

Check the label and dosage and confirm that the medication and dosage is correct. Reassure the client that this is a different manufacturer.

Which is the primary danger when administering oral medications to children? a. Giving the wrong dose b. The child not responding as expected to the drug c. Incorrect client identification d. Choking and aspiration

Choking and aspiration

As Cynthia compares the medication with the MAR, she recognizes that one of the medications is ordered for hs, an abbreviation from the Institute for Safe Medication Practices list of error-prone abbreviations. What should be the nurse's next action? Select all that apply. - Do not give the medication. - Confirm the original order for accuracy. - Consult the charge nurse for direction. - Contact the healthcare provider for clarification. - Call the pharmacist.

Confirm the original order for accuracy Explanation: Because the abbreviations on the error-prone list raise the possibility of risk for medication error, the nurse needs to be extra cautious when seeing them used. By confirming the original order, the nurse can determine whether the medication was transcribed accurately.

Which describes drugs with limited medical use and high potential for abuse or addiction? a. Controlled substances b. Prescription drugs c. Narcotics d. Placebo drugs

Controlled Substances

Which factors impact inaccuracies with dosage calculations in medication administration? Select all that apply. - Conversions are sometimes required. - Not all measurements fall within the standard systems of measure. - Multiple measurement systems are sometimes involved. - Medications prescribed are a different dose from what is available. - Errors are not reported.

Conversions are sometimes required. Not all measurements fall within the standard systems of measure. Multiple measurement systems are sometimes involved. Medications prescribed are a different dose from what is available.

Which can result as an increased response to repeated doses of a drug that occurs when the rate of administration is greater than the rate of metabolism and excretion? a. Pharmaceutical effect b. Cumulative effect c. Side effect d. Adverse effect

Cumulative effect

As Cynthia offers the medications to her, Mrs. Steinhart pulls one out and says, "I can't swallow a pill that large." What should the nurse do next? Select all that apply. - Decide not to give the medication. - Cut the pill in half if scored and have her take both halves. - Crush the pill and mix it with applesauce. - Dissolve the pill in water and have her drink the mixture. - Have her chew the pill and then swallow.

Cut the pill in if scored and have her take both halves. Explanation: If a table is scored, it can be cut in half if necessary, making it easier to take. Pills that are not scored should not be cut because they can break unevenly, providing an incorrect dose. Crushing, dissolving, or chewing the pill is less desirable because it could leave a bad taste.

In what forms can oral medications be delivered? Select all that apply. - Sublingual - Buccal - Tablet - Powder - Liquid

all

A nurse is drawing up a medication through a syringe from a single-use vial. After the prescribed amount is drawn up, there is still approximately 5 mL of solution in the vial. Which action should the nurse take? a. Draw up the remaining medication and administer to the client. b. Place the vial in the medication room in case another nurse needs it for another client. c. Place it in his or her pocket in case it is needed later. d. Discard the remaining medication.

Discard the remaining medication

While preparing a client's medications, a nurse notices that the client has a penicillin allergy, and the doctor has ordered penicillin. What are the next appropriate actions? a. Do not give the medication. Contact the provider for clarification. b. Call the pharmacy and see what the pharmacist thinks should be done. c. Give the medication as ordered. The provider is aware of the medical history. d. Call the pharmacy to substitute another antibiotic.

Do not give the medication. Contact the provider for clarification.

When using a volume-control administration set and medication has finished infusing, why does the nurse add a small amount of the primary IV fluid to the chamber and flush the tubing?

Ensures delivery of all medication Explanation: After using a volume-control administration set, flushing the line ensures all the medication is given to the patient and does not adhere to the tubing.

What is the term for medication delivered by nebulization? a. Enteral b. Parenteral c. Instilled d. Inhaled

Inhaled

A client presents to the emergency department with severe pain related to a kidney stone. In order to obtain adequate pain relief quickly, which is the most rapid and effective route to administer pain medications? a. Intravenous b. Intramuscular c. Oral administration d. Subcutaneous injection

Intravenous

A student nurse is assigned to a client with a medical diagnosis of pneumonia who has been prescribed Levaquin. What is the generic name of this medication? a. Fluoroquinolone b. Levofloxacin c. (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid hemihydrate d. Levaquin oral solution

Levofloxacin

Which organ is the primary site for drug metabolism? a. Kidneys b. Bladder c. Liver d. Stomach

Liver

What is the preferred system for medication dosing in the United States? a. Apothecary b. International System of Units c. Metric d. Household

Metric

When administering subcutaneous medication, why does the nurse remove the needle along the line of insertion?

Minimizes discomfort Explanation: After the administration of a subcutaneous medication, the needle should be removed smoothly and along the line of insertion to prevent pulling against the skin and tissue, thus minimizing discomfort. The subcutaneous injection should be performed at a 45- to 90-degree angle using a 1.0-mL syringe or smaller and a 28- to 31-gauge needle, 1 inch or less in length.

Which describes the production of a fine spray, fog, powder, or mist from a liquid drug? a. Reconstitution b. Vaporization c. Nebulization d. Reformulation

Nebulization

Which describes medications that are given through injection into tissues or the bloodstream? a. Reconstituted administration b. Syringe administration c. Parenteral administration d. Metered dose administration

Paraenteral administration

Which action describes the period when the concentration of medicine is highest in the blood? a. Onset of action b. Peak action c. Duration of action d. Therapeutic range

Peak action

When administering oral medications, why does the nurse wipe the lip of the bottle with a tissue or paper towel after pouring?

Prevents contamination Explanation: During the pouring of liquid medication, if medication had dripped down over the lip of the bottle, wiping the lip with a tissue or paper towel prevents contamination, particularly for thicker solutions such as elixirs or syrups containing sugar. When measuring liquid medications, set the plastic medication cup on a flat surface and measure at eye level. The dose should be read at the lowest part of the concave surface (meniscus). Reading medications below eye level will cause you to read the dose incorrectly.

When administering ear drops, why does the nurse place a cotton ball, or a piece of one, loosely at the opening of the auditory canal for 15 minutes?

Prevents medication leakage Explanation: After the administration of otic medications, the client should remain on his or her side for 5 to 10 minutes to prevent leakage of the fluid. After that time, place a cotton ball. It will absorb excess fluid and keep the medication from flowing out. However, keep in mind that cotton left near an infant can be a choking hazard and must be carefully supervised.

When administering a metered-dose inhaler, why does the nurse ask the patient to rinse out her mouth and split the fluid out?

Prevents transfer of bacteria Explanation: Before the administration of a metered-dose inhaler, the client should be instructed to rinse his or her mouth. Spitting the fluid out without swallowing any prevents transfer of bacteria from the mouth to the inhaler. If a corticosteroid inhaler is used, the mouth should be rinsed out again afterward to prevent a secondary fungal infection.

When instilling nose drops, why does the nurse ask the patient to stay in the same position for 1 to 5 minutes?

Promotes better absorption Explanation: When administering nasal medication, the client should maintain the back-lying position to promote better absorption of the medication by using gravity to disperse the medication throughout the nasal passages and sinuses instead of draining out the nose. The client should be instructed not to blow his or her nose for several minutes after the instillation of nose drops so as not to expel the medication.

The nurse, Cynthia, has an order to deliver four oral medications to Mrs. Steinhart, an 85-year-old with mild dementia who is in the care center. The facility uses a unit-dose system, which is not automated. Over-the-counter medications are kept as a stock supply.Cynthia recognized two of the four medications because she has given them before, but she is unfamiliar with the other two prescriptions. What should her next action be? a. Research the two unknown medications. b. Research the two unknown medications and refresh her knowledge for the two known medications. c. Administer the medications as ordered. d. Ask another nurse what the two unknown medications are given for. e. Ask Mrs. Steinhart whether she knows what the medications are for.

Research the two unknown medications and refresh her knowledge for the two known medications. Explanations: A nurse should never give a patient an unfamiliar medication. Research should include safe-dose range, side effects, and any assessment or teaching that needs to take place before or after the medication is given. Refreshing knowledge of the other two medications is best practice that will alert the nurse to any potential contraindication for these medications being given together. Another nurse is not necessarily a reliable source of information, and the patient is not a reliable resource.

Which describes restorative effects of drugs? a. Relieves signs and symptoms of disease but does not provide treatment for the disease itself. b. Destroys disease-causing microorganisms or body cells. c. Returns or maintains the body at optimal health. d. supports the integrity of other body functions until other medicines or treatments are effective.

Returns or maintains the body at optimal health.

Which factors are included in the six rights of medication administration? Select all that apply. - Right room - Right location - Right medication - Right route - Right patient

Right patient Right Medication Right Route

When using the Z-track method to administer an intramuscular injection, why does the nurse, with her nondominant hand, displace the skin away from the injection site?

Seals in medication Explanation: During the administration of a medication using the Z-track method, the skin should be displaced away from the injection site 2.5 to 3.5 cm (1 to 1.5 in.) so that when it is released after the injection, the medication is sealed in the muscle.

A nurse is caring for a client who has a nasogastric tube set to low intermittent suction. She has an order to administer a liquid medication through the tube. Which action should the nurse take prior to administration of the medication? a. Increase the suction on the NG tube to empty the stomach. b. Turn suction off on the NG tube and leave off for 30 minutes. c. Turn suction off but return to low intermittent suction immediately after medication administration. d. Leave the NG tube at low intermittent suction so that the medication is absorbed quickly.

Turn suction off on the NG tube and leave off for 30 minutes.

Which is the most preferred site for intramuscular injections in adults? a. Rectus femorus b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis

Ventrogluteal