Chapter 28, Medications

Which of the following clients receives a drug that requires parenteral route? A) A woman who has been ordered intravenous antibiotics B) A woman who takes a diuretic pill each morning C) A man with emphysema who uses nebulized bronchodilators D) A man who has an antifungal ointment applied to his skin rash daily

Ans: A Feedback: The parenteral route includes such methods as intravenous administration and injections. Pills are given by an oral route and a nebulizer is administered by the pulmonary route. An ointment is a topical medication.

A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. The nurse knows that which of the following is the reason for bunching when injecting subcutaneously? A) To prevent needle-stick injuries B) To ensure the accuracy of landmarking C) To facilitate blood circulation at injection site D) To avoid instilling medication within the muscle

Ans: D Feedback: Nurses bunch tissue between the thumb and fingers before administering the injection to avoid instilling medication within the muscle. Bunching does not prevent needle-stick injuries, it does not facilitate blood circulation at the injection site, nor does it ensure the accuracy of landmarking.

A physician writes an order for ampicillin 1 gram every 6 hours for a client. What is missing in this order? A) Time B) Amount C) Route D) Frequency

Ans: C Feedback: The medication order does not identify a route.

A nurse is administering a liquid medication to an infant. Where will the nurse place the medication to prevent aspiration? A) Between the gum and the cheek B) In front of the teeth and gums C) On the front of the tongue D) Under the tongue

Ans: A Feedback: A dropper is used to give infants or very young children liquid medications while holding them in a sitting or semisitting position. The medication is placed between the gum and the cheek to prevent aspiration.

The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? A) Withhold the medication until the potential drug allergy has been addressed by the care team. B) Administer the medication and increase the frequency of assessments in the hours that follow. C) Substitute an antibiotic with similar action, but which is from a different drug family. D) Discuss the severity, signs and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

Ans: A Feedback: Client safety is paramount, and the nurse has a responsibility to ensure that a potential threat of harm is identified and dealt with promptly. It is beyond the nurse's scope of practice to independently substitute another drug, and it would be unsafe to administer the drug in light of this revelation. The nurse would not administer the drug even if the client stated that his or her allergy is mild.

The nurse is preparing to administer a medication via a nasogastric tube. What guideline is appropriate for the nurse to follow when administering a drug via this route? A) Flush the tube with water between each drug administered. B) Position the client supine prior to administering the drug. C) Administer the medication at a cold temperature. D) If connected to suction, do not reconnect to suction for five minutes after drug administration.

Ans: A Feedback: Guidelines to consider when administering a drug via nasogastric tube include positioning the client with the head of the bed elevated, administering the medication at room temperature for the client's comfort, flushing the tube with water between each drug administered, and avoiding the use of suction for 20 to 30 minutes after the drug is administered.

What does the nurse do to verify an order for a medication listed on a medication administration record (MAR)? A) Compare it with the original physician's order. B) Ask another nurse what the drug is. C) Look up the drug in a textbook. D) Call the pharmacist for verification.

Ans: A Feedback: In many institutions, the medication order is copied onto the client's medication record. The nurse is responsible for checking that the medication order was transcribed correctly by comparing it with the original physician's order.

A nurse at a health care facility has to instill ear drops in a client. The nurse knows that which of the following techniques varies for an adult and child client? A) Manipulation of the client's ear to straighten the auditory canal B) Dilution of the medication drops before instilling in the client's ear C) Position in which the client remains until medication reaches the eardrum D) Amount of time before instilling medication in the client's opposite ear

Ans: A Feedback: The nurse should be aware that the method of manipulation of the client's ear to straighten the auditory canal varies between an adult and child. In a young client, the nurse pulls the ear down; in an adult client, the nurse pulls the ear up and back. The medication is not diluted; the number of medication drops instilled is as per the physician's prescription, and does not depend on the client's age. The position in which the client remains until the medication reaches the eardrum, and the amount of time before instilling medication in the client's opposite ear, does not differ with the age of the client.

A nurse needs to administer a prescribed dose of a narcotic medication to a client with acute neck pain. Which of the following precautions should the nurse take when storing narcotic medications? A) In a double-locked drawer B) In a single container C) In a self-contained packet D) In disguised containers

Ans: A Feedback: The nurse should place narcotic drugs in a double-locked drawer. Narcotics are controlled substances, meaning that federal laws regulate their possession and administration. Health care facilities keep narcotics in a double-locked drawer, box, or room on the nursing unit. A narcotic drug may not be placed in a single container, self-contained packet, or in disguised containers.

A nurse is converting the dosage of a medication to a different unit in the metric system. The medication label specifies the drug as being 0.5 g per tablet. The order is for 500 mg. How many tablets will the nurse give? A) 1 B) 2 C) 5 D) 10

Ans: A Feedback: To convert in the metric system from a smaller unit to a larger unit, move the decimal point three places to the right. As 0.5 g = 500 mg, the nurse would administer one tablet.

A nurse at the health care facility is preparing the medication dosage for a client. Why should the nurse read and compare the label on the medication with the MAR at least three times (before, during, and after) while preparing the medication for administration? A) Ensures that the right medication is given at the right time by the right route B) Complies with the medical order and ensures that the right dose is given C) Ensures that the medication has been administered to the right client D) Demonstrates timely administration and compliance with the medical order

Ans: A Feedback: When preparing the medications for administration, the nurse reads and compares the label on the medication with the MAR at least three times. This is to ensure that the right medication is given at the correct time, and by the correct route. The nurse calculates the doses to comply with the medical order and ensure that the right dose is given. Before administration, the nurse identifies the client by checking the wristband or asking the client's name. This is to ensure that the medication is given to the right person. The nurse should plan to administer the medications within 30 to 60 minutes of their scheduled time, which demonstrates timely administration and compliance with the medical order.

A client diagnosed with anemia is receiving a blood transfusion. The client develops urticaria accompanied by wheezing and dyspnea not long after the transfusion starts. The nurse interprets this as indicative of which of the following? A) Allergic reaction B) Side effect C) Toxicity D) Antagonism

Ans: A Feedback: With urticaria, hives, wheezing, and dyspnea are the symptoms of severe allergic reaction, which is due to an anaphylactic reaction. Minor adverse effects are called side effects. Many side effects are essentially harmless and can be ignored. Toxicity results from overdosage or buildup of medication in the blood due to impaired metabolism and excretion. Antagonism is a drug interaction by which drug effects decrease.

The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply. A) Medication B) Client C) Prescribing physician D) Pharmacy E) Dosage F) Route

Ans: A, B, E, F Feedback: To prevent medication errors, always ensure that the: (1) Right medication is given to the (2) right client in the (3) right dosage through the (4) right route at the (5) right time.

A physician has ordered that a medication be given "stat" for a client who is having an anaphylactic drug reaction. At what time would the nurse administer the medication? A) At the next scheduled medication time B) Immediately after the order is noted C) Not until verifying it with the client D) Whenever the client asks for it

Ans: B Feedback: A stat order is a single order, and it is carried out immediately. This is a legal order. The nurse would not wait until the next scheduled medication time or verify the order with the client. With a p.r.n. order, the client receives medication when it is requested or required.

A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A) Recap the needle; place it in a puncture-resistant container. B) Do not recap the needle; place it in a puncture-resistant container. C) Break off the needle, place it in the barrel, and throw it in the trash. D) Take off the needle and throw the syringe in the client's trash can.

Ans: B Feedback: After use, needles and syringes are placed in a puncture-resistant container without being recapped. This prevents needlestick injuries, because most occur during recapping.

A client who is taking an oral narcotic for pain relief tells the nurse he is constipated. What is this common response to narcotics called? A) Therapeutic effect B) Adverse effect C) Toxic effect D) Idiosyncratic effect

Ans: B Feedback: Although therapeutic effect is the desired outcome of medication administration, sometimes adverse effects occur. Adverse effects (such as constipation from narcotics) often are predictable and can usually be tolerated. Toxic effects (toxicities) are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death. An idiosyncratic effect(sometimes called paradoxical effect) is any unusual or peculiar response to a drug that may manifest itself by over-response, under-response, or even the opposite of the expected response.

Medications administered that are renal toxic should have frequent assessments of which blood values? A) AST and ALT B) BUN and creatinine C) WBC and platelets D) RBC and differential

Ans: B Feedback: If medications are known to cause kidney dysfunction, kidney function tests (serum creatinine, blood urea nitrogen) should be frequent.

What would a nurse instruct a client to do after administration of a sublingual medication? A) "Take a big drink of water and swallow the pill." B) "Try not to swallow while the pill dissolves." C) "Swallow frequently to get the best benefit." D) "Chew the pill so it will dissolve faster."

Ans: B Feedback: Sublingual and buccal medications should not be swallowed, but rather held in place so that complete absorption takes place.

A nurse is teaching an older adult at home about taking newly prescribed medications. Which information would be included? A) "You can identify your medications by their color." B) "I have written the names of your drugs with times to take them." C) "You won't forget a medication if you count them every day." D) "Don't worry if the label comes off; just look at the shapes."

Ans: B Feedback: Teach clients the names of drugs rather than distinguishing drugs by color. Manufacturers may vary the color of generic drugs, and the visual changes associated with aging may make it more difficult to identify medications by color. Medications should not be identified by counting or by shapes.

A nurse is showing an older adult client the correct method of self-administering an insulin injection at home. Which of the following points should the nurse tell the client in order to avoid lipoatrophy and lipohypertrophy? A) Change the needle daily with each injection. B) Rotate the site with each injection. C) Apply local anesthetic to the injection site. D) Massage the injection site for 10 minutes.

Ans: B Feedback: The nurse should tell the client to rotate the injection site each time an insulin injection is administered to prevent lipoatrophy and lipohypertrophy. In case of an insulin injection, the needle need not be changed daily but rather after a specific period specified by the manufacturer on the injection. Local anesthetic need not be applied to the injection site when administering insulin as the needle used causes very little discomfort. There is also no need to massage the injection site when insulin is administered. Massaging is contraindicated when heparin is administered, because this can increase the tendency for local bleeding.

Which medication system allows for client independence? A) Unit dose system B) Self-administered medication system C) Automated medication-dispensing system D) Bar Code Medication Administration

Ans: B Feedback: The self-administered system allows the client independence and responsibility. It also allows nursing supervision, education, and evaluation for client compliance and safety medication management prior to facility discharge.

A client with dry skin has been prescribed inunction. Which of the following should the nurse do to promote absorption of the ointment? A) Shaking the contents of the ointment B) Applying inunction with a cotton ball C) Rubbing the ointment into the skin D) Warming the inunction before application

Ans: C Feedback: In order to promote absorption, the nurse should rub the ointment into the client's skin. Shaking the contents would mix the contents uniformly, whereas applying the with a cotton ball would distribute the substance over a wide area. Warming the ointment before application would provide comfort.

A client with allergy has been advised to have an allergy test. The nurse needs to administer an injection to the client for allergy testing. Which of the following injection routes is most suitable for allergy testing? A) Subcutaneous B) Intramuscular C) Intradermal D) Intravenous

Ans: C Feedback: Intradermal injection routes are commonly used for tuberculin tests and allergy testing because they are administered between the layers of the skin. A subcutaneous injection is not suitable because it is administered more deeply than an intradermal injection; whereas, an intramuscular injection is administered in one muscle or muscle group. Intravenous injection is also not suitable because it is instilled into veins.

A nurse at a health care facility administers a prescribed drug to a client and does not record doing so in the medical administration record. The nurse who comes during the next shift, assuming that the medication has not been administered, administers the same drug to the client again. The nurse on the previous shift calls to inform the health care facility that the administration of the drug to this client in the earlier shift was not recorded. What should the nurse on duty do immediately upon detection of the medication error? A) Report the incident to the physician. B) Report the incident to the supervising nurse. C) Check the client's condition. D) Fill in the accident report sheet.

Ans: C Feedback: On detection of the medication error, the nurse should immediately check the client's condition. When medication errors occur, nurses have an ethical and legal responsibility to report them to maintain the client's safety. As soon as the nurse recognizes an error, he or she should check the client's condition and report the mistake to the prescriber and supervising nurse immediately. Health care agencies have a form for reporting medication errors called an incident sheet or accident sheet.

What is the name of the process by which a drug moves through the body and is eventually eliminated? A) Pharmacology B) Pharmacotherapeutics C) Pharmacokinetics D) Pharmacodynamics

Ans: C Feedback: Pharmacokinetics is the process by which a drug moves through the body and is eventually eliminated.

A physician has ordered peak and trough levels of a medication. When would the nurse schedule the trough level specimen? A) Before administering the first dose B) Immediately after the first dose C) 30 minutes before the next dose D) 24 hours after the last dose

Ans: C Feedback: The trough level is the point when the drug is at its lowest concentration, and the specimen is usually drawn in the 30- minute interval before the next dose. The peak level, in contrast, is the highest plasma concentration of the drug.

A student nurse is administering medications through a nasogastric tube connected to continuous suction. How will the student do this accurately? A) Briefly disconnect tubing from the suction to administer medications, then reconnect. B) Realize this can't be done, and document information. C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D) Leave the suction alone and give medications orally or rectally.

Ans: C Feedback: To administer medications to clients with a nasogastric tube connected to continuous suction, disconnect the tubing from the suction, administer the medications one at a time, and then clamp the tubing for 20 to 30 minutes after administration to allow absorption.

A client taking insulin has his levels adjusted to ensure that the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A) Peak level B) Trough level C) Half-life D) Therapeutic range

Ans: D Feedback: A drug's therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. The peak level, or highest plasma concentration, of the drug should be measured when absorption is complete. The peak level may be affected by factors that affect drug absorption as well as the route of administration. The trough level is the point when the drug is at its lowest concentration, and this specimen is usually drawn in the 30- minute interval before the next dose. A drug's half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body.

A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A) To prevent absorption in the mouth B) To prevent absorption in the esophagus C) To facilitate absorption in the stomach D) To prevent gastric irritation

Ans: D Feedback: Enteric-coated tablets are covered with a hard surface to impede absorption until the tablet has left the stomach. Entericcoated tablets should not be chewed or crushed because the active ingredient of the drug is irritating to the gastric mucosa.

A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A) 10-mL syringe, 3-inch 18-gauge needle B) 5-mL syringe, 2-inch 20-gauge needle C) Insulin syringe, 1-inch 16-gauge needle D) Tuberculin syringe, 1/2-inch 26-gauge needle

Ans: D Feedback: Equipment used for an intradermal injection includes a tuberculin syringe calibrated in tenths and hundredths of a milliliter. A quarter-inch to half-inch 26- or 27-gauge needle is used.

A nurse is conducting an interview for a health history. In addition to asking the client about medications being taken, what else should be asked to assess the risk for drug interactions? A) The effects of prescribed medications B) Type and amount of foods eaten C) Daily amount of intake and output D) Use of herbal supplements

Ans: D Feedback: Herbal remedies can interact with prescribed medications. When asking a client if he or she is taking any medications, the nurse should specifically ask if herbal supplements are also being used.

A nurse is administering an intramuscular injection of a viscous medication using the appropriate-gauge needle. What does the nurse need to know about needle gauges? A) All needles for parenteral injection are the same gauge. B) The gauge will depend on the length of the needle. C) Ask the client what size needle is preferred. D) Gauges range from 18 to 30, with 18 being the largest.

Ans: D Feedback: The gauge is determined by the diameter of the needle and ranges from 18 to 30. As the diameter of the needle increases, the gauge number decreases (an 18-gauge needle is, therefore, larger than a 30-gauge needle). A viscous medication requires a larger-gauge needle for injection.

A nurse is caring for a client in the nursing unit when the physician, during the rounds, prescribes a medication for the client. What appropriate action should the nurse take to ensure the accuracy of the verbal medication order? A) Ask the physician to repeat the dosage. B) Ask the physician to spell out the medication name. C) Ask a second nurse to listen for accuracy. D) Ask the physician to write out the order.

Ans: D Feedback: To maintain the accuracy of a verbal order, the nurse should tactfully ask the physician for a written order. When obtaining phone orders, it is important to repeat the dosages of medications and to spell medication names for confirmation of accuracy. Some nurses may ask a second nurse to listen to a telephone order on an extension.

A nurse needs to administer an intradermal tuberculin skin test injection to a client. Which of the following is the most suitable angle when administering an intradermal injection? A) 180-degree angle B) 90-degree angle C) 45-degree angle D) 10-degree angle

Ans: D Feedback: When administering an intradermal injection, the nurse should hold the syringe almost parallel to the skin at a 10-degree angle with the bevel pointing upward. This facilitates delivering the medication between the layers of the skin and advances the needle to the desired depth. A nurse administers a subcutaneous injection at a 45-degree angle or a 90- degree angle to reach the subcutaneous level of tissue, depending on the length of the needle. The nurse will not be able to insert the injection if it is held at a 180-degree angle.

A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which of the following instructions are stated on the label of a vial container? A) Type of needle to be used for withdrawal B) Directions for administering the drug C) Best site for administering the drug D) Amount of diluent to be added

Ans: D Feedback: When reconstitution is necessary, the drug label lists instructions such as the amount of diluent to be added and the type of diluent to be used, but not the type of needle. The label states the dosage per volume after reconstitution, not the best site for administering the drug after the reconstitution. It also states the directions for storing the drug, not the directions for administering the drug to a client.