Chapter 29: Medication

The nurse is preparing to administer a transdermal medication. How should this be accomplished?

The nurse should apply the medication directly to the skin 823

After administering medication to a client subcutaneously, the nurse removes the needle at the same angle at which it was inserted. Which explains the nurse's action?

minimizes tissue trauma to the client 850

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10-15 degrees 849

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

Medications that need to be infused over 20-60 minutes 856

The nurse has received a telephone order for a client from a health care provider. How will the nurse indicate in the documentation that the order was received via telephone?

Record "T.O." at the end of the order 842

The nurse is caring for an older adult client who sees several different health care providers and specialists. Which question will the nurse ask?

"Do you get all of your medications filled at the same pharmacy?" Polypharmacy is a concern in the older adult population. The nurse will want to know if medications are filled at the same pharmacy, as this is often where pharmacists will note discrepancies in medications prescribed or duplicate orders written by different providers. 826

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the client indicates teaching was effective?

"I will call the health care provider if I develop dizziness, blurred vision, or nausea." 857

Which statement by a client indicates to the nurse that teaching was effective regarding the different parts of a syringe?

"The plunger is the part of the syringe that moves back and forth to withdraw and instill medication" 846

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long term use of nasal sprays can cause rebound nasal congestion" 861

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, knows as diluent, to a powdered substance" 845

A nursing student is teaching the client regarding insertion of a central line catheter. Which statement by the student would cause the nurse to intervene?

"The risks are the same for a central line as they are for peripheral lines." 828

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat?

"aim the tip of the container toward the nasal passage" 862

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

"medication stays in the chamber so you can continue to inhale it" 865

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" The nurse will teach the patient to wait 5 minutes between instillation of different types of eye drops to facilitate best absorption. 860

A nurse is administering intramuscular injections to clients. What needle size(s) has the nurse used correctly? Select all that apply.

-5/8-inch (2-cm) needle for the vastus lateralis site -1 1/2-inch (3.75-cm) needle for an adult in the deltoid site -5/8-inch (2-cm) needle for a child in the deltoid site 855

The nurse has inadvertently administered medication ordered for Client A to Client B. What is the appropriate nursing action? Select all that apply.

-Assess Client B thoroughly. -Complete an incident report. -Contact the provider to report the error. 869

The nurse is educating a client on how to use an insulin pen. Which steps reflect recommended procedure? Select all that apply.

-Hold the pen upright and tap to force any air bubbles to the top. -Dial the dose selector to 2 units to perform an "air shot" to get rid of bubbles. -Clean injection site and administer injection by holding pen like a dart. 851

A nurse is caring for a client who has been prescribed codeine, a narcotic medication to relieve severe postoperative pain. Which responsibility does the nurse have to complete when handling narcotic medications? Select all that apply.

-Maintain an accurate account of the use of the medication. -Record each medication used from the stock supply. -Count each narcotic medication at the change of each shift. 836

The nurse is caring for a client receiving D5 ½ NS + 20 mEq KCl/L infusing per pump at 125 mL/hr. The nurse prepares to administer 40-mg furosemide IVP. Which actions should the nurse take? Select all that apply.

-Stop the infusion pump and clamp the line. -Provide the medication at the recommended rate. -The second flush is at the same rate as the drug. 905

Which set of instructions the nurse should give to a client who is going home with eye drops? Select all that apply.

-Wait for 5 minutes between instillation of eye drops. -Apply the drops along the lower lid margin of the eye. -Keep the application tip of the medication container sterile. 860

The nurse recognizes which routes for parenteral medication administration? Select all that apply.

-subcutaneous -intramuscular -intradermal -intravenous 845

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer?

0.5 tablets 836

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?

1 mL The volume of a subcutaneous injection is usually up to 1 mL. An intramuscular injection is the administration of up to 3 mL of medication into one muscle or muscle group. Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01 to 0.05 mL 849

The nurse is preparing supplies for a tuberculosis screening. The nurse should choose which syringes and needles?

1 mL syringe; 1/2- inch (1.25-cm), 26-gauge needle 845

A bolus administration of medication has been ordered for a client. How will the nurse prepare to administer this drug?

1 mL/min 905

A pediatric client has a fever for which the provider has prescribed ibuprofen 200 mg orally every 6 hours. The instructions on the bottle indicate there is 100 mg/5ml. How many milliliters should the nurse give? Record your answer using a whole number.

10 mL 836

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15- degree angle 849

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?

1500 Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest. 830

The nurse has a prescription to administer 25 mg of furosemide IV to a client. The drug is supplied in a vial 40 mg/4 ml. How many milliliters will the nurse administer of the medication? Record your answer using one decimal place.

2.5 mL 836

Which gauge needle is the nurse expected to use to administer dimenhydrinate 50 mg?

22-gauge The 22-gauge needle is correct, as this size is long enough to reach the client's muscle. 910

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?

30 mL 836

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 minutes When ear drops are to be administered in both ears, the nurse would wait 5 minutes after giving the ear drops in the first ear before administering the ear drops into the second ear. This avoids causing the medication to run out immediately after administration 861

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication?

73-year-old client diagnosed with liver disease Older adults have a decrease in plasma protein, which is needed to bind and inactivate the medication in the bloodstream. The decrease in plasma proteins can increase the amount of medication circulating, which increases the effects. Decreased liver and kidney function also increases the amount of medication in the blood 825

Which medication interaction illustrates a synergism?

A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy. 826

To which client would the nurse be most likely to administer a p.r.n. medication?

A client who is reporting pain near the surgical site A report of "breakthrough" pain, especially postsurgery, would likely require the nurse to administer a p.r.n. analgesic. 831

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?

Absorption of the medication will be impaired. 838

The health care provider has prescribed the use of transdermal patch. Which information should the nurse tell the client regarding application?

Apply the patch to a clean, dry, hairless location on the skin 858

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

As the gauge number becomes larger, the size of the needle becomes smaller 845

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?

Assess the vaginal area. 863

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Avoid crushing sustained-release pellets 845

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

Bolus administration A bolus is a relatively large amount of medication given all at once; bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration 905

The nurse observes a prescription written for a client for a medication that does not correlate with the client's diagnosis or comorbid factors. What is the best action for the nurse to take?

Call the provider to obtain a rationale for the use of the medication for the client 834

A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration?

Check the client's identification band 832

A nurse is applying a vaginal cream to a client with a fungal infection. Which guideline is recommended for this application?

Cleanse area at vaginal orifice with washcloth and warm water. 863

The nurse is administering a subcutaneous injection of insulin to a client. Which action would the nurse take after choosing the appropriate administration site?

Cleanse the area around the injection site with alcohol 846

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatibility 848

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for order clarification 869

The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe?

Decreased irritation and pain in subcutaneous tissue 902

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid 853

The nurse prepares to administer a fentanyl transdermal patch and discovers two transdermal patches are on the client's back and upper right chest. Which best action should the nurse take next?

Determine what transdermal patches are currently on the skin 859

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues?

Distribution 823

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client?

Each unit of insulin is accompanied by a clicking sound in the pen 851

Which component of a syringe's needle does the nurse recognize that refers to width?

Gauge The gauge of a needle refers to width. The lumen is the opening of the needle; the shaft is the length of the needle; the bevel is the slanted portion of the needle that provides access into the vein. 845

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers. 843

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation?

Inner surface of the forearm Sites commonly used for intradermal injections are the inner surface of the forearm and the upper back, under the scapula. 890

A nurse is using the Z-track technique to administer an injection to a client. Which injection route utilizes the Z-track technique?

Intramuscular When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique. Clients report slightly less pain during (and the day after) a Z-track injection compared with the usual intramuscular injection technique. 855

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. 839

A nurse preparing medication for a client is called away to an emergency. What should the nurse do?

Lock the medications in a cart and finish them upon return 838

When administering heparin subcutaneously, the nurse should:

Never aspirate 925

The chemotherapy client has been admitted for thrombocytopenia. Which blood product will the nurse anticipate administering?

Platelets 863

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?

Provide education on taking all antibiotics for effective treatment 870

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

Report the needlestick to the nurse manager 868

The nurse is preparing to administer a tuberculin test to a client. Which instructions should the nurse provide to the client?

Return in 48 to 72 hours for results. 849

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 841

The nurse is preparing to administer a bolus of furosemide 0.8 mg to a client with congestive heart failure and kidney disease. Which right of drug administration would the nurse question and confirm in this client?

Right drug To ensure safe medication preparation and administration, the nurse should practice the rights of medication administration. Right client, right drug, right dose, and right route are rights of medication administration. In this client who has kidney disease, furosemide is contraindicated. Therefore, confirming the correct medication would be crucial. 842

A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate?

Select another site 857

The nurse transcribes an order that reads: Colace 100 mg PO daily. This is an example of which type of order?

Standing order 831

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention?

Stop the infusion of the antibiotic. 908

A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection?

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. 849

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug?

Swallowing the medication 833

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?

Tactfully request the provider to input the order into the computerized provider order 831

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements 832

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. 865

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?

Therapeutic range Therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. Peak level is the highest plasma concentration. Trough level is the point when the drug is at the lowest concentration. Half-life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body. 830

The primary reason for the Controlled Substances Act is:

To prevent drug use and dependence 830

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 client has disorders that affect the absorption of medications Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. 856

While injecting a needle into a client for an intramuscular injection, the nurse hits the client's bone. What would be the appropriate initial response of the nurse to this situation?

Withdraw the needle, apply a new needle to syringe, and administer the injection in an alternate site When the bone is hit during an intramuscular injection the nurse should withdraw and discard the needle. A new needle is then applied to the syringe and administered in an alternate site. Documentation of the incident in client's medical record is necessary and the primary care provider should be notified. Appropriate paperwork related to special events according to facility policy should be completed. 853

Which client would most likely require placement of an implantable port?

a 58-year-old woman with stage 3 breast cancer requiring weekly chemotherapy This client needs frequent IV access. A central port is easily accessed for chemotherapy sessions, then the access is discontinued even though the port remains in place subcutaneously. A central port also allows for the infusion of chemotherapy into a central vessel; this is important because chemotherapy is caustic and severely damages peripheral vessels. 833

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?

bolus administration Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. 905

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration?

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination The hepatitis B vaccine is administered intramuscularly. 856

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 828

A client at a health care facility has been prescribed scopolamine, to be administered transdermally. Which statement describes transdermal application?

drugs bonded to an adhesive and applied to the skin After application, the drug migrates through the skin and eventually is absorbed into the bloodstream. 823

The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication?

in the anterolateral aspect of the thigh The vastus lateralis site is in the anterior aspect of the thigh, in which the nurse places the injection in the middle third of the thigh and is often used for infants 853

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

intradermal 849

The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?

intradermal 849

The Z-track technique is utilized during drug administration by which route?

intramuscular The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. 855

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours for pain. What type of order is this considered?

p.r.n order 1257

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

place a date on the vial and retain for future use 885

The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?

removing prior application and any remaining residue from skin 824

A client is receiving a secondary infusion of a new antibiotic. After 5 minutes of administration, the client reports itching and appears flushed. What is the first nursing intervention?

stop the infusion The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life-threatening reactions can also occur quickly. The first nursing action is to stop the infusion 908

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client?

supine 863

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch?

upper back The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch 859