Chapter 29: Medications prepu

According to the nurse practice act, the nurse is liable for

Clarifying a physician order p.777

You need to prepare an insulin pen for injection of a prescribed dose of insulin. Arrange the following steps in the correct order.

Clean the tip of the pen with alcohol. Screw the correct needle onto the tip of the pen. Dial the dose selector to 2 units. Hold the pen upright and press the plunger firmly. Watch for a drop of insulin at the needle tip. Verify the dose selector returned to "0." p.751

A nurse is applying a vaginal cream to a patient with a vaginal infection. Which of the following is a recommended guideline for this application?

Cleanse area at vaginal orifice with washcloth and warm water p.763

A nurse needs to administer medications to a client through an intravenous port. Which of the following actions should the nurse perform to ascertain that the IV catheter is in the vein?

Observe the tubing near the insertion device p.800

The nurse is preparing to administer meperidine (Demerol) as an intramuscular injection in an adult patient's deltoid site. Which of the following needles should the nurse select for this injection?

1"; 22 gauge p.754

Which of the following clients is likely to have altered metabolism of medications?

Elderly p.730

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

1 mL p.749

You are preparing supplies for a tuberculosis screening. You should choose which of the following syringes and needles?

1 mL syringe; 1/2 half-inch, 26-gauge needle p.749

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

0.5 125 mcg = 0.125 mg. 0.0625 mg/0.125 mg = 0.5 tablets p.737

A client is to take Demerol 35 mg IM. You have Demerol 50 mg per cc. How many cc will you administer?

0.7 cc p.737

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?

10-degree angle p.788

A nurse needs to administer a continuous medication drip to a client. The nurse knows that, for a continuous infusion, he or she will likely need to add medication to which of the following volumes of IV solution?

500 to 1,000 mL p.756

Which of the following patients receives a drug that requires parenteral route?

A woman who has been ordered intravenous antibiotics p.735

A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which of the following describes the mechanism of a metered-dose inhaler?

A canister containing medication that is released when the container is compressed p.763

A nurse is administering a piggyback infusion to a client with second-degree burns. Which of the following describes the most important feature of a piggyback infusion?

A parenteral drug is given in tandem with IV solution pp.756-757

To which of the following patients would the nurse be most likely to administer a PRN medication?

A patient who is complaining of pain near her surgical site p.733

A client suffers from infectious diarrhea. Based on her loss of fluid, her protein level is below normal. What blood product will the physician order to restore intravascular volume?

Albumin p.730

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?

Allergic reaction p.728

When the client demonstrates a rash 30 minutes after she has taken a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction?

Allergy p.728

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?

Amount of diluent to be added p.749

A nurse is reviewing information about prescribed drug in a drug handbook in preparation for administration to a client. When reading about the drug, the nurse identifies which name as the generic name?

Ampicillin sodium p.725

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear?

Ask the client to maintain the position for some time p.761

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?

Ask the physician to write out the order p.732

A nurse has administered an injection to a client. Which of the following interventions should the nurse perform to reduce discomfort and provide quick relief?

Apply pressure to the site during needle withdrawal. p.797

A nurse is caring for an elderly client with a vaginal yeast infection. Which of the following actions should the nurse perform when instilling the medication in the client's vagina?

Apply the medication before the client goes to sleep. p.763

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

As the gauge number becomes larger, the size of the needle becomes smaller p.745

Which of the following are recommended guidelines for the nurse who is administering a piggyback intermittent intravenous infusion of medication?

Attach infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion. p.802

The maintenance of client safety with medication administration is of primary importance in healthcare. The most commonly used system for billing and record keeping is the

Automated medication-dispensing system p.736

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which of the following actions should the nurse perform when administering oral medication to the client?

Avoid administering medication prepared by another nurse. p.738-739

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 p.743

The nurse is preparing the dosage for a client as per the medication administration record. Which of the following precautions should the nurse take when preparing medications?

Avoid relabeling containers with missing labels p.738

When treating a client at a health care facility with nitroglycerin paste, how can the nurse prevent contamination in the client during application?

Avoid touching the application with bare fingers p.758

Which of the following medication-administration systems protects the client by identifying the rights of medication administration?

Barcode Medication Administration p.736.

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

Bolus administration p.756

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

Bolus administration p.756

A nurse receives doctor's orders to mix a patient's insulin in a syringe with two other medications. What is the recommended guideline in this situation?

Call the pharmacist to determine compatibility of the drugs. p.748

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

Check the patient's identification band. p.739

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

Deltoid p.752

A nurse needs to use a moisturizer for an elderly client with dry skin. Why is the onset of the medication action atypical in an elderly client?

Diminished subcutaneous fat p.730

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

Distribution p.727

A nurse is caring for a client with an intravenous catheter. When administering medication through the intravenous port, the nurse pinches the tubing upstream from the port when instilling it with the drug. Which of the following reasons explains the nurse's action?

Ensures administration of medication to the client p.800

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?

Ensures that the right medication is given at the right time by the right route p.738

A nurse is administering a prescribed dose of medication to a client through a medication lock. How often should the nurse flush the medication lock to maintain patency?

Every 8 to 12 hours p.806-807

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?

Flush the tube with water between each drug administered. p.744

An elderly client with pneumonia has been prescribed the use of a bronchodilator by the physician. What should the nurse monitor in a client taking an inhaled bronchodilator?

Heart rate pp.763-764

A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which of the following actions should the nurse perform to prevent gastric reflux?

Help the client into a Fowler's position. P.744

Which of the following accurately describes a recommended guideline when administering oral medications to patients?

If a child refuses to take medication, the medication can be crushed and added to a small amount of food. p.744

A nurse instills eardrops into a patient's ear to soften a wax buildup. Which of the following is a guideline the nurse should follow?

If both ears are to be treated, wait 5 minutes before instilling drops in the second ear. p.761

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?

In a double-locked drawer p.739

A nurse caring for a client with diarrhea needs to establish an intravenous (IV) access to administer fluids and medication. When explaining intravenous access to the client, which of the following would the nurse most likely incorporate into the description?

Insertion of a needle into a peripheral vein p.755

Following an allergic reaction to a medication, the nurse should

Instruct the client to wear an identification addressing the allergy p.770

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?

Intradermal p.749

A nurse is performing a sensitivity test on a patient. What would be the best type of injection to use for this procedure?

Intradermal p.749

Which parenteral route of administration has the longest absorption time?

Intradermal p.749

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

Intradermal p.789

A nurse has to administer a subcutaneous injection to a client. For which of the following clients can the nurse administer a subcutaneous injection at a 90-degree angle?

Obese clients p.750

You are caring for a patient who just returned from the postanesthesia care unit (PACU) and rates current pain as "9 out of 10." Which of the following prescribed medications will provide the fastest relief from pain?

Intravenous morphine sulfate p.755

When educating an elderly client about the administration of medication during discharge teaching, the nurse notes that the client is having difficulty comprehending the instruction. What intervention should the nurse follow in this case to ensure the client's safety?

Involve a second responsible person in the instruction. p.744

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. Which of the following is a feature of a metered-dose inhaler?

It is a canister that contains pressurized medication. p.763

A nurse is using an 18-gauge needle to administer a medication to a client. The nurse knows that when compared to a 27-gauge needle, an 18-gauge needle has which of the following features?

Larger diameter p.745

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?

Manipulation of the client's ear to straighten the auditory canal p.761

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

Medications that need to be infused over 20 to 60 minutes p.756

When administering heparin subcutaneously, the nurse should

Never aspirate p.750

A nurse is administering intermittent IV medication to an active adolescent. Which of the following IV systems could be used to allow the patient more freedom?

Peripheral venous access device p.757

What is involved in the absorption, distribution, metabolism, and excretion of medication?

Pharmacokinetics p.725

A nurse is using a volume control set to administer a dose of prescribed medication to a client. The nurse opens the lower clamp until the tubing is filled with fluid and then reclamps it. Which of the following statements explains the nurse's action?

Purges air from the tubing p.804

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. p.739

A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication?

Review the client's medication, allergy, and medical history p.735

A client with dry skin has been prescribed inunction. Which of the following should the nurse do to promote absorption of the ointment?

Rubbing the ointment into the skin p.757

Which medication system allows for client independence?

Self-administered medication system p.741

An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method?

Self-contained packets that hold one tablet or capsule for individual clients p.773

The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which of the following would help maximize drug absorption in this client?

Spacer p.764

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

Standing order p.733

A nurse is administering enoxaparin, (blood thinner) to a patient with DVT, via the subcutaneous route. Which of the following is a recommended guideline when administering a subcutaneous injection?

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis p.750

A nurse needs to withdraw a prescribed medication from an ampule and administer it to a client. Which of the following actions should the nurse perform to ensure that all the medication is equally distributed when withdrawing?

Tap the top of the ampule before withdrawing the medicine Tapping the top of the ampule distributes all the medication to the lower portion of the ampule. Tapping the barrel of the syringe near the hub does not distribute medication equally but moves the air toward the needle. Inserting the filter needle in the ampule ensures sterility of the needle. Using a smaller or bigger gauge needle does not ensure that all the medication is equally distributed when withdrawing. p.746

A physician has prescribed the use of Lubriderm lotion, which is an inunction application, for a client with complaints of dry skin. Which of the following information should the nurse tell the client regarding the correct method of usage?

The medication is administered by rubbing it into the skin p.735

A graduate nurse is administering several medications to a newly admitted patient. Who is legally responsible for the drugs administered by this nurse?

The nurse administering the drugs p.735

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

Therapeutic range p.732

A nurse is bunching the tissue of a client when administering a subcutaneous injection to a client. The nurse knows that which of the following is the reason for bunching when injecting subcutaneously?

To avoid instilling medication within the muscle p.750

A client with an infection is receiving intravenous antibiotic therapy. The client has an intermittent infusion device in place. The nurse flushes the device with normal saline solution before administering the antibiotic based on which rationale?

To prevent blood clot formation p.756

The primary reason for the Controlled Substances Act is

To prevent drug abuse p.739

You are preparing to administer an intramuscular injection. After inserting the needle, you should gently pull back on the syringe plunger and observe for blood in the syringe.

True p.750

A nurse is administering medication to a patient via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation?

Use a syringe to plunge the tube to try to dislodge the medication. p.744

When performing a piggyback infusion, the nurse lowers the container of primary solution approximately 10 inches below the height of the secondary solution. Which of the following reasons explains the nurse's action?

Uses gravity to infuse the secondary medication p.804

A nurse needs to administer a prescribed injection to a toddler. Which of the following injection sites is most suitable for the client?

Vastus lateralis site p.752

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which of the following situations?

When the client has disorders that affect the absorption of medications p.755

A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client with influenza. Which of the following precautions should the nurse take when combining drugs?

Withdraw exact amounts of each drug from each container. p.748

A nurse is administering an intramuscular injection to a client using the zig-zag technique. Which of the following actions should the nurse perform to prevent leaking and ensure sealing of medication in the subcutaneous and dermal layers of tissue?

Withdraw the needle and release taut skin immediately after injection. p.797

The medical chart of a newly admitted patient notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the patient's wound culture and sensitivity. How should the nurse respond to this situation?

Withhold the medication until the potential drug allergy has been addressed by the care team p.735

You are preparing to draw up a medication that is supplied in a glass ampule. Arrange the following steps in the correct order.

Wrap a small gauze pad around neck of ampule. Break off top of the ampule. Attach filter needle to the syringe. Withdraw medication. Discard filter needle. Attach sterile administration device to the syringe. p.778

A nurse is applying a nitroglycerine transdermal patch to a patient. Which of the following is the preferred site to use?

chest p.758

Children's medication dosages are most often calculated using the child's body surface area and

weight p.738

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

• Count each narcotic medication at the change of each shift • Record each medication used from the stock supply • Maintain an accurate account of the use of the medication p.739

The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply.

• Medication • Patient • Route • Dosage p.738

A nurse needs to administer a subcutaneous injection to a client. Which of the following alternative techniques should the nurse use to reduce discomfort? Select all that apply.

• Numb the skin with an ice pack before the injection • Insert and withdraw the needle without hesitation • Instill the medication slowly and steadily p.755

When administering oral medications, which of the following practices should the nurse follow? Select all that apply.

• Perform hand hygiene before and after medication administration. • Stay at the bedside until the patient has swallowed all the medications. • Verify the patient's response to the medication 30 minutes after administration, or as appropriate for the drug. p.733

Which of the following actions are included in the required "checks" for safe medication administration? Select all that apply

• Read the medication label when reaching for the unit dose package. • Read the medication label just before administering a unit dose medication to the patient. • Read the medication label after retrieving the medication from the drawer. p.738

Which of the following are included in the "five rights for medication administration"? Select all that apply.

• Right medication • Right route • Right dose • Right time p.738

A physician has ordered the nurse to administer a subcutaneous injection to a client. Which of the following factors should the nurse consider when selecting a syringe and needle? Select all that apply.

• Viscosity of the drug • Size of the client • Type of medication p.746

A nurse is administering insulin to a diabetic patient. Which of the following are three recommended times to check the label before administration? Select all that apply.

• When reaching for the container or unit dose package • After retrieval from the drawer and compared with the CMAR • When replacing the container to the drawer or shelf p.738