Chapter 32 Potter-Perry Fundamentals Medication Administration

*Answer: 8 days* Rationale: The patient is taking 2 puffs every 6 hours which is 8 puffs a day. The inhaler has 64 puffs in it. To determine how many days the inhaler will last, divide the number of puffs by the number of doses per day that the patient takes; 64 puffs/8 puffs per day = 8 days

*A child is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 64 puffs. The dose is 2 puffs every 6 hours. How many days will the pMDI last? ___________ days.*

*Answer: 1.6 mL *

*A health care provider ordered enalapril (Vasotec) 2 mg IV push for a patient with hypertension. The pharmacy sent vials marked 1.25 mg enalapril/mL. How many mL does the nurse administer? ______ mL*

*Answer: D* Rationale: Whenever a medication error occurs, the first action of the nurse is to assess the patient.

*A nurse accidently gives a patient the medications that were ordered for the patient's roommate. What is the nurse's first priority?* A. Complete an occurrence report. B. Notify the health care provider. C. Inform the charge nurse of the error. D. Assess the patient for adverse effects.

*Answer: C* Rationale: This patient most likely is experiencing polypharmacy. To minimize risks associated with polypharmacy, frequent communication among health care providers is essential to make sure that the patients' medication regimen is as simple as possible.

*A nurse admits a 72-year-old patient with a medical history of hypertension, heart failure, renal failure, and depression to a general medical patient care unit. The nurse reviews the patient's medication orders and notes that the patient has three health care providers who have ordered a total of 13 medications. What is the most appropriate action for the nurse to take next?* A. Give the medications after identifying the patient using two patient identifiers B. Provide medication education to the patient to help with adherence to the medical plan C. Review the list of medications with the health care providers to ensure that the patient needs all 13 medications D. Set up a medication schedule for the patient that is least disruptive to the expected treatment schedule in the hospital

*Answer: The nurse should administer the medication after reviewing the order.* Rationale: This order contains all the requirements for a medication order, including the patient's name, date and time the order is written, medication name, dose, route, frequency of administration, and provider's signature.

*A nurse caring for a patient on a general surgical unit notes the following medication order in the patient's medical record: 3 March 2016 1415 Administer 25 mg hydrochlorothiazide PO BID D.Anderson, MD What should the nurse do next?*

*Answer: B* Rationale: The nurse needs to return the medication to the pharmacy and get a tablet that is not expired because expired medications should not be administered.

*A nursing student is administering ampicillin PO. The expiration date on the medication wrapper was yesterday. What is the appropriate action for the nursing student to take next?* A. Ask the nursing professor for advice B. Return the medication to pharmacy and get another tablet C. Call the health care provider after discussing this situation with the charge nurse D. Administer the medication since medications are good for 30 days after their expiration date

*Answer: D* Rationale: Extended-release tablets should not be crushed; the nursing student needs to question this order and investigate alternative medications while the patient is receiving medications through the gastric tube.

*A nursing student is administering medications to a patient through a gastric tube (G-tube). Which of the following actions taken by the nursing student requires the nursing instructor to intervene?* A. The nursing student places all the patient's medications in different medicine cups. B. The nursing student evaluates each medication and holds the tube feeding before administering a medication that needs to be administered on an empty stomach. C. The nursing student flushes the tube with 30 mL of water between each medication. D The nursing student crushes a nifedipine extended-release tablet and mixes it with water before administering it.

*Answer: A* Rationale: Whenever a patient refuses a medication, the first step is to talk with the patient to gather the patient's insights and possible reasons for not taking the medication.

*A pediatric nurse takes a medication to a 12-year-old female patient. The patient tells the nurse to take it away because she is not going to take it. What is the nurse's next action?* A. Ask the patient's reason for refusal B. Consult with the patient's parents for advice C. Take the medication away and chart the patient's refusal D. Tell the patient that her health care provider knows what is best for her

*Answer: D* Rationale: Syringes for oral dosing are adapted for accurate administration of medication to pediatric patients. They do not have a syringe or needle cap and cannot accidentally be used to administer parenteral medications.

*A toddler is to receive 2.5 mL of an antipyretic by mouth. Which equipment is the most appropriate for medication administration for this child?* A. A medication cup B. A teaspoon C. A 5-mL syringe D. An oral-dosing syringe

*Answer: A, C, D* Rationale: If a patient describes localized pain, numbness, burning or tingling at an IM injection site, you need to suspect possible injury to nerve or tissues. Appropriate nursing actions include assessing the site, notifying the patient's health care provider, and documenting your findings.

*After receiving an intramuscular (IM) injection in the deltoid, a patient states, "My arm really hurts. It's burning and tingling where I got my injection. What should the nurse do next? (Select all that apply.)* A. Assess the injection site B. Administer an oral medication for pain C. Notify the patient's health care provider of assessment findings D. Document assessment findings and related interventions in the patient's medical record E. This is a normal finding so nothing needs to be done F. Apply ice to the site for relief of burning pain

*Answer: B* Rationale: Nursing students cannot take medication orders.

*After seeing a patient, the health care provider starts to give a nursing student a verbal order for a new medication. The nursing student first needs to:* A. Follow ISMP guidelines for safe medication abbreviations. B. Explain to the health care provider that the order needs to be given to a registered nurse. C. Write down the order on the patient's order sheet and read it back to the health care provider. D. Ensure that the six rights of medication administration are followed when giving the medication.

*Answer: D* Rationale: This is the appropriate order for a nurse to administer an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing.

*The nurse is administering an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in the appropriate order. 1. Release tubing and inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. Use watch to time administration. 2. Select injection port of intravenous (IV) tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy. 3. After injecting medication, release tubing, withdraw syringe, and recheck fluid infusion rate. 4. Connect syringe to port of intravenous (IV) line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port. 5. Clean injection port with antiseptic swab. Allow to dry. 6. Occlude intravenous (IV) line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return.* A. 2, 5, 4, 1, 3, 6 B. 2, 5, 6, 4, 1, 3 C. 5, 4, 2, 6, 1, 3 D. 2, 5, 4, 6, 1, 3

*Answer: B* Rationale: When administering medications to people 3 years of age and older, you need to pull the auricle upward and outward to straighten the ear canal when giving eardrops.

*What statement made by a 4-year-old patient's mother indicates that she understands how to administer her son's eardrops?* A. "To straighten his ear canal, I need to pull the outside part of his ear down and back." B. "I need to straighten his ear canal before administering the medication by pulling his ear upward and outward." C. "I need to put my son in a chair and make sure that he's sitting up with his head tilted back before I give him the eardrops." D. "After I'm done giving him his eardrops, I need to make sure that my son remains sitting straight up for at least 10 minutes."

*Answer: A* Rationale: Whenever you are unable to read a patient's order, you must consult with the health care provider to clarify the order before giving the medication.

*You are a new graduate nurse completing your orientation on a very busy intensive care unit. You cannot read a health care provider's order for one of your patient's medications. You have heard from more experienced nurses that this health care provider does not like to be called, and you know that another of the health care provider's patients is very unstable. What is the most appropriate next step for you to take?* A. Call the health care provider to clarify the order B. Talk with your preceptor to help you interpret the order C. Refer to a medication manual before giving the medication D. Use your best judgment and critical thinking and administer the dose you think the health care provider ordered

*Answer: B, C, E* Rationale: When giving viscous medications intramuscularly, a patient typically experiences pain. Giving the medication in the ventral gluteal site using the z-track method and distracting the patient during medication administration will help to decrease pain associated with the medication.

*You are working in a health clinic on a college campus. You need to administer medroxyprogesterone acetate intramuscularly (IM) to a female patient for birth control. You look up this medication in a reference manual and determine that it is viscous and injections can be painful. On the basis of this information, you plan which of the following when administering this medication? (Select all that apply.)* A. Inject the medication over 3 minutes to reduce pain associated with the injection B. Administer the medication in the ventral gluteal site C. Use the z-track method when administering the medication D. Use the deltoid site for medication administration E. Ask the patient questions about her major and which classes she is taking during the injection to provide distraction

1, 4, 5 Insulin is given as a subcutaneous injection for slower absorption. The rate of absorption of insulin differs in various sites. The abdomen has the quickest absorption. The recommended sites of insulin injection include the upper arms, anterior and lateral part of the thighs, buttocks, and abdomen. These sites have the appropriate amount of subcutaneous tissue for absorption of insulin. The injection site should not be chosen again for a month. The injection site should be rotated with each injection. Repeated injection at the same site may lead to lipodystrophy.

A diabetic patient has been switched from oral antidiabetic drugs to insulin. Which information would help the patient to ensure correct self-administration of insulin? Select all that apply. 1 The recommended sites of injection include the upper arm, thigh, abdomen, and buttocks. 2 Once a site is chosen for injection, the same site should be used for further injections. 3 The site of injection should be changed monthly. 4 The insulin is absorbed more quickly when injected into the abdomen. 5 Insulin is given as a subcutaneous injection.

2, 3, 4, 5 Self-administration of insulin requires proper visual acuity to ensure drawing the appropriate amount of insulin. Insulin must be stored as directed by the manufacturer to maintain vitality. The site of insulin injection must be rotated to prevent local changes of the skin. The nurse should demonstrate the proper preparation of a single insulin preparation. Insulin doses may be adjusted based on home-based blood glucose estimation of capillary blood or per the health care provider's instructions.

A diabetic patient is prescribed insulin. Which interventions should the nurse perform to teach the patient how to self-administer insulin? Select all that apply. 1 Instruct the patient not to titrate the insulin dose based on glucose monitoring. 2 Demonstrate the preparation of a single insulin preparation. 3 Demonstrate rotation of insulin site injections. 4 Instruct the patient about the appropriate storage of insulin. 5 Check the visual acuity of the patient.

100 The highest reading of a therapeutic range corresponds to the toxic range of plasma concentration. Any drug levels above this concentration are toxic. The highest value of the therapeutic range of the drug in question is 100 mg/dL, so plasma concentration of the drug above 100 mg/dL is toxic.

A medication has a minimum effective concentration of 25 mg/dL and the therapeutic range is 25 to 100 mg/dL. What is the plasma concentration above which the toxic effects of the drug may appear? Record your answer using a whole number. ___ mg/dL

3, 4, 2, 1, 6, 5 First, insert the squeeze-and-breathe metered-dose inhaler (MDI) canister into the holder. Next, remove the mouthpiece cover from the inhaler. Then, shake the inhaler vigorously five or six times. Then, have the patient sit up, take a deep breath, and exhale. Next, tilt the patient's head back slightly and inhale slowly and deeply through the mouth. Then, remove the MDI from the mouth and exhale through pursed lips.

A nurse explains the steps for administering a squeeze-and-breathe metered-dose inhaler (MDI) without a spacer to a patient. Arrange the steps explained by the nurse in order. 1. Sit up, take a deep breath, and exhale 2. Shake the inhaler vigorously five or six times 3. Insert the metered-dose inhaler canister into the holder 4. Remove the mouthpiece cover from the inhaler 5. Remove the metered-dose inhaler from the mouth and exhale through pursed lips 6. Tilt the head back slightly and inhale slowly and deeply through the mouth

4 The nurse should assess the patient's medical history, medication history, and history of allergies to reduce the risk of an allergic drug response. The nurse should check the patient's name, medication name, and dosage to ensure that the patient receives the correct medication. Assessing the patient's body build, muscle size, and weight helps to determine the type and size ofthe syringe and needles for injection. The nurse should review all pertinent information regarding medication action, dose, purpose, and route of administration to administer the medication properly and to monitor the patient's response.

A nurse is about to withdraw medication from an ampule. Which nursing action reduces the patient's risk for an allergic drug response? 1 Checking the patient's name, medication name, and dosage 2 Assessing the patient's body build, muscle size, and weight 3 Reviewing the medication action, purpose, dose, and route 4 Assessing the patient's medical history and medication history

4 Skin encrustation harbors microorganisms and blocks the contact of medication with the tissue to be treated. Therefore, it is very important to clean the skin thoroughly by washing the area gently with soap and water to improve the contact of medication with the affected tissue. Applying the gauze dressing over the medication would help to prevent soiling clothes and wiping away the medication. However, it is not meant for improving the contact of medication with the affected tissue. Ointments should be spread evenly over the surface without applying an overly thick layer. Liniments should be applied by rubbing them gently into the skin. However, ointments should not be rubbed on the skin, because this can cause irritation.

A nurse is applying an ointment to a patient with skin encrustation. Which action of the nurse would be beneficial to increase the contact of medication with the tissue to be treated? 1 Applying gauze dressing over the medication 2 Applying a thick layer of medication on the affected area 3 Applying the medication by rubbing it gently into the skin 4 Applying the medication after cleaning the skin thoroughly

2 A patient who underwent appendectomy (surgical removal of appendix) may not be contraindicated for oral route of drug administration because the appendix is not a major part of the gastrointestinal (GI) tract. Oral medication is generally avoided in patients with a surgical resection of the GI tract. A patient with reduced GI motility after general anesthesia or bowel inflammation is contraindicated for oral medication administration. Oral administration is contraindicated in patients with esophageal strictures because of the difficulty in swallowing. The oral route is also avoided when patients have alterations in GI function. Therefore, a patient with nausea and vomiting is contraindicated for oral route of drug administration.

A nurse reviews the clinical data of four patients. Which patient is suitable for oral medication administration? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

1 If the site bleeds after the medication administration, the medication might have been administrated into the subcutaneous tissue. The intradermal site is chosen because blood supply is reduced and absorption is slow. An anaphylactic reaction may occur when the medication enters the circulation too rapidly. To avoid this circumstance, skin-testing sites should be chosen that allow the nurse to easily assess for change in color. The sites should be lightly pigmented. Changes in tissue integrity are also assessed to prevent an anaphylactic reaction. The appearance of a small bleb that resembles a mosquito bite indicates that the medication has been correctly administered.

A nursing student communicates with the registered nurse after administering an intradermal medication to the patient. Which statement made by the nursing student causes the registered nurse to suspect that the medication has entered the subcutaneous tissue? 1 "The site is bleeding." 2 "The color of the site has changed." 3 "The tissue integrity of the site has changed." 4 "A mosquito bite type resemblance appeared on the site."

1, 2 Aspiration is a serious problem encountered while administering oral medications. While administering oral medications, the patient should not use a straw because it decreases the patient's control over volume intake, thereby increasing the risk of aspiration. The patient should be positioned in an upright sitting position while administering medications to prevent aspiration. A single pill should be administered at one time, because it helps to swallow easily, which prevents the risk for aspiration. The patient can safely drink the medication from a cup; it will prevent the risk for aspiration. Allowing the patient to self-administer the medication decreases the risk of aspiration.

A nursing student prepares to administer medication to a patient through the oral route. Which actions made by the nursing student may cause the patient to experience aspiration? Select all that apply. 1 Positioning the patient in a relaxed sleeping position during administration 2 Instructing the patient to use straws while taking liquid medication 3 Allowing the patient to self-administer the medication 4 Instructing the patient to drink the medication from a cup 5 Administering one pill at a time

3 Patients need to know information about their medications so they can take them correctly and safely. The nursing student can provide the name of the medication and a description of its desired effect. The student should not dismiss the patient's concerns by telling the patient that he should speak with the physician or assigned nurse.

A nursing student takes a patient's antibiotic to his room. The patient asks the nursing student what it is and why he should take it. How should the nursing student respond to the patient? 1 Tell the patient he has to speak with his assigned nurse about this. 2 State that information about medications is confidential and cannot be shared. 3 Provide the name of the medication and a description of its desired effect. 4 Explain that only the patient's physician can give this information

4 The route of administration appropriate for a patient with a bleeding tendency is the oral route, because it does not involve the use of needles. Any mode of administration that uses needles may increase the risk of bleeding. Therefore, intradermal, intramuscular, and subcutaneous routes should be avoided in this case to prevent bleeding.

A patient has a bleeding tendency due to hemophilia. Which route of drug administration is appropriate for this patient? 1 Subcutaneous 2 Intramuscular 3 Intradermal 4 Oral

50 The daily requirement for this patient is 2 X 2 puffs—that is, 4 puffs a day. The canister has a total of 200 puffs; therefore, using 4 puffs daily will empty the canister in (200/4) = 50 days, so the patient should come in for a canister replacement after 50 days.

A patient has been advised to use a metered dose inhaler (MDI) two puffs two times a day. The canister has a total of 200 puffs of medicine. When should the nurse ask the patient to come in for a new canister? Record your answer using a whole number. ___ days

2, 5 Enoxaparin is a low-molecular-weight heparin that is administered in subcutaneous tissue of the abdomen, at least 2 inches away from the umbilicus. The injection site has to be pinched as the needle is inserted. This helps ensure that the medicine is injected into the subcutaneous tissue. Subcutaneous injections are not to be given over bony prominences, because doing so can cause injury. When administering enoxaparin, air within the syringe should not be expelled, because doing so can affect the dosing. Subcutaneous injections should not be given over large underlying muscles, because the medicine can be accidently injected into the muscles. Medication injected into a muscle is absorbed more quickly than from the subcutaneous tissue.

A patient has been prescribed enoxaparin. Which points should the nurse keep in mind when administering enoxaparin? Select all that apply. 1 The injection should be given over large underlying muscles. 2 The injection site should be pinched while the needle is being inserted. 3 Air should be expulsed from the syringe before administration. 4 The injection should be given over a bony prominence. 5 The injection should be given in the abdomen.

2 The patient with unilateral weakness may have an increased risk of aspiration due to impaired swallowing. To prevent aspiration, the medication should be placed on the stronger side of the mouth. This action improves swallowing of the medication. Providing medication as a solution increases the risk of aspiration. Placing the medication in the weaker side of the mouth may lead to inappropriate swallowing. Grinding the medication before administration does not reduce the incidence of aspiration.

A patient has unilateral weakness due to a medical disorder. How can the nurse administer medication to this patient without causing aspiration? 1 Crush the medication before administration. 2 Place the medication in the stronger side of mouth. 3 Place the medication in the weaker side of mouth. 4 Provide the medication as a solution.

4 A STAT order indicates that the single dose of medication should be given immediately and only once. When a patient with high blood pressure is admitted to an emergency unit, then a STAT order is used by the primary health care provider. A now order is used when the patient requires the medication within the next 90 minutes, but not immediately. A single order is used for preoperative medications or medications given before diagnostic examinations; these medications are given at once in a specified time. A standing order is an order that is carried out until the primary health care provider cancels it.

A patient is admitted to the emergency unit with hypertension. Which prescription order would the primary health care provider use in this situation? 1 Standing order 2 Single order 3 Now order 4 STAT order

4 While using a breath-activated metered-dose inhaler, the inhaler should not be shaken. The mouthpiece should be positioned between the lips for medication administration. The patient should inhale deeply and forcefully through the mouth to create an aerosol. The patient should hold his or her breath for 5 to 10 seconds during inhalation to ensure full medication administration.

A patient is inhaling using a breath-activated metered-dose inhaler. Which action made by the patient indicates a need for correction? 1 Holding the breath for 5 to 10 seconds during inhalation 2 Inhaling deeply and forcefully through the mouth 3 Positioning the mouthpiece between the lips 4 Shaking the inhaler vigorously

25 Two puffs of a medication four times a day indicates eight puffs per day. 200 puffs divided by eight puffs per day equal 25 days.

A patient is instructed to use two puffs of salbutamol (Ventolin) four times a day. The canister has 200 puffs. Calculate how long the metered-dose inhaler will last. Record your answer using a whole number. ____________ days

4, 5 A patient is prescribed a sublingual nitroglycerin drug. Which instructions should the nurse provide to the patient? Select all that apply. 1 Place the drug between your tongue and cheeks. 2 Take the medication with water. 3 Spit out the drug in case of irritation. 4 Place the medication under the tongue. 5 Do not swallow the medication

A patient is prescribed a sublingual nitroglycerin drug. Which instructions should the nurse provide to the patient? Select all that apply. 1 Place the drug between your tongue and cheeks. 2 Take the medication with water. 3 Spit out the drug in case of irritation. 4 Place the medication under the tongue. 5 Do not swallow the medication

2, 4 Lozenges are slowly absorbed through the buccal mucosa; therefore, they should be kept in the mouth an adequate time to allow dissolution. Lozenges should not be ingested quickly because they are more effective when absorbed through the buccal mucosa and not the gastric mucosa. The lozenges should not be crushed or dissolved in water or juice, because this can make them ineffective.

A patient is prescribed lozenges for a cough. Which instructions should the nurse give to this patient regarding the use of lozenges? Select all that apply. 1 Dissolve in juice before swallowing. 2 Do not ingest the medication quickly. 3 Dissolve in water before swallowing. 4 Allow the medication to dissolve in the mouth. 5 Crush the lozenge before swallowing.

2 A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications. Setting up follow-up appointments, ensuring that someone will provide housekeeping for the patient, and making sure the patient's family knows how to safely bathe the patient are not the priority for the discharge nurse in relation to medication administration.

A patient is transitioning from the hospital to the home environment and obtains a home care referral. Which is priority for the discharge nurse in relation to safe medication administration? 1 Make sure the patient's family knows how to safely bathe the patient and provide mouth care. 2 Ensure that the home care agency is aware of medication and health teaching needs. 3 Ensure that someone will provide housekeeping for the patient at home. 4 Set up the follow-up appointments with the physician for the patient.

1 While using a breath-activated metered-dose inhaler, holding the breath for 5 to 10 seconds ensures full medication distribution. Positioning the mouthpiece between the lips prevents medication from escaping through the mouth. Exhaling away from the inhaler before inhalation prevents a loss of powder. Inhaling deeply and forcefully through the mouth creates an aerosol.

A patient is using a breath-activated metered-dose inhaler. Which action made by the patient ensures full medication distribution? 1 Holding the breath for 5 to 10 seconds during inhalation 2 Inhaling deeply and forcefully through the mouth 3 Exhaling away from the inhaler before inhalation 4 Positioning the mouthpiece between the lips

1 Vomiting, diarrhea, and abdominal cramps are suggestive of the disturbed gastrointestinal tract. The oral route of drug administration is contraindicated in patients with gastrointestinal disturbance, because there will not be effective drug absorption. The astopial route, intravenous route, and transdermal route do not require gastrointestinal system for drug metabolism, so these routes of drug administration are safe for this patient.

A patient reports severe vomiting, diarrhea, and abdominal cramps to the nurse. Which form of medication is contraindicated in the patient? 1 Tablet administered through the oral route 2 Transdermal medicine administered through the skin surface 3 Solution administered through an intravenous line 4 Lotion applied to the topical surface

1 Internal ear structures are very sensitive to temperature extremes. Therefore, the eardrops instilled should be at room temperature. Extremes in the temperature of eardrops may cause vertigo, dizziness, or nausea. Use of nonsterile eardrops may lead to infection of the eardrum. Forcing the medication into an occluded ear canal creates pressure that injures the eardrum. Occluding or blocking the ear canal with the dropper or irrigating syringe is not associated with symptoms such as nausea, dizziness, vertigo.

A patient reports vertigo, dizziness, and nausea after administering eardrops. What could be the reason for these symptoms in the patient? 1 The eardrops are cold. 2 The eardrops are nonsterile. 3 The eardrops are forced into an occluded ear canal. 4 The ear canal is blocked by the dropper while administering the eardrops.

1 The intravenous route is used to administer adrenaline to patients with cardiac arrest. This route is often used in emergencies when a fast-acting medication needs to be delivered quickly. Injecting the medication through the intradermal route of administration is not beneficial because it may delay the action since the medication is injected under the epidermis. Subcutaneous injections involve a very slow medication absorption. The intramuscular route of administration has a faster absorption rate than the subcutaneous route, but this route may not be used in emergencies.

A patient who has been resuscitated following a cardiac arrest needs to be administered adrenaline. Which route of administration is most appropriate? 1 Intravenous 2 Intradermal 3 Intramuscular 4 Subcutaneous

3 One household cup is approximately equivalent to 240 mL. . Therefore the patient would require 2 cups of oral rehydration solution (2 X 240 mL). Three cups are equivalent to 240 X 3 = 720 mL of the solution. Four cups would be equivalent to 240 x 4 = 960 mL of the solution.

A patient who has diarrhea is dehydrated and needs 480 mL of oral rehydration solution. How can the nurse show the patient what 480 mL is using a household measurement? 1 Four cups are approximately equivalent to 480 mL. 2 Three cups are approximately equivalent to 480 mL. 3 Two cups are approximately equivalent to 480 mL. 4 One cup is approximately equivalent to 480 mL.

1 Overuse of nasal medications could lead to a rebound effect in which nasal congestion worsens. It is easier to have patients self-administer nasal sprays because they are able to control the spray and inhale the medication as it enters the nasal passages. However, this action might not cause increased nasal congestion. Swallowing excess decongestant solution may cause serious systemic effects but not nasal congestion. Saline drops are safer than nasal preparations containing sympathomimetics as decongestants for children; however, saline drops are not associated with the worsening of nasal congestion.

A patient who is prescribed nasal spray for sinus congestion reports increased severity of nasal congestion. Which statement made by the patient gives a clue about the cause of this? 1 "I overused the nasal spray." 2 "I self-administered the nasal spray." 3 "I swallowed excess decongestant solution." 4 "I replaced the nasal spray with saline drops."

1 Burned areas have a poor vascular supply and exhibit delayed absorption. In order for the medication to act more rapidly, it should be directly injected into the bloodstream. Thus the intravenous route is best. Injecting the medication directly into the burned skin is not a feasible route of administration because the skin has a poor vascular supply after the burns. Because the burned areas are deficient in blood supply, medications should not be injected subcutaneously. Intramuscular medications are injected deep into the muscles, which have a rich blood supply. Because a patient with burn injuries has a poor vascular supply, this route of administration is unsuitable.

A patient with second-degree burns complains of severe pain. What is the best route of administration to achieve immediate pain relief? 1 Intravenous 2 Intradermal 3 Subcutaneous 4 Intramuscular

1 Household measurement is most familiar and includes drops, teaspoons, tablespoons, and cups for volume, pints, and quarts for weight. The prescription order containing 30 mL indicates that 2 tablespoons of the medication should be taken. 240 mL indicates 1 cup of the medication. 960 mL indicates 1 quart of the medication. 5 mL indicates 1 teaspoon of the medication.

A patient's prescription order calls for 30 mL of the medication to be taken. What should the nurse instruct the patient regarding the administration of the medication according to household measurement? 1 "You should take 2 tablespoons of the medication." 2 "You should take 1 teaspoon of the medication." 3 "You should take 1 quart of the medication." 4 "You should take 1 cup of the medication."

0.4 Each milliliter of U-100 insulin contains 100 units of insulin. Therefore, the nurse has to fill 0.4 mL of insulin in a U-100 insulin syringe to administer 40 units.

A primary health care provider orders the nurse to administer 40 units of insulin to a patient with diabetes. How many milliliters of insulin should the nurse administer using a U-100 syringe? Record your answer using a decimal, and add leading zeros if necessary. ____________ mL

2, 3, 5 Medication remains on the patch even after its recommended duration of use. When the old transdermal patch is inadvertently left in place while a new one is applied, it may result in an overdose of medication. The patient using fentanyl transdermal patches for pain management can experience coma, death, and respiratory depression when the patches are not removed in the recommended time. Pain and allergic reactions are not typical when the patches are not removed in the recommended time.

A primary health care provider prescribed a transparent fentanyl patch to manage a patient's pain. A new patch was applied without removing the old one. Which symptoms may be seen in the patient due to the delayed removal of the fentanyl patch? Select all that apply. 1 Pain 2 Coma 3 Death 4 Allergic reactions 5 Respiratory depression

2 Maintenance medications are inhaled; their effects lasts for long periods of time. Rescue medications are short acting and provide immediate relief. Maintenance medications are used on a daily basis to prevent acute respiratory distress.

A primary health care provider prescribes maintenance medication to a patient with respiratory distress. What does the nurse teach the patient about maintenance medication? 1 A dose of maintenance medication is administered monthly. 2 The effects of maintenance medication last for a long time. 3 Maintenance medication provides immediate relief. 4 Maintenance medication is short acting.

1 The nursing student should not shake the insulin bottle because bubbles may develop that can alter the dose by taking up space in the syringe. The nursing student can mix two different types of insulin into one syringe based upon the medication compatibility and the patient's requirement. Before drawing up insulin doses, the nursing student should gently roll all cloudy insulin preparations between the palms to resuspend the insulin to normal body temperature.

A registered nurse evaluates a nursing student who is preparing an insulin injection. Which action made by the nursing student indicates the need for correction? 1 Shaking the insulin bottle to reduce the cloudiness 2 Mixing two different types of insulin into one syringe 3 Rolling the insulin bottle after taking it out from the refrigerator 4 Using an insulin syringe to draw up the doses from the insulin bottle

4 The nursing student should hold the vial between the thumb and middle fingers of the nondominant hand. The dominant hand should be used to grasp the end of the syringe barrel and plunger to counteract pressure in the vial. Injecting air into the vial with the syringe creates a vacuum needed to get the medication into the syringe. This action also helps prevent the formation of bubbles and inaccuracy in the dose. The nursing student should wipe the vial cap with alcohol to maintain asepsis. Application of pressure to the tip of the needle during insertion prevents coring of the rubber seal.

A registered nurse evaluates the actions made by a nursing student who is preparing an injection from a vial. Which nursing action needs correction? 1 Injecting air into the vial with the syringe 2 Wiping the rubber seal of the vial with alcohol 3 Applying pressure to the needle tip during insertion into the vial 4 Holding the vial between the fingers of the dominant hand

2, 4, 5 Oral disintegrating tablets begin to dissolve immediately. Therefore, they should not be pushed through the foil. Oral disintegrating medications should be placed on the patient's tongue and should not be chewed. Because these tablets dissolve when placed on the tongue, water is not necessary. Oral disintegrating medications should be placed on top of the patient's tongue. Oral disintegrating medications should be removed from the blister packet just before use.

A registered nurse evaluates the actions of a nursing student who is administering oral disintegrating tablets to a patient. Which actions made by the nursing student indicate a need for correction? Select all that apply. 1 Removing the medication from the blister packet just before use 2 Offering water to the patient to help swallow the tablet 3 Placing the medication on top of the patient's tongue 4 Instructing the patient to chew the medication 5 Pushing the tablet through the foil

1, 3 Most of the drugs undergo biotransformation in the liver before they are excreted through kidneys. Enema, which increases the rate of peristalsis, will accelerate the excretion of medication through feces. Renal failure may result in drug toxicity due to improper excretion of the drug from the body. Adequate fluid intake promotes proper elimination of medications through kidneys. Drug doses should be minimized in patients with renal disease to avoid the risk of drug toxicity.

A registered nurse is teaching a nursing student about medications in patients with renal disease. Which statements, if made by the nursing student, indicate a need for further teaching? Select all that apply. 1 "Enemas will accelerate excretion of the drug through the kidneys in patients with renal failure." 2 "Health care providers should decrease the medication dose in patients with renal disease." 3 "Most drugs undergo biotransformation in the kidney before they are excreted." 4 "Adequate fluid intake promotes proper elimination of medications through the kidneys." 5 "Renal failure may lead to drug toxicity in the body."

4 A troche is a flat, round tablet that should be dissolved in the mouth for medication release. Therefore, a patient who is prescribed a troche form of medication should be instructed to dissolve the medication slowly in the mouth. A caplet is a solid dosage form of medication, which is available in coated form and meant to be swallowed whole. A capsule is a form of medication that is encased in a gelatin shell; this medication is meant to be swallowed whole. A tablet is a powdered medication compressed into a hard disk or cylinder; this medication is also meant to be swallowed whole.

A registered nurse prepares to administer medications to four patients through the oral route. Which patient is instructed to dissolve the medication slowly in the mouth? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

4 The nurse should assess the vital signs before, during, and after administering potent medications to the patient. The nurse should double check the medication calculation with another nurse before administering the medication. The nurse should know the desired action and side effects of every medication. The nurse should make sure that the antidote is available during administration.

A registered nurse teaches a nursing student about administering intravenous medication. Which statement made by the nursing student indicates the need for further teaching? 1 "I should double check the medication calculation with another nurse." 2 "I should know the desired action and side effects of every medication." 3 "I should make sure that the antidote is available during administration." 4 "I should assess vital signs only before administration of potent medications."

2 The nurse should not add medication to intravenous bags that are already hanging, because there is no way to tell the exact concentration of the medication. The nurse should check the site frequently for infiltration and phlebitis while administering intravenous infusions. The nurse should regulate the intravenous rate according to the primary health care provider's order. The nurse should monitor the patient closely for any adverse reactions to the medications.

A registered nurse teaches a nursing student about administering medications in large intravenous infusions. Which statement made by the nursing student indicates the need for further teaching? 1 "I should check the site frequently for infiltration and phlebitis." 2 "I should add medication to intravenous bags that are hung already." 3 "I should regulate the intravenous rate according to the health care provider's order." 4 "I should monitor the patient closely for any adverse reactions to the medications."

4 The nurse should begin giving instructions about intravenous therapy when the patient is hospitalized. The nurse should teach the patient and family how to recognize problems of intravenous therapy. The nurse should carefully assess the patient's and family's ability to manage home intravenous therapy. The nurse should teach patients and family how to maintain intravenous administration therapy equipment.

A registered nurse teaches a nursing student about instructions to be given to a patient on intravenous therapy at home. Which statement made by the nursing student indicates the need for further teaching? 1 "I should teach the patient and family how to recognize problems of intravenous therapy." 2 "I should carefully assess the patient's and family's ability to manage intravenous therapy at home." 3 "I should teach patients and their families how to maintain intravenous administration therapy equipment." 4 "I should begin giving instructions to the patient about intravenous therapy when the patient is at home."

2 Heparin solutions are used for intermittent infusions (according to some agency policies) to maintain the patency of the intravenous catheter.These solutions are not the only solutions used however; 0.9% sodium chloride is most commonly used for intermittent infusions to maintain the patency of IV catheters. Intermittent infusions are indicated in patients requiring intravenous medications to be administered periodically, such as insulin. Intravenous catheters should be flushed with normal saline to maintain patency for next use.

A registered nurse teaches a nursing student about intermittent infusions. Which statement made by the nursing student indicates a need for further teaching? 1 "0.9% sodium chloride is used for intermittent infusions." 2 "Heparin is the only solution used for intermittent infusions." 3 "Intermittent infusions are indicated for patients requiring intravenous medication." 4 "After administration, the intravenous catheter should be flushed with normal saline."

1 Only oral syringes should be used when preparing medications for the enteral route to prevent accidental parenteral administration. If liquid medications are not available, the nurse can crush simple tablets or open capsules and dilute them in water before administering them. Enteral tubes should be flushed with at least 30 mL of water before and after giving medications. The incompatibility of the location of the tube with the medication being administered may lead to poor bioavailability of the drug administered.

A registered nurse teaches a nursing student about the precautionary measures to be taken while caring for a patient with enteral tubes. Which statement made by the nursing student indicates the need for further teaching? 1 "I will use regular syringes while preparing medications for a patient." 2 "I will verify the compatibility of the location of the tube with the medication being administered." 3 "I will flush tubes with at least 30 mL of water before and after administering medications." 4 "I will crush tablets and dilute them with water before administering them to the patient."

2 Parenteral administration is an invasive procedure performed using aseptic techniques. The nurse should prevent infection by using friction and a circular motion while cleaning the area with the antiseptic swab. Before injecting the medication, the nurse should use alcohol to cleanse the patient's skin. The nurse should avoid having the needle touch the outer edges of the ampule because this action may cause contamination. The antiseptic should be swabbed from the center of the site and move outward in a 5-cm radius.

A registered nurse teaches a student nurse about preventing infections during the administration of an injection via the parenteral route. Which statement made by the student nurse shows ineffective learning? 1 "I should wash the patient's skin with alcohol." 2 "I should avoid friction and circular motion while cleansing the site." 3 "I should avoid letting the needle touch the outer edge of the ampule." 4 "I should swab the antiseptic starting from the center of the site and move outward."

4 The descriptive term "IV over 5 minutes" is used during the administration of drugs. The ISMP recommends avoiding using terms such as "IVP," "IV push," or "bolus" in orders with drugs that require administration over 1 minute or longer.

According to ISMP (Institution of safe medication practices), which descriptive term is used during the administration of drugs? 1 IVP 2 Bolus 3 IV push 4 IV over 5 minutes

3 The nurse flushes the injection port with normal saline to prevent the occlusion of the intravenous access devices. The nurse should dispose of uncapped needles and syringes in puncture-proof containers to reduce the risk of accidental needlesticks. The nurse should remove the saline flush syringe to reduce the transmission of infection. The nurse removes and disposes of used gloves to prevent transmission of microorganisms.

After administrating intravenous medication, the nurse flushes the injection port with normal saline. What is the rationale behind this intervention? 1 To reduce the risk of accidental needlesticks 2 To reduce the transmission of infection 3 To prevent the occlusion of the intravenous access devices 4 To prevent the transmission of microorganisms

3 The nurse should determine the reason for the improper circulation of flow rate when the medication does not infuse over the desired period. The nurse should insert a new intravenous site if the patient shows symptoms of infiltration or phlebitis. The nurse should stop the medication infusion if the patient develops any allergic reactions. The nurse should add the information to the patient's record if the patient develops any allergic reactions.

After evaluating the medication administration record of a patient, the nurse found that the medication does not infuse over the desired period. Which nursing intervention is appropriate in this situation? 1 Inserting a new intravenous site 2 Stopping the medication infusion 3 Determining the circulation of flow rate 4 Adding the information in to patient's medical record

3 AD in the prescription order indicates that the medication should be administered in the right ear. AS in the prescription order indicates that the medication should be administered in the left ear. OD indicates that the medication should be administered in the right eye. OS indicates that the medication should be administered in the left eye.

After reading the prescription order of a patient, the nurse prepares to administer the medication in the patient's right ear. Which abbreviation in the prescription reflects the nurse's action? 1 OS 2 OD 3 AD 4 AS

3 Nursing students cannot take orders from physicians. Thus, there is no need to refer to the ISMP for abbreviation guidelines, write down the order, and ensure the six rights of medication administration are followed in this instance.

After seeing a patient, the physician gives the nursing student a verbal order for a new medication. What should the nursing student do first? 1 Ensure that the six rights of medication administration are followed when giving the medication. 2 Write down the order on the patient's order sheet and read it back to the physician. 3 Explain to the physician that the order should be given to a registered nurse. 4 Follow Institute for Safe Medication Practices (ISMP) guidelines for abbreviations.

2, 4, 5 Subcutaneous injections may be painful with irritating medication or if a large volume of medications is injected. Repeated injections at the same site may cause hypertrophy of the skin. The injected medication may collect at the site causing sterile abscess. Phlebitis is inflammation of the veins. Infiltration happens when the intravenous fluid or medication accidently enters extravascular space.

An elderly obese patient who has undergone total hip replacement surgery has been put on low-molecular-weight heparin (LMWH) enoxaparin. For which complications of subcutaneous injections should the nurse monitor? Select all that apply. 1 Phlebitis 2 Pain 3 Infiltration 4 Hypertrophy of the skin 5 Sterile abscess

2, 5, 1, 3, 6, 4 The first step is to ensure that the intravenous fluid and medication are compatible. Then, prepare the medication in a syringe using a strict aseptic technique. Clean the injection port of the intravenous bag with an alcohol swab, remove the cap from the needle, and insert the needle through the intravenous port. Push the syringe plunger to instill medication into the intravenous fluid and mix the solution by turning the intravenous bag gently, end to end. Next, attach a medication label following safe-label guidelines. Then, administer the medication to the patient at the prescribed rate.

Arrange the order of the procedure for preparing intravenous medications safely. 1. Clean the injection port of the intravenous bag with an alcohol swab 2. Ensure that the intravenous fluid and medication are compatible 3. Push the syringe plunger to instill medication into the intravenous fluid 4. Administer the medication to the patient at the prescribed rate 5. Prepare the medication in a syringe using a strict aseptic technique 6. Follow the safe-label guidelines and attach a medication label

3, 2, 1, 4, 5, 6 First, remove the cover from the mouthpiece. Then, hold the inhaler upright and turn the wheel to the right. Then, turn the wheel to the left until a click is heard. Next, load the medication pellet and exhale away from the inhaler before inhalation. Then, position the mouthpiece between the lips. Finally, inhale deeply and forcefully through the mouth.

Arrange the steps in administering a breath-activated metered-dose inhaler in sequential order. 1. Load the medication pellet 2. Hold the inhaler upright and turn the wheel to the right and left until a click is heard 3. Remove the cover from the mouthpiece 4. Exhale away from the inhaler before inhalation 5. Position the mouthpiece between the lips 6. Inhale deeplyand forcefully through the mouth

4 Effervescent medications are added to a glass of water and immediately given before dissolving. Therefore, a patient who is prescribed effervescent medication should be offered a glass full of water. Lozenges act through slow absorption through the oral mucosa. Therefore, a patient who is prescribed a lozenge is instructed not to swallow the medication. Sublingual medications are absorbed through the blood vessels of the undersurface of tongue. Therefore, a patient who is prescribed a sublingual medication is instructed to place the medication under the tongue. Buccal medications act locally on the mucosa. Therefore, a patient who is prescribed a buccal medication is instructed to place the medication in the mouth against the mucous membranes of the cheek until it dissolves.

Four patients are prescribed medications. Which patient should be offered a glass full of water during medication administration? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

2 Redness, warmth, and tenderness at the intravenous (IV) site are signs of phlebitis.

If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, what would the nurse suspect? 1 Sepsis 2 Phlebitis 3 Infiltration 4 Fluid overload

5, 3, 2, 6, 4, 1 The first step for administering nasal drops is to place the patient in the supine position and place the head properly. The second step is to support the patient's head with the nondominant hand. The third step is to hold the dropper 1 cm (12 inches) above the nares. The fourth step is instillation of the prescribed number of drops toward the midline of the ethmoid bone. The fifth step is to instruct the patient to remain in the supine position for 5minutes so that the medication is properly delivered to the site. The sixth step is to offer facial tissues to the patient to blot a runny nose.

In which order should the nurse perform the steps of nasal drop administration? 1. Offering facial tissues 2. Holding the dropper 1 cm (12 inches) above the nares 3. Supporting the patient's head with the nondominant hand 4. Instructing the patient to remain in the supine position for 5 minutes 5. Placing the patient in the supine position and placing the head properly 6. Instilling the prescribed number of drops toward the midline of the ethmoid bone

0.4 The volume required is calculated by the formula: (Dose ordered/dose on hand) x Amount on hand = Amount to administer. (4 mg/10 mg) x 1 mL = Amount to administer = 0.4 mL. Therefore, the patient requires 0.4 mL of morphine to be administered.

The healthcare provider has instructed the nurse to administer 4 mg of morphine sulfate intravenously to a patient. The ampule of morphine contains 1 mL of the solution with a concentration of 10 mg/mL. What volume of the medication should the nurse administer to this patient? Record your answer to one decimal place. ___ mL

125 The amount of drug to be administered to the patient is calculated as: Dose ordered/dose on hand × amount on hand. Here, the amount of medication administered to the patient is 0.25 L, and the dose on hand is 500 mg/L. The amount on hand is 1 L. Therefore, the calculation is 0.25/500 x 1 = 125. Therefore, the prescribed dose is 125 mg/L.

The nurse administers 0.25 L of 500 mg/L paracetamol (over-the-counter analgesic) to a pediatric patient through intravenous route. What is the actual dose prescribed to the patient? Record your answer in the whole number _____ mg/L

2 Intrathecal medications are often administered for long-term treatment. These medications are administered through a catheter surgically placed in the subarachnoid space or the ventricles of the brain. Epidural medications are administered in the epidural space through a catheter. Intrapleural medications are injected directly into the pleural space through either a syringe and needle or a chest tube. Intraperitoneal medications (such as chemotherapeutic agents, insulin, and antibiotics) are administered into the peritoneal cavity.

The nurse administers a medication in the subarachnoid space. Which route of administration did the nurse use? 1 Epidural 2 Intrathecal 3 Intrapleural 4 Intraperitoneal

4 The nurse should assess the vital signs before, during, and after the administration of potent medication because there may be large changes in the vital signs. Before administrating a drug through an IV, the nurse double-checks the medication calculations, follows the six rights of safe medication administration, and knows the desired actions and side effects of the drug.

The nurse administers a potent medication to a patient through the IV. What is the most appropriate intervention followed by the nurse? 1 Double-checking the medication calculation 2 Knowing the desired actions and side effects of the drug 3 Following the six rights of safe medication administration 4 Assessing the vital signs before, during, and after infusion

2 After administering a rectal suppository to a patient, the nurse should instruct the patient to lay flat for at least 5 minutes to prevent expulsion of the suppository. Before administering a rectal suppository, the nurse should help the patient into the Sims' position. The nurse should instruct the patient to take slow, deep breaths through the mouth and relax the anal sphincter before administration. The nurse should lubricate the rounded end of the suppository with a sterile water-soluble lubricant before administration to make it easier to insert the suppository.

The nurse administers a rectal suppository to a patient with constipation. Which action of the nurse would be most effective in preventing expulsion of the suppository? 1 Helping the patient into the Sims' position 2 Asking the patient to lay flat for at least 5 minutes 3 Asking the patient to take slow, deep breaths through the mouth 4 Lubricating the rounded end of the suppository with a sterile water-soluble lubricant

3 Acidic medications cause gastric irritation. Nonfat snacks should be offered to reduce gastric irritation, because snacks that are rich in fat can delay the medication absorption. Lozenges are absorbed slowly through the oral mucosa. Therefore, a patient taking a lozenge is cautioned against chewing or swallowing the lozenge. Powdered medications should be mixed with liquid just before administration because when prepared in advance, powdered medications often thicken, which makes swallowing difficult. Effervescent medications should be dissolved in water and given immediately after dissolving.

The nurse administers different forms of medications to a patient. Which action made by the nurse indicates a need for correction? 1 Giving effervescent medications to a patient immediately after dissolving them in water 2 Mixing powdered medications with liquid just before administration 3 Offering a snack rich in fats after administering acidic medication 4 Cautioning the patient against chewing or swallowing a lozenge

1, 2, 3, 4, 5, 6, 7, 8 The nurse should first fill the buretrol with the desired amount of fluid, then close the clamp and check the clamp for the air vent. Then, the nurse should clean the buretrol injection port with an antiseptic swab, remove the needle cap, and insert the syringe through the port. Then, the nurse should regulate the intravenous infusion rate to allow the medication to infuse. Next, the nurse labels the buretrol with the name of the medication, dosage, and total volume and checks for primary infusion after the medication has infused. Finally, the nurse should dispose of the uncapped needle, safety shield, and syringe in a proper container.

The nurse administers intravenous fluids to a child by volume-control administration set. Arrange the order of the steps followed during administration. 1. Fill the buretrol with the desired amount of fluid 2. Close the clamp and check the clamp for air vent 3. Clean the buretrol injection port with an antiseptic swab 4. Remove the needle cap and insert the syringe through the port 5. Regulate the intravenous infusion rate to allow the medication to infuse 6. Label the buretrol with the name of medication, dosage, and total volume 7. Check for primary infusion after the medication has infused 8. Dispose of the uncapped needle, safety shield,and syringe in a proper container

4 When administering medications through the epidural route, the catheter should be placed in the epidural space—that is, just before the dura mater. The intrathecal space refers to the subarachnoid space or ventricles of the brain; administering medication there requires that the dura mater be punctured for administering the medication.

The nurse anesthetist has been asked to administer a medication through the epidural route. Where should the nurse place the catheter for administering the medication? 1 Intrathecal space 2 Ventricles of brain 3 Subarachnoid space 4 Just before the dura mater

2 Evaluation is the skill involved when the nurse assesses a patient's status after giving an intravenous medication. Planning involves collecting the medication administration record as well as taking steps to avoid interruptions. Assessment involves checking the accuracy and completeness of each medication administration record with the primary health care provider's medication orders. Implementation involves performing hand hygiene, putting on gloves, explaining the procedures, and administering medications.

The nurse assesses a patient's status after giving intravenous medication. Which nursing skill is involved in this situation? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

2 Patient B is unconscious and is unable to take the medication orally. Therefore, the nurse has to administer the medication parentally in the patient B. Parental administration of the medication may increase anxiety in children. Therefore, the nurse should either calm patient A first and then begin parenteral injection or avoid this route altogether. Because patient C has bleeding tendencies, the parenteral route is considered to be too invasive. A patient with an eye infection can take medications orally, which is more comfortable and convenient.

The nurse cares for four patients in the medical unit. Which patient does the nurse suspect most likely needs parental administration of medication? 1. A 2. B 3. C 4. D

5, 1, 2, 3, 4 The first step in administering vaginal cream to a patient is filling the cream or foam applicator by following the package directions. The second step is exposing the vaginal orifice by gently retracting the labial folds. Then, the applicator is inserted to approximately 5 to 7.5 cm (2 to 3 inches). This is followed by pushing the applicator plunger to deposit medication into the vagina. The last step is placing a paper towel and wiping off the residual cream from the vaginal orifice.

The nurse delegates the task of administering vaginal cream for a patient to a licensed practical nurse (LPN). In which order should the LPN complete the steps of administering the vaginal cream? 1. Exposing the vaginal orifice by gently retracting the labial folds 2. Inserting the applicator approximately 5 to 7.5 cm (2 to 3 inches) 3. Pushing the applicator plunger to deposit medication into the vagina 4. Placing a paper towel and wiping off the residual cream from the vaginal orifice 5. Filling the cream or foam applicator by following the package directions

1 While using a metered-dose inhaler using a spacer, the small exhalation slots should not be covered because it prevents the air from moving out of the inhaler. The spacer mouthpiece should be placed into the mouth and the lips should be closed. Before exhaling, the metered-dose inhaler should be removed from the mouth. The medication canister should be depressed and one puff should be sprayed in the spacer.

The nurse evaluates the actions of a patient who is self-administering medication through a metered-dose inhaler using a spacer. Which action made by the patient indicates a need for correction? 1 Covering the small exhalation slots with the lips 2 Depressing the medication canister and spraying one puff in the spacer 3 Removing the metered-dose inhaler and spacer before exhaling 4 Placing a spacer mouthpiece into the mouth and closing the lips

4 Soon after reconstituting and extracting medication from multiple dose vials, the nurse should label the vial with information regarding the date and time of mixing. The nurse should also make sure to label the concentration of medication per milliliter to minimize administration errors. The nurse should check and discard the vial after extracting the medication if any leakages are found. After labeling, the nurse should place the vial in the refrigerator to prevent medication disintegration. Then, the nurse monitors for adverse reactions after injecting the medication into the patient.

The nurse extracts medication from multiple dose vials after reconstitution. Which priority nursing action should the nurse perform? 1 Checking the vial for leakage 2 Placing the vial in the refrigerator 3 Monitoring the patient for reactions 4 Labeling the date and time of mixing on the vial

3 STAT medications are given once and at the time the medication is ordered. Therefore, it requires administration immediately and only once. Medications that are not time-critical can be administered within 1 to 2 hours of the scheduled dose. Prn medications require administration as needed. STAT orders do not indicate administering the medication before the surgical procedure.

The nurse finds a STAT order in the medication administration record of a patient. What action of the nurse is appropriate in this situation? 1 Administering the medication after 1 hour 2 Administering the medication when it is needed 3 Administering the medication only once and immediately 4 Administering the medication before the surgical procedure

26 mL One teaspoon is equal to 5 mL in the metric system. Therefore, 5 teaspoons of magnesium hydroxide is equal to 25 mL (5 x 5 = 25 mL). Fifteen drops of medication is equal to 1 mL. Therefore, 25 mL + 1 mL = 26 mL.

The nurse finds an order for 5 teaspoons of magnesium hydroxide and 15 drops of diphenhydramine hydrochloride in a patient's prescription. How much medication (in volume) should the nurse administer in total? Record your answer using a whole number.

4 For rectal administration of a suppository, the patient should be placed in the Sims' position. Neither the patient nor the nurse would be comfortable if the patient were placed in the prone position, lateral position, or dorsal recumbent position.

The nurse has been asked to administer a rectal suppository to a patient. In what position should the nurse place the patient? 1 Doral recumbent 2 Lateral position 3 Prone position 4 Sims' position

3 A rectal suppository for an adult should be placed against the rectal wall about 10 cm into the rectum. For children and infants, the suppository should be placed 5 cm deep into the rectum against the rectal wall. The inner aspect of the anal orifice is not the right position for suppository administration. The suppository has to be placed past the internal anal sphincter.

The nurse has been asked to administer a rectal suppository to an adult patient. Where should the nurse place the medication? 1 Just prior to the internal anal sphincter 2 Inner aspect of the anal orifice 3 Rectal wall 10 cm into the rectum 4 Rectal wall 5 cm into the rectum

1, 3, 4 The three common sites for administering intramuscular (IM) injections are the deltoid, vastus lateralis, and ventrogluteal muscles. The deltoid site is easily accessible and is used for injecting small volumes. The vastus lateralis is a thick and well-developed muscle, located on the anterior lateral aspect of the thigh. The ventrogluteal muscle is the safest site for injection. It is deep and away from major nerves and blood vessels. The brachioradialis is a muscle of the arm and is not used for injecting medications. The sternocleidomastoid is a muscle of the neck and is not a favorable site for administering IM injections.

The nurse has to administer a medication via intramuscular (IM) injection. Which are the various sites that can be used for an IM injection? Select all that apply. 1 Deltoid 2 Brachioradialis 3 Vastus lateralis 4 Ventrogluteal 5 Sternocleidomastoid

1, 2 Administering a subcutaneous injection for an average-size patient involves pinching the skin with the nondominant hand and injecting the needle quickly and firmly at a 45- to 90-degree angle. The medication has to be injected slowly to minimize pain. The skin is pinched with the nondominant hand, because the dominant hand is used for administering the injection. Piercing a blood vessel during a subcutaneous injection is very rare, so aspiration is not necessary. Injecting the needle should be quick. Inserting the needle with bevel up at a 5- to 15-degree angle is done for intradermal injection.

The nurse has to administer a subcutaneous injection to a patient. Which precautions should the nurse follow when administering the subcutaneous injection? Select all that apply. 1 Inject medication slowly. 2 Pinch skin with the nondominant hand. 3 Aspirate when administering the injection. 4 Inject the needle slowly at a 45- to 90-degree angle. 5 Insert the needle with bevel up at a 5- to 15-degree angle.

2 The use of opioid drugs is carefully controlled through federal and state guidelines. Violation of these guidelines is punishable under the controlled substance law. State Nurse Practice Acts (NPAs) define the scope of nurses' professional functions and responsibilities. The Pure Food and Drug Act is the first American law to regulate medications. The Food and Drug Administration is the current monitoring body for maintaining the standards of medication, through its medication law.

The nurse in the palliative care unit is administering a higher-than-prescribed dose of opioid analgesic to a patient with terminal stage cancer to relieve pain. Which act or law should discipline the nurse? 1 Medication law of Food and Drug Administration 2 Controlled Substance Act 3 Pure Food and Drug Act 4 Nurse Practice Act

3 The nurse should rotate the buretrol between the hands to ensure equal distribution of medication. The nurse should close the clamp on the air vent of buretrol to prevent additional leakage of fluid into the buretrol. The nurse should re-establish the saline lock to ensure appropriate fluid balance and to maintain the IV site. Connecting the prefilled syringe to mini-infusion tubing may not ensure equal distribution of medication.

The nurse is administrating medication to a patient through volume-controlled administration set. Which action performed by the nurse ensures equal distribution of the medication? 1 Closing the clamp on the air vent 2 Re-establishing the saline lock 3 Rotating the buretrol between the hands 4 Connecting the prefilled syringe to mini-infusion tubing

2, 4, 5 A full prescription of the antibiotics should be completed to ensure the therapeutic effect. An incomplete course of antibiotics may worsen the condition being treated and also lead to development of resistance to the antibiotic. Full treatment must be taken even if the patient attains early symptomatic relief. If the patient's condition does not improve with full treatment, then treatment should be discontinued.

The nurse is attending to a patient with a pulmonary infection. The healthcare provider prescribes antibiotics for the patient. Which instructions should the nurse give to the patient regarding antibiotic treatment? Select all that apply. 1 Emphasize continuation if the condition does not improve with a full course of medication 2 Explain that improper treatment may cause development of bacterial resistance. 3 Emphasize discontinuing the treatment once the patient attains symptomatic relief. 4 Explain that improper treatment may worsen the patient's condition. 5 Emphasize taking the full prescription.

2 After verifying the insulin dosages with the medication administration record (MAR) a third time, the nurse should show the insulin prepared in the syringe to another nurse to verify that the correct dosage is prepared. This is considered part of the third accuracy check. The nurse should review the patient's medical history and any allergies to various medications; this is unrelated to the third accuracy check. While mixing the two types of insulin in one syringe, the first step is to check the accuracy and completeness of each MAR ordered by the primary health care provider. The nurse should verify the insulin dosages against the medication administration (MAR) before wiping the insulin vials tops with alcohol as part of the second accuracy check.

The nurse is mixing two types of insulin in one syringe. Which action is associated with the third accuracy check? 1 Reviewing the patient's medical history and allergies to medications, food, and latex 2 Showing insulin prepared in the syringe to another nurse to verify the correct dosage preparation 3 Verifying insulin dosages against medication administration records (MAR) after wiping the insulin vials tops with alcohol 4 Checking the accuracy of each medication administration record (MAR) with the health care provider's medication order

4 The nurse should prioritize care while caring for a patient on insulin treatment. The nurse should mention that the patient consume candy when experiencing hypoglycemia, an adverse effect of insulin. Then the nurse should educate the patient about insulin injection site rotation and when to take insulin. The nurse should finally ask the patient to maintain an insulin administration log.

The nurse is preparing a counseling plan for a patient on insulin treatment. Which instruction should the nurse first specify to the patient? 1 "Rotate the insulin injection site regularly." 2 "Take insulin subcutaneously before food." 3 "Keep a daily administration log for insulin injection." 4 "Eat candy while experiencing hypoglycemia after taking insulin."

0.5 By using the formula method: (Dose ordered/Dose on hand) x amount on hand = Amount to administer. (250 mg/1000 mg) x 2 mL = ½ mL = 0.5 mL.

The nurse is preparing a medication ordered by the physician. The physician ordered 250 mg of Tylenol to be given to the patient. The medication comes from the pharmacy in dosage strength of 1 gram of Tylenol in 2 mL. How many mL should the nurse administer? Record your answer using one decimal place. ____________ mL

1, 2, 5 The interventions for safe insulin administration include teaching the patient how to determine the expiration date of insulin. The nurse should help the patient to determine the amount of insulin required based on the home capillary glucose monitoring results. Insulin should be administered as a subcutaneous injection. The nurse should instruct the patient to refrigerate the medication whenever needed. Insulin should be self-administered; however, when necessary, a caregiver can assist in rotating injection sites.

The nurse is preparing a teaching plan for safe insulin administration. Which interventions included in the plan is appropriate for the patient? Select all that apply. 1 Helping the patient determine the insulin required based on the home capillary glucose monitoring 2 When necessary, instructing the patient to accept help from the caregiver for rotating injection sites 3 Instructing the patient to avoid refrigeration of the medication 4 Teaching the steps of administering intramuscular injection 5 Teaching the patient to determine the expiration date of insulin

1 The capacity of the tuberculin syringe is 1 mL and is used to prepare small amounts of medications (e.g., intradermal or subcutaneous injections).

The nurse is preparing an intravenous medication for an infant in the pediatric unit and is using a tuberculin syringe for precise medication measurement. The tuberculin syringe is calibrated in hundredths of a milliliter. What is the capacity of the syringe? Record your answer using a whole number. __ mL

1 If the medication has an antidote, the nurse should keep it at the bedside while administering intravenous medication to treat any toxicities. The nurse should not administer the antidote unless the patient exhibits symptoms of medication toxicity. The nurse should ensure accurate dose calculation and preparation while preparing intravenous medications to minimize the risk of adverse effects. Placing the antidote at the patient's bedside while administering the medication does not enhance the medication's therapeutic action.

The nurse is preparing to administer an intravenous medication to a patient and keeps its antidote at the bedside. What is the probable reason for doing this? 1 To treat the medication toxicity 2 To administer along with medication 3 To prevent the risk of adverse effects 4 To enhance the medication's therapeutic action

1, 3, 5 All narcotics should be stored in a locked, secure cabinet or container to ensure safe storage. The narcotics should be counted with the opening of narcotic drawers and/or at shift change to ensure that narcotics are not missing. The patient's name, date, time of medication administration, name of medication, dose, and signature of the nurse dispensing the medication should be recorded. Documentation is necessary to keep a proper count of drug usage. Discrepancies in narcotic counts should be immediately reported, because they may be a result of theft or illegal drug use. Any unused portion should be disposed of to prevent abuse.

The nurse is responsible for the storage and safe usage of drugs. Which guidelines should the nurse follow for the safe use of narcotics? Select all that apply. 1 Document and record patient details. 2 Do not report discrepancies in narcotic count. 3 Frequently count narcotics, especially during shift change. 4 Preserve unused portion of the drug. 5 Store narcotics in locked containers.

2, 3, 5 The components of a medication order include dose and frequency of the medication, route of administration, and generic name of the medication. The dose and frequency are decided based on the patient's weight and the amount of medication required to obtain the therapeutic effect. The route of administration depends on the types of medication and the condition of the patient. The medication can be given via enteral or parenteral route. The generic name of the drug is an important component of the medication order and is used to identify the drug. The chemical name of the medication and the name of the nurse in charge are not components of the medication order.

The nurse is reviewing a medication order for a patient. What are the components of medication orders? Select all that apply. 1 Chemical name of medication 2 Generic name of medication 3 Route of administration 4 Specific nurse in charge 5 Dose and frequency

1 The intraosseous route of administration is common in toddlers who have poor access to intravascular space. Insulin is administered through the intraperitoneal route. Epidural medication is administered in the spinal canal in the epidural space. Intraarterial medication administration is managed by the nurse who continuously infuses the clot-dissolving agent and carefully monitors the integrity of the infusion.

The nurse is teaching a nursing student about parenteral routes. Which statement made by the nursing student indicates a need for correction? 1 "Intrapleural administration is common in toddlers who have poor access to intravascular space." 2 "Epidural medication is used to administered medicine in the spinal canal." 3 "Intraarterial medication administration is managed by the nurse." 4 "The intraperitoneal route is used to administer insulin."

3 Cloudy insulin preparations should be rolled between the palms to resuspend them before drawing into injections. The insulin vial should not be shaken, because shaking can create bubbles that can interfere with correct dosage administration. Regular insulin is given subcutaneously, not intramuscularly. If insulin is taken after meals, it cannot control the rise of blood sugar levels that occurs due to food intake.

The nurse is teaching self-administration of insulin to a patient. Which instruction should the nurse include in the teaching? 1 Shake the vial before drawing insulin. 2 Administer regular insulin intramuscularly. 3 Roll the insulin between your palms if the preparation is cloudy. 4 Administer insulin after having meals.

1 An infusion that is too rapid may cause an excessive infusion of intravenous fluids, which may cause circulatory fluid overload during fluid replacement therapy. Lowering the level of the fluid bag causes a decreased rate of infusion. Rotating the sites of the administration can minimize a patient's pain and discomfort; this action does not cause fluid overload. Placing the patient in high Fowler's position is not responsible for fluid overload.

The nurse observes weight gain, edema, hypertension, and distended neck veins in a patient who is on fluid replacement therapy. What could be the reason behind this condition in the patient? 1 The intravenous solution is infusing too fast. 2 The level of the fluid bag has been lowered 3 The intravenous sites of administration have been rotated. 4 The patient was placed in a high Fowler's position.

2, 3, 5 In a hospital setting, whenever a verbal order is given, the nurse should read back the order to the prescriber to confirm it. The order should be entered in the computer. The nurse should receive confirmation of the order from the prescriber for validation. The nurse should enter the time and the prescriber's name and then sign the order, indicating that it was read back. The prescriber should countersign the order within 24 hours, not 48 hours.

The nurse on night shift explains a patient's condition to the healthcare provider, who in turn provides the verbal order of medication over the phone. Which accurately describe the roles of nurse and health care provider in executing telephone orders? Select all that apply. 1 The prescriber should countersign within 48 hours. 2 The nurse should receive confirmation from the prescriber. 3 The nurse has to enter the order in the computer. 4 The nurse should not sign the order. 5 The nurse should read back the order.

4 The nurse should check and discard any unclosed, leftover ampules to prevent the chance of infection. The nurse should draw the multivitamin solution quickly out of the ampule to prevent contamination of the medication. The nurse should clean the patient's skin with an antiseptic cotton swab to maintain asepsis. The nurse should apply friction in a circular motion from the center of the site outward in a 5-cm (2-inch) radius to prevent the chances of infection.

The nurse prepares to administer a multivitamin from an ampule to a patient. Which nursing action indicates a need for correction? 1 Drawing the medication quickly from the ampule 2 Cleaning the patient's site of injection with an antiseptic cotton swab 3 Applying friction in a circular motion up to 5 cm (2 inch) while cleaning the site 4 Extracting the medication from a previously opened ampule first followed by the new ampule

4 Splitting tablets in half, even if they are prescored with a line down the middle, leads to medication errors. If a pill must be split within inpatient settings, the pharmacist splits the pill with a splitting device, repackages and labels it, and sends it to the nurse for administration. Nurses should not split pills. When using a blister pack, the nurse should pop medications through the foil or paper backing into a medication cup. To prepare tablets or capsules from a floor stock bottle, the nurse should pour the required amount into a bottle cap and transfer the medication to the medication cup without touching the medication with his or her fingers. To prepare unit-dose tablets or capsules, place the packaged tablet or capsule directly into the medicine cup without removing the wrapper.

The nurse prepares to administer a solid form of oral medications. Which action made by the nurse indicates a need for correction? 1 Placing the tablet into a cup without removing the wrapper while preparing unit dose tablets 2 Pouring the required tablet into a bottle cap 3 Popping medications through the file into the cup when using a blister pack 4 Splitting the tablet in half when it is necessary to give half of a pill

3 The order from the prescriber should indicate the route of administration, rather than hospital policy, type of mediation, or size of the patient.

The nurse receives an order to start giving a loop diuretic to a patient to help lower blood pressure. Which will help the nurse determine the appropriate route for administering the diuretic? 1 The patient's size and muscle mass 2 The type of medication ordered 3 The prescriber's orders 4 Hospital policy

3 Asthma is primarily an inflammatory disease; therefore a patient with asthma may require anti-inflammatory agents through inhalational route. Patients with chronic obstructive pulmonary disease (COPD) receive bronchodilators because they usually have problems with bronchoconstriction. A patient with emphysema may receive a bronchodilator because emphysema causes bronchoconstriction. A patient with pneumonia may not receive anti-inflammatory agents through the inhalational route because pneumonia is treated with antibiotics. A patient with bronchitis may not receive anti-inflammatory agents through the inhalational route because bronchitis causes bronchoconstriction.

The nurse reviews the clinical data of four patients. Which patient is suitable to receive anti-inflammatory agents through the inhalational route? 1 Patient D 2 Patient C 3 Patient B 4 Patient A

2 To provide more consistency in the absorption of insulin, the nurse should rotate the injection sites within the same body part. The slowing down of the injection rate reduces pain and bruising. The injection site should be pinched while inserting the needle for the ease of administration of the medication. The nurse should expel the air bubble in the syringe before administering the medication. If this does not occur, the dosage will not be accurate; this may not affect the absorption of medication.

The nurse uses a U-100 insulin syringe to inject insulin in the anterior and lateral parts of the thigh of the patient. Which nursing intervention would provide consistent absorption of the insulin? 1 Slowing the injection rate to 30 seconds 2 Rotating the injections within the same body part 3 Pinching the injection site while inserting the needle 4 Expelling the air bubble in the syringe before giving the medication

4 Many locally applied medications create systemic and local effects; therefore, these medications are applied with gloves and applicators. The nurse should wear disposable gloves while removing and applying transdermal patches for a patient, to prevent the absorption of medications by the skin. Infections may not occur due to the application of patch without the use of gloves. Using sterile techniques will help in preventing contamination of the patch. To prevent contact with the body fluids of the patient, wearing gloves may be appropriate.

The nurse wears disposable gloves while removing and applying transdermal patches for a patient. What is the most appropriate reason behind this nursing intervention? 1 To prevent contracting infection from the patient 2 To prevent contamination of the patch being applied 3 To prevent contact with the body fluids of the patient 4 To prevent medication from being absorbed into the nurse's skin

1 When there is a prn order, the nurse may use his or her own discretion for administering or withholding medication based on a subjective or objective assessment. Stat orders refer to single doses of medication to be given immediately or only once. Standing orders and routine medication orders are the same; in either case, the nurse continues the medication as directed by the prescriber until the prescriber asks the nurse to stop the medication.

The nurse works in a postoperative unit. Under which order should the nurse perform an assessment to determine whether the patient needs medication? 1 Prn order 2 Routine medication order 3 Standing order 4 Stat order

4, 5 The unit-dose system uses a cart with drawers with a 24-hour supply of medications for each patient. The drawers are labeled with the patient's name. Controlled substances are not kept in the patient's drawer; they are kept separately in locked drawers. The cart also has prn and stock medications. The carts have the ordered dose of medication for each patient for 24 hours, which may not be the full course.

The nursing instructor is talking to nursing students about the unit-dose system used in medication distribution. Which statements accurately describe the unit-dose system? Select all that apply. 1 It includes ordered doses of medication for a full course. 2 It does not contain prn and stock medication. 3 It has controlled substances kept in foil. 4 It has labeled drawers. 5 It uses carts for distribution.

1 The amount to be given is half the amount that is provided in the solution. Therefore, the answer is 1 mL. The nurse will calculate the answer using the proportion method. Because the ampule has 40 mg/2 mL, and the nurse has to administer only 20 mg, use the formula 40 mg/2 mL = 20 mg/x mL, 40x = 40, x = 1 mL.

The order is for 20 mg of a medication to a pediatric patient. The ampule of the medication has 40 mg/2 mL of the medication. What is the correct volume to be administered? Record your answer using a whole number. ______ mL

2 Morphine sulfate 2 mg IV q2h prn indicates a prn order. A prn order of prescription by the primary health care provider indicates that the medication should be administered whenever the patient requires it. A STAT order indicates that the medication should be given immediately. A now order indicates that the medication should be given within 90 minutes. A single order indicates that the medication should be given once at a specified time before the diagnostic examination.

The prescription order of a patient contains morphine sulfate 2 mg IV q2h prn for incisional pain. Which intervention made by the nurse would be appropriate for this patient? 1 Administering the medication before the diagnostic examination 2 Administering the medication only when the patient requires it 3 Administering the medication within 90 minutes 4 Administering the medication immediately

4, 5 It is always advisable to awaken a sleeping child before giving an injection. Parents or other nurses may help restrain unpredictable and uncooperative children. Infants and children have underdeveloped muscles, so intramuscular injections must be done with caution and in accordance with the agency's policies. It helps if the child is distracted with bubbles, toys, and other fun stimuli to reduce the pain perception. Application of lidocaine gel is safe and appropriate for reducing pain perception to a certain extent.

The primary health care provider instructs the nurse to administer a booster dose of tetanus toxoid to a 7-year-old patient. Which nursing actions are appropriate? Select all that apply. 1 Avoiding the application of topical lidocaine ointment before injecting the vaccine 2 Avoiding distracting the concentration of child while injecting the vaccine 3 Always look for a muscular site for injection 4 Having a parent help restrain the patient if he or she is unpredictable or uncooperative 5 Avoiding injections when the patient is asleep

1 For patients younger than 3 years of age, the nurse should straighten the ear canal by pulling the auricle down and back. For patients 3 years of age and older, the nurse should straighten the ear canal by pulling the auricle upward and outward. The nurse should help patients of every age to remain in the side-lying position for 2-3 minutes so that the medication completely enters the ear canal. For patients of every age, the nurse should apply gentle massage or pressure to the tragus of the ear with a finger after the administration of medication unless contraindicated because of pain. The nurse should instill prescribed drops by holding the dropper at 1 cm (1/2 inch) above the ear canal for patients of every age group.

The primary health care provider ordered the nurse to administer eardrops to a 2-year-old patient. Which action of the nurse would be effective specifically for this patient? 1 Straightening the ear canal by pulling the auricle down and back 2 Helping the patient remain in the side-lying position for 2-3 minutes 3 Applying gentle massage or pressure to the tragus of the ear with a finger 4 Instilling prescribed drops by holding the dropper at 1 cm (1/2 inch) above the ear canal

1 For patients younger than 3years of age, the nurse should straighten the ear canal by pulling the auricle down and back. For patients3years of age and older, the nurse should straighten the ear canal by pulling the auricle upward and outward. The nurse should help patients of every age to remain in the side-lying position for 2-3 minutes so that the medication completely enters the ear canal. For patients of every age, the nurse should apply gentle massage or pressure to the tragus of the ear with a finger after the administration of medication unless contraindicated because of pain. The nurse should instill prescribed drops by holding the dropper at 1 cm (1/2 inch) above the ear canal for patients of every age group.

The primary health care provider ordered the nurse to administer eardrops to a 2-year-old patient. Which action of the nurse would be effective specifically for this patient? 1 Straightening the ear canal by pulling the auricle down and back 2 Helping the patient remain in the side-lying position for 2-3 minutes 3 Applying gentle massage or pressure to the tragus of the ear with a finger 4 Instilling prescribed drops by holding the dropper at 1 cm (1/2 inch) above the ear canal

2, 4 During the administration of eardrops in a 5-year-old patient with a latex allergy, the nurse should use latex-free gloves for cleaning the outer ear. For patients 3 years of age and older, the nurse should straighten the ear canal by pulling the auricle upward and outward. For patients of every age the nurse should remove the cotton ball after 15 minutes, hold the dropper 1 cm (1/2 inch) above the ear canal before administering eardrops, and help the patient to remain in the side-lying position for 2 to 3 minutes.

The primary health care provider ordered the nurse to administer eardrops to a 5-year-old patient with an ear infection and a latex allergy. Which action of the nurse indicates a need for improvement? Select all that apply. 1 Removing the cotton ball after 15 minutes 2 Using latex gloves for cleaning the outer ear 3 Holding the dropper 1 cm (1/2 inch) above the ear canal 4 Straightening the ear canal by pulling the auricle down and backward 5 Asking the patient to remain in the side-lying position for 2 to 3 minutes

1, 2, 5

The primary health care provider ordered the nurse to administer nasal drops to a patient with a sinus infection. Which nursing interventions would be beneficial for the patient? Select all that apply. 1 Holding dropper 1 cm (½ inch) above the nares 2 Instructing the patient to breathe through the mouth 3 Instilling the drops towards the side of the ethmoid bone 4 Tilting the patient's head forward for access to posterior pharynx 5 Tilting the patient's head back over the edge of the bed for access to the ethmoid bone

2, 5 The nurse should ask the patient to spray the medication while inhaling so that more of the drug will reach the target site. The nurse should instruct the patient to hold the breath for a few seconds after removing the nozzle from the nose so that more of the drug reaches the target site. The nasal spray is not sprayed from 1 cm (1/2 inch) above the nares. The nozzle spray should be placed in appropriate nares, pointing the nozzle to the side and away from the center of the nose. The patient should be placed in the supine position with the head bending slightly forward. During the administration of eardrops, the nurse should ask the patient to turn toward the side to be treated. The nurse should help the patient into the supine position and bend his or her neck slightly forward during the administration of nasal spray. The nurse should help the patient into the supine position and tilt the head backward during the administration of nasal drops.

The primary health care provider ordered the nurse to administer nasal spray in a patient with bronchial tree inflammation. Which action of the nurse shows efficient skill? Select all that apply. 1 Holding the spray 1 cm (1/2 inch) above the nares 2 Asking the patient to spray medication while inhaling 3 Asking the patient to turn toward the side to be treated 4 Helping the patient into the supine position and tilting the head backward 5 Instructing the patient to hold the breath for a few seconds after taking the nozzle out of the nose

1 When the medication, to which the patient is allergic, is modified before reaching the patient, it is called a near miss. When such an error occurs in a health care setting, it should be reported to the hospital administration. Even though it did not harm the patient, it should be reported so as to prevent such errors in the future. Reporting it to the patient is not appropriate, because it may create a negative impression about the hospital. The nurse should not consider it a common error, because it could have harmed the patient. Writing it in the patient's medical record is not an appropriate intervention.

The primary health care provider prescribed sulfamethoxazole (Bactrim) to a patient with a urinary tract infection. The nurse finds that the patient is allergic to sulfa drugs and obtains an order for another medication. What is the nurse's responsibility in this situation to prevent such medication error in future? 1 Reporting it to the hospital administration 2 Writing it in the patient's medical record 3 Considering it as a common error 4 Reporting it to the patient

2, 4 The suppository form of medication involves the insertion of pellets of medications in body cavities such as the vagina and rectum. The oral route, topical route, and intravenous route of drug administration do not use the suppository form of medications.

The primary health care provider prescribes a suppository form of medication to a patient. What are the probable routes of administration advised for the patient? Select all that apply. 1 Intravenous route 2 Vaginal route 3 Topical route 4 Rectal route 5 Oral route

2 Difficulty in breathing is the adverse effect of decongestants; therefore, it is important to ask a patient immediately if he or she has difficulty breathing after the administration of decongestants. After 15 to 30 minutes of decongestant administration, the nurse should observe the patient for any signs of side effects. Before the administration of nasal sprays, the patient is positioned in the supine position and the head is tilted forward. Before administering the medication, the name of the medication on the label is compared with the medication administration record.

The primary health care provider prescribes decongestant spray to a patient with sinusitis. Which action should the nurse perform immediately after administering the decongestant? 1 Observing the patient for side effects 2 Asking if the patient is experiencing any difficulty in breathing 3 Positioning the patient's head tilted slightly forward in the supine position 4 Comparing the name of the medication on the label with the medication administration record

0.4 The amount of drug to be administered to the patient is calculated as: Dose ordered/Dose on hand × Amount on hand. Here, the dose ordered is 200 mg and the dose on hand is 500 mg. The amount on hand is 1 L. The calculation is: 200/500 x 1= 0.4 L. Therefore, 0.4 L, or 400 mL of 500 mg/L conc. of amoxicillin should be administered to the patient, to meet the requirement of the primary health care provider.

The primary health care provider prescribes intravenous administration of 200 mg of amoxicillin to a pediatric patient with acute gastritis. However, the pharmacy has intravenous drips of only 500 mg/L. How much volume of 500 mg/L dose should the nurse administer to the patient to ensure that the dosage suffices the primary health care provider's prescription? Record your answer to one decimal. ____ L.

4 The notation "prn" in the prescription indicates that the medication can be taken as and when required, maintaining a specific time interval between doses. The notation "qh" indicates that the medication should be taken every hour. The notation "ac" indicates that the medication should be taken before meals. "bid" indicates that the medication should be taken twice a day.

The primary health care provider prescribes pain medication to a patient with the notation "prn" in the prescription. What should the nurse interpret from the prescription? 1 The medication should be taken twice each day. 2 The medication should be taken before meals. 3 The medication should be taken every hour. 4 The medication should be taken as needed.

3 When administering nasal drops, the patient should be positioned in the supine position. When accessing the ethmoid, or sphenoid, sinus, a small pillow should be placed under the patient's shoulder, and the patient's head should be tilted back. When accessing the posterior pharynx, the patient's head should be tilted back. If the patient is turned on the affected side while in the supine position, the medication will not properly enter the affected area. When assessing the frontal and maxillary sinus, the patient's head should be tilted back over the edge of the bed or pillow, and the head should be turned toward the side to be treated.

The primary health care provider told the nurse to access the ethmoid, or sphenoid, sinus of a patient while administering nasal drops by placing the patient in the supine position. Which action of the nurse would be most effective for the patient? 1 Tilting the patient's head backward 2 Turning the patient on the affected side 3 Placing a small pillow under the patient's shoulder and tilting the head back 4 Tilting the patient's head back over the edge of the bed or pillow with the head turned toward the side to be treated

3, 4 Hydralazine is an emergency drug that should be administered as per the STAT order of prescription that is written in emergencies when a patient's condition changes suddenly. Lorazepam is an example of a drug that is administered following a one-time prescription order. A single order prescription necessitates the administration of medication at one specific time. A prn order prescription necessitates the administration of medication only when a patient requires it.

The registered nurse is teaching a nursing student about prescription orders. Which statement if made by the nursing student indicates the need for further teaching? 1 "A prn order is prescribed when the drug should be administered to the patient as and when required." 2 "A single order prescription necessitates the administration of medication at one specific time." 3 "Administration of lorazepam is an example of a prn order of prescription." 4 "Administration of hydralazine is an example of a now order prescription." 5 "Only emergency medications are prescribed in STAT prescription orders."

1 While administering eardrops, the ear canal should be straightened by pulling the auricle down and back in children younger than 3 years of age. The cotton ball should be placed in the outermost part of the ear canal, if needed after instilling the drops. The ear canal should be straightened by pulling the auricle upward and outward in children over 3 years of age and older adults. The prescribed eardrops should be instilled by holding a dropper 1 cm (½ inch) above the ear canal.

The registered nurse is teaching a nursing student how to administer eardrops to a 3-year-old patient with otitis media. Which action of the nursing student needs further correction? 1 Instilling the drops directly into the ear canal 2 Placing the cotton ball in the outermost part of the ear canal 3 Straightening the ear canal by pulling the auricle upward and outward 4 Instilling the drops holding the dropper 1 cm (½ inch) above the ear canal

1 Most pediatric medications are not rounded to the nearest thousandth decimal. They are rounded to the nearest tenth, to prevent drug overdose. Ototoxicity is the reported adverse effect of vancomycin. Therefore, it is challenging to administer this drug to infants who cannot talk. Unlike the adult drug regimen, most pediatric medications are ordered in milligrams per kilogram (mg/kg) of body weight. A child's age, weight, and maturity of body systems affect the ability to metabolize and excrete medications.

The registered nurse is teaching pediatric drug dosages to a nursing student. Which statement if made by the nursing student indicates a need for further teaching? 1 "After the dose calculation as per the age, most of the doses are rounded to the nearest thousandth." 2 "A child's age, weight, and maturity of body systems affect the drug dosage. " 3 "Most pediatric medications are ordered in milligrams per kilogram dosage." 4 "Drugs such as vancomycin should be administered to infants with caution."

3 Mixing the medication in the pediatric patient's favorite drink should be avoided, because the child may later refuse the same drink. A pediatric patient may accidentally aspirate a pill, which could be fatal. Therefore, liquids or elixirs are safer in children. Offering the child juice after he or she has swallowed the medication will help get rid of any bad taste in the child's mouth and incentivize the child to take the next dose if he or she is promised juice afterward. Droppers are indicated for the administration of tablet solution to infants.

The registered nurse is teaching the nursing student about the administration of oral analgesic medications in the pediatric patients. Which of the student's actions indicates the need for further teaching? 1 Using droppers to administer tablet solution to infants 2 Offering the child juice after he or she has swallowed the medication 3 Mixing the medication in the child's favorite drink 4 Administering an elixir or liquid rather than pills

2, 3, 4, 1 When performing vaginal administration of a suppository, the index finger of the dominant hand is lubricated with a water-soluble lubricant jelly. Then the vaginal orifice is exposed with the nondominant hand by retracting the labial folds. The rounded end of the suppository is then inserted along the posterior wall of the vagina to ensure uniform distribution of medication along the walls of the vaginal cavity. Last, wipe off the remaining lubricant around the orifice and labia.

The various steps involved in vaginal administration of a suppository are listed. Arrange the steps in the correct sequence. 1. Wipe away remaining lubricant around orifice. 2. Lubricate index finger of dominant hand. 3. Expose vaginal orifice with nondominant hand. 4. Insert suppository along posterior wall of vagina.

3, 4, 5 The advantages of the oral route of medication administration are that the medications are easy to administer, this method rarely causes anxiety, and this method is convenient and comfortable. The disadvantages of the oral route are that it cannot be used when a patient has gastric suction or reduced gastric mobility.

What are the advantages of administering medications by the oral route? Select all that apply. 1 The oral route is effective when a patient has reduced gastric mobility. 2 The oral route can be used when a patient has gastric suction. 3 The oral route is convenient and comfortable. 4 The oral route rarely causes anxiety. 5 The oral route is easy to administer.

1, 2, 3, 6 Intravenous therapy is used to transfuse blood products, provide parenteral nutrition to patients who are unable to take medications orally, supply electrolytes and nutrients to maintain proper electrolyte balance, and provide treatment to unconscious patients who are unable to take medications orally. Intravenous therapy is the most costly route of administration and is used for a limited time only.

What are the purposes of intravenous therapy? Select all that apply. 1 Transfusing blood products 2 Providing parenteral nutrition 3 Supplying electrolytes and nutrients 4 Providing treatment with low cost 5 Providing medication in a long-term therapy 6 Providing medications to unconscious patients

4 The parenteral route of administration involves injecting the medication into the body tissues; this route places patients at a high risk of reactions. The oral route of medication administration may cause discoloration of the teeth. The parenteral route can be safely given to both unconscious and conscious patients, depending upon their medical condition. Before some tests or surgery, the oral route of medication administration is contraindicated.

What is a disadvantage of the parenteral route of medication administration? 1 The parenteral route causes discoloration of the teeth. 2 The parenteral route can only be given to unconscious patients. 3 The parenteral route is contraindicated before some tests or surgery. 4 The parenteral route may place the patient at a higher risk of reactions.

4 The intravenous route is the best route for establishing constant therapeutic blood levels. Because the intravenous route is limited to injecting highly soluble medications, it cannot be used to inject partially soluble medications. Only patients who have suitable veins can be administered drugs through the intravenous route so this is not an advantage of the IV route. It is not the suitable route of administration for all patients. The intravenous route poses the risk of a medication overdose if the drug is injected too rapidly. Therefore, this is one of its disadvantages.

What is the advantage of the intravenous route of drug administration? 1 The intravenous route is used to inject highly soluble medications. 2 The intravenous route is used for the rapid injection of medications. 3 The intravenous route is administered to patients with suitable veins. 4 The intravenous route is the best route to establish constant therapeutic blood levels.

3 After administering the medication, the nurse should observe the patient closely for symptoms of adverse reactions because intravenous medications begin to act immediately after entering the bloodstream. The nurse should check the patency of the intravenous line prior to medication administration. The nurse should know the desired action and side effects of the medication before administering it. If the medication has an antidote, the nurse should make sure that it is available during administration, instead of checking after the mediation has been administered.

What is the most appropriate nursing intervention after administering an intravenous medication to a patient? 1 Checking the patency of the intravenous line 2 Knowing the desired action and side effects of the medication 3 Assessing the patient closely for symptoms of adverse reactions 4 Checking whether there is any antidote for the administered medication

2 The deltoid muscle site is easily accessible and is used to administer small volumes of a medication. It is mainly used for giving immunizations such as hepatitis B and flu shots. Heparin is most likely to be administered via the subcutaneous route of administration. Medications that are more than 2 mL would be administered through the ventrogluteal muscle site. The ventrogluteal site is also preferred for medications that are viscous and irritating.

What is the significance of the deltoid muscle site in parenteral administration? 1 The deltoid muscle site is used to administer heparin 2 The deltoid muscle site is used to administer hepatitis B vaccine 3 The deltoid muscle site is used to administer medications that have larger volumes 4 The deltoid muscle site is used to administer medications that are viscous and irritating

1 The nurse should draw up the medication quickly, not slowly, to prevent contamination. The nurse should cover the tip of the syringe with a cap or needle to prevent contamination. The syringe needle also should not touch the outer edges of the ampule. The nurse should not touch the plunger length or inner part of the barrel.

Which action may cause the contamination of the solution during an injection? 1 Drawing up the medication slowly 2 Keeping the tip of the syringe covered with a cap or needle 3 Avoiding the needle touching the outer edges of ampule 4 Not touching the plunger length or inner part of the barrel with the hands

1 Topical medications can be applied by instillation of fluids into a body cavity such as administering an eardrop. Topical medications are also applied by inserting medication into a body cavity such as placing a suppository in the rectum. Topical medications can be applied by irrigating a body cavity such as flushing the vagina with medicated fluid. Inserting medicated packing into the vagina is an example of inserting medication into a body cavity.

Which action of the nurse indicates instillation of fluids into a body cavity? 1 Administering an eardrop 2 Placing a suppository in the rectum 3 Flushing the vagina with medicated fluid 4 Inserting medicated packing into the vagina

1 An idiosyncratic reaction is an unpredictable effect that involves over-reaction or under-reaction to a medication. A side effect is a predictable and unavoidable adverse effect that is produced at a usual therapeutic dose. A toxic effect is an effect that occurs after prolonged intake of medications. An allergic reaction is an unpredictable response of medications that occurs with repeated administration.

Which adverse effect involves overreaction or under-reaction to a medication effect? 1 Idiosyncratic reaction 2 Allergic reaction 3 Toxic effect 4 Side effect

4 Propofol, used for anesthesia and sedation, includes egg lecithin and soybean oil as inactive ingredients. Therefore, patients who have an egg or soy allergy should not receive propofol. Lorazepam is an anti-anxiety drug administered to patients with anxiety. Hydralazine is a muscle relaxant, indicated in emergency conditions. Vancomycin is an antibiotic medication.

Which anesthetic drug is contraindicated in patients with allergy to soy products? 1 Vancomycin 2 Hydralazine 3 Lorazepam 4 Propofol

2, 4 When administering nasal drops, the ethmoid and sphenoid sinuses are accessed by tilting the head of the patient back over the edge of the bed. The frontal and maxillary sinuses are accessed by tilting the head of the patient back over the edge of the bed and turning the patient toward the side to be treated. The posterior pharynx is accessed by tilting the patient's head backward.

Which body cavities are accessed while administering nasal drops by tilting the head of the patient back over the edge of the bed? Select all that apply. 1 Frontal sinus 2 Ethmoid sinus 3 Maxillary sinus 4 Sphenoid sinus 5 Posterior pharynx

2 The use of opioid drugs is carefully controlled through federal and state guidelines. Violation of these guidelines is punishable under the controlled substance law. Antiemetics, antihistamines, and nonsteroidal anti-inflammatory drugs are not controlled substances.

Which class of drugs, if administered to the patient without a prescription, is punishable under the Controlled Substance law? 1 Nonsteroidal anti-inflammatory drugs 2 Opioid analgesics 3 Antihistamines 4 Antiemetics

2 Tuberculin may be potent and a patient may have a severe anaphylactic reaction when tuberculin enters the circulation too rapidly. Therefore, tuberculin is administered through the intradermal route. An intrathecal injection is given to the spinal canal and is very painful. An intravenous injection may cause the patient to experience anaphylactic reactions. A subcutaneous injection may lead to unwanted reactions.

Which injection is given to a patient attending a tuberculin screening test? 1 Intrathecal 2 Intradermal 3 Intravenous 4 Subcutaneous

1, 2, 5 Many locally applied medications such as lotions, pastes, and ointments create systemic and local effects. Therefore, these medications should be applied with gloves and applicators. Different types of topical medication should be applied according to the directions to ensure proper penetration and absorption. Documenting the location on the patient's body where the medication was placed will help to prevent multiple dosing in the patient. The medications should be applied using sterile techniques in the case of open wounds. Before applying medications to the injured area, the skin should be thoroughly cleaned by washing the area gently with soap and water, and ensuring the soaking of the involved site.

Which interventions should the nurse follow while administering topical medications? Select all that apply. 1 Applying the topical medications with gloves and applicators 2 Applying each type of medication according to the directions of use 3 Using nonsterile techniques while applying medications for open wounds 4 Cleaning the skin thoroughly by washing the injured area gently with hot water 5 Documenting the location on the patient's body where the medication was placed

2, 4

Which is an example of the direct application of topical medications? Select all that apply. 1 Eardrops 2 Eyedrops 3 Nose drops 4 Swabbing the throat 5 Inserting medicated packing into the vagina

1, 2 Powder and solution are medication forms that are commonly prepared for administration by parenteral routes. Elixir is a clear fluid containing water and or alcohol that is given orally. Troche is a lozenge that is given orally. Extract is a concentrated form of medication that is made by removing the active part of medication from its other components. It is given orally.

Which medication forms are commonly prepared for administration by parenteral routes? Select all that apply. 1 Solution 2 Powder 3 Extract 4 Troche 5 Elixir

4 Every route of administration has different rates of absorption. The physical makeup of the skin makes the absorption slow for medications placed on the skin. Medications placed under the tongue have quick absorption. Respiratory airways and mucous membranes have many blood vessels. Therefore, medications placed in the oral mucosa, on the respiratory airways, and on the mucous membranes are absorbed most quickly after administration.

Which medication route is absorbed slowly after administration? 1 Medications placed on the respiratory airways 2 Medications placed in the oral mucosa 3 Medications placed under the tongue 4 Medications placed on the skin

4 Administrating medications in liquid form rather than pill form will help to avoid aspiration in children. Using a straw for medication administration will help in ease of administration. Offering juice after medication administration and avoid mixing a large amount of medication into foods will not help prevent aspiration.

Which nursing intervention avoids aspiration in children? 1 Avoid mixing a large amount of medication into foods 2 Offering juice after medication administration 3 Using a straw for medication administration 4 Using liquid medication form

3 The nurse should use the needleless port of the main intravenous line after cleaning with an antiseptic swab to prevent accidental needlestick injuries. The nurse should adjust the regulator clamp infusion rate to maintain therapeutic blood levels. The nurse regulates the main infusion line to the desired rate to prevent interference with the mainline infusion rate. The nurse should hang the piggyback medication bag above the level of the primary fluid bag to prevent negative flow rate effects.

Which nursing intervention is done to prevent accidental needlestick injuries? 1 Adjusting the regulator clamp infusion rate 2 Regulating the main infusion line to the desired rate 3 Using the needleless port of the main intravenous line after cleaning with an antiseptic swab 4 Hanging the piggyback medication bag above the level of the primary fluid bag

3 The nurse should avoid recapping used needles and should dispose in puncture-proof and leak-proof containers to prevent accidental needlestick injuries. The nurse should not break or bend needles before disposal. The nurse should not clean used needles with an antiseptic swab because they are not used again and should be disposed.

Which nursing intervention is done to prevent needlestick injuries after intravenous administration? 1 Bend the needle before disposal 2 Break the needle before disposal 3 Avoid recapping the used needles 4 Clean the needle with an antiseptic swab before disposal

4 The nurse should remove the old patch before administering a new transdermal patch to avoid an overdose; this is because the medicine remains in the patch even after its prescribed duration of use. Placing the new patch over the old patch could cause an overdose which may result in potential adverse effects. A noticeable label is not applied to the old patch. If the new patch is difficult to see, then a noticeable label should be applied to the new patch. Applying the new patch next to the old patch could cause an overdose.

Which nursing intervention would be beneficial and safe for a patient who has an existing transdermal patch? 1 Placing the new patch over the old patch 2 Applying a noticeable label to the old patch 3 Applying the new patch adjacent to the old patch 4 Removing the existing patch before applying the new patch

4 An elixir is a clear fluid containing water; this medication is available in liquid form and administered orally. Tablets, capsules, and lozenges are available in solid form.

Which oral medication is available in liquid form? 1 Lozenge 2 Capsule 3 Tablet 4 Elixir

1, 2, 3, 4, 5 The first step while administering a vaginal suppository in a patient is removing the suppository from the foil wrapper. The next step is applying a liberal amount of water-based lubricating jelly to the rounded end of the suppository. This is followed by exposing the vaginal orifice with the nondominant gloved hand. Next the rounded end of the suppository is gently inserted with the dominant gloved hand. The final step is withdrawing the finger and wiping away the remaining lubricant from around orifice and labia.

Which order should a nurse follow while administering vaginal suppository in a patient? 1. Remove suppository from foil wrapper 2. Apply a liberal amount of water-based lubricating jelly to the rounded end 3. Expose vaginal orifice with the nondominant gloved hand 4. With the dominant gloved hand gently insert the rounded end of the suppository 5. Wipe away remaining lubricant from around orifice and labia

1 A spacer is a 10- to 20-cm (4- to 8-inch) long tube that attaches to the pressurized metered-dose inhaler and allows the medication particles to slow down and separate into smaller pieces. This action improves drug absorption in a patient's airway. A canister is a container that consists of the drug and the propellant. Propellant is used to for effective dispersion of the drug in the canister. Spacers have face masks for children less than 4 years of age. They are especially helpful when a patient has difficulty coordinating the steps involved in self-administering inhaled medications.

Which part of a pressurized metered-dose inhaler is used to improve drug absorption in a patient's airway? 1 Spacer 2 Face mask 3 Propellant 4 Canister

1 In Sims' position, the patient lies on the left side with the left thigh slightly flexed. The right thigh is acutely flexed on the abdomen; the left arm is behind the body with the body inclined forward. The right arm is positioned according to the patient's comfort. This is also called lateral position. This positioning is helpful while administering rectal suppositories in a patient. Sitting position is best while administering intravenous injections. The supine position will be helpful while instilling nasal drops. The dorsal recumbent position will be helpful while administering vaginal suppositories in the patient.

Which positioning of the patient would be appropriate while administering rectal suppositories? 1 Sims' position 2 Sitting position 3 Supine position 4 Dorsal recumbent position

4 In dorsal recumbent position, the patient lies on the back, with lower limbs flexed and rotated outward. This position is used in the vaginal examination, application of obstetrical forceps, and other procedures. Therefore, this position will be helpful while administering vaginal suppositories in the patient. This is also called lateral position. Sims' positioning is helpful while administering rectal suppositories in a patient. Sitting position will be required while administering intravenous injections. The supine position will be helpful while instilling nasal drops.

Which positioning of the patient would be appropriate while administering vaginal suppositories? 1 Sims' position 2 Sitting position 3 Supine position 4 Dorsal recumbent position

3, 4 In order to inject medication in the ventrogluteal muscle site, the patient is placed into the supine or the lateral position. The prone position is unsuitable for intramuscular injections at the ventrogluteal muscle site. The sitting position is appropriate for vastus lateralis intramuscular injections. The standing position is suitable for intramuscular injections at the deltoid muscle site.

Which positions are most suitable for administering intramuscular medications in the ventrogluteal muscle site? Select all that apply. 1 Prone 2 Sitting 3 Supine 4 Lateral 5 Standing

4 The image illustrates the ventrogluteal site, which is the most preferred and safest site for intramuscular injections. Intramuscular injections are usually given at an angle of 90 degrees. Intradermal administration includes injection of the medication directly into the dermis, just under the epidermis at an angle of 15 degrees. Intraarterial medications are administered directly into the arteries through infusions. Intraosseous administration involves the infusion of medication directly into bone marrow.

Which route of administration is illustrated in the image? 1 Intradermal 2 Intraarterial 3 Intraosseous 4 Intramuscular

3 The image illustrates an intramuscular injection at the deltoid site at an angle of 90 degrees. An intradermal injection is given to the epidermal layer of the skin at a 15 degree angle. An intravenous injection is given to a large vein present in the limbs. A subcutaneous injection is given to the dermis at a 45 or 90 degree angle.

Which route of administration is illustrated in the image? 1 Intradermal route 2 Intravenous route 3 Intramuscular route 4 Subcutaneous route

2 The inhalational route of administration uses aerosol sprays, mists, or powders that penetrate lung airways. The oral route of administration generally uses medication in the form of solids and liquids. The buccal route of administration also uses medications in the form of solids and liquids. The transdermal route generally uses medication in the form of transdermal patches.

Which route of administration mainly uses medication in the form of aerosol sprays? 1 Transdermal 2 Inhalational 3 Buccal 4 Oral

4 The easiest and most desirable route for administering medications is oral. Rectal and vaginal routes may cause discomfort. The intravenous route of medication administration may be painful to the patient.

Which route of medication administration is easiest and most desirable? 1 Intravenous 2 Vaginal 3 Rectal 4 Oral

4 The intravenous (IV) administration of medication produces the most rapid absorption because it directly facilitates the entry of the medication into the systemic circulation. Oral medications have to pass through the gastrointestinal (GI) tract; therefore, the overall rate of absorption is usually slow. Topical medications may be absorbed slowly due to the physical makeup of the skin. Intradermal administrations provide sustained release delaying the absorption.

Which route provides the most rapid absorption of a medication? 1 Oral administration 2 Topical administration 3 Intradermal administration 4 Intravenous administration

1, 2, 4 Timing medications with meals reduces the risk of aspiration, because the medications are consumed with food. If the risk of aspiration increases, the nurse may choose different routes of drug administration. The nurse should encourage the patient to take medications on his or her own if possible. Medications should be administered one after the other, not all at once. The use of straws should be discouraged, because straws affect patient control of volume intake and increase the risk of aspiration.

Which safety measures should the nurse implement to prevent aspiration when administering oral medications? Select all that apply. 1 Recommend self-administration if possible. 2 Choose a different route if the risk of aspiration increases. 3 Encourage the use of straws whenever possible. 4 Time the medications with meals. 5 Administer all medications at the same time.

4 The image depicts the vastus lateralis muscle, located on the anterior lateral aspect of the thigh, which is suitable for intramuscular injections. The deltoid site is an easily accessible site that lies within the upper arm under the triceps and along the humerus. The ventrogluteal muscle involves the gluteus medius site. The dorsal gluteal site is an alternative subcutaneous injection site.

Which site is depicted in the image? 1 Deltoid site 2 Ventrogluteal site 3 Dorsal gluteal site 4 Vastus lateralis site

2 Heparin is administered subcutaneously at the abdominal site. This site has the best absorption. The thigh, upper arm, and dorsal gluteal areas are other sites for subcutaneous injection that are not widely recommended to administer heparin

Which site is frequently recommended for administering heparin injections? 1 Thigh 2 Abdomen 3 Upper arm 4 Dorsal gluteal area

2 The nurse should inform the patient about the nature of a drug being administered if it is an experimental drug or a standard drug. Labeled medications should be administered to patients. Any patient of consenting age has the right to refuse medicine; the nurse should not forcefully administer medication to the patient in such situations. Transparency should be maintained regarding the medication administration.

Which statement about a patient's rights of medication is incorrect? 1 The nurse should maintain transparency of the standard drugs being administered to the patient. 2 The nurse should maintain confidentiality of the experimental drugs administered to the patient. 3 The nurse cannot forcefully administer any medication to a patient of consenting age. 4 The nurse should always administer labeled medications to the patient.

1 First exposure to an allergen will sensitize the immune system. When the patient is exposed to the same allergens for the second time, an anaphylactic reaction may occur. Pharyngeal edema, constriction of bronchiolar muscles, and severe wheezing are the signs of an anaphylactic reaction. It is a life-threatening condition and is a type of allergic reaction.

Which statement about anaphylactic reaction requires correction? 1 Occurs when a patient is exposed to the allergens for the first time. 2 Anaphylactic reactions are a type of allergic reactions. 3 Anaphylactic reactions may be life threatening. 4 Anaphylactic reactions may cause pharyngeal edema.

2 Some dry powder inhalers are unit dosed. These inhalers require patients to load a single dose of medication into the inhaler with each use. Other dry powder inhalers hold enough medication for 1 month. The medication inside a dry powder inhaler can clump if the patient is in a humid climate, because dry powders generally clump when exposed to humidity. Some patients cannot inspire fast enough to administer the entire dose of the medication. Dry powder inhalers require less manual dexterity. Because the device is activated with the patient's breath, there is no need to coordinate puffs with inhalation.

Which statement about dry powder inhalers indicates a need for correction? 1 A dry powder inhaler is activated with the patient's breath so there is no need to coordinate puffs with inhalation. 2 All dry powder inhalers require patients to load a single dose of medication into the inhaler with each use. 3 Few patients cannot inspire fast enough to administer the entire dose of the medication. 4 The medication inside a dry powder inhaler can clump if exposed to humid climate.

1 The Food and Drug Administration enforces medication laws that ensure all medications on market undergo vigorous testing before they are sold. The Pure Food and Drug Act is the first American law to regulate medications. The Food and Drug Administration is the current monitoring body for maintaining the standards of medications. MedWatch is a voluntary program that enables health care personnel to report any adverse events of medicines.

Which statement about medical legislation and standards requires correction? 1 MedWatch ensures all medications on market undergo vigorous testing before they are sold. 2 MedWatch enables healthcare personnel to report any adverse events of medicines. 3 The current monitoring body for maintaining the standards of medications is the Food and Drug Administration. 4 The first American law to regulate medications was the Pure Food and Drug Act.

1 Chemotherapeutic agents are the most common medications administered through intrapleural injection. Subcutaneous injection deposits the medication just below the dermis of the skin. The intraosseous method of medication administration involves the infusion of medication directly into the bone marrow. It is used most commonly in infants and toddlers who have poor access to their intravascular space. Patients taking medication through the sublingual route are instructed not to swallow or drink water until the tablet dissolves.

Which statement about various routes of drug administration requires correction? 1 Intradermal injection deposits the medication just below the dermis of the skin. 2 Patients taking medication through sublingual route are instructed not to drink water until the tablet dissolves. 3 Intraosseous administration of drugs is most commonly used in infants and toddlers. 4 Chemotherapeutic agents are administered through the intrapleural route.

2 A syringe pump is a volume-controlled infusion set that is used to administer medications through intravenous therapy. It is used to administer medications in very small amounts of fluids. A piggyback set is a microdrip or macrodrip system. Buretrol sets are small containers that attach just below the primary infusion bag or bottle. Syringe pumps are used to administer 5 to 60 mL of medications in controlled infusion times.

Which statement is true regarding a syringe pump? 1 A syringe pump is a microdrip or macrodrip system. 2 A syringe pump is used to administer medications in very small amounts of fluids. 3 A syringe pump is a very small container that is attached just below the primary infusion bag. 4 A syringe pump is used to administer 30 to 50 mL of medications in controlled infusion times.

3 Inhalers that contain rescue medications are used to provide immediate relief for acute respiratory distress. Rescue medications are short-acting. Maintenance medications last for a long period of time and are used on a daily schedule.

Which statement is true regarding an inhaler containing rescue medication? 1 Rescue medication is used on a daily schedule. 2 The effects of rescue medication last for a longer period. 3 Rescue medication provides immediate relief. 4 Rescue medication is long acting.

4 Parenteral medications are sterile preparations that contain water with one or more dissolved compounds. Transdermal medications are medicated disks that are slowly absorbed through the skin. Concentrated sugar solutions are medications dissolved in sugar solutions are referred to as syrup. Lotions are semi-liquid suspensions that usually protect, cool, or cleanse skin.

Which statement is true regarding parenteral medications? 1 Parenteral medications are medicated disks absorbed slowly through the skin. 2 Parenteral medications are dissolved in a sugar solution. 3 Parenteral medications are semi-liquid suspensions that usually protect, cool, or cleanse the skin. 4 Parenteral medications are sterile preparations that contain water with one or more dissolved compounds.

3 The apothecary system of measurement is used infrequently today. Household measurement is most familiar to people. Household measurement does not allow the use of teaspoons and cups. The metric system of measurement is not officially adopted by the U.S. Congress but is used by most health professionals in the United States.

Which statement is true regarding systems of medication measurement? 1 The metric system of measurement is officially adopted by the U.S. Congress. 2 Household measurements allow the use of teaspoons and cups. 3 The apothecary system is used infrequently today. 4 The metric system is most familiar to people.

3 Volume-controlled infusion administers medications through small amounts such as 100mL. Volume-controlled infusions reduce the risk of rapid-dose infusion by IV push. Medications are diluted and infused over longer time intervals such as 30 to 60 minutes. Volume-controlled infusions allow for administration of medications that are stable for a limited time in solution.

Which statement is true regarding volume-controlled infusions? 1 They increase the risk of rapid-dose infusion by IV push. 2 The medications are diluted and infused at a time interval of 20 minutes. 3 The medications are administered through small amounts such as 100 mL. 4 They allow for administration of medications that are unstable for a limited time in solution.

4 Positioning a patient in a seated position at a 90-degree angle when administering oral medications reduces the risk of aspiration, but this is not the case during enteral feeding. Special consideration is needed while administering medication to patients with enteral feeding tubes to help avoid increased risk of medication toxicity. Failing to follow recommendations may lead to reduced medication effectiveness and tube obstruction.

Which statement related to enteral feeding needs correction? 1 Following the recommendations during medication administration may help avoid tube obstruction. 2 Reduced medication effectiveness is due to a failure of precautionary measures while administering. 3 Special consideration while administering medication helps to avoid the risk of medication toxicity. 4 Positioning a patient at a 90-degree angle while administering enteral feeding reduces the risk of aspiration.

2, 3 Medications are absorbed slowly through the skin due to the makeup of the skin. The oral route of administration is contraindicated in patients with gastrointestinal disorders. The administration of medications through the parenteral route often causes anxiety in patients, especially in children. The intramuscular and intravenous routes have higher absorption rates. The oral route is contraindicated in patients with reduced gastrointestinal motility.

Which statements are true regarding routes of medication administration? Select all that apply. 1 Oral route is used in patients with reduced gastrointestinal motility. 2 Oral route is avoided in patients with gastrointestinal disorders. 3 Medications are absorbed slowly through the skin. 4 Inhalational routes have higher absorption rates. 5 Parenteral route causes anxiety in patients.

1, 3, 4 Vaginal medications are often given to treat infection and when discharge smells foul. Vaginal suppositories are sometimes stored in the refrigerator to prevent them from melting. Solid, oval-shaped suppositories are packaged individually in foil wrappers. Foam, jellies, and creams are administered with an applicator inserter; suppositories are applied with gloved hands. After a suppository is inserted into the vaginal cavity, body temperature causes it to melt and be distributed and absorbed. Therefore, a suppository should not be kept in room temperature before administration.

Which statements are true regarding vaginal suppositories? Select all that apply. 1 They are prescribed for treating infection. 2 They are administered with an applicator inserter. 3 They are stored in the refrigerator to prevent them from melting. 4 Solid, oval-shaped suppositories are packaged individually in foil wrappers. 5 They should be kept at room temperature for some time before administration.

1, 3, 5 Nursing students cannot take medication orders of any kind, and so their initials do not have to appear on the order because they won't have taken it. The primary health care provider must countersign the telephone order given by that provider at a later time, usually within 24 hours after giving it. This type of prescription order given by the primary health care provider is referred to as a telephone order. The nurse should sign on the telephone order and indicate the time and the name of the health care provider who gave the order. The nurse should document the telephone order given by the primary health care provider.

Which statements regarding the guidelines to be followed for telephone and verbal order require correction? Select all that apply. 1 It is not mandatory for the primary health care provider to sign on the telephone prescription order, because the nurse signs it. 2 The nurse should document the telephone order given by the primary health care provider. 3 The telephone order should contain the initials of the nurse who received the order. 4 The type of prescription order involved in this condition is the telephone order. 5 Nursing students can take telephone orders.

3 A liniment is a semisolid preparation containing alcohol, oil, or soapy emollient that is applied to the skin. Capsules are taken through the oral route. However, a capsule is a medication encased in a gelatin shell. A clear fluid containing water and/or alcohol is an elixir. However, the route of administration of elixirs is oral, not parenteral. A suppository is a solid dosage mixed with gelatin and shaped in the form of a pellet for insertion into a body cavity (rectum or vagina). It is not dissolved in a sterile fluid.

Which student nurse's assessment sheet is accurate regarding various forms of medication? 1 Student nurse 4 2 Student nurse 3 3 Student nurse 2 4 Student nurse 1

1, 3 Children are in a special age group and require special consideration during medication administration, such as using straws for children will help them to swallow medication. The nurse should mix a small amount of medication with other foods or liquids, because children might refuse to take a larger mixture. The nurse should avoid mixing medications with the child's favorite foods, because the child may refuse those foods later. Juice should be offered only if it is allowed. A plastic, disposable syringe should be used while preparing liquid doses.

Which tips are appropriate for the safe administration of medications in children? Select all that apply. 1 Mixing a small amount of medication with other foods or liquids 2 Using a glass disposable syringe to prepare liquid doses 3 Using straws to help the child swallow the medication 4 Offering juice after the child swallows the medication 5 Mixing medications with the child's favorite foods

4 Transdermal patches may show systemic side effects. Paste, lotion, and liniment may not show systemic side effects; these show local effects.

Which topical dosage form may show systemic side effects? 1 Paste 2 Lotion 3 Liniment 4 Transdermal patch

2 Liniment usually contains alcohol and is applied to the skin. Lotion is a semi-liquid suspension that usually protects, cools, or cleanses the skin. Ointment is a semisolid, externally applied preparation that usually contains one or more medications. Transdermal disks, or patches, are medications that are absorbed through the skin slowly over a long period. Lotions, ointments, and transdermal disks may not contain alcohol.

Which topical medication contains alcohol? 1 Lotion 2 Liniment 3 Ointment 4 Transdermal disk

3 Liniment usually contains soapy emollient. Paste is a form of thick ointment which may not contain soapy emollient. Lotion is a semi-liquid suspension which may not contain soapy emollient. Ointment is semi-solid which may not contain soapy emollient.

Which topical medication contains soapy emollient? 1 Paste 2 Lotion 3 Liniment 4 Ointment

4 The overuse of transdermal patches such as a fentanyl transdermal patch may lead to respiratory depression, coma, or even death. Lotion, liniment, and ointment do not cause serious adverse effects such as respiratory depression.

Which topical medication may lead to respiratory depression in the case of an overdose? 1 Lotion 2 Liniment 3 Ointment 4 Transdermal patch

4 The preparation of ointment may involve more than one medication. Paste is a thick ointment that is absorbed through the skin more slowly than ointment. Lotion is a semi-liquid suspension that usually protects, cools, or cleanses the skin. Liniment usually contains alcohol, oil, or soapy emollient applied to the skin.

Which topical medication preparation may involve more than one medication? 1 Paste 2 Lotion 3 Liniment 4 Ointment

4 Intraosseous administration involves the infusion of medication directly into the bone marrow. It is most commonly used for infants and toddlers in emergency cases when no other sites are available. The intrathecal route involves surgically placing the medications through a catheter in the subarachnoid space. The intrapleural route uses either a syringe and needle or a chest tube to administer the intrapleural medications directly into the pleural space. It is most commonly used for the administration of chemotherapeutic agents. Intraarterial route involves the direct administration of medications into the arteries; this site is most commonly used for patients with arterial clots

Which type of parenteral administration is used in emergency cases for infants and toddlers when no other sites are available? 1 Intrathecal 2 Intrapleural 3 Intraarterial 4 Intraosseous

4 A tuberculin syringe is a small diameter syringe that is useful for preparing small, precise doses of medication for subcutaneous injection in infants and newborns. An insulin syringe is used only for injecting a very small dose of insulin. Both 5-mL and 3-mL syringes are used for large volumes of parental medication administration.

Which type of syringe is used to administer a small and precise amount of medication subcutaneously in infants and newborns? 1 5-mL syringe 2 3-mL syringe 3 Insulin syringe 4 Tuberculin syringe

1 The piggyback tubing is a macrodrip system. A syringe pump is battery-operated and allows the medication to be given in very small amounts of fluid. Intermittent venous access is commonly known as a saline lock. Volume-control administration sets are small containers that attach just below the primary infusion bags or bottles.

Which type of volume-controlled infusions sets involves a macrodrip system? 1 Piggyback 2 Syringe pump 3 Intermittent venous access 4 Volume-controlled administration set

3 While administering a rectal suppository, asking a patient to take slow, deep breaths through the mouth will help in relaxing the anal sphincter. The third accuracy check is performed to confirm or ensure that the desired patient is being treated. Applying gentle pressure on buttocks and holding them together will be helpful in keeping the medication in place. Instructing the patient to remain in the side position for 5 minutes will help in preventing expulsion of the suppository.

While administering a rectal suppository in a patient, the nurse finds that anal sphincter is not relaxed. Which intervention of the nurse would help the patient relax the anal sphincter? 1 Performing the third accuracy check again 2 Applying gentle pressure on buttocks and holding them together 3 Instructing the patient to take slow, deep breaths through the mouth 4 Instructing the patient to remain in the side position for 5 minutes after administration

3 The nurse should occlude the intravenous line by pinching the tubing just above the injection port and pull back gently on the syringe plunger to aspirate blood return. This helps to check whether the medication is being delivered into the bloodstream. Inserting a needleless tip or small-gauge needle of a syringe containing a prepared drug through the center of the injection port helps to prevent damage to the port's diaphragm and subsequent leakage. Allowing intravenous fluids to infuse while pushing the intravenous drug enables the medications to be delivered to the patient at the prescribed rate. Cleaning the injection port with an antiseptic swab and allowing it to dry helps prevent the introduction of microorganisms during needle insertion.

While administering an intravenous push, the nurse occludes the intravenous line by pinching the tubing just above the injection port. What is the reason for this nursing action? 1 To prevent damage to the port's diaphragm 2 To enable medications to be delivered at the prescribed rate 3 To check that the medication is being delivered into the bloodstream 4 To prevent the introduction of microorganisms during needle insertion

1 When an older patient has a difficult time swallowing a medication and a physical problem has been ruled out, the nurse should report the situation to the primary health provider in order to have him or her change the medication form. The nurse should be patient and should not insist the patient to take the tablet by explaining its benefits. Holding onto the tablet until the patient is ready to swallow the tablet is not an appropriate intervention, because the medication may be required immediately. If a physical problem has not been ruled out, the patient should be taught to keep the tablet on the front of the tongue, and he or she may be able to swallow by washing it back off the throat.

While administering medication to an older patient, the nurse finds that the patient has difficulty in swallowing a tablet; however, after assessment, a physical problem is ruled out. Which nursing intervention is appropriate in this condition? 1 Reporting the situation to the primary health care provider and changing the medication form 2 Instructing the patient to keep the tablet on the front of the tongue and swallow 3 Holding onto the tablet until the patient is ready to swallow the tablet 4 Encouraging the patient to take the tablet by explaining its benefits

4 Before applying a new patch, the existing one should be removed. When old transdermal patches are left in place it may result an overdose of the medication in the patient. This may lead to toxic reaction. Applying half of the new patch is not appropriate because this may also lead to an increased amount of the drug in the body. Applying the new patch on top of the existing patch may cause an overdose of medication. Applying the new patch adjacent to the existing patch is not appropriate, because the patch should be applied only on the desired affected area.

While applying a transdermal patch to a patient with pain, the nurse finds an existing patch on the skin. Which action of the nurse would be appropriate in this situation? 1 Applying only half of the new patch 2 Applying the new patch on top of the existing patch 3 Applying the new patch adjacent to the existing patch 4 Applying the new patch after removing the existing patch

3 Rhinitis is characterized by the inflammation of mucous membranes lining the nose. This inflammation causes swelling along with clear, watery discharge. Rashes are small, raised vesicles that are usually reddened and are distributed over the entire body. Pruritus is itching of the skin. It is accompanied with red rashes that are distributed over the entire body. The patient with urticaria shows raised, irregularly shaped skin eruptions of varying sizes and shapes. These eruptions have reddened margins and pale centers. Inflammation of the nasal mucous membranes is seen in a patient with urticaria.

While assessing a patient who experienced a mild allergic reaction, the nurse observes swelling and a clear, watery discharge from the nose. Upon nasal mucosal biopsy, the nurse finds inflammation of the mucous membranes. Which allergic reaction should the nurse suspect in the patient? 1 Urticaria 2 Pruritus 3 Rhinitis 4 Rash

2 Rapid infusion of the intravenous fluid may cause circulatory overload in patients on intravenous therapy. Therefore, the nurse should verify the rate of administration with a medication reference or a pharmacist before giving them to ensure that intravenous infusions are safe over an appropriate amount of time. The patient is at a risk of medication overdose if the intravenous fluids are infused too rapidly. Flushing the intravenous port with the saline solution helps to maintain the patency of the intravenous line, but does not cause any adverse effects. The nurse should check the incompatibility of the medication with the fluid before starting the therapy.

While assessing a patient who is receiving intravenous therapy, the nurse notices circulatory fluid overload. What may be the reason for the patient's condition? 1 Overdose of the medication 2 Rapid infusion of the intravenous fluid 3 Flushing the intravenous port with saline solution 4 Incompatibility between the medication and the intravenous fluid

1 Hives, or urticaria, is a mild allergic reaction that is characterized by raised, irregularly shaped skin eruptions with red margins. Rash is a mild allergic reaction that is characterized by small, raised vesicles that are usually reddened all over the body. Inflammation of the mucous membrane lining the nose mucosa is referred to as rhinitis. Pruritus is a mild allergic reaction that involves itching of the skin that accompanies rashes.

While assessing a patient, the nurse observes raised, irregularly shaped skin eruptions with red margins. Which mild allergic reaction does the nurse document in the medical record? 1 Hives 2 Pruritus 3 Rhinitis 4 Rash

1 Patients using pressurized metered-dose inhalers are instructed to apply approximately 5 to 10 lbs of pressure to the top of the canister to administer the medication. Patients using breath-actuated metered-dose inhalers are instructed to coordinate the puffs with inhalation for an effective outcome. Patients using dry powder inhalers are instructed to inspire fast enough to administer the entire dose of the medication. These inhalers should be stored away from humidity because there is a chance for formation of clumps.

While caring for an older adult patient with respiratory problems, the nurse teaches the patient about the effective use of an inhaler. Which instruction given by the nurse would be most appropriate if a pressurized metered-dose inhaler was prescribed to the patient? 1 "Apply approximately 5 to 10 lbs of pressure to the top of the canister to administer the medication." 2 "Place the medication away from humidity, as there is a chance for formation of clumps." 3 "Inspire fast enough to administer the entire dose of the medication." 4 "Coordinate the puffs with inhalation for effective outcome."

2 The nurse should not take phone calls or speak with others while preparing IV medications to avoid interruptions that may result in medication errors. The nurse should keep an antidote close by while administering medications to treat medication toxicity. The nurse should double-check dosage calculations while preparing intravenous medications to avoid the risk of adverse effects. The nurse should collect appropriate equipment and check the medication administration record to enhance time management and efficiency.

While preparing intravenous medications, the nurse does not take phone calls or speak with others. What is the reason for this nursing action? 1 To treat medication toxicity 2 To prevent medication errors 3 To avoid the risk of adverse effects 4 To enhance time management and efficiency