Chp 29 PrepU Medications
A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?
1 mL
The nurse is preparing to administer eye drops to a client with glaucoma. A discrepancy is noted between dosage recorded on the medication administration record (MAR) and what the client states that he takes daily at home. What is the appropriate nursing action?
Contact the health care provider for clarity
When administering a subcutaneous injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation?
Engage safety shield on needle guard and discard needle appropriately
A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?
1500
A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss? -When giving an injection, the amount of the medication directs the choice of gauge. -The size of the syringe is directed by the viscosity of the medication to be given. -When looking at a needle package, the first number is the length in inches and the second number is the gauge or diameter of the needle. -As the gauge number becomes larger, the size of the needle becomes smaller.
As the gauge number becomes larger, the size of the needle becomes smaller.
A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear? -Ask the client to maintain the position for some time. -Instill the medication in the opposite ear if prescribed. -Place a cotton ball in the ear to absorb excess medication. -Briefly postpone the application in the second ear.
Ask the client to maintain the position for some time.
When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?
Assess the vaginal area.
The nurse is caring for a client who just returned from the postanesthesia care unit and rates current pain as "9 out of 10." Which prescribed medication would provide the fastest relief from pain? -Intramuscular ketorolac tromethamine -Intravenous morphine sulfate -Oral acetaminophen with codeine - Oral acetaminophen and oxycodone
Intravenous morphine sulfate
A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider? -Generally, the nurse should change the administration sets of simple IV solutions every 24 hours. -As one bag is infusing, the nurse should prepare the next bag so it is ready for a change when less than 10 mL of fluid remains in the original container. -It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. -The nurse should use new tubing when attaching additional IV solutions.
It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order.
The nurse is caring for an older adult client who sees several different health care providers and specialists. Which question will the nurse ask?
Do you get all of your medications filled at the same pharmacy?"
The nurse has just completed a teaching session with clients on safety precautions to take when applying a transdermal patch. Which statement made by the client indicates that the teaching was effective?
I will dispose of the patch away from children and pets."
The nurse is preparing to administer an intramuscular (IM) injection into a client who is worried about pain. How will the nurse explain use of the Z-track technique?
I will manipulate the muscular tissue, which results in slightly less pain.
To convert 0.8 grams to milligrams, the nurse should do which of the following?
Move the decimal point 3 places to the right.
Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler? The nurse should instruct the child to prolong his/her inhalation. The nurse should assess the child's mucous membranes. The nurse should use a nebulizer to administer the medication. The nurse should provide simple written instructions.
The nurse should use a nebulizer to administer the medication.
The nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not?
aspirating for a blood return
In terms of categories of controlled substance, which description reflects schedule IV drugs? - may lead to limited physical dependence -has the highest potential for abuse -may lead to severe psychological dependence -deemed safe for use in pregnancy
may lead to limited physical dependence
When administering heparin subcutaneously, the nurse should:
never aspirate
A nurse is preparing to administer a scheduled dose of enteric-coated ASA to a client who has a history of angina. When preparing the medication, the nurse is careful to check the five rights of medication administration. The five rights include which of the following? -Right setting - Right time -Right reason -Right documentation
right time
A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?
bolus administration
What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?
to determine the extent to which the client responded to the drugs
The nurse is preparing supplies for a tuberculosis screening. The nurse should choose which syringes and needles?
1 mL syringe; ½-inch (1.25-cm), 26-gauge needle
A nurse needs to administer a continuous medication drip to a client. The nurse knows that, for a continuous infusion, she will likely need to add medication to which volume of IV solution? 500 to 1,000 mL 50 to 100 mL 15 to 50 mL 150 to 250 mL
500 to 1,000 mL
A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?
Avoid crushing sustained-release pellets
A client's eMAR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action? -Recognize that it is not safe to mix two medications in one syringe. -Page the health care provider to determine whether the drugs can be mixed. -Collaborate with the pharmacy to have one of the times changed. -Determine the compatibility of the two drugs by consulting clinical resources.
Determine the compatibility of the two drugs by consulting clinical resources.
Which situation accurately describes a recommended guideline when administering oral medications to clients?
If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.
Which situation accurately describes a recommended guideline when administering oral medications to clients? -If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. - If a client vomits immediately after receiving oral medications, readminister the medication. - If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. -Assume that the client is the authority on whether or not the medication was swallowed
If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food.
While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?
Report the needlestick to the nurse manager.
A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point would the nurse include in the education plan?
Rotate the injection site.
A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection?
Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.
A nurse is administering medication to a client via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation? Call the physician before instituting any corrective interventions. Use a syringe to plunge the tube to try to dislodge the medication. Remove the tube and replace it with a new tube. Wait the prescribed amount of time and attempt to administer the medication again before calling the physician.
Use a syringe to plunge the tube to try to dislodge the medication
A nurse is administering an intramuscular injection to a client using the Z-track method. Which action should the nurse perform to prevent leaking and ensure sealing of medication in the subcutaneous and dermal layers of tissue?
Withdraw the needle and release taut skin immediately after injection.
A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler?
a canister containing medication that is released when the container is compressed
To which client would the nurse be most likely to administer a p.r.n. medication? -a client whose asthma is treated with inhaled corticosteroids -a client who is reporting pain near the surgical site -a client who is experiencing severe and unprecedented chest pain -a client who requires daily medication to control hypertension
a client who is reporting pain near the surgical site
The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe?
decreased irritation and pain in subcutaneous tissue
The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?
intradermal
A nurse is using an 18-gauge needle to administer medication to a client. The nurse knows that, when compared with a 27-gauge needle, an 18-gauge needle has which feature?
larger diametter
Which component of a syringe's needle does the nurse recognize that refers to width?
gauge
The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangement does the nurse anticipate in the discharge plan of care?
home nursing visits
The registered nurse (RN) supervises the LPN/LVN administering a purified protein derivative (PPD) tuberculin skin test to a client. During which step should the RN establish the need to intervene? The LPN/LVN: -inserts the tip of the needle at a 5-degree angle with the bevel partly under the skin. -draws up 0.1-mL tuberculin per order after cleansing the vial with a sterile swab. -cleanses the site with antimicrobial swab in circular motion from center outward. -draws the skin taut on the client's right forearm 2 in below the elbow.
inserts the tip of the needle at a 5-degree angle with the bevel partly under the skin.
The nurse is teaching a nursing student regarding safety of chemotherapeutic medication. Which statement by the nurse is correct? "Antineoplastic drugs can be absorbed through the skin." -"Pharmacists usually administer chemo drugs." -"Once the drugs are packaged in the pharmacy, there are no risks in handling the medication." -"Antineoplastic drugs only target cancer cells."
"Antineoplastic drugs can be absorbed through the skin."
The charge nurse has just completed an inservice with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?
"Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes."
The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?
"I am taking tadalafil in addition to nitroglycerin."
Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply.
"The cylinder of the insulin pen contains a prefilled reservoir of insulin." "The dose of insulin in an insulin pen is displayed in a window of the syringe." "The insulin pen automatically resets the dose window to zero, following the injection."
A nurse is caring for a client who has been prescribed codeine, a narcotic medication to relieve severe postoperative pain. Which responsibility does the nurse have to complete when handling narcotic medications? Select all that apply.
-Maintain an accurate account of the use of the medication. -Record each medication used from the stock supply. -Count each narcotic medication at the change of each shift.
A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? -1.5 -2 -0.5 -4
0.5
The nurse is working the night shift in the ER when an ambulance arrives carrying a man s/p motor vehicle accident (MVA). His initial BP is 100/56 and the nurse notes that he is bleeding heavily from a laceration on the forehead. Fifteen minutes later, the nurse reassesses the client and finds that his BP is 95/58. What IV fluid would the nurse expect to be ordered? D5 ¼ NS 0.45% NS 3% NS 0.9% NS
0.9% NS
The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?
10 to 15 degrees
It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client?
A 70-year-old demonstrating muscle wasting prescribed chlorpromazine
A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the first assessment the nurse should make?
Assess the IV site for redness.
The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?
Give written instructions to the client and caregivers.
After inserting an intravenous catheter into a client's vein, the nurse does not obtain blood return. What is the appropriate nursing action? -Begin infusion of IV fluids and document the procedure. -Obtain a larger bore catheter. -Change the catheter insertion site. -Gently insert the IV catheter further into the vein.
Change the catheter insertion site.
The nurse is preparing to administer two IV medications. What is the appropriate nursing action?
Consult a current drug reference book for IV compatibility.
A client with a new diagnosis of glaucoma (increased pressure within the eye) has been prescribed a medication that is to be administered by an eye drop. Which action should the nurse perform?
Ensure that drops of the medication fall onto the client's conjunctival sac.
The nurse is preparing to administer a nasal spray. Place the nurse's actions in order, from first to last. Use all options.
Identify the client using two identifiers and verify any allergies. Offer the client a tissue and ask the client to blow the nose. Insert the tip of the nasal spray into one nostril and close the other nostril with a finger. Compress the nasal spray while the client breathes in through the nose. Remove the tip of the spray from the client's nostril and release the compression.
The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse?
Insert a new IV medication lock and remove the old one.
Which parenteral route of administration has the longest absorption time?
Intradermal
The nurse is caring for a client who has been prescribed an enteric-coated drug. What should the nurse inform the client regarding the administration of this drug? -It should not be chewed or crushed. -It can be cut into pieces. -It is available in liquid form. -It should not be opened.
It should not be chewed or crushed.
What is the best response by the nurse when a client asks about the side effects of using nasal spray?
Long-term use of nasal sprays can cause rebound nasal congestion."
A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?
Medication stays in the chamber so you can continue to inhale it."
The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action?
Notify the health care provider.
When administering oral medications, which practices should the nurse follow? Select all that apply
Perform hand hygiene before and after medication administration. Stay at the bedside until the client has swallowed all the medications. Verify the client's response to the medication 30 minutes after administration or as appropriate for the drug.
In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action? - Place the date on the vial and retain for future use. -Send the vial with the remaining drug back to the pharmacy. -Discard the remaining drug. -Draw up the remaining medication to give at the next time of administration.
Place the date on the vial and retain for future use.
Which nursing action promotes safety in preparation of medication? Select all that apply.
Return medications with obscured labels to the pharmacy. Note the expiration dates on liquid medications. Prepare medications in well-lit conditions.
A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case? -Leave the medication on the client's bedside table. - Inform the head nurse about the client's absence. -Inform the physician about the client's absence. -Return the medication to the medication cart or medication room.
Return the medication to the medication cart or medication room.
The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this scheduled unit-dose packaged antihypertensive medication?
Set the antihypertensive dose aside pending assessment
A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse's appropriate response?
Tactfully request the provider to input the order into the computerized provider order system
The nurse is preparing to draw up a medication that is supplied in a glass ampule. Place, in order, the steps the nurse will take. Use all options.
Wrap a small gauze pad around the neck of the ampule. Break off the top of the ampule. Attach the filter needle to the syringe. Withdraw the medication. Discard the filter needle. Attach a sterile administration device to the syringe.
A nurse is administering an injection of insulin to a 5-year-old who has type I diabetes. Which statement by the nurse would take into consideration this child's developmental level?
You will just feel a little pinch."
A medication order has ac written after the medication dosage. What does ac stand for?
before meals
A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?
bolus administration
A client with chronic obstructive pulmonary disease has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client: -coughs intermittently while the medication is being administered. -takes rapid, shallow breaths until the medication is complete. -breathes through his or her mouth until all the medication has been inhaled. -rinses his or her mouth with water before the medication is administered.
breathes through his or her mouth until all the medication has been inhaled
Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?
checking for documented allergies to food or drugs
Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration?
client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination
A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?
deltoid
A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration? -Vastus lateralis -Ventrogluteal -Deltoid -Scapula
deltoid
A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?
deltoid
After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues?
distribution
The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity? -stopping the primary solution until the secondary infusion is completed - placing the secondary and primary infusion at equal height -placing the primary solution higher than the secondary solution -placing the secondary infusion higher than the primary solution
placing the secondary infusion higher than the primary solution
A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? -allow sufficient time to prepare the medication with minimal distraction -administer medication within 30 to 60 minutes of the scheduled time - read and compare labels on the medication with the medical record -review the client's medication, allergy, and medical history
review the client's medication, allergy, and medical history
What would be considered a "right" of drug administration? Select all that apply.
right drug right documentation right dose right client
A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate? Loosen the tourniquet slightly. Apply a topical anesthetic. Apply a warm compress for 5 minutes. Select another site.
select another site
An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method? -self-contained packets that hold one tablet or capsule for individual clients -a supply that remains on the nursing unit for use in an emergency -a container with enough prescribed medications for several days for a client -systems that contain frequently used medication for that unit
self-contained packets that hold one tablet or capsule for individual clients
The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client?
spacer
The nurse is teaching a client about indomethacin SR. When the client asks, "What does the SR mean?" what is the appropriate nursing response?
sustained release
The primary reason for the Controlled Substances Act is:
to prevent drug use and dependence.
The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?
removing prior application and any remaining residue from skin