Chp 31 Medication Administration

15. A patient is taking albuterol through a pressurized metered dose inhaler (pMDI) that contains a total of 200 puffs. The patient takes 2 puffs every 4 hours. How many days will the pMDI last? __________ days

16 Two puffs × 6 times a day = 12 puffs per day; 200 puffs/12 puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a total of 17 days.

8. The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? A) Ask the prescriber to change the order B) Crush the pill with a mortar and pestle C) Hide the capsule in a piece of solid food D) Open the capsule and sprinkle it over pudding

A Enteric-coated or sustained-release capsules should not be crushed; the nurse needs to contact the prescriber to change the medication to a form that is liquid or can be crushed.

9. The nurse takes a medication to a patient, and the patient tells him or her 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) Explain that she must take the medication C) Take the medication away and chart the patient's refusal D) Tell the patient that her physician knows what is best for her

A When patients refuse a medication, first ask why they are refusing it.

If a client who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects A. Sepsis. B. Phlebitis. C. Infiltration. D. Fluid overload.

B. Phlebitis.

To better control the client's blood glucose level, the physician orders a high regular insulin dosage of 20 units of U-500 insulin. The nurse has only a U-100 syringe. How many units will be given? A. 4 B. 5 C. 10 D. 20

A. 4 U-500 insulin is 5 times as strong as U-100 insulin. Therefore the amount of U-500 insulin should be divided by 5; 20 units ÷ 5 = 4 units.

The nurse is administering a sustained-release capsule to a new client. The client insists that he cannot swallow pills. The best course of action for the nurse is to: A. Ask the physician to change the order. B. Crush the pill with a mortar and pestle. C. Hide the capsule in a piece of solid food. D. Open the capsule and sprinkle it over pudding.

A. Ask the physician to change the order. Sustained-release medications should never be crushed or sprinkled on food. Hiding the capsule in a piece of solid food is not an appropriate nursing step. The nurse should contact the physician for an order change.

While the nurse is administering medication, the client says, "This pill looks different from what I usually take." What is the nurse's best action? A. Go recheck the medication order, taking along the medication. B. Ignore the statement because the client has a history of confusion. C. Leave the medication at the bedside and go recheck the order. D. Tell the client that pill manufacturers often change the color of pills.

A. Go recheck the medication order, taking along the medication. This is a safety issue and should not be ignored. Leaving the medication at the bedside is an unsafe practice and does not demonstrate the nurse's responsibility. If checking the medication order does not clarify the situation, then the nurse should check with the pharmacist regarding pill shape, color, and so on. Different manufacturers will design their own brands to look different from their competitors' brands. Checking the client's statement can avoid a potential medication error, and the client appreciates the efforts of the nurse.

13. After seeing a patient, the physician gives 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 physician 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 physician. D) Ensure that the six rights of medication administration are followed when giving the medication.

B Nursing students cannot take orders.

7. 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. Which information does the nursing student include when replying to the patient? A) Only the patient's physician can give this information. B) The student provides the name of the medication and a description of its desired effect. C) Information about medications is confidential and cannot be shared. D) He has to speak with his assigned nurse about this.

B Patients need to know information about their medications so they can take them correctly and safely.

12. If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects: A) Sepsis. B) Phlebitis. C) Infiltration. D) Fluid overload.

B Redness, warmth, and tenderness at the IV site are signs of phlebitis.

10. The nurse receives an order to start giving a loop diuretic to a patient to help lower his or her blood pressure. The nurse determines the appropriate route for administering the diuretic according to: A) Hospital policy. B) The prescriber's orders. C) The type of medication ordered. D) The patient's size and muscle mass.

B The order from the prescriber needs to indicate the route of administration.

1. The nurse is having difficulty reading a physician's order for a medication. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take? A) Call a pharmacist to interpret the order B) Call the physician to have the order clarified C) Consult the unit manager to help interpret the order D) Ask the unit secretary to interpret the physician's handwriting

B You must have the right documentation and clarify all orders with the prescriber before administering medications.

When administering medications, it is essential for the nurse to have an understanding of basic arithmetic to calculate doses. The physician has ordered 250 mg of a medication that is available in 1-g amount. The vial reads 2 ml = 1 g. What dose would be given by the nurse? A. 0.25 ml B. 0.5 ml C. 1 ml D. 2.5 ml

B. 0.5 ml 0.5 ml = 250 mg of this medication. (Dose ordered/dose on hand) × amount on hand = amount administered [250 mg/1000 mg (1 g)] × 2 ml = 500/1000 = ½ ml or, in decimals, 0.5 ml

A site that was a traditional location for intramuscular (IM) injections in the past is no longer recommended because its use carries the risk of striking the underlying sciatic nerve or major blood vessel. What is the name of this site? A. Plexor B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis

B. Dorsogluteal The dorsogluteal is the not-so-safe traditional site. The ventrogluteal muscle is situated deep and away from major nerves and blood vessels. The vastus lateralis muscle is thick and well developed. The plexor is the middle finger of the dominant hand used during percussion or a percussion hammer used to strike the pleximeter and is not related to IM sites.

A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is and why he should take it. The nursing student should: A. Inform the client that only the client's physician can give this information. B. Provide the name of the medication and a description of its desired effect. C. Tell the client that information about medications is confidential and cannot be shared. D. Explain that, because of the limits placed on nursing students, the client will have to speak with his assigned nurse about this.

B. Provide the name of the medication and a description of its desired effect. The nursing student should know the name, dose, and purpose of all medications that he or she is responsible for administering. Part of client teaching is sharing this information with the client, so the student should be able to verbalize this information to the client. This information is not confidential, and the student nurse should present this information without waiting for a physician or the client's assigned nurse.

The nurse selects the route for administering medication according to: A. Hospital policy B. The prescriber's orders C. The type of medication ordered D. The client's size and muscle mass

B. The prescriber's orders Facilities have protocols for medication administration that the nurse must follow. If a physician's order contradicts the protocols, then the order must be clarified with the physician and the protocol explained. The protocol will include specifics for the type of medication ordered and the client's size and muscle mass.

The nurse is having difficulty reading a physician's order for a medication. The nurse knows the physician is very busy and does not like to be called. The nurse should: A.Call a pharmacist to interpret the order. B.Call the physician to have the order clarified. C.Consult the unit manager to help interpret the order. D.Ask the unit secretary to interpret the physician's handwriting.

B.Call the physician to have the order clarified. It is the nurse's responsibility to ensure that the medication orders are correct. Asking a unit manager or pharmacist to help interpret an order is always helpful, but the nurse is still responsible. A unit secretary can help with reading handwriting, but the nurse is still responsible.

Most medication errors occur when the nurse: A.Is caring for too many clients B.Fails to follow routine procedures C.Is administering unfamiliar medications D.Is responsible for administering numerous medications

B.Fails to follow routine procedures Medication errors occur most often when the nurse fails to follow the routine procedures that are in place to ensure client safety. The other options are not correct if the nurse follows the protocols.

6. A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse? A) Set up the follow-up appointments with the physician for the patient. B) Ensure that someone will provide housekeeping for the patient at home. C) Ensure that the home care agency is aware of medication and health teaching needs. D) Make sure that the patient's family knows how to safely bathe him or her and provide mouth care.

C A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications.

5. A nurse is administering medications to a 4-year-old patient. After he or she explains which medications are being given, the mother states, "I don't remember my child having that medication before." What is the nurse's next action? A) Give the medications B) Identify the patient using two patient identifiers C) Withhold the medications and verify the medication orders D) Provide medication education to the mother to help her better understand her child's medications

C Do not ignore patient or caregiver concerns; always verify orders whenever a medication is questioned before administering it.

11. A patient is receiving an intravenous (IV) push medication. If the drug infiltrates into the outer tissues, the nurse: A) Continues to let the IV run. B) Applies a warm compress to the infiltrated site. C) Stops the administration of the medication and follows agency policy. D) Should not worry about this because vesicant filtration is not a problem

C When an IV medication infiltrates, stop giving the medication and follow agency policy.

A client is receiving an intravenous (IV) push medication. If this type of drug infiltrates into the outer tissues the nurse will: A. Continue to let the IV run. B. Apply a warm compress to the infiltrated site. C. Follow facility policy or the drug manufacturer's directions. D. Not worry about this because vesicant filtration is not a problem.

C. Follow facility policy or the drug manufacturer's directions. The infusion of the medication should be halted and the facility policy or drug manufacturer's directions followed. Infiltration of some medications will create no harm. For others, harm can be averted by the application of warm compresses. Still others may require other treatments if infiltration occurs.

When identifying a new client before administering medications, the nurse asks the client to state his name. The client does not give the correct name. The nurse asks again and the client states still another name. What is the nurse's next action? A. Laugh at the client and tell him to "quit kidding." B. Give the medications without any further questioning. C. Investigate the client's mental status before administering any further medications. D. Look at the client's arm band to identify the client and disregard what the client said.

C. Investigate the client's mental status before administering any further medications. The ongoing physical and mental status of a client affects whether a medication is given or how it is administered. The client should be assessed carefully before administering any medication. The nurse should always check the client's arm band to ensure that this is the correct client for the given medication, even if the client responds with the correct name. The client should always be identified using at least two identifiers before administering medication, preferably by comparing the client identifiers on the MAR with the client's arm band at the bedside.

A nurse administering medications has many responsibilities. Among these responsibilities is a knowledge of pharmacokinetics. Which statement is the best description of pharmacokinetics? A. The passage of medication molecules into the blood from the site of administration B. The degree to which medications bind to serum proteins, which affects distribution C. The study of how medications enter the body, reach their site of action, metabolize, and exit the body D. The method by which a medication, after absorption, is moved within the body to tissues, organs, and specific sites of action

C. The study of how medications enter the body, reach their site of action, metabolize, and exit the body Pharmacokinetics is the study of how medications enter the body, travel to the site of action, metabolize, and exit the body. Distribution refers to the method by which medication, after absorption, is moved within the body. Absorption is the passage of medication molecules into the blood from the site of administration. The degree to which medications bind to serum protein is protein binding.

The following orders were written by a prescriber (physician, advanced practice nurse, physician's assistant). Which order is written correctly? A. Aspirin 2 tablets prn B. Haloperidol (Haldol) ½ tablet at bedtime C. Zolpidem (Ambien) 5 mg PO at bedtime prn D. Levothyroxine (Synthroid) 0.05 mg 1 tablet

C. Zolpidem (Ambien) 5 mg PO at bedtime prn The order for zolpidem is the only medication order that contains the essential components of a drug order—name of medication, dose, route of administration, and frequency.

2. The patient has an order for 2 tablespoons of Milk of Magnesia. How much medication does the nurse give him or her? A) 2 mL B) 5 mL C) 16 mL D) 30 mL

D 1 tablespoon = 15 mL; 2 tablespoons = 30 mL.

3. A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the medication? A) Outward B) Back C) Upward and back D) Upward and outward

D Eardrops are administered with the ear positioned upward and outward for patients greater than 3 years of age.

14. A nurse accidently gives a patient a medication at the wrong time. The nurse's first priority is to: 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.

D Patient safety and assessing the patient are priorities when a medication error occurs.

4. A patient is to receive cephalexin (Kefl ex) 500 mg PO. The pharmacy has sent 250-mg tablets. How many tablets does the nurse administer? A) ½ tablet B) 1 tablet C) 1 ½ tablets D) 2 tablets

D Using dimensional analysis: Tablets = 1tablet/250 mg× 500 mg = 500/250 = 2 tablets.

A client is to receive cephalexin (Keflex) 500 mg by mouth. The pharmacy has sent 250-mg tablets. The nurse gives: A. ½ tablet B. 1 tablet C. 1½ tablets D. 2 tablets

D. 2 tablets Two 250-mg tablets = 500 mg.

A client is transitioning from the hospital to the home environment. A home health referral has been obtained. In terms of safe medication administration, what is a priority for the discharge nurse? A. Set up the follow-up physician appointments for the client. B. Ensure that someone will provide housekeeping for the client at home. C. Make sure that the client has plenty of diapers and blue pads to take home. D. Ensure that the home health care agency is aware of medication and health teaching needs.

D. Ensure that the home health care agency is aware of medication and health teaching needs. The home care agency should be aware of the medication and health teaching needs of all clients. The other options are issues that should be addressed, but the question is specifically asking regarding safe medication administration, so this answer is the only one that answers the question correctly.

The nurse is administering an intramuscular (IM) injection. The Z-track method is recommended for IM injections because: A. It is easier for the nurse to use. B. It allows for repeated injections into the same site. C. It does not require the nurse to aspirate before injecting the medication. D. It minimizes local skin irritation by sealing the medication in muscle tissue.

D. It minimizes local skin irritation by sealing the medication in muscle tissue. The Z-track method minimizes local skin irritation, providing more comfort for the client. Repeated injections in the same muscle can cause severe discomfort and poor absorption. The Z-track method

The client is a 40-year-old man who weighs 160 lb and is 5 feet 9 inches tall. The order is for 5 ml of a medication to be given as a deep intramuscular (IM) injection. What size of syringe and gauge and length of needle should the nurse use for best practice? A. One 5-ml syringe, 20- to 23-gauge 1-inch needle B. Two 2-ml syringes, 25-gauge 1-inch needle C. Two 3-ml syringes, 23-gauge, ½-inch needle D. Two 3-ml syringes, 20- to 23-gauge, 1½-inch needle

D. Two 3-ml syringes, 20- to 23-gauge, 1½-inch needle A medication dose of 5 ml administered IM is unlikely to be absorbed properly. Therefore, dividing the dose is correct. Dividing the doses equally allows 2.5 ml to be given in two different sites, so the nurse will need two 3-ml syringes. A deep IM injection must pass through subcutaneous tissue and penetrate deep muscle; therefore the needle must be long enough (1½ inch) and the gauge heavy enough (20 to 23 is the best choice).

The client has an order for 2 tablespoons of milk of magnesia. The nurse converts this dose to the metric system and gives the client: A.2 ml B.5 ml C.16 ml D.30 ml

D.30 ml Each teaspoon is 5 ml and 2 tablespoons is 6 teaspoons, so 5 × 6 = 30 ml.

What is the best nursing practice for administrating a controlled substance if part of the medication must be discarded? A. The nurse documents on the medication administration record. B. The nurse discards the unused portion and documents on the control inventory form. C. The nurse does not discard any controlled substance to prevent environmental contamination. D. The nurse documents on the medication administration record and the control inventory form, and has a second nurse witness the medication being discarded.

The nurse signs both records and has a second nurse witness the discarding of the controlled substance and also sign the control inventory form. Agency policy dictates how the substance is discarded to avoid environmental concerns.