Medications Prep U

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

"Aim the tip of the container toward the nasal passage"

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

Cleanse area around the injection site with alcohol.

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

Cleanse area at vaginal orifice with washcloth and warm water

The nurse is instructing a client with xerostomia (Dry mouth) about taking several pills and capsules that have been prescribed. Which statement made by the client indicated to the nurse that the client understood the instructions?

"I will take a sip or two of water prior to taking my pills. "

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

5 minutes

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 IV solution?

500-1000mL

A nurse is administering an injection of insulin to a 5year old who has type 1 diabetes. Which statement by the nurse would take into consideration the child's developmental level?

"You will just feel a little pinch" Rationale: Telling the child that the injection will feel like a little pinch is appropriate for the age of the child. A child should not be told that an injection does not hurt as this will create distrust. Telling a child to be brave and not to cry is inappropriate b/c it prevents the child from displaying his feelings. Telling the child to not move or it will hurt more may frighten the child.

The nurse is teaching a client with diabetes about insulin pen injection. The nurse will teach that the insulin in prefilled pens is stable for how long?

1 month

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

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

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

90 degrees

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

A parenteral drug is given in tandem with an IV solution. Rationale: In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusions specifically, but in general to maintain patency. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution.

The nurse is caring for a client who is receiving a prescribed IV infusion of an antibiotic to treat an infection. The client asks the nurse, "Can I just take a pill?" What is the best response by the nurse?

An IV infusion maintains a therapeutic level of the medication in your blood.

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

Apply pressure to the site during needle withdrawal Rationale: to reduce discomfort associated with an injection, the nurse should apply pressure to the site during needle withdrawal. The nurse should numb the skin with an ice pack before not AFTER the injection.

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.

A young women has an IV infusing for Mg sulfate to treat preterm labor. The women develops a fever. What is the first assessment the nurse should take?

Assess the IV site for redness Rationale: if tenderness, fever w/t obvious source, or symptoms of local or blood stream infections are present, remove the dressing and inspect the site directly.

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

Which is a recommended guideline for the nurse who is administering a piggyback intermittent IV infusion of medication?

Attach infusion tubing to the minibag by inserting the tubing spike into the port with a firm push and twisting motion. Rationale: Attach the infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion, taking care to avoid contaminating either end. The IV piggyback delivery system requires the intermittent or additive solution to be placed higher than the primary solution container.

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

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Check the expiration date.

The nurse has given medications to four clients. Which client will the nurse monitor most closely for a possible reaction to occur?

Client with infection who received a bolus of LR solution. Rationale: nurses carefully monitor all clients and know that reactions are more likely to occur when something is given IV. Therefore the nurse will most closely monitor the client who received a bolus of LR solution.

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse?

Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole. Rationale: An enteric coated medication should never be crushed since it disrupts the integrity of the pill and may cause irritation. The drug will dissolve prematurely in the gastric secretions and irritate the lining of the stomach.

A nurse is administering a medication to a 78 year old female client who experienced symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that the client has an increased possibility of drug toxicity due to what age-related factor?

Decline in liver function and production of enzymes needed for drug metabolism. Rationale: older clients are at risk for experiencing a cumulative effect, related to a decreased rate of drug metabolism, higher drug plasma concentrations. This leads to prolonged action and an increased possibility of drug toxicity if the liver function and production of enzymes for metabolism are decreased.

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

Deltoid

A nurse is administering an adult client's ordered antipsychotic drug IM. What would be most appropriate site for administration?

Deltoid

Which statement made by the nurse would indicate that teaching regarding the absorption of topical medications in the older adult was effective?

Diminished subcutaneous fat will lead to the rapid absorption of topical medication. Rationale: Decreased subcutaneous fat is correct, as this could lead to more rapid absorption of topical medication. Increased subcutaneous fat, decreased elasticity, and increased elasticity are incorrect and are less significant as they relate to older adults

The nurse is caring for an older 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?

A nurse is administering an intradermal injection to a client for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at site of injection. What is the nurse's best action in this situation?

Document the administration and inform the primary care provider. Rationale: A wheal or blister indicates that the medication has been injected into the dermis. if the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be reinjected into another site. The PCP needs to be notified that the skin test needs to be administered again so that an order can be obtained.

A nurse needs to administer an injection to a client in the deltoid site. Which action should the nurse perform to avoid the risk of damaging the radial nerve and artery?

Draw an imaginary line at the axilla between the acromion and brachial vessels

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

Past the internal sphincter

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

The nurse is caring for a client who is taking nitroglycerin. Which statement requires immediate nursing intervention?

I am taking tadalafil in addition to nitro Clients taking nitro in any form should not take drugs or herbs for erectile dysfunction.

The nurse is preparing to administer a nasal spray. Place the nurse's action 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 a client's nostril and release the compression. Instruct the client not to blow the nose for 5-10 minutes

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.

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

In the anterolateral aspect of the thigh.

The nurse is preparing to administer prescribed IV 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 is an accurate guideline for client teaching regarding the use of a dry powder inhaler (DPI)?

Instruct the client that if mist can be seen from the mouth or nose, the DPI is being used incorrectly.

Which parenteral route of administration has the longest absorption time?

Intradermal Rationale: medicines are absorbed the fastest in areas of the body that contain the greatest blood supply.

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

Lock the medications in a cart and finish them upon return. Rationale: once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

Miconazole Rationale: the nurse anticipates the miconazole, a vaginal cream, will be prescribed for a yeast infection. Oxymetazoline is a nasal decongestant used to alleviate congestion; bisacodyl is a rectal suppository used for softening stool; timolol is an eye drop used to treat glaucoma.

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

Place the date on the vial and retain for future use.

The nurse is caring for a client who has a normal saline infusing through a peripheral IV 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?

Placing the secondary infusion higher than the primary solution. Rationale: The nurse should place the secondary infusion higher than the primary infusion. This will allow the secondary infusion to infuse first. When completed, the primary infusion will continue to infuse.

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states "I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it." What would the nurse do to address the situation?

Provide education on taking all antibiotics for effective treatment

Which teaching will the nurse provide to a client with the NANDA nursing diagnosis of "Ineffective Protection r/t cancer and chemotherapy treatment" ?

Refrain from using aspirin while undergoing chemo treatment. Rationale: the nurse will teach that aspirin and products containing salicylates should be avoided during chemo treatment, since these interfere with clotting. Teeth should be brushed with a soft-bristle brush; chemotherapy may be delayed if platelets are low or for other reasons; urine and stool should be tested daily for occult blood.

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

Review the client's medication, allergy, and medical history

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

Select another site. Rationale: If a vein appears hard or ropelike, the nurse should select another spot for the venipuncture.

When administering oral medications, which practices should the nurse follow? select all that apply

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. Perform hand hygiene before and after medication administration

A nurse is caring for a 6 year old client on the hematology-oncology floor. During a packed RBC transfusion, the client reports of pain at the peripheral IV site. The nurse assesses the site and notices that the site is purple. What is the nurse's best course of action?

Stop the transfusion and insert peripheral IV at a new site. Rationale: pain and a purplish bruise at the IV site are signs of infiltration. Infiltration with PRBCs will give the appearance of a bruise. If infiltration or phlebitis occurs, the nurse should remove the device and insert a new catheter in a new site. The prescriber should be contacted after the nurse has stopped the infusion and started a new IV site.

A client is prescribed an opioid analgesic. The nurse is teaching the client about the need to avoid ingesting alcohol with the drug to prevent an interaction which would potentiate the effects of analgesic. The nurse is describing which event?

Synergism

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

The nurse should use a nebulizer to administer the medication. Rationale: The nurse's use of a nebulizer to administer medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Providing written instructions will enhance the teaching/learning process not the coordination of the child's inspiration.

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug.

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals?

This is because food and some drinks can affect that way your medicine works

The nurse is preparing to withdraw liquid medication from an ampule for injection into an IV. What is the appropriate action for the nurse to take when withdrawing the medication?

Use a filter needle to withdraw the medication

A client with COPD has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in order to ensure safe and complete deliver?

Use a spacer or extender with the metered dose inhaler. Rationale: the use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible. MDIs are placed 1-2 inches in front of mouth, not deeply into the mouth. Oxygen therapy prior to administration does not aid in delivery. Multiple puffs, if ordered are given 1-5 mins apart.

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?

Use a syringe to plunge the tube to try to dislodge the medication

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

Vastus lateralis site

It is particularly important for the nurse to use this technique when administering IM medication to which client?

a 70-year old demonstrating muscle wasting prescribed chlorpromazine

A client with COPD has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client:

breathes through his or her mouth until all the medication has been inhaled.

A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency?

before and after each medication administration Rationale: peripheral intermittent lines are usually flushed before and after each medication administration and every 8 hours when medications are not being given.

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

count each narcotic medication at the change of shift record each medication used from the stock supply maintain an accurate account of the use of the medication

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

drugs are bonded to an adhesive and applied to the skin. Rationale: transdermal applications are drugs that are bonded to an adhesive and applied to the skin. After application, the drug migrates through the skin and eventually is absorbed into the blood stream.

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

it is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order rationale: The nurse's ongoing verification of the IV solution and the infusion rate with the physician's order is essential. if more than one IV solution or medication is ordered, the nurse should make sure the additional IV solution can be attached to the existing tubing. As one bag is infusing, the nurse should prepare the next bag so it is ready for change when less than 50mL of fluid remains in the original container. Every 72 hours is recommended for changing the administration sets of simple IV solution.

A nurse who is administering an injection to a client has an accidental needle stick injury after withdrawing the needle from the client's tissue. Which action(s) will the nurse take? select all that apply

perform hand hygiene per agency protocol document the injury per agency protocol in a timely manner seek a medical assessment and follow up as needed report the injury to a supervisor immediately.

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.