NCLEX - Medication and I.V. Administration

The nurse is using the Z-track method of I.M. injection to administer iron dextran to a client with iron deficiency anemia. Which techniques should the nurse use to give this injection? Select all that apply:

1. Confirm the client's identity before administering the iron dextran. 3. Change the needle after drawing up the iron dextran. 4. Before inserting the needle, displace the skin laterally by pulling it away from the injection site. 5. Inject the iron dextran after aspirating for a blood return.

When preparing to give a client a prescribed drug, the nurse realizes that the drug is one the nurse has never administered before. No drug references on the nursing unit contain information about the drug in question. What should the nurse do?

1. Contact a pharmacist to obtain information about the drug.

If a central venous catheter becomes disconnected accidentally, what should the nurse do immediately?

3. Clamp the catheter

Why would the nurse be interested in a client's dietary history when administering drugs?

3. Dietary intake can alter the effectiveness of some drugs.

A client is scheduled for an excretory urography at 10 a.m. An order states to insert a saline lock I.V. device at 9:30 a.m.. The client requests a local anesthetic for the I.V. procedure and the physician orders lidocaine-prilocaine cream (EMLA cream). The nurse should apply the cream at:

1. 7:30 a.m.

A client who sustained a head injury in a motor vehicle accident is prescribed phenytoin (Dilantin) liquid to prevent seizures. The client is unable to take anything by mouth and has a feeding tube in place for enteral feedings. Which intervention by the nurse is most appropriate when administering phenytoin to this client?

1. Administering the phenytoin 2 hours before or 2 hours after beginning the tube feedings

A 64-year-old client has just had total hip replacement surgery. The physician orders heparin 8,000 units to be administered subcutaneously. The label on the heparin vial reads: "Heparin 10,000 units/ml." How many milliliters of heparin should the nurse draw up in the syringe to administer the correct dose?

0.8

After knee replacement surgery, a client is being discharged with a prescription for acetaminophen and codeine tablets, 30 mg, for pain. During discharge preparation, the nurse should include which instruction?

1. "Avoid driving a car while taking this medication."

A client is to be discharged on daily medication delivered by a transdermal disk. Which statement indicates the need for further medication teaching?

1. "I'll place the disk on the same spot every time."

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. Her physician prescribes neomycin (Mycifradin), 4 g by mouth daily in four divided doses. Her husband asks how neomycin decreases his wife's serum ammonia concentration. How should the nurse respond?

1. "It decreases the number of ammonia-producing bacteria in the GI tract."

Before administering the evening dose of a prescribed medication, the nurse on the evening shift finds an unlabeled, filled syringe in the client's medication drawer. What should the nurse do?

1. Discard the syringe to avoid a medication error.

The nurse is caring for a 62-year-old client with type 2 diabetes. The client takes an oral antidiabetic to control blood glucose levels. The physician prescribed ramipril (Altace) to help treat this client's elevated blood pressure. The nurse should be alert for which drug interaction?

1. Hypoglycemia

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion?

1. Instructing the client to report any itching, swelling, or dyspnea

A client with diabetes mellitus is receiving insulin. Which statement correctly describes an insulin unit?

1. It's a measure of effect, not a standard measure of weight or quantity.

The nurse prepares to administer a cleansing enema. What is the most common client position used for this procedure?

1. Left lateral Sims'

The nurse is preparing to administer 4 units of regular insulin to a client with type 1 diabetes mellitus. Which of the following equipment does the nurse need to perform the injection? Select all that apply:

1. Medication administration record 3. 27-gauge, ½" needle

What is the first action that a nurse should take after accidentally failing to administer an ordered medication?

1. Notify the prescriber, nursing supervisor, and pharmacist.

A facility has a system for transcribing medication orders to a Kardex as well as a computerized medication administration record (MAR). A physician writes the following order for a client: "Prednisone 5 mg by mouth daily for 3 days." The order is correctly transcribed on the Kardex. However, the nurse who transcribes the order onto the MAR neglects to place the limitation of 3 days on the prescription. On the 4th day after the order was instituted, a nurse administers prednisone 5 mg by mouth. During an audit of the chart, the error is identified. The person most responsible for the error is the:

2. nurse who administered the erroneous dose.

The nurse is checking a client's I.V. infusion rate at the beginning of her shift. The nursing Kardex states that the infusion should run at 125 ml/hour. To verify the I.V. drip rate, the nurse must know the drip factor, which is:

2. the number of drops in one milliliter.

A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child?

3. Hypokalemia

What is one disadvantage of using the rectal route for drug administration?

3. It can result in incomplete drug absorption.

A client is scheduled to receive levothyroxine (Synthroid) at 0900. When the nurse is finally able to administer the medication at 0930 the client is eating breakfast. The nurse knows that levothyroxine should be administered on an empty stomach. Which action by the nurse is best?

4. Administer the medication 30 minutes after the client is finished eating.

Small air bubbles adhering to the interior surface of the syringe might have which effect with parenteral administration?

4. Altered drug dose

Which type of medication order might read "Vitamin K 10 mg I.M. daily × 3 days?"

4. Standard written order

The nurse is calculating the proper dosage of medication for a child. What parameters should this calculation be based on?

2. Body weight

A client is to receive a glycerin suppository. When inserting the suppository, the nurse should advance it approximately how far into the client's rectum?

3. 3" (7.5 cm)

The physician prescribes 60 mEq of potassium chloride liquid as a one-time dose. The pharmacy supplies a liquid containing 20 mEq/15 ml. How many milliliters of solution should the nurse administer?

3. 45 ml

The physician orders milk of magnesia, 2 teaspoons by mouth as needed, for a constipated client. What is the equivalent of 1 teaspoon in the metric system?

3. 5 ml

A client is in the bathroom when the nurse enters to give a prescribed medication. What should the nurse do?

3. Return shortly to the client's room and remain there until the client takes the medication.

For a hospitalized client, the physician prescribes hydromorphone (Dilaudid) I.M. every 4 hours as needed for pain. However, the client refuses to take injections. Which nursing action is most appropriate?

2. Calling the physician to request pain medication that isn't administered I.M.

The nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should include information about which medication?

3. Tamoxifen (Nolvadex)

A medication order reads "Meperidine 1 ml I.M. stat." The nurse responsible for administering the drug should base the next action on which understanding?

3. The order should be clarified with the physician.

The physicians order reads, "Apply bacitracin ointment to finger laceration q 8 hours." Which action by the nurse is most appropriate?

3. Using her judgment to determine the amount of ointment to apply

The nurse administers hydromorphone (Dilaudid) 2 mg I.V. to a client complaining of incisional pain. While documenting the administration, the nurse notes that the medication was prescribed by the I.M. route. Which action should the nurse take?

3. Obtain vital signs and notify the physician and nursing supervisor of the error.

Which of the following must be included in a medication order?

3. Physician's signature

After being treated with heparin for a pulmonary embolism, a client is prescribed warfarin (Coumadin) using a sliding scale. Which action should the nurse take before administering this drug?

1. Closely monitor prothrombin time (PT) and international normalized ratio (INR) results to determine the dose of warfarin to administer.

The nurse is preparing to administer a sustained-release tablet to a client. Which statement about sustained-release tablets is true?

1. They should never be split, crushed, or chewed.

The physician orders nitroglycerin, 5 mg by mouth twice per day, for a client. The drug is dispensed in 2.5-mg tablets. How many tablets will the nurse administer twice per day?

1. Two

The physician orders ampicillin, 500 mg by mouth every 6 hours. This medication order is an example of:

1. a standard written order

Metoprolol (Lopressor) is prescribed to control angina in a client with type 1 diabetes. The nurse should be aware that:

1. metoprolol alters insulin requirements in previously stabilized clients.

A geriatric client who experiences several adverse drug reactions may benefit from:

1. reduced drug dosages.

A 76-year-old client who failed swallowing studies has a nasogastric (NG) tube in place for medication administration. When the nurse checks the client's medications, she notices that only tablets have been dispensed by the pharmacy. How should the nurse proceed?

2. Crush those tablets that may be crushed according to the manufacturer and administer them through the NG tube; request an alternate form of those that can't be crushed.

After laparoscopic cholecystectomy, a 43-year-old client complains of pain and nausea. The nurse is preparing meperidine hydrochloride (Demerol) 75 mg and promethazine hydrochloride (Phenergan) 12.5 mg to be administered I.M. in the same syringe. If the label on the Demerol reads 50 mg/ml and the label on the Phenergan reads 25 mg/ml, how many milliliters should the nurse have in the syringe after the correct doses are drawn up?

2

What is the maximum amount of medication (in milliliters) that can be administered into the deltoid muscle?

2

The physician writes the following order for a client: "Digoxin .125 mg by mouth once daily." To prevent a dosage error, how should the nurse transcribe this order onto the medication administration record?

2. "Digoxin 0.125 mg by mouth once daily"

The nurse is preparing a client who has been newly diagnosed with asthma for discharge. As part of his discharge orders, the client is prescribed albuterol (Proventil) via nebulizer every 8 hours for 3 days, followed by one dose daily thereafter. Which instruction should the nurse include when teaching the client about nebulizer use?

2. "You should take your pulse before and after treatment; if your pulse rate increases by more than 30 beats/minute you should notify your physician."

The nurse is preparing to give a 9-year-old client a preoperative I.M. injection. Which size needle should the nurse use?

2. 22G, 1"

After a client receives an I.M. injection, he complains of burning pain in the injection site. Which nursing action would be the best to take at this time?

2. Apply a warm compress to dilate the blood vessels.

A client is to receive a glycerin suppository. Which nursing action is appropriate when administering a suppository?

2. Applying a lubricant to the suppository

The nurse prepares to administer a buccal medication. Where should the nurse place this medication?

2. Between the client's cheek and gum

A client with an I.V. line in place complains of pain at the insertion site. Assessment of the site reveals a vein that is red, warm, and hard. Which of the following actions should the nurse take? Select all that apply:

2. Discontinue the infusion. 4. Have the registered nurse restart the infusion in the opposite arm. 5. Apply warm soaks to the I.V. site. 6. Document assessment of the I.V. site, the nurse's actions, and the client's response to the situation.

Which I.M. sites are appropriate for the nurse to use in an adult client? Select all that apply:

2. Dorsogluteal muscle 3. Deltoid muscle 4. Vastus lateralis muscle 5. Rectus femoris muscle

A client is being discharged after cataract surgery. After providing medication teaching, the nurse asks the client to repeat the instructions. The nurse is performing which professional role?

2. Educator

The nurse is caring for a 72-year-old client with heart failure. When administering drug therapy, the nurse must stay especially alert for adverse effects. Which factor makes geriatric clients more vulnerable than younger clients to adverse drug effects?

2. Hepatic and renal changes

The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

2. Hypokalemia

The nurse is monitoring the effectiveness of a client's drug therapy. When should the nurse obtain a blood sample to measure the trough drug level?

2. Immediately before administering the next dose

A client who underwent abdominal surgery returns from the postanesthesia care unit with a nasogastric (NG) tube in place. The client complains of nausea. While preparing to attach the client's NG tube to intermittent suction, the nurse notices that the ground on the suction machine's plug is broken. What should the nurse do first?

2. Obtain another machine from central supply.

Which moral principle is the nurse applying by deciding what is best for a client and acting without consulting that client?

2. Paternalism

When checking a client's medication profile, the nurse notes that the client is receiving a drug that is contraindicated in clients with glaucoma. The nurse knows that this client has a history of glaucoma and has been receiving the medication for the past 3 days. What should the nurse do first?

2. Report the information to the physician to ensure client safety.

A nurse is teaching a client about a newly prescribed drug. What could cause a geriatric client to have difficulty learning about prescribed medications?

2. Sensory deficits

After reconstituting a multidose vial of medication, the nurse writes the date and time of reconstitution on the vial label. What else should the nurse write on the label?

2. Strength of the medication

The nurse receives a medication order from a physician over the telephone. How should the nurse handle this situation?

2. Verify the order by repeating it back to the physician over the phone.

The nurse is caring for a client who is taking an anticoagulant. The nurse should teach the client to:

2. avoid foods high in vitamin K.

A client is receiving furosemide (Lasix), 40 mg by mouth twice per day. In the plan of care, the nurse should emphasize teaching the client about the importance of consuming:

2. bananas and oranges.

A nurse must verify a client's identity before administering medication. The safest way to verify identity is to:

2. check the client's identification band and ask the client his name.

The nurse is administering sublingual nitroglycerin to the client. Immediately afterward, the client may experience:

2. throbbing headache or dizziness.

The nurse is to give a client a 325-mg aspirin suppository. The client has diarrhea and is in the bathroom. The best nursing approach at this time would be to:

2. withhold the suppository and notify the client's physician.

A client is prescribed clozapine (Clozaril) 250 mg by mouth daily. How many tablets should the nurse administer if each tablet contains 100 mg?

2.5

The physician prescribes 20 units of U-100 regular insulin for a client. The only syringe available is a 1-ml tuberculin syringe. How many milliliters of insulin should the nurse administer?

3. 0.2

The label of a drug package reads "hydralazine (Apresoline), 20 mg/ml." How many milliliters would the nurse give a client for a 25-mg dose?

3. 1.25

The physician prescribes an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, the client should receive how many milliliters of I.V. fluid per hour?

3. 120 ml/hour

The nurse is caring for a client who underwent internal fixation of the right hip. Before administering the client's warfarin (Coumadin), the nurse checks the laboratory report for the client's International Normalized Ratio (INR) results. Which of the following indicates the therapeutic range for this client?

3. 2.0 to 3.0

The nurse is administering ampicillin (Polycillin) 125 mg I.M. every 6 hours to a 10-kg child with a respiratory tract infection. The drug label reads, "The recommended dose for a client weighing less than 40 kg is 25 mg to 50 mg/kg/day I.M. or I.V. in equally divided doses at 6- to 8-hour intervals." The drug concentration is 125 mg/5 ml. Which nursing interventions are appropriate at this time? Select all that apply:

3. Assess the client for allergies to penicillin. 4. Administer the medication because it's within the dosing recommendations. 6. Obtain a sputum culture before administering the medication.

The physician orders an I.M. injection for a client. Which factor may affect the drug absorption rate from an I.M. injection site?

3. Blood flow to the injection site

A client who's aphasic and has left-sided paralysis after sustaining a stroke is scheduled for debridement of a left leg ulcer. Whenever passive range-of-motion (ROM) exercises are performed on the left leg, the client grimaces and moans. Which action should the nurse take before the physician performs the debridement?

3. Check the client's medication administration record to see when he last received pain medication and administer a dose, if appropriate, before debridement.

When checking a client's I.V. insertion site, the nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

3. Check the tubing for kinks and reposition the client's wrist and elbow.

A client who's admitted with new-onset diabetes mellitus is prescribed an 1,800-calorie diabetic diet. His insulin orders include regular insulin coverage using a sliding scale, and long-acting insulin every morning just before breakfast. Why was the sliding scale insulin coverage prescribed?

3. Directs the nurse to administer regular insulin doses according to finger-stick glucose levels without notifying the physician

A nurse is caring for a client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/μl. The client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour. He reports severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, the nurse should avoid which route?

3. I.M.

A client is scheduled for surgery at 8 a.m. While completing the preoperative checklist, the nurse sees that the surgical consent form hasn't been signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation?

3. Notifying the surgeon that the consent form hasn't been signed

A client with hypothyroidism is prescribed levothyroxine (Synthroid) 0.05 mg by mouth daily before breakfast. As the nurse gives the client the medication, the client states, "What dose am I getting? I've been taking 0.15 mg every day for years." Which action by the nurse is most appropriate?

3. Verifying the dose with the physician's order on the client's medical record

After intentionally taking an overdose of amitriptyline (Elavil), a client is admitted to the emergency department. The nurse knows that the activated charcoal given to the client will:

3. bind with the ingested drug.

The nurse administers an I.M. injection. Afterward, the nurse should:

3. discard the uncapped needle in a puncture-proof container.

Following a fall from a horse during rodeo practice, an 18-year-old client is seen in the emergency department. He has a large, dirty laceration on his leg. The wound is vigorously cleaned, closed, and dressed. In the past, the client has received the full immunization regimen for tetanus toxoid. The nurse asks the client about his tetanus immunization history, and he says, "I had my last shot when I was 11 years old." The nurse should:

3. plan on administering a dose of tetanus vaccine.

The physician prescribes 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?

3. ½ ml

The physician orders heparin, 7,500 units, to be administered subcutaneously every 6 hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much heparin for each dose?

3. ¾ ml

When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

4. 90 degrees.

The nurse is teaching a client how to administer subcutaneous (subQ) insulin injections. Which injection site would be appropriate for the client to use?

4. Anterior aspect of the thigh

The nurse is identifying a unit of packed red blood cells with a coworker before administration. The client's blood type is AB negative. Which blood type can safely be administered to this client?

4. B negative

A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What should the nurse do to resolve this problem?

4. Check for availability of a liquid preparation

When a nurse brings prescribed medication to a client, the client says she usually takes a white tablet, not the yellow tablet that the nurse has brought. What should the nurse do first?

4. Check the name and strength of the medication again.

A client with a fluid volume deficit is receiving an I.V. infusion of dextrose 5% in water and lactated Ringer's solution at 125 ml/hour. Which data collection finding indicates the need for additional I.V. fluids?

4. Dark amber urine

What is the best way for the nurse to improve client compliance with the prescribed medication schedule?

4. Devise the simplest medication schedule possible.

A client admitted with bacterial pneumonia is prescribed cefuroxime axetil (Ceftin) 550 mg I.V. every 4 hours. While assessing the client, the nurse notices that cefazolin (Ancef) 500 mg I.V. is infusing. Which action by the nurse is most appropriate?

4. Discontinuing the medication and notifying the physician of the error

Which type of solution, when administered I.V., would cause a shift of fluid from the interstitial space to the intravascular space?

4. Hypertonic

A drug must enter the bloodstream before it can act within the body. Which parenteral administration route places a drug directly into the circulation, requiring no absorption?

4. I.V.

The nurse is preparing to administer a flu shot to an elderly client. How should the nurse proceed? Rank in chronological order. Use all the options.

4. Put gloves on 3. Locate the Deltoid muscle 5. Clean the injection site with an alcohol pad 6. Expel air bubbles from the syringe 1. Gently stretch the skin taut at the sites 2. Inject it into the muscle at a 90 degree angle

The nurse has an order to administer an I.M. injection using the Z-track technique. When carrying out this order, what should the nurse do?

4. Simultaneously withdraw the needle and release the skin.

A client is to receive several oral medications. Which nursing instruction or action is appropriate in this situation?

4. Stating the name and action or use of each medication before administering it

The nurse is teaching a client how to rotate insulin injection sites. What is the purpose of rotating injection sites?

4. To prevent the formation of hard nodules

After intentionally taking an overdose of hydrocodone (Vicodin), a client is admitted to the emergency department. Activated charcoal is prescribed. Before administering the drug, the nurse should ensure that the client:

4. has audible bowel sounds.