nclex style: Safety and Quality

4. The pediatric nurse reviews a hand-written medication order which reads, 09/16/2013, acetaminophen 160 mg (5 mL) PO q4h for fever. What will the nurse do next? a. Administer the drug when indicated. b. Ask the provider to confirm if dose is correct for the patients age. c. Clarify the nursing assessments necessary for giving a dose. d. Contact the provider to request patient allergy information.

ANS: C This order contains all components except the level of temperature necessary to justify a dose of an antipyretic. The patients age and allergy information are part of the medical record data base.

7. The nurse is preparing to administer a chewable tablet to a preschool-age child. The childs parent reports always crushing the tablet and mixing it with pudding when giving it at home. What is the nurses next action? a. Ask the pharmacist if the drug may be crushed. b. Crush the tablet and mix it with pudding. c. Insist that the tablet must be chewed as ordered. d. Request a liquid form of the medication from the pharmacy.

a. Ask the pharmacist if the drug may be crushed. ANS: A Nurses should not crush or mix medications in other substances without consultation with a pharmacist or a reliable drug reference. Even if the family has been doing this at home, the nurse must still determine safety and efficacy. If the medication cannot be crushed or mixed into another substance, the nurse may need to insist on the child taking the dose as ordered or may need to ask the provider to prescribe a different form of the medication.

3. A health care provider calls a nursing unit to leave a telephone order for a PRN antipyretic medication for a child. The provider tells the nurse to give PO acetaminophen for a fever greater than 101 F per protocol. What will the nurse do next? a. Ask the provider to verify how many mg per kg per dose and how frequently to give the medication. b. Look up the protocol in the unit manual and write the drug order for the provider to sign. c. Provide the childs weight to the hospital pharmacist to write the order based on the protocol. d. Transcribe the verbal order to the order sheet as give PO acetaminophen for a fever greater than 101 F per protocol.

a. Ask the provider to verify how many mg per kg per dose and how frequently to give the medication. ANS: A The components of a drug order include drug name, dose, route, frequency, and any instructions for dosing. A nurse receiving a telephone order should read back the order from the provider that includes this information. The provider, and not the nurse or the pharmacist, is responsible for writing the order with all components.

13. Which is a violation of a nurses right when administering medications? a. A hospital policy for off-label drug uses b. A medication preparation area at the unit secretarys desk c. A multiple-dose drug vial requiring the nurse to calculate and measure the dose d. A new drug ordered that the nurse must look up in a drug manual

b. A medication preparation area at the unit secretarys desk ANS: B Nurses have a right to administer drugs safely and have the right to stop, think, and be vigilant when administering medications. Another workers desk will be noisy, with many distractions. Many drugs are used for off-label purposes; having a hospital policy helps ensure safety. Single-dose vials are more convenient and help to reduce calculation errors, but multi-dose vials are often used; nurses unsure of calculations should check their work with another nurse. Nurses frequently have to look up information on new drugs, and hospitals should offer reasonable access to current information.

10. The nurse assumes care of a patient who had surgery that morning. The provider has ordered hydrocodone (Lortab) every 4 hours for mild to moderate pain and morphine sulfate for moderate to severe pain. The nurse reviews the patients record and notes the patient has received two doses of hydrocodone 4 hours apart for a pain level of 7 to 8 on a scale of 1 to 10 and has reported a decrease in pain to a level of 6 to 7 after 30 minutes. It has been 4 hours since the last dose, and the patient reports a pain level of 7. What will the nurse do? a. Administer the hydrocodone. b. Administer morphine. c. Ask the patient which drug to give. d. Notify the provider of the patients current pain level.

b. Administer morphine. ANS: B The previous nurse has documented a poor response to pain medication given for mild to moderate pain. The nurse should administer the medication ordered for moderate to severe pain. Hydrocodone has not been effective and should not be given. The nurse bases the drug selection on the patients evaluation of pain, not on which drug the patient wants. The provider has written an order with nursing evaluations specified, so there is no need for the nurse to notify the provider.

9. The nurse is caring for a patient who has asthma. The provider has ordered an albuterol metered-dose inhaler (MDI), 2 puffs q4 to 6h PRN wheezing. The patients last dose was 4 hours ago. What is the nurses next action? a. Administer 2 puffs of albuterol with the MDI. b. Auscultate the patients lung sounds. c. Give the albuterol if the patient reports wheezing. d. Give the medication and evaluate its effectiveness.

b. Auscultate the patients lung sounds. ANS: B The albuterol is to be given PRN if the patient is wheezing. The nurse should assess breath sounds and give the medication if the patient is wheezing. Even if the patient reports wheezing, the nurse should make and document an assessment.

11. The nurse is caring for a patient who will begin taking a thiazide diuretic to treat hypertension. The patient says, I know this will lower my blood pressure, but how does it work? How will the nurse respond? a. It can cause orthostatic hypotension, so be careful. b. It reduces the volume of fluid in your blood stream to lower blood pressure. c. The actions are complicated, but its an effective drug. d. Your provider should explain this medication to you.

b. It reduces the volume of fluid in your blood stream to lower blood pressure. ANS: B Patients have a right to understand how the drugs they are taking work and to know about side effects. The nurse should explain how the medication can cause orthostatic hypotension after addressing the patients current question. Telling the patient that the drug actions are complicated is disrespectful. Nurses are responsible for educating patients about medications.

8. The nurse is caring for a patient who will have surgery that morning. The patient usually takes an antihypertensive medication every morning. The patient has been NPO since midnight. What action will thenurse perform? a. Ask the patient to swallow the pill without water. b. Give the medication with a small sip of water. c. Consult the provider and surgeon about giving the medication. d. Hold the medication until after the patients surgery.

c. Consult the provider and surgeon about giving the medication. ANS: C The patients provider or surgeon should determine the importance of giving the medication along with the safety of administering it prior to anesthesia. The nurse should not give the medication with or without water without the providers permission.

6. The nurse is preparing to administer a medication from a unit-dose system. The nurse verifies that the medication, dose, and time are correct and that the expiration date was the day prior. Which action is correct? a. Administer the medication and observe for adequate drug effects. b. Notify the pharmacist and provider of a medication error. c. Return the medication to the pharmacy to be replaced. d. Verify the right patient and administer the medication.

c. Return the medication to the pharmacy to be replaced. ANS: C If a drug expiration date has passed, it should be returned to the pharmacy or discarded, never used. A medication error would occur only if the medication was given.

5. The nurse is caring for a 20-kg child who is ordered to receive amoxicillin 400 mg PO TID for 10 days. The nurse reviews the drug information and notes that the correct dose of amoxicillin is 40 to 50 mg/kg/day in two to three divided doses. Which action by the nurse is correct? a. Adjust the drug dose based on drug manufacturer dosing information. b. Administer the medication as ordered. c. Ask the pharmacist to double-check that the dose is correct. d. Contact the provider and ask whether the drug should be given BID instead of TID.

d. Contact the provider and ask whether the drug should be given BID instead of TID. ANS: D The correct range for this drug for this child is 800 to 1000 mg per day. If 400 mg were administered TID, it would result in 1200 mg per day being administered. Twice daily (BID) dosing would be in the correct range.

1. When the nurse practices the 5-plus-5 rights of medication administration, what does it ensure? a. Adequate information is given b. Cost-effective use of medications c. Informed consent for drug administration d. Safe administration of medications

d. Safe administration of medications ANS: D The 5-plus-5 rights ensure that the nurse has considered all of the details of safe medication administration. Giving information to patients and obtaining informed consent are part of the 5-plus-5 rights. Cost effectiveness is not part of the 5-plus-5 rights.

2. In order to ensure that a medication is given to the right patient, the nurse must perform which action? a. Ask the patient to spell their last name. b. Match the patient with a photo ID. c. Swipe a bar code on the patients ID bracelet. d. Verify the patient using two identifiers.

d. Verify the patient using two identifiers. ANS: D The Joint Commission requires two forms of identification before medication administration. Patients are asked to state their name and date of birth. Some, but not all institutions, use photos and bar codes to aid in identification.