Pharmacotherapeutics - Ch 26 - Plus/Davis Questions

4 (Rationale Option 1: This is done with lotions, creams, or ointments. Option 2: This is unnecessary. When the powder is sprinkled gently on the site, the powder should not become aerosolized. Option 3: This is not a universal requirement. When necessary, a dressing is applied with a practitioner's order. Option 4: Moisture harbors microorganisms and when mixed with a powder will result in a paste-like substance. The site should be clean and dry before medication administration to ensure effective action of the drug.)

. A practitioner prescribes a medicated powder to be applied to a patient's skin. What is most essential for the nurse to do when applying the medicated powder? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Analysis [Analyzing] 1. Apply a thin layer in the direction of hair growth 2. Protect the patient's face with a towel 3. Dress the area with dry sterile gauze 4. Ensure that the skin surface is dry

4

3. A client you are caring for has developed respiratory depression as a result of excessive morphine. This is an example of which of the following drug effects? 1) Primary effect 2) Side effect 3) Adverse reaction 4) Toxic reaction

6

A child has a surgical repair of an inguinal hernia and the health-care provider prescribes acetaminophen (Tylenol) 192 mg PO every 4 hours x four doses. Liquid Tylenol is available 160 mg/5 mL. How many milliliters should the nurse administer? Record your answer using a whole number.

2

A client comes into the physician's office where you work complaining that his prescription narcotic has expired after only 7 days and requesting a new prescription, this time for a longer period of time. You explain that you will be happy to ask the physician about renewing the prescription, but that time frame that the prescription is in effect is set by protocol and may not be altered. Which type of prescription is the narcotic most likely to be? 1) Standard written prescription 2) Automatic stop date 3) STAT 4) Standing order

3

A client just admitted with an acute myocardial infarction (heart attack) is prescribed heparin (an anticoagulant) 2,000 units IV now. Which action should the nurse take first before administering this medication? 1) Make sure the informed consent is signed. 2) Verify the prescription with the provider. 3) Check the laboratory results of coagulation studies. 4) Be sure a signed HIPPA form is on the chart.

1

A health-care provider orders eplerenone (Inspra) 100 mg/day in two divided doses PO for a client diagnosed with fluid volume excess and hypertension secondary to primary hyperaldosteronism. The dose of eplerenone on hand is 50 mg/tablet. How many tablets should a nurse administer to the client every 12 hours? Record your answer as a whole number.

10

A health-care provider prescribes ampicillin (Omnipen) 250 mg every 6 hours. An oral suspension is obtained because the patient has difficulty swallowing pills as a result of a brain attack (stroke). The bottle of ampicillin (Omnipen) indicates there are 125 mg/5 mL. How much oral suspension should the nurse administer? Record your answer using a whole number.

2

A health-care provider prescribes digoxin (Lanoxin) 0.25 mg once a day by mouth. The pharmacy supplies digoxin 0.125 mg/tablet. How many tablets should the nurse administer? Record your answer using a whole number.

2.5

A health-care provider prescribes diltiazem (Cardizem) 75 mg po t.i.d. The scored Cardizem tablets are labeled 30 mg/tablet. How many tablets should the nurse administer? Record your answer using 1 decimal place.

3

A hospitalized patient's medical record contains the following medication prescription. The patient's name is stamped on the order sheet. Which prescription is complete? 1) Furosemide 40 mg IV daily 2) 5/26/13—digoxin 0.25 mg IV daily, G. Horowitz RN 3) 5/28/13—0930—K-lor 40 mEq PO now, James Carp MD 4) 5/29/13—metopropol 5 mg IV q 6 hours, Robert Young DO

38

A newly diagnosed client with type 1 diabetes mellitus asks a nurse how much regular insulin he should expect to self-inject over the course of an entire day. The nurse reinforces that the client should follow his prescribed insulin schedule carefully and informs the client that the general calculation for the body's daily insulin requirement is the client's weight in pounds divided by 4. If the client weighs 150 pounds, how many units of insulin should the client require each day? Record your answer as a whole number.

3

A nurse concludes that a transdermal patch is the most effective route for the delivery of an analgesic for a patient with cancer. Which rationale supports the nurse's conclusion? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Analysis [Analyzing] 1. Has an immediate systemic effect 2. Affects only the area covered by the patch 3. Releases controlled amounts of medication over time 4. Produces fewer side effects than other routes of administration

1

A nurse enters a patient's room to administer a drug that is in the form of a tablet. The patient states, "I am nauseated and feel like I am going to vomit." What should the nurse do next in relation to administering the medication? Course Topic: Medication Administration Concept(s): Collaboration; Communication; MedicationCognitive Level: Application [Applying] 1. Obtain a prescription for an alternate route of administration. 2. Give the medication and hope that the patient does not vomit. 3. Obtain a liquid form of the prescribed medication and give it to the patient. 4. Hold the medication for an hour and a half and then attempt to give it again.

3 (Rationale Option 1: Instilling medication into the conjunctival sac prevents the trauma of drops falling on the cornea. Option 2: Closing the eyes gently, rather than squeezing the lids shut, prevents the loss of medication from the conjunctival sac. Option 3: Closing the eyes moves the medication over the conjunctiva and eyeball and helps ensure an even distribution of medication. Option 4: Gentle pressure over the inner canthus for 1 minute after administration prevents medication from entering the lacrimal duct.)

A nurse instructs a patient to close the eyes after the administration of eye drops. What rationale for this instruction should the nurse explain to the patient? Course Topic: Medication Administration Concept(s): Medication; Nursing RolesCognitive Level: Application [Applying] 1. Limits corneal irritation 2. Squeezes excess medication from the eyes 3. Disperses the medication over the eyeballs 4. Prevents medication from entering the lacrimal duct

3 (Rationale Option 1: There is no advantage in prolonging the treatment. Option 2: Slow, deep breathing will limit hyperventilation. Option 3: A pause at the height of inspiration will promote distribution and absorption of the medication before exhalation begins. Option 4: Slow inhalations and exhalations with pursed lips help prevent bronchial spasms.)

A nurse instructs a patient to inhale deeply and hold each breath for a second when using a hand-held nebulizer. The patient asks, "Why do I have to hold by breath?" The nurse responds, "This technique will: Course Topic: Medication Administration Concept(s): Medication; Nursing RolesCognitive Level: Application [Applying] 1. Prolong treatment." 2. Limit hyperventilation." 3. Disperse the medication." 4. Prevent bronchial spasms."

2

A nurse is administering medication to a patient in a geriatric facility. The nurse anticipates the risk of drug toxicity in this older adult primarily because of a decrease in the patient's: Course Topic: Medication Administration Concept(s): Critical Thinking; MedicationCognitive Level: Analysis [Analyzing] 1. Serum calcium level 2. Glomerular filtration 3. Red blood cell count 4. Frequency of voiding

4 (Rationale Option 1: An intramuscular site, preferably the dorsogluteal, is used for Z-track, not the abdomen, which is used for subcutaneous injections. Option 2: The buttocks are not divided by a "Z." When the buttocks (dorsogluteal) are used for intramuscular injections, the usual bony landmarks must be used to identify the correct insertion site. Option 3: The air-lock technique also can be done with intramuscular injections. When air is injected behind the medication, the air clears the needle of medication. This technique is controversial and is being researched for evidenced-based practice. Option 4: The "Z" in the Z-track method refers to pulling the skin to the side before and during an intramuscular injection. This technique alters the position of skin layers so that after the skin is released and the needle is removed, the injected fluid is kept within the muscle tissues and does not rise in the needle tract, which can irritate subcutaneous tissues.)

A nurse is administering medication via the Z-track injection method. What action is unique to this procedure? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. The injection sites are rotated along a "Z" pattern on the abdomen. 2. A "Z" is formed when dividing the buttocks into quadrants. 3. An air lock is established behind the bolus of medication. 4. The skin is pulled laterally before needle insertion.

4

A nurse is administering medications via several parenteral routes. Which nursing intervention should the nurse plan to perform regardless of the parenteral route? Course Topic: Medication Administration Concept(s): Critical Thinking; Medication; SafetyCognitive Level: Application [Applying] 1. Recap the used needle. 2. Massage the site after administration. 3. Hold the skin taut before insertion of the needle. 4. Wipe the site with alcohol before needle insertion.

3 (Rationale Option 1: Water will not increase the absorption of medications administered orally. Water will facilitate the swallowing of and the movement of the medication down the esophagus to the stomach. Option 2: The time of day does not influence the rate of absorption of medications administered orally. Option 3: Food can delay the dissolution and absorption of many drugs; therefore, most oral medications should be administered on an empty stomach. Oral medications should be administered with food only when indicated by the manufacturer's directions. Option 4: Physical rest does not influence the rate of absorption of medications administered orally.)

A nurse is administering oral medications to several patients. It is important that the nurse anticipate that oral medications are absorbed more quickly when they are given: Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. With water 2. In the morning 3. On an empty stomach 4. When the patient is resting

4002

A nurse is admitting a client diagnosed with chronic kidney disease who is receiving calcium acetate (PhosLo) 2 tablets with each meal three times per day as ordered. Each tablet contains 667 mg of calcium acetate. How many milligrams of calcium acetate should the nurse record that the client receives daily? Record your answer as a whole number.

1, 3, 4

A nurse is applying a transdermal patch to a patient's upper arm. Which nursing actions are essential for every patient to complete this procedure? Select all that apply. Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Wear clean gloves when removing and applying a medicated patch. 2. Shave body hair in the area that the medicated patch is to be applied. 3. Wash and dry the area where the previous medicated patch was removed. 4. Compress the medicated patch against the skin for 10 seconds after it is applied. 5. Remove the previous medicated patch one hour after applying the new medicated patch.

4

A nurse is assessing the blood glucose level of a client diagnosed with diabetic ketoacidosis who is being converted to subcutaneous sliding scale insulin. The nurse calculates the high blood glucose correction insulin dose using the following formula: High blood sugar correction dose = Actual blood sugar - Target blood sugar ÷ Correction factor (50). Knowing that the client's target blood sugar should be 100 mg/dL, how many units of insulin should the nurse administer to the client if the client's actual blood sugar is 280 mg/dL? Record your answer as a whole number.

4

A nurse is caring for a patient receiving a steroidal nasal spray. For which nontherapeutic effect should the nurse assess the patient? Course Topic: Medication Administration Concept(s): Assessment; Critical Thinking; MedicationCognitive Level: Application [Applying] 1. Dry mouth 2. Blurred vision 3. Urinary retention 4. Oral fungal infection

2

A nurse is caring for a patient who has a prescription for 500 mg of azithromycin (Zithromax). It is available in 250-mg tablets. How many tablets should the nurse administer to the patient? Record your answer using a whole number.

a

A nurse is caring for a patient who is to be tested for tuberculosis. Which injection route should the nurse use to inject tuberculin purified protein derivative?

3

A nurse is planning to apply a transdermal patch to a patient. What action should the nurse implement? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Use the same area each time to limit skin irritation and excoriation 2. Rub the area to promote comfort and vasodilation before applying the patch 3. Shave the area to facilitate adherence of the patch and medication absorption 4. Remove the old patch an hour after applying the new patch to ensure a therapeutic blood level of the drug

4 (Rationale Option 1: Although insulin can be administered at the deltoid site, it is a small area that is not conducive to injection rotation within the site. The rate of absorption at this site is slower than at the preferred site for insulin administration. Option 2: Although insulin can be administered in this site, the tissue of the thighs and buttocks have the slowest absorption rate. Option 3: This site is not acceptable for the administration of insulin because of the lack of adequate subcutaneous tissue. Option 4: The abdomen is the preferred site for administration of insulin because it is a large area that promotes a systematic rotation of injections and it has the fastest rate of absorption.)

A nurse is preparing to administer a subcutaneous injection of insulin. What site should the nurse use to best promote its absorption? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Upper lateral arms 2. Anterior thighs 3. Upper chest 4. Abdomen

2 (Rationale Option 1: This is unsafe. This exposes the medication to the environment where it may become contaminated or grouped with other medications being administered to the patient, thus interfering with safe administration of one or more of the medications. Option 2: The medication should be opened and administered immediately to the patient, limiting the potential for contamination. Reading the label immediately before opening the package is an additional safety check. Immediate administration prevents accidental disarrangement of medications that may result in a medication error. Option 3: This is unsafe. It unnecessarily exposes the medication to the environment because it requires the nurse to carry the medication through the unit to the patient's room. In addition, it can become confused with the medications for other patients. Option 4: This is unsafe. The medication is exposed unnecessarily to the environment and it can be inadvertently confused with the medications for other patients.)

A nurse is preparing to administer a tablet to a patient. When should the nurse remove the medication from its unit dose package? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Outside the door to the patient's room 2. At the patient's bedside 3. In the medication room 4. At the medication cart

115

A nurse is preparing to administer an insulin drip to a client diagnosed with diabetic ketoacidosis. A health-care provider orders an initial infusion of 23 units/hr of regular insulin IV. The pharmacy supplies 100 units of regular insulin in 500 mL of 0.9% (normal) saline solution. How many milliliters of solution should the nurse infuse hourly? Record your answer as a whole number.

100

A nurse is preparing to administer an insulin drip to a client with a blood glucose level of 600 mg/dL and an arterial blood pH of 7.21. A physician orders an initial IV infusion of 20 units of regular insulin per hour. The pharmacy supplies 100 units of regular insulin in 500 mL of 0.9% saline solution. How many milliliters of solution should the nurse infuse hourly? Record your answer as a whole number.

1 (Rationale Option 1: This will ensure a tight seal and a closed system. If not firmly connected, the hub of the needle may disengage from the barrel of the syringe during preparation or administration of the medication when internal and external pressures are exerted on the needle and syringe. Option 2: The top just needs to be swiped. Rubbing back and forth is a violation of surgical asepsis because it reintroduces microorganisms to the area being cleaned. Option 3: This should be avoided because it causes bubbles that may interfere with the drawing up of an accurate volume of solution. Option 4: Excess air in the closed system raises pressure in the vial which may cause bubbles when withdrawing the fluid and result in an inaccurate volume of solution.)

A nurse is preparing to draw up medication from a vial. What should the nurse do first? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Ensure that the needle is firmly attached to the syringe 2. Rub vigorously back and forth over the rubber cap with an alcohol swab 3. Inject air into the vial with the needle bevel below the surface of the medication 4. Draw up slightly more air than the volume of medication to be withdrawn from the vial

1 (Rationale Option 1: The dorsal recumbent position (supine position with the hips and knees bent) allows easy access to and exposure of the vaginal orifice. Lying in this position for 10 minutes after administration of the vaginal cream prevents its drainage from the vaginal canal. Option 2: The low-Fowler position does not thoroughly expose the vaginal orifice. Option 3: The left-lateral position does not thoroughly expose the vaginal orifice. This position is used for the administration of enemas and rectal suppositories. Option 4: The supine position does not expose the vaginal orifice.)

A nurse is preparing to instill a vaginal cream. What position should the nurse instruct the patient to assume? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Dorsal recumbent position 2. Low-Fowler position 3. Left-lateral position 4. Supine position

3

A nurse is to administer an intramuscular injection into the deltoid muscle. What bony landmark should the nurse use to help locate the appropriate site? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Knee 2. Greater trochanter 3. Acromion process 4. Anterior superior iliac spine

1, 2, 3, 4 (Rationale Option 1: This ensures that the appropriate site is evaluated. Option 2: Immunosuppressants can cause a false-positive result. Option 3: A severe reaction may occur when the PPD is injected into a patient who had a previous positive reaction; the patient has been immunosensitized. Option 4: The intradermal route is used for this test. The allergen is injected just below the epidermis, where a reaction will be able to be observed. Option 5: This will result in an inaccurate evaluation. The site of the intradermal injection of PPD should be evaluated within 48 to 72 hours after the PPD is injected.)

A nurse is to perform a purified protein derivative (PPD) test on a patient who was exposed to a person with the diagnosis of tuberculosis. What are essential nursing interventions related to this test? Select all that apply. Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Encircle the injection site with an indelible pen. 2. Identify if the patient is taking an immunosuppressant. 3. Determine if the patient had a previous positive reaction. 4. Inject the purified protein derivative via an intradermal injection. 5. Explain that the results must be evaluated within 24 hours.

3

A nurse must administer a medication that is supplied in an ampule. What should the nurse do first to access the ampule? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Inject the same amount of air as the fluid to be removed 2. Wipe the constricted neck with an alcohol swab 3. Break the constricted neck using a barrier 4. Insert the needle into the rubber seal

4 (Rationale Option 1: The Z-track technique is used for an intramuscular injection. A 25-gauge needle is too thin and fragile as well as too short (usually is ½ to 1 inch in length) for an intramuscular injection. In addition, medications administered via the Z-track technique are thick (viscous) and require a needle gauge of 18 to 22. Option 2: This is unsafe because medication clinging to the outside of the needle can irritate tissue along the needle tract. The Z-track technique is used for medications that are known to irritate or discolor subcutaneous tissue. Therefore, the needle should be changed so that there is no medication residue on the needle during insertion. Option 3: A 1-inch needle is used for subcutaneous injections. The Z-track technique is used for an intramuscular injection. Therefore, a needle length of 1½ inches should be used to ensure access to a muscle. Option 4: Pulling the skin and subcutaneous tissue to the side establishes a zigzag path before needle insertion; when the skin is released after insertion of the medication the tissue planes slide across each other confining the medication in the muscle and preventing it from flowing back up the needle track.)

A nurse observed another nurse administering an injection via the Z-track technique. Which action by the nurse indicated that the technique was performed correctly? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Obtained a syringe with a 25-gauge needle for the procedure 2. Used the same needle for drawing up and administering the medication 3. Attached a needle with a 1-inch length after the medication was drawn into the syringe 4. Pulled the skin laterally before insertion of the needle and removed the needle at the same angle of its insertion

1

A nurse plans to administer a 3-mL intramuscular injection. Which muscle is the least desirable to use for the administration of this medication? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Deltoid 2. Dorsogluteal 3. Ventrogluteal 4. Vastus lateralis

3

A nurse teaches a patient about taking a sublingual nitroglycerin tablet. The nurse evaluates that the patient understands the teaching when the patient states, "I should place it: Course Topic: Medication Administration Concept(s): Medication; Nursing RolesCognitive Level: Analysis [Analyzing] 1. On my skin." 2. Inside my cheek." 3. Under my tongue." 4. In my eye on the lower lid."

1 (Rationale Option 1: Rinsing the mouth removes any remaining medication. This prevents irritation to the oral mucosa and tongue and prevents oral fungal infections. Option 2: This may not mix the medication adequately and result in an inadequate dose. The canister should be shaken several times before use. Option 3: When an extender (spacer) is used with a metered-dose inhaler the mouthpiece of the extender should be placed in the mouth over the tongue with the teeth and lips tightly around the mouthpiece. Option 4: The patient should be in an upright (standing, sitting, or high-Fowler) position to promote lung expansion when inhaling.)

A nurse teaches a patient how to self-administer a corticosteroid via a metered-dose inhaler with an extender. Which behavior indicates to the nurse that the patient understands the teaching? Course Topic: Medication Administration Concept(s): Medication; Nursing RolesCognitive Level: Analysis [Analyzing] 1. Rinses the mouth with water after the treatment 2. Rolls the canister between the hands slowly before using the inhaler 3. Positions the mouthpiece directly in front of the mouth while inhaling 4. Assumes the semi-Fowler position with the head supported on a pillow

2

A patient calls the nurse because he is having incision pain and wants a dose of analgesic medication. When the nurse checks the patient's medication administration record, she notes that he is prescribed the narcotic hydromorphone (Dilaudid). Where should the nurse expect to retrieve this drug for administration? 1) Cabinet in the patient's room 2) Double-locked medication drawer 3) Stock supply cabinet 4) Portable medication cart

1 (Rationale Option 1: This ensures that a maximum amount of the drug is inhaled while the medication is still aerosolized. Option 2: The breath should be held for 10 seconds, or longer, to promote distribution and absorption of the medication. Option 3: One puff, not 2, should be delivered with each inhalation. Option 4: The inhalation should start with compression of the canister and continue for another 3 to 5, not 8 to 10, seconds to ensure distribution of the medication.)

A patient has a prescription for 2 puffs of a bronchodilator via a metered-dose inhaler. What should the nurse teach the patient to do when self-administering the medication? Course Topic: Medication Administration Concept(s): Medication; Nursing RolesCognitive Level: Application [Applying] 1. Start breathing in while compressing the canister 2. Hold the inspired breath for several seconds 3. Deliver 2 puffs with each inspiration 4. Inhale slowly for 8 to 10 seconds

2

A patient has an infected pressure ulcer. What should the nurse do when applying a topical antibiotic to the infected wound? Course Topic: Medication Administration Concept(s): Medication; Skin IntegrityCognitive Level: Application [Applying] 1. Use medical asepsis. 2. Apply a thin layer of medication. 3. Rub the medication into the skin surface. 4. Place it on the intact skin around the wound.

2

A patient has had difficulty sleeping and the health-care provider prescribes zolpidem (Ambien CR) 12.5 mg at bed time. The medication supplied by the pharmacy is 6.25 mg/tablet. How many tablets should the nurse administer? Record your answer using a whole number.

c

A patient is admitted to the emergency department for treatment after stepping on a rusty nail at a job site. The practitioner prescribes tetanus immune globulin 250 units IM stat. Which illustration indicates the angle at which this injection should be administered by the nurse?

3

A patient is prescribed fluoxetine 20 mg by mouth daily for treatment of depression. The nurse caring for the patient is unfamiliar with this drug. Which action should she take before administering the medication? 1) Inform the prescriber that she is not comfortable administering the drug. 2) Ask a nursing colleague for relevant information about the drug. 3) Consult the drug formulary accessible to staff at the patient care unit. 4) Trust that the prescriber wrote the correct dose and administer the drug as intended.

1

A patient is receiving a narcotic analgesic for pain associated with cancer of the pancreas. Several weeks after the initiation of therapy, the patient says to a nurse, "The medication does not control the pain as much as it did several weeks ago." What response to the medication should the nurse conclude this patient is experiencing? Course Topic: Medication Administration Concept(s): Comfort; Critical Thinking; MedicationCognitive Level: Analysis [Analyzing] 1. Tolerance 2. Potentiation 3. Adverse effect 4. Idiosyncratic reaction

1, 2, 3, 4 (Rationale Option 1: Oral antibiotics can interfere with the normal gastrointestinal (GI) flora. An active-culture yogurt will help maintain proper GI flora. Option 2: A white tongue may indicate a superinfection and warrants appropriate medical intervention. Option 3: Blood in the stool may indicate pseudomembranous colitis, which requires medical intervention. Option 4: Taking Keflex with food will limit GI irritation. Option 5: An increased fluid intake will not alter the potential side effects of Keflex.)

A patient is to begin a regimen of cephalexin (Keflex) by mouth for a pneumococcal infection. What actions should the nurse take to help the patient avoid complications from this medication? Select all that apply. Course Topic: Medication Administration Concept(s): Critical Thinking; MedicationCognitive Level: Application [Applying] 1. Suggest that the patient eat an active-culture yogurt while taking the medication. 2. Tell the patient to inform the clinic if the tongue develops a white coating. 3. Inform the patient to call the clinic if there is blood in the stool. 4. Advise the patient to take the medication with food. 5. Encourage the patient to drink more fluids.

2

A patient reports that he has been taking famotidine (Pepcid) for treatment of esophageal reflux disease. Pepcid is the _____________ name of the drug. 1) official 2) brand 3) chemical 4) generic

1

A patient with diabetes who is on insulin coverage has been receiving 3 to 4 injections of insulin a day. What is important for the nurse to do when administering these injections? Course Topic: Medication Administration Concept(s): Medication; Safety; Skin IntegrityCognitive Level: Application [Applying] 1. Alternate injection sites to minimize tissue injury. 2. Spread the skin to facilitate entry of the needle through the skin. 3. Instill the medication over 5 seconds to promote absorption of the medication. 4. Use a syringe with a needle that is 1½ inches long to ensure access to subcutaneous tissue.

31.5

A physician orders hydrochlorothiazide 3 mg/kg/day in two divided doses by mouth for a 46-pound child with edema secondary to congestive heart failure (CHF). How many milligrams of hydrochlorothiazide should a nurse administer to this child every 12 hours (twice daily)? Record your answer using one decimal place.

1.6

A physician orders hydrochlorothiazide oral solution 2 mg/kg/day in two divided doses for a 36-pound child with edema secondary to CHF. The dose on hand is 10 mg/mL. How many milliliters should a nurse administer to this child every 12 hours? Record your answer using one decimal place.

4

A physician orders spironolactone (Aldactone®) 400 mg/day in two divided doses by mouth for a client diagnosed with primary hyperaldosteronism. The dose of spironolactone on hand is 50 mg/tablet. How many tablets should a nurse administer to the client every 12 hours? Record your answer as a whole number.

31 (Solve the problem by using the following formula. Total volume to be infused x drop factor/Total time in minutes 125 mL x 15 drops per mL1 hour x 60 minutes 1875 mL60= 31.25)

A practitioner orders an IV infusion of 1000 mL of D5W with 20 mEq of potassium chloride to be administered at 125 mL/hr. The infusion set has a drop factor of 15/mL. At how many drops per minute should the nurse set the IV infusion? Record your answer using a whole number.

3 (Rationale Option 1: A medication that is aerosolized is inhaled. Option 2: A tablet, such as nitroglycerine (Nitrostat), is dissolved under the tongue. Option 3: A medicated patch or disk can be applied directly to the skin where the medication is released and absorbed over time. This method ensures a continuous therapeutic drug level and reduces fluctuations in circulating drug levels. Option 4: Medications in the form of a suppository are inserted into the rectum.)

A practitioner prescribes a medication that must be administered transdermally. The nurse determines that a drug administered transdermally is: Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Inhaled into the respiratory tract 2. Dissolved under the tongue 3. Absorbed through the skin 4. Inserted into the rectum

2

A practitioner prescribes an antibiotic of 400,000 units IVPB every 6 hours. The medication vial contains 1 million units with the following directions: add 4.6 mL of diluent to yield a concentrated solution of 200,000 units/mL. How much solution of the antibiotic should the nurse administer? Record your answer using a whole number.

1

A practitioner prescribes nose drops to be administered twice a day. What should the nurse do when instilling nose drops? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Place the patient in the supine position with the head tilted backward 2. Pinch the nares of the nose together briefly after the drops are instilled 3. Instruct the patient to blow the nose 5 minutes after the drops are instilled 4. Insert the drop applicator 1/8 inch into the nose toward the base of the nasal cavity

7.5

A practitioner prescribes ondansetron (Zofran) 6 mg to be administered via oral suspension to a 12-year-old child 30 minutes before chemotherapy and then every 8 hours for two more doses. The medication states that there are 4 mg/5 mL. How much oral solution should the nurse administer per dose? Record your answer using one decimal place.

4 (Rationale Option 1: This is unsafe and outside the legal role of the nurse. The administration of intravenous fluids is a dependent function of the nurse and the nurse should administer only the fluid ordered by the primary health-care provider. Option 2: This is unsafe. The time it takes to obtain the correct bag of solution will deprive the patient of the ordered therapy. The primary health-care provider ordered intravenous fluids that the nurse should institute as soon as possible. Option 3: This is an excessive dose of KCl and could harm the patient. Excessive potassium can cause cardiac dysrhythmias. Option 4: A 250 mL bag of 0.9% sodium chloride is ¼ of the solution ordered (1000 mL ÷ 250 mL = 4). Therefore, the nurse should divide the ordered amount of KCl by 4 (20 mEq ÷ 4 = 5 mEq) to determine the amount of KCl to add to a 250 mL bag of solution.)

A primary health-care provider orders 1000 mL of 0.9% sodium chloride with 20 mEq of KCl to be administered at 75 mL/hour. The nurse finds only 250 mL bags of 0.9% sodium chloride on the unit. What should the nurse do in this situation? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Use a 1000 mL bag of dextrose 5% in water with 20 mEq of KCl until the appropriate bag of solution is obtained. 2. Withhold starting the intravenous infusion until a 1000 mL bag of the appropriate solution is obtained. 3. Insert 20 mEq of KCl into a 250 mL bag of 0.9% sodium chloride and set it at 25 mL/hour. 4. Insert 5 mEq of KCl into a 250 mL bag of 0.9% sodium chloride and set it at 75 mL/hour.

1

A provider's prescription reads "diltiazem (Cardiazem) 5 mg IV now." Which type of prescription did the provider write? 1) STAT 2) single 3) prn 4) standing

1

A surgeon prescribes potassium chloride 20 mEq by mouth for a patient with a nasogastric (NG) tube for gastric drainage. How should the nurse proceed? 1) Seek clarification from the surgeon about the medication prescription. 2) Clamp the NG tube while administering the dose by mouth. 3) Instill the medication through the NG tube. 4) Withhold the oral potassium chloride elixir.

2

A visiting nurse is teaching a patient how to manage medication therapy in the home. What should the nurse encourage the patient to do with the medications to provide for safety? Course Topic: Medication Administration Concept(s): Medication; Nursing Roles; SafetyCognitive Level: Analysis [Analyzing] 1. Keep over-the-counter medication in a place separate from prescription drugs. 2. Put all medications in a dark, cool environment. 3. Place medications in a safe, secure place. 4. Lock leftover medication in a closet.

4

A woman arrives at your clinic complaining of vision problems, confusion, and excessive thirst. Seeing in her health record that she is diabetic, you assess her blood glucose level and find it to be over 300 mg/dL. You learn that she has not been taking her antidiabetic medication for months now. When you ask her why, she says that it's too expensive. Which of the following best describes this patient's behavior? 1) Polypharmacy 2) Misuse 3) Abuse 4) Noncompliance

1, 3, 5

Acetaminophen is a common drug that is classified in many different ways. Which of the following classifications associated with this drug identifies what it is used for (usage)? SELECT ALL THAT APPLY. 1) Antipyretic 2) Paraminophenol derivatives 3) Analgesic 4) Nervous system 5) Antiarthritic 6) Gastrointestinal

3 (Rationale Option 1: Massaging may be traumatic and may cause further bleeding. Option 2: Taking the patient's vital signs is unnecessary. The loss of a drop of blood will not influence vital signs. Option 3: Pressure constricts blood vessels, which limits bleeding. Option 4: Documentation of this event is unnecessary; although this is not an expected therapeutic response, it does occur occasionally because the needle may pierce a tiny blood vessel.)

After a nurse administers an intramuscular (IM) injection, a drop of blood appears at the injection site. What should the nurse do? Course Topic: Medication Administration Concept(s): Medication; SafetyCognitive Level: Analysis [Analyzing] 1. Massage the area gently. 2. Take the patient's vital signs. 3. Apply pressure with the antiseptic swab. 4. Document this reaction in the patient's chart.

50

An older adult is admitted to the hospital in heart failure. The primary health-care provider orders an IV of dextrose 5% water to infuse at 50 mL/hour. The nurse uses a microdrip infusion set that has a drop factor of 60. At what rate should the nurse administer the intravenous solution? Record your answer using a whole number.

2

How often should "docusate sodium (Colace) 100 mg b.i.d." be given? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Three times a day 2. Two times a day 3. Every other day 4. At bedtime

1

One hour after receiving a dose of lispro insulin (Humalog), a patient begins sweating and develops tremors and dizziness. His blood glucose level signals hypoglycemia (low blood glucose). Which type of adverse reaction to insulin is this patient most likely experiencing? 1) Dose-related 2) Patient sensitivity 3) Allergic 4) Anaphylactic

3

Per physician's orders, you have administered a combination of analgesic drugs that together have a stronger effect than either of them given individually. Which of the following most accurately describes this phenomenon? 1) Drug interaction 2) Antagonistic drug relationship 3) Synergistic drug relationship 4) Drug incompatibility

4

Question 1. Where is medication absorbed when the nurse administers a suppository? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Knowledge [Remembering] 1. Ear 2. Nose 3. Mouth 4. Rectum

4 (Rationale Option 1: When the Z-track method is used during an intramuscular injection, the skin and subcutaneous tissue are pulled 1 to 11/2 inches to one side, not pinched. Option 2: Massage is contraindicated because it will force medication back up the needle track, which may result in tissue irritation or staining. Option 3: Removal of the needle should be delayed 10 seconds to allow the medication to begin to be dispersed and absorbed. Option 4: The Z-track method is used with viscid or caustic solutions. Changing the needle ensures that medication is not on the outside of the needle, which prevents tracking of the medication into subcutaneous tissue during needle insertion.)

The instructions with a medication states to use the Z-track method. What should the nurse do that is specific to this procedure? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Pinch the site throughout the procedure 2. Massage the site after the needle is removed 3. Remove the needle immediately after the medication is injected 4. Change the needle after the medication is drawn into the syringe

(Rationale Option 1: This goal is inappropriate because the word good is not specific, measurable, or objective. Option 2: This is a well-written goal. Goals must be patient centered, measurable, realistic, and indicate the time frame in which the expected outcome is to be accomplished. The word correctly implies that critical elements are used as standards to measure the patient's actions when self-administering medications. Option 3: This is an action the nurse plans to implement; it does not identify a patient goal or expected outcome. Option 4: This is an action the nurse plans to implement; it does not identify a patient goal or expected outcome.)

The most appropriate goal associated with medications is: The patient will: Course Topic: Medication Administration Concept(s): Critical Thinking; MedicationCognitive Level: Analysis [Analyzing] 1. have a good understanding of the drugs prescribed. 2. self-administer medications correctly in one week. 3. be taught the common side effects of medications. 4. be administered medications as prescribed.

3

The nurse is caring for a patient who is constipated. The primary health-care provider prescribes bisacodyl (Dulcolax) 15 mg PO h.s. Dulcolax is supplied in 5 mg tablets. How many tablets should the nurse administer? Record your answer using a whole number.

2

The nurse must administer a medication by subcutaneous injection. She has a ⅝-inch needle available. For an average patient, at which angle should the nurse administer the injection? 1) 30° 2) 45° 3) 60° 4) 90°

4

The primary care provider prescribes furosemide 40 mg IV for a patient with heart failure. Which drug name is used in this prescription? 1) Chemical 2) Brand 3) Trade 4) Generic

0.5

The primary health-care provider orders Versed 2.5 mg IV push for preoperative sedation. It is available in 5 mg/mL. How many milliliters should the nurse prepare to administer?

3

The time it takes for drug concentration to reach a therapeutic level in the blood is known as: 1) peak action. 2) duration of action. 3) onset of action. 4) half-life.

2

What action is associated with the correct administration of medication delivered by the Z-track method? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Using a special syringe designed for Z-track injections 2. Pulling laterally and downward on the skin before inserting the needle 3. Giving the injection in the muscle on the anterior lateral aspect of the thigh 4. Inserting the needle in a separate spot for each dose on a Z-shaped grid on the abdomen

1

What does the nurse conclude is the most dangerous method of administering medication? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Intravenous push 2. Piggyback infusion 3. Subcutaneous injection 4. Intramuscular injection

4

What is the preferred site of intramuscular injection for children who are walking? 1) Dorsogluteal 2) Rectus femoris 3) Vastus lateralis 4) Ventrogluteal

4

What question should the nurse ask the patient before administering a medication that is teratogenic? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. "Have you ever had an anaphylactic reaction?" 2. "Were you ever addicted to drugs?" 3. "Do you have any allergies?" 4. "Are you pregnant?"

1

What route is inappropriate for a topical medication? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Intradermal 2. Bladder 3. Rectum 4. Vagina

3 (Rationale Option 1: Either a gloved finger or an applicator is used to insert a vaginal suppository, not a cream. Option 2: It is impossible to insert a cream into the vaginal canal with a gauze pad. If attempted, it would traumatize the mucous membranes of the vagina. Option 3: The consistency of a cream requires that an applicator be used to ensure that the medication is deposited along the full length of the vaginal canal. Option 4: The consistency of a cream is too thick to be inserted into the vagina with an irrigating kit.)

What should a nurse use when placing a cream into a patient's vaginal canal? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. A finger 2. A gauze pad 3. An applicator 4. An irrigation kit

3

When a patient takes a medication by mouth, it is absorbed through the gastrointestinal (GI) tract and circulates through the liver before entering systemic circulation. Many medications are almost completely inactivated during this process. This process is known as: 1) absorption. 2) distribution. 3) first-pass effect. 4) excretion.

4

Which abbreviation indicates that the practitioner wants a medication administered before meals? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. pc 2. qh 3. po 4. ac

3 (Rationale Option 1: Potassium should never be administered by IV push because it will cause cardiac dysrhythmias. Option 2: Potassium may be diluted in dextrose, saline, and lactated Ringer's solutions and combinations of these solutions. Option 3: When preparing to administer IV potassium, the nurse should recognize that IV potassium should be administered at no more than 10 mEq/hr. An infusion pump should always be used in the administration of potassium. Option 4: Potassium should never be added to an infusing IV solution because it may infuse at an unsafe rate.)

Which factor should a nurse consider when preparing to administer IV potassium to a client diagnosed with moderate hypokalemia? Course Topic: Medication Administration Concept(s): Critical Thinking; Fluid and Electrolyte Balance; MedicationCognitive Level: Comprehension [Understanding] 1. IV potassium should be administered by IV push. 2. IV potassium should be diluted only in normal saline solution. 3. IV potassium should be administered at no more than 10 mEq/hr. 4. IV potassium should be added to the solution that is currently infusing.

3

Which intervention is uniquely related to the administration of an intradermal injection? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Using the air-bubble technique 2. Pinching the skin during needle insertion 3. Inserting the needle with the bevel upward 4. Massaging the area after the fluid is instilled

1 (Rationale Option 1: Positioning the medication cart outside a patient's room prevents it from becoming contaminated by microorganisms in the patient's room. Option 2: Locking the medication cart when walking away from the cart maintains the security of the cart, preventing individuals from tampering with its contents. Option 3: A nurse does not have to wear clean gloves when removing a medication from the cart; however, the nurse must perform hand hygiene before removing a medication from the cart. Option 4: Trash can be discarded in a receptacle attached to the medication cart as long as the receptacle is impervious to liquid and is away from the surface where medications are being dispensed. This container should be used only for medication-related trash, not trash that touched a patient or was in a patient's room.)

Which intervention should be performed by a nurse when administering medication to a patient to maintain medical asepsis? Course Topic: Medication Administration Concept(s): Medication; SafetyCognitive Level: Application [Applying] 1. Position the medication cart outside a patient's room. 2. Lock the medication cart when walking away from the cart. 3. Remove a medication from the cart after donning clean gloves. 4. Discard trash only in the patient's room, not in a bag attached to the medication cart.

4 (Rationale Option 1: This is contraindicated. Rubbing the site can cause bleeding and bruising because heparin is an anticoagulant. Option 2: Placing the needle just under the epidermis is the technique used for an intradermal injection. Heparin is administered via the subcutaneous route. Option 3: This is contraindicated. Pinching the skin can cause bleeding and bruising because heparin is an anticoagulant. Option 4: The needle must enter the skin and subcutaneous tissue during an injection of heparin. A disinfectant, such as alcohol, will minimize microorganisms on the skin before the needle pierces the skin. This will limit the development of an infection at the site of the injection.)

Which nursing action is indicated when administering a heparin injection? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Application [Applying] 1. Rubbing the site after the injection 2. Placing the needle just under the epidermis 3. Pinching the skin during insertion of the medication 4. Cleaning the site with a disinfectant before the injection

4

Which nursing action would the nurse implement to reduce medication errors? 1) Check to be sure pediatric medication is prescribed using dose per pound of body weight. 2) Administer prescribed medication if you note it is not documented on the MAR. 3) Administer medication before the patient goes to sleep when it is prescribed "at bedtime." 4) Draw up liquid suspension in an oral syringe with a bulb or plunger and no needle.

3

Which of the following is responsible for regulating the testing, manufacture, and sale of all medications and for monitoring the safety and effectiveness of medications available to consumers in the United States? 1) Board of Nursing 2) United States Pharmacopoeia 3) Food and Drug Administration 4) National Formulary

2

Which of the following measurement systems is the preferred system for healthcare? 1) Apothecary 2) Metric 3) Household 4) Special

1

Which route is unrelated to the parenteral administration of medications? Course Topic: Medication Administration Concept(s): MedicationCognitive Level: Comprehension [Understanding] 1. Buccal 2. Z-track 3. Intravenous 4. Intradermal

1

You administer intravenous morphine to a client who is in severe pain. Five minutes later, you hear him sigh deeply. "Is the morphine kicking in now?" you ask. "Yes," he replies. In this case, the 5 minutes represents which of the following? 1) Onset of action 2) Minimum effective concentration 3) Peak action 4) Duration of action

3, 4, 6

You administered intravenous morphine to a client 10 minutes ago and are returning now to assess him. Which of the following should you assess at this time? SELECT ALL THAT APPLY. 1) Vital signs 2) Appropriateness of client's general condition for medication 3) Effectiveness of the drug 4) Side effects 5) Biological factors that affect drug metabolism 6) Signs of toxicity or adverse reactions

1, 3, 4, 6

You are preparing to administer a medication to a client. Which of the following are among the "rights of medication" that you should check before administering this medication? SELECT ALL THAT APPLY. 1) Right drug 2) Right nurse 3) Right patient 4) Right dose 5) Right hospital 6) Right time

1

You are preparing to administer an intramuscular injection to an older adult client. Which of the following sites is preferred for this type of injection? 1) Ventrogluteal 2) Dorsogluteal 3) Deltoid 4) Vastus lateralis

1

You are trying to find the physical and chemical composition of several drugs that have been approved by the Food and Drug Administration (FDA). Which of the following sources would be best for you to consult? 1) United States Pharmacopoeia (USP) 2) National Formulary (NF) 3) Nursing Drug Handbook 4) Physicians' Desk Reference (PDR®)

4

You have received an oral antibiotic to administer to a client who is NPO. Which of the following should you do? 1) Have the client take the pills with just a few sips of water. 2) Crush the pills up, mix them in some water, and have the client drink it. 3) Have the client take the pills with no water. 4) Obtain a prescription for an alternate route.

3, 4, 5, 6

You just gave a patient an oral analgesic. He is complaining because it has not taken effect yet. You explain that many factors affect the absorption of a drug, including which of the following? SELECT ALL THAT APPLY. 1) Metabolism 2) Excretion 3) Route of administration 4) Solubility of the drug 5) pH of the local environment 6) Blood flow to area of absorption

2

You realize that you have just given the wrong dose of hypertension medication to a client. Which of the following should you do first? 1) Notify the client's primary care provider. 2) Assess the client's vital signs. 3) Apologize to the client. 4) Fill out an incident report.