Quiz: Administering Oral Medications

After reviewing the skills for administering different medications, a student nurse demonstrates the need for additional review when she does takes which action?

Leaves before verifying that the client has swallowed the medication Rationale:It is important to verify that the client has swallowed the medication before leaving the room and document it in the MAR. This ensures that the client has actually taken the medication so that accurate follow-up with the client can be performed.

The nurse prepares the client's nightly medication doses and needs to administer an as needed dose of a hypnotic medication for sleep. The sleep medication is in a unit-dose package. What action does the nurse take?

Open the package after the client confirms the dose is wanted. Rationale:This medication requires additional assessment prior to administration. The nurse needs to ensure the client still wants the sleep medication prior to opening it. The nurse does not need vital signs or the client's pain score to administer the sleep medication. The nurse does not place the medication with the scheduled medications. Remediation:

The nurse is preparing to split medication for client administration. What method should the nurse use to split the medication?

Place the pill in the pill splitter and close. Rationale:The nurse should wear gloves and place the medication in the pill splitter and close down on the score on the tablet to split in half. The tablet should not be split by hand, smashed, or ground. The tablet may split in another area other than the score, rendering half with too much or not enough medication for the client

A nurse is preparing several oral medications for administration. One of the medications requires the nurse to obtain the client's apical pulse before administering it. Which action would be most appropriate?

Placing the medication requiring the assessment in a separate medication cup. Rationale:When preparing several oral medications, including one that requires an assessment before administration, the nurse would place the medication in a separate medication cup so that it is easily identified should the assessment reveal the need to withhold the drug. Placing all the medications in the same cup could lead to confusion should the medication requiring assessment need to be held. Medications are prescribed to be given at specific times, so it would be inappropriate to give the medication at a different time from that which is prescribed. The nurse should have all the medications prepared before going into the client's room and performing the necessary assessments. Performing the assessment first and then going to prepare the medication would be less efficient.

The nurse is distributing afternoon medications to the clients. When removing a tablet from a multi-dose bottle, what should the nurse do first

Pour the tablet into the bottle cap. Rationale:The nurse should pour the tablet into the bottle cap and then into a medication cup for each client. The nurse should never let the tablet touch his or her fingers or bare hand. The nurse should drop the tablet into the bottle cap before putting it into a medication cup.

The nurse has administered a client's medication. Which action would be most appropriate if the client vomits immediately, or soon after administration?

Check the vomit/emesis for pills or pill fragments and call the client's health care provider. Rationale:If the client vomits after medication is administered, the nurse should check the vomit/emesis for pills or pill fragments. Then, findings should be reported to the client's health care provider, and the mess should be cleaned up. If the pills, or pill fragments, are found in the vomit, the health care provider may ask that the medication be re-administered. If no pills or pill fragments are found in the vomit, the health care provider would probably ask that the medication not be re-administered because the client might receive too large a dose.

The nurse is in the client's room to administer the client's morning oral medications. Which action should the nurse take first?

Confirm the client's identity. Rationale:When administering medications to the client, first the nurse must confirm the client's identity to ensure that it is the "right client." Then the nurse would perform any assessments necessary for the medications being given. Next the nurse would open the medications and offer them to the client along with a fluid to drink. Documentation occurs after the medication has been given and the nurse has witnessed the client swallowing them

The nurse needs half of a tablet of medication and is preparing to split the tablet but there is no score. What should the nurse do? Select all that apply.

Correct Response: Call the health care provider., Refrain from splitting the tablet. Rationale:The nurse should refrain from splitting the tablet because only scored tablets can be cut in half so that the client gets the correct dose. The health care provider should be called to relay that the medication cannot be given as prescribed and request another prescription. The nurse should not administer a whole tablet nor cut the tablet in half unless there is a score on the tablet.

17A nurse is distributing the 0900 medications to the client. What should the nurse do when removing a tablet from a multi-dose bottle? Select all that apply.

Correct Response: Put an extra tablet back into the bottle from cap., Use gloves for extra protection., Take the multi-dose bottle into the client's room. Rationale:The nurse must refrain from touching the tablets. It is permitted to put an extra tablet back into the bottle if it was deposited into the cap first. It is permitted to take the multi-dose bottle into the room if the room is not isolation. It is permitted to use gloves in any situation when the nurse feels the need for extra protection.

The nurse splits a medication for client administration. What should the nurse do to assure safety and proper documentation? Select all that apply.

Correct Response: Take medication to bedside., Take medication package and label to bedside., Take computer to the bedside. Rationale:To assure safety and proper documentation of a medication administration, the medication, medication package and label, and computer should be taken to the client's bedside before administering medication. There is no need to take the health care provider's prescription or the client's entire medication drawer to the bedside.

The nurse opens the multidose container of oxycodone. The nurse needs 1.5 tablets to deliver the as needed dose, and the tablets in the container are not scored. What action by the nurse is best?

Correct Response:Call the pharmacy to request a supply change. Rationale:The best action by the nurse is to request scored tablets or the correct dose from the pharmacy. If this is not possible, the nurse considers cutting the unscored tablet with the pill splitter, recognizing that this could result in an inaccurate dose. The nurse could choose not to give the medication, but this leaves the client in needless pain. The nurse could choose to administer two thirds of the dose by giving one tablet, but this leaves the client underdosed for pain rel

A nurse is measuring a liquid medication in a graduated liquid medication cup. The nurse determines the correct amount by reading:

Correct Response:the bottom of the meniscus. Rationale:When measuring the correct amount of liquid medication in a graduated liquid medication cup, the nurse would measure the liquid at eye level at the bottom of the meniscus to ensure an accurate dosage. Measuring at the top of the amount line, just below it or on both sides would be inaccurate.

The nurse is administering a client's medication and more tablets than needed fall into the bottle cap. What should the nurse do?

Drop extra tablets into bottle from bottle cap. Rationale:If more tablets than are needed fall into the bottle cap, the nurse should drop the extra tablets into the bottle from the bottle cap. The extra tablets should not be thrown away, dropped down the sink, or put into a specialty disposal unit.

The instructor observes a nursing student who is preparing a liquid medication from a multi-dose bottle. Which action would concern the instructor if it were demonstrated by the student?

Holds the bottle of liquid medication with the label facing the medication cup. Rationale:When pouring liquid medications, the bottle should be held with the label facing the palm of the hand to prevent any liquid from dripping onto the label while pouring and thus making it difficult to read. It is appropriate to wipe the lip of the container with a paper towel to prevent the liquid from dripping on the label. In addition, it is appropriate to measure the amount using the bottom of the meniscus and to compare the label on the bottle with the medication administration record.

The nurse is preparing to administer a sublingual medication. Which instruction to the client is correct?

Your Response: "Try not to swallow while the pill dissolves." Rationale:Place medications intended for sublingual absorption under the client's tongue. Instruct the client to allow the medication to dissolve completely. Reinforce the importance of not swallowing the medication tablet, as sublingual medications are intended to be absorbed through the oral mucosa.

The client is prescribed digoxin 0.125 mg PO every day. The nurse obtains the medication from unit stock and discovers that digoxin only comes in a 0.25-mg tablet. How many tablets of digoxin should the nurse administer to the client?

Your Response: 0.5 tablet Rationale:Because the client only needs 0.125 mg of digoxin per day, the nurse would need to split the 0.25-tablet in half to obtain the correct dose; therefore, the nurse should administer 0.5 tablet to the client. Administering 1, 1.5, or 2 tablets would be too much medication for the client. 0.125 mg ÷ 0.25 mg/tablet = 0.5 tablet

The nurse is preparing hydrochlorothiazide 50-mg tablet from unit stock. The health care provider orders 75 mg of hydrochlorothiazide PO for the client's hypertension. How many tablets of hydrochlorothiazide will the nurse administer to the client?

Your Response: 1.5 tablets Rationale:Because the client only needs 50 mg of hydrochlorothiazide per day, the nurse would need to split one of the 50-mg tablets in half to obtain the correct dose, which is 1.5 tablets. Administering 0.5, 1, or 2 tablets would be either too much or too little medication for the client. 75 mg ÷ 50 mg/tablet = 1.5 tablets

The nurse is preparing a liquid medication for a client. The health care provider prescribes cimetidine hydrochloride 600 mg PO for gastrointestinal bleeding. The pharmacy sends cimetidine hydrochloride 300 mg/5 mL. How many teaspoons should the nurse administer?

Your Response: 2 teaspoons The nurse should administer 2 teaspoons of the cimetidine hydrochloride. If the nurse administers 0.5, 1, or 1.5 teaspoons of the medication, the client will not receive the prescribed dose. The pharmacy sent medication with the concentration of 300 mg per teaspoon (1 teaspoon = 5 mL). and the dose is 600 mg. Therefore, to obtain a 600-mg dose, the nurse administers 2 teaspoons, or 10 mL

The nurse is performing the third medication check for a medication administered from a multi-dose bottle. What should the nurse do?

Your Response: Check the multi-dose bottle label after identifying the client and before administering the medication. Rationale:When performing the third medication check for a medication from a multi-dose bottle, the nurse should check the multi-dose bottle label after identifying the client and before administering the medication. The tablet is not taken from the bottle and identified visually. Identification of the client is always performed before administration of the medication. The first, not third, medication check is to compare the medication label on the bottle to the MAR.

A nurse is preparing to administer oral medications to a client. While opening the unit dose package, the medication inadvertently falls on the floor. Which action by the nurse would be most appropriate?

Your Response: Discard the current unit-dose package and obtain a new one. Rationale:If a medication falls on the floor, the nurse must discard it and obtain a new dose. Since the medication was in a unit dose-package, the nurse would easily be able to tell which medication had fallen. The client did not refuse the medication so it would be inappropriate to document it as such. There is no need to call the pharmacy or notify the health care provider. The nurse would call the pharmacy if he or she was unsure as to which medication had fallen on the floor.

The nurse is splitting medications. After splitting the tablet and administering half to the client, what should the nurse do with the remaining half? Select all that apply.

Your Response: If the medication is a narcotic, waste with another nurse present., Dispose of medication per hospital protocol. Rationale:Medications should already be split, if coming from the pharmacy. If the nurse uses unit stock and must split, the medication must be disposed of per hospital protocol. If the medication is a narcotic, the medication should be wasted in the presence of another nurse. Medications should not be wasted in the toilet or down a sink, sent back to pharmacy, or saved in the client's drawer

Which route of medication administration is most commonly prescribed?

Your Response: Oral Rationale:Oral administration is the most commonly used route of administration. It is usually the route most convenient and comfortable for the client.

The nurse enters the client's room to administer oral medications. Which action would the nurse take first?

Your Response: Perform hand hygiene. Rationale:When administering medications, the first step is to perform hand hygiene. The nurse then would confirm the client's identity and offer water or some other permitted fluids to take with the medications. The nurse would check the client's chart for any allergies, as well as ask the client prior to administering the medications if he or she has any allergies.

When pouring a liquid medication into a graduated liquid medication cup, which nursing action would be most appropriate?

Your Response: Place the cup on a flat surface at eye level. Rationale:When pouring liquid medications, it is essential to place the cup on a flat surface at eye level and pour the liquid into the cup, reading the amount at the bottom of the meniscus. This ensures that the medication dosage is accurate. Pouring the liquid into a cup that is being held can lead to inaccurate dosages.

The nurse is administering routine medications to a postsurgical client and the client asks, "Could I have something for pain?" The nurse checks the medication administration record (MAR) and notes that the medication is an opioid. What should the nurse do?

Your Response: Place the opioid into a separate cup. Rationale:The medication should be given in separate cups so that an additional assessment can be performed. Orally administered medications should be dispensed into a medicine cup and ingested when administered, not when the client wants. Medications that need additional assessments should not be administered together.

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this scheduled unit-dose packaged antihypertensive medication?

Your Response: Set the antihypertensive dose aside pending assessment. Rationale:Knowing that the previous dose was held, the nurse sets the antihypertensive aside until an assessment of current blood pressure is performed or verified. The nurse scans and administers all the regularly scheduled medications at one time, except for those requiring additional assessment. Those unit-dose packages are set to the side until the nurse is sure that administration is the correct action. The client should already know to call for assistance, if needed, and to report new or worsening symptoms, such as feeling dizzy.

The client tells the nurse that the medication in the cup is not the same as the medication he took the day before. The client is insistent that the medication is not the one prescribed. Which action by the nurse would be least appropriate?

Your Response: Tell the client that he must take this medication because it is prescribed by the health care provider. Rationale:If a client voices concerns about a medication to be administered, the nurse would verify that the medication is indeed the one that the client is to receive. Telling the client that he or she must take the medication is inappropriate because it is threatening and coercive. The nurse would double-check the drug package with the medication administration record and verify that the order on the client's chart has been transcribed correctly to the medication administration record. In addition, if there is still some question, the nurse would contact the client's health care provider to ensure that the medication order is correct.

The nurse is teaching a client how to prepare and administer liquid medications. The client has been on other types of medications for several years. What common error would be most appropriate for the nurse to include in teaching this client?

Your Response: The client can use any type of measuring device. Rationale:One common error with liquid medicines involves taking the wrong amount due to use of an inaccurate device such as a kitchen teaspoon. Using an oral syringe or other graduated measuring device is necessary to deliver an accurate dose. The client does not have to use one specific device but must use something that measures accurately. There is confusion between different dose measurements. For example, liquid medicines can be dosed in household measurements (teaspoons or tablespoons) or in the metric system (milliliters). Using a household implement often leads to guessing and an underdose or overdose of medication. Clients must be taught that a "teaspoon" from the kitchen is not the same as a medication teaspoon. It is never acceptable to share prescription medications with other people; they may be harmed because the medication was not prescribed for that individual. People often "save" medication, and this is an unsafe practice.

When administering medications to a client, what information should the nurse know about the medication? Select all that apply.

Your Response: action, safe dose range, adverse effects, purpose Rationale:The nurse should know the following information about the medications being administered: its actions, special nursing considerations, safe dose ranges, allergies, purpose, and adverse effects. The nurse does not need to know the cost of the medication.