Chapter 20: Safe Medication Preparation Nursing School Test Banks

MULTIPLE CHOICE

1. The prescribed dose of Tylenol is given to a patient. The nurse recognizes the name Tylenol as which of the following?

a.

Chemical name

b.

Trade name

c.

Generic name

d.

United States Pharmacopeia

ANS: B

A medication trade name or brand name is used to market the medication. The trade name has the symbol at the upper right of the name, indicating a manufacturers trademark for the name (e.g., Panadol, Tempra, Tylenol). The chemical name describes the medications composition and molecular structure, such as N-acetyl-para-aminophenol, commonly known as Tylenol. The chemical name rarely is used in clinical practice. A manufacturer who first develops a medication gives the generic name of a medication. Acetaminophen is the generic name for Tylenol. The generic name is the official name that is listed in official publications such as theUnited States Pharmacopeia (USP). The USP is a drug book that lists all drugs by generic name.

DIF: Cognitive Level: Remembering REF: Text reference: p. 474

OBJ: Discuss factors that contribute to medication errors. TOP: Medication Names

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The nurse is aware that a patient with liver disease and a decreased albumin level may develop which of the following effects?

a.

Toxicity on normal doses of medication

b.

Less active medication available in the body

c.

Reduction in therapeutic effect

d.

Accelerated biotransformation of the medication

ANS: A

Most medications bind to albumin to some extent. When medications bind to albumin, they are unable to exert pharmacological activity. Only the unbound or free medication is active. Older adults and patients with liver disease or malnutrition have reduced albumin, which increases their risk for medication toxicity. With less albumin to bind with the medication, more free or active medication is present in the body. This would result in an increase in therapeutic effect and possibly in toxicity. Most biotransformation occurs in the liver, although the lungs, kidneys, blood, and intestines also play a role. Patients (e.g., elderly, those with chronic disease) are at risk for medication toxicity if their organs that metabolize medications do not function correctly.

DIF: Cognitive Level: Applying REF: Text reference: p. 474

OBJ: Discuss the types of medication actions. TOP: Protein Binding

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. During the admission process, the patient states that he stopped taking daily aspirin because of nausea. The nurse documents the nausea as which of the following?

a.

Noncompliance

b.

Toxic effects of the medication

c.

Side effects of the medication

d.

Allergic reaction to the medication

ANS: C

Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. For example, some antihypertensive medications cause impotence in male patients. Noncompliance is almost an accusatory name given to patients who do not follow their medical regimen such as by not taking their medications. Usually, however, there is a reason for noncompliance, and in this case, the reason is the side effect of the medication. Be careful with this term because it carries a negative connotation. Toxic effects develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given. Allergic reactions are unpredictable responses to a medication. Exposure to an initial dose of a medication causes a patient to become sensitized immunologically. The medication acts as an antigen, and this causes antibodies to be produced. Nausea is not an antigen-antibody response.

DIF: Cognitive Level: Applying REF: Text reference: p. 475

OBJ: Discuss the types of medication actions. TOP: Side Effects

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. An 80-year-old patient who complains of feeling anxious is given lorazepam (Ativan). The patient becomes agitated and delirious. The nurse documents this reaction to Ativan as which of the following?

a.

Toxicity

b.

Side effect

c.

Idiosyncratic reaction

d.

Allergic reaction

ANS: C

Medications often cause unpredictable effects such as an idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction different from normal. Predicting which patients will have an idiosyncratic response is impossible. For example, Ativan, an antianxiety medication, when given to an older adult, may cause agitation and delirium. Toxic effects develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given. Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. Allergic reactions are unpredictable responses to a medication. The medication acts as an antigen, and this causes antibodies to be produced. With repeated administration, the patient develops an allergic response. Sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, severe wheezing, and shortness of breath are characteristic of severe or anaphylactic reactions. Some patients become severely hypotensive, necessitating emergency resuscitation measures. Anaphylaxis is potentially fatal.

DIF: Cognitive Level: Applying REF: Text reference: p. 476

OBJ: Discuss the types of medication actions. TOP: Idiosyncratic Reactions

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. A patient admitted to the hospital with pneumonia has IV antibiotics ordered. He receives the first dose with no problem, but during the second dose, he begins to complain of shortness of breath and difficulty breathing. The nurse notes wheezes throughout the lung fields. The nurse documents these symptoms as which of the following?

a.

Idiosyncratic reaction

b.

Toxic effect of the antibiotic

c.

Side effect of the medication

d.

Anaphylactic reaction

ANS: D

An allergic reaction ranges from mild to severe, depending on the patient and the medication. Among the different classes of medications, antibiotics cause a high incidence of allergic reactions. Sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, severe wheezing, and shortness of breath are characteristic of severe or anaphylactic reactions. Some patients become severely hypotensive, necessitating emergency resuscitation measures. Anaphylaxis is potentially fatal. Medications often cause unpredictable effects, such as an idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction that is different from normal. However, the symptoms displayed by this patient are classic anaphylactic symptoms. Toxic effects develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given. Two doses of a medication usually are not enough to develop toxic effects. Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. Anaphylaxis is usually unpredictable initially and is avoided after the first reaction by listing the cause of the anaphylaxis in the allergy alert section of the patient record.

DIF: Cognitive Level: Applying REF: Text reference: p. 476

OBJ: Discuss the types of medication actions. TOP: Allergic Reactions

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. A patient with chronic back pain has been taking oral morphine sulfate (MS Contin) for the past 2 years. Upon admission to the hospital, the patient receives morphine sulfate for back pain but reports no pain relief. The nurse notifies the health care provider, recognizing that the reason for the lack of pain relief is which of the following?

a.

Side effect of the morphine

b.

Drug dependence

c.

Idiosyncratic response to the morphine

d.

Medication tolerance

ANS: D

Medication tolerance is a decreased physiological response that occurs after repeated administration of a medication. Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. Drug dependence can be physical or psychological. In psychological dependence, patients have an emotional desire for a drug to maintain an effect. A person believes that a desirable effect will result when taking the medication. Physical dependence is a physiological adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn. Medications often cause unpredictable effects, such as an idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction that is different from normal.

DIF: Cognitive Level: Analyzing REF: Text reference: pp. 476-477

OBJ: Discuss the types of medication actions. TOP: Medication Tolerance

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. A patient is receiving vancomycin IV every 8 hours at 0800, 1600, and 2400. A serum peak and trough level is ordered after the third dose, which will be given at 1600. When should the nurse order the trough level?

a.

1630

b.

1800

c.

2330

d.

2400

ANS: C

The point at which the lowest amount of drug is in the serum is the trough concentration. Some medication doses (e.g., vancomycin, gentamicin) are based on peak and trough serum levels. A patients trough level is drawn as a blood sample 30 minutes before the drug is administered, and the peak level is drawn whenever the drug is expected to reach its peak concentration. The third dose will be given at 1600, which means that the lowest level of drug will be present 30 minutes before the fourth dose at midnight. A patients trough level is drawn as a blood sample 30 minutes before the drug is administered. 1630 is 30 minutes after the drug is administered. 1800 is 2 hours after the drug is administered. If the medication reaches its peak concentration in 2 hours, this could be a peak concentration, because the peak level is drawn whenever the drug is expected to reach its peak concentration. 2400 is the time that the next dose is due. A patients trough level is drawn as a blood sample 30 minutes before the drug is administered.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Trough Concentration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. The hospital uses a unit-dose system for medication distribution. The nurse recognizes that this system includes which safety feature?

a.

All medications are kept in the patients drawer.

b.

Liquids are kept in multi-dose containers to prevent spillage.

c.

Narcotics are kept in an area separate from the patients regular medications.

d.

The nurse is responsible for restocking the medication drawers daily.

ANS: C

Controlled substances are not kept in the individual patient drawer; they are kept in a larger locked drawer to keep them secure. The unit dose is the ordered dose of medication that the patient receives at one time. Each tablet or capsule is wrapped in a foil or paper container. Liquid doses come in prepackaged foil or paper cups. At a designated time each day, the pharmacist or a pharmacy technician refills the drawers in the cart with a fresh supply.

DIF: Cognitive Level: Understanding REF: Text reference: pp. 478-479

OBJ: Discuss factors that contribute to medication errors. TOP: Unit Dose

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. The nurse is calculating a medication dosage using the metric system. A vial contains 1 mL of fluid, and the nurse calculates the correct dosage to be half of the medication in the vial. How should the nurse document the correct dosage?

a.

mL

b.

.5 mL

c.

0.5 mL

d.

0.50 mL

ANS: C

When writing medication dosages in metric units, convert fractions to decimals. Always include a zero before a decimal point (e.g., 0.1 mL is correct). Never use a trailing zero (e.g., 1.0 mL is incorrect).

DIF: Cognitive Level: Applying REF: Text reference: p. 480

OBJ: Identify the system of measurement for a given prescribed medication.

TOP: The Metric System KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. The nurse is teaching a patient how to measure medication dosages at home. The prescription is written for 30 mL of the medication. Which household measurement will the nurse teach the patient to use?

a.

Drops

b.

Teaspoon

c.

Tablespoon

d.

Cup

ANS: C

The equivalents of measurement are as follows: 15 drops = 1 mL, 1 teaspoon = 5 mL, 1 tablespoon = 15 mL, and 1 cup = 240 mL; therefore, a tablespoon is most appropriate, with 2 tablespoons = 30 mL.

DIF: Cognitive Level: Applying REF: Text reference: p. 480 |Text reference: p. 486

OBJ: Identify the system of measurement for a given prescribed medication.

TOP: Household Measurement KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. The patient is complaining of severe leg pain. No pain medication is ordered, so the nurse calls the health care provider. An order for Tylenol with Codeine prn is given, in addition to a one-time order for morphine sulfate to be given stat. Which action by the nurse is most appropriate?

a.

Give the morphine sulfate and Tylenol with Codeine immediately.

b.

Give the Tylenol with Codeine now.

c.

Give the morphine sulfate immediately.

d.

Ask the patient which medication he would like first.

ANS: C

Types of orders based on frequency and/or urgency of medication administration include prn orders (given only when a patient requires it) and stat orders (given immediately and only once).

DIF: Cognitive Level: Applying REF: Text reference: p. 481

OBJ: List and discuss the six rights of medication administration.

TOP: Medication Orders KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. The nurse is preparing to administer medication to a patient who is alert and oriented. When medications are reviewed with the patient, the patient states that he does not take metoprolol. Which action by the nurse is most appropriate?

a.

Ignore the patients statement and give the medication.

b.

Withhold the medication.

c.

Convince the patient that the doctor ordered it, and he should take it.

d.

Give the medication and check the order afterward.

ANS: B

If a patient questions the medication a nurse prepares, it is important not to ignore these concerns. An alert patient will know whether a medication is different from those received before. Withhold the medication until you are able to recheck the preparation against the order. If a medication order seems incorrect or inappropriate, always consult the prescriber.

DIF: Cognitive Level: Applying REF: Text reference: p. 481

OBJ: List and discuss the six rights of medication administration.

TOP: Medication Orders KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. The nurse is preparing a liquid medication. Which action is most appropriate?

a.

Pour the liquid medication toward the label.

b.

Draw the liquid quickly into a syringe.

c.

Place the medication cup on a flat surface at eye level.

d.

Measure the poured liquid to the top of the meniscus.

ANS: C

Pour liquid medication into a medication cup with the cup on a flat surface at eye level, so you can accurately see the desired amount. The amount of poured liquid should be even with the base of the meniscus. Pour liquid medications away from a label to ensure that liquid will not run down a label, making it difficult to read. Draw liquid medication into a syringe (without a needle) slowly, to prevent air bubbles from entering the syringe. Air displaces medications, which leads to inaccurate measurement of doses.

DIF: Cognitive Level: Applying REF: Text reference: p. 481

OBJ: List and discuss the six rights of medication administration.

TOP: Right Dose KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

14. The nurse enters the patients room to give medications. Which action is most appropriate to identify the right patient?

a.

Ask the patient to state his name.

b.

Ask the patient to state his name and birth date.

c.

Ask the primary nurse to identify the patient.

d.

Say the patients name and date of birth and request patient validation.

ANS: B

Before giving a medication to a patient, always use at least two patient identifiers (TJC, 20121a). Acceptable patient identifiers include the patients name, an identification number assigned by the health care agency, and the date of birth.

DIF: Cognitive Level: Applying REF: Text reference: p. 483 |Text reference: p. 489

OBJ: List and discuss the six rights of medication administration.

TOP: Right Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15. When medications are administered, which action by the nurse is appropriate?

a.

Administering medications prepared by another nurse

b.

Using sterile technique for nonparenteral medications

c.

Leaving medication at the bedside when the patient is in the bathroom

d.

Documenting the reason for medication refusal in the nurses notes

ANS: D

When a patient refuses a medication, determine the reason for it, and take action. Document refusal of medications, and notify the prescriber. Never administer a medication prepared by another nurse. Use good medical aseptic technique and perform hand hygiene before preparing a dose of medication. Avoid touching tablets and capsules. Use sterile technique for parenteral medications. Remain with the patient as the patient takes the medication. Provide assistance if necessary (e.g., for the patient who is weak and unable to administer eyedrops). Do not leave medications at a patients bedside without a prescribers order to do so.

DIF: Cognitive Level: Applying REF: Text reference: p. 488

OBJ: Identify guidelines for safe administration of medications.

TOP: Medication Preparation/Medication Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16. When controlled substances are administered, which action is required by the nurse?

a.

Discard and sign for unused quantities.

b.

Count the amount of medication daily.

c.

Keep narcotics to be given with other patient medications.

d.

Have a second nurse witness disposal of unused portions and sign the record.

ANS: D

If you give only part of a premeasured dose of a controlled substance, a second nurse must witness disposal of the unused portion. Both nurses sign their names on the required form. Store all narcotics in a locked, secure cabinet separate from the patients routine medications. (Computerized, locked cabinets are preferred.) The computerized dispensing system should maintain the inventory of medications.

DIF: Cognitive Level: Applying REF: Text reference: p. 489

OBJ: Identify guidelines for safe administration of medications.

TOP: Controlled Substances KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17. To prevent medication errors, which action should be taken by the nurse?

a.

Clarify illegible orders with the prescriber.

b.

Document the medication before administration.

c.

Read medication labels 2 times when preparing.

d.

Prepare all of the clients medications for the shift at the same time.

ANS: A

Do not interpret illegible handwriting; clarify illegible orders with the prescriber. Document all medications as soon as they are given. Be sure to read labels at least 3 times (comparing MAR with label): before, during, and after administering the medication. Prepare medications at the time ordered, and document all medications as soon as they are given.

DIF: Cognitive Level: Applying REF: Text reference: p. 485 |Text reference: pp. 488-489

OBJ: Identify guidelines for safe administration of medications.

TOP: Medication Orders/Right Documentation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

18. The patient is to receive a medication via the sublingual route. Which action by the nurse is appropriate?

a.

Placing the medication under the tongue

b.

Crushing the medication before administration

c.

Offering the client a glass of orange juice after administration

d.

Using sterile technique to administer the medication

ANS: A

Administering a medication by the sublingual route involves placing the solid medication in the mouth under the tongue until the medication dissolves. Crushing the medication is not necessary because it is designed to dissolve under the tongue. Patients are not to take any liquids with medications given by sublingual administration or immediately afterward. The mouth is not sterile. Sterile technique is not necessary for sublingual administration.

DIF: Cognitive Level: Applying REF: Text reference: pp. 478-479

OBJ: Identify guidelines for safe administration of medications.

TOP: Routes of Medication Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

19. The nurse is caring for several patients. The patient in which situation can safely receive oral medications?

a.

Nausea with frequent episodes of vomiting

b.

Taking a daily dose of vitamins

c.

Nasogastric tube connected to suction

d.

Diagnosed with an esophageal stricture

ANS: B

Avoid giving oral medications to patients with alterations in gastrointestinal function (e.g., nausea and vomiting), reduced motility (after general anesthesia or inflammation of the bowel), or surgical resection of a portion of the gastrointestinal tract. Oral medications cannot be given when the patient has gastric suctioning and are contraindicated in patients before some tests or surgery. Oral administration is contraindicated in patients who are NPO and unable to swallow (e.g., patients with neuromuscular disorders, esophageal strictures, or lesions of the mouth).

DIF: Cognitive Level: Applying REF: Text reference: p. 479

OBJ: Identify guidelines for safe administration of medications.

TOP: Factors Influencing Choice of Administration Routes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

20. The nurse receives an order to give a drug parenterally. The nurse will administer this medication by which route?

a.

Oral

b.

Topical

c.

Sublingual

d.

Intramuscular

ANS: D

Parenteral medications can be intramuscular, subcutaneous, intradermal, epidural, or intravenous. Medications given orally are given by mouth. Topical medications are applied on the skin (as a cream or patch) and as eye/eardrops. Sublingual medications are given under the tongue.

DIF: Cognitive Level: Applying REF: Text reference: p. 484

OBJ: Identify guidelines for safe administration of medications.

TOP: Routes of Medication Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. A patient with a history of renal failure and liver disease has been receiving morphine sulfate every 4 hours for the past 2 weeks. The nurse finds the patient lethargic with a respiratory rate of 6 breaths per minute. The health care provider orders naloxone (Narcan). The nurse anticipates which effects when naloxone (Narcan) is given? (Select all that apply.)

a.

Increase in alertness

b.

Decrease in urine output

c.

Complaints of pain

d.

Increase in respiratory rate

ANS: A, C, D

Toxic effects develop after prolonged intake of a medication, when a medication accumulates in the blood as the result of decreased clearance by the liver and/or kidneys (because of impaired metabolism or excretion), or when too high a dose is given. Respiratory depression and sedation are known effects of opioid toxicity. Naloxone reverses the effects of opioids, including pain relief.

DIF: Cognitive Level: Applying REF: Text reference: p. 476

OBJ: Discuss the types of medication actions. TOP: Toxic Effects

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. When do most medication errors occur? (Select all that apply.)

a.

During hospital admission

b.

During transfer from one unit to another

c.

During discharge home

d.

During discharge to another facility

ANS: A, B, C, D

Most medication errors occur at patient care transition points such as during hospital admission, transfer from one unit to another, and discharge to home or another facility.

DIF: Cognitive Level: Remembering REF: Text reference: p. 473

OBJ: Discuss factors that contribute to medication errors.

TOP: Safe Medication Administration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3. The nurse recognizes that patients with which conditions will have a reduction in the distribution of drugs? (Select all that apply.)

a.

Peripheral vascular disease

b.

Heart failure

c.

Liver disease

d.

Obesity

ANS: A, B

The rate and extent of distribution depend on circulation, cell membrane permeability, and protein binding. Peripheral vascular disease and heart failure result in a decrease in circulation, which reduces distribution. Liver disease causes a reduction in plasma proteins, which results in more free active drug that is distributed more readily. Obesity does not affect distribution.

DIF: Cognitive Level: Applying REF: Text reference: p. 474

OBJ: Discuss the types of medication actions. TOP: Pharmacokinetics

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

4. The hospital has implemented a computerized physician order entry system (CPOE) to eliminate the need for written orders. The benefits of this system include which of the following? (Select all that apply.)

a.

Automatic drug allergy checks

b.

Automatic dosage indications

c.

Identification of potential drug interactions

d.

Reduced number of medical errors

ANS: A, B, C, D

Decision support software, integrated into a CPOE system, allows for automatic drug allergy checks, dosage indications, and identification of potential drug interactions. Use of CPOE systems may significantly reduce medication errors by as much as 55% to 83%.

DIF: Cognitive Level: Understanding REF: Text reference: pp. 477-478 |Text reference: p. 480

OBJ: Describe the safety features of medication delivery systems.

TOP: Computerized Provider Order Entry

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. The nurse reviews a medication administration record for an anticoagulant that is ordered at 0900 daily. The medication record indicates that the drug was given at the following times over the past 4 days. Which times follow the right time of medication administration? (Select all that apply.)

a.

0800

b.

0830

c.

0930

d.

1000

ANS: B, C

Time-critical medications such as anticoagulants must be administered within 30 minutes of the scheduled time. Nontime-critical medications can be given 1 to 2 hours before or after the scheduled time.

DIF: Cognitive Level: Applying REF: Text reference: p. 484

OBJ: List and discuss the six rights of medication administration.

TOP: Right Time KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. Medication errors include which of the following? (Select all that apply.)

a.

Administration of the wrong medication

b.

Administration via the wrong route

c.

Inaccurate prescribing

d.

Failing to administer a medication

ANS: A, B, C, D

Medication errors include inaccurate prescribing and administering the wrong medication, by the wrong route, and in the wrong time interval, as well as administering extra doses or failing to administer a medication.

DIF: Cognitive Level: Understanding REF: Text reference: p. 473

OBJ: Identify guidelines for safe administration of medications.

TOP: Reporting Medication Errors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

7. The nurse administers a medication to the wrong patient but the patient suffers no harm from the medication error. What actions should the nurse take? (Select all that apply.)

a.

Prepare a written incident report.

b.

Document in the nurses notes that an incident report was completed.

c.

Report the incident to a manager only if the patient is harmed.

d.

Notify the prescriber.

ANS: A, D

When a medication error occurs, the nurse assesses the patient and notifies the prescriber as soon as possible. When the patient is stable, the nurse notifies the appropriate person in the institution (e.g., manager, supervisor). The nurse is responsible for preparing a written incident report usually within 24 hours of the incident. To legally protect the nurse and the institution, the incident report is not referred to in the nurses notes. All medication errors, including those that do not cause obvious or immediate harm, should be reported.

DIF: Cognitive Level: Applying REF: Text reference: p. 489

OBJ: Identify steps to take in reporting medication errors. TOP: Reporting Medication Errors

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

1. A patient receives the usual dose of a medication for the first time and develops severe hypotension and bradycardia. The nurse reports this event as an __________ type of medication action.

ANS:

adverse drug effect (ADE)

Adverse drug effects are unintended, undesirable, and often unpredictable. They occur at doses normally used.

DIF: Cognitive Level: Applying REF: Text reference: p. 475

OBJ: Discuss the types of medication actions. TOP: Adverse Drug Effect

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. Medication safety is always one of the ______________ set by The Joint Commission.

ANS:

National Patient Safety Goals

Medication safety has consistently been one of the National Patient Safety Goals.

DIF: Cognitive Level: Remembering REF: Text reference: p. 473 |Text reference: p. 482

OBJ: Discuss National Patient Safety Goals for medication administration.

TOP: National Patient Safety Goals KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3. The intended or desired physiological response to a medication is known as its ____________.

ANS:

therapeutic effect

Each medication has a therapeutic effectthe intended or desired physiological response to a medication. For example, the nurse administers morphine sulfate, an analgesic, to relieve a patients pain.

DIF: Cognitive Level: Remembering REF: Text reference: p. 474

OBJ: Discuss the types of medication actions. TOP: Therapeutic Effects

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. ______________ are predictable and often unavoidable secondary effects of a medication produced at a usual therapeutic drug dose.

ANS:

Side effects

Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. For example, some antihypertensive medications cause impotence in male patients.

DIF: Cognitive Level: Remembering REF: Text reference: p. 475

OBJ: Discuss the types of medication actions. TOP: Side Effects/Adverse Effects

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. The patient reports taking an opioid medication in large dosages for the past several years. While in the hospital, the patient is not prescribed the medication and develops tachycardia, hypertension, sweating, and tremors. He becomes confused and experiences visual hallucinations. The nurse recognizes these signs as indicative of _____________.

ANS:

physical dependence

Drug dependence can be physical or psychological. Physical dependence is manifested by intense physical disturbance when the medication is withdrawn.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions.

TOP: Medication Tolerance and Dependence

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. A drug interaction in which the combined effect of drugs is greater than the sum of the effects of each individual agent acting independently is known as a _____________.

ANS:

synergistic effect

A synergistic effect is a drug interaction in which the combined effect of two drugs is greater than the sum of the effects of each individual agent acting independently. In other words, 1+1 = 3 or more. The use of a combination of drugs to treat hypertension is an example of synergism. Each drug lowers blood pressure but in a different way; the summed effect produces a greater reduction in hypertension than is produced by the effects of each medication.

DIF: Cognitive Level: Remembering REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Medication Interactions

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. The prescriber orders an IV antibiotic every 8 hours. The nurse administers the medication at 0900. The medications onset of action is 5 minutes, peak action is 30 minutes, and duration is 6 to 24 hours. An order for peak and trough levels is written. The nurse will have the peak level drawn at _________.

ANS:

0930

The highest level is called the peak concentration. The peak level is drawn whenever the drug is expected to reach its peak concentration.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Medication Dose Responses

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

8. The nurse administers 100 mg of a drug at 0800. The drugs biological half-life is 4 hours. A serum drug level is drawn at 1600. The nurse should anticipate ___________ milligrams will be left in the body at 1600?

ANS:

25 mg

Biological half-life is the time it takes for excretion processes to lower the serum medication concentration by half. After the first half-life (1200), 50 mg will be left in the body. After the second half-life (1600), 25 mg will be left in the body. Each half-life lowers the amount of drug in the body by half.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Medication Dose Responses

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. A patient reports a pain level of 7 out of 10 and receives 10 mg of morphine IV. The nurse knows that IV morphine has an onset of 1 to 2 minutes, a peak of 20 minutes, and a duration of 4 to 5 hours. The patient asks when he will start to feel some pain relief. The nurse should respond that relief should begin in _____________.

ANS:

1 to 2 minutes

The period of time it takes after a medication is administered for it to produce a therapeutic effect is known as the onset of medication action.

DIF: Cognitive Level: Applying REF: Text reference: pp. 474-475 |Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Onset of Medication Action

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

10. The nurse administers 650 mg of acetaminophen (Tylenol) orally to a patient with a pain level of 4 out of 10. The nurse is aware that the onset of action is 30 minutes to 1 hour, the peak action is 1 to 3 hours, and the duration of action is 3 to 8 hours. After _____ hours, the nurse should assess the patient to determine the maximum effectiveness of the drug.

ANS:

1 to 3

Peak action is the time it takes for a medication to reach its highest effective peak concentration.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Peak Action

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. A patient is prescribed diltiazem tablets, which have an onset of 30 minutes, a peak of 2 to 3 hours, and a duration of 6 to 8 hours. The nurse anticipates that the medication will be prescribed ____________ per day.

ANS:

3 to 4 times

Duration of action is the length of time during which the medication is present in a concentration great enough to produce a therapeutic effect. A medication with a duration of action of 6 to 8 hours will usually be given 3 to 4 times daily to maintain therapeutic effects.

DIF: Cognitive Level: Applying REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Duration of Action

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. The _________________ of a drug is the blood serum concentration reached and maintained after repeated, fixed doses.

ANS:

plateau

The plateau of a drug is the blood serum concentration reached and maintained after repeated, fixed doses.

DIF: Cognitive Level: Remembering REF: Text reference: p. 477

OBJ: Discuss the types of medication actions. TOP: Plateau

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. A medication distribution system that uses individual patient drawers and whereby medication is packaged according to what the patient would receive at one time is known as the _______ system.

ANS:

unit-dose

The standard for medication distribution is the unit-dose system. The system uses automated medication dispensing systems or carts containing a drawer with a 24-hour supply of medications for each patient. Each drawer has a label with the name of the patient in the designated room. The unit dose is the ordered dose of medication the patient receives at one time.

DIF: Cognitive Level: Remembering REF: Text reference: p. 478

OBJ: Describe the safety features of medication delivery systems.

TOP: Unit Dose KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

14. The patient is to receive 200 mg of a medication. There are 100-mg scored tablets available. The nurse prepares _________ tablets.

ANS:

2

The dose ordered is the amount of medication prescribed (e.g., 200 mg). The dose on hand is the dose (e.g., mg, mL, units) of medication supplied by the pharmacy (in this case, 100-mg tablets). The amount on hand is the weight or volume of medication available and supplied by the pharmacy. It appears on the medication label as the contents of a tablet or capsule, or as the amount of medication dissolved per unit volume of liquid. The amount on hand is the basic quantity of the medication that contains the dose on hand. For solid medications, the amount on hand is often one capsule; the amount of liquid on hand is often 1 mL or 1 L (in this case, it is 1 tablet). The amount to be administered (e.g., mL, mg) is always expressed in the same measure as the amount on hand.

Dose ordered Amount on hand = Amount to administer

Dose on hand

200 mg 1 tab = 200 mg = 2 tablets

100 mg 100 mg

DIF: Cognitive Level: Applying REF: Text reference: pp. 486-487

OBJ: Accurately calculate medication doses. TOP: Dosage Calculations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15. The dose ordered for a patient is 75 mg IM. The medication is available in a 50-mg/mL solution. The nurse prepares ________________ mL.

ANS:

1.5

The dose ordered is the amount of medication prescribed (e.g., 75 mg). The dose on hand is the dose (e.g., mg, mL, units) of medication supplied by the pharmacy (in this case, a 50-mg solution). The amount on hand is the weight or volume of medication available and supplied by the pharmacy. It appears on the medication label as the contents of a tablet or capsule, or as the amount of medication dissolved per unit volume of liquid. The amount on hand is the basic quantity of the medication that contains the dose on hand. The amount of liquid on hand is often 1 mL or 1 L (in this case, it is 1 mL). The amount to administer (e.g., mL, mg) is always expressed in the same measure as the amount on hand.

Dose ordered Amount on hand = Amount to administer

Dose on hand

75 mg 1 mL = 75 mg = 1.5 mL

50 mg 50 mg

DIF: Cognitive Level: Applying REF: Text reference: pp. 486-487

OBJ: Accurately calculate medication doses. TOP: Dosage Calculations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16. The prescriber orders 3 mg/kg/d of a medication to be given in 3 equal doses. The patient weighs 44 pounds. The nurse calculates that the proper amount per dose is ___________.

ANS:

20 mg

Convert pounds to kilograms.

44 pounds 1 kg/2.2 lb = 20 kg

Solve the equation for how many mg/d.

20 kg 3 mg/kg = 60 mg/d

Solve the equation for how many mg/dose.

60 mg divided by 3 equal doses = 20 mg/dose

DIF: Cognitive Level: Applying REF: Text reference: p. 480 |Text reference: pp. 485-487

OBJ: Accurately calculate medication doses. TOP: Pediatric Doses

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17. The nurse calculates that the proper dosage of a medication is 2 tsp. The nurse prepares _______ mL to administer to the patient.

ANS:

10

Conversion: 1 tsp = 5 mL; 2 tsp = 10 mL.

DIF: Cognitive Level: Applying REF: Text reference: p. 480

OBJ: Accurately calculate medication doses. TOP: Equivalents of Measurement

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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