Chapter 31: Medication Administration Nursing School Test Banks

Test Bank

MULTIPLE CHOICE

1. A nurse knows that patient education has been effective when the patient states

a.

I must take my parenteral medication with food.

b.

If I am 30 minutes late taking my medication, I should skip that dose.

c.

I will rotate the location where I give myself injections.

d.

Once I start feeling better, I will stop taking my medication.

ANS: C

Rotating injection sites provides greater consistency in absorption of medication. Parenteral medication absorption is not affected by the timing of meals. Taking a medication 30 minutes late is within the 60-minute window of the time medications should be taken. Medications should be stopped based on the providers orders. With some medications, such as antibiotics, it is crucial that the full course of medication is taken to avoid relapse of infection.

DIF: Apply REF: 571-572

OBJ: Discuss the nurses role and responsibilities in medication administration.

TOP: Evaluation MSC: Medication Administration

2. Which statement by the patient is an indication to use the Z-track method?

a.

Im really afraid that a big needle will hurt.

b.

The last shot like that turned my skin colors.

c.

I am allergic to many medications.

d.

My legs are too obese for the needle to go through.

ANS: B

The Z-track is indicated when the medication being administered has the potential to irritate sensitive tissues. The Z-track method is not meant to reduce discomfort from the procedure. If a patient is allergic to a medication, it should not be administered. If a patient has additional subcutaneous tissue to go through, a needle of a different size may be selected.

DIF: Understand REF: 629

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Planning MSC: Medication Administration

3. A 2-year-old child is ordered to have ear irrigation performed daily. The nurse correctly performs the procedure by

a.

Pulling the auricle down and back to straighten the ear canal.

b.

Pulling the auricle upward and outward to straighten the ear canal.

c.

Instilling the irrigation solution by holding the syringe just inside the ear canal.

d.

Holding the fluid in the canal for 2 to 3 minutes with a cotton swab.

ANS: A

Children up to 3 years of age should have the auricle pulled down and back, children 4 years of age to adults should have the auricle pulled upward and outward. Irrigation solution should be instilled 1 cm (1/2) above the opening of the ear canal. Irrigation solution should be allowed to drain freely during instillation.

DIF: Understand REF: 597

OBJ: Correctly and safely prepare and administer medications. TOP: Planning

MSC: Medication Administration

4. A patient has an order to receive 10 units of U-50 insulin. The nurse is using a U-100 syringe. How many units should the nurse draw up in the syringe and administer?

a.

0.2 units

b.

2 units

c.

5 units

d.

20 units

ANS: D

The nurse is careful to perform nursing calculations to ensure proper medication administration. U-50 insulin has 50 units of insulin in every milliliter, a U-100 syringe has 100 units in every milliliter. Conversion equals 20 units.

DIF: Understand REF: 601-604 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Medication Administration

5. A patient has an order to receive 20 units of U-50 insulin. The nurse is using a U-100 syringe. How many units should the nurse draw up in the syringe and administer?

a.

0.04 mL

b.

0.4 mL

c.

4 mL

d.

10 mL

ANS: B

The nurse is careful to perform nursing calculations to ensure proper medication administration. U-50 insulin has 50 units of insulin in every milliliter, a U-100 syringe has 100 units in every milliliter. Conversion equals 20 units.

DIF: Understand REF: 601-604 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Medication Administration

6. The patient is to receive phenytoin (Dilantin) at 0900. The nurse knows that the ideal time to draw a trough level is

a.

0800.

b.

0830.

c.

0900.

d.

0930.

ANS: B

Trough levels are generally drawn 30 minutes before the drug is administered. If the medication is administered at 0900, the trough should be drawn at 0830.

DIF: Understand REF: 567-570

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

7. A patient who has been receiving intermittent chemotherapy through a peripheral IV site is ordered to receive a high dose of vancomycin through the same vein. Why does this concern the nurse?

a.

Chemotherapy is irritating to the vascular system and may cause the vein to infiltrate.

b.

Two medications should never be placed into the same IV site.

c.

Once chemotherapy is in a patients system, any additional medicine given will cause a synergistic effect.

d.

Chemotherapy treatments require a special pump designed solely for chemotherapy.

ANS: A

Chemotherapy medications and vancomycin are irritating to the veins and introduce increased risk for infiltration. Infiltration of a chemotherapy medication can lead to extravasation, a serious IV complication. Medications can be placed into the same IV site if they are compatible. Chemotherapy does not cause a synergistic effect with antibiotics. Chemotherapy medications can be infused through the same device as maintenance IV fluids or even antibiotics.

DIF: Apply REF: 610-611

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Implementation MSC: Medication Administration

8. A physician orders 1000 mL of normal saline to infuse at a rate of 50 mL/hr. The nurse plans on hanging a new bag at what time?

a.

2 hours

b.

5 hours

c.

10 hours

d.

20 hours

ANS: D

It will take 20 hours for a liter (1000 mL) of fluid to infuse at a rate of 50 mL/hr. After 2 hours, only 100 mL would have infused. After 5 hours, only 250 mL would have infused. At 10 hours, 500 mL would have infused.

DIF: Remember REF: 573-577 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Medication Administration

9. The nurse is preparing to administer a 0.5-mL rabies vaccine into the deltoid muscle of a patient. Which needle size is best for the procedure?

a.

20 gauge 1 1/2 inch

b.

23 gauge 1/2 inch

c.

25 gauge 5/8 inch

d.

27 gauge 3/8 inch

ANS: C

For an intramuscular injection into the deltoid, a 25-gauge, 5/8-inch needle is recommended. Needles that are 20 gauge 11/2 inch, 23 gauge 1/2 inch, and 27 gauge 3/8 inch are not appropriately sized for this type of injection.

DIF: Remember REF: 601

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Implementation MSC: Medication Administration

10. The nurse knows that the purpose of aspiration on IM injections is to

a.

Ensure proper placement of the needle.

b.

Increase the force of the injection.

c.

Reduce the discomfort of the injection.

d.

Prolong the absorption time of the medication.

ANS: A

The purpose of aspiration is to ensure that the needle is in the belly of the muscle and not in the vascular system. Blood return upon aspiration indicates improper placement, and the injection should not be given. Increasing the force of the injection, reducing discomfort, and prolonging absorption time are not reasons for aspirating medications.

DIF: Understand REF: 601-609

OBJ: Implement nursing actions to prevent medication errors. TOP: Implementation

MSC: Medication Administration

11. The nurse is giving an IM injection. Upon aspiration, the nurse notices blood return in the syringe. What should the nurse do?

a.

Administer the injection at a slower rate.

b.

Withdraw the needle and prepare the injection again.

c.

Pull the needle back slightly and inject the medication.

d.

Give the injection and hold pressure over the site for 3 minutes.

ANS: B

Blood return upon aspiration indicates improper placement, and the injection should not be given. Instead withdraw the needle, dispose of the syringe and needle properly, and prepare the medication again. Administering the medication into a blood vessel could have dangerous adverse effects, and the medication will be absorbed faster than intended owing to increased blood flow. Holding pressure is not an appropriate intervention. Pulling back the needle slightly does not guarantee proper placement of the needle and medication administration.

DIF: Apply REF: 601-609

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

12. The nurse is planning to administer a tuberculin test with a 27-gauge, 3/8-inch needle. The nurse should insert the needle at an angle of _____ degrees.

a.

15

b.

45

c.

90

d.

180

ANS: A

A 27-gauge, 3/8-inch needle is used for intradermal injections such as a tuberculin test, which should be inserted at a 15-degree angle, just under the dermis of the skin. Placing the needle at 45 degrees, 90 degrees, or 180 degrees will place the medication too deep.

DIF: Understand REF: 604-605

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Implementation MSC: Medication Administration

13. The nurse knows to assess for signs of medication toxicity within older adults because of which physiological change?

a.

Reduced glomerular filtration

b.

Delayed esophageal clearance

c.

Decreased gastric peristalsis

d.

Decreased cognitive function

ANS: A

All of the options are signs of aging; however, the glomerular filtration rate affects metabolism and medication clearance. The buildup of medication can cause toxicity in older patients.

DIF: Understand REF: 589-592

OBJ: Discuss developmental factors that influence pharmacokinetics.

TOP: Implementation MSC: Medication Administration

14. A registered nurse interprets that a scribbled medication order reads 25 mg. The nurse administers 25 mg of the medication to a patient, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who is ultimately responsible for the error?

a.

Physician

b.

Pharmacist

c.

Nurse

d.

No fault

ANS: C

Ultimately, the person administering the medication is responsible for ensuring that it is correct. The nurse administered the medication, so in this case it is the nurse. This is the importance of verifying the Six Rights of Medication Administration.

DIF: Understand REF: 582-588

OBJ: Compare and contrast the roles of the prescriber, pharmacist, and nurse in medication administration. TOP: Implementation MSC: Medication Administration

15. A patient is to receive medication through a nasogastric tube. What is the most important nursing action to ensure effective absorption?

a.

Thoroughly shake the medication before administering.

b.

After all medications are administered, flush tube with 15 to 30 mL of water.

c.

Position patient in the supine position for 30 minutes.

d.

Clamp suction for 30 to 60 minutes after medication administration.

ANS: D

Absorption time for a medication administered through a nasogastric (NG) tube is the same as for an oral medication: 30 to 60 minutes. Therefore, the nurse would need to hold the suction for that amount of time to let the medication absorb. Thoroughly shaking the medication mixes the medication before administration but does not affect absorption. Flushing the medications ensures that all were administered. Patients with NG tubes should never be positioned supine but instead should be positioned at a 30- to 90-degree angle to prevent aspiration, provided no contraindication condition is known.

DIF: Analyze REF: 611-614

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Patient Needs Category

16. Aspirin is an analgesic, antipyretic, antiplatelet, and anti-inflammatory agent. A physician writes for aspirin 650 mg every 4 to 6 hours prn: febrile. For which patient would this order be appropriate?

a.

7-year-old with hemophilia

b.

21-year-old with a sprained ankle

c.

35-year-old with a severe headache

d.

62-year-old female with pneumonia

ANS: D

The provider wrote for the medication to be given for a fever. Hemophilia is a bleeding disorder; therefore, antiplatelets would be contraindicated. Although it can be used for inflammatory problems and pain, this is not what the order was written for.

DIF: Evaluate REF: 584-587

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Patient Needs Category

17. A patient is in need of immediate pain relief for a severe headache. The nurse knows that which medication will be absorbed the quickest?

a.

Tylenol 650 mg PO

b.

Morphine 4 mg SQ

c.

Ketorolac (Toradol) 8 mg IM

d.

Hydromorphone (Dilaudid) 4 mg IV

ANS: D

IV is the fastest route for absorption owing to the increase in blood flow. Oral, subcutaneous (SQ), and intramuscular (IM) are others ways to deliver medication but with less blood flow.

DIF: Understand REF: 567-570 OBJ: Discuss factors that influence medication actions.

TOP: Implementation MSC: Pharmacological

18. A drug requires a low pH to be metabolized. Knowing this, the nurse anticipates that the medication will be administered by which route?

a.

Oral

b.

Parenteral

c.

Buccal

d.

Inhalation

ANS: A

An oral medication would pass through to the stomachan area of low pH. The nurse would question an order for a medication that required an acidic environment to be metabolized. Buccal, inhalation, and parenteral routes provide neutral or alkaline environments.

DIF: Apply REF: 567-570

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Implementation MSC: Pharmacological

19. The nurse knows that an idiosyncratic event with the stimulant pseudoephedrine (Sudafed) is occurring when the patient

a.

Experiences blurred vision while driving.

b.

Falls asleep during daily activities.

c.

Presents with a pruritus rash.

d.

Develops xerostomia.

ANS: B

An idiosyncratic event is a reaction opposite to what the side effects of the medication normally are, or the patient overreacts or underreacts to the medication. Blurred vision is a toxic effect. A rash could indicate an allergic reaction. Dry mouth is a typical response to a stimulant.

DIF: Apply REF: 569

OBJ: Differentiate among different types of medication actions.

TOP: Assessment MSC: Pharmacological

20. An order is written for (phenytoin) Dilantin 500 mg IM q3-4h prn for pain. The nurse recognizes that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes that the prescriber meant to write for hydromorphone (Dilaudid). What should the nurse do?

a.

Give the patient Dilaudid, as it was meant to be written.

b.

Call the prescriber to clarify and justify the order.

c.

Administer the medication and monitor the patient frequently.

d.

Refuse to give the medication and notify the nurse supervisor.

ANS: B

If the nurse is apprehensive about the drug, dose, route, or reason for a medication, the nurse should first call the prescriber and clarify. The nurse should not change the order without the prescribers consent. Ultimately, the nurse can be held responsible for administering an incorrect medication. If the prescriber is unwilling to change the order and does not justify the order in a reasonable and evidence-based manner, the nurse may refuse to give the medication and notify her supervisor.

DIF: Apply REF: 584-588

OBJ: Compare and contrast the roles of the prescriber, pharmacist, and nurse in medication administration. TOP: Implementation MSC: Pharmacological

21. A patient needs assistance excreting a gaseous medication. What is the correct nursing action?

a.

Encourage the patient to cough and deep-breathe.

b.

Suction the patients respiratory secretions.

c.

Administer the antidote via inhalation.

d.

Administer 100% FiO2 via simple face mask.

ANS: A

Gaseous and volatile medications are excreted through gas exchange. Deep breathing and coughing will assist in clearing the medication more quickly.

DIF: Understand REF: 572-573

OBJ: Describe the physiological mechanisms of medication action.

TOP: Implementation MSC: Pharmacological

22. A nurse has withdrawn a narcotic from the medication dispenser. Upon checking the drug against the medication administration record, the nurse notices that the narcotic order has expired. What should be the nurses first action?

a.

Return the medication to the medication dispenser according to protocol.

b.

Exit the medication room to call the physician to request a reorder of the narcotic.

c.

Assess the patient to see if the narcotic is still needed; if so, administer the medication.

d.

Call the pharmacy and request that the narcotic be removed from the patient profile.

ANS: A

The nurse should follow Nurse Practice Acts and safe narcotic administration guidelines by safely returning the medication to the secure medication dispenser. This allows for an accurate narcotic count. The nurse should not leave the medication room with a nonprescribed medication; the physician can be contacted once the medication is replaced safely. The nurse cannot administer a medication when there is no current order; this is a violation of the Six Rights of Medication Administration. The nurse should notify the pharmacist after safely returning the narcotic to the medication dispenser; removing the medication from the patient profile will reduce further medication errors.

DIF: Analyze REF: 566-567

OBJ: Identify the six rights of medication administration and apply them in clinical settings.

TOP: Implementation MSC: Pharmacological

23. The nurse knows that patient education about a buccal medication has been effective when the patient states

a.

I should let the medication dissolve completely.

b.

I can only drink water, not juice, with this medication.

c.

For faster distribution, I should chew my medication first.

d.

I should place the medication in the same location.

ANS: A

Buccal medications should be placed in the side of the cheek and allowed to dissolve completely. Buccal medications act with the patients saliva and mucosa. The patient should not chew or swallow the medication. Gastric secretions may destroy some medications. The patient should rotate sides of the check to avoid irritating the mucosal lining.

DIF: Understand REF: 571-573

OBJ: Discuss methods used to educate patients about prescribed medications.

TOP: Evaluation MSC: Pharmacological

24. What is the nurses priority action to protect a patient from medication error?

a.

Requesting that the prescriber write out an order, rather than giving a verbal order

b.

Asking anxious family members to leave the room before giving a medication

c.

Checking the patients room number against the medication administration record

d.

Administering as many of the medications as possible at one time

ANS: A

Verbal orders should be limited to urgent situations where written communication is unavailable. The nurse should explain the reasons and logistics of a procedure to calm anxious family members, and should ask family members not to distract medication administration for the patients safety. After proper education, if the family members are creating an unsafe environment, the nurse may ask them to step out of the room. The medication administration record should be checked against the patients hospital identification band; a room number is not an acceptable identifier. Medications should be given when scheduled, and medications with special assessment indications should be separated.

DIF: Analyze REF: 577-581

OBJ: Implement nursing actions to prevent medication errors. TOP: Implementation

MSC: Pharmacological

25. The patient is in severe pain and is requesting a prn medication before the prn time interval has elapsed. The nurses priority is to

a.

Give the medication early for any pain score greater than 8.

b.

Call the prescriber and request a stat order.

c.

Explain to the patient why he will have to wait for the medication.

d.

Document the patients request and pain score.

ANS: B

The nurse should utilize clinical judgment to advocate for the patient by requesting a stat order for the patients breakthrough pain. The nurse cannot give a medication without an order because this violates the Right Time portion of the Six Rights of Medication Administration. If a nurse assesses that a patient is in severe pain, she must use clinical judgment to find that patient a means of pain relief. Although the nurse should document the patients request and pain score, this is not the priority.

DIF: Analyze REF: 577-581

OBJ: Identify the six rights of medication administration and apply them in clinical settings.

TOP: Implementation MSC: Pharmacological

26. A patient is at risk for aspiration. What nursing action is most appropriate?

a.

Hold the patients cup for him so he can concentrate on taking pills.

b.

Thin out liquids so they are easier to swallow.

c.

Give the patient a straw to control the flow of liquids.

d.

Have the patient self-administer the medication.

ANS: D

Aspiration occurs when food, fluid, or medication intended for GI administration inadvertently enters the respiratory tract. To minimize aspiration risk, allow the patient, if capable, to self-administer medication. Patients should also hold their own cup to control how quickly they take in fluid. Liquids should be thickened to reduce the risk of aspiration. Patients at risk for aspiration should not be given straws because use of a straw decreases the control the patient has over volume intake.

DIF: Understand REF: 593

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Pharmacological

27. A confused patient refuses his medication. What is the nurses first response?

a.

Agrees with the patients decision and documents it in his chart

b.

Educates the patient about the importance of the medication

c.

Discreetly hides the medication in the patients favorite Jell-O

d.

Informs the patient that he must take the medication whether he wants to or not

ANS: B

Much of a patients apprehension about medication comes from lack of understanding, and educating the patient may lead to better compliance. Ultimately, the patient does have the right to refuse the medication; however, the nurse should first try to educate the patient. Hiding, deceiving, or forcing a patient into taking a medication is unethical and violates his right to autonomy.

DIF: Apply REF: 587-590

OBJ: Discuss methods used to educate patients about prescribed medications.

TOP: Planning MSC: Pharmacological

28. A patient who is being discharged today is going home with an inhaler. The patient is to administer 2 puffs of his inhaler twice daily. The inhaler contains 200 puffs. When should the nurse appropriately advise the patient to refill his medication?

a.

As soon as he leaves the hospital

b.

When the inhaler is half empty

c.

6 weeks from the start of using the inhaler

d.

50 days after discharge

ANS: C

The inhaler should last the patient 50 days; the nurse should advise the patient to refill the prescription when he has 7 to 10 days of medication remaining. Refilling it as soon as he leaves the hospital or when the inhaler is half empty is too early. If the patient waits 50 days, the patient will run out of medication before it can be refilled.

DIF: Understand REF: 619-623 OBJ: Calculate prescribed medication doses correctly.

TOP: Teaching/Learning MSC: Pharmacological

29. The nurse knows that a subcutaneous injection takes longer to absorb because

a.

Fewer blood vessels are found under the subcutaneous level.

b.

Adipose tissue takes longer to metabolize medication.

c.

Connective tissue holds medication in place longer.

d.

Some medication leaks out after instillation.

ANS: A

How quickly a medication is absorbed is dependent on blood flow to the site. Locations with less blood supply take longer to absorb. Absorption is not based on adipose tissue; however, excessive adipose tissue may cause the medication to take longer before reaching the blood supply. The connective tissue is not part of medication absorption. If a medication is properly administered, none of it should be wasted.

DIF: Understand REF: 592 OBJ: Discuss factors that influence medication actions.

TOP: Planning MSC: Pharmacological

30. The nurse realizes which patient is at greatest risk for an unintended synergistic effect?

a.

72-year-old who is seeing four different specialists

b.

4-year-old who has mistakenly taken the entire packet of his mothers birth control pills

c.

50-year-old who was prescribed a second blood pressure medication

d.

35-year-old drug addict who has ingested meth mixed with several household chemicals

ANS: A

A synergistic effect occurs when two medications potentiate each other, creating a greater effect than a single medication on its own. The 72-year-old seeing four different providers is likely to experience polypharmacy. Polypharmacy places the patient at risk for unintended mixing of medications that potentiate each other. The child taking too much of a medication by mistake could experience overdose or toxicity. The 50-year-old is prescribed two different blood pressure medications for their synergistic effect, but this is a desired event. A drug addict mixing chemicals can be toxic.

DIF: Analyze REF: 568-570

OBJ: Differentiate among different types of medication actions.

TOP: Assessment MSC: Pharmacological

31. Which patient using an inhaler would benefit most from using a spacer?

a.

3-year-old with a cleft palate

b.

25-year-old with multiple sclerosis

c.

50-year-old with hearing impairment

d.

72-year-old with left-sided hemiparesis

ANS: B

A spacer is indicated for a patient who has limited coordination or function. Individuals with multiple sclerosis often lose motor control and function and have difficulty seeing. Children often have difficulty using a spacer, so a simple face mask is preferred for infants and children younger than 4. Hearing impairment may make teaching the patient to use the inhaler difficult, but it does not indicate the need for a spacer. A patient with one-sided weakness would have a difficult time assembling and administering an inhaler by using a spacer, but the patient could use the inhaler single-handedly.

DIF: Analyze REF: 619-623

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP: Implementation MSC: Pharmacological

32. The prescriber wrote for a 40-kg child to receive 25 mg of medication 4 times a day. The therapeutic range is 5 to 10 mg/kg/day. What is the nurses priority?

a.

Administer the medication because it is within the therapeutic range.

b.

Notify the physician that the prescribed dose is in the toxic range.

c.

Notify the physician that the prescribed dose is below the therapeutic range.

d.

Change the dose to one that is within range.

ANS: C

The dosage range is 200 to 400 mg a day. The prescribed dose is 100 mg/day, which is below therapeutic range. The nurse should notify the physician first and ask for clarification on the order. The dose is not above the therapeutic range and is not at a toxic level. The nurse should never alter an order without the prescribers approval and consent.

DIF: Apply REF: 574-576 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Pharmacological

33. The nurse is administering an intravenous medication that is to be administered over 10 minutes. Which method should the nurse choose to efficiently administer the medication?

a.

Place the medication in a large-volume cath-tipped syringe.

b.

Mix the medication into the patients maintenance fluids.

c.

Attach separate tubing and set the medication syringe in a mini-infusion pump.

d.

Stand at the patients bedside and carefully watch the clock while pushing the medication.

ANS: C

To administer this medication efficiently, the nurse should use an infusion pump to run the medication in over a prolonged time. This method is more accurate and is more time efficient than other methods because the nurse can leave the room. The nurse should not mix medication into the maintenance bag without pharmacist and physician approval. Pushing the medication is not a time-efficient method for the nurse. A cath-tipped syringe is an inappropriate device for administration of a medication.

DIF: Analyze REF: 611

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

34. A nurse is caring for a patient who is in hypertensive crisis. When the nurse is flushing the patients peripheral IV, the patient complains of pain. Upon assessment, the nurse notices a red streak that is warm to the touch. What is the nurses initial action?

a.

Notify the physician.

b.

Administer pain medication.

c.

Discontinue the IV.

d.

Apply a cool compress to the site.

ANS: D

The patient has phlebitis; the initial nursing action would be to apply a cool compress. The nurse should start a new IV before discontinuing the old one because it is important to always have an IV access site in case of emergency. Then the physician can be notified. Pain medication may need to be administered.

DIF: Apply REF: 632

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

35. The nurse is preparing to administer medications to two patients with the same last name. After the administration, the nurse realizes that she did not check the identification of the patient before administering medication. Which of the following actions should the nurse complete first?

a.

Return to the room to check and assess the patient.

b.

Administer the antidote to the patient immediately.

c.

Alert the charge nurse that a medication error has occurred.

d.

Complete proper documentation of the medication error in the patients chart.

ANS: A

The nurses first priority is to establish the safety of the patient by assessing the patient. Second, notify the charge nurse and the physician. Administer antidote if required. Finally, the nurse needs to complete proper documentation.

DIF: Evaluate REF: 609

OBJ: Implement nursing actions to prevent medication errors. TOP: Implementation

MSC: Medication Administration

36. The nurse knows that caring for two patients with the same last name can lead to a medication error involving which right of medication administration?

a.

Right medication

b.

Right patient

c.

Right dose

d.

Right route

ANS: B

The nurse should ask the patient to verify his identity and should check the patients ID bracelet against the medication record to ensure proper patient. Acceptable patient identifiers include the patients name, an identification number assigned by a health care agency, or a telephone number. Do not use the patients room number as an identifier. To identify a patient correctly in an acute care setting, compare the patient identifiers on the MAR with the patients identification bracelet while at the patients bedside. Right medication, right dose, and right route are equally as important, but this example outlines right patient.

DIF: Remember REF: 585

OBJ: Identify the six rights of medication administration and apply them in clinical settings.

TOP: Implementation MSC: Medication Administration

37. A patients states that she would prefer not to take her daily allergy pill this morning because it makes her too drowsy throughout the day. The nurse responds therapeutically by saying,

a.

The physician ordered it; therefore you must take your medication every morning at the same time whether youre drowsy or not.

b.

Lets change the time you take your pill to 9 PM, so the drowsiness occurs when you would normally be sleeping.

c.

You can skip this medication on days when you need to be awake and alert.

d.

Try to get as much done as you can before you take your pill, so you can sleep in the afternoon.

ANS: B

The nurse should use knowledge about the medication to educate the patient about potential response to medications. Then the medication schedule can be altered based on that knowledge, after the physician has been notified. It is the patients right to refuse her medication; however, the nurse should educate the patient on the importance and effects of her medication. Asking a patient to change her entire life schedule around a medication is unreasonable and will decrease compliance. The nurse should be supportive and should offer solutions to manage medication effects.

DIF: Apply REF: 588

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

38. A provider has ordered a STAT medication to be administered. The nurse knows that the best route of administration is

a.

IV.

b.

IM.

c.

SQ.

d.

PO.

ANS: A

IV medications have the quickest effect because they receive the most blood flow. A STAT order is to be carried out as quickly as possible, so the effect should be as immediate as possible. Oral, subcutaneous (SQ), and intramuscular (IM) are other ways to deliver medication but with less blood flow.

DIF: Understand REF: 578| 609

OBJ: Describe the physiological mechanisms of medication action.

TOP: Implementation MSC: Medication Administration

39. A nurse is attempting to administer medication to a child, but the child refuses to take the medication. The nurse asks for the parents cooperation by saying

a.

Please hold your childs arms down at her sides, so I can get the full dose of medication into her mouth.

b.

I will prepare the medication for you and observe if you would like to try to administer the medication.

c.

Lets turn the lights off and give the child a moment to fall asleep before administering the medication.

d.

Since your child loves applesauce, lets add the medication to it, so your child doesnt resist.

ANS: B

Children often have difficulties taking medication, but it is less traumatic for the child if the parent administers the medication. Holding down the child is not the best option because it may further upset the child. Never administer an oral medication to a sleeping child. Dont mix medications into the childs favorite foods, because the child might start to refuse the food.

DIF: Evaluate REF: 591

OBJ: Discuss developmental factors that influence pharmacokinetics.

TOP: Implementation MSC: Medication Administration

40. A 64-year-old quadriplegic patient needs an IM injection of antibiotic. What is the best site for the administration?

a.

Deltoid

b.

Dorsal gluteal

c.

Ventrogluteal

d.

Vastus lateralis

ANS: D

Vastus lateralis is a large muscle that is easily accessible from the supine position. Because this patient no longer walks, the ventrogluteal muscle will begin to atrophy and is not the ideal location. The dorsal gluteal site is a location for a subcutaneous injection, and this patient requires an IM injection. The deltoid is easily accessible, but this muscle is not well developed in many adults.

DIF: Apply REF: 604| 606-607

OBJ: Discuss factors that influence medication actions. TOP: Implementation

MSC: Medication Administration

41. Which nursing action is the number one priority for ensuring that medication stays in the target therapeutic range?

a.

Drawing the peak and trough levels at the same time each day

b.

Administering a double dose after a dose was missed

c.

Delivering the same amount of the drug at the same time each day

d.

Increasing absorption by holding all other medications 1 hour before administration

ANS: A

The quantity and distribution of a medication in different body compartments change constantly. Drawing peak and trough levels allows health care providers to see whether the current medication dosage is effective for the patient, or if it needs to be adjusted. Administering a double dose is dangerous and could cause the medication to cross the toxic threshold. Delivering the same amount each day may not be therapeutic or may be toxic for the patient. Holding all other medications should not affect the peak or half-life of the medications, assuming that they are compatible.

DIF: Apply REF: 570

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

42. Which of the following demonstrates proper oral medication administration?

a.

Removing the medication from the wrapper and placing it in a cup labeled with the patients information

b.

Using the edge of the medicine cup to fill with 0.5 mL of liquid medication

c.

Placing all of the patients medications in the same cup, except medications with assessments

d.

Combining liquid medications from 2 single dose cups into 1 medicine cup

ANS: C

Placing medications that require preadministration assessment in a separate cup serves as a reminder to check before the medication is given, making it easier for the nurse to withhold medication if necessary. Medications should not be removed from their package until they are in the patients room because this makes identification of the pill easier and reduces contamination. When measuring a liquid, the nurse should use the meniscus level to measure, not the edge. In addition, liquid medications measuring less than 10 mL should be drawn up in a needleless syringe. Single-dose medications should not be transferred to medicine cups to reduce unnecessary manipulation of the dose.

DIF: Understand REF: 593

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

43. A patient who is receiving IV fluids notifies the nurse that his arm feels tight. Upon assessment, the nurse notes that the arm is swollen and cool to the touch. What should the nurses first action be?

a.

Discontinue the IV site, and apply a warm compress.

b.

Attached a syringe, and pull back on the plunger to aspirate the IV fluid.

c.

Start a new IV site distal from the site.

d.

Stop the IV fluids, and notify the physician immediately.

ANS: A

An IV site that is puffy, swollen, and cool to the touch indicates infiltration. The IV site should be discontinued immediately because it is no longer a viable access point. Pulling back on the syringe will not result in fluid return because there is no longer venous access. A new IV should be started in the opposite arm after the old IV has been removed. The IV should be removed; it is not sufficient to only stop the fluids.

DIF: Apply REF: 635

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

44. A patient informs the nurse that his urine is starting to look discolored. How should the nurse respond?

a.

Dont worry, that is a normal side effect of your medication.

b.

That is an unusual side effect. Ill notify your provider immediately.

c.

You need to drink more fluids to flush the medication from your system.

d.

Other than the discoloration, has anything changed with your urination?

ANS: D

The nurse wants to gather additional assessment information about the change in urine color. Information is insufficient to recommend drinking more fluids, or to know whether this is a normal or abnormal side effect. The other options do not provide a focused assessment and are not therapeutic responses.

DIF: Apply REF: 587

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

45. The physician orders 4 mg of oxycodone to be delivered every 6 hours. After 4 hours, the patient is complaining that she is in more pain. The nurse advises the physician to make which medication adjustment?

a.

Add an additional narcotic on top of the oxycodone.

b.

Divide the dose in half and administer 2 mg every 3 hours.

c.

Give another 4 mg of oxycodone after 4 hours.

d.

Change the medication being administered for pain relief.

ANS: B

The patients metabolism causes the peak effect to occur when the medicine is at its highest concentration. After reaching its peak, the serum concentration of the medication falls progressively. By spreading out the dose, the patient should receive constant pain relief. Changing the medication, increasing the dose, or adding another medication is not the best course of action.

DIF: Apply REF: 570-571

OBJ: Discuss factors to include in assessing a patients needs for and response to medication therapy. TOP: Implementation MSC: Medication Administration

MULTIPLE RESPONSE

1. Which of the following are methods to reduce the risk of needlestick injury? (Select all that apply.)

a.

Recap the needle after giving an injection.

b.

Have sharps boxes emptied when three-quarters full.

c.

Use two hands to dispose of sharps into the disposal.

d.

Never force a needle into the sharps disposal.

e.

Clearly mark sharps disposal containers.

f.

Use needleless devices whenever possible.

ANS: B, D, E, F

To prevent the risk of needlesticks, the nurse should never recap needles. Empty sharps boxes before they become too full, so needles do not stick out the top. Needles should not be forced into the box. Clearly mark receptacles to warn of danger. Using needleless systems when possible will further reduce the risk of needlestick injury.

DIF: Remember REF: 607-608

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

2. What methods are used to properly discard narcotics? (Select all that apply.)

a.

Placing the syringe of narcotics in the sharps container

b.

Washing liquids down the sink

c.

Flushing tablets down the toilet

d.

Returning the open tablet to the medication dispenser

e.

Locking the narcotic in a secure cabinet

f.

Throwing tablets into the trash

ANS: B, C

Proper disposal of wasted narcotics involves washing liquids down the sink and tablets down the toilet. This prevents others from accessing the wasted narcotics. Placing the syringe in the sharps container is not recommended; it could be accessed inappropriately. Once a medication is opened, it cannot be returned to the medication dispenser and must be wasted. Locking the narcotics in a secure cabinet is not a proper method of disposal; they could be accessed by someone other than the nurse. Throwing tablets into the trash is unsafe because pills may be recovered by inappropriate persons.

DIF: Understand REF: 566

OBJ: Correctly and safely prepare and administer medications. TOP: Implementation

MSC: Medication Administration

SHORT ANSWER

1. A patient is taking 1 tablet of hydrocodone bitartrate 5 mg and acetaminophen 500 mg (Vicodin) every 4 hours. He is also taking 2 tablets of acetaminophen (Tylenol) 325 mg every 12 hours. How many grams of acetaminophen is he taking daily?

ANS:

3.3

The nurse should calculate the dosage taken via the first medication and add it to the daily intake of the second medication. Then, convert milligrams to grams.

500 mg 6 doses a day = 3000 mg/day + (2 tablets 325 mg) 2 doses a day = 1300 mg/day = 3300 mg/day total of acetaminophen; 3300 mg converted to grams = 3.3 grams

DIF: Apply REF: 574-576 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Pharmacological

2. The nurse is administering 250 mg of a medication elixir to the patient. The medication comes in a dose of 1000 mg/5 mL. How many milliliters should the nurse administer?

ANS:

1.25

The nurse needs to first determine how many milligrams are in each milliliter of the elixir. Then the nurse calculates how many milliliters would contain 250 mg.

1000 mg/5 mL = 200 mg/1 mL

250 mg/(X) = 200 mg/mL = 1.25 mL

DIF: Apply REF: 574-576 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Pharmacological

3. The patient is to receive amoxicillin (Moxatag) 500 mg q8h; the medication is dispensed at 250 mg/5 mL. How many teaspoons would the nurse administer for one dose?

ANS:

2 tsp

The drug is dispensed at 250 mg/5 mL. The nurse is to give 500 mg, which is 10 mL. There is 5 mL in a teaspoon; therefore, the patient receives 2 tsp.

DIF: Apply REF: 573-577 OBJ: Calculate prescribed medication doses correctly.

TOP: Implementation MSC: Medication Administration

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