Chapter 34: Medication Administration Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. A client is nauseated, has been vomiting for several hours, and needs to receive an antiemetic (antinausea) medication. The nurse recognizes that which of the following is accurate?

a.

An enteric-coated medication should be given.

b.

Medication will not be absorbed as easily because of the nausea.

c.

A parenteral route is the route of choice.

d.

A rectal suppository must be administered.

ANS: c

c. The parenteral route provides a means of administration when oral medications are contraindicated. Onset of action is quicker. Less cause for embarrassment is given than with a rectal suppository.

a. An enteric-coated medication is given orally. Because the client is vomiting, the oral route should not be used.

b. Nausea does not affect the rate of absorption.

d. It is inaccurate to state that a rectal suppository must be administered. A rectal suppository is one option. The disadvantage of a rectal suppository is that insertion often causes embarrassment for the client. It is contraindicated if rectal bleeding is present or if the client had rectal surgery. Stool in the rectum can impair absorption.

REF: Text Reference: p. 832

2. The client receiving an intravenous infusion of morphine sulfate begins to experience respiratory depression and decreased urine output. This effect is described as:

a.

Therapeutic

b.

Toxic

c.

Idiosyncratic

d.

Allergic

ANS: b

b. Toxic levels of morphine may cause severe respiratory depression. Toxic effects may develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. The client with a decreased urine output is not excreting the morphine.

a. The therapeutic effect is the expected or predictable physiological response a medication causes. Respiratory depression and decreased urine output are not the desired (i.e., therapeutic) effect of morphine.

c. An idiosyncratic effect is when a medication causes an unpredictable outcome, such as when a client overreacts or under-reacts to a medication. This is not an example of an idiosyncratic effect.

d. When a client experiences an allergic response to a medication, the medication acts as an antigen, triggering the release of the bodys antibodies. The client may experience itching, urticaria, a rash, or in more severe cases, have difficulty breathing. The clients response to morphine is not an example of an allergic effect.

REF: Text Reference: p. 829

3. The client is to receive a medication via the buccal route. The nurse plans to implement the following action:

a.

Place the medication inside the cheek

b.

Crush the medication before administration

c.

Offer the client a glass of orange juice after administration

d.

Use sterile technique to administer the medication

ANS: a

a. Administration of a medication by the buccal route involves placing the solid medication in the mouth and against the mucous membranes of the cheek until the medication dissolves.

b. Crushing the medication is not necessary, as it is designed to dissolve in the clients cheek.

c. Clients are not to take any liquids with medications given by buccal administration or immediately after.

d. The mouth is not sterile. Sterile technique is not necessary for buccal administration.

REF: Text Reference: p. 831

4. The physician orders a grain and a half of sodium quinalbarbitone (Seconal) to help a client sleep. The label on the medication bottle reads, Seconal, 100 mg. How many capsules should the nurse give the client?

a.

1/2

b.

1

c.

11/2

d.

2

ANS: b

b. To calculate this problem, the nurse should first convert the measurements to one system. Because 1 grain = 60 mg, the nurse may multiply the a.5 grains by 60 to equal 90 mg. The nurse may then use the formula for calculating a drug dosage:

90 mg_

100 mg 1 capsule = 0.9 capsules

Because 0.9 of a capsule cannot be administered, it is rounded to a. The nurse will administer 1 capsule.

a. This is not a correct dosage calculation. Furthermore, capsules cannot be halved.

c. This is not a correct dosage calculation. Furthermore, capsules cannot be halved.

d. This is not a correct dosage calculation.

REF: Text Reference: p. 835

5. The physician has ordered 6 mg morphine sulfate every 3 to 4 hours prn for a clients postoperative pain. The unit dose in the medication dispenser has 15 mg in 1 ml. How much solution should the nurse give?

a.

1/5 ml

b.

1/3 ml

c.

2/5 ml

d.

1/4 ml

ANS: c

c. The nurse should use the formula to calculate a drug dosage:

6 mg_

15 mg 1 ml = 2/5 ml

a. This is not a correct dosage calculation.

b. This is not a correct dosage calculation.

d. This is not a correct dosage calculation.

REF: Text Reference: p. 835

6. To determine proper drug dosages for children, calculations are most precisely made on the basis of the childs:

a.

Weight

b.

Height

c.

Age

d.

Body surface area

ANS: d

d. The most accurate method of calculating pediatric doses is based on a childs body surface area.

a. Drug calculations are not most precise when made on the basis of a childs weight. Height and weight do not always correlate with the maturity of the childs organs, such as the liver, for metabolizing a drug.

b. Drug calculations are not most precise when made on the basis of a childs height.

c. Drug calculations are not most precise when made on the basis of a childs age. Children vary widely in size and maturity for chronological age.

REF: Text Reference: p. 837

7. The nurse is documenting administration of a medication that is given at 10:00 AM, 2:00 PM, and 6:00 PM. The medication that the nurse is documenting is:

a.

Morphine sulfate, 10 mg q4h prn

b.

Propranolol (Inderal), 10 mg po bid

c.

Diazepam, 5 mg po tid

d.

Cephalexin (Keflex), 500 mg po q8h

ANS: c

c. The medication is being given 3 times a day, 4 hours apart. The medication the nurse is documenting is diazepam, 5 mg PO tid.

a. Although the medication is being given 4 hours apart, it is not being given every 4 hours. If it were given every 4 hours, it could be given 6 times in 24 hours, not 3, as with tid administration.

b. Bid means twice a day. The client is receiving the medication 3 times a day.

d. The medication is not spaced apart as every 8 hours.

REF: Text Reference: p. 831

8. The nurse is working on the pediatric unit. In preparing to give medications to a preschool-age child, and appropriate interaction by the nurse is:

a.

Do you want to take your medication now?

b.

Would you like the medication with water or juice?

c.

Let me explain about the injection that you will be getting.

d.

If you dont take the medication now, you will not get better.

ANS: b

b. Allowing the child a choice of taking a medication with water or juice may have greater success because the child is involved.

a. The child should not be given the option of not taking a medication.

c. The nurse should explain the procedure to a child, using short words and simple language appropriate to the childs level of comprehension. Long explanations may increase a childs anxiety.

d. This statement is not a motivation for a child to take a prescribed medication. Giving the child a star or token afterward would be more motivating for a child.

REF: Text Reference: p. 847, Text Reference: p. 849

9. In preparing two different medications from two vials, the nurse must:

a.

Inject fluid from one vial into the other

b.

Uncap the syringe and wipe the needle with an alcohol preparation before inserting into either vial

c.

Discard the medication from vial number two if medication from vial number one is pushed into it

d.

Insert air into the first vial, but not the second vial

ANS: c

c. If a vial becomes contaminated with another medication, it should be discarded.

a. Fluid from one vial should not be injected into another, as it would contaminate the second vial.

b. The needle should not be wiped with alcohol. It is considered sterile and does not require to be wiped with alcohol. Wiping the needle would place the nurse at risk for a needle stick.

d. Air should be inserted into both vials, making sure the needle does not touch the solution in the first vial.

REF: Text Reference: p. 674, Text Reference: p. 879

10. The nurse is teaching the client how to prepare 10 units of regular insulin and 5 units of NPH insulin for injection. The nurse instructs the client to:

a.

Inject air into the regular insulin, then into the NPH

b.

Withdraw the regular insulin first

c.

Inject air into and withdraw the NPH immediately

d.

Inject air into both vials and withdraw the regular insulin first

ANS: d

d. The client should be taught to inject air into both vials and withdraw the regular insulin first.

a. Air should be injected into the vial of NPH insulin, and then the vial of regular insulin.

b. The regular insulin should be withdrawn after air has been injected into both vials.

c. Air should be injected into the vial of NPH insulin, and then the vial of regular insulin. The regular insulin should be withdrawn immediately after injecting the air into the vial of regular insulin. Then the NPH insulin is withdrawn.

REF: Text Reference: p. 880

11. A client has a prescription for a medication that is administered via an inhaler. To determine whether the client requires a spacer for the inhaler, the nurse will determine the:

a.

Dosage of medication required

b.

Coordination of the client

c.

Schedule of administration

d.

Use of a dry powder inhaler (DPI)

ANS: b

b. Spacers are especially helpful when the client has difficulty coordinating the steps involved in self-administering inhaled medications.

a. The use of a spacer is not dependent on the dosage of medication.

c. The use of a spacer is not dependent on the schedule of administration.

d. Spacers are not required with the use of a dry powder inhaler.

REF: Text Reference: p. 867

12. The student nurse reads the order to give a 1-year-old client an intramuscular injection. The appropriate and preferred muscle to select for a child is the:

a.

Deltoid

b.

Dorsogluteal

c.

Ventrogluteal

d.

Vastus lateralis

ANS: c

c. Research that has investigated complications associated with IM injection sites indicates that the ventrogluteal site is the preferred site for most injections given to adults and children older than 7 months.

a. The deltoid muscle is not developed enough for an IM injection in the 1-year-old client.

b. The dorsogluteal site is not recommended because of the risk of the needle hitting the sciatic nerve.

d. The vastus lateralis is a preferred site for infants younger than 12 months.

REF: Text Reference: p. 888

13. The nurse administers the intramuscular medication of iron by the Z-track method. The medication was administered by this method to:

a.

Provide faster absorption of the medication

b.

Reduce discomfort from the needle

c.

Provide more even absorption of the drug

d.

Prevent the drug from irritating sensitive tissue

ANS: d

d. The Z-track method is used to minimize local skin irritation by sealing the mediation in muscle tissue.

a. The Z-track method does not provide faster absorption of the medication.

b. The Z-track method does not reduce discomfort from the needle.

c. The Z-track method does not provide a more even absorption of the drug.

REF: Text Reference: p. 890

14. The client is ordered to have eye drops administered daily to both eyes. Eye drops should be instilled on the:

a.

Cornea

b.

Outer canthus

c.

Lower conjunctival sac

d.

Opening of the lacrimal duct

ANS: c

c. Eye drops should be instilled into the lower conjunctival sac. The conjunctival sac normally holds 1 or 2 drops and provides even distribution of medication across the eye.

a. The cornea is very sensitive. If drops were instilled onto the cornea it would stimulate the blink reflex.

b. The outer canthus would not hold the eye drop, and medication would be wasted, nor would it be distributed evenly across the eye.

d. The opening of the lacrimal duct is not the correct site for eye drops to be instilled. It would not provide even distribution of drops across the eye, and medication would most likely be wasted because this area could not contain the drops.

REF: Text Reference: p. 860

15. After administration of ear drops to the left ear, the client should be positioned:

a.

Prone

b.

Upright

c.

Right lateral

d.

Dorsal recumbent with hyperextension of the neck.

ANS: c

c. The client should remain in the side-lying position, in this case, the right lateral position, for 2 to 3 minutes after ear drops are administered.

a. The prone position is not recommended after administration of ear drops.

b. The upright position is not recommended after ear drop administration. The ear drops would run out of the ear canal.

d. The dorsal recumbent position with the neck hyperextended is not recommended after the administration of ear drops.

REF: Text Reference: p. 863

16. The order is for eye medication, ii gtts OD. The nurse administers:

a.

2 ml to the right eye

b.

2 drops to the left eye

c.

2 drops to the right eye

d.

2 drops to both eyes

ANS: c

c. ii, 2; gtts, drops; OD, right eye.

a. gtts is the abbreviation for drops, not ccs.

b. OS, left eye.

d. OU, both eyes.

REF: Text Reference: p. 859

17. The most effective way in the acute care environment to determine the clients identity before administering medications is to:

a.

Ask the clients name

b.

Check the name on the chart

c.

Ask the other caregivers

d.

Check the clients name band

ANS: d

d. To identify a client correctly, the nurse checks the medication administration form against the clients identification bracelet and asks the client to state his or her name to ensure that the clients identification bracelet has the correct information.

a. The nurse may ask the client his or her name if the identification bracelet is missing or illegible, and obtain a new identification bracelet for the client. The nurse should ask the client to state his or her full name. The nurse should not merely say the clients name and assume that the clients response indicates that he or she is the right person.

b. Checking the name on the chart does not identify the right client.

c. Asking other caregivers is not the most effective way to determine a clients identity before administering medications. The nurse should develop the habit of checking the clients name band.

REF: Text Reference: p. 842

18. An order is written for meperidine (Demerol), 500 mg IM q3-4h prn for pain. The nurse recognizes that this is significantly more than the usual therapeutic dose. The nurse should:

a.

Give 50 mg IM as it was probably intended to be written

b.

Refuse to give the medication and notify the nurse manager

c.

Administer the medication and watch the client carefully

d.

Call the prescriber to clarify the order

ANS: d

d. The nurse should question the order if the written order is illegible, the dose seems unusually low or high, or the medication seems inappropriate for the clients condition. The nurse should call the prescriber to clarify the order.

a. The nurse cannot independently change physicians orders. The nurse would have to call the prescriber and receive the order for the change.

b. The nurse should first call the prescriber and clarify the order. If the prescriber does not change the order, the nurse may then refuse to give the medication and notify the nurse manager.

c. The nurse could be held accountable for administering an ordered medication that is knowingly inappropriate for the client.

REF: Text Reference: p. 841

19. An order is written for 80 mg of a medication in elixir form. The medication is available in 80 mg/tsp strength. The nurse prepares to administer:

a.

2 ml

b.

5 ml

c.

10 ml

d.

15 ml

ANS: b

b. The nurse should first change the household measurement to a metric equivalent.

(5 ml = 1 tsp), and then the nurse should use the formula for calculating a medication dosage:

80 mg

80 mg 5 ml = 5 ml

a. This is an incorrect dosage.

c. This is an incorrect dosage. 10 ml would equal 2 teaspoons, in this case, 160 mg.

d. This is an incorrect dosage. 15 ml would equal 3 teaspoons, in this case, 240 mg.

REF: Text Reference: p. 835

20. The client is to receive a Mantoux test for tuberculosis. This test is administered via an intradermal injection. The nurse recognizes that the angle of injection that is used for an intradermal injection is:

a.

15 degrees

b.

30 degrees

c.

45 degrees

d.

90 degrees

ANS: a

a. The angle of injection for an intradermal injection is 5 to 15 degrees.

b. This is not the correct angle of injection.

c. Subcutaneous injections may be administered at a 45-degree angle.

d. Subcutaneous or intramuscular injections may be administered at a 90-degree angle.

REF: Text Reference: p. 884

21. The nurse prepares to administer an intradermal injection for the administration of medication for:

a.

Pain

b.

Allergy sensitivity

c.

Anticoagulant therapy

d.

Low-dose insulin requirements

ANS: b

b. Intradermal injections are typically given for allergy testing or tuberculin screening.

a. Pain medications are not administered intradermally.

c. Anticoagulants are not administered intradermally. They are typically given subcutaneously.

d. Intradermal injections are not used for low-dose insulin requirements.

22. The nurse is evaluating the integrity of the ventrogluteal injection site. The nurse finds the site by locating the:

a.

Middle third of the lateral thigh

b.

Greater trochanter, anterior iliac spine, and iliac crest

c.

Anterior aspect of the upper thigh

d.

Acromion process and axilla

ANS: b

b. The nurse finds the ventrogluteal site by locating the greater trochanter with the heel of the hand, the anterior iliac spine with the index finger, and the iliac crest with the middle finger.

a. The vastus lateralis site is found by locating the middle third of the lateral thigh.

c. The anterior aspect of the thigh may be used for subcutaneous injections; it is not how the ventrogluteal site is located.

d. The acromion process and axilla may be used to locate the deltoid site.

REF: Text Reference: p. 888

23. The client is to receive heparin by injection. The nurse prepares to inject this medication in the clients:

a.

Scapular region

b.

Vastus lateralis

c.

Posterior gluteal

d.

Abdomen

ANS: d

d. The site most frequently recommended for heparin injections is the abdomen.

a. The scapular areas may be used for subcutaneous injections, but it is not a recommended site for heparin injections.

b. The vastus lateralis is used for intramuscular injections; not subcutaneous injections.

c. The posterior gluteal site is not recommended for heparin injections.

REF: Text Reference: p. 886

24. A medication is prescribed for the client and is to be administered by intravenous (IV) bolus injection. A priority for the nurse before the administration of medication via this route is to:

a.

Set the rate of the IV infusion

b.

Check the clients mental alertness

c.

Confirm placement of the IV line

d.

Determine the amount of IV fluid to be administered

ANS: c

c. A priority for the nurse before the administration of medication via the IV route is to confirm placement of the IV line. Confirming the placement of the IV catheter and the integrity of the surrounding tissue ensures that the medication is administered safely.

a. The nurse should first confirm placement of the IV line.

b. The nurse should first confirm placement of the IV line before administering a medication by the IV route. The clients mental alertness may be something the nurse monitors after medication administration.

d. The nurse should first confirm placement of the IV line before administering any IV fluids.

REF: Text Reference: p. 897

25. A client on the medical unit receives regular insulin at 7:00 AM. The nurse is alert to a possible hypoglycemic reaction by:

a.

7:30 AM

b.

10:00 AM

c.

4:00 PM

d.

8:00 PM

ANS: b

b. Regular insulin reaches its peak in 2 to 4 hours after administration. If the client received regular insulin at 7:00 AM, the nurse should be alert for a possible hypoglycemic reaction from 9:00 AM to 11:00 AM.

a. Regular insulin has an onset in 30 minutes.

c. Intermediate-acting insulin (e.g., NPH insulin) would peak in 6 to 12 hours, not regular insulin.

d. The client would not be at risk for a hypoglycemic reaction from regular insulin 13 hours after administration. Long-acting insulin would have an effect this much later after administration.

REF: Text Reference: p. 880

26. A priority for the nurse in the administration of oral medications and prevention of aspiration is:

a.

Checking for a gag reflex

b.

Allowing the client to self-administer

c.

Assessing the ability to cough

d.

Using straws and extra water for administration

ANS: a

a. To protect the client from aspiration, the nurse should determine the presence of a gag reflex before administering oral medications.

b. The nurse should first check for a gag reflex. Then, if possible, the client should be allowed to self-administer oral medications.

c. Checking for a gag reflex takes priority over assessing the ability to cough in preventing aspiration.

d. Straws should be avoided because they decrease the control the client has over volume intake, which increases the risk of aspiration. Some clients cannot tolerate thin liquids such as water, and need them to be thickened.

REF: Text Reference: p. 856

27. The nurse is to administer several medications to the client via the N/G tube. The nurses first action is to:

a.

Add the medication to the tube feeding being given

b.

Crush all tablets and capsules before administration

c.

Administer all of the medications mixed together

d.

Check for placement of the nasogastric tube

ANS: d

d. The nasogastric tube should be verified for placement before administering any medication through it.

a. Medications should never be added to the tube feeding.

b. Not all tablets can be crushed, such as sustained release tablets, nor should all capsules be opened. Medications should be reviewed carefully before crushing a tablet or opening a capsule.

c. Medications should be dissolved and administered separately, flushing between 1 and 30 ml of water between each medication.

REF: Text Reference: p. 856

28. The nurse is administering an injection at the ventrogluteal site. Upon aspiration, the nurse notices that there is blood in the syringe. The nurse should:

a.

Inject the medication

b.

Pull the needle back slightly and inject the medication

c.

Move the skin to the side and inject the medication slowly

d.

Discontinue the injection and prepare the medication again

ANS: d

d. If blood appears in the syringe, the nurse should remove the needle and dispose of the medication and syringe properly. The nurse should then prepare another dose of medication for administration.

a. The medication should not be injected, as it would be entering a blood vessel.

b. The needle should not be pulled back slightly and then injected, as there is no assurance of the needle being out of the vessel.

c. The medication should not be injected, as there is no assurance of the needle being out of the vessel.

REF: Text Reference: p. 884

29. A 3-year-old child is to receive an iron preparation orally. The nurse should:

a.

Use a straw

b.

Administer the medication by injection

c.

Mix the medication in water

d.

Ask the pharmacy to send up a pill for the child to swallow

ANS: a

a. Straws may help children swallow pills. If it is a liquid iron preparation, the straw may help the children, as they are less able to see the medication and may see drinking from a straw as desirable.

b. The child is to receive the medication orally. The oral route is preferred unless contraindicated.

c. The medication should not be mixed with water, as the child may refuse to drink all of the larger mixture, and water does not mask the flavor of the medication. Juice, a soft drink, or a frozen juice bar may be offered after a medication is swallowed.

d. Many 3-year-olds have difficulty swallowing pills, and liquid forms are safer to swallow to avoid aspiration.

REF: Text Reference: p. 849

30. The client has an order for 30 U of U-500 insulin. The nurse is using a U-100 syringe and will draw up and administer:

a.

5 U

b.

6 U

c.

10 U

d.

30 U

ANS: b

b. U-500 insulin is 5 times as strong as U-100 insulin. Therefore the amount of U-500 insulin should be divided by 5. Thirty units of U-500 insulin/5 = 6 units of insulin to draw into a U-100 syringe.

a. This is an incorrect dosage.

c. This is an incorrect dosage.

d. This is an incorrect dosage.

REF: Text Reference: p. 879

Copyright 2005 by Mosby, Inc. All rights reserved.

Leave a Reply