Chapter 35: Medication Administration Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

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

1.

An enteric-coated medication should be given.

2.

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

3.

A parenteral route is the route of choice.

4.

A rectal suppository must be administered.

ANS: 3

The parenteral route provides a means of administration when oral medications are contraindicated. Onset of action is quicker. There is less cause for embarrassment than with a rectal suppository. An enteric-coated medication is given orally. Because the client is vomiting, the oral route should not be used. Nausea does not affect the rate of absorption. 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 there is rectal bleeding or if the client had rectal surgery. Stool in the rectum can impair absorption.

DIF: A REF: 694 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Therapeutic

2.

Toxic

3.

Idiosyncratic

4.

Allergic

ANS: 2

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. 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) effects of morphine.

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

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, or a rash, or, in more severe cases, may have difficulty breathing. The clients response to morphine is not an example of an allergic effect.

DIF: A REF: 691 OBJ: Comprehensive

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

3. The client is to receive a medication via the buccal route. The nurse plans to implement which of the following actions?

1.

Place the medication inside the cheek.

2.

Crush the medication before administration.

3.

Offer the client a glass of orange juice after administration.

4.

Use sterile technique to administer the medication.

ANS: 1

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. Crushing the medication is not necessary because it is designed to dissolve in the clients cheek. Clients are not to take any liquids with, or immediately after, medications given by buccal administration. The mouth is not sterile. Sterile technique is not necessary for buccal administration.

DIF: A REF: 693 OBJ: Comprehensive

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

4. The physician orders a grain and a half of 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?

1.

2.

1

3.

4.

2

ANS: 2

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

90 mg

100 mg x 1 capsule = 0.9 capsules

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

Options 1 and 3 are not correct dosage calculations. Furthermore, capsules cannot be halved.

Option 4 is not a correct dosage calculation.

DIF: B REF: 696 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

5. The physician has ordered 6 mg of 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?

1.

1/5 mL

2.

1/3 mL

3.

2/5 mL

4.

1/4 mL

ANS: 3

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

6 mg

15 mg x 1 mL = 2/5 mL

Options 1, 2, and 4 are not correct dosage calculations.

DIF: B REF: 697 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Weight

2.

Height

3.

Age

4.

Body surface area

ANS: 4

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

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

DIF: A REF: 698 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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:

1.

Morphine sulfate 10 mg q4h prn

2.

Inderal 10 mg PO bid

3.

Diazepam 5 mg PO tid

4.

Keflex 500 mg PO q8h

ANS: 3

The medication is being given 3 times a day, 4 hours apart. The medication the nurse is documenting is diazepam 5 mg PO tid. 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. Bid means twice a day. The client is receiving the medication 3 times a day. The medication is not administered every 8 hours.

DIF: A REF: 699 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Do you want to take your medication now?

2.

Would you like the medication with water or juice?

3.

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

4.

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

ANS: 2

Allowing the child the choice of taking a medication with water or juice may have greater success because the child is involved. The child should not be given the option of not taking a medication. 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. Option 4 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.

DIF: A REF: 715 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Inject fluid from one vial into the other

2.

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

3.

Discard the medication from vial number 2 if medication from vial number 1 is pushed into it

4.

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

ANS: 3

If a vial becomes contaminated with another medication, it should be discarded. Fluid from one vial should not be injected into another, as it would contaminate the second vial. 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. Air should be inserted into both vials, making sure the needle does not touch the solution in the first vial.

DIF: B REF: 715 OBJ: Application

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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:

1.

Inject air into the regular insulin and then into the NPH insulin

2.

Withdraw the regular insulin first

3.

Inject air into and withdraw the NPH insulin immediately

4.

Inject air into both vials and withdraw the regular insulin first

ANS: 4

The client should be taught to inject air into both vials and withdraw the regular insulin first. Air should be injected into the vial of NPH insulin and then the vial of regular insulin. The regular insulin should be withdrawn after air has been injected into both vials. 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. The NPH insulin is then withdrawn.

DIF: A REF: 742 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Dosage of medication required

2.

Coordination of the client

3.

Schedule of administration

4.

Use of a dry powder inhaler

ANS: 2

Spacers are especially helpful when the client has difficulty coordinating the steps involved in self-administering inhaled medications. The use of a spacer is not dependent on the dosage of medication. The use of a spacer is not dependent on the schedule of administration. Spacers are not required with the use of a dry powder inhaler.

DIF: A REF: 729 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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:

1.

Deltoid

2.

Dorsogluteal

3.

Ventrogluteal

4.

Vastus lateralis

ANS: 3

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 over 7 months. The deltoid muscle is not developed enough for an IM injection in the 1-year-old client. The dorsogluteal site is not recommended because of the risk of the needle hitting the sciatic nerve. The vastus lateralis is a preferred site for infants less than 12 months old.

DIF: A REF: 751 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Provide faster absorption of the medication

2.

Reduce discomfort from the needle

3.

Provide more even absorption of the drug

4.

Prevent the drug from irritating sensitive tissue

ANS: 4

The Z-track method is used to minimize local skin irritation by sealing the medication in muscle tissue. The Z-track method does not provide faster absorption of the medication. The Z-track method does not reduce discomfort from the needle. The Z-track method does not provide a more even absorption of the drug.

DIF: A REF: 753 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Cornea

2.

Outer canthus

3.

Lower conjunctival sac

4.

Opening of the lacrimal duct

ANS: 3

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. The cornea is very sensitive. If drops were instilled onto the cornea it would stimulate the blink reflex. The outer canthus would not hold the eye drop, medication would be wasted, and it would not be distributed evenly across the eye. 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.

DIF: A REF: 723 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Prone

2.

Upright

3.

Right lateral

4.

Dorsal recumbent with hyperextension of the neck.

ANS: 3

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. The prone position is not recommended following administration of ear drops. The upright position is not recommended following ear drop administration. The ear drops would run out of the ear canal. The dorsal recumbent position with the neck hyperextended is not recommended following the administration of ear drops.

DIF: A REF: 728 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

2 mL to the right eye

2.

2 drops to the left eye

3.

2 drops to the right eye

4.

2 drops to both eyes

ANS: 3

ii = 2; gtt = drops. OD = right eye. gtt is the abbreviation for drops, not mL. OS = left eye. OU = both eyes.

DIF: A REF: 723 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Ask the clients name

2.

Check the name on the chart

3.

Ask the other caregivers

4.

Check the clients name band

ANS: 4

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

DIF: A REF: 708 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

18. An order is written for 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:

1.

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

2.

Refuse to give the medication and notify the nurse manager

3.

Administer the medication and watch the client carefully

4.

Call the prescriber to clarify the order

ANS: 4

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. The nurse cannot independently change physicians orders. The nurse would have to call the prescriber and receive the order for the change. 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. The nurse could be held accountable for administering an ordered medication that is knowingly inappropriate for the client.

DIF: B REF: 705 OBJ: Application

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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:

1.

2 mL

2.

5 mL

3.

10 mL

4.

15 mL

ANS: 2

The nurse should first change the household measurement to a metric equivalent (5 mL = 1 tsp). Then the nurse should use the formula for calculating a medication dosage:

80 mg

80 mg 5 mL = 5 mL

Option 1 is an incorrect dosage.

Option 3 is an incorrect dosage. 10 mL would equal 2 teaspoons, in this case, 160 mg.

Option 4 is an incorrect dosage. 15 mL would equal 3 teaspoons, in this case, 240 mg.

DIF: B REF: 696-698 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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:

1.

15 degrees

2.

30 degrees

3.

45 degrees

4.

90 degrees

ANS: 1

The angle of injection for an intradermal injection is 5 to 15 degrees. 30 degrees is not the correct angle of injection. Subcutaneous injections may be administered at a 45-degree angle. Subcutaneous or intramuscular injections may be administered at a 90-degree angle.

DIF: A REF: 753 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Pain

2.

Allergy sensitivity

3.

Anticoagulant therapy

4.

Low-dose insulin requirements

ANS: 2

Pain medications are not administered intradermally.

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

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

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

DIF: A REF: 753 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Middle third of the lateral thigh

2.

Greater trochanter, anterior iliac spine, and iliac crest

3.

Anterior aspect of the upper thigh

4.

Acromion process and axilla

ANS: 2

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. The vastus lateralis site is found by locating the middle third of the lateral thigh. The anterior aspect of the thigh may be used for subcutaneous injections; it is not how the ventrogluteal site is located. The acromion process and axilla may be used to locate the deltoid site.

DIF: A REF: 751 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Scapular region

2.

Vastus lateralis

3.

Posterior gluteal

4.

Abdomen

ANS: 4

The abdomen is the site most frequently recommended for heparin injections is the abdomen.The scapular areas may be used for subcutaneous injections, but it is not recommended site for heparin injections. The vastus lateralis is used for intramuscular injections, not subcutaneous injections. The posterior gluteal site is not recommended for heparin injections.

DIF: A REF: 750 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Set the rate of the IV infusion

2.

Check the clients mental alertness

3.

Confirm placement of the IV line

4.

Determine the amount of IV fluid to be administered

ANS: 3

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

DIF: C REF: 755 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

7:30 AM

2.

10:00 AM

3.

4:00 PM

4.

8:00 PM

ANS: 2

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. Regular insulin has an onset in 30 minutes. Intermediate-acting insulin (i.e., NPH insulin) would peak in 6 to 12 hours, not regular insulin. 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 length of time after administration.

DIF: A REF: 743 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Checking for a gag reflex

2.

Allowing the client to self-administer

3.

Assessing the ability to cough

4.

Using straws and extra water for administration

ANS: 1

To protect the client from aspiration, the nurse should determine the presence of a gag reflex before administering oral medications. The nurse should first check for a gag reflex. Then, if possible, the client should be allowed to self-administer oral medications. Checking for a gag reflex takes priority over assessing the ability to cough in preventing aspiration. 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 for them to be thickened.

DIF: C REF: 717 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Add the medication to the tube feeding being given

2.

Crush all tablets and capsules before administration

3.

Administer all of the medications mixed together

4.

Check for placement of the nasogastric tube

ANS: 4

The nasogastric tube should be verified for placement before administering any medication through it. Medications should never be added to the tube feeding. Not all tablets can be crushed, such as sustained release tablets, nor all capsules should be opened. Medications should be reviewed carefully before crushing a tablet or opening a capsule. Medications should be dissolved and administered separately, flushing between 1 and 30 mL of water between each medication.

DIF: C REF: 740 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Inject the medication

2.

Pull the needle back slightly and inject the medication

3.

Move the skin to the side and inject the medication slowly

4.

Discontinue the injection and prepare the medication again

ANS: 4

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. The medication should not be injected, as it would be entering a blood vessel. The needle should not be pulled back slightly and then injected, as there is no assurance of the needle being out of the vessel. The medication should not be injected, because there is no assurance of the needle being out of the vessel.

DIF: A REF: 751 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

Use a straw

2.

Administer the medication by injection

3.

Mix the medication in water

4.

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

ANS: 1

Straws may help children swallow pills. If it is a liquid iron preparation, the straw may help the child as they are less able to see the medication and may see drinking from a straw as desirable. The child is to receive the medication orally. The oral route is preferred unless contraindicated. 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. Many 3-year-olds have difficulty swallowing pills, and liquid forms are safer to swallow to avoid aspiration.

DIF: A REF: 715 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

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

1.

5 units

2.

6 units

3.

10 units

4.

30 units

ANS: 2

U-500 insulin is 5 times as strong as U-100 insulin. Therefore the amount of U-500 insulin should be divided by 5. 30 units of U-500 insulin 5 = 6 units of insulin to draw into a U-100 syringe. Options 1, 3, and 4 are incorrect dosages.

DIF: B REF: 742 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

31. The nurse is preparing to administer 8 mg of a 10 mg dose of an intravenous narcotic. Which of the following statements made by the nurse best reflects an understanding of the appropriate manner to handle this situation?

1.

I will sign out the narcotic before the end-of-shift count is completed.

2.

I need to get another RN to witness the waste and sign the narcotic sheet.

3.

Narcotics are expensive, so it makes sense to save the unused portion for the next time they need the drug.

4.

I always make sure someone sees me place the unused portion on the narcotic in the sharps container.

ANS: 2

If a nurse gives only part of a premeasured dose of a controlled substance, a second nurse witnesses disposal of the unused portion. If paper records are kept, both nurses sign their names on the form. Do not place wasted portions in the sharps containers. Instead, flush wasted portions of tablets down the toilet and wash liquids down the sink. Unused portions of narcotics must not be saved.

DIF: C REF: 688 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

32. The nurse is caring for a client who is experiencing severe pain and is insistent about getting some relief quickly. Which of the following prescriptions is most likely to produce the quickest pain relief?

1.

Percodan orally

2.

Lidocaine topically

3.

Demerol intramuscularly

4.

Morphine sulfate intravenously

ANS: 4

Each route of medication administration has a different rate of absorption. When applying medications on the skin, absorption is slow because of the physical makeup of the skin. Medications placed on the mucous membranes and respiratory airways are quickly absorbed because these tissues contain many blood vessels. Because orally administered medications pass through the gastrointestinal tract, the overall rate of absorption is usually slow. Intravenous (IV) injection produces the most rapid absorption because medications are immediately available when they enter the systemic circulation.

DIF: A REF: 689 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

33. A 78-year-old client with congestive heart failure (CHF) is reporting vascular pain in his lower legs and requests his oral narcotic analgesic. The nurse recognizes that the clients pain relief will be negatively affected primarily because of:

1.

The clients age

2.

The systemic effects of CHF

3.

The route of administration

4.

The status of the peripheral vessels

ANS: 2

Clients with congestive heart failure have impaired circulation, which impairs medication delivery to the intended site of action. Therefore the efficacy of medications in these clients is delayed or altered. The other options reflect possible barriers, but they are not as directly responsible as is the hearts functional capacity

DIF: C REF: 689 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

34. The nurse is aware that which of the following clients is at greatest risk for developing medication toxicity?

1.

The 16-year-old anorexic

2.

The 35-year-old with liver cancer

3.

The 45-year-old chronic alcoholic

4.

The 73-year-old diagnosed with hepatitis B

ANS: 4

The degree to which medications bind to serum proteins such as albumin affects medication distribution. Older adults have a decrease in albumin levels in the bloodstream, probably caused by a change in liver function. The same is true for clients with liver disease or malnutrition. Because of the potential for more medication being unbound, some older adults are at risk for an increase in medication activity or toxicity or both.

DIF: C REF: 691 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

35. A 20-year-old diagnosed with Crohns disease is experiencing severe pain and is requesting the prescribed morphine as often as it can be administered. The nurse is particularly concerned about opioid toxicity because of:

1.

The clients frequent requests for the narcotic

2.

The clients compromised bowel absorption

3.

The drugs seeming inability to control the clients pain

4.

The drugs ability to produce marked respiratory depression

ANS: 2

Toxic effects develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. For example, toxic levels of morphine, an opioid, cause severe respiratory depression and death. This clients gastrointestinal problem puts her at particular risk. The remaining options, while not incorrect, are not the primary cause for concern related to toxicity.

DIF: C REF: 691 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

36. The nurse recognizes which of the following clients as being at greatest risk for anaphylactic shock?

1.

A 69-year-old client receiving an antibiotic for a respiratory tract infection

2.

A 45-year-old prescribed a decongestant as needed for seasonal allergies

3.

A 50-year-old client prescribed a therapeutic dose of an antihypertensive medication

4.

A 26-year-old receiving intravenous steroids for the initial flare-up of rheumatoid arthritis

ANS: 1

Among the different classes of medications, antibiotics cause a high incidence of allergic reactions.

DIF: C REF: 691 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

37. During the admission interview a client shares with the nurse that she is allergic to latex. The nurses immediate response is to:

1.

Place an allergic to latex sticker on the clients Kardex

2.

Verbally notify the staff of the clients allergy to latex

3.

Notify the clients health care provider of the clients allergy to latex

4.

Place an identification bracelet on the client that identifies the latex allergy

ANS: 4

The client needs to wear an identification bracelet that alerts nurses and physicians to the allergy. While the other options are not incorrect, the application of the identification bracelet has priority.

DIF: C REF: 691 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

38. A client is observed swallowing a chewable form of aspirin. Which of the following statements made by the nurse shows the best understanding of the educational reinforcement needed by this client?

1.

This aspirin is designed to be chewed, not swallowed.

2.

This aspirin will not give you the desired effects if its swallowed.

3.

I realize that you usually swallow aspirin, but this form only works if its chewed.

4.

I can see if your health care provider will order your aspirin in a form that can be swallowed.

ANS: 3

A medication given by the sublingual route should not be swallowed because the medication will not have the desired effect. The option suggesting a change in the medication routine is not necessarily appropriate while the remaining options do not give the client the total explanation.

DIF: C REF: 693 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

39. To minimize the risk for injury to the oral mucosa, a client ordered a buccally administered medication is instructed to:

1.

Alternate cheeks with each subsequent dose

2.

Swallow the medication with a full glass of liquid

3.

Chew the medication thoroughly before swallowing

4.

Avoid allowing the medication to dissolve on the tongue

ANS: 1

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. Teach clients to alternate cheeks with each subsequent dose to avoid mucosal irritation. The remaining options provide information that is not correct for the buccal route of medication administration

DIF: A REF: 693 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

40. To best prevent a systemic effect from a topically applied medication patch, the nurse must:

1.

Alternate application sites regularly

2.

Avoid applying the medication to broken skin

3.

Monitor the client for signs of an irritating rash

4.

Remove residual medication with mild soap and water

ANS: 2

Systemic effects often occur if a clients skin is thin or broken, if the medication concentration is high, or if contact with the skin is prolonged. The remaining options are more directed towards preventing skin irritations.

DIF: C REF: 695 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

41. The nurse assigns ancillary personnel the task of giving a client a pre-procedure enema. Which of the following statements made by the personnel requires immediate follow-up by the nurse?

1.

I use all of the soap provided in the kit.

2.

The soapy water just came right back out.

3.

An enema is intended to clean out the rectum.

4.

The client was able to hold the enema for 5 minutes.

ANS: 2

An enema is an example of an instillation whereby the fluid is retained for a period of time to facilitate a therapeutic response. What the ancillary personnel was describing was an irrigationthe liquid runs over or into the area and is allowed to immediately flow away. Options 1, 3, and 4 are correct and do not require follow-up.

DIF: C REF: 729 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

42. Research has shown that the primary reason nurses make medication errors is related to:

1.

The complexity of making accurate drug calculations

2.

Events that distract the nurse during the administration process

3.

The presence of multiple drugs with similar generic and trade names

4.

Heavy client assignments that require massive medication administrations

ANS: 2

Many medication errors occur when nurses become distracted or lose focus during medication administration. While the remaining options may reflect risks for medication errors, the primary factor continues to be distractions that cause the nurse to fail to follow the established protocol for drug administration.

DIF: C REF: 705 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

43. The nurse has taken a verbal order for a narcotic medication to be given to a client experiencing severe pain related to metastatic cancer of the bone. The nurses initial action regarding the order is to:

1.

Prepare the medication for administration to the client

2.

Properly sign for the narcotic analgesic in the narcotic records

3.

Notify the client that a verbal order for a narcotic pain medication has been received

4.

Write and then sign the complete order in the appropriate location in the clients chart

ANS: 4

All verbal orders should be converted immediately to writing and signed by the individual receiving the order. While the remaining options are not incorrect, they are not the immediate priority.

DIF: C REF: 699 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

44. During the admission interview the client reports to the nurse that she is a little allergic to penicillin. Which of the following questions asked by the nurse is most likely to provide the most relevant information regarding the clients possible allergy to penicillin?

1.

Who told you that you are allergic to penicillin?

2.

What makes you think you are allergic to penicillin?

3.

Can you describe what happens when you take penicillin?

4.

What do you take for an infection since you are allergic to penicillin?

ANS: 3

This question best allows for the client to describe the reaction and then affords the nurse the opportunity to assess the described reaction to determine the likelihood that it is an allergic reaction.

DIF: C REF: 710 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

45. Policies for the proper storage and distribution of narcotics within a health care organization are written by:

1.

Federal government

2.

State government

3.

Local governmental bodies

4.

Health care organization

ANS: 4

Institutional policies are often more restrictive than governmental controls, but are written to at least meet the governmental regulations. Although the federal, state, and local governments have regulations that must be followed regarding the proper storage and distribution of narcotics, the individual health care organizations must establish their own policies to meet these regulations.

DIF: C REF: 704 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe and Effective Care Environment/Safety and Infection Control

46. The nurse is administering morphine sulfate to a client for pain. The order has been written so that the nurse can chose from several routes of administration. The nurse knows that the morphine sulfate be most rapidly absorbed by which of the following routes?

1.

Oral

2.

IV

3.

IM

4.

Rectal

ANS: 2

IV injections produce the most rapid absorption because they are immediately available when they enter systemic circulation. Oral medication must pass through the GI tract, making absorption slow. IM medications must be absorbed by the blood flow to the site of the injection, making it slower than IV. Rectal medications must be absorbed through the rectal mucosa are fairly quickly absorbed due to the many blood vessels within the tissue.

DIF: A REF: 709 OBJ: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

47. On beginning the administration of 500 mg of aztreonam IV to a client with a urinary tract infection, the client complains of difficulty breathing. The nurse quickly identifies this as a symptom of a(n):

1.

Therapeutic effect

2.

Anaphylactic reaction

3.

Idiosyncratic reaction

4.

Medication interaction

ANS: 2

Anaphylactic reactions are characterized by sudden constriction of bronchiolar muscles. Therapeutic effect is what is expected physiological response. Idiosyncratic reactions are those in which a client overreacts or underreacts to a medication or has a reaction different than normal. Medication interactions are when one medication modifies the action of another medication.

DIF: A REF: 688 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

48. In the event of a medication error, the nurses first responsibility is to:

1.

Contact the physician

2.

Fill out an incident report

3.

Notify their supervisor

4.

Ensure the clients safety

ANS: 4

The clients safety and well-being are the top priority. The nurse is responsible for contacting the physician, notifying the supervisor, and documenting the event only after assessing and examining the clients condition.

DIF: A REF: 691 OBJ: Knowledge

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

49. The nurse prepares to administer a table to a client who has difficulty swallowing pills. The nurse decides to crush the tablet and mix it with food. The nurse should mix the crushed medication:

1.

In a large amount of food to mask the taste

2.

With the clients favorite food

3.

With grapefruit juice

4.

In a very small amount of food

ANS: 4

A very small amount of food or fluid should be used to mix the medication to ensure the client consumes the entire amount of medication. Do not use the clients favorite food because the medications may alter the taste and decrease the clients desire for them. Grapefruit juice can interfere with the absorption of some medications and should be avoided.

DIF: C REF: 703 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

50. The nurse prepares to administer a prn pain medication by IM injection. The client refuses the injection stating that I dont like shots. The best reaction by the nurse is to:

1.

Contact the physician for pain medication to be given by a different route

2.

Instruct the client that he or she needs to be brave and take the shot

3.

Contact the nursing supervisor to talk with the client

4.

Inform the client that the injection is the only route that the pain medication is ordered

ANS: 1

It is the right of the client to receive medications safely without discomfort in accordance with the six rights of medication administration.

DIF: B REF: 704-705 OBJ: Application

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

51. When teaching a pediatric clients parents about administering his medication at home, the nurse states that the most accurate device for measuring the liquid medication is:

1.

Cup

2.

Teaspoon

3.

Oral plastic disposable syringe

4.

Dropper

ANS: 3

A plastic, disposable syringe is the most accurate device for preparing liquid doses, especially those less than 10 mL. A cup can be hard to gauge liquids unless placed on a flat surface to read. Teaspoons can vary in the amount of volume they hold. Droppers are less accurate than plastic disposable syringes for preparing liquid medications.

DIF: B REF: 688 OBJ: Application

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

52. The nurse is preparing to administer a nasal instillation of medication to a client. The best position for accessing the posterior pharynx is to place the client in a supine position and tilt the clients head:

1.

Backward

2.

Over the edge of the bed with the head to one side

3.

Over a small pillow and back

4.

In a chin-down position

ANS: 1

Placing the clients head backward will allow the instillation to drop into the posterior pharynx. Turning the head to one side will allow the instillation to go into the frontal and maxillary sinuses. Putting the head over a pillow and placing it back will instill the drops in the ethmoid or sphenoid sinuses. A chin-down position will not allow the medication to enter the posterior pharynx.

DIF: B REF: 689 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

53. The nurse has an order for 325 mg acetaminophen p.r. q4h prn for pain for a 7-year-old client who has had surgery. In preparing the client for insertion of the suppository, the client states that she feels the need to have a bowel movement. The nurses best response is to:

1.

Insert the suppository, knowing that it will dissolve quickly

2.

Allow the client to defecate first to clear the rectum of stool

3.

Explain to the client that it is normal to feel the urge to defecate when a suppository is inserted into the rectum, but the urge will pass

4.

Hold the medication and contact the physician for a p.o. order

ANS: 2

By allowing the client to defecate before the suppository being inserted, the nurse knows that absorption will be facilitated. Placing the suppository into a mass of fecal material will not allow it to be absorbed by the rectal mucosa. The suppository may be expelled before it has a chance to be absorbed if the client has the urge to defecate before the suppository is inserted. There is no indication that the client cannot tolerate the suppository.

DIF: A REF: 691 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse plays a major role in which of the following aspects of medication therapy? (Select all that apply.)

1.

Determining the necessity of a particular medication

2.

Discontinuing prescribed medications when appropriate

3.

Preparation of the clients prescribed dose of medication

4.

Monitoring the pharmacological effects of the prescribed medication

5.

Delivering the medication in accordance with the prescribers directions

6.

Instructing the client regarding the pharmacological effects of the medication

ANS: 3, 4, 5, 6

The nurse plays an essential role in medication preparation and administration, medication teaching, and evaluating clients responses to medications. The remaining options are not in the nursing scope of the RN.

DIF: A REF: 705 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

2. The home health nurse is preparing to educate a client on his or her newly prescribed medications. Which of the following nursing statements are appropriate to be included in this discussion? (Select all that apply.)

1.

This medication is designed to lower your blood pressure.

2.

Do you have medical insurance that covers the cost of medication?

3.

The medication can make you dizzy especially if you stand up quickly.

4.

What do you think will be the most difficult thing about taking this medication?

5.

You will need to take this medication once a day; with breakfast seems to work best for most people.

6.

It is important that you dont miss taking the medication, If you do, take it when you remember but never take two at a time.

ANS: 1, 3, 4, 5, 6

Teaching clients about their medications and their side effects, ensuring adherence with the medication regimen, and evaluating the clients ability to self-administer medications are nursing responsibilities. The remaining option does not relate to the actually medication regimen.

DIF: C REF: 707 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

3. A nurse is accused of illegally abusing narcotic medications originally prescribed to clients. If found guilty this nurse is subject to: (Select all that apply.)

1.

Years of imprisonment in a federal prison

2.

Forced involvement in a drug rehabilitation program

3.

Inclusion on the State Board of Nursing Suspended license list

4.

Forfeiture of the professional license needed to practice nursing

5.

Monetary fines that can be in the hundreds of thousands of dollars

6.

Termination of employment from the institution where the abuse occurred

ANS: 1, 3, 4, 5, 6

Violations of the Controlled Substances Act are punishable by fines, imprisonment, and loss of nurse licensure.

DIF: A REF: 709 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

4. Which of the following clients is likely to experience altered medication excretion with resulting possible toxicity? (Select all that apply.)

1.

A 16-year-old with asthma

2.

A 34-year-old with hepatitis B

3.

A 72-year-old with lung cancer

4.

A 20-year-old with Crohns disease

5.

A 54-year-old in end-stage renal failure

6.

A 50-year-old with early Alzheimers disease

ANS: 1, 2, 4, 5

After medications are metabolized, they exit the body through the kidneys, liver, bowel, lungs, and exocrine glands.

DIF: C REF: 715 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

5. The pharmacist provides collaboration to the acute care nursing staff in the form of: (Select all that apply.)

1.

Accurate dispersal of prescribed medications

2.

Information regarding medication side effects

3.

Appropriate labeling of prescribed medications

4.

Clarification regarding proper medication dosage

5.

Education of clients regarding the therapeutic value of drugs

6.

Answering questions related to potential drug incompatibilities

ANS: 1, 2, 3, 4, 6

Most medication companies deliver medications in a form ready for use. Dispensing the correct medication in the proper dosage and amount and with an accurate label is the pharmacists main task. The pharmacist also provides information about medication side effects, toxicity, interactions, and incompatibilities. Client education is not a collaborative action provided by the pharmacist; client education is a nursing responsibility.

DIF: A REF: 724 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

6. The nursing role regarding a medication error includes: (Select all that apply.)

1.

Immediate assessment of the client

2.

Notification of the health care provider

3.

Report the error to the appropriate institutional administrator

4.

Notify the clients family or medical power of attorney of the error

5.

Attach a written incident report to the clients chart within 24 hours

6.

Monitoring of the client as indicated by the potential effects of the medication

ANS: 1, 2, 3, 6

When an error occurs, the clients safety and well-being become the top priority. The nurse assesses and monitors the clients condition and notifies the physician or prescriber of the incident as soon as possible. Once the client is stable, the nurse reports the incident to the appropriate person in the institution. The nurse is responsible for preparing a written occurrence or incident report that usually needs to be filed within 24 hours of the error. The occurrence report is not a permanent part of the medical record and is not referred to anywhere in the record. Notification of the clients family is not required unless the clients condition warrants it.

DIF: C REF: 729 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Pharmacological & Parenteral Therapies

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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