Best Practices for Medication Administration in Acute Care Settings, Exams of Medicine

Download Best Practices for Medication Administration in Acute Care Settings and more Exams Medicine in PDF only on Docsity! week 30: test bank medicine administration Questions with answers and rationales. 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. - Correct answer 3. A parenteral route is the route of choice. 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. 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 - Correct answer 2. Toxic 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. 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. - Correct answer 1. Place the medication inside the cheek. 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 client's 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. 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. 1/2 2. 1 3. 1/2 4. 2 - Correct answer 2. 1 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. Air should be inserted into both vials, making sure the needle does not touch the solution in the first vial. 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 - Correct answer 4. Inject air into both vials and withdraw the regular insulin first 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. 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 - Correct answer 2. Coordination of the client 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. 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 - Correct answer 3. Ventrogluteal 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. 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 - Correct answer 4. Prevent the drug from irritating sensitive tissue 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. 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 - Correct answer 3. Lower conjunctival sac 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. 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. - Correct answer 3. Right lateral 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. 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 - Correct answer 1. 2 drops to the right eye ii = 2; gtt = drops. OD = right eye. gtt is the abbreviation for drops, not mL. OS = left eye. OU = both eyes. The most effective way in the acute care environment to determine the client's identity before administering medications is to: 1. Ask the client's name 2. Check the name on the chart 3. Ask the other caregivers 4. Check the client's name band - Correct answer 4. Check the client's name band To identify a client correctly, the nurse checks the medication administration form against the client's identification bracelet and asks the client to state his or her name to ensure that the client's 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 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. The client is to receive heparin by injection. The nurse prepares to inject this medication in the client's: 1. Scapular region 2. Vastus lateralis 3. Posterior gluteal 4. Abdomen - Correct answer 4. Abdomen 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. 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 client's mental alertness 3. Confirm placement of the IV line 4. Determine the amount of IV fluid to be administered - Correct answer 3. Confirm placement of the IV line 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 client's 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. 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 - Correct answer 2. 10:00 AM 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. 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 - Correct answer 1. Checking for a gag reflex 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. The nurse is to administer several medications to the client via the N/G tube. The nurse's 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 - Correct answer 4. Check for placement of the nasogastric tube 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. 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 - Correct answer 4. Discontinue the injection and prepare the medication again 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. 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 - Correct answer 1. Use a straw 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 4. The 73-year-old diagnosed with hepatitis B - Correct answer 4. The 73- year-old diagnosed with hepatitis B 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. A 20 year old diagnosed with Crohn's 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 client's frequent requests for the narcotic 2. The client's compromised bowel absorption 3. The drug's seeming inability to control the client's pain 4. The drug's ability to produce marked respiratory depression - Correct answer 2. The client's compromised bowel absorption 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 client's gastrointestinal problem puts her at particular risk. The remaining options, while not incorrect, are not the primary cause for concern related to toxicity. 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 - Correct answer 1. A 69-year-old client receiving an antibiotic for a respiratory tract infection Among the different classes of medications, antibiotics cause a high incidence of allergic reactions. During the admission interview a client shares with the nurse that she is allergic to latex. The nurse's immediate response is to: 1. Place an allergic to latex sticker on the client's Kardex 2. Verbally notify the staff of the client's allergy to latex 3. Notify the client's health care provider of the client's allergy to latex 4. Place an identification bracelet on the client that identifies the latex allergy - Correct answer 4. Place an identification bracelet on the client that identifies the latex allergy 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. 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 it's swallowed." 3. "I realize that you usually swallow aspirin, but this form only works if it's chewed." 4. "I can see if your health care provider will order your aspirin in a form that can be swallowed." - Correct answer 3. "I realize that you usually swallow aspirin, but this form only works if it's chewed." 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. 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 - Correct answer 1. Alternate cheeks with each subsequent dose 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 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 - Correct answer 2. Avoid applying the medication to broken skin Systemic effects often occur if a client's 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. 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." - Correct answer 2. "The soapy water just came right back out." 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 irrigation—the 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. 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 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. In the event of a medication error, the nurse's first responsibility is to: 1. Contact the physician 2. Fill out an incident report 3. Notify their supervisor 4. Ensure the client's safety - Correct answer 4. Ensure the client's safety The client's 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 client's condition. 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 client's favorite food 3. With grapefruit juice 4. In a very small amount of food - Correct answer 4. In a very small amount of food 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 client's favorite food because the medications may alter the taste and decrease the client's desire for them. Grapefruit juice can interfere with the absorption of some medications and should be avoided. The nurse prepares to administer a prn pain medication by IM injection. The client refuses the injection stating that "I don't 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 - Correct answer 1. Contact the physician for pain medication to be given by a different route It is the right of the client to receive medications safely without discomfort in accordance with the six rights of medication administration. When teaching a pediatric client's 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 - Correct answer 3. Oral plastic disposable syringe 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. 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 client's 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 - Correct answer 1. Backward Placing the client's 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. 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 nurse's 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 - Correct answer 2. Allow the client to defecate first to clear the rectum of stool 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. 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 client's prescribed dose of medication 4. Monitoring the pharmacological effects of the prescribed medication 5. Delivering the medication in accordance with the prescriber's directions 6. Instructing the client regarding the pharmacological effects of the medication - Correct answer 3. Preparation of the client's prescribed dose of medication 4. Monitoring the pharmacological effects of the prescribed medication 5. Delivering the medication in accordance with the prescriber's directions 6. Instructing the client regarding the pharmacological effects of the medication 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. 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."