Medication And I.V. Administration (Part 1)

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion?

• Monitoring the client for itching, swelling, or dyspnea

• Informing the client that the transfusion usually takes 1½ to 2 hours

• Documenting blood administration in the client care record

• Assessing the client's vital signs at the conclusion of the transfusion

After knee replacement surgery, a client is being discharged with acetaminophen and codeine tablets, 30 mg, for pain. During discharge preparation, the nurse should include which instruction?

• Avoid driving a car while taking this medication.

• Decrease your fluid intake to two glasses daily.

• Take the medication on an empty stomach.

• Report any fine motor tremors to your physician.

A client is being discharged after cataract surgery. After providing medication teaching, the nurse asks the client to repeat the instructions. This approach is an example of which professional role?

• Manager

• Educator

• Caregiver

• Client advocate

A nurse prepares to administer a cleansing enema. What is the most common client position used for this procedure?

• Sims' left lateral

• Dorsal recumbent

• Supine

• Prone

A nurse is teaching a client about a newly ordered drug. What could cause an elderly client to have difficulty learning about ordered medications?

• Decreased drug excretion

• Sensory deficits

• Lack of family support

• Fixed income

Before administering packed red blood cells, a nurse must flush a client's I.V. line. Which solution should the nurse use to flush the line?

• Normal saline solution

• Lactated Ringer's solution

• Dextrose 5% in water

• Dextrose 5% in normal saline solution

A nurse receives a medication order over the telephone. What is the best way for the nurse to handle this situation?

• Tell the physician that the nurse practice act prohibits taking medication orders over the telephone.

• Verify the order by repeating it to the physician over the phone.

• Request that a second physician repeat the order to the nurse over the telephone.

• Request that a second physician repeat the order to the nurse over the telephone.

A client is in the bathroom when a nurse enters to give him a prescribed medication. What should the nurse do?

• Leave the medication at the client's bedside.

• Tell the client to be sure to take the medication; then leave it at the bedside.

• Return to the client's room a few minutes later and remain there until the client takes the medication.

• Wait for the client to return to bed; then leave the medication at the bedside.

When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

• 15 degrees.

• 30 degrees.

• 45 degrees.

• 90 degrees.

After an instructor has posted assignments, a person claiming to be a nursing student arrives on a unit and asks a nurse for access to the medication records of a client to whom she's assigned. The student's only identification (ID) is a laboratory coat with the school's name on it. What is the nurse's most appropriate response?

• Allow the student access to the medication record because the instructor has posted an assignment sheet.

• Ask the student to provide a photo ID for comparison with the names on the assignment sheet.

• Ask the student to contact the instructor by phone to verify her identification.

• Allow the student supervised access to the client's medication record.

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet:

• On the top of the tongue.

• On the roof of the mouth.

• On the floor of the mouth.

• Inside the cheek.

Which I.M. injection site is appropriate for a 6-month-old infant?

• Vastus lateralis muscle

• Ventrogluteal area

• Deltoid muscle

• Gluteus maximus muscle

Which human element should a nurse consider during assessment of home drug administration?

• The client's ability to recover

• The client's occupational hazards

• The client's socioeconomic status

• The client's cognitive abilities

When administering drug therapy to an elderly client, the nurse must remain especially alert for adverse effects. Which factor makes elderly clients more vulnerable than younger clients to adverse drug effects?

• Faster drug clearance

• Aging-related physiologic changes

• Increased quantity of neurons

• Enhanced blood flow to the GI tract

A nurse prepares to administer medication by the buccal route. Where should the nurse place this medication?

• On the client's skin

• Between the client's cheek and gum

• Under the client's tongue

• In the client's conjunctival sac

A physician orders morphine, 3 mg I.V. every 2 hours as needed, to control a client's postoperative pain. The package insert reads: "Morphine, 4 mg/ml." How many milliliters of morphine should the client receive?

• 0.25

• 0.5

• 0.6

• 0.75

A nurse is caring for a client who is taking an oral anticoagulant. The nurse should teach the client to:

• Report incidents of diarrhea.

• Avoid foods high in vitamin K.

• Use a straight razor when shaving.

• Take aspirin for pain relief.

A physician orders a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

• Hypervolemia

• Hypokalemia

• Hyperkalemia

• Hypernatremia

While preparing to start a stat I.V. infusion, a nurse notices a broken ground on the infusion pump's plug. What should the nurse do first?

• Use the pump as is because the physician has ordered the medication stat.

• Obtain another pump from central supply to use for the infusion.

• Tape the broken ground to the plug and use the pump.

• Report the problem to the supervisor.

A physician orders ampicillin (Omnipen), 500 mg by mouth every 6 hours. This medication order is an example of:

• A standing order.

• A single order.

• An as-needed order.

• A stat order.

A nurse is to give a client an I.V. infusion of 3,000 ml of dextrose and normal saline solution over 24 hours. She observes that the infusion rate is 150 ml/hour. If the solution runs continuously at this rate, the infusion will be completed in:

• 12 hours.

• 20 hours.

• 24 hours.

• 50 hours.

The physician orders milk of magnesia, 2 teaspoons by mouth as needed, for a constipated client. How many milliliters should the nurse administer to the client?

• 2

• 5

• 10

• 12

Before administering the evening dose of an ordered medication, a nurse on the evening shift finds an unlabeled, filled syringe in a client's medication drawer. What should the nurse do?

• Discard the syringe to avoid a medication error.

• Obtain a label for the syringe from the pharmacy.

• Use the syringe because it looks like it contains the same medication the nurse was prepared to give the client.

• Call the day nurse to verify the contents of the syringe.

An elderly client who experiences several adverse drug reactions may benefit from:

• Reduced drug dosages.

• Nursing home placement.

• Increased drug doses at longer intervals.

• Frequent visits to the physician.

A nurse is preparing to administer a sustained-release capsule to a client. Which is an appropriate nursing intervention?

• Administering the capsule whole with a glass of water

• Crushing the capsule and mixing the medication with applesauce

• Opening the capsule, shaking the contents into water, and administering it to the client

• Having the client chew the capsule before swallowing it

A physician orders an I.V. bolus injection of diltiazem hydrochloride (Cardizem) for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

• Gently aspirate the I.V. catheter to check for a blood return.

• Insert a second I.V. line into the opposite arm.

• Warm the I.V. medication to room temperature.

• Place a tourniquet on the arm in which she will administer the injection.

When checking a client's medication profile, a nurse notes that the client is receiving a drug contraindicated for clients with glaucoma. The nurse knows that this client, who has a history of glaucoma, has been taking the medication for the past 3 days. What should the nurse do first?

• Continue to give the medication because the client has been taking it for 3 days.

• Hold the medication and report the information to the physician to ensure client safety.

• File an incident report because several other staff members have given the medication to the client.

• Find out whether there are extenuating reasons for giving the drug to this client.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first?

• Draw a circle around the moist spot and note the date and time.

• Notify the physician.

• Remove the catheter, check for catheter integrity, and send the tip for culture.

• Remove the dressing, clean the site, and apply a new dressing.

A client receiving morphine for long-term pain management develops tolerance. Tolerance is defined as:

• A heightened response to a medication.

• A diminished response to a drug so that more medication is required to achieve the same effect.

• An allergic reaction to a medication.

• An ability to take the same drug for extended periods.

For a hospitalized client, the physician orders morphine, 4 mg I.V., every 2 hours as needed for pain. However, the client refuses to take injections. Which nursing action is most appropriate?

• Administering the medication as ordered

• Calling the physician to request an oral pain medication

• Withholding the medication until the client understands its importance

• Explaining that no other medication can be given until the client receives the pain medication

A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client?

• Heat the tablets until they liquefy; then pour the liquid down the NG tube.

• Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube.

• Cut the tablets in half and wash them down the NG tube, using a water-filled syringe.

• Crush the tablets and wash the powder down the NG tube, using a syringe filled with saline solution.

A physician writes a medication order for meperidine (Demerol) 500 mg. The nurse's appropriate action would be to:

• Give the medication as ordered.

• Clarify the order with the pharmacy.

• Clarify the order with the physician.

• Clarify the order with another nurse on the unit.

What information must a medication order include?

• Drug class

• Possible adverse reactions

• Physician's signature

• Client allergies

A client is to be discharged on daily medication delivered by a transdermal disk. Which statement indicates the need for further medication teaching?

• I'll place the disk on the same spot each day.

• I'll wash my hands after applying the disk.

• I'll change the disk at the same time every day.

• I'll avoid touching the gel in the disk.

A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next?

• Dissolve the capsule in a full glass of water.

• Break the capsule and mix the contents with applesauce.

• Withhold the medication.

• Check for availability of a liquid preparation.

When administering an I.M. injection, which action puts the nurse at risk for a needle-stick injury?

• Choosing safety needle devices for administering injections whenever possible and appropriate

• Planning safe handling and disposal of needles before initiating a procedure

• Disposing of needles, safety needle systems, and all sharps in sharps-disposal containers immediately after use

• Using the one-handed needle-recapping technique after administering all injections

A nurse regularly inspects a client's I.V. site to ensure patency and prevent extravasation during dopamine (Intropin) therapy. What is the treatment for dopamine extravasation?

• Elevating the affected limb, applying warm compresses, and administering phentolamine (Regitine) as ordered

• Elevating the affected limb, applying cold compresses, and administering hyaluronidase (Vitrase) as ordered

• Maintaining the limb in a dependent position and massaging it every 15 minutes

• Asking the physician to make an incision and allowing the affected area to drain

After undergoing small-bowel resection, a client is ordered metronidazole (Flagyl) 500 mg I.V. The mixed I.V. solution contains 100 ml. The nurse is to run the drug over 30 minutes. The drip factor of the available I.V. tubing is 15 gtt/ml. What is the drip rate? Round your answer to the nearest whole number.Answer: ___ gtt/minute

A medication order reads, "Meperidine 1 ml I.M. stat." A nurse responsible for administering the drug should base her next action on which understanding?

• The order should specify the precise time to give the drug.

• The ordered route is inappropriate for administration of this drug.

• She should clarify the order with the physician.

• The order is correct and valid.

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength (Bactrim-DS)?

• Don't expect improvement of symptoms for 7 to 10 days.

• Drink 6 to 8 glasses of fluid daily while taking this medication.

• If your mouth or throat becomes sore, take the medication with milk or an antacid.

• To protect against drug-induced photosensitivity, use a sunscreen of at least SPF-15 with PABA.

When a nurse tries to administer medication, the client refuses it, saying, "I don't have to take those pills if I don't want to. What good will they do?" Which action by the nurse would be most appropriate?

• Insisting that the client take the medication

• Reporting the client's comments to the physician

• Explaining the consequences of not taking the medication

• Exploring how the client's feelings affect his decision to refuse medication

After administering an I.M. injection, a nurse notices there isn't a sharps-disposal container nearby. Which action should the nurse take?

• Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle.

• With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest sharps-disposal container.

• With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest trash container.

• Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle. Carry the syringe to the closest sharps-disposal container.

A nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should include information about:

• Acetaminophen (Tylenol).

• Dopamine (Intropin).

• Tamoxifen (Nolvadex).

• Progesterone (Gesterol 50).

A nurse administers racemic epinephrine (Racepinephrine) to an 8-year-old boy. Ten minutes after administration, the nurse should be alert for:

• Respiratory distress.

• Profound tachycardia.

• Signs of improved oxygenation.

• Diminished cyanosis.

A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively?

• Elevating the hand and wrapping it in a warm towel

• Placing an ice pack on the hand

• Administering an as-needed analgesic

• Wrapping the arm in an elastic bandage from wrist to elbow

A client with diabetes mellitus is receiving insulin. Which statement correctly describes an insulin unit?

• It's a measure of effect, not a standard measure of weight or quantity.

• It's the smallest measurement in the apothecary system.

• It's the basis for solids in the avoirdupois system.

• It's a common measurement in the metric system.

When a nurse brings prescribed medication to a client, the client says she usually takes a white tablet, not the yellow tablet that the nurse has brought. What should the nurse do first?

• Tell the client that the white tablet must be from a different manufacturer.

• Reassure the client that the white tablet is the correct medication.

• Withhold the medication and notify the physician.

• Recheck the name and strength of the medication.

The physician orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V. tubing delivers 15 drops/ml. The nurse should run the I.V. infusion at a rate of:

• 15 drops/minute.

• 21 drops/minute.

• 32 drops/minute.

• 125 drops/minute.