Deck 36: Administering Oral, Topical, and Mucosal Medications

Question 1

A patient tells the nurse, "I have been using a decongestant nasal spray for 3 months, but I still have terrible nasal congestion." The nurse could appropriately respond:

A) "You probably need an antibiotic to clear up the congestion."
B) "Are you sure you are administering the nasal spray correctly?"
C) "Nasal decongestant sprays can cause rebound congestion with long-term use."
D) "Who told you to use that kind of nasal spray for 3 months?"

Answer 1

"Nasal decongestant sprays can cause rebound congestion with long-term use."

Question 2

A nurse correctly instructs a patient not to leave which of the following in a car?

A) Dry-powder inhalers (DPI)
B) Metered-dose inhalers (MDI)
C) Narcotics
D) Sublingual medications

Answer 2

Metered-dose inhalers (MDI)

Question 3

While preparing a dose of liquid medication for administration through a gastrostomy tube, the nurse measures 15 mL into a plastic medicine cup. Which of the following indicates the appropriate dose of medication?

A) When the cup is held at eye level, the lowest level of the medication meniscus rests on the 15-mL calibration line.
B) When the cup is held up to the light, the middle of the medication meniscus rests on the 15-mL calibration line.
C) When the cup is sitting on a level table, the top of the medication meniscus rests on the 15-mL calibration line.
D) When the cup is placed on a countertop, any part of the medication meniscus rests on the 15-mL calibration line.

Answer 3

When the cup is held at eye level, the lowest level of the medication meniscus rests on the 15-mL calibration line.

Question 4

The nurse is preparing to administer a medication by the sublingual route. The highest priority is to

A) Determine whether the patient can swallow safely.
B) Identify what time the patient typically takes the medication at home.
C) Crush the medication and mix it with applesauce.
D) Assess the patient's mouth for lesions.

Question 5

Under the supervision of a registered nurse (RN), an LVN/LPN is providing parents with instructions for administering eye drops to their young child, who has been diagnosed with pink eye. The nurse correctly tells the parents:

A) "Have your child tip his head back and look down."
B) "Brace your hand against the child's chin as you steady the dropper."
C) "Gently raise the upper lid to expose the eyeball before putting in the eye drops."
D) "Place the drop in the middle part of the space created when you pull down the lower lid."

Question 6

The nurse is providing care to a patient with colorectal cancer who typically takes sustained-release morphine (MS Contin), furosemide (Lasix), and metoprolol (Lopressor). The patient's wife reports that because the patient has bad mouth sores and has a hard time swallowing pills, she has crushed the pills and given him his medications in ice cream. The nurse correctly tells the patient's wife:

A) "Mixing the medication with ice cream is a bad idea, because dairy products reduce the absorption of blood pressure medications."
B) "I'm sure it has been hard for him to swallow. Has he lost any weight?"
C) "The morphine tablets shouldn't be crushed because that releases all of the medication at once."
D) "We usually tell people with mouth sores to suck on ice or popsicles before they try to swallow pills."

Question 7

A nurse appropriately remains with a patient until after the patient has swallowed narcotic medication because

A) The patient may rarely "cheek" the medication in an attempt to save it up and take an overdose later.
B) Narcotic medications pose extra safety risks because they depress respiration and lower blood pressure.
C) The patient may be afraid to take narcotic medication because of the risk for addiction.
D) All of the above.

Question 8

The nurse is providing meperidine (Demerol) to a patient who reports postsurgical pain 8/10. The order is for 50 mg to be orally administered to the patient in tablet form every 4 hours, but each tablet contains 100 mg. The best action by the nurse is to

A) Call the doctor to request that the order be changed to 100 mg every 8 hours.
B) Administer half of the tablet to the patient and then discard the other half by flushing it down the toilet.
C) Administer half the tablet to the patient and dispose of the other half in a chemical waste container with another licensed nurse as a witness, recording the narcotic drug wastage on the narcotic record and having the witness cosign.
D) Administer half the tablet to the patient and save the other half for the next dose.

Question 9

If a patient is using two types of inhalers-a bronchodilator and a steroid-the nurse correctly instructs the patient to

A) First use the bronchodilator, then wait 5 minutes, then use the steroid.
B) First rinse out his mouth, then use the steroid, then wait 5 minutes, then use the bronchodilator.
C) First use the bronchodilator, then wait 5 minutes, then use the steroid, then rinse out his mouth.
D) First use the steroid, then wait 5 minutes, then use the bronchodilator, then rinse out his mouth.

Question 10

When discussing discharge instructions provided to the parents of a 2-year-old with an ear infection, the nurse would know that more teaching is required if the mother states:

A) "I will pull her pinna down and back to straighten the ear canal before I put in the eardrops."
B) "I will pull her pinna up and back to straighten the ear canal before I put in the eardrops."
C) "I will position the dropper so that the drop rolls down the wall of the canal, to prevent it from landing on her eardrum."
D) "I will be careful not to let the dropper touch her skin to prevent contamination of the medicine."

Question 11

A patient who is alert and oriented refuses to take her blood pressure medication this morning. The nurse appropriately tells the patient:

A) "You really should take your medicine so you can get well."
B) "That is fine. I'll just throw the pill away, and we'll keep an eye on your blood pressure."
C) "Is there a reason why you don't want to take your blood pressure medicine today?"
D) "We can try again later and see if you feel like taking it with lunch."

Question 12

As a nurse, it is preferable to use electronic medication administration records (eMARs) whenever possible because

A) eMAR systems help prevent medication errors due to built-in safeguards.
B) Using eMAR systems reduces bookkeeping costs and thus helps reduce the cost of care for patients.
C) Paper MAR systems are frowned on by regulators.
D) eMAR systems increase security by preventing theft of narcotics and other drugs.

Question 13

The nurse is providing acetaminophen (Tylenol) suspension to a patient via percutaneous gastrostomy tube. First, the nurse should

A) Measure the appropriate dose of medication using a medicine cup.
B) Draw up the medication into a catheter-tipped syringe.
C) Uncap the bottle while wearing clean gloves.
D) Shake the bottle of medication gently.

Question 14

A nurse correctly administers digoxin (Lanoxin) and propranolol (Inderal) via a feeding tube by

A) Flushing with water, administering the digoxin, administering the propranolol, and flushing with water.
B) Checking the residual, flushing with water, administering the digoxin, flushing with water, administering the propranolol, and flushing with water.
C) Flushing with water, administering the digoxin, flushing with water, administering the propranolol, and flushing with water.
D) Checking the residual, flushing with water, administering the digoxin, administering the propranolol, and flushing with water.

Question 15

A nurse correctly notifies the prescribing physician that a prescription for an elixir is inappropriate if the patient

A) Does not like the taste of most medicine.
B) Cannot swallow solid food.
C) Has sores in the mouth.
D) Is a recovering alcoholic.

Question 16

A nurse correctly instructs a patient not to exhale into

A) A dry-powder inhaler (DPI).
B) A metered-dose inhaler (MDI).
C) A Nicotrol inhaler.
D) All of the above.

Question 17

A nurse would most appropriately administer medication via the rectal route to

A) A 56-year-old who has had surgery for rectal cancer.
B) A 45-year-old with severe nausea and vomiting, who is unable to keep anything down.
C) A 58-year-old with a recent myocardial infarction and ventricular dysrhythmias.
D) A 2-year-old with a newly diagnosed seizure disorder.

Question 18

While helping a student nurse apply a nitroglycerine patch to the patient's skin, the nursing instructor would appropriately intervene if

A) The student nurse removed a patch that was applied yesterday before applying the new patch.
B) The student nurse removed her gloves before placing the patch.
C) The student nurse wrote the date, time, and her initials on the patch before applying it to the patient's skin.
D) The student nurse placed the new patch on the patient's right shoulder because the last patch was on the left shoulder.

Question 19

A nurse correctly recognizes that a liquid medication with undissolved particles is

A) An elixir and should not be shaken before use.
B) A solution and should be shaken before use.
C) A suspension and should be shaken before use.
D) A syrup and should not be shaken before use.

Question 20

The nurse is providing medications to a patient who is currently receiving continuous tube feeding via gastrostomy tube. The patient has a dose of phenytoin (Dilantin) due. The nurse's best course of action is to

A) Determine whether the patient is experiencing any pain.
B) Flush the gastrostomy tube with 30 mL of water before administration.
C) Hold the medication for the day.
D) Stop the tube feeding for at least 1 hour before administration.

Question 21

The nurse is providing home care for a client who takes crushed medications via a gastrostomy tube. Which of the following over-the-counter medications could be included in the patient's plan of care?

A) Sustained-release analgesics
B) Chewable antacids
C) Liquid-filled gel caps
D) Effervescent antacids
E) Antihistamine tablets

Question 22

A patient has an order for miconazole nitrate (Monistat) vaginal cream to treat a yeast infection. Place the following actions in the order in which the nurse would perform them to correctly administer the vaginal cream (1-5). (Enter the number of each step in the proper sequence, do not use commas).
1. Squeeze the tube to fill the applicator.
2. Depress the plunger until all of the cream is inserted.
3. Attach the applicator to the end of the tube containing the cream.
4. Detach the applicator from the tube of medication.
5. Wearing gloves, insert the applicator into the patient's vagina along the posterior wall for approximately 3 inches.

Question 23

The nurse is preparing to provide a dose of liquid oral antibiotic to a 2-year-old whose mother reports, "She doesn't like the taste of that and won't take it without a fight." To successfully provide the medication, the nurse could appropriately do which of the following?

A) Offer the child a warm bottle with the medication mixed in.
B) Offer the child a frozen juice bar before medication administration.
C) Discuss the addition of a flavoring with the pharmacist.
D) Place a syringe at the tip of the child's tongue and encourage the child to suck out the medication.
E) Place the dose in a plastic medicine cup and encourage the child to "drink it like a big girl."

Question 24

A nurse correctly recognizes that administration of medication via the rectal route is appropriate for

A) A small child who does not like the taste of orally administered medication.
B) A patient being treated for a heart attack.
C) A patient who is recovering from prostate cancer surgery.
D) A patient with severe hemorrhoids.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 25

When administering medication via the oral route, a nurse correctly recognizes that he must measure which of the following medications carefully, using a medicine cup, to ensure that the dosage is correct?

A) Suspensions
B) Elixirs
C) Solutions
D) All of the above

Question 26

The nurse correctly administers a medication by having the patient drink it through a straw if

A) The medication can cause nausea.
B) The medication must be taken in small gulps.
C) The medication can stain teeth.
D) The medication has an unpleasant taste.

Question 27

Select the correct order in which a nurse follows the listed steps to replace a transdermal patch for a patient.

A) Select a location for the new patch, cleanse the new location with an alcohol swab, apply the new patch, and remove the old patch.
B) Cleanse the location where the new patch is to be placed; remove the old patch; write the date, time, and nurse's initials on the new patch; and apply the new patch.
C) Remove the old patch; cleanse the old patch's location with an alcohol swab; write the date, time, and nurse's initials on the new patch; and apply the new patch.
D) Remove the old patch, select a location for the new patch, cleanse the location of the new patch with an alcohol swab, and apply the new patch.

Question 28

If a nurse commits a medication error, she should do all of the following except

A) Have another nurse assigned to the patient.
B) Check for adverse reactions to the erroneous medication.
C) Report the error to the prescribing physician.
D) Fill out an incident report per facility procedures.

Question 29

A patient refuses to take a medication for depression, even after the nurse explains its purpose and the intended effect to help the patient. The nurse will document which of the following?

A) The date, time, and reason for withholding the medication
B) That the patient is being uncooperative
C) The name of the prescriber notified of patient's refusal to take the medication
D) Any information about times the patient has refused medication in the past
E) The response of the prescriber

Question 30

When preparing to administer medication through a feeding route, the nurse correctly

A) Dissolves the medication in cold water.
B) Dissolves and administers each medication separately.
C) Flushes the tube with 30 to 60 mL apple or orange juice between administrations.
D) Mixes different medications together to simplify administration.