Deck 35: Medication Administration

Question 1

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

Answer 1

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 body's antibodies.The client may experience itching,urticaria,or a rash,or,in more severe cases,may have difficulty breathing.The client's response to morphine is not an example of an allergic effect.

Question 2

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.

Answer 2

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.

Question 3

The physician has ordered 6 mg of morphine sulfate every 3 to 4 hours prn for a client's 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

Answer 3

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.

Question 4

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

Question 5

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

Question 6

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

Question 7

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

Question 8

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

Question 9

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

Question 10

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.

Question 11

To determine proper drug dosages for children,calculations are most precisely made on the basis of the child's:
1) Weight
2) Height
3) Age
4) Body surface area

Question 12

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

Question 13

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

Question 14

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

Question 15

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

Question 16

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 don't take the medication now,you will not get better."

Question 17

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

Question 18

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

Question 19

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

Question 20

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.

Question 21

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."

Question 22

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 client's pain relief will be negatively affected primarily because of:
1) The client's age
2) The systemic effects of CHF
3) The route of administration
4) The status of the peripheral vessels

Question 23

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

Question 24

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

Question 25

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

Question 26

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

Question 27

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."

Question 28

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

Question 29

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

Question 30

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

Question 31

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

Question 32

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."

Question 33

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

Question 34

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

Question 35

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

Question 36

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

Question 37

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

Question 38

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

Question 39

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

Question 40

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

Question 41

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

Question 42

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

Question 43

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

Question 44

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

Question 45

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

Question 46

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

Question 47

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

Question 48

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

Question 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 client's favorite food
3) With grapefruit juice
4) In a very small amount of food

Question 50

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 nurse's 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 client's chart

Question 51

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 client's 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?"

Question 52

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