Question 1

The student nurses have completed their first class on drug administration and the roles and responsibilities of the nurse. Which statement by one of the students indicate that more clarification is required

A)" It is important for us to know why a physician would order a particular type of antibiotic."
B) "We need to use our knowledge of pathophysiology and how it may impact the median effective dose of the drug."
C) "A nurse needs to understand that a common serious side effect of narcotics is respiratory depression."
D) "We need to know how a pain medication blocks pain receptors in the body."
E) "How altered protein levels in the body will affect the metabolism of the drug."

"We need to use our knowledge of pathophysiology and how it may impact the median effective dose of the drug."
"How altered protein levels in the body will affect the metabolism of the drug."

Accepted Answer

Rationale 1. A nurse must understand why a drug is being ordered for the client and it's intended use.
Rationale 2: While it is important to understand the pathophysiology related to the condition of the client, this will not affect the median dose of the drug.
Ratioanle 3. Understanding the common side effects is important as the nurse evaluates the effectiveness of the drug and the client's response to it.
Rationale 4: It is important for the nurse to understand how the drug works on the condition being treated.
Rationale 5: Altered protein levels would not affect metabolism of a drug, they would effect distribution of a drug.

Question 2

A young client is seen in the emergency room for signs of a urinary tract infection and is ordered an antibiotic. What are methods the nurse can use to increase adherence to the treatment ordered?&#10;A) Teach the patient about the drug and expected side effects.&#10;B) Ask the client whether he can afford the drug,&#10;C) Supply client with enough medication to take over the prescribed time period.&#10;D) Have client use pill containers to remind her to take the drug.&#10;E) Advising the client on how to the manage side effects.&#10;

Accepted Answer

Rationale 1. Educating the client on what the medication does, and what side effects to expect will help to increase adherence to the treatment plan.
Rationale 2. Asking the client whether they can afford the medication is important to assess, clients may seek treatment for a condition but be unable to afford the treatment ordered.
Rationale 3. Supplying the client with the first dose of a medication is usual practice in some emergency rooms, especially during the night when a client may be unable to get a prescription filled. It would not increase the adherence to the drug treatment plan.
Rationale 4. Using pill containers to organize the medication may improve adherence
Rationale 5. Advising clients how to manage side effects like headaches or diarrhea will improve adherence.

Question 3

The Institute for Safe Medication Practice has advised the use of some abbreviations in order to increase medication safety. Which of the following abbreviations are no longer recommended for
Use?

A) OD
B) qhs
C) Ad lib
D) qh
E) qod

OD
qhs
qod

Accepted Answer

Ratioanle 1. The ISMP recommends that OD should be written out as "daily."
Ratioanle 2. The recommendation is that qhs should be written as "nightly.'
Rationale 3. Ad lib is an approved abbreviation for "as needed.'
Rationale 4. An approved abbreviation for hourly is "qh"
Rationale 5. The ISMP recommends that qod be written out as "every other day"

Question 4

The Institute for Safe Medication Practice recommends writing out _____ ____ ______ instead of the abbreviation qod.

Accepted Answer

Ratioanale The ISMP makes recommendations on the safe use of abbreviations when writing medication orders. To decrease the chance of medication errors, some abbreviations are no longer recommended; sod should be written in full as every other day.

Question 5

Mrs Benton is seen in the clinic with her 3 year old child, who has been diagnosed with an ear infection. He is ordered an antibiotic in elixir form. When reviewing the drug with the mother, the nurse tells her that she should give her son 5 mls four times daily. When the mother asks how much is 5 mls, what is the response of the nurse?

A) 5 mls is equivalent to 1/2 teaspoon.
B) 5 mls is equivalent to 1.5 teaspoons.
C) 5 mrs is equivalent to 1 teaspoon.
D) 5 mrs is equivalent to 1 tablespoon.

Accepted Answer

Ratioanle 1 The metric equivalent of 5 mls is 1 teaspoon
Rationale 2 The metric equivalent of 5 mls is 1 teaspoon
Rationale 3 The metric equivalent of 5 mls is 1 teaspoon
Rationale 4 The metric equivalent of 5 mls is 1 teaspoon

Question 6

What is additional information can the nurse share with Mrs. Benton that will ensure accuracy of the dose delivered to her son?&#10;A) &#34;You may need to give more than one spoonful depending on the size of your utensils.&#34;&#10;B) &#34; You should use your baking measuring spoons to give a more accurate dose.&#34;&#10;C) &#34;You may need to use less than 1 spoonful if your utensils are large.&#34;&#10;D) &#34; Ask the pharmacist to include a medication syringe with your antibiotic&#10;

Accepted Answer

Rationale 1. Household utensils vary in size and do not always hold the amount that their name implies. This is an inaccurate way of dispensing medications.
Rationale 2. Baking utensils are standardized measurements and are thus more accurate to use when dispensing medications.
Rationale 3. Household utensils vary in size and do not always hold the amount that their name implies. This is an inaccurate way of dispensing medications.
Rationale 4. This would be an alternative to using measuring spoons.

Question 7

One of the disadvantages of giving medications by the enteral route is that some of the medication is inactivated before it reaches it's target organ. This process is called the ______ _______ effect.

Accepted Answer

Rationale Medications given by the enteral route are absorbed from the stomach and small intestine first travel to the liver, where they may be inactivated before they ever reach their target organs.

Question 8

Which of the following drugs would undergo hepatic first pass metabolism?&#10;A) Antihypertensive capsule&#10;B) Nitroglycerin sublingual&#10;C) Midazolam patch buccaly&#10;D) Antitussive cough syrup&#10;E) Analgesic tablet&#10;

Accepted Answer

Rationale 1. All enteral medications that are absorbed in the stomach or small intestines undergo first pass effect.
Rationale 2. Sublingual and ducal medications are absorbed in the mouth directly into the bloodstream and thus bypass first pass metabolism.
Rationale 3. Sublingual and buccal medications are absorbed in the mouth directly into the bloodstream and thus bypass first pass metabolism.
Rationale 4. All enteral medications that are absorbed in the stomach or small intestines undergo first pass effect.
Rationale 5. All enteral medications that are absorbed in the stomach or small intestines undergo first pass effect.

Question 9

A student nurse is preparing to administer a nitroglycerin transdermal patch on her client for his heart disease. Before she goes into the room, her instructor asks her to walk through the steps she will take to administer this drug. What does the student include in her Answer?

A) Wear gloves during administration
B) Ask client where they would prefer to have patch applied
C) Remove old patch
D) Document date, dose and initials on the patch
E) Document date, time and initials on the MAR

Accepted Answer

Rationale 1. Wearing gloves will protect the student from absorbing some of the medication from the new and old patch into her system.
Rationale 2. There are some patch's that have specific recommendations by the manufacturer about where they are placed. The student needs to follow these guidelines.
Rationale 3. It is important to remove the old patch because there may still be active ingredient in it, leaving it on may cause the patient to get too much of the drug and possibly experience adverse effects.
Rationale 4. The dose is usually already on the patch, the student would document the date, time and her initials on the patch.
Rationale 5. Date, time and initials would be documented on the MAR as well.

Question 10

The student is preparing to give her first subcutaneous injection to her client. What information that she shares with her instructor about this skill indicates the need for more teaching?&#10;A) &#34; I will choose an area to administer avoiding bony prominences.&#34;&#10;B) &#34; I will choose a 3 ml syringe with a 22 -25 gauge needle for injection.&#34;&#10;C) &#34; I will wear gloves when cleaning the site and administering injection.&#34;&#10;D) &#34; I will not give more than 5 mls of medication by this route.&#34;&#10;E) &#34; I will gently pat the site with an antiseptic swab after injection.&#34;&#10;

Accepted Answer

Rationale 1. This is a correct statement about subcutaneous medications and does not require further teaching for the student.
Rationale 2. A 3 ml syringe is correct, but the gauge is 25-27, not 22-25. 
Rationale 3. This is correct, the student would use gloves and good aseptic technique because an injection breaks the protective skin barrier and places the client at risk for infection.
Rationale 4. The usual amount of medication given by this route is between 0.5- 2 mls, not 5. This is incorrect and is indicative of the need for clarification.
Rationale 5. This is correct, areas should not be massaged after an injection but a gentle swab over the site with an antiseptic swab or gauze is appropriate.

Question 11

The student is preparing to give oral medications to a client she has looked after for 2 days. She completes her checks while pouring the medications and enters the room with her instructor. She asks the client her name and birthdate, and the client responds, Don't you know who I am by now?" What is the best response by the student?
1. " Yes I do, but my instructor needs to know."
2. " Sure I do, and gives the client her meds."
3. " I do, this is my last check to ensure safe medication administration."
4. " It is hospital policy that I ask you your name and birthdate."

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Deck 4: Principles of Drug Administration