Question 1

A 64-year-old quadriplegic patient needs an IM injection of antibiotic.What is the best site for the administration?

Accepted Answer

Vastus lateralis is a large muscle that is easily accessible from the supine position.Because this patient no longer walks,the ventrogluteal muscle will begin to atrophy and is not the ideal location.The dorsal gluteal site is a location for a subcutaneous injection,and this patient requires an IM injection.The deltoid is easily accessible,but this muscle is not well developed in many adults.

Question 2

The patient is in severe pain and is requesting a prn medication before the prn time interval has elapsed.The nurse's priority is to

Accepted Answer

The nurse should utilize clinical judgment to advocate for the patient by requesting a stat order for the patient's breakthrough pain.The nurse cannot give a medication without an order because this violates the "Right Time" portion of the Six Rights of Medication Administration.If a nurse assesses that a patient is in severe pain,she must use clinical judgment to find that patient a means of pain relief.Although the nurse should document the patient's request and pain score,this is not the priority.

Question 3

A provider has ordered a STAT medication to be administered.The nurse knows that the best route of administration is

Accepted Answer

IV medications have the quickest effect because they receive the most blood flow.A STAT order is to be carried out as quickly as possible,so the effect should be as immediate as possible.Oral,subcutaneous (SQ),and intramuscular (IM)are other ways to deliver medication but with less blood flow.

Question 4

What is the nurse's priority action to protect a patient from medication error?

Accepted Answer

Verbal orders should be limited to urgent situations where written communication is unavailable.The nurse should explain the reasons and logistics of a procedure to calm anxious family members,and should ask family members not to distract medication administration for the patient's safety.After proper education,if the family members are creating an unsafe environment,the nurse may ask them to step out of the room.The medication administration record should be checked against the patient's hospital identification band; a room number is not an acceptable identifier.Medications should be given when scheduled,and medications with special assessment indications should be separated.

Question 5

The nurse knows that caring for two patients with the same last name can lead to a medication error involving which right of medication administration?

Accepted Answer

The nurse should ask the patient to verify his identity and should check the patient's ID bracelet against the medication record to ensure proper patient.Acceptable patient identifiers include the patient's name,an identification number assigned by a health care agency,or a telephone number.Do not use the patient's room number as an identifier.To identify a patient correctly in an acute care setting,compare the patient identifiers on the MAR with the patient's identification bracelet while at the patient's bedside.Right medication,right dose,and right route are equally as important,but this example outlines right patient.

Question 6

The nurse realizes which patient is at greatest risk for an unintended synergistic effect?

Accepted Answer

A synergistic effect occurs when two medications potentiate each other,creating a greater effect than a single medication on its own.The 72-year-old seeing four different providers is likely to experience polypharmacy.Polypharmacy places the patient at risk for unintended mixing of medications that potentiate each other.The child taking too much of a medication by mistake could experience overdose or toxicity.The 50-year-old is prescribed two different blood pressure medications for their synergistic effect,but this is a desired event.A drug addict mixing chemicals can be toxic.

Question 7

The nurse knows that patient education about a buccal medication has been effective when the patient states

Accepted Answer

Buccal medications should be placed in the side of the cheek and allowed to dissolve completely.Buccal medications act with the patient's saliva and mucosa.The patient should not chew or swallow the medication.Gastric secretions may destroy some medications.The patient should rotate sides of the check to avoid irritating the mucosal lining.

Question 8

The nurse is preparing to administer medications to two patients with the same last name.After the administration,the nurse realizes that she did not check the identification of the patient before administering medication.Which of the following actions should the nurse complete first?

Accepted Answer

The nurse's first priority is to establish the safety of the patient by assessing the patient.Second,notify the charge nurse and the physician.Administer antidote if required.Finally,the nurse needs to complete proper documentation.

Question 9

A confused patient refuses his medication.What is the nurse's first response?

Accepted Answer

Much of a patient's apprehension about medication comes from lack of understanding,and educating the patient may lead to better compliance.Ultimately,the patient does have the right to refuse the medication; however,the nurse should first try to educate the patient.Hiding,deceiving,or forcing a patient into taking a medication is unethical and violates his right to autonomy.

Question 10

Which patient using an inhaler would benefit most from using a spacer?

Accepted Answer

A spacer is indicated for a patient who has limited coordination or function.Individuals with multiple sclerosis often lose motor control and function and have difficulty seeing.Children often have difficulty using a spacer,so a simple face mask is preferred for infants and children younger than 4.Hearing impairment may make teaching the patient to use the inhaler difficult,but it does not indicate the need for a spacer.A patient with one-sided weakness would have a difficult time assembling and administering an inhaler by using a spacer,but the patient could use the inhaler single-handedly.

Question 11

A nurse is attempting to administer medication to a child,but the child refuses to take the medication.The nurse asks for the parent's cooperation by saying

Accepted Answer

Children often have difficulties taking medication,but it is less traumatic for the child if the parent administers the medication.Holding down the child is not the best option because it may further upset the child.Never administer an oral medication to a sleeping child.Don't mix medications into the child's favorite foods,because the child might start to refuse the food.

Question 12

A patient needs assistance excreting a gaseous medication.What is the correct nursing action?

Accepted Answer

Gaseous and volatile medications are excreted through gas exchange.Deep breathing and coughing will assist in clearing the medication more quickly.

Question 13

A nurse is caring for a patient who is in hypertensive crisis.When the nurse is flushing the patient's peripheral IV,the patient complains of pain.Upon assessment,the nurse notices a red streak that is warm to the touch.What is the nurse's initial action?

Accepted Answer

The patient has phlebitis; the initial nursing action would be to apply a cool compress.The nurse should start a new IV before discontinuing the old one because it is important to always have an IV access site in case of emergency.Then the physician can be notified.Pain medication may need to be administered.

Question 14

The nurse is administering an intravenous medication that is to be administered over 10 minutes.Which method should the nurse choose to efficiently administer the medication?

Accepted Answer

To administer this medication efficiently,the nurse should use an infusion pump to run the medication in over a prolonged time.This method is more accurate and is more time efficient than other methods because the nurse can leave the room.The nurse should not mix medication into the maintenance bag without pharmacist and physician approval.Pushing the medication is not a time-efficient method for the nurse.A cath-tipped syringe is an inappropriate device for administration of a medication.

Question 15

The nurse knows that a subcutaneous injection takes longer to absorb because

Accepted Answer

How quickly a medication is absorbed is dependent on blood flow to the site.Locations with less blood supply take longer to absorb.Absorption is not based on adipose tissue; however,excessive adipose tissue may cause the medication to take longer before reaching the blood supply.The connective tissue is not part of medication absorption.If a medication is properly administered,none of it should be wasted.

Question 16

The prescriber wrote for a 40-kg child to receive 25 mg of medication 4 times a day.The therapeutic range is 5 to 10 mg/kg/day.What is the nurse's priority?

Accepted Answer

The dosage range is 200 to 400 mg a day.The prescribed dose is 100 mg/day,which is below therapeutic range.The nurse should notify the physician first and ask for clarification on the order.The dose is not above the therapeutic range and is not at a toxic level.The nurse should never alter an order without the prescriber's approval and consent.

Question 17

A nurse has withdrawn a narcotic from the medication dispenser.Upon checking the drug against the medication administration record,the nurse notices that the narcotic order has expired.What should be the nurse's first action?

Accepted Answer

The nurse should follow Nurse Practice Acts and safe narcotic administration guidelines by safely returning the medication to the secure medication dispenser.This allows for an accurate narcotic count.The nurse should not leave the medication room with a nonprescribed medication; the physician can be contacted once the medication is replaced safely.The nurse cannot administer a medication when there is no current order; this is a violation of the Six Rights of Medication Administration.The nurse should notify the pharmacist after safely returning the narcotic to the medication dispenser; removing the medication from the patient profile will reduce further medication errors.

Question 18

A patient who is being discharged today is going home with an inhaler.The patient is to administer 2 puffs of his inhaler twice daily.The inhaler contains 200 puffs.When should the nurse appropriately advise the patient to refill his medication?

Accepted Answer

The inhaler should last the patient 50 days; the nurse should advise the patient to refill the prescription when he has 7 to 10 days of medication remaining.Refilling it as soon as he leaves the hospital or when the inhaler is half empty is too early.If the patient waits 50 days,the patient will run out of medication before it can be refilled.

Question 19

A patient is at risk for aspiration.What nursing action is most appropriate?

Accepted Answer

Aspiration occurs when food,fluid,or medication intended for GI administration inadvertently enters the respiratory tract.To minimize aspiration risk,allow the patient,if capable,to self-administer medication.Patients should also hold their own cup to control how quickly they take in fluid.Liquids should be thickened to reduce the risk of aspiration.Patients at risk for aspiration should not be given straws because use of a straw decreases the control the patient has over volume intake.

Question 20

A patients states that she would prefer not to take her daily allergy pill this morning because it makes her too drowsy throughout the day.The nurse responds therapeutically by saying,

Accepted Answer

The nurse should use knowledge about the medication to educate the patient about potential response to medications.Then the medication schedule can be altered based on that knowledge,after the physician has been notified.It is the patient's right to refuse her medication; however,the nurse should educate the patient on the importance and effects of her medication.Asking a patient to change her entire life schedule around a medication is unreasonable and will decrease compliance.The nurse should be supportive and should offer solutions to manage medication effects.

Quiz 31: Medication Administration