Question 1

Which schedule would the nurse select to achieve a therapeutic level if the medication is prescribed for administration 4 times a day?

Accepted Answer

The nurse administers medications 4 times a day by evenly spacing out the medications over a 24-hour period so a steady,therapeutic blood level can be achieved.

Question 2

The nurse needs to administer 1000 mcg of a medication and has 1-mg tablets.How many tablets does the nurse administer?

Accepted Answer

The nurse administers 1 tablet,because 1 mg = 1000 mcg.

Question 3

A patient received a drug that caused an unpredictable and unusual effect.Which term does the nurse use to describe this effect?

Accepted Answer

An unpredictable overreaction or underreaction to a medication is an idosyncratic reaction.Toxic medication effects occur with prolonged therapy,excessive dosing,or impaired metabolism or systemic accumulation in the patient.They are adverse effects with the potential to cause patient injury and death.Allergic reactions are unpredictable,unless the patient has a history of a medication allergy,and result from an immunological patient response to the medication involving antibody formation.A therapeutic response is a desirable or intended patient response.

Question 4

The nurse admits a patient who has an acute kidney infection but refuses to take any medication.Which is the best initial nursing intervention to implement the therapeutic regimen?

Accepted Answer

The basis of the patient's refusal is unknown; discussing the situation with the patient provides the nurse with an opportunity to clarify misunderstandings,provide information,and gather valuable patient data to plan nursing care.Notifying the healthcare provider is premature.The nurse takes care of the situation initially by educating the patient.Emphasizing the risk of renal failure may be interpreted as an indirect threat by the patient.The patient has the right to refuse taking the medication,and disguising the medication is neither indicated nor appropriate.

Question 5

The nurse needs to administer a medication to a toddler who weighs 20 kg.The dosage is 50 mg/kg/day in divided doses,and the medication is available as an elixir at 25 mg/mL.How many milliliters of medication should the nurse administer at each scheduled dose?

Accepted Answer

First calculate the daily dose in milligrams per day.
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Then calculate how many milliliters of elixir to administer daily.
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Finally calculate the dosage at each scheduled time with two doses/day.
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Question 6

The nurse prepares to administer a parenteral medication.Which route of administration does the nurse use for the medication?

Accepted Answer

Parenteral medications are always injected into a vessel or tissue; thus intramuscular administration is suitable.The other routes are suitable for nonparenteral medications.

Question 7

The nurse is preparing to administer a controlled substance.Which action must the nurse take first if controlled medication is discarded?

Accepted Answer

The nurse discards the unused portion of the patient's controlled substance medication and has another nurse witness the event; then both nurses document the transaction.The nurse follows agency policy about discarding controlled substances.Controlled substances are counted and verified at a frequency determined by regulatory agencies and the institution to prevent unauthorized administration.Documenting the amount wasted occurs after the waste has been discarded and witnessed by another nurse.Unused portions of the patient's medication may not be administered to another patient,even if they are kept sterile.

Question 8

The nurse discharges a patient from the ambulatory surgical center with a prescription for an opioid analgesic.The patient can take the medication every 4 to 6 hours as needed for pain.What does the nurse include in patient teaching about the prescription before discharging the patient?

Accepted Answer

The nurse instructs the patient to wait 4 to 6 hours between doses avoid serious effects of opioid analgesics,including respiratory depression.The nurse encourages the patient to take an analgesic when the pain is mild because the medication will be more effective.Opioids have little to do with healing; however,if the patient has a thoracotomy or an abdominal incision,opioid analgesia is usually needed to facilitate coughing and deep breathing.

Question 9

An older adult who lives alone takes three different white,flat,unscored medications every day.He has trouble remembering if he has taken the correct pill at the correct time.What strategy would best help this patient maintain independence and safety in taking his medications?

Accepted Answer

Color coding the pill bottles has the most likelihood of success.It's essential to keep the medications in their original containers for safety.A system could be set up with the patient to make clear which medications he needs to take at what time.Placing the similar-looking pills in to a pill container could cause more confusion for the patient.Their identities need to be maintained for correct scheduling.Having someone administer the medications reduces the patient's independence and could become burdensome.Since the patient has not been able to manage his medications to date,an open-ended question about how he wants to identify his medications may be confusing.Suggesting a plan allows the patient to recognize a solution and agree to see if it works.

Question 10

The patient is to receive 750 mg of a medication.The pharmacy sent 500-mg scored tablets.How many tablets does the nurse administer?

Accepted Answer

The nurse administers 1 1/2 tablets = 500 mg + 250 mg = 750 mg.The nurse calculates the dosage with a proportion equation.
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Cross-multiply and divide: 1 × 750 = 500x
Solve for x: 750 ÷ 500 = 1 1/2 tablets

Question 11

A male patient looks at the medication in the cup and tells the nurse that he does not take one of the tablets.Which action should the nurse take next?

Accepted Answer

A safe nursing intervention is to recheck both the medication and the order because the drug in question may be a new prescription,a new strength of the same medication,or a different generic form of the same medication.Regardless of the cause,the problem needs clarification.Telling the patient that the medications are correct is premature and misleading and denies the patient the right to information.The nurse does not know if the medications are correct yet.After checking the medications against the medication administration record (MAR)and the original prescriptions,he or she can call the pharmacy for help.The nurse removes the entire cup of medications and rechecks all of them.Documenting the incident is premature because the nurse needs to complete the investigation first.

Question 12

The nurse needs to administer 2 tsp of a medication to the patient.How much of the medication should the nurse administer?

Accepted Answer

1 tsp = 5 mL; 2 × 5 mL = 10 mL.

Question 13

The nurse is having difficulty reading a medication order.Which is the best action for the nurse to take to prevent a medication error?

Accepted Answer

To prevent patient injury and decrease nursing liability,the nurse clarifies illegible prescriptions and handwriting with the healthcare provider who wrote it.Asking the pharmacist about what is usually ordered does not reflect what may be in the current order.Changes may have been requested.Asking another nurse to try to read the order doesn't eliminate the chance of error.

Question 14

The nurse is reviewing concepts of safe medication preparation and administration with a group of nursing students.Which statement should the nurse include during the review?

Accepted Answer

The students should be reminded to verify medication calculations to ensure that the math is correct.Calculate medication doses accurately and use appropriate measuring devices.Verify that the dose prescribed is within a safe dosage range and is appropriate for the patient.Clean technique is used for nonparenteral medication.Nurses should avoid administering medication prepared by another nurse.They should also avoid leaving medication at the bedside or on the meal tray because the nurse will not witness the medication administration and cannot document the time that the medication was taken.In addition,the patient can spill the medication,dispose of it,or leave it on the tray.

Question 15

A patient has been given high doses of an opioid medication for severe pain.Which assessment data indicate the most toxic effect of a medication?

Accepted Answer

Respiratory depression is an undesirable and potentially fatal effect of medication that occurs with prolonged therapy,excessive dosing,impaired metabolism,or systemic accumulation in the patient.Respiratory depression can quickly deteriorate into respiratory failure,tissue damage,and death without airway and respiratory support.Nausea and vomiting can be clinical indicators of a toxic effect; however,they lack the same fatal potential as respiratory depression.The reddened skin rash is consistent with a hypersensitivity reaction.Bloating and constipation are most likely adverse effects of medication with a very low risk of fatality.

Question 16

The provider prescribes aluminum hydroxide gel 2 ounces.The nurse has aluminum hydroxide in 30-mL containers in the patient's medication drawer.How many containers does the nurse administer to the patient?

Accepted Answer

The nurse administers two containers at 30 mL per container because 1 ounce = 30 mL.The prescription calls for aluminum hydroxide 60 mL; thus,to administer 60 mL,the nurse needs two containers.

Question 17

The nurse administers sulfamethoxazole and trimethoprim (Bactrim)for a desirable patient response derived from the combination of agents.Which type of medication effect does the nurse anticipate?

Accepted Answer

The nurse anticipates a synergistic effect because the two antibiotics,sulfamethoxazole and trimethoprim,work better in combination than either agent works alone.Drug tolerance means that a larger dose of medication is needed to produce the same therapeutic effect over time.Drug dependence is psychological or physical.The patient takes the medication for an effect other than the therapeutic effect,resulting in psychological dependence.Physical dependence involves physiological adaptation to the medication that results in severe adverse effects if withdrawn abruptly.A subtherapeutic effect is less than therapeutic; the therapy treats the disorder inadequately.

Question 18

A prescription reads,"Aspirin 325 mg 2 tablets orally for pain." What action should the nurse take when the patient has pain?

Accepted Answer

The nurse speaks with the provider to clarify the frequency of administering aspirin.Aspirin is generally prescribed once daily or every 4 to 6 hours with a prn designation.The nurse does not alter the prescription unless instructed by the provider,and the order already states orally.The prescriber is the person with whom the nurse must clarify the order.Aspirin is not administered whenever the patient requests it.It has a frequency of administration.

Question 19

The nurse administers a patient's medication; within 30 minutes the patient has bilateral wheezing and large red blotches on the face and is anxious and dizzy.Which should the nurse implement?

Accepted Answer

The patient has clinical indicators of a moderate-to-severe hypersensitivity reaction,most likely related to the medication.The wheezing increases the risk of impairing the patient's airway,and the blood pressure can be low already,as evidenced by patient dizziness.The nurse should stay with the patient and wait for emergency equipment,supplies,and personnel to assist.In the meantime he or she should plan to support the patient's airway,breathing,and circulation.Hydrating the patient will not flush the allergic reaction from him or her because it is under way; besides,drinking fluid increases the risk of aspiration of gastric contents or choking.An antihistamine potentially helps to reverse some of the allergic effects; however,the nurse should not leave the patient.The nurse documents the events after the patient is stable.

Question 20

The dose ordered for the patient is 37.5 mg intramuscularly (IM).How many milliliters of the medication should the nurse administer from a 100-mg/2-mL syringe?

Accepted Answer

The nurse administers 0.75 mL of a 2-mL syringe containing 100 mg and uses a proportion equation to calculate the dosage.
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Cross-multiply and divide: 37.5 × 2 = 100x
Solve for x: 75 ÷ 100 = 0.75 mL

Quiz 21: Preparation for Safe Medication Administration