chapter 30 medication administration

A postoperative client's medication administration record (MAR) provides for PRN administration of a number of analgesics by various routes. Which action should the nurse take to assess the client’s pain to determine the appropriate analgesic to administer?

The nurse will have the client rate pain on the pain scale of 0 to 10 and proceed accordingly.

A client who has been prescribed an inhaler points to the spacer and asks, “What is this for?” What is the appropriate nursing response?

“Medication stays in the chamber so you can continue to inhale it.”

The nurse is teaching a client about the proper use of transdermal patches. In which location(s) will the nurse teach the client to apply the patch? Select all that apply.

• chest

• abdomen

• upper arms

• buttocks

During a teaching session on self-administration of insulin, the client asks the nurse why it is necessary to bunch the skin before inserting the needle. How will the nurse respond?

“Bunching your skin facilitates the placement of the needle in the subcutaneous tissue.”

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

Assess the vaginal area.

The nurse is preparing to administer an IM injection in the vastus lateralis site. Where will the nurse administer the medication?

in the anterolateral aspect of the thigh

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the health care provider's order.

Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply.

• “The cylinder of the insulin pen contains a prefilled reservoir of insulin.”

• “The dose of insulin in an insulin pen is displayed in a window of the syringe.”

• “The insulin pen automatically resets the dose window to zero, following the injection.”

The nurse recognizes which routes for parenteral medication administration? Select all that apply.

• subcutaneous

• intramuscular

• intradermal

• intravenous

A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which action should the nurse perform to prevent gastric reflux?

Help the client into a Fowler position.

A health care provider who just arrived on the unit gives a verbal order to the nurse regarding a nonemergent client situation. What is the nurse’s appropriate response?

Tactfully request the provider to input the order into the computerized provider order system.

The nurse is preparing to administer insulin to a client with a 2-inch (5-centimeter) tissue fold when bunched. At what angle will the nurse plan to insert the needle into the client?

90 degrees

Nurses who will soon complete their 12-hour shift are preparing to account for controlled substances. Which nursing action is appropriate? Select all that apply.

• One nurse counts the supply; another nurse checks the record of administration.

• Two nurses must ensure that the counts of controlled substances agree.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug?

swallowing the medication

The nurse is preparing supplies for a tuberculosis screening. The nurse will choose which syringe and needle combination?

1-ml syringe; 0.5-in (1.25-cm), 26-gauge needle

To which client would the nurse be most likely to administer a PRN medication?

a client who is reporting pain near the surgical site

A nurse is taking care of a 56-year-old client with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client? Record your answer using a whole number.

30

A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration?

Check the client's identification band.

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client?

supine

The nurse is administering medication to a client through a drug-infusion lock using the saline flush. During the process, the client reports pain at the site. Which interventions are appropriate in this situation? Select all that apply.

• Stop the medication and assess the site for signs of infiltration and phlebitis.

• Flush the medication lock with normal saline again to recheck patency.

• If site is within normal limits, resume medication administration at a slower rate.

Using the Z-track method is particularly important for the nurse to use when administering an intramuscular (IM) medication to which client?

A 70-year-old demonstrating muscle wasting prescribed chlorpromazine

The nurse is performing the admissions assessment for a client admitted with right hip pain. When performing the assessment, the client stated all of the prescribed medications they take from the previous admission. Which question is the priority for the nurse to ask the client?

"Do you take any over-the-counter medications?"

A client admitted with an acute exacerbation of asthma requires immediate intravenous medication. Which intervention(s) does the nurse include when administering intravenous medication by the intermittent infusion technique? Select all that apply.

• Ensure that the medication supplied is the medication prescribed

• Confirm that the medication, as prescribed, is safe for the client

• Verify that the intravenous catheter is in the vein and not clotted

• Ensure that medication infusion begins immediately for the required therapeutic effect

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Check the expiration date.

A nurse is accessing a client's Hickman catheter in order to administer a prescribed IV medication. The nurse knows that these tunneled catheters help the client in which of the following ways?

stabilize the catheter

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication.

To convert 0.8 grams to milligrams, the nurse should do which of the following?

Move the decimal point 3 places to the right.

The health care provider has prescribed the use of a transdermal patch. Which information will the nurse tell the client regarding the application of the patch?

Apply the patch to a clean, hairless location on the skin.

The nurse is beginning to administer oral medications to a client. The client states, "I have not taken that pill before. Are you sure it is right?" The nurse rechecks the CMAR/MAR and finds that the medication is indeed scheduled to be administered. Which response is appropriate?

"Do not take that pill yet. I will verify the medication prescription."

Which medication interaction illustrates a synergism?

A client takes acetaminophen to help them sleep. The client also takes an oxycodone for pain related to recent hip surgery, which makes them even more drowsy.

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatibility.

The nurse is administering morphine oral solution 5 mg to a client requesting medication for pain. The preparation is delivered as morphine solution 10 mg/5 ml. Calculate the amount, in milliliters, the will nurse administer. Record your answer to one decimal place.

2.5

The nurse has confirmed the client’s identity and provided the client with prescribed oral medication. What is the next appropriate nursing intervention?

Stay with the client while medications are taken.

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse?

Insert a new IV medication lock and remove the old one.

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees

A nurse is caring for an asthmatic client who reports an unpleasant aftertaste after using the inhaler. What should the nurse tell the client to gargle with to avoid this aftertaste?

salt water

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, “I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it.” What would the nurse do to address this situation?

Provide education on taking all antibiotics for effective treatment

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues?

Distribution

The nurse is teaching a client with diabetes how to withdraw insulin from a vial. In which order should the nurse explain the steps to the client?

1. Select appropriate syringe and needle.

2. Remove the metal cover from the rubber stopper.

3. Fill the syringe with a volume of air equal to the volume that will be withdrawn from the vial.

4. Pierce the rubber stopper with the needle and instill the air.

5. Invert the vial, hold, and brace it while pulling on the plunger.

6. Date and initial the vial for future use.

The nurse is caring for a client who has a history of asthma. The client has been admitted to a hospital unit for treatment of shortness of breath related to asthma exacerbation. The client tells the nurse, "I have been using my metered-dose inhalers but I still feel tightness in my chest." Which action(s) will the nurse take in response to the client's statement? Select all that apply.

• Assure the client that using inhaled medications can be challenging and provide a demonstration of proper inhaled medication use.

• Assess the client's SpO₂ levels before and after the inhaled medications have been properly administered.

• Contact the client's provider and recommend the use of a spacer to aid effective administration of inhaled medications.

• Conduct a thorough review of effective breathing techniques with the client and encourage the client to practice.

The nurse is educating a client on how to self-administer subcutaneous insulin injections. The client asks why the needle must be removed at the same angle as that of insertion. How will the nurse respond?

It minimizes tissue trauma.

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration?

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat?

"Aim the tip of the container toward the nasal passage."

A nurse is administering medication to a 78-year-old client who experienced symptoms of a stroke. When administering the medication prescribed, the nurse should be aware that this client has an increased possibility of drug toxicity due to which age-related factor?

decline in liver function and production of enzymes needed for drug metabolism

The nurse is preparing to administer an intramuscular injection to the client and intends to use the Z-track method. What potential benefit of this technique should the nurse describe?

decreased irritation and pain in subcutaneous tissue

A client with gastritis who is taking aspirin for cardiovascular prophylaxis asks the nurse whether there is benefit in buying the enteric-coated product. What is the appropriate nursing response?

“The enteric coating will protect your stomach.”

A client requests more medication for pain at the surgical site rated 8 out of 10. There is a PRN prescription for 10 mg PO of oxycodone for pain greater than 6 out of 10 on the pain scale. Which action should the nurse take first?

Verify clients name and date of birth

The nurse is preparing to instill eye medication for a client with bacterial conjunctivitis. Which intervention(s) will the nurse include? Select all that apply.

• donning gloves

• wiping the eye from the nose to the outer canthus

• asking the client to look toward the ceiling

The nurse transcribes a prescription that reads: "docusate 100 mg PO BID." This is an example of which type of prescription?

standing perscription

A nurse is teaching a client to correctly administer an inunction in order to maximize therapeutic effect. Which product is an inunction?

hydrocortisone cream applied to a client's rash

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client?

vastus lateralis site

A nurse needs to administer a subcutaneous injection to a client. Which techniques should the nurse use to reduce discomfort? Select all that apply.

• Support the client's tissue when withdrawing the needle.

• Numb the skin with an ice pack before the injection.

• Insert and withdraw the needle without hesitation.

• Instill the medication slowly but steadily.

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration?

Check the tube placement before administration.

The nurse has finished teaching a client about medications that have been prescribed for administration. Which client statement reflects that teaching about a piggyback infusion of antibiotics has been successful?

“When I am out of bed the small IV bag must not be lower than the large IV bag.”

Which nursing action(s) promotes safety in the preparation of medication? Select all that apply.

• Return medications with obscured labels to the pharmacy.

• Note the expiration dates on liquid medications.

• Prepare medications in well-lit conditions.

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle

A client is receiving a secondary infusion of a new antibiotic. After 5 minutes of administration, the client reports itching and appears flushed. What is the first nursing intervention?

Stop the infusion.

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid

How should the nurse instruct clients to clean their eyes before instilling medications?

Wipe your eyes from the inner canthus toward the outer canthus.

The nurse is preparing medications and is notified that a health care provider is on the phone. What is the nurse’s appropriate response?

Ask the unit clerk to take a message from the provider.

The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have Klonopin 10 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for clarification of the prescription.

A group of nursing students is learning about the rationale for intravenous (IV) drug and fluid administration as well as the various methods of delivering these parenterally. The intravenous (IV) route of administration delivers drugs or fluids directly into which structures? Select all that apply.

central veins

peripheral veins

Which client is likely to benefit from the administration of an otic medication?

client being treated for an inner ear infection

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees

A nurse is administering medication to a client with a triple-lumen central venous catheter. Which action should the nurse perform to maintain patency of an unused lumen?

Flush it with normal saline.

A nurse is caring for a client at a health care facility who is undergoing nicotine withdrawal therapy and has been prescribed a nicotine patch. Which statement is true with regard to the application of a transdermal patch?

The patch is applied to an area of the skin with adequate circulation.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?

Therapeutic range

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to food or drugs

When administering heparin subcutaneously, the nurse should:

never aspirate.

A client who has been receiving a secondary infusion of a new antibiotic for several minutes reports itching and a sensation of throat tightness. What is the priority nursing intervention?

Stop the infusion of the antibiotic.

An automated medication-dispensing system has been introduced at health care facility, eliminating the need for two nurses to count controlled substances at the end of each shift. Which practice should the nurses on the unit perform to ensure accurate inventory of controlled substances?

Verify the count each time a medication is removed from the system.

The nurse is teaching a client about zolpidem CR for sleep. When the client asks, “What does the CR mean?” what is the appropriate nursing response?

“continuous release”

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals?

"This is because food and some drinks can affect the way your medicine works.”

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug.

The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action?

Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription.

The primary reason for the Controlled Substances Act is:

to prevent substance use and dependence.

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for order clarification.

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that, so you will have to crush it and put it in applesauce for me as the other nurse does." What is an appropriate reply from the nurse?

"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole."

Which action describes buccal medication administration?

placing a medication underneath the upper lip or in the side of the mouth

The nurse is preparing to administer a medication through a peripheral intravenous line. What should the nurse do when administering the medication to ensure safe delivery? Select all that apply.

• Flush with small amounts of saline pushed through the device on a routine basis to ensure patency.

• Flush the access device before the infusion is begun and after the infusion is completed.

• Don't start administering the medication until intravenous placement is confirmed.

• Observe for signs of infiltration or phlebitis prior to administration

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective?

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance."

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?

The area is free of major blood vessels and fat.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation?

Inner surface of the forearm

Which set of instructions the nurse should give to a client who is going home with eye drops? Select all that apply.

• Wait for 5 minutes between instillation of eye drops.

• Apply the drops along the lower lid margin of the eye.

• Keep the application tip of the medication container sterile.

The nurse is teaching a client about using two inhalers. Which client statement reflects that nursing teaching has been effective

“I must wait at least 1 full minute between inhalers.”

A nurse needs to withdraw a prescribed medication from an ampule and administer it to a client. Which action should the nurse perform to ensure that all the medication is equally distributed when withdrawing?

Tap the top of the ampule before withdrawing the medicine.

The nurse is administering morphine 5 mg oral solution, which is located in a locked drawer in the medication room. The medication is provided in a unit-dose container that is labeled 10 mg/5 ml. What action(s) are required for the nurse to perform?

• Provide written documentation for the removal of the medication dose.

• Obtain another nurse to witness the waste of the unused medication.

• Count the number of the morphine unit-dose containers prior to removal.

• Document each shift by two nurses that an opioid count was performed.

The nurse administers the client’s scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider’s parameters. What does the nurse do with this upcoming dose of scheduled unit-dose packaged antihypertensive medication?

Set the antihypertensive dose aside pending assessment.

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can be easily converted between measurements

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients?

ventrogluteal

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

The ventrogluteal site provides a location with the capacity for depositing and absorbing the drug.

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

intradermal

Which nursing techniques should the nurse use to assist a client who is having difficulty using the metered-dose inhaler correctly? Select all that apply.

re-demonstrating the correct use of a metered-dose inhaler

observing the client’s technique when using the metered-dose inhaler at least four times

monitoring the client’s saturated oxygen with a pulse oximeter before and after the use of the metered-dose inhaler

Nurse A is having difficulty logging into the automated medication-dispensing system and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B’s appropriate response?

“I will get the hospital IT department's phone number for you.”

The nurse is caring for a client who is receiving a prescribed intravenous (IV) infusion of an antibiotic to treat an infection. The client asks the nurse, “Can I just take a pill?” What is the best response by the nurse?

“An IV infusion maintains a therapeutic level of the medication in your blood.”

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

“I am taking tadalafil in addition to nitroglycerin.”

The nurse administered 0900 medications to the team of clients. The nurse notes that a medication error was made. One client received a medication that was prescribed for the roommate. What action(s) does the nurse perform?

• Document the error in the nurse's notes.

• Notify the health care provider.

• Perform an assessment of the client.

• Complete an incident report.