FA DAVIS CH 35 - Researching and preparing medications

The nurse is administering medications to a patient who takes multiple drugs at home. When the nurse presents an allergy pill the patient states, "That's not my allergy pill." The nurse explains the pill is the hospital substitute. Which action will the nurse take if the patient refuses the medication?

1.Explain to the patient that the medication is a different brand but does the same thing.

2.Call the pharmacy to see if the brand the patient takes can be ordered.

3.Tell the patient about the unwanted symptoms that will occur if the medication is not taken.

4.Place the medication back into the patient's bin and mark "refused" on the Medication Administration Record (MAR).

4! Place the medication back into the patient's bin and mark "refused" on the Medication Administration Record (MAR).

Rationales

Option 4:

The nurse needs to understand the patient has the right to refuse any medication, at any time, for any reason. The medication should be placed in the patient's bin so a charge is not made, and the MAR is marked "refused."

_________________________ medications are available with a written direction from a health-care provider with prescriptive authority.

1.Prescription

2.Brand name

3.Generic name

4.Over-the-counter (OTC)

1. Prescription

Rationales

Option 1:

Prescription medications are available with a written direction from a health-care provider with prescriptive authority. This includes physicians, nurse practitioners, and, in some situations, physician assistants, depending on state laws.

The nurse is preparing to administer medication to a preschool patient. The health-care provider's order reads in part, "5 mg/kg." After weighing the patient, which conversion will the nurse use to determine the correct dosage?

1.Multiply the patient's weight in pounds by 2.2 to get the weight in kilograms.

2.Convert the number of the patient's weight in pounds to the same number in kilograms.

3.Take the patient's weight in pounds and divide the number by 2.0 to get kilograms.

4.Divide the patient's weight in pounds by 2.2 to get the weight in kilograms.

4.Divide the patient's weight in pounds by 2.2 to get the weight in kilograms.

Rationales

Option 4:

The correct conversion is that 1 kg = 2.2 pounds. Therefore, the patient's weight in pounds is divided by 2.2 to get the weight in kilograms. This conversion will ensure that the patient gets the correct amount of medication.

The nurse is reviewing the use of a newly prescribed drug with a patient who has high cholesterol. The nurse reminds the patient not to eat grapefruit or drink grapefruit juice while taking the drug. For which reason does the nurse give this advice?

1.Grapefruit enhances the action of the drug and decreases cholesterol too quickly.

2.Grapefruit blocks the action of the drug and causes an increase in cholesterol.

3.Grapefruit is a high-cholesterol food source and counteracts the drug.

4.Grapefruit interferes with the enzymes that break down the drug.

4.Grapefruit interferes with the enzymes that break down the drug.

Rationales

Option 4:

Grapefruit does interfere with the enzymes that break down the drug and causes the blood levels of the drug to become too high.

The licensed practical nurse/licensed vocational nurse (LPN/LVN) is providing care for a patient receiving a new medication being delivered by IV piggy back. The registered nurse (RN) who hung the medication leaves the patient's room, and the LPN/LVN notices the patient experiencing respiratory distress. Which action by the LPN/LVN is performed first?

1.Notify the RN who hung the IV piggy back.

2.Obtain a blood pressure reading.

3.Place the bed in high Fowler position.

4.Stop the flow of the IV piggy back medication.

4.Stop the flow of the IV piggy back medication.

Rationales

Option 4:

The patient is likely to be experiencing an anaphylactic reaction to the IV piggy back medication. Therefore, the infusion of the medication should be stopped; continued infusion increases the seriousness of the reaction.

The nurse is reviewing discharge medications with a patient. One of the medications is liquid and the instructions state in part, "take 1 ounce daily." Which household measurement will the nurse give the patient to measure the medication accurately?

1. One ounce is equal to two measuring-set tablespoons.

2. Two standard tableware tablespoons will equal one ounce.

3. Eight measuring-set teaspoons will equal one ounce.

4. One-sixteenth of a cup equals one ounce.

1.One ounce is equal to two measuring-set tablespoons.

Rationales

Option 1:

The patient needs to know that one ounce is equal to two measuring-set tablespoons.

The nurse needs to research a medication that is unfamiliar. A Physician's Desk Reference (PDR) and nursing drug handbook are both available in the nursing unit. Which is the advantage of using the nursing drug handbook?

1. Information about the chemical composition of the medication is included.

2. Medications are listed by brand or trade names for better recognition.

3. The information is more geared toward the nurse's need.

4. All medications are included to prevent the need to use additional resources.

3.The information is more geared toward the nurse's need.

Rationales

Option 3:

The advantage is that the nursing drug book specifically addresses information that is pertinent to the nurse. The reference may include patient teaching, side effects, and dietary information, among other things.

The nurse is planning to assist with tuberculosis testing at a community health fair. Which method of administration will the nurse use?

1. Intramuscularly

2. Intravenously

3. Parenterally

4. Topically

3. Parenterally

Rationales

Option 3:

Tuberculosis testing is performed by injecting the serum between the skin layers (intradermal), which is classified as a parenteral route.

The nurse is interviewing a young female patient who experiences periods of depression. The patient states, "I have been taking St. John's wort and I have been feeling less depressed. "Which question should the nurse ask the patient?

1."What method of birth control do you use?"

2."Have you noticed any recent weight changes?"

3."Are you noticing any changes in bowel habits?"

4."How many times a day do you need to urinate?"

1."What method of birth control do you use?"

Rationales

Option 1:

St. John's wort increases the breakdown of estrogen and decreases the effectiveness of oral contraceptives. The patient should be advised to use an additional method of birth control while taking the herbal supplement.

Question 10. The nurse is preparing to administer medication to an older adult patient. For which reason should the nurse check the patient for indications of toxicity?

1.An older adult may not be able to voice the effects of toxicity.

2.Older adults have a decrease in liver and kidney function.

3.It is difficult to distinguish the causes of toxicity in an older adult.

4.Older adults have a decreased ability to experience or describe pain.

2.Older adults have a decrease in liver and kidney function.

Rationales

Option 2:

Older adults have a decrease in liver and kidney function, which interferes with the clearance of medications. Toxicity results when the medication builds up in the body. The nurse should check the patient for physical changes, as well as lab results.

The nurse is to administer 250 mg of an antibiotic to a patient with an infection. The medication comes in 125 mg tablets. How many tablets will the nurse give the patient? Perform the calculations, rounding to the whole number if necessary.

2

The nurse receives a hand-written prescription order from a health-care provider. When reading the order, the nurse cannot verify the existence of a decimal point. The prescription may read "1.5 mg" or "15 mg." Which action does the nurse take?

1. Call the health-care provider for verification of the order.

2. Call the pharmacist for dosage parameters.

3. Look the drug up in a Physician's Desk Reference.

4. Look up recommended doses in a drug handbook.

1.Call the health-care provider for verification of the order.

Rationales

Option 1:

When there is a question about a prescribed drug, the nurse must always verify the order with the prescriber.

Question 13. The nurse in an acute care setting is finishing a shift. The nurse follows facility policy and performs a count of the drugs kept locked up. Which drug schedule medications are secured and counted?

1.Schedule I

2.Schedule II

3.Schedule III

4.Schedule IV

2. Schedule II

Rationales

Option 2:

Schedule II drugs have a high potential for abuse, but also have an accepted medical use. Examples include morphine, codeine, fentanyl, oxycodone, methadone, and meperidine. These are drugs kept locked up and counted at each shift.

The nurse reviews a medication order that designates the method of administration as an orally dissolving tablet (ODT). By which method will the nurse administer the drug?

1.Oral route

2.Sublingual route

3.Mucosal route

4.Buccal route

2.Sublingual route

Rationales

Option 2:

The sublingual route is taken by placing the medication underneath the tongue. ODT stands for "orally disintegrating tablet."

The nurse is aware of the high incidence of nurses who become dependent on drugs or alcohol. Which condition is the greatest contributor to drug abuse among nurses?

1. High-stress level jobs

2. Shift rotations

3. Easy access to drugs

4. Twelve-hour shifts

3.Easy access to drugs

Rationales

Option 3:

The greatest contributor to drug abuse by nurses is the easy access to the drugs. Nurses will frequently obtain drugs by diverting drugs ordered for patients to their own use.

The nurse is caring for a patient who is prescribed to receive 2 mg of medication per kilogram every 4 hours (q4h). The patient weighs 121 pounds. How many milligrams are in each dose? Perform the calculations, rounding to the whole number if necessary.

110

The nurse is to administer 15 mg/kg to a patient who weighs 132 pounds. The medication comes in 300 mg tablets. How many tablets will the nurse administer to the patient? Perform the calculations, rounding to the whole number if necessary.

3

The nurse in a health-care provider's office is interviewing a patient. The nurse is obtaining information about the patient's current medications. The nurse recognizes which primary reason for the health-care provider to carefully review the patient's medications?

1.To decide if generic drugs can be prescribed.

2.To decide if over-the-counter drugs can be used.

3.For the possibility of drug-drug interactions.

4.For the possibility of reducing medication costs.

3.For the possibility of drug-drug interactions.

Rationales

Option 3:

The primary reason the health-care provider will carefully review the patient's medications is to look for the possibility of drug-drug interactions.

The nurse is providing care for a patient who suddenly experiences chest pain. The health-care provider orders sublingual nitroglycerine STAT. When will the nurse give the medication?

1.Upon pharmacy delivery of the drug

2.Within 30 min of the order

3.Within 15 min of the order

4.As the patient needs the medication

3.Within 15 min of the order

Rationales

Option 3:

STAT orders are fulfilled within 15 min of receiving the order.

The nurse is working in the emergency department (ED). A patient is brought into the ED in a state of anaphylaxis. The nurse is aware that which symptoms distinguish anaphylaxis from an allergic reaction? Select all that apply.

1.Decreased blood pressure

2.Shortness of breath

3.Swelling of the airways

4.Circulatory collapse

5.Respiratory arrest

5.Respiratory arrest

Rationales

Option 5:

Anaphylaxis is a life-threatening condition. The patient is a risk for respiratory arrest due to the level swelling of the airways. Respiratory arrest is not a common allergy reaction.

The nurse is providing care for a patient who is prescribed an antibiotic. Which conditions cause the nurse to closely monitor the patient for adverse effects to the drug? Select all that apply.

1.The patient frequently has diarrhea with medications.

2.The patient has a history of diabetes mellitus.

3.The patient has experienced hives with medications.

4.The patient has compromised renal function.

5.The patient had a previous reaction to penicillin.

2.The patient has a history of diabetes mellitus.

3.The patient has experienced hives with medications.

4.The patient has compromised renal function.

5.The patient had a previous reaction to penicillin.

Rationales

Option 2:

Chronic diseases such as diabetes mellitus can place patients at greater risk for adverse effects due to the body's inability to metabolize and excrete the drugs. The nurse will monitor closely for adverse effects.

Option 3:

If a patient has experienced allergic reactions to medications, they are at greater risk for the same reaction with any new prescription. The nurse will monitor closely for adverse effects.

Option 4:

When the patient has compromised renal or liver function, there is a high risk for the inability to clear the drug, which can result in toxicity. The nurse will monitor closely for adverse effects.

Option 5:

Antibiotics, especially penicillin and sulfa drugs, will commonly cause an allergic reaction. However, having one reaction places the patient at risk with other antibiotics. The nurse will monitor closely for adverse effects.

The nurse is passing medications to patients on an in-patient unit. The nurse uses a medicine cart for the process. Which actions by the nurse assures safety during medication administration? Select all that apply.

1.The patient is asked to identify the drug and explain its use before it is administered.

2.All aspects of the medication order are checked when the drug is removed from the patient's bin.

3.The Medication Administration Record (MAR) is filled in with the patient's response to the medication.

4.The medication is checked against the information on the MAR pertaining to the drug.

5.Information about the patient and drug are checked at the bedside prior to opening the medication.

2.All aspects of the medication order are checked when the drug is removed from the patient's bin.

4.The medication is checked against the information on the MAR pertaining to the drug.

5.Information about the patient and drug are checked at the bedside prior to opening the medication.

Rationales

Option 2:

The nurse checks the date, time, amount, route, and reason for the medication when removing the drug from the patient\"s bin.

Option 4:

The MAR is another opportunity to check the medication, dose, and route before placing the medication in a medicine cup.

Option 5:

The nurse makes the final safety check at the patient's bedside by checking the identity of the patient and the medication one final time.

The nurse is passing medications to patients in an acute care setting. Which guidelines does the nurse follow during the process of administering medications? Select all that apply.

1.Perform calculations if doses ordered and medications are in a different unit of measure.

2.open the medications at the medication cart to decrease the risk of dropping.

3.Look up and read about unfamiliar medications.

4.Inquire if the patient needs the nurse to stay until the medications are swallowed.

5.Store prepared medications according to facility policy if the patient is unavailable.

1.Perform calculations if doses ordered and medications are in a different unit of measure.

3.Look up and read about unfamiliar medications.

5.Store prepared medications according to facility policy if the patient is unavailable.

Rationales

Option 1:

If the nurse receives medications that are in a different unit of measure than the ordered dose, calculations must be performed to ensure that the correct dose is given.

Option 3:

The nurse needs to look up and read about unfamiliar medications; it is important to understand all effects, and any nursing-specific interventions.

Option 5:

If the patient is unavailable to take the medications, the unopened medications are then stored according to facility policy.

The nurse is to administer 15 mg/kg to a patient who weighs 132 pounds. The medication comes in 300 mg tablets. How many tablets will the nurse administer to the patient? Perform the calculations, rounding to the whole number if necessary.

3

When a patient's body reacts to a medication as a foreign invader to be destroyed and simply causes a rash, a(n)______________________________________occurs.

1. mild allergic reaction

2. side effect

3. desired effect

4. anaphylactic reaction

1. mild allergic reaction

Rationales

Option 1:

Allergic reactions to medications occur when the patient's body sees the medication as a foreign invader that needs to be destroyed.

The nurse is preparing to review prescriptions for a patient that were ordered by the health-care provider. Which characteristic of the written prescription indicates a generic drug?

1.The name of the drug is not capitalized.

2.The prescription contains two capitalized names.

3.The drug name on the prescription reads like a chemical formula.

4.The prescription contains both the generic and trade names.

1.The name of the drug is not capitalized.

Rationales

Option 1:

Generic drugs are not capitalized; brand-, or trade names are capitalized.