Medication And I.V. Administration (Part 1)

A cardiologist orders digoxin (Lanoxin) 0.125 mg by mouth every morning for a client diagnosed with heart failure. The pharmacy dispenses tablets that contain 0.25 mg each. How many tablets should the nurse administer in each dose? Record your answer using one decimal place. Answer: ___ tablets

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet:

• A.

  On the top of the tongue.

• B.

  On the roof of the mouth.

• C.

  On the floor of the mouth.

• D.

  Inside the cheek.

A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

• A.

  Place the client in a supine position and prepare to perform cardiopulmonary resuscitation.

• B.

  Place the client in high-Fowler's position and administer supplemental oxygen.

• C.

  Turn the client on his left side and place the bed in Trendelenburg's position.

• D.

  Position the client in the shock position with his legs elevated.

After undergoing small-bowel resection, a client is ordered metronidazole (Flagyl) 500 mg I.V. The mixed I.V. solution contains 100 ml. The nurse is to run the drug over 30 minutes. The drip factor of the available I.V. tubing is 15 gtt/ml. What is the drip rate? Round your answer to the nearest whole number.Answer: ___ gtt/minute

A physician orders morphine, 3 mg I.V. every 2 hours as needed, to control a client's postoperative pain. The package insert reads: "Morphine, 4 mg/ml." How many milliliters of morphine should the client receive?

• A.

  0.25

• B.

  0.5

• C.

  0.6

• D.

  0.75

Before administering packed red blood cells, a nurse must flush a client's I.V. line. Which solution should the nurse use to flush the line?

• A.

  Normal saline solution

• B.

  Lactated Ringer's solution

• C.

  Dextrose 5% in water

• D.

  Dextrose 5% in normal saline solution

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream?

• A.

  Hypotonic

• B.

  Isotonic

• C.

  Sodium chloride

• D.

  Hypertonic

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength (Bactrim-DS)?

• A.

  Don't expect improvement of symptoms for 7 to 10 days.

• B.

  Drink 6 to 8 glasses of fluid daily while taking this medication.

• C.

  If your mouth or throat becomes sore, take the medication with milk or an antacid.

• D.

  To protect against drug-induced photosensitivity, use a sunscreen of at least SPF-15 with PABA.

While performing rounds, a nurse finds that a client is receiving the wrong I.V. solution. The nurse's initial response should be to:

• A.

  Remove the I.V. catheter and call the physician.

• B.

  Write up an incident report describing the mistake.

• C.

  Slow the I.V. flow rate and hang the appropriate solution.

• D.

  Wait until the next bottle is due and then change to the proper solution.

Which I.M. injection site is appropriate for a 6-month-old infant?

• A.

  Vastus lateralis muscle

• B.

  Ventrogluteal area

• C.

  Deltoid muscle

• D.

  Gluteus maximus muscle

When administering an I.M. injection, which action puts the nurse at risk for a needle-stick injury?

• A.

  Choosing safety needle devices for administering injections whenever possible and appropriate

• B.

  Planning safe handling and disposal of needles before initiating a procedure

• C.

  Disposing of needles, safety needle systems, and all sharps in sharps-disposal containers immediately after use

• D.

  Using the one-handed needle-recapping technique after administering all injections

After suffering an acute myocardial infarction (MI), a client with a history of type 1 diabetes is ordered metoprolol (Lopressor) I.V. Which nursing interventions are associated with I.V. metoprolol administration? Select all that apply.

• A.

  Monitor glucose level closely.

• B.

  Monitor the client for heart block and bradycardia.

• C.

  Monitor blood pressure closely.

• D.

  Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 minutes.

• E.

  Know that the drug isn't compatible with morphine.

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion?

• A.

  Monitoring the client for itching, swelling, or dyspnea

• B.

  Informing the client that the transfusion usually takes 1½ to 2 hours

• C.

  Documenting blood administration in the client care record

• D.

  Assessing the client's vital signs at the conclusion of the transfusion

Which class of medication protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

• A.

  Beta-adrenergic blockers

• B.

  Calcium channel blockers

• C.

  Calcium channel blockers

• D.

  Nitrates

An elderly client who experiences several adverse drug reactions may benefit from:

• A.

  Reduced drug dosages.

• B.

  Nursing home placement.

• C.

  Increased drug doses at longer intervals.

• D.

  Frequent visits to the physician.

A nurse is calculating the proper dosage of medication for a child. What parameter should influence this calculation?

• A.

  Age

• B.

  Body weight

• C.

  Developmental stage in relation to age

• D.

  Body surface area in relation to weight

A nurse is caring for a client who is taking an oral anticoagulant. The nurse should teach the client to:

• A.

  Report incidents of diarrhea.

• B.

  Avoid foods high in vitamin K.

• C.

  Use a straight razor when shaving.

• D.

  Take aspirin for pain relief.

A client is to receive a glycerin suppository. When administering the suppository, the nurse should insert it approximately how far into the client's rectum?

• A.

  1″ (2.5 cm)

• B.

  2″ (5 cm)

• C.

  3″ (7.5 cm)

• D.

  4″ (10 cm)

A nurse is delivering a client's 10 a.m. medications. The client is away from his room for a diagnostic study. Which action is most appropriate for the nurse to take?

• A.

  Leave the medications on the client's bedside table.

• B.

  Ask the client's roommate to keep the medications until the client returns.

• C.

  Lock the medications in the medicine cabinet until the client returns.

• D.

  Have the client skip that dose of medication.

After an instructor has posted assignments, a person claiming to be a nursing student arrives on a unit and asks a nurse for access to the medication records of a client to whom she's assigned. The student's only identification (ID) is a laboratory coat with the school's name on it. What is the nurse's most appropriate response?

• A.

  Allow the student access to the medication record because the instructor has posted an assignment sheet.

• B.

  Ask the student to provide a photo ID for comparison with the names on the assignment sheet.

• C.

  Ask the student to contact the instructor by phone to verify her identification.

• D.

  Allow the student supervised access to the client's medication record.

A nurse receives a medication order over the telephone. What is the best way for the nurse to handle this situation?

• A.

  Tell the physician that the nurse practice act prohibits taking medication orders over the telephone.

• B.

  Verify the order by repeating it to the physician over the phone.

• C.

  Request that a second physician repeat the order to the nurse over the telephone.

• D.

  Request that a second physician repeat the order to the nurse over the telephone.

A client admitted to the hospital with diabetic ketoacidosis is receiving a continuous infusion of regular insulin. The physician orders an I.V. containing 1 liter of dextrose 5% in water at 150 ml/hour to be started when the client's blood glucose level reaches 250 mg/dl. The drip factor of the I.V. tubing is 15 gtt/ml. What is the drip rate for this I.V. infusion in drops per minute? Record your answer using one decimal place. Answer: ___ gtt/minute

A client is in the bathroom when a nurse enters to give him a prescribed medication. What should the nurse do?

• A.

  Leave the medication at the client's bedside.

• B.

  Tell the client to be sure to take the medication; then leave it at the bedside.

• C.

  Return to the client's room a few minutes later and remain there until the client takes the medication.

• D.

  Wait for the client to return to bed; then leave the medication at the bedside.

What is the first action that a nurse should take after omitting an ordered medication?

• A.

  Notify the prescriber.

• B.

  Document the omission and the reason for it.

• C.

  Write an incident report.

• D.

  Give the client an extra dose of the medication at the next scheduled administration time.

A nurse must deliver 1,000 ml of normal saline solution over 8 hours. The I.V. tubing has a drop factor of 10 gtt/ml. The nurse should set the flow rate as:

• A.

  20.5 gtt/minute

• B.

  21 gtt/minute

• C.

  25 gtt/minute

• D.

  31 gtt/minute

Which human element should a nurse consider during assessment of home drug administration?

• A.

  The client's ability to recover

• B.

  The client's occupational hazards

• C.

  The client's socioeconomic status

• D.

  The client's cognitive abilities

A nurse is preparing to administer a sustained-release capsule to a client. Which is an appropriate nursing intervention?

• A.

  Administering the capsule whole with a glass of water

• B.

  Crushing the capsule and mixing the medication with applesauce

• C.

  Opening the capsule, shaking the contents into water, and administering it to the client

• D.

  Having the client chew the capsule before swallowing it

A nurse is teaching a client how to rotate insulin injection sites. What is the purpose of rotating injection sites?

• A.

  To prevent bruising

• B.

  To prevent medication leakage from tissue or muscle

• C.

  To prevent erratic drug distribution

• D.

  To prevent formation of hard nodules

What information must a medication order include?

• A.

  Drug class

• B.

  Possible adverse reactions

• C.

  Physician's signature

• D.

  Client allergies

A facility has a system for transcribing medication orders to a Kardex as well as a computerized medication administration record (MAR). A physician writes the following order for a client: "Prednisone 5 mg P.O. daily for 3 days." The order is correctly transcribed on the Kardex. However, the nurse who transcribes the order onto the MAR neglects to place the 3-day limitation on the record. On the fourth day after the physician wrote the order, a nurse administers prednisone 5 mg P.O. A nurse identifies the error during a chart audit. The person most responsible for the error is the:

• A.

  Nurse who incorrectly transcribed the order on the MAR.

• B.

  Nurse who administered the erroneous dose.

• C.

  Pharmacist who filled the order and provided the erroneous dose.

• D.

  Facility because of its policy on transcription of medications.

A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively?

• A.

  Elevating the hand and wrapping it in a warm towel

• B.

  Placing an ice pack on the hand

• C.

  Administering an as-needed analgesic

• D.

  Wrapping the arm in an elastic bandage from wrist to elbow

A client returns to his room from the postanesthesia care unit after undergoing right hemicolectomy. The physician orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drip factor of the available I.V. tubing is 15 gtt/ml. What's the drip rate in drops per minute? Round your answer to the nearest whole number. Answer: ___ gtt/minute

The nurse is to administer an I.M. injection into a client's left vastus lateralis muscle. How should the nurse position the client?

• A.

  Lying supine

• B.

  Lying on his stomach

• C.

  Lying on his left side

• D.

  Lying on his right side

A nurse prepares to administer a cleansing enema. What is the most common client position used for this procedure?

• A.

  Sims' left lateral

• B.

  Dorsal recumbent

• C.

  Supine

• D.

  Prone

After administering an I.M. injection, a nurse notices there isn't a sharps-disposal container nearby. Which action should the nurse take?

• A.

  Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle.

• B.

  With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest sharps-disposal container.

• C.

  With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest trash container.

• D.

  Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle. Carry the syringe to the closest sharps-disposal container.

A nurse prepares to administer medication by the buccal route. Where should the nurse place this medication?

• A.

  On the client's skin

• B.

  Between the client's cheek and gum

• C.

  Under the client's tongue

• D.

  In the client's conjunctival sac

While preparing to start a stat I.V. infusion, a nurse notices a broken ground on the infusion pump's plug. What should the nurse do first?

• A.

  Use the pump as is because the physician has ordered the medication stat.

• B.

  Obtain another pump from central supply to use for the infusion.

• C.

  Tape the broken ground to the plug and use the pump.

• D.

  Report the problem to the supervisor.

A client receiving morphine for long-term pain management develops tolerance. Tolerance is defined as:

• A.

  A heightened response to a medication.

• B.

  A diminished response to a drug so that more medication is required to achieve the same effect.

• C.

  An allergic reaction to a medication.

• D.

  An ability to take the same drug for extended periods.

For a hospitalized client, the physician orders morphine, 4 mg I.V., every 2 hours as needed for pain. However, the client refuses to take injections. Which nursing action is most appropriate?

• A.

  Administering the medication as ordered

• B.

  Calling the physician to request an oral pain medication

• C.

  Withholding the medication until the client understands its importance

• D.

  Explaining that no other medication can be given until the client receives the pain medication

Which type of medication order might read "Vitamin K 10 mg I.M. daily × 3 days?"

• A.

  One-time order

• B.

  Stat order

• C.

  Standing order

• D.

  As-needed order

A client begins taking haloperidol (Haldol). After a few days, he experiences severe tonic contractures of muscles in his neck, mouth, and tongue. The nurse should recognize this as:

• A.

  Psychotic symptoms.

• B.

  Parkinsonism.

• C.

  Akathisia.

• D.

  Dystonia.

A physician orders normal saline solution to infuse at a rate of 150 ml/hour for a client admitted with dehydration and pneumonia. How many liters of solution will the client receive during an 8-hour shift? Record your answer using one decimal place. Answer: ___ liters

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

• A.

  Discontinue the I.V. infusion at that site and restart it in the other arm.

• B.

  Irrigate the I.V. tubing with 1 ml of normal saline solution.

• C.

  Check the tubing for kinks and reposition the client's wrist and elbow.

• D.

  Elevate the I.V. fluid bag.

A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client?

• A.

  Heat the tablets until they liquefy; then pour the liquid down the NG tube.

• B.

  Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube.

• C.

  Cut the tablets in half and wash them down the NG tube, using a water-filled syringe.

• D.

  Crush the tablets and wash the powder down the NG tube, using a syringe filled with saline solution.

A physician orders an I.V. bolus injection of diltiazem hydrochloride (Cardizem) for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

• A.

  Gently aspirate the I.V. catheter to check for a blood return.

• B.

  Insert a second I.V. line into the opposite arm.

• C.

  Warm the I.V. medication to room temperature.

• D.

  Place a tourniquet on the arm in which she will administer the injection.

A client is being discharged after cataract surgery. After providing medication teaching, the nurse asks the client to repeat the instructions. This approach is an example of which professional role?

• A.

  Manager

• B.

  Educator

• C.

  Caregiver

• D.

  Client advocate

A nurse is to give a client an I.V. infusion of 3,000 ml of dextrose and normal saline solution over 24 hours. She observes that the infusion rate is 150 ml/hour. If the solution runs continuously at this rate, the infusion will be completed in:

• A.

  12 hours.

• B.

  20 hours.

• C.

  24 hours.

• D.

  50 hours.

A physician writes a medication order for meperidine (Demerol) 500 mg. The nurse's appropriate action would be to:

• A.

  Give the medication as ordered.

• B.

  Clarify the order with the pharmacy.

• C.

  Clarify the order with the physician.

• D.

  Clarify the order with another nurse on the unit.

A physician orders cefoxitin (Mefoxin), 1 g in 100 ml of 5% dextrose in water, to be administered I.V. A nurse determines that the recommended infusion time is 15 to 30 minutes. The available infusion set has a calibration of 10 drops/ml. To infuse cefoxitin over 30 minutes, which drip rate should the nurse use?

• A.

  10 drops/minute

• B.

  30 drops/minute

• C.

  33 drops/minute

• D.

  66 drops/minute

The physician orders milk of magnesia, 2 teaspoons by mouth as needed, for a constipated client. How many milliliters should the nurse administer to the client?

• A.

  2

• B.

  5

• C.

  10

• D.

  12