|The nurse practices the “10 rights” of drug administration to ensure which of the following?
1. correct mixing of the drug
2. safe drug administration
3. time-saving administration
4. gaining knowledge about the drug
||safe drug administration
The 10 rights ensure that the nurse has considered all of the details of safe medication administration.|
|“Give Tylenol 650 mg q3-4h as needed for headache” is an example of which of the following categories of drug orders?
PRN means as-needed|
|A nurse is administering a medication to a client. The nurse tells the client the rationale for the medication. This nurse is observing the client’s right to:
1. informed consent
To observe a client’s rights for informed consent, clients must be taught all aspects of drug therapy.|
|During administration of eye drops, the nurse should teach the client to prevent systemic absorption of the drug by doing which of the following?
||A : Gently press on the lacrimal duct.
By applying pressure on the inner canthus of the eye, the medication is less likely to be systemically absorbed.|
|A nurse is preparing to administer an IM injection to an 8-month-old infant. The primary intramuscular injection site for infants is the:
4. vastus lateralis
||A : vastus lateralis
The gluteal muscles should not be used until the child has been walking well for 1 year. The vastus lateralis is a large muscle that is accessible in infants.|
|A nurse administers an injection using the Z-track method. The nurse instructs the patient that the Z-track technique is designed to accomplish which of the following?
||A : Prevent medication from leaking into subcutaneous tissue
The Z-track method displaces the tissue during medication injection and replaces the tissue when withdrawn. This prevents leaking.|
|A nurse is applying nitroglycerin ointment to a client. When applying medication topically, the nurse should:
1. apply medication liberally
2. avoid contact of the medication with the nurse’s skin
3. massage the area
4. have client apply medication
||A : avoid contact of the medication with the nurse’s skin
Because this medication is topically absorbed, contact with the nurse’s skin may cause the nurse to feel the effects of the medication.|
|A nurse prepares to administer an ear medication to a 2-year-old child. The nurse correctly:
||A : pulls the ear downward and backward
This is the correct method for a child younger than 3. Older than 3 years, the ear is pulled up and back.|
|A nurse is ordered to administer a medication via the sublingual route. The nurse correctly places the medication:
1. in the buccal mucosa
2. under the tongue
3. between the teeth and gums
4. in a cup of water to dissolve
||A : under the tongue
Sublingual means under the tongue.|
|A client has been receiving pain medication secondary to surgery. Two weeks postoperatively, the client reports that “the medication doesn’t seem to work as well as it did.” The nurse should first assess for:
||A : tolerance to the medication
This is the definition of tolerance.|
|A client with chronic angina is ordered to receive nitroglycerin via a patch. Which of the following is true about the application of this transdermal medication? ||A : The old patch should be removed before applying the new patch.
This option is correct; the other options are not.|
|A nurse is administering an intradermal PPD to test for client exposure to the tuberculosis bacterium. Which of the following demonstrates the correct method to administer this injection? ||A : Use a 10-degree angle to insert a 25-gauge needle
This is the correct procedure for an intradermal injection.|
|A client returns to the nursing unit from conscious sedation after having a fracture set and placed in a cast. The client expresses pain 3 hours after the procedure. The choice of medication and route will be based on the following information: ||A : The client’s ability to swallow should be evaluated before receiving oral medication
Before providing oral medication, it is essential for the nurse to evaluate the client’s level of consciousness and ability to swallow.
|A nurse is preparing to administer a subcutaneous injection of morphine sulfate (MSO4) to a client. The client’s height, weight, and muscle mass are within normal limits. Which of the following describes the appropriate needle size and angle? ||A : 25-gauge needle, 45-degree angle
This is the correct angle and size for a subcutaneous injection.|
|A nurse is preparing to administer an ointment to the eye and is preparing the needed supplies. Select all of the following needed to complete this task: ||A :
clean gloves, medication ointment, sterile gauze, tissues
|The universally accepted, official name of a drug is known as the:
1. brand name
2. trade name
3. proprietary name
4. generic name
||A : generic name
This is the definition of generic.|
|The current authoritative source for drug standards in the United States, revised every 5 years by a group of professional medical experts, is the:
||United States Pharmacopeia
This is the function of the United States Pharmacopeia.|
|Each state has laws regarding drug administration by nurses, which is part of the:
1. National League for Nurses
2. American Nurses Association
3. nurse practice acts
4. drug standards
||A : nurse practice acts
Each state legislates the practice of nursing, including medication administration. These are the nurse practice acts.|
|A nurse is administering a controlled substance. The controlled substances are described in five categories (schedules). A substance that is medically accepted and has limited potential for dependence is schedule:
||A : V
This is the definition of schedule V medications.|
|A client has been prescribed an expensive drug. If available, what drug group may be suggested to decrease drug cost with the health care provider’s approval?
1. generic drug
2. trade drug
3. brand drug
4. chemical drug
||A : generic drug
Generic drugs are chemically similar to brand medications and are frequently cheaper. |
|A nurse is learning safe administration of controlled substances. Which of the following is not indicated as a nursing intervention regarding all controlled substances? ||A : Discard wasted controlled substance; countersigning is not necessary
All wasted controlled substances must be witnessed during the wasting process and countersigned in order to ensure proper control.|
|A nurse working in an obstetrics clinic is reviewing the pregnancy classification of drugs. The FDA developed a pregnancy classification regarding drug effects on a fetus. The two drug categories that are considered safe to use during pregnancy are: ||A : categories A and B
This is the definition of these categories; the others are not considered safe.|
|A nurse is soliciting a history from a woman of childbearing years and the client believes she may be pregnant. She is taking a medication that the nurse discovers is category X. The description for pregnancy category X is: ||A : a risk to the human fetus has been proven
his is the definition of category X.
This medication would be contraindicated.|
|A client refuses to take a medication. According to the Code of Ethics for nurses, the nurse’s actions that are warranted in this case include to: ||A : determine the client’s rationales for refusing the medication
The nurse has a responsibility to respect the rights of the client. By assessing the client’s reasons, the nurse upholds the client’s rights to autonomy.|
|A nurse working at a nursing home is administering medications. The nurse misreads the medication orders and administers a medication via the intravenous line, rather than via an IM injection. The client sustains permanent injuries and eventually dies. ||A : malfeasance
This is the definition of malfeasance or “doing harm.”|
|Which of the following is an example of primary prevention in avoiding ingestions and poisoning in children? ||A : providing billboards with poison control center phone numbers
Primary prevention is aimed at preventing a disease/injury through public awareness of all the population. Advertising via billboards is directed toward the entire population. |
|A nurse is counseling clients about drugs available on the Internet. Which of the following could indicate that a medication is counterfeit? ||A : There are variations in the drug’s appearance or packaging
Any variation in drugs or packaging may indicate inferior manufacturing or decreased controls. It also may indicate a counterfeit medication.|
|A nurse is preparing to administer a Schedule II medication to a client. Select all of the following that are part of this process: ||witnessing any wasted medication with another registered nurse, ensuring that two nurses check the dosage,
ensuring that two nurses sign the medication record,
assessing the client’s response to the medication
|Drug abuse can lead to drug addiction and psychologic dependence. With drug addiction, the client: ||A : has drug craving and does experience reactions when discontinuing drug
Addiction is characterized by compulsive uncontrolled craving for and dependence on a substance to such a degree that cessation causes severe mental, emotional, or physiologic.|
|A nurse working the evening shift notes that another nurse makes frequent errors in documentation, behaves inappropriately at work, appears unkempt, and demonstrates poor judgment in patient care situations. One night during the narcotics count.. ||A : notify the nursing supervisor
Professional nurses have a responsibility to the safety of the clients and themselves. It is appropriate to notify the nursing supervisor to deal with the situation in the correct manner.|
|A client has terminal cancer. She is taking large doses of opiates to control pain. The nurse should:
||A : allow the prescribed opiate dose unless drug toxicity occurs
Patients with terminal disease may require large doses of pain medication to manage their pain. The priority in this case is managing the pain, not the potential for addiction.|
|A client enters the emergency department complaining of acute lower right quadrant abdominal pain. It is determined that the client has appendicitis and is scheduled to go to the operating room immediately. The nurse notes on the database.. ||A : the client would require a greater level of anesthesia as a result of cross-tolerance
Because the client has not imbibed recently, the client would not have an elevated blood alcohol level.may be tolerant to the sedation effects of the anesthesia |
|A spouse of a client asks why her husband seems to drink more when he is depressed. The nurse responds: ||A : “Research indicates that alcohol elevates a person’s mood.”
Current research demonstrates that drinking and use of other recreational drugs increases dopamine at the synapses, leading to mood elevation and euphoria.|
|A client expresses the desire to quit smoking. He elects to use nicotine gum replacement therapy. Which of the following statements by the nurse is true regarding this smoking cessation technique? ||A : “You should not eat or drink during the chewing regimen.”
Option 1 is true. This is sold over-the-counter, does reduce the exposure to carcinogens, and decreases but does not eliminate cravings.|
|A client with a history of long-term alcohol abuse is diagnosed with Wernicke’s encephalopathy. The nurse would plan the client’s care with the knowledge that the client needs to be first treated with: ||A : intravenous thiamine to address deficiency
The client needs to receive thiamine first and then be started on glucose infusions. The other options are not indicated.|
|A client is admitted to a nursing unit in acute alcoholic withdrawal. Which of the following nursing diagnoses is a priority early in this admission? ||A : risk for injury related to disorientation and seizure activity
Risk for injury is the priority because of the safety needs of this client, which take precedence over the other problems|
|A nurse in the emergency department receive a call that a client is being transported to the hospital by paramedics. The client is a known heroin addict and is showing signs of potential overdose. The nurse would expect which of the following symptoms? ||A : clammy skin, constricted pupils, decreased level of consciousness
these are behaviors characteristic of heroin overdose. |
|A postoperative client received morphine in the recovery room. Upon assessment, the nurse notes that the client’s respiratory rate is 6 breaths/minute and that the client has a decreased level of consciousness. The anesth. orders narcan. ||A : opioid antagonist
Naloxone is a short-acting opioid antagonist given with suspected opioid overmedication.|
|A client with congestive heart failure receives digoxin to slow and strengthen ventricular contraction. He tells a nurse during his health history that he frequently uses cocaine to “deal with all the stress.” ||A : auscultation of heart rhythm and an ECG
Cocaine may cause ventricular dysrhythmias. Digoxin may accentuate these rhythm changes, which need to be monitored through auscultation and a rhythm strip.|
|Which of the following client statements demonstrates the greatest readiness for smoking or alcohol cessation? ||A : “I need help in dealing with my addiction to smoking/drinking.”
Option 3 indicates the greatest readiness. The other answers show a reluctance to recognize the problems imposed by the addiction
|The nurse is aware that some drugs of abuse may cause significant withdrawal effects. The nurse anticipates withdrawal syndrome with the following medications: (Select all that apply.) ||A : opioids
|Appropriate labeling on an herbal product may be which of the following?
1. “helps to increase blood flow to heart”
2. “cures multiple sclerosis”
3. “prevents heart disease”
4. “eliminates benign prostatic hypertrophy”
||A : “helps to increase blood flow to heart”
Labeling of herbal products may not include reference to disease cure not substantiated by clinical trials. Labels may disclose potential actions. This information may also be found in drug monographs.|
|Which of the following herbs is U.S. Food and Drug Administration (FDA) approved as a laxative?
||A : Aloe
Aloe is approved as a laxative.|
|Which of the following statements is true about saw palmetto?
1. It acts as an astringent.
2. It has antiandrogenic properties.
3. It is used as a flavoring agent.
4. It decreases cholesterol levels.
||A : It has antiandrogenic properties.
Saw palmetto is known for its antiandrogenic properties, used in treating benign prostatic hypertrophy and urinary conditions.|
|Isolating components of an herb leads to more reliable dosing and results in which of the following forms?
1. dried herb
||A : extract|
|A nurse is instructing a client about safe use of herbal supplements. The safest use with herbs is for which population?
2. pregnant or nursing women
3. older adults
4. healthy middle-aged adults
||A : healthy middle-aged adults
The other three groups are at increased risk.|
|Which of the following herbs may lower seizure threshold if taken with anticonvulsants?
1. evening primrose
2. milk thistle
3. saw palmetto
4. ginkgo biloba
||A : evening primrose|
|Which of the following herbs is known as the “liver tonic”?
1. milk thistle
3. St. John’s wort
4. saw palmetto
||A : milk thistle|
|The effects of St. John’s wort are expected to manifest in which time frame?
1. 2 to 3 days
2. 2 to 3 weeks
3. 1 to 2 months
4. 3 to 4 months
||A : 1 to 2 months.
To reach therapeutic levels, St. John’s wort must be taken for 1 to 2 months.
|A client enters the nurse practitioner’s office complaining of menstrual cramps and irregular menstrual cycles. The client states that she has been taking an herb that has been used to address these symptoms. The herb she is referring to is: ||A : dong quai
Dong quai is considered effective in relaxing uterine muscle tone.|
|Which of the following is frequently used to treat digestive disorders?
1. milk thistle
||A : peppermint
Peppermint is considered effective in calming abdominal and intestinal cramping.|
|A client is receiving chemotherapy to treat a solid organ tumor. The client admits to the nurse that he has been drinking Chinese teas to treat the disease. The appropriate response for the nurse to make is: ||A : “We need to make sure that your teas do not interact with the medications you are taking.”
Clients have the right to use complementary treatments. It is the responsibility of nurses to ensure that no unsafe interactions exist.
|Which of the following herbs are thought to decrease platelet aggregation? (Select all that apply.)
4. ginkgo biloba
||A : garlic, ginger, ginkgo biloba,
All of the herbals above except goldenseal and ginseng decrease platelet aggregation.
|Neonates and infants have a decreased metabolism and excretion of drugs because of immature:
1. lungs and kidneys
2. liver and kidneys
3. spleen and pancreas
4. gastrointestinal tract and kidneys
||A : liver and kidneys
The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants.|
|The gastric pH of children younger than 3 years is greater (more alkaline) than adults. Penicillin can be destroyed by gastric acidity. Compared to an adult, the penicillin dose for a child should be:
||A : decreased
Because the gastric pH is more alkaline, less penicillin would be destroyed. Therefore the dose should be decreased.|
|Because the gastric pH is more alkaline, less penicillin would be destroyed. Therefore the dose should be decreased. ||A : is decreased
With fewer binding sites, there is more active drug available. This requires a reduction in the dose.|
|Drug half-life for an older child can be shortened because of increased metabolic rate. The drug dose for older children may be: ||A : increased because of drug metabolism
With a shorter half-life, more of the drug is eliminated quickly. This requires a higher dose of the medication.|
|The nurse needs to understand the differences in drug excretion in children. The nurse bases decisions in medication administration on the knowledge that drug excretion in infants and children is usually: ||A : decreased
As a result of immature kidney function, drugs are eliminated more slowly, requiring vigilant monitoring for toxicity.|
|Client teaching to family members with children includes:
||A : instructing family members to use child-resistant medication containers
Child-proofing medications may decrease the risk for inadvertent ingestion.|
|Which of the following routes is the most exact and predictable route through which to administer medications to children?
||A : intravenous
The IV route allows for the greatest titration and bioavailability of the medication. The other routes are less exact.|
|A parent is learning to administer medication to a preschool-age child. Which of the following strategies would be most effective in achieving cooperation?
||A : providing age-appropriate explanations
Preschool-age children are beginning to understand more complex concepts. Physical restraint is needed more with infants and toddlers, violent reactions are characteristic of toddlers, and contracts |
|An 8-month-old child is discharged from the hospital with a plan of care to receive intramuscular (IM) injections each day. The parents have been taught to administer the injections. The nurse would reinforce using which of the following sites 8-month old ||A : deltoid
The leg is the optimal site for injection until children have been walking well for 1 year and the gluteal muscle is well developed.|
|An infant client is ordered to receive a topical silver nitrate ointment to prevent infection after sustaining burns. The nurse must be vigilant for signs of silver toxicity primarily because: ||A : infants have thinner skin, allowing for greater absorption
The thinner epidermis allows for greater absorption of topical medications, increasing the risk for toxicity.|
|A client is to be discharged to home on an oral liquid suspension in the amount of 4 ml per dose. Which of the following would ensure the highest level of accuracy in home administration of the medication? ||A : using an oral syringe
The oral syringe provides the greatest accuracy in measuring medications.
|A child is diagnosed with an ear infection. The physician orders an oral antibiotic. Which of the following is true of the calculation of this medication dose? ||A : The dose is calculated on body weight.
Pediatric medications should be calculated on body weight or body surface area. The other three options are not correct, and adult-based calculations are no longer recommended.|
|Which of the following vitamins is excreted in the urine if the intake exceeds the quantity needed by the human body?
1. vitamin A
2. vitamin D
3. vitamin C
4. vitamin E
||A : vitamin C
As a water-soluble vitamin, vitamin C is excreted in the urine and does not accumulate.|
|Which of the following vitamins can be toxic if taken in excess amounts over a period of time?
1. vitamins A and B
2. vitamins A and E
3. vitamins B and C
4. vitamins C and D
||A : vitamins A and E
As fat-soluble vitamins, vitamins A and E are not excreted and may accumulate, leading to toxic effects|
|A client reports taking megadoses of vitamin A. Symptoms of excess vitamin A intake, causing hypervitaminosis A, include: ||A : hair loss and peeling of skin
These are the major symptoms of hypervitaminosis A.
|Vitamins B1 and B6 are frequently used to correct symptoms of neuritis. The nurse should instruct the client to increase intake of which group of foods rich in vitamin B? ||A : whole-grain cereal and bread
These foods contain the B vitamins.|
|Folic acid (folate) is necessary for body growth. Folic acid deficiency during preconception and in the first trimester of pregnancy: ||A : may cause spinal cord dysfunctions
Preconceptual and prenatal folic acid deficiency has been associated with neural tube defects in the fetus|
|A client is taking large doses of vitamin C. She tells you she heard it prevents and cures colds and is wondering if this is true. You respond: ||A : “I have also heard that vitamin C will help prevent colds; however, so far it hasn’t been proven true.”|
|During pregnancy, an increase of iron is needed. Why are megadoses of iron contraindicated during the first trimester of pregnancy? ||A : 4. possible teratogenic effect on the fetus
Iron in large amounts is considered teratogenic.|
|Absorption of iron intake may be hampered by:
1. oral ascorbic acid and citrus fruits
2. antacids and food
3. other multivitamins concurrently ingested
4. iron intake 2 hours before mealtime
||A : antacids and food
Antacids and food decrease the ability for iron to be absorbed by the gastric lining. Ascorbic acid enhances absorption.|
|Iron toxicity is a serious cause of poisoning in children. Client teaching includes which of the following?
||A : Keep iron preparations out of reach of children.
Iron is a frequently ingested substance by children because of the pill’s candy-like appearance and the fact that many adults do not take the same precautions with vitamins as meds. |
|In the past few years, the use of zinc has greatly increased. A client is considering taking a zinc preparation. Based on current knowledge, which of the following statements made by the client indicates a need for more teaching? ||A : “Zinc may be taken with all drugs including antibiotics.”|
|In teaching a client about zinc, the nurse instructs that foods rich in zinc include:
1. meat and eggs
||A : meat and eggs
Zinc is concentrated in animal products.|
|A client is diagnosed with type 2 diabetes mellitus. The nurse counsels the client that the mineral that is helpful for controlling non–insulin-dependent diabetes mellitus is: ||A : chromium
Chromium is thought to assist in controlling blood sugar levels in clients with type 2 diabetes.|
|A mineral that is an antioxidant and is thought to reduce the risk of cancer is:
||A : selenium
Selenium is thought to have antioxidant qualities. Antioxidants are thought to decrease the risk for some types of cancer.|
|A client is ordered to take iron to treat iron deficiency anemia. Which of the following signs and symptoms would the nurse use to evaluate that this treatment was effective? ||a decrease in shortness of breath (SOB)|
|A nurse is counseling a client taking iron. Which of the following statements is true regarding increasing iron’s absorption in the body? ||A : “Take the iron with orange juice.”
Orange juice increases the absorption of iron in the stomach.|
|A client is asking a nurse about the need for vitamin therapy. The nurse directs the client that vitamin therapy is indicated for clients who: ||A : are on a restricted diet
Patients on a restricted diet often require vitamin therapy.|
|A client is taking large dose of multivitamins. The nurse teaches the client about the dangers of these because fat-soluble vitamins can be: ||A : toxic if taken in excess amounts over a period of time
Fat-soluble vitamins accumulate in the body and may accumulate over time.|
|The nurse should be aware of those vitamins that are fat soluble and those that are water soluble. Select all of the following vitamins that are fat soluble: ||A : Vitamin A
|A client’s serum osmolality is 270 mOsm/kg. His body fluid osmolality is:
||A : hypo-osmolar
Normal osmolality is 275 to 295 mOsm/kg. This client is therefore hypo-osmolar.|
|A client’s serum chemistry values are serum sodium level 142 mEq/L, blood urea nitrogen (BUN) 15 mg/dl, and glucose level 90 mg/dl. His body fluid osmolality is: ||A : iso-osmolar
To calculate osmolality, use the equation:
2(serum Na concentration) + BUN/3 + glucose level/18
2(142) + 15/3 + 90/18 = 294 mOsm/kg, or iso-osmolality
|A client’s serum chemistry measurements are serum sodium level 146 mEq/L, BUN 24 mg/dl, and glucose level 90 mg/dl. Her serum osmolality is: ||A : 305 mOsm/kg
To calculate osmolality, use the equation:
2(serum Na concentration) + BUN/3 + glucose level/18
2 (146) + 24/3 + 90/18 = 305 mOsm/kg
|A client received 3 L of D5W. With continuous use of 5% dextrose in water, the intravenous (IV) fluids become:
||A : hypotonic
D5W is isotonic, but when the dextrose is metabolized in the human body, it becomes hypotonic.
|A client is ordered to receive lactated Ringer’s solution. This is what type of IV solution?
4. blood product
||A : crystalloid|
|A client in severe shock is ordered to receive dextran as a volume expander. This type of fluid is known as a:
4. blood product
||A : Colloid|
|A nurse is calculating a client’s daily fluid needs. The client weighs 85 kg. The daily fluid requirement would be approximately:
1. 1700 ml
2. 2000 ml
3. 2550 ml
4. 3000 ml
||A : 2550 ml
fluids for adults may be calculated as 30 ml/kg/day: 30 85 = 2550 ml.|
|A client with a history of vomiting presents to the emergency department with a serum potassium level of 3 mEq/L. The client’s serum potassium level indicates:
1. normal serum potassium value
||A : hypokalemia
Normal serum K level is 3.5 to 5.3 mEq/L.