Chapter 28 Medications

Question 1

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

Answer 1

Bolus administration

Explanation:
A bolus is a relatively large amount of medication given all at once; bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration. A continuous infusion, also called continuous drip, is instillation of a parenteral drug over several hours. It involves adding medication to a large volume of IV solution. After the medication is added, the solution is administered by gravity infusion or, more commonly, with an electronic infusion device such as a controller or pump.

Question 2

A nurse is administering a piggyback infusion to a client with partial-thickness or second-degree burns. Which describes the most important feature of a piggyback infusion?

Answer 2

A parenteral drug is given in tandem with IV solution.

Explanation:
In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency. IV medication or fluid is given all at one time as quickly as possible in a bolus administration, not in piggyback infusion. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution.

Reference:
Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 28: Medications, p. 785.

Question 3

When administering oral medications, which practices should the nurse follow? Select all that apply.

Answer 3

• Perform hand hygiene before and after medication administration.
• Stay at the bedside until the client has swallowed all the medications.
• Verify the client’s response to the medication 30 minutes after administration, or as appropriate for the drug.

Explanation:
When administering oral medications, it is important to perform hand hygiene before and after administration and to stay with the client until all medications have been swallowed. The nurse should also assess the effect of the medication at a reasonable time after administration. The MAR should be brought to the bedside to verify the client, but it is not left at the bedside. It would be inaccurate and unsafe to dispense multiple liquid medications into a single cup, as this may result in dosage errors.

Question 4

The nurse is preparing to insert an intravenous needle in a 1-year-old child for a one-time administration of fluids due to dehydration. Which needle would the nurse likely select?

Answer 4

A 23-gauge winged infusion set

Explanation:
Winged infusion or small vein needles may be used for short-term or one-time infusion therapies or may be used with infants and small children. These are short, beveled needles with plastic flaps or wings.

Question 5

The charge nurse on the medical/surgical unit is reviewing physician orders for a client with a diagnosis of congestive heart failure. Which infusion orders would the nurse question?

Answer 5

1000 D5W to run in 30 minutes

Explanation:
Medications administered by intermittent infusion are supplied either in bags that contain 50 to 250 mL of IV fluid (0.9 normal saline or 5% dextrose in water) or in 20- to 60-mL syringes to be used with an infusion pump.

Question 6

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

Answer 6

90 degrees

Explanation:
Insulin injections are given subcutaneously to clients with obesity at a 90 degree angle. Other answers are incorrect.

Question 7

The nurse is preparing to administer insulin to an older client who is frail and has failure to thrive. At what angle will the nurse plan to insert the needle into the client?

Answer 7

45 degrees

Explanation:
Insulin injections are given subcutaneously to clients who are very thin at a 45 degree angle. Other answers are incorrect.

Question 8

A code is called and Nurse A hands several drugs to Nurse B, stating while rushing off, “Give these to my client while I help with the code.” What is Nurse B’s appropriate response?

Answer 8

State, “I cannot give medications for other nurses.”

Explanation:
Nurses must never administer medications prepared by another nurse. Nurse B will professionally reply, “I cannot give medications for you.” Nurse B should not hold the medications, nor ask another nurse to give the medications.

Question 9

The nurse is preparing to administer an oral medication to a client with xerostomia. Which nursing action is appropriate?

Answer 9

Offer a sip of water before administering medication.

Explanation:
Xerostomia, a condition of dry mouth, affects some older adults and clients taking certain kinds of medications. To prevent oral medications from sticking to the tongue, administer with a sip of water prior to taking the drug, or mix with a soft food such as applesauce. Other answers are incorrect.

Question 10

The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangements does the nurse anticipate in the discharge plan of care?

Answer 10

home nursing visits

Explanation:
The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. Other answers are incorrect, as the client does not need assisted living, long-term care, or continued admission.

Question 11

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Answer 11

Avoid crushing sustained-release pellets.

Explanation:
When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication’s dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.

Question 12

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

Answer 12

medications that need to be infused over 20 to 60 minutes

Explanation:
Intermittent infusions are used for medications that need to be administered for an intermediate length of time, usually 20 to 60 minutes. The intravenous push technique is used for medications that can be given over 1 minute for rapid therapeutic effect, and may be given into a continuously infusing IV set or into a capped IV port. The continuous infusion technique is used for medications that are toxic if given over short periods.

Question 13

The nurse is administering blood to the client. During the infusion, the client reports a headache and feeling very tired. What will the nurse do first?

Answer 13

pause the infusion

Explanation:
If symptoms occur after the infusion of blood has started, stop the transfusion immediately and keep the IV open with normal saline. Vital signs can then be safely taken.

Question 14

A nurse is preparing to convert a client’s IV to an intermittent infusion device. The IV is connected to extension tubing. Before disconnecting the IV tubing from the extension tubing, the nurse clamps the extension tubing for which reason?

Answer 14

prevent air from entering the line

Explanation:
When converting to an intermittent infusion device, the nurse clamps the extension tubing to prevent air from entering the line. The primary IV tubing is clamped to prevent blood loss when the IV and tubing are disconnected. Flushing maintains IV line patency. Taping the adapter device and extension tubing secures the device in the proper position.

Question 15

The health care provider has given and signed an order for a specific client for zolpidem, 10 mg by mouth once daily at hour of sleep, and recorded the specific date and time of the order. What is the appropriate nursing action?

Answer 15

Administer the drug.

Explanation:
All seven components of the order are present; the nurse can safely administer the medication. The nurse does not co-sign the order, nor does the nurse need to call the healthcare provider for clarification or show the order to the nurse manager.

Question 16

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client?

Answer 16

Avoid administering medication prepared by another nurse.

Explanation:
A nurse should never administer medications prepared by another nurse. The nurse administers only those medications that she has prepared. The nurse should prepare and bring oral medications to the client’s bedside in a paper or plastic cup, not in a glass container or ceramic cup, in order to avoid accidents and spills. The nurse checks the label of the medication container three times when preparing it, not when administering it to the client.

Question 17

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler?

Answer 17

It is a canister that contains pressurized medication.

Explanation:
A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.

Question 18

A client is being started on total parenteral nutrition (TPN). When initiating the therapy, the nurse gradually tapers up the infusion rate as ordered to prevent which potential complication?

Answer 18

Hyperglycemia

Explanation:
Metabolic complications also may present a problem for the client receiving TPN. Most commonly, clients experience hyperglycemia if they are unable to tolerate the high glucose content of the TPN solution. When therapy is initiated, the infusion rate is usually tapered up over a period of a day or two. Using strict aseptic technique during catheter manipulations, dressing changes, and tubing and bottle changes helps to reduce the risk for infection. Air embolism and pneumothorax are potential complications that are associated with central line placement, not TPN administration.

Question 19

A nurse is preparing to administer several prescribed medications to a client. The medications ordered are to be given by the following routes: oral, subcutaneous, intramuscular and intravenous. Place the routes in the proper order from slowest to fastest absorption.

Answer 19

• Oral
• Subcutaneous
• Intramuscular
• Intravenous

Explanation:
Absorption is the process by which a medication enters the bloodstream. The route of administration affects how quickly and completely a medication is absorbed. Intravenous (IV) administration offers the quickest rate of absorption, followed in descending order by intramuscular (IM), subcutaneous, and oral (PO) routes.

Question 20

After inserting an intravenous catheter into a client’s vein, the nurse does not obtain blood return. What is the appropriate nursing action?

Answer 20

Change catheter insertion site.

Explanation:
If a blood return is not obtained, the IV catheter is not appropriately placed. The nurse will remove the IV catheter and change the site. Other actions are incorrect.

Question 21

A nurse is assessing the reading on a volume-control set when administering an IV drug to a client. Which of the following functions is performed by a volume-control set?

Answer 21

Eliminates the need for an additional bag of fluid

Explanation:
A volume-control set eliminates the need for additional fluid by substituting for the separate secondary container of solution. It is used to administer IV medication in a small volume of solution at intermittent intervals and to avoid accidentally overloading the circulatory system. A medication lock, not a volume-control set, allows instant access to the venous system. A volume-control set is a chamber in IV tubing that holds a portion of the solution from a larger container, not a smaller container.

Question 22

The nurse is caring for a client with visual impairment who has been prescribed two different types of eye drops. Which nursing intervention will best assist the client in differentiating between the bottles of drops?

Answer 22

Place a rubber band snugly around one of the bottles.

Explanation:
The client with visual impairment will best benefit from a tactile difference between bottles; therefore, placing a rubber band snugly around one bottle is the best approach. Writing names on the bottle may still be difficult to read due to the client’s visual impairment, and color-coding may not work if the client is color-blind. Placing bottles on different ends of the table can be confusing if the client forgets which medication is which.

Question 23

A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC). After 5 minutes of administration, the client reports itching and appears flushed. What is the most appropriate nursing intervention?

Answer 23

Clamp the PICC line.

Explanation:
The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life threatening reactions can also occur quickly. The first nursing action is to stop the infusion. Clamping the PICC line will stop the infusion. Slowing the rate is inappropriate, as this will not solve the problem if the client is having a reaction. Removing the PICC is unnecessary, and flushing the line may introduce more of the medication to the client.

Question 24

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

Answer 24

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

Explanation:
The cylinder of an insulin pen contains a prefilled reservoir of insulin, because insulin comes prepared. The dose of insulin in an insulin pen is displayed in a window of the syringe, making it easier for the client see the remaining dose. Insulin pens automatically reset the dose window to zero following the injection; this minimizes client error. The cylinder of the insulin pen is made out of hard plastic, not soft plastic, to allow the client to grasp it like a pen. Insulin pens are more expensive, not less expensive, than insulin vials.

Question 25

The nurse is caring for a client with endocarditis who will require 6 weeks of antibiotic therapy. The nurse should anticipate which type of access for this client?

Answer 25

-peripheral inserted central catheter (PICC) in the right axillary vein

Explanation:
The PICC line would be appropriate for clients who are to receive short term fluid or medication therapy. The other options would not be appropriate for this client.