Chapter 32: Medication Administration

Question 1

1. A nurse is teaching a patient about medications. Which statement from the patient indicates teaching is effective?
   a.
   “My parenteral medication must be taken with food.”
   b.
   “I will rotate the sites in my left leg when I give my insulin.”
   c.
   “Once I start feeling better, I will stop taking my antibiotic.”
   d.
   “If I am 30 minutes late taking my medication, I should skip that dose.”

Answer 1

ANS: B
For daily insulin, rotate site within anatomical area. Rotating injections within the same body part (instrasite rotation) provides greater consistency in absorption of medication. Parenteral medication absorption is not affected by the timing of meals. Taking a medication 30 minutes late is within the 60-minute window of the time medications should be taken. Medications are usually stopped based on the provider’s orders except in extenuating circumstances. With some medications, such as antibiotics, it is crucial that the full course of medication is taken to avoid relapse of infection.

Question 2

2. A nurse is preparing to administer an injection to a patient. Which statement made by the patient is an indication for the nurse to use the Z-track method?
   a.
   “I am allergic to many medications.”
   b.
   “I’m really afraid that a big needle will hurt.”
   c.
   “The last shot like that turned my skin colors.”
   d.
   “My legs are too obese for the needle to go through.”

Answer 2

ANS: C
The Z-track is indicated when the medication being administered has the potential to irritate sensitive tissues. It is recommended that, when administering IM injections, the Z-track method be used to minimize local skin irritation by sealing the medication in muscle tissue. The Z-track method is not meant to reduce discomfort from the procedure. If a patient is allergic to a medication, it should not be administered. If a patient has additional subcutaneous tissue to go through, a needle of a different size may be selected.

Question 3

3. A 2-year-old child is ordered to have eardrops daily. Which action will the nurse take?
   a.
   Pull the auricle down and back to straighten the ear canal.
   b.
   Pull the auricle upward and outward to straighten the ear canal.
   c.
   Sit the child up for 2 to 3 minutes after instilling drops in ear canal.
   d.
   Sit the child up to insert the cotton ball into the innermost ear canal.

Answer 3

ANS: A
Children up to 3 years of age should have the auricle pulled down and back, children 3 years of age to adults should have the auricle pulled upward and outward. Solution should be instilled 1 cm (1/2 in) above the opening of the ear canal. The patient should remain in the side-lying position 2 to 3 minutes. If a cotton ball is needed, place it into the outermost part of the ear canal.

Question 4

4. A patient has an order to receive 0.3 mL of U-500 insulin. Which syringe will the nurse obtain to administer the medication?
   a.
   3-mL syringe
   b.
   U-100 syringe
   c.
   Needleless syringe
   d.
   Tuberculin syringe

Answer 4

ANS: D
Because there is no syringe currently designed to prepare U-500 insulin, many medication errors result with this kind of insulin. To prevent errors, ensure that the order for U-500 specifies units and volume (e.g., 150 units, 0.3 mL of U-500 insulin), and use tuberculin syringes to draw up the doses. A 3 mL and U-100 can result in inaccurate dosing. A needleless syringe will not be acceptable in this situation.

Question 5

5. A patient has an order to receive 12.5 mg of hydrochlorothiazide. The nurse has on hand a 25 mg tablet of hydrochlorothiazide. How many tablet(s) will the nurse administer?
   a.
   1/2 tablet
   b.
   1 tablet
   c.
   1 1/2 tablets
   d.
   2 tablets

Answer 5

ANS: A
1/2 tablet will be given. The nurse is careful to perform nursing calculations to ensure proper medication administration. The dose ordered is 12.5. The dose on hand is 25. 12.5/25 = 1/2 tablet.

Question 6

6. The patient is to receive phenytoin (Dilantin) at 0900. When will be the ideal time for the nurse to schedule a trough level?
   a.
   0800
   b.
   0830
   c.
   0900
   d.
   0930

Answer 6

ANS: B
Trough levels are generally drawn 30 minutes before the drug is administered. If the medication is administered at 0900, the trough should be drawn at 0830.

Question 7

7. A patient is receiving vancomycin. Which function is the priority for the nurses to assess?
   a.
   Vision
   b.
   Hearing
   c.
   Heart tones
   d.
   Bowel sounds

Answer 7

ANS: B
A side effect of vancomycin is ototoxicity—hearing. It does not affect vision, heart tones, or bowel sounds.

Question 8

8. A health care provider orders lorazepam (Ativan) 1 mg orally 2 times a day. The dose available is 0.5 mg per tablet. How many tablet(s) will the nurse administer for each dose?
   a.1
   b.2
   c.3
   d.4

Answer 8

ANS: B
The nurse will give 2 tablets. It will take 2 tablets (0.5) to equal 1 mg OR ordered dose (1) over dose on hand (0.5). 1/0.5 = 2 tablets.

Question 9

9. The nurse is preparing to administer an injection into the deltoid muscle of an adult patient. Which needle size and length will the nurse choose?
   a.
   18 gauge × 1 1/2 inch
   b.
   23 gauge × 1/2 inch
   c.
   25 gauge × 1 inch
   d.
   27 gauge × 5/8 inch
   ANS: C
   For an intramuscular injection into an adult deltoid muscle, a 25-gauge, 1-inch needle is recommended. An 18-gauge needle is too big. While a 23-gauge needle can be used, a 1/2-inch needle is too small. A 27-gauge, 5/8 -inch needle is used for intradermal.

Answer 9

ANS: C
For an intramuscular injection into an adult deltoid muscle, a 25-gauge, 1-inch needle is recommended. An 18-gauge needle is too big. While a 23-gauge needle can be used, a 1/2-inch needle is too small. A 27-gauge, 5/8 -inch needle is used for intradermal.

Question 10

10. When the nurse administers an IM corticosteroid injection, the nurse aspirates. What is the rationale for the nurse aspirating?
    a.
    Prevent the patient from choking.
    b.
    Increase the force of the injection.
    c.
    Ensure proper placement of the needle.
    d.
    Reduce the discomfort of the injection.

Answer 10

ANS: C
The purpose of aspiration is to ensure that the needle is in the muscle and not in the vascular system. Blood return upon aspiration indicates improper placement, and the injection should not be given. While a patient can aspirate fluid and food into the lungs, this is not related to the reason for why a nurse pulls back the syringe plunger after inserting the needle (aspirates) before injecting the medication. Reducing discomfort and prolonging absorption time are not reasons for aspirating medications.

Question 11

11. The nurse is giving an IM injection. Upon aspiration, the nurse notices blood return in the syringe. What should the nurse do?
    a.
    Administer the injection at a slower rate.
    b.
    Withdraw the needle and prepare the injection again.
    c.
    Pull the needle back slightly and inject the medication.
    d.
    Give the injection and hold pressure over the site for 3 minutes.

Answer 11

ANS: B
Blood return upon aspiration indicates improper placement, and the injection should not be given. Instead withdraw the needle, dispose of the syringe and needle properly, and prepare the medication again. Administering the medication into a blood vessel could have dangerous adverse effects, and the medication will be absorbed faster than intended owing to increased blood flow. Holding pressure is not an appropriate intervention. Pulling back the needle slightly does not guarantee proper placement of the needle and medication administration.

Question 12

12. The nurse is planning to administer a tuberculin test with a 27-gauge, -inch needle. At which angle will the nurse insert the needle?
    a.
    15 degree
    b.
    30 degree
    c.
    45 degree
    d.
    90 degree

Answer 12

ANS: A
A 27-gauge, -inch needle is used for intradermal injections such as a tuberculin test, which should be inserted at a 5- to 15-degree angle, just under the dermis of the skin. Placing the needle at 30 degrees, 45 degrees, or 90 degrees will place the medication too deep.

Question 13

13. The nurse closely monitors an older adult for signs of medication toxicity. Which physiological change is the reason for the nurse’s action?
    a.
    Reduced glomerular filtration
    b.
    Reduced esophageal stricture
    c.
    Increased gastric motility
    d.
    Increased liver mass

Answer 13

ANS: A
The reduced glomerular filtration rate delays excretion, increasing chance for toxicity. In older adults, gastric motility and liver mass decrease. Esophageal stricture is not a physiological change associated with normal aging.

Question 14

14. A registered nurse interprets that a scribbled medication order reads 25 mg. The nurse administers 25 mg of the medication to a patient and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who is ultimately responsible for the error?
    a.
    Health care provider
    b.
    Pharmacist
    c.
    Hospital
    d.
    Nurse

Answer 14

ANS: D
Ultimately, the person administering the medication is responsible for ensuring that it is correct. The nurse administered the medication, so in this case it is the nurse. Accept full accountability and responsibility for all actions surrounding the administration of medications. Do not assume that a medication that is ordered for a patient is the correct medication or the correct dose. This is the importance of verifying the six rights of medication administration. The ultimate responsibility and accountability are with the nurse, not the health care provider, pharmacist, or hospital.

Question 15

15. A patient is to receive a proton pump inhibitor through a nasogastric (NG) feeding tube. Which is the most important nursing action to ensure effective absorption?
    a.
    Thoroughly shake the medication before administering.
    b.
    Position patient in the supine position for 30 minutes to 1 hour.
    c.
    Hold feeding for at least 30 minutes after medication administration.
    d.
    Flush tube with 10 to 15 mL of water, after all medications are administered.

Answer 15

ANS: C
If a medication needs to be given on an empty stomach or is not compatible with the feeding (e.g., phenytoin, carbamazepine [Tegretol], warfarin [Coumadin], fluoroquinolones, proton pump inhibitors), hold the feeding for at least 30 minutes before or 30 minutes after medication administration. Thoroughly shaking the medication mixes the medication before administration but does not affect absorption. Flushing the tube after all medications should be 30 to 60 mL of water; 15 to 30 mL of water is used for flushing between medications. Patients with NG tubes should never be positioned supine but instead should be positioned at least to a 30-degree angle to prevent aspiration, provided no contraindication condition is known.

Question 16

16. A health care provider prescribes aspirin 650 mg every 4 hours PO when febrile. For which patient will this order be appropriate?
    a.
    7 year old with a bleeding disorder
    b.
    21 year old with a sprained ankle
    c.
    35 year old with a severe headache from hypertension
    d.
    62 year old with a high fever from an infection

Answer 16

ANS: D
Aspirin is an analgesic, an antipyretic, and an anti-inflammatory medication. The provider wrote the medication to be given for a fever (febrile). Fevers are common in infections. If a child is bleeding, aspirin would be contraindicated; aspirin increases the likelihood of bleeding. Although it can be used for inflammatory problems (sprained ankle) and pain/analgesia (severe headache), this is not how the order was written.

Question 17

17. A patient is in need of immediate pain relief for a severe headache. Which medication will the nurse administer to be absorbed the quickest?
    a.
    Acetaminophen 650 mg PO
    b.
    Hydromorphone 4 mg IV
    c.
    Ketorolac 8 mg IM
    d.
    Morphine 6 mg SQ

Answer 17

ANS: B
IV is the fastest route for absorption owing to the increase in blood flow. The richer the blood supply to the site of administration, the faster a medication is absorbed. Medications administered intravenously enter the bloodstream and act immediately, whereas those given in other routes take time to enter the bloodstream and have an effect. Oral, subcutaneous (SQ), and intramuscular (IM) are others ways to deliver medication but with less blood flow, slowing absorption.

Question 18

18. While preparing medications, the nurse knows one of the drug is an acidic medication. In which area does the nurse anticipate the drug will be absorbed?
    a.
    Stomach
    b.
    Mouth
    c.
    Small intestine
    d.
    Large intestine

Answer 18

ANS: A
Acidic medications pass through the gastric mucosa rapidly. Medications that are basic are not absorbed before reaching the small intestine.

Question 19

19. The nurse administers a central nervous system stimulant to a patient. Which assessment finding indicates to the nurse that an idiosyncratic event is occurring?
    a.
    Falls asleep during daily activities
    b.
    Presents with a pruritic rash
    c.
    Develops restlessness
    d.
    Experiences alertness

Answer 19

ANS: A
An idiosyncratic event is a reaction opposite to what the effects of the medication normally are, or the patient overreacts or underreacts to the medication. Falls asleep is an opposite effect of what a central nervous system stimulant should do. A stimulant should make a patient restless and alert. A pruritic (itch) rash could indicate an allergic reaction.

Question 20

20. An order is written for phenytoin 500 mg IM q3-4h prn for pain. The nurse recognizes that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes that the health care provider meant to write hydromorphone. What should the nurse do?
    a.
    Call the health care provider to clarify the order.
    b.
    Give the patient hydromorphone, as it was meant to be written.
    c.
    Administer the medication and monitor the patient frequently.
    d.
    Refuse to give the medication and notify the nurse supervisor.

Answer 20

ANS: A
If there is any question about a medication order because it is incomplete, illegible, vague, or not understood, contact the health care provider before administering the medication. The nurse cannot change the order without the prescriber’s consent; this is out of the nurse’s scope of practice. Ultimately, the nurse can be held responsible for administering an incorrect medication. If the prescriber is unwilling to change the order and does not justify the order in a reasonable and evidence-based manner, the nurse may refuse to give the medication and notify the supervisor.

Question 21

21. A patient needs assistance in eliminating an anesthetic gaseous medication (nitrous oxide). Which action will the nurse take?
    a.
    Encourage the patient to cough and deep-breathe.
    b.
    Suction the patient’s respiratory secretions.
    c.
    Suggest voiding every 2 hours.
    d.
    Increase fluid intake.

Answer 21

ANS: A
Gaseous and volatile medications are excreted through gas exchange (lungs). Deep breathing and coughing will assist in clearing the medication more quickly. It is a gaseous medication and cannot be suctioned out of the lungs. It is not excreted through the kidneys so fluids and voiding will not help.

Question 22

22. A nurse has withdrawn a narcotic from the medication dispenser and must waste a portion of the medication. What should the nurse do?
    a.
    Have another nurse witness the wasted medication.
    b.
    Return the wasted medication to the medication dispenser.
    c.
    Place the wasted portion of the medication in the sharps container.
    d.
    Exit the medication room to call the health care provider to request an order that matches the dosages.

Answer 22

ANS: A
The nurse should follow Nurse Practice Acts and safe narcotic administration guidelines by having a nurse witness the “wasted” medication. The nurse cannot return the wasted medication to the medication dispenser. Wasted portions of medications are not placed in sharps containers. The nurse should not leave the narcotic unattended and call the health care provider to obtain matching dosages; the nurse is expected to obtain the correct dose.

Question 23

23. A nurse teaches the patient about the prescribed buccal medication. Which statement by the patient indicates teaching by the nurse is successful?
    a.
    “I should let the medication dissolve completely.”
    b.
    “I will place the medication in the same location.”
    c.
    “I can only drink water, not juice, with this medication.”
    d.
    “I better chew my medication first for faster distribution.”

Answer 23

ANS: A
Buccal medications should be placed in the side of the cheek and allowed to dissolve completely. Buccal medications act with the patient’s saliva and mucosa. The patient should not chew or swallow the medication or take any liquids with it. The patient should rotate sides of the cheek to avoid irritating the mucosal lining.

Question 24

24. What is the nurse’s priority action to protect a patient from medication error?
    a.
    Reading medication labels at least 3 times before administering
    b.
    Administering as many of the medications as possible at one time
    c.
    Asking anxious family members to leave the room before giving a medication
    d.
    Checking the patient’s room number against the medication administration record

Answer 24

ANS: A
One step to take to prevent medication errors is to read labels at least 3 times before administering the medication. The nurse should address the family’s concerns about medications before administering them. Do not discount their anxieties. The medication administration record should be checked against the patient’s hospital identification band; a room number is not an acceptable identifier. Medications should be given when scheduled, and medications with special assessment indications should be separated. Giving medications at one time can cause the patient to aspirate.

Question 25

25. The nurse prepares a pain injection for a patient but had to check on another patient and asks a new nurse to give the medication. Which action by the new nurse is best?
    a. Do not give the medication.
    b. Administer the medication just this once.
    c. Give the medication for any pain score greater than 8.
    d. Avoid the issue and pretend to not hear the request.

Answer 25

ANS: A
Because the nurse who administers the medication is responsible for any errors related to it, nurses administer only the medications they prepare. You cannot delegate preparation of medication to another person and then administer the medication to the patient. The right medication cannot be verified by the new nurse; do not violate the six rights. Do not administer the medication even one time. Do not administer the medication regardless of the pain rating. Avoiding the issue is not appropriate or safe.

Question 26

26. A patient is at risk for aspiration. Which nursing action is most appropriate?
    a.
    Give the patient a straw to control the flow of liquids.
    b.
    Have the patient self-administer the medication.
    c.
    Thin out liquids so they are easier to swallow.
    d.
    Turn the head toward the stronger side.

Answer 26

ANS: B
Aspiration occurs when food, fluid, or medication intended for GI administration inadvertently enters the respiratory tract. To minimize aspiration risk, allow the patient, if capable, to self-administer medication. Patients should also hold their own cup to control how quickly they take in fluid. Some patients at risk for aspiration may require thickened liquids; thinning liquids does not decrease aspiration risk. Patients at risk for aspiration should not be given straws because use of a straw decreases the control the patient has over volume intake. Turning the head toward the weaker side helps the medication move down the stronger side of the esophagus.

Question 27

27. A patient refuses medication. Which is the nurse’s first action?
    a.
    Educate the patient about the importance of the medication.
    b.
    Discreetly hide the medication in the patient’s favorite gelatin.
    c.
    Agree with the patient’s decision and document it in the chart.
    d.
    Explore with the patient reasons for not wanting to take the medication.

Answer 27

ANS: D
The first response is to explore reasons the patient does not want the medication. After the assessment, the nurse can decide what to do next. Educating is important, but it is not the first action. Ultimately, the patient does have the right to refuse the medication; however, the nurse should first try to find out reasons for the refusal and provide education if needed based upon the assessment findings. Hiding medication and deceiving a patient into taking a medication is unethical and violates right to autonomy.

Question 28

28. A patient who is being discharged today is going home with an inhaler. The patient is to administer 2 puffs of the inhaler twice daily. The inhaler contains 200 puffs. When should the nurse appropriately advise the patient to refill the medication?
    a.
    6 weeks from the start of using the inhaler
    b.
    As soon as the patient leaves the hospital
    c.
    When the inhaler is half empty.
    d.
    50 days after discharge

Answer 28

ANS: A
Six weeks will be about the time the inhaler will need to be refilled. The inhaler should last the patient 50 days (2 puffs × 2/twice daily = 4; 200/4 = 50); the nurse should advise the patient to refill the prescription when there are 7 to 10 days of medication remaining. Refilling it as soon as the patient leaves the hospital or when the inhaler is half empty is too early. If the patient waits 50 days, the patient will run out of medication before it can be refilled.

Question 29

29. The supervising nurse is watching nurses prepare medications. Which action by one of the nurses will the supervising nurse stop immediately?
    a.
    Rolls insulin vial between hands
    b.
    Administers a dose of correction insulin
    c.
    Draws up glargine (Lantus) in a syringe by itself
    d.
    Prepares NPH insulin to be given intravenously (IV)

Answer 29

ANS: D
The only insulin that can be given IV is regular. NPH cannot be given IV and must be stopped. All the rest demonstrate correct practice. Insulin is supposed to be rolled, not shaken. Glargine is supposed to be given by itself; it cannot be mixed with another medication. Correction insulin, also known as sliding-scale insulin, provides a dose of insulin based on the patient’s blood glucose level. The term correction insulin is preferred because it indicates that small doses of rapid- or short-acting insulins are needed to correct a patient’s elevated blood sugar.

Question 30

30. Which patient does the nurse most closely monitor for an unintended synergistic effect?
    a.
    The 4 year old who has mistakenly taken a half bottle of vitamins
    b.
    The 35 year old who has ingested meth mixed with several household chemicals
    c.
    The 50 year old who is prescribed a second blood pressure medication
    d.
    The 72 year old who is seeing four different specialists

Answer 30

ANS: D
The 72 year old seeing four different providers is likely to experience polypharmacy. Polypharmacy places the patient at risk for unintended mixing of medications that potentiate each other. When two medications have a synergistic effect, their combined effect is greater than the effect of the medications when given separately. The child taking too much of a medication by mistake could experience overdose or toxicity. The 50 year old is prescribed two different blood pressure medications for their synergistic effect, but this is a desired, intended event. A patient taking meth and mixing chemicals can be toxic.

Question 31

31. Which patient using an inhaler would benefit most from using a spacer?
    a.
    A 15 year old with a repaired cleft palate who is alert
    b.
    A 25 year old with limited coordination of the extremities
    c.
    A 50 year old with hearing impairment who uses a hearing aid
    d.
    A 72 year old with left-sided hemiparesis using a dry powder inhaler

Answer 31

ANS: B
A spacer is indicated for a patient who has difficulty coordinating the steps, like patients with limited mobility/coordination. An alert adolescent with a repaired cleft palate would not need a spacer. Hearing impairment may make teaching the patient to use the inhaler difficult, but it does not indicate the need for a spacer. Although a patient with left-sided hemiparesis could have coordination problems, a patient using a dry powder inhaler does not require the use of spacers.

Question 32

32. The prescriber wrote for a 40-kg child to receive 25 mg of medication 4 times a day. The therapeutic range is 5 to 10 mg/kg/day. What is the nurse’s priority?
    a.
    Change the dose to one that is within range.
    b.
    Administer the medication because it is within the therapeutic range.
    c.
    Notify the health care provider that the prescribed dose is in the toxic range.
    d.
    Notify the health care provider that the prescribed dose is below the therapeutic range.

Answer 32

ANS: D
The dosage range is 200 to 400 mg a day (5 × 40 = 200 and 10 × 40 = 400). The prescribed dose is 100 mg/day (4 × 25 = 100), which is below therapeutic range. The nurse should notify the health care provider first and ask for clarification on the order. The dose is not above the therapeutic range and is not at a toxic level. The nurse should never alter an order without the prescriber’s approval and consent.

Question 33

33. The supervising nurse is observing several different nurses. Which action will cause the supervising nurse to intervene?
    a.
    A nurse administers a vaccine without aspirating.
    b.
    A nurse gives an IV medication through a 22-gauge IV needle without blood return.
    c.
    A nurse draws up the NPH insulin first when mixing a short-acting and intermediate-acting insulin.
    d.
    A nurse calls the health care provider for a patient with nasogastric suction and orders for oral meds.

Answer 33

ANS: C
The supervising nurse must intervene with the nurse who is drawing up the NPH insulin first; if regular and intermediate-acting (NPH) insulin is ordered, prepare the regular insulin first to prevent the regular insulin from becoming contaminated with the intermediate-acting insulin. All the other actions are appropriate and do not need follow-up. The CDC no longer recommends aspiration when administering immunizations to reduce discomfort. In some cases, especially with a smaller gauge (22) IV needle, blood return is not aspirated, even if the IV is patent. If the IV site shows no signs of infiltration and IV fluid is infusing without difficulty, proceed with IV push slowly. Oral meds are contraindicated in patients with nasogastric suction.

Question 34

34. A nurse is caring for a patient who is receiving pain medication through a saline lock. After obtaining a good blood return when the nurse is flushing the patient’s peripheral IV, the patient reports pain. Upon assessment, the nurse notices a red streak that is warm and tender to the touch. What is the nurse’s initial action?
    a.
    Do not administer the pain medication.
    b.
    Administer the pain medication slowly.
    c.
    Apply a warm compress to the site.
    d.
    Apply a cool compress to the site.

Answer 34

ANS: A
The patient has phlebitis; the initial nursing action is do not administer the medication. The medication should not be given slowly. A cool or warm compress may be used later depending upon protocol, but it is not the first action.

Question 35

35. The nurse is preparing to administer medications to two patients with the same last name. After the administration, the nurse realizes that did not check the identification of the patient before administering medication. Which action should the nurse complete first?
    a.
    Return to the room to check and assess the patient.
    b.
    Administer the antidote to the patient immediately.
    c.
    Alert the charge nurse that a medication error has occurred.
    d.
    Complete proper documentation of the medication error in the patient’s chart.

Answer 35

ANS: A
When an error occurs, the patient’s safety and well-being are the top priorities. You first assess and examine the patient’s condition and notify the health care provider of the incident as soon as possible. The nurse’s first priority is to establish the safety of the patient by assessing the patient. Second, notify the charge nurse and the health care provider. Administer antidote if required. Finally, the nurse needs to complete proper documentation.

Question 36

36. The nurse is caring for two patients with the same last name. In this situation which right of medication administration is the priority to reduce the chance of an error?
    a.
    Right medication
    b.
    Right patient
    c.
    Right dose
    d.
    Right route

Answer 36

ANS: B
The nurse should ask the patient to verify identity and should check the patient’s ID bracelet against the medication record to ensure right patient. Acceptable patient identifiers include the patient’s name, an identification number assigned by a health care facility, or a telephone number. Do not use the patient’s room number as an identifier. To identify a patient correctly in an acute care setting, compare the patient identifiers on the MAR with the patient’s identification bracelet while at the patient’s bedside. Right medication, right dose, and right route are equally as important, but in this situation, right patient is the priority (two patients with the same last name).

Question 37

37. A patient prefers not to take the daily allergy pill this morning because it causes drowsiness throughout the day. Which response by the nurse is best?
    a.
    “The physician ordered it; therefore, you must take your medication every morning at the same time whether you’re drowsy or not.”
    b.
    “Let’s see if we can change the time you take your pill to 9 PM, so the drowsiness occurs when you would normally be sleeping.”
    c.
    “You can skip this medication on days when you need to be awake and alert.”
    d.
    “Try to get as much done as you can before you take your pill, so you can sleep in the afternoon.”

Answer 37

ANS: B
The nurse should use knowledge about the medication to educate the patient about potential response to medications. Then the medication schedule can be altered based on that knowledge. It is the patient’s right to refuse medication; however, the nurse should educate the patient on the importance and effects of the medication. Asking a patient to fit a schedule around a medication is unreasonable and will decrease compliance. The nurse should be supportive and should offer solutions to manage medication effects.

Question 38

38. A nurse is preparing to administer a medication from a vial. In which order will the nurse perform the steps, starting with the first step?
39. Invert the vial.
40. Fill the syringe with medication.
41. Inject air into the airspace of the vial.
42. Clean with alcohol swab and allow to dry.
43. Pull back on the plunger the amount to be drawn up.
44. Tap the side of the syringe barrel to remove air bubbles.
    a.
    4, 1, 5, 3, 6, 2
    b.
    1, 4, 5, 3, 2, 6
    c.
    4, 5, 3, 1, 2, 6
    d.
    1, 4, 5, 3, 6, 2

Answer 38

ANS: C
When preparing medication from a vial, the steps are as follows: Firmly and briskly wipe the surface of the rubber seal with an alcohol swab and allow to dry; pull back on the plunger to draw an amount of air into the syringe equal to the volume of medication to be aspirated from the vial; inject air into the airspace of the vial; invert the vial while keeping firm hold on the syringe and plunger; fill the syringe with medication; and tap the side of the syringe barrel carefully to dislodge any air bubbles.

Question 39

39. A nurse is attempting to administer an oral medication to a child, but the child refuses to take the medication. A parent is in the room. Which statement by the nurse to the parent is best?
    a.
    “Please hold your child’s arms down, so I can give the full dose.”
    b.
    “I will prepare the medication for you and observe if you would like to try to administer the medication.”
    c.
    “Let’s turn the lights off and give your child a moment to fall asleep before administering the medication.”
    d.
    “Since your child loves applesauce, let’s add the medication to it, so your child doesn’t resist.”

Answer 39

ANS: B
Children often have difficulties taking medication, but it can be less traumatic for the child if the parent administers the medication and the nurse supervises. Another nurse should help restrain a child if needed; the parent acts as a comforter, not a restrainer. Holding down the child is not the best option because it may further upset the child. Never administer an oral medication to a sleeping child. Don’t mix medications into the child’s favorite foods, because the child might start to refuse the food.

Question 40

40. An older-adult patient needs an IM injection of antibiotic. Which site is best for the nurse to use?
    a.
    Deltoid
    b.
    Dorsal gluteal
    c.
    Ventrogluteal
    d.
    Vastus lateralis

Answer 40

ANS: C
The ventrogluteal site is the preferred and safest site for all adults, children, and infants. While the vastus lateralis is a large muscle that could be used it is not the preferred and safest. The dorsal gluteal site is a location for a subcutaneous injection, and this patient requires an IM injection. The deltoid is easily accessible, but this muscle is not well developed and is not the preferred site.

Question 41

41. A nurse is preparing an intravenous IV piggyback infusion. In which order will the nurse perform the steps, starting with the first one?
42. Compare the label of the medication with the medication administration record at the patient’s bedside.
43. Connect the tubing of the piggyback infusion to the appropriate connector on the upper Y-port.
44. Hang the piggyback medication bag above the level of the primary fluid bag.
45. Clean the main IV line port with an antiseptic swab.
46. Connect the infusion tubing to the medication bag.
47. Regulate flow.
    a.
    5, 2, 1, 4, 3, 6
    b.
    5, 2, 1, 3, 4, 6
    c.
    1, 5, 4, 3, 2, 6
    d.
    1, 5, 3, 4, 2, 6

Answer 41

ANS: D
When preparing and administering IV piggybacks, use the following steps: Compare the label of medication with the medication administration record at the patient’s bedside; connect the infusion tubing to the medication bag; hang the piggyback medication bag above the level of the primary fluid bag; clean the main IV line port with an antiseptic swab; connect the tubing of the piggyback infusion to the appropriate connector on the upper Y-port; and regulate flow.

Question 42

42. A nurse is administering oral medications to patients. Which action will the nurse take?
    a.
    Remove the medication from the wrapper, and place it in a cup labeled with the patient’s information.
    b.
    Place all of the patient’s medications in the same cup, except medications with assessments.
    c.
    Crush enteric-coated medication, and place it in a medication cup with water.
    d.
    Measure liquid medication by bringing liquid medication cup to eye level.

Answer 42

ANS: B
Placing medications that require preadministration assessment in a separate cup serves as a reminder to check before the medication is given, making it easier for the nurse to withhold medication if necessary. Medications should not be removed from their package until they are in the patient’s room because this makes identification of the pill easier and reduces contamination. When measuring a liquid, the nurse should use the meniscus level to measure; make sure it is at eye level on a hard surface like a countertop. Enteric coated medications should not be crushed.

Question 43

43. A nurse is performing the three accuracy checks before administering an oral liquid medication to a patient. When will the nurse perform the second accuracy check?
    a.
    At the patient’s bedside
    b.
    Before going to the patient’s room
    c.
    When checking the medication order
    d.
    When selecting medication from the unit-dose drawer

Answer 43

ANS: B
Before going to the patient’s room, compare the patient’s name and name of medication on the label of prepared drugs with MAR for the second accuracy check. Selecting the correct medication from the stock supply, unit-dose drawer, or automated dispensing system (ADS) is the first check. The third accuracy check is comparing names of medications on labels with MAR at the patient’s bedside. Checking the orders is not one of the three accuracy checks but should be done if there is any confusion about an order.

Question 44

44. A nurse is preparing to administer an antibiotic medication at 1000 to a patient but gets busy in another room. When should the nurse give the antibiotic medication?
    a.
    By 1030
    b.
    By 1100
    c.
    By 1130
    d.
    By 1200

Answer 44

ANS: A
Give time-critical scheduled medications (e.g., antibiotics, anticoagulants, insulin, anticonvulsants, and immunosuppressive agents) at the exact time ordered (within 30 minutes before or after scheduled dose). Give non–time critical scheduled medications within a range of either 1 or 2 hours of scheduled dose. 1100, 1130, and 1200 are too late.

Question 45

45. The nurse is administering medications to several patients. Which action should the nurse take?
    a.
    Advise a patient after a corticosteroid inhaler treatment to rinse mouth with water.
    b.
    Administer an intravenous medication through tubing that is infusing blood.
    c.
    Pinch up the deltoid muscle of an adult patient receiving a vaccination.
    d.
    Aspirate before administering a subcutaneous injection in the abdomen.

Answer 45

ANS: A
If the patient uses a corticosteroid, have him or her rinse the mouth out with water or salt water or brush teeth after inhalation to reduce risk of fungal infection. Piercing a blood vessel during a subcutaneous injection is very rare. Therefore, aspiration is not necessary when administering subcutaneous injections. When giving immunizations to adults: to avoid injection into subcutaneous tissue, spread the skin of the selected vaccine administration site taut between the thumb and forefinger, isolating the muscle. Never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions.

Question 46

1. A nurse is following safety principles to reduce the risk of needlestick injury. Which actions will the nurse take? (Select all that apply.)
   a.
   Recap the needle after giving an injection.
   b.
   Remove needle and dispose in sharps box.
   c.
   Never force needles into the sharps disposal.
   d.
   Use clearly marked sharps disposal containers.
   e.
   Use needleless devices whenever possible.

Answer 46

ANS: C, D, E
Needles should not be forced into the box. Clearly mark receptacles to warn of danger. Using needleless systems when possible will further reduce the risk of needlestick injury. To prevent the risk of needlesticks, the nurse should never recap needles. The syringe and sheath are disposed of together in a receptacle.

Question 47

2. Which methods will the nurse use to administer an intravenous (IV) medication that is incompatible with the patient’s IV fluid? (Select all that apply.)
   a.
   Start another IV site.
   b.
   Administer slowly with the IV fluid.
   c.
   Do not give the medication and chart.
   d.
   Flush with 10 mL of sterile water before and after administration.
   e.
   Flush with 10 mL of normal saline before and after administration.

Answer 47

ANS: A, D, E
When IV medication is incompatible with IV fluids, stop the IV fluids, clamp the IV line above the injection site, flush with 10 mL of normal saline or sterile water, give the IV bolus over the appropriate amount of time, flush with another 10 mL of normal saline or sterile water at the same rate as the medication was administered, and restart the IV fluids at the prescribed rate. Do not administer the drug slowly with the IV; this is contraindicated when incompatibility exist. Not giving the medication and charting is inappropriate; this is not a prudent or safe action by the nurse.

Question 48

1. A patient is taking 1 tablet of hydrocodone bitartrate 5 mg and acetaminophen 500 mg (Vicodin) every 4 hours. The patient is also taking 2 tablets of acetaminophen (Tylenol) 325 mg every 12 hours. How many grams of acetaminophen is the patient taking daily? Record your answer using one decimal place. ______ g

Answer 48

ANS:
3.3
The nurse should calculate the dosage taken via the first medication and add it to the daily intake of the second medication. Then, convert milligrams to grams.
500 mg × 6 doses a day = 3000 mg/day + (2 tablets × 325 mg) × 2 doses a day = 1300 mg/day = 3300 mg/day total of acetaminophen; 3300 mg converted to grams = 3.3 grams.

Question 49

2. The nurse is administering 250 mg of a medication elixir to the patient. The medication comes in a dose of 1000 mg/5 mL. How many milliliters should the nurse administer? Record your answer using two decimal places. ____ mL

Answer 49

ANS:
1.25
The nurse needs to first determine how many milligrams are in each milliliter of the elixir. Then the nurse calculates how many milliliters would contain 250 mg.
1000 mg/5 mL = 200 mg/1 mL
250 mg/(X mL) = 200 mg/mL = 1.25 mL. OR Dose ordered over dose on hand (250/1000) × volume or amount on hand (5). 250/1000 = 0.25 × 5 = 1.25 mL.

Question 50

3. The patient is to receive amoxicillin 500 mg q8h; the medication is dispensed at 250 mg/5 mL. How many milliliters will the nurse administer for one dose? Record your answer using a whole number. ___ mL

Answer 50

ANS:
10
The drug is dispensed at 250 mg/5 mL. The nurse is to give 500 mg, which is 10 mL. OR Dose ordered over dose on hand (500/250) × volume or amount on hand (5). 500/250 × 5 = 10 mL