clinical book CH 20 Safe med prep Flashcards
An older adult is weak and malnourished. For what should the nurse be especially watching for after administering the pt’s usual meds?
- Signs & symptoms (s/sx) of drug toxicity.
- increased dependence on the medication.
- side effects of the medication.
- An allergic reaction
- Signs & symptoms (s/sx) of drug toxicity.
Rationale: Many medications bind to albumin (protein). If a pt is malnourished, the level of protein can be lowered; and toxicity can be a problem, espeically if the medication would normally bind to the protein. the pt should always be watched for other problems.
A nurse needs to draw a serum trough level of a medication. When should he or she obtain the blood sample?
- right before the next dose of the drug is due.
- midpoint between the times the drug doses are given.
- 2 hours after the medication is given.
- When the serum level is scheduled to plateau, usually early in the morning.
- right before the next dose of the drug is due
Rationale; The trough is drawn when the level of medication is th elowest, Which occurs right before the next dose is due.
A pt has has asked for pain medication to relieve the discomfort from her abdominal incision. she has experienced nausea since this after several bites of her soft-diet breakfast. She last received a dose of her ordered oral analgesic 4 hours ago. the medication, hydrocodone 10 mg PO, is ordered q4h prn. Which of the following rights of drug administration will most likely challenge the nurse caring for this pt?
- Right route
- Right pt
- Right dose
- Right time
- Right route
Rationale: the pt is nauseated; therefore it is important to judge which route is best for her because of the chance of vomiting the medication.
A medication order is for 0.5 g PO every 12 hours. The medication is available in 250-mg tablets How many tablets should the nurse administer?
- 1/2 tablet
- 1 tablet
- 1 1/2 tablets
- 2 tablets
- 2 tablets
Rationale: 0.5 g = 500 mg. If each tablet is 250 mg, two tablets are needed.
A pt has been having enemas until clear for an upcoming intestinal surgery. He is on several oral meds. What effect do enemas have on the absorption of medications?
- They increase the rate of excretion of the medications.
- the decrease the rate of excretion of the medications.
- They prolong the effects of the medication.
- it is unknown because the mechanism of medication excretion is not started.
4.it is unknown because the mechanism of medication excretion is not started.
Rationale: the nurse must know how the medication is metabolized and excreted (i.e., through the liver, kidneys, or intestines). Whichever system is effected can affect the manner and amount of the drug absorbed or excreted.
A nurse is administering multiple medications to multiple pt on a very busy unit. Which action by the nurse requires an intervention?
- the nurse performs dosage calculations and has them checked by another nurse needed.
- The nurse keeps unit-dose medications closed in their wrappers until arriving at the pt’s bedside.
- the nurse administers clear liquid medication containing sediment at the bottom of the bottle.
- the nurse checks medications at least 3 times before administering them to the pt.
- the nurse administers clear liquid medication containing sediment at the bottom of the bottle.
Rationale: If sediment is seen at the bottom of the container of a clear liquid medication, the medication should be discarded or sent back to the pharmacy with an explanation according to the institutional policy. The medication components may have gone through a change during transport or storage, or the medication may have expired.
the home health nurse notes that an elderly pt uses mouthwash 3 or 4 times every day and that he periodically swallows some of it. Which action is the most appropriate for the nurse to take?
- Tell the pt not to use the mouthwash as often
- Ask the pt if he smokes.
- obtain a dietary history from the pt from the pst 2 days.
- Check the pt’s medications and the mouthwash label.
- Check the pt’s medications and the mouthwash label.
Rationale: the nurse needs to check if the mouthwash contains anything that might interact with the pt’s medications for possible interactions. the pharmacist or health care provider could also be contacted. the nurse could also recommend switching to a safer mouthwash unless it is contraindicated. None of the other answers is a priority or relevant.
The nurse is reviewing the medication order sheet and finds an order for MSO4 8 mg IM q 3-4h prn. What is the appropriate initial nursing action?
- Contact the pharmacist to approve the order.
- Ask another nurse if she can give the medication.
- Contact the prescriber for clarification, including a “read-back”
- administer the medication order as ordered by the health care provider.
- Contact the prescriber for clarification, including a “read-back”
Rationale: the joint commission has prohibited the use of MSO4 as the abbreviation for morphine sulfate. the nurse needs to call the health care provider who prescribed the order for clarification and to read back the order to the health care provider. this would then be transcribed as a verbal order and noted per institutional policy.
The nurse administered lorazepam (Ativan), an anti-anxiety medication, to an 84 year old pt who is agitated and experiencing delirium.what are the nurse’s primary responsibilities?
- Administer naloxone (Narcan) and prepare to call a “code”
- assess the pt’s oxygen saturation and prepare to administer oxygen
- Monitor the pt and have another nurse call the prescriber
- Contact the nursing supervisor and the pharmacist
- Monitor the pt and have another nurse call the prescriber
Rationale: the pt needs to be assessed and not left alone since this response to the medication was unpredicted and the pt outcome is not known. the health care provider needs to be notified, and orders nay be given for medical interventions. this type of medication can cause difficulty in the elderly population. Naloxone is used for opioid toxicity and is not appropriate.
During the admission history the nurse determiners that his 80-year old pt is currently taking a salmon-colored blood pressure pill, a yellow “muscle relaxing” pill, a pink liquid to calm his stomach, and a green and yellow “joint” pill. Which action should the nurse take first?
- Ask the pt if he brought the medications with him
- Check the pt’s armband before administering any medications.
- Try to identify the medications by the pt’s descriptions
- Call the pharmacist to see if she can figure out what the medications are.
- Ask the pt if he brought the medications with him
rationale: the medications may be appropriate or inappropriate for this pt. the nurse is attempting to asses and obtain a medication history. Since the pt does not know the name of the medication, the nurse should check to see if the pt brought the medications with him. Identification of medications is done by the pharmacist, not the nurse. The older adult has alterations in the absorption, distribution, metabolism and excretion of medications and needs to be monitored. Option 2 has nothing to do with the question.
To reduce the risk of polypharmacy, how should the nurse advise the older patient regarding medications?
A) Never use over-the-counter (OTC) drugs or herbal supplements.
B) Use one pharmacy to coordinate all medications.
C) Allow a family member to coordinate all prescriptions.
D) Have the prescriber call in all prescriptions to the patient’s preferred pharmacy instead of providing written prescriptions to the patient.
B
Coordinating all medications through one pharmacy may decrease the risk of drug interactions and duplications. Over-the-counter medications and herbal medications may be acceptable as long as the patient checks with the prescriber or the pharmacist. Family members may not understand the issues around polypharmacy and may not necessarily coordinate prescriptions through one pharmacy; also, enlisting the help of a family member takes away patient autonomy. Asking prescribers to call in all prescriptions does not ensure that a single pharmacy will be used and takes away patient autonomy. (REF: p. 487)
The nurse contacts the prescriber and receives a STAT telephone order for a medication. What is the first thing the nurse should do after writing down the order?
A) Locate the prescriber and obtain a signature.
B) Prepare the medication for administration.
C) Contact the pharmacy to have the medication sent to the nursing unit STAT.
D) Read back the telephone order to the prescriber.
D
After receiving a verbal or telephone order, the first thing the nurse should do is read back the order to verify what was said. Once the order has been verified, the nurse would prepare the medication or would contact the pharmacy in the event that the medication is not readily available. The prescriber would be expected to counter-sign the order within 24 hours. (REF: p. 481)
The nurse is ready to administer a patient’s morning medication when the patient states, “Please leave the medication on my table. I will take it after I use the restroom.” Which is the most appropriate response from the nurse?
A) “I will bring the medication back to your room once you return from the bathroom.”
B) “It will take only a minute to swallow the medication before you go to the bathroom.”
C) “That’s fine, please take it the minute you get back from the restroom. I will be back to check on you.”
D) “I will wait until noon, when you have more medication ordered, and will bring it back to you then.”
A
The nurse should remain with the patient as the patient takes the medication. It is not acceptable to leave medication at the bedside unless a prescriber order to do so has been received. (REF: p. 488)
What is the goal of computerized physician order entry (CPOE)?
A) To increase the number of medication orders
B) To decrease the number of medication orders
C) To cause less inconvenience for prescribers
D) To prevent serious medication errors
D
CPOE systems may significantly reduce medication errors, by as much as 55% to 83%. The use of CPOEs does not increase or decrease the number of medication orders and was not instituted to cause less inconvenience for prescribers. (REF: p. 478)
In the event that a medication error occurs, the nurse should do the following first:
A) Contact the prescriber to inform him/her of the error.
B) Contact the manager or supervisor of the area where the error occurred.
C) Assess and examine the patient.
D) Complete the institution’s incident or occurrence report.
C
The nurse should always assess and examine the patient immediately after an error has occurred. Once the patient’s safety and well-being have been assessed, the nurse should contact the prescriber. Completing the occurrence or incident report and notifying the manager or supervisor would take place next. (REF: p. 489)
