EOC Fund. Ch. 31 & Clinical Skills Ch 20 & 21

Question 1

The nurse is having difficulty reading a physician’s order for a medication. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take?

1. Call a pharmacist to interpret the order
2. Call the physician to have the order clarified
3. Consult the unit manager to help interpret the order
4. Ask the unit secretary to interpret the physician’s handwriting

Answer 1

2

Question 2

The patient has an order for 2 tablespoons of Milk of Magnesia. How much medication does the nurse give him or her?

1. 2 mL
2. 5 mL
3. 16 mL
4. 30 mL

Answer 2

4

Question 3

A nurse is administering ear drops to an 8 year old patient with an ear infection. How does the nurse pull the patient’s ear when administering the medication?

1. Outward
2. Back
3. Upward and back
4. Upward and outward

Answer 3

4

Question 4

A patient is to receive cephalexin (Keflex) 500 mg PO. The pharmacy has sent 250 mg tablets. How many tablets does the nurse administer?

1. 1/2 tablet
2. 1 tablet
3. 1 1/2 tablets
4. 2 tablets

Answer 4

4

Question 5

A nurse is administering medications to a 4 year old patient. After he or she explains which medications are being given, the mother states, “I don’t remember my child having that medication before.” What is the nurse’s next action?

1. Give the medications
2. Identify the patient using two patient identifiers
3. Withhold the medications and verify the medication orders
4. Provide medication education to the mother to help her better understand her child’s medications

Answer 5

3

Question 6

A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse?

1. Set up the follow-up appointments with the physician for the patient
2. Ensure that someone will provide housekeeping for the patient at home
3. Ensure that the home care agency is aware of medication and health teaching needs
4. Make sure that the patient’s family knows how to safely bathe him or her and provide mouth care

Answer 6

3

Question 7

A nursing student takes a patient’s antibiotic to his room. The patient asks the nursing student include when replying to the patient?

1. Only the patient’s physician can give this information
2. The student provides the name of the medication and a description of its desired effect
3. Information about medications is confidential and cannot be shared
4. He has to speak with his assigned nurse about this

Answer 7

2

Question 8

The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse’s next best course of action?

1. Ask the prescribe to change the order
2. Crush the pill with a mortar and pestle
3. Hide the capsule in a piece of solid food
4. Open the capsule and sprinkle it over pudding

Answer 8

1

Question 9

The nurse takes a medication to a patient, and the patient tells him or her to take it away because she is not going to take it. What is the nurse’s next action?

1. Ask the patient’s reason for refusal
2. Explain that she must take the medication
3. Take the medication away and chart the patient’s refusal
4. Tell the patient that her physician knows what is best for her

Answer 9

1

Question 10

The nurse receives an order to start giving a loop diuretic to a patient to help lower his or her blood pressure. The nurse determines the appropriate route for administering the diuretic according to:

1. Hospital policy
2. The prescriber’s orders
3. The type of medication order
4. The patient’s size and muscle mass

Answer 10

2

Question 11

A patient is receiving an intravenous push medication. If the drug infiltrates into the outer tissues, the nurse:

1. Continues to let the IV run
2. Applies a warm compress to the infiltrated site
3. Stops the administration of the medication and follows agency policy
4. Should not worry about this because vesicant filtration is not a problem.

Answer 11

3

Question 12

If a patient who is receiving intravenous fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects:

1. Sepsis
2. Phlebitis
3. Infiltration
4. Fluid overload

Answer 12

2

Question 13

After seeing a patient, the physician gives a nursing student a verbal order for a new medication. The nursing student first needs to:

1. Follow ISMP guidelines for safe medication abbreviations
2. Explain to the physician that the order needs to be given to a registered nurse
3. Write down the order on the patient’s order sheet and read it back to the physician
4. Ensure that the six rights of medication administration are followed when giving the medication

Answer 13

2

Question 14

A nurse accidentally gives a patient a medication at the wrong time. The nurse’s first priority is to:

1. Complete an occurence report
2. Notify the health care provider
3. Inform the charge nurse of the error
4. Assess the patient for adverse effects

Answer 14

4

Question 15

A patient is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 200 puffs. The patient takes 2 puffs every 4 hours. How many days will the pMDI last?
_____ days

Answer 15

16

Question 16

An older adult is weak and malnourished. For what should the nurse be especially watching for after administering the patient’s usual medications?

1. Signs and symptoms of drug toxicity
2. Increased dependence on the medication
3. Side effects of the medication
4. An allergic reaction

Answer 16

1. Many medications bind to albumin (protein). If a patient is malnourished, the level or protein can be lowered; and toxicity can be a problem, especially if the medication would normally bind to the protein. The patient should always be watched for the other problems.

Question 17

A nurse needs to draw a serum trough level of medication. When should he or she obtain the blood sample?

1. Right before the next dose of the drug is due
2. Midpoint between the times the drug doses are given
3. 2 hours after the medication is given
4. When the serum level is scheduled to plateau, usually early in the morning

Answer 17

1. The trough is drawn when the level of the medication is the lowest, which occurs right before the next dose is due.

Question 18

A patient has asked for a pain medication to relieve the discomfort from her abdominal incision. She has experienced nausea since this morning 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 patient?

1. Right route
2. Right patient
3. Right dose
4. Right time

Answer 18

1. The patient is nauseated; therefore it is important to judge which route is best for her because of the chance of vomiting the medication.

Question 19

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. 1/2 tablet
2. 1 tablet
3. 1 1/2 tablets
4. 2 tablets

Answer 19

4. 0.5g= 500mg. If each tablet is 250 mg, two tablets are needed.

Question 20

A patient has been having enemas until clear for an upcoming intestinal surgery. He is on several oral medications. What effect do enemas have on the absorption of medications?

1. They increase the rate of excretion of the medications
2. They decrease the rate of excretion of the medications
3. They prolong the effects of the medications
4. It is unknown because the mechanism of medication excretion is not stated

Answer 20

4. The nurse must know how the medication is metabolized and excreted (i.e. through the liver, kidneys, or intestines). Whichever system is affected can affect the manner and amount of drug absorbed or excreted.

Question 21

A nurse is administering multiple medications to multiple patients on a very busy unit. When action by the nurse requires an intervention?

1. The nurse performs dosage calculations and has them checked by another nurse as needed
2. The nurse keeps unit-dose medications closed in their wrappers until arriving at the patient’s bedside
3. The nurse administers clear liquid medication containing sediment at the bottom of the bottle
4. The nurse checks medications at least 3 times before administering them to the patient

Answer 21

3. 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 institutional policy. The medication components may have gone through a change during transport or storage, or the medication may have expired.

Question 22

The home health nurse notes that an elderly patient used mouthwash 3 or 4 times every day and that he periodically swallows some of it. Which action is most appropriate for the nurse to take?

1. Tell the patient not to use the mouthwash as often
2. Ask the patient if he smokes
3. Obtain a dietary history from the patient from the past 2 days
4. Check the patient’s medications and the mouthwash label

Answer 22

4. The nurse needs to check if the mouthwash contains anything that might interact with the patient’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.

Question 23

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?

1. Contact the pharmacist to approve the order
2. Ask another nurse if she can give the medication
3. Contact the prescriber for clarification, including a “read-back”
4. Administer the medication as ordered by the health care provider

Answer 23

3. The Joint Commision has prohibited the use of MSO4 as an 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.

Question 24

The nurse administered lorazepam (Ativan), an antianxiety medication, to an 84 year old patient who now is agitated and experiencing delirium. What are the nurse’s primary responsibilities?

1. Administer the naloxone (Narcan) and prepare to call a code
2. Assess the patient’s oxygen saturation and prepare to administer oxygen
3. Monitor the patient’s oxygen saturation and prepare to administer oxygen
4. Contact the nursing supervisor and the pharmacist

Answer 24

3. The patient needs to be assessed and not left alone since this response to the medication was unpredicted and the patient outcome is not known. The health care provider needs to be notified, and orders may be given for medical intervention. This type of medication can cause difficulty in the elderly population. Naloxone is used for opioid toxicity and is not appropriate.

Question 25

During the admission history the nurse determines that his 80 year old patient 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?

1. Ask the patient if he brought the medications with him
2. Check the patient’s armband before administering any medications
3. Try to identify the medications by the patient’s descriptions
4. Call the pharmacist to see if she can figure out what the medications are

Answer 25

1. These medications may be appropriate or inappropriate for this patient, but it won’t be known until they are identified. The nurse is attempting to assess and obtain a medication history. Since the patient doesn’t know the name of the medication, the nurse should check to see if the patient 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.