Exam 3 Flashcards
The nurse is preparing hydrochlorothiazide 50-mg tablet from unit stock. The health care provider orders 75 mg of hydrochlorothiazide PO for the client’s hypertension. How many tablets of hydrochlorothiazide will the nurse administer to the client?
1.5 tablets
The client is prescribed digoxin 0.125 mg PO every day. The nurse obtains the medication from unit stock and discovers that digoxin only comes in a 0.25-mg tablet. How many tablets of digoxin should the nurse administer to the client?
0.5 tablet
The nurse has administered a client’s medication. Which action would be most appropriate if the client vomits immediately, or soon after administration?
Check the vomit/emesis for pills or pill fragments and call the client’s health care provider.
The nurse prepares the client’s nightly medication doses and needs to administer an as needed dose of a hypnotic medication for sleep. The sleep medication is in a unit-dose package. What action does the nurse take?
Open the package after the client confirms the dose is wanted.
The nurse is preparing to administer a sublingual medication. Which instruction to the client is correct?
“Try not to swallow while the pill dissolves.”
The nurse is preparing a liquid medication for a client. The health care provider prescribes cimetidine hydrochloride 600 mg PO for gastrointestinal bleeding. The pharmacy sends cimetidine hydrochloride 300 mg/5 mL. How many teaspoons should the nurse administer?
2 teaspoons
The nurse is administering routine medications to a postsurgical client and the client asks, “Could I have something for pain?” The nurse checks the medication administration record (MAR) and notes that the medication is an opioid. What should the nurse do?
Place the opioid into a separate cup.
Which route of medication administration is most commonly prescribed?
Oral
A nurse is preparing several oral medications for administration. One of the medications requires the nurse to obtain the client’s apical pulse before administering it. Which action would be most appropriate?
Placing the medication requiring the assessment in a separate medication cup.
The nurse administers the client’s scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider’s parameters. What does the nurse do with this scheduled unit-dose packaged antihypertensive medication?
Set the antihypertensive dose aside pending assessment.
The nurse opens the multidose container of oxycodone. The nurse needs 1.5 tablets to deliver the as needed dose, and the tablets in the container are not scored. What action by the nurse is best?
Call the pharmacy to request a supply change.
When administering medications to a client, what information should the nurse know about the medication?
Adverse effects, purpose, safe dose range, action
A nurse is measuring a liquid medication in a graduated liquid medication cup. The nurse determines the correct amount by reading:
The bottom of the meniscus.
The nurse is preparing to administer a transdermal medication. Which placement is appropriate?
A. Inner aspect of the forearm.
B. Posteriorly on the shoulder.
C. Site of the client’s discomfort.
D. Anteriorly over the sternum.
B. Posteriorly on the shoulder.
The nurse teaches the client about home use of a transdermal medication patch for pain. The nurse evaluates the teaching as effective when the client makes which statement?
A. I should place this patch over my back where the pain is worst.”
B. “If the dose feels too high, I can cut the next patch in half to use.”
C. “The patch is replaced whenever I feel the medication effects diminishing.”
D. “I can’t use my heating pad in the same area as the patch.”
D. “I can’t use my heating pad in the same area as the patch.”
The new nurse places a transdermal medication patch on a client. The preceptor stops the new nurse for which action?
A. Wears gloves to remove old patch.
B. Writes date on medication patch.
C. Applies patch to flank skin.
D. Presses the patch onto the skin.
B. Writes date on medication patch.
The nurse is preparing to apply a new transdermal patch to a client’s chest. What would the nurse do first?
A. Wash the area of the old patch with soap and water.
B. Initial and write the date and time on the label of the new patch.
C. Remove the old patch from the client’s skin.
D. Remove the new patch from its protective covering.
C. Remove the old patch from the client’s skin.
The nurse is preparing to administer a transdermal medication. How should the nurse proceed?
A. Inject the medication into a body cavity.
B. Apply the medication directly to the skin.
C. Ask the client to swallow the medication.
D. Inject the medication just below the dermis of the skin.
B. Apply the medication directly to the skin.
The nurse is administering prescribed eye drops to a client. What action would cause the nurse to stop the administration?
A. The dropper touches the client’s eyelid.
B. The drops fall into the lower conjunctival sac.
C. The client looks upward at the ceiling.
D. The client blinks while administering the eye drops.
A. The dropper touches the client’s eyelid.
What instructions should the nurse give a client following the administration of prescribed eye drops? Select all that apply.
A. “Do not rub the medicated eye(s).”
B. “Damage may occur if you touch the dropper to the eye.”
C. “Allow the drops to flow into the other eye.”
D. “Apply gentle pressure to the inner canthus hourly.”
E. “Wash your hands before and after you use the eye drops.”
A. “Do not rub the medicated eye(s).”
B. “Damage may occur if you touch the dropper to the eye.”
E. “Wash your hands before and after you use the eye drops.”
Prior to the nurse administering eye drops to the client, what should the nurse do?
A. Clean the eyelids of any loose eyelashes.
B. Have the client focus downward toward the dropper.
C. Ask the client to blink several times.
D. Tell the client to rub the eye.
A. Clean the eyelids of any loose eyelashes.
The nurse is preparing to administer eye drops to a client. What purposes are commonly associated with instilling medications via eye drops? Select all that apply.
A. Infection treatment
B. Pupil constriction
C. Control of intraocular pressure
D. Pupil dilation
E. Allergy testing
A. Infection treatment
B. Pupil constriction
C. Control of intraocular pressure
D. Pupil dilation
The nurse is administering eye drops to a client. Where should the nurse place the drops?
A. Cornea
B. Lower conjunctival sac
C. Outer eyelid margin
D. Inner canthus
B. Lower conjunctival sac
The nurse is preparing to administer ear drops to an adult client. In what direction would the nurse position the pinna?
A. Laterally toward the skull base
B. Up and back
C. Down and forward
D. Outward, away from the nose
B. Up and back
The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?
A. 10 minutes
B. 15 minutes
C. 5 minutes
D. 20 minutes
C. 5 minutes
After administering ear drops to a client, how does the nurse ensure the medication is delivered completely?
A. Place gentle pressure on the tragus after administration.
B. Straighten the ear canal during administration.
C. Place the client’s head to the side prior to administration.
D. Ensure the dropper does not touch the ear during administration.
A. Place gentle pressure on the tragus after administration.
The nurse is preparing to administer ear drops to a 2-year-old client. The nurse would pull the pinna in which direction?
A. Laterally toward the skull base
B. Up and back
C. Down and backward
D. Outward, away from the nose
C. Down and backward
The nurse is teaching a parent how to administer ear drops to a 3-year-old client with an ear infection. What instructions should the nurse give the parent?
A. “Keep the drops refrigerated until just before you administer and apply the drops onto a cotton ball then insert into the ear.”
B. “Pull the child’s pinna up and backward to straighten the ear canal before administration of the drops.”
C. “Have the child lie down with the affected ear facing the ceiling while administering the drops and then wait for 5 minutes after the drops are in.”
D. “Administer the eardrops while holding the dropper 2 to 3 in (5 to 7.5 cm) above the ear canal.”
C. “Have the child lie down with the affected ear facing the ceiling while administering the drops and then wait for 5 minutes after the drops are in.”
The nurse is teaching a client how to use nasal spray. What will the nurse include in the teaching plan? Select all that apply.
A. Tilt the head slightly forward.
B. Insert the tip of the nose piece into one nostril.
C. Hold the breath for a few seconds after administering the spray.
D. Sit up comfortably in the bed.
E. Blow the nose 1 minute after administering the spray.
B. Insert the tip of the nose piece into one nostril.
C. Hold the breath for a few seconds after administering the spray.
D. Sit up comfortably in the bed.
A nurse has just administered a medication to client via nasal spray. The nurse instructs the client to refrain from blowing the nose for a minimum of how long?
A. 30 seconds
B. 1 minute
C. 5 minutes
D. 3 minutes
C. 5 minutes
What instruction will the nurse include when teaching a client how to administer nasal drops?
A. Hold the dropper just above the nostril to administer the drops.
B. Administer drops when in a supine position to improve absorption.
C. Tilt the head forward and blow the nose after administering the drops.
D. Breathe in deeply through the nose when administering the drops
A. Hold the dropper just above the nostril to administer the drops.
The nurse has just completed administering a nasal spray to a client. What should the nurse do next?
A. Evaluate client for level of discomfort.
B. Assess the client for any allergies.
C. Assess the client’s nose for any drainage.
D. Evaluate client for medication effectiveness.
D. Evaluate client for medication effectiveness.
The nurse caring for a client has just inserted a rectal suppository. What is the best instruction by the nurse at this time?
A. “You can go home now.”
B. “Remain in horizontal position for 10 to 20 minutes.”
C. “You may go to the bathroom as soon as you feel the urge.”
D. “Sit up and hold it as long as you can.”
B. “Remain in horizontal position for 10 to 20 minutes.”
When administering a rectal suppository, in which position would the nurse position the client?
A. Supine
B. Prone
C. Side-lying
D. Semi-Fowler’s
C. Side-lying
The nurse is inserting a medication via a rectal suppository to a client. What would the nurse instruct the client to do?
A. Inhale for a count of 10.
B. Hold the breath.
C. Take slow, deep breaths.
D. Use panting breaths.
C. Take slow, deep breaths.
The nurse is preparing to administer a rectal suppository to an adult client. How many inches (or centimeters) should the nurse plan to insert the suppository?
A. 3 inches (7.5 cm)
B. 2 inches (5 cm)
C. 5 inches (12.5 cm)
D. 1 inch (2.5 cm)
A. 3 inches (7.5 cm)
The nurse is caring for an adult client by inserting a rectal suppository. Which action would be most appropriate by the nurse?
A. Insert the suppository to a depth of about 1 inch (2.5 cm).
B. Lubricate the suppository and gloved finger.
C. Insert the suppository’s flat end first.
D. Encourage the client to remain still for about 30 minutes.
B. Lubricate the suppository and gloved finger.
Adequate studies in pregnant people have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimester. This is category ____.
A
This is an example of which category? Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant people, or animal studies have shown an adverse effect, but adequate studies in pregnant people have not demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evident of risk in later trimesters.
B
Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans; the benefits from the use of the drug in pregnant people may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans. This is category ____.
C
This explains category _____. There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant people may be acceptable despite its potential risks.
D
Studies in animals or humans demonstrate fetal abnormalities or adverse reactions; reports indicate evidence of fetal risk. The risk of use in a pregnant women clearly outweighs any possible benefit. This is an example of category ___.
X
Category ____ is least harmful and category ___ is the most harmful.
A; X
Explain schedule I.
High abuse potential and no accepted medical use (heroin, LSD).
High abuse potential with severe dependence liability (narcotics, amphetamines, and barbiturates). This is explaining schedule ___.
II
Less abuse potential than schedule II drugs and moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants). This explains schedule ___.
III
What is schedule IV?
Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics).
Schedule ___ is limited abuse potential. Primary small amount of narcotics used as antitussives or antidiarrheals.
V
Schedule I is the ____ addictive and schedule V is the ____ addictive.
Most; least
_____ is the study of interactions between the chemical components of living systems and foreign chemicals.
Pharmacodynamics
What is pharmacokintetics?
The study of how medications travel through the body. This includes absorption, distribution, metabolism, and excretion of drugs.
The ____ _____ is the ratio of the blood concentration at which a drug becomes toxic to the concentration at which the drug is effective.
Therapeutic index.
_____ ____ is used if a drug is needed to get to the patient quickly.
Loading dose.
_______ is what happens to the drug from the time it is introduced to the body until it reaches the circulating fluids and tissue.
Absorption
The route of administration influences _____.
Absorption
Passive diffusion, active transport, and filtration are apart of the _____ process.
Absorption
Explain passive diffusion.
Is like a natural, easy movement of tiny particles from one place to another, and it does not require energy.
Explain active transport.
Its a process in your body where your cells use energy to move things around.
Active transport allows your body to ____ and _____ the levels of specific substances.
Control and regulate.
Filtration is a natural way your body ____ _____.
Separates things.
Distribution involves the _____ of a drug to the body’s ______.
Movement; tissues
Why is filtration so importnt?
Because it helps your body get rid of waste and keep what is needed.
What is protein binding?
The more bound to the protein, the more difficult it can be for the medication to be released and to cross the membrane to get to the tissue cells. The drug must be freed from the proteins binding site to act on the tissue. Some drugs are tightly bound and are released very slowly. Some drugs are loosely bound and tend to act quickly and be excreted quickly.
A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic?
A. The client must consume adequate protein in order to achieve a therapeutic effect.
B. The molecules of the drug that are bound to protein are inactive and do not affect body cells.
C. Increased levels of serum protein will increase the effect of the drug.
D. Each molecule of the drug must bind to a protein molecule to become effective
B. The molecules of the drug that are bound to protein are inactive and do not affect body cells.
The blood-brain barrier is protective system of cellular activity that keeps many things away from the _____ _____ _____.
Central nervous system
What is the first-pass effect?
Its a process that occurs in the liver after the drug is absorbed from the GI tract. It refers to the fact that some of the drug is broken down before it even reaches the bloodstream.
Not all drugs are ____ in the same way.
Excreted.
_____ ____ is the time it takes for the drug in your body to decrease by one half of its peak level.
Half life.
Your patient is taking 50 mg of a medication with a half-life of 12 hours. How long will it take for the drug to be out of the patients system?
It would take about 9 half-lives or about 4.5 days.
After a discussion about the half-life of a drug, a nursing instructor concludes further teaching is necessary when nursing students choose which facts as true? Select all that apply.
A. It can be decreased in clients with renal disease.
B. It can help determine dosing frequency.
C. It does not change throughout a client’s life.
D. Liver disease can increase half-life.
E. It is the measure of the rate at which drugs are removed from the body.
A. It can be decreased in clients with renal disease.
C. It does not change throughout a client’s life.
What are factors that affect the body’s response to a drug?
Weight, age, sex, physiological factors, pathological factors, immunological factors, psychological factors, environment factors, drug intolerance, accumulation effects, and interactions.
A patient who has kidney impairment may not be able to excrete the drug and may accumulate the drug in the body, this causes ____ _____.
Toxic effects
What are the four classifications for drug allergies?
Type I, type II, type III, and type IV.
What is type I classification for drug allergies?
Immediate hypersensitivity disorders.
Antibody-mediated disorders falls under which classification for drug allergies?
Type II.
Type III classification for drug allergies is….
Immune complex-mediated disorders.
Which classification for drug allergies is cell-mediated hypersensitivity disorders?
Type IV
A client is receiving antibiotics for treatment of infection. The nurse should assess for what potential indications of superinfection? Select all that apply.
A. Fever
B. Glossitis
C. Joint pain
D. Difficulty swallowing
E. Epistaxis
A. Fever
B. Glossitis
Drugs can produce a wide variety of effects in addition to the desired pharmacological effect. Sometimes the drug dose can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. Which are examples of this secondary action? Select all that apply.
A. Spontaneous bleeding after taking warfarin (Coumadin)
B. Reports of dizziness after starting amlodipine (Norvasc)
C. Reports of drowsiness after taking an diphenhydramine (Benadryl)
D. Diarrhea after taking cefuroxime (Ceftin)
C. Reports of drowsiness after taking an diphenhydramine (Benadryl).
D. Diarrhea after taking cefuroxime (Ceftin).
How long does acute pain last?
30-60 days
What is chronic pain?
Lasts longer than 3-6 months; constant or intermittent pain.
What are some examples of somatic pain?
Strained muscle or sprain.
_____ pain originates in tendons, ligaments, blood vessels, and nerves.
Somatic
Somatic pain responds well to mild _____.
Analgesics
Gastroenteritis and appendicitis are example of _____ pain.
Visceral
Where does visceral pain originate?
Internal organs and linings of body cavities in the cranium, chest, abdomen, and pelvic area.
Which type of pain responds well to opioids?
Visceral pain.
What is an example of referred pain?
When you have cardiac pain it radiates to the left arm.
What are some examples of deafferentation pain?
Phantom pain, poststroke pain, or pain after spinal cord injury.
______ ______ pain is associated with dysregulation of the autonomic nervous system.
Sympathetically maintained
What is an example of sympathetically maintained pain?
Complex regional pain syndrome.
is pain felt along the distribution of many peripheral nerves.
Peripherally generated pain.
What are some examples of peripherally generated pain?
Diabetic neuropathy, alcohol nutritional neuropathy, some types of neck, shoulder, and back pain, and pain of Guillain-Barre syndrome.
Usually associated with a known peripheral nerve injury. Pain is felt at least partly along the distribution of the damaged nerve.
Painful mononeuropathies
Nerve root compression, nerve entrapment, trigeminal neuralgia. Some neck, shoulder, and back pain. These are example of what type of pain?
Painful mononeuropathies
The nurse is caring for a client who had a below-the-knee amputation to the left leg 8 months ago. The client is reporting left foot pain of 7 on a 1-to-10 scale. The pain began earlier today. How will the nurse document this type of pain? Select all that apply.
A. Somatic
B. Visceral
C. Referred
D. Neuropathic
E. Acute
D. Neuropathic
E. Acute
A nurse is assessing an adult client with back pain. The client is unable to speak the dominant language. Which pain scale is most appropriate for the nurse to use?
A. PAINAD scale
B. 0 to 10 numeric rating scale
C. CPOT scale
D. FLACC scale
B. 0 to 10 numeric rating scale
A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client’s room to administer the medication, the client is laughing with visitors. The client’s pulse rate is 64, respirations 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse?
A. Hold the pain medication at this time.
B. Administer the pain medication.
C. Reassess the need for pain medication in 30 min.
D. Encourage the client to use alternative pain relief measures.
B. Administer the pain medication.
A client prescribed pain medication around the clock experiences pain 1 hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse?
A. Assess for medication prescription for breakthrough pain.
B. Tell the client he or she will have to wait for 1 hour.
C. Administer the next dose of the pain medication.
D. Assess the client for signs of opioid addiction.
A. Assess for medication prescription for breakthrough pain.
What is a PCA?
A button the patient pushes to receive a prescribed dose of analgesic at a set time interval.
What is a basal rate?
A continuous rate being given to the patient.
The nurse is caring for a client receiving opioid therapy and notes that the client’s respirations are 7. What is the first action by the nurse?
A. Tell the client loudly to breathe.
B. Take the client’s blood pressure.
C. Begin cardiac compressions.
D. Administer naloxone.
D. Administer naloxone.
A nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. When assessing the client, she notes that his respiratory rate is 4. What should the nurse do first?
A. Notify the health care provider.
B. Stop the PCA pump.
C. Administer naloxone.
D. Increase the primary IV rate.
B. Stop the PCA pump.
Chronic insomnia occurs at lease _____ times per week and persists for ____ months.
3; 3
The nurse is teaching a preoperative client how to cough following a surgical procedure. Which statement accurately describes a step in this procedure?
A. Inhale and exhale three times, inhale and hold the breath for three seconds, and lightly cough three times.
B. Inhale and hold the breath for five seconds; let the breath out in five short coughs.
C. Inhale and hold the breath for five seconds; let the breath out in five deep hacking coughs.
D. Inhale and exhale five times, inhale and hold the breath for three seconds, and lightly cough five times.
A. Inhale and exhale three times, inhale and hold the breath for three seconds, and lightly cough three times.
When initiating deep-breathing exercises for a postoperative client, what would be the nurse’s instructions for the first breath?
A. Exhale first and breathe in through the mouth.
B. Exhale first and breathe in through the nose.
C. Inhale deeply and exhale through pursed lips.
D. Inhale through the mouth and exhale through the nose.
B. Exhale first and breathe in through the nose.
The nurse is teaching deep-breathing exercises to a client who is undergoing thoracic surgery. In what position would the nurse place the client for these exercises?
A. Fowler’s
B. Trendelenburg
C. Side-lying
D. Prone
A. Fowler’s
The nurse is teaching a preoperative client how to perform deep-breathing exercises. What is the next step the client would take after exhaling first and breathing in through the nose?
A. Breathe out through the mouth and inhale again through the nose.
B. Hold the breath for ten seconds and exhale through pursed lips.
C. Hold the breath for five seconds and exhale through pursed lips.
D. Breathe out through the nose and inhale again through the mouth.
C. Hold the breath for five seconds and exhale through pursed lips.