Medications Flashcards
A client tells the nurse, “This pill is a different color than the one that I usually take at home.” Which is the best response by the nurse?
1. “Go ahead and take your medicine.”
2. “I will recheck your medication orders.”
3. “Maybe the doctor ordered a different medication.”
4. “I’ll leave the pill here while I check with the doctor.”
- Answer: 2. Rationale: If there is any doubt, the medication administration process should be interrupted until the question is clarified. Listen to the client. Find out any other information the client may have about that certain medication. For example, does he know the dosage of the medication taken at home? Do not administer the medication (option 1). Inform the client that you will check the chart first. Review the chart to make sure there is no discrepancy between the physician’s order and the MAR. Review the physician’s progress notes because the medication may have been increased or reduced as part of the treatment plan (option 3). Check with the pharmacist because sometimes a pill may be a different color or shape based on the pharmaceutical company. Do not leave medications at the bedside. Medications should never be left unattended (option 4). Inform the client of your findings. The client will appreciate that you took the time to make sure that he received the correct medication. While it takes time to check out the client’s statement, you will be glad that you avoided a potential medication error. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-11.
The following medications are listed on a client’s medication administration record (MAR). Which medication order should the nurse question?
1. Lasix 40 mg, po, STAT
2. Ampicillin 500 mg, q6h, IVPB
3. Humulin L (Lente) insulin 36 units, subcutaneously, every morning before breakfast
4. Codeine q4–6h, po, prn for pain
- Answer: 4. Rationale: Options 1, 2, and 3 are written appropriately. Option 4 is incorrect because the dosage is missing from this order. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcome: 35-6.
The primary care provider prescribed 5 mL of a medication to be given deep intramuscular for a 40-year-old female who is 5′7″ tall and weighs 135 pounds. Which is the most appropriate equipment for the nurse to use? Select all that apply.
1. Two 3-mL syringes
2. One 5-mL syringe
3. A #20–#23 gauge needle
4. A 1-inch needle 5. A 1 1/2-inch needle
- Answer: 1, 3, and 5. Rationale: Five milliliters is too large an amount to inject into one site. The nurse needs to divide the amount into two 2.5-mL injections. A 3-mL syringe could be used (option 1). The length of the needle will depend on the muscle development of the client. The nurse needs to assess the client. The presumption, based on the information provided, is that this client’s muscle mass is within normal limits. The needle length would need to be 1 1/2 inches because the medication is ordered to be given “deep IM” (option 5). This also suggests that the medication should be given in the preferred site for IM injections—the ventrogluteal site—because it provides the greatest thickness of gluteal muscle. The gauge of the needle for an IM injection into the ventrogluteal muscle can range between #20 and #23 (option 3). The nurse needs to assess the viscosity of the medication. Smaller gauges (e.g., #23) produce less tissue trauma; however, viscous solutions may require a larger gauge (e.g., #20–#21). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-5.
The nurse is to administer 0.75 mL of medication subcutaneously in the upper arm to a 300-pound adult client. The nurse can grasp approximately 2 inches of the client’s tissue at the upper arm. Which is the most appropriate for the nurse to use?
1. A tuberculin syringe, #25–#27 gauge, 1/4- to 5/8-inch needle
2. Two 3-mL syringes, #20–#23 gauge, 1 1/2-inch needle
3. 2-mL syringe, #25 gauge, 5/8-inch needle
4. 2-mL syringe, #20–#23 gauge, 1-inch needle
- Answer: 3. Rationale: The type of syringe for subcutaneous injections depends on the medication to be given. This situation does not indicate that the medication is insulin and, thus, another syringe is needed. Generally a 2-mL syringe is used for most subcutaneous injections. Generally, a #20- to #23-gauge needle is used for IM injections. Needle size and length are based on the client’s body mass, the intended angle of insertion, and the site of the injection. Generally, a #25-gauge, 5/8-inch needle is used for adults of normal weight and the needle is inserted at a 45° angle. Because 2 inches of tissue can be grasped or pinched at the site of the injection, the nurse should administer the medication at a 90° angle to ensure the medication reaches subcutaneous tissue. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-18b.
The nurse is to administer a tuberculin test to a client who is 6feet tall and weighs 180 pounds. Which is the most appropriate for the nurse to use?
1. A tuberculin syringe, #25–#27 gauge, 1/4- to 5/8-inch needle
2. Two 3-mL syringes, #20–#23 gauge, 1 1/2-inch needle
3. 2-mL syringe, #25 gauge, 5/8-inch needle
4. 2-mL syringe, #20–#23 gauge, 1-inch needle
- Answer: 1. Rationale: A tuberculin test is given by intradermal injection. A tuberculin syringe is used because the dosage will most likely be 0.1 mL. A short, fine needle is needed to avoid entering the subcutaneous tissue. The needle should have a short bevel and usually be between #25 and #27 gauge. The needle should be between 1/4 to 5/8 inch long. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-18a.
The nurse is to administer 0.5 mL of a medication by intramuscular injection to an older emaciated client. Which is the most appropriate for the nurse to use?
1. A tuberculin syringe, #25–#27 gauge, 1/4- to 5/8-inch needle
2. Two 3-mL syringes, #20–#23 gauge, 1 1/2-inch needle
3. 2-mL syringe, #25 gauge, 5/8-inch needle
4. 2-mL syringe, #20–#23 gauge, 1-inch needle
- Answer: 4. Rationale: If the nurse goes by the amount of the medication (0.5 mL) only, the deltoid muscle would be the site. However, knowing and assessing the client is critical. The muscles of an older, emaciated client will most likely be diminished or atrophied. The nurse should consider the ventrogluteal site because that site will have the most muscle mass. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcomes: 35-17c; 35-12.
An older client with renal insufficiency is to receive a cardiac medication. Which is the nurse most likely to administer?
1. A decreased dosage
2. The standard dosage
3. An increased dosage
4. Divided dosages
- Answer: 1. Rationale: Due to renal insufficiency, the dose of the medication would need to be decreased in order to avoid accumulation of the medication and the risk of toxicity. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 35-12.
Proper administration of an otic medication to a 2-year-old client includes which of the following?
1. Pull the ear straight back.
2. Pull the ear down and back.
3. Pull the ear up and back.
4. Pull the ear straight upward.
- Answer: 2. Rationale: To straighten the ear canal in children less than 3 years of age, the ear must be pulled down and back. In individuals over 3 years of age, the ear is pulled up and back. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-20c.
A primary care provider writes a prescription for 0.15 milligram of digoxin intravenously every day. The medication is available in a concentration of 400 micrograms per mL. How many mL will the nurse administer?
- Answer: 0.375 or rounded to 0.38 mL. Rationale: After converting to like numbers, the formula would be set up as follows: 400 micrograms = 1 mL 150 micrograms = X mL Cross multiply (400 X = 150) Divide by 400 X = 0.375 Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-9.
A nursing student is preparing to administer insulin to a client with diabetes. Indicate the correct order for the administration of this medication:
1. Cleanse the site with alcohol.
2. Insert the needle quickly into the subcutaneous tissue.
3. Mix the insulins.
4. Assess the skin for the injection.
5. Pinch the skin lightly.
6. Inject the medication.
7. Count to five.
8. Remove the syringe. Correct sequence: _______________
- Answer: 3, 4, 1, 5, 2, 6, 7, and 8. Rationale: This is the correct order for this skill—first the nurse mixes the insulin, assesses the skin, and cleanses the skin. The nurse would then pinch the skin, insert the needle, inject the medication, count to five, and remove the syringe. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 35-18b.
