TBRQ Ch: 32 - Medication Andministration

Question 1

You are a new graduate nurse completing your orientation on a very busy intensive care unit. You cannot read a health care provider’s order for one of your patient’s medications. You have heard from more experienced nurses that this health care provider does not like to be called, and you know that another of the health care provider’s patients is very unstable. What is the most appropriate next step for you to take?

1. Call the health care provider to clarify the order
2. Talk with your preceptor to help you interpret the order
3. Refer to a medication manual before giving the medication
4. Use your best judgment and critical thinking and administer the dose you think the health care provider ordered

Answer 1

Answer: 1.

Whenever you are unable to read a patient’s order, you must consult with the health care provider to clarify the order before giving the medication.

Question 2

A toddler is to receive 2.5 mL of an antipyretic by mouth. Which equipment is the most appropriate for medication administration for this child?

1. A medication cup
2. A teaspoon
3. A 5-mL syringe
4. An oral-dosing syringe

Answer 2

Answer: 4. 


Syringes for oral dosing are adapted for accurate administration of medication to pediatric patients. They do not have a syringe or needle cap and cannot accidentally be used to administer parenteral medications.

Question 3

What statement made by a 2-year-old patient’s mother indicates that she understands how to administer her son’s eardrops?

1. “To straighten his ear canal, I need to pull the outside part of his ear down and back.”
2. “I need to straighten his ear canal before administering the medication by pulling his ear upward and outward.”
3. “I need to put my son in a chair and make sure that he’s sitting up with his head tilted back before I give him the eardrops.”
4. “After I’m done giving him his eardrops, I need to make sure that my son remains sitting straight up for at least 10 minutes.”

Answer 3

Answer: 2. 


When administering medications to people 3 years of age and older, you need to pull the auricle upward and outward to straighten the ear canal when giving eardrops.

Question 4

A health care provider ordered enalapril (Vasotec) 2 mg IV push for a patient with hypertension. The pharmacy sent vials marked 1.25 mg enalapril/mL. How many mL does the nurse administer? ___ mL

Answer 4

Answer:

1.6 mL. 
Using dimensional analysis to solve the problem

Question 5

A nurse admits a 72-year-old patient with a medical history of hypertension, heart failure, renal failure, and depression to a general medical patient care unit. The nurse reviews the patient’s medication orders and notes that the patient has three health care providers who have ordered a total of 13 medications. What is the most appropriate action for the nurse to take next?

1. Give the medications after identifying the patient using two patient identifiers
2. Provide medication education to the patient to help with adherence to the medical plan
3. Review the list of medications with the health care providers to ensure that the patient needs all 13 medications
4. Set up a medication schedule for the patient that is least disruptive to the expected treatment schedule in the hospital

Answer 5

Answer: 3.


This patient most likely is experiencing polypharmacy. To minimize risks associated with polypharmacy, frequent communication among health care providers is essential to make sure that the patients’ medication regimen is as simple as possible.

Question 6

The nurse is administering an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in the appropriate order.

1. Release tubing and inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. Use watch to time administration.
2. Select injection port of intravenous (IV) tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy.
3. After injecting medication, release tubing, withdraw syringe, and recheck fluid infusion rate.
4. Connect syringe to port of intravenous (IV) line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port.
5. Clean injection port with antiseptic swab. Allow to dry.
6. Occlude intravenous (IV) line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return.

Answer 6

Answer:

2, 5, 4, 6, 1, 3.

Question 7

A nursing student is administering ampicillin PO. The expiration date on the medication wrapper was yesterday. What is the appropriate action for the nursing student to take next?

1. Ask the nursing professor for advice
2. Return the medication to pharmacy and get another tablet
3. Call the health care provider after discussing this situation with the charge nurse
4. Administer the medication since medications are good for 30 days after their expiration date

Answer 7

Answer: 2. 


The nurse needs to return the medication to the pharmacy and get a tablet that is not expired because expired medications should not be administered.

Question 8

A nursing student is administering medications to a patient through a gastric tube (G-tube). Which of the following actions taken by the nursing student requires the nursing instructor to intervene?

1. The nursing student places all the patient’s medications in different medicine cups.
2. The nursing student evaluates each medication and holds the tube feeding before administering a medication that needs to be administered on an empty stomach.
3. The nursing student flushes the tube with 30 mL of water between each medication.
4. The nursing student crushes a nifedipine extended-release tablet and mixes it with water before administering it.

Answer 8

Answer: 4. 


Extended-release tablets should not be crushed; the nursing student needs to question this order and investigate alternative medications while the patient is receiving medications through the gastric tube.

Question 9

A pediatric nurse takes a medication to a 12-year-old female patient. The patient tells the nurse 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. Consult with the patient’s parents for advice
3. Take the medication away and chart the patient’s refusal
4. Tell the patient that her health care provider knows what is best for her

Answer 9

Answer: 1. 


Whenever a patient refuses a medication, the first step is to talk with the patient to gather the patient’s insights and possible reasons for not taking the medication.

Question 10

A nurse caring for a patient on a general surgical unit notes the following medication order in the patient’s medical record:
3 March 2016 1415 Administer 25 mg hydrochlorothiazide PO BID D. Anderson, MD
What should the nurse do next?

Answer 10

Answer:

The nurse should administer the medication after reviewing the order. This order contains all the requirements for a medication order, including the patient’s name, date and time the order is written, medication name, dose, route, frequency of administration, and provider’s signature.

Question 11

After receiving an intramuscular (IM) injection in the deltoid, a patient states, “My arm really hurts. It’s burning and tingling where I got my injection. What should the nurse do next? (Select all that apply.)

1. Assess the injection site
2. Administer an oral medication for pain
3. Notify the patient’s health care provider of assessment findings
4. Document assessment findings and related interventions in the patient’s medical record
5. This is a normal finding so nothing needs to be done
6. Apply ice to the site for relief of burning pain

Answer 11

Answer: 1, 3, 4.


If a patient describes localized pain, numbness, burning or tingling at an IM injection site, you need to suspect possible injury to nerve or tissues. Appropriate nursing actions include assessing the site, notifying the patient’s health care provider, and documenting your findings.

Question 12

You are working in a health clinic on a college campus. You need to administer medroxyprogesterone acetate intramuscularly (IM) to a female patient for birth control. You look up this medication in a reference manual and determine that it is viscous and injections can be painful. On the basis of this information, you plan which of the following when administering this medication? (Select all that apply.)

1. Inject the medication over 3 minutes to reduce pain associated with the injection
2. Administer the medication in the ventral gluteal site
3. Use the Z-track method when administering the medication
4. Use the deltoid site for medication administration
5. Ask the patient questions about her major and which classes she is taking during the injection to provide distraction

Answer 12

Answer: 2, 3, 5.


When giving viscous medications intramuscularly, a patient typically experiences pain. Giving the medication in the ventral gluteal site using the Z-track method and distracting the patient during medication administration will help to decrease pain associated with the medication.

Question 13

After seeing a patient, the health care provider starts to give 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 health care provider 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 health care provider.
4. Ensure that the six rights of medication administration are followed when giving the medication.

Answer 13

Answer: 2. 


Nursing students cannot take medication orders.

Question 14

A nurse accidently gives a patient the medications that were ordered for the patient’s roommate. What is the nurse’s first priority?

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

Answer 14

Answer: 4.


Whenever a medication error occurs, the first action of the nurse is to assess the patient.

Question 15

A child is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 64 puffs. The dose is 2 puffs every 6 hours. How many days will the pMDI last?
___________ days.

Answer 15

Answer: 8. 


The patient is taking 2 puffs every 6 hours which is 8 puffs a day. The inhaler has 64 puffs in it. To determine how many days the inhaler will last, divide the number of puffs by the number of doses per day that the patient takes; 64 puffs/8 puffs per day = 8 days.