Test 5 Ch 2 Flashcards
You have obtained a liquid narcotic for a patient in pain from the unit’s locked cabinet. However, the dose was accidentally spilled before giving it to the patient. What is the best action to take at this point?
a. Ask another nurse to cosign the inventory record describing the situation.
b. Immediately obtain another dose from the narcotic control system.
c. Document the occurrence in the drug record.
d. Clean up the spill and notify the supervisor.
ANS: A
Accounting for controlled substances is a legal requirement. If the drug is accidentally dropped, contaminated, or spilled two nurses must sign the inventory report and describe the situation.
As you arrive to work, a nurse from the previous shift tells you that she has completed the narcotic count for your shift. What action should be taken?
a. There is no need for any additional action as this is the standard procedure.
b. Accept the keys to the narcotic cabinet and recount the drugs yourself.
c. Recount the narcotics again with a nurse from the previous shift.
d. Recount the drugs yourself at the end of your shift.
ANS: C
At the end of each shift, the contents of the locked cabinet are counted together by one nurse from each shift in order to verify the narcotics count. If not done properly, the nurse risks being held accountable for any shortages or discrepancies, and may be found guilty of falsifying the narcotic count records.
A one-time order for a controlled substance drug has been written for a patient you are caring for. However, the drug ordered is available only in a larger dose than is needed. What should you do with the remaining drug?
a. Give the full dose that is available.
b. Flush the remaining drug in the toilet of the patient’s bathroom.
c. Save the remaining drug in case the patient needs it again.
d. Have another nurse to witness wasting of the leftover drug, and document according to policy.
ANS: C
If the ordered dose is smaller than the dose provided (so that some drug must be discarded), two nurses witness the wasting of the drug, and sign the controlled substance inventory report according to institution policy.
An elderly patient in an assisted living home requests an over-the-counter cough preparation for a mild cough she is experiencing.
What is your best response?
a. “I do not have any of this drug for you at this time, but can give you a dose from another patient’s supply.”
b. “I will bring it to you right away, but I must keep it with your other prescription drugs.”
c. “I will need to contact your healthcare provider for an order before I can give this drug to you.”
d. “You may have this, but your family will need to bring it in for you.”
ANS: C
Over-the-counter (OTC) drugs do not require a prescription for purchase, but a healthcare provider’s order is required before it can be given by the LPN/LVN in an institutional setting. OTC drugs may interact with a patient’s prescribed drugs, especially in the elderly.
Which of the following orders is an example of a single drug order?
a. Atenolol 50 mg orally daily
b. Morphine sulfate 4 mg IV stat
c. Cefazolin 1 g IV 8 a.m. before surgery
d. Tramadol 50 mg orally as needed for pain
ANS: D
A single drug order is a drug that is scheduled to be given at a specified time for one dose only.
Diphenhydramine 50 mg IV push is ordered by the healthcare provider to be given “stat.” When should this drug be given?
a. Immediately
b. As need upon the patient’s request
c. Within 1 hour of receiving the order
d. When you have completed giving the oral drugs first
ANS: A
A stat order is a type of drug order that is to be given immediately.
You are giving drugs to the patients assigned to you when you realize that you gave a drug to the wrong patient. What action should you take?
a. Evaluate the patient’s condition and notify the healthcare provider.
b. Submit a report only if the patient has an adverse reaction.
c. Inform the patient and complete an incident report.
d. Document the occurrence in the patient record.
ANS: A
When it is discovered that an error has been made, you should immediately evaluate the patient for any adverse reactions and notify the healthcare provider as soon as possible. An incident report should be completed, and the supervisor notified.
MULTIPLE RESPONSE
Which of the following drugs is considered a high alert drug? (Select all that apply.) a. Percocet
b. Insulin
c. Heparin
d. Herceptin
e. Potassium
f. Indomethacin
ANS: B, C, E
Categories of common high alert drugs can be remembered using the acronym “PINCH.” P is for potassium; I is for insulin, N is for narcotics (opioids), C is for cancer chemotherapy drugs, and H is for heparin or any drug type that interferes with blood clotting.
MULTIPLE RESPONSE
Which of the following scenarios may be a sign of possible drug diversion on a unit? (Select all that apply.)
a. A patient is dissatisfied with the drug administration schedule.
b. A patient receiving oral antibiotics has an excess number of pills. c. A patient is unaware that the nurse mixed a drug in applesauce. d. A patient receiving opioids reports increased pain.
e. A nurse reports the narcotic count is inaccurate.
f. A patient brings his pain drug from home to the hospital.
ANS: D, E
Drug diversion is defined as the illegal transfer of regulated drugs (like narcotics) from the patient for whom it was prescribed, to another person, such as a nurse, for their own (or others) use. Drug diversion should also be suspected if patients continually report pain despite appropriate drug treatment, and if inaccurate narcotic counts are noted. While it is not acceptable for patients to bring or use home-based drugs in the hospital, it is not a sign of drug diversion by a staff member.
MULTIPLE RESPONSE
A 90-year-old woman with dementia is refusing to take her prescribed morning drugs. Another nurse urges you to mix her drugs into some applesauce and feed it to her as a way to give her drug. Which of the following actions should you take before you give a drug mixed into food or drink? List the appropriate actions. (Select all that apply.)
a. Inform the patient or family.
b. Assure the patient she does not need to take her prescribed drugs.
c. Thoroughly crush only pills with an enteric coating.
d. Only mix liquid drugs into food.
e. Give the prescribed drug mixed in food during a regular patient meal.
f. Document the mixing of drugs in food or drink in the chart.
g. Have the family give the food containing the drugs.
h. Inform the healthcare provider.
ANS: A, F, H
Covert drug administration is discouraged. Therefore, nurses are under obligation to inform the healthcare provider who ordered the drug, and the patient or family. Some drugs may not be mixed with certain foods or drinks, or may not be crushed, so checking the drug handbook is a necessary step to ensure patient safety. The mixing of drugs with food or drink must be documented in the patients care plan, and on the drug administration chart to address the legal aspects of this practice.
MULTIPLE RESPONSE
You have just completed giving the patient drugs for your shift when you discover that you made a drug administration error. What steps should you take? (Select all that apply.)
a. Fill out an incident report as soon as possible.
b. Fill out an incident report only if the patient suffers an adverse event. c. Call the healthcare provider immediately.
d. Check your patient and assess vital signs.
e. Report the drug error to the Joint Commission.
f. Discuss the potential cause of the error with the nurse manager.
ANS: A, C, D
The priority action is related to patient safety. So, the first step taken is to check the patient, and assess vital signs, then notify the healthcare provider. All drug errors must be reported, typically though an incident report. The incident report is then used to uncover what may have led to the error to prevent the error from re-occurring.
MULTIPLE RESPONSE
You are caring for an elderly patient who was just admitted the rehabilitation unit following a hospitalization for a fractured hip.
You suspect that in the transfer from the hospital to the rehabilitation unit an error in the patient’s drug orders may have been made.
Which steps should you take to identify possible drug errors in a patient’s drug orders? (Select all that apply.)
a. Call the pharmacy.
b. Clarify anything that is unreadable.
c. Ask the patient about the drug.
d. Reconcile the drug list with an old drug record.
e. Clarify vague orders with the healthcare provider.
f. Check the original written order with the healthcare provider.
g. Inform the nurse manager.
ANS: A, B, E, F
Checking with a reliable source, such as the pharmacist, clarifying vague orders or anything that is difficult to read (if handwritten), and checking the original written order are all ways to avoid drug errors. Informing the nurse manager is not only contraindicated but also not essential to investigating the source of the potential drug error.
MULTIPLE RESPONSE
A narcotic control system is used in any hospital or agency. Which of the following are special regulations applied for control of narcotics that you must follow? List the special regulations applied for the control of narcotics that the nurse must follow. (Select all that apply.)
a. Narcotics may be borrowed from patient to patient for emergency use.
b. Narcotics are stored in a special locked cabinet.
c. You may return unused narcotics to the patient’s family upon discharge.
d. An inventory of the narcotics on a unit must be kept and verified by two nurses.
e. You are responsible for signing out every narcotic drug used for a patient.
f. Narcotics control is the responsibility of everyone on the unit.
ANS: B, D, E
Narcotics are stored in special, limited-access, locked cabinets. A nurse records all controlled- substance drug during the shift. The inventory report form is completed before the drug is removed from the cabinet.
MULTIPLE RESPONSE
A discrepancy in the narcotics inventory for morphine 5 mg/mL vials is discovered when the narcotics count is performed. The count is short by one vial. Which of the following steps should you take to reconcile the count? (Select all that apply.)
a. No action needs to be taken for small discrepancies.
b. Notify the nursing supervisor and the pharmacy of the discrepancy.
c. Identify if any nurse forgot to record any of the narcotics removed.
d. Ask only the nurses who used narcotics about the drugs they have given.
e. Check drug records to reconcile if narcotics given and not signed for.
f. Notify the security department of the institution if drug diversion is suspected.
ANS: B, C, E, F
All nurses must be asked about narcotics that may have been given. Steps must be retraced to see if someone forgot to record any drug. Patient charts might also be checked to see if drug was given that was not signed for on the inventory report. If errors in the report cannot be found, both the pharmacy and the nursing service office must be notified. If drug diversion is suspected, the hospital administrator and security police are usually contacted.
