Test 5 Ch 4 Flashcards
When calculating the dose of a drug to be given to a child, Clark’s rule is used. What measure is Clark’s rule based upon?
a. The age of the child
b. The weight of the child
c. One-half of the adult dose
d. The international standardized ratio
ANS: B
The Joint Commission now recommends that all dosages for children be weight-based. Clark’s rule: Pediatric child dose = (weight of child/150 lb adult dose).
An elderly patient is scheduled to take six drugs each morning. What action should you take when giving these drugs?
a. Allow extra time to give all the drugs.
b. Crush all the drugs before giving them.
c. Allow the patient to take only the drugs she can swallow.
d. Leave the drugs at the bedside so the patient can take them slowly.
ANS: A
Allow extra time to give drug to the elderly. These individuals often are slower at swallowing drugs and water. The nurse must be present for the administration of every drug.
You have just finished giving a 72-year-old male patient with a nasogastric (NG) tube connected to suction his morning drugs.
What action is appropriate to take next?
a. The NG tube is clamped for 10 minutes and then reconnected to suction.
b. The NG tube is clamped for 30 minutes and then reconnected to suction.
c. The NG tube is immediately reconnected to the suction.
d. The NG tube is disconnected for 4 hours, and then reconnected to suction.
ANS: B
When the drug has passed through the tube, reclamp the tube for 30 minutes before reattaching the suction.
A patient in your care is suddenly experiencing a life-threatening emergency. Which route would you expect that emergency drugs may be given during this situation?
a. IV route
b. IM route
c. Rectal route
d. Subcutaneous route
ANS: A
IV injections or infusions may be needed when drug must go directly into the bloodstream, because the action of this method is rapid.
The LPN/LVN is about to prepare an intramuscular injection for a patient containing a nonsteroidal anti-inflammatory drug for pain. Which is the correct needle gauge for giving an intramuscular (IM) injection?
a. 18 G, 1-inch needle
b. 20 G, 1
/2-inch needle
c. 25 G, 2-inch needle
d. 21 G, 11
/2-inch needle
ANS: D
An IM injection is usually given with a 1- to 2-inch, 20- to 22-gauge needle.
Which principle of drug administration will you include in the teaching plan of a patient who will be giving his own subcutaneous injections?
a. Rotate sites among the upper arm, abdomen, and anterior thigh.
b. Avoid injecting within 3 inches of a previous injection site.
c. Insert the needle at a 30-degree angle to the skin.
d. Use a 22-gauge, 5/8-inch needle.
ANS: A
The patient should be taught the principles of injection site rotation and be given a diagram to take home at discharge.
What physical assessment findings would you observe when an IV becomes infiltrated?
a. Pallor and pain
b. Pallor, warmth
c. Pain, warmth, and burning
d. Pain, swelling, and redness
ANS: D
Infiltration produces pain, swelling of the area, and redness. Pain with warmth and burning are signs of infection.
- Which correct step should you take when giving a Z-track injection?
a. Draw up the exact amount of the drug adding 0.5 mL of air.
b. Do not massage the injection site after giving the drug.
c. Use the deltoid site for this injection.
d. Pull the tissue upward and away.
ANS: B
The “Z-track technique” of IM injection uses the skin itself as a “door” to seal in the drug and prevent it from leaking back out from muscle tissue. 0.1 to 0.2 mL of air is added to the drug after it is drawn up. The tissue is pulled down and away, and the site is not massaged after the injection is given.
What step should be taken when applying a topical nitroglycerin ointment to a patient?
a. Squeeze the nitroglycerine ointment onto the applicator paper and place it on the skin.
b. Apply the nitroglycerine ointment to the medial aspect of the thigh.
c. Massage the nitroglycerine ointment thoroughly into the skin.
d. Shave the skin before application.
ANS: A
The correct number of inches of drug is squeezed onto the applicator paper as a small ribbon. The applicator paper is then laid on top of the skin where the drug is to be applied. A non-hairy area on the chest, upper arm, or flank area should be selected for application. Apply it to the paper because the nurse can receive some of the drug if it comes in contact with his or her fingers and is absorbed into the skin.
You are preparing to give a drug by the transdermal route to a patient. Which safety precaution should you use when giving this type of drug?
a. Always wear gloves when giving transdermal drugs. b. To maintain blood levels, do not clean the skin.
c. Remove all patches before showering.
d. Keep all prior patches on the skin.
ANS: A
Always wear gloves to avoid drug absorption onto your own skin.
You are preparing to teach a teenage patient with asthma about using a metered-dose inhaler. What instruction would be appropriate in teaching this patient?
a. Never shake the inhaler drug before use.
b. Hold the head back while inhaling the drug.
c. Exhale while squeezing the canister to deliver the drug.
d. Sit upright, exhale, then activate the inhaler as the next inhalation begins.
ANS: D
The patient should exhale and then activate the inhaler as the next inspiration begins. This will carry drug down into the lungs.
You are instructing a clinic patient on how to use an inhaler during an asthma attack. Which statement is most important about the use of an inhaler during an asthma attack? a. The drug must be delivered into the back of the nose.
b. The drug must be delivered directly into the throat.
c. The drug must be delivered into the lungs.
d. The drug must be delivered onto the tongue.
ANS: C
If using inhalers, patients must be carefully instructed so the drug goes all the way into the lungs, not just to the back of the nose or throat. Take a deep breath first, exhale, and then inhale the drug.
A patient with pneumonia has been ordered to receive an antibiotic to be given by the intravenous (IV) route. The nurse uses her understanding of drug preparation and administration to complete this task.
The nurse first before preparing the drug. Once the drug is prepared, the nurse———
a. checks the drug order and the patient’s allergy history; identifies the patient per institution policy and explains what drug is being given
b. returns expired drugs to the pharmacy and the patient’s allergy history; uses betadine to prepare the IV site for injection and explains what drug is being given
c. reports adverse reactions and the patient’s allergy history; obtains a 25-gauge needle and prepares the skin for injection
d. gives the drug and disposes of the glass vial in the trash; reports adverse reactions and checks the patient allergy history
ANS: A
The nurse first checks the drug order and the patient’s allergy history before preparing the drug. Once the drug is prepared, the nurse identifies the patient per institution policy and explains what drug is being given.
You are caring for a patient with Parkinson’s disease who has been ordered to receive an oral capsule of the drug rivastigmine.
Which actions represent the proper procedure for giving an oral capsule?
a. Crush and dilute the capsule contents in warm water.
b. Tell the patient to swallow the capsule whole.
c. Open the capsule and mix the drug with soft foods. Tell the patient to chew the capsule completely.
d. Pierce the capsule with a needle and squeeze the contents into the mouth.
e. Remain at the patient’s bedside until the drug is swallowed.
ANS: B
Remain at the patient’s bedside until the drug is swallowed. Do not crush tablets or break capsules without checking with the pharmacist. Many drugs have special coatings that are essential for proper absorption. Capsules should not be opened or mixed with foods without checking with the pharmacist for potential interactions.
MULTIPLE RESPONSE
1. The nurse is taking care of a patient receiving an IV infusion. During her rounds, the nurse discovers that the IV infusion is failing to flow properly. List the nursing action for the patient’s care at this time. (Select all that apply.)
a. Change the IV tubing.
b. Lower the IV pole height.
c. Check the IV tubing for kinks.
d. Check the position of the needle.e. Examine IV site for infiltration.
f. Check the IV solution type.
g. Reposition the patient’s wrist and elbow.
e. Examine IV site for infiltration.
f. Check the IV solution type.
g. Reposition the patient’s wrist and elbow.
ANS: B, C, D, E, G
Failure of an IV to infuse properly warrants the following nursing actions: check for bent or kinked tubing, reposition the patient’s wrist and elbow, check the needle position—it should be against a vein wall, the IV pole may be too low, or the needle may be out of the vein and infiltrated.
