Chapter 22: Preparation for Safe Medication Administration Perry et al.: Nursing Interventions & Clinical Skills, 7th Edition

Multiple Choice

1. A patient received a drug that caused an unpredictable and unusual effect. Which term does the nurse use to describe this effect?

a. Toxic b. Allergic c. Therapeutic d. Idiosyncratic

ANS: D

An unpredictable overreaction or underreaction to a medication is an idiosyncratic reaction. Toxic medication effects occur with prolonged therapy, excessive dosing, or impaired metabolism or systemic accumulation in the patient. They are adverse effects with the potential to cause patient injury and death. Allergic reactions are unpredictable, unless the patient has a history of a medication allergy and result from an immunological patient response to the medication involving antibody formation. A therapeutic response is a desirable or intended patient response.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Assessment a. Tolerance b. Synergistic c. Dependence d. Subtherapeutic

2. The nurse administers a combination medication for a desirable patient response derived from the combination of agents. Which type of medication effect does the nurse anticipate?

ANS: B

The nurse anticipates a synergistic effect because the two different medications work better in combination than either agent works alone. Drug tolerance means that a larger dose of medication is needed to produce the same therapeutic effect over time. Drug dependence is psychological or physical. The patient takes the medication for an effect other than the therapeutic effect, resulting in psychological dependence. Physical dependence involves physiological adaptation to the medication that results in severe adverse effects if withdrawn abruptly. A subtherapeutic effect is less than therapeutic; the therapy treats the disorder inadequately.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Assessment a. Tell the patient that the medications are correct. b. Recheck the medication and the medication order. c. Call the pharmacy to bring the correct medication. d. Remove the medication and document the incident.

3. A patient looks at the medication in the cup and tells the nurse that one of the tablets is unfamiliar. Which action would the nurse take next?

ANS: B

A safe nursing intervention is to recheck both the medication and the order because the drug in question may be a new prescription, a new strength of the same medication, or a different generic form of the same medication. Regardless of the cause, the problem needs clarification. Telling the patient that the medications are correct is premature and misleading, denies the patient the right to information, and possibly leads to an error. The nurse does not know if the medications are correct yet. After checking the medications against the medication administration record (MAR) and the original prescriptions, he or she can call the pharmacy for help. The nurse removes the entire cup of medications and rechecks all of them. Documenting the incident is premature because the nurse needs to complete the investigation first.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation a. Notify the health care provider of the situation. b. Inform the patient about the risk of renal failure. c. Talk with the patient about taking the antibiotics. d. Disguise the medications so the patient takes them.

4. The nurse admits a patient who has an acute kidney infection but refuses to take any medication. Which is the best initial nursing intervention to implement the therapeutic regimen?

ANS: C

The basis of the patient’s refusal is unknown; discussing the situation with the patient provides the nurse with an opportunity to clarify misunderstandings, provide information, and gather valuable patient data to plan nursing care. Notifying the health care provider is premature. The nurse takes care of the situation initially by educating the patient. Emphasizing the risk of renal failure may be interpreted as an indirect threat by the patient. The patient has the right to refuse taking the medication, and disguising the medication is neither indicated nor appropriate.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Assessment a. Take the medication for severe pain. b. Use the medication to facilitate healing. c. Wait 4 d. Take every 4–6 hours until the bottle is empty.

5. The nurse discharges a patient from the ambulatory surgical center with a prescription for an opioid analgesic. The patient can take the medication every 4–6 hours as needed for pain. What does the nurse include in patient teaching about the prescription before discharging the patient?

6 hours before taking the next dose.

ANS: C

This is a prn order and has a minimum time interval of every 4 hours. The most important instruction is not to take the medicine any more frequent than that. The patient should not wait until pain is severe before using it. Opioids do not facilitate healing. The patient does not need to take the entire bottle of medication.

DIF: Cognitive Level: Understanding OBJ: NCLEX: Physiological Integrity

TOP: Integrated Process: Teaching-Learning a. Encourage the patient to drink plenty of fluids. b. Direct a colleague to contact the provider right away. c. Retrieve an antihistamine from the medication supply. d. Document potential patient allergy to medication.

6. The nurse administers a patient’s medication; within 30 minutes the patient has bilateral wheezing and large red blotches on the face and is anxious and dizzy. What action by the nurse is best?

ANS: B

The patient has clinical indicators of a moderate-to-severe hypersensitivity reaction, most likely related to the medication. The wheezing increases the risk of impairing the patient’s airway, and the blood pressure can be low already, as evidenced by patient dizziness. The nurse should stay with the patient and wait for emergency equipment, supplies, and personnel to assist. In the meantime, he or she should plan to support the patient’s airway, breathing, and circulation. Hydrating the patient will not help. An antihistamine potentially helps to reverse some of the allergic effects; however, the nurse should not leave the patient. The nurse documents the events after the patient is stable.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation a. Nausea and vomiting b. Respiratory depression c. Erythema and skin rash d. Bloating and constipation

7. A patient has been taking high doses of an opioid medication for severe pain. Which assessment data indicate the most toxic effect of this medication?

ANS: B

Respiratory depression is an undesirable and potentially fatal effect of medication that occurs with prolonged therapy, excessive dosing, impaired metabolism, or systemic accumulation in the patient. Respiratory depression can quickly deteriorate into respiratory failure, tissue damage, and death without airway and respiratory support. Nausea and vomiting can be clinical indicators of a toxic effect; however, they lack the same fatal potential as respiratory depression. The reddened skin rash is consistent with a hypersensitivity reaction. Bloating and constipation are most likely adverse effects of medication with a very low risk of fatality.

DIF: Cognitive Level: Analyzing OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Evaluation a. Oral b. Topical c. Sublingual d. Intramuscular

8. The nurse prepares to administer a parenteral medication. Which route of administration does the nurse use for the medication?

ANS: D

Parenteral medications are always injected into a vessel or tissue; thus, intramuscular administration is suitable. The other routes are suitable for nonparenteral medications.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning a. Place a piece of different colored tape on each pill bottle. b. Take the medications out of the bottles and place them in a pill holder. c. Have a neighbor give the patient his pills once each day. d. Ask the patient how he wants to identify the medications.

9. An older adult who lives alone takes three different white, flat, unscored medications every day. He has trouble remembering if he has taken the correct pill at the correct time. What strategy would best help this patient maintain independence and safety in taking his medications?

ANS: A

Color coding the pill bottles has the most likelihood of success. It’s essential to keep the medications in their original containers for safety. A system could be set up with the patient to make clear which medications he needs to take at what time. Placing the similar-looking pills in to a pill container could cause more confusion for the patient. Their identities need to be maintained for correct scheduling. Having someone administer the medications reduces the patient’s independence and could become burdensome. Since the patient has not been able to manage his medications to date, an open-ended question about how he wants to identify his medications may be confusing. Suggesting a plan allows the patient to recognize a solution and agree to see if it works.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Assessment a. 8 AM, 10 AM, 2 PM, and 8 PM b. 10 AM, 2 PM, 6 PM, and 8 PM c. 10 AM, noon, 4 PM, and 6 PM d. 8 AM, 2 PM, 8 PM, and 2 AM

10. Which schedule would the nurse select to achieve a therapeutic level if the medication is prescribed for administration 4 times a day?

ANS: D

The nurse administers medications 4 times a day by evenly spacing out the medications over a 24-hour period so a steady, therapeutic blood level can be achieved.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning a. Use sterile technique for most nonparenteral medications. b. Administer the medication prepared by the medication nurse. c. Leave the medication on the meal tray if the patient requests it. d. Verify medication dosage is within a safe dosage range.

11. The nurse is reviewing concepts of safe medication preparation and administration with a group of nursing students. Which statement does the nurse include during the review?

ANS: D

The students should be reminded to verify medication calculations to ensure that the math is correct. Calculate medication doses accurately and use appropriate measuring devices. Verify that the dose prescribed is within a safe dosage range and is appropriate for the patient. Clean technique is used for nonparenteral medication. Nurses should avoid administering medication prepared by another nurse. They should also avoid leaving medication at the bedside or on the meal tray because the nurse will not witness the medication administration and cannot document the time that the medication was taken. In addition, the patient can spill the medication, dispose of it, or leave it on the tray.

DIF: Cognitive Level: Understanding OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation a. Save the unused portion for the next dose. b. Document the amount wasted. c. Have a nurse witness the wasting of the drug. d. Administer the unused portion on another patient.

12. The nurse is preparing to administer a controlled substance. Which action must the nurse take first if controlled medication is discarded?

ANS: C

The nurse discards the unused portion of the patient’s controlled substance medication and has another nurse witness the event; then both nurses document the transaction. The nurse follows agency policy about discarding controlled substances. Documenting the amount wasted occurs after the waste has been discarded and witnessed by another nurse. Unused portions of the patient’s medication may not be administered to another patient, even if they are kept sterile or saved for a later dose.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation a. Clarify the order with the health care provider who wrote it. b. Talk with the pharmacist who knows what is usually ordered. c. Ask a nurse who knows the health care provider to read it. d. Have a nurse interpret the written medication order.

13. The nurse is having difficulty reading a medication order. Which is the best action for the nurse to take to prevent a medication error?

ANS: A

To prevent patient injury and decrease nursing liability, the nurse clarifies illegible prescriptions and handwriting with the health care provider who wrote it. Asking the pharmacist about what is usually ordered does not reflect what may be in the current order. Asking another nurse to try to read the order doesn’t eliminate the chance of error.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning a. Add “by mouth” to the prescription for clarification. b. Clarify the administration frequency and if it is a prn or standing order. c. Clarify the dose per tablet with the pharmacist. d. Administer the dose whenever the patient requests it.

14. A prescription reads, “Aspirin 325 mg 2 tablets orally for pain.” What action does the nurse take when the patient has pain?

ANS: B

A complete prescription includes the drug name, dose, route, the frequency, and the time interval, which can be either a standing time (every 4 hours) or a prn time frame (every 4 hours, prn). The nurse speaks with the provider to clarify the frequency of administering aspirin. The nurse does not alter the prescription unless instructed by the provider, and the order already states orally. The prescriber is the person with whom the nurse must clarify the order. Aspirin is not administered whenever the patient requests it. It has a frequency of administration.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning a. Prepare the medications for several patients at the same time. b. Remove the medication from the package and take it to the patient’s room. c. Compare the packaged medication with the health care provider’s prescription. d. Take the prescribed dose into the patient’s room in the original packaging.

15. The nurse administers oral medications according to the unit-dose system. Which technique does the nurse include?

ANS: D

The nurse brings the medication to the patient in the original packaging, provides explanations and information to the patient, and opens the package at the bedside. This helps maintain safety, provides reassurance to the patient that the correct medication is being administered, and limits waste. This policy lowers the risk of contaminating the medication on the way to the patient’s room, provides a second opportunity to read the label on the medication, and facilitates patient teaching. The nurse prepares medication for one patient at a time to avoid confusion. Medication remains in the original packaging until the nurse is at the bedside. The medication administration record is compared to the provider’s original prescription.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation

Multiple Response

1. The nurse is working with a group of students and asks them to list the common causes of medication errors. Which of the following are among the common causes of medication errors? (Select all that apply.)

a. Distractions b. Illegible handwriting c. Drug product nomenclature d. Labeling errors e. Medication unavailable f. Damaged labels

ANS: A, B, C, D, E

Medication safety is a priority goal for safe nursing practice. It begins by having a thorough understanding of the medications being administer and whether patients have any drug allergies. Then it is important to follow safe preparation and administration standards, which are part of the six rights of medication administration. There are many causes of medication errors, including distractions, illegible handwriting, drug product nomenclature, labeling errors, medication unavailable, and excessive workload. Damaged labels do occur but are not one of the more common causes of medication errors.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation a. “The trough is the lowest level of drug in the blood.” b. “The peak is the highest level of drug in the blood.” c. “With IV administration, the serum level falls more slowly.” d. “Toxic concentration is when toxic effects occur.” e. “Peak levels always occur in 30 minutes.”

2. The nurse is explaining pharmacokinetic effects to a new nurse working on the unit. Which of the following statements alerts the nurse that a good level of understanding has been achieved? (Select all that apply.)

ANS: A, B, D

Pharmacokinetics affects how much of a drug dose reaches the site of action. The goal in administering a medication is to achieve a constant blood level within a safe therapeutic range. The toxic concentration is the level at which toxic effects occur. When a medication is administered repeatedly, its serum level fluctuates between doses. The highest level is called the peak concentration and the lowest level is the trough concentration. After peaking, the serum concentration falls progressively. With IV infusions, the peak concentration occurs quickly, but the serum level also begins to fall immediately. Each medication reaches its peak at different times.

DIF: Cognitive Level: Evaluating OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Evaluation a. Assess the medication plan. b. Review the orders for accuracy and validity. c. Prepare the correct medication. d. Deliver them to the nursing unit. e. Adjust incorrect medication orders.

3. The nurse is describing the role of the pharmacist in medication administration. Which of the following are correct? (Select all that apply.)

ANS: A, B, C, D

Pharmacists assess the medication plan and ensure that orders are valid. The pharmacist is then responsible for preparing the correct medications and delivering them to the nursing unit where they are stocked in a medication administration station. If there are errors, the pharmacist consults with the health care provider who wrote the order to have those errors corrected.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation

Completion

1. The provider prescribes aluminum hydroxide gel 2 ounces. The nurse has aluminum hydroxide in 30-mL containers in the patient’s medication drawer. How many containers does the nurse administer to the patient? _______ containers.

ANS: 2 two

The nurse administers two containers at 30 mL per container because 1 ounce = 30 mL. The prescription calls for aluminum hydroxide 60 mL; thus, to administer 60 mL, the nurse needs two containers.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation

2. The patient is to receive 750 mg of a medication. The pharmacy sent 500-mg scored tablets. How many tablets does the nurse administer? The nurse administers _____ tablets.

ANS: 1 1/2

The nurse administers 1 1/2 tablets = 500 mg + 250 mg = 750 mg. The nurse calculates the dosage with a proportion equation.

Cross-multiply and divide: 1  750 = 500x Solve for x: 750 ÷ 500 = 1 1/2 tablets

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation

3. The dose ordered for the patient is 37.5 mg intramuscularly (IM). How many milliliters of the medication does the nurse administer from a 100-mg/2-mL syringe? Administer _____ mL.

ANS: 0.75

The nurse administers 0.75 mL of a 2-mL syringe containing 100 mg and uses a proportion equation to calculate the dosage.

Cross-multiply and divide: 37.5  2 = 100x Solve for x: 75 ÷ 100 = 0.75 mL

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning

4. The nurse needs to administer 1000 mcg of a medication and has 1-mg tablets. How many tablets does the nurse administer? Administer _____ tablet.

ANS: 1 one

The nurse administers 1 tablet, because 1 mg = 1000 mcg.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation

5. The nurse needs to administer 2 tsp of a medication to the patient. How much of the medication does the nurse administer? _____ mL.

ANS: 10 1 tsp = 5 mL; 2  5 mL = 10 mL.

DIF: Cognitive Level: Applying OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning

6. The nurse needs to administer a medication to a toddler who weighs 20 kg. The dosage is 50 mg/kg/day in two divided doses, and the medication is available as an elixir at 25 mg/mL. How many milliliters of medication will the nurse administer at each scheduled dose? The nurse administers _____ mL each dose.

ANS: 20

First calculate the daily dose in milligrams per day.

Then calculate how many milliliters of elixir to administer daily.

Finally calculate the dosage at each scheduled time with two doses/day.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Physiological Integrity

TOP: Nursing Process: Planning