Chapter 10: Principles of Drug Administration

Multiple Choice

1. Before administering any medication, which action by the nurse is most important?

a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient‘s identification and allergy bracelets

ANS: D

Checking the patient‘s identification and allergy bracelets are important for the patient‘s safety and reflects some of the six (or more) Rights of medication administration. Verifying orders with another nurse is not required; only some medications require double-checking with another nurse. Documenting the medications given or counting medications in the medication cart drawers do not affect safety.

DIF: Cognitive Level: Comprehension REF: p. 155 a. 3-mL syringe b. 1-mL tuberculin c. 2-mL tuberculin d. 2-mL syringe

2. What is the proper syringe size for an intradermal (ID) injection?

ANS: B

The proper syringe size for ID injection is a 1-mL tuberculin, or a 1-mL syringe with a 26- or 27-gauge needle that is 10 mm to 16 mm long.

DIF: Cognitive Level: Knowledge REF: p. 169 a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees

3. A patient is to receive an intramuscular (IM) injection of penicillin in the ventrogluteal site. What is the proper angle for needle insertion in an adult who is not emaciated?

ANS: D

The proper angle for IM injections is 90 degrees.

DIF: Cognitive Level: Comprehension REF: p. 168 a. Occluding the IV line by folding the tubing just above the injection port b. Clamping the tubing just above the insertion site c. Pinching the tubing just above the injection port d. Pinching the tubing at least 5 cm above the injection port

4. When the nurse is administering medication by intravenous (IV) bolus (push), which is the correct procedure?

ANS: C

Before injecting an IV push medication, occlude the IV line by pinching the tubing just above the injection port.

DIF: Cognitive Level: Comprehension REF: p. 181 a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis

5. The nurse is preparing to administer IM immunization to a 2-month-old infant. Which site is acceptable for this injection?

ANS: D

The vastus lateralis is the acceptable IM site for infants.

DIF: Cognitive Level: Comprehension REF: p. 169, Box 10-2 a. Use the Z-track method b. Insert the needle at a 5- to 15-degree angle until resistance is felt c. Pinch the skin at the injection site and inject the needle below the skin fold d. Spread the skin tightly over the injection site, insert the needle, then release the skin

6. The nurse is administering insulin subcutaneously to a patient who is obese. Proper technique for this injection requires the nurse to do which?

ANS: C

The proper technique for admNiniR steriIng G a suBbc . uC taneMous injection to a patient who is obese is to pinch the skin at the site and inject the needle below the skin fold at a 90-degree angle.

DIF: Cognitive Level: Comprehension REF: p. 171 a. When the medication is known to be irritating to tissues b. When the patient is emaciated and has very little muscle mass c. When the medication must be absorbed quickly into the tissues d. When the patient is obese and has a deep fat layer below the muscle mass

7. When should the nurse administer IM medication with the Z-track method?

ANS: A

The Z-track method should be used for medications known to irritate tissues. This method prevents the deposit of medication through sensitive tissues and reduces pain, irritation, and staining at the injection site.

DIF: Cognitive Level: Application REF: p. 172 a. Apply heat b. Massage the area c. Report the bleb to the physician d. Do nothing

8. After administering an ID injection for a skin test, the nurse notices a small bleb at the injection site. What is the proper action for the nurse to take?

ANS: D

The formation of a small bleb is expected after an ID injection for skin testing. It is normal to feel resistance, and a bleb that resembles a mosquito bite (about 6 mm in diameter) will form at the site if accurate technique is used.

DIF: Cognitive Level: Comprehension REF: p. 170 a. Flush the lock. b. Regulate the IV flow. c. Clamp the tubing for 10 minutes. d. Hold the patient‘s arm up to improve blood flow.

9. What important action should the nurse take after administering an IV push medication through an IV lock?

ANS: A

IV locks are to be flushed before and after each use. Either a heparin or saline flush is used, depending on the particular institution‘s policy. Regulating the IV flow, clamping the tubing for 10 minutes, or holding the patient‘s arm up to improve blood flow are not appropriate actions.

DIF: Cognitive Level: Comprehension REF: p. 179 a. Shaking the bag or bottle vigorously b. Holding the bag or bottle and gently turning it end to end c. Inverting the bag or bottle just once after injecting the medication d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication

10. Which is the proper method of mixing IV solutions and medications?

ANS: B

When adding medications to IV fluid containers, mix the medication and the IV solution by holding the bag or bottle and gently turning it end to end.

DIF: Cognitive Level: Comprehension REF: p. 177 a. Use a teaspoon to measure and administer the elixir. b. Hold the medication cup at eye level and fill it to the desired level. c. Withdraw the elixir from the container with a syringe with a needle attached. d. Withdraw the elixir from the container with a syringe without a needle attached.

11. To measure 4 mL of a liquid cough elixir properly for a child, what should the nurse do?

ANS: D

Liquid medication volumes of less than 5 mL should be withdrawn in a syringe without a needle. To prevent accidental ingestion of the needle during administration of the liquid, never use a needle to draw up oral medication; never withdraw the elixir from the container with a syringe with a needle attached. Using a teaspoon to measure and administer liquid medication or holding the medication cup at eye level and filling it to the desired level are not accurate methods for measuring small volumes.

DIF: Cognitive Level: Comprehension REF: p. 160

12. The nurse is helping a patient to take his medications; however, the medication cup falls to the floor, spilling the contents. The appropriate action for the nurse to take is to a. discard the medications and repeat the preparation. b. document the client‘s refusal of the medications. c. wait until the next dosage time, then give the medications. d. retrieve the medications and administer them to avoid waste.

ANS: A

Medications that fall onto the floor need to be discarded, and the procedure must be repeated with new medications.

DIF: Cognitive Level: Application REF: p. 157 a. Encourage the patient to swallow if necessary. b. Administer water after the medication has been given. c. Place the medication between the upper molar teeth and cheek. d. Place the tablet under the client‘s tongue, and allow the tablet to dissolve completely.

13. The patient is to receive a buccal medication. Which action is appropriate for the nurse to take?

ANS: C

Buccal medications are properly placed between the upper or lower molar teeth and the cheek. Caution the patient against swallowing, and do not administer with water. Medications given under the tongue are said to be sublingually administered.

DIF: Cognitive Level: Comprehension REF: p. 159 a. Administer the medication with a small medication syringe. b. Apply gentle pressure on the syringe‘s piston to infuse the medication. c. Flush the tubing with 30 mL of saline after the medication has been given. d. Using the barrel of the syringe, allow the fluid to flow via gravity into the NG tube.

14. How should the nurse administer medication through a nasogastric (NG) tube?

ANS: D

For NG tubes, medications are poured into the barrel of the syringe with the piston removed, and fluid is allowed to flow via gravity into the tube. Never force any fluid into the tube. Flush the tubing with 30 mL of tap water to ensure that the medication is cleared from the tube.

DIF: Cognitive Level: Comprehension REF: p. 162 a. Having the patient lie on the right side of the body, unless contraindicated b. Having the patient hold the breath during insertion of the medication c. Lubricating the suppository with a small amount of petroleum-based lubricant d. Encouraging the patient to lie on the left side of the body for 15 to 20 minutes after insertion

15. Which technique should the nurse use to facilitate the administration of a rectal suppository?

ANS: D

For rectal suppository insertion, the patient should be positioned on the left side of the body. Lubricate the suppository with a small amount of water-soluble lubricant, have the patient take a deep breath and exhale through the mouth during insertion, and then have the patient remain lying on the left side for 15 to 20 minutes to allow absorption of the drug.

DIF: Cognitive Level: Application REF: p. 162 a. Wiping off excess liquid immediately after instilling drops. b. Having the patient close the eye tightly after instilling drops. c. Having the patient close the eye, then moving the eye around to help distribute the medication. d. Applying gentle pressure to the patient‘s nasolacrimal duct for 30 to 60 seconds after instilling drops.

16. What is the best action for the nurse to take to reduce systemic effects after administering eye drops?

ANS: D

When administering drugs that cause systemic effects, protect your finger with a clean tissue, then apply gentle pressure to the patient‘s nasolacrimal duct for 30 to 60 seconds.

DIF: Cognitive Level: Comprehension REF: p. 182 a. Administering the drops without altering the ear canal direction. b. Straightening the ear canal by pulling the lobe upward and back. c. Straightening the ear canal by pulling the pinna down and back. d. Straightening the ear canN al byRpuIllinG g thB e . piC nnaMupward and outward.

17. What is the proper technique for administering ear drops to a 2-year-old child?

ANS: C U S N T O

For an infant or a child younger than 3 years, straighten the ear canal by pulling the pinna down and back. For adults, pull the pinna up and outward.

DIF: Cognitive Level: Comprehension REF: p. 182 a. Repeat subsequent puffs, if ordered, after 5 minutes. b. Inhale slowly while pressing down to release the medication. c. Inhale quickly while pressing down to release the medication. d. Administer the inhaler while holding it 7.5 to 10 cm away from the mouth.

18. A patient with asthma is to begin medication therapy with a metered-dose inhaler. What important reminder should the nurse include during teaching sessions with the patient?

ANS: B

The patient should position the inhaler at the open mouth with the inhaler 3 to 5 cm away from the mouth, attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, the patient presses down on the inhaler to release the medication while inhaling slowly, waiting 1 to 2 minutes between puffs.

DIF: Cognitive Level: Application REF: p. 184 a. Bending the syringe to prevent reuse b. Recapping needles to prevent needlestick injury c. Discarding all syringes and needles in a wastebasket d. Discarding all syringes and needles in a puncture-resistant container

19. Which action is considered a standard precaution for medication administration?

ANS: D

Standard precautions include wearing clean gloves when there is potential exposure to a patient‘s blood or other body fluids. Discard all disposable syringes and needles in an appropriate puncture-resistant container. Never bend needles or syringes, never recap needles, and never discard syringes and needles in wastebaskets.

DIF: Cognitive Level: Application REF: p. 156, Box 10-1 a. Break the tablet into halves or quarters. b. Dissolve the tablet in a small amount of water before giving it. c. Do not crush or break the tablet before administration. d. Use a mortar and pestle to crush the tablet if crushing it is needed to ease administration.

20. The patient states that he prefers chewing rather than swallowing pills. The label on the container of one prescribed pill has the abbreviation ―SR‖ after the name of the medication. Which instruction should be followed when giving this medication?

ANS: C

In order to protect the gastrointestinal lining and the medication itself, sustained-release (SR) pills, enteric-coated tablets, and capsules should not be crushed before administration.

DIF: Cognitive Level: Application REF: p. 157 a. ―You will need to blow yNourRnosI e beGforeBI.gCiveMyou this medication.‖ b. ―You will need to blow your nose after I give you this medication.‖ c. ―When I give you this medication, you will need to hold your breath.‖ d. ―You should sit up for 5 minutes after you receive the nasal spray.‖

21. When preparing to administer nasal spray, what should the nurse tell the patient?

ANS: A

The patient will need to blow the nose before the medication is administered, because the nasal passages should be cleared before receiving nasal spray. Blowing the nose after receiving the medication will remove the medication from the nasal passages. The patient should receive the spray while inhaling through the open nostril. Afterwards, the patient should remain in a supine position for 5 minutes.

DIF: Cognitive Level: Application REF: p. 183

Multiple Response

1. The nurse is preparing to give an IM injection to an average-sized adult male. Which statement applies to an IM injection? (Select all that apply.)

(Your answer should appear as lowercase letters separated by a comma and a space as follows: a, b, c, d) a. A 6- to 13-mm ( to inch) 26- or 27-gauge needle should be chosen. b. A 13- to 16-mm ( to -inch) 25-gauge needle should be chosen. c. A 38-mm ( inch) 21- to 25-gauge needle should be chosen. d. A site at least 5 cm away from the umbilicus should be selected. e. The dorsogluteal site is the preferred site for IM injections. f. The ventrogluteal site is the preferred site for IM injections. g. The needle should be inserted at a 45-degree angle. h. The needle should be inserted at a 90-degree angle.

ANS: C, F, H

Choose a 38-mm 21- to 25-gauge needle for an IM injection. The ventrogluteal site is preferred for IM injections; insert the needle at a 90-degree angle. Some agencies recommend that all IM injections be given by the Z-track method. Before administering the injection, pull back on the plunger and check for blood return.

DIF: Cognitive Level: Analysis REF: pp. 172-173