N212-Safe Medication Administration and Dosage Exam Latest Updated

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A nurse gives a medication without checking the medication administration record (MAR) When the nurse documents the medication given, the nurse notices that the medication was also given 15 minutes ea... rlier by another nurse, resulting in the client receiving a double dose. The nurse notifies a supervisor and a physician of the event. Which action should the nurse who administered the second medication dose expect? a. Assignment of fewer clients at one time b. Disciplinary action to the first nurse for giving the first dose c. Disciplinary action possibly including suspension or termination d. Completion of a variance (incident) report that would be reviewed by management - ANSWER ANSWER: D The nurse who made the error should expect the completion of a variance report with review by management. A complete review of the situation needs to occur, including the type of medication, dose, outcome of the client, and steps of medication administration, including documentation. The nurse should not expect a change in client assignments. Although disciplinary action varies by organization, generally a pattern of incompetent actions must be demonstrated for suspension or termination. ➧Test-taking Tip: Use the process of elimination. Focus on the professional responsibility of the nurse. Look for the strategic words "variance" and "reviewed." Heparin Lab - ANSWER aptt or ptt or anti-xa lab for warfarin/comadin - ANSWER INR Order for Nitro - ANSWER 0.4mg SL x3 per 5 min until pain stops What if order is 1/150th of a grain 60mg = 1grain Fluids in order of osmolarity - ANSWER 0.45% NS, D5W, D10W, LR, 0.9% NS, D5LR, D5 0.9%, 2% Give dopamine 2mcg per kg per minute. Available is Dopamine 200mg in 250 mls of NS. The patient weighs 60kg. What flow rate will be set on the pump to the nearest tenth of a ml - ANSWER 9ml/hr A nurse is caring for a 12 month old child who has been admitted to a pediatric unit for dehydration secondary to vomiting and diarrhea/ The toddler weighs 22 lb. The toddler is to receive D5 1/2 NS with 20 MEQ KCL at 4ml/kg/hr. The nurse should set the pump to deliver ___ ml per hr - ANSWER 40 *common question What would you look up if you were unsure of the medication? - ANSWER What it is Safe dose/route What does it do Why are they taking it Interactions SE How do you know if its working Know which medication is used for maintenance vs sliding scale - ANSWER A nurse, checking newly written physician orders, determines that which orders require the nurse to contact the physician to clarify the order? SELECT ALL THAT APPLY. a. Aspirin 325 mg orally qd b. MS 4 mg IV q2hr prn c. Furosemide (Lasix®) 40 mg IV now d. D5W with 20 mEq KCL IV at 124 mL/hr (volume) e. Heparin 5,000 u subcutaneously bid - ANSWER ANSWER: A, B, D, E The abbreviations "qd," "MS," and "u" are disallowed by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]). Responses C and D are incorrect choices because these responses have the essential components of a medication order—medication name, dose, frequency, and route—and use of acceptable abbreviations. D is missing amount of fluid to give. ➧ Test-taking Tip: Read each order carefully to identify the disallowed abbreviations. Make sure each medication was the drug name, route, quantity, and time Before a child's hospital discharge, a nurse is teaching the parents how to administer an oral medication to the child. Which nurse instruction would be most appropriate? a. Administer the medication and then follow it with a small glass of milk b. Give the child a flavored ice pop just before the medication (numb taste buds) c. Tell the child that the medication will taste good d. Open all capsules and mix the contents with applesauce - ANSWER ANSWER: B The cold from the ice pop will help to numb the taste buds and weaken the taste of the medication. Options A, C, and D are incorrect. Essential foods, such as milk, should be avoided because the child may later refuse the food that he/she associates with the medicine. If the child is old enough, warn the child that the medication is objectionable, but then praise the child after the medication is swallowed. Some capsules are extended release and should not be opened. Milk can also decrease absorption. ➧ Test-taking Tip: Note the key words "most appropriate." Recall that cold has a numbing effect. Therefore, select option 2. A nurse is evaluating whether a client on multiple oral medications is taking the medications correctly. Which finding should be most concerning to the nurse because the absorption rate of medications can be increased? a. Taking afternoon oral medications with a carbonated soft drink b. Drinking a glass of milk with the tetracycline antibiotic oral medication c. Taking morning oral medications with water and consuming 2,500 mL of water daily d. Taking mealtime oral medication with a meal low in fiber and high in fatty foods - ANSWER ANSWER: A Carbonated beverages can cause oral medications to dissolve faster, be neutralized, or experience a change in absorption rate in the stomach. When dairy products are taken with an antibiotic, such as tetracycline, there is decreased drug absorption in the stomach. Medications should be taken with a full glass of water. Foods low in fiber and high in fat will delay stomach emptying and medication absorption by up to 2 hours. ➧ Test-taking Tip: Focus on key words "most concerning" and the focus of the question: increases rate of absorption. Then use the process of elimination to select option 1. Although options 2 and 4 are concerning, these do not increase medication absorption rate. A nurse is administering multiple anticonvulsant medications to children. For which medication should a nurse teach the parents about ensuring that their child has good oral care to prevent gingival hyperplasia? a. Carbamazepine (Tegretol®) b. Valproic acid (Depakene®) c. Phenobarbital d. Phenytoin (Dilantin®) - ANSWER ANSWER: D About 20% of people taking phenytoin have gingival hyperplasia. This can be minimized with thorough oral care. Gingival hyperplasia is unique to phenytoin among antiepileptic medications and is not a side effect of carbamazepine, valproic acid, or phenobarbital. ➧ Test-taking Tip: Apply knowledge of medication side effects to answer this question. A nurse receives an order to administer hydroxyzine (Vistaril®) 25 mg intramuscularly (IM) to a client. Before injecting the medication, which statements should the nurse make to the client? SELECT ALL THAT APPLY. a. "You will feel minimal pain at the injection site." b. "Expect to experience relief from nausea within about 10 minutes." c. "You will feel me pull the skin to the side at the site before I inject the medication." d. "Tense your muscle as I make the injection to avoid focusing on the injection itself." e. "I will select your deltoid muscle because use of the muscles with turning increases absorption." f. "You will feel a cold sensation as I cleanse your skin with the alcohol swab." - ANSWER ANSWER: C, F Hydroxyzine is an antiemetic and sedative/hypnotic. The injection can be extremely painful, so it is administered by the Z-track IM method. In the Z-track method, the skin is pulled away from the injection site, the injection made, the medication is administered, and the nurse waits 10 seconds before the needle is withdrawn and the skin is released. The skin is disinfected with alcohol prior to administration, which will feel cool when applied. Medications administered by the IM route generally take 15 to 30 minutes to become effective. Tensing muscles increase pain. A large muscle such as the ventrogluteal, not the deltoid muscle, should be used for the injection. Literature suggests the ventrogluteal site is safer than the dorsogluteal site for intramuscular injections. ➧ Test-taking Tip: Note the issue of the question, an IM injection of hydroxyzine. Apply knowledge of IM injections and hydroxyzine to answer this question A clinic nurse is administering HepB (hepatitis B vaccine) intramuscularly to a newborn prior to hospital discharge. Which site is best for the nurse to plan to administer the injection? a. Deltoid b. Ventrogluteal c. Dorsogluteal d. Vastus lateralis - ANSWER ANSWER: D The anterolateral thigh muscle is recommended as the site for HebB administration for neonates (age less than 1 month). The deltoid and dorsogluteal muscles are not well-developed in neonates. Although 0.5 mL of medication can be administered into the ventrogluteal muscle of neonates, it is not a recommended site. ➧ Test-taking Tip: Think about the largest muscle in neonates before reviewing the options. The key word is "best." An experienced nurse is supervising a new nurse caring for a hospitalized child who is receiving intravenous (IV) therapy. Which action should indicate to the experienced nurse that the new nurse needs additional orientation regarding IV therapy for children? a. Determines that the current solution has been infusing for 24 hours and should be changed b. Selects a 1,000 mL bag of the prescribed IV solution and checks it against the orders c. Prepares new tubing and the prescribed IV solution 1 hour before it is due to be changed d. Removes the plastic cover, spikes the bag with the tubing spike, and squeezes the drip chamber - ANSWER ANSWER: B IV solutions in 250- and 500-mL containers should be selected to guard against circulatory overload. IV solutions are considered medications and errors in administration can have negative consequences. IV solutions open longer than 24 hours are no longer considered sterile. Tubing is changed every 72 to 96 hours, depending on agency policy. The procedure for spiking the bag is correct. The bag could be either hung first or after being spiked. IV can be spiked up to 1hr before administration. ➧ Test-taking Tip:The key words are "needs additional orientation." Read each option carefully to determine which option has the greatest potential for producing harm. A nurse receives the following medication orders while caring for multiple clients. Which medication should the nurse plan to administer first? a. Nitroglycerin (Nitrostat®) 0.4 mg sublingually (SL) stat for the client experiencing chest pain b. Morphine sulfate 4 mg intravenously (IV) now for the client experiencing incisional pain c. Lorazepam 2 mg IV now for the client experiencing restlessness and picking at tubing d. One unit packed red blood cells stat for the client with a hemoglobin of 9.5 g - ANSWER ANSWER: A Nitroglycerin increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic areas of the heart. Increasing collateral blood flow reduces anginal pain and the potential of myocardial infarction. This action has the greatest potential of changing client outcomes and can be performed more quickly than the other actions. Both morphine and lorazepam are controlled substances, requiring the nurse to retrieve and sign these out from a secure location. Administering IV medications takes longer than SL medications. Obtaining blood from the blood bank will take longer than the time it takes to administer a SL medication. Blood usually only if hgb <7 ➧ Test-taking Tip: Use the ABCs (airway, breathing, circulation) and the time it takes to implement each action to establish the priority. Because nitroglycerine affects the circulatory system, this action should be first. A nurse is caring for a woman who was admitted at 25.2 weeks gestation in preterm labor. The woman received nifedipine (Procardia®) but continued having contractions. The nurse is now administering magnesium sulfate. Which assessment findings indicate that the woman is experiencing an adverse effect from the magnesium sulfate? SELECT ALL THAT APPLY. a. Shortness of breath b. Nausea c. Hypertension d. Dizziness e. Hypotension f. Insomnia - ANSWER ANSWER: A, B, D, E Women receiving magnesium sulfate may encounter hypotension, shortness of breath, nausea, and dizziness. Hypertension and insomnia are not commonly associated with magnesium sulfate, and they also are not side effects of nifedipine. Hypotension is more common with nifedipine. Hold for decreased DTR ➧ Test-taking Tip:The key words are "adverse effects." Think about the effect of magnesium on cells. Note that options 3 and 5 are opposites; eliminate one of these A client admitted with unstable angina is started on intravenous heparin and nitroglycerin. The client's chest pain resolves, and the client is weaned from the nitroglycerin. Noting that the client had a synthetic valve replacement for aortic stenosis 2 years ago, a physician writes an order to restart the oral warfarin (Coumadin®) 5 mg at 1900 hours. Which is the nurse's best action? a. Administer the warfarin as prescribed. b. Call the physician to question the warfarin order. c. Discontinue the heparin drip and then administer the warfarin. d. Hold the dose of warfarin until the heparin has been discontinued. - ANSWER ANSWER: A Both heparin and warfarin are anticoagulants, but their actions are different. Oral warfarin requires 3 to 5 days to reach effective levels. It is usually begun while the client is still on heparin. Calling the physician is unnecessary. The nurse's scope of practice does not permit altering medication orders. The nurse should neither discontinue the heparin nor hold the warfarin without a written order. ➧ Test-taking Tip: Use the process of elimination to eliminate options 3 and 4, which alter medication orders, because these are not within the nurse's scope of practice. Of the two remaining options, focus on the action of heparin and warfarin. Recall that warfarin takes 3 to 5 days to reach therapeutic effectiveness, during which time the client will continue to require anticoagulation. A nurse administers a usual morning dose of 4 units of regular insulin and 8 units of NPH insulin at 0730 to a client with a blood glucose level of 110 mg/dL. Which statements regarding the client's insulin are correct? a. The onset of the regular insulin will be at 0745 and the peak at 1300. b. The onset of the regular insulin will be at 0800 and the peak at 1000. c. The onset of the NPH insulin will be at 0800 and the peak at 1000. d. The onset of the NPH insulin will be at 1230 and the peak at 2330. - ANSWER ANSWER: B The onset of regular insulin (short-acting) is one-half to 1 hour, and the peak is 2 to 4 hours. The onset of NPH insulin (intermediate acting) is 1 to 2 hours, and the peak is 6 to 10 hours. All other options have incorrect medication onset and peak times. ➧ Test-taking Tip: Apply knowledge of insulin onset and peak times. Which instructions should the nurse provide to a client regarding diabetes management during stress or illness? SELECT ALL THAT APPLY. a. Notify the health-care provider if unable to keep fluids or foods down. b. Test finger stick glucose levels and urine ketones daily and keep a record. c. Continue to take oral hyperglycemic medication and/or insulin as prescribed. d. Supplement food intake with carbohydrate containing fluids, such as juices or soups. e. When on an oral agent, administer insulin in addition to the oral agent during the illness. f. A minor illness, such as the flu, usually does not affect the blood glucose and insulin needs. - ANSWER ANSWER: A, C An acute or minor illness can evoke a counterregulatory hormone response resulting in hyperglycemia, thus the client should continue medications as prescribed. If the client is unable to eat due to nausea and vomiting, dehydration can occur from hyperglycemia and the lack of fluid intake. Blood glucose should be checked every 4 hours when ill and the ketones tested every 3 to 4 hours if the glucose is greater than 240 mg/dL. The client should supplement the diet with carbohydrate-containing fluids only if eating less than normal due to the illness. Insulin may or may not be necessary; it is based on the client's blood glucose level. ➧ Test-taking Tip: Focus on the counterregulatory hormone response during an illness that causes hyperglycemia. A health-care provider (HCP) adds a second medication for blood pressure control for a client whose blood pressure has not been well-controlled with one antihypertensive medication. If the HCP orders the following medication combinations, which combination should the nurse question? a. Atenolol (Tenormin®) and metoprolol (Lopressor®) b. Metolazone (Zaroxolyn®) and valsartan (Diovan®) c. Captopril (Capoten®) and furosemide (Lasix®) d. Bumetanide (BUmex®) and diltiazem (Cardizem®) - ANSWER ANSWER: A When two medications are used to treat hypertension, each medication should be from different drug classifications. Atenolol and metroprolol are both beta-adrenergic blockers and would essentially have the same mechanism of action. Metolazone is a thiazide-like diuretic, and valsartan is an angiotensin II receptor blocker (ARB). Captopril is an angiotensinconverting enzyme (ACE) inhibitor, and furosemide is a loop diuretic. Bumetanide is a loop diuretic, and diltiazem is a calcium channel blocker. ➧ Test-taking Tip: Recall that beta blockers end in "lol." Use this as a cue to identify the two medications that are within the same drug classification and would be inappropriately prescribed. A nurse is assessing a client who is taking atorvastatin (Lipitor®). For which manifestations should the nurse specifically assess? a. Constipation and hemorrhoids b. Muscle pain and weakness c. Fatigue and dysrhythmias d. Flushing and postural hypotension - ANSWER ANSWER: B Atorvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) used to lower lipid levels. Statins can cause muscle tissue injury manifested by muscle ache or weakness. Muscle injury can progress to myositis (muscle inflammation) or rhabdomyolysis (muscle disintegration). Additional SE of statins is confusion and decreased UO. Bile acid sequestrants may cause constipation and hemorrhoids because they are not absorbed from the small intestine. Diarrhea, not constipation, is a side effect of statin medications. Side effects of niacin, a lipid-lowering agent, include flushing, dysrhythmias, and postural hypotension. ➧ Test-taking Tip:The key words are "specifically assess." The nurse should be monitoring for side effects. Select the option that includes the side effect for the HMG-CoA reductase inhibitors (statins). A nurse is caring for a group of clients all in need of pain medication. The nurse has determined the most appropriate pain medication for each client based on the client's level of pain. Prioritize the order in which the nurse should plan to administer the pain medication beginning with the analgesic for the client with the most severe pain. a. ___ Ketorolac (Toradol) 10 mg oral b. ___Fentanyl (Sublimaze®) intravenously per patient-controlled analgesia with a bolus dose c. ___Hydromorphone (Dilaudid®) 5mg oral d. ___Morphine sulfate 4 mg IV - ANSWER a. _4__ Ketorolac (Toradol) 10 mg oral b. _1__Fentanyl (Sublimaze®) intravenously per patient-controlled analgesia with a bolus dose c. _3__Hydromorphone (Dilaudid®) 5mg oral d. _2__Morphine sulfate 4 mg IV The most potent of the medications is fentanyl (Sublimaze®), an opioid narcotic analgesic that binds to opiate receptors in the central nervous system (CNS), altering the response to and perception of pain. A dose of 0.1 to 0.2 mg is equivalent to 10 mg of morphine sulfate. Morphine sulfate is also an opioid analgesic. Hydromorphone, another opioid analgesic, would be third in priority. The oral dosing of this medication would indicate that the client's pain is less severe than the client receiving fentanyl or morphine sulfate. Hydromorphone 7.5 mg oral is an equianalgesic dose to 30 mg of oral morphine or 10 mg parenteral morphine. Ketorolac is a NSAID and nonopioid analgesic that inhibits prostaglandin synthesis, producing peripherally mediated analgesia. Propoxyphene is last in priority. It also binds to opiate receptors in the CNS but is used in treating mild to moderate pain. It has analgesic effects similar to acetaminophen. ➧ Test-taking Tip: Focus on ordering the medications starting with the most potent opioid analgesics and ending with the nonopioid analgesic. [Show More]

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