Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley – Test Bank

Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley – Test Bank

Chapter 09: Photo Atlas of Drug Administration

Lilley: Pharmacology and the Nursing Process, 8th Edition

MULTIPLE CHOICE

1. Before administering any medication, what is the nurse’s priority action regarding patient safety?

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 using two identifiers

ANS: D

Verifying the patient’s identity, using two identifiers, before administering any medication is essential for the patient’s safety and reflects checking one of the “Nine Rights” of medication administration. Documentation is done after the medications are given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 104-105

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

2. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection?

a.

b.

c.

d.

ANS: B

The proper size syringe for ID injection is 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: pp. 116-117

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

3. A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?

a.

15 degrees

b.

45 degrees

c.

60 degrees

d.

90 degrees

ANS: D

The proper angle for IM injections is 90 degrees. The other angles are incorrect.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 116

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?

a.

Not pinching the IV tubing at all

b.

Pinching the tubing just above the injection port

c.

Pinching the tubing just below the injection port

d.

Pinching the tubing just above the drip chamber of the infusion set

ANS: B

Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 128

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection?

a.

Deltoid

b.

Dorsogluteal

c.

Ventrogluteal

d.

Vastus lateralis

ANS: D

The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 122

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?

a.

Using the Z-track method

b.

Inserting the needle at a 5- to 15-degree angle until resistance is felt

c.

Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle

d.

Spreading the skin tightly over the injection site, inserting the needle, and then releasing the skin

ANS: C

The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the site and inject the needle to below the skin fold at a 90-degree angle.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 116

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?

a.

The medication is known to be irritating to tissues.

b.

The patient is emaciated and has very little muscle mass.

c.

The medication must be absorbed quickly into the tissues.

d.

The patient is obese and has a deep fat layer below the muscle mass.

ANS: A

The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 120

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

8. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to:

a.

apply heat.

b.

massage the area.

c.

do nothing.

d.

report the bleb to the physician.

ANS: C

The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 116

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next?

a.

Flushing the lock

b.

Regulating the IV flow

c.

Clamping the tubing for 10 minutes

d.

Holding the patient’s arm up to improve blood flow

ANS: A

IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual institution’s policy. The other actions are not appropriate.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 128

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution?

a.

Shaking the bag or bottle vigorously

b.

Turning the bag or bottle gently from side to side

c.

Inverting the bag or bottle one time after injecting the medication

d.

Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication

ANS: B

When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 124

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate?

a.

Using a teaspoon to measure and administer

b.

Holding the medication cup at eye level and filling it to the desired level

c.

Withdrawing the elixir from the container using a syringe without a needle attached

d.

Withdrawing the elixir from the container using a calibrated oral syringe

ANS: D

Small doses of liquid medications must be withdrawn using a calibrated oral syringe. A hypodermic syringe or a syringe with a needle or syringe cap must not be used. If hypodermic syringes are used, the drug may be inadvertently given parenterally, or the syringe cap or needle, if not removed from the syringe, may become dislodged and accidentally aspirated by the patient when the syringe plunger is pressed. The other methods are not accurate for small volumes.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 109

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the tablets. What is the nurse’s best action at this time?

a.

Discarding the medications and repeating preparation

b.

Asking the patient if he will take the medications

c.

Waiting until the next dose time, and then giving the medications

d.

Retrieving the medications and administering them to avoid waste

ANS: A

Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 105

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

13. When giving a buccal medication to a patient, which action by the nurse is appropriate?

a.

Encouraging the patient to swallow, if necessary

b.

Administering water after the medication has been given

c.

Placing the medication between the upper or lower molar teeth and the cheek

d.

Placing the tablet under the patient’s tongue and allowing it to dissolve completely

ANS: C

Buccal medications are properly administered 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 sublingually administered.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 106

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is giving medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct?

a.

Administering the medications using a 3-mL medication syringe

b.

Applying firm pressure on the syringe’s piston to infuse the medication

c.

Flushing the tubing with 30 mL of saline after the medication has been given

d.

Using the barrel of the syringe, allowing the medication to flow via gravity into the tube

ANS: D

For PEG tubes (and nasogastric tubes), medications are poured into the barrel of the syringe with the piston removed, and the medication is allowed to flow via gravity into the tube. Fluid must never be forced into the tube. The tubing is to be flushed with 30 mL of tap water (not saline) to ensure that the medication is cleared from the tube after the medication has been given. A 3-mL syringe is too small for this procedure.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 110

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of the rectal suppository?

a.

Having the patient lie on his or her right side, unless contraindicated

b.

Having the patient hold his or her breath during insertion of the medication

c.

Lubricating the suppository with a small amount of petroleum-based lubricant before insertion

d.

Encouraging the patient to lie on his or her left side for 15 to 20 minutes after insertion

ANS: D

Position the patient on his or her left side for rectal suppository insertion. The suppository is then lubricated with a small amount of water-soluble lubricant, not petroleum-based substances. The patient is told to take a deep breath and exhale through the mouth during insertion. Then the patient needs to remain lying on the left side for 15 to 20 minutes to allow absorption of the drug.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 111

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient is receiving eyedrops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects after administering the eyedrops?

a.

Wiping off excess liquid immediately after instilling the drops

b.

Having the patient close the eye tightly after the drops are instilled

c.

Having the patient try to keep the eye open for 30 seconds after the drops are instilled

d.

Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds after instilling the drops

ANS: D

When administering ophthalmic drugs that may cause systemic effects, one’s finger should be protected by a clean tissue or glove and gentle pressure applied to the patient’s nasolacrimal duct for 30 to 60 seconds. The other actions are not appropriate.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 130

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child?

a.

Administer the drops without pulling on the ear lobe.

b.

Straighten the ear canal by pulling the lobe upward and back.

c.

Straighten the ear canal by pulling the pinna down and back.

d.

Straighten the ear canal by pulling the pinna upward and outward.

ANS: C

In an infant or a child younger than 3 years of age, the ear canal is straightened by pulling the pinna down and back. In adults, the pinna is pulled up and outward. Pulling the lobe and administering eardrops without pulling on the ear lobe are not appropriate actions.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 131

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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

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 3 to 4 inches away from the mouth.

ANS: B

Position the inhaler to an open mouth, with the inhaler 1 to 2 inches away from the mouth, or attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, press down on the inhaler to release the medication while inhaling slowly. Wait 1 to 2 minutes between puffs if a second puff of the same medication has been ordered.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 132

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. When giving medications, the nurse will use Standard Precautions, which include what action?

a.

Bending the needle to prevent reuse

b.

Recapping needles to prevent needle sticks

c.

Discarding all syringes and needles in the trash can

d.

Discarding all syringes and needles in a puncture-resistant container

ANS: D

Standard Precautions include wearing clean gloves when there is potential exposure to a patient’s blood or other body fluids; never recapping needles; never bending needles or syringes; and discarding all disposable syringes and needles in the appropriate puncture-resistant container.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 108

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

20. A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember which correct instruction regarding how to give this medication?

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.

Crush the tablet as needed to ease administration.

ANS: C

Sustained-release (SR) and enteric-coated tablets or capsules are forms of medications that must not be crushed before administration so as to protect the gastrointestinal lining or the medication itself. Do not break, dissolve, or crush these tablets before administering.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 106

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

21. When administering nasal spray, which instruction by the nurse is appropriate?

a.

“You will need to blow your nose before I give this medication.”

b.

“You will need to blow your nose after I give this medication.”

c.

“When I give this medication, you will need to hold your breath.”

d.

“You need to sit up for 5 minutes after you receive the nasal spray.”

ANS: A

Clear the nasal passages before receiving nasal spray. Blowing one’s nose after receiving the medication will remove the medication from the nasal passages. The patient will receive the spray while inhaling through the open nostril and needs to remain in a supine position for 5 minutes afterward.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 136

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate? (Select all that apply.)

a.

Choose a 26- or 27-gauge, – to -inch needle.

b.

Choose a 22- to 27-gauge, 1- to -inch needle.

c.

Choose the dorsogluteal site, the preferred site for IM injections for adults.

d.

Insert the needle at a 45-degree angle.

e.

Insert the needle at a 90-degree angle.

f.

Before injecting the medication, withdraw the plunger to check for blood return.

ANS: B, E, F

In general, aqueous medications can be given with a 22- to 27-gauge needle, and average needle lengths for adults range from 1 to inches. Insert the needle at a 90-degree angle. Checking for blood return is also part of the technique for IM injections to prevent inadvertent administration into the bloodstream. The ventrogluteal site is the preferred site for IM injections in adults. The dorsogluteal site is to be avoided because of proximity to nerves and blood vessels.

DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 116

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

COMPLETION

1. A patient is to receive hydromorphone (Dilaudid) 1.5 mg IV push now. The medication comes in a prefilled syringe, 2 mg/mL. Identify how many milliliters will the nurse administer for this dose. _______

ANS:

0.75 mL

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies