Administering Medications

1.A registered nurse for more than 15 years was concerned when she learned that her hospital was going to let unlicensed nursing assistants start IVs on patients. The nurse knew this was in violation of the scope of nursing practice in her state. Which of the following organizations defines the scope of nursing’s professional functions and responsibilities?

a.
The US Food and Drug Administration (FDA)
b.
The MedWatch program
c.
Employee assistance programs (EAP)
d.
State Nurse Practice Acts

ANS: D

State Nurse Practice Acts have the most influence over nursing practice because they define the scope of nurses’ professional functions and responsibilities. The primary intent of state Nurse Practice Acts is to protect the public from unskilled, undereducated, and unlicensed nurses. The FDA ensures that all medications on the market undergo rigorous review before allowing manufacturers to distribute them to the public. In 1993, the FDA instituted the MedWatch program. This voluntary program encourages nurses and other health care professionals to report when a medication, product, or medical event causes serious harm to a patient. Mandatory reporting is required for medication manufacturers, distributors, and packers. A wide variety of programs to help people who abuse medications are offered through an institution’s employee assistance program (EAP), the State Board of Nursing, and community agencies.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:378 | 379

OBJ: Discuss legal responsibilities in medication prescription and administration.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2.A 34 year old has been on morphine for 6 months after back surgery and has gone to multiple health care providers to obtain prescriptions. Which term best describes this situation?

a.
Medication dependence
b.
Medication abuse
c.
Medication misuse
d.
Medication underuse

ANS: B

Medication abuse happens when patients repeatedly use an addictive substance (e.g., opioids or alcohol). Medication dependence happens when a patient experiences withdrawal symptoms when the medication is stopped abruptly. Medication misuse includes overuse, underuse, erratic use, and contraindicated use of medications. Patients of all ages misuse medications. Some people use medications for purposes other than their intended effect. Medication underuse occurs when people use medications less than the amount intended when symptoms subside

PTS:1DIF:Cognitive Level: Applying (Application)

REF:379

OBJ: Discuss legal responsibilities in medication prescription and administration.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3.A patient calls to say that he is unable to pay for the medication from a specific manufacturer that was prescribed. The health care provider gives another name for the medication and suggests the patient look for this name instead. The new name was probably which of the following?

a.
Generic
b.
Trade
c.
Chemical
d.
Proprietary

ANS: A

The trade or brand name (e.g., Tylenol) is the name under which a manufacturer markets a medication. The trade name has the symbol ® to the upper right of the name, indicating that the manufacturer has registered the medication’s name. Acetaminophen is an example of a generic name. It is the generic name for Tylenol. A medication sometimes has as many as three different names. A medication’s chemical name is an exact description of the medication’s composition and molecular structure. In clinical practice, health care workers rarely use chemical names. An example of a chemical name is N-acetyl-para-aminophenol, which is commonly known as Tylenol. The manufacturer who first develops the medication gives the generic or nonproprietary name with United States Adopted Names Council (USANC) approval. The generic name becomes the official name that is listed in publications such as the United States Pharmacopeia (USP).

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:379

OBJ: Discuss legal responsibilities in medication prescription and administration.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4.A patient is unable to swallow pain medication following oral surgery. What would be the appropriate form of the medication to use to administer the drug using the rectal route?

a.
Tablet
b.
Elixir
c.
Capsule
d.
Suppository

ANS: D

Medications are available in a variety of forms or preparations. The form of the medication determines its route of administration. Manufacturers make many medications in several forms, such as tablets, capsules, elixirs, and suppositories. Suppositories are solid dosage form mixed with gelatin and shaped in the form of a pellet for insertion into a body cavity (rectum or vagina). A suppository melts when it reaches body temperature, allowing the medication to be absorbed. A tablet is a powdered medication compressed into a hard disk or cylinder and designed to be taken orally. An elixir is a clear fluid containing water and alcohol; designed for oral use; usually sweetener has been added. A capsule is medication encased in a gelatin shell and taken orally.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:379 | 380 | 385

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5.A 12-year-old patient has undergone knee surgery. She has an order for pain medication, which can be given by several different routes. Which of the following routes of administration will provide the fastest pain relief?

a.
Transcutaneous
b.
Intravenous
c.
Oral
d.
Rectal

ANS: B

Intravenous (IV) injection produces the most rapid absorption because medications given in this route are immediately absorbed into the systemic circulation. When you place medications on the skin (transcutaneous), absorption is slow because of the physical makeup of the skin. The body also absorbs oral medications at a slow rate because these medications have to pass through the gastrointestinal (GI) tract. The body absorbs medications through the mucous membranes (rectal and buccal) and respiratory airways quickly because these tissues contain many blood vessels, but the intravenous route is fastest.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:379 | 380

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP:Nursing Process: Implementation

MSC: NCLEX: Safe and Effective Care Environment

6.The nurse is preparing oral medications for a patient. In preparing these medications the nurse is aware of which of the following?

a.
Acidic medications are absorbed slowly by the gastric mucosa.
b.
Alkaline medications are absorbed rapidly by the gastric mucosa.
c.
Solutions and suspensions are more difficult to absorb than capsules.
d.
Alkaline medications are absorbed in the small intestine.

ANS: D

The ability of an oral medication to dissolve depends largely on its formulation or preparation. Acidic medications are absorbed in the gastric mucosa rapidly, whereas medications that are alkaline are not absorbed until reaching the small intestine. Solutions and suspensions are already in a liquid state and are easier for the body to absorb than tablets or capsules.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 380 | 381 OBJ: Describe the physiological mechanisms of medication action.

TOP:Nursing Process: Assessment

MSC: NCLEX: Safe and Effective Care Environment

7.A nurse is caring for a patient with kidney disease. The nurse needs to make more focused assessments when administering medications to this patient because the patient may experience problems with the process of:

a.
excretion.
b.
absorption.
c.
distribution.
d.
metabolism.

ANS: A

The kidneys are the main organs that excrete medications. Some medications escape extensive metabolism and exit unchanged in the urine. Other medications undergo biotransformation in the liver before the kidneys excrete them. If renal function declines, a patient is at risk for medication toxicity. Absorption refers to the passage of medication molecules into the blood from the site of administration. Medication is distributed within the body to tissues and organs to specific sites. After the medication reaches its site of action, it becomes metabolized (biotransformation).

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 380 | 381 OBJ: Discuss factors that influence medication actions.

TOP:Nursing Process: Assessment

MSC: NCLEX: Safe and Effective Care Environment

8.The nurse is preparing to give an intramuscular (IM) injection of pain medication. The nurse prepares this medication knowing which of the following?

a.
Intramuscular (IM) medications are absorbed faster than subcutaneous medications.
b.
Medication absorption is faster with subcutaneous medications.
c.
Blood supply to the subcutaneous tissue is richer than to muscle.
d.
Muscle tissue has a less developed vascular system than subcutaneous tissue.

ANS: A

The blood supply to the site of administration determines how quickly the body absorbs a drug. Sites with rich blood supplies absorb medications more quickly. For example, the body absorbs a medication administered in the muscle (intramuscular [IM] route) faster than a medication administered in the subcutaneous tissue (subcutaneous route) because the blood supply to muscle is richer than the blood supply to subcutaneous tissue.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:381

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9.A nurse is working with the pharmacist to determine when a patient’s medications should be given. Several medications are due to be given in the morning. What is the most important reason to appropriately schedule the patient’s medications?

a.
Some medications are absorbed more quickly on an empty stomach.
b.
All medications are hindered by the presence of gastric contents.
c.
If given at the same time, all medications will be absorbed at the same rate.
d.
The nurse must schedule medications to fit the pharmacy’s schedule.

ANS: A

Some oral medications are absorbed more quickly on an empty stomach; other medications are unaffected by gastric contents. In addition, some medications interfere with the absorption of other medications if given at the same time. A nurse uses knowledge about the factors that alter or impair absorption of medications to develop a medication administration schedule that ensures optimal absorption of patients’ drugs.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 381 OBJ: Discuss factors that influence medication actions.

TOP:Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10.A patient is hospitalized with a central nervous system infection that needs to be treated with water-soluble antibiotics. The medications will be instilled into the subarachnoid space via an epidural catheter. Why is this the best route of administration for this patient?

a.
Intravenous water-soluble antibiotics cannot pass through the blood-brain barrier.
b.
Only water-soluble medications can pass into the brain and cerebrospinal fluid.
c.
Older patients better tolerate lipid soluble medications than younger patients.
d.
Lipid soluble medications are safer for patients who are pregnant.

ANS: A

To be distributed to an organ, a medication needs to pass through all the biological membranes of that organ. Some membranes serve as barriers to the passage of medications. For example, the blood-brain barrier allows only lipid-soluble medications to pass into the brain and cerebrospinal fluid. Therefore central nervous system (CNS) infections sometimes require treatment with antibiotics injected directly into the subarachnoid space in the spinal cord. Older patients often experience adverse effects (e.g., confusion) because they experience a change in the permeability of the blood-brain barrier, which enhances the passage of fat-soluble medications into the brain. Lipid-soluble, nonionized drugs easily cross the placenta and can cause serious harm to the fetus.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:381

OBJ: Describe factors to consider when choosing routes of medication administration.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11.Which of the following patients is most at risk for theophylline toxicity due to decreased biotransformation ability?

a.
A 45-year-old man with renal insufficiency
b.
A 59-year-old man with chronic obstructive airway disease
c.
A 53-year-old woman who smokes and has asthma
d.
A 49-year-old woman with chronic obstructive airway disease and hepatitis

ANS: D

Biotransformation occurs when enzymes detoxify (remove toxic qualities), degrade (break down), and remove biologically active chemicals. Most biotransformation occurs within the liver, although the lungs, kidneys, blood, and intestines also metabolize medications. The liver is especially important because its specialized structure oxidizes and transforms many toxic substances. The liver degrades many harmful chemicals before they become distributed to the tissues. If a decrease in liver function occurs, such as with aging or liver disease, the body slowly eliminates a medication, resulting in a buildup of the medication. When organs that metabolize medications do not function correctly, patients are at risk for medication toxicity.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 381 OBJ: Discuss factors that influence medication actions.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12.Which of the following patients is most at risk for digoxin toxicity resulting from impaired excretion?

a.
A 56-year-old man with coronary artery disease
b.
A 24-year-old woman with cystic fibrosis
c.
A 53-year-old woman with renal disease
d.
A 57-year-old man with a hemorrhagic stroke

ANS: C

The kidneys are the main organs that excrete medications. Some medications escape extensive metabolism and exit unchanged in the urine. Other medications undergo biotransformation in the liver before the kidneys excrete them. If renal function declines, a patient is at risk for medication toxicity.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 381 OBJ: Discuss factors that influence medication actions.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13.A woman has been prescribed a daily iron supplement by her health care provider. She recently became constipated, most likely related to the iron supplement. Which of the following best describes this response?

a.
Therapeutic effect
b.
Adverse reaction
c.
Side effect
d.
Toxicity

ANS: C

A side effect is a predictable and often unavoidable secondary effect produced at a usual therapeutic dose. Each medication has a therapeutic effect, the intended or desired physiological response of a medication. Undesired, unintended, and often unpredictable responses to medication are referred to as adverse effects. Toxic effects are capable of causing injury or death. They often develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:382-383

OBJ: Compare and contrast the different types of medication effects and reactions.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14.A postoperative patient is receiving morphine sulfate from a patient-controlled analgesia device. On assessment, the nurse notes that the patient’s respirations are depressed. The nurse realizes the effect of morphine sulfate infusion can be labeled as which of the following?

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

ANS: A

Toxic effects are capable of causing injury or death. They often develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. When patients become immunologically sensitized to a medication after taking at least one dose, allergic reactions occur. When a patient’s immune system causes abnormal reactions to a medication, the patient has a medication allergy. Each medication has a therapeutic effect, the intended or desired physiological response of a medication. Some medications cause unpredictable effects, such as idiosyncratic reactions, in which a patient overreacts or underreacts to a medication or has a reaction different from what is expected.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:382-383

OBJ: Compare and contrast the different types of medication effects and reactions.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15.A patient states that aspirin upsets her stomach. This is known as a(n):

a.
allergic response.
b.
toxic effect.
c.
idiosyncratic reaction.
d.
side effect.

ANS: D

A side effect is a predictable and often unavoidable secondary effect produced at a usual therapeutic dose. Toxic effects are capable of causing injury or death. They often develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Some medications cause unpredictable effects, such as idiosyncratic reactions, in which a patient overreacts or underreacts to a medication or has a reaction different from what is expected. Sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath all characterize severe or anaphylactic reactions.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:382-383

OBJ: Compare and contrast the different types of medication effects and reactions.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16.A postoperative patient is undergoing antibiotic therapy. She has never had any problems taking medications in the past. When the nurse hung the second dose of IV antibiotics, the patient suddenly developed shortness of breath and had difficulty breathing. The nurse recognized this was most likely a(n):

a.
idiosyncratic reaction.
b.
toxic effect.
c.
side effect.
d.
anaphylactic reaction.

ANS: D

Sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath characterize severe or anaphylactic reactions. In anaphylaxis a patient becomes severely hypotensive, necessitating emergency resuscitation measures. Some medications cause unpredictable effects, such as idiosyncratic reactions, in which a patient overreacts or underreacts to a medication or has a reaction different from what is expected. Toxic effects are capable of causing injury or death. They often develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. A side effect is a predictable and often unavoidable adverse effect produced at a usual therapeutic dose.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:382-383

OBJ: Compare and contrast the different types of medication effects and reactions.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17.The nurse is medicating the patient daily with warfarin (Coumadin). The patient is having blood levels drawn daily to determine the dose needed. The nurse realizes that the goal is to reach which of the following?

a.
The minimum effect concentration (MEC) in the plasma
b.
Reach the peak concentration level of the medication
c.
The level that falls between the MEC and toxic level
d.
An adequate trough level in the plasma

ANS: C

The goal of medication therapy is to achieve a constant, therapeutic level, which falls between the MEC and the toxic concentration. As patients take medication doses over time, the plasma level of the medication fluctuates constantly between doses. The minimum effect concentration (MEC) is the plasma level below which a patient does not experience the effect of a medication. The peak concentration is the highest plasma level, whereas the trough concentration is the lowest plasma level.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 383 | 384 OBJ: Describe the physiological mechanisms of medication action.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18.A patient with a respiratory infection asks the nurse why some antibiotics are prescribed to be taken every 12 hours and some have to be taken 4 times a day. What is the nurse’s bestresponse?

a.
“The time between doses changes because any medication’s half-life varies so much.”
b.
“We need to vary the times to keep the blood values fluctuating.”
c.
“We try to give the next dose of medication only after the last dose is gone.”
d.
“Regular doses are given based on the half-life to maintain a therapeutic plateau.”

ANS: D

All medications have a biologic half-life, which is the time it takes for the body to lower the amount of unchanged medication by half. A drug with a short half-life (e.g., 2 to 3 hours) needs to be given more frequently than a drug with a longer half-life (e.g., 10 to 12 hours). A medication’s half-life does not change with the dose of the medication; its half-life is always the same no matter how much medication is administered. To maintain a therapeutic plateau, a patient receives regular fixed doses at specific intervals that correspond with their half-life. The goal of medication administration is to achieve a therapeutic plateau, a point at which the blood level of a medication remains consistent. After an initial medication dose, the patient receives each successive dose when the previous dose reaches its half-life.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 384 OBJ: Describe the physiological mechanisms of medication action.

TOP:Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19.A patient has an order for a subcutaneous injection of insulin. The nurse will prepare to give this injection into which of the following tissues?

a.
Into a large muscle
b.
Into the connective tissue beneath the dermis
c.
Into a vein using a pump
d.
Between the epidermis and dermis

ANS: B

Subcutaneous = injection into tissues just below the dermis of the skin

Intramuscular (IM) = injection into a muscle

Intravenous (IV) = injection into a vein

Intradermal (ID) = injection into the dermis just under the epidermis

Insulin could be given into a vein using an infusion pump, but the question states it is an injection. Insulin should not be given into an artery.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:386

OBJ:List the six rights of medication administration and implement their use in clinical practice.TOP:Nursing Process: Implementation

MSC:NCLEX: Integrity: Pharmacological and Parenteral Therapies

20.A patient’s health care provider wrote a prescription for an antibiotic for an upper respiratory infection. According to safe medication practice standards, the nurse should transcribe the order as which of the following?

a.
.5 mg
b.
5.0 mg
c.
mg
d.
0.5 mg

ANS: D

Follow practice standards when medications are ordered to prevent medication errors. For example, to make the decimal point more visible, a leading zero is always placed in front of a decimal (e.g., use 0.5, not .5). On the other hand, do not use a trailing zero, a zero after a decimal point, because if a health care worker does not see the decimal point, the patient may end up receiving 10 times more medication than what is prescribed (e.g., use 5 not 5.0). Always give fractions in decimal form.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:387

OBJ: Identify and implement nursing actions that prevent medication errors.

TOP:Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

21.A nurse working in a clinic is teaching a patient how much cough syrup to take. The cough syrup comes in a 250-mL bottle, and the dosage is 10 mL every 4 hours. How many teaspoons should she instruct the patient to take?

a.
1
b.
2
c.
3
d.
4

ANS: B

When the accuracy of a medication dose is not critical, it is safe to use household measures. For example, you can safely measure many OTC medications by this method. In this case 5 mL = 1 teaspoon, so 10 mL would equal 2 teaspoons.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:387

OBJ:List the six rights of medication administration and implement their use in clinical practice.TOP:Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

22.A nurse is working in a newborn special care unit that has numerous premature infants. She recently transferred to this unit from an adult intensive care unit. The nurse is very cautious in administering medications because premature newborns are especially vulnerable to medication errors. Why is this true?

a.
Premature infants excrete urine more quickly than older infants.
b.
Premature infants metabolize medications more quickly than older children.
c.
Premature infants require more frequent dosing to achieve desired effects.
d.
Premature infants have less mature livers and kidneys.

ANS: D

A child’s age, weight, and maturity of body systems affect the ability to metabolize and excrete medications. For example, premature infants have underdeveloped livers and kidneys, which makes them especially susceptible to the harmful effects of medications. As children develop out of the newborn period, they metabolize medications quicker, resulting in the need for more frequent dosing of medications to achieve the medication’s desired effect.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:390

OBJ:Discuss developmental factors that influence pharmacokinetics.

TOP:Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies