Chapter 7: Principles of Medication Administration and Medication Safety
Test Bank
MULTIPLE CHOICE
1. Where would the procedures and treatments directed by the health care provider be found?
a.
Summary sheet
b.
Physicians order form
c.
Physicians progress notes
d.
History and physical examination form
ANS: B
The physicians order form contains all procedures and treatments ordered by the health care provider. A summary sheet provides a brief overview of the hospital course at discharge. Physicians progress notes provide regular observations on the patients course of treatment and response. A history and physical examination form provides information about baseline information from the patient.
DIF: Cognitive Level: Knowledge REF: p. 80 OBJ: 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
2. Which action will the nurse take when it is determined that the narcotic count is incorrect while obtaining a medication from the narcotic area?
a.
Determine the cause of the discrepancy at the end of the shift.
b.
Notify the health care provider stat.
c.
Call the nurse from the previous shift to determine if there was a discrepancy earlier.
d.
Report the discrepancy to the charge nurse immediately.
ANS: D
Reporting the discrepancy to the charge nurse immediately enables the supervisory staff to narrow the time frame during which a medication was taken and not documented. The discrepancy needs to be addressed immediately, and therefore determining the cause of the discrepancy at the end of the shift is not the most appropriate action for the nurse to take. It is not appropriate to contact the health care provider for an incorrect narcotic count. The count would have been verified at shift change; calling the nurse from the previous shift is not an appropriate action for the nurse to take.
DIF: Cognitive Level: Analysis REF: p. 95 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
3. Which action will the nurse take if a dosage is unclear on a health care providers order?
a.
Ask the patient what dosage was given in the past.
b.
Ask another physician to determine the correct dosage.
c.
Tell the patient that the medication will not be given.
d.
Contact the health care provider to verify the correct dosage.
ANS: D
Any questionable orders should be verified by the health care provider who wrote the orders. The patient is not a reliable source of verification. The physician who wrote the order should verify it. It would be a medication error to withhold the dose instead of verifying it.
DIF: Cognitive Level: Application REF: p. 99 OBJ: 5
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
4. What is the most reliable method to calculate a pediatric patients medication dosage?
a.
Age
b.
Height
c.
Body surface area (BSA)
d.
Placement on a growth scale
ANS: C
The most reliable method is by proportional amount of BSA or body weight. Because of the differences in weight among children, age is not a reliable method. Because of the differences in height among children, this is not a reliable method. Placement on a growth scale identifies how the child corresponds to other children on a percentile. Although it is determined by a specific measurement, the percentile identified would not be a specific measurement; therefore, this is not a reliable method.
DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: 10
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5. Which medication route provides the most rapid onset of a medication, but also poses the greatest risk of adverse effects?
a.
Intradermal
b.
Subcutaneous (subcut)
c.
Intramuscular (IM)
d.
Intravenous (IV)
ANS: D
IV medications are delivered directly into the bloodstream and avoid the first pass effect of the liver. Intradermal, subcut, and IM administration have a slower absorption rate.
DIF: Cognitive Level: Knowledge REF: p. 102 OBJ: 10
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
6. Which is known as the fifth vital sign?
a.
Temperature
b.
Respirations
c.
Pain
d.
Pulse
ANS: C
Pain is known as the fifth vital sign.
DIF: Cognitive Level: Knowledge REF: p. 86 OBJ: 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7. Which is true regarding the unit dose drug distribution system?
a.
The inventory is delivered to each nursing unit on a regular and recurring basis.
b.
The system delivers one dose of each medication to be administered until the subsequent delivery of inventory.
c.
The use of single dose packages of drugs dispensed to fill each dose requirement as it is ordered.
d.
The amount of inventory needed to dose all patients on the unit for a 24 hour interval.
ANS: C
The unit dose drug distribution system uses single unit packages of drugs dispensed to fill each dose requirement as it is ordered.
DIF: Cognitive Level: Comprehension REF: p. 93 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
8. The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally. Which is true regarding the substitution of this medication to suppository form?
a.
It is standard practice when the patient is unable to take the ordered medication.
b.
It is acceptable if the patient agrees to the altered route form.
c.
It is preferable to having the patient miss a dose of the medication.
d.
It is contraindicated without an order from the health care provider.
ANS: D
One dosage form of medication should never be substituted for another unless the prescriber is consulted; there can be a great variation in the absorption rate of the medication through different routes of administration. The substitution of one form for another is not standard practice, and is not acceptable or preferable without the prescribers order.
DIF: Cognitive Level: Application REF: p. 99 OBJ: N/A
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
9. Which medication order requires nursing judgment and means administer if needed?
a.
Morphine 4 mg IV stat
b.
Morphine 4 mg IV prior to procedure
c.
Morphine 4 mg IV four times a day
d.
Morphine 4 mg IV every 4 hours PRN
ANS: D
PRN indicates for the nurse to administer morphine every 4 hours if needed and requires nursing judgment. Stat means the dose of morphine would be given immediately, not as needed. The orders for the dose of morphine to be given prior to the patients scheduled procedure and four times a day, do not indicate to give the dose as needed.
DIF: Cognitive Level: Comprehension REF: p. 89 | p. 97 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
10. What is medication reconciliation?
a.
Comparing the patients current medication orders to all of the medications actually being taken
b.
The administration of high alert medications that have been ordered on admission to an acute care facility
c.
The completion of an incident report following a variance that resulted in a serious complication
d.
A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered
ANS: A
Medication reconciliation is the process of comparing a patients current medication orders to all of the medications that the patient is actually taking. Administering high alert medications and completing an incident report are not the same as medication reconciliation. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered is a description of the medication administration record (MAR), not a description of medication reconciliation.
DIF: Cognitive Level: Knowledge REF: p. 98 OBJ: 4 | 9 | 10
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
11. Which example best demonstrates safe drug administration by the nurse?
a.
Administering an oral medication with the patient sitting upright
b.
Asking children to say their name before administering the medication
c.
Leaving the medications on the bedside stand after verifying patient identification
d.
Returning the unused portion of a medication to a stock supply bottle
ANS: A
Sitting the patient upright for oral medications is safe medication practice. Children should never be asked their names as a means of positive identification. Remaining with a patient until the drug is swallowed is safe practice. Returning an unused portion of medication to the stock supply bottle is not safe medication practice.
DIF: Cognitive Level: Application REF: p. 103 OBJ: 10
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
12. The nurse determines that a prescribed medication has not been administered as ordered on the previous shift. What action will the nurse take?
a.
Administer the medication immediately.
b.
Complete an incident report.
c.
Notify the nurse responsible for the error.
d.
Record the occurrence in the nurses notes.
ANS: B
An incident report is completed when a medication error occurs. Depending on the medication and frequency of administration, the medication may not be given immediately. It is not the nurses responsibility to notify another nurse of the error. Medication errors are not recorded in the nurses notes.
DIF: Cognitive Level: Application REF: p. 100 OBJ: 6 | 11
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
13. A patients liquid cough medicine has been discontinued with one half of the bottle remaining. The home health nurse is aware that according to the U.S. Food and Drug Administration (FDA) guidelines on prescription medication disposal, the next step should be to:
a.
save the remainder for another patient with the same prescription.
b.
flush the remainder down the toilet.
c.
read the drug label for specific disposal instructions.
d.
pour remaining medication into a hazardous waste container.
ANS: C
The nurse must follow specific disposal instructions on the drug label or in the patient information leaflet that accompanies the medication. Prescription medications should not be shared among patients. Prescription drugs should not be flushed down the toilet unless specifically instructed to do so by the manufacturer. The first action to be taken is to follow disposal instructions on the label. If the drug label indicates it should be emptied into a hazardous waste container, measures should be taken to prevent leaking and/or accidental ingestion.
DIF: Cognitive Level: Analysis REF: p. 96 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity
MULTIPLE RESPONSE
14. Who defines the standards of care for the practice of nursing? (Select all that apply.)
a.
State boards of nursing
b.
Hospital policy and procedures
c.
Federal laws regulating health care facilities
d.
The Joint Commission
e.
Professional nursing associations
ANS: A, C, D, E
Standards of care are defined by state boards of nursing, federal laws regulating health care facilities, The Joint Commission, and professional nursing associations such as the American Nurses Association. Individual hospital policies and procedures incorporate federal and state guidelines into their respective policies and procedures and are often more stringent than state and federal regulations.
DIF: Cognitive Level: Knowledge REF: p. 79 | p. 91 | p. 92
OBJ: 1 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
15. What must the nurse have before administering any medication? (Select all that apply.)
a.
A current license to practice
b.
A medication order signed by a practitioner licensed with prescription privileges
c.
Knowledge of the medication
d.
Consultation with a pharmacist
e.
Knowledge of the clients diagnosis
ANS: A, B, C, E
Physicians must be licensed to prescribe medications; nurses must be licensed to administer medications. Safe medication administration includes knowledge of the medication, pathophysiology of patient diagnoses, and pharmacodynamics of the ordered medication on the pathophysiology. It is not necessary for the nurse to consult with a pharmacist each time medication is to be administered to a patient.
DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 1
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
16. Which advantage(s) does the unit dose drug distribution system include? (Select all that apply.)
a.
There is decreased participation by the pharmacy.
b.
The pharmacist is able to analyze prescribed medications for each client for drug interactions and contraindications.
c.
There is less waste of medications.
d.
The time spent by nursing personnel preparing these medications is increased.
e.
Credit is given to the patient for unused medications.
ANS: B, C, E
Because the pharmacist has a profile of all medications for each patient, he or she is able to analyze prescribed medications for each patient for drug interactions and contraindications. This is an advantage of the unit dose drug distribution system. Less waste of medications is an advantage of the unit dose drug distribution system. Because each dose is individually packaged, credit can be given to the patient for unused medications. There is increased pharmacist involvement and better use of his or her extensive drug knowledge and nursing personnel time is decreased with this method.
DIF: Cognitive Level: Knowledge REF: p. 93 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
17. Which statement(s) is/are true regarding the types of medication orders? (Select all that apply.)
a.
Stat orders are the same as single dose orders.
b.
Standing orders indicate the number of specified doses of a medication to be given.
c.
Renewal orders facilitate physician review before continuance of high risk medications.
d.
PRN medications will designate a mandatory number of times the medication is to be administered.
e.
Verbal orders should be used as much as possible.
ANS: B, C
Standing orders state the frequency of medication dosages to be administered or indicate the time frame of administration. Renewal orders require the physician to review medications that have expired orders, as determined by facility policy. Renewal policies facilitate physician verification of the necessity to continue a medication beyond a usual time frame and help ensure patient safety. Single dose and stat orders are not the same. PRN medications are not ordered a mandatory number of times, although a maximum number might be specified. Verbal orders should be avoided whenever possible.
DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: 8
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
18. Which statement(s) is/are true regarding computerized prescriber order entry (CPOE)? (Select all that apply.)
a.
Integrates the ordering system with the pharmacy, laboratory, and nurses stations
b.
Provides instant access to online information to facilitate patient care needs
c.
Facilitates review of ordered medications for potential drug interactions
d.
Facilitates review of drugs for appropriateness of dosages
e.
Alleviates the need to perform mathematical computations
ANS: A, B, C, D
CPOE systems integrate patient information, provide instant access, facilitate review of ordered medications for potential drug interactions, and facilitate review of drugs for appropriateness of dosages. Alleviation of the need to perform mathematical computations is not a component of the CPOE system.
DIF: Cognitive Level: Knowledge REF: p. 92 OBJ: 8
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity; Safe, Effective Care Environment
19. Which lab test(s) would be used to assess liver and/or renal function before administering medications? (Select all that apply.)
a.
CBC
b.
LDH
c.
ALT
d.
Crs
e.
BUN
f.
aPTT
ANS: B, C, D, E
Liver function tests include LDH (lactic dehydrogenase) and ALT (alanine aminotransferase). Renal function tests include Crs (serum creatinine) and BUN (blood urea nitrogen). Although a CBC (complete blood count) and an aPTT are useful in assessing the patient before administration of medication, they are not renal or hepatic function tests.
DIF: Cognitive Level: Knowledge REF: p. 101 OBJ: N/A
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
20. The nurse is preparing to administer Lanoxin to a patient on the telemetry unit. In addition to understanding the patients diagnosis, the nurse must also know which characteristic(s) of the medication? (Select all that apply.)
a.
Chemical composition
b.
Adverse effects
c.
Expected actions
d.
Contraindications for use
e.
Usual dosing
ANS: B, C, D, E
The nurse must understand the individual patients diagnosis and symptoms that correlate with the rationale for drug use. The nurse should also know why a medication is ordered, expected actions, usual dosing, proper dilution, route and rate of administration, adverse effects, and contraindications for the use of a particular drug. It is not required that the nurse know the chemical composition of the medication prior to administration.
DIF: Cognitive Level: Application REF: p. 80 OBJ: 5
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity
21. The nurse transcribes an order to administer Valium 10 mg IV stat. This order is correctly interpreted by the nurse to mean it should be provided how? (Select all that apply.)
a.
As needed
b.
Immediately
c.
One time only
d.
In divided doses
e.
Intravenously
ANS: B, C, E
The stat order is generally used on an emergency basis. It means that the drug is to be administered as soon as possible, but only once. IV indicates the route is intravenous. A PRN order means administer if needed. The order would specify divided doses and amount per dose if indicated.
DIF: Cognitive Level: Analysis REF: p. 80 OBJ: 8
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
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