Chapter 10: Parenteral Administration: Safe Preparation of Parenteral Medications My Nursing Test Banks

Chapter 10: Parenteral Administration: Safe Preparation of Parenteral Medications

Test Bank

MULTIPLE CHOICE

1. Which part of the syringe contains the calibrations for drug volume measurement?

a.

Plunger

b.

Tip

c.

Luer Lok

d.

Barrel

ANS: D

The barrel contains the calibrations necessary for measurement. The plunger, the tip, and the Luer Lok do not have the calibrations indicated on them.

DIF: Cognitive Level: Knowledge REF: p. 141 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

2. Which needle will the nurse use to administer an intramuscular (IM) immunization on an 18 month old child?

a.

18-gauge, 1 inch needle

b.

20-gauge, 1/2 inch needle

c.

27-gauge, 1 1/2 inch needle

d.

25-gauge, 1/2 inch needle

ANS: C

The most appropriate needle gauge for pediatric IM injections is a 25- or 27-gauge, 1 1/2 inch needle. An 18 gauge, 1 inch needle is too short and too large in diameter for pediatric injections. A 20-gauge, 1/2 inch needle is too short and too large in diameter for pediatric injections. A 25-gauge, 1/2 inch needle is too short for pediatric IM injections.

DIF: Cognitive Level: Application REF: p. 145 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. Which syringe will the nurse use to administer insulin subcutaneously to a patient?

a.

A syringe calibrated in minims

b.

A syringe calibrated in units

c.

A syringe calibrated in tenths of mL

d.

A syringe calibrated in mL

ANS: B

A syringe calibrated in units is used for insulin. A tuberculin syringe is not properly calibrated for use with insulin. A syringe calibrated in mL or in tenths of mL would not be an accurate way to measure insulin doses.

DIF: Cognitive Level: Comprehension REF: p. 143 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which action by the nurse is most accurate when drawing up medication from an ampule?

a.

Consider the rim of the ampule as sterile.

b.

Use a filter needle to withdraw the medication.

c.

Wrap a paper towel around the neck of the ampule before breaking it.

d.

Inject 0.5 mL of air into the ampule before withdrawing the medication.

ANS: B

Filtered needles are used to withdraw the medication and then changed before administration of the injection. The rim of the ampule is considered to be contaminated because of the possible presence of broken glass. Paper towels do not protect the nurse from broken glass. The ampule is not airtight, so no air needs to be injected into it before removing the medication.

DIF: Cognitive Level: Application REF: p. 150 OBJ: 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which action by the nurse is accurate when withdrawing medication into a syringe from a vial?

a.

Inject an amount of air equal to the medication into the vial.

b.

Break the thin neck of the vial container.

c.

Remove the rubber stopper on the top of the vial.

d.

Discard the initial 0.5 mL of medication to ensure sterility.

ANS: A

An equal amount of air is first injected into the vial to help displace the needed medication upon withdrawal. Vials are not meant to be broken at the neck. Removal of the rubber stopper on a vial is unsafe and not recommended. Medication should not be discarded because it is sterile as long as the vial is airtight and has not been contaminated.

DIF: Cognitive Level: Application REF: p. 153 OBJ: 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

6. An adult patient is to receive two medications IM. Which action by the nurse is most important in order to mix the medications in one syringe?

a.

Assess for the presence of adequate muscle mass.

b.

Ensure that the combined medication amount is less than 2 mL.

c.

Determine the compatibility of the medications.

d.

Use a needle that is 25 gauge.

ANS: C

Compatibility is determined to prevent a reaction between the mixed medications. This is important once the medication will be administered, but first it needs to be determined that the medications can be mixed. IM injections in the adult can exceed 2 mL. A 25-gauge needle is not appropriate for an IM injection.

DIF: Cognitive Level: Analysis REF: p. 153 OBJ: 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. The nurse is preparing to administer insulin. What does U 100 indicate?

a.

100 mL per unit

b.

10 units per mL

c.

100 units per mL

d.

10 units per 100 mL

ANS: C

U 100 means 100 units per mL.

DIF: Cognitive Level: Comprehension REF: p. 143 OBJ: 3 | 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

8. After teaching a diabetic patient about proper disposal of used syringes and needles, which statement by the patient indicates a need for further teaching?

a.

Even needles with sleeves should be disposed of appropriately.

b.

It is unusual that anyone could get a needle injury or disease from used needles.

c.

It is important for me to use the designated container to dispose of my syringes and needles.

d.

I am going to purchase the Sharps by Mail Disposal System once I am home.

ANS: B

The patient needs more education because injury from needlesticks and transfer of pathogens is a health concern. It is accurate that even needles with sleeves should be disposed of appropriately and that a designated container to dispose of syringes and needles should be used. The patient should be encouraged to purchase the Sharps by Mail Disposal System.

DIF: Cognitive Level: Application REF: p. 140 | pp. 146-147

OBJ: 1 TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which nursing action is accurate when administering parenteral medication?

a.

Adjust the route of the medication, if needed.

b.

Document the response to PRN medications at the end of the shift.

c.

Request the pharmacist to provide education about the medication to the patient.

d.

Use clinical judgment when rescheduling missed doses of a medication.

ANS: D

The nurse must exercise clinical judgment about the scheduling of new drug orders, missed dosages, modified drug orders or substitution of therapeutically equivalent medicines by the pharmacy, or changes in the patients condition that require consultation with the physician, health care provider, or pharmacist. Adjusting the route is not within the role of the nurse. Documenting the response to PRN medications at the end of the shift is not an acceptable timeframe. Educating the patient about the medication is within the nurses role.

DIF: Cognitive Level: Application REF: p. 140 OBJ: N/A

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

10. What is an advantage of administering a drug parenterally?

a.

The duration of action is longer.

b.

Medications given by this route are inexpensive.

c.

The onset of action is more rapid.

d.

The dose is usually larger than an oral dose.

ANS: C

The onset of drug action is generally more rapid but of shorter duration. Duration of action is not affected by administering a drug parenterally. Parenteral administration can be expensive. The dose of parenteral medications is typically smaller than an oral dose.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

11. Which information provided by the nurse is most important to include when teaching a patient about the use of an EpiPen?

a.

Hold the syringe at a 45-degree angle against the skin.

b.

Monitor the expiration date of this medication.

c.

After using the EpiPen, lie down for 1 hour.

d.

Place the syringe in a cartridge prior to using.

ANS: B

It is important to monitor the expiration date of this medication on a regular basis. The syringe is held perpendicular to the skin. The patient should go to the emergency department after use of an EpiPen. Placing the syringe into a cartridge is not accurate for use of an EpiPen.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

12. Which type of parenteral medication container is made of glass, is scored, and needs to be broken open before withdrawing the medication?

a.

Ampule

b.

Carpuject

c.

Mix-O-Vial

d.

Vial

ANS: A

Ampules are glass containers that need to be broken open before withdrawing medication. Carpujects are prefilled syringes. Mix-O-Vial containers have two compartments for mixing medications and are not scored. Vials are glass or plastic containers that are not broken open.

DIF: Cognitive Level: Knowledge REF: p. 149 OBJ: 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The operating room (OR) nurse is preparing medications for use in a sterile field during a surgical procedure. While preparing these medications, the nurse will:

a.

save unused portions of medication for use in another procedure.

b.

differentiate between sterile and nonsterile medications to be used in the OR.

c.

ensure the scrub (sterile) nurse retrieves the medication from storage.

d.

read the label aloud for verification against the order from the surgeon.

ANS: D

It is best to read the label aloud to ensure that both individuals are verifying the contents against the verbal order from the surgeon. Unused portions of medication should not be saved for use in another procedure. All medication during an operative procedure must remain sterile. The circulating (nonsterile) nurse retrieves the medication from storage.

DIF: Cognitive Level: Application REF: p. 155 OBJ: 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

14. The mother of a 6-year-old child informs the school nurse that the child is allergic to insect stings and requires an EpiPen. If the child is stung by an insect while in school, the nurse must:

a.

hold the EpiPen perpendicularly against the thigh and activate.

b.

provide additional care in the nurses office prior to sending the child back to class.

c.

call the physician prior to administration.

d.

provide a second dose within 2 minutes following initial dose.

ANS: A

When held perpendicularly against the thigh and activated, the needle of the EpiPen penetrates the skin and a single dose of epinephrine is injected into the muscle. Once the epinephrine is administered, the person should go to a hospital emergency department because additional treatment may be necessary. The physician does not have to be notified prior to administration. A second dose should not be provided at this time.

DIF: Cognitive Level: Application REF: p. 144 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

15. Which principle(s) is/are correct for mixing insulin? (Select all that apply.)

a.

Insulin orders and calculations must be checked with another nurse.

b.

Air is injected into the vial of the shorter acting insulin first.

c.

The longer acting insulin is drawn up first.

d.

The nurse must verify the compatibility of the insulin types.

e.

Withdraw the shorter acting insulin first.

ANS: A, D, E

Two nurses should verify orders and prepared insulin amounts to prevent inaccuracy in administration. When two medications are mixed in the same syringe, compatibility must be determined. The shorter acting insulin is withdrawn first and air is injected into the longer acting insulin first.

DIF: Cognitive Level: Application REF: p. 153 OBJ: 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which risk factor(s) should be considered when administering medications by injection? (Select all that apply.)

a.

Trauma at the site of the needle puncture

b.

Possibility of infection

c.

Irretrievability of the medication once administered

d.

Delayed absorption

e.

Delayed onset of action

f.

Chance of allergic reaction

ANS: A, B, C, F

Injecting medications involves risk for trauma, infection, and allergic reaction and increases the difficulty of treating adverse reactions or errors because of the inability to retrieve the medication. Delayed absorption and onset of action are not risks of injecting medications.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: N/A

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. When preparing parenteral medications, the nurse should perform which intervention(s)? (Select all that apply.)

a.

Check the expiration date.

b.

Use sterile technique throughout the entire procedure.

c.

Check the drug dose form ordered against the source available.

d.

Prepare the drug in a clean well lighted area.

e.

Check calculations.

ANS: A, C, D, E

The standard procedure for preparing all parenteral medications includes checking the expiration date on the medication container, checking the drug dose form ordered against the source available, preparing the drug in a clean well lighted area, and checking calculations for accuracy. Aseptic technique is used at times during preparation. The primary rule is sterile to sterile and unsterile to unsterile.

DIF: Cognitive Level: Application REF: p. 150 OBJ: 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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