Chapter 34: Administering Oral, Topical, and Inhalant Medications My Nursing Test Banks

Chapter 34: Administering Oral, Topical, and Inhalant Medications

Test Bank

MULTIPLE CHOICE

1. Before the nurse administers a liquid medication to an 83-year-old male patient, the nurse should:

a.

assess the swallowing reflex by offering a sip of water.

b.

ask the patient if he would prefer to give the medication to himself.

c.

mix thoroughly in applesauce or pudding.

d.

assess the ability to understand information relative to the drug.

ANS: A

A factor to consider when giving anything orally is the ability of the patient to swallow.

DIF: Cognitive Level: Application REF: p. 654, Skill 34-1

OBJ: Theory #7 TOP: Routes of Medication Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

2. The nurse receives an order to give vitamin D 10 mcg bid. The nurse recognizes that the abbreviation mcg refers to a measurement in:

a.

milligrams.

b.

milliequivalents.

c.

milliliters.

d.

micrograms.

ANS: D

The abbreviation mcg refers to a measurement of micrograms.

DIF: Cognitive Level: Knowledge REF: p. 644, Table 34-3

OBJ: Clinical Practice #4 TOP: Abbreviations

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

3. The licensed nurse who is responsible for doing the narcotic count for the shift should count the drugs:

a.

alone for accuracy.

b.

with any licensed person.

c.

with another nurse working on the shift.

d.

with a nurse coming on duty for the next shift.

ANS: D

Controlled substances must be counted by one nurse going off duty and one coming on duty at the change of each shift.

DIF: Cognitive Level: Comprehension REF: p. 648 OBJ: Theory #1

TOP: Counting Controlled Substances KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

4. Before the nurse administers a dose of digoxin (Lanoxin) to a patient, the nurse should assess:

a.

blood pressure.

b.

respiratory rate.

c.

apical heart rate.

d.

level of consciousness.

ANS: C

The apical heart rate is measured before giving a dose of digoxin (Lanoxin) to determine whether it is safe to give; the apical rate should be greater than 60 beats/min for an adult patient.

DIF: Cognitive Level: Application REF: p. 654, Skill 34-1

OBJ: Theory #7 TOP: Medication Administration

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

5. A nurse is administering oral medications to a patient who is having intake and output (I&O) measured. When giving medications, it is most important to:

a.

give the medication with a small piece of cracker or cookie.

b.

give the medication with as much fluid as possible.

c.

record the fluid taken on the MAR.

d.

record the fluid taken on the intake record.

ANS: D

When a patient is having I&O measured, the nurse must record all fluid that the patient drinks while taking medications in the oral intake column of the I&O sheet.

DIF: Cognitive Level: Application REF: p. 654, Skill 34-1

OBJ: Theory #1 TOP: Medication Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

6. An elderly patient is having difficulty swallowing an enteric-coated tablet for which there is no liquid form available. To help the patient swallow the dose more easily, the nurse should:

a.

request the patient to tilt the chin down slightly to swallow.

b.

crush the pill and administer it in applesauce.

c.

use a spoon to place the tablet at the back of the tongue.

d.

take only a small sip of water to swallow the tablet.

ANS: A

If elderly patients have difficulty swallowing, they should swallow a sip of water first, then place the tablet toward the back of the tongue, then take a large sip of water. Finally, they should place the tongue on the roof of the mouth and swallow with the chin tilted downward, followed by another sip of water. Enteric-coated medications should not be crushed.

DIF: Cognitive Level: Application REF: p. 560, Elder Care

OBJ: Theory #7 TOP: Safe Administration of Medications: Elderly

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Pharmacological Integrity: reduction of risk

7. A patient complains about the taste of the sublingual nitroglycerin and admits that he swallows it rather than holding it under his tongue. The nurse explains that sublingual medications:

a.

should not be swallowed because it alters the absorption potential.

b.

can be inserted rectally without loss of absorption potential.

c.

can be held against the roof of the mouth with the tongue to reduce taste.

d.

can be taken between the cheek and tongue to diminish taste.

ANS: A

Sublingual medications are placed under the tongue and they should not be swallowed because that alters the absorption potential.

DIF: Cognitive Level: Comprehension REF: p. 651 OBJ: Theory #1

TOP: Medication Administration: Sublingual Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

8. To reduce the systemic absorption of eye drops, the nurse should:

a.

use finger pressure to close the eyelid tightly.

b.

apply slight finger pressure over the lacrimal duct.

c.

request the patient tilt the head slightly to the side of the unaffected eye.

d.

instruct the patient to widen the eyes in order to increase access to the lacrimal duct.

ANS: B

Blocking the entrance to the lacrimal duct by placing a finger over it helps reduce systemic absorption of an eye drop.

DIF: Cognitive Level: Application REF: p. 656, Skill 34-2

OBJ: Clinical Practice #3 TOP: Medication Administration: Optic Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

9. A patient is attempting to put pills in his mouth from a medicine cup and drops one pill on the bed sheet. The nurse should:

a.

retrieve the pill from the linens and allow the patient to take it.

b.

scoop up the pill in a souffl cup and hand the cup to the patient.

c.

discard the pill and get another from the dose pack.

d.

report the loss of the pill as a medication error.

ANS: C

A pill that is dropped on the dirty linen or the floor must be discarded and replaced from the dose pack.

DIF: Cognitive Level: Application REF: p. 649, Elder Care

OBJ: Theory #1 TOP: Dropped Pill KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

10. For an adult patient who has an order to receive an otic medication, the nurse should plan to administer it by pulling the pinna:

a.

down and forward.

b.

up and forward.

c.

down and back.

d.

up and back.

ANS: D

The pinna of the adult should be pulled up and back, whereas that of a child younger than 3 years of age is pulled slightly down and back.

DIF: Cognitive Level: Application REF: p. 68, Steps 34-1

OBJ: Clinical Practice #3 TOP: Medication Administration: Otic Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

11. The nurse administering a nasal medication via an atomizer bottle should:

a.

leave the other nostril open while giving the medication.

b.

have the patient squeeze the bottle while inhaling.

c.

have the patient sit up straight.

d.

have the patient tilt the head forward.

ANS: B

The proper procedure for using an atomizer bottle is to have the head hyperextended, holding one nostril closed and squeezing the bottle and inhaling at the same time.

DIF: Cognitive Level: Application REF: p. 657 OBJ: Clinical Practice #2

TOP: Medication Administration: Nasal Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

12. A nurse is providing instructions to a patient about how to use a metered-dose inhaler. The nurse should instruct the patient to:

a.

lie down while taking the medication.

b.

gently roll the canister in the hands to mix the medication.

c.

breathe out through the mouth before positioning the canister.

d.

try to hold the breath for at least 3 seconds after inhaling the medication.

ANS: C

The patient should sit up or stand to take the medication, shake the canister to mix the medication with the propellant, breathe out through the mouth before positioning the canister, depress the cylinder, and hold the breath for at least 10 seconds before exhaling.

DIF: Cognitive Level: Application REF: p. 658 OBJ: Theory #4

TOP: Medication Administration: Inhalant Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

13. The nurse explains that the patient with a respiratory disorder can open small airways to ease respiration effort with the use of:

a.

albuterol (Proventil).

b.

montelukast (Singulair).

c.

ipratropium (Atrovent).

d.

beclomethasone (Vanceril).

ANS: A

Albuterol eases respiratory effort by opening the small airways.

DIF: Cognitive Level: Comprehension REF: p. 659, Table 34-5

OBJ: Theory #4 TOP: Use of Inhalants

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

14. A patient of the Cambodian culture reports that a new medication is not adequate for treatment because it is:

a.

colored red.

b.

a smaller size than the older medication.

c.

offered before a meal.

d.

is in liquid form.

ANS: B

Persons of Cambodian origin believe the size of the medication indicates its curative value. A small pill does not have as much curative value as a larger one.

DIF: Cognitive Level: Comprehension REF: p. 650, Cultural

OBJ: Theory #1 TOP: Medication Administration: Cultural Concerns

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

15. For easier insertion of a rectal suppository, the nurse should position the patient in the __________ position.

a.

knee-chest

b.

prone

c.

left Sims

d.

dorsal lithotomy

ANS: C

Placing the patient in the left Sims position provides for easier insertion of the suppository into the rectum.

DIF: Cognitive Level: Comprehension REF: p. 661, Steps 34-2

OBJ: Clinical Practice #6 TOP: Medication Administration: Rectal Route

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

16. A patient has an order for a nitroglycerin transdermal patch. The best way to ensure proper administration of this medication is to:

a.

apply it behind the ear.

b.

rotate sites to avoid skin irritation.

c.

place it over a hairy skin area.

d.

put the initials on patch when applied.

ANS: B

A nitroglycerin transdermal patch should be applied to an area with good circulation, such as the chest, shoulders, or upper arm, and should be placed over hairless areas, with the date and the nurses initials written on the patch. Rotating sites prevents irritation.

DIF: Cognitive Level: Application REF: p. 662, Skill 34-3

OBJ: Clinical Practice #7 TOP: Medication Administration: Transdermal Route

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

17. The nurse administering nitroglycerin ointment to a patient will:

a.

apply with gloves or tongue blade.

b.

apply in same area as the old patch.

c.

place the paste on the chest and massage it in the skin.

d.

inform the patient that the medicinal effect will take about 45 minutes.

ANS: A

The nurse should wear gloves to avoid exposure to nitroglycerin. The area of the old patch should be cleaned and the new patch placed in another area and not massaged in. The effect of the patch occurs in about 30 minutes.

DIF: Cognitive Level: Application REF: p. 662, Skill 34-3

OBJ: Clinical Practice #2 TOP: Medication Administration: Topical Route

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

18. When the nurse sees the order for Milk of Magnesia 2 tablespoons, qod, hs, the nurse translates to mean he should give:

a.

1 ounce of Milk of Magnesia every other day at bedtime.

b.

1 ounces of Milk of Magnesia every day.

c.

2 tablespoons of Milk of Magnesia whenever necessary.

d.

2 ounces of Milk of Magnesia every night.

ANS: A

The order is asking that 3 tablespoons (1 ounce) of Milk of Magnesia be given every other day at bedtime.

DIF: Cognitive Level: Analysis REF: p. 644, Table 34-3

OBJ: Theory #2 TOP: Abbreviations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

19. When administering medications to a patient with a feeding tube, the nurse should dissolve each crushed medication in at least _____ mL of water.

a.

30 to 60

b.

20 to 30

c.

15 to 20

d.

5 to 15

ANS: B

Each medication should be dissolved in 20 to 30 mL of water, which does not include the water used to flush the tube before and after giving medications.

DIF: Cognitive Level: Comprehension REF: p. 664, Skill 34-4

OBJ: Theory #8 TOP: Medication Administration: Feeding Tube

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

20. Data pertaining to a patients medication therapy that the nurse should document in the nurses notes, in addition to charting in the medication administration record (MAR), is:

a.

medication name and dose.

b.

the route of the medication.

c.

the time of the medication.

d.

medication side effects experienced.

ANS: D

Side effects of drug therapy are charted in the nurses notes.

DIF: Cognitive Level: Comprehension REF: p. 666 OBJ: Theory #3

TOP: Documentation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

21. A patient on the long-term care unit receives the wrong medication. The charge nurse should instruct which staff member to complete the incident report?

a.

The nurse who administered the wrong drug

b.

The nursing supervisor for the day

c.

The nurse who discovered the error

d.

No one, because the charge nurse should do it

ANS: C

The nurse who discovers the error reports it and fills out the incident report.

DIF: Cognitive Level: Application REF: p. 666 OBJ: Theory #8

TOP: Medication Errors KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

22. The physician writes a medication order on the order sheet of the patient. The order that includes all the necessary information is:

a.

1/5/13 @ 0900: Warfarin (Coumadin) 1 mg p.o. qd A. Physician.

b.

1/5/13 Give Warfarin 1 tab qd A. Physician.

c.

1/5/13 Coumadin 1 tab p.o. A. Physician.

d.

0900 Give warfarin (Coumadin) 1 mg p.o. A. Physician.

ANS: A

A complete drug order includes the full name of the drug, the dose to be given, the route of administration, how often the drug is to be given, and the date and time written, as well as the prescribers signature.

DIF: Cognitive Level: Analysis REF: p. 642 OBJ: Theory #1

TOP: Medication Orders KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

23. The nurse checking the MAR finds that an order for an antibiotic is now 8 days old. The nurse should:

a.

check the medications, performing three medication checks.

b.

give the ordered medication.

c.

contact the physician for a new order.

d.

give the medication, then notify the physician.

ANS: C

The nurse contacts the physician for a new order. Antibiotic orders generally have a 5- to 7-day limit before they need to be renewed.

DIF: Cognitive Level: Application REF: p. 643 OBJ: Theory #1

TOP: Expired Orders KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

24. The nurse is to administer a dissolved medication via feeding tube. After donning gloves and attaching the irrigation syringe to the tube, the nurse should next:

a.

instill the medication into the syringe slowly.

b.

draw the medication into the syringe and gently push into the tube.

c.

flush the tubing with 15 to 30 mL of tap water and add the medication just as the water is about to finish.

d.

flush the tubing with 15 to 30 mL of sterile water and add the medication just as the water is about to finish.

ANS: C

The nurse should flush the tubing with tap water and add the medication as the water is about to finish. Administration of medication into the feeding tube should be done by gravity instillation, and pressure should be applied gently only if needed to initiate flow.

DIF: Cognitive Level: Application REF: p. 664, Skill 34-4

OBJ: Theory #8 TOP: Medication Administration: Feeding Tube

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

25. When administering several medications via feeding tube, the nurse should:

a.

dilute each medication with at least 40 mL of water.

b.

mix each medication individually.

c.

mix all medications together to facilitate administration.

d.

use sterile gloves for the procedure.

ANS: B

Medications should be mixed separately to prevent clumping.

DIF: Cognitive Level: Application REF: p. 664, Skill 34-4

OBJ: Theory #8 TOP: Medication Administration: Feeding Tube

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

26. In the event of a discrepancy in the count of the narcotics between the day shift and the evening shift, the day nurse is required to:

a.

correct the count to the number of pills counted and sign full name.

b.

write a report and give it to the charge nurse with signatures of both nurses.

c.

notify the pharmacy of the discrepancy.

d.

remain on duty until the miscount is resolved.

ANS: D

The nurse of the ending shift must resolve the discrepancy before leaving the unit.

DIF: Cognitive Level: Application REF: p. 648 OBJ: Theory #1

TOP: Narcotic Discrepancy KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

COMPLETION

27. There is an order to give a patient 45 mL of Maalox. The nurse should administer ____ oz.

ANS:

1.5

There are 30 mL in 1 oz. Using the D/H formula, the calculation is as follows: 45 / 30 mL/oz = 1.5 oz.

DIF: Cognitive Level: Analysis REF: p. 644, Table 34-3

OBJ: Clinical Practice #2 TOP: Conversions KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

28. The nurse is aware that a medication error event that causes a patient death or causes serious injury to a patient is classified as a(n) _______ event.

ANS:

sentinel

The Joint Commission views an event that causes the patient death or causes serious injury a sentinel event and is followed up with a root cause analysis.

DIF: Cognitive Level: Knowledge REF: p. 666 OBJ: Theory #8

TOP: Sentinel Event KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

MULTIPLE RESPONSE

29. The nurse is aware that medications that should not be crushed and administered through a feeding tube include: (Select all that apply.)

a.

enteric-coated.

b.

liquid.

c.

sublingual.

d.

buccal.

e.

sustained-release.

f.

antineoplastics.

ANS: A, C, D, E, F

Many oral medications can be given through a feeding tube. Liquid medications are best, but if a tablet is crushable or a capsule can be opened and the contents mixed with liquid, or if the liquid within the capsule can be aspirated with a needle and syringe, then the medication can be administered through the feeding tube. Medications that should not be crushed and administered through the tube are sublingual or buccal, enteric-coated, or sustained-release preparations or products with a carcinogenic potential (e.g., antineoplastics).

DIF: Cognitive Level: Application REF: p. 663 OBJ: Theory #6

TOP: Medication Administration KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

30. When applying ophthalmic ointments, the nurse should: (Select all that apply.)

a.

fill only the center of the conjunctival sac.

b.

ask the patient to roll the eye around and from side to side.

c.

remove excess ointment from the lid with a cotton ball.

d.

ask the patient to close the eyelids tightly to distribute ointment.

e.

remove gloves and perform hand hygiene.

ANS: B, C, E

When the nurse administers ophthalmic ointment, the entire conjunctival sac should be filled, the patient should be asked to close the lids lightly and move eye about to distribute the medication, the excess ointment should be removed with a cotton ball, and hand hygiene should be performed.

DIF: Cognitive Level: Application REF: p. 656, Skill 34-2

OBJ: Clinical Practice #2 TOP: Ophthalmic ointment

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

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