Chapter 10, Administration Procedures

Format:  Choice Multiple

Chapter:  10

Client Needs:  Safe and Effective Care Environment: Safety and Infection Control

Cognitive Level:  Understand

Difficulty:  Moderate

Page and Header:  409, Standard Precautions Applied to Administration of Medications

Integrated Process:  Teaching/Learning

Objective:  4

1. When administering injections, which general safeguards in administering medications must be followed? Select all that apply.

A) Wash hands.

B) Wear gloves.

C) Recap needle after use.

D) Disposal of used sharps in a puncture-proof container.

E) Wear protective eyewear.

Difficulty:  Moderate

Page and Header:  409, Standard Precautions Applied to Administration of Medications

Integrated Process:  Teaching/Learning

Objective:  4

2. A nursing faculty member is reviewing general standards, precautions, and safeguards used to administer medications to nursing students. Which statement is correct and should be included in the presentation she is preparing?

A) Bend the needle off a syringe after using it to administer an injection to a patient/client.

B) Gowns must be worn to administer medications to mucous membranes.

C) Wear gloves for any direct contact with a patient/client's blood, body fluids, or secretions.

D) A mask is required when administering oral medications with patients/clients on any isolation procedure.

Difficulty:  Moderate

Page and Header:  409, Standard Precautions Applied to Administration of Medications

Integrated Process:  Teaching/Learning

Objective:  4

3. A nurse was stuck with a used needle while dropping it into a full puncture-proof container. What would the nurse do first?

A) Apply an acceptable antiseptic.

B) Follow protocol for accidental exposure to blood or body fluids.

C) Squeeze the area of contact.

D) Wash the area with soap and copious amounts of water.

Difficulty:  Moderate

Page and Header:  405, Systems of Administration

Integrated Process:  Teaching/Learning

Objective:  3

4. Choose the most widely used system of medication administration.

A) Mobile cart

B) Scanner device

C) Tickets

D) Unit-dose packaging

Difficulty:  Moderate

Page and Header:  405, Systems of Administration

Integrated Process:  Teaching/Learning

Objective:  3

5. A patient/client refused to take an ordered stool softener. What is the correct procedure to document the refused medication?

A) Circle the time and document a reason the medication was not given.

B) Circle the time and initial and document a reason the medication was refused.

C) Draw a line through the time and document a reason the medication was not given.

D) Draw a line through the time and initial and document a reason the medication was refused.

Difficulty:  Difficult

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

6. Select the correct sequence of steps for the administration of oral medications.

1) Administer oral tablets first.

2) Administer oral capsules second.

3) Administer oral liquid medications first.

4) Administer oral liquid medications second.

A) 1, 4

B) 2, 3

C) It does not matter what order the medications are administered.

D) Capsules have to be administered first, then tablets and oral liquid medications._

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

7. What type of precaution must the nurse use to break a scored tablet?

A) Clean technique

B) Respiratory technique

C) Strict asepsis

D) Standard asepsis

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

8. Select all correct statements about the administration of oral medications.

A) Check expiration dates on all labels.

B) Check patients/clients for allergies to drugs.

C) Be aware that some drugs are best taken on an empty stomach.

D) When a patient/client is NPO, he or she cannot receive any drugs.

E) Use one primary method of verifying the identity of the patient/client.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

9. The nurse has to give an intramuscular injection to an adult. What is the correct gauge needle that should be used?

A) 21

B) 23

C) 25

D) 28

Difficulty:  Difficult

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

10. The nurse had to prepare an injection of regular and NPH insulin. What is the correct sequence of steps for preparing the insulin injection?

1) Draw up into the syringe an amount of air equivalent to the amount of regular insulin and expel the air into the vial.

2) Draw up into the syringe an amount of air equivalent to the amount of NPH insulin and expel the air into the vial.

3) Draw up the ordered amount of regular insulin.

4) Draw up the ordered amount of NPH insulin.

A) 1, 2, 3, 4

B) 1, 2, 4, 3

C) 2, 1, 3, 4

D) 2, 1, 4, 3

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

11. The nurse had to administer 2.25 mL of an intramuscular medication to an adult patient/client. According to the medication administration record, the previous injection was administered in the right dorsogluteal site. In which site should the nurse administer this intramuscular injection?

A) Deltoid

B) Lower abdomen

C) Left ventrogluteal site

D) Thigh

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

12. The nurse has to administer an intradermal injection for skin testing for allergies. Which action is correct for intradermal injections?

A) Insert the needle inch, almost parallel to the skin.

B) Hold the syringe in four fingers and thumb, with the bevel of the needle down.

C) Inject the solution so that it raises a small wheal, raised bump, or blister.

D) Massage the skin for 10 seconds after removal of the needle.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration; 440, Special Considerations

Integrated Process:  Teaching/Learning

Objective:  5, 6

13. A 6-month-old infant is to receive 0.5 mL of a preoperative injection, intramuscularly, prior to going to surgery to have tubes inserted in the ears. What site should the nurse select to administer the medication?

A) Deltoid

B) Dorsogluteal

C) Ventrogluteal

D) Vastus lateralis

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

14. While administering the flu vaccine via the intramuscular route, the nurse sees a blood return in the syringe barrel after aspirating 0.1 mL. What is the nurse's next step?

A) Inject the medication slowly.

B) Remove the needle quickly and reinsert in a new site.

C) Press down on the area with an alcohol pad.

D) Withdraw the needle and prepare another injection.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

15. Which statement is true about Z-track technique for intramuscular injections?

A) The ventrogluteal site is used to prevent medication from seeping into the needle tract and onto the skin.

B) Inject the needle at a 90-degree angle. After giving the injection, count to 10 prior to removal of the needle.

C) After preparing the medication, use the same needle to prevent leakage along the tract of the injection.

D) Add 0.1 mL of air to the syringe to seal off the medication and prevent it from leaking onto the skin.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

16. The patient/client has a 1000 mL bag of NS running at 30 mL/hour. In how many hours would the nurse anticipate having to change the IV bag?

A) 16

B) 24

C) 72

D) 96

Difficulty:  Moderate

Page and Header:  411, Routes of Administration; 440, Special Considerations

Integrated Process:  Teaching/Learning

Objective:  5, 6

17. The nurse has to administer a bitter-tasting oral medication to a 5-year-old patient/client. What is the best strategy to administer this drug to the child?

A) Before administering the medication, offer a popsicle.

B) Administer the medication in a cup of milk.

C) Have the child keep his nostrils open and drink the medication through a straw.

D) Use a specially manufactured medication nipple or pacifier.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration; 440, Special Considerations

Integrated Process:  Teaching/Learning

Objective:  5, 6

18. A geriatric patient/client has had a cerebrovascular accident and has a feeding tube in place. Which statement is correct about the administration of drugs through a feeding tube?

A) Dilute medications with normal saline at room temperature.

B) Elevate the head of the bed to 30 degrees prior to administering.

C) Check the position of the tube in the stomach by inserting 60 mL of air.

D) Flush the tube with 15 mL of warm water to ensure patency.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration; 440, Special Considerations

Integrated Process:  Teaching/Learning

Objective:  5, 6

19. A geriatric patient/client has to administer frequent eye drops in both eyes prior to cataract surgery. Which action is most important for the patient/client to consider when administering eye drops?

A) The patient/client should gently draw the lower eyelid down to create a sac to instill the medication.

B) The medication should be inserted into the outer canthus of the eye.

C) The patient/client should look down when instilling the eye drops into his eye.

D) The medication should touch the eye membrane to ensure proper placement.

Difficulty:  Moderate

Page and Header:  411, Routes of Administration; 440, Special Considerations

Integrated Process:  Teaching/Learning

Objective:  5, 6

20. A 2-year-old patient/client has to have ear drops administered. What is the correct procedure for the nurse to administer the ear drops?

A) Straighten the ear canal by pulling the pinna up and back.

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

C) The patient/client should rest on the affected side for 10 to 15 minutes.

D) The patient/client should rest on the unaffected side for 5 to 10 minutes.

Difficulty:  Moderate

Page and Header:  399, Three Checks and the Rights of Medication Administration

Integrated Process:  Teaching/Learning

Objective:  1

21. There are six standard rights that a nurse must adhere to before administering medications. Select all that apply. The right to the:

A) Right medication

B) Right assessment

C) Right drug preparation

D) Right documentation

E) Right time

Difficulty:  Moderate

Page and Header:  400, Medication Orders

Integrated Process:  Teaching/Learning

Objective:  2

22. Select the type of medication order that is labeled as a “single-dose” order.

A) Synthroid 0.05 mg, po, daily.

B) Morphine sulfate, 3 mg, q4h, prn for chest pain.

C) Zithromax (“Z-Pak”), 6,250 mg tablets; take 2 tablets on the first day and then one tablet daily for the next four days.

D) Valium 5 mg, po, daily prior to a bone biopsy.

Difficulty:  Moderate

Page and Header:  400, Medication Orders

Integrated Process:  Teaching/Learning

Objective:  2

23. Medication orders in an institution can be written by approved practitioners. Select all categories of personnel that can write medication orders.

A) Physicians

B) Medical students

C) Registered nurses

D) Emergency medical technicians

E) Nurse practitioners

Difficulty:  Moderate

Page and Header:  403, Medication Administration Record (MAR ), Computerized Medication Administration Records (CMAR ), and Electronic Medical Administration Record (eMAR )

Integrated Process:  Teaching/Learning

Objective:  2

24. A physician ordered a medication to be given four times a day. The dosage administration schedule was 10:00 am, 2:00 pm, 6:00 pm, and 10:00 pm. The nurse recorded the drug's administration, in military time, on the medication administration record (MAR). Select the correct sequence of drug administration using military time.

A) 1000, 1200, 1500, 2000

B) 1000, 1300, 1600, 2100

C) 1000, 1500, 1900, 2300

D) 1000, 1400, 1800, 2200

Difficulty:  Moderate

Page and Header:  411, Routes of Administration

Integrated Process:  Teaching/Learning

Objective:  5

25. The nurse is aware that some patients/clients have difficulty swallowing solid preparations of medications. Therefore, special considerations can be used. Choose the best approach to help a geriatric patient/client take a solid form of a medication.

A) Open a sustained-release capsule and mix the contents with applesauce.

B) Crush a prolonged-release tablet into fine particles.

C) Crush an enteric-coated tablet and give with milk.

D) Break a scored tablet in half and give first and then about 1 minute later.

Difficulty: Moderate

Page and Header: 400, Medication Orders

Integrated Process: Teaching/Learning

Objective: 2

26. Select the example of a medication order that is written without termination.

A) Mevacor (lovastatin) 10 mg, po, every 12 hours for 7 days

B) Motrin (ibuprofen) 400 mg, po, daily

C) Demerol (meperidine HCL) 50 mg, IM, prior to surgery

D) Lasix (furosemide) 40 mg, IV, stat

Difficulty: Moderate

Page and Header: 400, Medication Orders

Integrated Process: Teaching/Learning

Objective: 2

27. Hospital guidelines provide an automatic stop time for some drug classifications. Select the drug classification that would most likely have a 10-day automatic stop time.

A) Narcotic

B) Anticoagulant

C) Antibiotic

D) Antihypertensive

Difficulty: Moderate

Page and Header: 411, Routes of Administration

Integrated Process: Teaching/Learning

Objective: 5

28. When administering medications by the oral route a number of safeguards are required. Select all that apply:

A) Break unscored tablets by placing the tablet in a paper towel and, using your thumb and index finger, break the tablet.

B) Crush enteric-coated tablets to facilitate rapid absorption.

C) Shake liquid medications thoroughly before pouring.

D) Pour liquids at eye level, using a medicine cup.

E) Lozenges should dissolve slowly in the mouth.

Difficulty: Moderate

Page and Header: 411, Routes of Administration

Integrated Process: Teaching/Learning

Objective: 5

29. The most common syringe used for injections is a standard 3-mL size, marked in milliliters to the nearest tenth. Select the standard gauge of the injection needle for the 3-mL syringe.

A) 25 -28

B) 25-26

C) 20-28

D) 20-23

Difficulty: Difficult

Page and Header: 411, Routes of Administration

Integrated Process: Teaching/Learning

Objective: 5

30. There are four common sites for intramuscular injections for adults: dorsogluteal, ventrogluteal, the vastus lateralis and the deltoid muscles. Select the landmarks to use to correctly identify the exact site for the dorsogluteal site.

A) The crest of the posterior ileum as the superior boundary and the inferior gluteal fold as the lower boundary.

B) The greater trochanter, the anterior superior iliac spine and the iliac crest

C) One hand’s width below the greater trochanter and one hand’s width above the knee.

D) The lower edge of the acromion process and the axilla are boundaries.