Ch. 35.

Question 1

A nursing student is reviewing the history of drug legislation in the United States. Which legislative act was the first to prohibit the labeling of medicines with false therapeutic claims intended to defraud the public?
A. Pure Food and Drug Act of 1906
B. Harrison Narcotic Act of 1914
C. Sherley Amendment of 1912
D. Federal Food, Drug, and Cosmetic (FDC) Act of 1938

Answer 1

Answer: C. Sherley Amendment of 1912

Rationale: The Sherley Amendment of 1912 was enacted to address the loophole in the Pure Food and Drug Act of 1906, which did not prohibit false therapeutic claims. This amendment specifically made it illegal to label medicines with false claims intended to defraud. The Pure Food and Drug Act of 1906 was the first law to regulate drugs but focused on misbranding and adulteration, not therapeutic claims. The Harrison Narcotic Act of 1914 regulated habit-forming drugs, and the Federal Food, Drug, and Cosmetic (FDC) Act of 1938 required that new drugs be proven safe before marketing.

Question 2

A patient with a history of seizures is prescribed a medication that is classified as a controlled substance. The nurse knows that the Comprehensive Drug Abuse Prevention and Control Act of 1970 had which of the following effects?
A. It required all drugs to be tested for harmful effects.
B. It mandated that oral contraceptives contain patient information inserts.
C. It categorized drugs based on their abuse and addiction potential.
D. It accelerated the review process for investigational new drugs.

Answer 2

Answer: C. It categorized drugs based on their abuse and addiction potential.

Rationale: The Comprehensive Drug Abuse Prevention and Control Act of 1970, also known as the Controlled Substances Act, established the five schedules (I-V) for controlled substances. This categorization is based on the drug’s potential for abuse and addiction, as well as its accepted medical use. The requirement for testing for harmful effects was part of the Federal Food, Drug, and Cosmetic Act of 1938. The patient package insert requirement for oral contraceptives was established in 1970. The acceleration of the review process for investigational new drugs was a feature of the Food and Drug Administration Modernization Act of 1997.

Question 3

A nurse is explaining to a new colleague the significance of the Durham-Humphrey Amendment of 1951. Which statement by the new colleague indicates an understanding of this amendment?
A. “This law requires that all medications be free of impurities.”
B. “This law is the reason we have prescription and over-the-counter medications.”
C. “This law established the five schedules for controlled substances.”
D. “This law was passed in response to birth defects from thalidomide.”

Answer 3

Answer: B. “This law is the reason we have prescription and over-the-counter medications.”

Rationale: The Durham-Humphrey Amendment of 1951 is significant because it created the distinction between “prescription” (legend) drugs, which require medical supervision, and “over-the-counter” (OTC) drugs, which can be sold without a prescription. The requirement for medications to be free of impurities was part of the Pure Food and Drug Act of 1906. The five schedules for controlled substances were established by the Comprehensive Drug Abuse Prevention and Control Act of 1970. The law passed in response to the thalidomide tragedy was the Kefauver-Harris Drug Amendments of 1962.

Question 4

When administering a narcotic medication to a patient, the nurse follows specific protocols for record-keeping. Which act first regulated the use and record-keeping of habit-forming drugs?
A. Kefauver-Harris Drug Amendments of 1962
B. Sherley Amendment of 1912
C. Comprehensive Drug Abuse Prevention and Control Act of 1970
D. Harrison Narcotic Act of 1914

Answer 4

Answer: D. Harrison Narcotic Act of 1914

Rationale: The Harrison Narcotic Act of 1914 was the first federal law to regulate and tax the production, importation, and distribution of opiates and coca products. It required practitioners, manufacturers, and distributors to register and keep records of these drugs. The Kefauver-Harris Drug Amendments of 1962 focused on drug efficacy. The Sherley Amendment of 1912 addressed false therapeutic claims. The Comprehensive Drug Abuse Prevention and Control Act of 1970 replaced and updated previous drug abuse laws.

Question 5

Question 5
A pharmaceutical company is submitting a new drug for approval. They must provide evidence of the drug’s safety and efficacy before it can be marketed. This requirement is a direct result of which legislation?
A. Federal Food, Drug, and Cosmetic (FDC) Act of 1938
B. Kefauver-Harris Drug Amendments of 1962
C. Durham-Humphrey Amendment of 1951
D. Food and Drug Administration Modernization Act of 1997

Answer 5

Answer: B. Kefauver-Harris Drug Amendments of 1962

Rationale: While the Federal Food, Drug, and Cosmetic (FDC) Act of 1938 required drugs to be proven safe, the Kefauver-Harris Drug Amendments of 1962, passed in the wake of the thalidomide tragedy, added the requirement that manufacturers also prove the efficacy (effectiveness) of their drugs before they could be approved and marketed. The Durham-Humphrey Amendment created the prescription/OTC distinction, and the Food and Drug Administration Modernization Act of 1997 introduced measures to accelerate drug review.

Question 6

A patient asks the nurse why their oral contraceptive has a detailed information insert. The nurse correctly explains that this is mandated by the:
A. Patient package insert requirement of 1970.
B. Drug Quality and Security Act of 2013.
C. Project BioShield Act of 2004.
D. Food and Drug Administration Modernization Act of 1997.

Answer 6

Answer: A. Patient package insert requirement of 1970.

Rationale: The requirement for patient package inserts (PPIs) was established in 1970, mandating that certain medications, including oral contraceptives, provide patients with information about the drug’s benefits and risks. The other acts listed address different aspects of drug regulation: drug supply chain security (Drug Quality and Security Act), biodefense (Project BioShield Act), and drug review processes (Food and Drug Administration Modernization Act).

Question 7

In response to the threat of terrorism, which act was established to expedite the review and distribution of treatments for chemical, biological, and nuclear agents?
A. Food and Drug Administration Modernization Act of 1997
B. Drug Quality and Security Act of 2013
C. Project BioShield Act of 2004
D. Comprehensive Drug Abuse Prevention and Control Act of 1970

Answer 7

Answer: C. Project BioShield Act of 2004

Rationale: The Project BioShield Act of 2004 was specifically created to facilitate the development and deployment of medical countermeasures against chemical, biological, radiological, and nuclear (CBRN) agents of terrorism. It provides funding and allows for the expedited review and emergency use of such treatments.

Question 8

A hospital is implementing a new electronic system to trace prescription drugs throughout the supply chain. This initiative is in compliance with which of the following acts?
A. Kefauver-Harris Drug Amendments of 1962
B. Drug Quality and Security Act of 2013
C. Harrison Narcotic Act of 1914
D. Federal Food, Drug, and Cosmetic (FDC) Act of 1938

Answer 8

Answer: B. Drug Quality and Security Act of 2013

Rationale: The Drug Quality and Security Act of 2013 includes the Drug Supply Chain Security Act (DSCSA), which mandates the implementation of an electronic, interoperable system to track and trace prescription drugs as they are distributed throughout the United States. This is intended to protect consumers from counterfeit, stolen, or contaminated drugs.

Question 9

The nurse understands that the official authorities for establishing drug standards in the United States, such as the United States Pharmacopeia (USP) and the National Formulary (NF), were designated by which act?
A. Sherley Amendment of 1912
B. Pure Food and Drug Act of 1906
C. Durham-Humphrey Amendment of 1951
D. Harrison Narcotic Act of 1914

Answer 9

Answer: B. Pure Food and Drug Act of 1906

Rationale: The Pure Food and Drug Act of 1906 was the first law to give official status to the United States Pharmacopeia (USP) and the National Formulary (NF), establishing them as the official sources for drug standards in the U.S. This act required that drugs meet the standards of strength, purity, and quality set forth in these publications.

Question 10

A nurse is preparing to administer morphine for a patient’s severe pain. The nurse understands that morphine is a Schedule II drug, which means it has:
A. A high potential for abuse and no accepted medical use.
B. A high potential for abuse and an accepted medical use with severe restrictions.
C. A lower potential for abuse than Schedule III drugs.
D. A low potential for abuse and is available over-the-counter.

Answer 10

Answer: B. A high potential for abuse and an accepted medical use with severe restrictions.
Rationale: According to the table, Schedule II drugs have a high potential for abuse but also have a currently accepted medical use, though with severe restrictions. Morphine is listed as an example.

Option A describes Schedule I drugs.

Option C describes Schedule IV drugs.

Option D describes Schedule V drugs.

Question 11

A patient in the emergency department admits to using heroin. The nurse correctly identifies this substance as a Schedule I controlled drug. Which of the following is a key characteristic of Schedule I substances?
A. They have a currently accepted medical use.
B. They have no currently accepted medical use in the United States.
C. They lead to moderate physical dependence.
D. They have a low potential for abuse relative to Schedule IV drugs.

Answer 11

Answer: B. They have no currently accepted medical use in the United States.
Rationale: The primary defining characteristic of Schedule I drugs, as stated in the text, is a high potential for abuse and no currently accepted medical use in the United States. Heroin is provided as a key example.

Options A and C are incorrect as they contradict the definition of Schedule I.

Option D describes Schedule V drugs.

Question 12

A nurse is administering alprazolam, a Schedule IV drug, to a patient for anxiety. The nurse recognizes that this classification indicates the drug has:
A. A high potential for abuse that may lead to severe psychological dependence.
B. The same abuse potential as codeine combined with acetaminophen.
C. A lower potential for abuse relative to drugs in Schedule III.
D. No potential for abuse or dependence.

Answer 12

Answer: C. A lower potential for abuse relative to drugs in Schedule III.
Rationale: The table defines Schedule IV drugs as having a “lower potential for abuse relative to the drugs in schedule III.” Alprazolam is listed as an example.

Option A describes Schedule II drugs.

Option B is incorrect; codeine with acetaminophen is a Schedule III drug, which has a higher abuse potential than Schedule IV drugs.

Option D is incorrect as Schedule IV drugs may lead to limited dependence.

Question 13

A nursing student is reviewing the different schedules of controlled substances. Which of the following drug examples correctly matches its schedule classification?
A. Heroin - Schedule II
B. Morphine - Schedule III
C. Anabolic steroids - Schedule III
D. Diazepam - Schedule V

Answer 13

Answer: C. Anabolic steroids - Schedule III
Rationale: The table explicitly lists anabolic steroids as an example of a Schedule III controlled substance.

Heroin is a Schedule I drug.

Morphine is a Schedule II drug.

Diazepam is a Schedule IV drug.

Question 14

A patient asks about purchasing an over-the-counter cough medicine that contains a small amount of codeine. The nurse understands that this medication falls under which schedule of controlled substances?
A. Schedule II
B. Schedule III
C. Schedule IV
D. Schedule V

Answer 14

Answer: D. Schedule V
Rationale: The table provides “Over-the-counter (OTC) cough medicines with codeine” as a specific example of a Schedule V drug. This schedule has a low potential for abuse relative to other scheduled drugs, which allows for some preparations to be available without a prescription.

Question 15

A nurse is preparing to administer a medication to a patient. Which of the following statements best defines the medication’s therapeutic effect?
A. The passage of the drug from the site of administration into the bloodstream.
B. The movement of the medication from the blood into the body’s tissues and organs.
C. The desired result or intended action of a medication on physiologic function.
D. The way the medication is altered into a less active form to prepare for excretion.

Answer 15

Answer: C. The desired result or intended action of a medication on physiologic function.
Rationale: The highlighted text defines the therapeutic effect as “the desired result or action of a medication.”

Option A defines absorption.

Option B defines distribution.

Option D defines metabolism.

Question 16

A physician has ordered a new medication for a patient to be administered intravenously (IV). The nurse understands that this route is chosen over an oral route when a rapid onset of action is desired because:
A. Oral medications have a higher rate of excretion from the body.
B. IV administration results in the quickest rate of absorption into the bloodstream.
C. Oral medications are more likely to be affected by the patient’s age.
D. IV administration is less dependent on blood flow to the administration site.

Answer 16

Answer: B. IV administration results in the quickest rate of absorption into the bloodstream.
Rationale: The text explicitly states, “Administration of a medication intravenously, or directly into a blood vessel, results in the quickest rate of absorption…” This rapid absorption leads to a faster onset of action. The other options are incorrect or not the primary reason for choosing the IV route for speed.

Question 17

A nurse is caring for an older adult patient with chronic kidney disease. When reviewing the patient’s prescribed medications, the nurse must consider that the medication’s effectiveness will be most influenced by which factor mentioned in the text?
A. The ability of the drug to dissolve.
B. The patient’s body surface area.
C. The function of metabolizing organs.
D. The blood flow to the administration site.

Answer 17

Answer: C. The function of metabolizing organs.
Rationale: The text states that effectiveness is influenced by the “function of metabolizing organs (such as the liver or kidneys).” Since the patient has chronic kidney disease, the function of this key organ is impaired, which will significantly impact the medication’s effect and excretion. The other options are factors that primarily affect absorption.

Question 18

A nursing instructor asks a student to identify the process of absorption. Which of the following statements by the student indicates a correct understanding?
A. “Absorption is how a medication is delivered to a specific site of action.”
B. “Absorption is the passage of a drug from the administration site into the bloodstream.”
C. “Absorption is the time it takes for a medication to produce a response.”
D. “Absorption is the process by which a drug is altered to prepare for excretion.”

Answer 18

Answer: B. “Absorption is the passage of a drug from the administration site into the bloodstream.”
Rationale: This is the precise definition of absorption provided in the highlighted text.

Option A describes distribution.

Option C relates to the onset of action.

Option D describes metabolism.

Question 19

When comparing medication administration routes, which route would the nurse expect to have the slowest rate of absorption?
A. Intravenous
B. Intramuscular
C. Subcutaneous
D. Oral

Answer 19

Answer: D. Oral
Rationale: The text provides a clear hierarchy for the rate of absorption, stating it is quickest for intravenous, “followed in descending order by intramuscularly, subcutaneously, and orally administered medications.” This identifies the oral route as the slowest among the options provided.

Question 20

A nurse is administering medication to an older adult patient with impaired liver function. The nurse recognizes this patient is at an increased risk for medication toxicity primarily because of a potential decrease in:
A. Absorption
B. Distribution
C. Metabolism
D. Excretion

Answer 20

Answer: C. MetabolismRationale: The text states, “Most metabolism takes place in the liver, which may be slowed in elderly individuals or anyone with impaired liver function.” It further explains that if the liver cannot break the drug down, “toxic levels of a medication can build up.” The patient’s conditions (older adult, impaired liver function) directly point to an impairment in metabolism. While excretion can also be affected by age, it is primarily a function of the kidneys.

Question 21

A patient with chronic kidney disease is prescribed a new medication. The nurse anticipates that the prescriber will make which adjustment to the dosage regimen to prevent adverse effects?
A. Prescribe a larger dose of the medication.
B. Change the route from oral to intravenous.
C. Prescribe smaller doses or longer durations between doses.
D. Order the medication to be taken on an empty stomach.

Answer 21

Answer: C. Prescribe smaller doses or longer durations between doses.Rationale: The text explicitly states that for people with impaired kidney function, drug accumulation may occur, “necessitating prescription of smaller doses or longer durations between doses.” This adjustment helps prevent the drug from building up to toxic levels when the primary route of excretion is compromised. The other options would not address the problem of impaired excretion.

Question 22

When providing patient education, the nurse explains that the liver’s primary role in pharmacokinetics is metabolism. Which statement best describes this process?
A. The removal of the less active drug from the body.
B. The delivery of the medication to the body’s tissues.
C. The alteration of a drug into a less active form to prepare for excretion.
D. The passage of a drug from the administration site into the bloodstream.

Answer 22

Answer: C. The alteration of a drug into a less active form to prepare for excretion.Rationale: This is the precise definition of metabolism provided in the first sentence of the highlighted text.

Option A describes excretion.

Option B describes distribution.

Option D describes absorption.

Question 23

A nursing mother asks if a medication she is taking can be passed to her infant. The nurse’s knowledge is based on the principle that while most drug metabolites are removed by the kidneys, they can also be excreted through:
A. The liver
B. The pancreas
C. The circulatory system
D. Breast milk

Answer 23

Answer: D. Breast milkRationale: The section on excretion states that while most metabolites exit through the kidneys, “some may be excreted in feces, breath, saliva, sweat, and breast milk.” The liver is the primary site of metabolism, not excretion.

Question 24

The nurse is aware that both elderly patients and those with impaired kidney function require careful medication monitoring. This is because both groups are at high risk for which of the following?
A. Rapid absorption of the medication.
B. Accumulation of the drug to unwanted levels.
C. Decreased therapeutic effect of the drug.
D. An allergic reaction to the medication.

Answer 24

Answer: B. Accumulation of the drug to unwanted levels.Rationale: The text on excretion specifies, “The drug may accumulate to unwanted levels in elderly individuals and people with impaired kidney function…” Similarly, the text on metabolism notes that slowed function in the elderly can cause “toxic levels of a medication to build up.” Therefore, accumulation is the primary risk for these populations. A decreased therapeutic effect is the opposite of the expected outcome, and rapid absorption or allergic reactions are unrelated to impaired metabolism and excretion.

Question 25

A patient is receiving a medication that has a half-life of 12 hours. The nurse administers a dose at 8:00 AM. At which time would the nurse expect the blood concentration of the drug to be approximately 50% of the original level? A. 12:00 PM (noon) B. 2:00 PM C. 8:00 PM D. 8:00 AM the next day

Answer 25

Answer: C. 8:00 PM Rationale: The text defines a drug's half-life as the time it takes for the blood concentration to measure one-half (50%) of the original dose. Since this medication has a 12-hour half-life, 12 hours after the 8:00 AM dose (which is 8:00 PM), the concentration will be at 50%.

Question 26

A nurse is preparing to administer a scheduled dose of vancomycin. The medication administration record indicates that a trough level needs to be drawn. The nurse should coordinate with the phlebotomist to have the blood sample collected at which time? A. Immediately after the infusion is complete. B. 60 minutes after the infusion starts. C. At the medication's expected half-life. D. Just before the administration of the scheduled dose.

Answer 26

Answer: D. Just before the administration of the scheduled dose. Rationale: The highlighted text defines the trough as the lowest serum level of the medication. It explicitly states that "samples for trough levels are drawn just before the administration of a scheduled dose" to measure this lowest point. Option A would measure the peak level. Options B and C are incorrect timings for a trough level.

Question 27

A patient who has just received a new oral medication for pain asks the nurse, "How long will it take for this to start working?" The nurse's response is based on knowledge of the medication's: A. Peak plasma level B. Onset of action C. Trough level D. Half-life

Answer 27

Answer: B. Onset of action Rationale: The text defines onset of action as "the time the body takes to respond to a drug after administration." This directly answers the patient's question about when the medication will begin to work. Peak plasma level is when the drug is at its highest concentration. Trough level is the lowest concentration. Half-life relates to dosing intervals.

Question 28

A primary care provider orders peak and trough levels for a patient receiving a new medication. The nurse understands that the primary reason for these laboratory tests is to: A. Determine the drug's route of excretion. B. Identify the drug's onset of action. C. Adjust dose amounts and monitor for toxicity. D. Confirm the drug's half-life.

Answer 28

Answer: C. Adjust dose amounts and monitor for toxicity. Rationale: The text clearly states that the results from peak and trough level tests "are used to adjust dose amounts and monitor for toxicity." This ensures the medication stays within a safe and effective therapeutic range. While the results are related to half-life (Option D), their primary clinical purpose is for dosage adjustment and safety.

Question 29

After administering a medication, the nurse monitors the patient for the drug's therapeutic effects. The nurse knows that the point at which the medication reaches its highest concentration in the bloodstream is known as the: A. Trough B. Half-life C. Onset of action D. Peak plasma level

Answer 29

Answer: D. Peak plasma level Rationale: This is the direct definition provided in the highlighted text: "Peak plasma level indicates the highest serum (blood) concentration." The trough is the lowest level. Half-life and onset of action are measures of time, not concentration.

Question 30

A patient taking an antihypertensive medication reports feeling dizzy upon standing. The nurse educates the patient to change positions slowly. This predictable and unwanted reaction is best described as which of the following? A. Adverse effect B. Toxic effect C. Side effect D. Anaphylactic reaction

Answer 30

Answer: C. Side effect Rationale: The text defines side effects as "predictable but unwanted and sometimes unavoidable reactions to medications." Dizziness upon standing (orthostatic hypotension) is a known, predictable side effect of many antihypertensive drugs. An adverse effect is severe and often unpredictable. A toxic effect results from overdose or impaired metabolism/excretion. An anaphylactic reaction is a severe, life-threatening allergic reaction.

Question 31

A nurse administers a new antibiotic to a patient who suddenly develops shortness of breath, wheezing, and hypotension. The nurse recognizes these symptoms as a life-threatening anaphylactic reaction. What is the nurse's priority action? A. Administer epinephrine. B. Immediately stop the medication. C. Administer intravenous fluids. D. Document the patient's reaction.

Answer 31

Answer: B. Immediately stop the medication. Rationale: The text states that treatment for an anaphylactic reaction "includes immediate discontinuation of the drug." Stopping the infusion of the causative agent is the absolute first priority to prevent the patient's condition from worsening. The other actions (administering epinephrine, IV fluids) are critical subsequent steps.

Question 32

An older adult patient with impaired kidney and liver function is receiving a new medication. The nurse should be most concerned about the patient developing which type of medication effect? A. Toxic effects B. Side effects C. Allergic reactions D. Idiosyncratic reactions

Answer 32

Answer: A. Toxic effects Rationale: The text states that toxic effects "result from a medication overdose or the buildup of medication in the blood due to impaired metabolism and excretion." Since this patient has impaired kidney (excretion) and liver (metabolism) function, they are at a high risk for the drug accumulating to toxic levels.

Question 33

Question 4 A patient develops a severe, unintended, and unpredictable skin rash after taking the first dose of a medication. The primary care provider discontinues the drug immediately. The nurse correctly identifies this as which type of reaction? A. Adverse effect B. Side effect C. Toxic effect D. Idiosyncratic reaction

Answer 33

Answer: A. Adverse effect Rationale: The definition of an adverse effect in the text is a "severe, unintended, unwanted, and often unpredictable drug reaction." It also states that an adverse effect "may occur after one dose, such as a severe allergic response" and that the medication is immediately stopped, which matches the scenario perfectly.

Question 34

After receiving a dose of morphine sulfate, a patient's respiratory rate drops to 8 breaths per minute. The nurse recognizes this as a result of a medication overdose. This life-threatening reaction is classified as a(n): A. Allergic reaction B. Side effect C. Anaphylactic reaction D. Toxic effect

Answer 34

Answer: D. Toxic effect Rationale: The text uses the specific example of "toxic levels of a pain medication (such as morphine sulfate) may cause respiratory depression" to define a toxic effect. This effect results from an overdose or buildup of the medication in the blood.

Question 35

A nurse administers a common sedative to a patient to help them sleep. Instead of becoming drowsy, the patient becomes hyperactive and agitated. The nurse should classify this unpredictable response as which of the following? A. Synergistic effect B. Antagonism C. Idiosyncratic reaction D. Adverse effect

Answer 35

Answer: C. Idiosyncratic reaction Rationale: The text defines an idiosyncratic reaction as an unpredictable patient response to a medication that can be an overresponse, underresponse, or abnormal reaction. The patient's hyperactivity is an abnormal and unpredictable response to a sedative.

Question 36

A patient with hypertension is prescribed two different medications, a diuretic and a vasodilator. The nurse understands that these drugs are given together because their combined effect is greater than the effect of either drug taken alone. This is an example of: A. Antagonism B. Drug incompatibility C. Idiosyncratic reaction D. Synergistic effect

Answer 36

Answer: D. Synergistic effect Rationale: The text states that a synergistic effect occurs when the combined effect of two substances is greater than the effect of either substance taken alone. The text uses the specific example of a diuretic and a vasodilator given together for hypertension.

Question 37

A nurse is educating a patient who is taking oral contraceptives and has just been prescribed a new antibiotic. The nurse should warn the patient about which potential medication interaction? A. The antibiotic may decrease the effectiveness of the oral contraceptive. B. The oral contraceptive will increase the risk of an allergic reaction to the antibiotic. C. The two medications will cause a synergistic effect, increasing the risk of blood clots. D. The patient will likely experience an idiosyncratic reaction from the combination.

Answer 37

Answer: A. The antibiotic may decrease the effectiveness of the oral contraceptive. Rationale: This is an example of antagonism, which the text defines as occurring when the drug effect is decreased by taking it with another substance. The text gives the specific example that "antibiotics can lessen the effect of birth control medications."

Question 38

While preparing two different medications to be administered intravenously, the nurse mixes them in the same syringe and observes that the solution becomes cloudy and forms a precipitate. This reaction is known as: A. Antagonism B. Drug incompatibility C. A synergistic effect D. An idiosyncratic reaction

Answer 38

Answer: B. Drug incompatibility Rationale: The text defines drug incompatibility as "Mixing medications in a solution that causes precipitation or combining a drug with another drug that causes an adverse chemical reaction." This is specific to administering parenteral medications.

Question 39

A nurse is reviewing the medication history of a patient who takes a statin medication for high cholesterol. The patient states they drink grapefruit juice every morning. The nurse recognizes that this can cause which of the following? A. A medication interaction that alters absorption. B. A synergistic effect that lowers cholesterol too much. C. A predictable side effect of the statin. D. An antagonistic effect that makes the statin ineffective.

Answer 39

Answer: A. A medication interaction that alters absorption. Rationale: The text defines medication interactions as occurring when the drug action is modified by a certain food, herb, or another medication, which can alter how it is absorbed, metabolized, or eliminated. The text specifically mentions that "grapefruit juice alters the absorption of statins."

Question 40

A patient on the medical-surgical unit suddenly develops acute shortness of breath and wheezing. The healthcare provider at the bedside verbally orders "albuterol nebulizer treatment immediately." How should the nurse categorize this medication order? A. PRN order B. Now order C. Routine order D. Stat order

Answer 40

Answer: D. Stat order Rationale: The key word "immediately" and the context of an acute emergency (sudden shortness of breath) indicate this is a stat order. According to the text, a stat order is given immediately and only once, frequently in emergency situations. A now order is for a medication needed quickly but not as immediately as a stat order.

Question 41

The nurse receives a new electronic order for a patient admitted with pneumonia that reads: "levofloxacin 750 mg IV now." Which action by the nurse is most appropriate? A. Administer the medication within the next 90 minutes. B. Give the medication immediately, as it is a top priority. C. Administer the medication when the next scheduled IV antibiotic is due. D. Wait for the patient to show further signs of infection before giving the dose.

Answer 41

Answer: A. Administer the medication within the next 90 minutes. Rationale: The order specifies "now," which, according to the textbook, is used when a medication is needed quickly but not as immediately as a stat medication. This implies it should be administered very soon, but it does not carry the extreme urgency of a life-threatening emergency. Typically, facilities have a policy that "now" medications should be given within 60-90 minutes. Administering it immediately (B) is characteristic of a "stat" order.

Question 42

A patient is experiencing a hypertensive crisis with a blood pressure of 210/118 mmHg. The provider orders "labetalol 20 mg IV push." What is the priority nursing action? A. Administer the medication within a 30-minute timeframe. B. Prepare the medication for administration at the next scheduled assessment. C. Administer the medication immediately and only once. D. Clarify the order as it should be scheduled routinely.

Answer 42

Answer: C. Administer the medication immediately and only once. Rationale: A hypertensive crisis is an emergency situation. The order for an IV push antihypertensive is intended for immediate administration to prevent organ damage. This is the definition of a stat order: given immediately and only once in a single dose for an emergency.

Question 43

A nurse is preparing to administer medications. Which of the following orders should be carried out first? A. Furosemide 20 mg PO daily B. Vancomycin 1g IV now C. Morphine 2 mg IV PRN for pain D. Lorazepam 1 mg PO at bedtime

Answer 43

Answer: B. Vancomycin 1g IV now Rationale: Based on the definitions, a "now" order has a higher priority than a "daily" (routine), "PRN" (as needed), or "bedtime" (routine) order. While a stat order would be the absolute highest priority, among the choices provided, the "now" order requires the most timely administration.

Question 44

Which statement correctly differentiates a "stat" order from a "now" order? A. A "now" order is given one time, while a "stat" order can be repeated. B. A "stat" order is given immediately for an emergency, while a "now" order is given quickly but is not for an emergency. C. A "now" order must be administered within 15 minutes, while a "stat" order must be given within 30 minutes. D. Both "stat" and "now" orders are used interchangeably for urgent situations.

Answer 44

Answer: B. A "stat" order is given immediately for an emergency, while a "now" order is given quickly but is not for an emergency. Rationale: This statement accurately summarizes the distinction provided in the text. A stat order is for emergency situations and requires immediate action. A now order indicates a need for prompt administration, but the situation is less critical than a stat order.

Question 45

A nurse is preparing a medication that is supplied in a glass ampule. After breaking the neck of the ampule, which action must the nurse take to ensure patient safety? A. Inject an amount of air equal to the dose into the ampule. B. Use a filter needle to withdraw the medication, then administer the injection with the same filter needle. C. Use a standard needle to withdraw the medication, then change to a filter needle to administer the injection. D. Use a filter needle to withdraw the medication, then change to a new, standard needle to administer the injection.

Answer 45

Answer: D. Use a filter needle to withdraw the medication, then change to a new, standard needle to administer the injection. Rationale: The highlighted text states, "Filter needles or straws are used when medications are being withdrawn from a glass ampule. The filter traps glass fragments. A filter needle or straw must be replaced with a regular needle before injecting the patient." This prevents microscopic glass shards from being injected into the patient.

Question 46

A staff nurse is caring for a patient who is receiving medication via an epidural catheter that was inserted by an advanced practice provider. Which of the following actions is within the staff nurse's scope of practice? A. Inserting the epidural catheter. B. Administering the initial bolus dose into the catheter. C. Evaluating the patient's response to the medication. D. Repositioning the catheter if it becomes dislodged.

Answer 46

Answer: C. Evaluating the patient's response to the medication. Rationale: The text specifies that advanced parenteral routes (such as epidural) are used by "advanced practice nurses in specialty areas or physicians." It defines the nurse's role as "monitoring the integrity of the delivery system, understanding the desired outcome of the medication, and evaluating the patient response to the medication for all routes of delivery."

Question 47

What is the primary purpose of using a needleless delivery system for administering intravenous (IV) medications? A. To allow for faster administration of emergency medications. B. To reduce the cost of IV tubing and supplies. C. To decrease the risk of needlestick injuries to healthcare workers. D. To eliminate the need to check for medication compatibility.

Answer 47

Answer: C. To decrease the risk of needlestick injuries to healthcare workers. Rationale: The highlighted text explicitly states, "Needleless delivery systems significantly decrease needlestick injuries and exposure to blood-borne pathogens." This is their main safety advantage.

Question 48

A patient is being discharged with a prescription for insulin to be administered via a prefilled insulin pen. The nurse should explain that this device is used because it: A. requires a filter needle to draw up the medication. B. combines the insulin container and the syringe for convenience. C. prevents needlestick injuries for hospital staff. D. can only be used for epidural injections.

Answer 48

Answer: B. combines the insulin container and the syringe for convenience. Rationale: According to the highlighted text, "Insulin may be administered by a prefilled insulin pen... which combines the insulin container and syringe." This design simplifies the self-administration process for the patient.

Question 49

When preparing to administer an IV medication through a needleless port, the nurse should use which piece of equipment to access the port? A. A standard hypodermic needle. B. A blunt-tip cannula or Luer-Lok syringe tip. C. A filter straw. D. The needle attached to a prefilled insulin pen.

Answer 49

Answer: B. A blunt-tip cannula or Luer-Lok syringe tip. Rationale: The text describes needleless systems as requiring "special tubing ports and blunt-tip cannulas that attach to the syringe in place of a needle" or allowing syringes to connect directly to the port. Using a standard needle would defeat the purpose of the safety system and damage the port.

Question 50

A nurse is preparing to administer an intramuscular (IM) injection of an oil-based solution to an adult patient with average muscle mass. Which needle gauge is most appropriate for this injection? A. 25 gauge B. 22 gauge C. 19 gauge D. 27 gauge

Answer 50

Answer: C. 19 gauge Rationale: The highlighted table indicates that oil-based solutions for IM injections may require an 18- to 20-gauge needle. A 19-gauge needle falls within this range and is appropriate for the thicker viscosity of the medication. The other options are too small (higher gauge number) for an oil-based solution.

Question 51

An infant requires a routine vaccination to be administered via the intramuscular (IM) route. Which needle length would be most appropriate for this patient? A. 1/4 inch B. 5/8 inch C. 1.5 inches D. 2 inches

Answer 51

Answer: B. 5/8 inch Rationale: The table specifies that for pediatric IM injections, a 5/8- to 1-inch needle is typically used. A 5/8-inch needle is a safe and common choice for an infant to ensure the medication reaches the muscle without hitting bone.

Question 52

A nurse is administering a subcutaneous injection to an obese adult patient. Which needle length should the nurse select to ensure the medication is delivered to the subcutaneous tissue? A. 1/4 inch B. 3/8 inch C. 5/8 inch D. 1 inch

Answer 52

Answer: D. 1 inch Rationale: For a subcutaneous injection, the table indicates a standard length of 3/8 to 5/8 inch. However, it specifically notes that a needle up to 1 inch may be used for an obese patient to penetrate the adipose tissue and reach the subcutaneous layer effectively.

Question 53

Question 4 A patient is scheduled to receive a tuberculosis (TB) test. The nurse correctly selects which syringe and needle combination for this intradermal injection? A. 3-mL syringe with a 22-gauge, 1-inch needle B. 1-mL tuberculin syringe with a 27-gauge, 1/2-inch needle C. Insulin syringe with a 29-gauge, 1/2-inch needle D. 5-mL syringe with a 20-gauge, 1.5-inch needle

Answer 53

Answer: B. 1-mL tuberculin syringe with a 27-gauge, 1/2-inch needle Rationale: The table specifies that intradermal injections require a 1-mL tuberculin syringe with a 25- to 27-gauge, 1/4- to 5/8-inch needle. This combination allows for the precise measurement of a small dose and shallow injection into the dermal layer.

Question 54

A nurse is preparing to administer insulin to a patient using an insulin syringe. Which gauge range is standard for a pre-attached needle on an insulin syringe? A. 18-20 gauge B. 22-25 gauge C. 25-27 gauge D. 29-33 gauge

Answer 54

Answer: D. 29-33 gauge Rationale: The highlighted text clearly states that for an insulin syringe with a pre-attached needle, the gauge range is 29-33 gauge. This very fine needle minimizes discomfort for frequent subcutaneous injections.

Question 55

A nurse is accessing a needleless IV port to administer a medication. Which of the following should the nurse use? A. A 25-gauge, 5/8-inch needle B. A blunt-tip cannula or Luer-Lok syringe C. An 18-gauge, 1-inch needle D. A filter needle

Answer 55

Answer: B. A blunt-tip cannula or Luer-Lok syringe Rationale: The table explicitly states for intravenous administration to use a "needleless, blunt-tip cannula or Luer-Lok used with associated IV ports" and includes the warning, "(Do not use needles in a needleless system to access IV ports)."

Question 56

An adult patient of average weight is to receive an IM injection in the deltoid muscle. What is the maximum volume of medication that can be safely administered to this site in a single injection? A. 0.5 mL B. 1 mL C. 3 mL D. 5 mL

Answer 56

Answer: B. 1 mL Rationale: The table indicates that for adults, the syringe selection for IM injections can be from 1-5 mL depending on the site. However, the deltoid is a smaller muscle, and best practice dictates administering no more than 1 mL to this site to prevent tissue damage. The ventrogluteal site can accommodate larger volumes.

Question 57

Which site is recommended for an intradermal injection? A. Abdomen B. Vastus lateralis C. Ventrogluteal D. Inner forearm

Answer 57

Answer: D. Inner forearm Rationale: The table identifies the inner forearm, upper arm, and across the scapula as appropriate sites for intradermal injections. The other options are sites for subcutaneous or intramuscular injections.

Question 58

A nurse is preparing a subcutaneous injection for an average-sized adult. Which syringe and needle combination is most appropriate? A. 1-mL tuberculin syringe with a 26-gauge, 3/8-inch needle B. 3-mL syringe with a 22-gauge, 1.5-inch needle C. 5-mL syringe with a 20-gauge, 1-inch needle D. U-50 insulin syringe with a 30-gauge, 5/16-inch needle

Answer 58

Answer: A. 1-mL tuberculin syringe with a 26-gauge, 3/8-inch needle Rationale: According to the table, a subcutaneous injection requires a 1/2- to 3-mL syringe with a 25- to 31-gauge, 3/8- to 5/8-inch needle. Option A is the only choice that falls within all of these parameters for a non-insulin medication.

Question 59

When selecting a site for an IM injection for an adult patient, which site is generally preferred for safety because it is free of major nerves and blood vessels? A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Scapular area

Answer 59

Answer: C. Ventrogluteal Rationale: The chart identifies the ventrogluteal, vastus lateralis, and deltoid as the primary IM sites for an adult. Of these, the ventrogluteal site is often considered the safest and is preferred for adults due to its larger muscle mass and distance from major nerves and vessels.

Question 60

What do the abbreviations ac, pc, prn, and sl mean?

Answer 60

ac- before meals, pc- after meals, prn- as needed, and sl- sub-lingual.

Question 61

Before administering a cardiac medication, the nurse uses a barcode scanner to scan the patient's wristband and the medication packet. This action is performed to ensure which of the Six Rights of Medication Administration? A. Right Dose and Right Time B. Right Drug and Right Patient C. Right Route and Right Documentation D. Right Time and Right Patient

Answer 61

Answer: B. Right Drug and Right Patient Rationale: The text states the nurse must verify the medication will be administered to the "right patient" by using a barcode scanning system. This system verifies at least two identifiers and confirms a match between the patient and the prescribed medication ("right drug").

Question 62

A patient is prescribed an oral pain medication PRN (as needed) every 4 hours. The patient last received the medication at 0600 and is requesting another dose at 0930 for severe pain. What is the nurse's best action? A. Administer the medication as requested because the patient is in severe pain. B. Explain to the patient that it is too early and they must wait until 1000. C. Contact the primary care provider to request an order for an alternate medication. D. Offer non-pharmacological comfort measures and explain the time constraint.

Answer 62

Answer: D. Offer non-pharmacological comfort measures and explain the time constraint. Rationale: The highlighted text emphasizes verifying the "right time" by ensuring the "correct frequency (especially important with PRN...as the patient may meet the indications for administration but the correct amount of time has not elapsed between doses)." The nurse must adhere to the 4-hour frequency and should offer other comfort measures while explaining why the medication cannot be given until 1000.

Question 63

A nurse prepares a patient's morning medications in the medication room. After verifying the medication with the MAR, the nurse is called to assist another patient in an emergency. What should the nurse do with the prepared medications? A. Ask another nurse to administer the medications. B. Leave the medications at the bedside for the patient to take. C. Place the medications back in the dispensing unit and re-prepare them later. D. Lock the medications in the cart or keep them in their possession until they can be administered.

Answer 63

Answer: D. Lock the medications in the cart or keep them in their possession until they can be administered. Rationale: The guideline states, "Never administer medication that you did not prepare" and "Never leave the medication unattended at the bedside." The only safe option is for the preparing nurse to maintain control over the medications until they can personally administer them.

Question 64

When is the most appropriate time for the nurse to document the administration of a medication? A. As soon as the medication is removed from the dispensing unit. B. Immediately after the medication has been administered to the patient. C. At the end of the shift when all medications have been given. D. Just before entering the patient's room to ensure it is not forgotten.

Answer 64

Answer: B. Immediately after the medication has been administered to the patient. Rationale: The text specifies that "Documentation is completed after administration to reflect the administration, refusal, or withholding of prescribed medication." Documenting before administration is a medication error if the patient refuses or is unable to take the medication.

Question 65

When preparing an injection, a nurse has another registered nurse check the dosage calculation for a high-risk medication. This action fulfills which of the Six Rights? A. Right Route B. Right Time C. Right Dose D. Right Documentation

Answer 65

Answer: C. Right Dose Rationale: The text suggests as an additional verification for the "right dose" to "Have another nurse check critical dosage calculations." This is a key safety strategy to prevent dosing errors with high-risk drugs.

Question 66

A patient tells the nurse, "This pill is a different color than the one I took yesterday." What is the nurse's priority action? A. Explain that different manufacturers make pills that look different. B. Stop the administration process and re-verify the medication and the order. C. Crush the medication in applesauce to hide the color. D. Check the patient's allergy band one more time.

Answer 66

Answer: B. Stop the administration process and re-verify the medication and the order. Rationale: A core patient concern listed in the text is, "If the patient questions or refuses the medication, stop the administration, verify the information, and proceed accordingly." The nurse must treat the patient's concern as a potential error and perform all safety checks again.

Question 67

According to the procedural guidelines, the nurse must verify that the drug is the right drug at which of the following points in the administration process? A. When taking the drug out of the dispensing unit. B. When comparing the drug with the MAR as it is being prepared. C. At the bedside immediately before administration. D. When the primary care provider first writes the order. E. After the medication has been swallowed by the patient.

Answer 67

Answer: A, B, C Rationale: The highlighted text explicitly outlines the three verification checks: "When taking the drug out of the drawer or dispensing unit," "When comparing it with the MAR as the drug is being prepared," and "At the bedside immediately before administration."

Question 68

To ensure the "right patient," which of the following are acceptable identifiers the nurse can use before administering medication? A. The patient's room number. B. The patient's full name. C. The patient's date of birth. D. A current photograph of the patient on the MAR. E. The patient's physical location in the room.

Answer 68

Answer: B, C, D Rationale: The guideline specifies verifying the right patient by using "at least two identifiers (such as full name of the patient, date of birth, and current photograph) against the MAR." It explicitly states, "Never use the patient’s room or physical location to verify identity."

Question 69

A nurse administers a PRN dose of an opioid analgesic for a patient's pain. Which elements must be included in the "right documentation"? A. The time the medication was administered. B. The patient's response to the medication. C. The name of the nurse who administered the medication. D. The indication that necessitated the administration. E. The name of the pharmacy that dispensed the drug.

Answer 69

Answer: A, B, C, D Rationale: The text states documentation must be "accurate and complete according to facility policy," and specifically for PRN medications, it must "Include the indications that necessitate administration of PRN medications and the patient’s response to medication." Standard documentation always includes the time (A) and the nurse's identity (C). The pharmacy name (E) is not part of the administration documentation.

Question 70

A nurse is reviewing the Medication Administration Record (MAR) at the end of a shift. Which of the following documentation practices represent a high-risk situation for patient safety? (Select all that apply.) A. Using the abbreviation "U" for units when documenting an insulin dose. B. Failing to document a patient's response to a PRN anti-nausea medication. C. Documenting the apical heart rate next to the entry for a scheduled digoxin dose. D. Failing to document that a scheduled 0800 antibiotic was administered. E. Documenting that the provider was notified after a patient refused a medication.

Answer 70

Answer: A, B, D Rationale: The highlighted text identifies failing to document the patient response to medications (B) and failing to document that medications were administered (D) as high-risk situations. Using unapproved or illegible information, such as the dangerous abbreviation "U" for units (A), also falls under the category of using inaccurate information. Documenting required assessment data (C) and documenting provider notification (E) are examples of correct and safe documentation practices.

Question 71

A nurse is preparing to administer a scheduled dose of warfarin to a patient. Which documentation omissions in the patient's chart would create a high-risk situation related to this medication? (Select all that apply.) A. Lack of documentation of the patient's most recent INR level. B. No documented assessment of the patient for signs of bleeding. C. Failure to document the patient's preferred time for morning care. D. The MAR entry for the previous dose lacks the signature of the administering nurse. E. Lack of documentation regarding the patient's food allergies.

Answer 71

Answer: A, B, D Rationale: The text states that lacking documentation of required assessment data, such as laboratory values (A) or physical assessment findings (B), is a high-risk situation. Warfarin administration requires monitoring the INR and assessing for bleeding. Incomplete or illegible information, such as a missing signature (D), also creates a risk. Food allergies (E) are important but less critical for warfarin than bleeding assessments, and the timing of morning care (C) is not a required assessment for this specific medication.

Question 72

A charge nurse is educating a group of new nurses about safe documentation habits. Which actions should the charge nurse identify as increasing the risk of medication errors? (Select all that apply.) A. Documenting a medication immediately after the patient has swallowed it. B. Documenting all scheduled 0900 medications as "given" at 0845 before starting the medication pass. C. Waiting until the end of the shift to document a STAT medication that was given 4 hours prior. D. Documenting a patient's refusal of a medication. E. "Pre-charting" the administration of a routine IV antibiotic infusion.

Answer 72

Answer: B, C, E Rationale: The highlighted text identifies documenting administration before the medication is administered (B, E) as a high-risk situation. This is a critical error because the patient may refuse the medication or be unable to take it after it has already been charted as given. Failing to document in a timely manner (C) is also a risk, as it can lead to another nurse administering a duplicate dose or result in inaccurate documentation from memory. Documenting after administration (A) and documenting a refusal (D) are correct procedures.

Question 73

A nurse withholds a patient's scheduled antihypertensive medication because the patient's blood pressure is 88/50 mmHg. The nurse notifies the primary care provider. Which elements must the nurse document to avoid a high-risk documentation error? (Select all that apply.) A. The patient's blood pressure reading of 88/50 mmHg. B. The reason the medication was withheld. C. The name of the primary care provider who was notified. D. The time the notification was made. E. The brand name of the sphygmomanometer used.

Answer 73

Answer: A, B, C, D Rationale: According to the highlighted text, failing to document the notification of a provider when a dose is not administered is a high-risk situation. Therefore, the nurse must document that the provider was notified (C) and the time of the notification (D). It is also critical to document the assessment data (A) that led to the decision and the reason for withholding the medication (B). The brand of the equipment used (E) is not necessary documentation.

Question 74

A patient who received a PRN dose of hydromorphone for postoperative pain 1 hour ago is now resting comfortably. Which documentation entries are necessary to fully comply with the principles of safe medication administration? (Select all that apply.) A. The time the medication was administered. B. The patient's reported pain score before administration. C. A follow-up entry describing the patient's current pain level and comfort. D. The name of the nurse who administered the medication. E. The name of the pharmacy that supplied the medication.

Answer 74

Answer: A, B, C, D Rationale: Failing to document the patient's response to medication (C) is identified as a high-risk situation. It is also essential to document the indication or the pre-administration assessment (B) for a PRN medication. Standard safe documentation always includes the time of administration (A) and the signature of the nurse who gave it (D). The pharmacy name (E) is not a required element of administration documentation.

Question 75

A nurse manager is performing a chart audit. Which of the following findings would be identified as a "Right Documentation" error according to the high-risk situations list? (Select all that apply.) A. A nurse has documented a patient's scheduled insulin as "given" before going to the patient's room. B. A nurse documented the patient's response to a pain medication as "tolerated well." C. A nurse documented that the provider was notified after a dose was withheld, but did not specify the provider's name. D. A nurse administered furosemide but failed to document the patient's most recent potassium level. E. A nurse failed to document the patient's statement that "the pain is completely gone" after receiving a PRN analgesic.

Answer 75

Answer: A, C, D, E Rationale: The highlighted text identifies several high-risk documentation errors. These include documenting before administration (A), using incomplete information such as not specifying which provider was notified (C), lacking required assessment data like laboratory values (D), and failing to document the patient's response to medications (E). While "tolerated well" (B) is not very specific, it is still a form of documenting a patient response and is less of a direct error than the other options.

Question 76

A nurse is preparing to administer a rectal suppository for constipation. In which position should the nurse place the adult patient? A. Supine with knees bent. B. Prone with feet flat on the bed. C. Right lateral recumbent. D. Left lateral recumbent.

Answer 76

Answer: D. Left lateral recumbent. Rationale: On page 826, the procedural concerns for rectal medication administration in Box 35.12 state to "Position the patient on the left side, with the upper knee flexed (i.e., left lateral recumbent position)." This position follows the natural curve of the colon, facilitating easier insertion and retention.

Question 77

A nurse is preparing to administer a prefilled syringe of enoxaparin. The nurse notes a small air bubble in the syringe. Which action is appropriate? A. Expel the air bubble before administering the injection. B. Administer the injection with the air bubble. C. Discard the syringe and obtain a new one. D. Shake the syringe to disperse the air bubble.

Answer 77

Answer: B. Administer the injection with the air bubble. Rationale: Page 828 notes a special consideration for prefilled syringes: "...some prefilled medication syringes, such as enoxaparin, contain air that should not be removed before administration." This air bubble helps ensure the full dose is delivered from the syringe.

Question 78

A primary care provider has ordered two different medications to be mixed in a single syringe for an intramuscular injection. What is the nurse's priority action before preparing the medications? A. Use a filter needle to draw up both medications. B. Draw up the medication from the ampule before the medication from the vial. C. Determine the compatibility of the two medications. D. Prepare the injection in two separate syringes to be safe.

Answer 78

Answer: C. Determine the compatibility of the two medications. Rationale: As stated on page 828, "If two medications are compatible, they can be mixed in one injection... Compatibility is determined through drug information and pharmacy resources." This is the first and most crucial step to prevent precipitation or an adverse chemical reaction.

Question 79

A nurse is preparing to withdraw medication from a multi-dose vial. Which actions demonstrate correct procedure? (Select all that apply.) A. Cleaning the rubber seal with an alcohol swab. B. Injecting an amount of air into the vial equal to the dose being withdrawn. C. Vigorously shaking the vial to ensure the medication is mixed. D. Touching the inside of the vial with the needle tip only. E. Labeling the vial with the date and time it was first opened.

Answer 79

Answer: A, B, E Rationale: Page 827 describes the correct procedure which includes cleaning the rubber seal with alcohol (A), injecting air equivalent to the amount of liquid to be withdrawn (B), and, if it is a multi-dose vial being used for the first time, it must be labeled with the date and time it is opened (E). Vials should typically be rolled, not shaken, and aseptic technique requires that the needle does not contaminate any non-sterile surfaces.

Question 80

A nurse is administering a rectal suppository. Which of the following are correct steps in the procedure? (Select all that apply.) A. Use a water-soluble gel to lubricate the suppository. B. Position the patient in the left lateral recumbent position. C. Insert the suppository with the flat end first. D. Gently push the suppository past the internal sphincter. E. Instruct the patient to have a bowel movement within 5 minutes of insertion.

Answer 80

Answer: A, B, D Rationale: The procedure described on page 826 specifies lubricating the suppository with a water-soluble gel (A), positioning the patient on the left side (B), and inserting the suppository past the internal sphincter (D). The suppository should be inserted with the rounded end first, and for a laxative effect, the patient should be instructed to retain it for 35-45 minutes.

Question 81

Which of the following nursing actions are critical for preventing needlestick injuries during and after parenteral medication administration? (Select all that apply.) A. Recap used needles using the two-handed method. B. Immediately activate the needle's safety mechanism after injection. C. Dispose of used needles and syringes in a puncture-resistant container. D. Use needleless systems when available for IV medication administration. E. Remove the needle from the syringe before disposal.

Answer 81

Answer: B, C, D Rationale: Pages 827 and 636 emphasize several key safety points. The text explicitly states not to recap used needles. It mandates activating the safety mechanism immediately after use (B) and disposing of the unit in an approved puncture-resistant container (C). The text also highlights that needleless systems significantly decrease needlestick injuries (D) and should be used when appropriate. Needles should not be removed from the syringe before disposal. Sources

Question 82

A nurse is preparing to administer an intramuscular (IM) injection of an antibiotic to a healthy adult patient. Which injection site is considered the safest and most preferred for this patient? A. Dorsogluteal B. Deltoid C. Ventrogluteal D. Scapular

Answer 82

Answer: C. Ventrogluteal Rationale: Page 830 of the text identifies the ventrogluteal site as the primary and preferred site for IM injections in patients older than 7 months because it is "free of major blood vessels, nerves, and fat and is associated with lower rates of injury." The dorsogluteal site is no longer recommended due to its proximity to the sciatic nerve.

Question 83

A patient is prescribed an IM injection of iron dextran, a medication known to be irritating and to discolor tissue. The nurse should use which injection technique? A. Z-track method B. Intradermal method C. Subcutaneous method D. Air-lock method

Answer 83

Answer: A. Z-track method Rationale: Page 830 specifically states, "Intramuscular injections of medications that discolor tissue (e.g., iron) or are irritating to tissue... are administered by the Z-track method." This technique seals the medication into the muscle tissue, preventing it from tracking back into the subcutaneous tissue upon needle withdrawal.

Question 84

A nurse is preparing to administer a dose of insulin using a multidose insulin pen. Before dialing the prescribed dose, what is the nurse's priority action to ensure the pen is working correctly? A. Invert the pen 20 times to mix the insulin. B. Clean the injection site with an alcohol swab. C. Prime the pen by dialing 2 units and depressing the plunger until a drop of insulin appears. D. Attach a new needle to the pen and remove the cap.

Answer 84

Answer: C. Prime the pen by dialing 2 units and depressing the plunger until a drop of insulin appears. Rationale: The procedural concerns for using an insulin pen on page 828 (Box 35.13) outline the critical step of priming the pen. This action clears any air from the needle and cartridge and ensures the pen is functioning correctly to deliver a full, accurate dose.

Question 85

A nurse is administering a purified protein derivative (PPD) test for tuberculosis exposure. At which angle should the nurse insert the needle for this intradermal injection? A. 15 degrees B. 45 degrees C. 90 degrees D. 30 degrees

Answer 85

Answer: A. 15 degrees Rationale: Page 828 describes intradermal injections and the corresponding angles of insertion. The text and accompanying Figure 35.12 clearly show that the needle should be inserted at a very shallow angle, between 5 and 15 degrees, for an intradermal injection to ensure the medication is delivered into the dermis.

Question 86

A nurse is administering a subcutaneous injection of heparin to a very thin, cachectic patient. Which needle insertion angle is most appropriate for this patient? A. 90 degrees B. 45 degrees C. 15 degrees D. 5 degrees

Answer 86

Answer: B. 45 degrees Rationale: On page 828, the text explains that for a subcutaneous injection, "A 45-degree angle may be used to give a subcutaneous injection to a very thin patient to ensure that the medication is injected into fatty tissue." A 90-degree angle might penetrate into the muscle on a patient with very little subcutaneous tissue.

Question 87

A nurse is preparing to give an IM injection to an 8-month-old infant for a routine vaccination. Which muscle is the most appropriate site for this injection? A. Deltoid B. Ventrogluteal C. Vastus lateralis D. Dorsogluteal

Answer 87

Answer: C. Vastus lateralis Rationale: Page 830 indicates that the vastus lateralis site is a primary site for IM injections in infants. The ventrogluteal site is not recommended until the infant is older than 7 months and has started walking, and the deltoid muscle is not well-developed enough in infants for IM injections.

Question 88

What is the primary reason the nurse must use specific anatomic landmarks to locate an IM injection site before administering a medication? A. To ensure the medication is absorbed more rapidly. B. To reduce the pain of the injection for the patient. C. To prevent damage to underlying tissues, bones, or nerves. D. To make documentation of the injection site easier.

Answer 88

Answer: C. To prevent damage to underlying tissues, bones, or nerves. Rationale: The "Safe Practice Alert" on page 830 explicitly warns, "Failure to find the correct injection site by using anatomic landmarks before injecting medication can result in tissue, bone, or nerve damage." This is the most critical safety reason for accurate site selection.

Question 89

A nurse is preparing to administer a subcutaneous injection. Which of the following actions are consistent with safe practice for this route? (Select all that apply.) A. Selecting a site on the patient's abdomen. B. Choosing a 3-inch needle to ensure the medication reaches the correct tissue layer. C. Administering a total volume of 0.75 mL. D. Vigorously massaging the site after the injection to promote absorption. E. Rotating injection sites for a patient receiving frequent injections.

Answer 89

Answer: A, C, E Rationale: Page 828 identifies the abdomen as a common subcutaneous site (A), states the volume should not exceed 1 mL (C is within this limit), and recommends that the injection site should be rotated to avoid tissue damage (E). A 3-inch needle (B) is too long and would be used for an IM, not subcutaneous, injection. The site should not be massaged (D), especially for medications like heparin or insulin.

Question 90

A nurse is using the Z-track method to administer an irritating IM medication into the ventrogluteal site. Which steps should the nurse include in this procedure? (Select all that apply.) A. Place a new needle on the syringe after drawing up the medication. B. Pull the overlying skin and subcutaneous tissue approximately 1 inch laterally. C. Massage the site vigorously after withdrawing the needle. D. Insert the needle and hold it in place for approximately 10 seconds after injecting. E. Release the skin immediately after injecting the medication but before withdrawing the needle.

Answer 90

Answer: A, B, D Rationale: The procedure for the Z-track method described on page 830 includes placing a new needle on the syringe so no medication is on the outside of the needle (A), pulling the skin laterally before injection (B), and holding the needle in place for approximately 10 seconds to allow medication dispersion before withdrawing it (D). The site should not be massaged, and the skin is released after the needle is withdrawn to seal the medication tract.