C HAPTER 31: M EDICATION
A DMINISTRATION
Fundamentals of Nursing 10th Edition; Potter Perry
MULTIPLE CHOICE
1. The client is to receive heparin by injection. The nurse prepares to inject
this medication in the clients:
A. Scapular region
B. Vastus lateralis
C. Posterior gluteal
D. Abdomen
ANS: D
The abdomen is the site most frequentl y recommended for heparin
injections is the abdomen. The scapular areas may be used for
subcutaneous injections, but it is not recommended site for heparin
injections. The vastus lateralis is u sed for intramuscular injections, not
subcutaneous injections. The posterior gluteal site is not recommended
for heparin injections.
DIF: A REF: 750 OBJ: Comprehension TOP: Nursing
Process: Planning MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapies
,2. A medication is prescribed for the client and is to be administered by IV
bolus injection. A priorit y for the nurse before the administration of
medication via this route is to:
A. Set the rate of the IV infusion
B. Check the clients mental alertness
C. Confirm placement of the IV line
D. Determine the amount of IV fluid to be administered
ANS: C
A priorit y for the nurse before the administration of medication via the
IV route is to confirm placement of the IV line. Confirm ing the
placement of the IV catheter and the integrit y of the surrounding tissue
ensures that the medication is administered safel y. The nurse should
first confirm placement of the IV line. The nurse should first confirm
placement of the IV line before adm inistering a medication by the IV
route. The clients mental alertness may be something the nurse
monitors after medication administration. The nurse should first
confirm placement of the IV line before administering any IV fluids.
DIF: C REF: 755 OBJ: Ana l ysis TOP: Nursing Process:
Implementation MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapies
3. A client on the medical unit receives regular insulin at 7:00 AM. The
nurse is alert to a possible hypogl ycemic r eaction by:
A. 7:30 AM
B. 10:00 AM
C. 4:00 PM
D. 8:00 PM
, ANS: B
Regular insulin reaches its peak in 2 to 4 hours after administration. If
the client received regular insulin at 7:00 AM, the nurse should be alert
for a possible hypoglycemic reaction from 9:00 AM to 1 1:00 AM.
Regular insulin has an onset in 30 minutes. Intermediate -acting insulin
(i.e., NPH insulin) would peak in 6 to 12 hours, not regular insulin.
The client would not be at risk for a hypogl ycemic reaction from
regular insulin 13 hours after administr ation. Long-acting insulin
would have an effect this length of time after administration.
DIF: A REF: 743 OBJ: Comprehension TOP: Nursing
Process: Evaluation MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapie s
4. A priorit y for the nurse in the administration of oral medications and
prevention of aspiration is:
A. Checking for a gag reflex
B. Allowing the client to self -administer
C. Assessing the abilit y to cough
D. Using straws and extra water for administration
ANS: A
To protect the client from aspiration, the nurse should determine the
presence of a gag reflex before administering oral medications. The
nurse should first check for a gag reflex. Then, if possible, the client
should be allowed to self -administer oral medications. Checking for a
gag reflex takes priorit y over assessing the abilit y to cough in
preventing aspiration. Straws should be avoided because they decrease
, the control the client has over volume intake, which increases the risk
of aspiration. Some clie nts cannot tolerate thin liquids such as water,
and need for them to be thickened.
DIF: C REF: 717 OBJ: Anal ysis TOP: Nursing Process:
Planning MSC: NC LEX test plan designation: Physiological
Integrit y/Pharmacological & Parenteral Therapies
5. The nurse is to administer several medications to the client via the N/G
tube. The nurses first action is to:
A. Add the medication to the tube feeding being given
B. Crush all tablets and capsules before administration
C. Administer all of the medications mixed together
D. Check for placement of the nasogastric tube
ANS: D
The nasogastric tube should be verified for placement before
administering any medication through it. Medications should never be
added to the tube feeding. Not all tablets can be crushed, such as
sustained release tablets, nor all capsules should be opened.
Medications should be reviewed carefully before crushing a tablet or
opening a capsule. Medications should be dissolved and administered
separatel y, flushing between 1 and 30 mL of water between each
medication.
DIF: C REF: 740 OBJ: Anal ysis TOP: Nursing Process:
Planning MSC: NC LEX test plan designation: Physiological
Integrit y/Pharmacological & Parenteral Therapies
A DMINISTRATION
Fundamentals of Nursing 10th Edition; Potter Perry
MULTIPLE CHOICE
1. The client is to receive heparin by injection. The nurse prepares to inject
this medication in the clients:
A. Scapular region
B. Vastus lateralis
C. Posterior gluteal
D. Abdomen
ANS: D
The abdomen is the site most frequentl y recommended for heparin
injections is the abdomen. The scapular areas may be used for
subcutaneous injections, but it is not recommended site for heparin
injections. The vastus lateralis is u sed for intramuscular injections, not
subcutaneous injections. The posterior gluteal site is not recommended
for heparin injections.
DIF: A REF: 750 OBJ: Comprehension TOP: Nursing
Process: Planning MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapies
,2. A medication is prescribed for the client and is to be administered by IV
bolus injection. A priorit y for the nurse before the administration of
medication via this route is to:
A. Set the rate of the IV infusion
B. Check the clients mental alertness
C. Confirm placement of the IV line
D. Determine the amount of IV fluid to be administered
ANS: C
A priorit y for the nurse before the administration of medication via the
IV route is to confirm placement of the IV line. Confirm ing the
placement of the IV catheter and the integrit y of the surrounding tissue
ensures that the medication is administered safel y. The nurse should
first confirm placement of the IV line. The nurse should first confirm
placement of the IV line before adm inistering a medication by the IV
route. The clients mental alertness may be something the nurse
monitors after medication administration. The nurse should first
confirm placement of the IV line before administering any IV fluids.
DIF: C REF: 755 OBJ: Ana l ysis TOP: Nursing Process:
Implementation MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapies
3. A client on the medical unit receives regular insulin at 7:00 AM. The
nurse is alert to a possible hypogl ycemic r eaction by:
A. 7:30 AM
B. 10:00 AM
C. 4:00 PM
D. 8:00 PM
, ANS: B
Regular insulin reaches its peak in 2 to 4 hours after administration. If
the client received regular insulin at 7:00 AM, the nurse should be alert
for a possible hypoglycemic reaction from 9:00 AM to 1 1:00 AM.
Regular insulin has an onset in 30 minutes. Intermediate -acting insulin
(i.e., NPH insulin) would peak in 6 to 12 hours, not regular insulin.
The client would not be at risk for a hypogl ycemic reaction from
regular insulin 13 hours after administr ation. Long-acting insulin
would have an effect this length of time after administration.
DIF: A REF: 743 OBJ: Comprehension TOP: Nursing
Process: Evaluation MSC: NC LEX test plan designation:
Physiological Integrity/Pharmacological & Parenteral Therapie s
4. A priorit y for the nurse in the administration of oral medications and
prevention of aspiration is:
A. Checking for a gag reflex
B. Allowing the client to self -administer
C. Assessing the abilit y to cough
D. Using straws and extra water for administration
ANS: A
To protect the client from aspiration, the nurse should determine the
presence of a gag reflex before administering oral medications. The
nurse should first check for a gag reflex. Then, if possible, the client
should be allowed to self -administer oral medications. Checking for a
gag reflex takes priorit y over assessing the abilit y to cough in
preventing aspiration. Straws should be avoided because they decrease
, the control the client has over volume intake, which increases the risk
of aspiration. Some clie nts cannot tolerate thin liquids such as water,
and need for them to be thickened.
DIF: C REF: 717 OBJ: Anal ysis TOP: Nursing Process:
Planning MSC: NC LEX test plan designation: Physiological
Integrit y/Pharmacological & Parenteral Therapies
5. The nurse is to administer several medications to the client via the N/G
tube. The nurses first action is to:
A. Add the medication to the tube feeding being given
B. Crush all tablets and capsules before administration
C. Administer all of the medications mixed together
D. Check for placement of the nasogastric tube
ANS: D
The nasogastric tube should be verified for placement before
administering any medication through it. Medications should never be
added to the tube feeding. Not all tablets can be crushed, such as
sustained release tablets, nor all capsules should be opened.
Medications should be reviewed carefully before crushing a tablet or
opening a capsule. Medications should be dissolved and administered
separatel y, flushing between 1 and 30 mL of water between each
medication.
DIF: C REF: 740 OBJ: Anal ysis TOP: Nursing Process:
Planning MSC: NC LEX test plan designation: Physiological
Integrit y/Pharmacological & Parenteral Therapies
