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CHAPTER 10 DOCUMENTATION REVIEW QUESTIONS WITH 100% RATED ANSWERS 2025/2026 LATEST UPDATE/GET A+

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The S in SBAR stands for situation. In this case, the patient is resting, and the pain is rated 3/10 at 1 hour after receiving a narcotic analgesic. Describing the admission reason and time provides the background (B). Assessment (A) of this patient revealed pain rated 8/10 before giving pain medication. The nurse's recommendation (R) is that pain should be assessed every 2 hours and that pain medications should be given as prescribed. The nurse administers morphine sulfate (Infumorph) 5 mg IV as per prescription to a patient who rates the pain as 8 on a scale of 0-10. After 20 minutes, the patient rates the pain levels as 3 on a scale of 0-10. Which format is best for the nurse to documentation? a. PIE note b. ADPIE note c. SOAP note d. SOAPIE note - a. PIE note Which statement would the nurse identify as the full form of the DAR format of problem- oriented medical recording? a. DAR refers to Data, Action, Response. b. DAR refers to Drug, Action, Response c. DAR refers to Data, Assessment, Revision d. DAR refers to Drug, Assessment, Revision. - a. DAR refers to Data, Action, Response. D: includes the patient's subjective and objective data. A: the nurse initiations the interventions according to the patient's identified needs. R: The nurse evaluates the interventions implemented and documents their effectiveness. The nurse writes a nursing care plan for a patient diagnosed with depression. While evaluating the patient, the nurse finds some goals have been met. Which method would the nurse use to document the findings? a. The nurse adds a note in the goal column as "goals met". b. The nurse writes a new nursing care plan with only the unmet goals. c. The nurse highlights the met goals in yellow. d. The nurse strikes a single line through the met goals with a signature and date. - d. The nurse strikes a single line through the met goals with a signature and date. Which note would the nurse record after administering an enema to a patient? a. Time at which enema is administered b. Equipment used for administration c. Patient's verbal behavior d. Description of the ailment e. Medications administered to the patient the previous night. - a. Time at which enema is administered b. Equipment used for administration Everything else will not be recorded because these may not affect the administration of the treatment or its outcome. The nurse writes a change-of-shift report, which includes the complete patient data and the interventions provided. Which documentation system does the nurse use? a. flow chart b. narrative charting c. formatted charting e. charting by exception - b. narrative charting Flow charting: used to document routine nursing care and observations using flow sheets.

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Institution
Nursing Pharmacology
Course
Nursing pharmacology

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CH. 5 & 9 MEDICATION ADMINISTRATION
QUESTIONS WITH 100% RATED ANSWERS 2025/2026
LATEST UPDATE/GET A+

5 rights of drug administration - 1. Right patient
2. Right medication
3. Right dose
4. Right route of administration
5. Right time of delivery

Keys of med administration - - Always wash hands before & after
- Watch patient swallow meds
- Never record before giving

Medication order components - 1. Patients name
2. Name of medication
3. Dose
4. Route
5. Frequency of administration
6. Date, time and signature of prescriber

If patient vomits after giving meds and can see the med in the emesis what do you do? -
Don't re-adminster
Call doctor

Peg tube medication if pill form.. - *Always check that you can crush the medication*
Crush completely and mix into liquid
(some capsules can be opened and mixed)

Can you feed and give meds through the peg tube at the same time? - No - stop the
feeding before giving medication

What to check when giving med through g-peg tube - - HOB elevated 30-45 degrees
- Check residual before
- Flush the tube
- Flush between meds

Injection - intradermal - TB test
Do not rub site afterwards

Subcutaneous injections are administered into the ____________ tissue - Adipose
tissue

Subcutaneous injection sites - - Abdomen (fastest absorption)

, - Upper arm
- Upper thighs
- Upper back
- Upper ventral gluteal areas (slowest absorption)

Subcutaneous injection needle size - 3/8 - 5/8 inch

Do you massage the site after a Subcutaneous injection?
Do you need to aspirate for blood? - NO - it alters absorption
NO

Intramuscular (IM) injection benefits - - Handles more volume
- Longer duration of action
- Can have systemic effect

IM injection needle length - 1-1 1/2 in

IM injection sites - Gluteal (Buttocks)
Deltoid
Vastus Lateralis (thigh)

Do you need to aspirate for blood before an IM injection?
Do you massage or apply pressure after? - YES
Apply pressure

Why do we use the Z-track method? - Prevents tracking (leakage) of the medication into
the subcutaneous tissue

*pull skin taught to inject - when pull out needle release skin* makes a Z shape

Ampule (glass tube) medication administration - Tap top to remove medication from top
Use gauze to break open
*Use filter needle to draw up medication (to prevent glass in administration*
Then CHANGE to REGULAR needle to administer

Mixing insulins rule - Clear (rapid/regular) before cloudy (NPH)

How to mix insulin - Inject air into long acting
Inject air into short acting then withdraw the amount needed (clear)
Withdraw EXACT amount from long-acting (cloudy)

Before hanging any IV medication... - Assess the IV site

How long is an IV site good for? - Around 72 hr, then its rotated

Before administering , the IV/hep-lock has to be flushed with what? - Normal saline

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Institution
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Course
Nursing pharmacology

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