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Chapter 02, Administration of Drugs
1. A nurse is required to give an intramuscular (IM) injection to an 18-month-old
toddler. The nurse would prepare which site for administration?
A) Dorsogluteal site
B) Deltoid muscle
C) Vastus lateralis
D) Ventrogluteal site
Answer: C
Rationale: The vastus lateralis site is frequently used for infants and small
children because it is more developed than the other intramuscular sites such as
the dorsogluteal and deltoid muscle. Ventrogluteal sites may be used in children
who have been ambulating for more than 2 years.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 7
Cognitive Level: Apply
Client Needs: Health Promotion and Maintenance
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 29, Administration of Drugs by the Intramuscular Route
2. A health care provider instructs a nurse to administer a medication to a client
STAT. Which action by the nurse would be most appropriate?
A) Insist on obtaining a written report before administering any drug.
B) Administer the drug as ordered by the health care provider.
C) Forego obtaining the health care provider's order after the drug has been
administered.
D) Document the administration of the drug only after receiving the health care
provider's order.
Answer: B
Rationale: The nurse should administer the drug as instructed without a written
order as it is an emergency. The nurse should, however, ensure that the health
care provider's order is obtained after the drug has been administered. Waiting
for a written order during an emergency may exacerbate the client's condition.
The nurse should complete the documentation immediately after the
administration of the drug and not wait until the health care provider's order is
received.
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Question Format: Multiple Choice
Chapter: 2
Learning Objective: 3
Cognitive Level: Apply
Client Needs: Safe and Effective Care Environment: Coordinated Care
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 21, Right Dose, Right Route, and Right Time
3. A nurse has administered an opioid drug to a client. Which action would be most
appropriate for the nurse to do immediately after administering the drug?
A) Monitor the vital signs of the client.
B) Document administration of the drug.
C) Inform the client about the type of drug.
D) Update the health care provider regarding the client's condition.
Answer: B
Rationale: After administration of any drug, the nurse should immediately
document the administration. After the documentation is complete, the nurse can
record the client's vital signs. The client needs to be informed about the drug
before the administration. The health care provider need not be immediately
informed, unless the client develops severe adverse reactions.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 9
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Communication and Documentation
Reference: p. 33, Nursing Responsibilities After Drug Administration
4. A health care provider orders a transdermal drug. When administering this drug,
which action by the nurse would be most appropriate?
A) Apply next dose to a new site.
B) Check the infusion rate.
C) Inject only the inner part of the forearm.
D) Give small volumes of doses.
Answer: A
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Rationale: An important nursing intervention when administrating drugs through
the transdermal route is to apply the next dose to a new site. It is important to
check the infusion rate every 15 to 30 minutes in clients using infusion controllers
or infusion pumps. When using the intradermal route, the inner part of the
forearm should be used as the injection site and small volumes of doses should be
administered.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 8
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 33, Administration of Drugs by the Transdermal Route
5. The health care provider has asked a nurse to administer a drug intravenously to
an unresponsive client. How can the nurse ensure that the drug is administered to
the right client?
A) By waking the client up to ask their name
B) By identifying the client's room number
C) By checking the client's wristband
D) By asking the nursing assistant for the client's location
Answer: C
Rationale: The nurse should identify a client by checking the client’s wristband,
which has the client's name. The nurse should not ask the client to confirm their
name, because some clients, particularly those who are confused or have
difficulty hearing, may respond by answering yes. Additionally, this client is
unresponsive. The nurse can obtain the client's location by asking any other
member of the health care staff, but should verify the client's identity by checking
the wristband. The nurse should not rely on the client's room number alone.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 1
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 20, Right Client
6. A client is ordered to receive subcutaneous heparin twice a day. When
administering this drug, what action would be most important for the nurse to
take to minimize tissue damage?
A) Insert the needle at the appropriate angle.
B) Select the needle length based on the client's weight.
C) Ensure that there is no hair on the injection site.
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Chapter 02, Administration of Drugs
1. A nurse is required to give an intramuscular (IM) injection to an 18-month-old
toddler. The nurse would prepare which site for administration?
A) Dorsogluteal site
B) Deltoid muscle
C) Vastus lateralis
D) Ventrogluteal site
Answer: C
Rationale: The vastus lateralis site is frequently used for infants and small
children because it is more developed than the other intramuscular sites such as
the dorsogluteal and deltoid muscle. Ventrogluteal sites may be used in children
who have been ambulating for more than 2 years.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 7
Cognitive Level: Apply
Client Needs: Health Promotion and Maintenance
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 29, Administration of Drugs by the Intramuscular Route
2. A health care provider instructs a nurse to administer a medication to a client
STAT. Which action by the nurse would be most appropriate?
A) Insist on obtaining a written report before administering any drug.
B) Administer the drug as ordered by the health care provider.
C) Forego obtaining the health care provider's order after the drug has been
administered.
D) Document the administration of the drug only after receiving the health care
provider's order.
Answer: B
Rationale: The nurse should administer the drug as instructed without a written
order as it is an emergency. The nurse should, however, ensure that the health
care provider's order is obtained after the drug has been administered. Waiting
for a written order during an emergency may exacerbate the client's condition.
The nurse should complete the documentation immediately after the
administration of the drug and not wait until the health care provider's order is
received.
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Question Format: Multiple Choice
Chapter: 2
Learning Objective: 3
Cognitive Level: Apply
Client Needs: Safe and Effective Care Environment: Coordinated Care
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 21, Right Dose, Right Route, and Right Time
3. A nurse has administered an opioid drug to a client. Which action would be most
appropriate for the nurse to do immediately after administering the drug?
A) Monitor the vital signs of the client.
B) Document administration of the drug.
C) Inform the client about the type of drug.
D) Update the health care provider regarding the client's condition.
Answer: B
Rationale: After administration of any drug, the nurse should immediately
document the administration. After the documentation is complete, the nurse can
record the client's vital signs. The client needs to be informed about the drug
before the administration. The health care provider need not be immediately
informed, unless the client develops severe adverse reactions.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 9
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Communication and Documentation
Reference: p. 33, Nursing Responsibilities After Drug Administration
4. A health care provider orders a transdermal drug. When administering this drug,
which action by the nurse would be most appropriate?
A) Apply next dose to a new site.
B) Check the infusion rate.
C) Inject only the inner part of the forearm.
D) Give small volumes of doses.
Answer: A
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To Access The FULL VERSION
Rationale: An important nursing intervention when administrating drugs through
the transdermal route is to apply the next dose to a new site. It is important to
check the infusion rate every 15 to 30 minutes in clients using infusion controllers
or infusion pumps. When using the intradermal route, the inner part of the
forearm should be used as the injection site and small volumes of doses should be
administered.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 8
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 33, Administration of Drugs by the Transdermal Route
5. The health care provider has asked a nurse to administer a drug intravenously to
an unresponsive client. How can the nurse ensure that the drug is administered to
the right client?
A) By waking the client up to ask their name
B) By identifying the client's room number
C) By checking the client's wristband
D) By asking the nursing assistant for the client's location
Answer: C
Rationale: The nurse should identify a client by checking the client’s wristband,
which has the client's name. The nurse should not ask the client to confirm their
name, because some clients, particularly those who are confused or have
difficulty hearing, may respond by answering yes. Additionally, this client is
unresponsive. The nurse can obtain the client's location by asking any other
member of the health care staff, but should verify the client's identity by checking
the wristband. The nurse should not rely on the client's room number alone.
Question Format: Multiple Choice
Chapter: 2
Learning Objective: 1
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies
Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 20, Right Client
6. A client is ordered to receive subcutaneous heparin twice a day. When
administering this drug, what action would be most important for the nurse to
take to minimize tissue damage?
A) Insert the needle at the appropriate angle.
B) Select the needle length based on the client's weight.
C) Ensure that there is no hair on the injection site.
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