TEST BANK ROACH'S INTRODUCTORY CLINICAL PHARMACOLOGY 11TH EDITION

TEST BANK ROACH'S INTRODUCTORY CLINICAL PHARMACOLOGY 11TH EDITION1. A nursing instructor is preparing a teaching plan for a group of nursing students about pharmacology. When describing this topic, the instructor would focus the discussion on which of the following as an essential aspect? A) Drug name B) Drug class C) Drug action D) Drug source Ans: C Feedback: Pharmacology is the study of drugs and their action on living organisms. Thus, an essential aspect of pharmacology is drug action. An understanding of the drug name, drug class, and drug source is important, but the most critical aspect related to pharmacology is how the drug acts in the body. 2. A nursing student is preparing to administer a prescribed drug to a patient. The student reviews information about the drug and its actions. Which of the following would be the best choice for obtaining this information? Select all that apply. A) Nursing instructor B) Nurse assigned to the patient C) Clinical drug reference D) Prescribing health care provider E) Clinical pharmacist Ans: C, E Feedback: Although the nursing student can ask the nursing instructor, the nurse assigned to the patient, and the prescribing health care provider for information about the drug, the best choices for drug information would include an appropriate drug reference and the clinical pharmacist. 3. When describing the various types of medications to a group of nursing students, a nursing instructor would identify which of the following as a source for deriving medications? Select all that apply. A) Plants B) Synthetic sources C) Mold D) Minerals E) Animals Ans: A, B, C, D, E Feedback: 1 | P a g eMedications are derived from natural sources, for example, plants, molds, minerals, and animals, as well as created synthetically in a laboratory. 4. Which of the following names may be assigned to a drug during the process of development? Select all that apply. A) Chemical name B) Official name C) Pharmacologic name D) Trade name E) Nonproprietary name Ans: A, B, D, E Feedback: Throughout the process of development, drugs may have several names assigned to them including a chemical name, a generic (nonproprietary) name, an official name, and a trade or brand name. 5. A drug may be classified by which of the following? Select all that apply. A) The chemical type of the drug's active ingredient B) The way the drug is used to treat a specific condition C) The generic name of the drug D) The trade name of the drug E) The nonproprietary name of the drug Ans: A, B Feedback: A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Generic, trade, and nonproprietary refer to how a drug is named. 6. A group of nursing students are reviewing information about the process of drug development in the United States. The students demonstrate understanding of this process when they identify that which of the following categories are assigned by the Food and Drug Administration to newly approved drugs? Select all that apply. A) Metabolite B) Noncontrolled substance C) Prescription D) Nonprescription E) Controlled substance Ans: C, D, E Feedback: Once drugs are approved for use, the FDA assigns the drug to one of the following categories: prescription, nonprescription, or controlled substance. Metabolite refers to the inactive form of the drug. Noncontrolled substance is a term that is not used. 2 | P a g e7. Which of the following would be most important for the nurse to do to ensure the safe use of prescription drugs in the institutional setting? Select all that apply. A) Administering drugs B) Monitoring clients for drug effects C) Prescribing drugs D) Evaluating clients for toxic effects E) Educating clients/caregivers about drugs Ans: A, B, D, E Feedback: In the institutional setting, the nurse's role to ensure safe use of prescription drugs includes administering drugs, monitoring drug effects, evaluating for toxic effects, and educating clients and caregivers about drugs. 8. The nurse is helping a client review a prescription from the health care provider. When examining the prescription, which of the following would the nurse expect to find documented? Select all that apply. A) Name of the drug B) Dosage of the drug C) Route of drug administration D) Times of drug administration E) Licensed prescriber's signature Ans: A, B, C, D, E Feedback: The prescription must contain the client's name, the name of the drug, the dosage, the method and times of administration, and the signature of the licensed health care provider prescribing the drug. 9. After teaching a group of nursing students about nonprescription drugs, the nursing instructor determines that the teaching was successful when the students identify which of the following? Select all that apply. A) They require a licensed health care provider's signature. B) They are referred to as over-the-counter drugs. C) They can be taken without risk to the client. D) They have certain labeling requirements. E) They should be taken only as directed on the label. Ans: B, D, E Feedback: Nonprescription drugs are often referred to as over-the-counter (OTC) drugs. They do not require a prescription (a licensed health care provider's signature) but do not come without risk to the client. The federal government has imposed labeling requirements of OTC drugs and they should only be taken as directed on the label unless under the supervision of a health care provider. 3 | P a g e10. A nursing student is reviewing information about the Controlled Substances Act of 1970. The student would expect to find which of the following as being regulated for drugs classified as controlled substances? Select all that apply. A) Manufacturing B) Elimination C) Distribution D) Formulation E) Dispensing Ans: A, C, E Feedback: The Controlled Substances Act of 1970 regulates the manufacture, distribution, and dispensing of drugs classified as controlled substances. Elimination refers to the excretion of drugs from the body, a pharmacokinetic activity. The act does not address formulation of the drug. 11. When reviewing information about the Orphan Drug Program, which of the following would the nurse expect to find? Select all that apply. A) The program encourages the development and marketing of products to treat rare diseases. B) The program grants provisional approval with a written commitment from the drug company to formally demonstrate client benefits. C) The program provides for incentives, such as research grants, protocol assistance, and special tax credits, to develop products to treat rare diseases. D) The program grants 7 years of exclusive marketing rights to the manufacturer if approved. E) The program accelerates approval of drugs based on preliminary evidence before formal demonstration of client benefits. Ans: A, C, D Feedback: The Orphan Drug Program encourages the development and marketing of products used to treat rare diseases. The program provides incentives to encourage manufacturers to develop orphan drugs, and if approved, the manufacturer has 7 years of exclusive marketing rights. Accelerated programs involve provisional approval and approval based on preliminary evidence. 12. After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which of the following as a phase? Select all that apply. A) Absorption B) Distribution C) Administration D) Metabolism E) Excretion Ans: A, B, D, E 4 | P a g eFeedback: The pharmacokinetic phases are absorption, distribution, metabolism, and excretion. The acronym ADME is a helpful way to remember the pharmacokinetic phases. 13. A nurse is preparing a teaching plan for a client who is prescribed an oral medication. As part of the plan, the nurse expects to describe the importance of absorption. The nurse would integrate knowledge of which of the following as a mechanism for absorption in the gastrointestinal tract? Select all that apply. A) Active transport B) Transposition C) Passive transport D) Endocytosis E) Pinocytosis Ans: A, C, E Feedback: During absorption, the drug particles in the GI tract are moved into the body fluids via active transport, passive transport, and pinocytosis. 14. After teaching a group of nursing students about the half-life of a drug, the instructor determines the need for additional teaching when the students identify which of the following as true? Select all that apply: A) Half-life can be decreased in clients with renal disease. B) Half-life can help determine dosing frequency. C) Half-life does not change throughout a client's life. D) Liver disease can increase half-life. E) Half-life is the measure of the rate at which drugs are removed from the body. Ans: A, C Feedback: Half-life is the measure of the rate at which drugs are removed from the body, and any difficulty in excreting a drug increases half-life, including liver or kidney disease or advanced age. 15. A nurse is assessing a client after administering a prescribed medication. Which of the following would alert the nurse to suspect that the client is developing anaphylactic shock? Select all that apply. A) Bradycardia B) Hypertension C) Dyspnea D) Urticaria E) Angioedema Ans: C, D, E Feedback: The symptoms of anaphylactic shock are dyspnea, feeling of fullness in the throat, cough, 5 | P a g ewheezing, extremely low blood pressure, tachycardia (heart rate >100 bpm), palpitations, syncope, cardiac arrest, urticaria, angioedema, pruritus, sweating, nausea, vomiting, and abdominal pain. 16. Which of the following would the nurse identify as a factor that alters drug response in children and infants? Select all that apply. A) Slower gastric emptying B) Greater surface area C) Less protein binding D) Decreased body water content E) Less cutaneous fat Ans: A, B, C, E Feedback: Children and infants are not small adults; therefore, they have altered pharmacokinetics. Factors that alter pharmacokinetics in children include slower gastric emptying, less cutaneous fat, greater surface area, increased body water content, less protein binding, and immature hepatic and renal function. 17. The FDA established a safety information and adverse events reporting program called MedWatch. Which individuals can access the MedWatch website to obtain safety alerts on drugs, devices, or dietary supplements? Select all that apply. A) Physicians B) Nurses C) Patients D) Pharmacists E) Caregivers Ans: A, B, C, D, E Feedback: Anyone can access the MedWatch website to obtain safety alerts on drugs, devices, or dietary supplements. 18. A nurse is preparing to administer a prescribed medication to a client. The nurse integrates knowledge of which of the following as a possible factor that could influence the drug response? Select all that apply. A) Age B) Polypharmacy C) Weight D) Sex E) Disease Ans: A, B, C, D, E Feedback: Drug response can be influenced by the following factors: age, polypharmacy, weight, sex, disease, and genetics. 6 | P a g e19. A nurse is assessing a client and notes that the client has developed swelling of the eyelids and lips after administration of a prescribed medication. The nurse interprets this finding as specifically indicating which of the following? A) Mild allergic reaction B) Anaphylactic shock C) Angioedema D) Drug idiosyncrasy Ans: C Feedback: Angioedema is a type of allergic drug reaction manifested by the collection of fluid in the subcutaneous tissues, most commonly affecting the eyelids, lips, mouth, and throat. Allergic reactions can be manifested by a wide range of signs and symptoms such as itching, rashes, and hives. Anaphylactic shock is a serious allergic reaction that requires immediate medical attention. Drug idiosyncrasy describes any unusual or abnormal reaction to a drug, one that is different from the one normally expected. 20. Which of the following is true regarding the Dietary Supplement Health and Education Act (DSHEA)? Select all that apply. A) The act allows for DEA enforcement of the act. B) The act gives the FDA power to enforce the laws governed by the act. C) The act permits general health claims. D) The act permits curative health claims. E) The act defines specific substances as “dietary supplements.” Ans: B, C, E Feedback: The DSHEA defines substances such as herbs, vitamins, minerals, amino acids, and other natural substances as “dietary supplements” and permits general health claims as long as the label also has a disclaimer stating that the supplements are not approved by the FDA and are not intended to diagnose, treat, cure, or prevent any disease. The act gives the FDA the power to enforce the laws governed by the act. 21. When reviewing the phases of drug development, the nurse finds a discussion about the postmarketing surveillance phase. Which one of the following activities would the nurse expect to find as being carried out during this phase? A) Health care providers report adverse effects to FDA. B) Healthy volunteers are involved in the test. C) In vitro tests are performed using human cells. D) The drug is given to patients with the disease. Ans: A Feedback: The postmarketing surveillance phase of drug development encourages health care professionals to report adverse effects of drugs to the FDA using MedWatch. Phase 1 of 7 | P a g eclinical testing involves 20 to 100 healthy volunteers. In vitro testing of the drug on human or animal cells is done in the pre-FDA phase. In Phase 2 of clinical testing, the drug is given to patients with the disease for which the drug is manufactured. 22. A nurse is assessing a pregnant client and learns that the client is addicted to cocaine. The nurse informs the client about the risks of cocaine addiction for her fetus. Which of the following would the nurse include? A) The child may be born with diabetes. B) The child may be born with hypertension. C) The child may be born with an addiction to drugs. D) The child may be born with CNS defects. Ans: C Feedback: The nurse informs the client that children born to mothers using addictive drugs are often born with an addiction to the drug. Children born to mothers who are addicted to cocaine are not known to be born with diabetes, CNS defects, or hypertension. 23. A patient arrives at the health care clinic and informs the nurse that he has consumed several aspirin tablets for a severe headache over the past 24 hours. The nurse would be alert for which of the following as a harmful effect? A) Gastrointestinal bleeding B) Breathing difficulties C) Visual disturbances D) Loss of balance Ans: A Feedback: Aspirin is potentially harmful and can cause gastrointestinal bleeding and salicylism. Breathing difficulties, visual disturbances, and loss of balance could be due to an illness or the effects of some other drug. 24. The nurse observes that after administration of a drug the patient has developed itching and a skin rash. The nurse interprets these findings as which of the following? A) Toxicity B) Allergic reaction C) Angioedema D) Crystalluria Ans: B Feedback: Allergic reactions are manifested by a variety of signs and symptoms including itching, skin rashes, and hives. Swollen eyelids, lips, and mouth are some of the symptoms of angioedema, an allergic drug reaction that may block the airway, causing asphyxia. Toxicity or toxic reactions are caused when blood concentration levels exceed the therapeutic level of drugs. Reduced blood pressure is called hypotension. Crystals in the urine are symptoms of crystalluria. 8 | P a g e25. A patient is receiving digoxin as treatment for heart failure. Which of the following would be most important for the nurse to monitor to reduce the risk for toxicity? A) Seizure activity B) Drug blood level C) Urinary output D) Blood pressure Ans: B Feedback: The nurse should monitor the patient's blood level of the drug to ensure that the level remains within the therapeutic range. Monitoring seizure activity, urination frequency, and blood pressure will not prevent toxicity. Seizure activity is unrelated to digoxin or heart failure. 26. A patient has been using sleeping pills every night for the past several months. Now admitted to the hospital, he is prescribed his usual dose of sleeping pill. After administration, the patient continues to be restless and is wide awake. The nurse notifies the health care provider, who prescribes an increased dose. After receiving the new dose, the patient falls asleep. The nurse interprets this as which of the following? A) Drug idiosyncrasy B) Cumulative drug effect C) Drug tolerance D) Toxic reactions Ans: C Feedback: The patient has developed drug tolerance and has to be administered an increased dosage of the drug to achieve the desired effect. Cumulative drug effect occurs when the body is unable to metabolize and excrete one (normal) dose of a drug before the next dose is given. Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. Toxic reactions are caused when blood concentration levels exceed the therapeutic levels of a drug. 27. A patient wants to know about the possible interactions of the various drugs that he has been prescribed for an illness. The nurse explains that the drugs interact with each other and produce an effect that is greater than the sum of their separate actions. Which of the following reactions is the nurse informing about? A) Additive drug reaction B) Synergistic drug reaction C) Antagonistic drug reaction D) Toxic drug reaction Ans: B Feedback: A synergistic drug reaction occurs when drugs interact with each other and produce a 9 | P a g esum greater than the sum of their separate actions. An additive drug reaction occurs when the combined effect of two drugs is equal to the sum of each drug given alone. An antagonistic drug reaction occurs when one drug interferes with the action of another, causing neutralization or a decrease in the effect of one drug. Toxic drug reactions are caused when blood concentration levels exceed the therapeutic levels of a drug. 28. A nurse has administered drugs to a patient as per the physician's orders. Which of the following activities should the nurse perform after administering the prescribed drugs to the patient? A) Record symptoms of the condition. B) Perform a culture and sensitivity test. C) Obtain history of drug allergy. D) Check for adverse drug reactions. Ans: D Feedback: After administering the drug to the patient, the nurse should observe the patient for adverse drug reactions. Recording symptoms of infection, performing a culture and sensitivity test, and obtaining a history of drug allergy are typically performed by the nurse in the preadministration assessment stage. 29. The nurse administers a prescribed medication that is supplied as an enteric-coated tablet. The patient asks the nurse about this form of tablet. When describing how this tablet is absorbed, which response by the nurse would be most accurate? A) “The medication dissolves directly from the stomach into the body.” B) “The drug breaks up into pieces as it moves through the stomach.” C) “The medication bypasses the GI tract and goes quickly into the bloodstream.” D) “The drug dissolves into fragments after it reaches your small intestine.” Ans: D Feedback: Enteric-coated tablets disintegrate or fragment after reaching the alkaline medium of the small intestine. Tablets and capsules break up into small particles and dissolve into body fluids in the gastrointestinal tract. Liquids and parenteral drugs are quickly absorbed into the body system. 30. After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which of the following as the first phase? A) Metabolism B) Absorption C) Distribution D) Excretion Ans: B Feedback: 10 | P a g ePharmacokinetics refers to the transportation activity of drugs in the body after administration. The first component is absorption. This is followed by distribution, metabolism, and finally excretion. 31. A patient is considering using herbal supplements and asks the nurse about them. Which response by the nurse would be most appropriate? A) “Herbal supplements are safe to use because they are regulated closely.” B) “Herbal supplements can affect the way other medications will act.” C) “Taking more than the recommended amount usually is not harmful because they are natural.” D) “The risk of the supplement interacting with any prescription medications is extremely low.” Ans: B Feedback: The nurse needs to explain to the patient that just because an herbal supplement is labeled “natural” does not mean the supplement is safe or without harmful effects. Herbal supplements can act the same way as drugs and can cause medical problems if not used correctly or if taken in large amounts. Herbal supplements are not regulated by the FDA, so products lack standardization in relation to purity and potency. In addition, the patient should be warned not to take more than the recommended dose of any herbal health product or supplement. The problems that these products can cause are much more likely to occur if the patient takes too much or takes them for too long. 32. A nurse is reading a journal article about seasonal allergies and comes across the name of the drug loratadine. The nurse identifies this drug name as which of the following? A) Chemical B) Generic C) Trade D) Brand Ans: B Feedback: The generic name is the name given to a drug that can be made or marketed by any company and is the name given to the drug by the FDA. The chemical name is the scientific term that describes the molecular structure of the drugs, typically the chemical components. The trade or brand name of the drug is the name selected by a specific company for marketing purposes and is followed by a trademark symbol or registered trademark symbol. 33. A group of nursing students are reviewing information about drug development in the United States in preparation for an exam. The students demonstrate understanding of this material when they identify testing of which of the following as one of the first steps? A) Small group of healthy volunteers B) People who have the disease 11 | P a g eC) Live animals D) Large numbers of patients Ans: C Feedback: Initially, drug testing begins with testing in an artificial environment such as a test tube, and then this testing is followed by testing on live animals. Next, clinical testing occurs with each phase involving a larger number of people. First, a small group of 20 to 100 healthy volunteers are tested; then testing is performed on people who have the disease or condition. Last, the drug is given to large numbers of patients in medical research centers. 34. After teaching a group of nursing students about pharmacokinetics, the instructor determines that the teaching was successful when the students identify which of the following as the site for the metabolism of most drugs? A) Liver B) Lungs C) Kidneys D) Intestinal mucosa Ans: A Feedback: Although the kidneys, lungs, plasma, and intestinal mucosa may aid in the metabolism of drugs, most drugs are metabolized by the liver. 1. Which of the following reflects a nurse's responsibility when a drug is prescribed for a client? Select all that apply. A) Administering the drug to the client B) Monitoring for therapeutic response C) Checking for drug–drug interactions D) Reporting adverse reactions E) Teaching the client information needed to administer drugs safely at home Ans: A, B, D, E Feedback: When a drug is prescribed to a client, the nurse is responsible for the administration of the drug, monitoring for therapeutic effects, reporting adverse drug reactions, and teaching the client information needed to administer the drug safely at home. A pharmacist checks for drug–drug interactions prior to dispensing a drug for administration. 2. A group of nursing students are reviewing the concept known as the five + 1 rights of drug administration. The group demonstrates understanding of this concept when they identify which of the following as being included? Select all that apply. A) Right documentation B) Right patient C) Right route 12 | P a g eD) Right drug E) Right prescriber Ans: A, B, C, D Feedback: The five + 1 rights of drug administration include the following: right patient, right drug, right dose, right route, right time, and right documentation. 3. Prior to administering a prescribed drug, the nurse correctly identifies the client by which method? Select all that apply. A) Checking a client's name on his or her wristband B) Checking a client's chart C) Asking the client to identify himself or herself and give his or her birth date D) Asking a client if he or she is the correct client E) Using a current picture of the client if available Ans: A, C, E Feedback: Client identifiers can include visual and verbal methods. Visual methods include use of a recent picture of the client or client wristband. Verbal methods include asking the client for his or her name and another unique identifier, such as his or her birth date. Never ask a client, “Are you Mr. Jones?” because some clients may respond by answering “yes” even though that is not their name due to confusion or difficulty hearing. Checking the client's chart would be inappropriate to use for identifying the client. 4. When completing the check to ensure that the right drug is being administered to the client, which of the following should the nurse compare? Select all that apply. A) Medication B) Container label C) Medication record D) MAR E) Nursing notes Ans: A, B, C, D Feedback: The nurse compares the medication, container label, and medication record and then the MAR as the item is removed from the cart and before the actual administration of the drug. 5. A nurse is reviewing the order for a medication. Which of the following must be included? Select all that apply. A) Client's name B) Drug name C) Dosage form D) Route of administration E) Frequency of administration 13 | P a g eAns: A, B, C, D, E Feedback: A primary health care provider's order must include the client's name, the drug name, the dosage form and route, the dosage to be administered, and the frequency of administration. 6. When a primary health care provider phones in a medication order for a client, the nurse should do which of the following? Select all that apply. A) Write down the order. B) Record the order as soon as the MAR is retrieved. C) Repeat back the information exactly as written. D) Clarify any unclear information. E) Obtain verbal confirmation that the information is correct. Ans: A, C, D, E Feedback: If a verbal order is given over the telephone, the nurse writes down the order immediately, repeats back the information exactly as written, and then asks for a verbal confirmation that it is correct. Any order that is unclear should be questioned and clarified. 7. A nurse is preparing to administer a prescribed drug. Which information about the drug would be most important for the nurse to know? Select all that apply. A) Normal dosage range B) Special precautions in administration C) Drug's most common adverse effects D) Drug's general action E) Reason for use of the drug Ans: A, B, C, D, E Feedback: The nurse must have factual knowledge of each drug given, the reason for use of the drug, the drug's general action, the more common adverse reactions associated with the drug, special precautions in administration (if any), and the normal dose ranges. 8. A nurse is reviewing the medical record of a client and notes the various orders for drug therapy. Which of the following would the nurse most likely expect to find? Select all that apply. A) Standing order B) STAT order C) Single order D) Alternate order E) PRN order Ans: A, B, C, E Feedback: 14 | P a g eCommon orders given by health care providers for drug therapy include the standing order, the single order, the PRN order, and the STAT order. 9. When administering a prescribed drug to a client, which action would be completely inappropriate? Select all that apply. A) Charting immediately on the MAR after drug administration B) Removing a drug from an unlabeled container C) Giving a drug that someone else prepared D) Crushing tablets or opening capsules E) Removing the drug's unit dose wrapper at the client's bedside Ans: B, C, D Feedback: The nurse should always record immediately on the MAR after drug administration. The nurse should never remove a drug from an unlabeled container, give a drug that someone else prepared, or crush tablets or open capsules without consulting a pharmacist. The drug's unit dose wrapper should remain on until the nurse arrives at the client's bedside. 10. Drug errors are most likely to occur at which time? Select all that apply. A) When transcribing the drug order B) When verifying the client C) When dispensing the drug D) When charting after drug administration E) When administering the drug Ans: A, C, E Feedback: Drug errors may occur in transcribing drug orders, when the drug is dispensed, or in administration of the drug. Nurses, as the drug administrators, serve as the last defense against drug errors. Verifying the client and charting after administration are two important areas to help prevent medication errors. 11. A nurse is preparing a presentation for a group of nurses about actions that nurses can do to help prevent drug errors. Which of the following would the nurse include? Select all that apply. A) Rechecking all calculations B) Always administering the drug before answering any of the client's questions C) Avoiding distractions and concentrating on only one task at a time D) Confirming any questionable orders E) Practicing the five + 1 rights of drug administration Ans: A, C, D, E Feedback: In addition to following the five + 1 rights of drug administration, a nurse can employ the following strategies to aid in the prevention of drug errors: confirm any questionable orders; when calculations are necessary, verify them with another nurse; listen to the 15 | P a g eclient when he or she questions a drug, the dosage, or the drug regimen; never administer the drug until the client's questions have been adequately researched; and avoid distractions and concentrate on only one task at a time. 12. When documenting, which of the following would be appropriate for the nurse to use at accredited health care organizations? Select all that apply. A) IU B) QD C) 0.2 mg D) Units E) 2.0 mg Ans: C, D Feedback: Always use a leading zero when writing decimals (i.e., 0.2 mg, not .2 mg) and leave off the trailing zero (i.e., 2 mg, not 2.0 mg). Always write out units, international units, and daily; do not use U, IU, or QD. 13. When using a bar-code point-of-care medication system, the nurse would scan which of the following prior to drug administration? Select all that apply. A) Client's hospital chart B) Client's identification band C) Drug unit dose package D) Nurse's identification badge E) Client's medication administration record Ans: B, C, D Feedback: The bar-code point-of-care medication system requires that the client's identification band, the drug unit dose package, and the nurse's identification badge are all scanned prior to drug administration. 14. Which of the following is considered a unit dose system? Select all that apply. A) Floor stock bottle of aspirin 81 mg B) A prefilled Lovenox syringe C) One Phenergan suppository D) Floor stock bottle of ibuprofen suspension E) Single-dose cup of Maalox Ans: B, C, E Feedback: Examples of unit dose medications include a package that contains one tablet or capsule, a premeasured amount of a liquid drug, a prefilled syringe, or one suppository. 15. A nurse is preparing to administer a prescribed drug by the oral route. Which of the 16 | P a g efollowing would be most important for the nurse to do? Select all that apply. A) Making sure the client is in an upright position prior to administration B) Ensuring that a full glass of water is readily available C) Leaving PRN drugs at the bedside for ready access if needed D) Instructing the client to tilt his or her head back to swallow a capsule E) Having the client refrain from sipping on the water before placing the tablet in the mouth Ans: A, B Feedback: Clients should always be in an upright position when receiving oral drugs and a glass of water should be readily available. They should be encouraged to take a few sips of water before placing the tablet or capsule in the mouth. Drugs should never be left at the client's bedside. Instruct clients to tilt their head back to swallow a tablet and slightly forward to swallow a capsule. 16. The nurse is caring for a client who has a nasogastric tube in place. The client is to receive an oral medication through the tube. Which action by the nurse would be most appropriate? Select all that apply. A) Not diluting liquids prior to administration B) Checking the tube for placement C) Dissolving crushed tablets in water prior to administration D) Flushing the tube with water after drugs are administered E) Clearing the tube with air prior to administration Ans: B, C, D Feedback: Before administration of an oral drug through an NG tube or gastrostomy tube, the nurse should check the tube for placement, dilute and flush liquid drugs through the tube, crush tablets and dissolve them in water before administering them through the tube, and flush the tube with water after the drugs are placed in the tube to clear the tubing completely. 17. When administering parenteral drugs, which of the following routes would the nurse use? Select all that apply. A) Subcutaneous B) Intramuscular C) Intradural D) Intravenous E) Intradermal Ans: A, B, D, E Feedback: A nurse can administer parenteral drugs via subcutaneous, intramuscular, intravenous, intradermal, and, in some instances, intra-arterial routes by means of a catheter placed by a physician in an artery. The primary health care provider can administer a drug via the intradural route. 17 | P a g e18. A nurse is preparing to administer a prescribed drug via an intramuscular injection. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Always wear gloves. B) Cleanse skin at injection site. C) Place pressure on the area after removing the needle. D) Recap the needle before disposal. E) Aspirate after inserting the needle. Ans: A, B, C, E Feedback: When administering an intramuscular injection, the nurse should always wear gloves, cleanse the skin at the injection site prior to administration, aspirate for 5 to 10 seconds after inserting the needle, apply pressure to the area after removing the needle, and never recap the needle. 19. When administering an intradermal injection, the nurse would use a 1-mL syringe with which gauge of needle? Select all that apply. A) 26 gauge B) 28 gauge C) 29 gauge D) 25 gauge E) 27 gauge Ans: A, D, E Feedback: A 1-mL syringe with a 25- to 27-gauge needle that is 1/4 to 5/8 inches long is best suited for intradermal injections. 20. A client has an order to receive 10 units of intermediate-acting insulin at bedtime via subcutaneous injection. The nurse would expect to administer the injection at which site? Select all that apply. A) Upper arm B) Inner forearm C) Upper abdomen D) Gluteus maximus E) Upper thigh Ans: A, C, E Feedback: The sites for subcutaneous injection are the upper arms, the upper abdomen, and the upper thighs. 21. A nurse is required to give an intramuscular (IM) injection to an 18-month-old toddler. The nurse would prepare which site for administration? 18 | P a g eA) Dorsogluteal site B) Deltoid muscle C) Vastus lateralis D) Ventrogluteal site Ans: C Feedback: 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. 22. A primary health care provider instructs a nurse to administer a medication to a patient 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 physician. C) Forgo obtaining the physician's order after the drug has been administered. D) Document the administration of the drug only after receiving the physician's order. Ans: B Feedback: The nurse should administer the drug as instructed without a written order as it is an emergency. The nurse should, however, ensure that the physician's order is obtained after the drug has been administered. Waiting for a written order during an emergency may exacerbate the patient's condition. The nurse should complete the documentation immediately after the administration of the drug and not wait until the physician's order is received. 23. A nurse has administered an opioid drug to a patient. Which action would be most appropriate for the nurse to do immediately after administering the drug? A) Monitoring the vital signs of the patient B) Documenting administration of the drug C) Informing the patient about the type of drug D) Updating the physician regarding the patient's condition Ans: B Feedback: After administration of any drug, the nurse should immediately document the administration. After the documentation is complete, the nurse can record the patient's vital signs. The patient needs to be informed about the drug before the administration. The physician need not be immediately informed, unless the client develops severe adverse reactions. 24. A primary health care provider orders a transdermal drug. When administering this drug, which action by the nurse would be most appropriate? 19 | P a g eA) 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. Ans: A Feedback: 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 patients 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. 25. The physician has asked a nurse to administer a drug intravenously to a patient who is unresponsive. How can the nurse ensure that the drug is administered to the right patient? A) By waking him up to ask him his name B) By identifying the patient's room number C) By checking the patient's wristband D) By asking the nursing assistant for the patient's location Ans: C Feedback: The nurse should identify a patient by checking his wristband, which has the patient's name. The nurse should not ask the patient to confirm his name, because some patients, particularly those who are confused or have difficulty hearing, may respond by answering yes. Additionally, this patient is unresponsive. The nurse can obtain the patient's location by asking any other member of the health care staff, but should verify the patient's identity by checking the wristband. The nurse should not rely on the patient's room number alone. 26. A patient is ordered to receive a subcutaneous injection of heparin twice a day. When administering this drug to the patient, which of the following would be most important for the nurse to do to minimize tissue damage? A) Insert the needle at the appropriate angle. B) Select the needle length based on the patient's weight. C) Ensure that there is no hair on the injection site. D) Rotate the injection site regularly. Ans: D Feedback: The nurse should rotate the injection sites to minimize the damage caused to the tissue. Inserting the needle at the proper angle and selecting the needle length based on the patient's weight will not significantly help in minimizing tissue damage if the same site is repeatedly injected. It is not necessary to avoid injection sites that have hair as long as the drug is administered in the upper arms, the upper abdomen, and the upper back. 20 | P a g e27. The nurse is checking the medical record of an assigned patient for medication orders. The nurse is unable to read the primary health care provider's handwriting. Which action would be most appropriate? A) The nurse should question the order with the primary health care provider. B) The nurse should try to interpret the handwriting. C) The nurse should confirm the order with a nearby health care provider. D) The nurse should obtain a verbal order. Ans: A Feedback: Any order that is unclear, particularly due to illegible handwriting, should be questioned. The nurse should not try to interpret the handwriting as it may lead to a misinterpretation. The nurse should also not confirm the order with any other physician who is nearby. Administering drugs based on verbal orders is permissible only during emergencies. 28. A nurse is preparing to administer an intramuscular injection to a patient for the first time. Which of the following would be most important for the nurse to do? A) Obtain the patient's allergy history. B) Obtain information about the drug. C) Inquire if the patient has any objections to syringes. D) Discuss the dosage with other nurses. Ans: A Feedback: Before giving any drug for the first time, the nurse should ask the patient about any known allergies as well as any family history of allergies. The nurse need not particularly obtain information about the drug as it has been prescribed by the physician, but needs to be aware of the adverse effects it may cause. There is also no need to discuss the dosage with other nurses or to find out if the client has any objections to syringes. However, the nurse should help allay the patient's fears by reassuring him or her about the administration. 29. After teaching a group of students about the different routes of medication administration, the nursing instructor determines that the teaching was successful when the students identify which of the following as a topical drug? Select all that apply. A) Eyedrops B) Suppository C) Nebulized bronchodilator D) Nicotine patch E) Capsule Ans: A, B Feedback: Topical drugs are drugs that are applied to the outer layer of the skin but not absorbed through the skin, such as eyedrops and suppositories. A nebulized bronchodilator is an inhaled medication. A nicotine patch delivers the medication transdermally; that is, it is 21 | P a g ereadily absorbed from the skin. A capsule is a form of oral medication. 30. The nurse is preparing to administer a prescribed drug to a patient. The patient looks at the tablet and says, “This doesn't look like my usual pill.” Which response by the nurse would be most appropriate? A) “This is the same pill your doctor has been ordering.” B) “It must be from a different manufacturer.” C) “It looks different? Are you sure?” D) “Let me double check with your doctor and the order.” Ans: D Feedback: If the patient makes any statement about the drug, the nurse needs to hold the drug and investigate the patient's statement, double checking the chart and the order and obtaining clarification and/or confirmation from the prescriber. It may be that the dosage or manufacturer has changed and that is what makes the pill look different. It is always important to err on the side of caution. Telling the patient that the pill is the same or that it is from a different manufacturer may be true, but the nurse needs to confirm that before giving it to the patient. Repeating the patient's statement and then asking him if he is sure is inappropriate because it implies that the patient is incorrect. 31. A nursing instructor is observing a nursing student prepare an oral drug for administration. The instructor determines that the student is performing the procedure correctly when the student compares the label of the drug with the MAR how many times? A) 2 B) C) D) 3 4 5 Ans: B Feedback: The proper procedure is to compare the drug label with the MAR three times: (a) when the drug is taken from its storage area, (b) immediately before removing the drug from the container, and (c) before administering the drug to the patient. 32. A patient is prescribed a buccal medication. The nurse would instruct the patient to place the drug at which location? A) Under the tongue B) Against the cheek mucous membrane C) Inside the rectum D) At the back of the tongue Ans: B Feedback: Buccal drugs are placed in the mouth against the mucous membranes of the cheek in 22 | P a g eeither the upper or lower jaw. Sublingual medications are placed under the tongue. Rectal suppositories are inserted into the rectum. Oral medications are placed at the back of the tongue. 33. The nurse is preparing to administer an intradermal injection. The nurse would insert the needle at which angle? A) 15 degrees B) 30 degrees C) 45 degrees D) 90 degrees Ans: A Feedback: When giving an intradermal injection, the needle is inserted bevel up at a 15-degree angle. The nurse would insert the needle at a 90-degree angle for an intramuscular injection or for a patient who is obese and requires a subcutaneous injection. Typically a subcutaneous injection is given at a 45-degree angle. 1. A nursing instructor is describing the various work factors that can lead to errors in dosage calculations to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as a factor? Select all that apply. A) Poor lighting B) Heavy workload C) Noise D) Temperature E) Interruptions Ans: A, B, C, E Feedback: Factors in the work environment that often contribute to errors made by people include poor lighting, noise, interruptions, and a taxing workload. 2. A nurse is checking the label of a drug. Which of the following would the nurse identify as an important item needed to administer a drug? Select all that apply. A) Monitoring parameters B) Side effects C) Dosage form D) Drug name E) Dosage strength Ans: C, D, E Feedback: Although drug labels contain a great amount of information about the drug being given, three specific items are needed to administer a drug: the drug name, dosage form, and dosage strength. 23 | P a g e3. A nurse is reviewing the package label of a drug. Which name would the nurse find on the drug label? Select all that apply. A) Trade name B) Scientific name C) Pharmacologic name D) Nonproprietary name E) Generic name Ans: A, E Feedback: The nurse will find two names on the drug label, the trade or brand name and the generic (official) name. 4. A nurse is reading a drug label. Which of the following might help the nurse distinguish between the trade and generic names on the drug label? Select all that apply. A) The trade name is written in smaller print. B) The trade name is usually capitalized. C) The trade name is followed by a registration symbol. D) The trade name is often in parentheses. E) The trade name is found under the generic name. Ans: B, C Feedback: To help the nurse distinguish between the trade and generic names on a drug label, the nurse should know the following: the trade name is usually capitalized, written first on the label, and identified by the registration symbol, whereas the generic name is written in smaller print, often in parentheses, and usually located under the trade name. 5. A client has been taking warfarin (Coumadin) 5 mg daily. After a check of the client's INR, the physician wants to increase the client's dose to 7.5 mg on Wednesdays and continue 5 mg all the other days of the week. The client has warfarin 5-mg tablets on hand. The nurse would instruct the client to take tablets on Wednesdays. Ans: 1.5 tablets Feedback: 7.5 mg/5 mg = 1.5 6. A physician writes an order for a client to receive levothyroxine (Synthroid) 0.2 mg, but 100-mcg tablets are supplied. The nurse would administer tablets to the client. Ans: Two tablets Feedback: 1000 mcg/1 mg = 100 mcg/X mg X 24 | P a g e= 100/1000 X = 0.1 mg 0.2 mg/0.1 mg = 2 7. A group of nursing students are reviewing the various systems of measurement. The students demonstrate understanding of the information when they identify which of the following as a metric system unit? Select all that apply. A) Inch B) Milligram C) Centimeter D) Ounce E) Pound Ans: B, C Feedback: The metric system uses the gram, liter, and meter. Milligram and centimeter are metric units. 8. Which of the following drug doses is written correctly? Select all that apply. A) Synthroid 0.175 mg B) Synthroid .175 mg C) Synthroid 175 mcg D) Synthroid 175.0 mcg E) Synthroid .1750 mg Ans: A, C Feedback: When there is no number to the left of the decimal, a zero is written; therefore, Synthroid 0.175 mg and 175 mcg are correct. 9. A group of nursing students are reviewing information about drugs and how they are supplied for parenteral administration. The students demonstrate understanding of the information when they identify which forms as available for parenteral administration? Select all that apply. A) Disposable syringes B) Reusable cartridges C) Ampules containing liquid form of the drug D) Reusable vial containing liquid form of the drug E) Vial containing drug powder Ans: A, C, D, E Feedback: Parenteral drugs may be available in the following forms: liquids in disposable cartridges or disposable syringes; ampules or vials that contain the liquid form of the drug; and ampules or vials that contain the powder or crystal form of the drug. These vials may be single-dose or multidose vials. 25 | P a g e10. A client weighs 56 kg. The client weighs pounds. Ans: 123.2 lb Feedback: Kilograms must be converted to pounds using the conversion factor of 2.2 pounds in 1 kg. Therefore, 56 × 2.2 = 123.2. 11. The nurse is checking the dosage of a drug ordered in mg/kg. A client weighs 275 lb. The client weighs kilograms. Ans: 125 kg Feedback: Pounds must be converted to kilograms using the conversion factor of 2.2 lb in 1 kg. Therefore, 275/2.2 = 125. 12. A client has a temperature of 39°C. The client's temperature is degrees Fahrenheit. Ans: 102.2°F Feedback: To convert from Celsius to Fahrenheit, the formula F = 9/5 C + 32 is used. Therefore, 9/5 × 39 = 70.2. 70.2 + 32 = 102.2 13. When assessing a client's temperature, the nurse finds it to be 99°F. The client's temperature is degrees Celsius? Ans: 37.2°C Feedback: To convert Fahrenheit to Celsius, the formula C = 5/9 (F – 32) is used. Therefore, 99 – 32 = 67. 67 × 5/9 = 37.2 14. Amoxicillin 250 mg is ordered for a child. The pharmacy supplies the drug in a suspension form. The label reads 500 mg/5 mL. The nurse would administer Ans: 2.5 mL Feedback: 500 mg/5 mL = 250 mg/X mL 500 X = 1250 X = 2.5 15. A client is to receive 0.5 mg of a drug parenterally. The drug is available in a 2-mg/mL vial. The nurse would administer mL. Ans: 0.25 mL Feedback: 26 | P a g e mL.0.5 mg × 1 mL/2 mg = 0.25 mL. 16. A client is to receive a 7.5-mg/kg dose of a drug. The client weighs 155 lb. The client would receive mg per dose. Ans: 528.4 mg Feedback: First, the client's weight needs to be converted to kilograms. 155 lb × 1 kg/2.2 lb = 70.5 kg. Then the drug dosage is calculated as follows: 70.5 kg × 7.5 mg/kg = 528.4 mg. 17. The physician writes an order for a client to receive 1 mg of vitamin B12 once every month. Vitamin B12 comes in a 1000-mcg/mL vial. The nurse would administer mL to the client each month. Ans: 1 mL Feedback: First, the nurse needs to convert the milligrams to micrograms. Therefore, 1 mg = 1000 mcg. Since there is 1000 mcg/mL, the nurse would give 1 mL. 18. A client is to receive 250 mg of penicillin VK twice daily for 10 days. Penicillin VK is available in a 500-mg tablet. The nurse would instruct the client to take tablet(s) at each dose. Ans: 1/2 tablet Feedback: 250 mg/500 mg = 0.5 tablets. 19. A client weighs 200 lb. The client is to receive 5 mg/kg per dose of drug. The client will receive mg of the drug in each dose. Ans: 454.5 mg/dose Feedback: First, the patient's weight must be converted to kilograms: 200 lb × 1 kg/2.2 lb = 90.9 kg. Then the dosage is calculated: 90.9 kg × 5 mg/kg = 454.5 mg. 20. A nursing instructor is describing the importance of preventing errors in medication administration and doses. Which of the following would the instructor emphasize as the best method for detecting errors? A) Checking calculations three times B) Having each person involved in the process check the dosage C) Reading drug labels very carefully D) Checking the dosage in a reputable drug reference Ans: B Feedback: The best method of error detection is the manual redundancy system. This is a system in 27 | P a g ewhich each person in the process of medication prescription and delivery checks the drug dosage for accuracy. Nurses use this system when they perform the “5 rights and 3 checks” to catch a potential error in drug administration. Double checking calculations and reading labels carefully are important, but they are not the best method for detecting errors. Checking the dosage in a reputable drug reference would help to ensure that the dosage is within the safe dosage range, but this would do nothing to ensure that the dosage is accurate. 21. After teaching a group of nursing students about measurement systems, the instructor determines that the teaching was successful when the students identify which of the following as units of the metric system? A) Minims B) Grains C) Drams D) Grams Ans: D Feedback: Grams are units of weight in the metric system. Minims are units of volume in the apothecary system. Grains and drams are units of weight in the apothecary system. 22. “Dose desired / dose on hand = dose administered” is the formula for calculating the dose to be administered. Under which of the following circumstances is this to be used? A) When the physician is not available to calculate the dosage B) When the dosage is written in the apothecary system C) When the dose desired and dose on hand are in the same system D) When the label of the drug is in the metric system Ans: C Feedback: When the dose ordered by the physician (dose desired) is written in the same system as the dose on the drug container (dose on hand), the above formula is used for calculating the dose to be administered. When the physician is not available to calculate the dosage, the dosage is written in the apothecary system, and the label of the drug is in the metric system are circumstances in which it becomes necessary for the nurse to compute the drug dosage. 23. A medication is ordered for a client. The dosage he is to receive is 100,000 U. The drug label reads 400,000 units/mL. When setting up the dosage calculation using dimensional analysis, the nurse identifies the unit of measure to be calculated as which of the following? A) Milliliters