Nursing 223 Final Exam (With complete solutions)

1. A nurse instructs a client to close the eyes gently after administration of eyedrops. Which rationale for this instruction should the nurse explain to the client? correct answers 3 - Disperses the medication over the eyeballs : Closing the eyes moves the medication over the conjunctiva an eyeball and helps ensure an even distribution of medication 1. How often should docusate sodium 100 milligrams PO bid be given? correct answers 1. A nurse is preparing to reconstitute a medication in a multiple dose vial. Which is the most essential step in the preparation of this medication? correct answers - 1 - instilling an accurate amount of dilutant into the vial : The required amount of the dilutant must be followed exactly in a multiple dose formulation to ensure accurate dosage preparation. The diluted for a single dose formulation also must be measured exactly so the medication is diluted enough not to injure body tissues. correct answers - 4 - 90 degree angle of insertion : 1/2 inch length needle inserted at 90 degree angle will ensure that the heparin is inserted into the subcutaneous tissue. 1. A home care nurse observes the spouse of a client inserting a rectal Suppository into the client. Which behavior indicates that the nurse must provide further teaching about the Suppository administration? correct answers - 3 - insert the Suppository while the client bears down : Bearing down increases intra- abdominal pressure which impedes the insertion of the Suppository. The client should be instructed to relax and breathe deeply and slowly while the Suppository is inserted. 1. A Primary Health care provider prescribes a medication that must be administered via intramuscular route Which side should the nurse eliminate from consideration because it has the highest potential for injury when administering an intramuscular injection? correct answers - 4 - dorsogluteal : The dorsogluteal site has the highest risk for injury because of the close proximity or the sciatic Nerve, blood vessel, and bone. 1. Which information about the parenteral medication indicates that the nurse should use a filtered needle when preparing the medication? correct answers - 2 - is supplied in an ampule : The top of an ampule must be snapped off at its neck to access the fluid. A filtered needle prevents glass particles from being drawn into the syringe. 1. What should the nurse use when administering a subcutaneous injection? correct answers - 2 - 25 gauge needle : Subcutaneous injection should use a 25 to a 29 gauge needle, which minimizes tissue trauma. The diameter of the needle is referred to as a gauge which ranges from 28 (small) to 14 (large). 1. When the nurse brings a pill to a client, the client is unable to hold the paper Cup with the medication. Which should the nurse do? correct answers - 1 - use the Cup to introduce the pill to the client's mouth : The client needs assistance. Keeping medication in the Cup, rather than touching it with the hands, maintains medical asepsis. 1. Which route is inappropriate for a topical medication? correct answers 1 - intradermal : In intradermal injection is inserted below, not on top of, the epidermis