Nursing practice Exam 3 1st semester 134 Questions with Verified Answers,100% CORRECT

Nursing practice Exam 3 1st semester 134 Questions with Verified Answers A client admitted to the inpatient medical-surgical unit has suffered sudden respiratory failure. The client's condition is getting worse; he is cyanotic (turning blue) with periods of labored breathing. What action should the nurse take first? a) Study the discharge plan. b) Check the graphic data for vital signs. c) Examine the history and physical examination. d) Look for an advance directive. - CORRECT ANSWER ANS: D The advance directive, which should be located in a special section of the patient's medical record, should be examined first because the patient's symptoms indicate that he may need to be resuscitated. The advance directive contains information about the patient's wishes for intensity of care and actions that should be taken in the event of a life-threatening event. The discharge plan contains data from utilization review, case managers, or discharge planners on anticipated needs after discharge. Graphic data record assessment should be done frequently, such as vital signs. The history and physical examination provide a detailed summary of the patient's current problem, past medical and social history, medications taken by the patient, review of systems, and physical examination data. A hospital uses a source-oriented medical record. What is a major disadvantage of this charting system? a) It involves a cooperative effort among various disciplines. b) The system requires diligence in maintaining a current problem list. c) Data may be fragmented and scattered throughout the chart. d) It allows the nurse to provide information in an unorganized manner. - CORRECT ANSWER ANS: C A major disadvantage of a source-oriented medical record is that data may be fragmented and scattered throughout the chart. The problem-oriented medical record requires a cooperative effort among disciplines and diligence in maintaining a current problem list. Narrative charting allows the nurse to provide information in a disorganized manner. A student nurse makes the following comments to her preceptor: "I love getting information from the chart. Everything related to the patient's problem is together and addressed by various members of the healthcare team." The student nurse has been introduced to which type of charting system? a) Narrative b) Focus c) Source oriented d) Problem oriented - CORRECT ANSWER ANS: D Narrative charting is a free text description of the patient status and nursing care, not usually organized according to patient problems. Focus charting highlights the patient's concerns, problems, and strengths in a three-column format. Source-oriented record systems require members of each discipline to record their findings in a separately labeled section of the chart. A problem-oriented record system is organized around the patient's problems and each member of the healthcare team document in the area designated for that problem. This method makes it easier to view the patient's progress and integrate the interdisciplinary perspective. The department of nursing at a local hospital is considering changing to charting by exception (CBE). A major disadvantage of CBE is that it: a) Increases the time nurses spend on charting in narrative format b) Does not clearly identify deviations from normal expectations c) Requires all providers to document in the same sections of the chart d) Can increase the risk of omissions in patient care - CORRECT ANSWER ANS: D A major disadvantage of CBE is that it can result in omissions in documenting client care because of either varying views of what is abnormal or deviations. Another disadvantage is that is does not capture the application of critical thinking by the nurse in the provision of care. CBE reduces the amount of time spent in charting because if nurses document only deviations from the normal CBE, then it is assumed that unless a separate entry is made, all standards have been met with a normal response. Which prescription below is not consistent with the standards established by The Joint Commission? a) Administer Lasix 20 mg PO daily at 1000. b) Administer Lasix 10.0 mg PO daily at 1000. c) Administer digoxin 10 mg PO daily at 1000. d) Administer digoxin 0.3 mg IV daily at 1000. - CORRECT ANSWER ANS: B The Joint Commission recommends that certain words are written out instead of using symbols and abbreviations to minimize the risk of medication errors. The trailing zero should not be used in medication prescriptions; thus, 10.0 mg is incorrect. It should be correctly written as 10 mg. The word daily should be used in place of qd or q.d., as is done in all the options. The Joint Commission does not support the lack of a leading zero; thus, 0.3 mg is correctly written. A patient with a history of hypertension and rheumatoid arthritis is admitted for surgery, a colon resection, for colon cancer. Which integrated plan of care (IPOC) would be most appropriate for the nurse to implement? a) Hypertension b) Rheumatoid arthritis c) Postoperative colon resection d) Follow all three plans - CORRECT ANSWER ANS: C The postoperative colon resection integrated plan of care should be followed; however, modifications should be made to meet the patient's other health needs. Therefore, portions of the hypertension and rheumatoid arthritis integrated plan of care may be added to the postoperative colon resection plan of care, or individualized nursing diagnoses and interventions may be integrated into the plan. 7. The nurse notifies the primary care provider that the patient is experiencing pain. The provider gives the nurse a telephone prescription for morphine 4 mg intravenously every hour as needed for pain. How should the nurse document this telephone order? a) 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain. Kay Andrews, RN b) 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain T.O.: Dr. D. Kelly/Kay Andrews, RN c) 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain V.O.: Dr. D. Kelly/Kay Andrews, RN d) 09/02/16 0845 morphine 4 mg intravenously q 1 hour V.O. Kay Andrews, RN - CORRECT ANSWER ANS: B Correct documentation of a telephone order is as follows: "09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain T.O.: Dr. D. Kelly/Kay Andrews, RN" (date, time, medication, route, frequency of dose, circumstances under which it is to be given, prescriber's name and title, nurses name and title.) The other options demonstrate incomplete documentation of a telephone order. A patient refuses a dose of medication. How should the nurse document the event? a) Patient is uncooperative and refuses the prescribed dose of digoxin. b) Patient refuses the 0900 dose of digoxin. c) Patient is belligerent, argumentative, and refuses the 0900 dose of digoxin. d) 0900 dose of digoxin not given. - CORRECT ANSWER ANS: B "Patient refuses the 0900 dose of digoxin" objectively describes the event in which the patient refuses to take his 0900 dose of digoxin. "0900 dose of digoxin not given," provides no explanation why the medication was not given. The other two options offer judgmental information, which should be avoided when charting. At 1000 on 11/14/16, the nurse takes a telephone prescription for "metoprolol 5 mg intravenously now." What is the latest date and time the nurse will expect the prescriber to countersign the order? a) 11/14/16 at 1200 b) 11/14/16 at 2200 c) 11/15/16 at 1000 d) 11/16/16 at 1000 - CORRECT ANSWER ANS: C The prescriber must countersign all verbal and telephone orders within 24 hours. The nurse takes a telephone order from a primary care provider for 40 mEq potassium chloride in 100 mL of sterile water for injection to be infused over 4 hours. Which action must the nurse take to ensure the accuracy of the order? a) Repeat the order to the prescriber even if she believes she understood the order correctly. b) Immediately notify the pharmacy of the order and verify it with a pharmacist. c) Ask the unit secretary to listen to the prescriber on the phone to verify the order. d) Transcribe the order on notepaper and verify the dosage in a drug handbook. - CORRECT ANSWER ANS: A The nurse should repeat the order to the prescriber even if she believes she understood it entirely. If possible, she should have a second nurse (not the unit secretary) listen to the order to verify accuracy. Only the prescribing provider, not the pharmacist, can verify the order. The nurse should transcribe the order directly on the patient's chart. Transcribing it on a piece of paper and then copying it again introduces one more chance of error. A resident in a long-term care facility is unable to provide self-care owing to dementia and is receiving Medicare funds. How often must the nurse document this resident's care? a) Every 2 weeks b) Every shift c) Every week d) Every 3 months - CORRECT ANSWER ANS: D The Minimum Data Set for Resident Assessment and Care Screening (MDS) must be updated every 3 months, unless there is a significant change in the resident's condition. What is the deadline after admission for using the Minimum Data Set to evaluate a newly admitted resident is of a long-term care facility? a) 14 days b) 3 days c) 2 days d) 24 hours - CORRECT ANSWER ANS: A Federal regulations require that a resident be evaluated using the Minimum Data Set within 14 days of admission to a long-term care facility. A client is admitted to a long-term care facility. The nurse knows that federal law requires the use of: a) The Minimum Data Set (MDS) for assessment b) Situation-Background-Assessment-Recommendation (SBAR) for reporting c) Health Care Financing Administration guidelines prior to surgery d) The Joint Commission guidelines for discharge planning - CORRECT ANSWER ANS: A Federal regulations require that a resident be evaluated using the Minimum Data Set (MDS) within 14 days of admission to a long-term care facility. SBAR is a technique used for communicating and organizing a handoff report. HCFA guidelines govern home healthcare documentation. Joint Commission guidelines do apply to long-term care facilities. However, only the MDS assessment is mandated by federal law. The surgeon enters a computerized order for a patient in the postoperative period after a unilateral thoracotomy for lung cancer. The order states: OOB in AM. Which action indicates that the nurse is following the surgeon's order? The nurse: a) Performs oral care b) Assists the patient out of bed c) Assists the patient with bathing d) Changes the patient's operative dressings - CORRECT ANSWER ANS: B OOB is the abbreviation for "out of bed." The nurse is following the physician's order when she assists the patient out of bed in the morning. OOB does not indicate that the nurse should perform oral care, assist with bathing, or change the patient's postoperative dressings. Which instruction by a registered nurse should the student nurse clarify with her clinical instructor? "When taking off the provider's orders, you should: a) Write drug names in full—rather than using abbreviations" b) Use apothecary units—instead of metric units" c) Write 'at' or 'each'—rather than use the '@'symbol" d) Write 'mL' or 'milliliters'—in place of the 'cc' abbreviation" - CORRECT ANSWER ANS: B The student nurse should question the instruction to use apothecary units—instead of metric units. Nurses are encouraged to use metric units instead of the rarely used apothecary system. The nursing instructor is teaching the student about occurrence reports. Which statement by the student indicates an understanding of the purpose of occurrence reports? a) "Occurrence reports track problems and identify areas for quality improvement." b) "Occurrence reports are required by the Food and Drug Administration (FDA) to report drug errors." c) "The Joint Commission requires occurrence reports for all client falls." d) "Occurrence reports provide legal information should the patient seek legal action after an unusual occurrence." - CORRECT ANSWER ANS: A Occurrence reports are used to track problems and identify areas for quality improvement. Occurrence reports are not used to provide legal information should a patient seek legal action. As an internal communication and documentation tool, occurrence reports are not required to be reported to the FDA or The Joint Commission. Which of the following is the most beneficial aspect of electronic documentation systems? a) Assist collaboration b) Provide cautionary reminders c) Improve legibility d) Serve as a resource - CORRECT ANSWER ANS: C One of the most beneficial aspects of electronic documentation systems is its ability to improve legibility, which reduces the risk for medication administration and other errors. Electronic documentation systems also assist collaboration, provide cautionary reminders about possible adverse reactions, and serve as a resource; but these are not the most beneficial aspects. The nursing assistive personnel (NAP) informs the nurse that a patient has fallen out of bed and is in pain. The nurse assesses the patient and provides care. Identify the correct documentation of the fall. a) Patient found on floor after falling out of bed and verbalizes (L) hip pain. b) Patient found on floor by NAP Smith and verbalizing (L) hip pain. c) Patient fell out of bed but is currently in bed. d) Patient reminded not to climb OOB after falling. - CORRECT ANSWER ANS: B Charting must be accurate and succinct. Only chart what you observe. Do not chart what others have observed as your own observation. Avoid judging patients; instead, chart objectively. Which set of topics makes up a handoff report given in a recommended format? a) Data-action-response (DAR) b) Subjective-objective-assessment-plan (SOAP) c) Situation-background-assessment-recommendation (SBAR) d) Patient-diagnosis-medications-activity - CORRECT ANSWER ANS: C The SBAR technique is used as a mechanism to give a handoff report by enabling a focused communication between healthcare team members. DAR is used in Focus Charting®, SOAP is a method for documenting nursing care. The nursing admission assessment is completed and documented at the time of admission. What is one advantage of problem-intervention-evaluation (PIE) charting? a) Focuses on a complete list of client problems b) Assesses the client in a comprehensive manner c) Documents the planning portion of the client's care d) Establishes an ongoing plan of care for the client - CORRECT ANSWER ANS: D The PIE charting format organizes information by the client's problems and requires a daily assessment record and progress notes, thus eliminating the need for a nursing care plan. It documents, in a comprehensive manner, the client information. It does not assess the client. A client is admitted to the birthing unit to rule out preterm labor. The nurse charts only abnormal findings. This type of charting is a form of: a) Narrative charting b) Charting by inclusion c) Charting by exception d) Source oriented charting - CORRECT ANSWER ANS: C Charting by exception is a system of charting where only exceptions to the normal findings or to the unit standards are charted. These are directed by organizational, professional, and legal guidelines. Narrative charting records all findings, normal and abnormal. Charting by inclusion is not discussed in the text. Source-oriented charting refers to each healthcare practitioner's charting in a specific section of the chart. For example, nurses would document in the nurses' notes section and physicians would document in the physician section of the healthcare record. At the end of a 12-hour shift, the nurse gives a verbal report to the oncoming nurse. This face-to-face reporting, using the acronym "CUBAN," does which of the following? a) Ensures that the nurse is able to finish the shift as quickly as possible b) Provides a guide for the nurse's report to the oncoming nurse c) Requires the nurses to engage in walking rounds for the report d) Provides a detailed cultural report for Latino patients - CORRECT ANSWER ANS: B The CUBAN acronym is used in all types of report formats and stands for Confidential, Uninterrupted, Brief, Accurate, Named nurse. Following this format, the nurse giving report has a guide to remember the important data that need to be shared with the oncoming nurse who will care for the patient. Report should not be rushed in order for a nurse to finish the shift as quickly as possible. However, the nurse should try to begin report before the shift is over, early enough to complete report before the next shift begins. The CUBAN approach does not require walking rounds. The CUBAN acronym can be used for report about any patient regardless of race, ethnicity, or religion and does not necessarily provide cultural information. It is not specific to Latino patients. The instructor is teaching the nursing students about electronic health records (EHR). Which student statement indicates the need for further instruction? a) "I have had EHR instruction and understand the basics of the system. If I need assistance, I will ask for it." b) "The EHR integrates the patient's health information documented by the entire healthcare team into one electronic system." c) "The EHR can track problems and errors, which can direct quality improvement efforts in a given institution." d) "I am proficient with a computer; therefore, I am completely prepared to use the EHR in any institution." - CORRECT ANSWER ANS: D The EHR can vary according to institution and is employed through integrative technology for the entry of data from all healthcare professionals. Although a student knows how to use a computer, this knowledge may not directly translate so that the student is able to accurately document in any particular institution. A person needs to be taught the specifics of each system. A student who understands that even though the system has been taught to him also knows that the instructor will be a resource for EHR questions that may arise. The EHR generally integrates information to be used by the healthcare team. Data can be collected and analyzed multiple ways to evaluate and improve patient care. A medical provider has prescribed milk of magnesia (magnesium hydroxide) 30 mL, PO bid. Here bid means: a) Once every day b) Two times every day c) Three times every day d) Four times a day - CORRECT ANSWER ANS: B Bid is the abbreviation for twice a day, which is generally 12 hours between doses. Once a day is written as "daily": every hour is abbreviated qh, three times a day is tid and four times a day is qid. Abbreviations are used with caution to reduce error(s) by the nurse and the healthcare teams. The abbreviation qd is not used for once a day, but is written as "daily." Why might a healthcare provider choose narrative charting instead of using forms or checklists? a) Narrative charting tracks the client's changing health status as it occurs. b) Free form documentation is inconsistent among healthcare providers. c) Less charting time by healthcare provider is needed for narrative charting. d) Less interdisciplinary discussion occurs with the narrative style of charting. - CORRECT ANSWER ANS: A A narrative chart entry tells the story of the patient's experience as it occurs in a chronological format with the goal to track a client's changing medical and health status. It also documents progress toward goals for the client. Disadvantages to narrative charting include the following: inconsistency among healthcare providers and the manner in which they document using narrative charting; longer time spent in documenting client progress; and a decrease in interdisciplinary discussion of client progress owing to lengthy and redundant documentation by healthcare team members. Which statement(s) by the student nurse indicates an understanding of the nursing Kardex? Select all that apply. a) "It pulls data from multiple areas of the patient's chart." b) "It is usually kept at the patient's bedside." c) "It is used to document patient response to interventions." d) "It summarizes the plan of care and guides nursing care." - CORRECT ANSWER ANS: A, D The Kardex is a tool that pulls data from multiple areas of the patient's health record and helps guide nursing care. Responses to interventions are documented on flowsheets and in nurses' notes. Kardexes are paper forms that are kept together in a portable file at the nurses' station to allow all team members access to the summary information. The file is portable, so it could be carried to the bedside briefly; however, it is not stored there as a general rule. Which action by the nurse breaches patient confidentiality? Select all that apply. a) Leaving patient data displayed on a computer screen where others may view it b) Remaining logged on to the computer system after documenting patient care c) Faxing a patient report to the nurses' station where the patient is being transferred d) Informing the nurse manager of a change in the patient's condition - CORRECT ANSWER ANS: A, B Leaving patient data displayed on a computer screen where others may view them breaches patient confidentiality. The nurse should log off the computer immediately after use. Faxing a report to the nurses' station receiving a patient does not breach patient confidentiality because it is located at the nurses' station out of others' view. Anyone directly involved in the patient's care has the right to know about the patient's condition without breaching patient confidentiality. Which statement(s) by the new graduate nurse indicates a need for further instruction about documentation? Select all that apply. a) "I can wait until the end of the shift to document my care." b) "Charting every 2 hours is the most appropriate way to document nursing care." c) "I find it easier to chart before I go to lunch, and then after my shift report." d) "I should chart as soon as possible after nursing care is given." - CORRECT ANSWER ANS: A, B, D Documentation should be performed as soon as possible after the nurse makes an assessment or provides care. The longer the nurse waits, the less accurate the documentation will be. Leaving documentation until the end of the shift may cause important details to be omitted or mistaken. It is not necessary to complete documentation on a strict schedule, such as every 2 to 4 hours. Even waiting until lunch or report after the shift is over is too long a period of time for accurate documentation. In addition, the objectivity of documentation might be influenced by the discussion that occurs during report. The implementation of electronic health records (EHRs) allows the nurse to do which of the following? Select all that apply. a) Use trend data to facilitate evidence-based nursing practice b) Promote efficient use of time spent charting c) Reduce the opportunity for interdisciplinary collaboration d) Activate the system's safeguards to promote client safety - CORRECT ANSWER ANS: A, B, D The implementation of electronic health records (EHR) has many advantages for the nurse. These include the ability to identify trends in data to facilitate evidence-based nursing practice, promote the efficient use of the time nurses spend documenting client care, and use the system's safeguards to minimize errors in clients care. EHR does not impair interdisciplinary collaboration; rather, EHR fosters communication and collaboration among healthcare team members. In performing a handoff report, the nurse should communicate information on which of the following? Select all that apply. a) Teaching performed b) Any change in client status c) Treatments administered d) Hygiene measures performed - CORRECT ANSWER ANS: A, B, C Handoff reports include any client teaching done, therapies and treatments administered, and changes in the client's status. Hygiene care is routinely done in inpatient settings and is usually recorded on a flowsheet. Handoff reports should be succinct and not contain routine information. Knowing that discharge summary information is integral to the client's ongoing care, which of the point(s) regarding discharge summaries must the nurse be aware? Select all that apply. a) The discharge summary is important because many clients require follow-up care. b) A complete discharge summary is a guide for healthcare professionals in the community. c) The nurse can give a verbal transfer report, which is the same as a discharge summary. d) The discharge summary is the final note in the client's health record e) A complete discharge summary must be handwritten using the narrative note format. - CORRECT ANSWER ANS: A, B, D A complete discharge summary must be completed even if a complete verbal transfer report is given to ensure that all important and specific information is communicated to another healthcare provider when the client is discharged from the hospital. It is important for every client for ongoing care and documentation while the client is in the community. A verbal transfer report is not a replacement for the comprehensive discharge record; it can be done in the EMR formats, a narrative note, or on a discharge summary form. The nurse is administering the 0900 dose of heparin 5,000 units subcutaneously ordered every 6 hours to a patient with deep vein thrombosis (DVT). At 0800, the patient's laboratory values show partial thromboplastin time (PTT) and clotting times are four times the normal range. The nurse observes petechiae on the patient's buttocks and back and recognizes these as signs of risk for significant bleeding. The correct nursing actions at this time are below. Select all that apply. a) Notify the prescriber before giving the medication. b) Give subcutaneous heparin as ordered. c) Hold the medication dose at this time. d) Chart the reason the medication was not given. e) Assess for other significant signs and symptoms. f) Record abnormal findings in the patient's health record. - CORRECT ANSWER ANS: C, D, E, F Heparin, an anticoagulant, should be given to achieve one and a half to two times the normal clotting times and PTT. Because the findings of the laboratory values are four times the normal range and petechiae are present, this indicates a significant risk for bleeding. Therefore, the heparin should be held; the physician should be notified immediately. The nurse must document why the medication was not given and should assess for other significant findings. Omitted or delayed administration must be charted as soon as possible with an explanation for the delay or omission. The nurse will notify the provider but not give the medication. Heparin is given via a subcutaneous injection; however, because it is being held, it will not be administered or documented as "given." Because the findings regarding the heparin and its use are abnormal, the nurse would not document normal findings. The electronic health record (EHR) is used to document client care management. Which statement(s) below is/are applicable to EHR? Select all that apply. a) Increases the potential for breaches in confidentiality b) Decreases the time spent to complete documentation c) Minimizes medical errors through use of alert systems d) Communicates the client's plan of care to the healthcare team - CORRECT ANSWER ANS: B, C, D The EHR streamlines many documentation steps, making written communication concise and standardized. Electronic access to the patient's health record increases confidentiality and security of information by using customized passwords for each healthcare professional to limit access to the records. Time for documentation is decreased as the nurse becomes more comfortable using electronic documentation. Medical errors are decreased owing to programmed alerts that are automatically displayed when a healthcare provider takes an action that could potentially be harmful to the client. The EHR facilitates communication of client care across the healthcare team because all of the information is in one place and multiple people can access it from different computers at the same time. The nurse administered the narcotic Demerol, 50 mg PO at 1400 to a patient with pain rated as 9 on a 0 to 10 scale. At 1430, the patient stated that the medication was not working and requested to have morphine IV, which the provider had prescribed for severe pain. What is the nurse's best evaluation of this situation? a) The patient needs to understand that it takes time for the medication to reduce pain. b) Administering Demerol PO was not the best nursing intervention in this situation. c) The provider should be notified if the patient's pain is not relieved in 2 hours. d) Demerol PO was the best intervention because morphine IV can cause drug addiction. - CORRECT ANSWER ANS: B Administering Demerol PO was not the best nursing intervention in this situation because the patient was in severe pain (9/10). The patient needed immediate pain relief, which would not occur with PO pain medication. The nurse should have been administered morphine IV. Waiting 2 hours to notify the physician does not provide patient comfort. The nurse should focus on pain relief and not worry about the patient becoming "addicted" to the morphine. An insulin-dependent diabetic patient tells the nurse that she has been giving herself injections in the same location in her right thigh for the past several months because it is easier. What is the nurse's best action? a) Provide patient teaching on rotating injection sites. b) Assess the patient for cumulative effects. c) Check the type of insulin the patient receives to ensure that it is compatible with the vastus lateralis site. d) Document the patient's comments, as the patient understands the treatment regimen. - CORRECT ANSWER ANS: A Administering medications in the same site over prolonged periods of time can cause fat deposits and skin lumps, which will interfere with absorption and thus hinder the effectiveness of the medication. Insulin is administered subcutaneously, not intramuscularly. The patient should be taught to rotate injection sites. A surgeon prescribes heparin 2,500 mEq IM q 12 hr. What is the nurse's best action? a) Administer the medication as prescribed. b) Clarify the medication dose with the surgeon. c) Administer the medication subcutaneously. d) Clarify the dose and route with the surgeon. - CORRECT ANSWER ANS: D The nurse should contact the surgeon to clarify the dosage and route of administration. Heparin is measured in units and administered either subcutaneously or intravenously. The nurse should contact the provider who prescribed the medications. A patient is having pain and has requested a dose of analgesic medication. The medication administration record indicates that he prescribed the narcotics hydromorphone (Dilaudid) intramuscularly and morphine sulfate intravenously. Where should the nurse first assess to determine which medication to administer? a) The patency of the IV site b) Which drug the patient prefers c) The patient's pain level d) Skin integrity of the dorsogluteal site - CORRECT ANSWER ANS: C The nurse should check the patient's pain level. If the pain is severe, the nurse should administer IV morphine to provide the patient immediate relief. The dorsogluteal site for IM injections should be avoided. Which term refers to the movement of a drug from the site of administration to the bloodstream? a) Absorption b) Distribution c) Metabolism d) Excretion - CORRECT ANSWER ANS: A Absorption refers to the movement of drug from the site of administration into the bloodstream. Distribution involves the transport of the drug in body fluids, such as blood, to the tissues and organs. Metabolism is the biotransformation of the drug into a more water-soluble form or into metabolites that can be excreted from the body. Excretion, or the removal of drugs from the body, takes place in the kidneys, liver and gastrointestinal tract, lungs, and exocrine glands. A patient who just returned from the postanesthesia care unit is complaining of severe incision pain. Which drug contained in his medication administration record will offer him the fastest relief? a) Liquid acetaminophen with codeine b) Intravenous morphine sulfate c) Intramuscular meperidine d) Oral oxycodone tablets - CORRECT ANSWER ANS: B Drugs administered by the intravenous route are injected directly into the bloodstream and do not have to be absorbed into it. Therefore, they act more quickly than drugs administered by the oral or intramuscular routes. A nurse is being investigated for stealing narcotics from several patients. Which federal agency can become involved in the investigation of this incident? a) State Board of Nursing b) U.S. Food and Drug Administration c) U.S. Drug Compliance Department d) U.S. Drug Enforcement Agency - CORRECT ANSWER ANS: D The U.S. Drug Enforcement Agency (DEA) can investigate diversion and theft of controlled substances. The State Board of Nursing is not a federal agency and is only empowered to discipline a nurse's license. The U.S. Food and Drug Administration regulates the testing, sale, and manufacture of drugs. A patient is given furosemide 40 mg orally at 0900. The duration of action for this drug is approximately 6 hours after oral administration. At which time in military hours should the nurse no longer expect to see the effects of this drug? a) 0930 b) 1000 c) 1100 d) 1500 - CORRECT ANSWER ANS: D The nurse should no longer see the effects of furosemide at around 1500 hours (3:00 p.m.). The effects of oral furosemide should be seen 30 to 60 minutes after administration, which is 0900 (9:30 a.m. in this case). Peak effect (diuresis) should occur in 1 to 2 hours, which is 1000 hours (10:00 a.m.) to 1100 (11:00 a.m.) in the scenario. Which factor in a patient's medical history is most likely to prolong the half-life of certain drugs? a) Heart disease b) Liver disease c) Rheumatoid arthritis d) Tobacco use - CORRECT ANSWER ANS: B Metabolism takes place largely in the liver. If there is a decrease in liver function (e.g., because of liver disease), the drug will be eliminated more slowly, prolonging the drug's half-life. Tobacco use can increase the elimination of some drugs, decreasing their effectiveness. The nurse receives a laboratory report that states her patient's digoxin level is 1.2 mg/mL; therapeutic range for this drug is 0.5 to 2.0 mg/mL. Which action should the nurse take? a) Notify the prescriber to reduce the dose. b) Withhold the next dose of digoxin. c) Administer the next dose as prescribed. d) Notify the prescribing healthcare provider to increase the dose. - CORRECT ANSWER ANS: C Therapeutic range is a range whereby the medication is at a concentration to produce the desired effect. This patient's level is within the therapeutic range, so the nurse should administer the next dose as prescribed. The dose should not be increased or decreased because the prescribed dose is producing a level within the therapeutic range. The dose should not be withheld; this action could result in detrimental cardiac effects for the patient. The primary care provider orders peak and trough levels for a patient who is receiving intravenous vancomycin every 12 hours. When should the nurse obtain a blood specimen to measure the trough? a) With the morning routine laboratory studies b) Approximately 30 minutes before the next dose c) Two hours after the next dose infuses d) While the drug is infusing - CORRECT ANSWER ANS: B Trough levels are typically obtained approximately 30 minutes before administering the next dose of the drug. Therefore, the trough cannot be collected with the morning routine laboratory studies. The vancomycin peak should be obtained 2 hours after the next dose infuses. Peak level must be measured when absorption is complete. This depends on all the factors that affect absorption. Trough levels would be inaccurate if the specimen is obtained while the drug infuses. Teratogenic drugs should be avoided in which patient population? a) Pregnant women b) Elderly c) Children d) Adolescents - CORRECT ANSWER ANS: A Drugs that are known to cause developmental defects are termed teratogenic. These drugs are contraindicated during pregnancy because of the likelihood of adverse effects in the embryo or fetus. A patient with end-stage cancer is prescribed morphine sulfate to reduce pain. For which effect is this medication prescribed? a) Supportive b) Restorative c) Substitutive d) Palliative - CORRECT ANSWER ANS: D Morphine is prescribed for its palliative effects—to relieve pain, a symptom of cancer. Supportive effects support the integrity of body functions until other medications or treatments become effective. Restorative effects return the body to or maintain the body at optimal levels of health. Substitutive effects replace either body fluids or a chemical required by the body for improved functioning. After receiving diphenhydramine, a patient complains that his mouth is very dry. This is not uncommon for patients taking this medication. Which drug effect is this patient experiencing? a) Side effect b) Adverse reaction c) Toxic reaction d) Supportive effect - CORRECT ANSWER ANS: A Dry mouth is a side effect of diphenhydramine. Side effects are unintended, often predictable, physiological effects that are well tolerated by patients. Adverse reactions are harmful, unintended, usually unexpected reactions to a drug administered at a normal dosage. They are commonly more severe than are side effects. Toxic reactions are dangerous, damaging effects to an organ or tissue. Supportive effects are intended effects that support the integrity of body functions. While receiving an intravenous dose of an antibiotic, levofloxacin, a patient develops severe shortness of breath, wheezing, and severe hypotension. Which action should the nurse take first? a) Administer epinephrine IM. b) Give bolus dose of intravenous fluids. c) Stop the infusion of medication. d) Prepare for endotracheal intubation. - CORRECT ANSWER ANS: C The patient is experiencing an anaphylactic reaction (severe shortness of breath, wheezing, and severe hypotension), a life-threatening allergic reaction. Therefore, the nurse should immediately discontinue the medication. The first priority is to eliminate the cause of the problem. Next, the nurse should notify the physician, give IV fluids, and administer epinephrine, steroids, and diphenhydramine. Respiratory support ranging from oxygen administration to endotracheal intubation and mechanical ventilation may also be necessary. A patient develops urticaria and pruritus 5 days after beginning phenytoin for treatment of seizures. Which type of reaction is the patient most likely experiencing? a) Mild adverse reaction b) Dose-related adverse reaction c) Toxic reaction d) Anaphylactic reaction - CORRECT ANSWER ANS: A Urticaria and pruritus are considered minor adverse reactions. Dose-related adverse reactions are undesired effects that result from known pharmacological effects of the medication. Toxic reactions are dangerous, damaging effects to an organ or tissue. Anaphylactic reaction is a life-threatening allergic reaction that occurs during or immediately after administration. Laboratory test results indicate that warfarin anticoagulant therapy is suddenly ineffective in a patient who has been taking the drug for an extended period of time. The nurse suspects an interaction with herbal medications. What type of interaction does she suspect? a) Antagonistic drug interaction b) Synergistic drug interaction c) Idiosyncratic reaction d) Drug incompatibility - CORRECT ANSWER ANS: A In an antagonistic drug interaction, one drug interferes with the actions of another and decreases the resultant drug effect. In a synergistic drug interaction, there is an additive effect; that is, the effects of both drugs combined are greater than the individual effects. An idiosyncratic reaction is an unexpected, abnormal, or peculiar response to a medication. Drug incompatibilities occur when drugs are physically mixed together, causing a chemical deterioration of one or both drugs. A patient with terminal cancer requires increasing doses of an opioid pain medication to obtain relief from pain. This patient is exhibiting signs of drug: a) Abuse b) Misuse c) Tolerance d) Dependence - CORRECT ANSWER ANS: C Patients in the terminal stages of cancer commonly exhibit drug tolerance, a decreasing response to repeated doses of a medication. Therefore, pain management must be carefully planned to promote patient comfort. Drug abuse is the inappropriate intake of a substance continually or periodically. Drug misuse is the nonspecific, indiscriminate, or improper use of drugs, including alcohol, over-the-counter preparations, and prescription drugs. Drug dependence occurs when a person relies on or needs a drug. Dependence leads to lifestyle changes that focus on obtaining and administering the drug. Before administering a medication, the nurse must verify the six rights of medication administration, which include: a) Right patient, right room, right drug, right route, right dose, and right time b) Right drug, right dose, right route, right time, right physician, and right documentation c) Right patient, right drug, right route, right time, right documentation, and right equipment d) Right patient, right drug, right dose, right route, right time, and right documentation - CORRECT ANSWER ANS: D The six rights of medication administration are the right patient, right drug, right dose, right route, right time, and right documentation. Which expected outcome is best for a patient with a nursing diagnosis of Deficient Knowledge related to new drug treatment regimen? a) After an explanation and written materials, describes the expected actions and adverse reactions of his medication b) In 1 week after instructional session, describes the expected actions and adverse reactions of his medications c) Follows the treatment plan as prescribed d) Experiences no adverse effect from his prescribed treatment plan - CORRECT ANSWER ANS: B The best phrasing for the expected outcome is the one with a specific, measurable time frame (1 week) and details for how to resolve the patient's knowledge deficit. The other options provide no time line for achieving the goal and, therefore, are not measurable. Expected outcome statements must be measureable. When the nurse enters a patient's room to administer a medication, he calls out from the bathroom, telling her to leave his medication on the bedside table. He reassures her that he will take the medication as soon as he is finished. How should the nurse proceed? a) Inform the patient that she will return when he is finished in the bathroom. b) Wait outside the bathroom door until the patient is ready for the dose. c) Withhold the dose until the next administration time later in the day. d) Document that the dose was omitted in the medication administration record. - CORRECT ANSWER ANS: A The nurse should inform the patient that she will return with the medication when he is finished in the bathroom. The nurse likely would not have time to stand outside the door and wait for the patient to finish in the bathroom. If the medication is left at the bedside for the patient, the nurse cannot be sure that the patient actually took the medication. Withholding the dose until the next administration time may compromise the patient's condition and is not appropriate nursing action. The drug should not be omitted; therefore, the nurse should not document a missed dose in the medication administration record. Which documentation entry related to prn medication administration is complete? a) 6/5/14 0900 morphine 4 mg IV given in right antecubetal fossa for pain rated 8 on a 1-10 scale, J. Williams RN b) 0600 famotidine 20 mg IV given in right hand, S. Abraham RN c) 9/2/14 0900 levothyroxine 50 mcg PO given d) 1/16/14 furosemide 40 mg PO given, J. Smith RN - CORRECT ANSWER ANS: A The longest option, signed by J. Williams, is complete because it contains the date and time the medication was administered, the name of the medication, the route of administration and injection site, and the name of the nurse administering the medication. Because the medication administered was a prn order, the nurse also included the reason the medication was administered. Other options are incomplete. A patient has difficulty taking liquid medications from a cup. How should the nurse administer the medications? a) Request that the physician change the order to the IV route. b) Administer the medication by the IM route. c) Use a needleless syringe to place the medication in the side of the mouth. d) Add the dose to a small amount of food or beverage to facilitate swallowing. - CORRECT ANSWER ANS: C When a patient has difficulty taking liquid medications from a cup, the nurse should use a syringe without a needle to place the medication in the side of the patient's mouth. After placing the syringe between the gum and cheek, the nurse should push the plunger to administer the medication slowly. It is not necessary to ask the prescriber to change the order to the IV route; it is preferable to use the least invasive route. The nurse cannot administer a drug by another route without a prescription to do so. Dosing might not necessarily be the same in the oral versus the IM route; thus, a prescription is needed to change the route. Some drugs are not compatible with various food or liquid substances and should be taken on an empty stomach. Consult a pharmacist, prescriber, or drug formulary. The primary care provider prescribes nitroglycerin 1/150 g SL for a patient experiencing chest pain. How should the nurse administer the drug? a) Place the drug in the cheek and allow it to dissolve. b) Place the drug under the tongue and allow it to dissolve. c) Inject the drug superficially into the subcutaneous tissue. d) Give the pill and water to the patient for him to swallow the tablet. - CORRECT ANSWER ANS: B Drugs administered by the sublingual (SL) route should be placed under the patient's tongue and allowed to dissolve. Drugs administered by the buccal route are placed in the cheek and allowed to dissolve. A subcutaneous injection is administered into the subcutaneous tissue. Placing the drug into the patient's mouth, giving him water, and instructing him to swallow the tablet describe oral administration. Which action should the nurse take immediately after administering a medication through a nasogastric tube? a) Verify correct nasogastric tube placement in the stomach. b) Auscultate the abdomen for presence of bowel sounds. c) Immediately administer the next prescribed medication. d) Flush the tube with water using a needleless syringe. - CORRECT ANSWER ANS: D The nurse should flush the nasogastric tube with water using a needleless syringe after administering each medication. Some medications are less effective when given in combination with others. The nurse should verify nasogastric tube placement and auscultate the abdomen for bowel sounds before administering the medication. How should the nurse dispose of a contaminated needle after administering an injection? a) Place the needle in a specially marked, puncture-proof container. b) Recap the needle, and carefully place it in the trashcan. c) Recap the needle, and place it in a puncture-proof container. d) Place the needle in a biohazard bag with other contaminated supplies. - CORRECT ANSWER ANS: A To avoid needlestick injuries, the nurse should place the uncapped needle, pointing downward, directly into a specially marked, puncture-proof container. Recapping the needle should only be done when no other feasible alternative is available. When recapping is necessary, use an acceptable technique such as the one-handed scoop technique in which the nurse places the needle cap on a sterile surface and, using one hand, scoops up the cap with the needle. Placing the needle in an improper container (biohazard bag) that could be punctured by the contaminated needle places other staff members at risk. The nurse must administer hepatitis B immunoglobulin 0.5 mL intramuscularly to a 3-day-old infant born to an HB Ag-positive mother. Which injection site should the nurse choose to administer this injection? a) Ventrogluteal b) Vastus lateralis c) Deltoid d) Dorsogluteal - CORRECT ANSWER ANS: B The preferred site for IM injections for infants who are not yet walking is the vastus lateralis muscle because there are no major blood vessels or nerves in the area and the gluteal muscles have not been developed by walking. For children who are walking, the site of choice is the ventrogluteal muscle. The dorsogluteal site is not recommended for children or adults. The deltoid muscle can be used for small volumes in older children and adults. Which action should the nurse take to relax the vastus lateralis muscle before administering an intramuscular injection into the site? a) Apply a warm compress. b) Massage the site in a circular motion. c) Apply a soothing lotion. d) Have the client assume a sitting position. - CORRECT ANSWER ANS: D To relax the vastus lateralis for injection, the nurse should have the patient assume a sitting position or lie flat with his knee slightly flexed. Applying a warm compress, massaging the site, and applying soothing lotion are inappropriate interventions before administering an IM injection. After injection, massaging the site can enhance the absorption of medication into the muscle. Applying a warm compress increases circulation to the site, which can also enhance absorption. This action would be performed after the injection and not before. The physician prescribes warfarin 5 mg orally at 1800 for a patient. After administering the medication, the nurse realizes that she administered a 10 mg tablet instead of the prescribed 5 mg PO. Which of the following actions by the nurse is appropriate? a) No action is necessary because an extra 5 mg of warfarin is not harmful. b) Call the prescriber and ask her to change the order to 10 mg. c) Document on the chart that the drug was given and indicate the drug was given in error. d) Complete an incident report according to the facility's policy. - CORRECT ANSWER ANS: D When a medication error is made, the nurse should first check the patient to assess for negative effects. If she is unfamiliar with the side effects of the medication, she should consult a drug reference, the licensed pharmacist at the institution, or the prescriber. Next, she should verify that she made an error and identify the type. Notify the nurse in charge and the physician. Follow any orders the physician prescribes. Document the drug, the dose, site, route, date, and time in the patient's healthcare record but do not document that the drug was given in error. Complete an incident report according to the facility's policy; submit the signed report to the nurse manager. Finally, critically review the error, and identify ways to improve your practice. The nurse must administer ear drops to an infant. How should she proceed? a) Pull the pinna down and back before instilling the drops. b) Pull the pinna upward and outward before instilling the drops. c) Instill the drops directly; no special positioning is necessary. d) Position the patient supine with the head of the bed elevated 30°. - CORRECT ANSWER ANS: A For a child younger than 3 years old, the nurse should pull the pinna down and back. For older children and adults, the nurse should pull the pinna upward and outward. Doing each straightens the ear canal for proper channeling of the medication. The patient should be assisted into a side-lying position with appropriate ear facing up before instillation. The nurse is teaching parents ways to give oral medication to their child. Which action would they implement to improve compliance? a) Crush time-release capsules to put in his favorite food. b) Give medication quickly before he knows what is happening. c) Allow the child to eat a frozen pop before receiving the medication. d) Mask the flavor of medication in a toddler cup with orange juice. - CORRECT ANSWER ANS: C The parent can give the child a frozen fruit bar or frozen flavored ice pop just before the medication. This helps to numb the taste buds to weaken the taste of the medication. To mask bad-tasting medicines, parents can crush pills or empty the contents of a capsule as long as it is not a time-release dose and mix with soft foods, such as applesauce, hot cereal, or pudding. This is helpful for patients who might aspirate liquids, as well. If the child is old enough to understand, warn him when a medication has an objectionable taste. Otherwise, his trust might be compromised if he is surprised with a bad taste. Do not use essential foods in the child's diet (e.g., milk or orange juice) to mask the taste of medications. The child may later refuse a food that he associates with the medicine. An adult patient admitted with lower gastrointestinal bleeding is prescribed a unit of packed red blood cells. Which gauge needle should be inserted to administer this blood product? a) 18 gauge b) 22 gauge c) 24 gauge d) 26 gauge - CORRECT ANSWER ANS: A Large-gauge needles, 14 to 18 gauge, are used for blood products in adults because the bore is large enough to allow transfusion without cell damage (lysis). Smaller-gauge bores can cause clumping and breakage of the cell, thus leading to reduced effectiveness of the transfusion as well as contributing to fragmented by-product of red blood cell waste. What is the most essential action by the nurse prior to delegating the administration of an intravenous (IV) medication to a licensed practical nurse (LPN)? a) Review the state's nurse practice act for LPN scope of practice. b) Review the unit policy and procedure for IV medication administration. c) Determine whether the LPN has previously performed this procedure. d) Demonstrate the procedure; then allow the LPN to administer the IV medication. - CORRECT ANSWER ANS: A The State Board of Nursing regulates the types and routes of medications that can be administered by the various levels of nurses. For example, LPNs in some states cannot administer IV medications, whereas other states require additional education and experience before LPNs can perform this action. The nurse must refer to her state's nurse practice act for the scope of practice. Once scope of practice is identified, the nurse can proceed with reviewing the unit policies and assessing the experience level of the LPN. If state regulations do not allow LPNs to administer IV medications, there is no reason for the nurse to proceed with the other actions. Which body organ is mostly responsible for the metabolism of medications? a) Kidney b) Skin c) Liver d) Large intestine - CORRECT ANSWER ANS: C Drug metabolism takes place mainly in the liver, but medications can also be detoxified in the kidneys, blood plasma, intestinal mucosa, and lungs. If liver function is impaired due to liver disease, medications will be eliminated more slowly, and toxic levels may accumulate. Which body organ is mostly responsible for medication excretion? a) Liver b) Kidney c) Lungs d) Exocrine glands - CORRECT ANSWER ANS: B The kidneys are the primary site of excretion. Adequate fluid intake facilitates renal excretion. If the patient has decreased renal function, the nurse should closely monitor for medication toxicity. The nursing student is preparing to administer an intramuscular (IM) injection to her patient. She states to her instructor, "I'm going to administer this medication in my patient's buttocks at the dorsogluteal site." What is the most appropriate response by the instructor? a) "Okay. Explain the procedure to me and you are good to go." b) "This may not be the best site owing to proximity of the sciatic nerve." c) "I agree, this is a good site for thin patients such as this one." d) "Okay, but first be sure to locate the bony landmarks carefully." - CORRECT ANSWER ANS: B The dorsogluteal site consists of the gluteal muscles of the buttocks. Avoid using the dorsogluteal site for IM injections because its close proximity to the sciatic nerve and superior gluteal artery increases the risk of injection into a major blood vessel and damage to the sciatic nerve. Furthermore, the site is difficult to identify accurately in older adults or people with flabby skin. The instructor should advise the student that this is not the appropriate site and elicit another site from the student. Once this is identified, the student can proceed with patient identifiers. The nursing student is preparing to administer lisinopril to her patient but does not know what lisinopril is used for. What is the most appropriate action by the student to obtain the information? a) Consult the pharmacist. b) Ask the primary nurse. c) Ask her nursing instructor. d) Look up lisinopril in a medication reference text. - CORRECT ANSWER ANS: D Look it up! As a nurse, one is professionally, ethically, legally, and personally responsible for every dose of medication administered to a patient. Always use current information when researching a medication. The nurse mixes two medications together in one syringe and is preparing to administer them to her patient. On entering the patient's room, the nurse notices that the medication looks cloudy and there are some particles floating in the mixture. What is the most appropriate action by the nurse? a) Notify the pharmacist before proceeding. b) Check for medication compatibility. c) Discard the medications and syringe. d) Remix the medications in a different syringe. - CORRECT ANSWER ANS: C Drug incompatibilities occur when multiple drugs are mixed together, causing a chemical deterioration of one or more of the drugs. The result is an incompatible solution that should not be administered. You can usually recognize an incompatibility when the mixed solution takes on a changed appearance. If the contents of the syringe become discolored or there are particles in the solution, do not administer the medication. The nurse should always consult a medication resource and compatibility chart before mixing medications. Remixing the medications using a different syringe is inappropriate, as this will only elicit the same result. The nursing student has registered for a class on pharmacokinetics. Which of the following reflects the student's accurate understanding of what he can expect to focus on in this class? a) The study of drug actions and their various side effects b) A classification system for organizing brand names and generic names of drugs c) The absorption, distribution, metabolism, and excretion of drugs d) The study of how medications achieve their effects at various sites in the body - CORRECT ANSWER ANS: C Pharmacokinetics refers to the absorption, distribution, metabolism, and exertion of a drug. These four processes determine the intensity and duration of a drug's action. Each drug has unique pharmacokinetics characteristics. Pharmacology is the science of drug effects. It deals with all drugs used in society, legal and illegal, prescription and nonprescription. Pharmacodynamics, another subconcept of pharmacology, is the study of how medications achieve their effects at various sites in the body, how specific drug molecules interact with target cells, and how biological responses occur. What is/are the primary roles of the Food and Drug Administration (FDA)? Select all that apply. a) Regulate the testing, manufacture, and sale of all medications b) Monitor safety and effectiveness of medications available to consumers c) Manage the storage and handling of controlled substances d) Manage the sale and regulation of all herbal remedies - CORRECT ANSWER ANS: A, B The FDA of the U.S. Department of Health and Human Services regulates the testing, manufacturing, and sale of all medications. This agency also monitors the safety and effectiveness of medications available to consumers. This process helps to ensure that ineffective or unsafe drugs are not marketed or are recalled, if later found unsafe. However, many medicinal products are not regulated by the FDA. For example, herbal remedies and some naturopathic supplements are considered "food products" and are not regulated, even though they are advertised as having health benefits. The management of controlled substances is under the auspices of the Drug Enforcement Agency (DEA) The new nurse is beginning her orientation on a medical-surgical unit. What is most important for the nurse to know regarding hospital policies concerning controlled substances? Select all that apply. a) Controlled substances are usually stored in a double-locked area. b) A count of all controlled substances is performed at specific times, usually monthly. c) The facility must keep a record of every dose of a controlled substance that is administered. d) Handling and storage of controlled substances is regulated by the U.S. Drug Enforcement Agency (DEA). - CORRECT ANSWER ANS: A, C, D Controlled substances must be stored, handled, disposed of, and administered according to regulations established by the U.S. Drug Enforcement Agency (DEA). Controlled substances must be stored in locked drawers with a second locked area. This process is known as double-locking. The facility must also keep a record of every dose administered. A count of all controlled substances is performed at specified times, usually at change of shift (not monthly). The nurse is preparing to administer a subcutaneous does of insulin to a patient with diabetes. Which two sites might the nurse use that would provide the best absorption of the injection? Select all that apply. a) Upper arm b) Abdomen c) Thigh d) Upper buttocks - CORRECT ANSWER ANS: A, B Subcutaneous injections are given into the subcutaneous tissue, the layer of fat located below the dermis and above the muscle tissue. Absorption is slower than through the intramuscular route because subcutaneous tissue does not have as rich a blood supple as does muscle. However, the speed of absorption varies with the subcutaneous site selected. Absorption is fastest in sites on the abdomen and arms; it is slower on the thigh and upper buttocks. Medication is absorbed more evenly from the abdomen than from the thighs and buttocks because it is affected less by activity. The nurse is preparing to administer ophthalmic eye drops to her patient. What are the most appropriate actions for administering eye drops? Select all that apply. a) Place the patient in a high-Fowler's position. b) Administer the eye drops from the inner to the outer canthus of the eye. c) Position the eyedropper 1 to 2 inches above the eye. d) Apply the medication into the conjunctival sac. - CORRECT ANSWER ANS: A, B, D When administering ophthalmic medications, use a high-Fowler's position, work from the inner canthus to the outer canthus, and apply the medication into the conjunctival sac. Position the eyedropper about 1.5 to 2.0 cm ( to in.) above the eye; 1 to 2 inches is too high. Do not apply the medication to the cornea and do not allow the dropper to touch the eye. The nurse is preparing to administer otic medications to her 35-year-old patient. What are the most appropriate actions by the nurse? Select all that apply. a) Pull the pinna up and back. b) Pull the pinna down and back. c) Place patient in side-lying position with appropriate ear up. d) Instruct the patient to remain on his side for at least 30 minutes. - CORRECT ANSWER ANS: A, C When administering otic medications, warm the solution to be instilled to body temperature, assist the patient to a side-lying position with the appropriate ear facing up, straighten the ear and pull the pinna up and back (adult patient), and instill the prescribed number of drops into the ear canal. Instruct the patient to remain on his side for 5 to 10 minutes after the procedure. The home health nurse is caring for a 75-year-old pati