Answer: D
Rationale: If the client makes any statement about the drug, the nurse needs to hold the drug and investigate the client's statement,
... [Show More] 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 client 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 client.
Repeating the client's statement and then asking for confirmation is inappropriate because it implies that the client is incorrect.
Question Format: Multiple Choice Chapter: 2
Learning Objective: 2 Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 22, Considerations in Drug Administration
1. A nursing instructor determines the nursing student is performing an oral drug administration correctly after comparing the drug label and MAR how many times?
A) 2
B) 3
C) 4
D) 5
Answer: B
Rationale: The proper procedure is to compare the drug label with the MAR three times: (1) when the drug is taken from its storage area, (2) immediately before removing the drug from the container, and (3) before administering the drug to the client.
Question Format: Multiple Choice Chapter: 2
Learning Objective: 2 Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 23, Preparing a Drug for Administration
2. The nurse is preparing to administer a buccal medication to a client. The nurse will instruct the client 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
Answer: B
Rationale: Buccal drugs are placed in the mouth against the mucous membranes of the cheek in either 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.
Question Format: Multiple Choice Chapter: 2
Learning Objective: 7 Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 26, Administration of Drugs by the Oral Route
3. 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
Answer: A
Rationale: 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 client who is obese and requires a subcutaneous injection. Typically, a subcutaneous injection is given at a 45-degree angle. A 30-degree angle is not typically sued for any injections.
Question Format: Multiple Choice Chapter: 2
Learning Objective: 7 Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 28, Administration of Drugs by the Intradermal Route
4. Which actions reflect 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
Answer: A, B, D, E
Rationale: 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.
Question Format: Multiple Select Chapter: 2
Learning Objective: 2 Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process)
Reference: p. 20, Introduction
5. A nursing mentor is monitoring a student prepare a prescribed drug for a client. The mentor determines the student is well prepared when which factors are verified? Select all that apply.
A) Right documentation
B) Right client
C) Right route
D) Right drug
E) Right prescriber
Answer: A, B, C, D
Rationale: The five + 1 rights of drug administration include the following: right client, right drug, right dose, right route, right time, and right documentation. Question Format: Multiple Select
Chapter: 2
Learning Objective: 1 Cognitive Level: Understand
Client Needs: Physiological Integrity: Pharmacologic Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 20, The (Five + 1) Rights of Drug Administration
6. Prior to administering a prescribed drug, the nurse determines the correct client by which method? Select all that apply.
A) Checking a client's name on the wristband
B) Checking a client's chart
C) Asking the client to identify themselves and give date of birth
D) Asking a client if they are the correct client
E) Using a current picture of the client if available [Show Less]