TEST BANK ROACH'S INTRODUCTORY CLINICAL PHARMACOLOGY 11TH EDITION
1. A nursing instructor is preparing a teaching plan for a group of nursing students
... [Show More] 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: Medications 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
1 | P a g eB) 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.
7. 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
2 | P a g eeducating 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.
10. 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.
3 | P a g e11. 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
Feedback:
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
4 | P a g edetermines 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,
wheezing, 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
5 | P a g eD) 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.
19. 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
6 | P a g eand 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
clinical 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
7 | P a g eD) 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.
25. 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
8 | P a g eD) Toxic drug reaction
Ans: B
Feedback:
A synergistic drug reaction occurs when drugs interact with each other and produce a
sum 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:
Pharmacokinetics refers to the transportation activity of drugs in the body after
9 | P a g eadministration. 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
C) 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
10 | P a g ehealthy 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
D) 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
11 | P a g eD) 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
Ans: 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
12 | P a g econfirmation 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:
Common 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
13 | P a g eC) 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
client 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
14 | P a g eFeedback:
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
following 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
15 | P a g euse? 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.
18. 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
16 | P a g eAns: 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?
A) 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.
17 | P a g e24. A primary health care provider orders a transdermal drug. When administering this
drug, which action by the nurse would be most appropriate?
A) Apply next dose to a new site.
B) Check the infusion rate.
C) Inject only the inner part of the forearm.
D) Give small volumes of doses.
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.
27. 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?
18 | P a g eA) 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
readily 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.”
19 | P a g eB) “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)
3 C) 4
D) 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 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.
33. The nurse is preparing to administer an intradermal injection. The nurse would insert the needle at which angle? [Show Less]