NUR 2407 Pharm Quiz 1. Rasmussen College. Graded A

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QUESTION 1 1. A client reports that he has been swallowing his nitroglycerin instead of leaving it under his tongue. Teaching is needed. What can happen if sublingual medications are swallowed? ... first pass may inactivate the medication The medication effects will simply be delayed An esophageal burn will occur The medication effects will be increased due to first pass effect 0.25 points QUESTION 2 1. Which of these statements regarding controlled substances made by the nurse intern reveals the need for further teaching? Circle all that apply When controlled medications drop on the floor they should be wasted with a witness present Controlled substances of deceased people should be flushed in presence of a witness Controlled substances should be counted by the oncoming and exiting nurse every shift Patients should be asked to rate their pain 1:10 both prior to and after giving analgesics. It is a DHS rule that med carts must be locked whenever the nurse is not watching them. The cart keys should be hidden in the MAR when the nurse goes to lunch 0.25 points QUESTION 3 1. Which comment about over the counter (OTC) medications indicates the need for further teaching? They tend to have a high therapeutic index They are generally safe to take in pregnancy While safe for the general public they may be unsafe for people with renal or hepatic harms People who take other medications should consult their provider about before taking OTCs 0.25 points QUESTION 4 1. When entering the clients room for assessment purposes, which of these steps would be questionable? Knocking on the door Handwashing Asking the client to share their name and date of birth The nurse shares his/her own date of birth 0.25 points QUESTION 5 1. A nurse is wondering if advocacy for oral medication is appropriate. What rationale for advocacy would be appropriate? Oral medications are more completely absorbed than IV medications. IV medications should only be given to clients who can’t swallow A serious infection or injury may start at the site of instillation. IV medication are more vulnerable to first pass effect than oral medications 0.25 points QUESTION 6 1. Which of these is not an essential aspect of a medication order? Both trade and generic name must be cited together. The clients name must appear on the order sheet. The dose of the medication must be cited The route of the medication must be cited 0.25 points QUESTION 7 1. If phenobarbital has a four day half-life, and a client accidentally took 200 mg of the drug on Tuesday morning, and no intervention occurred, how much medication will remain in the bloodstream of that client on Thursday morning? 150 mg 100 mg 75 mg 50 mg 0.25 points QUESTION 8 1. Which of these statements made by the trained medication assistant reveals the need for further teaching? Circle all that apply It is OK to crush medications in advance when batch prepping them at the station When a patient has difficulty swallowing, even long acting medicines should be crushed Suspensions should never be shaken before they are measured Suspensions can be measured via syringe but should be given to elderly people in a med cup Pills should never be touched during the preparation phase Unused (remnant) half tabs of medication should be returned to the bottle for later use. Discarded medications should go into the sharps container 0.25 points QUESTION 9 1. A laboring mother wants to know why pain medication is not advisable. What rationales could the nurse offer for this? The blood brain barrier of an infant isn’t fully developed, so infants are at risk for sedation The liver of an infant is not well developed, so the effects of sedation can linger in the infant Epidural analgesia offers an alternative that will not harm the infant. The baby will not be able to eliminate the medication until it has its first stool The baby can be given naloxone, so analgesia really isn’t a problem. It just isn’t “natural”. 0.25 points QUESTION 10 1. Which of these is not an essential part of a medication order? The prescriber’s signature / nurse’s co-signature if telephoned. The date and time that the prescription was ordered must be cited. The frequency and timing of the medication must be cited The related diagnosis must be cited 0.25 points QUESTION 11 1. If a medication is ordered by trade name but the pharmacy sends up a medication that has a different, unfamiliar name, the nurse should Have a peer confirm that this is the right medication Look up the generic name of the needed drug to confirm they are the same thing Use the patient’s supply of medication from home Hold the medication until the trade name version of the medication is brought up 0.25 points QUESTION 12 1. Which of these statements made by the student nurse reveals the need for further teaching? Circle all that apply Reasons for refusals do not need be documented on the MAR. Refusal is a basic right Pills can be hidden in food without MD and guardian consent whenever necessary Meds may be documented before giving them because they can be circled if refused. Two patient identifiers should also be used in a long term care setting Unopened insulin, eye drops, vaccines & suppositories should be stored at 35O—46O F. Food may be kept in refrigerators holding medications if it is dated. 0.25 points QUESTION 13 1. When a nurse checks the MAR, pulls out needed medications, inserts them in a common cup, signs the medications off, then gives them to the patient after checking name and allergy bands, he or she is Adhering to accepted guidelines for medication administration Being hyper-vigilant (overly cautious) Falsifying the record by signing that the med was given before the patient took it Completing the three needed checks 0.25 points QUESTION 14 1. A client who takes Theo-24 (theophylline) for asthma, is experiencing theophylline toxicity. Which of these may be a contributing factor? (Select all that apply) First pass effect. Forgetfulness (double dosing) Chewing the capsule Cirrhosis with Gallstones Taking the medication with food 0.25 points QUESTION 15 1. Which of these assessments is not considered essential prior to giving medications to an acutely ill client Vital signs and O2 saturations Pain rating Level of consciousness *e. Mood 0.25 points QUESTION 16 1. A nurse is prioritizing what step to take first when beginning to care for a client before entering the room What step should occur first? Prepare the morning medications Introduce self and confirm the patient’s identity Assess the patient and document the findings Check the patients chart & last set of vital signs 0.25 points QUESTION 17 1. Which of these practices is most apt to contribute to time related medication errors? Avoiding the use of abbreviations Documenting in military time Giving HS (hour of sleep) medications whenever the patient is ready to retire Allowing the nurse to give medications within a ½ hour leeway either before or after a medication is scheduled 0.25 points QUESTION 18 1. Which of these factors might impair the absorption of and oral medication? The presence of food in the stomach Renal insufficiency Hepatic insufficiency High serum albumin 0.25 points QUESTION 19 1. Which statements made by the nurse peer reveal the need for further teaching? Class C medications are controlled substance medications Class D medications can be safely taken during pregnancy Class X medications refer to illicit substances like Cocaine Herbal remedies need not go through FDA efficacy trials before being marketed. Controlled substances cannot be refilled by phone 0.25 points QUESTION 20 1. A malnourished elderly client has a low albumin level. What is the implication of this finding? (Select all that apply) Less protein binding will occur. Medication will be more free to bind with target receptors. This may cause excessive effects. Blood brain barrier crossover will be impaired. Albumin is a lipid. More medicine will be needed. Low albumin levels will lead to receptor disintegration, so more medication will be needed. Protein insufficiency can lead to loss of metabolizing enzymes and consequential drug accumulation Albumin insufficiency signifies impaired absorption. Doses will need to be increased 0.25 points Question 1 1. A client asks what is meant by the term "first pass effect"? How would the nurse explain the term? "It refers to the first sign that the medication is starting to work." " It refers to the bodies push-back response to medicines it isn't familiar with." "It means that the liver starts to break down oral medicines before they even hit their intended receptors." "It means that the body becomes sensitized to the medicine so lower doses will be needed in the future." 0.25 points Question 2 1. A nurse is ready to administer the first dose of a new oral penicillin prescription to a client. The client states she tool penicillin 3 years ago and developed a rash. Based on this information, the nurse should Withhold the medication and inform the provider of the client's previous reaction. give the medication as prescribed and observe for a reaction Administer the medication intravenously to bypass gastric absorption. Combine the medication with an antihistamine to decrease the possibility of a reaction. 0.25 points Question 3 1. An older patient must learn to administer a medication using a device that required manual dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing this task. Which action will the nurse perform next? Ask the patient to keep trying until the skill is learned. Schedule multiple sessions and practice each step separately. Provide written instructions with illustrations showing each step of the skill. Teach the procedure to family members who can administer the medication for the patient. 0.25 points Question 4 1. If a medication is ordered by trade name but the pharmacy sends up a medication that has a different, unfamiliar name, the nurse should: Have a peer confirm that this is the right medication Look up the generic name of the needed drug to confirm they are the same thing Use the patient’s supply of medication from home Hold the medication until the trade name version of the medication is brought up 0.25 points Question 5 1. In order to ensure that a medication is given to the right patient, the nurse must perform which action? Ask the patient to spell their last name. Match the patient with a photo ID. Swipe a bar code on the patient's ID bracelet. Verify the patient using two identifiers. 0.25 points Question 6 1. Medication dosages may need to be decreased for which of the following reasons? Increased renal excretion. Increased medication-metabolizing enzymes. Liver failure. Peripheral vascular disease. Concurrent use of medication metabolized by the same pathway. 0.25 points Question 7 1. The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting which of the following: Drug-seeking behavior Drug tolerance The placebo effect Tachyphylaxis 0.25 points Question 8 1. The nurse gives 800mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given? None 50 mg 100 mg 200 mg 0.25 points Question 9 1. The nurse reviews a patient's database and learns that the patient lives alone, if forgetful, and does not have an established routine. The patient will be sent home with three new medications to be taken at different times of day. The nurse develops a daily medication chart and enlists a family member to put the patient's pills in a pill organizer. This is an example of which phase of the nursing process? Assessment Evaluation Implementation Planning 0.25 points Question 10 1. When a nurse checks the MAR, pulls out needed medications, inserts them in a common cup, signs the medications off, then gives them to the patient after checking name and allergy bands, he or she is Adhering to accepted guidelines for medication administration Being hyper-vigilant (overly cautious) Falsifying the record by signing that the med was given before the patient took it Completing the three needed checks 0.25 points Question 11 1. When the nurse practices the "5-plus-5" rights of medication administration, what does it ensure? Adequate information is given. Informed consent for drug administration Safe administration of medications Cost -effective use of medications 0.25 points Question 12 1. Which lab value will best reflect renal function in a client taking multiple medicines? Creatinine clearance Potassium levels Sodium levels Urinalysis 0.25 points Question 13 1. Which of these assessments is not considered essential prior to giving medications to an acutely ill client? Vital signs and O2 saturations Pain rating Level of consciousness Mood 0.25 points Question 14 1. Which of these factors might impair the absorption of and oral medication? The presence of food in the stomach Renal insufficiency Hepatic insufficiency High serum albumin 0.25 points Question 15 1. Which of these is not an essential aspect of a medication order? Both trade and generic name must be cited together. The clients name must appear on the order sheet. The dose of the medication must be cited The route of the medication must be cited 0.25 points Question 16 1. Which of these is not an essential part of a medication order? The prescriber’s signature / nurse’s co-signature if telephoned. The date and time that the prescription was ordered must be cited. The frequency and timing of the medication must be cited The related diagnosis must be cited 0.25 points Question 17 1. Which of these practices is most apt to contribute to time related medication errors? Avoiding the use of abbreviations Documenting in military time Giving HS (hour of sleep) medications whenever the patient is ready to retire Allowing the nurse to give medications within a ½ hour leeway either before or after a medication is scheduled 0.25 points Question 18 1. Which of these statements made by the student nurse reveals the need for further teaching? Select all that apply Reasons for refusals do not need be documented on the MAR. Refusal is a basic right Pills can be hidden in food without MD and guardian consent whenever necessary Meds may be documented before giving them because they can be circled if refused. Two patient identifiers should also be used in a long term care setting 0.25 points Question 19 1. Which of these statements made by the trained medication assistant reveals the need for further teaching? Select all that apply It is OK to crush all medications in advance when batch prepping them at the station When a patient has difficulty swallowing, even long acting medicines should be crushed Pills should never be touched during the preparation phase A double check system is used for safety during med pass. 0.25 points Question 20 1. Which teaching point is correct with respect to the concept of "tolerance"? Tolerance is a state where people become used to pain, and therefore need less pain medicine. In tolerance higher doses of medication are needed to achieve prior effects because a body learns to push back. Tolerance occurs in slow metabolizers. Slow metabolism leads to prolonged sedation. When sedative help people cope better with their suffering, we call it "drug tolerance." 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