Pharmacology Chapter 1 The Nursing Process and Drug Therapy – Flashcards
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In which step of the nursing process does the nurse determine the outcome of medication administration? A. Planning B. Evaluation C. Assessment D. Implementation
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B
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The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next? A. Enlist the help of a home care nurse for pharmacotherapy. B. Examine the results of nursing help with the medications. C. Collaborate with the provider on a new medication regimen. D. Assess the impact of home self-management of medications.
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A
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Which statement is an example of objective data? (Select all that apply.) A. The patient states that she has a headache. B. The patient has clear urine. C. The patient says that she feels like someone is touching her arm. D. The patient has had a fever for 5 days. E. The patient says that she has felt tired for almost a week.
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B D
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What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.) A. The patient's home address B. The route of administration C. The age of the patient D. The signature of the prescriber E. The patient's emergency contact
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B D
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What information should the nurse chart when documenting medication administration? (Select all that apply.) A. The time of administration B. Information about an "incident report" in the patient's chart C. The patient's age D. The route of administration E. The dosage of medication administered
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A D E
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The nurse is to administer a medication at 0730 that is prescribed three times a day. What times are acceptable for administration of the drug to the patient? Select all that apply. 1. 0600 2. 0700 3. 0715 4. 0800 5. 0900
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2, 3, 4 Routine or scheduled medicines must be administered within the time frame of 30 minutes before and 30 minutes after the scheduled administration time. Therefore 0700, 0715, and 0800 all fall within the acceptable time frame. The time 0600 is too early for administration of medicine, and 0900 is too late.
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The nurse is unsure of the exact dosage of a prescribed medicine. What action does the nurse take? 1 Give the standard dosage of the medication. 2 Look for the dosage on the label of the medicine. 3 Contact the health care provider for dosage clarification. 4 Ask a colleague for the common dosage of the medication.
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3
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Which is the correct order for the steps of the nursing process? 1 Evaluation, planning, diagnoses, assessment, implementation 2 Planning, assessment, diagnoses, implementation, evaluation 3 Diagnoses, assessment, planning, evaluation, implementation 4 Assessment, diagnoses, planning, implementation, evaluation
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4
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Which symptom is an example of an allergic reaction? 1 Hives 2 Dry eyes 3 Constipation 4 Frequent urination
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1 Hives are the only physiologic symptom associated with an allergic reaction. The others are possible side effects of many medications but do not demonstrate an allergic reaction.
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An experienced nurse is discussing the rights of medication administration with nursing students. The nurse teaches that completion of which "right" is essential as proof of completion of all other rights? 1 Right dose 2 Right drug 3 Right route 4 Right documentation
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4 Right documentation is the essential "proof" that all is completed. If it is not documented, it is not completed! The other choices do not indicate completion.
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During the implementation phase of the nursing process, which action will the nurse perform when administering medications? 1 Prepare medications for all patients, then administer. 2 Decide the route of administration based on drug availability. 3 Call the patient by name to verify the drug is for the right person. 4 Check the patient's identification band before administering the medication.
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4 Checking the patient's identification band is the most accurate method of determining identity. Patient medications should be prepared immediately before administering to a patient to help prevent medication errors; medications for multiple patients should not be prepared at once. The nurse does not change the route of administration. Calling the patient by name does not verify who the patient is.
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When assigned to a maternity unit, what technique should be used to identify the mother and child for safe administration of medication? 1 Ask the mother to state the baby's name. 2 Ask the mother if she can identify her newborn. 3 Ask the mother and father both to identify the baby. 4 Make certain the identification bracelets on the mother and baby have the same numbers
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4 The commonly used system to identify a new mother with her baby is for each to wear bracelets with matching identification numbers. The other statements are not accurate ways to identify the baby correctly.
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The nurse is assessing a patient who reports abdominal pain. What subjective data should the nurse document? 1 The abdominal x-ray is normal. 2 Bowel sounds are heard on auscultation. 3 No abnormality is detected on palpation. 4 The patient reports abdominal pain since yesterday.
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4
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The nurse is caring for a patient who is ordered to receive a medication "stat." What are the time limits within which the nurse must administer the medication? 1 Within ½ hour of the prescription 2 Within 1 hour of the prescription 3 Within 2 hours of the prescription 4 Within 3 hours of the prescription
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1 When medications are prescribed as "stat," the nurse must administer the dose within ½ hour of the time the prescription was written. Administering a medicine ordered to be given stat within 1, 2, or 3 hours are all incorrect because they exceed the ½ hour requirement.
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An elderly patient has refused to take his prescribed antihypertensive tablet and is adamant that the tablet is worsening his condition. What should the nurse do? 1 Continue to encourage the patient to take the medication. 2 Offer the medication to the patient again after a few hours. 3 Respect the patient's right to refuse and notify the health care provider. 4 Return the unwrapped medication to the medication drawer for future use.
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3 The patient has the right to refuse a medication, and this right must be respected. The nurse should determine the cause of refusal, notify the provider, and make appropriate revisions in the nursing care plan. It is not safe to skip the dose and offer it again after a few hours. Unwrapped medicine should never be returned to the medication drawer; agency policy requires it to be discarded. The nurse should not keep trying to persuade the patient to take the medication; the patient has the right to refuse.
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A medication prescription is written as "ampicillin, PO, 500 mg every 8 hours." The nurse administers the drug at 1300 hours. As per military time, when does the nurse administer the next dose? 1 0100 2 0900 3 1600 4 2100
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4
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What information is essential for the nurse to assess when evaluating the medication order? 1 Age of the patient 2 Sex of the patient 3 Occupation of the patient 4 Date of the medication order
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4 While evaluating the medication order, the following elements should be assessed: patient's name, date of drug order, name of drug(s), drug dosage amount and frequency, route of administration, and prescriber's signature. This ensures accuracy of drug administration. The patient's age, sex, and occupation are not assessed during the evaluation of a medication order.
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For which activity is the nurse responsible during the evaluation phase of drug administration? 1 Gathering data in a drug and dietary history 2 Preparing and administering prescribed medications safely 3 Planning measurable outcomes for the patient related to drug therapy 4 Monitoring the patient continuously for therapeutic as well as adverse effects
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4 Ongoing monitoring of the patient evaluates the effect of the drug on the patient. All of the other answers refer to different steps in the nursing process.
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The health care provider has prescribed a 500-mg dose of a medication to a patient. The pharmacy has dispensed 250-mg tablets because the larger dose is unavailable. What should the nurse instruct the patient while teaching about medication administration? 1 "Take two tablets at once." 2 "Take the drug with a meal." 3 "Grind the tablets into granules." 4 "Dissolve the tablets in 250 mL of water."
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1 The nurse should tell the patient to take two tablets at once, because the medication ordered is twice the amount of one tablet. Medications should not be crushed unless it is known the patient has difficulty swallowing and the effect of crushing the tablet is known. There is no reason to instruct a patient to take the drug with a meal unless it is specified the medication causes gastric distress or other complications. There is no reason to dissolve the tablet in water unless it is known that the patient cannot swallow pills. If this is the case, other options should be explored before trying to dissolve a pill.
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The patient's prescription reads, "Amoxicillin 250 mg twice a day for chronic bronchitis." Of the options given, what would be the best nursing intervention before drug administration? 1 Check the dietary plan. 2 Prepare intravenous tubing. 3 Consult with the health care provider. 4 Reconstitute the drug with saline solution.
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3 The order is missing a route of administration. The nurse needs to consult with the health care provider before any intervention can be done. In assessing, the nurse would examine the order to determine whether the drug, dose, and route are appropriate. The prescription must include the route of administration. A dietary plan may help when assessing for drug-food interactions; however, it is not the best intervention. The accuracy of the order is the first priority. The nurse should never assume the route of administration. The nurse may administer the drug intravenously only if it is the appropriate route and ordered by the prescriber. Reconstitution of the amoxicillin is necessary only if a powder form of the drug is ordered. That information is not in this example.
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The home health nurse is caring for a pediatric patient. What instructions will the nurse follow in order to administer the "right dose" to the patient? Select all that apply. 1 Depend on the pharmacist for giving the correct dose. 2 Check the dose according to the patient's age and size. 3 Pay close attention to the decimal point in the prescription order. 4 Remember that pediatric patients are more sensitive to medication. 5 Use the drugs from the available stock with the patient; do not buy a new drug.
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2 3 4 The nurse needs to always remember that the dose should be calculated according to the patient's age and size. The decimal point in the prescription should not be missed, because it can make a significant difference in the dosage. The nurse keeps in mind that pediatric patients are more sensitive to medication than adults are because of their smaller body surface area. The nurse never depends on the pharmacist wholly for all patients. Instead, the nurse checks the availability of the drugs and orders new ones if required.
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The nurse has been instructed to give a medication to a patient three times daily at 1000, 1400, and 1800 hours. The nurse dispenses the first dose at 1200 instead of 1000. What should the nurse do next? 1 Give the rest of the doses as ordered at 1400 and 1800. 2 Give the medication twice daily for that day at 1200 and 1800. 3 Skip the first dose and give the other two doses at 1400 and 1800. 4 Change the subsequent dose schedule after contacting the provider.
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4 Changing the dose timings of the medication is unlikely to result in harm or decreased benefit to the patient. So after contacting the physician, the nurse can adjust the dose timings and give the prescribed antacid around the meal timings.
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A patient with diabetes is prescribed 10 units of insulin lispro (Humalog). Which nursing actions are appropriate? Select all that apply 1 Assessment of blood glucose 2 Intramuscular administration of the drug 3 Administration of the drug before bedtime 4 Administration of the drug 15 minutes before the patient eats 5 Administration of the drug by inserting the needle at a 45-degree angle to the injection site
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1 4 5 Insulin is a peptide hormone that regulates the blood glucose level. The nurse should administer the drug subcutaneously. Subcutaneous administration of insulin (Humalog) by inserting the needle at a 45-degree angle to the site helps with proper delivery of the drug. Intramuscular administration of the drug is not appropriate. The administration of insulin lispro (Humalog) 15 minutes before a meal regulates postprandial blood glucose levels. This type of insulin is not administered at bedtime.
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The nurse should use various methods of data collection for a detailed nursing assessment of the patient. What does the nurse consider to be a method of data collection? 1 Observing the patient 2 Explaining the illness to the patient 3 Changing the patient's wound dressing 4 Performing relevant diagnostic procedures
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1 Detailed data collection is required for the proper assessment of the patient. The methods of data collection include interviewing the patient and caregivers, observing the patient, and performing head-to-toe, detailed physical examination. Explaining the patient's illness to the patient is not an assessment method. Diagnostic procedures should be done only by specialists; nurses are not supposed to perform diagnostic procedures. Changing the patient's wound dressing is a nursing procedure, not a method of data collection.
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According to the current health care laws in the United States, which professionals can legally prescribe medications? Select all that apply. 1 Psychologists 2 Critical care nurse 3 Nurse practitioners 4 Physician assistants 5 Primary health care providers
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3 4 5 According to current health care laws in the United States, medicine can legally be prescribed only by primary health care providers, nurse practitioners, physician assistants, and dentists. Psychologists and critical care nurses are not legally allowed to prescribe medications.
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A patient reports chest pain, shortness of breath, and palpitations. The patient's electrocardiogram (ECG) indicates a rapid heart rate. The medical record indicates that the patient is allergic to penicillin. What data are classified as objective data? 1 Chest pain 2 Palpitations 3 Shortness of breath 4 Abnormal heart condition on ECG
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4
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A health care provider writes "acetaminophen 80 mg PO every 4-6 hours." What change is needed for the order to be written correctly? 1 The correct order is "acetaminophen 80.0 every 4-6 hours prn." 2 The correct order is "acetaminophen 80.0 mg PO every 4-6 hours." 3 The correct order is "acetaminophen 80 mg PO every 4-6 hours prn." 4 The correct order is "acetaminophen 80 mg PO every 4-6 hours as needed."
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4 Misplacement of the decimal point could lead to a dose 10 times greater ending in an overdose. The instruction 80.0 mg could be easily mistaken for 800 mg; therefore, 80.0 is not allowed when writing prescriptions. Leading zeros, or zeros placed before a decimal point, are allowed, but trailing zeros, or zeros following the decimal point, are to be avoided. Unless the order reads "prn," or "as needed," the dose will be given routinely and not as needed. Because of mistakes that occur when using abbreviations, it is now correct to spell out "as needed" instead of using the abbreviation for "pro re nata," or "prn."
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The nurse is reviewing a patient's prescriptions. Which elements of the medication prescription will the nurse specifically check? Select all that apply. 1 Drug name on the prescription 2 Name of the patient on the prescription 3 Signature of the prescriber on the prescription 4 Expiration date of the drugs in the prescription 5 Drug allergy of the drug specified on the prescription
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1 2 3 Once the detailed drug assessment is completed, the nurse checks seven elements of the medication prescription: name of the patient, date the prescription was written, drug name(s), drug dose, dosage frequency, route of administration, and prescriber's signature. Information about allergies to drugs should be requested during the initial assessments. The expiration date of the drug is not included on the prescription.
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Which statement indicates the student has understood the principles of charting? 1 "I will avoid negative language in charting." 2 "I will record staffing problems in charting." 3 "I will use abbreviations in charting whenever I can." 4 "I will make sure to mention incident reports in charting."
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1 The principle of charting is that one should not use negative language in charting. Staffing problems should not be mentioned in charts and should be sorted out after consultation with the nursing manager. Abbreviations should be avoided to keep the order clear and well understood by all. The incident report is confidential and should be filed separately.
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The nurse is developing a care plan for a patient related to medication therapy. What is the most important goal of this care plan? 1 Safe and effective administration of medications 2 Safe storage and handling techniques of the drugs 3 Proper understanding of the various drug interactions 4 Proper understanding of the importance of the drug therapy
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1 The nurse's primary goal in developing a care plan for a patient's drug therapy is the safe and effective administration of the drugs. This goal can be achieved by fulfilling various outcome criteria such as understanding safe handling and storage techniques for drugs, as well as the drugs' various reactions. Although the patient should understand the importance of the drug therapy, it is not a primary goal of the drug therapy plan.
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The nurse should check a medication how many times before administering it? 1 One time 2 Five times 3 Three times 4 Varies, depending on the drug being administered
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3 The nurse should check the medication three times and confirm each time that the medication is the right drug before administering the medication.
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What information is essential for the nurse to evaluate after a medication is administered to a patient? 1 Patient allergies to medications 2 Therapeutic effect on the patient 3 Dose of medication administered 4 Time the medication was administered
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2 The effect of the medication on the patient is part of the evaluation process after a medication is administered.
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The nurse assesses open wounds, hemorrhage, and hypoxia in a patient admitted to the emergency department after a motor vehicle crash. What is the priority intervention? 1 Wound care 2 Oxygen administration 3 Administration of antibiotics 4 Administration of blood products
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2 The nurse should follow the ABCs of care as a basis for prioritizing nursing interventions; that is, the nurse should follow interventions to maintain a patent airway and to restore breathing and circulation. Oxygen administration to correct hypoxia is the priority. Administration of blood products and wound care would be secondary interventions, followed by antibiotic administration.
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What should a nurse do before administering acetaminophen to a pediatric patient? 1 Verify the patient's home address on the prescription. 2 Verify the manufacturer of the drug on the prescription. 3 Verify the signature of the patient's parent on the prescription. 4 Verify the name of the drug to be administered on the prescription.
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4 Before administering a drug to a pediatric patient, the nurse verifies the name, dose, route, and frequency of the drug; the name of the patient; and the prescriber's signature on the prescription. It is not necessary for the nurse to verify the parent signature, drug manufacturer, or patient home address because these items are not included on the prescription.
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The health care provider writes a prescription for an antibiotic medication to be given at 0900 and then twice daily to a hospitalized patient. At 1800 the patient reports severe abdominal pain. The health care provider prescribes an analgesic drug to be given to the patient stat. What is the correct time for the analgesic drug to be administered? 1 The nurse can administer the analgesic at 2100 along with the antibiotic. 2 The nurse can administer the analgesic at any time between 1800 and 1830. 3 The nurse may administer the antibiotic exactly at 1800 along with the analgesic. 4 The nurse can administer the prescribed analgesic at the nurse's first available opportunity.
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2 The nurse can administer a scheduled drug within 30 minutes before and 30 minutes after the scheduled time. When a drug is prescribed to be administered stat, the nurse should administer the drug as soon as possible but must administer it within 30 minutes of the time the prescription was written. Therefore the nurse should administer the stat analgesic as soon as possible after 1800 but before 1830. The nurse cannot wait to administer the analgesic at the first available opportunity, whenever that may occur; she must administer it within 30 minutes of the time the prescription was written.
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A medication is ordered as "0.5 gram PO tid." The nurse identifies the patient using two identifiers and administers 500 mg of the drug orally every 12 hours. Which of the nurse's actions are correct? Select all that apply. 1 Dose administered. 2 Time administered. 3 Route administered. 4 Patient identification. 5 Does not need to clarify doctor's orders.
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1 3 4 5 The order is three times daily (tid), but the nurse administered the drug every 12 hours, which equals twice daily. The dose is correct (0.5 gram equals 500 mg). The route is correct (PO means orally). The nurse correctly identifies the patient using two identifiers. The nurse could accurately administer this medication without further clarification.
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A prescription is written "Diltiazem 30 mg orally three times daily at 0700, 1300, and 1900." The trainee nurse misreads the prescription and administers the drug at 1000. What is the best nursing action before administration of the next dose of medication? 1 Consult the peer group. 2 Calculate the next dose time. 3 Calculate the dose accordingly. 4 Consult the health care provider.
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4 Administration of the right drug at the right time may influence many factors, including patient condition, drug resistance, serum drug concentration, and laboratory findings. Any missed dose or late dose may compromise the patient's well-being. Therefore the nurse should inform the practitioner of any change in the dosage or timing of medication administration. The nurse should not depend on peer nursing groups in case of doubt. The nurse should not perform any action until the practitioner suggests a change in the drug administration. Therefore the nurse should not adjust the time of the next dose or recalculate the dose of the drug without consulting the practitioner.
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The nurse reviews a chart and suspects a medication order is written incorrectly. What is the nurse's best action? 1 Call the pharmacy. 2 Hold the medication. 3 Call the health care provider. 4 Discuss the issue with the nurse manager.
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3 The nurse should ensure that the correct drug has been prescribed before administration. If doubt exists, the nurse must contact the health care provider who wrote the order. The nurse must avoid relying on the knowledge of peers because this is an unsafe nursing practice. The nurse cannot administer the medication until the order is confirmed and all doubt is removed.
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A health care provider writes a prescription for "gentamicin 100 mg every 8 hours." What information is missing from the prescription? 1 The dose of the drug 2 The route of the drug 3 The strength of the drug 4 The generic name of the drug
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2 The prescription does not indicate the route for administering the drug, so the nurse must contact the prescriber for this information. The drug name, dose, and frequency of administration are all included in the prescription. Therefore no clarification is necessary for these items. The strength of the drug is not required on the prescription. This factor is usually determined by the pharmacist.
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A patient has filed a malpractice lawsuit against a nurse involving medication administration. Which of the rights of medication administration is most important for the nurse defense? 1 Right dose 2 Right route 3 Right patient 4 Right documentation
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4 Documenting patient observations and nursing actions, such as drug administration, has always been an important ethical responsibility of the nurse, but now it is becoming a major medical-legal consideration as well. A nurse may administer the right drug at the right dose to the right patient through the right route at the right time, but if the right documentation is not present in the patient chart, the nurse has no evidence that these rights were accurate in the event of a malpractice lawsuit.
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The nurse has an order for administering a medication to a patient. Which providers have legal authority to prescribe medications for patients? Select all that apply. 1 Dentist 2 Physician 3 Pharmacist 4 Physical therapist 5 Nurse practitioner 6 Physician assistant
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1 2 5 6 The providers who have privileges to prescribe medications for patients include dentists, physicians, nurse practitioners, and physician assistants. The exact medications that can be prescribed by nonphysicians and the type of agreement for prescriptive authority may vary from state to state.
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A patient is discharged on a medication to be taken twice a day. The patient verbalizes, "I will take this medication every morning." What term describes the error in this situation? 1 Reading error 2 Medication error 3 Prescription error 4 Communication error
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4 Because the patient is stating something in error, the nurse should reteach the information on the prescription. This is a communication error. Reading errors are errors in computer language. Although a misinterpretation of a prescription component may occur as a result of a failure in communication, it is considered a medication error if the patient takes the medication at the wrong time or it is given to the patient at the wrong time. Communication error is a broad term associated with problems arising from the failure of health care team members to communicate information properly or patients having difficulty in receiving the information. These communication errors can occur in any health care-related activity. Prescription errors are made by the prescriber when writing the prescription.
