CCRI Nursing 1010 Exam #3| Questions
solved 100% Correct/Verified Solutions
What nursing intervention could possibly prevent buccal irritation of a buccal medication (one
dissolved through the mouth's membrane)? - ANSWER • Buccal administration of medication
may lead to buccal irritation by erosion of the mucus membrane. This may be very
uncomfortable for the client. Buccal irritation can be minimized by alternating the placement
of the medication with each subsequent dose so that a single area is not affected. Buccal
medications are not to be chewed, swallowed, or taken with any liquids, as the rate of
absorption may be affected.
A nurse has been asked by a doctor to administer ear drops for a 4-year-old client. What is
the proper method? - ANSWER • Eardrops are administered with the ear positioned upward
and outward for clients greater than 3 years of age. STUDY TIP: Think of making a cup—by
pulling upward and outward—to accept and hold the eardrops.
How should Enoxaparin, a low molecular weight heparin, be administered? - ANSWER •
Enoxaparin is a low molecular weight heparin that is administered in subcutaneous tissue of
the abdomen, at least 2 inches away from the umbilicus. The injection site has to be pinched as
the needle is inserted. This helps ensure that the medicine is injected into the subcutaneous
tissue. Subcutaneous injections are not to be given over bony prominences as doing so can
cause injury. When administering enoxaparin, air within the syringe should not be expelled, as
doing so can affect the dosing. Subcutaneous injections should not be given over large
underlying muscles, as the medicine can be accidently injected into the muscles. Medication
injected into a muscle is absorbed more quickly than from the subcutaneous tissue.
,What should be discussed with a client with regards to side effects? - ANSWER • Every drug has
a desired therapeutic effect, and certain other effects, which are not desired. These effects of
the drug are called side effects. These effects are usually predictable and often unavoidable
due to the action of the drug on the organs other than the target organ. These side effects
occur at the usual therapeutic dose, and dose adjustments may have little effect on it. Side
effects are not due to prolonged intake or defective excretion of the drug. Prolonged intake
and defective excretion of the drug may cause toxic effects due to drug accumulation.
A nurse wants to provide a client with immediate relief. What characteristic of the drug matters
most here? - ANSWER • For providing immediate relief to the client, a drug should have a faster
onset of action. A drug with a slow onset of action may show a delayed effect. Peak
concentration refers to the time taken to attain the highest effective concentration and does
not provide information related to the onset of action. Plateau concentration is the plasma
concentration attained and maintained after repeated fixed doses. Duration is the amount of
time for which the drug produces its effect and does not provide information regarding onset
of action.
How should a patient be positioned for insertion of a rectal suppository? - ANSWER • For rectal
administration of a suppository, the client should be placed in the Sims position. Neither the
client nor the nurse would be comfortable if the client were placed in the prone position, lateral
position, or dorsal recumbent position.
• If a client who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema,
and pain at the site, the nurse suspects: - ANSWER Phlebitis -- Redness, warmth, and
tenderness at the IV site are signs of phlebitis. The cardinal signs of inflammation as established
by early Greek and Roman physicians are the four "or's": rubor (redness), calor (heat—think
"calorie"), dolor (pain), and tumor (swelling).
• If the daily requirement of the client is 2 X 2 puffs for a metered dose inhaler (MDI), when
should the client come in for replacement? - ANSWER • If the daily requirement of the client is
2 X 2 puffs for a metered dose inhaler (MDI), that is 4 puffs a day. If the canister has a total
of 200 puffs, then using 4 puffs daily will empty the canister in () = 50 days. So, the
client should come in for a canister replacement after 50 days.
What medication rights do clients have? - ANSWER • In accordance with The Client Care
Partnership and because of the potential risks related to medication administration, a client has
,the right to know the name, purpose, action, and potential undesired effects of a medication,
and can refuse a medication. The client has the right not to receive unnecessary and
unlabeled medications. The client does not have the right to administer the medication
himself unless ordered so.
What are the roles of the nurse and doctor during a verbal phone order? - ANSWER • In a
hospital setting, whenever a verbal order is given, the nurse should read back the order to the
prescriber to confirm it. The order should be entered in the computer. The nurse should receive
confirmation of the order from the prescriber for validation. The nurse should enter the time
and the prescriber's name and then sign the order, indicating that it was read back. The
prescriber should countersign the order within 24 hours, not 48 hours.
When giving an injection to a client, what contamination precautions should be taken? -
ANSWER • Injections cross the first line of defense of the body and may increase the risk of
infection. To reduce the risk of infection, the tip of the syringe should be covered either with a
cap or a needle. The skin should be cleaned in a circular motion with an antiseptic swab. This
decreases the microbial count in the injection area. Care should be taken to prevent touching
the needle to contaminated areas such as the outer surface of the cap, ampule, and tables.
Drawing of the medication from the ampule should be quick to minimize exposure. Swabbing
has to be done from the center to the periphery to push germs away from the injection site.
Why is insulin given as a subcutaneous injection? - ANSWER • Insulin is given as a
subcutaneous injection for slower absorption. The intradermal route is used for skin tests. The
intramuscular route is used for medications that need a faster absorption and are given in a
volume which cannot be given through subcutaneous route. The intravenous route is used for
medications that are administered in a large volume
What considerations must a nurse make when medicating elderly clients? - ANSWER • In
elderly clients, liver function is grossly reduced, which affects the metabolism of drugs and
prolongs the half-life of drugs. The absorptive capacity of the intestines also declines in elderly
clients. The brain receptors become more sensitive, and the clients are very much susceptible
to psychoactive drugs. The kidney function diminishes and the half-life of drugs excreted
through the kidney lengthens. The efficiency of the immune system decreases with age, but
the immune system does not interact with the drug metabolism process
, When should the nurse compare the medication label on the container with the MAR? -
ANSWER • It is the nurse's responsibility to ensure that the right drug is administered to the
right client. Therefore, the nurse should compare the label of the medication container with
the MAR three times. The medication label should be checked before removing the container
from the drawer or shelf. The medication label should be verified again as the right amount of
medication ordered is removed from the container. Finally, the medication label should be
checked at the client's bedside before administering the medication to the client.
How should the nurse educate a client about medications in the form of lozenges? - ANSWER •
Lozenges are slowly absorbed through the buccal mucosa; therefore, it should be kept in the
mouth for adequate time to allow dissolution. Lozenges should not be ingested because it is
more effective when absorbed through the buccal mucosa and not the gastric mucosa. The
lozenges should not be crushed or dissolved in water or juice, as this can make them
ineffective.
• One household cup is approximately ___mL. - ANSWER equivalent to 240 mL
• One kilogram is ___ lb. - ANSWER equal to 2.2 pounds.
One teaspoon is equal to ___ mL. - ANSWER 1 tsp= 5 mL
One tablespoon is equal to ___ teaspoons. - ANSWER 1 Tablespoon = 3 teaspoons = 15 mL
A nurse is discharging a client to a rehab. center, but she is concerned about the patient
taking the proper amounts of her medication. How should the nurse proceed? - ANSWER •
One important nursing responsibility is to collaborate with community resources when clients
have home care needs or difficulty understanding their medications.
What nursing education is necessary for a patient who has just been put on insulin? - ANSWER
• Rolling cloudy insulin between the palms of the hand helps to resuspend the insulin in the
vial. The regular insulin should be prepared first to prevent its contamination with the NPH
insulin. The mixed insulin dose should be injected 15 minutes before a meal for its peak
action