CCRI Nursing 1010 Exam 3 chapter 31 (Medication Administration), Chapter 32 (Alternative/C, Exams of Nursing

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CCRI Nursing 1010 Exam 3 chapter 31

(Medication Administration), Chapter 32

(Alternative/Complementary Therapies), Chapter 44

(Nutrition), and Chapter 48 (Skin Integrity and Wound

Care)

• A client has a bleeding tendency due to hemophilia. What route of drug administration is appropriate for this client? - Correct answer The route of administration appropriate for a client with a bleeding tendency is the oral route, as it does not involve the use of needles. Any mode of administration that uses needles may increase the risk of bleeding. Therefore, intradermal, intramuscular, and subcutaneous routes should be avoided in this client's case to prevent bleeding.
• A client has to be given a bladder irrigation with 100 ml of medicated solution with 1/1000 dilution. How much of the medication should the nurse dissolve in 100 ml of solvent? Record your answer using a whole number. ___ mg. - Correct answer A: 1/1000 solution means presence of 1 gram of the medication in 1000 ml of solution. This means that each ml of the solution contains 1 mg of the medication. Since the nurse has to prepare 100 ml of the solution, the nurse should dissolve 100 mg of medication in 100 ml of solvent.
• A client is prescribed a sublingual nitroglycerin drug. What instructions should the nurse provide to the client? Select all that apply: - Correct answer Do not swallow the medication; Place the medication under the tongue. When administering medications through the sublingual route, the medication has to be placed under the tongue until it fully dissolves. The medication should not be swallowed. Swallowing can make the medication ineffective. The medication should not be spit out to prevent irritation; however, it may be spit out if the desired therapeutic effect is attained. The medication should not be taken with water, as this can alter its effectiveness. Sublingual medication should be administered under the tongue, not between the tongue and cheeks.
• A client is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 200 puffs. The client takes 2 puffs every 4 hours. How many days will the pMDI last? Record your answer using a

whole number. _____ days: - Correct answer Two puffs × 6 times a day = 12 puffs per day; 200 puffs/12 puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a total of 17 days.

• A diabetic client has been switched from oral antidiabetic drugs to insulin. What information would help the client to ensure correct self-administration of insulin? Select all that apply. - Correct answer Insulin is given as a subcutaneous injection for slower absorption. The rate of absorption of insulin differs in various sites. The abdomen has the quickest absorption. The recommended sites of insulin injection include upper arms, anterior and lateral part of thighs, buttocks, and abdomen. These sites have appropriate amount of subcutaneous tissue for absorption of insulin. The injection site should not be chosen again for a month. The injection site should be rotated with each injection. Repeated injection at the same site may lead to lipodystrophy. What should be emphasized during patient teaching with regards to antibiotics? - Correct answer • A full prescription of antibiotics should be completed to ensure the therapeutic effect. An incomplete course of antibiotics may worsen the condition being treated, and also lead to development of resistance to the antibiotic. Treatment has to be taken fully even if the client attains early symptomatic relief. If the client's condition does not improve with full treatment, then treatment should be discontinued.
• A nurse has been asked to prepare a 1% solution of medication in distilled water. How much of the medication should the nurse dissolve in 100 ml of distilled water? Record your answer using a whole number. ___ mg - Correct answer A: A 1% solution contains 1 gram of the medication dissolved in 100 ml of the solution. Since the unit is mg, and 1 gram is 1000 mg, the nurse should dissolve 1000 mg of the medication in 100 ml of water.
• A nurse is teaching self-administration of insulin to a client. What instruction should the nurse include in the teaching? - Correct answer Roll the insulin between your palms if the preparation is cloudy. Cloudy insulin preparations should be rolled between the palms to re-suspend them before drawing into injections. The insulin vial should not be shaken, because shaking can create bubbles that can interfere with correct dosage

administration. Regular insulin is given subcutaneously, not intramuscularly. If insulin is taken after meals, it cannot control the rise of blood sugar levels that occurs due to food intake.

• A nurse working in a neonatal ward finds it difficult to establish an IV (intravenous) line for an infant. What route of medication administration is suitable for this clinical situation? - Correct answer In the intraosseous route, the medication is directly administered into the bone marrow; this route is suitable for infants for whom securing an IV line is difficult. The intrapleural route is used for performing pleurodesis in clients with persistent pleural effusion. The intraarterial route is suitable for breaking clots within the arteries. The intraperitoneal route is suitable for administering insulin and antibiotics. A doctor has ordered the nurse to insert a rectal suppository on an adult. What is the correct positioning of the suppository? - Correct answer • A rectal suppository for an adult should be placed against the rectal wall about 10 cm into the rectum. For children and infants, the suppository should be placed 5 cm deep into the rectum against the rectal wall. The inner aspect of the anal orifice is not the right position for suppository administration. The suppository has to be placed past the internal anal sphincter.
• After seeing a client, the physician gives a nursing student a verbal order for a new medication. What should the student nurse do next? - Correct answer The nursing student first needs to explain to the physician that the order needs to be given to a registered nurse. Reason: Nursing students cannot take orders.
• An elderly obese client who has undergone total hip replacement surgery has been put on low molecular weight heparin (LMWH) enoxaparin. What complications of subcutaneous injections should the nurse monitor for? Select all that apply: - Correct answer Pain, Hypertrophy of the skin, and Sterile abscess. Subcutaneous injections may be painful with irritating medication or if a large volume of medications is injected. Repeated injections at the same site may cause hypertrophy of the skin. The injected medication may collect at the site causing sterile abscess. Phlebitis is the inflammation of the veins. Infiltration happens when the intravenous fluid or medication accidently enters extravascular space.

• A nurse accidently gives a client a medication at the wrong time. The nurse's first priority is to: - Correct answer Assess the client for adverse effects because client safety and assessing the client are priorities when a medication error occurs.
• A nurse has to administer a subcutaneous injection to a client. What precautions should the nurse follow when administering the subcutaneous injection? Select all that apply: - Correct answer Inject medication slowly; Pinch skin with the nondominant hand. The technique of administering subcutaneous injection for an average-size client involves pinching the skin with the nondominant hand and injecting the needle quickly and firmly at a 45- to 90-degree angle. The medication has to be injected slowly to minimize pain. The skin is pinched with the nondominant hand, because the dominant hand is used for administering the injection. Piercing a blood vessel during a subcutaneous injection is very rare, so aspiration is not necessary. Injecting the needle should be quick. Inserting the needle with bevel up at a 5- to 15-degree angle is done for intradermal injection.
• A nurse has to administer an alkaline medication to a client. What is the preferred route of administration of this medication? - Correct answer Intravenous! Alkaline and other irritant medications are usually administered through the intravenous route, as this causes less discomfort. Intradermal, intramuscular, and subcutaneous administration of alkaline medications may irritate the tissues and cause the client discomfort.
• A nurse is administering medications to a 4-year-old client. After he or she explains which medications are being given, the mother states, "I don't remember my child having that medication before." What is the nurse's next action? - Correct answer Withhold the medications and verify the medication orders. Do not ignore client or caregiver concerns; always verify orders whenever a medication is questioned before administering it. Test- Taking Tip: For medication questions, ask yourself, "What is the safest response?"
• A nurse is responsible for the storage and safe usage of drugs. What guidelines should the nurse follow for the safe use of narcotics? Select all that apply. - Correct answer Store narcotics in locked containers; Frequently count narcotics, especially during shift change; Client details should be documented and recorded. All narcotics should be stored in a locked, secure cabinet or container to ensure safe storage. The narcotics

should be counted with the opening of narcotic drawers and/or at shift change to ensure that narcotics are not missing. The client's name, date, time of medication administration, name of medication, dose, and signature of the nurse dispensing the medication should be recorded. Documentation is necessary to keep a proper count of drug usage. Discrepancies in narcotic counts should be immediately reported as they may be a result of theft or illegal drug use. Unused portion should be disposed to prevent abuse.

• A nurse works the night shift. For which client is obtaining a verbal order from the prescriber contraindicated? - Correct answer A client with malignancy. Obtaining a verbal order is not permitted for managing malignancy because antineoplastic medications are not administered in emergency or urgent situations. In addition, these drugs have a narrow margin of safety. A verbal order should be taken for providing immediate care to clients with angina, asthma, and stroke, as a delay in managing these situations is life threatening.
• A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is and why he should take it. Which information does the nursing student include when replying to the client? - Correct answer The student provides the name of the medication and a description of its desired effect. Clients need to know information about their medications so they can take them correctly and safely.
• An elderly obese client who has undergone total hip replacement surgery has been put on low molecular weight heparin (LMWH) enoxaparin. What is the proper technique the nurse should use to administer enoxaparin? Select all that apply. - Correct answer The needle should be injected at a 90-degree angle because the client is obese. Enoxaparin is injected subcutaneously for gradual absorption. The injection site is pinched as the needle is inserted to ensure that the drug is injected into the subcutaneous tissues. Enoxaparin should be injected on the right or left site of the abdomen at least 2 inches from the umbilicus. The air bubble should not be expelled to avoid loss of drug. What nursing intervention could possibly prevent buccal irritation of a buccal medication (one dissolved through the mouth's membrane)? - Correct 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? - Correct 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?

• Correct 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? - Correct 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? - Correct 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? - Correct 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: - Correct 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? - Correct 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 (200 / 4) = 50 days. So, the client should come in for a canister replacement after 50 days. What medication rights do clients have? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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. - Correct answer equivalent to 240 mL
• One kilogram is ___ lb. - Correct answer equal to 2.2 pounds. One teaspoon is equal to ___ mL. - Correct answer 1 tsp= 5 mL One tablespoon is equal to ___ teaspoons. - Correct 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? - Correct 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? - Correct 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 during the meal time. Bubbles can form if the insulin vial is shaken. The presence of bubbles interferes with the correct dosing of insulin. What nursing interventions are necessary when educating a client who has just been put on insulin for the first time and will be self-administering at home? - Correct answer • Self-administration of insulin requires proper visual acuity to ensure drawing the appropriate amount of insulin. Insulin has to be stored as directed by the manufacturer to maintain vitality. The

site of insulin injection has to be rotated to prevent local changes of the skin. The nurse should demonstrate the proper preparation of a single insulin preparation. Insulin doses may be adjusted based on home-based blood glucose estimation of capillary blood or as per the health care provider's instructions. A doctor has ordered a suppository for a client. Which routes are indicated for this purpose? - Correct answer • Suppositories are meant to be inserted into the body cavities, such as the rectum or the vagina. The oral route is used for administering tablets, capsules, and liquid medications. Transdermal patches are applied on the skin. The parenteral route generally refers to intravenous injections. What can affect the absorption rate of a medication? - Correct answer • The absorption of drugs depends on the route of administration; oral route has the least absorption and the intravenous route has the highest absorption. The human body absorbs medications in a liquid state more readily than tablets and capsules. Higher blood flow to the site of administration favors faster absorption of drugs. Absorption of drugs depends on body surface area, not on body weight. Body temperature does not affect the absorption of drugs. A nurse is injecting an infant with medication and using a tuberculin syringe for accurate measurement (in the hundredths). What is the capacity of the tuberculin syringe she's using? - Correct answer • The capacity of the tuberculin syringe is 1 mL, and is used to prepare small amounts of medications (e.g. intradermal or subcutaneous injections). What are the most common sites for intramuscular injections? - Correct answer • The common sites for administering an intramuscular injection are the deltoid, ventrogluteal, and vastus lateralis. These muscle groups are large and have good blood circulation for easy absorption of the drug. The deltoid site is easily accessible and is used for injecting small volumes. The vastus lateralis is a thick and well-developed muscle, located on the anterior lateral aspect of the thigh. The ventrogluteal is the safest site for injection. It is deep and away from major nerves and blood vessels. A doctor has prescribed the "sliding scale" and for the patient to receive 2 units of insulin when his blood sugar level is between 150 and 200 mg/dl. The patient's finger-stick test results equal 175 mg/dl, so how many units of

insulin should the nurse give? - Correct answer • The correction or sliding scale of insulin is based on the client's blood sugar levels at a given point in time. The prescribed dose of insulin for a blood glucose level of 150 to 200 mg/dL is 2 units, and since the client's level falls in that range, he should be given 2 units. Which organization ensures vigorous testing of a drug's safety and efficacy before being sold in the USA? - Correct answer • The Food and Drug Administration ensures that all medications available in the market undergo vigorous testing so as to ensure their safety and efficacy. The Medicare program does not ensure testing of drugs. The United States Pharmacopeia and the National Formulary set standards for medication strength, quality, purity, packaging, safety, and dose form. A client has unilateral weakness. How should the nurse proceed with offering oral medications in order to prevent aspiration? - Correct answer • The client with unilateral weakness may have an increased risk of aspiration due to impaired swallowing. To prevent aspiration, the medication should be placed on the stronger side of the mouth. This action improves swallowing of the medication. Providing medication as a solution increases the risk of aspiration. Placing the medication in the weaker side of the mouth may lead to inappropriate swallowing. Grinding the medication before administration does not reduce the incidence of aspiration. Which of the following are components of a medication order? Select all that apply. A -- Dose and Frequency B -- Route of Administration C -- Generic Name of Drug D-- Chemical Name of Drug E- Nurse in Charge of Unit - Correct answer • The components of a medication order include dose and frequency of the medication. The dose and frequency are decided based on the client's weight and the amount of medication required to obtain the therapeutic effect. The route of administration depends on the types of medication and the condition of the client. The medication can be given via enteral or parenteral route. The generic name of the drug is an important component of the medication order and is used to identify the drug. Chemical name and nurse in charge are not components of the medication order.

• The nurse is administering a sustained-release capsule to a new client. The client insists that he cannot swallow pills. What is the nurse's next best course of action? - Correct answer Ask the prescriber to change the order. Enteric-coated or sustained-release capsules should not be crushed; the nurse needs to contact the prescriber to change the medication to a form that is liquid or can be crushed.
• The nurse is having difficulty reading a physician's order for a medication. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take? - Correct answer CALL HIS LAZY ASS UP! Call the physician to have the order clarified. You must have the right documentation and clarify all orders with the prescriber before administering medications.
• The nurse receives an order to start giving a loop diuretic to a client to help lower his or her blood pressure. Where should the nurse look to find the administration route? - Correct answer The nurse determines the appropriate route for administering the diuretic according to the prescriber's orders. The order from the prescriber needs to indicate the route of administration.
• The nurse takes a medication to a client, and the client tells him or her to take it away because she is not going to take it. What is the nurse's next action? - Correct answer Ask the client's reason for refusal; when clients refuse a medication, first ask why they are refusing it. When giving subcutaneous administration of a drug, what are important considerations regarding the chosen injection sites? - Correct answer • The sites chosen for subcutaneous administration should be far from bony prominences. There should not be any big muscles and nerves underlying the site of injection. These tissues can get injured during administration of injection. The medication is placed into the connective tissue below the dermis for slow absorption. The subcutaneous tissue has pain receptors, therefore, the injection may cause pain and discomfort to the client. The medication is absorbed slowly because the blood supply to the subcutaneous tissue is poor. The abdomen is a suitable site for subcutaneous injections.

A patient is having a CT Scan with IV contrast when she begins to show signs of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath. What kind of reaction is the patient experiencing? - Correct answer • The sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath indicate the severe form of allergic reaction called anaphylactic reaction; the nurse should call a rapid response immediately! Rhinitis is a minor form of allergic reaction that manifests as sneezing, swelling, and clear nasal discharge. Medication allergy is a nonspecific term and encompasses rhinitis, rash, urticaria, and pruritis. Idiosyncratic reaction is the onset of unpredictable response in a client. An average size client is prescribed a medication that needs to be administered subcutaneously. How should the nurse proceed? - Correct answer • The technique of administering subcutaneous injection for an average-size client involves pinching the skin with the nondominant hand and injecting the needle quickly and firmly at a 45- to 90-degree angle. The medication has to be injected slowly to minimize pain. The skin is pinched with the nondominant hand, because the dominant hand is used for administering the injection. Piercing a blood vessel during a subcutaneous injection is very rare, so aspiration is not necessary. Injecting the needle should be quick. Inserting the needle with bevel up at a 5- to 15-degree angle is done for intradermal injection, not subcutaneous injection. A nursing instructor is describing to students how the unit dose system works. What does she describe? - Correct answer • The unit dose system uses a cart with drawers with a 24-hour supply of medications for each client. The drawers are labeled with the client's name. Controlled substances are not kept in the client's drawer; they are kept separately in locked drawers. The cart also has prn and stock medications. The carts have the ordered dose of medication for each client for 24 hours, which may not be the full course. What interventions does the nurse make when offering oral medications to a patient who is at risk of aspiration? - Correct answer • Timing medications with meals reduces the risk of aspiration, as the medications are consumed with food. If the risk of aspiration increases, the nurse may choose different routes of drug administration. The client should be encouraged to take medications on his own if possible. Medications are to be administered one after the other, not all at once. The use of straws

should be discouraged because they affect client control of volume intake and increase the risk of aspiration.

• To prevent aspiration while administering oral medications, the nurse should also assess if the client is able to cough, has intact gag reflex, and has the ability to swallow. Presence of these reflexes reduces the chances of aspiration. The ability to clench the teeth and move the tongue is not protective against aspiration. How can medication errors be reduced? - Correct answer • Using at least two client identifiers before administering the drugs ensures that the medication is given to the right client. The nurse should ensure adequate rest for him or herself, as fatigue increases medication errors. Medication errors are greatly reduced if medications are prepared for one person at a time. Medication errors should be evaluated for their health impact and should be dealt with accordingly; concealing them is ethically unacceptable. Illegible prescriptions should be confirmed rather than interpreted. A CRNA (Nurse Anesthetist) needs to administer a medication through the epidural route. Where should the catheter be placed for this purpose? - Correct answer • When administering medications through the epidural route, the catheter should be placed in the epidural space, that is, just before the dura mater. The intrathecal space refers to the subarachnoid space or ventricles of the brain; administering medication there requires that the dura mater be punctured for administering the medication. A nurse is required to administer medication into a patient's ethmoid sinus. How should the patient be positioned in order to proceed properly? - Correct answer • When administering medication into the ethmoid sinus, the head of the client should be tilted backwards over the edge of the bed and a pillow should be placed under the client's shoulder. This position helps provide easy access to the site of medication administration. Tilting the head forward and flexing the neck laterally do not improve access to the ethmoid sinus. Tilting the head toward the side of treatment is useful for accessing the frontal and maxillary sinus. When administering medications through the NG tube, what considerations should the nurse make? - Correct answer • When administering medication through a nasogastric tube, all the medications should be dissolved separately in suitable solvents. The nasogastric tube should be flushed prior to drug administration and following administration of each

drug to prevent blockage. If the nurse encounters resistance while administering the medication, the health care provider should be notified. Each medication should be separately dissolved and administered to prevent mixing of medications. The nurse should not use a pigtail vent after connecting the tube to the syringe as it can cause air to escape into the digestive tract. What should the nurse do immediately upon noticing signs of infiltration during an IV medication push? - Correct answer • When an IV medication infiltrates, stop giving the medication and follow agency policy.

• When calculating dosages, always divide what is ordered by what you have on hand. - Correct answer For example, if we have an order of 500 mg of Tylenol but we only have 250 mg tablets, then we obviously give 2 tablets. But this also works for more complicated calculations. For example, what if dilaudid is ordered for a 10 kg person as 20 mg/kg, but we have on hand 4 mg/ml? We simply divide 200 mg by 4 mg/mL. This works out to be 50 mL because.......... ...............200mg * 1mL/4mg = 50 mL (the reason: when dividing a whole number by a fraction, we just multiply it by the denominator's reciprocal). In which order should vaginal administration of a suppository be inserted? - Correct answer • When performing vaginal administration of a suppository, the index finger of the dominant hand is lubricated with a water-soluble lubricant jelly. Then the vaginal orifice is exposed with the nondominant hand by retracting the labial folds. Then the nurse should apply gloves (haha, just making sure you're paying attention). The rounded end of the suppository is then inserted along the posterior wall of the vagina to ensure uniform distribution of medication along the walls of the vaginal cavity. Last, the remaining lubricant has to be wiped off around the orifice and labia. Which of the following orders require a PACU Post-Op nurse to use his or her own discretion for administering or withholding medication? A -- PRN B -- STAT C -- Standing Order D -- Routine Medication Order - Correct answer • When there is a prn order, the nurse may use her own discretion for administering or withholding medication based on her subjective or objective assessment.

Stat orders refer to single doses of medication to be given immediately or only once. Standing orders and routine medication orders are the same; in either case, the nurse continues the medication as directed by the prescriber until the prescriber asks the nurse to stop the medication. A nurse is educating a diabetic client about how to administer insulin. Which of the nurse's statements pertaining to use of insulin are appropriate? Select all that apply. A --The insulin vial should be shaken well before drawing the injection. B --Insulin should not be mixed with any other medication. C -- Insulin detemir should not be mixed with any insulin. D -- Insulin glargine should be mixed only with regular insulin. E -- Rapid-acting insulin mixed with NPH insulin should be given along with meals. - Correct answer Answer: Only B & C Explanation: Insulin should never be mixed with any other medication as it can hamper the effectiveness of the insulin. Insulin detemir should not be mixed with any other insulin as it can make it ineffective. Shaking an insulin vial can form bubbles that can interfere with correct dosage. Insulin glargine should not be mixed with any other insulin. Rapid- acting insulin mixed with NPH insulin has to be given 15 minutes before meals for maximum benefit. What is the correct sequence of steps for Tube Feeding? - Correct answer Correct Sequence of Steps for Tube Feeding: 1 - CHECK ORDER 2 - WASH HANDS & DON GLOVES 3 - CHECK ID 4 - ELEVATE HOB 5 - CHECK Bowel Sounds 6 - CHECK RESIDUAL (DON'T DISCARD , RETURN TO PT) - HOLD ACCORDING TO MD ORDER OR FACILITY PROTOCOL AND RECHECK IN 1 HR

7 - CHECK PLACEMENT ( PH)

8 - INITIATE Tube Feeding AT RATE ORDERED 9 - DOCUMENT PT RESPONSE

• Which statement best describes the evidence associated with complementary therapies as a whole? - Correct answer The science supporting the effectiveness of complementary therapies is early in its development. Systematic reviews of the evidence often indicate beginning support for therapies, but there is a lack of strong evidence supporting their widespread use. Science in the field is just beginning. Before the 1990s there was little attention in the United States at the National Institutes of Health to support funding for studies about complementary therapies. Most of the evidence cited in systematic reviews throughout this chapter indicates preliminary support for the effectiveness of a variety of complementary therapies. Conditions that appear to be particularly responsive include chronic pain, chronic autoimmune disorders, anxiety, depression, impaired well-being and quality of life that accompany cancer and other chronic conditions, and some time-limited acute illnesses and the symptoms that accompany them (e.g., gastrointestinal disturbances, colds/flus).
• How can energy-based therapies be described or defined? - Correct answer A: The use of a person's energy field to facilitate healing. Energy- based therapies believe that a disruption in the flow of energy can result in symptoms of physical or psychological illness. Balancing and returning the optimal flow of energy facilitates healing. The use of pharmaceutical therapies is known as allopathy. Body-based and manipulative methods use muscle strength for healing. Mind-body interventions use connections between thoughts, emotion, and physiological functioning to influence health and well-being. TEST-TAKING TIP: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. In this question about energy-based therapies, the Correct answer is the only one with the word "energy" included.

• A postoperative client requires assistance with ambulation. A nurse places her hands gently on the client's shoulder and tells the client, "I really like that you are making an effort to walk." Which therapy is being used by the nurse? - Correct answer A: Simple touch. Simple touch is helpful to make connections, display acceptance, and give appreciation. Touching the client gently and showing appreciation for the client's efforts encourages the client to continue efforts in walking. In reiki therapy the practitioner places hands on or above the body area and transfers universal life energy. Healing touch is a type of biofield therapy. In this therapy the practitioner touches the client to influence and support the human energy system and bring balance to the whole body. In therapeutic touch the practitioner touches the client's body to direct energy towards the client in an intentional manner.
• A client who is taking antidepressants has been unable to sleep due to anxiety before a scheduled angiography. Which strategy does the nurse use to reduce the anxiety of the client before the scheduled procedure? - Correct answer Meditation can be used to calm and reduce anxiety in the client. Chamomile should be avoided in this client who is taking antidepressants as this herb may interact with antidepressants and potentially cause adverse drug effects. Telling the client to think of something else may not be a useful coping strategy, as the client may feel his or her concerns are being dismissed. Postponing the angiography is inappropriate; the nurse should focus on reducing the client's anxiety.
• Energy therapies are used to treat various disease conditions. Which energy therapy is derived from ancient Buddhist rituals? - Correct answer Reiki Therapy is derived from ancient Buddhist rituals. In this therapy the practitioner places hands on or above the body area and transfers universal life energy. It provides strength, harmony, and balance to treat a client's health disturbances. Healing touch, magnet therapy, and therapeutic touch therapies are not derived from ancient Buddhist rituals. Healing touch uses gentle touch to the client's body to help bring balance to the whole body (physical, spiritual, emotional, and mental). In magnet therapy magnets are placed over the client's body to create an electromagnetic field. This magnetic field is useful for relieving pain in musculoskeletal disorders. Therapeutic touch is a treatment method where the practitioner directs energies to the client in an intentional manner.

•A postmenopausal client with high blood pressure suffers from flushing and irritability. This client refuses to take medications to relieve the postmenopausal symptoms. The nurse suggests the client use relaxation therapy. What health benefits of relaxation therapy should the nurse emphasize? Select all that apply. - Correct answer Relaxation therapy causes the muscle fibers to elongate, reduces the neural impulses sent to the brain, and decreases the activity of all the body systems. As a result, the blood pressure reduces. It induces a peaceful attitude by decreasing activity of all the body systems. Relaxation therapy helps to relieve menopausal symptoms like flushing and irritability by reducing the neural impulses to the brain. It helps to reduce pain and anxiety. Relaxation therapy reduces muscle tension and relaxes them, which in turn is helpful in reducing mental tension. •A client has hypertension. Which is the best therapy for the nurse to suggest to the client to reduce the need for antihypertensive drugs? - Correct answer Prolonged practice of meditation techniques is helpful for the client to reduce the need for antihypertensive drugs. Meditation is self- directed and it involves relaxed, deep, slow, abdominal breathing that evokes a restful state. It reduces the respiratory rate, lowers oxygen consumption, and decreases heart rate. Simple touch, acupuncture, and therapeutic touch have not been shown conclusively to reduce blood pressure. The client may enjoy these therapies, but they are not necessarily helpful in reducing the need for antihypertensive drugs. •A client is diagnosed with a urinary tract infection. The client asks a nurse about natural products for the treatment of urinary tract infections. Which natural product does the nurse advise the client to take in order to treat urinary tract infections? - Correct answer Cranberry juice is used for the treatment of urinary tract infections. Cranberry molecules bind with the iron that bacteria need to grow and reproduce. Cranberry blocks the adherence of bacteria to the walls of the bladder. Ginger is used to prevent nausea and vomiting. Life root is used as a menstrual flow stimulant. Coltsfoot is used as an antitussive. •A client suffering from bronchoconstriction wants to use the herbal ephedra. What does the nurse advise the client before the use of ephedra?

• Correct answer The client should avoid consumption of ephedra with caffeine, as it can lead to adverse interactions. Ephedra does not contain carcinogenic agents. Ephedra does not induce venoocclusive disease or

hepatotoxicity. Calamus is an herb that contains carcinogens. Comfrey is an herb that causes venoocclusive disease. Chaparral is an herb that can cause severe liver toxicity. •A client who has a psychiatric disorder wants to know more about touch therapy as a treatment for the illness. What explanation does a nurse provide to the client regarding touch therapy? - Correct answer Touch therapy is contraindicated for clients with psychiatric disorders. The client may misinterpret the intent of the treatment and feel threatened and anxious by the touch therapy. Touch therapy does not necessarily take a long time to cure disorders, but it is contraindicated in psychiatric disorders and would not be recommended by the nurse. A consent form is not required for touch therapy. Family members are not required to sit beside the client during touch therapy. •The nurse is planning care for a group of clients who have requested the use of complementary health modalities. Which client is not a good candidate for imagery? - Correct answer Imagery can often recreate the traumatic experience, intensifying the sensations and emotions that accompany the memory of it and bringing the PTSD to a crisis level. •A client is performing meditation. Which findings in the client can be attributed to the effects of meditation? Select all that apply. - Correct answer Meditation is an activity that helps to decrease the number of inputs to the brain by refocusing attention to a single repetitive stimulus. Therefore, it helps the client to become more aware of self, increase the client's ability to live freely, and remove negativity from the mind. Meditation techniques reduce anxiety. Meditation involves slow abdominal breathing, which lowers oxygen consumption. Meditation techniques relax the muscles, rather than increasing muscle tension. Meditation therapy is known to produce a long-term effect of reducing the systolic and diastolic pressures. •A nurse is teaching a group of nursing students about acupuncture. Which statement by a nursing student indicates effective learning? - Correct answer "Acupuncture is contraindicated in persons who have bleeding disorders." Acupuncture is contraindicated in persons who have bleeding disorders. Acupuncture therapy is used for various disease conditions, not only for chronic disease conditions. Electroacupuncture is contraindicated for pregnant women. Semipermanent needles should not be used with

clients who have valvular heart disease. It may increase the risk of infection. •A client reports sleep disturbance. Which herbal medicine does the nurse suggest to promote sleep? - Correct answer Chamomile is helpful to promote sleep. It also helps in relaxation and treatment of mild gastrointestinal disturbances and premenstrual symptoms. Aloe is used to treat skin disorders, inflammation and acute injuries, gastrointestinal ulcerations, and ulcerative colitis. Echinacea is used to treat upper respiratory tract infections. Cranberry juice is used to treat urinary tract infections. •A nurse is teaching a client about relaxation therapy. What benefits would the client obtain from relaxation? Select all that apply. - Correct answer The relaxation response decreases cognitive, physiological, and behavioral arousal. The process of relaxation elongates muscle fibers, decreases the respiratory rate, and reduces the neural impulses sent to the brain. These actions in turn cause relaxation of muscles and reduce the stress response. Increased heart rate and increased metabolic rate are changes associated with the stress response and are opposite to the "meditation response". •A postmenopausal client with high blood pressure suffers from flushing and irritability. This client understands that high blood pressure may increase the risk of having a myocardial infarction. Which herb is likely to help the client reduce blood pressure? - Correct answer Garlic lowers serum cholesterol and blood pressure, making it beneficial in the management of blood pressure. Echinacea is helpful for respiratory infections. Gingko biloba is helpful for neurodegenerative diseases. Licorice soothes and helps in healing of peptic ulcers. •A client is diagnosed with end-stage prostate cancer. The client is depressed. The client approaches the nurse to seek advice regarding nonpharmacological therapies to manage depression. What information should the nurse provide to the client about meditation? Select all that apply. - Correct answer Meditation reduces anxiety, depression, and distress associated with cancer. The client should be receptive and should focus his attention during meditation. Meditation should be done in a quiet space and in a comfortable position. It helps to improve the quality of life and not the quantity. It does not reduce the dose of chemotherapeutic agents.

•A nurse is assessing a client who is bedridden and debilitated. The nurse is advising passive relaxation therapy for the client rather than progressive relaxation therapy. What is the benefit of passive relaxation therapy over progressive relaxation therapy? - Correct answer Progressive relaxation therapy involves tightening and relaxing the muscles. It requires more energy than passive relaxation. The client already has muscle weakness, so during muscle contraction the client may feel discomfort. Passive relaxation does not require the expenditure of efforts for muscle contraction. Both types of relaxation therapy reduce depression, and involve slow, abdominal breathing exercises. Both therapies reduce tension in the body. •Which concept do many complementary and alternative therapies share? - Correct answer The emphasis of alternative and complementary therapies is that the client is viewed as a whole being, capable of decision-making and an integral part of the health care team. The client should be aware that proper Nutrition, adequate rest, relaxation, exercise, and emotional health, not herbs, are cornerstones of good health. The use of touch has many forms and is used for a multitude of purposes such as increasing circulation, decreasing edema, promoting lymphatic drainage, relieving muscle tension, and improving the functioning of certain body systems. The road to healing is an individual journey; clients are encouraged to take responsibility for their health and healing. •A nurse is teaching progressive relaxation to a client. Which instructions should the nurse give to the client while teaching this technique? Select all that apply. - Correct answer A: "Perform deep abdominal breathing", and "You should relax and tighten muscle groups in ordered succession." The technique of progressive relaxation should be practiced in a quiet and calm place. The client should perform deep abdominal breathing. The muscle groups should be relaxed and tightened in a successive order. In this technique, clients keep their eyes closed throughout. Clients should keep their arms and legs uncrossed. The client should feel localized tension in the body, focusing on one muscle at a time. •The nurse understands that providing holistic care includes treating which of the following? - Correct answer A - Disease, spirit, and family interactions; B - Desires and emotions of the client; C - Mind-body-spirit of the client and their families; D - Muscles, nerves, and spine disorders. A:

You could argue that, when you consider the totality of the client/family, all of these come into play, but AHNA/ANA Standards of Holistic Nursing speak specifically to the mind-body-spirit focus of holistic nursing. •The nurse manager of a community clinic arranges for staff in-services about various complementary therapies available in the community. What is the purpose of this training? Select all that apply. - Correct answer A -- Nurses have a long history of providing some of these therapies and need to be knowledgeable about their positive outcomes; B -- Nurses are often asked for recommendations and strategies that promote well-being and quality of life; C -- Nurses play an essential role in client education to provide information about the safe use of these healing strategies; D -- Nurses appreciate the cultural aspects of care and recognize that many of these complementary strategies are part of a client's life; E -- Nurses play an essential role in the safe use of complementary therapies; F -- Nurses learn how to provide all of the complementary modalities during their basic education. A: All of the statements are true except option F. Nurses play an essential role in the safe use of complementary therapies in our emerging health care system. They have an appreciation for many types of interventions and can understand the client's need to become more involved in their health care decisions and choices. They also understand clients' desire to take a more active role in their healing and health promotion processes. Culturally relevant care that uses a full complement of intervention strategies that are supported with evidence is a central tenet of contemporary nursing practice. •A client frequently takes the herb calamus for treatment of fever. What is the risk associated with this? - Correct answer The client is at a high risk for development of cancer. Calamus contains varying amounts of carcinogenic cis-isoasarone. It leads to the development of cancer. Hepatotoxicity, venoocclusive disease, and severe uterine contractions are not adverse effects of calamus. Chaparral is an herb used as an anticancer medication, and it is known to be hepatotoxic in some clients; Chaparral is also known to cause severe uterine contractions. Comfrey is used to accelerate wound healing in acute injuries, but comfrey is also known to cause venoocclusive disease. •Touch therapy is an energy-based therapy. Which of the following are phases of touch therapy? Select all that apply. - Correct answer The five phases of touch therapy are centering, assessing, unruffling, treating, and

evaluating (C-A-U-T-E). Touch therapy affects the energy fields that surround and penetrate the human body with the conscious intent to heal. Planning and implementing are not phases of touch therapy. Planning and implementation are parts of the nursing process. •A nurse is educating a group of individuals about acupuncture. Which statements by the individuals indicate effective teaching? Select all that apply. - Correct answer Acupuncture therapy involves altering the function of a body system by inserting thin needles along a series of lines or channels. Acupuncture therapy is helpful for the treatment of various diseases. Acupuncture therapy is effective for the treatment of sinusitis and low back pain. Acupuncture therapy regulates the vital energy in the body. Acupuncture therapy is contraindicated for the treatment of skin infections and bleeding disorders as it may worsen these conditions. •When planning client education, it is important to remember that clients with which of the following often find relief in complementary therapies? - Correct answer Evidence supports the use of many complementary therapies for chronic pain syndromes, particularly pain that is unremitting and unresponsive to conventional allopathic therapies. •A client has hypercholesterolemia. A nurse advises the client to increase the intake of vitamin C and beta-carotene. Which therapy is the nurse suggesting to the client? - Correct answer Orthomolecular medicine therapy believes in the intake of megavitamins to treat diseases. It includes an increased intake of vitamin C and beta-carotene. Probiotic therapy involves the consumption of live microorganisms that are similar to beneficial microorganisms found in the human gastrointestinal system. These microorganisms are called good bacteria. In mycotherapies, consumption of fungi-based products is recommended. A macrobiotic diet consists of a predominantly vegan diet that includes fish, but no other animal products. •A nurse is giving information about energy therapies to nursing students. Which energy therapy is known as bioelectromagnetic therapy? - Correct answer Magnet therapy is known as bioelectromagnetic therapy. In magnet therapy, magnets are applied to the body surface, which produces a measurable magnetic field. It is used to alleviate pain associated with musculoskeletal injuries. Art therapy, biofeedback, and massage therapy are not included in energy therapies. Art therapy and biofeedback are

forms of mind-body interventions. Massage therapy is a type of manipulative and body-based method. •In addition to an adequate client assessment, when the nurse uses one of the nursing-accessible complementary therapies, he or she must ensure that which of the following has occurred? - Correct answer A: The client has provided permission and consent. Nurse-accessible therapies are independent nursing interventions. As long as the Scope of Practice identified by the nurse's State Board of Nursing permits this activity, you do not need to obtain permission from the client's primary provider or their family members unless the client is underage. An adult can provide consent. Complete understanding of any procedure or intervention is impossible to ensure. •Complementary and alternative therapies are helpful to treat different disease conditions. Which therapy involves the insertion of thin needles in a specific body region? - Correct answer Acupuncture therapy involves the insertion of thin needles in specific body regions. This traditional Chinese treatment method is used to realign the flow of vital energy (qi) in the body into specific channels that form a system of pathways called meridians. Reiki therapy, acupressure, and chiropractic medicine do not involve the insertion of thin needles into a specific body region. •The nurse is caring for a client experiencing a stress response. The nurse plans care with the knowledge that systems respond to stress in what manner? - Correct answer In the beginning stress responses serve as a warning and physiological "alarm" of sorts, preparing the person to respond to harm. In this way it can be a protective mechanism. However, stress that continues unmitigated for long periods of time creates states of "exhaustion" that translate ultimately into negative physiological and psychological events. •When meditation therapy is used, nurses need to monitor clients' medications carefully because meditation may augment the effects of certain drugs such as: - Correct answer A: Antihypertensive and thyroid- regulating medications. Mind-body techniques, including meditation, create physiological responses in the cardiovascular and respiratory systems. These responses may include decreased blood pressure, reduced heart rate, and slowed respirations. They decrease the need for antihypertensive and other cardiac regulators and thyroid-regulating medications.