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Fundamentals of Nursing Care 2nd Edition Burton Ludwig Test Bank

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Fundamentals of Nursing Care 2nd Edition Burton Ludwig Test Bank

ISBN-13: 978-0803639744

ISBN-10: 0803639740

 

Description

Fundamentals of Nursing Care 2nd Edition Burton Ludwig Test Bank

ISBN-13: 978-0803639744

ISBN-10: 0803639740

 

 

 

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Free Nursing Test Questions:

Chapter 37. Administering Intradermal, Subcutaneous, and Intramuscular Medications

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   The nurse is providing care for a 32-year-old with suspected bowel obstruction who is receiving intramuscular injections of narcotic pain medication. The patient states, “I hate shots. Why can’t I just take a pill?” The best response by the nurse is

A. “We want to avoid giving you medication that you have to digest.”
B. “By giving the pain medication this way, it will last longer.”
C. “Narcotic medications are destroyed by the acid in your stomach.”
D. “The drug will be absorbed more slowly this way.”

 

 

____     2.   The nurse is teaching a 64-year-old with newly diagnosed diabetes to manage diabetes and insulin provision. The best action by the nurse is to

A. Have the patient practice injecting his or her thigh with an empty syringe.
B. Encourage the patient to identify a family member who will be giving the insulin shots.
C. Obtain small insulin syringes that the patient can use to draw up the insulin.
D. Instruct the patient to attend a diabetic support group that is offered on a monthly basis.

 

 

____     3.   The student nurse is preparing to provide meperidine (Demerol) 25 mg IM for pain. The pyxis is loaded with prefilled meperidine 50 mg syringes. An intervention by the instructor would be required if the student nurse

A. Obtains a Carpuject® system to administer the medication.
B. Recaps the needle after the injection.
C. Wastes 25 mg of the meperidine prior to administration.
D. Unscrews the syringe from the holder before discarding in the sharps container.

 

 

____     4.   The nurse is preparing to provide a subcutaneous injection. The nurse’s technique would include

A. Pointing the bevel of the needle up before piercing the skin.
B. Selecting a 14 g, 11/2” needle.
C. Placing the total dose of 2.5 mL of medication in one syringe.
D. Donning sterile gloves.

 

 

____     5.   The nurse is preparing to reconstitute a medication in a multiple-dose vial. The nurse understands that the most essential step in this process is

A. Wiping the rubber stopper of the vial with alcohol before and after needle insertion.
B. Instilling the accurate amount of diluents into the vial.
C. Using a filtered needle to draw up the medication.
D. Instilling air into the vial before withdrawing medication.

 

 

____     6.   While withdrawing medication from an ampule, which of the following is considered an essential?

A. Injecting air into the ampule prior to withdrawing medication.
B. Using a filtered needle to withdraw medication.
C. Tapping the bottom of the ampule prior to breaking the neck.
D. Taking care not to invert the ampule while withdrawing medication.

 

 

____     7.   After withdrawing medication and removing the needle from the vial, the nurse notes there is an air bubble in the syringe. The nurse should

A. Return the medication to the vial and attempt to draw it again.
B. Gently shake the syringe in a downward motion.
C. Roll the syringe gently between his or her hands.
D. Tap the barrel of the syringe to float the bubble toward the needle.

 

 

____     8.   Which of the following accurately describes the phenomenon of first-pass metabolism?

A. Sublingual medications pass first through the mucosal lining of the mouth.
B. Intradermal medications are absorbed first by the skin and then by underlying tissue.
C. Oral medications are metabolized by the liver before entering the blood stream.
D. Intramuscular injections pass through the subcutaneous layer of skin into muscle.

 

 

____     9.   The nurse recognizes that a 22 g ´ 1” needle would be most appropriate for a(n)

A. Adult intradermal injection (ID).
B. Child subcutaneous injection (Subcut).
C. Adult intramuscular injection (IM).
D. Newborn intramuscular injection (IM).

 

 

____   10.   As the nurse is giving an intramuscular injection, she notes blood return into the syringe with aspiration. The best action by the nurse is to

A. Withdraw the needle and dispose of the syringe.
B. Withdraw the needle, replace the needle, and then provide the injection in a different location.
C. Push the needle deeper into the muscle and aspirate again.
D. This is a normal finding with an intramuscular injection; the nurse should proceed with the injection.

 

 

____   11.   Which of the following is considered the safest and most comfortable injection site for a patient who is requiring an intramuscular (IM) injection?

A. The ventrogluteal site
B. The dorsal gluteal site
C. The vastus lateralis site
D. The left deltoid site

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____     1.   The nursing student is studying how to provide medications via parenteral routes. Which of the following would be included? Select all that apply.

A. Intradermal tuberculin test (PPD)
B. Intravenous morphine (Morphine Sulfate)
C. Oral warfarin (Coumadin)
D. Intramuscular ketorolac (Toradol)
E. Subcutaneous regular insulin (Humulin R)

 

 

____     2.   The home care nurse is preparing to provide an intramuscular injection to a 42-year-old woman. Which of the following supplies will be needed to complete this task? Select all that apply.

A. Alcohol prep pad
B. Sterile gloves
C. Adhesive bandage
D. Syringe
E. 25 g ´ 1/2” needle
F. Needle disposal container

 

 

____     3.   The nurse is preparing to administer insulin that was drawn up in the medication room. In order to recap the needle prior to walking to the patient’s room, it would be necessary to (select all that apply):

A. Hold the syringe in the nondominant hand.
B. Place the cap on a flat surface.
C. Lay the cap with the open end extending beyond the countertop edge.
D. Push the cap onto the exposed needle using the dominant hand.
E. Maintain sterility of the syringe and needle.
F. Scoop the cap onto the tip of the syringe needle.

 

 

Completion

Complete each statement.

 

  1. Place the following steps of withdrawing medication from a vial in the appropriate order.

____________________Pierce the rubber stopper at a 90-degree angle.

____________________Invert the vial and syringe.

____________________Inject air into the vial.

____________________Pull the plunger back to the desired level to fill the syringe with air.

____________________Withdraw the appropriate amount of medication into the syringe.

____________________Wash hands.

 

 

Chapter 37. Administering Intradermal, Subcutaneous, and Intramuscular Medications

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  A

 

  Feedback
A Bypassing the gastrointestinal tract and thereby preventing gastrointestinal irritation is one benefit of parenteral therapy. Chapter Objective: Explain the significance of first-pass metabolism.
B Parenteral therapy has a more rapid onset time compared to the oral route.
C Narcotics can be taken orally.
D Parenteral therapy will actually be absorbed more quickly than an oral medication.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 880                    OBJ:   Chapter Objective: 37-2

KEY:  Content Area: Medication Administration | Integrated Process: Communication and Documentation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  C

 

  Feedback
A The patient should practice on a pillow or orange rather than subjecting herself to numerous injections that are not necessary.
B It will be important for the patient to be able to provide her own insulin.
C The smaller size that holds only 0.3 mL is best for children who need very small doses of insulin and for people with poor eyesight. The calibrations are printed in a larger font, making it easier for patients with impaired vision to see the numbers more accurately. Chapter Objective: Select appropriate needle gauge and length for the different routes of administration in the various injection sites.
D This will help provide emotional support but will not achieve the goal of patient teaching at this time.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 882                    OBJ:   Chapter Objective: 37-8

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  B

 

  Feedback
A Prefilled injection systems like Carpuject® (Abbott) and Tubex® (Wyeth-Ayerst) are designed for safe and quick loading and unloading.
B Safety: The nurse should not recap the needle. Chapter Objective: Identify appropriate safety measures related to administration of injections.
C The order is for Demerol 25 mg only, making it necessary to waste the other 25 mg of the prefilled 50-mg syringe.
D After using the cartridge, the nurse should unscrew it from its holder and drop it vertically into a disposal container.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 883                    OBJ:   Chapter Objective: 37-11

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  A

 

  Feedback
A The bevel should always face upwards when piercing the skin. Chapter Objective: Select appropriate needle gauge and length for the different routes of administration in the various injection sites. Describe proper injection technique for intradermal, subcutaneous, and intramuscular injections, including Z-track.
B A smaller gauge, from 14 g (2.1 mm) to 20 g (0.9 mm), has a larger diameter and because of this, it is required for viscous, or thick, medications.
C The maximum volume for subcutaneous injection according to most facility policies is 1 mL to 2 mL.
D Asepsis is a primary concern when handling syringes and needles, but sterile gloves are not needed.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 884

OBJ:   Chapter Objectives: 37-8| Chapter Objectives: 37-9

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  B

 

  Feedback
A It is not necessary to wipe the rubber stopper after needle insertion.
B The nurse should review the drug insert for proper diluent, volume, and instructions for reconstitution. This will ensure accurate dosing. Chapter Objective: Discuss diluents and any restrictions for use related to various age groups.
C This is not necessary with a vial; it is used for drawing medication up from an ampule.
D This is a recommended practice, but is not the highest priority.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 887                    OBJ:   Chapter Objective: 37-16

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  B

 

  Feedback
A Air is not injected into an ampule—this will cause the medication to spill.
B A filter needle has a device for filtering debris, such as glass shards from ampules or rubber cores from vials. Chapter Objective: Correctly draw up medications from a vial and from an ampule.
C To prepare the ampule for withdrawal of medication, the nurse should tap the top of the ampule to distribute the medication to the lower portion of the ampule.
D The nurse should invert or tilt the ampule to facilitate withdrawal of medication.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 888                    OBJ:   Chapter Objective: 37-15

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  D

 

  Feedback
A This is not a recommended practice.
B This is not a recommended practice.
C This is not a recommended practice to release air.
D If air is present in the syringe, the nurse should tap the barrel of the syringe near the hub to move air toward the needle. Chapter Objective: Correctly draw up medications from a vial and from an ampule.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 888                    OBJ:   Chapter Objective: 37-15

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  C

 

  Feedback
A This is not a description of first-pass metabolism.
B This is not a description of first-pass metabolism.
C The downside is that the process of metabolizing the drug decreases the amount of drug remaining in the blood after it leaves the liver to enter the systemic circulation where it can work its magic. This phenomenon is known as first-pass metabolism. Chapter Objective: Explain the significance of first-pass metabolism.
D This is not a description of first-pass metabolism.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 890                    OBJ:   Chapter Objective: 37-2

KEY:  Content Area: Medication Administration | Integrated Process: Teaching/Learning | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Comprehension

 

  1. ANS:  C

 

  Feedback
A The length of the needle for an ID injection should be one-quarter to one-half inch with a very tiny diameter needle between the 25 g and 30 g, with a length between one-half and five-eigths of an inch.
B To administer a subcutaneous injection, the nurse will need a needle between three-eighths  and seven-eigths of an inch with a diameter between 24 g and 29 g.
C For average adults, the length of the needle should be one to one-half inch (2.5 cm to 3 cm) in length, with a gauge size between 20 and 22 (1.1 mm to 0.7 mm). Chapter Objective: Select appropriate needle gauge and length for the different routes of administrationl in the various injection sites.
D A smaller gauge and shorter length needle should be used to give an IM injection to a newborn. An example might include a 25 g ´ 5/8” needle.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 896                    OBJ:   Chapter Objective: 37-8

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  A

 

  Feedback
A The nurse should aspirate to ensure that the needle is not in a vessel. If blood returns into the syringe with aspiration, the nurse should withdraw the needle, dispose of medication-filled syringe in a sharps container, and draw up another dose of medication using a new syringe and needle. Chapter Objective: Correctly draw up medications from a vial and from an ampule.
B This is not recommended.
C This is not recommended.
D This is not recommended.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 897                    OBJ:   Chapter Objective: 37-15

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  A

 

  Feedback
A The ventrogluteal site is considered best. Chapter Objective: Identify the anatomical landmarks and muscles used for intramuscular injections in adults and children.
B The dorsogluteal site is no longer considered to be a safe site due to the proximity of the sciatic nerve.
C The ventrogluteal site is considered to be safer and more comfortable for IM injections.
D The deltoid site is too small for the larger volume IM injections.

 

 

PTS:   1                    REF:   Chapter: 37 | Page: 898                    OBJ:   Chapter Objective: 37-6

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. ANS:  A, B, D, E

Feedback: The parenteral routes of medication administration include intradermal (ID), subcutaneous (Subcut), intramuscular (IM), and intravenous (IV). Chapter Objective: Identify appropriate safety measures related to administration of injections.

 

PTS:   1                    REF:   Chapter: 37 | Page: 880                    OBJ:   Chapter Objective: 37-11

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Comprehension

 

  1. ANS:  A, C, D, F

Feedback: Administration of medication per an injectable route requires various supplies and equipment, including a syringe, needle, alcohol prep pads, dry cotton ball or 2” ´ 2” (5 ´ 5 cm) gauze pad, needle disposal container, examination gloves, and adhesive bandage. Sterile gloves are not necessary. The listed needle is appropriate for subcutaneous injections; it is not long enough for an intramuscular injection. Chapter Objective: Describe proper injection technique for intradermal, subcutaneous, and intramuscular injections, including, Z-track,

 

PTS:   1                    REF:   Chapter: 37 | Page: 881                    OBJ:   Chapter Objective: 37-9

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

  1. ANS:  B, C, E, F

Feedback: When recapping a clean needle, the nurse must use the one-handed scoop technique. The nurse should lay the cap on a flat surface with the open end extending a short distance beyond the edge of the flat surface. Maintaining sterility, the nurse should scoop the cap onto the tip of the syringe needle that he or she is holding in his or her dominant hand. Chapter Objective: Identify appropriate safety measures related to administration of injections.

 

PTS:   1                    REF:   Chapter: 37 | Page: 885                    OBJ:   Chapter Objective: 37-11

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

COMPLETION

 

  1. ANS:

3, 4, 5, 2, 6, 1

Feedback: The nurse should wash his or her hands before handling medication and equipment. The nurse should wipe the rubber stopper of the vial with an alcohol wipe and pull the plunger back, filling the syringe reservoir with air equal to the amount of solution to be drawn up. The nurse should pierce the rubber stopper of the medication vial at a 90-degree angle. The needle tip must be kept above the fluid level while slowly injecting the air from the syringe into the air space above the medication in the vial. The nurse should invert both the vial and the syringe and carefully draw up the appropriate volume of medication. Chapter Objective: Correctly draw up medications from a vial and from an ampule.

 

PTS:   1                    REF:   Chapter: 37 | Page: 887                    OBJ:   Chapter Objective: 37-15

KEY:  Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

 

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