ATI Dosage Calculation and Safe Medication Administration 3.0 - Safe Dosage

A nurse manager is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse manager take first?

A. Complete an incident report.
B. Notify the provider about the medication error.
C. Assess the client for adverse effects.
D. Report the error to the risk manager.
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A nurse manager is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse manager take first?

A. Complete an incident report.
B. Notify the provider about the medication error.
C. Assess the client for adverse effects.
D. Report the error to the risk manager.
C. Assess the client for adverse effects.

Rationale:
A. Complete an incident report.
The nurse who discovers an error should complete an incident report as part of the facility's risk management program; however, this is not the first action the nurse should take.
B. The nurse should notify the provider of the client's status change in case diagnostic testing or an antidote is necessary; however, this is not the first action the nurse should take.
C. When using the nursing process, the first step the nurse should take is to assess the client. By checking the client for adverse effects, the nurse can provide prompt treatment to minimize harm to the client.
D. The nurse should report the error to the risk manager to promote quality improvement in the facility; however, this is not the first action the nurse should take.
A charge nurse is reviewing the types of prescriptions with a newly licensed nurse. Which of the following prescriptions should the nurse include as an example of a standing prescription?

A. Oxycodone 5 mg by mouth every 4 hr as needed for pain
B. Furosemide 20 mg IV stat
C. Acetaminophen 650 mg by mouth every 6 hr for temperature greater than 38.4° C (101.2° F)
D. Diazepam 10 mg IV 30 min prior to procedure
C. Acetaminophen 650 mg by mouth every 6 hr for temperature greater than 38.4° C (101.2° F)

Rationale:
A. Prescriptions which are administered on an as needed, or PRN, basis are dependent upon set parameters, such as pain, heart rate, or blood pressure.
B. Stat prescriptions are one-time orders that should be implemented in emergency situations and administered immediately.
C. A standing prescription is protocol-based and contains directions for administration based upon specific situations, such as the development of a fever.
D. A single, or one-time, prescription is implemented once. Often, the medication is prescribed to be administered at a specific time, such as prior to, during, or following a procedure.
A nurse is preparing to administer a time critical medication to a client at 0800. Which of the following times are appropriate for the nurse to administer the medication? (Select all that apply.)

A. 0700
B. 0745
C. 0830
D. 0845
E. 0900
B. 0745
C. 0830

Rationale:
A. Time-critical medications should be administered within 30 min before or after the scheduled time in order to maintain consistent medication plasma levels. 0700 is too early to administer a time-critical medication scheduled for 0800.
B. The nurse should follow facility policy when selecting the time to administer medication to the client. Typically, facility policy permits the nurse to administer a time-critical medication 30 min before or after the scheduled time for administration. 0745 is within 30 min of the 0800 administration time.
C. 0830 is within 30 min of the 0800 administration time. Administering time-critical medications, such as antibiotics, in a timely manner helps to maintain therapeutic levels of the medication in the client's blood.
D. Time-critical medications should be administered within 30 min before or after the scheduled time in order to maintain consistent medication plasma levels. 0845 is too late to administer the medication.
E. Time-critical medications should be administered within 30 min before or after the scheduled time in order to maintain consistent medication plasma levels. 0900 is too late to administer the medication.
A charge nurse is teaching a newly licensed nurse about medication reconciliation. Which of the following information should the charge nurse include in the teaching?

A. Perform medication reconciliation daily during a client's hospitalization.
B. Only newly prescribed medications need to be reviewed during a medication reconciliation.
C. Vitamins, supplements, and over-the-counter (OTC) medications should be included in a medication reconciliation.
D. The goal of medication reconciliation is to minimize the financial impact of prescription medications to the client.
C. Vitamins, supplements, and over-the-counter (OTC) medications should be included in a medication reconciliation.

Rationale:
A. Medication reconciliation is performed when a client is admitted and discharged or transferred to a different facility or level of care.
B. All medications that the client is currently prescribed need to be included in a medication reconciliation.
C. The nurse needs to include a list of all medications that the client takes, both prescribed and OTC. Medication reconciliation can identify potential interactions between medications and help avoid possible adverse effects.
D. Medication reconciliation is performed to decrease the risk of medication errors due to duplicate medications and unintended interactions between prescribed medications.
A nurse is preparing to administer insulin subcutaneously to a client. The nurse should document the administration of the medication immediately after which of the following actions?

A. Taking the insulin from the automated dispensing machine
B. Injecting the insulin
C. Checking the client's blood glucose level
D. Checking the correct dosage of the insulin
B. Injecting the insulin

Rationale:
A. The nurse should take the insulin from the automated dispensing machine to prepare it for administration, but this is not the correct time to document its administration.
B. The nurse should document interventions, such as medication administration, immediately after they occur. The nurse should not delay documentation because this could lead to errors, such as omission of the documentation or administration of a second dose of medication to the client by another nurse. The nurse should never document an action prior to implementation.
C. The nurse should check the client's blood glucose prior to administering the insulin, and possibly after peak onset of the medication, but this is not the correct time to document the administration of the medication.
D. The nurse should check the correct dosage of the insulin carefully before administering it, but this is not the correct time to document its administration.
A nurse is caring for a client who states that his provider told him he is at risk for anaphylaxis after the administration of amoxicillin and that he does not understand what this means. Which of the following is an appropriate response by the nurse?

A. "Anaphylaxis is a predictable and often unavoidable secondary effect that can occur at a usual therapeutic dose."
B. "Anaphylaxis will cause you to experience withdrawal symptoms when you discontinue taking the medication."
C. "Anaphylaxis is an unusual response that can occur due to an inherited predisposition."
D. "Anaphylaxis is a severe hypersensitivity or allergic reaction that is life-threatening."
D. "Anaphylaxis is a severe hypersensitivity or allergic reaction that is life-threatening."

Rationale:
A. A side effect or adverse effect is a predictable and often unavoidable secondary effect, such as the sedation that occurs when taking an opioid.
B. Physical dependence will cause withdrawal symptoms when a client stops taking a medication, such as sweating after stopping long-term use of an opioid.
C. An idiosyncratic effect is a response that occurs when a client has an unusual or uncommon response to a medication as a result of heredity.
D. Anaphylaxis is a severe allergic reaction that can result in severe bronchoconstriction with laryngeal edema and a precipitous drop in blood pressure.
A nurse is reviewing a client's prescriptions. The nurse should contact the provider to clarify which of the following prescriptions?

A. Phenytoin 100 mg PO every 8 hr
B. Morphine 2.5 mg IV bolus PRN for incisional pain
C. Regular insulin 7 units subcutaneous 30 min before breakfast and dinner
D. Lisinopril 20 mg PO every 12 hr. Hold for systolic BP less than 110 mm Hg
B. Morphine 2.5 mg IV bolus PRN for incisional pain

Rationale:
A. This prescription is correct as written.
B. This prescription requires clarification because it is missing the frequency of medication administration.
C. This prescription is correct as written and includes circumstance for use. Because lisinopril can cause hypotension, it is appropriate for the provider to include parameters for withholding the medication for a specific blood pressure finding.
A nurse on a medical unit is assisting with the orientation of a newly licensed nurse. The nurse should remind the newly licensed nurse to have a second nurse review the dosage of which of the following medications prior to administration?

A. Heparin
B. Acetaminophen
C. Acetylcysteine
D. Hydroxychloroquine
A. Heparin

Rationale:
A. The nurse should have a second nurse check the dosage of high-alert medications, such as heparin, because serious client harm can occur if the dosage is excessive. High-alert medication classes include central nervous system drugs, chemotherapeutic agents, and anticoagulants.
B. The nurse does not have to ask a second nurse to check the dosage of acetaminophen because it is not considered a high-alert medication.
C. The nurse does not have to ask a second nurse to check the dosage of acetylcysteine because it is not considered a high-alert medication.
D. The nurse does not have to ask a second nurse to check the dosage of hydroxychloroquine because it is not considered a high-alert medication.
A nurse is transcribing a provider's prescription for a client. The prescription reads morphine 2 mg IV bolus at 1400. The nurse should recognize this as which of the following types of medication orders?

A. Routine order
B. Stat order
C. PRN order
D. Single order
D. Single order

Rationale:
A. A routine order is in effect until the provider changes it, discontinues it, or the client is discharged. This ensures that the client receives the medication or treatment on a continual basis.
B. A stat order stipulates to administer the medication immediately and only one time. The prescription must include the word stat to classify as this type of order.
C. A PRN order stipulates at what dosage, what frequency, and under what conditions the nurse should administer the medication. The nurse uses clinical judgment to determine the client's need for the medication.
D. A single (one-time) order stipulates to administer the medication one time either at a specific time the provider indicates or as soon as possible.
A nurse discovers a medication where the client received twice the prescribed amount of medication. Which of the following actions should the nurse take first?

A. Notify the provider.
B. Complete an incident report.
C. Assess the client.
D. Report the error to the nurse manager.
C. Assess the client

Rationale:
A. While the nurse should notify the provider so that any additional prescriptions for medications or treatments can be ordered, this is not the first action the nurse should take.
B. While the nurse should complete an incident report so that processes involved in the medication delivery system can be reviewed and changed if needed in order to avoid similar medication errors in the future, this is not the first action the nurse should take.
C. When using the nursing process framework, the first action the nurse should take after discovering a medication error is to assess the client's status. This ensures that any adverse effects of the medication error are identified and that relevant interventions are implemented.
D. While the nurse should report the error to the nurse manager to make them aware of the situation and alert them of any complications related to the medication error, this is not the first action the nurse should take.
A nurse is caring for a client who received lisinopril 30 minutes ago and is now reporting dizziness and a headache. Which of the following actions should the nurse take first? A. Obtain the client's vital signs. B. Notify the provider. C. Document the client's response in the medical record. D. Tell the client to change positions slowly.A. Obtain the client's vital signs. Rationale: A. The first action the nurse should take when using the nursing process is to assess the client; therefore, the first action the nurse should take is to obtain the client's vital signs. B. It is important for the nurse to notify the provider of the client's response, but this is not the first action the nurse should take. C. It is important for the nurse to document the client's response in the medical record to ensure continuity of care, but this is not the first action the nurse should take. D. It is important for the nurse to tell the client to change positions slowly to prevent injury, but this is not the first action the nurse should take.A nurse is preparing to administer digoxin 225 mcg for a pediatric client who has a heart rate above 90/minute. Which of the following actions should the nurse take to ensure administration of the right dose? (Select all that apply.) A. Validate that the dosage is within the safe range. B. Confirm the medication amount is appropriate for the child. C. Verify that the medication is not expired. D. Check the client's heart rate prior to administration. E. Document the administration in the medication administration record.A. Validate that the dosage is within the safe range. B. Confirm the medication amount is appropriate for the child. Rationale: A. The nurse should validate that the dosage is within the safe range by using the child's current weight and a medication reference text that indicates appropriate dosage parameters. Closely adhering to the rights of medication administration, which include the right medication, right dose, right time, right route, right client, and right documentation, helps to reduce medication errors. B. The nurse should confirm the medication amount is appropriate when ensuring administration of the right dose to the child. Closely adhering to the rights of medication administration, which include the right medication, right dose, right time, right route, right client, and right documentation, helps to reduce medication errors. C. The nurse should verify that the medication is not expired. However, this is not related to ensuring the administration of the right dose. D. The nurse should check the child's heart rate prior to administering the medication as part of the assessment step of the nursing process. E. The nurse should document the administration of the medication as a part of right documentation. However, this is not related to ensuring the administration of the right dose.A nurse is caring for a client who reports severe back pain at 1400. The client's prescriptions include oxycodone extended-release 20 mg PO every 12 hours (last dose received at 0600) and oxycodone immediate-release 5 mg PO every 4 hours PRN (last dose received at 2300 the day before). Which of the following actions should the nurse take? A. Contact the provider to request an order for a different pain medication. B. Administer oxycodone immediate-release 5 mg PO at 1600. C. Administer oxycodone immediate-release 5 mg PO now. D. Contact the provider to request an increase in the oxycodone extended-release dose.C. Administer oxycodone immediate-release 5 mg PO now. Rationale: A. The client has a prescribed medication the nurse can safely administer; therefore, the nurse should not contact the provider at this time. B. The client is reporting severe pain, so it is not appropriate for the nurse to wait to administer pain medication. C. It has been 15 hr since the previous dose of oxycodone immediate-release, and the medication is prescribed every 4 hr as needed, so the nurse should prepare to administer a dose now to treat the client's pain. D. The nurse does not have enough information to prove that the dose needs to be increased based on this single incidence; therefore, the nurse should not contact the provider at this time. Clients receiving long-term oxycodone therapy require periodic dosage adjustments.A nurse is reviewing a client's prescriptions. The nurse should contact the provider to clarify which of the following prescriptions? A. Ampicillin 100 mg/kg/day by mouth in 4 equally divided doses B. Phenytoin 300 mg by mouth every 12 hours C. Metronidazole 500 mg IV bolus every 6 hr D. Acetaminophen 325 mg every 6 hr PRN for headacheD. Acetaminophen 325 mg every 6 hr PRN for headache Rationale: A. This prescription is correct as written. B. This prescription is correct as written. C. This prescription is correct as written. D. This prescription contains name of medication, dosage, frequency, and circumstance for administration, but not the route.A nurse is preparing to administer a medication to a client who has a prescription for docusate sodium 50 mg capsule PO twice daily. The client refuses to take the medication because of nausea. Which of the following actions should the nurse take? A. Administer a docusate sodium capsule rectally. B. Withhold the medication. C. Administer 100 mg docusate sodium with the next scheduled administration. D. Encourage the client to take the medication as the provider prescribed.B. Withhold the medication. Rationale: A. It is not within the nurse's scope of practice to change the route of the medication. Docusate sodium is available as an enema for rectal administration, but the nurse should not administer the oral formulation rectally. B. The nurse should withhold the medication due to the client's nausea and notify the provider. If nausea persists, the nurse should contact the provider to prescribe an antiemetic. C. It is not within the nurse's scope of practice to change the dose of the medication. Administering 100 mg of docusate sodium at the next scheduled administration does not follow the rights of medication administration, specifically the right time and right dose. D. The client has the right to refuse the medication. Giving anything PO might worsen the client's discomfort. The nurse should collect data to determine the cause of the nausea and document the client's refusal in the medical record.A nurse is administering medications to four clients. The nurse should identify which of the following nursing actions as a part of the evaluation phase of the nursing process? A. Collecting information about a client's pain level following administration of a narcotic B. Taking the blood pressure of a client before administering an antihypertensive medication C. Lowering the level of a client's bed before administering a benzodiazepine medication D. Instructing a client to rinse their mouth following administration of an inhalation corticosteroidA. Collecting information about a client's pain level following administration of a narcotic Rationale: A. The nurse should identify that collecting information from a client regarding a medication's therapeutic response is part of the evaluation phase of the nursing process. The nurse should include in the evaluation phase the client's therapeutic response, adverse effects, and client adherence to the medication therapy. B. The nurse should identify that taking a client's blood pressure prior to administering an antihypertensive medication is part of the assessment phase of the nursing process. C. The nurse should identify that lowering the level of a client's bed before administering a benzodiazepine medication is part of the planning phase of the nursing process. This action reduces the risk for client injury due to an adverse effect of the medication. D. The nurse should identify that instructing a client to rinse their mouth following inhalation of a corticosteroid is part of the implementation phase of the nursing process. This action reduces the client's risk for adverse effects of the medication.A nurse is transcribing medication prescriptions for a group of clients. Which of the following is the appropriate way for the nurse to record medications that require the use of a decimal point? A. .4 mL B. 0.6 mL C. 8.0 mL D. 125.0 mLB. 0.6 mL Rationale: A. Writing ".4" could mistakenly be interpreted as "four," leading to an excessive dosage and client harm. B. The nurse should place a leading zero to the left of the decimal point when the dose is less than 1 and should not use a trailing zero at the end of the number. This ensures the number is read as "six tenths" of a milliliter. C. Writing "8.0" could be mistakenly interpreted as "eighty," leading to an excessive dosage and client harm. D. Writing "125.0" could be mistakenly interpreted as "one thousand two hundred-fifty," leading to an excessive dosage and client harm.A nurse is teaching a newly licensed nurse about crushing medications. The nurse should explain that which of the following medications can be crushed? A. Extended-release oxycodone B. Sublingual nitroglycerin C. Enteric-coated aspirin D. Sucralfate tabletsD. Sucralfate tablets Rationale: A. The nurse should explain that crushing certain medications, such as extended-release medications, can result in a sudden release of the medication, instead of a gradual release of the medication. This action might result in client injury. B. The nurse should explain that crushing certain medications, such as sublingual medications, can result in an altered release of the medication, which might alter the efficacy. This action might result in client injury. C. The nurse should explain that crushing certain medications, such as enteric-coated medications, can result in a sudden release of the medication, instead of a gradual release of the medication. This action might result in client injury. D. The nurse should explain that certain medications, such as those that are scored, can be safely crushed and mixed with food or water for a client who has difficulty swallowing. The nurse should check with the pharmacist before crushing a medication to make certain it can safely be crushed.A nurse is caring for a client who is to receive topiramate XR 100 mg PO daily. The client tells the nurse that the capsule is too hard to swallow. Which of the following actions should the nurse take? A. Crush the contents of the capsule to administer in a small amount of pudding. B. Request extended-release sprinkles from the pharmacy. C. Ask the charge nurse to clarify the prescription with the provider. D. Withhold the medication until the time for the next dose.B. Request extended-release sprinkles from the pharmacy. Rationale: A. Topiramate XR capsules cannot be crushed or chewed because a larger dose of the medication would be absorbed all at once, increasing the risk for medication toxicity. B. The nurse can administer topiramate XR in sprinkle form, if available. This is not changing the route of the medication. The sprinkle capsules can be opened and mixed with food for ease of swallowing while still remaining extended release. C. There is no reason to clarify the prescription with the provider because the prescription is complete. D. If the nurse withholds the medication until the next dose is due, the client will not receive the appropriate dosage.A nurse is preparing to administer a medication to a newly admitted client. The nurse should identify which of the following actions as a part of the assessment phase of the nursing process? A. Asking the client about a history of medication allergies B. Instructing the client about the medication's adverse effects C. Determining whether the medication should be administered with or without meals D. Monitoring the client's response to the medicationA. Asking the client about a history of medication allergies Rationale: A. The nurse should identify that data collection is part of the assessment phase of the nursing process. The nurse should collect data regarding the client's prior adverse reactions to medications, laboratory data, use of other medications, and pertinent vital signs as part of the assessment phase to ensure safe medication administration. B. The nurse should identify that instructing the client about the medication's adverse effects is part of the implementation phase of the nursing process. C. The nurse should identify that determining whether the medication should be administered with or without meals is part of the planning phase of the nursing process. D. The nurse should identify that collecting information from a client regarding the client's response to a medication is part of the evaluation phase of the nursing process.A nurse is preparing to administer a high-alert pain medication to a client. Which of the following actions should the nurse perform during the planning stage of medication administration? A. Assess the effectiveness of the pain medication. B. Verify the dosage calculation with another nurse. C. Teach the client about the action of the medication. D. Ask the client to state their name and birthdate.B. Verify the dosage calculation with another nurse. Rationale: A. The nurse should assess the effectiveness of the pain medication during the evaluation stage of medication administration. B. To ensure client safety and prevent harm, the nurse should always have another nurse verify dosage calculation prior to administering a high-alert medication. This occurs during the planning stage of medication administration. C. Education about the action of the medication should occur during the implementation stage when the nurse dispenses the medication to the client. D. Verifying a client's identity should take place during the implementation stage of medication administration.A nurse is providing teaching regarding medication administration to a group of newly licensed nurses. Which of the following is a legal responsibility of a nurse? A. Prescribing the correct dosage B. Modifying the medication regimen C. Reporting medication errors D. Delegating administration to assistive personnelC. Reporting medication errors Rationale: A. Prescribing the correct dosage is outside of a nurse's scope of practice; however, a nurse should make sure that a prescribed dose is within safe guidelines. B. The provider is legally responsible for modifying the medication regimen. C. A nurse is legally responsible for reporting medication errors according to facility policy. D. Medication administration is not within the range of function for an assistive personnel.A nurse is preparing to administer an oral medication. Which of the following actions should the nurse take? (Select all that apply.) A. Provide client education about the medication. B. Check the expiration date of the medication. C. Verify the dosage of the medication. D. Call the client by name to confirm their identity. E. Ask the client if they have any allergies.A. Provide client education about the medication. B. Check the expiration date of the medication. C. Verify the dosage of the medication. E. Ask the client if they have any allergies. Rationale: A. The nurse should provide education for the client regarding the name and purpose of each medication when administering them to the client. B. The nurse should review the package information prior to administering the medication, including the expiration date. C. The nurse should review the package information prior to administering the medication, including the medication name and dosage. D. The identity of the client should be verified with at least two distinct identifiers. Potential identifiers include client's name, a facility-assigned identification number, telephone number, birthdate, or another person-specific identifier. E. The nurse should ask the client about any allergies that they have to decrease the risk of an adverse reaction.A nurse working in a medical-surgical is preparing to administer medications to a client. Which of the following actions can the nurse take to identify the client? (Select all that apply.) A. Compare the name on the client's wristband with the name in the medication administration record (MAR). B. Ask the client to state his date of birth. C. Check the room number in the medication administration record (MAR) with the room number of the client. D. Ask the client to state his name. E. Use the barcode scan to identify the client.A. Compare the name on the client's wristband with the name in the medication administration record (MAR). B. Ask the client to state his date of birth. D. Ask the client to state his name. E. Use the barcode scan to identify the client. Rationale: A. Verifying the data on the client's wrist band is an acceptable method of identification. B. The client's date of birth is an acceptable identifier. C. The client's room number is not an acceptable identifier. The client could have moved to a different room since the MAR was printed or share the room with another client. D. The client's full name is an acceptable identifier. E. Scanning the client's bar code is an acceptable method of identification.A nurse is assessing a client following administration of an antibiotic. The nurse should identify that which of the following findings is a manifestation of an anaphylactic reaction to the medication? A. Swollen lips B. Hypertension C. Low heart rate D. ConstipationA. Swollen lips Rationale: A. The nurse should identify that swollen lips is a manifestation of an anaphylactic reaction. Other manifestations include stridor, dyspnea, wheezing, urticaria, and pruritus. The nurse should notify the rapid response team, elevate the client's head off the bed, apply high-flow oxygen, and prepare to administer epinephrine. B. The nurse should identify that hypotension, rather than hypertension, is a manifestation of an anaphylactic reaction. C. The nurse should identify that tachycardia, rather than bradycardia, is a manifestation of an anaphylactic reaction. D. The nurse should identify that nausea and vomiting are manifestations of an anaphylactic reaction.