# 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.
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.
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.
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.