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Chapter 2: Drug Administration

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Chapter 2: Drug Administration

20 problems · 0 figures

2-1 §2.RQ source ↗

The client is taking an 800 mg dose of a medication with a half-life of 4 hours. How much medication will be available in the body after 12 hours?
  1. a.
    400 mg
  2. b.
    200 mg
  3. c.
    100 mg
  4. d.
    50 mg

Answer

C. 100 mg
The amount of the drug would halve every 4 hours. In 4 hours, 400 mg of the drug would be available. In 8 hours, 200 mg would be available, and in 12 hours, 100 mg of the drug would be available

2-2 §2.RQ source ↗

Which laboratory test should the nurse check prior to administering a drug that can cause harm to the kidneys?
  1. a.
    Hemoglobin
  2. b.
    Alanine transaminase
  3. c.
    Aspartate transaminase
  4. d.
    Serum creatinine

Answer

D. Serum creatinine
The serum creatinine level is an indicator of kidney function.

2-3 §2.RQ source ↗

The nurse is preparing to administer an intramuscular injection in the deltoid muscle. At which site will the nurse inject the medication?
  1. a.
    1.5 inches below the acromion process
  2. b.
    1 inch in front of the acromion process
  3. c.
    At the level of the axilla
  4. d.
    Between the acromion process and the scapula

Answer

A. 1.5 inches below the acromion process
An intramuscular injection in the deltoid muscle is administered approximately 1.5 inches below the acromion process in the upside-down triangle formed by the acromion process and the axilla.

2-4 §2.RQ source ↗

The nurse is teaching a client about self-administering a fentanyl transdermal patch. Which statement indicates an understanding of client teaching?
  1. a.
    “I will cut the patch in half when my pain is not severe.”
  2. b.
    “I will rotate the patch application site every 7 days.”
  3. c.
    “I will remove the old patch before applying a new one.”
  4. d.
    “I will cleanse the application site with alcohol before applying.”

Answer

C. “I will remove the old patch before applying a new one.”
The old patch should be removed before applying a new one to avoid a drug overdose.

2-5 §2.RQ source ↗

Which action will the nurse take when administering a subcutaneous enoxaparin injection?
  1. a.
    Administer the injection at a 90-degree angle.
  2. b.
    Aspirate for blood return.
  3. c.
    Administer the injection in the deltoid area.
  4. d.
    Massage the site after injection.

Answer

A. Administer the injection at a 90-degree angle.
The nurse should insert the needle at a 90-degree angle when administering enoxaparin.

2-6 §2.RQ source ↗

When administering an oral medication to a client with renal insufficiency, which potential complication is of greatest concern to the nurse?
  1. a.
    Decreased drug absorption
  2. b.
    Increased risk of drug toxicity
  3. c.
    Increased risk of an allergic reaction
  4. d.
    Decreased therapeutic drug effects

Answer

B. Increased risk of drug toxicity
Drugs are excreted through the kidneys, so drug toxicity can develop in the client with renal insufficiency as drug levels rise because they are not properly eliminated from the body.

2-7 §2.RQ source ↗

When administering digoxin, a drug with a narrow therapeutic index, the nurse should assess for which effect?
  1. a.
    Reduced first-pass effect
  2. b.
    Increased tolerance
  3. c.
    Reduced dependence
  4. d.
    Increased toxicity

Answer

D. Increased toxicity
A narrow therapeutic index indicates that it has a narrow safety margin, thus requiring frequent monitoring for drug toxicity.

2-8 §2.RQ source ↗

The health care provider has changed the order for a medication from an IV dose to an oral dose of the same medication. The oral medication has a high first-pass effect through the liver. What does the nurse expect to see when checking the order for the oral medication to achieve similar concentrations?
  1. a.
    The oral medication dose will be the same as the IV dose.
  2. b.
    The oral medication dose will be lower than the IV dose.
  3. c.
    The oral medication dose will be higher than the IV dose.
  4. d.
    The oral medication dose has no relation to the IV dose.

Answer

C. The oral medication dose will be higher than the IV dose.
Because a portion of an oral dose of a medication is inactivated by the first-pass effect in the liver, a drug that has been administered IV may now require a larger oral dose to achieve a therapeutic effect.

2-9 §2.RQ source ↗

A client has been prescribed an oral medication that is supplied as a large unscored caplet. The client refuses to take the medication with the statement, “I cannot swallow such a large pill.” What is the nurse’s best action?
  1. a.
    Convince the client to go ahead and take the medication.
  2. b.
    Call the provider to request an IV form of the drug.
  3. c.
    Break the caplet in half so it is easier to swallow.
  4. d.
    Call the pharmacy and request an oral solution of the drug.

Answer

D. Call the pharmacy and request an oral solution of the drug.
The best course of action is to request the pharmacy to send up a liquid form of the medicine because that does not change the route. A caplet that is not scored should not be split by the nurse.

2-10 §2.RQ source ↗

A client is complaining of severe pain and has an order for morphine sulfate. Which route would give the client the fastest pain relief?
  1. a.
    PO
  2. b.
    IV
  3. c.
    IM
  4. d.
    Subcutaneous

Answer

B. IV
IV is the fastest route because the medication is 100% bioavailable and has immediate onset.

2-11 §2.RQ source ↗

The provider has ordered dofetilide 0.5 mg orally every 12 hours. The pharmacy supplies dofetilide 125 mcg tablets. How many tablets will the nurse administer?
  1. a.
    0.5 tablets
  2. b.
    2 tablets
  3. c.
    3 tablets
  4. d.
    4 tablets

Answer

D. 4 tablets
The nurse determines that 0.5 mg is equal to 500 mcg and sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 500 mcg ÷ 125 mcg × 1 tablet = 4   tablets .

2-12 §2.RQ source ↗

The provider has ordered meperidine 150 mg IM every 6 hours, as needed, for pain. The pharmacy supplies meperidine 100 mg/mL. How many mL should the nurse administer to the client?
  1. a.
    1 mL
  2. b.
    1.5 mL
  3. c.
    2 mL
  4. d.
    3.5 mL

Answer

B. 1.5 mL
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 150 mg ÷ 100 mg × 1 mL = 1.5 mL .

2-13 §2.RQ source ↗

The health care provider ordered heparin sodium 4000 units subcutaneously every 12 hours. The pharmacy supplies 5000 units/1 mL in a 10 mL vial. How many mL should the nurse administer to the client?
  1. a.
    0.8 mL
  2. b.
    1.2 mL
  3. c.
    8 mL
  4. d.
    2.5 mL

Answer

A. 0.8 mL
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 4000 units ÷ 5000 units × 1 mL = 0.8 mL .

2-14 §2.RQ source ↗

The health care provider ordered 10 mL of cough syrup for a client. How many teaspoons will the client take per dose?
  1. a.
    2
  2. b.
    5
  3. c.
    7.5
  4. d.
    10

Answer

A. 2
When converting metric and household units, 4.93 mL (which rounds to 5 mL) is equal to 1 teaspoon;
2 teaspoons are equivalent to 10 mL.

2-15 §2.RQ source ↗

The health care provider ordered enoxaparin 1.5 mg/kg/day. The client weighs 176 lb. How many milligrams of enoxaparin should the client receive?
  1. a.
    80 mg
  2. b.
    100 mg
  3. c.
    120 mg
  4. d.
    150 mg

Answer

C. 120 mg
First, convert the client’s weight from pounds to kilograms ( 2.2 lb = 1 kg therefore, the client weighs 80 k g ). Next, calculate the amount of drug the client should receive: 1.5 mg/kg × 80 kg = 120 mg .

2-16 §2.RQ source ↗

The health care provider ordered 6 mg of dexamethasone sodium phosphate injection. The pharmacy provided a vial labeled 120 mg/30 mL. How many mL will be administered to the client? (Round to the nearest tenth.)
  1. a.
    0.6 mL
  2. b.
    1.5 mL
  3. c.
    2.3 mL
  4. d.
    3.3 mL

Answer

B. 1.5 mL
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 6 mg ÷ 120 mg × 30 mL = 1.5 mL .

2-17 §2.RQ source ↗

The provider ordered heparin sodium 1250 units/hour IV infusion. The pharmacy supplied heparin sodium 25,000 units in 500 mL of D5W. Calculate the infusion rate in mL/hour.
  1. a.
    6 mL/hour
  2. b.
    12 mL/hour
  3. c.
    20 mL/hour
  4. d.
    25 mL/hour

Answer

D. 25 mL/hour
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 1250 units/hour ÷ 25,000 units × 500 mL = 25 mL/hour .

2-18 §2.RQ source ↗

The provider ordered fluoxetine hydrochloride 60 mg oral solution for a client who has difficulty swallowing. The pharmacy supplied fluoxetine hydrochloride oral solution 20 mg/5 mL in a 120 mL bottle. How many mL should the nurse administer?
  1. a.
    15 mL
  2. b.
    20 mL
  3. c.
    30 mL
  4. d.
    60 mL

Answer

A. 15 mL
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 60 mg ÷ 20 mg × 5 mL = 15 mL .

2-19 §2.RQ source ↗

The provider ordered moxifloxacin 400 mg IV piggyback daily. The pharmacy supplied moxifloxacin 400 mg in 250 mL normal saline. The instructions are to infuse over 60 minutes. At how many mL/hour will the infusion pump be set?
  1. a.
    100 mL/hour
  2. b.
    200 mL/hour
  3. c.
    250 mL/hour
  4. d.
    400 mL/hour

Answer

C. 250 mL/hour
The nurse sets up the following equation: D ÷ H × Q = A . D represents the desired dose (the dose ordered), H the amount on hand or available, Q the quantity or volume of the drug form (tablet, capsule, liquid), and A the amount calculated to be administered to the client. Therefore, 400 mg ÷ 400 mg × 250 mL = 250 mL to be infused over 1 hour.

2-20 §2.RQ source ↗

The provider ordered dobutamine hydrochloride 5 mcg/kg/minute IV for a 132 lb client. The pharmacy supplied 250 mg in 250 mL of D5W. How many mL/hour should be infused?
  1. a.
    12 mL/hour
  2. b.
    15 mL/hour
  3. c.
    18 mL/hour
  4. d.
    23 mL/hour

Answer

C. 18 mL/hour
First, convert the client’s weight from pounds to kilograms ( 2.2 lb = 1 kg ). Therefore, the client weighs
60 kg.
Set the equation up in dimensional analysis:
5 mcg kg/min × 60 kg × 60 min 1 hour × 1 mg 1000 mcg × 250 mL 250 mg = 4 , 500 , 000 250 , 000 = 18 mL/hour .

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.