Nokea
You are caring for a patient who is taking valproic acid (Depakote) to prevent seizure activity. The therapeutic blood level of this medication is 50 to 100 g/mL. The patient's laboratory results show a level of 108 g/mL. The medication is ordered to be administered orally at 9:00 a.m. You are caring for this patient, and it is 8:00 a.m. What will you do?
- A. Give the medication as ordered; the blood level is only slightly elevated and the health-care provider will see it when making rounds later.
- B. Hold the medication until the health-care provider sees the patient next; then you can ask whether to continue giving the medication.
- C. Give the medication as ordered; administer one aspirin with it to bind some of the drug.
- D. Hold the medication; notify the health-care provider of the blood level and obtain orders regarding the administration of the medication.
Correct Answer: D
Rationale: A supratherapeutic level of valproic acid risks toxicity. Holding the medication and notifying the provider ensures patient safety.
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A patient with pneumonia is allergic to cephalosporin antibiotics. He tells you that he breaks out in a rash and itches if he takes it. The health-care provider has prescribed cefazolin (Ancef) for him because it is one of the few antibiotics that will kill the bacteria cultured from his sputum. What will you do?
- A. Hold the medication and notify the health-care provider.
- B. Give the medication and administer oral diphenhydramine (Benadryl) without an order because it is an OTC medication.
- C. Ask the supervising nurse to give the medication because the patient may have an allergic reaction.
- D. Give the medication and watch the patient closely for any signs of anaphylaxis.
Correct Answer: A
Rationale: Due to the patient's known allergy, administering cefazolin risks a severe reaction. Holding the medication and notifying the provider is the safest action.
A 46-year-old female patient developed swelling of the tongue and throat after taking a new antibiotic. She went to the ER because she was having difficulty breathing. Which drug effect has occurred?
- A. A desired effect
- B. A side effect
- C. An adverse effect
- D. A severe adverse effect
Correct Answer: D
Rationale: Swelling of the tongue and throat with difficulty breathing indicates a severe adverse effect, likely anaphylaxis, which is life-threatening.
Identify the three times to check the medication, dose, route, and patient to ensure that you are administering the medication safely.
- A. When removing the medication from the storage area
- B. When preparing the medication
- C. When administering the medication to the patient
- D. When documenting the administration
- E. When reviewing the patient's chart
- F. When consulting the pharmacist
- G. When checking the medication order
Correct Answer: A,B,C
Rationale: Checking the medication, dose, route, and patient at removal, preparation, and administration ensures safety by catching errors at multiple points.
Schedule II drugs
- A. Have a high potential for abuse.
- B. Must be counted and accounted for.
- C. Have no medicinal purpose.
- D. Include morphine, codeine, oxycodone, and meperidine.
- E. Must be kept under double lock.
Correct Answer: A,B,D,E
Rationale: Schedule II drugs have a high abuse potential, include medications like morphine and oxycodone, require strict accounting, and are often stored under double lock due to their controlled status.
Which of the following is an example of an over-the-counter medication?
- A. Hydrocodone (Lortab)
- B. Amoxicillin (Amoxil)
- C. Acetaminophen (Tylenol)
- D. Cefazolin (Ancef)
Correct Answer: C
Rationale: Acetaminophen (Tylenol) is available without a prescription, making it an over-the-counter medication, unlike the others, which require prescriptions.