NUR 139 CHP 5 EXAM QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026

NUR 139 CHP 5 EXAM QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026 1. The nurse is reviewing medication errors. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after having started an IV antibiotic 24 hours earlier. d. A patient complains of severe pain still present 60 minutes after a pain medication was given. - Answers ANS: b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. The other options are not preventable. The patient's refusing to take medications and complaining of pain after a medication is given are patient behaviors, and the development of hives is a possible allergic reaction. What is Just Culture? - Answers An environment where after a systematic review of errors disciplined is applied appropriately Where do many serious medication errors occur? - Answers Many serious medication errors occur in the home. The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dos of the drug ordered? a. Digoxin .125 mg b. Digoxin .1250 mg c. Digoxin 0.125 mg d. Digoxin 0.1250 mg - Answers ANS: C Digoxin0.125 mg Digoxin 0.125 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Digoxin .125 mg and digoxin .1250 mg do not have the leading zero before the decimal point. Digoxin 0.1250 mg has a trailing zero, which also is incorrect. When given a scheduled morning medication, the patient states, ―I haven't seen that pill before. Are you sure it's correct?‖ The nurse checks the medication administration record and verifies that it is listed. Which is the nurse's best response? a. ―It's listed here on the medication sheet, so you should take it.‖ b. ―Go ahead and take it, and then I'll check with your doctor about it.‖ c. ―It wouldn't be listed here if it were not ordered for you!‖ d. ―Let me check on the order first before you take it" - Answers Ans. d. ―Let me check on the order first before you take it When giving medications, the nurse should always listen to and honor any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order and/or check with the prescriber. The other options illustrate that the nurse is not listening to the patient's concerns. Adverse drug effect - Answers Any undesirable occurrence related to administration of or failure to administer a prescribed medication Adverse drug reaction - Answers Unexpected unintended or excessive responses to medications given at therapeutic dosages (as opposed to overdose) one type of adverse drug event Allergic reaction - Answers An immunologic reaction resulting from an unusual sensitivity of a patient to certain mediation ; a type of adverse drug event and a subtype of adverse drug reactions Idiosyncratic reaction - Answers Any abnormal and unexpected response to a mediation, other than an allergic reaction, that is peculiar to an individual patient Medical errors - Answers A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm "To err is human" Medication errors - Answers Any preventable adverse drug events involving inappropriate medication used by a patient or health care professionals; they may or may not cause the patient harm Medication reconciliation - Answers A procedure to maintain an accurate and up to date list of medications for all patients between all phases of health care delivery. During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time? a. Ask a colleague what the order says. b. Contact the prescriber to clarify the order. c. Wait until the prescriber makes rounds again to clarify the order. d. Ask the patient what medications he takes at home. - Answers ANS: B contact the prescriber to clarify the order If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. Asking a colleague is not useful because the colleague did not write the order. Waiting for the prescriber to return is incorrect because it would delay implementation of the order. Asking the patient about medications is incorrect because this question will not clarify the current order written by the prescriber. When taking a telephone order for a medication, which action by the nurse is most appropriate? a. Verify the order with the charge nurse. b. Call back the prescriber to review the order. c. Repeat the order to the prescriber before hanging up the telephone. d. Ask the pharmacist to double-check the order. - Answers ANS: C- repeat the order to the prescriber before hanging up the telephone For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone. The other options are incorrect. The nurse can prevent medication errors by following which principles? (Select all that apply.) a. Assess for allergies after giving medications. b. Use two patient identifiers before giving medications. c. Do not give a medication that another nurse has drawn up in a syringe. d. Minimize the use of verbal and telephone orders. e. Use trade names instead of generic names to avoid confusion. - Answers ANS: B, C, D Measures that prevent medication errors include using two patient identifiers, giving only medications that you have drawn up or prepared, and minimizing the use of verbal and telephone orders. Assessment for allergies should be done before medications are given. Generic names should be used to avoid the many sound-alike trade names of medications. Levothyroxine is available in 88-mcg tablet form. Convert this dose to milligram strength. (do not round) - Answers ANS: 0.088 mg One mg equals 1000 mcg. To convert 88 mcg to mg, divide 88 by 1000 to equal 0.088 mg, or move the decimal point to the left three spaces. Do not forget to include the leading zero. Digoxin is available in 0.125-mg tablet form. Convert this dose to microgram strength. (do not round) - Answers ANS: 125 mcg One mg equals 1000 mcg. To convert 0.125 mg to mcg, multiply by 1000 to equal 125 mcg, or move the decimal point to the right three spaces. What are the keys to prevent medication errors? - Answers Report the errors Reporting of potential errors Non-punitive approach to error reporting or "Just Culture" QSEN initiatives QSEN - Answers Quality and safety education for nurses a project preparing future nurses with knowledge, skills, and attitudes to continuously improve the profession. The nurse keeps in mind that which measure is used to reduce the risk of medication errors? a. When questioning a drug order, keep in mind that the prescriber is correct. b. Be careful about questioning the drug order a board-certified physician has written for a patient. c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. d. If the drug route has not been specifies, use the oral route. - Answers c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. During the medication administration process, it is important that the nurse remembers which guideline? a. When in doubt about a drug, ask a colleague about it before giving the drug. b. Ask what the patient knows about the drug before giving it. c. When giving a new drug, be sure to read about it after giving it. d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns. - Answers d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns. If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept? a. The student bears no legal responsibility when giving medications. b. The major legal responsibility lies with the health care institution at which the student is placed for clinical experience. c. The major legal responsibility for drug errors lies with the faculty members. d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable. - Answers d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: "Digoxin, 250 mpg stat." Which action is appropriate? a. Give the medication immediately (stat) by mouth because the patient has no intravenous (IV) access at this time. b. Clarify the order with the prescribing physician giving the drug. c. Ask the charge nurse what route the physician meant to use. d. Start an IV line, then give the medication IV so that it will work faster, because the patient's status is NPO at this time. - Answers b. Clarify the order with the prescribing physician giving the drug. The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. digoxin .25 mg b. digoxin .250 mg c. digoxin 0.250 mg d. digoxin 0.25 mg - Answers d. digoxin 0.25 mg The nurse is administering medications. Examples of high-alert medications include: Select all that apply a. Chemotherapeutic agents b. Antibiotics c. Opiates d. Antithrombotics e. Potassium chloride for injection - Answers a. Chemotherapeutic agents d. Antithrombotics e. Potassium chloride for injection Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes. - Answers 0.25 mg The nurse is performing medication reconciliation during a patient's admission assessment. Which question by the nurse reflects medication reconciliation? a. "Do you have any medication allergies?" b. "Do you have a list of all the medications, including over-the-counter, you are currently taking?" c. "Do you need to take anything to help you to sleep at night?" d. "What pharmacies do you use when you fill your prescription?" - Answers b. "Do you have a list of all the medications, including over-the-counter, you are currently taking? Just after the nurse administers an oral antihypertensive drug, the patient asks, "Wasn't that supposed to be a half-tablet? I just took the whole tablet!" The nurse realizes that the patient was given twice the ordered amount. The order was for 25 mg, a half-tablet, and the entire 50-mg tablet was given. At this time, what would the nurse need to say to the patient? What are the nurse's propriety actions? - Answers The nurse must acknowledge the wrong dose immediately and honestly, rather than trying to ignore or cover up the error. This patient was aware of the error from the start. The nurse has an ethical and legal responsibility to acknowledge and report the error. The supervisor and the patient's prescriber must be notified, and the appropriate protocol for a medication error must be completed. In addition, monitor the patient's blood pressure closely and instruct the patient to get up slowly in case of orthostatic blood pressure changes. Patient safety is most important in this situation, and the patient needs to be told what happened. The nurse is reviewing the orders on a newly admitted patient and reads this order: "Humalog insulin, 4 U q.d.? What problems, if any, would the nurse identify in this order? - Answers The order is written as follows: Humalog insulin, 4U q.d. The nurse notes the following issues: The U needs to be written out as units because this abbreviation could be mistaken for a zero (0), a four (4), or cc. The q.d. needs to be written out as every day because the period after the q can be mistaken for an i, meaning that a medication would be given qid (four times daily) instead of once daily. No route is specified. Humalog insulin is on the high-alert medication list, and these orders must be checked carefully. Humalog insulin is also on the look-alike, sound-alike drug list and must be carefully noted because it can be confused with Humulin insulin. The nurse needs to clarify this order with the prescriber before administering the insulin. What brought medial errors to the publics attention? - Answers Institute of Medicine (IOM) in 1999 What are widely recognizable and common causes of errors? - Answers Misunderstanding of abbreviations Illegibility of prescribers handwriting Miscommunication during verbal or telephone orders Confusing drug nomenclature What is the first priority when an error occurs? - Answers To protect the patient All errors are RED flags What are two types of adverse drug reactions? - Answers Allergic reaction (predictable) Idiosyncratic reaction (unpredictable) What are high alert medications? - Answers Medications that have been identified through national literature as having the greatest frequency of misuse, coupled with the highest severity of harm when administered improperly. True or false High alert medications are not necessarily involved in more errors than other drugs, however the potential for patient harm is higher - Answers True What are the classifications for high alert medications? - Answers Adrenergic agonists Adrenergic antagonist Anesthetic agents Anti arrhythmic Antithrombotic agents IV unfractionated heparin, factor XA inhibitors Cardioplegic solutions Chemotherapeutic agents Dextrose Dialysis sol Epidural Hypoglemics oral Insulin Inotropic meds Liposomal drugs Moderate sedation agents Narcotics/opiates Neuromuscular blocking agents Parenteral nutrition prep Radiocontrast agents Sterile water for injection/inhalation/irrigation Sodium chloride for injection In a 2006 IOM study, it was estimated that some fm of medication error results in harm to how many patients? A.400,000 B. 800,000 C. 1 million D. 1.5 million - Answers D. 1.5 million What are some specific high alert drugs? - Answers Epinephrine Epoprostenol Insulin Magnesium sulfate injection Methotrexate Opium tincture Oxytocin Nitroprussside sodium injection Potassium chloride Potassium phosphate injection Promethazine Vasopressin if or intraossesous What are the common drugs involved in severe medication errors: central nervous system drugs? - Answers Anticoagulants Chemotherapeutic AHRQ (Agency for Healthcare Research and Quality) - Answers a federal agency established to improve the quality, safety, efficiency, and effectiveness of health care for Americans Joint Commission speak up campaign - Answers The goal of Speak Up is to help patients become active in their care (provides pamphlets in various different areas to bring awareness for the patient to be educated and ask question), used to decrease mistakes within the hospital "High alert" medications - Answers Identified as those that, because of their potential toxic nature, require special care when prescribing, dispensing and/or administering Potential for patient harm is high Adrenergic agonists - Answers intravenous (IV) Ex. Epinephrine, phenylalanine,norepinephrine Adrenergic antagonist - Answers intravenous (IV) Ex. Propranolol, metoprolol , labetalol Anesthetic agents - Answers general, inhaled and IV Ex. Propofol, ketamine Antiarrhythmics - Answers IV Ex. Lidocaine , amiodarone Antithrombotic agents - Answers Includes warfarin ,Low molecular weight heparins, IV unfractionated heparin , facto XAX inhibitors Ex. (Fondaparinux , apixaban, rivaroxaban) Thormbolytics Ex. (Alterplase, reteplase, tenecteplase) Glycoprotein llb/llla inhibitors Ex. (Eptifibatide) SALAD - Answers Sound alike, look alike drugs Ex: buspirone and bupropion LASA - Answers Look alike sound alike Ex: prednisone and predniosolone Who requires bar codes for all prescriptions and over the counter medications - Answers FDA What is the most common point in the process at which medication errors occur? A. Prescribing B. Dispensing C. Administering D. Monitoring - Answers A. Prescribing CPOE - Answers Computerized Provider Order Entry Emilia test handwriting and standardizes many prescribing functions What are the different contributions to errors can occur in the medication process? - Answers Procuring Prescribing Transcribing Dispensing Administering Monitoring Organization issues Edu system issues Sociologic factors Use of abbreviations Near miss - Answers Even or situation that didn't produce patient injury but only bc f chance A situation that isn't distinguishable from a preventable adverse event except for the outcome Close call - Answers An event or situation or error that took place but was identified and captured prior to reaching the patient What are some strategies to minimize errors? - Answers Awareness (" speak up) Computerized prescriber order entry (CPOE) Bar codes and scanning devices Automated dispensing machines Effective communication When should a nurse check for medication errors? - Answers Before administering it Double check info before proceeding When does patient begins where? - Answers In the educational process with nursing students and faculty members What are the types of medication errors? - Answers No error, although circumstances or events occurred that could lead to an error Medication error that causes no harm Medication error that causes harm Medication error that results in death Disruptive behavior - Answers Is a personal, verbal or physical conduct that affects or potentially may affect patient care in a negative fashion What are common nursing student errors ? - Answers Unusual dosing times MAR issues Failure to review record before admin Admission of discontinued or held meds Failure to monitor vitals/lab results Administration of oral liquids as injections Preparation of meds for multiple patients at the same time Classifications of disruptive behavior - Answers Intimidation and violence Inappropriate language or comments Sexual harassment Inappropriate responses to patient needs or staff requests What are some ways you can prevent medication errors? - Answers Do multiple system checks and balances Prescribers must write legible orders that contain correct information , or orders entered electronically Authoritative resources, such as pharmacists or current (within past 3-5 years) drug reference or literature must be consulted for clarity