NUR 324 Exam #1 without CPL content Fundamentals
Questions With Complete Solutions
1: Right Drug
• Compare the EMAR (electronic medication administration
record) to med order in the chart as per policy
• Compare EMAR to medication label three times
•When removing from storage unit
•Before taking to patient’s room
•Before giving the medication
• Do NOT give meds from an unmarked container, or from a
package with illegible labeling
2: Right Dose
• Ascertain the available concentration of the medication
•Ex: Lasix 40 mg; have 20 mg tabs; give 2
•How many tabs are given if 10 mg ordered? 1/2
• Ask a peer or coworker to confirm your dosage calculation
• VERY important with vasoactive meds, heparin, and insulin
•ALWAYS have another RN double check insulin
• Visually examine scanned meds
3: Right Route
•Consult the healthcare provider who wrote order if…
,•Route was not specified
•Med is not available via ordered route
•Unable to access specified route (i.e. no IV, unconscious)
•What would you do?
•Your client is NPO and all meds are administered crushed via
gastrostomy tube. The healthcare provider had ordered a
medication that is enteric coated (sits in stomach over a period
of time, not supposed to crush those).
•Pharmacy, then call provider if pharmacy cannot change the
route of the order. Pharmacy cannot change the medicine, but
they can change how we give the medication.
4: Right Assessment
•Labs
•Vital Signs
Your patient's K+ = 2.3. Would you administer a K wasting
diuretic? No, call provider.
Your patient's AP = 52. Would you administer the
antiarrhythmic Digoxin? No, call provider.
Your patient's BP = 100/60 and it is time to administer their
antihypertensive medication. What would you do? Hold, and
call provider.
,The HCP just ordered Vancomycin, a nephrotoxic drug. Which
labs should you check? BUN and creatinine
5: Right Time
•Know military time! Ex. 1400; 2 1900; 7
•Actual time not always ordered, go by facility’s “schedule”
•i.e., “daily” could be 0900 or 1000
•i.e., “TID” could be 0600, 1400, and 2200 or 0700, 1300, 2100
•EMAR will have actual times assigned by pharmacy
•Clinical judgment may be required
•Some meds have “priority” Ex. first-dose antibiotics or insulin
•Given within 30 min to 1 hour before/after time drug is
scheduled
Knowledge check: A nurse is preparing to administer a 0900
medication to a client. Which of the following are acceptable
times for this medication? (Select all that apply)
A. 0905
B. 0825
C. 0840
D. 0935
ABCD
Clinical Judgement and Right Time
, •Med ordered "daily", EMAR defaults to 1000, pt prefers to take
with breakfast. What would you do? Call pharmacy and let them
know so they can reschedule it for the nurse.
•Med ordered daily HS, EMAR defaults to 2200, pt likes to go
to bed at 2100. What would you do? Give it because it is within
the hour.
•Insulin is ordered for 0700 but patient is NPO. What would you
do? Pt is already not eating, call provider. Consider BS, how
much insulin do they really need?
•Meds are ordered for 0900 but pt is nauseous. What would you
do? Start meds early, do not give the PO medication, try to get it
changed to another route/ get Zofran.
Special Note About Insulin
•Regular insulin is fast acting (within 30 minutes)
•Must have food available
•Long-acting insulin (i.e., NPH) acts over 12-24 hours
•Both can be ordered to maintain BG during hospitalization
•"NPH 20 units SQ every am"
•"Regular Insulin SQ at ac and hs per Sliding Scale below"
•BG<70 follow hypoglycemic protocol and give 0 units
•BG 71-120 give 0 units
•BG 121-180 give 2 units
•BG 181-250 give 4 units
•BG 251-325 give 6 units
•BG 326-400 give 8 units
Questions With Complete Solutions
1: Right Drug
• Compare the EMAR (electronic medication administration
record) to med order in the chart as per policy
• Compare EMAR to medication label three times
•When removing from storage unit
•Before taking to patient’s room
•Before giving the medication
• Do NOT give meds from an unmarked container, or from a
package with illegible labeling
2: Right Dose
• Ascertain the available concentration of the medication
•Ex: Lasix 40 mg; have 20 mg tabs; give 2
•How many tabs are given if 10 mg ordered? 1/2
• Ask a peer or coworker to confirm your dosage calculation
• VERY important with vasoactive meds, heparin, and insulin
•ALWAYS have another RN double check insulin
• Visually examine scanned meds
3: Right Route
•Consult the healthcare provider who wrote order if…
,•Route was not specified
•Med is not available via ordered route
•Unable to access specified route (i.e. no IV, unconscious)
•What would you do?
•Your client is NPO and all meds are administered crushed via
gastrostomy tube. The healthcare provider had ordered a
medication that is enteric coated (sits in stomach over a period
of time, not supposed to crush those).
•Pharmacy, then call provider if pharmacy cannot change the
route of the order. Pharmacy cannot change the medicine, but
they can change how we give the medication.
4: Right Assessment
•Labs
•Vital Signs
Your patient's K+ = 2.3. Would you administer a K wasting
diuretic? No, call provider.
Your patient's AP = 52. Would you administer the
antiarrhythmic Digoxin? No, call provider.
Your patient's BP = 100/60 and it is time to administer their
antihypertensive medication. What would you do? Hold, and
call provider.
,The HCP just ordered Vancomycin, a nephrotoxic drug. Which
labs should you check? BUN and creatinine
5: Right Time
•Know military time! Ex. 1400; 2 1900; 7
•Actual time not always ordered, go by facility’s “schedule”
•i.e., “daily” could be 0900 or 1000
•i.e., “TID” could be 0600, 1400, and 2200 or 0700, 1300, 2100
•EMAR will have actual times assigned by pharmacy
•Clinical judgment may be required
•Some meds have “priority” Ex. first-dose antibiotics or insulin
•Given within 30 min to 1 hour before/after time drug is
scheduled
Knowledge check: A nurse is preparing to administer a 0900
medication to a client. Which of the following are acceptable
times for this medication? (Select all that apply)
A. 0905
B. 0825
C. 0840
D. 0935
ABCD
Clinical Judgement and Right Time
, •Med ordered "daily", EMAR defaults to 1000, pt prefers to take
with breakfast. What would you do? Call pharmacy and let them
know so they can reschedule it for the nurse.
•Med ordered daily HS, EMAR defaults to 2200, pt likes to go
to bed at 2100. What would you do? Give it because it is within
the hour.
•Insulin is ordered for 0700 but patient is NPO. What would you
do? Pt is already not eating, call provider. Consider BS, how
much insulin do they really need?
•Meds are ordered for 0900 but pt is nauseous. What would you
do? Start meds early, do not give the PO medication, try to get it
changed to another route/ get Zofran.
Special Note About Insulin
•Regular insulin is fast acting (within 30 minutes)
•Must have food available
•Long-acting insulin (i.e., NPH) acts over 12-24 hours
•Both can be ordered to maintain BG during hospitalization
•"NPH 20 units SQ every am"
•"Regular Insulin SQ at ac and hs per Sliding Scale below"
•BG<70 follow hypoglycemic protocol and give 0 units
•BG 71-120 give 0 units
•BG 121-180 give 2 units
•BG 181-250 give 4 units
•BG 251-325 give 6 units
•BG 326-400 give 8 units
