Mod 6

The nurse administers a sublingual tablet and
instructs the patient to avoid swallowing the

tablet but rather to allow it to dissolve. The
patient asks why. The nurse’s best response
is:
INCORRECT
 "It is a safer method of taking the medication because it

dissolves rapidly under your tongue and bypasses the liver so
the drug won’t become toxic."
Sublingual medications are absorbed through blood vessels of
the undersurface of the tongue. The effect of sublingual
medications is quicker than that of oral medications. The
sublingual route is more dangerous than the oral route because
the medication is absorbed more rapidly. If swallowed, the drug
is destroyed by gastric juices or so rapidly detoxified by the liver
that therapeutic blood levels are never obtained.
 "It will cause gastric irritation and may upset your stomach if it
is swallowed."
CORRECT
 "It is designed to be absorbed through the vessels of the

undersurface of the tongue, and if it is swallowed, the medication
will be destroyed by the gastric juices."
 "It will work quicker this way than waiting until it is digested."
Question 2 of 5
The nurse is administering medication to a
patient when the patient accidentally drops the
tablet on the floor. What should the nurse do?
INCORRECT
 Allow the patient to take the tablet if it appears clean.

To prevent transmission of microorganisms, the nurse should
discard the medication and repeat the preparation. A
replacement may need to be obtained from the pharmacy with
unit-dose systems.
CORRECT
 Discard the tablet and get another one.

unit-dose systems.
 Ask the patient whether he would like for the nurse to obtain a
new tablet or take the one that fell on the floor.
unit-dose systems.
 Quickly remove the tablet from the floor and wipe off the
tablet with a gloved hand. Administer the tablet because
medications are costly.
unit-dose systems.
Question 3 of 5
A patient is on a fluid restriction. When giving
oral medications, which of the following
considerations are needed?
INCORRECT
 Allow the patient to take medications with water. The amount

consumed does not affect fluid restriction.
The patient can take medications with water or juice; however,
the amount should be documented and counted as part of the
fluid restriction. Liquid thickener is used for patients who have
difficulty swallowing and are at risk for aspiration. Some
medications cannot be crushed.
CORRECT
 Allow the patient to take medications with a small amount of

water and document the amount on the patient's record.
 Use a commercial liquid thickener.
 Avoid giving the patient any liquid. Crush the medications and
offer them in applesauce.
Question 4 of 5
A patient states that she has difficulty
swallowing pills and asks the nurse to crush
them. Which of the following medications
would it be okay to crush
INCORRECT
 Entex LA (guaifenesin).
a. Incorrect. Medications that are enteric coated should
not be crushed because they are designed to dissolve in
the small intestine to avoid gastrointestinal (GI) upset.
b. Incorrect. Medications listed as CD (controlled dose),
SR (slow-release), or LA (long-acting) should not be
crushed because they are designed to be time-released.
*c. Correct! A scored tablet can be split, and there is
nothing to indicate this is a time-release medication.
d. Incorrect. Medications listed as CD (controlled dose),
 Cardizem CD (diltiazem).
 Enteric coated aspirin.

CORRECT
 A scored tablet of Lanoxin (digoxin).

Question 5 of 5
Which of the following are contraindications to
oral medication administration? (Select all that
apply.)
CORRECT
 Postoperative after gastrointestinal surgery.

Alterations in gastrointestinal function can interfere with drug
absorption, distribution, and excretion. Giving oral medication to
patients with impaired swallowing increases their risk of
aspiration. The following are contraindications to oral medication
administration: inability to swallow, nausea/vomiting, bowel
inflammation, reduced peristalsis, gastrointestinal surgery, and
gastric suction.
 Confusion.
gastric suction.
CORRECT
 Continuous gastric suction.

gastric suction.
 Fluid restriction.
gastric suction.
CORRECT
 Nausea/vomiting.
gastric suction.
CORRECT
 Inability to swallow.
gastric suction.
The correct order is:
1. Assist patient to sitting position. Apply gloves. Aspirate gastric contents and check pH.
2. Determine gastric residual volume and return aspirated contents to stomach.
3. Pinch tubing and remove syringe. Draw up 30 mL of water and flush tube.
4. Clamp tubing and remove syringe. Remove plunger of syringe and reinsert into end of
feeding tube.
5. Unclamp; administer first dose of medicine. Flush with 30 to 60 mL of water. Clamp end
of feeding tube.
6. Keep head of bed elevated 1 hour. Discard soiled supplies. Perform hand hygiene.
A family caregiver is observing a nurse

preparing to administer medications through
her father’s feeding tube. The caregiver asks,
“What is the purpose of the pH paper?” Which
of the following is the best response?
CORRECT
 “It is used to verify correct placement of the feeding tube in

the stomach.”
The purpose of pH paper is to determine correct placement of
the feeding tube. Gastric contents are aspirated and placed on a
pH test strip. A gastric pH less than 5 is good indicator the tube
is in the stomach.
 “I will test gastric aspirate before and after medication
administration to note any change."
is in the stomach.
 “It is used to determine if the pH is low enough for
medications to dissolve.”
is in the stomach.
 “The pH paper will help us know whether your father is getting
enough water.”
is in the stomach.
Question 3 of 4
A nurse is preparing medications to be
administered through a patient’s feeding tube.
The patient is to receive nifedipine XL. Which
of the following would be a correct action by
the nurse?
CORRECT
 Hold the drug and notify the health care provider.

The nurse should not crush a long-acting medication, nor should
a patient who has a feeding tube be asked to attempt to swallow
the tablet. The nurse may ask the pharmacist if an alternative
form of the medication is available but should not administer the
drug until an order is received that is conducive to administration
via the feeding tube. Many long-acting drugs are multiple-layer
tablets that allow release of the medication as each layer is
dissolved. The nurse should not change the frequency of
medication administration.
 Administer the medication every 12 hours rather than every 6.
 Crush the tablet and dissolve in 30 mL of tepid water.
 Encourage the patient to swallow the medication whole.
Question 2 of 4
The nurse is giving report to another nurse
regarding a patient who receives medications
through a feeding tube. The nurse states that
in order to prevent clogging of the tube,
preventive measures need to be continued.
The nurse knows this would include which of
the following?
INCORRECT
 Administering a pancrelipase tablet in the enteral feeding tube

every 24 hours.
Prevent the tube from becoming blocked by flushing it with at
least 15 to 30 mL of tepid water before and after administering
each dose of medication, 30 to 60 mL after last dose of
medication, before and after checking gastric residual volumes,
and every 4 to 12 hours around the clock (refer to agency
policies). A large-bore feeding tube should be used for flushing
the tube, as a small-bore syringe can create too much pressure
and rupture the feeding tube.
 Using a small-bore syringe to flush the feeding tube as
ordered around the clock.
CORRECT
 Administering 30 to 60 mL of tepid water following the last

dose of medication.
 Administering 60 mL of soda, such as Coke, through the tube
every 4 hours.
Question 4 of 4
A nurse is preparing to administer medication
through a feeding tube. Which of the following
supplies should the nurse include, besides the
medication, to perform this procedure? (Select
all that apply.)
CORRECT
 Water.
Equipment needed for administering medication through a
feeding tube includes the following: Medication administration
record (MAR) (electronic or printed), appropriate medication
syringe or 60-mL Asepto syringe for large-bore tubes only,
enteral-only connector (ENFit) designed to fit the specific enteral
tube (TJC, 2014), gastric pH test strip (scale of 1 to 11),
graduated container, medication to be administered, pill crusher
if medication in tablet form, water or sterile water for
immunocompromised patients, tongue blade or straw to stir
dissolved medication, clean gloves, stethoscope, and pulse
oximeter (for evaluation).
CORRECT
 Gastric test strip.

CORRECT
 Appropriately sized medication syringe.

 Sterile gloves.
CORRECT
 MAR.
CORRECT
 Graduated container and straw.

Question 1 of 5
Which patient is at lowest risk for a systemic
effect from a topical agent? A patient who:
INCORRECT
 had radiation and is receiving topical ointment for the skin

burn.
*a. Systemic effects from medications applied directly to
the skin can occur if the skin is thin, if drug concentration
is high, or if contact with the skin is prolonged. A patient
who is receiving a drug topically in low concentration is
the patient at least risk for developing a systemic effect.
b. Incorrect. Patients who have received radiation
therapy often have a thinning of their tissues. Systemic
effects from medications applied directly to the skin can
occur if the skin is thin, if drug concentration is high, or if
contact with the skin is prolonged.
c. Incorrect. Prolonged contact with the skin increases
the risk for systemic effect of a topical agent.
d. Incorrect. If drug concentrations are high, as can
occur when taking a medication both topically and orally,
an increased likelihood of systemic effects can result.
 is taking a medication to reduce itching both topically and

orally.
CORRECT
 is very mobile and receiving a drug in low concentration.

 has ointment reapplied frequently for a skin graft.

Question 4 of 5
The hospice nurse comes to the home of a
patient with terminal cancer. She discovers
several fentanyl (Duragesic) pain patches on
the patient’s body. What should the nurse do
first?
INCORRECT
 Assess the patient’s level of pain and skin for any irritation.
a. The nurse cannot assume the patient is getting
insufficient pain relief. It may be a lack of knowledge to
remove the old transdermal patch before applying a new
one. Further assessment needs to be made, but for
patient safety, the nurse should first remove the excess
pain patches.
*b. Correct! The nurse needs to determine if there is a
transdermal patch applied for the current period and
remove all others. The nurse needs to instruct the patient
to remove the old pain patch, fold with insides together,
and discard appropriately before applying a new
transdermal patch because prolonged or high doses can
cause toxic systemic effects such as respiratory
depression. The patient should be instructed to keep
transdermal fentanyl patches out of the reach of children.
The nurse may assess the patient further, including a
pain assessment, and notify the health care provider.
c. It is unnecessary to remove excess transdermal pain
patches in a tapered fashion.
d. The nurse should first remove the excess transdermal
pain patches and provide teaching.
CORRECT
 Remove the patches except for the most recent and provide
patient teaching.
pain patches.
 Notify the health care provider that the patient is not getting
sufficient pain relief.
pain patches.
 Have the patient remove one pain patch every hour until they
are all removed.
pain patches.
Question 5 of 5
You don clean gloves and measure the
antianginal ointment onto dosage paper
according to health care provider's orders.
You rub the ointment off the paper directly
onto the female patient's skin of the anterior
chest and cover the area of ointment with
plastic wrap and tape. You discard the gloves
and perform hand hygiene. Which steps of the
procedure were incorrect and/or
missing? (Select all that apply.)
INCORRECT
 You applied the ointment to the anterior chest wall.

Failing to remove the previous dosage paper could lead to
overdose. You should leave the dosage paper in place on the
patient's skin and avoid rubbing the ointment. Rubbing the
ointment may increase absorption. Covering the ointment with
plastic wrap increases rate of absorption. The ointment and
dosage paper are left in place, and the date, time, and your
initials are written on the dosage paper to promote accuracy. The
paper is covered with plastic wrap and secured with tape to
prevent staining of the clothes and/or accidental removal of the
medication. You should wear clean gloves to prevent absorption
of antianginal ointment on your skin. It is appropriate to apply the
ointment to the anterior chest wall as long as it is a nonhairy
surface (as it would be with a female patient).
CORRECT
 You rubbed the ointment off the paper and covered with
pastic wrap.
CORRECT
 You did not write the date, time, and initials on the paper
wrapper.
CORRECT
 You did not remove the previous dosage paper.

 You wore nonsterile gloves.
Question 2 of 5
A patient has been hospitalized for several
days after a motor vehicle accident. The
patient has several fractured bones and has
cuts and scratches across the chest area.
Where should you apply the fentanyl
(Duragesic) patch to treat the patient's pain?
CORRECT
 On the upper back in an area that is free of hair.

a. You should never apply the patch to skin that is oily,
burned, cut, or irritated in any way because this will
affect absorption.
b. Application on hairy surfaces or scar tissue may
interfere with absorption.
c. The forearm is an inappropriate site for a transdermal
patch. The upper arm has adequate circulation and
subcutaneous tissue for absorption.
*d. Appropriate sites include the chest area, back, upper
arm, or legs where there is adequate circulation and
 On the patient’s nondominant forearm.

affect absorption.
 Over a previous scar to cause less pain.

affect absorption.
 Over one of the cuts and/or scratches so it is absorbed more
quickly.
affect absorption.
Question 3 of 5
What should the nurse do to maximize the
effectiveness of medicated lotions and/or
ointment?
CORRECT
 First wash area with nondrying soap and water.

a. The skin should be cleansed gently and thoroughly
with soap and water before medications are applied.
When medication is applied over skin encrustation, the
dead tissues harbor microorganisms and block contact of
the medication with the tissues to be treated.
*b. The skin should be cleansed gently and thoroughly
c. The dose paper may be applied over the upper arm,
not the lower arm.
d. The ointment should not be massaged as this can
affect the rate of absorption.
 Apply the dose paper over a nonhairy area of the lower arm.
not the lower arm.
 Apply a thick, even layer.

not the lower arm.
 Massage the ointment into the skin.

not the lower arm.
Question 1 of 5
The nurse is going to administer eye drops
into the eye of a confused elderly patient.
What safety precautions should the nurse
take?
INCORRECT
 Wait and administer the eye drops in the corner of the

patient’s eye when the patient is asleep and then awaken the
patient to open the eye.
The resting hand helps prevent accidental contact of the
eyedropper with the eye and reduces the risk of injury because
the hand will move in unison with the patient's head. A health
care provider's order would be required to apply restraints, and
restraints may only make the patient more resistant to instillation
of the eye drops. The therapeutic effect of the drug is obtained
only when the drops enter the conjunctival sac. Also, gentle
pressure needs to be applied to the lacrimal duct to prevent
absorption into the systemic circulation, and this might wake the
patient. Furthermore, best practice is to perform procedures on a
patient when the patient is awake so as to maintain the trust
between the nurse and patient. An eye patch may be applied
after instillation to reduce the chance of infection.
 Apply restraints while instilling the eye drops.
 Apply an eye patch and instruct the patient to avoid rubbing
the eye and causing further irritation.
CORRECT
 Rest hand holding the eyedropper on the patient's forehead

and hold the eyedropper 1 to 2 cm (0.4 to 0.8 inches) above the
conjunctival sac.
Question 2 of 5
The patient asks why the nurse applies the
drops in the conjunctival sac. What is the
nurse’s best response to the patient’s
question?
INCORRECT
 “There is less chance of the medication getting into the

lacrimal duct.”
Medication is applied in the conjunctival sac rather than onto the
cornea because the cornea is richly supplied with sensitive nerve
fibers (creating more discomfort). The conjunctival sac is much
less sensitive and thus a more appropriate site for medication
administration. Applying drops to the conjunctival sac provides
even distribution of medication across the eye. The conjuctival
sac normally holds one or two drops. Applying gentle pressure
over the lacrimal duct reduces the chance of systemic effects of
the medication. Having the patient look upward toward the
ceiling helps reduce the blink response.
CORRECT
 “Applying drops to the conjunctival sac provides even

distribution of medication across the eye.”
 “The cornea is less sensitive and therefore has a decreased
ability to absorb medication.”
 “The conjunctival sac can normally hold three drops of
medication.”
Question 3 of 5
The nurse is going to administer eye ointment
in the newborn’s eyes. Which action by the
nurse is the correct procedure?
INCORRECT
 The nurse applies the ointment using a sterile cotton-tipped

applicator to the lower conjuntival sac.
*a. Correct! The nurse should apply the ribbon of
ointment to the conjunctival sac from inner to outer
canthus and then allow the infant to close its eyes so the
ointment is distributed across the eye. It is unnecessary
to apply pressure to the nasolacrimal duct as it is with
eye drops.
b. Using a cotton-tipped applicator could injure the eye.
The nurse should apply the ribbon of ointment to the
conjunctival sac from inner to outer canthus and then
allow the infant to close its eyes so the ointment is
distributed across the eye.
c. The nurse should apply the ribbon of ointment to the
allow the infant to close the eyes so the ointment is
distributed across the eye. It is unnecessary to apply
pressure to the nasolacrimal duct as it is with eye drops.
d. The nurse needs to be sure the ointment is placed in
the conjunctival sac in order to be effective rather than
just on the external eye structures.
CORRECT
 The nurse applies a ribbon of ointment along the lower eyelid

on the conjunctiva from inner to outer canthus.
eye drops.
 The nurse applies gentle pressure to the nasolacrimal duct

after administering the ointment.
eye drops.
 The nurse applies a ribbon of ointment to the lower eyelid and

then stimulates the baby to open its eyes.
eye drops.
Question 4 of 5
The nurse is instilling eye drops into a
patient's eye. The nurse checks the patient's
identification, performs hand hygiene, and
applies gloves. The nurse follows the six
rights of medication administration. The nurse
asks the patient to tilt the head back and look
up. The nurse holds the patient's eye open by
pushing up on the skin of the upper orbit, and
with the free hand instills the drops of
medication onto the patient's cornea at a
distance of 2.5 to 5 cm (1 to 2 inches). The
nurse applies gentle pressure to the lacrimal
duct and asks the patient to close the eyes
gently. The nurse discards the gloves,
performs hand hygiene, and documents the
procedure. What actions by the nurse, if any,
were incorrect? (Select all that apply.)
CORRECT
 Applying the eye drops onto the patient's cornea.

The nurse performed the procedure incorrectly. The nurse
should have used the nondominant hand to hold a clean tissue
on the patient's cheekbone, just below the lower eyelid, and then
gently pressed downward with either the thumb or forefinger
against the bony orbit to expose the conjunctival sac. The nurse
should have also rested the dominant hand on the patient's
forehead and held the filled medication eyedropper
approximately 1 to 2 cm (0.4 to 0.8 inches) above the
conjunctival sac. The nurse should have instilled the drops into
the conjunctival sac instead of onto the cornea.
 The nurse performed the procedure correctly.
CORRECT
 Using the free hand to instill the drops at a distance of 2.5 to

5 cm (1 to 2 inches).
 Asking the patient to close the eyes gently.
 Applying pressure to the lacrimal duct.
CORRECT
 The method used to hold the patient’s eye open.

Question 5 of 5
The nurse is administering eye medication.
Which nursing action requires further
intervention by the nurse? (Select all that
apply.)
INCORRECT
 The nurse cleans the eye from inner to outer canthus with
warm water and a clean wash cloth.
The therapeutic effect of the medication is obtained only when
drops enter the conjunctival sac. Applying gentle pressure to the
nasolacrimal duct for 30 to 60 seconds prevents absorption into
the systemic circulation. The nurse rests her dominant hand on
the patient's forehead and uses that hand to administer the eye
drops to prevent accidental contact of the eyedropper with the
eye structures and reduce the risk of injury to the eye or transfer
of infection to the dropper. The ointment should be applied along
the inner edge of the lower eyelid from the inner to outer
canthus.
 The nurse rests the dominant hand on the patient’s forehead
and uses this hand to administer the eye drops.
canthus.
 The nurse applies gentle pressure to the patient’s
nasolacrimal duct for 30 to 60 seconds.
canthus.
CORRECT
 The patient blinks and the eye drop falls on the outer lid after
instillation.
canthus.
CORRECT
 The nurse applies the ointment along the inner edge of the
lower eyelid from the outer to inner canthus.
canthus.
Question 1 of 5
The nurse is going to instill eardrops in a 7-
year-old child. In which direction should the
nurse pull the pinna of the ear?
CORRECT
 Up and back.
The ear canal can be straightened by pulling the auricle upward
and outward (adult or child older than 3 years) or down and back
(child age 3 or younger). Straightening of the ear canal provides
direct access to deeper ear structures.
 Up and forward.
 Down and back.
 Down and forward.
Question 3 of 5
What is the purpose of massaging the tragus
of the ear after eardrop instillation?
CORRECT
 It helps move the medication inward.

Gentle massage or pressure to the tragus of the ear moves the
medication inward. Inserting a portion of a cotton ball into the
outermost part of the canal prevents escape of the medication
when the patient sits or stands.
 It keeps the ear from tickling.
 It prevents escape of the medication when the patient sits or
stands.
 It reduces the perception of pain.
Question 4 of 5
At what temperature should the solution be
when eardrops are instilled?
CORRECT
 Body temperature.
The ear drops should be warmed to body temperature by holding
the bottle in the hands and/or placing it in warm water. Ear
structures are very sensitive to temperature extremes. When
drops are instilled directly from a refrigerator, the patient may
experience vertigo (severe dizziness) and/or nausea.
Administration of eardrops that are too cold may cause vertigo or
nausea.
 Very warm (105° F [40.6° C]).
nausea.
 Refrigerated.
nausea.
 Any temperature (the ear tolerates temperature variances
well).
nausea.
Question 2 of 5
The mother of a 10-year-old child calls the
doctor's office stating that she just
administered eardrops to her child and the
child is crying, stating that the ear hurts worse
than it did before the eardrops were applied.
What should the nurse tell the mother?
INCORRECT
 "The eardrum is very sensitive; I'm sure the pain will go away
once the drops have been absorbed."
Increased ear pain is an unexpected outcome. The health care
provider should be notified.
 "You may give your child some Tylenol for the pain. The
eardrops were probably too cold."
 "This is an expected response after the instillation of
eardrops. Place some cotton in the ear for comfort."
CORRECT
 "I will notify the health care provider. It is possible the

eardrum may have ruptured."
Question 5 of 5
What is the primary danger associated with
occluding the ear canal with the ear dropper
during the administration of eardrops?
INCORRECT
 It will impair the patient’s ability to hear.

*a. Correct! The medicine dropper should be held
approximately ½ inch above the ear canal so that it does
not occlude the canal. Do not occlude the ear canal with
a medicine dropper because this can cause pressure
within the canal during instillation and subsequent injury
to the eardrum.
b. A sterile dropper and sterile solution should be used in
case the tympanic membrane is ruptured. However, the
primary reason to avoid occluding the ear canal is to
prevent the administration of eardrops with too much
pressure, which could cause injury to the eardrum.
c. The patient may experience decreased hearing during
the instillation of eardrops. However, the primary reason
to avoid occluding the ear canal is to prevent the
administration of eardrops with too much pressure, which
could cause injury to the eardrum.
d. The primary reason to avoid occluding the ear canal is
to prevent the administration of eardrops with too much
 It will break the sterility of the medicine dropper.

to the eardrum.
CORRECT
 It can create too much pressure within the canal with

subsequent injury to the eardrum.
to the eardrum.
 The nurse will not be able to accurately determine the number

of drops that are being administered.
to the eardrum.
Question 1 of 4
What additional instruction should you include
for the patient who is receiving steroids via an
MDI? The patient:
INCORRECT
 should use the steroid before a bronchodilator, if ordered.

The patient should be instructed to rinse the mouth after the use
of steroid medications. Removing medication residue from the
oral cavity area reduces the risk of an oral yeast infection (oral
candidiasis). Bronchodilators (if ordered) should be administered
before steroids to open the airway. A spacer device may or may
not be used. The patient should administer the inhalant as
prescribed.
 should avoid scheduled inhalation if the respiratory rate is
less than 20.
prescribed.
 should always use a spacer device.
prescribed.
CORRECT
 should rinse the mouth after use of the MDI.

prescribed.
Question 2 of 4
When should the patient depress the canister
when using an MDI?
INCORRECT
 The patient should inhale, then depress the canister, and hold
the breath for 10 seconds.
Depressing the canister and slow inhalation should be done
simultaneously for maximum effectiveness.
 The patient should hold the breath to maximize lung
expansion, exhale, depress the canister, and then inhale.
 The patient should exhale, depress the canister, and then
inhale.
CORRECT
 The patient should depress the canister simultaneously with

slow inhalation.
Question 3 of 4
A patient is demonstrating the use of an MDI
(without a spacer device). The patient removes
the mouthpiece cover and shakes the inhaler.
The patient takes a deep breath and exhales,
places the mouthpiece of the inhaler in the
mouth, and depresses the canister while
inhaling. The patient holds the breath for
approximately 10 seconds and exhales with
canister in mouth. The patient shakes the
canister again and repeats the procedure in
approximately 10 seconds. The patient
replaces the mouthpiece cover when finished
administering puffs. What steps did the patient
eliminate or require further teaching? (Select
all that apply.)
INCORRECT
 Held the breath for 10 seconds.

Positioning the mouthpiece 1 to 2 cm (0.4 to 0.8 inches) from the
mouth is considered the best way to deliver the medication
without a spacer. After administration, the patient should exhale
slowly through pursed lips. Pursed-lip breathing keeps small
airways open during exhalation. The patient should wait at least
20 to 30 seconds between puffs to allow time for the inhalation to
open airways and reduce inflammation so that subsequent puffs
penetrate deeper airways. The patient should clean the inhaler in
warm water after each use and then replace the mouthpiece
cover. Accumulation of spray around the mouthpiece can
interfere with proper distribution during use. The patient was
correct in shaking the inhaler, depressing the canister while
inhaling, and holding the breath for 10 seconds after inhalation.
CORRECT
 Repeated the procedure in 10 seconds.

 Shook the inhaler.
 Depressed the canister during inhalation.
CORRECT
 Replaced the mouthpiece cover when finished administering

puffs.
CORRECT
 Used the wrong method of exhalation after using the MDI.

Question 4 of 4
You are planning to teach a patient about
using an MDI without a spacer device. What
are some points you should include in the
teaching plan? (Select all that apply.)
CORRECT
 Instruct the patient how to time inhalation with the depression

of the medication canister.
You should explain and demonstrate how the canister fits into
the inhaler. The patient must be familiar with how to assemble
and use the equipment. You should warn the patient about
overuse of the inhaler, including drug side effects. The patient
needs to know the dangers of excessive inhalations. If the drug
is given in recommended doses, the side effects are minimal.
The patient needs to know how to time inhalation with
depression of the medication canister, especially if the inhaler is
used without a spacer. The patient should be instructed to shake
the inhaler well for 2 to 5 seconds to ensure mixing of the
medication in the canister. The patient should be instructed to
wait 2 to 5 minutes between puffs. This allows time for the first
inhalation to open the airways and reduce inflammation so the
second and/or third inhalations may penetrate deeper airways.
The patient should be instructed to have the lips open when
inhaling and have pursed lips when exhaling. Pursed-lip
breathing keeps small airways open during exhalation. You
should teach the patient to clean the inhaler in warm water after
each use to avoid accumulation of spray that can interfere with
proper distribution during use.
 Instruct the patient to wait 1 minute between puffs.
CORRECT
 Warn the patient about overuse of the inhaler, including drug

side effects.
 Instruct the patient to clean the canister daily in warm water.
CORRECT
 Show the patient how the canister fits into the inhaler.
 Instruct the patient to inhale through pursed lips.
CORRECT
 Instruct the patient to shake the canister before
administration.
Question 1 of 5
What position should the patient assume for
insertion of a rectal suppository?
INCORRECT
 Right side-lying with head flat.

The patient should be assisted to a left side-lying Sims' position
with the upper leg flexed upward. This position exposes the anus
and helps the patient to relax the external anal sphincter. The left
side lessens the likelihood of the suppository and/or feces being
expelled. The dorsal recumbent position is correct for inserting a
vaginal suppository.
CORRECT
 Left Sims' position.

 Dorsal recumbent.
 Left side-lying with head flat.
Question 2 of 5
What can the nurse do to help the patient relax
the anal sphincter before administering a
rectal suppository?
INCORRECT
 Instruct the patient to perform the Valsalva maneuver.

Taking slow, deep breaths through the mouth helps the patient to
relax the anal sphincter.
 Have the patient alternately contract and relax the abdominal
muscles.
 Instruct the patient to perform pursed-lip breathing.
CORRECT
 Ask the patient to take slow, deep breaths through the mouth.
Question 3 of 5
The nurse is going to insert a rectal
suppository. The nurse provides privacy,
performs hand hygiene, dons gloves, places
the patient in the Sims' position, drapes the
patient appropriately, and removes the
suppository from its wrapper. The nurse tells
the patient to take a few slow, deep breaths,
and the nurse inserts the blunt end into the
patient's rectum until it is unable to be seen.
The nurse removes the gloves, performs hand
hygiene, and assists the patient onto the back
with the head elevated to the level of comfort.
What steps, if any, are missing and/or did the
nurse perform incorrectly? (Select all that
apply.)
INCORRECT
 The patient was placed in the Sims' position.
should have lubricated the suppository with water-soluble
lubricant to reduce friction as the suppository entered the rectal
canal. The nurse should have inserted the suppository with the
rounded end first for patient comfort. The nurse should have
inserted the suppository past the internal sphincter. The nurse
should have asked the patient to remain on the side for 5 to 10
minutes to provide sufficient time for the effects of the
suppository to reach maximum effectiveness and to prevent
expulsion of the suppository.
 The nurse performed the procedure correctly.
CORRECT
 The suppository was inserted without additional lubricant.

CORRECT
 The blunt end of the suppository was inserted into the
patient's rectum.
CORRECT
 The suppository was inserted into the patient's rectum until it

was unable to be visualized.
CORRECT
 The patient was assisted onto the back with the head
elevated.
Question 4 of 5
How far should the nurse insert a rectal
suppository in an adult? (Select all that apply.)
INCORRECT
 Just past the external anal sphincter.

A rectal suppository should be inserted past the internal
sphincter, or approximately 10 cm (4 inches) in an adult. A
vaginal suppository is inserted approximately 7.5 to 10 cm (3 to 4
inches). A rectal thermometer is inserted approximately 3.75 to 5
cm (1½ to 2 inches).
CORRECT
 Approximately 10 cm (4 inches).
 Approximately 7.5 cm (3 inches).
 Approximately 3.75 cm to 5 cm (1½ to 2 inches).
CORRECT
 Past the internal anal sphincter.
Question 5 of 5
The nurse is instructing the patient on how to
insert a vaginal suppository. Which statement
if made by the patient indicates further
instruction is needed? (Select all that apply.)
CORRECT
 “I should warm the suppository to body temperature by

putting it under warm running water while it is still in the
wrapper.”
The vaginal suppository should not be warmed to body
temperature because this would only melt the suppository and
make it more difficult to insert. The vaginal suppository should be
inserted along the posterior wall of the vagina approximately 3 to
4 inches or 7.5 to 10 cm (the approximate length of the index
finger). The patient should remain lying on back for at least 10
minutes after instillation to prevent loss through the vaginal
orifice and allow time for the suppository to melt. The patient
may have a small amount of discharge the color of the
medication and may therefore wish to wear a perineal pad.
 “I may have a small amount of discharge that is the color of
the medication from my vagina.”
CORRECT
 “I should insert the rounded end of the suppository along the

side wall of the vagina approximately 1 inch or 2.5 cm
(approximately to the first knuckle of the index finger).”
 “I can wear a perineal pad after administration.”
 “I should remain lying down on my back for at least 10
minutes after instillation.”

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The nurse administers a sublingual tablet and

instructs the patient to avoid swallowing the

 "It is a safer method of taking the medication because it

 "It is designed to be absorbed through the vessels of the

 Allow the patient to take the tablet if it appears clean.

 Discard the tablet and get another one.

 Allow the patient to take medications with water. The amount

 Allow the patient to take medications with a small amount of

 Enteric coated aspirin.

 A scored tablet of Lanoxin (digoxin).

 Postoperative after gastrointestinal surgery.

 Continuous gastric suction.

A family caregiver is observing a nurse

 “It is used to verify correct placement of the feeding tube in

 Hold the drug and notify the health care provider.

 Administering a pancrelipase tablet in the enteral feeding tube

 Administering 30 to 60 mL of tepid water following the last

 Gastric test strip.

 Appropriately sized medication syringe.

 Graduated container and straw.

 had radiation and is receiving topical ointment for the skin

 is taking a medication to reduce itching both topically and

 is very mobile and receiving a drug in low concentration.

 has ointment reapplied frequently for a skin graft.

 You applied the ointment to the anterior chest wall.

 You did not remove the previous dosage paper.

 On the upper back in an area that is free of hair.

 On the patient’s nondominant forearm.

 Over a previous scar to cause less pain.

 First wash area with nondrying soap and water.

 Apply a thick, even layer.

 Massage the ointment into the skin.

 Wait and administer the eye drops in the corner of the

 Rest hand holding the eyedropper on the patient's forehead

 “There is less chance of the medication getting into the

 “Applying drops to the conjunctival sac provides even

 The nurse applies the ointment using a sterile cotton-tipped

 The nurse applies a ribbon of ointment along the lower eyelid

 The nurse applies gentle pressure to the nasolacrimal duct

 The nurse applies a ribbon of ointment to the lower eyelid and

 Applying the eye drops onto the patient's cornea.

 Using the free hand to instill the drops at a distance of 2.5 to

 The method used to hold the patient’s eye open.

 It helps move the medication inward.

 "I will notify the health care provider. It is possible the

 It will impair the patient’s ability to hear.

 It will break the sterility of the medicine dropper.

 It can create too much pressure within the canal with

 The nurse will not be able to accurately determine the number

 should use the steroid before a bronchodilator, if ordered.

 should rinse the mouth after use of the MDI.

 The patient should depress the canister simultaneously with

 Held the breath for 10 seconds.

 Repeated the procedure in 10 seconds.

 Replaced the mouthpiece cover when finished administering

 Used the wrong method of exhalation after using the MDI.

 Instruct the patient how to time inhalation with the depression

 Warn the patient about overuse of the inhaler, including drug

 Right side-lying with head flat.

 Left Sims' position.

 Instruct the patient to perform the Valsalva maneuver.

 The suppository was inserted without additional lubricant.

 The suppository was inserted into the patient's rectum until it