5. Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in using medication dispensing systems?

1. "Does the patient need her pain medication?"
2. "Let me know if she complains of any nausea."
3. “Ask her to describe her pain and show you where it is."
4. "Remember to log off of the system when you are finished."

6. The patient refuses the scheduled dose of an antibiotic, saying that the medication makes him feel nauseated. What it the nurse’s best response?

1. Informing the patient why the medication is necessary
2. Notifying the prescriber of the patient's reason for refusing the medication
3. Offering to administer the medication with the patient's favorite snack food
4. Noting the patient’s refusal in the medication administration record (MAR)

7. Which example reflects effective documentation of medication administration by a nurse?

1. Comparing the written order with the medication administration record (MAR) three times
2. Providing patient education regarding a medication
3. Obtaining a BP before giving a blood pressure medication
4. Including the location of an injection site on the medication administration record

8. What is the nurse’s first step in preparing to administer a prescribed medication using an automated medication dispensing system?

1. Establish the patient’s ID using two identifiers
2. Review the medication administration record (MAR)
3. Provide patient education
4. Review applicable nursing considerations

9. While reviewing a new medication order, the nurse notes that the frequency of administration has been omitted. What is the nurse’s best response?

1. Immediately contacting the prescriber to complete the order
2. Referring to a current drug book for the most commonly prescribed dosage
3. Calling the pharmacy to determine the frequency
4. Asking a registered nurse who is familiar with the prescriber to identify the usual frequency ordered

10. The nurse is preparing to administer several oral medications when the patient says he would like to take his pills with orange juice. What is the nurse’s best response?

1. Determine whether the patient’s prescribed diet includes orange juice.
2. Establish whether the medications may be taken with orange juice.
3. Ask the dietary aide to order extra orange juice for the unit.
4. Administer the pills with orange juice.

11. After requesting a narcotic pain medication, the patient refuses it after the nurse prepares the injection. What is the nurse’s best initial response?

1. Ask the patient the reason for his refusal
2. Notify the physician and asking for a different type of pain medication
3. Have another registered nurse witness the proper discarding of the drug
4. Explain to the patient the need to manage pain effectively

12. Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in documenting medication administration?

1. “Make a note that the patient just received her pm dose of pain medication.”
2. “Let me know if she says her nausea is getting worse."
3. “Can you check the MAR and see when this patient had her pain med last?"
4. “Ask the patient if I need to get another order from the provider."

13. Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in medication administration?

1. “Does the patient need her pain medication?”
2. “Let me know if she complains of any nausea.”
3. “What is the quality of her pain now?”
4. “Tell her she doesn’t have an order for the drug she’s asking for.”

14. As the nurse is giving a patient his medications, he remarks, “I’ve never seen this blue pill before.” What is the nurse’s correct response?

1. “I’m sure the doctor knows what he’s doing. Don’t worry.”
2. “Our pharmacy probably sent a generic form of what you’re used to taking.”
3. “What color pill are you used to seeing?”
4. “Don’t take it. Let me double-check the doctor’s order to make sure this is the correct medication for you.”

15. As the nurse prepares to administer oral acetaminophen, the patient refuses to accept the drug because it doesn’t look like the Tylenol she takes at home. After verifying that the medication and dosage are correct, what is the nurse’s best response?

1. Informing the patient that the medication is a form of Tylenol
2. Explaining that she will probably have increased pain if she refuses the medication
3. Showing the patient a picture of the medication
4. Explaining that drugs often come in different physical forms, depending on the manufacturer

16. What is the most important step the nurse can take to ensure that the patient is getting the correct medication?

1. Assess the patient’s ability to swallow oral medications without difficulty.
2. Question the patient about his or her experience with this or similar medications.
3. Compare the medication label with the MAR three times.
4. Evaluate the patient’s understanding of the safety issues related to the specific drug.

17. Which action by a nurse is most important in protecting the safety of patients and staff when using an automated medication dispensing system?

1. Refusing to share his or her individual security log-in code for the dispensing system
2. Having another registered nurse check his or her mathematical calculations
3. Reviewing a current drug book for dosing information
4. Using two different mathematical formulas to cross-check a dosage calculation

18. What is the best way for the nurse to ensure that the patient does not receive the wrong dose because of a calculation error?

1. Ask the pharmacy to calculate the correct dosage.
2. Consult a current drug book to determine the new dosage.
3. Defer the calculation process to the provider.
4. Ask another registered nurse to verify the calculation.

19. As the nurse is administering medication to a patient, the patient states, “I’ve never seen that pill before.” What is the nurse’s most appropriate response?

1. Reassure the patient that the pharmacy sent the right medication.
2. Tell the patient that it is probably a different brand than what he takes at home and not to worry.
3. Tell the patient that you will review the physician’s order to clarify any discrepancies.
4. Tell the patient that the doctor probably ordered a new medication.

20. As the nurse is at the bedside preparing to administer a new medication, the patient mentions that he is allergic to the drug. What will the nurse do first?

1. Notify the physician
2. Withhold the medication
3. Check to see if the patient is wearing a red allergy ID band
4. Review the medication administration record (MAR) for allergies

21. The nurse has provided a patient with a prn oral analgesic that may be repeated as needed every 6 to 8 hours. What is the most appropriate follow-up action to ensure appropriate pain management?

1. Reassess the patient’s pain in 30 to 40 minutes.
2. Document the patient’s request for pain medication.
3. Administer the pain medication again in 6 hours.
4. Include the patient’s pain history in the end-of-shift nursing report.

22. What is the most appropriate way for the nurse to split an unscored tablet?

1. Use a pill-splitting device to split an unscored pill in half.
2. Ask the pharmacy if it is appropriate to split the pill and if so, ask them to split and repackage it with the adjusted dose given on the label.
3. Use scissors to cut the pill in half.
4. Administer a whole pill every other day instead of every day.

23. When is a patient at a higher risk for a medication administration error?

1. During a care transition point, such as transfer to another unit
2. While on a hospital unit for an extended length of time
3. On the third postoperative day
4. When taking an active role in self-administration of insulin

24. A patient with a history of nighttime confusion is to receive several oral medications at bedtime. What is the best way for the nurse to ensure that the patient has swallowed the medication?

1. Administer each tablet individually.
2. Observe the patient closely as he swallows the tablets.
3. Ask the patient to open his mouth after swallowing each tablet.
4. Ask the patient to swallow a full glass of water with the tablets.

25. The patient has requested a PRN medication for nausea. Which of the following should the nurse do first?

1. Offer dry crackers and ice chips if not contraindicated
2. Ask the patient about his allergies
3. Explain the specific purpose of the medication
4. Check to see when the medication was given last and make sure the time interval is up

26. What is the nurse’s first response when a patient requests another dose of narcotic pain medication before it is time for the next dose?

1. Consulting with the physical therapy department to arrange for a visit with the patient
2. Working with the patient to find alternative nonpharmacologic means of pain management
3. Contacting the patient's provider to request an order for additional pain medication
4. Giving the patient a detailed explanation of the need to limit the amount of narcotic medication she takes

27. How might the nurse safely administer an extended-release capsule to a patient with dysphagia?

1. Encourage the patient to drink plenty of water when swallowing the capsule.
2. Open the capsule, and place the contents into 90 mL (3 fl. oz.) of juice.
3. Place the capsule in a spoonful of the patient’s applesauce.
4. Save the capsule to be administered last.

28. What is the best way for the nurse to ensure that a patient receives the correct dose of a medication?

1. Compare the prescriber’s order with the medication administration record before dispensing the medication
2. Ask the patient if he would like a larger dose of pain medication
3. Assess the patient's ability to swallow oral medications without difficulty
4. Check the name of the medication three times against the medication administration record

29. While preparing a patient's oral medication dispensed from an automatic system, the nurse realizes that the pill dispensed is twice the required dose. What is the nurse’s best response?

1. Notify the health care provider and ask if the higher dose could be given
2. Access the dispenser again for the appropriate dose
3. Notify the pharmacy to determine if the accurate dose is available
4. Splitting the pill in half

30. Which of the following nursing actions will reduce the risk of “wrong route” when administering a medication?

1. Only splitting pills or tablets that have been prescored by the manufacturer
2. Using an oral dosing syringe when administering oral liquid medication
3. Transcribing a fractional dose of less than one with a leading zero (e.g., 0.5 mg)
4. Crushing an oral medication that is difficult to swallow