Correct answer: a) "Schedule I drugs have no accepted medical use and a high potential for abuse."

Rationale: Schedule I drugs, such as heroin, LSD, and ecstasy, are the most restricted category of controlled substances and have no currently accepted medical use in the United States. Schedule II drugs, such as morphine, oxycodone, and cocaine, have a high potential for abuse and can only be dispensed with a written prescription that cannot be refilled. Schedule III drugs, such as codeine, ketamine, and anabolic steroids, have a moderate potential for abuse and can be refilled up to five times within six months with a prescription. Schedule IV drugs, such as diazepam, alprazolam, and zolpidem, have a low potential for abuse and can also be refilled up to five times within six months with a prescription. Schedule V drugs, such as cough syrups with codeine, have the lowest potential for abuse and may be dispensed without a prescription under certain conditions.

Incorrect choices:
b) "Schedule II drugs can be refilled up to five times within six months.": This is incorrect as Schedule II drugs cannot be refilled.
c) "Schedule III drugs have a lower potential for abuse than Schedule IV drugs.": This is incorrect as Schedule III drugs have a higher potential for abuse than Schedule IV drugs.
d) "Schedule V drugs are available over-the-counter without a prescription.": This is incorrect as Schedule V drugs may require a prescription depending on the state law and the amount dispensed.

Correct answer: a) "You should keep your medication in its original container with the label attached."

Rationale: Keeping the medication in its original container with the label attached helps to prevent errors, confusion, misuse, or diversion of the medication. The label also provides important information about the medication name, dosage, instructions, expiration date, and prescriber.

Incorrect choices:
b) "You should share your medication with your family members if they have similar symptoms.": This is incorrect as sharing prescription medication with others is illegal and dangerous. Prescription medication should only be taken by the person for whom it was prescribed and as directed by the prescriber.
c) "You should dispose of any unused or expired medication by flushing it down the toilet.": This is incorrect as flushing medication down the toilet can contaminate the water supply and harm the environment. Unused or expired medication should be disposed of properly according to the FDA guidelines or local regulations.
d) "You should stop taking your medication if you experience any side effects.": This is incorrect as stopping medication abruptly can cause adverse effects or worsen the condition. The client should report any side effects to the prescriber and follow their advice on how to manage them or whether to adjust or discontinue the medication.

Correct answer: c) Assess the client's vital signs and level of consciousness.

Rationale: The first action that the nurse should take when using the nursing process is to assess the client. Assessing the client's vital signs and level of consciousness is essential to determine the severity of the overdose and the need for immediate interventions. The nurse should also monitor the client for signs of respiratory depression, cardiac arrhythmias, seizures, or other complications.

Incorrect choices:
a) Notify the health care provider and request an order for a urine drug screen.: This is an important action, but not the first one. The nurse should notify the health care provider and request an order for a urine drug screen after assessing the client and stabilizing their condition. A urine drug screen can help to identify the type and amount of drugs that the client has ingested and guide the treatment plan.

b) Administer naloxone as prescribed to reverse the effects of opioids.: This is an important action, but not the first one. The nurse should administer naloxone as prescribed to reverse the effects of opioids after assessing the client and confirming that they have signs of opioid toxicity, such as pinpoint pupils, decreased respiratory rate, and decreased level of consciousness. Naloxone is an opioid antagonist that can rapidly restore normal respiration and alertness in opioid overdose cases. However, naloxone has no effect on other types of drugs and may precipitate withdrawal symptoms in opioid-dependent clients.

d) Educate the client about the risks and consequences of drug abuse.: This is an important action, but not the first one. The nurse should educate the client about the risks and consequences of drug abuse after assessing the client and ensuring their safety and stability. The nurse should also provide emotional support and refer the client to appropriate resources for substance abuse treatment and recovery.

Correct answer: d) All of the above.

Rationale: Schedule II drugs are highly regulated by the federal Controlled Substances Act and require a new written prescription for each refill. Morphine sulfate can cause nausea and vomiting, so taking it with food may help prevent these adverse effects. Morphine sulfate is also a potential drug of abuse and diversion, so it should be stored securely and disposed of properly when no longer needed.

Incorrect choices:
a) "You will need a new written prescription from your provider every time you need a refill.": This is correct, but not the only information the nurse should include in the teaching.

b) "You can take this medication with or without food, depending on your preference.": This is correct, but not the only information the nurse should include in the teaching.

c) "You should store this medication in a locked cabinet away from children and pets.": This is correct, but not the only information the nurse should include in the teaching.

Correct answer: b) "I should store my medication in a locked cabinet."

Rationale: Schedule II controlled substances have a high potential for abuse and addiction and are subject to strict regulations by the DEA. The client should store the medication in a secure place to prevent theft or misuse. The client cannot refill the prescription by calling the pharmacy but must obtain a new written prescription from the provider. The client should not share the medication with anyone else, as this is illegal and dangerous. The client should take the medication as prescribed and report any inadequate pain relief to the provider.

Incorrect choices:

a) "I can refill my prescription by calling the pharmacy.": This is incorrect as Schedule II drugs cannot be refilled by phone, but require a new written prescription.

c) "I can share my medication with my spouse if they have similar symptoms.": This is incorrect as sharing controlled substances is illegal and can cause harm to others.

d) "I should take more medication if my pain is not relieved.": This is incorrect as taking more medication than prescribed can lead to overdose, addiction, or adverse effects.

Correct answer: a) Naloxone

Rationale: Naloxone is an opioid antagonist that blocks the opioid receptors and reverses the respiratory depression, sedation, and hypotension caused by opioids. It is given intravenously, intramuscularly, or intranasally to treat opioid overdose.

Incorrect choices:

b) Flumazenil: This is a benzodiazepine antagonist that reverses the effects of benzodiazepines, such as diazepam or alprazolam.

c) Acetylcysteine: This is an antidote for acetaminophen overdose that replenishes glutathione and prevents liver damage.

d) Glucagon: This is a hormone that increases blood glucose levels and is used to treat hypoglycemia caused by insulin or oral antidiabetic drugs.

Correct answer: d) The amount and strength of medication

Rationale: The amount and strength of medication are not required to be documented in the MAR for Schedule IV controlled substances, as these are low-abuse potential drugs that have accepted medical uses. However, they are required for Schedule I, II, and III controlled substances, which have higher abuse potential and stricter regulations.

Incorrect choices:

a) The nurse's signature and initials: These are required to be documented in the MAR for all medications, including controlled substances, to ensure accountability and accuracy.

b) The date and time of administration: These are required to be documented in the MAR for all medications, including controlled substances, to ensure adherence to the prescribed schedule and avoid errors.

c) The route and site of administration: These are required to be documented in the MAR for all medications, including controlled substances, to ensure proper delivery and avoid complications.

Correct answer: c) Verify the client's identity using two identifiers

Rationale: The first action that the nurse should take before administering any medication is to verify the client's identity using two identifiers, such as name and date of birth, to ensure that the right medication is given to the right client. This is one of the six rights of medication administration that help prevent medication errors and promote client safety.

Incorrect choices:

a) Check the expiration date of the drug: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should check the expiration date after comparing the drug label with the MAR and before opening the drug container.

b) Compare the drug label with the MAR: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should compare the drug label with the MAR after verifying the client's identity and before checking the expiration date.

d) Explain the purpose and side effects of the drug: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should explain the purpose and side effects of the drug after checking the expiration date and before administering the drug.

Correct answer: d) "I should use over-the-counter drugs instead of prescription drugs if I have pain."

Rationale: This statement indicates a need for further teaching, as over-the-counter drugs can also be abused or misused and cause harm to the client. The client should consult with their provider before taking any medications for pain and follow the directions carefully. The client should also use nonpharmacological methods for pain relief, such as relaxation techniques, massage, or ice packs.

Incorrect choices:

a) "I should avoid situations or people that trigger my urge to use drugs.": This statement indicates an understanding of the teaching, as avoiding triggers is one of the prevention and education strategies for substance abuse.

b) "I should seek professional help if I have signs of depression or anxiety.": This statement indicates an understanding of the teaching, as seeking professional help is one of the prevention and education strategies for substance abuse. Depression and anxiety are common co-occurring disorders with substance abuse and can increase the risk of relapse.

c) "I should join a support group or a 12-step program to stay sober.": This statement indicates an understanding of the teaching, as joining a support group or a 12-step program is one of the prevention and education strategies for substance abuse. Support groups and 12-step programs can provide peer support, guidance, and accountability for clients who are recovering from substance abuse.

Correct answer: b) Count and document the remaining supply of medication

Rationale: Schedule III controlled substances are drugs that have a moderate potential for abuse and addiction and are subject to moderate regulations by the DEA. The nurse should count and document the remaining supply of medication every time they administer a Schedule III controlled substance to ensure accuracy and prevent diversion.

Incorrect choices:

a) Obtain a written prescription from the provider every time: This is not required for Schedule III controlled substances, as they can be refilled up to five times within six months by phone or fax. However, this is required for Schedule II controlled substances, which have a higher potential for abuse and addiction.

c) Dispose of any unused medication in a sharps container: This is not an appropriate way to dispose of any unused medication, as it can pose a risk of injury or infection to others. The nurse should dispose of any unused medication by using a DEA-approved disposal company or following the facility's policy.

d) Administer the medication only by intravenous route: This is not required for Schedule III controlled substances, as they can be administered by various routes depending on the formulation and indication. However, some Schedule II controlled substances, such as morphine or fentanyl, are administered only by intravenous route for acute pain management.