Ch. 29 Medication Flashcards
A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation?
A) Readminister the medication and notify the primary care provider.
B) Readminister the pill in a liquid form if possible.
C) Assess the vomit, looking for the pill.
D) Notify the primary care provider.
c. If a patient vomits immediately after swallowing an oral pill, the nurse should assess the vomit for the pill or fragments of it. The nurse should then notify the primary care provider to see if another dosage should be administered.
A nurse is administering phenytoin via a gastric tube to a patient who is receiving tube feedings. What would be an appropriate action of the nurse in this situation?
A) Discontinue the tube feeding and leave the tube clamped for required period of time before and after medication administration.
B) Notify the primary care provider that medication cannot be given to the patient at this time via the gastric tube.
C) Remove the tube in place and replace it with another tube prior to administering the medication.
D) Flush the tube with 60 mL of water prior to administering the medication.
a. If the patient is receiving tube feedings, the nurse should review information about the drugs to be administered. Absorption of some drugs, such as phenytoin, is affected by tube-feeding formulas. The nurse should discontinue a continuous tube feeding and leave the tube clamped for the required period of time before and after the medication has been given, according to the reference and facility protocol.
A nurse who is administering medications to patients in an acute care setting studies the pharmacokinetics of the drugs being administered. Which statements accurately describe these mechanisms of action? Select all that apply.
A) Distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues.
B) Metabolism is the process by which a drug is transferred from its site of entry into the body to the bloodstream.
C) Absorption is the change of a drug from its original form to a new form, usually occurring in the liver.
D) During first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the system’s circulation.
E) The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug absorption.
F) Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body.
a, d, f. Distribution occurs after a drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues. Some drugs move from the intestinal lumen to the liver by way of the portal vein and do not go directly into the systemic circulation following oral absorption. This is called the first-pass effect, or hepatic first pass. Excretion is the process of removing a drug or its metabolites (products of metabolism) from the body. Absorption is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Metabolism, or biotransformation, is the change of a drug from its original form to a new form. The liver is the primary site for drug metabolism. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug excretion.
A nurse who gives subcutaneous and intramuscular injections to patients in a hospital setting attempts to reduce discomfort for the patients receiving the injections. Which technique is recommended?
A) The nurse selects a needle of the largest gauge that is appropriate for the site and solution to be injected.
B) The nurse injects the medication into contracted muscles to reduce pressure and discomfort at the site.
C) The nurse uses the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track.
D) The nurse applies vigorous pressure in a circular motion after the injection to distribute the medication to the intended site.
c. The nurse should use the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. The nurse should select a needle of the smallest gauge that is appropriate for the site and solution to be injected, and select the correct needle length. The nurse should also inject the medication into relaxed muscles since there is more pressure and discomfort if medication is injected into contracted muscles. The nurse should apply gentle pressure after injection, unless this technique is contraindicated.
A medication order reads: “K-Dur, 20 mEq po BID.” When and how does the nurse correctly give this drug?
A) Daily at bedtime by subcutaneous route
B) Every other day by mouth
C) Twice a day by the oral route
D) Once a week by transdermal patch
c. The abbreviation BID refers to twice-a-day administration; “po” (by mouth) refers to administration by the oral route.
A nurse is preparing medications for patients in the ICU. The nurse is aware that there are patient variables that may affect the absorption of these medications. Which statements accurately describe these variables? Select all that apply.
A) Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed.
B) Some people experience the same response with a placebo as with the active drug used in studies.
C) People with liver disease metabolize drugs more quickly than people with normal liver functioning.
D) A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication’s effects.
E) Oral medications should not be given with food as the food may delay the absorption of the medications.
F) Circadian rhythms and cycles may influence drug action.
a, b, d, f. Nurses need to know about medications that may produce varied responses in patients from different ethnic groups. The patient’s expectations of the medication may affect the response to the medication, for example, when a placebo is given and a patient has a therapeutic effect. The patient’s environment may also influence the patient’s response to medications, for example, sensory deprivation and overload may affect drug responses. Circadian rhythms and cycles may also influence drug action. The liver is the primary organ for drug breakdown, thus pathologic conditions that involve the liver may slow metabolism and alter the dosage of the drug needed to reach a therapeutic level. The presence of food in the stomach can delay the absorption of orally administered medications. Alternately, some medications should be given with food to prevent gastric irritation, and the nurse should consider this when establishing a patient’s medication schedule. Other medications may have enhanced absorption if taken with certain foods.
A health care provider orders a pain medication for a postoperative patient that is a PRN order. When would the nurse administer this medication?
A) A single dose during the postoperative period
B) Doses administered as needed for pain relief
C) One dose administered immediately
D) Doses routinely administered as a standing order
b. When the prescriber writes a PRN order (“as needed”) for medication, the patient receives medication when it is requested or required. With a single or one-time order, the directive is carried out only once, at a time specified by the prescriber. A stat order is a single order carried out immediately. A standing order (or routine order) is carried out as specified until it is canceled by another order.
A nurse is administering a pain medication to a patient. In addition to checking his identification bracelet, the nurse correctly verifies the patient’s identity by performing which action?
A) Asking the patient his name and birthdate
B) Reading the patient’s name on the sign over the bed
C) Asking the patient’s roommate to verify his name
D) Asking, “Are you Mr. Brown?”
a. The nurse should ask the patient to state his name and birthdate based on facility policy. A sign over the patient’s bed may not always be current. The roommate is an unsafe source of information. The patient may not hear his name but may reply in the affirmative anyway (e.g., a person with a hearing deficit).
The nurse is administering a medication to a patient via an enteral feeding tube. Which are accurate guidelines related to this procedure? Select all that apply.
A) Crush the enteric-coated pill for mixing in a liquid.
B) Flush open the tube with 60 mL of very warm water.
C) Use the recommended procedure for checking tube placement in the stomach or intestine.
D) Give each medication separately and flush with water between each drug.
E) Lower the head of the bed to prevent reflux.
F) Adjust the amount of water used if patient’s fluid intake is restricted.
c, d, f. The nurse should use the recommended procedure for checking tube placement prior to administering medications. The nurse should also give each medication separately and flush with water between each drug and adjust the amount of water used if fluids are restricted. Enteric-coated medications should not be crushed, the tube should be flushed with 15 to 30 mL of water, and the head of the bed should be elevated to prevent reflux.
A medication order reads: “Hydromorphone, 2 mg IV every 3 to 4 hours PRN pain.” The prefilled cartridge is available with a label reading “Hydromorphone 2 mg/1 mL.” The cartridge contains 1.2 mL of hydromorphone. What should the nurse do?
A) Give all the medication in the cartridge because it expanded when it was mixed and this is what the pharmacy sent.
B) Call the pharmacy and request the proper dose.
C) Refuse to give the medication and document refusal in the EHR.
D) Dispose of 0.2 mL before administering the drug; verify the waste with another nurse.
d. Many cartridges are overfilled, and some of the medication needs to be discarded. Always check the volume needed to provide the correct dose with the volume in the syringe. Giving the excess medication in the cartridge may result in adverse effects for the patient. For this dose, it is not necessary to call the pharmacy or refuse to give the medication, provided the order is written correctly. Wasting narcotics typically requires a second RN to witness the waste and verify the amount of narcotic discarded.
A patient requires 40 units of NPH insulin and 10 units of regular insulin daily subcutaneously. What is the correct sequence when mixing insulins?
A) Inject air into the regular insulin vial and withdraw 10 units; then, using the same syringe, inject air into the NPH vial and withdraw 40 units of NPH insulin.
B) Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin.
C) Inject air into the regular insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the NPH insulin vial and withdraw 40 units; then, withdraw 10 units of regular insulin.
D) Inject air into the NPH insulin vial and withdraw 40 units; then, using the same syringe, inject air into the regular insulin vial and withdraw 10 units of regular insulin.
b. Regular or short-acting insulin (unmodified insulin) should never be contaminated with NPH or any insulin modified with added protein. Placing air in the NPH vial first without allowing the needle to contact the solution ensures that the regular insulin will not be contaminated.
Ms. Hall has an order for hydromorphone, 2 mg, intravenously, q 4 hours PRN pain. The nurse notes that according to Ms. Hall’s chart, she is allergic to hydromorphone. The order for medication was signed by Dr. Long. What would be the correct procedure for the nurse to follow in this situation?
A) Administer the medication; the doctor is responsible for medication administration.
B) Call Dr. Long and ask that the medication be changed.
C) Ask the supervisor to administer the medication.
D) Ask the pharmacist to provide a medication to take the place of hydromorphone.
b. The nurse is responsible for any medications given and must inform the doctor of the patient’s allergy to the drug. The nurse should not give the medication and might speak with the supervisor only if uncomfortable with the health care provider’s answer when notified. The nurse is legally unable to order a replacement medication, as is the pharmacist.
c. When giving heparin subcutaneously, the nurse should not aspirate or massage, so as not to cause trauma or bleeding in the tissues.A nurse is administering heparin subcutaneously to a patient. What is the correct technique for this procedure?
A) Aspirate before giving and gently massage after the injection.
B) Do not aspirate; massage the site for 1 minute.
C) Do not aspirate before or massage after the injection.
D) Massage the site of the injection; aspiration is not necessary but will do no harm.
c. When giving heparin subcutaneously, the nurse should not aspirate or massage, so as not to cause trauma or bleeding in the tissues.
A nurse discovers that a medication error occurred. What should be the nurse’s first response?
A) Record the error on the medication sheet.
B) Notify the physician regarding course of action.
C) Check the patient’s condition to note any possible effect of the error.
D) Complete an incident report, explaining how the mistake was made.
c. The nurse’s first responsibility is the patient—careful observation is necessary to assess for any effect of the medication error. The other nursing actions are pertinent, but only after checking the patient’s welfare.
A nurse is teaching a patient how to use a meter-dosed inhaler to control asthma. What are appropriate guidelines for this procedure? Select all that apply.
A) Shake the inhaler well and remove the mouthpiece covers from the MDI and spacer.
B) Take shallow breaths when breathing through the spacer.
C) Depress the canister releasing one puff into the spacer and inhale slowly and deeply.
D) After inhaling, exhale quickly through pursed lips.
E) Wait 1 to 5 minutes as prescribed before administering the next puff.
F) Gargle and rinse with salt water after using the MDI.
a, c, e. The correct procedure for using a meter-dosed inhaler is: Shake the inhaler well and remove the mouthpiece cover; breathe normally through the spacer; depress the canister releasing one puff into the spacer and inhale slowly and deeply; after inhaling, hold breath for 5 to 10 seconds, or as long as possible, and then exhale slowly through pursed lips; wait 1 to 5 minutes as prescribed before administering the next puff; and gargle and rinse with tap water after using the MDI.
