Chapter 19: Medication Administration

Question 1

chemical name

Answer 1

based on its molecular structure

Question 2

generic name

Answer 2

given by the United States Adopted Names Council and is the drug’s official name throughout its lifetime

Question 3

trade or brand name

Answer 3

used by the pharmaceutical company for a 17-year period in which it has the exclusive rights to make and sell the drug.

Question 4

unit-dose system

Answer 4

involves the pharmacy or manufacturer in prepackaging and prelabeling an individual patient dose

Question 5

Bar Code Medication Administration

Answer 5

Uses a handheld laser scanner, a laptop, and bar codes. Patients wear bar-coded id bracelets. The nurse enters a password to access the computer. When the nurse scans the id bracelet, the computer displays the medication record. The nurse selects medications from a drawer and scans the bar code on each packaged medication. The system confirms patient, medication, dose, and route. It also tracks time and nurse. The system will warn of a potential error if the action does not meet five of the six rights.

Question 6

self-administered medication system

Answer 6

supplies each patient with prescribed doses

Question 7

prescription

Answer 7

is a legal order for the preparation and administration of a medication.

Question 8

SAFETY ALERT

Answer 8

Always determine which nonprescription medications the patient has been taking and ensure that he takes no medications without the healthcare provider’s knowledge.

Question 9

Tallman letters

Answer 9

minimize the risk of selecting the wrong medication name

Question 10

SAFETY ALERT

Answer 10

Always clarify with the provider any medication order that is unclear or seems inappropriate.

Question 11

SAFETY ALERT

Answer 11

If an order specifies a certain route of administration and the patient’s condition changes, making the ordered route inappropriate or possibly unsafe, notify the provider so that he or she can change the route of administration.

Question 12

SAFETY ALERT

Answer 12

To ensure accuracy when taking telephone orders, always repeat the order to the provider after writing it down. The provider must cosign the order within a specified time, usually 48 hours. Do not take verbal orders except in an emergency situation (code), because the risk for error is very great. Direct the provider to write the order.

Question 13

Food and Drug Administration (FDA)

Answer 13

Division of the U.S. Department of Health and Human Services. Regulates the manufacture, sale, and effectiveness of medications. Requires drug testing in lab animals and humans before a drug is approved for use. Keeps ineffective or unsafe drugs off the market and recalls inadequately tested or dangerous drugs. Identify which medications can be obtained with or without a prescription, set and enforce standards of purity and potency, oversee all drugs, and control drug advertising to the medical profession.

Question 14

SAFETY ALERT

Answer 14

You have the right and responsibility to decline to administer a medication if you believe it jeopardizes patient safety.

Question 15

SAFETY ALERT

Answer 15

Do not give any medication prepared by another nurse unless the unit-dose label identifies the drug and the seals are intact.

Question 16

6 rights

Answer 16

right patient
right medication
right dose
right route
right time
right documentation
In addition, the patient has the right to refuse.

Question 17

Controlled substances

Answer 17

drugs that are considered to have either limited medical use or high potential for abuse or addiction.

Question 18

SAFETY ALERT

Answer 18

The chemically impaired nurse cannot be trusted to exercise optimal clinical judgment. Such individuals must be identified in order to protect patient safety and so that the nurse can obtain treatment.

Question 19

Pharmacokinetics

Answer 19

Is the process by which a drug moves through the body and is eventually eliminated. It involves the absorption, distribution, metabolism, and excretion of a medication.

Question 20

Pharmacodynamics

Answer 20

refers to the physiologic and biochemical effects of a drug on the body.

Question 21

Absorption

Answer 21

process by which a medication enters the bloodstream

Question 22

Distribution

Answer 22

process by which the medication is delivered to the target cells and tissues

Question 23

Metabolism

Answer 23

process of chemically changing the drug in the body. It takes place mainly in the liver.

Question 24

Excretion

Answer 24

process of removing the drug or its metabolites from the body

Question 25

therapeutic effects

Answer 25

medication’s desired and intentional effects

Question 26

adverse drug event

Answer 26

effect other than therapeutic

Question 27

side effects

Answer 27

Minor adverse effects

Question 28

Tolerance

Answer 28

when a patient develops a decreased response

Question 29

Medication toxicity

Answer 29

overdose or buildup of medication in the blood due to impaired metabolism and excretion.

Question 30

medication interaction

Answer 30

when a medication’s effects are altered by the concurrent presence of other medications or food

Question 31

synergism

Answer 31

increase in drug’s effects

Question 32

antagonism

Answer 32

decrease in drug’s effects

Question 33

SAFETY ALERT

Answer 33

Always be aware of the possibility of drug incompatibilities and interactions in order to protect patients from harmful effects. Refer to incompatibility charts and check with the pharmacist for valuable information.

Question 34

SAFETY ALERT

Answer 34

To avoid potentially fatal anaphylaxis, always check a patient’s allergy history before giving any medication.

Question 35

SAFETY ALERT

Answer 35

If the calculated dosage of a medication seems unusual or if you have any doubts about the accuracy of your calculation, ask another nurse or a pharmacist to check the dosage calculation.

Question 36

SAFETY ALERT

Answer 36

Each time you administer a medication, be sure that you give the right patient the right medication, in the right dose, by the right route, at the right time, followed by the right documentation.

Question 37

SAFETY ALERT

Answer 37

Before giving any medication, always check the patient’s MAR to note when the medication was last administered and if a change has occurred in medication orders.

Question 38

SAFETY ALERT

Answer 38

To avoid medication errors, always document immediately after giving a medication.

Question 39

SAFETY ALERT

Answer 39

Never crush enteric-coated or sustained-release tablets. Crushing enteric-coated tablets allows the irritating medication to come in contact with the oral or gastric mucosa, resulting in mucositis or gastric irritation. Crushing a sustained-release medication allows all of the medication to be absorbed at the same time, resulting in a higher-than-expected initial level of the medication and a shorter-than-expected duration of action.

Question 40

SAFETY ALERT

Answer 40

To avoid medication errors, always label syringes with the name of the medication and dose after you draw up the dose. Deaths have occurred when unlabeled medication has been injected into the wrong patient.

Question 41

SAFETY ALERT

Answer 41

Never recap a needle (placing the protective cap back onto the needle) after injection because of the increased risk of injury and exposure to bloodborne pathogens.

Question 42

SAFETY ALERT

Answer 42

If a patient has little or abnormal subcutaneous tissue or abnormal blood flow to subcutaneous tissue, check with the provider to see whether you can use an alternative route of administration.

Question 43

SAFETY ALERT

Answer 43

If you must use the deltoid site, locate the site carefully, using anatomic landmarks to decrease the risk of injury to the radial nerve and brachial artery.

Question 44

SAFETY ALERT

Answer 44

Use the dorsogluteal site only for medications that can be safely given into subcutaneous fat. Use the vastus lateralis or ventrogluteal sites to give irritating medications and medications that must be more rapidly and consistently absorbed, such as hepatitis B vaccine.

Question 45

SAFETY ALERT

Answer 45

Do not use the dorsogluteal site in infants and toddlers. Muscles in this site are not well developed until children begin to walk. Older and debilitated patients who have lost muscle mass elsewhere usually have enough muscle in the dorsogluteal site to allow safe IM injections.

Question 46

teratogenic

Answer 46

Drugs known to cause birth defects

Question 47

buccal

Answer 47

placing medications underneath the upper lip or in the side of the mouth

Question 48

parenteral

Answer 48

medications that are given by injection or infusion

Question 49

Intradermal

Answer 49

into the dermis, the layer of tissue located beneath the skin surface

Question 50

Subcutaneous

Answer 50

layer of fat located below the dermis and above the muscle tissue

Question 51

Intramuscular

Answer 51

beneath the dermis and subcutaneous tissue

Question 52

medication order must include

Answer 52

patient’s name, the date of the order, the medication’s name, the dose, the frequency, the route of administration, and the provider’s signature

Question 53

Types of medication orders

Answer 53

routine
prn
one-time
stat
telephone
verbal
electronic

Question 54

Sites commonly used for IM injections

Answer 54

deltoid
ventrogluteal
vastus lateralis
rectus femoris
dorsogluteal

Question 55

Angiotensin converting enzyme (ACE) inhibitors

Answer 55

end in -pril

Question 56

Antilipemic medications

Answer 56

end in -statin

Question 57

Antiviral medication

Answer 57

contain “vir” in their name

Question 58

B-Adrenergic blockers

Answer 58

end in -lol

Question 59

Calcium channel blockers

Answer 59

end in -pine

Question 60

Polypharmacy

Answer 60

when a patient takes two or more medications to treat the same illness, from the same chemical class, with the same actions, or mixes supplements or herbal products with medications.

Question 61

Antacids

Answer 61

not usually administered with medication

Question 62

Grapefruit juice

Answer 62

contains a substance that inhibits the metabolism of some drugs. (Inhibits the activity of cytochrome P450)

Question 63

A nurse administers a medication to a patient at the end of her shift. She brings in a blue pill in a medication cup, places it on the dinner tray, and states “Remember to take that, Betty” before leaving to document and give shift report. Which “rights” were not done?

Answer 63

Patient identity was not confirmed. The medication was not checked against the order or labeled when it was brought into the patient’s room. Documentation may be done, but there is no assurance that the medication was actually taken because it was left on the dinner tray.

Question 64

A new nurse is hanging a bag of continuous infusion IV fluids. The medication dispensing cart releases the wrong bag, and the nurse infuses the wrong type of fluids. Another nurse notes the error, the correct fluids are infused, and there is no harm done to the patient. Which nursing action would be most appropriate in acknowledging this error?

Answer 64

A Patient Safety Alert should be filed because this error occurred as a result of an improperly functioning system (i.e., the medication dispensing device released the wrong type of intravenous [IV] fluid bag). All errors should be submitted in order to prevent future errors from occurring.

Question 65

When giving Heparin subcutaneously…

Answer 65

Do not aspirate or massage so no trauma or bleeding is caused in the tissue