Chapter 35 - Meds Study Guide Flashcards
1
Q
Severe allergic reaction
A
anaphylactic reaction
2
Q
Unpredictable patient response to medication
A
idiosyncratic reaction
3
Q
Predictable but unwanted and sometimes unavoidable reactions to medications
A
Side effects
4
Q
Occurs when the combined effect is greater than the effect of either substance if taken alone
A
synergistic effect
5
Q
Severe, unintended, unwanted, and often unpredictable drug reactions
A
adverse effects
6
Q
The desired result or action of a medication
A
therapeutic effect
7
Q
Unpredictable immune response to medications
A
allergic reaction
8
Q
Occurs when the drug action is modified by the presence of a certain food or herb or another medication
A
medication interaction
9
Q
Result from a medication overdose or the buildup of medication in the blood due to impaired metabolism and excretion
A
toxic effects
10
Q
Occurs when the drug effects is decreased by taking the drug with another substance
A
antagonism
11
Q
What is the difference between the term drug and medication?
A
Drug- any substance that either positively or negatively alters physiological function. A medication is a drug specifically administered for its therapeutic effect on physiological function
12
Q
Is Lasix a chemical, generic, or trade name?
A
Trade name
13
Q
Is acetaminophen a chemical, generic, or trade name?
A
generic name
14
Q
Is fentanyl a chemical, generic, or trade name?
A
generic name
15
Q
Is acetylsalicylic acid a chemical, generic, or trade name?
A
chemical name
16
Q
Is Prozac a chemical, generic, or trade name?
A
Trade name
17
Q
What is the most effective way in the acute care environment to determine the patient’s identity before administering medications?
A
Check the patient’s medical record number on the ID band, compare an ID photo with the patient, check the patient’s DOB, and use the bar code system, if available.
18
Q
What special considerations would be taken when administering medication for a woman who is pregnant?
A
Take extreme care when administering medications throughout pregnancy, and especially in the first trimester, due to risk of harm to the developing fetus
19
Q
What special considerations would be taken when administering medication for an infant?
A
infants require small doses related to their body size and immature organs. Use a calibrated dropper for infants or very young children. Place medication between gum and cheek to prevent aspiration
20
Q
What special considerations would be taken when administering medication for an older adult?
A
increased fat deposits, decreased gastric mobility, decreased renal and liver function and changes in the blood-brain barrier can lead to increased side effects of meds.
21
Q
Which organs are affected by metabolism of drugs?
A
Liver
22
Q
Which organs are affected with excretion of drugs?
A
kidneys
23
Q
If a medication is administered that has an onset of action of 1/2 hour and the medication is given at 0800, when should the nurse return to evaluate the patient’s response?
A
The nurse should return at 0830 ( 1/2 hour)
24
Q
The patient has come to the clinic for treatment of an infection and is given new antibiotic. What should the nurse do to promote patient safety?
A
Determine if patient has an known allergies to medications, especially antibiotics. The patient should also stay in the clinic for at least 20 to 30 minutes to observe if there is a reaction to the medication
25
Provide examples of synergistic and antagonist drugs
synergistic- alcohol with a narcotic ( morphine) - both depress the CNS. Antagonist- a stimulant (cocaine) taken with a depressant ( codeine)
26
What are examples of common OTC medications that patients may purchase?
cough meds, mild analgesics, sleep aids, and antacids
27
Patient- J. Smith
August 20, 2014 1000. B Careful, MD
a. Digoxin 0.125 mg PO
b. Lasix 40 mg daily
What is missing from each drug?
a. the frequency of administration is missing
| b. the route of administration is missing
28
When is special documentation required on the computerized or paper medication admission record (MAR) for medication administration?
If the patient refuses a medication or it is held
29
What route is placing the med under the tongue?
sublingual
30
Provide an example of medication given by the sublingual route
Nitroglycerin
31
What general types of medications cannot be crushed for administration through an enteric tube?
Enteric-coated, time-release, sublingual, buccal, and medication with special coatings
32
Although the UAP do not normally administer medications in the acute care area, what can the nurse delegate to this caregiver regarding the patient's meds?
Observation of the patient for changes in vital signs, patient complaints or discomforts, reporting of any meds found in the room, and sharing of any questions that the patient has about the meds. For IV infusion, the UAP can report on any issues at the access site, low volume in the IV bag, and pump alarms
33
Identify the topical medication route
vaginal suppository, transdermal patch, ear irrigation, and antiseptic throat spray
34
What supplies are needed for an injection to an average-size adult?
a. IM injection: 3 mL syringe, 1 1/2 inch needed
| b. SubQ injection: 1 mL syringe (3 mL can also be used) 5/8 inch needle
35
Which specific assessments should be done by the nurse before administration of antihypertensive meds?
vital signs, (BP) and other indications of lightheadedness or dizziness
36
Which specific assessments should be done by the nurse before administration of bronchodilator?
vital signs, (respiratory rate) and auscultation of lung sounds
37
Which specific assessments should be done by the nurse before administration of narcotic analgesic?
vital signs, (respiratory rate) and determination of LOC and comfort level
38
Which specific assessments should be done by the nurse before administration of anticoagulant?
review of lab results for coagulant studies and observation for signs of bruising or bleeding
39
Which specific assessments should be done by the nurse before administration of antipyretic?
vital signs, (temperature) and indications of reduced fever such as cooler skin temp.
40
What are three wats that nurses can reduce medication errors?
Take time to read orders correctly, being knowledgeable about the medications ( side effects, etc) recognizing prescription errors, following the Six Rights and performing triple checks before administration and communicating with colleagues about questions or concerns
41
Which abbreviations and dose designations are appropriate to use?
PO, prn, mL, bid ( no trailing zeros)
42
What type of injection is at 90 degree?
IM
43
what type of injection is at 45 degree?
SubQ
44
What type of injection is at 15 degree?
ID
45
What are the six rights of medication administration?
right drug, dose, time, route, patient, and documentation
46
When does the nurse perform the three checks of medications to be given?
verifying that the medication matches the MAR, calculating the dosage, and checking the expiration date of the medication; preparing the medication and checking the label again with MAR; rechecking the label of the medication before returning it to its storage area or right before opening the package at the bedside
47
The patient has been newly diagnosed with a heart-related condition and is prescribed a number of different medications. The patient is unsure about the medications and would like to know what they are and how they work. Identify a nursing diagnosis for this individual and a relevant goal as well
Knowledge deficit R/T new diagnosis and prescriptions AEB asking about the medications. Goal: patient will verbalize information about the prescribed meds before discharge or next clinic visit.
48
What are three assessment questions that the nurse can ask a patient about their medication history?
Do you have any food or drug allergies? What is your alcohol intake? caffeine intake? use of home remedies? What medications have you stopped taking recently?
49
What are some special considerations for administration of medications to children?
liquid forms of oral meds are preferred for children younger than the age of 5; parents or caregivers may need instruction, with pictures and written directions, on home medication administration, a calibrated dropper is used for infants or very young children ( place between check and gum to prevent aspiration) Warn the child if the med taste bad, it builds trust and praise the child after the med is swallowed
50
When is oral med administration contraindicated?
if patient is not able to swallow, diminished LOC, no gag reflex present, nausea, or vomiting, NPO order, or procedures/treatment in the mouth or throat
51
Which type of oral med should be given last?
sublingual, buccal, "swish and swallow" liquids, other oral or pharyngeal treatments, and cough meds
52
The nurse is to administer meds through the patient's NG tube. What techniques are correct?
Check the placement of the tube before giving meds; have the patient sit upright for the med administration; keep the patient's head elevated after the administration for at least 30 mins.
53
What do the following abbreviations mean?
a. pc
b. bid
c. prn
d. IV
e. qid
a. after meals
b. twice a day
c. as needed
d. intravenous
e. four times a day
54
The nurse is to apply transdermal patches to his patients, which of the following techniques is correct?
Write initials, date, and time on patches before applied; remove patches if the patient requires defibrillation; and clean the skin site where the patch will be placed
55
To prevent nausea, pain and dizziness during the administration of ear drop, the nurse should:
use ear drops that are at room temp.
56
The ear canal is straightened in an adult patient is:
pinna should be pulled up and back
57
What does the nurse ask the patient to first before administering nasal medications?
blow their nose
58
What assessment does the nurse do before inhalation administration?
assess patient's breathing, breath sounds, respiratory rate, and use of accessory muscles
59
The patient is taking a steroid via an inhaler. What should be done after administration?
rinse their mouth or receive oral care
60
How does the patient/nurse determine the amount of doses in a container?
its determined by dividing the total amount by the number of doses that the patient takes each day
61
What position do you place the patient during a vaginal suppository insertion?
dorsal recumbent or sims position
62
What position do you place the patient during a rectal suppository insertion?
Sims position (left side with upper knee flexed)
63
What type of asepsis is used for administration of parenteral meds?
sterile technique
64
The nurse prepares the injection in the medication room and needs to bring it to the patient down the hall. What is the correct technique for covering the needle for transport?
use the one-handed technique and slide the needle into the cap using a scooping motion, without contamination it or using the free hand. When needle is back on the cap, the syringe is held vertically and the cap is snapped back on by holding the sides of the cap
65
The nurse is preparing an injection from an ampule. What special safety techniques are used?
use a 2x2 gauze to cover the neck of the ampule to protect the hand while snapping off the top. Excess medication is discarded. A filter needle is used to remove the medication from the ampule and then changed for the injection
66
Two meds are to be given, one from an ampule and one from a vial. Identify the correct order of the procedure for putting the meds into the same syringe. The ampule and vial have both been prepared.
1. Attach a filter needle to the syringe
2. Draw an amount of air into the syringe equal to the vial's medication dose
3. Insert the needle into the vial and instill the air into the space above the med
4. Draw the med from the vial
5. Draw up the amount of med ordered from the ampule
6. verify the total dose in the syringe
67
For ID injections, when is this type of injection route used and where can it be given?
administer local anesthetics, test for allergies and exposure of TB; inner forearm, upper arm, and scapular area
68
An IM injection is to be given into the ventrogluteal muscle. The nurse should aspirate before administering the medication ( T or F)
False. Aspiration is not required for injections into the deltoid, vastus lateralis, or ventrogluteal sites
69
What is the maximum amount of meds that should be given for SubQ injection? Deltoid?
SubQ: 0.5 -1 mL; 1 mL or less for deltoid
70
Epipen injections can be done through the patient's clothes ( T or F)
True
71
How can IV meds be administered to the patient?
IV push, intermittent small-volume administration, or volume control administration set
72
Special considerations for administration of IV medication include:
patient allergies, medication/IV solution compatibility, amount and rate of the medication administration, IV access site- check for infiltration, phlebitis, sterile technique is used consistently
73
The older adult patient has several medications at home and tens to forget whether the daily doses have been taken. What can the nurse do to assist this patient with the medications?
set up a pill reminder system with either a commercially made product that has the the days of the week or homemade set of labeled containers. Reminders on the phone, calendars or journals may be use to reinforce the mgmt of meds.
74
What is the "Ask Me 3" program?
What is my main problem? What do I need to do? why is it important for me to do this?
75
How can the patient and nurse evaluate the effectiveness of insulin?
check the blood glucose levels to see how the insulin is working, along with observation for signs and symptoms that would indicate an insufficient or excess amount of insulin.
76
A patient is nauseated, has been vomiting for several hours, and needs to receive an antiemetic med. The nurse recognizes that administration of the med, considering the patient's status and the med, is best via which route?
Parenteral and topical-rectal suppository
77
Bar-code scanning is used to verify what?
patient's ID and meds
78
What instructions does the nurse give the patient specifically for buccal and sublingual meds?
do not swallow these meds but allow them to dissolve. Food and fluid are not administered along with sublingual or buccal meds
79
The patient is to use traditional metered-dose inhaler(MDI). What are the steps?
1. Patient shakes the MDI
2. Patient takes a deep breath and blows out completely
3. Patient places the mouthpiece of the inhaler in the mouth
4. Patient inhales slowly and pushes the canister
5. Patient continues to inhale for 3-5 secs and hold breath to 5-10 secs
6. Patient removes inhaler and exhales through pursed lips
80
How are meds that are reconstituted in vials mixed?
mixed by rolling the vial in the hands. Shaking the vial can create excess air bubbles
81
The nurse assesses the area where an injection will be given. What assessment findings will require the need to use a different site?
If the area has moles, scars, rashes, or breaks in the skin, the area should not be used for an injection
82
What is the anatomic landmarks for the deltoid injection? Vastus lateralis?
Deltoid- place ring finger along the lower edge of the acromial process, with the middle finger (and possibly index finger) joined with the ring finger. The point of injection is midline immediately below the middle or index finger in line with the axilla
Vastus lateralis- place one hand below the greater trochanter of the femur, with the thumb pointing toward the knee to form an L or backward- L shape. Place the other hand above the knee, with the thumb pointing toward the hip to form an L or backward- L shape. The point of injection is in the center third of the lateral thigh between the hands and at the center of the side of the leg
83
Identify the steps in the procedure of a direct IV push of a med through a saline lock (intermittent access port)
Prepare the med in the syringe. A needleless port may be in place
Use an alcohol wipe to clean the injection port of the saline lock
Flush the IV per agency guidelines
Inject the med, adhering to safe med guidelines
Flush the IV
84
The Kefauver-Harris Drug amendments were passed in 1962 in order to:
require proof of drug safety and efficacy before marketing
85
Which of the following is a correct technique for use of an insulin pen?
Prime the pen with 2 units before use
86
A med order that is be administered immediately is:
diazepam 10 mg IV stat
87
Which one of the following actions performed by the new staff nurse and observed by the nurse manager requires additional instruction?
Apply topical medicated cream without gloves
88
The patient tells the nurse that he is experiencing nausea, vomiting, clumsiness, and blurred vision. He says that he has been taking a lot of vitamins. On the basis of the patient's symptoms, which vitamin does the nurse suspect is creating the adverse effects?
Vitamin A
89
The patient asks the nurse about different herbal therapies that may promote physical stamina and mental concentration. On the basis of the patient's request, the nurse provides info on:
ginseng
90
The patient is taking an herbal remedy for mild anxiety and difficulty sleeping. It also has the potential to interact with antidepressant medications. The nurse expects that this patient is taking:
St. John's wort
91
The patient is to be given the med that is enclosed in a cylindrical gelatin coating. The nurse knows that this med comes in the form of a :
capsule
92
The patient receiving an IV infusion of morphine sulfate begins to experience respiratory depression and decreased urine output. This effect is described as:
toxic
93
The patient is to receive a med via the buccal route. The nurse plans to implement which action?
Place the med inside the cheek
94
The physician orders 100 mg of a hypnotic med to help the patient sleep. The label on the med bottle reads Seconal 50 mg. How many tabs should the nurse give the patient?
2
95
The doctor has ordered 6 mg morphine sulfate every 3 to 4 hours prn for a patient's post op pain. The unit dose in the med dispenser has 15 mg in 1 mL. How much solution should the nurse give?
2/5 mL
96
The nurse is documenting administration of a med that is given at 1000, 1400, and 1800. The med that the nurse is documenting is:
diazepam 10 mg PO tid
97
The nurse is working on the peds unit. In preparing to give meds to a preschool age child, an appropriate interaction by the nurse is:
" would you like the med with water or juice?
98
A patient has a prescription for a med that is administered via an inhaler. In order to determine if the patient requires a spacer for the inhaler, the nurse will determine the:
ability of the patient to control the rate of inhalation
99
The student nurse reads the order to give a 10-month old patient an IM injection. The appropriate and preferred muscle to select for a child is the:
vastus lateralis
100
The nurse administers the IM med of ion by the Z-track method. The med was administered by this method to:
prevent the drug from irritating sensitive tissue
101
The patient is ordered to have eyedrops administered daily to both eyes. Eyedrops should be instilled on the :
lower conjunctival sac
102
Following the administration of eardrops to the left ear, the patient should be positioned:
right lateral
103
An order is written by the prescriber for Demerol 500 mg IM q3-4h prn for pain. The nurse recognized that this is significantly more than the usual therapeutic dose. The nurse should:
call the prescriber to clarify the order
104
An order is written for 80 mg of a med in elixir form. The med is available in 80 mg/tsp strength. The nurse prepare to administer how much?
5 mL
105
The nurse prepares to administer an ID injection for the administration of med for:
allergy sensitivity
106
The nurse is evaluating the integrity of the ventrogluteal injection site. The nurse finds the site by location the:
greater trochanter, anterior iliac spine, and iliac crest
107
The patient is to receive heparin by injection. The nurse prepares to inject the med in the patient's
abdomen
108
A med is prescribed for the patient and is to be administered by IV bolus injection. A priority for the nurse before the administration of med via this route is to:
confirm placement of the IV line
109
The nurse recognizes that an example of a Schedule II med is:
morphine
110
A priority for the nurse in the administration of oral meds and prevention of aspiration is:
checking for gag reflex
