clinical book CH 21 Oral & topical medications Flashcards
An infant is to receive 4mL of an antibiotic by mouth. which equipment would be most appropriate for preparation and administration?
- a teaspoon
- a plastic medication cup
- a syringe
- an oral-dosing syringe
- an oral-dosing syringe
Rationale: An oral dosing syringe has the appropriate markings for accuracy and usually has a protective covered tip to prevent it from being lost in the infant’s environment.
A pt says that he has difficulty swallowing pills and would prefer to chew them. one of the medications is an extended-release tablet. Which is the appropriate action in response to his request?
- break the tablet into halves or quarters so they are not as difficult to swallow.
- encourage the pt to chew the tablet instead.
- Educate the pt on the purpose of the extended release tablets.
- Crush the tablet and mix in applesauce.
- Educate the pt on the purpose of the extended release tablets.
Rationale: Explain that the tablet is formulated to release slowly over time and should not be crushed, broken or chewed.
A pt is to receive medications through a gastrostomy. Which nursing actions are appropriate? (select all that apply)
- Verify tube placement after medications are given,
- mixing all crushed medications together and give all at once.
- flushing tube with cold water after giving medications.
- Flushing tube with 30 to 60 mL of water after the last dose of medication
- Checking the gastric residual before giving medications
- Keeping the head of the bed elevated 30 to 60 minutes after the medications are given.
- Flushing tube with 30 to 60 mL of water after the last dose of medication
- Checking the gastric residual before giving medications
- Keeping the head of the bed elevated 30 to 60 minutes after the medications are given.
Rationale: the tube should be adequately flushed after the last dose of medication to decrease the chance of crusting inside the tube and to ensure that all the medication has left it. Gastric residue should be checked before giving medications. If too much gastric content is still left in the stomach, there mat be a problem with the pt’s rate of absorption, which can affect the medication absorption as well, the head of the bed should be left elevated to prevent aspiration.
An immunocompromised pt has an open wound that needs topical medication. Which nursing technique is most appropriate?
- use clean gloves when applying medication.
- use sterile gloves when applying medication.
- previously applied medication should remain on the wound surface.
- be sure to apply a thick layer of medication over the wound.
- use sterile gloves when applying medication.
Rational: Because the pt is immunocompromised and has a large wound, sterile gloves should be used when applying medication because of risk for infection.
A pt is using trans-dermal patches to relieve his mild cardiac pain. Which pt statement demonstrates understanding of the use of trans-dermal patches?
- “I’ll need to apply the patch to a different area each time.”
- ” I need to leave the old patch on to make sure I receive all the medicine.”
- ” If I get a headache from this medicine, I’ll cut the patch in half.”
- “It doesn’t matter where I throw away the old patch because the medicine is gone.”
- “I’ll need to apply the patch to a different area each time.”
Rationale; Applying the patch to a different area each time prevents skin irritation, which would affect the absorption rate.
The nurse is caring for a t who is receiving nitroglycerin ointment. which nursing intervention is most appropriate to protect the nurse against accidental exposure?
1 Cleaning the skin thoroughly before applying the next dose of medication.
2. Wearing gloves when applying the ointment.
3. Using the appropriate applicator to apply the medication.
4. Drawing blood test for therapeutic drug values.
- Wearing gloves when applying the ointment.
Rationale: Wearing gloves minimizes the likelihood of the nurse being exposed to the medication.
the nurse is educating an adolescent about using a metered-dose inhaler (MDI) for exercise induced asthma. The nurse knows that teaching was successful when the pt states:
- “I’ll rinse my mouth thoroughly after I use my inhaler.”
- “I’ll wait 5 to 10 seconds between inhalations “
- “I’ll position the inhaler between my lips and pointed toward the top of my mouth.”
- “I hould hold my breath 20 to 30 seconds after each inhalation.”
- “I’ll rinse my mouth thoroughly after I use my inhaler.”
Rationale; Steroid use can cause oral candidiasis, and therefore the mouth should be rinsed to avoid complications.
A nurse is caring for an adult pt who is resistant to receiving his ear medication because th elast time it made him nauseated. Which nursing intervention will reduce the chance that this complication will happen again?
- position the pt is supine position with his affected ear facing upward.
- Pulling the pinna upward and outward.
- Gently cleaning out any cerumen impaction before administering medication
- running warm water over the medicine bottle to warm the medication
- running warm water over the medicine bottle to warm the medication.
Rationale; Warming the medication is less irritating to the nerves in the ear and will reduce vertigo.
the nurse is administering nasal drops for a maxillary sinus infection. How should the nurse position the pt to administer the drops?
- Tilt the pt’s head over a pillow with head turned to the affected side.
- Tilt the pt’s head backwards over the edge of the bed.
- place a small pillow under the pt’s shoulder and tilt head back.
- Lower the head of the bed and have the pt lie supine
- Tilt the pt’s head over a pillow with head turned to the affected side.
Rationale: this is the correct position for administering medication to the maxillary sinus.
A nurse is administering an opthalmic ointment to a pt with conjunctivitis. place the steps of the procedure in the correct order.
- Clean eye, washing from inner to outer canthus
- assess condition of external eye structure
- Apply thin ribbon of ointment evenly along inner edge of lower eyelid on conjunctiva.
- Have pt close eye and rub lid lightly in circular motion with cotton ball.
- Ask pt to look at ceiling and explain steps to him or her.
2,1,5,3,4
This is the correct order of action for administering opthalmic ointment to a pt.
Which nursing action has the highest priority for a patient receiving medication via a nasogastric feeding tube?
A) Flush with 30 mL of water before and after feedings.
B) Keep head of bed elevated above 30 degrees for at least 30 to 60 minutes after feeding.
C) Wait 30 to 60 minutes after feeding to reconnect to suctioning.
D) Change the feeding pump bag and tubing every 24 hours.
A
Flushing before and after feeding ensures patency of the feeding tube and correct delivery of the medication. Although keeping the head of the bed elevated is an important step in preventing aspiration, the patency of the tube is a higher priority in correct administration of medication through this route. While waiting the correct amount of time before connecting suctioning and changing the bag on an appropriate schedule are important, flushing is a much higher priority. (REF: pp. 503-504)
Which task would be most appropriate for the nurse to delegate to the nursing assistive personnel (NAP)?
A) Administering oral medications
B) Documenting patient’s response to medication
C) Reporting any changes in patient’s status after medication administration
D) Calling the pharmacy to clarify the correct dose of medication
C
The NAP has a limited scope of practice; the most appropriate delegation is to have the NAP report changes in the patient’s status. (REF: p. 494)
The nurse is caring for a patient who has an order for an acetaminophen (Tylenol) rectal suppository. Which finding contraindicates the use of a rectal suppository? A) Rectal hemorrhoids B) Presence of a fever C) Rectal bleeding D) Constipation
C
Rectal suppositories are contraindicated in patients with rectal, bowel, or prostate surgery or with active rectal bleeding. (REF: p. 533)
When a patient self-administers a vaginal suppository, which behavior would require further teaching? (Select all that apply)
A) The patient voids before insertion.
B) The patient lies on her left side.
C) The patient uses her dominant hand to insert the suppository along the posterior wall of the vaginal canal.
D) The patient inserts the suppository 10 cm (4 inches) into the vaginal canal.
B and D
Answer B describes the correct position for a rectal suppository, and answer D explains the correct distance for insertion of a rectal suppository. (REF: pp. 531-532)
