Enteral and Parental Meds ( Chap 21 and 22) Flashcards
The nurse is administering a buccal medication. Which instruction should be given to the patient?
a. Hold the medication under the tongue.
b. Swallow the medication after 30 seconds.
c. Chew the medication before swallowing.
d. Hold the medication against the cheek membranes.
ANS: D
Buccal medication is placed between the upper or lower molar teeth and the cheek area and is allowed to dissolve. The sublingual route is used to administer medication under the tongue. Medication is dissolved rather than swallowed using the buccal route.
The nurse is preparing to administer a medication. Which of the following is the most critical to assess before medication administration?
a. Diet history
b. Allergy history
c. Surgical history
d. Drug tolerance
ANS: B
Drug allergies should be listed on each page of the MAR, prominently displayed on the patient’s medical record, and the patient should be wearing the facility’s allergy bracelet. Assessment for drug allergies is necessary before medication is administered. A patient’s diet, surgical, and drug histories are important to assess, but they are not as critical as allergy history, which can reveal life-threatening conditions.
The nurse is preparing oral medications for administration. Which action by the nurse is appropriate?
a. Using a cutting device to cut scored tablets
b. Unwrapping all of the medications to be given and placing them together in a cup
c. Crushing capsules and enteric-coated medication for easier swallowing
d. Holding the medication cup at eye level to pour a liquid dosage
ANS: A
If you have to break a medication to administer half the dosage, use a clean, gloved hand to break the tablet or cut it with a cutting device. Tablets that are to be broken in half must be pre-scored by a manufactured line that transverses the center of the tablet. Tablets that are not pre-scored cannot be broken into equal halves, and the result will be an inaccurate dose. Using a cutting device results in a more even split of the tablet. Wrappers maintain the cleanliness of medications and identify drug name and dose. Not all drugs can be crushed (e.g., capsules, enteric-coated, long-acting/slow-release drugs). The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids. Liquid medications poured from a stock bottle should be poured into a medication cup that is placed at eye level on a flat surface.
The nurse is caring for four patients who require medications at 0900. Which action by the nurse adheres to the six rights of medication administration?
a. Prepare medications for all of the patients at once and keep the cups separate.
b. Ask the supervisor to clarify an unclear medication order.
c. Give the prescribed anticonvulsant between 0830 and 0930.
d. Leave each patient’s medications at the bedside and return within 30 minutes to make sure they have been taken.
ANS: C
Time-critical medications such as anticonvulsants must be given within 30 minutes of the prescribed time. Prepare medications for one patient at a time. Keep all pages of the MAR for one patient together. This prevents preparation errors. Unclear orders should be clarified with the prescriber before administration. Stay with each patient until the medication is swallowed completely or is taken by the prescribed route.
What should the nurse do to assist a patient who is having difficulty swallowing tablets?
a. Administer the medication with less fluid.
b. Insert a nasogastric tube and instill the medication.
c. Crush the medications and administer with a small amount of food.
d. Administer the tablets one at a time with plenty of water.
ANS: C
If the patient has difficulty swallowing, use a pill-crushing device to crush the tablets. Mix the ground tablet in a small amount of soft food (custard or applesauce). Large tablets are often difficult to swallow. A ground tablet mixed with palatable soft food is usually easier to swallow. Not all drugs can be crushed (e.g., capsules, enteric-coated, long-acting/slow-release drugs). The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids. Administration of medication with less fluid could make it more difficult for the patient to swallow. Insertion of a nasogastric tube requires an order from the health care provider. A patient who is having difficulty swallowing may not be safe when swallowing large capsules or tablets even one at a time. Thin liquids such as water are more readily aspirated than thickened liquids.
The nurse is preparing to administer a pediatric dose of liquid medication to an infant. Which action by the nurse is appropriate?
a. Empty the unit-dose container into a plastic cup.
b. Gently shake the multi-dose bottle before pouring the medication.
c. Draw the medication into a syringe with a needle.
d. Use an oral syringe to measure liquid dosages greater than 25 mL.
ANS: B
If the liquid medication is in a multi-dose bottle, gently shaking the bottle ensures that the correct amount of medication, not just the solvent, is measured for the dose. If the medication is in a unit-dose container in the correct amount to be administered, no further preparation is necessary. If giving less than 10 mL of liquid medication, use an oral syringe. Do not use a syringe with a needle. The medication may be accidentally given parenterally, or the needle may become dislodged and aspirated during administration.
The patient is unable to sit upright for medication administration. The nurse should assist the patient to which position to decrease the risk for aspiration?
a. Prone
b. Supine
c. Side-lying
d. Dorsal recumbent
ANS: C
Assist the patient to a side-lying position if sitting is contraindicated by the patient’s condition. This decreases the risk for aspiration during swallowing. Swallowing is difficult or impossible in the prone position. The risk for aspiration is increased when the patient is swallowing in the supine position or in the dorsal recumbent position.
The nurse is preparing to give sublingual nitroglycerin to a patient complaining of chest pain. The nurse instructs the patient not to swallow the medication. Why is this instruction important?
a. The effects of the medication will be nullified if swallowed.
b. Sublingual drugs begin to dissolve when placed on the tongue.
c. The medication needs to be held against the cheek membranes until dissolved.
d. The patient may aspirate on the water used for these medications.
ANS: A
If swallowed, the drug is destroyed by gastric juices or is detoxified so rapidly by the liver that therapeutic blood levels are not attained. Orally disintegrating formulations begin to dissolve when placed on the tongue. Sublingually administered medications are placed under the tongue and are allowed to dissolve completely. Water is not needed with these medications.
The nurse is preparing a medication for a small child. The medication comes in pill or liquid form, but the liquid preparation has a bitter taste. Which action by the nurse is most appropriate?
a. Give the pill form.
b. Mix the liquid with honey.
c. Mix the liquid in milk.
d. Mix the liquid in applesauce.
ANS: D
Children will refuse bitter or distasteful oral preparations. Mix the drug with a small amount (about 1 tsp) of a sweet-tasting substance such as jam, applesauce, sherbet, ice cream, or fruit puree. Offer the child juice or a flavored ice pop after medication administration. Liquid forms of medication are safer to swallow to avoid aspiration of small pills. Do not use honey in infants because of the risk for botulism. Do not place medication in an essential food item such as milk or formula; the child may refuse the food at a later time.
The nurse is preparing to administer aspirin to a patient via an enteral feeding tube. Which form is appropriate for the nurse to administer?
a. Crushed chewable aspirin
b. Liquid aspirin
c. Enteric-coated aspirin
d. Sustained-release aspirin capsule
ANS: B
Preferably, medications administered by enteral tubes should be given in liquid form. If liquid form is not available, you will have to modify the form of the medication tablet by crushing or dissolving it. However, you cannot crush sustained-release, chewable, long-acting, or enteric-coated tablets and capsules. Therefore, do not administer these medications by enteral tubes. Consult with the hospital pharmacy when in doubt.
The nurse is preparing to administer a medication via a jejunostomy tube to a patient who is receiving continuous tube feedings. The medication needs to be given on an empty stomach and comes only in tablet form. What action should the nurse take first?
a. Add the medications directly to the tube feeding.
b. Flush the tubing before the medication is given.
c. Stop the feeding 30 minutes before medication administration.
d. Dissolve the medication in cold water.
ANS: C
If the patient needs to take the medication on an empty stomach, stop the feeding 30 minutes before medication administration to facilitate absorption of the medication. Never add crushed medications directly to the tube feeding. Whenever possible, use liquid medications instead of crushed tablets, but if you have to crush tablets, the tubing must be flushed before and after the medication is given to prevent the drug from adhering to the inside of the tube. Dissolve in at least 30 mL of warm water. Cold water causes gastric cramping.
The nurse is to administer several medications to a patient via a nasogastric (NG) tube. What should the nurse do first?
a. Add the medications to the tube feeding being given.
b. Crush all tablets and capsules before administration.
c. Administer all of the medications mixed together.
d. Check for placement of the NG tube.
ANS: D
Check the placement of the feeding tube by observing gastric contents and checking the pH of aspirated contents. Gastric pH should be 4 or less. This ensures proper tube placement and reduces the risk of introducing fluids into the respiratory tract. Never add medications directly to the tube feeding. Not all tablets can be crushed, such as sustained-release tablets, nor should all capsules be opened. Medications should be reviewed carefully before a tablet is crushed or a capsule is opened. To administer more than one medication, give each separately, and flush between medications with 10 mL of water. Keeping the medications separate allows for accurate identification of medication if a dose is spilled. In addition, some medications are not compatible with each other, and this may cause clogging of the tube.
When preparing to administer medication via a nasogastric tube, the nurse aspirates 275 mL of gastric residual. What is the first action the nurse should take?
a. Wait 1 hour and recheck the residual.
b. Administer the medication with more fluid.
c. Return the aspirate and withhold the medication.
d. Attach the nasogastric tube to suction to remove additional volume.
ANS: C
Return aspirated contents to the stomach unless a single volume exceeds 500 mL or two measurements taken 1 hour apart each exceed 250 mL. When gastric residual is greater than 250 mL, the medication is withheld and the residual is rechecked in 1 hour. Large-volume aspirates indicate delayed gastric emptying and place the patient at risk for aspiration. Additional fluid would not be administered if the patient had a large residual. Use of suction would require an order from the health care provider.
The patient is to receive three different medications via a nasogastric tube. What is the total amount of water the nurse should prepare to administer?
a. 30 mL of water
b. 60 mL of water
c. 90 mL of water
d. 250 mL of water
ANS: C
30 mL of water is administered before the medications, 15 to 30 mL of water is administered after each of the first two medications, and 30 to 60 mL is administered after the third medication, so 90 to 150 mL of water is needed.
The nurse is applying a new nitroglycerin transdermal patch. Which action by the nurse is appropriate?
a. Instructing the patient to wear the patch 24 hours a day every day
b. Applying the new patch to the same site as the previous patch
c. Cutting the patch in half when a change of dose is ordered
d. Instructing the patient to avoid heat sources over the patch
ANS: D
Heat sources over a transdermal patch can increase the rate of absorption, leading to potentially serious adverse effects. It is recommended to have a daily “patch-free” interval of 10 to 12 hours because tolerance develops if patches are used 24 hours a day every day. The patch should not be applied to previously used sites for at least 1 week. Transdermal patches are never to be cut in half. A change in dosage requires a new prescription.
The nurse is teaching a patient how to use a topical medication. Which statement indicates an understanding of the procedure?
a. “If the patch starts to come off, I can secure it with tape.”
b. “If the patch falls off, I will put a new one on in the same place.”
c. “If my skin is irritated, I will cleanse it using water only.”
d. “I can dispose of used materials in the household trash as usual.”
ANS: C
If skin is inflamed, instruct patients to use only warm water rinse without soap for cleansing.
Instruct the patient on how to manage a transdermal patch that begins to peel off before the next dose is due. Rather than tape the patch or cover it, instruct the patient to remove the patch, clean the skin, and apply a new patch to a different area. Instruct the patient to wrap applicators, used patches, and similar materials and dispose of them into cardboard or plastic disposable containers. Careful disposal is necessary to ensure the safety of the patient, other adults, pets, and children.
The patient is prescribed an ophthalmic medication via an intraocular disc. Which action by the nurse is appropriate when administering the medication?
a. Place the disc in the conjunctival sac.
b. Apply sterile gloves before placing the disc.
c. Pull on the patient’s upper eyelid and ask the patient to look up.
d. Instruct the patient that the disc will be changed daily.
ANS: A
Medications delivered by disc resemble a contact lens, but the disc is placed in the conjunctival sac, not on the cornea. Clean gloves are used to place and remove the disc. The lower eyelid is pulled down and the patient is asked to look up. The disc remains in place for up to 1 week.
The patient has eyedrops ordered daily to both eyes. Which action by the nurse is appropriate when administering the medication?
a. Carefully place the drop on the cornea.
b. Wipe the eye with a tissue after placing the eyedrop.
c. Hold the eyedropper about 1 to 2 cm above the eye.
d. Instruct the patient to squeeze the eye shut after instillation.
ANS: C
Holding the eyedropper approximately 1 to 2 cm ( to inch) above the conjunctival sac of the eye prevents accidental contact of the eyedropper with the eye and reduces risk for injury and transfer of microorganisms to the dropper. The cornea is very sensitive. If drops were instilled onto the cornea, this would stimulate the blink reflex. The tissue should be placed just below the lower eyelid so medication that escapes the eye is absorbed. Wiping the eye removes too much of the medication. Squinting or squeezing the eyelids after instillation forces the medication from the conjunctival sac.
The nurse is preparing to administer an eye ointment to the patient. Which action by the nurse is appropriate?
a. Clean away drainage or crusts by wiping from the outer to the inner canthus.
b. Instruct the patient to keep the eye open for 2 minutes after instillation.
c. Apply a thin ribbon evenly along the inner edge of the lower eyelid.
d. Instruct the patient to avoid wiping the eye after instillation.
ANS: C
While holding the ointment applicator above the lower lid margin, apply a thin ribbon of ointment evenly along the inner edge of the lower eyelid on the conjunctiva from the inner canthus to the outer canthus. This distributes medication evenly across the eye and lid margin. Eyes are cleansed from the inner to the outer canthus to avoid entry of microorganisms into the lacrimal duct. After instillation, the patient is instructed to close the eye and rub the lid lightly in a circular motion, if not contraindicated, to distribute the medication. If excess medication is on the eyelid, it can be gently wiped from the inner to the outer canthus.
A patient is experiencing a systemic effect from eyedrops. Which assessment finding by the nurse is indicative of this?
a. Headache
b. Reddened eyes
c. Darkened conjunctiva
d. Elevated pulse and blood pressure
ANS: D
An unexpected outcome is noted when the patient experiences systemic effects from drops (e.g., increased heart rate and blood pressure from epinephrine, decreased heart rate and blood pressure from timolol). Local side effects include headache, bloodshot eyes, and local eye irritation.
A nurse is preparing to administer eardrops to an adult patient. Which action should be taken by the nurse?
a. Warm the medication to room temperature using warm water.
b. Pull the pinna down and back to straighten the ear canal.
c. Apply gentle pressure or massage to the pinna of the ear.
d. Remove cerumen from the inner ear canal with a cotton-tipped applicator.
ANS: A
Internal ear structures are very sensitive to temperature extremes. Failure to instill a solution at room temperature can cause vertigo (severe dizziness) or nausea and can debilitate a patient for several minutes. Pulling the pinna down and back is the procedure for children aged 3 and younger. Do not massage the pinna of the ear; instead massage the tragus. Gentle pressure or massage to the tragus of the ear moves medication inward. Cerumen is removed from the outer canal only.
The nurse administers eardrops in the patient’s left ear. Which of the following positions is appropriate after instillation of the drops?
a. Prone
b. Upright
c. Right lateral
d. Dorsal recumbent with hyperextension of the neck
ANS: C
The patient should remain in the side-lying position, with the treated ear upward for a few minutes. Upright, prone, and dorsal recumbent positions are not recommended after administration of eardrops. The eardrops would run out of the ear canal.
How should the nurse position the patient to administer nose drops to the maxillary sinus?
a. Sitting upright with the head tilted backward toward the side to be treated
b. Supine with a small pillow under the shoulders and the head tilted backward
c. Supine with the head tilted backward and turned to the unaffected side
d. Head tilted back over the edge of the bed and turned toward the side to be treated
ANS: D
For access to the frontal and maxillary sinus, tilt the head back over the edge of the bed or pillow with the head turned toward the side to be treated. This position allows medication to drain into the affected sinus. For access to the posterior pharynx, tilt the patient’s head backward. For access to the ethmoid or sphenoid sinus, tilt the head back over the edge of the bed or place a small pillow under the patient’s shoulder and tilt the head back.
The nurse is teaching a mother how to administer nasal drops to her infant. What should be included in the teaching plan?
a. Over-the-counter nasal drops can be saved and used later.
b. Nasal decongestants are safe and have no serious side effects.
c. Infants should receive nose drops 20 to 30 minutes before feedings.
d. Infants are mouth breathers, so nasal medications are well tolerated.
ANS: C
Infants are nose breathers, and the possible congestion caused by nasal medications may inhibit their sucking. Administer nose drops 20 to 30 minutes before feedings. Over-the-counter nasal sprays or nose drops should be used for only one illness; bottles become easily contaminated with bacteria. Nasal decongestants can enter the systemic circulation by way of the nasal mucosa or the gastrointestinal tract if swallowed, causing restlessness, nervousness, tremors, or insomnia in some patients. Long-term use can worsen nasal congestion through a rebound effect.
Several patients have been prescribed inhalation medications. The nurse is aware that a spacer will be beneficial for which patient?
a. A young child using a dry powder inhaler
b. An elderly patient who uses a metered-dose inhaler
c. A teenager who has just started using a nebulizer
d. A young child who needs medication several times per day
ANS: B
Because use of a metered-dose inhaler (MDI) requires coordination during the breathing cycle, many patients spray only the back of their throat and fail to receive a full dose. The inhaler must be depressed to expel medication just as the patient inhales. This ensures that the medication reaches the lower airways. Poor coordination can be solved by the use of spacer devices. Coordination is not necessary with dry powder inhalers or nebulizers. The use of a spacer is not dependent on the schedule of administration.
The nurse is teaching a patient how to use a metered-dose inhaler without a spacer. Which action by the patient demonstrates correct use of the device?
a. Being careful not to shake the canister
b. Positioning the mouthpiece in front of the mouth while not touching the lips
c. Depressing the canister fully, waiting 3 to 5 seconds, then inhaling slowly and deeply
d. Taking another puff of the medication within 10 seconds
ANS: B
The best way to deliver medication without a spacer is to position the mouthpiece 2 to 4 cm in front of a widely opened mouth with the opening of the inhaler toward the back of the throat. The lips should not touch the inhaler. Shaking the inhaler before administration is the correct procedure; it mixes the medication within the canister. The correct procedure is to depress the canister fully while inhaling slowly and deeply through the mouth for 3 to 5 seconds. A wait of 20 to 30 seconds is advised between doses of the same medication; 2 to 5 minutes is the standard time between doses of different medications.
The patient has a bronchodilator and an inhaled steroid scheduled for the same time. What teaching should the nurse provide to the patient about administering these medications?
a. Inhale the bronchodilator, wait 20 to 30 seconds, then inhale the steroid.
b. Inhale the bronchodilator, wait 2 to 5 minutes, then inhale the steroid.
c. Inhale the steroid, wait 20 to 30 seconds, then inhale the bronchodilator.
d. Inhale the steroid, wait 2 to 5 minutes, then inhale the bronchodilator.
ANS: B
Drugs must be inhaled sequentially. If bronchodilators are administered with inhaled steroids, the bronchodilators should be given first to dilate the airway passages for the second medication. The patient is instructed to wait 2 to 5 minutes between inhalations when different medications are being given. The patient is instructed to wait 20 to 30 seconds between inhalations if the same medication is being taken.
The nurse is administering a beta-adrenergic medication via a small-volume nebulizer. Which assessment finding requires the nurse to withhold the medication immediately?
a. Episodes of coughing
b. Rapid and shallow respirations
c. Wheezing noted on auscultation of the lungs
d. Irregular pulse with light-headedness
ANS: D
If the patient experiences cardiac dysrhythmias (light-headedness, syncope), especially if receiving beta-adrenergics, withhold all additional doses of medication, assess vital signs, and notify the prescriber regarding reassessment of the type of medication and delivery method. Coughing, rapid and shallow respirations, and wheezing would be assessed and recorded, but this would not necessarily require discontinuation of treatment. The prescriber would be notified to reassess the type of medication and/or delivery system.
The patient is receiving vaginal suppositories for a vaginal infection. Which assessment finding by the nurse indicates a desired outcome of the treatment?
a. The patient reports pruritus and burning.
b. The vaginal walls are bright red in color.
c. White curdlike patches appear on the vaginal walls.
d. Vaginal discharge the same color of the medication is noted.
ANS: D
Some vaginal discharge that is the same color as the medication is an expected outcome after vaginal instillation. Local pruritus and burning indicate inflammation or infection and is an unexpected outcome. Bright red vaginal walls or white curdlike patches are signs of a possible yeast infection.
The nurse is preparing to administer a rectal suppository to a patient. The patient should be assisted to which position for insertion of the rectal suppository?
a. Prone
b. Supine
c. Dorsal recumbent
d. Left Sims’ position
ANS: D
Left side-lying Sims’ position exposes the anus and helps the patient to relax the external anal sphincter, while lessening the likelihood that the suppository or feces will be expelled. Supine and dorsal recumbent positions would make access to the anus difficult and would allow the suppository to slip out. The prone position would make inserting the suppository difficult.
The nurse is preparing to administer a rectal suppository to an adult patient. Which action should be taken by the nurse?
a. Apply sterile gloves before handling the suppository.
b. Apply extra lubricant to the suppository if there is active rectal bleeding.
c. Insert the suppository past the internal sphincter, against the rectal wall, about 6 to 10 inches.
d. Instruct the patient to remain lying flat or on the side for 5 minutes after insertion of the suppository.
ANS: D
Lying flat or on the side for 5 minutes after the suppository is inserted prevents it from being expelled. Administering a suppository is not a sterile procedure; clean examination gloves are used. A suppository is contraindicated in the presence of active bleeding. The suppository is inserted 4 inches (10 cm).
