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Essentials of Nursing 2024 > Essentials Exam 2 > Flashcards

Essentials Exam 2 Flashcards

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1
Q

Nurse Practice Act: 5 points? (for meds)

A

– Locked storage
– Change of shift count
– Sign out system for each narcotic
dispensed
– 2nd nurse verification and witness
– Disposal/waste policies

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2
Q

Medication names: chemical, generic, trade/brand. Which one is most important to know

A

Chemical: N-(4-hydroxyphenyl)acetamide
Generic: Acetaminophen
Trade/Brand/Proprietary: Tylenol

need to know generic names!!!!

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3
Q

can drugs have more than one classification?

A

yes, it’s the effect of the medication on the body’s system

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4
Q

routes of med administration

A

non-parenteral
parenteral

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5
Q

absorption: (in med administration terms)

A

Passage of medication INTO THE BLOOD from administration site

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6
Q

distribution: (in med administration terms)

A

Distribution occurs within the body to specific sites of action.

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7
Q

metabolism: (in med administration terms)

A

Medications are metabolized into a less-
potent or an inactive form

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8
Q

half-life:

A

The time required for a quantity to
reduce to half its initial value

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9
Q

Biotransformation

A

enzymes detoxify, break
down, and remove active chemicals

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10
Q

where does the most biotransformation occur

A

occurs in the liver

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11
Q

Excretion (med administration)

A

How medications exit the body

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12
Q

routes of excretion

A

– Kidney: Main organ of excretion
– Liver: Excreted in bile (then in stool)
– Bowel
– Lungs: Nitrous oxide (anesthesia) and alcohol
– Exocrine glands

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13
Q

ADME: route of medication

A

absorption, distribution, metabolism, excretion

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14
Q

Therapeutic effect

A

– Expected or predicted physiological response

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15
Q

Adverse effect

A

– Unintended, undesirable, often unpredictable

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16
Q

Side effect

A

– Predictable, unavoidable secondary effect

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17
Q

Toxic effect

A

– Accumulation of medication in the bloodstream
» Damaging or lethal effect

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18
Q

idiosyncratic reaction

A

– Over-reaction/under-reaction or different reaction from normal

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19
Q

allergic vs anaphylactic reaction

A

allergic: unpredictable response
anaphylactic: life-threatening response. swelling of tongue, throat, constriction of bronchial muscles

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20
Q

Drug-drug interaction

A
  • One drug decreases the efficacy of
    another
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21
Q

Synergistic effect

A
  • Combined effect of two
    medications are greater than the
    effect of the medications given
    separately
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22
Q

Time-critical medications

A

– Within 30 minutes of
scheduled dose

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23
Q

how to count zeros in medical calc

A

leading zeros but no trailing

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24
Q

can students take verbal orders?

A

no

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25
Q

can you use abbreviations during medicine orders?

A

no DO NOT USE abbreviations
ex of bad) subcutaneous: SQ, units: U, daily: qd

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26
Q

components of a medication order

A

pt name, generic med name, dose, form, route, frequency

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27
Q

PRN orders

A

as per needed
must include reason
ex) prn constipation

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28
Q

STAT orders

A

single dose given immediately

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29
Q

NOW orders

A

single dose within 90 minutes

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30
Q

six rights (there’s actually 7 so wtf)

A
    1. Right patient
      – 2. Right Medication
      – 3. Right Dose
      – 4. Right Route
      – 5. Right Time
      – 6. Right Documentation
      – 7. Right Indication
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31
Q

Med administration PMART

A

P-patient
M- medication
A- amount
R- route
T- time

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32
Q

Types of High-Alert Meds

A

insulin, heparin, IV push, narcotics

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33
Q

Reconciliation process

A

comparing order with the MAR

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34
Q

how many times do you check the MAR during medication administration?

A

3 times

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35
Q

Common routes of non-parenteral meds

A

oral, topical, inhalation, irrigation

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36
Q

common routes of parenteral

A

IM, SQ, ID, IV

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37
Q

which two types of tablets can never be crushed?

A

Enteric-coated or sustained-release tablets should
never be crushed

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38
Q

suspension (liquid meds)

A

shake container before administration

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39
Q

sublingual route

A

oral med is placed under tongue

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40
Q

buccal route

A

oral med is placed in the side of the mouth against the inner cheek

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41
Q

transdermal medications

A

designed to be absorbed through the skin
for systemic effect
extended release: 12 hours- 7 days

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42
Q

where to dispose of a transdermal med with controlled substances

A

Dispose of patch in a tamperproof,
childproof storage container/controlled
substance container

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43
Q

how to dispose of transdermal medications

A
  • Wear ‘clean’ gloves to prevent accidental
    exposure to the drug
    – Fold the patch in half, sticky sides together
    – Dispose in trash
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44
Q

why do you remove transdermal patches during a cardiac emergency

A

prevents burns during defibrillation

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45
Q

Pressurized metered-dose inhalers (pMDIs)

A
  • Need sufficient hand strength and coordination
    – Use a ‘spacer’: Enhances absorption
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46
Q

Breath-actuated metered-dose
inhalers (BAIs)

A
  • Release depends on strength of patient’s breath
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47
Q

Dry powder inhalers (DPIs)

A
  • Activated by patient’s breath
    – Delivers more medication
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48
Q

Bronchodilators

A

– Immediate relief of acute respiratory distress
» Asthma attack

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49
Q

Corticosteroids

A

– Long term effects
* Combination inhalers

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50
Q

why/when to rinse out mouth after inhaler

A

Steroids can alter normal flora
– Rinse out mouth after use (~2 min after)

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51
Q

Peak flow meter

A

used for resp assessment
blowing into hard and fast for a single blow

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52
Q

time in between puffs?

A

30-60 seconds

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53
Q

how to have a patient laying during nasal drops?

A

supine

54
Q

cons of using excessive nasal instillation

A

they may have systemic effects
such as increased heart rate and a rebound effect that increases congestion

55
Q

eye instillation proper administration

A

Avoid the cornea
* Look up and place drops in outer third of conjunctival sac
* ‘Ribbon of ointment’ from inner to outer canthus

56
Q

intraocular route

A

medicated contact lens
slow release: 1 week

57
Q

ear instillation “otic” administration

A

room temp
never occlude ear canal
use sterile solution

58
Q

how to pull ears (adults and children)

A

children < 3: down/back
> 3: up and out

59
Q

vaginal instillation

A

refrigerated and melts when inserted
allow self-administration if possible
remain supine for 10 minutes at least

60
Q

how to lay patient for rectal instillation

A

Left side lying
– Remain supine/side
lying for 5 minutes

61
Q

Cleansing enema solutions

A
  • Held in for short period of time
    (5 minutes)
    – Volume or expansion
    – Irritant
62
Q

Retention enema solutions

A
  • Held in for longer period of
    time (15 minutes)
    – Softens the stool
    » Water or oil based
63
Q

what to document after the use of an epipen

A
  • Document whether the injection was given in the left or right thigh.
    – Document the patient’s vital signs and response to the injection
64
Q

Polypharmacy

A

– Multiple medications
– Potentially inappropriate or unnecessary
medications
– When a medication does not match a diagnosis.

65
Q

definition of parenteral medications

A

administration of meds through a needles

66
Q

Pros and cons of parenteral meds

A

pro: faster absorption directly into body tissues. unconscious pt. nausea/vomiting
con: risk of tissue damage

67
Q

Luer-lock syringe

A

screw top

68
Q

hub of needle

A

connects the needle to the barrel
can read gauge number here

69
Q

shaft of needle

A

actual sticky into the skin part

70
Q

bevel of needle

A

sharp tip of a needle shaped like a little shovel

71
Q

gauge

A

needle diameter

72
Q

how to choose needle gauge

A

based on the viscosity of the medication

73
Q

filter needle

A

used when drawing meds from an ampule (prevents little glass from getting sucked up)

74
Q

where to dispose of needless-devices during injections

A

still red sharps bin

75
Q

SQ needle size? gauge/mL

A

1-3 mL 27-25 gauge

76
Q

insulin needle size? gauge/mL

A

.5-1 mL (preattached needle) 26-31 gauge

77
Q

intradermal needle size? gauge/mL

A

1 mL tuberculin syringe 26-27 gauge

78
Q

IM Adult needle size? gauge/mL

A

2-3 mL 20-25 gauge

79
Q

IM infant needle size? gauge/mL

A

0.5-1 mL 18-25 gauge

80
Q

IV needle size? gauge/mL

A

depends on infusion, typically large gauge

81
Q

Vial vs Ampule

A

Vial: best for STABLE elements
ampule: best for UNSTABLE elements

82
Q

when to wear gloves during injections

A

not usually necessary for preparation of syringe/meds
MUST wear during injection

83
Q

sharper vs less sharp bevel

A

sharper bevel = less pain

84
Q

angle of IM injection

A

90 degree

85
Q

angle of SQ injection

A

45-90 degree

86
Q

angle of intradermal injection

A

15 degrees

87
Q

where to give heparin and enoxaparin injections?

A

abdomen ONLY
rotate sites on abdomen

88
Q

Injection Pens

A

– Prefilled disposable cartridge

89
Q

Needleless Jet Injection

A

– Uses high pressure to penetrate the
skin

90
Q

Subcutaneous Injection device

A

– Cannula left in subcutaneous tissue for
several days

91
Q

IM injection suggested max for adults

A

3 mL, 1 mL deltoid

92
Q

IM injection suggested max for children

A

suggested max 1 mL

93
Q

steps for mixing meds in a vial and ampule

A

prepare meds from the vial first then ampule

94
Q

when preparing insulin which insulin do you draw up first

A

regular first
NPH second

95
Q

which insulins should never mix

A

long-lasting insulins
ex) glargine (lantus), detemir (levemir)

96
Q

NRRN insulin rule

A

N- air into NPH
R- air into regular
R- withdraw regular
N- withdraw NPH

97
Q

4 pros of IVs

A
  • Conscious or unconscious
  • Rapid effect
  • Only 1 needle stick for multiple medications
  • Allows use of drugs that may be unstable
98
Q

cons of IVs

A
  • Sterile Procedure
  • Risk of infection
  • Learned skill
  • Pain
  • Anxiety
  • Expense
  • Limited to highly soluble medications
  • Need ‘usable’ veins
99
Q

Bolus

A
  • fluid by injection or small volume of medication through an existing
    IV infusion line
    (NOT for nursing students)
100
Q

Piggyback

A
  • infusion of solution containing prescribed medication mixed in a small volume of IV fluid through an existing IV line
101
Q

exit port of IV

A

hole of IV bag leading to tubing

102
Q

bulb chamber of IV

A

where the drips take place

103
Q

protective cap of IV

A

end of tubing that’s removed to connect to IV line in patient

104
Q

5 high alert meds

A

potassium
insulin
narcotics
chemo
heparin

105
Q

bolus pros and cons

A
  • Advantageous for a patient who is on ‘fluid
    restriction’
  • Dangerous method for medication
    administration
  • No time to correct errors
106
Q

volume-controlled infusions and the pros

A
  • Uses small amounts (50 to 100 mL) of compatible fluids
    Types of containers:
  • Volume-control administration sets
  • IV Piggyback sets
  • Syringe pumps
  • Advantages
  • Reduces the risk of rapid-dose infusion by IV push
  • Allows for administration of medications that are stable for a limited time in solution
  • Allows control of IV fluid intake
107
Q

volume-control administration

A

150-mL containers that attach just below the infusion bag or bottle

108
Q

Isotonic solutions

A
  • Same osmolality of body fluids (NS)
  • 0.9% Normal Saline
  • LR-contains electrolytes and expands the vascular volume
109
Q

Hypotonic

A
  • Osmolality less than body fluids
  • Moving water into cells
110
Q

Hypertonic

A
  • Osmolality greater than body fluids
  • Move water out of cells into the intravascular space
  • 3% Normal Saline
111
Q

what to do before IV administration

A

Assess the patency and placement of the IV catheter
* Most common and effective is a normal
saline(NS) flush

112
Q

what to do after IV administration

A

The access line must be flushed with a solution to keep it
patent
* Flush with NS

112
Q

nursing action in the case of pulmonary edema/fluid overload

A

reduce flow rate of infusion

112
Q

phlebitis

A

trauma to veins caused by IV

113
Q

Major symptoms of phlebitis

A

red “streak”
palpable cord

114
Q

extravasation vs infiltration

A

chemical is more serious
have to aspirate from catheter
possible antidote

115
Q

extravasation symptoms

A

burning/stinging pain

116
Q

what to do first if there’s an error with the IV

A

stop infusion!

117
Q

when to calculate flow rate

A

when pumps are not available

118
Q

how to know the medication flow rate/calibration to set the iv to

A

on the package of the medication

119
Q

normal range for blood glucose levels

A

70-99 mg/dl

120
Q

differences between type I/II diabetes

A

type I:
symptoms typically start in childhood
episodes of LOW blood sugar too
cannot be prevented
type II:
increased cases of diagnosis in childhood but mostly adulthood
NO low blood sugar episodes
can be prevented/delayed

121
Q

hypoglycemia symptoms

A

shaking, high HR, sweats, anxious, dizzy, hungry, impaired vision, fatigue, headache, irritable

122
Q

hyperglycemia symptoms

A

thirst, frequent urination, dry skin, hunger, impaired vision, drowsy, nausea

123
Q

Three Ps of hyperglycemia

A

polydipsia
polyuria
polyphasia

124
Q

polydipsia

A

thirst

125
Q

polyuria

A

increased urination

126
Q

polyphasia

A

hunger

127
Q

Diabetic ketoacidosis

A

– Without enough insulin, body begins
to break down fat for fuel
* process produces a buildup of
acids/ketones
» Life threatening condition

128
Q

accucheck

A

blood glucose monitoring

128
Q

Diabetic ketoacidosis symptoms

A

thirst, urination increase, abdominal pain, SOB

128
Q

3 domains of learning

A
  • Cognitive (knowledge)
  • Affective (attitude)
  • Psychomotor (skill)

Essentials of Nursing 2024 (3 decks)

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