Final exam review Flashcards
what are the rights of medication administration
right patient, dose, route, time, medication, documentation
What is the oral route of administration
swallowed by mouth
Sublingual route of administration
under the tongue (ex. zofran)
Buccal route of administration
between the cheek and teeth
What are the parenteral routes of administration
intradermal, subcutaneous, intramuscular, intravenous
What are the two ways to administer topical medications
absorb through skin, on mucous membranes
What are considered topical medications that go on mucous membranes?
suppositories , vaginal creams
What is the inhalation route
inhaled into lungs
What is the intraocular route
absorbs in the eye (eye drops)
Verbal medication orders from the provider should be?
repeated back. provider must confirm it is correct
If a nurse questions an order, who should they go to?
the physician that wrote it
Can insulin ‘units’ be abbreviated?
no
What is a routine/standing order
given until it is changed or discontinue d
What is a single/one-time order
given one time only for a specific reason
What is a now order
give within 90 minutes
what is a prn order
given when patient requires it (must state reason why they need it)
what is a STAT order
given immediately ; used in emergencies
what is a prescription order
medication to be taken outside of hospital
Can the nurse use the patients room as an identifier before administering medications
no
Why is a medication reconciliation helpful
reduces likelihood of medication error
Who must report an error?
whoever discovers it
If a nurse knows they have made a medication error, must they report it?
YES
Why should nurses report medication errors and near misses
maintains safety and reduces chance of reoccurrence
All sharps must be placed in?
biohazard container
If the sharps container is 2/3 full, can we put more in there
NO
least invasive route of medication
oral
How to prevent aspiration when taking oral meds
chin to chest, sit up 90 degrees
When administering small-bore / enteral feedings, the best practice is to?
use liquids or mix with water to prevent blockages
When our client has a enteral or small bore feeding, it is important to verify?
placement ; tube location is compatible with medication absorption (stomach vs jejunum)
Risk of drug-drug interactions is higher with tube feedings, so it is important to?
administer one at a time and flush between each meds
Are enteral feedings tubers luerlocking or non-luer locking
non
If our skin is warm, will topical administration absorb faster or slower
faster
When administering topical medications/ patches, the nurse should?
wear gloves
What should we do with transdermal patches after placement?
label date, time, initial ; document where new placement is
Is nasal spray clean or sterile?
clean
Are nasal drops clean or sterile
sterile (should not touch patient)
How long should we wait in between administering different eye drops?
five minutes
Are eye drops clean or sterile?
sterile
When instilling eye drops, the nurse should wear
gloves
When administering eye drops, how can we prevent systemic effects
apply macular pressure
What is intraocular instillation
disk resembling contact lens and stays in the eye
For adults, pull the pinna
up and back
for kids, pull the pinna
down and back
Why should eardrops be instilled at room temperature
reduce vertigo
Are ear medication solutions sterile or clean
sterile
If the patient has ear drainage, should we administer drops?
no, can indicate ruptured eardrum
What allows vaginal meds to be broken down and absorbed
vaginal pH
If patients cannot administer their own vaginal meds, what should nurses do?
have second provider present
What shape are rectal suppositories
cone shaped
Do rectal and vaginal suppositories need refrigeration
rectal suppositories do, vaginal suppositories do not (remember vaginal suppositories have the protective coating)
What allows rectal medications to be broken down and absorbed
body heat
Why should nurses immediately administer rectal suppositories
they will melt by body heat
When administering rectal suppositories, what should the nurse do to ensure ease of use
lubricate it
Rectal suppositories should be placed against
rectal wall
pMDIs should be used with
a spacer
what does a spacer do
increase medication amount in the lungs
Nursing considerations for our clients using pMDIs
asses coordination and hand strength
BAIs have no set dose, so their medication release depends on
the client’s breath
DPIs are activated by
clients breath
do DPIs have a standardized dose?
yes
Special considerations for steroid inhalers
rinse and clean mouth after to prevent infection
If we are irrigating an open wound, the nurse should use?
sterile technique
If there is no break non the skin, irrigation should be?
aseptic technique
IV tubing uses luer-lok or non luer-lok
luer lok
enteral feeding tubes use luer-lok or non luer-lok
non luer-lok
When administering injections, the bevel should be
up
The bigger the gauge, the
smaller the needle
Viscous medications require a smaller or larger guage
smaller
Considerations for drawing from an ampule
snap away and draw up with filter needle
before injecting air into the vial, we should
clean the top
When mixing medications from a vial and ampule, which do we draw first
vial
How to mix insulin
air into NPH, air into regular, draw regular, draw NPH
insulin syringe
100-unit insulin syringe
Insulin is a _____ injection and we should?
subcutaneous ; rotate sites
Classifications of insulin
rapid, short, intermediate, long
What insulins cannot be mixed
glargine and determine
Before administering insulin we must
verify the dose
Rate of parenteral administration
1 ml / 10 seconds
Subcutaneous injection site
bat wings and belly (abdomen and back of arms)
Angle for subcutaneous; what determines this?
45 or 90 ; determined by body mass
IM injection angle
90 always
site of IM injection is determined by
amount and viscosity of medicine
What are the IM injection sites
ventrogluteal, vastus lateralis, deltoid
What IM injection site should be used for very viscous medications
ventrogluteal
Indicator for ventrogluteal site
greater trochanter and iliac crest
Where is the vastus lateralis
middle of the leg
Vastus lateralis is used most often in
children receiving immunizations
small amounts and noninvasive medications can be administered in the
deltoid muscle
location indicator for deltoid IM injeciton
acromian process
What is the safest IM injection spot for adults and children
ventrogluteal
What is the Z-Track method
displacement of the skin to seal needle track (medication cannot escape)
What angle is an intradermal injection
15
Indications for intradermal injection
TB, allergies
intradermal injections will form a ?
wheal or bleb
Should we rotate insulin injection sites
yes
What is the purpose of a capillary blood glucose
asses glucose levels
Important reminders for POC glucose sticks
puncture OUTSIDE of finger, wipe away first drop of blood, strips should be replaced every month
What is important to remove for MRIs
metal, jewelry, zippers, medicine patches
Clients with titanium on their body should keep?
MRI safety card on their bodyI
If a patient says their MRI safety card is valid, but they do not have it on them, can we do the MRI?
NO
Examples of meds that would be a subcutaneous injection
insulin, heparin, lovanox
What is an NG tube
Short-term tube that ends in stomach and can administer feedings and medications
Can NG tubes be inserted at the bedside
yes
Why is it important to monitor the #’s on the nasogastric tube?
tell us the length inside patient, makes sure it is in the correct spot
Nasogastric tubes NGT can have both continuous and bolus feedings. T or F
T
What is a continuous tube feed
24 hours
What is a bolus tube feed
short term; 30 mins
Clients receiving tube feedings should sit up for _____ following to prevent
1 hr ; aspiration (can lead to pneumonia)
Along with aspiration, what is another way tube feedings can cause pneumonia
the feedings are very high in sugar -> this attracts bacteria
Enteral tube feeding should be room temperature to prevent
bloatedness and cramping
What is the PEG tube
percutaneous endoscopic gastrostomy
What is the PEJ tube
percutaneous endoscopic jejunostomy tube
PEG and PEJ tubes are surgically implanted tubes
outside of the body (this makes them longterm)
Small bore feedings tubes such as Dobbhoff/Nasojejunal end in the
jejunum (small intestine)
Can we do bolus feeds with dobbhoff/nasojejunal tubing
no
Why are dobbhoff tubes weighted
to push through the stomach sphincter
If our client is receiving a continuous tube feeding, how many hours does this last
24 hrs
Continuous feedings require a _____ while bolus doses can depend on _____
pump ; gravity
If our client is on continuous feedings, the HOB must be ____ degrees ALWAYS
30
What should tube feeding look like
coffee with cream
Intestinal residual volume should be less than
10 ML ; if it is higher than this twice.. hold the medication
Gastric residual volume should be less than
500 ml (if it is 500 ml once, or 250 ml twice –> hold the feeding)
Can XR tablets go in our tube feedings
NO
When administering meds through NG, PEG, and PEJ tubes, it is important to remember
to flush in between each and do a big flush at the end
Bolus feeds are good for
8 hours
Bolus feeds use an __ system
open system
Bolus feeding clients need to sit up for
one hour
Continuous feeding clients need to change tubing and feed every
24 hours
Continuous feeds use a
closed system
Patients with diabetes may require _____ amounts of nutrition
increased
What should we monitor on all patients if they are receiving feedings
blood glucose
A dobhoff tube requires ______ to confirm placement
scanning
before unclamping feedings, the nurse should
pinch line (prevent it from spraying)
If an NG tube is inserted with a brain shunt, the client is at risk of
disloding the tube. Leads to no breathing, no blood to the brain
IF our client is immunocompromised, we should flush their lines with
sterile water
Purpose of catheters
acute retention, acute bladder obstruction, urinary output in critically ill, open sacral/perineal wounds in incontinent client , end of life care, strict prolonged immobilization
Catheters should be wiped down at least
once shift
How to prevent infection in catheters
bag below the waist, do not put on floor, empty when 1/2 full, not using unless necessary, sterile technique, closed drainage system
What is a clean catch ‘Mid stream” catch
for culture and sensitivity. clean, start urine, catch in middle
T or F , we can touch the inside lid of a collection cup
FALSE, collection cups are sterile inside
What is culture and what is sensitivity?
culture is the type of bacteria, sensitivity is what will kill it
What is a random urine specimen
taken anytime, no special instructions
What is first morning specimen
taken upon waking up
rules of 24 hour urine collection:
start with empty bladder, keep on ice, MUST GET EVERY SINGLE DROP OR START OVER, immediately go to lab,time and date
