Fundamentals Exam #2

Question 1

ID characteristics of adverse drug events (ADEs)

Answer 1

— They are unintended, undesirable, and often unpredictable responses to medication
— Can take weeks/months to develop
Patients most at risk: pregnant women, very young patients, have chronic d/o’s (e.g. HTN, epilepsy, CVDs, psychoses)

Question 2

RN roles + responsibilities in medication administration

Answer 2

The SIX Rights
1) Right patient
2) Right medication
3) Right route
4) Right time
5) Right documentation
6) Right dose

NOTE: Use TWO patient IDs (name & birthday)

Question 3

Compare + contrast roles of medication administration

Answer 3

Doctor:
Pharmacist: split, label, package, send to RN for administration to ensure patient safety in inpatient settings
RN: administer prescribed/ordered medications using the 6 “Rights”

Question 4

Medication errors when administering

Answer 4

— Inaccurate prescribing
— Administering the wrong medication, dose, route, and time interval
— Administering to the wrong patient
— Administering extra doses
— Failing to administer a medication

Question 5

What should the RN do if a med error happens?

Answer 5

— RN assesses and examines patient’s condition
— Notifies Dr. of incident ASAP
— Once patient is stable, RN reports incident to the appropriate institution (e.g. manager, supervisor); provide written occurrence/incident report within 24 hours of incident
— The report should not be referred to in the patient’s medical record as it legally protects the HCprofessional and agency
— Incident reports are used to track errors and patterns and initiate quality improvement programs as needed

Question 6

A patient has the right to

Answer 6

Be informed about a medication
Refuse a medication
Have a medication history
Be properly advised about experimental nature of medication
Receive labeled medications safely
Receive appropriate supportive therapy
Not receive unnecessary medications
Be informed if medications are part of a research study

Question 7

Poly-pharmacies increase risk with

Answer 7

Frequent use of OTC medications
Lack of knowledge about medications
Incorrect beliefs about medications
Visits to several health care providers for different illnesses

Question 8

Oral administrations

Answer 8

Easiest + best route
— Food can affect absorption
— Watch our for aspiration + precautions (e.g. swallow assessment)

Question 9

Topical medication applications

Answer 9

Skin applications include:
— ointments and pastes | spread evenly over surface
— lotions and creams | apply lightly, do not rub
— transdermal patches | don disposable clean gloves when applying + removing old patch |

Question 10

Nasal instillations

Answer 10

Sprays
Drops

Question 11

Advantages of Oral, Buccal, Sublingual Routes

Answer 11

— Convenient, comfortable
— Economical
— Easy to administer
— Often produce local/systemic effects
— Rarely causes anxiety for patient

Question 12

Types of Inhaled medications + interventions

Answer 12

— Dispersed through an aerosol spray, mist, or powder that penetrates lung airways
pMDIs = pressurized metered-dose inhalers
DPIs = dry powder inhalers
BAIs = breath-actuated metered-dose inhalers
NOTE: all produce local effects in the airway (e.g. bronchodilation)

Question 13

Advantages of Subcutaneous, Intramuscular (IM), Intravenous (IV), & Intradermal (IM) (Parenteral) Routes

Answer 13

— Can be used when oral medications are contraindicated
— More rapid absorption than with topical or oral routes
— IV infusion provides medication delivery when patient is critically ill or long-term therapy is necessary; if peripheral perfusion is poor
— IV route preferred over injections

Question 14

Advantages of Topical Routes

Answer 14

— Primarily provides local effect
— Painless
— Limited side effects

Question 15

Advantages of Transdermal Route

Answer 15

Prolonged systemic effects with limited side effects

Question 16

Advantages of Mucous Membranes (nasal) Route

Answer 16

— Therapeutic effects provided by local application to involved sites
— Aqueous solutions readily absorbed and capable of causing systemic effects
— Potential route of administration when oral medications are contraindicated

Question 17

Eye Instillation Interventions

Answer 17

— Avoid the cornea
— Avoid touching parts of. The eye w/ eyedroppers/tubes to decrease the risk of infection
— Use only the affected eye
— Never allow patients to share medication!

Question 18

Rectal Instillation Interventions

Answer 18

— Medication is thin and bullet-shaped
— Medications expert local effects: promoting defecation or systemic effects (e.g. reducing nausea)
— Must refridgerate
— May require cleansing enema before application
— DOUBLE GLOVE

Question 19

Ear Instillation Interventions

Answer 19

— Instill drops/solutions @ room temperature
— Use sterile solutions
— Consult a HCP 1st if the patient has ear drainage
— Do not occlude the ear canal w/ dropper/syringe

Question 20

Advantages of Inhalation Route

Answer 20

— Provides rapid relief for local respiratory problems
— Used for introduction of general anesthetic gases

Question 21

Advantages of Intraocular Disk Route

Answer 21

Route advantageous because it does not require frequent administration such as with eye drops

Question 22

Intraocular disks Interventions

Answer 22

— Remains in place for up to 1 week
— Teach patients to monitor for adverse effects
— Explain insertion and removal

Question 23

Guidelines for Telephone/Verbal Orders

Answer 23

• Only authorized staff members receive and record telephone or verbal orders. Institutional policies identify which members are authorized.
• Clearly identify patient’s name, room number, and diagnosis.
• Read back all orders to health care provider (TJC, 2018).
• Use clarification questions to avoid misunderstandings.
• Write “TO” (telephone order) or “VO” (verbal order) and include date and time, name of patient, and complete order; sign the name of the health care provider and nurse.
• Follow agency policies; some require documentation of the “read-back” or require two nurses to review and sign telephone or verbal orders.
• Health care provider co-signs the order within the time frame required by the agency (usually 24 hours; verify agency policy)

Question 24

EVERY medication order should have the following parts

Answer 24

— Patient’s FULL NAME
— Date/Time that order was written
— Medication name
— Dosage
— Route of administration
— Time & Frequency of administration
— Signature of HCP