Med Administration Exam Flashcards

1
Q

therapeutic effects

A

intended or desired response to med

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2
Q

adverse drug reactions

A

unintended, undesirable and often unpredictable

effects of med

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3
Q

side effects

A

predictable and often unavoidable secondary effects of a med at usual therapeutic dose

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4
Q

toxic effects

A

med accumulates in blood because impaired metabolism or excretion, or when too high of dose is given

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5
Q

idiosyncratic effects

A

patients overact or underreact to a med or have

reactions different than normal

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6
Q

medication tolerance

A

more medication is required to achieve the same therapeutic effect

-tolerance is decreased physiological response that occurs after repeated administration of med.

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7
Q

medication dependence

A

Dependance can be physical or

psychological

-described in the past as addiction

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8
Q

medication misuse

A

overuse, underuse, nonadherence, polypharmacy

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9
Q

medication interactions

A

med modifies action of another med

-may result in an increase or decrease in therapeutic effect of each medication

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10
Q

absorption

A

passage of medication molecules into the blood from site of administration

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11
Q

what factors influence absorption

A

-first pass effect

-blood flow to site

-administration route

-patient size

-ability of med to dissolve

-lipid solubility of med

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12
Q

distribution

A

process of transporting a drug to the site of action

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13
Q

what factors influence the extent of distribution

A

-binding to albumin/protein binding (unbound goes to site)

-circulation

-cell membrane permeability

-perfusion

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14
Q

What do nurses need to be aware of with older adults and patients with liver disease?

A

-older patients and patients with liver disease have less albumin and decreased metabolism so there is more free and unbound drug causing toxicity

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15
Q

metabolism

A

medication is broken down to remove the active chemicals

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16
Q

where does metabolism occur?

A

mostly in liver but lungs, kidneys, blood and intestines play a role

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17
Q

excretion

A

process of medication exiting the body

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18
Q

peak plasma level

A

when a drug is at its highest concentration, not necessarily at its most therapeutic level

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19
Q

trough serum levels

A

lowest level of concentration of a medication that correlates to the rate of elimination

-happens 30 minutes before next dose

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20
Q

serious adverse drug event

A

life threatening reaction that requires medical intervention to prevent death or permanent disability

-must be reported to FDA to improve safety outcomes, revise drug labels and warnings and when to withdraw drugs from the market

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21
Q

black box warning

A

issues on medications that may produce lethal and iatrogenic results

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22
Q

medication reconciliation

A

performed anytime a patient is transferred from one health care professional to another

-reviews patients current medications with newly prescribed medications. getting rid of duplicates

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23
Q

verify all new orders

A

one time for every new order

-check order from provider and compare to the MAR to make sure it matches exactly

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24
Q

3 safety checks for medication administration accuracy.

A
  1. when retrieving medication from storage bin
  2. before placing in medication cup or before taking to the patients room (leave meds in wrappers to explain meds)
  3. at bedside before giving to the patient
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25
Q

What are the guidelines for administering opioids (narcotics)?

A

special handling:

-securely locked

-counted

-waster

-witness

-tamper evident syringes

Draw up all medicine in a bottle, discard extra in designated spot with another witness and both nurses fill out disposal form

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26
Q

What are the principles for safely handling chemotherapy medications?

A

-hand hygiene before and after gloving

-do not crush, cut or split medication

-use separate equipment

-know the agency spill policy

-dispose of single use clothing

-wash clothes or sheets contaminated by body fluids: wash twice in hot water, do not wash with other items

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27
Q

who can give chemotherapy?

A

any nurse can give PO chemo, certified nurse gives IV chemo

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28
Q

standing order

A

give until discontinued or prescribed number of days elapse

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29
Q

PRN order

A

as needed

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30
Q

single order

A

one time

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31
Q

STAT order

A

carried out immediately

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32
Q

NOW order

A

within 90 minutes

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33
Q

time critical medications

A

administer within 30 minutes before or after the scheduled time

-antibiotics, anticoagulants, insulin, immunosuppressives

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34
Q

non critical medications

A

administer 1-2 hours before or after scheduled time

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35
Q

unit dose

A

drug dosage system that provides prepackaged, prelabeled, individual medications that are ready for immediate use by the specific patient patient

-decreases med errors and saves steps in dispensing medications

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36
Q

standard measurement devices

A

-graduated cups

-syringes

-scaled droppers

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37
Q

can we split pills

A

only if medication is scored

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38
Q

How should we administer crushed medication

A

-mix with food or liquid

-clean device

-check do not crush list

39
Q

do not crush list

A

-enteric coated

-long acting tablets

-contents of capsules

-sublingual medications

40
Q

oral route of medication administration

A

-most desired (po)

-know if should be taken with or without food

-can the patient swallow safely

41
Q

enteral feeding tube route of medication administration

A

-always verify placement first

-do not administer medication in tube if used for gastric decompression

-use liquid med if possible

-HOB 30-45 degrees

-check gastric residual volume

-flush with 30-60mL of water

42
Q

enteral feeding tube route of medication administration with multiple medications

A

flush between each medication with 15-30mL of water

43
Q

topical route of medication administration

A

apply to mucous membranes, skin, tissues

-need gloves and or applicators

-apply to intact skin

-never apply new med over old

-remove old patches

-never apply heat to patch

-clean skin first

44
Q

ophthalmic route of medication administration

A

eye medications in the form of drops, ointments or intraocular disc

-expose conjunctival sac (never press on eyeball)

-rest dominant hand on forehead

-hold eye dropper 1/4 to 1/2in above conjunctival sac

45
Q

ophthalmic route of medication administration potential of systemic effects

A

apply gentle pressure to nasolacrimal duct with tissue 30-60secs

46
Q

otic route of medication administration

A

ear medications usually drop form

-drops at room temp

-dont force solution into ear

-after administration keep patient in side lying position for a few mins

-dont occlude ear canal with dropper

-apply gentle pressure to tragus

-use cotton ball if ordered

47
Q

nasal route of medication administration

A

nose medications in form of drops, sprays, tampons

-drops: patient in supine position, tilt head backward, hold dropper 1/2in above nares and instill, remain supine for 5 mins

-spray: upright position with head tilted forward and occlude other nostril

48
Q

inhaler route of medication administration

A

medications dispersed through aerosol spray, mist or powder that penetrates airways

-pMDI: pressure metered-dose inhalers

-BAI: breath-actuated-metered-dose inhaler

-DPI: dry powder inhaler

49
Q

vaginal installations route of medication administration

A

forms of foam, jelly, cream or suppository

-stored in fridge

-insert with applicator or gloved hand

-patients can administer themselves if taught and able

-dorsal recumbent position

-insert suppository entire length of finger (3-4in)- applicator (2-3in)

-remain supine for 10 mins

50
Q

rectal suppositories route of medication administration

A

inserted in rectum and absorbed into rectal mucosa

-stored in fridge

-4in in adult

-2in in infants and children

-patients can administer themselves if taught and able

-contraindicated after rectal surgery

-left side lying sims with upper leg flexed forward

-use lubrication

51
Q

parenteral route of medication administration

A

enters body tissues and circulation by injection

-intradermal (ID)

-subcutaneous

-intramuscular (IM)

-intravenous (IV)

-sterile procedure

52
Q

parenteral route of medication administration ampule

A

use filter needle

53
Q

Know how to select equipment (syringe size, needle length and gauge) for each type of injection

A

Length: depends on pt size, gender, condition, weight, type of tissue injected and route.

Gauge: depends on viscosity and volume of med

-Smaller gauge number= larger diameter needle (thicker)

54
Q

intradermal route of medication administration

A

-needle size: 25-27g pre-attached 3/8”-5/8”

-just under the skin inject very small amount 0.01-0.1 mL

-do not aspirate

-5-15 degree angle

-use TB (tuberculin) syringe

-for TB screening or allergy tests

55
Q

subcutaneous route of medication administration

A

beneath dermis, poor blood supply

-0.5-1.5mL total volume

-5/8” inserted at 45 degree angle, pinch 1in of tissue

-1/2” inserted at 90 degree angle, pinch 2in tissue

56
Q

subcutaneous insulin administration

A

-U 100 insulin

-1mL insulin syringe

-28-31 gauge

-pre attached needle: 5/16-3/16 length

-needle 3/16in administered at 90 degree angle to reduce pain and achieve adequate control of blood sugars

-abdomen or outer aspect of thighs preferred, rotating within site

-pinch skin and insert needle, release pinch (unless using a pen)

-do not aspirate

-do not massage site

57
Q

Mixing insulins in one syringe

A
  1. inject air in A (cloudy or long acting)
  2. inject air in B (clear or rapid acting), then draw up dose
  3. with B dose syringe draw up dose from A
  4. inject A and B dose from syringe into vial
58
Q

mixing insulins in one syringe requirements

A

-dont mix insulin with other meds

-never mix insulin glargine (lantus) or insulin detemir (levemir) with other types on insulin

-verify insulin doses with another nurse while preparing

59
Q

subcutaneous heparin or lovenox administration

A

-abdomen preferred

-use tuberculin (TB) syringe

-25-27 gauge

-3/8-5/8 length

-2” around umbilicus

-dont expel air bubble

-pinch skin, insert needle, hold pinch

-inject over 30 secs

-dont aspirate or massage site

60
Q

intramuscular (IM) route of administration sites

A

deep muscle tissue with rich blood supply

-ventrogluteal (hip) preferred site

-dorsogluteal (upper buttock) not used anymore

-vastus lateralis (leg)

-deltoid (arm)

61
Q

intramuscular (IM) route of administration requirements

A
  • 2-3mL syringe
  • 22-25g aqueous solutions
  • larger gauge viscous solutions
  • 90 degree angle
  • 1-3mL volume
  • aspirate for blood (no longer aspirating when administering vaccines or toxoids)

-inject slowly

62
Q

ventrogluteal site for IM injections

A

-reduces risks of muscle and nerve injury

-preferred and safest site

-can hold longer volumes and viscous meds

-little side effects

-inject at 90 degrees, dartlike, to the hub of the needle at 10 seconds per mL

-wait 10 seconds before withdrawing the needle

63
Q

vastus lateralis site for IM injections

A

-preferred site for toddlers 1-2 years

-grasp muscle in young children or cachectic patients to be sure med is deposited into tissue

64
Q

deltoid site for IM injection

A

-easily accessible

-only small doses, 2mL or less

65
Q

steps of administering Z track method injection (IM)

A

Deep into muscle, pull skin over taught with hand 1-1/2in laterally, hold skin and insert needle and inject slowly, leave needle in place 10 sec, withdraw needle and release skin

66
Q

what is the purpose of Z track method injection

A

minimize local skin irritation by sealing off medication in muscle tissue

67
Q

how to minimize pain of an injection

A

-position and flex patients limbs to reduce muscular tension

-sharp beveled needle in shortest length and smallest gauge

-insert needle rapidly, inject slowly and withdraw rapidly

-change needle if liquid med coats shaft of needle

-apply vapocoolant spray

68
Q

how to prevent contamination of solutions to avoid patient infection when using ampules

A

ampules should not sit open, remove med quickly

69
Q

how to prevent needle contamination to avoid patient injection

A

-avoid letting needle touch outer edges of ampule or vial, outer surface of needle cap, your hands, countertop, table surface.

-avoid touching length of plunger or inner part of barrel

-keep tip of syringe covered with cap or needle

70
Q

advantages and disadvantages of IV bolus push method

A

administer into vein

-advantages: rapid onset

-disadvantages: small volumes, not all medications, higher risk

71
Q

how to keep patients free from infection by preparing the skin properly

A

-wash skin soiled with dirt, drainage, or feces with soap and water

-use friction and circular motion while cleaning with antiseptic swab

-swab from center of site and move outward in 2in radius

72
Q

needle safety

A

-never ever recap used needle after medication administration

-use needleless systems

-properly dispose of used needle in sharps container

-use plastic guard to prevent needle sticks

73
Q

verbal or telephone orders

A

-students cant take these

-clearly ID patient name, room number, and diagnosis to HCP

-write order then read it back

-use VO for verbal order and TO for telephone order

-document read back and name of HCP

-HCP will countersign

-verbal orders are discouraged except for emergent situations

74
Q

what to do if you make a medication error

A

-make sure patient is safe first

-report error by recording all meds in record (even drugs administered in error)

-do not document med was given in error

-complete occurrence or incident report (not part of the health record or nurses notes)

-notify prescriber

75
Q

What are the steps to prevent medication errors?

A

Follow 7 rights, prepare meds for one patient at a time, check med label 3 times comparing to MAR, 2 patient identifiers, no distractions, double check calculations and high risk meds with another nurse, don’t attempt to clarify ineligible or smudged writing, question unusually large or small doses, document as soon as meds given, ensure well rested

76
Q

generic name of a drug

A

the official name that is listed in official publications such as the United States Pharmacopeia (USP).

77
Q

trade name of a drug

A

the name used to market the medication; it suggests the action of the drug

78
Q

IV medication administration absorption

A

most rapid absorption because going directly into a vessel

79
Q

IM medication administration absorption

A

absorb rapid but not as fast as IV

80
Q

subcutaneous medication administration absorption

A

absorb faster than oral but not as fast as IM or IV

81
Q

oral medication administration absorption

A

absorb slowly

82
Q

Every medication order must include:

A

patients name, the drug ordered, dosage, route of

administration, and time(s) of administration.

83
Q

adults and children older than 3 years old otic medication administration

A

gently pull pinna up and outward

84
Q

children younger than 3 years old otic medication administration

A

pull the pinna down and back

85
Q

ampules

A

-single doses of injectable medication

-glass/constricted restored neck you snap off

-use filter needle

-open system

86
Q

vial

A

-single or multidose

-inject air

-closed system

87
Q

mixing medications from vial and ampule

A

Prepare medication from the vial first.

Use the same syringe and filter needle to withdraw medication from the ampule.

88
Q

what does viscous mean

A

syrupy: having a relatively high resistance to flow, or having a glutinous consistency and the quality of sticking, or adhering.

89
Q

BID

A

twice a day

90
Q

TID

A

three times a day

91
Q

ac

A

before meals

92
Q

hs

A

at bedtime, hour of sleep

93
Q

pc

A

after meals