Med Administration UNIT 9&10Chapter 35 Flashcards
1
Q
Drug
A
A drug is any substance that positively or negatively alters physiologic function and psychologic function
2
Q
Medication
A
A medication is a drug specifically administered for its therapeutic effect on physiologic function.
3
Q
Medication designations:
A
Chemical name
Official name
Generic name
Trade name
example
Chemical Name
2-(4-isobutylphenyl)propionic acid
Generic Name
ibuprofen
Brand name
Motrin, Advil, Nuprin
4
Q
- A nurse knows that patient education has been effective when the patient states
a.
I must take my parenteral medication with food.
b.
If I am 30 minutes late taking my medication, I should skip that dose.
c.
I will rotate the location where I give myself injections.
d.
Once I start feeling better, I will stop taking my medication.
A
c.
I will rotate the location where I give myself injections.
ANS: C
Rotating injection sites provides greater consistency in absorption of medication. Parenteral medication absorption is not affected by the timing of meals. Taking a medication 30 minutes late is within the 60-minute window of the time medications should be taken. Medications should be stopped based on the providers orders. With some medications, such as antibiotics, it is crucial that the full course of medication is taken to avoid relapse of infection.
5
Q
- The nurse reviews a primary care provider’s order and finds that the medication amount is greater than the standard dose. What action should the nurse take?
A. Give the standard dose rather than the one that is ordered.
B. Consult with the nursing supervisor to get a second opinion.
C. Call the primary care provider to discuss the order in question.
D. Administer the medication as ordered by the primary care provider.
A
C. Call the primary care provider to discuss the order in question
6
Q
- The nurse is developing a plan of care for a patient.
What is the most appropriate goal for a patient related to medications?
A. The patient will administer all medications correctly by discharge.
B. The patient will be taught common side effects of prescribed medications.
C. The patient will have a good understanding of prescribed medications.
D. The patient will have all medications administered by staff as prescribed.
A
A. The patient will administer all medications correctly by discharge.
7
Q
- What action should be taken by the nurse first when administering medications to a patient?
A. Check the medication expiration date.
B. Check the medication administration record (MAR).
C. Call the pharmacy for administration instructions.
D. Check the patient’s name band.
A
D. Check the patient’s name band.
8
Q
- The nurse is teaching a patient about how to take a sublingual nitroglycerin tablet. Which statement by the patient best demonstrates understanding of the teaching?
A. “I will take the tablet with plenty of water.”
B. “I will place the tablet inside my cheek.?
C. “I will put the tablet under my tongue.”
D. “I will take the tablet while I am eating.”
A
C. “I will put the tablet under my tongue.”
9
Q
An order is written for Demerol 500 mg IM q3-4h prn for pain. The nurse recognizes that this is significantly more than the usual therapeutic dose. The nurse should:
1.Give 50 mg IM as it was probably intended to be written
2. Refuse to give the medication and notify the nurse manager
3.Administer the medication and watch the client carefully
4.Call the prescriber to clarity the order
A
4.Call the prescriber to clarity the order
10
Q
The client is to receive a Mantoux test for tuberculosis TB. This test is administered via an intradermal injection. The nurse recognizes that the angle of injection that is used for an intradermal injection is:
1. 15 degrees
2.30 degrees
3.45 degrees
4.90 degrees
A
- 15 degrees
11
Q
The nurse prepares to administer an intradermal injection for the administration of medication for
1. Pain
2. Anticoagulant therapy
3.Allergy sensitivity
4.Low-dose insulin requirements
A
3.Allergy sensitivity
12
Q
A priority for the nurse in the administration of oral medications and prevention of aspiration is
1. Checking for a gag reflex
2. Allowing the client to self-administer
3. Assessing the ability to cough
4. Using straws and extra water for administration
A
- Checking for a gag reflex
The patient’s ability to swallow, level of consciousness, gag reflex, and whether the patient is experiencing nausea and vomiting are assessed to ensure the patient’s ability to take medications by the oral route and to prevent aspiration (i.e., inhalation of gastric contents into the respiratory system).
13
Q
The nurse is to administer several medications to the client via the N/G tube. The nurse’s
first action Is tO:
1. Add the medication to the tube feeding being given
2.Crush all tablets and capsules before administration
3. Administer all of the medications mixed together
4.Check for placement of the nasogastric tube
A
4.Check for placement of the nasogastric tube
14
Q
Following the administration of ear drops to the left ear, the client should be positioned:
1. Prone
2. Upright
3. Right lateral
4. Dorsal recumbent with hyperextension of the neck
A
- Right lateral
15
Q
The client is ordered to have eye drops administered daily to both eyes. Eye drops should be instilled on the:
1.Cornea
2.Onter canthus
3. Lower conjunctival sac
4.Opening of the lacrimal duct
A
- Lower conjunctival sac
16
Q
The student nurse reads the order to give a I-year-old client an intramuscular injection.
The appropriate and preferred muscle to select for a child is the:
1. Deltoid
2.Dorsogluteal
3.Ventrogluteal
4 Vastus lateralis
A
4.Vastus Lateralis
17
Q
The nurse is teaching the client how to prepare 10 units of regular insulin and 5 units of
PH insulin for iniection. The nurse instructs the client to:
1. Inject air into the regular insulin and then into the NPH insulin
2.Withdraw the regular insulin first
3.Inject air into and withdraw the NPH insulin immediately
4. Iniect air into both vials and withdraw the regular insulin first
A
- Iniect air into both vials and withdraw the regular insulin first
18
Q
The nurse is working on the pediatric unit. In preparing to give medications to a preschool-age child, an appropriate interaction by the nurse is:
1.”Do you want to take your medication now?”
2.”Would you like the medication with water or juice?”
3.”Let me explain about the injection that you will be getting.”
4. “If you don’t take the medication now, you will not get better.”
A
2.”Would you like the medication with water or juice?”
19
Q
The nurse is documenting administration of a medication that is given at 10:00 AM. 2:00
PM, and 6:00 PM. The medication that the nurse is documenting is:
1. Morphine sulfate 10 mg q4h prn
2. Inderal 10 mg PO bid
3. Diazepam 5 mg PO tid
4. Keflex 500 mg PO q8h
A
- Diazepam 5 mg PO tid
20
Q
The client is to receive a medication via the buccal route. The nurse plans to implement which of the following actions?
1. Place the medication inside the cheek.
2.Crush the medication before administration.
3. Offer the client a glass of orange juice after administration.
4.Use sterile technique to administer the medication.
A
- Place the medication inside the cheek.
21
Q
The nurse administers the intramuscular medication of iron by the Z-track method. The medication was administered by this method to:
1. Provide faster absorption of the medication
2.Reduce discomfort from the needle
3.Provide more even absorption of the drug
4.Prevent the drug from spilling out of muscle tissue, seals the medication in the muscle and stops the medicationfrom irritating sensitive tissue
A
4.Prevent the drug from spilling out of muscle tissue, seals the medication in the muscle and stops the medicationfrom irritating sensitive tissue
22
Q
- True or False: The purpose of the medication administration rights is to help prevent medication errors.
True
False
A
True
23
Q
- During medication administration how can the nurse properly confirm he or she has the right patient?
A. Ask the patient to state their last name and compared this to the patient’s ID arm band.
B. Ask the patient to state their full name and compare this information to the medication administration record and the patient’s ID arm band.
C. Ask the patient to state their full name along with their date of birth and compare this information to the medication administration record and the patient’s ID arm band.
D. Ask the patient to state their full name and compare this to the patient’s ID arm band.
A
C. Ask the patient to state their full name along with their date of birth and compare this information to the medication administration record and the patient’s ID arm band.
24
Q
which of the following medication administration routes is most commonly prescribed?
A. intravenous
B. Topical
C. Subcutaneous
D. Oral
A
D. Oral
25
The nurse is demonstrating to a client with diabetes how to self-inject insulin properly. Which of the following injection sites would be most appropriate?
A. Upper back, under the scapula
B. Inner surface of the forearm
C. Abdomen
D. Shoulder
C. Abdomen
Rationale: the abdomen and anterior aspect of the thigh are common injection sites for subcutaneous injections
26
The nurse is preparing to administer a transdermal medication. How should this be accomplished?
A. Inject the medication into a body cavity
B. Apply the medication directly to the skin
C. inject the medication just below the dermis of the skin
D. Ask the client to swallow the medication
B. Apply the medication directly to the skin
B. apply the medication directly to the skin
rationale: transdermal medication are absorbed through the skin typically from a patch
27
What are the 6 Rights of Med Administration (Select All That Apply)
1. Right Medication
2. Right Region
3.Right Language
4. Right Documentation
5.Right Dose
6.Right Route
7.Right Time
8.Right Patient
1,4,5,6,7,8
28
The nurse identifies which medication that has the highest potential for abuse?
a. Methylphenidate (Ritalin)—schedule II
b. Alprazolam (Xanax)—schedule IV
c. Acetaminophen & codeine (Tylenol #3)—schedule III
d. Diphenoxylate & atropine (Lomotil)—schedule V
a. Methylphenidate (Ritalin)—schedule II
According to the Controlled Substances Act, drugs that have the potential for abuse/dependency are classified as schedule I–V. Schedule I drugs have no approved medical applications in the United States. Schedule II drugs have high potential for abuse/dependency and have multiple restrictions for prescriptions. Schedule III, IV, and V have lower risks of dependency/abuse and fewer restrictions for prescriptions. Methylphenidate has the highest risk of abuse in this selection.
29
3. The nurse is caring for a patient who is in agonizing pain. All the following options are listed on the patient’s medication order sheet to relieve pain. The nurse knows which option that will provide the most rapid pain relief for the patient?
a. Morphine (MSContin) 10 mg PO
b. Hydromorphone (Dilaudid) 1 mg IV push
c. Meperidine (Demerol) 75 mg IM
d. Fentanyl (Duragesic) 50 mcg transdermal patch
b. Hydromorphone (Dilaudid) 1 mg IV push
IV administration has the most rapid onset of action and will provide the patient with the quickest pain relief.
30
4. The nurse administers a medication to a patient. Shortly afterward, the patient develops an itchy rash over the entire body and reports feeling very unwell. What is the priority action of the nurse?
a. Leave the patient to notify the provider and the pharmacist.
b. Determine if the patient is having any difficulty breathing.
c. Document the reaction in the patient’s chart.
d. Obtain an order for hydrocortisone cream to relieve the itching.
b. Determine if the patient is having any difficulty breathing.
ANS: B
The nurse must first determine if the patient is having any difficulty breathing, since the patient may be starting to have an anaphylactic reaction to the medication, which can lead to shortness of breath and airway swelling. After assuring that the patient is stable, the nurse can notify the appropriate personnel and request any treatments for the reaction.
31
5. The nurse identifies which medication order to be administered PRN?
a. Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep
b. Prednisone 10 mg PO today, then taper down 1 mg each day for the next 10 days
c. Humulin R 10 units subcutaneously before each meal and at bedtime
d. Kefzol (Ancef) 1 g IVPB 30 minutes prior to surgery
a. Zolpidem (Ambien) 10 mg PO tonight if the patient cannot sleep
ANS: A
The nurse is to give the zolpidine (Ambien) if the patient cannot sleep. Therefore, this is the PRN (as needed) medication order. The other orders have specific time frames.
32
17. The nurse is noting an order for a medication to be given TID. Which times will the nurse plan to administer the medication to the patient?
a. 9 a.m., 1 p.m., 5 p.m., and 10 p.m.
b. 9 a.m. and 9 p.m.
c. 9 a.m., 1 p.m., and 5 p.m.
d. Nightly before the patient goes to sleep
ANS: C
TID indicates that the medication is to be administered three times daily. Common times for TID medications are 9 a.m., 1 p.m., and 5 p.m.
33
Pharmacokinetics
Study on how the medication enters the body, transdermal, po, iv, im,subq , moves through the body and exits the body
34
Pharmadynamics
is the process in how the medication interacts with the body's cells to produce a biologic response.
35
20. The nurse is to administer 15 mg of morphine liquid to the patient. How much morphine liquid will the nurse draw up to administer to the patient?
Morphine sulfate oral solution (CONCENTRATE)
100 mg/5 mL
(20 mg/mL)
CII only
a. 0.5 mL
b. 0.75 mL
c. 1.3 mL
d. 1.5 mL
b. 0.75 mL
36
What should the nurse do if the tip of the ophthalmic medication touches the patient's skin?
A. Continue to administer the eye drop
B. acknowledge that the tip of the medication is not sterile and requested a new eye drop from the pharmacy
C. Call the doctor
D. Use a rag to wipe the tip of the applicator and continue to give the eye drops
B. acknowledge that the tip of the medication is not sterile and requested a new eye drop from the pharmacy
37
The nurse is preparing to administer a rectal suppository to an adult client. How many inches should you plan to insert the suppository?
A. 2
B. 3
C. 1
D. 5
B. 3 inches
rationale: 3-4 inches because a rectal suppository has to make contact with rectal mucosa for absorption to occur.
38
What angle should you administer Subcutaneous injection?
A 100 degreea
B 45 degrees
C 15 degrees
D 20 degrees
B 45 degrees
you administer a subq injection from a 45 degree angle or a 90 degree angle (pinch skin) ( fatty area)
39
Which of the following med administration sites is considered Parental? ( SELECT ALL THAT APPLY)
A. Topical
B. Transdermal
C. Rectal
D. Subcutaneous
E. Intramuscular
F. intradermal
G. Intravascular
H. Oral
D. Subcutaneous
E. Intramuscular
F. intradermal
G. Intravascular
40
A patient stated "I just got a shot" what type of med administration was given?
A. Topical
B. Rectal
C. Oral
D. Parental
D. Parental
41
The nurse removes the eardrops out of the fridge, what priority action should she do first.
A. position the patient side laying
B. warm up the eardrop solution to avoid damaging the tympanic membrane
C. Administer the eardrum with the patient laying a prone position
D. Recommend the patient to insert their eardrops while they are taking a shower.
B. warm up the eardrum solution to avoid damaging the tympanic membrane
42
13. The nurse administers a medication to the patient. Which symptoms indicate to the nurse that the patient is having an allergic reaction rather than a side effect?
a. Hair loss and sweaty skin
b. Nausea and constipation
c. Heartburn and nasty taste in the mouth
d. Itchy rash and difficulty breathing
d. Itchy rash and difficulty breathing
ANS: D
Itchy rash and difficulty breathing are indicative of an allergic reaction to a medication. The other symptoms are common side effects of medications.
43
The nurse is preparing to administer an allergy test via an intradermal injection. Which of the following injection sites would be most appropriate for this situation?
a. anterior aspect of the thigh
b. abdomen
c. inner surface of the forearm
d. shoulder
c. inner surface of the forearm
44
The nurse is reviewing a client's newly written medication order and is unable to read the prescriber's handwriting. Which of the following actions is most appropriate?
a. confirm with another nurse who is more familiar with the prescriber's handwriting.
b. send the order to the pharmacy for accurate inspection
c. contact the prescriber to clarify the order
d. disregard the order until the prescriber returns to the unit
c. contact the prescriber to clarify the order
rationale: anytime the nurse has a question regarding handwriting of a prescription, the must clarify with the person who wrote it
45
1. A nurse instructs a client to close the eyes gently after the administration of eyedrops. Which rationale for this instruction should the nurse explain to the client?
A. Limits corneal irritation
B. Forces excess medication from the eyes
C. Disperses the medication over the eyeballs
D. Prevents medication from entering the lacrimal duct
C. Disperses the medication over the eyeballs
46
2. How often should “docusate sodium 100 mg PO bid” be given?
A. Three times a day
B. Two times a day
C. Every other day
D. At bedtime
B. Two times a day
47
3. A nurse is preparing to reconstitute a medication in a multiple-dose vial. Which is the most essential step in the preparation of this medication?
A. Instilling an accurate amount of diluent into the vial
B. Using a filtered needle when drawing up the medication from the vial
C. Instilling air into the vial before withdrawing the reconstituted solution
D. Wiping the rubber seal of the vial with alcohol before and after each needle
A. Instilling an accurate amount of diluent into the vial
48
4. Which characteristic is associated with a subcutaneous injection of 5,000 units of heparin?
A. 3-mL syringe
B. 22-gauge needle
C. 1 1 ⁄ 2 -inch needle length
D. 90-degree angle of insertion
D. 90-degree angle of insertion
49
92. The patient is to receive heparin by injection. The preferred site for this injection is in which location?
a. Abdomen
b. Vastus lateralis
c. Posterior gluteal
d. Scapular region
a. Abdomen
50
94. The nurse recognizes that an example of a Schedule II medication is
a. heroin.
b. diazepam.
c. morphine.
d. acetaminophen.
c. morphine
51
91. The nurse is evaluating the integrity of the ventrogluteal injection site. The nurse finds the site by locating the
a. middle third of the lateral thigh.
b. anterior aspect of the upper thigh.
c. acromion process and axilla.
d. greater trochanter, anterior iliac spine, and iliac crest.
d. greater trochanter, anterior iliac spine, and iliac crest.
52
93. A medication is prescribed for the patient and is to be administered by IV bolus injection. A priority for the nurse before the administration of medication via this route is to
a. set the rate of the IV infusion.
b. check the patient's mental alertness.
c. confirm placement of the IV line.
d. determine the amount of IV fluid to be administered.
c. confirm placement of the IV line.
53
89. An order is written for 80 mg of a medication in elixir form. The medication is available in 80 mg/tsp strength. The nurse prepares to administer how much?
a. 2 ml
b. 5 mL
c. 10 ml
d. 15 mI
b. 5 mL
54
88. An order is written by the prescriber for morphine 40 mg IM 92h pm for pain. The nurse recognizes that this is significantly more than the usual therapeutic dose. The nurse should
a. call the prescriber to clarify the order.
b. give 4 mg IM as it was probably intended to be written.
c. refuse to give the medication and notify the nurse manager.
d. administer the medication and watch the patient carefully.
a. call the prescriber to clarify the order.
55
84. The student nurse reads the order to give a 4 month-old patient an intramuscular injection. The appropriate and preferred muscle to select for a child is the
a. deltoid.
b. dorsogluteal.
c. ventrogluteal.
d. vastus lateralis.
d. vastus lateralis.
The vastus lateralis site has no large blood vessels or nerves and can safely be used for
most patients.
The primary site for administering an IM injection for patients older than 7 months of age is the ventrogluteal site, which is free of major blood vessels, nerves, and fat and is associated with lower rates of injury (Arslan & Ozden. 2018).
56
80. The physician has ordered 6 mg morphine sulfate every 3 to 4 hours pm for a patient's postoperative pain. The wit dose in the medication dispenser has 15 mg in 1 mL. How much solution should the nurse give?
a. 0.2 ml
b. 0.3 mL
c. 0.4 ml
d. 0.75 mL
c. 0.4 ml
57
79. The physician orders 100 mg of a hypnotic medication to help the patient sleep. The label on the medication bottle reads Seconal 50 mg. How many tablets should the nurse give the patient?
a. 1/2 tablet
b. 1 tablet
c. 11/2 tablets
d. 2 tablets
d. 2 tablets
58
76. The patient is to be given the medication that is enclosed in a cylindrical gelatin coating. The nurse knows that this medication comes in the form of a
a. tablet.
b. powder.
c. capsule.
d. suppository.
c. capsule.
59
73. The patient tells the nurse that he is experiencing nausea, vomiting, clumsiness, and blurred vision. He says that he has been taking a lot of vitamins. On the basis of the patient's symptoms, which vitamin does the nurse suspect is creating the adverse effects?
a. Vitamin B3
b. Vitamin C
c. Folic acid
d. Vitamin A
d. Vitamin A
60
69. The Kefauver-Harris Drug Amendments were passed in 1962 to
a. classify habit-forming medications as narcotics.
b. mandate accuracy in drug labeling.
c. require proof of drug safety and efficacy before marketing.
d. categorize drugs on their abuse and addiction potential.
c. require proof of drug safety and efficacy before marketing.
61
70. Which of the following is a correct technique for use of an insulin pen?
a. Clean the pen tip with household soap.
b. Prime the pen with 2 units before use.
c. Cover the needle until the next dose.
d. Empty the pen and complete the dosage with a new pen, if necessary.
b. Prime the pen with 2 units before use
62
72. Which one of the following actions performed by the new staff nurse and observed by the nurse manager requires additional instruction?
a. Giving medications 20 minutes before the scheduled time.
b. Applying a topical medicated cream without gloves.
c. Alternating the sides of the cheeks for buccal medications.
d. Documenting on the MAR that the patient refused the medication
b. Applying a topical medicated cream without gloves.
63
71. Which of the following is a medication order that is to be administered immediately?
a. Diazepam 10 mg IV stat
b. Lanoxin 0.125 mg PO daily
c. Ibuprofen 300 mg gth pm
d. Ativan 1 mg IV on call for surgery
a. Diazepam 10 mg IV stat
64
18. The nurse is caring for a patient who was just made NPO. The nurse is to administer carvedilol (Coreg) 25 mg PO to the patient for control of high blood pressure. What is the best action of the nurse?
a. Crush the medication and administer it to the patient mixed with applesauce.
b. Administer the medication to the patient with a small sip of water.
c. Contact the patient’s provider to clarify the order.
d. Administer the equivalent medication dose through the patient’s IV.
c. Contact the patient’s provider to clarify the order.
ANS: C
If a patient should receive nothing by mouth (NPO), an alternate route is used or an order is obtained for the patient to be NPO except for medications. Not all medications can be administered intravenously.
65
19. The nurse is to administer 1 mL of prochlorperazine (Compazine) 10 mg IM to an adult patient. Which syringe will the nurse select to administer the medication?
a. 1 mL tuberculin syringe with 27 gauge, 1/2 inch needle
b. 3 mL syringe with 23 gauge, 1 1/2 inch needle
c. 1 mL syringe with 27 gauge, 5/8 inch needle
d. 3 mL syringe with 18 gauge, 1 inch needle
b. 3 mL syringe with 23 gauge, 1 1/2 inch needle
ANS: B
Intramuscular injections for adults are usually administered with a 3 mL syringe and a 1 to 3 inch, 19 to 25 gauge needle. Tuberculin syringes are typically used for subcutaneous injections. The inch needles are too short for intramuscular injections into adults. The 18 gauge needle may be too large for intramuscular injections and the 27 gauge needles are too small for adult intramuscular injections.
66
The nurse is to administer 15 mg of morphine liquid to the patient. How much morphine liquid will the nurse draw up to administer to the patient?
Morphine sulfate oral solution (CONCENTRATE)
100 mg/5 mL
(20 mg/mL)
CII Rx only
a. 0.5 mL
b. 0.75 mL
c. 1.3 mL
d. 1.5 mL
b. 0.75 mL
67
2. The nurse identifies which medications that are to be administered via parenteral routes? (Select all that apply.)
a. Bisacodyl (Dulcolax) 10 mg suppository daily PRN constipation
b. Prochlorperazine (Compazine) 10 mg IM q 6 hours PRN nausea
c. Brimonidine (Alphagan) 0.1% solution 2 drops to each eye daily
d. Proventil (Ventolin) inhaler 2 puffs as needed for shortness of breath
e. Fentanyl (Duragesic) 50 mcg transdermal patch apply every 72 hours
f. Insulin lispro (Humalog) insulin 15 units subcutaneously ac meals
ANS: B,F
Parenteral medications are administered by injection into tissue, muscle, or a vein rather than through the gastrointestinal or respiratory route.
68
1. The nurse is caring for a patient who is NPO with a new PEG (percutaneous endoscopic gastrostomy) tube. Which of the patient’s medications can the nurse administer through the tube? (Select all that apply.)
a. Zolpidem tartrate (Edluar) sublingual tablet 5 mg nightly at bedtime
b. Ondansetron (Zofran) oral disintegrating tablet 8 mg q 8 hours PRN nausea
c. Cefaclor (Ceclor) for oral suspension 250 mg q 6 hours
d. Oxymorphone hydrochloride extended release (Opana ER) 40 mg q 12 hours
e. Phenytoin (Dilantin) chewable tablet 100 mg q 12 hours
f. Potassium chloride oral solution 20 mEq daily
ANS: C, E, F
Extended-release, oral disintegrating, and sublingual tablets may not be administered through feeding tubes. Suspensions and oral solutions are ideal for feeding tube administration. Chewable tablets may be crushed and dissolved in liquid for administration through feeding tubes
69
A primary health care providers orders a medication to be administered every 6 hrs prn. What should the nurse teach the patient about this medication.
1. "i will give this medication every 6 hours"
2. "I can give you this medication every 6 hours if you need it"
3."I must wait 6 hours before administering this medication to you"
4."I have to give you this medication every 6 hours around the clock.
2. "I can give you this medication every 6 hours if you need it"
70
A patient has a prescription for 2 drops of medication to be placed into an eye. What is the important nursing actions associated with this procedure?
1. Having the patient look down while the medication is inserted
2. Applying slight pressure over the inner canthas of the eye after drop administering
3. Placing a finger the top lid while simultaneously pulling the lid toward the forehead.
4. Cleansing the eye by wiping gently from the outer canthus to the inner canthus with a cotton ball.
2. Applying slight pressure over the inner canthas of the eye after drop administering
71
A nurse is caring for a patient who is to be screened for tuberculosis. Which injection route should the nurse use to inject tuberculin purified protein derivative?
1. Hold needle at 90 degree angle and push into the muscle
2. Hold needle at 90 degree angle and push into the fat.
3. Hold at a 45 degree angle and push into the fat
4. Hold at a 10 degree angles and push just under the epidermis.
4. Hold at a 10 degree angles and push just under the epidermis.
72
A nurse is to administer an intramuscular injection into the deltoid muscle. What body landmark should the nurse use to help located the appropriate site?
1.Knee
2.Greater Trochanter
3.Acromion process
4.Anterior superior iliac spine.
3.Acromion process
73
What should the nurse do to best prevent needle stick injuries when administering injections?
1. Bend the needle of the syringe before disposal
2. recap the needles while transporting it to a sharps container.
3.Use a syringe with a device that automatically covers the needle after its use.
4. dispose of a syringe with its attached needle into the closest sharps
3.Use a syringe with a device that automatically covers the needle after its use.
74
A patient has a prescription for 22 units of NPH insulin and 8units of regular insulin once daily at 8 am. The nurse teaches a patient how to draw up and self administer these insulins.Which amount of solution indicated that the patient prepared the correct dose?
1. 8 units
2. 22 units
3. 30 units
4. 44 units
3. 30 units
75
Schedule 1 Drug - CONTROLLED SUBSTANCE
DESCRIPTION
High potential for abuse
No currently accepted medical use
in treatment in the United States
EXAMPLE
Heroin, lysergic acid diethylamide (LSD), and methaqualone
76
Schedule 2 Drug - CONTROLLED SUBSTANCE
High potential for abuse; may lead to severe psychological or physical dependence
Has a currently accepted medical use with severe restriction
EXAMPLE
Morphine, cocaine, methadone, and methamphetamine
77
Schedule 3 Drug- CONTROLLED SUBSTANCE
Lower potential for abuse compared to the drugs in schedules I and II in regard to moderate dependence
Has a currently accepted medical use
EXAMPLE
Anabolic steroids, narcotics such as codeine or hydrocodone with aspirin or acetaminophen, and some barbiturates
78
Schedule 4 Drug - CONTROLLED SUBSTANCE
Lower potential for abuse relative to the drugs in schedule III; may lead to limited dependence
Has a currently accepted medical us
EXAMPLE
Pentazocine, meprobamate, diazepam, and alprazolam
79
Schedule 5 Drug - CONTROLLED SUBSTANCE
Low potential for abuse relative to the drugs in schedule IV
Has a currently accepted medical use in treatment in the United States.
EXAMPLE
the drugs in schedule IV
Has a currently accepted medical use in treatment in the United States.
Over-the-counter (OTC) cough medicines with codeine
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Therapeutic effect of medication
The therapeutic effect, or intended effect, is the desired result or action of a medication.
for example, the therapeutic effect of Morphine is pain relief
Desired result or action of a medication
◦ To achieve therapeutic effect, medication must:
Be taken into the body
Be absorbed and distributed in cells
and tissues
Alter physiologic functioning
◦ Effectiveness is influenced by:
Medication dose
Route of administration
Frequency of administration
Function of metabolizing organs
Age of patient
81
Adverse effect of medication
Adverse effects are severe, unintended, unwanted, and often unpredictable drug reactions.
for example, the adverse effect of morphine is hallucinations and fever
82
Toxic effect of medication
Toxic effects result from a medication OVERDOSE or the buildup of medication in the blood due to impaired metabolism and excretion.
For example, toxic levels of a pain medication (such as morphine sulfate) may cause respiratory depression, leading to respiratory arrest. Toxic levels of a drug can lead to serious physiologic effects that may be lethal.
83
Side effect of medication
Side effects are predictable but unwanted and sometimes unavoidable reactions to medications.
Side effects may be minor and harmless, or they may cause patient injury. Patients may refuse to continue a medication because of side effects.
for example, the side effect of morphine is drowsiness
84
Allergic reactions to medications
Allergic reactions are unpredictable immune responses to medications. When a patient is first exposed to a foreign substance (antigen), the body produces antibodies.
On exposure, the patient reacts to the antigen with an allergic reaction that ranges from minor to severe.
Minor allergic reactions include a rash, itching of the skin, inflammation of the nasal passages causing swelling and a clear discharge, and raised skin eruptions (hives).
A severe allergic reaction is called an anaphylactic reaction, and it is a medical emergency. Anaphylaxis can occur immediately after the administration of medication and can be fatal.
85
Medications and
Regulations
Medications and
Regulations
State and local medication regulations
Health care facilities develop policies and
procedures
◦ That must be in compliance with federal, state,
and local regulations
◦ That may be more restrictive than government
controls
◦ The goal is to prevent adverse patient outcomes
Nurse practice act
◦ Defines the functions and professional
responsibilities of nurses
◦ Health care facilities cannot modify or expand the
nurse practice act
5
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pharmokinetic how it enters the body
Pharmacokinetics
Absorption: passage of a drug from the
administration site into the bloodstream
Distribution: process of delivering the
medication to tissues and organs
Metabolism: process by which a drug is
altered to a less active form to prepare for
excretion
Excretion: process that removes the less
active drug or its metabolite
87
Anaphylactic
A severe allergic reaction is called an anaphylactic reaction, and it is a MEDICAL EMERGENCY. Anaphylaxis can occur immediately after the administration of medication and can be fatal.
88
Idiosyncratic
An idiosyncratic reaction is an unpredictable patient response to medication. This response can be an overresponse, underresponse, or abnormal reaction to the medication. For example, a patient receiving an antihistamine may become overly alert and be unable to sleep rather than being drowsy, as expected.
89
Medication interactions
Medication interactions occur when the drug action is modified by the presence of a certain food or herb or another medication. The interaction can alter the way the medication is absorbed, metabolized, or eliminated.
90
Synergistic
A synergistic effect occurs when the combined effect is greater than the effect of either substance if taken alone. Alcohol, for example, is a central nervous system depressant that has an increased effect when taken with antihistamines, antidepressants, or barbiturates.
A synergistic effect may be specifically sought by the primary care provider; for example, a patient with hypertension may receive a diuretic and a vasodilator to achieve a greater antihypertensive response than would be achieved by either drug alone.
91
Antagonism
Antagonism occurs when the drug effect is decreased by taking the drug with another substance, including herbs. For example, antibiotics can lessen the effect of birth control medications, and grapefruit juice alters the absorption of statins, a class of lipid-lowering drugs.
92
Drug incompatibility
Mixing medications in a solution that causes precipitation or combining a drug with another drug that causes an adverse chemical reaction is called drug incompatibility.
Compatibility must be verified before
mixing or administering medications.
93
Nonprescription Medication
Over-the-counter (OTC) medications
◦ Do not require a prescription
◦ Regulated by the FDA
When selecting an OTC medication,
consider:
◦ The desired effect and potential side and
adverse effects of all ingredients
◦ Possible allergic reactions
◦ Potential interactions with other
medications and herbs
◦ Warnings, directions, and dosage
◦ Safety features
Examples are cold medicines, mild analgesics, diet and nutrition supplements, and sleep aids. The FDA regulates OTC medications relative to safety and recommended dosage, but it does not regulate all supplements
94
Prescription Medications
The only person or individual who can prescribe meds are professionals with DEA# numbers
Medications are usually dispensed by a pharmacist on receipt of electronically transmi ed PCP orders, or via wri en directions, or prescription (Fig. 35.2).
Prescription medications
Medication order components
* Patient's name
* Date and time
* Drug name
* Dosage
* Drug route
* Administration frequency
* Signature
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Vitamins
Vitamins needed by the body are usually acquired from food that is eaten. The body uses vitamins for the biologic processes of growth, digestion, and nerve function.
CAUTION WITH VITAMINS
Fat-soluble vitamins are stored by the body for use as needed; however, excess can build up in the liver, so they must be used with caution.
Vitamin use should be recorded as part of the patient history. They can have side effects, such as anticoagulation and interfering with the results of medical tests (Table 35.3). Vitamin products are regulated by the FDA as dietary supplements, with testing for purity, strength, and composition.
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VITAMIN A ADVERSE EFFECTS
Nausea, vomiting, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, possible risk of osteoporosis
The fat-soluble vitamins are the A, D, E, and K vitamins. There are certain conditions in which vitamins should be considered for use. They include pregnancy, breastfeeding, a vegetarian or vegan diet, an illness or condition that prevents oral consumption of foods, and the need for dietary supplements.
97
VITAMIN D ADVERSE EFFECT
Nausea, vomiting, poor appetite, constipation, weakness, weight loss, confusion, heart rhythm problems, deposits of calcium and phosphate in soft tissues
The fat-soluble vitamins are the A, D, E, and K vitamins. There are certain conditions in which vitamins should be considered for use. They include pregnancy, breastfeeding, a vegetarian or vegan diet, an illness or condition that prevents oral consumption of foods, and the need for dietary supplements.
98
VITAMIN B3 NIANCIN ADVERSE EFFECTS
Flushing, redness of the skin, upset stomach
99
VITAMIB B6 ADVERSE EFFECTS
B6 (pyridoxine, pyridoxal, and pyridoxamine)
100
VITAMIN C ASCORBIC ACID ADVERSE EFFECTS
Upset stomach, kidney stones, increased iron absorption
101
Herbal Supplements
Many people take herbal supplements to support and maintain their health. Herbal therapy has roots that date back to ancient times.
Herbal medications come from plants or a plant part and are found in many foods. Herbs can be dried and processed to make a more concentrated product that is delivered in a capsule or pill. Many commercial herbal preparations contain more than one herb. Many nonprescription and prescription drug formulations include a plant or plant extract. Common examples are aspirin (willow tree bark), morphine (opium poppy), and digitalis (foxglove
102
Echinacea
Uses
Stimulates the immune system; facilitates wound healing; fights flu and colds
Side effect Drug Interaction
Possible liver inflammation and damage if used with anabolic steroids or methotrexate
103
Garlic
Uses
Lowers blood pressure and cholesterol and triglyceride levels
Side effect Drug interaction
Increased bleeding; potentiates action of anticoagulants
104
Ginkgo biloba
Uses
Improves memory and mental alertness
Side effect Drug interaction
Increased bleeding; potentiates action of anticoagulants
105
Ginseng
Uses
Increases physical stamina and mental concentration
Side effect Drug Interaction
Can increase heart rate and blood pressure; decreases effectiveness of anticoagulants; may cause hypoglycemia in patients taking oral hypoglycemics or insulin
106
Saw palmetto
Uses
Helps with enlarged prostate and urinary
inflammation
Side Effect Drug interaction
Interacts with other hormones
107
St. John's wort
Uses
Alleviates mild to moderate depression, anxiety, and sleep disorders
Side effect Drug Interaction
Interacts with anti-anxiety medications, antidepressants, anticoagulants, birth control pills, cyclosporine, digoxin, statins, and human immunodeficiency virus (HIV) and cancer medications
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Medication Administration Record
Each patient in a health care facility has a medication administration record (MAR). The MAR includes the patient's name, full name of medication, administration time, dose, route, frequency, site of administration for parenteral medications, and the nurses’ initials and signatures.
Medication orders can change on the basis of the status of the patient. For example, a sudden change in condition, an adverse reaction to a medication, or a patient transfer to a different care unit can necessitate a change in medication orders
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Routine Order
Administered until the health care provider discontinues the order or until a prescribed number of doses or days have occurred.
example
digoxin 0.125 mg PO daily
amoxicillin 250 mg PO q 8 hr × 10 days
110
PRN order (as needed)
Given only when the patient requires it. Use determined by objective and subjective assessment and clinical judgment of the nurse.
example
morphine sulfate 4 mg IV q 2 hr PRN pain
111
STAT (immediately)
Given immediately and only once in a single dose; frequently given for emergency situations.
diazepam 10 mg IV stat for seizure
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One time/ On Call/
Given only once at a specified time, often before a diagnostic or surgical procedure.
example
lorazepam 1 mg IV on call surgery
113
Now Order
Used when a medication is needed quickly but not as immediately as a stat medication; given one time.
example
vancomycin 1 g IV now, on admit
114
Med Admin Routes
Common routes of administration include oral (by mouth),
buccal (against the cheek),
sublingual (under the tongue),
parenteral (by injection or infusion),
topical (on skin or mucous membranes),
by inhalation,
and through a medical tube (e.g., a nasogastric tube, percutaneous endoscopic gastrostomy [PEG] tube). Each route has advantages and disadvantages (Table 35.7).
115
What form of medication would a suppository be?
A. Oral
B. Topical
C.Intramuscular
D. Transdermal
B. Topical
116
Oral Medications
Advantages
Convenient, cost-effective, and comfortable, with low stress for the patient.
Certain oral tablets formulated to dissolve on contact with the tongue
Disadvantages
Inappropriate for patients with nausea or vomiting; contraindicated for patients with swallowing difficulty
Can irritate gastrointestinal lining, have unpleasant taste, or discolor teeth
Patient must be alert and oriented to safely administer
Cannot be used with simultaneous gastric suctioning or before various diagnostic or surgical procedures
Possible irregular or slow absorption
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The patient was scheduled to receive 4mg of morphine PO STAT because of severe pain, on the assessment you see that the patient has severe vomiting. What would you do to administer this medication?
A. still administer the medication even though she is vommiting
B. hold the medication, call and notify the PCP of the pt's current state and ask for another administration route to be ordered
C. Let the patient finish vommiting and immediately administer the PO med
D. Crushing it and have them drink it with a glass of water
B. hold the medication, call and notify the PCP of the pt's current state and ask for another administration route to be ordered
118
Sublingual or buccal
The sublingual and buccal oral routes are used for absorbing small amounts of medications quickly through the oral mucosa; this prevents destruction of the medication by gastric or intestinal secretions. For the sublingual route, medications are placed under the tongue to dissolve (Fig. 35.4).
Nitroglycerin for chest pain is administered by this route.
For the buccal route, medications are placed against the mucous membrane of the cheek until completely dissolved (Fig. 35.5). Medications administered by the buccal route include antiemetics and opiate pain medications.
Advantages
As above plus more potent because the drug bypasses the liver and enters the bloodstream directly
Disadvantages
May be inactivated by gastric juices if swallowed
119
Topical
Medications formulated for topical application are applied to a specific skin surface or mucous membrane of a body cavity. Nurses administer medications to the skin and mucous membranes in a variety of ways. Liquids and ointments can be directly applied to the eyes. Suppositories can be inserted into the rectum or vagina. Fluids can be instilled into a body cavity such as the ear, nose, bladder, or rectum. Body cavities such as the eye, ear, vagina, bladder, and rectum can be flushed with a medicated solution. A spray can be applied to the throat. Lotions and ointments can be applied to any skin surface.
Advantages
Local effect with few side effects
Local effects to involved sites with systemic effects possible; readily absorbed; may be used if the oral route is contraindicated
Disadvantages
Mucous membranes are highly sensitive to concentrated medications
Dose absorption may be unpredictable
Procedure may be messy
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Inhaled Medication
Advantages
Rapid localized effect; may be administered to unconscious patients
Disadvantages
May cause serious systemic effects; can be administered only through the respiratory system
Medications for inhalation are taken into the body through the respiratory tract. The deeper passages of the respiratory tract provide a large surface for medication absorption. Inhaled medications are effectively used to induce anesthesia and to treat respiratory disorders. Nurses administer inhaled medications through nasal passages, oral passages, an endotracheal tube, or a tracheostomy tube. Means of delivery include small amounts of fluids, metered-dose inhalers (MDIs), turbo-inhalers, and nebulizers
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Parental Medication
The four major sites of injection are
◦ Intradermal (ID): Shallow injection
into the dermal layer just under the
epidermis (5-15 degrees)
◦ Subcutaneous (subq;
subcutaneously): Injection into the
subcutaneous tissue just below the
skin (45-90 degrees)
◦ Intramuscular (IM): Injection into a
muscle of adequate size to
accommodate the amount and type
of medication (90 degrees)
◦ Intravenous (IV): Injection or infusion
directly into the bloodstream through
a vein
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Filter needles and Straws
Filter needles or straws are used when medications are being withdrawn from a glass ampule. The filter traps glass fragments. A filter needle or straw must be replaced with a regular needle before injecting the medication into the patient.
◦ Used when medications are being
withdrawn from a glass ampule.
Needleless delivery systems
◦ Significantly decrease needlestick
injuries and exposure to bloodborne
pathogens.
◦ Needleless devices are disposed of
in the same manner as are regular
needles.
123
44. The patient tells the nurse about a burning sensation in the epigastric area. The nurse should describe this type of pain as
A. referred.
B. radiating.
C. visceral.
D. superficial.
C. visceral.
124
49. The nurse tells the patient in advance that the urinary catheter insertion may feel uncomfortable. This is most accuratelv an example of which of the following?
A. Distraction
B. Reducing pain perception
C. Anticipating a response
C. Self-care maintenance
C
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50. A patient with chronic back pain has an order for a transcutaneous electrical nerve stimulation unit for pain control. The nurse is aware that this therapy is contraindicated for the patient with
A. a pacemaker.
B. muscle pain.
C. diabetes.
D. arthritis.
A
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51. A terminally ill patient with liver cancer is experiencing great discomfort. What would be a realistic intervention for the patient?
A. Increasingly administer narcotics to oversedate the patient and thereby decrease the pain.
B Continue to change the analgesics until the right narcotic is found that completely alleviates the pain.
C. Adapt the analgesics, as the nursing assessment reveals the need for specific medications.
D. Withhold analgesics, as they are not being effective in relieving discomfort.
C
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52. Nurses working with patients in pain need to recognize and avoid common misconceptions and myths about pain. In regard to the pain experience, which of the following is
COrrect?
A. Chronic pain is mostly psychological in nature.
B.Regular use of analgesics leads to drug addiction.
C. The patient is the best authority on the pain experience.
D. The amount of tissue damage is accurately reflected in the degree of pain perceived.
C
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53. A nonpharmacological approach that the nurse may implement for patients experiencing pain that focuses on creating a calm state with controlled breathing and relaxation is
A. acupressure.
B. meditation.
C. biofeedback.
D. hypnosis.
B
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54. The nurse consults with the primary care provider of a patient who is experiencing continuous, severe pain. In planning for the patient's treatment, the nurse is aware of the principles of pain management, and that it is appropriate to expect treatment to include which intervention?
A. Focusing on intramuscular administration of analgesics
B. Waiting for pain to become more intense before administering opioids
C. Administering opioid with nonopioid analgesics for severe pain experiences
D. Administering large doses of opioids initially to patients who have not taken the medications before
C
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55. On entering the room, the nurse discovers that the patient is experiencing acute pain. An expected assessment finding for this patient is
A. bradycardia.
B. diaphoredis.
C. bradypnea.
D. decreased muscle tension.
B
131
56. Which of the following is an example of multimodal analgesia?
A. Ginseng
B. Massage
C. IV morphine
D. Tylenol with codeine
D
132
57. Knowing the major side effect of nonsteroidal anti-inflammatory drug medications, the nurse specifically instructs the patient to
A. apply skin lotion daily.
B. take the medication with food.
C. avoid taking it with other drugs.
D. take the medication in the morning.
B
133
58. The nurse expects to administer which of the following medications for a narcotic overdose?
A. Naloxone
B. Meperidine
C. Butorphanol
D. Dezocine
A
134
SUB Q NEEDLE LENGTH AND GAUGE
25-31 gauge, Length- 3/8 and 5/8 inch (up to 1 inch for an obese patient)
Site
Abdomen, lateral aspects of the upper arm and thigh, scapular area of the back, and upper ventrodorsal gluteal area
Syringe
1/2- -3 mL Insulin
syringe: U- 100, U-50, or U-30
135
IM NEEDLE LENGTH AND GAUGE
19-25 gauge, 1-3 inch (adult)
Site
Ventrogluteal, vastus lateralis, and deltoid
Age of patient and
corresponding site†: Infant: Vastus lateralis Children: Vastus lateralis or deltoid
Adult: Ventrogluteal or
deltoid
Syringe
Adults: 1-5 mL
depending on site and muscle
massb Infants,
small children: 0.5-1 mL
136
INTRADERMAL NEEDLE LENGTH AND GAUGE
Prea ached 25-27gauge, 1/4 or 5/8 of an inch.
0.1 ML ONLY TO FORM A BLEB
Site
Innerforearm,upperarm,
and across the scapula
Syringe - 1-mL tuberculin
syringe
137
IV NEEDLE LENGTH AND GAUGE
Typically, a large-gauge, 1- inch needle; needleless, blunt-tip cannula or Luer- Lok used with associated IV ports.
Site
Vein
Syringe
Depends on amount of medication to be infused
138
Medication Administration Rules
Each medication that a nurse administers
must be prescribed by a health care
provider and be appropriate for the patient.
Use the Medication Administration Record
when preparing and administering all
medications.
Follow established protocols for
administering medications safely by each
route.
Use special techniques for children and
elderly individuals.
139
Z track Method
Intramuscular injections of medications that discolor tissue (e.g., iron) or are irritating to tissue (e.g., hydroxyzine) are administered by the Z-track method. This technique seals the medication into the muscle tissue, with no tracking of medication into the subcutaneous tissue when the needle is withdrawn.
140
Can a pt eat or drink anything while taking a sublingual medication?
A. Yes
B. No
B. No
A sublingual medication is placed under the tongue and allowed to dissolve. The patient should not eat or drink anything until the medication is completely dissolved.
141
NPO patients
If a patient should receive nothing by mouth (NPO), an alternate route is used or an order is obtained for the patient to be NPO except for medications.
142
Should you use a large amount of apple sauce or pudding when mixing the crushed tablet in the mixture?
A. Small
B. Large
A. Small
Some capsules may be opened and the contents added to a small amount of applesauce, pudding, or ice cream. Certain tablets may be crushed and added to food in a similar manner. Use a small amount of food so that the entire dose is administered if the patient eats only a small amount.
143
ORAL MEDS KEY POINTS
ORAL MEDS KEY POINTS
Special techniques are used for the patient who has difficulty swallowing large tablets.
The patient's ability to swallow, level of consciousness, gag reflex, and whether the patient is experiencing nausea and vomiting are assessed to ensure the patient's ability to take medications by the oral route and to prevent aspiration (i.e., inhalation of gastric contents into the respiratory system).
After administration, verify medication was swallowed
◦ Do not use medications in containers with missing or hard-to-read labels; do not return
medication to a multidose container
144
ENTERAL ROUTE MEDS
Medication may be administered by the enteral route (i.e., through a gastrointestinal tube).
Liquid medication is preferred, although some tablets may be finely crushed and dissolved in sterile water.
Care is taken that the tube is flushed before and after administration with 15 mL of sterile water (or in accordance with facility policy) to clear the tube of medication and prevent clogging of the tube.
Having the patient sit as upright as possible decreases the risk of aspiration. The patient should remain with the head elevated for at least 30 minutes after administration.
To allow absorption time, gastric suction should not be used for 20 to 30 minutes after administration (Boullata, Kirby, & Krzywda, 2016). Water intake associated with medication administration is counted as intake on the intake and output record.
145
LIQUID ORAL MEDICATIONS
Liquid medications often come in premeasured packages. If not, a calibrated syringe or medication cup is used to accurately measure the prescribed amount. Antifungal liquid medications (e.g., nystatin) may need longer contact with mucous membranes and be prescribed as “swish and swallow.” The patient swishes the medication back and forth in the mouth several times and then swallows it. This should be the last oral medication administered so that additional use of fluids to swallow the other medications does not rinse the medication from the mucous membranes.
146
SUBLINGUAL AND BUCCAL MEDICATIONS
The sublingual and buccal routes allow rapid absorption of medications, such as nitroglycerin for chest pain. A sublingual medication is placed under the tongue and allowed to dissolve. The patient should not eat or drink anything until the medication is completely dissolved.
Patients are taught to alternate cheeks to avoid mucosal irritation. Buccal medication should not be chewed, swallowed, or taken with liquids.
147
TOPICAL MED PRECAUTIONS
Cleanse the skin before applying topical medications to remove body oils or dry skin, which can impair medication absorption
Gloves and applicators are used to avoid absorption through the nurse's skin during placement of topical medications.
Apply gloves to avoid being exposed to the patient's medication that is absorbed through the skin.
Gauze dressing may be applied over the medication to prevent removal of the medication by clothing.
Topical medications are placed on the skin surface, on mucous membranes, or in body cavities (Box 35.7). Placement sites in addition to the skin include eyes, ears, nose, rectum, vagina, and lungs. Drugs applied directly to skin for a local effect include lotions, creams, powders, and aerosol sprays
148
TRANSDERMAL MED
CARE GUIDELINES
Remove the old patch from the patient's skin; fold it so that it sticks to itself instead of having exposed adhesive surfaces.
* Assess, clean, and dry new and old sites: * Rotate application sites.
* Ensure that each site is free from hair and is not located over a bony prominence.
* Note any redness, irritation, or skin breakdown; do not apply a new patch to an area of skin irritation or breakdown.
* Never apply a patch over a pacemaker or implanted port.
* Do not massage the patch.
Medications designed to be absorbed through the skin for systemic effect are administered transdermally, usually in the form of a patch. The skin site is cleansed because skin oils may interfere with the adhesive on these products. A previously placed patch and remaining medication must be removed. Patches are disposed of according to facility policy, especially if the patch contains a controlled substance. Placement sites are rotated to avoid skin irritation. The placement of the new patch and removal of the old patch are recorded in the MAR.
149
OPTHALMIC MED (EYE DROPS AND OINTMENTS)
EYEDROPS
Hold the bo le above the eye that is to be treated.
* Place drops into the pouch formed by the lower eyelid
in the lower conjunctival sac.
* Have the patient blink several times. Maintain slight
pressure on the inner canthus to prevent loss of medication through the tear duct and reduce systemic effects of the medication.
OINTMENTS
* Squeeze a 1/2 -inch strip of ointment from the tube into the lower eyelid, moving from the inner canthus to the outer canthus being careful to not allow the tip of the tube to touch the eyelid (maintain medical asepsis).
* Instruct the patient to close and roll the eyes around.
* Inform the patient that the medication may temporarily
blur vision.
Ophthalmic medications (i.e., eyedrops and ointments), including OTC preparations, are used to treat eye irritation, infections, or disorders, such as glaucoma (Box 35.8). Eyedrops can be used for diagnostic procedures or to anesthetize the eye for procedures. Cross- contamination is a potential problem with eye medications. Each patient has an individual bo le of eye medication. Care is taken not to touch the tip of the dropper or tube to the patient's eye, because infection can be transferred from one eye to the other if the applicator touches the eye.
150
OTIC MED (EAR DROPS)
* Have the patient lie with the ear to be treated in the
uppermost position.
* Hold the medication bo le above the ear.
* Straighten the auditory canal of an adult patient by
gently pulling the pinna up and back.
* Place the specified number of drops into the ear canal.
* Release the pinna, and press on the tragus several times
to prevent loss of medication and reduce systemic
effects from the medication.
* If ordered, place co on loosely in the auditory canal.
* Wait 5 minutes before administering medication in the
other ear (if bilateral administration is ordered).
Solutions administered to the ear canal are otic medications (Box 35.9). Eardrops are used to treat ear infections and associated pain, soften earwax to ease removal, apply a local anesthetic, and remove foreign particles trapped in the ear canal. The internal ear is very sensitive to temperature changes, and it is important to use eardrops at room temperature to prevent nausea, pain, and dizziness. If the tympanic membrane has been damaged, all procedures are performed with sterile technique to prevent infection. Medication should not be forced into the ear canal because forcing may rupture the tympanic membrane.
*USE EAR DROPS ROOM TEMPERATURE TO AVOID PAIN DIZZINESS AND NAUSEA*
151
NASAL MEDICATIONS
* Have the patient blow the nose first. (CLEAN NOSE)
* Medication administration:
* Tilt the patient's head slightly back, or have the patient
lie in the supine position with the head tilted backward. * Have the patient breathe out through the mouth.
*Insert the end of the delivery device 1/2 inch into one nostril. Have the patient plug the opposite nostril. Do not touch the insides of the nares with the device, because doing so may cause sneezing and contamination.
* Administer the drops or spray as the patient inhales through the nose.
* Have the patient exhale through the mouth.
* Keep the patient's head tilted back for several minutes
while the patient continues to breathe through the mouth.
Nasal medications are administered by drop or nebulizer formulations into the nose (Box 35.10). The nose is a clean, not sterile, cavity, but the nurse uses medical asepsis when administering nasal preparations because of the connection of the nose to the sinuses. Decongestant sprays or drops to relieve symptoms of sinus congestion are the most common medications administered through nasal instillation. When these medications are used in excess, they may have systemic effects such as increased heart rate and a rebound effect that increases congestion.
152
INHALED MEDICATION
The nose and mouth provide entry to the lower respiratory system. MDIs and dry powder inhalers (DPIs) are small, hand-held devices that a patient activates before inhaling (Skill 35.2). Each time the device is pressed, a specific dose is released. Medication absorption is very rapid. Spacers can be used with the MDI to trap the medication
152
RECTAL MEDICATIONS
Position the patient on the left side, with the upper knee flexed (i.e., Sims position) (see Fig. 28.20).
* Unwrap the suppository and lubricate it and a gloved index finger, using water-soluble gel.
* Separate the bu ocks to expose the anus.
* Have the patient breathe slowly and deeply.
* Insert the suppository with the rounded end inserted first.
* Gently push the suppository along the rectal wall; avoid embedding it in feces.
* Continue until the suppository is inserted past the internal sphincter (approximately 3 to 4 inches).
* Cleanse excess lubricant or stool from the patient's perirectal area.
* Instruct the patient to remain in left lateral position with bu ocks pressed together for 5 to 10 minutes; if a laxative was inserted, the patient should remain supine for 35 to 45 minutes.
* Remove gloves, turning them inside out to avoid possible contamination with microorganisms.
* Wash hands thoroughly.
153
VAGINAL MEDICATIONS
Have the patient empty her bladder.
* Instruct the patient to lie on her back with knees flexed (i.e., dorsal recumbent position), or, if unable to tolerate the dorsal recumbent position, have her lie in the Sims position.
* Put on gloves.
* Lubricate the applicator or suppository using a water-soluble gel.
* Separate the labia with the nondominant hand to expose the vaginal opening.
* Cleanse the vaginal opening (see Skill 27.2).
* Fully insert the applicator or suppository. Use a rolling motion,
inserting downward and backward.
* Remove gloves, turning them inside out to prevent the spread of microorganisms.
* Instruct the patient to remain on her back, in a side-lying position, or with hips elevated on a pillow for 5 to 10 minutes.
* Offer the patient a perineal pad.
154
What is Medical Reconciliation?
The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider.
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9. A client in pain requests the prescribed pain medication, which is an opioid. Which nursing assessment is essential before administering the opioid?
1. Blood pressure
2. Respirations
3. Temperature
4. Pulse
2. Respirations
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Reconstituted Medications
Proper Mixing
. Roll the vial between your palms. Make sure that all the powder dissolves and the solution contains no sediment. Proper procedure ensures that the medication is evenly
mixed.
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Scored Tablet Medications
If a tablet it’s scored it can be cut half. And the patient can recieve half the dose of the pill if half of it is ordered.
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NG TUBE MED ADMIN/ ENTERAL FEEDING
- Position Patient in. Semi fowlers position
-Irrigate 30ML OF STERILE WATER BEFORE AND AFTER EVERY FEEDING AND EVERY MED ADMIN
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PROPER MED ADMIN
verification ensures the accuracy of the dose. Avoid possible medication errors by adhering to the Six Rights of Medication Administration and by checking the medication with the MAR three times. Pouring into the lid avoids touching the medication, preventing the spread of microorganisms. Not removing medication from the wrapping allows another check and patient education at the bedside.
4. Enter the patient's room, perform patient identification, check patient allergies, assess patient knowledge, and educate the patient as needed.
Communication with the patient facilitates cooperation. Avoid possible medication errors by adhering to the Six Rights of Medication Administration.
5. Recheck the label on the medication with the MAR a third time before returning the medication to its storage place or before opening the package at the bedside. Prepare or open unit-dose medication.
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Flushing an Intravenous Line
Before administering IV medication
Always check the patency of the IV line by flushing it with 0.9 normal saline
* Flushing an intravenous (IV) line maintains the saline lock patency.
* Flushing keeps incompatible solutions separate and allows assessment of the IV line.
Flush with 10cc of 0.9 normal saline
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A patient is scheduled for Q4H furosemide and they're sleeping What should you do?
A. wait until they wake up
B. do not administer until 24H later
C. Wake them up because it is a scheduled drug and administer it
D. give the medication as needed PRN when the patient requests it
C. Wake them up because it is a scheduled drug and administer it
PRN MEDS ARE ACCEPTABLE NOT TO WAKE THE PATIENT UP.
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How many times would you check the medication against the MAR?
a. 20 TIMES
b. 1 time
c. 0 times
d. 3 times
d. 3 times
Verification ensures the accuracy of the dose. Avoid possible medication errors by adhering to the Six Rights of Medication Administration and by checking the medication with the MAR three times. Pouring into the lid avoids touching the medication, preventing the spread of microorganisms. Not removing medication from the wrapping allows another check and patient education at the bedside.
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A nurse has administered the wrong medication, to the patient. What priority action should the nurse do first?
A. Assess the patient's reaction to the medication
B. Document that the patient was given the wrong medication, without including the patient's reaction to drug .
C. Administer reversal medication
D. do not notify anyone about the medication error
A. Assess the patient's reaction to the medication
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Medication error steps
Asssess patients reactions
Notify doctor or charge nurse
Administrar reversal medication
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