Module 3B: General Patient Care 1

Question 1

Thermometer

Answer 1

Used to measure body temperature

Question 2

Stethoscope

Answer 2

Used to amplify sounds in the body, such as the beating of the heart, respirations in the lungs, and bowel sounds in the abdomen

Question 3

Sphygmomanometer

Answer 3

Used to measure blood pressure

Question 4

Pulse oximeter

Answer 4

Used to measure oxygen saturation in the blood by a noninvasive device that is clipped on the fingertip, bridge of the nose, forehead, or earlobe.

Question 5

Reflex hammer

Answer 5

Used for testing reflexes

Question 6

Otoscope

Answer 6

An instrument used for visual examination of the eardrum and ear canal, typically having a light for visibility.

Question 7

Ophthalmoscope

Answer 7

Instrument used to examine the interior of the eye especially the retina

Question 8

Common Supplies, Equipment, and Procedures for Dermatology

Answer 8

A medical assistant may assist in minor surgical procedures to help obtain skin biopsies or in the debridement of wounds and collect specimens from wound cultures. Follow sterile procedures when assisting in minor surgical procedures and obtaining wound cultures.

• Dermal punch biopsy
• Dermal cutter
• Scalpel
• Gauze
• Incision and drainage tray​​​​​​​
• Specimen collection swabs and containers

Question 9

Common Supplies, Equipment, and Procedures for Cardiology

Answer 9

A medical assistant may need to perform electrocardiograms (EKGs) and Holter monitoring on patients with cardiac symptoms or diseases. Both tests are used to monitor and record the heart’s electric activity and are often used to diagnose heart disorders, especially regarding its rhythm and rate.

• Three-channel electrocardiograph
• Electrodes
• EKG paper​​​​​​​
• Holter monitor

Question 10

Common Supplies, Equipment, and Procedures for Endocrinology

Answer 10

Endocrinology involves hormones. Medical assistants should be familiar with venipuncture and capillary punctures (fingersticks). Medical assistants will perform glucose monitoring and patient education related to proper use of glucose monitoring equipment.

• Glucometers
• Alcohol pads
• Adhesive strips
• Test strips​​​​​​​
• Lancets

Question 11

Common Supplies, Equipment, and Procedures for Neurology

Answer 11

A neurological examination focuses on the patient’s reflex response, motor response, muscle tone, speech patterns, coordination, sensory response, gait, and mental status and behavior. The MA may assist the provider throughout the exam, as directed.

• Otoscope
• Ophthalmoscope
• Percussion hammer
• Penlight
• Tuning fork
• Cotton balls
• Safety pin
• Tongue depressor
• Small vials containing hot and cold liquids
• Vials with different scents​​​​​​​
• Vials with different tasting liquids

Question 12

Common Supplies, Equipment, and Procedures for Obstetrics and gynecology

Answer 12

This specialty practice may assist in a number of procedures, including minor surgery. A common procedure is a Pap test. A Pap test is a screening procedure that collects and examines cells from the vaginal and cervical mucosa to check for precancerous or abnormal cells.

• Vaginal speculums and retractors
• Cytology kits
• Stitch removal sets
• Dressing kits
• Exam tables with stirrups
• Ultrasound machine​​​​​​​
• Handheld fetal Doppler machine

Question 13

Common Supplies, Equipment, and Procedures for Pulmonology

Answer 13

A pulmonology practice may conduct different tests to assess respiratory function, to assist in the diagnosis of patients with suspected obstructive or restrictive pulmonary disease, and to assess the effectiveness of medication and other pulmonary therapies.

One of the most common tests to evaluate lung function that a medical assistant may perform is a pulmonary function test (PFT). The most common tests and procedures performed are spirometry, peak flow meters, and pulse oximetry.

• Peak flow meter
• Spirometry machine​​​​​​​
• Disposable mouthpieces and nose clips

Question 14

Spirometers

Answer 14

Small, handheld devices that provide digital readings, and there are portable meters with integrated printers.

Advanced spirometry systems are computerized and can be configured to send results directly to a patient’s electronic health record (EHR).

All spirometers consist of a mouthpiece and tubing connected to a recording device.

Question 15

Peak flow meter

Answer 15

Often used for patients who have asthma to monitor their daily respiratory function and condition.

The peak flow meter measures the fastest rate at which the patient exhales after taking a maximum breath.

Question 16

Common Supplies and Equipment for General Exam Rooms

Answer 16

Supplies are disposable items used for patient examination and treatment.
- examination table paper
- paper drapes and gowns
- dressings and bandages
- tongue depressors
- disposable gloves (sterile and nonsterile)
- syringes and needles (stored securely locked)
- alcohol pads

Equipment is usually more durable and requires routine maintenance and cleaning between use. Equipment should be properly stored and not left on countertops or within reach of the patient.
- Thermometer
- Stethoscope
- Sphygmomanometer
- Pulse oximeter
- Reflex hammer
- Otoscope
- Ophthalmoscope

Question 17

First steps to any procedure

Answer 17

All procedures should begin with good hand hygiene and a routine introduction (identifying the patient and introducing yourself).

Question 18

Providing Patient Education

Answer 18

• Provide the patient information about any follow-up appointments, additional exams, aftercare instructions, and referrals.
• Let the patient know when to expect results from lab, radiology, or any other diagnostic tests.
• Ask if the patient has any questions and direct appropriate questions to the health care provider to answer.

Question 19

Steps to prepare a patient for a procedure or examination

Answer 19

1. Review the patient’s medical chart
2. Prepare the exam room with the necessary supplies and equipment
3. Identify the patient and introduce yourself
4. Provide the patient a gown and drape
5. Assist the patient with dressing, if requested, after the procedure.

Question 20

Supine Positioning and Draping for Exams

Answer 20

*Aka horizontal recumbent position

Position: patients lie flat on their back with hands at the sides. Be sure that the patient’s feet are supported by extending the examination table.

Use:
- to examine anything on the anterior or ventral (front) surface of the body (head, chest, stomach) and for certain types of x-rays.

Draping:
- The patient should be draped from the chest down to the feet.
- During the examination, expose areas as necessary and as indicated by the health care provider.

Considerations:
- The supine position may not be comfortable for patients who have difficulty breathing or who have lower back problems. For these patients, placing a pillow under the head and under the knees may help alleviate pain and provide more comfort.

Question 21

Prone Positioning and Draping for Exams

Answer 21

Position: Requires the patient to lie face down, flat on the stomach, with the head turned to one side, and arms either alongside the body or crossed under the head.
*This position is the opposite of the supine position.

Use:
- for back exams and certain types of surgery

Draping:
- The drape should cover the patient from upper back to over the feet.

Question 22

Dorsal Recumbent Positioning and Draping for Exams

Answer 22

Position: Patient is lying flat on the back with knees bent and feet flat on the examination table.
*This position relieves strain on the lower back and relaxes abdominal muscles.

Use:
- to inspect the head, neck, chest, vaginal, rectal, and perineal areas.
- can be used for digital (using the gloved fingers) exams of the vagina and rectum.

Draping:
- place the drape at the patient’s neck or underarms and cover the body down to the feet.

Question 23

Lithotomy Positioning and Draping for Exams

Answer 23

Position: similar to the dorsal recumbent position, except the patient’s feet are placed in stirrups attached to the end and sides of the table. After the feet are in place in the stirrups, the patient is instructed to slide down until the buttocks are positioned at the edge of the table.

Use:
- vaginal examinations, often requiring the use of a vaginal speculum (an instrument used to hold open the walls of the vagina)
- obtaining cell samples of the cervix

Draping:
- The patient is draped from under the arms to the ankles.

Considerations:
- The stirrups must be locked in place to ensure patient safety. Provide additional assistance to patients who may have difficulty placing their feet in the stirrups.

Question 24

Fowler’s Positioning and Draping for Exams

Answer 24

Position: patient sits on the examination table with the head of the table raised to a 90-degree angle. If able, the patient may be seated on the edge of the table with feet over the edge in an upright position.

Use:
- examinations of the head, neck, and upper body
- Patients who have difficulty breathing in the supine position may find this position more comfortable.

Draping:
- placed over the patient’s lap and cover the legs

Question 25

Semi-Fowler’s Positioning and Draping for Exams

Answer 25

Position: The semi-Fowler’s position is a modified Fowler’s position with the head of the table at a 45-degree angle instead of a 90-degree angle.

Use:
- postsurgical exams and patients with breathing difficulties or lower back injuries.

Draping:
- placed over the patient’s lap and covering the legs

Question 26

Left Lateral Positioning and Draping for Exams

Answer 26

Position: requires the patient to be placed on the left side with the right leg sharply bent upward and the left leg slightly bent. The right arm is flexed next to the head for support.
*also known as lateral semi-prone recumbent position and formerly known as Sims’ position

Use:
- rectal exams
- taking rectal temperatures
- enemas
- perineal and pelvic exams

Draping:
- draped from under the arm or shoulders to below the knees at an angle. This allows the health care provider to raise a small section of the drape while keeping the rest of the patient covered.

Question 27

Knee–Chest Positioning and Draping for Exams

Answer 27

Position: patient is placed in the prone position and then asked to pull the knees up to a kneeling position with thighs at a 90-degree angle to the table and buttocks in the air. The head is turned to one side, and the arms may be placed under the head or on either side of the head for comfort and support.

Use:
- proctologic exams
- sigmoidoscopy procedures
- rectal and vaginal exams

Question 28

Parenteral

Answer 28

Administered non-orally. Generally, the medication is injected directly into the body, or occurring in the body bypassing the gastrointestinal tract.

Question 29

Nonparenteral

Answer 29

Given by mouth, delivered to the gastrointestinal tract.

Question 30

Parenteral medication administration routes

Answer 30

Subcutaneous: Injection administered below the skin layer into the adipose (fat) layer

Intradermal: Injection administered into the dermis

Intramuscular: Injection administered into the muscle

Intravenous: Injection administered directly into the vein

Question 31

Oral

Answer 31

Taken by mouth

Question 32

Sublingual

Answer 32

Placed under the tongue

Question 33

Buccal

Answer 33

Between the cheek and gums resulting in rapid absorption

Question 34

Inhalation

Answer 34

Inhaled through the mouth, passes through the trachea into the lungs;inhaled through the nose and absorbed through the nasal mucous membrane

Question 35

Ocular orotic

Answer 35

Drops of medication are instilled directly into the eye (ocular) or ear (otic).

Question 36

Transdermal

Answer 36

Applied to the skin and designed to release slowly and systemically into circulation. Administered in an adhesive patch in asingle layer drug, multi-layer drug, drug in resevoir, or drug matrix.

Question 37

Topical

Answer 37

Applied to the skin or mucous membrane (faster) and acts locally. Administered as creams, ointments, or emulsions.

Question 38

Rectal

Answer 38

Inserted into rectum

Question 39

Dosage

Answer 39

Indicates the strength of the medication or how much of the medication a person should take.

Can be in milligrams (mg) for tablets or capsules, grams (g) for creams or ointments, and milliliters (mL) for liquid medications. Some medications and supplements, such as insulin and vitamins, are listed as units (U).

*Only the dose stated in the prescription or medical order should be administered.

Question 40

3 pieces of information needed for individual dosage calculation

Answer 40

1. The desired dose (D)
2. The dosage strength or supply on hand (H)
3. The medication’s unit of measurement or quantity of unit (Q)

Question 41

Dosage formula

Answer 41

X=D/H×Q

​​​​​​​
X= amount to administer
D= desired dose
H= dosage strength or supply on hand (H)
Q= medication’s unit of measurement or quantity of unit

Question 42

Prescription

Answer 42

Require a medication order by an authorized health care provider to be dispensed to patients.

Medication orders are directions provided by an authorized health care provider for a specific medication to be administered to an individual.

Question 43

Nonprescription,

Answer 43

aka over-the-counter (OTC), medications do not require a prescription.

Question 44

Medication brand name vs generic name

Answer 44

• brand name (or trade name) is the name assigned by the medication manufacturer
• generic name is the standard or official name and assigned by the United States Adopted Names (USAN) Council and the World Health Organization (WHO)

Ex:
- metoprolol (generic name) for Lopressor and Toprol (brand names)
- Aspirin (generic name) for Bayer (brand name)
- acetaminophen (generic name) for Tylenol (brand name)
- ibuprofen (generic name) for Advil, Motrin (brand names)

*Brand names are usually capitalized and are listed first, followed by the generic name, which is not capitalized
Ex: Lopressor (metoprolol) and Toprol XL (metoprolol)

Question 45

Checking the Medication Order

Answer 45

Checking the medication three times helps prevent medication errors:
1. The first check is comparing the medication order to the medication.
2. The second check occurs when preparing the medication for administration.
3. The third check is completed when returning the medication back to the shelf.

Question 46

Rights of Medication Administration

Answer 46

Collection of safety checks that everyone who administers medications to patients must perform to avoid medication errors.

1. right patient
2. right medication
3. right form
4. right dose
5. right route
6. right time
7. right technique
8. right education
9. right documentation.

Question 47

Right Patient

Answer 47

Use two patient identifiers, usually full name and date of birth, to verify the right patient.

Then verify that data with the information on the medical record or medication administration record (MAR).

Question 48

Right Medication

Answer 48

Check the label three times to verify the medication, strength, and dose—often referred to as the “three befores.”
1. The first time to check the medication label is when taking the medication container from the storage cabinet or drawer.
2. The second is when taking the medication from its container to prepare to administer it.
3. The third check is when putting the container back in storage or discarding it.

Question 49

Right Form

Answer 49

Medications can come in several different forms (Ex: liquid, tablet, capsules, suppositories, drops, and creams) The same medication can be available in several different forms. Each form of medication has benefits in terms of effectiveness, ease of use, and safety.

Ex: amoxicillin can come in a capsule, tablet, chewable tablet, and liquid.

Checking the correct form of medication to be administered is essential when checking all rights of medication administration.

Question 50

Right Dose

Answer 50

Compare the dosage on the prescription in the patient’s MAR with the dosage on the medication’s label and determine if medication calculations need to be performed to arrive at the prescribed dose.

Question 51

Right Route

Answer 51

Compare the route on the prescription in the MAR with the administration route they are planning to use.

Determine whether the route is appropriate for the patient and that the medication formulation is right for that route.

Question 52

Right Time

Answer 52

Always confirm whether the medication has any timing specifications, such as the patient having an empty stomach or waiting several hours after taking another medication (such as an antacid) that might interact with the new medication.

Question 53

Right Technique

Answer 53

MAs must know the correct techniques for administering every medication they give by every route.

Ex: taking an apical pulse prior to administering digoxin to ensure the patient’s pulse is not less than 60.

Question 54

Right Education

Answer 54

Prior to administration of a medication, explain to the patient the name of the medication, the ordering provider, and the reason and intended effect of the medication; disclose any side effects; and confirm any allergies the patient may have.

Question 55

Right Documentation

Answer 55

Always document administering a medication after the patient receives it, not before.

If you do not administer a medication as prescribed, the documentation must include this and why the patient did not receive it.

Proper documentation includes date, time, quantity, medication, strength, lot number, manufacturer, expiration date, consent obtained, and patient outcome.

Question 56

Eye medication instillation

Answer 56

Position: the patient should be lying down or sitting back in a chair with the head tilted back. The patient should look toward the ceiling with both eyes open. Clean any debris from the eye area. Provide a tissue to the patient to blot excess medication.

Procedure:
1. With your nondominant hand, gently pull down the lower lid of the affected eye using the thumb or two fingers to expose the conjunctival sac.
2. Gently rest the dominant hand on the patient’s forehead and dispense a drop approximately ½ inch above the sac. If a cream or ointment is being administered, evenly apply a thin ribbon of the ointment along the inside edge of the lower eyelid on the conjunctiva, moving from the medial to lateral side.
3. Release the eyelid and instruct the patient to close the eyes.
4. Repeat if the other eye requires treatment.
5. Remove any excess medication with a clean tissue. 6. Ask whether the patient is feeling any discomfort or pain and observe for any adverse reactions.
7. Apply a clean eye patch, if ordered.

Question 57

Ear Medication Instillation

Answer 57

Position: Have the patient lie on one side with the affected ear facing up.

Procedure:
1. With your nondominant hand, pull the pinna of the auricle (outer ear) outward and upward for adults and outward and downward for infants and children. (This will straighten the ear canal and allow for better medication distribution.)
2. Hold the applicator ½ inch above the ear canal and administer the number of prescribed drops.
3. Have the patient remain in the position for at least 5 min.
4. Ask whether the patient is feeling any discomfort or pain and observe for any adverse reactions.
5. Loosely insert a small, clean wad of cotton, if ordered, before treating the other ear, if applicable.

Question 58

Allergy

Answer 58

A condition of sensitivity in which the immune system reacts abnormally to a foreign substance.

Question 59

Mild Allergic Reactions

Answer 59

Most allergic reactions are common and present with mild symptoms, such as hives, itching, rashes, watery eyes, and nasal congestion.

Treatment usually includes an over-the-counter hydrocortisone cream and an antihistamine.

Question 60

Anaphylactic shock

Answer 60

A systemic allergic reaction that can be life-threatening without immediate medical intervention.

Can occur within minutes after exposure to the allergen, or a delayed reaction could occur within a couple of hours.

Question 61

Symptoms of Anaphylactic shock

Answer 61

• weakness
• sweating
• dyspnea

can progress to:
- hypotension
- arrhythmia
- difficulty in swallowing
- convulsions

Question 62

1st line of treatment for anaphylactic shock

Answer 62

Epinephrine

Question 63

Administering Epinephrine

Answer 63

*ADMINISTERED AS AN IM INJECTION

• The upper thigh is a common site and, in an emergency, can be injected through the patient’s clothes.

1. Once injected, hold the injector or needle into the thigh for at least 10 seconds.
2. Massage the injection site for a few minutes.
3. Immediately call 911.

The autoinjector is for emergency supportive care and does not replace the patient seeking advanced medical care afterwards. If the patient loses consciousness and stops breathing, administer cardiopulmonary resuscitation (CPR).

Question 64

Documentation required for a patient’s allergy history

Answer 64

For medication allergies, ask and document the following:

• Name of the suspected medication, prescribed (brand or generic) and non-prescribed (over-the-counter) medications
• Timeframe of the reaction from initiation of the medication
• Strength and formulation
• Description of the reaction
• Indication for the medication being taken (if there is no clinical diagnosis, describe the illness)
• Date and time of the reaction
• Number of doses taken or number of days on the medication before onset of the reaction
• Route of administration

Question 65

3 categories of reusable medical devices

Answer 65

1. Critical devices: come in contact with blood or normally sterile tissue
   ex: surgical forceps,
2. Semi-critical devices: come in contact with mucus membranes
   ex: endoscopes
3. Non-critical devices: come in contact with unbroken skin
   ex: stethoscopes

Question 66

Unsafe injection practices

Answer 66

Result in disease transmission

Commonly caused by:
- Using the same syringe to administer medication to more than one patient
- Accessing a medication vial with a syringe that has already been used to administer medication to a patient, then using the remaining contents from that vial or bag for another patient
- Using medications packaged as single-dose or single-use for more than one patient
- Failing to use aseptic technique when preparing and administering injections.

Question 67

Ampule

Answer 67

Sealed glass capsule designed to hold a single dose of medication.

Ampules have a particular shape with a constricted neck. They are designed to snap open. The neck of the ampule may be scored or have a darkened line or ring around it to indicate where it should be broken to withdraw medication. ​​​​​​​

Question 68

Cleaning procedures for IM injections

Answer 68

Alcohol swabs are necessary to wipe off vials or wrap around the neck of an ampule, as well as for skin preparation.

Cleaning the vial stopper assists in preventing contamination or introduction of germs into the solution as well as keeping the needle sterile.
The top of the vial stopper should be wiped with an alcohol swab each time it’s used.

Do not introduce the needle into the vial more than once. Each repuncture into a vial dulls the needle and predisposes the equipment to contamination.

Allowing solutions to run down a needle also increases the likelihood of contamination.

A gauze pad is used to apply pressure or hold at the site after administration. An adhesive bandage should be available if there is bleeding at the site.

Question 69

Resheathing devices

Answer 69

Shields that cover the needle or retract the needle after use, such as a needle cap and safety lock.

Resheathing covers, as well as other needle safety devices, prevent the repeated use of needles and do not penetrate, cut, or scratch during the disposal of the needles.

Question 70

How should sed needles should be disposed of?

Answer 70

Used or unsterile needles should NEVER be recapped to prevent needle stick injuries.

They should immediately be disposed of in the sharps waste container.

Question 71

Advantages of parenteral administration

Answer 71

1. to allow for better absorption into the body
2. to administer a more precise level of medication
3. the patient needing a rapid effect
4. the inability of the patient to receive the medication through a different route of administration (ex: oral due to inability to swallow or the medication can be destroyed in the GI tract)

Question 72

Items needed to perform an injection

Answer 72

needle and syringe

Question 73

Parts of a syringe

Answer 73

1. barrel: a cylinder that holds the medication and has volume marking on its side
   - Volume: 0.5 mL to 500 mL
   - Insulin syringes are calibrated in units (U), commonly either 50 U or 100 U.
2. plunger: forces the medication through the barrel and out the needle

Question 74

mL vs cc

Answer 74

These measurements are equivalent
1 milliliter (mL) = 1 cubic centimeter (cc)

Question 75

Parts of a needle

Answer 75

1. Hub: is what is twisted on to the syringe.
2. Shaft: the length of the needle
3. Bevel: tip of the needle (beveled, or angled, to allow for better skin penetration)
   *When inserting a needle, the bevel should be up.
4. Lumen: the opening of the needle

Question 76

Needle’s gauge (G)

Answer 76

Refers to the size of the opening of the needle, or lumen.

The higher the gauge, the smaller or narrower the lumen is.
- Ex: 25 G has a smaller lumen than an 18 G needle.

Question 77

Needle length

Answer 77

Based on inches and can vary from 5/16 inch to 1 ½ inches.

Question 78

Selecting a needle

Answer 78

When selecting a needle, select an appropriate length for the type of injection and size of the patient.

The needle should be long enough to penetrate the layers of tissue appropriate to the injection without being too long.

Ex: if a patient is obese, a longer needle may be needed in order to penetrate the fat layer. ​​​​​​​

Question 79

Subcutaneous (SC)

Answer 79

SC injections are administered beneath the skin and into the adipose (fat) tissue. This allows for slow, sustained release of a medication with long duration of effect.

Used to administer smaller doses of medication, usually less than 1.5 mL.

Common medications that are injected SC are insulin, heparin, immunizations, and allergy medications.

Sites:
- Common: upper, outer arm; abdominal region; and the upper thigh
- Lesser common areas: scapula (upper back area) and lower back/upper buttocks.

Needle Size: 23 -25 G

Needle Length: 5/8 inch

Angle of Injection: 45 degrees

Question 80

Performing a SC injection

Answer 80

1. Ensure that you can gently grasp and pinch the area selected as an injection site using your nondominant hand.
2. Hold the syringe in the dominant hand between the thumb and forefinger like a dart and insert the needle quickly at a 45-degree angle. (Since SC administration is to be delivered in the adipose tissue, the injection is 45 degrees from the surface of the skin to penetrate the layers of the skin but not deep enough to enter any muscle tissue. ​​​​​​​​​​​​​)
3. After the needle is in place, release the tissue with your nondominant hand.
4. With your dominant hand, inject the medication. Avoid moving the syringe.
5. Withdraw the needle quickly at the same angle at which it was inserted.
6. Using gauze, apply gentle pressure at the site after the needle is withdrawn.
7. Do not massage the site. ​​​​​​

Question 81

Intradermal (ID)

Answer 81

ID injections are administered between the upper layers of the skin, between the epidermis and dermis.

With ID injections, a very small amount of a medication may be injected, often 0.1 mL or less.

Most common site: mid forearm
- When using the forearm, measure using one hand width above the wrist and one hand width from the elbow or antecubital space. Any area within the anterior forearm visible is acceptable for the injection.
- The forearm is often used to administer a tuberculosis (TB) test.

Rare cases: upper chest and scapula (upper back)
- The upper chest and scapula may be used for skin tests, such as allergy testing.

Needle Size: 25-27 G

Needle Length: ¼ to ½ inch

Angle of Injection: 5 to 15 degrees

Question 82

Performing a ID injection

Answer 82

1. Use your nondominant hand, spread the skin taut over the injection site. Taut skin provides easy entrance for the needle and is also important to do for older adults, whose skin is less elastic.
2. Hold the syringe in the dominant hand between the thumb and forefinger, with the bevel of the needle up at a 5- to 15-degree angle at the selected site
3. Place the needle almost flat against the patient’s skin, bevel side up, and insert the needle into the skin. Keeping the bevel side up allows for smooth piercing of the skin and induction of the medication into the dermis.
4. Advance the needle no more than an eighth of an inch to cover the bevel
5. Once the syringe is in place, use the thumb of the nondominant hand to push on the plunger to slowly inject the medication.
6. Carefully withdraw the needle out of the insertion site using the same angle it was placed.

*Do not massage or apply pressure or a bandage to the site after injection.

In a TB test, a wheal, or a bubble, below the skin must be formed with the ID injection.

Question 83

Intramuscular (IM)

Answer 83

IM injections are administered into the muscle of the patient.

IM injections generally allow for larger administration of medication than SC and ID injections. However, the amount varies with injections sites.
- In general, up to 3 mL of a medication may be administered into the ventrogluteal and vastus lateralis for adults. Older adults and thin patients may only tolerate up to 2 mL in a single injection. No more than 1 mL should be given in the deltoid.

Common sites: deltoid (shoulder), ventrogluteal (outer hip), and vastus lateralis (upper, outer thigh) muscles.

Common medications: antibiotics (penicillin), hormones (testosterone), and some vaccines.

Needle Size: 22-25 G

Needle Length: 1 to 1 ½ inch

Angle of Injection: 90 degrees

Question 84

IM injection in the deltoid

Answer 84

The site of injection on the deltoid should be 1 to 2 inches below the acromion process.

The deltoid muscle can only hold up to 1mL of medication.

*should be avoided for infants or children younger than 3 years of age.

Question 85

IM injection in the ventrogluteal

Answer 85

This site provides the greatest thickness of muscle that is free of nerves and blood vessels, and it has a narrower layer of fat.

This injection site can hold up to 3 mL of medication.

To locate the site:
1. place the heel of your hand on the greater trochanter (right hand placed on left hip and left hand placed on right hip), the middle finger is placed on the iliac crest, and your fingers are spread.
2. Give the injection where the V is made between your index finger and middle finger (position the thumb pointing towards the groin).

*safe injection site for adults, children, and infants

Question 86

IM injection in the vastus lateralis muscle

Answer 86

Vastus lateralis muscle is located on the anterior lateral aspect of the thigh and extends from one hand’s breadth above the knee to one hand’s breadth below the greater trochanter. The outer middle third of the muscle is used for injections.

The injection site is halfway down the muscle, between the greater trochanter and the lateral femoral condyle.

This site is recommended for children younger than 3 years of age. ​​​​​​​

Question 87

Steps to perform an injection

Answer 87

1. Don nonsterile gloves.
2. Clean the site with an alcohol swab for 30 seconds using firm, concentric circles.
3. Allow the site to dry to prevent introducing alcohol into the tissue, which can be irritating and uncomfortable.
4. Remove the guard cap from the needle by pulling it off in a straight motion.
5. A straight motion helps prevent needlestick injury.

Question 88

Performing an IM injection

Answer 88

1. stabilize the skin around the injection site by pulling the skin taut with the forefinger and thumb of your nondominant hand.
2. With your dominant hand, hold the syringe like a dart and insert the needle quickly into the muscle at a 90-degree angle using a steady and smooth motion.
3. After the needle pierces the skin, use the thumb and forefinger of the nondominant hand to hold the syringe and inject the medication.
4. Remove the needle at the same angle at which it was inserted.
5. Cover the injection site with sterile gauze using gentle pressure and apply a bandage if needed.

Question 89

Administering Insulin

Answer 89

Insulin is always ordered and administered in unit dosage.

Only insulin syringes should be used to administer an insulin injection. Insulin syringes are supplied in 30-, 50-, or 100-unit measurements, so read the barrel increments (calibration) carefully.

One anatomic region should be selected for a patient’s insulin injections to maintain consistent absorption, and then sites should be rotated within that region.
- The abdomen absorbs insulin the fastest, followed by the arms, thighs, and buttocks.
- If regular SC injections need to be given, as in the case of insulin, rotate the injection site and avoid using a site that is edematous (swollen) and has too much scar tissue or adipose (fat) tissue.

Question 90

Adverse reactions following an injection

Answer 90

After administration of any medication, ask the patient to wait 20 to 30 min before leaving for observation of any possible adverse reactions or allergic reactions:

• Severe pain at the injection site
• Tingling or numbness
• Redness, swelling, or warmth at the injection site
• Prolonged bleeding
• Signs of an allergic reaction, such as difficulty breathing or facial swelling

Question 91

What needle size would you select for a tuberculin (TB) test?

Answer 91

A tuberculin test is performed as an intradermal injection.
The appropriate needle and syringe size would be 26 gauge and ½ inch long.

Question 92

Types of parenteral medication packaging

Answer 92

• vials (most common)
• ampules
• premeasured syringes and cartridges

Question 93

Vials

Answer 93

A plastic or glass container that has a rubber stopper (diaphragm) on the top. (most common)
- The rubber stopper is covered with a metal lid or plastic cover to maintain sterility until the vial is used for the first time.

Sizes: single or multi dose

*Some manufacturers do not guarantee a sterile top even though it is covered, and therefore it is necessary to wipe the top with alcohol pad with first use and any use after

Question 94

Multidose vials expiration

Answer 94

28 days (unless the manufacturer states otherwise)
*Make sure you write the expiration date on the vial upon opening.

Question 95

Reconstitution

Answer 95

Requires the adding a liquid diluent to a dry ingredient to make a specific concentration of a medication. ​​​​​​​

Question 96

Withdrawal from a Vial Technique

Answer 96

1. Before withdrawing medication from a vial, wipe the top with alcohol and allow it to dry.
2. A vial is a closed system, and air must be injected into it to allow for withdrawal of the medication. If air is not injected into the vial before the medication is withdrawn, a vacuum remains in the vial that makes the withdrawal of medication difficult. Inject air equal to the amount of solution being withdrawn into the air space between the solution and the rubber stopper
3. invert the vial
4. withdraw the desired volume of medication

Question 97

Withdrawal from an Ampule Technique

Answer 97

1. Snap the neck off by grasping it with an alcohol wipe, sterile gauze, or ampule protector.
2. Aspiration of the medication into a syringe occurs easily and may be accomplished with a filter needle, if required by the medical practice’s policy.
3. A filter needle prevents withdrawal of glass or rubber particulate.
4. When the needle is inserted into an ampule, take care to prevent the shaft and tip of the needle from touching the rim of the ampule.
5. Withdraw medication into the syringe by gently pulling back on the plunger, which creates a negative pressure and allows the medication to be pulled into the syringe.
6. Discard the needle used to withdraw the medication and replace it with a new needle.

Question 98

Types of syringes

Answer 98

1. Premeasured Syringes
   or
2. Hypodermic Syringe, Tuberculin Syringe, and Insulin Syringe

Question 99

Premeasured Syringes

Answer 99

Prefilled syringes that are single dosed and packaged with the needle that is provided by the manufacturer. These syringes are disposable and supplied already loaded with the substance to be injected.

Common prefilled syringes are often used for immunizations and for emergency administration, such as naloxone for overdoses and sodium bicarbonate for shock and cardiac arrests.

Advantages:
1. Convenient and help ease the administration process
2. Allow for convenience and efficiency, accuracy in dosing, reduced risk of infection and contamination, and reduced waste
3. You do not have to worry about the transfer of a medication from a vial to a syringe or about leaving a small percentage of the dose behind.

Question 100

Hypodermic Syringe

Answer 100

Come in a variety of sizes from 0.5 to 60 mL and even larger.

Question 101

What volume of hypodermic syringe is used most often for the administration of medication?

Answer 101

3 mL

Question 102

Tuberculin Syringe

Answer 102

A narrow syringe that has a capacity of 0.5 mL or 1 mL.

The volume of a tuberculin syringe can be measured on the milliliter scale. On the milliliter side of the syringe, the syringe is calibrated in hundredths (0.01 mL) and tenths (0.1 mL) of a milliliter.

Tuberculin syringes are used to accurately measure medications given in very small volumes (e.g., heparin).

This syringe is also often used in pediatrics and for diagnostic purposes (e.g., skin testing for tuberculosis).

Question 103

What volume of Tuberculin syringe is used most often for the administration of medication?

Answer 103

1 mL

Question 104

What dosages require a tuberculin syringe?

Answer 104

It is recommended that dosages less than 0.5 mL be measured with a tuberculin syringe to make certain that the correct dosage is administered to a patient.

Dosages such as 0.42 mL and 0.37 mL can be measured accurately with a tuberculin syringe.

When using a tuberculin syringe, read the markings carefully to avoid error.​​​​​​​

Question 105

Insulin Syringe

Answer 105

Designed for the administration of insulin only.

Insulin dosages are measured in units.
Insulin syringes are calibrated to match the dosage strength of the insulin being used. They are marked U-100 and are designed to be used with insulin that is marked U-100.
- U-100 insulin should be measured only in a U-100 insulin syringe.
- It is important to note that for U-100 insulin, 100 units = 1 mL.

Insulin syringes do not have detachable needles. The needle, hub, and barrel are inseparable.

Question 106

Food and Drug Administration (FDA)

Answer 106

Organization responsible for protecting the public health by ensuring safety, efficacy, and security of human medications.

Question 107

Drug Enforcement Administration (DEA)

Answer 107

Maintains oversight for legally prescribed and used narcotic drugs and for containment of illegal drugs.

Question 108

Refrigerated/frozen medication recommended temperature

Answer 108

Refrigerated medications: between 2˚ and 8˚ C (35˚ and 46˚ F).

Frozen medications: between –50˚ and –15˚ C (–58˚ and 5˚ F).

*The temperatures of the refrigerators and freezers must be checked daily.

Question 109

“If it wasn’t documented……

Answer 109

it wasn’t done.”

Question 110

Medication administration record (MAR)

Answer 110

A report that serves as a legal record of the medications administered to a patient at a facility by a health care provider or professional.

The following information must be documented in the MAR about the medication:
- Any allergies or history of allergies
- What medication is being administered
- Medication dosage
- Administration route
- When is it being administered—what time, how often, how long
- The name of the health care provider who prescribed the medication

A MAR must be filled out each time a patient is administered a medication.

*Can also be documented in an EMR system

Question 111

Room temperature

Answer 111

20˚ to 25˚ C (68˚ to 77˚F)

Question 112

Eye Irrigation

Answer 112

The process of using a sterile solution to flush the eyes of any foreign bodies or any toxic chemicals.

Question 113

Sterile technique

Answer 113

A group of strategies used to reduce exposure to micro-organisms and keep the patient as safe as possible.

Question 114

Eye Irrigation Setup and Supplies

Answer 114

1. As with all procedures, review the patient’s medical record and the health care provider’s order.
2. Introduce yourself and identify the patient.
3. Explain the procedure to the patient and reason why it needs to be performed.
4. Assemble the equipment and two sets of the supplies and equipment if both eyes are to be irrigated.
5. Perform a triple check of the medication and provider’s order and the rights of administration and check for expiration dates on the medication and all supplies.
6. Warm the irrigation solution to normal body temperature by placing the solution in a basin of warm water.

Supplies:
- sterile basin
- return basin
- sterile solution
- sterile irrigating syringe
- sterile gauze
- tissues
- towel
- waterproof drape
- nonsterile gloves.

Question 115

Eye irrigation Patient Prep

Answer 115

1. Place the patient in a supine or sitting position
2. Place a waterproof drape on the patient’s shoulder to absorb any solution if any spills.
3. Perform hand hygiene.
4. Cleanse the eyelid with a gauze pad moistened with the sterile solution, making sure to maintain sterility at all times.
   - Clean from the inner to outer canthus (corner) of the eye, where the upper and lower lids meet.
5. Repeat with a newly moistened gauze pad until the eyelid is free of dirt and other debris.

Question 116

Eye Irrigation Procedure

Answer 116

1. Instruct the patient to tilt the head toward the side that is being irrigated, to hold the return basin below the affected eye, and to look straight ahead on a fixed object while keeping both eyes open.​​​​​​​
2. Using the thumb and index finger of your nondominant hand, pull upward on the patient’s upper lid and downward on the patient’s lower lid—hold the eye open and maintain this position throughout the irrigation.
3. With the dominant hand, hold the irrigating bottle of solution on or near the bridge of the nose and hold the tip of the solution about an inch above the eye.
   *Do not to touch any part of the eye or skin with the tip of the solution applicator.
4. Start squeezing the bottle so that the solution flows from the inner canthus to the outer canthus in a steady stream directed toward the lower conjunctiva.
5. Continue the flow until the irrigation solution is empty and the desired results are achieved, such as removal of debris. Repeat if the other eye requires treatment.
6. Take the collection basin from the patient and dry the eyelid with gauze, once again moving from the inner to outer canthus.
7. Provide the patient with a towel to dry any skin that may have gotten wet during the procedure and help the patient to a comfortable position.
8. Examine and take note of any visible debris in the return basin.
9. Discard the solution from the return basin, throw away disposable items, remove gloves, and wash hands.

Question 117

Ear Irrigation

Answer 117

Necessary to remove impacted cerumen, or earwax, or a foreign matter from the ear.

Question 118

Ear Irrigation Set up, Patient Prep, and Supplies

Answer 118

Set up:
1. As with all procedures, review the patient’s medical record and the health care provider’s order.
2. Introduce yourself and identify the patient.
3. Explain the procedure to the patient and reason why it needs to be performed.
4. Assemble the equipment and two sets of the supplies and equipment if both ears are to be irrigated.
5. Perform a triple check of the medication and provider’s order and the rights of administration and check for expiration dates on the medication and all supplies.
6. Warm the irrigation solution to normal body temperature by placing the solution in a basin of warm water.

Patient Prep:
1. Place the patient in a sitting or lying on the side with the affected ear facing up.
2. Place a waterproof drape on the patient’s shoulder to absorb any solution if any spills.
3. Perform hand hygiene.
4. Using an otoscope, examine the affected ear, taking note of any cerumen or foreign bodies (if allowed by practice policy).
5. Cleanse the outer ear with a gauze pad moistened with the irrigating solution.

Supplies:
ear syringe, sterile basin, return basin, warmed irrigation solution, a waterproof drape, towel, and gauze or cotton balls.

Question 119

Ear Irrigation Procedure

Answer 119

1. Instruct the patient to tilt their head toward the side that is being irrigated and to hold the ear wash basin tightly below the affected ear.
2. Gently insert the disposable tip into the ear so that it is positioned toward the top of the ear canal.
3. Start spraying the solution by pushing the trigger on the spray bottle, checking to be sure the tubing remains straight.
4. Continue to spray until you have used up the solution, the maximum time has been reached, or you have obtained the desired results (cleared the ear of cerumen). ​​​​​​​
5. Remove the tip from the patient’s ear, allow any residual solution to drain out, and place a loose cotton ball in the canal.
6. Take the return ear basin from the patient, observing for any debris, and instruct them to lie on the side that was irrigated for 15 minutes.
7. Dry the outside of the ear. If policy allows, examine the ear with an otoscope to see if all cerumen has been removed. (If not, check with provider about proceeding.)
8. Have the provider check the ear and follow any additional orders.
9. Dispose of the supplies in a waste can and clean the area.
10. Remove gloves and wash your hands.

Question 120

What process is considered the most convenient and efficient when prescribing?

Answer 120

The most efficient, electronic process is a medication order created by e-prescription tool in the EHR software that is automatically sent to the pharmacy through a secure electronic transmission.

Question 121

Electronic prescribing (e-prescribing) Benefits

Answer 121

• allows providers to enter prescription information into a computer device and securely transmit the prescription to pharmacies using a special software program and connectivity to a transmission network.
• When a pharmacy receives a request, it can begin filling the medication right away.
• can also reduce opportunities for diversion of controlled substances by eliminating the use of paper forms, which can be lost, stolen, and used illegally.

Question 122

What is required when transmitting an e-prescription?

Answer 122

Both the pharmacy and the health care provider must use software that is DEA Electronic Prescription for Controlled Substances (EPCS) approved.

The software may be either a standalone product or a part of the EHR software

Question 123

Specialty pharmacy

Answer 123

Prepares and dispenses medication for complex, chronic, and rare diseases. It can also create a medication specific to the needs of a specific patient, such as weight.

Ex: A young patient needing a weight-based dosage of a medication for leukemia

Question 124

Compounding medication

Answer 124

Created by combining, mixing, or altering two or more drugs or ingredients to create a medication tailored to the needs of a specific patient.

It may be in many forms, including capsules, injectables, syrups, and creams.

It may be prepared by a licensed pharmacist or physician.

Question 125

Required Components of Medical Records: Administrative Sections

Answer 125

1. Demographic Data
   - Name
   - Address
   - Birthdate
   - Sex
   - Gender
   - Social Security number
   - Phone number
   - Employment information
2. Administrative Data
   - Notice of privacy practices form
   - Advance directives
   - Consent forms
   - Medical records release form
3. Correspondence
   - Any correspondence related to the patient (e.g., from patient’s insurance company, attorney, or the patient themselves)
4. Schedule, Financial, and Billing Information
   - Information regarding any appointments, insurance information, balances

Question 127

Required Components of Medical Records: Clinical Section

Answer 127

1. Health History
   - Chief complaints
   - Present illness
   - Past medical history
   - Family history
   - Social history
   - Review of systems
2. Physical Examination
   - Assessment of each body part
3. Allergies
   - All known patient allergies
4. Medication Record
   - Detailed information related to patient’s medication
5. Problem List
   - Problems identified, updated each visit
6. Progress Notes
   - New information each time the patient visits or telephones the office
7. Laboratory Data
   - Any laboratory reports obtained on the patient
8. Diagnostic Procedures
   - Electrocardiogram report
   - Holter monitor report
   - Spirometry report
   - Radiology report
   - Diagnostic imaging report
9. Continuity of Care
   - Consultation report
   - Home health care report
   - Therapeutic service documents​​​​​​​
   - Hospital documents

Question 128

What type of patient conditions is required to be reported to local and state government agencies?

Answer 128

Health care providers and organizations are required to report statistics on communicable and infectious diseases (HIV/AIDS, tuberculosis, sexually transmitted infections) to local and state government agencies.

These agencies will also collect this data and report it to the federal government and agencies, such as the CDC.

Question 129

Computerized provider order entry (CPOE)

Answer 129

Electronic process in which providers enter and send treatment instructions, including medications, laboratory, and radiology orders, via a computer application rather than paper, fax, or phone.

Once you have electronically entered an order for lab tests, prescription medications, radiology tests, and referrals, the CPOE system interfaces or integrates with other EHR components, such as the pharmacy or laboratory system, to process the order.

Question 130

Benefits of a CPOE system

Answer 130

By reducing the use of written orders, this reduced medical and medication errors since it prevented transcription errors, misplaced decimals, and illegible handwriting.

• Reducing the potential for human errors
• help prevent errors of medication ordering and suggest recommendations for medication dosage, routes of administration, and frequency
• Prevent medication allergies or drug–drug or even drug–laboratory
• Reducing time to care delivery
• Improving order accuracy
• Decreasing time for order confirmation and turnaround
• Improving clinical decision support at the point of care (ex: assist in recommending treatment options for diseases)
• Making crucial information more readily available
• Improving communication among health care providers and professionals and patients ​​​​​​​

Question 131

Which patients most benefit from telehealth?

Answer 131

Patients who have difficulty with transportation and getting to an in-person medical visit, such as older adult patients, those who have disabilities, those who are bed- or homebound, and those in rural areas