NU 301 Exam 2 Flashcards
What provides the exact description of a medication’s make up?
The chemical name
What is the name that manufacturers first assing a drug? It is listed as this in the U.S. pharmacopeia.
A generic name
What is the name that the drug is marketed under?
Trade name
- You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may experience problems with:
A. absorption.
B. biotransformation.
C. distribution.
D. excretion.
Answer:
D. excretion.
What factors influence absorption?
Route of administration
Ability of a medication to dissolve
Blood flow to the site of administration
Body surface area
What is the definition of a therapeutic effect?
Expected or predicted physiological response
What is the definition of an adverse effect?
: Unintended, undesirable, often unpredictable
What is the definition of a side effect?
Predictable, unavoidable secondary effect
What is the definition of a toxic effect?
Accumulation of medication in the bloodstream
What is an idiosyncratic effect?
Overreaction or underreaction or different reaction from normal
What is the definition of an allergic reaction?
Unpredictable response to a medication
What is the definition of a medication interaction?
One medication modifies the action of another
What is the definition of medication tolerance?
More medication is required to achieve the same therapeutic effect
What are the oral routes of administration?
Buccal and sublingual
What are the topical sites of administration?
Skin and mucous membrane
What is the nurse’s role in medication administration?
Determines medications ordered are correct
Assesses patient’s ability to self-administer
Determines medication timing
Administers medications correctly
Closely monitors effects
Provides patient teaching
Does not delegate medication administration to AP
What do you do when a medication error occurs?
First assess the patient’s condition, then notify the health care provider
When patient is stable, report the incident
Prepare and file an occurrence or incident report
Report near misses and incidents that cause no harm
. If a nurse experiences a problem reading a physician’s medication order, the most appropriate action will be to:
A. call the physician to verify order.
B. call the pharmacist to verify order.
C. consult with other nursing staff to verify.
D. withhold the medication until physician
makes rounds.
Answer:
A. call the physician to verify order.
What are the 7 rights to administering medication?
Right medication
Right dose
Right patient
Right route
Right time
Right documentation
Right indication
Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following?
A. Medication before administering it.
B. Medication after administering it.
C. Rationale for administering it.
D. Prescriber rationale for prescribing it
Answer:
B. Medication after administering it.
What are some considerations for topical application?
Ask patients if they take any topical medications.
When applying a transdermal patch, ask the patient whether he or she has an existing patch.
Wear disposable clean gloves when removing and applying transdermal patches.
If the dressing or patch is difficult to see (e.g., clear), apply a noticeable label to the patch.
Document patch or medication location on the MAR
Document patch or medication removal on the MAR
What are some considerations for eye instillation
Avoid the cornea.
Avoid touching eye or eyelid with droppers or tubes.
Use only on the affected eye.
Never share eye medications.
What are some considerations for ear drops?
Instill eardrops at room temperature.
Use sterile solutions.
Check with the health care provider for eardrum rupture if patient has ear drainage.
Never occlude the ear canal.
What are some considerations for ear irrigation?
Performed to remove cerumen that cannot be removed with wax softeners
Performed only in cases of hearing deficit, ear discomfort, or to visualize the tympanic membrane
How are vaginal medications inserted?
Inserted with a gloved hand if suppository.
Applicator inserter for
foam
jelly
cream
How are suppositories administered?
Administered with an applicator inserter
What are some considerations for rectal administration?
Thinner and more bullet-shaped than vaginal suppositories
Rounded end prevents anal trauma during insertion
Contain medications that exert local effects
A small cleansing enema may be required before inserting a suppository
When is the onset of rapid-acting insulin?
15 minutes
When is the peak for rapid-acting insulin?
1-2 hours
When is the onset for short acting insulin?
30-60 minutes
When is the peak for short-acting insulin?
2-5 hours
When is the onset of intermediate-acting insulin?
1-2 hours
When is the peak of intermediate-acting insulin?
4-8 hours
What are signs of hypoglycemia?
Confusion
Irritability
Tremor
Sweating
A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as:
A. a poisoning accident.
B. an equipment-related accident.
C. a procedure-related accident.
D. an accident related to time management.
Answer:
C. a procedure-related accident
What are some factors that influence patient safety?
Patient’s developmental level
Mobility, sensory, and cognitive status
Lifestyle choices
Knowledge of common safety precautions
What age children use a rear-facing carseat?
Newborns to age 2
What age children use a front-facing car seat?
2 to at least 5
What age children use boosterseats?
5 up until seatbelts fit properly
What age children use seatbelts?
When booster seat is no longer required
While caring for a child, you identify that additional safety teaching is needed when a young and inexperienced mother states that:
A. teenagers need to practice safe sex.
B. a 3-year-old can safely sit in the front seat of the car.
C. children need to wear safety equipment when bike riding.
D. children need to learn to swim even if they do not have a pool.
B. a 3-year-old can safely sit in the front seat of the car.
What are some other individual risk factors for people?
Lifestyle
Impaired mobility
Sensory or communication impairment
Economic resources
Lack of safety awareness
What does RACE stand for?
R - rescue
A - activate alarm
C - confine fire
E - extinguish
What actions should you perform if a patient has a seizure?
Clear area of all hard or sharp objects.
● Ease person to floor and put something soft under head.
● Remove eyeglasses and loosen tie.
● Time seizure with watch (remember 5 minutes is significant).
● Do NOT try to stop the movements.
● Do NOT put anything into the persons mouth.
What is a physical restraint?
manual method, physical or mechanical device that immobilizes or reduces the ability to move arms, legs, body or head freely
What are the rules for restraints?
Must have an order for a restraint of any kind.
Order must include: reason, type, how long to use.
Restraints cannot be ordered on a PRN basis and always have a limited time frame.
Where do you tie knots for restraints?
To the bedframe, NOT the bedrail.
How often do you assess the skin of a client in restraints?
Every 2 hours
How loose should restraint knots be?
Enough to fit 2 fingers
A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this patient would include:
A. raise all four side rails when darkness falls.
B. use an electronic bed monitoring device.
C. place the patient in a room close to the nursing station.
D. use a loose-fitting vest-type jacket restraint.
B. use an electronic bed monitoring device.
What is the definition of infection?
RESULTS WHEN A PATHOGEN INVADES TISSUES AND BEGINS
GROWING WITHIN A HOST
* COLONIZATION
* PRESENCE AND GROWTH OF MICROORGANISMS WITHIN A HOST
WITHOUT TISSUE INVASION OR DAMAGE
SCIENTIFIC KNOWLEDGE
BASE
2
What is the definition of colonization?
PRESENCE AND GROWTH OF MICROORGANISMS WITHIN A HOST
WITHOUT TISSUE INVASION OR DAMAGE
What can be considered a reservoir for infection?
FOOD, OXYGEN, WATER, TEMPERATURE, PH, LIGHT
What is a portal of exit?
The route a pathogen takes to exit a reservoir.
A PATIENT IS ADMITTED TO A MEDICAL UNIT FOR A HOME-
ACQUIRED PRESSURE ULCER. THE PATIENT HAS
ALZHEIMER’S DISEASE AND HAS BEEN INCONTINENT OF
URINE. THE NURSE INSERTS A FOLEY CATHETER. YOU
WILL IDENTIFY A LINK IN THE INFECTION CHAIN AS:
A. RESTRAINTS.
B. POOR HYGIENE.
C. FOLEY CATHETER BAG.
D. IMPROPER POSITIONING.
Copyright © 2017, Elsevier Inc. All Rights Reserved. 5
C. FOLEY CATHETER BAG.
What are the steps in the chain of infection?
infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
What are HAI’s
healthcare-associated infections
What are airborne precautions?
Used for diseases spread through air, Private, monitored negative pressure room
with door always closed. N95 required. Air from room is filtered before it exits.
What is required for droplet precautions?
Droplet precautions require the wearing of a surgical mask when
within 3 feet of the patient, proper hand hygiene, and some
dedicated-care equipment.
How is MRSA transmitted?
Person-to-person contact
* Contaminated devices (IV poles, over bed tables, exercise
equipment and shopping carts)
* Linens
* Clothing
What are 5 moments for hand hygiene?
Before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.
YOU ARE CARING FOR A PATIENT WHO UNDERWENT
SURGERY 48 HOURS AGO. ON PHYSICAL
ASSESSMENT, YOU NOTICE THAT THE WOUND
LOOKS RED AND SWOLLEN. THE PATIENT’S WBCS
ARE ELEVATED. YOU SHOULD:
A. START ANTIBIOTICS.
B. NOTIFY THE PROVIDER.
C. DOCUMENT THE FINDINGS AND REASSESS IN 2
HOURS.
D. PLACE THE PATIENT ON ISOLATION
PRECAUTIONS.
B. NOTIFY THE PROVIDER.
What are s/s of a local infection?
Swelling
Redness
Heat
Pain
Tenderness
What are s/s of a systemic infection?
Fever
* Leukocytosis –WBC >
10,000/mcl (normal 4,500 –
10,000)
* Malaise
* Anorexia
* Lymph node enlargement
Define medical asepsis
Reduces the number of
organisms present
*Hand washing
*Cleaning used equipment (a used
bed pan is considered contaminated).
Define surgical asepsis (sterile)
Eliminates all
microorganisms
*Sterile fields
*An area is
considered
contaminated if an
unsterile object
touches the field
What are the body’s normal defenses against infection?
Normal floras, inflammation, tissue repair, inflammatory exudate, vascular and cellular response
What increases the risk of healthcare-associated infections?
Invasive procedures
Antibiotic administration
Multidrug-resistant organisms (MDROs)
Breaks in infection prevention and control activities
What are examples of standard precautions?
hand hygiene, gown, gloves, goggles.
Why are isolation precautions used?
To protect patient from microorganisms
What factors contribute to skin ulcer formation?
Age, mobility, sitting/lying position, nutrition, sensation level, infection, tissue perfusion.
Define a stage 1 pressure wound
non-blanch-able erythema of intact skin. No skin break, may be red, blue, or purple.
Define a state 2 pressure wound
Partial thickness skin loss that extends to the dermis.
Define a stage 3 pressure wound
Full-thickness skin loss. Adipose exposed
Define a stage 4 pressure wound
Full thickness skin and tissue loss. Muscle/bone visible.
Define an unstageable pressure wound
A pressure wound with too much slough/eschar to determine depth.
What is serous edudant drainage?
Straw colored
What is sanguineous drainage?
Bloody colored
What is serosanguineous drainage?
mix of bloody and straw colored
What is purulent drainage?
Yellow, pus filled
A postoperative patient arrives at an ambulatory care center and states, “I am not feeling good.” Upon assessment, you note an elevated temperature. An indication that the wound is infected would be:
A. it has no odor.
B. a culture is negative.
C. the edges reveal the presence of fluid.
D. it shows purulent drainage coming from the incision site.
D. it shows purulent drainage coming from the incision site.
What precautions should you take for heat and cold therapy?
Patient’s temperature tolerance
. A surgical wound requires a Hydrogel dressing. The primary advantage of this type of dressing is that it provides:
A. an absorbent surface to collect wound drainage.
B. decreased incidence of skin maceration.
C. protection from the external environment.
D. moisture needed for wound healing.
D. moisture needed for wound healing.
What are the early signs of hypoxia?
Tachypnea and tachycardia
Restless and anxious
Pale skin and mucous membranes
Use of accessory muscles, nasal flaring
What are the late signs of hypoxia?
Stupor
Cyanotic
Bradypnea
Hypotension
Cardiac dysrhythmia
What physiological factors influence a patient’s oxygenation?
Decreased oxygen-carrying capacity
Hypovolemia
Decreased inspired oxygen concentration
Increased metabolic rate
What conditions can influence oxygenation?
Pregnancy, obesity, neuromuscular disease, musculoskeletal abnormalities, trauma, neuromuscular disease, CNS alterations
How much oxygen and what percentage does a nasal canula deliver?
Can deliver 1-6L of O2 (delivers 24%-44% oxygen)
How much oxygen and what percentage does a simple mask deliver?
Can deliver 6-12L of O2 (delivers 35%-50% oxygen)
How much oxygen and what percentage does a non-rebreather deliver?
Can deliver 10-15L of O2 (delivers 60%-90% oxygen)
What causes oxygen toxicity
Result from high concentrations of oxygen (above 50%) for 24-48 hours.
What nursing interventions are taken for oxygen toxicity?
Use lowest levels of O2 needed *titrate as ordered
Monitor O2 sat and ABG’s.
Monitor respiratory pattern.
What are the s/s of oxygen toxicity?
nonproductive cough, substernal pain, nasal stuffiness, N/V, fatigue, H/A, sore throat, uncontrolled coughing, muscle twitching
How much urine can you release at one time?
1,000mL
What are the four major sites of injection?
Intradermal, Subcutaneous, Intramuscular, Intravenous
What are some considerations for nasal instillations?
For decongestants: Caution patients to avoid the rebound effect
Serious systemic effects also develop if excess decongestant solution is swallowed, especially in children
What is the procedure for preparing an injection from an ampule?
Snap off ampule neck
Aspirate medication into syringe using filter needle
Replace filter needle with an appropriate size needle or needless device
Administer injection
What is the procedure for preparing an injection from a vial?
If dry, use solvent or diluent as needed
Inject air into vial
Label multidose vials after mixing
Refrigerate remaining doses if needed
What are some specific risks to a patient’s safety within the health care environment?
Falls, patient-inherent accidents, procedure-related accidents, equipment-related accidents, workplace safety.
What are some nursings diagnoses for patients with safety risk?
Risk for fall, risk for injury, confusion, risk for poisoning, risk for trauma, impaired home maintenance.
What kind of infection is MRSA?
Skin infection
What are reverse isolation techniques?
Goal is to protect patient from exposure to microorganisms.
* Positive airflow room
* No fresh flowers / fruit
What determines the classification of a medication?
Effect of medication on body system
Symptoms the medication relieves
Medication’s desired effect
Define absorption
Passage of medication molecules into the blood from the site of administration
How does medication exit the body?
Kidney
Liver
Bowel
Lungs
Exocrine glands
A nurse is administering an oral tablet to a patient. Which of the following steps is the second check for accuracy in determining the patient is receiving the right medication?
A. Logging on to the AMDS or unolcking the medicine drawer or cart.
B. Before going to the patient’s room, comparing patient’s name and name of medication on label of prepared drugs with MAR or computer printout.
C. Selecting correct medication from tADMS, unit-dose drawer, or stock supply and comparing name of medication on label with MAR or computer printout.
4. Comparing MAR or computer pintout with names of medications on medicationl labels and patient name at patient bedise.
B.
An older adult states that she cannot see her medication bottles clearly to determine when to take her perscription. What actions should the nurse take to help hte older adult patient? Select all that apply
A. Provide a dispensing system for each day of the week.
B. Provide larger, easier-to-read labels.
C. Tell the patient what is in each container.
D. Have a family caregiver administer the medication?
E. Use teach-back to ensure that the patient knows what medication to take and when.
A,B, and E.
Which of the following guidelines must a nurse use for taking verbal or telephone orders? (Select all that apply)
A. Follow the health care agency guidelines regarding authorized staff who may recieve and record verbal or telephone orders.
B. Clearly identify patient’s name, room number, and diagnostic.
C. Read back all orders to health care provider.
D. Use clarification questions to aboid misunderstandings.
E. Write VO (verbal order) or TO (telephone order) including date and time, name of patient, and complete order, sign the name of the health care provider and nurse.
A, B, C, D, E.
Which aspects of the patient’s care related to the administration of heparin can the nurse delegate to the nursing AP?
A. Notify the nurse if there are any signs of bleeding.
B. Assess the vital signs for possible for possible symptoms of bleeding.
C. Assess bleeding sites and apply appropriate pressure to the stites.
D. Notify the nurse if there is blood noted in the patient’s urine.
E. Notify the nurse if there is oozing from any puncture sites.
A., D., E.
What are some common methods of nasal instillation?
Spray, drops, and tampons
