Parenteral Medications

Question 1

What gauge and size needle should be used for intradermal, subcutaneous, and intramuscular injections?

Answer 1

1) Intradermal - Guage: 26 or 27; Size: 1/4” to 1/2”
2) Subcutaneous - Gauge: 25 to 30; Size: 3/8” to 1”
3) Intramuscular - Gauge: based on medication being administered (aqueous solutions = 20 to 25 & oil-based solutions = 18 to 25); Size: 5/8” to 1 1/2”

Question 2

What is the maximum amount of medication (mL) that can be injected intradermally, subcutaneously, and intramuscularly?

Answer 2

1) Intradermal - 0.5mL
2) SQ - 1mL
3) IM - 4mL (1mL for deltoid)

Question 3

What site should you absolutely avoid when giving intramuscular injections? Why?

Answer 3

Dorsogluteal site, because it’s too close to the sciatic nerve.

Question 4

What does the term “wheal” mean?

Answer 4

It is a pocket of fluid that forms when medication is given intradermally with the bevel upwards.

Question 5

What angle should be used when giving injections

1) intradermally?
2) subcutaneously?
3) intramuscularly?

Answer 5

1) intradermal - 15 deg
2) subcutaneously - 45 to 90 deg
3 intramuscular - 72 to 90 deg

Question 6

What type of needle is used to withdraw medication from an ampule?

Answer 6

A filtered needle

Question 7

When mixing the following medication, which one is drawn up into the syringe first?

1) NPH and regular insulin
2) Single-Dose vial and Multidose-Vial
3) Ampule and Vial

Answer 7

1) Regular insulin is drawn up into the syringe before NPH (think clear then cloudy)
2) Multidose vial is drawn up into the syringe before the single-dose
3) Draw up medication in the Ampule before drawin up the vial

Question 7

(T/F) Insulin dosages must be checked by two nurses?

Answer 7

True

Question 8

What are the two different methods of administering IV fluids and drugs? What is the difference between the two?

Answer 8

1) Continuous - Replaces or maintains fluid and electrolytes and serve as a vehicle for drug administration.
2) Intermittent (aka saline or heparin lock) - Used for IV administration of drugs and supplemental fluids (i.e., IVPB & IV push).

Question 9

Which parenteral route has the 2nd fastest absorption rate, next to IV?

Answer 9

Intramuscular - muscles have a large vascular network that ensures rapid absorption into the bloodstream.

Question 11

Name two reasons why you would choose to use the IV route to deliver medications? Name two disadvantages of this route?

Answer 11

1) Indications - Immediate effect, Only route available (PT may be NPO) or tissue absorption is poor.
2) Disadvantages - Least safe of all medication routes, instant drug Rx (no recall), infiltration into tissue

Question 12

Why do we flush IVs with normal saline at regular intervals, before and after medications, and PRN?

Answer 12

Flushing ensures patency so there is no clotting or air in the line. It also clears the vein of any residual medication.

Question 13

Why are medications such as nytroglicerin and albumin packaged in glass vials instead of plastic IV bags?

Answer 13

Because medications such as these react with plastic to form a precipitate.

Question 14

How often are IV bags, IV tubes, and IV catheters changed?

Answer 14

IV bags are changed every 24 hrs, IV tubes and catheters are changed every 48 to 96 hrs.

Question 15

What is the formula used to calculate gtt/min?

Answer 15

Gtt/min = (Volume in mL x drop factor [gtt/mL]) / Time in mins

Question 16

What is the primary cause of air in the IV tubing?

Answer 16

Priming the tubing too quickly

Question 17

Why do you warm cold IV medications

Answer 17

Because giving cold IV medications can cause venous spasms.

Question 18

List at least 3 complications that can result from IVs.

Answer 18

1) Infiltration
2) Phlebitis
3) Fluid Overload
4) Air Embolus
5) Speed Shock - Delivering medication too fast via an IV
6) Thrombus

Question 19

What is the drip rate of macrodropper and microdroppers? why select one over the other?

Answer 19

1) Macrodroppers - 10 drops in 1mL (used for adults)

2) Microdroppers - 60 drops in 1mL (used for pediatrics)

Question 20

How is it possible for a patient to have excess fluid volume and still have low BP?

Answer 20

The fluid may be outside of the vascular space (i.e., edema)

Question 21

When do most medication errors occur?

Answer 21

During shift to shift transitions

Question 22

How drugs in hospitals generally classified?

Answer 22

By body systems

Question 23

What is an example of a class of drugs that the FDA do not have oversight of?

Answer 23

Herbals

Question 24

Because many drugs are still metabolized by the liver, regardless of the route, Dr.s write dosages based on what patient variable?

Answer 24

Based on the patient’s liver functioning

Question 25

What is the worst/most severe adverse effect a person could have to a drug?

Answer 25

An anaphylactic reaction

Question 26

What 3 things happen during anaphylaxis? Name 6 different methods used to treat anaphylaxis.

Answer 26

``` Anaphylaxis results in respiratory distress, sudden severe bronchospasms, and cardiovascular collapse. This reaction is treated with: 1) Vasopressors 2) Bronchodilators 3) Corticosteroids 4) Oxygen Therapy 5) IV fluids 6) Antihistamines ```

Question 27

(T/F) Antibiotics are the most important drugs to maintain serum levels in order to achieve a therapeutic level.

Answer 27

True

Question 28

(T/F) Half-Life affects dosage (how often a drug will be given, I.e., a.4h, bid, etc.,)

Answer 28

True

Question 29

What are the 7 parts of a medication order?

Answer 29

1) Patient's name 2) Date and time order was written 3) Name of drug 4) Dosage of drug 5) Route 6) Frequency of administration 7) Signature of prescriber

Question 30

List the three times a medication label should checked during preparation and administration

Answer 30

1) When the nurse reaches for the medication 2) Immediately before pouring or opening the medication 3) Before giving the medication to the patient

Question 31

What are the 7 "rights" of medication administration?

Answer 31

1) Right patient 2) Right medication 3) RIght dosage 4) Right route 5) right time 6) Right reason 7) Right documentation

Question 32

Name the 5 sites on the body where SQ injections can be given

Answer 32

1) Upper arm 2) Abdomen 3) Anterior Thigh 4) Upper back 5) Upper ventral or dorsogluteal area

Question 33

What steps should be taken if a patient refuses to take a medication?

Answer 33

1) Explore why 2) Educate the PT why the medication is beneficial 3) Document 4) Inform the physician

Question 34

What kinds of medications are administered intradermally, SQ, and IM?

Answer 34

1) Intradermal - Tuberculin and allergy tests 2) SQ - Insulin and LMWH 3) IM - Antibiotics, hormones, and vaccines

Question 35

Name the 6 complications that can happen from an IM injection

Answer 35

1) Abscesses 2) Cellulitis 3) Injury to blood vessels, bones, and nerves 4) Lingering pain 5) Tissue necrosis 6) Periostitis

Question 36

What are the 3 sites on the body where IM injections can be given?

Answer 36

1) Ventrogluteal 2) Vastus Lateralis 3) Deltoid

Question 37

What is an actovial?

Answer 37

A vial containing diluent and powder but separated by a rubber stopper. The rubber stopper is activated when the nurse is ready to reconstitute the med.

Question 38

Why should you give potassium-based IVs in larger veins? What can you do if the problem persists in the larger vein?

Answer 38

Potassium irritates the vein and causes a burning sensation. If the problem persists when you switch to a bigger vein, try slowing the rate of infusion.