SG Ch: 32 - Medication Administration Pt. 2

Question 1

Identify the components of medication orders.

Answer 1

• Patient’s full name
• Date and time that the order is written
• Medication name
• Dose
• Route of administration
• Time and frequency of administration
• Signature of provider

Question 2

The recording of medication includes:

Answer 2

• The name of the medication
• Dose
• Route
• Exact time of administration
• Site

Question 3

Explain the reasons why polypharmacy happens to a patient.

Answer 3

When patients need to take several medications to treat their illnesses, take two or more medications from the same chemical class, use two or more medications with the same or similar actions or mix nutritional supplements or herbal products with medications, polypharmacy happens

Question 4

Identify two goals for safe and effective medication administration.

Answer 4

1. Patient responds to therapy.
2. Patient has the ability to assume responsibility for self-care.

Question 5

Identify the precautions to take when administering any oral preparation to prevent aspiration.

Answer 5

• Determine the patient’s ability to swallow and cough and check for gag reflex.
• Prepare oral medications in the form that is easiest to swallow.
• Allow the patient to self-administer medications if possible.
• If the patient has unilateral weakness, place the medication in the stronger side of the mouth.
• Administer pills one at a time, ensuring that each medication is properly swallowed before the next one is introduced.
• Thicken regular liquids or offer fruit nectars if the patient cannot tolerate thin liquids.
• Avoid straws because they decrease the control the
• patient has over volume intake, which increases
• the risk of aspiration. h. Have the patient hold the cup and drink from it if
• possible. i. Time medications to coincide with meal times
• or when the patient is well rested and awake if
• possible. j. Administer medications using another route if risk
• of aspiration is severe.

Question 6

Identify the guidelines to ensure safe administration of transdermal or topical medications.

Answer 6

• Medication history and reconciling medications
• Assess if patient has an existing patch before application.
• Wear disposable gloves when applying and removing patches.
• Apply a noticeable label to the patch.
• Document removal of medication on the MAR.
• Document the location of the patient’s body where the medication was placed on the medication administration record (MAR)

Question 7

The most common form of nasal instillation is:

Answer 7

Decongestant spray or drops

Question 8

List four principles for administering eye instillations.

Answer 8

1. Avoid instilling any eye medication directly onto the cornea.
2. Avoid touching the eyelids or other eye structures with eye droppers or ointment tubes.
3. Use medication only for the patient’s affected eye.
4. Never allow a patient to use another patient’s eye medications

Question 9

Failure to instill ear drops at room temperature causes:

Answer 9

• Vertigo
• Dizziness
• Nause

Question 10

Vaginal medications are available as:

Answer 10

• Suppositories
• Foam
• Jellies
• Creams

Question 11

Rectal suppositories are used for:

Answer 11

Exerting local effects (promoting defecation) or systemic effects (reducing nausea)

Question 12

Explain the following types of inhalation inhalers:

a) Pressurized metered-dose inhalers (pMDIs):
b) Breath-actuated metered-dose inhalers (BAIs):
c) Dry powder inhalers (DPIs):

Answer 12

a) Delivers a measured dose of medication with each push of a canister often used with a spacer
b) Releases medication when a patient raises a level and then inhales
c) Hold dry, powdered medication and create an aerosol when the patient inhales through a reser- voir that contains the medication

Question 13

Identify the four aseptic techniques to use to prevent an infection during an injection.

Answer 13

1. Draw medication from ampule quickly; do not allow it to stand open.
2. Avoid letting the needle touch contaminated surface.
3. Avoid touching the length of the plunger or inner part of the barrel.
4. Prepare the skin, use friction and a circular motion while cleaning with an antiseptic swab, and start from the center and move outward.

Question 14

Identify the two factors that must be considered when selecting a needle for an injection.

Answer 14

1. The patient’s size and weight
2. Type of tissue into which the medication is to be injected

Question 15

Describe each of the following.

• Ampule:
• Vial:

Answer 15

Ampule: Contain single doses of medications in a liquid

Vial: A single dose or multidose container with a rubber seal at the top (closed system)

Question 16

List the three principles to follow when mixing medications from two vials.

Answer 16

1. Do not contaminate one medication with another.
2. Ensure that the final dose is accurate.
3. Maintain aseptic technique.

Question 17

Insulin is classified by:

Answer 17

Rate of action (rapid, short, intermediate, and long acting); each has a different onset, peak, and duration of action.

Question 18

Identify the principles to follow when mixing two types of insulin in the same syringe.

Answer 18

• Need to maintain their individual routine when preparing and administering their insulin
• Do not mix insulin with any other medication or diluents.
• Never mix insulin glargine or insulin detemir with other types of insulin.
• Inject rapid-acting insulin mixed with NPH within 15 minutes before a meal.
• Verify insulin dosages with another nurse while preparing them.

Question 19

List the techniques used to minimize patient discomfort that is associated with injections.

Answer 19

• Use a sharp beveled needle in the smallest suitable length and gauge.
• Position the patient as comfortably as possible to reduce muscle tension.
• Select the proper injection site. d. Apply a vapocoolant spray or topical anesthetic to the site if possible.
• Divert the patient’s attention from the injection.
• Insert the needle quickly and smoothly.
• Hold the syringe while the needle remains in
  tissues.
• Inject the medication slowly and steadily.

Question 20

Identify the three best sites for subcutaneous injections.

Answer 20

1. The outer posterior aspect of the upper arms
2. The abdomen (below the costal margins to the
   iliac crests)
3. The anterior aspects of the thighs

Question 21

What is the maximum amount of water-soluble medication given by the subcutaneous route?

Answer 21

0.5 to 1 mL

Question 22

What angles should be used when administering a subcutaneous injection, and with which needle should they be used?

Answer 22

• 25-gauge, 5/8-inch needle inserted at a 45-degree
  angle
• 1/2-inch needle inserted at a 90-degree angle

Question 23

What is the angle of insertion for an intramuscular (IM) injection?

Answer 23

90°

Question 24

Indicate the maximum volume of medication for an IM injection in each of the following groups.

1. Well-developed adults:
2. Older children, older adults, and thin adults:
3. Older infants and small children:

Answer 24

1. 2 to 5 mL into a large muscle
2. 2mL
3. 1mL

Question 25

Describe the characteristics of the following intramuscular injection sites.

1. Ventrogluteal:
2. Vastus lateralis:
3. Deltoid:

Answer 25

1. Deep site away from nerves and blood vessels; preferred
   site for medications for adults; children and infants for
   large volumes and viscous and irritating solutions
2. For adults and children, muscle is thick and well
   developed; anterior lateral aspect of the thigh
3. Easily accessible but muscle not well developed; use small amounts; not used in infants or children; potential for injury to radial and ulnar nerves; immunizations for children; recommended site for hepatitis B
   and rabies injections

Question 26

Explain the rationale for the Z-track method in IM injections.

Answer 26

Minimizes local skin irritation by sealing the medication in muscle tissue

Question 27

Explain the rationale for intradermal injections.

Answer 27

Skin testing; injected into the dermis where medica-
tion is absorbed slowly

Question 28

List the methods a nurse can use to administer medications intravenously.

Answer 28

• As mixtures within large volumes of IV fluids
• Injection of a bolus or small volume of medication
• Piggyback infusion

Question 29

Identify the advantages of the intravenous (IV) route of administration.

Answer 29

• Fast-acting medications must be delivered quickly.
• It provides constant therapeutic blood levels.
• It can be used when medications are highly alkaline and irritating to the muscle and subcutaneous tissue

Question 30

The disadvantages of IV bolus medications are:

Answer 30

• It is the most dangerous method because there is no time to correct errors.
• A bolus may cause direct irritation to the lining of blood vessels

Question 31

List the advantages of using volume-controlled infusions.

Answer 31

• They reduce risk of rapid infusion by IV push.
• They allow for administration of medications that are stable for a limited time in solution.
• They allow for control of IV fluid intake

Question 32

What is a piggyback set?

Answer 32

A small (25- to 250-mL) IV bag connected to short tubing lines that connects to the upper Y port of a primary infusion line

Question 33

What is a volume-control administration set?

Answer 33

A small (50- to 150-mL) container that attaches below the primary infusion bag

Question 34

What is a syringe pump?

Answer 34

A battery-operated machine that allows medications to be given in very small amounts of fluid (5 to 60 mL)

Question 35

List the five advantages of using intermittent venous access devices.

Answer 35

1. Cost saving
2. Convenience
3. Increased mobility
4. Safety
5. Patient comfort

Question 36

The study of how drugs enter the body, reach their sites of action, are metabolized, and exit from the body is called:

1. Pharmacology
2. Pharmacopoeia
3. Pharmacokinetics
4. Biopharmaceutical

Answer 36

3. Definition of pharmacokinetics

Question 37

Which statement correctly characterizes drug absorption?

1. Most drugs must enter the systemic circulation to have a therapeutic effect.
2. Oral medications are absorbed more quickly when administered with meals.
3. Mucous membranes are relatively impermeable to chemicals, making absorption slow.
4. Drugs administered subcutaneously are absorbed more quickly than those injected intramuscularly.

Answer 37

1. Absorption refers to the passage of medication molecules into the blood from the site of administration

Question 38

The onset of drug action is the time it takes for a drug to:

1. Produce a response
2. Accelerate the cellular process
3. Reach its highest effective concentration
4. Produce blood serum concentration and maintenance

Answer 38

1. Definition of onset

Question 39

Which of the following is not a parenteral route of administration?

1. Buccal
2. Intradermal
3. Intramuscular
4. Subcutaneous

Answer 39

1. An oral route

Question 40

The nurse is preparing an insulin injection in which both regular and NPH will be mixed. Into which vial should the nurse inject air first?

1. The vial of regular insulin
2. The vial of NPH
3. Either vial, as long as modified insulin is drawn up first
4. Neither vial; it is not necessary to put air into vials before withdrawing medication

Answer 40

2. If mixing rapid- or short-acting insulin with intermediate-acting insulin, take the insulin syringe and aspirate a volume of air equivalent to the dose of insulin to be withdrawn from the intermediate-acting insulin firs