Chapter 28 Medication Management

A client is to take Demerol 35 mg IM. You have Demerol 50 mg per cc. How many cc will you administer?

0.7cc

What are the three checks of safety?

1 When the nurse reaches for the unit dose package or container. 2. After retrieval from the drawer and compared with the CMAR/MAR, or compared with the CMAR/MAR immediately before pouring from a muti-dose container. 3. Before giving the unit dose medication to the patient, or when replacing the multi-dose container in the drawer or shelf.

When the client demonstrates a rash 30 minutes after she has taken a dose of penicillin, the nurse recognizes that the client is likely demonstrating which type of drug reaction?

Allergy. Allergic reactions result from an immunologic response to a substance to which the client is sensitized.

A nurse is reviewing information about prescribed drug in a drug handbook in preparation for administration to a client. When reading about the drug, the nurse identifies which name as generic name?

Ampicillin sodium. Ampicillin sodium is a generic name. Each drug has only one generic name, which is often simpler than the chemical name from which it was derived. Omnipen-N, Polycillin-N, and SK Ampicillin-N are trade names. The brand name, or trade name, is a registered name assigned by the manufacturer.

Which one of the following medications would most likely be administered via a transdermal patch?

Hormonal medications. Transdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiac medications, and nicotine.

The nurse enters a client's room to administer medications, and the client calls out from the bathroom, "Just leave the medicines on my bedside table. I promise I'll take them as soon as I'm finished." Which of the following responses is most appropriate?

I will return with the medications when you are finished in the bathroom. You should observe the client take medications and should not leave them unattended.

The Z-track technique is utilized during drug administration by which of the following routes?

Intramuscular. The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort.

A nurse is using the Z-track technique to administer an injection to a client. Which of the following injection routes utilizes the Z-track technique?

Intramuscular. When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique. Clients report slightly less pain during (and the day after) a Z-track injection compared with the usual intramuscular injection technique.

What are the principals used to prepare and administer medications safely by oral, subcutaneous injections, and rectal routes?

Oral: make sure patient doesn't have impaired swallowing ability. Subcutaneous: make sure injection goes into fatty material. Rectal routes: Make sure to observe for vagus nerve stimulation, if patient feels light headed or passes out.

What ar the parts of the medication order?

Patient's name, date and time the order is written, name of drug to be administered, dosage of the drug, route by which the drug is to be administered, frequency of administration of the drug, signature of person writing the order.

What are the types of orders?

Standing, prn, stat

When the nurse administers the morning dose of a medication during the evening, which of the rights of medication administration has she failed to follow?

Time. When the nurse administers the right medication to the right client at the wrong time, the nurse has failed to follow the right time.

A client with chronic obstructive pulmonary disease has been prescribed an inhaled bronchodilator. Which of the following techniques should the nurse implement in order to ensure safe and complete delivery of the prescribed medication?

Use a spacer or extender with the metered-dose inhaler. The use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible.

A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection?

1 mL

The nurse is preparing supplies for a tuberculosis screening. The nurse should choose which of the following syringes and needles?

1 mL syringe; ½ inch, 26 gauge needle. For a tuberculosis screening, the nurse should choose a 1mL syringe with a ½ inch, 26-gauge needle.

What are the 11 rights of medication?

1 right medication 2 right patient 3 right dosage 4 right route 5 right time 6 right reason 7 right (appropriate) assessment data 8 right documentation 9 right response 10 right to education 11 right to refuse.

The nurse is preparing to draw up a medication that is supplied in a glass ampule. Arrange the following steps in order.

1 wrap a small gauze pad around neck of ampule. 2. Break off top of the ampule. 3. Attach filter needle to the syringe. 4 Withdraw medication 5 Discard filter needle. 6 Attach sterile administration device to the syringe.

What are the types of drug preparations?

Drugs are available in many forms, or preparations. The form in which the drug is prepared may determine the route of administration. Drug preparations are available for oral, topical, and parenteral administration.

At what point should the nurse perform the first of the three checks of medication administration?

As the nurse reaches for the drug package or container. The first of the three checks associated with safe medication administration takes place when the nurse reaches for the container or unit dose package.

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Avoid crushing sustained-release pellets. When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption.

A nurse needs to use a moisturizer for an older adult client with dry skin. Why is the onset of the medication action atypical in an older adult client?

Diminished subcutaneous fat. The onset of medication action is atypical for topical medications due to diminished subcutaneous fat, resulting in quicker absorption. Decreased appetite, diminished physical mobility, and decreased body temperature may not lead to atypical action with relation to the application of topical medication.

The nurse is beginning to administer oral medications to a client. The client states, "I haven't taken that pill before. Are you sure it's correct?" You recheck the CMAR/MAR and find that the medication is scheduled to be administered. Which of the following responses is most appropriate?

Don't take that pill yet. I will verify that the medication was ordered by your primary care provider. This action indicates adherence to the five rights of medication administration.

A nurse is administering a prescribed dose of medication to a client through a medication lock. How often should the nurse flush the medication lock to maintain patency?

Every 8 to 12 hours To maintain patency, nurses usually flush medication locks every 8 to 12 hours with saline or heparin.

A nurse needs to administer an intradermal injection to a client. Which of the following is the most common site for administering an intradermal injection?

Forearm. The most common site for an intradermal injection is the inner aspect of the forearm. Intradermal injections are commonly used for diagnostic purposes. Examples include tuberculin tests and allergy testing. Small volumes, usually 0.01 to 0.05 mL, are injected because of the small tissue space. Other areas that may be used are the back and upper chest, not the stomach.

A nurse is using an 18-gauge needle to administer a medication to a client. The nurse knows that when compared to a 27-gauge needle, an 18-gauge needle has which of the following features.

Larger diameter. For most injections, 18 to 27 gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27 gauge needle. The needle gauge or the diameter refers to its width.

What are the principals of medication administration?

No medication may be given to a patient without a medication order from a licensed practitioner. When a patient is transferred, it is general practice that all medications are discontinued and new orders are made for the new facility.

A nurse has to administer a subcutaneous injection to a client. For which of the following clients can the nurse administer a subcutaneous injection at a 90 degree angle?

Obese clients. The nurse inserts the needle to reach the subcutaneous tissue in a normal-size or obese client who has a 2-inch fold when it is bunched. For thing clients who have a 1-inch fold of tissue, the nurse inserts the needle at a 45-degree angle. Bunching is preferred for infants, most children, and thin adults.

A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case?

Return the medication to the medication cart or medication room. If the client is not present at the time when the medication needs to be administered, the nurse should return the medication to the medication cart or medication room.

The nurse transcribes an order that reads: Colace 100 mg PO daily. This is an example of which type of order?

Standing order. This is an example of a standing order, which is to be carried out as specified until it is cancelled by another order.

A client has been admitted to the health care facility with an asthmatic attack. The medication order for the client indicates that the nurse administer the prescribed medication immediately. Which of the following standard abbreviations indicates immediate medication?

Stat The standard abbreviation "stat" indicates that the client's medication should be started immediately. "q.d" means every day, "t.i.d" means 3 times a day, "q4h" indicates that the medication needs to be administered every four hours.

A client is ordered to receive an intramuscular injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?

The area is free of major blood vessels and fat. The ventrogluteal site for intramuscular injection is free of major blood vessels and fat. It is considered the safest and least painful site.

A nurse needs to administer a prescribed injection to a toddler. Which of the following injection sites is most suitable for the client?

Vastus lateralis site. The bastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles. The dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed; whereas; the ventrogluteal site is safe for children.