Chapter 29: Medication

A nurse who is administering medications to patients in an acute care setting studies the pharmacokinetics of the drugs being administered. Which statements accurately describe these mechanisms of action? Select all that apply.

- distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues. - during first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the systems circulation. - the gastrointestinal tract, as well as sweat, salivary and mammary glands, are routes of drug absorption.

The nurse is teaching a client how to use nasal spray. What will the nurse include in the teaching plan? Select all that apply.

- hold the breath for a few seconds after administering the spray. - insert the tip of the nose piece into one nostril. - sit up comfortably in bed.

A nurse is preparing medications for patients in the ICU. The nurse is aware that there are patient variables that may affect the absorption of these medications. Which state statements accurately describes these variables? Select all that apply.

- patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed. - some people experience the same response with a placebo as with the active drug used in studies. - a patient who receives a pain medication in a noisy environment may not receive full benefit from the medication effects. - circadian rhythms and cycles may influence drug action.

The nurse is administering a medication to a patient via an enteral feeding tube. Which are accurate guidelines related to this procedure? Select all that apply.

- use the recommended procedure for checking tube placement in the stomach or intestine. - give each medication separately and flush with water between each drug. - adjust the amount of water used if patients fluid intake is restricted.

A nurse is teaching a patient how to use a meter dosed inhaler to control asthma. What are appropriate guidelines for this procedure? Select all.

--- shake the inhaler well and remove the mouthpiece covers from the MDI and spacer. -- depress the canister releasing one puff into the spacer and inhale slowly and deeply. --- wait 1 to 5 minutes as prescribed before administering the next puff.

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse have to insert the needle into the client?

90 degrees. - insulin injections are given subcutaneously to clients with obesity at a 90 degree angle.

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees.

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 min

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that it is to be applied topically. Which instructions should the nurse provide?

Apply the medication to clean, dry skin of the affected area using gloves

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that it is to be applied topically. Which instruction should the nurse provide?

Apply the medication to clean, dry skin of the affected area using gloves.

A nurse educator is teaching a student how to choose the correct needle for an injection.

As the gauge number becomes larger, the size of the needle becomes smaller. ---- the first number on a needle package is the gauge or diameter of the needle; the second number is the length in inches. When giving an injection, the viscosity of the medication directs the choice of gauge. The size of the syringe is directed by the amount of the medication to be given.

A nurse at the health care facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed eardrops in the client's ear?

Ask the client to maintain the position for some time.

A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation?

Assess the vomit, looking for the pill. - If a patient vomits immediately after swallowing an oral pill, the nurse should assess the vomit for the pill or fragments of it. The nurse should then notify the primary care provider to see if another dosage should be administered.

Ms. Hall has an order for hydromorphone, 2 mg, intravenously, q 4 hours PRN pain. The nurse notes that according to Ms. Hall's chart, she is allergic to hydromorphone. The order for medication was signed by Dr. Long. What would be the correct procedure for the nurse to follow in this situation?

Call Dr. Long and ask that the medication be changed.

The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate 40 mg by mouth twice daily. What is the appropriate nursing action?

Contact the health care provider for clarification of the prescription.

A nurse is administering an adults clients ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?

Deltoid -- the deltoid and ventrogluteal sites are more appropriate for adults than the vastus lateralis. The scapula is a site for INTRADERMAL not INTRAMUSCULAR.

A nurse is administering a hepatitis B shot IM. What would be appropriate administration?

Deltoid. - deltoid is the best site for this medication. Biologicals for infants and young children are administered at the vests laterals. The vfntrogluteal site is used for depot formulations and irritating medications. The scapula is a site for an intradermal injection.

A medication order reads: "Hydromorphone, 2 mg IV every 3 to 4 hours PRN pain." The prefilled cartridge is available with a label reading "Hydromorphone 2 mg/1 mL." The cartridge contains 1.2 mL of hydromorphone. What should the nurse do?

Dispose of 0.2 mL before administering the drug; verify the waste with another nurse.

A nurse is administering heparin subcutaneously to a patient. What is the correct technique for this procedure?

Do not aspirate; massage the site for 1 minute.

The nurse is assessing a client with diabetes who has poor vision. Which feature of the insulin pen makes it beneficial for this client?

Each unit of insulin is accompanied by a clicking sound in the pen.

The nurse is caring for a client who is taking nitroglycerin. Which client statement requires immediate nursing intervention?

I am taking tadalafil in addition to nitroglycerin. - clients taking nitroglycerin should not take any drug or herbs for ED. This may cause severe hypotension due to combined vasodilation effect.

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick?

Immediately activate the safety needle and place the syringe and needle into a Sharps

Dispose of 0.2 mL before administering the drug; verify the waste with another nurse.

Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin.

A nurse is showing an older adult client the correct method of self-administering an insulin injection at home. Which statement best describes lipoatrophy and lipohypertrophy to the client?

Lipoatrophy and lipohypertrophy are conditions of the fatty tissue that can occur from not rotating injection site

A client asks the nurse what action clients should take in ensuring that medications are instilled appropriately. What is the best response by the nurse?

Turn the head slightly to the affected side to prevent solution or tears from flowing toward the opposite side.

A nurse enters a clients room to check on his intravenous infusion. An electronic infusion device is not being used. When checking the solution container and rate, the nurse notes that the fluid is infusing at rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion?

The client is resting his arm with the IV on his head.

A nurse needs to administer a subcutaneous heparin injection to a client. Which injection site is most suitable for heparin?

abdomen. - abdomen area is the preferred site for a subcutaneous heparin injection because of less pain intensity. The forearm, back and upper chest are common sites for an intradermal injection, not a subcutaneous injection.

The nurse is preparing medications and is notified that a health care provider is on the phone. What is the nurse's appropriate response?

ask the unit clerk to take a message from the provider

the nurse is preparing medications and is notified that a health care provider is on the phone. What is the nurses appropriate response?

ask the unit clerk to take a message from the provider.

A nurse is administering a pain medication to a patient. IN addition to checking his identification bracelet, the nurse correctly verifies the patients identity by performing which action?

asking the patient his name and birthdate.

When preparing to administer a second dose of a prescribed vaginal suppository, the client reports discomfort in the vaginal area. What should the nurse do next?

assess the vaginal area

What is the term used for the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body?

half life

During a teaching session on self administration of insulin, the client asks the nurse why is it necessary to bunch the skin before inserting the needle. What is the nurses best response?

bunching your skin facilities the placement of the needle in the subcutaneous tissue.

A nurse discovers that a medication error occurred. What should be the nurses first response?

check the patients condition to note any possible effect of the error.

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

checking for documented allergies to foods or drugs.

The nurse has completed medications through an enteral tube used for decompression. What is the appropriate nursing action?

clamp the tube for at least 30 seconds.

A nurse is administering phenytoin via a gastric tube to a patient who is receiving tube feedings. What would be an appropriate action of the nurse in this situation?

discontinue the tube feeding and leave the tube clamped for required period of time before and after medication administration. -- If the patient is receiving tube feedings, the nurse should renew information about the drugs to be administered. Absorption of some drugs, such as phenytoin, is affected by tube feeding formulas. The nurse should discontinue a continuous tube feeding and leave the tube clamped for the required period of time before and after the medication has been given, according to the reference and facility protocol.

A healthcare provider orders a pain medication for a postoperative patient that is a PRN order. When would the nurse administer this medication??

doses administered as needed for pain relief.

A client at health care facility has been prescribed scopolamine, to be administered transdermally. Which statement describes transdermal application?

drugs bonded to an adhesive and applied to the skin.

xerostomia

dry mouth

The nurse is reading an order that indicates that a drug is to be given to a client q4h. How will the nurse administer this medication?

every 4 hours

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

forearm

What sites are commonly used for intradermal injections?

inner surface of the forearm upperback under the scapula

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection would be the most appropriate in this situation?

inner surface of the forearm.

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

intramuscular

A nurse preparing medication for a client is called away to an emergency. What should the nurse do?

lock the medications in a cart and finish them upon return.

What is the best response by the nurse when a client asks about the side effects of using a nasal spray?

long term use of nasal sprays can cause rebound nasal congestion.

If the dosage is inappropriate for a client, who is responsible?

nurse

The nurse is preparing to administer an oral medication to a client with xerostomia. Which nursing action is appropriate?

offer a sip of water before administering medication.

What is term used for the highest plasma concentration??

peak level

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

place the date on the vial and retain for future use.

The chemotherapy client has been admitted for thrombocytopenia. Which blood product will the nurse anticipate administering?

platelets

A nurse is preparing to convert a client's IV to an intermittent infusion device. The IV is connected to extension tubing. Before disconnecting the IV tubing from the extension tubing, the nurse clamps the extension tubing for which reason?

prevent air from entering the line

Which nursing actions should be performed in the required checks for safe medication administration? select all that apply

read the med label when ruching for unit dose package read med label after retrieving med from the drawer rad med label just before administering a unit dose medication the client.

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

report the needlestick to the nurse manager

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.

A nurse is assessing a client's lower arm for insertion of an IV catheter. The nurse palpates the vein and notes that it feels hard. Which action by the nurse would be most appropriate?

select another site

The nurse has conformed the clients identity and provided a client with oral medication. what is the next appropriate nursing intervention?

stay with the client while medications are taken.

Regarding medication administration, what must occur at the change of shifts?

the narcotics for the division are counted.

The nurse is preparing to administer a transdermal medication. how should this be accomplished?

the nurse should apply the medication directly to the skin.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

the nurse should use a nebulizer to administer the medication.

A nurse who gives subcutaneous and intramuscular injections to patients in a hospital setting attempts to reduce discomfort for the patients receiving the injections. Which technique is recommended?

the nurse uses the Z track technique for intramuscular injections to prevent leakage of medication into the needle track. -- The nurse should use the z track technique for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. The nurse should select a needle of the smallest gauge that is appropriate for the site and solution to be injected and select the correct needle length. The nurse should also inject the medication into relaxed muscles since there is no more pressure and discomfort if medication is injected into the contracted muscles.

Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection?

the vfntrogluteal site provides a location with the capacity for depositing and absorbing the drug. the ventrogluteal site is a large muscular injection site that provides a location with the capacity for depositing and absorbing the drug and is therefore correct. The nurse will reduce the transmission of microorganisms by hand washing and not by selecting the ventrogluteal site. The nurse will aspirate for a blood return to determines whether or not the needle is in a blood vessel. Changing the needle will prevent tissue contact with the irritating drug, not the usage of the ventrogluteal site.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity?

therapeutic range.

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal?

to determine the extent to which the client responded to the drugs

What is the term used for the point when the drug is at the lowest concentration?

trough level

A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation?

when the client has disorders that affect the absorption of medications.