foundations Ch. 28: Medications PrepU, foundations med. administration powerpoint 211, foundations CH 28 medications course point
A nurse is administering a hepatitis B immunization injection to an adult clent. Which site would the nurse choose for this injection?
deltoid muscle site
trade name
drug name selected and trademarked by the company marketing the drug; also called brand name or proprietary name
The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? a) lower abdomen b) upper arm c) upper back d) side of buttock
upper back Explanation: The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily
medication reconciliation
process of creating an accurate list of all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing the list to the physician's admission, transfer, or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital
excretion
removal of a drug from the body
An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method? a) systems that contain frequently used medication for that unit b) a supply that remains on the nursing unit for use in emergency c) a container with enough prescribed medications for several days for a client d) self-contained packets that hold one tablet or capsule for individual clients
self-contained packets that hold one tablet or capsule for individual clients Explanation: The nurse should understand that a unit dose supply method is a method in which self-contained packets hold one tablet or capsule for an individual client. An individual supply is a container with enough of the prescribed medication for several days or weeks and is common in long-term care facilities such as nursing homes. A stock supply remains on the nursing unit for use in an emergency or so that a nurse can give a medication without delay.
anaphylactic reaction
severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse
anaphylaxis
severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse
stat order
single order carried out immediately
toxic effect
specific groups of symptoms related to drug therapy that carry risk for permanent damage or death
pharmacology
study of actions of chemicals on living organisms
ethnopharmacology
study of the effect of ethnicity on responses to prescribed medication, especially drug absorption, metabolism, distribution, and excretion
When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug? a) talking when taking the medication b) swallowing the medication c) performing physical activities d) taking the medication on an empty stomach
swallowing the medication Explanation: When administering medication by sublingual application, the client should avoid swallowing or chewing the medication. Eating or smoking during administration is also contraindicated. Taking the medication on an empty stomach, talking, or performing physical activities may not be contraindicated when administering drugs sublingually.
Z-track technique
technique used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort
drug tolerance
tendency of the body to become accustomed to a drug over time; larger doses are required to produce the desired effects
Drugs known to cause birth defects are called: a) nosocomial. b) umbilical cross. c) teratogenic. d) pregnancy sensitivity.
teratogenic. Explanation: Drugs know to cause birth defects are called teratogenic.
therapeutic range
that concentration of drug in the blood serum that produces the desired effect without causing toxicity
half-life
the amount of time it takes for half a dose of a drug to be eliminated from the body
PDR (Physician's Desk Reference)
the drug bible. doses, pronunciation, administration, side effects etc..
solvent
the liquid that the powder is mixed with for reconstitution 500mg/ 1 mL
trough level
the point when a drug is at its lowest concentration
solute
the powder medication 500mg/ 1 mL
pharmacogenetics
the study of how genetic variation affects an individual's response to drugs
The primary reason for the Controlled Substances Act is: a) to regulate the purchase of antibiotics. b) to prevent drug abuse. c) to regulate the purchase of narcotics. d) to prevent overuse of antibiotics.
to prevent drug abuse. Explanation: The primary reason for the Controlled Substances Act is to prevent drug abuse and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug abuse laws.
adverse drug reactions (ADRs)
undesirable effects other than the intended therapeutic effect of a drug
idiosyncratic effect
unusual, unexpected response to a drug that may manifest itself by overresponse, underresponse, or response different from the expected outcome
Which technique should the nurse employ when instilling otic medication in an adult ear?
up and back
During a teaching session on self-administration of insulin, the client asks the nurse why it is necessary to bunch the skin before inserting the needle. What is the nurse's best response? a) "Bunching your skin steadies the syringe." b) "Bunching your skin facilitates the placement of the needle in the subcutaneous tissue." c) "Bunching your skin controls bleeding." d) "Bunching your skin ensures complete delivery of the insulin."
"Bunching your skin facilitates the placement of the needle in the subcutaneous tissue." Explanation: Facilitating the placement of the needle in the subcutaneous tissue is correct, as this action enables the skin to accommodate the length of the needle better. Controlling bleeding, steadying the syringe, and ensuring complete delivery of the insulin are incorrect, as these are not why it is necessary to bunch the skin.
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?" The nurse rechecks the CMAR/MAR and finds that the medication is scheduled to be administered. Which response is most appropriate? a) "Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." b) "It wouldn't be listed on this CMAR/MAR if it wasn't prescribed for you." c) "It's listed here on the CMAR/MAR, so you should take it." d) "Go ahead and take it, and then I'll check with your primary care provider about it."
"Don't take that pill yet. I will verify that the medication was ordered by your primary care provider." Explanation: This action indicates adherence to the five rights of medication administration.
The telehealth nurse receives a call from a client who is using a topical nasal decongestant and states, "I feel like my nose is stuffier than ever." What is the appropriate response by the telehealth nurse? a) "Please hang up and call 9-1-1. This is an emergency." b) "How often are you administering the nasal decongestant?" c) "Increase the frequency of taking this drug to help ease the congestion." d) "Are you willing to take an over-the-counter cold remedy to more fully treat your symptoms?"
"How often are you administering the nasal decongestant?" Explanation: The telehealth nurse will want to know how often the client is taking the medication, as this may represent a rebound effect. This is not an emergent condition. The client should not take more medication without consulting the healthcare provider, nor should an over-the-counter cold remedy be added since this also typically contains a decongestant.
The nurse is teaching a client about using two inhalers. Which client statement reflects that nursing teaching has been effective? a) "I will breathe in for about 10 seconds, and exhale quickly." b) "I must wait at least 1 full minute between inhalers." c) "I will wash the holder in warm water mixed with 1 tablespoon of bleach." d) "I should be careful to refrain from shaking the canisters of medication."
"I must wait at least 1 full minute between inhalers." Explanation: Teaching has been effective when the client states that a full minute must elapse between taking doses of medication from different inhalers. The canisters must be shaken after being placed in the holder. After breathing the medication in over 10 seconds, the client should exhale slowly through pursed lips. Holders should be rinsed in warm water daily, and cleaned weekly with mild soap and water.
The nurse is teaching a client with arthritis about taking medications at home. Which client statement indicates that nursing teaching has been effective? a) "Setting up a monthly medication management system will be helpful." b) "I trust my daughter to give my medications when I need them." c) "I will ask my pharmacist about an easy-to-open lid." d) "Brand name drugs are cheaper than generic drugs."
"I will ask my pharmacist about an easy-to-open lid." Explanation: The client with arthritis may benefit from an easy-to-open lid on the medication bottles. Generic drugs are usually cheaper than brand name drugs. Setting up a weekly medication management system can be helpful; monthly may be too long in case medications are not working, dosing changes, or the client experiences a reaction. The client may wish to include the daughter in maintenance of care, yet the nurse still needs to assess the client's learning about self-managemen
Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delaying in administering client medications. What is Nurse B's appropriate response? a) "I can log in and give the medications for you." b) "I am giving you my password so you can log in." c) "I will log in so that you can proceed with medication delivery." d) "I will get the hospital's information systems' phone number for you."
"I will get the hospital's information systems' phone number for you." Explanation: Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue.
A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response? a) "You will receive the medication faster as it goes through this device." b) "Medication stays in the chamber so you can continue to inhale it." c) "It makes the inhaler easier to hold in case you have arthritis." d) "This is to decrease the amount of drug that you receive."
"Medication stays in the chamber so you can continue to inhale it." Explanation: A spacer provides a reservoir for aerosol medication. The client can take additional breaths (after the initial breath) to continue inhaling the medication held in the reservoir. The spacer does not decrease the amount of medication received, make the medication move faster, nor serve as a holding device
A client asks why the client is being prescribed an otic medication. What is the best response by the nurse? a) "Otic medications are used to treat local fungal infection on the skin." b) "Otic medications are used to treat local fungal infection in the ears." c) "Otic medications are used to treat local fungal infection in the nostrils." d) "Otic medications are used to treat local fungal infection in the eyes."
"Otic medications are used to treat local fungal infection in the ears." Explanation: Otic medications are to be instilled in the outer ear and are often used to treat local fungal infection in the ear and not in the eyes, on skin, or in the nostrils.
The nurse just completed a refresher course on parental drug administration. Which statement by the nurse indicates that teaching was effective? a) "Reconstitution is a sealed glass cylinder of parenteral medication with an attached needle." b) "Reconstitution is a glass or plastic container of parental medication with self-sealing rubber stopper." c) "Reconstitution is the process of adding liquid, known as diluent, to a powered substance." d) "Reconstitution is a sealed glass drug container that must be broken to withdraw the medication."
"Reconstitution is the process of adding liquid, known as diluent, to a powered substance." Explanation: Reconstitution is the process of adding liquid, known as diluent, to a powered substance. A sealed glass cylinder of parenteral medication with an attached needle is a refilled cartridge, not reconstitution. A glass or plastic container of parental medication with self-sealing rubber stopper is a vial, not reconstitution. A sealed glass drug container that must be broken to withdraw the medication is an ampoule, not reconstitution.
An older adult client has been prescribed a transdermal patch. Which client statement demonstrates the need for further teaching by the nurse? a) "I will close the adhesive edges of the patch before I dispose of it." b) "When changing patches, I will change the location of application." c) "This medication is likely to work slower on me than on a younger person." d) "I will place this on my buttock."
"This medication is likely to work slower on me than on a younger person." Explanation: The nurse will need to teach the client that the onset of drug action may be faster in an older adult than in a younger adult. All other statements are appropriate and do not require further education
The nurse has finished teaching a client about medications that have been ordered for administration. Which client statement reflects that teaching about a piggyback infusion has been successful? a) "A piggyback is a type of chemotherapy that will treat my cancer." b) "You will give me that medication in tandem with my other IV solution." c) "I could not receive this type of medication if I were under the age of 18." d) "This is the first medication I will receive."
"You will give me that medication in tandem with my other IV solution." Explanation: A piggyback is a secondary infusion - the administration of a parenteral drug that has been diluted in a small volume of IV solution over 30-60 minutes. It is called a piggyback because it is given in tandem with primary IV solution; therefore, this client statement reflects that teaching has been successful. Other client statements are incorrect and require further teaching
PRN order
"as needed" order for medication
inhalation
(1) act of breathing in; synonym for inspiration; (2) administration of a drug in solution via the respiratory tract
metabolism
(1) chemical changes in the body by which energy is provided; (2) breakdown of a drug to an inactive form; also referred to as biotransformation
oral suspension
-drug is mixed with, but not completely dissolved into a liquid -needs to be shaken before administration in order to suspend the drug particles evenly
reconstituted medication package
-volume of dilutant -total volume after mixed -name of solvent and solute -solution ratio -how mixed med is stored -how long it is good -how it will be administered
A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? a) 1.5 b) 4 c) 2 d) 0.5
0.5 Explanation: 125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets
The nurse is working the night shift in the ER when an ambulance arrives carrying a man s/p motor vehicle accident (MVA). His initial BP is 100/56 and the nurse notes that he is bleeding heavily from a laceration on the forehead. Fifteen minutes later, the nurse reassesses the client and finds that his BP is 95/58. What IV fluid would the nurse expect to be ordered? a) D5 ¼ NS b) 0.9% NS c) 3% NS d) 0.45% NS
0.9% NS Explanation: Isotonic fluids are used to increase blood pressure secondary to hypovolemia
A nurse is administering a subcutaneous injection to a client. What is the common maximum volume of a subcutaneous injection? a) 3 mL b) 1 mL c) 0.05 mL d) 0.01 mL
1 mL Explanation: The volume of a subcutaneous injection is usually up to 1 mL. An intramuscular injection is the administration of up to 3 mL of medication into one muscle or muscle group. Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01 to 0.05 mL
The nurse is preparing supplies for a tuberculosis screening. The nurse should choose which syringes and needles? a) 1 mL syringe; ½-inch, 26-gauge needle b) 5-mL syringe; 2-inch, 20-gauge needle c) 10-mL syringe; 3-inch, 18-gauge needle d) Insulin syringe; 1-inch, 16-gauge needle
1 mL syringe; ½-inch, 26-gauge needle Explanation: For a tuberculosis screening, the nurse should choose a 1 mL syringe with a ½-inch, 26-gauge needle.
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- 15 degrees
A nurse is preparing to administer IV therapy to a client and selects a catheter with a large lumen. Which catheter would have the largest lumen? a) 18 gauge b) 22 gauge c) 20 gauge d) 21 gauge
18 gauge Explanation: IV catheters are available in various sizes. The lumen size is measured in gauges; odd numbers designate winged infusion needles (19, 21, 23), whereas even numbers designate catheter sizes. The most common adult catheter sizes are 22, 20, and 18. As the numbers increase, the lumen size decreases; thus, a 22-gauge needle is smaller in diameter than an 18-gauge needle. Of the catheter gauges listed, 18 would be the largest.
A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose which have 30 g in 45 mL. How many milliliters is the nurse going to administer every 6 hours to the client? a) 15 mL b) 67.5 mL c) 22.5 mL d) 30 mL
30 mL Explanation: The formula to calculate the correct medication amount is: (Dose on hand/Quantity on hand = Dose desired/X). If you use this for this scenario you would have 30 g/45 mL = 20 g/X, where X = 30 mL.
The nurse is preparing to administer insulin to an older client who is frail and has failure to thrive. At what angle will the nurse plan to insert the needle into the client? a) 90 degrees b) 20-30 degrees c) 45 degrees d) 10-15 degrees
45 degrees Explanation: Insulin injections are given subcutaneously to clients who are very thin at a 45 degree angle.
The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication? a) 73-year-old client diagnosed with liver disease b) 35-year-old client diagnosed with migraines c) 16-year-old client diagnosed with left radial fracture d) 45-year-old client diagnosed with lung cancer
73-year-old client diagnosed with liver disease Explanation: Older adults have decrease in plasma protein, which is needed to bind and inactivate the medication in the bloodstream. The decrease in plasma proteins can increase the amount of medication circulating, which increases the effects. Decreased liver and kidney function also increases the amount of medication in the blood. The other options can have a risk, but they are not the highest.
A nurse is reviewing information about a prescribed drug in a drug handbook in preparation for administration to a client. When reading about the drug, the nurse identifies which name as the generic name? a) Ampicillin sodium b) SK Ampicillin-N c) Polycillin-N d) Omnipen-N
Ampicillin sodium Explanation: 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.
What factor is used to calculate drug dosages for a child? a) Ethnicity b) Body surface area (BSA) c) Developmental level d) Age
Body surface area (BSA) Explanation: Pediatric doses are calculated according to the child's weight or BSA. The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height.
The nurse is preparing to administer two IV medications. What is the appropriate nursing action? a) Administer the drugs through the same tubing. b) Consult current drug reference book for IV compatibility. c) Prepare to administer through two separate tubes. d) Hold one medication for an hour and administer it after the first medication.
Consult current drug reference book for IV compatibility. Explanation: The nurse should consult a current drug reference book for compatibility before administering two IV medications. Other answers are incorrect.
absorption
process by which drugs are transferred from the site of entry into the body to the bloodstream
oral
Capsule, pill, tablet, extended release, elixir, suspension, syrup
After inserting an intravenous catheter into a client's vein, the nurse does not obtain blood return. What is the appropriate nursing action? a) Obtain larger bore catheter. b) Change catheter insertion site. c) Gently insert the IV catheter further into the vein. d) Begin infusion IV fluids and document procedure.
Change catheter insertion site. Explanation: If a blood return is not obtained, the IV catheter is not appropriately placed. The nurse will remove the IV catheter and change the site. Other actions are incorrect.
The nurse has inserted a peripheral intravenous catheter into a client. What is the appropriate action when a blood return is not obtained? a) Change the site of catheter insertion. b) Begin infusing the IV fluid. c) Insert the IV catheter further. d) Pinch IV tubing to prohibit initial infusion.
Change the site of catheter insertion. Explanation: If a blood return is not obtained, the IV catheter is not appropriately placed. The nurse will remove the IV catheter and change the site. It is not appropriate to insert the catheter further, begin infusion, or pinch IV tubing
A nurse is providing care for a client who has a history of dementia. Which method should the nurse use in order to determine the client's identity prior to medication administration? a) Enlist the help of a colleague who is familiar with the client. b) Check the client's identification band. c) Cross-reference the MAR with the client's medical record. d) Ask the client his name prior to giving the drug.
Check the client's identification band. Explanation: For all clients, the preferred method of confirming identity is to read the client's identification band.
After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues? a) Metabolism b) Synergism c) Absorption d) Distribution
Distribution Explanation: The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver.
During a visit to the clinic, the physician prescribes an intramuscular injection of a medication for an 8-month old. When administering this medication to the infant, which of the following sites should the nurse rule out first? a) Deltoid b) Ventrogluteal c) Vastus lateralis d) Dorsogluteal
Dorsogluteal Explanation: The dorsogluteal site is not used in infants and toddlers. Muscles in this site are not well developed until children begin to walk. Any other site would be more appropriate to use.
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.
A nurse is caring for a client who has a PICC line. Which nursing action is recommended? a) Change catheter caps every 10 days or as per facility policy. b) Use clean technique when changing dressing. c) Keep external portion of catheter coiled on top of dressing. d) Flush using normal saline and/or heparin solution according to facility policy.
Flush using normal saline and/or heparin solution according to facility policy. Explanation: PICC lines are flushed with normal saline and/or heparin in order to maintain patency by preventing clot formation in the line. Sterile technique should be used for dressing changes for at least 24 hours after insertion and 3 to 7 days thereafter. The external part of the catheter should be kept under the dressing to prevent the introduction of microorganisms, leading to infection. Catheter caps should be changed every 3 to 7 days.
A nurse is administering medications through an enteral tube to a client with swallowing difficulties due to a cerebrovascular accident (CVA). Which action should the nurse perform to prevent gastric reflux? a) Administer the medication over several minutes. b) Help the client into a Fowler's position. c) Check for drug allergies in the client's history. d) Add diluted medication to the syringe.
Help the client into a Fowler's position. Explanation: Assuming Fowler's position can help prevent gastric reflux when medications are administered through an enteral tube.
Which medication would most likely be administered via a transdermal patch? a) Epinephrine b) Hormonal medications c) Antibiotics d) Antidepressants
Hormonal medications Explanation: Transdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiac medications, and nicotine.
Which situation accurately describes a recommended guideline when administering oral medications to clients? a) If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs. b) If a child refuses to take medication, the medication can be crushed and added to a small amount of food. c) If a client vomits immediately after receiving oral medications, re-administer the medication. d) Assume that the client is the authority on whether or not the medication was swallowed
If a child refuses to take medication, the medication can be crushed and added to a small amount of food. Explanation: Medication can be added to small amounts of food, but should not be added to liquids. If it is questionable whether the medication was swallowed, check the client's mouth and cheeks. If a pill is dropped, it should be discarded. If a client vomits, notify the physician to see if the medication should be re-administered
The Z-track technique is utilized during drug administration by which route? a) Subcutaneous b) Intramuscular c) Intravenous d) Intradermal
Intramuscular Explanation: The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort.
A nurse is preparing a prescribed dosage of an inhalant medication for a client with asthma. Which statement explains why inhalation is a good route for medication administration? a) It prevents unpleasant aftertastes associated with oral medications. b) It allows the lungs to quickly absorb the medication. c) It eliminates the potential of suffocation and asphyxia. d) It eliminates bad breath.
It allows the lungs to quickly absorb the medication. Explanation: The inhalant route is effective because the lungs provide an extensive area from which the circulatory system can quickly absorb the medication. The inhalant method distributes medication to distal areas of the airways, but some clients find that the inhaled drugs leave an unpleasant aftertaste. Inhalants carry some risk of suffocation and asphyxia. Inhalants may cause bad breath
A nurse is caring for a client with scabies. The client has been prescribed a drug that has a topical route of administration. What should the nurse tell the client regarding the administration of the drug? a) It has to be swallowed. b) It has to be applied on the skin. c) It has to be injected. d) It has to be inhaled.
It has to be applied on the skin. Explanation: The nurse should tell the client that the drug is to be administered by application on the skin because it has a topical route of administration.
A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler? a) It is a battery-operated device that spins. b) It is a canister that contains pressurized medication. c) It suspends finely powdered medication. d) It has propellers that get activated during inhalation.
It is a canister that contains pressurized medication. Explanation: A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.
placebo
Latin word meaning, "I shall please"; an inactive substance that gives satisfaction to the person using it
topical
Liniment, lotion, ointment, suppository, transdermal patch
A nurse preparing medication for a client is called away to an emergency. What should the nurse do? a) Put the medications back in the containers. b) Have another nurse finish preparing and administering the medications. c) Lock the medications in a cart and finish them upon return. d) Have another nurse guard the preparations.
Lock the medications in a cart and finish them upon return. Explanation: Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.
Medication medical record documentation (7)
Name of the medication Dosage Route and time of administration Nurse's initials Intentional or inadvertently omitted drugs Refused drugs Medication errors
The nurse is providing care to a client who has a Groshong catheter inserted. When irrigating the catheter, the nurse would use which solution? a) 5% dextrose b) Diluted heparin c) Normal saline d) Sterile water
Normal saline Explanation: Catheter patency is usually maintained by periodically flushing the catheter with diluted heparin. However, because of its unique design, the Groshong catheter requires irrigation with normal saline rather than heparin.
intentional omitted drug
Nurse decides to not administer medication (ex out of required range) and holds it
While reviewing the medical record of a newly admitted client, the nurse identifies that the client is considered a universal donor. Which blood type would this client most likely have? a) AB positive b) A negative c) O negative d) B positive
O negative Explanation: People with group O negative blood are often referred to as universal donors for packed cells because type O blood has neither A nor B antigens, and people with other blood types can safely receive it. Likewise, clients with AB positive blood are often referred to as universal recipients because the lack of antibodies enables transfusions from other blood groups to be accepted
The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, "I felt better after 2 days of the antibiotic the provider prescribed, so I quit taking it." What would the nurse do to address this situation?
Provide education on taking all antibiotics for effective treatment
Three Checks of Medication Administration
Read the label: When the nurse reaches for the container or unit dose package After retrieval from the drawer and compared with the CMAR, or compared with the CMAR immediately before pouring from a multidose container When replacing the container to the drawer or shelf, or before giving the unit dose medication to the patientz
A client has been prescribed nasal medication. What care should the nurse take to avoid potential complications due to the administration of this medication? a) Allow sufficient time to prepare the medication with minimal distraction. b) Administer medication within 30 to 60 minutes of the scheduled time. c) Read and compare labels on the medication with the medical record. d) Review the client's medication, allergy, and medical history.
Review the client's medication, allergy, and medical history. Explanation: To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history.
6 rights of medication administration
Right patient (2 identifiers) Right time Right medication Right dose Right route Right documentation
A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point would the nurse include in the education plan? a) Use the same site on the body for each injection. b) Reuse syringes and needles up to three times. c) Rotate the injection site. d) Store needles and syringes in a glass container.
Rotate the injection site. Explanation: Insulin may be administered subcutaneously in the upper arm, anterior or lateral aspects of the thigh, buttocks, or abdomen (avoiding a 2-inch radius around the umbilicus). Rotate the site for each injection systematically about 1 inch from the previous injection site. Rotation within one area is preferred to rotation to a new body area with each injection
The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client? a) Spacer b) Turbo-inhaler c) Nasal drops d) Metered-dose inhaler
Spacer Explanation: A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption because it prevents drug loss.
A client who has been receiving a secondary infusion of a new antibiotic for several minutes reporting itching and a sensation of throat tightness. What is the priority nursing intervention? a) Stop the infusion of antibiotic. b) Open the airway. c) Assess skin for rash. d) Activate the Rapid Response Team.
Stop the infusion of antibiotic. Explanation: The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life threatening reactions can also occur quickly. The first nursing action is to stop the infusion. The nurse will proceed to assure that there is an open airway, assess the skin for rash, and activate the Rapid Response Team if needed
A client is receiving a secondary infusion of a new antibiotic. After 5 minutes of administration, the client reports itching and appears flushed. What is the first nursing intervention? a) Slow the rate of infusion. b) Assess the characteristics of the itching. c) Contact the healthcare provider. d) Stop the infusion.
Stop the infusion. Explanation: The client may be experiencing a reaction to the antibiotic. Because intravenous administration occurs quickly, life threatening reactions can also occur quickly. The first nursing action is to stop the infusion. Slowing the rate is inappropriate, as this will not solve the problem if the client is having a reaction. Assessing the itching and contacting the healthcare provider can occur after the infusion is stopped
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
A nurse enters a client's 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 that fluid is infusing at a rate slower than intended. When assessing the client, which finding would the nurse identify as most likely contributing to the slowed rate of infusion? a) The fluid, although running slow, is infusing. b) The client is resting his arm with the IV on his head. c) The client is using his non-IV hand to push the IV pole when ambulating. d) The tubing is visible, running freely from the solution to the access site.
The client is resting his arm with the IV on his head. Explanation: When the extremity is elevated, such as the client resting his arm on his head, the fluid will infuse more slowly. Kinked or obstructed tubing (not visible and running freely), a patent catheter (such that the fluid is infusing), and the height of the solution container (such as when the client gets up and walks in the hall pushing the IV pole with the hand containing the IV) are factors that would contribute to a slowed rate.
Regarding medication administration, what must occur at the change of shifts? a) The narcotics for the division are counted. b) The medications for the division are counted. c) The client's medications must be drawn up. d) Only the LPNs on the division count medications.
The narcotics for the division are counted. Explanation: Health care facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).
The nurse is preparing to administer a transdermal medication. How should this be accomplished? a) The nurse should apply the medication directly to the skin. b) The nurse should inject the medication into a body cavity. c) The nurse should ask the client to swallow the medication. d) The nurse should inject the medication just below the dermis of the skin.
The nurse should apply the medication directly to the skin. Explanation: Transdermal medications are adsorbed through the skin.
Which statement best describes the nurse's rationale for selecting the ventrogluteal site when using the Z-track technique for administering an injection? a) The ventrogluteal site provides a location with the capacity for depositing and absorbing drug. b) The ventrogluteal site prevents tissue contact with the irritating drug. c) The ventrogluteal site reduces the transmission of microorganisms. d) The ventrogluteal site determines whether or not the needle is in a blood vessel.
The ventrogluteal site provides a location with the capacity for depositing and absorbing drug. Explanation: The ventrogluteal site is a large muscular injection site that provides a location with the capacity for depositing and absorbing 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, and not the usage of the ventrogluteal site
Which is not true regarding Nurse Practice Acts? a) They vary among states. b) They describe what dedications nurses can prescribe. c) They define the boundaries of the functions of a nurse. d) They were established to describe legitimate nursing function.
They describe what medications nurses can prescribe. Explanation: Prescribing and dispensing medications are not legal practices for registered nurses, with the exception of nurses in advance practice roles.
A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler? a) a canister containing medication that is released when the container is compressed b) a device that forces liquid drug through a narrow channel using pressurized air c) a device that forces medication through a narrow channel with the help of inert gas d) a propeller-driven device that spins and suspends a finely powdered medication
a canister containing medication that is released when the container is compressed Explanation: A metered-dose-inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas.
suppository
a cone-shaped, solid drug that is inserted into a body opening(usually rectally) ; it melts at body temperature
Reconstituting medication
a drug that was in powder form in vile and has been mixed with usually ns(normal saline), 5% dextrose or bsw(bacteriostatic water) so that it can be injected iv or im. Volume may change during process
ac/pc drug
ac: before meal pc: after meal
intramuscular injection
an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm
topical application
application of a substance directly to a body surface
PRN order
as needed -typically on med sheet on a separate area. -Always needs a follow up within a specific time frame oral: 30-60 min IV: 15-30 min
The nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not? a) waiting 10 seconds with the needle still in place and the skin held taut b) inserting the needle at a 90-degree angle c) aspirating for a blood return d) withdrawing the needle and immediately releasing the taut skin
aspirating for a blood return Explanation: Aspirating for a blood return is correct, as this will determine if the needle is in the blood vessel.
what dilutent do you use for multidose vials
bacteriostatic saline. A small amount of alcohol
stock supply
bulk quantity, central location, not client specific. Standing orders
stat order
carried out immediately
standing order
carried out until cancelled by another order (fever = Tylenol ____ dosage )
A client with a central venous catheter develops a catheter-related bloodstream infection (CRBSI). The nurse understands that which route is the most common for causing this type of infection? a) catheter tip contamination due to skin organisms encountered during insertion b) irregularities in the catheter's material c) contamination of the infusion solution being used d) an infection in another part of the body traveling to the catheter tip
catheter tip contamination due to skin organisms encountered during insertion Explanation: There are four recognized routes for catheter contamination. The most common route of infection is colonization of the catheter tip due to migration of skin organisms from insertion site. Direct contamination of the catheter or catheter hub is also a contributing factor
Which assessment should be conducted by the nurse before the nurse administers Tuberculin intradermal injection? a) cleaning the area with an alcohol swab b) preparing the syringe with the medication c) gathering all the equipment needed d) checking for documented allergies to food or drugs
checking for documented allergies to food or drugs Explanation: Checking for documented allergies to food or drugs is done to ensure safety, and is therefore correct. Preparing the syringe with the medication is incorrect because this is considered planning and not assessment. Cleaning the area with an alcohol swab is implementing and not assessing. Gathering all the equipment needed is also considered planning
synergistic effect
combined effect of two or more drugs is greater than the effect of each drug alone
A client at a health care facility has been prescribed scopolamine, to be administered transdermally. Which statement describes transdermal application? a) drugs within a thick base applied, not rubbed, into the skin b) drugs placed against the mucous membrane of the inner cheek c) drugs bonded to an adhesive and applied to the skin d) drugs placed under the tongue and allowed to dissolve slowly
drugs bonded to an adhesive and applied to the skin Explanation: Transdermal applications are drugs that are bonded to an adhesive and applied to the skin. After application, the drug migrates through the skin and eventually is absorbed into the bloodstream.
pharmacotherapeutics
dynamic that achieves the desired therapeutic effect of the drug without causing other undesirable effect
qhs
every night at bedtime
inadvertently omitted drug
ex Missed time frame, patient refused
vial
glass bottle with self-sealing stopper through which medication is removed; may be single or multiple dose
ampule
glass flask containing a single dose of medication for parenteral administration
peak level
highest plasma concentration of a drug
The nurse is providing discharge teaching for an older adult with arthritis who also has an implanted catheter. Which care does the nurse anticipate the client will need to provide catheter care? a) long-term care facility b) home care c) inpatient admission d) assisted living
home care Explanation: The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. The scenario presented does not indicate that the client needs long-term care, nor assisted living. An inpatient admission is not anticipated to be needed for the sole purpose of catheter care.
The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangements does the nurse anticipate in the discharge plan of care? a) home nursing visits b) assisted living arrangements c) long-term care facility admission d) continued inpatient admission
home nursing visits Explanation: The nurse anticipates the client will need home care to maintain and care for the implanted catheter, something that may be difficult to do with arthritis. Other answers are incorrect, as the client does not need assisted living, long-term care, or continued admission.
allergic effect
immune system response that occurs when the body interprets an administered drug as a foreign substance and forms antibodies against the drug
individual unit dose supply
individual patient has section of drawer divided by time of day. Blister pack. Has all prescription information printed on it.
subcutaneous injection
injection into the subcutaneous tissue that lies between the epidermis and the muscle
intravenous route
injection of a solution into the vein
intradermal injection
injection placed just below the epidermis
The nurse is preparing to administer a Tuberculin test. Which route will the nurse select to administer this injection? a) intradermal b) intramuscular c) subcutaneous d) intravenous
intradermal Explanation: The nurse will use the intradermal route, which is injecting the drug between the layers of the skin. The subcutaneous route is reserved for drugs to be injected beneath the skin, but above the muscle. The intramuscular route is reserved for drugs to be injected in the muscle. The intravenous route is reserved for drugs to be instilled into veins
The nurse administers medications by various routes of delivery. The nurse would use which route for a client that needs immediate effect of the medication? a) intravenous b) Ttransdermal c) rectal d) oral
intravenous Explanation: Medication administered through IV route has an immediate effect. The medication is infused directly into the blood stream and circulates through the body. The other routes are not immediate in action.
teratogenic
known to have potential to cause developmental defects in the embryo or fetus
computerized automated dispensing system ex) Pyxis, bar code enabled cart
med cart that scans the patients name band and medication and computer confirms accuracy
pharmacokinetics
movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion
distribution
movement of drugs by the circulatory system to the site of action
generic name
name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name
When administering heparin subcutaneously, the nurse should: a) vigorously massage the site. b) aspirate before the injection. c) never aspirate. d) aspirate after the injection.
never aspirate. Explanation: When administering heparin subcutaneously, never aspirate before administration.
can you use tap water for IM/IV solution
no, has to be sterile
single/ one time order
one time dose then discontinued. *document and discontinue
parenteral
outside of intestines or alimentary canal; popularly used to refer to injection routes
A nurse is taking care of a client who asks if she can have some acetaminophen to help with her headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours for pain. What type of order is this considered? a) STAT order b) Standing order c) p.r.n. order d) One-time order
p.r.n. order Explanation: A p.r.n. order is one that is given to a client on an "as needed" basis.
scored tablet
pills that can be split in half
pharmacodynamics
process by which drugs alter cell physiology and affect the body
A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which situation? a) when the client wants to avoid the discomfort of an intradermal injection b) when the drug needs to be administered only once c) when the drug needs to act on the client very slowly d) when the client has disorders that affect the absorption of medications
when the client has disorders that affect the absorption of medications Explanation: Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections. A single administration of a drug does not indicate the need for intravenous administration.
The nurse is providing discharge teaching about multiple medications to a client with mild dementia. Which nursing intervention is appropriate? (Select all that apply.) a) Teach family members about medication administration. b) Refrain from teaching client since information will not be retained. c) Tell client that taking medication is a personal responsibility. d) Recommend use of a medication dispenser. e) Obtain referral for skilled nursing visits at home
• Obtain referral for skilled nursing visits at home. • Teach family members about medication administration. • Recommend use of a medication dispenser. Explanation: Skilled nursing visits at home can be helpful in dispensing medications and assessing adherence. Family members can assist with this process, as well. A medication dispenser can help the client organize medications. Telling the client that taking medication is a personal responsibility is nontherapeutic and may invoke extra stress which leads to further confusion. The nurse should continue to include the client in teaching at this stage of dementia.
What would be considered a "right" of drug administration. (Select all that apply.) a) Right drug b) Right class c) Right dose d) Right documentation e) Right client
• Right drug • Right documentation • Right dose • Right client Explanation: Clients have the right to expect safe and appropriate drug administration. Nurses must observe each of these rights to ensure that the administration is done accurately.
Which gerontology considerations will the nurse recommend for older clients with low vision who may have difficulty filling their own insulin syringe? (Select all that apply.) a) referring the clients to sight centers b) introducing the insulin pen to the clients c) introducing the use of the loading gauge syringe to the clients d) introducing clients to safety injection devices with plastic shields e) introducing clients to safety injection devices with needles that retract into the syringe
• referring the clients to sight centers • introducing the insulin pen to the clients • introducing the use of the loading gauge syringe to the clients Explanation: The nurse should refer the clients to sight centers, as these centers are good sources for obtaining assistive devices to facilitate self-administration of insulin. The nurse should introduce the insulin pen to the clients because these pens have unique features that the client population may find beneficial. The nurse should introduce the use of the loading gauge syringe to the clients, as this will prevent filling a syringe with more than one prescribed dose. Devices with plastic shields and needles that retract are features of modified safety injections designed for healthcare workers to avoid needlesticks, and are therefore incorrect
The nurse is teaching a client about the proper use of transdermal patches. Which location will the nurse teach the client to apply the patch? (Select all that apply.) a) upper arms b) chest c) behind knee d) abdomen e) foot f) buttock
• upper arms • chest • abdomen • buttock Explanation: Transdermal patches are generally applied to the upper body (chest, abdomen, upper arms) and the buttocks. They are not applied behind the knee, nor to the feet.
