NRN11

Timely medication administration

Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order.

Promote safe preparation of medication by

Allowing sufficient time to prepare the medication with minimal distraction

Biologicals for infants admin site

Biologicals for infants and young children are administered at the vastus lateralis.

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

Sites commonly used for intradermal injections are the inner surface of the forearm and the upper back, under the scapula.

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 minutes

It is particularly important for the nurse to use this technique when administering intramuscular (IM) medication to which client?

A 70-year-old demonstrating muscle wasting prescribed chlorpromazine The Z-track method is suggested for older adults who have decreased muscle mass

The nurse is preparing to apply nitroglycerin paste. After checking the order, washing hands, checking the client's identity, and applying gloves, which is the next nursing action?

removing prior application and any remaining residue from skin The nurse will then proceed to squeeze the paste onto the paper, spread the paste over the paper, apply the paper, and cover it with a transparent semipermeable dressing

Site for ID injection

scapula

bevel

slanted portion of the needle that provides access to the vein

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client?

supine

Polypharmacy is MOST accurately defined as:

the prescribing of multiple drugs to treat multiple conditions.

medication designed to produce systemic effect and absorbed through the skin

transdermal

sublingual medication placement

under the tongue

The nurse is preparing to withdraw liquid medication from an ampule for injection into an IV. What is the appropriate action for the nurse to take when withdrawing the medication?

use a filter needle to withdraw the medication

Continuous infusion

Continuous drips- instillation of parenteral drugs over several hours

Common injection site for IM

Deltoid

The nurse is instructing a client with xerostomia (dry mouth) about taking several pills and capsules that have been prescribed. What statement made by the client indicates to the nurse that the client understood the instructions?

"I will take a sip or two of water prior to taking my pills."

Which nursing action(s) promotes safety in the preparation of medication? Select all that apply. You Selected:

-Note the expiration dates on liquid medications. -Prepare medications in well-lit conditions. -Return medications with obscured labels to the pharmacy.

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?

1500 Peak levels are drawn shortly after the drug is administered. The best choice is 1500 because it closely follows the time of infusion, which is when the drug concentration would be highest.

The nurse is caring for a client who has normal saline infusing through a peripheral intravenous catheter with a prescription for a secondary infusion of antibiotic. Which technique would be most appropriate for the nurse to administer the secondary infusion by gravity?

placing the secondary infusion higher than the primary solution The nurse should place the secondary infusion higher than the primary infusion. This will allow the secondary infusion to infuse first. When completed, the primary infusion will continue to infuse. The other options are not correct.

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

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?

Intradermal injections are given at a 10- to 15-degree angle

right client

An important "right" of administering medications, the right client, means that the medication is given to the client for whom it is intended and the nurse must always use at least two of these separate identifiers when administering medications: client's name (first and last names), medical record number (MRN), or birth date.

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 health care provider has prescribed the use of transdermal patch. Which information should the nurse tell the client regarding application?

Apply the patch to a clean, dry, hairless location on the skin Transdermal applications are medications that are bonded to an adhesive and applied to the skin in a clean, dry and hairless location. Any previously applied patch should be removed and a new location should be chosen for the new application. The area should not be cleaned with alcohol prior to application as the medication may be altered if not completely dried through all the skin's layers.

The nurse is creating a professional development presentation about medication orders. Which teaching will the nurse include? Select all that apply.

Be extra cautious with look-alike and sound-alike drugs. The health care providers must sign all orders.

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Checking the expiration date on liquid medication can ensure the medication is at the desired potency, because liquid medications may become stronger or weaker with the passing of time.

A nurse is administering a hepatitis B shot intramuscularly. What would be the appropriate site for administration?

Deltoid

A client's EHR states that two medications are due at the same time, both of which are available in vials and are to be administered by injection. What is the nurse's most appropriate action?

Determine the compatibility of the two drugs by consulting clinical resources

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location.

The nurse is to start providing care for an older adult client who sees several different health care providers and specialists. Which question should the nurse prioritize on assessment?

Do you get all of your medications filled at the same pharmacy Polypharmacy is a concern in the older adult population. The nurse will want to know if medications are filled at the same pharmacy, as this is often where pharmacists will note discrepancies in medications prescribed or duplicate orders written by different providers. The other questions posed are not a priority or helpful.

In which order should the nurse instruct the client to follow when inserting vaginal medication?

Empty your bladder just before inserting the medication. Lubricate the applicator tip with water-soluble lubricant. Lie down, bend your knees, and spread your legs. Separate the labia and insert the applicator into the vagina, and insert the medication. Remain recumbent for at least 30 minutes. Wash and store the reusable applicator properly.

When administering a subcutaneous injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation? You Selected:

Engage safety shield on needle guard and discard needle appropriately. cannot be reinserted due to contamination

The charge nurse has just completed an in service with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?

Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes.

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

For a tuberculosis screening, the nurse should choose a 1 mL syringe with a ½-inch (1.25-cm), 26-gauge needle.

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 in any form should not take drugs or herbs for erectile dysfunction. -may cause severe hypotension due to the combined vasodilation effect.

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the client indicates teaching was effective?

I will call the health care provider if I develop dizziness, blurred vision, or nausea Digoxin is a cardiac glycoside that slows the heart rate and strengthens myocardial contraction. It is imperative to keep therapeutic blood levels of this medication. As such, teaching the client to report signs and symptoms of digitalis toxicity such as dizziness, blurred vision, nausea, and vomiting is imperative.

Which resource(s) does the nurse utilize to identify the right client when administering medications? Select all that apply.

Identification bracelet Verbal statement from the client verifying name and date of birth Electronic medication record with personal identifiers

Which situation accurately describes a recommended guideline when administering oral medications to clients?

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If unsure 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 health care provider to see if the medication should be readministered.

The nurse is preparing to administer a bolus of furosemide 0.8 mg to a client with congestive heart failure and kidney disease. Which right of drug administration would the nurse question and confirm in this client?

In this client who has kidney disease, furosemide is contraindicated. Therefore, confirming the correct medication would be crucial.

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse?

Insert a new IV medication lock and remove the old one. The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock.

An ER nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation?

Intravenous infusion is the fastest route of administration because the medication goes into the bloodstream immediately and is dispensed over a period of time which is needed in pulmonary hypertension

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order.

A nurse is caring for a client on IV therapy. The IV tubing has a volume-control set. Which of the following is a function of the volume-control set?

It is used to administer small volumes of IV medication A volume-control set is used to administer a small volume of IV medication at intermittent intervals to avoid accidentally overloading the circulatory system. A volume-control set is used to administer IV medication at intermittent intervals, not continuously.

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

Long-term use of nasal sprays can cause rebound nasal congestion

A nurse is caring for a client who has been prescribed codeine, an opioid medication to relieve severe postoperative pain. Which responsibility does the nurse have to complete when handling opioid medications? Select all that apply.

Maintain an accurate account of the use of the medication. Count each opioid medication at the change of each shift. Record each medication used from the stock supply.

The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action?

Notify the health care provider.

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

The nurse is teaching a client about insulin. What teaching will the nurse include? Select all that apply.

Rapid-acting insulin and short-acting insulin are often combined with intermediate-acting insulin. Humulin 50/50 contains equal amounts of intermediate-acting and short-acting insulin.

Sites for an ID injection

Sites commonly used for an intradermal injection are the inner surface of the forearm and the upper back, under the scapula.

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals?

Some medicines need to be taken "before food" or "on an empty stomach." This is because food and some drinks can affect the way these medicines work.

A nurse is administering enoxaparin sodium (anticoagulant) to a client with deep vein thrombosis, via the subcutaneous route. What is a recommended guideline when administering a subcutaneous injection?

Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis.

The nurse is caring for a client with visual impairment who has been prescribed two different types of eye drops. Which nursing intervention will best assist the client in differentiating between the bottles of drops?

The client with visual impairment will best benefit from a tactile difference between bottles; therefore, placing a rubber band snugly around one bottle is the best approach.

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?

The first nursing action is to stop the infusion.

Which component of a syringe's needle does the nurse recognize that refers to width?

The gauge of a needle refers to width.

The IM method

The intramuscular method is performed by pulling the skin taut between two fingers while injecting.

intramuscular injection

The intramuscular route is reserved for drugs to be injected in the muscle.

Intravenous route (IV)

The intravenous route is reserved for drugs to be instilled into veins

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

The larger the gauge, the smaller the needle. An obese person requires a longer needle to reach muscle tissue than does a thin person. When giving an injection, the viscosity of the medication directs the choice of needle gauge. The size of the syringe is directed by the amount of the medication to be given.

Which parts of the syringe and needle must be kept sterile when preparing and administering an injection? Select all that apply.

The needle hub Inside the barrel The needle

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration?

The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children). The nurse should never have the client swallow the pills if the client has an nasogastric tube.

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

The nurse should consult a current drug reference book for compatibility before administering two IV medications.

The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission?

The nurse should notify the health care provider and should refrain from administering the medication until the missing information is obtained.

Right time and Righ Route for meds

The nurse should read and compare the label on the medication with the medical record at least 3 times (before, during, and after preparing the medication) to ensure that the right medication is given at the right time by the right route.

The nurse is administering a client's scheduled intramuscular injection. What is the nurse's most appropriate action?

The nurse should support the ventrogluteal site with the nondominant hand and wear gloves during in an intramuscular injection. Gloves should be worn, and a 90-degree insertion is preferred.

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 The nurse's use of a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children.

The nurse is preparing to administer an intramuscular (IM) injection into a client. Which procedure should the nurse use to administer the injection?

The nurse should use the Z-track technique. It is generally used with medications that are irritating to the tissues, and it can be used routinely for all IM injections, provided that the overlying tissue at the chosen site can be displaced by at least 1 in (2.5 cm). The procedure includes pulling the skin and subcutaneous tissue 1 to 1.5 in (2.5 to 3.75 cm) to one side of the injection site while injecting.

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?

The nurse will place the date on the vial and retain it for future use since the vial is indicated for multiple uses.

The nurse is preparing to administer a tuberculin test. Which route will the nurse select to administer this injection?

The nurse will use the intradermal route, which is injecting the drug between the layers of the skin.

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

The opioids for the division are counted. Health care facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).

The primary reason for the Controlled Substances Act is:

The primary reason for the Controlled Substances Act is to prevent drug use and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug use laws.

The Sub Q method

The subcutaneous method of injection is performed while the skin is pinched up between two fingers.

Subcutaneous route of administration

The subcutaneous route is reserved for drugs to be injected beneath the skin but above the muscle.

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients?

The ventrogluteal or deltoid muscles may be the preferred intramuscular sites for older adult clients experiencing impaired mobility. This site has the potential of retaining greater muscle mass longer than other sites. It is also usually less painful for the client. The rectus femoris site is most suitable for infants. The upper chest muscle is part of intradermal injections, not intramuscular injections.

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 care should the nurse take to avoid potential complications due to the administration of this medication?

To avoid any potential complications, the nurse should review the client's medication, allergy, and medical history.

Rights

To ensure safe medication preparation and administration, the nurse should practice the rights of medication administration. Right client, right drug, right dose, and right route are rights of medication administration.

When instructing a client regarding sublingual application, the nurse should inform the client that which action is contraindicated when administering the drug?

When administering medication by sublingual application, the client should avoid swallowing or chewing the medication.

central venous catheter

a blood-vessel access device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium; used for long-term intravenous therapy or parenteral nutrition

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 canister containing medication that is released when the container is compressed

Common site for Sub Q injection

abdomen anterior aspect of the thigh

Half-life

amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

A nurse needs to administer a subcutaneous injection to a client. How far from the previous injection site to the area should the nurse administer the injection?

at least 1 inch (2.5 cm) Admin sites need to be rotated a finger's width apart to avoid tissue injury

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

bolus administration AKA IV push

Which client does the nurse recognize will require an intramuscular administration of the medication instead of an intravenous administration?

client who is low risk for hemorrhage and prescribed the Hepatitis B vaccinatio

nasogastric medication

considered oral

The nurse is preparing to administer a client's intramuscular injection and intends to use the technique shown. What potential benefit of this technique should the nurse describe? You Selected:

decreased irritation and pain in subcutaneous tissue This technique is Z-tracking. The Z-track technique allows the medication to be administered into the muscle tissue with no tracking of medication in the subcutaneous tissues as the needle is removed, resulting in less pain and irritation.

Depot formulations

drugs that are slowly released once administered, so they only need to be given every week or so, depending on the drug; some are formulated in oil site: ventrogluteal

The nurse is caring for a client who has been prescribed an enteric-coated drug. Which should the nurse include when teaching the client proper administration of this drug?

enteric-coated drugs should not be chewed, crushed, or cut because if the integrity of the coating is impaired, it dissolves prematurely in the gastric secretions and can irritate the lining of the stomach (be absorbed too quickly).

Peak level

highest plasma concentration

The ID method

intradermal, just below the epidermis, into the dermis itself (2nd layer) The intradermal method of injection is performed by placing the needle, bevel up just under the skin.

shaft

length of the needle

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

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.

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

ntradermal injections are given at a 10- to 15-degree angle.

lumen

opening of the needle

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

Which action describes buccal medication administration?

placing a medication underneath the upper lip or in the side of the mouth Buccal medication is not chewed, swallowed, or placed under the tongue