Other Medications Administration

Failure of drug reaching lower airways Incorrect dose of drug administered Failure to get 200 puffs from inhaler No drug administered Risk for serious side effects and/or drug tolerance Right Column

1. Pressing canister before taking breath. 2. Forgetting to shake the MDI 3.Failure to clean the valve 4.Failure to check if inhaler is releasing spray 5.Using inhaler excessively

he patient experiences the effects of the medication within ________, which validates that the proper administration technique has been used.

10-15 minutes

At what temperature should the solution be when eardrops are instilled? Body temperature. Correct Refrigerated. Very warm (105° F [40.6° C]). Any temperature (the ear tolerates temperature variances well).

a

The nurse is going to instill eardrops in a 7-year-old child. In which direction should the nurse pull the pinna of the ear? Up and back. Correct Down and back. Up and forward. Down and forward.

a

What position should the patient assume for insertion of a rectal suppository? Left Sims' position. Correct Dorsal recumbent. Left side-lying with head flat. Right side-lying with head flat.

a

The nurse is instructing the patient on how to insert a vaginal suppository. Which statement if made by the patient indicates further instruction is needed? (Select all that apply.) "I should warm the suppository to body temperature by putting it under warm running water while it is still in the wrapper." Correct "I should insert the rounded end of the suppository along the side wall of the vagina approximately 1 inch or 2.5 cm (approximately to the first knuckle of the index finger)." Correct "I should remain lying down on my back for at least 10 minutes after instillation." "I may have a small amount of discharge that is the color of the medication from my vagina." "I can wear a perineal pad after administration."

a, b The vaginal suppository should be inserted along the posterior wall of the vagina approximately 3 to 4 inches or 7.5 to 10 cm (the approximate length of the index finger).

Question 1: A patient has not had a bowel movement in 4 days and is complaining of a stomachache. The health care provider has ordered a rectal suppository to relieve the patient's constipation. Which of the following are appropriate expected outcomes for the patient? (Select all that apply.) The patient will have a bowel movement. You will instruct the patient on steps for proper suppository insertion. The patient is able to discuss the purpose and side effects of the medication. The patient reports relief of abdominal discomfort. The patient is able to self-administer the suppository correctly and/or describe the steps for proper suppository insertion.

a, c, d, e

Question 1: A patient states he feels short of breath and asks for his metered-dose inhaler. What should you assess before giving it to him? When the patient last had a dose. Why he feels short of breath. How many puffs the patient should take. When he last ate. If the patient is able to self-administer the MDI. Auscultate the patient's lung sounds.

a, c, e

Question 1: The patient has been instructed on use of his MDI. Which of the following statements indicates understanding? (Select all that apply.) "I should take a deep breath and exhale completely, and then with the inhaler properly positioned, I should inhale slowly and deeply for 3 to 5 seconds while I depress the canister fully." "When using both a bronchodilator and an inhaled steroid, I should use the steroid first, wait 2 to 5 minutes, and then use the bronchodilator." "I should hold my breath for approximately 10 seconds after inhaling so the medication reaches the deeper branches of my airways." "If I use a spacer device, I do not have to shake the inhaler prior to administration." "I don't have to take a deep breath and exhale completely before placing the mouthpiece in my mouth when I use a spacer device."

a, c, e

Question 1: Which of the following are appropriate evaluation measures to determine whether expected outcomes for instilling antibiotic eardrops have been met? (Select all that apply.) You ask the patient if burning and/or pain occurs upon instillation of the eardrops. You ask the patient about the purpose and possible side effects of the medication. You inspect the patient's ears for cerumen. You inspect the ear canal for redness and view the eardrum with an otoscope, noting a pearly gray tympanic membrane. You ask the patient to rate the ear pain according to a pain scale. You observe the patient during self-administration of the medication.

a, d, e

Question 1: A patient has been on extended antibiotic therapy and has developed a vaginal yeast infection. The patient verbalizes an understanding of how to administer the prescribed vaginal cream. What additional supplies may you provide to the patient? Lubricant (water soluble) Perineal pad Disposable gloves A bed protector (e.g., Chux)

b

Question 1: The nurse is observing the patient use his dry powder inhaler. Which of the following actions, if made by the patient, indicate further instruction is needed? The patient looks at the counter and pulls the lever down to load the medication. The patient shakes the DPI well for 2 to 5 seconds prior to use. The patient inhales deeply and quickly and holds breath for 10 seconds. After administration, the patient rinses the mouth with warm water and spits it out.

b

The patient has been taught how to self-administer his two different inhalers. Which statement made by the patient would indicate further teaching is necessary? "I should keep count of how many doses I have used." "I should wait one minute between using the two inhalers." "I should inhale slowly and deeply as I push down on the canister." "I should rinse my mouth out with water when I am finished.

b The patient should be instructed to wait 20 to 30 seconds between inhalations (when it is the same medication), and 2 to 5 minutes between inhalations if the medications are different (between inhalers).

How far should the nurse insert a rectal suppository in an adult? (Select all that apply.) Just past the external anal sphincter. Past the internal anal sphincter. Correct Approximately 10 cm (4 inches). Correct Approximately 7.5 cm (3 inches). Approximately 3.75 cm to 5 cm (1½ to 2 inches).

b, c

You have gathered equipment to administer medication with an MDI intended to produce a local effect of reducing inflammation. When would you expect the nurse to use the stethoscope? (Select all that apply.) Only if the patient experiences respiratory distress To auscultate the lungs after the treatment To assess the patient's blood pressure before use of the MDI To auscultate the lungs before use of the MDI When the medication will reach its peak effect

b, d

What is the purpose of massaging the tragus of the ear after eardrop instillation? It keeps the ear from tickling. It reduces the perception of pain. It helps move the medication inward. Correct It prevents escape of the medication when the patient sits or stands.

c

While inserting the rectal suppository, you note a large mass of stool in the rectum. What is the most appropriate action you should take? Remove the suppository and wait until the patient has a bowel movement. Insert the suppository into the mass of fecal material because this will help it to break up. Insert the suppository against the rectal wall and past the internal sphincter. Have the patient change positions to the right side to lessen the likelihood of the suppository and/or feces being expelled.

c

The nurse is going to insert a rectal suppository. The nurse provides privacy, performs hand hygiene, dons gloves, places the patient in the Sims' position, drapes the patient appropriately, and removes the suppository from its wrapper. The nurse tells the patient to take a few slow, deep breaths, and the nurse inserts the blunt end into the patient's rectum until it is unable to be seen. The nurse removes the gloves, performs hand hygiene, and assists the patient onto the back with the head elevated to the level of comfort. What steps, if any, are missing and/or did the nurse perform incorrectly? (Select all that apply.) The nurse performed the procedure correctly. The patient was placed in the Sims' position. The suppository was inserted without additional lubricant. Correct The blunt end of the suppository was inserted into the patient's rectum. Correct The suppository was inserted into the patient's rectum until it was unable to be visualized. Correct The patient was assisted onto the back with the head elevated. Correct

c, d, e, f,

You should wear sterile gloves when applying eye ointment and/or an intraocular disk to the eye.

false Clean disposable gloves are worn to prevent transfer of microorganisms and to follow the Centers for Disease Control and Prevention (CDC) recommendations for prevention of accidental exposure to body fluids.

The patient asks why the nurse applies the drops in the conjunctival sac. What is the nurse's best response to the patient's question? "The conjunctival sac can normally hold three drops of medication." "There is less chance of the medication getting into the lacrimal duct." "The cornea is less sensitive and therefore has a decreased ability to absorb medication." "Applying drops to the conjunctival sac provides even distribution of medication across the eye."

d

A patient is demonstrating the use of an MDI (without a spacer device). The patient removes the mouthpiece cover and shakes the inhaler. The patient takes a deep breath and exhales, places the mouthpiece of the inhaler in the mouth, and depresses the canister while inhaling. The patient holds the breath for approximately 10 seconds and exhales with canister in mouth. The patient shakes the canister again and repeats the procedure in approximately 10 seconds. The patient replaces the mouthpiece cover when finished administering puffs. What steps did the patient eliminate or require further teaching? (Select all that apply.) Shook the inhaler. Depressed the canister during inhalation. Held the breath for 10 seconds. Used the wrong method of exhalation after using the MDI. Correct Repeated the procedure in 10 seconds. Correct Replaced the mouthpiece cover when finished administering puffs. Correct

d, e, f

There is no need to coordinate puffs of a DPI with inhalation because it comes with an attached spacer. True False

false DPIs do not come with an attached spacer device. There is no need for a spacer with a DPI nor is there a need to coordinate puffs with inhalation.

Question 2: Inhaled medications are preferred for targeting respiratory problems because they produce a local effect only. True False

false Inhaled medications are designed to produce local effects. Because inhaled medications are absorbed rapidly, most also create systemic side effects.

MDIs are effective because once the medication is inhaled, the medication is able to remain in the lung as the alveolar-capillary network slowly absorbs the medication. True False

false The deeper passages of the respiratory tract provide a large surface area for drug absorption. The alveolar-capillary network absorbs medication rapidly.

Warm water and a washcloth are necessary to remove excess eye medication that can cause staining of the skin.

false Warm water and a washcloth are used to cleanse the eye before instillation of medication. A damp washcloth or cotton ball can be placed over the eye for a few minutes to soak any crusts that are dried. The eye is then wiped clean from the inner to the outer canthus. A tissue may be used to remove any excess eye medication.

Question 1: You are preparing to administer eye drops. A complete health care provider's medication order should include the patient's name, the name of the drug, the concentration, the number of drops, and the time of administration. True False

false You need to know which eye is to receive the medication or if both eyes are to receive the medication.

What additional instruction should you include for the patient who is receiving steroids via an MDI? The patient:

should rinse the mouth after use of the MDI.

A difficulty with using MDIs is coordination of expelling the dose from the inhaler when the patient inhales. True False

true

A spacer device allows the medication to float in with my breath rather than hitting the back of my throat."

true

A spacer is a hollow tube that improves the delivery of inhaled medications. It resolves the issue of coordinating the use of the MDI with the patient's breathing.

true

Applying gentle pressure to the nasolacrimal duct for 30 to 60 seconds prevents absorption into the systemic circulation.

true

Patients who have rectal bleeding should never receive a rectal suppository. True False

true

Rectal surgery, active rectal bleeding, and diarrhea are contraindications to administration of a rectal suppository. Another route should be considered, such as parenterally in this c

true

The patient should be instructed to insert the medication at bedtime to prevent expulsion of the medication."

true

The rectal suppository should be inserted rounded end first to prevent tissue trauma

true

Vaginal suppositories are oval shaped. Rectal suppositories are bullet shaped. True False

true

When should the patient depress the canister when using an MDI? The patient should depress the canister simultaneously with slow inhalation.

true