Pharm 1 - Exam 1

Oral Medication for Infants and Children

- A plastic disposable oral-dosing syringe is recommended for measuring small doses of liquid medications. Use of an oral-dosing syringe prevents the inadvertent parenteral administration of a drug once it is drawn up into the syringe. - Position the infant so that the head is slightly elevated to prevent aspiration *A crying infant can easily aspirate medication - Place the plastic dropper or syringe inside the infant's mouth, beside the tongue, and administer the liquid in small amounts while allowing the infant to swallow each time

How to prepare for drug administration

- Check the "six rights." Then check the "four more" - Standard precautions: perform hand hygiene! - Double check if unsure about anything! - Check for drug allergies. - Prepare drugs for one patient at a time. - Check the label three times! - Use the verified medication record. - Check expiration dates. - Check for compatibility. - Check patient's identification; two identifiers required. - Use bar code system. - Give medications on time. - Explain medications to the patient. - Open medications at the bedside. - Try not to touch the medications. - Document medications given before going to the next patient. - Follow policy if the patient refuses a drug. - Discard any medications that fall to the floor or become contaminated. - Stay with the patient while the patient takes the drug(s). - Do not leave the drug(s) in the patient's room to take at another time. - Assess and document the patient's response to the drug(s) administered.

Needle Insertion Angles for Intramuscular Injections

- For intramuscular (IM) injections, insert the needle at a 90-degree angle - IM- aqueous medications can be given with a 22- to 27-gauge needle, but oil-based or more viscous (thick) medications are given with an 18- to 25-gauge needle. Average needle lengths for children range from 5/8 to 1 inch, and needles for adults range from 1 to 1.5 inches - If more than 3 mL is needed for the ordered dose, then the medication will need to be given in two separate injections. However, if the patient is an older adult or is thin, a smaller maximum volume, such as 2 mL, is recommended.

Needle Insertion Angles for Subcutaneous Injections

- For subcutaneous (subcut) injections, insert the needle at either a 45- or 90-degree angle - drugs are absorbed more slowly than drugs given intramuscularly - Doses are usually 0.5 to 1 mL. In general, use a 25-gauge, 1/2-5/8-inch need - A 90-degree angle is used for an average-sized patient; a 45-degree angle may be used for thin, emaciated, and/or malnourished adults and for children. To ensure correct needle length, grasp the skinfold with thumb and forefinger, and choose a needle that is approximately half the length of the skinfold from top to bottom

Administering Rectal Drugs

- HH, gloves, standard precautions - Assess patient for active rectal bleeding or diarrhea, (usually contraindication) - Position patient on left side unless contraindicated (Sims' position) - Do not insert the suppository into stool. Gently palpate the rectal wall for the presence of feces. If possible, have the patient defecate. DO NOT palpate the patient's rectum if the patient has had rectal surgery - Remove the wrapping from the suppository, and lubricate the rounded tip with water-soluble gel - Insert the tip of the suppository into the rectum while having the patient take a deep breath and exhale through the mouth. With your gloved finger, quickly and gently insert the suppository into the rectum, alongside the rectal wall, at least 1 inch beyond the internal sphincter - Have the patient remain lying on his or her left side for 15 to 20 minutes to allow absorption of the medication - Age-related considerations: With children, it may be necessary to gently but firmly hold the buttocks in place for 5 to 10 minutes until the urge to expel the suppository has passed. Older adults with loss of sphincter control may not be able to retain the suppository - Document the medication given on the medication record, and monitor the patient for a therapeutic response as well as for adverse reactions

Removing Medications from Ampules

- HH, gloves, standard precautions - When removing medication from an ampule, use a sterile filter needle - Filter needles help to remove tiny glass particles that may result from the ampule breakage. DO NOT USE A FILTER NEEDLE FOR INJECTION INTO A PATIENT! Some facilities may also require the use of a filter needle to withdraw medications from a vial - Medication often rests in the top part of the ampule. Tap the top of the ampule lightly and quickly with your finger until all fluid moves to the bottom portion of the ampule - Place a small gauze pad or dry alcohol swab around the neck of the ampule to protect your hand. Snap the neck quickly and firmly, and break the ampule away from your body - to draw up the medication, either set the open ampule on a flat surface or hold the ampule upside down. Insert the filter needle (attached to a syringe) into the center of the ampule opening. Do not allow the needle tip or shaft to touch the rim of the ampule - Gently pull back on the plunger to draw up the medication. Keep the needle tip below the fluid within the vial - excess disposed in sink - Remove the filter needle, and replace with the appropriate needle for administration - Be sure to ensure the sterility of the injection needle throughout the process. Do not touch the open end of the needle hub, or the tip of the syringe, when attaching a needle to a syringe - Dispose of the glass ampule pieces and the used filter needle in the appropriate sharps container

Removing Medications from vials

- HH, gloves, standard precautions - single or muli-dose, for multi-dose: Mark vials with the date and time of opening and the discard date (per institutional policy). If you are unsure about the age of an opened vial of medication, discard it and obtain a new one - If the vial is unused, remove the cap from the top of the vial. - If the vial has been previously opened and used, wipe the top of the vial vigorously with an alcohol swab. - Air must first be injected into a vial before fluid can be withdrawn. The amount of air injected into a vial needs to equal the amount of fluid that needs to be withdrawn - Determine the volume of fluid to be withdrawn from the vial. Pull back on the syringe's plunger to draw an amount of air into the syringe that is equivalent to the volume of medication to be removed from the vial. Insert the syringe into the vial, preferably using a needleless system.Inject the air into the vial. - while holding onto the plunger, invert the vial and remove the desired amount of medication - Gently but firmly tap the syringe to remove air bubbles. Excess fluid, if present, must then be discarded into a sink - When an injection requires two medications from two different vials, begin by injecting air into the first vial (without touching the fluid in the first vial), and then inject air into the second vial. Immediately remove the desired dose from the second vial. Change needles (if possible), and then remove the exact prescribed dose of drug from the first vial. Take great care not to contaminate the drug in one vial with the drug from the other vial. Check with a pharmacist to make sure the two drugs are compatible for mixing in the same syringe - For injections, if a needle has been used to remove medication from a vial, always change the needle before administering the dose. - Ensure the sterility of the injection needle throughout the process. Do not touch the open end of the needle hub, or the tip of the syringe, when attaching a needle to a syringe.

Needle Insertion Angles for Intradermal Injections

- Intradermal (ID) injections are given into the outer layers of the dermis in very small amounts, usually 0.01 to 0.1 mL. These injections are used mostly for diagnostic purposes, such as testing for allergies or tuberculosis, and for local anesthesia - In general, choose a tuberculin or 1-mL syringe with a 25- or 27-gauge needle that is 3/8-5/8 inch long - The angle of injection is 5 to 15 degrees

Liquid Medications

- Liquid medications may come in a single-dose (unit-dose) package, may be poured into a medicine cup from a multidose bottle, or may be drawn up in an oral-dosing syringe - When pouring a liquid medication from a container, first shake the bottle gently to mix the contents if indicated. Remove the cap, and place it upside down on a paper towel on the counter. Hold the bottle with the label against the palm of your hand to keep any spilled medication from altering the label. Place the medicine cup at eye level, and fill to the proper level on the scale - Discard excess medication in the sink - For small volumes, use a calibrated oral syringe - Document medication administration and patient response -

Preparing Parenteral Drug Administration

- NEVER recap a needle - May recap an unused needle with the "scoop method" - Prevention of needlesticks - Filter needles

Oral Disintegrating medications

- Tablet or medicated strip form - Dissolve in the mouth without water within 60 seconds - Medications are placed on the tongue, not under the tongue, as in the sublingual route - Instruct the patient to allow the medication to dissolve on the tongue and not to chew or swallow the medication - Make sure the patient has not eaten or had anything to drink for 5 minutes before and after taking these medications - Orally disintegrating medications are often packed in foil blister packs. Do not open the package until just before giving the medication. Carefully open one dose at a time. These medications are fragile and may break if they are pushed through the blister pack. Once a blister or foil pack is opened, the tablet must either be taken or discarded; it cannot be stored for another time

Enteric- Administering Oral Medications

- assess for dysphagia (difficulty swallowing), some meds may be crushed and mixed in a small amount of soft food (be sure it can be crushed) - Position in sitting or lying on side to avoid aspiration - offer pt full glass of water - age considerations: young/older pts may not be able to consume entire glass of water, check interactions between mediations and fluid of choice - if pt request, nurse may place pill in pt mouth with gloved hand - remain with pt until all meds have been swallowed -document medication administration and pt response

Administering Drugs through a Nasogastric or Gastrostomy Tube

- start with standard precautions, gloves HH - Before giving drugs via these routes, position the patient in a semi-Fowler's or Fowler's position, and leave the head of the bed elevated for at least 30 minutes afterward to reduce the risk for aspiration - Assess whether fluid restriction or fluid overload is a concern. It will be necessary to give water along with the medications to flush the tubing - Check to see if it is recommended for the drug to be given on an empty or full stomach - If tablets must be given, crush the tablets individually into a fine powder. Administer the drugs separately and dilute in 15-30 ml of water - Remove the piston from an adaptable-tip syringe, and attach the syringe to the end of the tube. Unclamp the tube, and pinch the tubing to close it again. Add 30 mL of warm water, and release the pinched tubing. Allow the water to flow in by gravity to flush the tube, and then pinch the tubing closed again before all the water is gone to prevent excessive air from entering the stomach. If a stopcock valve device is present on the enteral tube, then open and close the stopcock instead of pinching the tubing to clamp it - our the diluted medication into the syringe and release the tubing to allow it to flow in by gravity (Figure 9-14). Flush between each drug with 10 mL of warm water. Be careful not to spill the medication mixture. Adjust fluid amounts if fluid restrictions are ordered, but sufficient fluid must be used to dilute the medications and to flush the tubing. - After the last drug dose, flush the tubing with 30 mL of warm water, and then clamp the tube. Resume the tube feeding when appropriate - Document the medications given on the medication record, the amount of fluid given on the patient's intake and output record, and the patient's response in the patient's record.

Sublingual and Buccal Medications

- sublingual tablets placed under the tongue - Buccal tablets placed between the upper or lower molar teeth and the cheek - These drug forms are not taken with fluids - Instruct the patient to allow the drug to dissolve completely before swallowing or drinking - When using the buccal route, alternate sides with each dose to reduce risk of oral mucosa irritation - Document the medication given on the medication record, and monitor the patient for a therapeutic response as well as for adverse reactions

While administering medications, the nurse finds a patient's eardrops in the medication refrigerator. If the nurse gives the eardrops immediately, what response might the patient have? A. No unusual response B. Immediate relief of ear discomfort C. A vestibular-type reaction D. Increased ear pain

-Correct answer: C -Rationale: Administration of cold eardrops may cause a vestibular type of reaction, resulting in vomiting and dizziness.

Gentle massage of the tragus area of the ear after administering eardrops results in A. decreased absorption of the medication. B. softening of the cerumen in the ear canal. C. increased coverage of the medication in the ear canal. D. reduced pain in the ear.

-Correct answer: C -Rationale: Gentle massage of the tragus area of the ear after instillation of eardrops helps to increase the coverage or distribution of the medication in the ear canal.

When teaching an adult patient about eardrops, which statement will the nurse include? A. "Hold your ear down and back to instill the drops." B. "If you feel dizzy after instilling the ear drops, stand up and walk around the room." C. "Warm the ear drops up for 30 seconds in the microwave before using them." D. "Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug."

-Correct answer: D -Rationale: The adult ear should be held up and back to instill eardrops. Warn the patient that dizziness may occur after application of the medication, requiring the patient to remain supine or sitting during instillation and for a few minutes thereafter. Advise the patient not to heat the medication; for example, a microwave oven must not be used for warming—because eardrops that are overheated may lose potency.

The primary mechanism of action of Timolol (Timoptic) in the treatment of intraocular pressure 1. increase the outflow of aqueous humor. 2. constrict the pupil. 3. dilate the pupil to increase outflow. 4. reduce production of aqueous humor.

1, 4. reduce production of aqueous humor. and increase the outflow of aqueous humor as well as decrease its formation

The client receives timolol (Timoptic) eyedrops for glaucoma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement? 1. "I will discuss use of over-the-counter (OTC) medications with my physician." 2. "I will store my drops in the refrigerator to keep them fresh." 3. "I will restrict my caffeine to one cup of coffee per day." 4. "I will discontinue the drops if my eye looks red."

1. "I will discuss use of over-the-counter (OTC) medications with my physician."

Which statements would the nurse interpret as indicating that the client understands the diagnosis of open-angle glaucoma? Select all that apply. 1. "My eye cannot drain the fluid that it produces." 2. "One of the first signs of this is pain behind my eyes." 3. "My type of glaucoma is a medical emergency." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

1. "My eye cannot drain the fluid that it produces." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

The client receives eyedrops as treatment for glaucoma. The client calls the clinic one day and tells the nurse that his eye color is changing. What is the best response by the nurse? 1. "This is an expected side effect of the medication." 2. "This is unusual; please come in for an evaluation." 3. "Are you sure that your eyes have changed color?" 4. "What do you mean that your eyes have changed color?"

1. "This is an expected side effect of the medication."

A client is prescribed a beta-adrenergic blocker for treatment of glaucoma. The nurse provides specific information on administration technique to avoid which adverse effects? Select all that apply. 1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure 4. Rash 5. Vomiting

1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure

Which of the following best describes open-angle glaucoma? 1. It is bilateral with a slow onset. 2. It is less common than closed-angle glaucoma. 3. It is accompanied by eye pain. 4. It is unilateral with a rapid onset.

1. It is bilateral with a slow onset.

The client wears contact lenses and has been prescribed eyedrops for glaucoma. What will the best education by the nurse include with regard to contact lenses? 1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes. 2. Instill the drops with the contacts in as long as they are the hard kind of contacts. 3. Eyeglasses must be worn for as long as the client must have the eyedrops. 4. Instill the drops with the contacts in as long as they are the soft kind of contacts.

1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes.

The client tells the nurse that when he uses his timolol (Timoptic) eyedrops, they sting his eyes. What is the best response by the nurse? 1. "Hold the next dose and contact your physician." 2. "This is a normal and expected effect of the drops." 3. "Your eyedrops may have expired; check the date." 4. "You should wash your eyes immediately with saline."

2. "This is a normal and expected effect of the drops."

A client presents to the emergency department with symptoms of closed-angle glaucoma. Intraocular pressure is measured at 30 mmHg. Which assessment findings would the nurse anticipate? Select all that apply. 1. Absence of eye pain 2. Headache 3. Bloodshot eyes 4. Vomiting 5. Bruising around the orbit

2. Headache 3. Bloodshot eyes 4. Vomiting

The client tells the nurse that he experiences frequent eye irritation even after using over-the-counter (OTC) medications. What is the best recommendation by the nurse? 1. Increase your fluid intake; you are probably dehydrated. 2. See your eye doctor for further evaluation. 3. This sounds like an allergic response; try an antihistamine. 4. Use normal saline rinses instead of over-the-counter (OTC) preparations

2. See your eye doctor for further evaluation.

A client has been diagnosed with closed-angle glaucoma. Which findings would the nurse interpret as indicating that the pharmacologic treatment regimen has been successful? Select all that apply. 1. The client reports being hungry. 2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot. 4. The client reports a sensation of drainage down the nose. 5. The client's cough has diminished.

2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot.

The client is to receive eyedrops for glaucoma. What is the correct method of administration? 1. Place the drop in the center of the eye. 2. Place the drop so it falls on the white part of the eye. 3. Place the drop in the conjunctival sac below the eye. 4. Turn the head to the side so that the drop flows to the outer corner.

3. Place the drop in the conjunctival sac below the eye.

The nurse has taught the client about open-angle glaucoma. The nurse evaluates learning has occurred when the client makes which statement? 1. "The eyedrops only need to be used when my eyes hurt." 2. "I will need to continually increase the dose of my eyedrops." 3. "I can stop the eyedrops when the glaucoma has resolved." 4. "I must use my eyedrops as prescribed for the rest of my life."

4. "I must use my eyedrops as prescribed for the rest of my life."

A client has had several measurements of intraocular pressure. Which measurements would the nurse interpret as indicating need for pharmacologic intervention? Select all that apply. 1. A single reading of 14 mmHg 2. A consistent reading trending between 15 and 16 mmHg. 3. A single reading of 19 mmHg. 4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

The client has glaucoma. Which assessment finding indicates to the nurse that a client's medical regimen could have contributed to onset of glaucoma? 1. Taking a beta blocker to treat hypertension 2. Occasional use of antihistamines for allergies 3. Taking glucocorticoids to treat arthritis 4. Regular use of an antidepressant drug

4. Regular use of an antidepressant drug

The nurse is counseling a client with glaucoma. The nurse explains that, if left untreated, the condition can lead to 1. myopia. 2. nearsightedness. 3. diabetes mellitus. 4. blindness.

4. blindness.

A patient is prescribed epinephrine eye drops for treatment of chronic open-angle glaucoma. The patient complains of burning with instillation of the drops. How would the nurse respond to the patient? A. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider." B. "That should not occur. Come to the office now." C. "This only occurs if the drop is not placed in the correct area of the eye." D. "This is normal and will continue as long as you use the drops."

A. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider."

The nurse prepares to administer daily medications to a female patient who takes furosemide (Lasix) for heart failure and uses brinzolamide (Azopt) ophthalmic drops for glaucoma. The nurse notes that the patient's serum potassium level is 3.0 mEq/L. What should the nurse do next? A. Assess the patient's cardiac rhythm B. Withhold the brinzolamide C. Withhold the furosemide D. Administer the medications

A. Assess the patient's cardiac rhythm Before administering or withholding the medications, the nurse should assess the patient for clinical indicators of hypokalemia, including the cardiac rhythm, because hypokalemia increases the risk of ventricular dysrhythmias. Once the assessment is complete, the nurse can determine if medication should be administered or withheld.

The nurse is educating a patient newly diagnosed with open-angle glaucoma on the adverse effects of the indirect-acting miotic eye drops prescribed. What will the nurse include in the teaching as possible adverse effects? (Select all that apply.) A. Blurred vision B. Farsightedness C. Stinging on instillation D. Decreased nighttime vision E. Paralysis of eyelids

A. Blurred vision C. Stinging on instillation D. Decreased nighttime vision

A patient with type 2 diabetes mellitus who takes metformin (Glucophage) daily has excessively high intraocular pressure (IOP). Which medication used in the treatment of increased IOP should the nurse avoid administering to this patient to prevent a serious adverse effect of therapy? A. Mannitol (Osmitrol) B. Betaxolol (Betoptic) C. Latanoprost (Xalatan) D. Brinzolamide (Azopt)

A. Mannitol (Osmitrol) The nurse avoids administering an osmotic diuretic such as mannitol to the patient taking metformin as a means of preventing metabolic acidosis because acidosis is an adverse effect of mannitol and metformin. Betaxolol is indicated in the treatment of chronic glaucoma. Lantanoprost is used in the treatment of open-angle glaucoma and ocular hypertension when other treatments have failed. Brinzolamide is a carbonic anhydrase inhibitor used in the treatment of open-angle and angle-closure glaucoma but not usually for the treatment of acute intraocular hypertension.

A patient requires dorzolamide (Trusopt) for glaucoma. What is the nurse's priority patient assessment before therapy is begun? A. Medication list B. Fine motor skills C. Eyelid condition D. Systemic illnesses

A. Medication list The nurse's priority is the compilation of a list of the patient's medications to help identify potential drug interactions and the potential for cross-sensitivity to sulfa drugs. The nurse will analyze the medication list for sulfa drugs and sulfonamides and diuretics because these medications have side-effect profiles similar to the hematologic, gastrointestinal, integumentary, and metabolic effects of carbonic anhydrase inhibitors. It is important to assess fine motor skills to determine whether the patient will be able to self-administer the dorzolamide. The condition of the eyelid is a reasonable nursing assessment before the start of any ophthalmic medication regimen. Listing of comorbid illnesses is an important means of identifying conditions that might affect therapy.

Which glaucoma ophthalmic drops reduce increased intraocular pressure without affecting pupil size? A. Timolol (Timoptic) B. Dipivefrin (Propine) C. Pilocarpine (Pilocar) D. Epinephryl (Epinal)

A. Timolol (Timoptic) Beta-adrenergic blockers such as timolol reduce increased intraocular pressure by slowing the formation of aqueous humor. Dipivefrin, pilocarpine, and epinephryl decrease intraocular pressure by means of mydriatic and miotic actions.

Before giving eardrops, the nurse check for potential contraindications to the use of otic preparations. Such as which of these conditions? A. eardrum perforation B. infection C. presence of cerumen D. mastoiditis

A. eardrum perforation

The nurse is preparing to administer carbamide peroxide (debrox) to an adult patient with impacted cerumen. Which actions by the nurse are correct? Select all that apply A. have the patient lie on his side with the affected ear up B. chill the medication before administering it C. pull the pinna of the ear down and back D. pull the pinna of the ear up and back E. gently irrigate the ear with warm water to remove the softened ear wax

A. have the patient lie on his side with the affected ear up D. pull the pinna of the ear up and back E. gently irrigate the ear with warm water to remove the softened ear wax

While teaching a patient about treatment for otitis media, the nurse should mention that untreated otitis media may lead to? A. mastoiditis B. throat infections C. fungal ear infections D. decreased cerumen producti

A. mastoiditis

A child has been diagnosed with bacterial otitis externa and will be receiving eardrops. Which of these eardrops are appropriate for this infection? (Select all that apply.) a. Floxin Otic b. Cortic c. Debrox d. Acetasol HC e. Cipro HC Otic

ANS: A, E Both Floxin Otic and Cipro HC Otic are antibacterial eardrops. Cipro HC also contains a corticosteroid. Both Cortic and Acetasol HC are antifungal products; Debrox (carbamide peroxide) is an earwax emulsifier used to loosen earwax for easier removal. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 922 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is preparing to give an earwax emulsifier to a patient and will assess the patient for which contraindication before administering the drops? a. Allergy to penicillin b. Drainage from the ear canal c. Partial deafness in the affected ear d. Excessive earwax in the outer ear canal

ANS: B Earwax emulsifiers are indicated for excessive earwax in the outer ear canal and are not to be used without prescription when ear drainage, tympanic membrane rupture, or significant pain or other irritation is present. Cerumen impaction may cause partial deafness in the affected ear. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 923 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is assessing a child with otitis media. Which statement about otitis media is correct? a. It is treated with over-the-counter medications. b. In children, it commonly follows a lower respiratory tract infection. c. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ears. d. Hearing deficits are associated only with inner ear infections, not with otitis media.

ANS: C Otitis media is rarely treated with over-the-counter medications and commonly follows an upper respiratory tract infection in children. Hearing deficits may occur if prompt therapy is not started. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ear. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 922 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When reviewing a patient's medical record, the nurse notes an order for carbamide peroxide eardrops. Based on this information, the nurse interprets that these eardrops are being used for which purpose? a. To reduce inflammation b. To reduce production of cerumen c. To loosen the cerumen for easier removal d. To inhibit growth of microorganisms in the external canal

ANS: C Wax emulsifiers such as carbamide peroxide work to loosen the cerumen for easier removal. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 923 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is teaching a patient about proper administration of eardrops. Which statements are correct? (Select all that apply.) a. Remove cerumen with a cotton-tipped swab before instilling the drops. b. Instill the drops while still cool from refrigeration. c. Warm the eardrops to room temperature before instillation. d. The adult patient should pull the pinna of the ear up and back. e. Insert a dry cotton ball firmly into the ear canal after instillation. f. Massage the earlobe after instillation.

ANS: C, D, E Remove cerumen before instillation by irrigation, not with cotton-tipped swabs. The drops must be at room temperature; cold drops may cause dizziness or other discomfort. Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. Massage the tragus area after instillation to encourage flow through the ear canal. A small cotton ball may be inserted gently into the ear canal to keep the drug in place, but do not force or jam it into the ear canal. Gentle massage to the tragus area of the ear (not the earlobe) may also help to increase coverage of the medication after it is given. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 924 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

The nurse is administering eardrops that contain a combination of an antibiotic and a corticosteroid. What is the rationale for combining these two drugs in eardrops? a. The combination works to help soften and eliminate cerumen. b. The corticosteroid reduces pain associated with ear infections. c. The drops help to eliminate fungal infections. d. The corticosteroid reduces the inflammation and itching associated with ear infections.

ANS: D Corticosteroids, such as hydrocortisone, are commonly used in combination with otic antibiotics to reduce the inflammation and itching associated with ear infections. Antibiotics do not eliminate fungal infections. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 922 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is teaching patients with glaucoma to self-administer their medications. Which patient teaching should the nurse provide? A. Apply an ointment under the upper eyelid. B. Allow eyedrops to fall on the conjunctival sac. C. Allow all excess medication to be absorbed slowly. D. Wipe the eyes with a warm compress after administering eyedrops.

B. Allow eyedrops to fall on the conjunctival sac. The nurse instructs the patients to allow the medication to fall on the conjunctival sac and not directly on the eye. Ointment is applied under the lower eyelid. Excess medication may be dabbed away with a tissue, provided the patient is careful not to allow the tissue to remove medication from the eye. The nurse avoids instructing patients to wipe the eyes with a warm compress because the heat may affect the absorption of the medication.

A patient's intraocular pressure (IOP) is dangerously high. Which patient assessment data should the nurse use as baseline data before administering treatment for the IOP? A. Gastrointestinal (GI) function B. Breath sounds C. Renal function D. Peripheral edema

B. Breath sounds An osmotic diuretic such as mannitol is indicated in the treatment of acute intraocular hypertension. The nurse assesses the patient's breath sounds before administering mannitol for the acute reduction of IOP because osmotic diuretics are contraindicated in pulmonary edema. Assessments of GI function, renal function, and peripheral edema are reasonable nursing assessments before the administration of an osmotic diuretic but do not reveal contraindications to therapy.

Which medication used as maintenance therapy in the treatment of glaucoma works by providing another exit route of aqueous humor besides the trabecular network? A. Isosorbide (Ismotic) B. Latanoprost (Xalatan) C. Dorzolamide (Trusopt) D. Levobetaxolol (Betagan)

B. Latanoprost (Xalatan) Lantanoprost is a prostaglandin agonist that relieves intraocular pressure (IOP) by increasing the outflow of aqueous humor between the uvea and the sclera in addition to the trabecular network. Isosorbide is an osmotic diuretic that reduces IOP by drawing water from the aqueous humor by means of osmotic pressure. Dorzolamide is a carbonic anhydrase inhibitor, and levobetaxolol is a beta-adrenergic blocker that reduces the formation of aqueous humor.

When applying opthalmic drugs, the nurse will follow which instructions. Select all that apply.... A. apply drops directly onto the cornea B. apply drops into the conjunctival sac C. apply pressure to the inner canthus for 1 minute after medication administration D. apply ointments in a thin layer E. avoid touching the eye with the tip of the medication dropper

B. apply drops into the conjunctival sac C. apply pressure to the inner canthus for 1 minute after medication administration D. apply ointments in a thin layer E. avoid touching the eye with the tip of the medication dropper

Direct-acting cholinergics are usually in a bottle that has a? A. purple lid B. green lid C. teal/clear lid D. orange lid

B. green lid

An older adult patient has a buildup of cerumen in his left ear. The nurse expects that this patient will receive which type of drug for this problem? A. antifungal B. wax emulsifier C. steroid D. local analgesic

B. wax emulsifier

Which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops? A. "I will put pressure on the inside corner of my eye after I administer the drops." B. "I will be careful not to touch my eye with the dropper." C. "I will rinse the eyedropper with tap water after each use." D. "I will turn my head slightly toward the outside of the eye I am putting the drops in."

C. "I will rinse the eyedropper with tap water after each use.

During an exam, the nurse notes that a patient has perforated tympanic membrane. There is an order for eardrops. Which action by the nurse is most appropriate? A. Give the medication as ordered B. Check the patient's hearing and then give the drops C. Hold the medication and check with the prescriber D. Administer the drops with a cotton wick

C. Hold the medication and check with the prescriber

A child has a case of otitis media, the nurse knows that otitis media in children is usually preceded by? A. participation on a swim team B. injury with a foreign object C. upper respiratory tract infection D. mastoiditis

C. upper respiratory tract infection

child born with increased intraocular pressure is likely to be diagnosed with which type of glaucoma? Congenital Pigmentary Open angle Angle closure

Congenital

A 2-year-old is seen in the pediatrician's office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child? amoxicillin Cortic carbamide peroxide (Debrox) Acetasol HC

Correct answer: A Amoxicillin is the first-line drug for most children with bacterial otitis media. Cortic is composed of hydrocortisone (a steroid), pramoxine (a local anesthetic), chloroxylenol (an antiseptic antifungal), propylene glycol diacetate (an emulsifying drug), and benzalkonium chloride (an antiseptic preservative), and is used for fungal infections of the ear. Carbamide peroxide (Debrox) is a commonly used earwax emulsifier. Acetasol HC is used to treat fungal infections of the ear.

A female patient who has glaucoma and has used dipivefrin (Propine) ophthalmic drops for 6 months tells the nurse that she is experiencing palpitations. Which action should the nurse implement? A. Checking for over-the-counter medication B. Telling the patient to visit her health care provider C. Asking the patient about excessive caffeine intake D. Assessing the patient for signs of cardiac stimulation

D. Assessing the patient for signs of cardiac stimulation With prolonged use or excessive dosing, a sympathomimetic agent such as dipivefrin can cause systemic effects, including extrasystoles, hypertension, and tachycardia; although this is uncommon, the nurse assesses the patient for clinical indicators of sympathetic stimulation.

The nurse wants to decrease the risk of secondary infections and complications associated with the use of antimicrobial eyedrops. What is the nurse's priority instruction during teaching of patients who are beginning to use the eyedrops? A. Tilt the head up and open the eye wide. B. Apply gentle pressure to the inner canthus. C. Retract the lower eyelid to instill the eyedrops. D. Avoid touching the medication container to the eye.

D. Avoid touching the medication container to the eye. The nurse stresses the importance of avoiding contact between the medication container and the infected tissue as a means of preventing both contamination of the medication and secondary infections. Tilting the head, applying gentle pressure, and retracting the lower eyelid are reasonable nursing instructions for a patient using eyedrops; however, these measures are unrelated to infection control.

The nurse is preparing to administer eardrops. Which technique for administration is correct? A. Warm the solution to 100 degree F before using B. Position the patient so that the unaffected ear is accessible C. massage the tragus before administering the drops D. Gently insert a cotton ball into the outer ear canal after the drops are given

D. Gently insert a cotton ball into the outer ear canal after the drops are given

The nurse is preparing to administer eardrops and finds that the bottle has been stored in the refrigerator. Which is the best action by the nurse? A. Remove the bottle from the fridge and administer the drops B. Heat the bottle for 5 seonds in the microwave before administering C. Let the bottle sit in a cup of hot water for 15 minutes before administering D. Remove the bottle from the fridge 1 hour before the drops are to be given

D. Remove the bottle from the fridge 1 hour before the drops are to be given

Which assessment does the nurse give priority before administering carbamide peroxide (Debrox) for the removal of cerumen? A. The patient's complaint B. The patient's hearing acuity C. The patient's ability to cooperate D. The presence of an intact tympanic membrane

D. The presence of an intact tympanic membrane The most important assessment before the administration of any medication in the ear is whether the tympanic membrane is intact; if it is not, medication could reach the inner ear. Complete understanding of the patient's complaint and assessment of the patient's ability to hear and ability to cooperate are reasonable nursing interventions before the administration of carbamide peroxide, but they are less important than protection of the inner ear.

A patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient regarding administration of which medication to correct this problem? A. hydrocortisone B. pramoxine C. acetic acid D. carbamide peroxide

D. carbamide peroxide

A patient with a severe middle ear infection will generally require treatment with which type of drug? A. topical steroids B. systemic steroids C. topical antibiotics D. systemic antibiotics

D. systemic antibiotics

Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? Miosis Mydriasis Cause the pupils to get larger Decrease in drainage of aqueous humor

Miosis

Which statement about use of corticosteroids for ocular inflammation does the nurse identify as being true? A. They are used during the acute phase of the injury process to prevent fibrosis and scarring, which result in visual impairment. B. Corticosteroids produce a lesser immunosuppressant effect than the NSAIDs. C. They are used for the treatment of minor abrasions and wounds of the eye. D. Use of corticosteroids for ocular inflammation results in discoloration of the iris.

a

After administering an ophthalmic anesthetic drug, which adverse effects does the nurse anticipate as possibly developing in the patient? (Select all that apply.) a. Stinging b. Burning c. Redness d. Lacrimation e. Blurred vision

a, b, c, d, e

A patient has undergone an eye procedure during which ophthalmic mydriatics and anesthetic drops were used. The nurse gives which instructions to the patient prior to discharge? (Select all that apply.) a "Do not rub or touch the numb eye." b "You may reinsert your contact lenses before you leave." c "Be sure to wear sunglasses when you go outside." d "Your pupils will appear very tiny until the medication wears off." e "Report any increase in eye pain or drainage to the ophthalmologist immediately."

a, c, e

The nurse is teaching the mother of a 1-year-old client how to instill ear drops for OE. What instructions on instillation does the nurse provide to the mother? a. "Hold the pinna down and back." b. "Put a cotton ball in to keep the medication in the ear." c. "Keep the ear drops in cold place so they work better." d. "Just put in as many drops as you can get into the ear."

a. "Hold the pinna down and back." When administering eardrops to adults, hold the pinna up and back. In children younger than 3 years of age, hold the pinna down and back. Allow a period of time for adequate coverage of the ear by the medication. Store eardrops, solutions, and ointments at room temperature before instillation. Administration of solutions that are too cold may cause a vestibular type of reaction with vomiting and dizziness.

The nurse is providing education to a client diagnosed with otitis externa (OE). Which statement by the client indicates an understanding of the OE treatment plan? a. "I will use the eardrops in the ear canal to treat this condition." b. "I will finish taking all of my antibiotic pills for my ear infection." c. "This is contagious, so I need to stay away from others for 24 hours." d. "The cold I had last week caused this to occur; it will go away on its own."

a. "I will use the eardrops in the ear canal to treat this condition." The treatment for OE is use of otic drops in the ear canal.

The nurse is educating the mother of an infant on how to instill eardrops for otitis media with a perforated eardrum. Which is an appropriate nursing outcome criterion for the mother? a. Demonstrates accurate medication administration technique b. Takes infant's oral temperature before administration of medication c. Uses a hot washcloth over affected ear to reduce ear pain and discomfort d. Instructs infant to remain supine for 5 minutes after instillation of ear drops

a. Demonstrates accurate medication administration technique The outcome criterion for this client is for the mother to demonstrate the appropriate administration of the medication to the infant.

The camp nurse reviews the "shopping list" of supplies needed for the upcoming camping season. What product is recommended to prevent and treat chronic impaction of cerumen? a. Hydrogen peroxide b. Rubbing alcohol c. Charcoal d. Salt solution

a. Hydrogen peroxide

The nurse is evaluating the effectiveness of the otic medication used for OE. What will the nurse evaluate to determine if the goal of therapy has been met? a. Improved hearing b. Redness around the ear c. Increased pain in the ear d. Discharge in the ear canal

a. Improved hearing The therapeutic effects of otic drugs, as with all drugs, are gauged by evaluating whether goals and objectives have been met. The therapeutic effects of otic drugs include less pain, redness, and swelling in the ear; a reduction in fever; and resolution of any other signs and symptoms associated with the ear disorder. Improvement in hearing may also be an anticipated therapeutic effect. The other options are indicative the therapy was not effective and further evaluation needs to be completed by the health care provider.

The nurse prepares a health teaching plan for the client with glaucoma. Which important nursing intervention are included for this client? (Select all that apply.) a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops. c. Include return demonstration only with geriatric clients. d. Wait 10 minutes to instill the second eye medication to be given at the same time.

a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops.

Sympathomimetic mydriatics have the potential to react with other drugs if sufficient topical absorption occurs. When given concurrently, drugs in which class may interact with the sympathomimetic mydriatics? a. Thyroid hormones b. Oral contraceptives c. Calcium channel blockers d. Nonsteroidal antiinflammatory drugs

a. Thyroid hormones With sufficient topical absorption, sympathomimetic mydriatics have the potential to react with other drugs. Cardiac dysrhythmias are potentiated when mydriatic drugs are given with halogenated anesthetics, cardiac glycosides, thyroid hormones, or tricyclic antidepressants.

During an ophthalmic procedure, the patient receives ophthalmic acetylcholine. The nurse is aware that which effect is the purpose of administering this drug? a. To produce mydriasis for ophthalmic examination b. To produce immediate miosis during ophthalmic surgery c. To cause cycloplegia to allow for measurement of intraocular pressure d. To provide topical anesthesia during ophthalmic surgery

b

When assessing a patient who is receiving a direct-acting cholinergic eyedrop as part of treatment for glaucoma, the nurse anticipates that the drug affects the pupil in which way? a It causes mydriasis, or pupil dilation. b It causes miosis, or pupil constriction. c It changes the color of the pupil. d It causes no change in pupil size.

b cholinergic will cause miosis, pupil constriction

During a teaching session about eardrops, the patient tells the nurse, "I know why an antibiotic is in this medicine, but why is hydrocortisone in these eardrops?" What is the nurse's best response? a. "The hydrocortisone will help to soften the cerumen." b. "The hydrocortisone reduces itching and inflammation." c. "The hydrocortisone also has antifungal effects." d. "This medication helps to anesthetize the area to decrease pain."

b. "The hydrocortisone reduces itching and inflammation.

A mother of a young child asks the nurse what over-the-counter (OTC) medication will remove earwax build up in her child's ears. What OTC medication should the nurse suggest? a. Ofloxacin (Floxin) b. Carbamide peroxide (Debrox) c. Ciprofloxacin and dexamethasone otic (Ciprodex) d. Chloroxylenol, hydrocortisone, and pramoxine (Aero Otic HC)

b. Carbamide peroxide (Debrox) Carbamide peroxide (Debrox) is a commonly used OTC earwax emulsifier. It is combined with other components (e.g., glycerin, a lubricant) that help soften and lubricate cerumen before irrigation. Carbamide peroxide slowly releases hydrogen peroxide and oxygen when exposed to moisture. The others are antifungals or antibacterial otic drugs.

When the nurse is providing teaching about eye medications for glaucoma, the nurse tells the patient that miotics help glaucoma by which mechanism of action? a. Decreasing intracranial pressure b. Decreasing intraocular pressure c. Increasing tear production d. Causing pupillary dilation

b. Decreasing intraocular pressure

The nurse evaluates the client using eyedrops. The client puts two drops into his eye. What is the nurse's best action? a. Continue to observe the client. b. Instruct the client that one drop is optimal. c. Have the client irrigate his eye to remove excess medication. d. Have the client close his eye and rub to assist in absorption.

b. Instruct the client that one drop is optimal.

When assessing a patient who is receiving a direct-acting cholinergic eyedrop as part of treatment for glaucoma, the nurse anticipates that the drug affects the pupil in which way? a. It causes mydriasis, or pupil dilation. b. It causes miosis, or pupil constriction. c. It changes the color of the pupil. d. It causes no change in pupil size.

b. It causes miosis, or pupil constriction.

The nurse is providing education to a client with a diagnosis of bilateral conjunctivitis (pink eye) who is prescribed sulfacetamide (Bleph-10). What information in the client history is MOST important and should be reported immediately to the health care provider? a. The client does not like eyedrops b. The client is allergic to sulfa drugs. c. The client has never had pink eye before. d. The client wears colored soft contact lenses.

b. The client is allergic to sulfa drugs. The other data are important for education and teaching; however, a client allergic to sulfa drugs should not be prescribed a sulfa drug for treatment. The health care provider would need to be alerted immediately.

When giving latanoprost (Xalatan) eyedrops, the nurse will advise the patient of which possible adverse effects? a. Temporary eye color changes, from light eye colors to brown b. Permanent eye color changes, from light eye colors to brown c. Photosensitivity d. Bradycardia and hypotension

b.) permanent eye color changes, from light eye colors to brown

A newborn infant is about to receive medication that prevents gonorrheal eye infection. The nurse will prepare to administer which drug? a. dexamethasone (Maxidex) ointment b. gentamicin (Genoptic) solution c. erythromycin ointment d. sulfacetamide (Cetamide) solution

c

A client is complaining of excessive earwax, leading to diminished hearing ability. The nurse will anticipate to teach the client about which medication to treat this condition? a. Pramoxine (Caladryl) b. Ofloxacin (Floxin Otic) c. Carbamide peroxide (Debrox) d. Hydrocortisone (A-Hydrocort)

c. Carbamide peroxide (Debrox) Carbamide peroxide works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection

The client is prescribed olopatadine (Patanol) for treatment of allergic conjunctivitis. The nurse knows the medication works though which action? a. Inhibits release of mast cells b. Lubricates the surface of the eye c. Competes at histamine receptor sites d. Stimulates the dilator muscle to contract

c. Competes at histamine receptor sites Patanol is an ocular antihistamine and works by competing at histamine receptor sites.

The nurse is educating a client who was administered atropine sulfate solution for an eye examination. The nurse includes which information in the education? a. Instruct that a common adverse effect is dry eyes. b. Instruct to wait 72 hours to wear contact lenses. c. Encourage use of sunglasses to decrease sunlight sensitivity. d. Advise that pupils may remain small for 12 hours after administration.

c. Encourage use of sunglasses to decrease sunlight sensitivity. The medication is a mydriatic and is used to dilate the pupils for eye exams. The client may have increased sunlight sensitivity and should wear sunglasses until the pupils return to normal size.

A client is diagnosed with a perforated tympanic membrane, OE, and otitis media. What does the nurse anticipate the health care provider will prescribe? a. Oral antibacterial only b. Otic antibacterials only c. Otic and oral antibacterials d. Otic antibacterial and otic antifungal

c. Otic and oral antibacterials The client will need a topical or local otic antibacterial for the OE and perforated tympanic membrane in addition to a systemic (oral) antibacterial to treat the otitis media.

The health care provider has prescribed ciprofloxacin-dexamethasone (Ciprodex) otic drops for a client with OE. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. What is the purpose of the steroid in this medication? a. Relieve pain b. Treat infection c. Reduce inflammation d. Decrease the amount of earwax

c. Reduce inflammation The purpose of a steroid included in otic drops is to assist in decreasing inflammation in the canal and the itching associated with the inflammation.

The nurse is preparing to administer ketorolac (Acular) eyedrops. The patient asks, "Why am I getting these eyedrops?" Which is the correct answer by the nurse? a "These drops will reduce the pressure inside your eye as part of treatment for glaucoma." b "These drops are for a bacterial eye infection." c "These drops will relieve your dry eyes." d "These drops work to reduce the inflammation in your eyes."

d

The ophthalmologist has given a patient a dose of ocular atropine drops before an eye examination. Which statement by the nurse accurately explains to the patient the reason for these drops? a "These drops will cause the surface of your eye to become numb so that the doctor can do the examination." b "These drops are used to check for any possible foreign bodies or corneal defects that may be in your eye." c "These drops will reduce your tear production for the eye examination." d "These drops will cause your pupils to dilate, which makes the eye examination easier."

d

The nurse administers pilocarpine (Pilocar) to a client with glaucoma. Which assessment finding would indicate a therapeutic effect of the medication? a. Client's eyes appear clear, without drainage. b. Client states that her eyes feel very dry. c. Client's pupils are dilated to 4 mm. d. Client's pupils are constricted to 2 mm.

d. Client's pupils are constricted to 2 mm.

At the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism? a. Candida albicans b. Malassezia furfur c. Aspergillus fumigatus d. Neisseria gonorrhoeae

d. Neisseria gonorrhoeae Erythromycin eye ointment is indicated for the treatment of neonatal conjunctivitis caused by Chlamydia trachomatis and for the prevention of eye infections in newborns that may be caused by N. gonorrhoeae or other susceptible organisms.

The nurse bases the plan of care regarding administration of eardrops on what knowledge? a. The pinna of an adult should be held down and back. b. Eardrops may be warmed in the microwave before administration. c. Proper administration includes holding the pinna up and out in an infant. d. Warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction.

d. Warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction. Eardrops that are administered too cold may cause vomiting and dizziness by stimulating a vestibular-type reaction. Neither should the eardrops be warmed in the microwave because too high a temperature can destroy the effectiveness of the medication. Room air temperature is sufficient. Eardrops in adults should be administered by holding the pinna up and out; in children younger than 3 years of age, the pinna is held down and back.

The ophthamologist tells the patient that she is going to place a dye onto the patient's eye to help identify the location of the foreign object. Which drug does the nurse anticipate the ophthamologist will use? A. olopatadine (Patanol) B. cromolyn sodium (Crolom) C. tetrahydrozoline D. fluorescein (AK-Fluor)

fluorescein (AK-Fluor) Rationale: Fluorescein (AK-Fluor) is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Olopatadine (Patanol) is an ocular antihistamine used to treat symptoms of allergic conjunctivitis (hay fever). Cromolyn sodium (Crolom) is an antiallergic drug that inhibits the release of inflammation-producing mediators from sensitized inflammatory cells called mast cells. Tetrahydrozoline is an ocular decongestant. It works by promoting vasoconstriction of blood vessels in and around the eye.

A 60-year-old man with a history of benign prostatic hypertrophy and hypertension is seen in the emergency department because he was trimming his shrubs and got something in his right eye. He complains of a pain rating of 8 on a scale of 1 to 10 in the right eye. Which medication does the nurse anticipate administering via eyedrop to help control the patient's pain? tetracaine atropine morphine lidocaine

tetracaine Rationale: Tetracaine is a local anesthetic of the ester type. It is applied as an eyedrop to numb the eye for various ophthalmic procedures. Tetracaine begins to work in about 25 seconds and lasts for about 15 to 20 minutes. Additional drops are applied as needed. It is currently available only in solution form.

Standard Precautions

• Wear clean gloves when exposed to or when there is potential exposure to blood, body fluids, secretions, excretions, and any items that may contain these substances. Always wash hands immediately when there is direct contact with these substances or any item contaminated with blood, body fluids, secretions, or excretions. Gloves must always be worn when giving injections and may be necessary during medication preparation. Be sure to assess the patient for latex allergy and use nonlatex gloves if indicated. • Perform hand hygiene after removing gloves and between patient contacts. According to the Centers for Disease Control and Prevention, the preferred method of hand decontamination is with an alcohol-based hand rub, but washing with an antimicrobial soap and water is an alternative to the alcohol rub. Use soap and water to wash hands when hands are visibly dirty. • Perform hand hygiene: • Before direct contact with patients • After contact with blood, body fluids, excretions, mucous membranes, wound dressings, or nonintact skin • After contact with a patient's skin (i.e., when taking a pulse or positioning a patient) • After removing gloves • Wear a mask, eye protective gear, and face shield during any procedure or patient care activity with the potential for splashing or spraying of blood, body fluids, secretions, or excretions. Use of a gown may also be indicated for these situations. • When administering medications, once the exposure or procedure is completed and exposure is no longer a danger, remove soiled protective garments or gear and perform hand hygiene. • Never remove, recap, cap, bend, or break any used needle or needle system. Be sure to discard any disposable syringes and needles in the appropriate puncture-resistant container.