Medication Administration

A nurse is distributing the 0900 medications to the client. What should the nurse do when removing a tablet from a multi-dose bottle? Select all that apply.

Put an extra tablet back into the bottle from cap., Use gloves for extra protection., Take the multi-dose bottle into the client's room. Rationale: The nurse must refrain from touching the tablets. It is permitted to put an extra tablet back into the bottle if it was deposited into the cap first. It is permitted to take the multi-dose bottle into the room if the room is not isolation.

The client is prescribed digoxin 0.125 mg PO every day. The nurse obtains the medication from unit stock and discovers that digoxin only comes in a 0.25-mg tablet. How many tablets of digoxin should the nurse administer to the client?

0.5 tablet Rationale: Because the client only needs 0.125 mg of digoxin per day, the nurse would need to split the 0.25-tablet in half to obtain the correct dose; therefore, the nurse should administer 0.5 tablet to the client.

The nurse is preparing hydrochlorothiazide 50-mg tablet from unit stock. The health care provider orders 75 mg of hydrochlorothiazide PO for the client's hypertension. How many tablets of hydrochlorothiazide will the nurse administer to the client?

1.5 tablets

The nurse is administering medications to a client via a gastric tube. After administering the last dose of medication, how much water should the nurse flush through the gastric tube?

30 to 60 mL Rationale: When administering medications via a gastric tube, the nurse would flush the tube with 30 to 60 mL of water to maintain tube patency. A 5- to 10-mL water flush would be used between medications when the nurse is administering more than one medication at a time.

The nurse is in the client's room to administer the client's morning oral medications. Which action should the nurse take first?

Confirm the client's identity. Rationale: When administering medications to the client, first the nurse must confirm the client's identity to ensure that it is the "right client." Then the nurse would perform any assessments necessary for the medications being given

A nurse is preparing to administer oral medications to a client. While opening the unit dose package, the medication inadvertently falls on the floor. Which action by the nurse would be most appropriate?

Discard the current unit-dose package and obtain a new one. Rationale: If a medication falls on the floor, the nurse must discard it and obtain a new dose. Since the medication was in a unit dose-package, the nurse would easily be able to tell which medication had fallen. The client did not refuse the medication so it would be inappropriate to document it as such.

The nurse has just completed administering a nasal spray to a client. What should the nurse do next?

Evaluate client for medication effectiveness. Rationale :After administering a medication, in this case a nasal spray, the nurse should evaluate for effectiveness, therapeutic effect, or adverse reactions. Assessing for allergies and assessing the client's nose should be done before administering the nasal spray. The nurse would evaluate for level of discomfort after implementing an intervention to relieve discomfort or pain, which is not the purpose of a nasal spray

The client with a gastric tube is prescribed a delayed-release tablet. Which are appropriate actions for the nurse? Select all that apply.

Hold the medication., Call the health care provider for prescription., Check the drug guide. Rationale: If a medication has a delayed-release response, it cannot be crushed or split. The medication is intended to have a delayed response and crushing it would not produce this effect; it would have an immediate effect instead. Holding the medication and calling the health care provider for additional prescription are also appropriate actions, as well as checking the drug guide to verify if the medication can be crushed or split.

The instructor observes a nursing student who is preparing a liquid medication from a multi-dose bottle. Which action would concern the instructor if it were demonstrated by the student?

Holds the bottle of liquid medication with the label facing the medication cup. Rationale: When pouring liquid medications, the bottle should be held with the label facing the palm of the hand to prevent any liquid from dripping onto the label while pouring and thus making it difficult to read.

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

Insert the tip of the nose piece into one nostril., Sit up comfortably in the bed., Hold the breath for a few seconds after administering the spray. Rationale: The nurse will teach the client to sit up and tilt the head slightly back, not forward. The client will blow the nose before administering the spray to help clear the nasal passage ways. Then insert the tip of the nose piece into one nostril while closing off the other nostril. Next, the client will administer the spray and then hold the breath for a few seconds to allow the medication to remain in contact with the mucosa. The client should not blow the nose for 5 to 10 minutes after administration of a nose spray.

The nurse is preparing to administer a nasal spray. Place the nurse's actions in order, from first to last. Use all options.

1)Identify the client using two identifiers and verify any allergies. 2)Remove the tip of the spray from the client's nostril and release the compression. 3)Offer the client a tissue and ask the client to blow the nose. 4)Insert the tip of the nasal spray into one nostril and close the other nostril with a finger. 5)Compress the nasal spray while the client breathes in through the nose.

The client is to receive several medications via a gastric tube. How much water would the nurse flush the tube between the medications?

15-30mL Mostly 30

The nurse is preparing a liquid medication for a client. The health care provider prescribes cimetidine hydrochloride 600 mg PO for gastrointestinal bleeding. The pharmacy sends cimetidine hydrochloride 300 mg/5 mL. How many teaspoons should the nurse administer?

2 teaspoons Rationale: The nurse should administer 2 teaspoons of the cimetidine hydrochloride.

The nurse prepares the client's nightly medication doses and needs to administer an as needed dose of a hypnotic medication for sleep. The sleep medication is in a unit-dose package. What action does the nurse take?

Open the package after the client confirms the dose is wanted. Rationale:This medication requires additional assessment prior to administration. The nurse needs to ensure the client still wants the sleep medication prior to opening it. The nurse does not need vital signs or the client's pain score to administer the sleep medication. The nurse does not place the medication with the scheduled medications.

The nurse is distributing afternoon medications to the clients. When removing a tablet from a multi-dose bottle, what should the nurse do first?

Pour the tablet into the bottle cap. Rationale: The nurse should pour the tablet into the bottle cap and then into a medication cup for each client. The nurse should never let the tablet touch his or her fingers or bare hand. The nurse should drop the tablet into the bottle cap before putting it into a medication cup.

A nurse has administered a pain medication to the client. What should the nurse do next?

Reassess the client. Rationale:The most appropriate action after administering pain medication is to reassess the client for the right response. The client should not be left alone without access to the call bell and should be instructed not to get out of bed without help. All four side rails should not be up; this is a form of restraint.

The nurse is preparing to apply a new transdermal patch to a client's chest. What would the nurse do first?

Remove the old patch from the client's skin. Rationale: When applying a new transdermal patch, the nurse would first remove the old patch from the client's skin and then gently wash the area with soap and water to remove all traces of medication in that area. Then the nurse would remove the new patch from its protective covering, and initial and write the date and time on the label side of the new patch.

A nurse is measuring a liquid medication in a graduated liquid medication cup. The nurse determines the correct amount by reading:

the bottom of the meniscus. Rationale: When measuring the correct amount of liquid medication in a graduated liquid medication cup, the nurse would measure the liquid at eye level at the bottom of the meniscus to ensure an accurate dosage. Measuring at the top of the amount line, just below it or on both sides would be inaccurate.

The nurse is caring for a client who has a newly written prescription for "fluoxetine 20 mg by mouth daily for treatment of depression." The nurse is unfamiliar with this medication. Which action is most appropriate?

Consult a professional medication reference before preparing to administer the medication. Rationale:The nurse must not administer medications that are unfamiliar to him or her. The nurse should be able to review appropriate references, as opposed to consulting a colleague.

The nurse is preparing to administer medications to the client. The client sees the nurse double checking each medication and asks the nurse what is occurring. What is the nurse's best response?

"Checking the medication again to ensure the right medication is given to you." Rationale:The purpose of checking the medication is to ensure that the right medication is going to the right client. Three checks are completed during medication preparation and administration.

What instructions should the nurse give a client following the administration of prescribed eye drops? Select all that apply.

"Damage may occur if you touch the dropper to the eye.", "Do not rub the medicated eye(s).", " Wash your hands before and after you use the eye drops."

The nurse is administering eye drops to a client. Where should the nurse place the drops?

lower conjunctival sac Rationale: When administering eye drops, the nurse would place the eye drops into the lower conjunctival sac. After administration, the nurse would apply pressure to the inner canthus to prevent the eye drops from entering the tear duct.

The nurse is required to give a prescribed medication via a gastric tube. The medication is available in tablet form. What should the nurse do first?

Check the drug administration guide to see if the medication can be crushed. Rationale: When giving medications via a gastric tube, the medication should be in liquid form to prevent the tube from clogging. The nurse would first check the drug reference guide to see if the tablet can be crushed. If it can, the nurse would then crush the tablet and mix it with 15 to 30 mL of water or the recommended liquid.

The nurse is preparing to administer medications to a client with a gastric tube. What is the best way to determine which medications can be crushed?

Check the drug guide. Rationale: Certain solid dosage medications can be crushed and combined with liquid, but the nurse must check the drug guide first before administering to a client with a gastric tube

The nurse is preparing to administer medications to a client with a gastric tube. What equipment will the nurse gather to administer medications to the client? Select all that apply.

Gloves, Tap water, Waterproof pad, Irrigation set Rationale: To administer medications the equipment needed includes gloves, waterproof pad, irrigation set, and tap water. A pill cutter is not needed to administer medications to a client with a gastric tube.

What instruction will the nurse include when teaching a client how to administer nasal drops?

Hold the dropper just above the nostril to administer the drops. Rationale: The client should be instructed to hold the dropper about 1/3 of an inch (about 3/4 of a centimeter) just above the nostril to administer the drops. The dropper should not be placed inside the nostril to help prevent contamination of the dropper. The nurse should teach the client to get into an upright position and tilt the head backward to administer the drops.

After administering ear drops to a client, how does the nurse ensure the medication is delivered completely?

Place gentle pressure on the tragus after administration. Rationale:The nurse applies gentle pressure to the tragus after administering ear drops to move the medication from the canal toward the tympanic membrane. A cotton ball, if inserted, would also help prevent the medication from leaking out of the ear. Pulling the pinna up and back and position the client's head correctly is proper technique but does not assist the medication in getting to the eardrum

The nurse is preparing to split medication for client administration. What method should the nurse use to split the medication?

Place the pill in the pill splitter and close. Rationale: The nurse should wear gloves and place the medication in the pill splitter and close down on the score on the tablet to split in half.

The new nurse places a transdermal medication patch on a client. The preceptor stops the new nurse for which action?

Writes date on medication patch. Rationale: Dating the patch is ideally done on a separate piece of tape near the skin, not on the patch itself, because this action can interfere with medication delivery.

The nurse is preparing to administer a transdermal medication. Which placement is appropriate?

posteriorly on the shoulder Rationale: A transdermal patch should be applied to an area of skin that is clean, dry, intact, and free of hair. The shoulder is usually a good area for these reasons. A fatty area is best for transdermal medication absorption.

The nurse is teaching a parent how to administer ear drops to a 3-year-old client with an ear infection. What instructions should the nurse give the parent?

"Have the child lie down with the affected ear facing the ceiling while administering the drops and then wait for 5 minutes after the drops are in." Rationale: The flow of the drops is facilitated by gravity and will be retained more efficiently by staying in the side-lying position for 5 minutes and preventing the medication from leaking out of the ear canal. The pressure of falling drops may injure the tympanic membrane and should not be held close to the ear canal. The medication should not be kept refrigerated but be administered as close to body temperature as possible. The pinna should be pulled up and backward only for an adult client.

Which route of medication administration is most commonly prescribed?

Oral

the nurse is preparing to administer medications to a client with a gastric tube. What information should the nurse check before administering any medication through the gastric tube? Select all that apply.

whether tube feedings should be held, if medication should be given on a full or empty stomach, client's allergies Rationale: Before any medications should be administered the nurse should check for allergies, if the medication(s) should be administered on a full or empty stomach, and whether tube feeding should be held. Residual and placement of tube should be initiated immediately before administering medications.

The nurse teaches the client about home use of a transdermal medication patch for pain. The nurse evaluates the teaching as effective when the client makes which statement?

"I can't use my heating pad in the same area as the patch." Rationale: The client is correct that a heating pad or other heat source should not be used over the patch, because this may cause the medication to release too quickly into the system by speeding release and absorption rates

A nurse has just administered a medication to client via nasal spray. The nurse instructs the client to refrain from blowing the nose for a minimum of how long?

5 minutes Rationale: Once medication is administered via nasal spray, a client should be instructed to avoid blowing the nose for 5 to 10 minutes, depending on the medication. Doing so keeps the medication in contact with the mucous membranes of the nose.

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 Rationale: When ear drops are to be administered in both ears, the nurse would wait 5 minutes after giving the ear drops in the first ear before administering the ear drops into the second ear. This avoids causing the medication to run out immediately after administration. Other times are longer than are needed between ears.

The nurse is preparing to administer a transdermal medication. How should the nurse proceed?

Apply the medication directly to the skin. Rationale: Transdermal medications are absorbed through the skin, typically from a patch, not injected or taken orally. Therefore, they should be applied directly to the skin. Injecting the medication below the dermis, asking the client to swallow the medication, or injecting the medication into a body cavity are incorrect.

The nurse needs half of a tablet of medication and is preparing to split the tablet but there is no score. What should the nurse do? Select all that apply.

Call the health care provider., Refrain from splitting the tablet. Rationale: The nurse should refrain from splitting the tablet because only scored tablets can be cut in half so that the client gets the correct dose. The health care provider should be called to relay that the medication cannot be given as prescribed and request another prescription.

The nurse opens the multidose container of oxycodone. The nurse needs 1.5 tablets to deliver the as needed dose, and the tablets in the container are not scored. What action by the nurse is best?

Call the pharmacy to request a supply change. Rationale: the best action by the nurse is to request scored tablets or the correct dose from the pharmacy. If this is not possible, the nurse considers cutting the unscored tablet with the pill splitter, recognizing that this could result in an inaccurate dose.

The nurse is performing the third medication check for a medication administered from a multi-dose bottle. What should the nurse do?

Check the multi-dose bottle label after identifying the client and before administering the medication. Rationale: When performing the third medication check for a medication from a multi-dose bottle, the nurse should check the multi-dose bottle label after identifying the client and before administering the medication.

The nurse is to administer a medication to a client in isolation and the medication is in a multi-dose container. How will the nurse complete the third check of medication administration?

Check the multi-dose label before putting the container back in the drawer and label medicine cup with needed information. Rationale:The multi-dose container should not be taken into an isolation room. The label should be verified, and medication placed into a medicine cup. The cup should be labeled with client's name, date of birth, identification number, medication name, and dose.

The nurse has administered a client's medication. Which action would be most appropriate if the client vomits immediately, or soon after administration?

Check the vomit/emesis for pills or pill fragments and call the client's health care provider. Rationale: If the client vomits after medication is administered, the nurse should check the vomit/emesis for pills or pill fragments. Then, findings should be reported to the client's health care provider, and the mess should be cleaned up.

Prior to the nurse administering eye drops to the client, what should the nurse do?

Clean the eyelids of any loose eyelashes. Rationale: When administering eye drops, the nurse would clean the eyelids of any eyelashes so that they do not fall into the eye and cause discomfort for the client. The client should look up at the ceiling and focus on something. After the drops are given, the client should close the eyes gently and wipe away any excess fluid. The client should be instructed not to rub the eyes.

The nurse is splitting medications. After splitting the tablet and administering half to the client, what should the nurse do with the remaining half? Select all that apply.

Dispose of medication per hospital protocol., If the medication is a narcotic, waste with another nurse present. Rationale: Medications should already be split, if coming from the pharmacy. If the nurse uses unit stock and must split, the medication must be disposed of per hospital protocol. If the medication is a narcotic, the medication should be wasted in the presence of another nurse. Medications should not be wasted in the toilet or down a sink, sent back to pharmacy, or saved in the client's drawer.

The nurse is administering a client's medication and more tablets than needed fall into the bottle cap. What should the nurse do?

Drop extra tablets into bottle from bottle cap. Rationale: If more tablets than are needed fall into the bottle cap, the nurse should drop the extra tablets into the bottle from the bottle cap. The extra tablets should not be thrown away, dropped down the sink, or put into a specialty disposal unit.

The nurse cares for a client with a gastric tube in place. Which actions does the nurse perform? Select all that apply.

Give liquid stool softener and crushed pain medication through the tube as needed., Insert a large syringe to decompress the stomach when the client reports nausea., Administer one can of nutritional formula every 4 hours as prescribed.

After reviewing the skills for administering different medications, a student nurse demonstrates the need for additional review when she does takes which action?

Leaves before verifying that the client has swallowed the medication. Rationale: It is important to verify that the client has swallowed the medication before leaving the room and document it in the MAR. This ensures that the client has actually taken the medication so that accurate follow-up with the client can be performed.

The nurse enters the client's room to administer oral medications. Which action would the nurse take first?

Perform hand hygiene Rationale: When administering medications, the first step is to perform hand hygiene. The nurse then would confirm the client's identity and offer water or some other permitted fluids to take with the medications.

When pouring a liquid medication into a graduated liquid medication cup, which nursing action would be most appropriate?

Place the cup on a flat surface at eye level. Rationale: When pouring liquid medications, it is essential to place the cup on a flat surface at eye level and pour the liquid into the cup, reading the amount at the bottom of the meniscus. This ensures that the medication dosage is accurate. Pouring the liquid into a cup that is being held can lead to inaccurate dosages.

A nurse is preparing several oral medications for administration. One of the medications requires the nurse to obtain the client's apical pulse before administering it. Which action would be most appropriate?

Placing the medication requiring the assessment in a separate medication cup. Rationale: When preparing several oral medications, including one that requires an assessment before administration, the nurse would place the medication in a separate medication cup so that it is easily identified should the assessment reveal the need to withhold the drug.

The nurse is caring for a client with a gastrointestinal bleed who has a nasogastric (NG) tube. After administering the medications via the NG tube, what would the nurse do next?

Shut off nasogastric tube for 30 minutes Rationale: The nasogastric tube should be shut off for 30 minutes to enhance medication absorption and then reestablish decompression. The nasogastric tube should be reestablished to suction per the health care provider's prescription. The nasogastric tube should be flushed with 5 to 10 mL warm water after each medication, and 30 to 60 mL warm water after the last dose of medication.

The nurse splits a medication for client administration. What should the nurse do to assure safety and proper documentation? Select all that apply.

Take medication to bedside., Take medication package and label to bedside., Take computer to the bedside. Rationale: To assure safety and proper documentation of a medication administration, the medication, medication package and label, and computer should be taken to the client's bedside before administering medication.

The nurse is administering prescribed eye drops to a client. What action would cause the nurse to stop the administration?

The dropper touches the client's eyelid. Rationale: If the dropper touches the client's eyelid, the nurse should stop the administration because the dropper has become contaminated. If the client blinks while trying to instill the drops, the nurse should help the client relax and then try again, encouraging the client to focus upward. The drops are instilled into the lower conjunctival sac.

The nurse is preparing to administer ear drops to a 2-year-old client. The nurse would pull the pinna in which direction?

down and backward Rationale: The pinna should be pulled down and backward to straighten the ear canal of a child younger than age 3. The pinna should only be pulled up and backward to straighten the ear canal of an adult or child older than age 3. The pinna should not be pulled laterally toward the skull base nor outward, away from the nose.

The nurse is preparing to administer eye drops to a client. What purposes are commonly associated with instilling medications via eye drops? Select all that apply.

pupil constriction, infection treatment, control of intraocular pressure, pupil dilation Rationale: Eye drops are instilled for their local effects, such as for pupil dilation or constriction when examining the eye, for infection treatment, or for controlling intraocular pressure (for clients with glaucoma).

When administering medications to a client, what information should the nurse know about the medication? Select all that apply.

safe dose range, purpose, action, adverse effects Rationale: The nurse should know the following information about the medications being administered: its actions, special nursing considerations, safe dose ranges, allergies, purpose, and adverse effects. The nurse does not need to know the cost of the medication.

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according the health care provider's parameters. What does the nurse do with this scheduled unit-dose packaged antihypertensive medication?

set the antihypertensive dose aside pending assessment Rationale: Knowing that the previous dose was held, the nurse sets the antihypertensive aside until an assessment of current blood pressure is performed or verified. The nurse scans and administers all the regularly scheduled medications at one time, except for those requiring additional assessment

The nurse is preparing to administer ear drops to an adult client. In what direction would the nurse position the pinna?

up and back Rationale: When administering eardrops to an adult, the nurse would pull the pinna up and back to straighten the ear canal properly. Moving the pinna laterally toward the skull base, down and forward, or outward will not help position the pinna for accurate ear drop administration.

The nurse is administering medications to the client. What does the nurse explain to the client who asks about the checks of medication administration? Select all that apply.

"I check the label of any medication before administering it to you.", "I check the label before removing the medication from its container.", "I check the label when taking medication from the storage area." Rationale:The nurse should check the label when he or she selects the container or unit dose package; after he or she takes it from the storage area and compares it with the medication administration record; and right before administering the medication to the client. There is no need to check the label after the pharmacy delivers the medication if the nurse is not going to administer it at that time. Labels should be checked before administering to the client.

The client overhears the nurse reviewing the rights of medication administration and asks, "Why are you saying, 'right medication, right client, right route, right dose'?" What is the nurse's best response?

"I review these to make sure your medications are accurate and correct." Rationale:Medication errors can be prevented by carefully adhering to these rights, understanding the important concepts that apply to each right, and utilizing a nursing drug reference guide to provide accurate information for each medication administered

The nurse administers medication to a client. Which statement by the nurse is required to satisfy the three checks and rights of medication administration?

"Please tell me your name and date of birth." Rationale:The minimum number of times the nurse should check the medication label before administering the medication is three times: right medication, right client, right route, right dose.

The nurse is educating a preoperative client about gastric tubes. The client asks, "Why do I need to have a gastric tube?" How should the nurse respond?

"To help you consume sufficient nutrition." Rationale: The gastric tube is usually placed for the client who cannot swallow or those who have had oral surgery to supplement feeding and allow the client to consume sufficient nutrition.

The nurse is preparing to administer a sublingual medication. Which instruction to the client is correct?

"Try not to swallow while the pill dissolves." Rationale: Place medications intended for sublingual absorption under the client's tongue. Instruct the client to allow the medication to dissolve completely. Reinforce the importance of not swallowing the medication tablet, as sublingual medications are intended to be absorbed through the oral mucosa.

The nurse is educating a family of a client with a gastric tube about administering medications. What would be appropriate to include? Select all that apply.

All ground powder must be mixed with tap water. Delayed-response tablets cannot be ground. Tablets must be ground to a fine powder. Enteric-coated tablets cannot be ground. Rationale: Tablets must be ground into a fine powder and mixed with tap water. Enteric-coated and delayed-response tablets cannot be ground; if a medication has enteric coating or a delayed response, it was intended not to have an immediate response, so crushing the medication would not produce the delayed effect. Sterile water is not necessary when administering medications through the gastric tube.

The nurse is administering routine medications to a postsurgical client and the client asks, "Could I have something for pain?" The nurse checks the medication administration record (MAR) and notes that the medication is an opioid. What should the nurse do?

Place the opioid into a separate cup. Rationale: The medication should be given in separate cups so that an additional assessment can be performed. Orally administered medications should be dispensed into a medicine cup and ingested when administered, not when the client wants

The client tells the nurse that the medication in the cup is not the same as the medication he took the day before. The client is insistent that the medication is not the one prescribed. Which action by the nurse would be least appropriate?

Tell the client that he must take this medication because it is prescribed by the health care provider. Rationale: If a client voices concerns about a medication to be administered, the nurse would verify that the medication is indeed the one that the client is to receive. Telling the client that he or she must take the medication is inappropriate because it is threatening and coercive.

The nurse is teaching a client how to prepare and administer liquid medications. The client has been on other types of medications for several years. What common error would be most appropriate for the nurse to include in teaching this client?

The client can use any type of measuring device. Rationale: One common error with liquid medicines involves taking the wrong amount due to use of an inaccurate device such as a kitchen teaspoon. Using an oral syringe or other graduated measuring device is necessary to deliver an accurate dose.