(PrepU) Medication Administration: Concept Exemplars

The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period?

"This will help prevent you from getting sick." When providing teaching to a child it is important to be open and honest and provide developmentally appropriate information. Explaining that this will prevent later illness is something a child can understand. Saying that pain may result if movement occurs is a scare tactic and counterproductive. Using the word "immunization" employs terminology that is too complex for a child. Using the word "shot" is scary for the child and should be avoided if possible.

The nurse is teaching the parents of a school-aged child who is to receive medication therapy. What instructions should the nurse include?

"Tell your health care provider about all the medicines that your child is taking." Health care providers don't always know what a child is taking if multiple providers are involved or over-the-counter medications are administered, so parents need to keep a list of all medications given to a child including prescription, over-the-counter, and herbal medicines. Liquid medications should be measured with appropriate measuring devices such as a measured dosing device or spoon from a measuring set. A household teaspoon or tablespoon should not be used because the amounts are highly variable. The body organs and systems of children are very different from those of an adult. Most children require supervision in order to ensure safety. Parents should not be encouraged to take OTC medications without checking with the provider first.

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug?

15-degree angle A 15-degree angle is correct, as this allows the drug to be injected between the layers of the skin. A 45-degree angle is incorrect, as this will allow the drug to be injected beneath the skin but above the muscle. A 90-degree angle is incorrect, as this will allow the drug to be injected in the muscle. A 120-degree angle is incorrect, as this will be more suitable for intravenous injections.

A nurse is preparing to administer IV therapy to a client and selects a catheter with a large lumen. Which catheter would have the largest lumen?

18 gauge IV catheters are available in various sizes. The lumen size is measured in gauges; odd numbers designate winged infusion needles (19, 21, 23), whereas even numbers designate catheter sizes. The most common adult catheter sizes are 22, 20, and 18. As the numbers increase, the lumen size decreases; thus, a 22-gauge needle is smaller in diameter than an 18-gauge needle. Of the catheter gauges listed, 18 would be the largest.

A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client?

30 mL The formula to calculate the correct medication amount is: (Dose on hand/Quantity on hand = Dose desired/X). If you use this for this scenario, you would have 30 g/45 mL = 20 g/X, where X = 30 mL.

The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process?

Absorption Drug absorption (transfer of the drug from its point of entry in the body into the bloodstream) is influenced by the route of administration as well as by the concentration and acidity of the drug. Vomiting and diarrhea, frequent symptoms of childhood illnesses, interfere with absorption because a drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution refers to the movement of the drug through the bloodstream to a specific site of action. Metabolism involves conversion of the drug into an active form (biotransformation) or an inactive form (inactivation). Excretion is the elimination of raw drug or drug metabolites, a process that largely prevents properly administered drugs from becoming toxic.

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

Consult a current drug reference book for IV compatibility. The nurse should consult a current drug reference book for compatibility before administering two IV medications. Other answers are incorrect.

The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action?

Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. The nurse should always have the health care provider clarify the prescription. The nurse cannot assume that a medication is to be given at certain times, nor should another nurse verify the frequency or clarify the prescription. The nurse should remain on the phone with the provider and read back the entire prescription for verification. Documentation should reflect that it is a phone prescription. Usually the phone prescription has to be reviewed and cosigned by the provider within 24 hours.

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

Deltoid The deltoid is the best site for this medication. Biologicals for infants and young children are administered at the vastus lateralis. The ventrogluteal site is used for depot formulations and irritating medications. The scapula is a site for an intradermal injection.

A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?

Divide the dose. Administer 0.75 ml IM in each vastus lateralis. The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 ml. Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.

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

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. Medication can be added to small amounts of food, but should not be added to liquids. If unsure whether the medication was swallowed, check the client's mouth and cheeks. If a pill is dropped, it should be discarded. If a client vomits, notify the health care provider to see if the medication should be readministered.

A nurse preparing medication for a client is called away to an emergency. What should the nurse do?

Lock the medications in a cart and finish them upon return. Once medications have been prepared the nurse must either stay with the medications or lock them in an area such as the medication cart. The medications should never be left unattended or placed back in their containers. Another nurse cannot administer medications that have been prepared by the first nurse.

A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?

Place the pills in a bite of ice cream or applesauce. The most useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. This allows the medication to be administered in the original form. The nurse should not use candy for practice, because this may suggest to the child that medicine is the same as candy. The nurse should never crush medications which are enteric coated or time released. The nurse should always strive to administer a prescribed medication, even if doing so may be difficult.

The nurse is preparing to administer a tuberculin test to a client. Which instructions should the nurse provide to the client?

Return in 48 to 72 hours for results. The nurse must read the results of the tuberculin test on the client's arm in person. The client should be directed to return for results in 48 to 72 hours.

A code is called and Nurse A hands several drugs to Nurse B, stating while rushing off, "Give these to my client while I help with the code." What is Nurse B's appropriate response?

State, "I cannot give medications for other nurses." Nurses must never administer medications prepared by another nurse. Nurse B will professionally reply, "I cannot give medications for you." Nurse B should not hold the medications or ask another nurse to give the medications.

A nurse is administering medication to a client via a gastric tube and finds that the medicine enters the tube and then the tube becomes clogged. What is the appropriate intervention in this situation?

Use a syringe to plunge the tube to try to dislodge the medication. When medication becomes clogged in the tube, the nurse should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified. The nurse should not remove the tube nor wait for a prescribed amount of time to attempt to readminister the medication.

The nurse has drawn opioid pain medication into a syringe. When preparing to administer the medication, the client refuses, stating that pain is controlled currently at a level of 2 on a scale of 1 to 10. Which action should the nurse take to waste the medication?

Waste the medication with another nurse witness present. If a controlled substance is wasted, this waste must be witnessed by and documented by the wasting nurse and another nurse. The wasting of the medication cannot be witnessed by a client. Medication should never be stored by the nurse for use later.

While injecting a needle into a client for an intramuscular injection, the nurse hits the client's bone. What would be the appropriate initial response of the nurse to this situation?

Withdraw the needle, apply a new needle to syringe, and administer the injection in an alternate site. When the bone is hit during an intramuscular injection the nurse should withdraw and discard the needle. A new needle is then applied to the syringe and administered in an alternate site. Documentation of the incident in client's medical record is necessary and the primary care provider should be notified. Appropriate paperwork related to special events according to facility policy should be completed.

The nurse is scheduled to administer a tablet of medication to a client and the medication is available as a unit dose. Where would the nurse remove the wrappings of the unit dose?

at the client's bedside. The nurse should not remove the wrappings from the unit dose until the drug reaches the bedside of the client who is to receive it. Any other place is inappropriate because it could get misplaced or mixed with other medications accidentally.

A nurse has been assigned the task of preparing educational materials for clients with diabetes. The nurse has included the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or the health care provider. Which information is essential to include in the educational materials?

drug administration method In addition to all the drug details, the nurse needs to include the best method to self-administer a drug, the drug; food or drug; drug interactions, any dietary restrictions, and the time and duration of the treatment. The nurse is expected to possess core drug knowledge, but is not supposed to transfer the entire core drug knowledge to clients. Diagnosis and outcome identification is a method to identify and label interactions between core drug knowledge and core client variables; this exercise is generally done by nurses to help them identify adverse effects and their causes quickly and reliably. The vital signs of a client do not need to be included in the education materials. Client education materials essentially help a client to administer drugs safely.

During assessment, a nurse asks a client about any chronic conditions that might have an impact on the client's prescribed drug therapy. What issue, if reported by the client, would alert the nurse to a possible problem?

kidney disease diagnosed 2 years ago Chronic conditions, such as renal disease, heart disease, diabetes, or chronic lung disease, can affect the pharmacokinetics and pharmacodynamics of a drug and may be contraindications to the use of a drug. These conditions may also require cautious use or dosage adjustment when administering a certain drug. Pneumonia, nearsightedness, or an episode of gastroenteritis would not be as significant as a history of kidney disease.

A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step?

to clear medication and prevent clot formation The intravenous lock is flushed before and after the infusion is completed to clear the vein of any medication and to prevent clot formation in the needle.

The nurse is preparing a teaching plan for a client who will be discharged home with several new medications. When preparing the teaching session, what is the nurse's best action?

Determine the client's level of education. Gathering information about the client's level of understanding about his or her condition, illness, or drug therapy helps the nurse determine where the client is in terms of his or her status and the level of explanation that will be required. It also provides additional baseline information for developing a client education program. Medication inserts are too detailed for consumer use. The nurse should assess how much information to provide, but giving no information to the client is not an option. Medication administration would not be part of the preparation.