Week 3 - Lesson 1: Overview of IV Medication Administration

If the medication has a(n) ________, it must be available during administration. quickly slowly health care provider vital signs potentiate drug reference antidote stop

antidote

Match the patient situation with the expected method for IV medication administration. Left Column 1. Malnourished patient with potassium depletion 2. NPO patient with a saline lock requesting pain medication 3. Patient requiring IV antibiotics A. Large-volume infusion B. Injection of a bolus of medication C."Piggyback" infusion

1. A 2. B 3. C

Match the correct "right" of medication administration to the related nursing action. 1. Check the health care provider's order for morphine with the medication vial labeled "morphine sulfate." 2. Compare the order with the medication label of 2 mg per mL and calculate the dosage to be 0.5 mL. 3. Check the MAR against the patient identification bracelet and ask the patient to state his name and birthdate. 4. Review the order and prepare the medication and saline flush syringes. 5. Administer the medication slowly within the prescribed time frame. 6. Record the medication, dose, time, and route on the appropriate form. A. Right medication B. Right dose C. Right documentation D. Right time E. Right route F. Right patient

1. A 2. B 3. F 4. E 5. D 6. C

When preparing to administer an IV medication, a nurse checks the health care provider's order with the medication administration record (MAR) and the label on the medication vial. The nurse verifies the IV route for administration. Next the nurse computes the correct dosage and withdraws the medication according to the MAR using the appropriate dilution. The nurse administers the medication intravenously at the time ordered and at the correct rate. Which of the six rights of medication administration did the nurse fail to demonstrate? (Select all that apply.) A. Right patient. B. Right documentation. C. Right concentration. D. Right tubing. E. Right date of expiration.

A and B The nurse failed to identify the right patient by comparing the MAR to the patient's identification bracelet and asking the patient to state his or her name and birth date. Also the nurse is not described as recording the medication administration on completion of the procedure. Although the right concentration is excluded from the six rights of medication administration, the nurse did demonstrate the right dose by calculating the dosage and preparing it according to the medication order. Right tubing and right date of expiration also are not identified as among the six rights of medication administration. The nurse did verify the right drug by looking at the medication label on the vial and comparing it with the MAR. The nurse would also check the expiration date on the medication label at this time.

Identify nursing precautions to ensure safe patient care when administering IV medications. (Select all that apply.) A. Observing for symptoms of adverse reactions. B. Following the six rights of medication administration. C. Being knowledgeable of the desired action and side effects of the medication. D. Adding IV medications to IV bags that are already hanging. E. Assessing vital signs before, during, and after infusion with potent medications. F. Verifying the rate of administration with a drug reference or pharmacist. G. Informing assistive personnel how to assess for fluid overload and evaluate medication effectiveness. H. Having the antidote available, if the medication has one.

A, B, C, E, F and H The nurse takes special care to avoid errors in dose calculation and preparation because once the dose enters the bloodstream, it begins to act immediately and there is no way to stop its action. The nurse uses the six rights of medication administration to verify that the right dose of the right medication is given by the right route to the right patient at the right time and then documented accurately. The nurse verifies the prescribed rate of administration with a drug reference or pharmacist before giving any IV medication so that the medication is given over the appropriate amount of time. Patients may experience severe adverse reactions if IV medications are administered too quickly. The nurse is aware of the desired therapeutic effect and potential side effects for accurate observation and evaluation of the medication therapy. The nurse continuously observes the patient for symptoms of adverse reactions so that early intervention may be implemented. This includes having an antidote available if the medication has one. When administering potent medications, the nurse assesses vital signs before, during, and after administration to assess for any alteration in the patient's status. It is inappropriate to delegate nursing assessment and evaluation to assistive personnel. Only add medications to new IV fluid containers as ordered by the health care provider, and administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

The nurse should anticipate the IV route for administration of medication in which of the following situations? (Select all that apply.) A. Patient brought into emergency department from ambulance with acute chest pain B. Patient who is eating a regular diet and needs a prn order for a temperature of 100.4° F(37.8 °C) C. Patient who is NPO (nothing by mouth) but requires potassium chloride to correct hypokalemia D. Patient with methicillin-resistant Staphylococcus aureus (MRSA) who needs therapeutic level of antibiotics E. Patient with chronic hypertension who requires daily blood pressure medication

A, C and D A. The IV route would enable the most rapid medication response. C. A large-volume IV infusion would be expected to administer potassium when the patient is NPO. D. The patient who requires therapeutic drug levels to treat an infection would be expected to receive IV piggybacks of antibiotics.

A nurse takes precautions to prevent an undesirable outcome when administering medications by the IV route. Which of the following actions may produce an undesirable outcome? The nurse: A. Adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. B. Explores patient's cultural beliefs regarding use of alcohol, herbal remedies, and dietary preferences. C. Verifies prescribed dilution and rate of administration for medication. D. Administers solutions and medications prepared and dispensed from pharmacy when possible.

A. Adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. The nurse should never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions because the medications may cause the blood cells to clump or cause clotting. Cultural assessment yields information about dietary preferences, tobacco and alcohol use, and use of herbal remedies that affect drug action and response. Patients may experience severe adverse reactions if IV medications are administered too quickly. Verify the rate of administration with a drug reference or a pharmacist before giving any IV medication to ensure medication is given over the appropriate time in the appropriate concentration. For risk reduction, the nurse should administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

Identify advantages of administering medication by the IV route. (Select all that apply.) A. Less risk of an allergic response. B. Onset of therapeutic action is delayed. C. Delivers medication quickly in an emergency. D. Establishes therapeutic blood levels. E. Causes less discomfort with highly alkaline medications that are irritating to subcutaneous or intramuscular tissue. F. Requires less knowledge and skill.

C, D and E The advantages of administering medication by the IV route are that it provides a route for administering medication when the drug must be delivered quickly, it is the preferred route when it is necessary to establish constant therapeutic blood levels, and it causes less discomfort with highly alkaline and irritating medications than the subcutaneous or intramuscular route. After a medication enters the bloodstream, it begins to act immediately. If the patient is allergic to the medication, the reaction will be more prompt. Administering medications by the IV route requires more knowledge and skill to prevent negative outcomes.

After a medication enters the bloodstream, it begins to act immediately and it is impossible to ________ its action. quickly vital signs health care provider antidote drug reference slowly stop potentiate

Stop

Verify the rate of administration with a(n) ________ or a pharmacist before giving any IV medication. stop antidote vital signs health care provider slowly potentiate quickly drug reference

drug reference

Patients may experience severe adverse reactions if IV medications are administered too ________. stop antidote drug reference slowly quickly potentiate vital signs health care provider

quickly

When administering potent medications, the nurse assesses ________ before, during, and after infusion. stop quickly potentiate vital signs slowly health care provider antidote drug reference

vital signs