ATI definitions, terms, and practice questions for exam!
what is one minute after midnight in military time? (12:01 am)
0001
12:30 am military time?
0030
A nurse is preparing to administer sucralfate 1 g PO twice a daily to a client. Available is sucralfate 1,000 mg tablet. How many tablets should you give per dose?
1 tablet= 1,000mg 1,000 mg= 1 gram =1 tablet per dose
Six Rights of Medication Administration
1. Right medication-does it make sense? compare to MAR 3x times, make sure its not expired, don't give it if your unfamiliar 2. Right dose-compare to prescription, is this dose appropriate? Be ready to do conversions. Have another nurse check your calculations and double check your math. 3. Right patient- acceptable identifiers include pt name, faculty assigned ID number, telephone number, DOB, photo-barcode scanning 4. Right route- if route isn't there on prescription then contact physician for clarification 5. Right time-time critical meds need to be administered within 30 mins. Give meds prescribed after or before meals within 30 mins 6. Right documentation- right after you give med! also make sure you explain why you chose to held a med
steps in reconstituting a powdered drug?
1. cleanse tops of vials with antiseptic wipes 2. withdraw diluent 3. inject diluent 4. roll vial 5. aspirate medication dose
a nurse is preparing to administer ranitidine 50 mg by intermittent IV bolus every 6 hr. Availabe is ranitidine 50 mg in D5W 100 mL to infuse over 30 min. The nurse should set IV pump to deliver how many mL/hr?
100/30X60/1=200mL/hour
A nurse is preparing to administer ceftriaxone 2g by intermittent IV bolus every 24 hr. Available is is ceftriaxone injection 2g in dextrose 5% in water (D5W) 100mL to infuse over 30 min. The nurse should set the IV pump to deliver how many mL/hr?
100mL/30minX60min/1hr= 200mL/1hr
A nurse is preparing to administer clindamycin 900 mg by intermittent IV bolus over 45 min. Available is clindamycin 900 mg in 100 mL dextrose 5%. The nurse should set the IV pump to deliver how many mL/hr? round to whole number
100mL/45 minX60min/1hr= 133 mL/hour
micro?
10^-6
what is 12:58 pm in military time?
1258
A nurse is preparing to administer heparin 15,000 units subcutaneous every 12 hours. Available is heparin injection 20,000 units/mL. How many mL should the nurse administer per dose?
15,000 units X1ml/20,000 units=0 .75 mL
a nurse is preparing to administer heparin 15,000 units subq every 12 hr. availabe is 20,000 units/ml. How many ml should the nurse administer per dose?
15,000/20,000=.75
D5W calories
170
A nurse is preparing to administer codeine 30 mg PO every 4 hr for pain. The client received the medication at 1 p.m. The earliest the nurse should administer the next dose at which of the following times? 1400 1500 1600 1700
1700 1 after 4 hours = 5pm +12= 1700
How should you write 3/10 1. 0.3 2. .3
1= 0.3
A nurse is preparing to administer dextrose 5% in water 2L to infuse over 6 hr. The nurse should administer how many mL?
2,000 mL
seeing how pt. responded to medication, adverse effects?
evaluation
XL or XR
extended release
SOB, increased bp, HR, RR, crackles in lungs, neck vein distension, and crackles in extremities all indicate...? a. anaphylactic shock b. fluid overload
fluid overload
QID
four times a day
if i put a hypertonic solution IV (intravascular) where will fluid go?
from the interstitial and intracellular spaces and into the veins
h
hour
explaining the purpose of a medication is what part of the nursing process?
implementation
phlebitis
inflammation of a vein
LA
long acting
should you use a trailing zero?
no
should you add 12 to 12:00 pm?
nope!
SA
sustained action
TD
timed-delay
TR
timed-release
BID
twice a day
IU
unit
standard way to measure insulin
units
what is an intermittent IV bolus?
used to administer small amounts of med, 50 to 250 mL -piggyback infusion= bag is higher than primary bag
how often should you do medication reconciliation?
whenever a client transitions from one level of care or inpatient to another= new admissions to facility, moving to a different level of care within a facility, transferring to another facility, and discharge
what is medication reconciliation?
where you are supposed to compare the meds they should be on (and actually using) to new meds that are ordered to resolve any discrepancies
PRN
as needed
what should you do immediately after adverse effects, or med error?
assess client, contact provider, fill out incident report
If a client has recieved a double dose what is the first thing the nurse should do?
assess the client for adverse effects!
HS
at bedtime
AC
before meals
ac?
before meals
PO
by mouth
CD
controlled dose
millimeter to centimeter
divide by 10
Microgram to milligram conversion
divide by 1000
ml in tbsp
divide by 15
mL to tsp?
divide by 5
a nurse is preparing to administer daptomycin 360 mg IV bolus. The nurse reconstitutes a vial of daptomycin to yield a final concentration of .5g/10mL. How many mL should the nurse administer?
doesn't matter if you convert 350 mg to g or if you convert .5g into mg they still both equal 7.2 .360X10/.5=7.2
gtt
drop
a nurse has reconstituted a powdered medication. Which of the following information should the nurse include on the written label?
-Date of preparation -Medication concentration -Time diluent -Expiration date and time
Planning - Med Administration
-calculate and measure doses precisely -identify goals for client needs (insulin= client teaching, monitoring glucose, etc) -verify calculation for high alert
how can you ensure you have the right dose?
-check the dose you prepare against the prescription -review medication reference to ensure its the appropriate dose for the client -clarify any doubts with the provider= is the dose beyond usual range? should it be lower due to pt kidney problems?
what are appropriate identifiers?
-client's name -facility assigned ID number -telephone number -birth date -another person specific identifier (photo)
A nurse is preparing to administer levothyroxine 0.25mg IV bolus stat. Available is levothyroxine 100mcg/mL. How many mL should the nurse administer
-convert 100mcg to mg= 100mcg/1,000=.1 mg .25mgX1ml/.1mg=2.5 mL
Ways to prevent phlebitis?
-correct IV size for vein -secure IV tubing -use aseptic technique -cover IV site with clear dressing= sterile -change dressing if its wet or dislodged
things to do in assesment in medication administration?
-current status -history -vital signs= withold if not within range for med -monitor lab results -check allergies -verify prescription
what should a prescription by a provider include?
-date and time of prescription -dosage of medication- amount, times or frequency of medication, and strength -route of administration -generic name of med -provider's signature -client's full name -dispensing instructions (eat with food, etc)
what are some advantages of IV therapy?
-immediate effect -precise amounts of med, large volumes of fluid -can administer meds that would be irritating to tissue -prevent discomfort of subq or intramuscular
Why is the prescription "Acetaminophen 325 mg every 6 hr PRN for headache" an incomplete prescription?
-it doesn't have the route even though it has the name, frequency, dosage
what are some ways you can check if you have the right medication?
-read prescription carefully and ask yourself if it makes sense for client to recieve this based on client's condition and diagnosis -compare prescription with MAR 3 times before obtaining the medication -look at expiration date -if you're unfamiliar with the med, consult pharm
fluid overload interventions?
-slow rate of infusion -raise head of bed -administer oxygen
what are some questions you should ask before you administer a medication?
-what medications is the client currently taking? -do any of these interact with the medication you are preparing? -does the client have any allergies? -what physical assessments are needed before you can safely administer the medication?
A nurse is preparing to administer digoxin .125 mg IV bolus stat. Available is digoxin injection .25mg/mL. How many mL should the nurse administer?
.125mgX1ml/.25mg=0.5 mL
A nurse is preparing to administer cephalexin .25g PO every 6 hr. Available is cephalixin 500mg tablets. How many tablets should the nurse administer per dose?
.25mgX1,000=250 -we want only to give 250 mg which is half of 500mg= .5 tablet
.5mg to mcg?
.5 X 1,000= 500 mcg
A nurse is preparing to administer furosemide 40 mg PO in .5 oz of orange juice. How many mL of orange juice should the nurse administer?
.5X30=15mL
what type of solution should you use for blood transfusions?
.9% NaCl
tuberculin and insulin syringes hold how much fluid?
0.3 to 1 mL of fluid -calibrated in 100ths of a milliliter
A nurse is preparing to administer levothyroxine 200 mcg IV bolus. The nurse reconstitutes a vial of levothryoxine to yield a final concentration of 100mcg/mL. How many mL should the nurse administer?
200mcg/100mcg=2 .02mg/.01mg=2 -conversion doesn't really matter because its in the same unit
1 cup is equal to how many mL?
240 mL
what is midnight in military time?
2400 or 0000
use a 5 mL syringe when the dose is greater than....?
3 mL
time critical meds should be given within...?
30 minutes
A nurse is preparing to administer furosemide 30 mg IV bolus stat. Available is furomeside injection 10mg/mL. How many mL should the nurse administer?
30mgX1mL/10mg=3mL
A nurse is preparing to administer nafcillin 375 mg IM to a school age child. Available is nafcillin powder for injection 2g vial. The nurse reconstitutes the powder to yield a final concentration of 250mg/mL. How many mL should the nurse administer.
375mgX1mL/250mg=1.5mL
A nurse is preparing to administer diazepam 3mg IV bolus every 3 hr PRN anxiety. Available is diazepam injection 5mg/ml. How many mL should the nurse administer?
3mgX1mL/5mg=0.6mL
a nurse is preparing to administer nystatin 400,000 units PO. Availabe is nystatin powder 500,000 units/0.125 tsp. The nurse reconstitutes a container of nystatin to yield a final concentration of 500,000 untils/120mL. How many mL should the nurse administer.
400,000 unitsX120mL/500,000 units=96mL
a provider prescribes filgrastim 5 mcg/kg/day subq for 14 days for a client who weighs 127 lb. Availabe is filgrastim 480 mcg/.8mL. How many mL should the nurse administer?
5 mcg X 57.7kgX.8mL/480mcg=.5 mL
a nurse is preparing to administer ampicillin 50mg/kg/day PO divided equally every 8 hrs to a child who weighs 39.6 lbs. Available is oral suspension 250 mg/5mL. How many mL should nurse administer per dose?
50 mgX18 kg/24 hrsX8hrsX5mL/250mg= 6 mL
a nurse is preparing to administer cefazolin 500 mg IV bolus. The nurse reconstitutes a vial of cefazolin to yield a final concentration of 100mg/1ml. How many mL should the nurse administer?
500mgX1mL/100mg= 5mL
A nurse is preparing to administer ranitidine 50 mg IV intermittent IV bolus every 6 hr. Availabe is is ranitidine 50 mg in D5W 100 mL to infuse over 30 min. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual infusion to deliver how many gtt/min?
50mg/30minX15gtt/1mL= 50 gtt/min
A nurse is preparing to administer .45% NaCl 600 mL IV to infuse over 8 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?
600mL/8hrX1hr/60minX15gtt/1mL= 19gtt/min
A nurse is preparing to administer 650 mg of acetaminophen syrup to a client. The amount available is acetaminophen syrup 160mg/5mL. How many tsp should the nurse administer?
650mgX5mL/160mg= 20mL/5=4 tsp
a nurse is preparing to reconstitute and administer a powdered medication in a multidose vial. Which of the following actions should the nurse plan to take? A. use a filtered needle to administer the med B. briskly shake the medication vial after adding the diluent C. label vial with time and date before giving the med D. swab the rubber seal
C. -you use a nonfiltering needle to administer -gently roll med -swab w/alcohol swab
could mean bedtime or half strength?
HS
Can I crush ER, sublingual, enteric coated drugs?
NO
Pt has topiramate XR PO but can't swallow, should I 1. Request XR sprinkles from pharmacy 2. Clarify prescription
No reason to clarify, prescriber already gave it -so you should request XR sprinkles
what type of prescription is oxycodone 5 mg by mouth every 4 hr as needed for pain?
PRN- dependent on set parameters such as pain, heart rate, blood pressure
What is a standing prescription?
Protocol based and contains directions for administration based on specific situations
reconstitute medication?
Reconstituting vial- powdered med Label will tell you what to mix with the powder- usually 0.9 NS or sterile water (diluent) Draw up amt needed of diluent and inject into bottle. Mix by gently rotating (rolling) vial until all powder dissolved. Remove needed amount. Label with date/time/diluent/concentration
What type of prescription is "Diazepam 10 mg IV 30 min prior to procedure?"
Singe prescription= only one time
What type of prescription is acetaminophen 650 mg by mouth every 6 hr for a temperature greater than 38.4 C?
Standing prescription= protocol based and contains directions for administration based on upon specific situations such as development of fever
What type of prescription is Furosemide 20 mg IV immediately?
Stat prescription- should be implemented in emergency situations immediately
Pt just took a med and has dizziness + headache. Should the nurse call the provider or take vital signs first?
Take vital signs first
intravenous infusion
The administration of fluid through a vein -used for administering medications, nutrients, electrolytes
intradermal injection
administer small amounts of fluid (usually less than .1ml) into the dermis -normally use small syringes
PC
after meals
common medication errors
• Wrong medication or IV fluid • Incorrect dose or IV rate • Wrong client, route or time • Administration of known allergic medication • Omission of dose • Incorrect discontinuation of medication
A nurse is preparing to administer meperidine 75 mg subcuatenous every 4 hr PRN pain. Available is meperidine injection 100mg/mL. How many mL should the nurse administer per dose? Round to nearest hundredth
75mgX1mL/100mg=.75
A nurse is preparing to administer amoxicillin 775 mg PO. The nurse reconstitutes a container of amoxicillin powder to yield a final concentration of 400 mg/5mL. How many mL should the nurse administer? Round to the nearest tenth
775mgX5mL/400mg=9.7 mL
A nurse is preparing to administer erythromycin ethylsuccinate 800 mg PO every 12 hr. Available is erythromycin ethylsuccinate suspension 400mg/5mL. How many mL should the nurse administer per dose?
800mgX5mL/400mg= 10mL
hypotonic osmolarity
<200
hypertonic solution osmolarity
<350 -500= irritate veins
if a pt has hypernatremia, what solution would we give?
hypotonic
STAT
immediately
subcutaneous injection
injection into the subcutaneous tissue that lies between the epidermis and the muscle -absorption rate is slower
what are some medications we measure in units?
insulin, heparin, penacillin, and some vitamins
ID
intradermal
IM
intramuscular
IV
intravenous
when a client needs a rapid reduction of blood glucose, you can administer inuslin by.....?
intravenous infusion
type of solution to treat speed shock?
isotonic solution
If I administer hypotonic solution IV (in veins/intravascular) where will fluid go?
it will go from the intravascular and into the intracellular and interstitial spaces (can cause hemolysis)
metric prefexes?
kilo-1,000 hecto-100 deka-10 deci- 0.1 centi- 0.01 mili-0.001 micro-0.000001
A nurse is preparing to administer phenytoin 15mg/kg/day in 3 equal doses to a client who weighs 120lb. Available is phenytoin 125mg/5mL. How many mL should the nurse administer PER DOSE?
15mg/1kgX54.5kg/3dosesX5mL/125mg=10.9mL
intramuscular injection
an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm -are used to administer large volumes of medication -since muscles have greater vascularity than subcutaneous tissue, absorption rate is faster
Do you use bacteriostatic or bottled water for oral reconstitution?
bottled water -if it was for injections you'd administer sterile water or bacteriostatic water or normal saline, etc
3 centimeter to meter?
centimeter=100 meter=1 meter is bigger so we go smaller (divide) 3/100= .03
CR
controlled release
CRT
controlled-release tablet
DC could mean...?
discharge or discontinue
intervention for extravasation?
discontinue IV line, apply cool compress to area, administer antidote for medication if indicated document using similar scale to infiltration
tuberculin syringes?
hold .3 to 1ml of fluid -use to administer very small volumes of medication -same with insulin syringes
what is flow rate?
mL/hr
QD error?
means once daily but can be seen as QID= 4x a day
ounces to mL?
multiply by 30
Should you force a pt to take a med if they have nausea?
no
should you administer a medication another nurse has prepared?
no
should you take out IV in anaphylactic shock?
no, keep it to administer fluids, antidote, etc
is sub q a correct abbreviation?
no, should be written subcutaneous or subcut
2 isotonic solutions are -
normal saline and lactate ringers -osmolarity of 250 to 350
The state boards of nursing regulate the scope of RN and PN practice through.....?
nurse practice acts
QD
once daily
should you ask a toddler or a parent to say their name for identification?
parent, the toddler is too young
what is an IV catheter embolism?
part of IV catheter breaks off in vein
calculating dose and verifying dose are which parts of the nursing process?
planning
lowering the client's bed before adminsitering benzodiazepine is what part of the nursing process?
planning
fluid overload?
rate of IV administration is faster than pt can tolerate
what do you put on the label of a reconstituted medication and when do you put the label on?
right after reconstituting -dosage strength of reconstituted med -date and time of preparation -date and time of expiration -storage method -nurse initials
To treat speed shock you should....?
stop administering medication, change IV to isotonic solution, notify provider, treat effects, monitor vital signsF
what should you do if pt has phlebitis?
stop infusion immediately and remove catheter
SC
subcutaneous
syringes from 3 to 5 ml are used for....?
subcutaneous, intramuscular, and intravenous administration
SL
sublingual
The 3 mL syringe is calibrated in what?
tenths
what is speed shock?
the body's reaction to a substance that is injected into the circulatory system too rapidly. causing blood levels to med become toxic -chest pain, light headedness, tachycardia, dizziness
TID
three times a day
are HS and SC error prone abbreviations?
yes
do lactate ringers correct metabolic acidosis?
yes
is IU an error prone abbreviation?
yes
should you use a leading zero before a decimal point?
yes
is QD an error prone abbreviation?
yes, can be interpreted as QID