Foundations Chapter 28: Medications

The nurse is teaching a nursing student regarding safety of chemotherapeutic medication. Which statement by the nurse is correct? -"Once the drugs are packaged in the pharmacy, there are no risks in handling the medication." -"Antineoplastic drugs can be absorbed through the skin." -"Pharmacists usually administer chemo drugs." -"Antineoplastic drugs only target cancer cells."

"Antineoplastic drugs can be absorbed through the skin." Antineoplastic drugs are absorbed through the skin and should always be handled with caution. All other options are incorrect.

administering enoxaparin (Lovenox)

(low molecular weight heparin) -subcutaneous -in an area on the abdomen between the left or right anterolateral and left or right posterolateral abdominal wall -pinch the tissue gently and insert the needle at a 90-degree angle -packaged in a prefilled syringe with an air bubble -do not expel the air bubble before administration

intramuscular injections

-Muscles have larger and a greater number of blood vessels than does subcutaneous tissue, allowing faster onset of action than with subcutaneous injections -injection angle 72-90 degrees

subcutaneous injections

-administered into the adipose tissue layer just below the epidermis and dermis -this tissue has few blood vessels, thus drugs administered here have a slow, sustained rate of absorption into the capillaries -used to administer drugs such as insulin and heparin. -Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventral or dorsogluteal area -Injections in the abdomen are absorbed most rapidly; ones in the arms are absorbed somewhat more slowly; those in the thighs, even more slowly; and those in the upper ventral or dorsogluteal areas have the slowest absorption -A 25- to 30-gauge, 3/8″ to 1″ needle can be used; the 3/8″ and 5/8″ needles are most commonly used -usually no more than 1 mL -45-90 degree angles

Intradermal injections

-administered into the dermis, just below the epidermis -has the longest absorption time -used for TB tests, allergy tests, local anesthesia -inner forearm and upper back under the scapula -1/4" to 1/2", 25 or 27 gauge needle -usually less than 0.5 mL -5-15 degree angle

administering heparin

-administered subcutaneously -abdomen is most commonly used site -avoid the area 2" around the umbilicus and belt line

Continuous subcutaneous insulin infusion (CSII or insulin pump)

-allows for multiple preset rates of insulin delivery -uses a small computerized reservoir that delivers insulin via tubing through a small plastic cannula or needle inserted into the subcutaneous tissue -sites are changed every 2-3 days -morphine can also be given as a continuous subcutaneous infusion for palliative dyspnea and pain management

ventrogluteal site

-involves the gluteus medius and gluteus minimus muscles in the hip area -offers a large muscle mass that is relatively free from major nerves and blood vessels, the area is clean (fecal contamination is rare at this site) -patient can be on the back, abdomen, or side -needle length: 1 1/2" -antibiotics, hormones, vaccines -To locate the ventrogluteal site, place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. The right hand is used for the patient's left hip, or the left hand for the right hip, to identify landmarks. Place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed, and the injection is given in the center of the triangle.

vastus lateralis site

-involves the quadriceps femoris muscle and is located along the anterolateral aspect of the thigh -particularly desirable for infants and children, whose gluteal muscles are poorly developed -restrain infants between the nurses arm and body -needle length: 5/8-1" -To locate the site, divide the thigh into thirds horizontally and vertically and administer the injection in the outer middle third

deltoid muscle site

-located in the lateral aspect of the upper arm -recommended site for vaccines for adults and may be used for children between 1 and 18 years of age for vaccine administration -the deltoid muscle is not developed enough in infants to absorb medication adequately -Damage to the radial nerve and artery is a risk -should be limited to 1 mL of solution. -Hepatitis B virus vaccine is one medication that should be given in the deltoid muscle in adults to induce adequate levels of the antibody -needle length for children: 5/8 to 1 1/4" -needle length for adults: 5/8 to 1 1/2"

volume-control administration set for intermittent intravenous infusion

-medication is diluted with a small amount of solution and administered through the patient's intravenous line -this type of equipment may be used for infusing solutions into children, critically ill, and older patients when the volume of fluid infused is a concern.

cumulative effect

-occurs when the body cannot metabolize one dose of a drug before another dose is administered -the drug is taken in more frequently than it is excreted, and each new dose increases the total quantity in the body -older patients are at risk for experiencing a cumulative effect, related to altered drug metabolism and elimination due to impaired hepatic metabolism and renal clearance related to normal changes with aging

z-track technique

-recommended for intramuscular injections to ensure that medication does not leak back onto the needle track and into subcutaneous tissue -also suggested for older patients who have decreased muscle mass -attach a clean needle to the syringe after the syringe is filled with the medication to prevent the injection of any residual medication on the needle into superficial tissues. Pull the skin down or to one side about 1″ (2.5 cm) and hold in this position with the nondominant hand. Insert the needle and inject the medication slowly. Withdraw the needle steadily and release the displaced tissue to allow it to return to its normal position. Massage of the site is not recommended because it may cause irritation by forcing the medication to leak back into the needle track.

intravenous piggyback delivery system

-requires the intermittent or additive solution to be placed higher than the primary solution container -the port on the primary intravenous line has a back-check valve that automatically stops the flow of the primary solution, allowing the secondary or piggyback solution to flow when connected

Body surface area (BSA)

-the area of the external surface of the body, expressed in square meters (m2) -considered the most accurate way to calculate the drug dose for infants, children, older adults, patients receiving oncologic medications, and patients with low body weight

pharmacokinetics

-the effect of the body on the drug, once the drug enters the body -movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion

dorsogluteal site

-this site has been associated with inadvertent injection into subcutaneous tissue because the area is covered with subcutaneous tissue in many people; injection into subcutaneous tissue alters drug absorption and causes tissue irritation -More important, this site has been associated with significant injury, including pain and temporary or permanent paralysis, caused by damage to the sciatic nerve. Therefore, *this site is no longer recommended for use for intramuscular injections*

three checks of medication administration

1) read the label when the nurse reaches for the container or unit dosed package 2) After retrieval and compared with the CMAR 3) before giving the medication to the patient

The charge nurse on the medical/surgical unit is reviewing physician orders for a client with a diagnosis of congestive heart failure. Which infusion orders would the nurse question? -20 mL 0.9 NaCl to run in 20 minutes -1000 D5W to run in 30 minutes -50 mL DSW to run in 60 minutes -250 mL 0.9 NaCl to run in 60 minutes

1000 D5W to run in 30 minutes Medications administered by intermittent infusion are supplied either in bags that contain 50 to 250 mL of IV fluid (0.9 normal saline or 5% dextrose in water) or in 20- to 60-mL syringes to be used with an infusion pump.

The nurse is preparing to insert an intravenous needle in a 1-year-old child for a one-time administration of fluids due to dehydration. Which needle would the nurse likely select?

A 23-gauge winged infusion set Winged infusion or small vein needles may be used for short-term or one-time infusion therapies or may be used with infants and small children. These are short, beveled needles with plastic flaps or wings.

The nurse is preparing to administer insulin to an older client who is frail and has failure to thrive. At what angle will the nurse plan to insert the needle into the client?

45 degrees Insulin injections are given subcutaneously to clients who are very thin at a 45 degree angle.

lipid solubility of drugs

A drug that is more lipid soluble can be absorbed more readily and pass more easily through the cell membrane.

A nurse is administering a piggyback infusion to a client with second-degree burns. Which describes the most important feature of a piggyback infusion? -Medication is given all at one time as quickly as possible. -A parenteral drug is given in tandem with IV solution. -Primary IV solution is infused by gravity. -Medication locks are changed every 72 hours.

A parenteral drug is given in tandem with IV solution. In a piggyback infusion, a parenteral drug is administered in tandem with a primary IV solution. Medication locks are not changed during piggyback infusion specifically, but in general to maintain patency. IV medication or fluid is given all at one time as quickly as possible in a bolus administration, not in piggyback infusion. It is not the primary IV solution but the secondary infusions that are administered by gravity in tandem with the currently infused primary solution.

A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation?

Assess the vomit, looking for the pill. If a patient vomits immediately after swallowing an oral pill, the nurse should assess the vomit for the pill or fragments of it. The nurse should then notify the primary care provider to see if another dosage should be administered.

pH of drugs

Acidic drugs are well absorbed in the stomach. Drugs that are basic remain ionized or insoluble in an acid environment. These drugs are not absorbed before reaching the small intestine.

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss? -As the gauge number becomes larger, the size of the needle becomes smaller. -The size of the syringe is directed by the viscosity of the medication to be given. -When looking at a needle package, the first number is the length in inches and the second number is the diameter, the gauge. -When giving an injection, the amount of medication directs the choice of gauge.

As the gauge number becomes larger, the size of the needle becomes smaller. The larger the gauge, the smaller the needle. The first number on a needle package is the gauge or diameter of the needle; the second number is the length in inches. When giving an injection, the viscosity of the medication directs the choice of gauge. The size of the syringe is directed by the amount of the medication to be given.

A nurse needs to administer a subcutaneous injection to a client. How far from the previous injection site to the area should the nurse administer the injection?

At least 1 inch (2.5 cm) Injection sites are rotated a finger's width apart or about 1 inch (2.5 cm) from a previous site to avoid repeatedly injecting into the same area in a short amount of time. Rotating sites avoids tissue injury.

A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client? Avoid administering medication prepared by another nurse. Prepare the exact dosage of medication in front of the client. Bring the prescribed medication in a ceramic cup or glass container. Check the label of the medication container 3 times at the bedside.

Avoid administering medication prepared by another nurse. A nurse should never administer medications prepared by another nurse. The nurse administers only those medications that she has prepared. The nurse should prepare and bring oral medications to the client's bedside in a paper or plastic cup, not in a glass container or ceramic cup, in order to avoid accidents and spills. The nurse checks the label of the medication container three times when preparing it, not when administering it to the client.

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube? -Mix all the medications together in 15 mL of water. -Add medications to the formula. -Use cold water when mixing powdered medications. -Avoid crushing sustained-release pellets.

Avoid crushing sustained-release pellets. When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication's dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.

The nurse should assess the client for the use of herbal and botanical supplements. What botanical medication is used to treat mild depression?

St. John's Wort

A nurse is using an IV port when administering medication to a client. Which IV administration has the greatest potential to cause life-threatening changes?

Bolus administration Because the entire dose is administered quickly, bolus administration has the greatest potential to cause life-threatening changes should a drug reaction occur. An electronic infusion device, continuous administration, and secondary administration do have the potential to cause life-threatening changes, but not to the same degree as a bolus administration, since the rate at which medication is administered is not as fast as during a bolus.

An oral medication has been ordered for a client who has a nasogastric tube in place. Which nursing activity would increase the safety of medication administration?

Check the tube placement before administration. The nurse must first verify that the tube is in place and not in the lungs prior to administering the medication. Next, the nurse can bring the liquids to room temperature. Typically the tube is flushed with 15 to 30 mL of water for adults (5 to 10 mL for children). The nurse should never have the client swallow the pills if the client has an nasogastric tube.

The nurse has completed administering medications through an enteral tube used for decompression. What is the appropriate nursing action?

Clamp the tube for at least 30 minutes. The tube should be clamped or plugged for at least 30 minutes to prevent removing the drugs before they leave the stomach.

A nurse is applying a vaginal cream to a client with a vaginal infection. What is a recommended guideline for this application?

Cleanse area at vaginal orifice with washcloth and warm water. The following is the procedure for applying a vaginal cream: Position the client so that she is lying on her back with the knees flexed. Spread labia with fingers, and cleanse area at vaginal orifice with washcloth and warm water, using a different corner of the washcloth with each stroke. Wipe from above the vaginal orifice downward toward the sacrum (front to back). Spread the labia with the nondominant hand and introduce the applicator with the dominant hand gently, in a rolling manner.

When administering a subcutaneous injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation?

Engage safety shield on needle guard and discard needle appropriately. The needle needs to be disposed of properly after engaging the safety guard because the needle cannot be reinserted due to contamination. A new needle can be attached to the syringe and the remainder of the medication administered after cleansing the site again. The incident does warrant notifying the primary care provider.

A nurse is caring for a client who has a PICC line. Which nursing action is recommended?

Flush using normal saline and/or heparin solution according to facility policy. PICC lines are flushed with normal saline and/or heparin in order to maintain patency by preventing clot formation in the line. Sterile technique should be used for dressing changes for at least 24 hours after insertion and 3 to 7 days thereafter. The external part of the catheter should be kept under the dressing to prevent the introduction of microorganisms, leading to infection. Catheter caps should be changed every 3 to 7 days.

No blood return is noted upon aspiration:

If medication lock appears patent, without signs of infiltration, and normal saline fluid infuses without difficulty, proceed with administration. Observe closely for signs and symptoms of infiltration during and after administration.

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse? -Administer the prescribed antibiotics as prescribed. -Insert a new IV medication lock and remove the old one. -Call the physician to request oral antibiotics. -Flush the lock with heparin solution.

Insert a new IV medication lock and remove the old one. The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the physician to change the order is not appropriate.

A nurse is caring for a client on IV therapy. The IV tubing has a volume-control set. Which of the following is a function of the volume-control set? -It is used to administer medication continuously. -It is used to administer medication in a large volume of blood. -It is used when IV medications are irritating to the peripheral veins. -It is used to administer small volumes of IV medication.

It is used to administer small volumes of IV medication. A volume-control set is used to administer a small volume of IV medication at intermittent intervals to avoid accidentally overloading the circulatory system. A volume-control set is used to administer IV medication at intermittent intervals, not continuously. It is not a volume-control set but a central venous catheter that is used to administer medication in a large volume of blood and when IV medications are irritating to peripheral veins.

A nurse is responsible for changing the dressing on a patient's infected wound, a procedure that has caused the patient significant pain in the past. Which of the nurse's actions best demonstrates an understanding of the pharmacokinetics of the pain medication that the nurse will administer?

Knowing the onset of the medication when deciding when to administer it When considering the timing of PRN analgesics, the nurse must know the onset of the medication in order to maximize therapeutic effect. Considering the patient's preferences is an important aspect of care, but this is not directly related to pharmacokinetics. The lowest possible dose may not always be desirable. Similarly, small repeated doses may not be in the patient's best interests.

The nurse is preparing to administer an oral medication to a client with xerostomia. Which nursing action is appropriate?

Offer a sip of water before administering medication. Xerostomia, a condition of dry mouth, affects some older adults and clients taking certain kinds of medications. To prevent oral medications from sticking to the tongue, administer with a sip of water prior to taking the drug, or mix with a soft food such as applesauce. Other answers are incorrect.

The nurse is providing care to a client who has a Groshong catheter inserted. When irrigating the catheter, the nurse would use which solution?

Normal saline Catheter patency is usually maintained by periodically flushing the catheter with diluted heparin. However, because of its unique design, the Groshong catheter requires irrigation with normal saline rather than heparin.

A nurse is preparing to administer a transfusion of packed red blood cells to a client. Which solution would the nurse expect to use to administer the transfusion?

Normal saline When administering a blood transfusion, normal saline should be used to prevent cell hemolysis. Solutions containing dextrose cause hemolysis. Lactated Ringer's is not recommended.

A glycerin suppository has been ordered for a patient who has not had a bowel movement for 3 days. Which of the following actions should the nurse perform when administering this medication? Perform a digital rectal exam to assess for rectal bleeding prior to administration. Apply petroleum jelly to the suppository and the patient's anus to ease insertion. Position the patient over a bedpan immediately after administering the suppository. Position the patient in a left side-lying Sims position.

Position the patient in a left side-lying Sims position. Suppositories are best administered with the patient in a left side-lying position. A digital rectal exam is not necessary before administration. Water-soluble lubricants are used, and the patient should not move for 5 or 10 minutes after administration.

Which teaching will the nurse provide to a client with the NANDA-I nursing diagnosis of "Ineffective Protection related to cancer and chemotherapy treatment"?

Refrain from using aspirin while undergoing chemo treatment. The nurse will teach that aspirin and products containing salicylates should be avoided during chemo treatment, since these interfere with clotting. Teeth should be brushed with a soft bristle brush; chemotherapy may be delayed if platelets are low or for other reasons; urine and stool should be tested daily for occult blood.

A patient requires 40 units of NPH insulin and 10 units of regular insulin daily subcutaneously. What is the correct sequence when mixing insulins? -Inject air into the regular insulin vial and withdraw 10 units; then, using the same syringe, inject air into the NPH vial and withdraw 40 units of NPH insulin. -Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin. -Inject air into the regular insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the NPH insulin vial and withdraw 40 units; then, withdraw 10 units of regular insulin. -Inject air into the NPH insulin vial and withdraw 40 units; then, using the same syringe, inject air into the regular insulin vial and withdraw 10 units of regular insulin.

Regular or short-acting insulin should never be contaminated with NPH or any insulin modified with added protein. Placing air in the NPH vial first without allowing the needle to contact the solution ensures that the regular insulin will not be contaminated.

Upon assessing the medication lock site before administering medication, you note that the medication lock has infiltrated:

Remove the medication lock from the extremity. Restart peripheral venous access in a different location. Continue to monitor the new site as the medication is administered.

While you are administering medication, patient begins to complain of pain at the site:

Stop the medication. Assess the medication lock site for signs of infiltration and phlebitis. Flush the medication lock with normal saline again to recheck patency. If the IV site appears within normal limits, resume medication administration at a slower rate. If pain persists, stop, remove the medication lock, and restart in a different location.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler?

The nurse should use a nebulizer to administer the medication. The nurse using a nebulizer to administer the medication is correct, as this is an alternative to administering an inhalant for young children. Instructing the child to prolong his/her inhalation is incorrect, as this is used to reduce side effects of using inhalants. Assessing the child's mucous membranes is incorrect, as this action is used to identify any break in the continuity of the membranes and will not assist with the coordination of inspiration. Providing simple written instructions is incorrect, as this will enhance the teaching/learning process of the child and not the coordination of the child's inspiration.

drawing medication from a glass ampule

The nurse will tap the top of the ampule to distribute medication to the lower part of the container; protect fingers with a gauze square; snap the neck of the ampule away from the nurse's body; refrain from allowing the needle to touch the outside of the ampule to maintain needle sterility; and invert the ampule to facilitate medication withdrawal. The nurse does not don sterile gloves before opening the ampule and does not snap the neck of the ampule while holding it close to the nurse's body for safety reasons.

pharmacodynamics

The process by which drugs alter cell physiology and affect the body

medications via an intravenous bolus or push

This involves a single injection of a concentrated solution directly into an intravenous line. The drug is administered very slowly over at least 1 minute. Confirm exact administration times by consulting a pharmacist or drug reference.

A nurse is administering medication to a patient 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, you 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.

A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client with influenza. Which precaution should the nurse take when combining drugs?

Withdraw exact amounts of each drug from each container. When combining more than one drug in a single syringe, the nurse should take exact amounts from each drug container because, once the drugs are in the barrel of the syringe, there is no way to expel one without expelling the other. Mixing the two drugs before administering, or shaking the drug containers before withdrawing, is not suitable because it can cause chemical reactions and precipitates. Expelling both the drugs separately in a vial before use could also lead to a chemical reaction, which often causes a precipitate to form.

A nurse is preparing medications for patients in the ICU. The nurse is aware that there are patient variables that may affect the absorption of these medications. Which statements accurately describe these variables? Select all that apply. A. Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed. B. Some people experience the same response with a placebo as with the active drug used in studies. C. People with liver disease metabolize drugs more quickly than people with normal liver functioning. D. A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication's effects. E. Oral medications should not be given with food as the food may delay the absorption of the medications. F. Circadian rhythms and cycles may influence drug action.

a, b, d, f. Nurses need to know about medications that may produce varied responses in patients from different ethnic groups. The patient's expectations of the medication may affect the response to the medication, for example, when a placebo is given and a patient has a therapeutic effect. The patient's environment may also influence the patient's response to medications, for example, sensory deprivation and overload may affect drug responses. Circadian rhythms and cycles may also influence drug action. The liver is the primary organ for drug breakdown, thus pathologic conditions that involve the liver may slow metabolism and alter the dosage of the drug needed to reach a therapeutic level. The presence of food in the stomach can delay the absorption of orally administered medications. Alternately, some medications should be given with food to prevent gastric irritation, and the nurse should consider this when establishing a patient's medication schedule. Other medications may have enhanced absorption if taken with certain foods.

A nurse is teaching an adolescent patient how to use a meter-dosed inhaler to control his asthma. What are appropriate guidelines for this procedure? Select all that apply. A. Remove the mouthpiece cover and shake the inhaler well. B. Take shallow breaths when breathing through the spacer. C. Depress the canister releasing one puff into the spacer and inhale slowly and deeply. D. After inhaling, exhale quickly through pursed lips. E. Wait 1 to 5 minutes as prescribed before administering the next puff. F. Gargle and rinse with salt water after using the MDI.

a, c, e. The correct procedure for using a meter-dosed inhaler is: remove the mouthpiece cover and shake the inhaler well; breathe normally through the spacer; depress the canister releasing one puff into the spacer and inhale slowly and deeply; after inhaling, hold breath for 5 to 10 seconds, or as long as possible, and then exhale slowly through pursed lips; wait 1 to 5 minutes as prescribed before administering the next puff; and gargle and rinse with tap water after using the MDI.

A nurse who is administering medications to patients in an acute care setting studies the pharmacokinetics of the drugs being administered. Which statements accurately describe these mechanisms of action? Select all that apply. A. Distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues. B. Metabolism is the process by which a drug is transferred from its site of entry into the body to the bloodstream. C. Absorption is the change of a drug from its original form to a new form, usually occurring in the liver. D. During first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the system's circulation. E. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug absorption. F. Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body.

a, d, f. Distribution occurs after a drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues. Some drugs move from the intestinal lumen to the liver by way of the portal vein and do not go directly into the systemic circulation following oral absorption. This is called the first-pass effect, or hepatic first pass. Excretion is the process of removing a drug or its metabolites (products of metabolism) from the body. Absorption is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Metabolism, or biotransformation, is the change of a drug from its original form to a new form. The liver is the primary site for drug metabolism. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug excretion.

The nurse is administering an intramuscular injection to a client. Which action made by the nurse could assess whether the needle is in the client's blood vessel or not?

aspirating for a blood return

mini infusion pump (syringe pump)

battery operated and allows medication mixed in a syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe plunger

intramuscular injection sites based on medication type

biologicals: vastus lateralis (for all ages) hepatitis B/rabies: deltoid medications that are known to be irritating, viscous, or oily solutions: deltoid, ventrogluteal

A client has just had a central venous catheter inserted. What would the nurse do next?

btain a chest x-ray. After all central venous catheter insertions, a chest x-ray verifies the position of the catheter before infusion of any solutions or medications. The chest x-ray also will detect pneumothorax. No other action should occur until catheter placement has been verified.

A client with a central venous catheter develops a catheter-related bloodstream infection (CRBSI). The nurse understands that this infection is most commonly due to:

colonization of the catheter tip from migration of skin organisms at the insertion site. There are four recognized routes for catheter contamination. The most common route of infection is colonization of the catheter tip due to migration of skin organisms from insertion site. Direct contamination of the catheter or catheter hub is also a contributing factor (O'Grady, N.P., et al, 2011). Less common, the catheters may be contaminated by organisms that migrate from infections in other areas of the client; rarely, the infusion itself may be contaminated. Additionally, the material the catheter is made from may contribute to CRBSI.

A client was admitted to the medical unit with a history of having difficulty breathing despite being compliant with the prescribed inhalers. On assessment, the client's respiration is 36 breathes per minute and oxygen saturation is 96%. Which nursing diagnosis is the nurse expected to record?

ineffective breathing pattern Ineffective breathing pattern is correct because although the client was compliant with the inhalers, the client was still not getting adequate ventilation. Impaired tissue perfusion is incorrect, as this is related to the inadequate oxygen and nutrients to tissues in the body. Impaired gaseous exchange is incorrect, as it is the excess or deficit in oxygenation elimination at the alveolar-capillary membrane. Ineffective airway clearance is the inability to clear secretions from the respiratory tract, and is therefore incorrect.

intramuscular injection sites based on patient's age

infants: vastus lateralis toddlers/children: vastus lateralis or deltoid adults: ventrogluteal or deltoid

elixir

medication in a clear liquid containing water, alcohol, sweeteners, and flavor

liniment

medication mixed with alcohol, oil, or soap, which is rubbed on the skin

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

miconazole The nurse anticipates that miconazole, a vagina cream, will be prescribed for a yeast infection. Oxymetazoline is a nasal decongestant used to alleviate congestion; bisacodyl is a rectal suppository used for softening stool; timolol is an eye drop used to treat glaucoma.

A nurse is taking care of a client who asks if she can have some acetaminophen to help with her headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours for pain. What type of order is this considered?

p.r.n. order

The nurse is caring for a client with endocarditis who will require 6 weeks of antibiotic therapy. The nurse should anticipate which type of access for this client?

peripheral inserted central catheter (PICC) in the right axillary vein

A nurse is preparing to convert a client's IV to an intermittent infusion device. The IV is connected to extension tubing. Before disconnecting the IV tubing from the extension tubing, the nurse clamps the extension tubing for which reason?

prevent air from entering the line When converting to an intermittent infusion device, the nurse clamps the extension tubing to prevent air from entering the line. The primary IV tubing is clamped to prevent blood loss when the IV and tubing are disconnected. Flushing maintains IV line patency. Taping the adapter device and extension tubing secures the device in the proper position.

trough level

the point when the drug is at its lowest concentration, indicating the rate of elimination

A client with an infection is receiving intravenous antibiotic therapy. The client has an intermittent infusion device in place. The nurse flushes the device with normal saline solution before administering the antibiotic based on which rationale?

to prevent blood clot formation The intermittent infusion devices are irrigated or flushed with a small quantity of sterile saline to prevent blood clot formation, thus maintaining patency. Irrigating the device with a small quantity of sterile saline does not facilitate cannulation of the central vein. The intermittent infusion device itself maintains venous access without requiring the client to receive continuous infusion, thus allowing increased mobility for the client and minimizing danger of fluid overload.

The nurse is caring for a confused client who requires a transdermal patch application. Which location will the nurse choose to apply the patch? -upper back -upper arm -side of buttock -lower abdomen

upper back The nurse will apply the patch to the upper back, as this makes it difficult for the confused client to pick at or remove the patch. The other locations are not appropriate or ideal, as the client could pick at or remove the patch more easily.

Which anatomic site is recommended for intramuscular injections for adults?

ventrogluteal The ventrogluteal site involves the gluteus medius and gluteus minimus muscles in the hip area. This site is recommended for adults because there are no large nerves or blood vessels, it is removed from bone tissue, it is clean, and the client may lie on the back, abdomen, or side for the injection.