Medication Administration Wk 6
A nurse is at the bedside to administer prescribed medications to a client. Which must the nurse verify before administration? Select all that apply.
Right medication Right client Right indication
When administering a routine medication, what is the standard of care for administration?
No more than ½ hour (30 minutes) before or after the actual time specified on the medication administration record.
What does the object in the image measure?
Nothing; it only amplifies sound.
The nurse is caring for a client who refuses to take a prescribed medication. After exploring the reasons for the refusal and providing education, the client continues to refuse the medication. Which is the priority action by the nurse?
Notify the healthcare provider and document the refusal.
The healthcare provider orders ciprofloxacin 750 mg po twice a day for sinusitis. The medication is supplied in 500 mg tablets. How many scored tablets will the nurse administer? Round to the nearest tenth
1.5 tabs
The provider orders methylergonovine 0.3 mg po twice a day after a client stabilizes from a post-partum hemorrhage. The medication is supplied in 0.2 mg tablets. How many tablets will the nurse administer?
1.5 tablets
A nurse is attempting to administer an oral medication to a child, but the child refuses to take the medication. A caregiver is in the room. Which statement provided by the nurse to the caregiver is best?
"I will prepare the medication for you and observe if you would like to try to administer the medication."
The student nurse is at the bedside and has completed the right medication, right dose, right route, and right time as per the rights to medication administration. The student nurse is reviewing the right indication. The patient is questioning getting an injection and states, "I never have taken shots before for my blood sugar." Using the right indication, what is the best response by the student nurse?
"Your blood sugar is 224. That number is higher than expected. This insulin will help lower your blood sugar levels faster than your oral medication."
Your client has received 1 mg of medication. How many grams does that equal? Fill in the blank.
0.001 g
How many liters is in 1 milliliter of medicine?
0.001 liters
The client received 9 mcg of medication. How many mg does that equal? Fill in the blank.
0.009 mcg
The client weighing 30 kg is receiving 30 mcg of medication in 100 mL IV solution. The drop rate is 20 gtts/min with tubing delivering 10 gtts/mL. How many mcg/kg/min is the client receiving? Round to the hundredths place.
0.02
A person needs 150 mL of a substance in their intravenous (IV) bag. How many liters is that?
0.15 L
The nurse must run an intravenous (IV) antibiotic that is 50 mL on the pump over 20 minutes. What is the infusion time in hours? Fill in the blank. Record your answer to the nearest tenth.
0.3 hr
The healthcare provider orders ciprofloxacin 250 mg po twice a day for sinusitis. The medication is supplied in 500 mg tablets. How many scored tablets will the nurse administer? Round to the nearest tenth
0.5 tabs
Match the following common metric conversions:
1 tsp = 5 mL 1 TBSP = 15 mL 1 oz = 30 mL
How many grams is 1 kilogram of a substance?
1,000 grams
The healthcare provider orders magnesium oxide 600 mg oral three times a day for a client with hypomagnesemia. Magnesium oxide is available in 400 mg tablets. How many tablets would the nurse administer with each dose? Round to the nearest tenth.
1.5 tabs
A client measures 6 foot 6 inches tall and the standard hospital beds are known to be 2 meters long. What is the height in meters, so you know if they can fit on a standard bed?
1.98 meters
The client has had 10 L of fluid over the past weeks in the hospital. How many mL does that equal? Fill in the blank. For values 1,000 or greater, include a comma in the appropriate location.
10,000 mL
A colleague asks for 1 liter of fluid for a client. How many milliliters is that?
1000 mL
The nurse received a pain medication order for 420 micrograms (mcg). The available drug is in milligrams (mg). What is the conversion factor?
1000 mcg = 1 milligram
A person was asked to carry 50 kg at work, and they have hurt their back. The job description says they should expect to lift 50 lbs to complete their job. How much did they lift in pounds?
110 lbs
The nurse is caring for a client at home who must take magnesium hydroxide/aluminum hydroxide (Maalox) 30 mL PO for indigestion. Using ordinary household measuring devices, what amount will you instruct the client to take? Enter only a number, rounding to the nearest whole number.
2 TBSP
The healthcare provider orders famotidine elixir 30 mg po twice a day for heartburn. The medication is supplied in 15 mg/mL. How many milliliters will the nurse administer?
2 mL
The healthcare provider orders famotidine elixir 30 mg po twice a day for heartburn. The medication is supplied in 15 mg/mL. How many milliliters will the nurse administer? Round to the nearest tenth.
2 mL
The provider has ordered glucose monitoring before meals and at bedtime. The student nurse is checking Mr. Jones blood sugar at bedtime and the glucose monitor reads 224 mg/dl. Based upon the Medication Administration Record (MAR), how much insulin should the student nurse prepare to administer?
2 units
A client states they are 210 centimeters tall. A standard hospital bed is 2 meters long. What is the height of the client in meters, so you can know if they fit in the standard sized bed?
2.1 meters
A client consumed only 9 oz of fluids during a shift. How many mL does that convert to? Fill in the blank. Record your answer to the nearest whole number.
270 mL
The healthcare provider orders norepinephrine intravenous (IV) at 2.5 mcg/min for hypotension. The medication supplied is 2 mg/500 mL of D5W. Calculate the flow rate in milliliters per hour. Round to the nearest tenth.
37.5 mL/hr
Your client weighs 98 lb. What is your client's weight in kg? Round to the nearest tenth.
44.5 kg
The healthcare provider orders norepinephrine intravenous (IV) at 3 mcg/min for hypotension. The medication is supplied in 2 mg/500 mL of D5W. Calculate the flow rate in milliliters per hour.
45 mL/hr
The healthcare provider (HCP) has ordered an infusion at 2 g/hour. The medication available is 40 g per 1000 mL. How many milliliters an hour does the client receive? Round to the nearest whole number.
50
The healthcare provider orders famotidine elixir 90 mg po twice a day for heartburn. The medication is supplied in 15 mg/mL. How many milliliters will the nurse administer?
6 mL
The client weights 163 lb. How many kilograms does the client weigh? Round to the nearest tenth.
74.1 kg
The healthcare provider gives orders to infuse 1 L of lactated Ringer's solution in 12 hours. Calculate the flow rate in milliliters per hour. Round to the nearest tenth.
83.3 mL/hr
The client weighs 185 lb. What is the client's weight in kg? Using the dimensional analysis (DA) grid, round to the nearest tenth.
84.1 kg
A client reports they have had a temperature of 37 degrees Celsius all week. What is the temperature in Fahrenheit, so you know if you should be concerned or not?
98.6 °F
The nurse inadvertently administers a medication to the wrong client. The client does not suffer harm and no one else knows what happened. Which ethical principle requires that the nurse report the medication error?
Accountability
A nurse is performing the three accuracy checks before administering a rectal suppository medication to a client. When will the nurse perform the second accuracy check?
Before going to the client's room
What method is commonly used to individualize medication for adults and children?
Body weight
Next, the student nurse verifies medication allergies with Mr. Jones. Patient states "I am allergic to penicillin and morphine sulfate." What additional information is needed to verify allergies?
Ask the patient what type of reaction occurs with the stated medication allergy.
A nurse is performing the three accuracy checks before administering an intravenous (IV) medication to a client. When will the nurse perform the third accuracy check?
At the client's bedside
A nurse is reviewing several prescriptions. Which is incomplete and requires clarification by the healthcare provider?
Atorvastatin 10 mg twice daily
The nurse will perform the second accuracy check ______ going to the client's room. The nurse compares the _________ and _______ on the label with the _______for the second accuracy check.
Before Client's name Name of medication MAR
On the medication administration record (MAR), the healthcare provider has written Lisinopril 100 mg PO daily. The nurse recognizes that 100 mg is not the right dose based on the drug reference guide. The nurse believes that the healthcare provider meant to write 10 mg. What action should the nurse take?
Call the healthcare provider to clarify the order.
Identify the category to which each of the statements belongs.
Client in need of medication therapy - where Achieve positive client outcomes - why Educated, titled, and licensed registered nurses - who Use three checks and follow the rights of medication administration - what Anytime and anywhere; when and where nursing knowledge and skill in medication therapy is needed - when
A registered nurse has two clients with similar last names. The nurse performs the first two medication label checks but forgets the third check at the bedside. The nurse administers medication to the wrong client. The nurse immediately assesses the client who has no adverse effects. What should the nurse do next?
Contact the healthcare provider.
The nurse is viewing the medication administration record (MAR) in preparation for the 1300 medication administration. New medications have been entered into the system for 1300; however, they have not been signed off by the prescribing provider. What is the priority action of the nurse?
Contact the prescribing provider to verify order entry and sign off on medications.
Based upon the medication orders, which medication would you hold for Mr. Jones based upon a heart rate of 50 beats per minute?
Digoxin
A nurse has prepared a syringe filled with a narcotic medication to administer to a client. Upon entering the room, the client refuses the medication. Which action taken by the nurse is most appropriate?
Dispose of the medication in a special container while witnessed by another nurse.
Which statements are true regarding the right documentation? Select all that apply.
Document drug action if any changes in symptoms, and effectiveness of treatment. Document any improvements in the patient's condition (whether or not it is therapeutic) and/or any adverse reactions. Document the name of medication, dose, route, and site of administration.
When considering the right dose of medication administration, which information will the nurse verify prior to medication administration? Select all that apply.
Drug mathematical calculations are correct. Patient assessment variables, such as vital signs, lab values, age, and weight.
Identify the category to which each of the statements belongs.
Educated, titled, and licensed registered nurses - who Client who is prescribed a medication to be administered - where Protecting clients by following safe medication administration practices - why Following the seven rights of medication administration - what Nursing knowledge and skill is required - when
A nurse is caring for a client who is refusing to take prescribed medications. Which action should the nurse take first?
Explore with the client the reason for medication refusal.
The nurse is preparing for the 0900 medication administration of furosemide. The nurse has verified the correct client before performing the medication check #1. On the Medications Orders tab, select the information the nurse should check when verifying the medication from the medication dispensing system.
Furosemide 80 mg IV
While verifying the medication orders to the MAR, the student nurse identifies a missing piece of information on the MAR. What is the missing piece of information?
Furosemide is missing the route.
Match the unit with the correct measurement.
Height - Feet and inches (' and ") Centimeters (cm) Weight - Pounds (lbs) Kilograms (kg Pressure - Millimeters of mercury (mmHg) Pounds per square inch (p.s.i.) Temperature - Fahrenheit (℉) Celsius (℃) Volume - Milliliters (mL) Cubic Centimeters (cc) Time - Seconds (s) Hours (h) Energy - Calorie (Cal) Joule (J) Current - Milliampere (mA) Ampere (A)
After reviewing the drug guide for safe dose ranges, levothyroxine 250 mcg is a high client dose. Levothyroxine doses greater than 200 mcg/day are seldom required. What are the nurse's priority actions? Select all that apply
Hold the medication and contact the prescriber Question the dose, "Is this really a safe dose to give?"
There is a discrepancy with the medication label and the medication administration record (MAR) based upon the three checks. The client's name on the MAR states John Rhodes and the medication label reads John Roads. What is the priority action of the nurse?
Hold the medication and seek further clarification.
Which is not the most commonly used measuring system in the sciences?
Imperial system
During which step of the nursing process does the nurse administer prescribed medications to a client?
Implementation
Which is the most commonly used measuring system for the sciences around the world?
Metric system
Three systems used for measuring medications and solutions are:
Metric, apothecary, and household
Match the following unit of measure with the correct system.
Metric: Kg, mL Apothecary: oz Household: tsp, TBSP
Now, here is a challenge. Identify if there is a time (frequency) within the problem. It may read BID, TID, QID, Q4h, Q6h, etc. This establishes the doses to be administered within the 24-hour time frame. A client weighs 15 kilograms and has an order for 200 mg of medication PO Q4h. The recommended dosage range for this medication is 10 to 15 mg/kg per 24 hours. Low = 15 kg x 10 mg = 150 mg High = 15 kg x 15 mg = 225 mg 200 mg x 6 = 1,200 mg The dose (multiplied by 6 [as 4 x 6 = 24 hours in a day]) is 1,200 mg. Is this within the safe dose range?
No, it is more than the safe dose range.
A registered nurse does not review the medication label with the medication administration record (MAR) based upon the three checks. The nurse administers 8 mg of the medication to a client and then discovers that the dose should have been 5 mg as per the MAR. Who is ultimately responsible for the error?
Nurse
A registered nurse performs the first two medication label checks, but forgets the third check at the bedside. The nurse administers 5 mg of the medication to the wrong client with a similar last name. Who is ultimately responsible for the error?
Nurse
Based on this case study, select all the problems indicated and related to medication administration. Patricia Sims (preferred pronouns: she/her) is a nurse working in an extended care facility who is preparing to administer medications to a client who is prescribed a controlled substance. Patricia is in a hurry to finish the shift and get to her son's baseball game. As she opens the packaging to extract the tablet, it falls on the floor. Patricia retrieves the tablet from the floor and tosses it into the trash can. She quickly gets another tablet from the dispensing cabinet but hands it to the charge nurse to administer so she can leave the unit.
Patricia is in a hurry falls on the floor tosses it into the trash can hands it to the charge nurse
The clinical nurse instructor is watching a student nurse prepare medications. Which action taken by the student nurse will result in the clinical instructor needing to intervene immediately?
Prepares NPH insulin to be given intravenously.
What does the device in the image measure?
Pressure
Which is the primary intention of the state nurse practice act?
Protect clients receiving nursing care
Before proceeding to the three checks, the nurse will determine which drugs to administer based on the medication administration record (MAR) and identify any client medication allergies. Review the electronic medication administration record (eMAR) and highlight the five (5) medication errors that will need to be verified by the healthcare provider. Be sure to review all tabs of the eMAR.
R. Jones Allergies: Furosemide 80.0 mg IV bid Digoxin 0.125 mg daily Simvastatin 40 mg every HS
What is the nurse's priority action to protect a client from medication errors?
Read medication labels at least three times before administering.
Upon discovering this situation, what should the charge nurse do?
Report this situation as a medication error.
The right to refuse a medication refers to a patient's desire to refuse medication therapy. Refusal of drug treatment could be for a variety of reasons. What priority nursing action is appropriate when the patient refuses to take a prescribed medication?
Respect the right of refusal as it is the patient's right to choose.
As the nurse prepares to administer a controlled substance, they become aware of missing narcotics in the medication dispensing cabinet. Which ethical principle obligates the nurse to report the missing tablets?
Responsibility
The nurse is administering medications. After medication administration, the nurse realizes that patient verification (i.e., right patient) did not occur before administering the medication and the wrong medication was given. Which action should the nurse complete first?
Return to the room to assess the patient immediately.
Using the "right medication," what is the student nurse's first priority?
Review the provider's medication order in the medical record and compare it to the Medication Administration Record (MAR).
Many medication errors can be linked to an inconsistency in adhering to the rights of medication administration. Which are the medication administration rights? Select all that apply.
Right indication Right client Right documentation Right medication Right time Right dose Right route
Match the key term to the example :
Right medication - compare MAR with physician's prescribed orders Right dose - confirm appropriateness of dose using a drug reference guide Right time - assess for a conflict of pharmacokinetic and pharmacodynamic drug properties prescribed Right route - oral suspension, tablet, capsule, gelcaps, drops, rectal suppository, IV, and IM Right patient - identity is checked using at least two approved identifiers Right documentation - record the medication, date, time and response after medication administration Right indication - appropriate use of the medication
The nurse is caring for two patients with the same last name. In this situation, which right of medication administration is the priority to reduce the chance of a medication error?
Right patient
Let's review leading and trailing zeros. Identify which ones are safe versus unsafe.
Safe: 0.5 mL 1 L 0.56 mg 0.9986 mcg Unsafe: .560 mg 1.0 L 0.90 mcg 0.50 mL
Which entity provides the authority to administer, requires safe medication administration, and can take disciplinary action against a nursing license?
State Nurse Practice Act
When considering the right dose of medication administration, which information will the nurse verify prior to proceeding with the three checks and other rights of medication administration? Select all that apply.
The client's assessment data, such as vital signs and lab values. The dosage amount is appropriate for the age and size of the client. The drug mathematical calculations are correct.
Miss Wallace, the student nurse, is comparing the MAR to the healthcare provider's medication orders to verify if they have been accurately transcribed. After reviewing the "eMAR" tab and the "Medication Order" tab in the EHR above, are there any discrepancies?
The medication orders and the MAR do not match.
Prior to medication administration, when should medication labels be checked for accuracy? Select all that apply.
When retrieving medication from the medication distribution system When preparing the medication prior to entering the client's room Prior to administering the medication at the bedside
A nurse is performing the three accuracy checks before administering the furosemide medication to a client. When will the nurse perform the first accuracy check?
When selecting medication from the medication dispensing drawer
When administering a stat medication, what is the standard of care for administration?
Within ½ hour (30 minutes) of being prescribed
Order: Gentamycin 40 mg IVPB every 8 hours for a child weighing 40 lb. The recommended dosage for a child is 6 to 7.5 mg/kg/day divided every 8 hours. Is the dosage ordered safe?
Yes, it falls within the safe dose range.
Which unit of measurement is most commonly found on the side of an intravenous (IV) bag?
mL
What measurement is most commonly used to measure volume in a syringe?
mL (milliliters)
Rights to medication administration include comparing the medication label to the ___________ for each medication prior to administration.
medication administration record (MAR)
Which is the most common unit of pressure in a blood pressure gauge?
mmHg
Based on this additional information, select each problem related to medication administration. The charge nurse reminds Patricia that the nurse who prepares the medication must administer itto the client. After administering the medication, Patricia notifies the pharmacist of the tablet that fell on the floor and was discarded in the trash can. The pharmacist tells Patricia to retrieve the tablet from the trash and return it to thepharmacy for proper disposal. She retrieves the tablet and places it in her pocket, quickly finishes her documentation, and prepares to leave the unit. In her hurry to leave, Patricia forgets to return the tablet and leaves the building with the tablet still in her pocket.
places it in her pocket forgets to return the tablet leaves the building with the tablet still in her pocket.
Drug therapy is complex, and priority interventions include understanding the "rights" of medication administration. Over the course of this module, you will explore seven rights of medication administration. Which seven rights can you identify in your assigned chapter readings?
right route right dose right medication right indication right patient right documentation right time
The medicine label and medication administration record (MAR) read MS04 2 mg sq qd. What parts of this order are considered dangerous abbreviations? Select all that apply.
sq qd MS04