Mod 1: EAQ Chapter 35 Medication Administration

A patient is prescribed lozenges for a cough. Which instruction would the nurse give to this patient regarding the use of lozenges? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected "The lozenge should be crushed before swallowing." "Allow the medication to dissolve in your mouth." "Dissolve the lozenge in water before swallowing." "The medication should not be ingested." "Dissolve the medication in juice before swallowing."

"Allow the medication to dissolve in your mouth." "The medication should not be ingested." Lozenges are slowly absorbed through the buccal mucosa; therefore, they should be kept in the mouth for adequate time to allow dissolution. Lozenges should not be ingested because they are more effective when absorbed through the buccal mucosa and not the gastric mucosa. The lozenges should not be crushed or dissolved in water or juice, as this can make them ineffective. p. 807, 808

Which instruction does the nurse give to the patient after applying eye ointment? "Put your face over a basin." "Flush your eye until the ointment drains out." "Close and roll your eyes around." "Keep your eyes closed for 10 minutes after application."

"Close and roll your eyes around." The nurse applies ointment from the inner canthus to the outer canthus and asks the patient to close and roll the eyes around. This helps uniformly disperse drug particles and reduces the risk of eye infection. The nurse places a basin below the patient's face and provides a towel when washing a patient's eyes with eye irrigation solution. Ointment should not be drained after application, as this reduces the efficiency of the drug. The nurse may instruct the patient to close the eyes for a minute or two to help in ointment absorption, not for 10 minutes. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. For this question, it would not be reasonable to drain the ointment or to expect the patient to keep his eyes closed for 10 full minutes. p. 823

The nurse is teaching a group of parents about medication administration to their children. Which statement made by the parents indicates the need for further teaching? Select all that apply. One, some, or all responses may be correct. "I will administer eyedrops inside the upper eyelid." "I will avoid removing the previously placed patch when applying a new patch." "I will mix the medication by shaking the bottle well before administration." "I will mix the medication with a favorite food before administering it." "I will use a calibrated dropper for the administration of liquid medications."

"I will administer eyedrops inside the upper eyelid." "I will avoid removing the previously placed patch when applying a new patch." "I will mix the medication with a favorite food before administering it." Eyedrops must be administered into the pouch formed by the lower eyelid instead of the upper eyelid to prevent corneal damage. A previously placed patch and any remaining medication are removed before the new patch is applied to prevent overdosing. Medications should not be mixed with a child's favorite food because the child may avoid these foods in the future if associated with the medication. Shaking the medication bottle well before administration helps uniformly disperse particles and administer the correct dose to the patient. Administration through a calibrated dropper or medication cup ensures the accurate prescribed dose and allows the child to swallow the medications slowly. p. 820, 821, 822

The nurse administers a 5-mg tablet of a medication to a patient who has osteoarthritis pain. The drug has a half-life of 4 hours. How much of the drug will remain in the blood after 12 hours? Record the answer to the third decimal place. ____________mg

0.625mg If a drug has a half-life of 4 hours, after 4 hours the patient will have 50 percent, or 2.5 mg, of the drug in the body. After 8 hours, the patient will have 1.25 mg of the drug in the body. After 12 hours, the patient will have 0.625 mg of the drug in the body. Test-Taking Tip: For the half-life of medication questions, say to yourself, "Half in 4 (or whatever the given half-life is), half again in 8 (or twice the half-life time), half again in 12 (or three times the length of the half-life)," etc. For this question, because the time is 12 hours, or three times the half-life, start with the total number of the dosage (in this case, 5 mg), divide it by half (= 2.5 mg), divide THAT by half (= 1.25 mg), and divide it by half a third time (= 0.625 mg). You would divide by half three times because the time the question asks about is three times the half-life (12 hours = 3 times 4 hours). p. 802

A patient is to receive cephalexin 500 mg PO. The pharmacy supplied the medication as 250-mg tablets. How many tablets does the nurse administer to the patient? 1/2 tablet 1 tablet 1 1/2 tablets 2 tablets

2 tablets Using dimensional analysis: Tablets = 1 tablet/250 mg × 500 mg = 500/250 = 2 tablets. One-half a tablet would deliver 125 mg. One tablet would deliver 250 mg. One and a half tablets would deliver 375 mg. p. 814

Which type of syringe and needle would the nurse select to perform a tuberculin test in a patient suspected of tuberculosis? 1-mL syringe, 1/4- to 5/8-inch needle 3-mL syringe, 1- to 3-inch needle 5-mL syringe, 1- to 2-inch needle 10-mL syringe, 1/2- to 5/8-inch needle

1-mL syringe, 1/4- to 5/8-inch needle The nurse performs a tuberculin test through an intradermal injection. These injections require a 1-mL tuberculin syringe with a short, 1/4- to 5/8-inch needle to avoid skin and tissue damage. This allows the easy administration of the medication and reduces pain. The nurse uses 5-mL and 3-mL syringes with a 1- to 3-inch needle for intramuscular injections to accommodate up to 2 to 5 mL of medication. The 1-mL syringe is sufficient to perform the test, and therefore the nurse need not use a 10-mL syringe. A 10-mL syringe would make it difficult to measure the medication accurately, which could lead to incorrect medication administration and inaccurate test results. STUDY TIP: To remember the relative needle size for intradermal injections, consider that intradermal injections are used in testing for allergies. If a patient is allergic to a substance, just a tiny amount will produce a reaction. p. 853

A nurse is reviewing the different routes of medication administration. Arrange the routes of medication administration in descending order (quickest to slowest) of drug absorption. Intramuscular Subcutaneous Oral Intravenous

1. Intravenous 2. Intramuscular 3. Subcutaneous 4. Oral Absorption is defined as the transfer of a drug from the administration site into the bloodstream. The intravenous route has the quickest route of absorption due to its direct entry into the bloodstream. Administration of a medication intravenously, or directly into a blood vessel, results in the quickest rate of absorption, followed by intramuscularly, subcutaneously, and orally administered medications. STUDY TIP: To recall that the oral route is the slowest route of absorption, consider (in addition to the O in oral and slow) what happens to the medication once it is swallowed. It may need a certain pH in the stomach or small intestines to break down, and the patient may or may not have that pH at the time the medication gets there. It may need to be taken with food (to avoid nausea), which could slow down its absorption. It may be affected by other conditions in the small intestine, which could be altered by disease (such as a rapid intestinal transit time). Many conditions can slow the absorption of medication taken orally. p. 802

Arrange the steps of vaginal administration of a suppository in the correct sequence. Expose the vaginal orifice with nondominant hand. Instruct the patient to remain on her back, in a side-lying position or with hips elevated on a pillow, for 5 to 10 minutes. Fully insert the applicator or suppository; use a rolling motion, inserting downward and backward. Lubricate the applicator or suppository using a water-soluble gel.

1. Lubricate the applicator or suppository using a water-soluble gel. 2. Expose the vaginal orifice with nondominant hand. 3. Fully insert the applicator or suppository; use a rolling motion, inserting downward and backward. 4. Instruct the patient to remain on her back, in a side-lying position or with hips elevated on a pillow, for 5 to 10 minutes. The nurse would instruct the patient to empty her bladder and then lie on her back with her knees flexed. The nurse would don gloves and lubricate the applicator or suppository using a water-soluble gel. The nurse would separate the labia with the nondominant hand, exposing the vaginal opening for cleansing. The nurse would fully insert the applicator or suppository using a rolling motion, inserting downward and backward. When the procedure is completed, the nurse would remove gloves, turning them inside out to prevent the spread of microorganisms. The nurse would instruct the patient to remain on her back, in a side-lying position or with her hips elevated on a pillow, for 5 to 10 minutes. Offer the patient a perineal pad. Test-Taking Tip: If you are having trouble with a sequencing question, use your first reading of the choices to pick the last or the first step—or both. Then work toward the middle steps. It's usually easier to spot the last or first steps than to determine the entire sequence on first reading. p. 825

The patient has an order for 2 tablespoons of magnesium hydroxide (Milk of Magnesia). How much medication does the nurse give the patient? 2 mL 5 mL 15 mL 30 mL

30 mL 1 tablespoon = 15 mL; 2 tablespoons = 30 mL. The patient will be given 30 mL of the medication. The other choices are incorrect. p. 814

Which intervention does the nurse implement while administering medications to older adult patients? Select all that apply. One, some, or all responses may be correct. Teach the name and color of the medication. Place the medication between the gum and cheek. Administer the medication slowly. Crush the enteric tablets for a faster effect. Allow time for slower swallowing of medications.

Administer the medication slowly. Allow time for slower swallowing of medications. The nurse should not rush medication administration for older adults. These patients may need additional time to understand the treatment and swallow the medication. The nurse teaches the name and purpose of the medication instead of its color because the color of the medication may vary from one manufacturer to another. Placing medication between the gum and cheek is more appropriate for children taking liquid medication through a dropper. Enteric-coated tablets are used for sustained release. If they are administered in the crushed form, the drug is absorbed all at once, resulting in possible side effects. p. 820

A nurse is preparing to administer ibuprofen. Which trade name is identified as ibuprofen? Select all that apply. One, some, or all responses may be correct. Advil Motrin Paracetamol Nuprin 2-(4 isobutylphenyl) propionic acid

Advil Motrin Nuprin Trade names are also known as brand names. The trade names of ibuprofen are Advil, Motrin, and Nuprin. These are the registered names of the drugs assigned by the drug manufacturer. Each drug has many trade names because one drug can be manufactured by several companies, although each drug will still have a common generic and chemical name. Paracetamol is the trade name of N-acetyl P-aminophenol. The chemical name of ibuprofen is 2-(4 isobutylphenyl) propionic acid, which describes its molecular structure. p. 800

A prescription states that a patient is to take a medication by mouth bid pc. Which dosing instruction does pc elicit from this prescription? Two times a day After meals Before meals Three times a day

After meals The instruction "after meals" is indicated by the abbreviation pc. Bid means twice a day. Before meals is indicated by ac. Tid means three times a day. STUDY TIP: The A of ac is the Latin word ante, which means "before." Think of an anteroom, which is the room that comes before another room, or anterior (front or before). The P of pc is the Latin word post that means "after." You know that post means "after" because you take a posttest after the material has been presented. The C means cibum, Latin for "meals," but you can think of it as meaning "consuming." So ac means "before consuming," and pc means "after consuming." p. 814

The nurse observes that a patient has a rash, itchy skin, inflammation and swelling of the nasal passages, and raised skin eruptions after intravenous drug administration. Which type of drug effect is the patient experiencing? Side effect Toxic effect Allergic effect Adverse effect

Allergic effect Allergic reactions are unpredictable immune responses caused by antibody reactions to antigens. These include rashes, itching, inflammation and swelling of the nasal passages, and raised skin eruptions. Severe allergic reactions are also referred to as anaphylactic reactions. Side effects are predictable but unwanted and sometimes unavoidable reactions to medications. These side effects may be minor, harmless, or harmful. Toxic effects are serious physiologic effects caused by medication overdose or long-term use that may impair metabolism and excretion. Adverse effects are severe, unintended, and unwanted reactions that occur when one drug interacts with another or when a drug interacts with food or after one dose of a single drug. STUDY TIP: Find a medical terminology or dermatology text and look up hives or wheals or search for photos of hives or wheals on the Internet. Once you see the irregularly shaped, raised rashes, you'll be able to identify them quickly in the clinical setting. The visual will help immensely! Adding a visual will help your memory. p. 803

The nurse has been assigned to administer a rectal suppository to an adult patient. Which suppository placement is correct? Along rectal wall, 1 to 2 inches into the rectum Along rectal wall, 3 to 4 inches into the rectum Inner aspect of the anal orifice Just before the internal anal sphincter

Along rectal wall, 3 to 4 inches into the rectum A rectal suppository for an adult should be placed against the rectal wall, about 3 to 4 inches into the rectum. The inner aspect of the anal orifice would not adequately hold the suppository with the rectum. The suppository has to be placed past the internal anal sphincter. p. 825

A patient develops buccal irritation following the administration of a buccal medication for 3 days. Which nursing instruction may have prevented the patient's buccal irritation? Chew the medication. Swallow the medication. Take the medication with water. Alternate the cheeks with each dose.

Alternate the cheeks with each dose. Buccal administration of medication may lead to buccal irritation by erosion of the mucous membrane. This may be very uncomfortable for the patient. Buccal irritation may be minimized by alternating the placement of the medication with each subsequent dose so that a single area is not affected. Buccal medications are not to be chewed, swallowed, or taken with any liquids as the rate of absorption may be affected. p. 281

A patient develops sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath following administration of a medication. Which type of allergic reaction is the patient experiencing? Rhinitis Medication allergy Anaphylactic reaction Idiosyncratic reaction

Anaphylactic reaction The sudden onset of bronchiolar constriction, edema of pharynx and larynx, and shortness of breath indicate the severe form of allergic reaction called anaphylactic reaction. Rhinitis is a minor form of allergic reaction that manifests as sneezing, swelling, and clear nasal discharge. Medication allergy is a nonspecific term and encompasses rhinitis, rash, urticaria, and pruritus. Idiosyncratic reaction is the onset of an unpredictable response in a patient. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers. p. 803

Which action will the nurse take to administer a sustained-release capsule to a new patient who insists that he cannot swallow pills? Ask the health care provider to change the prescription. Crush the pill with a mortar and pestle. Hide the capsule in a piece of solid food. Open the capsule and sprinkle it over pudding.

Ask the health care provider to change the prescription. Enteric-coated or sustained-release capsules should not be crushed; therefore, the nurse would contact the health care provider to change the medication to a form that is liquid or can be crushed. The nurse should never trick patients into taking their medications. This action is not ethical. Some medications are considered safe to open and sprinkle over certain foods; however, this action could alter the medication's absorption rate and may cause injury to the patient. The health care provider should specifically order this route of medication administration. p. 807

The nurse accidentally gives a patient a medication at the wrong time. Which action is the nurse's first priority? Complete an occurrence report. Notify the health care provider. Inform the charge nurse of the error. Assess the patient for adverse effects.

Assess the patient for adverse effects. Patient safety and assessing the patient are priorities when a medication error occurs. Therefore, if a medication is mistakenly given at the wrong time, the nurse should first assess the patient to determine the effects on the patient and intervene to offset any adverse effects of the error. The nurse should follow facility guidelines for medication error reporting, which may include completing an occurrence report, notifying the health care provider, and informing the charge nurse of the error. p. 803

A patient has asthma and receives an inhaled medication. Which local effect of this medication is desired? Inflammation Rebound effect Bronchodilation Increased heart rate

Bronchodilation Respiratory disorders like asthma are caused by constriction of the bronchioles. Therefore, the patient requires inhaled medicines that dilate the bronchioles (bronchodilation) and open the lungs for oxygenation. Steroids are used to treat inflammation. The rebound effect and increased heart rate are systemic effects of nasal medications caused by sympathetic nervous system stimulation. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. For this question, the important detail was that the medication was inhaled. You know the word root bronch/o in bronchodilation means bronchi, so you connect the inhalation with the location of the effect. p. 821

Otic medications can be administered to a patient by using which form of delivery? Select all that apply. One, some, or all responses may be correct. Extraocular disks Eardrops Injections Irrigations Ointments

Eardrops Irrigations Medications that are instilled into the ear are called otic medications. Two types of otic medications are available: eardrops and irrigations. Eardrops are used to treat ear infections and to soften cerumen (ear wax). Irrigations are used to remove foreign bodies and clean the ear canal. Extraocular disks are used to treat eye infections. Injections are parenteral medications, not otic medications. Ointments are not used in the ear because they are difficult to clean and may cause problems with hearing; ointments can be topical or ophthalmic. p. 821

Which regulatory agency is responsible for ensuring that medications undergo vigorous testing before they are made available to the public? Medicare program National Formulary United States Pharmacopeia Food and Drug Administration

Food and Drug Administration The Food and Drug Administration ensures that all medications available in the market undergo vigorous testing to ensure their safety and efficacy. Medicare provides insurance coverage to those aged 65 and over. The Medicare program does not ensure testing of drugs. The National Formulary and United States Pharmacopeia set standards for medication strength, quality, purity, packaging, safety, and dose form. p. 800

A patient is transitioning from the hospital to the home environment, and a home care referral is obtained. Which action will the discharge nurse take in relation to safe medication administration? Set up the follow-up appointments with the health care provider for the patient. Ensure that someone will provide housekeeping for the patient at home. Ensure that the home care agency is aware of medication and health teaching needs. Make sure that the patient's family knows how to safely bathe him or her and provide mouth care.

Ensure that the home care agency is aware of medication and health teaching needs. It is the nurse's or case manager's responsibility to ensure that the home care agency is aware of medication and health teaching needs. The nurse or case manager does this by collaborating with community resources when patients have home care needs or difficulty understanding their medications. The other options do not address the medication needs for the patient. Test-Taking Tip: Focus on key words in the question; in this instance, "safe medication administration" is key. Only one choice addresses the question directly. p. 830

A nurse is administering an eye medication that removes secretions and cleanses and soothes a patient's eye. Which type of ophthalmic medication is the nurse administering? Extraocular disks Eyedrops Eye ointments Eye irrigation

Eye irrigation Eye irrigation or eyewash gently cleanses, removes secretions or foreign bodies, and refreshes (soothes) the eye. For continuous administration of medication, the health care provider may prescribe an extraocular disk, which is similar to a contact lens. The health care provider may prescribe eyedrops for the treatment of eye diseases or irritations. The health care provider may prescribe eye ointments if the patient has an eye infection or irritation. p. 821

A patient informs the nurse that she is taking an herbal supplement daily to control blood pressure. The nurse explains that increased bleeding is a side effect of this herbal supplement. Which herb is the patient taking? Garlic Ginseng Feverfew Ginkgo biloba

Garlic Garlic is an herb and a natural remedy to lower blood pressure and levels of cholesterol and triglycerides. This herb may also cause increased bleeding in a patient. Ginseng is also a natural herb that increases physical stamina and mental concentration, but it may increase blood pressure and heart rate. Feverfew helps in preventing migraines and relieves the pain of arthritis, but it causes increased bleeding. Ginkgo biloba improves memory and mental alertness, but it may also cause increased bleeding. Although all options increase the risk for bleeding, only garlic lowers blood pressure, cholesterol, and triglyceride levels. p. 805

A postmenopausal patient with high blood pressure is experiencing facial flushing and irritability. The patient understands that high blood pressure increases her risk of having a myocardial infarction. Which herb is likely to help the patient reduce blood pressure? Echinacea Ginkgo biloba Garlic Licorice

Garlic Garlic lowers serum cholesterol and blood pressure, making it beneficial in management of blood pressure. Echinacea is helpful for respiratory infections. Ginkgo biloba is helpful for neurodegenerative diseases. Licorice soothes and helps in healing of peptic ulcers. p. 805

A nurse is preparing medications. Which form of medication is absorbed most rapidly? Inhalers Eardrops Eyedrops Coated tablets

Inhalers When an inhaler is used, the medication enters through the nose and mouth into the lower respiratory system, and the medication is absorbed very quickly. Eardrops and eyedrops are absorbed more slowly than inhaled medications. Coated tablets are absorbed from the colon, which means they have a delayed onset of action as they must pass through the digestive system first. p. 809

The nurse has been assigned to administer a rectal suppository to a patient. In which position would the nurse place the patient? Lateral recumbent position Prone position Lateral position Dorsal recumbent

Lateral recumbent position For rectal administration of a suppository, the patient should be placed on the left side with the right knee flexed (lateral recumbent position). The prone position would have the patient lying face down. The lateral position would place the patient on his or her side with legs extended. The dorsal recumbent position would place the patient on his or her back with legs extended. Neither the patient nor the nurse would be comfortable if the patient were placed in the prone position, lateral position, or dorsal recumbent position. p. 825

Which instruction does the nurse give to patients when teaching them about safe application of a transdermal patch? Select all that apply. One, some, or all responses may be correct. Select a bony prominence to apply the transdermal patch. Mark the patch with the date and time before applying. Massage the skin with gentle pressure after applying the patch. Rotate placement sites when applying the patch. Fold the old patch so it sticks to itself before disposing of it.

Mark the patch with the date and time before applying. Rotate placement sites when applying the patch. Fold the old patch so it sticks to itself before disposing of it. Transdermal patches are medicated adhesive patches that are used to deliver medication into the bloodstream. When applying a new patch, the patient should mark it with the date and time. This helps minimize medication errors and serves as evidence should any legal issues arise. The nurse teaches the patient to rotate/change the placement site of the patch to prevent skin irritation. The patient should fold the used patch so that the sticky ends face each other; this may prevent adhesion to other surfaces and cross-infection. The patch should not be applied to a bony prominence as this may decrease the absorption and efficiency of the medication. Gentle pressure, not massage, is used when applying transdermal patches. p. 822

A nurse is teaching a patient about examples of over-the-counter (OTC) medications. Which medication is classified as an OTC medication and will be included in the teaching session? Select all that apply. One, some, or all responses may be correct. Diuretics Vasodilators Mild analgesics Cold medications Nutritional supplements

Mild analgesics Cold medications Nutritional supplements OTC medications are those drugs that can be obtained without a prescription from a retailer. These drugs include mild analgesics, cold medications, and nutritional supplements. Analgesics are common medications used for reducing pain and promoting comfort. Cold medications are used to alleviate the symptoms of a common cold, such as a runny nose and cough. Nutritional supplements include multivitamins, minerals, fiber, fatty acids or amino acids, and iron supplements. Diuretics and vasodilators can be obtained only with a health care provider's prescription and are referred to as prescription drugs. STUDY TIP: Over-the-counter medications are available without a prescription. To help you remember this, draw a silly picture, such as an owl with two big O's for eyes, placed Over a countertop. Write "Over-the-counter" (or OTC) starting with one of the O's and withOut a prescription using the other O. Or think of your Own drawing for "OTC = withOut a prescription." p. 804

The nurse plans to administer a medication that can give immediate relief to a patient. Which parameter of the drug will the nurse check for to find if the drug can provide immediate relief to the patient? Peak concentration Onset of action Plateau concentration Duration of action

Onset of action For providing immediate relief to the patient, a drug should have a faster onset of action. A drug with a slow onset of action may show a delayed effect. Peak concentration refers to the time taken to attain the highest effective concentration and does not provide information related to the onset of action. Plateau concentration is the plasma concentration attained and maintained after repeated fixed doses. Duration is the amount of time for which the drug produces its effect and does not provide information regarding onset of action. Test-Taking Tip: Multiple-choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Before looking at the choices, see if you know the answer and can recall it. Then check what you remembered against the choices. pp. 802-803

The nurse works in a postoperative unit. Which type of primary care provider order warrants an assessment by the nurse to determine if the patient requires medication? PRN order Stat order Standing order Routine medication order

PRN order When a prescriber writes a PRN order, the nurse may use his or her own discretion for administering or withholding medication based on subjective or objective assessment. However, the nurse would perform an assessment to determine if the patient needs the prescribed "as needed" medication. Stat orders refer to single doses of medication to be given immediately or only once. Standing orders and routine medication orders are the same; in either case, the nurse continues the medication as prescribed until the prescriber asks the nurse to stop the medication. p. 807

Which nursing measure is helpful in minimizing medication errors? Select all that apply. One, some, or all responses may be correct. Patient identification Concealing medication errors Medication is administered only by the person who prepared it Properly interpreting illegible prescriptions Double-checking doses

Patient identification Medication is administered only by the person who prepared it Double-checking doses There are many situations that increase the risk of making a medication error and causing patient injury. However, facilities have safeguards in place for preventing medication errors. Safeguards include following facility policies regarding patient identification, administering only medication that you have prepared, double-checking doses, addressing patient questions about medication, and understanding why the patient is receiving a specific medication. Medication errors should be evaluated for their health impact and should be dealt with accordingly; concealing them is ethically unacceptable. Illegible prescriptions should be confirmed rather than interpreted. Test-Taking Tip: If you are anxious about a multiple-response question, read through the choices and then consider which are not correct. It is often easiest to determine the incorrect responses, and then the remainder of the responses may be the answers. For this question, concealing medication errors and attempting to interpret illegible prescriptions are clearly incorrect. p. 817

A patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site. Which condition would the nurse suspect? Sepsis Phlebitis Infiltration Fluid overload

Phlebitis Redness, warmth, and tenderness at the IV site are signs of phlebitis. Sepsis is an infection in the blood stream. Infiltration occurs when an IV catheter becomes dislodged (no longer in the vein) and the medication leaks into the surrounding tissue. Fluid overload occurs when a patient receives too much fluid intravenously. STUDY TIP: Sometimes learning a "fun" fact can help you memorize information, such as the signs of inflammation. The cardinal signs of inflammation as established by early Greek and Roman physicians are the four "or's": rubor (redness), calor (heat—think "calorie"), dolor (pain), and tumor (swelling). p. 830

The nurse has been assigned to administer a suppository to a patient. Which route of administration is suitable for administering a suppository? Oral Skin Rectal Parenteral

Rectal Suppositories are meant to be inserted into the body cavities, such as the rectum or the vagina. The oral route is used for administering tablets, capsules, and liquid medications. Transdermal patches are applied on the skin. The parenteral route generally refers to intravenous injections. p. 808

A nurse works on a geriatric unit. Which physiologic change affecting the metabolism of medication would the nurse be aware of in these patients? Select all that apply. One, some, or all responses may be correct. Reduced liver function Reduced absorptive capacity Reduced functioning of brain receptors Shortening of half-life of drugs excreted through the kidney Reduced function of the immune system

Reduced liver function Reduced absorptive capacity In elderly patients, liver function is grossly reduced, which affects the metabolism of drugs and prolongs the half-life of drugs. The absorptive capacity of the intestines also declines in elderly patients. The brain receptors become more sensitive, and the patients are more susceptible to psychoactive drugs. The kidney function diminishes and the half-life of drugs excreted through the kidney lengthens. The efficiency of the immune system decreases with age, but the immune system does not affect the drug metabolism process. p. 820

The nurse administers an opioid analgesic to a postoperative patient who reports pain at a level of 9 out of 10. Which vital sign does the nurse delegate to the unlicensed assistive personnel for frequent monitoring? Pulse Respiration Temperature Blood pressure

Respiration Respiration should be monitored frequently after the administration of opioid analgesics because these medications may decrease the respiratory rate. The pulse is measured frequently if the medication affects the heart rate. A patient's temperature is monitored after the administration of antipyretics. Blood pressure is measured frequently if the patient is on antihypertensive treatment. p. 819

A nurse is teaching self-administration of insulin to a patient. Which instruction would the nurse include in the teaching? Shake the vial before drawing insulin. Administer regular insulin intramuscularly. Roll the insulin between your palms if the preparation is cloudy. Administer insulin after having meals.

Roll the insulin between your palms if the preparation is cloudy. Cloudy insulin preparations should be rolled between the palms to resuspend them before drawing into syringes. The insulin vial should not be shaken because shaking can create bubbles that can interfere with correct dosage administration. Insulin is given subcutaneously, not intramuscularly. If insulin is taken after meals, it cannot control the rise of blood sugar levels that occurs due to food intake. p. 851

A patient is receiving an intravenous push (IVP) medication. As the nurse is administering the medication, the patient's intravenous (IV) site becomes swollen. Which action would the nurse take first? Continue to let the IV run Apply a warm compress to the infiltrated site Stop the administration of the medication and follow agency policy Do not worry about this because vesicant filtration is not a problem

Stop the administration of the medication and follow agency policy Infiltration occurs when an IV catheter becomes dislodged and is no longer in the vein, allowing medication to infuse into surrounding tissue. Infiltration causes swelling at and around the IV insertion site and usually causes discomfort for the patient. The nurse would immediately stop the administration of the medication and follow the facility's policy. This patient is receiving medication by IVP, not by continuous IV therapy. The nurse may apply warm compresses; however, the first action would be to stop the medication. The question does not tell us what medication is being administered; therefore, we do not know if the medication is a vesicant. High-risk medications require the use of an electronic infusion pump. p. 830

A nurse who is responsible for dispensing medications understands that every patient requires a different dosage for a given drug and that various factors affect the absorption of drugs. Which factor influences absorption? Select all that apply. One, some, or all responses may be correct. Total body weight Body temperature Route of administration Solubility Blood flow to the site of administration

Route of administration Solubility Blood flow to the site of administration Absorption is the passage of a drug from the administration site into the bloodstream. Several factors affect absorption: route of administration, ability of the drug to dissolve or become soluble, blood flow to the administration site, body surface area, and patient age. Absorption of drugs depends on body surface area, not on body weight. Body temperature does not affect the absorption of drugs. STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too. p. 801

A nurse is preparing a topical drug. Which topical drug form provides a local effect to the patient when administered? Select all that apply. One, some, or all responses may be correct. Spray Lotion Cream Patch Powder

Spray Lotion Cream Powder Aerosol sprays, lotions, creams, and powders are topical medications applied to the skin for a local effect. Transdermal patches are designed to absorb medications through the skin and have a sustained systemic effect. p. 821

A diabetic patient has been switched from oral antidiabetic drugs to insulin. The nurse teaches the patient about self-administration of insulin. Through which route would insulin be administered? Intradermal Subcutaneous Intramuscular Intravenous

Subcutaneous Insulin is given as a subcutaneous injection for slower absorption. The intradermal route is used for skin tests. The intramuscular route is used for medications that need a faster absorption and are given in a volume that cannot be given via the subcutaneous route. The intravenous route is used for medications that are administered in a large volume. p. 811

Which type of interaction occurs when a patient consumes an alcoholic beverage with an antihistamine? Side effect Toxic effect Synergistic effect Antagonistic effect

Synergistic effect A synergistic effect is the enhanced effect of one drug in the presence of another drug. Alcohol is a central nervous system (CNS) depressant, but the concomitant administration of alcohol along with the antihistamine drug causes the patient to experience greater CNS depression than normal. Side effects are predictable but unavoidable reactions to medications. Toxic effects refer to harmful effects of the drug, which may be lethal to the patient. Alcohol ingested along with antihistamines may increase a patient's drowsiness but does not normally have a toxic effect. Antagonism refers to the mechanism of action of one drug inhibiting the actions of another drug. Alcohol and antihistamines do not interfere with each other; instead, they enhance CNS depression by working synergistically with one another. STUDY TIP: The prefix syn- means "with" or "together." A synergistic effect, then, is the effect of two drugs taken with each other, taken together. Consider that syndrome is a set of symptoms that all appear together; or that syndactyly is the fingers or toes being fused together. Your clue for this question was that the alcoholic beverage was consumed with an antihistamine. p. 803

An elderly obese patient who has undergone total hip replacement surgery has been prescribed low-molecular-weight heparin (LMWH) enoxaparin. Which information would the nurse inform the patient about subcutaneous administration? Select all that apply. One, some, or all responses may be correct. It produces no discomfort or pain to patient. The medication is absorbed faster due to a rich blood supply. The abdomen is not an appropriate site for subcutaneous injections. The injection site should not be near any bony prominence or large nerves. The medication is injected into the connective tissue below the dermis.

The injection site should not be near any bony prominence or large nerves. The medication is injected into the connective tissue below the dermis. The sites chosen for subcutaneous administration should be far from bony prominences. There should not be any big muscles and nerves underlying the site of injection. These tissues can get injured during administration of injection. The medication is placed into the connective tissue below the dermis for slow absorption. The subcutaneous tissue has pain receptors, therefore the injection may cause pain and discomfort to the patient. The medication is absorbed slowly because the blood supply to the subcutaneous tissue is poor. The abdomen is a suitable site for subcutaneous injections. p. 827

The nurse receives a prescription to begin administering a loop diuretic to a patient with hypertension. Which factor would determine the route for administering the diuretic to the patient? Hospital policy The prescriber's orders The type of medication prescribed The patient's size and muscle mass

The prescriber's orders The factor that would determine the appropriate route for administering a medication to a patient would be the health care provider's order. The prescription from the provider must indicate the route of administration. If this information is not present, the nurse should contact the health care provider for clarification. Hospital policy does not dictate the routes of medication administration; health care providers do. The type of medication prescribed is listed as a diuretic. Diuretics are usually administered via the oral and parental routes; therefore, a patient's size and muscle mass should not be a factor. STUDY TIP: In your study group, discuss problems you have had with receiving unclear prescriptions. How did you handle them? Check the text for the appropriate action for these situations. p. 805

A patient is admitted to the hospital for hernia surgery and is informed of patient rights. Which right does this patient have in regard to medication administration? Select all that apply. One, some, or all responses may be correct. The right to order the medication himself The right to receive unnecessary medications The right to know the name and purpose of medications The right to refuse a medication regardless of the consequences The right to receive unlabeled medications safely without discomfort

The right to know the name and purpose of medications The right to refuse a medication regardless of the consequences In accordance with the Patient Care Partnership and because of the potential risks related to medication administration, a patient has the right to know the name, purpose, action, and potential undesired effects of a medication and has the right to refuse a medication. The patient does not have the right to order medications for himself. The patient has the right not to receive unnecessary and unlabeled medications. p. 817

The nursing student is preparing to administer an antibiotic to a patient. The patient asks the nursing student what the medication is and why he should take it. Which information would the nursing student include when replying to the patient? Only the patient's health care provider can give this information. The student provides the name of the medication and a description of its desired effect. Information about medications is confidential and cannot be shared. The patient has to speak with his assigned nurse about this.

The student provides the name of the medication and a description of its desired effect. If the student nurse is administering the patient's medications, it is his or her responsibility to be familiar with the patient's medications and their desired effects. The student nurse should be knowledgeable and comfortable addressing the patient's questions and concerns; however, the student nurse's clinical instructor should be present as well. The patient's health care provider is not the only one who can provide this information to the patient. A patient's medication is confidential and should not be shared with anyone other than the patient and others who are providing direct patient care. The patient does not have to speak with his assigned nurse. The student nurse was assigned to care for the patient, under the supervision of a clinical instructor or staff nurse; therefore, he or she should be qualified to answer the patient's questions regarding his medications. p. 819

The nurse is caring for an asthmatic patient who is on inhaled steroids. Which rationale explains why the patient is instructed by the nurse to rinse the mouth and perform oral hygiene after each dose? Select all that apply. One, some, or all responses may be correct. To prevent nausea To prevent bronchodilation To prevent oral fungal infections To prevent dryness of the mouth To prevent irritation in the oral mucosa

To prevent oral fungal infections To prevent irritation in the oral mucosa Steroids generally depress the immune system, which may in turn increase the risk of opportunistic fungal infections. When the patient uses inhaled steroids, droplets of the drug are deposited on the surfaces of the oral cavity and may cause irritation of the oral mucosa. Therefore, the nurse instructs the patient to rinse the mouth and perform oral care after inhalation of steroid medications. The patient does not rinse the mouth to prevent nausea; antiemetics are medications to prevent nausea and vomiting. Steroids act by decreasing inflammation of the respiratory tract and facilitate easy breathing by bronchodilation. Mouth dryness can be reduced by sucking on sugar-free sweets, chewing sugar-free gum, or drinking plenty of water, not by rinsing. p. 821

A nurse instructs the patient to release the pinna and press on the tragus several times after instilling eardrops. Which rationale explains the nurse's instructions? Select all that apply. One, some, or all responses may be correct. To prevent nausea To prevent dizziness To prevent systemic effects To prevent ringing in the ear To prevent loss of medication

To prevent systemic effects To prevent loss of medication Releasing the pinna and pressing the tragus help prevent systemic effects and loss of medication. Nausea and dizziness can be prevented by using eardrops at room temperature. Ringing in the ears (tinnitus) is not prevented by these actions. p. 824

A nurse instructs the patient to use eardrops at room temperature. Which rationale supports the nurse's instructions? Select all that apply. One, some, or all responses may be correct. To reduce pain To prevent nausea To prevent loss of medication To prevent dizziness To ease removal of earwax

To reduce pain To prevent nausea To prevent dizziness The internal ear is very sensitive to temperature changes; therefore, the nurse would recommend using eardrops at room temperature. This reduces pain associated with ear infections, prevents nausea, and prevents dizziness. To prevent loss of medication, the ear pinna is released immediately after administration of the medication. Eardrops may be used to soften and help in easy removal of earwax; however, ease of earwax removal is not associated with temperature. p. 821

A nurse is preparing to administer an intramuscular injection for a 6-month-old infant. Which site would the nurse choose? Deltoid Vastus lateralis Dorsogluteal site Ventrogluteal site

Vastus lateralis The selection of intramuscular injection site depends on the age of the patient. Intramuscular injections are administered into the vastus lateralis muscle for infants. Intramuscular injections are injected into the deltoid in children and adults. The dorsogluteal site is not recommended for infants, children, or adults. Intramuscular injections are injected into the ventrogluteal site in adolescents and adults. STUDY TIP: Use visuals to enhance your memory. Draw a picture of an infant even if you are not a great artist! Draw the vastus lateralis muscle (the most lateral of the four quadriceps muscles). Write the word intraMUSCULAR on the vastus lateralis. Add details to the infant to help you remember he or she is an infant, such as booties, a pacifier, or a rattle. Color the vastus lateralis the same color as the items that mean "infant" to you. p. 811

The nurse is administering prescribed medications to patients on the unit. The nurse would compare the label of the medication container with the medication administration record (MAR) during which circumstance? Select all that apply. One, some, or all responses may be correct. Comparison of the label with the MAR is not required When performing any dosage calculation Twice daily regardless of administration to patient When preparing the medication When returning the medication to its storage place

When performing any dosage calculation When preparing the medication When returning the medication to its storage place Before administering a medication, the nurse carefully reads the medication record and should conduct three checks with the labeled medication. The first check consists of verifying that the label of the medication matches the MAR, performing any dosage calculation, and checking the expiration date of the medication. The second check consists of preparing the medication and again checking the medication label against the MAR. The third check is a recheck of the label on the medication before returning the medication to its storage place or a recheck of the medication label a final time against the MAR before opening the package at the bedside. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p.817

The nurse is administering medications to a 4-year-old patient. After the nurse explains which medications are being given, the mother states, "I don't remember my child having that medication before." Which action would the nurse take next? Give the medications. Identify the patient using two patient identifiers. Withhold the medications and verify the medication prescriptions. Provide education to the mother to help her better understand her child's medications.

Withhold the medications and verify the medication prescriptions. The nurse would withhold the medications and verify the medication prescriptions with the health care provider. The nurse should not ignore patient or caregiver concerns; always verify orders whenever a medication is questioned before administering it. Identifying the patient using two patient identifiers would not correct the wrong medication. Once the medications have been verified by the health care provider, the nurse may need to provide education to the mother, especially if there has been a change to the medication regimen. Test-Taking Tip: For medication questions, ask yourself, "What is the safest response?" p. 833