Pharm Final Exam/ Chapters 63-64

What are Types of IVs?

Central lines, central venous access devices (CVAD), or central venous catheters •The short central venous catheter •The PICC line •The midline catheter Infusion ports

What is Enteral administration?

-Administration by way of the digestive tract -Oral, buccal, and via gastrointestinal tubes

What does TPN contain?

-Amino acids, dextrose (10% to 70%), and electrolytes -Lipids (fats), vitamins, and trace elements such as zinc, copper, manganese, or chromium

What must be done before medications can be administered?

-Interpret the medication order exactly. -Follow administration instructions accurately. -Be familiar with commonly used abbreviations, acronyms, and terminology. -Know how the facility stores and supplies or dispenses medications. -Know the proper measures for documenting that the client did or did not receive them.

What are Common methods of injections?

-Intradermal, subcutaneous (SC),intramuscular (IM), and IV -Intracardiac, intramedullary, intrathecal, intraosseous, and intraperitoneal

What are Injection or intravenous (IV) infusions?

-More invasive than administration by mouth, rectum, or through the skin

What are the most commonly used IV solutions?

-Normal saline (0.9% NS or 0.9% NaCl) -5% Dextrose in normal saline (D5NS) -5% Dextrose in sterile water (D5W) -5% Dextrose in 0.45% normal saline

What are the "Five Rights, Plus Two" of medication administration.

-Right client -Right medication -Right dose -Right time -Right route •Sixth "right"—right documentation •Seventh "right"—right programming, when using pump administration

What can be checked for safety to identify The RIGHT CLIENT is given the medication?

-The identification band -Asking the client's name -Asking the client's birth date -Corroboration by another responsible person

What is the definition of Venipuncture (Phlebotomy)?

-The process of puncturing a vein for the purpose of obtaining a blood specimen or establishing an IV access site

What is equipment needed for a Venipuncture?

-Vacutainer system -Butterfly needle

•What is Parenteral administration?

Administration into any part of the body other than by way of the gastrointestinal tract

The nurse obtains a medication that has a label damaged by a water spill. What is the appropriate action by the nurse? a. Return the container to the pharmacy. b. Change the label. c. Use the medication. d. Discard the medication in the trash.

Answer: a Cognitive Level: Apply Explanation: All medications must be properly labeled, with the client's name, medication name, dosage, and expiration date. If a label is illegible, return the container to the pharmacy for replacement. A nurse NEVER relabels a medication. The nurse cannot determine with certainty what the medication is with a damaged label and should not use the medication. The medication waste should never be placed in a trash receptacle to ensure that it cannot be used by anyone.

A client is scheduled to take a narcotic for pain but when the nurse offers it, the client states it is not needed. How should the nurse dispose of the medication? a. Have another nurse witness and cosign the waste. b. Throw it in the trash in the client's room. c. Return the medication to the pharmacy. d. Pour the medication down the sink.

Answer: a Cognitive Level: Apply Explanation: Have a witness cosign if a controlled substance is being discarded or returned. The nurse is legally required to maintain an accurate record of all controlled substances. The nurse should be sure never to ask another nurse to cosign a waste without observing it directly. Medications to be disposed of, as well as all medication packages, are usually required to be placed in the hazardous waste receptacle, not in the general trash or the sink. The pharmacy does not take back medication that has been refused and the medication should be disposed of properly.

The nurse is withdrawing medication from a new multiuse vial. After use, what action does the nurse perform? Select all that apply. a. Label the vial with the time opened. b. Label the vial with the nurse's initials. c. Label the vial with the client's name. d. Label the vial with the date first used. e. Discard the vial since it should not be used again.

Answer: a, b, d Cognitive Level: Apply Explanation: All multidose vials should be labeled with time, date, and the nurse's initials, detailing first use. Since the vials will be able to be used again for other client's, it is unnecessary to put the first client's name on the vial. It is not necessary to discard it since it can be used again.

The nurse is administering medication to a client. The client states, "I don't take this medication." What is the best response by the nurse? a. "You need to take your medication so that you can get well." b. "I will go and double check the order." c. "It probably doesn't look like the one you take at home, but I'm sure it's the same." d. "I will just document that you refuse the medicine."

Answer: b Cognitive Level: Analyze Explanation: If a client questions a medication, says it is the wrong medication, or says he or she has an allergy, stop and double-check. Do not give the medication until you are sure it is correct. Report and document what occurred. Most clients are knowledgeable about their medications, providing an extra safety factor. Double checking and explaining help clients to understand if medications are correctly prescribed for them. If it was an incorrect medication, an error has just been prevented. The nurse should never force clients to take the medication or be condescending and tell them they will get well. The client in this scenario is not refusing the medication.

The nurse is preparing to administer a medication via the subcutaneous route that requires 1.5 mL of medication. What is the priority action by the nurse? a. Administer 1.5 mL in one site. b. Divide the dose and use two sites. c. Notify the charge nurse the medicine can't be given. d. Obtain a larger syringe.

Answer: b Cognitive Level: Application Explanation: The subcutaneous (SC) method is used for small amounts of medication that require slow, systemic absorption. Generally, the duration of SC medications is longer than that of other parenteral medications. If the volume of medication is greater than 1 mL, the subcutaneous route is usually not recommended or two sites must be used. It is not appropriate to use 1.5 mL in one dose. The nurse is able to make the decision to divide the dose into two sites without notifying the charge nurse. Obtaining a larger syringe does not address the issue in the scenario.

The nurse is working on a busy acute care unit. At 1300, a client states to the nurse, "I was supposed to take my medication with my meal at 9 o'clock. " What action by the nurse is appropriate? a. Inform the client that it is too late to take the medication now. b. Omit the dose for the day. c. Report the error to the charge nurse. d. Double the dose at 0900 the next morning with breakfast.

Answer: c Cognitive Level: Apply Explanation: If a medication has been forgotten, report this promptly. This is a medication error. The nurse cannot double the dose the next day without a care provider's order since this can have detrimental effects on the client. The nurse should notify the charge nurse so that an order may be obtained for correction.

The nurse is preparing to administer medications to a client but observes there is no identification bracelet. What is the best action by the nurse? a. Take the client's word that he is who he says he is. b. Have another nurse identify the client. c. Do not administer the medication until the ID band has been replaced. d. Only administer the most important medication and then get the ID bracelet.

Answer: c Cognitive Level: Apply Explanation: The best way to identify a client is to check the wristband. It is important to check the client's medical record number, as well as his or her name because many clients have common names or similar names. Do not administer medications if the client does not have a wristband. (A nametag taped to a bed or door does not necessarily mean that this is the correct client.) The client that is disoriented may give a false name and should not be used as the only method of identification. Having another nurse identify the client should only be used as a last resort.

The nurse is administering an immunization to an 18-month-old child. What site does the nurse use to administer this injection? a. Deltoid b. Ventrogluteal c. Vastus lateralis d. Dorsogluteal

Answer: c Cognitive Level: Understand Explanation: The vastus lateralis is a thick muscle located on the anterior, lateral area of the thigh. This muscle may be used for intramuscular injections in infants and children younger than 3, because it is the largest muscle mass in this age group. Little risk of injury exists with this site, because no large nerves or arteries surround the area. The nurse should not use the deltoid, ventrogluteal, or dorsogluteal to administer an injection to an 18-month-old.

When preparing to administer an intramuscular injection into the dorsogluteal area, what instructions should the nurse give to the client? a. Stand and bend over the stretcher. b. Sit in the chair and expose the upper arm area. c. Lie on your back and bend the knees. d. Lie on your side and bend the knees.

Answer: d Cognitive Level: Apply Explanation: For the dorsogluteal site, the nurse assists the client to a side-lying or prone position. If the client is on the side, instruct him or her to bend the knees. If on the stomach, instruct the client to point the toes inward because this positioning aids in relaxation of the gluteal muscles, making the injection more comfortable. Standing over and bending over the stretcher will cause the muscles to contract and make a more painful injection. Lying on the back will obstruct access to the injection site. The upper arm area is the deltoid region.

The nurse is preparing to administer an intradermal tuberculin skin test. What type of needle should the nurse place on the syringe? a. 22 G with a 5/8 in bevel b. 20 G with a ¾ in bevel c. 18 G with a ¼ in bevel d. 25 G with a 3/8 in bevel

Answer: d Cognitive Level: Understand Explanation: When administering an intradermal medication, needles should be 25- to 26-G with a ⅜-in intradermal bevel. The intradermal bevel is blunter than a regular bevel and allows easier access to the epidermis. Regular-bevel needles are much more difficult to use for intradermal injections because their added length makes it almost impossible not to enter the dermis. Because the dermis contains blood vessels, the medication would be absorbed too quickly, causing an unwanted systemic reaction and defeating the purpose of the test. The other size needles in this scenario are not appropriate for this type of injection.

Is the following statement true or false? A nurse must always dispose of all syringes and needles in the hazardous waste container.

False Always dispose of all syringes and needles in the sharps container to prevent needlestick injuries to nurses and environmental personnel. A needlestick injury can cause serious infections and/or other disabilities. The hazardous waste container does not protect against needlesticks or injury from broken glass. The sharps container is managed using special procedures.

Is the following statement true or false? Enteric-coated or time-release medications may be crushed and given by nasogastric (NG) tube.

False Crushing an enteric-coated or time-release medication may interfere with its desired action. Only medications specified as enteral may be given via G-tubes.

Is the following statement true or false? Differences in color and shape of a medication mean that the medication is incorrect.

False Differences in color and shape of a medication may be due to a change in the dosage, the manufacturer, or because they are now receiving a generic form of the medication. Differences do not necessarily mean that the medication is incorrect, although it is important to verify that the correct medication is being administered.

Is the following statement true or false? A medication should be referred to as an IV push if it is to be given over a period of time.

False Do not refer to a medication as an IV push if it is to be given over a period of time. The procedure may be identified as "an IV to be given over 5 minutes or over 10 minutes," for example.

Medications may be given by _____________are also called a bolus.

IV "push," •The push introduces a concentrated dose of medication directly into the circulatory system. •This injection is given in a short period of time and is not intermittent. •In some cases, a "smart pump" is used.

What are Local effects by topical application?

May be applied to the mucous membranes of the eye, mouth, nose, throat, vagina, or rectum by instillation, irrigation, swabbing, or spraying.

What are Systemic effects?

Medications are administered by transdermal application, mouth, or injection, although other methods, such as nasal inhalation, can also produce systemic effects.

Is the following statement true or false? In addition to the client's history of drug allergies, the nurse must also document food allergies and allergies to latex.

True In addition to documenting a client's history of drug allergies, the nurse should also document food allergies, and allergies to OTC products, tape, or latex. Regular gloves, catheters, and tourniquets contain latex. In most facilities, latex-free products are used as much as possible. Always double-check for allergies before giving medications or performing any procedures.

Is the following statement true or false? A medication that is ordered for 1000 hours, may be administered anytime between 0930 hours and 1030 hours and still be considered "on time."

True Most facilities allow 30 minutes on each side of the scheduled time for administering medications. Deviation from the "time window" is considered a medication error.

Is the following statement true or false? Total parenteral nutrition can be administered only by way of a large central venous catheter.

True Total parenteral nutrition (TPN) can be administered only by way of a large central venous catheter because it is very concentrated. A peripheral blood vessel would not have sufficient blood flow to dilute the TPN solution.

Total parenteral nutrition (TPN), formerly known as hyperalimentation, is also called__________________________________________?

central parenteral nutrition (CPN).

Infusion of TPN requires insertion of an IV line in a large blood vessel,___________________________________or the superior vena cava (SVC line).

the internal jugular vein in the neck (an IJ line)

What are guidelines for checking The RIGHT TIME?

•Administer medications as ordered to maintain the medication's therapeutic effects. •Deviation from the "time window" is considered a medication error. -STAT doses -PRN doses -Hour of sleep (bedtime) doses

What are guidelines for checking The RIGHT ROUTE?

•Administering a medication by the wrong route, even though it is the correct medication, could be fatal. •Medications are absorbed at different rates, depending on the route of administration. •Dosages may be different when using different routes.

What are Nursing Considerations for IV ADMINISTRATION?

•Calculate the dosage correctly, double-check all IV push medications. •Confirm that the IV catheter is in the vein and the fluid is flowing freely. •If it appears that the IV is infiltrated, the push should not be given. •If IV push medication is injected into surrounding tissue rather than the vein, serious problems can occur, including an abscess or tissue sloughing. •If an IV push is given too fast, it can cause very serious complications, including death.

What is done in Determining Venous Access Sites?

•Choose a vein by considering its size for the purpose, length of time the vein will be accessed, mobility requirements, and comfort for the client. •Peripheral veins may be partially collapsed in a dehydrated client. •A longer needle may be needed for an obese client. •Special techniques may be required for small children and infants because they have smaller veins. •Access may be difficult in older adults and clients who are very ill.

What is listed on a Medication Administration Record (MAR)?

•Client's name •Medication's generic name •Dosage •Administration route •Scheduled times

What are guidelines for checking The RIGHT MEDICATION?

•Compare and confirm the medication's name and dosage with the client's MAR. -The first check is on removing the medication from the storage area. -The second check is when scanning it and placing it in the medication cup or envelope. -The third check is on opening the medication unit-dose package at the client's bedside. •Do not administer a medication that someone else has prepared or to a client assigned to another nurse.

What are guidelines for checking The RIGHT DOCUMENTATION?

•Documentation is an important part of medication administration. •Actions not documented are considered not to have been done. •It is necessary to check the MAR before giving any PRN medications and to document all PRN medications immediately on giving them.

What are guidelines for checking The RIGHT DOSE?

•Double-check that the amount of medication supplied matches the amount needed for the ordered dose. •Calculate a dose if the supplied medication is not exactly the same amount as the ordered dose. •Verify that the dose ordered is appropriate for the client. •Recheck the MAR, order, and medication label before giving the medication.

What are considerations for Administration of Intravenous MEDICATION?

•Ensure that the label of the medication to be infused states that it is safe for IV administration. •A medication given IV, even though it may be the correct medication and in an IV form, must be also given in the correct dosage. Never administer IV medications into tubing that is infusing blood or blood products or TPN solutions

What is Intravenous Administration?

•Fluids are administered via the circulatory system -Central line -Peripheral line •Primary, tandem, piggyback infusions •Infusion •Transfusion •Complications when working with IVs -Infiltration, phlebitis, embolism (thrombus), infection (sepsis)

What are examples of Pumps and Controllers?

•Infusion pumps •Electronic infusion controllers •Patient-controlled analgesia and portable pumps •Microdrip setup •Regulating the infusion rate -Calculating the rate of infusion •Correct programming of controllers and pumps is the "seventh right" in the guidelines for administration of medications

What are Parenteral Administration Methods?

•Injection •Vaginal administration •Eye (ophthalmic) administration •Ear (otic) administration •Nasal or respiratory administration -Inhalants and aerosol systems -Nasal sprays or drops Transdermal administration

What are Reasons for Administration of Medication by Injection?

•It is the most effective methods of administration. •Any other form of administration is unavailable. •The desired action is achieved quickly. •Dosage accuracy is critical. •The client cannot retain oral medications. •The client is unable or unwilling to swallow oral medications. The digestive system cannot absorb the drug.

What are other Considerations in Giving Medications?

•Medication errors •Medication compliance •Client refusal -Document client refusal or held medications. •Proper disposal of medication packages -Never sign that the disposal of a controlled substance was witnessed if the actual disposal was not seen. •Discontinued or changed medications

What are measures taken in setting up medications?

•Observe facility's routine for administering medications. •Follow universal rules for safe administration. •Check the order with the MAR. •Check for client allergies. •Set up medications for one client at a time. •Compare each medication label with the MAR. •Measure the dose with appropriate equipment.

What are Enteral Administration Methods?

•Oral administration •Sublingual administration •Translingual administration -Orally disintegrating tablets -Buccal administration -Administration through a gastric tube •Rectal administration

What are Types of Preparations of Injectable Medications?

•Powders that must be reconstituted with a diluent •Premixed by the manufacturer •Ampule -Discard any unused portion of an ampule's contents because there is no way to prevent contamination of an open ampule. •Vial Prefilled syringe

Enteral Versus Parenteral Administration?

•Rate of absorption •Onset of action

What are Safety Goals for Administration of Medications?

•Safe administration of medications is an absolute priority. •Improve the accuracy of client identification. •Improve the effectiveness of communication among caregivers. •Improve the safety of using medications.

What is proper storage for medications?

•Separate storage area or "med room" •Locked movable carts •Special med room refrigerator •Computerized dispensing machine •Locked medication cabinet •A nurse NEVER relabels a medication •If a label is illegible, return the container to the pharmacy for proper identification and labeling

What are Intradermal Injections?

•Shallow injections given just beneath the epidermis -Often used for diagnostic testing -Inner aspect of the forearm; the back may be used -Tuberculin syringes •Instruct the client not to scratch or pinch the site

What are some dispensing and supply systems called?

•Stock supply •Unit-dose systems •Automated systems •Self-administered medications

What are Signs of IV Infiltration?

•Swelling/puffiness •Coolness •Leaking fluid •Pain at the insertion site •Feeling of hardness

What are Types of Syringes and Injection Methods?

•The safety syringe •Needleless systems •Systems for various injection methods -SC injections -IM injections -Intradermal injections

What is a Volume-Controlled Infusion?

•The solution to be used to dilute the medication is supplied in a small bag that is hung on an IV pole and a volume-control device is hung below it. •After priming the tubing, the ordered amount of diluent is run into the volume-control chamber and then, the prescribed medication is injected into the intake port of the chamber. •This infusion is often given piggyback. •The rate of administration must be carefully controlled.

What are Desired and Undesired Effects of medications?

•Therapeutic effect •Adverse effect •Serious adverse effect •Anaphylaxis •Medication toxicity •Paradoxical effect Potentiation

What is some client teaching that is done for medications and administration?

•What medications they are given (generic and trade name), and why they are taking them •Dosage and frequency, and how to administer or take them at home •Expected effects and possible undesirable side effects •How long they will need the medications and what to do if they miss a dose •Signs and symptoms clients should report to healthcare provider

What are guidelines for checking The Right Programming?

•When medications are given by programmable pump, the programming must be done as carefully as if the medication were to be given by the nurse.