UWorld Medication Administration

The nurse reinforces teaching to a parent of a 2mo client regarding admin of oral liquid meds. The nurse knows that the parent understands the teaching when the parent performs which action? 1. Admins the med in small amounts at back of cheek using syringe. 2. Allows client to sip med from cup 3. Expels the med from a dropper onto back of tongue 4. Mixes med in infant's bottle of formula

1 Notes about 2: Although cup feeding may be a method used for infants in specific cases, med admin requires more accurate measurement. Syringe can provide accurate measurement and decrease risk of waste due to infant's spitting or drooling. Notes about 3: Infants, especially less than 4mo, have extrusion reflex (outward extension of tongue when touched) and decreased gag reflex. Dispensing med onto back of tongue would increase risk of aspiration. Notes about 4: Med should never be mixed in bottle of formula as infant may not consume entire amount.

A nurse is caring for 4 clients. Which prescription by the HCP would the nurse question and seek further clarification before admining? 1. 0.45 Na for client w/severe gastroenteritis who had 12 episodes of diarrhea and vomiting in the past 4 hours. 2. IV bolus of 1000mL 0.9 NaCl solution for a client in anaphylaxis due to food allergy. 3. IV bolus of 1000mL 0.9 NaCl solution for a client with DKA who has a serum glucose level of 650 mg/dL 4. IV mannitol 25% solution for a client with closed head injury who is exhibiting signs of ICP

1 Nurse should question the admin of hypotonic IV solution to replace GI tract fluid losses as this would create a concentration gradient and shift fluid out of the IV compartment and into the interstitial tissues and cells, worsening the client's fluid volume deficit. Isotonic IV solutions (0.9% NaCl, LR) have the same osmolality as plasma and are administered to expand IV fluid volume. These solutions replace fluid losses commonly associated with vomiting and diarrhea, burns, and traumatic injury. - Notes about 2: Anaphylaxis causes increased capillary permeability, leaking IV fluid into free spaces, putting client at risk for hypotension. Therefore, isotonic solutions should be given to such clients. Notes about 3: Extreme hyperglycemia results in osmotic diuresis and dehydration. The immediate initial treatment is IV fluid resuscitation with isotonic 0.9@ NaCl to replace fluid loses, stabilize vital signs, reestablish urine output, and dilute the serum glucose concentration before initiating insulin therapy. Notes about 4: Client with head trauma is at risk for ICP due to inflammation and cerebral edema. IV mannitol is an osmotic diuretic that reduces cerebral edema by pulling water from the cerebral cells into the vasculature.

The nurse is reinforcing teaching on self-admining opthalmic lubricating ointment med to a client with newly diagnosed Sjogren's syndrome. Which client statement indicates need for further teaching? 1. "After applying the ointment, I'll close my eyes tightly and tube the lid for 2-3 mins." 2. "I'll squeeze a thin strip of ointment on my lower eyelid from the inner to outer edge." 3. "I'll tilt my head back, pull my lower lid down, and look upward when admining the ointment." 4. "I'll use my ointment at bedtime and my eyedrops during the day."

1 Opthalmic ointment replaces tears and adds moisture to the eyes. They are prescribed to treat dry eyes, which is a common symptom with the autoimmune disorder of Sjogren's syndrome. After admining: (1) Wash hands (2) Tilt the head back, pull lower lid down and look upward (3) Squeeze a thin strip of ointment onto the lower eyelid, from inner to outer edge (4) Close the eyes gently for 2-3 mins after applying ointment

The clinic nurse is reinforcing client teaching about the tiptropium that has been prescribed for COPD. Which statement indicates that the client has a correct understanding of this med? 1. "A capsule holds the powdered med that I put in a special inhaler." 2. "I do not need to rinse my mouth our with water after taking tiotropium." 3. "I have been taking tiotropium every time I have difficulty breathing." 4. "Tiotropium helps control my COPD by reducing inflammation in my airway."

1 Tiotropium or Spiriva is a long-acting, 24 hour anticholinergic inhaled med used to control COPD and is administered via capsule-inhaler system called HandiHaler. As the client inhales, the powder is dispersed through the hole. Capsules should not be swallowed and that the button on the inhaler must be pushed to allow for med dispersion. - Notes about 1: Clients should rinse their mouth after using tiptropium and inhaled steroids like beclomethasone, budesonide, and fluticasone. This is to remove any med remaining in the mouth, which decreases risk of developing thrush. Notes about 3: Tiotropium is a controller med for COPD and the peak effect takes about a week. Therefore, short-acting bronchodilators (such as albuterol and/or ipratropium) should be used for symptom rescue. Clients must discontinue ipratropium before taking tiptropium as both are anticholinergics. Notes about 4: Anticholinergics in the -IUM category does not reduce inflammation in the airway. Instead, they relax the airway by blocking the parasympathetic bronchoconstriction and also dries up airway secretions.

The nurse is preparing client meds at the nurse's station. The nurse should perform which actions to be consistent with client safety practices r/t med admin? SATA. 1. Check lab values before administering anticoagulants 2. Compare med, dosages, routes to prescriptions prior to administration 3. Discard any unlabeled meds 4. Open unit dose packages and place meds in a dispensing cup to take to the bedside 5. Wear gloves to handle unopened individual unit dose med packages

1, 2, 3 Notes about 4: Individual dose packages should be opened at the client's bedside and place in a med cup only immediately before admining. Notes about 5: Gloves are generally not required during med prep/handling of unopened packages or vials. However, hand hygiene should be performed both prior to preping/handling + before admining. Nurse should wear gloves during med admining when coming into contact with a route that is potentially contaminated by blood or other body fluids. Such as admining IM/SQ injections, accessing closed IV tubing system, or placing a pill into a client's mouth using fingers.

A client is diagnosed w/HTN has been prescribed clonidine patch. Which instructions should nurse include to reinforce prior teaching? SATA. 1. Apply patch to upper arm or chse 2. Fold used patches in half with sticky sides together before discarding 3. Remove patch if dizziness occurs when getting up 4. Rotate sites each time a new patch is applied 5. Shave hair before applying patch

1, 2, 4 Clonidine is a potent anti-HTN agent and patches should be replaced every 7 days and can be left in place during bathing. Instructions include: (1) Apply patch to dry, hairless area on upper outer arm or chest. Do not shave area as skin should be free from cuts, scrapes, calluses or scars. (2) Wash hands with soap and water before + after application as some med may remain on hands afterwards (3) Wash area with soap and water, then rinse and wipe with clean, dry tissue. Rotate sites of patch application each new patch. (4) Notify HCP if experiencing side effects such as dizziness or bradycardia. Do not remove patch w/o discussing w/HCP as rebound HTN can occur

The practical nurse observes a student nurse admining ear drops to an elderly client to help loosen cerumen. The nurse intervenes when the student performs which action? 1. Instills ear drops at room temp 2. Instills ear drops w/dropper by occluding ear canal 3. Places cotton ball loosely in outermost auditory canal after instillation 4. Pulls pinna up and back and instills drops

2 Apply gentle pressure to tragus after instillation if this does not cause pain as this facilitates flow of med into ear canal. Intstruct client to remain side-lying for at least 2-3 mins to facilitate med distribution and prevent leakage. Place cotton ball loosely in client's outermost ear canal for 15 mins PRN to absorb excess meds. Avoid this in infants or toddlers as cotton ball is a choking hazard.

The nurse observes a client self-administering nasal fluticasone. Which observation would require the practical nurse to intervene and reinforce the instruction provided by the RN? 1. A sitting position is assumed as the head is bowed slightly forward 2. The client points the spray tip toward the nasal septum during instillation 3. The nasal spray tip is inserted into the nostril as the other nostril is occluded 4. While admining the med, the client inhales deeply through the nose

2 Assume a high Fowler's position with head slightly tilted forward. Insert the nasal spray nozzle into an open nostril, occluding the other nostril with a finger. Point the nasal spray tip toward the side and away from the center of the nose then spray the med into the nose while inhaling deeply. Remove the nozzle from the nose and breathe through the mouth and repeat the above steps for the other nostril. Lastly, blot a runny nose with a facial tissue but avoid blowing the nose for several minutes after instillation.

The nurse is teaching a client to self-admin enoxparin SQ for outpatient treatment of DVT. Client points to site of planned injection. Which site indicates client understands the instructions? 1. Outer two-thirds of mid thigh 2. Right side of the abdominal area, 2 in away from umbilicus 3. Upper arm in the deltoid muscle 4. The ventro-gluteal area below the iliac crest

2 Enoxaparin is a low-molecular-weight heparin used in prevention and treatment of DCT. It is administered as a deep SQ injection and usually in the abdomen, on the right or left side at least 2 in away from the umbilcus. An inch of skin should be punched up and the injection made into the fold of skin with the needle inserted at a 90-degree angle.

A nurse in a pediatric client is preparing to admin ear drops to a 5yo. Which is an appropriate action by the nurse? 1. Have the child sit upright with the chin tilted down 2. Pull the pinna upward and back 3. Remove the med from the fridge just before use 4. Touch the dropper to the entrance of the ear cannal

2 In adults or children age 3 or older, the pinna is pulled upward and back to straighten the external ear canal. Notes about 1: Child should be in prone or supine position with head turned to appropritae side. Notes about 3: Otic meds should be warmed to room temp as cold drop can cause vestibular reactions resulting in dizziness and vomiting. Notes about 4: Med dropper should be held near the entrance without touching it, allowing drops to fall against wall of canal and reducing comfort while avoiding contamination of dropper. After instillation, child should remain with affected ear up for several minutes to allow full coverage of meds.

The nurse is preparing to give a heparin injection to a client who is malnourished and cachetic. Which method of injection would be appropriate for this client? 1. 27 gauge of 1/4in ID 2. 18 gauge of 1/2in SQ 3. 25 gauge of 1/2in IM 4. 18 gauge of 1 1/2in IM

2 When administering SQ anticoagulant injections ending in the -ARIN category, the nurse must select the appropriate needle length and angle to avoid accidental IM injection, especially in clients with cachexia that have insufficient adipose tissue. IM injection of heparin would cause rapid absorption, resulting in a hematoma and painful muscle irritation. The nurse should administer SQ injections at 90* if 2in of SQ tissue can be grasped or at 45* if only 1in of SQ tissue can be grasped. Anticoagulants are best absorbed if admin in abd at least 2in away from umbilicus.

The nurse is preparing an injection of IM haloperidol from a glass ampule. Which of the following actions by the nurse is appropriate? SATA. 1. Attaches an 18-gauge injection needle to a syringe for withdrawal of meds 2. Breaks the ampule neck away from the nurse's body to prevent injury from the glass 3. Disposes of the empty glass ampule in a sharps container 4. Injects air into the glass ampule prior to withdrawing meds 5. Rests and steadies needle on ampule's outer rim to withdraw meds

2, 3 When prepping meds from a glass ampule (1) Flick upper stem with fingernail (2) Use gauze to break neck away from body (3) Withdraw med using filter needle (4) Replace filter needle with injection needle (5) Dispose ampule and filter needle in sharps container - Notes about 1: Glass shards may be present in meds after ampule is opened. To prevent accidental admin of glass shards, nurse must use filter needle, rather than injection needle when withdrawing meds. Notes about 4: If air is injected into glass ampule, contents will spill from container Notes about 5: Ensure that filter needle does not touch glass edges, which are not sterile, as this can introduce bacteria

The pediatric nurse is preparing to admin acetaminophen suppository to 11mo w/pyrexia. Which actions are appropriate? SATA. 1. Advance past external sphincter only 2. Guide suppository along rectal wall 3. Hold buttocks together firmly after insertion 4. Position client supine with knees and feet raised 5. Use gloved fifth finger for insertion

2, 3, 4, 5 Age-appropriate explanations and/or distractions should be implemented to reduce stress. Toddlers and infants may benefit from distraction w/toy while preschoolers and older children can be instructed to take deep breaths or count during procedure. Basic steps for suppository admin include: (1) Applying clean gloves and positioning client appropriately based on age and size. For less than 3yo, child is supine with knees and feet raised. For more than three years old, they are lying on their sides with knees bent. (2) Lubricate tip of suppository w/water-soluble jelly as petroleum-based can reduce absorption. (3) Insert suppository past internal sphincter using fifth finger if the child is under 3yo, as use of index could cause injury to colon or sphincters. (4) Angle suppository and guide it along rectal wall, as it should remain in contact w/rectal mucosa and not buried inside stool, as this will ensure systemic absorption. (5) Hold buttocks together for several mins or until urge to defecate has passed, as this will prevent immediate expulsion. (6) If bowel movement occurs within 10-30 mins, observe for presence of suppository - Notes about 1: Suppository must be inserted past both external and internal sphincters, as improper insertion may expel suppository before achieving therapeutic effect

The nurse precepts a student caring for a client w/glaucoma and observes the student admin timolol maleate, an opthalmic med. Which student action indicates that further instruction is needed? 1. Instructs client to close eyelid and move eye around, applying pressure to lacrimal duct for 30-60 secs. 2. Pulls lower eyelid down gently with thumb or forefingers against bony orbit to expose conjunctival sac. 3. Removes dried secretions with moistened sterile gauze pads by wiping from outer to inner canthus. 4. Rests hand on client's forehead and holds dropped 1-2cm above conjunctival sac

3 Nurse dons clean gloves and uses aspectic technique to admin opthalmic med. Joint Commission disallows use of abbreviations for R eye (OD), L eye (OS), and both eyes (OU). Nurse must verify prescription if HCP uses these abbreviations. Admin includes following in sequence (1) Remove dried secretions w/moistened warm water or NS sterile gauze pads by wiping from inner to outer canthus to keep eyelid and eyelash debris from entering eye and preventing transfer of debris into lacrimal duct (2) Placing client in supine or sitting position w/head tilted back towards side of affected eye, preventing excess med from flowing into lacrimal duct and minimizing systemic absorption through nasal mucosa (3) Resting hand on client's forehead and holding dropper 1-2cm above conjunctival sac, keeping the dropper away from eye globe and avoids contamination (4) Pulling lower eyelid down gently with thumb or forefinger against bony orbit to expose conjunctival sac (5) Instructing client to look upward and then instill drops of meds into conjunctival sac, minimizing blink reflex and retracting the cornea up then away from sac to avoid instillation onto cornea (6) Instructing client to close eyelid and move eye around, then apply pressure to lacrimal duct for 30-60 secs if med has systemic effects like beta blockers or timolol maleate. This will distribute med, prevent overflow into lacrimal duct, and reduce possible systemic absorption. (7) Remove excess med from each eye with new tissue or gauze pad to prevent cross contamination (8) Wait 5 mins before instilling different med into same eye

A nurse is preparing to administer 2 continuous IV meds concurrently via a 20 guage IV. What is the nurse's priority action? 1. Assess the condition of the IV site 2. Check 2 client identifiers before administering meds 3. Consult a med guide for compatibility 4. Wash hands prior to administering meds

3 Priority for administering 2 IV meds concurrently is to determine drug compatibility. Incompatible drugs given through the same IV line will deteriorate or form a precipitate. This change is visualized through either a color change, clouding of the solution, or presence of particles. If 2/+ drugs are incompatible, the nurse may insert a second IV or consult the pharm and HCP to determine safest plan for client.

The pediatric nurse is reinforcing education about med administration to the parents of a 4yo client. Which statements made by the parents demonstrate correct understanding? SATA. 1. "I can mix the med in a bowl of my child's fave cereal." 2. "I should give another dose if my child vomits after taking the med." 3. "I should measure liquid meds using an oral syringe." 4. "I will encourage my child to help me as I prepare the meds." 5. "I will place my child in time out if the med is refused."

3, 4 Liquid meds should be measured with oral syringes, which have small, well-defined increments and provides accuracy for small doses. Household measuring devices such as teaspoons are inaccurate due to variability of size and differences in measuring methods. Preschool children around 3-6yo typically start to take initiative and affirm power over their environment according to Erickson's Initiative vs Guilt. Encouraging participation promotes initiative and cooperation by giving the child a sense of control. - Notes about 5: Preschool children respond best to positive reinforcement and rewards, such as stickers, for incentives to follow desired behavior. Time-outs are more effective in interrupting undesired behavior.

The nurse prepares to admin oral expectorant to client w/pneumonia (Guaifenesin 600mg/dextromethorphan hydrobromide 30mg ER one tab PO q12h PRN for thick secretions). The client tells the nurse, "That pill is too big. I won't be able to swallow it." What is the best action by the nurse? 1. Contact pharm and request liquid form of med 2. Crush med and place it in small amount of applesauce 3. Instruct client to tuck chin to chest while swallowing the tablet 4. Obtain new prescription for liquid form of med

4 The HCP's prescription is specfically for a tablet. The pharm cannot substitute liquid form of med w/o HCP verification. Notes about 3: Instructing client to tuck chin to chest while swallowing is correct action for client w/impaired swallowing. However, this does not address client's concern about swallowing large tablet.

A nurse admins IM injection using Z-track technique. Place the steps in chronological order. 1. Apply gentle pressure at the injection site but do not massage 2. Inject medication slowly w/dominant hand while remaining traction 3. Hold skin taut w/non-dom hand and insert needle at 90-degree angle 4. Pull the skin 1-1 1/2in laterally and away from the injection site 5. Release the hold on the skin, allowing layers to slide back to their original position 6. Wait 10 secs after injecting med and withdraw the needle

4, 3, 2, 6, 5, 1 The Z-track technique prevents tracking or leakage of med into the SQ tissue and is universally rec for admin of IM injections. Preferred areas are the ventrogluteal site in adults and vastus lateralis in children. The procedure includes these steps: (1) Pull skin 1-1 1/2in laterally away from injection site (2) Hold skin taut w/non-dom hand, insert needle at 90* because taut skin facilitates entry of needle and this angle ensures that the needle will reach the muscle (3) Inject med slowly into muscle while maintaining traction because slow injection promotes comfort and allows time for tissue expansion to facilitate absorption of med (4) Wait 10 secs after injecting med and withdraw needle while maintaining traction on skin, allowing med to diffuse before needle removal and helps prevent tracking (5) Release hold on skin, allowing tissue layers to slide back to their original position, sealing off needle track (6) Apply gentle pressure at injection site but do not massage as this can cause med to seep back up the skin surface and cause local tissue irritation