Ch 35: Medication Administration

2. The nurse is caring for a critically ill patient. What are the contraindications for administering medications by the oral route for this type of patient? (Select all that apply.) a. Vomiting b. Unconsciousness c. Diarrhea d. Penicillin allergy e. Intubation

A, B, E Nothing that needs to be swallowed should be administered to an unconscious patient due to the risk of aspiration. Medications are unlikely to be absorbed in the patient who is vomiting. A penicillin allergy affects the type of medication to administer but not the route. A patient with diarrhea may have decreased absorption, but it does not affect the ability to swallow medications safely. An endotracheal tube makes it impossible for a patient to swallow oral medication.

4. A patient has been using herbal medication as part of her daily routine. Which actions should the nurse take? (Select all that apply.) a. Document the herbs as part of the medication history. b. Recommend a reputable company from which to buy herbs. c. Allow the patient to self-administer the herbs with her morning medications. d. Inform the primary care provider of the findings. e. Identify possible adverse effects of the herbal medications.

A, D, E It is important to include the herbal medications the patient reports using in the medication history, because there is the possibility of interactions among herbals and prescribed medications. The primary care provider should always be informed about the herbs being used by the patient. It is essential for the nurse to identify potential adverse effects of the herbal medications to prevent harmful drug interactions. It is inappropriate for the nurse to recommend a company for the patient to purchase herbal preparations and to allow the patient to self-administer the herbs while in the hospital without a specific physician order.

3. The nurse is in a patient room ready to administer a new medication to the patient. Which action best demonstrates awareness of safe, proficient nursing practice? a. Identify the patient by comparing her name and birth date to the medication administration record (MAR). b. Determine whether the medication and dose are appropriate for the patient. c. Make sure the medication is in the medication cart. d. Check the accuracy of the dose with another nurse.

a. Identify the patient by comparing her name and birth date to the medication administration record (MAR). The right patient is one of the six rights to ensure safe administration of the medication. At least two patient identifiers should be used and compared to the armband or MAR. Determining the appropriateness of a medication for a patient should be completed prior to entering the patient room. Not all medications require another nurse to check the accuracy of the dose. Determining whether the medication is available is a time management issue.

9. The nurse is preparing a plan of care for a patient. What is the most appropriate goal for a patient related to medications? a. The patient will administer all medications correctly by discharge. b. The patient will be taught common side effects of prescribed medications. c. The patient will have a good understanding of prescribed medications. d. The patient will have all medications administered by staff as prescribed.

a. The patient will administer all medications correctly by discharge. Evaluating the patient's ability to correctly administer medications is a patient-centered and measurable goal. Teaching side effects and administering medications by staff are nursing goals. Desiring a "good understanding" is not a measurable goal.

8. What should the nurse do first when preparing to administer medications to a patient? a. Check the medication expiration date. b. Check the medication administration record (MAR). c. Call the pharmacy for administration instructions. d. Check the patient's name band.

b. Check the medication administration record (MAR). Checking the MAR is the first step in administering medications. Checking the expiration date and administration instructions is done only after the order is verified. Checking the patient's name band is one of the six rights of medication administration, but it is done after the MAR has been checked and the drug, dose, route, and time of administration have been verified.

1. The nurse is teaching a patient about how to take a sublingual nitroglycerin tablet. Which statement by the patient best demonstrates understanding of the teaching? a. "I will take the tablet with plenty of water." b. "I will place the tablet inside my cheek." c. "I will put the tablet under my tongue." d. "I will take the tablet while I am eating."

c. "I will put the tablet under my tongue." Sublingual medications are placed under the tongue, where they are absorbed quickly into systemic circulation. Medications placed in the cheek are delivered by the buccal route. Sublingual medications should be taken without water or food.

10. The nurse reviews a primary care provider's order and finds that the medication amount is greater than the standard dose. What should the nurse do? a. Give the standard dose rather than the one that is ordered. b. Consult with the nursing supervisor to get a second opinion. c. Call the primary care provider to discuss the order in question. d. Administer the medication as ordered by the primary care provider.

c. Call the primary care provider to discuss the order in question. The nurse is responsible for understanding and further investigating a medication order that falls outside an acceptable standard. Ultimately, the nurse is responsible for his or her own action, despite a PCP's written order. It is not within the nurse's scope of practice to alter a medication order, but the nurse has the right to refuse to give a medication and the responsibility to question orders, as necessary, to ensure patient safety. Consulting with the nursing supervisor for a second opinion is unnecessary.

6. The health care provider prescribes a transdermal medication. The nurse understands what feature of the transdermal route? a. It is inhaled into the respiratory tract. b. It is dissolved inside the cheek. c. It is absorbed through the skin. d. It is inserted into the vaginal cavity.

c. It is absorbed through the skin. Medicated patches or disks can be applied directly to the skin. The transdermal route of administration allows release and absorption of the medication through the skin over time, producing a steady drug level. Medications that are inhaled are aerosolized and not absorbed through the skin. The buccal route (inside the cheek) is a form of topical administration, but it is through the mucous membranes of the mouth, not transdermal (through the skin). Medications administered vaginally are topical, but they are applied to the mucous membrane of the vaginal wall, not to the skin.

7. The nurse is caring for a patient who is unable to hold a cup or spoon. How should the nurse administer oral medications to the patient? a. Crush the pills and mix them in pudding before administering. b. Ask the pharmacist to change all of the medications to a liquid form. c. Use a small paper cup to place the pills into the patient's mouth. d. Place the pills on the table and have the patient take the pills by hand.

c. Use a small paper cup to place the pills into the patient's mouth. The nurse assists the patient by using a small cup to place the medications into the patient's mouth. Using a cup rather than the nurse touching the pills maintains medical asepsis. Crushing the pills with food is appropriate for a patient with dysphagia. Liquid medications may be used for some swallowing difficulties or to replace very large pills. It is not safe to leave medications on a table, because they can be contaminated, lost among other items, dissolve in spilled liquids, or be missed. Leaving the pills on a table does not address this patient's difficulty in holding objects and is not aseptic.