Module 05: exam
Which are correct regarding administration of a rectal suppository for relief of constipation? (Select all that apply.) -place patient in right Sims' position. -avoid using water-soluble lubricant. -insert the suppository past the internal sphincter. -lubricate and insert rounded end first. -insert the blunt end first. -place patient in left Sims' position.
-insert the suppository past the internal sphincter. -lubricate and insert rounded end first. -place patient in left Sims' position. The patient should be placed in the left Sims' position. The rectal suppository is bullet-shaped. The rounded end should be inserted first and water-soluble lubricant used to prevent trauma to the tissues. The suppository should be placed past internal sphincter and against the rectal mucosa for absorption and therapeutic action.
Which would be a contraindication for inserting a rectal suppository? A patient with: (Select all that apply.) -constipation. -rectal bleeding. -diarrhea. -recent rectal surgery. -hemorrhoids.
-rectal bleeding. -diarrhea. -recent rectal surgery. Generally, rectal suppositories are contraindicated in the presence of active rectal bleeding and diarrhea. Rectal medications are also contraindicated in patients who have had rectal surgery. Care must be taken for the patient with hemorrhoids (e.g., additional water-soluble lubricant applied to the suppository). Rectal suppositories may be prescribed to treat constipation.
Why is it important to hold a transdermal patch by the edge after it is removed from its protective covering? (Select all that apply.) -so the medication dosage will remain unchanged. -so you do not absorb the medication into your system. -so the patch will remain sterile. -to activate the medication for a therapeutic effect. -so the patch will adhere well to the patient's skin.
-so the medication dosage will remain unchanged. -so the patch will adhere well to the patient's skin. Touching only the edges ensures that the patch will adhere and that the medication dosage remains unchanged. You should be wearing disposable gloves to prevent absorption by your skin because once the protective covering is removed the medication can be absorbed through the skin. The medication is active when it is applied. Maintaining sterility is not the reason for only touching the edges of the patch.
The patient is to receive a transdermal patch, nitroglycerin (Nitrodisc) 0.4 mg/hr topically. The nurse has been teaching the patient about the medication. Which is accurate information to review with the patient? a. it is recommended that nitroglycerin transdermal patches be removed after 10 to 12 hours to allow for a nitrate-free interval. b. to obtain a therapeutic level, nitroglycerin is usually administered simultaneously in oral form and topically. c. it is important to keep the Nitrodisc in the same area of the chest; remove the old patch and place the new patch in the same place. d. there is little risk of overdose with nitroglycerin because the medication's effect expires as it is absorbed into the body.
a. it is recommended that nitroglycerin transdermal patches be removed after 10 to 12 hours to allow for a nitrate-free interval. A nitrate-free period reduces the chance of tolerance to the medication. The site should be rotated to prevent skin irritation and sensitization. Unless specifically ordered to do so by the health care provider, patients should avoid using topical and oral forms of the same medication. Use of additional preparations of the drug can result in toxicity and/or other side effects.
The nurse is reviewing medication administration through a feeding tube with the caregiver. Which of the following statements indicates further instruction is needed? a. "After medication administration, I will clamp the feeding tube and have him sit up for 1 hour." b. "After crushing all medications, I will mix them together with 30 mL of tepid water." c. "Following the last dose of medication, I will flush the feeding tube with 30 to 60 mL of sterile water because he is immunocompromised." d. "To verify gastric placement, the pH of aspirated gastric contents should 4 or less."
b. "After crushing all medications, I will mix them together with 30 mL of tepid water." Prior to medication administration through a feeding tube, placement should be verified. A gastric pH of less than 5 is a good indicator that tip of tube is correctly placed in stomach. Each crushed tablet should be dissolved in separate cup of 30 mL warm water. Administering medications separately allows for accurate identification of medication if dose is spilled. In addition, some medications may be incompatible, and giving medication separately followed by a flush solution decreases the risk for drug incompatibilities. Following the last dose of medication with a 30 to 60 mL flush maintains patency of feeding tube and ensures passage of medications into stomach. Clamping the tube if not being used prevents air from entering stomach. Keeping the head elevated for 1 hour after medication administration reduces risk of aspiration.
The ear canal should be straightened when instilling eardrops to provide direct access to deeper ear structures. In what direction should the auricle be pulled in an infant to straighten the ear canal? a. upward and back. b. downward and back. c. downward and inward. d. upward and outward.
b. downward and back. The ear canal is straightened by pulling the auricle downward and back in a child younger than 3 years. The ear canal is straightened by pulling the auricle upward and outward in an adult or child older than 3 years.
The nurse is teaching the patient how to use an MDI with a spacer device. Which statement, if made by the patient, indicates further teaching is required? a. "I should close my mouth around the mouthpiece of the spacer, depress the medication canister and breathe in slowly and fully for 5 seconds, then hold my breath for approximately 10 seconds." b. "I should remove the mouthpiece cover from the inhaler and spacer, insert the MDI into the end of the spacer, and shake the inhaler well for 2 to 5 seconds." c. "I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator." d. "I should rinse my mouth with warm water, then spit the water out after each use of the MDI."
c. "I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator." If bronchodilators are administered with inhaled steroids, the bronchodilators should be given first in order to dilate the airway passages for the second medication. Also, patients should be instructed to wait 30 seconds between inhalations of the same medication and 5 to 10 minutes between inhalations of different medications. The inhaler fits into the end of the spacer device and is used to improve delivery of correct dose of inhaled medication. Shaking ensures mixing of medication in canister. Medication should not escape through mouth. Breathing in slowly ensures that particles of medication are distributed to deeper airways and holding breath ensures full drug distribution. Inhaled bronchodilators may cause dry mouth and taste alterations. Inhaled corticosteroids may alter the normal flora of the oral mucous membrane and cause the development of oral candidiasis. Rinsing the mouth after MDI use can prevent these problems.
The nurse has obtained the patient's oral medications from the automated dispensing system. What should the nurse do with the medication prior to going to the patient's room? a. place medications between two cups and use a pill-crushing device. b. open the individual packages and place the medications into one medication cup. c. place the packaged tablets or capsules into the medication cup. d. open the individual medication packages and place each into separate medication cups.
c. place the packaged tablets or capsules into the medication cup. The nurse should place packaged tablets or capsules directly into medication cup without removing wrapper. All tablets or capsules that the patient will receive should be placed in one medicine cup, except for those requiring pre-administration assessments. Individual unit-dose packages should not be opened until at the patient's bedside and all three checks for accuracy have been made. There is no indication the patient has difficulty swallowing, requiring the medications to be crushed.
A medication label states, "For Parenteral Use Only." What is the correct interpretation of this statement? a. the medication should be given orally so it is absorbed through the GI tract. b. the medication should only be used in adults. c. the medication should be administered by injection. d. the medication should be administered topically.
c. the medication should be administered by injection. Parenteral means the medication is administered through the skin by injection or intravenously. Nonparenteral medication administration includes topical applications. Enteral means it goes through the GI tract.
The NAP reports the patient is complaining of dizziness and nausea after the administration of eardrops. What is the most likely cause of the dizziness? a. the patient failed to remain in the side-lying position long enough. b. cerumen or drainage is occluding the ear canal. c. too much pressure was applied during instillation, with subsequent injury to the eardrum. d. the medication was too cold when it was administered.
d. the medication was too cold when it was administered. Nausea and vertigo may occur if the medication is too cold. Warm the medication by running warm water over the bottle prior to administration. Blockage of the ear canal would result in impaired hearing. Applying too much pressure during installation would result in pain. If the patient failed to remain in the side-lying position long enough, the result would be insufficient time for absorption of the medication.
A patient has been prescribed eye drops for the treatment of glaucoma. The nurse is observing the patient self-administer the eye drops. Which action by the patient requires further teaching? a. the patient cleans the eye from the inner to the outer canthus. b. while administering the eye drops, a drop lands on the patient's outer lid, so the patient administers another drop. c. the patient looks upward toward the ceiling and administers the eye drops in the conjunctival sac. d. the patient touches the conjunctival sac with the eyedropper to make sure she is in the correct location.
d. the patient touches the conjunctival sac with the eyedropper to make sure she is in the correct location. The eyedropper should not touch the eye structures to reduce the risk for injury to the eye and transfer of microorganisms to the dropper. Ophthalmic medications are sterile. The eye should be cleansed from the inner to outer canthus to avoid introducing microorganisms into the lacrimal ducts. Looking toward the ceiling moves the sensitive cornea up and away from conjunctival sac and reduces stimulation of blink reflex. If the patient blinks or closes the eye or if a drop lands on the outer lid margins while eye drops are being instilled, the procedure should be repeated. The therapeutic effect of the drug is obtained only when the drops enter the conjunctival sac.
Which medication administration activity can be delegated to nursing assistive personnel (NAP)? a. application of a transdermal patch. b. instillation of eye drops. c. use of MDIs. d. inserting vaginal medications. e. application of a skin barrier cream to the perineal area. f. inserting rectal medications. g. instillation of ear drops.
e. application of a skin barrier cream to the perineal area. The application of some lotions and ointments to irritated skin for the protection of the perineum may be delegated to NAP (check agency policy). The administration of all other types of parenteral medication requires the critical thinking and knowledge application unique to a nurse and is inappropriate to delegate to NAP. NAP should be instructed about the potential side effects of medications and to report their occurrence. In addition, care providers should be notified if any adverse reactions occur after administration of medication.
