PHARM : CHAPTER 8 ENTERAL ADMINISTRATION

For patient who are receiving enteral nutrition via intermittent tube feeding :

1. check the residual volume before each feeding 2. check to ensure the presence of bowel sounds. The absence of bowel sounds indicated the need to contact the healthcare provider for order before proceeding. 3. Check the position of the tube to ensure that it is still in the stomach. 4. During the initiation of enteral feeding by intermittent or continuous methods, blood glucose testing may be ordered.

Why is the oral route the preferred route for medications? (Select all that apply.) 1. It is convenient. 2.It is safe. 3. The rate of absorption is dependable. 4.It is relatively economical. 5.Most medications are readily available in oral dose forms.

1 , 2, 4, 5 The oral form of a medication is usually cheaper than other forms. Most medications (or a comparable medication) are available in oral form. It is more convenient to give medications orally when available. The oral route is one of the safest routes of drug administration. However, the oral route has the slowest and least dependable rate of absorption due to frequent changes in the gastrointestinal environment.

Which type of drug preparation requires that the patient be instructed to "shake well" before self-administration? 1.Suspension 2.Emulsion 3. Elixir 4. Syrup

1. A suspension is a liquid dose form that contains solid, insoluble drug particles dispersed in a liquid base. These particles settle to the bottom of the container on standing, so all suspensions must be shaken well before administration to ensure thorough mixing. Syrups, elixirs, and emulsions do not require shaking.

Why is it important not to crush medications that considered long acting? 1. Medications that crushed are harder to swallow, making it harder to activate the effect. 2. Medications that are crush release the drug immediately , inactivating the long-acting effect and potentially causing an overdose. 3. Medication that are crushed will not be absorbed properly, inactivating the long- acting effect. 4. Medications that are crushed will become powder and lose all the effectiveness of the drug.

2

Oral drug administration includes which principle(s)? (Select all that apply.) 1. Dependable rate of absorption 2. Most economical 3.Insulin able to be administered via this route 4. Drugs delivered directly by the oral, rectal, or nasogastric (NG) methods 5. Dosage forms are convenient and readily available

2, 5 Oral administration is the most economical, convenient, and readily available. Absorption from oral medications can vary depending on many factors. Insulin cannot be administered via the oral route. In oral drug administration, drugs are only delivered via the oral route.

Which is a disadvantage of rectal administration of medications? 1.Risk of damage to the rectal sphincter 2.Variability in absorption 3.Resulting irritation of the large bowel 4.Slow onset of action

2. The presence of stool in the rectum and the risk of the patient expelling the drug before absorption can cause variability in medication absorption. Absorption through the mucous membrane of the rectum is rapid if the drug is in contact with it, and therefore the onset of action is not necessarily slow. Preparations designed for rectal administration do not enter the large bowel. No significant risk of damage to the rectal sphincter occurs.

The prescriber has changed the route of the patient's medication form an intravenous route to an oral route. What effect in (general ) does the change in route have on the drug dosage and the absorption time? 1. Decreased dosage and increased absorption time. 2. Increase dosage and increased absorption time. 3. Increase dosage and decreased absorption time. 4. Decrease dosage and decreased absorption time.

3

The nurse is assessing the patient's pH of aspirate after inserting an NG tube. Which value would the nurse expect if the NG tube is correctly placed? 1.Greater than 7 2.4 to 5 3.Less than 3 4.6 to 7

3. LESS THAN 3 If an NG tube is correctly placed in the stomach, the stomach pH would measure less than 3. A pH reading of 4 to 5 is acidic but is usually not a low enough reading for stomach contents unless the patient is receiving H2 antagonists, which would affect the aspirated fluid pH. Intestinal pH is typically 6 to 7. Respiratory pH is typically greater than 7.

Which scale is labeled on a medicine cup? 1.Centimeter 2.Millimeter 3.Kilogram 4.Metric

4. METRIC

In preparing to administer medications to a patient with an NG tube, which would be appropriate to give through that route? (Select all that apply.) a.Liquid medication b.Tablets crushed and diluted in 30 mL of water c.Enteric coated tablets crushed and diluted in 30 mL of water d.Capsules emptied into 30 mL of water e.Timed release capsules emptied into 30 mL of water f.Suppositories

A , B , D Liquid forms of medications are preferable. Tablets may be crushed and diluted in water. Capsules may be opened and the contents added to approximately 1 ounce of water. Enteric coated medications and timed release capsules should never be broken for administration. Suppositories are not given via NG route.

Which data will the nurse document when administering a PRN oral pain medication to a patient? (Select all that apply.) a.Date, time, drug name, dosage, and route of administration b.Essential patient education about the drug completed c.Administration receptacle used d.Signs and symptoms of adverse drug effects e.Evaluation of therapeutic effectiveness

A , B, D, E

NG medication administration includes which principle(s)? (Select all that apply.) a.The tube must be assessed for correct placement. b.All medications can be combined into one syringe. c.Tablets and capsules should be dissolved in water. d.The suction source should be immediately reconnected. e.Flush the tube with 30 mL of water after drug administration.

A , C ,E

Which nursing action(s) would be appropriate when administering a disposable enema? (Select all that apply.) a.Position the patient on the left side. b.Allow the solution to flow in by gravity. c.Instruct the patient to hold the solution 30 minutes before defecating. d.Maintain the six rights of medication administration. e. Lubricate the rectal tube.

A , C, D , E To facilitate flow into the large intestine, patients should be positioned on the left side. The solution should be held for 30 minutes before defecating. Enemas are medications, so the seven rights of medication administration should be followed. Lubrication of the rectal tube will facilitate insertion into the rectum. Gravity will not facilitate the administration of a small volume of enema solution administered from a bottle.

Which receptacle(s) is/are commonly used in the hospital with pediatric oral medications? (Select all that apply.) a.Oral syringe b.Baby bottle full of formula c.Infant feeding nipple d.Teaspoon e.Medicine dropper

A , C, E

Why does the nurse clamp an NG tube for at least 30 minutes?

Answer : Clamping an NG tube for at least 30 minutes following medication administration will prevent the medication from being removed from the stomach. Twenty minutes is not enough time to allow for medication absorption before applying the NG tube to suction. If the person requires suction, allowing the NG tube to be clamped for 60 or 90 minutes may cause nausea and vomiting.

An older patient who is prescribed acetaminophen (Tylenol) caplets for knee pain asks how the caplets differ from the tablets. Which explanation does the nurse provide to the patient?

Caplets are more easily swallowed. A caplet is a tablet that has an elongated shape and a smooth coating like a capsule. The smooth coating facilitates swallowing. A capsule is designed to hide unpleasant taste. Rate of dissolution and dosage are unrelated to the characteristics of a caplet.

The nurse is administering an oral medication to a 90 year old patient who has difficulty swallowing pills. One of the medications to be administered is a spansule type capsule. What nursing consideration(s) should be applied in this case? (Select all that apply.) a.Wash hands before preparing medications and before administration. b.Crush medications and administer with a soft food, such as applesauce. c.Check the patients ID band with the MAR to ensure patient rights are followed. d.Have an 8 ounce glass of water available. e. Check with the pharmacist to see if the spansule medication comes in a liquid form.

a, c, d, e

Why we cannot use petroleum jelly or mineral oil for rectal suppositories

it may reduce the absorption of the medicine.