ADMINISTERING ORAL, TOPICAL, AND MUCUSAL MEDICATIONS

The nurse is preparing a patient for surgery. The nurse notes that most of the patient's regular medications are on hold until after surgery; however, two medications are ordered to be given as usual. Which way will the nurse administer the medications since the patient is NPO? 1. With a sip of water. 2. Dissolved in 3 oz. of liquid. 3. Ask the patient to chew the drugs. 4. Give the drugs via the buccal route.

1 Rationales Option 1: Patients who are NPO can still be allowed to take oral medications with a sip of water. Option 2: Dissolving medication in 3 oz. of liquid is not appropriate. The patient can swallow the drugs with much less liquid. Also, not all medications can be dissolved. Option 3: Chewing the drugs may interfere with the absorption of the medications. In addition, the medication may be unchewable or have an offensive taste. Option 4: It is easier to have the patient swallow the drugs with a sip of water. Not all medications can be administered by the buccal route. There is also a risk for choking if the medication does not dissolve completely or in a timely manner.

The nurse recently began working in a facility that uses electronic medication administration record (MAR) documentation. Which is the main difference the nurse notices about using the electronic MAR? 1. The electronic system provides a method of inventory control. 2. The nurse will need to document the administration of medications on a written form. 3. The prescriptive process is initiated by the patient's health-care provider. 4. The patient is automatically charged for medications that are ordered.

1 Rationales Option 1: Because medications are scanned before leaving the pharmacy and again before being dispensed to the patient, the electronic system provides a method of medication inventory control. This is likely the main difference noticed by the nurse. Option 2: With an electronic MAR, the nurse is indicated as the dispenser of medication simply by the nurse's access to the electronic record. This why passwords are never shared. Option 3: This process is generally the same; however, the health-care provider may have the option of ordering a prescription electronically or by writing it by hand. Option 4: The patient will have an inventory of medications that are ordered; however, the validated charge is electronically made when the bar code is scanned and the drug is dispensed.

Which is a liquid medication that is an aqueous concentration of sugars and medical substances, with or without flavoring agents? 1. Syrup 2. Elixir 3. Solution 4. Suspension

1 Rationales Option 1: Syrup is an aqueous concentration of sugars and medical substances, with or without flavoring agents. Commonly, cough medications come in this form. Option 2: An elixir is a form of liquid medication that contains sweeteners or flavorings, and may contain water or alcohol. The liquid is commonly clear but may have coloring added. The patient on disulfiram should avoid elixirs because of the alcohol content. Option 3: A solution is a liquid that contains a dissolved substance. Option 4: A suspension contains fine particles of medication mixed with, but not dissolved in, a liquid.

The nurse is reinforcing teaching to a patient who is newly diagnosed with chronic respiratory disease about how to use a metered-dose inhaler. Which information should the nurse reinforce? 1. Hold the inhaler 1 to 2 in. in front of an open mouth. 2. Hold the inhaled medication in the lungs for 15 to 30 sec. 3. Place the inhaler in a cold location between medication administrations. 4. Firmly purse the lips around the inhaler mouthpiece for a good seal.

1 Rationales Option 1: The patient should hold the mouthpiece of the inhaler 1 to 2 in. in front of the open mouth. When the inhaler is depressed, the patient should deeply inhale the dispensed medication. Option 2: The inhaled medication only needs to be held for 10 sec and then the patient should exhale slowly through pursed lips. Option 3: The inhaler does not need to be in a cold location between uses. However, the inhaler should not be left in a hot location, such as a closed car, to prevent the canister from exploding. Option 4: The recommended method of using a metered-dose inhaler no longer requires the mouthpiece be placed in the patient's mouth. The new method prevents droplets of medication from landing on the tongue and increasing the severity of the side effects.

The nurse works in a clinic and is preparing to instill ear drops for a variety of diagnoses. For which patient should the nurse hold the prescribed medication? 1. The patient with an ear infection who has purulent drainage. 2. The patient who has an insect trapped in the ear canal. 3. The patient who has an accumulation of sticky wax in the ear canal. 4. The patient who has hardened wax wedged in the ear canal.

1 Rationales Option 1: The patient with an ear infection who has purulent drainage is likely to have a ruptured ear drum. Medication should not be administered if the ear drum is not intact. Option 2: The nurse can put ear drops into the ear canal of a patient who has a foreign object in the ear, such as a bug. The type of ear drop used may serve to "smother" the bug and prevent movement. Option 3: When a patient has an accumulation of sticky wax in the ear canal, ear drops may be instilled that will aid in cleaning the ear. Option 4: When a patient has hardened wax wedged in the ear canal, drops can be instilled that will soften the substance and aid in cleaning the ear.

The nurse in a health-care provider's office is discussing a patient's medications. The patient states, "The health-care provider said I should buy the enteric-coated aspirin, but they are more expensive." Which reason will the nurse provide regarding the health-care provider's order? 1. "The enteric coating prevents stomach irritation." 2. "The pill is easier to swallow with enteric coating." 3. "Aspirin lasts longer in the bottle if it is coated first." 4. "The health-care provider can write a prescription to contain the cost.

1 Rationales Option 1: The primary reason aspirin is prescribed with enteric coating is to avoid gastric irritation and/or the formation of ulcers. Option 2: The pill may or may not be easier to swallow if enteric coated. The primary purpose is to decrease or prevent gastric irritation. Option 3: Aspirin is not enteric coated so that the medication will last longer in the bottle. Option 4: The health-care provider has prescribed the aspirin as an over-the-counter drug. It is unlikely that the patient's third-party payer will pay for aspirin.

The nurse is reviewing a medication order for a patient. The health-care provider prescribed the medication to be given by mouth (PO). In which manner will the nurse give the medication to the patient if it arrives in tablet form? 1. Give the patient a fluid to help swallow the medication. 2. Place the medication carefully between the patient's cheek and gum. 3. Dissolve the medication in a glass of water and have the patient drink the fluid. 4. Check to see if the medication is securely under the patient's tongue.

1 Rationales Option 1: When medications are ordered PO, which means "by mouth" (per os in Latin). The nurse can confirm the order with the health-care provider to make sure that sublingual or buccal routes were not intended. Option 2: Oral medications can be placed between the patient's cheek and gum to be absorbed by the oral membranes. The health-care provider would need to order the medication to be administered buccal. Option 3: There is not enough information in the question to determine if the medication can be dissolved or not. In addition, dissolving the medication in a glass of water is risky because the patient may not be able to drink the entire amount. Option 4: Oral medications can be placed under the patient's tongue to be absorbed by the oral membranes. The health-care provider would have ordered the medication to be administered sublingual.

The nurse is providing care for a patient who is unconscious and receiving enteral feeding. The nurse is reviewing the classifications and characteristics of medications ordered for the patient. Which type of drug does the nurse identify as being safe to crush for administration? 1. An antihypertensive drug in tablet form 2. An enteric-coated anti-inflammatory pill 3. A sustained-release anti-allergy capsule 4. A liquid-filled vitamin gel capsule

1 Rationales Option 1: Drugs that are not enteric coated or sustained release can be crushed and administered through an enteric feeding tube. Option 2: Anti-inflammatory drugs are enteric coated because they cause gastric irritation. These medications should not be crushed. Option 3: Sustained released medications are frequently dispensed in capsule form. Opening the capsule and crushing the medication can result in a rapid absorption of the medications. Option 4: Liquid-filled gel capsules are not crushed or emptied. The gel is used to protect the medication inside from certain digestion processes. Vitamins need to be absorbed from the duodenum or small intestine.

The nurse is preparing to administer an oral medication to a patient sublingually. Which actions does the nurse perform? Select all that apply. 1. Ask the patient to lift the tongue. 2. Instruct the patient not to chew, swallow, or spit out the medication. 3. Place the medication between the cheek and gum. 4. If necessary, break or cut the sublingual medication in half. 5. Allow the patient to have water if the taste of the medication is offensive.

1&2 Rationales Option 1: Medication administered sublingually is placed under the tongue. Option 2: Sublingual medication is held under the tongue until it is dissolved and the medication is absorbed by the mucus membrane of the mouth. Option 3: Medication placed between the cheek and gum is administered by the buccal route. The patient's medication is ordered sublingually. Option 4: Sublingual and buccal tablets are kept whole; breaking or cutting the tablet may increase the rate of absorption. Option 5: Giving the patient water during the administration of a sublingual medication will impact the rate of absorption, or may result in the medication being swallowed. Sublingual medication is most likely to have a neutral taste.

The nurse manager provides guidelines for correcting some common medication errors. Which guidelines specifically address errors related to medication orders? Select all that apply. 1. Always check the original order by the health-care provider with the medication administration record (MAR) order. 2. Check frequently for new or changed medication orders. 3. Pull a computer printout of all prescribed medication at the beginning of the shift. 4. Carefully check for discontinued medication orders to prevent incorrect administration. 5. Look up unfamiliar medications and review intended effects and side effects.

1,2,&4 Rationales Option 1: Discrepancies can occur between the two orders. The nurse needs to validate both orders to prevent medication errors. Option 2: Medication orders can be added or changed throughout the shift. The nurse has a responsibility to check medication orders frequently in order to avoid errors or deletions. Option 3: A printout can be obtained at the beginning of the shift, but the nurse needs to be aware that medication orders change during the shift. This action is not directly related to medication orders. Option 4: It is vitally important for the nurse to frequently check for discontinued medication orders. An additional dose of some medications can have an undesirable outcome. Option 5: It is important for the nurse to be familiar with drugs being administered. However, this action is not directly related to medication orders.

The nurse is preparing to administer a rectal suppository to a patient experiencing constipation. Which actions will the nurse perform? Select all that apply. 1. Explain the procedure and the medication action. 2. Assist the patient to the bathroom when a strong urge to defecate occurs. 3. Insert the suppository with the patient in a knee-chest position. 4. Ask the patient to remain in a left-lateral position for 5 to 10 min. 5. Insert the suppository 1 to 3 in. with a gloved index finger.

1,2,4,&5 Rationales Option 1: Explaining the procedure and the action of the medication will help illicit the patient's cooperation. Option 2: The action of the suppository is to relieve constipation. The patient should hold the suppository until the urge to defecate is strong; early expulsion will decrease results. Option 3: The suppository is inserted with the patient in a left-lateral position, which provides the best access to the rectum and sigmoid colon. The knee-chest position is physically and psychologically challenging for most patients. Option 4: Remaining in a left-lateral position for 5 to 10 min will help to retain the suppository. Option 5: The nurse needs to be sure the suppository is inserted 1 to 3 in. to ensure it is past the internal sphincter. Having the patient exhale at the same time aids insertion.

The nurse is preparing to administer medications to patients in an acute care facility. Which actions will the nurse take to prevent medication errors? Select all that apply. 1. Question any order that requires more than two tablets. 2. Document all the medications administered after the prescribed drugs are passed. 3. Always perform a safety check at the medicine cart and again at the bedside. 4. Read medication orders carefully, paying close attention to similar drug names. 5. Check the patient and documentation that indicates parameters for the medication.

1,4,&5 Rationales Option 1: If an order requires more than one or two tablets, or seems to be an excessive amount, the order should be questioned before the medication is given. Option 2: The nurse should document a medication as soon as it is given in order to prevent another nurse from repeating administration of the same drug. Option 3: Three safety checks are performed: two at the medicine cart and one at the bedside. Option 4: The nurse should read each medication order carefully and be especially aware of drugs with similar names or spelling. Option 5: Prior to giving certain medications, the nurse will need to check laboratory results, vital signs, and other parameters to validate that a medication can be administered.

The nurse is interviewing a patient who reports prolonged use of nasal spray for nasal congestion. Which patient teaching does the nurse provide? 1. Frequent use of a decongestant spray can cause nasal cavity cancer. 2. Prolonged use of a decongestant spray can cause nosebleeds. 3. Recommended time for use of a decongestant spray is two weeks. 4. Side effects of a decongestant spray will eventually resolve with use.

2 Rationales Option 1: There is no specific information provided that indicates that frequent use of a decongestant spray can cause nasal cavity cancer. Option 2: Prolonged use of a decongestant spray will result in shrinking and scarring of the nasal passage, causing lesions and nosebleeds. Option 3: The recommended time for the use of a decongestant spray is three days, not two weeks. Option 4: The side effects of a decongestant spray (rebound congestion) will not resolve with continued use.

The nurse is instructing a patient on the use of a dry-powder inhaler. The prescribed medication comes in a diskus inhaler. Which information is most important for the nurse to provide to the patient? 1. The dispenser contains a small number of chambers with a single dose of medication in each. 2. Avoid directly exhaling into the powder chamber when the door is opened. 3. Dry-powder medication is inhaled by placing the mouthpiece into the mouth. 4. Sliding the thumb grip away reveals the mouthpiece and a lever. Rationales

2 Option 1: This provides a general description of the dry-powder inhaler. While the information is good to know, it is not the most important information to provide to the patient. Option 2: Once the powder chamber door is open, the patient can disperse the powder by exhaling into the open chamber. This is the most important information to provide to the patient. Failure to follow this procedure will result in wasted medication. Option 3: The diskus mouthpiece is placed in the patient's mouth, the patient's lips are closed around it, and the patient inhales deeply to draw the dry powder deep into the lungs. Option 4: The apparatus of the inhaler is revealed when the thumb grip is slid away from the patient. This information is necessary, but is not the most important to provide the patient.

The nurse in a long-term care facility has an old-old patient who needs medication for asthma several times daily. It has become increasingly difficult for the patient to inhale the dispersed medication from a 1 to 2 in. distance. Which solution will the nurse implement for this patient? 1. Allow the patient to place the mouthpiece of the inhaler in the mouth. 2. Apply an inhalation spacer to the mouthpiece of the inhaler. 3. Inquire about changing the patient's inhaler to oral medications. 4. Suggest that the medication be dispensed through a mask.

2 Rationales Option 1: Allowing the patient to place the mouthpiece of the inhaler into the mouth allows droplets of the medication to land on the tongue. Rapid absorption from the tongue intensifies side effects. Option 2: Applying an inhalation spacer on the mouthpiece of the inhaler allows the patient to inhale the medication in several smaller breaths. This method is recommended for children and older adults. Option 3: Inhalers provide the best and most effective delivery of respiratory medications to the patient's lungs. The tissues are directly exposed to the medication. Option 4: Medication for respiratory disorders are not inhaled as deeply when using a mask. The efficacy of the medication is notably decreased.

The registered nurse (RN) is making patient care assignments to the licensed practical nurse/licensed vocational nurse (LPN/LVN). The LPN/LVN assignment involves several patients ordered to receive oral medications. Which action regarding the LPN/LVN is the RN's responsibility? 1. To sign the RN's initials on the medication administration record (MAR) in addition to the LPN/LVN's initials. 2. To validate that ordered medications are given to the assigned patients. 3. To show trust toward the LPN/LVN's ability to fulfill the assignment. 4. To watch and make sure that the LPN/LVN passes all medications on time.

2 Rationales Option 1: The LPN/LVN is working within the appropriate scope of practice so there is no need for the nurse to countersign the patient's MAR. Option 2: The RN is still responsible for making sure that the assigned patients received medications as ordered. Option 3: The RN shows trust in the LPN/LVN when the patient assignment is made; the RN's will validate that medications are dispensed as ordered. Option 4: The RN only needs to validate that patients have received the prescribed medication within the designated timeframe.

The nurse is caring for a patient receiving a continuous tube feeding. The health-care provider prescribes phenytoin suspension to be administered via the feeding tube to manage the patient's history of seizure activity. Which action will the nurse take when administering the patient's medication? 1. Flush the feeding tube with 60 mL of water prior to administering the medication. 2. Stop the tube feeding for 1 to 2 hr before giving the drug. 3. Use 20 mL of water to flush the feeding tube after the medication is administered. 4. Monitor the feeding tube for 2 hr for clumping after the tube feeding is restarted.

2 Rationales Option 1: The feeding tube does not need to be flushed with 60 mL of water prior to administering the medication. Option 2: Because the formula in the patient's stomach can decrease the absorption of phenytoin by up to 70%, the tube feeding should be stopped for 1 to 2 hr so the stomach is empty of formula at the time of administration. Option 3: After giving phenytoin suspension through a feeding tube, the tube is flushed with 60 mL of water to prevent the drug from adhering to the tubing. Option 4: There is no need to monitor the feeding tube for clumping; clumping is not expected after the administration of phenytoin suspension.

The nurse is providing care for a patient with a severe skin irritation. The health-care provider's order reads, "Apply a thin coat of ointment 3 times a day to irritated areas." Which consideration requires the nurse to research the administration of this drug further? 1. Whether gloves should be donned to apply the medication. 2. Whether an occlusive dressing is applied to cover the area 3. Whether a tongue blade or cotton-tipped swab is used 4. How likely the medication is to stain the skin

2 Rationales Option 1: The nurse should wear gloves to decrease the nurse's exposure to pathogens, body fluids, and/or exposure to the medication being applied. Option 2: The nurse needs to research whether or not the skin needs an occlusive dressing after the medication is applied. An occlusive dressing can alter the absorption of the medication. Option 3: Unless specified, the nurse can use a tongue blade or cotton-tipped swab to apply the medication as prescribed. Option 4: Whether or not be medication is likely to stain the patient's skin is not a consideration that requires additional research.

The nurse manager on a busy acute care unit is concerned because the newly graduated nurses are not reporting any medication errors. For which reason is the nurse manager concerned? 1. The seasoned nurses are making more mistakes. 2. The new nurses may not be reporting errors they make. 3. The need for a medication review is indicated. 4. The nurse manager is just being suspicious.

2 Rationales Option 1: The question does not state that the seasoned nurses are making more mistakes, only that the new nurses are not reporting any errors. Option 2: The nurse manager is aware that most nurses will make medication errors. The expectation is that new nurses will make more mistakes before becoming confident with passing medications. The lack of errors may indicate a lack of reporting. Option 3: There is nothing in the question that indicates that a medication review is needed. Option 4: The nurse manager may or may not just be suspicious. However, a seasoned nurse has a realistic expectation for what should be happening. Concern sets in when expectations, either positive or negative, are not met.

The nurse is preparing to pass medications. When reviewing the medication administration record (MAR), the nurse notices a possible misspelling of a medication. Which action does the nurse take first? 1. Change the misspelled medication to the correct spelling. 2. Checks the health-care provider's order for the correct medication name. 3. Call the pharmacy to validate the name of the drug dispensed. 4. Search on the Internet for the correct spelling of the medication.

2 Rationales Option 1: Without validation of the specific drug ordered by the health-care provider, the nurse should not change the MAR. Any discovered mistakes must be handled according to facility policy. Option 2: The first action that the nurse will take is to compare the medication listed on the MAR with the health-care provider's order. Option 3: This is an unnecessary action; the pharmacy will have record of the drug that was dispensed. This action is not validation of the drug ordered. Option 4: Searching on the Internet does not necessarily validate the name of the drug ordered. The nurse first needs to compare the MAR to the health-care provider's order.

The nurse is expressing distress, stating, "I mixed a patient's medication in applesauce and now they won't eat it all." Which instruction by the nurse manager will be helpful? 1. "Maybe you should try something more appealing like chocolate pudding or ice cream." 2. "You should only mix medication with two tablespoons of food to ensure it will all be eaten." 3. "Well, you can remix the medicines in a smaller amount and try again to get them all in." 4. "I will keep trying to get the medication all down while you finish passing medications."

2 Rationales Option 1: Some medications should not be taken with dairy products because the proteins can interfere with the absorption process. Applesauce is a safer mixture to use. Option 2: The most helpful instruction by the nurse manager is how to prevent the event from happening again. Medications should only be mixed with two tablespoons of food to ensure that it will all be taken. Option 3: The medications cannot be remixed. This action can cause an overdose because the nurse is not aware of how much of each medication is remaining. Option 4: The nurse manager should not administer any medication that was prepared by another person. The nurse can keep trying to get the patient to take the rest of the medication.

The nurse is reviewing instruction about using a newly prescribed steroid inhaler with a patient. The patient is already using a bronchodilator inhaler. Which information is most important for the nurse to emphasize? 1. To rinse the mouth with water and spit it out after using the steroid inhaler. 2. To use the bronchodilator inhaler before the steroid inhaler. 3. To wait 5 min between the use of the two inhalers. 4. To hold the dispensed medication for 10 sec after it is inhaled.

2 Rationales Option 1: The nurse should emphasize that the patient needs to immediately rinse the mouth and spit out the water after using the steroid inhaler. Steroids in the oral cavity will cause a yeast infection called thrush. Option 2: This is the most important information for the nurse to emphasize. The bronchodilator inhaler is used first so that steroid is more likely to reach deeply into the lungs. Option 3: The nurse should emphasize that the patient needs to wait 5 min between using two inhalers; the time gives the first medication time to work effectively. Option 4: The nurse should emphasize the importance of holding the dispensed medication for 10 sec after it is inhaled. This action keeps the medication in the lungs.

The nurse is providing care for a patient who is receiving phenytoin suspension for management of seizure activity. The patient is also receiving continuous tube feedings to prevent aspiration. Which actions will the nurse take prior to administering the medication? Select all that apply. 1. Stop the formula and flush the feeding tube just prior to administration. 2. Flush the tube after medication administration with 60 mL of fluid. 3. Dilute the medication with 20 to 60 mL of water prior to administration. 4. Mix the delayed-release suspension with apple juice before administering. 5. Withdraw the stomach contents and then administer the medication.

2&3 Rationales Option 1: The formula must be stopped 1 to 2 hr prior to the administration because the medication will mix with the formula in the patient's stomach and decrease absorption by up to 70%. Option 2: After the phenytoin is administered, the feeding tube is flushed with 60 mL of fluid to prevent the medication from adhering to the tube. Option 3: Diluting the phenytoin prior to administration with 20 to 60 mL of water will improve the absorption of the medication. Option 4: Phenytoin is not a delayed-release suspension and does not need to be mixed with apple juice. An example of this would be a proton pump inhibitor (pantoprazole). Option 5: Withdrawing the stomach contents prior to administering the medication is not a valid action. The feeding should be discontinued 1 to 2 hr to empty the stomach of formula.

The nurse is preparing to perform an ear irrigation on an adult patient. Which actions are appropriate for the procedure? Select all that apply. 1. Have the patient tilt the head slightly toward the affected ear. 2. Aim the fluid stream at the top wall of the ear canal and depress the syringe plunger. 3. Draw up 30 mL of warm solution in a syringe for the irrigation. 4. Ask the patient to hold a basin under the affected ear to catch the irrigating fluid. 5. Straighten the patient's ear canal by gently pulling down and back on the pinna.

2,3,&4 Rationales Option 1: The nurse should have the patient tilt the head slightly toward the unaffected ear so that the affected ear is easily accessed. Option 2: Pointing the stream of irrigating fluid directly into the ear canal can cause pain or damage to the tympanic membrane. Option 3: The irrigation solution is warmed because cold solution can cause nausea or dizziness. Thirty milliliters of solution is adequate; the process can be repeated if necessary. Option 4: Asking the patient to hold a basin to catch the irrigating fluid is appropriate; the nurse needs both hands to perform the procedure. Assistance is needed if the patient is unable to help. Option 5: For an adult patient, the pinna is gently pulled up and back in order to straighten the ear canal. A patient under the age of three has the pinna pulled down and back.

The nurse is preparing to start a shift in an acute care facility. The nurse is aware that a drug count must be performed. Which actions are included in a drug count? Select all that apply. 1. The drug count is performed between the nurses coming onto the shift. 2. Discrepancies are discovered and amended while both nurses are present. 3. Both nurses are aware the count must match according to federal law. 4. The nurse who is leaving may be detained until discrepancies are resolved. 5. Unresolved drug discrepancies may require that nurses take a urine drug screen.

2,3,4&5 Rationales Option 1: Both nurses who are leaving a shift and coming onto a shift are involved in performing a drug count. The nurse leaving validates the count with the nurse coming onto the shift. Option 2: It is important that any discrepancies are discovered and amended while both nurses are present. The leaving nurse takes responsibility for accuracy and the nurse coming on validates the accuracy before assuming responsibility. Option 3: Federal law requires strict inventory and records in regards to the management of narcotics and other controlled substances. Option 4: Many facilities require the nurse who is leaving to stay at the facility until any discrepancy in the drug count is resolved. Option 5: When a drug discrepancy cannot be resolved, the facility can require nurses to take a urine drug screen. This action is performed to identify the action of diversion, which is when the nurse takes drugs intended for patients.

The nurse is working in an extended care facility. The nurse administers a number of medications via rectal suppositories. Which patient does the nurse identify as contraindicated for medication administered by the rectal route? 1. A patient with nausea and vomiting who is unable to retain food or fluid 2. A patient with swollen and inflamed hemorrhoids who is having pain 3. A patient with constipation who has a history of a recent heart attack 4. A patient who is prone to frequent seizure activity

3 Rationales Option 1: Aa rectal antiemetic suppository can be used when a patient has nausea and vomiting and is unable to retain food or fluid. Option 2: Patients with pain from swollen and inflamed hemorrhoids can be effectively treated with a hydrocortisone rectal suppository. Option 3: Insertion of a rectal suppository is contraindicated in a patient with a history of a recent heart attack because insertion may stimulate the vagus nerve and stimulate a dysrhythmia. The condition needs to be managed by diet or oral stool softeners; bearing down will also cause vagus nerve stimulation. Option 4: Patients who are prone to seizure activity can be treated with diazepam rectal jell as a means to control seizures.

The nurse is administering various drugs to a patient with a percutaneous endoscopic gastrostomy (PEG) tube. The drugs have all been supplied in liquid form. Which liquid medication is the nurse required to shake just prior to administration? 1. The medication that has dissolved into a liquid. 2. The medication that is suspended in a thick liquid. 3. The medication composed of small particles mixed in a solution. 4. The medication that is sweetened to improve the taste.

3 Rationales Option 1: If the medication is dissolved into a liquid, it is called a solution. The solution does not need to be shaken before administration. Option 2: A thick, aqueous solution made with sugars, with or without flavorings, is called a syrup. Syrup does not need to be shaken before administration. Option 3: A suspension contains fine particles of the medication, but is not dissolved in the liquid. If the suspension sits, the particles will settle at the bottom. A suspension is shaken just prior to administration to distribute the medication throughout. Option 4: An elixir contains sugar and flavorings and possibly water and alcohol. It is generally clear but may have some coloring added. It does not need to be shaken before administration.

The nurse is reinforcing instructions with a patient on how to insert a vaginal cream for treatment of an infection. Which information, if shared with the patient, would result in ineffective treatment? 1. Telling the patient to remain supine for a period of 5 to 15 min. 2. Directing the patient to insert the application tube 3 in. into the vagina. 3. Instructing the patient to insert the application tube while sitting on the toilet. 4. Suggesting that the patient may want to wear a perineal pad to protect clothing.

3 Rationales Option 1: In order to obtain effectiveness from medications administered via the vaginal route, the patient should remain supine for a period of 5 to 15 min so the medication can be absorbed. Option 2: The patient should be directed to insert the application tube 3 in. into the vagina, aiming the tip toward the posterior wall. Option 3: The patient should insert the medication using an application tube while lying in a supine position so that the medication does not run out. This action can result in ineffective treatment. Option 4: The patient may want to wear a perineal pad to protect clothing from drainage of the medication.

The nurse is caring for a patient who is receiving intermittent tube feedings and anticoagulant therapy. The health-care provider orders that warfarin be administered by the feeding tube once daily. Which intervention will the nurse implement for the warfarin administration? 1. Delay the medication administration until the last tube feeding of the day. 2. Stop the tube feeding administration until 2 hr after the medication is given. 3. Administer the medication when there is a 2-hr window between feedings. 4. Change the schedule for tube feedings to avoid interaction with the medication.

3 Rationales Option 1: Intermittent tube feedings are usually around the clock at specified intervals. Option 2: The tube feeding needs to be stopped before and after warfarin is given. Option 3: Warfarin can bind to the proteins in the tube- feeding formula and decrease absorption and effectiveness. The patient is receiving intermittent feedings and the nurse should administer the warfarin when there is a 2-hr window between feedings. The nurse will wait 1 hr after giving a feeding, give the warfarin, and wait an additional hour before giving the next feeding. Option 4: The schedule for the tube feedings will not necessarily need to be changed. However, the medication will interact with the formula and a schedule of 1 hr before and after the medication is necessary.

The nurse is preparing to apply a transdermal patch to a patient for the delivery of nitroglycerine. Which action by the nurse is most important? 1. Wearing gloves during the placement of the new patch 2. Changing the location of the new patch 3. Removing the old patch prior to applying the new one 4. Shaving body hair so the patch adheres well

3 Rationales Option 1: It is important for the nurse to wear gloves when applying a transdermal patch in order to avoid contact with the medications. However, another option is most important. Option 2: It is important to change the location of the new patch in order to prevent skin irritation. However, another option is most important. Option 3: It is most important to remove the old patch prior to applying the new one in order to prevent the patient from receiving an overdose of the medication. Option 4: It is important to shave body hair if needed so that the patch adheres well. However, another option is most important.

The nurse is preparing to administer an oral narcotic pain medication to a patient. The health-care provider's order reads in part, "dispense 1½ tablets orally." Which action does the nurse take? 1. Breaks one of the tables in half and stores it in the patient's bin for the next dose. 2. Disposes of half of the second tablet by flushing it down the sink drain. 3. Asks another nurse to witness the wasting of one-half tablet of the medication. 4. Documents the information about wasting one-half tablet in the medical record.

3 Rationales Option 1: Narcotics are not stored in any form in the patient's medicine bin. The narcotic cannot be returned to the narcotic storage; therefore, the portion not needed is wasted with a witness. Option 2: Narcotics are not flushed down sink drains or toilets to prevent pollution of the environment. The one-half tablet will be placed in a narcotic waste bin or disposed of according to facility policy. Option 3: When any portion of a narcotic dose is to be wasted, the nurse asks another nurse to witness the waste and to sign the narcotics record. Option 4: The wasting of a narcotic is not documented in the medical record. The amount of drug signed out and the amount of that same drug being wasted is documented on the narcotics record.

The nurse manager finds a nurse in tears. The nurse states, "I have just made another medication error. I am sure I will lose my job." Which comment by the nurse manager is appropriate? 1. "I know you are concerned. Do you know why you are prone to errors?" 2. "I think that you can keep your job, but you will need some extra education." 3. "Let's not worry about that, tell me what happened and let's check the patient." 4. "Do you have life issues that interfere with your ability to concentrate?"

3 Rationales Option 1: The "why" about the medication error can be explored later; the most appropriate comment from the nurse manager is about the safety of the patient. Option 2: This is not the time to discuss solutions to the nurse's issue. The nurse manager is correct by first focusing on the well-being of the patient. Option 3: The nurse and nurse manager's and first concern is for the safety and well-being of the patient. The mistake needs to be identified, the patient assessed, and the health-care provider notified. A medication error report is also needed after the patient is cared for. Option 4: It has not been determined what specifically caused the nurse to make the medication error. The most appropriate comment by the nurse manager is about the patient's safety and well-being.

The nurse is assisting a patient with administration of a steroid via a metered-dose inhaler (MDI). Which directions will the nurse give the patient? Select all that apply. 1. Instruct the patient to hold the inhaled medication in the lungs for 30 sec. 2. Have the patient wait 5 min between puffs if two puffs are ordered. 3. After the last puff, have the patient rinse out the mouth and spit the water out. 4. If possible, have the patient avoid brushing their teeth after using the inhaler. 5. Before the first puff, have the patient hold the head in a neutral position while exhaling.

3&4 Rationales Option 1: The patient will be instructed to hold the inhaled medication in the lungs for 10 sec. Option 2: If two puffs of the same medication are ordered, the patient needs to wait 1 min between puffs. Option 3: After the last puff of medication is administered, the patient should rinse the mouth with water and spit out the water. Leaving a steroid in the mouth can cause thrush. Option 4: The patient should avoid eating, drinking, or brushing their teeth after using an MDI because it can affect the absorption of the medication. Option 5: Initially, the nurse should instruct the patient to tilt the head back slightly in order to exhale completely.

The nurse is providing care for a patient who is depressed and receiving nutrition by continuous enteral tube feeding. The health-care provider orders the patient to receive lithium citrate through the feeding tube. Which factor will prevent the nurse from administering the medication with the feeding formula? 1. The tube feeding formula will bind with the medication and stop absorption. 2. The medication will be less effective due to decreased absorption. 3. The formula prolongs the effectiveness of the medication. 4. The medication will cause the formula to clump in the feeding tube.

4 Rationales Option 1: Lithium citrate does not bind with tube feeding formula and stop absorption of the medication. Option 2: The lithium citrate will not be less effective due to decreased absorption if administered with tube feeding formula. Option 3: The tube feeding formula does not prolong the effectiveness of lithium citrate. Option 4: When lithium citrate and the tube feeding formula are administered together, the formula will clump in the feeding tube. Clumped substances are very difficult to remove and may result in replacement of the feeding tube.

The nurse in the emergency department (ED) is caring for a patient with a severe laceration of the scalp. The ED health-care provider wants to numb the laceration for suturing, but wants to avoid the pain associated with injected local anesthesia. Which type of topical preparation does the nurse anticipate being used? 1. An ointment. 2. A lotion. 3. A cream. 4. A gel.

4 Rationales Option 1: An ointment is very thick (viscus) and has an emollient base, which will soften the skin. An ointment would be difficult to remove from the wound bed. Option 2: Lotions are also emollients but are less thick than ointments and creams. Lotions are less moisturizing, but would still be difficult to remove from the wound bed. Option 3: A cream is a viscus emulsion with some moisturizing ability. A cream would be difficult to remove from the wound bed. Option 4: A gel is not as thick as a cream or ointment and does not contain moisturizing properties. Gels are usually clear and are easy to remove due to the lack of an emollient base. Lidocaine gel is commonly used to numb lacerations prior to suturing.

The nurse works in a long-term care facility. The facility uses a punch card method for passing medications. Which information about this medication administration method is incorrect? 1. The unit has a large punch card for all residents. 2. The punch cards are distributed new each day. 3. The medical record is used to document refused drugs. 4. The acronym PIG is used to describe the method.

4 Rationales Option 1: Each patient will have a punch card for each of the medications the patient is prescribed. Option 2: The punch cards are used until the medication needs to be reordered; a new card is distributed when the new supply of medication arrives. Option 3: If a medication is refused, the nurse circles the nurse's initials next to the dose on the punch card. Option 4: The acronym PIG is used to describe the method of medication administration used in an extended care facility. It stands for: punch, initial, give; the nurse punches the medication card, initials the card space, and gives the medication.

The nurse is administering antibiotic drops to a patient's right eye for an infection. Which action by the nurse is incorrect when administering this drug? 1. Placing the medication into the middle of the conjunctival sac 2. Preventing injury by bracing the hand on the patient's cheek or forehead 3. Keeping the medicine local with gentle pressure on the lacrimal duct 4. Having the patient tilt the head back and slightly toward the left

4 Rationales Option 1: Eye medication, especially drops, are placed into the middle of the conjunctival sac. Dropping the medication on the lens can be painful. Option 2: To avoid injury in case the patient moves unexpectedly, the nurse should brace the hand with the medication on the patient's cheek or forehead. Option 3: If the medication is to remain local, gentle pressure with a gloved finger can be applied to the lacrimal duct located on the medial aspect of the eye being treated. Option 4: The head can be tilted back, but tilting the head slightly to the left will cause the medication to drain toward the lacrimal duct. Instead of local effect on the site of the infection, the action of the drug may become systemic.

The nurse is providing care for a patient with a feeding tube due to the inability to swallow. The patient is ordered on multiple oral medications. Which action by the nurse is incorrect when administering the patient's medications? 1. The feeding tube is flushed with 50 mL of water prior to medication administration. 2. The medications are crushed and administered one at a time followed by 20 mL of water. 3. The nurse researches each drug to verify the method of administration through a feeding tube. 4. The medications are crushed together and dissolved in water before administration.

4 Rationales Option 1: The feeding tube is flushed with 50 to 60 mL of water in order to clear the formula from the tube. Interaction between the medication and formula may cause the tube to block or medication to cling to the side of the tube. Flushing clears the tube. Option 2: Oral medications should be crushed and administered one at a time followed by 20 to 30 mL of water. Administering one medication at a time enables the nurse to watch for specific drug and formula interactions. Option 3: The nurse is responsible for researching every drug that is administered; it is important to ascertain the method by which a drug is administered through a feeding tube. Option 4: Medications should not be crushed together; some may need dissolved in water, and others in juice. The nurse cannot separate drugs (should the need arise) if the drugs are all crushed together.

The nurse is pouring liquid medication for administration to a patient. Which principle for accurate measurement used by the nurse is incorrect? 1. Placing the medicine cup on a flat surface before pouring. 2. Turning the measurement marks toward the nurse. 3. Positioning the nurse at eye level to the medicine cup. 4. Looking at the ends of the meniscus for the accurate amount.

4 Rationales Option 1: The medicine cup is placed on a flat surface before the medication is poured. Holding the cup unlevel may obscure the measurement marks when the cup is set down, making an accurate measurement difficult. Option 2: The nurse needs to be able to view the measurement marks while pouring the medication; the marks should be turned toward the nurse. Option 3: The nurse is positioned at eye level to the medicine cup to assure an accurate reading. Option 4: The meniscus appears when a liquid is poured into a container. The sides of the meniscus appear higher and the center appears lower. The lowest part of the meniscus is the area that designates an accurate measurement. Reference the illustration.

The nurse works in a facility that utilizes a paper medication administration record (MAR) for the documentation of medication administration. For which reason is it most important for the nurse to check health-care provider orders against the MAR prior to dispensing medications? 1. Ordered medications may not have been added to the MAR. 2. The nurse may not be aware that STAT medications have been ordered. 3. The patient may be refusing some medications and the reason is needed. 4. Discontinued drugs may not have been marked out on the MAR.

4 Rationales Option 1: The nurse is not to pass a drug until the health-care provider's order has been processed and written onto the MAR. Option 2: The nurse is informed directly when a STAT medication order is written so that the medication can be obtained and dispensed immediately. Option 3: The health-care provider's orders would not contain information about a patient refusing a medication or why. This information is found in the nursing notes. Option 4: It is most important to check health-care provider's orders against the MAR prior to dispensing medications to make sure that all discontinued medications are marked out. It is vital that some medications, such as anticoagulants, antihypertensives, and cardiac drugs not be mistakenly continued.

The nurse is reviewing information regarding the use of rectal suppositories. Which factor about administering medication via the rectal route does the nurse have incorrect? 1. The suppository should be inserted past the internal sphincter. 2. The suppository is inserted by the index finger pushing against the blunted end. 3. The suppository is refrigerated to decrease or stop it from melting. 4. The suppository needs lubricated with a petroleum-based lubricant.

4 Rationales Option 1: The suppository must be inserted past the internal sphincter so that it can be retained in the rectum. Option 2: The nurse inserts the suppository, tapered end first, by pushing on the blunted end with a gloved index finger. Option 3: Suppositories can be softened or melted by being stored at room temperature. The proper storage is in the refrigerator. Option 4: Suppositories are lubricated with a water-soluble lubricant to facilitate absorption. Petroleum-based lubricants are not used in the body.

The school nurse is asked to irrigate the eye of a student patient who has dirt in the left eye. Which steps will the nurse take to perform the procedure? Select all that apply. 1. Position the patient supine with the head turned to the right. 2. Provide the patient with a towel to catch the irrigation fluid. 3. Hold the patient's eye open and ask the patient to look down. 4. Aim the irrigant toward the conjunctival sac flowing from inner to outer canthus. 5. Gently depress the syringe plunger in one inch increments.

4&5 Rationales Option 1: The patient can be positioned with the head turned toward the affected eye. This position allows best access from the inner to the outer canthus. Option 2: A basin is placed beside the affected eye to catch the irrigation fluid. Using a towel will just transfer the fluid from one location to another. Option 3: The nurse will hold the patient's eye open with the nondominant hand, and ask the patient to look up. Option 4: Aiming the irrigant toward the conjunctival sac flowing from the inner to the outer canthus prevents damage to the cornea and assists in the removal of the irritant. Option 5: The irrigation of an eye is a gentle process using smaller portions of irrigation solution at a time. The process is repeated as necessary.