Administration of Medication (from Test Taking Strategies)

The nurse recognizes that the most dangerous method of administering medication is via: 1) Intravenous push 2) Piggyback infusion 3) Subcutaneous injection 4) Intramuscular injection

1) An IV push or bolus administration of medication is the instillation of a medication directly into a vein; this rapid administration of an entire dose of medication places the patient at highest risk for adverse effects.

Because of the physiologic changes associated with aging, when administering drugs to older adults, the nurse should specifically assess for signs of: 1) Toxicity 2) Side effects 3) Drug interactions 4) Allergic reactions

1) Biotransformation of drugs is less efficient in older adults than during younger developmental ages; when drugs are not fully metabolized, degraded, or excreted, toxic levels can accumulate.

Which site should the nurse use for a subcutaneous injection to ensure its most rapid absorption? 1) Abdomen 2) Buttock 3) Thigh 4) Arm

1) Medication injected into the abdomen is more rapidly absorbed than medication injected into the limbs of the body

The nurse is administering medication via the Z-track injection method. Which action is unique to this procedure? 1) The skin is pulled laterally before needle insertion 2) An air lock is established behind the bolus of medication 3) The injection sites are rotated along a "Z" on the abdomen 4) A "Z" is formed when dividing the buttocks into quadrants

1) The Z in the Z track method refers to pulling the skin to the side before and during an intramuscular injection. This technique alters the position of skin layers so that after the skin is released and the needle is removed, the injected fluid is kept within the muscle tissues and does not rise in the needle tract, which can irritate subcutaneous tissues.

The nurse is preparing to instill a vaginal cream. What position should the nurse instruct the patient to assume? 1) Dorsal recumbent 2) Low-Fowler's position 3) Left-lateral position 4) Supine position

1) The dorsal recumbent position allows easy access to and exposure of the vaginal orifice. Lying in this position for 10 minutes after the administration of the vaginal cream prevents its drainage from the vaginal canal.

The nurse teaches a patient to self-administer eye drops. The nurse identifies that further teaching is needed when the patient says, "I should: 1) Wipe my eye moving from the outer corner toward my nose 2) Hold the eyedropper about a half inch above my eye 3) Close my eyes after putting the drops in my eyes 4) Put the fluid in a pocket in the lower lid

1) The eye should be wiped moving from the inner to the outer canthus; this promotes comfort, prevents trauma, and moves excess medication away from the nasolacrimal duct, minimizing systemic absorption and infection.

The nurse changes the needle after drawing up the required dosage of a caustic drug. This is done primarily because the needle is: 1) Too long for the required route 2) Coated with medication 3) No longer sterile 4) Not sharp

2 - Changing to a new needle prevents tracking the medication through the subcutaneous tissue and skin.

Which statement indicates to the nurse that the patient needs further teaching regarding care of the eyes and eye medication? 1) "Excess medication on the eyelid can be wiped away" 2) "I should gaze downward while instilling the eye drops" 3) "I should place one drop of the medication inside my lower eyelid" 4) " The risk of transmitting infection from one eye to the other is high"

2 - The reverse is true- gazing upward moves the cornea up and away from the conjunctival sac where the medication is to be instilled.

Besides inhibiting microbial growth, an antibiotic may also depress the bone marrow. The nurse understands that this response is classified as: 1) An overdose 2) A side effect 3) An habituation 4) An idiosyncratic effect

2) A side effect is a secondary effect; side effects can be harmless or can cause injury; if injurious, the drug is discontinued.

Via what area should the nurse administer a medication in the form of a troche? 1) Rectal route 2) Buccal cavity 3) Vaginal vault 4) Auditory canal

2) A troche (lozenge) is placed in the space between the upper or lower molar teeth and gums (buccal cavity) so that it can dissolve and release medication

When administering an intradermal injection, the nurse understands that the patient is at the highest risk for exhibiting an: 1) Overdose 2) Allergic reaction 3) Idiosyncratic reaction 4) Interaction with other drugs

2) An intradermal injection is given under the skin to test for such things as tuberculosis and allergies; these drugs can cause an anaphylactic reaction if absorbed by the circulation too quickly or if the person has a hypersensitivity to the solution.

The nurse is administering oral medications to children. The nurse understands that the MOST important factor to consider is their: 1) Age 2) Weight 3) Level of anxiety 4) Developmental level

2) Children's body sizes are different, necessitating calculation of drug dosage by weight, rather than by age or developmental level. Weight is an objective, specific, and accurate way to calculate appropriate medication dosages for children.

The physician orders ear drops for an adult patient. When instilling ear drops into the patient's ear, the nurse should: 1) Press a cotton ball gently into the ear canal 2) Pull the pinna of the ear upward and backward 3) Tug the pinna of the ear downward and backward 4) Hold the dropper approximately two inches above the canal

2) Pulling the pinna of the ear upward and backward straightens out the ear canal of an adult. This action facilitates the distribution of the medication into the external ear canal.

Blood appears at the hub of the needle while the nurse is aspirating an intramuscular injection. The nurse should: 1) Remove the syringe and attach a new needle 2) Discard the syringe and prepare a new injection 3) Interrupt the procedure and notify the physician 4) Withdraw the needle slightly and inject the solution

2) The equipment should be discarded because a small vessel was pierced and the fluid and needle are contaminated. A new sterile syringe and medication should be prepared.

Which route is considered to be the most accurate and safe when administering medications? 1) Topical 2) By mouth 3) Intravenous 4) Via injection

2) Using the oral route is the safest way to administer a medication because it's convenient, it does not require piercing the skin, it usually does not cause physical or emotional stress, and the medication is absorbed slowly.

When using an insulin syringe with a 1/2 inch needle to administer insulin, the nurse should insert the needle at an angle of 1) 30 degrees 2) 45 degrees 3) 90 degrees 4) 180 degrees

3 - a 90 degree angle is appropriate for a subcutaneous injection with a 1/2 " needle. It injects the insulin into the loose connective tissue under the dermis.

The nurse plans to inject an intravenous medication via an existing intravenous line. What should he nurse do first? 1) Select the port closest to the needle entry site 2) Pinch the tubing above the port being used 3) Determine the patency of the intravenous line 4) Clean the injection port with an antiseptic

3) For medication to enter a vein, the intravenous line must be unobstructed; therefore, the nurse should determine the patency of the intravenous line. The nurse must also ensure that the medication is administered into a vein, not into subcutaneous tissue.

Which route of delivery for medication should be questioned by the nurse if the patient is an older adult who is cachectic? 1) Intradermal 2) Intravenous 3) Subcutaneous 4) Intramuscular

3) Older adults and cachectic individuals have a decrease in subcutaneous tissue. When subcutaneous injection is administered to a patient with insufficient subcutaneous tissue, the medication is usually absorbed faster; this may be unsafe.

The nurse is filling a syringe with medication from a multidose vial. What should the nurse do? 1) Keep the needle above the level of the liquid and maintain sterile technique 2) Keep the needle below the level of the liquid and change the needle after withdrawing the solution 3) Keep the needle below the level of the liquid and record the date and time on the vial when opened 4) Keep the needle above the level of the liquid and inject air at 1.5 times the volume of the ordered dose.

3) The bevel of the needle must be kept below the level of the fluid to prevent air from entering the syringe. Once opened, medications should be marked with the date and time of opening since medications generally have a recommended period of viability before they should be discarded.

The nurse plans to administer a medication via an intramuscular injection to an obese patient. The nurse understands that the least desirable site for an intramuscular injection in an obese adult is the: 1) Vastus lateralis 2) Rectus femoris 3) Dorsogluteal 4) Deltoid

3) The dorsogluteal muscle has a thick fat layer, and an intramuscular injection will deposit the medication into subcutaneous tissues

The nurse is administering an oral medication to a patient. To best protect the patient from aspirating, the nurse should: 1) Offer extra water 2) Crush the medication 3) Position the patient in a sitting position 4) Inspect the mouth after the patient swallows

3) The sitting position allows the patient to control the flow of fluid to the back of the oropharynx as well as promote the flow of fluid down the esophagus via gravity

The nurse understands that a transdermal patch for delivery of an analgesic is most effective because it: 1) Has an immediate systemic effect 2) Affects only the area covered by the patch 3) Releases controlled amounts of medication over time 4) Produces fewer side effects than other routes of administration

3) Transdermal disks or patches have semipermeable membranes that allow medication to be absorbed through the skin slowly over a long period of time (usually 24 to 72 hours).

The physician orders peak and trough levels to monitor an antibiotic. To measure trough levels, the nurse should plan for a blood specimen to be drawn: 1) First thing in the morning 2) Halfway between scheduled doses 3) A half hour before a scheduled dose 4) A half hour after drug administration

3) Trough level refers to when a drug is at its lowest concentration in the blood in response to biotransformation; this usually occurs during the time period just before the next scheduled dose.

Before administering a medication that is teratogenic, the nurse should ask the patient: 1) "Have you ever had an anaphylactic reaction?" 2) "Were you ever addicted to drugs?" 3) "Do you have any allergies?" 4) "Are you pregnant?"

4 - "Teratogenic" when used in the context of medication, refers to a drug that can cause adverse effects in a fetus or an embryo.

The nurse must administer a 2 ML intramuscular injection to an adult patient who is in severe pain and lying in the supine position. The muscle that is the safest and most therapeutic is the: 1) Deltoid 2) Dorsogluteal 3) Ventrogluteal 4) Vastus lateralis

4 - The vastus lateralis is the preferred site for this patient because this muscle has no nearby nerves and blood vessels, and absorbs drugs rapidly. In addition, using this muscle does not require the patient, who is in pain, to be moved and repositioned.

The nurse evaluates that a mother correctly administered nose drops to her child when she: 1) Told her child to sniff the medication into the lungs 2) Allowed her child to sit upright after its administration 3) Put the remaining fluid in the dropper back into the bottle 4) Held the dropper slightly above the nares during instillation

4) Holding the dropper approximately a half inch above the nares prevents touching the patient which maintains cleanliness of the dropper; a half inch above the nares is not too high to cause trauma to the tissue by the falling drop.

Which route of administration is used only for its local therapeutic effect? 1) Rectum 2) Skin 3) Nose 4) Eye

4) Medications are instilled into the eye only for their local effect; part of the procedure for instillation of eye drops is to apply gentle pressure to the nasolacrimal duct for 10 to 15 seconds to prevent absorption of the medication into the systemic circulation.

A patient is receiving an intravenous piggyback medication every 4 hours. Because the medication has a narrow therapeutic window, the physician orders a peak blood level. The nurse should plan to obtain a blood specimen: 1) Halfway between two scheduled doses 2) Three hours after administering a dose 3) One hour before administering a dose 4) One hour after administering a dose

4) Most medications administered every 4 hours have a peak concentration about 1 hour after administration.

The physician orders a medication for an infant that must be administered via an intramuscular injection. What site is the best choice for the nurse to administer the injection? 1) Deltoid 2) Dorsogluteal 3) Ventrogluteal 4) Rectus femoris

4) The rectus femoris muscle, which belongs to the quadriceps muscle group, is the site of choice for intramuscular injections in infants and children. It's the largest and most well-developed muscle in infants, is easy to locate, and is away from major blood vessels and nerves.