Chapter 13: Medication Administration

14. The nurse is demonstrating the Z-track injection technique to a nursing student on a patient who is receiving iron dextran. Which statement by the student indicates understanding of the teaching? a. "This is necessary to prevent staining of the patient's skin." b. "This technique allows slower, more sustained absorption." c. "You may use the ventrogluteal site when using this method." d. "I should use a 27-gauge needle to minimize discomfort with this method."

ANS: A The Z-track method is used to prevent staining of the skin. It does not affect absorption. The gluteal site is preferred, and, generally, the needle is a larger bore.

7. When administering topical medications, which is an important nursing action? a. Applying the medication liberally b. Cleaning skin with alcohol before applying c. Using sterile technique d. Wearing gloves

ANS: D To avoid contact with the medication, nurses should wear gloves when applying topical medications. Some topical medications are applied sparingly. Skin should be clean and dry, but it is not necessary to use alcohol. It is not always necessary to use sterile technique.

3. A patient is ordered to take an extended-release medication twice daily but has difficulty swallowing the tablet because of its size. The nurse will perform which action? a. Contact the provider to discuss an alternate form of the medication. b. Crush the tablet and put it in applesauce to help the patient swallow it. c. Cut the tablet in half so the patient can take it more easily. d. Dissolve the tablet in liquid.

ANS: A Enteric-coated and extended-release tablets must be swallowed whole to maintain a therapeutic drug level since they are designed to be absorbed in the small intestine. If crushed, an initial excessive release of the drug may occur, causing toxicity. Enteric-coated or extended-release tablets should not be dissolved in liquid. The nurse should contact the provider to discuss another form of the medication

2. A patient asks the nurse if an enteric-coated tablet can be crushed and put in pudding to make it easier to swallow. How will the nurse respond to the patient? a. "Crushing the medication can lead to a possibly toxic medication dose." b. "Crushing the medication is safe and can prevent gagging on pills." c. "The tablet may be done if a small amount of pudding is used." d. "The tablet may be dissolved in liquid but not crushed and put in food."

ANS: A Enteric-coated tablets must be swallowed whole to maintain a therapeutic drug level since they are designed to be absorbed in the small intestine. If crushed, an initial excessive release of the drug may occur, causing toxicity. Enteric-coated tablets should not be dissolved in liquid.

12. The nurse is teaching an overweight patient to administer subcutaneous heparin. Which statement by the patient indicates understanding of the teaching? a. "I should insert the needle and inject the medication without aspirating for blood." b. "I should put firm pressure on the injection site to decrease the risk for bleeding." c. "I will insert the needle at a 10-degree angle when injecting." d. "The subcutaneous route is used because absorption is faster this way."

ANS: A Patients giving subcutaneous medication should be taught not to aspirate after inserting the needle. They should not apply pressure. The needle should be inserted at a 45- to 90-degree angle. Absorption is slower with this route than with the intramuscular and intravenous routes.

13. The nurse is preparing to administer an intramuscular injection to a 14-month-old toddler. To help with site selection for this injection, what will the nurse ask the child's parent? a. "How long has your child been walking?" b. "How much does your child weigh?" c. "Is your child afraid to look at needles?" d. "Is your child right- or left-handed?"

ANS: A The ventrogluteal muscle is the preferred injection site for toddlers who have gluteal muscle development associated with firmly established walking. The muscle development, and not the child's weight, is more important. Asking if a patient is right- or left-handed is necessary if deltoid muscles are used.

8. A patient who has asthma will begin taking an inhaled corticosteroid medication to be used with a spacer. The patient asks why the spacer is necessary. The nurse will explain that the spacer a. allows a larger dose to be given safely. b. distributes medication to target tissues. c. minimizes adverse effects of the steroid. d. prevents contamination of the metered-dose inhaler.

ANS: B Spacers are used to enhance the delivery of medication to the lower, smaller airways. They do not allow higher dosing or minimize drug side effects.

5. The nurse is teaching a nursing student about giving liquid medications. Which statement by the student indicates understanding of the teaching? a. "A suspension is a mixture in which drug particles are dissolved in solution." b. "I will line up the bottom of the medication curve with the line in the syringe." c. "I will need to shake an elixir before measuring the dose." d. "I will not need to refrigerate liquids once they are reconstituted."

ANS: B To measure liquid medications accurately, line up the bottom of the curve of the medication with the desired line on the syringe. Suspensions are liquids in which particles are mixed but not dissolved. As a general rule, elixirs do not require shaking; shaking may suspend air into the liquid and affect accurate dosing by volume. Many liquids require refrigeration.

6. A patient asks the nurse why the provider has ordered a transdermal form of a medication. How will the nurse respond? a. "The patch can always be cut when dosage adjustments are needed." b. "Drug levels fluctuate less with the patch." c. "There are fewer systemic side effects with transdermal patches." d. "There is less risk of toxicity when using a patch."

ANS: B Transdermal patches provide more consistent blood levels. Cutting the patch is not recommended. Drugs given transdermally can still produce side effects and toxicity.

9. The nurse is teaching a parent to administer medications using a child's gastrostomy tube. The parent asks why it is necessary to give water after each medication. The nurse explains that the water is given for which purpose? a. To decrease gastrointestinal upset b. To dilute the medication and enhance absorption c. To ensure that all medication is infused into the stomach d. To improve overall hydration

ANS: C Flushing the tube after the medication is instilled ensures that the medication reaches the stomach. It is not always given to decrease gastrointestinal upset, to dilute the medication, or to improve hydration.

1. The nurse is assisting the parent of a 6-month-old infant to administer an oral liquid medication. The parent asks why the medication can't be given in a bottle of formula to make it taste better. How will the nurse respond? a. "Adding a medication to the formula will cause the formula to curdle." b. "Formula and medications can form toxic compounds if mixed together." c. "The infant may not always take the entire bottle of formula." d. "This may cause the infant to refuse formula in the future."

ANS: C Medications should not be mixed with a large amount of food or beverage because patients may miss the full dose if they do not consume the entire amount. If the entire bottle is not consumed, the nurse will have difficulty determining how much dose was received. If medications interact with formula in vivo, package information will indicate this.

10. The nurse is preparing to administer a rectal suppository antipyretic medication. Which action by the nurse is correct? a. Allowing the suppository to soften at room temperature before inserting b. Asking the patient to lie on the right side during insertion of the medication c. Having the patient remain in a side-lying position for 20 minutes after insertion d. Using a lubricant such as petrolatum gel (Vaseline) to lubricate the medication

ANS: C Patients should remain on their side for 20 minutes after insertion of suppositories. Softening the suppository is not indicated. Patients should lie on their left side, not the right. A water-soluble lubricant should be used.

15. The nurse is preparing to start an intravenous (IV) line in a preschool-age child. After applying a eutectic mixture of local anesthetics, what will the nurse do to prepare the child? a. Describe what the IV line will feel like and how long it will be in place. b. Explain the purpose of the procedure. c. Give the child equipment to handle and practice on a doll. d. Reassure the child that the pain will only last a few minutes.

ANS: C Preschool children should be allowed to play with and handle equipment and give "play" injections using a doll or stuffed animal. Describing the procedure or discussing pain will only heighten anxiety.

4. The nurse is teaching a patient about using sublingual nitroglycerin at home. Which statement by the patient indicates understanding of the teaching? a. "I may put the tablet in food if I don't like the taste." b. "I may take a sip of water after placing the tablet in my mouth." c. "I will place the tablet between my cheek and gum." d. "I will place the tablet under my tongue and let it absorb."

ANS: D Drugs given sublingually should be placed under the tongue. No foods or fluids should be given, since the tablet must remain under the tongue until it is fully absorbed. Medications ordered to be given "buccally" should be placed between the cheek and gum.

11. The nurse is performing tuberculin testing on a patient. Which action by the nurse is correct? a. Insert the needle, bevel up, at a 30-degree angle. b. Massage the area gently after the injection. c. Measure the diameter of the area of erythema when reading the result. d. Use a 25-gauge, 3/8" needle.

ANS: D Intradermal injections should be given with a 25- to 27-gauge, 3/8"- to 5/8"-long needle. The needle should be inserted at a 10- to 15-degree angle. The area should not be massaged. The nurse measures the area of induration, not erythema.