Chapter 29: Medication Administration

The nurse is preparing to administer a transdermal medication. How should this be accomplished?

The nurse should apply the medication directly to the skin

Which instruction should the nurse give to a client to ensure that a nasal medication is deposited within the nose rather than into the throat?

"Aim the tip of the container toward the nasal passage"

The nurse is caring for a client who is receiving a prescribed IV of an antibiotic to treat an infection. The client asks the nurse, "Can I just take a pill?" What is the best response by the nurse?

"An IV infusion maintains a therapeutic level of the medication in your blood"

The nurse is preparing a client newly prescribed digoxin for discharge. Which safety consideration should the nurse include in the client teaching?

"Check your radial pulse before taking the medication each day"

The nurse is preparing to administer an enteric-coated aspirin to a client. The client states, "I cannot swallow that so you will have to crush it and put it in applesauce for me as the other nurse does." Which is an appropriate reply from the nurse?

"Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole"

A nurse is preparing to irrigate an intermittent infusion device. Which size syringe would the nurse use?

10 mL

The nurse is preparing to administer an allergy test intradermally. At what angle will the nurse plan to insert the needle into the client?

10 to 15 degrees

The charge nurse on the med/surg unit is reviewing physician orders for a client with a diagnosis of CHF. Which infusion orders would the nurse question?

1000 D5W to run in 30 minutes

The nurse is preparing to administer insulin to an obese client. At what angle will the nurse plan to insert the needle into the client?

90 degrees

The nurse is preparing to insert an IV needle in a 1 y/o child for a one-time administration of fluids due to dehydration. Which needle would the nurse likely select?

A 23-gauge winged infusion set

Which client would most likely require placement of an implantable port?

A 58 y/o woman with stage 3 breast cancer requiring weekly chemotherapy

It is particularly important for the nurse to use this technique when administering IM medication to which client?

A 70 y/o demonstrating muscle wasting prescribed chlorpromazine

A physician at a healthcare facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler?

A canister containing medication that is released when the container is compressed

Which medication interaction illustrates a synergism?

A client takes acetaminophen to help her sleep. She also takes an oxycodone for pain related to recent hip surgery, which makes her even more drowsy.

To which client would the nurse be most likely to administer a PRN medication?

A client who is reporting pain near the surgical site

The nurse is preparing a medication from a vial and contaminates the plunger after the medication is drawn into the syringe. What should the nurse do next?

Administer the medication as prescribed

The nurse is preparing to administer a bolus of an intravenous medication. How should the medication be administered?

All at once

A nurse has administered an injection to a client. Which intervention should the nurse perform to reduce discomfort and provide quick relief?

Apply pressure to the site during needle withdrawal

The client asks the nurse how to administer medication purchased over the counter for relief of arthritis pain. The nurse reviews the medication and determines that this is to be applied topically. Which instructions should the nurse provide?

Apply the medication to clean, dry skin of the affected area using gloves

A nurse educator is teaching a student nurse how to choose the correct needle for an injection. Which guidelines for needle selection might they discuss?

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller

A nurse at the healthcare facility needs to administer an otic application for a client with an earache. What should the nurse do after instilling the prescribed ear drops in the client's ear?

Ask the client to maintain the position for some time

A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the first assessment the nurse should make?

Assess the IV site for redness

A nurse is caring for a client who is being tube fed. What care should the nurse take when administering medications through an enteral tube?

Avoid crushing sustained-release pellets

A client has an intermittent infusion device inserted for the administration of antibiotic therapy every 6 hours. The nurse would expect to flush the device at which frequency?

Before and after each medication administration

A medication order has ac written after the medication dosage. What does ac stand for?

Before meals

Which IV administration has the greatest potential to cause life-threatening changes?

Bolus administration

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client?

Bolus administratoin

A client with COPD has been prescribed a bronchodilator to be administered by small-volume nebulizer. The nurse should ensure that the client:

Breathes through his or her mouth until all the medication has been inhaled

A nurse receives orders from the physician to mix a client's insulin in a syringe with two other medications. What is the recommended guideline in this situation?

Call the pharmacist to determine compatibility of the drugs

The nurse observes a prescription written for a client for a medication that does not correlate with the client's diagnosis or comorbid factors. What is the best action for the nurse to take?

Call the provider to obtain a rationale for the use of the medication for the client

The nurse is preparing to administer a liquid form of medication to a client. What action will the nurse take to ensure that administration of the drug is at the desired potency?

Check the expiration date

Which assessment should be conducted by the nurse before the nurse administers tuberculin intradermal injection?

Checking for documented allergies to food or drugs

A nurse is applying a vaginal cream to a client with a fungal infection. Which guideline is recommended for this application?

Cleanse area at vaginal orifice with washcloth and warm water

Which client does the nurse recognize will require an IM administration of the medication instead of an intravenous administration?

Client who is low risk for hemorrhage and prescribed the Hepatitis B vaccination

The nurse is preparing to administer two IV medications. What is the appropriate nursing action?

Consult a current drug reference book for IV compatability

After teaching a group of nursing students about pharmacokinetics, the instructor determines that the education was successful when the students identify what process by which the medication is delivered to the target cells and tissues?

Distribution

A nurse needs to administer an injection to a client in the deltoid site. Which action should the nurse perform to avoid the risk of damaging the radial nerve and artery?

Draw an imaginary line at the axilla between the acromion and brachial vessels

A home care nurse is educating a client with diabetes on how to self-administer insulin. Which teaching point should the nurse include in the education plan?

Each time you give the injection rotate the injection site

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation?

IV infusion

Which situation accurately describes a recommended guideline when administering oral medications to clients?

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food

A nurse is administering an injection to a client at a 15-degree angle. The client has a venous access port. Which injection can be administered at this angle?

Intradermal

Which parenteral route of administration has the longest absorption time?

Intradermal

The Z-track technique is utilized during drug administration by which route?

Intramuscular (IM)

A nurse needs to administer a prescribed injection to a toddler. Which of the following injection sites is most suitable for the client?

Vastus lateralis site

The nurse is teaching a client with heart failure about taking digoxin safely. Which statement by the nurse indicates teaching was effective?

"I will call the healthcare provider if I develop dizziness, blurred vision, or nausea"

What is the best response by the nurse when a client asks about the side effects of using nasal spray?

"Long-term use of nasal sprays can cause rebound nasal congestion"

A client who has been prescribed an inhaler points to the spacer and asks, "What is this for?" What is the appropriate nursing response?

"Medication stays in the chamber so you can continue to inhale it"

A nursing student is teaching the client regarding insertion of a central line catheter. Which statement by the student would cause the nurse to intervene?

"The risks are the same for a central line as they are for peripheral lines"

A client is newly prescribed a medication that must be taken on an empty stomach. Which statement by the nurse best describes why some medications should be taken before meals?

"This is because food and some drinks can affect the way your medicine works"

An older adult client has been prescribed a transdermal patch. Which client statement demonstrates the need for further teaching by the nurse?

"This medication is likely to work slower on me than on a young person"

A client is taking numerous eye drops to prepare for cataract surgery. Which teaching about ophthalmic application will the nurse provide?

"Wait 5 minutes between instillation of different types of eye drops"

The client is prescribed ear drops to be given in both ears. After administering the ear drops in one ear, how long would the nurse wait before administering the ear drops in the other ear?

5 minutes

A nurse is administering an adult client's ordered antipsychotic drug intramuscularly. What would be the most appropriate site for administration?

Deltoid

The nurse is preparing to administer two types of insulin by mixing in one syringe. What is the first action by the nurse?

Determine compatibility of the insulins by checking a drug company table

The nurse prepares to administer a fentanyl transdermal patch and discovers two transdermal patches are on the client's back and upper right chest. Which best action should the nurse take next?

Determine what transdermal patches are currently on the skin

While receiving a medication IV piggyback, the client reports discomfort at the IV site. Upon assessment, the site is cool to the touch and slightly swollen. What is the best action by the nurse?

Discontinue the IV site and restart IV in a new location

When administering a subcut injection to a client, the needle pulls out of the skin when the skin fold is released. What would be the appropriate next action of the nurse in this situation?

Engage safety shield on needle guard and discard needle appropriately

A client with a diagnosis of glaucoma has been prescribed a medication that is to be administered by an eye drop. Which action should the nurse perform?

Ensure that drops of the medication fall onto the client's conjunctival sac

The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented but unable to articulate the teaching back to the nurse. What is the appropriate nursing action?

Give written instructions to the client and caregivers

The nurse is providing teaching to an older adult with arthritis and an implanted catheter. What living arrangement does the nurse anticipate in the discharge plan of care?

Home nursing visits

A nurse is explaining to a client the correct method of using a metered-dose inhaler when self-administering a prescribed dose of medication. What is a feature of a metered-dose inhaler?

It is a canister that contains pressurized medication

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. What is an accurate guideline for IV management that the nurse should consider?

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation?

Medications that need to be infused over 20 to 60 minutes

The nurse is caring for a client with a yeast infection. Which medication does the nurse anticipate will be prescribed?

Miconazole

The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The MAR does not show that the initial dose was given. What is the appropriate nursing action?

Notify the healthcare provider

Place the routes in the proper order from slowest to fastest absorption

Oral Subcutaneous Intramuscular Intravenous

Which medications are dropped into the ear to treat ear infections or to soften and remove ear wax?

Otic

The client cannot swallow and just had an enteral tube placed for feeding and medications. Medications will have to be in liquid form or crushed for administration. The client has the following medications prescribed. Which medication will the nurse withhold and consult with the health care provider?

Oxycodone extended release tablet

The nurse beginning a shift has received a report from the previous nurse, who reports that a client has a catheter inserted into the subclavian vein. The oncoming nurse will plan to assess which type of catheter?

Peripherally inserted cutaneous catheter

The nurse is caring for a client with visual impairment who has been prescribed two different types of eye drops. Which nursing intervention will best assist the client in differentiating between the bottles of drops?

Place a rubber band snugly around one of the bottles

In preparing to administer a drug to a client, the nurse has pierced a multi-use vial of medication. What is the appropriate nursing action?

Place the date on the vial and retain for future use

The nurse is assessing a client who was seen 7 days ago with strep throat. The client states, "I felt better after 2 days of the antibiotic so I quit taking it". What would the nurse do to address this situation?

Provide education on taking all antibiotics for effective treatment

The nurse has received a telephone order for a client from a healthcare provider. How will the nurse indicate in the documentation that the order was received via telephone?

Record "T.O." at the end of the order

While administering a medication via a syringe, a client sharply moves and the nurse accidentally encounters a needlestick. What is the priority nursing action?

Report the needlestick to the nurse manager

A nurse brings a client the prescribed dose of medication and finds that the client is not in the unit. What should the nurse do in this case?

Return the medication to the medication cart/room

An acute care facility follows the unit dose supply method to supply medication to the clients. What is meant by the unit dose supply method?

Self-contained packets that hold one tablet or capsule for individual clients

The nurse administers the client's scheduled morning medications. The previous dose of antihypertensive was held due to a blood pressure that was too low according to the healthcare provider's parameters. What does the nurse do with this upcoming dose of scheduled unit-dose packaged antihypertensive medication?

Set the antihypertensive dose aside pending assessment

The nurse is caring for a client who has problems coordinating his breathing with the inhaler use. Therefore, the client is unable to receive the full dose. Which would help maximize drug absorption in this client?

Spacer

The nurse is preparing to administer nasal medication via a dropper to a client with severe congestion. Into which position will the nurse place the client?

Supine

A client is ordered to receive an IM injection of medication. When preparing to administer the injection, the nurse selects the ventrogluteal site based on which reason?

The area is free of major blood vessels and fat

The nurse correlates the metric system as the most accurate method utilized to administer medications for which reason?

The dosage prescriptions of medications most often use this system as it is measured in 10s and can easily be converted between measurements

The primary reason for the Controlled Substances Act is:

To prevent drug use and dependence

The nurse is preparing to withdraw liquid medication from an ampule for injection into an IV. What is the appropriate action for the nurse to take when withdrawing the medication?

Use a filter needle to withdraw the medication

A nurse needs to administer a prescribed injection to an older client with impaired mobility. Which IM site is preferred for administering an injection to older adult clients?

Ventrogluteal

The client states "I think my IV dressing needs to be changed." In which instance should the nurse change the dressing?

When the dressing is loose, bloody or wet

While injecting a needle into a client for an intramuscular injection, the nurse hits the client's bone. What would be the appropriate initial response of the nurse to this situation?

Withdraw the needle, apply a new needle to syringe, and administer the injection in an alternate site.