Medication Administration Chapter 29

Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B's appropriate response? "I can log in and give the medications for you." "I am giving you my password so you can log in." "I will get the hospital's information system's phone number for you." "I will log in so that you can proceed with medication delivery."

"I will get the hospital's information system's phone number for you." rationale: Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue

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 difficulty in coordinating breathing." "Long-term use of nasal sprays can cause rebound nasal congestion." "Long-term use of nasal sprays can repair the nasal passage." "Long-term use of nasal sprays can cause an unpleasant taste."

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

The nurse just completed a refresher course on parenteral drug administration. Which statement by the nurse indicates that teaching was effective? "Reconstitution is the process of adding liquid, known as diluent, to a powdered substance." "Reconstitution is a glass or plastic container of parental medication with a self-sealing rubber stopper." "Reconstitution is a sealed glass cylinder of parenteral medication with an attached needle." "Reconstitution is a sealed glass drug container that must be broken to withdraw the medication."

"Reconstitution is the process of adding liquid, known as diluent, to a powdered substance."

landmarks for vastus lateralis

- femoral artery - greater Trochanter of femus - Vastus Lateralis

parts of needles that need to be kept sterile

- inside of the barrel - plunger - tip of barrel - needle - except for needle hub - never open and set down a syringe or needle - first open the syringe and then open the needle from the hub side, screweing the needle onto the syringe threads while the covered tip of the needle is still int he package - cleanse skin with alcohol or another antimicrobial in a circular motion, working from center to outward

dorsogluteal landmarks

- posterior superior iliac spine - Gluteus Maximus - greater trochanter of femur - sciatic nerve

Z-track technique

- technique in which you pull the skin down or to the side about 1' and hold in position with nondominant hand. Insert needle and withrdraw the needle and release the displaced tissue to allow it to return to its normal position - used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort

rights of administration

-Right Client -Right Medication -Right Route -Right Time -Right Dose -Right Documentation - right reason - right assessment data - right to refuse - right reponse

A client with a complex cardiac history has been prescribed digoxin 0.0625 mg PO. The drug is available as 125 mcg tablets. How many of the tablets will the nurse administer? 1.5 4 0.5 2

0.5

how much dosage can you insert in intramuscular site

1-5 mL

The nurse is administering morphine oral solution 5 mg to a client requesting medication for pain. The preparation is delivered as morphine solution 10 mg/5 ml. Calculate the amount, in milliliters, the will nurse administer. Record your answer to one decimal place.

2.5 5mL/10mg X ?mL/5mg

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? When giving an injection, the amount of the medication directs the choice of gauge. A larger syringe is required when giving an intramuscular injection on an obese person. The size of the syringe is directed by the viscosity of the medication to be given. As the gauge number becomes larger, the diameter of the needle and the lumen become smaller.

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

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? A larger syringe is required when giving an intramuscular injection on an obese person. The size of the syringe is directed by the viscosity of the medication to be given. As the gauge number becomes larger, the diameter of the needle and the lumen become smaller. When giving an injection, the amount of the medication directs the choice of gauge.

As the gauge number becomes larger, the diameter of the needle and the lumen become smaller. rationale: The larger the gauge, the smaller the needle. An obese person requires a longer needle to reach muscle tissue than does a thin person. When giving an injection, the viscosity of the medication directs the choice of needle gauge. The size of the syringe is directed by the amount of the medication to be given.

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 vaginal mucosa. Assess the IV site for redness. Assess the client's blood pressure. Monitor the IV infusion rate.

Assess the IV site for redness.

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

Before meals bc : after meals

The nurse is preparing to administer two IV medications. What is the appropriate nursing action? Consult a current drug reference book for IV compatibility. Prepare to administer through two separate tubes. Administer the drugs through the same tubing. Hold one medication for an hour and administer it after the first medication.

Consult a current drug reference book for IV compatibility.

The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action? Input the prescription into the electronic medical record (EMR) to reflect that the drug is given every 8 hours, after verifying with the pharmacy. Ask the nursing supervisor to validate the frequency as every 8 hours and update the electronic medical record (EMR). Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. Ask another nurse to validate the frequency as every 8 hours, update the electronic medical record (EMR), flagging the prescription for the health care provider to review and cosign the prescription within 24 hours.

Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription rationale: The nurse should always have the health care provider clarify the prescription. The nurse cannot assume that a medication is to be given at certain times, nor should another nurse verify the frequency or clarify the prescription. The nurse should remain on the phone with the provider and read back the entire prescription for verification. Documentation should reflect that it is a phone prescription. Usually the phone prescription has to be reviewed and cosigned by the provider within 24 hours

What action should the nurse take when giving an intramuscular injection using the Z-track method? Withdraw the needle within 5 seconds of injecting the medication. Use a needle at least 1 inch (2.5 cm) long. Inject the medication quickly, and steadily withdraw the needle. Do not massage the site because it may cause irritation.

Do not massage the site because it may cause irritation.

A nurse is administering an intradermal injection to a client for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at the site of injection. What is the nurse's best action in this situation? Document the administration as correctly administered. Prepare another syringe and administer it to the client at the same site. Choose another site and reinject the medication. Document the administration and inform the primary care provider.

Document the administration and inform the primary care provider. rationale: A wheal or blister indicates that the medication has been injected into the dermis. If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be reinjected into another site. The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.

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? Aspirate for blood return from the tissue. Draw an imaginary line at the axilla between the acromion and brachial vessels. Pull the tissue laterally until it is taut. Avoid asking the client to lie down or sit.

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

The nurse has given a client an injection. How will the nurse prevent an accidental needle stick? Immediately activate the safety needle and remove the needle from the syringe. Place the needle in the Sharps container and the syringe in the trash. Immediately activate the safety needle and hold it close to the body until disposing it into the Sharps container. Immediately activate the safety needle and place the syringe and needle into a Sharps container. Immediately activate the safety needle and have a colleague hold the Sharps container within reach for disposing of the syringe and needle.

Immediately activate the safety needle and place the syringe and needle into a Sharps container.

The nurse is preparing to administer an allergy test via an intradermal injection. Which injection site would be most appropriate in this situation? Abdomen Anterior aspect of the thigh Inner surface of the forearm Shoulder

Inner surface of the forearm

Which actions by the nurse are appropriate when administering a vaginal cream? Select all that apply. Perform perineal care cleansing from just above the vaginal orifice downward. Insert the vaginal applicator directing it downward and backward. Put on sterile gloves after completing preparation of the applicator and perineal care. Keep the plunger applicator fully depressed until removed from the client. Assist the client to a sitting position after insertion of the cream.

Perform perineal care cleansing from just above the vaginal orifice downward. Insert the vaginal applicator directing it downward and backward.

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. Document the injury. Obtain the client's blood to be tested for HIV and HBV. Request counseling on the potential for infection.

Report the needlestick to the nurse manager.

The nurse is preparing to administer a transdermal medication. How should this be accomplished? The nurse should inject the medication just below the dermis of the skin. The nurse should ask the client to swallow the medication. The nurse should apply the medication directly to the skin. The nurse should inject the medication into a body cavity.

The nurse should apply the medication directly to the skin.

Which nursing strategy should the nurse employ to assist a child who has difficulty coordinating inspiration with the use of a handheld inhaler? The nurse should instruct the child to prolong his/her inhalation. The nurse should assess the child's mucous membranes. The nurse should use a nebulizer to administer the medication. The nurse should provide simple written instructions.

The nurse should use a nebulizer to administer the medication. rationale: alternative to administering an inhalant for young children

A postoperative client's medication administration record (MAR) provides for PRN administration of a number of analgesics by various routes. Which action should the nurse take to assess the client's pain to determine the appropriate analgesic to administer? The nurse will have the client rate pain on the pain scale of 1 to 10 and proceed accordingly. The nurse will explain the options to the client and let the client decide. The nurse will consult with the charge nurse to make the decision. The nurse will call the health care provider to ask which medication should be used.

The nurse will have the client rate pain on the pain scale of 1 to 10 and proceed accordingly

The nurse enters a client's room to administer preoperative antibiotics. Which rights of medication administration must the nurse follow? Room Heart rate Time Blood type

Time

A client with chronic obstructive pulmonary disease (COPD) has been prescribed an inhaled bronchodilator. Which technique should the nurse implement in order to ensure safe and complete delivery of the prescribed medication? Place the inhaler as deeply into the client's mouth as is comfortable. Provide oxygen therapy 30 minutes prior to administration. Use a spacer or extender with the metered-dose inhaler. Provide multiple puffs of the medication in rapid sequence.

Use a spacer or extender with the metered-dose inhaler rationale: The use of an extender or spacer ensures that the client receives as much of the inhaled medication as possible. MDIs are placed 1 or 2 inches (2.5 or 5 cm) in front of the mouth, not deeply into the mouth. Oxygen therapy prior to administration does not aid in delivery. Multiple puffs, if ordered, are given after 1 to 5 minutes.

A physician at a health care facility suggests the use of a metered-dose inhaler for an asthmatic client. Which describes the mechanism of a metered-dose inhaler? a device that forces medication through a narrow channel with the help of inert gas a device that forces liquid drug through a narrow channel using pressurized air a propeller-driven device that spins and suspends a finely powdered medication a canister containing medication that is released when the container is compressed

a canister containing medication that is released when the container is compressed rationale: A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas

The nurse is caring for a group of clients on the acute care unit. Which client(s) will benefit from urinary catheterization? Select all that apply. a client with an enlarged prostate that is unable to void a client that is unable to mobilize to the bathroom following abdominal surgery a confused client that requires a sterile urine specimen to be obtained a client in septic shock that is unresponsive a client that developed a urinary tract infection

a client with an enlarged prostate that is unable to void a confused client that requires a sterile urine specimen to be obtained a client in septic shock that is unresponsive

Which action(s) by a licensed practical nurse (LPN) will illicit immediate intervention by the registered nurse (RN)? Select all that apply. administering packed red blood cells to a client with anemia assisting a client with congestion with prescribed nasal spray giving a diuretic by mouth to a client with excess fluid volume flushing an implanted central venous access device preparing to apply a topical antibiotic to a client with an abrasion

administering packed red blood cells to a client with anemia flushing an implanted central venous access device rationale: LPNs are generally not permitted within their scope of practice to administer IV chemotherapy, blood, or blood products; to push IV medications; or to administer medications and flushes through tunneled or implanted central venous access devices. Other actions are generally within the scope of practice of an LPN and do not require immediate RN intervention.

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 administration electronic infusion device continuous drip gravity infusion

bolus administration rationale: A bolus is a relatively large amount of medication given all at once; bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration. A continuous infusion, also called continuous drip, is instillation of a parenteral drug over several hours. It involves adding medication to a large volume of IV solution. After the medication is added, the solution is administered by gravity infusion or, more commonly, with an electronic infusion device such as a controller or pump

The nurse is reading an order that indicates that a drug is to be given to a client "q4h." How will the nurse administer the medication? every 4 hours as needed four times daily immediately

every 4 hours

Following an allergic reaction to a medication, the nurse should: inform the client that the medication may cause an allergy only one time. instruct the client to wear an identification bracelet addressing the allergy. inform the client that an allergic reaction can be transient. instruct the client to be sure the allergy is on his medical record.

instruct the client to wear an identification bracelet addressing the allergy.

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? subcutaneous intramuscular intravenous intradermal

intradermal

After administering medication to a client subcutaneously, the nurse removes the needle at the same angle at which it was inserted. Which explains the nurse's action? prevents needlestick injuries verifies correct injection of the drug minimizes tissue trauma to the client helps to control placement of the needle

minimizes tissue trauma to the client rationale : Removing the needle at the same angle at which it was inserted to administer medication minimizes tissue trauma and discomfort to the client. To verify correct injection of the drug, the nurse pushes the plunger and watches for a small wheal. To prevent needlestick injuries, the nurse covers the needle with a protective cap. Holding the client's arm and stretching the skin taut helps to control placement of the needle.

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? aspirin chewable tablet furosemide liquid oxycodone extended release tablet acetaminophen tablet

oxycodone extended release tablet

Which action describes buccal medication administration? placing a medication that is designed to be absorbed through the skin for systemic effects on the skin placing a medication through a nasogastric tube placing a medication underneath the upper lip or in the side of the mouth placing a medication under the tongue and allowing it to dissolve

placing a medication underneath the upper lip or in the side of the mouth

What would be considered a "right" of drug administration? Select all that apply. right drug right documentation right class right dose right client

right drug right documentation right dose right client

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? oblique lithotomy prone supine

supine

Landmarks for deltoid injection

the acromion process and the axillary line- insert 1-2 inches below acromion process but above the axillary line - Deltoid muscle

What is the best explanation from the nurse as to why a client must return to the unit in 48 hours after having a tuberculin skin test intradermal? to determine the extent to which the client responded to the drugs to implement measures to reduce the transmission of microorganisms to administer timely emergency treatment to prevent interfering with test results

to determine the extent to which the client responded to the drugs

Large needles should be used for__

larger amount of medication being prescribed

Smaller needles should be used for

prescise dosing

A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client? deltoid site ventrogluteal site dorsogluteal site vastus lateralis site

vastus lateralis site

Gauge

- refers to the diameter of the needle. Named 18-30 - As the # of needle increses, the guage number decreases - EX) 18 guage needle is larger in daimeter than a 30 gauge needle. OPPOSITE RULE. THE LARGER THE GAUGE OF NEEDLE THE SMALLER THE DIAMETER

Viscosity of the solution Needle

- require a needle with a larger lumen

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? "The nurse should not have crushed this medication. It could have caused an allergic reaction." "I can crush the medication but will not be able to mix it in the applesauce, because it will limit the effectiveness." "I will ask the health care provider to cancel the prescription for aspirin since you are unable to take it." "Crushing the medication may cause the medication to irritate the stomach, so it must be swallowed whole."

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

The nurse is conducting teaching with a client who has a prescription for a wireless capsule endoscopy. Which statement by the client would indicate to the nurse that the teaching was effective? "I will return 24 to 48 hours after swallowing the capsule to have the capsule removed." "I will feel bloated and uncomfortable because of the air used to expand my small intestine." "I can go about my daily routine while the camera is passing though my small intestine." "I will not be allowed to eat anything after the first 4 hours of the study."

"I can go about my daily routine while the camera is passing though my small intestine." While the camera is passing through the small intestine, the client may resume normal activities. The client can have a small meal after the first 2 hours of the study. No air is used to expand the small intestine, so the client should not feel bloated and uncomfortable. The capsule will be excreted 24 to 48 hours after ingestion via normal defecation process.

Intramascular injection needle lenght

- A larger needle is required

landmarks for ventrogluteal

- Anterior superior iliac spine - Iliac crest ( hip bone) - Gluteus medius - Greater Trochanter

Intramuscular needle size

- Biologic agents: 20-25 guage - Oil based: 18-25 guage

The nurse has an order to infuse 1000 mL of dextrose 5% with 0.45 normal saline. The infusion is ordered over 8 hours. The solution set delivers 10 gtt/cc. How many drops per minute will the nurse need to infuse the intravenous fluids? 5 gtts/minute 15 gtts/minute 21 gtts/minute 30 gtts/minute

21 gtts/minute

Subcutanesouly needle size

25- 30 guage, 3/8 to 1" 3/8 ( 90 degree) and 5/8 ( 45 degree) are commonly used.

A nurse needs to administer a prescribed injection to an older adult client with impaired mobility. Which intramuscular site is preferred for administering an injection to older adult clients? rectus femoris gluteus maximus upper chest ventrogluteal

ventrogluteal

ventrogluteal adults needle lenght

1 to 1 1/2

A client has been prescribed 300 mg of an oral antibiotic. It is available in 200 mg tablets. How many tablets will the nurse administer? Record your answer using one decimal place.

1.5

Intradermal injection gauge needle size

1/4 to 1/2, 25-27 guage needle is used

The nurse is preparing to administer a tuberculin test. At which angle is the nurse expected to instill the drug? 120-degree angle 90-degree angle 45-degree angle 15-degree angle

15-degree angle

Angle of intradermal injection

5-15 degrees

deltoid adult needle lenght

5-8 - 1 1/2

Vastus laterials needle lenght adult

5/8 to 1

deltoid (children) needle length

5/8-1

The nurse is reviewing the plan of care for several clients who have prescriptions for intravenous medications. The nurse understands that which client is at the highest risk for greater effect of the IV medication? 16-year-old client diagnosed with left radial fracture 73-year-old client diagnosed with liver disease 35-year-old client diagnosed with migraines 45-year-old client diagnosed with lung cancer

73-year-old client diagnosed with liver disease rationale: Older adults have a decrease in plasma protein, which is needed to bind and inactivate the medication in the bloodstream. The decrease in plasma proteins can increase the amount of medication circulating, which increases the effects. Decreased liver and kidney function also increases the amount of medication in the blood. The other options can have a risk, but they are not the highest.

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 it is to be applied topically. Which instructions should the nurse provide? Clean the area with alcohol and apply a quarter size of medication to the affected area. Apply the medication to clean, dry skin of the affected area using gloves. Apply a small amount of the medication to the affected area then repeat after initial dose has dried. Using sterile gauze, apply to the affected area with gloves and cover with a bandage.

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

The nurse is preparing to give medications to a client with anxiety. The order indicates that the client is to have bupropion, 7.5 mg by mouth twice daily. What is the appropriate nursing action? Ask another nurse to verify the order. Contact the health care provider for order clarification. Assume that the provider meant to order buspirone. Administer the drug as ordered.

Contact the health care provider for order clarification. rationale: The nurse should contact the health care provider to verify the order. Bupropion and buspirone are drugs that have look-alike and sound-alike properties but are different in indication. The nurse should not automatically administer the drug, nor ask another nurse to verify an order, nor assume what is meant by an order

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

Deltoid rationale: The deltoid and ventrogluteal sites are more appropriate for adults than the vastus lateralis

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? Arrange for home health to see the client. Provide discharge paperwork to the client. Request another nurse to reteach the material. Give written instructions to the client and caregivers.

Give written instructions to the client and caregivers rationale: Older adults may not be able to remember instructions in order to repeat them back clearly. It is appropriate to provide written instructions so the client and caregivers have a quick reference to use for medication administration.

Which actions would the nurse perform when administering a subcutaneous injection correctly? Select all that apply. If using the outer aspect of the upper arm, place the client's arm over the chest with the outer area exposed. After removing the needle, do not massage the area to prevent hematoma formation. Remove the needle cap with the dominant hand, pulling it straight off. If blood appears when aspirating, withdraw the needle and reinject it at another site. Grasp and bunch the area surrounding the injection site or spread the skin taut at the site. Inject the needle quickly at an angle of 45 to 90 degrees.

Grasp and bunch the area surrounding the injection site or spread the skin taut at the site. Inject the needle quickly at an angle of 45 to 90 degrees. After removing the needle, do not massage the area to prevent hematoma formation.

Which situation accurately describes a recommended guideline when administering oral medications to clients? Assume that the client is the authority on whether or not the medication was swallowed. If a client vomits immediately after receiving oral medications, readminister the medication. If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. If a pill is dropped, it should be briefly immersed in saline to remove any dirt or germs.

If a child refuses to take medication, crush the medication, if allowable, and add to a small amount of food. rationale: medication can be added to small amounts of food, but should NOT be added to liquids

The nurse is preparing to administer prescribed intravenous antibiotics to a client. While assessing the medication lock, the nurse notes that there is resistance when administering the saline flush solution. What would be the best action by the nurse? Insert a new IV medication lock and remove the old one. Call the physician to request oral antibiotics. Flush the lock with heparin solution. Administer the prescribed antibiotics as prescribed.

Insert a new IV medication lock and remove the old one rationale: The nurse is to flush the medication IV lock every 8 to 12 hours, or depending on the facility policy. When flushing the IV lock, the nurse verifies the patency of the lock by aspirating blood return and the lock should flush without resistance. If the nurse is unable to flush without resistance, if there is leaking from the site during flushing, or if patency cannot be verified, the nurse should remove the IV lock and insert a new IV lock. If the nurse has resistance with flushing with saline, flushing with heparin would not be an appropriate option. The nurse should not administer the antibiotic if the IV lock is resistant during flushing. Calling the physician to change the order is not appropriate

dosage of intradermal injection

Less than 0.5mL

The nurse is reviewing a medication prescription for a client prior to administration and observes that the route of administration is not present in the prescription. What is the appropriate action by the nurse to address this omission? Call to ask the pharmacy how the drug should be administered. Omit the administration of the medication since it was written incorrectly. Notify the health care provider to add the route and then administer the medication when complete. Add the route to the prescription and administer the medication since the nurse is familiar with the drug.

Notify the health care provider to add the route and then administer the medication when complete

Ibuprofen 200 mg is obtained: as a supplement. by prescription. as an herb. over-the-counter.

OTC