Psych Tech Exam 2

An inhaler must be shaken: A. Before each and every time you use it. B. After each and every time you use it. C. If the physician orders more than one puff to be administered to the resident. D. Only if it becomes clogged.

A. An inhaler must be shaken before each and every time the inhaler is used. This helps to ensure that the proper amount of medication is administered.

What is another name for anticonvulsant?

Antiepileptic

If you question a dosage, give the medication then call the pharmacy. A. True B. False

B. If you have a question about a medication such as the dosage, you should always contact the pharmacy before administering the medication.

If you are not sure of an abbreviation, it is O.K. to guess A. True B. False

B. It is not OK to guess if you are not sure of an abbreviation. If you are not certain of an abbreviation, you should refer to the list

A medication cannot cause a resident to be confused. A. True B. False

B. Medications have side effects and many medications can cause a resident to become confused. This is especially true for elderly residents. It is important to report changes noticed with residents to the supervisor, nurse, pharmacist, or physician, according to the facility's policy. The facility's policy is to identify who will contact the physician of any changes noticed with a resident. A medication may be the reason for this change in the resident.

In order for a medication to be administered you must have: A. permission from the family B. a drug handout of information from the pharmacist C. a physician's order

C. An order from a physician or prescribing practitioner is required before any medication, prescription and non-prescription, is administered to a resident. Refer to regulation 13F/13G .1004

Lasix causes a loss of potassium. Why is this a potentially big problem?

Can lead to heart failure

3.The following are abbreviations for dosages or strengths of medications EXCEPT: A. mg B. ml C. gm D. PD

D. PD is not an abbreviation for dosages or strengths.

What class is the number 1, most prescribed drug in America, according to WebMD?

Narcotics

List the adverse reaction possibilities for Lasix.

Orthostatic hypotension, thrombophlebitis, chronic arthritis, vertigo, headache, dizziness, paresthesia, restlessness, fever, photosensitivity, urticaria, pruritus. Blurred vision, tinnitus, nausea, vomiting, diarrhea. Urinary bladder spasm, agranulocytosis, jaundice, hypokalemia, hyperglycemia, metabolic alkalosis, muscle spasm, weakness

Discuss the principles related to application of sterile gloves.

Perform thorough hand hygiene Carefully peel apart outer packaging Lay inside packaging containing gloves on flat, clean surface Pull edges apart and smooth over surface Pick up glove closest to you from inside of glove and put it on without touching the sterile part Using gloved hand, put fingers under cuff of other glove without breaking sterile field and out it on.

Tell me your thoughts on hydrocodone/APAP (acetaminophen; what is the abuse potential of this drug? What schedule is given to this drug?

Schedule 3. Schedule III drugs have less potential for abuse or addiction than drugs in the first two schedules and have a currently accepted medical use

Beta receptors are found in the sympathetic nervous system. Beta receptors, when stimulated will cause a sympathetic nervous system response. So, for that reason, what do you think a beta blocker blocks?

Stress hormones/the effects of the sympathetic nervous system

What are the classifications of these 2 drugs?

Sulfonylurea and biguanide

Why should a patient be warned against abruptly discontinuing/stopping a beta blocker?

it can cause life threatening adverse effects.

Why might a doctor prescribe a combination drug like glucovance?

to improve glycemic control in patients with type 2 diabetes

When applying a topical medication, you should wear: A. A waterproof gown. B. A mask. C. Gloves. D. A mask and gloves.

. C. Gloves are required when applying topical medications. This is protection for you and the resident.

Consider problems with the prescribing doctor's order, the pharmacy role and the functions of the nursing staff related to administration of medications. You will be expected to trouble shoot issue of collaboration to the administration of meds.

...

The physician's order is for Milk of Magnesia 2 Tbsp. by mouth at bedtime. How much would you give using the metric system? A. 30 ml. B. 45 ml. C. 10 ml. D. 60 ml.

A. "Tbsp" means tablespoon and 1 tablespoon is equal to 15ml. So 2 tablespoons would be equal to 30ml.

When administering medications, the main concern with leaving medications at the bedside is that: A. the resident may never take the medications and someone else may. B. the medications may accumulate dust. C. it may increase confusion. D. a staff member might report you

A. All of the choices may apply, but the main concern is that the resident may never take the medication and someone else may. Leaving the medications unattended is not a safe practice.

.It is important to know the policy on approved abbreviations for your facility. A. True B. False

A. Approved abbreviations may vary between facilities. Some facilities do not use certain abbreviations because of the potential of medication errors. It is important for you to know the facility's policy.

A delay in administering a medication may cause a life-threatening incident. A. True B. False

A. Medications are to be administered as prescribed. A delay in administering a medication such as Nitroglycerin or insulin may be life threatening.

The physician's order is for Lactulose 2 tsp. by mouth at bedtime. How much would you give using the metric system? A. 10 ml. B. 15 ml. C. 20 ml. D. 30 ml.

A. The abbreviation "tsp" means teaspoon and 1 teaspoon equals 5ml. So 2 teaspoons would be equal to 10ml.

You receive an order for Nitroglycerin to be given sublingually. It would be given: A. Under the tongue B. By mouth C. Instilled in the ear D. Applied to the skin

A. Under the tongue.

When should medications be signed off on the MAR? A. After a resident has been observed to actually take the medication B. After all the residents have been administered their medications and observed to actually take the medications C. After the medication label is checked with the MAR D. Before the county or state visits the home.

A. You document immediately after you administer the medications to a resident and after you observe the resident actually take the medications and prior to administering another resident's medications. Remember, it is important for documentation on the MAR to be accurate. Documenting immediately after you administer a medication helps to ensure accurate documentation. Precharting or documenting the administration of a medication before the medication is administered is prohibited. Refer to regulation 13F/13G .1004.

Review the steps of the nursing process and be prepared to problem solve using the nursing process

ADPIE Assess: Gather information about client's condition Diagnose: Identify problem Plan: Set goals of care and desired outcomes and identify appropriate nursing actions Implement: Perform nursing actions identified in planning Evaluate: Determine if the goals were met and outcomes achieved

What was the most prescribed antibiotic?

Azithromycin (brand names include Z-Pak and Zithromax)

A milliliter is the same as a milligram. A. True B. False

B. A milliliter is not the same as a milligram. Volume refers to the amount of liquid in a container and it is measured in milliliters (ml) and cubic centimeters (cc). Strength refers to the amount of drug. Strength is measured in milligram (mg), grams (gm), micrograms (mcg) and milliequivalents (mEq)

If you are unable to read the physician's handwriting on a prescription or health services record or the directions for a medication are incomplete, you should: A. Leave the orders for the staff on the next shift. B. Contact your supervisor, the pharmacist or the physician. C. Ask the resident or a family member. D. Use your best "guess."

B. Contacting the supervisor, nurse, pharmacist or physician is the correct answer. The physician or prescribing practitioner must be contacted when clarification of medication orders or prescriptions is required. Clarification is needed when staff or health professionals can not read the physician's handwriting or the directions are incomplete. Depending on a coworker or family member may not give accurate information. You never guess what the physician may have written!

Before administering a "PRN" medication, you need to: A. Know the reason the medication is being requested and ask the resident when the medication was last administered. B. Know the reason the medication is being requested and look at the MAR to see when the medication was last administered.

B. Medications, including PRNs, are to be administered as prescribed. You need to look at the resident's MAR in order to know when the medication was last administered and the reason the medication is prescribed. You need to know why the medication is being requested or needed so you can make sure the medication is administered for the reason prescribed.

The following are abbreviations for drug routes, EXCEPT: A. PO B. IM C. PD D. SL

C. PD is not an abbreviation for route of administration. PO means orally or by mouth. IM means intramuscularly or into the muscle. SL means sublingually or under the tongue.

Mrs. Smith has an order for Darvocet N-100 1 tablet every 4 hours as needed for pain. According to the MARs, she has been taking the Darvocet at 8AM, 12PM, 4PM and 8PM every day for the past 2 months. Which of the following statement is correct? A. Schedule the Darvocet for 8AM, 12PM, 4 PM and 8PM on the (MAR) B. Just continue to administer the medication when Mrs. Smith requests the Darvocet. C. Mrs. Smith's physician should be contacted about how often Mrs. Smith is taking the Darvocet.

C. Specific administration times for PRN medications are never scheduled on the MAR. The resident's physician needs to be contacted and told how often the resident is taking the medication. The physician may change the medication order or decide that the resident needs to be seen. Whether the order is changed or not, contact with the physician is always documented in the resident's record

The physician's order is for Haldol Liquid Concentrate 2ml every 8 hours. How much would you give? A. 1 milligram (mg). B. 2 milligrams (mg). C. 5 milligrams (mg). D. None of the above are correct.

D. The order states "2ml" and that means 2 milliliters. All the choices are milligrams (mg). Remember a milliliter (ml) is not equal to a milligram (mg).

The physician's order is for Riopan Liquid 2 every 4 hours as needed for heartburn. How much would you give using the metric system? A. 1 ml. B. 2 teaspoons. C. 2 Tablespoons. D. Can't tell how much to give from this order.

D. You can not tell how much to administer because the order is not complete. The physician ordered 2, but two what? This is not stated. You may be tempted to guess that the physician meant 2 teaspoons or 2 tablespoons, but remember when you guess, you may be right or you might be wrong. The physician is contacted for complete instructions.

How does gabapentin work?

It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain

Metformin is in the top 10 - what does this tell you about DM in America?

It's common/an epidemic due to poor diet and sedentary lifestyle

What is gluconeogenisis?

glucose production: the production of glucose, especially in the liver, from amino acids, fats, and other substances that are not carbohydrates

What are the 2 drugs combined in the drug glucovance?

glyburide and metformin

When measuring liquids, which of the following statements is FALSE: A. A teaspoon or tablespoon from the kitchen may be used. B. A calibrated syringe or dropper is often necessary for measuring amounts less than 5ml and unequal or odd amounts. C. When using a medication cup, it should be placed on a flat surface and measured at eye level. D. You never approximate or guess the amount of medication to administer.

. A. Household utensils such as a teaspoon and tablespoon are not used to measure liquids. Teaspoons and tablespoons are not calibrated for measuring medications. Only devices that are calibrated for measuring medications are used to administer medications. A calibrated syringe or dropper is often necessary for measuring amounts less than 5ml and unequal or odd amounts. Medication cups may not have the appropriate markings and you would have to approximate the amount of medication to administer for amounts less than 5ml or odd amounts. You never approximate or guess the amount of medication to administer. A medication cup is placed on a flat surface and measured at eye level to ensure accuracy.

Medications should be given within one hour before or one hour after the prescribed or scheduled time of administration. A. True B. False

. A. Refer to regulation 13F/13G .1004. A medication scheduled for administration at 8AM would have to be administered between 7AM and 9AM, in order for the administration to be considered timely. This does not apply to medications prescribed in accordance with meals or medications such as insulin.

When medications are stored in a refrigerator that is accessible to residents, the medications are to be: A. Stored in a separate container in the refrigerator. B. Stored in a separate locked container in the refrigerator.

. B. Medications stored in a refrigerator containing non-medication-related items such as food, are to be stored in a separate container. Unless the refrigerator is locked or stored in a locked medication area, the medications in the refrigerator have to be stored in a locked container. In this example, the refrigerator is accessible to residents; therefore, the medications stored in the refrigerator have to be stored in a locked container. Refer to regulation 13F/13G .1006.

. When you are administering a medication and the order on the MAR does not match the directions on the medication label, you should: A. Administer the medication according to the MAR. B. Notify the supervisor, nurse or pharmacist and/or look in the resident's record for the current medication order. C. Administer the medications according to the directions on the medication label. D. Omit the medication and leave a note for the next shift.

. B. When the directions on the medication label do not match the order on the MAR, you are not to administer the medication. The orders in the resident's record must be checked before administering the medication. Always contact the supervisor, nurse or pharmacist if you can not find an order or need assistance. Two reasons why the directions on the medication label and the information on the MAR would not match are: 1) An order was changed and the MAR was not updated. If the MAR is not correct, then continuing to administer the medication as written on the MAR would result in a medication error. 2) The order was changed on the MAR but the facility's policy on direction changes for medication labels was not followed. If you administered the medication according to the directions on the medication label then a medication error would occur. It is very important to always use the MAR when administering medications and compare the directions on the medication label with the order on the MAR. If the label and MAR do not match, then the orders in the resident's record are reviewed and either the MAR or the medication label are corrected according to the facility's policy and procedures.

A medication order is transcribed onto the MAR: A. Only after the medication arrives from the pharmacy. B. Only after the family brings in the medication C. Only after a physician's order for the medication is received by the facility. D. All of the above.

. C. A medication is transcribed onto the MAR when the facility receives a medication order. This procedure ensures that the medication order on the MAR matches the order in the resident's record. Having the order on the MAR is also important to check that medications arrive from the pharmacy. If a medication has not arrived by the scheduled administration time on the MAR, you should document that the medication was not administered and the reason why. The pharmacy is also contacted about the delivery of the medication. If there is going to be a delay in obtaining a medication, the physician may need to be contacted. You should also let the supervisor or nurse know when medications are not available.

. "As needed" (PRN) medications must be administered according to: A. The facility's administration time schedule for medications. B. The resident's choice of time and frequency. C. The reason and frequency of administration specified in the physician's order. D. The family's request on how often the medication can be given and for what reasons.

. C. All medications, including PRN's, are to be administered as prescribed; therefore, PRN medications must be given according to the frequency (how often a medication can be given) and reason(s) specified by the physician or prescribing practitioner. PRN medications can not be administered any more frequently than ordered by the physician or prescribing practitioner. If the resident is requesting or needing the medication more frequently or requests the medication for another reason or symptom, the physician should be contacted. Refer to regulation 13F/13G .1004. It is true that PRN medications are administered when needed by the resident, but the frequency and reason for administration is according to the physician's order.

A resident returns from a home visit and the resident's mother brings an over-the counter medication that she purchased and asks you to administer it for cold symptoms, you should: A. Give the medication as requested. B. Refuse and throw the medication away. C. Explain to the mother that even over-the-counter medications require a physician's order.

. C. All medications, including non-prescription medications, require a physician's order to be administered. When family members or residents bring in medications to be administered and there is no order, the physician should be contacted regarding administration.

Never administer medications that: A. are discolored. B. are outdated or expired. C. both A and B.

. C. Medications that are discolored or outdated/expired should never be administered. You always check the expiration date on the medication label before administering medications. If you can not find the expiration date on the medication label, you should ask the supervisor or pharmacist. If you notice a difference in the appearance of a medication, you should contact the pharmacist

If you have to calculate dosages, it is best to: A. ask the resident the correct dosage. B. do your best calculations and administer the medication. C. ask the supervisor, nurse or the pharmacist to calculate the dosage with you.

. C. The best answer is to ask the supervisor, nurse, or pharmacist to calculate the dosage with you. Administering the proper amount of medication is very important and some calculations may be difficult.

You are assigned to administer 8:00AM medications today. It is 8:00AM and the residents need to be at the workshop by 8:00AM, the van is waiting. You should: A. Pour medications from memory. B. Get the untrained staff (no medication training) to assist you. C. Administer medications as you were trained, even if this means the residents will be late for the workshop. D. Tell the residents you will bring their medications to the workshop and administer them later.

. C. You always administer medications as you were trained. You should never administer medications from memory nor have untrained staff administer medications. The MAR is always used when administering medications. It is better to go ahead and administer the medications rather than taking the medications to the workshop to administer later.

After the resident has received nose drops, the resident should: A. Remain with his head tilted slightly back for about 60 minutes. B. Blow his nose. C. Remain with his head tilted slightly forward for a few minutes. D. Lie down with head lower than shoulders for a few minutes.

. D. It is best to have the resident lie on his back with his head lower than shoulders for a few minutes to ensure the medication reaches the nasal tissue. If the resident can not or will not lie down, the resident should remain with his head tilted slightly back for a few minutes. The resident does not need to have his head tilted back for 60 minutes.

When administering medications, it is safe practice to: A. rely only on the color of the medication. B. rely only on the shape of the medication. C. rely only on the location of the container. D. read the label and the MAR each time a medication is administered.

. D. When administering medications, you compare the directions on the label with the information or order on the MAR 3 times. The MAR is always used when you are administering medications. If you notice that the color or shape of a medication is different or changed, you should always contact your pharmacist before administering a medication. You should never rely only on the color, shape or location of a medication

An order is received for Mellaril 10mg every morning. The physician orders Mellaril Liquid, since the resident is not able to swallow tablets or capsules. Which of the measuring devices above would you use to measure 10mg of Mellaril? A. Medication Cup. B. Tablespoon. C. Oral Syringe. D. Oral Dropper. E. None of the devices should be used.

. E. A mg is not equal to a ml; therefore, you can not use the medication cup or oral dropper. Be sure that the amount you are about to measure matches the marking on the measuring device. Household utensils such as a tablespoon are not calibrated and should not be used to measure medications. The oral syringe is only used to measure Lasix Solution. Again, the correct measuring device would be one specifically for measuring Mellaril Liquid or you would have to know the "mls" to administer.

9. Side effects of medications may include: A. Change in behavior. B. Rash. C. Change in swallowing. D. Change in mobility or walking. E. All of the above.

. E. Side effects of medications may include changes in a resident's behavior, a rash, and/or a change in swallowing or in walking. Any changes with a resident should be reported immediately to the supervisor, nurse, pharmacist, or physician, according to the facility's policy. It is important to have the resident's record and MARs available when you contact the supervisor, nurse, pharmacist or physician. The facility's policy is to identify who will contact the physician of any changes noticed with a resident.

. When administering two or more different eye drops at the same time, which of the following apply: A. Wash your hands prior to and after administration of the eyedrops. B. Wear gloves when there is redness, drainage or possibility of infection. C. Allow a 3-minute to 5-minute period between the administration of each eye medication. D. Sign/initial the medication administration record (MAR) after the administration of each type of eye drop. E. All of the above.

. E. The answer is all of the above. Washing your hands before and after the administration of eye drops and wearing gloves when there is redness or possibility of infection are appropriate infection control measures. This is protection for you and the resident. When administering two or more different eye drops at the same time, you should wait 3 to 5 minutes between the administration of each medication. This ensures that the medication remains in the eye. If the eye medications are administered one right after the other, the solution will just run out of the resident's eye. The MAR is initialed or signed after the administration of any medication.

What is ataxia? (this is often a question on STATE BOARD

1.lack of muscle control: the inability to coordinate the movements of muscles

What does prophylaxis mean?

1.treatment to prevent disease: a treatment that prevents disease or stops it from spreading, e.g. vaccination

When preparing oral medications, describe the 3 safety checks and 8 rights.

3 checks: Pull it, pop it, pass it. 1-When taking the med from the drawer 2-Before removing from the container 3.Before putting back in the drawer Right patient: Check the name on the order and the patient. Use 2 identifiers. Ask patient to identify himself/herself. When available, use technology (for example, bar-code system). Right drug: Check the medication label. Check the order. Right route: Again, check the order and appropriateness of the route ordered. Confirm that the patient can take or receive the medication by the ordered route. Right amount: Check the order. Confirm appropriateness of the dose using a current drug reference. If necessary, calculate the dose and have another nurse calculate the dose as well. Right time: Check the frequency of the ordered medication. Double-check that you are giving the ordered dose at the correct time. Confirm when the last dose was given. Right reason: Confirm the rationale for the ordered medication. What is the patient's history? Why is he/she taking this medication? Revisit the reasons for long-term medication use. Right to refuse: Patient has the right to refuse medication, continue to educate patient about why the medication was ordered and what could happen if the patient continues to refuse treatment. Make sure you document the refusal. Right documentation: Document administration AFTER giving the ordered medication. Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug.

. Unlicensed staff in adult care homes may administer intramuscular (IM) injections and subcutaneous (SQ) injections. A. True B. False

5. B. Unlicensed staff in adult care homes are not allowed to administer IM injections. Unlicensed staff in adult care homes may administer subcutaneous injections, excluding anticoagulants such as heparin, if appropriate training is provided. Refer to regulation 13F/13G .1004.

An antiseptic gel or product should be used for handwashing in place of soap and water, when soap and water is not readily available. A. True B. False

A

Handwashing with soap and water is the one of the most important measures or ways to prevent the spread of germs or infection. A. True B. False

A

When crushing medications, it is important to use procedures that prevent contamination of other medications crushed afterward. A. True B. False

A When crushing medications, it is very important that there is no cross-contamination (mixing of crushed medications for different residents) of residents' medications. Facilities may use different devices to crush medications. The most common method is using a pill crusher and crushing the medications using two medication soufflé cups. If a device such as a mortar and pestle is used, and the residue from the medications is present, the device has to be cleaned thoroughly before crushing another resident's medications. You should follow your facility's policy and procedures for crushing medications.

A drug reference book is a helpful tool to identify or find information on medications and dosages and side effects. A. True B. False

A. A drug reference helps you find information about medications. A facility should have a reference available for staff to use. A reference is not a substitute for contacting the pharmacist, nurse or physician when you have questions about a resident's medication, but it will help answer questions about medications. You should use a reference that is easy to understand. References written for non-health professionals are available at pharmacies and not very expensive. It is important to have current and updated drug references available.

. Regulations for the accountability or recordkeeping of controlled substances differ from the regulations for non-controlled medications. A. True B. False

A. Additional documentation or records are necessary for controlled substances because each dose of a controlled substance has to be accounted for. When a dose of a controlled substance is prepared for administration and then not administered, it is destroyed at the facility and specific information must be recorded. It is very important that you understand the facility's policy and procedure for controlled substances. Refer to regulations 13F/13G .1007 and .1008

The facility is required to maintain or keep all medication orders for a resident: A. in the resident's record in the facility. B. at the pharmacy. C. in any type of notebook or record, as long as the order is in the facility. D. in the resident's room.

A. All medication orders are to be maintained in the resident's record in the facility. This helps to ensure that medications are administered as prescribed. Refer to regulation 13F/13G .1002. The pharmacy also has to maintain orders or prescriptions for medications dispensed, but these records are maintained for the pharmacy.

Checking the medication label against the MAR three times should always: A. Be done with each medication administered to each resident. B. Be done by the new staff members. C. Be done if you do not know the resident. D. Be done if it is a new medication order.

A. Checking the medication label against the MAR three times is done before each medication is administered to a resident. This is added protection for you and the resident. This applies to all situations whether the staff, resident, or medication is new.

Staff giving medications in adult care homes have to demonstrate certain skills with administering medications and be checked off or validated by a registered nurse or registered pharmacist. A. True B. False

A. Effective 02/15/00, unlicensed staff administering medications in adult care homes must have validation of skills by a registered nurse or pharmacist before administering medications. Refer to regulation 13G .0403 and .0503 or 13F .0403 and .0503.

Which of the following is TRUE when prepouring or preparing medications in advance: A. Oral solid medications (tablets and capsules) for routine administration may be prepared within 24 hours of the prescribed time for administration. B. PRN medications may be prepared in advance. C. Medications may be crushed at the time the medications are prepoured or prepared in advance. D. A, B, and C are true.

A. Only oral solid medications such as tablets and capsules may be prepared in advance. Medications prescribed for PRN administration and liquid medications are only prepared immediately prior to the medications actually being administered. Medications are not crushed until immediately prior to the medications actually being administered. Refer to regulation 13F/13G .1004.

The physician orders Potassium Chloride Solution 1 tablespoonful mixed with water or juice every morning. Which of the measuring devices would you use to measure 1 tablespoon of Potassium Chloride? A. Medication Cup. B. Tablespoon. C. Both A (Medication Cup) and B (Tablespoon) may be used.

A. Only the medication cup is used. It is calibrated and has a marking to measure a tablespoon. Household utensils such as a tablespoon are not calibrated and should not be used to measure medications.

Oral medications must be stored separately from topical or external medications. A. True B. False

A. Oral or internal medications are stored separately from external or topical medications for safety reasons. Refer to regulation 13F/13G .1006.

Over-the-counter drugs may be kept as floor stock or house stock in an adult care home. A. True B. False

A. Refer to regulation 13F/13G .1006. The regulations do not prohibit adult care homes from having over-the-counter medications as stock. Although, the over-the counter medications may be kept as floor stock, a physician's order is required to administer any medication, prescription and non-prescription. Only the prescription items listed in regulation 13F/13G .1006 are permitted to be kept as house stock in adult care homes.

A resident's allergies should be documented on the MAR and the resident's record. A. True B. False

A. Resident's allergies should be documented on the MAR and in the resident's record. Having the information on the resident's record is helpful when orders are received and having the allergy information on the MAR is helpful to staff administering medications. If a resident does not have any known allergies, it should be written in the resident's record and MAR. Usually you will see "NKA" for No Known Allergies. It is also important that the pharmacy is always notified of any allergies or changes in allergies.

Residents have a right to refuse medications. A. True B. False

A. Residents do have the right to refuse medications. An adult care home should have a policy on contacting the resident's physician when a resident is refusing medications. A resident is never forced to take medications.

Mr. Cook who is an alert and oriented resident refuses all of his morning medications. He says the medications do not help him and he doesn't need them. Your best response is to: A. Encourage the resident to take the medications by explaining the importance and purposes of the medications. B. Tell the resident " Your physician said that you must take this medication." And force him to take the medications. C. Hide the medication in the resident's food or drink. D. Leave the medications with the resident, in case he decides to take them later

A. Residents have the right to refuse medications; therefore, forcing the resident to take a medication or hiding the medication in the resident's food or drink are not appropriate and violate the resident's rights. Encouraging the resident to take the medication by explaining the importance and purposes of medications is appropriate. You need to be sure the resident's refusal is documented on the MAR and other forms according to the facility's policy. The supervisor, nurse or pharmacist needs to be notified of residents who refuse medications. The resident's physician may need to be contacted, so be sure you follow the facility's policy for refusals. Leaving medications with the resident is not appropriate or safe.

You are legally responsible for any medication or treatment you administer. A. True B. False

A. State regulations for adult care homes require medications to be administered as prescribed by a resident's physician or prescribing practitioner.

. When new orders are received, the MAR is changed to reflect the new orders. A. True B. False

A. The MAR is always changed to reflect new orders. Remember that the MAR is a legal document, and it must be kept updated. It is very important that documentation on the MAR be accurate. An accurate MAR promotes safe medication administration and resident safety.

If a resident is using the bathroom at the time you are to administer the resident's medications, it is acceptable to: A. Flag the MAR to remind you to return to that resident later in the medication pass to administer the medications. B. Omit the medications and record the medications were not administered on the MAR. C. Administer the medications while the resident is using the bathroom. D. A and C.

A. The answer is to flag the MAR and return later in the medication pass to administer the medications. Flagging the MAR will help to remind you to return later in the medication pass. When a medication can not be administered during the scheduled medication pass, document that the medication was not administered on the MAR in accordance with the facility's policy. It is a violation of resident's rights to administer medications to a resident when the resident is using the bathroom or receiving personal care such as bathing.

A telephone or verbal order for medications and treatments must be signed by the person who prescribed the medications within: A. 15 days from the date the order is given. B. 30 days from the date the order is given. C. 20 days from the date the order is given. D. None of the above

A. The physician or prescribing practitioner must sign the verbal or telephone orders within 15 days from the date the order is given. A telephone or verbal order is also signed/initialed and dated by the person taking the order. Refer to regulation 13F/13G .1002.

When a medication cannot be administered on time: A. document the reason for the delay on the MAR. B. call the resident's family. C. don't worry about it and continue with your work. D. tell the kitchen staff

A. When a medication can not be administered during the scheduled medication pass, you are to document the reason. If the medication is administered at a later time, you are to document the time the medication was administered. You should always let the supervisor, nurse, or pharmacist know when medications, especially ones prescribed more frequently than once daily, are administered late in case other administration times for a medication need to be changed.

Removal of foley catheter

Assemble 10mL syringe without a needle or larger depending on volume of fluid used to inflate balloon Assess Cover patient, exposing genitalia Insert hub of syringe into inflation valve and aspirate until tubing collapses Remove catheter smoothly and steadily Wrap catheter in waterproof pad. Unhook collection bag and drainage tubing from the bed. Measure urine and empty drainage bag Record output Cleanse perineum Educate patient on how to avoid catheterization again

Insertion of foley catheter

Assemble supplies Assess patient Arrange for extra nursing personnel if needed Position patient (male: Supine with thighs slightly abducted, Female, dorsal recumbent with knees flexed, knees 2 feet apart) Drape patient with bath blanket, making sure legs are covered and genitalia is exposed. Place waterproof absorbent pads under patient Arrange supplies and equipment on patient's bedside table Don clean gloves and wash patient's peri area with mild soap and warm water with disposable washcloth Sterile technique Apply lubricant to catheter. \ Wrap edges of sterile drape around hands and request patient to lift hips as drape goes under patient Wipe genital area with iodine in 3 motions (Female: middle, side, side; Male: Round, round, round) Insert catheter into urethra 6-7 in for male, or 2-4 in for female. When urination occurs, insert 1.5 in farther, inflate balloon, tug, if resistant, place bag on side of bed. Clean up.

What are several ways that you can avoid medications errors?

Avoid distractions and follow the same routine. Administer only medications you prepare, and never leave prepared medications unattended. Document medications immediately after administration. Use clinical judgment in determining the best time to administer prn medications. When preparing medications, check the medication container label against the medication administration record (MAR) three times.

Gloves and supplies that are soiled may be discarded in a wastebasket in the resident's room. A. True B. False

B

It is not necessary to change gloves between residents when administering eye drops or applying transderm patches such as Nitroglycerin. A. True B. False

B

The term "blocker" is another name for how a drug works. Blocker would be another name for .... a. agonist b. antagonist

B

. Which of the following statement is NOT true about allergies and medications? A. An allergy is a reaction that occurs as the result of an unusual sensitivity to a medication or other substance. B. Allergic reactions can include rashes, swelling, itching but are never life threatening. C. Document all allergies in the resident's record, or document "No Known Allergies", if the resident does not have any allergies. D. All allergic reactions or suspected reactions should be reported promptly to the supervisor, nurse, physician or pharmacist according to facility policy.

B. Allergic reactions can include rashes, swelling, itching and may be life threatening. This is why it is important to document information about the resident's allergies in the resident's record and MAR and report allergic reactions or suspected reactions promptly

You are with a resident at a doctor's appointment. The physician writes an order for Amoxicillin and you know the chart is flagged "Allergic to Amoxicillin". You should: A. Administer the medicine as ordered, the physician knows best. B. Remind the physician of the allergy warning. C. Pull the allergy label off the record.

B. If you discover or know a resident's record indicates that the resident is allergic to a medication that has been prescribed, the physician should always be contacted and reminded or told about the allergy. Physician's records may not always be updated or accurate or the allergy warning could have been overlooked. It is also possible that the resident's record at the facility is not accurate

Mr. Jones, a resident of an adult care home, is going to visit his family for the week. The proper way to prepare Mr. Jones' prescription medications to take with him would be to: A. Remove the amount of medications needed for the week from the resident's supply of medication, place the medications in labeled containers and document the medications sent on the appropriate facility form. B. Send the medications in containers that have been filled and labeled by a pharmacist and document the medications sent on the appropriate facility form.

B. Regulations for adult care homes prohibit staff from repackaging more than one dose of a medication for subsequent administration. It is usually allowable for one dose of medication to be removed from the original container and placed in another container for later administration. Remember that anytime more than one dose of medication from a supply is placed in another container and labeled, it is considered dispensing. When a medication is released to the responsible party, the facility must document the name of the medication, strength and the quantity released. The facility must also document the quantity of medication returned. Non-prescription medications that are not packaged and labeled by a pharmacist are released in the original container. Refer to regulation 13F/13G .1003. Since Mr. Jones is going away for a week, more than one dose of medication would be released. The medications must be sent in containers that have been filled and labeled by a pharmacist or dispensing practitioner. The medications released must also be documented on the appropriate facility form.

All of the following are examples of medication errors EXCEPT one. Which one of the following is NOT a medication error? A. the omission of a prescribed medication. B. the refusal of a medication by a resident. C. failing to perform any of the six rights of medication administration. D. administering medications that have not been prescribed including OTCs or non prescription medications.

B. Residents have the right to refuse medications, and the refusal of a medication is not a medication error. A medication error occurs when a medication is not administered as prescribed. Examples of medication errors include: omissions; administration of a medication not prescribed; wrong dosage; wrong time; wrong route; crushing a medication that shouldn't be crushed; and documentation errors. When a medication error is made or discovered, it should be reported immediately to the supervisor, nurse, pharmacist or physician according to the facility's policy. The supervisor or health professional will have to determine the next appropriate steps to be taken. Recognizing medication errors and acting quickly to correct them helps prevent more serious problems. Refer to regulation 13F/13G .1004.

A medication that is ordered sublingually may be chewed or swallowed. A. True B. False

B. Sublingual means under the tongue. Chewing or swallowing a medication that is to be administered sublingually may alter the effectiveness of the medication. An example is Nitroglycerin tablets.

"Ambien 5mg po as needed for sleep": A. is a complete medication order B. is an incomplete order

B. This order is incomplete because there is no frequency of administration (how often the medication can be given). Since the frequency of the medication order is not indicated, the physician has to be contacted before administering the Ambien. You can not assume the medication is to be administered every night at bedtime as needed for sleep. This medication is sometimes ordered every other night as needed for sleep. It is also important to check on the frequency of administration for medication orders such as Motrin 800mg pc. The medication could be ordered once, twice, or three times daily after meals. After meals, before meals, and with meals does not always mean three times daily.

When a resident has difficulty swallowing, the resident is at risk for: A. Asthma B. Aspiration C. Arrhythmia D. Arthritis

B. When a resident has difficulty with swallowing the resident is at risk of aspiration. Aspiration is defined as inhaling a substance into the lungs. When a substance such as liquid or food is inhaled into the lungs, it may cause a more serious problem. The resident may develop a condition called aspiration pneumonia. Aspiration pneumonia is an infection that may develop when food or liquid enters the lungs and can lead to life-threatening conditions. This is why it is important for you to report changes such as difficulty with swallowing to the supervisor, nurse, or physician. Asthma is when a person has difficulty breathing. Arrhythmia is when a person has an abnormal heart rate. Arthritis is when a person has difficulty with movement due to inflammation or swelling in the joints.

When administering medications, it is O.K. to leave a resident's medication at the bedside if the resident is present. A. True B. False

B. When administering medications, you are to observe the resident actually taking the medication. If the medications were left with the resident, you would not be certain if the resident took the medication or not, and the medication would also not be stored appropriately. Refer to regulation 13F/13G .1004 and .1006

When administering medications this morning, Mrs. Walls is extremely difficult to wake up. She is having difficulty with swallowing her medications. You should: A. Crush her medications so she will be able to swallow the medications and then notify your supervisor, nurse or physician. B. Hold her medications at this time and immediately notify your supervisor, nurse or physician.

B. When there is a change in a resident's behavior, physically or mentally, the supervisor, nurse or the resident's physician need to be contacted immediately. You would hold the medication since a medication may be a reason the resident's behavior has changed. Drowsiness or lethargy is often a side effect of medications.

Why is it important to ensure you are giving the right "type" of insulin?

Because a diabetic person could go into hyper/hypoglycemia if given too little or too much insulin

When administering medications to a resident's eye, you are to wash your hands: A. Only after administering the eye medication. B. Only before administering the eye medication. C. Before and after administering the eye medication.

C

A resident has just returned to the facility from the hospital and the medication order on the FL-2 is "Continue previous medications". You should: A. Ask the resident or family if there were any medication changes. B. Administer the medications that the resident was receiving prior to hospitalization. C. Contact the resident's physician for medication orders.

C. "Continue previous medications" is not a complete order; therefore, the physician must be contacted for medication orders. A complete medication order includes the name of the medication, the dosage, the route of administration, the frequency of administration and reason for administration if the medication order is a PRN order. The physician may be referring to the medications ordered in the hospital and these medications may not be the same as the medications prescribed prior to the resident going to the hospital. When a resident is admitted or readmitted, the facility may receive different forms with orders such as a discharge summary, a transfer order form and/or a FL-2. It is important that all the information is reviewed. If there is a difference between the orders on the forms, including the FL-2, the physician is contacted for clarification.

If the resident expresses concern about a medication you are about to administer: A. give it anyway. B. walk away and document "refused". C. double check the medication and dosage information. D. give it to his roommate.

C. Always double-check a medication and medication order, if a resident expresses concern about a medication you are about to administer. The resident may be right!

All of the following are considered reasons for medication errors, EXCEPT: A. Transcribing information incorrectly onto the MAR. B. Administering medications by the directions on the medication label without using the MAR. C. Checking the medication label with the MAR when administering medications. D. Administering medications by memory.

C. Always use the MAR when administering medications and check the medication label with the MAR. All of the other examples are reasons for medication errors.

A medication arrives from the pharmacy, and there is no order for the medication on the MAR, you should: A. Copy the directions on the medication label onto the MAR. B. Administer the medication according to the directions on the medication label. C. Look in the resident's record for an order and/or notify the supervisor, nurse, or pharmacist before administering the medication. D. Omit the medication and write a note for the next shift to check on it.

C. Medication orders are transcribed or written onto the MAR when an order is obtained or received. If a medication arrives from the pharmacy or is found in the resident's supply of medications and there is no order on the MAR, then an order must be found before writing the medication order on the MAR. If an order can not be found, the pharmacy is contacted immediately. Two reasons why a medication order would not be on a MAR are: 1) The order was not transcribed or written onto the MAR when received. 2) There is no order for the medication in the resident's record in the facility. It is possible that the medication was not ordered for the resident. Directions on the medication label should not be copied onto the MAR, unless you know the label matches the medication order in the resident's record. Remember that the MAR is to match the orders in the resident's record also.

How many minutes should a medication prescribed "before meals" be administered prior to eating? A. 15 minutes B. 5 minutes C. 30 minutes D. 60 minutes

C. Medications prescribed before meals are generally to be administered about 30 minutes prior to the resident eating.

You remove a resident's medications from the packages or containers and the resident refuses to take his 12PM medications, you should: A. Put each medication back into the appropriate container or package that the medication came from. B. Leave the medications with the resident in case the resident decides to take the medications later. C. Dispose of the medications in accordance with the facility's policy and procedures. D. Both A and C are correct.

C. Once a medication has been removed from the labeled package or container and prepared for administration, the medication is not put or placed back in the package or container. Medications are not transferred from one container to another except when prepared for administration. If there is reason to believe the resident may take the medications later during the medication pass, such as after encouraging the resident to take the medications, the medications may be kept and administered. This is done in accordance with the facility's policy and procedures. Otherwise, the medications should be promptly disposed of in accordance with the facility's policy and procedures. If an oriented and alert resident refuses medications frequently, it may be better to see if the resident will take the medication before always removing the medication from the package/container. Always contact the supervisor, nurse or pharmacist when you have residents refusing to take medications, according to the facility's policy. Refer to regulation 13F/13G .1003 and .1007 and .1008

The following statement about non-prescription (OTC) medications is FALSE: A. They may be kept in the original container with the manufacturer's label and expiration date. B. They may be packaged and labeled by a pharmacist. C. They may be administered to a resident without a physician's order. D. They can produce unwanted effects

C. Only medications, including non-prescription medications, prescribed by a physician or a prescribing practitioner are administered to a resident. A physician's order is required for any medication administered. Refer to regulation 13F/13G .1002 and .1004. Refer to regulation 13F/13G .1003 for packaging requirements of non prescription medications. Non-prescription medications can produce unwanted effects or adverse effects and interact with medications.

A used lancet or syringe should be discarded in: A. The wastebasket in the resident's room. B. The kitchen wastebasket. C. A plastic bag. D. A leakproof, puncture resistant container, such as a sharps container.

D

Gloves should be worn: A. When inserting suppositories. B. When applying a transderm patch such as Nitroglycerin. C. When changing a dressing. D. All of the above.

D

. Medication errors may: A. interfere with how effective the medication will be. B. produce bad reactions. C. threaten the resident's life. D. all of the above.

D. Medication errors may threaten the resident's life and safety by producing bad or adverse effects and interfere with the effectiveness of the medication.

One of the best ways of identifying the correct resident is to: A. Ask another staff member. B. Ask another resident. C. Ask residents to spell their names. D. Use photographs of the residents.

D. One of the six rights with medication administration is the right resident. The best way of identifying residents in adult care homes is by using photographs. Relying on staff and residents is not a safe or acceptable procedure for identifying residents. The photographs also need to be kept updated when a resident's appearance changes.

The resident's physician or prescribing practitioner is to be contacted about the resident's medication orders: A. if the FL-2 is not dated and signed within 24 hours of admission to the facility. B. when the medication orders on a FL-2 and discharge summary do not match. C. if a medication order is incomplete or unclear. D. all of the above.

D. Refer to regulation 13F/13G .1002. The resident's physician or prescribing practitioner must be contacted anytime clarification is needed about a medication order. A facility should verify orders whenever a resident is admitted or readmitted to the facility.

Three of the four statements below are requirements when residents administer their own medications. Which one is not a requirement for self-administration? A. A physician's order is necessary for the resident to self-administer. B. The physician is contacted if there is a change in the resident's physical or mental abilities. C. The medications are to be stored in a safe and secure manner. D. The resident has to be observed to take each dose of medication.

D. Residents have the right to administer their own medications. A physician's order is necessary for the resident to self-administer. The medications still have to be stored in a safe and secure manner in the resident's room. Storage of these medications will depend on the medication, the facility, and the other residents at the adult care home. A facility that has confused and wandering residents may have to require the medications to be stored in a locked area, while another facility without any confused or wandering residents may not. The medications are to be stored out of the site of visitors and other residents. The facility has a responsibility for monitoring the resident, and if there is a change in the resident's physical or mental abilities, the physician must be contacted. (Monitoring residents and contacting the physician if there is a change in the resident's physical and mental abilities applies to all residents.) If the resident is non-compliant with the administration or facility's policies and procedures, such as storage, then the physician should also be contacted. If there is a physician's order for a medication to be self-administered, there is no requirement for staff to observe the resident take each dose of the medication. This should not be necessary if the resident is capable of self-administering. It is helpful to have the medications that are self-administered on the MAR, but staff should not document on the MAR that they are administering the medications. Refer to regulation 13F/13G.1005 and .1006.

. You have to document on MAR when a medication is: A. Administered B. Refused C. Omitted D. All of the above.

D. Staff is required to document on the MAR when a medication is administered, omitted, or refused. The MAR is a legal document on how medications are administered by the facility. It is important that the documentation on the MAR is accurate. If a medication is omitted, you must document the reason, such as the resident was out of the facility or the medication was not available, on the MAR. A facility is required to have procedures for staff to follow for documenting on the MAR when a medication is administered, omitted or refused. Refer to regulation 13F/13G .1004.

The physician ordered Dilantin Suspension 4ml by mouth three times daily for a resident. Which measuring device would you use to measure 4ml of Dilantin? A. Medication Cup. B. Tablespoon. C. Oral Syringe. D. Oral Dropper. E. Both A (Medication Cup) and D (Oral Dropper).

D. The oral dropper is used because it has a marking to measure 4 ml. The medication cup could not be used, because it does not have a marking to measure 4 ml. You would have to approximate or guess the amount to measure, and you should never guess the amount of medication to administer. Household utensils such as a tablespoon are not calibrated and should never be used to measure medications. Remember, the oral syringe above is only used to measure Lasix Solution.

The medication label and the MAR are compared: A. When selecting or removing the medication from the supply or storage area. B. Before pouring the medication. C. After pouring and before returning the medication to the supply or storage area. D. All of the above.

D. To avoid medication errors, the medication label and MAR are compared 3 times: when selecting or removing the medication from the supply or storage area; before pouring the medication; and after pouring and before returning the medication to the supply or storage area.

Explain the safe use of sharps containers in the administration of injectables.

Don't touch the sharps container, hover above the container and drop your sharp object into it.

. The physician orders Haldol Solution 2mg by mouth at bedtime. Which of the measuring devices above would you use to measure 2mg of Haldol? A. Medication Cup. B. Tablespoon. C. Oral Syringe. D. Oral Dropper. E. None of the above devices should be used.

E. A mg is not equal to a ml; therefore, you could not use the medication cup or the oral dropper. Be sure that the amount you are about to measure matches the marking on the measuring device. Household utensils such as a tablespoon are not calibrated and should never be used to measure medications. An oral syringe or measuring device that has the name of a medication on it should only be used to measure that medication. The oral syringe above has Lasix written on it and is only used to measure Lasix Solution. The correct measuring device to measure the Haldol would be a measuring device specifically for Haldol Solution or you would have to know the "mls" to administer.

Information or documentation on the MAR for PRN (as needed) medications that are administered includes: A. the amount or quantity of medication administered. B. the specific time of administration. C. the initials of the person administering the medication. D. the effectiveness of the medication. E. all of the above.

E. The amount or quantity of medication administered, the time of administration, and the initials of the person administering the medication is required on the MAR for all medications administered. The effectiveness of PRN medications also has to be documented on the MAR. Refer to regulation 13F/13G .1004.

Why might a patient be prescribed Lasix?

Edema (swelling) and high blood pressure, renal disease, congestive heart failure, hepatic cirrhosis

Digoxin is dependent on serum (blood) potassium levels. And, this drug is often given with diuretics. What should you watch for?

Heart problems and low blood pressure

What are some of the side effects to watch for with beta blockers?

Hypotension Bradycardia Drowsiness Depression Signs of heart failure

Why would a client with epilepsy wear a medic alert bracelet?

In case of a seizure that turns out to be dangerous and the client now needs medical attention

If you were to give the drug seretide, what route would you be giving it?

Inhalation

Discuss the differences between medical asepsis (clean) and surgical asepsis ( sterile)

Medical asepsis inhibits the growth and spread of microorganisms and is used in many daily activities while surgical asepsis destroys all microorganisms and their spores and is used in invasive procedures

Review the skills check off list for dressing changes.

Place red bag in convenient location away from sterile field. Set up sterile field. Loosen tape appropriately. Don clean gloves. Remove dressing and discard correctly. Assess status of wound and wound drainage/exudate correctly. Remove and discard soiled gloves. Hand hygiene and don sterile gloves. Cleanse wound and surrounding area correctly. Stuff wound. Apply 4x4 dressing and tape. Discard gloves/other materials.

How are the actions of the different insulins going to affect a patient?

Rapid acting-covers insulin needs for meals eaten at the same time as the injection Short acting: covers insulin needs for meals eaten within 30-60 minutes Intermediate-acting insulin covers insulin needs for about half the day or overnight Long-acting insulin covers insulin needs for about one full day.

Discuss the different types of injections and the angle of insertion for the needle for SC and IM injections.

SC, IM, ID SC-subcutaneous, first two layers of skin-45 or 90 degree angle IM-all the way to the muscle-90 degree angle ID-Under first layer of skin-15 degree angle IV-directly into blood

Care of hygiene with catheter inserted

Same as inserting, but Expose meatus Wash area of the meatus and catheter with cotton balls Cleanse area of the meatus like insertion of a catheter Discard soiled cotton balls appropriately With forceps, pick up cotton ball soaked in antiseptic or mild soap and water and cleanse area around catheter from urethral opening to approximately 4 in of catheter Observe and assess area for abnormalities Dispose of equipment and linens; perform hand hygiene Retape catheter to thigh

Consider the needs for a client with a newly removed foley catheter. What would you watch for in the hours after removal?

UTI

What is orthostatic hypotension?

a form of low blood pressure that happens when you stand up from sitting or lying down

Advair is a combination drug, what drugs are in advair?

fluticasone and salmeterol

How will you ensure patient safety if you have a client on a beta blocker?

monitor his fluid balance by measuring intake and output and by obtaining daily weights. Record changes and report to his physician. Check the patient's skin turgor and mucous membranes for signs of dehydration, especially if elderly., • Monitor for difficulty breathing, night coughing, or swelling of the legs. • Tell client to report any complaints of dizziness, confusion, depression, and fever.