Safe dosage-pharmacology ATI
Single/one-time prescription
-A single/one-time prescription is to be administered once at a specified time or as soon as possible. For example, a one-time prescription instructs the nurse to administer warfarin (Coumadin) 5 mg PO at 1700
Stat prescription
-A stat prescription is only administered once, and it is administered immediately. For example, a stat prescription instructs the nurse to administer digoxin (Lanoxin) 0.125 mg IV bolus stat.
standing prescriptions
-Standing prescriptions may be written for specific circumstances and/or for specific units. For example, the critical care unit has standing prescriptions to treat a client who has asystole
Do not crush what type of pills?
-long acting -delayed release -EC, enteric-coated
subcutaenous injection
-use a 5/8 inch, 23- to 25-gauge needle -Pinch to avoid inecting medication into muscle -Age-appropriate sites * absorbs slower by subcutaneous method
a nurse is transcribing medication prescriptions for a group of clients. what is an example of the appropriate way for the nurse to record medications that require the use of a decimal point? .4 mL 0.6 mL 8.0 mL 125.0 mL
0.6 mL
a nurse is planning atraumatic care for a preschooler who has a prescription for an intramuscular medication. a parent is with the child. what actions should the nurse include in the plan of care? a. Provide an explanation of the hospital alarm system. b. Leave the door to the child's room open. c. Ask the parent to wait outside when administering the child's medications. d. Suggest that the parent bring the child's favorite toy to the hospital. e. Use a doll to demonstrate how the nurse will administer the intramuscular medication.
1. provide an explanation of the hospital alarm system 2. suggest the parent bring the child's favorite toy to the hospital 3. use a doll to demonstrate how the nurse will administer the IM medication
a nurse working in a medical surgical unit is preparing to administer medications to a client. the nurse plans to use 2 forms of ID to verify that she the right client. what actions should the nurse take to ID the client?
ANS: 1, 2, 4, 5 1. compare the name on the client's wristband with the name on the MAR 2. ask the client to state his DOB 3. Check the room number on the MAR with the room number of the client. 4. ask the client to state his name 5. use the bar code scan to ID the client
Right Documentation
After administration MAR- checking it 3 times Procedures for omitting, withholding
Examples of high alert medications:
Anticoagulants Chemotherapeutic agents Opioids Hypoglycemic
what to do incase of a medication error?
Assess/collect data from client Notify provider/ manager Document event Determine cause
(step in nursing process) Planning:
Avoid distractions, rushing Calculating, measuring Check strength Verify doses Prioritize
Equipment selection for children:
Calibrated syringes Precise measurements Needleless
right medication
Check prescription Three checks Verify expiration date Consult reference
right route
Comparison with label Clarification when necessary Liquid medications- Enteral, parenteral
a nurse is caring for a client who received lisinopril (Zestril) 30 min ago & is now reporting dizziness & headaches. what actions should the nurse take first? a. Obtain the client's vital signs. b. Notify the provider. c. Document the client's response in the medical record. d. Tell the client to change positions slowly.
a. obtain the client's vital signs The first action the nurse should take using the nursing process is to assess the client. Therefore, the first action the nurse should take is to obtain the client's vital signs.
Medication prescription includes?
Date Time Client name Medication name Dosage Route Time Frequency Provider signature
A nurse is planning to administer an intramuscular injection to a 3-month-old infant. Which of the following sites should the nurse choose for the injection?
Deltoid Dorsal gluteal Rectus femoris *Vastus lateralis The vastus lateralis site located at the anterolateral thigh is the preferred site for intramuscular injection for infants and children.
right time
Follow facility guidelines Give within 30 min Stat, PC, PRN
(step in nursing process) Implementation:
Follow rights of medication administration Give client instructions Controlled substances Address client concerns
routine prescriptions
In effect until cancellation Specific end date Time frames for renewal
right dose
Match prescription Perform conversion Calculate dosages
a nurse is reviewing a client's prescriptions. the nurse should contact the provider to clarify which of the following prescriptions? a. Phenytoin (Dilantin) 100 mg PO every 8 hr b. Morphine 2.5 mg IV bolus PRN for incisional pain c. Regular insulin (Humulin R) 7 units subcutaneous 30 min before breakfast and dinner d. Lisinopril (Zestril) 20 mg PO every 12 hr. Hold for systolic BP less than 110 mm Hg
Morphine 2.5 mg IV bolus PRN for incisional pain (prescription contains name of med, dosage, route, circumstance of administration, but no frequency ... therefore needs clarification)
(step in nursing process) Assessment/ data collection:
Pertinent data, history Pre-administration data Allergies, interactions Complete prescription information Accurate interpretation
Rights of Administration
Right client Right medication Right route Right time Right dose Right documentation
different types of prescriptions?
Routine Single Stat PRN Standing Now
PRN prescription
Stipulates at what dosage, what frequency, and under what conditions a medication may be given. ex of a circumstance= fever of 100.0 or above
Appropriate patient identifiers
The client's telephone number, name, photograph, and assigned identification number are appropriate identifiers. The client's place of birth and hospital room number are not appropriate identifiers. also if its a child without a wrist band, you can ask the father or mother the childs name
(step in nursing process) Evaluation:
Therapeutic response Side/adverse effects Medication errors
right client
Two identifiers Acceptable identifiers Bar code technology Identification of resident in long-term care setting
Medication error
Wrong medication, IV fluid, diluent Incorrect dose, IV rate Wrong client, route, time Known allergy Dose omission Expired medication Erroneous discontinuation
a nurse is preparing to administer a medication subcutaneously. what should the nurse use? a. 5/8-inch, 25 gauge needle b. 1-inch, 22 gauge needle c. 11/2-inch, 19 gauge needle d. 1-inch, 18 gauge needle
a. 5/8-inch, 25 gauge needle (This is the appropriate size needle for the nurse to use when giving a subcutaneous injection.) b. Intramuscular injection. c. Intramuscular injection. d. Intramuscular injection.
a nurse is preparing to administer potassium chloride 40 mEq PO daily. available is potassium chloride 20 mEq effervescent tablets. in addition to checking the correct dosage before administering the medication, the nurse should check what? select all that apply a. The amount of liquid in which to dissolve the tablets b. The type of liquid in which to dissolve the tablets c. The client's blood glucose level d. The client's blood pressure e. The acceptable dose range of the medication
a. the amount of liquid in which to dissolve the tablets b. the type of liquid in which to dissolve the tablets e. the acceptable dose range of the medication
A nurse is reviewing the medication administration record for an adult client's new prescriptions. Which of the following prescriptions should the nurse clarify with the provider? a. Ampicillin 500 mg by mouth every 6 hr b. Phenytoin (Dilantin) 300 mg by mouth daily c. Metronidazole (Flagyl) 500 mg intermittent IV bolus every 8 hr d. Acetaminophen (Tylenol) 325 mg by mouth PRN for headache
acetaminophen (Tylenol) 325 mg by mouth PRN for headache (prescription contains name of med, dosage, route, circumstance of administration, but no frequency)
a nurse is caring for a client who has a prescription for meperidine (Demerol) 50 mg PO every 3 hr PRN for moderate pain, & meperidine 75 mg PO every 3 hr PRN for severe pain. at 1200, the client reports back pain rated as 8 on a pain scale of 0-10. the client received 75 mg PO at 0700 & 50 mg PO at 1000. what action should the nurse take? 1. Administer hydroxyzine 50 mg now. 2. Administer hydroxyzine 50 mg at 1300. 3. Administer meperidine 75 mg PO now. 4. Administer meperidine 75 mg PO at 1300.
administer meperidine 75 mg PO now (the client is reporting severe pain and can receive another dose of meperidine now. it's been 5 hrs since the previous dose so this is the appropriate action) the client last received meperidine 75 mg PO at 0700.
a nurse on a med surg unit is caring for a client who has type 2 diabetes mellitus & has a prescription for metformin (Glucophage) 500 mg PO every 12 hr. the client is scheduled for a chest X-ray in the morning. what is an appropriate action by the nurse? a. Administer the morning dose after the client has the X-ray. b. Ask the dietician to decrease the percentage of carbohydrates in the client's meals today. c. Administer the medication as prescribed. d. Ask the pharmacist to substitute a different hypoglycemic agent.
administer the medication as prescribed The nurse should withhold metformin when a client is scheduled for a procedure that requires the use of contrast dye. Because routine chest X-rays do not require contrast dye, the nurse should administer the medication as prescribed.
a nurse is preparing to administer medication to a client who has a prescription for doxycycline (Vibramycin) 100 mg PO daily at 0800. what times are appropriate for the nurse to administer the medication? SATA a. 0700 b. 0745 c. 0830 d. 0845 e. 0900
anywhere within 30 min of the scheduled time (ex: 0745 or 0830)
a nurse manager is reviewing a client's medical record & discovers that the client received a double dose of a prescribed medication. what action should the nurse manager take first? a. Complete an incident report. b. Notify the provider about the medication error. c. Assess the client for adverse effects. d. Report the error to the risk manager.
assess the client for adverse effects Using the nursing process, the first step the nurse should take is to assess the client for adverse effects.
a nurse is in a client's room preparing to administer docusate sodium (Colace) PO & acetaminophen (Tylenol) PO. the client refuses to take the medications because of nausea. what action should the nurse take? a. Administer the medications in suppository form. b. Ask the pharmacist to change the route of administration for the client. c. Withhold the medications. d. Offer the client dry crackers to take with the medications.
c. withhold the medications The client has the right to refuse the medications. The nurse should collect data to determine the cause of the nausea before taking any further action. The nurse should also document the client's refusal and the reason in the medical record.
a nurse is caring for a client who states that his provider told him he is at risk for anaphylaxis following administration of amoxicillin (Amoxil) and that he does not understand what this means. what is an appropriate response? a. "Anaphylaxis is a predictable and often unavoidable secondary effect that can occur at a usual therapeutic dose." b. "Anaphylaxis will cause you to experience withdrawal symptoms when you discontinue taking the medication." c. "Anaphylaxis is an unusual response that can occur due to an inherited predisposition." d. "Anaphylaxis is a severe hypersensitivity or allergic reaction that is life-threatening."
d. "anaphylaxis is a severe hypersensitivity or allergic rxn that is life-threatening"
a nurse is transcribing a provider's prescription for a client. the prescription reads morphine 2mg IV bolus at 1400. the nurse recognizes this as which of the following types of medication orders? a. Routine order b. Stat order c. PRN order d. Single order
d. single order (A single (one-time) order stipulates to administer the medication one time either at a specific time the provider indicates or as soon as possible.) a. A routine order is in effect until the provider changes or discontinues it, or the client is discharged. b. A stat order stipulates to administer the medication immediately and only one time. c. A PRN order stipulates at what dosage, what frequency, and under what conditions the nurse should administer the medication. The nurse uses clinical judgment to determine the client's need for the medication.
a nurse is assisting w/ the orientation of a newly licensed nurse. the nurse should explain that it is important to have a second nurse review the dosage of high-alert medications, such as heparin & insulin, for what reason? a. Dosage errors have the potential for significant harm to the client. b. The provider prescribes high-alert medications in small amounts. c. The nurse making an error may lose his job. d. The health care facility may lose its accreditation.
dosage errors have the potential for significant harm to the client (The nurse should have a second nurse check the dosage of high-alert medications because serious harm with excessive dosing can occur. Heparin overdose can lead to hemorrhage, and insulin overdose can lead to shock.)
Incident report:
incase of a medication error, you will need to fill out an incident report. follow your facilities protocol. DO NOT place a copy of incident report in the patients chart!
a nurse is preparing to administer insulin subcutaneously to a client. the nurse should document the administration of the medication immediately after what action? a. Taking the insulin from the automated dispensing machine b. Injecting the insulin c. Checking the client's blood glucose level d. Checking the correct dosage of the insulin
injecting the insulin The nurse should not delay documentation because this could lead to errors, such as omission of the documentation or administration of a second dose of medication to the client by another nurse.
Now prescriptions
like a STAT prescription but does not need to be administered STAT, can be administered within 90 minutes
a nurse is preparing to administer a liquid medication to a toddler. what action should the nurse take? a. Mix the medication in 120 mL (4 oz) milk. b. Offer the child a choice of taking the medication with either a cup or a spoon. c. Obtain the medication in the form of a flavored tablet. d. Explain the medication's purpose to enhance cooperation.
offer the child a choice of taking the medication with either a cup or a spoon Toddlers respond well to choosing between two options.
a nurse is providing teaching regarding medication administration to a group of newly licensed nurses. what is a legal responsibility of a nurse? a. Prescribing the correct dosage b. Modifying the medication regimen c. Reporting medication errors d. Delegating administration to assistive personnel
reporting medication errors The nurse is legally responsible for reporting medication errors according to facility policy.
a nurse is caring for a client who is to receive omeprazole (Prilosec) 40 mg PO daily. the client tells the nurse that the pill is too hard to swallow. what action should the nurse take? a. Crush the medication to administer in a small amount of pudding. b. Request a liquid form of medication from the pharmacy. c. Ask the charge nurse to clarify the prescription with the provider. d. Withhold the medication until time for the next dose.
request a liquid form of the medication from the pharmacy (The nurse can administer a liquid form of an oral medication if available. This is not changing the route of the medication.)
atraumatic care
therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system
Endotracheal Administration
when an iv site cannot be obtained, you can use endotracheal administration to administer the following medications: L = lidocaine E = epinephrine A = atropine N = naloxone (Narcan) *Absorption through the endotracheal tube is inconsistent, not the best route