Chapter 32 Potter-Perry Medication Administration - IV only

1 The intravenous route is used to administer adrenaline to patients with cardiac arrest. This route is often used in emergencies when a fast-acting medication needs to be delivered quickly. Injecting the medication through the intradermal route of administration is not beneficial because it may delay the action since the medication is injected under the epidermis. Subcutaneous injections involve a very slow medication absorption. The intramuscular route of administration has a faster absorption rate than the subcutaneous route, but this route may not be used in emergencies.

A patient who has been resuscitated following a cardiac arrest needs to be administered adrenaline. Which route of administration is most appropriate? 1 Intravenous 2 Intradermal 3 Intramuscular 4 Subcutaneous

1 Burned areas have a poor vascular supply and exhibit delayed absorption. In order for the medication to act more rapidly, it should be directly injected into the bloodstream. Thus the intravenous route is best. Injecting the medication directly into the burned skin is not a feasible route of administration because the skin has a poor vascular supply after the burns. Because the burned areas are deficient in blood supply, medications should not be injected subcutaneously. Intramuscular medications are injected deep into the muscles, which have a rich blood supply. Because a patient with burn injuries has a poor vascular supply, this route of administration is unsuitable.

A patient with second-degree burns complains of severe pain. What is the best route of administration to achieve immediate pain relief? 1 Intravenous 2 Intradermal 3 Subcutaneous 4 Intramuscular

4 The nurse should assess the vital signs before, during, and after administering potent medications to the patient. The nurse should double check the medication calculation with another nurse before administering the medication. The nurse should know the desired action and side effects of every medication. The nurse should make sure that the antidote is available during administration.

A registered nurse teaches a nursing student about administering intravenous medication. Which statement made by the nursing student indicates the need for further teaching? 1 "I should double check the medication calculation with another nurse." 2 "I should know the desired action and side effects of every medication." 3 "I should make sure that the antidote is available during administration." 4 "I should assess vital signs only before administration of potent medications."

2 The nurse should not add medication to intravenous bags that are already hanging, because there is no way to tell the exact concentration of the medication. The nurse should check the site frequently for infiltration and phlebitis while administering intravenous infusions. The nurse should regulate the intravenous rate according to the primary health care provider's order. The nurse should monitor the patient closely for any adverse reactions to the medications.

A registered nurse teaches a nursing student about administering medications in large intravenous infusions. Which statement made by the nursing student indicates the need for further teaching? 1 "I should check the site frequently for infiltration and phlebitis." 2 "I should add medication to intravenous bags that are hung already." 3 "I should regulate the intravenous rate according to the health care provider's order." 4 "I should monitor the patient closely for any adverse reactions to the medications."

4 The nurse should begin giving instructions about intravenous therapy when the patient is hospitalized. The nurse should teach the patient and family how to recognize problems of intravenous therapy. The nurse should carefully assess the patient's and family's ability to manage home intravenous therapy. The nurse should teach patients and family how to maintain intravenous administration therapy equipment.

A registered nurse teaches a nursing student about instructions to be given to a patient on intravenous therapy at home. Which statement made by the nursing student indicates the need for further teaching? 1 "I should teach the patient and family how to recognize problems of intravenous therapy." 2 "I should carefully assess the patient's and family's ability to manage intravenous therapy at home." 3 "I should teach patients and their families how to maintain intravenous administration therapy equipment." 4 "I should begin giving instructions to the patient about intravenous therapy when the patient is at home."

2 Heparin solutions are used for intermittent infusions (according to some agency policies) to maintain the patency of the intravenous catheter.These solutions are not the only solutions used however; 0.9% sodium chloride is most commonly used for intermittent infusions to maintain the patency of IV catheters. Intermittent infusions are indicated in patients requiring intravenous medications to be administered periodically, such as insulin. Intravenous catheters should be flushed with normal saline to maintain patency for next use.

A registered nurse teaches a nursing student about intermittent infusions. Which statement made by the nursing student indicates a need for further teaching? 1 "0.9% sodium chloride is used for intermittent infusions." 2 "Heparin is the only solution used for intermittent infusions." 3 "Intermittent infusions are indicated for patients requiring intravenous medication." 4 "After administration, the intravenous catheter should be flushed with normal saline."

4 The descriptive term "IV over 5 minutes" is used during the administration of drugs. The ISMP recommends avoiding using terms such as "IVP," "IV push," or "bolus" in orders with drugs that require administration over 1 minute or longer.

According to ISMP (Institution of safe medication practices), which descriptive term is used during the administration of drugs? 1 IVP 2 Bolus 3 IV push 4 IV over 5 minutes

3 The nurse flushes the injection port with normal saline to prevent the occlusion of the intravenous access devices. The nurse should dispose of uncapped needles and syringes in puncture-proof containers to reduce the risk of accidental needlesticks. The nurse should remove the saline flush syringe to reduce the transmission of infection. The nurse removes and disposes of used gloves to prevent transmission of microorganisms.

After administrating intravenous medication, the nurse flushes the injection port with normal saline. What is the rationale behind this intervention? 1 To reduce the risk of accidental needlesticks 2 To reduce the transmission of infection 3 To prevent the occlusion of the intravenous access devices 4 To prevent the transmission of microorganisms

3 The nurse should determine the reason for the improper circulation of flow rate when the medication does not infuse over the desired period. The nurse should insert a new intravenous site if the patient shows symptoms of infiltration or phlebitis. The nurse should stop the medication infusion if the patient develops any allergic reactions. The nurse should add the information to the patient's record if the patient develops any allergic reactions.

After evaluating the medication administration record of a patient, the nurse found that the medication does not infuse over the desired period. Which nursing intervention is appropriate in this situation? 1 Inserting a new intravenous site 2 Stopping the medication infusion 3 Determining the circulation of flow rate 4 Adding the information in to patient's medical record

2 Nursing students cannot take medication orders.

After seeing a patient, the health care provider starts to give a nursing student a verbal order for a new medication. The nursing student first needs to: 1 Follow ISMP guidelines for safe medication abbreviations. 2 Explain to the health care provider that the order needs to be given to a registered nurse. 3 Write down the order on the patient's order sheet and read it back to the health care provider. 4 Ensure that the six rights of medication administration are followed when giving the medication.

2, 5, 1, 3, 6, 4 The first step is to ensure that the intravenous fluid and medication are compatible. Then, prepare the medication in a syringe using a strict aseptic technique. Clean the injection port of the intravenous bag with an alcohol swab, remove the cap from the needle, and insert the needle through the intravenous port. Push the syringe plunger to instill medication into the intravenous fluid and mix the solution by turning the intravenous bag gently, end to end. Next, attach a medication label following safe-label guidelines. Then, administer the medication to the patient at the prescribed rate.

Arrange the order of the procedure for preparing intravenous medications safely. 1 Clean the injection port of the intravenous bag with an alcohol swab 2 Ensure that the intravenous fluid and medication are compatible 3 Push the syringe plunger to instill medication into the intravenous fluid 4 Administer the medication to the patient at the prescribed rate 5 Prepare the medication in a syringe using a strict aseptic technique 6 Follow the safe-label guidelines and attach a medication label

2 Redness, warmth, and tenderness at the intravenous (IV) site are signs of phlebitis.

If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, what would the nurse suspect? 1 Sepsis 2 Phlebitis 3 Infiltration 4 Fluid overload

125 The amount of drug to be administered to the patient is calculated as: Dose ordered/dose on hand × amount on hand. Here, the amount of medication administered to the patient is 0.25 L, and the dose on hand is 500 mg/L. The amount on hand is 1 L. Therefore, the calculation is 0.25/500 x 1 = 125. Therefore, the prescribed dose is 125 mg/L.

The nurse administers 0.25 L of 500 mg/L paracetamol (over-the-counter analgesic) to a pediatric patient through intravenous route. What is the actual dose prescribed to the patient? Record your answer in the whole number _____ mg/L

4 The nurse should assess the vital signs before, during, and after the administration of potent medication because there may be large changes in the vital signs. Before administrating a drug through an IV, the nurse double-checks the medication calculations, follows the six rights of safe medication administration, and knows the desired actions and side effects of the drug.

The nurse administers a potent medication to a patient through the IV. What is the most appropriate intervention followed by the nurse? 1 Double-checking the medication calculation 2 Knowing the desired actions and side effects of the drug 3 Following the six rights of safe medication administration 4 Assessing the vital signs before, during, and after infusion

1, 2, 3, 4, 5, 6, 7, 8 The nurse should first fill the buretrol with the desired amount of fluid, then close the clamp and check the clamp for the air vent. Then, the nurse should clean the buretrol injection port with an antiseptic swab, remove the needle cap, and insert the syringe through the port. Then, the nurse should regulate the intravenous infusion rate to allow the medication to infuse. Next, the nurse labels the buretrol with the name of the medication, dosage, and total volume and checks for primary infusion after the medication has infused. Finally, the nurse should dispose of the uncapped needle, safety shield, and syringe in a proper container.

The nurse administers intravenous fluids to a child by volume-control administration set. Arrange the order of the steps followed during administration. 1. Fill the buretrol with the desired amount of fluid 2. Close the clamp and check the clamp for air vent 3. Clean the buretrol injection port with an antiseptic swab 4. Remove the needle cap and insert the syringe through the port 5. Regulate the intravenous infusion rate to allow the medication to infuse 6. Label the buretrol with the name of medication, dosage, and total volume 7. Check for primary infusion after the medication has infused 8. Dispose of the uncapped needle, safety shield,and syringe in a proper container

2 Evaluation is the skill involved when the nurse assesses a patient's status after giving an intravenous medication. Planning involves collecting the medication administration record as well as taking steps to avoid interruptions. Assessment involves checking the accuracy and completeness of each medication administration record with the primary health care provider's medication orders. Implementation involves performing hand hygiene, putting on gloves, explaining the procedures, and administering medications.

The nurse assesses a patient's status after giving intravenous medication. Which nursing skill is involved in this situation? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

3 STAT medications are given once and at the time the medication is ordered. Therefore, it requires administration immediately and only once. Medications that are not time-critical can be administered within 1 to 2 hours of the scheduled dose. Prn medications require administration as needed. STAT orders do not indicate administering the medication before the surgical procedure.

The nurse finds a STAT order in the medication administration record of a patient. What action of the nurse is appropriate in this situation? 1 Administering the medication after 1 hour 2 Administering the medication when it is needed 3 Administering the medication only once and immediately 4 Administering the medication before the surgical procedure

0.4 The amount of drug to be administered to the patient is calculated as: Dose ordered/Dose on hand × Amount on hand. Here, the dose ordered is 200 mg and the dose on hand is 500 mg. The amount on hand is 1 L. The calculation is: 200/500 x 1= 0.4 L. Therefore, 0.4 L, or 400 mL of 500 mg/L conc. of amoxicillin should be administered to the patient, to meet the requirement of the primary health care provider.

The primary health care provider prescribes intravenous administration of 200 mg of amoxicillin to a pediatric patient with acute gastritis. However, the pharmacy has intravenous drips of only 500 mg/L. How much volume of 500 mg/L dose should the nurse administer to the patient to ensure that the dosage suffices the primary health care provider's prescription? Record your answer to one decimal. ____ L.

4 This is the appropriate order for a nurse to administer an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing.

The nurse is administering an intravenous (IV) push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in the appropriate order. 1. Release tubing and inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. Use watch to time administration. 2. Select injection port of intravenous (IV) tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy. 3. After injecting medication, release tubing, withdraw syringe, and recheck fluid infusion rate. 4. Connect syringe to port of intravenous (IV) line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port. 5. Clean injection port with antiseptic swab. Allow to dry. 6. Occlude intravenous (IV) line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return. 1. 2, 5, 4, 1, 3, 6 2. 2, 5, 6, 4, 1, 3 3. 5, 4, 2, 6, 1, 3 4. 2, 5, 4, 6, 1, 3

3 The nurse should rotate the buretrol between the hands to ensure equal distribution of medication. The nurse should close the clamp on the air vent of buretrol to prevent additional leakage of fluid into the buretrol. The nurse should re-establish the saline lock to ensure appropriate fluid balance and to maintain the IV site. Connecting the prefilled syringe to mini-infusion tubing may not ensure equal distribution of medication.

The nurse is administrating medication to a patient through volume-controlled administration set. Which action performed by the nurse ensures equal distribution of the medication? 1 Closing the clamp on the air vent 2 Re-establishing the saline lock 3 Rotating the buretrol between the hands 4 Connecting the prefilled syringe to mini-infusion tubing

1 If the medication has an antidote, the nurse should keep it at the bedside while administering intravenous medication to treat any toxicities. The nurse should not administer the antidote unless the patient exhibits symptoms of medication toxicity. The nurse should ensure accurate dose calculation and preparation while preparing intravenous medications to minimize the risk of adverse effects. Placing the antidote at the patient's bedside while administering the medication does not enhance the medication's therapeutic action.

The nurse is preparing to administer an intravenous medication to a patient and keeps its antidote at the bedside. What is the probable reason for doing this? 1 To treat the medication toxicity 2 To administer along with medication 3 To prevent the risk of adverse effects 4 To enhance the medication's therapeutic action

2, 3, 5 The components of a medication order include dose and frequency of the medication, route of administration, and generic name of the medication. The dose and frequency are decided based on the patient's weight and the amount of medication required to obtain the therapeutic effect. The route of administration depends on the types of medication and the condition of the patient. The medication can be given via enteral or parenteral route. The generic name of the drug is an important component of the medication order and is used to identify the drug. The chemical name of the medication and the name of the nurse in charge are not components of the medication order.

The nurse is reviewing a medication order for a patient. What are the components of medication orders? Select all that apply. 1 Chemical name of medication 2 Generic name of medication 3 Route of administration 4 Specific nurse in charge 5 Dose and frequency

1 An infusion that is too rapid may cause an excessive infusion of intravenous fluids, which may cause circulatory fluid overload during fluid replacement therapy. Lowering the level of the fluid bag causes a decreased rate of infusion. Rotating the sites of the administration can minimize a patient's pain and discomfort; this action does not cause fluid overload. Placing the patient in high Fowler's position is not responsible for fluid overload.

The nurse observes weight gain, edema, hypertension, and distended neck veins in a patient who is on fluid replacement therapy. What could be the reason behind this condition in the patient? 1 The intravenous solution is infusing too fast. 2 The level of the fluid bag has been lowered 3 The intravenous sites of administration have been rotated. 4 The patient was placed in a high Fowler's position.

2, 3, 5 In a hospital setting, whenever a verbal order is given, the nurse should read back the order to the prescriber to confirm it. The order should be entered in the computer. The nurse should receive confirmation of the order from the prescriber for validation. The nurse should enter the time and the prescriber's name and then sign the order, indicating that it was read back. The prescriber should countersign the order within 24 hours, not 48 hours.

The nurse on night shift explains a patient's condition to the healthcare provider, who in turn provides the verbal order of medication over the phone. Which accurately describe the roles of nurse and health care provider in executing telephone orders? Select all that apply. 1 The prescriber should countersign within 48 hours. 2 The nurse should receive confirmation from the prescriber. 3 The nurse has to enter the order in the computer. 4 The nurse should not sign the order. 5 The nurse should read back the order.

1, 2, 3, 6 Intravenous therapy is used to transfuse blood products, provide parenteral nutrition to patients who are unable to take medications orally, supply electrolytes and nutrients to maintain proper electrolyte balance, and provide treatment to unconscious patients who are unable to take medications orally. Intravenous therapy is the most costly route of administration and is used for a limited time only.

What are the purposes of intravenous therapy? Select all that apply. 1 Transfusing blood products 2 Providing parenteral nutrition 3 Supplying electrolytes and nutrients 4 Providing treatment with low cost 5 Providing medication in a long-term therapy 6 Providing medications to unconscious patients

4 The intravenous route is the best route for establishing constant therapeutic blood levels. Because the intravenous route is limited to injecting highly soluble medications, it cannot be used to inject partially soluble medications. Only patients who have suitable veins can be administered drugs through the intravenous route so this is not an advantage of the IV route. It is not the suitable route of administration for all patients. The intravenous route poses the risk of a medication overdose if the drug is injected too rapidly. Therefore, this is one of its disadvantages.

What is the advantage of the intravenous route of drug administration? 1 The intravenous route is used to inject highly soluble medications. 2 The intravenous route is used for the rapid injection of medications. 3 The intravenous route is administered to patients with suitable veins. 4 The intravenous route is the best route to establish constant therapeutic blood levels.

3 After administering the medication, the nurse should observe the patient closely for symptoms of adverse reactions because intravenous medications begin to act immediately after entering the bloodstream. The nurse should check the patency of the intravenous line prior to medication administration. The nurse should know the desired action and side effects of the medication before administering it. If the medication has an antidote, the nurse should make sure that it is available during administration, instead of checking after the mediation has been administered.

What is the most appropriate nursing intervention after administering an intravenous medication to a patient? 1 Checking the patency of the intravenous line 2 Knowing the desired action and side effects of the medication 3 Assessing the patient closely for symptoms of adverse reactions 4 Checking whether there is any antidote for the administered medication

3 The nurse should use the needleless port of the main intravenous line after cleaning with an antiseptic swab to prevent accidental needlestick injuries. The nurse should adjust the regulator clamp infusion rate to maintain therapeutic blood levels. The nurse regulates the main infusion line to the desired rate to prevent interference with the mainline infusion rate. The nurse should hang the piggyback medication bag above the level of the primary fluid bag to prevent negative flow rate effects.

Which nursing intervention is done to prevent accidental needlestick injuries? 1 Adjusting the regulator clamp infusion rate 2 Regulating the main infusion line to the desired rate 3 Using the needleless port of the main intravenous line after cleaning with an antiseptic swab 4 Hanging the piggyback medication bag above the level of the primary fluid bag

3 The nurse should avoid recapping used needles and should dispose in puncture-proof and leak-proof containers to prevent accidental needlestick injuries. The nurse should not break or bend needles before disposal. The nurse should not clean used needles with an antiseptic swab because they are not used again and should be disposed.

Which nursing intervention is done to prevent needlestick injuries after intravenous administration? 1 Bend the needle before disposal 2 Break the needle before disposal 3 Avoid recapping the used needles 4 Clean the needle with an antiseptic swab before disposal

4 The intravenous (IV) administration of medication produces the most rapid absorption because it directly facilitates the entry of the medication into the systemic circulation. Oral medications have to pass through the gastrointestinal (GI) tract; therefore, the overall rate of absorption is usually slow. Topical medications may be absorbed slowly due to the physical makeup of the skin. Intradermal administrations provide sustained release delaying the absorption.

Which route provides the most rapid absorption of a medication? 1 Oral administration 2 Topical administration 3 Intradermal administration 4 Intravenous administration

2 A syringe pump is a volume-controlled infusion set that is used to administer medications through intravenous therapy. It is used to administer medications in very small amounts of fluids. A piggyback set is a microdrip or macrodrip system. Buretrol sets are small containers that attach just below the primary infusion bag or bottle. Syringe pumps are used to administer 5 to 60 mL of medications in controlled infusion times.

Which statement is true regarding a syringe pump? 1 A syringe pump is a microdrip or macrodrip system. 2 A syringe pump is used to administer medications in very small amounts of fluids. 3 A syringe pump is a very small container that is attached just below the primary infusion bag. 4 A syringe pump is used to administer 30 to 50 mL of medications in controlled infusion times.

3 Volume-controlled infusion administers medications through small amounts such as 100mL. Volume-controlled infusions reduce the risk of rapid-dose infusion by IV push. Medications are diluted and infused over longer time intervals such as 30 to 60 minutes. Volume-controlled infusions allow for administration of medications that are stable for a limited time in solution.

Which statement is true regarding volume-controlled infusions? 1 They increase the risk of rapid-dose infusion by IV push. 2 The medications are diluted and infused at a time interval of 20 minutes. 3 The medications are administered through small amounts such as 100 mL. 4 They allow for administration of medications that are unstable for a limited time in solution.

1 The piggyback tubing is a macrodrip system. A syringe pump is battery-operated and allows the medication to be given in very small amounts of fluid. Intermittent venous access is commonly known as a saline lock. Volume-control administration sets are small containers that attach just below the primary infusion bags or bottles.

Which type of volume-controlled infusions sets involves a macrodrip system? 1 Piggyback 2 Syringe pump 3 Intermittent venous access 4 Volume-controlled administration set

3 The nurse should occlude the intravenous line by pinching the tubing just above the injection port and pull back gently on the syringe plunger to aspirate blood return. This helps to check whether the medication is being delivered into the bloodstream. Inserting a needleless tip or small-gauge needle of a syringe containing a prepared drug through the center of the injection port helps to prevent damage to the port's diaphragm and subsequent leakage. Allowing intravenous fluids to infuse while pushing the intravenous drug enables the medications to be delivered to the patient at the prescribed rate. Cleaning the injection port with an antiseptic swab and allowing it to dry helps prevent the introduction of microorganisms during needle insertion.

While administering an intravenous push, the nurse occludes the intravenous line by pinching the tubing just above the injection port. What is the reason for this nursing action? 1 To prevent damage to the port's diaphragm 2 To enable medications to be delivered at the prescribed rate 3 To check that the medication is being delivered into the bloodstream 4 To prevent the introduction of microorganisms during needle insertion

2 Rapid infusion of the intravenous fluid may cause circulatory overload in patients on intravenous therapy. Therefore, the nurse should verify the rate of administration with a medication reference or a pharmacist before giving them to ensure that intravenous infusions are safe over an appropriate amount of time. The patient is at a risk of medication overdose if the intravenous fluids are infused too rapidly. Flushing the intravenous port with the saline solution helps to maintain the patency of the intravenous line, but does not cause any adverse effects. The nurse should check the incompatibility of the medication with the fluid before starting the therapy.

While assessing a patient who is receiving intravenous therapy, the nurse notices circulatory fluid overload. What may be the reason for the patient's condition? 1 Overdose of the medication 2 Rapid infusion of the intravenous fluid 3 Flushing the intravenous port with saline solution 4 Incompatibility between the medication and the intravenous fluid

2 The nurse should not take phone calls or speak with others while preparing IV medications to avoid interruptions that may result in medication errors. The nurse should keep an antidote close by while administering medications to treat medication toxicity. The nurse should double-check dosage calculations while preparing intravenous medications to avoid the risk of adverse effects. The nurse should collect appropriate equipment and check the medication administration record to enhance time management and efficiency.

While preparing intravenous medications, the nurse does not take phone calls or speak with others. What is the reason for this nursing action? 1 To treat medication toxicity 2 To prevent medication errors 3 To avoid the risk of adverse effects 4 To enhance time management and efficiency