UWorld Medication Administration
The clinic nurse is assessing the client's understanding of tiotropium, which has been prescribed for chronic obstructive pulmonary disease (COPD). Which statement indicates that the client has a correct understanding of this medication? Tiotropium and umeclidinium are long-acting, 24-hour, anticholinergic medications. Ipratropium is a short-acting anticholinergic used as a rescue medication for COPD and asthma. Tiotropium is typically administered as a powder via a special inhaler. Anticholinergic inhaled medications (eg, ipratropium, tiotropium, umeclidinium) do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions. Clients should rinse the mouth after using tiotropium and inhaled steroids (eg, beclomethasone, budesonide, fluticasone) to remove any medication remaining in the mouth, which decreases the risk of developing thrush.
1. "A capsule holds the powdered medication that I have to put in a special inhaler. Tiotropium (Spiriva) is a long-acting, 24-hour, anticholinergic, inhaled medication used to control chronic obstructive pulmonary disease (COPD). It is administered most commonly using a capsule-inhaler system called the HandiHaler. The powdered medication dose is contained in a capsule. The client places the capsule in the inhaler device and pushes a button on the side of the device, which pokes a hole in the capsule. As the client inhales, the powder is dispersed through the hole. Unlike most inhaled medications, tiotropium looks like an oral medication because it comes in a capsule. Therefore, it is important to teach the client proper administration prior to the first dose, emphasizing that the capsule should not be swallowed and that the button on the inhaler must be pushed to allow for medication dispersion. During future appointments, the nurse should assess/reassess the client's ability to use this medication correctly.
The nurse teaches a client with newly diagnosed Sjögren's syndrome how to self-administer ophthalmic lubricating ointment medication. Which statement that the client makes indicates the need for further teaching?
1. "After applying the ointment, I'll tightly close my eyes and rub the lid for 2-3 minutes." Teach client the following steps for self-administration of ophthalmic ointments: - Perform hand hygiene - Tilt the head back, pull the lower lid down, and look upward - Squeeze a thin strip of ointment onto the lower eyelid, from the inner to the outer edge - Close the eyes gently for 2-3 minutes after applying the ointment
The unit educator is performing skill validations with unit staff. Which of the following actions by the staff nurses demonstrate a correct understanding of parenteral medication administration? Select all that apply.
1. Injects subcutaneous insulin at a 90-degree angle into the lower abdomen of an obese client 4. Places client in a side-lying position to access the ventrogluteal site for IM injection Use filter needles to withdraw medications from ampules to prevent aspiration and injection of glass shards. Perform intradermal injections at 5- to 15-degree angles and avoid massaging injection sites to prevent accidental subcutaneous administration. Administer subcutaneous injections at 45 or 90 degrees, depending on the volume of subcutaneous tissue.
A nurse is caring for 4 clients. Which prescription by the health care provider would the nurse question and seek further clarification before administering? Anaphylaxis causes increased capillary permeability, leaking intravascular fluid into free spaces; this places the client at risk for hypotension. Therefore, isotonic solutions should be given to such clients. Extreme hyperglycemia in a client with diabetic ketoacidosis results in osmotic diuresis and dehydration. The immediate initial treatment is IV fluid resuscitation with isotonic 0.9% sodium chloride to replace fluid losses, stabilize vital signs, reestablish urine output, and dilute the serum glucose concentration before initiating insulin therapy.
1. 0.45% sodium chloride solution for a client with severe gastroenteritis who had 12 episodes of diarrhea and vomiting in the past 4 hours The nurse should question the administration of a hypotonic IV solution (ie, 0.45% sodium chloride) to replace gastrointestinal tract fluid losses as this would create a concentration gradient and shift fluid out of the intravascular compartment into the interstitial tissue and cells, worsening the client's fluid volume deficit. Isotonic IV solutions (eg, 0.9% sodium chloride, lactated Ringer's) have the same osmolality as plasma and are administered to expand intravascular fluid volume. These solutions replace fluid losses commonly associated with vomiting and diarrhea, burns, and traumatic injury.
The health care provider prescribes IV fluid resuscitation for a client in hypovolemic shock. The nurse should anticipate the rapid infusion of which of the following IV solutions initially?
1. 0.9% sodium chloride Hypovolemic shock occurs when there is inadequate circulating volume to maintain perfusion due to hemorrhage, decreased fluid intake, or fluid loss (eg, vomiting, diarrhea, diuresis). When caring for a client with hypovolemic shock, the priority is to restore intravascular volume, cardiac output, and perfusion. The nurse should anticipate fluid resuscitation with a crystalloid, isotonic IV fluid (eg, 0.9% sodium chloride, lactated Ringer) to rapidly correct hypotension (Option 1).
A client diagnosed with hypertension has been prescribed a clonidine patch. Which instructions should the nurse include? Select all that apply.
1. Apply patch to the upper arm or chest (every 7 days) 2.Fold used patches in half with sticky sides together before discarding 4.Rotate sites each time a new patch is applied - Do not shave the area before applying the patch. The skin should be free from cuts, scrapes, calluses, or scars (Option 5). - Wash the area with soap and water, then rinse and wipe with a clean, dry tissue. - Notify the HCP if you are experiencing side effects such as dizziness or slow pulse rate. Do not remove the patch without discussing this with the HCP as rebound hypertension can occur (Option 3).
The nurse is administering a pink pill to a hospitalized medical-surgical client. The alert, oriented client says, "This is a pill I haven't seen before." What follow-up action should the nurse take next?
1. Check the health care provider's prescription in the medical record Safe medication administration is conducted according to 6 rights: - Right client using 2 identifiers - Right medication - Right dose - Right route - Right time - Right documentation
A nurse on the telemetry unit is preparing client medications in the medication room. Which of the following actions should the nurse perform to be consistent with client safety practices related to medication administration? Select all that apply. (Option 3) Individual-dose packages should be opened at the client's bedside and placed in a medication cup only immediately before administration.
1. Confirm the client's identity, medication, dosage, time, and route prior to medication administration 2.Do not administer any medication that is damaged or has an unreadable label 4. Review laboratory values before administering anticoagulants 5.Wear gloves when handling transdermal medication patches
The nurse is caring for a hospitalized client with an acute exacerbation of heart failure. The client receives digoxin 0.5 mg PO once daily, furosemide 40 mg PO twice daily, and potassium chloride (KCl) 20 mEq PO twice daily. The client's child reports that the client has trouble swallowing the large KCl pill. The client's potassium level is 3.7 mEq/L (3.7 mmol/L). What action should the nurse take first?The nurse is caring for a hospitalized client with an acute exacerbation of heart failure. The client receives digoxin 0.5 mg PO once daily, furosemide 40 mg PO twice daily, and potassium chloride (KCl) 20 mEq PO twice daily. The client's child reports that the client has trouble swallowing the large KCl pill. The client's potassium level is 3.7 mEq/L (3.7 mmol/L). What action should the nurse take first?
1. Consult with the pharmacist to see if other oral forms of KCl are available If a client has difficulty swallowing large pills, the nurse should consult the pharmacist to see if other forms of KCl are currently available and to determine if the medication is safe to crush. If a more appropriate form (eg, liquid) is available, the nurse would then discuss that change in route with the health care provider and obtain an updated prescription. Tucking the chin to the chest during swallowing is a technique used to prevent aspiration. This most likely will not help the client swallow the large pill.
The nurse plans to administer 9:00 AM medications via the nasogastric (NG) route to a client with an NG tube. The nurse contacts the primary health care provider (PHCP) to clarify which prescriptions that are contraindicated using this route? Select all that apply. d 4) Double- and extra-strength drugs such as sulfamethoxazole and acetaminophen may be crushed and administered separately through an NG tube as long as they are not enteric-coated. The nurse should flush the tube with water before and after each drug administration.
1. Enteric-coated ibuprofen 200-mg tablet - Enteric-coated drugs have a barrier coating that dissolves at a slower rate (usually in the small intestine) to protect the stomach from irritant effects. Crushing enteric-coated medications (eg, ibuprofen) disrupts the barrier coating and may cause stomach irritation. In addition, the particles from the coating may clog the NG tube, particularly small-bore NG tubes 3. Metoprolol extended-release 50-mg tablet 5. Tamsulosin 0.4-mg slow-release capsule' - Slow-, extended-, or sustained-release drug formulations are designed to dissolve very slowly within a specific time frame. Crushing these medications alters this property and introduces the risk of adverse effects from toxic blood levels due to more rapid drug absorption. Therefore, the nurse should first contact the PHCP for clarification.
The nurse is preparing to give a heparin injection to a client who is severely malnourished and has minimal adipose tissue. Which method of injection would be appropriate for this client? Needles longer than 5⁄8 in (1.6 cm) are used to administer intramuscular injections (18 Gauge). 90-degree injection angle should be used only when sufficient adipose tissue (ie, ≥2 in [5 cm]) can be grasped. Using a 90-degree angle for a cachectic client would put the client at risk for intramuscular heparin delivery, which leads to rapid absorption, hematoma formation, and painful muscle irritation.
2. 25 G, 1/2 inch, 45 deg angle When administering subcutaneous anticoagulant injections (eg, heparin, enoxaparin), the nurse must select the appropriate needle length and angle to avoid accidental intramuscular injection, especially in clients with insufficient adipose tissue (eg, cachexia). The nurse should administer subcutaneous injections at 45 degrees if ≤1 in (2.54 cm) of tissue can be grasped (Option 2). Anticoagulants are best absorbed when administered in the abdomen, at least 2 in (5 cm) away from the umbilicus and above the level of the iliac crests
The nurse should anticipate administration of isotonic IV fluids in which of the following clients? Select all that apply. Isotonic IV fluids (eg, 0.9% sodium chloride, lactated Ringer solution) expand only the extracellular fluid and are used as fluid replacement for clients with fluid volume deficit. Urinary output of 2 mL/kg/hr and a flat fontanel are NORMAL findings in an infant. (Option 3) Hyponatremia = excess fluids. Elevated BUN would indicate dehydration
2. 3-month-old client with diarrhea, capillary refill of 4 seconds, and mottling in lower extremities - Capillary refill indicates adequacy of circulation and perfusion. Capillary refill time >3 seconds is abnormal and can indicate dehydration. Mottling is characterized by patches of pink, pale, and cyanotic skin and can indicate poor perfusion (Option 2). 4. Client having contractions every 10 minutes and will be receiving an epidural analgesic - Clients in labor usually receive 500-1000 mL of isotonic fluids prior to epidural anesthesia because vasodilation below the epidural site can occur and result in hypotension. Up to 40% of these clients may experience hypotension after an epidural anesthesia. The preadministration of IV fluids can lessen hypotension 5.Client received a bolus of IV fluid for hyperemesis gravidarum, and urine output is 80 mL/4 hr and pulse is 120/min - Hyperemesis gravidarum is severe vomiting that can result in dehydration. Despite being given some fluids; this client still needs additional fluids. Minimal obligatory urine output is 30 mL/hr or 120 mL/4 hr. Urine output is the best indicator of adequate rehydration. A pulse of 120/min (ie, tachycardia) indicates dehydration unless there is another clear etiology (Option 5).
The nurse is caring for 4 clients requiring IV fluid therapy. For which client should the nurse anticipate the need for isotonic crystalloid administration? Isotonic fluid therapy is used to treat clients with extracellular fluid deficits (eg, dehydration). Clients at risk for cerebral swelling (eg, increased intracranial pressure, hyponatremia) require hypertonic fluid administration to decrease cellular swelling. Isotonic fluid administration may cause fluid overload in clients with renal failure.
2. 45-year-old with acute gastroenteritis and dehydration - Isotonic crystalloid fluids (eg, 0.9% sodium chloride, lactated Ringer solution) are the treatment of choice due to the similarity in concentration with plasma and ability to increase extracellular fluid (ECF) without moving into the intracellular space. In addition, isotonic fluids may increase sodium levels in clients experiencing excess sodium loss (eg, vomiting, diarrhea) (Option 2).
The nurse is preparing an injection of IM haloperidol from a glass ampule. Which of the following actions by the nurse are appropriate? Select all that apply. Glass shards may be present in the medication after an ampule is opened. To prevent the accidental administration of glass shards, the nurse must use a filter needle, rather than an injection needle, when withdrawing medication. Unlike when withdrawing medication from a vial, air should NOT be injected into a glass ampule; this causes the contents to spill from the container. Ensure that the filter needle does not touch the glass edges, which are not sterile, as this can introduce bacteria.
2. Breaks the ampule neck away from the nurse's body to prevent injury from the glass 3.Disposes of the empty glass ampule in a sharps container When preparing medication from a glass ampule, the nurse breaks the ampule away from the body and discards it in the sharps container. The nurse withdraws medication using a filter needle to prevent the injection of glass shards, avoids touching the needle to contaminated ampule edges, and avoids injecting air to prevent spillage.
The nurse has received a new order to discontinue IV fluids for a client who is receiving bolus doses of morphine sulfate via an IV patient-controlled analgesia (PCA) device. Which of the following actions should the nurse take?
2. Clarify the order with the health care provider A patient-controlled analgesia (PCA) device delivers a set amount of IV analgesic each time the client presses the delivery button. With many PCA devices, a continuous IV solution (eg, normal saline) is required to keep the vein open and flush the medication through the tubing so that the boluses reach the client. Many facilities have a policy regarding IV fluids for use with PCA; however, an order may be required. To ensure uninterrupted delivery of the client's PCA, the nurse should contact the health care provider to clarify the order to discontinue the maintenance fluids (Option 2).
A nurse is teaching a parent of an infant about administration of an oral medication. What should be included in the teaching? Select all that apply.
2. Direct liquid medication toward the inside of the infant's cheek 3. Hold the infant in a semi-reclining position during administration - Oral medication should be administered with the infant in a semi-reclining position, which is similar to the feeding position (Option 3). This position promotes comfort, prevents aspiration, and may be better controlled by the nurse if the infant resists the medication. 4. Measure and administer the medication using an oral syringe
The nurse is precepting a new graduate nurse (GN) who is administering a prefilled enoxaparin injection to an obese client. Which action by the GN indicates the need for further education from the nurse preceptor? ) After subcutaneous anticoagulant injection, the client should not rub the injection site as this increases bruising and the risk for hematoma.
2. Ejects the air bubble from the prefilled syringe before administration Low-molecular-weight heparins (LMWHs) (eg, enoxaparin, dalteparin) are anticoagulants commonly used for prevention and treatment of deep venous thrombosis and pulmonary embolism. LMWH is administered subcutaneously and is often available in a prefilled syringe, which contains an air bubble to ensure delivery of the entire dose. During injection, the air bubble follows the medication out of the syringe, ensuring that no medication is left behind. The nurse should not expel the air bubble prior to administration as this could result in an incomplete dose and medication error (Option 2).
The nurse observes a student nurse administer ear drops to an elderly client to help loosen cerumen. The nurse intervenes when the student performs which action?
2. Instills ear drops with dropper by occluding the ear canal - Support hand on the client's head and instill the prescribed number of drops by holding the dropper 1 cm (1/2 in) above the ear canal. This avoids damaging the ear canal with the dropper (Option 2) To administer otic medications in an adult client, follow these steps: (1) Perform hand hygiene, (2) position the client side-lying with the affected ear up, (3) pull pinna up and back, (4) administer prescribed number of ear drops, (5) instruct the client to remain side-lying for 2-3 minutes, and (6) place cotton ball loosely in the outer ear canal for 15 minutes (if needed) to absorb excess medication. Perform this with caution and avoid in infants or very young clients as it is a choking hazard (Option 3)
A nurse in a pediatric clinic is preparing to administer ear drops to a 5-year-old. Which is an appropriate action by the nurse? The child should be placed in the prone or supine position with the head turned to the appropriate side and the medication is allowed to drop against the wall of the canal.
2. Pull the pinna upward and back When administering an otic medication to an adult or child age 3 and older, the pinna is pulled upward and back to straighten the external ear canal (Option 2). For an infant, the pinna is pulled downward and straight back.
The nurse is preparing to administer an IM vaccine to a 6-month-old client. Which of the following needle lengths and injection sites would be appropriate for the nurse to use? A 3⁄8-inch (9-mm) needle is too short to penetrate the muscle, and the infant's ventrogluteal muscle does not have enough muscle mass for use. A 1½-inch (38-mm) needle is typically used for older children and adults with sufficient muscle mass. The deltoid muscle is used in children age >3 and adults.
2. ⅝-inch (16-mm) needle in the anterolateral thigh muscle (vastus lateral injection) When administering IM injections, the appropriate needle length for newborns (age <1 month) is ⅝ inch (16 mm) and ⅝ (16 mm) to 1 inch (25 mm) for infants (age 1-12 months) and children. The vastus lateralis muscle in the anterolateral middle portion of the thigh is the preferred IM injection site for newborns and infants (Option 2).
The pediatric nurse is preparing to administer an acetaminophen suppository to an 11-month-old with pyrexia (fever/elevated body temperature). Which actions are appropriate? Select all that apply. The suppository must be inserted past both the external and internal sphincters for proper placement. If not inserted far enough, it may be expelled before achieving a therapeutic effect. Lubricate the tip of the suppository with water-soluble jelly. Petroleum-based products can reduce absorption. If a bowel movement occurs within 10-30 minutes, observe for the presence of the suppository.
2.Guide suppository along the rectal wall 3. Hold buttocks together firmly after insertion 4.Position client supine with knees and feet raised 5.Use gloved fifth finger for insertion
The pediatric nurse is reinforcing education about medication administration to the parents of a 4-year-old client. Which statements made by the parents demonstrate correct understanding? Select all that apply. Parents should notify the health care provider if the child vomits after oral medication administration; additional medication may cause an overdose, as some of the medication may have been absorbed.
3. "I should measure liquid medications using an oral syringe - For pediatric clients, liquid medications should be measured with oral syringes, which have small, well-defined increments and provide accuracy for small doses (Option 3). Household measuring devices (eg, teaspoon) are inaccurate due to variability of size and differences in measuring methods. ."4."I will encourage my child to help me as I prepare the medication." - Pediatric clients may refuse medication due to a fear of an unpleasant taste. Preschool children (age 3-6) typically start to take initiative and affirm power over the environment (Erickson's initiative vs. guilt). Encouraging participation (eg, allowing the child to depress the syringe plunger) promotes initiative and cooperation by giving the child a sense of control (Option 4)
The nurse is teaching a client who has an IV patient-controlled analgesia device. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.
3. "I will ask for assistance to get out of bed or walk to the bathroom." 5. "The device is programmed to decrease my risk for experiencing an overdose." The device will not deliver medication outside of the prescribed maximum doses per hour or the dosing interval, despite the number of dosing attempts (ie, button presses) by the client. (Option 2) For optimal pain relief, clients should self-administer doses before pain becomes severe. (Option 4) To prevent overdose, doses should not be delivered by anyone (eg, nurses, family) other than the client.
A nurse is preparing to administer 2 continuous IV medications concurrently via a 20-gauge IV. What is the nurse's priority action?
3. Consult a medication guide for compatibility The priority when administering 2 IV medications concurrently is to determine drug compatibility. Incompatible drugs given through the same IV line will deteriorate or form a precipitate. This change is visualized through either a color change, a clouding of the solution, or the presence of particles. If 2 or more drugs are not compatible, the nurse may consider inserting a second IV or consulting the pharmacist and the health care provider to determine the safest and most beneficial plan for the client.
A client with terminal cancer is prescribed fentanyl patches for pain management while receiving hospice care at home. Which instructions related to this medication should the nurse provide? Select all that apply. Patches should be applied to flat, intact skin (upper back, chest) to prevent accidental removal. Patches should not be cut, and heat should not be placed over them. Unlike transdermal patches, topical analgesic patches (eg, lidocaine, capsicum) deliver drug locally and are placed near the site of pain.
3. Fold the used patch in half so that the edges adhere and immediately discard - Used patches must be folded and discarded immediately, as some medication remains in a used patch. Opioid medications must be stored and disposed of securely (eg, flushed down the toilet, discarded in a sharps container) as accidental exposure is potentially fatal for children, pets, and caregivers (Option 3). 5. Remove the old patch when applying a new patch every 72 hours - Patches are replaced every 72 hours, and the used patch must be removed before applying a new one (Option 5).
The nurse is caring for a 2-year-old who is refusing oral antibiotics. What is the nurse's next action? The nurse should not call the health care provider without trying other age-appropriate techniques first.
3. Offer the child a choice of orange or apple juice with the antibiotic Toddlers (age 1-3) begin to demand autonomy and have a strong desire for independence. Negativistic behavior is common, and questions requiring a yes or no response should not be used. Offering limited choices will give the toddler a sense of control. Allowing the toddler to choose between orange or apple juice should improve cooperation.
The nurse is reconstituting methylprednisolone sodium succinate for IM injection. Place in order the steps that the nurse should perform to appropriately prepare the medication. All options must be used. To reconstitute powdered medication from a vial, the nurse should perform hand hygiene and don gloves; withdraw air equal to the prescribed amount of diluent to create negative pressure that will be equalized when the diluent is injected into the vial; inject the prescribed amount/type of diluent (sterile saline, sterile water); mix by rolling the vial between the palms of the hands/Avoid shaking the vial as bubbles may develop, making withdrawal of the reconstituted medication difficult (; withdraw the reconstituted medication into a syringe; and label the syringe with the medication name and dosage.
3. Perform hand hygiene and don clean gloves 5. Withdraw air from the vial 1. Inject diluent into the vial 4. Roll vial between the palms of the hands to mix 6. Withdraw reconstituted medication from the vial 2. Label syringe with medication name and dosage
The nurse precepts a nursing student caring for a client with glaucoma and observes the student administer timolol maleate, an ophthalmic medication. Which student action indicates that further instruction is needed? needs to be inner to outer To administer ophthalmic medications, follow these steps: (1) Remove secretions from the eyelid by wiping from the inner to outer canthus; (2) pull lower eyelid downward, have client look upward, and instill drops into the conjunctival sac; and (3) Instruct client to close the eyelid and move the eye around (if able). Then apply pressure to the lacrimal duct for 30-60 seconds if medication has systemic effects (eg, beta blocker, timolol maleate). Rest hand on client's forehead and hold dropper 1-2 cm (1/2-3/4 in) above the conjunctival sac, which keeps the dropper away from the eye globe and avoids contamination (Option 4) Place client in the supine or sitting position with head tilted back toward side of the affected eye to prevent excess medication from flowing into the lacrimal duct and minimize systemic absorption through the nasal mucosa
3. Removes dried secretions with moistened sterile gauze pads by wiping from the outer to inner canthus - Remove dried secretions with moistened (warm water or normal saline) sterile gauze pads by wiping from the inner to outer canthus to keep eyelid and eyelash debris from entering the eye and to prevent transfer of debris into the lacrimal (tear) duct (Option 3)
The registered nurse (RN) is providing nursing care with a licensed practical nurse and unlicensed assistive personnel. The RN administers hydromorphone 1.5 mg IVP per STAT order to a client with severe abdominal pain. Three hours later, the client rates pain as a 9 on a scale of 0-10 and requests pain medication. What is the most appropriate action for the RN to take? The RN can delegate repeat vital sign checks to the unlicensed assistive personnel, but it is not the most appropriate action.
4. Contact the health care provider A STAT order indicates that the medication should be given immediately and only one time. A new prescription for the medication must be acquired before the dose can be repeated. The most appropriate action is to contact the health care provider to request an as-needed prescription for pain medication
A nurse administers an intramuscular (IM) injection using the Z-track technique. Place the steps in chronological order. All options must be used.
4. Pull the skin 1-1 ½" (2.5-3.5 cm) laterally and away from the injection site 3. Hold the skin taut with non-dominant hand and insert needle at a 90-degree angle 2. Inject medication slowly with dominant hand while maintaining traction 6. Wait 10 seconds after injecting the medication and withdraw the needle 5. Release the hold on the skin, allowing the layers to slide back to their original position 1. Apply gentle pressure at the injection site but do not massage
The nurse working in an extended care facility transcribes a prescription from the health care provider for a single daily dose of 150 mg of ranitidine; this is to be taken orally at bedtime for treatment of gastroesophageal reflux disease. Of the following prescriptions, which one is transcribed correctly? : Ranitidine is a histamine-2 blocker, which decreases the amount of acid created by the stomach. Prescription ranitidine is approved for multiple indications, including treatment and prevention of ulcers of the stomach and intestines and treatment of gastroesophageal reflux disease.Apr
4. Ranitidine 150 mg PO at bedtime The abbreviation per os is interpreted as by mouth. The United States Pharmacopeia Institute for Safe Medication Practices Medication Error Reporting Program recommends that per os not be used as it may be read mistakenly as left eye.
The nurse is caring for a client who has a prescription for potassium chloride 10 mEq (10 mmol) IV. The nurse sets the infusion pump to administer the medication over one hour. Shortly after initiating the infusion, the client reports mild discomfort at the site of the peripheral venous access device. The nurse stops the infusion to assess the site and does not note any signs of infiltration or phlebitis. Which of the following actions should the nurse take next? IV potassium chloride is prescribed to correct severe hypokalemia. It should never be administered IV push. The recommended peripheral infusion rate is 5-10 mEq/hr (5-10 mmol/hr). However, the nurse should always follow facility policy and procedure for administration of potassium chloride A new VAD site should always be located proximal to all previous sites. A central VAD (eg, peripherally inserted central catheter) should be used to administer potassium chloride at higher concentrations or faster rates; however, these clients should receive cardiac monitoring in a critical care unit. IV potassium chloride is preferred over oral potassium chloride to correct hypokalemia quickly and decrease the risk for dysrhythmias with s
4. Restart the infusion at a slower rate and closely monitor the site Potassium chloride can cause irritation and discomfort at the peripheral venous access device (VAD) site. If the client is not experiencing any signs of adverse reactions (eg, phlebitis, infiltration, extravasation), the nurse can restart the infusion at a slower rate. Slowing the infusion rate can be effective in alleviating discomfort (Option 4). The nurse should continue to closely monitor the site and stop the infusion immediately if any signs of adverse reactions do occur.
A new graduate nurse is preparing to administer the following analgesics to clients with postoperative pain. Which situation would require intervention by the precepting nurse? Selecting a smaller first dose is appropriate if the nurse is unsure of how the client will respond to the medication Hydromorphone IV push, given undiluted or diluted with 5 mL of sterile water or normal saline, should be administered slowly over 2-3 minutes; rapid infusion increases the risk of opioid-induced adverse reactions (eg, nausea, itching). Undiluted morphine IV push should be administered slowly over 4-5 minutes; rapid infusion increases the risk of opioid-induced adverse reactions (eg, hypotension, flushing).
4. Selects a 25-gauge ½-inch (1.3-cm) needle to inject ketorolac intramuscularly Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) analgesic administered (orally, IV, or intramuscularly [IM]) for short-term relief of mild to moderate pain. Usage should not exceed 5 days due to adverse effects (eg, kidney injury, gastrointestinal ulcers, bleeding). Ketorolac IM should be administered into a large muscle using the Z-track method to mitigate burning and discomfort. A 1- to 1½-in (2.5- to 3.8-cm) needle is recommended to inject medication into the proper muscular space in average-weight individuals.
The nurse teaches a parent how to administer an oral liquid medication to a 2-month-old client. The nurse knows that the parent understands the teaching when the parent does which of the following?
4. Using a syringe, administers the medication in small amounts into the back of the cheek sing a syringe to measure the medication is the most accurate technique to ensure that the proper amount of medication is being administered. The correct procedure for administering oral medication to an infant is to place small amounts of the medication at the back of the cheek, allowing time for the infant to swallow each amount. This technique decreases the risk for choking and ensures that all the medication is consumed.
The nurse is observing a client self-administering nasal fluticasone. The nurse should intervene if the client
4. points the nasal spray tip toward the nasal septum during instillation When teaching a client how to self-administer nasal sprays, the nurse should instruct the client to point the nasal spray tip toward the side and away from the center of the nose (Option 4). - (Option 1) Assume a high Fowler or sitting position to allow the medication to reach the nasal passages - (Option 3) Insert the nasal spray nozzle into an open nostril while occluding the other nostril with a finger - (Option 2) Spray the medication into the nose while inhaling to facilitate distribution of the medication high into the nasal passages - Remove the nasal spray nozzle from the nose and breathe through the mouth - Repeat the steps instilling the number of prescribed sprays in each nostril - Blot a runny nose with a facial tissue, but avoid blowing the nose for several minutes to allow for absorption of the medication
The client is returning for a follow-up appointment after a bilateral mastectomy with lymph node removal 2 weeks ago for the treatment of breast cancer. The client is scheduled to receive the influenza vaccine. The nurse should administer the vaccine t) The nurse should avoid administering injections into the upper extremities (ie, deltoid muscle) because of the client's increased risk for lymphedema.
=At a 90-degree angle into the ventrogluteal muscle Lymphedema (ie, accumulation of lymph fluid in the soft tissue) is a complication of a mastectomy with axillary lymph node removal. Measures for preventing lymphedema include avoidance of injections, blood pressure readings, and venipuncture in the affected arm to prevent tissue trauma and potential infection. Although the deltoid injection site is commonly used for vaccinations, the ventrogluteal site should be used for clients who have had a bilateral mastectomy with axillary lymph node removal.
The charge nurse observes a student nurse administering a tuberculin skin test using the intradermal route. Which action by the student nurse requires intervention and additional teaching from the charge nurse?
Advances tip of needle through epidermis until the bevel is no longer visible under the skin - Advance the tip of the needle through the epidermis into the dermis; the outline of the bevel should be visible under the skin. Verify that the medication will be injected into the dermis (Option 1). For TB skin testing, the nurse should use an appropriate 1-mL tuberculin syringe (ie, 25- to 27-gauge, ¼- to ⅝-inch), administer the injection into the forearm at 5-15 degrees with the bevel up, make a wheal/bleb on the skin, and avoid rubbing the site after the injection.
Anticoagulant injections
Anticoagulant injections should be administered in the abdominal subcutaneous tissue at a 45- to 90-degree angle. A 45-degree angle is used for clients with minimal adipose tissue to avoid accidental intramuscular injection, which would cause rapid absorption and result in hematoma and painful muscle irritation.
The nurse should teach a client receiving a clonidine patch to:
Apply patch to a dry hairless area on the upper arm or chest Wash hands before and after application Rotate sites with each new patch application Discard patch away from children or pets with sticky sides folded together Never wear more than 1 patch at a time Never stop using the patch abruptly
Potassium chloride is currently infusing. The area surrounding the IV site is taut, edematous, blanched, and cool to the touch. Small, fluid-filled vesicles are noted around the IV site. Capillary refill distal to the IV site is >3 seconds. Client is grimacing. Client is unable to verbally report pain. Extravasation occurs when a tissue-damaging medication (ie, vesicant) leaks outside the vessel and into surrounding tissues.
Appropriate: Elevate the affected extremity, Discontinue the potassium chloride infusion, Aspirate the potassium chloride from the IV catheter, Leave the IV catheter in place for potential antidote administration - If extravasation is suspected, appropriate interventions include: - Elevating the affected extremity above the heart to reduce swelling - Immediately discontinuing the infusion to minimize tissue damage - Leaving the IV catheter in place to aspirate the medication and potentially administer an antidote - Notifying the health care provider - Initiating new IV access in the unaffected extremity - Administering pain medication Inappropriate: Apply pressure to the affected area - because this may cause the vesicant to spread, leading to increased tissue damage.
The nurse is teaching a client to self-administer enoxaparin subcutaneously for the outpatient treatment of deep-vein thrombosis (DVT). The client points to the site of planned injection. Which site indicates that the client understands the instructions?
Enoxaparin is a low-molecular-weight heparin used in the prevention and treatment of DVT. It is administered as a deep subcutaneous injection and is usually given in the abdomen. Clients or family members may be taught how to administer the injections. The injection should be made on the right or left side of the abdomen, at least 2 in from the umbilicus. An inch of skin should be pinched up and the injection made into the fold of skin with the needle inserted at a 90-degree angle.
