Chapter 32: Medication Administration Flashcards

Question

25. The nurse prepares a pain injection for a patient but had to check on another patient and asks a new nurse to give the medication. Which action by the new nurse is best? a. Do not give the medication. b. Administer the medication just this once. c. Give the medication for any pain score greater than 8. d. Avoid the issue and pretend to not hear the request.

Answer 1

ANS: A Because the nurse who administers the medication is responsible for any errors related to it, nurses administer only the medications they prepare. You cannot delegate preparation of medication to another person and then administer the medication to the patient. The right medication cannot be verified by the new nurse; do not violate the six rights. Do not administer the medication even one time. Do not administer the medication regardless of the pain rating. Avoiding the issue is not appropriate or safe.

Answer 2

ANS: B Aspiration occurs when food, fluid, or medication intended for GI administration inadvertently enters the respiratory tract. To minimize aspiration risk, allow the patient, if capable, to self-administer medication. Patients should also hold their own cup to control how quickly they take in fluid. Some patients at risk for aspiration may require thickened liquids; thinning liquids does not decrease aspiration risk. Patients at risk for aspiration should not be given straws because use of a straw decreases the control the patient has over volume intake. Turning the head toward the weaker side helps the medication move down the stronger side of the esophagus.

Answer 3

ANS: D The first response is to explore reasons the patient does not want the medication. After the assessment, the nurse can decide what to do next. Educating is important, but it is not the first action. Ultimately, the patient does have the right to refuse the medication; however, the nurse should first try to find out reasons for the refusal and provide education if needed based upon the assessment findings. Hiding medication and deceiving a patient into taking a medication is unethical and violates right to autonomy.

Answer 4

ANS: A Six weeks will be about the time the inhaler will need to be refilled. The inhaler should last the patient 50 days (2 puffs × 2/twice daily = 4; 200/4 = 50); the nurse should advise the patient to refill the prescription when there are 7 to 10 days of medication remaining. Refilling it as soon as the patient leaves the hospital or when the inhaler is half empty is too early. If the patient waits 50 days, the patient will run out of medication before it can be refilled.

Answer 5

ANS: D The only insulin that can be given IV is regular. NPH cannot be given IV and must be stopped. All the rest demonstrate correct practice. Insulin is supposed to be rolled, not shaken. Glargine is supposed to be given by itself; it cannot be mixed with another medication. Correction insulin, also known as sliding-scale insulin, provides a dose of insulin based on the patient’s blood glucose level. The term correction insulin is preferred because it indicates that small doses of rapid- or short-acting insulins are needed to correct a patient’s elevated blood sugar.

Answer 6

ANS: D The 72 year old seeing four different providers is likely to experience polypharmacy. Polypharmacy places the patient at risk for unintended mixing of medications that potentiate each other. When two medications have a synergistic effect, their combined effect is greater than the effect of the medications when given separately. The child taking too much of a medication by mistake could experience overdose or toxicity. The 50 year old is prescribed two different blood pressure medications for their synergistic effect, but this is a desired, intended event. A patient taking meth and mixing chemicals can be toxic.

Answer 7

ANS: B A spacer is indicated for a patient who has difficulty coordinating the steps, like patients with limited mobility/coordination. An alert adolescent with a repaired cleft palate would not need a spacer. Hearing impairment may make teaching the patient to use the inhaler difficult, but it does not indicate the need for a spacer. Although a patient with left-sided hemiparesis could have coordination problems, a patient using a dry powder inhaler does not require the use of spacers.

Answer 8

ANS: D The dosage range is 200 to 400 mg a day (5 × 40 = 200 and 10 × 40 = 400). The prescribed dose is 100 mg/day (4 × 25 = 100), which is below therapeutic range. The nurse should notify the health care provider first and ask for clarification on the order. The dose is not above the therapeutic range and is not at a toxic level. The nurse should never alter an order without the prescriber’s approval and consent.

Answer 9

ANS: C The supervising nurse must intervene with the nurse who is drawing up the NPH insulin first; if regular and intermediate-acting (NPH) insulin is ordered, prepare the regular insulin first to prevent the regular insulin from becoming contaminated with the intermediate-acting insulin. All the other actions are appropriate and do not need follow-up. The CDC no longer recommends aspiration when administering immunizations to reduce discomfort. In some cases, especially with a smaller gauge (22) IV needle, blood return is not aspirated, even if the IV is patent. If the IV site shows no signs of infiltration and IV fluid is infusing without difficulty, proceed with IV push slowly. Oral meds are contraindicated in patients with nasogastric suction.

Answer 10

ANS: A The patient has phlebitis; the initial nursing action is do not administer the medication. The medication should not be given slowly. A cool or warm compress may be used later depending upon protocol, but it is not the first action.

Answer 11

ANS: A When an error occurs, the patient’s safety and well-being are the top priorities. You first assess and examine the patient’s condition and notify the health care provider of the incident as soon as possible. The nurse’s first priority is to establish the safety of the patient by assessing the patient. Second, notify the charge nurse and the health care provider. Administer antidote if required. Finally, the nurse needs to complete proper documentation.

Answer 12

ANS: B The nurse should ask the patient to verify identity and should check the patient’s ID bracelet against the medication record to ensure right patient. Acceptable patient identifiers include the patient’s name, an identification number assigned by a health care facility, or a telephone number. Do not use the patient’s room number as an identifier. To identify a patient correctly in an acute care setting, compare the patient identifiers on the MAR with the patient’s identification bracelet while at the patient’s bedside. Right medication, right dose, and right route are equally as important, but in this situation, right patient is the priority (two patients with the same last name).

Answer 13

ANS: B The nurse should use knowledge about the medication to educate the patient about potential response to medications. Then the medication schedule can be altered based on that knowledge. It is the patient’s right to refuse medication; however, the nurse should educate the patient on the importance and effects of the medication. Asking a patient to fit a schedule around a medication is unreasonable and will decrease compliance. The nurse should be supportive and should offer solutions to manage medication effects.

Answer 14

ANS: C When preparing medication from a vial, the steps are as follows: Firmly and briskly wipe the surface of the rubber seal with an alcohol swab and allow to dry; pull back on the plunger to draw an amount of air into the syringe equal to the volume of medication to be aspirated from the vial; inject air into the airspace of the vial; invert the vial while keeping firm hold on the syringe and plunger; fill the syringe with medication; and tap the side of the syringe barrel carefully to dislodge any air bubbles.

Answer 15

ANS: B Children often have difficulties taking medication, but it can be less traumatic for the child if the parent administers the medication and the nurse supervises. Another nurse should help restrain a child if needed; the parent acts as a comforter, not a restrainer. Holding down the child is not the best option because it may further upset the child. Never administer an oral medication to a sleeping child. Don’t mix medications into the child’s favorite foods, because the child might start to refuse the food.

Answer 16

ANS: C The ventrogluteal site is the preferred and safest site for all adults, children, and infants. While the vastus lateralis is a large muscle that could be used it is not the preferred and safest. The dorsal gluteal site is a location for a subcutaneous injection, and this patient requires an IM injection. The deltoid is easily accessible, but this muscle is not well developed and is not the preferred site.

Answer 17

ANS: D When preparing and administering IV piggybacks, use the following steps: Compare the label of medication with the medication administration record at the patient’s bedside; connect the infusion tubing to the medication bag; hang the piggyback medication bag above the level of the primary fluid bag; clean the main IV line port with an antiseptic swab; connect the tubing of the piggyback infusion to the appropriate connector on the upper Y-port; and regulate flow.

Answer 18

ANS: B Placing medications that require preadministration assessment in a separate cup serves as a reminder to check before the medication is given, making it easier for the nurse to withhold medication if necessary. Medications should not be removed from their package until they are in the patient’s room because this makes identification of the pill easier and reduces contamination. When measuring a liquid, the nurse should use the meniscus level to measure; make sure it is at eye level on a hard surface like a countertop. Enteric coated medications should not be crushed.

Answer 19

ANS: B Before going to the patient’s room, compare the patient’s name and name of medication on the label of prepared drugs with MAR for the second accuracy check. Selecting the correct medication from the stock supply, unit-dose drawer, or automated dispensing system (ADS) is the first check. The third accuracy check is comparing names of medications on labels with MAR at the patient’s bedside. Checking the orders is not one of the three accuracy checks but should be done if there is any confusion about an order.

Answer 20

ANS: A Give time-critical scheduled medications (e.g., antibiotics, anticoagulants, insulin, anticonvulsants, and immunosuppressive agents) at the exact time ordered (within 30 minutes before or after scheduled dose). Give non–time critical scheduled medications within a range of either 1 or 2 hours of scheduled dose. 1100, 1130, and 1200 are too late.

Answer 21

ANS: A If the patient uses a corticosteroid, have him or her rinse the mouth out with water or salt water or brush teeth after inhalation to reduce risk of fungal infection. Piercing a blood vessel during a subcutaneous injection is very rare. Therefore, aspiration is not necessary when administering subcutaneous injections. When giving immunizations to adults: to avoid injection into subcutaneous tissue, spread the skin of the selected vaccine administration site taut between the thumb and forefinger, isolating the muscle. Never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions.

Answer 22

ANS: C, D, E Needles should not be forced into the box. Clearly mark receptacles to warn of danger. Using needleless systems when possible will further reduce the risk of needlestick injury. To prevent the risk of needlesticks, the nurse should never recap needles. The syringe and sheath are disposed of together in a receptacle.

Answer 23

ANS: A, D, E When IV medication is incompatible with IV fluids, stop the IV fluids, clamp the IV line above the injection site, flush with 10 mL of normal saline or sterile water, give the IV bolus over the appropriate amount of time, flush with another 10 mL of normal saline or sterile water at the same rate as the medication was administered, and restart the IV fluids at the prescribed rate. Do not administer the drug slowly with the IV; this is contraindicated when incompatibility exist. Not giving the medication and charting is inappropriate; this is not a prudent or safe action by the nurse.

Answer 24

ANS: 3.3 The nurse should calculate the dosage taken via the first medication and add it to the daily intake of the second medication. Then, convert milligrams to grams. 500 mg × 6 doses a day = 3000 mg/day + (2 tablets × 325 mg) × 2 doses a day = 1300 mg/day = 3300 mg/day total of acetaminophen; 3300 mg converted to grams = 3.3 grams.

Answer 25

ANS: 1.25 The nurse needs to first determine how many milligrams are in each milliliter of the elixir. Then the nurse calculates how many milliliters would contain 250 mg. 1000 mg/5 mL = 200 mg/1 mL 250 mg/(X mL) = 200 mg/mL = 1.25 mL. OR Dose ordered over dose on hand (250/1000) × volume or amount on hand (5). 250/1000 = 0.25 × 5 = 1.25 mL.

Answer 26

ANS: 10 The drug is dispensed at 250 mg/5 mL. The nurse is to give 500 mg, which is 10 mL. OR Dose ordered over dose on hand (500/250) × volume or amount on hand (5). 500/250 × 5 = 10 mL

Chapter 32: Medication Administration Flashcards

(50 cards)