NURSING SCR 110 medication Questions and Answers
1. The nurse teaches a patient about taking a sublingual nitroglycerin tablet. The nurse evaluates that
... [Show More] the patient understands the teaching when the patient states, “I should place it:
On my skin.”
Inside my cheek.”
Under my tongue.”
In the lower lid of my eye.”
2. The nurse plans to administer a bolus dose of a medication via a currently running intravenous infusion. The nurse should first:
Ensure that it is compatible with the IV solution being infused
Pinch the tubing above the infusion port while instilling the bolus
Instill it into a fifty mL bag of NS and infuse it via a secondary line
Administer it via a volume-control infusion set with micro drip tubing
3. The physician orders a rectal suppository for an adult patient. When administering the rectal suppository, the nurse should: 1. Lubricate the medication before insertion
Warm the medication to body temperature
Insert the medication at least two inches into the rectum
Place the patient in the prone position to administer the medication
4. The nurse is administering an intradermal injection. The nurse
inserts the needle at a:
15-degree angle
30-degree angle
45-degree angle
90-degree angle
The nurse plans to administer a 3-mL intramuscular injection. The nurse understands that the least desirable muscle for the administration of this medication is the:
Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis
6. The nurse is preparing to administer a subcutaneous injection of insulin. The nurse knows that the best site to use to promote its absorption is the patient’s:
Upper lateral arms
Anterior thighs
Upper chest 4. Abdomen
7. When placing a cream into a patient’s vaginal canal, the nurse should use:
A finger
A gauze pad
An applicator
An irrigation kit
8. The physician orders a medication that must be administered transdermally. The nurse understands that a drug administered transdermal is:
Inhaled into the respiratory tract
Dissolved under the tongue
Absorbed through the skin
Inserted into the rectum
9. The nurse is to administer an injection. To limit discomfort, the nurse should:
Test for a blood return before injecting the medication
Apply ice to the area before the injection
Pinch the area while inserting the needle
Inject the medication slowly
10. The nurse is preparing to draw up medication from a vial. What should the nurse do first?
Ensure that the needle is firmly attached to the syringe
Rub vigorously back and forth over the rubber cap with an alcohol swab
Inject air into the vial with the needle bevel below the surface of the medication
Draw up slightly more air than the volume of medication to be withdrawn from the vial
11. The instructions with a medication states to use the Z-track technique when administering the injection. Therefore, the nurse should:
Pinch the site throughout the injection
Massage the site after the needle is removed
Remove the needle immediately after the medication is injected
Change the needle after the medication is drawn into the syringe
12. The nurse instructs a patient to close his/her eyes after the administration of eye drops. The nurse understands that this is done to:
Limit corneal irritation
Squeeze excess medication from the eyes 3. Disperse the medication over the eyeballs
4. Prevent medication from entering the lacrimal duct
13. Which route is unrelated to the parenteral administration of medications? 1. Buccal
Z-track
Intravenous
Intradermal
14. How often should “Colace 100 mg b.i.d.” be given?
Three times a day
Two times a day
Every other day
At bedtime
15. The nurse must administer an intradermal injection. The technique uniquely related to the administration of an intradermal injection is:
Utilizing the air-bubble technique
Pinching the skin during needle insertion 3. Inserting the needle with the bevel upward
4. Massaging the area after the fluid is instilled
16. The nurse is preparing to reconstitute a medication in a multiple-dose vial. The
nurse understands that the most essential step in the preparation of this medication is:
Instilling an accurate amount of diluent into the vial
Using a filtered needle when drawing up the medication from the vial
Instilling air into the vial before withdrawing the reconstituted solution
Wiping the rubber seal of the vial with alcohol before and after each needle insertion
17. Which characteristic of a subcutaneous injection of 5000 units of heparin should be implemented by the nurse?
3-mL syringe
22-gauge needle
90° angle of insertion
1½-inch needle length
18. The nurse understands that a contraindication for the intake of medications via the oral route is:
Difficulty swallowing
Gastric suctioning 3. Unconsciousness
4. Nausea
19. The nurse teaches the spouse of a patient how to insert a rectal suppository. The nurse identifies that further teaching is necessary when the spouse:
Lubricates the tip of the suppository
Wears a glove when inserting the suppository
Places the suppository two inches into the rectum
Inserts the suppository while the patient bears down
20. The physician orders a medication that must be administered via the intramuscular route. When administering this medication, the nurse knows that the site that has the highest risk for injury is the:
Vastus lateralis
Rectus femoris
Ventrogluteal 4. Dorsogluteal
21. It is most important for the nurse to use a filtered needle when preparing a parenteral medication that:
1. Has to be reconstituted 2. Is supplied in an ampule
Appears cloudy in the vial
Is to be mixed with another medication
22. When administering a subcutaneous injection, the nurse should use a:
5-mL syringe
25-gauge needle
Tuberculin syringe
1½-inch long needle
23. The physician orders nose drops to be administered twice a day. When instilling the drops, the nurse should:
Place the patient in the supine position with the head tilted backward
Pinch the nares of the nose together briefly after the drops are instilled
Instruct the patient to blow the nose 5 minutes after the drops are instilled
Insert the drop applicator 1/8 inch into the nose toward the base of the nasal cavity
24. When the nurse brings pills to a patient, the patient is unable to hold the paper cup with the medications. The nurse should:
Crush the pills and mix it with applesauce
Have the physician order the liquid form of the drug
Use the paper cup to introduce the pills into the patient’s mouth
Put the pills into the patient’s hand and have the patient self-administer the pills
25. The nurse teaches a patient how to self-administer a steroid via a metered dose inhaler with an extender. The nurse identifies that the teaching is understood when the patient:
Rinses the mouth with water after the treatment
Position the mouthpiece one inch in front of the mouth while inhaling
Rolls the canister between the hands slowly before using the inhaler
Assumes the semi-Fowler’s position with the head supported on a pillow
26. The nurse understands that an inappropriate route for a topical medication is:
Intradermal
Bladder
Rectum
Vagina
27. The nurse adds a medication to an intravenous fluid bag. Which nursing action is the priority?
Attaching a completed IV additive label to the bag
Mixing the medication and solution by rotating the bag
Maintaining sterile technique throughout the procedure
Ensuring that the drug and the IV solution are compatible
28. The nurse holds a bottle with the label next to the palm of the hand when pouring a liquid medication. The nurse does this to:
Conceal the label from the curiosity of others
Prevent the soiling of the label by spilled liquid
Ensure the accuracy of the measurement of the dose
Guarantee the label is read before pouring the liquid
29. The nurse understands that the route of drug administration not considered parenteral is:
Epidural
Transdermal
Subcutaneous
Intramuscular
30. The physician orders a medicated powder to be applied to a patient’s skin.
When applying a medicated powder, it is most essential that the nurse:
Applies a thin layer in the direction of hair growth
Protects the patient’s face with a towel
Dresses the area with dry sterile gauze 4. Ensures that the skin surface is dry
31. The nurse must administer a medication that is supplied in an ampule. What should the nurse do first to access the ampule?
Inject the same amount of air as the fluid to be removed
Wipe the constricted neck with an alcohol swab
Break the constricted neck using a barrier
Insert the needle into the rubber seal
32. The nurse must administer a medication into the ear of an adult. To limit patient discomfort when administering ear drops, the nurse should: 1. Warm the solution to body temperature
Place the patient in a comfortable position
Pull the pinna of the ear upward and backward
Instill the fluid in the center of the auditory canal
33. The nurse instructs a patient to inhale deeply and hold each breath for a second when using a hand-held nebulizer. The nurse provides this instruction because this action will:
Prolong the treatment
Limit hyperventilation 3. Disperse the medication
4. Prevent bronchial spasms
34. Which abbreviation indicates to the nurse that the physician wants a medication administered at bedtime?
1. p.c. 2. h.s.
p.o.
a.c.
35. When administering a suppository, the nurse understands that it is absorbed in the:
Ear
Nose
Mouth 4. Rectum
36. The home care nurse is helping a patient with short-term memory loss how to remember to take multiple drugs throughout the day. The nurse should:
Instruct the patient to put medications in a weekly organizational pill container
Design a chart of the medications the patient takes each day during the week
Ask a family member to call the patient when medications are to be taken
Suggest that the patient wear a watch with an alarm
37. The nurse is to administer an eye irrigation to a patient’s right eye. What should the nurse do?
Direct the flow of solution from the inner to the outer canthus
Irrigate with an asepto syringe two inches from the eye
Don sterile gloves before beginning the procedure
Position the patient in a right lateral position
38. A medication is delivered by the Z-track method when the nurse:
Uses a special syringe designed for Z- track injections
Pulls laterally and downward on the skin before inserting the needle
Administers the injection in the muscle on the anterior lateral aspect of the thigh
Injects the needle in a separate spot for each dose on a Z-shaped grid on the abdomen
39. The nurse must reconstitute a powdered medication. The nurse should:
Keep the needle below the initial fluid level as the rest of the fluid is injected
Instill the solvent that is consistent with the manufacturer’s directions
Score the neck of the ampule before breaking it
Shake the vial to dissolve the powder
40. The nurse is preparing to administer a tablet to a patient. The nurse should remove the p.o. medication from its unit dose package:
1. Outside the door to the patient’s room 2. At the patient’s bedside
In the medication room
At the medication cart
41. When administering an analgesic, which nursing action is most appropriate?
Follow written orders exactly for the first 24 hours
Reassess the patient every 8 hours for drug effectiveness
Ask the physician to include a medication order for breakthrough pain
Seek a new order after two doses that do not achieve a tolerable level of relief
42. The physician orders a troche. The nurse should administer it by placing it in the patient’s:
Ear
Eye
Mouth
Rectum
43. A patient has an order for 2 puffs of a bronchodilator via a metered-dose inhaler. The nurse should teach the patient to:
Start breathing in while compressing the canister
Hold the inspired breath for several seconds
Deliver 2 puffs with each inspiration
Inhale slowly for 8–10 seconds
44. The nurse is to administer an intramuscular injection. Check all that apply to this procedure.
Use a 1-inch needle
Use a 25-gauge needle
Insert the needle at a 45angle 4. Aspirate before instilling the medication
5. Massage the insertion site after needle removal
45. The physician orders 18 units of Novolog R and 26 units of Novolog N to be given at 0730 AM in the same syringe. Indicate on the syringe, by shading in the appropriate area, how many total units of Novolog N and Novolog R are to be drawn into the syringe. 44 UNITS
Study guide questions:
Which of the following is the name assigned to a drug by the manufacturer that first develops it?
Trade name
Official name
Chemical name d. Generic name
Most drugs are excreted through which of the following organs?
Kidneys
Lungs
Intestines
Skin
Which of the following acts designated the United States Pharmacopeia and the National Formulary as official standards of drugs and empowered the federal government to enforce these standards?
Federal Food, Drug, and Cosmetic Act
Food and Drug Administration c. Pure Food and Drug Act
d. Comprehensive Drug Abuse Prevention and Control Act
Which of the following statements about patient medications is accurate?
Safe practice dictates that a nurse follows written or verbal orders.
In most settings, student nurses are permitted to accept verbal orders from a physician.
When a patient is admitted to a hospital, all drugs that the physician may have ordered while the patient was at home are continued.
Upon admittance to a hospital, all patient medications from home should be sent home with the family or placed in safekeeping.
Which of the following types of medication orders would a physician prescribe for “as needed” pain medication?
Standing order b. PRN order
c. Single order
d. Stat order
A nurse suspects a drug he/she administered to a patient is in error. Who is legally responsible for the error?
Nurse
Physician
Hospital
Pharmacist
Which of the following measurement systems use a grain as the basic unit of weight?
Metric
Apothecary
Household
Decimal
If a nurse is preparing medication for a patient and is called away to an emergency, which of the following should he/she do?
Have another nurse guard the preparations.
Put the medications back in the containers.
Have another nurse finish preparing and administering the medications.
Lock the medications in a room and finish them when he/she returns.
Before administering a drug to a patient, the nurse should identify the patient by doing which of the following?
Call the patient by name.
Check the patient’s ID bracelet.
Check the patient’s record.
Check the patient’s name with family or significant others.
Which means of drug administration would be used in an emergency to achieve rapid absorption and quicker results?
Injection
Oral
Patch
Inhalation
Which of the following sites is recommended for adults as a safe site for the majority of intramuscular injections?
Vastus lateralis site
Deltoid muscle site c. Ventrogluteal site
d. Dorsogluteal site
Mrs. Harris is a 78-year-old woman admitted to your unit after experiencing symptoms of stroke. When administering the medication prescribed for her, the nurse should be aware that this patient has an increased possibility of drug toxicity due to which of the following age-related factors?
Decreased adipose tissue and increased total body fluid in proportion to total body mass
Increased number of protein-binding sites
Increased kidney function, resulting in excessive filtration and excretion
To convert 0.8 grams to milligrams, the nurse should do which of the following?
a. Move the decimal point 2 places to the right. b. Move the decimal point 3 places to the right.
c. Move the decimal point 2 places to the left.
d. Move the decimal point 3 places to the left.
Mr. Downs is given a dose of gentamicin and has an immediate reaction of hypotension, bronchospasms, and rapid, thready pulse. Which of the following would be the drugs of choice for this situation?
Antibiotic, antihistamines, and Isuprel
Bronchodilators, antihistamines, and vasodilators
Epinephrine, antihistamines, and bronchodilators
Antihistamines, vasodilators, and bronchoconstrictors
Mrs. Banks has an order for Chloromycetin, 500 mg every 6 hours. The drug comes in 250-mg capsules. Which of the following would be the correct dosage?
a. 1 tab b. 2 tabs
c. 3 tabs
d. 4 tabs
An oral medication has been ordered for Mr. Moran, who has a nasogastric tube in place. Which of the following nursing activities would increase the safety of medication administration?
Check the tube placement before administration.
Have Mr. Moran swallow the pills around the tube.
Flush the tube with 30 to 40 mL saline before medication administration.
Bring the liquids to room temperature before administration.
When giving an intramuscular injection using the Z-track technique, the nurse should use which of the following techniques?
Use a needle at least 1 inch long.
Apply pressure to the injection site.
Inject the medication quickly, and steadily withdraw the needle.
Do not massage the site because it may cause irritation.
Which of the following statements accurately describe the influence of specific factors on the absorption of a drug? (Select all that apply.)
Injected medications are usually absorbed
more rapidly than oral medications.
Liquid preparations have to be dissolved in the gastrointestinal fluids.
The unionized form of drugs is absorbed more readily.
Acidic drugs are well absorbed in the stomach.
Food in the stomach always delays the absorption of medications.
A trough level is the point when a drug is at its highest concentration.
Which of the following statements accurately describe an adverse drug effect? (Select all that apply.)
A drug allergy is always manifested immediately after the patient receives the medication.
An anaphylactic reaction is a life- threatening immediate reaction to a drug that results in respiratory distress, sudden severe bronchospasm, and cardiovascular collapse.
Drug tolerance occurs when the body cannot metabolize one dose of a drug before another dose is administered.
A cumulative effect occurs when the body becomes accustomed to a particular drug over a period of time.
An idiosyncratic effect is any abnormal or peculiar response to a drug that may manifest itself by over response, under
response, or a response different from the expected outcome.
An antagonistic effect occurs when the combined effect of two or more drugs acting simultaneously produces an effect that is less than that of each drug alone.
Which of the following is a type of order that a physician might write? (Select all that apply.)
a. A standing order to be carried out as specified until canceled by another order b. A prn order for pain medication
A single order to be carried out only once at a specified time
A stat order to be carried out at a predetermined later date
A double order to increase the dosage of the medication being administered
A floating order to administer medication as needed
Which of the following factors should a nurse consider when administering medications to an older adult? (Select all that apply.)
An increased number of protein-binding sites
An increased difficulty with the penetration of fat-soluble drugs
Altered peripheral venous tone d. A decline in liver function
e. A decline in enzyme production needed for drug metabolism
f. An increased gastric emptying time
Which of the following actions would a nurse be expected to perform when instilling eyedrops correctly? (Select all that apply.)
Wash hands and put on gloves.
Clean the eyelids and eyelashes of any drainage with cotton balls soaked in clean water.
Tilt the patient’s head back slightly if sitting or place the head on a pillow if lying down.
Have the patient look up and focus on something on the ceiling.
Place the thumb near the margin of the lower eyelid and exert pressure upward over the bony prominence of the cheek.
Squeeze the container and allow the prescribed number of drops to fall into the cornea.
Which of the following actions would a nurse be expected to perform when instilling eardrops correctly? (Select all that apply.)
a. Make sure the solution to be instilled is at room temperature.
Place the patient on the affected side in bed.
Draw up the amount of solution needed in the dropper and return any excess medication to the stock bottle.
Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back in an adult and down and back in an infant or child under 3 years.
Hold the dropper in the ear with its tip above the auditory canal.
Which of the following actions would a nurse be expected to perform when administering a subcutaneous injection correctly? (Select all that apply.)
If using the outer aspect of the upper arm, place the patient’s arm over the chest with the outer area exposed.
Remove the needle cap with the dominant hand, pulling it straight off.
Grasp and bunch the area surrounding the injection site or spread the skin at the site.
Inject the needle quickly at an angle of 45 to 90 degrees.
If blood appears when aspirating, withdraw the needle and reinject it at another site.
After removing the needle, massage the area gently with the alcohol swab unless it is a subcutaneous heparin or insulin injection site.
Which of the following are components of a medication order? (Select all that apply.)
The full name of the patient
The date and sometimes the time when the order is written
Preferably the brand name of the drug to be administered
The dosage of the drug, stated in either the apothecary or metric system
The route by which the drug is to be administered, only if there is more than one route possible
The signature of the nurse carrying out the order
ANSWER KEY: 1. d 2.a 3. c 4. d 5. b
6. a 7. b 8. d 9. b 10. a 11. c
12. d 13. b 14. c 15. b 16. a 17. d
18. a, c, d 19. b, e, f 20. a, b, c
21. d, e 22. a, c, d 23. b, e, f
c, d, f
a, b, d
A nurse administers a dose of an oral medication for hypertension to a patient who immediately vomits after swallowing the pill. What would be the appropriate initial action of the nurse in this situation?
Readminister the medication and notify the primary care provider.
Readminister the pill in a liquid form if possible.
d. Notify the primary care provider.
A nurse is administering phenytoin via a gastric tube to a patient who is receiving tube feedings. What would be an appropriate action of the nurse in this situation?
time before and after medication administration.
Notify the primary care provider that medication cannot be given to the patient at this time via the gastric tube.
Remove the tube in place and replace it with another tube prior to administering the medication.
Flush the tube with 60 mL of water prior to administering the medication.
A nurse who is administering medications to patients in an acute care setting studies the pharmacokinetics of the drugs being administered. Which statements accurately describe these mechanisms of action? Select all that apply.
Distribution occurs after a drug has been absorbed into the bloodstream and is made available to body fluids and tissues.
Metabolism is the process by which a drug is transferred from its site of entry into the body to the bloodstream.
Absorption is the change of a drug from its original form to a new form, usually occurring in the liver.
During first-pass effect, drugs move from the intestinal lumen to the liver by way of the portal vein instead of going into the system’s circulation.
The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug absorption.
Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body.
A nurse who gives subcutaneous and intramuscular injections to patients in a hospital setting attempts to reduce discomfort for the patients receiving the injections. Which technique is recommended?
The nurse selects a needle of the largest gauge that is appropriate for the site and solution to be injected.
The nurse injects the medication into contracted muscles to reduce pressure and discomfort at the site.
leakage of medication into the needle track.
d. The nurse applies vigorous pressure in a circular motion after the injection to distribute the medication to the intended site.
A medication order reads: “K-Dur, 20 mEq po BID.” When and how does the nurse correctly give this drug?
Daily at bedtime by subcutaneous route
Every other day by mouth
Twice a day by the oral route
Once a week by transdermal patch
A nurse is preparing medications for patients in the ICU. The nurse is aware that there are patient variables that may affect the absorption of these medications. Which statements accurately describe these variables? Select all that apply.
Patients in certain ethnic groups obtain therapeutic responses at lower doses or higher doses than those usually prescribed.
Some people experience the same response with a placebo as with the active drug used in studies.
People with liver disease metabolize drugs more quickly than people with normal liver functioning.
A patient who receives a pain medication in a noisy environment may not receive full benefit from the medication’s effects.
Oral medications should not be given with food as the food may delay the absorption of the medications.
Circadian rhythms and cycles may influence drug action.
A health care provider orders a pain medication for a postoperative patient that is a PRN order. When would the nurse administer this medication?
a. A single dose during the postoperative period b. Doses administered as needed for pain relief
One dose administered immediately
Doses routinely administered as a standing order
A nurse is administering a pain medication to a patient. In addition to checking his identification bracelet, the nurse correctly verifies the patient’s identity by performing which action?
Asking the patient his name and birthdate
Reading the patient’s name on the sign over the bed
Asking the patient’s roommate to verify his name
Asking, “Are you Mr. Brown?”
The nurse is administering a medication to a patient via an enteral feeding tube. Which are accurate guidelines related to this procedure? Select all that apply.
Crush the enteric-coated pill for mixing in a liquid.
Flush open the tube with 60 mL of very warm water.
Use the recommended procedure for checking tube placement in the stomach or intestine.
Give each medication separately and flush with water between each drug.
Lower the head of the bed to prevent reflux.
Adjust the amount of water used if patient’s fluid intake is restricted.
A medication order reads: “Hydromorphone, 2 mg IV every 3 to 4 hours PRN pain.” The prefilled cartridge is available with a label reading “Hydromorphone 2 mg/1 mL.” The cartridge contains 1.2 mL of hydromorphone. What should the nurse do?
Give all the medication in the cartridge because it expanded when it was mixed and this is what the pharmacy sent.
Call the pharmacy and request the proper dose.
Refuse to give the medication and document refusal in the EHR.
Dispose of 0.2 mL before administering the drug; verify the waste with another nurse.
A patient requires 40 units of NPH insulin and 10 units of regular insulin daily subcutaneously. What is the correct sequence when mixing insulins?
Inject air into the regular insulin vial and withdraw 10 units; then, using the same syringe, inject air into the NPH vial and withdraw 40 units of NPH insulin.
Inject air into the NPH insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the regular insulin vial and withdraw 10 units; then, withdraw 40 units of NPH insulin.
Inject air into the regular insulin vial, being careful not to allow the solution to touch the needle; next, inject air into the NPH insulin vial and withdraw 40 units; then, withdraw 10 units of regular insulin.
Inject air into the NPH insulin vial and withdraw 40 units; then, using the same syringe, inject air into the regular insulin vial and withdraw 10 units of regular insulin.
Ms. Hall has an order for hydromorphone, 2 mg, intravenously, q 4 hours PRN pain. The nurse notes that according to Ms. Hall’s chart, she is allergic to hydromorphone. The order for medication was signed by Dr. Long. What would be the correct procedure for the nurse to follow in this situation?
Administer the medication; the doctor is responsible for medication administration.
Call Dr. Long and ask that the medication be changed.
Ask the supervisor to administer the medication.
Ask the pharmacist to provide a medication to take the place of hydromorphone.
A nurse is administering heparin subcutaneously to a patient. What is the correct technique for this procedure?
Aspirate before giving and gently massage after the injection.
Do not aspirate; massage the site for 1 minute.
d. Massage the site of the injection; aspiration is not necessary but will do no harm.
A nurse discovers that a medication error occurred. What should be the nurse’s first response?
Record the error on the medication sheet.
Notify the physician regarding course of action.
d. Complete an incident report, explaining how the mistake was made.
A nurse is teaching a patient how to use a meter-dosed inhaler to control asthma. What are appropriate guidelines for this procedure? Select all that apply.
spacer.
Take shallow breaths when breathing through the spacer.
Depress the canister releasing one puff into the spacer and inhale slowly and deeply.
After inhaling, exhale quickly through pursed lips.
Wait 1 to 5 minutes as prescribed before administering the next puff.
Gargle and rinse with saltwater after using the MDI.
ANSWERS WITH RATIONALES
c. If a patient vomits immediately after swallowing an oral pill, the nurse should assess the vomit for the pill or fragments of it. The nurse should then notify the primary care provider to see if another dosage should be administered.
a. If the patient is receiving tube feedings, the nurse should review information about the drugs to be administered. Absorption of some drugs, such as phenytoin, is affected by tube-feeding formulas. The nurse should discontinue a continuous tube feeding and leave the tube clamped for the required period of time before and after the medication has been given, according to the reference and facility protocol.
a, d, f. Distribution occurs after a drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues. Some drugs move from the intestinal lumen to the liver by way of the portal vein and do not go directly into the systemic circulation following oral absorption. This is
called the first-pass effect, or hepatic first pass. Excretion is the process of removing a drug or its metabolites (products of metabolism) from the body. Absorption is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Metabolism, or biotransformation, is the change of a drug from its original form to a new form. The liver is the primary site for drug metabolism. The gastrointestinal tract, as well as sweat, salivary, and mammary glands, are routes of drug excretion.
c. The nurse should use the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort. The nurse should select a needle of the smallest gauge that is appropriate for the site and solution to be injected, and select the correct needle length. The nurse should also inject the medication into relaxed muscles since there is more pressure and discomfort if medication is injected into contracted muscles. The nurse should apply gentle pressure after injection, unless this technique is contraindicated.
c. The abbreviation BID refers to twice-a-day administration; “po” (by mouth) refers to administration by the oral route.
a, b, d, f. Nurses need to know about medications that may produce varied responses in patients from different ethnic groups. The patient’s expectations of the medication may affect the response to the medication, for example, when a placebo is given and a patient has a therapeutic effect. The patient’s environment may also influence the patient’s response to medications, for example, sensory deprivation and overload may affect drug responses. Circadian rhythms and cycles may also influence drug action. The liver is the primary organ for drug breakdown, thus pathologic conditions that involve the liver may slow metabolism and alter the dosage of the drug needed to reach a therapeutic level. The presence of food in the stomach can delay the absorption of orally administered medications. Alternately, some medications should be given with food to prevent gastric irritation, and the nurse should consider this when establishing a patient’s medication schedule. Other medications may have enhanced absorption if taken with certain foods.
b. When the prescriber writes a PRN order (“as needed”) for medication, the patient receives medication when it is requested or required. With a single or one-time order, the directive is carried out only once, at a time specified by the prescriber. A stat order is a single order carried out immediately. A standing order (or routine order) is carried out as specified until it is canceled by another order.
a. The nurse should ask the patient to state his name and birthdate based on facility policy. A sign over the patient’s bed may not always be current. The roommate is an unsafe source of information. The patient may not hear his name but may reply in the affirmative anyway (e.g., a person with a hearing deficit).
c, d, f. The nurse should use the recommended procedure for checking tube placement prior to administering medications. The nurse should also give each medication separately and flush with water between each drug and adjust the amount of water used if fluids are restricted. Enteric-coated medications should not be crushed, the tube should be flushed with 15 to 30 mL of water, and the head of the bed should be elevated to prevent reflux.
d. Many cartridges are overfilled, and some of the medication needs to be discarded. Always check the volume needed to provide the correct dose with the volume in the syringe. Giving the excess medication in the cartridge may result in adverse effects for the patient. For this dose, it is not necessary to call the pharmacy or refuse to give the medication, provided the order is written correctly. Wasting narcotics typically requires a second RN to witness the waste and verify the amount of narcotic discarded.
b. Regular or short-acting insulin (unmodified insulin) should never be contaminated with NPH or any insulin modified with added protein. Placing air in the NPH vial first without allowing the needle to contact the solution ensures that the regular insulin will not be contaminated.
b. The nurse is responsible for any medications given and must inform the doctor of the patient’s allergy to the drug. The nurse should not give the medication and might speak with the supervisor only if uncomfortable with the health care provider’s answer when notified. The nurse is legally unable to order a replacement medication, as is the pharmacist.
c. When giving heparin subcutaneously, the nurse should not aspirate or massage, so as not to cause trauma or bleeding in the tissues.
c. The nurse’s first responsibility is the patient—careful observation is necessary to assess for any effect of the medication error. The other nursing actions are pertinent, but only after checking the patient’s welfare.
a, c, e. The correct procedure for using a meter-dosed inhaler is: Shake the inhaler well and remove the mouthpiece cover; breathe normally through the spacer; depress the canister releasing one puff into the spacer and inhale slowly and deeply; after inhaling, hold breath for 5 to 10 seconds, or as long as possible, and then exhale slowly through
pursed lips; wait 1 to 5 minutes as prescribed before administering the next puff; and gargle and rinse with tap water after using the MDI. [Show Less]