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Pharm test 10/2/13

Test Mod A

MAR Medication Administration Record
PRN when needed/as needed
Safe Administration 1. Wash hands 2. Check MAR 3. New Order 4. Check allergies 5. One patient at a time 6. Check SEVEN rights
Seven Rights of Medication Administration Drug, Dose, Document, Route, Reason, Patient, Time
Enteral Medications oral, sublingual, buccal, NG, G-tube, rectal
Parenteral Medications IV, subcut, IM, intradermal
Topical Medications eye, ear, nose, inhaled, meds to skin, vaginal
Considerations when administering a medication -proper timing -proper administration: with/without food -NPO or testing -LOC/swallowing ability -current health status -storage considerations -troubleshooting -right to refuse
NPO nothing by mouth
Intravenous directly into the blood stream
Intramuscular directly into the muscle tissue
High Alert Medications medications & classifications that pose significant risk in the acute clinical setting
Consent form grants permission to the health care facility and provider to provide treatment
Order form all procedures & treatments ordered by a physician. Includes: general care, tests, results, etc.
Graphic record the manual recording of temperature, pulse, respiration, blood pressure and pain
Kardex Records large index type card that is usually kept in a flip file/separate folder that contains pertinent information (e.g.: name, dx, allergies, history, and nursing care plan)
Narcotic control systems policy that controlled substances are issued in a single-unit package and kept in a lock cabinet
Unit-dose use single-unit packages of drugs that are dispensed to fill each dose requirement as it is ordered
Prescription must contain -patient's full name -date -drug name -route of administration -dose -duration of order -signature of provider
Stat Order drug used on emergency level, be administered A.S.A.P. but only once
Single Order administration at a certain time, but only once
Standing Order a medication is to be given for a specified number of doses (e.g.: cefazolin 1q q6h x 4 doses)
Medication Errors the failure of a planned action to be completed as intended or the use of a wrong plan to achieve a goal
Adverse Drug Events serious complications from medication errors
Percutaneous Administration refers to the application of medications to the skin or mucous membrane
Parts of a syringe -Tip -Barrel -Plunger
Parts of a needle -Hub -Shaft -Bevel -Needle cover
Drug Routes IM - intramuscular IV - intravenous PO - by mouth SC - subcutaneous (subcut)
Nursing Responsibilites -know expected therapeutic effect -know nursing implications -educate patient: REPORTABLE signs and symptoms -7 rights (and allergies) -3 label check
Buccal (dissolvable) between the cheek and lower molar teeth: rapid absorption (no swallowing, chewing or water)
Sublingual (dissolvable) under the tongue: rapid absorption (no swallowing, chewing or water)
Ophthalmic medications for use in the EYES only
Otic medications for use in the EARS only
Nasal Solutions nose drops or sprays
Aerosols flow of air or oxygen under pressure to disperse the drug throughout the respiratory tract
Intravaginally administration of medications into the vagina
Douches irrigation fluid to wash the vagina
3 routes of drug administration Enteral Parenteral Percutaneous
Capsules small, cylindrical, gelatin containers that hold dry powder or liquid medicinal agents
Time-released capsules (sustained) provide a gradual, but continuous release of a drug because the granules in the capsule dissolve at different rates
Pills capsules/tablets
Tablets dried powdered drugs that have been compressed into small disks
Caplet tablet shaped in the form of a capsule
Orally disintegrating tablet tablet that rapidly dissolves, under tongue, buccal, or on top of the tongue
Elixirs clear liquids that are comprised of drugs that have been dissolved in alcohol and water
Emulsions dispersions of small droplets of water-in-oil or oil-in-water (gelatin)
Suspensions liquid dose forms that contain solid, insoluble drug particles dispersed in a liquid base
Syrups contain medical agents that have been dissolved in a concentrated solution of sugar
Unit-dose packaging single-use package that provides a single dose of medication in one packet that is ready for dispensing
Souffle' Cup small paper cup that is used to transport solid medication forms such as capsules and tablets to the patient to prevent contamination by handling
Medicine Cup plastic container for measuring liquids
Medicine dropper used to administer eye drops, ear drops, and occasionally pediatric medications
Teaspoon liquid medications: use Tsp. as unit of measure; 1 tsp. is converted to 5 mL
Oral syringe plastic syringe used to measure liquid medications accurately
Nipple nipple w/ holes to administer oral medications to infants
Nasogastric tube used to give patients who have impaired swallowing, are comatose, or esophagus disorders medications
Suppository solid form of medication that is designed for introduction into a body orifice
2 types of Syringe tips -Luer-Slip -Luer-Lok
Luer-Slip male tapered end
Luer-Lok a threaded locking collar
3 sizes of syringes 1 mL - 3 mL - 5 mL
millimeter scale represents the units whereby medications are routinely ordered
Tuberculin syringe 1 mL; measures small volumes of medications
Insulin syringe has a scale that has been specifically calibrated for the measurement of insulin
Insulin important facts -only use insulin syringe for insulin -U-100 concentration = 100 unites of insulin -U-40 concentration = 40 units of insulin
Prefilled cartridges/syringes already measured; time saver, diminishes contamination
Insulin Pen prefilled syringe; patient carries discreetly; for diabetic patients
Epi-Pen prefilled with epinephrine to use in an emergency for allergic reactions
Needle Gauge the diameter of the hole through the needle
Subcut 25-29 gauge; 3/8, 1/2, 5/8 in.
Adult IM 20-23 gauge; 1-1/2 in.
Child IM 21-25 gauge; based on patient
Intradermal (e.g. TB testing) 26-28 gauge; 1/4-1/2 in.
Safety devices sleeve that is stored around the syringe barrel while the syringe is being filled; then sleeve is pulled forward fully to lock the shield permanently in place to cover the needle
Ampules glass containers that usually contain a single dose of medication; never put air into Ampule; always use a filter
Vials glass/plastic containers that contain one or more doses of a sterile medication
Liquid syringe always BROWN in color
Intradermal injections that are made into the dermal layer of the skin just below the epidermis
Anergic Reaction no reaction to the allergens, especially to the positive control
Subcutaneous injections that are made into the loose connective tissue between the dermis and the muscular layer; slower absorption; longer drug action
Intramuscular injections that are made by penetrating a needle through the epidermis, dermis and the subcut tissue into the muscle layer; rapid absorption; 90 degree angle for injecting
Deltoid Muscle easy access to area when patient is standing, sitting, or prone position; 1 mL or less
Intravenous (IV) the introduction of fluids directly into the venous blood stream; most rapid; most comfortable for patient
Intravascular within the vascular system (arteries, veins, capillaries)
Intracellular within the cells
Interstitial within the spaces between the cells
Extracellular composed of the intravascular and interstitial compartments and it contains about 1/3 of the total body water
IV Administration set an apparatus that connects a large volume of parenteral solution w/ the IV access device in the patients vein
Macro-drip 10, 15, or 20 drops/mL
Micro-drip 60 drops/mL
Blood-drip 10 drops/mL
Intravenous IV Solutions consist of water that contains one or more types of dissolved particles
Phlebitis inflammation of a vein
Thrombophlebitis inflammation of a vein with the formation of a thrombus in the area of inflammation (redness, warmth, tenderness, swelling or burning)
Infiltration the leakage of an IV solution into the tissue that surrounds the vein
Extravasation the leakage of an irritant chemical (medication) into the tissue surrounding the vein
AIR BUBBLE IMPORTANCE If air bubble is found in the tubing, clamp tubing immediately, swab injection site, insert needleless device below the bubble and withdraw the air pocket
Air Embolism occurs as a result of an air bubble entering the cardiovascular system
Pulmonary Edema caused by infusing fluid too rapidly or by giving to much fluid
Pulmonary Embolism occurs as a result of foreign materials being injected into the vein or from a blood clot that breaks loose and travels to the lungs, where it lodges in the arterioles
Speed Shock occurs as a systemic reaction to a foreign substance that is given to rapidly into the bloodstream (rapid IV)
Medication Administration -time frame -check label 3 times -unwrap dose at bedside -correct route -contraindications: antacids -check ID and 2 other identifiers
Patient Assessment before medication if blood pressure medication - what is the blood pressure
Patient Education what does the patient need to know? allow for questions; maintain dignity/provide privacy/is pt. comfortable
Remember after administration -did patient swallow meds? -did you document? -reassess: did you see the desired effect? -document your reassessment
Do you administer another medication for another nurse????? NO NO and NO!!!!!!! "Do it yourself HOMIE!!!!! Not going to be my ASS!!!!"
Written orders order by a physician, dentist, nurse practitioner, or other designated health professional for a medication to be dispensed by a pharmacy for administration to a patient
Verbal Orders orders given verbally by a health care provider, must sign within 24 hours; risk for med error; in an emergency situation only
Phone Orders medication orders taken from a licensed health care provider over the phone, must sign within 24 hours; always repeat orders back to the physician for confirmation; risk for error
Liquid Medications shake, if required, remove cap and place upside down on clean surface, label against palm, hold med cup at eye level, check meniscus, pour excess in drain, wipe rim before replacing cap
Crushed medications -when and why? -pill crusher -mix in small amount of soft food after crushing -clean the equipment! -DO NOT crush enteric coated tabs or time release tabs -may open capsules and mix with soft food
Splitting/Cutting Tablets -ONLY split scored tablets -DO NOT split enteric-coated or timed released tablets -use a cutting device -line up score with blade cutter -DON'T touch med -discard the extra portion properly
Sublingual Meds -place med under patient's tongue -instruct patient not to chew or swallow -med should dissolve completely
Powdered Meds mix with appropriate amount of appropriate liquid at the bedside
Enteral Tube Administration must be liquid or suspension form; pills must be crushed into a fine powder
Parenteral Meds -7 rights -needle and syringe selection -prepare injection -change needle, if indicated -select site -inject
Ampules -medication should be in body of ampule -place an alcohol wipe in unopened package around neck -snap neck away from you -use filter needle to draw up med -may invert, but don't touch rim of ampule -aspirate med, remove air bubbles -recap and change
Vials -unused vial; remove cap -previously used vial; cleanse rubber seal w/ alcohol wipe; dry -draw up air equal to amount of med to be withdrawn and inject into vial -invert vial, aspirate correct amount of med -dislodge bubbles and eject from vial -remo
Viscosity of a medication very "thick" meds may be better tolerated in a larger muscle, or in smaller divided doses
Z-Track injections -used to prevent irritating or staining meds from leaking to skin or subcut tissues -apply downward pressure to skin -inject as usual; wait 10 seconds -when ready to withdraw needle, withdraw then release traction on skin
Electrolytes solutes that dissolve in water and dissociate into ion particles; because the ions give water the ability to conduct electricity
Isotonic Solution IV solution and the blood have approximately the same osmolatity; 270 - 310 mOsm/L; acute blood loss due to trauma
Hypotonic Solution solution that have fewer dissolved particles than the blood ˄310 mOsm/L (cellular dehydration)
Hypertonic Solution solution that have a higher concentration of dissolved particles ˅270 mOsm/L (severe low sodium)
Normal Saline 0.9% solution of sodium chloride; isotonic solution with an osmolality of 308 mOsm/L
Tandem, Piggyback, or IV rider intermittent infusion; secondary to a primary set-up; small volume of fluid infused over 20-60 minutes
Solutes for IV Solutions -sodium chloride -dextrose -potassium chloride
Comma placing for units no commas unless it has at least 5 numbers NO - 1,000 YES - 1000 YES - 15,000
Milliequivalent mEq
1 part drug to 1000 parts solution 1:100
1 part drug in 5 parts solution 1:5
IM intramuscular
IV intravenous
PO by mouth
SC subcutaneous (also SQ, subq) under the skin
AC before meals
PC after meals
Ad lib as desired
Bid twice daily
h hour
HS hours of sleep
qd every day
qh every hour
qid 4 times a day
qod every other day
STAT at once
tid three times a day
mL/hr ordered 500 mL in 6 hours 500mL _______ = 83.3 or 83 mL/hr 6
mL/24 hrs ordered 125 mL/hr 125 x 24 = 3000 mL in 24 hr
750 mL of saline to infuse over 8 hours. how many drops/min? (15 tubing) 750mL x 20 11,250 ____________ = _______ = 23.4 or 23 gtt/min 8 x 60 480
1000 mL to L 1 L (move decimal point 3 places to the right)
1 L to mL 1000 mL (move decimal point 3 places to the left)
five hundred milliliters 500 mL
two-tenths of a milligram 0.2 mg
two and five tenths kilograms 2.5 kg
sixty milliequivalents 60 mEq
tablets: ordered 50 mg available 25 mg 50/25 = 2 tabs
tablets: ordered 37.5 mg available 75 mg 37.5/75 = 0.5 tabs
tablets ordered 300 mg available 100 mg 300/100 = 3 tabs
tablets ordered 62.5 mcg available 0.25 mg (convert) 62.5/250 = 0.25 NO, cannot give a quarter of tablet, must call pharmacy!!!!!!!!!!!
IM ordered 15 mg available 2%, 20 mg/mL 2 mL vial 15mg/20mg = 0.75 mL or 0.8 mL remember to round to the tenths for tablets and IV's
IV 1000 mL saline in 6 hours and 1 L bag on hand, tubing 10, how many drops/min. 1000 mL x 10 10,000 ______________ = _______ = 27.7 gtt/min or 28 gtt/min 6 x 60 360 remember to circle or box your final answer!!!!!!!
IV 1000 mL saline in 6 hours and 1 L bag on hand, tubing 10, how many drops per hour? 1000 mL / 6 = 166.6 mL/hr or 167 mL/hr remember to circle or box your final answer!!!!!!!
3 teaspoons 1 tablespoon
2 tablespoons 1 ounce
8 ounces 1 glass
1000 mL 1 liter
1000 micrograms 1 milligram
1000 milligrams 1 gram
1000 grams 1 kilogram
5 mL 1 teaspoon
30 mL 1 ounce
2 tablespoons 1 ounce
1 quart 1 liter
2.2 lb 1 kg
2.54 cm 1 inch
tab tablet
syp syrup
NS (N/S) normal saline
Pharmacokinetics the study of four major processes; medication absorption, distribution, metabolism, and excretion
Absorption passage of medication molecules from the site of administration into the blood
Therapeutic Effect the intended or desired physiological response of a medication
Toxic Effects capable of causing injury/death; excess amounts of medication within the body
Idiosyncratic Reactions individual sensitivity to effects of a drug caused by inherited or other bodily constitution factions
Allergic Reactions unfavorable physiological response to an allergen to which a person has previously been exposed and to which the person has developed antibodies
Synergist effect their combined effect is greater than their effects when given separately
Half-life the time it takes for the body to lower the amount of unchanged medication by half (ex: 12-6-3)
Peak concentration is the highest plasma level
Trough concentration is the lowest plasma level
Transdermal disk/patch disk/patch firmly holds the medicated ointment to the skin (ex: nicotine patch)
Solution a given mass of solid substance dissolved in a known volume of fluid or a given volume of fluid dissolved in a known volume of another fluid
NOW orders must be given within 60 minutes
Polypharmacy a patient uses two or more medications to treat the same illness, takes two or more medications from the same chemical class
Anaphylactic Reactions hypersensitive condition induced by contact with certain antigens
Apothecary System System of measurement.
Biotransformation the chemical changes that a substance undergoes in the body, such as by the action of enzymes
Medication Interaction the response when one drug modifies the action of another drug
ASAP as soon as possible
gm gram
gtt drop
kg kilogram
oz ounce
q6h every 6 hours
Infusion slow and/or prolonged intravenous delivery of a drug or fluids
Created by: Smccunn



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