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Med Admin P&P
Potter and Perry 7th Edition Chapter 35
| Question | Answer |
|---|---|
| Pharmacokinetics is? | The study of drug concentrations, how medications enter the body, reach their site, metabolize, and exit the body. |
| 1st American law to regulate medications? | Pure Food and Drug Act of 1906. |
| Who enforces medication laws? | Food and Drug Administration (FDA) |
| What is the government program that encourages health care workers to report harmful medications? | MedWatch which is located on the FDA website. |
| Who regulates alcohol and tobacco use? | Local government. |
| Nurse Practice Acts (NPAs) are what? | Laws defining the scope of a nurse's professional functions and responsibilities. |
| Primary intent of NPAs is what? | Protect the public from unskilled, undereducated, and unlicensed personnel. |
| Controlled substances are called? | Narcotics. |
| How many drug names do medications usually have? | 3 |
| What are the 3 names of medications? | Chemical name, Generic/common name, Trade/Brand name. |
| What is a common mistake amongs med admin involving drug names? | Similarities in names causing mix ups. |
| Medication classification indicates what? | Effect of medication on the body system. |
| Absorption refers to what? | Passage of meds into the blood stream from the site of admin. |
| Is med admin to the skin fast or slow? | Slow. |
| Is med admin to the mucous membranes fast or slow? | Fast. |
| Is oral med admin fast or slow? | Slow. |
| What is defined by administered to "mucous membranes"? | Membranes of mouth, eyes, nose, rectally. |
| Is IV med admin fast or slow? | FASTEST route of admin. |
| What determines the speed of a route of admin? | How long it takes for medication to reach the blood supply from the admin. |
| What is absorbed faster liquid/solutions or tablets? | Liquids. |
| Acidic medications pass through the gastric mucosa fast or slow? | Fast. |
| Basic medications are absorbed where? | Small intestine. |
| Does large surface area of admin increase or decrease speed of absorption? | Increases. |
| Would an oil based medication be absorbed easier or more difficult? | Easier based on lipid solubility across lipid based cell membranes. |
| Oral medications taken with food is good idea or bad? | Bad, some food alter the medication causing slow absorption. |
| What factors affect a drug once it is absorbed and on its way to destination site? | Circulation, membrane permeability, protein binding. |
| Why would heart failure influence a medication? | Poor circulation caused poor absorption. |
| Blood-brain barrier only lets WHICH type of medications to pass? | Fat-soluble. |
| What type of barrier does the placenta have and why is this important? | Nonselective; any and all medications can pass through the barrier and cause fetal defects. |
| How does albumin affect medication effects? | Most medications bind to albumin to an extent, binded medications are "not active" and do not cause pharmacological activity. |
| Metabolism of medication includes what? | Biotransformation: detoxify, degrade, and remove biologically active chemicals. |
| Most biotransformation occurs where? | Liver. |
| Where are meds metabolized other than the liver? | Lungs, kidneys, blood, and intestines. |
| Why can an average sedative dose cause a liver disease patient to lapse into a coma? | Decreased liver function means that the med is not being filtered out of the blood as much as normal, therefore more time for it to be absorbed. |
| Medications are excreted from which organs? | Kidneys, liver, bowels, lungs, and exocrine glands. |
| What determines where it is excreted? | Chemical makeup. |
| Where would gaseous/volatile compounds be excreted? | Lungs. |
| Lipid-soluble medications are excreted from where? | Exocrine glands. |
| If meds are degraded by the liver, where are they excreted? | In bile. |
| What does slow peristalsis do to medication? | Prolong its effects. |
| What is the main source of medication excretion? | Kidneys. |
| What is a therapeutic effect? | Intended effect. |
| What are side effects? | Predictable and often unavoidable secondary effects. |
| What are adverse effects? | Unintended, undesirable, and often unpredictable effects. |
| What is an idiosyncratic reaction? | Over/under reaction to a med. |
| Toxic effects would happen because what? | Impaired metabolism or excretion of med. |
| Allergic reactions happen when? | Client becomes immunologically sensitized to the med. |
| What has a high incidence of allergic reactions? | Antibiotics. |
| Anaphylactic reactions are characterized by? | bronchiolar constriction, edema of the pharynx and larynx, wheezing, shortness of breath. |
| Medication interaction is what? | When one medication modifies another. |
| Synergistic effect is what? | Combined effect of the 2 medications is greater than if they were separate. |
| What is an example of synergistic effect? | Alcohol's effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics. |
| What is the goal when a med is prescribed at a specific time/rate? | Constant blood levels within safe ranges. |
| When is the highest serum concentration? | Just before body absorbs the last of the medication. |
| When is the lowest serum concentration? | 30 mins before administering the drug. |
| What is the highest serum concentration called? | Peak. |
| What is the lowest serum concentration called? | Trough. |
| What is a serum half-life? | Time it takes for half of the dose of medication to be lowered via excretion. |
| Pain meds are most effective when admin when? | Around the clock. |
| What is the easiest med route? | Oral. |
| What is med admin under the tongue called? | Sublingual. |
| What is a very common sublingual route medication? | Nitroglycerin for heart attacks. |
| How would something be admin via buccal mucosa? | Placed next to inside of cheek and allowed to dissolve. |
| What are the 4 major Parenteral admin routes? | Intradermal, Subcutaneous, Intramuscular, Intravenous. |
| What are some other more advanced Parenteral admin routes? | Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial. |
| Where is an epidural placed? | Epidural space of the spinal column. |
| Where is an intrathecal placed? | Subarachnoid space or one of the ventricles of the brain. |
| Where is an intraosseous placed? | Infusion directly into bone marrow. |
| Where is intraperitoneal placed? | Peritoneal cavity of the abd. |
| Where is the intrapleural placed? | Pleural space in the chest. |
| Where is the intraarterial placed? | Arteries, usually for clots. |
| Transdermal disks have localized effects as well as? | Systemic effects. |
| What does "instillation" mean? | Fluid is retained. |
| Inhalation route is a quick way to admin drugs because? | The deeper passages of the resp system provide for large surface area that is highly vascular. |
| What is the most common intraoccular medication used to treat? | Glaucoma. |
| Why is the metric system used for medical dosages? | Easy to convert, units organized into factors of 10. |
| Which zero should you always have, and which should you never have in a med calculation? | Never = trailing, Always = leading. |
| What is the disadvantage of household measurements? | Inaccuracy |
| What are some examples of household measurements? | Cup, tablespoons, teaspoons, quarts, gallons. |
| What is a solution? | Mass of solid substance (solute) is dissolved in a liquid (solvent) |
| How are solutions represented? | Percentages or proportions |
| What is the smallest amount a tablet can be admin? | 1/2 |
| What is the smallest amount a capsule can be admin? | 1 |
| How many people should check a dosage calc before admin certain drugs such as insulin or heparin? | 2 |
| Why are premature and newborns at risk for adverse drug reactions? | Immature liver and kidneys. |
| What should be taken into consideration when calc child's dosages? | Age, weight, body surface area, hydration status. |
| What formulas are used to calc a child's body surface area ? | Mosterller's formula or nomogram. |
| Who is accountable for admin a dose to a client? | Nurse. |
| When a verbal order is given, what must ALWAYS be done? | Repeat it back. |
| What are 5 common orders in acute care? | Standing, prn, Single, STAT, Now. |
| What is a prn order? | As needed. |
| What is a STAT order? | Immediately. |
| What is a Now order? | Within the next 90mins. |
| When a med admin error occurs, what is 1st priority? | Stabilize patient. |
| When should an incidence report be filed? | Within 24 hrs. |
| Can you look in a patient's medical record to find old incidence reports? | No, they are not permanent. |
| What is medication reconciliation? | Checking medications taken prior to this time with the meds currently being admin. |
| What happens if a patient does not have enough potassium (K) in their bodies, what is it called? | Muscle fatigue, weakness, dysrhythmias; hypokalemia. |
| What are the 6 rights of med admin? | Medication, dose, client, route, time, documentation. |
| How do you ensure right medication? | Compare prescriber's written orders with the medication administration record. |
| What do you use to prepare and admin a med? | MAR |
| How many times do you check label of a med? | 3 |
| How many patient identifiers do you use each time a procedure/med is admin? | 2 |
| Who can prepare a medication that you are going to admin? | Licensed pharmacist only. |
| What should be done if a client refuses narcotics? | Dose should be destroyed while another staff member witnesses. |
| Why should the client's fav food/drink not be used to admin foods? | It alters the taste making the client not want it anymore. |
| Who is this "fav food" policy most immportant for? | Children and cancer patients. |
| What is an order does not have a specific route? | Consult the prescriber. |
| Why is the right time important? | It may conflict with the client's schedule and the nurse should know why this time in case it may be possible to change the time. |
| Why is the right documentation important? | If incorrectly documented, the next nurse will not know that this was an error. |
| What should be documented? | Name of med, dose, time, route, site, client's responses. |
| Who has the right to refuse medication? | Anyone 18 y/o or older and an emancipated minor. |
| Who should not receive propofol and why? | It contains egg lecithin and soybean oil, so anyone with these allergies should not take. |
| What should be provided first the proper med admin technique or the treatment for overdose? | Treatment of "overdose" and sign/symps should be taught 1st. |
| What is polypharmacy? | More than one med is taken to treat the same illness, usually because the client is being treated for several individual symptoms. |
| What are the 2 types of polypharmacy? | Rational and irrational. |
| What is the difference between rational and irrational polypharmacy? | Rational when the meds are necessary, irrational is when the meds are not necessary. |
| What is the most common measurements for a nurse to make to test the effectiveness of the NI? | Physiological such as BP, Heart rate, Visual acuity... easy to check and monitor. |
| How much fluid should oral admins be taken with? | 60-100 mL of fluid if allowed. |
| What is a possible side-effect of over use of nasal spray? | Rebound effect. |
| Why is epinephrine applied to nares during a nose bleed? | It reduces blood flow. |
| What part of the eye has many nerve fibers and should be avoided? | Cornea. |
| What would happen is ear drops are admin at anything other than room temp? | Vertigo, dizziness, or nausea. |
| When placing ear drops how must the canal be straightened? | Adult: pulled up and out. Young Child: Down and back |
| Where are suppositories stored and why? | Refrigerator, they will melt at higher temperatures. |
| Where should rectal suppositories be placed? | Against the rectal mucosa. |
| Where is the effect of Metered-dose inhalers and dry powder inhalers? | Locally, bronchodilation. |
| How are insulin syringes calibrated? | In units instead of mL or both. |
| What ranges are needles' lengths? | 1/4 - 3 inches. |
| As the gauge becomes smaller, the diameter of a needle becomes? | Larger. |
| Why are some medications dry and must be reconstituted? | They are unstable for long term storage as liquids. |
| When mixing insulin doses, which vial do you inject air in 1st? | Cloudy. |
| What is the order to mix insulin doses? | Air cloudy, air clear, aspirate clear, aspirate cloudy. |
| When preparing insulin, what is the difference between "R" and "NPR"? | R= regular fast acting insulin NPR= intermediate acting insulin. |
| Can NPR be given via IV? | No, only regular. |
| Why is the cloudy NPR solution aspirated last? | To prevent the clear, fast acting insulin from being mixed with the slower acting NPR. |
| Where is subQ placed? | Connective/fatty tissue; outer posterior of arms, abd, anterior aspects of thighs. |
| When injecting the abd, how far away from the umbilicus should it be? | 2 inches minimum. |
| What is the maximum sized dose for subQ? | 1 mL water soluble med. |
| What are the subQ insertion angles? | If you can pinch 2in of skin, 90 deg... if pinch 1in of skin, 45 deg. |
| Where are IM placed? | Deep muscle tissue. |
| What is the max IM admin? | 3 mL, 2 mL for children, older adults, and thin people, 1 mL for infants. |
| What angle is IM inserted? | 90 deg. |
| What are some IM sites? | Ventrogluteal, vastus lateralis, deltoid. |
| Which IM site should no longer be used? | Dorsogluteal. |
| What is different about a Z-track method? | The skin is pulled taut, injected, released. This makes it difficult for the fluid to return up the injection track. |
| What angle are intradermals? | 5-15 degs. |
| What is the only approved re-capping method? | 1 handed. |
| What are 2 commonly added to IV fluids? | Vitamins and Potassium chloride. |
| What is another name for an intravenous bolus? | IV Push. |
| Which bag should be placed higher primary or piggy back? | Piggy back. |
| Which should be higher if there is a tandem bag being used? | Same height. |
| What is another name for an intermittent venous access? | Heparin/saline lock. |
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