Medication Administration
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| What are the six 'rights' you must verify before drug administration? | Right Client. Right Medication. Right Time. Right Route. Right Dose. Right Documentation.
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| Prior to administering medication to a client, a nurse must: | *Obtain report on client. *Verify physician's orders. *Check for a presence of allergies.
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| What is the 3-way check? | *Ask client's full name. *Check the client's identification bracelet/armband. *Ask for date of birth or SSN.
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| You perform the 3-way check on the medication against what when preparing medication for administration? | medication administration record (MAR)
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| What the nurse must know for every drug prior to administration: | Generic/trade name. Classification. Expected action. Reason client is taking the medication. Dosage range. Contraindications to administration. Possible side effects. Any special precautions. (Critical Nursing Implications.)
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| Within what range of the scheduled time should medications be administered? | Medications should be administered within 30 minutes before or after the scheduled time.
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| Can you have another nurse prepare your patients medicine for you prior to you administering it? | No. Never give any medication that you have not prepared yourself.
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| When can you touch capsules or tablets with your bare hands? | Hands should never touch capsules or tablets.
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| What is the Safest and most economical route of medication? | Enteral.
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| Technical term for topical medications | Percutaneous.
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| Routes of instillation medications | Sublingual, Buccal, Eyes (ophthalmic), Ears (otic), nasal.
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| This form of instillation medication route is used when fast acting medications are indicated. | Sublingual.
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| This form of instillation medication route is used for irrigation to remove foreign bodies, pupil dilation and administering of antibiotics. | Ophthalmic.
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| This form of instillation medication route is used for irrigation to remove foreign bodies and to soften cerumen for removal and administer antibiotics. | Otic.
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| This form of instillation medication route is used to shrink the mucosa or administer antibiotics. | Nasal.
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| How easy is the drug dosage to establish via the inhalation route? | Not at all, It is very difficult to establish.
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| What medication route is used when digestive juices would counteract the effects of the drug? | Parenteral.
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| Which method of medication administration provides the fastest action? | Parenteral.
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| After admistering oral medication, how do you verify the patient taking it? | Remain in the room until the client swallows the medication.
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| When is the administration of liquid medication contraindicated? | Liquid medications may not be given to unconscious client related to the possibility of aspiration.
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| How and where should liquid medication be measured? | Graduated medicine cup on a flat surface at eye level while pouring and reading dosage.
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| Where specifically should the volume be read in the graduated cup? | Read amount at the bottom of the meniscus (curve formed by liquid's upper surface).
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| What are used to administer medications to clients who are unconscious, dysphasic and too ill to eat. | NG tubes.
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| If not in liquid form, how will medications be delivered via NG tube? | Tablets will need to be crushed. Capsules will need to be opened. -->Call pharmacist prior to crushing any tablet or opening any capsule.<--
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| How should the opened contents of a capsule or crushed tablet be prepared prior to administration via NG tube? | Mixed in 30 ml of water .
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| What position should the patient be in when being administered oral medications? | Sitting up if possible.
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| What position should the patient be in when being administered NG medications? | Place client in high fowler's position and place towel over chest to protect clothing and bedding.
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| PRIOR to NG medication being administered, what should be done with the tube? | Flush tube with 30 to 50 ml of water.
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| AFTER NG medication is administered, what should be done with the tube? | Follow medication with 30 to 50 ml of water to flush the medication into the stomach.
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| How should medication be poured into the NG tube? | Through an attached syringe with the plunger removed.
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| Where should suppositories be stored? | In the refrigerator.
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| How should the suppository be transported to the client? | In a medicine cup.
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| What should be done with the tapered end of the suppository for patient comfort? | Apply lubricant such as KY jelly to tapered end of suppository.
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| How far should suppository be inserted? | Beyond the internal anal sphincter.
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| Medications are contraindicated for clients who are vomiting or comatose via which route? | Oral.
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| One of your client's medications is in a liquid form. You pour the medication with the container at eye level and read the meniscus at what point? | Low part of the curve.
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| Never apply a topical medication without doing what first? | Protecting your own skin.
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| True or False: After applying topical medication to the client, you can reinsert your gloved hand into the container to retrieve more medication to apply to the client. | False. Do not "double dip". Gloves and applicators that come in contact with the client should not be reinserted into the container.
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| Assessments should be done before or after applying topical drugs? | Perform any assessments BEFORE administering the drug (I.e. apical heart rate).
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| What should be done after administration of EVERY medication? | Document and return to assess the clients response to the medication (further documentation may be applicable).
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| True or False: Eyedrops are sterile. | True.
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| How should the patient be positioned for administration of ophthalmic medication? | Position back of client's head on a pillow. Direct client's face upward toward ceiling.
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| What should be done to the eye prior to drops being administered? | Remove exudates.
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| What should be administered first if both need to be administered, Eye drops or ointments? | Eye drops.
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| How will containers of solutions to be used as eardrops be labeled? | "Otic"
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| What temperature must eardrops be in order to be administered? | Room temperature.
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| What should be done to the ear prior to the administration of ear drops (otic medication)? | Removal of external exudates from the ear.
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| How are ear drops (otic medications) administered to adults and children of 3+ years of age? | 1)Turn head with affected side up. 2)Pull earlobe UPWARD and back to straighten external auditory canal. 3)Give drops without touching ear with dropper.
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| How are ear drops (otic medications) administered to adults and children of less than 3 years? | 1)Turn head with affected side up. 2)Pull earlobe DOWNWARD and back. 3)Instill drops without touching ear with dropper.
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| What should be done with the nose prior to medication administration? | Ask client to remove accumulations by blowing gently into a tissue.
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| How should patient be positioned for administration of nasal drops? | Position client lying down, handing head backward over edge of bed or with pillow under shoulders to hyperextend the neck if client can tolerate it.
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| How should the inhaler be positioned if a aerochamber is not being used? | Open lips and place inhaler 0.5 to 1 inch from mouth with opening toward back of throat.
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| True or False: Lips and teeth can touch the inhaler. | False.
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| True or False: Lips and teeth can touch the aerochamber attached to the inhaler. | True. Proper usage of the aerochamber requires it to be grasped in the lips and teeth after exhalation.
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| How long should the client hold their breath after inhaling from the inhaler? | Approximately 10 seconds.
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| How long should an adequate inhalation from the inhaler take? | 2-3 seconds.
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| How long will the client have to wait between puffs on the inhaler? | 1 minute between puffs.
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| If more than one type of inhaled medication is prescribed, how long must the client wait between usage of each? | 5 to 10 minutes between inhalations or as ordered by physician.
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| What may the client experience with use of an inhaled medication? | the client may feel gagging sensation in throat caused by droplets of medication on pharynx or tongue.
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| How much fluid does a tuberculin syringe hold? | 1ml
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| What is a tuberculin syringe used for? | Giving small doses of epinephrine, intradermal skin tests and subcutaneous medications.
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| Prior to administration of a dose of insulin, what must be done? | All insulin doses should be checked with another nurse prior to administration. Both nurses must document that the insulin dose was checked.
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| What is used for most intramuscular injections. | 3ml syringes.
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| What is the name for the opening at the needle's beveled tip. | Lumen
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| Length of intradermal needles | 3/8 - 5/8 inch.
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| Length of subcutaneous needles | 5/8 - 1/2 inch.
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| Length of insulin needles | 1/2 - 5/16 inch.
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| Length of intramuscular needles | 1 - 1 1/2 inch.
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| After a possible exposure to tuberculosis, a 25 year old health worker receives a TB skin test. The skin test will be given by what type of injection? | Intradermal.
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| Determining factors of site selection for IM medications. | *Type of medication to be administered. *Size of the individual's muscle mass. *The integrity of the individual's tissue.
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| What is the most fully developed muscle in newborns. | Vastus Lateralis.
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| What large, developed muscle site lacks major nerves and blood vessels | Vastus Lateralis.
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| Which muscle has less chance of contamination in incontinent clients or infants after administration of IM medications. | Ventrogluteal.
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| Which IM site has a risk of risk of striking the sciatic nerve, greater trochanter, or major blood vessel. | Dorsogluteal.
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| How much medication can be administered to the deltoid? | 2 ml or less.
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| What age groups is the deltoid site contraindicated in? | Generally the deltoid is too small in children and older adults.
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| True or False: You can use any type of needle for ampule medications. | False. Use a filtered needle to aspirate medication from the ampule due to possible glass shards in the medication.
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| True or False: You can place two medications in the same syringe. | True. First you must check compatibility of the drugs by calling pharmacy.
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| What gauge of needle is generally used for IM injections? | 20-22 gauge.
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| When is the Z-track IM injection method used? | Used for injecting medications that is irritating to the tissues. Seals the medication deep within muscle tissue. It prevents staining or tracking of medication into tissue as the needle is withdrawn.
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| How should the medication be drawn using the Z-track method? | Use one needle to withdraw dose from container. Use another needle to inject medication so that no solution remains on the outside needle shaft.
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| What volume of medication is administered via the intradermal route? | Small volumes of 0.1 ml or less are given via this route.
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| What gauge of needle is used for intradermal medication administration? | 25 gauge that is 3/8 to 5/8 inch long.
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| At what angle should a intradermal needle be inserted? | Insert needle at approximately a 15 degree angle.
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| What Injections are made into the loose connective tissue between the dermis and the muscle layer? | Subcutaneous
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| What volume of medication is administered subcutaneously? | No more than 1ml.
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| What gauge nedle is used for subcutaneous injections? | 25 Gauge needle, length of 1/2 to 5/8 inch.
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| At what angle will the needle be inserted in subcutaneous injections? | Insert needle at 45 to 90 degree angle.
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| Which IM site is a patient most at risk for obtaining an injury, if incorrect technique is used is: ______________. | Dorsogluteal.
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| Why must air be injected into vial prior to removal of desired medication amount? | To prevent the development of a vacuum.
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| True or False: The LPN can administer medication via IV push. | False. Must be done by RN.
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| How often do saline locks need to be flushed? | Must be flushed with 3 ml of saline before and after use and/or every shift to ensure patency.
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| What is a PCA pump? | Patient Controlled Analgesia pump
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| How is the PCA pump verified? | Two RNs must verify the PCA pump settings against the order.
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| Effective and efficient method for administration of analgesic medications. | PCA pump
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| Parenteral nutrition is also known as _________ | Hyperalimentation.
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| Who is Total Parenteral Nutrition indicated for? | Indicated for clients with nonfunctioning or dysfunctions GI tracts.
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| What is Total Perenteral Nutrition composed of? | Glucose, amino acids, vitamins, minerals, and electrolytes
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| How often should Total Perenteral Nutrition be assessed? | Every 4 hours
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| What can result from a too rapid Total Perenteral Nutrition infusion? | Hyperglycemia or intolerance to TPN
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| How will the nurse assess the Total Perenteral Nutrition intervention? | monitor q4 hrs for redness, swelling, or drainage from site. Blood glucose: every 6-8 hours. Report abnormal values immediately. Vital signs: every 4-8 hours. Abnormal vital signs may indicate complications.
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| Why is a large vein with rapid blood flow needed for the infusion of TPN? | To dilute the solution rapidly.
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| What are some adverse reactions of TPN the nurse must check for? | Signs of systemic infections Signs of fluid overload Allergic reactions
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| What are signs of fluid overload? | Anxiousness, dyspnea, weak and rapid pulse.
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| Improper IM site selection can result in | *Damaged nerves *Abscesses *Necrosis *Sloughing of skin *Lingering pain *Periostitis: Inflammation of the lining covering the bone
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| What IM site should you NOT use with infants or children under age of 3 years old due to underdeveloped muscle | Dorsogluteal
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| What is the prefered IM site for children under 3 yrs of age? | Vastus Lateralis
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