Medication Administration

Ethics

100

What are common effects of medication errors? Select All that apply. A ) Increase length of stay B) Increased cost C) Patient disability D) Death E ) Nurse’s personal and professional status, confidence, and practice

There are all affects of medication errors .

200

15. A 80-year-old female patient refuses to take a medication because she says it burns her stomach. The nurse has educated patient on why the medication is necessary but she still refuses, what is the best nurse response ? A. "You have to take the medications, the physician ordered them" B. "You can refuse any medication you want. Would you like to talk about why you don't want to take medications?" C. "Don't be difficult, these medications will help you" D. "Legally, you have to take these medications. Would you like to discuss your feelings?"

Answer : B Ethics- Nursing organizations have adapted similar codes of ethics that can serve as guides for the development of one's own code. The client's rights as defined by these codes of ethics are to promote health, prevent illness, restore health, and alleviate suffering. For example, a patient has every right to know necessary information about a drug he or she is receiving and to refuse to take it after having been given an explanation, no matter what the consequences of that decision may be for the patient.

300

The nurse is obligated to follow a physician’s order unless: A) The order is a verbal order B) The physicians order is illegible C ) The order has not been transcribed D ) The order is an error, violates hospital policy, or would be detrimental to the client

D) The nurse must be fully aware of the consequences and why the medication is being given to the patient.

400

Which of the following are responsibilities of a nurse ? Select all that apply. A ) Obtaining current knowledge base of drugs B ) Referring to authoritative sources in professional literature (less than 5yrs old) C) Questioning a drug order that is unclear or that appears to contain an error D) Refusing to administer a drug if there is a reason to believe it will be harmful. E) Performing correct techniques and precautions F ) Monitoring client response and documenting drug effects G )Patient and family education

All are responsibilities .

500

Name ALL of the Safe Medication Administration Rights

1. Right Drug - Check and verify if it’s the right name and form. . 2. Right Patient - Ask the name of the client and check his/her ID band before giving the medication. 3. Right Dose - Check the medication sheet and the doctor’s order before medicating. Be aware of the difference of an adult and a pediatric dose. 4. Right Route -Check the order if it’s oral, IV, SQ, IM, etc.. 5. Right Time and Frequency.- Check the order for when it would be given and when was the last time it was given. 6. Right Documentation - Make sure to right the time and any remarks on the chart correctly. 7. Right History/ Assessment - Secure a copy of the client’s history to drug interactions and allergies. 8. Right to Refuse - Give the client enough autonomy to refuse to the medication after thoroughly explaining the effects. 9. Right Evaluation - Review any medications previously given or the diet of the patient that can yield a bad interaction to the drug to be given. Check also the expiry date of the medication being given. 10. Right Education - Provide enough knowledge to the patient of what drug he/she would be taking and what are the expected therapeutic and side effects. Route Evaluation Documentation Dose Assessment Refuse Time Medication Education Patient

Ethics

100

What are the top (5) drugs involved in harmful errors?? Select all that apply. A )Paclitaxel B) Insulin C )?Narcotics D ) Caffeine E )Heparin??

B, C, E Potassium Insulin Narcotics Coumadin Heparin

200

Which of the following are factors that contribute to appropriate medication dosage? A ) age related factors (Ex: pediatric , geriatric ) B) inherited factors C ) Slow versus Fast Acetylators ?differences D) Genetic group differences?

There ALL factors : Age-related Factors: ?Pediatric : absorption, distribution, metabolism, excretion differences? - weight based dosing? Geriatric : decreased body fat, lean muscle, water? , decreased plasma proteins? - diminished GI motility and absorption? - slower liver and kidney function Inherited Factors: Slow versus Fast Acetylators ?differences in metabolism of drugs?(IE: Asian Americans need lower doses of the antiaxiety drug Haldol) Known Genetic group differences?(IE: African Americans respond better to CCB drugs for hypertension)

300

What are drug information recourses Nurse can use ? Select all that apply. A ) Agency pharmacists are an appropriate resource for obtaining drug information on the job.  B ) Nursing drug handbooks: contain drug information along with nursing considerations. C ) Physician's Desk Reference (PDR) Contains manufacturer's descriptions (package inserts) which are written using FDA standards, but may be slanted in favor of the drug being described. D ) Package Inserts: Required by law for insertion with each new drug and must include a description, indications, precautions, dosage, and contraindications. E ) Electronic databases and Internet

They are all good sources nurse can use.

400

Which of the following is NOT a correct example? Select all that apply. Schedule I: lowest potential for abuse? (OTC cough suppressant w/codeine) Schedule II: (Morphine, Dilaudid) Schedule III: (Vicodin, Meperidine) Schedule IV: (Valium, Xanax) Schedule V: highest potential for abuse? Illicit drugs (Heroin, LSD, Marijuana)

Schedule 1 and 5 are incorrect. I (highest potential for abuse ) heroin, LSD, pot II morphine, cocaine, diaudid III steroids, codeine, vicodin, meperidine IV Valium, Xanax V ( lowest potential for abuse) OTC, cough medicines with codeine * ME= medication error ADR = adverse drug reactions ( allergic, idiosyncratic ) ADE = adverse drug events ( failure to administer, wrong dosage ) MAR = Medication Administration Records

500

Which of the following is correct regarding the Controlled Substance Act? Select all that apply. A ) Designed to promote treatment and prevention of drug dependence B) Prescribers are registered with the DEA. A registry number is issued to each person and is renewed annually. C) Complete written records of all drugs prescribed must be kept for two years. D ) Pharmacists record each sale in triplicate. Schedule I drug prescriptions cannot be renewed. E) DEA (Drug Enforcement Agency) monitoring Health care agencies must establish policies to comply with Federal law. F) All units have a record of every controlled drug on the unit and one nurses at the change of every shift count all drugs. G) All controlled drugs are stored using a double lock system. Keys to medication areas are under the control of nurses on the unit. H ) Discarding of controlled substances must be witnessed by another health care professional such as an LPN I ) Written renewal orders are required every 48 hours for narcotics and schedule II & III drugs.

A, B, C ,E ,G are correct D , F,H, I are INCORRECT Pharmacists record each sale in triplicate. Schedule (II) drug prescriptions cannot be renewed. All units have a record of every controlled drug on the unit and TWO nurses at the change of every shift count all drugs. Discarding of controlled substances must be witnessed by another NURSE Written renewal orders are required every (78) hours for narcotics and schedule II & III drugs.

Medical Administration

100

A drug has three different names Chemical ( Identifies drug’s atomic and molecular structure) , Generic ( Assigned by manufacturer that first developed the drug) , and Trade ( Brand name) . True or False . .

True . Nurses need to know Generic and Trade, but Generic Name is most commonly used in hospitals. EX: furosemide - Lasix acetaminophen - Tylenol bupropion- Wellbutrin

200

Drugs are classified according to A ) Effect on a particular body system B) Chemical composition C) Clinical indication D) Therapeutic action E ) All of the above

E) All of the above TIP: Understanding the classification of drugs is more effective than trying to memorize every specific drug within that classification.

300

Some Adverse Affects Include? Select all that apply. A ) Allergic reactions—anaphylactic reaction B ) Drug tolerance—body requires higher doses to achieve same effect C ) Toxic effect—prolonged intake or accumulation of drug in blood stream D ) Drug-drug interactions E ) Drug-food interactions

ALL

400

A nurse taking care of a client who asks if she can have some acetaminophen due to her sever Laceration on her back. The nurse checks to see if there is an order for acetaminophen and notices the client is to have 650 mg. What type of order is this considered? A ) Standing order B ) One-time order C) STAT order D) p.r.n. order

This is a Standing Order . Standing order (routine order): carried out until cancelled by another order??, given within 2 hours of being written and carried out on schedule PRN order: as needed?? Single or one-time order??: Medication administered at once at specified time. Stat order: carried out immediately?

500

What are the seven parts to a medication order ? * Hint PDDDRFS

What is Patient’s name Date and time order is written Drug to be administered Dosage of drug Route by which drug is to be administered Frequency of administration of the drug Signature of person writing the order

Methods

100

Which of the following are myths related to giving medication? Select All that apply. A) Pinching is advised for thinner patients B) Aspiration, or pulling back on the plunger to check that a blood vessel has been entered, is a reliable indicator of needle placement. C ) Massaging the site is necessary and can help tissue. D ) It is necessary to rotate sites or areas for injection if the patient is to receive frequent injections

B and C Aspiration, or pulling back on the plunger to check that a blood vessel has been entered, is not necessary and has not proved to be a reliable indicator of needle placement. Massaging the site is not necessary and can damage underlying tissue as well as increase the absorption of the medication. Massaging after heparin administration can contribute to hematoma formation.

200

Which of the following is correct regarding intravenous route? A ) The intravenous route is the most dangerous route of administration because the drug is placed directly into the bloodstream, it cannot be recalled, and its actions cannot be slowed B) Intravenous Solution using continuous infusion, the patient receives it slowly and over a long period C) Intermittent Intravenous Infusion: The drug is mixed with a small amount of the intravenous solution, such as 50 to 100 mL, and administered over a short period at the prescribed interval (e.g., every 4 hours). The administration is most often performed using an intravenous infusion pump, which requires the nurse to program the infusion rate into the pump. D ) Bolus Or Push This means that the patient has an IV site or a PICC line and the drug is administered by a syringe directly pushed into the IV by way of the vein, the medication enters the blood stream immediately.

These are All correct regarding the Intravenous Route

300

Which of the following is not correct regarding medication routes? A ) Oral: PO, Most convenient route and easiest and more desirable way to administer medication, least expensive. B ) Sublingual: A drug that is placed under the tongue, where it dissolves. A medication given by sublingual route can be swallowed. C ) Buccal : A medication is held in the mouth against the mucous membranes of the cheek until the drug dissolves. The medication should not be chewed, swallowed or placed under the tongue. D ) Parenteral Administration of medicine means giving a therapeutic agent including outside the alimentary tract and includes Intradermal, subcutaneous, intramuscular, intravenous

B is INCORRECT A medication given by sublingual route should not be swallowed, or the desired effects will not be achieved.

400

Which of the following is correct regarding Intradermal Injections. A ) Medicine is introduced under the epidermis, Injection into the dermis B) 10-15 degree angle C ) 0.5 mL or less of medication D ) Slowly inject medication until wheal forms on skin. E ) Common sites include bicep and back F ) TB and allergy testing most common G ) 3/4" - 1" , 16 g needle most common

ALL but E and G Common sites include Forearm upper back, upper dorsal aspect of the arm and upper chest. 27 g needle most common Intradermal - longest absorption time forearm and the upper back, under the scapula, tuberculin syringe calibrated in tenths and hundredths of a milliliter. A 1/4″ to 1/2″, 25- or 27-gauge needle is used. The dosage given intradermally is small, usually less than 0.5 mL. The angle of administration for an intradermal injection is 10 to 15 degrees. used for sensitivity tests, such as tuberculin and allergy tests, and local anesthesia

500

Which of the following is correct regarding pregnancy safety categories ? Select All that apply. 1. Category A: Studies indicate no risk to animal fetus: information in human is not available 2. Category B:Studies indicate no risk to the human fetus 3. Category C: Adverse effects reported in animal fetus; information in humans is not available. 4. Category D: Possible fetal risk in humans reported; however, considering potential benefits v. risk may, in selected cases, warrant the use of these drugs in pregnant women. 5. Category X: Fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs should not be used in pregnant women.

What is 3, 4, 5 Category A: Studies indicate no risk to the human fetus Category B: Studies indicate no risk to animal fetus: information in human is not available Category C: Adverse effects reported in animal fetus; information in humans is not available. Category D: Possible fetal risk in humans reported; however, considering potential benefits v. risk may, in selected cases, warrant the use of these drugs in pregnant women. Category X: Fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs should not be used in pregnant women.

Methods/Calculations

100

The nurse told a patient to hold his or her breath for 5 to 10 seconds, or as long as possible, then to exhale slowly through pursed lips. Wait 1 to 5 minutes, as prescribed, before administering the next puff, as prescribed. Is this the correct method to administer Meter-Dose Inhaler.

Dry Powder Inhalor: The patient should place teeth over, and seal lips around, the mouthpiece. Do not block the opening with the tongue or teeth. Have the patient breathe in quickly and deeply through the mouth, for longer than 2 to 3 seconds. Metered-Dose Inhaler (MDI)Instruct patient to hold his or her breath for 5 to 10 seconds, or as long as possible, then to exhale slowly through pursed lips. Wait 1 to 5 minutes, as prescribed, before administering the next puff, as prescribed. Small Volume Nebulizer : Have patient inhale slowly and deeply through the mouth and hold each breath for a slight pause before exhaling.

200

Which of the following is correct regarding Subcutaneous Injections ? Select All that apply? A ) Administered below epidermis and dermis. B ) Has slow sustained rate of absorption C ) used for Insulin and Heparin D ) A 16 gauge , 1/4"-3/8" needle is used E ) No more than .5 ml is given subcutaneously F ) Back of arm is most common site G ) Inserted at a 45 - 90 degree angle

A, B, C, G are CORRECT Subcutaneous injections are administered into the adipose tissue layer just below the epidermis and dermis. This tissue has few blood vessels, thus drugs administered here have a slow, sustained rate of absorption into the capillaries. This route is used to administer drugs such as insulin and heparin.A 25- to 30-gauge, 3/8″ to 1″ needle can be used. The 3/8″ and 5/8″ needles are most commonly used. Choose the needle length based on the amount of subcutaneous tissue present, which is based on the patient’s body weight a Usually, no more than 1 mL of solution is given subcutaneously, administered at a 45- to 90-degree angle. Choose the angle of needle insertion based on the amount of subcutaneous tissue present and the length of the needle. Generally, the shorter, 3/8″ needle should be inserted at a 90-degree angle, and the longer, 5/8″ needle is inserted at a 45-degree angle. Heparin is also administered subcutaneously. The abdomen is the most commonly used site. Avoid the area 2″ around the umbilicus and the belt line.  Various drugs require very specific equipment and/or techniques. Insulin is prepared using an insulin syringe. Other drugs are never administered with an insulin syringe. Insulin syringes are available with 28- to 30-gauge, 5/16″ and 1/2″ length needles, and in 3/10-mL to 1-mL sizes. The shorter needles (5/16″) are becoming the more common length used. Shorter needles are less painful, and there is less risk for inadvertent injection into muscle tissue. Insulin pens are also available for insulin administration. Insulin injection pens are prefilled devices that combine the insulin container and syringe

300

Which of the following is correct regarding Intramuscular injections? Select All that apply. A ) deliver medication through the skin and subcutaneous tissues into certain muscles B ) Z-track technique is recommended for all intramuscular injections to ensure that medication does not leak back along the needle track and into the subcutaneous tissue C) allowing faster onset of action than with subcutaneous injections D) biologic agents and medications in aqueous solutions should be administered with a 20- to 25-gauge needle. Medications in oil-based solutions should be administered with an 18- to 25-gauge needle E) Generally, 1 to 4 mL is the accepted volume range, with no more than 1 mL given at the deltoid site. The less-developed muscles of children and older adults limit the intramuscular injection to 1 to 2 mL at 90 degrees angle.

ALL are Correct. Intramuscular injections deliver medication through the skin and subcutaneous tissues into certain muscles. Muscles have larger and a greater number of blood vessels than does subcutaneous tissue, allowing faster onset of action than with subcutaneous injections • Dorsogluteal: is composed of the thick gluteal muscles of the buttock (Extreme caution: sciatic nerve and major blood vessels innervate this area) • Never used for kids less than 2 years old or small children with small body mass/muscle • Divide in further, upper/lateral divide in furthers again, outside top edge. Vastus Lateralis: This is a major muscle in the anterolateral thigh and is used most often for IM injections in infants • Ventrogluteal Mucles: These muscles make up the other preferred site for IM injection in infants, although this is a useful site for other age-groups as well. anterior superior iliac spine and your middle finger at the iliac crest. Generally, biologic agents and medications in aqueous solutions should be administered with a 20- to 25-gauge needle. Medications in oil-based solutions should be administered with an 18- to 25-gauge needle. Generally, 1 to 4 mL is the accepted volume range, with no more than 1 mL given at the deltoid site. The less-developed muscles of children and older adults limit the intramuscular injection to 1 to 2 mL at 90 degrees angle. Z-track technique is recommended for all intramuscular injections to ensure that medication does not leak back along the needle track and into the subcutaneous tissue Vastus lateralis 5/8″ to 1″ Deltoid (children) 5/8″ to 1¼″ Deltoid (adults) 5/8″ to 1½″ Ventrogluteal (adults) 1½″

400

A ) A nurse is preparing to administer methylprednisolone acetate (Depo-Medrol) 2 mg/kg IV bolus stat to a school-age child who weighs 82 lb. Available is methylprednisolone acetate injection 40 mg/mL. How many mL should the nurse administer? B ) ​A nurse is preparing to administer nitroprusside (Nipride) 2.5 mcg/kg/min by continuous IV infusion to toddler who weighs 10 kg. Available is nitroprusside 50 mg in dextrose 5% in water (D5W) 250 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest tenth.) C ) A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCl) 20 mL/kg IV to infuse over 6 hr to a school-age child who weighs 55 lb. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number.) D ) A nurse is preparing to administer albuterol sulfate 0.2 mg/kg PO every 8 hr to a toddler who weighs 28 lb. Available is albuterol sulfate syrup 2 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth.) E ) ​A nurse is preparing to administer IV fluid replacement for an infant who weighs 12 lb. What is the infant’s daily maintenance fluid requirement? (Round the answer to the nearest whole number.)

A ) 1.856 = 1.9 B ) 7.5ml /hr C ) 83 D ) 6.4 E ) 5.5 X 100 = 550ml/day 0 X 50 0 X 20

500

A ) A nurse is preparing to administer dextrose 5% in water (D5W) 150 mL IV to infuse over 45 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number.) B ) A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCl) 1,000 mL IV to infuse over 10 hr to a client. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion pump to deliver how many gtt/min? (Round the answer to the nearest whole number.) C ) A nurse is preparing to administer dopamine 3 mcg/kg/min by continuous IV infusion to a preschool-age child who weighs 19 kg. Available is dopamine 400 mg in dextrose 5% in water (D5W) 250 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest tenth.) D) A nurse is preparing to administer amoxicillin (Amoxil) 25 mg/kg/day PO divided in equal doses every 8 hr to a toddler who weighs 25 lb. Available is amoxicillin oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth.)

A) 200 ml/hr B ) 25gtt/min C ) 2.1 ml/hr D) 1.9 ml PO every 8hrs