Ouch! That's sharp!
Which syringe and needle size would be best use for a Subcutaneous injection?
1 ml syringe with 27 G 1/2 or 5/8 inch needle
The nurse is administering a medication to a patient when the patient states "That pill looks just like the one I took and hour ago." what is the nurse's best action?
STOP and review Medication, Order, MAR
How would you apply an otic drop of medication? How about a nasal medication? How about opthalmic drops?
Ophthalmic (eye) Form of drops, ointment, Ophthalmic must be clearly visible on container, Pull lower eyelid down, place drug in center
Otic (ear) Forms of drops or irrigation; Adult: Upward and backward; Child: Downward and backward
Nasal (nose) Dropper bottles; Atomizer bottles; Block one nostril and inhale through nose as atomizer is squeezed; Have client lying on back with neck hyperextended
How many nurses are needed when "wasting" a controlled medication? When does a narcotic count occur?
2 nurses; at the end of a shift between 2 nurses (offgoing and oncoming)
Describe common reasons for errors to occur
failure to communication drug orders, illegible handwriting, wrong medication selection, confusion over similar names and packages of medications, errors with weight or dosage
Which way should the bevel of a needle be placed?
Bevel up
When drawing up a medication, there is an air bubble in the syringe. What should the nurse do?
tap the barrel of the syringe to float the bubble to the top the syringe
When drawing up medication from an ampule, what type of needle should you use?
Filter needle
Describe the steps to take when drawing up 2 different insulins (one clear, one cloudy)
Step 1 Inject air into LONGER-acting insulin (CLOUDY!)
Step 2 Inject air into SHORT-acting insulin (CLEAR!)
Step 3 Withdraw amount of SHORT-acting insulin (CLEAR!)
Step 4 Withdraw amount of LONG-acting insulin (CLOUDY!
Who is responsible to report a medication error? To who does the LVN report a medication error?
Whoever conducts or discovers the error should report the error. The LVN should report to their supervisor and Healthcare Provider
What is the difference between an Insulin Syringe and a SubQ (TB) syringe?
Insulin is always in UNITS, other syringes are in ml
The client request their medications to be crushed. What types of medication should you not crush?
Extended release, sustained released, enteric coated; ask the Provider if medication is available as a liquid
What types of medication are best for feeding tubes?
Liquids or crushed medications
Safety syringes are available and should be used
Report all needle sticks
Immediately dispose of needles after use in Sharps Container!
When do you review an unfamiliar medication
BEFORE administering it
Name the acceptable locations for IM and SQ injections
IM: Deltoid, Ventrogluteal, Vastus Lateralis
SQ: Upper outer arm, Anterior surface of thigh, 2 inches away from umbilicus on abdomen
The vastus lateralis is the best site for infant injections
When recognizing a patient has an allergy to a medication, what steps should the nurse take?
record or update the allergy under allergies in the medical record and associated symptoms and place an allergy ID band on patient;
Always monitor client with first doses of medication for possible allergic reaction
Dependent on tissue to reach
5/8 to ½ inch: intradermal and subcutaneous
1 inch to 3 inches for intramuscular
Describe the process and important aspects of applying a transdermal nitroglycerine patch.
Supplied as paste or patch; Should be applied to clean, hairless area and left in place, shaving may cause irritation
WEAR GLOVES or YOU may be exposed to medication!!! Remove old patches before applying new one-Increased dosage
Site examples: chest, abdomen, buttocks, upper arm, behind ear, between shoulder blades (dementia)
Where do you always perform medication administration within the medical record?
Medication Administration Record (MAR)
Name the size of needles for an IM, SubQ, and Intradermal injection
IM: 22-to 23 gauge, 1 to-3 inches; most common 1 to 2 inches
SubQ: 25 gauge 5/8 inch; 27gauge needle, ⅜ - to ½ inch
Intradermal:1-ml syringe (Tuberculin),
25, 27 gauge, ¼ to 5/8 inch length
When administering a subcutaneous injection of Heparin, what is an important step to avoid?
Do not massage the area
What are the correct angles to use for an IM, SubQ, and Intradermal injections?
IM: 90 degree
SubQ: 5/8 inch needle-45 degree; 1/2 inch 90 degree
Intradermal: 5-15 degree
What may you see if a medication is incompatible with another
Color of medication may change, Precipitation may occur, Clouding may occur
Describe important actions to take when administering medications via a feeding tube
Position in High Fowlers, aspirate liquid or gel capsule with syringe and needle, maintain aseptic technique, use liquid or crush medications, flush before and after administration of medications, include totals in intake and output