Clinical Judgement & Communication
A patient refuses a prescribed dose. What should the nurse do before documenting the refusal?
Ask the reason for refusal and provide education if appropriate.
Which age group absorbs topical medications more quickly due to thinner skin and higher surface area?
Infants have thinner epidermis and greater body surface area-to-weight ratio, increasing drug absorption risk.
Where should a sublingual medication be placed for proper absorption?
Under the tongue
What term describes how a drug moves through the body—absorption, distribution, metabolism, and excretion?
Pharmacokinetics
Before giving any medication, which two patient identifiers must the nurse verify for accuracy?
Name and date of birth
A patient taking both opioids and gabapentin reports feeling unusually drowsy. What is the nurse’s top assessment priority?
Respiratory rate and oxygen saturation
Older adults are prone to constipation due to what common physiologic change in the gastrointestinal system?
Decreased intestinal motility
A nurse is teaching a parent to apply an antibiotic eye ointment. What is the correct direction for applying the medication?
From the inner canthus to the outer canthus along the lower eyelid
Which medication route provides the most rapid absorption into the bloodstream?
Inhalation-he lungs provide a large surface area and rich blood supply, allowing for quick drug absorption.
A nurse gives the wrong medication to a patient. What is the immediate nursing action?
Assess the patient’s condition
A patient states, “I stopped my blood pressure medicine because it made me dizzy.” What is the most therapeutic nursing response?
Tell me more about when the dizziness happens and how it affects you.
How does decreased hepatic blood flow in older adults affect drug metabolism?
Slower metabolism and prolonged drug effects
Which route of administration is designed for local rather than systemic drug effects?
Topical or ophthalmic
A client with liver disease is prescribed a medication metabolized by the liver. What is the nurse’s main concern?
Toxic accumulation due to slowed metabolism
When documenting medication administration, what principle ensures legal and accurate charting?
Document immediately after giving the medication
A patient with chronic alcohol use is prescribed acetaminophen. What teaching point is most important to prevent complications?
Avoid alcohol while taking acetaminophen to reduce liver toxicity risk.
Why are older adults at increased risk for adverse drug interactions when taking multiple medications?
Polypharmacy and slower metabolism increase cumulative effects.
When using an inhaler, what action helps ensure the medication reaches the lower airways effectively?
Inhale slowly and deeply, then hold breath for about 10 seconds
Define the “first-pass effect” and explain how it alters oral drug availability.
The liver metabolizes oral drugs before they reach systemic circulation, reducing bioavailability. Drugs absorbed from the GI tract first pass through the liver, where some is inactivated before entering circulation.
A student nurse fills out an incident report after a near miss. What detail should not be included in the patient’s medical record?
Reference to the incident report
After giving naloxone for an opioid overdose, the patient becomes restless and nauseated. What should the nurse anticipate next?
Monitor for recurrent respiratory depression and possible need for repeat dosing.
Which age-related changes can delay the absorption of oral medications in the gastrointestinal tract?
Decreased gastric acid and slowed gastric emptying
Why must a nurse be cautious when applying topical medication to a patient with open skin lesions?
absorption increases, which can lead to systemic side effects.
How does reduced kidney function influence the half-life of a drug, and why is that clinically important?
Half-life increases, raising the risk of accumulation and toxicity.
A nurse finds a new medication order that seems unusually high for the patient’s condition. What is the safest next step?
Verify the order with the prescribing provider