5 Rights
What are the 5 rights of medications?
Right Patient
Right Medication
Right Dose
Right Time
Right Route
P.O.
N.P.O
By Mouth
Nothing by mouth
Beta Blockers
Give me an example of one:
HTN
Heart rate control, example: AFIB
What is the most common side effect seen after Insulin administered
Hypoglycemia- sweating, weakness, confusion, patient describes "shakey" feeling
Only if too much insulin was given or patient did not eat enough
Patient is admitted for a GI bleed, she had a blood transfusion overnight and this morning her HGB came up to 7.2. Which of the 0900 medications should you question?
A.) Protonix 40mg IVP
B.) Lovenox 40mg SubQ
C.) Octreotide gtt 25mcg to run 12.5ml/hr
B.) Lovenox
Be cautious with any blood thinners for patient's with active bleeds. In the hospital setting, Lovenox and heparin orders are often protocol orders/part of order sets so it is up to you to make the catch.
The doctor writes an order for a medication. The nurse notes the order says to administer 12.5 mg PO. Pharmacy dispenses the nurse with 6.25 mg tablets. How many tablets will the nurse administer and what medication administration right is the nurse assessing?
2 Tablets
(right dose)
BID
TID
QID
Twice a Day
Three times a day
Four times a day
Levothyroxine
Hypothyroidism
Common side effect associated with giving Potassium Chloride through the IV?
Burning sensation
KCL is very strong, costic to veins. To avoid this, you can slow down the infusion.
Patient has 0900 dose of 50mg Metoprolol Tartrate due. What do you want to check prior to giving, what are the parameters?
Check heart rate and blood pressure
Parameters are typically hold metoprolol if HR <60 or SBP <100
The nurse notes in the MAR that the patient was ordered to take Acetazolamide 500 mg. The nurse checks the medication packaging on hand and finds it contains Acetohexamide 500 mg. The nurse is assessing the "Rights of Medication Administration", which "right" should be addressed?
Right Medication
*Always look at the spellings of medication because some are very similar and maybe used for completely different things.
GTT
Aspirin (ASA)
Common uses:
Mild pain relief
Mild blood thinner- often the first blood thinner recommended for patients with cardiac concerns or at high risk for stroke
One of the most common adverse effects of ACE inhibitors?
Angioedema
Swelling of the tongue
The patient is ordered to take Warfarin at 1800. Before administration of the medication, what should the nurse check before administering the Warfarin?
INR levels
Typically the goal is to be between 2.5-3 for patients on Warfarin. If patient's level is higher than that- check if the MD/pharmacy to verify dosage.
HGB/HCT levels
If a patient has low HBG/HCT and/or are actively bleeding- blood thinners would most likely be held.
Also check to see if patient has any upcoming procedures, blood thinners are typically put on hold days before procedures.
What is the best way for the nurse to make sure that the right patient is receiving a prescribed drug when the patient is alert and oriented?
Have the patient state their name and date of birth before giving
OD
OS
OD: Right eye
OS: Left eye
Naloxone (Narcan)
Overdose of Opiates/Narcotics
Prevent OD**
Patient just started on a dose of Vancomycin and begins to develop generalized body rash. What do you think happened? What are your next steps?
Commonly called "red man syndrome"- red rash developing around head, neck, torso
Stop infusion, call MD
Anticipate antihistamine to be given (i.e. Benadryl) and possibly corticosteroid (i.e. Solumedrol and prednisone)
Patient has an order to give 40mg IVP Lasix at 0900, in which cases would you hold or clarify with MD before giving?
Hypotension- if SBP less than 100, best to check with MD before administering
Hypokalemia- if potassium less than 3.5, best to check with MD before administering
High creatinine- if above 1.3, check with MD first
The doctor writes an order for a medication. The nurse notes the order says to administer potassium chloride 40MeQ IVP once. Is there something wrong with the order?
IVP (IV push) should either be IVPB (IV piggyback) or PO (oral)
NEVER PUSH POTASSIUM IN THE IV
ACHS
PC
ACHS: With Meals and at night
(often used when describing blood sugar checks, or may be phrased at QID)
HS: at night
PC: with meals
Pharmacologic treatment of heavy metal poisoning usually involves what?
Chelation
Foods rich in tyramine must be restricted while on monoamine oxidase inhibitors (MAOI’s) because of the possibility of what?
Severe HTN
Patient blood sugar is 50 in the morning after waking up, his medication regimen is below:
Humalog 15 units per meal plus sliding scale
Lantus 50 units at night
What suggestion would you make to MD regarding medications?
Decrease amount of Lantus (long acting) insulin given at night to avoid morning hypoglycemia.
Not enough information in the question to address the short acting insulin