Safety
Explain what happens during the first safety check.
read MAR and find drug in drawer
Name 2 reasons why a nurse might question a medication order.
Missing 1 of the 7 components
Patient states that they don't take that medication
Patient has an allergy to it
What is a PRN medication order?
What is as needed.
How should the nurse identify the patient?
2 identifiers: name, DOB, MRN, SSN
When you are going to administer eye ointment which hand pulls down the lower lid?
nondominant hand
What is the max volume you can inject into the deltoid?
1 mL
Which syringe gauge is smaller? 18g or 22g
22 g
Explain what happens during the second safety check.
Place drug label right up next to MAR, check drug expiration and complete drug dosage calculations with this check.
A patient refuses their morning medications. What should the nurse do?
Find out why, document in the MAR, notify the provider according to agency policy.
What do the terms ER and SR mean and what is significant about them?
Sustained release
Extended release
Do not crush or chew, medication releases over time
What are two ways that the nurse can work with a pediatric patient to take medications?
crush if able and place in applesauce/pudding
have a parent administer if able and willing
sweeten liquid medication/flavoring
oral syringe
When measuring liquid medication, how do you measure the correct dose?
place the medication cup at eye level
What are the landmarks for a deltoid injection?
Acromion process, axilla, inverted triangle
Name three parts of the syringe that you need to keep sterile. (should not touch)
Plunger
Shaft
Bevel
Explain what happens during the third safety check.
place next to MAR again, open place in cup if single unit dose, if multi-dose, dose to cap, do third check, then into cup, if liquid, pour measured dose, then do third check, then place back on shelf or in drawer
What is the proper way to read the medication administration record?
top to bottom and left to right
What does a one-time order mean?
It is given once and then a new order would be needed. Example would be a pre-operative antibiotic order.
Explain the proper way to remove a pill from a multi-dose bottle.
into the cap, check it against the MAR and then into the cup, bottle back into the supply cart
After administering otic drops, how long should the patient remain on their side?
5-10 min
What are the landmarks for the ventrogluteal site?
Greater trochanter
Anterior superior iliac spine
Iliac crest
What size syringe and needle is used for a subcutaneous injection?
1 mL and 25-27 gauge needle
Name 2 ways the nurse can minimize errors during medication preparation and administration.
double check that medications have not already been administered
always document ASAP after administration
complete necessary assessments before preparation of meds
check allergies during MAR scan
If the nurse only needs to give 1mL of a 2mL narcotic dose, what needs to occur?
Witness waste of the other 1mL, proper documentation of wasting.
What is an MDI?
Metered Dose Inhaler
Why are drug forms and drug preparations not interchangeable?
part of the 5 rights
If you are administering otic drops to a child younger than 3 years of age, what do you do with their pinna?
down and back
What are the landmarks for the vastus lateralis site?
greater trochanter
knee
midlateral thigh
middle third
What is important to note about an enoxaparin syringe?
Air bubble does not get expelled prior to injecting
What are the 5 rights of medication administration?
Patient
Medication
Dosage
Route
Time
What should you do if you think a prescription is incorrect?
Look up the medication in a reliable resource
Ask another nurse or provider to check the prescription
Contact the prescriber for clarifications, concerns, or questions.
What does MAR stand for?
Medication Administration Record
What are the other 4 rights?
Documentation
Reason
Refuse
Know
For nasal sprays how do you position the patient?
head down and forward
"To spray your nose, look at your toes."
What should you always do to find landmarks?
Palpate
When choosing equipment for injections what are three things to consider?
Route of medication
Amount of medication
Type of Syringe
Site chosen
Size of patient
Calibration of syringe
What method should you use when recapping a needle?
one handed scoop method
When drawing up insulin, what is the correct order when combining regular and NPH?
Clear to Cloudy
Regular first than NPH
How do you know what each line of the syringe represents?
calibration
What are you watching for when you place a TB skin test?
Wheal or bleb
When administering an intradermal injection, what angle of injection do you use?
5-15 degree
When administering intramuscular injections, what is the preferred method of injection?
Z-track
Each line of the insulin syringe represents what?
1 unit