Nursing Process
How would you know it's the "right time" to administer a PRN medication?
What is: When was the last time the drug was administered? Ex: If PRN every 4-6 hours it must have been at least 4 hours since drug last administered.
What is the difference between Pharmacokinetics vs Pharmacodynamics?
What is: Pharmacokinetics - study of what body does to drug (i.e. absorption, distribution, metabolism, elimination). Pharmacodynamics - study of what drug does to the body (i.e. mechanism of action, therapeutic effect, adverse effects, etc.)
Explain what a black box warning is
What is: Warning appears in prescribing information/on medication box - alerts prescribers of serious adverse events that have occurred with the given drug
Describe the best method for assessing a patient's learning needs
What is: Begin with validation of the patient's present level of knowledge and go from there
What is: Date, Time, Name of medication, Dose, Route, Site of administration, Therapeutic response, Adverse reactions - intervention to treat reactions (may be followed by a nurse's note)
Explain the "first-pass" effect of medications
What is: Drugs administered orally/PO will be metabolized immediately by the liver (mostly the liver) before reaching the site of action, which inactivates a portion of the drug.
Explain the different between malpractice vs negligence
What is: Malpractice is special type of negligence of healthcare professional failing to act in reasonable and prudent way. Negligence is failure to act in reasonable and prudent way when providing care
Which technique is most appropriate when teaching a patient with a language barrier?
What is: Utilize a medical interpreter who can speak in the patient's native tongue for teaching sessions
The order reads: "Give Atenolol 25 mg once daily at 0900". What should the nurse do? Why?
Do not give this medication because the route is missing. Must contact prescriber to clarify the route.
Place the following drug routes in order of fastest absorption: PO/enteral, parenteral/IV, sublingual/buccal, Subcutaneous injection, Topical/Transdermal, and which undergo first pass effect?
IV, SL/Buccal, SQ, PO, Topical *only PO undergoes first pass unless rectal (topical), will undergo first pass effect too
Explain what a nurse would do if a medication error has occurred
What is: Assess the patient/ensure safety issues addressed, follow policies/procedures for reporting & documenting error (call prescriber, nursing or facility management), closely monitor patient for adverse reactions, have another staff member stay with patient, follow-up tests/labs should be ordered or antidote prescribed/administered
A 47-year-old patient with Diabetes is being discharge to home and must take Insulin injections twice daily. What should the nurse keep in mind when considering patient teaching?
What is: Teaching needs to begin at time of diagnosis/administration and is individualized to the patient's reading level
The nurse is reviewing interactions between drugs & herbal products. Which of these herbal products may interact with anticoagulants, resulting in altered bleeding: Chamomile, Ginkgo Blob, Echinacea, Kava or Garlic
What is: Chamomile, Ginkgo Biloba & Garlic
Which orders will the nurse need to clarify? 1.) Metformin (Glucophage) 1000 mg PO twice a day, 2.) Sitagliptin (Januvia) 50 mg daily, 3.) Simvastatin (Zocor) 20 mg PO every evening, 4.) Irbesartan (Avapro) 300 mg PO once a day, 5.) Docusate (Colace) as needed for constipation
What is: Sitagliptin (Januvia) 50 mg daily (no route) & Docusate (Colace) as needed for constipation (no dose or route)
List minimum 3 nursing considerations for administering meds in neonates/pediatrics patients
What is: Gastric pH less acidic, GI motility slowed, first pass reduced, IM absorption faster/irregular, greater total body water, fat content lower, protein binding decreased, more drugs pass BBB, misocromal enzymes decreased, liver immature, renal elimination & kidney perfusion decreased
Describe the three steps of Medication Reconciliation
What is: 1.) Verify current medications (prescribed and OTC), 2.) Clarify as professional review to ensure medications/dosages are appropriate for the patient, 3.) Reconcile to further investigate any discrepancies or changes in the medication orders while the patient is under care in the facility
The nurse is developing a teaching plan for a patient who is newly-diagnosed with Type I Diabetes Mellitus. What is an appropriate outcome statement?
What is: 1.) The patient will list min three signs/symptoms of hypoglycemia, 2.) The patient will demonstrate how to self-administer an insulin injection before going home, 3.) The patient will describe steps to take in case of Hypoglycemia
When taking a patient's drug history, the nurse asks about the use of OTC drugs. The patient responds by saying, "Oh, I frequently take Aspirin for my headaches, but I didn't mention it because Aspirin is non-prescription." What is the nurse's best response?
What is: "Even though Aspirin is over the counter, it's still important to know why you take it (indication), how much you take (dose), and how often (frequency)
List the 9 Rights of Medication Administration
What is: Right Drug, Right Dose, Right Time, Right Route/Form, Right Patient, Right Documentation, Right Reason/Indication, Right Response, Right to Refuse
Identify 1 issue with absorption, distribution, metabolism and excretion of medications in older adults
What is: (Absorption) less gastric acidity, reduced blood flow to organs, GI motility slower (Distribution) reduced total body water, decrease in muscle mass/increase in fat, reduced protein, (Metabolism) reduced liver function & blood flow to liver, (Elimination) reduced renal function & blood flow to kidneys
Provide minimum 3 measures to reduce the risk of medication errors
What is: Avoid abbreviations/acronyms, Use 2 patient identifiers, Double check look-alike/sound-alike drugs, Legible/electronic orders from prescribers (no hand-written orders), Double check medication order and use 9 rights of medication administration, consult drug references (within 3-5 years) if need clarity, Hold drug/advocate for patient if any concern about drug - contact prescriber for clarification
The nurse is instructing an older adult patient on how to use his walker. Which education strategies are appropriate?
What is: 1.) Ensure quiet environment for learning, 2.) Repeat information frequently, 3.) Allow for an increased number of return demonstrations
A patient comes to the clinic complaining of elbow pain after an injury. He states that he has been taking two pain pills, eight times a day for the past few days. The medication bottle contains Acetaminophen 325 mg tablets. Calculate how much medication (how many mg) he has been taking per day. Is this a safe dose of this medication?
What is: 5,200 mg/day. No - the safe range per day is 3-4 g or 3,000-4,000 mg/day. This patient is at risk for Acetaminophen toxicity which can cause liver damage