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Medication Administration Test With
Correct Answers
A nurse is preparing to administer an IM injection to a client who is overweight. Which of the following sites should the nurse select for the injection? a. the lower, medial quadrant of the buttock near the coccyx b. the side hip between the iliac crest and anterior iliac spine c. the tissue of the posterior upper arm d. the lower, inner thigh 4 finger widths above the patella - ANSWER b. the side hip between the iliac crest and anterior iliac spine Ventrogluteal injection: the nurse should prepare for injection by placing a hand on the client's greater trochanter (right hand on left hip, for example) with the first two fingers touching the iliac crest and anterior superior iliac spine, forming a "V" shape. a. dorsogluteal site poses greater risks (sciatic nerve) c. this site would appropriate for subQ injections d. to inject in the vastus laterals site, the nurse should select one hand width below the greater trochanter and one hand width above the patella Classification of medications - ANSWER Based on:
- effects on body system
- symptoms relieved by medication
- medication's desired effect Pharmacokinetics - ANSWER The study of how medications enter the body, reach their site of action, metabolize, and exit the body. ADME Absorption - ANSWER Passage of medication molecules into the blood from the site of administration Factors that alter absorption:
- route
- ability of medication to dissolve
- blood flow to site of administration
- body surface area (increased surface area = increased absorption)
- lipid solubility of medication (BBB) Distribution - ANSWER After absorbed, the medication is distributed to body tissues/organs (the site of action) Rate/extent depends on:
- physical/chemical properties of medication
- physiology of client ** circulation (blood flow to liver decreases with age) ** membrane permeability ** protein binding (decreased albumin with age) Metabolism - ANSWER Metabolized into a less potent/inactive form
Synergistic effect - ANSWER combined effect of two medications is greater than the effect of medications given separately Mild allergic reaction symptoms - ANSWER Urticaria Rash Pruritus Rhinitis Peak - ANSWER time it takes for a medication to reach its highest effective concentration Trough - ANSWER minimum blood serum concentration of medication reached just before the next scheduled dose Onset - ANSWER time it takes after a medication is administered for it to produce a response Duration - ANSWER time during which the medication is present in concentration great enough to produce a response Plateau - ANSWER blood serum concentration of a medication reached and maintained after repeated fixed doses Administration of otic medications - ANSWER Children: upward & backward pulling of pinna Adults: downward & backward pulling of pinna Oral route - ANSWER easiest and most commonly used have a slower onset of action and a prolonged effect than parenteral medications
food may interfere or be helpful protect against aspiration enteral feedings Intraocular administration - ANSWER Into conjunctiva What is included in all drug orders? - ANSWER client name order date medication name dosage route time of administration prescriber's name AND signature types of medication orders - ANSWER standing/routine PRN single/one time STAT now prescriptions What to do if a med error occurs? - ANSWER report all errors!! assess client's condition notify physician
Mixing of herbal/nutritional products with medications Parenteral administration - ANSWER Administration of medications via injection into the body:
- invasive procedure --> use sterile technique
- risk of infection
- need to ensure medication reaches intended location
- effects develop rapidly (depending on rate of absorption) Parenteral syringes - ANSWER Leur-loc/non Leur-loc *used for IM and subQ injections TB syringes Insulin syringes Parenteral needles - ANSWER Choose according to clients size and tissue used Longer for IMs, shorter for subcut The bigger the gauge number, the smaller the needle outer diameter How to minimize discomfort with injections: - ANSWER use sharp needle position comfortably proper site divert patient's attention insert quickly
support needle inject slowly and steadily
Subcutaneous injections - ANSWER medication placed in loose connective tissue under skin
absorbs slower --> less blood supply
small volume (0.5-1.5 mL) gauge = 25- needle length = 3/8 - 5/
insert at 45 degree angle, unless obese (90)
tissue easily irritated by large volumes/solutions
client's weight indicate depth of SQ layer
locations:
needle size = 1 to 2" gauge = 18- volume = 1 to 3 mL angle of insertion = 90 degrees
Locations
- ventrogluteal
- vastus lateralis
- deltoid
- dorsogluteal
Ventrogluteal - ANSWER preferred and safest site for all adults, children, and infants... especially for medications that have larger volumes and are more viscous & irritating
greater trochanter thumb towards groin anteriosuperior iliac spine V
Z-track method - ANSWER used to minimize local skin irritation by sealing the medication in muscle tissue
put a new needle on the syringe after preparing the medication so no solution remains on the outside needle shaft
pull overlying skin and subcut tissues laterally or downward, hold until administer injection, leave needle inserted for 10 seconds to allow medication to disperse evenly rather than channeling back up track of needle, release skin after withdrawing. leaves a zigzag path that seals the needle track where tissue planes slide across one another.
we use it to keep the medication in, prevent leakage, skin acts as a natural barrier/seal
Intradermal injections - ANSWER used for skin testing (TB, allergy)
medications potent --> into dermis --> blood supply less --> absorbed slowly
Angle of insertion = 15 degrees
How to start an IV: - ANSWER
How do you instill eye drops? - ANSWER - tilt head backward, open eyes, & look up
- pull lower lid down against cheekbone
- place the prescribed dose of eye medication in the lower conjunctival sac, never directly onto the cornea! The cornea of the eye has many pain fibers.
- close eye gently to allow the drop to fall into the conjunctival sac
- to prevent overflow into nasal & pharyngeal passages, instruct client to apply pressure over inner canthus next to nose for 30-60 seconds following administration
Minimal information to be recorded after a drug is administered includes the name of the drug, dosage, and which of the following?
a. route, manufacturer, & who administered
b. route, time, and who administered c. time, route if other than oral, & initials of RN d. dosage, who administered, and who ordered - ANSWER b. route, time, and who administered
The symbol "p.r.n." means:
a. every hour b. when necessary c. three times daily d. after meals - ANSWER b. when necessary
Which of the following type of drugs is absorbed into the body most rapidly?
a. a liquid given orally b. a gelatin capsule given orally c. an enteric coated pill given orally d. ointment applied to the skin - ANSWER a. a liquid given orally
When administering eye drops, the nurse minimizes the risk of transmitting
emergency, which of the following should he/she do?
a. have another nurse guard the medications b. put the medications back in the containers c. have another nurse finish preparing and administering the medications d. lock the medication cart & finish when he/she returns - ANSWER d. lock the medication cart & finish when he/she returns
The safest and most convenient route of drug administration is:
a. oral b. dermal c. respiratory d. intravenous - ANSWER a. oral
In the unit-dose system of drug administration:
a. each dose of a drug is in an individual package b. drugs for each patient are in individual compartments for a limited time c. each patient is responsible for his medications
d. drugs are stored on nursing units in bulk containers - ANSWER a. each dose of a drug is in an individual package
Drugs administered sublingually are:
a. applied on the skin b. placed in the buccal space c. inserted into the rectum d. placed under the tongue - ANSWER d. placed under the tongue
The symbol "t.i.d." means:
a. before meals b. twice daily c. every two hours d. three times daily - ANSWER d. three times daily
When the nurse takes the medication to Mrs. Taylor's room, the nurse should do all of the following EXCEPT:
d. melt at body temperature - ANSWER d. melt at body temperature
Rectal suppositories
- Sims' position to help it flow into the sigmoid process
True or false:
If a drug is prepared by the manufacturer using the apothecary system, the nurse can calculate the dose using the metric system. - ANSWER False.
A conversion would need to be made first!
True or false:
Because of professional ethics, the nurse does not tell the patient what medications they are taking. - ANSWER False.
True or false:
Having the patient tell the nurse his name is a reliable means of patient identification. - ANSWER False.
Need TWO means of patient identification.
True or false:
When preparing liquid medications for oral administration, the nurse should always read the label for instructions. - ANSWER True.
Standing orders or routine medication orders - ANSWER Carried out until the prescriber cancels it by another order or a prescribed number of days elapse
Given 30 minutes before and 30 minutes after scheduled time window
PRN orders - ANSWER to be given only when a patient requires it
use objective and subjective assessment and discretion in determining whether or not it is needed
- big source of med errors if contain a range (q4-6h)
One-time order - ANSWER given only once at a specified time
