Pharm Test 2 Ch 10-11

Front 1

What does PARENTERAL mean?

Back 1

-admin by any route other than the enteral, or GI tract.

Front 2

PARENTERAL refers to?

Back 2

-Intradermal
-subcut
-IM
-IV

Front 3

3 differences in given a drug Parenterally rather than orally?

Back 3

Parenterally
**1. onset of drug action is generally more RAPID, But of SHORTER duration
2. dose is smaller b/c drug potency tends Not to be Immediately altered by the stomach or live
3. Drug cost is greater

Front 4

4 Uses of Parenteral Route?

Back 4

1. to provide a rapid onset of action
2. to ensure a high blood level of the drug (Bioavailabity < 100%)
3. Not able to take meds orally (NPO, N/V, commatose, No PEG tube)
4. Med can only be given parenterally

Front 5

What are 4 reasons why the injections of drugs require skill and special care?

Back 5

1. trauma at injection site
2. possibility of infection
3. chance of allergic reaction
4. drug is Irretrievable

Front 6

ASPEPTIC Technique is used to?

Back 6

-avoid infection
-accurate drug dosing, along w/ correct rate and site of injection, is followed to avoid injury

Front 7

Injuries that could occur at the site of Injection?

Back 7

-abscess formation
-necrosis
-skin sloughing
-nerve injuries
-prolonged pain
-periostitis

Front 8

Periostitis?

Back 8

Inflammation of the periosteum, a dense membrane composed of fibrous connective tissue that closely wraps (invests) all bone, except the bone of articulating surfaces in joints which are covered by synovial membranes

Front 9

1/3 of All "sharps" injuries are related to?

Back 9

-The disposal process

Front 10

What are the 3 primary safety concerns, nursing have?

Back 10

1. patient
2. themselves
3. other healthcare workers

Front 11

What must be practiced to avoid "sharpes" injuries?

Back 11

-Safety

Front 12

PLUNGER:

Back 12

-Inner cylindrical portion the fits snugly into the barrel

-Used to draw up and eject the solution from the syringe

Front 13

TIP of syringes?

Back 13

-portion that holds Needle

Front 14

BARREL of a syringe?

Back 14

-outer portion
-where the calibrations ofor the measurement of the drug volume are located

Front 15

PLUNGER:

Back 15

-Inner cylindrical portion the fits snugly into the barrel

-Used to draw up and eject the solution from the syringe

Front 16

TIP of syringes?

Back 16

-portion that holds Needle

Front 17

BARREL of a syringe?

Back 17

-outer portion
-where the calibrations ofor the measurement of the drug volume are located

Front 18

All syringes are available with what type of TIP?

Back 18

-Either a Luer Slip or a Luer Lock tip

Front 19

What are the 2 parts of a Luer system?

Back 19

-male tapered end
-the reverse tapered female connector flange (p147)

Front 20

TIP of syringes?

Back 20

-portion that holds Needle

Front 21

BARREL of a syringe?

Back 21

-outer portion
-where the calibrations ofor the measurement of the drug volume are located

Front 22

All syringes are available with what type of TIP?

Back 22

-Either a Luer Slip or a Luer Lock tip

Front 23

What are the 2 parts of a Luer system?

Back 23

-male tapered end
-the reverse tapered female connector flange (p147)

Front 24

What are the 2 types of Syringe Tips?

Back 24

-Luer Slip= a male tapered, plain tip (connection is only relatively secure)

-Luer Lock= threaded locking collar outside the male luer slip, that will lock the flange of the female connector securely, "locking" it in place

Front 25

What are the advantages of a GLASS Syringe?

Back 25

-economy
-easy-to-read calibrations
-availability in a wide range of sizes
-can be cleaned, packaged, sterilized & reused

Front 26

What are the Disadvantages of a GLASS syringe?

Back 26

-eaily breakable
-time consuming to clean & sterilize
-plunger may become loose w/ extended use, causing med to "creep" b/w plunger and barrel= Resulting in a inaccurate dose admin to pt

Front 27

What are the advantages of a PLASTIC syringe?

Back 27

-availability in sizes
-prepackaging w/ and w/o neddles in a vareity of gauges and needle lengths
-disposability
-convenience

Front 28

What are the Disadvantages of a PLASTIC syringe?

Back 28

-expense
-one-time use
-sometimes, unclear calibrations

Front 29

What are the advantages of a GLASS Syringe?

Back 29

-economy
-easy-to-read calibrations
-availability in a wide range of sizes
-can be cleaned, packaged, sterilized & reused

Front 30

What are the advantages of a PLASTIC syringe?

Back 30

-availability in sizes
-prepackaging w/ and w/o neddles in a vareity of gauges and needle lengths
-disposability
-convenience

Front 31

Milliliter?

Back 31

-measure of Volume

Front 32

The Shorter lines on a syringe represents?

Back 32

- O.1mL

Front 33

The Longer lines on a syringe represents?

Back 33

- 0.5ml

Front 34

What size syringe is used when administering < 0.5 mL

Back 34

** 1mL syringe

Front 35

Longest line on a Tuberculin syringe represents?

Back 35

- 0.1 (1/10) ml

Front 36

Intermediate line on a tuberculin syringe represents?

Back 36

- 0.05 (5/100)

Front 37

Shortest line on a tuberculin syringe represents?

Back 37

-0.01 (1/100)

Front 38

Where are the Volumes read on a Glass syringe?

Back 38

-at the point where the plunger is directly parallel w/ the calibration on the syringe

Front 39

Where are the Volumes read on a Plastic syringe?

Back 39

-rubber flange of the syringe plunger is parallel to the calibration scale

Front 40

PREFILLED SYRINGE?

Back 40

-premeasured amt of med in a Disposable cartridge-needle unit

-Carpuject
-Tubex

Front 41

What are the Advantages of a PREFILLED SYRINGE?

Back 41

-time saved in preparation
-diminishes chance of contamination b/w patient & nurse (the cartridge is in a sealed unit, used Once and discarded)

Front 42

What are the Disadvantages of a PREFILLED SYRINGE?

Back 42

-additional expenses
-need for diff holders for diff cartridges
-limitation of Volume of a second med that may be added to the cartridge

Front 43

Insulin is inserted in ______ tissue

Back 43

-subcutaneous

Front 44

INSULIN PEN

Back 44

-pre-filled syringe

Front 45

EPI PEN?

Back 45

-disposable automatic injection, prefilled w/ Epinephrine

-use w/ allergy to Insect bites, food, drugs

Front 46

NEEDLE GAUGE?

Back 46

-diameter of the hole through the needle

**the Larger the gauge number (ie. 28g), the Smaller the hole

-gauge is selected based on the viscosity (thickness) of the solution

Front 47

3 parts of a Needle?

Back 47

-hub
-shaft
-beveled tip

Front 48

3 Factors that determine what size of syringe to choose?

Back 48

-volume of med to admin
-degree of accuracy needed to measure dose
-type of med to admin

Front 49

Needle Selection is based on?

Back 49

-viscosity of the solution
-correct needle length for delivery of med to correct site

Front 50

Maximum Volume for IM injections at one site in small children and older adults?

Back 50

-1mL

Front 51

Max. Volume & needle length for small infants?

Back 51

-0.5mL
-1/2 in needle

Front 52

Max. Volume for older children?

Back 52

-Individualized

Front 53

*Volume for INTRADERMAL (ID) route?

Back 53

-0.01mL - 0.1mL

Front 54

*Gauge for ID route?

Back 54

26-29 gauge

Front 55

*Needle Length for ID route?

Back 55

-3/8" - 1/2"

Front 56

*Volume for SUBCUT route?

Back 56

-0.5mL - 1mL

Front 57

*Gauge for SUBCUT route?

Back 57

-25-27 gauge

Front 58

*Needle Length for SUBCUT route

Back 58

-individualize based on depth of appropriate tissue at site

Front 59

*Volume for IM route?

Back 59

-0.5mL - 3mL

Front 60

*Gauge for IM route?

Back 60

-20-22 gauge

Front 61

*Needle Length for IM route?

Back 61

-individualize based on depth of appropriate tissue at site

Front 62

*Volume for IV route?

Back 62

1-2000mL

Front 63

*Gauge for IV route?

Back 63

-20-22 gauge (solutions)

-15-19 gauge (blood)

Front 64

*Length of Needle for IV route?

Back 64

- solutions= 1/2" -1 1/4" (butterfly)

-Blood= 1/2" - 2" (regular needles)

Front 65

How many inches remain above the the skin surface when the injection is admin.?

Back 65

-1/4" to 1/2"
(consider this when judging the needle length)

Front 66

HYPODERMIC syringes?

Back 66

-AKA =standard syringe
-available in 3mL - 60mL

Front 67

When does OSHA require NEEDLELESS Systems to be used? (3)

Back 67

1. collection of body fluids or withdrawal of body fluids after initial venous arterial access is established
2. admin of meds or fluids
3. any other procedure involving the potential for occupational exposure to blood-borne pathogens as a result of percutaneous injuries for contaminated sharps

Front 68

What is an example of a needleless system?

Back 68

-IV med delivery system that admin meds or fluids through a catheter port or connector site using a blunt cannula

Front 69

BLUNT ACCESS DEVICE(spike)?

Back 69

-a safey innovation created to reduce the freq of needle injuries

-spike is used when drawing liquid from a rubber diaphragm-covered-vial

Front 70

FILTER Needle?

Back 70

-a type of blunt device
-contains an internal filter
-used to draw liquid from an ampule
-filter screens out glass particles from ampule

Front 71

Advantages of Blunt access devices?

Back 71

-preventing needle sticks
-nurse can draw up larger amts of fluid volumes faster

Front 72

BD Safety-Lok Syringe provides?

Back 72

-a sleeve that is stored around the syringe barrel p. 153

-after admin sleeve is pulled forward fully, locking the shield in place, covering needle

Front 73

BD Safety Glide shielding Hypodermic needle?

Back 73

device attached to the needle hub
-after injection, nurse pushed hinged shield forward, covering needle

Front 74

BD SafetyGlide Syringe TIny Needle?

Back 74

available for short needles

Front 75

AMPULES

Back 75

-glass container
-contain a single dose
-marking on ampule is the location where the ampule is broken open
P.154

Front 76

VIALS?

Back 76

-glass container w/ 1 or more doses
-can use spike to withdrawal med

Front 77

MIX-O-VIALS?

Back 77

-glass container w/ 1 dose, 2 compartments
-LOWER chamber contains the drug (Solute)
-UPPER chamber contains a sterile diluent (Solvent)

p154(picture)

Front 78

What equipment is needed for preparation of Parenteral Meds?

Back 78

-drug in sterile, sealing container
-syringe of the correct volume
-needles of the correct gauge and length
-needleless access device
-antiseptic swab
-MAR or Medication profile

Front 79

What is the Technique for preparing ALL Parenteral Meds?

Back 79

1. Wash hands
-keep "sterile to sterile" & "unsterile to unsterile" when handling the syringe and needle2. 5 Rights (Patient, Drug, Route, Dose, Time)
3. check drug dose form ordered against the source you are holding
4. check compatibility chart
5. check med calcuations (heparin & insulin, hospital may require calcul. to be checked by 2 nurses)
6. Prepare drug using aseptic tech
7. check exp date

Front 80

What is the technique for preparing a med from an Ampule?

Back 80

1. move all solution to the bottom of the ampule (by flicking side of container)
2. cover ampule neck w/ a sterile gauze or antiseptic swab while breaking the top off
3. use filter needle
4. remove needle from ampule & point Vertically
5. pull back the plunger, replace the aspiration needle w/ a new sterile needle
6. push plunger until med is at tip of needle

Front 81

Diluent?

Back 81

Solvent

Front 82

Solute?

Back 82

Drug

Front 83

*What do you label on a Reconstituted Medication Label?

Back 83

-date/time mixed
-resulting dosage supply
-date/time expired
-initials/title

Front 84

*What is labeled on a multi-use vial after opeing ?

Back 84

-date
-time
-initials

-check agency policy regarding when to discard

Front 85

What is the tech for preparing a med from a vial?

Back 85

p. 156-158

Front 86

Preparing a Drug from a Mix-O-Vial?

Back 86

p159

Front 87

What is the absorption rate for INTRADERMAL Sites?

Back 87

-SLOW

-usually 0.1mL

Front 88

What layer of skin of the intradermal injection?

Back 88

- DERMAL Layer of skin just below the epidermis

Front 89

Intradermal is the route of choice for what injections?

Back 89

-allergy sensitivity test
-desensitization injection
-local anesthetics
vaccinations

Front 90

What meds should a client NOT take within 24-48 hrs of local anesthetics and skin testing (intradermal route)

Back 90

-Antihistamines
-anti-inflammatory
-Immunosuppressant= prednisone

Front 91

Read a PPD test w/in ___ hours?

Back 91

-48 to 72 hrs

*don't massage intradermal sites after injections

Front 92

What are the most common injection sites for Intradermal?

Back 92

-upper chest
-scapular areas of the back
-inner aspect of the forearms

Front 93

What route of injections requires site to be hairles and recive little friction from clothing?

Back 93

-Intradermal

Front 94

What is the gauge and length used for a Intradermal route?

Back 94

-26-29 gauge
3/8" to 1/2" length

ONLY insert bevel of needle

Front 95

Do NOT start any type of allergy testing unless _______ _____ is available in immediate area?

Back 95

-Emergency equipment (in case of an Anaphylactic response

Front 96

What are some examples of an Antiinflammatory agent?

Back 96

-ASA
-Ibuprofen
-corticosteroids

Front 97

PPD

Back 97

-purified protein derivative

-ask if ever had a positive result

Front 98

Usual dose for a TB skin test?

Back 98

-5 units

Front 99

When reading a TB skin test what is the nursing observing for?

Back 99

-erythema (redness)
-induration ((a hard, raised area with clearly defined margins at and around the injection site)

record area in mm

Front 100

Longer absorption/longer duration?

Back 100

-Subcut

Front 101

Faster absorption/shorter duration?

Back 101

-Intramuscular

Front 102

What is the degree of the angle for Intradermal injection?

Back 102

15

Front 103

No reaction to the allergens, especially the positive control is know as ?

Back 103

-ANERGIC reaction

Front 104

Injections are made into the loose connective tissue b/w the Dermis and Muscle Layer?

Back 104

-SUBCUTANEOUS (subcut)

Front 105

Common drugs that are injected into the subcu tissue?

Back 105

-insulin
-heparin

Front 106

Commom sites for Subcut injections?

Back 106

-upper arm
-anterior thighs
-abdomen
Less common areas
buttocks
upper back
scapular region

Front 107

Never admin greater than ___ ml at subcut site?

Back 107

-1mL

Front 108

What gauge and length needle used used w/ SUBCUTANEOUS ROUTE?

Back 108

-25-27 g

- 3/8", 1/2", 5/8"

Front 109

Angle of injection for SUBCUTANEOUS ROUTE?

Back 109

- 45-90 degree angle

Front 110

With subcutaneous route, what is the angle of injection, if able to pitch 2" of skin?

Back 110

-insert needle at 90 degree angle

Front 111

With subcutaneous route, what is the angle of injection, if able to pitch 1" of skin?

Back 111

-insert at 45 degree angle

if pitch < 2", insert at 45 degree angle

Front 112

Where is the only injection site for HEPARIN?

Back 112

-Stomach (2" away from umbilicus & scars)

Front 113

Where is the ONLY injection site for LOVENOX?

Back 113

-Love handles

Front 114

Injection site for INSULIN?

Back 114

-abdomen
-legs
-back

-any subcut sites

Front 115

Subcutaneous Injection sites?

Back 115

-upper arms (outer aspect)
-anterior thighs
-abdomen (from below the costal margin to the iliac crests)

-Less Common-
buttocks
upper back
scapular region of upper back

Front 116

Absorption is slower and drug action is longer?

Back 116

-SUBCUT

Front 117

Where is the drug absorbed w/ SUCUT injection?

Back 117

if circulation is adequate, the drug is completely absorbed from the TISSUE

Front 118

What is the Pre-Assessment before administering HEPARIN?

Back 118

-draw PTT levels and INR

INR-international ratio level

*Never admin w/o checking lab values DAILY*

Front 119

What do you NOT do when administering HEPARIN (2)?

Back 119

-Do NOT aspirate
-Do NOT MASSAGE (may cause hematoma, bruise=contusion)

Front 120

What function class is HEPARIN?

Back 120

-anticoagulant
-anti-thrombotic

Front 121

What pre-assessment is performed before administering INSULIN?

Back 121

-blood glucose
-check order on chart
*always check blood glucose levels before administering insulin*

Front 122

What do you NOT do when administering INSULIN?

Back 122

-do NOT aspirate
-do NOT massage (may form hematoma, bruising)

Front 123

a collection of blood outside of a blood vessel. It occurs because the wall of a blood vessel wall, artery, vein or capillary, has been damaged and blood has leaked into tissues where it does not belong.

Back 123

HEMATOMA

Front 124

When adminstering Insulin, it is important to _____ _____.

Why?

Back 124

-rotate sites

*admin to prevent lipohypertrophy or lipoatrophy, slows the absorption rate of insulin

Front 125

How should insulin injection sites be rotated?

Back 125

-rotate SYSTEMATICALLY, w/in 1 area before progressing to a new site

Front 126

When injecting insulin, why rotate sites systematically?

Back 126

-to decrease variations in absorption

Front 127

Absorption of INSULIN is known to be fastest if absorbed, Where?

Back 127

-abdomen followed by arms, thighs, and buttocks

Front 128

What will affect absorption rate of INSULIN?

Back 128

-Exercise (site selection should take this factor into consideration)

Front 129

Why rotating sites of injection for INSULIN important?

Back 129

-Enhance drug absorption
-prevent LipoDystrophy
-prevent LipoHypertrophy
-preserve tissue integrity
-promote comfort

Front 130

LipoDystrophy?

Back 130

-disorder of adipose (fatty) tissue characterized by a selective loss of body fat. Patients with lipodystrophy have a tendency to develop insulin resistance, diabetes, a high triglyceride level (hypertriglyceridemia), and fatty liver

Front 131

localized hypertrophy of subcutaneous fat at insulin injection sites caused by the lipogenic effect of insulin.

Back 131

LipoHypertrophy

Front 132

When does the nurse Check the accurracy of the drug order against the med being prepared?

Back 132

-when 1st removing drug from storage area

-immediately after preparation storage area

-immediately before administration

Front 133

What is the rational for adding air to the syringe AFTER accurately measuring the prescribed volume of drug?

Back 133

-it will result in the needle being completely cleared of all medication at the time of injection

Front 134

IM injections penetrate what layers of skin?

Back 134

-epidermis
-dermis
-subcutaneous
-MUSCLE layer

Front 135

IM injections are more rapidly absorbed than _______ injections.

Why?

Back 135

-Subcut b/c muscle tissue has a greater blood supply

Front 136

Why is site selection so important w/ IM injections?

Back 136

-incorrect placement of needle may cause damage to nerves or blood vessels

Front 137

What factors influence IM syringe size that corresponds to the: (5)

Back 137

-volume of drug to be injected at 1 site
-type of med
-site of admin'
-thickness of subcut fatty tissue
-age

Front 138

Gauge and Needle size for IM injection?

Back 138

-Needle: 1 to 1 1/2" (based on pt size, needles go up to 3", ie. 400lb pt)

Gauge: 20-22 gauge

Front 139

Always inject IM at ____ degree angle?

Back 139

-90

Front 140

What is the max volume for deltoid muscle?

Back 140

-no more than 1mL

Front 141

When injecting, HOw much of the needle should be extending above the skin surface?

Back 141

1/4"

-consider this when estimating needle length for the pt

Front 142

How is the VENTROGLUTEAL site located?

Back 142

-use opposite hand (Left)
-place heal/palm of hand over greater trochanter (lateral portion)
-wrist perpendicular to femur
-point thumb toware groin & fingers toward client's head
-index finger on the anterior superior iliac spine
-extend middle finger back along the iliac crest toward the buttock
-a "V" is formed b/w index & middle finger
-Make injection site into center of the "V"

Front 143

Preferred injection site for infants?

Back 143

-Vastus Lateralis

Front 144

What injection site must NOT be used in children younger thatn 3 years old?

Back 144

-Gluteal area b/c muscle is not well developed for walking

Front 145

In what clients should the nurse carefully assess the sufficiency of the muscle mass before using the Vastus Lateralis site of injections?

Back 145

-older adult
-debilitated adult
-nonambulatory adult

Front 146

Where is the location of the RECTUS FEMORIS?

Back 146

-lies medial to the Vastus lateralis but does not cross the midline of the anterior thigh

Front 147

How is the injection site for RECTUS FEMORIS muscle located

Back 147

-same as vastus lateralis
(one handbreadth above the knee to 1 handbreadth below the greater trochanter)

site maybe used in both children and adults when other sites are unavailable.

Front 148

What is the Primary Advantage to using the RECTUS FEMORIS site for injections?

Back 148

-used more easily by patients for self -admin

Front 149

What is the DISAdvantage to using the RECTUS FEMORIS site for injections?

Back 149

-the medial border is close to the sciatic nerve and blood vessels

Front 150

What is the MAX volume of injection for the VENTROGLUTEAL muscle?

Back 150

-3 mL

-it's a Large muscle

Front 151

What are the Advantages for using the VENTROGLUTEAL muscle for injections?

Back 151

-deep and away from major nerves and blood vessels

Front 152

What is the preferred injection site for small or debilitated clients?

Back 152

-VENTROGLUTEAL

Front 153

Reaction readings of an allergy test
-1+
-2+
-3+
-4+

Back 153

1+ No wheal, 3mm flare
2+ 2 to 3mm wheal w/ flare
3+ 3 to 5 mm wheal w/ flare
4+ >5 mm
-a positive reaction to delayed hypersensitivity skin testing requires an induration of at least 5mm in diameter

Front 154

What is the gauge and needle length used for Pediatric IM injections?

Back 154

25 to 26 gauge
1" to 1 1/2" needle

ie 15 month old
(question from book)

Front 155

Do not aspirate when giving what 2 meds, Subcut?

Back 155

-heparin
-insulin