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198 Cards in this Set

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What must a nurse do before administering any medication?
Before administering any medication you must obtain a medication order from the care provider and verify that it is complete and correct
List 6 essential elements of a complete medication order
1. Patient's full name
2. Date and time order was written
3. Name of medication
4. Dosage (including size, frequency, and number of doses)
5. Route of administration
6. Signature of prescriber
Once a nurse determines a medication order is legible enough to read accurately, what questions should be asked about the ordered drug?
-Is the order legible enough for me to read?
-Is the ordered dose within the normally prescribed dosage range?
-Is the ordered route appropriate?
-Is the drug appropriate for the patient?
-Is the patient allergic to the medication ordered?
-Are the administration times appropriate?
When is the term "prescription" used to describe a medication order?
given to the pharmacy (often by the patient) to obtain medications for self-administration
When is the term "physician's order" used to describe a medication order?
used in the hospital or ambulatory care setting
What is the safest way to write words when dealing with medications?
It is always safest to write words out in full when you deal with medications.

Use abbreviations carefully, because some may be similar and confusing
Where would a nurse check for appropriate abbreviations to use in a medical facility?
You should be familiar with institutional policies for use of abbreviations and know the acceptable abbreviations used by that facility.
What term is used for an order that is applied indefinitely until the prescriber writes an order to alter or discontinue the medication?
Standard written orders
What term is used for protocols that hospitals use for discontinuing medication after a certain length of time?

Give an example of a class of medication managed this way.
Automatic stop dates

Narcotics-- in effect for only 7 days, another order must be written if needed after stop date
What term is used for an order of a single dose of medication to be given immediately and only once?
STAT order
What are two terms used for an order of a medication to be given only once at a specified time?

Give an example for a reason this type of medication order may be used.
Single order or one-time order

Preoperative medications, given prior to surgery or diagnostic procedures or treatments, are single orders
What term is used for an officially accepted set of orders to be applied routinely by nurse for the care of patient under certain condition or under certain circumstances and are established guidelines for treating a particular disease or set of symptoms?
Standing orders
What term is used for an order of a medication to be given whenever a patient requires?

Name two limitations that must be specified in the order.

Give three examples of medications that are usually given this way.
PRN orders

1. the condition for which the medication is to be given
2. The minimum time intervals between doses

1. Pain medications
2. Antiemetics (antinausea medications)
3. Laxatives
List three ways orders may be communicated.
1. Written orders
2. Verbal orders
3. Telephone orders
Why are verbal orders avoided?

When are they appropriate?
Avoid taking verbal orders and use them only in urgent situations, because they increase the risk for miscommunication and errors.

Given orally rather than in writing, while the physician is present with the nurse.
When are telephone orders usually needed?

What must the physician do after giving verbal or telephone orders?
Usually this will be in response to a call you have placed to report a change in the patient's condition or the results of laboratory or other tests.

The physician usually must cosign verbal and telephone orders within 24 hours.
Before meals
As desired
ad. lib.
Twice a day
Hour of sleep
After meals
Whenever there is a need
Every morning
Every day
Every hour
Every 4 hours
4 times a day
Every other day
every other day
Give immediately
Three times a day
Official "Do Not Use List"
U --> "unit"
IU --> "international unit"
Q.D., q.d. --> "daily"
Q.O.D., q.o.d. --> "every other day"
X.0 mg --> "X mg"
.X mg --> "0.X mg"
MS --> "morphine sulfate"
MSO4 & MgSO4 --> "magnesium sulfate"
Additional possible future "Do Not Use" list
> --> "greater than"
< --> "less than"
Abbreviations for drug names --> "write full drug names"
Apothecary units --> "metric units"
@ --> "at"
cc --> "ml" or "milliunits"
ug --> "mcg" or "micrograms"
Name seven responsibilities of the nurse when administering a drug order.
1. Interpret the order
2. Prepare the exact dosage of the prescribed drug
3. Identify the patient
4. Administer the proper dosage by the prescribed route, at the prescribed time intervals
5. Educate the patient regarding the medication
6. Record the administration of the prescribed drug
7. Monitor the patient's response for desired (therapeutic) and adverse effects
intravenous piggyback
before meals
after meals
when necessary
twice a day
three times a day
four times a day
a (with line on top)
p (with line on top)
c (with line on top)
s (with line on top)
nothing by mouth
List the seven parts of a legal drug order
1. Name of the PATIENT
2. Name of the DRUG to be administered
3. DOSAGE of the drug
4. ROUTE by which the drug is to be administered
5. FREQUENCY, time, & special instructions related to administration
6. DATE & TIME when the order was written
7. SIGNATURE & LICENSURE of the person writing the order
What is the sequence a drug order is written in?
The name of the drug is written first, followed by the dosage, route, & frequency
Is the generic name written with upper or lower case letters?

Is the brand name written with upper or lower case letters?
generic= lower case letters

brand= upper case letters
After the prescriber writes an order, where is it transcribed?

What does the abbreviation MAR stand for?

Identify three nursing actions using the MAR
The drug orders from the physician's order form are transcribed to a MAR

[MAR]Medication Administration Record

1. Check the drug order
2. Prepare the correct dosage
3. Record the drug administered & time
Identify four advantages for computerize medication administration systems
1. The computer can keep track of drug stock and usage patterns and even notify the business office to post charges to the patient's account.
2. It can scan for information previously entered, such as drug incompatibilities, drug allergies, safe dosage ranges, doses already given, or recommended administration times.
3. The health care staff can be readily alerted to potential problems or inconsistencies.
4. The corresponding medication administration record may also be printed directly from the computer [this reduces the risk of misinterpreting handwriting]
List three locations in inpatient health care facilities where medications may be stored and prepared by nurses.
1. central room ["medication room"]
2. mobile cart
3. locked cabinet in or near patient rooms
Describe the stock supply system

name one advantage

name one disadvantage.
Medications used most frequently may be kept in stock supply (bulk quantity), labeled, and in a central location.

Advantage: A bulk supply of medication is often extremely cost-effective.

Disadvantage: Stock supplies require you to measure the dose each time a patient needs it, so the potential for measurement error is present each time a dose is poured.
Describe the storage unit for the unit-dose system.
A locked, mobile cart is used, with drawers containing separate compartments for each patient's medications.

Limited amounts of PRN and stock medications are also kept in the mobile cart.
For what interval of time will medication be supplied using the unit dose system?
The pharmacy staff refills the drawers each shift or every 24 hours.
Define "unit dose"
the ordered amount of drug the patient receives at a single time
Name two advantages for the unit-dose system.
1. Each unit dose (usually one tablet) is individually packaged and labeled with the name, dose , and expiration date.
2. The unit dose system not only saves nursing time, but also is the safest method because of the double-check system
Describe a few functions of the automated medication dispensing systems.
a computerized system similar to unit dosage

The locked cart contains all the medications frequently used on a particular nursing unit, and the computer database contains records and counts of the medications, as well as the medication orders for each patient on the unit.
What would you consider as major advantages to the automated dispensing systems?
-The machine tracks dispensed medications for billing and controlled-substances monitoring.
-The medications are usually packaged in unit doses, but some bulk medications may also be kept on the cart.
-Allows for immediate administration of newly ordered meds, PRN meds, controlled substances, and emergency meds because the drugs are available on the unit [so the nurse doesn't need to wait for the pharmacy to fill an order]
What are the nursing responsibilities regarding self administration of medication?
Remind the patient to tell you when he takes the drug. This method promotes independence and allows you to evaluate prior to discharge the patient's ability to manage medications safely and accurately.
List four places a drug or food allergy should be recorded
1. admission notes
2. front of the patient's chart
3. MAR
4. Kardex
In addition to listing the type of allergy, what other information should be noted?
Correlate previous allergies with the potential for allergic reactions to similar medications
What information should be included in a list of the patient's current medication?
- all medications pt is taking
- length and time of each has been taken and the current dosage
- reason for taking them
- responses [expected, actual and adverse effects]
When taking a medication history, what two questions should be asked of all women between the ages of 14 and 60?
always ask women of child-bearing age where they are or might be pregnant and whether they are breastfeeding
Name four drug factors that may be monitored by laboratory tests.
1. serum drug levels
2. medication effects
3. medication side effects
4. proper dosages for the patient
What considerations may need to be taken regarding oral medications if a patient is scheduled for surgery and has an order for NPO (nothing by mouth)?
- Patients are usually NPO for several hours beforehand.
- NPO Patients usually have orders for important medications
- The plan of care must be discussed with the anesthesiologist.
- alternate route of administration may be ordered
- medications given with a few sips of water
Define polypharmacy
the ingestion of numerous medications in an attempt to treat many conditions simultaneously
What population of people are especially prone to polypharmacy?

Older adults may be especially prone to polypharmacy.

They typically take several medications prescribed for chronic diseases, and many experience symptoms related to the aging process for which they self-medicate.
Define noncompliance
[nonadherence] failure to follow the treatment plan (e.g., not taking a prescribed medication, or skipping doses)
Identify some reasons a person might be non-compliant.
- people on a limited budget often simply do not buy the more costly medications, or they may take only partial doses of maintenance medications
- some patients [older adults], may have visual and motor deficits that limit their ability to read labels and manipulate bottle caps, syringes, etc.
- lack of symptoms, inability to tolerate side effects, forgetfulness, and impaired mental capacity
According to a study published by the American Journal of Nursing (AJN) in 2003, what percentage of medication doses were administered incorrectly by nurses?
List examples of reported medication errors
- giving the dose at the wrong time
- omitting doses
- giving the wrong dose
- giving the dose without authorization
List and memorize the three times each medication should be checked
***ALWAYS check its label against the entry on the MAR!!!
1. BEFORE you pour, mix or draw up a medication
2. AFTER you prepare the medication, and before returning the container to the medication cart or discarding anything
3. AT THE BEDSIDE, check the medication again before actually administering it
What precautions regarding the appearance or name of a drug may help ensure the right drug is given?
- Avoid selecting medications based on size and color, because many medications are the same size, shape, and color as others.
- Similarly, be alert for similar-looking labels and similarly spelled names.
What precaution may be taken when repeating back verbal orders that may ensure the right drug is given?
- Always repeat back verbal orders to be sure you have heard correctly.
- Spell the medication name [medication names that sound the same can be very confusing and lead to administering the wrong drug]
How should a nurse break a tablet to help ensure the right dose is given?
use a knife or a cutting device, if the tablet does not break evenly, you should discard it
What time window is usually allowed in order for a scheduled medication to be considered given at the right time?
given within a "window" of one-half hour before and one-half hour after the scheduled time
According to the Joint Commission, how many forms of identification should be used to identify patient to help ensure medication are given to the right patient?
2 methods of patient identification and also ask the patient to state his name
When is administration of a medication documented on the MAR?
after administering a medication, document it immediately
When documenting a medication on a preprinted MAR, what should the nurse include?
- Name of medication give
- Dose of medication given
- Route of administration and injection site for parenteral medications
- Date and time administered
- Your name or initials as administering nurse
What should a nurse document if a schedule medication is not given?
If for some reason you do not administer an ordered medication, document that information on the MAR and write a nurse's note explaining the reason it was not given.
What should the nurse include in the documentation of a PRN medication?
In addition to recording on the MAR, you should write a nurse's note documenting your assessment and the time the drug was given. Then, after allowing time for the medication to be absorbed and take effect, evaluate and document the patient's responses.
How should a calibrated cup be held when pouring a liquid to measure the dosage?
Measure the dosage with the calibrated cup at eye level
What alternative technique may be used to administer liquid medication if a patient has difficulty taking liquids from a cup?

List two precautions to help prevent aspiration.
Use a syringe without a needle to place the medication in mouth; place the syringe between the gum and cheek, and slowly push the plunger to administer the liquid slowly.

Place the patient in a SIDE-LYING or UPRIGHT position to help prevent choking and aspiration.
Name three enteral tubes that may be used to give oral medication. Use your medical dictionary to define how these tubes differ.
1. Nasogastric (NG)- A tube that is passed through the nose and down through the nasopharynx and esophagus into the stomach.
2. Gastrostomy- A gastrostomy feeding tube insertion is the placement of a feeding tube through the skin and the stomach wall, directly into the stomach.
3. Jejunal tube- a tube placed directly into the jejunum for long-term enteral feeding.
List five methods a nurse may use when giving a patient an oral medication with an objectionable taste?
1. Unless contraindicated, have the patient drink a liberal amount of flavored liquid (e.g. juice) or water to dilute the medication.
2. Have the patient suck on ice chips for several minutes before taking the medication. Ice numbs the taste buds.
3. Store the medication in the refrigerator. Especially if it is an oily liquid, its smell and taste will be less objectionable.
4. Use a syringe to place the medication on the back of the patient's tongue. There are fewer taste buds there.
5. Regardless of method, offer oral hygiene immediately after giving the medication.
List three examples of situations when oral medications should not be given to patients.

Give two actions a nurse could take in these situations.
1. Cannot swallow fluids. The risk for aspiration is too great.
2. Have nausea or vomiting. The medication would be lost in the emesis.
3. Are NPO.

1. It may help to crush soluble tablets and place them in liquids or in a small amount of applesauce or pudding.
2. In NPO case, you should obtain a medical order for an alternative route or permission to give the medication with small sips of water.
What precaution should the nurse take to protect oneself when administering transdermal medication?
Wear gloves when applying and removing transdermal patches. Also, avoid placing the patch where there are skin lesions.
What statement should appear on all packaged opthalmic medications?
"For opthalmic use only."

**Do not place any medication in the eye unless this statement appears on the container.
Why should otic medications be administered at room temperature?
Use solutions at room temperature, because a solution that is too hot or too cold may cause vertigo, nausea, and pain.
Why are suppositories usually kept in the refrigerator?
to keep them firm enough to insert
Give three reasons why the rectal route might be preferred over the oral route.
1. may provide for higher blood levels of the medication [venous blood from the rectum does not pass through the liver before entering the general circulation]
2. when a drug has an unacceptable taste or odor
3. when it is not safe to use the oral route [patient who is vomiting or unconscious]
What does MAR stand for?
Medication administration record
To whom may an RN delegate medication administration?
to a licensed practical nurse (LPN/LVN)
**except for intravenous medications
What medication related tasks may be delegated to unlicensed assistive personnel (UAP)?
you can instruct a UAP in the therapeutic effect and side effects of medications and to report any effects observed.
If a state allows a UAP to administer medications, what is the RN still responsible for?
evaluating client responses, both therapeutic effects and side effects
List nine factors that should be assessed prior to administering any medication.
1. Assess your knowledge of the medication [e.g. drug action, purpose, recommended dosage, time of onset and peak action, common side effects, contraindications, drug interactions, and nursing implications]
2. Determine whether the prescribed dosage is appropriate for the patient's age and weight.
3. Check for any history of allergies to medications or food.
4. At least on the first administration, assess the patient's knowledge about the medications being given.
5. Assess the patient's ability to cooperate during the procedure.
6. Assess for any factors that would interfere with drug absorption [e.g. diarrhea, inadequate circulation, other medications]
7. Before administering the medication, assess vital signs and check lab studies specific to the medication to determine whether the medication can be safely administered.
8. Assess for patient findings that might affect absorption and/or metabolism of the medication, such as impaired liver function, edema, inflammation, or age-related changes.
9. Assess for any reasons that would preclude administering the medication, such as oral medications prescribed for a patient who is NPO for surgery or a test, who is vomiting, who has difficulty swallowing, or who is too sedated.
Although most agencies allow medications to be given 30 minutes before or 30 minutes after the time indicated on the MAR, is this good practice to follow on all medications?
No, the time of administration is more important for some medications.

ex. if an anti-infective agent is given early or late, a therapeutic blood level may not be maintained
There is an error in the textbook regarding the information about cephalexin (Keflex) in the paragraph about the right dose. Do some research in your drug guide to find out what the error is.
Keflex is an antiinfective not an antibiotic
Give one example of a bad medication habit that may lead to medication being given to the wrong patient.

What other "right" could be violated by continued use of this poor habit?
Asking the patient "Are you John Smith?" rather than Asking the patient "What is your name?"

"right patient" is being violated
What does it mean when medications have cross-sensitivity?
Some medications (e.g. penicillin and the cephalosporins) have cross-sensitivity; that is, a patient with a penicillin allergy is at high risk for also being allergic to cephalosporins.

Medications can also have cross-sensitivity with certain foods.
Prior to preparing medication what should the nurse do to minimize transmission of microorganisms?
wash your hands
When is the first check for the five rights of medication administration?
Select the ordered medication, and compare medication with the MAR for the first five rights (patient, drug, dose, route, time); check for drug allergies
When is the second check for the five rights of medication administration?
After preparing the medications, verify the correct medication, dose, route and time
When is the third check for the five rights of medication administration?
in the patient's room to verify that you are administering the correct medication to the correct patient
Give two important reasons to explain medication to the patient.
1. Increases the patient's understanding of and compliance with treatment.
2. The patient may identify potential errors in medication administration.
What should a nurse do if a patient questions a medication?
double-check the medication
How long should a nurse remain with a client after providing the medication?
until you are sure the client has taken the medication
Name four factors a nurse should assess as part of the evaluation process following medication administration.
1. therapeutic effects of medication, such as checking blood pressure after administering an antihypertensive medication or pain level after an analgesic
2. be alert for any adverrse reactions
3. side effects
4. allergic reactions
List three medication documentation "Do Not's"
1. Do not document before giving the drug
2. Do not document for anyone else
3. Do not ask another nurse to document a drug you have given
What action should the nurse take if the client is unable or refuses to take medication?
document on the MAR that that medication was not administered, along with the reason, and inform the physician
Define adverse drug reaction
aka ADR, any noxious, unintended, and undesired effect that occurs at normal drug doses
What conditions are excluded from the adverse drug reaction definition?
excludes undesired effects that occur when dosage is excessive (e.g. because of accidental poisoning or medication error)
Name four adverse reactions that might be considered "mild"
1. drowsiness
2. nausea
3. itching
4. rash
Name five adverse reactions that would be considered serious and potentially could result in death
1. respiratory depression
2. neutropenia
3. hepatocellular injury
4. anaphylaxis
5. hemorrhage
Name two age groups that are more vulnerable to adverse drug reactions than others
the elderly [patients over 60] and the very young
Name two factors, besides age, that increase the risk of an adverse drug reaction
1. severe illness
2. patients receiving multiple drugs
Define side effect
a nearly unavoidable secondary drug effect produced at therapeutic doses
What can be said about the predictability, intensity and time of onset of "side effects"?
Side effects are generally predictable and their intensity is dose dependent. Some side effects develop soon after the onset of drug use, whereas others may not appear until a drug has been taken for weeks or months
Define toxicity
an adverse drug reaction caused by excessive dosing
What has "toxicity" come to mean in more common everyday usage?
in everyday parlance the term toxicity has come to mean any severe adverse drug reaction, regardless of the dose that caused it
Define allergic reaction
an immune response in which the immune system has been sensitized to a drug, re-exposure to that drug can trigger an allergic response
What must have happened for an allergic reaction to occur?
there must be prior sensitization of the immune system
What primarily determines the intensity of an allergic reaction?
determined primarily by the degree of sensitization of the immune system--not by drug dosage.
**the intensity of allergic reactions is largely independent of dosage
Name the family of drugs that causes the most serious allergic reactions
the penicillins
Define idiosyncratic effect
an uncommon drug response resulting from a genetic predisposition
Briefly explain what is meant by an iatrogenic disease caused by a drug
Iatrogenic diseases are nearly identical to idiopathic (naturally occurring) diseases.
--if a syndrom is drug induced and essentially identical to a naturally occurring pathology, we would call the syndrome an iatrogenic disease
define physical dependence
a state in which the body has adapted to prolonged drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued
define carcinogenic effect
the ability of certain medications and environmental chemicals to cause cancer
define teratogenic
a drug-induced birth defect
name four organs that are common sites of injury due to drug toxicity
1. kidney
2. heart
3. lungs
4. inner ear
what is the most common reason for withdrawing an approved drug from the market?
the ability to cause severe liver damage
If a patient needs to take a drug that is hepatoxic what should be monitored?
the liver function by undergoing LFTs [liver function tests]
Name 8 signs of liver injury that should be included in patient teaching for persons taking hepatotoxic drugs
1. jaundice (yellow skin and eyes)
2. dark urine
3. light-colored stools
4. nausea
5. vomiting
6. malaise
7. abdominal discomfort
8. loss of appetite
Very briefly identify the very serious adverse effect some drugs can have on the heart that may result in death.
OT interval is prolonged, patients can develop a dysrhythmia known as torsades de pointes, which can progress to potentially fatal ventricular fibrillation
How may a nurse report a previously unknown adverse effect suspected to be a result of a drug?
you should report the effect to MEDWATCH, the FDA Medical Products Reporting Program.
**you can file your report electronically via the MEDWATCH web site:
How does the Pharmaceutical industry contribute to the reduction of adverse drug reactions?
The pharmaceutical industry must strive to produce the safest possible medicines
How does the Prescriber contribute to the reduction of adverse drug reactions?
the prescriber must select the least harmful medicine for a particular patient
How does the Nurse contribute to the reduction of adverse drug reactions?
the nurse must evaluate patients for ADRs and educate patients in ways to avoid or minimize harm
How does the Patients and families contribute to the reduction of adverse drug reactions?
patients and families must watch for signs that an ADR maybe developing, and should seek medical attention if one appears
What is done to monitor for toxic drug effects to the Liver?
-the patient should be monitored for signs and symptoms of liver damage [jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite]
-and periodic LFTs should be performed.
What is done to monitor for toxic drug effects to the Kidney?
-the patient should undergo routine urinalysis and measurement of serum creatine.
-periodic tests of creatine clearance should be performed.
What is done to monitor for toxic drug effects to the Bone marrow?
periodic blood cell counts are required
How does the Davis's Drug Guide identify side effects and adverse reactions?
side effects are underlined and adverse reactions are CAPITALIZED or is another color.
Choose any page in the drug guide and look at the bottoms of the page. What is stated following the word "underlines"?
underlines- most frequent [side effects]

CAPITALS- life threatening [adverse reactions]
So in the Davis's Drug guide what might you conclude about what they categorize as side effects and adverse reactions?
This drug guide considers reactions that occur most frequent as SIDE EFFECTS

This drug guide considers reactions that are life threatening as ADVERSE REACTIONS
Define medication error
"any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, healthcare produces, procedures, and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use."
Describe the full process of medication administration in the hospital setting.
First- it begins with... a physician writing a prescription
Then... someone transcribes the order
Then in the pharmacy... someone enters the order
Then... a pharmacy technician prepares the order
Then... a pharmacist checks it
Finally... a nurse checks the order again and then administers the drug
Who is the patient's last line of defense and the last person with the opportunity to make a medication error?
the nurse
Review the 13 types of medication errors in Table 7-3 p 70
1. Wrong patient
2. Wrong drug
3. Wrong route
4. Wrong time
5. Wrong dose
- overdose
- underdose
- extra dose
6. Omitted dose
7. Wrong dosage form
8. Wrong diluent
9. Wrong strength/ concentration
10. Wrong infusion rate
11. Wrong technique [includes appropriate crushing of tablets]
12. Deteriorated drug error [ dispensing a drug after its expiration date]
13. Wrong duration of treatment [continuing too long or stopping too soon]
Name the three categories of medication errors that account for 90% of all errors.
1. human factors
2. communication mistakes
3. name confusion
What are the three most common human factors causing medication errors?
1. performance deficits eg. administering a drug IV instead of IM [29.8%]
2. knowledge deficits [14.2%]
3. miscalculation of dosage [13%]
Identify 4 factors involved in miscommunication that frequently lead to medication errors.
1. Illegible handwriting
2. misreading or failure to read
3. confusion regarding decimal point placement in dosage
4. confusion between metric and apothecary units
What is the central theme in the efforts to change the institutional culture regarding medication errors?
to change institutional culture from one that focuses on "naming, shaming, and blaming" those who make mistakes to one focused on designing institution-wide processes and systems that can prevent errors from happening
What can be the result if an institutional environment is primarily punitive in regards to medication errors?
naming, blaming and shaming should be stopped as to encourage both the identification of errors and development of new safety systems
List 12 things that a nurse should consider including when planning to teach patients about their medication.
1. generic and brand names of medications
2. purpose of medications
3. dosage and how to take medications
4. what to do if dose is missed
5. duration of therapy
6. minor side effects and what to do if they occur
7. serious side effects and what to do if they occur
8. medications to avoid
9. foods to avoid and other precautions
10. how to store medications
11. follow up care
12. what not to take
Why is it important to give patient written instructions to take home?
so patients have visual reminders
What are scored tablets?

In how many parts is it possible to find scored tablets divided?
those marked for division

can be divided into halves or quarters
During step one of the dosage calculation process (covert) what must be assured before proceeding?
ensure that all measurements are in the same system of measurement and the same size unit of measurement. if not, convert before proceeding
During step two of drug calculation process (Think) what should the nurse estimate?
estimate what is a REASONABLE AMOUNT of the drug to administer
What is the dosage calculation formula?
D(desired) /(divided by) H(have) x(multipy by) Q(quantity) = X(amount)
Why is it wise to get in the habit of using the quantity value in the formula even when the Q is 1?
So that you will be prepared to accurately calculate dosages for oral liquid or parenteral injection drugs that may be supplied in a solution strength quantity of more or less than 1 (mL)
What is the maximum number of tablets for single dose of medication?
usually 3
Name three reasons that IV fluids may be used
1. replacement of loss fluids
2. to maintain fluid and electrolyte balance
3. to administer IV medication
define replacement fluids
often ordered because of losses that may occur from hemorrhage, vomiting, or diarrhea
define maintenance fluids
sustain normal fluid and electrolyte balance
**maybe be used for the patient who is not yet depleted by its beginning to show symptoms of depleteion
Define continuous infusion
replace or maintain fluid and electrolytes and serve as a vehicle for drug administration
Define intermittent infusion
such as IV PB and IV push infusions are used for IV administration of drugs and supplemental fluids
What is the responsibility of the nurse who is monitoring IV infusions?
to ensure that the correct IV fluid is administered to the correct patient at the prescribed rate, following the same six rights for medication administration
Identify the percent strength of the following solutions:
1. 5% Dextrose Injection =
2. 0.9% Sodium Chloride =
3. 0.45% Sodium Chloride =
4. 0.225% Sodium Chloride =

What is the common reference volume of all of them?
1. 5g Dextrose in 100mL
2. 0.9g or 900mg Sodium Chloride in 100mL
3. 0.45g or 450mg Sodium Chloride in 100mL
4. 0.225g or 225mg Sodium Chloride in 100mL

What is the percent strength of Sodium Chloride in the following IV solutions identified by their commonly used name or abbreviations?
1. Normal Saline (NS) =
2. 1/2 Normal Saline (1/2 NS) =
3. 1/4 Normal Saline (1/4 NS) =
1. 0.9% Sodium Chloride
2. 0.45% Sodium Chloride
3. 0.225% Sodium Chloride
Identify the full name of the following IV Solutions identified by their commonly used name or abbreviations:
1. D5W
2. D5NS
3. D51/2NS
4. D51/4NS
5. LR
6. D5LR
1. 5% Dextrose in water
2. 5% Dextrose in Normal Saline (0.9% NaCl)
3. 5% Dextrose in 1/2 Normal Saline (0.45% NaCl)
4. 5% Dextrose in 1/4 Normal Saline (0.225% NaCl)
5. Lactated Ringer's
6. 5% Dextrose in Lactated Ringer's
Briefly explain the components of Lactated Ringer's Solution (or Ringer's Lactate).

Why is it used?

What does the name mean?
What unites of measurement is usualli to regulate a promary IV infusion (Delivery Rate) using an electronic infusion pump?
Explain the difference between primary and secondary IVs and IV tubing
Primary IV tubing includes a drip chamber, one or more injection ports, and a roller clamp and is long enough to be attached to the hub of the IV catheter positioned int he patient's vein.

Secondary IV tubing is used when giving medications, usually "piggybacked" into the primary line. This type of tubing generally is shorter and also contains a drip chamber and roller clamp.
In order to manually regulate an IV rate, what will the calculated drip rate be based on?
drops per minute (gtt/min)
What is the drop factor based on?
drops per milliliter (gtt/mL)
All microdrip tubing has what drop factor?
1. Macrodrip tubing with a drop factor of 20 means...
2. Macrodrip tubing with a drop factor of 15 means...
3. Macrodrip tubing with a drop factor of 10 means...
4. Macrodrip tubing with a drop factor of 60 means...
1. 20 drops will equal 1mL
2. 15 drops will equal 1mL
3. 10 drops will equal 1mL
4. 60 drops will equal 1mL
Write the formula to calculate IV flow rates for manually regulated IVs.
V/T x C = R

Volume(mL)/Time(min) x Calibration or drop factor(gtt/mL) = Rate(gtt/min)
What unit of measurement must the VOLUME to calculate IV flow rate be expressed in?
What unit of measurement must the TIME to calculate IV flow rate be expressed in?
What is the drop factor (or calibration factor) always expressed in?
gtt per mL
What is the drip rate for manually regulated IVs always expressed in?
gtt per min
What can you actually see falling in the drip chamber... drops or mL?
What is a reasonable amount of time to count drops falling... one minute or one hour?
one minute
Therefore is the calculated drip rate to be counted in the drip chamber ever expressed in mL per h?
What is the drop factor constant for a drop factor of:
1. 10 gtt/mL
2. 15 gtt/mL
3. 20 gtt/mL
4. 60 gtt/mL
1. 60/10 = 6
2. 60/15 = 4
3. 60/20 = 3
4. 60/60 = 1

**the drop factor constant is 60 divided by the drop factor
What is the shortcut method to calculate IV flow rate?
(mL/h)/drop factor constant = gtt/min
What are the six rights of safe and accurate medication administration?
1. The RIGHT PATIENT must receive
2. the RIGHT DRUG in
3. the RIGHT AMOUNT by
4. the RIGHT ROUTE at
5. the RIGHT TIME followed by