Fundamentals Of Nursing Chapter 35

Front 1

Arrange the routes of medication administration in descending order of absorption

Back 1

1. intravenous

2. intramuscular

3. Subcutaneous

4. Oral

Front 2

what precautions should the nurse take to prevent infection during injection administration?

Back 2

1. Cover the tip of the syringe with a cap

2. Clean the skin with an antiseptic swab

3. Avoid touching the needle with the contaminated area

Front 3

The patient tells the nurse "it feels like the medication is stuck in my throat". What should the nurse tell the patient?

Back 3

1. drink fluids after swallowing

2. crush certain medications and put them in pudding

3. eat a small amount of food after swallowing

Front 4

The nurse is administering medications to a 4 year old. The mother states "I don't remember my child ever having that medication" what should the nurse do next?

Back 4

Withheld medications and verify the prescription

Front 5

The nurse has been assigned to give a medication in the dose of 10 mg/kg to a patient weighing 44 lbs. How many mg's should the nurse give?

Back 5

44/2.2 = 20 kg

20 x 10 = 200 mg

Front 6

How should the nurse position the patient that has to undergo administration of a nasal spray?

Back 6

- tilt the head slightly back

- Have the patient lay in the supine position with the head tilted slightly back

Front 7

The various steps of vaginal suppository administration in order

Back 7

1. Lubricate the applicator or suppository using a water soluble gel

2. expose the vaginal orifice with non dominant hand

3. Fully insert the applicator, using a rolling motion inserting downward and backward.

4. instruct the patient to remain on her side for 5-10 minutes

Front 8

IM injection site for a 6 month old?

Back 8

Vastus Lateralis

Front 9

IM injection site for children and adults?

Back 9

deltoid

Front 10

4 mg morphine sulfate ordered. Medication comes in an ampule reading 10 mg/1mL. How many mL's should be administered?

Back 10

(ordered dose/dose on hand)

= 4/10 = 0.4 mL

Front 11

Which instructions does the nurse give to a patient who is administering a transdermal patch?

Back 11

1. Mark the patch with the date and time before applying it.

2. Rotate placement site of the patches to prevent irritation

3. fold the old patch so that it sticks to itself before disposing of it.

Front 12

The nurse administers an opioid analgesic to a patient. Which vital sign does the nurse delegate to the aid?

Back 12

Respiratory Rate

Front 13

A medication has a minimum effective concentration of 25 mg/dL and the therapeutic range is 25-100 mg/dL. What is the plasma concentration above which the toxic effects of the drug may appear?

Back 13

100 mg/dL. The highest reading of a therapeutic range is the plasma concentration

Front 14

If the half life of a drug is 4 hours, and the nurse administers 1g of the drug, how many hours does it take to reach 250 mg of the original dose?

Back 14

If a drug has a half-life of 4 hours, 50 percent of the drug is eliminated from the body after 4 hours. Therefore, 500 mg will be present after 4 hours. After 8 hours, 25 percent of the original dose will be present in the body. Therefore, 250 mg of the original dose will be present in the body after 8 hours.

Front 15

An elderly obese patient has undergone total hip replacement surgery and has been prescribed low - molecular - weight - heparin (LMWH) enoxaparin. What should the nurse inform the patient about subcutaneous injections?

Back 15

1. The injection site should not be near any bony prominences

2. the medication is injected into the connective tissue below the dermis

Front 16

drug

Back 16

any substance that positively or negatively alters the physiologic function

Front 17

medication

Back 17

is a drug specifically administered for its therapeutic effects on physiologic function

Front 18

Generic name

Back 18

the official name and is simpler than the chemical name

Front 19

trade name

Back 19

or brand name that is assigned by the drug manufacturer

Front 20

Chemical name

Back 20

describes the elements of the medications molecular structure

Front 21

controlled substances

Back 21

have regulated manufacturing, prescribing, and dispensing requirements.

Front 22

schedule 1 controlled substance

Back 22

high potential for abuse - no currently accepted medical use in treatment in the US. EX: Heroin, LSD, and methaqualone

Front 23

Schedule II controlled substance

Back 23

high potential for abuse; may lead to severe psychological or physical dependence. Has a currently accepted medical use with severe restrictions. EX: morphine, cocaine, methadone, and methamphetamine

Front 24

Schedule III controlled substance

Back 24

lower potential for abuse compared to the drugs in schedules I and II in regard to moderate dependence. Has a currently accepted medical use. EX: anabolic steroids, narcotics such as codeine or hydrocodone with aspirin or acetaminophen, and some barbiturates

Front 25

Schedule IV

Back 25

lower potential for abuse relative to the drugs in schedule III; may lead to limited dependence. Has a currently accepted medical use EX: pentazocine, meprobamate, diazepam, and alprazolam

Front 26

Schedule V

Back 26

low potential for abuse relative to the drugs in schedule iv. has a currently accepted medical use in treatment in the US. EX: over the counter cough medicines with codeine.

Front 27

pharmacokinetics

Back 27

the study of how a medication enters the body, moves through the body, and ultimately, leaves the body.

Front 28

pharmacodynamics

Back 28

the process in which a medication interacts with the body's cells to produce a biologic response.

Front 29

Therapeutic effect

Back 29

or intended effect, is the desired result of action of a medication.

Front 30

absorption

Back 30

the passage of a drug from the administration route to the blood stream

Front 31

Distribution

Back 31

the process of delivering the medication to tissues and organs and ultimately to the specific site of action

Front 32

Metabolism

Back 32

the process by which a drug is altered to a less active form to prepare for excretion

Front 33

metabolites

Back 33

products of metabolism

Front 34

liver

Back 34

site of metabolism

Front 35

elderly precautions

Back 35

impaired liver functioning causing slower metabolism of drugs

Front 36

excretion

Back 36

process removed the less active drug or its metabolites

Front 37

half life

Back 37

the expected time it takes for the blood concentration to measure one half of the original drug dose due to drug elimination.

Front 38

onset of action

Back 38

the time the body takes to respond to a drug after administration

Front 39

peak plasma level

Back 39

indicates the highest serum (blood) concentration

Front 40

trough

Back 40

lowest serum level of the medication

Front 41

side effects

Back 41

are predictable but unwanted and sometimes unavoidable reactions to medication

Front 42

adverse effects

Back 42

are severe, unintended, unwanted, and often unpredictable drug reactions.

Front 43

Toxic effects

Back 43

result from a medication overdose or the buildup of medication in the blood due to impaired metabolism and excretion

Front 44

Allergic reactions

Back 44

unpredictable immune responses to medications.

Front 45

anaphylactic reaction

Back 45

a true medical emergency. Can occur after treatment and can be fatal

Front 46

idiosyncratic reaction

Back 46

unpredictable patient response to medication

Front 47

medication interactions

Back 47

occur when the drug action is modified by the presence of a certain food or herb or another medication

Front 48

synergistic effect

Back 48

occurs when he combined effect is greater than the effect of either substance if taken alone

Front 49

antagonism

Back 49

occurs when the drug effect is decreased by taking the drug with another substance, including herbs

Front 50

drug incompatibility

Back 50

mixing medications in a solution that causes precipitation or combining a drug with another drug that causes an adverse chemical reaction

Front 51

Echinacea

Back 51

uses: Stimulates the immune system; facilitates wound healing; fights flu and cold

side effects and drug interactions: possible liver inflammation and damage if used with anabolic steroids or methotrexate

Front 52

feverfew

Back 52

uses: alleviates and helps prevent migraines' relieves pain of arthritis

side effects and drug interactions: increased bleeding; potentiates action of anticoagulants

Front 53

Garlic

Back 53

uses: lowers blood pressure and cholesterol and triglyceride levels

side effects and drug interactions: increased bleeding; potentiates action of anticoagulants

Front 54

Ginkgo biloba

Back 54

improves memory and mental alertness

side effects: increased bleeding and potentiates action of anticoagulants

Front 55

Ginseng

Back 55

increases physical stamina and mental concentration

side effects: can increase heart rate and blood pressure; decreases effectiveness of anticoagulants

Front 56

Saw palmetto

Back 56

helps with enlarged prostate and urinary inflammation

side effects: interacts with other hormones

Front 57

St. John's Wort

Back 57

alleviates mild to moderate depression, anxiety and sleep disorders

side effects: interacts with antidepressants, birth control pills, cyclosporin, digoxin, and human immunodeficiency virus, and cancer medications

Front 58

prescription

Back 58

medications that are dispensed by a pharmacist on receipt of written directions

Front 59

Components for medication administration

Back 59

1. patient's name

2. date and time the order is written

3. name of drug to be administered

4. Dosage of drug

5. Route of drug administration

6. frequency of drug administration

7. signature of the person writing the prescription

Front 60

oral route

Back 60

by mouth

Front 61

buccal

Back 61

against the cheek

Front 62

sublingual

Back 62

under the tongue

Front 63

parenteral

Back 63

by injection or infusion

Front 64

topical

Back 64

on skin or mucous membranes

Front 65

inhalation

Back 65

Medications that are taken into the body through the respiratory tract. ex: MDI's and nebulizer

Front 66

medical tube

Back 66

nasogastric tube or percutaneous endoscopic gastrostomy

Front 67

PO

Back 67

by mouth. It is the safest, most convenient and least expensive route for medication administration

Front 68

Topical medications

Back 68

applied to a specific skin surface or mucous membrane of body cavity.

Front 69

Transdermal patch

Back 69

topical preparation designed to deliver medications slowly for systemic effects.

Front 70

parenteral medications

Back 70

administered through a needle by a route other than topical or through the gastrointestinal or respiratory tract.

Front 71

4 major sites for injection

Back 71

1. intradermal

2. Subcutaneous

3. Intramuscular

4. Intravenous

Front 72

intradermal injection

Back 72

ID. Shallow injection into the dermal layer just under the epidermis

Front 73

Subcutaneous injection

Back 73

Sub - Q, subQ; injection into the subcutaneous tissue just below the skin

Front 74

Intramuscular injection

Back 74

IM; injected into a muscle of adequate size to accommodate the amount and type of medication

Front 75

Intravenous injection

Back 75

IV; injected into a vein

Front 76

Syringe and needle size for subQ

Back 76

syringe selection: 1-3 mL; insulin syringe: 0.5-1 mL with reattached needle

Needle selection: 27-25 gauge, ⅜ -⅝ inch. insulin syringe: 26-31 gauge, 5/16 - ½ inch

site selection: abdomen, lateral aspects of the upper arm and thigh, scapular areas of the back, and upper ventrodorsal gluteal area

Front 77

Syringe and needle size for Intradermal

Back 77

Syringe selection: 1-mL tuberculin syringe

needle: reattached 25-27 gauge, ¼ - ⅝ inch

Site selection: inner forearm, upper arm and across the scapula

Front 78

Syringe and needle size for intramuscular

Back 78

Syringe: adults - up to 3 mL depending on the site; infants/small child - 0.5 - 1 mL

needle: 20-25 gauge, 1-3 inch/ oil based solutions: 18-20 gauge

Site: Ventrogluteal, vastus lateralis, and deltoid. age of patient and corresponding site:

adult - ventogluteal or deltoid

child - vastus lateralis or deltoid

infant: vastus lateralis

Front 79

Syringe and needle size for intravenous

Back 79

Syringe: depends on the amount of medication to be infused

needle selection: Typically a large gauge 1 inch needle; needleless, blunt tip cannula or luer lok used with associated intravenous ports. (do not use needles in a needleless system to access iv ports)

site: vein

Front 80

safe medication administration

Back 80

before administering a medication, the nurse should check the patient's MAR or the health care providers prescription, review diet and fluid orders, review relevant laboratory values, and perform a brief physical assessment.

Front 81

To decrease medication errors:

Back 81

the nurse should follow only written orders. in an emergency setting, a verbal order may be taken but must be put in writing as soon as possible.

Front 82

medication error

Back 82

any preventable event that may cause or lead to inappropriate medication use or patient harm while they medication is in the control of the health care professional; patient or consumer.

Front 83

types of medication errors:

Back 83

some cause harm to the patient directly (excessive dose), others fail to treat the patient's illness (not enough of a dose), giving the wrong drug, giving a med to the wrong patient, or using the wrong route.

Front 84

if a med error occurs:

Back 84

determine the effect on the patient and intervene to offset any adverse effects of the error. Actions include immediate and ongoing assessment, notification of the prescribing physician, initiation of interventions as prescribed to offset any adverse effects, and documentation relating to the event.

Front 85

Six rights of medication administration

Back 85

right drug

right dose

right time

right route

right patient

right documentation

Front 86

three checks

Back 86

1. verifying that the med matches the MAR, calculating the dosage, checking the expiration date of the drug

2. preparing the medication and again checking the med label to the MAR

3. recheck of the label again before returning the med to storage place or re checking of the label a final time against the MAR before opening the package at the bedside.

Front 87

preventing med errors

Back 87

following hospital policy for patient identifiers, giving med prepared by the person giving them, double checking doses, verifying high risk drug doses with a second nurse, addressing patient questions about the meds, and understanding why the patient is being given a certain medication.

Front 88

Patient rights

Back 88

- The right to be informed of the name, purpose, and potential side effects of medications

- The right to refuse medication

- The right to have an accurate medication history taken by a qualified person

- the right to receive medications in accordance with the 6 rights of med admin.

Front 89

Assessment:

Back 89

Information about the patient's allergies to drugs and food and the patient's pregnancy or breastfeeding status is especially critical.

Front 90

Important Data to be collected:

Back 90

patient's medical history, allergy information, medication history, including any prescription, over the counter, or alternative therapies; physical examination results, with a focus on medication effects of the body; and relevant lab results.

Front 91

Common Labs used to monitor medication responses:

Back 91

electrolytes, serum glucose, complete blood count (CBC), white blood cell count (WBC), bleeding time, blood urea nitrogen (BUN), creatinine, and serum levels of specific medications

Front 92

Respiratory assessment is performed before administration of a ___________________.

Back 92

bronchodilator treatment for a patient having an asthma attack

Front 93

Respiratory assessment:

Back 93

Respiratory rate, Auscultation of lung sounds, use of accessory muscles, and o2 saturation levels

Front 94

________ is obtained for 1 minute before digoxin is given

Back 94

apical pulse

digoxin is a medication that slows the heart rate.

Front 95

________ is evaluated before administration of a antihypertensive

Back 95

blood pressure

Front 96

________________ is evaluated before an antipyretic is administered

Back 96

temperature