Pharmacology Week 1, Exam 1: Nursing Process and Safety/Quality

What are the 6 rights of medication administration?

1. right patient

2. right drug

3. right dose

4. right time

5. right route

6. right documentation

When checking for the right patient, what two forms of identification should you use

name and birthday

What does MAR stand for?

medication administration record

when checking for right patient, what does the "name-alert" sticker mean

when 2 patients have same name

when checking for right patient, you should verify patients name with a family member when and if

the patient has a cognitive impairment

is it important to read the drug label ____ times

3

what 3 times should you check the drug label before giving it to a patient

when you take it out, when comparing it with the MMR, and when you check the patients record

what to look for and verify when it comes to giving the right dose

the dosage calculation, safeness, weight (if dose depends on it), dose of certain high-risk drugs, and pertinent lab values

what does AC mean

before meals

what does PC mean

after meals

to reduce errors you should use _____ time

military

when checking for right time it is important to consider the following factors

if the drug is affected by food and should be given with or without food, the expiration date, scheduled procedures, administration intervals, policies

when giving oral drugs it is important to

assess the patients ability to swallow oral medication and then stay with them until you see they are swallowed

do not crush or mix medications without

validation or consultation

when recording right documentation, make sure to record and document

drug administration, name, dose, route, time, date, the patient response, and add a signature or initials

identify 9pm in military time

21:00

Identify 12am in military time

00:00

What is the Just Culture of Safety?

individuals should be encouraged to report drug errors so the system can be repaired and fixed, driven to keep patients safe from harm

human error

individual inadvertently did something other than intended or other than what should have been done; a slip, lapse, an honest mistake

at risk behavior

Individual makes a behavioral choice that increases risk where risk is not recognized or is mistakenly believed to be justified; unintentional risk taking.

reckless behavior

individual makes the behavioral choice to consciously disregard a substantial and unjustifiable risk

system issues

Events or event elements that are primarily the result of factors beyond the individual's control.

Sentinal Event

an unexpected occurrence involving death, serious physical, or psychological injury

near miss

An error that could have harmed a patient, but harm did not occur as a result of chance

is .5mg an acceptable abbreviation and if no, why?

no, you need to use a zero before a decimal point when its less than a whole unit

is 1.0 mg an acceptable abbreviation and if no, why?

no, you should not use a decimal point or zero after a whole number

What is "Tall Man Lettering"?

practice of writing part of a drug's name in upper case letters to help distinguish sound and look-alike drugs from one another in order to avoid errors

ex: oxyCODONE and oxyCONTIN

what are the six clinical judgement measurement model cognitive skills

1. recognize cues

2. analyze cues

3. prioritize hypothesis

4. generate solutions

5. take action

6. evaluate outcomes

subjective data

information provided/told verbally by the patient, family, or friends (the patients pov)

objective data

information the nurse directly observes (measures, read, seen) about the patients health status

Examples of subjective data

current health history, symptoms, medications, health history, environment, etc.

examples of objective data

1. physical assessment

2. laboratory tests (blood, urine, vomit, etc.)

3. diagnostic studies (xray, mri, cat, etc)

4. vital signs

5. weight, temp, skin color, blood cell count

factors the nurse should consider when doing patient teaching

1. engagement

2. timing (am or pm)

3. environment

4. pain

5. language barriers

what does ADL stand for

activities of daily living

before information about drug therapy is presented to a patient, it is most important to

assess the patient's readiness to learn

What are the 6 steps of the nursing process?

Assessment, diagnosis, planning, implementation, evaluation

Recognize cues in the CJMM goes with ______ in the Nursing Process

Assessment

Analyze Cues and Prioritize Hypotheses in the CJMM goes with ______ in the Nursing Process

Diagnoses/Analysis

Generate solutions in the CJMM goes with ______ in the Nursing Process

Planning

Take Action in the CJMM goes with _____ in the Nursing Process

Interventions

Evaluate Outcomes in the CJMM goes with ____ in the Nursing Process

Evaluations

before administering oral medications, what should you assess

the patients ability to swallow

During a medication review session, a patient states, "I do not know why I am taking all of these pills." Based on this piece of subjective data, which problem will the nurse identify?

a. Pain

b. Knowledge

c. Fatigue

d. Anxiety

B

The nurse is developing a list of the patient's expected outcomes. Which is the best expected outcome for this patient?

A. The patient will self-administer albuterol by taking a deep breath before inhaling

B. The patient will self-administer albuterol by then end of the second teaching session

C. The patient will independently self-administer the prescribed dose of albuterol by the end of the second teaching session

D. The patient will organize their medications according to the time its due

C

When developing an effective medication teaching plan, which component will the nurse identify as most essential

A. Written instructions

B. The patients readiness to learn

C. Use of colorful charts

D. A review of community resources

B

When developing an individualized medication teaching plan, which topics will the nurse include (Select all that apply)

A. Adherence to the prescribed drug regimen

B. Always use the prescribed drug route

C. Knowing adverse side effects to report to doctor

D. Always doubling the next dose if drug is missed

E. Telling the doctor when taking over-the-counter

A, B, C, and E

The Nursing Alliance for Quality Care's main focus is for health care providers to strive for which goal?

A. Quality in medication administration

B. Confidentiality as determined by the patient

C. Development of patient relationship/ family engagement

D. Patient independence within the family of origin

C

Which teaching strategy is most likely to succeed in health teaching with the patient and family

A. Know the reason why each drug was ordered

B. Have patients learn the generic name of each pill

C. A repeat demonstration should follow the nurse's teaching

D. Have the patient identify the number and color of pills

C

When a drug has a long half life, it is usually given

once a day

Drugs with short half life are given

several times a day at specific intervals

Define the following abbreviations: bid, tid, and qid

Twice a day, three times a day, and four times a day

Do not crush any

extended- or sustained-release drugs

What are high alert drugs?

Drugs that can cause significant harm to a patient, especially if given in error

The patient asks the nurse how to dispose of old medications. What should the nurse tell the patient? (Select all that apply)

A. Mix old drugs with cat litter before disposing

B. Flush the medications down the toilet

C. Remove personal information from the bottle

D. Add water and crush drugs before disposing

E. Throw bottle of medications into the trashcan

A and C

The nurse educator on the unit receives a list of high-alert drugs. Which strategy is recommended to decrease the risk of errors? (Select all that apply.)

a. Store drugs on a shelf for quick retrieval.

b. Limit access to high-alert drugs.

c. Use special labels for high-alert drugs.

d. Provide increased training to staff.

e. Prior to administration, have two nurses confirm and document correct drug and dose.

B, C, D and E

The Joint Commission recommends which of the following abbreviations for the "Do Not Use" list?

a. qd

b. NPO

c. qid

d. bid

A

A patient refuses to take the prescribed medication. Which is the nurse's best response to this patient?

a. Leave the medication at the patient's bedside.

b. Persuade the patient to take the medication.

c. Tell the patient there is no choice in the matter.

d. Explain the benefits and side effects of the drug

D

What information is essential for the nurse to document when giving drugs? (Select all that apply.)

a. Document all drugs given by the end of a shift.

b. Document the correct site of an injectable drug.

c. Document the patient's response to the drug.

d. Document the blood pressure before giving a drug.

e. Document the date, time, and dose drug is given.

B, C, D, and E

The nurse prepares to administer medications. Which drug orders are complete? (Select all that apply.)

a. Aspirin 81 mg PO daily

b. Multivitamin sustained

c. Vitamin D PO

d. Ciprofloxacin 500 mg PO tid

e. Promethazine 25 mg STAT

A and D

The Quality and Safety Education for Nurses' focus on safety is best exemplified by which competency?

a. Patient advocacy

b. Technology

c. Infection control

d. Collaborative patient and family care

D

Possible injury would be included in which cognitive skill of the clinical judgment for a patient who is taking a sedative-hypnotic?

a. Recognize cues

b. Take action

c. Generate solutions

d. Analyze cues and prioritize hypothesis

D

The patient has congestive heart failure and has been prescribed a diuretic. Obtain patient's weight to be used for future comparison is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Evaluate outcomes

c. Generate solutions

d. Analyze cues and prioritize hypothesis

A

The patient will receive adequate nutritional support through enteral feedings is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Take action

c. Generate solutions

d. Analyze cues and prioritize hypothesis

C

The patient will maintain a diastolic blood pressure between 60 to 80 is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Evaluate outcomes

c. Generate solutions

d. Analyze cues and prioritize hypothesis

C

The patient has been diagnosed with angina and hypertension and has been started on a drug. Instruct patient to avoid caffeine-containing beverages is included in which cognitive skill of the clinical judgment?

a. Evaluate outcomes

b. Take action

c. Analyze cues and prioritize hypothesis

d. Generate solutions

B

Revision of goals is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Evaluate outcomes

c. Take action

d. Generate solutions

B

The patient has been prescribed a diuretic to treat hypertension. Disturbed sleep is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Evaluate outcomes

c. Take action

d. Analyze cues and prioritize hypothesis

D

The pediatric patient has been started on antibiotics for strep throat. Advise the child's parents to report adverse reactions such as nausea and vomiting to the health care provider is included in which cognitive skill of the clinical judgment?

a. Recognize cues

b. Take action

c. Generate solutions

d. Analyze cues and prioritize hypothesis

B

The patient has been prescribed an opioid pain drug after hip surgery. Psychological disturbance is included in which cognitive skill of the clinical judgment?

a. Take action

b. Evaluate outcomes

c. Analyze cues and prioritize hypothesis

d. Generate solutions

C

Instruct patient not to discontinue drugs abruptly is included in which cognitive skill of the clinical judgment for a patient with epilepsy who is taking phenytoin?

a. Recognize cues

b. Evaluate outcomes

c. Take action

d. Generate solutions

C

A patient has been prescribed antibiotics that are scheduled for every 8 hours. Which statement by the patient indicates the need for more teaching regarding the drug regimen?

a. "I take this drug every 8 hours around the clock."

b. "I have to take the drug even if I feel better."

c. "I just take it divided into three doses while I'm awake."

d. "I cannot take it more often even if I don't feel better."

C

The patient has been prescribed a drug to be taken a.c. and h.s. Which instruction would the nurse give the patient?

a. "Take this drug every 6 hours."

b. "Take this drug before meals and at bedtime."

c. "Take this drug after meals and first thing in the morning."

d. "Take this drug after meals and as needed."

B

Which statement describes the purpose of the "tall man" letters?

a. To assist with drug reconciliation.

b. To aid in labeling drug allergies.

c. To promote safety between drugs with similar names.

d. To label differences in dosage strength of the same drug.

C

The nurse is calculating an opioid dose for the patient. The dose seems "large." Which action would the nurse take initially?

a. Check the patient's name band and administer the drug.

b. Call the health care provider.

c. Recalculate the dose.

d. Withhold the drug and document as not given.

C

The older adult patient tells the nurse, "I'm not taking that pill. I don't want it, and I won't take it!" Which action would the nurse take first?

a. Document the patient's refusal.

b. Force the patient to take the drug.

c. Educate the patient on the importance of the drug.

d. Call the health care provider who prescribed the drug.

A

Which abbreviation is not allowed by The Joint Commission? (Select all that apply.)

a. IM

b. U

c. IU

d. q.d.

e. MS

B, C, D, E

A patient tells the nurse the unused opioids were flushed down the toilet. Which response would be best by the nurse?

a. "Flushing unused drugs is okay."

b. "Be sure to crush the drugs before flushing them."

c. "Crush the drugs and throw them in the trash."

d. "Throw them in the trash after mixing the drugs with unpalatable nonfood substance."

D