Medication Math Exam

what should you identify before calculating?

order, supply, dosage strength, route, frequency

what is the case approach?

c (convert) - change measurements into same units

a (approximate) - estimate expected answer

s (solve) - calculate using one of the 3 methods

e (evaluate) - check that the answer makes sense

important safety considerations (calculation)

- always check units before calculating

- never ignore decimal point

- estimate before solving

- question unusually large or small doses

- check the medications recommended dose and patient-specific factors

- never administer a dose that seems unsafe without clarification

3 dose calculation methods

1. ratio-proportion

2. formula method

3. dimensional analysis

inhaled medications (definition, types, steps for MDI)

- medications delivered directly to the respiratory tract and lungs

common types:

- metered-dose inhalers (delivers a measured amount of medication with each spray)

- dry powder inhaler (requires patient to inhale deeply to pull powdered medication into the lungs)

- nebulizer (converts liquid ,Des into a mist that the patient breathes through a mask or mouthpiece)

steps for MDI:

1. Verify the medication order and patient.

2. Assess respiratory status and lung sounds.

3. Have the patient sit upright.

4. Shake the inhaler if the product instructions require it.

5. Attach a spacer if prescribed or appropriate.

6. Have the patient exhale.

7. Place the mouthpiece in the mouth and seal lips around it.

8. Begin a slow, deep inhalation while activating the inhaler.

9. Continue inhaling slowly.

10. Hold breath for approximately 10 seconds if able.

11. Wait the prescribed interval before the next puff.

12. Document administration and reassess the patient.

7 rights of med administration

1. right patient (2 patient id, barcode, never use room #)

2. right drug (verify med name, compare with MAR/eMAR, perform label check 3 times, only administer meds you personally prepared)

3. right dose (verify, calculate)

4. right route (confirm, never substitute)

5. right time (follow schedule)

6. right reason (be aware, assess, check vitals)

7. right documentation (after administration, record refusal or omission and reason)

important safety considerations (administration)

- check allergies

- review med interactions

- monitor for adverse reactions

- use PPE and hand hygiene

- follow med storage requirements

- never leave meds unattended

- use barcode med administration when available

when do you preform the 3 label checks?

1st - when removing med from storage

2nd - during preparation

3rd - immediately before administration; typically at bedside

syringe size, common usage, and calibration

0.5 mL → very small med volumes → 0.01 mL

1 mL (TB) → small med volumes/TB testing → 0.01 mL

3 mL → common IM injections → 0.1 mL

5-12 mL → larger med volumes → 0.2 mL

20-60 mL → large-volume meds/irrigation use → 1-2 mL

maximum volumes (adults and peds)

insulin (definition, types/characteristics, U-100 vs. U-500)

→ insulin lowers blood glucose by helping glucose move from the blood stream into cells

types:

1. rapid-acting → works quickly; associated with meals

2. short-acting → could be given via IV

3. intermediate-acting → has pronounced peak

4. long-acting → provides basal coverage

5. ultra-long-acting → extended basal coverage

U-100:

100 units/mL

orange cap

standard 100 unit syringe

U-500:

- 500 units/mL

- green cap

- 250-unit capacity syringe

Insulin (regular vs. NPH, sliding scale insulin, hypo vs. hyper)

regular vs. NPH

- regular insulin is clear

- NPH insulin is cloudy

for draw: cloudy (air out) → clear (air out) → clear (insulin in) → cloudy (insulin in)

sliding scale/correction insulin

?

hypoglycemia: low blood sugar

symptoms → sweating, shaking, dizziness, hunger, confusion, weakness, rapid heartbeat

hyperglycemia: elevated blood sugar

symptoms → increased thirst, frequent urination, fatigue, blurred vision, increased hunger

ratio-proportion formula

supply dose. ordered dose

---------------- = ----------------- → cross multiply

supply quantity x

dimensional analysis formula

desired unit

given value x -------------- = target value

given unit

ophthalmic meds (definition, types, administration, considerations)

→ meds administered into the eye

common types:

- eye drops

- eye ointment

steps for administering eye drops:

1. hand hygiene

2. verify patient/med

3. explain procedure

4. position patient with head tilted back

5. ask patient to look upward

6. gently pull down lower eyelid

7. drops drops in conjunctival sac

8. avoid touching dropper to eye or surrounding tissue

9. ask patient to close eye gently

10. apply pressure to nasolacrimal duct if needed

11. wait prescribed interval between dif eye meds

12. document

steps for administering eye ointment:

1. apply thin ribbon inside lower conjunctival sac

2. avoid touching the tube to eye

3. ask patient to close gently

important considerations:

- never place meds directly into cornea

- use separate medication containers for each patient

- follow contact sense instructions

- report pain, redness, swelling, or visual changes

- ophthalmic meds must be sterile

oral medications (types, supplies, before admin, administration, difficulties)

→ administered by mouth and absorbed through GI tract

common types:

- tablets

- capsules

- caplets

- liquids

- chewable tablets

- sublingual tablets

supplies:

- medication

- medication cup

- cup of water

before administration:

- verify order

- verify identity

- assess ability to swallow

- review whether med should be given with food

- check NPO status

- review feeding tube instructions if applicable

administration:

1. position client upright

2. provide water is appropriate

3. give meds according to instructions

4. ensure meds have been swallowed

5. document administration

if patient has difficulty swallowing:

- do not force med

- assess cause

- notify provider or pharmacist

- ask about alternative drug forms

oral administration (med form&considerations)

enteric-coded → do not crush or chew

extended-release → do not curse or chew unless product specifically permits

sublingual → place under tongue to dissolve

buccal → place between cheek and gum

chewable → must be chewed

liquid → measure accurately

IM injections (sites, angle, considerations, needle selection, 2-track)

sites:

deltoid → common for vaccines and smaller volumes

vastus lateralis (thigh) → often used in infants and children

ventrogluteal (hip) →preferred site for many IM meds

dorsogluteal (butt) → not recommended because of sciatic nerve and vascular injury risk

angle:

90 degrees (dart)

important considerations:

- identify anatomical landmarks

- assess the site

- use appropriate needle length

- follow medication specific instructions regarding aspiration

- use 2-track technique

- rotate sites when repeated injections are needed

needle selection depends on:

- age

- muscle development

- body composition

- medication viscosity

- injection site

- volume

2-track technique:

- pull skin laterally before inserting needle

- maintain displacement while administering med

- release after removing needle

- helps prevent med from leaking into subcutaneous tissue

how to read: syringe, medicine cup, oral syringe

syringe:

- eye level

- identify correct calibration

- read leading edge of rubber plunger

- do not use trailing edge

medicine cup:

- place on flat surface

- read at eye level

- measure at bottom of meniscus

oral syringe:

- used for oral meds only

- calibrated in tenths of a mL

reconstitution

→ adding a liquid diluent to a powdered medication to make it liquid

common diluents:

- sterile water

- bacteriostatic water

- sterile normal saline

- lidocaine (only when specifically ordered)

reconstruction process:

1. review order

2. ID correct diluent

3. determine diluent required

4. calculate resulting concentration

5. label multidose vials appropriately

6. follow storage and expiration instructions

multi dose labeling:

- date and time reconstituted

- resulting dose strength

- storage instructions

- date and time discarded

- initials of person preparing

vocab:

soulte: powdered med

solvent/diluent: liquid used to dissolve med

reconstituted med: final liquid med

administration time

time-critical medications:

- need to be administered close to prescribed time

- specifically within 30 minutes

- ex: antibiotics, hormones, cardiac med

general time windows:

daily, weekly, monthly → within 2 hours

more than daily, no more frequent than Q4H → within 1 hour

more frequent than Q4H → within 25% of dosing interval

time-critical → within 30 minutes

multi-step problems

concentration and drainage

daily dose and frequency

dosage strength

→ tells you how much medication is present in a specific quantity

ex: A bottle may contain 100 tablets, each containing 10 mg. The dosage strength is 10 mg/tablet

SUBQ injections (sites, meds, angle, characteristics)

→ delivers medication into the fatty tissue beneath the dermis and epidermis

common sites:

1. abdomen

2. outer upper arms

3. anterior thighs

4. buttocks/hip region

common medications:

1. insulin

2. anticoagulants/heparin

angle:

45-90 degrees

characteristics:

- short, fine needles

- 25-31 gauge

- length selected based on patient anatomy and medication

- do NOT massage heparin sites (can cause bruising)

- rotate as needed

- avoid damaged tissue

SUBQ vs. IM injections

SUBQ IM

- fatty tissue - muscle

- 45-90 degrees - 90 degrees

- smaller volumes - larger volumes

- slower absorption - faster absorption

steps to complete before preparing medications

1. perform hand hygiene

2. review medication order

3. check allergies

4. review MAR/eMAR

5. gather supplies

6. perform the first label check

7. verify expiration date

8. calculate the dose if necessary

steps to complete during preparation

1. perform second label check

2. use aseptic technique for injectable medications

3. clean vial diaphragms with alcohol and allow them to dry

4. use sterile equipment for injections

5, never use a medication if the label is missing or unclear

6. check for discoloration, particles, or changes in appearance

steps after preparation

1. label prepared medications when they are not administered immediately

2. keep medications secure

3. perform the third label check at bedside

4. verify patients identity again

typical medication preparation equipment

medicine cup: for oral liquid medications

soufflé cup: for tablets and capsules

oral syringe: small oral liquid volumes

tuberculin syringe: small injectable volumes

insulin syringe: insulin

3 mL syringe: common IM injections

filter needle: drawing medications from certain ampules

enteral vs. parental

enteral - through the GI tract

parental - outside the GI tract

needle safety (principles and injury)

important principles:

- never recap a used needle using two hands

- never bend or break needles

- activate the safety device immediately after use

- dispose of needles directly into an approved sharps container

- do not overfill shapes containers

- never place needles into regular trash

- use PPE

needle stick injury:

- wash affected area

- report incident immediately

- follow facility exposure protocol

- obtain prompt medical evaluation

needle gauge

→ thickness/diameter of needle

→ smaller then gauge number, the thicker the needle

needle length

→ determined by route, injection site, patient anatomy, and medication

→ must be long enough to reach desired tissue

high-alert medication examples

- insulin

- anticoagulants

- opioids

- concentrated electrolytes

- some IV medications

what details are included in a complete med order?

1. patient name

2. date of birth

3. med name

4. dose

5. route

6. frequency/time

7. date and time order was written

8. prescriber signature

generic vs trade names

generic: official, nonproprietary med name (Ibuprofen)

trade: brand name belonging to specific manufacturer (advil)

patient rights and responsibilities

patients have the right to understand:

- Medication name

- Dose

- Schedule

- Reason for med

- Expected effects

- Side effects

- Drug-drug interactions

- Drug-food interactions

patients have the right to refuse:

- Patients can refuse medication

- The nurse should respect the patients decision

- Investigate why the patient refuses

- Explain the purpose and potential consequences of refusing

- Notify provider promptly

- Document refusal and reason in the MAR/eMAR

medication errors: what to do

What should the nurse do if the error occurs?

→ assess patient immediately

→ determine what medication was given and how much

→ monitor for adverse effects

→ Notify the provider

→ notify appropriate supervisor

→ follow orders for treatment and monitoring

→ complete an incident report/occurrence report

→ document patients assessment and clinical care in medical record

IMPORTANT:

Never hide a med error

Never alter documentation to cover up and error

Incident reports are separate from the patients medical record

Focus on patient safety rather than assigning blame

Adverse drug reaction vs medication error:

Adverse drug reaction: harmful or unintended response to a medication

Medication error: preventable mistake in prescribing, dispensing, or administering medications; can occur without causing harm

medication documentation

Document:

Medication name.

Dose.

Route.

Date and time.

Site, if applicable.

Relevant assessment findings.

Patient response.

Any adverse reaction.

Patient refusal and reason.

Provider notification when applicable.

Important rules:

Document immediately after administration.

Never document medication before giving it.

Never document a dose that was not administered.

If a medication is held, document the reason and follow notification procedures.

Document PRN medications and their effectiveness after administration.

controlled substance safety (5 schedules and safety rules)

FIVE SCHEDULES:

I → highest abuse possible; no currently accepted medical use under federal law (ex: heroin)

II → high abuse potential; accepted medical use (oxyCOntin and fentanyl)

III → lower abuse potential than II (Vicodin)

IV → lower abuse potential than III (valium)

V → lowest abuse potential (robitussin AC)

Controlled substance safety:

Store securely

Follow facility policies for access

Document administration accurately

Follow facility procedures for wasting unused meds

Obtain required witness verification

Report discrepancies immediately

otic medications (procedure and considerations)

→ medications administered into the ear

administration procedure:

1. perform hand hygiene

2. verify med and patient

3. confirm correct ear

4. position patient with affected ear upwards

5. warm drops in hand

6. for adults and children, gently pull pinna upward and backward

7. for children under 3 years, pull pinna downward and backward

important considerations:

- verify whether mediation is for the R or L ear or both

- do not use ear drops in the eyes

- avoid inserting the dropper into the ear canal

- check for allergies

- report pain, drainage, or worsening symptoms

rectal administration

→ meds administered through the rectum

common forms:

- suppositories

- rectal creams

- rectal ointments

- enemas

suppository administration:

1. perform hand hygiene

2. verify med and patient

3. explain procedure and provide privacy

4. position client in the left lateral/Sims position

5. put on gloves

6. lubricate the suppository

7. separate the buttocks and identify the anus

8. insert the suppository

9 encourage the patient to remain positioned briefly

10. dispose of supplies and perform hand hygiene

11. document

Important nursing considerations:

- Assess bowel function.

- Check for rectal bleeding or irritation.

- Check for contraindications, such as certain rectal procedures or conditions.

- Do not force insertion.

- Provide privacy and dignity.

- Document the patient's response.