foundations of nursing EXAM 3

what are nonparenteral meds?

oral, topical, and suppositories

what is the pharmaceutical class?

refers to the mechanism of action (how drug works in the body)

what is the therapeutic class?

refers to the clinical aspect (why are we giving this; what is it doing to the body)

what is a standard written prescription?

a scheduled order

what is an automatic stop date order for and what is different about it?

for narcotics or anything with high risk of abuse; may only be in effect 7 days

what type of order is this?

give nitroglycerin 0.5 mg sublingually every 2-5 minutes for chest pain, to a maximum of 4 doses in 20 minutes

standing order

what is a standing order for?

certain patient populations; those with specific chest pain, constipation, etc.

what is a PRN order?

as needed

what must a PRN order include?

frequency and what its for

what is a single order?

one time dose

what is a stat order?

one time dose immediately

what is the must unreliable and risky type of order?

verbal or telephone

what is the safest way for an order to be given?

written

what is the best way to form a written order?

prescribing provider writes it or directly enters into the EMR

when is a telephone order acceptable?

when it is impossible or impractical to do a written or electronic order

T/F: your prescriber is sending you a telephone order for your patient. You think you hear the medication correctly, but your not sure. It's okay to just assume you heard them correctly and go ahead and give them the med.

false; since you're unsure about what you heard, ask for clarification and to spell the name of the medication

T/F: if you have a good memory, you don't need to write down verbal or telephone orders

false!

T/F: even if it annoys the prescriber, you should always read back the order in the case of a verbal or telephone order

true

what process is required by joint commission and prevents medication errors due to duplication, drug interactions, and omissions?

medical reconciliation

when are the three times to perform medical reconciliation?

upon admission, transfer, and discharge

T/F: if you think, even for a second, that a prescription is incorrect you should NEVER just administer it

true!

when are the three medication checks?

before initial removal from omnicell, after retrieval from the omnicell, at bedside (after preparation)

T/F: its okay to leave medications unattended

false

T/F: whoever prepares the medication gives it

true

T/F: you don't have to watch the patient take the medication

false

what is the most common cause of medication error?

interruption or distraction

what are the 6 rights of medication administration?

right medication, right patient, right dose, right route, right time, right documentation

what is the first thing you should do if you're unsure a medication is the right dose?

look it up

what is a controlled substance?

drugs considered to have either limited medical use or high potential for abuse or addiction

T/F: controlled substances must be given within two hours after retrieving

false; given within an hour

what must you do if you don't use all of a controlled substance in an administration?

waste it AND have some witness you waste it

can you split or break a pill that isn't scored?

no

what is a tablet?

powdered drug compressed into hard, compact form

what is an enteric-coated tablet?

tablet coated in an acid-insoluble coating that keeps it from dissolving in the stomach (dissolve in small intestine)

can enteric-coated tablets be chewed or crushed?

no

what is an extended release (ER) med?

made to dissolve over a period of time

can extended release meds be chewed or crushed?

no

what is an elixir?

liquid medication

what is the enteral route?

intestine

what is the sublingual route?

under tongue

what is the buccal route?

in cheek

T/F: you can administer sublingual and buccal medications despite NPOs

true

what is the topical route?

apply directly to skin

when administering vaginally, how long should the patient remain supine?

5-10 minutes

how do you administer eye drops?

- tilt head back and toward affected side, looking up

- drop into conjunctival sac

what is the inhalation route?

breathed in

how do you administer ear drops?

- lie on side with affected ear up

- pull earlobe up and back (adult) or down and back (child)

- instill prescribed number of drops

- keep position on side for a few minutes

what is the transdermal route?

patch or disk applied to skin

what are the steps when a medication error occurs?

1. assess patient

2. notify someone

3. report

4. do not document patient's record that an incident report was filed!

what are parenteral medications?

intradermal, subcutaneous, intramuscular, intravenous, etc

what is different about insulin syringes?

they're in units

T/F: you can use insulin syringes for very small doses of other medications

false; only for insulin

T/F: you should always carefully recap your needles after use using the swoop method

false; never recap used needles

as needle gauge decreases, diameter ______

increases

how do you determine the appropriate needle gauge for a patient?

patient's size and skin condition, viscosity of medication, and speed of administration

what is an ampule?

glass container that holds a single dose

what needle MUST be used to withdraw medication from an ampule?

filter needle

how do you break open an ampule?

break neck away from your body with an unopened alcohol swab OR a hospital provided device

T/F: you shouldn't inject air into an ampule before withdrawing

true

how do you withdraw medication from an ampule?

usually single dose, so turn ampule upside down with needle within and withdraw total volume of ampule into syringe

what's very important to do before injecting your patient after using a filter needle to withdraw your medication?

change the needle!!

what is the angle of insertion for intramuscular injections?

90 degrees

what is the angle of insertion for subcutaneous injections?

45 or 90 degrees

what is the angle of insertion for intradermal injections?

5-15 degrees

where can you have intradermal injections?

inner lower arm, upper chest, or back beneath scapula

what should you never do after an intradermal injection?

apply pressure or massage

what are the steps of an intradermal injection?

1. pull the skin taut

2. slowly insert needle, bevel up, at a 5-15 degree angle until the bevel is just under the epidermis

3. inject medication slowly, observing the bubble-like bump that will form

where can you have subcutaneous injections?

outer aspect of upper arm, anterior aspect of thigh, abdomen, scapular area, ventrogluteal, dorsogluteal

what is the max amount that can be injected via subQ?

1 mL

should you pinch the skin for subcutaneous injections?

typically only for thinner patients

which injection is the slowest to absorb?

intradermal

at what angle do you insert a subQ injection with a needle length of 3/8 in?

90

at what angle do you insert a subQ injection with a needle length of 5/8 in?

45

what is the most common subcutaneous injection site?

abdomen

T/F: it's important to rotate sites for multiple subcutaneous injections

true

when administering a subcutaneous injection in the abdomen, how can you avoid causing harm?

avoid 2 in or 5 cm around the umbilicus

what is an example of a subcutaneous injection?

insulin

how do you give lovenox?

- pinch tissue gently and insert needle at 90-degree angle

- syringe is prefilled with an air bubble that shouldn't be expelled

what kind of injection is lovenox given?

subcutaneous

what are all the locations for intramuscular injections?

deltoid, vastus lateralis, ventrogluteal, rectus femoris, and dorsogluteal

what two locations are no longer recommended for IM due to proximity to major nerves and blood vessels?

rectus femoris and dorsogluteal

what needle length is best for ventrogluteal IM?

1 1/2 in

what needle length is best for deltoid IM?

5/8-1 1/2 in

what needle length is best for vastus lateralis IM?

5/8-1 in

what is the max amount of medication that can be injected in the ventrogluteal?

3 mL

what is the max amount of medication that can be injected in the deltoid?

1 mL

what is the max amount of medication that can be injected in the vastus lateralis?

3 mL

what gauge size is used for all intramuscular injections?

22-25

what gauge would be the best for comfort with IM?

smallest possible

what method increases patient comfort and best practice for IM injections?

z-track

what kind of motion increases patient comfort for IM injections?

dart-like motion

what rate should you inject IM injections?

10 sec/mL

T/F: you should wait 10 seconds before withdrawing after an IM injection?

true

landmark for ventrogluteal?

- heel of hand over greater trochanter

- index finger toward anterior superior iliac spine

- inject in the middle of pointer and middle

landmark for vastus lateralis?

- one hand width below greater trochanter and one hand width above lateral aspect of knee

- divide thigh into thirds

- inject in the middle third

landmark for deltoid?

- find lower edge of acromion process

- place 2-3 fingers at base of process

- form an upside down triangle where injection will go in the middle

what is z-tracking?

pulling the overlying skin laterally 1-1 1/2 inches before an IM injection

what is the purpose of z-tracking?

keeps the medicine deposited in the muscle

T/F: you shouldn't massage the injection site after giving an IM injection

true

how do you mix insulin?

Clear before Cloudy!

1. draw up air equivalent to total insulin mL

2. wipe vials with alcohol

3. inject air into the cloudy vial

4. Inject the remaining air into clear vial and draw up the clear insulin

5. reinsert the needle into the cloudy vial and withdraw the desired amount