Other Methods of Medication Administration Chapter 17, Dosage Calculation and Medication Administration

What is a suppository?

A drug designed to be inserted into the rectum, vagina, or urethra.

Which patient populations commonly benefit from the use of suppositories? (Select all that apply)
A. Elderly with arthritis
B. Babies
C. Patients who are vomiting
D. Patients unable to take oral medications

B. Babies
C. Patients who are vomiting

D. Patients unable to take oral medications

Why are suppositories a good option for patients who are nauseated or vomiting?

Because they bypass the gastrointestinal system and don’t require swallowing.

What storage precaution is important for suppositories?

They should be kept in a cool place to prevent melting.

What personal protective equipment should the nurse wear when handling a suppository, and why?

Gloves — to avoid direct skin absorption of the medication.

Why must a nurse perform the initial patient evaluation before a vaginal irrigation?

the initial evaluation requires critical thinking and assessment skills that cannot be delegated to unlicensed assistive personnel (UAP).

Can vaginal irrigation be delegated to a UAP?

Yes, but only in some settings and only if the irrigation does not involve medication. Always check facility policy.

Why is vaginal irrigation (douching) generally avoided?

Because it can disrupt the natural protective secretions of the vagina and lead to infections or irritation.

When is vaginal irrigation typically permitted or required?

When ordered for surgical preparation or for specific medical reasons directed by a healthcare provider.

What are the risks of frequent or excessive douching?

It can cause irritation of the vaginal mucosa and increase the risk of vaginal infections.

What forms do vaginal medications come in?

Foam, jelly, cream, and suppository forms.

Who determines the type of solution and frequency for a vaginal irrigation?

The healthcare provider.

What does "percutaneous route" mean in medication administration?

It refers to the absorption of medicine through the skin or mucous membranes.

What are common dosage forms used in the percutaneous route? (Select all that apply)
A. Capsules
B. Ointments
C. Creams
D. Powders
E. Lotions

B. Ointments
C. Creams
D. Powders
E. Lotions

What is the primary effect of most percutaneous medications—local or systemic?

Local, although some may have a systemic effect.

What are the three main types of percutaneous routes?

Topical application, instillation into mucous membranes, and inhalation.

What are the three main types of percutaneous routes?

Topical application, instillation into mucous membranes, and inhalation.

What forms of medication are typically used in topical application? (Select all that apply)
A. Capsules
B. Lotions
C. Creams
D. Powders
E. Ointments
F. Patches

B. Lotions
C. Creams
D. Powders
E. Ointments
F. Patches

What body areas are used for instillation in percutaneous medication administration? (Select all that apply)
A. Eyes
B. Ears
C. Nose
D. Vagina
E. Mouth
F. Rectum

A. Eyes
B. Ears
C. Nose
D. Vagina
E. Mouth

What are the sublingual and buccal percutaneous routes?

Sublingual: medication is placed under the tongue.

Buccal: medication is placed in the cheek.

What types of substances are used for inhalation in percutaneous medication administration?

Aerosolized liquids and gases.

What is an ointment?

An oil-based semisolid medication applied to the skin.

What is a transdermal patch?

A medicated adhesive patch applied to the skin that gradually releases medication over hours or days.

What types of medications are commonly delivered via transdermal patches? (Select all that apply)
A. Antibiotics
B. Analgesics
C. Nitroglycerin
D. Nicotine
E. Estrogen

B. Analgesics
C. Nitroglycerin
D. Nicotine
E. Estrogen

Why might a transdermal patch fail to adhere properly? (Select all that apply)
A. The skin is greasy
B. The patch is too small
C. The skin is hairy or damaged
D. The patch is expired

A. The skin is greasy
C. The skin is hairy or damaged

How should a transdermal patch be applied for best absorption?

Apply to clean, dry, hairless, and non-greasy skin

Why must ophthalmic medications be sterile?

To prevent eye infections, since the eye is highly sensitive and vulnerable to contamination

At what temperature should ophthalmic medications be administered?

At room temperature

ow can you maintain sterility when administering eye drops or ointments? (Select all that apply)
A. Warm the bottle in hot water
B. Avoid touching the eye with the dropper or tube
C. Keep the bottle tightly sealed when not in use
D. Share medication with only one other patient

B. Avoid touching the eye with the dropper or tube
C. Keep the bottle tightly sealed when not in use

What label should you verify on an eye medication before administering it?

The label must say “for ophthalmic use.”

Can you share ophthalmic medications between patients if they have the same diagnosis?

No, eye drops or ointments should never be shared between patients.

What is the primary purpose of eye irrigation in emergencies involving caustic chemicals?

To flush the chemical from the eye and prevent corneal burns.

How long should you flush the eye with tap water after exposure to a caustic chemical?

For at least 15 minutes, then consult a doctor immediately.

What solution is typically used for routine eye irrigation?

Warm normal saline solution.

In an emergency, what can be used to irrigate the eye if saline is not available?

Plain tap water.

How should eye irrigation be performed to avoid contamination of the nasolacrimal duct?

Irrigate from the inner to the outer canthus.

Can a nurse delegate eye irrigation to a UAP (unlicensed assistive personnel)?

No, it requires the nurse’s critical thinking and should not be delegated.

What tool can be used to instill large volumes of irrigation fluid into the eye?

A Morgan therapeutic lens attached to IV tubing and a solution bag.

What is important to instruct a patient regarding contact lenses before eye irrigation?

Contact lenses must be removed prior to irrigation or compressing.

What are key patient teaching points after eye irrigation? (Select all that apply)
A. Report any pain or photophobia
B. Close eyes occasionally during irrigation
C. Keep contact lenses in during irrigation
D. Inform the doctor of ongoing irritation or infection

A. Report any pain or photophobia
B. Close eyes occasionally during irrigation
D. Inform the doctor of ongoing irritation or infection

Why must you never place a syringe tip directly onto the eye during irrigation?

To avoid trauma or contamination of the eye.

Why are older adults more commonly affected by cerumen impaction? (Select all that apply)
A. They produce more earwax than younger adults
B. They often have excess ear canal hair
C. They may have benign growths narrowing the ear canal
D. They frequently use hearing aids

B. They often have excess ear canal hair
C. They may have benign growths narrowing the ear canal
D. They frequently use hearing aids

What solution can a healthcare provider recommend to soften cerumen before irrigation in older adults?

Slightly warmed mineral oil (0.5 to 1 mL), twice daily for several days.

What are signs and symptoms of cerumen impaction that patients should report? (Select all that apply)
A. Crackling noises in the ear
B. Sharp jaw pain
C. Decreased hearing
D. Tinnitus (ringing in the ear)
E. Ear pain

A. Crackling noises in the ear
C. Decreased hearing
D. Tinnitus
E. Ear pain

What effect can occluding the auditory canal during irrigation have?

It can increase pressure and rupture the tympanic membrane.

What precautions should the nurse take when performing ear irrigation? (Select all that apply)
A. Use body-temperature solution
B. Apply pressure to force the wax out quickly
C. Avoid inserting the syringe tip deeply
D. Avoid occluding the auditory canal

A. Use body-temperature solution
C. Avoid inserting the syringe tip deeply
D. Avoid occluding the auditory canal

Can ear irrigation be delegated to UAP (unlicensed assistive personnel)?

No, it requires the nurse’s competence and clinical judgment.

In what conditions is ear irrigation contraindicated? (Select all that apply)
A. Cold
B. Ear infection
C. Wax impaction
D. Ruptured tympanic membrane
E. Fever

A. Cold
B. Ear infection
D. Ruptured tympanic membrane
E. Fever

Why should vegetable foreign bodies like beans not be irrigated from the ear?

Because they absorb moisture, causing swelling, pain, and making removal harder.

Why should cotton-tipped applicators be avoided for ear cleaning?

They can rupture the eardrum or push wax deeper into the canal.

How should patients be taught to clean their ears safely at home?

With a damp washcloth wrapped around their finger.

What are the two main reasons for performing nasal irrigation?

To clear blocked sinus drainage and improve airflow through the nares

To wash away dried mucus, secretions, and foreign debris

What devices or tools are commonly used for nasal irrigation? (Select all that apply)
A. Neti pot
B. Inhaler
C. Electronic gadget
D. Bulb syringe

A. Neti pot
C. Electronic gadget
D. Bulb syringe

Who must perform a nasal irrigation if medication is involved?

A licensed nurse.

Under what condition can nasal irrigation be delegated to a UAP?

When it’s only to remove dried secretions (check facility policy).

Which patients benefit from nasal irrigation? (Select all that apply)
A. Patients with asthma
B. Patients with sinusitis or rhinitis
C. Patients exposed to allergens or poisons
D. Patients with nasal fractures

B. Patients with sinusitis or rhinitis
C. Patients exposed to allergens or poisons

Why is nasal irrigation commonly prescribed after nasal surgery? (Select all that apply)
A. To eliminate debris
B. To encourage mucosal membrane repair
C. To remove surgical stitches
D. To increase medication absorption

A. To eliminate debris
B. To encourage mucosal membrane repair

What are contraindications to nasal irrigation? (Select all that apply)
A. Seasonal allergies
B. Advanced sinus deterioration
C. Foreign bodies in the nasal passageways
D. Recurrent nosebleeds

B. Advanced sinus deterioration
C. Foreign bodies in the nasal passageways
D. Recurrent nosebleeds

How are medications absorbed when administered through inhalation?

Through the respiratory mucous membranes, allowing rapid absorption.

What is the main effect of inhaled medications?

Primarily local effects like bronchodilation or reduced inflammation, though some have systemic effects (e.g., increased heart rate or blood pressure).

Which devices are commonly used to administer inhalation medications? (Select all that apply)
A. Nebulizers
B. Metered dose inhalers (MDIs)
C. Inhalers with spacers
D. Intravenous ports

A. Nebulizers
B. Metered dose inhalers (MDIs)
C. Inhalers with spacers

What is a spacer (e.g., AeroChamber) used for in MDI administration?

To help patients who have difficulty coordinating breathing with inhaler activation.

Which chronic respiratory conditions commonly require inhaled medications? (Select all that apply)
A. Asthma
B. Emphysema
C. Bronchitis
D. Pneumonia

A. Asthma
B. Emphysema
C. Bronchitis

What position should the patient be in when using a metered dose inhaler?

Sitting upright to allow full lung expansion.

What are key patient instructions for using a metered dose inhaler? (Select all that apply)
A. Shake the canister
B. Hold canister vertically
C. Inhale quickly and deeply
D. Compress canister at start of inhalation
E. Inhale slowly

A. Shake the canister
B. Hold canister vertically
D. Compress canister at start of inhalation
E. Inhale slowly
(Note: Inhalation should be slow, not quick.)

How much pressure does it take to activate a metered dose inhaler?

About 5 to 10 pounds of pressure.

What should the nurse assess before instructing a patient to use an MDI?

The patient’s ability to manipulate and depress the inhaler canister.

Why is it important to stress consistent use of inhaled medications to patients?

To maintain effective respiratory treatment and prevent exacerbations of chronic conditions.

What is buccal drug administration?

Placement of a tablet or liquid between the cheek and teeth or cheek and gums for absorption.

How is the medication absorbed in buccal administration?

Through the capillaries of the cheek mucous membrane into the systemic circulation.

Why does buccal administration have a quick onset of action?

Because it bypasses the liver and enters direct systemic circulation.

What type of medication form can be used for buccal administration? (Select all that apply)
A. Cream
B. Liquid
C. Tablet
D. Suppository

B. Liquid
C. Tablet

What administration technique is used for buccal medications?

The same approach as for solid oral medications, with placement between the cheek and gums.