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Med Admin 1 ATI questions With which route of drug administration are there no barriers to absorption? - Intravenous * The definition of absorption is the movement of a drug from its site of administration into the blood. With intravenous administration, the drug is injected directly into a vein. Thus any possible barriers to absorption are bypassed, and the drug is completely and instantaneously absorbed. which of the following demonstrates the correct use of one of the Six Rights of Medication Administration? Administering a patient's medication by the route the provider has prescribed MY ANSWER The Six Rights of Medication Administration are the right medication, the right dose, the right patient, the right route, the right time, and the right documentation. Giving the medication by the route prescribed is indeed an application of the Six Rights of Medication Administration. Adhering as closely as possible to the medication schedule the patient follows at home This is not one of the Six Rights of Medication Administration. Some medications have to be administered at times relative to other activities, such as 1 hour before meals or at bedtime. But in general, it is not possible to duplicate patients’ home dosing schedules, plus their medications may change with hospitalization. Gathering a medication history from the patient before administering any drugs This is not one of the Six Rights of Medication Administration; however, it is the patient’s right to have a qualified health care professional take a medication history. Respecting a patient's refusal to take a new medication the provider has prescribed This is not one of the Six Rights of Medication Administration; however, patients have the right to refuse treatment or medications.

which of the following patients is exhibiting drug tolerance? A patient continues to take a medication despite harmful effects. This is a characteristic of addictive behavior. A patient requires an increased dose of a medication to achieve continued therapeutic benefit. MY ANSWER As tolerance develops to a medication, a patient requires higher and higher doses of that medication to achieve the desired effect. A patient exhibits signs of withdrawal when a medication is discontinued. Physical drug dependence is a state of adaptation in which an abstinence or withdrawal syndrome will result if the person stops taking the drug. A patient develops an intense craving for a drug. This is a reliance on a drug to maintain a sense of well-being, along with feelings of need or craving for the drug. A patient drinks 8 oz of water. Which of the following is a correct conversion of the patient's intake? - 240 mL 1 pint One pint equals 16 fluid oz. 4 tablespoons Two tablespoons equal 1 fluid oz; therefore, 4 tablespoons equal 2 fluid oz. 2 cups Eight oz equals 1 cup. 240 mL

MY ANSWER One fluid oz equals 30 mL; therefore, 8 fluid oz equals 240 mL. Which of the following represents the correct administration of the prescribed medication? Acetaminophen 650 mg PO prescribed; 5 tsp of 325 mg/10 mL liquid given To determine the correct dosage, start with the amount prescribed: 650 mg (milligrams). To determine how much liquid to give, divide the dose ordered by the dose on hand and multiply the result by the amount on hand. So, 650 mg (dose ordered) divided by 325 mg (dose on hand) = 2, then 2 X 10 mL (amount on hand) = 20 mL. Since 1 teaspoon equals 5 mL, 20 mL equals 4 teaspoons, which would be the correct dose to give (not 5 teaspoons). Levothyroxine 100 mcg PO prescribed; three 0.025 mg tablets given To determine the correct dosage, start with the amount prescribed: 100 mcg (micrograms). Since the tablets on hand are in milligrams, not micrograms, first convert the amount prescribed to milligrams. Since there are 1,000 micrograms in each milligram, 100 mcg = 0.1 mg. To determine how many tablets to give, divide the dose ordered by the dose on hand and multiply the result by the amount on hand. So, 0.1 mg (dose ordered) divided by 0.025 mg (dose on hand) = 4, then 4 X 1 tablet (amount on hand) = 4 tablets. The correct dose is four tablets, not three tablets. Amoxicillin 1 g PO prescribed; two 500-mg tablets given MY ANSWER To determine the correct dosage, start with the amount prescribed: 1 g (gram). To determine how many tablets to give, divide the dose ordered by the dose on hand and multiply the result by the amount on hand. So, 1 g (dose ordered, and also equivalent to 1,000 mg) divided by 500 mg (dose on hand) = 2, then 2 X 1 (amount on hand) = 2 tablets. So this is the correct amount to give. Diphenhydramine 40 mg IM prescribed; 1.25 mL of 50 mg/1 mL for injection given To determine the correct dosage, start with the amount prescribed: 40 mg (milligrams). To determine how much fluid to inject, divide the dose ordered by the dose on hand and

multiply the result by the amount on hand. So, 40 mg (dose ordered) divided by 50 mg (dose on hand) = 0.8, then 0.8 X 1 mL (amount on hand) = 0.8 mL. The correct dose is 0.8 mL, not 1.25 mL.

Which of the following is the most appropriate documentation of a patient's response to a pain medication?

The patient states, “I feel better” 10 minutes after medication administration. A patient report of “feeling better” is not an objective measurement of response to a pain medication. The patient is sleeping 1 hour after administration. A patient can still sleep even though he is experiencing pain; therefore, this is not an objective measurement of response to pain medication. The patient is up and walking in the hall 2 hours after administration. This patient may be using activity as a distraction; therefore, this is not an objective measurement of response to pain medication. The patient reports pain decreased to 3/10, 30 minutes after medication administration. MY ANSWER Using a standardized instrument is the most appropriate method of documenting a response to pain medication. A drug's generic name is the X- chemical name for the medication. A drug’s chemical name describes the drug’s components precisely and in chemical terms. For example, the chemical name for acetaminophen is N-acetyl-paraaminophenol. same as its nonproprietary name. A drug’s generic name is its nonproprietary or noncommercial name. Each drug has only one generic name. For example, acetaminophen is the generic name for the drug marketed as Tylenol, while ibuprofen is the generic name for the drugs Advil, Motrin, and others.

name under which the drug is marketed. The name (or names) under which a drug is marketed is its trade name, brand name, or proprietary name. The drug company manufacturing and marketing the drug assigns the trade name. For example, Tylenol is the trade name for acetaminophen. formal name of the particular drug. The term “formal” is not correct nomenclature for drugs. You are reading the physician's orders and note date and time of the prescriptions, as well as the physician's signature. Which of the following prescriptions is complete? Aspirin PO 1 tablet daily The dose of medication is missing from this order. Ferrous sulfate 624 mg PO The time of medication administration is missing from this order. Hydrocodone/acetaminophen (Vicodin) 5/325 mg PRN MY ANSWER The reason for the order, the route, and the frequency of medication administration are missing from this order. Digoxin (Lanoxin) 1.25 mg PO daily This order is complete with medication dose, the route, and the frequency of administration.

Which of the following is your highest priority action for ensuring overall safety during medication administration? Have another nurse check the dose you will give. This is a good practice when you have to perform a calculation; however, it is impractical for overall safety on an ongoing basis. Also, confirming the dose is only one aspect of safe medication administration. Teach the patient about possible adverse effects.

It is important to make sure that the patient understands all side effects and their risks, as well as what to report after taking a medication, but this action will not help ensure overall safety during medication administration. Identify the patient by two acceptable methods. MY ANSWER One of the six rights of medication administration is to identify that you are giving the medication to the correct patient. It is required that you check the medication administration record against the patient’s identification bracelet, and use a second method of patient identification, such as asking the patient his birth date. Confirm that the patient can swallow adequately. This is necessary when administering oral medications; however, it does not ensure overall safety, because not all medications are given orally.

An uncommon, unexpected, or individual drug response thought to result from a genetic predisposition is called an idiosyncratic effect. An idiosyncratic effect is an uncommon, unexpected, or individual drug response thought to result from a genetic predisposition. an allergic response. An allergic response is an immune response. Usually, a patient has been previously exposed to the offending allergen. Re-exposure to the drug causes a predictable reaction that can range in intensity from mild itching to anaphylaxis, a life-threatening response. a toxic effect. Drug toxicity is an adverse drug reaction caused by an excessive dose of a particular medication. a synergistic effect.

A synergistic effect is a result of the action of two medications combined, either to potentiate, block, or alter the effects of either or both drugs when used separately. These interactions are typically predictable and sometimes beneficial.

You have a handwritten medication order that is difficult to read. Which of the following is the most appropriate action to take to avoid an error in medication administration? Ask another nurse to decipher the medication order. Although a colleague might have more experience in deciphering a provider’s handwriting, there is no guarantee that she can read it correctly. Call the medical provider for clarification of the order. MY ANSWER There is no other way to be sure about what was intended other than confirming it with the person who wrote the order. Rely on your knowledge of the patient to get this order right. Although you may know a patient and his condition well, this is not within your scope of practice. Inquire at the hospital pharmacy about the order. Although a pharmacist might have more experience in deciphering a provider’s handwriting, there is no guarantee that she can read it correctly. You are giving a patient several PO medications to take. The patient tells you that she can only take one pill at a time. It is appropriate to place all of the medications in a cup and let the patient decide the order in which to take them. If the patient is going to take one pill at a time, the unit-dose medication packaging should be opened one at a time. crush the pills and mix them in applesauce. The patient can swallow the pills, so it is unnecessary to crush them. For various

reasons, it is possible that some of the pills should not be crushed. remain at the bedside until you are sure the patient has taken all of the medications. It is your responsibility to remain with the patient and observe that she has swallowed each medication. It is unacceptable to leave medications unattended for any period of time. leave the pills at the bedside for the patient to take. To ensure complete administration, you must observe the patient taking the medication.

Med Admin 2 ATI questions A nurse is administering aspirin 81 mg PO daily as prescribed. The medication is scheduled for 0800 hours. Which of the following demonstrates proper use of one of the six rights of medication administration? The nurse performs the first check of the correct dosage at the patient's bedside. The nurse performs three checks of the medication and dosage prior to administration. The first check is performed prior to removing the medication from the drawer. The nurse identifies the patient by stating the patient's name as written on the medication administration record. The nurse should ask the patient to state his name and should check the medication administration record against the patient’s identification bracelet to ensure proper identification. The nurse documents that the aspirin was given at 0825. MY ANSWER All routinely ordered medications should be given within 60 min of the time ordered (30 min before or after the prescribed time). The nurse opens the 81 mg aspirin unit dose package prior to entering the patient's room.

When using unit dose packages, the package is opened at the patient’s bedside after the third check. A patient is to receive his daily isoniazid (INH) dosage for tuberculosis. He states he is feeling nauseated with this medication and refuses to take it. The nurse knows that the correct way to indicate this refusal is to document the reason for refusal along with the date and time in the patient's medical record. The patient has the right to refuse medication. Refusals must be documented in the patient's record with the date, time, and reason for refusal, if known. circle the scheduled time of medication administration on the medication record. In some institutions, circling the scheduled medication time indicates that the medication was not given. This, however, does not indicate the reason why the medication was not given. initial the scheduled time of medication administration on the medication record. In some institutions, this indicates that the medication was given. notify the primary care provider that the patient refused to take the medication. It may be necessary to tell the primary care provider, but the refusal must still be documented in the patient's medical record. A nurse is teaching the daughter of an older adult patient how to instill eye drops in the patient's right eye. Which of the following statements indicates that the daughter has understood the directions? “I will have my mother look down while dropping the medication into her eye.” This method causes stimulation of the blink reflex. “I will instruct my mother to tightly close her eye for 30 to 60 seconds after the medication has been given.”

Closing the eye tightly after the medication has been given may force the medication out of the eye. “I should apply the medication using a thin stream from the inner canthus to the outer canthus.” This is the proper application technique for eye ointment, not eye drops. ”I will pull down her lower eyelid and drop the medication inside.” MY ANSWER This method will allow the medication to be distributed evenly across the eye with less discomfort. A nurse is caring for a patient who has been prescribed a fluticasone propinate (Flovent HFA) inhaler with a spacer. The patient asks the nurse why a spacer is needed with the inhaler. Which of the following responses by the nurse is correct? “By using a spacer, you can take the medication correctly without any spills.” Spilling is not an issue with aerosol medications such as albuterol. “You can inhale five or more puffs in 1 min when using a spacer.” Dosing is usually accomplished with one or two puffs. When two puffs are needed, an interval of at least 1 min is needed between the two puffs. “By using a spacer, you eliminate the need for mouth rinsing after administration.” The patient should rinse following administration to remove residual medication regardless of whether a spacer was used. “More medication is delivered to the lungs when you use a spacer.” A spacer slows down and breaks up the medication, allowing the patient to better control the flow of medication. This, in turn, decreases the amount of medication deposited in the oropharynx.

A nurse is preparing to instill antibiotic ear drops into a toddler's ear. Which of the

following techniques should the nurse use when administering ear drops to this patient? Have the patient maintain side-lying position for 30 min after administration of ear drops. The patient should remain in a side-lying position for 2 to 3 min. Pull the patient's auricle down and back to open the canal when administering ear drops. MY ANSWER The auricle should be pulled down and back for young children, up and out for adults. The nurse should don sterile gloves prior to administration of ear drops. It is not necessary to wear sterile gloves to maintain sterile technique when administering ear drops. Insert the tip of the dropper into the ear canal when administering ear drops. The dropper should be held 1 cm away from the canal to prevent contamination and maintain sterility. adding crushed medications to the enteral tube feedings and infusing via an electronic pump. Medications should not be diluted with enteral tube feedings. Dilute medications with agency-approved fluid as needed. infusing each medication by gravity and flushing with water before and after instillation. Medications should be instilled via gravity, flushing before and after with water. administering medications through a large bulb syringe. Use a Luer-Lok syringe when administering medications through a small bore nasogastric tube. lowering the syringe to promote instillation of medication. To facilitate instillation, raise the syringe up to 18 inches from the insertion site.

for which of the following inhalation medication delivery methods is it important for the nurse to assess the pt's ability to inhale deeply before administering the medication? Dry powder inhaler (DPI) MY ANSWER This method has no propellant and requires a deep inhalation to trigger the release of medication. Nasal spray Medication administered via nasal spray does not go into the lungs; therefore, it is not necessary for the patient to inhale deeply. Metered dose inhaler (MDI) with attached spacer The MDI inhaler contains propellant, so medication is forcefully expelled when triggered by hand. The spacer facilitates delivery of the medication, because it requires less hand coordination. Use of a nebulizer via a mask This delivery method is beneficial for a patient unable to use a hand-held nebulizer and provides continuous medication delivery until the measured dose has been delivered. a pt is to receive 12.5 mg of prednisone (deltasone) by mouth daily. the medication is available in 5 mg tablets. how many tablets should the nurse administer per dose? Use the following formula to determine how many tablets to administer: Divide the dose ordered by the dose on hand and multiply the result by the quantity on hand. So, 12.5 mg (dose ordered) divided by 5 mg (dose on hand) = 2.5, then 2.5 x 1 tablet (quantity on hand) = 2.5 tablets. which of the following should a nurse assess before administering medications through a nasogastric tube? Correct tube placement by inserting air into tube while auscultating at gastric fundus This is not an accurate method for assessing proper tube placement. Checking the pH of aspirate for acidity will determine if the tube is properly placed in the stomach. Areas of tympany and dullness by percussing abdomen

This assessment is not needed for medication administration. Tympany and dullness are used to assess for constipation and trapped gas in the intestines. Amount of residual volume left in stomach MY ANSWER Checking residual volume prevents putting medications into an already full stomach. Ability of patient to cooperate with instructions The patient is not required to cooperate with nursing instructions to receive medications through an NG tube.

Med Admin 3 ATI questions Which of the following terms indicates a medication is given by injection? a) enteral b) sublingual c) transdermal d) pareneteral Enteral Enteral refers to medication given via the gastrointestinal tract. Sublingual Sublingual refers to medication given via the mucosa under the tongue. Transdermal Transdermal refers to a medication given via a skin patch. Parenteral Parenteral indicates a medication is given by injection. A nurse is preparing to administer an intradermal injection. Which of the following

should the nurse do to ensure proper technique? a) Rub the injection site after withdrawing the needle b) Pinch 1/2 in o...