question

Prescriptive authority

answer

Physician, dentist, PA, and advance practice nurses (clinical nurse specialist, NP, CRNA, and nurse midwife)

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Principles of pharmacology

answer

drug nomenclature, types of drug preparation, drug classification, mechanism of drug action, adverse drug effects, and factors affecting drug action, as well as drug blood level monitoring.

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Drug classification

answer

classified by effect on body systems, chemical composition, or by clinical indication for the drug or therapeutic effect

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Mechanism of drug action

answer

absorption, distribution, metabolism, and excretion

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Absorption

answer

process by which a drug is transferred from its site of entry into the body to the bloodstream.

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Absorption factors

answer

route of admin, lipid solubility, pH, blood flow, local conditions at the site of admin, drug dosage.

question

Goal of drug dosing

answer

to give a dose that achieves the desired therapeutic effect of the drug without causing other undesirable effects

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Distribution

answer

depends on blood flow to the tissues, the drug's ability to leave the bloodstream, and the drug's ability to enter the cells.

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Metabolism

answer

biotransformation of a drug from its original form to a new form. Liver is the primary site.

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Excretion

answer

the process of removing a drug, or its metabolites, from the body. The kidneys excrete most drugs.

question

Elderly implications r/t excretion

answer

manufactures are required by law to include specific information regarding implications on geriatric patients. the law effects psychotropic drugs, nonsteriodal anti-inflammatory agents, oral hypoglycemic agents, anticoagulants, certain broad spectrum ABX, and cardiac drugs.

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Drug receptor interaction

answer

the drug interacts with one or more cellular structures to alter cell function

question

Drug enzyme interaction

answer

a drug combines with an enzyme to achieve desired effects

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Adverse drug effects

answer

secondary undesirable effects other than the intended therapeutic effect of a drug

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Types of adverse effects

answer

allergic effect, drug tolerance, toxic effects, idiosyncratic effects, drug interactions, predictable, iatrogenic disorder

question

Allergic effect

answer

is an immune response that occurs when the body interprets the administered drugs as foreign substance and forms antibodies against the drug

question

Allergic effect s/s

answer

rash, urticaria, fever, diarrhea, n/v, and anaphylaxis (a life threatening response due to respiratory distress)

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Drug tolerance

answer

the body becomes accustomed to the effects of a particular drug over a period of time

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Toxic effects

answer

are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death.

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Cumulative effect

answer

Toxicities can occur from this. It occurs when the body cannot metabolize one dose of a drug before admin of the next dose.

question

Idiosyncratic effect

answer

is any unusual or peculiar responses to a drug that may manifest itself by over response, under response, or even the opposite response

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Drug interaction

answer

one drug is affected in some way by another drug, or another substance that is taken at the same time

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Antagonist effect

answer

combined effect of two or more drugs acting simultaneously produces an effect less than that of each drug alone

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Synergistic effect

answer

combined effect of two or more drugs acting simultaneously produces an effect greater than that of each drug alone

question

Factors affecting drug action

answer

developmental considerations, patient's body weight, patient's gender, genetic and cultural factors, psychological factors, pathology, environment, and timing of medication admin

question

Parts of a medication order

answer

patients name, date and time the order was written, name of the drug, dosage, route, frequency, and signature of person writing the order

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1st check of medication administration

answer

when the nurse reaches for the container or unit dose package

question

2nd check of medication administration

answer

after retrieval from the drawer and compared with the CMAR or compared with the CMAR immediately before pouring from multidose containers

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3rd check of medication administration

answer

when placing the container to the drawer or shelf or before giving the unit dose medication to the patient

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7 rights

answer

right medication, patient, dosage, rouse, time, reason, documentation

question

Safety measures while preparing drugs

answer

Three checks and the rights of medication administration, maintaining a safe environment, handling controlled substance safely, identifying patient

question

Required information for narcotics

answer

name of patient receiving the narcotic, amount of the narcotic used, hour the narcotic was given, name of the physician who prescribed it, name of the nurse who administered it.

question

Oral drugs

answer

the most commonly used route of admin. it is usually the most convenient and comfortable for the pt. drug action has a slower onset and a more prolonged, but less potent, effect.

question

Sold oral drugs

answer

tablets, capsules, and pills

question

Don't chew or crush...

answer

enteric coated tabs, extended release forms such as SR (sustained release), XL (extended release), CR or CRT (controlled release), SA (sustained action), or LA (long acting)

question

Liquid oral drugs

answer

elixirs, spirits, suspensions, and syrups

question

Administering liquid oral drugs

answer

syringe should be placed between the gums and cheek with pt sitting up or lying on side, medication admin slowly

question

Enamel discoloring drug admin techniques

answer

have the pt take the medication mixed with liquid through a straw, and encourage the pt to drink water after admin

question

Bad tast drug admin techniques

answer

crush the med and mix with a food or a drink, allow the pt to suck on a small piece of ice for a few minutes before admin, store oily meds in refrigerator, place the meds in a syringe and place the syringe well back on the tongue, offer oral hygiene immediately after admin, give with generous amounts of fluid

question

Children drug admin techniques

answer

use a dropper while holding in sitting or semi sitting, crush uncoated tablets or empty soft capsules and mix with food, offer a flavored ice pop before admin, praise the child for taking the med

question

Geriatric drug admin techniques

answer

allow extra time, crush or give meds in liquid form, reevaluate the drug dosage, assist with setting up a med schedule, monitor closely for adverse effects, teach the pt the names of drugs rather than distinguishing between color or shape.

question

Successful self management of medication in geriatric patients

answer

establishing habits, adjusting routines, tracking medications, simplifying medication practices, and improving patient education related to the relationship of medications to maintaining health.

question

GI tube drug admin techniques

answer

use liquid meds when possible, crush and combine with liquid, certain capsules may be opened and emptied into a liquid, bring liquid meds to room temp, elevate HOB, remove the clamp from the tube and use the recommended procedure for checking tube placement before admin, flush the tube with 15-30ml of water before and after admin, give meds separately and flush with water between each drug, disconnect from suction, d/c continuous tube feeding, document water and liquid medication intake.

question

Sublingual and buccal drug admin techniques

answer

medications should not be swallowed, but rather held in place so that complete absorption can occur. Before admin off the pt a drink or provide oral care to an NPO pt.

question

Administering parenteral medications

answer

Injecting meds into an artery, the peritoneum, heart tissues, the spinal canal, and bones

question

Gauge of needle

answer

refers to diameter of needle, as the diameter increases the gauge decreases

question

Route of admin

answer

a longer needle is required for an IM injection than for an intradermal injection.

question

Viscosity of the solution

answer

some medications are more viscous than others and require a large lumen needle to inject the drug

question

Quantity to be administered

answer

the larger the amount of med to be injected, the greater the capacity of the syringe

question

Body size

answer

an obese person requires longer needles to reach the muscle than does a thin person.

question

Type of medication

answer

there are special syringes for certain uses.

question

Ampule

answer

use filter needle to remove meds. then place an unfiltered needle to admin.

question

Multidose vial

answer

good for 24 hours. Label the vial with date and time of opening. Wipe down rubber stopper before each use, and inject the equivalent amount of air in vial before removal of med.

question

Prefilled cartridge or syringe

answer

single dose of medication. Overfilled usually so eject until exactly correct amount remaining for admin.

question

Intradermal injections

answer

admin into the dermis just below the epidermis. Has the longest absorption time of all parental routes. Used for sensitivity tests and local anesthesia

question

Intradermal sites

answer

inner surface of the forearm and the upper back under the scapula.

question

Intradermal equipment

answer

TB syringe, a 1/4" to 1/2", 26-27 gauge needle.

question

Intradermal dosage

answer

usually less than 0.5ml

question

Intradermal angle of admin

answer

5-15 degrees

question

Sub-Q injections

answer

are administered into the adipose tissue layer just below the epidermis and dermis. This tissue has few blood vessels so drugs have a slow sustained rate of absorption.

question

Sub-Q sites

answer

outer aspect of arm, abd, anterior aspect of thigh, upper back, and the upper ventral or dorsogluteal area. avoid areas that are bruised, tender, hard, swollen, inflamed, or scarred.

question

Sub-Q absorption

answer

abd quickets, arms, thighs, and upper ventral or dorsogluteal slowest

question

Sub-Q equipment

answer

25-30 gauge, 3/8" to 1" needle. the 3/8" and 5/8" needle most common. choose needle length based on the amount of sub-q tissue present.

question

Sub-Q dosage

answer

no more than 1ml

question

Sub-Q angle of admin

answer

45-90 degrees

question

Sub-Q procedure

answer

pinch or fold skin, insert needle, release skin, inject meds. If blood or fluid comes out after removal of needle apply gentle pressure to spot. Massaging area is not necessary and can damage tissue. Rotate sites.

question

Insulin syringe

answer

28-30 gauge 5/16" to 1/2" needle, and 3/10mL to 1mL sizes.

question

IM injections

answer

larger and greater blood vessels allow for faster onset of action than sub-q. Some have longer durations.

question

IM sites inaccurate complications

answer

abscesses, cellulitis, injury to blood vessels, bones, and nerves, lingering pain, tissue necrosis, and periostitis. Avoid areas that are bruised, tender, hard, swollen, inflamed, or scarred

question

IM sites

answer

ventrogluteal, vastus lateralis, deltoid,

question

Ventrogluteal

answer

involves gluteus medius and gluteus minimus muscles in hip area. to relax the muscle pt may flex knees while supine, point toes inward while lying in prone, and flex upper leg in front of lower leg in side lying.

question

Ventrogluteal location

answer

place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. the right hand is used for the left hip. place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed and the injection goes in the middle of the triangle.

question

Vastus lateralis

answer

involves the quadriceps femurs muscle and is located along the anterolateral aspect of the thigh.

question

Vastus lateralis location

answer

divide the thigh into thirds horizontally and vertically and administer the injection in the outer middle third.

question

Deltoid

answer

lateral aspect of the upper arm. used for vaccines in adults and children 1-18. Damage to radial nerve and artery is a risk. Limited to 1mL.

question

Deltoid location

answer

palpate the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process.

question

IM equipment

answer

Needle length based on location and age of pt. Gauge determined by med being admin. Biological agents with a 20-25 gauge needle. Oil based solutions 18-25 gauge.

question

IM dosage

answer

1-4mL

question

IM angle of admin

answer

72-90 degrees

question

IM procedure

answer

administer IM so that needle is perpendicular to pts body. recommended z-track is used

question

Z-track

answer

attach clean needle once syringe filled with med, pull skin down or to one side about 1" and hold this position with nondominant and. Insert needle, aspirate, and inject meds. Withdraw needle and release displaced skin. Massaging site is not recommended, but gentle pressure may be applied

question

IV

answer

delivered directly to blood, and produce immediate effect. It is the most dangerous route of admin because it is placed directly into the blood. It cannot be recalled and actions can't be slowed.

question

IV meds

answer

may be added to infusion solution. check for adverse effects at least every hour

question

IV meds via bolus or push

answer

involves a single injection of a concentrated solution. drugs is admin very slowly over at the least 1 min.

question

IV meds via intermittent IV infusion

answer

drugs is mixed with a small amount of IV solution, such as 50-100mL, and admin over a very short period of time. Can receive via piggyback, volume controlled admin set, or mini infusion pump

question

Piggyback

answer

requires the intermittent or additive solution to be placed higher than the primary solution container.

question

Volume control admin set

answer

intermittent iv infusion. Med diluted with small amount of solution and admin through IV line.

question

Mini infusion pump

answer

intermittent infusion is battery operated and allows medication mixed in syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe

question

Topical admin

answer

applied to skin and mucus membranes. usually intended for direct action at a particular site, although some can have systemic effects and are given for systemic effect.

question

Skin application

answer

clean skin thoroughly with soap and water before admin and then rubbing the medicated preparation into the skin can enhance absorption.

question

inunction

answer

when a drug is incorporated in an agent such as an ointment and rubbed into the skin for absorption

question

Powders

answer

used to promote drying of the skin and prevent friction on the skin. use caution to prevent inhalation. apply the powder to a square gauze and then apply to the desired site to minimize inhalation

question

Ointments

answer

provide prolonged contact of a medication with the skin and soften the skin. they are usually thoroughly massaged into the skin

question

Creams and oils

answer

lubricate and soften the skin and prevent drying of the skin. if a large area of the body is to be covered, warm the preparation in hand to prevent chilling

question

Lotion

answer

protects and soothes the skin. shake lotion well and apply with cotton balls or gauze

question

Transdermal delivery

answer

utilize reservoirs, micro reservoirs, adhesives, or matrices. these systems are a sandwich of layers each with a specific job. drug is rate controlled.

question

Eye instillations and irrigations

answer

meds are placed onto or instilled or irrigated into the lower conjunctival sac. should be sterile. do not touch the eye with instiller and wash hands. eye drops, ointments, irrigation, medication disks

question

Eye ointments

answer

small amount distributed along the exposed lower conjunctival sac after the eyelids and eyelashes have been cleansed. about 1/2" applied to inner canthus to outer can thus. After application close eye; the warmth helps to liquefy ointment

question

Eye medication disks

answer

flexible resemblance of contact. contain meds that is released gradually into conjunctival sac. can remain for a week before needing to be changed.

question

Ear instillations and irrigations

answer

instilled for local effect. used to soften wax, relieve pain, apply local anesthesia, destroy organisms, or destroy an insect lodged in canal. it too swollen a wick is inserted so that one end is in the middle of the ear and the other outside of the ear. Meds are wicked to the correct location. ear drops, ear irrigation

question

Nasal instillation

answer

used to treat allergies, sinus infections, and nasal congestion.

question

Vaginal applications

answer

creams, foams, and tablets can be applied intravaginally using a narrow, tubular applicator with an attached plunger. suppositories that melt when exposed to body heat are also admin vaginally. Pt to void before admin. pt lying on back with knees flexed.

question

Rectal instillations

answer

used primarily for local action, such as laxatives and fecal softeners. systemic effects can also be met with suppositories. after inserted pt to remain in left lateral position for 5 minutes, if a laxative remain in position for 35-45 min

question

Inhalation drugs

answer

they are aerosolized. drugs are absorbed easily from lower resp tract. inhalation may be used to admin several different classes of drugs with varying properties of indications. may be admin with hand atomizer or nebulizer.

question

Common types of med errors

answer

inappropriate prescribing of the drug, extra omitted or wrong dose, admin of a med to a pt that was not ordered, admin of a drug by an incorrect route or rate, failure to give med within prescribed time, incorrect preparation, improper technique, giving drug that is deteriorated.

question

Steps after med error made

answer

check the pts condition immediately, notify nurse manager and the primary care provider, write description of the error on the pt MAR, complete the form used for reporting errors as directed by facility.

question

Patient should be able to verbalize after teaching...

answer

how and when to admin med, when to notify healthcare provider, expected adverse effects

question

Oral route advantages

answer

most convenient, easiest, safest, slower onset of action, more prolonged effect, preferred route by pt, less stress, most economical

question

Oral route disadvantages

answer

absorption is dependent on pH motility and presence of food in GI system, drugs can irritate stomach, unpleasant taste, contraindicated in pt with swallowing difficulties n/v unconscious, restrictions before diagnostic tests, NPO, and gastric suctioning.

question

PICC

answer

peripherally inserted central catheter. small flexible catheter inserted in a peripheral vein then threaded so that the tip is positioned in the heart.

question

PICC indications

answer

to draw blood. to administer fluids such as blood chemotherapy drugs and nutrition

question

Risk of PICC insertion

answer

catheter movement from site damage to the tube or malfunction, infection, pain or spasms in the shoulder neck arm or where the line enters the body, numbness and/or tingling in arm or hand

question

Central Line Access Device

answer

inserted directly into the subclavian or the internal jugular veins for short term use. can be tunneled through the sub-q skin to the subclavian vein for long term placement

question

Type of CVAD used depends on..

answer

the length of therapy, the pt condition, the type of solution or medication needed.

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