Question 1

The patient is to receive three different medications via nasogastric tube.What is the total amount of water the nurse should prepare to administer?

Accepted Answer

30 mL of water would be administered before and after the medication and 15 to 30 mL between medications for a total of at least 90 mL.

Question 2

An appropriate technique for a nurse to implement when administering a topical medication with a systemic effect is:

Accepted Answer

Remove the old patch,and choose a different site.Do not apply to previously used sites for at least 1 week.Rotation of sites reduces skin irritation from medication and adhesive.
Do not attempt to apply transdermal patches on skin that is oily,burned,broken out,cut,or irritated in any way.Apply to the thickness specified by manufacturer's instructions.This ensures even distribution and sufficient dosage of medication.Do not rub or massage ointment into skin.Medication is designed to absorb slowly over several hours; massaging increases the absorption rate.

Question 3

The patient is ordered to have eye drops administered daily to both eyes.On/in which part of the eye should eye drops be instilled?

Accepted Answer

Eye drops should be instilled into the lower conjunctival sac.The conjunctival sac
normally holds 1 or 2 drops and provides even distribution of medication across the eye.
The cornea is very sensitive.If drops were instilled onto the cornea,this would stimulate the blink reflex.The outer canthus would not hold the eye drop,and it would be wasted,nor would it be distributed evenly across the eye.The opening of the lacrimal duct is not the correct site for eye drops to be instilled.It would not provide even distribution of drops across the eye,and medication most likely would be wasted because this area could not contain the drops.

Question 4

What should the nurse do to assist a patient who is having difficulty swallowing tablets and capsules?

Accepted Answer

If patient has difficulty swallowing,use pill-crushing device to crush.Mix ground tablet in small amount of soft food (custard or applesauce).Large tablets are often difficult to swallow.Ground tablet mixed with palatable soft food is usually easier to swallow.Not all drugs can be crushed (e.g.,capsules,enteric-coated,long-acting/slow-release drugs).The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids.
Administration of medication with less fluid could make it more difficult for the patient to swallow.Insertion of a nasogastric tube requires an order from the provider.A patient who is having difficulty swallowing may not be safe swallowing large capsules or tablets even one at a time.

Question 5

The patient has been complaining of chest pressure.After the appropriate assessment,the nurse gives the patient sublingual nitroglycerin,telling the patient not to swallow the medication.Why are these instructions important?

Accepted Answer

If swallowed,the drug is destroyed by gastric juices or is detoxified so rapidly by the liver that therapeutic blood levels are not attained.
Orally disintegrating formulations begin to dissolve when placed on the tongue.Sublingual medications,however,are placed under the tongue.For sublingually administered medications: Have patient place medication under tongue,and allow it to dissolve completely.Water is not needed for these medications.

Question 6

The nurse is preparing to administer medications to a patient via his enteral feeding tube.Which of the following may be administered via his tube?

Accepted Answer

Preferably,medications administered by enteral tubes should be given in liquid form.If liquid form is not available,you will have to modify the form of the medication tablet by crushing or dissolving it.However,you cannot crush sustained-release,chewable,long-acting,or enteric-coated tablets and capsules.Therefore,do not administer these medications by enteral tubes.Consult with the hospital pharmacy when in doubt.
You cannot crush sustained-release,chewable,long-acting,or enteric-coated tablets and capsules.Therefore,do not administer these medications by enteral tubes.

Question 7

The patient has returned from a gastroscopy procedure.He has been NPO since midnight last night and has not received his morning medications.What should the nurse do before giving him his medications?

Accepted Answer

Assess patient's swallow,cough,and gag reflexes.Determine the patient's ability to swallow safely.Patients with altered ability to swallow are at higher risk for aspiration.
If possible,the patient should be allowed to self-administer oral medications.Checking for a gag reflex takes priority over assessing the ability to cough in preventing aspiration.Straws should be avoided because they decrease the control the patient has over volume intake,which increases the risk for aspiration.Some patients cannot tolerate thin liquids such as water and need them to be thickened.

Question 8

What should the nurse instruct her patient to do when she or he is administering a buccal medication?

Accepted Answer

Buccal medication is placed between the upper or lower molar teeth and the cheek area and is allowed to dissolve.
The sublingual route is used to administer medication under the tongue.Medication is dissolved rather than swallowed using the buccal route.

Question 9

The nurse is to administer several medications to the patient via the nasogastric (NG)tube.What should the nurse do first?

Accepted Answer

Check placement of feeding tube by observing gastric contents and checking pH of aspirate contents.Gastric pH should be 4 or less.This ensures proper tube placement and reduces the risk of introducing fluids into the respiratory tract.
Never add medications directly to the tube feeding.Not all tablets can be crushed,such as sustained-release tablets,nor should all capsules be opened.Medications should be reviewed carefully before a tablet is crushed or a capsule is opened.To administer more than one medication,give each separately,and flush between medications with 10 mL of water.Keeping the medications separate allows for accurate identification of medication if a dose is spilled.In addition,some medications are not compatible with each other,and this may cause clogging of the tube.

Question 10

The nurse is preparing to medicate a small child.The medication comes in pill or liquid form,but the liquid preparation has a bitter taste.What is the preferred way to administer the medication under this circumstance?

Accepted Answer

Children will refuse bitter or distasteful oral preparations.Mix the drug with a small amount (about 1 tsp)of a sweet-tasting substance,such as jam,applesauce,sherbet,ice cream,or fruit puree.Offer the child juice or a flavored ice pop after medication administration.
Liquid forms of medication are safer to swallow to avoid aspiration of small pills.Do not use honey in infants because of the risk of botulism.Do not place medication in an essential food item,such as milk or formula; the child may refuse the food at a later time.

Question 11

When administering an eye medication,the nurse should:

Accepted Answer

Holding ointment applicator above lower lid margin,apply thin ribbon of ointment evenly along inner edge of lower eyelid on conjunctiva from the inner canthus to outer canthus.This distributes medication evenly across eye and lid margin.
Eyes are cleansed from the inner to the outer canthus.Drops are instilled into the conjunctival sac.Have patient close eye and rub lid lightly in circular motion with cotton ball,only if rubbing is not contraindicated.

Question 12

The nurse is preparing to administer a pediatric dose of liquid medication to an infant.What should the nurse do to ensure an accurate dose of the medication?

Accepted Answer

For small doses of liquid medications,draw liquid into a calibrated oral syringe.Use only syringes specifically designed for oral use when administering liquid medications.
If medication is in a unit-dose container with the correct amount to administer,no further preparation is necessary.If using a medication cup,hold medication cup at eye level,and fill to desired level on scale.Scale should be even with fluid level at its surface or base of meniscus,not edges.Do not use a hypodermic syringe or a syringe with a needle or syringe cap.If hypodermic syringes are used,the medication inadvertently may be administered parenterally,or the syringe cap or needle,if not removed from the syringe before administration,may become dislodged and accidentally aspirated when the syringe plunger is pressed.

Question 13

The nurse is in the medication room preparing medications for her patients.She has four patients who require medications at 0900.Which of the following methods follows the six rights of medication?

Accepted Answer

To prepare unit-dose tablets or capsules,place packaged tablet or capsule directly into medicine cup.(Do not remove wrapper.)Wrapper maintains cleanliness of medications and identifies drug name and dose.
Prepare medications for one patient at a time.Keep all pages of MAR for one patient together.This prevents preparation errors.If you have to break a medication to administer half the dosage,use a clean,gloved hand to break the tablet or cut with a cutting device.Tablets that are to be broken in half must be prescored by a manufactured line that transverses the center of the tablet.This reduces contamination of the tablet.Tablets that are not prescored cannot be broken into equal halves,and the result will be an inaccurate dose.Using a cutting device results in a more even split of the tablet.

Question 14

When preparing to administer medication via an NG tube,the nurse aspirates a large volume of residual.What should the nurse do first?

Accepted Answer

If you find a large volume of aspirate (e.g.,200 mL or more),return aspirate to patient,withhold medication,and notify patient's health care provider.Check agency policy.Some agency policies will hold the tube feeding as well.Large-volume aspirates indicate delayed gastric emptying,which contributes to gastric distention,esophageal reflux,and vomiting,all of which place the patient at risk for aspiration.
Additional fluid would not be administered if the patient had a large residual.Use of suction would require an order from the provider.

Question 15

The nurse is teaching the patient how to use a topical medication.Which statement indicates an understanding of the procedure?

Accepted Answer

If skin is inflamed,instruct patients to use only warm water rinse without soap for cleansing.
Instruct patient how to manage a transdermal patch that begins to peel off before the next dose is due.Rather than tape the patch or cover it,instruct the patient to remove the patch,clean the skin,and apply a new patch to a different area.Instruct the patient to wrap applicators,used patches,and similar materials and dispose into cardboard or plastic disposable containers.Careful disposal is necessary to ensure the safety of the patient,other adults,pets,and children.

Question 16

Which of the following is the most critical to assess before medication administration?

Accepted Answer

Drug allergies should be listed on each page of the MAR,prominently displayed on the patient's medical record,and the patient should be wearing the facility's allergy bracelet.Assessment for drug allergies is necessary before medication is administered.
A client's diet,surgical,and drug histories are important areas to assess,but they are not as critical as his or her allergy history,which can be life-threatening.

Question 17

Which of the following is an appropriate technique for preparing medication for administration?

Accepted Answer

If you have to break a medication to administer half the dosage,use a clean,gloved hand to break the tablet or cut with a cutting device.Tablets that are to be broken in half must be prescored by a manufactured line that transverses the center of the tablet.This reduces contamination of the tablet.Tablets that are not prescored cannot be broken into equal halves,and the result will be an inaccurate dose.Using a cutting device results in a more even split of the tablet.
Wrapper maintains cleanliness of medications and identifies drug name and dose.Not all drugs can be crushed (e.g.,capsules,enteric-coated,long-acting/slow-release drugs).The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids.Medications poured from a stock bottle should be poured into the cap first to get the correct dose while avoiding waste.

Question 18

The nurse is preparing to administer medications via jejunostomy tube to a patient who has a continuous tube feeding.Some of the medications need to be given on an empty stomach and come only in tablet form which need crushing.After crushing them,the nurse needs to:

Accepted Answer

If the medication is not compatible with the feeding solution,or if the patient needs to take medication on an empty stomach,stop the feeding 15 to 30 minutes before medication administration to facilitate absorption of medication.
Never add crushed medications directly to the tube feeding.Whenever possible,use liquid medications instead of crushed tablets,but if you have to crush tablets,the tubing must be flushed before and after the medication is given to prevent the drug from adhering to the inside of the tube.Dissolve in at least 30 mL of warm water.Cold water causes gastric cramping.

Question 19

The patient is prescribed an ophthalmic medication to be administered via intraocular disk.The nurse knows that the disk resembles a contact lens and is:

Accepted Answer

Medications delivered by disk resemble a contact lens,but the disk is placed in the conjunctival sac,not on the cornea,and it remains in place for up to 1 week.

Question 20

For the patient who cannot sit upright,the next best position to prevent aspiration during medication administration is:

Accepted Answer

Assist patient to a seated or side-lying position if sitting is contraindicated by patient's condition.This decreases risk of aspiration during swallowing.
Swallowing is difficult or impossible in the prone position.The risk of aspiration is increased when the patient is swallowing in the supine position.The risk of aspiration is increased when the patient is swallowing in the dorsal recumbent position.

Quiz 21: Oral and Topical Medications