ADMINISTRACIÓN DE MEDICAMENTOS

A nurse is caring for a client who is prescribed a medication with a narrow therapeutic index (NTI). Which action should the nurse take when administering this medication? 

• A.Administer the medication as prescribed, ensuring strict adherence to the dosing schedule.

• B.Administer the medication concurrently with herbal supplements to augment its efficacy.

• C.Combine the medication with other medications to enhance its therapeutic effects.

• D.Administer the medication at a higher dose than prescribed to achieve faster results.

Answer explanation

Choice A is correct. Medications with a narrow therapeutic index (NTI) have a small margin of safety between their therapeutic and toxic doses. Therefore, it's essential to administer these medications precisely as prescribed to avoid adverse effects or therapeutic failure.

Choice B is incorrect. Concurrent administration of a medication with herbal supplements can increase the risk of drug interactions, potentially leading to adverse effects or therapeutic failures. Herbal supplements may contain active compounds that can interfere with the metabolism or efficacy of the medication, particularly in the case of NTI medications where precise dosing is essential.

Choice C is incorrect. Combining medications with a narrow therapeutic index with other medications may increase the risk of drug interactions, which can potentiate adverse effects or alter the drug's efficacy. Nurses should avoid combining medications without consulting the healthcare provider to ensure client safety.

Choice D is incorrect. Administering medication at a higher dose than prescribed can lead to overdose and increase the risk of adverse effects, especially with medications having a narrow therapeutic index. It is essential to follow the prescribed dosage precisely to avoid toxicity and maintain therapeutic efficacy.

The nurse is preparing to apply a prescribed nitroglycerin ointment to a client. The nurse should

• A.apply it only to the client's upper chest.

• B.rub the ointment into the client's skin until it disappears.

• C.rotate the application sites.

• D.cover the ointment with a gauze dressing.

Answer explanation

Choice C is correct. Topical nitroglycerin is used to help prevent/ treat anginal symptoms in coronary artery disease. To apply nitroglycerin correctly, be sure to rotate the application sites with each application to avoid irritation from the medication.

Choice A is incorrect. The nitroglycerin ointment may be applied anywhere on the anatomy as long as it is dry, clean, the skin is intact, and is hairless. It is not limited to just the client's chest.

Choice B is incorrect. The ointment should not be rubbed into the client's skin. This would enhance its absorption, exposing the client to the potential for severe hypotension.

Choice D is incorrect. The medication comes with a supply of paper applicators with a small ruler on the paper for proper measurement of the drug. Apply the appropriate amount of ointment on the paper and apply the cream to an area of the skin.

The nurse supervises a nursing student administering a purified protein derivative (PPD) skin test. Which action by the student requires follow-up by the nurse?

• A.Inserts the needle, bevel up at a 15-degree angle

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  B.Instructs the client that the test will be read in 48-72 hours
  

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  C.Selects a site 3 to 4 finger widths below the antecubital space
  

• D.Administers the test using a 20-gauge needle, 2 inches long

Answer explanation

Choice D is correct. When administering a PPD, the nurse should administer the test intradermal at an angle of 15-degrees. The appropriate gauge and length of the needle should be 25- to 27-gauge, ½- to 5⁄8-inch.

Choices A, B, and C are incorrect. These observations do not require follow-up because these observations are appropriate. It is appropriate for the nurse to administer this test at an angle of 15-degrees with the bevel up. PPD testing is read within 48-72 hours and is administered 3 to 4 finger widths below the antecubital space.

The nurse is planning a community health class for older adults. Which topic should the nurse prioritize?

• A.discussing and preventing polypharmacy

• B.strategies to stay physically active

• C.staying socially engaged in the community

• D.recommended immunizations

Answer explanation

Choice A is correct. Polypharmacy has been directly implicated in falls, confusion, hospital admissions, and adverse reactions. Older adults are highly susceptible to polypharmacy. This topic is a priority because of the broad spectrum of adverse outcomes associated with polypharmacy.

Choice B is incorrect. Staying physically active is an important topic to cover, considering the obesity rates for older adults are increasing. Physical activity has a plethora of benefits, including boosting the client's mood. This is not a priority teaching topic considering the broad spectrum of adverse outcomes polypharmacy has demonstrated to cause.

Choice C is incorrect. Social engagement in the community is key to a healthy mind. Additionally, loneliness is an unfortunate reality for some older adults. Loneliness may have substantial negative outcomes, including depressive disorders. This is not a priority teaching topic considering the broad spectrum of adverse outcomes polypharmacy has demonstrated to cause.

Choice D is incorrect. Immunizations for older adults are important. However, few immunizations are recommended for older adults compared to younger adults. This is not a priority teaching topic considering the broad spectrum of adverse outcomes polypharmacy has demonstrated to cause.

The nurse is caring for a client with a peripherally inserted central catheter (PICC) in the left upper extremity. It would indicate correct nursing care if the nurse

• A.pulsatile flushes each lumen with 0.9% sodium chloride (normal saline) in a 5 mL syringe.

• B.slowly flushes each lumen with 0.9% sodium chloride (normal saline) in a 10 mL syringe.

• C.pulsatile flushes each lumen with sterile water in a 10 mL syringe.

• D.pulsatile flushes each lumen with 0.9% sodium chloride (normal saline) in a 10 mL syringe.

Answer explanation

Choice D is correct. When flushing a central vascular access device, such as a PICC line, the nurse should flush each lumen with 0.9% sodium chloride (normal saline) in a 10 mL syringe. This 10 mL volume of the syringe is necessary because of its pressure to remove adequate debris and any fibrin clots that could form on the tip of the catheter. A pulsatile flushing technique removes any fibrin debris on the end of the catheter, which protects the lumen from becoming occluded. Because of its isotonicity, only 0.9% saline should be used to flush vascular access devices.

Choice A is incorrect. A 10 mL syringe should be used to administer medications and flush or aspirate blood from a central vascular access device. A 5 mL syringe would be an inadequate volume size.

Choice B is incorrect. The flushing technique for all central vascular access devices is the pulsatile method. The pulsatile method is a guideline because it removes debris that may cause catheter occlusion. Flushing slowly would be less effective in eliminating fibrin debris, and this method is not recommended.

Choice C is incorrect. Sterile water should not be used when flushing central vascular access devices. Sterile water is hypotonic, and the clinical guide for flushing all vascular access devices is normal saline (sodium chloride).

The nurse is preparing a staff education program about medication reconciliation.

Which of the following information should the nurse include? Select all that apply.

• A.Discontinued medications should be included while performing medication reconciliation.

• B.Medications taken on an as-needed basis can be excluded from this process.

• C.New medication orders should be compared with the current list.

• D.Medication reconciliation should be performed after the client has been discharged.

• E. Over-the-counter (OTC) medications should be included in the medication reconciliation.

Answer explanation

Choice C is correct. Medication reconciliation is the process of comparing the medications a client is taking (or should be taking) with newly ordered medications. It is designed to identify any omissions, duplications, or medication interactions. Medication reconciliation is performed at admission, transition of care (e.g., a client is transferred from medical-surgical to critical care), and discharge.

Choice E is correct. Over-the-counter (OTC) medications, homeopathic medications, and current medications should be included in this process. The nurse should collect a client's current medications precisely to ensure accuracy.

Choice A is incorrect. Discontinued medications should not be included while performing medication reconciliation. The medication reconciliation should reflect the client's current medications. The nurse needs to obtain prescribed medications, even if the client is not taking them.

Choice B is incorrect. As-needed (PRN) medications should be included on the list for reconciliation. This includes over-the-counter pain relievers and anti-emetics.

Choice D is incorrect. This process requires the client (or the client's family) and should be performed at discharge - not after discharge. This process is performed at admission, transition of care, and discharge.

The nurse is planning a staff development conference about medication reconciliation. Which of the following information should the nurse include?

• A.Medication reconciliation should occur just at discharge to prevent omissions.

• B.Prescribed medications should be obtained and omit herbs and supplements.

• C.This process should occur at admission, client transfer, and discharge.

• D.Obtain a list of the medications instead of reviewing the list with the client

Answer explanation

Choice C is correct. Medication reconciliation was designed to prevent omission and duplicate errors related to medication administration.

Choice A, B, and D are incorrect. This process should occur at admission, transfer, and discharge - not just at discharge. The medications that should be obtained should be the prescribed and over-the-counter medications. This process should involve the client as they should confirm their adherence to the medication.

The nurse is supervising a student administering prescribed ciprofloxacin eye drops.

It would indicate the correct technique if the student

• A.instructs the client to squeeze their eyes immediately after administering the drops.

• B.drops the prescribed number of drops into the cornea.

• C.drops the prescribed number of drops into the conjunctival sac.

• D.asks the client to position themselves in a left lateral position with the knees bent.

Answer explanation

Choice C is correct. Ophthalmic drops should be deposited into the lower conjunctival sac to allow even distribution. It is also imperative that the nurse never make contact with the dropper and the client's eye, as this contaminates the dropper and may cause ocular irritation.

Choice A is incorrect. This technique is inappropriate. Clients who squeeze their eyes will cause the medication to discharge from the eye. Following the administration of eye drops, the client should gently close their eyes and roll them to promote the distribution of the medication.

Choice B is incorrect. This technique is inappropriate. Ocular drops should be deposited into the lower conjunctival sac, not the cornea.

Choice D is incorrect. This technique is inappropriate. When positioning the client for administering eye drops, the client should be placed supine or sit back in the chair with the head slightly hyperextended and looking upward.

The nurse is preparing to administer ear drops to a client who is six years old.

The nurse should perform which action?

• A.Pull the ear pinna down and back

• B.Position the client on their side with the ear to be treated against a pillow

• C.Pull the ear pinna up and back

• D.Place cotton directly into the ear canal after ear drop administration

Answer explanation

Choice C is correct. When administering ear drops to this client, the nurse should have the client positioned on the side with the ear to be treated facing up, or the client may sit in a chair or at the bedside. Once the client is in an appropriate position, the nurse should straighten the ear canal by pulling the pinna up and back to the 10 o'clock position.

Choice A is incorrect. When administering ear drops to a client younger than the age of three, the nurse should pull the pinna down and back.

Choice B is incorrect. The affected ear that should receive the drops should be facing up and not against the pillow.

Choice D is incorrect. Cotton may be used to keep the medication from evacuating, but it should not be placed directly into the ear canal because it could cause an obstruction.