MEDICAMENTOS ORALES

The primary healthcare provider (PHCP) prescribes medication via the buccal route.

To correctly administer this medication, the nurse plans to place the medication

• A.in the client's ear while holding the pinna down and back.

• B.under the client's tongue.

• C.in the client's mouth toward the cheeK.

• D.into the client's nasal passage.

Answer explanation

Choice C is correct. Medication is placed between the cheek and gum when using the buccal route. The buccal route is advantageous because it provides fast drug absorption compared to tablets.

Choice A is incorrect. Administration of medications into the ear is referred to as auricular or otic administration. Pull the pinna up and back for an adult or a child older than 3 years of age.

Pull the pinna down and back for an infant or a child younger than 3 years of age.

Choice B is incorrect. Administration of drugs under the tongue is referred to as sublingual administration. Administering medications sublingual or buccal is advantageous for those who cannot swallow tablets or capsules.

Choice D is incorrect. Administration of medicines into the nasal passage is intranasal. Common medications administered this route include some analgesics (fentanyl) and endocrine medications (desmopressin).

The nurse is supervising a newly hired nurse administer prescribed medications via a double-lumen nasogastric tube (NGT) with an air vent. Which action by the newly hired nurse requires follow-up? The newly-hired nurse

• A.irrigates the air vent before medication administration with water.

• B.contacts the pharmacy to obtain available medications in liquid form.

• C.flushes the NGT between medications with water.

• D.administers each medication separately through the NGT.

Answer explanation

Choice A is correct. The air vent should not be irrigated with water or used to administer medications. The purpose of the air vent is to permit free, continuous drainage of secretions when the NGT is connected to suction. This vent is found on a Salem sump tube and is often called a blue "pigtail."

Choices B, C, and D are incorrect. These actions are correct and do not require follow-up. Fragments of medication may clog an NGT, and medications interchanged into a liquid form are preferred to prevent this obstruction. Medications should be administered individually to prevent medications from reacting with each other and causing obstruction in the tubing. Flushing the tube with 15-30 mL of water in between each medication is essential to prevent obstruction of the tubing.

The nurse is preparing to administer prescribed medications to a client via a nasogastric tube connected to low-intermittent suction.

The nurse should take which appropriate action? Select all that apply.

• A.Position the client in Trendelenburg position.

• B.Verify correct placement of the tube before medication administration.

• C.Turn off the suction during medication administration.

• D.Resume low-intermittent wall suction immediately after medication administration.

• E.Irrigate the nasogastric tube (NGT) with sterile water.

Answer explanation

Choice B is correct. It is essential to verify the placement of the nasogastric tube (NGT) before administering medications. The initial method of verification after NGT placement is an x-ray, as it is the gold standard for confirming correct positioning. For subsequent verification, aspirating gastric contents and assessing their pH is recommended. A gastric pH of less than 4 typically indicates proper placement in the stomach.

Choice C is correct. Turning off suction during medication administration is appropriate to prevent the medication from being immediately evacuated before it has time to absorb. After administering the medications, the nurse should clamp the NGT for 30 minutes to allow for full absorption before resuming low-intermittent wall suction.

Choice A is incorrect. Placing the client in the Trendelenburg position before administering medications through an NGT is highly inappropriate. This position increases the risk of aspiration. Instead, the client should be positioned with the head of the bed elevated to at least 30 degrees, or as high as tolerated, to promote the safe delivery of medications and reduce aspiration risk.

Choice D is incorrect. Resuming suctioning immediately after administering the medication would remove the medications before they are fully absorbed. This prevents the medications from achieving their therapeutic effects. Clamping the NGT for 30 minutes post-medication administration is sufficient to allow for proper absorption before returning the tube to low-intermittent wall suction.

Choice E is incorrect. Irrigating or flushing the NGT with sterile water is unnecessary and impractical in this scenario. The gastrointestinal tract is not sterile, so sterile water is not required. Room-temperature tap water is sufficient for flushing the tube and ensures efficient resource utilization.

A nurse is teaching a parent of an infant about administration of an oral medication.  What should be included in the teaching?  Select all that apply.

•  1. Add the medication to the bottle of formula before feeding

•  2. Direct liquid medication toward the inside of the infant's cheek

•  3. Hold the infant in a semi-reclining position during administration

•  4. Measure and administer the medication using an oral syringe

•  5. Open the infant's mouth by gently pinching the nose shut

Answer explanation

Giving oral medications to infants requires specialized techniques for safe administration.  A plastic, disposable oral syringe can be used for accurate dosing and ease of delivery (Option 4).  Oral medication should be administered with the infant in a semi-reclining position, which is similar to the feeding position (Option 3).  This position promotes comfort, prevents aspiration, and may be better controlled by the nurse if the infant resists the medication.  Liquid medications administered by oral syringe should be directed toward the back and inside of the infant's cheek (Option 2).  The medication should be dispensed slowly in small amounts, allowing the infant to swallow between squirts to prevent aspiration.

(Option 1)  Medications are never mixed in a bottle of infant formula as this can affect the taste and the infant may then refuse the formula in the future.  In addition, if the infant does not complete the full feed, underdosing will occur.

(Option 5)  Pinching the nose shut during medication administration may cause aspiration.  The infant's mouth should be opened by applying gentle pressure to the chin or cheeks.

Educational objective:

The nurse is caring for a 2-year-old who is refusing oral antibiotics.  What is the nurse's next action?

•   1. Ask the health care provider to switch to IV antibiotics

•   2. Hide the antibiotic in the child's favorite food or beverage

•   3. Offer the child a choice of orange or apple juice with the antibiotic

•   4. Tell the child that the medication tastes just like candy

Answer explanation

Toddlers (age 1-3) begin to demand autonomy and have a strong desire for independence.  Negativistic behavior is common, and questions requiring a yes or no response should not be used.  Offering limited choices will give the toddler a sense of control.  Allowing the toddler to choose between orange or apple juice should improve cooperation.

(Option 1)  The nurse should not call the health care provider without trying other age-appropriate techniques first.

(Option 2)  Medications should never be hidden in foods or beverages.  Pancreatic enzymes, given for cystic fibrosis, can be mixed in applesauce.

(Option 4)  Medication should not be referred to as candy as this increases the risk for a toxic ingestion.  The child might decide to eat the medication thinking that it is candy.