There are ten GOLDEN RULES of medications administration safety.
There has to be doctor’s orders.
First, Administration of the right medication. Remember that some medications look alike and sound alike. So administer the right medications.
Secondly, Administration of medications to the right patients. Make sure that the medication is not labeled with another patient name. Check the ID band.Nurses not familiar with the unit can get confused.Ask patient their name. Always check patient ID and never leave medications at bedside.
Thirdly, the right dose, age ,sex ,body size and patient condition needed for dosage. Check and double check the medication ordered.
Fourthly, The administration of medications through the right route. Oral medications are slow to kick in than intravenous route.Check the medications and the route.Parental route need extra caution.
Fifth,Administration of medications at the right time. The doctor orders keflex 250mg po Q6hours. That means the medications are scheduled 06am,12noon,6pm and midnight. Can you give the medication at 2pm after lunch or can you give it, like 10pm so that patient sleep will not be interrupted. It sounds so good but that practice is totally unacceptable. You can administer medications thirty minutes to one hour before the time.Or you can ask the doctor to choose appropriate administration time.Do not manufacture your own time. That will be above your scope of practice.
Sixth : Educate your patient about the medications that they are receiving. Give written instructions about their medications. Educate your patient to enhance safety and patient compliance. The patients should understand the importance of taking the medication for the entire prescribed course. They should not stop taking medication because they felt better.They should finish the course of medication prescribed by the doctor.
Seventh:Take a complete patient medication history. Knowing all the medications that your patient is taking will provide safety. This is very important to prevent adverse reactions and interactions. Also find out if your patient smokes because this will affect medication reactions.
Eight: Find out if the patient is allergic to any medications. You as a nurse should know the difference between allergies reaction and adverse reactions. Adverse reaction is Pharmacological ,controllable even though problematic. Allergic reactions is not Pharmacological rather a chemical reaction. Patients should tell the healthcare provider all the allergies reaction that they have to the nurse.
Nineth:Medications and food interactions. When two or more medications are given together. There may be a drug interaction. Dilantin increases liver metabolism. So it can lower the drug level of other medications .Seniors are at a greater risk for drug interaction. Some diuretics cause potassium to deplete. So the nurse will educate the patient to eat food with potassium or ask the doctor to order potassium supplements or potassium sparing diuretics.
Tenth: The right documentation of the medication is paramount important. If it is not documented, it is not given.That is the believe of third party players,and lawyers.If you don’t document what you did.You are placing yourself on legal jeopardy.Also remember to document medications that were not given and the reasons why it was not given.
NB: AN ADVERSE MEDICATION REACTION. If any prescribed medications cause a reaction that was not suppose to cause .And this lead to injury, a change in a medication or treatment or other healthcare involvement or resources. It must be reported. Follow your hospital policy and procedures. Notify the doctor, call pharmacy and fill out the required forms
(1)A patient is placed on Gentamicin Sulfate (Garamycin) IVPB Q8hrs. Which of the following assessment would indicate to the nurse Gentamicin toxicity in the blood.
(A) Voiding a lot and frequently.
(C) A & B
(D) All of the above .
Correct Answer: B.
RATIONALE: Decreased hearing and vertigo occur as a result of involvement of the eight cranial nerve which is caused from gentamicin toxicity. Antibiotics interferes with DNA RNA.
(2)A patient is discharged on oral ferrous sulfate therapy. When seen in the clinic two weeks later.Which of the following information is important for the nurse to obtain?.
Answer : What is the characteristic of your stool.Because constipation is the common side effects of ferrous sulfate. The nurse will also encourage patient to take medication with orange juice for better absorption.
(3) A 39years old female newly diagnosed with regular insulin and NPH insulin on a daily bases.The patient asked the nurse ,why she should need both insulin?.
Which of the following statements, if made by the nurse is most accurate.
(A)If you don’t want both.I tell your doctor
(B)Regular insulin is better.
(C)The combination of both insulin will result in a more stable level of blood glucose.
CORRECT Answer is C.
(4) A 51years old man is receiving intravenous cimetidine (Tagamet)After 20minutes of the infusion, the patient complains of headaches and dizziness.
What will be the immediate action for the nurse to take first.
Stop the infusion( because that is the safest action).
(5) A John receives 10units of NPH insulin every morning at 08am.At 4pm the nurse observes that the patient is diaphoretic and slightly confused. The first thing that the nurse should take is to :
Answer:Check blood sugar.
Give 6oz of skim milk. S/s of hypoglycemia, give fast acting sugar and protein. Recheck blood sugar in 15 minutes.
(6) The doctor orders Sucrafate( Carafate) 1gm po aid for a 47years old man seen in the clinic. The nurse should instruct the man to take the medication.
(A )During meal.
(B) After meal.
(C) A& B.
(D)Before meals. 1 hour ac ( before meals) and HS( hour of sleep)
Correct answer D
Rationale It is better to be taken before meal so that it will be more effective. 1gm= 1000mg. 1mg = 1000mcg.1gram is greater than a miligram,and 1 milligram is greater than 1microgram.
(7)Patient is very agitated. Notified the doctor, haldol 5mg im ordered ×1. What are the two major side effects of haloperidol(Haldol) the nurse should anticipate?.
Answer: Blood dyscrasia and extrapyramidol symptoms (Hematologic problems)
(8)The nurse knows the best administration schedule for a psycho stimulant medication, such as methylphenidate (Ritalin) is which of the following.
Breakfast time not after 2pm.Because the psychostimulant methylphenidate ( Ritalin) generates vigilance and attention in the medically Ill,depressed clients.
(9) The patient is a 66years old man with Uncontrolled high blood pressure. Hydralizine 10mg IV was given in Emergency department.The doctor orders Capoten 25mg po to be given Bid.(captopril )The most appropriate nursing action before the administration of the medication is:
Answer:To check the blood pressure first. Because Captopril is an antihypertensive medication which necessitates the blood pressure to be assessed prior to administration.
(10) Chemotherapy Administration. While a patient is placed on Chemotherapy administration. Which of the following lab tests should the nurse evaluate.
(A) There is no need for lab test.
( B) PT/PTT
(C )CBC,BUN,Cr,CHEM 7,PT,/PTT.
(D) CBC ,PT/PTT.
Chemotherapy interferes with normal cell activity as well as having effects on a malignant cells.
Prior to medications administration:
A physical assessment of patient must be done correctly before medication administration.
Check lab values, CBC, BUN, Cr.,CHEM 7,PT/PTT.
Assessment of patient knowledge about chemotherapy.
Assessment of patient’s psychological status as it relates to disease process and chemotherapy.
Monitor for Acute side and toxic effects. That is immediate side effects and Delayed side effects. The Delayed side effects can happen within 24hours.
(11) Before administering doxorubicin hydrochloride(Adriamycin) IVP to a patient with breast cancer. The nurse will first identify.
Answer: The patient using her ID and also asking patient her name.
Rationale: Appropriate identification of the patient is the first priority after the order has been verified.
(12) The doctor ordered tetracycline for the patient. The nurse would include which of the following in a teaching plan for a client receiving tetracycline treatment.
Answer: Use a maximum protection sunscreens when outdoors.
Rationale: Tetracycline cause photosensitivity. It may cause your skin to be more sensitive to sunlight than normal. Also it should not be given on an empty stomach and never taken with milk or antacids because it will inhibit medication action.
(13) What nursing action would be important in the safe administration of oxytocin?.
(A) Monitor the patient.
(B) Palpate the uterus frequently.
(C)Answer questions from patient family.
(D)Stay with the patient.
Correct answer B. Oxytocin stimulates the uterus to contract, which necessitates the nurse to frequently assess the uterus.
(14) Prior to the administration of hydralazine (Apressoline) The nurse will evaluate the following.
(A)The temperature .
(B )The heart rate
(C). His skin color.
(D) The blood pressure.
Correct answer D. Prior to the administration of antihypertensive medication, it is important to assess the client blood pressure for a decrease in Blood pressure.
(15) The nurse would identify which of the following as the desired patient response to hydoxyzine.( Vistaril)
Answer: Vistaril is an antihistamine with CNS depression, anticholinergic and antispasmodic activities.
(16) Which of the following nursing observations, would indicate the desired responses to epinephrine?.
Answer: Epinephrine acts to increase heart rate and relax smooth muscles of the bronchi, usually the blood pressure remain the same. A side effect would be increased in anxiety and reslessness not a decrease in agitation.
(17)What is colace?.Why did the doctor ordered colace for your patient when he ordered Norco 10/325mg po Q4hours prn pain. Answer : Colce is a stool softeners. It is used to treat occasional constipation. And prevent constipation and treatment of constipation.
(18)What is Warfarin?. Why is your patient on Warfarin?.Answer:Warfarin is used for the treatment of previous blood clots (DVT) of the leg and blood clots in the lungs. It also can be used to prevent blood clots with patient with atrial fibrillation and Thrombophilia.Note the following:You need a routine lab works monitoring. It has to be prescribed by the doctor. It is not over the counter medication. It should be taken in the morning or evening. In the hospitals, it is usually given in the evening. The antidote for Warfarin is Vitamin K.
(19)How often is Lovenox given in 24hours?.It is given once in 24hours SubQ. (Q24hours)It is a blood thinner.It must not be given immediately after surgery. It is usually given 24hours after surgery unless it is contraindicated.
(20) A client is admitted to the Psychiatric unit due to anxiety disorder. After the client begins taking chlordiazepoxide.(Librium)The nurse should assess for which of the following side effects?.
Answer: Drowsiness and blurred vision are side effects of antianxiety medication.
(21) The nurse knows that the patient with drug induced Cushing’s syndrome. Should first be instructed about?.
(A) First priority would be Schedule for gradual withdrawal of drug. Because if steroids are withdrawn suddenly, the patient may die of acute adrenal insufficiency.
(B) It’s okay patient will be fine.
( C) A & B.
(D) None of the above.
Correct answer A.
(22) A client is admitted for a series of test to verify the diagnosis of Cushing’s syndrome. Which of the following assessment findings if made would support this diagnosis?
ANSWER: Buffalo hump,hyperglycemia, and hypernatremia.Cushing Syndrome is characteristics of these assessment as well as weight gain, moon- like face,purple striae,Osteoporosis, mood swings, and highly susceptibility to infection.
(23) Which of the following could be included in a teaching plan for the client receiving peripheral vasodilator.
Answer:Vasodilator can cause postural hypotension, which can lead to dizziness when changing position. Change body position slowly to reduce dizziness.
(24)A client was admitted for regulation of her insulin. She takes 15units of Humulin insulin at 08am every day.At 4pm which observation would indicates complications from insulin.
Answer: Irritable, tachycardia, diaphoresis,Humulin N insulin is intermediate insulin that sparks from eight to twelve hours after onset.
(25) A 46 year old woman is admitted to the hospital. Admission records include Heparin 2,000units in 5% dextrose water.While the patient is receiving heparin therapy. Which of the following medication should the nurse have available?.
Answer: Protamine Sulfate.
Rationale: Protamine sulfate is a medication use to reverse the effects of heparin.
(26) A 62years old woman is brought to the Emergency room complaining of pressure in her chest .Her blood pressure is 150/90,pulse 88,respiration 20.The nurse administered nitroglycerin 0.4mg sublingual as ordered. To evaluate the effect of this medication, the nurse should expect which of the following changes in patient vital sign.
(A) No changes in blood pressure.
(B) Respiration increases.
(C )BP 100/60,pulse 96,respiration 20.
It reduces peripheral resistance decrease blood pressure, so pulse increases and respiration don’t change.
( D ) All of the above.
Correct answer C.
(27)The nurse performs teaching with a 36years old woman who is to be discharged. The patient is is to take ranitidine (Zantac)150mg po bid .And to return to the doctor office in two weeks. The nurse should instruct the patient that Zantac works?.
By decreasing the amount of acid released in the stomach.
Rationale: Inhibits action of histamine at parietal cells which reduces gastric acid secretion.
(28) A client is receiving phenytoin (Dilantin).The nurse should recognize that this medication is most effective for the treatment of which of the following conditions?.
Grand mal seizures in neurology clients.
Dilantin is primarily used as anticonvulsant. However occasionally it is used as an antiarrhythma agents( leads to bradycardia) hypotension and myocardia depression.
(29)The nurse knows which observations indicate the client is experiencing a side effects of prednisone ( Deltasone)
Ecchymosis and an increase in the retention of fluids.
Rationale Steriods such as prednisone have many side effects such as ecchymosis( large,bruised area of skin) and edema.
(30)What medication is use for the treatment of Parkinson’s disease.
Answer: Levodopa,Carbidopa (Sinemet)
Rationale It increases dopamine activity at neuron.It improves muscle rigidity.
(31)List some medications that are muscle relaxants. (Robaxin) also known as Methocarbamol).Carisoprodol (known as Soma),and Cyclobezaprine ( Flexeril).These medications help with muscle spasms due to trauma. It blocks transmission of the nerve impulses.
(32) Parathyroid hormone regulates body calcium and phosphate.It does it when calcium in the body are too low.It does it through the interaction of the kidney, the bone and the intestine. Provide calcium in the blood. The example of calcium medications are Calcitrol,Calcium gluconate, vitamin D.
Action: Cardiac excitability, muscle contractions.
Adverse effects: Hypercalcemia.
(33) The doctor orders a heparin drip for a patient with Cardiac disease. The order reads as follows 2000units of heparin per hour. The IVF solution contains 20,000units of heparin in 500ml of 5% dextrose water .The nurse should regulate the patient’s IVF to deliver.
2000units x500ml = 1,000000 divide by 20,000units= 50ml/hour.