ATI: Unit 3 chapters 44-46

  1. Who are the healthcare providers legally permitted to write prescriptions in the US?
    • Physicians
    • Advanced practice nurses
    • Dentists
    • Physician assistants
  2. What are the five legal responsibilities of the healthcare providers who can write prescriptions?
    • 1. Obtaining the client's medical history and physical examination
    • 2. Diagnosing
    • 3. Prescribing medications
    • 4. Monitoring response to therapy
    • 5. Modifying medication orders as necessary
  3. What are the responsibilities of the nurse in relation to legal responsibilities of safe medication administration and error prevention?
    • - Preparing, administering, and evaluating client responses to medications
    • - Developing and maintaining an up-to-date knowledge base of medications administered, including uses, mechanisms of action, routes of administration, safe dosage range, adverse/toxic responses, precautions, and contraindications
    • - Skill competency
    • - Knowledge of acceptable practice
    • - Determining accuracy of medication orders
    • - Reporting of all medication errors
    • - Safeguarding and storing medications
  4. What controls the prescribing, dispensing and administering of medications?
    • Federal, state and local laws
    • Health care agency policies
    • Each state's nurse practice act
  5. What are the types of medication orders?
    • Routine/standard order
    • Single/one-time order
    • Stat order
    • PRN order
    • Standing order
  6. What type of medication order may or may not have a termination date?
    Routine/standard order - will stay in effect until the PCP discontinues it or the client is discharged
  7. What type of medication order is to be given once at a specified time or as soon as possible?
    Single/one-time order
  8. What type of medication order is only given once and given immediately?
    Stat order
  9. What type of medication order stipulates at what dosage, what frequency, and under what conditions a medication may be given?
    PRN order
  10. What type of medication order would the nurse use clinical judgment with which to determine the client's need for the medication?
    PRN order
  11. What type of medication order may be written for specific circumstances and/or for specific units?
    Standing order
  12. What are the components of a medication order?
    • - Name of client
    • - Date and time of order
    • - Name of medication
    • - Dosage
    • - Route of administration
    • - Time and frequency
    • - Signature of prescribing provider
  13. What are the physiological variables affecting medication responses?
    • Age
    • Gender/body build
    • Chronic disease
    • Concurrent medication use
    • First-pass effects
    • Nutritional status
    • Pregnancy
    • Genetic factors
  14. How does age affect medication responses?
    • Infants immature liver function limits the ability to metabolize medications
    • Aging process can alter liver and kidney function and decrease metabolism and excretion of medications
    • Decreased circulation can negatively affect medication distribution
  15. How does gender/body build affect medication responses?
    • Differences in hormones
    • Distribution of fat and water
    • Weight
    • Height
    • Lean body mass
    • - All of the above affect medication absorption, distribution, metabolism and excretion -
  16. How does chronic disease affect medication responses?
    Body organ dysfunction influences how medications are absorbed, distributed, metabolized and excreted
  17. How does concurrent medication use affect medication responses?
    Different medications used together can lead to unexpected and/or unpredictable metabolism, interference with intended therapeutic effect and an increased risk of adverse medication reactions and interactions
  18. What is the first-pass effect of medication and how does it affect medication responses?
    • Certain medications, when taken orally, are inactivated on their first pass through the liver and must be given by an alternate route
    • If they are inactivated they have no therapeutic effect on the body
  19. What affect does nutritional status have on medication responses?
    • Presence or absence of food in the stomach can alter medication absorption.
    • Decreased nutritional status impairs the client's ability to produce specific medication-metabolizing enzymes, leading to impaired medication metabolism
  20. How does pregnancy affect medication responses?
    Circulatory changes, hormonal changes, and presence of fetus may influence how medications are absorbed, distributed, metabolized and excreted by the body
  21. How do genetic factors affect medication responses?
    Inherited traits may have specific influence on metabolism of medications
  22. What are the psychosocial variables affecting medication response?
    • Health illness beliefs
    • Previous experiences with medications
    • Knowledge base
    • Cultural beliefs
    • Developmental stage
    • Social support/financial status
    • Potential for medication dependence and misuse
  23. What are the six rights of safe medication administration?
    • Right client
    • Right medication
    • Right dose
    • Right route
    • Right time/frequency
    • Right documentation
  24. How do you verify the client's identification for medication administration?
    Check ID band, name, and/or photograph with the medication record
  25. How many times do you read the medication label to verify it's the right medication?
    3 times - when the container is selected, when removing the dose from container and when container is replace
  26. True or false: leave unit-dose medication in its package until administration
  27. Why is giving medication on time important?
    To maintain a consistent therapeutic blood level
  28. what is the time period in which a medication can be given?
    1/2 hour before or after the scheduled time
  29. What do you do if the route is not designated or the route designated is not recommended?
    Contact the primary care provider for clarification
  30. What are some resources for medication information?
    • Nursing drug books
    • Pharmacology textbooks
    • Professional journals
    • Physician's Desk Reference (PDR)
    • Professional websites
  31. How are medications organized?
    • Pharmacologic action
    • Therapeutic use
    • Body system
    • Chemical makeup
    • Safe use during pregnancy
  32. What is a medication's mechanism of action?
    How the medication produces the desired therapeutic effect
  33. This is the primary action for which the medication is administered to a specific client.
    Therapeutic effect
  34. These are undesired and sometimes dangerous effects of the medication - usually identified according to body system
    Adverse effects
  35. What is toxicity of medication?
    The specific risks and manifestations of toxicity
  36. Medication interactions can cause _________ and _________ effects.
    Desired; undesired
  37. What is a precaution for medication administration?
    Caution for use in some clients
  38. What are some contraindications for medication administration?
    • Specific disease
    • Condition
    • Age
    • Allergy
  39. What are the nursing implications for medication administration?
    • How to monitor for therapeutic effects
    • How to prevent and treat adverse effects
    • How to provide for comfort
    • How to instruct clients in the safe use of medications
  40. What are common medication errors?
    • - Wrong medication or IV fluid
    • - Incorrect dose or IV rate
    • - Wrong client, route or time
    • - Administration of known allergic medication
    • - Omission of dose
    • - Incorrect discontinuation of medication or IV fluid
  41. How are therapeutic responses monitored with medication administration?
    Change dosages gradually
  42. Who should administer medications?

    A. Individual who prepared the medication
  43. Where does self-administration of medications take place?
    • In the home and community-based settings
    • In a facility/agency setting when clients wish to so their home medications and the ability to do so safely
  44. What instructions should be given to a client who is going to be self-administering medication?
    Written and verbal instructions for each medication regarding dosage, expected responses, and side/adverse effects
  45. A nurse prepares an injection of an opiod to give to a client who reports pain. Prior to administering the medication, the nurse is called to another room to assist another client onto a bedpan. This nurse then asks a second nurse to give the injection to that she can help the client needing the bedpan. Which of the following actions is the most appropirate for the second nurse to take?

    D. Offer to assist the client needing the bedpan
  46. C. Remove the medications, discard them, report the error, and document according to facility/agency policy

    For a medication that ordered at 0900, which of the following are acceptable administration times? (select all that apply)
    - 0905
    - 0825
    - 1000
    - 0840
    - 0935
    • - 0905
    • - 0840
  47. Which of the following nursing actions may prevent medication errors from occurring?

    A. Checking with the PCP when a single dose requires administration of multiple tablets
  48. When implementing medication therapy, the nurse's responsibilities include which of the following? (select all that apply)
    - Observing for medication side effects
    - Monitoring for therapeutic effects
    - Ordering the appropriate dose
    - Changing the dose if side effects occur
    - Maintaining an up-to-date knowledge base
    • - Observing for medication side effects
    • - Monitoring for therapeutic effects
    • - Maintaining an up-to-date knowledge base
  49. 1 gr = ?
    60 mg
  50. 1 oz = ?
    30 ml
  51. 1 tsp = ?
    5 ml
  52. 1 tbs = ?
    3 tsp
  53. 1 kg = ?
    2.2 lb
  54. Round to what place in dosage calculations, unless otherwise indicated?
  55. A client is to receive 300 mg of phenytoin (Dilantin) now and every morning. The pharmacy sends 200 mg tablets. How many tablets should be given?
    1.5 tabs
  56. A client is to receive furosemide (Lasix) 80 mg IV q6h for 24 hr. Available is 10 mg/mL. How many mL should be administered for each dose?
    8 mL
  57. A client is to be given amicillin (Ampicin) 250 mg orally q6h. Available is 125 mg/5mL. How many mL should be given for each dose?
    10 mL
  58. A client is to receive aspirin 10 gr every 4 hr when necessary. Available are 325 mg tablets. How many tablets should be given for each dose?
    2 tablets
  59. A client is to receive acetaminophen (Tylenol) 320 mg every 3 to 4 hr for fever. Available is 160 mg/5 mL. How many tsp should be given each dose?
    2 tsp
  60. A primary care provider prescribes atropine 0.5 mg IV for bradycardia. The vial is labeled atropine 400 mcg/mL. How many mL should be given?
    1.25 mL
  61. A child weighs 31 lb. The PCP prescribes ampicillin 100 mg/kg/day in four divided doses. Available is ampicillin 250 mg/2 mL. How many mL per dose should be given?
    2.8 mL
  62. Phenytoin (Dilantin) 5 mg/kg/day is prescribed in two divided doses for a child weighing 16 lb. It is available at 50 mg/mL. What is the total daily dosage in mL for this child?
    0.7 mL/day
  63. Methylprednisolone (Solu-Medrol) 40 mg/kg/day is ordered every 4 hr for an adult weighing 154 lb. It is available at 40 mg/mL. How many mL should be given per dose?
    11.7 mL
  64. A client is to receive 1 L of normal saline over 8 hr. The tubing drop factor is 15 gtt/mL. Calculate how many gtt/min should be delivered per manual control.
    31 gtt/min
  65. A client is to receive metronidazole (Flagyl) 500 mg in 100 mL NS IV PB administered over 1 hr. The tubing drop factor is 60 gtt/mL. Calculate how many gtt/min should be delivered per manual control?
    100 gtt/min
  66. A client is to receive Zantac 50 mg in 100 mL NS IV PB administered over 20 min. The tubing drop factor is 10 gtt/mL. Calculate how many gtt/min should be delivered per manual control.
    50 gtt/min
  67. A nurse is to administer 600 mL of D5W over 8 hr. The IV pump should be set to deliver how man mL/hr?
    75 mL/hr
  68. An IV medication is to infuse over 20 min on the IV pump. The medication is mixed in 100 mL of normal saline. The IV pump should be set to deliver how many mL/hr?
    300 mL/hr
  69. An IV medication is to infuse over 30 min on the IV pump. The medication is mixed in 100 mL of normal saline. The IV pump should be set to deliver how many mL/hr?
    200 mL/hr
  70. What are the advantages of IV therapy?
    • Fast absorption and onset of action
    • Less discomfort after initial insertion
    • Maintains constant therapeutic blood levels
    • Less irritation to subcutaneous and muscle tissue
  71. What are the disadvantages of IV therapy?
    • Circulatory fluid overload is possible if infusion is large and/or too rapid
    • Immediate absorption leaves no time to correct errors
    • IV administration can cause irritation to the lining of the vein
    • Failure to maintain surgical asepsis can lead to local infection and septicemia
  72. What are the two types of IV access?
    • Peripheral
    • Central
  73. Why should some medications be infused on an IV pump instead of IV push?
    Medications (like potassium chloride) that can cause serious adverse reactions
  74. Should medication be added to an IV container that is already hanging?
    No, only add medication to a new IV fluid container
  75. True or false: Never administer IV medication through tubing that is infusing blood, blood products, or parenteral nutritional solutions
  76. What should be done before infusing a medication through tubing that is infusing another medication?
    Verify compatibility
  77. What are ways to prevent needlesticks?
    • Be familiar with IV insertion equipment
    • Avoid using needles when needless systems are available
    • Use protective safety devices when available
    • Never recap a needle
    • Dispose of needles immediately in designated puncture-resistant receptacles
    • Do not break or bend needles
  78. What are the methods of IV medication infusion?
    • - Mixed in large volumes of fluid and given as continuous IV infusion
    • - Intermittent IV administration
    • - Bolus IV administration
  79. When giving an IV medication infusions in a large volume of fluid, what amount of fluid is appropriate?
    500-1000 mL
  80. What amount of solution is used when giving medication through intermittent IV administration?
    25-250 mL
  81. What is intermittent IV administration?
    Medications given intermittently in a small amount of solution through a continuous IV system or with saline or heparin lock systems
  82. If given with a continuous IV infusion, what is the term for administering a medication through intermittent IV?
  83. What needs to be done before and after medication administration through a saline or heparin lock system?
    Flush the access port/tubing
  84. What is bolus IV administration?
    Medication in small amounts of solution that is injected over a short time (1 to 2 min) in emergent and nonemergent situations
  85. What is one reason why some medications are given as bolus IV?
    To achieve an immediate medication level in the bloodstream - pain medication
  86. What are some special considerations when giving IV medications to older adult clients, clients taking coagulants or clients with fragile veins?
    • Avoid tourniquets - use blood pressure cuff instead
    • Do not slap extremity to visualize veins
  87. What are some special considerations when giving IV medications to a client with edema in extremities?
    • Apply digital pressure over proposed vein to displace edema
    • Apply pressure with alcohol pad
    • Cannulation must be quick
  88. In what clients may anatomical landmarks need to be used to find veins for IV therapy?
    Obese clients
  89. What equipment is needed for IV medication administration?
    • Solution to be infused
    • Correct size catheter
    • Correct tubing
    • Infusion pump - if indicated
    • Insertion supplies
  90. How far above a proposed IV insertion site should the tourniquet be applied?
    4 to 6 inches
  91. Where should veins first be assessed for IV insertion?
    Distal veins on the nondominant hand
  92. What veins should be avoided when inserting an IV?
    • Varicosed veins that are permanently dilated and tortuous
    • Veins in inner wrist with bifurcations, in flexion areas, near valves, in lower extremities, and antecubital fossa
    • Veins that are sclerosed or hard
    • Veins in an extremity with impaired sensitivity
  93. How should a vein feel when assessing for an IV insertion site?
    Resilient, soft and bouncy on palpation
  94. What are methods to enhance venous access?
    Gravity, fist clenching, friction with alcohol, heat, percussion by tapping gently, multiple tourniquets and transillumination
  95. How should the area be cleansed prior to insertion of IV?
    • With alcohol, iodine preparation or chlorhexidine apply friction in a circular motion from middle to outward edge
    • Allow to air dry for 1 to 2 min
  96. Where should the vein be anchored when inserting an IV?
    Below the site of insertion
  97. What should the client be warned of prior to the nurse inserting the IV needle?
    Sharp, quick stick
  98. True or false: The bevel of the needle should be facing up when inserting an IV
  99. What angle should an IV be inserted at?
    15 to 20 degrees
  100. What is an indication of a successful IV insertion?
    Flashback of blood into the catheter
  101. After advancing the catheter into the vein, what should be done with the needle?
    Withdraw the needle
  102. When should the tourniquet be released?
    After IV catheter insertion and before attaching the tubing
  103. What needs to be documented on the IV catheter dressing?
    Catheter size, date/time of insertion, and the initials of the nurse that inserted the catheter
  104. What needs to be documented in the patient's chart after inserting an IV?
    • Date and time of insertion
    • Insertion site and appearance
    • Catheter size
    • Type of dressing
    • IV fluid and rate (if applicable)
    • Number, locations and conditions of site-attempted cannulations
    • Client response
  105. How is the patency of an IV maintained?
    • Do not stop a continuous infusion or allow blood to back up into the catheter
    • Instruct the client not to manipulate flow rate device, change settings on IV pump and avoid lying on tubing
    • Make sure the IV dressing is not too tight
    • Flush intermittent IV catheters
    • Monitor site and infusion rate at least every hour
  106. How often should an intermittent IV catheter be flushed?
    • After every medication administration
    • Every 8 to 12 hours when not in use
  107. How should IV therapy be discontinued?
    • Check order/prep equipment
    • Wash hands
    • Apply gloves
    • Remove tape and dressing
    • Clamp IV tubing
    • Apply sterile gauze pad over site without putting pressure on vein
    • Withdraw catheter
    • Elevate and apply pressure for 2 min
    • Assess site
    • Apply tape over gauze
    • Use pressure dressing if needed
    • Assess catheter for intactness
    • Document
  108. How do you prevent IV infections?
    • Use standard precautions
    • Change IV sites according to policy
    • Remove catheters as soon as they are no longer clinically indicated
    • Change catheter is any break in surgical aseptic technique is suspected
    • Use sterile needle/catheter for each insertion attempt
    • Avoid writing on IV bags with pens or markers
    • Change tubing immediately if contamination is known or suspected
    • Fluids should not hang more than 24 hours unless it is a closed system
    • Wipe all ports with alcohol before connecting IV lines or inserting a syringe
    • Never disconnect tubing for convenience or to position the client
    • Do not allow ports to remain exposed to air
    • Wash hands before and after handling the IV system
  109. Pain, burning
    Local swelling at the site
    Cool skin
    Damp dressing
    Slowed infusion
    These are signs of?
  110. How is infiltration prevented?
    • Careful selection of site and catheter
    • Securing the catheter
  111. Stop infusion
    Remove catheter
    Elevate extremity
    Encourage active ROM
    Apply warm compresses 3-4 times/day
    Restart IV proximal to site or other extremity
    Treatment of infiltration
  112. Edema
    Throbbing, burning or pain at the site
    May be a red line up the arm with a palpable band at the vein site
    Slowed infusion
    Signs of phlebitis/thrombophlebitis
  113. How is phlebitis prevented?
    • Rotation of sites
    • Avoiding lower extremities
    • Proper handwashing and surgical aseptic technique
  114. How is phlebitis treated?
    • Promptly discontinuing the infusion
    • Notify the PCP
    • Elevate extremity
    • War/moist compresses
    • Restart with new tubing and fluid
    • TED hose and/or anticoagulants
    • Culture the site and cannula if drainage is present
  115. What are the signs of a hematoma?
    Accumulation of clotted blood in the tissue, causing ecchymosis (bruising)
  116. How are hematomas prevented?
    • Minimize tourniquet time
    • remove tourniquet before starting IV fluid
    • Hold pressure after removal of IV
  117. How are hematomas treated?
    • Pressure dressings
    • Avoiding alcohol
    • After bleeding stops, using warm compresses and elevation
  118. What are the signs of a catheter embolus?
    • Possibly asymptomatic
    • With migration there will be severe pain at the site
  119. What is done to prevent catheter emboli?
    • Never reinsert the stylet into the catheter
    • Avoid joints
  120. How are catheter emboli treated?
    • Pacing the tourniquet high on the extremity to limit venous flow
    • Preparing for removal under x-ray or surgery
    • Saving the catheter after removal to determine the cause
  121. Tenderness, pain
    Red streaking
    Fever, chills, malaise
    Signs of cellulitis
  122. How is cellulitis prevented?
    • Rotations of sites
    • Avoiding the lower extremities
    • Proper handwashing and surgical aseptic technique (same as phlebitis)
  123. How is cellulitis treated?
    • Promptly discontinuing the infusion
    • Notify the PCP
    • Elevate extremity
    • War/moist compresses
    • Restart with new tubing and fluid
    • TED hose and/or anticoagulants
    • Culture the site and cannula if drainage is present
    • Antibiotics
    • Analgesics
    • Antipyretics
  124. Sudden or gradual rise in temperature, chills and shaking, increased HR and RR, headache, nausea, vomiting, diarrhea and confusion
    Bacteria cultured from blood
    Signs of septicemia
  125. What is the best way to prevent septicemia?
    Diligent adherence to maintaining surgical aseptic technique
  126. How is septicemia treated?
    • Monitoring the client's VS and assessing for s/s of infection
    • Notify PCP of changes in status
    • Blood cultures
    • Administering antibiotics as ordered
  127. How is fluid overload treated?
    • Raising HOB
    • VS
    • Notifying PCP of changes in status
    • Possible readjustment of rate
  128. How is fluid overload prevented in IV therapy?
    • Using an infusion pump
    • Monitoring I & O
  129. Distended neck veins
    Increased BP
    Crackles in the lungs
    Signs of fluid overload
  130. What are signs of air emoboli?
    • If in the pulmonary arteries - same as pulmonary embolism
    • Rarely occurs with peripheral lines
  131. How are air emboli prevented?
    • Priming/flushing all tubing to prevent air from entering the system
    • Changing the IV solution containers before empty
  132. How are air emboli treated?
    • Immediately
    • Putting the client in Trendelenburg position on the left side and instructing client to perform the Valsalva maneuver
    • Notify PCP
    • Perform frequent assessments
    • Ventilatory support and IV therapy per orders
  133. Which of the following techniques will minimize the risk of catheter embolism?

    C. Once in the vein, never put the stylet back through the catheter
  134. The nurse checks for patency of an IV saline lock by

    A. flushing the IV with NS and assessing the site
Card Set
ATI: Unit 3 chapters 44-46
ati flashcards basic nursing care