2. LEARNING OBJECTIVESLEARNING OBJECTIVES
At the end of the lecture discussion, RNs are expected to:
Enumerate principles, standards, guidelines in drug preparation and
administration
Identify vital functions, roles & responsibilities as RNKs in drug
preparation and administration
Calculate with 100 percent accuracy, completeness & organization
based on standardized conversion system, equation and units of
measurement
Appreciate the value and virtue of patience, humility, cooperation,
respect and dignity for human life in congruence with drug
preparation and administration
3. FLORENCE NIGHTINGALE’SFLORENCE NIGHTINGALE’S
PLEDGEPLEDGE
I solemnly pledge myself before God and the presence of this
assembly to pass my life in purity and to practice my
profession faithfully. I will abstain from whatever is deleterious
to mind and body and not take or knowingly administer any
harmful drugs. I will do all in my power to hold in confidence all
personal matters committed to my keeping and all family affairs
coming to my knowledge in the practice of my profession.
With loyalty will I endeavor to aid the physician in his work and
devote myself to the welfare of those committed to my care”.
Thus…
4. KNOWLEDGE, SKILLS, ATTITUDES AND VALUESKNOWLEDGE, SKILLS, ATTITUDES AND VALUES
• Promotion of health
• Prevention of illness
• Restoration of physiologic processes
• Provision of palliative effect
• Maintenance & sustenance of wellness
• Aid in diagnosis
• Treatment of diseases
Pharmacologic
aspects in
nurses’
contextualities
5. Rules and Techniques for Giving MedicinesRules and Techniques for Giving Medicines
Verify all new or questionable orders on the medication administration
record (MAR) against the physician orders for completeness
Prepare medications in a quiet environment
Wash hands thoroughly before measuring or preparing a medication
Collect all necessary equipments
Review MAR carefully (medication, dosage, route, expiration, date and
frequency)
Research drug compatibilities, purposes, contraindications, S/E, &
appropriate routes
Find medication for individual client
Accurate calculation is needed
Check expiration dates and signs of decomposition
6. Rules and Techniques for Giving Medicines
Compare labels three times
• When removing package from drawer
• Before preparing the medication
• After preparing the medication
Be sure medications are identified for each client
Check for any allergies and perform special assessment before
administration
Confirm patient’s identity
• Ask the name
Check the identification wrist band
• Check the bed tag (least reliable)
• Check the photo in bed
8. Rules and Techniques for Giving Medicines
Observe 10 Rights in giving
each medication
Do not give medicine that
someone else prepared.
• Institution policies may require
having a colleague double
check medication such as
insulin or heparin
If using a computer – controlled
dispensing system, follow
agency policy
9. Guides to the Administration of Some Specific AgentsGuides to the Administration of Some Specific Agents
Cough syrups are given undiluted in small
amount and in frequent doses
Laxatives or cathartics are given between
meals and on an empty stomach; those that
act quickly be given just before breakfast or
those requiring a longer time for action
should be given at night (laxative lubricant
12-18 hours action)
Bitter or unpleasant tasting drugs are given
in capsule form as a coated pill or in
effervescent preparations
Oils taken in liquid form should be chilled
• Castor oils taken with a lemon juice ¼ NAHCO3 in
effervescing action
10. Guides to the Administration of Some Specific AgentsGuides to the Administration of Some Specific Agents
Drugs that are destroyed by digestive juices are given in
enteric coated pills
Drugs are given several hours after meals for rapid action
Drugs to aid digestion are given one half before meals
Fe and Iodine preparations are given diluted and given with a
straw
Sedatives are given with warm milk to increase and hasten
desired effect of the drug
Bitter stomachaches, given to stimulate appetite should be
given undiluted and with no attempt to disguise the taste
11. Rules for Measuring Medications
Measure the amount of drug ordered,
using a calibrated measure
Do not converse while preparing the
medication
Make sure that medicine glasses are dry
before pouring or measuring a
medication
Cleanse the mouth of every bottle after
use before replacing it
Measure drops
Hold the medicine glass at eye level
12. Rules on Labels
Give medication only from a
clearly labeled container
Read the label three times
Never give a drug from an
unmarked bottle or box
Pour medicine from the bottles
on the side opposite the label
Labels on medicine containers
should be changed only by the
pharmacists
If a drug has two commonly
used names, both names
should appear on the label
13. Rules for Giving MedicationsRules for Giving Medications
Give the medication at the time for which it is ordered
Always identify the patient before giving the medication
If medication is refused or cannot be administered, notify the lead
head nurse
Remain at the bedside until the patient has taken the medication
Administer only those medicines which you have measured, poured
and prepared
Never give two drugs together, unless ordered to do so
When a patient goes to the OR, all orders for medication are DC
When special tests are being done, medications due at the particular
time are omitted they are resumed when next due
A mistake in medication must be reported immediately to the lead
head nurse or charge nurse
14. Rules for Recording Drugs AdministeredRules for Recording Drugs Administered
Record if an ordered medication is refused or if cannot be
administered
Record each dose of medicine soon after it is administered
Use standard abbreviations in recording medications
Record only those medicines which you have administered
Record time, kind and dose of drug given
Record effect, especially any unusual effect
Never record a medication as given before it has been
administered “IF IT WAS NOT DOCUMENTED, IT WAS NOT
DONE.”
15. Care of Drugs and Medicine CabinetCare of Drugs and Medicine Cabinet
Bottles, boxes & other containers Must be kept closed
Ointments, liniments, talcum
powder, rubbing alcohol
Must be kept in a separate
environment
Oils, serums, vaccines, liver
extracts
Must be placed in a refrigerator
Extreme colds prevents them from
becoming rancid and makes the oil
a little more palatable
Emergency Drugs Must be kept in a box or tray,
readily attainable
Labels Defaced or soiled should be
changed by the pharmacists
Medicines in unusual appearance Returned to the pharmacy &
discarded
16. Care of Drugs and Medicine CabinetCare of Drugs and Medicine Cabinet
Floor Drugs Checked twice daily
Two containers for each floor drug
Unused drugs for a patient being dismissed Should be sent back to the pharmacy
Medicines sent home for patients Complete directions are employed
Medicine Cabinet
Individual basis (UNIT DOSE FORM)
Opiates & narcotics
Poison
Adjacent to sink
Adequate light
Shallow
Proper drug classification of drug supplies
Drug per container/patient
Separate compartment & locked
Narcotic nurse with the key
Label POISON, separate and roughened surface
DRUG SUPPLY - UNIT DOSE FORM System of packaging and labeling each dose by pharmacy
supplied in a 24 hour time period
Replacement, constant monitoring of availability
DRUG SUPPLY – STOCK SUPPLIED Dispensed and labeled in large quantities
Stock supplies kept in a secured area
17. RNKs CAN
ALLAY PATIENT’S SUFFERING
THROUGH WRONG MEDICATION
AND NON COMPLIANCE TO
STANDARDS, PRINCIPLES AND
GUIDELINES
D
I
G
N
I
F
I
E
D
D
E
A
T
H
18. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
1. A nurse makes a medication error. The best action is to
A. Document in the patient’s record the error by either noting the
omission of a drug or adding the drug given if it does not
appear on the medication record
B. Document in the patient’s record the error by either noting the
omission of a drug or adding the drug as given even if it does
not appear on the medication record; describe the
circumstances surrounding the error.
C. Do not document any error on the patient’s record. Document
only on the incident or quality assurance report.
D. Document in the patient’s record the error by either noting the
omission of a drug or adding the drug as given if it does not
appear on the MAR; also document on the incident or quality
assurance report.
19. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
2. Among the following patient’s right, which is not
included?
A. Right route
B. Right medicine
C. Right site of administration
D. Right patient
20. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
3. Which of the following nursing actions is
most helpful for the patient with dysphagia?
A. Placing the patient in a sitting position
B. Mixing the medication with food
C. Turning the patient toward you
D. Dissolving the medication in a glass of
water
21. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
4. It is important not to leave medication at the
bedside because
A. You will not be able to document that the
patient actually took the medication
B. It may fall on the floor
C. The patient may forget to take it
D. It takes time to return and check with the
patient later
22. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL ANDAPPLICATION, CRITICAL THINKING, RECALL AND
RECOGNITIONRECOGNITION
5. Buccal medications are those
A. Placed between the cheek and the
gum
B. Placed under the tongue
C. Injected into the buttocks
D. Swallowed with water
23. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
6. Topical rinses have of the following
actions:
A. Systemic effect when swallowed
B. Decreased microorganisms and
tooth decay
C. Increased the ability to taste
D. Local effect through exposure to the
mucous membrane
24. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
7. Administration of which of the following requires the
use of sterile technique?
(1) Ophthalmic medications (2) Nasal medications
(3) Vaginal medications (4) Rectal medication
A. 1 only
B. 1, 2, and 3
C. 1 and 3
D. 2, 3, and 4
25. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
8. For safety and accuracy of medication being
administered to the patient, one of the
considerations is the three checks. Which of the
following is not applicable?
A. Reading the label after the medications has been
administered.
B. Reading the label before preparing.
C. Reading the label before picking the medication in
the locker.
D. Reading the label after withdrawing the
medication from the container.
26. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL ANDAPPLICATION, CRITICAL THINKING, RECALL AND
RECOGNITIONRECOGNITION
9. Which is the following route has the
faster effect?
A. Sublingual
B. Intravaginal
C. Inhalers
D. Intravenous
27. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
10. It is a medication order that is to be given once at specified time.
A. Stat order
B. Single order
C. Standing order
D. PRN order
11. “Multivitamins 1 tab daily” is an example of:
A. Stat order
B. Single order
C. Standing order
D. PRN order
12. A finely divided drug particles dispersed in liquid medium, when suspension is left
standing, particles settle at the bottom of container
A. Aqueous
B. Suspension
C. Syrup
D. Powder
28. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
13. Requires that the effectiveness of the medication be administered by client’s
response to the medication; it is appropriate to determine the extent of side
effects and adverse reaction supports which of the following medication golden
rule?
A. Right evaluation
B. Right assessment
C. Right education
D. Right documentation
14. Which of the following is not a principle for giving medications?
A. Be knowledgeable about medications that you administer.
B. Do not leave medication at bedside.
C. When a medication error is made, report it immediately to the nurse in
charge and/or physician.
D. Practice clean technique.
29. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
15. The following are rules for measuring medications, except:
A. Wash hands thoroughly before measuring medications.
B. Do not converse with anyone while preparing a medication.
C. Cleanse the bottom of each medicine bottle before replacing it after
use.
D. Make sure that the medicine glasses are dry before pouring the
medication.
16. Mrs. Brown is to receive a medication PO qid. This means
A. by mouth every other day
B. before meals every day
C. after meals every day
D. by mouth four times a day
30. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
17. When the client resists taking a liquid medication that is essential to treatment,
the nurse demonstrates critical thinking by doing which of the following first?
A. Omitting this dose of medication and waiting until the client is more
cooperative
B. Suggesting the medication can be diluted in a beverage
C. Asking the nurse manager about how to approach the situation
D. Notifying the physician that the nurse was unable to give the client this
medication
18. The nurse is administering medication in an extended care facility. The client
answers to Mr. Smith and Mr. Brown. What is the best way for the nurse to
correctly identify the client before administering the medications?
A. Ask the client's name.
B. Check the arm band.
C. Check the name on the bed.
D. Check the name on the room door.
31. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
19. Zantac is ordered for an adult client. The nurse mistakenly
administered Xanax. What is the most appropriate action for
the nurse to take?
A. Notify the physician and document in the nurse's notes that the
physician was notified of the error.
B. Notify the supervisor, complete a medication error incident
report, and document in the nurse's notes that an incident
report was completed.
C. Notify the house supervisor, assess client carefully, and
document only if adverse or untoward effects occur.
D. Notify the physician, complete an incident report, and
document the notification of the physician and any
assessments made.
32. TEST DRILLTEST DRILL
APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION
20. While preparing to give a morning medication, the first nursing action
is to:
A. Read the label
B. Check for the right dose
C. Wash hands
D. Check for the right time
21 – 25 FIVE RIGHTS OF DRUG ADMINISTRATION
69. Safety Related Issues in Pedia PatientsSafety Related Issues in Pedia Patients
Most Pediatric nursing units have a policy that children under a certain
age with IV fluids / IV medications will be placed on an infusion
pump.
Buretrol
Microtubing
Infusion Pump
Sometimes critical thinking is required to deliver
the medication/fluid in the most expedient, safe
manner for the individual child's needs.
Children cannot tolerate adult doses.