Medication Administration Study Guide by Jacque

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1.

1. Discuss the legal aspects of drug

administration

Federal drug legislation regulates the production, prescription, distribution, and

administration of drugs.
Health Care Institutions implement policies to adhere to Federal and State regulation and
within their facility.
Nursing practice acts define limits on the nurse's
responsibilities regarding medications.
Legally a nurse must follow prescriber's order unless it is in error or nurse believes harm will
come to pt.
Nurses are responsible for actions
question any order that appears unreasonable.
refuse to give med until order is clarified.

2.

2. Describe various routes of

medication administration

See the following

3.

oral

swallowed, safest

4.

sublingal

dissolved under tongue

5.

buccal

medication (e.g., a tablet) is held in the mouth against the mucous of cheek

6.

topical

topical can be dermatological, instillations, irrigations, and /or inhalations.

rectal
vaginal
transdermal
inhalation
eye
ear
nose

7.

rectal

Indications for administering rectal route medication 1. Place client on side in side-lying
(Sims) position or dorsal recumbent position
2. Use water soluble lubricant
3. remove wrapper
4. wear gloves
5. If a rectal suppository:
-patient should bear down as you insert approximately 1.5 in. past anal sphincter into rectal
canal
-patient should remain lying down for 15 min.

8.

vaginal

Vaginal medications are available as

1. Suppositories
2. Foam
3. Jellies
4. Creams
Indications for administering vaginal medication 1. Place patient in dorsal recumbent
position
2. Use water soluble lubricant
3. Remove wrapper
4. wear gloves
For vaginal suppositories:
-instert opened suppository into applicator
-insert at least 2 in. into vaginal canal
- have patient remain lying down for 15 min.

9.

otic

Indications for administering otic route medication

1. wear gloves
2. position patient on side with affected ear up
3. Infant: pinna down and back
Adult: pinna up and back
4. Remain on side for 2-3 min (notes say 5-10min). after administered
5. Make sure it's room temperature (may warm on hands)
place in side of canal not directly on ear drum. massage tragus of ear. May use cotton or gauze
pledget.
6. User sterile solutions
7. Note any drainage

10.

dermal or transdermal

clean skin.
apply with gentle strokes- avoid excessive pressure.
cover as indicted.
rotate sites if not specific.
Transdermal patch:
may need time overlap.
apply to area free of hair, irritation, or scratches.
avoid touching medication when handling.

11.

transdermal:

designed to be absorbed through the skin for systemic effects

12.

optic

use standard precautions.

cleanse eye inner to outer canthus.
pt supine or sitting.
have client look up.
expose conjunctival sac.
hold container 1-2 cm above eye.
do not touch eye with container.
never apply directly to cornea.
close eye, gently blot.
may hold nasolacrimal duct 30-60 sec to reduce systemic effect/ or taste
repostion as needed slowly.

13.

inhalation

MDI- metered dose inhaler.

use as instructed by care provider.
shake gently.
position thumb and first two fingers
tilt head head back slightly.
position at mouth.
exhale.
depress inhaler and inhale medication.
follow specific instruction w/ medication.
rinse mouth/brush teeth.

14.

nose

standard precautions.
have client clear nasal passages first unless ICP or surgery.
may have burning/ stinging.
supine position-drops
hold dropper1/2 " above nares toward midline of ethmoid bone.
Specific treatment areas:
-posterior pharynx: head back
-ethmoid/sphenoid: shoulder roll or head gently over edge of bed.
-frontal/maxillary; head back and to specific side.
Sprays-upright position.

15.

irrigations (example: bladder

irrigation)

surgical asepsis used in wound, bladder or other sterile body cavity.

Medical asepsis used on vaginal, rectal, and gastric areas.
Asepto syringes, piston syringe, and Pomeroy syringe often used.
follow prescribers orders regarding type, amount, temp, and strength of solution.

16.

intradermal:

Injection into the dermis just under the epidermis.

Angle: 15 degrees
Examples: for skin testing such as TB skin test or allergy testing
Sites for injection:
1. inner forearm 3-4 finger widths below antecubital space and 1 hand width
above wrist.
2. Upper back
Needle: 25-27 g.
1/4 to 5/8 in. needle
Syringe: 1 mL tuberuclin syringe with short bevel
Volume: 0.01 to 0.1 mL

17.

Nursing considerations for giving injections BLSTR

(Blaster acronym)

Blood flow to site of administration

Lesions at site
Skin integrity, scarring
Tattoos
Rotate Sides

18.

intramuscular:

Involving administration of a medication into the muscle layer beneath the

dermis and subcutaneous tissue
Injection into a muscle.
Angle: 90 degrees
Sites for injection:
1. Deltoid
2. Vastus Lateralis
3. Ventrogluteal
rate of injection 10 sec/ per mL

19.

Deltoid IM injection (needle, syringe, volume)

Location:three fingers below acromion process.

Needle: 18-25 g, 1-1.5 in.

Syringe: 1-3mL or 0.5-1.0mL
Volume: 1mL or less

20.

Vastus lateralis (needle, syringe, volume)

Location: place hand below greater trochanter.
place hand above the knee.
midline anterior thigh.
midline of lateral side of thigh.
area forms a rectangle.

Needle: 18-25 g, 5/8 to 1 in.

Syringe: 1-5mL
Volume: Up to 3 mL

21.

Ventrogluteal ( (needle, syringe, volume)

Location: right palm on right grater trochanter.
middle finger on illiac crest.
open fingers
between pointer and middle finger.

Needle: 18-25 g, 1-1.5 in.

Syringe: 1-5 mL
Volume: Up to 3 mL

22.

When is vastus lateralis typically used instead of

deltoid for an IM injection?

For children who are 1 year and younger because deltoid muscle not as
developed.

23.

intravenous:

Involving administration of fluid or medication within a vein

24.

parenteral:

Medications given by injection or infusion

25.

subcutaneous:

Injection into the subcutaneous tissues just below the dermis.

Angle: 45-90 degrees
Examples: insulin and heparin
Sites for injection:
1. abodmen just blow costal margin to iliac crest (best for heparin)
2. interior aspects of thigh
Needle: 25-27 g.
3/8 - 5/8 in.
Syringe: 1 to 3 mL
Volume: No more than 1 mL

26.

Injection site for insulin or heparin

1. abodmen just blow costal margin to iliac crest (best for heparin)
2. interior aspects of thigh
3. Always verify orders on MAR, check allergies, and have another nurse check dose

27.

insulin

always double check with another nurse.

always use insulin syringe (units).
inject slowly, then wait 5 sec, then withdraw.
know client's blood sugar.
when mixing medications draw up clear before cloudy.
never given IM. SubQ or IV (reg insulin)

28.

Injection site for LMWH Heparin

Right or left side of abdomen, 2 in. away from umbilicus is recommended.

29.

A nurse is administering a
subcutaneous injection to a client.
What is the common maximum
volume of a subcutaneous
injection?

The volume of a subcutaneous injection is usually up to 1 mL

30.

A nurse is administering a
intramuscular injection to a client.
What is the common maximum
volume of a intramuscular
injection?

An intramuscular injection is the administration of up to 3 mL of medication into one muscle or

muscle group.

31.

A nurse is administering a
Intradermal injection to a client.
What is the common maximum
volume of a Intradermal injection?

Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01
to 0.05 mL.

32.

A nurse needs to administer an

intradermal injection to a client.
Which of the following is the most
common site for administering an
intradermal injection?

The most common site for an intradermal injection is the inner aspect of the forearm. Intradermal
injections are commonly used for diagnostic purposes. Examples include tuberculin tests and
allergy testing. Small volumes, usually 0.01 to 0.05 mL, are injected because of the small tissue
space. Other areas that may be used are the back and upper chest, not the stomach.

33.

The nurse is preparing to

administer a medication via a
nasogastric tube. What guideline is
appropriate for the nurse to follow
when administering a drug via this
route?

Guidelines to consider when administering a drug via nasogastric tube include positioning the
client with the head of the bed elevated, administering the medication at room temperature for the
client's comfort, flushing the tube with water between each drug administered, and avoiding the
use of suction for 20 to 30 minutes after the drug is administered.

34.

A nurse is performing a sensitivity

test on a patient. What would be the
best type of injection to use for this
procedure?

Intradermal injections are administered into the dermis, just below the epidermis. The
intradermal route has the longest absorption time of all parenteral routes. For this reason,
intradermal injections are used for sensitivity tests, such as tuberculin and allergy tests, and local
anesthesia. The advantage of the intradermal route for these tests is that the body's reaction to
substances is easily visible, and degrees of reaction are discernible by comparative study.

35.

What medications would most

likely be administered via a
transdermal patch?

Hormonal medications
Transdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiac
medications, and nicotine.

36.

A client is ordered to receive an intramuscular

injection of medication. When preparing to
administer the injection, the nurse selects the
ventrogluteal site based on which reason?

The area is free of major blood vessels and fat.The ventrogluteal site for
intramuscular injection is free of major blood vessels and fat. It is considered
the safest and least painful site.
The dorsogluteal site is near the sciatic nerve and involves a high possibility of
injecting into subcutaneous fat. The deltoid region for an intramuscular
injection has little overlying subcutaneous fat and lies close to the radial nerve.

37.

A nurse is explaining to a client the correct method

of using a metered-dose inhaler when selfadministering a prescribed dose of medication.
Which of the following is a feature of a metereddose inhaler?

It is a canister that contains pressurized medication.

A meter-dose inhaler has a canister that contains medication under pressure. It
is much more commonly used than the turbo-inhaler, which is a propellerdriven device that spins and suspends a finely powdered medication. A turboinhaler, not a meter-dose inhaler, has propellers that get activated during
inhalation.

38.

A nurse has administered an intramuscular

injection. What will the nurse do with the syringe
and needle?

Do not recap the needle; place it in a puncture-resistant container.

39.

A nurse is using an 18-gauge needle to administer a

medication to a client. The nurse knows that when
compared to a 27-gauge needle, an 18-gauge needle
has which of the following features?

Larger diameter

40.

A nurse needs to administer an intradermal

tuberculin skin test injection to a client. Which of
the following is the most suitable angle when
administering an intradermal injection?

10-degree angle.
When administering an intradermal injection, the nurse should hold the syringe
almost parallel to the skin at a 10-degree angle with the bevel pointing upward.
This facilitates delivering the medication between the layers of the skin and
advances the needle to the desired depth.

41.

What is the most suitable angle when administering

an subcutaneous injection?

A nurse administers a subcutaneous injection at a 45-degree angle or a 90degree angle to reach the subcutaneous level of tissue, depending on the length of
the needle.

42.

3. Identify essential parts of a medication order

Full name of the client

Date and time the order is written
Name of the drug to be administered
Dosage of the drug
Frequency of administration
Route of administration
Signature of the person writing the order

43.

4. List and define the various types of medication

orders

Standing or routine order Given until order is changed or patient is discharged.

For most injections, 18- to 27-gauge needles are used; the smaller the number,
the larger the diameter. For example, an 18-gauge needle is wider than a 27gauge needle. The needle gauge or the diameter refers to its width

PRN order medication to be given when patient requires it (as needed) often seen
with pain meds
Single (one-time) order medication to be given only once at a specified time.
Common for pre-op. or before diagnostic exams
STAT order signal dose of medication to be given immediately and only once.
Often for emergencies when a patient's condition changes suddenly
Now order used when a patient needs a medication quickly but not right way
like a STAT order. When receiving a now order, the nurse has up to 90 min. to
administer. (administer it as soon as you get it. )
Scheduled order To be given at a specified time or frequency -ex: AC, PC,
"nightly" or "at bedtime"
44.

5. List 6 essential steps to follow when when

administering medication

1.Identify client
2.Inform client
3.Administer the drug
4. Provide adjunctive interventions as indicated
5.Record the drug administered
6.Evaluate the client's response to the drug

45.

6. Describe physiologic changes in

older adults that alter medication
administration and effectiveness

Altered memory
Decreased visual acuity
Decrease in renal function
Less complete and slower absorption from the gastrointestinal tract
Increased proportion of fat to lean body mass
Decreased liver function
Decreased organ sensitivity
Altered quality of organ responsiveness
Decrease in manual dexterity

46.

8. Patients' Rights

1. RIGHT MEDICATION:READ LABEL 3 TIMES

Compare to Mar
Watch for look alike/sound alike
Keep doses packaged until administration
Multi-dose
2. RIGHT DOSE:
Give appropriate dose
Double check calculations
Know usual dosage range
Questions doses outside usual ranges,
3 systems: Metric, Apothecary, Household
3. RIGHT TIME:
Exact time
Agency time
Usually 1 hour before or after a meal or after scheduled time
4. RIGHT ROUTE:
Correct route
Appropriate for client
Client able to take complete dose
Special meds
Others
Liquids
Sublingual
Parenteral
5. RIGHT CLIENT:
Always identify, 2 identifiers(unique, may not use rm#), Patient identifiers
Always recheck
Allergies
6. RIGHT CLIENT EDUCATION: Right to know name and information about medication
The education to take safely, and make informed decisions
7. RIGHT DOCUMENTATION:
Immediate
Mar
Chart
Anecdotal
8. RIGHT TO REFUSE:Inform client prior to administration about medication
9. RIGHT ASSESSMENT: Some medications require specific assessments prior to administration
(e.g., apical pulse, blood pressure, lab results). Medication orders may include specific parameters
for administration (e.g., do not give if pulse less than 60 or systolic blood pressure less than 100).
10. RIGHT EVALUATION: Conduct appropriate follow-up (e.g., was the desired effect achieved or
not? Did the client experience any side effects or adverse reactions?).

47.

Physical Assessment before

medication administration

ABILITY TO SWALLOW
GASTROINTESTINAL MOTILITY
ADEQUATE MUSCLE MASS
ADEQUATE VENOUS ACCESS
BODY SYSTEM ASSESSMENT

48.

Information Collected During

Initial Assessment pertaining to
medication

During the initial assessment, it is important to perform a medication history, assess for a history
of any allergies and medication intolerances, evaluate the patient's medical history, and determine
the patient's pregnancy and lactation status.

49.

9. Outline Steps to administer

medications safely

1. Use the rights

2.Calculate doses carefully; double-check with a second RN
3. Watch for drugs with similar names
4. Watch for clients with same last names
5. Clarify illegible orders
6. Know and use your resources
7. Keep up with changes in medication orders
**You are responsible for all medications you give
All errors should be reported: it is your responsibility! (clarify order, never assume. ask
another nurse, look up medication, call pharmacy, or contact physician)

50.

SAFE MEDICATION ADMINISTRATION

To administer medications safely, the following actions are necessary:

Accurately interpret the provider's order. ( readback all verbal, telephone orders to the
provider, students do not take verbal or telephone orders)
Accurately calculate the amount of drug to give for the prescribed dose. (never give a
medication you have not prepared)
Develop a systematic and safe procedure, using the six rights for drug administration,
including accurate identification using two separate identifiers.
Document medication administration according to best practice principles.
Explain the purpose of the medication to the patient.
Prevent medication errors.
Promote standardized communication.
Promote healthcare planning and home or community-based care.
Evaluate the patient's response to medications.

51.

what should the nurse assess after a

medication is given to the patient?

effectiveness of the drug

monitoring for adverse drug effects
monitoring for allergic reactions
the patients knowledge level concerning perscribed medication

52.

10. Describe how to prepare medications

from ampules and vials

Never open bare handed

Use sterile filter needle
Tap ampule to move medication from top/neck
Set on flat surface or hold upside down to remove med
Do not allow needle or tip or shaft to touch rim
Express air bubbles outside of ampule
Never use filter needle for injection!
Remove filter needle after medication drawn up
Dispose of ampule in sharps container

53.

11. Identify equipment required for

parenteral medication.
Identify parts of needle and syringe
What parts must be kept sterile?

Equipment preparation:
syringe/needle (size/gauge)
Medication Prep:
Vials
Reconstituting from powder
Two medications in one syringe
all internal parts must be kept sterile as well as the entire shaft of the needle.

54.

12. identify sites with correct anatomical terms used for ID, subq, and
IM injections:

intradermal injection sites

55.

Intramuscular injection sites

56.

Subcutaneous injection sites

57.

IV injection sites hand and arm

58.

13. Identify equipment used for intradermal, subcutaneous, and

intramuscular injections. Each needs client MAR and ampule or vial
medication to be administered. clean gloves, alcohol swabs, and maybe
a bandaid.

intradermal: tuberculin syringe or 1-mL syringe

calibrated into hundredths, 1/4-5/8 inch needle 25-27
gauge , 0.01-0.1ml (5-15 degree with bevel up)
subcutaneous: insulin or heparin syringe or 3mL, 3/8-5/8
inch needle 25-27 gauge, no more than 1.5mL (45-90
degree angle depending on size of client)
Intramuscular: 3-5ml syringe, 1-1.5 inch needle 18-27
gauge (22-25 preferred), no more than 3mL -divide if
greater (90 degree )

59.

14. State steps to mix 2 medications in one syringe

Step 1 Draw air into the syringe to equal the amount of medication to be
withdrawn from vial 1 (i.e. 1 mL)
Step 2 Insert syringe into vial 1 and inject the air. Do not let the needle touch
the medication. Then, remove the the needle.
Step 3 Draw air into the syringe to equal the amount of medication to be
withdrawn from vial 2 (i.e. 0.5ml).
Step 4 Insert needle into vial 2 and inject the air.
Step 5 Withdraw the desired amount of medication from vial 2 (i.e. 0.5 mL)
Step 6 Insert NEW needle into vial 1, invert vial and withdraw desired
amount of medication. (Ex: Total volume would be 1.5 mL)

60.

15. Describe 3 checks for unit dose and stock meds

*Before you pour:

check the medication label against the MAR
*While you pour:
Verify the label against the MAR
* At the bedside:
Check the medication again
*Stock/Bulk meds Check label against the MAR before returning to storage

61.

16. Describe the 2 checks for correct patient

identification. Identify what may not be used.

Wrist Band
Patient states name
Patient states DOB
MAR
You cannot use the room #

62.

17. Identify abbreviations that are on the do not use

list

U Write "unit"
IU Write "International Unit"
Q.D., QD, q.d., qd Write "daily"
Q.O.D., QOD, q.o.d., qod Write "every other day"
Trailing zero Write 0.X mg
MS Write "morphine sulfate"
MSO4 and MgSO4 Write "magnesium sulfate"
> Write "greater than"
< Write "less than"
Abbreviations for drug names ....Write drug names in full
Apothecary units..........Use metric units
@ Write "at"
cc Write "mL" or "milliliters"
g Write "mcg" or "micrograms

63.

18. commonly used abbreviations:

PO: per oral

SL: sublingual
SQ: subcutaneous
subq: subcutaneous
ID: intradermal
IM:intramuscular
inj: injection
top: topical
gtt: drip
cap: capsule
tab: tablet
susp: suspension
stat: do right away
asap: as soon as possible
ac: before meals
pc: after meals
TO: telephone order
VO: verbal order

64.

abbreviations continued:

ad lib: as desired
D/C: discontinued
prn: as needed
h and hr: hour
s with line over it : without
c with line over it: with
x with line over it: except
p with line over it: after
elix: elixir
NPO: nothing per oral
BID: twice daily
TID: three times a day
OS: left eye
OD: right eye or overdose
OU: both eyes

65.

abbreviations continued:

NKA: no known allergies

NKDA: no known drug allergies
qh or QH: per hour
q2h or Q2H: every two hours
q4h or Q4H: every 4 hours
ATC: around the clock
HS: hour of sleep
hs: hour of sleep

66.

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