Bethany Gerena Pharmacology study guide Chapter 1 The Nursing Process and Drug Therapy 14.Identify the “nine rights” of drug administration and specify ways to ensure that each of these rights is addressed.Right drug: Compare drug orders and medication labels. Consider whether the drug is appropriate for that patient. Obtain information about the patient’s medical history and a thorough, updated medication history, including over-the-counter medications taken.Right dose: Check the order and the label on the medication and check the “rights” at least three times before administering the medication. Recheck the math calculations for dosages, and contact the physician when clarification is needed. Check the dose and confirm that it is appropriate for the patient’s age and size and check the prescribed dose against the available drug stocks and against the normal dosage range.Right time: Assess for a conflict between the pharmacokinetic and pharmacodynamic properties of the drugs prescribed and the patient’s lifestyle and likelihood of compliance.Right route and form: Never assume the route of administration or change it; always check with the physician or prescriber. Additionally, it is critical to patient safety to be aware of the right form of medication. For example, there are various dosage forms of acetaminophen, a commonly used medication. It is available in oral suspension, tablet, capsule, gel cap, pediatric drops, and rectal suppository dosage forms. Nurses need to give the right drug via the right route with use of the correct dosage form.Right patient: Check the patient’s identity before administering a medication. Ask for the patient’s name and check the identification band or bracelet to confirm the patient’s name, identification number, and allergies. The Joint Commission requires the use of two patient identifiers, such as name and birthday, Social Security number, or medical record number.Right documentation: Record the date and time of medication administration, name of medication, dose, route, and site of administration. Do not forget to document the patient’s response to the medication.Right reason and response: Right reason refers to the appropriateness of the use of the medication for the patient. Confirm the rationale for use through researching the patient’s history while also asking the patient the reason he or she is taking the drug. Always revisit the rationale for long-term medication use.Right response: refers to the drug and its desired response. Continually assess and evaluate the achievement of the desired response and any undesired response.
- During a busy night shift, the nurse notices a medication order that reads: “give amoxicillin, 500
mg PO three times a day.” What is the most important thing the nurse must check before giving this medication to the patient? 1 / 4
The nurse must be sure to question the patient for any allergies, especially drug allergies, before giving the medication. If an allergy is present, question the patient about the type of reaction that occurred, and do not give the medication until the order is clarified with the prescriber.
- Summarize the nurse’s role in the prevention of medication errors. Relate how this role of
prevention meets the QSEN requirements for safe practice.The nurse's role is to always be alert for the Nine Rights. The information obtained from implementing the Nine Rights can lead to early identification of patient problems. The focus of nursing care is on patient safety. The Quality and Safety Education for Nurses (QSEN) project was initiated in 2005. QSEN attempts to address the continued challenge of preparing future nurses with the knowledge, skills, and attitudes (called KSAs) needed to continuously improve the quality and safety of patient care within the health care system. These KSAs that flow out of the QSEN initiatives and are being integrated into nursing education curricula and clinical outcomes. The six major initiatives are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. 2 / 4
Chapter 2 Pharmacologic Principles
- Mr. C is not to receive a drug that can be given by injection, either intramuscularly or
- Ms. D. had a thyroidectomy 4 years ago and has been taking the thyroid hormone levothyroxine
- E.S. has a prescription for an extended-release, enteric-coated tablet. The next day, his wife calls to
- Identify the advantages of a "biosimilar" drug for the pharmaceutical company and the patient.
subcutaneously. Mr. C’s condition dictates that the drug needs to be absorbed quickly. Which route of administration will the prescriber order? How can the nurse further increase absorption?Because muscles have a greater blood supply than the skin, drugs injected intramuscularly are typically absorbed faster than those injected subcutaneously. Absorption can be increased by applying heat to the injection site or by massaging the injection site, which increases the blood flow to the area and thus enhances absorption.
since the surgery. She visits her primary care provider for periodic laboratory work to check her hormone levels. This is an example of which type of drug therapy: acute, maintenance, supplemental, or palliative? Explain your answer.This is an example of supplemental therapy. Drug therapy that supplies the body with a substance needed to maintain normal function.
ask about crushing the tablet, saying, "He just cannot swallow that big pill." What is the nurse's best answer?Extended-release oral dosage forms must not be crushed because this could cause accelerated release of the drug from the dosage form and possible toxicity. Enteric-coated tablets also are not recommended for crushing. This would cause disruption of the tablet coating designed to protect the stomach lining from the local effects of the drug or protect the drug from being prematurely disrupted by stomach acid.
For the pharmaceutical company, the testing has been performed, and for the patient, the cost is reduced.Chapter 3 Lifespan Considerations 3 / 4
- The nurse works at a community clinic frequented by a number of older patients. Mrs. M comes to
- The physician confirms that Mrs. M.'s "new symptoms," as she refers to them, are a result of
- A 14-year-old girl has been diagnosed with type 1 diabetes mellitus, and the nurse is preparing to
- A nurse presenting information to new mothers at a community center is asked about the
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the clinic complaining of dizziness and nausea. As the nurse takes her medication history, she shows the nurse her “pill box.” Inside the nurse sees almost a dozen different pills, all to be taken at noon.How could this happen? How could she possibly need so many medications at the same time?Older patients take a greater proportion of both prescription and OTC meds, and they commonly take multiple meds daily. In addition, older adults also have more chronic diseases than younger people. They may see several different specialists, each of whom may each prescribe a different set of meds. In addition, some patients self-administer OTC products to ease the discomfort of even more ailments. This use of multiple meds is called polypharmacy.
polypharmacy. She protests, telling the nurse, "Honey, I've got new for the doctor. I've had to take lots of drugs at the same time all my life. It never bothered me before. Why would it now when I'm even more used to it?" Explain at least 3 physiologic changes that occur with aging and the way in which these changes affect pharmacokinetics and pharmacodynamics.As you age gastric pH is less acidic, so medication would have a harder time breaking down, hepatic enzyme production is slowed causing metabolism to slow as well, and renal blood flow is slower causing excretion to slow as well.
teach her how to test her own blood glucose levels with a glucometer. Describe some strategies that would be effective for this teaching session.It would be important to prepare her in advance for the teaching session. Let her know what to expect and include her parent, if possible, in the teaching session. It is also important to allow her time to express her feelings about this new diagnosis and the need to test her own blood glucose levels. Allow her to make choices when appropriate (i.e., choosing a glucometer with a special color). After demonstrating the procedure, encourage her participation and allow for return demonstration.
differences among infants, children, and adults in response to medications. What facts regarding these differences should the nurse include in her response?From the beginning to the end of life, the human body changes in many ways. These changes have a dramatic effect on the four phases of pharmacokinetics drug absorption, distribution, metabolism, and excretion. Newborn, pediatric, and older adult patients each have special needs. Drug therapy at both spectrums of life is more likely to result in adverse effects and toxicity. Examples of these differences include decreased first-pass effect and increased intramuscular absorption in neonates and younger pediatric patients and decreased protein binding and increased metabolism in older children. Similar absorption and metabolism changes are seen in older adults as their organs decline in function.Chapter 4 Cultural, Legal, and Ethical Considerations