What is IM?
Intramuscular
What is IV?
Intravenous
What is IV PB?
Intravenous piggyback
What is SQ/Subcut?
Subcutaneous
What is SL?
Sublingual
What is GT?
Gastrostomy tube
What is NG?
Nasogastric tube
What is NJ?
Nasojejunal tube
What is p.o.?
By mouth, orally
What is p.r.?
What is a.c.?
Before meals
What is p.c.?
After meals
As desired, freely
What is p.r.n.?
When necessary
What is stat?
Immediately, at once
What is asap?
As soon as possible
What is b.i.d.?
Twice a day
What is t.i.d.?
3 times a day
What is q.i.d.?
4 times a day
What is min?
Minute
What is h?
Hour
What is q.h?
Every hour
What is q.2h?
Every 2 hours
Before
After
With
Without
What is q?
Every
What is qs?
Quantity sufficient
What is aq?
Water
What is NPO?
Nothing by mouth
What is gtt?
Drop
What is tab?
Tablet
What is cap?
Capsule
What is et?
And
What is noct?
Night
NEVER relabels a medication, if a label is illegible, return the container to the the pharmacy for
proper identification and labeling
Clients name
Dosage
Administration route
Scheduled times
When setting up for administrating medications, what are some things to do to help you prevent
a medication error?
What are the "Five Rights" of medication administration? And the sixth and seventh?
Right client
Right medication
Right dose
Right time
Right route
To ensure that the correct medication is given to the correct client, what do you "Check TWO for
safety"?
As a nurse you compare and confirm the medication's name and dosage with the client's MAR
by doing what?
The first check is on removing the medication from the storage area
The second check is when scanning it and placing it in the medication cup or envelope
The third check is on opening the medication unit-dose package at the client's bedside
Also note to self, that you do not administer a medication that someone else has prepared or to a
client assigned to another nurse
How do you know when to administer medications as ordered to maintain the medication's
therapeutic effects?
STAT dose
PRN dose
A medication that is ordered for 1000 hours, may be administered anytime between 0930 hours
and 1030 hours and still be considered "on time".
True
Most facilities allow 30 minuets on each side of the schedule time for administering medications.
*What medications they are given (generic and trade name), and why they are taking them
*How long they will need the medications and what to do if they miss a dose
Differences in color and shape of a medication mean that the medication is incorrect.
False
Differences in color and shape of a medication may be due to a change in the dosage, the
manufacturer, or because they are now receiving a generic form of the medication.
Differences do not necessarily mean that the medication is incorrect, although it is important to
verify that the correct medication is being administered.
Applied to the mucous membranes of the eye, mouth, nose, throat, vagina, or rectum by
instillation, irrigation, swabbing, or spraying.
Administration into any part of the body other than by way of the gastrointestinal tract
Oral administration
Sublingual administration
Translingual administration
Buccal administration
Rectal administration
Injection
Vaginal administration
Transdermal administration
Enteric-coated or time-release medications may be crushed and given by nasogastric (NG) Tube.
False
Crushing an enteric-coated or time-release medication may interfere with its desired action.
SC injection
IM injection
Intradermal injection
A nurse must always dispose of all syringes and needles in the hazardous waste container.
False
Always dispose of all syringes and needles in the sharps container to prevent needlstick injuries
to nurse and environmental personnel. A needlstick injury can cause serious infections and/or
other disabilities.
72 to 90 degree angle
90 to 45 degree angle
15 degree angle
*Ampule- Filtered needles are what you use to draw up a medication and then switch the needle
with a new one
*Vial
Shallow injections given just beneath the epidermis, they are often used for diagnostic testing,
it's inner aspect of the forearm; the back may be used, tuberculin syringes, make sure you
instruct the client not to scratch or pinch the site
Right client
Right medication
Right dose
Right time
Right route
Two
Injection
Injection
Injection
Instill drops in the lower conjunctival sac, then gently apply pressure on the inner canthius
Hold drops over the ear, for an adult pull up, back, and out, for a child older than 3 pull lobe
straight back, for younger then 3, pull the lobe down and back
Rectal
Med mixed and then flushed before and after through the tube "be sure to clamp"
For safe medication administration, when administering meds and when receiving order you
must ?
Read back and you always read back when receiving telephone order
Apply clean gloves, vigorously shake the vial, wipe the rubber seal of the vial with an alcohol
swab, introduce air equal to the amount of medication needed, and then draw medication once
the rubber top has dried, to keep from contaminating the medication
Either an alcohol swab or 2x2 gauze to open it and then use a filter needle to draw up but then
switch the needle with a new one to administer
Single dose vials are approved for use on a SINGLE patient for a SINGLE procedure or injection.
Multi dose vials can be used for more than one patient when aseptic technique is followed, after
24 hours the medication is no longer good
When you are given a STAT order, what do you do when you receive this type of medication
order?
Intramuscular which could be the Deltoid (at the shoulder) or the Dorsogluteal (the lower back
upper butt)
Grab the bottle with the label in your palm so that the medication doesn't drain down the bottle
and make the label eligible, pour it out the side opposite of the label
SC injection
Medication calculation; the amount of air should equal the volume of medication to be drawn into
the syringe
Drug form
Dosage strength
Administration route
Expiration date
What is the appropriate gauge and needle length for Subcutaneous in Adults?
20-30 Gauge
What is the appropriate gauge and needle length for Subcutaneous in Adults?
25-27 Gauge
3/8-5/8 inches
When mixing insulin's, if you draw too much of the second insulin (NPH), you must what?
With Insulin and Heparin, you must what what before administering?
The abdomen
Two fingers or two inches from the umbilicus, any scar tissue, and recent injection sites. Too
close to any of these may interfere with absorption
In what position should the bevel be when preparing to injection a SQ/IM injection?
In an upward position
What are some rapid acting medications and whats their duration?
Humalog, Novalog, Apidra (glulisine) and their duration is 5-15 minuets onset, peak in 45 to 75
minuets, and 2-4 hours duration
Novolin (insulin) and it's duration is onset 30 minuets, peak 2-4 hours, and 5-8 hour duration
2 hours onset, no peak, 6-24 hours duration and Levemir(detemir) and Lantus(glargine)
Never
If you are unsure if the insulin's you are giving can be mixed what do you do?
Do not mix them, either give as two separate injections, or check with the pharmacist or drug
manual
Right patient, right medication, right time, right dose, right route, right assessment, right
evaluation, right documentation, right education, right to refuse
Three
Palm the label of the medication container; wipe the medication container spout, pour liquid into
medication cup at eye level and read the level at the bottom of the meniscus; set on flat surface
to verify
No
What does it mean when a tablet is scored? Should you cut or break a tablet that is not scored?
Scored tablets are marked at equal dosages; you should not cut or break a tablet that is not
scored because the client may not receive an accurate dose
How many methods of identifying your client must you use when administering medications?
Name these methods
Two
Compare the MAR with name and account number on the armband it ID bracelet; ask the client
to state his/her name and date of birth
If a client states that he/she would like to finish breakfast prior to taking his/her medications and
request that you leave them at the bedside, what should your response be?
I will return after you finish your breakfast and administer your medications; take medications
with you and bring them with you after they have finished eating to administer
As needed
Intramuscular
Subcutaneous
Can Heparin or enoxaparin (Lovenox) be given in SQ sites other than the abdomen?
No
No
Yes
SQ/IM injections are absorbed more quickly; because they absorb faster into systemic circulation
How does the nurse determine the volume of air to inject into the vial prior to drawing up the
medication for IM or SQ administration?
Medication calculation; the amount of air should equal the volume of medication to be drawn into
the syringe
Is it necessary to inject air into the ampule prior to drawing up the medication?
No
45 to 90
90
Facing upward
When breaking an ampule, the nurse must cover the neck of the ampule with what? Why? What
direction should the nurse break the ampule to?
Either an alcohol swab or 2x2 gauze; prevents cuts or injuries; break away from the body or face
The injection site must be cleaned prior to medication administration using what technique?
No
Cloudy
Clear
How should you draw up regular and NPH insulin to mix in a syringe?
Regular first the NPH; clear to cloudy; inject air into NPH(cloudy) first and then remove needle
without drawing up medication; then inject needed air into regular (clear) and withdraw needed
medication; the draw up NPH(cloudy)
To give medications
Fluid replacement
Electrolytes
Nurtients
Long term use, products that cannot be administered through a peripheral line (supplied in
plastic bags and rarely in glass bottles)
Physicians order, Infuse 1000 ml 0.9% NS over 3 hours, what does it mean?
Large amounts of IV fluid is given in a short period of time, usually less than 1 hr (it's wide open)
What gauge would you use for a IV catheter to maintain a rapid rate?
Physicians order, 1000 mL 0.9% NS with 20 mEq KCL @ 75 mL/hr, what does it mean?
1000 mL 0.9% NS mixed with 20 mEq KCL @ 75 mL over 1 hour continuously, it will either come
premixed or will be mixed by pharmacist
Done with Antibiotics, given in small amounts of solution (25 mL to 250 mL), it's done through a
continuous IV system or Saline/Heparin lock
Concentrated or diluted
Should only be administered via IV pump for accurate dosage control (never done by Bolus)
What should you not do if there is a IV line infusing blood, blood products, or parenteral nutrition
solutions (TPN)?
When mixing medication through IV line, what should you look for?
When multiple medications are being infused through the same line, they must be compatible.
Never hang meds if you are not sure if they are compatible, NEVER
What should you avoid and what should you use when inserting a IV?
You need to avoid Touniquets and use a blood pressure cuff instead, do not slap to visualize
veins
What can you do to make the insertion of a IV easier for the nurse?
Hold the skin below the vein taut (stretched or pulled tight) to stabilize the vein, hold the client's
hand below the heart
Changing IV solution bag every 24 hours, never disconnect tubbing for convenience, and a IV
should be changed every 3 days
Standard precautions
Discontinue asap
Don't write on IV bags with marker. Ink may contaminate the solution
Wipe ports with alcohol before each use to prevent introduction of micro-organisms
The back of the hand or wrist and inner aspect of forearm (but painful)
A roller clamp on the IV tubing regulates the flow rate. If the clamp is completely closed, the flow
is occluded and stops completely
Replace IV bag before, because air collecting in the tubing is dangerous to the client as a blood
clot may form
What are some benefits for the nurse when educating the client and family regarding IV therapy ?
If they are taught how the infusion should operate, they can recognize signs of infiltration, empty
bags, pump alarms, etc. and can notify the nurse immediately
If a client has to leave the unit, what should the nurse do?
Make sure there is enough fluids in the bag until their return
Make sure they are plugged at all times and it's because they have a back up battery
Gloves should be worn anytime IV is touched, an IV site presents direct exposure to the client's
bloodstream. Gloves also decreases the nurses risk of infection
A trauma client just came rushing in, as a nurse what IV therapy system will you use and gauge
to insert it?
20 Gauge
What gauge should you use on older adults and children for IV insertion?
22 to 24 gauge
Clots form at the tip of the needle or catheter and can become lodged against the vein wall,
blocking the flow of fluid
Instruct the client not to manipulate flow rate, change settings on IV pump, or lie on the tubing
It's flushed with the appropriate solution after every medication administration or every 8 to 12
hours when not in use
Catheter size
Type of dressing
Clients response
05/31/18 0800 20 Gauge IV to right inner forearm X1 attempt. Applied tegraderm dressing. Site
without bruising or bleeding. Initiated 1/2 NS @ 100 mL/hr via infusion pump. Patient tolerated
well. Denies c/o pain to insertion site. C. Meche, RN
Pallor
Local swelling
Damp dressing
Slowed infusion
Elevate extremity
Apply warm or cold compress based on type of solution infiltrated the tissue
Check with provider to determine whether client still needs IV therapy. If so, restart infusion
"proximal to the Infiltration site or in another extremity"
What are the findings to a Extravastion complication (Infiltration of a vesicant or tissue damaging
medication) with IV?
Pain
Burning
Redness
Swelling
Follow facility protocol, which may include infusing an antidote through the catheter before
removal
Large fluid filled mass with redness at IV site or large opening on the skin with redness around it
at the IV site
Edema
Throbbing
Burning
Erythema
Slowed infusion
Apply cold compress to minimize flow of blood, then apply warm compress to increase
circulation
If drainage present, obtain specimen from the site and send culture to lab, if ordered
Pain
Warmth
Edema
Induration
Red streaking
Elevate extremity
If drainage present obtain specimen from site and send it and the catheter for culture, if ordered
Increased BP
Tachycardia
Shortness of breath
Crackles in lung
Edema
Raise HOB
Check VS
Monitor I&O
Positive pressure
What are some IV medications that require two nurses to double-check pump programming?
May be delivered by continuous infusion or in PCA mode (patient activates pump when needed),
limits are present, time intervals are present (lockout)
Insulin pump for diabetes, antiemetics for chemotherapy patients or for hyperemesis of
pregnancy
Teach patient and/or family what to watch for, if they know how the infusion should operate, they
can report signs of Infiltration, an emptying bag, pump alarm, or other concerns so problems can
be dealt with immediately.
Stop the infusion and report the situation immediately. The provider will determine if the infusion
should be discontinued, tissue damage may occur if Infiltration is allowed to continue
Check IV fluid (IVF) to make sure there is no cloudiness or sediment, because cloudiness could
be life threatening to the client
If clogged or stopped IV has caused a blood clot in the vein, the clot could be dislodged, which
would be life threatening
Why do you monitor IV site for redness or hardness that follows the vein?
It is important to ensure that all settings are correct and that the fluids is flowing properly, what
do you do to monitor for this?
The rate,of flow and amount and type of solution present are carefully monitored
This is reassuring to the client and any difficulty can be quickly corrected
Why do you have to use preprinted stickers or a piece of tape and not write on IV bags with
markers or pen?
Ink may penetrate the plastic bag and contaminated the IV fluid. The tip of a pen could also
pierce the bag
Why do you have to make sure to replace IV bags before they are totally empty?
It is hazardous for the client if air has collected in the tubing, venous blood may clot if the bag
runs dry, this can be dangerous
As the nurse, why should you carefully protect the infusion site during transport, ambulate, and
transfers, also remember the IV controller works on principle of gravity?
Tubing may trip patient, tubing may be dislodged from the bag, blood may flow up the tubing and
cause complications
Why should you prevent the IV site from getting wet or soiled?
By doing so this will reduce the possibility of infection, moisture is route of transmission for
pathogens
When a patient is leaving the unit , why should you make sure there is adequate solution to be
infused while gone, and why make sure the battery is charged on the IV pump?
This allows the client to receive infusions without interruption and the backup battery is important
in the event of a power failure
Why should you change the IV dressing per facility protocol and why should you use clear
dressing over the IV site?
Each time dressing is changed there is a chance of contamination or dislodging the catheter,
however, dressing must be changed at appropriate intervals, to allow staff to inspect the site and
prevent infection. Clear dressing provides opportunity to observe the site without removal of the
dressing
As the nurse you must change IV tubing per facility protocol, when this is done what is attached
to the new set and why?
A preprinted sticker is attached, dated, and initialed when tubbing is changed, this is done
because the label allows staff to know when tubing was last changed
Why should gloves be worn at all times when starting or discontinuing an IV, and when adding
medications?
Gloves are worn because an IV site presents direct exposure to the client's body fluids,
particularly blood. Gloves help protect the client from infection
It is important that the nurse focuses on less handling with the dressing and connections to the
bag or IV catheter why?
D5NS
D5W
D51/2NS
They are used to administer large amounts of fluids, including total parenteral nutrition (TPN) and
examples are, Central lines, Central Venous Access Devices (CVAD), Central Venous Catheters
(CVC)
• Fluids to be administered
• Patient's condition
Central lines have lower risk of IV infiltration because of their deep placement
What's a Hickman?
Refers to all standard tunneled central catheters, it May have 1, 2, or 3 lumens, Used for blood
draws and Used for administration of IV fluids
What's a broviac?
Refers to standard tunneled central catheters, it's Smaller than Hickman, Can't be used for blood
draws and is Used for administration of IV fluids
Because tunneled catheters can stay in for long periods of time and decrease the risk for
infection
inserted into the subclavian vein and threaded up into the superior vena cava.
Inserted into the antecubital space and is sufficiently long enough to be threaded up into the
superior vena cava or right atrium of the heart.
• Incompatible fluids can be infused because they are being delivered to different areas.
• Short venous catheters can also be tunneled under the skin to allow for longer-term use
Who puts in a central line, where, and what kind of technique is used?
The Doctor puts in a central line, it can be done at the bedside, and it is a sterile procedure
• Single lumen
• Length is determined by measuring the client's arm to the central location (12-16 inches or
more)
• Disadvantage - restricts use of client's arm and excessive arm movement can cause the
catheter's outward migration or irritation at the insertion site.
• Subcutaneously implanted port allows long-term, intermittent access to the central vein,
without the need for a catheter protruding from the skin.
• Port is palpated under the skin, then a special angled needle - Huber 90 degree non-coring
needle is inserted into the port
• Not specifically a central venous catheter, because it does not extend into the great central
veins.
• Inserted into the antecubital area and extends only to the larger blood vessels in the proximal
area of the arm.
• Can deliver greater volume than a peripheral vessel, but not as great as the central veins.
PICC line and midline look the same and are placed in the same area but the PICC line is much
longer, it goes from the middle of the arm to the heart, the midline just goes up to the shoulder
• Scrupulous site care is REQUIRED for any central line to prevent infection
• Close the clamp on any CVC whenever the end will be opened for any reason
to prevent embolism.
What's TPN?
• Volume is equal to routine maintenance IV, but additional components can be added making it
much thicker than IV solution.
• Contents:
• Amino acids
• Dextrose (10%-70%)
• Electrolytes
• Vitamins (sometimes)
its used to maintain adequate levels of nourishment for clients who are unable to receive
adequate levels of nutrients by mouth
• Must be given in a large blood vessel - such as the subclavian vein, internal jugular vein in the
neck, or the superior vena cava
• Rationale: TPN is concentrated and could cause irritation, clots, or swelling if administered into
a smaller vessel. The larger vessel provides sufficient
When administering TPN you must do what before hanging it and you have to keep it at what
temp.
You have to get another nurse to check it before handing it and it must be kept at room
temperature for 30 to 60 min before hanging because it's kept in a fridge, you do this because
cold meds are uncomfortable through IV and can cause shock
You must have a 1.2 micron filter and (be sure to get all air out- (life threatening)
infused (60 gtts PER 1 mL)- used when infusion must be carefully
answers.
• A SLOWER RATE IS USUALLY NECESSARY FOR OLDER ADULTS AND SMALL CHILDREN,
CLIENTS WITH KIDNEY OR HEART DISEASE, AND CLIENTS WITH HEAD INJURIES.
INTRACRANIAL PRESSURE.
• SOMETIMES A FASTER INFUSION RATE IS OFTEN DESIRABLE FOR PERSONS WHO HAVE
To properly administer and IV infusion, you must know the flow rate
• Rationale – Metabolic and fluid balance changes can occur quickly. It is important not to raise
blood sugar to a dangerous level, and to make sure the client is not retaining too much fluid, and
is voiding in appropriate amounts. MONITOR I&O
Monitor vital signs at least every 4 hours. • Rationale – early detection of infection
Give the following temperature equivalent as indicated: Round answer to nearest tenth
°F = °C × 1.8 + 32 °C = °F - 32 = / 1.8
53. 44.6
55. 98.6
58. 8 63. 10
56. Order: Codeine 50 mg po every 4 hr prn pain Supply: Codeine 100 mg tablets
59. Order: Levothyroxine 500 mcg po bid Supply: Levothyroxine 0.5 mg tablets
62. Order: Robinal 250 mcg IM every 6 hrs Supply: Robinal 0.5 mg/1mL
Give: ______________ mL
Give: ______________ mL
64. Order: Morphine Sulfate 12.5 mg IM every 4 hours as needed Supply: Morphine Sulfate 25
mg/mL Give: _________________mL