A client is prescribed propranolol a systemically acting ophthalmic drop. What additional step must be included in the administration process?

Touch the tip of the bottle to the lacrimal duct

Apply pressure to inner canthus for 2 minutes

Have client e down or tilt the back of their head

Have client pull down their lower eye lid

Answer and Explanation

The Correct Answer is B

A) Touch the tip of the bottle to the lacrimal duct: Touching the tip of the bottle to the lacrimal duct is not a recommended practice when administering eye drops. This could introduce bacteria into the eye or nose, leading to potential infection. The goal is to administer the drops without contamination, and the tip of the bottle should never touch the eye or any part of the face.

B) Apply pressure to inner canthus for 2 minutes: Applying pressure to the inner canthus (the corner of the eye near the nose) for about 2 minutes after administering ophthalmic drops is a key step when using systemically acting eye medications like propranolol. This helps to prevent the systemic absorption of the medication through the nasolacrimal duct, reducing the risk of systemic side effects such as bradycardia or hypotension. This step ensures that the medication stays localized in the eye.

C) Have client lie down or tilt the back of their head: While lying down or tilting the head back may help the client instil the drops more comfortably, it is not a required step for the proper absorption or effectiveness of eye drops. The key to effective administration lies in positioning the drop in the correct part of the eye and minimizing systemic absorption, which is achieved by applying pressure to the inner canthus, not necessarily by tilting the head.

D) Have client pull down their lower eyelid: Pulling down the lower eyelid is a standard step in administering eye drops, as it creates a small pocket to hold the drop. However, it does not specifically address the concern for reducing systemic absorption of a medication like propranolol. The primary step for preventing systemic effects is applying pressure to the inner canthus after administration, making this less relevant for this specific question.

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Correct Answer is A

Explanation

To determine if the client's dose is safe and therapeutic, we need to calculate the appropriate dosing range based on the client's weight and compare it with the ordered dose.

Client's weight: 45 kg

Ordered dose: 500 mg every 8 hours, which equals 1500 mg/day (500 mg × 3 doses).

Calculate the therapeutic range:

The dosing range in the Davis Drug Guide is 20 to 40 mg/kg/day. So, for this client, based on their weight of 45 kg:

Minimum dose: 20 mg × 45 kg = 900 mg/day

Maximum dose: 40 mg × 45 kg = 1800 mg/day

The ordered dose of 1500 mg/day falls within this range (900 mg/day to 1800 mg/day), which means it is safe and therapeutic for the client.

A. Prepare and administer the prescribed antidote. B. Notify the charge nurse, the nurse manager, and the prescriber. C. Assess the identify the presence of urgent safety issues D. Complete an incident report detailing the error

Correct Answer is C

Explanation

A) Prepare and administer the prescribed antidote: Administering an antidote would only be appropriate if the medication error resulted in a harmful reaction that requires immediate reversal. Since the issue here is the timing of medication administration, it is more important to first assess the client for any immediate effects rather than administering an antidote, which might not be necessary at this stage.

B) Notify the charge nurse, the nurse manager, and the prescriber: While notifying the appropriate staff is crucial, the first action should be assessing the client for any safety concerns or complications resulting from the medication administration error. Immediate evaluation of the client's condition should take precedence over notification.

C) Assess and identify the presence of urgent safety issues: The first priority in this situation is to assess the client for any adverse effects or reactions due to the medication being administered too quickly. This could include monitoring for signs of toxicity, adverse reactions, or changes in vital signs that may indicate a potential risk to the client’s health. Once the client's status is assessed, further actions such as notifying other staff or completing an incident report can follow.

D) Complete an incident report detailing the error: While documenting the error in an incident report is necessary, this should not be the first step. The immediate priority is to ensure the client’s safety by assessing their condition, as an error in the timing of medication administration may result in unwanted side effects or complications that need to be addressed first.

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Laboratory Test	Result	Normal Range
Sodium	146 mEq/dL	135-145 mEq/L
Calcium	8.2 mg/dL	8.4-10.2 mg/dL
Magnesium	1.2 mg/dL	1.6-2.2 mg/dL
Gastric pH	6	1-4

A client is prescribed propranolol a systemically acting ophthalmic drop. What additional step must be included in the administration process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who weighs 45kg is ordered to receive 500 mg of amoxicillin every eight hours. The dosing range noted in the Davis Drug Guide is 20 to 40 mg/kg/day divided and to be given every 8 hours. True or False: the client's dose is safe and therapeutic?

Correct Answer is A

Explanation

A nurse recognizes they administered a medication over one hour when the order dictated the medication be given over 90 minutes. Which should be the first action performed by the nurse?

Correct Answer is C

Explanation

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