The nurse is administering medications to a client who has severe liver damage. Which medications, as ordered below, will avoid the first pass effect? (SELECT ALL THAT APPLY)

Acetaminophen 500 mg PO q4h PRN headache

Dulcolax suppository one per rectum PRN

Aspirin 10 mg PO crush and put in apple sauce

Fentanyl 25 mcg/h via transdermal patch daily

Morphine 0:4 mg IV q4h PRN severe pain

Answer and Explanation

Correct Answer : B,D,E

Choice A rationale: Acetaminophen 500 mg PO is subject to the first pass effect as it is absorbed through the gastrointestinal system.

Choice B rationale: Dulcolax suppository is not subject to the first pass effect as it is administered rectally.

Choice C rationale: Aspirin 10 mg PO is subject to the first pass effect as it is absorbed through the gastrointestinal system.

Choice D rationale: Fentanyl 25 mcg/h via transdermal patch avoids the first pass effect as it is absorbed through the skin.

Choice E rationale: Morphine 0.4 mg IV avoids the first pass effect as it is administered intravenously.

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Correct Answer is B

Explanation

Choice A rationale: Using a small gauge needle may reduce pain but does not specifically address tissue irritation.

Choice B rationale: The Z-track method is used to reduce irritation and prevent leakage of irritating medications into the subcutaneous tissues.

Choice C rationale: Administering at a 45-degree angle is a common angle for intramuscular injections but does not specifically address tissue irritation.

Choice D rationale: Applying ice to the injection site is not a standard practice for reducing tissue irritation with intramuscular injections.

A. Injecting one mL of air into a vial before withdrawing 20 mg furosemide from a vial labeled 20 mg/mL B. Instructing a client to place a buccal medication under the client's tongue and allowing it to absorb. C. Pouring the ordered medication "Robitussin 2 tsp. now to the 10 ml mark on a medication cup. D. Selecting a 1 ml syringe with a 5/8 inch needle to be used for giving 0.5 mL of heparin subcutaneously.

Correct Answer is B

Explanation

Choice A rationale: Injecting one mL of air into a vial before withdrawing 20 mg furosemide is an appropriate technique to equalize pressure in the vial.

Choice B rationale: Instructing a client to place a buccal medication under the client's tongue this is a method for administering sublingual medications. Buccal medications are placed between the cheek and the gum and allowed to dissolve slowly.

Choice C rationale: Pouring liquid medication to the 10 ml mark on a medication cup is acceptable, as long as the cup is held at eye level and the lowest point of the meniscus is used to measure the volume.

Choice D rationale: Selecting a 1 ml syringe with a 5/8 inch needle is suitable for giving heparin subcutaneously, as this ensures accuracy and minimizes tissue trauma.

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The nurse is administering medications to a client who has severe liver damage. Which medications, as ordered below, will avoid the first pass effect? (SELECT ALL THAT APPLY)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse must give a client an intramuscular injection of a medication which is very irritating to the subcutaneous tissues. To attempt to reduce irritation of the tissues, which action should the nurse take?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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