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The nurse is teaching the client how to use an MDI with a spacer device. Which statement, if made by the client, indicates further teaching is required?

"I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator."

"I should remove the mouthpiece cover from the inhaler and spacer, insert the MDI into the end of the spacer, and shake the inhaler well for 2 to 5 seconds."

"I should rinse my mouth with warm water, then spit the water out after each use of the MDI."

"I should close my mouth around the mouthpiece of the spacer, depress the medication canister and breathe in slowly and fully for 5 seconds, then hold my breath for approximately 10 seconds."

Answer and Explanation

The Correct Answer is A

A. "I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator."

Explanation:

Inhaled bronchodilators (such as albuterol) should be administered before inhaled steroids (such as fluticasone). This is because bronchodilators help open up the airways, allowing better delivery of the steroid medication to the lungs.
Steroids should not be given first because they are not effective in immediately opening the airways, which can reduce the effectiveness of the steroid if given before a bronchodilator.

Here’s a breakdown of the other options, which are correct:

B: Correct. The proper technique is to remove the mouthpiece cover, shake the inhaler well (2 to 5 seconds), and then insert the inhaler into the spacer.
C: Correct. Rinsing the mouth with warm water and spitting it out after using an inhaled steroid is important to prevent oral thrush (a fungal infection).
D: Correct. The proper technique involves closing the mouth around the spacer mouthpiece, pressing the MDI to release the medication, inhaling slowly and deeply for about 5 seconds, and holding the breath for about 10 seconds to allow for better absorption.

Thus, A is the statement that requires further teaching because the client has the incorrect sequence of medication administration (steroid first, bronchodilator second).

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Correct Answer is C

Explanation

A) Application of a transdermal patch: The application of transdermal patches is typically within the scope of licensed nursing personnel due to the need for appropriate placement, potential absorption risks, and proper documentation. This task requires understanding of the medication's effects, which is outside the scope of a UAP’s duties.

B) Use of MDIs: Metered-dose inhalers (MDIs) involve medication administration, which requires client assessment, monitoring of technique, and evaluation of response to therapy. These are skills that a UAP is not trained to handle, as they fall within a licensed nurse's responsibilities.

C) Application of a skin barrier cream to the perineal area: UAPs can apply non-medicated skin barrier creams to protect the skin in the perineal area, as it is a basic care activity. This task does not require specialized training in medication administration and is within the typical role of a UAP for maintaining skin integrity.

D) Instillation of eye drops: Administering eye drops involves medication administration, which includes proper technique, dosing, and monitoring for side effects, making it a task for licensed nursing personnel rather than a UAP.

E) Inserting rectal medications: Rectal medication insertion is a more advanced procedure that requires medication administration knowledge, correct positioning, and monitoring, which are responsibilities designated for licensed nursing staff, not a UAP.

F) Instillation of ear drops: Administering ear drops requires an understanding of dosing, technique, and monitoring for adverse effects, all of which are beyond the scope of practice for UAPs and are typically carried out by licensed nursing staff.

G) Inserting vaginal medications: Vaginal medication administration requires understanding of proper technique and monitoring for therapeutic effects or side effects, which necessitates a licensed nurse’s assessment skills and should not be delegated to a UAP.

A. apply it behind the ear. B. place it over a hairy skin area. C. rotate sites to avoid skin irritation. D. put the initials on patch when applied.

Correct Answer is C

Explanation

A) Apply it behind the ear: This option is not correct. Nitroglycerin patches are typically applied to hairless areas of the skin to ensure proper adhesion and absorption. The preferred locations are usually the chest, upper arm, or thigh.

B) Place it over a hairy skin area: This action is inappropriate as hair can interfere with the adhesion of the patch and may affect absorption. It is essential to apply the patch to a clean, dry, and hairless area for optimal effectiveness.

C) Rotate sites to avoid skin irritation: This is the correct action. Rotating the application site helps prevent skin irritation and allows for better absorption of the medication. It also reduces the risk of sensitization or reaction at any one site.

D) Put the initials on the patch when applied: While documenting the application is important, simply putting initials on the patch is not sufficient for ensuring proper administration. It is more crucial to ensure that the patch is applied correctly, and monitoring for skin integrity and effectiveness should be part of the nursing care plan.

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The nurse is teaching the client how to use an MDI with a spacer device. Which statement, if made by the client, indicates further teaching is required?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which medication administration activity can be delegated to a UAP?

Correct Answer is C

Explanation

A client has an order for a nitroglycerin transdermal patch. The best way to ensure proper administration of this medication is to:

Correct Answer is C

Explanation

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