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Nurses are expected to safely apply topical medications such as creams, lotions, powders, and ointments, which are absorbed through the skin. Proper technique includes wearing gloves to prevent unintentional absorption and cross-contamination. The nurse should gently smooth these medications over the skin, ensuring even distribution and therapeutic effectiveness while minimizing skin irritation or damage.

Rationale for correct answer:

Creams

Gently Smooth Over the Skin When Applying: Creams are semi-solid emulsions that are applied directly to the skin for localized effect; they require gentle spreading to ensure proper coverage and absorption.

Can Be Removed by Water: Most creams are water-based and can be rinsed off easily with soap and water.

Necessary to Use Gloves: Gloves prevent absorption through the nurse’s skin and reduce the risk of cross-contamination.

Lotions

Shake Container First: Lotions often separate upon standing; shaking ensures the active ingredients are evenly distributed.

Gently Smooth Over the Skin When Applying: Lotions are thinner than creams and are applied to large or hairy areas; gentle application ensures even absorption.

Can Be Removed by Water: Being primarily water-based, lotions wash off easily.

Necessary to Use Gloves: Wearing gloves protects the nurse from unintended exposure to medicated substances.

Powders

Necessary to Use Gloves: Powders can aerosolize and be unintentionally inhaled or absorbed through the skin, so gloves are important for nurse safety. They are typically dusted, not rubbed into the skin.

Ointments

Gently Smooth Over the Skin When Applying: Ointments are thick and greasy, requiring smoothing to stay in place and deliver medication effectively over time.

Necessary to Use Gloves: Gloves prevent greasy residue and protect the nurse from systemic absorption of the medication.

Take-home points:

• Always wear gloves when applying topical medications like creams, lotions, ointments, and powders to prevent nurse exposure and cross-contamination.
• Shake lotions before application to ensure proper distribution of active ingredients, as separation can occur.
• Creams and lotions can be removed with water, while ointments are thicker and adhere longer, requiring thorough smoothing during application.

A patch test for allergens is used to identify substances that may cause delayed allergic reactions in a client. The procedure includes asking about recent antihistamine or anti-inflammatory use, preparing the skin with alcohol, and applying designated allergen patches. It is crucial to have emergency equipment available in case of a severe reaction and to monitor the skin for the formation of a wheal, which indicates a positive response to an allergen.

Rationale for correct answer:

5. Ask the client if they have taken any antihistamines or anti-inflammatory agents
Antihistamines or corticosteroids can suppress allergic reactions and may cause false-negative results. It’s critical to verify that the client hasn’t taken such medications before testing.

1. Have emergency equipment available in case of an anaphylactic response
Even though patch tests are usually low risk, systemic allergic reactions are possible. Emergency equipment (e.g., epinephrine, oxygen) must be nearby to ensure client safety.

4. Cleanse the area for testing with alcohol
Cleansing removes oils, dirt, or lotions that may interfere with absorption of the allergen or patch adhesion. A clean surface ensures accurate test results.

2. Apply the designated patches to the skin
Once the area is prepped, the patches containing the suspected allergens are applied to the back or arm. They must be secured properly and left in place for the recommended time.

3. Recognize when a wheal has formed
After 48–72 hours, the nurse checks the site for a wheal, redness, or swelling. The formation of a wheal indicates a localized allergic reaction and helps identify specific allergens.

Take-home points:

• Verify that the client has not taken antihistamines or corticosteroids before performing a patch test to prevent false-negative results.
• Always have emergency equipment available when conducting allergy testing in case of an anaphylactic reaction.
• Monitor for a wheal or localized skin response after applying patches to identify a positive allergic reaction.

When administering medications via the enteral routes the nurse uses the gastrointestinal or oral route, and the nurse may have to crush the tablets or caplets dosage forms for easier delivery.

When administering medications via enteral routes, the nurse may need to crush tablets or caplets to ensure safe and effective delivery, especially through feeding tubes. However, it is essential to verify whether the medication is safe to crush, as some forms—such as enteric-coated or extended-release tablets—should never be altered due to the risk of dose dumping or reduced efficacy.

Rationale for correct answer:

Options for 1 – Route:

Gastrointestinal and oral are appropriate enteral routes. The term enteral specifically refers to medication administration involving the gastrointestinal (GI) tract, which includes the oral, gastric, and rectal routes.

Intravenous is a parenteral route, not enteral.

Rectal is enteral but less commonly used for general medication administration than oral.

Therefore, gastrointestinal and oral are the most broadly correct and inclusive for enteral routes.

Options for 2 – Dosage forms:

Tablets and caplets can usually be crushed (unless they are extended-release or enteric-coated), which is common practice for clients with feeding tubes or swallowing difficulties.

Timed-release capsules should not be crushed because doing so destroys the extended-release mechanism, potentially causing overdose.

Lozenges are meant to dissolve slowly in the mouth and are not suitable for crushing or enteral tube administration.

Take-home points:

• Enteral routes include the gastrointestinal and oral pathways, which are commonly used for administering medications through the GI tract.
• Tablets and caplets may be crushed for easier delivery, especially when using feeding tubes, but only if they are not extended- or enteric-coated.
• Timed-release capsules and lozenges should not be crushed, as this can alter drug absorption, reduce effectiveness, or increase the risk of adverse effects.

In medication administration, nurses must be familiar with different systems used to store and dispense medications, including the unit-dose system and the computer-controlled system. The unit-dose system provides individually packaged doses for each patient, promoting accuracy and minimizing waste. In contrast, the computer-controlled system uses automated dispensing cabinets with security access codes and barcode scanning to track medications, ensure patient safety, and maintain detailed administration records.

Rationale for correct answer:

Compares the label with the client profile – X (Both)
This is a universal safety step followed in both systems to verify the medication matches the prescription and patient details.

Uses bar code scanner – X (Computer-Controlled System only)
Computer-controlled dispensing units (like Pyxis or Omnicell) often use barcode scanning to verify the "Five Rights" and link administration data to the electronic health record.

Checks expiration date on label – X (Both)
Nurses are required to check expiration dates before giving any medication, regardless of the system used, to ensure safety.

Uses security access code – X (Computer-Controlled System only)
These systems are computerized and require a login or biometric scan to access medications, enhancing accountability and reducing diversion.

Obtains medications from cart with drawer assigned to client – X (Unit-Dose System only)
Unit-dose carts have individual drawers per client, prefilled with a 24-hour supply of medications. This design simplifies administration and reduces error risk.

Take-home points:

• Both unit-dose and computer-controlled systems require label verification and expiration date checks before medication administration.
• Computer-controlled systems enhance safety through security access codes and barcode scanning to match the right medication to the right patient.
• The unit-dose system uses client-specific drawers with prepackaged doses to minimize medication errors and improve efficiency.

When preparing to administer guaifenesin syrup to a 5-year-old, the nurse must follow specific steps to ensure accurate dosing and child safety. This includes reviewing the medication order, verifying the dose and concentration, and measuring the liquid accurately at eye level using a medicine cup. The nurse should protect the medication label, use two identifiers to confirm the child's identity, and document administration promptly.

Rationale for correct answer:

Review the order for the number of milligrams of medicine or the volume the liquid to be administered.
Understanding the exact dose prescribed is the starting point for safe administration. It ensures the correct drug and dose is given, especially important in pediatrics where dosing is often weight-based.

Check the expiration date on the medicine.
Verifying the expiration date ensures the medication is still effective and safe for administration. Giving expired medication can reduce therapeutic efficacy or introduce risk.

Review the label to assure correct medicine and appropriate concentration of the liquid (e.g., number of mg per mL) and calculate the volume to be poured into the cup.
This step ensures the right drug and dose are being prepared. Pediatric medications often come in different concentrations, so careful review is essential.

Hold the bottle containing the liquid so the label is covered with the palm of the hand.
Covering the label prevents dripping liquid from smudging or damaging it. This maintains legibility and allows continued verification in future uses.

Pour the correct volume of liquid in a medicine cup reading the meniscus at eye level.
Measuring at eye level ensures dosing accuracy. The lowest curve of the liquid (meniscus) must align with the dosage mark to avoid under- or overdosing.

Identify the client through two identifiers and hand the medication to the client for ingestion.
Confirming the client's identity using two identifiers (e.g., name and birthdate) ensures the medication is given to the correct person, a key part of the "Right Patient" principle.

Document the administration of the medicine in the client’s chart.
Timely documentation verifies the medication was given and provides a legal record. It also supports communication among the healthcare team and prevents duplicate dosing.

Take-home points:

• Always verify the medication order, check the expiration date, and calculate the dose based on concentration before preparing any pediatric medication.
• Use proper technique when pouring liquid medications, including covering the label and measuring at eye level for accuracy.
• Confirm the client's identity using two identifiers before administration, and document promptly to ensure safe and complete care.

When preparing to administer a rectal suppository, the nurse must follow both correct technique and use appropriate equipment to ensure safe and effective medication delivery. This includes using clean gloves, applying a water-soluble lubricant, and gently inserting the suppository past the internal anal sphincter while the client is positioned on their left side.

Rationale for correct answer:

Correct Technique

Gently insert suppository past the internal sphincter
Inserting the suppository beyond the internal sphincter ensures that the medication stays in place and is not expelled immediately. This allows for optimal absorption in the rectal mucosa.

Position the client on their left side
The left lateral (Sims') position takes advantage of the natural anatomy of the rectum and colon, making insertion easier and more comfortable for the client, and aiding the suppository in remaining in place.

Ask the client to remain on their side for 20 minutes
Staying in this position helps prevent the suppository from being expelled prematurely. It also allows the medication time to dissolve and begin absorption through the rectal wall.

Explain the procedure and educate the client on the drug being administered
Providing education reduces anxiety, ensures informed consent, and promotes client cooperation during the procedure, all of which contribute to safe and effective administration.

Correct Equipment:

Obtain a water-soluble lubricant
Lubrication is necessary to reduce friction and prevent trauma or discomfort during insertion. Water-soluble lubricants are preferred because they are easily absorbed and safe for mucosal tissues.

Remove suppository from unit-dose wrapper
Suppositories are typically packaged in a protective wrapper. Removing the wrapper is essential to prepare the medication for use and to avoid inserting packaging material.

Obtain clean gloves
Gloves provide a barrier that protects both the nurse and the client from transmission of microorganisms. Clean gloves are part of standard precautions for any procedure involving mucous membranes.

Take-home points:

• Position the client in the left lateral (Sims’) position to facilitate smooth insertion and reduce discomfort during rectal suppository administration.
• Always use clean gloves and water-soluble lubricant to maintain aseptic technique and minimize tissue trauma.
• Insert the suppository past the internal sphincter and instruct the client to remain on their side for 20 minutes to ensure optimal retention and absorption of the medication.