You have been assigned to be the medication nurse in a long-term care facility to a group of 20
residents, of which 7 are there for short-term rehabilitation after total hip replacement. It is the
first time you have worked with this group and therefore are unfamiliar with their medication
routines and preferences.
1. The 1900–0730 shift nurse has completed his report and asks you if there
are any questions. What information regarding the residents themselves would be
beneficial for you to know in order to organize the administration of medications for the
shift?
2. The distribution system for this facility is a combination of stock supply and unit dose.
Why would these two systems be most appropriate for a long-term care facility?
The Medication Administration Record (MAR) for one of your assigned residents, Mrs. Lowery, is
provided for you to use for your shift 0700–1930.
3. For medications you are unfamiliar with, what resources could you use to learn about these
medications prior to administration? Which one is the best source of nursing implications?
4. The MAR reflects the “standard” administration times used in the facility when transcribing
the medication orders. Based on an understanding of pharmacodynamics and medication
interactions for the oral medications, which administration times are not appropriate?
Explain.
5. For each of the medications listed on the MAR:
a. What equipment will you need to prepare and administer the medications?
b. What key physical assessments and/or lab data are needed prior to administering
these medications?
Medication
Nitro-Dur patch
NovoLog
Cardizem
Caltrate
Coumadin
Route
Equipment
Assessment/Lab
Lyrica
Combivent
Cyanocobalamin
6. A patient you are caring for on the unit is scheduled for 0900 dose of Novolog but they have
been NPO since midnight for a esophagogastroduodenoscopy procedure scheduled at 1100.
Which actions would you take and how would you utilize the SBAR report to address the
primary care provider to address the issue?
SITUATION:
BACKGROUND:
ASSESSMENT:
RECOMMENDATION:
7. Describe the “Rights of Medication” and the “Three Checks.” How do these facilitate a culture of
safety in medication administration?
Drug:
Patient:
Dose:
Route:
Time:
Documentation:
Reason:
To Know:
To Refuse:
8. Mrs. Lowery tells you, “I am not taking all those nine o’clock pills. I can’t swallow them— they get
stuck in my throat.”
a. What information do you need about the ordered medications to address this problem?
b. What alternatives are available to help with this swallowing issue?
c. How would you administer the medications to Mrs. Lowery?
9. The medication Lyrica is not available in the resident’s routine medication drawer. What could be
the cause of this problem and how will you obtain the medication when needed?
10. You go to place the Nitro-Dur patch on Mrs. Lowery and note that the patch from yesterday is
still applied to her chest. The MAR indicates that it was removed the previous evening as ordered.
What should be your first action? How will you address this occurrence?
11. Mrs. Lowery prefers to insert her own eye drops. As you observe her doing so, what key aspects
of the administration procedure should she be doing to ensure correct technique?
12. Mrs. Lowery refuses the extender or spacer for her Combivent inhaler, telling you, “It’s too
much trouble.” How would you explain the benefits of its use to her?
13. The cyanocobalamin solution is provided in a vial with a concentration of 4 mg/2 mL.
Ordered dose: 2 mg
a. Calculate the correct volume for the ordered dose.
b. What type of syringe and needle gauge will you use for administration? Are there others
that can also be used for this? Explain.
c. Where will you administer this injection? Give a rationale for your choice.
d. How can you minimize the discomfort of the injection for Mrs. Lowery?
14. Mrs. Lowery tells you, “I always have an allergic reaction to this drug. I get diarrhea for a few
days each month after I get it.” What information do you need and how would you address this
concern?