Chapter 3: Patient Safety in Medication Administration

Question 1

Anaphylaxis

Answer 1

hypersensitivity reaction between an allergenic antigen and immunoglobulin E bound to mast cells; stimulates the sudden release of immunologic mediators locally or throughout the body

Question 2

Antihypertensive

Answer 2

drug used to treat hypertension

Question 3

Geriatric

Answer 3

branch of health care concerned with care of the aged

Question 4

HIPAA

Answer 4

Health Insurance Portability and Accountability Act

Question 5

Lavage

Answer 5

irrigation of a cavity

Question 6

Pediatric

Answer 6

concerning the treatment of children

Question 7

Polypharmacy

Answer 7

concurrent use of a large number of drugs, a condition that increases the likelihood of unwanted side effects and adverse drug-drug interactions

Question 8

Seven Rights of Medication Administration

Answer 8

Right patient.
Right drug.
Right dose.
Right time.
Right route.
Right technique.
Right documentation.

Question 9

Teratogen

Answer 9

substance that impairs normal fetal development

Question 10

Teratogenic

Answer 10

literally, creating a monster; anything that adversely affects normal cellular development in the embryo or fetus

Question 11

Thrombolytic

Answer 11

substance that breaks apart clots

Question 12

Urticaria

Answer 12

multiple swollen raised areas on the skin that are intensely itchy and last up to 24 hours

Question 13

You enter the reception area of a medical office to look for the patient whose name is on the medication container. How can you be certain of giving the medication to the right patient? Because patients are sometimes confused or hard of hearing, how can you be certain that the patient who responds is the right one?

Answer 13

Instead of saying “Mrs. Watkins” or any other name, ask to have her photo in her patient file, so you can identify her in the waiting room. You could also ask to see her identification before administering medications. You could ask her to tell you her name, but if she is confused, other methods may be optimal.

Question 14

What kinds of drugs are usually prescribed to be given at equal intervals throughout the day? Explain why these drugs must be given at exact intervals. What might happen if doses are missed?

Answer 14

Antibiotics, seizure medications, and drugs that must not have a dip in levels will be administered in even intervals throughout the day. If not given at the correct time, microbes might rally, seizures might occur, and so on.

Question 15

Rachael has been told to be NPO after midnight before an x-ray series of her bowels. She calls to see whether she should take her morning dose of insulin. An office assistant says that she should take it, because insulin is not given by mouth. If you had taken her call, what would you have said or done? .

Answer 15

Insulin is not given if food is not given. Insulin’s role is to push glucose molecules into the cells. Giving insulin without food will lower blood
sugar dramatically.

Question 16

Imagine that you gave Cecile Masse 1 mL of a flu shot in the left deltoid muscle. You took the vaccine from a container that said lot no. 1234567, which expires on 12/01/12. How would you document this procedure?

Answer 16

Given 1 mL of influenza vaccine IM in L deltoid. Lot #1234567. Expiration 12/01/12. Pt was observed for 15 minutes after injection and tolerated procedure well. ______________ Signature (Answers may vary).

Question 17

While entering a crowded reception room, a medical assistant calls back to a colleague that she has to tell a patient the results of her test for a sexually transmitted disease. Immediately afterward, the medical assistant calls the patient’s name aloud.
Is this appropriate? How could she have better handled patient confidentiality?

Answer 17

She should have called the patient back to a private area to discuss drug therapy. The patient is certainly entitled to her privacy. Confidentiality
must be maintained.

Question 18

Seth comes to the office with a wound that does not seem to be healing. As he is leaving, he states, “I am going to see my herbalist. Your drugs can’t help me!” What would you do or say?

Answer 18

You must encourage your patient to be open with the physician about use of herbal products, which can interact with some medications. After creating an environment in which Seth is comfortable to talk, notify your physician to discuss this issue with Seth..

Question 19

How do pediatric patients differ from adult patients, regarding the following?

Answer 19

• Amount of dosage—Usually less.
• Site of administration—Use thigh instead of arm.
• Length of needle for parenteral administration—
Usually shorter.
• Fat/muscle body composition—Infants usually have more fat and less muscle.
• Metabolism of medication—Infants have higher metabolism.
• Blood vessel fragility—Infants’ vessels are much more fragile.
• Blood volume—Infants have less blood, and even a small loss of blood can hurt them.
• Cooperativeness with therapy—Usually infants are more portable but less cooperative.

Question 20

If an obstetric patient calls and asks what over-the- counter (OTC) drugs she can take for a cold, where would you find that information?

Answer 20

Even an OTC medication can cross the blood– placental barrier and potentially harm the fetus. She needs to consult the physician, who should know if a substance is teratogenic (dangerous to the fetus)

Question 21

How does liver disease affect the accumulation of drugs in the body?

Answer 21

The liver metabolizes the drug and prepares it for excretion. Decreased liver function can therefore increase accumulation.

Question 22

In patients more than 55 years old, decreased absorption occurs because of diminished gastrointestinal function and congestion of abdominal blood vessels.

Answer 22

True; patients older than 55 years have decreased absorption due to diminished gastric function and congestion of abdominal blood vessels.

Question 23

If a patient is NPO, he or she takes the medication only as needed.

Answer 23

False; NPO means the patient takes nothing by mouth.

Question 24

Drugs that are given a.d. are given in the right eye.

Answer 24

False; AD is the abbreviation for right ear

Question 25

There are five rights to medication administration.

Answer 25

False; there are seven rights of medication

administration.

Question 26

You should compare the order with the bottle at least three times.

Answer 26

True; check the label before you take the bottle from the shelf, before you pour the drug out, and before you put the bottle back on the shelf.

Question 27

In case of anaphylaxis, administer syrup of ipecac.

Answer 27

False; anaphylaxis is a severe allergic reaction and requires a drug such as epinephrine (EpiPen). The physician should be notified, call 911, administer CPR. Follow office protocol.

Question 28

Patients have the right to refuse treatment.

Answer 28

True; patients have the right to refuse treatment, including medications.

Question 29

HIPAA refers to standards holding health professionals accountable to protect the privacy
of patients.

Answer 29

True; the Health Insurance Portability and Accountability Act (HIPAA) holds allied health professionals accountable to the government to protect the privacy of the patient

Question 30

Patients should be discouraged from discussing their prescriptions with the physician.

Answer 30

False; patients should be encouraged to discuss their medications with their physician to avoid any misunderstandings.

Question 31

Lavage refers to the use of a large tube place through a patient’s nose to the stomach to remove remnants of poisons.

Answer 31

True; lavage is more commonly passed through the mouth, because of the large tube used to flush the stomach with sterile saline to remove any remaining poison or pill fragments.

Question 32

Which of the following is a sign of anaphylaxis?
A. Hallucinations 
B. Bleeding nose 
C. Fixed pupils
D. Wheezing

Answer 32

D. Signs of anaphylaxis include difficulty breath- ing, itching, wheezing, anxiety, and light- headedness.

Question 33

Which abbreviation means “before meals”?
A. a.c. 
B. a.d. 
C. a.m.
D. a.s. 
E. a.u.

Answer 33

A. The abbreviation a.c. means before meals.

Question 34

In an examination room in a medical office, which of the following is the best way to identify a patient? A. Check the patient’s wrist identification band. B. Call the patient by name.
C. Ask the patient his or her name. D. Compare the photograph in the patient’s chart with the patient.
E. Ask one of your coworkers who the patient is.

Answer 34

C. Ask the patient to identify himself by name, birthdate, and/or Social Security number.

Question 35

What does teratogenic refer to?
A. Causing birth defects in the unborn fetus B. Endangering the health of the mother C. Endangering the elderly
D. None of the above

Answer 35

A. Teratogenic refers to causing birth defects in the unborn fetus.

Question 36

Which of the following is NOT one of the seven rights of medication administration?
A. Right patient B. Right route C. Right time
D. Right place E. Right documentation

Answer 36

D. The seven rights of medication administration are the right patient, right drug, right dose, right time, right route, right technique, and right documentation.

Question 37

Why should you have a patient remain seated in the examination room for 15 minutes after receiving an injection, antibiotic, or allergy shot? A. This gives you time to chart and clean up. B. The purpose is to watch for allergic reaction symptoms.
C. Your next patient does not need to be seen for at least 15 minutes. D. The patient does not have to wait and can leave immediately.

Answer 37

B. Patients remain seated for 15 minutes to watch for allergic reaction symptoms.

Question 38

7. If a patient presents in your office and states that he has ingested a poisonous substance, what should you monitor while awaiting arrival of the emergency medical service? A. Changes in vital signs (heart rate, blood pressure, respiratory rate, temperature) B. Seizures
   C. Level of consciousness D. All of the above

Answer 38

D. While waiting for EMS you should monitor for changes in vital signs, seizures, and level of consciousness.

Question 39

What are some of the possible instructions that poison control may give you for the patient who has overdosed or ingested poison? A. Administer activated charcoal. B. Have the patient drink large amounts of water to dilute the poison or medication.
C. Have the patient drink milk to decrease the acidity of the poison. D. Any of the above

Answer 39

D. Poison control may ask you to administer activated charcoal, have the patient drink large amounts of water to dilute medication, or have the patient drink milk to decrease the acidity of the poison.

Question 40

Which of the following means to administer three times a day?
A. bid B. tid C. qid
D. None of the above

Answer 40

B. The abbreviation tid means three times a day

Question 41

Documenting items correctly would include documenting which of the following?
A. Medication B. Dose C. Route
D. Signature E. All of the above

Answer 41

E. Correct documentation includes documenting medication, dose, route, and signature of the person administering the medication.

Question 42

What are the three steps to confirm you have the right drug?

Answer 42

Comparing the medication label to the order when taking the medication from the cupboard, before pouring the medication, and when replacing the medication in the cupboard.

Question 43

What precautions should be taken in a medical office to ensure the safe dispensing of medications? What precautions are taken in a hospital setting?

Answer 43

Medications should be kept in a logical order with look-alike/sound-alike medications kept in separate locations. Medication preparation areas should be free from distraction and well lighted. Medication resources should be readily available to research unfamiliar drugs before administering. Only trained medical staff should be administering medications. This applies to both the medical office and hospital. As an additional safety step, the hospital pharmacy will provide many medications in patient-specific doses.

Question 44

What should you do if a patient begins itching after you gave an immunization?

Answer 44

Notify the physician immediately for treatment orders. Monitor vital signs, call 911, and administer CPR, if warranted.

Question 45

What are some possible instructions that a poison control center may give you?

Answer 45

Poison control may ask appropriate personnel to:
• lavage patient (insert large bore gastric tube,
flush with saline or sterile water, and aspirate poison fragments from stomach)
• administer water to dilute poison
• administer milk to change pH of poison
• administer activated charcoal
• monitor vital signs
• call 911

Question 46

What information should you have ready when you call a poison control center?

Answer 46

What the patient ingested, how much, and when.

Question 47

In a closet, the office stores drug samples from drug company representatives. What would be the most efficient way to store these samples: by classification, company, or expiration date? Defend your answer.

Answer 47

Classification would avoid sound-alike/look-alike errors of administration. The other methods may make finding medications difficult. Another com- mon way is alphabetical.

Question 48

You inject measles, mumps, and rubella vaccine into Brian’s left leg. The drug was from lot no. 2468, expiration date 03/1/14. After you give the injection, he begins to cry. How would you document this medication administration in baby Dale’s chart?

Answer 48

MMR L. vastus lateralis. Lot #2468. Exp. 03/01/14. Patient observed for 15 minutes after injection. No anaphylaxis noted.

Question 49

You pull the chart for Walter Roberts, and you notice that five patients named Walter Roberts are seen at this practice. What information would you need to find the correct chart?

Answer 49

Full name, including middle name and any prefix or suffix, address, insurance information.

Question 50

Inger frequently forgets to take her medications. She is 77 years old and claims that she cannot remember well. What would you do to help her learn her medication schedule?

Answer 50

Make a chart for her and encourage her to buy a large pill case, with multiple openings for morning, noon, and bedtime and fill them up every week or month.

Question 51

Derrick is a diabetic patient who lives with his daughter, who also has diabetes and wonders why they do not take the same dose of insulin. What would be your response?

Answer 51

Many things affect medication dosage, including age, sex, and organ health. Therefore, it is common for different patients to have different dosages of the same medication to produce
the desired effect.

Question 52

Mrs. Valenzuela does not understand English well, but her son, who does understand English, is with her. How can you be sure that she understands how and when to take her medications?

Answer 52

Provide education and ask her to tell you how she
will take her medication. Have her son translate
or have a staff member translate, if available.

Question 53

Elaine is receiving an experimental drug. Write how you would document her informed consent.

Answer 53

Include a statement about risks and benefits of the medication and signatures of the physician,
patient, and witness.

Question 54

Beth is pregnant. She calls the office to see what drugs she can use for cold symptoms. Where would you look to find out which drugs are safe for her?

Answer 54

The FDA provides this list. However, you would
advise her to speak to the physician. If you work in an office that deals with this situation frequently, there should be a list of medications that the physician approves in each situation
in the policy and procedure manual, which is updated annually. This policy should also state whether a medical office worker may advise a pregnant patient to take these medications and how and when to do so.

Question 55

Mickie is a diabetic patient with impaired vision. How should an allied health professional make sure he can take his medication safely?

Answer 55

Make sure the medications are in a clearly marked container (brail, large letters, certain colors, etc.)

Question 56

Valentina wants to know why she needs less of a medication as she ages. Because her liver is becoming more impaired, she insists that she should be taking more medication, not less. What would you say to her?

Answer 56

Explain to her how the liver functions to break down medication in the body and that, if it is not working well, the medication will build up in her body, causing harm.

Question 57

AU

Answer 57

both ears

Question 58

IV

Answer 58

intravenous

Question 59

AD

Answer 59

right ear

Question 60

SC

Answer 60

subcutaneous

Question 61

IM

Answer 61

intramuscular

Question 62

tid

Answer 62

three times a day

Question 63

bid

Answer 63

two times a day

Question 64

prn

Answer 64

an needed

Question 65

NPO

Answer 65

nothing by mouth

Question 66

p.c.

Answer 66

after meals

Question 67

OD

Answer 67

right eye

Question 68

ID

Answer 68

intradermal

Question 69

AS

Answer 69

left ear

Question 70

OU

Answer 70

both eyes

Question 71

OS

Answer 71

left eye