Medication/fluids Administration and Calculation

Question 1

What does APINCHS stand for?

Answer 1

High risk medication:

Antimicrobials
Potassium and electrolyte
Insulin
Narcotics & sedatives
Chemotherapeutic drugs
Heparin and anticoagulants
Systems ( independents double checks & Medication charts)

Question 2

Six rights of medication

Answer 2

Right drug
Right Dosage
Right route
Right date and time
Right patient ( Patient ID and med chart)
Right documentation

Question 3

When are Second nurse check of medication required?

Answer 3

For all parenteral medication (IV, subcutaneous inj)

Question 4

What does the second nurse need to check for medications?

Answer 4

Patient ID
Med chart
Vial of medication / dosage
amount in syringe
Compatible fluids

Question 5

What other checks are necessary besides the 6 rights?

Answer 5

• allergies
• expiry date of medication
• compatibility of fluid to medication
• does patient have fluid restrictions
• possible side effects of medication
• patient with liver/ kidney problems
• checking vitals beforehand (BP, RR, HR) for certain medication that alter vitals
• Australian Medication Handbook or online medication site
• independent double checks
• patient education

Question 6

What is Mane?

Answer 6

Morning

Question 7

What is Nocte?

Answer 7

Night

Question 8

What is ac?

Answer 8

Before meals

Question 9

What is pc?

Answer 9

After meals

Question 10

What is BD?

Answer 10

Twice a day

Question 11

What is TDS?

Answer 11

Three times a day

Question 12

What is QID?

Answer 12

Four times a day

Question 13

Routes of administration: sublingual

Answer 13

Medication that are placed under the tongue to dissolve

Question 14

Routes of administration: buccal

Answer 14

Medication held in mouth against mucous membranes of cheek

Question 15

Routes of administration: PICC

Answer 15

Peripherally inserted central catheter ( arm to heart)

Question 16

What are the common subcut regions ?

Answer 16

Abdominal umbilical region (5cm away form belly button)
Thighs

Question 17

How many mls of medication is safe to deliver via subcut inj?

Answer 17

0.5 to 1ml

Question 18

What is the pinch test when deciding the angle of a subcut inj?

Answer 18

If less than 25mm of tissue is grasped form the site, insert need at 45 degrees while pinching tissue

Question 19

A dose of 4500mg of medication ordered. The medication comes in 5g/0.3ml. What volume will you give the patient.

Answer 19

Formula: dose required (mg) / stock strength (mg) x stock volume(ml)/1

4500/5000 = 0.9
0.9 x 0.3 = 0.27

Question 20

A dose of 3500mg medication ordered. The med comes in 5g/2ml
What volume is given to patient.

Answer 20

3500/5000 = 0.7
0.7 x 2 = 1.4

Question 21

Patient weighs 45kg and prescribed med for 3mg/kg/dose
Stock strength is 2mg/0.5ml. What volume will you give patient?

Answer 21

45 x 3mg = 135
135/2 x 0.5 = 33.75mls

Question 22

A patient needs 0.075g of medicine that comes in 30mg tablets. How many tablets will the patient take?

Answer 22

1000mg = 1g

0.075g x 1000 = 75mg

75/30 = 2.5

Question 23

The total so volume ordered is 550mls N/S 0.9%. The time which is to be given is 4 hours. The drop factor is 20. How many drops per minute is delivered?

Answer 23

550/4 = 137.5mls per hour
137.5/60 = 2.29mls per minute

2.29mls x 20 drop factor = 46 drops per minute

Question 24

1300mL N/Saline 0.9% is running at a 6 hourly rate, which commenced at 1500hrs. At 1630hrs
the doctor requests for the remaining volume to be run over 3 hours. Calculate the mL per hour
for the remaining volume

Answer 24

Original rate —> 1300mls / 6 hourly

1.5 hours passed since commencement. 6/1.5 = 4

1300 / 4 = 325mls have been given to patient since commencement

Remaining volume = 1300 - 325 = 975mls

975 / 3 hours = 325mls / per hour

Question 25

1200mL N/Saline 0.9% has been running for 20 minutes at a 2 hourly rate. How many mL have been administered already?

Answer 25

1200mls/2 hourly 2 hours = 120 minutes 20/120= 1/6 1/6 x 1200 = 200 mls administered

Question 26

The dose to be given of a medication is 5mg. The stock strength is 1mg/4mL. Calculate the mL needed to deliver the medication.

Answer 26

5/1 = 5 5 x 4ml = 20mls

Question 27

Your patient is receiving 350MICROg of a medication in 750mL of CSL. How many MICROg per mL is the patient receiving?

Answer 27

0.5MICROG per mL

Question 28

A child who weighs 5kg is ordered 0.5g/kg IV, 4 hours before surgery. The solution strength is 2mg/mL. How many mL per hour do you administer?

Answer 28

5kg x 0.5g = 2.5g 2.5g = 2500mg 2500/2 = 1250mg 1250\4 hrs = 312.5mls

Question 29

1.5L N/Saline 0.9% is running at a 12 hourly rate, which commenced at 0800hrs. At 1200hrs the doctor requests for the remaining volume to be run over 4 hours. Calculate the mL per hour for the remaining volume.

Answer 29

Original rate: 1.5L / 12 hourly 4 hours have past since commencement. 12/4 = 3 1.5/3 = 0.5L has been administered to patient. 1.5 - 0.5 = 1L volume remaining 1L / 4 = New rate: 0.25mls / hr

Question 30

A child who weighs 14kg is ordered 55MICROg/kg IV, 2 hours before surgery. The solution strength is 2mg/mL. How many mL do you administer?

Answer 30

14 x 55 = 770 microg 770 microg / 2000 microg = 0.385 mls

Question 31

A child who weighs 5kg is ordered 0.5g/kg IV, 4 hours before surgery. The solution strength is 2mg/mL. How many mL per hour do you administer?

Answer 31

5kg x 0.5 = 2.5g 2.5g = 2500mg 2500mg / 2mg = 1250mls 1250mls / hour

Question 32

What does hypotonic IV fluids do ? And give example

Answer 32

Fluids goes into cells to expand the cell and increase total body fluid volume Example: 0.45% normal saline Hypotonic solutions have a lower concentration of dissolved solutes than blood - the 0.9% solute concentration (homeostasis) in blood is lowered so fluid need to move into cells intracellular space

Question 33

What does isotonic IV fluids do? And give example

Answer 33

The fluid replenishes cells from a fluid loss without changing shape Example: 0.9% normal saline, Because the concentration of the IV fluid is similar to the blood, the fluid stays in the intravascular space and osmosis does not cause fluid movement between compartments

Question 34

When is hypotonic fluids used ?

Answer 34

DKA TO increase total body fluid of patient Cellular dehydration ( if you don't have enough water circulating through your body, water will be drawn from the inside of the cells due to increased osmotic pressure — causing those cells to shrink)

Question 35

When is isotonic solution used in patient ?

Answer 35

HYPOVOLAEMIA hypotension Burns Blood loss Anaphylaxis Sepsis Dehydration

Question 36

What does hypertonic IV fluids do ? Give example

Answer 36

Fluid goes out of cell to shrink cells and to decrease fluid levels (dehydrate cells) Example: 3% normal saline Hypertonic solutions have a higher concentration of dissolved particles than blood causes the osmotic movement of water out of the cells and into the intravascular space to dilute the solutes in the blood

Question 37

When is hypertonic fluid used?

Answer 37

Fluid overload Cerebral oedema Ketosis

Question 38

What nursing consideration are needed for hypertonic and isotonic IV fluids ?

Answer 38

Hypervolaemia fluid overloading

Question 39

What is used to treat severe Hypernatremia?

Answer 39

Hypernatremia occurs due to net water loss or excess sodium intake Hypotonic solution 0.45% normal saline provide

Question 40

What nursing consideration is needed for hypotonic IV fluids ?

Answer 40

Hypovolaemia x low fluid volume in body

Question 41

What is considered in an Independent double checks

Answer 41

Medication Prescription Dose Rate Diluent compatibility Labels - expiry

Question 42

What’s checked at the bedside double checks

Answer 42

Patient ID Allergies Infusion lines Pump settings

Question 43

Writing medication dose as whole numbers

Answer 43

500mg ✅ 0.5g 🚫 125mcg ✅ 0.125mg 🚫 NEVER USE A TRAILING 0 example: 1.0g 🚫 ALWAYS WRITE 1g

Question 44

Common symbols abbreviations used when nurse does not administer medication

Answer 44

A - Absent F - Fasting R - Refused V - Vomiting W - Withheld N - Not available (med)

Question 45

Patient due for 1.5g Vancomycin antibiotics Stock strength is1g reconstituted with 20mls water for injection Stock strength —> 1000mg / 20mls = 50mg/ml Calculate how many mls you will need to draw up to obtain required dose of 1.5grams

Answer 45

1500/ 50 = 30mls

Question 46

What does a ratios of strength 1:1000 for adrenaline represent ?

Answer 46

1g of adrenaline in 1000mls of solution. Amount of unit per volume = 1mg/ml 1mg/ml is common IM dose for Anaphylaxis