Chapter 7
Preparing for Medication Questions
There is a saying that only the two elderly nurses who make up NCLEX questions know what you’ll be asked on the nursing boards – not your instructor or authors of NCLEX prep books. There aren’t two elderly nurses who make up NCLEX questions; however, NCLEX questions, of course, aren’t shared with your instructor or an author of NCLEX prep books. Likewise, only the interviewer and the test preparers know the medication questions that you’ll be asked during the pre-employment process.
Throughout this chapter, you will review the kinds of questions (and answers) that cover topics that you might be asked by a nurse manager or find on a pre-employment medication administration test. This chapter reviews medication topics helping you to brush up on some basics that may have slipped your mind. This is a good way to prepare for your pre-employment medication questioning.
You Don’t Need to Be a Genius
You will need to be prepared to be asked questions about medications during interviews with the nurse manager. Some healthcare facilities require that you pass an online medication administration test even before you meet with the nurse manager. One thing is for certain: there are no standards when it comes to quizzing you about medication. In fact, you may be lucky and have no one challenge your knowledge about medication until you begin your job orientation.
There may be general questions about medication and medication administration and then there may be questions that focus on medications that you administer in a specialty area, if this is a requirement for your job. The format of the questions may range from a simple one formulated by the nurse manager or more complex (NCLEX) online questions supplied by a vendor.
Don’t panic! You probably know the answer. Nurse managers tend to ask questions related to patient safety rather than those that require knowledge of obscure facts about medications. For example, the nurse manager may ask you how you administered Lopressor. The nurse manager is looking for more than making sure you have the right patient, the right medication, the right time, the right dose, and the right route. That’s a given, especially since many healthcare facilities use an electronic medication administration record (eMAR) system that checks this for you. Think safety. The nurse manager is hoping you say that you’ll take the patient’s blood pressure before administering Lopressor. Lopressor is a medication that lowers blood pressure. You want to be sure that the patient’s blood pressure isn’t low already. Giving Lopressor in that case may cause the patient to fall.
Listen carefully to each question asked by the nurse manager. The question may not be as precisely worded as an NCLEX question. Ask the nurse manager if she can restate the question if you don’t understand it. You, too, can restate the question before answering to ensure that you understood it.
Rather than give a brief textbook answer, walk through a clinical situation that you experienced, highlighting the problem mentioned in the question, and then explain how you handled the situation. For example, you might say that you once had a patient who had relatively unstable blood pressure. You made sure to take the patient’s blood pressure before each administration of Lopressor because sometimes the medication had to be held since the patient’s blood pressure was low. You might also say that you make these standing procedures before administering any medication that affects blood pressure. Walking through a clinical situation when answering a question gives you an opportunity to share your critical thinking abilities with the nurse manager.
Walking through a clinical scenario is also a good approach to take when you are unsure of what the nurse manager is looking for in the answer. The walkthrough may satisfy the nurse manager because somewhere during the walkthrough you answered the nurse manager’s question. Even if you don’t specifically answer the question, the walkthrough may provide the nurse manager with sufficient insight into your nursing skills.
Each nurse manager establishes her own criteria when selecting the ideal candidate for the position. You don’t know what medication questions – if any – will be asked. You don’t know how the nurse manager will evaluate your problem-solving ability. You don’t know the passing grade except on a medication online test.
The nurse manager is likely evaluating how you approach solving the question and is less concerned that you use the perfect language or recite policy and procedures. Can you think on your feet? Are you focused on patient safety? How do you compare with other candidates who might have been asked the same questions?
Expect that some questions can be vague or difficult to answer. As a result, you might give the wrong answer. Typically, the nurse manager may give you additional information (hints) that get your thoughts back on track. Don’t take this as a negative. Other candidates may have needed help answering the question. What is important is how you handle incorrect questions. That is, how many hints do you need before you answer correctly?
Also expect that you’ll sometimes answer questions incorrectly. That’s okay too. Rarely does anyone answer all questions correctly. Be honest and tell the nurse manager that you are unsure of the answer, however, also state how you would find the answer if you were on the unit. This shows how you would solve problems in real life. Doing so changes an incorrect response – not knowing the answer – to a correct response – how you would find the answer.
Online Medication Tests
You may have to take an online medication administration test prior to employment as a way for the healthcare facility to remove unqualified candidates from the mix before time and money is spent on the interview process. Online medication administration tests are more structured and more predictable than medication questions asked during interviews because typically online tests are provided by a vendor.
Some healthcare facilities use vendors that supply nursing schools with exit exams. In fact, the pre-employment online medication administration test is likely to have elements of the exit exam used by nursing schools. This is a good thing if you are a recent graduate because you have recent testing skills and the content is fresh in your mind. The test might be a challenge for experienced nurses who haven’t prepped for a medication administration test in years.
Don’t assume that you can whiz through the online medication administration test because you administer hundreds of medications per month to your patients. Some healthcare facilities report that more nurses fail than pass their online medication administration test. It is not that they are asked about strange medications – nearly all medications on the test are the basic meds that you find in a typical medical-surgical unit. The problem is that experienced nurses don’t prepare for the test.
Vendors tend to use NCLEX-type multiple-choice questions where two answers are wrong and two answers are correct – one more correct than the other. You may also find medication calculation questions, which can frustrate experienced nurses, since many healthcare facilities use single-dose medication. Nurses rarely calculate the medication dose and some healthcare facilities have policies that prohibit nurses from calculating doses, leaving the calculation to the pharmacist.
Although vendors provide healthcare facilities with online medication administration tests, the healthcare facility determines the passing grade. There are a number of philosophies used to establish the passing grade. The healthcare facility may base the passing grade on what local nursing schools use as the passing grade for their exit exam. Typically, nursing schools set the passing grade based on the percentage of their graduates who pass the NCLEX on the first attempt. The higher the passing grade, the better chance that their graduates will pass the NCLEX – those who don’t pass the exit exam don’t graduate and don’t take the NCLEX. The healthcare facility may follow the lead of the local nursing schools, but then lower the passing grade if they find an insufficient pool of applicants.
Always ask the nurse recruiter if there is a review sheet available. Many do if they require a pre-employment medication test. Sometimes the review sheet simply lists general information about common medications. This is likely if the review sheet is prepared by the healthcare facility. Other times, the review sheet is prepared with assistance from the vendor who prepared the test and reflects medications that are on that test. In either case, make sure you study the review sheet before sitting for the test.
Prepping for Dose Calculation Questions
Be prepared to answer dose calculation questions. The trend is for healthcare facilities to use singe-dose medications and infusion pumps that automatically calculate the drip rate. It is rare for nurses to perform dose calculations these days, and the healthcare facility usually wants the pharmacist to perform dose calculations in those circumstances. However, vendors who supply pre-employment medication tests to healthcare facilities may include dose calculation questions; so brush up on the calculations before sitting for the test. There are many types of dose calculations. Here are commonly used dose calculation formulas that you might find on a pre-employment medication test.
Order: Motrin 600 mg one time now
Order: Ativan 1 mg
Here are conversion factors that you should know for the pre-employment medication test.
2.2 lb. = 1 kg
1 kilogram = 1000 grams (g)
1 gram = 1000 mg (mg)
1 milligrams = 1000 micrograms (mcg)
30 cc = 1 oz.
How Medications Work
There are three common actions of medications: replacement of a chemical or hormone in the body, such as insulin; interruption of normal physiological process, such as dilating blood vessels to decrease blood pressure; or increasing an existing physiological process (potentiation), such as stimulating the increase in urination (diuretic) to remove fluid from the body.
The dose and frequency of a medication administration determines the strength of the medication action. A loading dose (high dose) is administered initially to increase the concentration of the medication and to strengthen the action of the medication. Subsequent maintenance doses provide an ongoing therapeutic level of the medication in the bloodstream.
The half-life of a medication is the time necessary for half the medication to be excreted from the body and is used to determine the frequency with which to administer the medication to maintain a therapeutic effect. Medications with a short half-life require more frequent administration compared with medications with a longer half-life.
The medication onset is the time for the initial therapeutic response to occur. The peak time is when there is the highest concentration of medication in the bloodstream. Duration is the length of time that the therapeutic response occurs. The margin of safety is identified by the Therapeutic Index (TI) and determines the safe range of dose levels. The TI is a ratio that compares the blood concentration at which a drug becomes toxic and the concentration at which the drug is effective. A TI closer to 1 indicates danger of toxicity. The level of medication in the bloodstream is measured with a trough level. A sample of blood is drawn right before the next dose is to be administered to the patient. The trough level indicates if the medication is near the toxic level and also indicates the rate at which the medication is excreted from the body.
A medication contains active and inactive ingredients. The active ingredient provides the therapeutic effect and the inactive ingredient is commonly referred to as a filler and has no therapeutic effect. For example, inactive ingredients include the enteric coating around a time-release capsule that delays the onset of therapeutic effect.
Medication directly enters the bloodstream through intravenous injection. Other routes require that medication be absorbed before the medication enters the bloodstream. Medication attaches to a target receptor sites in the body where the medication provides a therapeutic benefit (primary effect). Some medications attach to non-targeted receptor sites resulting in a side effect (secondary effect) or an adverse side effect. For example, the primary effect of Benadryl is to reduce allergy symptoms. A side effect of Benadryl is drowsiness. A rare adverse side effect of Benadryl is blurred vision.
Once in the bloodstream, medications typically bind to proteins (albumin or globulins) in plasma that carry the medication throughout the body. Most, but not all, medications are delivered to the liver where the medication is metabolized (called the first pass). The active ingredient is returned to the bloodstream where it is carried to receptor sites in areas of the body that require therapeutic treatment. The inactive ingredients (metabolites) are returned to the bloodstream where they are carried to the kidneys for excretion. Some inactive ingredients are also excreted in bile.
Here are elements of absorption that you should keep in mind during your interview:
–Absorption usually occurs in the small intestine when the medication is given orally
–Tissue absorbs medication when medication is given sublingually (under the tongue) or buccally (between the gum and the cheek.) Sublingual and buccal administration bypass the first pass
–The skin absorbs medication when administered transdermally (the patch)
–Subcutaneous injection has a slow absorption rate
–Intramuscular injection has fast absorption and bypasses the first pass
–Inhalation medications are absorbed by lung tissue
–Intravenous injection has instant absorption in the bloodstream and bypasses the first pass
Facts to Remember
–Up to 40% of medications administered orally are bioavailable (enter the bloodstream). The remaining medication is impaired through the absorption process. In contrast, 100% of intravenous medication is bioavailable.
–Oral medications have typically four times the dose of intravenous medication to compensate for the relatively low bioavailability.
–Absorption rate and metabolism can be impaired by:
○Poorly functioning intestine
○Liver disease
○Kidney disease
○Impaired blood flow may decrease circulation of medication and circulation to organs
○Food can slow or block absorption of some medication
–The deltoid muscle has more blood vessels and absorbs medication faster than the gluteal muscle.
–Subcutaneous tissues have fewer blood vessels than muscle and absorb medication more slowly than muscle.
–Free medication that is absorbed but not bound to a receptor site may result in toxicity.
–Low levels of plasma protein (malnourishment) may increase free medication in the bloodstream.
–Low levels of fat tissue may increase free medication for medications that attach to receptors in fat tissue for storage.
–Two or more medications (Inderal and Warfarin) may compete for the same receptor site in the body leading to increased free medication in the bloodstream.
–Dialysis can be used to increase excretion of medication in an emergency.
–Children have an immature liver that may affect metabolism of medication.
–Geriatric patients may have diminished liver, kidney, and circulation function that may affect metabolism of medication.
–The patient’s metabolism (fast/slow) may affect the therapeutic effect of medication. A fast metabolism may fail to give the medication time to work before the medication is excreted. A slow metabolism may cause a backup of the medication risking an overdose if another dose is administered under the assumption that the previous dose was metabolized and excreted.
–Some patients build a tolerance for the medication requiring an increased dosage to achieve the desired therapeutic effect.
–Some patients are sensitized to a medication resulting in an allergic reaction.
–The reasons for administering multiple PRN (taken “as needed”) medications must be different. You shouldn’t have two PRN medications prescribed for the same reason. For example, pain medication (such as Tylenol) can be for mild pain (4 – 6 on a scale of 1 – 10) and severe pain (10). Two PRN medications cannot be prescribed for “pain.”
–Consult the practitioner if two medications of the same class of medication are scheduled to be administered at the same time. Medications of the same class typically have the same therapeutic reaction, therefore administering both may not be appropriate.
Revisiting the Basics
Oral Medications
–Don’t give oral medications to patients who are vomiting or who are unresponsive. The patient must have a gag reflex in order to be administered oral medication.
–Oral medications peak one to three hours after the medication is administered to the patient.
–Tablets can be cut to create a partial dose. Some tablets can be crushed and mixed with food.
–Capsules must be taken whole.
–Enteric-coated particles of a medication aren’t released until the particles enter the small intestine.
–Oral medication should be given on an empty stomach unless otherwise specified. Large amounts of food may alter the medication’s effectiveness.
Liquid Medication
–There are three types of liquid medications:
○Elixir: Pleasant smelling sweet solutions, such as Robitussin.
○Emulsion: A suspension where two liquids don’t mix, such as Keralac, used for hyper-keratotic conditions. Shake well before using.
○Suspensions: Particles are dispersed undissolved in the liquid such as Pepto-Bismol.
–Refrigerate open liquid medication.
–Date all opened medication with the date opened and the expiration date.
–Pour liquid at eye level so you can see the meniscus (lowest fluid mark) through the measured medication cup.
–If required by the manufacturer’s instructions, dilute, stir, or shake the medication.
–Administer liquids to patients who may cheek tablets and capsules.
Sublingual and Buccal Medication
–Tissues in the sublingual (under the tongue) and buccal (between gums and the cheek) areas are thin and have a large network of capillaries to carry medication throughout the body.
–Don’t allow the patient to ingest food or liquid until the medication is completely absorbed.
–Sublingual medication can be administered to a non-responsive patient because there is minimal chance of aspiration and the medication dissolves quickly.
Transdermal Medication
–Transdermal administration is via a patch placed on the skin. This method provides consistent medication flow through the skin.
–Use gloves when applying a patch to reduce the risk that you’ll absorb the medication through your hands.
–Don’t cut the patch. The patch must remain intact.
–Make sure the previously applied patch is removed before applying another patch.
–Apply the patch to different sites on the body – not the same site.
–Apply the patch on a clean, dry area where the skin is intact and hairless.
–Apply the patch to the appropriate area of the body:
○Nitroglycerin: chest or upper arm
○Nicotine: trunk or upper arm
○Fentanyl: chest, flank or upper arm
–Date, time, and initial the patch.
Topical Medication
–Topical medication has a local effect.
–Apply using a glove, cotton-tipped applicator, or tongue blade.
–Stroke topical medication firmly on the skin.
–If skin is broken or burned, use a clean or sterile technique when applying medication.
–Make the patient comfortable when medication is applied to painful areas.
Eye Drop Medication
–Have the patient look toward the ceiling.
–Pull down the skin below the eye exposing the conjunctival sac.
–Administer the appropriate number of drops in the center of the conjunctival sac.
–Don’t touch the dropper to the eyelids or eyelashes.
–Release the skin. Pressure the inner corner of the eye (lacrimal duct) with a sterile cotton ball or tissues for two minutes. This prevents medication from being absorbed through the lacrimal canal.
Eye Ointment Medication
–Have the patient look towards the ceiling.
–Pull down the skin below the eye exposing the conjunctival sac.
–Squeeze a half-inch of ointment into the conjunctival sac. Don’t place medication on the cornea. This may damage the cornea and cause discomfort to the patient.
–The patient may experience temporary blurred visions.
–Keep eyes closed for two minutes.
Ear Drop Medication
–Tilt head slightly toward the unaffected side.
–Pull auricle (earlobe) up and back for patients three years and older and down for patients under three years to straighten the external ear canal.
–Drop medication into the ear.
–Don’t touch the ear with the dropper to avoid contamination.
–The head should be tilted for three minutes.
Nose Drop Medication
–Ask the patient to blow his nose.
–If the infection is in the frontal sinus, then tilt the patient’s head back.
–If the infection is in the ethmoid sinus, then place the patient’s head to the affected side.
–Administer the drops.
–Place the patient’s head backwards for five minutes after administering the medication.
Nose Spray Medication
–Ask the patient to close the unaffected nostril.
–Tilt the patient head to the side of the closed nostril.
–Spray the medication.
–The patient should open the closed nostril or briefly hold his breath depending on manufacturer’s instructions.
Inhalation Medication
–Hand-held nebulizer inhalers change liquid medication to a fine spray, while a push-button-activated hand-held metered dose inhaler sprays the medication into the patient’s mouth.
–Inhalers deliver 9% of the medication to the lungs. A spacer is used with an inhaler to deliver 21% of medications to the lungs. The spacer is a funnel-like device that attaches to the mouthpiece of a metered dose inhaler.
–Patients should inhale slowly and deeply so the medication fully enters the patient’s lungs.
–Place the patient in a semi- or high-Fowler’s position (sitting up).
–Wait two minutes between puffs if a hand-held metered dose inhaler is used.
–Rinse the patient’s mouth with water to prevent oral fungal infections if a steroid inhalant is administered to the patient.
Nasogastric and Gastrostomy Tube Medication
–Used for patients who are unable to swallow or ingest orally.
–Nasogastric tubes pass through the nose into the stomach allowing medication and food to be placed into the stomach and to remove the stomach contents using suction.
–Gastrostomy tubes are inserted directly through the skin into the stomach to form a permanent feeding tube.
–Before administering medications, make sure that the tube is patent.
–Open the clamp on the tube.
–Inject 20 mL of air into the tube as you listen for the air entering the stomach.
–Aspirate the contents of the stomach and test the pH level of the contents. A pH ≤5.5 indicates that the tube is in the proper position.
–Remove the plunger from the syringe.
–Pour the medication into the syringe.
–Flush the tube with 30 mL of water.
–Close the clamp and remove the syringe.
Suppository Medication
–Used when the upper GI tract is not functioning or when digestive enzymes change the medication.
–The rectum contains a vast network of blood vessels.
–Provide privacy for the patient.
–Place the patient in the Sims’ position (lying on the left side).
–Wash hands, apply gloves, and lubricate the suppository as necessary.
–Ask the patient to break wind to relax the anal sphincter.
–Insert the suppository.
–The patient should remain in the Sims position for 20 minutes.
Intradermal Injection
–Intradermal injection is commonly used for the Mantoux tuberculin test.
–Injection sites are inner forearm, scapular area of the back, Medial thigh or the upper chest.
–Use a 26- or 27-gauge needle with a 1 mL syringe that is calibrated in increments of 0.01 mL.
–Clean the injection site with alcohol or betadine.
–Hold skin taut.
–Position the bevel of the needle up.
–Insert the needle at a 10 to 15-degree angle so you can see the needle through the skin. Medication does not enter the bloodstream.
–Slowly form a wheal and remove the needle.
–Don’t massage the injection site.
–Assess the site 48 to 72 hours after the injection.
Subcutaneous Injection
–Used for medications that need to be absorbed slowly, such as insulin and heparin.
–Injection sites are: abdomen, upper hips, upper back, lateral upper arms, and lateral thighs.
–Use a 25- to 27-gauge needle 1/2 or 5/8 inches in length and a 1 to 3 mL syringe. The syringe should be calibrated 0.5 to 1.5 mL. Syringes used for insulin are calibrated in units.
–Clean the injection site with alcohol.
–Pinch the skin.
–Insert the needle at a 45 to 90-degree angle – the smaller degree is best for a patient with a small amount of subcutaneous tissue.
–Release the skin.
–Inject the medication slowly
–Remove the needle quickly.
–Massage the injection site unless the medication heparin is injected.
Intramuscular Injection
–Medication is rapidly absorbed.
–There should be no more than 3 mL of medication delivered in the same injection.
–Select the injection site based on the size of the muscle and minimum of nerves and blood vessels at the site.
–Injection sites: Ventrogluteal (hip), Dorsogluteal (buttocks), Deltoid (upper arm), or Vastus lateralis (front of thigh).
–Use a 20- to 23-gauge needle 1 to 1.5 inches in length. The syringe should be 1 to 3 mL and calibrated with 0.5 to 1.5 mL.
–Clean the injection site with alcohol
–Flatten the skin with your thumb and index finger.
–Insert the needle at a 90-degree angle into the muscle.
–Release the skin.
–Slowly inject the medication.
–Quickly remove the needle.
–Massage the area unless not recommended by the medication manufacturer.
Z-Track Injection
–Used to prevent medication (for example, dextran iron) from leaking back into the subcutaneous tissue of where the medication is injected that might result in permanent skin discoloration.
–Clean the injection site with alcohol.
–Pull and hold the skin to one side.
–Insert the needle at a 90-degree angle.
–Inject the medication.
–Withdraw the needle.
–Release the skin.
Intravenous Injections
–Provides rapid onset of the medication.
–Insert the intravenous catheter (butterfly needle, angiocatheter) in the cephalic vein in the arm or the dorsal vein in the hand. Start with the hand, then work towards the cubital vein.
–Avoid the cubital vein except in emergencies since the cubital vein is used for drawing blood specimens.
–Use a 14-gauge intravenous catheter for whole blood and 23-gauge for rapid infusion.
–Medication may be directly injected into a vein using a 21- to 23-gauge needle 1 to 1.5 inches in length. Use the larger needle for more viscous medications.
–Clean the insertion site based on hospital protocol.
–Apply a tourniquet above the site.
–Insert the intravenous catheter until there is a blood return.
–Remove the tourniquet.
–Dress the intravenous catheter per hospital protocol.
–Monitor the site:
○Skin color (redness)
○Infiltration (swelling)
○Distal pulse
○Skin temperature
–Flush the intravenous catheter before and after administering an IV push medication.
Before Administering Medications
You know how to give medication to a patient but over the years some nurses – not you – may deviate from the proper way to administer them. Let’s say that the way some nurses gave medication in front of your nursing instructor during clinicals is not exactly the way some nurses give medication today. It is not that the medication is administered incorrectly but some factors are assumed to be correct and, therefore, not verified unless something goes amiss. It is probably best to describe how you gave medication during your clinicals if asked during your pre-employment interviews with the nurse manager. Let’s review the basics.
Make sure the medication order is valid. Each order must have:
–Date and time
–Name of the medication
–Dose
–Route of administration
–Frequency of administration
–Duration that the patient is to receive the medication
–Signature of the prescriber
–When administering the medication make sure you:
–Have the right patient
–Are administering the medication at the right time
–Have the right medication
–Know why the medication is prescribed
–Know the symptoms the patient exhibits
–Know the expected outcome of taking the medication
–Know how the medication is absorbed, distributed, metabolized, and eliminated. Current status of the patient may have changed since the order was written, making the medication contraindicated.
–Know onset and peak times of the medication
–Know side effects and adverse side effects of the medication (know what signs and symptoms must be monitored)
–Is the medication available?
–Has the medication expired?
–Is it the right dose?
–Is it the right route? (The patient’s current status may indicate that a route different from the order is necessary.)
–Know and assess for contraindications for administering the medication.
Things to Remember
–Reference recent vital signs and labs before administering medication to assess the patient’s current status
–Identify patient allergies
–Wash hands before administering medication
–Never administer medication prepared by someone else
–Tell the patient the name of the medication and why the patient is receiving the medication before administering it
–Show the medication to the patient. Stop immediately if the patient doesn’t recognize the medication. You may have the wrong medication or the pharmacy switched vendors and the medication looks different but is still the medication ordered by the practitioner.
–Explain the possible side effects to the patient.
–The patient has the right to refuse the medication. Notify the practitioner if the patient refuses to take the medication.
–Stay with the patient until the medication is swallowed.
–Monitor the patient for the therapeutic effect, side effects, and adverse side effects.
–Wash hands after administering the medication.
–Chart that the medication was administered.
–Reassess the patient within an hour of administering the medication if this was the initial dose of the medication or if it was a PRN medication. Document your reassessment, especially whether or not symptoms subsided in the case of a PRN medication.
–Don’t recap needles.
–Place needles and syringes in a sharpie container.
–Dispose of wasted medication according to hospital policy. Have another nurse witness and document waste of a controlled substance.
Experienced nurses implement tricks of the trade that make administering medication efficient. Here are some of the ones you may want to bring up during your interview with the nurse manager.
–Give ice chips before administering bad tasting medication since ice chips numb the taste buds. Also give bad tasting medication first and then pleasant tasting medication to shorten the duration of the bad taste.
–Administer medication last to patients who require extra help with the medication.
–Replace the needle after withdrawing medication from a vial with a new needle. Withdrawing medication may damage the needle.
–Ask the patient to relax before inserting the needle to reduce pain when giving an injection.
–Avoid injecting into hardened tissue or sensitive tissues.
Remember that the nurse manager is likely to focus on safety during the interview. Try to interject into the conversation procedures that you use to avoid medication errors. Here are common ways to prevent medication errors:
–Avoid distraction when preparing medication
–Pour medications from clearly marked containers
–Open single-dose packages in front of the patient after telling the patient about the medication
–Never guess at the name of the medication or dose if you cannot understand the medication order
–Avoid administering medications that appear different than normal (that is, discolored, cloudy)
–Don’t leave medication by the patient’s bedside
–You administer the medication – not the patient, visitors, or unlicensed staff
–Hold the medication if the patient states the he is allergic to the medication
–Identify the patient by name and date of birth – and electronically if available
–Notify the charge nurse and practitioner immediately upon recognizing that a medication error has occurred and document appropriately
Common Medications That Are Helpful to Know
It’s not feasible to memorize facts on all medications that might be asked about in your pre-employment interview. There are simply too many medications, most of which would never come up in the interview or on the pre-employment medication test. You should, however, review medications that are commonly prescribed in your specialty if you are applying for a similar position at another healthcare facility. For example, brushing up on facts about cardiac-related medications is probably a good move if you are applying to work on a cardiac unit.
There are four types of medications – antihypertensive medication, diabetic medication, antibiotics, and pain medication – that are commonly administered on virtually all units, which is why we’ll take a few moments to review these medications. This review focuses on patient safety, safe medication administration, and patient education.
Hypertension Medication
Medication prescribed for hypertension lowers blood pressure. Make sure that you assess the patient’s blood pressure before you administer any medication that may affect blood pressure – including medications that are prescribed for purposes other than hypertension – that may lower blood pressure.
Diuretics
Diuretics are often the first choice to lower blood pressure because diuretics cause the kidneys to increase elimination of sodium and water, resulting in decreased blood volume and the relaxing of blood pressure walls.
–Thiazide diuretics (HCT, Maxzide) are usually prescribed with another hypertensive medication
–Quinazoline diuretics (Metolazone, Zaroxolyn) are used for patients who have kidney problems or when other diuretics have not worked
–Loop diuretics (Lasix, furosemide, bumetanide, Demadex) are used for patients who have kidney problems, heart failure, or for swollen legs as a result of heart failure
–Potassium-sparing diuretics (Aldactazide, Aldactone) are used for patients who have low potassium levels
–Safety issues to consider:
–Difficulty breathing and swelling may indicate that the medication needs adjustment. Hold the medication and notify the practitioner immediately.
–Confusion, muscle cramps, or an irregular heartbeat may indicate a change in potassium level. Diuretics, except for potassium-sparing diuretics, may cause a decrease in potassium. The practitioner may order that the patient take a potassium supplement.
–Dry mouth or increased thirst may indicate dehydration as a result of loss of fluids and require a medication adjustment and rehydration.
–Make sure that the patient is able to safely go to the toilet since the patient will experience increased urination especially when the patient begins taking the medication.
Consider asking the practitioner to modify the schedule for taking hypertension medication if increased urination interferes with the patient’s lifestyle, especially for patients who tend to skip a dose when it is inconvenient to urinate.
Non-diuretic medication is also use for hypertension and is sometimes administered along with a diuretic medication. Commonly prescribed non-diuretic medications are:
–Beta blockers (Lopressor, Corgard, Inderal, Sectral, Tenormin) relax blood vessels, decreasing the workload of the heart. This results in decreased heart rhythm and decreased force of blood flow. Beta blockers are more effective when combined with other antihypertensive medications.
–Angiotensin-converting enzyme (ACE) inhibitors (Zestril, Capoten, Accupril, Monopril) block angiotensin-converting enzyme which forms chemicals that narrow blood vessels, as a result blood vessels relax.
–Angiotensin II receptor blockers (ARBs) (Cozaar, Micardis, Diovan, Benicar, Avapro) prevents the action of chemicals that narrow blood vessels.
–Calcium channel blockers (Norvasc, Cardizem, Calan, Felodipine) prevent calcium from entering the cells of blood vessel walls, causing muscles in arterial walls to relax and resulting in the widening of blood vessels.
–Renin inhibitors (Tekturna, Aliskiren) decrease production of renin. Renin is an enzyme produced in the kidneys that causes increased blood pressure.
–Alpha blockers (Minipress, Cardura) reduce nerve impulses to blood vessels, resulting in the widening of blood vessels.
–Alpha-beta blockers (Coreg, Trandate) combine the effects of alpha and beta blockers by reducing nerve impulses to narrow blood vessels and reduce the heartbeat, this decreases the amount of blood pumped through blood vessels.
–Central-acting agents (Catapres, Intuniv, Methyldopa) inhibit the nervous system from increasing the heart rate and narrowing blood vessels.
–Vasodilators (Hydralazine, Minoxidil) relax muscles in arterial walls, preventing the narrowing of arteries.
Medications That Interfere with Hypertensive Medications
–Pain medication (indomethacin, Indocin, and anti-inflammatory (Naproxen, Aleve, Ibuprofen, Advil, Motrin) medications) may cause the patient to retain water resulting in increased blood pressure.
–Antidepressants (Prozac, Sarafem, fluoxetine, Effector) may increase blood pressure.
–Birth control pills and hormonal birth control devices may increase blood pressure.
–Caffeine may increase blood pressure temporarily.
–Decongestants (Sudafed, Neo-Synephrine) narrows blood vessels, resulting in increased blood pressure.
–Herbal supplements (Ginkgo, Ginseng, St. John’s Wort, Senna) can increase blood pressure.
Always be prepared to answer questions relative to what a nurse can do to care for a patient diagnosed with hypertension. A good response is to educate the patient on non-medication methods of lowering blood pressure. These include:
–The Dietary Approaches to Stop Hypertension (DASH) diet is a lifestyle change that emphasizes eating fruits, vegetables, whole grains, poultry, fish, low-fat dairy products, and potassium-containing foods.
–Decrease salt intake to no more than 1,500 milligrams per day. Don’t use the salt shaker. Be aware of salt contained in processed foods.
–Decrease intake of saturated fat and trans fats.
–Lose weight, if the patient is overweight.
–Don’t smoke.
–Exercise regularly. At least three hours of moderate aerobic activity weekly.
–Decrease stress.
–Limit alcohol use.
Some Facts to Remember
–Normal blood pressure is 120/80 (systolic over diastolic).
–Hypertensive crisis is systolic pressure equal to or greater than 180 millimeters of mercury or a diastolic pressure equal to or greater than 120 millimeters of mercury. This may also include headache, confusion, blurred vision, nausea/vomiting, shortness of breath, and severe anxiety.
–Low blood pressure is systolic pressure lower than 90 millimeters of mercury or diastolic pressure lower than 60 millimeters of mercury. This may result in dizziness or fainting. Severe low blood pressure may result in poor perfusion of organs.
–Take the patient’s blood pressure before administering any medication that will lower blood pressure. Hold the medication if blood pressure is less than 90 mm systolic or less than 60 mm diastolic. Also hold the medication if the heartrate is less than 60.
–Always consult with the practitioner if you held a patient’s medication that would lower the patient’s blood pressure (medication other than antihypertensive medications lower blood pressure). For example, Librium lowers blood pressure and can be prescribed to prevent seizures. The practitioner may want the patient who had moderately low blood pressure to receive the scheduled dose of Librium to prevent seizures. The practitioner may have the patient lie in bed for several hours after taking Librium to prevent the patient from falling related to moderately low blood pressure.
–If blood pressure is marginally low, ask the patient to drink water and walk around (assuming the patient isn’t dizzy). This will increase blood pressure.
Diabetic Medications
Medications for diabetes is another area where you might be asked questions during the pre-employment process because diabetic medication is commonly prescribed and may lead to patient safety issues if improperly administered to the patient. There are two types of diabetic medications. These are for Type I diabetes, an autoimmune disease where the body is unable to produce insulin, and Type II, where the body is making insufficient insulin or is unable to use the insulin that is made by the body.
Blood glucose levels vary throughout the day. A patient who does not have diabetes will have a blood glucose level under 100 mg/dl when they awaken. Before meals the patient should experience blood glucose level of 70 – 99 mg/dl (3.9 – 5.5 mmol/L). Two hours after meals, blood glucose should be less than 140 mg/dl (7.8 mmol/L). In contrast, a patient who has diabetes will have a blood glucose level between 80 – 130 mg/dl (4.5 – 72 mmol/L) when they awaken and less than 180 mg/dl (10 mmol/L) two hours after their meal.
Insulin
Insulin is injected as replacement for the patient’s own insulin when they have Type 1 diabetes because the patient is unable to make insulin. There are a number of insulin types. The choice depends on the severity of the insulin depletion. Some patients are prescribed a combination of insulins that are identified by percentages such as Humulin 70/30, which is a mixture of human insulin intermediate-acting (NPH) and human insulin regular.
Amylinomimetic medication (pramlintide, SymlinPen) is sometimes prescribed for patients diagnosed with Type I diabetes. Amylinomimetic medication delays emptying of the stomach, resulting in decreased glucagon secretion after meals, leading to lower blood glucose levels. Glucagon is a hormone produced by the pancreas that raises blood glucose levels.
–Short-acting (regular insulin, Humulin, Novolin) has on onset of 30 to 45 minutes and peaks between 2 hours and 3.5 hours.
–Rapid-Acting (aspart, NovoLog, FlexPen, glulisine, Apidra, lispro, Humalog) has an onset of 1 hour to 3 hours and peaks between 4 hours and 9 hours.
–Intermediate-acting (NPH) insulin (isophane, Humulin N, Novolin N) has on onset of 1 to 20 minutes and peaks between 1.5 and 2.5 hours.
–Long-acting insulin (degludec, Tresiba, insulin detemir, Levemir, glargine, Lantus, Toujeo) has on onset of 1 hour to 3 hours and peaks between 6 hours and 10 hours.
Type 2 Diabetic Medication
The purpose of Type 2 diabetic medication is to decrease blood glucose levels by making better use of existing insulin. Typically, Type 2 diabetic medication is taken orally and not injected. Some patients are prescribed a combination of Type 2 diabetic medications.
–Alpha-glucosidase Inhibitors (acarbose, Precose, miglitol, Glyst) assist the body in metabolizing table sugar and starchy foods.
–Biguanides (Fortamet, Metformin, Glucophage, Glumetza, Riomet) decrease glucose absorption by the intestine, decrease glucose production by the liver, and increase glucose absorption by muscles. Biguanides also makes cells more sensitive to insulin.
–Dopamine agonist (bromocriptine, Parlodel) reduces the resistance to insulin by cells.
–DPP-4 inhibitors (sitaglipin, Januvia, alogliptin-metformin, Kazano) increase insulin production by the pancreas and lowers blood glucose without causing hypoglycemia.
–Glucagon-like peptides (Bydureon, Tanzeum, Byetta) are metabolic hormones called incretin that stimulate insulin secretion whenever food is ingested leading to an increased production of insulin by the pancreas.
–Meglitinides (Prandin, Prandimet, Starlix) increases the release of insulin by the pancreas; however, there may be a tendency for over-production of insulin resulting in hypoglycemia.
–Sodium Glucose Co-Transporter-2 inhibitors (SGLT2) (Farxiga, Jardiance, Invokana) increase glucose excretion by the kidneys.
–Sulfonylureas (Glucotrol, DiaBeta, Diabinese, Metaglip) stimulates the pancreas to increase insulin production.
–Thiazolidinediones (Actos, Duetact, Amaryl M, Avandia) decrease glucose in the liver and increase the use of insulin by adipose cells. There is an increased risk of heart disease with these medications.
Some Facts to Remember
–Blood glucose levels are raised shortly after meals and gradually return to normal levels if the patient is not diabetic.
–Patients who have Type I diabetes typically require insulin injections to help the body return to normal blood glucose levels.
–Always draw “clear” regular insulin first before “cloudy” insulin when mixing insulin in the same syringe to prevent the “cloudy” intermediate-acting (NPH) insulin from entering the “clear” insulin vial.
–Rotate the insulin injection sites to prevent development of hard lumps or fat deposits at the site.
–Rapid-acting and regular insulin are used to cover meals and lower periods of high levels of blood glucose that may occur.
–Intermediate-acting insulin and long-acting insulin are used to maintain blood glucose levels throughout the day.
–Rapid-acting or short-acting insulin should be administered 15 minutes before the patient eats. The patient may experience hypoglycemia if insulin is administered earlier.
–If insulin is taken 15 minutes before eating high-fat foods such as pizza, blood glucose levels may drop immediately then rapidly increase hours later once the body absorbs and metabolizes the food.
–Exercise lowers blood glucose levels.
–Patients who have Type II diabetes usually use oral diabetic medications to maintain a relatively normal blood glucose level.
–Hyperglycemia:
○Normal blood glucose level range is 90 – 160 mg/dl
○Blood glucose level range of 240 – 300 mg/dl may indicate diabetes is out of control.
○Diabetic ketoacidosis (DKA) is when the body breaks down stored fat because there is insufficient blood glucose to supply muscles and ketones build up in the body and appear in urine. Diabetic ketoacidosis can lead to diabetic coma. This may be the first sign of Type I diabetes. The patient may have thirst that lasts for days resulting in frequent urination. The patient may also have a fruity smell to their breath. Treat with insulin injection.
○Diabetic hyperosmolar syndrome (HSS) occurs when the blood glucose level is 600 mg/dl (3.33 mmol/ L) or higher, resulting in the blood becoming syrupy. The patient may become dehydrated as fluid is brought into blood vessels from other areas of the body and can lead to diabetic coma. Treat with insulin injection.
–Hypoglycemia:
○A blood glucose level below 70 mg/dl indicates hypoglycemia.
○The patient may feel hungry, shaky, sweating, and have tachycardia symptoms.
○Give the patient glucose tablets, orange juice with two packs of sugar added, two sugar lumps, two teaspoons of granulated sugar, or hard candy if the patient is conscious.
○Give the patient I.V. 75 – 90 ml 20% glucose. If I.V. access cannot be established, then give glucagon 1 mg IM or SC.
○Mental confusion, antagonistic behaviors, unconsciousness, or seizures are signs of life-threatening hypoglycemia.
○Hypoglycemia may be from too much diabetic medication being administered to the patient or from vigorous exercise or drinking too much alcohol.
○Hypoglycemia is more serious than hyperglycemia because the body has insufficient glucose to maintain bodily functions.
–Brittle diabetes is usually Type I diabetes that is difficult to control, leading to blood glucose levels rapidly spiking and then dropping unpredictably leading to dramatic symptoms. Patients typically receive insulin by a subcutaneous insulin pump.
–Some patients with brittle diabetes may experience severe hypoglycemia when they are sleeping. As a result, the patient may be unable to awaken. Checking blood glucose on a schedule during sleeping hours – even if the patient has to be awakened – may be necessary.
Antibiotics
Antibiotics are another area of medication that you might be questioned about during your pre-employment interview and testing. Don’t expect questions about prescribing antibiotics unless you are applying for a nurse practitioner’s position. Questions will likely focus on patient safety, managing side effects of the medication, and patient education.
Typically, a practitioner will order a broad-spectrum antibiotic when the practitioner suspects that the patient has a relatively common bacterial infection. A culture and sensitivity test will also be ordered as a precaution if the broad-spectrum antibiotic doesn’t work. The culture and sensitivity test identifies the bacteria and identifies antibiotics that kill the particular bacteria. It is critical that the specimen for the culture be taken before the patient receives the antibiotic otherwise the antibiotic may kill the bacteria before the bacteria is cultured. Also make sure that you follow hospital policies for taking samples (that is, use the clean catch method for sampling urine). A contaminated sample invalidates the culture and sensitivity test.
Facts to Remember
–The patient may experience common side effects of soft stool, diarrhea, or mild stomach upset. Administering probiotics or yogurt may reduce diarrhea.
–Some antibiotics should be taken on an empty stomach and others with food. Be sure to follow the manufacturer’s instructions.
–Hold the antibiotic and contact the practitioner if the patient experiences more severe side effects such as vomiting, severe diarrhea, abdominal cramps, rash, itching, white patching on the tongue, or an allergic reaction.
–Antibiotics assist the immune system in combatting a bacterial infection. The antibiotic reduces the level of bacteria that is causing the infection to a level where the immune system can finish the job.
–Antibiotics don’t work for the flu or cold. These are viral, as you probably know, but this is an important fact to share with your patients who demand an antibiotic.
–The color of mucus or phlegm is not always an indication of a bacterial infection.
–If the patient’s symptoms don’t improve after taking an antibiotic, then either the wrong antibiotic was prescribed or the patient doesn’t have a bacterial infection.
There are many antibiotics available to the practitioner and new antibiotics continue to reach the market as bacteria become resistant to older antibiotics. Here are twelve of the common classes of antibiotics. You may not be quizzed on specific classes during the pre-employment process, but it might be worth a review just in case an antibiotic or a class of antibiotics slips into a question.
–Penicillins include amoxicillin, Augmentin, and penicillin G and penicillin V
–Penicillinase-Resistant antibiotics include nafcillin and oxacillin
–Tetracyclines are broad spectrum antibiotics that are prescribed for urinary tract infections, intestinal tract infections, and sexually transmitted diseases. These include demeclocyline, doxycycline, and tetracycline
–Cephalosporins have evolved into five generations, each of which treats additional types of bacteria. Cephalosporins are prescribed for strep throat, urinary tract infections, meningitis, skin infections, and ear infections. The fifth generation is prescribed for methicillin-resistant Staphylococcus aureus (MRSA).
○First generation includes Keflex, and cefadroxil
○Second generation includes Cefoxtin, cefprozil and cefuroxime
○Third generation includes Rocephin, Ceptaz, and Tazicef
○Fourth generation includes Cefepime and Maxipime
○Fifth generation includes ceftaroline (Teflao)
–Fluoroquinolones also known as quinolones are a broad-spectrum type of antibiotics that are prescribed for difficult to treat bacterial infections such as urinary tract infections, hospital acquired pneumonia, anthrax, and the plague. Fluoroquinolones includes Levaquin, Avelox, and Cipro.
–Lincomycins are prescribed for serious infections such as joint and bone infections, lower respiratory tract infections, and pelvic inflammatory infections because they are effective against gram-positive aerobes and anaerobes. Lincomycins include lincomycin and clindamycin.
–Macrolides are antibiotics prescribed for pertussis, community-acquired pneumonia, and for simple skin infections. In recent years, some bacteria have become resistant to Macrolides and practitioners have begun to use the Ketolides class of antibiotics in place of Macrolides. Macrolides include Zithromax, erythromycin, and Biaxin.
–Sulfonamides are prescribed for ear infections, urinary tract infections, and pneumocystis pneumonia. Sulfonamides include Bactrim, Septra, Azulfidine, and sulfisoxazole.
–Glycopeptides are prescribed for methicillin-resistant Staphylococcus aureus (MRSA), C.difficile-related diarrhea, endocarditis that is resistance to other antibiotics, and complicated skin infections. Glycopeptides include vancomycin, telavancin, and dalbavancin.
–Aminoglycosides are fast-acting antibiotics that are typically administered intravenously. Aminoglycosides include amikacin, gentamicin, and tobramycin.
–Carbapenems are a wide spectrum antibiotic commonly prescribed for life-threatening bacterial infections in the stomach, kidney, and lungs include multi-antibiotic resistant hospital acquired infections. Carbapenems include meropenem, ertapenem, Doribax, Invanz, and Primaxin.
Pain Medications
Managing a patient’s pain is bound to come up in the pre-employment interview with the nurse manager or may appear on a pre-employment test because the nurse manager wants to be sure that you appropriately respond to a patient’s report of pain. Remember that pain is defined by the patient. Don’t second guess the patient based on your observations of the patient or your own pain tolerance. Some patients don’t display outward signs of pain yet they are still experiencing pain – and you may have higher pain threshold than the patient.
Pain is commonly measured using the numeric rating scale by asking the patient to rate his pain on a scale from zero to 10 where zero is no pain and 10 is the worst pain. The Wong-Baker FACES Pain Rating scale uses a series six of simple faces to indicate the level of pain. Each face is assigned a numeric value and a two or three word description. A smiley face indicates no hurt and has a value of zero. A sad face showing tears has a value of 10 and states that the pain hurts worst. This is a good scale to use for patients who have difficulty expressing themselves in English.
Patients who are unable to convey the feeling of pain usually give you clues that they are in pain. Look for:
–Facial grimacing
–Frowning
–Rapid blinking
–Shifting in bed
–Groaning
–Agitation
–Restlessness
–Inactivity
–Acting withdrawn
–Increased heart rate, blood pressure, breathing
–Guarding the area of pain
–Resisting care
–Irritability
–Increased confusion
–Changes in sleep and appetite
–Diaphoresis (sweating)
–Dilated pupils
Be sure to explain how you assess pain. The numeric pain scale (older children and adults), the Wong-Baker FACES Pain Rating Scale (non-verbal patients and children three years and older), and clinical signs of pain (patients unable to speak) are used to describe the severity of pain. You also want to assess the acceptable level of pain, location of pain, does the pain move or stay in one place, when did the pain begin, what predicated the pain, and what makes the pain better or worse. You may also suggest that the patient use a pain log to track incidents of pain to better determine the pattern of pain.
Think about discussing non-medication approaches to pain management during your pre-employment interview with the nurse manager. This shows that you are using critical thinking skills to help the patient. Some commonly used non-medication techniques for managing pain are:
–Distraction helps to refocus the mind and is a good technique for relatively minor pain and for periods between pain medication administrations.
–Relaxation techniques such as guided imagery, breathing techniques, and the gentle movements of tai chi.
–Pet therapy refocuses the patient away from the pain and onto a pet.
Non-medication techniques have their limitations when reducing pain. Pain medication (analgesics) is sometimes the only treatment for pain. Pain medication either blocks the pain signal from reaching the brain or modifies how the brain interprets the pain signal. Keep in mind that pain medication does not fix the cause of the pain. The pain persists unless the underlying cause of the pain is addressed.
For example, pain for a soft tissue injury may be caused by swelling as the inflammation process repairs the injured site. Applying a cold then warm compress to the site may reduce the swelling and reduce the pain. Anti-inflammatory medication decreases the inflammation process, reducing the swelling and pain.
There are two primary types of pain medications. These are non-narcotic and narcotic. Non-narcotic medication is not controlled and narcotics are controlled. Non-narcotic medications include analgesics for mild to moderate pain such as acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, naproxen) are also non-narcotic medications that are used to treat pain that is associated with inflammation such as muscle strains and osteoarthritis.
Facts to Remember
–The practitioner must specify in the order the reason for prescribing a non-narcotic medication (acetaminophen) that can be prescribed for pain and for fever especially if the medication is a PRN medication.
–Non-narcotic pain medication is available without prescription; however, a prescription may be written for a non-narcotic pain medication at a higher therapeutic dose (ibuprofen 200 mg per tablet OTC and 600 mg per tablet prescribed).
–Alert the patient about the dangers associated with taking more than the recommended OTC dose. For example, 800 mg is the maximum dose for ibuprofen with a four dose maximum per day. Patients in pain may increase the dose rather than consulting a practitioner for a more appropriate medication.
–NSAIDs
○Increase the risk of stomach bleeding for patients with stomach disorders.
○May cause an upset stomach, heartburn, and nausea
○Long-term use may lead to stomach ulcers, cardiovascular event, kidney disorders, and liver disorders
○Non-traditional NSAIDs medication (celecoxib, Celebrex) do not cause stomach problems
Narcotic medications are opioid-based drugs that attach to opioid receptors, changing the way the patient experiences pain. These are prescribed for severe injury. Narcotics are a controlled substance classified in five schedules.
Schedule I medications have no currently accepted medical use in the United States and have a high potential for abuse. These medications include heroin, lysergic acid diethylamide (LSD), cannabis, peyote, methaqualone, and 3, 4-methylenedioxymethamphetamine (Ecstasy).
Schedule II medications have a high potential for abuse that can lead to physical and psychological dependency. These medications include Dilaudid, Demerol, Oxycodone, Percocet, fentanyl and methadone.
Schedule IIN medications are stimulants rather than pain medication. These include amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin).
Schedule III medications may lead to moderate or low physical dependence or high psychological dependency but have a lower potential for abuse than medications in Schedules I and II. These medications include Vicodin, Suboxone, and Tylenol with codeine.
Schedule IIIN medications are non-narcotics that may have the same risk for physical and psychological dependency as Schedule III. These include Didrex (stimulant), anabolic steroids, phendimetrazine (stimulant), and ketamine (anesthetic).
Schedule IV medications have a low potential for abuse. These include Xanax, Klonopin, Valium, Ativan, Versed, Restoril, and Halcion.
Schedule V medications have the lowest potential for abuse. These medications include Robitussin AC, Phenergan with codeine, and ezogabine (anticonvulsant).
Facts to Remember
–A patient is unlikely to become addicted to narcotic medication if the medication is administered as prescribed and the practitioner closely supervises the patient.
–Administer pain medication an hour before any painful treatment to allow time for the pain medication to work.
–Narcotic medications may lead to constipation. The practitioner should anticipate this problem and order a stool softener or other therapeutic treatment to reduce constipation.
–High doses of narcotic medication can lead to respiratory depression and depress the cough reflex.
–Patients administered pain medication may be at risk for falls.
–Chronic pain may lead to depression. Antidepressant medication may relieve pain and depression associated with pain. These medications include Celexa, Prozac, Zoloft, Cymbalta, and Wellbutrin.
You don’t have to be a whiz at pharmacology to pass a pre-employment pharmacology test or to answer medication questions asked by the hiring nurse manager. However, you do need to have a good knowledge of basic medications that are common in most practices. This chapter no doubt brought back memories of the pharmacology course in nurse school. Keep in mind that no one except the nurse manager knows the medication questions that you’ll be asked on your interview, but this chapter gives you an edge when answering her medication questions.