NR224 Fundamentals of Nursing Final Exam Study Guide | Medication Administration, Patient Safety & Clinical Procedures | Comprehensive Review Questions & Answers | Graded A+

Master the core principles of nursing with this NR224 Fundamentals of Nursing Final Exam Study Guide. This comprehensive document covers critical topics from Chapter 32 on Medication Administration, including pharmacokinetics, routes of administration, and the six rights of medication safety. Students will gain deep insights into clinical procedures such as NG tube insertion, fecal occult blood (guaiac) testing, and nursing interventions for dysphagia and stomatitis. The guide also details essential skills like suctioning techniques, tracheostomy care, and oxygen therapy protocols. Designed to help students excel in their Fundamentals of Nursing final exam, this study resource simplifies complex concepts like wound healing stages, pressure injury prevention, and urinary catheterization. Prepare for clinical success with these verified nursing notes and detailed rationales. NR224 Fundamentals of Nursing Final Exam Study Guide | Medication Administration, Patient Safety & Clinical Procedures | Comprehensive Review Questions & Answers | Graded A+ Chapter 32 - Medication Administration: 1. What are the different components of drug names? Chemical name, the exact description of its composition and molecular structure; The generic name, official name listed in official publications from the manufacturer who first develops it and markets it; the trade name, indicates that the manufacturer has trademarked the medication. a. How do generic and trade drug preparations differ? Generic names are the name of the active ingredient, where trade name is an easy to say name for sales and marketing purposes. 2. How are drugs classified? Classification indicates the effect of a medication on a body system, the symptoms a medication relieves, or its desired effect. 3. Describe the following: a. Pharmacokinetics: the study of how medications enter the body, reach their site of action, metabolize, and exit the body. b. Absorption: occurs when medication molecules pass into the blood from the site of medication administration. Factors that influence absorption are the route of administration, ability of the medication to dissolve, blood flow to the site of administration, body surface area (BSA), and lipid solubility of medication. c. Distribution: movement of a drug to and from the blood and various tissues of the body and the relative proportions of drug in the tissues. d. Metabolism: medications are metabolized into a less potent or an inactive form. Kidneys, blood, intestines, and lungs play a role. e. Excretion: medications are excreted thru kidney, liver, bowel, lungs, exocrine glands. The chemical makeup of medication determines the organ of excretion. f. Therapeutic Effect: expected or predicted physiological response g. Therapeutic range: occurs between the minimum effective concentration and the toxic concentration. h. Adverse Effect: unintended, undesirable, often unpredictable. i. Idiosyncratic reaction: over-reaction or under-reaction or different reaction from normal j. Side effect: unavoidable secondary effect k. Toxic effect: accumulation of medication in the bloodstream. l. Allergic reaction: unpredictable response to a medication 4. Describe the following dose responses: a. Onset: time it takes after a medication is administered for it to produce a response. b. Trough: minimum blood serum concentration of medication reached just before the next scheduled dose.i. When is this drawn? 30 minutes before administering the drug ii. What is the process after this is drawn? Peak level is then drawn whenever the drug is expected to reach its peak concentration. c. Plateau: point at which blood serum concentration is reached and maintained d. Peak: time at which a medication reaches its highest effective concentration e. Duration: time medication takes to produce greatest result f. Biological half-life: time for serum medication concentration to be halved5. What are the different routes of drug administration? Oral (sublingual, buccal), topical (direct, body cavity), parenteral (ID, Sub-Q, IM, IV), inhalation, intraocular a. What are advantages and/or disadvantages of each? i. Advantages 1. Oral: convenient, comfortable, easy to administer, rarely cause anxiety 2. Parenteral: used when oral meds are contraindicated, more rapid absorption, delivers meds when Pt is critically ill or long-term therapy is necessary 3. Topical: provides local effect, painless, limited side effects 4. Inhalation: provides rapid relief for local respiratory problems 5. Intraocular: does not require frequent administration ii. Disadvantages 1. Oral: avoided when alterations in GI, unable to swallow, unconscious, can’t if Pt has gastric suction, can irritate GI lining, unpleasant taste. 2. Parenteral: risk of introducing infection, expensive, painful from repeated needlesticks, risk of tissue damage, higher risk for reactions, cause anxiety. 3. Topical: absorbed slowly, those with skin abrasions are at risk for rapid medication absorption and systemic effects. 4. Inhalation: cause serious systemic effects 5. Intraocular: reactions possible, expensive, Pt must be taught. 6. What must a medication order include? (Ex. patients name, medication name, dose, etc.) Pt full name, date and time of order, name of medication, ordered dosage, form of medication, route of administration, time or frequency of administration, and signature of ordering physician. 7. Describe the different types of medication orders: a. Standing or routine: administered until dosage is changed or another medication is prescribed b. Single (one time): given one time only for a specific reason c. Now: when a medication is needed right away but not STAT d. PRN: given when patient requires it e. STAT: given immediately in an emergency f. Prescriptions: medication to be taken outside of the hospital. 8. What is the nurse’s role in medication administration? Assess patient’s ability to self-administered, determine whether the patient should receive, administer medication correctly, and closely monitor effects, do not delegate this task. a. If for any reason a nurse is not comfortable giving a medication (can’t read writing, dose doesn’t sound correct, etc.) what should he/she do? Call doctor who ordered medication. 9. What are ways to accurately give medications? Avoid distractions, follow same routine, administer only meds that are prepared, never leave meds unattended, document immediately after, use clinical judgement when determining best time to administer PRN meds, check med container label against MAR 3x. 10. What are the 6 rights to medication administration? Right med, dose, patient, route, time, documentation. 11. How many checks of these 6 rights do we do before giving a patient medication? 3 times 12. What three things do you ask the patient before giving medication: a. Name b. Birthday c. Allergies*Know that forever and ever and check it every single time you give medication 32. What are patient rights for medication administration? To be informed about a med, to refuse a med, to have a medication history, to be properly advised about experimental nature of medication, to receive labeled medications safely, to receive appropriate supportive therapy, to not receive unnecessary medications, to be informed if medications are part of a research study. 33. What is the risk of polypharmacy? When a patient takes 2 or more medications to treat the same illness, takes 2 or more medication from the same chemical class, uses 2 or more medications with same or similar actions to treat several disorders simultaneously, or mixes nutritional supplements or herbal products with medications. • How can we prevent complications of polypharmacy? Frequent communication among health care providers is essential to make sure that the patients' medication regimen is as simple as possible. 34. From your book, describe how to give medications in the following ways: • Oral: by mouth • Topical: skin, nasal, eye, ear, vaginal, or rectal • Eye: avoid cornea, avoid eyelids with droppers or tubes to decrease risk of infection, do only affected eye, never allow patient to use another patient’s medication. • Ear: sensitive to temperature, use sterile solutions, drainage indicates eardrum rupture, never occlude ear canal, don’t force medication into occluded ear canal. • Inhalation: need sufficient hand strength for use of inhaler, release depends on strength of patient’s breath, and activated by their breath. • Parenteral: requires aseptic technique, if 2 meds are compatible they can be mixed into one injection, apply topical anesthetic when possible, divert the patients attention, insert needle quickly and smoothly, hold syringe steady, and inject slowly. • Intravenous o What are the benefits to this route? Drug is delivered quickly into body. o What are the risks to this route? Risk for overdose or fluid overload if infused too rapidly. o How long does the medication take to kick in? very short, 30 seconds to a few minutes. o Describe bolus, large volumes and piggybacks. Bolus: small volume of medication thru existing IV infusion line. Large volumes: safest and easiest to infuse over long time frame. Piggybacks: infusion of a solution containing the prescribed medication and a small volume of IV fluid through an existing IV line. o How does chemotherapy affect the veins? What can happen? Can lead to blood clots or collapsed veins. • Intradermal o What angle do you use? 5 to 15 degrees. o What needle do you use? Tuberculin or small hypodermic syringe. o How long does the medication take to kick in? 5 to 10 min. • Subcutaneous injection o What angle do you use? 45-90 degrees o What sites do you use? Abdomen, arm, or thigh. o What needle do you use? 5/8” 23-25 gaugeo How long does the medication take to kick in? Absorbed more slowly, up to 24 hours. o How do you correctly mix insulins? One will be clear and short rapid-acting, while the other is cloudy and long-acting. • IM injection o What angle do you use? 90 degrees. o What site do you use? Ventrogluteal (upper butt), vastus lateralis (upper thigh), deltoid (upper arm) ▪ How many mL’s can eat site hold? 2-5 mL but children no more than 2 mL. o What needle do you use? 3/8 to 1.5 inches. o Why use the Z-track method? To minimize local skin irritation by sealing the medication in muscle tissue, and not allowing any leakage into the subcutaneous tissue. o How long does the medication take to kick in? within 5-10 minutes. o How can we minimize patient discomfort during injections? Helping a patient assume a position that helps to reduce muscle strain, distract them, or apply pressure. o How can we minimize the risk of needlesticks? Needle safety devices, such as a sheath or guard that covers the needle immediately after its withdrawn from the skin. 35. What are medication administration considerations for children and older adults? For children, need psychological preparation before receiving, short explanation, supportive care, don’t give them options, distract them. For older adults, keep instructions clear and simple, carefully monitor their response, teach alternatives to medications, try to substitute for liquids if they have difficulty swallowing pill. 36. Can parents help give a child the medication after the nurse prepares it? Yes, it can be less traumatic for the child, but the nurse will supervise. Chapter 47 – Bowel Elimination: 1. Describe the anatomy and physiology of each organ in the digestive system: a. -Mouth: A: lips, vestibule, mouth cavity, gums, teeth, hard and soft palate, tongue and salivary glands. P: mechanically and chemically breaks down nutrients into useable size and form; teeth chew food, breaking it down into a size for swallowing; saliva dilutes and softens the food b. Esophagus: A: muscular tube connecting the throat with the stomach, about 8in. long, lined by moist pink tissue called mucosa, P: with aid of peristalsis moves food into the stomach c. Stomach: A: LUQ, P: stores food; mixes food, liquid, and digestive juices; moves food into small intestines d. Small intestine: A: divided into duodenum, jejunum, and ileum; P: facilitates both digestion and absorption, chime comes into the small intestine as a liquid material and mixes with digestive enzymes e. Large intestine: A: divided into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum; P: primary organ of bowel elimination f. Anus: A: end of digestive tract, P: expels feces and flatus from the rectum2. What is segmentation and peristalsis? Segmentation is contractions of the circular muscles in the digestive tract, and peristalsis is rhythmic contractions of the longitudinal muscles in the GI tract. a. What do they facilitate? Move content in anal direction and mixing is promoted to absorb nutrients and water. 3. Describe how the following affects bowel elimination: a. Age: Infants have a small stomach capacity and rapid peristalsis; adolescents experience rapid growth and increased metabolic rate, rapid growth of large intestine and increased secretion of gastric acids to digest food fibers; older adults may have decreased chewing ability. b. Fluid intake: Body needs adequate fluid to liquefy intestinal contents; unless a medical contraindication is known, an adult needs to drink six to eight glasses (1500 to 2000mL) of fluid daily. c. Diet: Regular daily food intake helps maintain a regular pattern of peristalsis in the colon; fiber provides the bulk in the fecal material; bulk-forming foods such as whole grains, fresh fruits, and veggies help flush fats and waste products from the body with greater efficiency; food intolerance is not an allergy, but rather related to a particular food that causes the body distress within a few hours of ingestion. d. Physical activity: Physical activity promotes peristalsis, whereas immobilization depresses it; encourage early ambulation as illness begins to resolve or after surgery; weakened abdominal and pelvic floor muscles impair the ability to increase intraabdominal pressure and control the external sphincter; changes in abdominal muscles and pelvic floor can lead to constipation. e. Position during defecation: Squatting is normal position; modern toilets allow a person to lean forward, exert intraabdominal pressure, and contract the gluteal muscles; difficult for a person to be supine in bed due to muscles not being able to effectively contract. f. Pain: Defecation is normally painless; conditions such as hemorrhoids, rectal surgery, anal fissures, painful linear splits in the perianal area, and abdominal surgery can result in discomfort. g. Pregnancy: As pregnancy advances, size of fetus increases, pressure is exerted on the rectum; temporary obstruction created by fetus impairs passage of feces; slowing of peristalsis during the 3rd trimester often leads to constipation; hemorrhoids are common in pregnant people due to straining. h. Biliary disease: Chronic disease in which the bile ducts in the liver are slowly destroyed; when the bile ducts are damaged, bile can back up in your liver and sometimes lead to irreversible scarring of liver tissue. Surgery: General anesthetic agents used during surgery cause temporary cessation of peristalsis. i. What must we assess for after surgery? Why? Bowel movement because inhaled anesthetic agents block parasympathetic impulses to the intestinal musculature and can stop peristaltic waves. ii. What type of ileus is it if peristalsis doesn’t return? Paralytic ileus. i. Laxatives/cathartics: Medications used primarily for their action on the bowel and will promote defecation or control diarrhea. i. What will happen with overuse of these medications? The intestines will lose muscle tone and become less responsive to medication stimulation. j. Diagnostic tests (coloscopy & endoscopy) Often require a prescribed bowel preparation to ensure bowel is empty; patients can usually not eat or drink several hours before examinations. Describe each procedure: Colonoscopy: Exam used to detect changes or abnormalities in the large intestine and rectum; a long, flexible tube is inserted into the rectum, a tiny video camera at the tip of the rube allows the doctor to view the inside of the entire colon4. Constipation: Endoscopy: Exam to view esophagus, stomach and small intestines; thin flexible tube inserted through the mouth with camera at the tip of tube. a. What are the clinical manifestations? Infrequent stool and/or hard, dry, small stools that are difficult to eliminate. b. What are possible causes? Ignoring urge to defecate, chronic illnesses, low-fiber diet, stress, lack of physical activity, medications, changes in life routine, neurological conditions. c. What are recommendations to treat constipation? Drink more water, eat more fiber, exercise, drink coffee, take Senna, eat probiotic foods. d. What scale is used to assess stool? Bristol Stool Form scale 5. Describe the following: a. Impaction: results from unrelieved constipation, a collection of hardened feces wedged in the rectum that a person cannot expel. b. Diarrhea: an increase in the number of stools and the passage of liquid, unformed feces. i. What are complications of diarrhea? Can lead to dehydration with fluid, electrolyte, or acid-base imbalances if not replaced. Skin breakdown can occur too. c. Incontinence: inability to control passage of feces and gas to the anus. i. What can moisture on the skin cause? Irritation, inflammation, or erosion. d. Flatulence: common cause of abdominal fullness, pain, and cramping. Will cause abdominal distention and severe, sharp pain if intestinal motility is reduced because of opiates, general anesthetics, abdominal surgery, or immobilization. e. Hemorrhoids: dilated, engorged veins in the lining of the rectum. i. How do we try to prevent hemorrhoids? Eat high fiber foods, plenty of fluids, fiber supplements, don’t strain, go as soon as you feel urge, avoid long periods of sitting. ii. Who often gets them? Those who strain while defecating, pregnancy, heart failure, and chronic liver disease. f. Clostridium difficile: causative agent of diarrhea. i. What precautions are these patients placed on? Contact precautions. ii. Can we wash our hands with alcohol-based hand sanitizer? No, only soap and water is effective. iii. Can they take antidiarrheal agents? No, because it can make it worse. 6. Explain the different types of colostomy’s: Loop colostomy: temporary in the transverse colon. End colostomy: proximal end forms stoma and distal end is removed or sewn closed. Double-barrel colostomy: bowel is surgically cut, and both ends are brought through the abdomen. a. What does a normal colostomy stoma look like? Beefy red or pink color, moist, shiny, similar to inside of your mouth along cheek. b. What does an abnormal colostomy stoma look like? Very pale pink, bluish purple or black color. c. What is possible nursing diagnosis associated with colostomy’s? impaired bowel habits, self-conscious, skin integrity.7. Describe the process of giving an enema: gently insert tip of nozzle into anus, and insert 10 cm into rectum, and slowly squeeze liquid from container until its empty, and wait until enema takes effect. 8. What should be done if a patient experiences cramping with an enema? Slow the injection of fluid down, make sure they’re relaxed. If it continues, get their doctor. 9. What temperature should the water be for an enema? 105-110 degrees 10. What is a kayexalate enema used for? Used to treat high level of potassium in your blood, and exchanges it with sodium ions. 11. Why is the Valsalva maneuver risky? It can put an unhealthy strain on your heart or raise your blood pressure. a. Who is at highest risk for complications due to the vasovagal response? Older adult. 12. What is stomatitis? Inflammation of mouth and lips causing painful swelling and sores inside the mouth. 13. Who usually gets stomatitis? Common in young people because of braces and retainers, but older people too because of dentures. 14. What are recommendations/interventions we can do for a patient with stomatitis? Avoid hot beverages and foods that are salty or citrus based. Gargle with cool water or suck on ice pops. 15. Describe how to perform a guaiac test (fecal occult blood) & why we do it: Will need 3 stool samples and will smear on guaiac paper, drop developing solution on each sample, and interpret the color after 30-60 seconds. Blue indicated a positive guaiac or presence of fecal occult blood. Check for hidden blood in stool. 16. How much stool do you need to perform the test? 3 stool samples from different bowel movements. 17. Describe the insertion of an NG tube: Measure insertion length, lube tip of NG tube, warn patient tube will be inserted, advance NG tube into nasopharynx aiming down and back towards patients’ ear, once patient gags instruct them to take sips of water, every time they swallow – advance the tube until reaching marked length, then tape and secure to gown. 18. When are NG tubes indicated? Decompression, enteral feeding, compression, and lavage (washing out colon or stomach). 19. Describe nursing interventions for a patient with dysphagia: Rest before meals, eliminate external stimuli, oral cleaning before feeding, suction at bedside to use when needed, artificial saliva, position patient at a 90-degree angle with head flexed forward at 45-degree angle, give specific directions when eating, maintain patient in highFowler’s position during meals, instruct patient not to talk during meals.