NUR 125 Final Exam
1. NCJMM – Nursing Clinical Judgment Measurement Model
• Definition: Nursing Clinical Judgment Measurement Model (NCJMM)
• Step 1: Recognizing Cues (Assessment)
• Evaluate Outcomes: Determine whether actions taken helped the patient.
2. Medication Administration Fundamentals
Core Nursing Responsibilities
• Assess patient condition
• Verify medication orders
• Know medication purpose, action, and side effects
• Prepare and administer medications safely
• Monitor therapeutic and adverse effects
• Educate patients
• Document accurately
• Prevent errors
• Handle controlled substances safely
• Advocate for patient safety
Ten Rights of Medication Administration
1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
6. Right documentation
7. Right indication
8. Right assessment
9. Right evaluation
10. Right to education & refusal
Medication Error Response
• Assess patient immediately
• Notify provider
• Report error
• Complete occurrence report
• Analyze incident to prevent recurrence
Common Causes of Medication Errors
• Work-arounds
• Interruptions
• Look-alike/sound-alike meds
• Misreading orders
• Incorrect calculations
• Failure to follow the Ten Rights
Oral Medication Considerations
• Ability to swallow
• GI function
• Food interactions
• Absorption speed
• Taste
• First-pass metabolism
Topical Medication Considerations
• Skin condition
• Desired effect
• Risk of systemic absorption
, • Accurate placement
• Patient ability to apply
Developmental Pharmacokinetics
Infants:
• Immature liver/kidneys
• Higher body water
• Thinner skin
• Smaller doses
• Higher toxicity risk
Older Adults:
• ↓ gastric motility
• ↓ cardiac output
• ↓ albumin
• ↓ liver & renal function
• Polypharmacy
3. Injectable Medications
Routes
• Intradermal (ID)
• Subcutaneous (SQ)
• Intramuscular (IM)
• Intravenous (IV)
IM Injections
• Preferred for irritating meds (muscle buffering)
• Max volume: Up to 3 mL depending on site
SQ Injections
• Poor perfusion → slower absorption
4. Enteral Medication Administration
Routes
• Oral
• NG tube
• PEG tube
Pre-Administration
• Verify tube placement (pH, X-ray initially)
• Assess gastric residuals
• Evaluate GI motility
• Assess aspiration risk
Preparation
• Use liquid meds when possible
• Crush only meds approved for crushing
Aspiration Prevention
• HOB elevated 30–45° during and 30–60 min after administration
5. Medication Abbreviations
• ac: before meals
• prn: as needed
• Avoid: U, IU, QD, QOD, trailing zeros, missing leading zeros
6. Infection Control
Standard Precautions
• Protect nurse & patient even when no symptoms present
Chain of Infection
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
1. NCJMM – Nursing Clinical Judgment Measurement Model
• Definition: Nursing Clinical Judgment Measurement Model (NCJMM)
• Step 1: Recognizing Cues (Assessment)
• Evaluate Outcomes: Determine whether actions taken helped the patient.
2. Medication Administration Fundamentals
Core Nursing Responsibilities
• Assess patient condition
• Verify medication orders
• Know medication purpose, action, and side effects
• Prepare and administer medications safely
• Monitor therapeutic and adverse effects
• Educate patients
• Document accurately
• Prevent errors
• Handle controlled substances safely
• Advocate for patient safety
Ten Rights of Medication Administration
1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
6. Right documentation
7. Right indication
8. Right assessment
9. Right evaluation
10. Right to education & refusal
Medication Error Response
• Assess patient immediately
• Notify provider
• Report error
• Complete occurrence report
• Analyze incident to prevent recurrence
Common Causes of Medication Errors
• Work-arounds
• Interruptions
• Look-alike/sound-alike meds
• Misreading orders
• Incorrect calculations
• Failure to follow the Ten Rights
Oral Medication Considerations
• Ability to swallow
• GI function
• Food interactions
• Absorption speed
• Taste
• First-pass metabolism
Topical Medication Considerations
• Skin condition
• Desired effect
• Risk of systemic absorption
, • Accurate placement
• Patient ability to apply
Developmental Pharmacokinetics
Infants:
• Immature liver/kidneys
• Higher body water
• Thinner skin
• Smaller doses
• Higher toxicity risk
Older Adults:
• ↓ gastric motility
• ↓ cardiac output
• ↓ albumin
• ↓ liver & renal function
• Polypharmacy
3. Injectable Medications
Routes
• Intradermal (ID)
• Subcutaneous (SQ)
• Intramuscular (IM)
• Intravenous (IV)
IM Injections
• Preferred for irritating meds (muscle buffering)
• Max volume: Up to 3 mL depending on site
SQ Injections
• Poor perfusion → slower absorption
4. Enteral Medication Administration
Routes
• Oral
• NG tube
• PEG tube
Pre-Administration
• Verify tube placement (pH, X-ray initially)
• Assess gastric residuals
• Evaluate GI motility
• Assess aspiration risk
Preparation
• Use liquid meds when possible
• Crush only meds approved for crushing
Aspiration Prevention
• HOB elevated 30–45° during and 30–60 min after administration
5. Medication Abbreviations
• ac: before meals
• prn: as needed
• Avoid: U, IU, QD, QOD, trailing zeros, missing leading zeros
6. Infection Control
Standard Precautions
• Protect nurse & patient even when no symptoms present
Chain of Infection
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
