HESI PN MED SURG EXAM FOR 2025 Administering Oral, Topical, And Mucosal Medications

The nurse is reviewing a medication order for a patient. The health-care provider prescribed the medication to be given by mouth (PO). In which manner will the nurse give the medication to the patient if it arrives in tablet form? 1. Give the patient a fluid to help swallow the medication. 2. Place the medication carefully between the patient's cheek and gum. 3. Dissolve the medication in a glass of water and have the patient drink the fluid. 4. Check to see if the medication is securely under the patient's tongue. - 1 Rationales Option 1: When medications are ordered PO, which means "by mouth" (per os in Latin). The nurse can confirm the order with the health-care provider to make sure that sublingual or buccal routes were not intended. Option 2: Oral medications can be placed between the patient's cheek and gum to be absorbed by the oral membranes. The health-care provider would need to order the medication to be administered buccal. Option 3: There is not enough information in the question to determine if the medication can be dissolved or not. In addition, dissolving the medication in a glass of water is risky because the patient may not be able to drink the entire amount. Option 4: Oral medications can be placed under the patient's tongue to be absorbed by the oral membranes. The health-care provider would have ordered the medication to be administered sublingual. The nurse is providing care for a patient who is unconscious and receiving enteral feeding. The nurse is reviewing the classifications and characteristics of medications ordered for the patient. Which type of drug does the nurse identify as being safe to crush for administration? 1. An antihypertensive drug in tablet form 2. An enteric-coated anti-inflammatory pill 3. A sustained-release anti-allergy capsule 4. A liquid-filled vitamin gel capsule - 1 HESI PN MED SURG EXAM FOR 2025 Administering Oral, Topical, And Mucosal Medications Rationales Option 1: Drugs that are not enteric coated or sustained release can be crushed and administered through an enteric feeding tube. Option 2: Anti-inflammatory drugs are enteric coated because they cause gastric irritation. These medications should not be crushed. Option 3: Sustained released medications are frequently dispensed in capsule form. Opening the capsule and crushing the medication can result in a rapid absorption of the medications. Option 4: Liquid-filled gel capsules are not crushed or emptied. The gel is used to protect the medication inside from certain digestion processes. Vitamins need to be absorbed from the duodenum or small intestine. The nurse works in a clinic and is preparing to instill ear drops for a variety of diagnoses. For which patient should the nurse hold the prescribed medication? 1. The patient with an ear infection who has purulent drainage. 2. The patient who has an insect trapped in the ear canal. 3. The patient who has an accumulation of sticky wax in the ear canal. 4. The patient who has hardened wax wedged in the ear canal. - 1 Rationales Option 1: The patient with an ear infection who has purulent drainage is likely to have a ruptured ear drum. Medication should not be administered if the ear drum is not intact. Option 2: The nurse can put ear drops into the ear canal of a patient who has a foreign object in the ear, such as a bug. The type of ear drop used may serve to "smother" the bug and prevent movement. Option 3: When a patient has an accumulation of sticky wax in the ear canal, ear drops may be instilled that will aid in cleaning the ear. Option 4: When a patient has hardened wax wedged in the ear canal, drops can be instilled that will soften the substance and aid in cleaning the ear. The nurse is interviewing a patient who reports prolonged use of nasal spray for nasal congestion. Which patient teaching does the nurse provide? 1. Frequent use of a decongestant spray can cause nasal cavity cancer. 2. Prolonged use of a decongestant spray can cause nosebleeds. 3. Recommended time for use of a decongestant spray is two weeks. 4. Side effects of a decongestant spray will eventually resolve with use. - 2 Rationales Option 1: There is no specific information provided that indicates that frequent use of a decongestant spray can cause nasal cavity cancer. Option 2: Prolonged use of a decongestant spray will result in shrinking and scarring of the nasal passage, causing lesions and nosebleeds. Option 3: The recommended time for the use of a decongestant spray is three days, not two weeks. Option 4: The side effects of a decongestant spray (rebound congestion) will not resolve with continued use. The nurse is reinforcing teaching to a patient who is newly diagnosed with chronic respiratory disease about how to use a metered-dose inhaler. Which information should the nurse reinforce? 1. Hold the inhaler 1 to 2 in. in front of an open mouth. 2. Hold the inhaled medication in the lungs for 15 to 30 sec. 3. Place the inhaler in a cold location between medication administrations. 4. Firmly purse the lips around the inhaler mouthpiece for a good seal. - 1 Rationales Option 1: The patient should hold the mouthpiece of the inhaler 1 to 2 in. in front of the open mouth. When the inhaler is depressed, the patient should deeply inhale the dispensed medication. Option 2: The inhaled medication only needs to be held for 10 sec and then the patient should exhale slowly through pursed lips. Option 3: The inhaler does not need to be in a cold location between uses. However, the inhaler should not be left in a hot location, such as a closed car, to prevent the canister from exploding. Option 4: The recommended method of using a metered-dose inhaler no longer requires the mouthpiece be placed in the patient's mouth. The new method prevents droplets of medication from landing on the tongue and increasing the severity of the side effects. The nurse in a long-term care facility has an old-old patient who needs medication for asthma several times daily. It has become increasingly difficult for the patient to inhale the dispersed medication from a 1 to 2 in. distance. Which solution will the nurse implement for this patient? 1. Allow the patient to place the mouthpiece of the inhaler in the mouth. 2. Apply an inhalation spacer to the mouthpiece of the inhaler. 3. Inquire about changing the patient's inhaler to oral medications. 4. Suggest that the medication be dispensed through a mask. - 2 Rationales Option 1: Allowing the patient to place the mouthpiece of the inhaler into the mouth allows droplets of the medication to land on the tongue. Rapid absorption from the tongue intensifies side effects. Option 2: Applying an inhalation spacer on the mouthpiece of the inhaler allows the patient to inhale the medication in several smaller breaths. This method is recommended for children and older adults. Option 3: Inhalers provide the best and most effective delivery of respiratory medications to the patient's lungs. The tissues are directly exposed to the medication. Option 4: Medication for respiratory disorders are not inhaled as deeply when using a mask. The efficacy of the medication is notably decreased. The nurse recently began working in a facility that uses electronic medication administration record (MAR) documentation. Which is the main difference the nurse notices about using the electronic MAR? 1. The electronic system provides a method of inventory control. 2. The nurse will need to document the administration of medications on a written form. 3. The prescriptive process is initiated by the patient's health-care provider. 4. The patient is automatically charged for medications that are ordered. - 1 Rationales Option 1: Because medications are scanned before leaving the pharmacy and again before being dispensed to the patient, the electronic system provides a method of medication inventory control. This is likely the main difference noticed by the nurse. Option 2: With an electronic MAR, the nurse is indicated as the dispenser of medication simply by the nurse's access to the electronic record. This why passwords are never shared. Option 3: This process is generally the same; however, the health-care provider may have the option of ordering a prescription electronically or by writing it by hand. Option 4: The patient will have an inventory of medications that are ordered; however, the validated charge is electronically made when the bar code is scanned and the drug is dispensed. The nurse is preparing to pass medications. When reviewing the medication administration record (MAR), the nurse notices a possible misspelling of a medication. Which action does the nurse take first? 1. Change the misspelled medication to the correct spelling. 2. Checks the health-care provider's order for the correct medication name. 3. Call the pharmacy to validate the name of the drug dispensed. 4. Search on the Internet for the correct spelling of the medication. - 2 Rationales Option 1: Without validation of the specific drug ordered by the health-care provider, the nurse should not change the MAR. Any discovered mistakes must be handled according to facility policy. Option 2: The first action that the nurse will take is to compare the medication listed on the MAR with the health-care provider's order. Option 3: This is an unnecessary action; the pharmacy will have record of the drug that was dispensed. This action is not validation of the drug ordered. Option 4: Searching on the Internet does not necessarily validate the name of the drug ordered. The nurse first needs to compare the MAR to the health-care provider's order. The nurse is preparing to administer an oral narcotic pain medication to a patient. The health-care provider's order reads in part, "dispense 1½ tablets orally." Which action does the nurse take? 1. Breaks one of the tables in half and stores it in the patient's bin for the next dose. 2. Disposes of half of the second tablet by flushing it down the sink drain. 3. Asks another nurse to witness the wasting of one-half tablet of the medication. 4. Documents the information about wasting one-half tablet in the medical record. - 3 Rationales Option 1: Narcotics are not stored in any form in the patient's medicine bin. The narcotic cannot be returned to the narcotic storage; therefore, the portion not needed is wasted with a witness. Option 2: Narcotics are not flushed down sink drains or toilets to prevent pollution of the environment. The one-half tablet will be placed in a narcotic waste bin or disposed of according to facility policy. Option 3: When any portion of a narcotic dose is to be wasted, the nurse asks another nurse to witness the waste and to sign the narcotics record. Option 4: The wasting of a narcotic is not documented in the medical record. The amount of drug signed out and the amount of that same drug being wasted is documented on the narcotics record. The nurse is providing care for a patient with a feeding tube due to the inability to swallow. The patient is ordered on multiple oral medications. Which action by the nurse is incorrect when administering the patient's medications? 1. The feeding tube is flushed with 50 mL of water prior to medication administration. 2. The medications are crushed and administered one at a time followed by 20 mL of water. 3. The nurse researches each drug to verify the method of administration through a feeding tube. 4. The medications are crushed together and dissolved in water before administration. - 4 Rationales Option 1: The feeding tube is flushed with 50 to 60 mL of water in order to clear the formula from the tube. Interaction between the medication and formula may cause the tube to block or medication to cling to the side of the tube. Flushing clears the tube. Option 2: Oral medications should be crushed and administered one at a time followed by 20 to 30 mL of water. Administering one medication at a time enables the nurse to watch for specific drug and formula interactions. Option 3: The nurse is responsible for researching every drug that is administered; it is important to ascertain the method by which a drug is administered through a feeding tube. Option 4: Medications should not be crushed together; some may need dissolved in water, and others in juice. The nurse cannot separate drugs (should the need arise) if the drugs are all crushed together. The nurse is administering antibiotic drops to a patient's right eye for an infection. Which action by the nurse is incorrect when administering this drug? 1. Placing the medication into the middle of the conjunctival sac 2. Preventing injury by bracing the hand on the patient's cheek or forehead 3. Keeping the medicine local with gentle pressure on the lacrimal duct 4. Having the patient tilt the head back and slightly toward the left - 4 Rationales Option 1: Eye medication, especially drops, are placed into the middle of the conjunctival sac. Dropping the medication on the lens can be painful. Option 2: To avoid injury in case the patient moves unexpectedly, the nurse should brace the hand with the medication on the patient's cheek or forehead. Option 3: If the medication is to remain local, gentle pressure with a gloved finger can be applied to the lacrimal duct located on the medial aspect of the eye being treated. Option 4: The head can be tilted back, but tilting the head slightly to the left will cause the medication to drain toward the lacrimal duct. Instead of local effect on the site of the infection, the action of the drug may become systemic. The nurse is working in an extended care facility. The nurse administers a number of medications via rectal suppositories. Which patient does the nurse identify as contraindicated for medication administered by the rectal route? 1. A patient with nausea and vomiting who is unable to retain food or fluid 2. A patient with swollen and inflamed hemorrhoids who is having pain 3. A patient with constipation who has a history of a recent heart attack 4. A patient who is prone to frequent seizure activity - 3 Rationales Option 1: Aa rectal antiemetic suppository can be used when a patient has nausea and vomiting and is unable to retain food or fluid. Option 2: Patients with pain from swollen and inflamed hemorrhoids can be effectively treated with a hydrocortisone rectal suppository. Option 3: Insertion of a rectal suppository is contraindicated in a patient with a history of a recent heart attack because insertion may stimulate the vagus nerve and stimulate a dysrhythmia. The condition needs to be managed by diet or oral stool softeners; bearing down will also cause vagus nerve stimulation. Option 4: Patients who are prone to seizure activity can be treated with diazepam rectal jell as a means to control seizures. The nurse is reviewing information regarding the use of rectal suppositories. Which factor about administering medication via the rectal route does the nurse have incorrect? 1. The suppository should be inserted past the internal sphincter. 2. The suppository is inserted by the index finger pushing against the blunted end. 3. The suppository is refrigerated to decrease or stop it from melting. 4. The suppository needs lubricated with a petroleum-based lubricant. - 4 Rationales Option 1: The suppository must be inserted past the internal sphincter so that it can be retained in the rectum. Option 2: The nurse inserts the suppository, tapered end first, by pushing on the blunted end with a gloved index finger. Option 3: Suppositories can be softened or melted by being stored at room temperature. The proper storage is in the refrigerator. Option 4: Suppositories are lubricated with a water-soluble lubricant to facilitate absorption. Petroleum-based lubricants are not used in the body. The nurse is instructing a patient on the use of a dry-powder inhaler. The prescribed medication comes in a diskus inhaler. Which information is most important for the nurse to provide to the patient? 1. The dispenser contains a small number of chambers with a single dose of medication in each. 2. Avoid directly exhaling into the powder chamber when the door is opened. 3. Dry-powder medication is inhaled by placing the mouthpiece into the mouth. 4. Sliding the thumb grip away reveals the mouthpiece and a lever. Rationales - 2 Option 1: This provides a general description of the dry-powder inhaler. While the information is good to know, it is not the most important information to provide to the patient. Option 2: Once the powder chamber door is open, the patient can disperse the powder by exhaling into the open chamber. This is the most important information to provide to the patient. Failure to follow this procedure will result in wasted medication. Option 3: The diskus mouthpiece is placed in the patient's mouth, the patient's lips are closed around it, and the patient inhales deeply to draw the dry powder deep into the lungs. Option 4: The apparatus of the inhaler is revealed when the thumb grip is slid away from the patient. This information is necessary, but is not the most important to provide the patient. The nurse works in a facility that utilizes a paper medication administration record (MAR) for the documentation of medication administration. For which reason is it most