Clayton's-Basic-Pharmacology-for-Nurses-Ch.7:-Percutaneous-Administration
1. •A-patient-is-being-instructed-on-the-use-of-a-dry-powder-inhaler-(DPI)-for-
newly-diagnosed-asthma-and-has-successfully-demonstrated-an-ability-to-use-
the-DPI.-The-patient-asks-the-nurse-how-to-tell-when-it-is-time-to-replace-the-
inhaler.-How-does-the-nurse-respond?
a) "When-you-don't-notice-symptom-improvement-after-using-the-inhaler."
b) "When-you-don't-feel-pressure-or-taste-the-drug-when-administering-it."
c) "Before-the-gauge-on-the-canister-nears-zero."
d) "When-you-float-the-canister-in-water-and-it-floats-levelly."-
--CORRECT-ANSWER-c)-"Before-the-gauge-on-the-canister-nears-zero."
Rationale:-Dry-powder-inhalers-have-a-dose-counter-on-the-device-to-show-the-
amount-of-remaining-doses.-The-patient-should-plan-ahead-and-obtain-a-
renewal-prescription-before-the-dose-counter-is-allowed-to-near-the-empty-
point.
2. •When-applying-a-topical-nitroglycerin-ointment-to-a-patient,-what-must-the-
nurse-be-sure-to-do?
a) Massage-it-thoroughly-into-the-skin.
b) Squeeze-it-onto-the-applicator-paper-and-place-it-on-the-skin.
c) Apply-it-to-the-medial-aspect-of-the-thigh.
d) Shave-the-skin-before-application.-
--CORRECT-ANSWER-b)-Squeeze-it-onto-the-applicator-paper-and-
place-it-on-the-skin.
Rationale:-Using-applicator-paper-to-apply-topical-nitroglycerin-ensures-that-
the-correct-amount-is-administered.-It-is-applied-to-areas-of-the-chest,-
shoulder,-or-back-with-little-hair;-it-must-not-be-massaged-into-the-skin-or-the-
drug-will-be-absorbed-too-rapidly;-and-skin-is-never-shaved-before-
administration-because-skin-breakdown-and-uneven-absorption-through-skin-
abrasions-can-occur.
3. •When-instilling-ophthalmic-drops,-which-step-does-the-nurse-take-to-
minimize-the-risk-of-systemic-absorption?
a) Places-a-gloved-finger-against-the-inner-canthus-for-1-to-2-minutes
b) Has-the-patient-hold-the-eyes-closed-firmly-for-5-minutes
c) Has-the-patient-lean-forward-and-hold-the-head-in-a-lowered-position
d) Positions-the-patient-so-the-head-is-lower-than-the-feet-
--CORRECT-ANSWER-a)-Places-a-gloved-finger-against-the-inner-
canthus-for-1-to-2-minutes
,Clayton's-Basic-Pharmacology-for-Nurses-Ch.7:-Percutaneous-Administration
Rationale:-By-placing-a-finger-with-a-tissue-at-the-inner-canthus,-the-drug-will-
have-less-opportunity-to-drain-from-the-eye-and-into-the-mucous-membranes,-
where-absorption-into-the-systemic-circulation-could-occur.-This-also-keeps-a-
greater-concentration-of-the-drug-against-the-eye.-The-position-of-the-head-is-
irrelevant-as-it-pertains-to-systemic-absorption.
4. A-2-year-old-child-is-being-treated-for-an-external-ear-infection.-What-is-the-
correct-ear-position-for-the-nurse-to-administer-ear-drops?
a) Pull-the-affected-ear-up-and-back.
b) Pull-the-affected-ear-down-and-back.
c) Place-the-child-on-his-or-her-abdomen-with-the-affected-ear-facing-the-
floor.
d) Pull-the-affected-ear-down-and-forward.-
--CORRECT-ANSWER-b)-Pull-the-affected-ear-down-and-back.
Rationale:-For-children-younger-than-3-years,-the-ear-should-be-pulled-down-
and-back-to-straighten-the-ear-canal-to-prepare-for-the-drops.
5. Administration-of-a-Vaginal-Douche:-Documentation-
--CORRECT-ANSWER-
i. Chart-the-date,-time,-drug-name,-dosage,-and-route-of-administration.
ii. Perform-and-record-regular-patient-assessments-for-the-evaluation-of-
therapeutic-effectiveness-(e.g.,-type-of-discharge-present,-irritation-of-labia,-
discomfort,-degree-and-duration-of-pain-relief).
iii. Chart-and-report-any-signs-and-symptoms-of-adverse-drug-effects.
iv. Perform-and-validate-essential-patient-education-about-the-drug-therapy-
and-other-essential-aspects-of-intervention-for-the-disease-process-that-is-
affecting-the-individual.
6. Administration-of-a-Vaginal-Douche:-Dose-Form
---CORRECT-ANSWER---used-to-wash-the-vagina
7. Administration-of-a-Vaginal-Douche:-Equipment-
--CORRECT-ANSWER---IV-pole
- Clean-gloves
- Water-soluble-lubricant
- Bag-with-tubing-and-nozzle
- Douche-solution
- MAR-and-medication-profile
8. Administration-of-a-Vaginal-Douche:-Patient-Teaching-
--CORRECT-ANSWER-
, Clayton's-Basic-Pharmacology-for-Nurses-Ch.7:-Percutaneous-Administration
i. Teach-the-patient-how-to-administer-the-douche-correctly.
ii. Explain-that-the-bag-and-tubing-should-be-washed-in-warm-soapy-water-
after-each-use-so-that-they-do-not-become-a-source-of-reinfection.
iii. Review-personal-hygiene-measures,-such-as-wiping-from-the-front-to-the-
back-after-voiding-or-defecating.
iv. Explain-that-douching-is-not-recommended-during-pregnancy.
v. With-most-types-of-infections,-both-male-and-female-partners-require-
treatment.-To-prevent-reinfection,-patients-should-abstain-from-sexual-
intercourse-until-all-partners-are-cured.
9. Administration-of-a-Vaginal-Douche:-Site---CORRECT-ANSWER-Vagina
10. Administration-of-a-Vaginal-Douche:-Techniques-
--CORRECT-ANSWER-
i. Follow-the-procedure-protocol-described-earlier.
ii. Ask-the-patient-to-void-before-the-procedure.
iii. If-the-nurse-is-teaching-this-procedure-to-a-patient-for-home-use,-the-
patient-would-customarily-recline-in-a-bathtub.-Depending-on-the-
patient's-condition-in-the-hospital,-this-too-could-occur.-However,-it-
may-be-necessary-to-place-the-patient-on-a-bedpan-and-drape-for-
privacy.
iv. Fill-the-bag-with-douche-solution-and-hang-the-bag-on-an-IV-pole,-at-a-
level-about-12-inches-above-the-vagina.-Apply-clean-gloves.-Apply-
water-soluble-lubricant-to-a-plastic-vaginal-tip.
v. Cleanse-the-vulva-by-allowing-a-small-amount-of-solution-to-flow-over-
the-vulva-and-between-the-labia.
vi. Gently-insert-the-nozzle-into-the-vagina,-directing-the-tip-backward-and-
downward-2-to-3-inches.
vii. Hold-the-labia-together-to-facilitate-filling-the-vagina-with-solution.-
Rotate-the-nozzle-periodically-to-help-irrigate-all-parts-of-the-vagina.
viii. Intermittently-release-the-labia,-allowing-the-solution-to-flow-out.
ix. When-all-of-the-solution-has-been-used,-remove-the-nozzle.-Have-the-
patient-sit-up-and-lean-forward-to-empty-the-vagina-thoroughly.
x. Pat-the-external-area-dry.
xi. Clean-all-equipment-with-warm-soapy-water-after-every-use;-rinse-the-
equipment-with-clear-water,-and-allow-it-to-dry.
xii. Thoroughly-clean-and-disinfect-the-bathtub,-if-used.
xiii. Remove-gloves-and-dispose-of-them-in-accordance-with-institutional-
policy.
xiv. Perform-hand-hygiene.
1. •A-patient-is-being-instructed-on-the-use-of-a-dry-powder-inhaler-(DPI)-for-
newly-diagnosed-asthma-and-has-successfully-demonstrated-an-ability-to-use-
the-DPI.-The-patient-asks-the-nurse-how-to-tell-when-it-is-time-to-replace-the-
inhaler.-How-does-the-nurse-respond?
a) "When-you-don't-notice-symptom-improvement-after-using-the-inhaler."
b) "When-you-don't-feel-pressure-or-taste-the-drug-when-administering-it."
c) "Before-the-gauge-on-the-canister-nears-zero."
d) "When-you-float-the-canister-in-water-and-it-floats-levelly."-
--CORRECT-ANSWER-c)-"Before-the-gauge-on-the-canister-nears-zero."
Rationale:-Dry-powder-inhalers-have-a-dose-counter-on-the-device-to-show-the-
amount-of-remaining-doses.-The-patient-should-plan-ahead-and-obtain-a-
renewal-prescription-before-the-dose-counter-is-allowed-to-near-the-empty-
point.
2. •When-applying-a-topical-nitroglycerin-ointment-to-a-patient,-what-must-the-
nurse-be-sure-to-do?
a) Massage-it-thoroughly-into-the-skin.
b) Squeeze-it-onto-the-applicator-paper-and-place-it-on-the-skin.
c) Apply-it-to-the-medial-aspect-of-the-thigh.
d) Shave-the-skin-before-application.-
--CORRECT-ANSWER-b)-Squeeze-it-onto-the-applicator-paper-and-
place-it-on-the-skin.
Rationale:-Using-applicator-paper-to-apply-topical-nitroglycerin-ensures-that-
the-correct-amount-is-administered.-It-is-applied-to-areas-of-the-chest,-
shoulder,-or-back-with-little-hair;-it-must-not-be-massaged-into-the-skin-or-the-
drug-will-be-absorbed-too-rapidly;-and-skin-is-never-shaved-before-
administration-because-skin-breakdown-and-uneven-absorption-through-skin-
abrasions-can-occur.
3. •When-instilling-ophthalmic-drops,-which-step-does-the-nurse-take-to-
minimize-the-risk-of-systemic-absorption?
a) Places-a-gloved-finger-against-the-inner-canthus-for-1-to-2-minutes
b) Has-the-patient-hold-the-eyes-closed-firmly-for-5-minutes
c) Has-the-patient-lean-forward-and-hold-the-head-in-a-lowered-position
d) Positions-the-patient-so-the-head-is-lower-than-the-feet-
--CORRECT-ANSWER-a)-Places-a-gloved-finger-against-the-inner-
canthus-for-1-to-2-minutes
,Clayton's-Basic-Pharmacology-for-Nurses-Ch.7:-Percutaneous-Administration
Rationale:-By-placing-a-finger-with-a-tissue-at-the-inner-canthus,-the-drug-will-
have-less-opportunity-to-drain-from-the-eye-and-into-the-mucous-membranes,-
where-absorption-into-the-systemic-circulation-could-occur.-This-also-keeps-a-
greater-concentration-of-the-drug-against-the-eye.-The-position-of-the-head-is-
irrelevant-as-it-pertains-to-systemic-absorption.
4. A-2-year-old-child-is-being-treated-for-an-external-ear-infection.-What-is-the-
correct-ear-position-for-the-nurse-to-administer-ear-drops?
a) Pull-the-affected-ear-up-and-back.
b) Pull-the-affected-ear-down-and-back.
c) Place-the-child-on-his-or-her-abdomen-with-the-affected-ear-facing-the-
floor.
d) Pull-the-affected-ear-down-and-forward.-
--CORRECT-ANSWER-b)-Pull-the-affected-ear-down-and-back.
Rationale:-For-children-younger-than-3-years,-the-ear-should-be-pulled-down-
and-back-to-straighten-the-ear-canal-to-prepare-for-the-drops.
5. Administration-of-a-Vaginal-Douche:-Documentation-
--CORRECT-ANSWER-
i. Chart-the-date,-time,-drug-name,-dosage,-and-route-of-administration.
ii. Perform-and-record-regular-patient-assessments-for-the-evaluation-of-
therapeutic-effectiveness-(e.g.,-type-of-discharge-present,-irritation-of-labia,-
discomfort,-degree-and-duration-of-pain-relief).
iii. Chart-and-report-any-signs-and-symptoms-of-adverse-drug-effects.
iv. Perform-and-validate-essential-patient-education-about-the-drug-therapy-
and-other-essential-aspects-of-intervention-for-the-disease-process-that-is-
affecting-the-individual.
6. Administration-of-a-Vaginal-Douche:-Dose-Form
---CORRECT-ANSWER---used-to-wash-the-vagina
7. Administration-of-a-Vaginal-Douche:-Equipment-
--CORRECT-ANSWER---IV-pole
- Clean-gloves
- Water-soluble-lubricant
- Bag-with-tubing-and-nozzle
- Douche-solution
- MAR-and-medication-profile
8. Administration-of-a-Vaginal-Douche:-Patient-Teaching-
--CORRECT-ANSWER-
, Clayton's-Basic-Pharmacology-for-Nurses-Ch.7:-Percutaneous-Administration
i. Teach-the-patient-how-to-administer-the-douche-correctly.
ii. Explain-that-the-bag-and-tubing-should-be-washed-in-warm-soapy-water-
after-each-use-so-that-they-do-not-become-a-source-of-reinfection.
iii. Review-personal-hygiene-measures,-such-as-wiping-from-the-front-to-the-
back-after-voiding-or-defecating.
iv. Explain-that-douching-is-not-recommended-during-pregnancy.
v. With-most-types-of-infections,-both-male-and-female-partners-require-
treatment.-To-prevent-reinfection,-patients-should-abstain-from-sexual-
intercourse-until-all-partners-are-cured.
9. Administration-of-a-Vaginal-Douche:-Site---CORRECT-ANSWER-Vagina
10. Administration-of-a-Vaginal-Douche:-Techniques-
--CORRECT-ANSWER-
i. Follow-the-procedure-protocol-described-earlier.
ii. Ask-the-patient-to-void-before-the-procedure.
iii. If-the-nurse-is-teaching-this-procedure-to-a-patient-for-home-use,-the-
patient-would-customarily-recline-in-a-bathtub.-Depending-on-the-
patient's-condition-in-the-hospital,-this-too-could-occur.-However,-it-
may-be-necessary-to-place-the-patient-on-a-bedpan-and-drape-for-
privacy.
iv. Fill-the-bag-with-douche-solution-and-hang-the-bag-on-an-IV-pole,-at-a-
level-about-12-inches-above-the-vagina.-Apply-clean-gloves.-Apply-
water-soluble-lubricant-to-a-plastic-vaginal-tip.
v. Cleanse-the-vulva-by-allowing-a-small-amount-of-solution-to-flow-over-
the-vulva-and-between-the-labia.
vi. Gently-insert-the-nozzle-into-the-vagina,-directing-the-tip-backward-and-
downward-2-to-3-inches.
vii. Hold-the-labia-together-to-facilitate-filling-the-vagina-with-solution.-
Rotate-the-nozzle-periodically-to-help-irrigate-all-parts-of-the-vagina.
viii. Intermittently-release-the-labia,-allowing-the-solution-to-flow-out.
ix. When-all-of-the-solution-has-been-used,-remove-the-nozzle.-Have-the-
patient-sit-up-and-lean-forward-to-empty-the-vagina-thoroughly.
x. Pat-the-external-area-dry.
xi. Clean-all-equipment-with-warm-soapy-water-after-every-use;-rinse-the-
equipment-with-clear-water,-and-allow-it-to-dry.
xii. Thoroughly-clean-and-disinfect-the-bathtub,-if-used.
xiii. Remove-gloves-and-dispose-of-them-in-accordance-with-institutional-
policy.
xiv. Perform-hand-hygiene.
