ATI RN Pharmacology for Nursing (8th Edition) PDF

07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 CHAPTER 1 UNIT 1 PHARMACOLOGICAL PRINCIPLES Inhalation via mouth, nose CHAPTER 1 Pharmacokinetics BARRIERS TO ABSOR...

07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 CHAPTER 1 UNIT 1 PHARMACOLOGICAL PRINCIPLES Inhalation via mouth, nose CHAPTER 1 Pharmacokinetics BARRIERS TO ABSORPTION: Inspiratory effort and Routes of ABSORPTION PATTERN: Rapid absorption through alveolar capillary networks Administration Intradermal, topical BARRIERS TO ABSORPTION: Close proximity of Pharmacokinetics refers to how medications epidermal cells travel through the body. They undergo a variety ABSORPTION PATTERN Slow, gradual absorption of biochemical processes that result in absorption, Effects primarily local, but systemic as well, especially distribution, metabolism, and excretion. with lipid-soluble medications passing through subcutaneous fatty tissue PHASES OF PHARMACOKINETICS Subcutaneous, intramuscular BARRIERS TO ABSORPTION: Capillary walls have ABSORPTION large spaces between cells. Therefore, there is no significant barrier. Absorption is the transmission of medications from the location of administration (gastrointestinal [GI] tract, ABSORPTION PATTERN muscle, skin, mucous membranes, or subcutaneous Solubility of the medication in water: Highly soluble tissue) to the bloodstream. The most common routes of medications have rapid absorption (10 to 30 min); poorly administration are enteral (through the GI tract) and soluble medications have slow absorption. parenteral (by injection). Each of these routes has a unique Blood perfusion at the site of injection: sites with high pattern of absorption. blood perfusion have rapid absorption; sites with low The rate of medication absorption determines how soon blood perfusion have slow absorption. the medication will take effect. The amount of medication the body absorbs determines Intravenous the intensity of its effects. BARRIERS TO ABSORPTION: No barriers The route of administration affects the rate and amount of absorption. ABSORPTION PATTERN Immediate: enters directly into the blood Oral Complete: reaches the blood in its entirety BARRIERS TO ABSORPTION: Medications must pass through the layer of epithelial cells that line the GI tract. DISTRIBUTION ABSORPTION PATTERN: Varies greatly due to: Distribution is the transportation of medications to sites Stability and solubility of the medication of action by bodily fluids. Factors influencing distribution GI pH and emptying time include the following. Presence of food in the stomach or intestines Circulation: Conditions that inhibit blood flow or Other concurrent medications perfusion, such as peripheral vascular or cardiac disease, Forms of medications (enteric-coated pills, liquids) can delay medication distribution. Sublingual, buccal Permeability of the cell membrane: The medication must be able to pass through tissues and membranes to reach BARRIERS TO ABSORPTION: Swallowing before dissolution its target area. Medications that are lipid-soluble or have allows gastric pH to inactivate the medication. a transport system can cross the blood-brain barrier and ABSORPTION PATTERN: Quick absorption systemically the placenta. through highly vascular mucous membranes Plasma protein binding: Medications compete for protein binding sites within the bloodstream, primarily albumin. Other mucous membranes (rectal, vaginal) The ability of a medication to bind to a protein can affect BARRIERS TO ABSORPTION: Presence of stool in the how much of the medication will leave and travel to rectum or infectious material in the vagina limits target tissues. Two medications can compete for the same tissue contact. binding sites, resulting in toxicity. ABSORPTION PATTERN: Easy absorption with both local and systemic effects RN PHARMACOLOGY FOR NURSING CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION 3 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 07/24 METABOLISM THERAPEUTIC INDEX Metabolism (biotransformation) changes medications into Medications with a high therapeutic index (TI) have a less active or inactive forms by the action of enzymes. wide safety margin. Therefore, there is no need for routine This occurs primarily in the liver, but it also takes place in blood medication-level monitoring. Medications with the kidneys, lungs, intestines, and blood. a low TI require close monitoring of medication levels. Nurses should consider the route of administration when FACTORS INFLUENCING THE RATE OF MEDICATION monitoring for peak levels (highest plasma level when METABOLISM elimination = absorption). For example, an oral medication Age: Infants have a limited medication-metabolizing can peak from 1 to 3 hr after administration. If the route capacity. The aging process also can influence medication is IV, the peak time might occur within 10 min. (Refer to metabolism, but varies with the individual. In general, a drug reference or a pharmacist for specific medication hepatic medication metabolism tends to decline with age. peak times.) For trough levels, obtain a blood sample Older adults require smaller doses of medications due to immediately before the next medication dose, regardless the possibility of accumulation in the body. of the route of administration. A plateau is a medication’s Increase in some medication-metabolizing enzymes: concentration in plasma during a series of doses. This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase HALF-LIFE in the metabolism of other concurrent-use medications. Half-life (t½) refers to the time for the medication in First‑pass effect: The liver inactivates some the body to drop by 50%. Liver and kidney function medications on their first pass through the liver, and affect half-life. It usually takes four half-lives to thus they require a nonenteral route (sublingual, IV) achieve a steady blood concentration (medication because of their high first-pass effect. intake = medication metabolism and excretion). Similar metabolic pathways: When the same SHORT HALF-LIFE pathway metabolizes two medications, it can alter the Medications leave the body quickly (4 to 8 hr). metabolism of one or both of them. In this way, the Short-dosing interval or MEC drops between doses. rate of metabolism can decrease for one or both of the medications, leading to medication accumulation. LONG HALF-LIFE Nutritional status: Clients who are malnourished can Medications leave the body more slowly: over more than be deficient in the factors that are necessary to produce 24 hr, with a greater risk for medication accumulation specific medication-metabolizing enzymes, thus and toxicity. impairing medication metabolism. Medications can be given at longer intervals without loss of therapeutic effects. OUTCOMES OF METABOLISM Medications take a longer time to reach a steady state. Increased renal excretion of medication Inactivation of medications Increased therapeutic effect PHARMACODYNAMICS Activation of pro-medications (also called pro-drugs) Pharmacodynamics describes the interactions between into active forms medications and target cells, body systems, and organs Decreased toxicity when active forms of medications to produce effects. These interactions result in functional become inactive forms changes that are the mechanism of action of the Increased toxicity when inactive forms of medications medication. Medications interact with cells in one of two become active forms ways or in both ways. Agonists are medications that bind to or mimic the EXCRETION receptor activity that endogenous compounds regulate. For Excretion is the elimination of medications from the body, example, morphine is an agonist because it activates the primarily through the kidneys. Elimination also takes receptors that produce analgesia, sedation, constipation, place through the liver, lungs, intestines, and exocrine and other effects. (Receptors are the medication’s target glands (such as in breast milk). Kidney dysfunction can sites on or within the cells.) lead to an increase in the duration and intensity of a Antagonists are medications that can block the usual medication’s response, so it is important to monitor BUN receptor activity that endogenous compounds regulate or and creatinine levels. the receptor activity of other medications. For example, losartan, an angiotensin II receptor blocker, is an MEDICATION RESPONSES antagonist. It works by blocking angiotensin II receptors on blood vessels, which prevents vasoconstriction. Medication dosing attempts to regulate medication responses to maintain plasma levels between the minimum Partial agonists act as agonists and antagonists, with effective concentration (MEC) and the toxic concentration. limited affinity to receptor sites. For example, nalbuphine A plasma medication level is in the therapeutic range when acts as an antagonist at mu receptors and an agonist it is effective and not toxic. Nurses use therapeutic levels of at kappa receptors, causing analgesia with minimal many medications to monitor clients’ responses. respiratory depression at low doses. 4 CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION CONTENT MASTERY SERIES 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 Routes of administration TOPICAL Medications directly applied to the mucous membranes or skin. Includes powders, sprays, creams, ointments, pastes, ORAL OR ENTERAL oil-and suspension-based lotions. Painless Tablets, capsules, liquids, Limited adverse effects suspensions, elixirs, lozenges NURSING ACTIONS Most common route Apply with a glove, tongue blade, or cotton-tipped applicator. Do not apply with a bare hand. NURSING ACTIONS For skin applications, wash the skin with soap and Contraindications for oral medication administration water. Pat dry before application. include vomiting, decreased GI motility, absence of a Use surgical asepsis to apply topical medications to gag reflex, difficulty swallowing, and a decreased level open wounds. of consciousness. Have clients sit upright at a 90° angle to Transdermal facilitate swallowing. Administer irritating medications, such as analgesics, Medication in a skin patch for absorption through the with small amounts of food. skin, producing systemic effects Do not mix with large amounts of food or beverages in CLIENT EDUCATION case clients cannot consume the entire quantity. Apply patches to ensure proper dosing. Avoid administration with interacting foods or Wash the skin with soap and water, and dry it beverages, such as grapefruit juice. thoroughly before applying a new patch. Administer oral medications as prescribed, and follow Place the patch on a hairless area, and rotate sites daily directions for whether medication is to be taken on an to prevent skin irritation. empty stomach (30 min to 1 hr before meals, 2 hr after meals) or with food. Eye Follow the manufacturer’s directions for crushing, cutting, and diluting medications. Break or cut scored Have clients sit upright or lie supine, tilt their head tablets only. (See the Institute for Safe Medication slightly, and look up at the ceiling. Practices website.) Rest your dominant hand on the clients’ forehead, hold the Make sure clients swallow enteric-coated or dropper above the conjunctival sac about 1 to 2 cm, drop time-release medications whole. the medication into the sac, avoid placing it directly on the Use a liquid form of the medication to facilitate cornea, and have them close the eye gently. If they blink swallowing whenever possible. during instillation, repeat the procedure. For liquids, including suspension and elixirs, follow Apply gentle pressure with your finger and a clean facial directions for dilution and shaking. To prepare the tissue on the nasolacrimal duct for 30 to 60 seconds to medication, place a medicine cup on a flat surface before prevent systemic absorption of the medication. pouring, and ensure the base of the meniscus (lowest If instilling more than one medication in the same eye, fluid line) is at the level of the dose. wait at least 5 min between them. For eye ointment, apply a thin ribbon to the edge of the ADVANTAGES lower eyelid from the inner to the outer canthus. Safe Inexpensive Ear Easy and convenient Have clients sit upright or lie on their side. DISADVANTAGES Straighten the ear canal by pulling the auricle upward and Oral medications have highly variable absorption. outward for adults or down and back for children less than Inactivation can occur in the GI tract or by 3 years of age. Hold the dropper 1 cm above the ear canal, first-pass effect. instill the medication, and then gently apply pressure with Clients must be cooperative and conscious. your finger to the tragus of the ear unless it is too painful. Do not press a cotton ball deep into the ear canal. If Sublingual and buccal necessary, gently place it into the outermost part of the Sublingual: under the tongue ear canal. Have clients remain in the side-lying position if Buccal: between the cheek and the gum possible for 2 to 3 min after instilling ear drops. Directly enters the bloodstream and bypasses the liver CLIENT EDUCATION Keep the medication in place until complete absorption occurs. Do not eat or drink while the tablet is in place or until it has completely dissolved. RN PHARMACOLOGY FOR NURSING CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION 5 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 07/24 Nose Hold your breath for 10 seconds to allow the medication to deposit in your airways. Use medical aseptic technique when administering Take the inhaler out of your mouth and slowly exhale medications into the nose. through pursed lips. Have clients lie supine with their head positioned to allow Resume normal breathing. the medication to enter the appropriate nasal passage. A spacer keeps the medication in the device longer, Use your dominant hand to instill nasal drops, thereby increasing the amount of medication the device supporting the head with your nondominant hand. delivers to the lungs and decreasing the amount of Instruct clients to breathe through the mouth, stay in a medication in the oropharynx. supine position, and not blow their nose for 5 min after If using a spacer: drop instillation. ◯ Remove the covers from the mouthpieces of the For nasal spray, prime the spray if indicated, insert tip into inhaler and of the spacer. nare, and point nozzle away from the center of the nose. ◯ Insert the MDI into the end of the spacer. Spray into nose while the client inhales. Instruct the ◯ Shake the inhaler five or six times. client not to blow their nose for several minutes. ◯ Exhale completely, and then close your mouth around the spacer’s mouthpiece. Continue as with an MDI. Rectal suppositories Position clients in the left lateral position or DPI Sims’ position. CLIENT EDUCATION Insert the suppository just beyond the internal sphincter. Do not shake the device. Instruct clients to remain flat or in the left lateral Take the cover off the mouthpiece. position for at least 5 min after insertion to retain the Follow the manufacturer’s directions for preparing the suppository. Absorption times vary with the medication. medication, such as turning the wheel of the inhaler or loading a medication pellet. Vaginal Exhale completely. Position clients supine with their knees bent and their Place the mouthpiece between your lips and take a deep feet flat on the bed and close to their hips (modified inhalation breath through your mouth. lithotomy or dorsal recumbent position). Hold your breath for 5 to 10 seconds. Provide perineal care, if needed. Take the inhaler out of your mouth and slowly exhale Lubricate the suppository or fill the applicator, through pursed lips. depending on the formulation. Resume normal breathing. Insert the medication along the posterior wall of If more than one puff is needed, wait the length of time the vagina (7.5 to 10 cm [3 to 4 in] for suppositories; the provider specifies before self-administering the 5 to 7.6 cm [2 to 3 in] for creams, jellies or foams) or second puff. instill irrigation as indicated. Rinse the mouth out with water or brush the teeth Instruct clients to remain supine for at least 5 min after if using a corticosteroid inhaler to reduce the risk of insertion to retain the suppository. fungal infections of the mouth. If using a reusable applicator, wash it with soap and Remove the canister and rinse the inhaler, cap, and water. (If it is disposable, discard it.) spacer once a day with warm running water and dry them completely before using the inhaler again. INHALATION Nasogastric and gastrostomy tubes Administered through metered dose inhalers (MDI) or Use liquid forms of medications; if not available, consider dry-powder inhalers (DPI) crushing medications if appropriate guidelines allow. MDI Do not administer sublingual medications through the NG tube (can give sublingual medications under the tongue). CLIENT EDUCATION Do not crush specifically-prepared oral medications Remove the cap from the inhaler’s mouthpiece. (extended/time-release, fluid-filled, enteric-coated). Shake the inhaler vigorously five or six times. Administer each medication separately. Hold the inhaler with the mouthpiece at the bottom. Do not mix medications with enteral feedings. Hold the inhaler with your thumb near the mouthpiece Completely dissolve crushed tablets and capsule contents and your index and middle fingers at the top. in 15 to 30 mL of sterile water prior to administration. Hold the inhaler about 2 to 4 cm (1 to 2 in) away from the front of your mouth or close your mouth around the NURSING ACTIONS mouthpiece of the inhaler with the opening pointing Verify proper tube placement. toward the back of your throat. Use a syringe and allow the medication to flow in by Take a deep breath and then exhale. gravity or push it in with the plunger of the syringe. Tilt your head back slightly, press the inhaler, and, at To prevent clogging, flush the tubing before and after the same time, begin a slow, deep inhalation breath. each medication with 15 to 30 mL of sterile water. Continue to breathe in slowly and deeply for 3 to Flush with another 15 to 30 mL of warm sterile water 5 seconds to facilitate delivery to the air passages. after instilling all the medications. 6 CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION CONTENT MASTERY SERIES 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 PARENTERAL ADVANTAGES Use for poorly soluble medications. NURSING ACTIONS Use for administering medications that have The vastus lateralis is best for infants 1 year slow absorption for an extended period of time and younger. (depot preparations). The ventrogluteal site is preferable for IM injections and for injecting volumes exceeding 2 mL. DISADVANTAGES The deltoid site has a smaller muscle mass and can only Injections are more costly. accommodate up to 1 mL of fluid. Injections are inconvenient. Use a needle size and length appropriate for the type There can be pain with the risk for local tissue damage of injection and the client’s size. Syringe size should and nerve damage. approximate the volume of medication. There is a risk for infection at the injection site. Use a tuberculin syringe for solution volumes smaller than 0.5 mL. Rotate injection sites to enhance medication absorption, INTRAVENOUS and document each site. NURSING ACTIONS Do not use injection sites that are edematous, inflamed, Use for administering medications, fluid, and or have moles, birthmarks, or scars. blood products. For IV administration, immediately monitor clients for Vascular access devices can be for short-term use therapeutic and adverse effects. (catheters) or long-term use (infusion ports). Use Discard all sharps (broken ampule bottles, needles) in 16-gauge devices for clients who have trauma, 18-gauge leak- and puncture-proof containers. during surgery and for blood administration, and 22- to 24-gauge for children, older adults, and clients who have medical issues or are stable postoperatively. INTRADERMAL Peripheral veins in the arm or hand are preferable. Ask NURSING ACTIONS clients which site they prefer. For newborns, use veins Use for tuberculin testing or checking for medication or in the head, lower legs, and feet. After administration, allergy sensitivities. immediately monitor for therapeutic and adverse effects. Use small amounts of solution (0.01 to 0.1 mL) in Use the Z-track technique for IM injections of a tuberculin syringe with a fine-gauge needle irritating fluids or fluids that can stain the skin (iron (26- to 27-gauge) in lightly pigmented, thin-skinned, preparations). This method prevents medication from hairless sites (the inner surface of the mid-forearm or leaking back into subcutaneous tissue. scapular area of the back) at a 10° to 15° angle. ADVANTAGES Insert the needle with the bevel up. A small bleb Onset is rapid, and absorption into the blood is should appear. immediate, which provides an immediate response. Do not massage the site after injection. This route allows control over the precise amount of medication to administer. SUBCUTANEOUS AND INTRAMUSCULAR It allows for administration of large volumes of fluid. It dilutes irritating medications in free-flowing IV fluid. NURSING ACTIONS DISADVANTAGES Subcutaneous IV injections are even more costly. Use for small doses of nonirritating, water-soluble IV injections are inconvenient. medications, such as insulin and heparin. Absorption of the medication into the blood is Use a 3/8- to 5/8-inch, 25- to 27-gauge needle or a immediate. This is potentially dangerous if giving the 28- to 31-gauge insulin syringe. Inject no more than wrong dosage or the wrong medication. 1.5 mL of solution. There is an increased risk for infection or embolism Select sites that have an adequate fat-pad size (abdomen, with IV injections. upper hips, lateral upper arms, thighs). Poor circulation can inhibit the medication’s distribution. For average-size clients, pinch up the skin and inject at a 45° to 90° angle. For clients who are obese, use a 90° angle. EPIDURAL Intramuscular NURSING ACTIONS Use for irritating medications, solutions in oils, and Use for IV opioid analgesia (morphine or fentanyl). aqueous suspensions. The clinician advances the catheter through the needle The most common sites are ventrogluteal, deltoid, and into the epidural space at the level of the fourth or vastus lateralis (pediatric). The dorsogluteal is no longer fifth vertebra. recommended as a common injection site due to its Use an infusion pump to administer medication. close proximity to the sciatic nerve. Use a needle size 18- to 27-gauge (usually 22- to 25-gauge), 1- to 1.5-inch long, and inject at a 90° angle. Solution volume is usually 1 to 3 mL. Divide larger volumes into two syringes and use two different sites. RN PHARMACOLOGY FOR NURSING CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION 7 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 07/24 Application Exercises Active Learning Scenario 1. A provider prescribes phenobarbital for a client who A nurse is showing a client how to use a metered-dose has a seizure disorder. The medication has a long inhaler (MDI) with a spacer. What should the nurse half-life of 4 days. How many times per day should include in the instructions? Use the ATI Active Learning the nurse expect to administer this medication? Template: Therapeutic Procedure to complete this item. A. One INDICATIONS: Identify the medication absorption B. Two pattern and a barrier to absorption. C. Three CLIENT EDUCATION: Describe the steps to D. Four follow when using an MDI with a spacer. 2. A nurse educator is reviewing medication metabolism at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply.) A. Increased renal excretion B. Increased medication-metabolizing enzymes C. Liver failure D. Peripheral vascular disease E. Concurrent use of medication the same pathway metabolizes 3. A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply.) A. Have the client lie on one side. B. Ask the client to look up at the ceiling. C. Tell the client to blink when the drops enter the eye. D. Drop the medication into the client’s conjunctival sac. E. Instruct the client to close the eye gently after instillation. 4. A nurse is teaching a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands? A. “I will clean the site with an alcohol swab before I apply the patch.” B. “I will rotate the application sites weekly.” C. “I will apply the patch to an area of skin with no hair.” D. “I will place the new patch on the site of the old patch.” 5. A nurse reviewing a client’s medical record notes a new prescription for verifying the trough level of the client’s medication. Which of the following actions should the nurse take? A. Obtain a blood specimen immediately prior to administering the next dose of medication. B. Verify that the client has been taking the medication for 24 hr before obtaining a blood specimen. C. Ask the client to provide a urine specimen after the next dose of medication. D. Administer the medication, and obtain a blood specimen 30 min later. 8 CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION CONTENT MASTERY SERIES 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 Application Exercises Key Active Learning Scenario Key 1. A. CORRECT: Medications with long half-lives remain Using the ATI Active Learning Template: Therapeutic Procedure at their therapeutic levels between doses for INDICATIONS long periods of time. The nurse should expect to Medication Absorption Pattern: rapid absorption through administer this medication once a day. the alveolar capillary network. A spacer keeps the B. Medications with long half-lives remain at their therapeutic medication in the device longer, thereby increasing the levels between doses for long periods of time. A amount of medication the device delivers to the lungs and medication the nurse administers twice a day would decreasing the amount of medication in the oropharynx. have a shorter half-life. An example is vancomycin. C. Medications with long half-lives remain at their therapeutic Barrier to Absorption: Inadequate respiratory effort levels between doses for long periods of time. A CLIENT EDUCATION medication the nurse administers three times a day would Remove the covers from the mouthpieces have a shorter half-life. An example is zidovudine. of the inhaler and of the spacer. D. Medications with long half-lives remain at their therapeutic Insert the MDI into the end of the spacer. levels between doses for long periods of time. A Shake the inhaler five or six times. medication the nurse administers four times a day would have a shorter half-life. An example is ibuprofen. Exhale completely, and then close your mouth around the spacer’s mouthpiece. NCLEX Connection: Pharmacological and Parenteral Therapies, ® Take a deep breath and then exhale. Medication Administration Tilt your head back slightly, press the inhaler, and, at the same time, begin a slow, deep inhalation breath. 2. A. Increased renal excretion decreases the concentration of Continue to breathe in slowly and deeply for 3 to 5 seconds the medication, requiring an increased dosage. to facilitate delivery to the air passages. B. Increased medication-metabolizing enzymes Hold your breath for 10 seconds to allow the decrease the concentration of the medication, medication to deposit in your airways. requiring an increased dosage. Take the mouthpiece out of your mouth and C. CORRECT: Liver failure decreases metabolism and slowly exhale through pursed lips. thus increases the concentration of a medication. Resume normal breathing. This requires decreasing the dosage. NCLEX® Connection: Pharmacological and Parenteral Therapies, D. Peripheral vascular disease impairs distribution, Medication Administration requiring an increased dosage. E. CORRECT: When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications. NCLEX® Connection: Pharmacological and Parenteral Therapies, Adverse Effects/Contraindications/Side Effects/Interactions 3. A. The client should be sitting or in a supine position to facilitate the instillation of eye drops. B. CORRECT: The client should look upward to keep the drops from falling onto the cornea. C. Ideally, the client should not blink so that they do not eject the eye drops. If they do blink, repeat the instillation. D. CORRECT: Drop the medication into the conjunctival sac to promote distribution. E. CORRECT: The client should close the eye gently to promote distribution of the medication. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration 4. A. The client should wash their skin with soap and water and dry it thoroughly before applying a transdermal patch. B. The client should rotate application sites daily to prevent skin irritation. C. CORRECT: The client should apply the patch to a hairless area of skin to promote absorption of the medication. D. The client should rotate application sites daily to prevent skin irritation. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration 5. A. CORRECT: To verify trough levels of a medication, the nurse should obtain a blood specimen immediately before administering the next dose of medication. B. The length of time the client has been taking the medication does not affect trough levels. C. Trough levels are measured from the blood, not urine. D. Trough levels reflect the least concentration of the medication in the client’s blood. It will be higher after administration of the medication. NCLEX® Connection: Pharmacological and Parenteral Therapies, Parenteral/Intravenous Therapies RN PHARMACOLOGY FOR NURSING CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION 9 07/24/15 April 15, 2019 3:31 PM rm_rn_2019_pharm_chp1 10 CHAPTER 1 PHARMACOKINETICS AND ROUTES OF ADMINISTRATION CONTENT MASTERY SERIES