CHAPTER 8: ADMINISTRATION BY THE GASTROINTESTINAL ROUTE

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CHAPTER 27: DRUGS AND OLDER ADULTS

TRUE/FALSE

1. Medications are administered by the gastrointestinal route more often than any other way.

ANS: T

This includes orally, rectally, and by nasogastric and gastric tube.

PTS: 1

2. The oral route of administration is preferred over injection.

ANS: T PTS: 1

3. Administration of medications by the oral route should be used in order to prevent aspiration in unconscious patients.

ANS: F

Unconsciousness is a clear contraindication to oral administration due to the risk of aspiration.

PTS: 1

4. The rectal route of administration may be preferred due to availability of almost all medications in suppository form.

ANS: F

Actually, many medications are not available in suppository form, which is a disadvantage.

PTS: 1

5. Aspiration is defined as the inhalation of a foreign substance or regurgitated gastric contents.

ANS: T PTS: 1

6. Administration of liquid oral medications is preferred for children under 5 years of age.

ANS: T PTS: 1

7. Patient cooperation is not required for administration of rectal medications.

ANS: F PTS: 1

8. One disadvantage to the oral route of administration is that it should not be used prior to surgery.

ANS: T PTS: 1

9. A physician’s order is not required to crush pills for administration.

ANS: F

An order may or may not be required depending on the practice area.

PTS: 1

10.A nasogastric tube is always inserted solely for the purpose of administering medication.

ANS: F PTS: 1

Multiple Choice

1. Oral medications may not be administered in which of the following situations?

a. Children c. NPO status b. Elderly d. Mentally disabled

ANS: C

NPO status is the only clear contraindication for oral administration of medications.

PTS: 1

2. A disadvantage of the oral route of administration is: a. patient discomfort. b. rapid rate of absorption. c. more costs related to oral administration. d. unable to use this route for unconscious patients.

ANS: D

Oral administration is associated with less patient discomfort and fewer costs, but these pluses are accompanied by a decreased rate of absorption.

PTS: 1

3. Aspiration is best defined as: a. unintentional inhalation of a substance that may result in lung damage or infection. b. administration of medication via the nasogastric route. c. administration of a medication by breathing in via inhaler delivery. d. irritation of the upper GI tract.

ANS: A

Feedback

A Correct!

B NG tube administration is used in order to help prevent aspiration.

C Inhalation administration is achieved by inhaler delivery.

D GI irritation may be caused by prolonged placement of an NG tube or by certain medications administered orally.

PTS: 1

4. A gastric tube is used for medication delivery: a. in patients able to tolerate oral medications. b. in patients who are unable to take anything by mouth for an extended period of time. c. in patients who are nauseated. d. all of the above.

ANS: B

A

Feedback

If a patient can tolerate oral medications, a gastric tube is not indicated.

B Correct!

C

Nauseated patients may receive food and nutrients via less invasive means than a gastric tube, e.g., rectally or by NG tube.

There is only one correct response.

PTS: 1

5. A disadvantage of rectal administration may be: a. patients who have difficulty retaining suppositories. b. incomplete or irregular absorption of the medication due to the presence of feces. c. irritation related to the medication being given by suppository. d. all of the above.

ANS: D

All responses are correct.

PTS: 1 a. Bypasses the action of digestive enzymes b. Avoids irritation to the upper GI tract c. Not appropriate for use in children d. Useful in patients with dysphagia

6. Which of the following is NOT true regarding rectal administration?

ANS: C

All are true except for C. Rectal route of administration is often very helpful in children in order to avoid injections and in those too young to follow instructions regarding oral administration.

PTS: 1 a. Blood pressure, before c. Respiratory rate, after b. Heart rate, before and after d. Blood pressure, before and after

7. _____ should be measured _____ administration of antihypertensives.

ANS: D PTS: 1

8. When administering a liquid medication to a person who is unable to drink from a cup, it may be necessary to: a. use a syringe. b. use an NG tube. c. pour the medication from the cup into the patient’s mouth. d. have the order changed to an injection.

ANS: A

A syringe may be a useful tool in helping to give medication to a person who is unable to drink from a cup but still has an intact swallow reflex. An NG tube is not indicated for medication administration only. Pouring the medication into the patient’s mouth would increase the risk for aspiration and should not be attempted. It is usually unnecessary to change the order to an injection as the route of administration.

PTS: 1 a. Intravenous c. Intraosseous b. Injection d. Oral liquid

9. Which is the route of choice for administering medications to a child under 5 years of age?

ANS: D

Intravenous, injection, and intraosseous [injected into the bone marrow] are possible routes but are not the preferred routes. Oral liquid administration is the preferred route of administration when the child is able to swallow and retain oral liquids.

PTS: 1 a. Prepare a large syringe in case additional pressure is required to force the medication through the tube. b. Check for proper tube placement by auscultation with a stethoscope and by aspiration. c. Clamp the tube for 30 minutes. d. Flush the tube with water to make sure it is patent.

10.What should be done PRIOR to administration of medications by NG tube?

ANS: B Feedback

A Pressure should not be used in an NG tube either before or after administration.

B Correct! Placement should be checked by at least two methods prior to medication delivery.

C Clamping the tube should be performed only after administration to permit absorption.

D The tube should only be flushed after medication has been administered and should never be flushed prior to checking for placement.

PTS: 1

11.The guidelines for administering medications via a gastric tube are the same as for an NG tube EXCEPT: a. wash your hands. b. it is not necessary to aspirate or use a stethoscope to check for placement. c. clamp the tube after the medication has been instilled. d. turn the patient on the right side.

ANS: B

A

Handwashing is always necessary.

B Correct! It is not necessary to verify placement because a gastric tube has been surgically placed.

C The tube should still be clamped after instilling medication.

D Turning the patient to the right side aids in emptying of the stomach.

PTS: 1

12.With regard to rectal administration of medications, it is very important to remember: a. rectally administered medications are especially dangerous. b. positioning the patient is irrelevant as long as the medication is placed in the rectum. c. to respect the patient’s dignity. d. that the patient’s cooperation is not necessary once the medication is in place.

ANS: C

Feedback

A There is no particular risk associated with rectally administered medications versus other routes of delivery.

B Positioning on the left side with the knee bent helps the patient retain the medication for the desired length of time.

C Correct! This may be an uncomfortable or embarrassing event for the patient and his privacy and dignity must be considered.

D The patient’s cooperation helps a great deal in placement, administration, and retention of the medication.

PTS: 1 a. So that the bottom of the cup is visible at all times b. Slightly tilted so the measuring lines on the side are easier to see c. Level and on the counter to avoid spilling d. Level and with the miniscus at eye level

13.When preparing liquids for oral administration, the medicine cup should be held in what position for measuring?

ANS: D

A

This perspective will make the cup appear more full than it is, resulting in an incomplete dose.

B Tilting the cup will alter the measurement, resulting in underdosing or overdosing.

C This perspective may cause the cup to be overfilled, resulting in an overdose.

D Correct! The miniscus is the concave line seen in the top of a liquid, and it is used in achieving the desired volume when measuring in a vessel.

PTS: 1

14.When administering medications via the oral, nasogastric, or gastric tube, the medication temperature: a. should be room temperature. c. should be heated. b. should be cold. d. does not matter.

ANS: A

Feedback

A Correct! Room temperature is optimal for absorption of medications.

B Cold temperatures delay gastric absorption and emptying.

C Heating a medication may alter it or destroy its efficacy, particularly antibiotics.

D Incorrect.

PTS: 1

MATCHING a. Prepare the dose as ordered. b. Measure pertinent vital signs. c. Wash the hands. d. Locate the medication in the cupboard and compare it against the medication sheet. e. Provide a full glass of water. f. Record medication, dose, and time on the patient’s record. g. Check for completeness of the order. h. Open unit-dose packet.

Place the following oral medication administration activities in order.

3. ANS: D PTS: 1