What should the nurse do to assist a patient who is having difficulty swallowing tablets?

The answer to question 1

C
If the patient has difficulty swallowing, use a pill-crushing device to crush the tablets. Mix the ground tablet in a small amount of soft food (custard or applesauce). Large tablets are often difficult to swallow. A ground tablet mixed with palatable soft food is usually easier to swallow. Not all drugs can be crushed (e.g., capsules, enteric-coated, long-acting/slow-release drugs). The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids. Administration of medication with less fluid could make it more difficult for the patient to swallow. Insertion of a nasogastric tube requires an order from the health care provider. A patient who is having difficulty swallowing may not be safe when swallowing large capsules or tablets even one at a time. Thin liquids such as water are more readily aspirated than thickened liquids.

The answer to question 2

C
When writing medication dosages in metric units, convert fractions to decimals. Always include a zero before a decimal point (e.g., 0.1 mL is correct). Never use a trailing zero (e.g., 1.0 mL is incorrect).

The answer to question 3

C
Effective treatment for dry skin does not include limiting the frequency of bathing but lies in bathing with warm, not hot, water and using moisturizers. Superfatted soap (e.g., Dove) should be used for cleansing. The body should be rinsed well of all soap, because residue left can cause irritation and breakdown. Moisture should be added to the air through the use of a humidifier. Fluid intake should be increased when the skin is dry.

The answer to question 4

A
If you have to break a medication to administer half the dosage, use a clean, gloved hand to break the tablet or cut it with a cutting device. Tablets that are to be broken in half must be pre-scored by a manufactured line that transverses the center of the tablet. Tablets that are not pre-scored cannot be broken into equal halves, and the result will be an inaccurate dose. Using a cutting device results in a more even split of the tablet. Wrappers maintain the cleanliness of medications and identify drug name and dose. Not all drugs can be crushed (e.g., capsules, enteric-coated, long-acting/slow-release drugs). The coating of these drugs protects the stomach from irritation or protects the drug from destruction by stomach acids. Liquid medications poured from a stock bottle should be poured into a medication cup that is placed at eye level on a flat surface.

The answer to question 5

B
Drug allergies should be listed on each page of the MAR, prominently displayed on the patient's medical record, and the patient should be wearing the facility's allergy bracelet. Assessment for drug allergies is necessary before medication is administered. A patient's diet, surgical, and drug histories are important to assess, but they are not as critical as allergy history, which can reveal life-threatening conditions.

The answer to question 6

D
Ask the patient to look toward the brow. Gently irrigate with a steady stream toward the lower conjunctival sac. This will minimize the force of the stream on the cornea and will flush irritant out of the eye and away from the other eye and nasolacrimal duct. In an emergency such as first aid for a chemical burn, do not delay flushing by removing the patient's contact lens before irrigation. Do not remove the contact unless rapid swelling is occurring. Flush the eye from the inner to the outer canthus. Advise the patient to consult the prescriber before reusing the contact lens.

The answer to question 7

effleurage
Effleurage is massaging upward and outward from the vertebral column and back again. Gliding strokes, used without manipulation of deep muscles, smooth and extend muscles, increase nutrient absorption, and improve lymphatic and venous circulation.

The answer to question 8

D
An allergic reaction ranges from mild to severe, depending on the patient and the medication. Among the different classes of medications, antibiotics cause a high incidence of allergic reactions. Sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, severe wheezing, and shortness of breath are characteristic of severe or anaphylactic reactions. Some patients become severely hypotensive, necessitating emergency resuscitation measures. Anaphylaxis is potentially fatal. Medications often cause unpredictable effects, such as an idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction that is different from normal. However, the symptoms displayed by this patient are classic anaphylactic symptoms. Toxic effects develop after prolonged intake of a medication, when a medication accumulates in the blood because of impaired metabolism or excretion, or when too high a dose is given. Two doses of a medication usually are not enough to develop toxic effects. Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. Anaphylaxis is usually unpredictable initially and is avoided after the first reaction by listing the cause of the anaphylaxis in the allergy alert section of the patient record.