Problem 82 - Cliffs Test Prep NCLEX-RN

Question

What nursing action would cause an inadvertent toxic dose to be administered? 1\. The nurse administers an enteric-coated tablet with an antacid. 2\. The nurse crushes a sustained-release tablet and administers it via the gastrostomy tube. 3\. The nurse administers a suspension medication through the nasogastric tube and then flushes the tubing with clear water. 4\. The nurse administers the intravenous dose of Demerol via the intramuscular route.

Step-by-Step Solution

Answer

Crushing a sustained-release tablet and administering it causes a toxic dose (Option 2).

Step 1: Understand the Options

We have four different scenarios related to medication administration by a nurse. Each scenario must be analyzed to determine if it could lead to a toxic dose being administered inadvertently.

Step 2: Analyze Option 1

When a nurse administers an enteric-coated tablet with an antacid, the antacid can alter the stomach's pH, potentially affecting the dissolution of enteric-coated medications. However, this situation is less likely to cause an immediate toxic dose since enteric-coated tablets are designed to resist stomach acid.

Step 3: Analyze Option 2

Crushing a sustained-release tablet and administering it via a gastrostomy tube alters the release mechanism of the medication. Sustained-release tablets are designed to release medication gradually. Crushing it results in the entire dose being released at once, potentially causing toxicity.

Step 4: Analyze Option 3

Administering a suspension medication through a nasogastric tube and flushing it with water is a commonly accepted practice and does not inherently lead to a toxic overdose, as long as the dosage is correct.

Step 5: Analyze Option 4

Administering an intravenous dose of Demerol via the intramuscular route changes the absorption rate and effectiveness, but does not directly cause an overdose. The administration route needs to be appropriate but in this case it's about efficacy rather than toxicity.

Step 6: Identify the Correct Option

Based on the analysis, Option 2 involves crushing a sustained-release tablet which can release the medication all at once, potentially causing an overdose. This action is the most likely to inadvertently cause a toxic dose.

Key Concepts

Medication Administration

In the nursing field, medication administration is a crucial task that requires precision and adherence to protocols. This ensures safe and effective patient care. Administering medication involves the correct delivery of drugs as prescribed by a healthcare provider. Nurses must know the "five rights" of medication administration:

• Right patient
• Right medication
• Right dose
• Right route
• Right time

Adhering to these ensures medications are given safely and effectively.
Another important aspect is understanding the forms and routes of medications. For example, some medications should not be crushed or altered, as doing so can change their therapeutic effect or cause harm, as in the exercise where crushing a sustained-release tablet can lead to toxic dosing.
Comprehensive knowledge of each drug's properties helps nurses prevent errors and provide optimal patient care.

Toxic Dose Prevention

Preventing toxic doses is a fundamental responsibility for nurses, as even a minor error could lead to significant harm for patients. When considering toxic dose prevention, it’s important to understand:

• Drug interactions: Some drugs may interact with others, or with food, like antacids altering the absorption of enteric-coated tablets.
• Specific drug mechanisms: For instance, sustained-release formulations that are crushed will release their active ingredients too quickly, potentially leading to overdose.
• Assessments of patient status: Monitoring vital signs and lab results helps in recognizing early signs of toxicity.

In addition to understanding these factors, continuous education on new medications and updates in pharmacology contributes to safer medication practices. Nurses must always double-check doses and seek clarification if uncertain, highlighting the importance of vigilance in preventing toxic doses.

Drug Delivery Methods

Understanding drug delivery methods is essential in nursing pharmacology, as different methods can greatly influence drug effectiveness and patient outcomes. There are numerous drug delivery methods, including oral, sublingual, inhalation, intravenous (IV), intramuscular (IM), and subcutaneous, among others. Each method has specific considerations:

• Oral medications: Swallowed and absorbed through the digestive tract, requiring time for effect.
• Intravenous (IV): Delivered directly into the bloodstream for rapid effect, avoiding the digestive system.
• Intramuscular (IM): Administered into a muscle, releasing medication more slowly than IV administration but faster than oral.
• Enteric-coated tablets: Designed to resist stomach acid and dissolve in the intestine to avoid stomach irritation.

Choosing the appropriate delivery method involves understanding the patient's condition, the desired speed of effect, and the nature of the medication itself. For example, delivering an IV medication by the IM route, as noted in the exercise, may alter the rate of absorption, affecting therapeutic outcomes. Mastery of various administration techniques enhances patient safety and therapy effectiveness.