CMT Medication Administration Routes — Questions and Answers
Question 1: The sublingual route of medication administration involves placing the medication:
- Under the tongue (Correct answer)
- Between the cheek and gum
- In the ear canal
- On the skin surface
Correct answer: Under the tongue
Sublingual means 'under the tongue,' where the medication dissolves and is absorbed directly into the bloodstream through the oral mucosa.
Sublingual administration provides rapid drug absorption through the highly vascular mucosa under the tongue, bypassing first-pass metabolism in the liver. This results in faster onset and higher bioavailability compared to oral (swallowed) medications. The most common sublingual medication is nitroglycerin for angina relief. Patients should not eat, drink, or smoke during sublingual administration. The medication should be placed under the tongue and allowed to dissolve completely without swallowing. Buccal administration (between cheek and gum) is similar but uses a different mucosal surface.
Question 2: Which injection route has the slowest absorption rate?
- Intravenous
- Intramuscular
- Subcutaneous
- Intradermal (Correct answer)
Correct answer: Intradermal
Intradermal injections are placed in the dermis, which has limited blood supply, resulting in the slowest absorption.
Absorption rates from fastest to slowest: intravenous (immediate—directly into bloodstream), intramuscular (moderate—well-vascularized muscle tissue absorbs within 10-20 minutes), subcutaneous (slower—fat tissue has less blood supply, absorption takes 15-30 minutes or longer), intradermal (slowest—the dermis has very limited vascularity). Intradermal injections (TB skin test, allergy testing) use a 25-27 gauge needle at a 5-15 degree angle, injecting only 0.01-0.1 mL into the dermis to create a visible wheal. The slow absorption is actually desired for these diagnostic tests.
Question 3: Transdermal medication patches work by:
- Injecting medication through the skin with microneedles
- Delivering medication through intact skin into systemic circulation over time (Correct answer)
- Numbing only the skin surface
- Absorbing toxins from the skin
Correct answer: Delivering medication through intact skin into systemic circulation over time
Transdermal patches deliver medication through the intact skin at a controlled rate for systemic absorption over hours or days.
Transdermal drug delivery systems release medication at a controlled rate through the skin into the capillary network for systemic circulation. Advantages include sustained drug levels, avoidance of first-pass metabolism, improved compliance, and non-invasive application. Common transdermal medications include fentanyl (pain), nitroglycerin (angina), nicotine (smoking cessation), estrogen (hormone replacement), and scopolamine (motion sickness). Application rules: rotate sites to prevent skin irritation, apply to clean, dry, hairless skin (do not shave—clip if needed), avoid areas with cuts or irritation, date and initial the patch, and remove the old patch before applying a new one.
Question 4: When administering eye drops, the medication should be instilled into the:
- Center of the cornea
- Upper eyelid
- Lower conjunctival sac (Correct answer)
- Inner canthus
Correct answer: Lower conjunctival sac
Eye drops are placed into the lower conjunctival sac (the pocket formed by gently pulling down the lower eyelid) to avoid direct corneal irritation.
Proper ophthalmic instillation technique: (1) Perform hand hygiene and don gloves, (2) Have patient look up, (3) Gently pull down the lower eyelid to expose the conjunctival sac, (4) Instill the prescribed number of drops into the conjunctival sac (not directly on the cornea), (5) Release the lid and have patient close eyes gently (not squeezing), (6) Apply gentle pressure to the nasolacrimal duct (inner corner of eye) for 1-2 minutes to prevent systemic absorption, (7) Wait 5 minutes between different eye medications. Never touch the dropper tip to the eye or any surface. For ointments, apply a thin ribbon along the inner lower lid from inner to outer canthus.
Question 5: The intravenous (IV) route is preferred in emergencies because:
- It is the easiest to administer
- It provides immediate drug bioavailability and rapid onset (Correct answer)
- It requires the smallest needle
- It causes the least pain
Correct answer: It provides immediate drug bioavailability and rapid onset
IV administration delivers medication directly into the bloodstream, providing 100% bioavailability and immediate onset of action.
Intravenous administration provides the fastest onset because medication enters the systemic circulation immediately without requiring absorption. Bioavailability is 100%—the entire dose reaches the bloodstream. In emergencies, this allows rapid titration of critical medications (epinephrine, atropine, vasopressors). IV medications can be given as bolus (push—rapid injection), intermittent infusion (over 15-60 minutes), or continuous infusion (ongoing drip). Disadvantages include infection risk, phlebitis, infiltration, air embolism, and the inability to recall medication once administered. Medical technicians must verify IV competency is within their scope of practice.
Question 6: Rectal medication administration is appropriate when a patient:
- Has an IV line available
- Is vomiting and unable to take oral medications (Correct answer)
- Prefers this route over oral
- Has a rectal infection
Correct answer: Is vomiting and unable to take oral medications
The rectal route is used when oral administration is not possible due to nausea, vomiting, unconsciousness, or NPO status.
Rectal administration is indicated when oral intake is impossible (vomiting, seizures, unconsciousness, NPO), when drugs would be destroyed by gastric acid, or for local effects (hemorrhoids, constipation). Medications include suppositories and enemas. Approximately 50% of rectally absorbed medication bypasses first-pass hepatic metabolism (through the inferior and middle rectal veins). Administration technique: position patient in left lateral (Sims') position, lubricate suppository, insert past the internal anal sphincter (approximately 1 inch in adults), and have patient remain lying down for 15-20 minutes. Contraindications include rectal surgery, active bleeding, and low platelet counts.
Question 7: The Z-track technique for intramuscular injection is used to:
- Speed up medication absorption
- Prevent medication from leaking back through the needle track (Correct answer)
- Reduce the pain of injection
- Allow for larger volumes of medication
Correct answer: Prevent medication from leaking back through the needle track
The Z-track method displaces the skin and subcutaneous tissue before injection, creating a zigzag path that seals the medication in the muscle.
The Z-track technique prevents medication from tracking back through subcutaneous tissue, which can cause irritation, staining, or pain. Procedure: (1) Pull the skin and subcutaneous tissue 1-1.5 inches laterally from the injection site, (2) Insert the needle at 90 degrees, (3) Aspirate if required by facility policy, (4) Inject medication slowly (10 seconds per mL), (5) Wait 10 seconds after injection, (6) Withdraw needle, (7) Release the displaced tissue. The tissue layers slide back to their normal position, creating a zigzag path that seals the medication in the muscle. Originally recommended only for irritating medications (iron dextran, hydroxyzine), the Z-track is now recommended for all IM injections.
Question 8: Nebulizer treatments deliver medication via:
- Injection into the lungs
- Aerosolized mist inhaled into the respiratory tract (Correct answer)
- Absorption through the nasal mucosa
- Oral tablets that dissolve quickly
Correct answer: Aerosolized mist inhaled into the respiratory tract
Nebulizers convert liquid medication into a fine aerosol mist that is inhaled deep into the lungs through a mouthpiece or mask.
Nebulizers are devices that convert liquid medications into aerosolized particles (1-5 microns) small enough to reach the lower respiratory tract. Types include jet nebulizers (compressed air), ultrasonic nebulizers (high-frequency vibrations), and mesh nebulizers (vibrating mesh plate). Common nebulized medications include bronchodilators (albuterol), corticosteroids (budesonide), and mucolytics (acetylcysteine). Treatment typically takes 10-15 minutes. Patient positioning should be upright (45-90 degrees) for optimal lung expansion. After corticosteroid nebulization, patients should rinse their mouth to prevent oral thrush. Medical technicians should monitor respiratory status before, during, and after treatments.
Question 9: When administering an otic (ear) medication, the adult ear canal is straightened by pulling the pinna:
- Down and back
- Up and back (Correct answer)
- Straight outward
- Forward and down
Correct answer: Up and back
In adults, the ear canal is straightened by pulling the pinna (outer ear) up and back to facilitate medication delivery.
The external ear canal in adults has an S-shaped curve. Pulling the pinna up and back straightens this curve, allowing drops to flow to the tympanic membrane. For children under 3 years, the pinna is pulled down and back because the ear canal is more horizontal. Administration technique: (1) Warm drops to body temperature by holding the bottle for a few minutes (cold drops cause vertigo), (2) Position patient with affected ear up, (3) Straighten the canal with appropriate technique, (4) Instill prescribed drops along the canal wall, (5) Have patient remain in position for 5 minutes, (6) Place a cotton ball loosely at the ear opening if ordered. Never force drops into an obstructed canal or insert the dropper into the canal.
Question 10: The maximum volume for a single subcutaneous injection in an adult is typically:
- 0.1 mL
- 0.5 mL
- 1.0-1.5 mL (Correct answer)
- 3.0 mL
Correct answer: 1.0-1.5 mL
The maximum volume for subcutaneous injection in adults is generally 1.0-1.5 mL to prevent tissue distension and discomfort.
Subcutaneous injection volume is limited by the capacity of subcutaneous tissue to absorb fluid without causing excessive pain or impaired absorption. The generally accepted maximum is 1.0-1.5 mL in adults (some sources cite up to 2 mL for certain medications). For comparison, IM injection volumes can be up to 3 mL in the ventrogluteal site (5 mL in very large muscles). Common subcutaneous injection sites include the abdomen (avoiding 2 inches around the umbilicus), upper outer arms, anterior thighs, and upper buttocks. Sites should be rotated to prevent lipohypertrophy (tissue thickening) especially with insulin. Subcutaneous injections use 25-30 gauge needles at 45-90 degrees depending on tissue thickness.
Question 11: Topical medications are applied to:
- Directly into the bloodstream
- The skin surface or mucous membranes for local or systemic effect (Correct answer)
- Only open wounds
- Internal organs during surgery
Correct answer: The skin surface or mucous membranes for local or systemic effect
Topical medications are applied to the skin or mucous membranes and may provide local effects (anti-itch cream) or systemic effects (transdermal patches).
Topical medications include creams, ointments, lotions, gels, powders, sprays, and transdermal patches applied to the skin or mucous membranes. Local topical effects include anti-inflammatory, antimicrobial, anesthetic, and antipruritic actions at the application site. Systemic topical medications (transdermal patches, some creams) are absorbed through the skin into circulation. Application principles: clean the area before application, use gloves to avoid absorbing the medication yourself, apply a thin even layer unless otherwise directed, do not cover with occlusive dressing unless ordered, and document the site, time, and patient response. Nitroglycerin paste requires measured application paper.
Question 12: Before administering any medication, the medical technician must first verify:
- That the pharmacy is open
- The prescriber's order and the five rights of medication administration (Correct answer)
- That the patient has insurance coverage
- That the medication is the cheapest available option
Correct answer: The prescriber's order and the five rights of medication administration
Medication administration always begins with verifying a valid prescriber's order and checking the five rights: right patient, drug, dose, route, and time.
The medication administration process begins with a valid prescriber's order—verbal, written, or electronic. The technician must verify the order is complete (patient name, medication, dose, route, frequency, prescriber signature), check for allergies, review for contraindications and interactions, and apply the five rights at three checkpoints: when retrieving the medication, when preparing it, and when administering it. Additional checks include verifying the medication has not expired, confirming the patient has not already received the dose, and assessing whether the patient's current condition warrants giving the medication (e.g., holding blood pressure medication if BP is too low). Documentation must occur immediately after administration.
CMT Medication Administration Routes
The sublingual route of medication administration involves placing the medication:
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