Medication Management Flashcards

A patient is prescribed subcutaneous enoxaparin (low molecular weight heparin). What technique is important for injection?

Answer: Inject into the anterolateral or posterolateral abdominal wall, do not aspirate, do not rub the site

Enoxaparin is given SC into the abdomen (alternating left and right sides, at least 2 inches from the umbilicus). Aspiration is not required for SC injection. Rubbing after injection increases bruising and hematoma formation. Inject the entire air bubble last to prevent solution tracking back.

A patient on chemotherapy develops a fever of 38.3°C. What is the priority nursing action?

Answer: Treat as neutropenic fever — obtain blood cultures and administer broad-spectrum IV antibiotics within 1 hour

Neutropenic fever (temperature ≥38.3°C or 38°C twice in one hour in a neutropenic patient) is an oncological emergency. Blood cultures must be obtained from all lumens of the central line and peripherally, and empirical broad-spectrum antibiotics started within 60 minutes. Delay significantly increases mortality.

Which medication requires a test dose before the first full dose due to risk of anaphylaxis?

Answer: IV iron dextran

IV iron dextran (not iron sucrose or ferric carboxymaltose) carries a significant risk of anaphylaxis and requires a test dose of 25 mg over 5 minutes with monitoring for 30–60 minutes before the full therapeutic dose. Oral iron and other IV iron formulations have different risk profiles.

A patient on corticosteroid therapy requires surgery. What medication adjustment is required?

Answer: Administer stress-dose corticosteroids (hydrocortisone) perioperatively to prevent adrenal crisis

Chronic corticosteroid use suppresses the HPA axis, impairing the body's ability to mount a cortisol stress response to surgery. Stress-dose steroids (hydrocortisone 50–100 mg IV every 6–8 hours) are required perioperatively to prevent adrenal crisis (hypotension, vomiting, shock).

A nurse is educating a patient prescribed oral bisphosphonates (alendronate) for osteoporosis. What is the most critical instruction?

Answer: Take with a full glass of plain water, remain upright for 30 minutes, take on empty stomach

Bisphosphonates can cause esophageal ulceration. To prevent this: take on an empty stomach with plain water (food, coffee, and antacids reduce absorption), remain upright (sitting/standing) for at least 30 minutes, and do not crush or chew. Take first thing in the morning before any food.

A patient's medication administration record shows methotrexate ordered daily for cancer. The nurse notes the usual dose for rheumatoid arthritis is weekly. What should the nurse do?

Answer: Clarify the order with the prescriber before administration; cancer dosing and RA dosing are different regimens

Methotrexate is a high-alert medication with dramatically different dosing regimens: weekly for RA/psoriasis vs. daily or high-dose protocols for specific cancers. However, a nurse unfamiliar with the specific cancer protocol MUST clarify before administering. Errors have caused fatal outcomes. Never assume.