those daggone tricky questions!!

[DAMomma]

Here is the question:

What would a priority be when administering a medication?

a) is the med in the med cart?

b) is the dose ordered correct?

c) for the patient to state name

4) some other obviously wrong answer

I picked B. We have to make sure the dose is correct before administering right? For this question...WRONG! The question is to be read as you are already in the patient's room. Your priority at this point would be to have the patient to state name...:trout: . You should have checked to see if the dose is safe back in the med room.... .

[Cindy_A]

I think that they should have stated that you are already in the pt.'s room.

Besides it's not always a good idea to ask a patient to state his or her name. But I guess they ASSUME everyone is able to state their own name, which is not always the case. I guess you didn't do too well in Mind-reading. :uhoh3: Me neither!

[TazziRN, RN]

If you are in the room, then having the pt state his/her name is the best answer among the choices given, but the location of the nurse was not made clear in the question. I think that one could be argued if enough people in the class got it wrong.

[happybunny1970]

Forgive me... it's been a few years since Nursing School... Don't those "5 R's" start with Right Patient? My instructors always used to hammer that kind of thing into my head... that the first thing you need to do before doing ANYTHING with or for a patient was to be sure you had the right patient. Seemed extraneous at the time, but man, have I seen/heard about some doozy mistakes!

That was a kind of test-taking skill... break it down and don't read too much into the question.

[Daytonite, BSN, RN]

If you read the root of the question closely it is telling you that you are already at the point of "administering" the medication, or giving it, ready to have the patient put it in their mouth (if it is an oral med). That would mean that all the other preliminary stuff has been completed. You would have known by then that a dose was missing from the cart or that the ordered dose was incorrect. You have to look at the root of those questions carefully and figure out where they are putting you in the procedure or the process timeline and then go from there. In probably 90% of these critical thinking or application type questions that is what they are doing. You have to always be thinking like this.

What instructors know about these kinds of questions is that when students aren't able to get the critical thinking part of them, they will go for the answer choice that seems the most familiar to them. They also know that many students are very good about following rules, so they'll stick a good rule in there. Students are told about the 5 R's of drug administration ad nauseum, so they recognize this rule about the ordered dose being correct right off the bat. However, in the chain of events that occurs during medication administration that would have come up as you read the medication record, long before the actual administration of the drug to the patient. It helps to picture an actual scenario of going through the process of giving a patient a medication from start (doctor's order) to finish (patient's body) in your mind.

Cinda A. . .there is no rationale to support not asking a patient to state their name. This is usually listed as part of the medication administration protocol in the procedure manuals of most facilities. It is also an assessment tool. Never assume that a patient isn't able to state or remember their name. Never assume that giving you a wrong name is evidence of dementia. It could also be evidence of a psychiatric problem or impending brain pathology. You are always assessing as you go through your workday with patients. In every devious and tactful way you can dream up. Always. That is part of our responsibility.

[EricJRN, MSN, RN]

Hard to know what the person writing the question has in mind exactly, but I leaned away from answer C simply because I think it would be preferable to check an armband.

[jjjoy, LPN]

What do we want to test that the student knows? For patient safety, a nurse should always check that the dosage is correct and the nurse should always verify who the patient is. To be efficient, the nurse should make sure that the med is available to give when at the ordered time. So what exactly is this question testing?

Is the student seriously supposed to look at this question and think... "it says 'when administering' and that must mean I already have the med ready and have checked the dosage so those two important steps aren't 'priorities' now because they've already been done and so right now, the 'priority' is to verify the patient identity which I can do by having the patient state their name, thus answer C is correct."

It may be testing one's ability to choose the "best" answer with uncertainty and incomplete information. In this case, we have to interpert that "when administering the medication" means that the nurse is already at the bedside and assume that the previous important steps have already been taken. That's a rather pointless exercise since as the nurse you have to make sure the med is in the med cart, check that the ordered dosage is correct and verify the patient identity. They are all "a priority" at some point in the process.

Heck, I could argue that it's ALWAYS "a priority" to check the correct dosage but that the patient can't always state their name (eg a baby, an unresponsive patient). Thus, answer "c" can't be correct because that's not ALWAYS "a priority."

Also, just to be nitpicky, the five rights of medication administration includes verifying "right dosage" so it's rather contradictory if the instructor is asking the student to assume that the nurse in this question is already at the bedside having already checked the dosage.

Perhaps the point of this question is that even if you're positive you know the patient (as you've been working with them all day) that you still should ask them state their name. The problem here is that we can't even tell what the question is testing.

[DAMomma]

Thanks guys, the teacher said the point was "when administrating" the med. That is funny you guys mentioned 5 patient rights. We were taught to remember this way: TPRMD = Right Time, Right Patient, Right Route, Right Medication, Right Dose.

Always a learning experience!

[happybunny1970]

Hard to know what the person writing the question has in mind exactly, but I leaned away from answer C simply because I think it would be preferable to check an armband.

Yeah, but I had a patient a couple years ago who had been in the hospital for more than 24 hours... and when I checked his wristband IT WAS WRONG. This was a walkie-talkie -- he just hadn't looked at it, and apparently neither had any of the staff before I got there.

[Daytonite, BSN, RN]

i had never heard that there was a specific sequence to the 5 r's. in any case, it is a nursing fundamental, a piece of information, that you also needed to incorporate into your critical thinking in reasoning out the answer. the next time you are in a clinical area, pull out the facility procedure for administration of medications to a patient and you are going to see how the answer to this question works out.

once you've established the sequence of all the links in the chain of administering a medication, pick one of the steps, and develop a question around it and put 3 other answer choices with it. they might be good choices, but they won't fit in the exact place (link) of the chain that the question is asking for. that's how instructors come up with these kinds of questions. this is why i'm saying determine what process or procedure you've been dropped into the middle of and proceed from there. there is only one nursing process and all kinds of different nursing procedures. if you assess your situation (nursing process? or nursing procedure?) incorrectly because you didn't interpret the stem of the question correctly, you're going to choose the wrong answer. good instructors knowing the difference between the two are going to supply answer choices that will lead you down each path to see who is thinking and who isn't. sometimes, you're going to get tripped up on vocabulary. so, you also need to be aware of the lingo being used. this is how you develop your critical thinking skills. this was a fair question.

[Rhfish2]

I've taught clinicals for many years as an adjunct at both the ADN and BSN levels and we always explain the rationale to the student. Check the meds, dose route of admin etc prior to even going in to the patient room, or you will have to take the cart with you as you leave the room to contact the pharmacy and this effects productivity. At the patient bedside the most important thing to do is to identify the correct patient and the most prudent way to do this is to ask the patient his or her name as well as check their armband as a back-up. As nurses it is incumbent upon us to provide safety to our patients.

[jjjoy, LPN]

I still don't see that "administering the medication" necessarily means that you've already checked and prepared the medication and are just about to give it to the patient. The term "medication administration" often includes the preparation phase - as on these websites

http://www.mapharm.com/safety_guides.htm

http://www.massnurses.org/nurse_practice/sixrights.htm

The question asks what's "a priority" when administering. Checking the dosage and having the patient state their name (if possible) are each "a priority" in their own right.

This seems like a better question: What would a priority be when administering any medication to an alert and oriented patient?

A. Bringing fresh water for the patient

B. Having the patient state their name

C. Documenting patient input and output

D. Taking patient blood pressure

All of those tasks are important, but only one is the correct answer to that question.