Medication Calc/Administration Help!

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Hi,

I have a medication calculation/administration test coming up. Our professor gave us a practice exam, but there are a few questions I am unsure of and wasn't able to find by looking them up.

  1. We are to give 1 mg Ativan IVP. It is available as 2 mg/ml, so we would administer 0.5 mL. The next questions asks, "If you were to administer this drug orally, would you give more or less of the active ingredient, lorazpam?" And "how long will you take to push this medication?" I know you should push it slowly, but I don't know how slow.
  2. You are to give ibuprofen 400 mg PO Q 4 hours PRN for temp > 101. The patient's temp is 101.5. It is available in 200 mg tabs, so we would give 2 tabs. The next part of the question says, "The patient is also complaining of nausea and has 15 ml of emesis. What will you do?" Would we hold the med and order an anti-emetic?
  3. "We have on hand Furosemide 40mg/4ml for IM or IV use. You are in an emergency situation. Your patient is experiencing pulmonary edema and the MD orders 20mg Lasix IV, STAT." So, I would draw up 2 mLs from the vial. The rest of scenario says, "You see that the IV site is infiltrated and remember that the label on the box states that the medication is for IV OR IM use. Would you put a 1.5 inch 20 gauge needle on the syringe and give the medication IM for the same affect? Yes or No?" Some of my newly graduated friends said that you wouldn't give IM and instead establish a new IV access because giving IM vs IV in an emergency situation would NOT give the same effect, since IV route works much quicker than IM. Thoughts?


Any advice helps! Thank you!!!

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1. do you have a nursing drug guide? it will tell you the time frame that any IV drug should be give and any adverse effects to watch for during the push --- as far as an oral dose, it would tell you the recommended dose for both IV and oral -- but you should understand why the dose may be higher --- hint: research and understand first pass effect.

2. is ibuprofen an NSAID? what are some of the potential complications of this class of drug? would that warrant hold the drug with any GI distress?

3. you are in an "emergency" situation -- look up the onset of action for both IM and IV for Lasix and determine if it would be appropriate.

You seem to be on the right track, just need a little more understanding -- Best of luck.

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  1. We are to give 1 mg Ativan IVP. It is available as 2 mg/ml, so we would administer 0.5 mL. The next questions asks, "If you were to administer this drug orally, would you give more or less of the active ingredient, lorazpam?" And "how long will you take to push this medication?" I know you should push it slowly, but I don't know how slow.

You can look that up in your drug handbook. There may be a range.

As to whether you'd give more or less if it were PO vs IV, that's actually not your call-- it's the purview of the prescriber.

  1. You are to give ibuprofen 400 mg PO Q 4 hours PRN for temp > 101. The patient's temp is 101.5. It is available in 200 mg tabs, so we would give 2 tabs. The next part of the question says, "The patient is also complaining of nausea and has 15 ml of emesis. What will you do?" Would we hold the med and order an anti-emetic?

What's the most common SE of NSAIDs? He's already barfing-- what do you think?

If the patient has emesis after you give the tabs, what might you think was happening? Would there be something else s/he could take for fever? What would you do to get it for him/her?(There's a hint in the previous scenario answer)

  1. "We have on hand Furosemide 40mg/4ml for IM or IV use. You are in an emergency situation. Your patient is experiencing pulmonary edema and the MD orders 20mg Lasix IV, STAT." So, I would draw up 2 mLs from the vial. The rest of scenario says, "You see that the IV site is infiltrated and remember that the label on the box states that the medication is for IV OR IM use. Would you put a 1.5 inch 20 gauge needle on the syringe and give the medication IM for the same affect? Yes or No?" Some of my newly graduated friends said that you wouldn't give IM and instead establish a new IV access because giving IM vs IV in an emergency situation would NOT give the same effect, since IV route works much quicker than IM. Thoughts?

If there's an emergency situation, how important is it to have IV access? Why?

As to changing route, again....whose call is that? Not yours.

And if it WERE your call to change the route, and your patient needed stat diuresis (why? heart failure?) would giving it IM be useful?

(Hint: I once had a kid on the wait list for a heart transplant, had an ejection fraction of about 8% (yep). I gave him 120mg furosemide IV slow push (yep) and I don't think his kidneys even saw it for about forty-five minutes.)

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1. The maximum rate that you can push lorazepam is 2mg/minute. And incidentally, it must be diluted with an equal volume of NS before pushing it. So if you have 1mL of lorazepam to give, you need to dilute it in at least 1mL of NS before pushing it.

2. Ibuprofen is not an anti-pyretic, so do you think this is an appropriate pharmacological intervention for someone with a fever?

3. First of all, you have to give the medication via the route that it was ordered. If you want to give it by another route, your provider must change the order to reflect the new route of administration. Like others said, it's not your call. However, if they do decide to give the furosemide IM, consider ADME (absorption, distribution, metabolism, excretion) with respect to that route of administration. Would absorption be different when giving the med IV vs. IM?

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