A nurse is preparing to administer fentanyl 400 mcg via the buccal route. Which of the following actions should the nurse take?
Dissolve the tablet in 118 mL (4 oz) liquid.
Have the client chew the medication before swallowing.
Mix the medication in 5 mL (1 tsp) soft food.
Place the tablet between the client's cheek and gums.
The Correct Answer is D
A. Dissolve the tablet in 118 mL (4 oz) liquid: This option is incorrect because buccal tablets are specifically designed to dissolve in the mouth without liquid. Using liquid can dilute the medication and hinder effective absorption.
B. Have the client chew the medication before swallowing: Chewing the buccal tablet is not appropriate, as it can lead to rapid release and loss of the intended slow absorption through the mucous membranes. This method undermines the effectiveness of the medication.
C. Mix the medication in 5 mL (1 tsp) soft food: This action is also incorrect, as mixing the buccal tablet with food may interfere with its absorption. Buccal medications are intended to dissolve between the cheek and gums for optimal effect.
D. Place the tablet between the client's cheek and gums: This is the correct method for administering a buccal tablet. This placement allows the medication to dissolve slowly and be absorbed effectively through the buccal mucosa, providing the desired therapeutic effect.
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Correct Answer is D
Explanation
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B. Lithium 300 mg PO three times daily: This is a standard initial dose for lithium therapy in managing mania, and dosing may be adjusted based on therapeutic levels. Regular monitoring is essential for safety.
C. Risperidone 3.0 mg PO daily: This dosage aligns with typical dosing for managing manic episodes and is within the acceptable therapeutic range for antipsychotic medications. It's commonly used in acute settings.
D. Divalproex 1.5 g PO twice daily: This high dosage raises concern as it significantly exceeds typical recommendations for divalproex. Standard dosing usually starts much lower, and this amount could increase the risk of side effects and toxicity. Clarification with the provider is warranted to ensure safe medication management.
Correct Answer is C
Explanation
A. Albuterol metered dose inhaler 2 inhalations every 4 to 6 hr PRN for bronchospasm: This prescription is appropriate for managing acute bronchospasm. Albuterol is commonly used as a rescue inhaler, and the frequency aligns with standard practice for its use.
B. Clozapine 25 mg PO daily: This dosage is appropriate for initiating treatment with clozapine, which often starts at a low dose due to the risk of agranulocytosis. Regular monitoring of blood counts is required but the prescription itself is clear.
C. Haloperidol 0.5 mg PO 2 times each day: This prescription raises a concern due to the formatting error (there is a missing space after "Haloperidol"). The clarity of the dose is crucial, especially with potent medications like haloperidol, and the nurse should confirm the intended dosage to avoid medication errors.
D. Flunisolide 80 mcg inhalation twice daily: This is a standard prescription for a corticosteroid inhaler, used for long-term control of asthma or COPD. The dosage and frequency are appropriate, requiring no further clarification.