The nurse administering a nasal medication via an atomizer bottle should:
have the client sit up straight.
leave the other nostril open while giving the medication.
have the client tilt the head forward.
have the client squeeze the bottle while inhaling.
The Correct Answer is A
A) Have the client sit up straight: This is the correct action. Sitting up straight helps ensure that the medication can be properly delivered to the nasal passages and increases the likelihood of effective absorption.
B) Leave the other nostril open while giving the medication: While it is often recommended to keep the opposite nostril open to allow for airflow, the medication should be delivered to one nostril at a time. The other nostril should typically be closed or pinched shut to direct the medication effectively.
C) Have the client tilt the head forward: This option is incorrect. Tilting the head forward can make it more difficult for the medication to reach the upper nasal passages. The client should usually keep their head in a neutral position or slightly tilted back.
D) Have the client squeeze the bottle while inhaling: This action is not ideal. The client should inhale gently while the nurse squeezes the atomizer to ensure that the medication is effectively distributed throughout the nasal passages. Squeezing the bottle should be coordinated with inhalation to achieve the best results.
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Correct Answer is B
Explanation
A) Ask the client if he would prefer to give the medication to himself: While involving the client in their care is important, this option does not assess the client’s ability to safely take the medication. The nurse should first ensure that the client can swallow the medication safely.
B) Assess the swallowing reflex by offering a sip of water: This is the correct action. Assessing the swallowing reflex is essential, especially in older adults, to determine if they can safely swallow liquid medications without risk of aspiration.
C) Mix thoroughly in applesauce or pudding: This option is not appropriate unless specifically ordered or indicated. Mixing medications in food may not be suitable for all clients, and it can affect the medication's absorption or effectiveness. Additionally, it does not assess the client's swallowing ability.
D) Assess the ability to understand information relative to the medication: While this is important, it is secondary to ensuring that the client can physically take the medication safely. Assessing understanding can occur after confirming the client’s ability to swallow the medication.
Correct Answer is A
Explanation
A) Should not be swallowed because it alters the absorption potential: This is the correct explanation. Sublingual medications, such as nitroglycerin, are designed to be absorbed quickly through the mucous membranes under the tongue. Swallowing the medication can significantly reduce its effectiveness and delay absorption, which is crucial for medications used in acute situations like angina.
B) Can be held against the roof of the mouth with the tongue to reduce taste: This option is not correct. Holding the medication against the roof of the mouth does not facilitate the intended sublingual absorption and may not significantly mitigate the taste issue. The medication needs to dissolve under the tongue for effective absorption.
C) Can be inserted rectally without loss of absorption potential: This option is incorrect. Sublingual medications are formulated for absorption through the sublingual mucosa and would not provide the same effects if administered rectally. Different routes of administration have different absorption profiles.
D) Can be taken between the cheek and tongue to diminish taste: While this may help with taste, it does not achieve the desired sublingual absorption. For optimal effect, the medication should be held under the tongue, where it can dissolve and be absorbed directly into the bloodstream.