1. How much of the Dilaudid is drawn up by the nurse for the correct dose? 0.

5 ml is drawn up for the correct dose. 2. How is wasting, if any, handled by the nurse? A medication is wasted if all or part of a controlled substance dose remains and cannot be returned to the Pyxis for future use. Wasting a medication requires another nurse to witness the wastage. When the amount of medication to be wasted is identified, the second nurse (witness) will enter his/her ID. The unused medication should be wasted by flushing in a sink or an appropriate container and witnessed by both persons. 3. How much sterile water does the nurse inject into the vial of medication? The nurse injects 2.4 ml of sterile water into the vial. 4. How much is the nurse to draw from the vial for the correct dosage? 1.2 ml of Gentamicin is drawn up for the correct dose. 5. Describe the nurse's safety steps in preparing and administering the drug both in the med room and at the bedside. The safe administration of medications requires knowledge of the drug, its effects, and the reason it has been prescribed. The nurse should first practice hand hygiene, analyze the recent laboratory results, and check the Medical Administration Record (MAR) for up to date scheduled medications. To assure the safety of the patient, the nurse should follow the 5 rights of medication administration: The right patient, the right drug, the right dose, the right time, and the right route. The nurse can also collaborate with the pharmacists on checking the accuracy and appropriateness of drug orders prior to client administration when in doubt. It is also important for the nurse to focus entirely on the task at hand and instruct others who are talking to stop when preparing medications. At the bedside, the nurse must perform the five rights of medication administration again. Ensure patients allergy bracelet matches whats on record. Carefully transport medications to bedside. Keep medications in sight at all times. Open medications immediately prior to administering the medication. Wear gloves when appropriate. Administer the medication according to hospital policy. Remain with patient until each medication has been followed. Wash Hands after administering medications. Record each medication in patients chart. Record if medication was refused. Record if patients condition warranted omitting medication. Check patient after 30 minutes to verify his/her response to medication.

Following these techniques will help safeguard against medication administration errors, and prevent cross contamination which could harm the patient. 6. Describe the drug as a narrow or broad spectrum, its action, and its classification. Gentamicin is a broad-spectrum antibiotic. It acts by inhibiting protein synthesis in bacteria at level of 30S ribosome. Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. (Daviss Drug Guide website) 7. Describe what the nurse does to assess for efficacy and possible side effects. Monitor renal function by urinalysis, specific gravity, BUN, and creatinine before and throughout therapy. The nurse should assess for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated peak aminoglycoside levels. Aminoglycosides should be discontinued if tinnitus or subjective hearing loss occurs. Monitor intake and output and daily weight to assess hydration status and renal function. Assess for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea). (Daviss Drug Guide website)

8. Describe patient teaching regarding possible adverse effects and superinfection. The nurse should instructs patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating. Teach patient to report signs of superinfection such as fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea. Advise to avoid alcohol and stay well hydrated, practice good hand hygiene, and the importance of full completion of therapy.