Chapter 46. Holistic Healing, Funds II Chapter 46. Holistic Healing, Pharmacology: Hypertension, Davis Edge Medication Patients (Chp 25), Pain and CAM, Pharmacology Exam 1 Review Questions, Chapter 25: Pharmacology Quiz, Pharmacology Chapter 25, Phar...

One third of older adult patients report that they are often nonadherent with drug therapy. Which response is given most frequently for nonadherence?

"I didn't have my medicine with me." Rationale: 31% of older adult patients report that they did not take their medication because they did not have it on hand when it was time to take it

What does angiotensin II do

1) Bind to AT1 to cause vasoconstriction 2) Stimulate aldosterone release 3) Stimulates ADH release

Your patient was told to take Sudafed 12 Hour sustained release 120 mg tablets tabs twice a daily. The pharmacy has generic immediate release pseudoephedrine 30 mg tabs on sale. Which dose is correct if he uses the release tables. What you need to think about here is the expected blood levels from a sustained release product versus an immediate release product and how you can best mimic that using an immediate release product.

60 mg (2 tabs) four times daily

Which patient characteristics, if noted in the patient's medical record, would the nurse consider important information that may affect the physiological response to various types of drug therapy? Select all that apply

82-year-old female Asian and obese past medical history of kidney disease Mother and sister with diabetes Rationale: physiological response to drugs are affected by the patients age, gender, race, body mass and health status

Normal BP

<120 / <80

Stage II hypertension

> 160 / > 100

The nurse is caring for several patients. Which patient will the nurse anticipate is most likely to experience an alteration in drug metabolism?

A 3-day-old premature infant Rationale: Infants do not develop a mature microsomal enzyme system until they are 1 year; therefore, they don't metabolize drugs efficiently.

ACE-Inhibitor mechanism of action

ACE-Inhibitors inhibit the conversion of angiotensin-1 to its more active form, angiotensin-2. ACE-Inhibitors counteract or inhibit all of the pharmacological effects of angiotensin-2. Thus ACEinhibitors cause vasodilation, decrease aldosterone levels, Na+ & fluid wasting & K+ retention

A woman is receiving physical therapy after surgery to repair a hip fracture. She tells the therapist before therapy begins that she expects therapy to be very painful. She rates her pain as 1 on a scale of 1 to 10 before therapy. Three minutes into the treatment session, the patient complains of excruciating pain rated as 10 and says she cannot tolerate exercise any longer. The therapist is concerned with the amount of pain, because severe pain is not expected during that form of exercise. The therapist considers the patient could be experiencing: 1) Phantom limb pain. 2) Ineffective pain medication. 3) A nocebo effect. 4) A complication from the surgery.

ANS: 3 The nocebo effect is a demonstration of the power of the mind to create bodily distress. The patient was expecting the treatment to be very painful, and this tends to increase the treatment discomfort. Phantom limb pain is sometimes experienced after an amputation but has nothing to do with surgery to repair a hip fracture. There is no evidence that the patient's pain medication is ineffective or that she is experiencing a complication from surgery. PTS:1DIF:ModerateREF:p. 3 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Analysis

An elderly client with a history of COPD is having difficulty sleeping and does not wish to see a medical practitioner. Which of the following strategies should the nurse discourage the client from using, or urge him to see a physician before beginning the therapy? The client has not used any of these therapies in the past. Choose all that apply. 1) Aromatherapy 2) Tai chi 3) Yoga 4) Melatonin

ANS: 3, 4 Aromatherapy is known to be safe, and may be effective. Tai chi is safe for older adults and may be effective for sleep. Yoga is possibly effective for sleep, but it is physically rigorous, so it has the potential to be harmful for older adults, who may have a variety of chronic conditions. The client should see a physician before beginning yoga. Melatonin is effective for certain sleep disorders, but it does interact with several prescription drugs. Therefore, the client should not take melatonin without consulting a physician. PTS:1DIFgrinifficult REF: pp. 9, 11, 14, 15; not stated directly in text: critical thinking required

A client wishes to avoid taking blood pressure medications. He is watching his diet and exercising. In addition, a CAM therapist has recommended an alternative therapy that will allow him to learn voluntary control over his blood pressure. What type of therapy is the therapist probably recommending? a) Homeopathy b) Naturopathy c) Biofeedback d) Hypnosis

ANS: C Biofeedback is a technique by which people learn voluntary control over typically involuntary activities. Homeopathy is based on an understanding of how the body heals itself and an acceptance that all symptoms represent the body's attempt to restore itself to health. Naturopathy is the belief that nature and each living being have the innate ability to establish, maintain, and restore health. Hypnosis is a trancelike state characterized by relaxed brain waves, hypersuggestibility, and heightened imagination. Hypnosis has been used to promote relaxation, weight loss, and smoking cessation and to suppress various symptoms.

ARBs are antagonist of what receptor

AT1

ADME

Absorption Distribution Metabolism Excretion

What does ADME stand for as it relates to the processes of pharmacokinetics

Absorption, Distribution, Metabolism, Excretion

When dealing with pain in a geriatric population, what is the pain medication of choice?

Acetaminophen

Loop Diuretics mechanism of action

Act in the ascending limb of the loop of Henle. Loop of Henle is responsible for ~20 % of all Na+ reabsorption. This is why loop diuretics are the most powerful diuretics. Must enter the nephron via the organic acid pathway of the proximal tubule to be effective. Onset of Action: 30 minutes after an oral dose & 5 minutes after an IV dose

Diphenylalkylamines

Acts on heart and vasculature, least selective

Describe cellular functions when an agonist normally binds to beta repceptors

Agonist binds to the beta G protein-coupled receptor > cAMP created from adenylyl cyclase > activates protein kinase > Ca channels gets phosphorylated > increases calcium in the cell

Direct Renin Inhibitor generic name

Aliskiren

Calcium Channel Blockers mechanism of action

All inhibit entrance of Ca++ into smooth muscle cells of coronary and arterial vessels. Calcium is necessary for strength of muscle contraction & tone. All these drugs are vasodilators. Calcium channels are also present on the heart, coupled with b1-receptors. Nondihydropyridines, diltiazem and verapamil, also act on the calcium channels of the heart which causes them to have some effects similar to the selective b1-blockers.

ACE in the lungs converts angiotensin I to

Angiotensin II

Renin converts what

Angiotensinogen > angiotensin I

Baroreceptors are located where

Aortic arch and carotid sinus

Potassium Sparing Diuretics Mechanism of Action - for amiloride & triamterene

Are NOT aldosterone antagonists. Act directly in the distal renal tubule to inhibit the Na+ reabsorption & K+ elimination that is normally stimulated by aldosterone

The nurse knows that patients characterized as slow acetylators:

Are more prone to drug toxicity Rationale: Slow acetylator patients have reduced hepatic metabolism and reduced clearance by the kidney; therefore; greater risk of drug toxicity

The patient requests that a refill prescription of a Schedule II controlled substance be telephones to the drug store. When responding to the patient, the nurse would consider which factor? Refills of Schedule II drugs:

Are not permitted under federal law Rationale: Telephone orders aren't permissible under fed law for schedule II drugs

The nurse is researching a new drug prior to administration. The drug handbook states that the adverse effects are "dose related," which means that:

As the dose increases, the risk of adverse effects also increases. Rationale: Dosage increases, risk increases

What drug treats bradycardia?

Atrophine

What receptors cause vasodilation? Vasocontsriction?

Beta / Alpha

Which 2 classes of drugs might be used to treat asthma or COPD

Beta 2 agonists and muscarininc antagonists

Which antihypertensives are negative inotropes

Beta- blockers, cardioselective, beta-blockers nonselective, alpha-1 beta-1 beta-2 blockers, some calcium channel blockers (verapamil, diltiazem)

Direct Renin Inhibitor mechanism of action

Binds tightly with renin and inhibits cleavage of angiotensinogen into angiotensin-1. Reduces influence of entire Renin-Angiotensin-Aldosterone system.

How do beta blockers reduce peripheral resistance

Binds to beta-1 in the kidney and blocks renin release

ACEI prevent the normal breaking down of bradkinin by ACE, therefore increasing bradykinin levels, what does bradykinin do?

Binds to bradykinin receptor and stimulates nitric oxide synthase

Beta blocker MOA

Blocks beta receptors on heart = decreased CO

What is the firing of the baroreceptors stimulated by?

Blood pressure and heart rate

Which drug class is used to treat both hypertension and antidysrhythmias?

Calcium channel blockers

The nurse cannot read the number of milligrams to be administered in a drug order written by the health care provider. It is questionable whether 125 mg 1.25 mg or 12.5 mg should be administered. What action would be most appropriate to prevent a med error?

Call the health care provider about the illegible medication order Rationale: When in doubt, call prescriber to clarify

The patient asks the nurse, "Why are herbal supplements so popular?" The nurse's answer is based on which factors? Select all that apply. Herbal supplements:

Can now be purchased in virtually all supermarkets Are aggressively marketed by the herbal and supplement industry Cost less than prescription medicines Appeal to the aging population Rationale: Natural substances are not necessary safer than synthetic products and do not undergo same testing as synthetics

Non-selective beta-blockers therapeutic uses

Cardiac: Hypertension, angina, post MI, heart failure, atrial fibrillation, & tachycardia. Some, carteolol (Ocupress) & timolol (Timoptic), are used as eye drops to treat glaucoma. Other: Hyperthyroidism, migraine prophylaxis, essential tremor, stage fright

CPR

Cardiopulmonary resuscition

What type of beta blocker is atenolol

Cardioselective (binds only beta-1)

Where do the baroreceptors (stretch receptors) send there signal to?

Cardiovascular control center in the medulla

The nurse is preparing to discuss drug use during pregnancy with a group of nursing students. The main topic is the FDA drug classifications. Which of the following drugs should the nurse inform the students are the most detrimental to the fetus?

Category X Rationale: These drugs are clearly contraindicated because they can seriously harm fetus

When considering various drug therapies, the nurse knows that most drug testing and approval occurs with which population?

Caucasian males and may not be safe for other populations Rationale: most drug testing uses white males, which may limit the generalization of the results to other populations.

What effect does pain have on ACTH and how does this affect the body?

Causes an increase, causing weight loss from increased catabolism

What does the influx of extracellular calcium through these L-type calcium channels do?

Causes intracellular stores of Ca2+ to be released from the sarcoplasmic reticulum (huge amount of calcium)

CCBs do what to the vascular smooth muscle

Causes relaxation

What is an example of a COX-2 inhibitor?

Celebrex

Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment?

Check apical pulse and blood pressure.

Direct Renin Inhibitor therapeutic uses

Chronic hypertension

Therapeutic Uses of ACE-Is

Chronic hypertension Chew & swallow oral tablets for hypertensive urgencies. Congestive heart failure: Slows the progression of HF & improves the patient's quality of life. Diabetes: Slows the progression of renal failure in diabetics, even without HTN.

What is an example of idiopathic pain?

Chronic regional pain syndrome

Sodium channel blockers are considered which class of antidysrhythmic drugs?

Class I

The nurse is using a drug handbook to determine the indications for the drug furosemide or Lasix. The term indications is defined as:

Conditions for which a drug is approved Rationale: indications = the conditions for which a particular drug is approved

The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason?

Conversion of recent-onset atrial fibrillation and flutter

When observing a patient for bone marrow toxicity, the nurse would monitor for:

Decrease in RBC's WBC's, and platelets Rationale: The function of the bone marrow is to produce blood cells; bone marrow toxicity manifests as decreased blood cells of all types

Which age-related change in the older patient makes it necessary to reduce drug dosages

Decrease in renal blood flow Rationale: In the older adult, renal blood flow decreases and excretion of drugs also decreases, requiring dosage or frequency adjustments

The patient is receiving multiple medications, including one drug specifically used to stimulate gastric peristalsis. The nurse knows that this drug could have what influence on additional oral medications?

Decreased absorption Rationale: Peristalsis = wavelike muscle contraction of GI tract. An increase of peristalsis would decrease the time the drug would remain in GI system; therefore, decreasing absorption.

Benzothiazepine

Effects both cardiac and vascular but less negative inotropic effect

Which of the following is considered a gender factor that may influence effective pharmacotherapy? Select all that apply

Fat-to-muscle ratio Cerebral blood flow Limited drug research on females Health beliefs Rationale: Dietary considerations are a potential ethnic or cultural consideration

A nurse notes that multiple patients had a reaction to the same medication, a drug that has been available for several years. Which actions should the nurse take? Select all that apply

Fill an adverse Event Report with the FDA Note the reaction in the patient's chart Notify the health care provider who ordered the drug Rationale: Adverse reactions may be discovered well after FDA approval as larger groups of patients take the drug.

Your drug book lists a drug interaction between digoxin & furosemide. Is it OK to take these drugs together? Which statement is most accurate?

Furosemide and digoxin can be taken together as long as potassium is monitored and hypokalemia is prevented.

Direct Renin Inhibitor adverse effects

Generally well tolerated, diarrhea Contraindicated in pregnancy

alpha 1 blockers therapeutic uses

HTN, urinary retention associated with benign prostatic hyperplasia and Raynaud's disease

A patient asks why all health care providers do not rely on complementary and alternative medicine, When talking to this patient the nurse knows that many complementary and alternative therapies:

Have not been subjected to rigorous clinical studies Rationale: many CAM meds lack scientific data to back up claims of effectiveness

Potassium Sparing Diuretics adverse effects

Hyperkalemia. Can be life-threatening. Monitor K+ closely if using with ACE-I or ARB. Use extreme caution if giving K+ supplements to patients receiving potassium-sparing diuretics! Spironolactone, since it chemically resembles some sex steroids, may cause gynecomastia in men and menstrual irregularities & deepening of voice in females.

Prolonged use of any diuretic can cause? Why does this matter?

Hypokalemia, potassium is needed for normal heart function

ACE-Inhibitors Adverse effects

Hypotension (especially with the first dose - give a test dose of captopril to be safe) Hyperkalemia (elevated serum K+) - due to aldosterone effects Bradykinin related side effects Dry hacky cough (can reduce dose & retry) [5%] Non-allergic rash Rarely angioedema (swelling of lips & face) - immediately discontinue! Contraindicated in pregnancy

Non-selective beta-blockers

Hypotension, sexual impairment, nightmares, some HDL & Tg (minor with chronic use). Heart failure, reduced cardiac output (fatigue) arrhythmias, & bradycardia (b1 mediated). Peripheral vasoconstriction (b2 mediated): Not a problem for most people unless there is a history of peripheral vascular disease (PVD), Reynaud's, or non-healing ulcers where there is already some decreased peripheral blood flow. Bronchoconstriction (b2 mediated): This bronchoconstriction is not a problem for most patients. However, patients with COPD or asthma may be adversely affected. May mask signs & symptoms of hypoglycemia in diabetics. Metabolism disturbances (b2 mediated): Lead to decreased release of glucagon & decreased liver glycogenolysis (decreased conversion of glycogen to glucose). This can decrease a diabetic's ability to correct hypoglycemia. Again, this is normally not a problem for most people, but can cause prolonged hypoglycemia in diabetics. Do Not Stop Abruptly!! May cause rebound angina, arrhythmias, heart attack, & DEATH

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.)

Hypothyroidism Visual halos Photosensitivity Blue gray skin discoloration

The nurse is caring for a patient with hepatitis and resulting hepatic impairment. The nurse would expect the duration of action for most medications to:

Increase Rationale: duration of action = length of time a drug concentration remains in the therapeutic range. Patients with hepatic impairment do not effectively metabolize drugs, which increases the duration of action

The patient is receiving a medicatin that may cause nephrotoxicity. To decrease the risk of this adverse reaction, the nurse should encourage the patient to:

Increase fluid intake to promote adequate hydration Rationale = hydration may reduce the risk of renal damage produced by drug therapies

In general, drug absorption in the older adult is somewhat slowed. What physiological changes may account for this? Select all that apply

Increased gastric pH Decreased rate of blood flow to the GI tract

Compare the pharmacokinetics of oral marijuana tablets vs inhaled marijuana. Which has the fastest onset of action

Inhaled

One of the active ingredients in the marijuana plant (THC) undergoes extensive first-pass metabolism. Therefore which route of administration is expected to achieve the highest blood levels

Inhaled

Thiazide MOA

Inhibit Na+/Cl- cotransporter therefore inhibiting Na+ reabsorption in the DCT

MOA loop diuretic

Inhibits Na+/K+/Cl- cotransporter in the ascending tubule of the loop of henle

Various psychosocial variables may influence nonadherence to pharmacotherapy. An example of this would occur when the patient reports that the prescribed drug:

Is too expensive for the patient to afford Factors associated with drug cost and the patients ability to purchase or access meds are considered psychosocial variables that may influence drug therapy adherence.

What is good about activated charcoal and how is it limited?

It absorbs poison and drugs in overdose situations and when the substance absorbs in the blood it does not work.

What is the good thing about ipecac syrup and how can it be abused?

It helps patients puke during overdose event and it is abused by bulimic patients.

What is the use of TPN?

Its used to meet patients long-term nutritional needs

CCBs block what type of calcium channels

L type voltage

Therapeutic index =

LD50/ED50

LR

Lactate Ringers intravenous fluid

Whats better about ARBs over ACE

Less adverse effects

LD50

Lethal median lethal dose; the drug dose that will kill 50% of a group of animals in a study

What is the drug that treats v-fib?

Lidocaine

What happens in response to low amount of NE regarding vasodilation?

Low amounts bind B and cause vasodilation

MAP requation

MAP = CO x TPR

What can hypertension cause

MI, CVA, CKD

Angiotensin-2 Receptor Blockers (ARBs) adverse effects

May cause hyperkalemia & hypotension. Less likely to cause cough, rash, & angioedema due to their lack of effects on bradykinin. Also contraindicated in pregnancy.

Polyherbacy may be of concern in the older adult population. A pharmacokinetic factor for this concern is that the older adult:

May have age-related changes in liver or kidney function. Rationale: changes in liver or kidney functions = changes in metabolism or excretion of herbal drugs

Muscarinic Agonists (direct acting) Bethanechol

Mechanism of action: bind directly to muscarinic receptors and mimic ACh, preferentially in the GI and urinary tract Therapeutic uses: treats urinary retention in postaprtum and postoperative patients, rarely used to treat gastroesophageal reflux disease to increase GI motility

Which statement regarding treatment of Alzheimer's dementia is true

Medications used to treat Alzheimer's dementia are only minimally effective at treating symptoms

Calcium Channel Blockers Therapeutic uses

Most can be used to treat chronic hypertension & angina. Like the b1-blockers, verapamil & diltiazem can also be used for arrhythmias such as atrialfibrillation & tachycardia

The nurse is asked by a family member, "They're giving mom Motrin and she takes Advil. Hasn't the wrong drug been ordered?" The nurse will respond, knowing that:

Motrin and Advil are trade names of the same generic drug, ibuprofen Rationale: Motrin and Advil are trade names

Calcium is required for

Muscle contraction (ATP needed also)

What chemical is released that acts upon the sympathetic and parasympathetic nerves?

NE is released

What are the 5 emergency drugs give via endotracheal tube and what is the acronym to help remember?

Naloxone (Narcan), atopine, vacopressin, epinephrine, and lidocaine (Xylocaine). NAVEL

CCBs have a ____ effect on the heart

Negative inotropic effect

A patient with myasthemia gravis has been receiving neostigmine, a cholinergic agonist, for the past 3 years, The nurse is ready to administer benztropine, a cholinergic antagonist. Which result will likely occur when these drugs are combined?

Neostigmine will exhibit a lesser effect Rationale: Benztropine is an antagonist. Antagonists bind to receptors and block the effects of an endogenous chemical or drug.

Can ARBs or ACEI be taken if you are pregnant or going to become pregnant?

No, fetotoxic

Baroreceptors normally release ____ in the CCC

Norepinephrine

Potassium Sparing Diuretics therapeutic uses

Not a powerful enough diuretic to use alone Used in combination with thiazides or loops to help retain K+ and prevent hypokalemia. Are useful in treating ascites associated with liver failure. Spironolactone & eplerenone have been shown to reduce mortality in heart failure patients

What is unique about the drug digoxin immune fab?

Obtained by sheep and produces antibodies against the basic molecule of digoxin

Loop Diuretics dosing

Once daily morning dosing is preferred. If the diuresis is adequate, but fluid returns too quickly, try twice daily dosing. Do NOT take diuretics before bedtime! Nocturnal awakenings can cause falls in elderly patients.

When providing nursing care for the patient, the nurse understands the drugs are:

One of many tools available to prevent or treat human suffering Rationale: Drugs are tools that are part of the overall treatment plan

Which route of administration do you think is the safest (e.g. purest ingredients, standardized dosing)

Oral (Marinol)

PRBC

Packed red blood cells

The nurse understands adenosine (Adenocard) is used to treat which condition?

Paroxysmal supraventricular tachycardia (PSVT)

The drug research participant with a particular disease is taking part in an investigative study to examine the effects of a new drug. Previously, this drug was tested using healthy volunteers. The next phase of the clinical trial investigation on which the patient will be participating is:

Phase 2 Rationale: phase 2 of clinical investigation relies on studying patients with the disease. furthermore, phase 1 studies small # of healthy patients; phase 3 studies large # of sick patients; phase 4 is postmarketing surveillance after drug is approved

What parameters would the nurse use to determine whether the average dose of medication is effective for the patient? Select all that apply

Physical examination Vital signs Lab values Efficacy Rationale: Efficacy means the ability of a drug to to produce the desired therapeutic effect. Dosage time DOES NOT directly evaluate the effectiveness of drug therapy.

Loop diuretics are primarily used in those with

Poor renal function

Methyldopa is mainly used for treatment of hypertension in

Pregnancy

Older male, it didn't seem to treat my pain very well at all

Probably a poor CYP2D6 metabolizer or lacks the CYP2D6 enzyme

Younger male, it wiped me out i slept for hours

Probably an ultra rapid CYP2D6 metabolizer

Female Patient, i thought it worked just fine

Probably has normal levels and activity of CYP2D6

What does nitric oxide do?

Produces nitric oxide which is a very potenet vasodilator

A diabetic patient is prescribed a new medication to control mild hypertension. The patient then become less aware of hypoglycemic symptoms. Which of the follow medications was most likely prescribed?

Propranolol (Inderal)

The physician decides to discontinue his propranolol. Which best explains how to do this safely and why it is important to do it this way?

Propranolol should be tapered over 3 - 5 days to avoid hypertension, tachycardia, & death

What substances lack intravenous dextrose and saline fluids?

Protein, fat, and minerals

Not all drugs for hypertension have a ______ benefit

Proven

RBC

Red blood cells

The healthcare provider knows that the pediatric patient and parents will most likely adhere to the medication regimen if the:

Regimen is simple and inexpensive Rationale: They're most likely to adhere if the regimen is easy and cheap

What is responsible for release of renin

Renin released by B1 stimulation of kidney in response to low BP

It is 2:45 a.m. and the nurse has telephones the prescriber to report that the patient is experiencing an acute episode of postoperative pain. How can the nurse avoid medication errors when receiving a telephone order from a prescriber?

Repeat the order verbally to ensure accuracy Rationale: Repeat the order verbatim to prevent recording errors.

The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system?

Respiratory

The patient is receiving a medication that causes hepatotoxicity. What symptoms would alert the nurse that this drug related toxicity has occurred?

Right upper quadrant pain and anorexia Rationale: these are symptoms of drug-induced liver damage. hepatotoxicity = drug-induced liver damage

RL

Ringers lactate intravenous fluid

Cardioselective b1-blocker therapeutic uses

Same cardiac therapeutic uses as the non-selective b-blockers.

Cardioselective b1-blocker adverse effects

Same hypotensive, cardiac, and sexual side effects as the non-selective b-blockers. They are less likely to cause peripheral vasoconstriction, bronchoconstriction, or hypoglycemia, but can still mask hypoglycemia. They should also NOT be stopped suddenly.

Angiotensin-2 Receptor Blockers (ARBs)Therapeutic uses

Same therapeutic uses as the ACE-Inhibitors. Good choice as an alternative to an ACE-I in patients who cannot tolerate ACE-I side effects

Dihydropyridines

Selective for vascular smooth muscle

What happens in the CCC in the medulla when stimulated by baroreceptors?

Stimulates parasympathetic system which decreases heart rate, inhibits sympathetic system which decreases stroke volume and causes vasodilation

Potassium Sparing Diuretics Mechanism of Action - for spironolactone & eplerenone

Synthetic aldosterone antagonists. Compete with aldosterone at renal receptor sites. Aldosterone normally stimulates Na+ reabsorption & K+ elimination at the distal tubule. Thus they cause Na+ elimination and K+ reabsorption.

Tacrolimus (an immunosuppressant) and itraconazole (an antifungal drug) are both metabolized by the same cytochrome P450 enzyme. Itraconazole is strong INHIBITOR of that enzyme. Predict what change you would expect to see in the plasma concentration of tacrolimus

Tacrolimus plasma concentration will decrease

Which health teaching concept should be included in the instructions for a patient taking echinacea?

Take the smallest amount possible when starting herbal therapy Rationale: start low to determine any initial intolerance

What patient education should be provided concerning administration times for her loop diuretic

Taking furosemide at 9pm could cause her to wake up throughout the night having to go to the bathroom

You are administering a brand new medication (Drug X). It is an adrenergic agonist with equal affinity for both beta-1 and beta-2 receptors. Which of the following statements best describes the expected physiological effects of Drug X on the vasculature?

The beta-2 stimulation will cause vasodilation of the vessels of the skeletal muscle

ED50

Therapeutic median effective dose or dose required to produce specific therapeutic response in 50% of a group of patients

Thiazide Diuretics mechanism of action

They enter the nephron via the organic acid secretory pathway of the proximal tubule. They block the tubular reabsorption of Na+ at the early part of the distal convoluted tubule

What diuretics are most used for treatment of hypertension?

Thiazide

How are 90% of cancer patients able to treat their pain?

Through relatively simple means

TPN

Total parental nutrition

A research nurse is discussing TD50 of a drug with the other members of the investigation team. On which of the following would the discussion focus?

Toxicity Rationale: TD50 measures the median toxicity dose. This info indicates the dose that will produce a given toxicity in 50% of a group of patients

While completing the health history, the nurse ask the patient, "What medications do you take regularly?" Which drug name would the nurse expect the patient to use in providing the answer?

Trade name Rationale: Trade names are designed to help the patient remember the name of the drug

The nurse is preparing to give an intramuscular injection to a 7-month-old infant. Which is the preferred site?

Vastus lateralis Rationale: The vastus lateralis muscle mass is the most developed in infants and toddlers and therefore the most appropriate for IM injections

A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition?

Ventricular dysrhythmias

When given a medication, the patient tells the nurse, "I've never seen this pill before. It's not like the others I take." Which would be the most appropriate action for the nurse to take?

Verify the order and double-check the drug label Rationale: nurse should always validate a questionable order when a patient or family member verbalizes concern

What two states is assisted suicide legal?

Washington and Oregon

plasma half-life

When half of med has been processed; dose decreased by half.

A patient in her first trimester of pregnancy asks the nurse which medications should be avoided during pregnancy. The nurse's response is based on the knowledge that during pregnancy:

When possible, drug therapy is postponed until after pregnancy and lactation Rationale: It is recommended that ALL drugs be avoided as much as possible while pregnant or nursing

What are the 3 things in the blood?

White blood cells, Red blood cells, and platlets

Antagonist

a drug that binds with a receptor blocks the receptor from stimulation and prevents it from being triggered normally

loading dose

a higher amount of drug, often given only once or twice, that is administered to "prime" the bloodstream with a level sufficient to quickly induce a therapeutic response

Levodopa is a drug that when taken orally is turned into its active form, dopamine. This is an example of

a prodrug

When dealing with opioid related constipation, what is important to remember?

a stool softener with a laxative should be given, not just a stool softener

What is neuropathic pain?

abnormal processing of sensory input or 'messages' by PNC or CNS as a result of damage to peripheral nerves or structures in the CNS

A nurse needs to ______ ______ pain and communicate this information to other healthcare providers

accurately assess

Cardioselective b1-blocker generic names

acebutoLOL atenoLOL betaxoLOL metoproLOL bisoproLOL esmoLOL

Describe the effectiveness music therapy

achieve state of relaxation, deep self-awareness and creativity, improves learning, clarifies personal values and copes with variety of psychosocial dysfunctions, psycho-physiologic stress, pain, anxiety and isolation

Pain is a response to ________ or ________ tissue damage

actual, potential

What traditional pain remedies for healing might be used by the Chinese?

acupuncture, herbal remedies, yin/yang, cold treatment

atropine

antisecretory- blocks upper and lower respiratory tract secretions prior to surgery, bradycardia- treats severe bradycardia, antispasmodic and antidiarrheal- relaxes GI tract and bladder, Ophthalmic- mydriatic-useful for ophthalmic exams and eye surgery

teratogens

any substance, organism, or physical agent that can interfere with growth and development of fetus; can result in miscarriage or birth defects

Antiplatelet

aspirin, clopidogrel, dipyridamole, drugs block platelet aggregation

bradycardia

atenolol, any beta-blocker plus diltiazem and verapamil

alpha 2 Adrenergic Agonists warnings

avoid abrupt withdrawl- will cause severe rebound HTN

alpha-1 blockers

azosin

Which foods are rich in potassium

bananas, tomatoes

enterohepatic recirculation

can increase half-life of a drug in the body and prolong its duration of action. Rationale: drug in small intestine is absorbed and excreted in bile then returns to intestine when gallbladder contracts

How does unrelieved pain impact musculoskeletal response

can lead to muscle spasms, impaired muscle function, fatigue and immobility

ACE-Inhibitors generic names

captoPRIL, enalaPRIL lisinoPRIL benazePRIL ramiPRIL quinaPRIL fosinoPRIL moexiPRIL trandolaPRIL

Beta Blockers with Vasodilating Actions

carvediLOLTherapeutic uses: HTN and heart failure It has similar side effects to the 1-blockers (except will not cause reflex tachycardia) & the same side effects as the non-selective b-blockers. labetaLOL (Normodyne, Trandate) Labetalol is not used for HF. It is most commonly used for hypertensive emergencies. It has similar side effects to carvedilol, discussed above. NebivoLOL ,Nebivolol is used to treat hypertension. Promotes synthesis and release of nitric oxide causing vasodilation

What is nociceptive pain?

caused by damage to nerve endings in somatic or visceral tissues

What effect does pain have on insulin?

causes a decrease

What is idiopathic pain?

chronic pain without identifiable physical or psychological cause or pain perceived as excessive

A nurse should ________ responsibilities in pain relief

clarify

alpha 2 Adrenergic Agonists generic names

clonidine

Who might a nurse need to advocate for when dealing with pain?

cognitively impaired patients and those with substance abuse issues

alpha 1 blockers mechanism of action

competitive blocking of the alpha 1 receptors, HTN: lowers blood pressure by causing vasodilation, relaxes both arterial and venous smooth muscle surrounding some blood vessels BPH: these drugs also relax the smooth muscle of the bladder neck and prostate which improve urine flow

Non-selective beta-blockers mechanism of action

competitive blocking of the b1 & b2-receptors, Cardiovascular effects (b1 mediated): decreased heart rate (negative chronotrope); decreased force of contraction (negative inotrope); decreased cardiac workload & oxygen demand

Therapeutic effect

consistent concentration of the drug in the plasma

Define art therapy

creative expression through art to facilitate expression of emotions, memories or conscious/unconscious concerns

When dealing with a culturally diverse population, what is required for accurate pain assessment?

culturally-specific questions about client's belief about health care practices

adverse effects

deadly

How is deep somatic pain generally characterized?

deep, aching, throbbing

The nurse knows that governmental drug legislation requires the drug manufacturers to prove that a drug is both safe and:

effective for a specified purpose Rationale: FDA mandates that drug manufacturers demonstrate safety and effectiveness of products

ED

emergency department

ER

emergency room

Which of her medications may cause hyperkalemia?

enalapril, spironolactone

What should a nurse do after pain relief interventions have been implemented?

evaluate their effectiveness

side effects

expected

Besides the patient, who should a nurse include in the pain assessment?

family and friends and their interaction with the client

What responses would you expect to observe in chronic pain?

flat affect, decrease in physical movement/activity, fatigue, withdrawal from others and social interaction

What is the focus in alternative therapies involving energy?

focus on using or manipulating energy fields

Bioavailabilty

fraction(%) of drug available in bloodstream after administration as compared to the IV route

Anticoagulant

heparin (unfractioned), enoxaparin, warfarin, block parts of the coagulation cascade

What concepts are common to most alternative practices?

holism, humanism, balance, spirituality, energy

pharmacodynamics

how a drug effects the body

Absorption

how a drug gets to the blood stream

pharmacokinetics

how drug moves thru the body. Think ADME

Metabolism

how the body chemically alters the drug

Excretion

how the body eliminates the drug

Med errors are caused by:

human factors inadequate communication confusing labels bad packaging similar drug names

Thiazide Diuretics generic names

hydrochlorothiazid

How does the onset differ in chronic pain or acute pain?

in acute pain, the onset is sudden, but in chronic pain, the onset can be either gradual or sudden

Prodrug

inactive compound that must be metabolized in order to become active

Beta-1 stimulation leads to dramatic _______ in heart rate due to direct stimulation

increase

In humanism, mind and body are

indivisible

Combined toxicity

isoniazid and rifampin both cause hepatic injury

What happens if acute pain is not treated?

it can alter the neurological system's response to pain in general, and create lasting, chronic pain

What is biofeedback?

learning to control the body's physiological responses

In comparison to women, men are ______ likely to use CAMs for pain treatment

less

In general, men are ________ likely to report pain

less

What might indicate pain in geriatric patients?

lethargy, anorexia fatigue

Potency

measure of amount of drug required to produce given degree of effect

Think about what effect this drug will have on heart rate, if any

most patients will experience an decrease in heart rate

Absorption

movement of drug from its site of administration into the systemic circulation

Distribution

movement of drug into the various body fluids and tissues

Which class of drugs might cause diarrhea?

muscarinic agonists

Which class of drugs might cause constipation?

muscarinic antagonist

Cl-

negative electrolyte chloride

Calcium Channel Blockers Dihydropyridines

nifediPINE nicardiPINE amlodiPINE isradiPINE felodiPINE nimodiPINE nisoldiPINE

Should meperidine (demerol) be prescribed in geriatric populations?

no

Is the use of placebos considered ethical in the treatment of pain?

no, it is condemned by several professional medical organizations

What types of medicationsis nociceptive pain most responsive to?

non-opoid medications such as NSAIDs and opioids

How can mild pain be effectively treated?

non-pharmacological modalities (rest, exercise, heat, cold)

As a nursing consideration, when is biofeedback cotraindicated?

not recommended for individuals with bipolar disease or psychoses such as schizophrenia

How is neuropathic pain best controlled?

not through the use of opioids alone, but through the application of adjuvant analgesics, including antidepressants, anticonvulsants, muscle relaxants, ect

How is neuropathic pain best controlled

not well controlled by opioids alone but augmented with adjuvant analgesics

Alpha 1 blockers adverse effects

orthostatic hypotension, First dose effect- fainting following first dose, to minimize falls instruct patient about orthostatic hypotension give at bedtime and initiate therapy with dosage titration, dizziness, lack of energy, drowsiness, nasal congestion, headache, decreased libido, inhibition of ejaculation

"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

pain

What is referrent pain and why does it occur?

pain that shows up in an area other than where the actual trauma occurred, happens because the body is "overloaded" with information about extremely painful stimuli, ie jaw or back pain in MI

Pain is a _______ and _______ experience

physical, emotional

Na+

positive electrolyte sodium

325mg aspirin daily PLUS clopidogrel daily

post cardiac stent placement

When considering pharmacodynamic principles for a patient's drug therapy, the nurse is aware that affinity for a receptor is most closely associated with a drug's:

potency Rationale: potency is a reflection of the drug's ability to bind to a receptor

What cultural differences in the treatment of pain might a nurse encounter in Hispanic culture?

prayer, use of amulets, use of herbs

Direct Chemical interaction

precipitation, inactivation

ACE- inhibitors

pril

Selectivity

refers to some degree to which a drug acts upon one site relative to all possible sites, if it is more selective the fewer adverse effects it will cause

What is the goal of meditation?

relaxed, hypometabolic state, accompanied by a quiet body/mind

How long does neuropathic pain last?

sudden, intense, short-lived or lingering

What types of somatic pain might an individual experience?

superficial and deep

Pharmocodynamic interactions

synergistic and antagonistic drug interactions

Mr. Brown has a difficult to control hypertension. Therefore, he takes three different blood pressure medications, hydrochlorothiazide, ramipirl, and amlodipine to control it. This is an example of

synergistic effects

Define music therapy

systematic application of music without lyrics to produce relaxation and desired changes in client's emotions, behavior and physiology

Drug clearance

term used to describe the volume of blood which is completely cleared of a drug per unit

What protection does the rule of double effect provide?

that if a nurse gives a pain medication to alleviate pain and death is hastened, the nurse is not liable for this consequence as long as the drugs were given as prescribed with the intention of relieving pain

If a patient or patient's family expresses fear that using sufficient drugs to relieve pain will precipitate death in terminal illness, how should you respond?

that there is no scientific evidence that opioids can hasten death, even with patients at the end of life

Efficacy

the ability of a drug to produce a desired therapeutic effect

A nurse should demonstrate ________ _______ when a patient is experiencing pain

therapeutic presence

How do school-aged children perceive their pain?

they can rationalize and are responsive to explanations about pain

How do COX-2 inhibitors work?

they impede the production of the chemical messengers or "prostaglandins" that cause pain and swelling

What views might an adolescent have regarding pain?

they may see pain or "giving in" as sign of weakness

Why might a teen be reluctant to report pain?

they want to be seen as strong and brave in front of peers

How can mild to moderate pain be effectively treated?

through the use of non-opoid pain relievers (acetaminophen, salicylates, NSAIDs, and COX-2 inhibitors

Half life

time required for the drug's plasma to be reduced by one-half, to be cleared it takes 4-5 half lives

What is the goal of mind-body interventions?

to create absence of physical, mental and emotional tension

Acute pain is also known as

transient pain

What causes neuropathic pain?

trauma, inflammation, metabolic diseases, alcoholism, infections of the nervous system, HIV, tumors, toxins, neurological diseases (ie MS)

dobutamine

treat acute heart failure

Isoproterenol

treat bradycardia, asthma

650mg aspirin every 6 hours

treatment of pain or inflammation

A critical element of holistic nursing assessment and management of a client with pain is to establish a _______ _______ with the client and the family

trusting relationship

How do school aged children generally respond to pain?

trying to be brave

When using CAM, it is important for a nurse to accurately assess client's ______ of CAM

use

Define animal-assisted therapy

use of animals in attainment of health care goals

hyoscyamine(levsin, anaspaz), hyosycamine + atropine+ scopolamine+ phenobarbital (donnatal)

used to treat GI spasms irritable bowel spastic bladder

Trihexyphenidyl (artane), Benztropine( cogentin)

used to treat mild symptoms of Parkinson's, cause anticholingeric adverse effects

What nursing interventions might be effective in managing pain in infants?

using tactile stimulation, playing music or tapes of a heartbeat

Phase 2 reactions

usually no change with age

How do infants respond to pain

with sensitivity

The nurse is teaching the patient about a newly prescribed medication. Which statement made by the patient would indicate the need for further medication education?

"If I take more, I'll have a better response." Rationale: If a toxic level is reached from too large a dose, the drug will have adverse effects instead of a better therapeutic response.

The experienced pediatric nurse is teaching a new nursing student about injections in the pediatric population. Which statement by the student would indicate that teaching was effective?

"Intramuscular or IM injections in infants are absorbed slowly." Rationale: IM injections in infants are absorbed slowly due to low blood flow to skeletal muscles.

Which statements by the patient would inform the nurse that more teaching is necessary prior to discharge?

"It doesn't matter if the medication works as long as the doctor prescribed it." Rationale: Older adults may comply with prescribed drug regimens because of confidence in the ability of their provider; the statement indicates that the patient is not aware of how to monitor the drug's effectiveness or for adverse effects

As the nurse enters the room to administer medication, the patient states, "I'm in the bathroom. Please leave the medication on my bedside table, and I will take it when I come out." Which would be the appropriate response by the nurse?

"Let me know when you are ready, and I will then return with your medicine." Rationale: ensures that the patient took the med; offers nurse a chance to assess for effects of the drug or provide teaching

A patient is being discharges from the hospital with a nebulizer for self-administration of inhalation medication. Which statement made by the patient indicates to the nurse that patient education has been successful?

"Medicines taken by inhalation produce a very rapid response" Rationale: Inhaled drugs produce immediate therapeutic response

The community health nurse is visiting a postpartum mother who is breast-feeding her 3.2 kg or 7 pound infant daughter. Which of the following statements, if made by the mother, indicates that further teaching is necessary? Select all that apply

"When using OTC meds, I should take only the lowest effective dose." "I shouldn't take any drug during breast-feeding, even my prescriptions." "Medication in liquid form should be avoided since it more readily enters the breast milk." "Now that I'm no longer pregnant, I don't need to worry about the medicines affecting my baby."

It is time to give a 3-year-old oral medication. Which comment made by the nurse is most therapeutic?

"Would you like to take your medicine with water or juice?" Rationale: Child begins seeking control and independence at 3 years of age. Giving the patient the choice of liquid will give the child a feeling of control and independence; thus, encouraging cooperation.

What are the risks of intracardiac route?

- Pneumothorax - Cardiac tamponade - Coronary Artery laceration

The provider has prescribed Demerol 25 mg IM now. You have a prefilled syringe of Demerol 50 mg in a 1 mL volume. How many mL will be administered to the client?

0.5 mL 50x = 25x = 25 divided by 50x = 0.5 mL

The provider has prescribed Phenergan 18.75 mg to be administered IM now and q4-6hr prn for nausea. You have on hand Phenergan 25 mg/mL. How many mL should be drawn for this client?

0.75 mL 25 x = 18.75 x = 18.75 divided by 25 x = 0.75 mL

The nurse is administering medication to a group of pregnant women. At which stage of fetal development will congenital malformations LEAST likely occur?

1 to 2 weeks Rationale: 1-2 weeks of first trimester = preimplantation phase = embryo hasn't established a blood supply with the mother yet.

What 3 way can we change blood pressure

1) Cardiac output 2) Vasodilation / Vasoconstriction 3) Water volume (kidney)

adults who live with some form of chronic pain

1/3 to 1/2

Full effects of thiazide diuretics take

10-12 weeks, very slow

Prehypertension

120-139 / 80-89

Whats the target blood pressure after treatment?

135/80-85

Stage I hypertension

140-159 / 90-99

Place the procedural steps in order for administering otic solutions. 1. Assisting the client, have him or her lie on the side with ear facing up. 2. Clean the external ear with cotton tip swab. 3. Warm the otic solution bottle in hand. 4. Gently tug on the ear. 5. Place a cotton ball, or a piece of cotton, in the opening for approximately 15 minutes. 6. Straighten the ear canal as appropriate for age. 7. Fill the dropper with the appropriate amount of solution. 8. Instill the designated number of drops. 9. Instruct the client to remain on the side for approximately 5-10 minutes.

3. Warm the otic solution bottle in hand. 1. Assisting the client, have him or her lie on the side with ear facing up. 2. Clean the external ear with cotton tip swab. 7. Fill the dropper with the appropriate amount of solution. 6. Straighten the ear canal as appropriate for age. 8. Instill the designated number of drops. 4. Gently tug on the ear. 9. Instruct the client to remain on the side for approximately 5-10 minutes. 5. Place a cotton ball, or a piece of cotton, in the opening for approximately 15 minutes. First, warm the otic solution bottle in the hands. Assist the client with lying on the side with ear facing up. Clean the external ear with a cotton tip swab. Fill the dropper with an appropriate amount of solution. Straighten the ear canal as appropriate for the age of the client. Instill the designated number of drops. Gently tug on the ear to be sure the drops go into the ear. Instruct the client to remain on the side for approximately 5-10 minutes. Place a cotton ball, or a piece of cotton, in the opening for approximately 15 minutes.

Your patient is taking metronidazole, an antibiotic, which will cause a severe reaction if he drinks alcohol while taking the medication. The medication has an 8 hour half life. How long until the medication is clinically cleared from his body and he can have a beer with his friends?

40 hours

The pediatrician has ordered Erythromycin 30 mg/kg of body weight for a 32-pound client. What is the correct dosage for this client?

437 mg Convert the weight to kilograms by dividing 32 by 2.2: the child weighs 14.55 kg. Multiply the prescribed dose (30 mg) by body weight (14.55 kg): 30 mg 14.55 = 436.5 mg; round up. 437 mg is the dosage for a 14.55-kg child.

___% of American women report daily pain

46

How much acetaminophen can be given in a day?

4g/4000mg

Describe calcium release into cells

A calcium channel is open due to binding of a receptor like NE binding to beta receptors > causes calcium channel to open > the + charge causes another L type voltage gated channel to open > a lot more calcium rushes in changing the charge even more > this causes voltage gated channels on the SR to open releasing its massive stores of calcium

The physician decides to add lisinopril for HTN. The patient says his neighbor takes Norvasc for HTN & asks you why his physician is choosing lisinopril. Which best explains why an ACE-I will be more beneficial for him?

ACE-Is also slow progression of renal failure in diabetics

A client has a diagnosis of chronic pain. The physician has prescribed tramadol hydrochloride (Ultram) for the pain. The patient also receives therapeutic touch (TT) from a practitioner three times a week. In this situation, TT is considered to be which of the following? 1) A complementary modality 2) An alternative modality 3) A placebo response 4) Holistic healthcare

ANS: 1 A complementary modality is one that is used alongside traditional medical care. The patient receives prescription medication from a physician as well as receiving TT. An alternative modality is one that is used instead of traditional medical care. A placebo response is the client's expectation that a treatment will be effective. Holistic healthcare uses the concept of holism to focus on the relationships among all living things. PTS: 1 DIF: Moderate REF: p. 3 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

Therapeutic touch, Reiki, and Qigong are examples of: 1) Energy therapies. 2) Manipulative therapies. 3) Biologically based therapies. 4) Mind-body interventions.

ANS: 1 Therapeutic touch, Reiki, and Qigong involve manipulation of energy fields and are classified as energy therapies. Manipulative therapies focus on body manipulation and movement to improve health. Biologically based therapies use substances found in nature, such as food, herbs, vitamins, and aromatherapy. Mind-body therapies are based on awareness of the unity of the mind and body and on the ability of social, familial, and economic factors to affect all aspects of health and illness. PTS: 1 DIF: Moderate REF: pp. 15-17 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

Which of the following are reasons for the popularity of biologically based therapies, such as dietary supplements and herbal products? Choose all that apply. 1) They are almost all readily available to consumers. 2) They can be practiced as self-care measures. 3) It is easy to know what dosage you are obtaining from a product. 4) Products on the market have been proven to be safe to use.

ANS: 1, 2 Biologically based therapies use substances found in nature, such as food, herbs, vitamins, and aromatherapy. These therapies are readily available and are often practiced as self-care measures, so people who do not wish to see a practitioner may not need to do so. The U.S. Food and Drug Administration (FDA) regulates biologically based therapies and is developing guidelines for good manufacturing practices (GMPs). However, dosage and manufacturing processes are not standardized. The Federal Trade Commission monitors dietary supplements for truth in advertising. At present, it is difficult to know what dosage you are obtaining from a product, and safety cannot always be guaranteed. PTS:1DIF:ModerateREF:p. 10 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis

Which of the following beliefs is an essential component of holistic healthcare? Choose all that apply. 1) Illness occurs when there is a shift in an individual's balance. 2) Regardless of the type of care received, ultimately all healing is self-healing. 3) More healthcare resources should be focused on alternative healers. 4) Illness can create an opportunity for personal and spiritual growth.

ANS: 1, 2, 4 Foundational beliefs of holistic care include the following: illness reflects a shift in balance, all healing is self-healing, and illness creates an opportunity for growth. Although holistic healthcare includes the use of alternative modalities, it does not emphasize the use of healthcare resources (money, time, etc.) for alternative healers. PTS: 1 DIF: Moderate REF: p. 3 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Synthesis

Which of the following complementary and alternative modalities may be considered alternative medical systems? Choose all that apply. 1) Acupuncture 2) Prayer 3) Ayurveda 4) Aromatherapy

ANS: 1, 3 Acupuncture and Ayurveda are considered alternative medical systems. Prayer is a mind-body intervention, and aromatherapy is a biologically based therapy. PTS:1DIF:EasyREF:pp. 5-7 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension

Identify the holistic nursing theorist who describes disease as disequilibrium, which stimulates the person toward growth and regaining wholeness. 1) Jean Watson 2) Margaret Newman 3) Martha Rogers 4) Charles Darwin

ANS: 2 Margaret Newman identifies disease as disequilibrium, which stimulates the person toward growth and regaining wholeness. Jean Watson identifies caring as the primary focus of nursing. Martha Rogers states that the environmental energy field is in constant and meaningful interaction with the human energy field. Charles Darwin created the theory of natural selection. He is not a nursing theorist. PTS:1DIFgrinifficultREF:p. 5 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall

A client wishes to avoid taking blood pressure medications. He is eating a healthy diet and exercising regularly. In addition, a CAM therapist has recommended an alternative therapy that will allow him to learn voluntary control over his blood pressure. What type of therapy is the therapist probably recommending? 1) Homeopathy 2) Naturopathy 3) Biofeedback 4) Hypnosis

ANS: 3 Biofeedback is a technique by which people learn voluntary control over typically involuntary activities. Homeopathy is based on an understanding of how the body heals itself and an acceptance that all symptoms represent the body's attempt to restore itself to health. Naturopathy is the belief that nature and each living being have the innate ability to establish, maintain, and restore health. Hypnosis is a trancelike state characterized by relaxed brain waves, hypersuggestibility, and heightened imagination. Hypnosis has been used to promote relaxation, weight loss, and smoking cessation and to suppress various symptoms. PTS:1DIF:ModerateREF:pp. 9-10 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

The concept of holism focuses on which of the following? 1) Relationship between nurse and patient 2) Practice of spiritualism 3) Relationships among all living things 4) Totality of the body

ANS: 3 The concept of holism focuses on the relationships among all living things. PTS:1DIFgrinifficultREF:p. 2 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension

A client tells the nurse that he is having difficulty sleeping. He says, "I don't want to use sleeping pills, but I'm thinking about getting some melatonin." Which of the following is most important for the nurse to include in a response to the client? 1) "Melatonin is an effective treatment for certain sleep disorders." 2) "Melatonin appears to be a relatively safe sleep aid for most people." 3) "You may experience some side effects, such as elevated blood pressure." 4) "Before taking melatonin, you should consult your primary care provider."

ANS: 4 All of the statements are true about melatonin; however, side effects are rare. It is most important to consult the primary care provider because melatonin is known to interact with other medications, including prescription medications. Therefore, the client should talk with the provider about this possibility. PTS:1DIFgrinifficultREF:p. 14 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

A patient is receiving healthcare focused on his illness and counteracting his symptoms. What type of healthcare is he receiving? 1) Holistic 2) Integrative 3) Complementary 4) Allopathic

ANS: 4 Allopathic care is conventional medical care focused on counteracting symptoms. Holistic healthcare uses the concept of holism to focus on the relationships among all living things. Integrative healthcare encompasses all traditional and alternative health practices used by a patient. Complementary healthcare is alternative care used in conjunction with traditional medical care. PTS: 1 DIF: Moderate REF: p. 3 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall

What is the best rationale to gather data about patients' use of herbal products? 1) The nurse practice act requires RNs to monitor all drug dosages. 2) Herbal products need to be evaluated for research purposes. 3) Patients' medication records must be kept accurate. 4) Many herbs are known to interact with medications.

ANS: 4 Many herbs are known to interact with medications and to affect some disease processes adversely. Nurse practice acts do require RNs to assess patients but do not specifically require monitoring of drug dosages. Herbal products do need to be evaluated in research, and medication records must be accurate, but they do not provide the rationale for patient data collection. PTS:1DIF:ModerateREF:p. 11 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application

A patient at the Integrative Health Clinic is scheduled for a massage technique that promotes unblocking of a terminal nerve in order to improve function along that nerve pathway. What type of therapy is he receiving? 1) Myofascial release 2) Shiatsu massage 3) Swedish massage 4) Reflexology

ANS: 4 Reflexology is a massage technique that promotes unblocking of a terminal nerve in order to improve function along that nerve pathway. Myofascial release restores balance, alignment, and mobility to the body by releasing tension in the soft connective fasciae. Shiatsu massage is a finger pressure method that balances the energy force in the body. Swedish massage is used to induce relaxation and restore flexibility. PTS:1DIF:ModerateREF:p. 15 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

The health and well-being of a holistic nurse in relation to helping patients constitute an important part of the healing process. A method that would be helpful to nurses in fostering their own health and the health of their patients is: a) Role modeling healthy behaviors b) Avoiding discussions on personal behaviors c) Working and acting in isolation d) Setting goals for the patient

ANS: A A holistic nurse role models healthy behaviors for her patients. Practically speaking, a holistic nurse understands that unless her own health is balanced, it is difficult to sustain the energy necessary to be a constructive presence and an effective practitioner. Stress evokes negative physiological responses in the body, which could lead to illness. Working in isolation does not allow one to gain the perspectives and insights of others in a commonly shared experience.

The nurse in a women's health clinic, educates patients about the benefits of probiotic therapy. Today, the nurse is working with a patient complaining of recurrent vaginal yeast infections. The patient's laboratory tests confirm Candida albicans. Which statement helps the nurse to determine that the patient needs more teaching regarding probiotic therapy? a) "If I eat yogurt, I will not get any more yeast infections." b) "I can eat yogurt and it will reduce my yeast infections." c) "Eating yogurt once a day will help to balance my natural body flora." d) "I can take probiotics once I read their labels to ensure the bacteria are live."

ANS: A Eating yogurt does not eliminate yeast infections permanently or completely take away the potential for them to occur. Eating a probiotic, such as yogurt, can reduce vaginal yeast infections if eaten on a regular basis by establishing and supporting healthy body flora. Probiotics are most helpful when the bacteria are live and of a sufficient number to reestablish healthy amounts of flora. The statement that probiotics will prevent future infections is false, so the patient requires teaching on this point.

The health clinic nurse is interviewing a new patient. The nurse asks questions about the patient's self-care and about his healthcare providers. Which statement is likely to yield the most information from the patient regarding the use of CAM? a) "Many people go to a medical provider and other healers, as well. Please tell me about the practitioners and healers you use." b) "Some people go to both medical and nonmedical providers for healthcare. Do you use both?" c) "Many people only go to a medical physician. Tell me about the practitioners you see for healthcare." d) "Some people go to different types of CAM healers. You don't use CAM, do you?"

ANS: A For therapeutic questioning, the nurse should use open-ended questions to yield the most information. The question ending in "Do you use both?" is a yes/no question that will likely elicit very little information. Although the option ending in "Tell me about the practitioners you see for healthcare," seems open ended, the negative use of "only" ("only go to a medical physician") implies that there is not another acceptable answer, thus decreasing the information the patient may share. "You don't use CAM, do you?" is a negative, closed question. It suggests that the patient should answer "No," and almost certainly will elicit a one-word answer.

A client has a diagnosis of chronic pain. The physician has prescribed tramadol hydrochloride (Ultram) for the pain. The patient also receives therapeutic touch (TT) from a practitioner three times a week. In this situation, TT is considered to be which of the following? a) A complementary modality b) An alternative modality c) A placebo response d) Holistic healthcare

ANS: A A complementary modality is one that is used alongside traditional medical care. The patient receives prescription medication from a physician and also receives TT. An alternative modality is one that is used instead of traditional medical care. A placebo response is the client's expectation that a treatment will be effective. Holistic healthcare uses the concept of holism to focus on the relationships among all living things.

Which of the following are reasons for the popularity of biologically based therapies, such as dietary supplements and herbal products? Select all that apply. a) They are almost all readily available to consumers. b) They can be practiced as self-care measures. c) It is easy to know what dosage is being obtained from a product. d) Products on the market have been proved to be safe to use.

ANS: A, B Biologically based therapies use substances found in nature, such as food, herbs, vitamins, and scents used in aromatherapy. These therapies are readily available and are often practiced as self-care measures, so people who do not wish to see a practitioner may not need to do so. The U.S. Food and Drug Administration (FDA) regulates biologically based therapies and is developing guidelines for good manufacturing practices (GMPs). However, dosage and manufacturing processes are not standardized. The Federal Trade Commission monitors dietary supplements for truth in advertising. At present, it is difficult to know what dosage you are obtaining from a product, and safety cannot always be guaranteed.

Herbs are used in a number of ways in CAM (complementary & alternative medicine). Why might a patient choose to use CAM for healing? Select all that apply. a) Aromatherapy b) Health maintenance c) Health promotion d) Infection prevention e) Avoidance of treatment side effects

ANS: A, B, C, D Herbal remedies have long been used to prevent or fight infection, promote and maintain health in a number of ways such as aromatherapy. As with pharmacological therapies, herbal remedies are not risk free and sometimes do have complications (e.g., allergic response).

Which of the following beliefs is an essential component of holistic healthcare? Select all that apply. a) Illness occurs when there is a shift in an individual's balance. b) Regardless of the type of care received, ultimately all healing is self-healing. c) More healthcare resources should be focused on alternative healers. d) Illness can create an opportunity for personal and spiritual growth.

ANS: A, B, D Foundational beliefs of holistic care include the following: illness reflects a shift in balance, all healing is self-healing, and illness creates an opportunity for growth. Although holistic healthcare includes the use of alternative modalities, it does not emphasize the use of healthcare resources (money, time, etc.) for alternative healers.

Which of the following complementary and alternative modalities may be considered alternative medical systems? Select all that apply. a) Acupuncture b) Prayer c) Ayurveda d) Aromatherapy

ANS: A, C Acupuncture and ayurveda are considered alternative medical systems. Prayer is a mind-body intervention, and aromatherapy is a biologically based therapy.

The nurse understands that there are potential risks with herb use, just as there are risks with standard Western medications. These risks with herb use include which of the following? Select all that apply. a) Interaction with other medications b) Standardization of herbal preparations c) Lack of standardization of herbal preparations d) Lack of a formulary e) Reduced chance of toxicity

ANS: A, C, D Herbal therapies are not as regulated or standardized as Western medications. The major risks of herbal therapies are the lack of a formulary, the lack of standardization, the potential for interactions that are not identified, and the potential for toxicity as a result of dosages and interactions.

Through the use of the nursing process, holistic healthcare implemented by nurses includes which of the stated activities? Select all that apply. a) Health promotion b) Illness accentuation c) Health maintenance d) Education

ANS: A, C, D Holistic healthcare includes illness prevention, not accentuation, along with health education, health promotion, health maintenance, and restorative rehabilitative care.

The nurse is caring for a patient with severe, chronic headaches. According to a recent medical work-up, there "is no definitive physiological reason for these headaches." The nurse counsels the patient about alternative therapies for headaches, knowing that: a) Homeopathic medications eliminate migraine and other chronic headaches b) Acupuncture is more effective than medication in relieving chronic headaches c) Western medicine has no alternative treatment for severe, chronic headaches d) There is no palliative care for chronic headaches without physiological basis

ANS: B Acupuncture has been shown to more effectively relieve chronic headaches than medications. Homeopathic medicine is person specific and not disease/symptom specific—that is, it cannot be said that it affects headaches in a specific way. Western medicine does have other alternative treatments for severe and chronic headache management (e.g., biofeedback, botulinum toxin). There is palliative care for chronic headaches to manage the process rather than effecting a "cure."

The nurse is caring for a patient who after removal of a tumor had radiation therapy. The patient, without consulting his primary provider, added nutritional therapy and the use of acupuncture. The treatments chosen by the patient are examples of what type of treatments? a) Alternative modalities b) Complementary modalities c) Integrative healthcare d) Conventional biomedical therapies

ANS: B Complementary modalities (i.e., nutritional therapy and acupuncture) are used in conjunction with traditional medical care (the radiation treatments). Alternative modalities are used instead of conventional medical therapies. Integrative modalities are therapies that are proved to be effective and safe when combined with or integrated into conventional therapies. Conventional biomedical therapies include radiation therapy.

The nurse understands that CAM therapies are popular with many patients. What is the most important thing for the nurse to know regarding safe use of CAM therapies? CAM therapies a) Must be sensitive to the patient's culture b) Need to be tested to establish their effectiveness c) Should be determined by the patient d) Chosen by the patient can bypass testing

ANS: B Patients may use CAM therapies even if there is no accurate evidence on which to base their effectiveness or safety. Therefore, the nurse needs to look at empirical research to guide the nurse, patient, and healthcare provider in using these therapies. The other responses negate the importance of research data in the use of CAM, although they do suggest issues that can improve the effectiveness of any therapy (i.e., cultural sensitivity, the patient wants to use them).

Which groups of people choose CAM more often than do others? Select all that apply. a) Men b) Women c) People younger than 18 years of age and older than 70 years of age d) People older than 18 years of age and younger than 70 years of age e) Caucasians

ANS: B, D, E Caucasian women over 18 years of age and younger than 70 years of age are the main group that uses CAM. Although the other groups do use CAM, they do not use it as much as those groups.

The nurse is caring for a patient, who recently emigrated from India. The patient states the reason for the visit is for a well-patient visit. While taking the patient's history, the nurse ascertains that the patient is using ayurvedic herbal remedies. Which statement below assists the nurse to determine whether the patient understands the pros and cons of these herbal remedies? a) "I can continue to order these herbal remedies from the shop in India where I have always purchased them." b) "I can order these herbal remedies from any Internet source selling them." c) "I should order these herbal remedies over the Internet from an FDA-approved site." d) "I have had no problems from taking these herbal remedies, so I can continue their use."

ANS: C Ayuvedic herbal remedies are frequently combined with metals that can be harmful to the patient. Purchasing them from an unregulated shop or Web site increases the chances of there being higher levels of toxic metals in the herbal mixtures. Therefore, the patient should purchase these herbal remedies only from an FDA-approved Web site source. Also, because the patient believes there is no problem with taking these unregulated remedies, the nurse must educate him about the potential issues with this.

Herbal products are very popular worldwide for prevention and treatment of illness. As a nurse you should: a) Advise patients to purchase herbal products from the least expensive source b) Inform patients that research conclusively states that herbs are safe c) Learn about herbal therapies and include them in questions when taking a patient's history d) Disregard patients' use of herbal products, as their use will not impact traditional medicine

ANS: C Because herbal products are readily available and widely used, you should learn about herbal products and include them in questions when taking a patient's history. The National Center for Complementary and Alternative Medicine (NCCAM) offers extensive material on herbal products for professionals and consumers. Advise patients to purchase herbs from a reliable source and seek advice from credentialed practitioners when incorporating herbs into their care.

The concept of holism focuses on which of the following? a) Relationship between nurse and patient b) Practice of spiritualism c) Relationships among all living things d) Totality of the body

ANS: C The concept of holism focuses on the relationships among all living things.

A woman is receiving physical therapy after surgery to repair a hip fracture. She tells the therapist before therapy begins that she expects therapy to be very painful. She rates her pain as 1 on a scale of 1 to 10 before therapy. Three minutes into the treatment session, the patient complains of excruciating pain rated as 10 and says she cannot tolerate exercise any longer. The therapist is concerned with the amount of pain, because severe pain is not expected during that form of exercise. The therapist considers the patient could be experiencing: a) Phantom limb pain b) Ineffective pain medication c) A nocebo effect d) A complication from the surgery

ANS: C The nocebo effect is a demonstration of the power of the mind to create bodily distress. The patient was expecting the treatment to be very painful, and this tends to increase the treatment discomfort. Phantom limb pain is sometimes experienced after an amputation but has nothing to do with surgery to repair a hip fracture. There is no evidence that the patient's pain medication is ineffective or that she is experiencing a complication from surgery.

An elderly client with a history of COPD is having difficulty sleeping and does not wish to see a medical practitioner. Which of the following strategies should the nurse discourage the client from using, or urge him to see a physician before beginning the therapy? The client has not used any of these therapies in the past. Select all that apply. a) Aromatherapy b) T'ai chi c) Yoga d) Melatonin

ANS: C, D Aromatherapy is known to be safe, and may be effective. Tai chi is safe for older adults, and may be effective for sleep. Yoga is possibly effective for sleep, but it is physically rigorous, so it has the potential to be harmful for older adults, who may have a variety of chronic conditions. The client should see a physician before beginning yoga. Melatonin is effective for certain sleep disorders, but it does interact with several prescription drugs. Therefore, the client should not take melatonin without consulting a physician.

A client tells the nurse that he is having difficulty sleeping. He says, "I don't want to use sleeping pills, but I'm thinking about getting some melatonin." Which of the following is most important for the nurse to include in a response to the client? a) "Melatonin is an effective treatment for certain sleep disorders." b) "Melatonin appears to be a relatively safe sleep aid for most people." c) "You may experience some side effects, such as elevated blood pressure." d) "Before taking melatonin, you should consult your primary care provider."

ANS: D All of the statements are true about melatonin; however, side effects are rare. It is most important to consult the primary care provider because melatonin is known to interact with other medications, including prescription medications. Therefore, the client should talk with the provider about this possibility.

A patient is receiving healthcare focused on his illness and counteracting his symptoms. What type of healthcare is he receiving? a) Holistic b) Integrative c) Complementary d) Allopathic

ANS: D Allopathic care is conventional medical care focused on counteracting symptoms. Holistic healthcare uses the concept of holism to focus on the relationships among all living things. Integrative healthcare encompasses all traditional and alternative health practices used by a patient. Complementary healthcare is alternative care used in conjunction with traditional medical care.

A patient has been taking herbal remedies to decrease blood pressure. The patient is convinced that this has reduced his blood pressure and he refuses to take a prescribed antihypertensive medication. The nurse checks his blood pressure reading during an office visit, with the following results: Left arm: 130/94, 140/86, and 160/90 mm Hg. With this information, what is the nurse's best response to the patient's refusal to take antihypertensive medications? a) "I see that you are correct; your blood pressure readings do not indicate hypertension." b) "Your blood pressure is elevated, so you will need to take a prescribed antihypertensive." c) "Your blood pressure is within normal limits and does not need anything for it." d) "Your blood pressure is elevated. It is important to discuss this with your doctor."

ANS: D The nurse identifies that these blood pressure readings are elevated and correctly suggests the discussion with the physician. The nurse is not the person to determine potential therapies for the patient. The nurse cannot tell the patient he is correct and does not have hypertension because his vital signs do not support that. The patient's blood pressure is not within normal limits.

The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication?

Administer it as a fast IV push.

ACLS

Advanced cardiac life support

Prazosin MOA

Alpha-1 antagonist > blocks alpha-1 on vascular smooth muscle and stops vasocontriction thus reducing TPR

You are administering a 2nd, different medication (Drug Z). It is an adrenergic agonist that has high affinity and selectivity for alpha-1 receptors. Which of the following statements best describes the expected physiological effects of Drug Z on the vasculature?

Alpha-1 stimulation leads to intense vasoconstriction of vasculature of skin and mucous membranes

Which patient is most likely to experience drug toxicity while taking herbal supplements?

An 80-year-old female with cirrhosis Rationale: She's old, she has a bad liver = RISK

A nurse has just completed inventory on the controlled substances on the unit, has completed necessary documentation, and locked the cabinet. He or she walks away, leaving the locked cabinet on the counter in an open workstation. What step has the nurse not completed? 1. Double-locking the controlled substances 2. Putting them inside a cabinet 3. Having a second witness sign the documentation 4. Passing keys to the locked cabinet to the next charge nurse

Answer 1 Option 1: All controlled substances must be double-locked (stored in locked drawers, in a second locked area) Option 2: Controlled substances can be put inside a cabinet, but they should be secured appropriately. Option 3: A second signature is not needed unless the facility requires it. Option 4: Inventory typically is conducted at the beginning of the shift, so passing keys off to another nurse is not needed.

Which are examples of parenteral administration of medication? Select all that apply. 1. Intramuscular 2. Intravascular 3. Inhaled 4. Oral suspension 5. Topical application

Answer 1, 2 Option 1: Intramuscular medications are injected into a muscle, which is parenteral administration. Option 2: Intravascular medications are injected into a vein, which is parenteral administration. Option 3: Inhaled medication is not injected and is not parenteral administration. Option 4: Oral suspension is not injected and is not parenteral medication. Option 5: Topical application of medication is not parenteral, as it is not injected.

The pediatrician has ordered erythromycin 20 mg/kg of body weight for a 55-pound client. The medication on hand is 250 mg tablets. How many tablets will be administered to this client?

Answer is 2 (DO NOT SAY TABLETS ON QUIZ AS IT WILL MARK IT WRONG... DUMB...) Convert weight to kg: 55 lb/2.2 kg = 25 kg Determine amount needed: 20 mg x 25 = 500 mg Determine how many tablets needed to get 500 mg: 500/250 = 2

Once the student nurse has researched the new antibiotic prescribed to treat the client's pneumonia, he or she feels more information is needed to plan nursing interventions based on side effects of the drug. What resource would be best suited to obtain this information? 1. Nursing drug handbook 2. The National Formulary 3. Physician's Desk Reference 4. A pharmacopoeia

Answer: 1 Option 1: A nursing drug handbook provides important information regarding the drug, how it is prescribed, side effects, and nursing interventions. Option 2: The formulary identifies the therapeutic value of drugs as well as their formulas and prescriptions, but may not be the best for nursing intervention recommendations. Option 3: While an excellent resource, the PDR contains information on dosing, routes of administration, and side effects, but does not include nursing interventions. Option 4: The Unites States Pharmacopoeia (USP) is a directory of drugs approved by the Food and Drug Administration (FDA) and includes a list of the physical and chemical composition of each drug.

A client has been prescribed an antibiotic that has side effects including nausea, vomiting, abdominal pain, and diarrhea. What nursing intervention would be appropriate for this client? 1. Instruct the client on side effects, what to report, and when. 2. Instruct the client on documenting bowel movements, consistency, and frequency. 3. Document that the client reports no nausea, vomiting, abdominal pain, or diarrhea. 4. State that the client will be free from side effects including nausea, vomiting, and diarrhea

Answer: 1 Option 1: As a primary nurse, the responsibility is to educate the client on possible side effects including what to look for, what to report to nursing staff, and when. Option 2: Having clients document bowel movements is not needed; if monitoring is needed, it should include the nursing staff. Option 3: Making statements regarding what has occurred is an evaluation. Option 4: Making a statement regarding what will or should happen is an outcome, not an intervention.

The student nurse is about to administer a rectal suppository to an older adult. What advice should the preceptor offer this student in regard to older clients and rectal suppositories? 1. Due to poor sphincter control, a bed pan should be used during the procedure. 2. Suppositories are only inserted ½ in. in older adults. 3. Suppositories may have to be pushed a little harder due to a tightened rectal sphincter. 4. The buttocks may need to be held together to ensure the suppository remains in place.

Answer: 1 Option 1: As older adults lose control over sphincter muscles, it is wise to use a bed pain while inserting the suppository in the event of loss of control. Option 2: In all adults, it is suggested to insert rectal suppositories 1 to 3 in. into the rectum, past the internal sphincter. Option 3: Suppositories should never be forced, as it could mean blockage due to fecal matter that will prevent absorption of medication. Option 4: Holding the buttocks together is suggested in pediatric clients, not for older clients.

Which describes drugs with limited medical use and high potential for abuse or addiction? 1. Controlled substances 2. Prescription drugs 3. Narcotics 4. Placebo drugs

Answer: 1 Option 1: Controlled substances are available by prescription only and are used with caution. Option 2: Prescription drugs is a broad category of drugs only available with a medical order. Option 3: Narcotics are a category of potentially addictive drugs. They are, however, medically useful for pain control. Option 4: Placebo drugs have no effect and are given in some clinical trials. Their use is controversial and considered a violation of patient rights.

Why are lipid-soluble drugs used for sedation? 1. They can pass through the blood brain barrier. 2. They cannot be broken down by acids, preventing the medication from being diluted before it reaches the nervous system. 3. They release small amounts for absorption over several hours. 4. They are rapidly absorbed from the GI tract and take effect faster.

Answer: 1 Option 1: Due to the ability of fat-soluble drugs to attach to lipids, they can easily pass through the blood brain barrier and effect sedation. Option 2: Enteric-coated medication cannot be broken down by GI acids that prevent dilution before entering the intestines. Option 3: Time-released or sustained-release formulas release small amounts of the medication over a period of several hours, allowing for absorption over a longer period of time. Option 4: Water-soluble drugs are rapidly absorbed from the GI tract, which has a quicker effect.

A client presents to the emergency department with severe pain related to a kidney stone. In order to obtain adequate pain relief quickly, which is the most rapid and effective route to administer pain medications? 1. Intravenous 2. Intramuscular 3. Oral administration 4. Subcutaneous injection

Answer: 1 Option 1: Intravenous administration of medication directly injects the medication into the bloodstream, which has the fastest action. Option 2: Intramuscular injection must be absorbed into muscle tissue before being taken up by the bloodstream. This is not the fastest route. Option 3: Oral administration of medications must be processed through the stomach, and then absorbed into the bloodstream through the digestive tract. This is not the fastest route of administration. Option 4: Subcutaneous injections are absorbed into the soft tissues before being disbursed into the bloodstream.

To whom can a nurse delegate the administration of ophthalmic solutions? 1. LPN/LVN 2. NAP 3. PA 4. ANP

Answer: 1 Option 1: LPN/LVNs are authorized to administer ophthalmic solutions. Option 2: Nurses cannot delegate ophthalmic administration to NAPs, as it is not in their scope of practice. Option 3: A physician's assistant would not normally take direct orders from a charge or unit nurse. Option 4: Advanced nurse practitioners can delegate this responsibility, but they are typically not taking direct orders from a charge or unit nurse.

A client is brought into the emergency department in shock due to a trauma. What method would be the most effective route for administering emergency medications? 1. Intravenously 2. Intramuscularly 3. Sublingually 4. Orally

Answer: 1 Option 1: Shock reduces peripheral circulation, so administering medication directly into the bloodstream is the best method. Option 2: As peripheral circulation is reduced in shock, administering medications intramuscularly would not be effective. Option 3: Not all medications can be administered sublingually, so this would not be an effective method. Option 4: Oral medications take longer to take effect and therefore would not be the best method.

What is the benefit of using an automated dispensing system? 1. Allows for immediate availability and administration of newly prescribed and prn medications 2. Promotes independence and allows evaluation of a client's ability to manage medications safely and accurately before discharge 3. Saves nursing time and is the safest method 4. Automatic inventory of all unit medications

Answer: 1 Option 1: The computer database contains prescriptions, records, and counts of the medications for each client on the unit which allows for immediate availability of medications. Option 2: Self-administering of medications is the method that promotes independence and also gives the nurse an opportunity to evaluate for ability to self-medicate at home. Option 3: The safest method is the unit-dose method, as it involves a double-check system. Option 4: While an automated system keeps track of a client's medication and what is held within the system, this is not specifically a benefit.

Which is the usual dosing method of drugs for pediatric clients? 1. Milligrams per kilogram of body weight 2. Ounces per pound of body weight 3. Milligrams per pound of body weight 4. Ounces per kilogram of body weight

Answer: 1 Option 1: The metric system is used for calculating drug dosages for pediatric clients. Option 2: Ounces and pounds are part of the apothecary system and are not used for pediatric dosing. Option 3: Milligrams is metric and pounds is apothecary. Two different methods should not be used in drug calculation. Option 4: Ounces is apothecary and kilogram is metric; this combination should not be used to calculate dosage.

The nursing outcome for a client with a nursing diagnosis of Risk for constipation r/t analgesic is as follows: Client will not experience constipation as evidenced by usual frequency of bowel movements; passage of soft, formed stool. Constipation is a common side effect of analgesics, so what is an appropriate nursing intervention to help address this? Select all that apply. 1. Instruct the client to increase intake of foods high in fiber. 2. Instruct the client to maintain a minimum fluid intake of 2,500 mL/day unless contraindicated. 3. Administer laxatives or cathartics and/or enemas if ordered. 4. Report a pattern of decreasing bowel sounds. 5. Expect an absence of abdominal distention and pain.

Answer: 1, 2, 3 Option 1: By teaching the client to increase intake of fiber, he or she can deal with possible side effects of constipation easier. Option 2: Increasing fluid intake will help minimize risk for the side effect of constipation. Option 3: If needed, laxatives or enemas can be used to relieve constipation. Option 4: Intervention of bowel sounds is not indicated by the nursing diagnosis and outcome. Option 5: Making a statement of what should or will occur is an outcome, not an intervention.

A client is scheduled for an annual PPD for work. What considerations should the nurse be aware of before administering this test? Select all that apply. 1. Pregnancy 2. Previous skin reaction 3. Use of topical anesthetic 4. Fever 5. Use of an antihistamine within past 4 hours

Answer: 1, 2, 3 Option 1: If client is pregnant, PPD should be deferred and the provider alerted. Option 2: Depending on the type of reaction, further testing may be needed and the provider should be informed. Option 3: If the client has used a topical anesthetic in the location, the test should be conducted on the other arm or rescheduled. Option 4: Fever is always a consideration in any type of medication administration but typically does not affect PPD testing. Option 5: Use of an antihistamine does not have any contraindications for the testing of PPD.

Which are safety challenges related to medication self-administration in older adults? Select all that apply. 1. Opening medication containers 2. Remembering to take medications 3. Visualizing labels for correct dosing 4. Asking doctors for medications 5. Thinking medications are not needed

Answer: 1, 2, 3 Option 1: Medications for elderly adults should be provided in easy-to-open bottles. Option 2: An elderly person who has dementia may forget to take medications or forget that he or she has already taken a medication. Option 3: Elderly clients who have trouble seeing may not be able to accurately read a medication label. Option 4: Difficulty asking for medications is not associated with the elderly. Option 5: Thinking medications are not needed is not a consideration unique to the elderly.

A client has a medication, metoprolol (Lopressor), due at 0800, and the student nurse is not familiar with this medication. What information should be researched before giving this medication? Select all that apply. 1. Classification of drug 2. The use of the medication 3. Body system affected 4. All trade names 5. Chemical name

Answer: 1, 2, 3 Option 1: The classification of the drug is important in understanding how and why this medication is used. Option 2: Why the medication is prescribed is important to understand prior to administering. Option 3: The body system the medication will affect is important information. Option 4: It is not necessary to research all trade and brand names of medications for a specific client and medication. Option 5: The chemical name is not particularly important if the nurse has researched the drug classification.

What conditions are contraindicated in rectal suppository administration? Select all that apply. 1. Recent rectal surgery 2. Rectal bleeding 3. Cardiac disease 4. Hemorrhoids 5. Irritation

Answer: 1, 2, 3 Option 1: When a client has recently had rectal surgery, there may be issues with effectively administering rectal suppositories. Option 2: Rectal bleeding could indicate disease or other issues that could prevent effective medication absorption and administration. Option 3: The use of glycerin in clients with heart disease can cause irregular heart rates and other cardiovascular dysfunction. Option 4: Hemorrhoids are not considered a contraindication. Option 5: Irritation may make administration uncomfortable but is not considered a contraindication.

When preparing to administer an otic solution to a client, what should the nurse assess the client for? Select all that apply. 1. Redness 2. Cerumen 3. Drainage 4. Ear pain 5. Fever

Answer: 1, 2, 3, 4 Option 1: Erythema should be noted both inside and outside of the ear canal. Option 2: Wax buildup should be taken care of prior to administering medications. Option 3: Drainage should be noted, (color and amount) and may possibly need to be irrigated prior to administering medication in the ear. Option 4: Any ear pain the client is experiencing should be noted, and the provider will determine if the nurse is to proceed. Option 5: The client's temperature should be taken, but this is not a needed assessment directly related to administering ear medications.

How are medications detoxified from the body? Select all that apply. 1. Kidneys 2. Blood plasma 3. Intestinal mucosa 4. Lungs 5. Large intestine

Answer: 1, 2, 3, 4 Option 1: Kidneys filter and work to excrete waste, so metabolized medications from the liver can be removed here. Option 2: Blood plasma carries waste to be filtered and excreted, so metabolized medications from the liver can be removed here. Option 3: Intestinal mucosa has the ability to absorb metabolized waste from medication and transfer it to be carried for excretion. Option 4: The lungs act as a method of removing waste from the body, and metabolized medication waste can be removed this way as well. Option 5: The large intestine absorbs water but is not a viable manner for detoxifying medications from the body.

A nurse is scheduled to administer the following drugs to the client: (1) insulin subcutaneously for diabetes, and (2) morphine intravenously to relieve pain. What factors should be considered that will affect the pharmacokinetics of the drugs when administering these medications? Select all that apply. 1. Body mass 2. Gender 3. Pregnancy 4. Time of administration 5. Therapeutic effect 6. Location

Answer: 1, 2, 3, 4, Option 1: Medication dosage is based on an "average" weight for adults of 150 lbs, so anything over or under must be recalculated. Option 2: Men and women absorb medications differently due to differences in muscle mass, hormones, and fat distribution. Option 3: Pregnancy must be considered due to the teratogenic effect of some medications. Option 4: Time of administration must be considered, as some medications should be taken on an empty stomach, full stomach, and so forth. Option 5: The therapeutic effect is a factor of pharmacodynamics, not pharmacokinetics. Option 6: Route of administration is a factor; however, location is not a factor in pharmacokinetics.

Which are classification systems for drugs? Select all that apply. 1. Usage 2. How supplied 3. Body system 4. Chemical or pharmacological class 5. Manufacturer

Answer: 1, 3, 4 Option 1: Why the drug is used is a type of classification. Option 2: The form of the drug is not a classification system for drugs. Option 3: Drugs are classified according to the body system on which they act. Option 4: Drugs are classified by the class of chemical compound used. Option 5: Drugs are not classified by manufacturer.

Which would be an appropriate technique and preparation for administration of subcutaneous injection in a morbidly obese person? Select all that apply. 1. 25- to 27-gauge needle 2. 18- to 20-gauge needle 3. Inject substance at a 45-degree angle 4. Inject at a 90-degree angle 5. Pull skin taut when administering

Answer: 1, 4, 5 Option 1: A small-gauge needle is appropriate for subcutaneous injection. Option 2: These needle gauges are too large for subcutaneous injection. Option 3: A 45-degree angle is too superficial in an obese person. Option 4: Injection into subcutaneous tissue should be performed at a 90-degree angle in obese clients. Option 5: Pull skin taut rather than pinching when performing a subcutaneous injection in obese clients.

Which are sources of discomfort associated with injections? Select all that apply. 1. The needle itself 2. Anxiety of the client 3. Movement of the client 4. Chemical irritation caused by certain drugs 5. Pressure of the volume of medication in the tissue

Answer: 1, 4, 5 Option 1: The sharp needle going through skin may cause momentary discomfort. Option 2: Client anxiety may increase the anticipation of discomfort, but it is not a cause of actual discomfort. Option 3: Movement of the client is rarely a case of discomfort. Option 4: Chemicals used in the constitution of drugs can cause irritation of tissues. Option 5: The volume of the drug injected into the tissues can cause local discomfort.

Which characteristics of a drug are part of pharmacokinetics? Select all that apply. 1. Absorption 2. Packaging 3. Dosage 4. Distribution 5. Excretion

Answer: 1, 4, 5 Option 1: This describes the movement of a drug from the site of administration into the bloodstream. Option 2: Packaging is not part of drug pharmacokinetics. Option 3: Dosage is not part of a drug's pharmacokinetics. Option 4: Distribution describes the movement of a drug in the body. Option 5: Excretion describes how a drug is processed and eliminated from the body.

Which are examples of the "rights of medication" administration? Select all that apply. 1. Right client 2. Right room 3. Right nurse assigned to administer 4. Right dose 5. Right time 6. Right route

Answer: 1, 4, 5, 6 Option 1: Making sure the right client is getting the medication is part of the five rights of medication administration. Option 2: The room number should not be used as part of identifying a client in safe medication administration. Option 3: The nurse assigned to the client is not part of the five rights of medication administration. Option 4: The right dose of medication is part of the five rights of medication administration. Option 5: Right time of administration is an important part of safe medication administration. Option 6: The route of administration is part of the five rights of medication administration.

Advil is an example of which type of drug name? 1. Generic name 2. Brand name 3. Official name 4. Chemical name

Answer: 2 Option 1: Advil is not a generic name; the generic name for Advil is ibuprofen. Option 2: Advil is a brand name for the generic drug ibuprofen. Option 3: The official name is the same as the generic name. Option 4: The chemical name is the drug's chemical composition and molecular structure contained in the medication.

Which is the correct meaning of the abbreviation IVPB? 1. Drop 2. Intravenous piggyback 3. Keep vein open 4. Teaspoon

Answer: 2 Option 1: Drop is the meaning of the abbreviation gtt. Option 2: Intravenous piggyback is the meaning of the abbreviation IVPB. Option 3: Keep vein open is the meaning of the abbreviation KVO. Option 4: Teaspoon is the meaning of the abbreviation tsp.

A student nurse is assigned to a client with a medical diagnosis of pneumonia who has been prescribed Levaquin. What is the generic name of this medication? 1. Fluoroquinolone 2. Levofloxacin 3. (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid hemihydrate 4. Levaquin oral solution

Answer: 2 Option 1: Fluoroquinolone is the drug class of levofloxacin, not the chemical name. Option 2: The generic name of Levaquin is levofloxacin. Option 3: The chemical name of Levaquin is denoted by a combination of letters, symbols, and numbers. Option 4: Levaquin is the trade or brand name and oral solution is the form in which it is available.

A nurse is caring for a client who has a nasogastric tube set to low intermittent suction. She has an order to administer a liquid medication through the tube. Which action should the nurse take prior to administration of the medication? 1. Increase the suction on the NG tube to empty the stomach. 2. Turn suction off on the NG tube and leave off for 30 minutes. 3. Turn suction off but return to low intermittent suction immediately after medication administration. 4. Leave the NG tube at low intermittent suction so that the medication is absorbed quickly.

Answer: 2 Option 1: NG tube suction should not be increased at any point when giving medication. Option 2: Turning the NG tube suction off and leaving off for 30 minutes will ensure the medication has gone through the stomach. Option 3: The suction must be off for at least 30 minutes after medication administration to pass through the stomach. Option 4: The NG tube should be turned off when administering medication. Leaving it on suction will result in the medication being aspirated out of the stomach.

Which can result as an increased response to repeated doses of a drug that occurs when the rate of administration is greater than the rate of metabolism and excretion? 1. Pharmaceutical effect 2. Cumulative effect 3. Side effect 4. Adverse effect

Answer: 2 Option 1: The pharmaceutical effect is the expected action of the drug on the body. Option 2: The cumulative effect occurs when a drug is administered in repeated doses and is not metabolized quickly. Option 3: A side effect is an unintended effect of a drug on a body. Option 4: An adverse effect is a negative, unintended effect of a drug on a body.

Which action describes the period when the concentration of medicine is highest in the blood? 1. Onset of action 2. Peak action 3. Duration of action 4. Therapeutic range

Answer: 2 Option 1: This is when levels are high enough in the bloodstream for effects to begin. Option 2: Peak action is when the concentration of medicine is highest in the blood. Option 3: This is the period of time in which the medication has a pharmacological effect. Option 4: The therapeutic range is the range of time of therapeutic concentration.

Which organ is the primary site for drug metabolism? 1. Kidneys 2. Bladder 3. Liver 4. Stomach

Answer: 3 Option 1: Kidneys filter any additional waste product from drugs, but are not the primary organs of metabolism. Option 2: The bladder stores urine until it can be passed from the body. It is not a site of metabolism. Option 3: The liver is the primary site of metabolism of drugs in the body. Option 4: The stomach holds drugs and other foods and ingested products, but it is not an organ of metabolism.

Which describes medications that are given through injection into tissues or the bloodstream? 1. Reconstituted administration 2. Syringe administration 3. Parenteral administration 4. Metered dose administration

Answer: 3 Option 1: Many injectable drugs are reconstituted prior to administration, but this is not a description of these drugs. Option 2: Injectable drugs are given through a syringe, but this is not a description of these drugs. Option 3: Drugs that are administered through injection into the tissues or bloodstream are given through parenteral administration. Option 4: Metered dose administration is a method of administering an inhaled medication.

Which describes the prescribed amount of drug a client receives at a single time? 1. Multidose 2. Divided dose 3. Unit dose 4. Adjusted dose

Answer: 3 Option 1: Multidose vials contain multiple doses of medications. These should only be kept in areas used for preparation of medications, such as hospital pharmacies. Option 2: A divided dose is a dose that is given in smaller increments over a period of time. Option 3: A unit dose is the prescribed amount of drug to be given at a single time. Option 4: An adjusted dose is a dose of medication that has been changed to accommodate an individual need.

Which describes the production of a fine spray, fog, powder, or mist from a liquid drug? 1. Reconstitution 2. Vaporization 3. Nebulization 4. Reformulation

Answer: 3 Option 1: Reconstitution refers to the mixing of two products to create a medication. Option 2: Vaporization is the release of liquid into the air. Option 3: Nebulization is fine particles of a liquid medication converted to an inhaled form. Option 4: Reformulation is the revision in formulating medication.

A nurse is preparing oral medications. A client is concerned that the blood pressure pill is a different color than the one he or she takes at home. How should the nurse respond? 1. Return the medication to the pharmacy, as it is the wrong medication. 2. Reassure the client that this is what the doctor has prescribed. 3. Check the label and dosage and confirm that the medication and dosage is correct. Reassure the client that this is a different manufacturer. 4. Ask the client to bring his medications from home and he can take those.

Answer: 3 Option 1: The medication should be questioned and verified, but this should be done by the nurse. The medication is likely a different brand. Option 2: Reassurance without validation is not safe. The nurse should check the medication and ensure the appropriate medication is being given. Option 3: The nurse should confirm the medication dosage and use the five rights to verify the correct medication. If this is the correct medication, reassure the client that it is a different brand, but the same medication. Option 4: Clients should only bring medications from home under special circumstances, such as the hospital does not stock their usual medications.

Which describes restorative effects of drugs? 1. Relieves signs and symptoms of disease but does not provide treatment for the disease itself 2. Destroys disease-causing microorganisms or body cells 3. Returns or maintains the body at optimal health 4. Supports the integrity of other body functions until other medicines or treatments are effective

Answer: 3 Option 1: This describes palliative effects. Option 2: This describes chemotherapeutic effects. Option 3: This correctly describes restorative effects. Option 4: This describes supportive effects.

Which is a safe volume of medication to be administered through the subcutaneous route? 1. 3 to 5 mL 2. 2 to 4 mL 3. 0.5 to 1 mL 4. 1.5 to 3 mL

Answer: 3 Option 1: This is too large a volume to be injected into subcutaneous tissues. Option 2: This is too large a volume to be injected into subcutaneous tissues. Option 3: Only small amounts of medication should be injected into subcutaneous tissues. Option 4: This is too large a volume to be injected into subcutaneous tissues.

Which is the primary danger when administering oral medications to children? 1. Giving the wrong dose 2. The child not responding as expected to the drug 3. Incorrect client identification 4. Choking and aspiration

Answer: 4 Option 1: If pediatric dosages are calculated correctly, dosage should be correct. Option 2: Children may respond differently to medications than adults, but this is not the primary danger. Option 3: Incorrect client identification should be avoided in all medication administration. Option 4: Children who may be unable or unwilling to swallow medications are at risk of choking.

A nurse is drawing up a medication through a syringe from a single-use vial. After the prescribed amount is drawn up, there is still approximately 5 mL of solution in the vial. Which action should the nurse take? 1. Draw up the remaining medication and administer to the client. 2. Place the vial in the medication room in case another nurse needs it for another client. 3. Place it in his or her pocket in case it is needed later. 4. Discard the remaining medication.

Answer: 4 Option 1: If the prescribed amount has been drawn up, additional volume of the medication should not be added. Option 2: Single-use vials should not be left for use on another client. Option 3: Single-use vials should not be used at different times or for more than one use. Option 4: The remaining volume of medication should be discarded.

Morphine 8 mg q3-4hr IM has been ordered for a client, and the nurse is monitoring to see if the client needs a PCA pump. Knowing that the half-life of morphine is 3 hours, if administered at 0800, what amount will be left in the body at the client's next dosage administration (1100)?

Answer: 4 mg Correct Feedback If the half-life of the drug is 3 hours, the client's next dosage in 3 hours would be ½ the original amount administered. 8 mg / 2 = 4 mg

When checking the medication administration record, the nurse notices it is time to prepare the next dose of antibiotics for IV administration. The nurse also notices the client received morphine for pain 1 hour ago. When you enter the room, you find the client sleeping and are unable to waken him or her to verify the need to proceed. What can be inferred from what is observed? 1. Possible adverse reaction 2. Toxic reaction 3. Allergic reaction 4. Idiosyncratic response

Answer: 8 Option 1: Adverse reactions and drug sensitivity can cause a reaction to the effects of the drug. Option 2: With morphine, a toxic reaction would be noted by depressed respiratory rate and depth. Option 3: Allergic reactions are an immune system response causing minor to severe manifestations ranging from urticaria to anaphylaxis. Option 4: Idiosyncratic responses are an abnormal reaction or response to a medication that is typically denoted by a lack of response or an opposing response.

The oncologist has prescribed Herceptin 4 mg/kg IV infusion over the next 90 minutes to a client weighing 114 lbs. After reconstituting. you have a multi-dose solution containing 21 mg/mL. How many mL should the nurse administer to the client?

Answer: 9.87 mL (DO NOT ROUND ON THIS ONE) The dose is weight-based. You need to determine the desired dose and then plug it into the formula Dose on HandQuantity on Hand=Desire DoseQuantity DesiredDose on HandQuantity on Hand=Desire DoseQuantity Desired Convert weight from lbs to kg: 114/2.2 = 51.8 kg Multiply dosage by weight to get amount to be administered: 4 mg x 51.8 = 207.2 mg Set-up your problem 21 mg1 mL=207.2x21 mg1 mL=207.2x Cross multiply and then divide to get amount to be administered (quantity desired) (9.87mL).

The nurse is looking up a drug that has been prescribed and wants to know the therapeutic classification for the drug. Which of the following would indicate therapeutic classification?

Antihypertensive Rationale: antihypertensive = the therapeutic classification of the drug by describing its usefulness in lowering blood pressure

Prior to the administration of an antibiotic, the patient informs the nurse that 4 years ago the patient experienced an allergic reaction. Based on this info what should the nurse do first?

Ask the patient to describe the reaction further Rationale: collecting more info will provide prescriber with knowledge about type and severity of the reaction

In initiating holistic care with a patient who has chronic headaches, which action would the nurse take?

Ask the patient what he or she believe may be contributing to the problem Rationale: The statement reflects an attempt to understand the patient holistically.

While administering medication to several patients, the nurse suddenly realized that the wrong medication has been given to a patient. Which would be the FIRST PRIORITY action taken by the nurse?

Assess the patient in order to monitor for adverse effects Rationale: The nurse's first priority = PATIENT. The nurse should first determine patient's baseline assessment data to determine if adverse effects are happening

To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient?

Avoid drinking grapefruit juice.

Which 2 classes of medications cna be used to treat bradycardia( cause an increase in heart rate)

B1 agonists and muscarnic antagonists

Which 2 classes of medications can be used to treat tachycardia( cause a decrease in heart rate)

B1 blockers and muscarnic agonists

Which 2 medications can be used to enhance bronchodilation?

B2 agonist and muscarinic antagonists

Which 2 classes of drugs might cause bronchoconstriction?

B2 blockers and muscarinic agonists

The alpha-1 blockers can cause reflex tachycardia as a side effect. Carvedilol is an alpha-1, beta-1, beta-2 blocker. However, carvedilol does NOT cause reflex tachycardia even though it is an alpha-1 blocker. Which statement best explains why?

Baroreceptor will kick in but it will be blocked because the drug also directly lowers heart rate (beta-1).

Which is the most effective method for a nurse to recognize patient-specific genetic influences?

Be cautious with all drugs and observe for individual patient responses Rationale: Drug response is unique to each individual.

Why do patients taking digoxin develop drug toxicity?

Because digoxin's low therapeutic index

Why is a drug needed to treat metabolic acidosis during cardiac and respiratory arrest?

Because it brings pH of blood back to its normal limits

Which of the following are signs/symptoms of digoxin toxicity?

Blurred vision, yellow vision, Fatigue & confusion, Loss of appetite, Nausea/vomiting, Slow pulse or skipped beats

ACE causes the degradation of

Bradykinin

Potentially dangerous rebound hypertension is most likely seen from abrupt cessation of treatment with

Clonidine (Catapres)

Methyldopa MOA

Converted to a-methylnoradrenaline which binds to CNS a2 receptors in the CCC which decrease sympathetic response ONLY not the parasympathetic nerves

Calcium channel blockers have which pharmacodynamic effect?

Coronary vasodilation

What advantages do white blood cells and packed red blood cells have over plasma?

Corrects blood loss and carries oxygen and carbon dioxide to the body

Native American patient states, "I will only take medications that are approves by the Shaman." The nurse understands that this statement reflects the patient's:

Cultural belief Rationale: A preference for traditional healers, such as a Shaman, reflects cultural beliefs.

Thiazide Diuretics adverse effects

Dehydration & electrolyte balance: Hypokalemia, hyponatremia, hypochloremia, hyperuricemia, & alkalosis. Patients should still drink normal amounts of fluid to avoid dehydration. Hypokalemia Thiazides cause the kidneys to pull K+ into the urine. Bananas & fruits are a good dietary source of potassium. Some patients will take a KCl (potassium chloride) supplement like K-Dur or Micro-K. Hyperuricemia (Can produce gout attacks by blocking the elimination of uric acid) Large doses may cause hyperglycemia in diabetics

Angiotensin-2 Receptor Blockers (ARBs) mechanism of action

Directly bind & block the angiotensin-2 receptors.

Elimination =

Drug half life times 4

Loop Diuretics therapeutic uses

Drugs of choice for edema associated with congestive heart failure or renal failure. Drugs of choice for acute pulmonary edema. (Fluid in the lungs) Treatment of hypertension. Thiazides actually work better for hypertension.

The nurse is administering meds to a patient who is 32 weeks pregnant. Which of the following normal physiological principles associated with pregnancy will affect drug absorption?

Drugs remain longer in the GI tract, leading to extended time for absorption Rationale: high progesterone = decrease in gastric tone and intestinal motility = delayed gastric emptying = extended time for drug absorption

What drug is used to treat anaphylaxis and what are the 2 benefit effects?

Epinephrine, constricts blood vessels to restore BP and relaxes bronchial to open air way

Older adults experience adverse effects more frequently than young adults due to which of the following? Select all that apply

Excessive prescribing Multiple-drug therapy Increased drug sensitivity Rationale: Body mass decreases as age increases; exercise doesn't influence the frequency of adverse effects

Drugs that are most likely to create drug interactions in pediatric patients are those with:

Extensive protein binding Rationale: drugs with extensive protein binding compete for binding sites, resulting in increased absorption and high potential for drug interactions.

What is the agency responsible for the safety of blood products in the U.S.?

FDA (The Food and Drug Administration)

Calcium Channel Blockers adverse effects

Flushing, peripheral edema, headache, and reflex tachycardia are common side effects. Verapamil & diltiazem also have side effects similar to the selective b1-blockers. They can slow the S-A node & A-V node conduction, causing bradycardia. They can also have negative inotropic effects. All CCBs can cause peripheral edema & constipation. Constipation is caused by relaxation of the smooth muscle of the GI tract. Gingival enlargement Immediate-release / short-acting nifedipine (10mg cap) is associated with dangerous pingponging blood pressure, reflex tachycardia, arrhythmias, myocardial infarction, & death. Not recommended for PRN use. Sustained-release nifedipine is perfectly safe.

The nurse is counseling the patient on a medication taken daily. Which is a strategy that the nurse should include in this teaching session that might prevent a medication error?

Have all prescriptions filled at one pharmacy Rationale: Pharmacies keep records of prescriptions dispensed; keep all of your records at one place

Phase 1 Reactions

Hepatic microsomal enzyme system: Cytochrome p450 (CYP2D6)

What happens in response to high amount of NE regarding vasodilation

High amounts overwhelm the B receptors and then bind alpha causing vasoconstriction

A pregnant patient asks the nurse what factors determine if a drug will cross the placenta. The nurse's response will be based on which of the following principles?

Highly lipid-soluble drugs cross the placental membrane more easily than low lipids Rationale: lipid soluble's cross placental barrier better than water soluble's

The nurse completes an initial home assessment of an independent 82-year-old woman recently diagnosed with type 2 diabetes mellitus managed with insulin injections.What is the appropriate nursing action for insulin administration for the patient?

Instruct the patient how to administer the insulin Rationale: A patient who is functioning independently in all ADL's should be encouraged to tske full responsibility for self-administering meds

Which of the following antihypertensive medications are contraindicated in pregnancy

Lisinopril (Zestril), Valsartan (Diovan)

This patient has a potentially serious medication-related problem. Which statement best describes that potential problem?

Non-selective beta-blockers can mask signs and symptoms of hypoglycemia and prolong hypoglycemic episodes

Loop Diuretics adverse effects

Orthostatic hypotension & dizziness Dehydration, Hypokalemia & electrolyte imbalance (much more severe than with thiazides) Patients often will require supplemental K+ to avoid hypokalemia. Ototoxicity - hearing can be affected, especially if used in conjunction with aminoglycosides. Hyperuricemia & Hyperglycemia in diabetics

The nurse is preparing to administer medication to the pediatric patient. Which factors are true regarding the pharmacokinetics in the pediatric population? Select all that apply

Slower gastric motility in young children will keep the drug in the stomach longer. Before age 5, the liver may not metabolize drugs readily as an adult's liver and doses must be adjusted accordingly.

the nurse is monitoring the therapeutic drug level for a patient on vancomycin or Vancocin and notes the the level is within the accepted range. What does this indicate to the nurse? Select all that apply

The drug level is appropriate to exert therapeutic effects. The nurse will need to continue monitoring because each patient response to a drug is unique Rationale: A therapeutic drug level that is in the acceptable range indicates that the drug is at a minimally effective concentration but not at a toxic level.

Thiazide Diuretics therapeutic uses

Treatment of hypertension. Work better than loop diuretics in the treatment of chronic hypertension. Why? They do not cause rebound vasoconstriction as the loops sometimes do. They also have mild vasodilating properties. Treatment of mild to moderate edema.

The nurse is teaching at a community wellness seminar when one participant asks, "How can I be sure that my herbal supplement is pure?" Which of the following labeling marks indicates that the product meets the acceptable standards of purity?

USP verified dietary supplement mark Rationale: This mark is given only to supplements that pass verification process; mark represents that USP tested the supplement

On physical examination, the nurse observes raised hive-like welts civering the patient's trunk and arms. The patient also reports intense itching after receiving a new medication. The nurse will suspect what dermatologic adverse effect?

Urticaria aka hives Rationale: urticaria or hives = a sign of allergic reaction

Receptor Theory

a drug produces an effect by combining with some specific molecular constituent, the function of the receptor or cell is modified to produce a measurable effect

Agonist

a drug that mimics some natural compound by binding with the receptor and stimulating some cellular response

Aspirin 325mg chew & swallow immediately

acute heart attack (occurring right now)

Which 2 classes of drugs might increase blood pressure and cardiac output

adrenergic agonists and muscarinic antagonists

Which 2 classes of drugs might reduce blood pressure?

adrenergic blockers and muscarinic agonists

Pharmacokinetic interactions

altered GI adsorption, altered pH, altered distribution, altered metabolism( enzyme induction, enzyme inhibition), altered renal excretion

teratogenic effect

an adverse effect on fetus during pregnancy caused by teratogens

In order to make appropriate recommendations to allopathic care providers about which therapies might be useful to a client, the nurse must

be knowledgable of CAM therapies

Why might pain continue after the cause of injury has been resolved?

because neurons in the peripheral areas of the body affected by pain can be permanently changed by the pain experience itself

Why might an elderly patient withhold information about pain they are experiencing?

because of a fear of prescriptions or becoming dependent upon pain medication, may think it is unacceptable to show pain

Why is the severity of injury/illness not a good predictor of pain intensity?

because the amount of tissue damage might not necessarily correlate to greater pain; severe tissue damage may also result in loss of pain sensing neurons.

Why might a drug abuser have a greater need for pain medication?

because they have an exaggerated psychological response to pain stimuli as a result of the damages of drug use, will require higher doses to deal with the pain.

Why do preschool children respond with crying and anger in response to pain?

because they perceive pain as a threat to security

What is a cultural difference in pain management seen in some African-American cultures?

belief in power of healers who rely on religious faith of the people and often use prayer and the laying on of hands

A critical element of the holistic nursing assessment and management of a client in pain is to _______ the client

believe

How does the invasiveness of biomedical health care differ from integrative health care?

biologic tends to be technologic, invasive while integrative tends to be non-invasive

How is the focus different between the biomedical health care model versus the integrative health care model?

biomedical focuses on the physical body, while integrative health care focuses on mind-body-spirit (YYYYYyyyyyy-m-c-a!)

In terms of prevention, how do the biomedical and integrative health care models differ?

biomedical has little focus on prevention, while integrative has a primary focus on prevention

How does the cost of the biomedical and integrative health care models differ?

biomedical tends to cost more, while integrative tends to be low cost

Metabolism

biotransformation chemical alteration of the parent compound usually resulting in excretion inactivation or sometimes active metabolites

Bleeding (INR is too high)

black tar- looking feces, bruising, bleeding gums when you brush your teeth

belladonna/ opium

bladder and rectal antispasmodic, especially for painful post- surgical spasms

Oxybutynin

block muscarinic receptors in the bladder muscle, cause anticholinergic adverse effects, responses to treatment are realtively modest, muscarininc antagonists for overactive bladder

antagonist

blocks response of an endogenous substance or reverse adverse effects of drug over dose

Where is deep somatic pain experienced?

bones, joints, muscles, skin or connective tissue

How does the severity of acute pain compare to chronic pain?

both can range from mild to severe

Bethanechol (Urecholine®) is a muscarinic agonist. It preferentially stimulates muscarinic receptors of the GI and urinary tract but is not completely selective. Which of the following are possible side effects you might see with this medication?

bronchoconstriction

ipratropium bromide ( atrovent), tiotropium bromide (spiriva)

bronchodilater inhaled agents and dilate bronchioles in COPD and asthma, it does not cross lipid barriers well so little systemic absorption occurs from the lung or GI

How might a nurse reduce a client's misconceptions about pain and pain treatment?

by explaining that pain is a highly individualized experience

How can a nurse empower their client to be an active partner in reporting information about pain?

by teaching the client how to use a pain rating scale and providing factual information to address the client's concerns

How do older infants try and avoid pain?

by turning away and physically resisting health care providers?

How should a nurse best prevent pain?

by using a preemptive approach that provides round-the-clock analgesics rather than PRN

A nurse should ________ with the patient when managing pain

collaborate

Which foods are rich in vitamin K

collard greens, broccoli

What does "integrative" mean with regards to pain management?

combines complimentary and alternative therapies with conventional therapies

What nursing interventions are appropriate for adults?

dealing with misconceptions about pain, allay fear and anxiety when possible, giving factual information about prescription pain medication

phenylephrine

decongestant, increase blood pressure, used in Afrin 12 hr and Visine eye drops

What are the evidence-based physical responses of mind-body interventions?

decreased HR, decreased BP, decreased RR, decreased muscle tension, decreased sweat activity, increased sense of well-being

How does unrelieved pain affect the immune system?

decreased immune response leading to increased vulnerability to infection and sepsis

How does unrelieved pain affect GU system?

decreased urinary output, urinary retention, fluid imbalance, electrolyte imbalance

How does unrelieved pain affect the GI system?

decreases gastric and bowel motility

Calcium Channel Blockers Non-Dihydropyridines

diltiazem, verapamil

Thrombolytics

dissolve clots

What nursing interventions might be appropriate for preschool children?

distract with toys, books, pictures, involve child in blowing bubbles as a way of blowing away pain, hold the child to provide comfort

orthostatic hypotension, dizziness, syncope

doxazosin, almost all the antihypertensives can cause orthostatic hypotension. Alpha-1 blockers are a very common cause and cause syncope (passing out) especially with the first dose.

Alpha 1 blockers generic names

doxazosin, prazosin, terazosin, tamsulosin, alfuzosin, silodosin

alpha 2 Adrenergic Agonists adverse effects

drowsiness, dry mouth, constipation, headache and impaired ejaculation

dopamine

drug of choice to treat cardiovascular shock, treats acute heart failure

Anticholinergic Adverse Drug Effects

dry mouth, blurred vision, constipation, urinary retention, tachycardia, CNS: memory loss, confusion, restlessness, agitation, hallucination and delirium

In alternative therapies, how is energy defined?

force that integrates boyd, mind and spirit, connecting everything

Loop Diuretics generic names

furosemide bumetanide torsemide

Which of her medications may cause hypokalemia?

furosemide, hydrochlorothiazide

What might influence behaviors regarding pain seen in adult patients?

gender or culture based behaviors learned as a child

When using CAM, it is important that a nurse demonstrate

good ethical and moral judgment

What types of pain are women more likely to report?

headache, back pain, arthritis, footache

hypokalemia

hydrochlorothiazide, thiazide and loop diuretics

Due to beta-2 stimulation, diabetic patients may experience

hyperglycemia

What is essential to successfully treating pain?

identifying the cause of pain

Spirituality is an ancient practice involving finding significant meaning in the entirety of life, including _______ and ______

illness, death

Pharmacodynamics

impact of drugs in the body, what does the drug do to the body

What are some examples of the effectiveness of meditation?

improves stress-related illness, improved breathing patterns in asthmatics, decreased BP in clients with HTN, decreased BG in diabetics, decreased sleep-onset insomnia, decreased stuttering, decreased 02 consumption, RR, HR

How is the course of pain different between acute and chronic pain?

in acute pain, it generally goes away over time as recovery occurs, but in chronic pain, it typically does not go away, and is characterized by periods of waxing and waning.

How do the physical and behavioral manifestations differ between acute and chronic pain?

in acute pain, manifestations generally reflect activation of the sympathetic nervous situation. In contrast, chronic pain manifests as behavioral modifications

How is the duration differ between acute pain and chronic pain?

in acute pain, the duration is generally less than three months or until normal healing occurs, in chronic pain, duration is generally more than 3 months, and there is not necessarily recovery

How do treatment goals differ between acute pain and chronic pain?

in acute pain, the goal is pain control with ultimate goal of elimination. In chronic pain, the goal is pain control to the extent possible, with the focus on enhancing the function and quality of life

How is the cause of pain different between acute pain and chronic pain?

in acute pain, the precipitating event can generally be identified, but in chronic pain, the cause may not be known, and the original cause of pain may be different than the underlying mechanisms that first caused it

In how health care is determined and directed, how does the biomedical health care model differ from the integrative health care model?

in biomedical, HCP directs, but in integrative, individual directs care and personal responsibility for health is encouraged

How does the focus of treatment differ between biomedical and integrative health care models?

in the biomedical health care model, the focus is on disease states, but in integrative care, the focus is on health and wellness

Beta-1 stimulation will _____ force of cardiac contraction

increase

Overall this drug would be expected to ______ blood pressure

increase

What effect does pain have on epinephrine?

increase

What effect does pain have on cortisol, and what does this cause?

increase cortisol, increasing HR and RR

What is meditation defined as?

increased concentration and awareness

What responses would be observed in acute pain?

increased heart rate, increased respiratory rate, increased blood pressure, diaphoresis/pallor, anxiety, agitation or confusion, urine retention

How might unrelieved pain affect development?

increases behavioral and psychologic responses to pain, alters temperaments, increased vulnerability to stress disorders, addictive behavior

How does unrelieved pain affect cognitive function?

increases mental confusion, decreases cognitive function

How might unrelieved pain affect quality of life?

increases sleeplessness, anxiety, fear, hopelessness, social isolation, increased thoughts of SI

What effect does pain have on renin and aldosterone, and what does this cause?

increases, causing fluid overload and HTN

What effect does pain have on ADH and what does this cause?

increases, causing shock

Primary prevention

indicates that the patient has NOT had a "bad clot" before but does have risk factors for clots like HTN, diabetes, high cholesterol, or smoking

secondary prevention

indicates that the patient has already had one "bad clot" and we want to prevent a second event. These patients will have a history of ischemic stroke, TIA, MI, angina, stents, etc

What should a nurse ensure when delivering pain relief measures?

initiation and coordination of adequate pain relief measures

What does the INR measure?

level of anticoagulation effect (mathematically converted from the PT)

Angiotensin-2 Receptor Blockers (ARBs) generic names

loSARTAN valSARTAN telmiSARTAN candeSARTAN irbeSARTAN olmeSARTAN eproSARTAN

What are the components of a pain assessment interview?

location, quality, intensity, pattern, precipitating factors, alleviating factors, associated symptoms, effects on ADLs, past pain experiences, meaning of pain, coping resources, affective responses

What Native American treatments might be used for treating pain?

massage, application of heat, herbs and being in harmony with nature

Affinity

measure of the strength of attraction between a drug and its receptors, describes tightness of the bond

______, ________, ______, _______ and ________components play cruicial and equal roles in a person's state of health

mental, emotional, spiritual, relationship, environmental

Balance is an equilibrium between

mental, physical, emotional, spiritual and environmental components

What are some examples of chronic episodic pain?

migraines, headaches, pain r/t sickle cell disease

Health care providers overestimate _________ and underestimate _________

mild, severe

He has been on this same dose of warfarin for the last 3 months with an INR of 2.5 as measured 4 weeks ago. Today his INR is only 1.2. What are some common reasons a patient's INR may be low?

missed doses, eating foods high in vitamin K

What nursing considerations are important when using meditation?

monitor patients who are taking anti-hypertensives, anti-depressive, anti-anxiety or thyroid regulating mediations as medicaiton may augment the effects of these drugs

In comparison to women, men generally report _______ control over pain

more

What are some examples of opioids?

morphine, hydromorphone, levorphanol, fentayl, oxycodone, hydrocodone, duragesic patch, codeine

How is neuropathic pain characterized?

numbing, hot-burning, shooting, stabbing, sharp or electric shock

Describe chronic episodic pain

occurs sporadically over an extended duration of time, may last hours, days or weeks

synergistic effects

occurs when the effects of two drugs are greater than would have been predicted from each of their side effects

Antagonistic effects

occurs when the effects of two drugs are less than predicted from their effects when given

How does pain perception differ in older adults?

older adults may perceive pain as a normal part of the aging process, and may have decreased sensation or perception of pain, may consider it unacceptable to show or admit pain.

beta-blockers

olol

First-pass effect

oral drug is metabolized to an inactive form before it can reach target cells

Under the concept of humanism in alternative practice, people are responsible for the _______________, and have the power to ______________

patterns of their own lives, solve their own problems

What are the principles of mind-body interventions based upon?

people are more than physical bodies with fixable and replaceable parts

What is the focus of integrative health?

personal responsibility for health, joining of mind-body-spirit, use of natural, less invasive modalities

Which of the following drugs can be used to treat norepinephrine or dopapmine extravasation

phentolamine IV

When using CAM, it is important that a nurse assess patient's _______ and _______ status

physiological and psychological

calcium channel blockers

pine

81mg aspirin daily

primary stroke prevention

The nurse knows that a drug with a high therapeutic index is;

probably safe Rationale: therapeutic index = the ratio between therapeutic dose and the toxic dose of a drug; it's used as a measure of relative safety.

Distribution

process by which drugs are transported

Excretion

process by which the drug is eliminated from the body, some are eliminated after metabolism, some are eliminated uncharged

agonist

promotes action from receptor; initiates response

Non-selective beta blockers generic names

propranoLOL nadoLOL pindoLOL sotaLOL carteoLOL penbutoLOL timoLOL

what nursing interventions are appropriate for school aged children?

provide support and nurturing, use imagery, rehearsal of what to expect, be honest

What nursing interventions are appropriate for adolescents?

providing opportunity to discuss pain privately, encouraging music or TV for distraction

This is also an exercise in looking things up. Which of the following medications can increase blood pressure?

pseudoephedrine (Sudafed), ibuprofen (Motrin, Advil), oral contraceptives (birth control pills), cocaine (snow, blow, crack, coke, cabello, candy, CDs, Charlie, line, Snow White, snowball, sugar, toot, yeyo)

Pharmacokinetics

quantitative approach to describe the behavior of a drug in the body, what does the body do to the drug

dry cough

ramipril, bradykinin-related side effect of ACEs & ARBs

What might persistent pain cause in school aged children?

regression

How is spirituality defined?

relationship with oneself, with others, and with a higher power

Cardioselective b1-blocker mechanism of action

selectively blocks b1-receptors. These agents have a higher affinity for the b1-receptors than the b2-receptors. They can lose their selectively at higher doses.

norepinephrine

severe septic shock

how is superficial somatic pain characterized?

sharp, burning, prickly

Clotting (INR is too low)

shortness of breath, swollen leg, chest pain

Where is superficial somatic pain experienced?

skin, mucous membranes and subcutaneous tissue

Which of these situations or conditions will decrease the patients INR

skipping doses of warfarin, eating vitamin K rich foods

What are two types of nociceptive pain?

somatic and visceral pain

Potassium Sparing Diuretics generic names

spironolactone

Define hypnosis

state of attentive, focusing concentration with suspension of peripheral awareness

alpha 2 Adrenergic Agonists mechanism of action

stimulates the alpha 2 receptors of the brain stem associated with autonomic regulation of the cardiovascular system. will cause decreased blood pressure and heart rate.

Epinephrine

stops small bleeding, injected local anesthetics to prolong effectiveness, treats anaphylatic shock, cardiac arrest code blue, treats asthma

What do women identify as a cause of pain?

stress

Which of these situations or conditions will increase the patients INR

taking extra doses of warfarin, taking a medication that inhibits the metabolism of warfarin, taking a drug with a high percentage of protein binding

ARBs

tan

What ability regarding their pain do children have by preschool?

the ability to describe their pain, intensity and location

prototype drug

the agent to which all other medications in class are compared

While reviewing a drug manufacturer's package insert, the nurse reads about the dose-response curve. The purpose of the dose-response curve is to illustrate the relationship between:

the amount of a drug administered and the degree of response it produces Rationale: a dose-response curve = a graphic representation that shows the relation between the amount of a drug administered and the extent of response it produces.

Why might adults ignore pain?

they might view pain as failure and weakness, may be afraid of what pain might indicate

Skeletal muscle and tendon toxicity

think statins

alpha 2 Adrenergic Agonists Therapeutic uses

treatment of chronic hypertension, hypertensive urgencies, withdrawl symptoms of nicotine opiates benzodiasepines and alcohol.

What are the causes of pain in cancer patients?

tumor progression, pathological processes, procedures, treatment, infection, and physical limitations, referred pain

What is a huge issue in pain management of cancer patients?

undertreatment of pain

Pain is a ________ experience

universal

scopolamine

very similar to atropine, very effective antimotion sickness drug produces CNS sedation instead of excitation, antisecretory agent decreases secretions as well as induces short term memory loss

What are the consequences of persistent pain?

weight gain, insomnia, constipation, HTN, deconditioning, chronic stress and depressive

In providing mind-body interventions, what is the aim is to promote ________, restore ________ and _______ and to facilitate the body's own ______ ________

wellness, harmony balance, healing response

What is referred pain?

when a patient senses pain at the actual site of the tumor or distant to the site

When using CAM therapy, it is important that the nurse provide educated advice about

when to seek conventional therapy rather than CAM therapy

The nurse knows that drugs that are subject to stricter regulations are those:

with a high potential for abuse or dependency Rationale: More likely the drugs risk of abuse, the stricter the regulation.

How is moderate to severe pain best treated?

with opioids

Define journaling

writing one's thoughts, feelings, perceptions

Do you think this patient may have digoxin toxicity?

yes

Who should you include when planning pain options and modalities?

your client