Module 4 Pharm exam

Discuss the uses and any adverse effects of benzodiazapines and cannabinoids

Benzodiazepines—sedation, reduction in anxiety, possible depression of the vomiting center cannabinoids-inhibit pathways to the vomiting center Common adverse effect: Dysphoric effects

treatments for canker sores, cold sores, thrush, and mucositis.

Cold sores: docosanol (abreva) Canker sores: aphthasol thrush: antifungal mucositis: commonly associated with chemotherapy & radiation therapy. oral hygiene

stimulant laxative - bisacodyl

Do not administer with mild, antacids, cimetidine, famotidine, nizatidine, or ranitidine. They may cause enteric coating to dissolve prematurely -> nausea, vomiting and cramping.

T or F? Oral Antidiabetics meds have the same action as insulin for type 2 diabetics

False!!!

Discuss the common causes of nausea/vomiting

Postoperative Nausea and vomiting (PONV) Motion sickness Pregnancy (Morning sickness) Psychogenic-◦Self-induced or involuntary vomiting in response to threatening or distasteful situations Chemotherapy-induced nausea and vomiting(CINV) Radiation-induced nausea and vomiting (RINV)

mechanism of action of the different oral antidiabetic agents.

Biguanides- decreases glucose production and absorption. Sulfonylureas- decreases production of glucose & increases secretion of insulin. Meglitinides- stimulates release of insulin from pancreas in the presence of glucose Thiazolidineiones (TZD)- decrease glucose production & increase glucose absorption into cell Alpha-Glucosidase Inhibitors- Increases serum insulin, delays gastric emptying reducing appetite Amylinomimetic Agent- Suppressing glucagon secretion from liver, Slows carb & lipid absorption, Suppresses appetite; subsequent weight loss Sodium Glucose Cotransporter 2 Inhibitors (SGLT2)- decreases reabsorption of glucose by the kidneys; increases glucose excretion through urine DDP4 Inhibitors- stimulates βeta cells to secrete more insulin, increasing glucose production GLP1 Receptor Agonist- Increases serum insulin, delays gastric emptying reducing appetite

A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider? A. Aspirin EC 325 mg per NG tube daily B. Atorvastatin 40 mg per NG tube daily C. Propranolol 20 mg per NG tube daily D. Sucralfate 2 g oral suspension per NG tube BID

Correct Answer: A. Aspirin EC 325 mg per NG tube daily The nurse should clarify the prescription for aspirin EC 325 mg per NG tube daily, as enteric-coated tablets should not be crushed. Incorrect Answers: B. This prescription requires no clarification because atorvastatin can be administered through an enteral feeding tube. C. This prescription requires no clarification because propranolol can be administered through an enteral feeding tube. D. This prescription requires no clarification because sucralfate oral suspension can be administered through an enteral feeding tube.

A nurse is administering an enteric-coated tablet to a client and explaining the pharmaceutical preparation. Which of the following statements should the nurse make? A. "This coated tablet dissolves better in your stomach and intestines." B. "You are less likely to have an upset stomach with this pill because of the coating on the tablet." C. "The coating on the tablet improves the absorption of the medication." D. "The coating on the tablet allows a gradual release of the medication."

Correct Answer: B. "You are less likely to have an upset stomach with this pill because of the coating on the tablet." Enteric-coated preparations have an outside coating of a substance that dissolves in the intestines instead of in the stomach. This protects the medication from acids and enzymes in the stomach and protects the stomach from ingredients in the medication that can cause gastric upset. Incorrect Answers: A. The nurse should recognize that enteric-coated preparations sometimes fail to dissolve. When this occurs, the client does not get the therapeutic effects of the medication. C. Absorption varies with enteric-coated preparations due to variations in gastric emptying time. D. Sustained-release formulations have small spheres of medication with coatings that dissolve at variable rates. Therefore, they release

A nurse is caring for a client who is taking streptomycin. Which of the following medications increases the client's risk of developing ototoxicity when taken with streptomycin? A. Cefoxitin B. Furosemide C. Naproxen D. Amphotericin B

Correct Answer: B. Furosemide Furosemide, a high-ceiling (loop) diuretic, increases the risk of developing ototoxicity when taken with streptomycin, an aminoglycoside. Incorrect Answers: C. Naproxen, an NSAID, increases the risk of developing nephrotoxicity when taken with streptomycin. D. Amphotericin B, an antifungal agent, increases the risk of developing nephrotoxicity when taken with streptomycin.

A nurse is reviewing the medication administration record of a client who has impaired swallowing. The nurse should crush the medication when administering which of the following prescriptions? A. Aspirin EC 80 mg PO daily B. Levothyroxine 75 mcg PO q AM before breakfast C. Metformin XR 500 mg PO daily D. Nitroglycerin 0.3 mg SL PRN chest pain, may repeat q 5 min for 2 additional doses

Correct Answer: B. Levothyroxine 75 mcg PO q AM before breakfast Levothyroxine can be crushed because it is not extended-release, sublingual, or enteric-coated. If crushed, the medication should be mixed with 5 to 10 mL of water. Incorrect Answers: A. Aspirin is an enteric-coated medication. Enteric coatings are applied to ensure that medication contents are released in the intestines rather than the stomach. This form of release protects the stomach from gastric irritation and protects the medication from breakdown by gastric acid. The medication must be swallowed whole and not crushed or chewed to allow the enteric coating to function properly. C. The abbreviation "XR" indicates the metformin is an extended-release medication. Extended-release medications contain tiny spheres that are released over time to provide a steady therapeutic level throughout the day. For an extended-release medication to function properly, the tablet must be swallowed whole, not crushed or chewed. D. The abbreviation "SL" indicates that the nitroglycerin is administered sublingually. Sublingual tablets should be held under the tongue until they dissolve, not crushed or chewed. Sublingual nitroglycerin tablets are ineffective when swallowed.

A nurse is preparing to administer a bolus feeding to a client through an NG tube and observes that the exit mark on the tube has moved since the last feeding. Which of the following actions should the nurse plan to take? A. Auscultate over the stomach while injecting air B. Request an X-ray of the client's abdomen C. Place the head of the client's bed in a flat position D. Administer the feeding if the pH of the aspirated contents is >6

Correct Answer: B. Request an X-ray of the client's abdomen The nurse should request an X-ray to verify the placement of the NG tube both after the initial insertion of the tube and if displacement of the tube is suspected. The nurse should verify NG tube placement prior to administering a bolus feeding. Incorrect Answers: A. The nurse should not verify the NG tube placement by auscultating over the stomach while injecting air because it is difficult to distinguish whether the sound is coming from the stomach, lung, or intestine. C. The nurse should verify the NG tube placement and elevate the head of the client's bed before administering a bolus tube feeding to reduce the risk of aspiration. D. The pH of gastric contents should be ≤5. Aspirated contents that have a pH of ≥6 indicates the NG tube is in the lungs or intestines. Therefore, the nurse should not administer the feeding.

A nurse is providing teaching to a client with a new diagnosis of heart failure who has a prescription for furosemide. Which of the following statements should the nurse include in the teaching? A. "You can take ibuprofen for headaches while taking this medication." B. "You may experience increased swelling in your lower extremities while taking this medication." C. "You should eat foods that are high in potassium while taking this medication." D. "You should take this medication at bedtime."

Correct Answer: C. "You should eat foods that are high in potassium while taking this medication." The nurse should instruct this client who has a prescription for furosemide to consume foods that are high in potassium. Furosemide is a high-ceiling loop diuretic that depletes potassium, sodium, chloride, magnesium, and water. Incorrect Answers: A. The nurse should instruct the client that ibuprofen, which is an NSAID, can cause an interaction with furosemide. NSAIDs can decrease the efficacy of this medication. B. The nurse should instruct the client that furosemide is prescribed to secrete fluid from the body and should reduce the client's swelling and edema. D. The nurse should instruct the client to avoid taking furosemide at bedtime to prevent the disruption of the client's sleep, as this medication increases the need to urinate.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first? A. Notify the provider B. Contact the nursing supervisor C. Assess the client's apical pulse D. Complete an incident report

Correct Answer: C. Assess the client's apical pulse Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status, she must first collect adequate data from the client. An assessment will provide the nurse with the knowledge needed to make an appropriate decision. Incorrect Answers: A. The nurse should notify the provider to determine if the client needs further treatment; however, there is another action the nurse should take first. B. The nurse should contact the nursing supervisor to obtain assistance; however, there is another action the nurse should take first. D. The nurse should complete an incident report to document the occurrence; however, there is another action the nurse should take first

A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects? A. Thrombophlebitis B. Hyperactive reflexes C. Muscle weakness D. Hypoglycemia

Correct Answer: C. Muscle weakness Chlorothiazide is a thiazide diuretic used to treat hypertension and congestive heart failure. It promotes the excretion of water, sodium, and potassium and can cause hypokalemia. Manifestations of hypokalemia include muscle weakness, muscle cramps, and dysrhythmias. Incorrect Answers: A. Chlorothiazide can cause hypercalcemia but does not cause thrombophlebitis. B. Chlorothiazide can cause hypoactive reflexes. D. Chlorothiazide can cause hyperglycemia but does not cause hypoglycemia.

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs? A. Nasal congestion B. Tremors C. Tinnitus D. Frontal headache

Correct Answer: C. Tinnitus Loop diuretics such as furosemide can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs. Incorrect Answers: A. Nasal congestion is not an adverse effect of furosemide. B. Furosemide does not cause movement disorders such as tremors. D. Headaches are not an adverse effect of furosemide. Headaches can occur in a client who has fluid overload, which furosemide might be prescribed to treat.

A nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I know that blurred vision is expected to happen while I'm taking digoxin." B. "I will measure my urine output each day and document it in my diary." C. "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." D. "I will eat fruits and vegetables that have a high potassium content every day."

Correct Answer: D. "I will eat fruits and vegetables that have a high potassium content every day." Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain a potassium level between 3.5 to 5.0 mg/dL to avoid digoxin toxicity. Incorrect Answers: A. Visual disturbances such as blurred vision or yellow vision can occur with digoxin toxicity. The client should report any changes in vision to the provider immediately. B. For home care, the nurse should instruct the client to weigh herself daily at the same time, record the weight, and report weight gain or loss to the provider. Measurement of intake and output is done in acute care facilities but is not necessary for the home setting. C. Clients are instructed to withhold digoxin if their heart rate is below 60/min. The client should report a heart rate of <60/min, which can signify digoxin toxicity.

A nurse is providing teaching to a client who has heart failure and is taking spironolactone. Which of the following statements by the client indicates an understanding of the teaching? A. "I will increase my intake of citrus fruits, bananas, and potatoes." B. "I will use salt substitutes on my food." C. "I will drink as much water as I can while taking this medication." D. "I will watch for increased breast tissue growth while taking this medication."

Correct Answer: D. "I will watch for increased breast tissue growth while taking this medication." Spironolactone, which is derived from steroids, can cause adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women. The nurse should instruct the client that these changes can occur. Incorrect Answers: A. Spironolactone is a potassium-sparing diuretic. Clients taking potassium-sparing diuretics should limit their intake of foods high in potassium due to the risk of hyperkalemia. B. Clients who are taking potassium-sparing diuretics should not use salt substitutes because they contain potassium and place the client at risk for hyperkalemia. C. Drinking large amounts of water can cause dilutional hyponatremia, which is dangerous when taking spironolactone since electrolyte imbalances, including hyponatremia, are common.

A nurse has administered a medication to a client. Which of the following circumstances should the nurse identify as a medication error that resulted from a performance deficit by the nurse? A. A medication safety coordinator was not present. B. A verbal prescription was transcribed incorrectly. C. A medication with a similar name was dispensed instead of the correct medication. D. An intramuscular injection was given instead of a subcutaneous injection.

Correct Answer: D. An intramuscular injection was given instead of a subcutaneous injection. Performance deficits such as using an improper route of administration for a medication are the most common causes of medication errors that result from human error. The nurse can effectively reduce medication errors in clinical practice by implementing a safety checklist and diligently using the rights of medication administration. If the nurse is not following the rights of medication administration, then the nurse has a performance deficit. Incorrect Answers: A. The nurse is responsible for using the rights of medication administration, not having the medication safety coordinator present when administering medication to a client. The rights of medication administration are intended to help nurses avoid a medication error and to promote safety. A medication safety coordinator can help to reduce medication errors and is part of the infrastructure of the facility. B. A transcription error is not related to a performance deficit. To reduce errors in the transcription of medications, the nurse should perform a "read-back" of the prescription to the provider to verify each detail of the prescription. C. Many medications have names that sound or look alike (e.g. hydroxyzine and hydralazine). This is a generic name confusion error on the part of the prescriber or the dispenser. However, it is still the nurse's responsibility to verify the administration of the medication the provider prescribed. If the error was on the part of the prescriber, the nurse cannot always tell if the provider intended to prescribe a different medication.

A nurse is caring for a semiconscious client who had a small-bore NG tube placed yesterday for the administration of enteral feeding. Which of the following methods should the nurse use to verify correct tube placement? (Select all that apply.) A. Auscultate injected air B. Verify the initial X-ray examination C. Measure the length of the exposed tube D. Determine the pH of aspirated fluid E. Check the aspirated fluid for glucose

Correct Answers: B. Verify the initial X-ray examination C. Measure the length of the exposed tube D. Determine the pH of aspirated fluid The nurse should confirm the NG tube placement by checking the X-ray results following the insertion of the NG tube. In addition, the nurse should check the length of the NG tube that is exposed by comparing the markings on the tube to the client's nose to verify tube placement. Finally, the nurse should check the pH of aspirated fluid to verify the tube placement. Incorrect Answers: A. Auscultating air injected into an NG tube is not a reliable method of determining correct NG tube placement. E. Checking for glucose in the aspirated fluid is not a reliable method of determining correct NG tube placement.

Describe the indications and intended use/effects of diuretics.

Purpose: increase flow of urine decrease excess water in body. Used to treat: Heart failure, hypertension, liver disease, renal disease, cerebral edema, increased intraocular pressure and hypercalcemia. Therapeutic outcomes: reduce edema, improve symptoms of excess fluid.

mechanism of action and uses for laxatives

Saline: Action-Draw water into the intestine from surrounding tissues, distending the bowel, causing peristalsis Stimulant laxatives: (bisacodyl, sennosides A and B): Action-Directly on intestines; cause irritation that promotes peristalsis and evacuation methylnaltrexone (Opioid antagonists): Action- Bind to opioid receptors in the GI tract, inhibiting constipation Used-in treatment of opioid induced constipation

Discuss the scheduling of antiemetics for maximum benefit

Schedule antiemetic meds, rather than PRN to stay on top of the nausea ecause once they start throwing up its hard to keep the nausea medicine down. take 30 mins before nausea inducing activities.

when to not use Systemic Agents

Should not be used to treat diarrhea caused by substances toxic to the GI tract (e.g. food poisoning). This allows the toxin to stay in the GI tract.

locally acting agents

activated charcoal- Absorb excess water to cause a formed stool and adsorb irritants or bacteria that are causing the diarrhea bismuth subslicylate- stop secretion of fluids into the GI tract that promote diarrhea. It may also have local antimicrobial effects, killing bacteria and viruses that may cause diarrhea.

mechanism of action and uses for anti-diarrheal agents

localize anti-diarrheal- increase absorption in intestines and reduce fluid secretions being put in intestines. systemic anti-diarrheal- Reduce peristalsis and motility of the GI tract.

Describe the teaching needs of clients on antiemetics

warn patients about driving or performing any hazardous tasks antiemetics with alcohol may cause severe CNS depression change position slowly to avoid hypotensive effects