Pharm Exam 5

A patient who has come to the emergency department after being raped is given a dose of emergency contraception at 12 AM. The nurse would instruct the patient to take another dose of the drug at which time?

12 PM With emergency contraception, the first dose is started within 72 hours after unprotected intercourse; then, a follow-up dose of the same dosage must be taken 12 hours after the first dose.

The medication order reads" "Atomoxetine (Strattera) 1.2 mg/kg/day in 2 divided doses." The child weighs 66 lbs. How much will be given w/each dose?

18 mg/dose

How should betamethasone be administered?

2 doses (usually IM) 24 hrs apart. Repeat doses not recommended

How long after varicella administration should pregnancy be avoided?

3 months

In administering intravenous furosemide (Lasix) to a patient, the nurse anticipates diuresis to begin within what time frame? 1 minute 5 minutes 30 minutes 60 minutes

5 minutes Furosemide can be administered orally, IV, and IM. With oral administration, diuresis begins in 60 minutes and persists for 8 hours. Oral therapy is used when rapid onset is not required. The effects of intravenous furosemide begin within 5 minutes and last for 2 hours. Intravenous therapy is used in critical situations (e.g., pulmonary edema) that demand immediate mobilization of fluid

A child is to receive phenobarbital 2 mg/kg IV on call as a preoperative sedative. The child weighs 64 pounds. How many milligrams will the child receive for this dose?

58.2 mg

The nurse is preparing to administer phenytoin intravenously to a patient after a craniotomy to remove a brain tumor. The order is for 300 mg IV. The nurse should administer this dose over, at the very least, how many minutes?

6 minutes

What is the best diagnostic study with which to determine the type of seizure activity while the patient is experiencing the seizure? A) Electroencephalogram (EEG) B) Computed tomography (CT) C) Magnetic resonance imaging (MRI) D) Positron emission tomography (PET)

A The EEG is the best diagnostic study with which to determine the type of seizure a patient is having while experiencing the seizure, because an EEG detects electrical discharges in the brain and records them as waves on a tracing. Electrical activity associated with seizures is excessive and disorganized, but the waves are correlated with different neurologic conditions. CT, MRI, and PET do not detect electrical activity in the brain.

The nurse observes a patient demonstrating automatism and correlates this with what?

A complex partial seizure

The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply. A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B) "You may have some mild sedation. Do not drive until you know how this drug will affect you." C) "This drug may cause easy bruising. If you notice this, call the clinic immediately." D) "It is very important to have good oral hygiene and visit your dentist regularly." E) "You may continue to have wine with your evening meals but only in moderation."

A, B, D Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels. Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.

A patient who needs an antiepileptic medication for tonic-clonic seizures is unresponsive. Which antiepileptic medication(s) should the nurse avoid administering to this patient? (Choose all that apply.) A) Tiagabine (Gabitril) B) Phenytoin (Dilantin) C) Topiramate (Topamax) D) Gabapentin (Neurontin) E) ethosuximide (Zarontin) F) Phenobarbital (Luminal)

A, C, D, E Because the patient is unresponsive, the nurse avoids administering medications by mouth, because doing so exposes the patient to an increased risk of aspiration. Until the level of consciousness improves and the patient can swallow, the nurse should not administer tiagabine, topiramate, gabapentin, or ethosuximide, which are available for oral administration only. In addition, tiagabine, gabapentin, and ethosuximide are not indicated therapy for tonic-clonic seizures. Topiramate, phenytoin, and phenobarbital are suitable for tonic-clonic seizures, but only phenytoin and phenobarbital, which may be administered intravenously, are indicated for an unresponsive patient.

Which statement made by a patient receiving pharmacologic treatment for Parkinson's disease indicates the need for further teaching? A) "These drugs should cure me within 18 months." B) "I hope my tremors will become less incapacitating." C) "Even with drugs, I know that I will continue to get worse." D) "These drugs should make it easier for me to take care of myself."

A. "These drugs should cure me within 18 months."

Q. A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance? A. Atomoxetine (Strattera) B. Methylphenidate (Concerta) C. Amphetamine aspartate (Adderall) D. Dextroamphetamine sulfate (Dexedrine)

A. Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance because it lacks drug addictive (psychological dependence) properties, unlike amphetamines and phenidates.

20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient?

"Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision."

A woman who is at 31 weeks' gestation comes to the clinic in labor. The physician decides to use terbutaline therapy before transferring the woman to the hospital. The patient is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be

"The drug provides sufficient time for other medications to be given to improve your baby's outcome."

What are indications for RhoGAM use? When is it administered?

-Within 72 hr after birth if mother is Rh negative, newborn is Rh positive, and Coombs' test is negative -Prophylactically at 28 wks gestation and after any event where fetal cells can mix with maternal blood (e.g. miscarriage, amniocentesis, induced abortion)

Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) A. Dizziness B. Headache C. Hyperkalemia D. Mental confusion E. Muscle weakness

A. Dizziness Correct B. Headache Correct C. Hyperkalemia Correct Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.

To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient? A. Furosemide (Lasix) B. Amiloride (Midamor) C. Triamterene (Dyrenium) D. Spironolactone (Aldactone)

A. Furosemide (Lasix) Correct Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat pulmonary edema. The other medications are not potent enough to cause the diuresis necessary to treat this condition.

Which laboratory test result is a common adverse effect of furosemide (Lasix)? A. Hypokalemia B. Hypernatremia C. Hyperchloremia D. Hypophosphatemia

A. Hypokalemia Correct Furosemide is a potent loop diuretic, and the most common adverse effect of loop diuretics is electrolyte imbalances. This results in major electrolyte losses of potassium and sodium and, to a lesser extent, calcium.

Q. A patient with narcolepsy is prescribed methylphenidate (Ritalin). Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) A. Insomnia B. Headache C. Weight Loss D. Increased appetite E. Decreased blood pressure

A. Insomnia B. Headache C. Weight Loss The adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth, and worsening of or new onset of psychiatric disorders (including mania, psychoses, or aggression).

Q. Which instructions should the nurse discuss to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)? A. Limit dietary intake of fat. B. Increase fluid and fiber in the diet. C. Advise to take vitamin C supplement. Take the medication with an antacid.

A. Limit dietary intake of fat. Orlistat is an anorexiant that works by blocking the absorption of fat from the GI tract. Restricting dietary intake of fat reduces the GI adverse effects associated with increased fat content in stool (flatulence, oily spotting, and fecal incontinence).

A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) A. Apples B. Bananas C. Pineapple D. Lean meat E. Winter squash Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.

A.Apples Correct C.Pineapple Correct D. Lean meat Correct Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.

Rivastigmine (Exelon)

Acetylcholinesterase/Cholinesterase inhibitors · Action: o Allow more acetylcholine in neuron receptors o Increase cognitive function, slows disease process · Side effects: o Dehydration, weight loss, bradycardia, orhto hypo, dysrhythmia o Hepatotoxicity, suicidal ideation, Stevens Johnson · Pt care o Maintain consistency in care o Record vital signs o Observe for behavioral changes and note any improvement or decline o Teach family about safety measures o Inform family of available support groups

The nurse recognizes what as the action of pramipexole in the treatment of Parkinson's disease?

Activation of dopamine receptors

What nursing intervention should be implemented for a patient on oxytocin exhibiting signs of hyperstimulation?

Administer 10L oxygen via face mask

The nurse recognizes that a major known risk factor for Alzheimer's disease is what?

Advancing age

When should a cervical diaphragm be refitted?

After childbirth or weight gain/loss of over 10 lbs

In providing teaching to a patient being discharged with a prescription for valproic acid, the nurse instructs the patient to notify the prescriber immediately in the event of what?

Anorexia

What is the purpose of oxytocin in antepartum, intrapartum, and postpartum?

Antepartum: for contraction stress test Intrapartum: induction or augmentation of labor Postpartum: promote uterine tone

What medications reduce the effectiveness of oral contraceptives?

Antibiotics, phenytoin, rifampin

A patient receives phenytoin (Dilantin) for partial seizures. Which medication will require a higher-than-normal dosage when taken by the patient during this therapy? A) Tiagabine (Gabritril) B) Lamotrigine (Lamictal) C) Gabapentin (Neurontin) D) Phenobarbital (Luminal)

B A normal dosage of lamotrigine is unlikely to be effective against partial seizures when administered with phenytoin, because these medications are metabolized by the same hepatic enzymes, resulting in decreased effectiveness of the lamotrigine. For the lamotrigine to be therapeutically effective, the dosage must be increased when the drug is administered concurrently with phenytoin.

After the nurse administers lidocaine for ventricular tachycardia, the patient experiences status epilepticus. Which medication could be administered to treat both problems? A) Diazepam (Valium) B) Phenytoin (Dilantin) C) Phenobarbital (Luminal) D) Carbamazepine (Tegretol)

B Diazepam is a first-line therapy for the initial control of generalized convulsive status epilepticus; however, because the patient is also experiencing ventricular tachycardia, phenytoin may be a better choice of antiepileptic agent because it is indicated for both conditions. Once the patient's condition has stabilized, maintenance therapy may include phenytoin; however, oral phenytoin is not indicated as maintenance antidysrhythmic therapy. Phenobarbital is indicated for status epilepticus; but, because of its side effect profile, it has been replaced clinically by diazepam and phenytoin. Carbamazepine is not indicated for status epilepticus.

The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of antiepilepsy medication therapy? A) "With proper treatment we can completely eliminate your seizures." B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." C) "Epilepsy medication does not reduce seizures in most patients." D) "These drugs will help control your seizures until you have surgery."

B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A) Tonic-clonic B) Absence C) Simple partial D) Complex partial

B) Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following? A. "You can't be pregnant if you have been taking your oral contraceptives correctly." B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test." C. "There is no need to worry. Oral contraceptives are very effective." D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."

B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.

When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? A. 2 mg/min B. 4 mg/min C. 6 mg/min D. 8 mg/min

B. 4 mg/min Correct Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.

For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value? A. Sodium B. Glucose C. Calcium D. Chloride

B. Glucose Correct Thiazide and thiazide-like diuretics are associated with adverse metabolic effects of hyperglycemia; therefore, close monitoring of blood glucose levels are needed. Other metabolic disturbances include hyperlipidemia and hyperuricemia.

Which laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)? A. Sodium levels B. Glucose levels C. Calcium levels D. Chloride levels

B. Glucose levels Correct Hydrochlorothiazide can cause hyperglycemia; therefore, glucose levels can indicate this adverse response.

When assessing a patient taking triamterene (Dyrenium), the nurse would monitor for which possible adverse effect? A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

B. Hyperkalemia CorrectTriamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.

Q. A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified? A. Schedule I B. Schedule II C. Schedule III D. Schedule IV

B. Schedule II CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

The nurse is providing education to a patient on why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. What information does the nurse provide to the patient? A. Moderate doses of two different types of diuretics are more effective than a large dose of one type. B. This combination promotes diuresis but decreases the risk of hypokalemia. Correct C. This combination prevents dehydration and hypovolemia. D. Using two drugs increases osmolality of plasma and the glomerular filtration rate. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

B. This combination promotes diuresis but decreases the risk of hypokalemia. Correct Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient? A. Using two drugs increases blood osmolality and the glomerular filtration rate. B. This combination promotes diuresis but decreases the risk of low levels of potassium. C. The lowest dose of two different types of diuretics are more effective than a large dose of one type. D. This combination maintains water balance to protect against dehydration and electrolyte imbalance.

B. This combination promotes diuresis but decreases the risk of low levels of potassium. Correct Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.

Q. Ergot alkaloids exert their therapeutic effect by which action? A. Vasodilation. B. Vasoconstriction. C. Blockade of the beta2 receptors. D. Simulation of the alpha receptors.

B. Vasoconstriction. Ergot alkaloids narrow or constrict blood vessels in the brain. They are useful in the treatment of migraine headache caused by vasodilation of vessels in the brain. Ergot alkaloids were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy.

In preparing an inservice about Alzheimer's disease, the nurse notes that an increase in foods rich in what vitamin can decrease the level of homocysteine, which has been linked to Alzheimer's disease?

B6

What 3 things should the nurse be assessing in a patient taking methylergonovine?

BP, uterine bleeding, uterine tone

The nurse teaches the patient who has hypokalemia caused by diuretic therapy to increase intake of which food? Bananas Lean meats Milk products Yellow vegetables

Bananas Potassium is lost through increased secretion in the distal nephron. If serum potassium falls below 3.5 mEq/L, fatal dysrhythmias may result. The consumption of potassium-rich foods (e.g., dried fruits, nuts, spinach, citrus fruits, potatoes, bananas) can help prevent or treat hypokalemia.

What should the client do after administration of a cervical ripening agent?

Bedrest for at least 2 hours (30 min for the gel) after insertion

A new client calls on the phone requesting a prescription for contraceptives, which she has been taking for 2 years. She has not been seen in more than a year and is unable to come into the clinic until next month. She insists she is doing fine on this medication and must have her prescription now. Your best response would be:

Before the drugs are prescribed, a complete medical history, physical examination, pap test, urinalysis, and weight and blood pressure measurements are recommended.

Drugs for Osteoporosis

Bisphosphonates: alendronate

The nurse recognizes that the therapeutic action of spironolactone (Aldactone) is what? Increased ADH secretion Decreased ADH secretion Blocked action of aldosterone Enhanced action of aldosterone

Blocked action of aldosterone Aldosterone, a hormone secreted from the adrenal cortex, leads to sodium retention and potassium excretion. Spironolactone blocks the action of aldosterone, leading to sodium loss and potassium retention.

The nurse prepares a female patient who takes phenobarbital (Luminal) and oral contraceptives for discharge. Which intervention is the nurse's priority before discharge? A) Planning for regular exercise in a safe setting B) Making a medication reminder sign for the home C) Instructing the patient to get help before climbing stairs D) Helping the patient plan another form of birth control

C Because phenobarbital can cause lethargy, drowsiness, and dizziness, the nurse instructs the patient to get help when climbing stairs to help prevent injury. The nurse instructs the patient to continue precautions to maintain safety until the full effects of the drug are known. Of secondary importance, the nurse instructs the patient to use an alternative form of birth control, because the effect of the oral contraceptives is blunted with concomitant administration of phenobarbital. The nurse instructs the patient to plan exercise, because the lethargy from this medication can contribute to deconditioning. The nurse also instructs the patient to post a sign as a reminder to take phenobarbital once a day to maintain adherence to therapy.

A patient's pharmacotherapy includes valproic acid (Depakene), and the prescriber wants to add carbamazepine (Tegretol). After the new medication is added, which phenomenon is the nurse most likely to observe in the patient? A) Less amnesia after a convulsion B) Increased number of convulsions C) Changes in nature of convulsions D) Improved level of consciousness

C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.

The nurse prepares to administer carbamazepine (Tegretol) to a patient receiving temazepam (Restoril). Which risk to the patient is increased by the concomitant administration of these medications? A) Inability to have sound sleep B) Incidence of absence seizures C) Carbamazepine toxicity D) Circulatory collapse

C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.

The nurse needs to administer phenytoin (Dilantin) 300 mg IV bolus to a patient. At a minimum, over how many minutes should the nurse should administer this dose? A) 3 minutes B) 5 minutes C) 6 minutes D) 10 minutes

C The nurse administers IV phenytoin no faster than 50 mg/min to reduce the risk of cardiovascular collapse. Calculation: (1 minute/50 mg) x 300 mg = 300 ÷ 50 = 6 minutes.

The nurse finds a patient on the floor who is unresponsive but exhibiting spasms of the trunk and flexion of the arm alternating with periods of relaxation. Which finding should the nurse include in the nursing documentation? A) Patient on floor as a result of loss of consciousness B) Patient fallen to floor, exhibiting tonic convulsions C) Patient exhibiting arm flexion with trunk spasms D) Patient fallen to floor as a result of tonic-clonic seizure

C The nurse documents an objective description of the event by stating that the patient is exhibiting arm flexion and trunk spasms and therefore that the patient is experiencing a type of generalized seizure involving tonic-clonic convulsive activity. The nurse does not know how the patient got to the floor; however, the facts that the patient was found on the floor and is unresponsive should be documented. The nurse avoids documenting that the patient fell, fell because of the convulsions, or first lost consciousness, because the nurse did not witness the sequence of events.

What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? A) Report any vision or hearing problems with levetiracetam (Keppra). B) Stir phenobarbital (Luminal) elixir into a cold carbonated beverage. C) Have a complete blood count monthly while taking carbamazepine (Tegretol). D) Administer pregabalin (Lyrica) every morning on an empty stomach.

C The nurse instructs the patient taking carbamazepine to have complete blood counts as directed, usually every month at first, because iminostilbenes can cause bone marrow suppression. Patients taking levetiracetam are told to report changes in mood or behavior or motor difficulties. Patients taking phenobarbital are instructed to mix the elixir with fruit juice, milk, or water but not a carbonated beverage. The nurse instructs the patient taking pregabalin to take the medication in 2 or 3 doses and to avoid sudden withdrawal of the medication.

1. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching? A. "I will increase the dose if my seizures don't stop." B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy." C. "I will take good care of my teeth and see my dentist regularly." D. "I cannot take this drug with food."

C.

A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? A. "I will call your health care provider and discuss your concern." B. "I would recommend that you take two multivitamins every day." C. "This diuretic is potassium sparing, so there is no need for extra potassium." D. "You will need to take potassium supplements for the medication to be effective."

C. "This diuretic is potassium sparing, so there is no need for extra potassium." Correct Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.

To evaluate the therapeutic effects of mannitol (Osmitrol), the nurse should monitor the patient for which clinical finding? A. Increase in urine osmolality B. Decrease in serum osmolality C. Decrease in intracranial pressure t D. Increase in cerebral blood volume

C. Decrease in intracranial pressure Correct Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This decreases intracranial pressure and cerebral blood volume, increases excretion of medications, decreases urine osmolality, and increases serum osmolality.

Acetazolamide (Diamox) is used to treat which conditions? (Select all that apply.) A. Dry eye syndrome B. Cardiac dysrhythmias C. High-altitude sickness D. Open-angle glaucoma E. Edema associated with heart failure

C. High-altitude sickness Correct D. Open-angle glaucoma Correct E. Edema associated with heart failure Correct Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat high-altitude sickness, edema secondary to heart failure, open-angle glaucoma, and rarely as an antiepileptic drug. It is not used for treatment of dry eye syndrome or cardiac dysrhythmias.

Which information should be given to the client taking phenytoin (Dilantin)? A. Taking the medication with meals will increase its effectiveness. B. The medication can cause sleep disturbances C. More frequent dental appointments will be needed for special gum care. D. The medication decreases the effects of oral contra- ceptives.

C. More frequent dental appointments will be needed for special gum care. Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Answers A, B, and D do not apply to the medication; therefore, they are incorrect.

To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic? A. Furosemide (Lasix) B. Acetazolamide (Diamox) C. Spironolactone (Aldactone) D. Hydrochlorothiazide (HydroDIURIL)

C. Spironolactone (Aldactone) Correct Spironolactone is the direct antagonist for aldosterone.

The nurse correlates the action of memantine in the treatment of Alzheimer's disease with regulation of which ion?

Calcium

What should be administered for magnesium sulfate toxicity?

Calcium Gluconate 10%

Acetazolamide (Diamox)

Carbonic anhydrase inhibitor · Action o Blocks action of enzyme carbonic anhydrase (needed to maintain acid/base balance) o Excretes Na, K, and bicarbonate · Use: o Primarily to decrease IOP in patients with open-angle (chronic) glaucoma o Diuresis (management of epilepsy/absence seizures) o Treatment for altitude/mountain sickness · Side effects o Confusion, ortho hypo, GI distress, metabolic acidosis, electrolyte imbalance o Crystalluria, renal calculi, hemolytic anemia · Contraindications: o First trimester of pregnancy

A nurse should monitor a patient receiving oxytocin (Pitocin) for which of the following adverse effects?

Cardiac arrhythmias

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following?

Cardiovascular complications

The nurse questions the administration of a cholinesterase inhibitor to the patient with a history of what?

Chronic obstructive pulmonary disease (COPD)

Methylphenidate

Concerta, Ritalin o Controlled substance: level 2 o Most frequent prescribed for ADHD o Action: modulates serotonergic pathways by affecting changes in dopamine transport o Interactions: § Caffeine, oral anticoagulants, barbiturates, anticonvulsants, TCAs, MAOIs, antihypertensives, insulin o Pt care: § Teach to take before meals § Avoid foods with caffeine § Avoid alcohol § Use sugarless gum for dry mouth § Report irregular heartbeat § Record height, weight, and growth of children § Do not stop abruptly, taper off

The nurse recognizes that antidiuretic hormone (ADH) causes what? Excretion of sodium Conservation of water Reabsorption of potassium Excretion of waste products

Conservation of water ADH acts on the collecting duct to regulate conservation of water. In the absence of ADH, the collecting duct is impermeable by water. Tubular urine entering the collecting duct is isotonic (300 mOsm/L). ADH acts on the collecting duct to increase its permeability by water. By rendering the collecting duct permeable by water, ADH allows water to be drawn from the duct as it passes through the hypertonic renal medulla. Because of this water reabsorption, urine that enters the duct in a relatively dilute state becomes concentrated and reduced in volume.

The patient is receiving IV antiepileptic therapy. Which parenteral antiepileptic drug is effective against generalized seizures? A) Phenytoin (Dilantin) B) Fosphenytoin (Cerebyx) C) Phenobarbital (Luminal) D) Valproic acid (Depakene)

D Valproic acid is indicated in all its forms for generalized seizures, including tonic-clonic, absence, and myoclonic seizures. Phenytoin, fosphenytoin, and phenobarbital are parenteral antiepileptic medications, effective in the treatment of partial seizures and, secondarily, generalized tonic-clonic seizures.

The nurse would question the use of mannitol (Osmitrol) for which patient condition? A. Increased intraocular pressure B. Oliguria from acute renal failure C. Cerebral edema from head trauma D. Anuria related to end-stage kidney disease

D. Anuria related to end-stage kidney disease Correct Mannitol does not influence urine production; it only increases existing urine output. It is not metabolized but excreted unchanged in the urine by the kidneys. Thus, if no urine is produced (anuria), mannitol is not excreted, which increases

Q. A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants? A. CNS stimulants block or reduce the activity of inhibitory neurons. B. CNS stimulants activate cyclic adenosine monophosphate. C. CNS stimulants decrease the production of excitatory neurotransmitters. D. CNS stimulants increase release of and block reuptake of neurotransmitters.

D. CNS stimulants increase release of and block reuptake of neurotransmitters. CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

Q. The nurse explains to a patient that using caffeine may exacerbate which health condition? A. Heart block B. Constipation C. Myelin degeneration D. Cardiac dysrhythmias

D. Cardiac dysrhythmias Caffeine is a CNS stimulant. It should be used with caution in patients with a history of peptic ulcers, cardiac dysrhythmia, or recent myocardial infarction.

Why does the health care provider prescribe furosemide (Lasix) 40 mg twice a day by mouth for a patient with a history of renal insufficiency? A. Furosemide is effective in treating patients withhypoaldosteronism. B. Furosemide helps the kidney with reabsorption of sodium and water. C. Furosemide has an antagonist effect to prevent respiratory alkalosis. D. Furosemide is effective in treating patients with impaired kidney function.

D. Furosemide is effective in treating patients with impaired kidney function. Correct Furosemide effectiveness continues in impaired renal function. When creatinine clearance decreases below 25 L/min (normal is 125 L/min), the loop diuretics can still work.

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? A. Diaphoresis B. Constipation C. Blurred vision D. Muscle weakness

D. Muscle weakness Correct Muscle weakness is a common symptom of hypokalemia. The other answers are incorrect.

IUD use is contraindicated for women with what conditions?

Diabetes, history of PID

The nurse prepares for intravenous administration of what drug to the patient experiencing status epilepticus?

Diazepam

The nurse recognizes that the underlying cause of Parkinson's disease is related to a lack of what?

Dopamine

Amantadine (Symmetrel)

Dopamine agonist; · Also an antiviral drug for influenza A · Taken alone or in combo with levodopa or anticholinergic

The nurse monitors the patient receiving phenobarbital for what adverse reaction?

Drowsiness

The nurse realizes that which clinical manifestation as the most troubling adverse effect of levodopa?

Dyskinesia

The nurse recognizes that the results of which diagnostic test are essential to the accurate diagnosis of type of seizure activity?

Electroencephalogram (EEG)

Your client informs you that she had unprotected intercourse last night. She is considering requesting emergency postcoital contraception. Your best response is:

Emergency contraception is most effective if started within 24 hours and no later than 72 hours after exposure.

The nurse is aware that older men are more prone to urinary tract infections because of what physiologic change related to aging?

Enlargement of the prostate

A 28-year-old patient, on infusion of methyl ergonovine, suddenly develops numbness, tingling of extremities, dyspnea, nausea, confusion, tachycardia, chest pain, hallucinations, and convulsions. Which of the following is the possible condition the nurse should suspect in this case?

Ergotism Ergotism or ergot poisoning may occur with the administration of excessive amounts of ergonovine or methylergonovine. Symptoms of ergotism involve coolness, numbness and tingling of extremities, dyspnea, nausea, confusion, tachycardia or bradycardia, chest pain, hallucinations, and convulsions.

Your client is menopausal and has been given a prescription for estrogen. She asks you what some of the risks in taking the medication are. Your best response is:

Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.

What antiepilepsy medication does the nurse recognize as effective in the treatment of absence seizures?

Ethosuximide

A female client has a history of renal impairment and is visiting the family nurse practitioner to discuss the use of estrogen. The nurse knows that this medication will be used only with extreme caution because of what adverse effect associated with estrogen?

Fluid retention

How does betamethasone adversely affect the mother when taken?

Fluid retention, elevate BP, maternal hyperglycemia, transient increase in WBC

A patient who is taking an estrogen complains of swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority?

Fluid volume excess

Dexmethylphenidate

Focalin XR o Uses: increases attention span and cognitive performance o Decreases impulsiveness, hyperactivity, and restlessness

Nitrofurantoin (Macrodantin)

For UTI treatment § Bacteriostatic or bactericidal (dosage) § Effective against many gram + and - organisms § Side effects: · Anorexia, nausea, vomiting, ab pain, C. Diff, peripheral neuropathy, brown urine discoloration § Pt care: · Monitor urine output and specific gravity · Identify organism before initiation of therapy · Avoid antacids · Increase fluids, take drug with food Contact if sudden onset of dyspnea, chest pain, cough, fever, and chills

When is methylergonovine (Methergine) used?

Fpr postpartum hemorrhage

When should terbutaline sulfate not be administered?

HR >130 bpm or patient has chest pain

The nurse teaches the patient receiving levodopa to avoid which diet because of its effects on levodopa?

High-protein

How long is a hormonal IUD effective for? Copper IUD?

Hormonal: 5 years, Copper: 10 years

A patient is using an oral contraceptive combination that include drospirenone. The nurse would assess the patient for which of the following?

Hyperkalemia Drospirenone used in combination contraceptives has antimineralocorticoid activity and can block aldosterone, leading to increased potassium levels.

The nurse monitors the patient receiving spironolactone (Aldactone) for which electrolyte imbalance? Hyperkalemia Hypernatremia Hyperglycemia Hypercalcemia

Hyperkalemia Spironolactone is a potassium-sparing diuretic, and use of this drug may lead to hyperkalemia.

The nurse recognizes which finding as a possible focus for seizure generation? (Select all that apply.)

Hypoxia Head trauma Congenital defects

The nurse is preparing to administer Sinemet to a patient with Parkinson's disease. The nurse recognizes that this drug is a combination of levodopa and carbidopa and that the carbidopa does what?

Increases the amount of levodopa available in the central nervous system

What is the time frame for cervical diaphragm use?

Insert 6 hr prior to intercourse, leave in for 6 hrs after intercourse

A nurse is caring for a pregnant patient receiving oxytocin. Via which of the following routes should oxytocin be administered during the third stage of labor?

Intramuscular

In preparing an inservice about Parkinson's disease, the nurse describes which drug as the most effective treatment for patients with severe symptoms?

Levodopa

Furosemide (Lasix)

Loop diuretic · Action: o Acts on ascending loop of Henley o Inhibits chloride transfer of sodium into circulation · Indications o Acute CHF o Acute pulmonary edema o Edema associated with renal or liver dx o Hypertension · Side effects: o Related to electrolyte imbalances § Hypokalemia, alkalosis, hyperglycemia, hypocalcemia, etc. § Elevated BUN, creatinine, lipids § Renal failure · Pt care: o Monitor weight daily o If giving IV, give slowly à may cause hearing loss o Monitor K

What does the nurse recognize as an indicator of more advanced Alzheimer's disease?

Loss of bladder control

What medication should not be used concurrent with nifedipine?

Magnesium sulfate

The nurse prepares to administer which medication to reduce intracranial pressure by creating an osmotic gradient and decreasing cerebral edema? Hydrochlorothiazide (HydroDIURIL) Spironolactone (Aldactone) Furosemide (Lasix) Mannitol (Osmitrol)

Mannitol (Osmitrol) Mannitol is a potent osmotic diuretic that leads to water being pulled out of the brain. This drug is indicated in the treatment of increased intracranial pressure because it facilitates the movement of edema (water) out of brain tissue.

Why is methotrexate given in L&D?

May be used with ectopic pregnancy to stop the growth of the embryo to save the tube

A 38-year-old female client has just visited the physician and has received a prescription for birth control pills. The client calls the nurse and states that she doesn't need birth control pills because she had voluntary sterilization after her third child. The nurse explains that birth control pills may be used for what other reason?

Menstrual disorders

In reviewing admission orders for a patient with Parkinson's disease treated with selegiline, what drug order would cause the nurse to question the prescriber?

Meperidine

The nurse recognizes that anticholinergic agents are used in the treatment of Parkinson's disease because they block what?

Muscarinic receptors

The nurse is teaching a patient about the side effects from donepezil. What are the most common side effects that should be included in the patient teaching? (Select all that apply.)

Nausea Diarrhea

What is the time frame for use of emergency contraception?

No later than 72 hours after unprotected sex

Which of the following is an example of a progestin?

Norethindrone (Aygestin)

Which finding does the nurse recognize as a clinical manifestation of phenytoin toxicity?

Nystagmus

In the patient with a history of simple partial seizures, the nurse should look for which clinical manifestations of this disorder?

Olfactory hallucinations

After teaching a patient who is prescribed estradiol vaginal cream, the nurse determines that the patient has understood the instructions when she states that she will administer the medication at which frequency?

Once a day

A postmenopausal woman is receiving raloxifene as part of a treatment plan for osteoporosis. The nurse would instruct the patient that this drug is administered by which route?

Oral

Estradiol is sometimes administered to postmenopausal women to prevent which of the following conditions?

Osteoporosis

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the physician?

Pain in one leg Pain in one leg could indicate a thrombus formation.

Oxytocin is an endogenous hormone produced by which of the following?

Posterior pituitary gland

When should a not-immune woman be administered varicella vaccine in pregnancy?

Postpartum period

In administering dopamine agonists to a patient with Parkinson's disease, the nurse assesses for which adverse effect?

Postural hypotension

What condition that sometimes develops in pregnancy does magnesium sulfate help treat?

Preeclampsia. Mag sulfate is given to decrease risk of seizures

The nurse knows that, in a client whose uterus is intact, estrogen must be paired with what other drug when used to treat menopausal symptoms?

Progestins

What does betamethasone do?

Promotes fetal lung maturity in preterm labor (for fetus b/w 24-34 wks gestation)

In administering levodopa to a patient with Parkinson's disease, the nurse understands that it works by doing what?

Promoting dopamine synthesis

The nurse is comparing the actions of several diuretics. The nurse reads that greater diuresis occurs when the diuretic works on which part of the nephron? Proximal convoluted tubule Descending loop of Henle Ascending loop of Henle Distal convoluted tubule

Proximal convoluted tubule Drugs that block solute reabsorption to the greatest degree produce the most profound diuresis. Because the amount of solute in the nephron becomes progressively smaller as filtrate flows from the proximal tubule to the collecting duct, drugs whose site of action is early in the nephron have the opportunity to block the greatest amount of solute reabsorption and produce the greatest diuresis. Because most of the filtered solute has already been reabsorbed by the time the filtrate reaches the distal parts of the nephron, diuretics that act at distal sites have little reabsorption available to block, and these distally acting agents produce relatively scant diuresis.

A client who is on estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse tells the client to go to the emergency department immediately, because the nurse suspects what adverse reaction related to estrogen therapy?

Pulmonary embolism

In assessing a patient with Alzheimer's disease, the nurse correlates degeneration of the hippocampus with what?

Short-term memory loss

What should a client taking oral contraceptives avoid?

Smoking

In administering diuretics, the nurse understands that most of these drugs work by disrupting which stage of the renal process? Water filtration Solute filtration Water reabsorption Solute reabsorption

Solute reabsorption Most diuretics act by disrupting solute reabsorption. It is important to understand the major processes by which nephrons reabsorb filtered solutes. Because sodium and chloride ions are the predominant solutes in the filtrate, reabsorption of these ions is of greatest interest.

Dopamine replacements/agonists for Parkinson's Treatment

Stimulate dopamine receptors

Susan, age 21, is prescribed an oral contraceptive pill to prevent pregnancy. What is the mechanism of action of oral contraceptive pills?

Suppress ovulation

The nurse should question the administration of which drug for the treatment of Alzheimer's disease in the patient with a history of liver disease?

Tacrine

A young woman is being seen in the gynecology clinic of the local health department. She has decided to begin hormonal contraceptives. What action is specific to hormonal contraceptives and should be taught to this woman?

The cervical mucus is made resistant to penetration by spermatozoa.

The nurse recognizes that the earliest clinical manifestations of Alzheimer's disease are related to damage to what?

The hippocampus

While monitoring a woman who is receiving IV oxytocin for induction of labor, what event would cause the nurse to contact the health care provider immediately?

The uterine contractions are occuring every 90 seconds.

Hydrochlorothiazide (HCTZ)

Thiazide and thiazide-like diuretic · Actions: o Keeps chloride and sodium in the tubule to be excreted in the urine, thus preventing the reabsorption of both in the vascular system o Act on distal convoluted renal tubule · Indications: o Treatment of edema from CHF, liver, or renal dx o Monotherapy or adjunct for hypertension o Normal renal dx o Not effective for immediate diuresis · Caution: o Diabetes o Hyperparathyroidism · Contraindications: o Renal failure · Side effects: o Hypotension, hyperkalemia, decreased calcium secretion o GI distress, urticaria, hyperuricemia, blood dyscrasias · Drug interactions: o Enhances action digoxin!!

For which adverse effect should the nurse monitor the patient receiving carbamazepine?

Thrombocytopenia

Why is indomethacin given in L&D?

Tocolytic for preterm labor. Only given for gestational age <32 wks

Mrs. Garcia is a 7-month-pregnant woman who is experiencing contractions. She is admitted to the hospital in preterm labor. What will the physician prescribe in order to stop the labor?

Tocolytics Tocolytics are uterine relaxants that are used to stop labor contractions that occur before the completion of the 37th week of gestation. Oxytocics are uterine stimulants used to initiate or augment a contractile pattern of labor. On the other hand, prostaglandins prepare the uterus for labor and delivery by ripening the cervix. Finally, estrogen may have a role in the creation of additional oxytocin receptors.

The nurse sees a patient fall to the floor and begin to exhibit muscle jerking, impaired consciousness, and urinary incontinence. The nurse records this as what type of seizure?

Tonic-clonic

Methenamine

Treatment for UTI § Bactericidal when urine is acidic (pH < 5.5) § Use: · Chronic UTIs · Effective for E.coli and P. aeruginosa § Side effects: · Crystalluria, elevated hepatic enzymes § Consideration · Avoid taking with sulfonamides · Consume with acidic foods and fluids to acidify urine (cran juice)

In assessing the patient with Parkinson's disease, the nurse recognizes what finding as an early clinical manifestation?

Tremor

Why is tamoxifen used? What does it increase the risk of?

Tx breast cancer. Icnreases risk of endometrial cancer, deep vein thrombosis, pulmonary embolism

What must be monitored for a patient on oxytocin?

Uterine contractions, fetal heart rate. Used in postpartum: monitor for uterine bleeding

What drug is effective against most forms of epilepsy?

Valproic acid

The nurse monitors the patient taking digoxin and furosemide (Lasix) for which of these complications? Seizures Hypertension Hyperreflexia Ventricular dysrhythmias

Ventricular dysrhythmias Digoxin is used to treat heart failure and cardiac dysrhythmias. In the presence of a low potassium level, the risk of serious digoxin-induced toxicity (ventricular dysrhythmias) is greatly increased. Because high-ceiling diuretics promote potassium loss, use of these drugs in combination with digoxin can increase the risk of dysrhythmias. The potassium level should be checked routinely, and when indicated, a potassium supplement or a potassium-sparing diuretic should be given.

The nurse is reviewing the admission orders for a patient with a new diagnosis of seizure disorder. These drugs are being taken by the patient. Which will require an increased dosage if the patient is started on carbamazepine?

Warfarin

Which of the following is an adverse effect caused by all uterine stimulants because of their antidiuretic effect?

Water intoxication

The nurse limits the amount of oral fluids given to a client receiving oxytocin (Pitocin) for induction of labor. This is done to prevent what serious complication?

Water intoxication Water intoxication is a serious complication that can occur with the continuous use of oxytocin, especially if the drug is administered by continuous infusion and the client is receiving fluids by mouth. Oxytocin may also cause fetal bradycardia, uterine rupture, and uterine hypertonicity.

What is the antidote to terbutaline sulfate?

a beta-blocking agent

nalidixic acid (NegGram) is prescribed for a client with a UTI. on review of the client's record, the nurse notes that the client is taking warfarin sodium (coumadin) daily. which prescription should the nurse anticipate for this client?

a decrease in the warfarin sodium (coumadin) dosage

The nurse will monitor the patient who is taking a muscle relaxant for which adverse effect? a) CNS depression b) hypertension c) peripheral edema d) blurred vision

a) CNS depression

The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy? a) cardiovascular disease b) chronic bronchitis c) history of renal calculi d) diabetes mellitus type 2

a) cardiovascular disease

The nurse correlates a decreased level of ________ with the clinical manifestations of advanced Alzheimer's disease.

acetylcholine

Analeptics and caffeine

act on the brainstem and medulla to stimulate respiration

What is the effect of tocolytic medications?

act on uterine muscle to cease contractions

A patient has been admitted to the ER because of an overdose of an oral benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate intervention? a) hemodialysis to remove the medication b) administration of flumazenil c) administration of naloxone d) intubation and mechanical ventilation

b) administration of flumazenil

The nurse is preparing to administer a medication for sleep. Which intervention applies to the administration of a non-benzodiazepine, such as zaleplon (Sonata)? a) these drugs need to be taken about 1 hour before bedtime b) because of their rapid onset, these drugs need to taken just before bedtime c) the patient needs to be cautioned about the high incidence of morning drowsiness that may occur after taking these drugs c) these drugs are less likely to interact w/alcohol

b) because of their rapid onset, these drugs need to taken just before bedtime

A patient w/narcolepsy will begin treatment w/a CNS stimulant. The nurse expects to see which adverse effect? a) bradycardia b) nervousness c) mental clouding d) drowsiness at night

b) nervousness

A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information? a) correct technique for IM injections b) take the medication before the HA worsens c) Allow at least 30 minutes between injections d) take no more than 4 doses in a 24-hour period

b) take the medication before the HA worsens

a nurse who is administering bethanechol chloride (urecholine) is monitoring for acute toxicity associated with this medication. the nurse checks the client for which sign of toxicity?

bradycardia

The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (select all that apply) a) "be sure to have your child blow his nose before administering the nasal spray" b) "this medication is used only when symptoms of ADHD are severe" c) "the last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep" d) "be sure to contact the physician right away if you notice expression of suicidal thoughts" e) "we will need to check your child's height and weight periodically to monitor physical growth" f) "if adverse effects become severe, stop the medication for 3 to 4 days"

c) "the last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep" d) "be sure to contact the physician right away if you notice expression of suicidal thoughts" e) "we will need to check your child's height and weight periodically to monitor physical growth"

An older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the patient was awake most of the night, watching TV and reading in bed. The nurse documents that the patient has had which type of reaction to the medication? a) allergic b) teratogenic c) paradoxical d) idiopathic

c) paradoxical

Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative-hypnotic drug? (select all that apply) a) these drugs are intended for long-term management of insomnia b) the drugs can be administered safely with other CNS depressants for insomnia c) the dose needs to be given about 1 hour before the patient's bedtime d) the drug is used as a first choice for treatment of sleeplessness e) the patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken

c) the dose needs to be given about 1 hour before the patient's bedtime e) the patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken

What precautions must be taken before giving a patient Rho(D) Immune Globulin?

confirm mother is Rh-, never administer to a neonate, never administer IV

A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a "terrible side effect." The nurse suspects that the patient is referring to which problem? a) nausea b) sexual dysfunction c) urinary incontinence d) fecal incontinence

d) fecal incontinence

The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate? a) deficient fluid volume b) sleep deprivation c) impaired memory d) imbalanced nutrition, less than body requirements

d) imbalanced nutrition, less than body requirements

A hospitalized patient is complaining of having difficulty sleeping. Which action will the nurse take first to address this problem? a) administer a sedative-hypnotic drug if ordered b) offer tea made with the herbal preparation valerian c) encourage the patient to exercise by walking up and down the halls a few times if tolerated d) provide an environment that is restful, and reduce loud noises

d) provide an environment that is restful, and reduce loud noises

the client who has a cold is seen in the emergency department with an inability to void. because the client has a hx of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which of the following medications?

decongestants

after kidney transplantation, cyclosporine (sandimmune) is prescribed for a client. which lab results would indicate an adverse effect from the use of this medication?

elevated blood urea nitrogen level

Methylergonovine should be used with caution in patients with what conditions?

hypertension, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, CV/hepatic/renal impairment

The nurse identifies ________ as an adverse effect of hydrochlorothiazide (HydroDIURIL). hyperuricemia hypernatremia hyperchloremia hypermagnesemia

hyperuricemia Thiazides such as hydrochlorothiazide cause increased uric acid retention, which can lead to an increased level of uric acid.

Eunuchism

inadequate production of androgens in male due to pituitary malfunction, or atrophy/injury to, or removal of testes

Tolcapone (Tasmar)

inhibits COMT (enzyme that metabolizes DA); · Side effects: o Excessive dreams, insomnia, sudden sleep onset, ortho hypotension, impulse control disorder

Selegiline (Eldepryl)

inhibits MAO-B; prolongs duration of DA; · Side effects: o Ortho hypotension, suicidal ideation, impulse control disorder, hypertension · Interactions: foods high in tyramine can cause hypertensive crisis (aged cheese, red wine, bananas)

a nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. which of the following should be included in the list of instructions?

maintain a high fluid intake

the nurse is reinforcing discharge teaching instructions to a client receiving sulfadiazine. which should be included in the list of instructions?

maintain a high fluid intake rationale: each dose of sulfadiazine should be administered with a full glass of water, and the client should maintain a high fluid intake.

drugs to treat benign prostatic hyperplasia (hypertrophy)

o Action: § Alpha adrenergic blockers (Tamsulosin, terazosin) § Testosterone production blockers (Dutasteride, finasteride) o Indication: BPH o Side effects: lethargy, tachy, hypotension, decreased libido, impotence, sexual dysfunction Drug interactions: theophylline

Drugs for treatment of Penile Erectile Dysfunction

o Actions: inhibits PDES receptors leading to a release of nitrous oxide, which activates oGMP to cause a prolonged smooth muscle relaxation allowing the flow of blood into the corpus cavernosum and facilitating o Indications: erectile dysfunction o Contraindications: § Conditions that may predispose to priapism § Penile implants § Use in women o Caution: § Bleeding disorders, CAD, active peptic ulcer, hypotension or severe hypertension, congenital prolonged QT interval or severe hepatic or renal disorders o Side effects: edema, headache, syncope, angina, dyspnea o Drug interactions: § Combination with organic nitrates or alpha blockers ca cause dangerous CV effects (death) o Drugs approved: § Alprostadil · Prostaglandin that relaxes vascular smooth muscle and allows filling of the corpus cavernosum when it is injected directly into cavernosum § sildenafil

Urinary Stimulants

o Bethanechol § Action: · Increase bladder tone of detrusor muscle - stimulate micturition § Use: · Neurogenic bladder cause by lesion of nervous system or spinal cord injury, severe head injury § Side effects: · Nephrotoxicity, hepatotoxicity § Contraindications · Peptic ulcer

status epilepticus

o Continuous seizure state o Medical emergency o Treatment must begin immediately; or death could result o Treatment: § Diazepam § Lorazepam § Followed by phenytoin IV § For continued seizures: midazolam, Propofol § Slow IV admin to avoid resp depression

UTIs

o Cystitis § Lower tract infection · E. coli, staphylococcus, Klebsiella, proteus, Pseudomonas o Pyelonephritis § Upper tract infection § Usually F patients § Usually e. coli

Antiseizure meds and pregnancy

o Episodes increase 25% in women with epilepsy when pregnant o Hypoxia during seizures places mom and fetus at risk o Many meds are teratogenic o Meds tend to inhibit vitamin K § Contributes to infant hemorrhage soon after birth § Vitamin K may be give last few days of pregnancy or to infant soon after birth o Meds increase loss of folate in pregnant pt's

BHP

o Glandular units in prostate gland undergo tissue hyperplasia with aging o Treatment: safety § Alpha-adrenergic antagonists (Tamsulosin) § 5-alpha-reductase inhibitors (Finasteride) § Anticholinergics § Phosphodiesterase-5-inhibitors (tadalafil)

Urinary Antispasmodics

o Oxybutynin § Action: · Direct action on smooth muscles of urinary tract to relieve spams from infection or injury § Contraindication · Avoid in glaucoma, GI or urinary obstruction o Tolterodine tartrate § Use: · Control overactive bladder · Decrease urge and urinary incontinence § Side effects: · Dysphonia, peripheral edema, blurred vision, confusion, elevated hepatic enzymes, ab pain § Contraindication · Narrow-angle glaucoma Hepatic impairment

Bladder protectants

o Pentosan polysulfate sodium § Actions · Heparin-like compound that has anticoagulant and fibrinolytic effects · Adheres to bladder wall mucosal membrane and acts as buffer to control cell permeability, preventing irritating solute in urine from reaching cell walls § Indication: Interstitial cystitis § Side effects: bleeding that may progress to hemorrhage § Drug interactions: anticoagulants, aspirin, or NSAIDs

Drugs for menopause

o Pharmacologic therapy: HT or HRT o Hormone therapy: estrogen-progestin for females with intact uterus o Hormone therapy: estrogen for females with hysterectomy o Hormone therapy: improves vasomotor symptoms and vaginal dryness and decreases risk of osteoporosis o BB Warning!: should be used only for treatment of menopausal symptoms, at lowest dose possible, for shortest duration possible

Gonadotropins

o Secreted by both anterior and posterior lobes of pituitary gland o Hormones include: § FSH à stimulates production of ovarian follicles in female and sperm production in male § LH > works in conjunction with FSH to induce secretion of estrogen, ovulation and development of corpus luteum § LTH > stimulates secretion of progesterone by corpus luteum and secretion of milk in mammary gland

Anticonvalsants, antiepileptics

o Stabilize nerve cell membranes o Suppress abnormal electric impulses to cerebral cortex

Actions of Antiseizure Meds

o Suppress sodium influx (prevents neuron firing) o Suppress calcium influx (prevents electric current generated by calcium ion to the calcium channel) o Enhance action GABA (inhibits neurotransmitters throughout the brain) Promote GABA release

Types of seizures

o Tonic-clonic (grand mal) § Most common § Generalized alternating muscle spasms and jerkiness o Absence: (petit mal) § Brief loss of consciousness (10 sec or less) § Usually occur in children o Common partial seizure type: § Psychomotor: · Repetitive behavior (chewing or swallowing moitons) · Behavioral changes · Motor seizures

Febrile seizures

o Usually occur in children between ages of 3 months and 5 years o Epilepsy develops in approx. 2.5% children who have had 1 or more febrile seizures o Prophylactic treatment for high risk pts: phenobarbital or diazepam o Valproic acid is not given to children under 2 years due to possible hepatic effects

Anticholinergics for Parkinson's Treatment

o block cholinergic receptors § Action: · Inhibit release of acetylcholine · Reduce rigidity and some tremors · Minimal effect of bradykinesia § Pt care: · Routine eye exams (glaucoma) · Relieve dry mouth with hard candy, ice chips etc. · Monitor urine output for early detection of retention · Increase fluid intake, fiber, and exercise to avoid constipation

Urinary Analgesics

oPhenazopyridine § Action: · When excreted in urine, exerts direct topical analgesic effect of urinary mucosa · Relieves pain, burning, frequency, urgency § Side effects: · GI, red-orange urine, hemolytic anemia · Nephrotoxicity, hepatotoxicity · Can effect urine glucose test · Garlic-like taste, skin hyperpigmentation

Mannitol (Osmitrol)

osmotic diuretic · Action: o Increases concentration and sodium reabsorption in proximal tubule and loop of Henle o Excretes Na, Cl, K and water · Indications o Increased cranial pressure or acute renal failure due to shock, drug OD or trauma · Contraindications o Renal dx and anuria, pulmonary congestion, intracranial bleeding, dehydration, CHF, heart dx · Use: o Prevent kidney failure o Decrease ICP and IOP · Side effects o Related to sudden drop in fluid levels § Nausea, vomiting, light head, confusion § Electrolyte imbalance, pulmonary edema, tachy

What class of drugs do dinoprostone and misoprostol belong to?

oxytocic cervical ripening agents. they soften & thin the cervix

What are contraindications for oxytocin use?

placental abnormalities, fetal malpresentation, previous uterine surgery, fetal distress, Bishop Score <6

cinoxacin (cinobac) or mehenamine (urex), urinary antiseptics, are prescribed for the client. the nurse reviews the client's medical record and should contact the HCP regarding which documented finding to verify the prescription?

renal insufficiency

What are some key adverse effects of magnesium sulfate use?

respiratory depression, diminished DTRs, decreased urine output

oxybutynin chloride (ditropan XL) is prescribed for a client with neurogenic bladder. which sign would indicate a possible toxic effect related to this medication?

restlessness

The nurse correlates the amount of urine production after administration of a diuretic with the amount of ________ reabsorption that is blocked. sodium glucose calcium potassium

sodium Most diuretics share the same basic mechanism of action: blockade of sodium and chloride reabsorption. By blocking the reabsorption of these solutes, diuretics create osmotic pressure within the nephron that prevents the passive reabsorption of water. The increase in urine flow that a diuretic produces is directly related to the amount of sodium and chloride reabsorption that it blocks. Diuretics cause water and solutes to be retained within the nephron and thereby promote the excretion of both water and sodium.

The nurse correlates the action of aldosterone with the reabsorption of ________ from the distal nephron. sodium calcium potassium magnesium

sodium Aldosterone, the principal mineralocorticoid of the adrenal cortex, stimulates the reabsorption of sodium from the distal nephron. At the same time, aldosterone causes potassium to be secreted. It has no direct action on calcium or magnesium regulation.

trimethroprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. a nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?

sore throat

What is a major adverse effect of cervical ripening agents?

tachysystole

Which tocolytic medication can cause hyperglycemia, chest pain, and tremulousness?

terbutaline sulfate

phenazopyridine hydrochloride (pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower UTI. the nurse reinforces to the client:

that a reddish orange discoloration of the urine may occur

bethanechol chloride (urecholine) is prescribed for a client with urinary retention. which disorder would be a contraindication to the administration of this medication?

urinary strictures

A 24-year-old woman has come to the clinic with an infection and has been prescribed penicillin. The nursing assessment reveals that she is taking oral contraceptives. The nurse will instruct her to

use an additional form of birth control while taking penicillin.

What must the nurse monitor in a patient taking magnesium sulfate?

vital signs, deep tendon reflexes (DTRs), magnesium levels (therapeutic range: 4-8 mg/dL), urinary output

Estrogen Receptor Modulators

§ Action: · Modulating effects of estrogen receptors · Used to stimulate specific estrogen reception to increase bone mineral density § Indications: postmenopausal osteoporosis § Contraindications: pt with hx of venous thrombosis or smoking § Side effects: · Changes in fluid balance, headache dizziness, visual changes · Estrogen receptors stimulation: hot flashes, skin rash, edema, vaginal bleeding § Drug interactions: cholestyramine, warfarin § Ex: raloxifene

Carbidopa/Levodopa

§ Action: converts dopamine and increases mobility § Side effects: orhto hypotension, dyskinesia, severe depression psychosis, dystonic movement

Emergency Contraception

§ Actions: · Prevents fertilization by raising progestin and estrogen to delay or prevent ovulation, interferes with transport of embryo, or changes hormones necessary for preparation of uterine lining

Estrogen and Progestins

§ Actions: · Protects the heart from atherosclerosis · Retains calcium in body · Maintains secondary female sex characteristics § Indications · Hormone Replacement Therapy (HRT) · Palliative and preventative therapy during menopause § Contraindications · Idiopathic vaginal bleeding, breast cancer, estrogen dependent cancer § Drug-drug interactions · Drugs that enhance hepatic metabolism · Corticosteroids § Ex: conjugated estrogen

Amphetamines

§ Acts on cerebral cortex (long term use can produce psychological dependence or tolerance) § Action: speed up · Simulates release of norepinephrine and dopamine · Inhibits reuptake of norepinephrine and dopamine § Side effects/AR: · Tachycardia, palpitations, hypertension, restlessness, irritability, confusion, euphoria, insomnia, blurred vision, dysrhythmias, tremors, anorexia, dry mouth, weight loss, diarrhea, constipation, erectile dysfunction · Excess use: psychosis

Anorexiants

§ Acts on satiety center in hypothalamic and limbic areas § Causes stimulant effect on hypothalamic and limbic areas of brain to suppress appetite § Side effects: Nervousness, irritability, insomnia, tachy, hypertension, palpitations, seizures

Phenytoin (Dilantin)

§ Inhibits sodium influx, stabilized cell membranes, reduces repetitive neuron firing, limits seizures § Contraindications: pregnancy § Therapeutic serum level: 10-20 mcg/mL § Side effects/adverse reactions: · Gingival hyperplasia, nystagmus, diplopia, headache, dizziness, slurred speech, alopecia, purple glove syndrome (IV), ventricular fibrillation, depression, suicidal ideation, hyperglycemia, GI distress, urine discoloration, thrombocytopenia, leukopenia, Stevens-Johnson § Drug interactions: · Cimetidine, isoniazid, chloramphenicol, sulfonamides (increased) · Folic acid, antacids, calcium sucralfate, antineoplastic, antipsychotics, primrose, gingko, borage (decreased) · Anticoagulants, oral contraceptives, antihistamines, corticosteroids, theophylline, dopamine, cyclosporine, quinidine, rifampin (decrease of) § Pt care: · Monitor serum levels to determine therapeutic range · Advise female pts taking oral contraceptives and antiseizure drugs to use additional contraceptive methods · Use seizure precautions for patient at risk of seizures · Advise patients to not drive or perform other hazardous activities when initiating therapy

Drugs for Labor and Delivery

§ Oxytocin · Given IV to induce labor · Syntocinon nasal spray given as agent to release flow of milk from mammary glands § Prostaglandins · Used for cervical ripening; also stimulate smooth muscles of GI tract · Also used for uterine evacuation for fetal death or therapeutic abortion, postpartum bleeding due to uterine atony that has not responded to Oxytocin § Methylergonovine: · Used for prevention and treatment of postpartum and post abortion hemorrhage § Terbutaline: used in management of preterm labor to relax uterine muscle § Magnesium sulfate: depresses CNS, causing cerebral vasodilation (anticonvulsive). Also manages uterine tetany occurring as result of oxytocin effects; also antihypertensive

Trimethoprime and trimethoprime sulfamexthoxazole

§ Use: · Acute, chroming UTIs (staph aureus or MRSA) § Side effects: · Photosensitivity, crystalluria, C. diff, elevated hepatic enzymes, seizures · Hyperkalemia, torsade's de pointes

Flouroquinolones

§ Use: treats LOWER UTIs § Side effects: · Peripheral neuropathy, tendinitis, tendon rupture seizures, C.diff § Caution: in uncomplicated UTI only if no other treatment available

Phenobarbital (Luminal)

· Action: enhances GABA activity · Use: tonic-clonic, partial, myoclonic seizures, status epilepticus · Therapeutic serum range: 20-40 mcg/mL · Side effects: sedation, tolerance · d/c: gradual

Spironolactone (Aldactone)

· Actions: o Promotes Na/water excretion and potassium retention o Blocks action of aldosterone in distal tubule o Mild diuretic, antihypertensive · Indication o Adjunct with thiazide or loop diuretics o Pt at risk for hypokalemia o Edema due to HF, cirrhosis of the liver · Side effects: o Hyperkalemia, headache, paresthesia, muscle cramps, hyperuricemia, blood dyscrasias · Drug-to-drug interactions: o Salicylates · Pt care: o Administer in morning o Avoid foods high in K

Ethosuximide (Zarontin)

· Actions: decreases calcium influx · Use: treats absence seizures · Therapeutic range: 40-100mcg/mL · Adverse effects: blood dyscrasias, renal and hepatic impairment systemic lupus erythematosus

Abortifacients

· Antiprogesterone drug, used with misoprostol · Stops uterine pregnancy · Treats early ectopic pregnancy

Diuretics

· Indications for use: o Edema associated with CHF o Acute pulmonary edema o Liver disease (including cirrhosis) o Renal dx o Hypertension o Conditions that cause hyperkalemia · Diuretics produce increased urine flow by inhibiting sodium and water reabsorption from the kidneys

Amphetamine-like drugs for Narcolepsy

· Methylphenidate · Modafinil o Action: not fully understood · Uses: both increase wakefulness in patients with sleep disorders

Clonazepam (Klonopin)

· Treats absence and myoclonic seizures; tolerance may occur in 6 mo · Clorazepate dipotassium: treat partial seizures · Diazepam o Treats status epilepticus o Must be administered IV for status epilepticus o Short term effect: other antiseizure drugs must be given during or immediately after administration

Valproic Acid (Depakote)

· Use: tonic-clonic, absence and mixed seizures · Therapeutic range: 50-100 mcg/mL · Side effects: thrombocytopenia, hepatotoxicity

Carbamazepine

· Use: tonic-clonic, partial, psychiatric disorders (bipolar, trigeminal neuralgia and alcohol withdrawal) · Therapeutic range: 4-12 mcg/mL