Pharm test 1

Criteria: of a proper written medication

Medication Name - Dose - Route - Time and frequency Example: Amoxicillin, 500 mg, take 1 capsule by mouth 3 times a day [TID]

How do you assess vitamins?

Obtain 24- and 48-hour diet history analysis. Obtain levels to assess adequacy.

How do you assess minerals

Obtain a history of current drugs and herbs the patient is taking. Assess the patient for signs and symptoms of iron deficiency anemia.

WE CAN USE ANTICHOLINERGICS FOR ANTISPASMODICS FOR OUR

PARKINSON'S PATIENTS, ANTIPSYCHOTICS- SEROQUEL. ANTIHISTAMINES ALSO HAVE ANTICHOLINERGIC PROPERTIES. WE ARE BLOCKING THE ANTICHOLIN RECEPTORS!"

Vitamin B9 (folic acid)

PREGNANT LADIES (FOLIC)

low of B12

Paresthesia, weakness, fatigue, GI upset, Memory loss, mood changes, psychosis, Megaloblastic Anemia

What is a secondary effect of benedryl?

Sleep Aid (Secondary Effect) - DROWSINESS

Colloid

Solutions that constrain protein or other large molecular substances that increase osmolarity without dissolving in the solution

A patient has been on TPN for a month, and there is an order to discontinue TPN tmw. The nurse contacts the HCP because sudden interruption may cause what condition? A.) dehydration B.) tremors C.) urinary retention D.)hypoglycemia

d

What is the rule for selenium?

"Give all minerals through food sources first before pills!""Never use a NG tube long term - eventually move to G Tube or J Tube"

B1 (thiamine)

(beans, nuts, rice)

Vitamin E

- Excess Doses can cause: Fatigue, Weakness, GI upset, Headaches, Breast Tenderness, Bleeding

Vitamin D

- Excess Doses can cause: Hypervitaminosis D [Hypercalcemia, Anorexia, Nausea, Vomiting]

Vitamin B9

- Excess Doses can cause: Lower Phenytoin levels, Mask Vitamin B12 deciency

Hypertonic

- Fluids from the cells are being pulled into the intravascular space

Hypotonic

- Replaces cellular uid and Treats intracellular dehydration

How long do oral meds hit the peak?

2-3 hours

How long do IV meds hit the peak?

30-60 minutes

When should we draw a peak?

30-60 minutes after administration

What are food sources of vitamin A?

Carrots, pumpkin, cantaloupe, spinach (dark green leafy veggies)

3 days after a patient's total colectomy and ileostomy, he has an NG tube for continuous suction and a foley catheter for continuous drainage. The night nurse reports a high output from the ileostomy. The Patient's pulse is irregular, and he reports leg weakness. Based on this situation, the nurse would correctly suspect what type of imbalance? A.) hypokalemia B.)hyperkalemia C.)Hyponatremia D.) hypercalcemia

A

A native american patient is newly diagnosed with tpes 2 diabetes mellitus and is prescribed the antidiabetic drug metformin 500 mg by mouth with morning and evening meals. Which statements best indicates to the nurse that the patient will adhere to the medication? A.) I will no longer put sugar on my cereal because that will help me be healthier B.) If i take this medicine, I will feel better soon and won't have to take it anymore C.) To reduce the possibility of damage to my body, I must take the medicine as scheduled D.) I have diabetes because of my ancestry, so therefore theres not much I can do about it

A

A nurse is teaching a client who has a new prescription for beclomethasone. Which of of the following instructions should the nurse include? A.) rinse your mouth after each use of this medication b>)limit fluid intake while taking this medication C.) Increase your intake of vitamin B12 while taking this medication d.) You can take the medication as needed

A

A patient has COPD is taking leokotrine antagonist montelukast. The nurse is aware that this medication is given for which purpose? A.) maintenence tx of asthma B.) tx of acute asthmatic attack c.)reversing bronchospasm associated which COPD d.) tx of inflammation in chronic bronchitis

A

A patient has just received a nebulizer treatment of metaproterenol. It is most important for the nurse to assess the patient for the development of which side effect/adverse effect? A.Tremors B.Bradycardia C.Hypotension Hypoglycemia

A

A patient is receiving TPN at home. The visiting nurse assists the family with the care plan, which includes changing the TPN solution and tubing. What is the recommended initial frequency for changing tubing? A.) q 24 h B.) q 36 h C.) q 48 h D.) q 72 h

A

A patient is recieving IV K supplements what is the most important implication when administering this drug? A.) It is diluted with IV fluids and delivered by infusion pump B.) its administered via central vascular device C.) IV K must be chilled before admin D)IV k preps should not contain presevatives

A

A provider prescribes phenobarbital. for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer this med? A.) 1 B.) 2 C.) 3 D.) 4

A

PTs with HIV should recieve genetic testing for the allele HLA B*5701 before being treated with A.) abacavir B.) tenofovir C.) lamivudine D.) rilpivrine

A

The nurse is interviewing a patient in a phase 1 clinical trial. Which patient statement indicates an understanding of this trial phase? A.) I am doing this to make sure the drug is safe B.) I am doing this to be sure the drug is effective C.) I hope this drug is better then the current one D.) I can be a part of determining a cure

A

The nurse is reviewing a patient's list of medications and notes that several have the highest abuse potential. According to the US standards, the highest potential for abuse of drugs with accepted medical uses is found in drugs included in which schedule? A.) II B.) III c.)IV D.)V

A

The nurse knows the importance of administering the right medication to the patient and that drugs have many names. It is therefore most important that drugs be ordered by which name? a. Generic b. Brand c. Trade d. Chemical

A

The nurse recognises that when a patient takes a hepatic enzyme inducer the dose of warfarin is usually modified in which way? A.) it is increased b.) it is decreased C.) It remains the same D.) It is unpredictable

A

The nurse will question the health care provider if a drug with a half life, of more than 24 hours is ordered to be given more than how often? A.) once daily B.) every other day C.) twice weekly D.) once weekly

A

What provisions from the controlled substances act of 1970 were designed to remedy drug abuse? A.) The act established treatment and rehab facilities B.) The act tightened controls on experimental drugs C.) the act required clinical trial data on drugs D.) The act required drug companies to give information on off-label use of drugs

A

When teaching a patient about use of nasal decongestant sprays, the nurse informs the patient that they are most effective and less likely to lead to rebound congestion when administered for how many days? A.3 days B.10 days C.14 days 20 days

A

nurse is reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take? A.)Obtain a blood specimen immediately prior to administering the next dose of med B.) Verify the client has been taking the med for 24 h before obtaining specimen C.) Ask the client to provide a urine specimen after the next dose of medication D.) Administer the medication, and obtain a blood specimen 30 minutes later

A

The nurse is teaching an older adult patient about guaifenesin. Which information is appropriate to include in this teaching? (Select all that apply.) A.Take the drug with a glass of water. B.Read labels on over-the-counter drugs and check with health care provider before taking cold remedies. C.Take the drug at bedtime. Advise patient to contact health care provider if cough persists more than 2 days

A,B

The nurse is meeting with a community group about medication safety. The nurse must emphasize that patients at high risk for drug interactions include which groups SATA A>) older patients B.) Patients with chronic health conditions C.) Patients taking 3 or more drugs D.) Ptaients dealing with only one pharmacy E.) Patients covered by private insurance

A,B,C

When developing an individualized medication teaching plan, which topics will the nurse include? SATA A.) Adherence to the prescribed drug regimen B.) Always use the prescribed drug route C.) Know adverse effects to report to the doctor D.) Always double the next dose if missed E.) Tell the doctor when taking OTC supplements

A,B,C,E

The nurse is aware that the rate of absorption can be changed by which actions? SATA A.) modifying emptying time B.) changing gastric pH C.) decreasing inflammation D.) forming drug complexes E.) eating too slowly

A,B,D

The nurse is reviewing the drug approval process in the United States and learns that the food and drug administration modernization act of 1997 contains which provisions? SATA A.) review of the new drugs accelerated B.) Drug companies must provide information on off label use of drugs C.) privacy of individual identifiable health info must be protected D.) Drug companies must offer advanced notice of plans to discontinue drugs E.) Drug labels must describe side effects and adverse reactions

A,B,D

What is appropriate nursing care for a patient receiving TPN in an acute care setting? SATA A.) Monitor blood glucose level B.) measure I/O each shift C.) Administer blood via TPN line D.) Monitor TPN insertion site for erythema E.) monitor weight monthly

A,B,D

the patient has questions about counterfeit drugs. Which factors alert the patient or nurse that a drug is counterfeit or adulterated? SATA A.) Variations in packaging B.) Unexpected side effects C.) different chemical components D.) different taste E.) different odor

A,B,D

A Nurse is assessing the IV catheter insertion site for a client recieving a nonvescident solution and notes swelling at the site with decreased skin temperatures. Which of the following actions should the nurse? SATA A.) Stop the infusion B.) Start a new IV access distal to this site C.) Apply warm compress to the insertion site d.) Elevate th client's arm

A,C,D

A nurse is preparing a client's med. Which of the following actions should the nurse take in following legal practice guidlines? SATA A.) Teach the client about the medication B.) Determine the dosage C.) Monitor for side effects D.) Lock compartments for controlled substances E.) determine client's insurance status

A,C,D

A nurse is assessing a client before administration of a med. Which of the following data should the nurse obtain? SATA A.) Use of herbal supplements B.) Daily fluid intake C.) Ability to swallow D.) Previous surgical history E.) Allergies

A,C,E

A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take? SATA A.) Infuse medications through a large bore needle B.) monitor urine output to ensure at least 20 ml/h C.) administer med direct IV bolus D.)implement cardiac monitoring E.) Administer the infusion using an IV pump

A,D,E

The nurse researcher reviews the proposed informed consent form for a future clinical trial. The nurse expects to find which in the document? A.) Description of benefits and risks B.) Identification of related drugs, tx, and techniques C.) Description of outcomes D.)Statments of compensation for participants, if any E.) Description of serious risks

A,b,D,e

The foundation of clinical trials, Good Clinical Practice is helpful resource for nurses. The nurse is correct in choosing Good clinical practice as a reference for standards in which areas? SATA A.) Design B.) Monitoring Auditing C.) Analysis D.) Reporting E.) Outcomes evaluation

A,b,c,d

A nurse is teaching a client who has anemia and a new prescription for a liquid iron supplement. Which of the following information should the nurse include in the teaching? SATA A.) "Add foods high in fiber into your diet" B.) "Rinse your mouth after taking the medication" C.) 'expect stool to be green or black in color" D.) "Take the medication with milk" E.) "Add red meat to your diet"

A,b,c,e

The nurse is reviewing the care plan with a patient using enteral nutri. Which interventions by the nurse are appropriate for this strategy? SATA A.) check continuous route for gastric residual q2-4 h B.) elevate bed 30-45 degrees angle before administering EN C>) change enteral feeding bag/tubing q 3-4 days D.) report absent bowel sounds to HCP E.) explain that diahrea is r/t nutrition formula

A,b,d

A patient has hypernatremia. Which components are appropriate to include in the nursing teaching plan of care? SATA A.) instruct the patient on seisure precautions B.) keep appointments for lab tests C.) a sign of hypernatremia is muscle cramps D.) explain meaning on fluid restrictions E.) instruct the patient on how to read food labels

A,b,d,,e

The nurse is reviewing the med list of a patient with hypokalemia. Which products may contribute to the cause of this imbalance? SATA A.) cortisone B.) licorice C.)azithromycin D.) estrogen E.)digoxin

A,b,e

What are contradictions to nasal decongestions?

Caution with patients who have HTN cause it can increase the BP even more and be careful with pts who have DM because we can see an increase in blood sugar too

function of vitamin C

Absorption of iron, tissue repair and growth

What is an example of a Mucolytics

Acetylcysteine, Dornase alfa

What is the action of antitussives?

Act on the cough-control center in the medulla to suppress the cough reflex → Tickle Cough: Cough center is being triggered → Antitussive takes down that tickle / dry cough

Agonist

Activate Receptors Turns On - Produce desired response

What is the function of selenium

Acts as a cofactor for an antioxidant enzyme that protects protein and nucleic acids from oxidative damage

What do you use Diphenhydramine (Benadryl) for?

Acute and allergic rhinitis, pruritus, urticaria, Common cold, sneezing, cough, or allergy symptoms, prevent motion sickness (NAUSEA),

What are the uses of bronchodilators?

Acute bronchospasm, asthma, anaphylaxis, angioedema, & status asthmaticus

colloid examples

Albumin Dextran Hetastarch Mannitol

What is an an example of Bronchodilators: Selective Beta-Adrenergics

Albuterol, Formoterol, Levalbuterol (Quick Acting

How do you use intranasal glucocorticoids

Allergic rhinitis or symptoms of viral infection like common cold

What are the uses of a nasal decongestion?

Allergic rhinitis, hay fever, acute coryza

low copper

Anemia, decrease in WBCs, Decrease in skin and hair pigmentation , Glucose intolerance, mental retardation

What is the action of Beclomethasone & Dexamethasone (Anti Inflammatories)

Antiinflammatory, decrease rhinorrhea, sneezing, and congestion → can help take down inflammation because it is a steroid

What is the function of vitamin E?

Antioxidant properties, Cardiac health, used to help build up RBCs

A nurse is working with a newly liscenced nurse who is administering medications to the clients. Which of the following actions should the nurse identify as an indication that the newly liscenced nurse understands med error prevention? A.) Taking all meds out of the unit-dose wrappers before entering the client's room B.) Checking the prescription when a single dose requires administration of multiple tablets C.) administering a medication, then looking up the usual dosage range. D.) Relying on another nurse to clarify a medication prescription

B

The. nurse in the clinical research setting is knowledgeable about ethical principles and protection of human subjects. What principle is demonstrated by ensuring the patient's rights to self determination? A.) Beneficence B.) Respect for persons C.) justice D.) informed consent

B

A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a potential contradition to a medication for which of the following clients? SATA A.) A client at 8 weeks of gestation who asks for an influenza vaccine B.) A client taking presidone and has a possible fungal infection C.)A client who has chronic liver disease and is taking hydrocodone/acetaminophen D.) A client who has peptic ulcer disease takes sulcrafate, and has started OTC aluminum hydroxide E.)A client who has a prosthetic heart valve, takes warfarin, and reports suspected pregnancy

B,CE

Synthesis Inhibitors (LEUKOTRIENE IS A CHEMICAL MEDIATOR SO THE ANTAGONIST

BLOCKS THE INFLAMMATION IN THE AIRWAYS) THIS IS A MAINTENANCE THERAPY FOR PTS WITH ASTHMA - TAKE THEM EVERY DAY. YOU CAN ALSO USE THESE EVERY DAY DURING OUR SOCCER PRACTICE. IT IS NOT FOR AN ACUTE ATTACK!!

2 examples of intranasal glucocorticoids

Beclomethasone & Dexamethasone (Anti Inflammatories)

2 examples of Glucocorticoids steroids

Beclomethasone, Prednisone

food source of zinc

Beef, eggs, greens, root veggies

What is the function of vitamin A?

Bone growth, skin, eye and hair health

Ginseng (Root)

Boost immune system, Side effects include headaches, GI distress, hypo/hypertension (LOW BLOOD PRESSURE), hypoglycemia (LOW BLOOD SUGAR), breast tenderness, menstrual irregularities.

low vitamin E causes

Breakdown of RBCs,

A home care nurse is visiting a patient with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer? • A.Zafirlukast B.Cromolyn C.Metaproterenol D.Zileuton

C

A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse take? A.) Use a disposible razor to remove excess hair on the extremity B.) Select the back of the client's hand to insert the IV catheter C.) Distend the veins by using a blood pressure cuff D.) Direct the client to raise their arm above the heart

C

A nurse is reviewing a client's prescribed med. Which of the following situations represents a contradiction to a med admin? A.) The client drank grapfruit juice, which could reduce the effect of the med B.) The med has orthostatic hypotension as an adverse effect C.) A med is approved for ages 12 and older and the client is 8 years old D.) An antianxiety med that has an adverse effect of drowsiness is prescribed as a preoperative sedative

C

A nurse is teaching a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands? A.) "I will clean the site with alcohol swab before I apply the patch" B.)" I will rotate the application site weekly C.) "I will apply the patch to an area of skin with no hair" D.)" I will place the new patch on the site of the old patch"

C

A nurse on a medical surgical unit administers a hypotonic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identfify as a possible reason for the client's drowsiness? A.) reduced cardiac function B.) first pass effect C.) reduced hepatic function D.) increased gastric motility

C

A patient asks a nurse about the drug interaction with OTC preparations. What is the nurses's best response? A.) Discuss this with you HCP B.) There are not many interactions so dont worry C.) read labels carefully, and check with your health care provider D.) Avoid OTC preps

C

A patient recieving 10Meq of potassium chloride in 100 mL of normal saline intravenously to infuse over 1 hour via infusion pump. The patient has a 22 gauge peripheral IV in his right forearm and reports pain at the insertion site, the nurse notes that the site is red, warm, and tender to touch, What action by the nurse should they take? A.) Aspirate and check for blood return, then slow the IV rate B.) discontinue IV then have a central line placed C.) Stop the infusion, and discontinue the IV immediatly D.) Apply warm compress over the site and elevate extremety

C

The nursing alliance for quality Care's Focus is for health care providers to strive for which goal? A.) Quality and safety in medication administration B.) Confidentiality as determined by the patient C.) Development of a patient relationship/family engagement D.)Patient independence within the family of origin

C

Which teaching strategy is most likely to succeed in health teaching with the patient and family? A.)Know the reason why this drug was ordered B.) have patients learn generic name of each pill c.) A repeat demonstration should follow the nurse's teaching d.) Have the patient identify the number and color of the pills

C

A nurse educator is reviewing medication metabolism at an in service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosage? A.) increased renal excretion B.)increased medication metabolizing enzymes C.) liver failure D.) peripheral vascular disease E.) Concurrent use of med the same pathway metabolizes

C and E

Which components of pharmacokinetics does the nurse need to understand before administering a drug? SATA A.) drugs with smaller volume of drug distribution have a longer halflife B.) oral drugs are dissolved through the process of pinocytosis C.) patients with kidney diseases may have few protein binding sites and are at risk for drug toxicity D.) rapid absoprtion decreases the bioavailabiltiy of the drug E.) When the drug metabolism rate decreases, excess drug accumulation can occur, which can cause toxicity

C,E

What can opioid antitussives do?

Can decrease the respiratory system and cause drowsiness

Pernicious Anemia

Can't absorb the B12 naturally and will need it to be supplemented! Need it for the RBCS

What is the rule of thumb for excess vitamin E

Careful because you can see it in toxicity""If a patient is going INTO surgery, you would be more concerned about a patient bleeding if they are talking Vitamin E. Have them stop taking it 48-72 hours before surgery and 48 hours after surgery once they've been able to clot

Hypophosphatemia

Check for high calcium - Foods high in it: chocolate, milk, nuts, whole grains

Right Time

Check for scheduled procedures and follow orders - This is done to avoid complications and to ensure the medications eect is designated and optimal

What are the principles of safe medication administration?

Check meds with doctor's order - Disposal of meds - Disposal of sharps - Check medication and expiration - Distraction free environment to prevent med calc errors - Check allergies - Prepare one patients meds at a time, give meds one at a time - Double check calculations - Never leave meds unattended - See patient take meds and tolerate them - Assessment before and during administration (record the effectiveness) - Patient identifiers - "Right to correct dose" - "Right to policies"

Right Route

Check the prescribed route of administration - This is done to ensure medication has its desired eect

food sources of vitamin C

Citrus, tomatoes, greens, strawberries

What are 3 examples of opioid antitussives?

Codeine, Hydrocodone, Guaifenesin (Musinex)

Antitussives:

Codeine, Hydrocodone, Guaifenesin (Musinex), Dextromethorphan, Benzonatate, Diphenhydramine

Right Assessment

Collect appropriate baseline data before, during, and after drug administration - This is done to ensure the med has its desired eect and that the patient does not experience any adverse eects

What is the use of an Expectorants?

Common Cold

What is the role of antihistamine mediations?

Competes with histamine for receptor sites and prevents a histamine response by blocking the H1 receptor sites, nasopharyngeal secretions and itching sneezing decrease.

What are excess doses of zinc

Copper deficiency, Decrease in HDL cholesterol (decrease good cholesterol), Weakened immune system, & Loss of taste and smell

Isotonic

Corrects dehydration and sodium

2 examples of cromolyn

Cromolyn Sodium, Nedocromil

A nurse is preparing to administer digoxin to a client who states," I don't want to take that medication. I do not want one more pill." Which of the following responses should the nurse make? A.) "Your doctor prescribed it to you, so you should really take it." B.) "Well, let's just get it over with then" C.) "Okay, I'll just give you your other medications." D.) "Tell me your concerns about this med"

D

Before administering diphenhydramine to a patient, it is most important for the nurse to assess the patient for a history of A.allergy to penicillin. B.hypertension. C.diabetes mellitus type 2. D.narrow-angle glaucoma.

D

Personalized medicine takes into account the patient's A.)pharmacogenetic profile B.) lifestyle choices C.) enviromental factors D.) All of the above

D

The nurse describing to a patient the synergistic effects of two of his meds. Which statments by the nurse is correct about synergistic drugs effects? A.) Two drugs have antagonistic effects on each other B.) The action of drugs are nullified by another drug C.) One drug acts as an anidote to the side effects of another drugs D.) A greater effect is achieved when two drugs are combined

D

The nurse is reviewing a patients lab test results and current medications and notes that the patient's prothrombin time is prolonged. The nurse checks the patients medications list. What vitamin/mineral might be contributng to this? A.) VIT A B.) VIT C C.) VIT D D.) VIT E

D

The research nurse is meeting with a patient and determines based on the assessment, that the patient meets inclusion criteria for clinical research. The patient agrees to participate in the clinical trial. The nurse advises the patient that which member of the health care team has the responsibility to explain the study and respond to questions? A.) RN B.) Pharmicist C.) research associate D.) health care provider

D

What class of drug is clopidogrel? A.) low molecular weight herapin B.) Vit K antagonist C.) direct thrombin inhibitor D.) inhibitor of PLT aggregation

D

What are the clinical applications of pharmacogenetics SATA A.) Improve patient quality B.) customize patient POC C.) Decrease adverse effects on drug therapy D.) decrease tx failures E.) reduce cost

D, ABC

Hypertonic examples

D5NSD10W3% and 5% NaCl

Beta2 receptors

Decreases GI tone and motility Bronchodilation, Increases blood flow in skeletal muscles, Relaxes smooth muscles of uterus, Activates liver glycogenolysis Increases blood glucose

Right Evaluation

Determine drug eectiveness and determine side/adverse eects - This is done to see if the medication works properly for the patient's particular issue

What are 3 examples of non opioid antitussives?

Dextromethorphan, Benzonatate, Diphenhydramine

6 examples of antihistamines

Diphenhydramine (Benadryl), Alkylamine, Chlorpheniramine, Cetirizine, Loratadine, Fexofenadine

What are side effects of bronchodilators?

Dizziness, nervousness, tremors, hypertension, palpitations, tachycardia, dysrhythmias, & angina

What are contradictions of a Expectorants?

Do NOT use with patients who have COPD because it causes drowsiness. You can give a COPD patient a non opioid instead. Also, make sure to tell the patient to increase their fluids to at least 8 glasses of water a day or more

What are side effects of antitussives?

Drowsiness, dizziness, headache, blurred vision, upset stomach, nausea, constipation, or dry mouth/nose/throat may occur.

What are the side effects of an Expectorants?

Drowsiness, dizziness, irritability, & nausea (especially Guaifenesin since it's an opioid)

What are side effects of intranasal glucocorticoids?

Drowsiness, dizziness, nervousness, or GI distress

Synergistic

Effect is much greater when combined - One potentiates the other - One med acts on the other med

Evaluation

Evaluate if: Goals were met, Teaching objectives were met, and Need for follow up - See if medications were eective - Refer to community resources - Document successful goal attainment

hypotonic examples

Examples: 0.45% NaCl 0.33% NaCl 0.225% NaCl

Vitamin C

Excess Doses can cause: GI upset, Headache, Decreased effect oral anticoagulants, Crystalluria if taken with aspirin or sulfonamides

Vitamin A

Excess Doses can cause: Teratogenic effect, Thrombocytopenia, Hypervitaminosis A [hair loss, peeling skin, GI upset, lethargy]

2 examples of

Expectorants

Prioritize the steps of the nursing process. a. Planning b. Problem (diagnosis) c. Assessment d. Evaluation e. Implementation f. Concept

F,C,B,A,E,D

high vitamin E causes

Fatigue, weakness, GI upset, Headaches, breast tenderness, bleeding

Hypertonic Fluids

Fluids from the cells are being pulled into the intravascular space - Water moves out of the cell and into the solution - Cell Shrinks

copper function

Formation of RBC's and Connective tissue

excess vitamin C

GI upset / irritation, headache, Crystalluria if taken with aspirin or sulfonamidesDecreased effect oral anticoagulants - Water soluble → Give daily

Assessment

Gathers subjective [things we have to ask about] and objective [things we can see] data - Subjective Data: Asking patient about attitudes and values should be considered when planning interventions - Objective Data: provides additional information about the patients symptoms and also targets the organs most likely to be aected by drug therapy

What can nonopioid antitussives do?

Good for COPD Patients because they do not cause drowsiness

What is the action of Expectorants?

Loosens bronchial secretions (TOP OF LUNG) by reducing surface tension of secretions Allows elimination by coughing

Trough

Lowest concentration in blood

Cinnamon (Plant):

May decrease blood clotting (could increase bleeding) Garlic: Side effects may include heartburn, upset stomach, body odor, decreased blood clotting (more prone to bleeding), hypotension

What is the rule of thumb for vitamin K

Have the patient stop taking it 2-3 days BEFORE surgery and have them not take it again until about 2-3 weeks AFTER surgery because you don't want them to have a clotting issue while they are not moving around much / healing

causes of FVE

Heart or Renal Failure, Cirrhosis, Adrenal Gland Disorders, Corticosteroids, Stress Conditions, Excess Sodium Intake, Medication Side Eects

function of chromium

Helps to normalize Blood Sugar, Decrease insulin resistance, can cause hypoglycemia if there is too much

concept

Helps us gain understanding of what the patient's needs are and helps guide us through the problem

Peak

Highest concentration of medication in the blood

What are excess doses in vitamin D

Hypervitaminosis D, hypercalcemia, anorexia, nausea and vomiting - Will usually follow Calcium

excess doses of chromium

Hypoglycemia if concurrent hypoglycemic or insulin

Hypernatremia

Hypotonic solution, D5W, do we need to dilute or move sodium out, encourage fluids

Why do we have so many side effects from antihistamines?

IT IS BECAUSE OF RECEPTORS. WHEN YOU BLOCK THOSE HISTAMINE RECEPTORS, YOU HAVE H1, H2, H3, AND H4. THEY ARE INSELECTIVE AND Identify the action, use and contraindications/ cautions and side effects of the following categories of meds and be able to give examples of each: Antihistamines: BLOCK MANY THINGS THROUGHOUT THE BODY CAUSING MANY SIDE EFFECTS THROUGHOUT THE BODY. THE SECOND GENERATION ALLOWS US TO BE MORE SELECTIVE SO WE DON'T HAVE AS MANY SIDE EFFECTS. THEY ARE ALSO NOT AS SELECTIVE AS WE WISH THEY WOULD BE BECAUSE THEY BLOCK ACETYLCHOLINE RECEPTORS TOO. AGONIST - TURNING ON AND ANTAGONIST - TURNING THEM OFF.

Hypermagnesemia interventions

IV calcium gluconate or loop diuretic - Teach pt about OTC medications with mgSO4 - May need mechanical ventilation - May use laxative

Nursing Interventions [Implementation]

Includes: Education, Drug Administration, Monitoring for side/adverse effects - Interventions should be for established goals

What is the action of bronchodilators?

Increases cAMP in lung tissue causing bronchodilation, restores circulation and increases airway patency, & opening narrowed airways

Beta1 receptors

Increases cardiac contractility, heart rate Increases renin secretion and increases BP

Alpha1 receptors

Increases cardiac contractility, vasoconstriction, Dilates pupils, decreases salivary gland secretion Increases bladder and prostate contraction

Alpha2 receptors

Inhibits norepinephrine release •Promotes vasodilation and decreased BP Decreases GI motility and tone

FVD causes

Injury, Inammation, Burns, Sepsis, Cancer, Intestinal Obstruction, Malnutrition, Liver dysfunction, High Vascular Hydrostatic Pressure

Jejunostomy Tube

Inserted through a small surgical incision in the abdominal wall directly into the jejunum - Used for long-term nutrition, who require feeding into the small intestine

Nasogastric Tube

Inserted through one of the nostrils, down the nasopharynx and the esophagus, and into the stomach - Used for short-term feeding in patients who have intact gag and cough refexes, and adequate gastric emptying

Treatment: for FVE

Intake and Output, Daily Weights, Assess Lung Sounds, Monitor Response to Treatment, Encourage Rest, Semi Fowler's, Diuretics, Check Renal and Liver Function, Assess Mental Status, Skin Care and Positioning

What are examples of Bronchodilators: Anticholinergics?

Ipratropium bromide, Tiotropium

Isotonic examples

Lactated Ringers0.9% Sodium Chloride (NaCl) 5% Dextrose in water

food sources of B12

Liver, kidneys, fish, eggs

What are food sources of selenium

Liver, seafood, eggs, dairy products

food sources of chromium

Meat, Whole-grain cereals, Brewer's yeast

Airflow Disorders medication uses

Medication management usually addresses both inflammation and bronchoconstriction. These same medications used to treat Asthma can also be used to treat the manifestations of chronic obstructive pulmonary disease (COPD).

Hyperkalemia interventions

Monitor EKG, give kayexalate (PO) which pulls K from bowel and excreted, dialysis possibly

FVD tx

Monitor Labs, Daily Weights, Administer and Monitor intake of oral uids, Assess vital signs, Administer IV uids

for parenteral feedings

Monitor for fluid overload since it is going through the bloodstream → JVD, hypertension, pulmonary edema. Also, monitor blood sugars because feeding has a lot of dextrose (hypo or hyperglycemia). Then, if you stop the feeding too quickly, the pt could have hypoglycemia since the dextrose is no longer running - but still have insulin. You can hang a bag of D5/D10 until the insulin is out of the body and the blood sugars stablizine - take them every 15 min

How do you administer zinc

Nasally, Oral- Wait at least 2 hours after antibiotic administration.

What are side effects of nasal decongestions?

Nervous, restless, Rebound nasal congestion if use is prolonged

low B6

Neuritis, seizure, anemia, depression, confusion, seborrheic dermatitis

What are the contradictions of antihistamines

Never give to a patient with a history of glaucoma! Also, be careful to tell the patient to not drive or operate heavy machinery while taking the medication because it causes drowsiness

What are the contradictions of intranasal glucocorticoids?

Never stop the medication abruptly → always taper off the medication slowly

What are defects in low vitamine A

Night blindness, skin lesions, dysfunction of mucous membranes

What are food sources of vitamin E

Nuts, Oils

What are contradictions of antitussives?

Patent airways, patients who need to cough to maintain the airways (e.g., postoperative patients and those who have undergone abdominal or thoracic surgery) to avoid respiratory distress, asthma and emphysema, addiction, sedation, & pregnancy.

low B3

Pellagra, headache, memory loss, GI upset

Rate of Availability Continuum for Medications

Pills→Oral→Transdermal→Subcutaneous→Intramuscular→IV [Slowest to Fastest]

Gastrostomy Tube

Plastic tube inserted directly into the stomach through an incision in the abdomen.- Used for clients who are on NPO for an extended period, bypass obstruction, drainage, and gastric decompression

low B1

Polyneuritis, cardiac pathology, Wernicke-Korsakoff syndrome, neurologic disorders, ataxia, diplopia

low of vitamin C

Poor wound healing, bleeding gums, scurvy - rashes and sores on body from lack of Vit C, faulty bone and tooth development

We do follow these rights in order to:

Protect the nurse and the patient - To prevent death and promote safe medication administration since we are the nal link before the patient takes the medication

What happens in hypotonic solutions

Pulls from the intravascular cells and sends to interstitial space - Fluids moves into the cell [Cell swells] - Used when the cell is dehydrated and fluids need to be put back intracellularly - Water moves into the cell causing plant cells to swell and animal cells to swell and burst

Function of B12

RBC formation

Right Drug

Read the label 3 times and scan the medicationKnow why the patient is receiving this medication - This is done to ensure the patient is getting the correct medication prescribed by the HCP

Right Documentation

Record drug administration and its eectiveness immediately - This is done to ensure the right med was given to the right patient, at the right time

What is the function of vitamin D?

Regulating calcium and phosphorus metabolism

What is the action of aminophylline, theophylline

Relaxes smooth muscle of bronchi and bronchioles promoting bronchodilation

hypokalemia interventions

Replace K with pills or liquid, no IV push - Monitor EKG, ABG's, diet K+, watch IV site

Hypomagnesemia interventions

Replace with dietary, oral, MgSO4 IV, monitor IV site, monitor calcium for hypo

What are defects in low vitamin D?

Rickets in children and osteomalacia in adults, soft weak bones

What are the 10 Rights of Medication Administration

Right patient (Patient Identifiers → ID Band, name, birthdate) Right drug Right route Right dose Right time (Given when prescribed - sometimes you may need to hold meds if there is a procedure, do nursing process first to determine if patient is ready for it with vitals too / other assessments) Right documentation (Document how patient tolerated, BP before and after, etc.) Right assessment Patients right to education Right evaluation Patients right to refuse

We do not prescribe Methylxanthines TO PATIENTS WITH

SEIZURES, RENAL FAILURE PTS, OR CARDIAC PATIENTS!!"

For asthmatic young kids make sure to

See more maintenence, get them stable!!!! See them take a series of glucocorticoids only if they have a flare up of symptoms for 7-10 days! then wean them off

food sources of copper

Shellfish, liver, nuts

Hawthorn (Berry)

Side effects include headache, dizziness, nausea.

low B2

Sore throat, cheilosis, skin cracks at corners of mouth

What is the action of a nasal decongestion? (pseudo/ OS)

Stimulate alpha-adrenergic receptors (TURNING ON - AGONIST- TO HELP CONSTRICT BLOOD VESSELS TO DECREASE CONGESTION / SECRETIONS), Produces nasal vascular constriction, Shrinks nasal mucous membranes, Reduces nasal secretion

Additive

Sum effects of two days drugs, two drugs work better together for good effect - Don't work so well alone, but work better together

What are food sources of vitamin D?

Sunshine, added in our milk

What is the use of antitussives?

Suppresses coughing

What is the function of vitamin K?

Synthesis of prothrombin and clotting factors VII, IX, X

When should we draw a trough?

Take lab draw right before the next dos

Right Education

Teach patient accurate and complete drug information includingWhy they are taking this med, how it is benecial, how it works, and give them the right to refuse - This is done to give patient choice to whether they want to take the medication or not

What are defects in high vitamin A?

Teratogenic effect, thrombocytopenia, hypervitaminosis A (hair loss , peeling skin, GI upset, lethargy)

Half Life: t 1⁄2

The amount of time that it takes for the amount of drug in the body to be reduced by half- Can help decide timing for medication: Q6, Q8, etc.- Amount of drug administered, Amount Remaining, Metabolism, and Elimination all aect half life- Dysfunction in the liver or kidney would extend the half life

Right to Refuse

The patient has the refuse the medicationExplain the benets and risks involved and if patient refuses document and follow up - This is done to give patients the opportunity of choice

function of zinc

Tissue growth and repair, wound healing, taste and smell

Peppermint

To sooth GI problems

Hypercalcemia interventions

Treat underlying cause, volume expansion and isotonic saline diuresis - Hypertonic solutions to pull from other tissues then hypotonic to flush out of body - Loop diuretics, sodium phosphate (these help clear calcium) - Provide fluids with Na, increase fiber due to constipation

How do you use antihistamines?

Treats runny nose / help dry secretions / primarily used to treat rhinitis

Antimicrobial

Trimethoprim-sulfamethoxazole

chamomile (Leaves, Seeds, Flowers)

Used for anxiety, sooth GI; Side effects include mild allergic reactions, to anaphylaxis → can cause sedation (so be careful / check order with doctor if a sedation prescription was also prescribed → don't want to double dip a patient with herbal and prescription)

Ginkgo biloba (leaves, berry)

Used for improved memory and to treat poor circulation; Side effects include headache, dizziness, nausea, GI upset, increased bleeding, allergic reactions.

Ginger (Root):

Used for motion sickness and GI upset; Side effects may include gas, bloating, heartburn, nausea.

What is the purpose in drawing peak and trough?

Used for therapeutic drug monitoring [change dosage, frequency] ● We use peak and trough to make sure we are dosing right and giving the drug in a timely manner

Nursing Diagnosis [Patient Problems]

Used to diagnose patient problems in nursing terms - Knowledge decit and potential for injury are the most common nursing diagnoses in pharmacology

Isotonic Fluids

Used to increase the extracellular uid volume due to blood loss, surgery, dehydration, and uid loss - Water moves across the membrane in both directions maintaining cell size - Fluids stay in veins and arteries [Cell remains the same]

Side effects of antihistamines

Usually cause drowsiness, dry mouth, dizziness, fatigue, blurred vision, disturbed coordination, urine retention!!! SO check their urinary output

Right Dose

Verify dose calculation and verify drug is safe for patient - Done to ensure the patient is getting a dose that is not within dangerous range

Right Patient

Verify the patient with two forms of identication - This helps ensure we are giving the correct medication to the correct patient

Hyperphosphatemia

Vitamin D - Calcium binding antacids - Phosphate binding meds - Possibly dialysis, loop diuretics

Water Soluble Vitamins

Vitamins B Complex - Vitamin C - Can wash out of our body: not maintaining good therapeutic lev

Vitamin K can block the effects of

WARFARIN → so we ask patients to not eat green leafy veggies"

Hyponatremia

Water restriction, sodium replacement

What does an excess dose of selenium mean?

Weakness, GI upset, Garlic-like odor from skin and breath, Hair loss, dermatitis

FVD s/s

Weight Loss, Thirst, Concentrated Urine, Low Urine Volume, Dry Skin and Decreased Turgor, Sunken Eyeballs, Sunken or Depressed Fontanels, Hypotension, Decreased Cardiac Output, Tachypnea, Low Grade Fever, Mental Status Changes, Acute Weight Loss

high copper

Wilson's disease (Genetic)- Copper accumulates, possibly to a life-threatening level.- Symptoms typically begin between the ages of 12 and 23 (kills many children and don't live with it long term) → organ failure- Symptoms include swelling, fatigue, abdominal pain, and uncontrolled or poorly coordinated movements organ failure.

What are 3 examples of Leukotriene Receptor Antagonists Synthesis Inhibitors?

Zafirlukast, Montelukast, Zileuton

A nurse is teaching a client who has a prescription for long term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following s/s as an adverse effect of this medication A.) weight gain B.)nervousness C.)bradycardia D.) constipation

a

A patient comes to the office with a chief complaint of hair loss and peeling skin. The nurse notes many vitamins and minerals are on the med list. The patient reports using vitamins to treat liver disease. The patient's complaint may be caused by an excess of which vitamin or mineral? A.) Vit A B.) zinc C.) VIT c D.) VITd

a

The nurse is doing preconception counseling with a patient. The patient asks why she must take folic acid during pregnancy. What is the nurse's response? A.)prevents neural tube defects to the fetus B.)lowers blood glucose C.)prevents celiac disease D.)prevnts migraines

a

A patient is receiving fluid replacement. The nurse's health teaching with this patient includes which suggestions? SATA A.) Measure pt weight every morning B.) know that the thrist means mild fluid deficit c.) avoid calcium and chloride supplements D.) review the pt electrolyte labs for changes

a,b,c,e

A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhintiitis. The nurse should instruct the client to monitor for which of the following s/s as an adverse effect of this medication? SATA A.)dry mouth b.)nonproductive cough C.)skin rash d.)drowsiness e.)urinary hesitation

a,d,e

What are bronchodilators?

albuterol, ephedrine, Epinephrine (Agonist)

Vitamin B complex is gievn to

alcoholics; aka banana bag

Name two examples of Bronchodilators: Methylxanthines

aminophylline, theophylline

inc can interact with a lot of

antibiotics and they should come off the Zinc before taking the meds"

A nurse is caring for a client experiencing IV extravasation. The faculty requires the administration of an antidote for the prescribed IV solution. After stopping the IV infusion, which of the following actions should the nurse take? A.)Remove the IV catheter B.) Withdraw solution from IV access C.) Administer the antidote to the vesicant D.) Insert a new IV access in a different extremity

b

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following s/s as an adverse effect? A.)sedation b.)nasal congestion c.)productive cough d.) constipation

b

A nurse is caring for a client who is recieving IV potassium. The nurse should monitor the client for which of the following manifestations of hyperkalemia? A.) tachycardia B.) dyspnea C.) lethargy d.) increased thirst

b

A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago they developed a rash, Which of the following actions should the nurse take? A.) Administer the dose B.) Withhold med C.) Ask the provider to change the prescription to oral form D.) Administer an oral histamine at the same time

b

A nurse is providing instructions to a client who has a new prescription for albuterol and betaclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching A.) take the albuterol at the same time each day b.) administer the albuterol inhaler prior to the use of betaclomethasone inhaler c.) Use beclomethasone if experiencing an acute episode d.) Avoid shaking the beclomethasone before use

b

A nurse is providing instructions to a client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse indicate? A.) You can take this medication to abort acute asthma attack B.)tremors are an adverse effect of this medication C.) prolonged use of this medication can cause hyperglycemia d.) this medication can slow skeletal growth rate.

b

A nurse is teaching a client about the use of fluticasone to treat perennial rhinitis. Which of the following statements by the client indicates understanding of the teaching? A.)I should use the spray every 4 hours while I am awake. b.)It can take as long as 3 weeks before the medication takes a maximum effect c.) this medication can also be used to treat motion sickness d.) I can use this medication when my nasal passages are blocked

b

A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcystanine. Which of the following information should the nurse include in the instructions? A.)expect this medication to suppress your childs cough B.)expect this medication to smell like rotten eggs C.) expect this medication to cause euphoria d.) expect this medication to turn your childs urine orange

b

A patient complains of night blindness. The nurse correctly recommends which foods? A.) skim milk and peas b.) fortified milk and eggs c.) nuts and yeast d.) enriched breads and cereals

b

A patient gained 4.4 (2 kg) pounds and has been determined that the weight gain is caused by fluid retention. The nurse correctly estimates that the weight gain may be equivalent to approximately how much fluid? A.) 1L B.) 2L C.) 6L D.) 8L

b

A patient tates iron on a daily basis. which comment from the patient suggests the need for health teaching r/t iron? A.) i will swallow the tablet whole b.) I will take the tablet before bed c.) some multivitamins might include iron d.) I will keep this vitamin without child's reach

b

A patient with chronic obstruction pulmonary disease has an acute bronchospasm. The nurse anticipates that the HCP will prescribe which medication? A.)zafirlukast b.)epinephrine C.)dexamethasone d.)beclomethasone

b

A pt diagnosed with alcoholism has questions about his meds. The nurse correctly explains that alcoholism can be associated with defeciency of which vitamins? A.) A (beta carotone) b.) B (b complex) c.) D (ergocalcified) d.) K (phytonadione)

b

Codeine is an examples of______ as the cytochrome P450 system metabolizes the drug to facilitate receptor affinity A.) agonist B.) prodrug C.) antagonist D.) enzyme

b

During a medication review session, a patient states, "I do not know why I am taking all these pills." Based on the piece of subjective data, which is the problem the nurse will identify? A.) pain B.) knowledge C.) fatigue D.) anxiety

b

The nurse is preparing class for patients with asthma. The nurse will inform the patients that leukotriene modifiers are used in the treatment of asthma to A.assist in opening narrowed airways. B.suppress the release of histamine and other mediators from the mast cells. C.loosen mucus from the airways. D.prevent serious complications from bacterial infections.

b

The nurse is to administer enteral medications to a patient who can not swallow and is recieving continuos use enteral feedings. Which is correct concerning administration of EN meds? A.) All ordered meds are added to enteral feeding solution. B.) dilute liquid meds before administering through feeding tube C.) extra amounts of water are used to dissolve time released meds D.) undiluted hyperosmolar meds may be given to pt on fluid restriction

b

The nurse routinely includes health teaching about vitamins to clients/ vitamin D has a major role in which process? a. Ensuring night and color vision b. Regulating calcium and phosphorous metabolism c. Body growth d. DNA and prothrombin synthesis

b

When developing an effective medication teaching plan, which component will the nurse identify as MOST essential? A.) Written instructions b.) the patient's readiness to learn C.) Use of colorful charts d.) A review of community resources

b

Which statement about benzonatate does the nurse identify as being true? A.It is an opioid antitussive. B.It suppresses the cough center of the medulla. C.It suppresses respirations. It causes physical dependence.

b

A nurse is preparing to administer medications to a 4 month old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client SATA A.) Infants have a more rapid gastric emptying time b). infants have immature liver function C.) infants have blood brain barrier is poorly developed d.) Infants have an increased ability t absorb topical medications

b,c,d

Name the 4 categories of enteral formulas? SATA A.) enteral macronutrient b.) elemental/semi elemental c.) disease specific d.) polymeric formula e.) modular formula

b,c,d,e

A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy? A.)12 yo child with iron deficiency anemia B.) 24 yo female with no health problems C.) 44 yo male w/ hypertension D.) 55 yo female who has alcohol use disorder

b,d

Fluticasone Propionate and salmeterol combo inhalation is ordered for a patient with chronic obstruction pulmonary disease. What does the nurse know about the medication? SATA A.)it can be used to treat an acute attack b.)It is delivered as a dry powder inhaler c.)It contains beta 1 agonist and cromolyn d.)It is taken as one puff 2 times a day e.) It promotes bronchodilation

b,d,e

A nurse assessing a client who is receiving magnesium sulfate and notes the client has depressed deep tendon reflexes. The nurse should expect to administer which of the following medications? A.) Potassium chloride B.) folic acid C.) calcium gluconate D>)cyanocoblamin

c

A patient with chronic bronchitis is admitted to the health care facility for treatment of a bacterial respiratory infection. Which antimicrobial will most likely be ordered for the patient? A.Seldane B.Amphotericin B C.Acyclovir D.) Trimethoprim-sulfamethoxazole

d

A nurse is caring for a client who is taking oral oxycodone. the client is also taking ibuprofen in 3 recommended doses daily. The nurse should identify that an interaction between these two meds will cause which of the following findings? A.) A decrease in blood levels of ibuprofen possibly leading to a need for increased doses of this med B.) a decrease in blood levels of oxycodone possibly leading to the need for increased doses of this medication c.) An increase in the expected therapeutic effect of both medications D.) An increase in expected adverse effects for both medications

c

A nurse is reviewing a client's health record and notes that the client experienced premanant extrapyramidal effects based on the previous med. The nurse should recognize that the med affected which of the following systems in the client? A.) cardiovascular B.) Immune C.) Central nervous D.) gastrointestinal

c

A nurse is teaching a client who has a new prescription for dextromethorphan to suppress a cough. The nurse should instruct the client to monitor for which of the following s/s as an adverse effect of this medication A.)diahrea b.)anxiety c.)sedation d.) palpitations

c

A patient asks a nurse," what does copper do for me? I think it must be bad for me?" Whats the nurses' best response? A.) copper is needed for RBC formation b.) be sure to include nuts and seeds in your diet c.) why do you think copper is bad for you? d.) are you taking 5 mg of copper a day?

c

A patient is prscribed aminophylline-theophylline. for what adverse effect should the nurse monitor the patient A.)Drowsiness b.)Hypoglycemia C.)Increased HR d.) decreased WBC

c

A patient is receiving an expectorant. The nurse knows the drug is exerting its therapeutic effect when the patient experiences A.bronchodilation. B.decreased coughing. C.loosening of bronchial secretions. D.relief of nasal congestion.

c

A patient is reviewing intravenous aminophylline. the nurse checks the patient's lab values and sees the serum theophylline level is 32 mcg/mL What action should the nurse take? A.) Assess the patient's breath sounds for improvement b.)Increase the dosage per sliding scale directions c.)Notify the HCP of the level d.)have lab collect another sample to verify

c

A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the patient that rinsing the mouth is done to A.avoid mucous membrane breakdown. B.increase hydration of the oral mucosa. C.decrease risk of infection. slow the development of cavities.

c

A prenatal pt tells the nurse may cause damage to the fetus if she becomes pregnant just because it causes damage to the fetus. What is the nurse's best response? A.) vitamins are beneficial to mom and baby b.) take extra vitamins now to make up for missed doses C.) megadose of vitamins can be harmful in the first trimester D.) taking vitamin doses above RDA is not recommened

c

A pt asks the nurse for info about fat soluable vitamins. Whats the nurses best response? A.) fat soluables are metabolized rapidly b.) fat soluables cannot be stored in the liver c.) fat soluables are extreted slowly in urine d.) fat soluables can never be toxic

c

The clinical research nurse knows that only a small proportion of drugs survive the research and development process. An Appreciation of the process and associated costs grows when the nurse is aware that approximately one in how many potential drugs is approved by the US Food and Drug Administration? A.)100 B.)1,000 C.)10,000 D.)100,000

c

The nurse is determining a patient's gastric residual before administrating an enteral feeding; the last feeding was 24 mL. The patient will be discharged on enteral feedings. It is important to include in the teaching plan that a residual of more than which amount would indicate gastric emptying (based on the last feeding)? A.) 60 mL b.) 125 mL c.) 150 mL d.) 75 mL

c

The nurse is developing goals in collaboration with a patient. Which is the best goal statement? A.) The patient will self administer albuterol by taking a deep breath before inhaling B.) The patient will self administer albuteral by the end of the second teaching session. C.) The patient will independently self administer the prescribed dose of albuterol by the end of the second teaching session. D.) The patient will organize his or her medications according to the time each medication is due .

c

The nurse is reviewing the plan of care for a patient recieving enteral therapy. What is the most common complication of enteral therapy? A.) aspiration b.)constipation C.)Diahrea d.) muscle weakness

c

The nurse knows that the patient should be informed about the risks and benefits related to clinical research. What ethical principle does that describe? A.) respect for persons B.) justice C.) beneficence D.) informed consent

c

Which medication is a first-generation antihistamine? A.Cetirizine B.Fexofenadine C.Diphenhydramine D.Loratadine

c

a nurse in a providers office is reviewing the medical record of a client who is pregnant and at the first prenatal visit. Which of the following immunizations can the nurse administer safely to this client? A.) varicella vaccine B.) Rubella vaccine C.) Inactivated influenza vaccine d.) measeles vaccine

c

Echinacea

stimulates immune system

What are asthmatic considerations for older audlts?

careful consideration of drug selections/dosages d/t adverse effects (think of liver, kidneys, lungs...)

What are drug therapies for young children?

cromolyn, oral glucocorticoids

A nurse is providing discharge instructions for a client who has a new prescription for an antihypertensive med. Which of the following statements should the nurse take? A.)" be sure to limit your potassium intake while taking this med" b.)" You should check your BP q8h while on this med" c.)"Your med dosage will be increased if you develop tachycardia" d.)"Change positions slowly when you move from sitting to standing'

d

A patient complains of anorexia, n/v. the patient's list of meds includes multiple large doses of vitamins. the nurse notes that pt complains may be r/t early signs of toxicity of which vitamin? A.) A b.) b c.) c d.)d

d

A patient has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat this patient? A.Antihistamines B.Antitussives C.Expectorants Antibiotics

d

A patient with chronic obstructive pulmonary disease asks the nurse what the albuterol he is taking does. The nurse should inform the patient that albuterol is used to • A.mobilize respiratory secretions. B.decrease the cough response. C.increase the work of breathing. D.dilate the larger airways.

d

The HCP orders hypertonic crystalloid IV solution for 70 year patient. Which solution will the nurse hang? A.) LR B.) 0.45% NACL C.) 0.9 % NACL D.)5% dextrose in 0.9% NaCL

d

If peak is too ↓:

dose is too low and needs to be increased

hypocalcemia Interventions

drug therapy, nutrition therapy, preventing injury, seizure precautions, reducing environmental stimuli to avoid overstimulation

Sympathomimetics

epinephrine and ephedrine

Pharmacogenetic testing is appropriote for everyone True or false

false

If trough is too ↓:

give dose later In order for the body to not metabolize and excrete the med so fast

If trough is too ↑:

give dose sooner, In order for the body to have enough time to metabolize and excrete med

Milk Thistle

good for regulating cholesterol and blood sugars; can cause hypoglycemia

What are food sources of vitamin K

green leafy vegetables

If you need to replace calcium...

it is a DAILY replacement and combine it with Vitamin D for better absorption

COPD patients diet

less carbs, higher protein, more complex carbs, less simple carbs

How is chronic asthma controlled?

long term medication program or quick relief program for an acute phase

If you have high calcium levels...

lush it out of the body with dialysis / diuretics → It is water soluble

B3

nicotinic acid or niacin (yeast, meat, poultry)

Planning Goals Should Be

patient centered, realistic, measurable, identify components for evaluation, acceptable to the patient and nurse, dependent on patient's decision making ability, and shared with other HCPs, family, and caregiver

FVE s/s

peripheral Edema, High CVP, Pulmonary Edema, Acute Rapid Weight Gain, Altered Urine Output/Concentration, Distended Neck Veins, Crackles, Tachycardia. Increased Weight, Shortness of Breath/Wheezing

Antagonist

prevent receptor activation Turns O - Block Response, One drugs blocks or reduces the effect of the other

B6

pyridoxine (wide variety of foods)

Water-soluble vitamins dissolve in water, which means these vitamins and nutrients dissolve

quickly in the body. Unlike fat-soluble vitamins, water-soluble vitamins are carried to the body's tissues, but the body cannot store them. Any excess amounts of water-soluble vitamins simply pass through the body

B2

riboflavin (milk, bread, almonds)

If they are not taking in more than 1⁄2 of the feeding, then you should

slow down the feeding. Always replace residual

Licorice

sore throat, bronchitis; Side effects: food retention, hypertension

What does a defect in low vitamin K do

spontaneous hemorrhage

What are nursing implications, including patient teaching, related to herbal products?

tell doctor if switch from prescription to herbal products, tell patient about good food sources for nutrition, foods that might interact with medications/herbs, side effects, evaluate perceived effectiveness

f peak is too ↑:

the dose is too high and needs to be reduced

What is cromolyn used for?

treats inflammatory effects of asthma

What are oral glucocorticoids used for?

treats moderate to severe asthmatic states

Vitamin B deficiency is uncommon

unless there is a disturbance of the intrinsic factor and intestinal absorption

Fat Soluble Vitamins

vitamin A - Vitamin D - Vitamin E - Vitamin K - Can see toxicity: because not leaving our body

What is the therapeutic range for aminophylline, theophylline (Methylxanthines)

Ø5-15 mcg/mL ØToxicity greater than 20

What is the use of Metaproterenol (Long Acting)

ØAcute bronchospasm, asthma, COPD

Beclomethasone, Prednisone action

ØAntiinflammatory effect

What is the use of aminophylline, theophylline

ØAsthma

What is the use of Albuterol, Formoterol, Levalbuterol (Quick Acting)

ØAsthma, bronchospasm, Bronchospasm prophylaxis ØFormoterol- prophylaxis of exercise induced bronchospasms

What is the use of Cromolyn Sodium, Nedocromil

ØBronchial asthma prophylaxis ØTaken daily

2 types of medications for airflow disorders are

ØBronchodilator agents: and ØAnti‑inflammatory agents:

Common side effects of Cromolyn Sodium, Nedocromil

ØCough, bad taste

What are common side effects of Zafirlukast, Montelukast, Zileuton?

ØDizziness, headache, confusion ØGI distress, depression, weakness, infection

side effects of Beclomethasone, Prednisone

ØDry mouth, throat irritation, hoarseness ØHeadache, euphoria, confusion, depression ØHyperglycemia, GI distress, hypertension ØElectrolyte imbalance, fluid retention ØOsteoporosis, psychosis, superinfections

What are side effects of Albuterol, Formoterol, Levalbuterol (Quick Acting)

ØHeadache, rhinitis, excitability, tremors, palpitations, tachycardia

What are the side effects of Metaproterenol (Long Acting)

ØHeadache, tremor, nausea, palpitations, tachycardia

Beclomethasone, Prednisone administration

ØMDI inhaler, tablet, intravenous

What is the action of Cromolyn Sodium, Nedocromil

ØMast cell stabilizer ØInhibits histamine release preventing asthmatic attacks

What do you use Zafirlukast, Montelukast, Zileuton for?

ØNot for treatment of acute asthmatic attacks ØMaintenance therapy for chronic asthma ØUsed for Prophylaxis of exercise-induced bronchospasm

What are adverse effects of Cromolyn Sodium, Nedocromil

ØRebound bronchospasm ØDo not stop Abruptly

What is the action of Zafirlukast, Montelukast, Zileuton?

ØReduce inflammatory process and ØDecrease bronchoconstriction

Albuterol, Formoterol, Levalbuterol (Quick Acting)

ØSelect Beta-2 Agonist ØCauses bronchodilation ØRapid onset of action ØLonger duration of action ØFew side effects

Metaproterenol (Long Acting)

ØSelect Beta-2 Agonist ØInhalation administration preferred for long-term asthma treatment ØAllow 2 minutes between MDI inhalations

administration of Acetylcysteine

•Administer by nebulizer 5 minutes after a bronchodilator •Should not be mixed with other drugs

ØBronchodilator agents:

•Beta2‑adrenergic agonists: Albuterol •Methylxanthines: Theophylline •Inhaled anticholinergics: Ipratropium

Dornase alfa

•Digests DNA in thick sputum secretions of patients with cystic fibrosis

What are common side effects of Ipratropium bromide, Tiotropium?

•Dry mouth, constipation, abdominal pain •Depression, insomnia, headache •Pharyngitis, sinusitis, infection •Arthralgia, peripheral edema

ØAnti‑inflammatory agents:

•Glucocorticoids: Beclomethasone, prednisone •Leukotriene modifiers: Montelukast & Zileuton

Acetylcysteine action

•Liquefies and loosens thick mucus secretions

What is the use of Ipratropium bromide, Tiotropium?

•Maintenance treatment of bronchospasms associated with COPD •Dilating the Bronchioles Administered by inhalation only with the HandiHaler device (dry-powder capsule inhaler)

Trimethoprim-sulfamethoxazole uses

•Mild to moderate acute exacerbations of chronic bronchitis from infectious causes

What are side effects of Dornase alfa

•Sore throat, laryngitis, hoarseness, chest pain

side effects of Acetylcysteine

•Stomatitis, rhinorrhea •Nausea, vomiting

What is the use of Dornase alfa

•Treatment of patients with Cystic Fibrosis