Exam 4 Pharm Spring 2019 Review

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? a. "You won't see effects for at least 1 week." b. "Limit use of this spray to 3 to 5 days." c. "Continue the spray until nasal stuffiness has resolved." d. "Avoid use of this spray if a fever develops."

"Limit use of this spray to 3 to 5 days." Frequent, long-term, or excessive use of nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.

What is a Stimulant

-Drugs that stimulate a specific area of the brain or spinal cord -Also known as Sympathomimetic drugs

Herbal products: Omega-3 Fatty Acids

-used to reduce cholesterol -adverse effects: rash, belching, allergic rxn

what is the normal range of amylase

0-130 UL

A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug? a. Dizziness b. Diarrhea c. Dry mouth d. Blurred vision

ANS: B Diarrhea is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs

When administering a neuromuscular blocking drug such as pancuronium (Pavulon), the nurse needs to remember which principle? a. It is used instead of general anesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anesthetics. d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles

ANS: D Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery

Laxatives: Adverse Effects - Hyperosmotic

Abdominal bloating Electrolyte imbalances Rectal irritation

Albumin 5%, 25%

Albuked, Albuminar, Albutein, AlbuRx, Flexbumin

Aminocaproic acid (Amicar)

Antifibrinolytic drug used to prevent and control excessive bleeding. Route by oral or IV

electrolytes in plasma

Cations (Sodium, Potassium, Calcium) and anions (Chloride, Phosphate, Sulfate)

What is an example of an intranasal steroid?

Fluticasone (Flonase)

Laxatives: Mechanism of Action - Bulk forming

High fiber Absorb water to increase bulk Distend bowel to initiate reflex bowel activity Examples: psyllium (Metamucil) methylcellulose (Citrucel)

What is the primary thiazide diuretic used?

Hydro-diuril (hydrocholorthiazide) ...you re'zide' in the 'hydro' (reside in the water)

Hydro-diuril and the ceiling effect...

Hydro-diuril has a ceiling effect d/t daily doses. As frequency of doses increase, the body adapts and no improvement occurs with increased doses. The ceiling effect can result in toxicity.

What are calcium deficiency disorders?

Infantile rickets osteomalacia osteoporosis muscle cramps

_________ is the number one killer in the United States today.

Ischemic heart disease

What type of drug is nitroglycerin?

Nitrate

Serotonin Blockers- ondansetron (Zofran) interactions

No significant drug interactions are known to occur

What is the most common manifestation of untreated B12 (cyanocobalamin) deficiency?

Pernicious anemia

Hemostatic

Referring to any procedure, device, or substance that arrests the flow of blood

What should patients immediately report while on immunosuppressors?

Signs of infection

Liotrix

Thyrolar Contains combination of T4 and T3 4:1 ratio

How is B3 (Niacin) synthesized?

Tryptophan

what are some parenteral anesthetics(general)?

etomidate, ketamine, methohexial, PROPOFOL, thiopental

What can cause hypomagnesemia?

malabsorption alcoholism long-term IV feedings diuretics metabolic disorders

Osmotic diuretics: electrolyte loss?

- Small electrolyte losses

Vitamin C

Ascorbic Acid

How is K2 synthesized in the body?

By the intestinal flora

What is the most commonly prescribed synthetic thyroid hormone?

Levothyroxine

Vitamin B2

Riboflavin

What is the newest, most often used antiluekotrine agent?

Singulair.

What is the function of Vitamin E?

Unknown Possibly antioxidant

What are signs of severe hypercalcemia?

cardiac irregularities delirium coma

Hyponatremia

deficient sodium in the blood

what are some signs and symptoms of benzodiazepine overdose?

somnolence, confusion, diminished reflexes, coma

Neuromuscular Blocking agents: Depolarizing drug- Succinylcholine

this drug can be used for patients/ to intubate in order to relax their muscles. Especially for fasciculation and muscle spasms

When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.) a. "Antihistamines are generally safe to take with over-the-counter medications." b. "Take the medication on an empty stomach to maximize absorption of the drug." c. "Take the medication with food to minimize gastrointestinal distress." d. "Drink extra fluids if possible." e. "Antihistamines may cause restlessness and disturbed sleep." f. "Avoid activities that require alertness until you know how adverse effects are tolerated."

"Take the medication with food to minimize gastrointestinal distress." "Drink extra fluids if possible." "Avoid activities that require alertness until you know how adverse effects are tolerated." Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.

A patient wants to switch brands of levothyroxine (Synthroid). What is the nurse's best response?

"You should check with your physician before switching brands."

Diseases of the respiratory tract include...

- Asthma - Emphysema - COPD

What conditions are osmotic diuretics good for?

- Good to prevent kidney damage in pts. with acute renal failure - Used to reduce increased intracranial pressure and cerebral edema d/t head injury or craniotomy - Given IV; use a filter

The stomach secretes:

- Hydrochloric acid, an acid that aids digestion and also serves as a barrier to infection • Bicarbonate, a base that is a natural mechanism to prevent hyperacidity • Pepsinogen, an enzymatic precursor to pepsin, an enzyme that digests dietary proteins • Intrinsic factor, a glycoprotein that facilitates gastric absorption of vitamin B12 • Mucus, which protects the stomach lining from both hydrochloric acid and digestive enzymes • Prostaglandins, which have a variety of antiinflammatory and protective functions

When would you NOT give an anticholinergic bronchodilator?

- If the pt. is allergic to peanuts, soy, and legumes. (Think: it is an anti-peanut drug!) - Anticholinergic bronchodilators contain soy lecithin.

Airway obstruction r/t...

- Inflammation that results in a narrowing of the interior airway - Muscle construction that results in a narrowing of the bronchus

Hydro-iuril when compared to loop diuretics (furosemide/lasix)

- Less effective than loop diuretics but more frequently prescribed d/t less incidence of SE

What is a benefit of traditional antihistamines?

- anticholinergic effects, making them more effective than nonsedating drugs in some cases

What are important subjects for patient teaching regarding antitussives?

- avoid driving or operating heavy equipment - encourage cough & DB exercises - report symptoms lasting longer than 1 week

The three different Types of Acid-Controlling Drugs

-Antacids -H2 antagonists - Proton pump inhibitors

Treatment of hyperthyroidism (Aimed at treating either the primary cause or the symptoms of the disease)

-Antithyroid drugs (methimazole and propylthiouracil) -iodides -ionic inhibitors -surgery -radioactive isotopes of iodine

What are the two classes of drugs for antilipemics??

-HMG-CoA reductase inhibitors (HMG's or statins) -niacin (nicotinic acid)

Antacids: Aluminum Salts

-Have constipating effects -Often used with magnesium to counteract constipation -Often recommended for patients with RENAL disease (more easily excreted) -Examples Aluminum carbonate: Basaljel Hydroxide salt: AlternaGEL Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel

Antacids: Sodium Bicarbonate RE

-Highly soluble -Buffers the acidic properties of HCl -Quick onset, but short duration -May cause metabolic alkalosis -Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency - RECOMMENDED FOR RENAL patients

What are drugs that are used for Narcolepsy?

-Modafinil (Provigil) -Armodafinil (Nuvigil)

H2 Antagonists: Adverse Effects

-Overall, very few adverse effects -Cimetidine may induce impotence and gynecomastia -all four H2s may increase the secretion of prolactin ( LTH) - Thrombocytopenia has been reported with rantidine and famotidine -May cause headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects - CNS effects rare but are sometimes seen in the elderly

what are the adverse effects of anorexiants?

-Possible elevated BP and Heart Palpitations -Anxiety -Agitation -Dizziness -Headache

What nursing implications should a nurse assess for with Analeptics?

-Potential contraindications -Potential interactions, including herbal therapies -Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems -For children, assess baseline height and weight

what is the mechanism of action of Triptans

-Stimulate 5-ht receptors in cerebral arteries causeing vasoconstriction and reducing headache syptoms -They reduce the production of inflammatory neuropeptides

What is the mechanism of action of Anorexiants?

-Suppress appetite control centers in the brain -Increase the body's basal metabolic rate -mobilization of adipose tissue -enhanced cellular glucose uptake -reduce dietary fat absorption

Misoprostol (Cytotec) PREGNANCY X

-Synthetic prostaglandin analog -Prostaglandins have cytoprotective activity: Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate Promote local cell regeneration Help to maintain mucosal blood flow - Used for prevention of NSAID-induced gastric ulcers -Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea NOTE : also used to INDUCE ABORTIONS. Making it a pregnancy X drug

what adverse effects can Amphetamines cause

-The adverse effects have a wide range and are Dose-related -Tend to speed up body systems -Common AEs include: --->Palpitations, Tachycardia, Hypertension, Angina, Disrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others

Proton Pump Inhibitors

-The parietal cells release positive hydrogen ions (protons) during HCl production -This process is called the proton pump -H2 blockers and antihistamines do not stop the action of this pump. But PPIs DO! EVEN MORE POTENT THAN THE H2s

Statins adverse effects

-They can have some negative side effects e.g. headaches, kidney failure, liver damage and memory loss

What is Vitamin C (Ascorbic Acid) indicated for?

-Treatment and prevention of scurvy - urinary acidifier

Analeptics (Doxapram)

-Treatment of respiratory depression associated with anesthetic drugs and drug abuse, COPD-induced hypercapnia -Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug -Drug used for neonate respiratory depression and in some cases COPD in adults

Herbal products: Flax

-atherosclerosis, hypercholesterolemia, GI distress, menopausal symptoms -adverse effects: diarrhea and allergic rxn

Miscellaneous Acid-Controlling Drugs

-sucralfate (Carafate) -misoprostol (Cytotec) -simethicone (Mylicon)

What are the two primary forms of lipids in the blood?

-triglycerides and cholesterol

antilipemic drug mechanism

-used to lower lipid levels -drug is based on the specific lipid profile of patient

Niacin B3 mechanism

-vitamin B3 -thought to inc. activity of lipase, which breaks down lipids -lowers LDL, total serum cholesterol, and triglycerides -inc. HDL levels

What to remember with corticosteroids and giving a PO therapy?

...Always d/c IV infusion before starting on PO therapy.

How are Stimulants Classified?

1) Classified according to chemical structural similarities 2) Classified according to site of therapeutic action in the central nervous system 3) Classified according to major therapeutic uses (ADHD, Narcolepsy, Obesity, Migraine, and Respiratory depression syndromes)

What are two (2) indications of Cardiac Glycosides?

1) Heart failure 2) Supraventricular dysrhythmias ➤ Atrial fibrillation and atrial flutter.

Name the two (2) Adverse effects of Phosphodiesterase Inhibitors?

1) INAMRINONE ➤ Thrombocytopenia ➤ Dysrhythmia, nausea, hypotension ➤ Elevated liver enzymes with long-term use 2) MILRINONE ➤ Dysrhythmia, mainly ventricular ➤ Hypotension, angina, hypokalemia, tremor, thrombocytopenia.

Heart failure symptoms depend on what two affected cardiac areas?

1) SYSTOLIC dysfunction 2) DIASTOLIC dysfunction → less common

Categories of Antihypertensives

1. Adrenergics (many sub classes) 2. Angiotensin-converting enzyme inhibitors 3. Angiotensin II blockers 4. Direct renin inhibitors 5. Aldosterone antagonists 6. Calcium channel blockers 7. Direct acting vasodilators 8. Diuretics

What are the two non-bronchodilating drugs?

1. Antileukotrine agents 2. Corticosteroids

Major SE of Beta-agonists?

1. Anxiety 2. Restlessness, insomnia 3. Palpitations, HTN, hypotension All r/t SNS stimulation by mimicking the effects of norepinephrine...

What are the three types of bronchodilator drugs?

1. Beta-agonists (beta adrenergic-agonists) 2. Anti-Cholinergics 3. Xanthine derivatives

SE of potassium sparing diuretics

1. Gynecomastia 2. Amenorrhea 3. Post menopausal bleeding 4. Watch for hyperkalemia; if used alone or with a high potassium diet or with potassium supplements

Possibly nursing diagnoses for a patient with hypertension

1. Ineffective peripheral tissue perfusion r/t the impact of the hypertensive disease process and/or possible severe hypotensive adverse effects associated with antihypertensive drug therapy. 2. Sexual dysfunction r/t adverse effects of some antihypertensive drugs. 3. Constipation r/t adverse effects of some antihypertensive drugs. 4. Noncompliance with drug therapy r/t lack of familiarity with or acceptance of the disease process. 5. Risk for injury r/t possible antihypertensive drug-induced orthostatic hypotension with dizziness and syncope.

Theophylline: what are the two sub-classes of drugs?

1. Slow-bid (think: theo is slow) 2. Theo-dur These are slow onset drugs. Used to PREVENT asthma attacks.

What are the three main therapeutic objectives of anti anginal drugs?

1. minimizes the frequency of attacks and decrease the duration and intensity of the anginal pain. 2. improves the patient's functional capacity with as few adverse effects as possible. 3. prevent or delay the worst possible outcome, myocardial infarction.

What are toxic amounts of Vitamin D?

1.25 - 2.5 mg daily

What are the normal serum levels of magnesium?

1.7-2.2 mg/mL

The nurse is giving an intravenous dose of levothyroxine. The order reads: "Give 0.1 mg IV push now." The vial of reconstituted levothyroxine contains 200 mcg. What is the ordered dose in mcg?

100 mcg

an IVPB antibiotic needs to infuse over 30 min. the IVPB contains 50 mL. calculate the setting for the infusion pump.

100 ml/hr

Phosphate values

2.4-4.4

A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses. How many milligrams will the patient receive per dose?

200 mg

What is the normal serum level of b12 (cyanocobalamin)

200-900 pg/mL

Bicarbonate normal range

22-26 mEq/L

The nurse is caring for a pediatric patient with a prescription for 0.2 mg/kg bolus of verapamil (Calan). What is the correct dose for a pediatric patient with a weight of 34 lb?

3.1 mg

Potassium normal value

3.5-5

what is the normal range Albumin

3.5-5

Albumin normal values

3.5-5.0

What are the normal levels of K+?

3.5-5.0 mEq/l

RBC count

4-6 million

WBC count

5,000-10,000

A patient has a metered-dose inhaler that contains 200 actuations (puffs), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, how many days will this inhaler last at the prescribed dose?

50 days

Embolus

A blood clot (thrombus) that has been dislodged from the wall of a blood vessel and is traveling throughout the bloodstream.

hyperglycemia

A fasting blood glucose level of 126 mg/dL or higher or a nonfasting blood glucose level of 200 mg/dL or higher.

Tissue plasminogen activator

A naturally occurring plasminogen activator secreted by vascular endothelial cells in the walls of blood vessels. Thrombolytic drugs are based on this blood component

Nebivolol (Bystolic)

A newer beta blocker. Beta 1 selective (cardio-selective) beta blocker. *Used to treat* hypertension, investigational for heart failure. In addition to blocking beta 1 receptors, it also produces vasodilation, which results in a decrease in systemic vascular resistance (SVR).

Fibrinogen

A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions

Plasminogen

A plasma protein that is converted to plasmin

Angiotensin II

A potent vasoconstrictor activated by renin; also triggers release of aldosterone.

Enzyme

A protein molecule that catalyzes chemical reactions of other substances without being altered or destroyed in the process

Hemophilia

A rare, inherited blood disorder in which the blood does not clot normally

isotonic solution

A solution with the same concentration of water and solutes as inside a cell, resulting in the cell retaining its normal shape because there is no net movement of water.

What does a spacer do when giving an inhaled medication?

A spacer will increase the amount of drug deliver. Rinse and air dry spacer between uses.

type 2 diabetes mellitus

A type of diabetes mellitus that most commonly presents in adults and is becoming more common in children and adolescents due to inactivity and weight gain. The disease may be controlled by lifestyle modifications, oral drug therapy, and/or insulin, but patients are not necessarily dependent on insulin therapy.

The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) a. Garlic b. Ginkgo c. Dong quai d. Glucosamine e. St. John's wort

A,B,C,E

When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? A. Alpha blockers such as doxazosin. B. Diuretics such as furosemide. C. ACE inhibitors such as captopril. D. Vasodilators such as hydralazine.

A. Alpha blockers such as doxazosin.

A beta 1 blocker is prescribed for a patient with heart failure and hypertension. Which adverse effects, if present, may indicate a serious problem is developing while the patient is taking this medication? (Select all that apply) A. Edema B. Nightmares C. Shortness of breath D. Nervousness E. Constipation

A. Edema C. Shortness of breath

A patient is being treated for a hypertensive emergency. The nurse expects which drug to be used? A. Sodium nitroprusside B. Losartan C. Captopril D. Prazosin

A. Sodium nitroprusside

A patient is experiencing severe diarrhea, flushing, and life-threatening hypotension associated with carcinoid crisis. The nurse will prepare to administer which drug? A.) Octreotide (Sandostatin) B.) Vasopressin (Pitressin) C.) Somatropin (Humatrope) D.) Cosyntropin (Cortrosyn)

A.) Octreotide (Sandostatin)

What is essential to remember when taking an inhaled corticosteroids to reduce inflammation and aid in breathing?

ALWAYS wash mouth out after corticosteroid administration; this will decrease the change for thrush

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. "I will take this medication regularly to prevent a migraine headache from occurring." b. "I will take this medication when I feel a migraine headache starting." c. "This medication does not reduce the number of migraines I will have." d. "I will keep a journal to record the headaches I have and how the injections are working."

ANS: A Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful.

The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure? a. Cardiac output and systemic vascular resistance b. Heart rate and peripheral resistance c. Blood volume and renal blood flow d. Myocardial contractility and arteriolar constriction

ANS: A Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 343 TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?" a In the morning b At noon c With supper d At bedtime

ANS: A It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy? a. Chest pain b. Hypotension c. Confusion d. Dysuria

ANS: A Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours

ANS: A Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient's blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient's blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 357 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.) a. Procedural sedation b. Surgeries of short duration c. Surgeries of long duration d. Postoperative anxiety e. Sedation of mechanically ventilated patients

ANS: A, B, E Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

The nurse is instructing a male patient about application of transdermal testosterone gel (AndroGel). Which body location is preferred for this medication? (Select all that apply.) a. Back b. Chest c. Thigh d. Scrotum e. Abdomen f. Upper arms

ANS: A, C, E, F AndroGel is applied to the skin of the back, abdomen, upper arms, or thighs. Testoderm patches are applied to the scrotal skin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started a. Eye examination b. Height and weight c. Liver studies d. Hearing test

ANS: B Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.

3. A patient is on vitamin D supplemental therapy. The nurse will monitor for which signs of toxicity during this therapy? a. Tinnitus b. Anorexia c. Diarrhea d. Hypotension

ANS: B The toxic effects of vitamin D are those associated with hypertension, such as weakness, fatigue, headache, anorexia, dry mouth, metallic taste, nausea, vomiting, abdominal cramps, ataxia, and bone pain. If not recognized and treated, these symptoms can progress to impairment of renal function and osteoporosis. The other options listed are not signs of vitamin D toxicity.

A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct? a. "Lomotil acts faster than Imodium." b. "Imodium does not cause physical dependence." c. "Lomotil is available in suppository form." d. "Imodium is a natural antidiarrheal drug."

ANS: B Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect.

A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a. Diarrhea b. Constipation c. Nausea d. Abdominal cramping

ANS: B Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure

ANS: B Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis? a. Emollient laxatives b. Bulk-forming laxatives c. Hyperosmotic laxatives d. Stimulant laxatives

ANS: B Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect.

A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image? a. Weight loss b. Weight gain c. Pale skin color d. Hair loss

ANS: B Facial erythema, weight gain, hirsutism, and "moon face" (characteristic of Cushing's syndrome) are possible body changes that may occur with long-term prednisone therapy.

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?" a Loop diuretics b Osmotic diuretics c Thiazide diuretics d Vasodilators

ANS: B Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.) a. Irritable bowel syndrome b. Abdominal pain of unknown origin c. Nausea and vomiting d. Fecal impaction e. Ingestion of toxic substances f. Acute abdominal pain

ANS: B, C, D, F Cautious use of laxatives is recommended in the presence of the following: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use.

2. When reviewing the health history of a patient, the nurse will note that a potential contraindication to potassium supplements exists if the patient has which problem? a.Burns b.Diarrhea c.Renal disease d.Cardiac tachydysrhythmias

ANS: C Potassium supplements are contraindicated in the presence of renal disease; the other conditions listed may be treated with potassium supplements.

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially?" a Loop diuretics b Osmotic diuretics c Thiazide diuretics d Potassium-sparing diuretics

ANS: C The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics?" a They work by inhibiting aldosterone. b They are very potent, having a diuretic effect that lasts at least 6 hours. c They have a rapid onset of action and cause rapid diuresis. d They are not effective when the creatinine clearance decreases below 25 mL/min.

ANS: C The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Sleep deprivation d. Imbalanced nutrition: less than body requirements

ANS: C The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, sleep deprivation is the most appropriate nursing diagnosis of those listed.

When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity

ANS: C Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect

The nurse is reviewing the medication orders for a patient who will be taking an H2 antagonist. Which drug may have an interaction if taken along with the H2 antagonist? a. ibuprofen (Motrin) b. ranitidine (Zantac) c. tetracycline (Doryx) d. ketoconazole (Nizoral)

ANS: D All H2 receptor antagonists may inhibit the absorption of certain drugs, such as the antifungal ketoconazole, which require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.)" a Dyspnea b Constipation c Tinnitus d Muscle weakness e Anorexia f Lethargy

ANS: D, E, F Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.

Caffeine and Xanthine Derivatives

AVOID CAFFEINE. Xanthine derivatives cause an increase in SNS stimulation. Will cause palpitations, HTN, tachycardia, insomnia. You do not want to increase SNS stimulation.

What is gestational diabetes?

Abnormal blood glucose maintenance during pregnancy. hyperglycemia occurs, insulin must be given to prevent birth defects. usally disappear after delivery. 30% of Pt. may develop Type 2 within 10-15 years

Discharge teaching for a patient receiving glucocorticoids would include the use of which medication for pain management? Naprosyn (Naproxen) Aspirin (Acetylsalicylic acid) Ibuprofen Acetaminophen (Tylenol)

Acetaminophen (Tylenol) Acetaminophen does not cause GI distress as do aspirin, ibuprofen, naproxen, and glucocorticoids.

What do you do when administering a bronchodilator (MDI form) AND a steroid (MDI form)?

Administer the bronchodilator first. This will adequately open up airways for maximal amount of steroid to reach the lung bases. Wait five minutes. THEN, administer the steroid.

diphenhydramine (Benadryl) interactions

Alcohol, MAOIs, CNS depressants

What are the causes for a Vitamin B2 (Riboflavin) deficiency?

Alcoholism intestinal malabsorption long-term infections liver disease malignancy probenecid therapy

Fibrinolytic system

An area of the circulatory system undergoing fibrinolysis

ginger AE

Anorexia, nausea and vomiting, skin reactions

Enoxaparin (Lovenox)

Anticoagulant. Low molecular weight heparin (LMWH). Does not require laboratory monitoring and can be given at home for treatment of DVT or pulmonary embolism. Never give enoxaparin in combination with heparin. Antidote: protamine sulfate. Route by subcutaneous

Warfarin sodium (coumadin)

Anticoagulant; inhibits vitamin K synthesis. Interactions: amiodarone, fluconazole, erythromycin,metronidazole, sulfonamide antibiotics, and cimetidine. Must maintain consistency in intake of leafy green vegetables. Herbal products interactions that cause increase risk of bleeding: dong quai, garlic, ginko, and st. Johns wort. Antidote: giving vitamin K1 (phytonadione). Route by mouth

What are the indications for magnesium?

Anticonvulsant preeclampsia and eclampsia tocolytic drug for inhibition of uterine contractions pediatric acute nephropathy cardiac dysrhymias short-term treatment for constipation

Desmopresdin (DDAVP)

Antifibrinolytic drug. Increase in plasma factor VIII along with an increase jn tissue plasminogen activator which causes increase clot formation. Contraindicated in those with nephrigenic diabetes insipidus. Route by both injectable and intranasal

Antidiarrheals: Mechanism of Action - Antimotility drugs: anticholinergics

Antimotility drugs: anticholinergics Decrease intestinal muscle tone and peristalsis of GI tract. Result: slows the movement of fecal matter through GI tract. Examples: belladonna alkaloids (atropine, hyoscyamine)

Antidiarrheals: Mechanism of Action - Antimotility drugs: opiates

Antimotility drugs: opiates Decrease bowel motility and relieve rectal spasms. Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed. Reduce pain by relief of rectal spasms. Examples: paregoric, opium tincture, codeine, loperamide (over the counter), diphenoxylate

Mr. K has had a dry, hacking cough for 2 weeks. He said he had the flu, but the cough is just lingering, keeping hi up at night. He asks what he could take. What would you say?

Antitussive

Three main emotional and mental disorders:

Anxiety (least worst) Affective disorders Psychoses (worst)

As a nurse, what should you assess for people continuously using anti anginal drugs?

Assess for tolerance.

A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? A. Give IV vitamin K B. Guve IV protamine sulfate Antidote C. Call the blood bank for an immediate platelet transfusion D. Obtain an order for packed red blood cells

B

The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? a. "I will take my medication in the early evening each day." b. "I will increase the dark green leafy vegetables in my diet." c. "I will contact my health care provider if I develop excessive bruising." d. "I will avoid activities that have a risk for injury such as contact sports."

B

The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation? a. Warfarin (Coumadin) b. Tirofiban (Aggrastat) c. Aminocaproic acid (Amicar) d. Protamine (Protamine sulfate)

B

Describe Water-Soluble Vitamins

B-complex group and VC Can be dissolved in water Easily excreted in the urine Cannot be stored by the body in large amounts Daily intake required to prevent deficiencies

Which nursing diagnosis is most appropriate for a patient who is receiving a pituitary drug? A.) Constipation B.) Disturbed body image C.) Impaired physical mobility D.) Impaired skin integrity

B.) Disturbed body image

What are the main medications used for Topical anesthesia?

Benzocaine ( Lanacaine, solarcaine)

Where is the highest concentration of calcium in the body?

Bones and teeth

How is Vitamin B12 (cyanocobalamin) synthesized?

By microorganisms present in the body

Given the nurse's knowledge of the side effects of alpha blockers, which instruction should the nurse provide to the patient with a new order for an alpha blocker to treat hypertension? A. Drink plenty of fluids. B. Wear sunscreen outside. C. Change positions slowly. D. Increase intake of potassium-rich foods.

C. Change positions slowly.

potassium food sources

Citrus fruits and dried fruits, Bananas, Watermelon, Potatoes, Legumes, Tea, Peanut butter, and Spinach

The nurse knows a common expected adverse effect of iron supplementation is which effect? Fatigue Constipation Heartburn Flatus

Constipation

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

Correct answer: ANS:C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy.

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

Correct answer: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors.

What are the types of fat soluble vitamins?

D, A, K, E

Where do we get D2 vs. D3?

D2 - plants/diet D3 - produced in the skin by ultraviolet irradiation

What is an example of a traditional antihistamine?

Diphenhydramine (Benadryl)

The nurse is educating a patient on diet. Which food will the nurse encourage the patient to include in a diet as a source of folate? Cheese Dried beans Steak Apples

Dried beans

Tetrahydorcannibinoids- dronabinol (Marinol) AE

Drowsiness, dizziness, anxiety, confusion, euphoria Visual disturbances Dry mouth

What are food sources of Vitamin B1 (Thiamine)?

Enriched whole grain breads and cereals, liver, beans, yeast

A replacement fluid that increases clotting factors

Fresh Frozen Plasma (FFP)

What are food sources of Vitamin K1?

Green leafy vegetables, cheese, soybean oils

Excessive secretion of thyroid hormones is called?

Hyperthyroidism

Clot

Insoluble solid element of blood that have chemically seperated from the liquid (plasma) component of the blood

What are causes or Type II Diabetes

Insulin deficiency and insulin resistance

What is an example of an intranasal anticholinergic?

Ipratropium (Atrovent)

How do beta blockers impact type II diabetes?

It can mask hypoglycemia-induced tachycardia. It is a contraindication

Tetrahydorcannibinoids- dronabinol (Marinol) mechanism

It is a synthetic derivative of THC, the major active substance in marijuana

Nebulizer therapy: what is it?

It is the MOST effective way to deliver bronchodilating drugs (or the antileukotrines or corticosteroids). Small amounts of misted droplets of drug will reach the lower air spaces. Delivered by mouthpiece or mask.

Lasix toxicity can occur with the use of a loop diuretic. What does this look like?

Lasix toxicity can occur with too rapid an infusion or high doses of a loop diuretic. Lasix toxicity includes: tinnitus, abdominal pain, sore throat, fever

Serum concentration levels of theophylline?

Levels for toxicity: 20 mEq and above 1st sign of xanthine toxicity? GI symptoms of nausea, vomiting, anorexia

Its therapeutic effects may take several months to occur (thyroid meds)

Levothyroxine or Synthroid

What are food sources of calcium?

Milk, dairy, fortified cereals, orange juice, sardines, salmon

What are the AE of phosphorus?

N/V/D, Gi disturbances, confusion, weakness, breathing difficulties

What are AE of a megadose of Vitamin C (Ascorbic Acid)?

N/V/cramps, HA, acidified urine, stone formation

What are adverse effects of Ergot alkaloids

Nausea and vomiting cold or clammy hands and feet muscle pain dizziness others

What is myocardial infarction? (MI)

Necrosis of the myocardium following interruption of blood supply; it is almost always caused by atherosclerosis of the coronary arteries and is commonly called a heart attack. It is disabling or fatal.

What is magnesium required for in the body?

Nerve physiology muscle contraction

What is the function of calcium?

Nervous, muscular, skeletal systems, cell membrane and capillary permeability transmission of nerve pulses contractions of cardiac, smooth, and skeletal muscles Renal function respiration blood coagulation

What are long-term effects of uncontrolled diabetes

Neuropathy, Retinopathy, PVD, Neuropathy, Delayed wound healing

Vitamin B3

Niacin

Laxatives: Adverse Effects - Stimulant

Nutrient malabsorption Skin rashes Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation

What are common issues with vitamins?

Nutrient megadosing toxic hypervitaminosis RDA DRI

As a nurse, how do you assess someone prior to an anti anginal drug being given?

Obtain medical history, medication history, measure weight, height and vital signs. Blood pressure in supine, sitting and standing positions. Report a systolic blood pressure reading of less than 90 mm HG to prescriber before administering any dose of these drugs. Take apical pulse for 1 minute

Stroke

Occlusion of the blood vessels of the brain by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in ischemia of the brain tissue

When teaching a patient who has a new prescription for thyroid hormone, the nurse should instruct the patient to notify the physician if which adverse effect is noted?

Palpitations

Caffeine should be used with caution in patients with

Peptic ulcers recent myocardial infractions dysrhythmias

What is Ischemia?

Poor blood supply to an organ

procainamide

Pronestyl used to manage atrial and ventricular tachydysrhythmias can cause erythematosus-like syndrome contraindicated with known hypersensitivity and in those with heart block and SLE

What is Vitamin D responsible in the body?

Proper utilization of calcium and phosphorus Calcification of bone and teeth

Vitamin B6

Pyridoxine

what are some contraindications for taking Benzodiazepines?

RESPIRATORY DEPRESSION FOR SURE, liver disorder because of the active metabolites, kidney disorder, history of alcohol or drug abuse, used cautiously with other CNS depressants, DO NOT GIVE TO SOMEONE WHO IS PREGNANT OR WHO HAS GLAUCOMA

Diltiazem (Cardizem)

Same effects as verapamil. First pass effect. Similar adverse effects, except less chance of constipation. *Interactions:* digoxin, grapefruit juice. *Indications:* hypertension, angina, anti-dysrhythmia.

What are pituitary agent is used to help children grow

Somatropin Somatrem

What are nitrates used for?

Stable, unstable and vaasospastic angina. Long dosage forms used for prevention of anginal episodes. Rapid acting dosage forms are used to treat acute anginal attacks.

Why are toxic reactions to water-soluble vitamins rare?

The body excretes what it does not need through urine

Fibrinolysis

The continual process of fibrin decomposition produced by the actions of enzymatic protein fibrinolysin. It is the normal mechanism for removing small fibrin clots and is stimulated by anoxia, inflammatory reactions, and other kinds of stress

The common cold is treated with empiric therapy, which means...

The medications only treat the symptoms

Coagulation

The process of blood clotting.

What is an anti migraine?

They are serotonin agonists, also they are called triptans`

What are anorexiants used for?

They are used to treat obesity

What is another name for TSH?

Thyrotropin

analeptics

Used less frequently Still used for neonatal apnea

A patient who is beginning therapy with levothyroxine (Synthroid) asks the nurse when the medication will start working. What is the nurse's best answer?

Within a few weeks

How does singulair (antileukotrine agent) work?

Works by preventing smooth muscle constriction and decreasing mucus secretion. It does this by decreasing immune responses to allergens.

Primary use for corticosteroids?

a. Used to treat bronchospasms b. Asthma

For calcium channel blockers, how should you counsel your patient?

abrupt withdrawal can precipitate rebound hypertension and worsening of tissue ischemia. Weight must be measured daily, instruct patient to move and change positions slowly, constipation may be improved via liquids/fiber in diet.

Antacids Indications

acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn.

a patient has been intravenous postassium, which is important for the nurse to remember. a. intravenous doses are preferred over oral dosage b. intravenous solutions should contain at least 50ml c. potassium must always be given in diluted form d. it is given slowly intravenous bolus.

c

The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson's disease. Which condition is a concern for the patient, who will be taking tolcapone (Tasmar)? a. Glaucoma b. Seizure disorder c. Liver failure d. Benign prostatic hypertrophy

c. Liver failure

The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects? a. Palpitations b. Drowsiness and dizziness c. Black, tarry stools d. Orange-red discoloration of the urine

c.Black, tarry stools

adverse effects of calcium channel blockers

constipation bradycardia heart block hypotension dizziness dyspnea

premature ventricular contractions (PVCs)

contractions generated by impulses arising from actopic foci within ventricular myocardium problematic when they occur frequently enough to compromise heartbeat

antidysrhythmic drugs

correct abnormal cardiac electrophysiologic function by various degrees by various mechanisms

What drugs can cause post transplant diabetes?

corticosteroids, cyclosporine, tacrolimus

what causes albumin raise

dehydration hyper infusion of albumin

what is the sedative effect?

given during the waking hour, may cause drowsiness

Hypokalemia

low potassium

what are some long term complications of both types of DM

macrovascular (atherosclerotic plaque) caronary arteries, cerebral arteries, peripheral vessels micovascular (capilly damage) retinopathy, neuropathy, nephropathy.

topical/ local infiltrative: Lidocaine (amide class)

most commonly used local anesthetic. It is a topical/infiltrative /nerve block drug with may be combined with EPINIPHERINE. Topical-EMLA- Lidocaine/prilocaine. the transdermal lidocaine (Lidoderm) is used for postherpatic--> e.g trigeminal pain neuralgia. three patches up to 12 hours within a 24 hour period, and needs to be changed at 12 hours because it can have adverse effects on the heart. the perenteral is used for cardiac dysrhythmias

what are symptoms of type 1 and type 2 diabetes mellitus

polyuria (excess urination) polydipsia (excess thirst) polyphagia (excess food intake) glycosuria (present of glucose in urine) unexplained weight loss; fatigue; hyperglycemia

interactions of dysrhytmias

potentiation of anticoagulant activity with warfarin monitor INR to adjust dosages

What is the function of phosphorus?

precursor for the synthesis of essential body chemicals Cellular energy transfer Development and maintenance of skeletal system and teeth Synthesis of nucleic acid, ADP, AMP, ATP

What is CellCept indicated for?

prevention and treatment of organ rejection

Prokinetics- metocloperamide (Reglan) contra

seizure disorder, pheochromocytoma, breast cancer, or GI obstruction and also in patients with a known hypersensitivity to it or to procaine or procainamide

Digoxin: Adverse Effects (cont'd)

❑ Digoxin (Lanoxin) (cont'd) ➤ EYE → Colored vision (seeing green, yellow, purple), halo vision, flickering lights. ➤ GI → Anorexia, nausea, vomiting, diarrhea

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) a. "I will rinse my mouth with water after using the inhaler and then spit out the water." b. "I will gargle after using the inhaler and then swallow." c. "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." d. "I will use this inhaler for asthma attacks." e. "I will continue to use this inhaler, even if I am feeling better." f. "I will use a peak flow meter to measure my response to therapy."

"I will gargle after using the inhaler and then swallow." "I will use this inhaler for asthma attacks." The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what to do. Which is the best response by the nurse?

"Let me ask your physician what should be done; we will need to watch how you do if you switch brands."

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? a. "Take the corticosteroid inhaler first." b. "Take the bronchodilator inhaler first." c. "Take these two drugs at least 2 hours apart." d. "It does not matter which inhaler you use first."

"Take the bronchodilator inhaler first." An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the antiinflammatory drug.

After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? a. "This is an expected adverse effect. Let me take your pulse." b. "The next scheduled nebulizer treatment will be skipped." c. "I will notify the physician about this adverse effect." d. "We will hold the treatment for 24 hours."

"This is an expected adverse effect. Let me take your pulse." Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.

Key point

(Page 360) Always assess for the presence of contraindications, cautions, and potential drug interactions before administering any of the antihypertensive drugs. Contraindications include a history of MI or chronic renal disease. Cautious use is recommended in patients with renal insufficiency or glaucoma. Drugs that interact with antihypertensive drugs include other antihypertensive drugs, anesthetics, and diuretics.

How do you know if diuretic therapy is successful?

***- Weight loss: best indicator of diuretic success - Less edema - Breath sounds clear - Decreased intraoccular eye pressure - BP below 120/80

Thiazide Diuretics: are they commonly used?

***Most widely prescribed class of diuretics

Adverse effects and interactions of the use of Calcium Channel Blockers

*Adverse effects*- orthostatic hypotension, constipation, peripheral edema, bradycardia, reflex tachycardia. *Interactions*- beta blockers, grapefruit juice, digoxin.

Contraindications and adverse effects of Angiotensin Receptor Blockers (ARBs)

*Contraindications*- drug allergy, pregnancy, lactation; use cautiously in older adults and in patients with renal dysfunction. *Adverse effects-* angioedema, fetal harm, renal failure, hyperkalemia, chest pain, fatigue, hypoglycemia, diarrhea, UTI, anemia, and weakness.

Hypernatremia causes

*Decreased water intake* *Fever* *Excessive perspiration *Dehydration* *Hyperventilation* *Watery* diarrhea Enteral nutrition and parenteral nutrition deplete the cells of water *Diabetes insipidus* Cushing's syndrome *Impaired* renal function Use of corticosteroids *Excessive administration of sodium bicarbonate*

nursing implication

*For chemotherapy, antiemetics are often given 30 to 60 minutes before chemotherapy begins.*

What condition are carbonic anhydrase inhibitors used for?

*Used mostly for the treatment of glaucoma; decreases intraoccular pressure by increasing the outflow of aqueous humor in the eye

Prokinetics- metocloperamide (Reglan) indications

*delayed gastric emptying and gastroesophageal reflux* and also as an antiemetic

promethazine (Phenergan) contraindications

*if given intraarterially instead of intravenously, severe tissue damage, often requiring amputation, can occur, do not give in hand, give through large vein, dilute the shit out of it* children younger than 2 years of age

Carbonic Anhydrase Inhibitors: Mechanism of Action

- A diuretic that inhibits the action of carbonic anhydrase so that hydrogen can not be exchanged. This allows excretion of sodium and water from the body.

Diuretics and potassium supplements?

- Administer K+ supplements as ordered to patients on diuretics (except K+ sparing diuretics/aldactone)

Describe the physiology of emphysema.

- Air stuck in the lower respiratory track, gets stuck in the alveoli - Alveoli degenerate in function --> fuse together --> alveoli collapse --> impaired gas exchange

Age group considerations r/t Aldactone (potassium-sparing diuretics)

- Aldactone often used in pediatrics for children with CHF

What are the two types of xanthine derivatives used?

- Aminophyll"ine" - Thophyll"ine"

What are drugs that are used for ADHD ?

- Amphetamine (Dexedrine, Adderall) - Methylphenidate (Concerta, Ritalin, Metadate CD) - Atomoxetine (Straterra) ---->Nonaddictive ----> May cause suicidal thinking and behavior -Lisdexamfetamine (Vyvanse) ----> Prodrug for dextroampetamine

Cortico-steroids: what are they used for?

- Anti-inflammatory drug used for acute asthma attacks (don't take everyday). - BUT, can be used prophylactically: to prevent and treat asthma - Provides a decrease in inflammation of the airways. - Non-bronchodilating

Blood transfusions and pts. on diuretic therapy...

- Assess K+ levels in pts. who have received blood transfusions. Blood can contain more than 30 mEq/l when stored. This is a problem for pts. that are already on a K+ supplement and on a K+ sparing diuretic. Produces hyperkalemia.

Uses of xanthine derivatives?

- Asthma (dyspnea, increased respiratory rate, SOB) - Wheezing - COPD

Diuretics: what should pts. limit in their diet?

- Avoid all alcohol and caffeine; these produce a diuretic effect and lower BP (this is problematic as a SE of most diuretics is postural hypotension) - Limit sodium in the diet if diuretic is being given for HTN

What foods should you avoid when on an xanthine derivative?

- Avoid charcoal (don't charcoal amongst the p"ine" trees in the woods!) - Avoid high protein and low carb diets (when camping: high in protein diets) ...Both reduce serum concentrations of xanthine derivatives

Nursing process for all diuretics: assessment

- Before beginning therapy, gather the following baseline data: a. VS b. fluid volume c. I&O d. serum electrolyte values e. weight - **Also, measure their postural blood pressures: supine and sitting

What are examples of non-opioid antitussives?

- Benzonatate (Tessalon Perles) - Dextromethorphan (Vicks 44, Robitussin-DM)

What happens with chronic inflammation of the airways?

- Cilia atrophy - Muscle action is lost - With cilia atrophy, pt. is at increased risk of infection, pneumonia, and inhalation of foreign substances deep into the respiratory tract

When assessing the older adult patient, the nurse keeps in mind that certain nonspecific symptoms may represent hypothyroidism in older patients, such as:

- Cold intolerance - Depression

When are beta-agonists most used?

- Commonly used during the acute phases of an asthma attack to quickly dilate airways and restore air flow - Used for bronchospasms, COPD, asthma, and airway obstruction

What is the therapeutic action of corticosteroids?

- Corticosteroids stabilize the cells that release histamine to prevent inflammation. - Takes about a full week to achieve the full therapeutic benefits in patients

What are the three primary concerns involved with taking corticosteroids?

- Cushing's syndrome - Addison's syndrome - Slowed bone growth in children

Reported deaths and corticosteroids?

- Deaths r/t adrenal gland failure; the switch to inhaled forms of steroids can be made too quickly and the dose of IV or PO drugs not reduced. MUST SLOWLY TAPER DOSE OF CORTICOSTEROID.

Nursing teaching for xanthine derivatives...

- Do not chew pill if xanthine derivative is given PO - Take with food to avoid GI upset - Avoid smoking: smoking increases drug metabolism

How would use an MDI?

- Exhale, then breath in a puff of the inhaler medication - As the pt. inhales deeply, lean head backward to maximize opening of airways - Hold for 10 seconds - Wait 1-2 minutes between puffs of the same drug

Thiazide diuretic and blood sugar levels

- Frequently need to watch blood sugars for hyperglycemia if on a thiazide diuretic (hydro-diuril)

Best route for corticosteroid administration?

- Inhalation is best: gets the steroid molecules straight into the lungs to prevent airway inflammation - Can also give oral or IV

What is Kayexalate?

- Kayexalate is given to treat hyperkalemia. Promotes the excretion of K+ from the large intestine. - Given to treat levels of K+ above 5.0 mEq/l - Give it PO (juice) or rectally (enema); if given via enema, retain 30-50 minutes after enema - After administration, K+ levels need to be at or below 5.0 mEq/l

Which information should be included in the nurse's teaching of patients taking thyroid medication?

- Keeping a log of journal of individual responses and a graph of pulse rate, weight, and mood would be helpful. - The medication should be taken at the same time every day. - Nervousness, irritability, and insomnia may be a result of a dosage that is too high.

Antacids: Magnesium Salts

- LAXATIVE effect -Commonly cause diarrhea; usually used with other drugs to counteract this effect -Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation -examples: -Hydroxide salt: magnesium hydroxide (Milk of Magnesia) -Carbonate salt: Gaviscon (also a combination product) -Combination products such as Maalox, Mylanta (aluminum and magnesium)

What are adverse effects of expectorants?

- N/V - Gastric irritation - drowsiness

What are osmotic diuretics NOT good for?

- Not beneficial for pts. with peripheral edema, will only result in a small loss of sodium

Loop Diuretics: mechanism of action

- POTENT diuretics that work to produce profound diuresis with water and electrolyte depletion (there is no sodium or chloride reabsorption int eh ascending loop of Henle) "CRAZY amounts of water and sodium being excreted... will throw me for a LOOP!"

SE of corticosteroids?

- Possible weight gain - Sore-throat - Cough - Dry mouth

Are potassium-sparing diuretics used alone or in junction with other meds?

- Potassium-sparing diuretics are often used in junction with other antihypertensives; has synergistic diuretic effects; the two agents given together also counteract the adverse effects of one another

****Fluid Rebound and Diuretics

- Pts. need to keep drinking fluids. Some pts. will stop drinking fluid to decrease trips to the bathroom. As a result, the plasma becomes more concentrated and ADH will be released to hold onto water and to dilute the blood. This will result in rebound edema.

Potassium-Sparing Diuretics: what do they do and what is the advantage

- Referred to as aldosterone (causes sodium and water retention) inhibiting diuretics - Interfere with the Na+ and K+ exchange in collecting ducts and distal convoluted tubules - Advantage: conserves the electrolyte K+ (prevents hypokalemia)

SE of hydro-diuril (hydrocholorthiazide)

- SE stem from the electrolyte disturbances caused they produce. a. Hypokalemia (low potassium) b. Hypercalcemia (high calcium) c. Hyperlipidemia and hyperuricemia d. Orthostatic hypotension e. Hydro-diuril has a ceiling effect --> toxicity if tx. continues ...think: there is a limit ("ceiling, limit") to how much water ("hydro") you can consume at a given time

What is the Mechanism of Action of analeptics?

- Stimulate areas of the CNS that control respiration - Methylxanthines -->inhibit phosphdiesterase, leading to buildup of cyclic adenosine monophosphate -Caffeine --> antagonizes adenosine receptors

GI distress and diuretics...

- Take diuretics with food if GI distress occurs d/t med administration - N/V may be indicative of electrolyte imbalance

What do beta-agonists do?

- They activate the SNS by mimicking the action of norepinephrine; in activating the SNS, the airways dilate, rate and depth of respirations increase - Beta-agonists also affect the beta-2 adrenergic receptors throughout the lung, dilating the constricted airways

Potassium-Sparing Diuretics: Disadvantage

- They are weak diuretics and antihypertensives

Xanthine derivative bronchodilators: how do they work?

- Think: when you see xanth"ine," think p"ine" trees when you go "camp"ing - Xanthine derivatives increase levels of camp by inhibiting phosphodiesterase, the enzyme responsible fo breaking down camp - cAMP is responsible for inhibiting histamine, the chemical responsible for producing allergic reactions --> decreasing oxygen flow to the lungs ...to remember "phospho"diesterase is the enzyme inhibited by xanthine derivatives, think about how "photo"sythesis goes on in the woods where you set up "camp"

Thiazide Diuretics: Mechanism of Action

- Used as adjunct therapy to treat CHF, hepatic cirrhosis, edema - Works by preventing K+, Na+, Cl- reabsorption in the distal tubules and by ***lowering peripheral vascular resistance ...vasodilating effect will decrease HTN

Dig. toxicity and potassium levels?

- Watch pulse and dig. levels in pts. receiving cardiotonic drugs (high risk for dig. toxicity if K+ levels are decreased)

Vulnerable Patients and Diuretics?

- Watch vulnerable pts. to avoid excess/deficits in fluid volume status: elderly, chronic illness, altered renal/liver function

Osmotic Diuretics (Mannitol)

- Works by osmosis; they pull fluid/water out of surrounding tissues. Increases urine production and diuresis. - **Small loss of electrolytes - Works by a process of vasodilation and an increased GF rate - "think "man"atees live in water (osmosis)"

What kind of decongestants are oral decongestants, and what is an example?

- adrenergics - pseudoephedrine (Sudafed)

What are adverse effects of antihistamines?

- anticholinergic effects - sedative and respiratory depressant effects - urinary retention

What are some treatments for the common cold?

- antihistamines - nasal decongestants - antitussives - expectorants

What are important subjects for patient teaching regarding nasal decongestants?

- avoid caffeine - report if symptoms last longer than 1 week - don't crush or break EXR forms - take last dose at least 2 hours before bed - limit intranasal forms to 3-5 days to avoid rebound swelling

What is the mechanism of action of antihistamines?

- blocks action of histamine at H1 receptor sites - prevents adverse consequences of histamine stimulation (swelling, vasodilation, respiratory secretions)

What should be included in a nursing assessment regarding respiratory illnesses/medications?

- data about condition or allergic reaction that required treatment - drug allergies - medication history - focused respiratory assessment - VS, O2 sat, WBC - any contraindications to treatment

What are the cons of oral decongestants?

- delayed onset - effect less potent than topical

What are adverse effects of echinacea?

- dermatitis - GI disturbance - dizziness - headache

What is the mechanism of action of expectorants?

- direct stimulation - reflex stimulation (both resulting in thinner mucus that is easier to remove)

What are adverse effects of antitussives?

- dizziness - headache - sedation - constipation - hypotension - respiratory arrest

With a pt. receiving diuretic therapy, you must monitor K+ levels. What are s/sx of hypokalemia?

- drowsiness/weakness - muscle cramp (at night in the calves especially) - parasthesia (numbness) - constipation (d/t fluid loss) - irregular heart rate (potassium regulates heart contractions)

What are benefits of nonsedating/peripherally acting antihistamines?

- eliminates unwanted sedation - longer duration of action

What are some examples of nonsedating/peripherally acting antihistamines?

- fexofenadine (Allegra) - Ioratadine (Claritin) - Cetirizine (Zyrtec)

What are the major classes used to prevent organ rejection?

- glucocorticoids - calcineurin inhibitors - antimetabolites - biologics

What are AE of immunosuppressants?

- increased risk for infection - increased risk for cancers (especially skin cancer)

What are key nursing diagnoses regarding respiratory illnesses/medications?

- ineffective health maintenance - risk for injury - deficient knowledge related to drug therapy - etc

What are adverse effects of steroidal nasal decongestants?

- local mucosal dryness and irritation

Sucralfate (Carafate)

- mucosal protectant -Used for stress ulcers, peptic ulcer disease -Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas -Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse) -Little absorption from the gut -May cause constipation, nausea, and dry mouth -May impair absorption of other drugs—give other drugs at least 2 hours before sucralfate -Do not administer with other medications -Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels - Usually given 4 times a day ( fallen out of use due to the fact that its effects are transient and its multiple daily dosing)

What are adverse effects of adrenergic nasal decongestants?

- nervousness - insomnia - palpitations - tremors (think adrenaline-like)

What are some nursing implications regarding expectorants?

- patients should receive more fluids - report symptoms lasting longer than 1 week - monitor for intended therapeutic effects

What are the pros of oral decongestants?

- prolonged decongestant effects - no rebound congestion

What are some pros of topical nasal decongestants (adrenergics)?

- prompt onset - potent

What are important subjects for patient teaching regarding antihistamine use?

- report excessive sedation, confusion, or hypotension - avoid driving or operating heavy machinery - avoid alcohol or CNS depressants - best tolerated when taken with meals - keep mouth moist

What is the use of antihistamines indicated for? (Management of...)

- seasonal allergic rhinitis - allergic reactions (urticaria) - motion sickness - Parkinson's disease - common cold - sleep disorders

Mrs. T has very thick secretions during a course of pneumonia and wants to take a cough suppressant. What would you say to her?

- she needs to cough to get mucus out - use an expectorant, like mucinex

parietal cells, chief cells, and mucous cells.

-**Parietal cells** produce and secrete hydrochloric acid (HCl). They are the primary site of action for many of the drugs used to treat acid-related disorders. -Chief cells secrete pepsinogen. Pepsinogen is a proenzyme (enzyme precursor) that becomes pepsin when activated by exposure to acid. Pepsin breaks down proteins and is therefore referred to as a proteolytic enzyme. - Mucous cells are mucus-secreting cells that are also called surface epithelial cells. The secreted mucus serves as a protective coating against the digestive action of hydrochloric acid and digestive enzymes.

Isotonic fluids

-0.9% Saline -5% dextrose in water (D5W)**also used as a hypotonic solution after it is administered because the body absorbs the dextrose BUT it is considered isotonic) -5% Dextrose in 0.225% saline (D5W1/4NS) -Lactated Ringer's

Antacids: Drug Interactions 4 basic mechanisms by which antacids cause interactions

-Adsorption of other drugs to antacids: Reduces the ability of the other drug to be absorbed into the body -Chelation: Chemical binding, or inactivation, of another drug Produces insoluble complexes Result: reduced drug absorption -Increased stomach pH: Increased absorption of basic drugs Decreased absorption of acidic drugs -Increased urinary pH: Increased excretion of acidic drugs Decreased excretion of basic drugs

Simethicone

-Antiflatulent drug -Used to reduce the discomforts of gastric or intestinal gas (flatulence) -Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones -Result is decreased gas pain and increased expulsion via mouth or rectum - foods that cause gas: legumes ( beans), broccoli , coli flower.

Proton Pump Inhibitors: Nursing Implications

-Assess for allergies and history of liver disease -Not all are available for parenteral administration -May increase serum levels of diazepam and phenytoin; -may increase chance for bleeding with warfarin - The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 g or the tube may become clogged -Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules -Proton pump inhibitors often work best when taken 30 to 60 minutes before meals

H2 Antagonists: Nursing Implications

-Assess for allergies and impaired renal or liver function -Use with caution in patients who are confused, disoriented, or elderly -Take 1 hour before or after antacids -For intravenous doses, follow administration guidelines

Antacids: Nursing Implications

-Assess for allergies and preexisting conditions that may restrict the use of antacids, such as: Fluid imbalances Renal disease GI obstruction Heart failure (HF) Pregnancy -Patients with HF or hypertension should not use antacids with high sodium content -Use with caution with other medications because of the many drug interactions -Most medications should be given 1 to 2 hours after giving an antacid -Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset -Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving -Administer with at least 8 ounces of water to enhance absorption (except for "rapid-dissolve" forms) - Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as cancer or bleeding ulcers -If symptoms remain ongoing, patient should seek medical evaluation

Antacids and Antiflatulents

-Calcium carbonate antacids -Antiflatulents: used to relieve the painful symptoms associated with gas -Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products -Over-the-counter antiflatulents --Activated charcoal --Simethicone Alters elasticity of mucus-coated bubbles, causing them to break Used often, but there are limited data to support effectiveness

Glands of the Stomach

-Cardiac: locoated in the cardiac sphincter ( also known as the gastroesophageal sphincter). - Pyloric: in the pyloric region -*Gastric*: Are in the fundus.The cells of the gastric gland are the largest in number and of primary importance when discussing acid control. The three most important cell types are parietal cells, chief cells, and mucous cells.

Acid-Related Diseases -cause - lay terms of overproduction of HCI - medical terms

-Caused by imbalance of the three cells of the gastric gland and their secretions -Most common: hyperacidity -Lay terms for overproduction of HCl by the parietal cells: Indigestion, sour stomach, heartburn, acid stomach - Peptic ulcer disease (PUD): pepsin digests the GI mucosa -Gastroesophageal reflux disease (GERD) -Helicobacter pylori (H. pylori): Bacterium found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers Can be detected by serum antibody tests Antibiotics are used to eradicate H. pylori

What are nursing implications associated with SSRAs (seratonin selective releasing agent)?

-Dissolvable wafers, nasal spray, and self-injectable forms -Provide specific teaching about correct administration Instruct patients to keep journal to monitor response to therapy

What are statins?

-Drugs that reduce the amount of bad cholesterol (LDL) in your bloodstream -They slow down the rate of fatty deposits forming -They reduce the risk of strokes, coronary heart disease and heart attacks -They increase the amount of good cholesterol (HDL) in your bloodstream - HDL removes LDL from the blood -They are a long-term drug that must be taken regularly - could be forgotten to be taken -It takes time for them to reach therapeutic levels

What are nursing implications taken with anorexiants?

-Follow instructions for diet and exercise -Take in the morning -Avoid Caffeine -Fat-soluble vitamin supplementation may be needed

H2 Antagonists: Indications

-GERD -PUD ( Peptic ulcer disease) -Erosive esophagitis -Adjunct therapy to control upper GI bleeding -Pathologic gastric hypersecretory conditions

Antipsychotics important facts/nursing implications:

-Instruct patients to wear sunscreen due to photosensitivity -tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose -tell patients to avoid alcohol and other CNS depressants -oral forms should be taken with meals -may cause drowsiness, dizziness, and fainting

Proton Pump Inhibitors: Mechanism of Action

-Irreversibly bind to H+/K+ ATPase enzyme -This bond prevents the movement of hydrogen ions from the parietal cell into the stomach -Results in achlorhydria—ALL gastric acid secretion is temporarily blocked -To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase

What nursing implications should a nurse assess for with ADHD drugs?

-Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia -take on an empty stomach, 30 to 45 minuets before meals -Drug "holidays" may be ordered -Instruct parents to keep a journal to monitor childs response to therapy -monitor child for continued physical growth, including height and weight

Antacids: Calcium Salts

-Many forms, but carbonate is most common -May cause constipation, kidney stones -Also not recommended for patients with renal disease—may accumulate to toxic levels -Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound) -Often advertised as an extra source of dietary calcium Example: Tums (calcium carbonate) - Calcium carbonate neutralization will possibly cause gas and belching. So it may be combined with an anti flatulent drug.

Antacids: Mechanism of Action

-Neutralize stomach acid -Promote gastric mucosal defense mechanisms -Secretion of: Mucus: protective barrier against HCl Bicarbonate: helps buffer acidic properties of HCl Prostaglandins: prevent activation of proton pump -Antacids DO NOT prevent the overproduction of acid -Antacids DO neutralize the acid once it is in the stomach

Histamine Type 2 (H2) Antagonists

-Reduce acid secretion ( but do not completely abolish it) -All available over the counter in lower dosage forms -Most popular drugs for treatment of acid-related disorders cimetidine (Tagamet) nizatidine (Axid) famotidine (Pepcid) ranitidine (Zantac)

Hydrochloric Acid

-Secreted by parietal cells when stimulated by food -Maintains stomach at pH of 1 to 4 -Secretion also stimulated by: Large fatty meals Excessive amounts of alcohol Emotional stress

Herbal products: Garlic

-antispasmodic, antihypertensive, antiplatelet, lipid reducer -adverse effects: dermatitis, vomiting, flatulence, diarrhea, antiplatelet activity -may enhance bleeding when taken with NSAIDS

Fluid and Electrolytes nursing implications

-assess baseline: fluid volume and electrolyte status, daily weight, I&O, vital signs, skin, mucous membranes -before giving assess ECG -assess for contraindication of therapy -assess transfusion history -establish venous access as needed -monitor serum electrolyte levels during therapy -observe for infiltration, other complications IV therapy -monitor parenteral infusions of potassium closely -administer colloids slowly -monitor for fluid overload and possible heart failure -for blood products, follow administration procedures closely -monitor therapeutic response: normal lab values for RBC, WBC, H&H, and electrolytes levels, improved fluid volume status and increase tolerance activity -monitor for adverse effects

H2 Antagonists: Drug Interactions

-cimetidine (Tagamet) Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels -All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption - Smoking has been shown to decrease the effectiveness of H2 blockers

Niacin adverse effects

-flushing (caused by histamine release) -pruritus -GI distress

Antilipemic drug: Statin drugs (5)

-lovestatin (mevacor) -pravastatin (pravachol) -simvastatin (zocor) -atorvastatin (lipitor) -fluvastatin (lescol) ** STATIN**

Risk factors for CHD

-male 45+ y/o -female 55+ y/o -family history of premature CHD -smoker -hypertension BP: 140/90 or any antihyper. meds -low HDL's: <40 mg/dL -diabetes mellitus

Statin adverse effects

-mild, transient GI disturbances -rash -headache -myopathy -elevations in liver enzymes or liver disease

What is suffix for beta blockers?

-olol

A patient is starting warfarin (coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) A. Teach proper subcutaneous administration B. Administer the oral dose at the same time every day. C. Assess carefully for excessive bruiaing or unusual bleeding D. Monitor laboratory results for a target INR of 2 to 3 E. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value

...

The order for enoxaparin ( Lovenox ) reads: give 1 mg/kg subcut every 12 hrs. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8ml. How mNy milligrams will this patient receive? How many millimeters will the nurse draw up for the injection? ( round to hundredths)

...

Levothyroxine, 88 mcg PO is ordered. What is 88 mcg expressed as mg?

0.088 mg

What is the normal serum level of Vitamin K?

0.1-2.2 ng/mL

Hypotonic solutions

0.45% Saline (1/2 NS) 0.225% Saline (1/4 NS) 0.33% saline (1/3 NS)

half normal saline

0.45% sodium chloride

the intravenous order for a newly admitted patient call for normal saline to run at 100mL/hr. the nurse will choose which concentration of normal saline?

0.9%

normal saline

0.9% sodium chloride; an isotonic crystalloid.

How often per day should a loop diuretic be administered?

1 x day It is a single dose therapy drug.

List three (3) causes of Heart Failure:

1) CARDIAC DEFECT ➤ Myocardial infarction ➤ Valve deficiency 2) DEFECT OUTSIDE THE HEART ➤ Coronary artery disease ➤ Pulmonary hypertension ➤ Diabetes 3) SUPRAVENTRICULAR DYSRHYTHMIAS ➤ Atrial fibrillation ➤ Atrial flutter

What are the three main beta-agonist drugs used?

1. *Albuterol (Proventil, Xoponex): inhaler (short-acting) 2. *Servent: longer acting, used to maintain asthma control or COPD a. Can be given in a Diskus: inhaled powder b. Servent can be combined with a corticosteroid: *Advair

What are the two types of anticholinergic bronchodilators? How often a day do you take them?

1. Atrovent (ipratropium): used for asthma (given inhaler, liquid arosol, nebulizer treatment), BID ...'At'rovent: I want to be 'at' the pool where there is chlorine (anti'cholin'ergic); and I want to go to the pool at 2xday 2. Spiriva: QD dosing

Adverse Reactions r/t Loop Diuretics

1. Increased electrolyte depletion (especially hypokalemia) 2. Excessive diuresis --> circulatory collapse 3. High doses or rapid infusion can lead to transient hearing loss. This is called tinnitus. 4. Postural hypotension 5. *Lasix toxicity

When is a loop diuretic most useful?

1. When RAPID diuresis is desired: fast onset (1 hour) 2. Useful with a low creatine clearance: works even with poor renal function (...even in pts. with poor renal function, they can't escape the potency of loop diuretics. they will still be thrown for a loop)

A patient will be receiving diphenhydramine (Benadryl) via a PEG tube, 25 mg, every 8 hours for an allergic rash. The medication is available as a 12.5 mg/5 mL syrup. How many milliliters will the nurse administer with each dose?

10 mL 12.5 mg : 5 mL :: 25 mg : x mL

What are normal serum levels for Vitamin D?

12-50 ng/mL

the orders read, infuse 1000mL of normal saline over the next 8 hours. the IV tubing has a drop factor of 15 gtt/ml. calculate the mL hourly rate and calculate the drops per minute setting for the IV tubing with this gravity infusion.

125 mL/hourly 31 gtt/ min

Sodium Normal Value

135-145

A 2-year-old child will be receiving ferrous sulfate oral drops (Fer-Iron) 5 mg/kg/day in three divided doses. The child weighs 26 pounds. Identify how many milligrams will the nurse administer per dose. (record answer using one decimal place) _______

19.7 mg

the risk of CHD in patients with cholesterol levels of 300 mg/dL is ___ to ____ times greater than in patients with levels <200 mg/dL

3 to 4 times greater!

Hypertonic solutions

3% Saline 5% Saline 10% Dextrose in Water (D10W) 5% Dextrose in 0.9% Saline 5% Dextrose in 0.45% saline 5% Dextrose in Lactated Ringer's

hypertonic saline

3% sodium chloride

The following IV is to be given: 1000 ml D5W with 20 mEq potassium chloride (KCI) over the next 24 hours. the tubing drop factor is 15. At what rate will the KCI be administer? what will the gtt/min.

42 gtt/hr 10 gtt/min

A child will be receiving diphenhydramine (Benadryl), 5 mg/kg/day, in divided doses, every 6 hours. The child weighs 80 pounds. How many milligrams of medication will the child receive with each dose? (Record answer using one decimal place.)

45.5 mg 80 pounds ÷ 2.2 = 36.36, which rounds to 36.4 kg 5 mg/kg/day ´ 36.4 kg = 182 mg/day

D5W

5% dextrose in water

Calcium values

8.5-10.5 mg

Calcium normal range

8.5-10.5 mg/dL

Cholride (CI) values

98-106 mEq/L

How do beta blockers impact hyperthyroidism?

??????

A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? a. Inform the patient of potential drug interactions with anticoagulants. b. Explain that a common initial adverse effect is a headache for this drug. c. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen. d. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.

A

Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? a. Check apical pulse and blood pressure. b. Measure urine output and specific gravity. c. Obtain temperature and pulse oximetry on room air. d. Evaluate peripheral pulses and level of consciousness.

A

Sodium channel blockers are considered which class of antidysrhythmic drugs? a. Class I b. Class II c. Class III d. Class IV

A

The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication? a. Administer it as a fast IV push. b. Assess for burning sensation at the IV site. c. Monitor the infusion site for hematoma. d. Flush the IV catheter with normal saline.

A

The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? a. The patient's warfarin dose is within the therapeutic range. b. The patient needs the subcutaneous heparin dose increased. c. The patient is not receiving enough warfarin for a therapeutic effect. d. The patient is receiving too much heparin and is at risk for bleeding.

A

To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient? a. Avoid drinking grapefruit juice. b. Remind the patient to change positions slowly. c. Advise the patient to wear sunscreen every day. d. Increase dietary intake of potassium.

A

Which medication is an antiplatelet drug? a. Clopidogrel (Plavix) b. Alteplase (Activase) c. Heparin (Hemochron) d. Enoxaparin (Lovenox)

A

Hypokalemia S/S

A SIC WALTD A-Alkalosis S-Shallow respiration I-Irritability C-Confusion and drowsiness W-Weakness and fatigue A-Arrhythmias- irregular heart rate, tachycardia L-Lethargy T-Thready pulse D-decrease intestinal mobility, nausea and vomiting

Hypoglycemia

A blood glucose level of less than 70 mg/dL, or above 50 mg/dL with signs and symptoms of hypoglycemia.

What is bicarbonate?

A buffer that helps to maintain a constant pH in a solution even if a acid or base is added.

Prodrugs

A drug that is inactive in its administered form and must be metabolized to its active form in the body, generally by the liver, to be effective.

Hyperosmolar nonketotic syndrome (HNKS)

A metabolic complication of uncontrolled type 2 diabetes, similar in severity to diabetic ketoacidosis but without ketosis and acidosis.

The nurse is reviewing the use of antitussive drugs. Antitussive drugs would be most appropriate for which patient? a. A patient who has pneumonia with a productive cough b. A patient who has a tracheostomy and thick mucus secretions c. A patient who has had a productive cough for 2 weeks d. A patient who has developed bronchitis 2 days after abdominal surgery

A patient who has developed bronchitis 2 days after abdominal surgery Although most of the time coughing is a beneficial response, there are times when it is not useful and may even be harmful (e.g., after a surgical procedure such as hernia repair or in cases of nonproductive, or dry, cough). Coughing would be beneficial in the other three situations.

Psychosis:

A severe emotional disorder that impairs the mental function of the affected individual to the point that the individual can't participate in activities of daily living. Hallmark: loss of contact with reality Examples: Schizophrenia Depressive and drug-induced psychoses

diabetic ketoacidosis is

A severe metabolic complication of uncontrolled diabetes that, if untreated, leads to diabetic coma and death.

A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)

A short-acting beta2 agonist such as albuterol (Proventil) The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.

Lactated Ringer's Solution

A sterile crystalloid isotonic IV solution of specified amounts of calcium chloride, potassium chloride, sodium chloride, and sodium lactate in water.

Fibrin

A stringy, insoluble protein produced by the action of thrombin on fibrinogen during the clotting process

Antithrombin III

A substance that inactivates 3 major activating favtors of clotting cascade ( activated factor II-thrombin, activated factor X, and activated factor IX)

For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken? (Select all that apply.) a. Assess for cardiac dysrhythmias. b. Administer injections intramuscularly. c. Record vital signs and report changes. d. Monitor for an increase in liver enzymes. e. Observe for signs and symptoms of bleeding.

A,C,E

When applying transdermal nitroglycerin patches, which instruction by the nurse is correct? A. "Rotate application sites with each dose." B. "Use only the chest area for application sites." C. "Temporarily remove the patch if you go swimming." D. "Apply the patch to the same site each time."

A. "Rotate application sites with each dose." Rationale: Application sites for transdermal nitroglycerin patches need to be rotated. Apply the transdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed.

When administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin? A. 0.5 mg B. 5 mg C. 5.5 mg D. 15 mg

A. 0.5 mg Rationale: One vial of digoxin immune Fab binds 0.5 mg of digoxin. The other options are incorrect.

Which drug classes are considered first-line treatment for heart failure? (Select all that apply.) A. Angiotensin-converting enzyme (ACE) inhibitors B. Angiotensin II receptor blockers (ARBs) C. Digoxin (cardiac glycoside) D. Beta blockers E. Nesiritide (Natrecor), the B-type natriuretic peptide

A. Angiotensin-converting enzyme (ACE) inhibitors B. Angiotensin II receptor blockers (ARBs) D. Beta Blockers Rationale: ACE inhibitors, ARBs, and beta blockers are now considered the first-line treatments for heart failure. Digoxin is used when the first-line treatments are not successful; nesiritide is considered a last-resort treatment.

The nurse notes in a patient's medication history that the patient is taking buspirone (BuSpar). Based on this finding, the nurse interprets that the patient has which disorder? A. Anxiety disorder B. Depression C. Schizophrenia D. Bipolar disorder

A. Anxiety disorder, buspirone is safe non sedating non addiciting drug for anxiety .

patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action? A. Assess the patient for symptoms of digoxin toxicity. B. Withhold the next dose of the diuretic. C. Administer the digoxin and diuretic together as ordered. D. Document this finding, and reassess in 1 hour.

A. Assess the patient for symptoms of digoxin toxicity Rationale: Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient complains of this, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. Administering the drug or withholding the diuretic are incorrect options.

A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites? A. Blood pressure of 88/62 mm Hg B. Apical pulse rate of 110 beats/min C. History of renal disease D. History of a myocardial infarction 2 years ago

A. BP of 88/62 mmHg Rationale: Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect.

A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing? A. Classic B. Variant C. Unstable D. Prinzmetal's

A. Classic Rationale: Classic, or chronic stable, angina is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.

In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug? A. Potassium level 2.8 mEq/L B. Potassium level 4.9 mEq/L C. Sodium level 140 mEq/L D. Calcium level 10 mg/dL

A. Potassium level 2.8 mEq/L Rationale: Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect.

A patient has asked for a cup of coffee. The nurse keeps in mind that caffeine should be avoided by patients who have a history of which condition? A. cardiac dysrhythmias B. asthma C. diabetes mellitus D. gallbladder disease

A. anorexia

A patient is experiencing a seizure that has lasted for several minutes and he has not regained consciousness. The nurse recognizes that this is a life-threatening emergency known as: A. status epilepticus B. tonic-clonic confulsion C. epilepsy D. secondary epilepsy

A. status epilepticus

When assessing a patient who is receiving octreotide (Sandostatin) therapy, the nurse will closely monitor which assessment finding? A.) Blood glucose levels B.) Pulse C.) Weight D.) Serum potassium levels

A.) Blood glucose levels

The nurse will instruct a patient taking desmopressin acetate as a nasal spray for the treatment of diabetes insipidus to perform which action to obtain maximum benefit from the drug? A.) Clear the nasal passages before spraying the medication. B.) Blow his nose after taking the medication. C.) Take an over-the-counter preparation to control mucus if nasal congestion occurs. D.) Press on the pump once to prime it before delivering the dose.

A.) Clear the nasal passages before spraying the medication.

1. The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, "What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you." Which actions by the patient are appropriate in this situation? (Select all that apply.) A.Stop the activity, and lie down or sit down. B. Call 911 immediately. C. Call 911 if the pain is not relieved after taking one sublingual tablet. D. Call 911 if the pain is not relieved after taking three sublingual tablets in 15 minutes. E. Place a tablet under the tongue. F. Place a tablet in the space between the gum and cheek. G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.

A.Stop the activity, and lie down or sit down. C. Call 911 if the pain is not relieved after taking one sublingual tablet. E. Place a tablet under the tongue. G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total. Rationale: With sublingual forms, the medication is taken at the first sign of chest pain, not delayed until the pain is severe. The patient needs to sit down or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. Placing a tablet between the gum and cheek is the buccal route.

1. A patient will be receiving monthly injections of cyanocobalamin (Nascobal). The dose is 100 mcg/month IM. The medication is available in a strength of 1000 mcg/mL. How many milliliters will the nurse draw up into the syringe? (Record answer using one decimal place.)

ANS: 0.1 mL 1000 mcg : 1 mL :: 100 mcg : x mL (1000 ´ x) = (1 ´ 100); 1000x = 100; x = 0.1 mL

An agitated patient is to receive an intravenous dose of diazepam (Valium). The order reads, "Give diazepam, 2 mg, IV push, now. Repeat in 15 minutes if needed." Identify how many milliliters will the nurse administer for this dose. The medication vial contains 5 mg/mL.

ANS: 0.4 mL How to solve: 5mg:1ml=2mg:xml (5xX)=(1X2) 5x=2 x=0.4

A patient is to receive enalapril (Vasotec) 5 mg IV every 6 hours. Each dose is given over 5 minutes. The medication is available in an injectable form, 1.25 mg/mL. Identify how many milliliters of medication will the nurse draw up for each dose. _______

ANS: 4 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient will be starting vitamin D supplements. The nurse reviews his medical record for contraindications, including which condition? a. Renal disease b. Cardiac disease c. Hypophosphatemia d. There are no contraindications to vitamin D supplements.

ANS: A Contraindications to vitamin D products include known allergy to the product, hypercalcemia, renal dysfunction, and hyperphosphatemia.

1. The nurse is reviewing conditions caused by nutrient deficiencies. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral? a. Vitamin D b. Vitamin C c. Zinc d. Cyanocobalamin (vitamin B12)

ANS: A Infantile rickets, tetany, and osteomalacia are all a result of long-term vitamin D deficiency. The other options are incorrect.

A patient will be starting therapy with a corticosteroid. The nurse reviews the patient's orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes? a. Nonsteroidal anti-inflammatory drugs b. Antibiotics c. Opioid analgesics d. Antidepressants

ANS: A The use of corticosteroids with aspirin, other NSAIDs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. The other options are incorrect.

2. When starting a patient's drug therapy with corticosteroids, the nurse is aware that some drug classes can have adverse interactions with corticosteroids, such as A. nonsteroidal antiinflammatory drugs. B. antibiotics. C. opioid analgesics. D. antidepressants.

ANS: A The use of corticosteroids with aspirin, other nonsteroidal antiinflammatory drugs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers.

The nurse is reviewing the medication list of a patient who will be starting androgen therapy. Which drug classes, if taken with androgens, may have an interaction with them? a. Oral anticoagulants b. Nitrates c. Beta blockers d. Proton pump inhibitors

ANS: A Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. The other options are incorrect.

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that calcium antacids are not used as frequently as other antacids because a. their use may result in kidney stones. b. they cause decreased gastric acid production. c. they cause severe diarrhea. d. their use may result in fluid retention and edema.

ANS: A Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.

The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects? a. Dark stools and blue gums b. Urinary hesitancy c. Drowsiness and dizziness d. Blurred vision and headache

ANS: A Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal drugs.

When a male patient is receiving androgen therapy, the nurse will monitor for signs of excessive androgens such as: a. fluid retention. b. dehydration. c. restlessness. d. visual changes.

ANS: A Fluid retention is an undesirable effect of androgens. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 557 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is receiving lactulose (Chronulac) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? a. High ammonia levels due to liver failure b. Prevention of constipation c. Chronic renal failure d. Chronic diarrhea

ANS: A Lactulose (Chronulac) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect.

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?" a Intravenously, through a filter b By rapid intravenous bolus c By mouth in a single morning dose d Through a gravity intravenous drip with standard tubing

ANS: A Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.

When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance? a. Fat-soluble vitamins b. Water-soluble vitamins c. Minerals d. Electrolytes

ANS: A Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are incorrect.

A 21-year-old male athlete admits to using androgenic steroids. The nurse tells him that which of these is a possible adverse effect of these drugs? a. Liver damage b. Renal failure c. Heart failure d. Stevens-Johnson syndrome

ANS: A Peliosis of the liver, the formation of blood-filled cavities, is a potential effect of androgenic anabolic steroid therapy and may be life threatening. Other serious hepatic effects are hepatic neoplasms (liver cancer), cholestatic hepatitis, jaundice, and abnormal liver function. The other options are incorrect.

A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy? a. Several days before the surgery, the medication will be administered orally. b. The oral doses need to be taken 1 hour before meals to maximize absorption. c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration. d. Intramuscular injections of the medication will be needed for several days preceding surgery.

ANS: A Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain

ANS: A Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 358 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

An elderly patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, "He seems to be more confused this afternoon. He's never been like this. What could be the problem?" The nurse reviews the patient's medication record and suspects that which drug could be the cause of the patient's confusion? a. cimetidine (Tagamet) b. pantoprazole (Protonix) c. clarithromycin (Biaxin) d. sucralfate (Carafate)

ANS: A Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the elderly, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a. Prevent stress ulcers b. Reduce bacteria levels in the stomach c. Reduce gastric gas formation (flatulence) d. Promote gastric motility

ANS: A Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol? a. Oral hypoglycemic drugs b. Antibiotics c. acetaminophen (Tylenol) d. Antidepressants

ANS: A Taking oral hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect.

A patient is taking tegaserod (Zelnorm) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? a. Chest pain b. Chronic constipation c. Abdominal cramps d. Elevated blood glucose levels

ANS: A Tegaserod (Zelnorm) has been associated with serious adverse effects, including angina, heart attacks, and stroke. Abdominal cramps and chronic constipation are symptoms of irritable bowel disease. Elevated blood glucose levels are not an adverse effect of tegaserod.

A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a. An antibiotic b. A nonsteroidal antiinflammatory drug c. An antacid d. An antiemetic

ANS: A The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?" a Digitalis b Penicillin c Potassium supplements d Aspirin

ANS: A There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones

ANS: A Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine

A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication? a. Pruritus, cutaneous flushing b. Tinnitus, urine with a burnt odor c. Myalgia, fatigue d. Blurred vision, headaches

ANS: A Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue

A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which typeof drug will be used to promote gastric emptying for this patient? a.Prokinetic drugs, such as metoclopramide (Reglan) b.Serotonin blockers, such as ondansetron (Zofran) c.Anticholinergic drugs, such as scopolamine (Scopace) d.Neuroleptic drugs, such as chlorpromazine (Thorazine)

ANS: A Prokinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility

A patient who has severe nausea and vomiting following a case of food poisoning comes to the urgent care center. When reviewing his medication history, the nurse notes that he has an allergy to procaine. The nurse would question an order for which antiemetic drug if ordered for this patient? a.metoclopramide (Reglan) b.promethazine (Phenergan) c.phosphorated carbohydrate solution (Emetrol) d.palonosetron (Aloxi)

ANS: A The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options

3. During an intravenous infusion of calcium, the nurse carefully monitors the patient for symptoms of hypercalcemia. Which are symptoms of hypercalcemia? (Select all that apply.) a. Anorexia b. Nausea and vomiting c. Diarrhea d. Constipation e. Cardiac irregularities f. Drowsiness

ANS: A, B, D, E Symptoms of hypercalcemia include anorexia, nausea, vomiting, and constipation. Long-term excessive calcium intake can result in severe hypercalcemia, which can cause cardiac irregularities, delirium, and coma. The other options are incorrect.

The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment? (Select all that apply.) a. Dehydration b. Weight loss c. Steroid psychosis d. Increased potassium levels e. Increased blood glucose levels f. Decreased serum sodium levels

ANS: A, B, D, F The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison's disease, which is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. Steroid psychosis is an effect of glucocorticoid excess.

The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Systolic blood pressure higher than 200 mm Hg e. Temperature over 100° F (37.7° C) f. Pulse rate 110 beats/minute

ANS: A, C, D Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal

1. The nurse is reviewing vitamin therapy in preparation for a nutrition class. Which statements are accurate regarding vitamin C (ascorbic acid)? (Select all that apply.) a. Vitamin C is important in the maintenance of bone, teeth, and capillaries. b. Vitamin C is essential for night vision. c. Vitamin C is important for tissue repair. d. Vitamin C is found in animal sources such as dairy products and meat. e. Vitamin C is found in tomatoes, strawberries, and broccoli. f. Vitamin C is also known as the "sunshine vitamin." g. Vitamin C deficiency is known as scurvy.

ANS: A, C, E, G These statements are true of vitamin C. Vitamin A is essential for night vision, and vitamin D is known as the sunshine vitamin. With the exception of liver, meat and dairy products are not sources of vitamin C.

When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. "You need to have your blood pressure checked once a week and keep track of the readings." b. "If you notice that the symptoms have gone away, you should be able to stop taking the drug." c. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." d. "If you experience severe side effects, stop the medicine and let us know at your next office visit." e. "Most over-the-counter decongestants are compatible with antihypertensive drugs." f. "Please continue taking the medication, even if you are feeling better."

ANS: A, C, F Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 359 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse notes in a patient's medication history that the patient is taking the synthetic androgen danazol (Danocrine). Indications for danazol include which conditions? (Select all that apply.) a. Endometriosis b. Decreased sexual libido c. Postpartum breast engorgement d. Fibrocystic breast disease in women e. Hereditary angioedema f. Metastatic breast cancer

ANS: A, D, E Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 555 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression

ANS: A, D, E, F Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks

Which of these characteristics are considered to be risk factors for coronary heart disease? (Select all that apply . ) a. Being male, 45 years of age or older b. Being female, 45 years of age or older c. Having a family history that includes a mother who died of a myocardial infarction at 71 years of age d. Having a high-density lipoprotein (HDL) level of 65 mg/dL e. Having an HDL level of 30 mg/dL f. Having a history of diabetes mellitus

ANS: A, E, F Risk factors include being male, 45 years of age or older, and being female, 55 years of age or older; having a family history of premature congenital heart disease (e.g., myocardial infarction or sudden death before 55 years of age in a father or other male first-degree relative, or before 65 years of age in a mother or other female first-degree relative); currently smoking cigarettes; having hypertension (blood pressure higher than 140/90 mm Hg or current antihypertensive drug therapy); having a low HDL level (lower than 40 mg/dL); and having diabetes mellitus

The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation programs is true? a.Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b.Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c.Compliance with treatment is higher with use of the gum rather than the transdermal patch. d.The nicotine gum can be used only up to six times per day

ANS: AQuick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke

11. After a severe auto accident, a patient has been taken to the trauma unit and has an estimated blood loss of more than 30% of his blood volume. The nurse prepares to administer which product? a.Albumin b.Whole blood c.Packed red blood cells d.Fresh frozen plasma

ANS: B A patient who has lost a massive amount (over 25%) of blood volume would receive whole blood. PRBCs are given to increase the oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume. A patient with a coagulation disorder or a clotting-factor deficiency would receive fresh frozen plasma; albumin is used to expand fluid volume.

1. The nurse is administering adrenal drugs to a patient. Which of the following actions is appropriate for this patient? A. Administering oral drugs before meals to maximize absorption B. Rinsing the oral cavity after using steroid inhalers C. Administering the corticosteroids before bedtime to minimize adrenal suppression D. Discontinuing the medication immediately if a weight gain of more than 5 pounds in 1 week is experienced

ANS: B After the patient has used the steroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs should be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they should be discontinued by weaning, not abruptly.

9. The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which intravenous solution is correct for use with the PRBC transfusion? a.5% dextrose in water (D5W) b.0.9% sodium chloride (NS) c.5% dextrose in 0.45% sodium chloride (D5NS) d.5% dextrose in lactated Ringer's solution (D5LR)

ANS: B Blood products should be given only with normal saline 0.9% because D5W will also cause hemolysis of the blood product.

11. A newly admitted patient has orders for both vitamin C and zinc supplements. The nurse reviews the patient's medical history and concludes that these supplements are ordered for which reason? a. To treat pellagra b. To aid in wound healing c. To treat osteomalacia d. As an antidote for anticoagulant overdose

ANS: B Both zinc and vitamin C are important for normal tissue growth and repair, which makes them helpful with wound healing. Vitamin B3 (niacin) is used to treat pellagra; vitamin D is used to treat osteomalacia; and vitamin K is used as an antidote for anticoagulant overdose.

13. The nurse is preparing to give a potassium supplement. Which laboratory test should be checked before the patient receives a dose of potassium? a.Complete blood count b.Serum potassium level c.Serum sodium level d.Liver function studies

ANS: B Contraindications to potassium replacement products include hyperkalemia from any cause. It is important to know the patient's electrolyte levels before beginning electrolyte replacement therapy. Giving potassium supplements to a patient whose serum potassium levels are already high may cause worsening of the hyperkalemia. The other options are incorrect.

10. The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which patient would be best treated with this transfusion? a.A patient with a coagulation disorder b.A patient with severe anemia c.A patient who has lost a massive amount of blood after an accident d.A patient who has a clotting-factor deficiency

ANS: B PRBCs are given to increase the oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume. Patients with coagulation disorder or clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

7. A patient with a history of alcohol abuse has been admitted for severe weakness and malnutrition. The nurse will prepare to administer which vitamin preparation to prevent Wernicke's encephalopathy? a. Vitamin B3 (niacin) b. Vitamin B1 (thiamine) c. Vitamin B6 (pyridoxine) d. Folic acid

ANS: B Thiamine is necessary for the treatment of a variety of thiamine deficiencies, including Wernicke's encephalopathy. The other options are incorrect.

2. The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which nursing diagnosis is appropriate for this patient? a. Impaired tissue integrity related to vitamin deficiency b. Risk for injury related to night blindness caused by vitamin deficiency c. Impaired physical mobility (muscle weakness) related to vitamin deficiency d. Acute confusion related to vitamin deficiency

ANS: B Vitamin A deficiency causes night blindness, so risk for injury is an appropriate nursing diagnosis. The other nursing diagnoses are not appropriate for patients receiving vitamin A.

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers

ANS: B ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output

ANS: B ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect?" a Metabolic alkalosis b Elevated blood glucose c Hyperkalemia d Mental alertness

ANS: B An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur.

The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? a. Adsorbents such as Pepto-Bismol b. Anticholinergics such as belladonna alkaloids c. Probiotics such as Lactinex d. Lubricants such as mineral oil

ANS: B Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect.

A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3? a. Serum potassium level b. Fluid volume status c. Electrocardiogram d. Blood glucose level

ANS: B Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 777 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A glucocorticoid is prescribed for a patient. The nurse checks the patient's medical history knowing that glucocorticoid therapy is contraindicated in which disorder? a. Cerebral edema b. Peptic ulcer disease c. Tuberculous meningitis d. Chronic obstructive pulmonary disease

ANS: B Contraindications to the administration of glucocorticoids include drug allergy and may include cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The other options are indications for glucocorticoids.

A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug a.The patient may skip doses if the patient is feeling well b.The patient will need to avoid driving because of possible drowsiness. c.The patient may experience occasional problems with taste. d.It is safe to take the medication with a glass of wine in the evening to help settle thestomach

ANS: B Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so

3. A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of lupus erythematosus. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image? A. Weight loss B. Weight gain C. Pale skin color D. Loss of hair

ANS: B Facial erythema, weight gain, hirsutism, and "moon face" (characteristic of Cushing's syndrome) are possible body changes that may occur with long-term prednisone therapy.

A patient is receiving finasteride (Proscar) for treatment of benign prostatic hyperplasia. The nurse will tell him that a possible effect of this medication is: a. alopecia. b. increased hair growth. c. urinary retention. d. increased prostate size.

ANS: B Finasteride is given to reduce prostate size in men with benign prostatic hyperplasia. It has been noted that men taking this medication experience increased hair growth. The other options are incorrect.

During the administration of finasteride (Proscar), the nurse must remember which important precaution? a. It must be taken on an empty stomach. b. It must not be handled by pregnant women. c. It is given by deep intramuscular injection to avoid tissue irritation. d. The patient needs to be warned that alopecia is a common adverse effect.

ANS: B Finasteride must not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is providing teaching to a patient who will be taking the laxative bisacodyl (Dulcolax). Which statement by the nurse is appropriate during this teaching session? a. "You can crush the laxative tablets for improved action." b. "Take the tablets with water, not milk or juice." c. "This laxative is not known to cause dependence." d. "In a normal bowel pattern, a bowel movement occurs daily."

ANS: B Give bisacodyl only with water because interactions with milk, juices, and antacids may occur. All laxative tablets should be swallowed whole; a normal bowel pattern does not necessarily mean one bowel movement a day. Bisacodyl is a stimulant laxative; this class of laxative is the most likely of all the classes to cause dependence.

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used? a. Azathioprine (Imuran) b. Glatiramer acetate (Copaxone) c. Daclizumab (Zenapax) d. Sirolimus (Rapamune)

ANS: B Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the medication must be stopped if which laboratory result is noted? a. White blood cell count of 550 cells/mm3 b. Hemoglobin level of 12 g/dL c. Potassium level of 4.2 mEq/L d. Glucose level of 78 mg/dL

ANS: B If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may experience serious adverse events, including heart attack, stroke, and death. Guidelines now recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients. For renal patients, the target hemoglobin level is 11 g/dL for patients on dialysis and 10 g/dL for chronic renal patients not on dialysis.

A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil

ANS: B In patients with pre-existing cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results? a. Serum potassium levels b. White blood cell (leukocyte) count c. Red blood cell count d. Serum albumin levels

ANS: B Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy d. A patient who will be having colon surgery in the morning

ANS: B Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.

A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery? A. Hypotension B. Delayed wound healing C. Muscle weakness D. Osteoporosis

ANS: B Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient's recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.

A patient is taking fludrocortisone (Florinef) for Addison's disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information? a. It may cause severe postural hypotension. b. It needs to be taken with food or milk to minimize gastrointestinal upset. c. The medication needs to be stopped immediately if nausea or vomiting occurs. d. Weight gain of 5 pounds or more in 1 week is an expected adverse effect.

ANS: B Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension.

4. A patient is taking fludrocortisone (florinef) for Addison's disease, and his wife is concerned about all the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse should include which information? A. It may cause severe postural hypotension. B. It should be taken with food or milk to minimize gastrointestinal upset. C. The medication should be stopped immediately if nausea or vomiting occurs. D. Weight gain of 5 pounds or more within a week is an expected adverse effect.

ANS: B Patients receiving fludrocortisone should take it with food or milk to minimize gastrointestinal upset; weight gain of more than 5 pounds a week should be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory

ANS: B Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug? a. He takes the cimetidine with meals. b. He smokes two packs of cigarettes a day. c. He drinks a glass of water with each dose. d. He takes an antacid 3 hours after the cimetidine dose.

ANS: B Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse should monitor for signs of which condition? A. Dehydration B. Hypokalemia C. Hyponatremia D. Hypoglycemia

ANS: B Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia.

When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition? a. Dehydration b. Hypokalemia c. Hyponatremia d. Hypoglycemia

ANS: B Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia. The other options are incorrect.

A mother calls the pediatrician's office to report that her 18-month-old child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?" What is the nurse's best response? a."Go ahead and give him the ipecac, and then call 911." b."Don't give him the ipecac. Call the Poison Control number immediately for instructions." c."Please come to the office right away so that we can check him." d."Go ahead and take him to the emergency room right now."

ANS: B The American Academy of Pediatrics no longer recommends the use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, firstcall the national poison control hotline at 800-222-1222. In allcases of poisoning,if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital

When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction? a. Reduced adverse effects of the cyclosporine b. Increased levels of cyclosporine and toxicity c. Reduced uric acid levels d. Reduced nephrotoxic effects of cyclosporine

ANS: B The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Warfarin (Coumadin) c. Digoxin (Lanoxin) d. Phenytoin (Dilantin)

ANS: B When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal anti-inflammatory drugs, and aspirin. The other drugs listed do not have known interactions with garlic.

A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite? a.metoclopramide (Reglan), a prokinetic drug b.dronabinol (Marinol), a tetrahydrocannabinoid c.ondansetron (Zofran), a serotonin blocker d.aprepitant (Emend), a substance P/NK1 receptor antagonist

ANS: B Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite

A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication? a. Constipation b. Diarrhea c. Joint pain d. Dry mouth

ANS: B Fibric acid derivatives may cause nausea, vomiting, diarrhea, drowsiness, and dizziness. Other effects are listed in Table 27-8. The other options are not adverse effects of fibric acid derivatives.

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such a ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine d. Neuroleptic drugs, such as promethazine (Phenergan

ANS: B Serotonin blockers have proven to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting. The other options are incorrect.

A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel "normal" again. Which statement by the nurse is correct? a. "It's possible that these cravings will never stop." b. "These cravings may persist for several months." c. "The cravings tell us that you are still using nicotine." d. "The cravings show that you are about to experience nicotine withdrawal."

ANS: B Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false.

The nurse is presenting a substance-abuse lecture for teenage girls and is asked about "roofies." The nurse recognizes that this is the slang term for which substance? a. cocaine b. flunitrazepam c. secobarbital d. methamphetamine

ANS: B Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the "date-rape" drug). The other drugs are not known as roofies.

A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation? a. Local anesthesia b. Moderate sedation c. Topical anesthesia d. Spinal anesthesia

ANS: B Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patient's ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect.

The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs? a. Niacin b. HMG-CoA reductase inhibitors c. Fibric acid derivatives d. Bile acid sequestrants

ANS: B Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG- CoA reductase inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy need to be advised to report any unexplained muscular pain or discomfort to their health care providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy

A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? a. diazepam (Valium) b. methadone c. disulfiram (Antabuse) d. bupropion (Zyban

ANS: B Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation

During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103 F (39.4 C). The nurse will prepare for what immediate treatment? a. naltrexone hydrochloride (Narcan) injection, an opioid reversal drug b. dantrolene (Dantrium) injection, a skeletal muscle relaxant c. An anticholinesterase drug, such as neostigmine d. Cardiopulmonary resuscitation (CPR) and intubation

ANS: B Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation

When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the nurse will discuss which food? a. Oatmeal b. Grapefruit juice c. Licorice d. Dairy products

ANS: B Taking HMG-CoA reductase inhibitors with grapefruit juice may cause complications. Components in grapefruit juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin metabolism. The presence of grapefruit juice in the body may therefore result in sustained levels of unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to rhabdomyolysis. The other foods do not interact with these drugs

A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response? a. "Blood levels return to normal within a week of beginning therapy." b. "It takes 6 to 8 weeks to see a change in cholesterol levels." c. "It takes at least 6 months to see a change in cholesterol levels." d. "You will need to take this medication for almost a year to see significant results."

ANS: B The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect

A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic? a. acetaminophen (Tylenol) b. warfarin (Coumadin) c. digoxin (Lanoxin) d. phenytoin (Dilantin)

ANS: B When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal antiinflammatory drugs, and aspirin. The other drugs listed do not have known interactions with garlic.

The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs? (Select all that apply.) a. Glaucoma b. Cerebral edema c. Chronic obstructive pulmonary disease and asthma d. Organ transplantation e. Varicella f. Septicemia

ANS: B, C, D Cerebral edema, chronic obstructive pulmonary disease, asthma, and organ transplantation are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy.

1. Which conditions are indications for glucocorticoid drugs? Select all that apply. A. Glaucoma B. Cerebral edema C. Chronic obstructive pulmonary disease and asthma D. Organ transplantation E. Varicella F. Septicemia

ANS: B, C, D Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. The others are indications for glucocorticoid therapy.

Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply . ) a. Limit fluid intake to prevent fluid overload. b. Eat extra servings of raw vegetables and fruit. c. Report abnormal or unusual bleeding or yellow discoloration of the skin. d. Report the occurrence of muscle pain immediately. e. Drug interactions are rare with antilipemics. f. Take the drug 1 hour before or 2 hours after meals to maximize absorption

ANS: B, C, D Instructions need to include preventing constipation by encouraging a diet that is plentiful in raw vegetables, fruit, and bran. Forcing fluids (up to 3000 mL/day unless contraindicated) may also help to prevent constipation. Notify the prescriber if there are any new or troublesome symptoms, abnormal or unusual bleeding, yellow discoloration of the skin, or muscle pain. These drugs are highly protein bound, therefore they interact with many drugs. Taking these drugs with food may help to reduce gastrointestinal distress

2. The patient asks the nurse about taking large doses of vitamin C to improve her immunity to colds. "It's just a vitamin, right? What can happen?" Which responses by the nurse are correct? (Select all that apply.) a. "Vitamin C is harmless because it is a water-soluble vitamin." b. "Large doses of vitamin C can cause nausea, vomiting, headache, and abdominal cramps." c. "Keep in mind that if you suddenly stop taking these large doses, you might experience symptoms similar to scurvy." d. "Studies have shown that vitamin C has little value in preventing the common cold." e. "Vitamin C acidifies the urine, which can lead to the formation of renal stones." f. "Large doses of vitamin C may delay wound healing."

ANS: B, C, D, E Vitamin C is usually nontoxic unless excessive dosages are consumed. Large doses (megadoses) can produce nausea, vomiting, headache, and abdominal cramps, and they acidify the urine, which can result in the formation of renal stones. Furthermore, individuals who discontinue taking excessive daily doses of ascorbic acid can experience scurvylike symptoms. Studies have shown that megadoses of vitamin C have little or no value as prophylaxis against the common cold. Vitamin C is required for several important metabolic activities, including collagen synthesis and the maintenance of connective tissue and tissue repair.

A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. Take this medication after meals. b. Take this medication in the morning. c. This drug is taken along with supervised exercise and suitable diet. d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. e. Avoid foods that contain caffeine, such as coffee, tea, and colas

ANS: B, C, D, E This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect.

The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.) a. Antacids reduce the production of acid in the stomach. b. Antacids neutralize acid in the stomach. c. Rebound hyperacidity may occur with calcium-based antacids. d. Aluminum-based antacids cause diarrhea. e. Magnesium-based antacids cause diarrhea.

ANS: B, C, E Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.

A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.) a.This drug is available as a chewing gum that can be taken to reduce cravings. b.Use caution when driving because drowsiness may be a problem. c.There have been very few adverse effects reported for this drug. d.Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur. e.Avoid caffeine while on this drug

ANS: B, D Patients taking varenicline have reported drowsiness, which has prompted the FDA to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug

1. During diuretic therapy, the nurse monitors the fluid and electrolyte status of the patient. Which assessment findings are symptoms of hyponatremia? (Select all that apply.) a.Red, flushed skin b.Lethargy c.Decreased urination d.Hypotension e.Stomach cramps f.Elevated temperature

ANS: B, D, E Hyponatremia is manifested by lethargy, hypotension, stomach cramps, vomiting, diarrhea, and seizures. The other options are symptoms of hypernatremia.

A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.) a. Tremors b. Leukopenia c. Diarrhea d. Thrombocytopenia e. Hepatotoxicity f. Fluid retention

ANS: B, D, E Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.) a. Administering it as a single IV bolus injection to minimize adverse effects b. Using an infusion pump to administer this medication c. Monitoring the patient for potential delayed adverse effects, which may be severe d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy

ANS: B, D, E, F Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.) a. Euphoria b. Severe vomiting c. Diarrhea d. Pulsating headache e. Difficulty breathing f. Sweating

ANS: B, D, E, F Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy. Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness, weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not adverse effects associated with acetaldehyde syndrome

A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply.) a.Giving antinausea drugs at the beginning of the chemotherapy infusion b.Administering antinausea drugs 30 to 60 minutes before chemotherapy is started c.For best therapeutic effects, medicating for nausea once the symptoms begin d.Observing carefully for the adverse effects of restlessness and anxiety e.Instructing the patient that the antinausea drugs may cause extreme drowsiness f.Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension

ANS: B, E, F Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, not restlessness and anxiety. Orthostatic hypotension is a possible adverse effect that may lead to injury.

A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy? a. He should not smoke cigarettes while on this drug b.He needs to know about the common over-the-counter substances that contain alcohol. c.This drug will cause the same effects as the alcohol did, without the euphoric effects. d.Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts

ANS: BThe use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicitsevere adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol

3. During a blood transfusion, the patient begins to have chills and back pain. What is the nurse's priority action? a.Observe for other symptoms. b.Slow the infusion rate of the blood. c.Discontinue the infusion immediately, and notify the prescriber. d.Tell the patient that these symptoms are a normal reaction to the blood product.

ANS: C Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the prescriber notified. The intravenous line should be kept patent with isotonic normal saline solution infusing at a slow rate, and the facility's protocol for transfusion reactions should always be followed. The other options are inappropriate actions.

7. During an infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect? a.Hypernatremia b.Fluid volume deficit c.Fluid volume overload d.Transfusion reaction

ANS: C During the infusion of albumin, the development of fluid volume overload must be monitored by the nurse, especially in those at risk for heart failure. The other options are incorrect.

1. A patient has a deficiency in clotting factors. The nurse will prepare to administer which blood product? a.Albumin b.Cryoprecipitate c.Fresh frozen plasma d.Packed red blood cells (PRBCs)

ANS: C Fresh frozen plasma is indicated to increase clotting factor levels in patients with demonstrated deficiency. Cryoprecipitate is used to manage acute bleeding; PRBCs are used to increase the oxygen-carrying capacity of the blood; albumin is used to expand fluid volume.

8. A patient is receiving an infusion of fresh frozen plasma. Based on this order, the nurse interprets that this patient has which condition? a.Hypovolemic shock b.Anemia c.Coagulation disorder d.Previous transfusion reaction

ANS: C Fresh frozen plasma is used as an adjunct to massive blood transfusion in the treatment of patients with underlying coagulation disorders. The other options are not indications for fresh frozen plasma.

8. Niacin is prescribed for a patient who has hyperlipidemia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder? a. Renal disease b. Cardiac disease c. Liver disease d. Diabetes mellitus

ANS: C Niacin, unlike certain other B-complex vitamins, has additional contraindications besides drug allergy. They include liver disease, severe hypotension, arterial hemorrhage, and active peptic ulcer disease. The other options are incorrect.

12. A patient who is severely anemic also has acute heart failure with severe edema due to fluid overload. The prescriber wants to raise the patient's hemoglobin and hematocrit levels. The nurse anticipates that the patient will receive which blood product? a.Fresh frozen plasma b.Albumin c.Packed red blood cells (PRBCs) d.Whole blood

ANS: C PRBCs are given to increase the oxygen-carrying capacity in a patient with anemia, in a patient with substantial hemoglobin deficits, and in a patient who has lost up to 25% of total blood volume. A patient with a coagulation disorder or a clotting-factor deficiency would receive fresh frozen plasma; a patient who has lost a massive amount of blood would receive whole blood.

A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects? a. Take the drug on an empty stomach. b. Take the medication every other day until the effects subside. c. Take an aspirin tablet 30 minutes before taking the drug. d. Take the drug with large amounts of fiber

ANS: C The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin's adverse effects, and it is not within the nurse's scope of practice to suggest a change of medication dosage.

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics

ANS: C According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present? a. High ammonia levels due to liver failure b. Diverticulosis c. Abdominal pain of unknown origin d. Chronic constipation

ANS: C All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of the following: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? a. Advise the patient to increase intake of fluids and fiber b. Advise the patient to hold the drug for 2 days c. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated d. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation

ANS: C Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect.

When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction? a. The water acts to stimulate bowel movements. b. The water will help to reduce the bulk of the intestinal contents. c. These laxatives may cause esophageal obstruction if taken with insufficient water. d. The water acts as a lubricant to produce bowel movements.

ANS: C Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which condition is found upon assessment? A. Osteoporosis B. Steroid psychosis C. Dehydration and weight loss D. Water retention

ANS: C Dehydration and weight loss are the result of undersecretion of adrenocortical hormones, or Addison's disease. The other responses are possible effects of glucocorticoid excess

A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate 5 or 6 times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate? a. Constipation b. Metabolic acidosis c. Metabolic alkalosis d. Excessive gastric mucus

ANS: C Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.

The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil? a. Fecal impaction b. Electrolyte imbalances c. Lipid pneumonia d. Esophageal blockage

ANS: C Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are incorrect.

While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient? a. She needs to be sure to take this medication with plenty of fluids. b. It is important to have a daily bowel movement to promote bowel health. c. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. d. She needs to switch to glycerin suppositories to continue having daily bowel movements.

ANS: C Long-term use of laxatives or cathartics often results in decreased bowel tone and may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.

At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct? a. Give both the antacid and medications at 0900. b. Give the antacid at 0900, and then the medications at 0930. c. Give the medications at 0900, and then the antacid at 1000. d. Give the medications at 0900, and then the antacid at 0915.

ANS: C Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of their impact on the absorption of many medications in the stomach.

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates

ANS: C Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? a. Bulk-forming laxative, such as psyllium (Metamucil) b. Stool softener, such as docusate salts (Colace) c. Magnesium hydroxide (MOM) d. Magnesium oxide tablets

ANS: C Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

A patient with motion sickness is planning a cross-country car trip and has a new prescription for a scopolamine transdermal patch The nurse provides teaching for the use of this patch medication. The patient shows a correct understanding of the teaching with which statement? a."I will change the patch every day." b."I will change the patch every other day." c."I will change the patch every 3 days." d."I will remove the patch only if it stops working."

ANS: C Scopolamine patches are 72-hour doses and are changed every 3 days. The other options are incorrect.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? a. acetaminophen (Tylenol), an analgesic b. levothyroxine (Synthroid), a thyroid replacement drug c. warfarin (Coumadin), an anticoagulant d. fluoxetine (Prozac), an antidepressant

ANS: C The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when coadministered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect.

A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, "Why am I getting a patch? Can't I just take a pill?" Which response by the nurse is correct? a. "The patch reduces the incidence of side effects." b. "If you don't take the patch, you will have to have injections instead." c. "The patch allows for better absorption of the medication." d. "You will only have to change the patch weekly."

ANS: C The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 555 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, "I've heard that ginger tablets may be a natural way to ease the nausea andvomiting. Is it okay to try them?" What is the nurse's best response? a."They are a safe and natural remedy for nausea when you are pregnant." b. "Go ahead and try them, but stop taking them once the nausea is relieved." c. "Some health care providers do not recommend ginger during pregnancy. Let's check with your provider." d. "You will need to wait until after the first trimester to try them."

ANS: C There is some anecdotal evidence that ginger may have abortifacient properties, and for this reason some clinicians do not recommend its use during pregnancy.

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status?" a Blood pressure and pulse b Serum potassium and sodium levels c Intake, output, and daily weight d Measurements of abdominal girth and calf circumference

ANS: C Urinary intake and output and daily weights are the best reflections of a patient's fluid volume status.

An ergot alkaloid is prescribed for a patient who is having frequent migraine headaches. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which problem occurs? a. Nervousness b. Dizziness c. Chest pain d. Nausea and vomiting

ANS: C Nervousness, dizziness, and nausea and vomiting are expected adverse effects of ergot alkaloids. However, if chest pain occurs, the prescriber should be contacted immediately, or the patient should seek emergency care

When reviewing patients' histories, the nurse recognizes that which patient would be a likely candidate for drug therapy for cholesterol reduction? a. A patient who has coronary heart disease and an LDL level of 100 mg/dL b. A patient who has one risk factor, an LDL level of 170 mg/dL, and no history of coronary heart disease c. A patient who has coronary heart disease and an LDL level of 165 mg/dL d. A patient who has two risk factors and a low-density lipoprotein (LDL) level of 100 mg/dL, without coronary heart disease

ANS: C A patient with coronary heart disease is considered to be at high or very high risk, and with an LDL level greater than or equal to 130 mg/dL, drug therapy will be initiated. The other situations would warrant dietary therapy, initially

A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration? a. Mix the powder in a carbonated soda drink to dissolve it faster. b. Add the powder to any liquid, and stir vigorously to dissolve it quickly. c. Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid. d. Sprinkle the powder into a spoon and take it dry, followed by a glass of water

ANS: C Mix the powder with food or at least 4 to 6 ounces of fluid. The powder may not mix completely at first, but patients should be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid. The powder should be dissolved for at least 1 full minute. Powder and granule dosages are never to be taken in dry form

When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition? a. Renal failure b. Cerebrovascular accident c. Korsakoff's psychosis d. Alzheimer's disease

ANS: C A variety of serious neurologic and mental disorders, such as Korsakoff's psychosis and Wernicke's encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer's disease are not associated directly with chronic use of alcohol.

A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance? a. Opioids b. Alcohol c. Stimulants d. Depressants

ANS: C The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects

A patient has been given succinylcholine (Anectine) after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine a. valium (Diazepam) b. caffeine c. neostigmine (Prostigmin) d. vecuronium (Norcuron

ANS: C The antidote for neuromuscular blocking drugs is an anticholinesterase drug, such as neostigmine. Neostigmine reverses the effects of neuromuscular blocking drugs. The other drugs listed are not antidotes for neuromuscular blocking drugs

A patient is to receive local anesthesia for removal of a lymph node from his armpit. The physician asks for a solution of premixed lidocaine and epinephrine. The nurse knows that the epinephrine is used for which reason? a. It prevents an anaphylactic reaction from occurring. b. The anesthetic enhances the effect of the epinephrine. c. Epinephrine contributes to a balanced anesthetic state. d. It keeps the anesthetic at its local site of action and decreases incisional bleeding.

ANS: D Vasoconstrictors such as epinephrine are coadministered with local anesthetics to keep the anesthetic at its local site of action and to prevent systemic absorption. The other options are not correct rationales for using this medication.

6. The nurse will prepare to give which preparation to a newborn upon arrival in the nursery after delivery? a. vitamin B1 (thiamine) b. vitamin D (calciferol) c. folic acid d. vitamin K (AquaMEPHYTON)

ANS: D Deficiency in vitamin K can be seen in newborns because of malabsorption attributed to inadequate amounts of bile. AquaMEPHYTON is given as a single intramuscular dose for infants upon arrival in the nursery.

4. The nurse is counseling a patient about calcium supplements. Which dietary information is appropriate during this teaching session? a. "Take oral calcium supplements with meals." b. "There are no drug interactions with calcium products." c. "Avoid foods that are high in calcium, such as beef, egg yolks, and liver." d. "Be sure to eat foods high in calcium, such as dairy products and salmon."

ANS: D Foods high in calcium include dairy products, fortified cereals, calcium-fortified orange juice, sardines, and salmon. Patients can be encouraged to add dietary sources of calcium to their diets. Oral-dosage forms of calcium need to be given 1 to 3 hours after meals. Calcium salts will bind with tetracycline and quinolone antibiotics and result in an insoluble complex.

5. A patient is in an urgent care center and is receiving treatment for mild hyponatremia after spending several hours doing gardening work in the heat of the day. The nurse expects that which drug therapy will be used to treat this condition? a.Oral supplementation of fluids b.Intravenous bolus of lactated Ringer's solution c.Normal saline infusion, administered slowly d.Oral administration of sodium chloride tablets

ANS: D Mild hyponatremia is usually treated by oral administration of sodium chloride tablets. Pronounced sodium depletion is treated by intravenous normal saline or lactated Ringer's solution.

6. When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign? a.Seizures b.Cardiac dysrhythmias c.Diarrhea d.Muscle weakness

ANS: D Muscle weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac dysrhythmias are a late symptom of hypokalemia. The other options are incorrect.

4. The nurse is working with a graduate nurse to prepare an intravenous dose of potassium. Which statement by the graduate nurse reflects a need for further teaching? a."We will need to monitor this infusion closely." b."The infusion rate should not go over 10 mEq/hour." c."The intravenous potassium will be diluted before we give it." d."The intravenous potassium dose will be given undiluted."

ANS: D When giving intravenous potassium, the medication must always be given in a diluted form and administered slowly. Intravenous bolus or undiluted forms may cause cardiac arrest. Intravenous rates are not to exceed 10 mEq/hr unless the patient is on a cardiac monitor. Oral forms should be mixed with juice or water or taken according to instructions.

10. A patient accidentally took an overdose of the anticoagulant warfarin (Coumadin), and the nurse is preparing to administer vitamin K as an antidote. Which statement about vitamin K is accurate? a. The vitamin K dose will be given intramuscularly. b. The patient will take oral doses of vitamin K after the initial injection. c. The vitamin K cannot be given if the patient has renal disease. d. The patient will be unresponsive to warfarin therapy for 1 week after the vitamin K is given.

ANS: D When vitamin K is used as an antidote to warfarin therapy, the patient becomes unresponsive to warfarin for approximately 1 week after vitamin K administration. The use of vitamin K products is contraindicated in patients who are in the last few weeks of pregnancy and in patients with severe hepatic disease. Vitamin K is given subcutaneously and not intramuscularly when used to reverse warfarin effects.

A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? a. "Weigh yourself daily, and report any weight loss to your prescriber." b. "Increase your potassium intake by eating more bananas and apricots." c. "The impaired taste associated with this medication usually goes away in 2 to 3 weeks." d. "Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."

ANS: D A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 354 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic? a. Captopril rarely causes first-dose hypotensive effects. b. Captopril has little effect on electrolyte levels. c. Captopril is a prodrug and is metabolized by the liver before becoming active. d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.

ANS: D A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 348 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 63-year-old male patient is scheduled for a physical examination, and he tells the nurse that he wants to start taking a vitamin formula that includes saw palmetto for prostate health. Which is the nurse's best response? a. "I've heard many good things about saw palmetto." b. "It's not a good idea to start herbal therapy at your age." c. "There are very few adverse effects with saw palmetto therapy." d. "The doctor will need to draw some blood and do a digital rectal exam first."

ANS: D A prostatic-specific antigen test and digital rectal examination needs to be performed before initiation of treatment with saw palmetto for benign prostatic hyperplasia. Adverse effects may include gastrointestinal upset, headache, back pain, and dysuria.

During the immediate postoperative recovery period, what is the nurse's priority assessment? a. Pupil responses b. Return to sensation c. Level of consciousness d. Airway, breathing, and circulation

ANS: D After surgery and the termination of general anesthesia, the priority assessment is the patient's airway, breathing, and circulation status. The other assessments are important but are not the immediate concern.

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient?" a He should take the diuretic with his evening meal. b He should skip the diuretic dose if he plans to leave the house. c If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. d He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

ANS: D Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.

A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids? a. Triglycerides b. Low-density lipoproteins (LDLs) c. Very-low-density lipoproteins (VLDLs) d. High-density lipoproteins (HDLs)

ANS: D HDLs are responsible for the "recycling" of cholesterol. HDLs are sometimes referred to as the "good" lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the "bad" cholesterol.

During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result? a. No serious consequences b. Prevention of more serious problems, such as an ulcer c. Chronic constipation d. Masked symptoms of serious underlying diseases

ANS: D Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.

A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet)

ANS: D Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 347 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

The nurse notes in a female patient's history that she has an order for the androgen methyltestosterone (Android). Based on this finding, the nurse interprets that the patient has which disorder? a. Fibrocystic breast disease b. Hereditary angioedema c. Hypertension d. Inoperable breast cancer

ANS: D Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 557 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect? a. Nausea and vomiting b. Fever and tremors c. Agitation d. Hypertension

ANS: D Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct? a. Proton pump inhibitors can cause diarrhea. b. These drugs can cause nausea and anorexia. c. Proton pump inhibitors cause drowsiness. d. Long-term use of these drugs may contribute to osteoporosis.

ANS: D New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? a. "Take this medication once a day after breakfast." b. "You will be on this medication for only 2 weeks for treatment of the reflux disease." c. "The medication may be dissolved in a liquid for better absorption." d. "The entire capsule must be taken whole, not crushed, chewed, or opened."

ANS: D Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?" a "Take this medication in the evening." b "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates." c "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." d "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

ANS: D Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.

A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel? a. docusate sodium (Colace) b. magnesium hydroxide (milk of magnesia) c. mineral oil d. polyethylene glycol (GoLYTELY)

ANS: D Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect.

A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a. Lubricants b. Adsorbents c. Anticholinergics d. Probiotics

ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria.

A patient is complaining of excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem? a. famotidine (Pepcid) b. aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta) c. calcium carbonate (Tums) d. simethicone (Mylicon)

ANS: D Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent. The other options are incorrect.

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?" a Hydrochlorothiazide (HydroDIURIL) b Furosemide (Lasix) c Acetazolamide (Diamox) d Spironolactone (Aldactone)

ANS: D Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies? a. A nonsteroidal anti-inflammatory drug b. A benzodiazepine c. An opioid pain reliever d. A corticosteroid

ANS: D The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct? a. Hold the dose until the prescriber makes rounds. b. Give the cyclosporine-modified drug. c. Double-check the order, and then give the cyclosporine-modified drug. d. Notify the pharmacy to obtain the Sandimmune form of the drug.

ANS: D The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing new postoperative orders and notes that the order reads, "Give hydroxyzine (Vistaril) 50 mg IV prn nausea or vomiting." The patient is complaining of slight nausea. Which action by the nurse is correct at this time? a.Hold the dose until the patient complains of severe nausea. b.Give the dose orally instead of intravenously c.Give the patient the IV dose of hydroxyzine as ordered. d.Call the prescriber to question the route that is ordered

ANS: D The nurse needs to question the route. Hydroxyzine (Vistaril) is an antihistamine-class antiemetic that is only to be given either by oral or intramuscular routes. It may be easy to make the mistake of giving hydroxyzine intravenously because many other antiemetics are given by that route. It is important to note that intravenous, intraarterial, or subcutaneous administration of hydroxyzine may result in significant tissue damage, thrombosis, and gangrene. The nurse cannot change the route of an ordered medication without a prescriber's order. Antiemetic drugs are best given before the patient's nausea become severe.

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension

ANS: D The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse? a. "We need to monitor for drug toxicity." b. "We must watch for increased intraocular pressure." c. "The provider is assessing for visual changes that may occur with drug therapy." d. "The provider is making sure the treatment is effective over the long term."

ANS: D The physician would examine the fundus of a patient's eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 358 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. "This therapy will take about 3 months." b. "This therapy will take about a year." c. "This therapy will go on until your symptoms disappear." d. "Therapy for high blood pressure is usually lifelong."

ANS: D There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct?" a "It's important to try to stay on your prescribed medication. Try to take it with sips of water." b "Stop taking the diuretic for a few days, and then restart it when you feel better." c "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician." d "Please come into the clinic for an evaluation to make sure there are no complications."

ANS: D Vomiting and diarrhea cause fluid and electrolyte loss. The patient must not continue to take the diuretic until these problems have stopped. He needs to be checked for possible hypokalemia and dehydration. The other options are incorrect responses.

A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia

ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school.

During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure? a. No anesthesia b. Topical benzocaine spray on the area c. Topical prilocaine (EMLA) cream around the site d. Infiltration of the puncture wound with lidocaine

ANS: D Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of "no anesthesia" is incorrect

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects

ANS: D Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect

Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which condition, which is a contraindication if present? a. Hypotension b. Renal disease c. Liver damage d. Cardiovascular disease

ANS: D Triptans are contraindicated in patients with serious cardiovascular disease because of the vasoconstrictive potential of these medications. The other options are incorrect

While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem? a. Neutropenia b. Pulmonary problems c. Vitamin C deficiency d. Liver dysfunction

ANS: D Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely monitored. The other options do not reflect problems that may occur with antilipemic drugs

While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem? a. Tachyphylaxis b. Postoperative infection c. Malignant hypertension d. Malignant hyperthermia

ANS: D A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed

The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by which mechanism? a. Inhibiting HMG-CoA reductase b. Preventing resorption of bile acids from the small intestines c. Activating lipase, which breaks down cholesterol d. Inhibiting cholesterol absorption in the small intestine

ANS: D Ezetimibe selectively inhibits absorption in the small intestine of cholesterol and related sterols. The other options are incorrect

A patient with risk factors for coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids? a. Triglycerides b. Low-density lipoproteins (LDLs) c. Very-low-density lipoproteins (VLDLs) d. High-density lipoproteins (HDLs)

ANS: D HDLs are responsible for the "recycling" of cholesterol. HDLs are sometimes referred to as the "good" lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the "bad" cholesterol

A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? a. Naltrexone prevents the cravings for opioid drugs. b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid's desired effects are lost

ANS: D Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost.

When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? a. The 30-year-old patient who has never had surgery before b. The 45-year-old patient who stopped smoking 10 years ago c. The 21-year-old patient who is to have a kidney stone removed d. The 78-year-old patient who is to have gallbladder removal

ANS: D The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems

A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient? a. Anxiety related to the use of an anesthetic b. Risk for injury related to increased sensorium from general anesthesia c. Decreased cardiac output related to systemic effects of local anesthesia d. Impaired gas exchange related to central nervous system depression produced by general anesthesia

ANS: D The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.

Diarrhea

Abnormal passage of stools with increased frequency, fluidity, and weight, or with increased stool water excretion. Acute diarrhea Chronic diarrhea

Constipation

Abnormally infrequent and difficult passage of feces through the lower GI tract. Constipation is a symptom, not a disease. Disorder of movement through the colon and/or rectum. Can be caused by a variety of diseases or drugs.

Direct Renin Inhibitor

Acts on renin to inhibit the conversion of angiotensin to angiotensin I. Example drug- Aliskiren

Neurokinin antagonists- aprepitant (Emend) indications

Acute and delayed vomiting associated with chemotherapy

adenosine

Adenocard unclassified antidysrhythmic slows electrical conduction time through the AV node when PSVT doesn't respond to veramapil has extremely short half-life commonly causes asystole for a period of seconds

Antidiarrheals: Interactions

Adsorbents decrease the absorption of many drugs, including digoxin, clindamycin, quinidine, hypoglycemic drugs, others. Adsorpents cause increased bleeding time and bruising when given with anticoagulants. Antacids can decrease effects of anticholinergic antidiarrheal drugs. Many other interactions.

Antidiarrheals: Mechanism of Action - Adsorbents

Adsorbents: Coat the walls of the GI tract. Bind to the causative bacteria or toxin, which is then eliminated through the stool. Examples: bismuth subsalicylate (Pepto-Bismol), activated charcoal, aluminum hydroxide, others.

Based on the nurse's knowledge of glucocorticoids, what instructions should be given for this drug? Advise that the drug does not have to be tapered before stopped. Inform the patient that the drug can be taken with coffee. Take the medication every evening. Advise to take drug with milk, other dairy products, or food.

Advise to take drug with milk, other dairy products, or food. Glucocorticoids can cause gastrointestinal (GI) distress and should be given with milk or food. They should not be administered with coffee, which contains caffeine and may increase gastric irritation. The best time to give exogenous glucocorticoids is early in the morning (6 AM to 9 AM) to minimize the amount of adrenal suppression. These medications should be tapered off slowly to prevent adrenal crisis and can be administered intravenously (IV).

What are AE of Prograf?

Agitation anxiety confudion hallucinations neuropathy albuminuria dysuria acute renal failure renal tubular necrosis post transplant diabetes

What is the most common potassium-sparing diuretic used?

Aldactone

What are the forms of Vitamin E?

Alpha Beta Gamma Delta tocopherol

Nursing implications

Always take BP and heart rate before giving any antihypertensive (parameters are usually set by the prescriber, HR should be > 60 and BP > 100 systolic. Always monitor for side effects. Monitor lab values.

Therapeutic effects of antihypertensives

An improvement in blood pressure and in the disease process. A return to a normal baseline level of blood pressure with improved energy levels and decreased signs and symptoms of hypertension, such as less edema, improved breath sounds, no abnormal heart sounds, capillary refill in less than 5 seconds, and less shortness of breath.

What is desiccated thyroid?

Animal thyroid (hogs). Lacks purity, uniformity, & stability

Fondaparinux (Arixtra)

Anticoagulant. Selective inhibitor of factor Xa,which is indicated for prophylaxis or treatment of DVT or PE. Contraindicated with patients with a creatinine clearance less than 30 ml/min or body weight of less than 50 kg. Bleeding is the most common and serious adverse reaction. Side effects : anemia, ^ wound drainage, postoperative hemorrhage, hematoma, confusion, UTI, hypotension, dizziness, and hypokalemia. Route by subcut

Argatroban

Anticoagulant. Synthetic direct thrombin inhibitor. Indicated both for treatment of HIT and for percutaneous coronary interventionprocedures in patients at risk for HIT. Lower dose must be given in patients with severe hepatic dysfunction. Route by IV

Dabigatran (Pradaxa)

Anticoagulant. Thrombin inhibitor approved for prevention of strokes and thrombosis in patients with nonvalvular atrial fibrillation. Drug interactions: phenytoin (decreased effect) and amiodarone (increased effect). Route by mouth

Heparin

Anticoagulant. When given by IV infusion, monitoring by frequent measures of aPPT (usually every 6 hours until therapeutic effects are seen) Antidote: protamine sulfate. Route IV or Subcut

For transdermal forms of meds, how should you counsel your patient?

Apply patches to clean, residue-free, hairless area, and rotate sites. If cardioversion or use of defribilator is needed, remove the patch to avoid buring of skin.

Aspirin

Aspirin and dipyridamole (Aggrenox) used for Antiplatelet drug. Contraindication: flulike symptoms in children and teenagers. Patients with aspirin allergy must not receive NSAIDs. Route by mouth

Nursing Implications Psychotherapeutic Drugs in general:

Assess emotional status level of consciousness (LOC) contraindications to therapy and drug interactions. obtain baseline vitals obtain liver and renal function tests advise pt to avoid abrupt withdrawal advise pt to change position slowly in elderly patients monitor for oversedation and profound CNS depression

what are some important interventions that the nurse would take care of?

Assess for airway, breathing and circulation. Nurse would have resuscitative equipment and medications, like antidotes if they have them. Would assess for hypotension, or orthostatic hypotension. would assess neuroparameters such as commands and reflexes, level of consciousness, sedation, and pupil reflexes. Monitor for changes in sensation, movement in the extremities, distal pulses, temp with nerve blocks and spinal anesthesia. alert to the risk that anesthetic drugs can move upward, like in the spine so you would monitor the dermatomes, assess for spinal headaches as a result of a rise in the intracranial pressure, and pay special attention to careful assessment of serum potassium and magnesium levels because an imbalance of these will lead to an increased action of neuromuscular binding drugs

indications for class Ia drugs disopyramide procainamide quinidine

Atrial fibrillation premature atrial contractions premature ventricular contractions ventricular tachycardia

A patient is receiving dabigatran (Pradaxa). 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive his dose? A. Asthma B. Renal impairment C. History of myocardial infarction D. Elevated liver enzymes.

B

The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement? a. "I should keep taking ibuprofen for my arthritis." b. "I should use a soft toothbrush for dental hygiene." c. "I should decrease the dose if I start bruising easily." d. "I will double my dose if I forget to take it the day before."

B

The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering? a. Vitamin E b. Vitamin K (Phytonadione) c. Protamine (Protamine sulfate) d. Calcium gluconate

B

The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? a. Conversion of life-threatening ventricular dysrhythmias b. Conversion of recent-onset atrial fibrillation and flutter c. Treatment of dysrhythmias in patients with acute renal failure d. Treatment of PSVT

B

Which drug class is used to treat both hypertension and antidysrhythmias? a. Sodium channel blockers b. Calcium channel blockers c. Direct-acting vasodilators d. Alpha-adrenergic-blocking

B

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action? a. Does not aspirate before injecting the medication b. Massages the site after administration of the medication c. Administers the medication into subcutaneous (fatty) tissue d. Injects the medication greater than 2 inches away from the umbilicus

B

How is humoral immunity mediated?

B lymphocytes

the nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. which action by the nurse are appropriate (select all that apply) a. administer the potassium by slow IV bolus b. administer the potassium at a rate no faster than 20mEq/hour c. monitor the patients cardiac rhythm with heart monitor d. use an infusion pump for the administration of IV potassium chloride e. administer the potassium IV push.

B,C,D

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Diarrhea b. Visual halos c. Hypothyroidism d. Photosensitivity e. Overgrowth of gum tissue f. Blue gray skin discoloration

B,C,D,F

The nurse is teaching a patient about self-administation of enoxaparin (Lovenox). Which statement should be included in this teaching session? A. " we will need to teach a family member how to give this drug in your arm." B. "This drug is given in the folds of your abdomen, but at least 2 inches away from your naval. " C. "This drug needs to be taken at the same time every day with a full glass of water." D. "Be sure to massage the injection site thoroughly after giving the drug."

B.

A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse? A. "Not to worry. Eventually, tolerance will develop." B. "The physician can work with you on changing the dose and/or drugs." C. "Sexual dysfunction happens with this therapy, and you will learn to accept it." D. "This is an unusual occurrence, but it is important to stay on your medications."

B. "The physician can work with you on changing the dose and/or drugs."

A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply) A. A benzodiazepine taken as needed for allergies. B. A potassium supplement taken daily. C. An oral anticoagulant taken daily. D. An opioid used for occasional severe pain. E. An NSAID taken as needed for headaches.

B. A potassium supplement taken daily. E. An NSAID taken as needed for headaches.

The nurse notes in a patient's medical record that nesiritide (Natrecor) has been ordered. Based on this order, the nurse interprets that the patient has which disorder? A. Atrial fibrillation B. Acutely decompensated heart failure with dyspnea at rest C. Systolic heart failure D. Chronic, stable heart failure

B. Acutely decompensated heart failure with dyspnea at rest Rationale: Nesiritide is indicated for the treatment of acutely decompensated heart failure with dyspnea at rest. Digoxin is used for the treatment of atrial fibrillation and systolic heart failure. Nesiritide is not indicated for chronic, stable heart failure.

Before beginning a patient's therapy with tricyclic antidepressants, the nurse should assess for concurrent use of which medications or medication class? A. Aspirin B. Anticoagulants C. Diuretics D. Nonsteroidal antiinflammatory drugs

B. Anticoagulants, any anti-depresants interact with warfarin!!!

While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient? A. Decreased blood pressure B. Decreased heart rate C. Decreased conduction D. Decreased ectopic beats

B. Decreased HR Rationale: A negative chronotropic effect results in a decreased heart rate; this is one effect of cardiac glycosides. The other options are incorrect.

- When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse should monitor for which therapeutic effect? A. Sedation B. Decreased paranoia and delusions C. Decreased feeling of hopelessness D. Fewer suicidal ideations

B. Decreased paranoia and delusions question ask about anti-psychotic youd think it should decrease paranoira and delusions because thats what is for

The nursing is administering antihypertensive drugs to older adult patients. The nurse knows which adverse effect is of most concern for these patients? A. Dry mouth B. Hypotension C. Restlessness D. Constipation

B. Hypotension

A patient with type 2 diabetes mellitus has developed hypertension. What is the blood pressure goal for this patient? A. Less than 110/80 mmHg. B. Less than 130/80 mmHg. C. Less that 130/84 mmHg. D. Less that 140/90 mmHg.

B. Less than 130/80 mmHg.

A patient with a history of angina will be started on ranolazine (Ranexa). The nurse is reviewing the patient's history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.) A. Type 2 diabetes mellitus B. Prolonged QT interval on the electrocardiogram C. Heart failure D. Closed-angle glaucoma E. Decreased liver function

B. Prolonged QT Interval on the Electrocardiogram E. Decreased Liver Function Rationale: Ranolazine is contraindicated in patients with pre-existing QT prolongation or hepatic impairment. The other options are not contraindications.

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse knows to observe for which problem during the early time frame of this therapy? A. Hypertensive crisis B. Self-injury or suicidal tendencies C. Parkinsonian symptoms D. Euphoria

B. Self-injury or suicidal tendencies

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? A. The patient should avoid caffeine while on this drug. B. The patient should wear sunscreen while outside because of photosensitivity. C. Long-term therapy may result in nervousness and excitability. D. The medication may be taken with an antacid to reduce gastrointestinal upset.

B. The patient should wear sunscreen while outside because of photosensitivity.

When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab (Digifab)? (Select all that apply.) A. The patient reports seeing colorful halos around lights. B. The patient's serum potassium level is above 5 mEq/L. C. The patient is experiencing nausea and anorexia. D. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing. E. The patient has received an overdose of greater than 10 mg of digoxin. F. The patient reports fatigue and headaches.

B. The patient's serum potassium level is above 5 mEq/L. D.The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing. E. The patient has received an overdose of greater than 10 mg of digoxin. Rationale: Clinical situations that would require the use of digoxin immune Fab in a patient with digoxin toxicity include serum potassium level above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. Seeing colorful halos around lights and experiencing nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment.

The nurse is administering a stimulant drug. which are results of stimulation of the central nervous system (CNS) by these drugs? (select all that apply) A. increased fatigue B. decreased drowsiness C. increased repiration D. bradycardia E. euphoria

B. decreased drowsiness C. increased respiration D. bradycardia

A patient has been admitted to the emergency department with status epilepticus. The nurse knows that which drug is considered the first choice for this condition? A. phenobarbital (Luminal) B. diazepam (Valium) C. valproic acid D. phenytoin (Dilantin)

B. diazepam (Valium)

A patient with migraine headaches is being evaluated. one potential treatment is ergotamine tablets. the nurse notes that the patient has the following conditions. Which would be a contraindication to the use of ergotamine? A. asthma B. hypertension C. pregnancy D. hypothyroidism

B. hypertension

A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for potential adverse effects, which may include A. drowsiness. B. palpitations and anxiety. C. difficulty with urination. D. constipation.

B. palpitations and anxiety.

the nurse is giving an intravenous dose of phenytoin (Dilantin). which guidelines will the nurse follow for administration? (select all that apply) A. phenytoin should be injected quickly B. phenytoin should be injected slowly C. phenytoin should be followed by an injection of sterile saline D. continuous infusion should be avoided

B. phenytoin should be injected slowly C. phenytoin should be followed by an injection of sterile saline D. continuous infusion should be avoided

When a child is taking drugs for attention deficit hyperactivity disorder (ADHD), what will the nurse instruct the caregivers to closely monitor in the child? A. blood glucose levels B. physical growth, especially weight C. grades at school D. respiratory rates

B. physical growth, especially weight

The nurse is reviewing a patient's medication administration record. Which best describes a common use for doxapram (Dopram)? A. to control increased respiration caused by other drugs B. to treat respiratory insufficiency associated with chronic obstructive pulmonary disease C. to treat postoperative respiratory excitation D. to stimulate respiration's in patients with head injury

B. to treat respiratory insufficiency associated with chronic obstructive pulmonary disorder

Which drugs have an action similar to that of the naturally occurring hormone ADH? Select all that apply. A.) Cosyntropin (Cortrosyn) B.) Desmoprressin (DDAVP) C.) Somatropin (Humatrope) D.) Vasopressin (Pitressin) E.) OCtreotide (Sandostatin)

B.) Desmopressin (DDAVP) D.) Vasopressin (Pitressin)

The nurse is preparing to administer somatropin (Humatrope) and will monitor the patient for which adverse effects? Select all that apply. A.) Increased blood pressure B.) Headache C.) Flulike syndrome D.) Nausea E.) Hyperglycemia F.) Fever

B.) Headache C.) Flulike syndrome E.) Hyperglycemia

Hypokalemia causes

B.A.D. L.O.A.D. B-barters/Conns syndrome(hyperaldosteronism) A-alkalosis D-diuretics L-laxative abuse O-other causes: insulin overdose A-acute glucose load D-diarrhea

patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct? A. It is below the therapeutic level. B.It is within the therapeutic range. C. It is above the therapeutic level. D. It is at a toxic level.

B.It is within the therapeutic range. Rationale: The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are incorrect.

lab finding for DKA

BGL 250-500 mg/dl HCO3 18 mEq/L increase anion gap positive serum ketones serum osmolality <320 mOsm/kg hyponatremia

lab finding for Hyperosmolar Nonketotic syndrome

BGL >600 mg/dl HCO3 >18 mEq/L anion gap normal serum osmolality >320 mOsm/kg negative or small serum ketones hyponatremia

What are the cardiovascular adverse effects of beta blockers?

BRADYCARDIA, hypotension, atriventricular block

Causes of Acute Diarrhea

Bacterial Viral Drug Induced Nutritional factors Protozoa

What are potassium rich foods?

Bananas, oranges, dates, raisins, plums, fresh veggies, potato skins, red meat, fish

What are food sources of vitamin B3 (Niacin)?

Beans, turkey, liver, yeast, enriched whole-grain breads and cereals, wheat germ

Name some anorexiant drugs.

Benzohetamine (Didrex) methamphetamine (desoxyn) Phentermine (lonamin) Orlistat (Xenical) -Lipase inhibitor, not a CNS stimulant -Also used to treat obesity -may cause fecal incontinence

What are common B1 (Thiamine) deficiencies?

Berberi Wernicke's encephalopathy

________ help by slowing the heart rate and decreasing contractility, thereby decreasing oxygen demands.

Beta blockers

sotalol

Betapace selective beta blockers has prodysrhythmic properties contraindications include bronchial asthma, cardiogenic shock, and sinus bradycardia

Antihistamines- meclizine (Antivert) mechanism

Block H1 receptors, thereby preventing ACh from binding to receptors in the vestibular nuclei

dimenhydrinate (Dramamine) mechanism

Block H1 receptors, thereby preventing ACh from binding to receptors in the vestibular nuclei

diphenhydramine (Benadryl) mechanism

Block H1 receptors, thereby preventing ACh from binding to receptors in the vestibular nuclei

Calcium Channel Blockers

Block calcium channels in blood vessels (vascular smooth muscles), which causes vasodilation in arterioles (little to no effect in veins). *Therapeutic uses:* hypertension, angina, cardiac dysrhythmias.

Prokinetics- metocloperamide (Reglan) mechanism

Block dopamine in the CTZ or stimulate ACh receptors in the GI tract

Antidopaminergics- prochlorperazine (Compazine) mechanism

Block dopamine receptors in the CTZ

promethazine (Phenergan) mechanism

Block dopamine receptors in the CTZ

Aldosterone Antagonist

Block receptors of aldosterone. Example drug- Eplerenon

Serotonin Blockers- ondansetron (Zofran) mechanism

Block serotonin receptors in the GI tract, CTZ, and VC

Angiotensin Receptor Blockers (ARBs)

Block the *actions* of angiotensin II (ACE inhibitors block the *production* of angiotensin II). Effects are much like those of ACE inhibitors, but do not increase bradykinin (thus less incidence of a cough). *Therapeutic uses:* hypertension, heart failure, diabetic neuropathy, stroke prevention, prevent mortality following MI.

Verapamil (Calan, Isotopin)

Blocks calcium channels in the heart and blood vessels. The following occurs- - vasodilation - increased coronary artery perfusion *Indicated for* hypertension, angina, cardiac dysrhythmias. Administered P.O. or IV, extensive first pass through the liver. *Adverse effects:* edema, constipation, bradycardia, flushing, decreased conduction, headache. *Interactions:* beta blockers, grapefruit juice, digoxin.

What is hypoglycemia

Blood sugar less than 50

What is the site of action of topical adrenergic nasal decongestants?

Blood vessels surrounding nasal sinuses

A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? a. Memory enhancement b. Boosting the immune system c. Improving mood d. Promoting relaxation

Boosting the immune system Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.

What are the indications of Muromonad-CD3, mycophenolate, and tacrolimus?

Both prevention of rejection and treatment of organ rejection

Cultural implications

Both thiazide-type diuretics and calcium channel blockers (CCBs) are recommended as first-line therapy for management of HTN in black patients. Asian patients receiving a CCB have been reported as achieving the highest rates of control of HTN. ARBs and ACEIs appear to have tolerability and/or adherence advantages. Asian patients have increased risk of occurrence of serious side effects with diuretic use.

The most common adverse effects of adrenergic drugs are-

Bradycardia with reflex tachycardia. Postural and postexercise hypotension. Dry mouth Drowsiness, dizziness. Depression Edema Constipation Sexual dysfunction Other- headache, sleep disturbances, nausea, rash, and palpitations.

esmolol

Brevibloc ultra-short-acting beta blocker preferentially blocks the beta1-adrenergic receptors in the heart acute treatment of supraventricular tachydysrhythmias

Bronchodilators: what three conditions are they given for? What do bronchodilators do?

Bronchodilators are given for 1. asthma 2. chronic bronchitis 3. emphysema Bronchodilators relax and dilate the airways. They relax bronchial smooth muscle bands.

Laxatives

Bulk forming Emollient Hyperosmotic Saline Stimulant Peripherally acting opiod antagonists

Laxatives: Indications

Bulk forming: Acute/chronic constipation, irritable bowel syndrome, diverticulosis. Emollient: Acute/chronic constipation, fecal impaction, facilitation of BMs in anorectal conditions. Hyperosmotic: Chronic constipation, diagnostic and surgical preps. Saline: Constipation, diagnostic and surgical preps. Stimulant: Acute constipation, diagnostic and surgical preps.

Calcium channel blockers have which pharmacodynamic effect? a. Positive inotropic b. Positive chronotropic c. Coronary vasodilation d. Shortened refractory period

C

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

C

Treatment of hyperkalemia

C BIG K: C-calcium gluconate B- bicarbonate insulin G-glucose K-Kayexalate (removes excess potassium)

A 46-year-old man has been taking clonidine for 5 months. For the past 2 months, his blood pressure has been normal. During this office visit, he tells the nurse that he would like to stop taking the drug. What is the nurse's best response? A. "I'm sure the doctor will the stop it — your blood pressure is normal now." B. "Your doctor will probably have you stop taking the drug for a month, and then we'll see how you do." C. "This drug should not be stopped suddenly; let's talk to your doctor." D. "It's likely that you can stop the drug if you exercise and avoid salty foods."

C. "This drug should not be stopped suddenly; let's talk to your doctor."

A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the nurse give this drug? A. Infuse the drug into the same intravenous line as the milrinone. B. Stop the milrinone, flush the line, and then administer the furosemide. C. Administer the furosemide in a separate intravenous line. D. Notify the prescriber that the furosemide cannot be given at this time.

C. Administer the furosemide in a separate intravenous line. Rationale: Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the patient's condition. A separate line will be needed. The other options are incorrect.

While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect? A. Nervousness B. Hypertension C. Bradycardia D. Dry cough

C. Bradycardia Rationale: Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness.

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will assess for what immediate concern? A. Hypertension B. Headache C. Cardiac dysrhythmias D. Gastrointestinal bleeding

C. Cardiac dysrhythmias because TCA block re-uptake of neurotransmitters and allows themto accummulate at nerve endings, the more Neurotransmitters the better the mood tho.

In a patient taking an MAOI, which of the following breakfast choices would indicate the need for additional teaching? A. Orange juice B. Fried eggs C. Cheddar cheese omelet D. French toast

C. Cheddar cheese omele

When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? A. Diarrhea B. Nausea C. Dry, nonproductive cough D. Sedation

C. Dry, nonproductive cough

The nurse is obtaining a drug history on the patient being treated for hypertension. The prescriber has chosen the angiotensin receptor blocker losartan (Avapro) to treat the patient's hypertension. Which drug on the patient's current drug list would most concern the nurse? A. Furosemide B. Albuterol C. Ibuprofen D. Augmentin

C. Ibuprofen (An NSAID)

A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction? A. Take up to 5 doses at 15-minute intervals for an angina attack. B. If the tablet does not dissolve quickly, chew the tablet for maximal effect. C. If the chest pain is not relieved after one tablet, call 911 immediately. D. Wait 1 minute between doses of sublingual tablets, up to 3 doses.

C. If the chest pain is not relieved after one tablet, call 911 immediately. Rationale: According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved.

The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect? A. Increased heart rate B. Increased blood vessel dilation C. Increased force of cardiac contractions D. Increased conduction of electrical impulses across the heart

C. Increased force of cardiac contractions Rationale:Positive inotropic drugs increase myocardial contractility, thus increasing the force of cardiac conduction. Positive chronotropic drugs increase the heart rate. Positive dromotropic drugs increase the conduction of electrical impulses across the heart. Blood vessel dilation is not affected.

A patient receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? A. Opiods B. Acetaminophen (tylenol) C. NSAIDs D. There are no restrictions

C. NSAIDs

When the nurse is administering topical nitroglycerin ointment, which technique is correct? A. Apply the ointment on the skin on the forearm. B. Apply the ointment only in the case of a mild angina episode. C. Remove the old ointment before new ointment is applied. D. Massage the ointment gently into the skin, and then cover the area with plastic wrap.

C. Remove the old ointment before new ointment is applied. Rationale: The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.

Which of the following statements are true regarding the selective serotonin-reuptake inhibitors (SSRIs)? Select all that apply. A. Foods and beverages containing tyramine should be avoided. B. The nurse should monitor for extrapyramidal symptoms. C. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. D. If the patient has been on an MAOI, there should be a 2- to 5-week or longer span of time before beginning an SSRI medication. E. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. F. Cogentin is often also prescribed to reduce the adverse effects that may occur.

C. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. D. If the patient has been on an MAOI, there should be a 2- to 5-week or longer span of time before beginning an SSRI medication.

When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation? A. To prevent low blood pressure B. To relieve shortness of breath C. To prevent the occurrence of angina D. To keep the heart rate from rising too high during exercise

C. To prevent the occurrence of angina Rationale: Transdermal dosage formulations of nitroglycerin are used for the long-term prophylactic management (prevention) of angina pectoris. Transdermal nitroglycerin patches are not appropriate for the relief of shortness of breath, to prevent palpitations, or to control the heart rate during exercise.

- A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? A. Cogwheel rigidity B. Drowsiness and dizziness C. Tremors and muscle twitching D. Dry mouth, constipation, and blurred vision

C. Tremors and muscle twitching

The nurse is administering phenobarbital (Luminal) and will monitor the patient for which possible adverse effect? A. constipation B. gingival hyperplasia C. drowsiness D. dysrhythmias

C. drowsiness

A patient who is experiencing neuropathic pain tells the nurse that the physician is going to start him on a new medication that is generally used to treat seizures. The nurse anticipates that which drug will be ordered? A. phenobartial (Luminal) B. phenytoin (Dilantin) C. gabapentin (Neurontin) D. tigabine (Gabitril)

C. gabapentin (Neurontin)

A nurse is administering octreotide (Sandostatin) to a patient who has a metastatic carcinoid tumor. The patient asks about the purpose of this drug. What is the nurse's best response? A.) "This drug helps to reduce the size of your tumor." B.) "This drug works to prevent the spread of your tumor." C.) "This drug helps to control the flushing and diarrhea that you are experiencing." D.) "This drug reduces the nausea and vomiting you are having from the chemotherapy."

C.) "This drug helps to control the flushing and diarrhea that you are experiencing."

During vasoprerssin therapy, which is the priority nursing action? A.) Check blood glucose levels regularly. B.) Monitor the electrocardiogram for changes. C.) Monitor the IV site for signs of infiltration. D.) Watch for hyperthermia.

C.) Monitor the IV site for signs of infiltration.

A patient who is about to be given octreotide is also taking a diuretic, IV, heparin, ciprofloxacin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction? A.) Hypokalemia due to an interaction with the diuretic B.) Decreased anticoagulation due to an interaction with the heparin C.) Prolongation of the QT interval due to an interaction iwth the ciprofloxacin D.) Increased sedation if the opioid is given

C.) Prolongation of the QT interval due to an interaction iwth the ciprofloxacin

-cimetidine (Tagamet) -Ranitidine (Zantac) - Famotidine (Pepcid)

CImetidine ( Tagament) - First drug of this class. First major prescription drug to go OTC. - Due to potential to cause drug interactions, it has been largely replaced by Zantac and Pepcid Ranitidine ( Zantac) - 2nd H2 to be introduced - does not have the drug interactions that tagemet does, it has become the most widely used - in oral and intravenous form Famotidine ( Pepcid) - - does not have the drug interactions that tagemet does -oral and injecticle form

Barbiturates and the mechanism of action

CNS depressants that INHIBITS nerve impulses transmission by potentiating the inhibitory neurotransmitter GABA. this raises the seizure threshold.

What are some Barbiturate interactions?

CNS depression occurs with co-administration with alcohol, antihistamines, benzodiazepines, oipiods and tranquilizers. enzyme inductions include- hepatic microsomal p-450 enzymes by the increased drug metabolism and breakdown, MAOI's tricyclic antidepressants, anticoagulants and oral contraceptives

Antidiarrheals: Adverse Effects - Anticholinergics

CNS: headache, dizziness, confusion, anxiety, fatigue, weakness, drowsiness. CV: hypertension or hypotension, dysrhythmias: V-tach or V-fib, palpitations. GU: urinary retention, hesitancy, impotence. Senses: Mydriasis, blurred vision, increase IOP. Skin: dry skin, flushing.

What are common Xanthine derivatives

Caffeine Theophylline Aminophylline

verapamil

Calan calcium-channel blocker inhibits calcium ion influx across the slow calcium channels prevents and convert recurrent PSVT and control ventricular response to atrial flutter or fibrillation also used for angina, hypertension, and hypertrophic cardiomyopathy

What is the most abundant mineral in the body?

Calcium

_______ work by decreasing calcium influx into the smooth muscle, causing vascular relaxation. This either reverses or prevents the spasms of coronary vessels that cause the angina pain associated with prinzmetal or chronic angina.

Calcium channel blockers

Antacids OTC formulations

Capsules and tablets Powders Chewable tablets Suspensions Effervescent granules and tablets

Examples of Angiotensin-Converting Enzyme (ACE) Inhibitors

Captopril Enalapril Fosinopril Lisinopril Moexipril Ramipril

What is the function of B1 (Thiamine)?

Carbohydrate metabolism metabolic pathways Maintains integrity of PNS, Cardiovascular system, GI tract

What are contraindications to treatment of respiratory illness?

Cardiac disease, renal disease, pneumonia

What kind of drug is atenolol?

Cardioselective beta 1 adrenergic receptor drug.

diltiazem

Cardizem calcium-channel blocker temporary control of a rapid ventricular response in patients with atrial fibrillation or flutter and PSVT contraindicated in acute MI, pulmonary congestion, sever hypotension, cardiogenic shock, certain AV blocks

Direct-acting vasodilators

Cause direct vasodilation of peripheral arteries and veins. Example drugs- Hydralazine, Sodium nitroprusside, Minoxidil.

Sodium Nitroprusside (Nipride)

Causes arterial and venous dilation. Administered via IV only; effect begins immediately. *Adverse effects:* reflex tachycardia, excessive hypotension, cyanide poisoning (delirium, hallucinations). *Black box alert*: should only be mixed with D5W. Fresh solutions may appear faint brown in color; solutions that are deeply colored should be discarded. Protect from light when administering. Max rate of 10 mcg/kg/min (max rate can only be for 10 min. Do not mix with other drugs.

Hydralazine (Apresoline)

Causes selective dilation of arterioles, has little or no effect on veins. Occurs from direct action on vascular smooth muscle. Metabolism occurs by acetylation and is highly variable among patients. *Used to treat:* essential hypertension, hypertensive crisis, heart failure. *Adverse effects:* lupus-like syndrome (fever, joint pain, rash), reflex tachycardia, fluid retention, neutropenia, hemoglobin. Available P.O. and IV (IV reserves for treating hypertensive crisis).

Clonidine (Catapres)

Centrally acting alpha 2 receptor agonist. Highly lipid soluble. *Approved for* hypertension (HTN), severe pain, and ADHD. Off-label or investigational uses: migraine prevention, opioid withdrawal, Tourette's. *Adverse effects:* dry mouth, constipation, nightmares, sedation, rebound hypertension (if abruptly d/c), sexual dysfunction. Usually administer twice a day (BID); available as a transdermal patch. *Safety measures:* take 2nd dose at bedtime, monitor blood pressure, change positions slowly; use hard candy, gum, and increase fluid intake.

When developing a nursing care plan for a patient receiving epoetin alfa (Epogen), the nurse will include monitoring for which adverse effect? Chronic diarrhea Severe hypotension Impaired liver function Change in level of consciousness

Change in level of consciousness

Affective Disorders (mood disorders)

Changes in mood that range from mania to depression. * Some apitents may exhibit both mania and depression: bipolar disorder (BPD)

What drugs interacts with calcium?

Chelation Digoxin

What nursing implementations are associated with Ergot alkaloids?

Chest pain Confusion slurred speech vision changes need immediate medical attention

What is angina pectoris?

Chest pain that occurs when the heart's supply of blood carrying oxygen is insufficient to meet the demands of the heart. The heart muscle "aches"

What is an example of an opioid antitussive?

Codeine (Robitussin A-C, Dimetane-DC) - sometimes hydrocodone

Antacids: Adverse Effects & Contraindications

Contraindications : Known allergy. evere renal failure or electrolyte disturbances (because of the potential toxic accumulation of electrolytes in the antacids themselves) and GI obstruction (antacids may stimulate GI motility when it is undesirable because of the presence of an obstructive process requiring surgical intervention). Adverse effects: -Minimal, and depend on the compound used -Aluminum and calcium Constipation -Magnesium Diarrhea -Calcium carbonate Produces gas and belching; often combined with simethicone( antiflatulent drug)

Sodium is responsible for

Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participation in acid-base balance

amiodarone

Cordarone Pacerone prolongs the action potential duration and the effective refractory period blocks alpha- and beta-adrenergic receptors of the SNS drug of choice for ventricular dysrhythmias adverse effects: concentrate in adipose tissue, cause hypothyroidism or hyperthyroidism, vorneal microdeposits, photophobia, dry eyes, pulmonary toxicity has a long half-life interacts with digoxin and warfarin

Male > 45 Female>55 Premature menopause Htn > 140/90 On a hypertensive medication HDL < 35 DM Family history Smoker The risk associated with?

Coronary Heart Disease

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

Correct Answer:C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur.

Primary side effects of SSRI's include which of the following symptoms: 1. Rash and alopecia 2. Gastritis and diarrhea 3. Weight gain and sexual dysfunction 4. Photosensitivity and discoloration of the skin

Correct answer: 3, Weight gain and sexual dysfunction.

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

Correct answer: A Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. **acute mania level 1.0-1.5 Levels above 1.5 cause toxicity, GI issues, tremor, confusion, seizures, somnolence ***(Lithium is the drug of choice in treatment of mania)

When administering certain antipsychotic drugs, the nurse monitors for extrapyramidal effects such as (select all that applys) a. tremors b. elation and a sense of well-being c. painful muscle spasms d. motor restlessness e. bradycardia

Correct answer: A, C, D

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

Correct answer: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. St. John's Wort is used for depression, anxiety, sleep disorders, and nervousness

During therapy for depression with SSRI, it is most important for the nurse to instruct the family to monitor for which adverse effect? a. Suicidal thoughts b. Visual disturbanes c. Tradive dyskinsesia d. Bleeding tendencies

Correct answer: A, Suicidal thoughts

A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b .Palpitations and anxiety c. Dry mouth d. Constipation

Correct answer: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. -interacts with anticoagulants,immunosupressants, anticonvulsants, and antidiabetic drugs -used for more than 5000 years -used for stress reduction, increase physical endurance, and increased concentration

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

Correct answer: B In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed.

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a.The patient needs to avoid caffeine while on this drug. b.The patient needs to wear sunscreen while outside because of photosensitivity. c.Long-term therapy may result in nervousness and excitability. d.The medication may be taken with an antacid to reduce gastrointestinal upset.

Correct answer: B Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

Correct answer: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

Correct answer: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a.Avoid foods and beverages that contain tyramine. b.Monitor the patient for extrapyramidal symptoms. c.Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d.If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e.These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f.Cogentin is often also prescribed to reduce the adverse effects that may occur.

Correct answer: C, D During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications.

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a."I can't sleep at night." b."I feel hungry all the time." c."Look at how red my hands are." d."My mouth has been so dry lately."

Correct answer: D Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.

What outcome represents the most serious adverse effect of lithium? 1. Renal failure 2. Hyponatremia 3. Respiratory depression 4. Cardiac dysrhythmia

Correct answer: D Cardiac dysrhythmia *cardiac dysrhythmia is an abnormal heart beat: Some dysrhythmias are potentially life threatening while other dysrhythmias (such as sinus arrhythmia) and normal.

The nurse reads in the patient's medication history that the patient is taking Buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder

Correct answer:A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a . "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c ."It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

Correct answer:B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. It can take 4-6 weeks*

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a .Fewer panic attacks b .Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

Correct answer:B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs.

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

Correct answer:B Anticoagulants Use of SSRI antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed.

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b ."Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

Correct answer:D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Hypertensive crisis may occur.

ibutilide

Corvert only class III drug indicated for atrial dysrhythmias based on patient weight can produce dysrhythmias should not be given with disopyramide, quinidine, procainamide, amiodarone, and sotalol

A patient is being assessed for possible adrenocortical insufficiency. The physician orders a dose of cosyntropin (Cortrosyn). The patient, upon hearing that he will be receiving an injection, states "Oh, good! The doctor has already found something to cure me!" How will the nurse respond?

Cosyntropin (Cortrosyn) is used for the diagnosis of adrenocortical insufficiency, not for treatment. Once a diagnosis is made, the actual drug treatments generally involves replacement hormonal therapy using drug forms of the deficient corticosteroid hormones.

Vitamin B12

Cyanocobalamin

Liothyronine

Cytomel T3 Thyroid replacement

A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding." b. "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." c. "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." d. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect."

D

A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? a. Atrial fibrillation b. Sinus bradycardia c. First-degree heart block d. Ventricular dysrhythmias

D

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? a. Vitamin K (Phytonadione) b. Vitamin E c. Phenytoin (Dilantin) d. Protamine (Protamine sulfate)

D

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? a. Thrombolytic drug b. Oral anticoagulant c. Glycoprotein IIb/IIIa inhibitor d. Low-molecular-weight heparin

D

The nurse understands adenosine (Adenocard) is used to treat which condition? a. Atrial flutter b. Atrial fibrillation c. Second-degree atrioventricular block d. Paroxysmal supraventricular tachycardia (PSVT)

D

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)? a. Prothrombin time (PT) b. Blood urea nitrogen c. Complete blood count d. Activated partial thromboplastin time (aPTT)

D

The patient asks the nurse, "What is the difference between dalteparin (Fragmin) and heparin?" What is the nurse's best response? a. "There is really no difference, but dalteparin is preferred because it is less expensive." b. "I'm not really sure why some health care providers choose dalteparin and some heparin." c. "The only difference is that the heparin dosage calculation is based on the patient's weight." d. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect."

D

A patient has been taking a beta blocker for 4 weeks as part of his antianginal therapy. He also has type II diabetes and hyperthyroidism. When discussing possible adverse effects, the nurse will include which information? A. "Watch for unusual weight loss." B. "Monitor your pulse for increased heart rate." C. "Use the hot tub and sauna at the gym as long as time is limited to 15 minutes." D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."

D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia." Rationale: Beta blockers can cause both hypoglycemia and hyperglycemia. They may also cause weight gain if heart failure is developing, and decreased pulse rate. The use of hot tubs and saunas is not recommended because of the possibility of hypotensive episodes.

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. He has shown marked improvement. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? A. "I can't sleep at night." B. "I feel hungry all the time." C. "Look at how red my hands are." D. "My mouth has been so dry lately."

D. "My mouth has been so dry lately." common effect of phenothiazines is dry mouth!!!!

A 44-year-old patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which statement by the nurse is appropriate in reply? A. "That should be no problem." B. "Soon you'll be able to stop taking the Zoloft!" C. "Be sure to stop taking the herb if you notice a change in adverse effects." D. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

D. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab (Digifab). The patient asks the nurse why the medication is ordered. What is the nurse's best response? A. "It will increase your heart rate." B. "This drug helps to lower your potassium levels." C. "It helps to convert the irregular heart rhythm to a more normal rhythm." D. "This drug is an antidote to digoxin and will help to lower the blood levels."

D. "This drug is an antidote to digoxin and will help to lower the blood levels." Rationale: Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose. It is given intravenously. The other options are incorrect.

A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct? A. Chew the tablet for faster release of the medication. B. To increase the effect of the drug, take it with grapefruit juice. C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately. D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.

D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur. Rationale: Constipation is a common effect of CCBs, and a high-fiber diet and plenty of fluids will help to prevent it. Grapefruit juice decreases the metabolism of CCBs. Extended-release tablets must never be chewed or crushed. These medications should never be discontinued abruptly because of the risk for rebound hypertension

The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin? A. Leafy green vegetables B. Dairy products C. Grapefruit juice D. Bran muffins

D. Bran Muffins Rationale: Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels.

A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion? A. Hypertension B.Hyperkalemia C. Nausea and vomiting D. Cardiac dysrhythmias

D. Cardiac Dysrhythmias Rationale: The primary adverse effects seen with milrinone are cardiac dysrhythmias, mainly ventricular. It may also cause hypotension, hypokalemia, and other effects, but not nausea and vomiting.

- A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" What advice should the nurse give to this patient? A. Drinking beer is permitted as long as he has a designated driver. B. He can drink beer if it is a low-calorie product. C. If he begins to experience a throbbing headache, rapid pulse, or nausea, he should stop drinking. D. He needs to avoid all foods that contain tyramine, including beer, while taking the MAOI.

D. He needs to avoid all foods that contain tyramine, including beer, while taking the MAOI.

The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? A. Dizziness B. Blood pressure of 130/ 98 mm Hg C. Slight bloody oozing from the IV insertion site D. Irregular heart rhythm

D. Irregular heart rhythm

The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication? A. The solution will be slightly colored green or blue. B. The intravenous form is given by bolus injection. C. It can be given in infusions with other medications. D. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.

D. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used. Rationale: The non-PVC infusion kits are used to avoid absorption and/or uptake of the nitrate by the intravenous tubing and bag and/or decomposition of the nitrate. The medication is given by infusion via an infusion pump and not with other medications. It is not given by bolus injection. If the parenteral solution is discolored blue or green, it should be discarded.

What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy? A. Omit a dose once a week. B. Leave the patch on for 2 days at a time. C. Cut the patch in half for 1 week until the tolerance subsides. D. Remove the patch at bedtime, and then apply a new one in the morning.

D. Remove the patch at bedtime, and then apply a new one in the morning. Rationale: To prevent tolerance, remove the transdermal patch at night for 8 hours, and apply a new patch in the morning. Transdermal patches must never be cut or left on for 2 days, and doses must not be omitted.

The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? A. Asthma B. Rheumatoid arthritis C. Hyperthyroidism D. Renal insufficiency

D. Renal insufficiency

A patient in her eighth month of pregnancy has preeclampsia. Her blood pressure is 210/100 mmHg this morning. This type of hypertension is classified as which of the following? A. Primary B. Idiopathic C. Essential D. Secondary

D. Secondary

A 22-year-old patient has been taking lithium for 6 months. She comes in for blood work every month, and the nurse assesses her for signs of toxicity. What are indications of toxicity? A. Serum lithium level 0.5 mEq/L and excitability B. Serum lithium level 0.8 mEq/L and palpitations C. Serum lithium level 1.0 mEq/L and hypertension D. Serum lithium level 1.5 mEq/L and cardiac dysrhythmias

D. Serum lithium level 1.5 mEq/L and cardiac dysrhythmias

A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min. What will the nurse do next? A. Administer the dose. B. Administer the dose, and notify the prescriber. C. Check the radial pulse for 1 full minute. D. Withhold the dose, and notify the prescriber.

D. Withhold the dose, and notify the prescriber Rationale: Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. The other options are incorrect.

The physician has ordered orlistat (Xenical). the nurse recognizes that this drug is used to treat which condition? A. anorexia B. malnutrition C. narcolepsy D. obesity

D. obesity

A patient has been taking antiepileptic drugs for a year. the nurse is reviewing his recent history and will monitor for which condition that may develop during this time? A. loss of appetite B. jaundice C. weight loss D. suicidal thoughts or behavior

D. suicidal thoughts or behavior

When administering vasopressin, which is the priority vital sign for the nurse to monitor? A.) Temperature B.) Pulse C.) Respiration D.) Blood Pressure

D.) Blood Pressure

A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? A.) Octreotide (Sandostatin) B.) Vasopressin (Pitressin) C.) Somatropin (Humatrope) D.) Cosyntropin (Cortrosyn)

D.) Cosyntropin (Cortosyn)

When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful? A.) Increased insulin levels B.) Decreased diarrhea C.) Improved nasal patency D.) Decreased thirst

D.) Decreased thirst

The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which type of drug would raise a concern that needs to be addressed before the patient starts the somatropin? A.) Nonsteroidal antiinflammatory drug for arthritis B.) Antidepressant drug C.) Penicillin D.) Glucocorticoid

D.) Glucocorticoid

what is the prototype benzodiazepines?

DIAZEPAM (Valium) its an antianxiety, anticonvulsant, sedative/hypnotic, and skeletal muscle relaxant. It's a schedule IV drug, which means it has the potential for abuse. pregnancy category D, half life is 20-50 hours; the metabolites also cause a sedation up to 100 hours! this is the DRUG OF CHOICE TO TREAT STATUS EPILETICUS WHICH ARE SUSTAINED SEIZURES.

A patient informs the nurse she must take her iron with a meal to avoid stomach upset. To increase uptake of oral iron, which food group should the nurse instruct the patient to avoid? Proteins Fruits Vegetables Dairy

Dairy

Benzodiazepines

Dangerous potential of overdose when taken with other sedatives or alcohol. (overdose can also occur in patients with renal or hepatic compromise) ***Adverse affects include: Decrease CNS sedation Hypotension Drowsiness Nausea, vomiting dry mouth constipation

what is the name of the drug that works specifically on skeletal muscles?

Dantroline

How does a pt become deficient in fat-soluble vitamins?

Deficiencies occur only after prolonged deprivation from an adequate supply or from disorders that prevent their absorption

What is type 1 diabetes?

Diabetes mellitus that is a genetically determined autoimmune disorder characterized by a complete or nearly complete lack of insulin production; it most commonly arises in children or adolescents.

What is the main carbohydrate anhydrase inhibitor used?

Diamox ("di" rhymes with "eye"... Think decreases intra-occular pressure by increasing outflow of aqueous humor from the "eye")

what drugs are benzodiazepines?

Diazapam ( Valuim), alprazolam (Xanax), chlordiazepoxide (Librium), flurazepam (dalmane), lorazepam (Ativan), midazolam ( versed), triazolam (halcoin), temazepam (restoril)- which is intermediate acting, induces sleep within 20 to 40 minutes, take one hour prior to going to bed., and clonazepam (klonopin)

Nifedipine (Procardia)

Differs from verapamil and diltiazem in that it does not produce blockade of calcium channels in the heart, only in the periphery (therefore it is not used for dysrhythmias). Causes vasodilation by blocking calcium channels in the peripheral arterioles. Activates the baroreceptor reflex (reflex tachycardia)- can combine with a beta blocker to prevent it. Used for angina and hypertension. Adverse effects are similar to verapamil and diltiazem, except it causes *reflex tachycardia* instead of bradycardia or heart block.

Aliskiren (Rasilez, Tekturna)

Direct Renin Inhibitor. Approved only for hypertension. Route- P.O., avoid high fat foods/meals. *Adverse effects-* angioedema, cough, diarrhea, hyperkalemia. *Black box alert*- fetal injury/harm.

What is the treatment for overdose/toxicity of Vitamin A?

Discontinue drug

Diuretics: mechanism of action

Diuretic refer to a class of drugs that accelerate the rate of urine formation and excretion. The result is a removal of sodium and water from the body.

Antihistamines- meclizine (Antivert) AE

Dizziness, drowsiness, confusion Blurred vision, dilated pupils, dry mouth Urinary retention

Anticholinergics- scopolomine AE

Dizziness, drowsiness, disorientation Tachycardia Blurred vision, dilated pupils, dry mouth Difficult urination, constipation Rash, erythema

Contraindications for a beta-agonist?

Do NOT give to a patient with 1. HTN or 2. dysrhythmias

During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? a. Constipation b. Abdominal cramps c. Drowsiness d. Decreased libido

Drowsiness Drowsiness is usually the chief complaint of people who take antihistamines.

Antidiarrheals: Adverse Effects - Opiates

Drowsiness, sedation, dizziness, lethargy. Nausea, vomiting, anorexia, constipation. Respiratory depression. Hypotension. Urinary retention. Flushing.

Contraindications for use of adrenergic antihypertensives

Drug allergy Acute heart failure Concurrent use of monoamine oxidase inhibitors (MAOIs) Peptic ulcer Severe liver or kidney disease Asthma (with use of any non-selective beta blockers)

Contraindications to the use of Angiotensin-Converting Enzyme (ACE) Inhibitors

Drug allergy Patients with a high baseline potassium level. Lactating women Children Patients with bilateral renal artery stenosis.

What are some contraindications for nitrates/nitrites?

Drug allergy, severe anemia, closed-angled glaucoma, hypotension, severe head injury, erectile dysfunction drugs.

What are the concerns with the use of nonselective beta blockers and beta 2 blockers (as vasodilators) in patients with bronchospastic disease?

Drug related effects of bronchoconstriction and increased airway resistance, which results in wheezing and dyspnea as adverse effects.

What are expectorants?

Drugs that aid in the removal of mucus - reduce the viscosity of secretions

Hemorheologic drugs

Drugs that alter the function of platelets without compromising their blood-clotting properties

Thrombolytic drugs

Drugs that dissolve thrombi by functioning similarly to tissue plasminogen activator

Antifibrinolytic drugs

Drugs that prevent the lysis of fibrin and in doing so promote clot formation

Adverse effects of Angiotensin-Converting Enzyme (ACE) Inhibitors

Dry cough Taste impairment Rash Angioedema Hyperkalemia Agranulocytosis

What are adverse effects of anticholinergics

Dry mouth Difficulty urinating Constipation Change in vision Drowsiness

SE of an anti-cholinergic bronchodilator?

Dry mouth, headache

What is the main problem with loop diuretic drug therapy?

Electrolyte imbalance & dehydration; pt. will need K+ supplement

The formation of erythrocytes and maturation of the red blood cell (RBC) is driven by what hormone? Progesterone Testosterone Erythropoietin Free thyroxin

Erythropoietin

Thromboembolic events

Events in which a blood vessel is blocked by an embolus carried in the bloodstream from the site of formation. The tissue supplied by an obstructed artery may tingle and become cold, numb, cyanotic, and eventually necrotic (dead)

Prokinetics- metocloperamide (Reglan) AE

Extrapyramidal adverse effects can occur with its use, especially in young adults *potential for developing tardive dyskinesia with long-term use*

Proton Pump Inhibitors: Indications

FIRST LINE THERAPY FOR: -GERD maintenance therapy -Erosive esophagitis -Short-term treatment of active duodenal and benign gastric ulcers -Zollinger-Ellison syndrome - NSAIDs induced ulcers - Stress ulcer prophylaxis -Treatment of H. pylori-induced ulcers ( combined with antibiotics)

what is the reversal agent for overdose of benzodiazepines?

FLUMAZENIL. this is the antidote and it is indicated for the reversal of moderate sedation or general anesthesia

screening for DM

Fasting plasma glucose (FPG) levels higher than or equal to 110 mg/dL but less than 126 mg/dL may indicate "prediabetes". Glucose tolerance level (oral glucose challenge). Screening recommended every 3 years for all patients 45 years or older.

Diuretics: first line of treatment for what disease?

First line of treatment for HTN and CHF. Other indications: kidney failure and liver failure.

What is the first sign of Xanthine derivative toxicity?

First sign in N/V and anorexia. ...Think: when you are in the woods camping, increased risk for GI issues

Which foods have Vitamin D?

Fish liver oils, saltwater fish, milk, orange juice, cereals, animal livers, eggs, butter, dairy products

What should you assess in patients taking calcium channel blockers?

Food interactions (grapefruit), vital signs, hypotension, palpitations, tachycardia/bradycardia, constipation, dyspnea and edema.

Haloperidol (Haldol)(antipsychotic)

For use in long term treatment of psychosis. Useful in treating patients with schizophrenia who were nonadherent with their drug therapy. Long term use may result in tremors, nausea, vomiting, uncontrollable shaking of small muscle groups.

A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? a. Force fluids to help loosen and liquefy secretions. b. Report clear-colored sputum to the prescriber. c. Avoid driving a car or operating heavy machinery because of the sedating effects. d. Report symptoms that last longer than 2 days.

Force fluids to help loosen and liquefy secretions. Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient also must report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.

Analeptics (Caffeine)

Found in: - OTC drugs - Combination prescription drugs - Foods and beverages

What are food sources of Vitamin E?

Fruits, grains, fortified cereals, vegetable oils, wheat germ, nuts, eggs, chicken, meats, fish

What is the Main Loop Diuretic drug?

Furosemide (Lasix), think "fur"ious release of fluids **Always take a potassium supplement with Lasix

Eptifibatide (Integrilin), tirifiban (aggrastat), and abciximab (ReoPro)

GP IIb/IIIa inhibitor. They block the receptor protein by the same name that occurs in the platelet wall membranes. (Antiplatelet drug). Route by IV infusion only

We are a class of Adrenal agents commonly used for asthma control

Glucocorticoids

What are food sources of Vitamin B2 (Riboflavin)?

Green, leafy veggies eggs and dairy nuts, legumes, meats, liver, yeast, enriched whole-grain products

What is the function of Vitamin A in the body?

Growth and development of bones and teeth Night and normal vision Reproduction Integrity of mucosal and epithelial surfaces Cholesterol and steroid synthesis

What is an example of an expectorant?

Guaifenesin (Mucinex) - many OTC cold and flu medications

SE of singulair?

HA, nausea, liver toxicity

What are the adverse effects of nitrates/nitrites?

HEADACHE (most common), tachycardia, postural hypotension, reflex tachycardia (if vasodilation occurs too rapidly , cardio system overcompensates and increases the heart rate), tolerance may also develop.

What are the AE of cyclosporine?

HTN neurotoxicity tremors hepatotoxicity nephrotoxicity posttransplant diabetes gingival hyperplasia hirsutism

What are signs of Vitamin D toxicity?

HTN, Weakness, fatigue, HA, Anorexia, dry mouth, metallic taste, N/V, ataxia, bone pain, impaired renal fxn and osteoporosis

1. When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action? a. Causing depression of the central nervous system b. Anesthetizing the stretch receptors c. Having direct action on the cough center d. Decreasing the viscosity of the bronchial secretions

Having direct action on the cough center Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.

Serotonin Blockers- ondansetron (Zofran) AE

Headache Diarrhea Rash, bronchospasm, prolonged QT interval

Monitored by PTT levels and is reversed by protamine sulfate

Heparin

Secondary hypertension

High blood pressure caused by another disease such as renal, pulmonary, endocrine, or vascular disease. May also result from the use of certain medications.

Essential hypertension

High blood pressure with no known cause. 90% of cases are this type. Also called primary or idiopathic hypertension.

When assessing for potential adverse effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which condition? Hypovolemia Hyponatremia Hypercalcemia Hypokalemia

Hypercalcemia Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. Thus, a potential adverse effect is hypokalemia. Assessing for signs and symptoms of hypokalemia and close monitoring of electrolytes is needed.

What are contraindications to Vitamin D?

Hypercalcemia Renal dysfunction kidney stones hyperphosphatemia

What are the metabolic adverse effects of beta blockers?

Hyperglycemia and/or hypoglycemia, hyperlipidemia

What can cause calcium deficiency?

Hypoparathyroidism malabsorption Inadequate intake of calcium or Vitamin D

diphenhydramine (Benadryl) AE

Hypotension, palpitations, syncope Sedation, dizziness, muscular weakness, paradoxical excitement, restlessness, nervousness, seizures Nausea, vomiting, diarrhea, constipation Dryness of mouth, nose, and throat; urinary retention; vertigo; visual disturbances; tinnitus; headache

Crystalloid solutions

IV fluids containing varying concentrations of electrolytes.

A pt. is on an xanthine derivative. They begin to experience tachycardia. Is the drug d/c?

If tachycardia occurs while on an xanthine derivative, the drug is not d/c. The dosage will simply be lowered.

Antidepressants (tricyclics) and overdose

If you overdose 70-80% die before reaching the hospital. -CNS and cardiovascular system mainly affected. -Death results from seizures and dysrhythmias -Charcoal can decrease drug absorption. Its speeds up elimination by alkalinizing urine -Manage seizures and dysrhythmias -Provide basic life support

Laxatives: Adverse Effects - Bulk forming

Impaction Fluid overload Electrolyte imbalance Esophageal blockage

What are some other adverse effects of beta blockers?

Impotence, wheezing, dyspnea

Nursing implications therapeutic effectiveness for anxiolytics:

Improved mental alertness, cognition, and mood fever anxiety and panic attacks improved sleep pattern less tension irritability more interest in self and others

How do you prepare oral cyclosporine?

In a glass container - not styrofoam because it adheres to the inside of the wall.

The nurse has recently begun working in a specialized endocrinology clinic. Her first patient, Patricia, a second-grader, is not growing at the expected rate. The physician has determined that Patricia is a candidate for somatropin therapy. What will be emphasized when the nurse is teaching her parents about giving this drug?

In addition to information about proper subcutaneous injection techniques, the teaching plan needs to include a reminder of the dosage form and amount and the importance of compliance with therapy, as well as keeping the follow-up appointments. The nurse will show the parents how to keep a journal of Patricias growth measurements.

What time of the day should diuretics be administered?

In the morning to prevent nocturia and interrupted sleep patterns.

What causes a Vitamin b6 (pyridoxine) deficiency?

Inadequate intake, poor absorption, uremia, alcoholism, cirrhosis, hyperthyroidism, malabsorption, HF, drug induced

Laxatives: Mechanism of Action - Hyperosmotic

Increase fecal water content Results in bowel distention, increased peristalsis, and evacuation Examples: Polyethylene glycol (PEG) AKA: GoLytely Sorbitol, glycerin Lactulose (also used to reduce elevated serum ammonia levels)

Laxatives: Mechanism of Action - Saline

Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines. Results in bowel distention, increased peristalsis, and evacuation. Examples: Magnesium hydroxide (Milk of Magnesia) Magnesium citrate (Citroma)

Antidiarrheals: Adverse Effects - Adsorbents

Increased bleeding time. Constipation, dark stools. Confusion, twitching. Hearing loss, tinnitus, metallic taste, blue gums.

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? a. Increased sputum production b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing

Increased ease of breathing The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.

Laxatives: Mechanism of Action - Stimulant

Increases peristalsis via intestinal nerve stimulation. Examples: senna (Senekot) bisacodyl (Dulcolax)

When is singulair indicated?

Indicated for children and adults over 12 years. It is a PREVENTATIVE. It is not used for an acute asthma attack. Will see improvement after taking 1 week of singulair.

What is Vitamin A typically prescribed for?

Infants Pregnant and nursing women hyperkeratosis of the skin Night blindness Acne Psoriasis Keratosis follicularis isotretinoin

What are common uses for glucocorticoids

Inflammation, immune response, organ transplant, cerebral edema, derm/collagen diseases

Neurokinin antagonists- aprepitant (Emend) mechanism

Inhibit the substance P-neurokinin receptors

Clopidogrel (Plavix)

Inhibits platelet aggregation by altering platelet membrane to no longer receive signal to aggregate and form clot. Hematologic adverse effects. Route by mouth.

Minerals

Inorganic elements or salts required for intracellular and extracellular body fluid electrolytes

human based insulins: intermediate-acting

Intermediate-Acting: Isophane insulin suspension (also called NPH): (Humulin N, Novolin N) insulin zinc suspension (aka Lente) (Humulin L, Novolin L) Cloudy appearance Slower onset and more prolonged in duration than endogenous insulin. Often combined with Regular insulin to reduce number of insulin injections per day. Given subq, onset 1-2 hours Duration of action: 10-18 hours

Antidiarrheals: Mechanism of Action - Intestinal flora modifiers

Intestinal flora modifiers Probiotics or bacterial replacement drugs. Bacterial cultures of Lactobacillus organisms work by: Supplying missing bacteria to the GI tract. Suppressing the growth of diarrhea-causing bacteria. Example: L. acidophilus (Lactinex)

The nurse will plan to inject iron dextran by which technique? Subcutaneous injection with a ½-inch, 25-gauge needle Intramuscular injection using the Z-track method Intradermal injection with a sunburst technique of administration Intramuscular injection with a ½-inch, 18-gauge needle

Intramuscular injection using the Z-track method

What are signs of Vitamin A toxicity?

Irritability, drowsiness, vertigo, delirium, vomiting, increased intracranial pressure in infants Generalized peeling of the skin and erythema over several weeks

Antianginal drugs such as nitrates, nitrites, beta blockers, and calcium channel blockers are used to reduce _______, by increasing the delivery of oxygen- rich blood to cardiac tissues or by reducing oxygen consumption by the coronary vessels.

Ischemia

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? a. It is indicated for the treatment of acute bronchospasms. b. It needs to be used with a spacer for best results. c. Patients need to avoid drinking water for 1 hour after taking this drug. d. It is used for prevention of bronchospasms.

It is used for prevention of bronchospasms. Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.

What is important to note about IV calcium?

It must be given slowly (less than 1 mL/min) because it can precipitate severe hypercalcemia with cardia irregularities or cardiac arrest

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? a. The proper technique for inhalation must be followed. b. The patient needs to keep it close by at all times to treat acute asthma attacks. c. It needs to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

It needs to be taken every day on a continuous schedule, even if symptoms improve. These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.

For IV forms, how should you counsel your patient?

Its for use in emergency situations only and in settings that provide close monitoring of blood pressure/pulse. IV admin of nitrates may lead to severe hypotension, cardiovascular collapse, and shock. Always give IV via infusion pump.

What is the best indicator of diuretic success?

Keep daily weights. Report a weight gain of 2 lbs. in one day or 5 lbs. in one week.

How can B2 effect urine?

Large doses will discolor urine to a yellow-orange

What are contraindications to Vitamin B3 (Niacin)?

Live disease Severe hypotension arterial hemorrhage Active PUD

If a pt is deficient in Vitmin A, which foods could the nurse recommend?

Liver, fish, dairy products, egg yokes, dark green leafy vegetables, yellow-orange vegetables and fruits

What are food sources of vitamin B12 (cyanocobalamin)?

Liver, kidney, fish, shellfish, poultry, milk, eggs, blue cheese, fortified cereals

Human-Based Insulins: Long-Acting

Long-Acting: Glargine (Lantus), determir (Levemir): Normally clear, colorless solution. Referred to as basal insulin. Injected subq and forms microprecipitates that are slowly absorbed over 24 hours so it provides a constant level of insulin. Usually dosed once daily or once every 12 hours.

metoprolol

Lopressor cardioselective beta blockers commonly given after an MI to reduce risk of SCD used to treat hypertension and angina

Examples of Angiotensin Receptor Blockers (ARBs)

Losartan Candesartan Irbesartan Olmesartan Valsartan

Lung sounds and diuretics?

Lung sounds should be clear to auscultation.

Hyperkalemia causes

M.A.C.H.I.N.E. M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hyperaldosteronism, hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion - Impaired

Hyperkalemia S/S

M.U.R.D.E.R. M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

Hemocrit (Hct)

M: 39-50% F: 35-47%

Major Long-Term Consequences of Type 1 and Type 2 Diabetes

MI stroke PVD (peripheral vascular disease) Part or complete blindness (retinopathy) nerve damage (Neuropathy) proteinuria

What is the principal cation of intracellular fluid?

Magnesium

Laxatives: Adverse Effects - Saline

Magnesium toxicity (with renal insufficiency) Cramping Electrolyte imbalances Diarrhea Increased thirst

What is the function of Vitamin B6 (Pyridoxine)?

Many metabolic functions Integrity of peripheral nerves, skin, mucous membranes, hematopoietic system

Flumazenil (Romazicon)

May be used to reverse benzos (it may cause seizures so it's a last resort)

Crystalloids Adverse Effects

May cause edema, especially peripheral or pulmonary May dilute plasma proteins, reducing COP Effects may be short-lived Prolonged infusions may worsen alkalosis or acidosis

Black box warning for Angiotensin-Converting Enzyme (ACE) Inhibitors

May cause fetal malformation if taken in the 2rd or 3rd trimester of pregnancy.

ginger interactions

May increase absorption of oral medications Increase bleeding risk with anticoagulants

What are food sources of phosphorus?

Milk, yogurt, cheese, peas, meat, fish, eggs

What are antileukotrine agent drug effects

Modify/inhibit the activity of leukotrienes and result in decreased inflammation and reduced bronchoconstriction

S/Sx of dehydration with pts. on diuretic therapy?

Monitor for poor skin turgor, dry mucous membranes. Avoid heat/sun exposure.

potassium is responsible for

Muscle contraction Transmission of nerve impulses Regulation of heartbeat Maintenance of acid-base balance Isotonicity

For patients taking vasodilators, how should you counsel them?

Must avoid alcohol, saunas, hot tubs, hot showers, hot weather or a hot environment (will exacerbate vasodilation and increase the occurrence of orthostatic hypotension-->increase risk of dizziness, falls). Extended release meds (wax matrix) may appear in stool. Encourage patient to self monitor pulse/blood pressure.

Sublingual forms of nitroglycerin guidelines

Must be taken at the first sign of chest pain and not delayed until the pain is severe. The patient needs to sit or lie down and take one sublingual tablet. If the chest pain and discomfort isn't relieved in 5 minutes, the patient or family member must call 911 immediately. The patient can take one more tablet and another 5 minutes apart while awaiting emergency care. Bot no more than 3 tablets.

Human-Based Insulins: Combination insulin products:

NPH 70% and regular insulin 20% (Humulin 70/30, Novolin 70/30, Novolog 70/30). NPH 50% and regular insulin 50% (Humulin 50/50) insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog mix 75/25). Do not mix with other insulins. Injected subq Onset 1-2 hours Duration 24 hours

What are intermediate acting insulins

NPH, Lente

What are crystalloids?

NS LR D5W D5 ½ NS 0.45% NS

Interactions for use of Angiotensin-Converting Enzyme (ACE) Inhibitors

NSAIDs, other anti-hypertensives, diuretics, lithium, drugs that raise potassium levels, ETOH.

What is an example of an inhaled adrenergic?

Naphazoline (Privine)

What is the mechanism of action of Ergot Alkaloids

Narrow or constrict blood vessels in the brain

Hyponatremia S/S

Nausea Muscle cramps Confusion Muscular twitching, coma Seizures Headache

What are the three main classes of drugs used to treat angina pectoris?

Nitrates, nitrites, beta blockers and calcium channel blockers.

______ and_______ work by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload).

Nitrates/nitrites

propylthiouracil

No trade name generic only -Works by inhibiting the process required to make monoiodotyrosine and diiodotyrosine precursor to T3 and T4 - Adverse Effects liver and bone marrow toxicity

Propranolol (Inderal)

Non-selective beta blocker. Can decrease BP by blocking renin release from the kidney, and reducing heart rate (which decreases O2 demand on the heart). Highly lipid soluble. *Adverse effects*: bradycardia, AV heart block, heart failure, rebound cardiac excitation, bronchoconstriction, inhibition of glycogenolysis. *Cautious use with* diabetics, respiratory patients, and heart failure patients. *Interactions:* calcium channel blockers, insulin. *Black box warning*- taper slowly to avoid rebound cardiac excitation.

methimazole

Northyx or Tapazole -Works by inhibiting the process required to make monoiodotyrosine and diiodotyrosine precursor to T3 and T4 - Adverse Effects liver and bone marrow toxicity

Anxiety Disorders (persistent anxiety) Six major anxiety disorders:

Obsessive-compulsive disorder (OCD) Post traumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) Panic Disorder Social Phobia (social anxiety disorder) Simple Phobia

Laxatives: Nursing Implications

Obtain a thorough history of presenting symptoms, elimination patterns, and allergies. Assess fluid and electrolytes before initiating therapy. Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain. High fiber diet, increase fluid intake. Long-term use has detrimental effects. Administration of oral laxative pills. Patients should take all laxative tablets with 6-8 oz of water. Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water. Give bisacodyl with water because of interactions with milk, antacids, and juices. Inform patients to contact their physician if they experience sever abdominal pain, muscle weakness, crams, and/or dizziness, which may indicate possible fluid or electrolyte loss. Monitor for therapeutic effect.

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? a. Notify the doctor that the patient is unable to use the MDI. b. Obtain an order for a peak flow meter. c. Obtain an order for a spacer device. d. Ask the prescriber if the medication can be given orally.

Obtain an order for a spacer device. The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.

Antidiarrheals: Nursing Implications

Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies. Do NOT give bismuth subsalicylate to children or teenagers with chickenpox or influenza because the risk of Reye's syndrome. Use adsorpents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion. Do not administer anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon. Teach patients to take medications exactly as prescribed and be aware of their fluid intake and dietary changes. Assess fluid volume status, I&O, and mucous membranes before, during, and after initiation of treatment. Teach patients to notify their physician immediately if symptoms persist. Monitor therapeutic effect.

Proton Pump Inhibitors: Omeprazole ( Prilosec) Lansoprazole ( Prevacid) Pantoprazole ( Protonix)

Omeprazole (Prilosec) - first drug in this breakthrough class - often work best when taken 30 to 60 minutes before meals - first PPI to become available generically, and many insurance companies dictate its use as a first-line drug unless there is a documented treatment failure. Lansoprazole ( Prevacid) -The capsules can be opened and mixed (not crushed) with apple juice for administration via NG tube, or the Solu-tab can be dissolved in water. -Lansoprazole drug is also available as Prevpac, a combination product for the treatment of H. Pylori infection. Pantoprazole ( Protonix) -first PPI available for intravenous use. It was also the first drug to be used as a continuous infusion for the treatment of GI bleeding. -granules are large, and the NG tube must be at least size 16, or the granules may clog the tube.

Minoxidil

Only used for patients with severe hypertension that is unresponsive to safer drugs, causes more intense vasodilation, but also has more severe side effects. *Adverse effects:* tachycardia, Na and H2O retention, hypertrichosis (hair growth), and rarely pericardial effusion. *Black box alert*- pericarditis. Cardiac tamponade. PO and topical formulations.

Sodium Adverse Effects

Oral administration: Nausea, vomiting, cramps IV administration: Venous phlebitis

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? a. Fatigue and depression b. Anxiety and palpitations c. Headache and rapid heart rate d. Oral candidiasis and dry mouth

Oral candidiasis and dry mouth Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.

Potassium adverse effects

Oral preparations - Diarrhea, nausea, vomiting, GI bleeding, ulceration IV administration -Pain at injection site -Phlebitis Excessive administration - Hyperkalemia, toxic effects

When given ______, nitroglycerin goes directly to the liver to be metabolized before it can become active in the body. A lot of it is removed for circulation (high pass effect). So nitroglycerin is given via other routes to avoid this.

Orally

When administering ferrous sulfate (iron) to a patient, the nurse plans to give this medication with which fluid to increase absorption of the iron? 8 ounces of water 4 ounces of milk Hot tea Orange juice

Orange juice

Ketones

Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.

Define Vitamins

Organic molecules needed in small quantities for normal metabolism and other biochemical functions

Antidopaminergics- prochlorperazine (Compazine) AE

Orthostatic hypotension, tachycardia Extrapyramidal symptoms, tardive dyskinesia, headache Blurred vision, dry eyes Urinary retention Dry mouth, nausea and vomiting, anorexia, constipation

A type of diuretic given to pts. with head injury or brain surgery?

Osmotic diuretics (Mannitol)

Drug interactions with Angiotensin Receptor Blockers (ARBs)

Other anti-hypertensives Picture (page 351)

What is the function of Vitamin C (Ascorbic Acid)?

Oxidation-reduction reactions collagen synthesis maintenance of connective tissue tissue repair maintenance of bone, teeth, capillaries folic acid metabolism erythropoiesis Enhances absorption of iron Synthesis of lipids, proteins, steroids Aids in cellular respiration aids in resistance to infections

Proton Pump Inhibitors: Adverse Effects

PPIs are generally well tolerated. - There are some concerns that these drugs may be overprescribed and may predispose patients to GI tract infections because of the reduction of the normal acid-mediated antimicrobial protection. -New concerns have arisen over the potential for long-term users of PPIs to develop osteoporosis. it is speculated that PPIs speed up bone mineral loss.

What kind of coughs are expectorants used to relieve?

PRODUCTIVE coughs - common cold, bronchitis, influenza

Normal regulation of blood pressure and corresponding medications (picture)

Page 343

Adrenergic drugs: Drug interactions (picture)

Page 347

The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? a. Heartburn b. Bradycardia c. Drowsiness d. Palpitations

Palpitations Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect.

Who should not take muromonab-CD3 (Orthoclone OKT3)?

Patients in fluid overload

A patient has a new order for an ipratropium (Atrovent) inhaler, an anticholinergic drug. The nurse knows to assess for an allergy to which food before giving this drug? a. Shellfish b. Soy products c. Peanuts d. Eggs

Peanuts There have been reported cases of severe anaphylactic reactions to ipratropium inhalers in patients with allergies to peanuts, and such use must be avoided.

Doxazosin (Cardura, Cardura XL)

Peripherally acting alpha 1 receptor antagonist (blocker). Used for hypertension. *Adverse effects:* orthostatic hypotension, reflex tachycardia, first dose effect, nasal congestion, sexual dysfunction. P.O. only (immediate or extended release). Other anti-hypertensives can intensify hypotensive effects. Educate patients that when the drug is released from the extended-release form, the matrix of the capsule is expelled in the stool.

Carvedilol (Coreg)

Peripherally acting dual alpha 1 and beta receptor blocker. Dilates arterioles and veins, blocks beta 1's on the kidney and heart. *Used to treat* mild to moderate heart failure, hypertension, and angina. *Adverse effects:* mild. Similar to those of both alpha and beta blockers. Give with food. Full effects take 2-3 weeks. Contraindications: drug allergy, cardiogenic shock, severe bradycardia or heart failure, bronchospastic conditions such as asthma, and various cardiac problems involving the conduction system.

What is an example of a topical adrenergic nasal decongestant?

Phenylephrine (Neo-Synephrine)

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that a. the safe and the toxic plasma levels of the drug are very close to each other. b. phenytoin has a slim chance of being effective. c. there is no difference between safe and toxic plasma levels. d. a very small dosage can result in the desired therapeutic effect

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that a. the safe and the toxic plasma levels of the drug are very close to each other.

What are the types of Vitamin K?

Phytonadione (K1) menaquinone (K2) menadione (K3)

What is ischemic heart disease?

Poor blood supply to the heart muscle via the coronary arteries. Caused by atherosclerosis --> coronary artery disease

What commonly causes a B1 deficiency?

Poor diet extended fever hyperthyroidism liver disease alcoholism malabsorption Pregnancy/breastfeeding

Chapter 24 (Heart Failure Drugs)

Power-point information

Who is at high risk for a Vitamin E deficiency?

Premature infants

What are Simulect and Zenapax used for?

Prevent rejection of transplanted kidneys

What is Vitamin B3 (Niacin) indicated for?

Prevention and treatment of pellagra antihyperlipidemic drug

What is Prograf indicated for?

Prevention of liver transplant rejection

What is cyclosporine indicated for?

Prevention of organ rejection or other autoimmune disorders

What type of hypothyroidism is due to the inability of the thyroid gland to perform a function?

Primary Hypothyroidism

What is atenolol used for?

Prophylactic treatment of angina pectoris. Use of this drug after MI has been shown to decrease mortality.

What drug is used to treat Hyperthyroidism?

Propylthiouracil

What are the three compounds of Vitamin B6 (Pyridoxine)

Pyridoxine pyridoxal pyridoxamine

quinidine

Quinidex direct action on the electrical activity of the heart indirect effect can cause cinchonism - tinnitus, loss of hearing, blurring of vision, GI upset contraindicated with known hypersensitivity, AV block, intraventricular conduction defects, and torsades de pointes

Human Based Insulins: Rapid Acting

Rapid-Acting: Most rapid onset of action (5 to 15 minutes) Shorter duration (3-5 hours). Are clear ,do not use if cloudy. Patient must eat a meal after injection. Insulin lispro (Humalog): Similar action to endogenous insulin. Insulin aspart (NovoLog) Insulin glulisine (Apidra): newest May be given SC or via continuous SC infusion pump (but not IV).

What are food sources of Zinc?

Red meats, oysters, milk products, eggs, beans, nuts, whole grains, fortified cereals, seafood

Anxiolytic Drugs

Reduce anxiety by reducing over activity in CNS. Alprazolam (Xanax) is the most commonly used to treat GAD, panic disorder, and anxiety associated with depression. (contraindications with oral contraceptives, alchol)

Angiotensin-Converting Enzyme (ACE) Inhibitors

Reduces levels of angiotensin II (a vasoconstrictor) and increases levels of bradykinin (a potent vasodilator). *Therapeutic uses:* hypertension, heart failure, nephropathy, high risk cardiovascular patients. All are P.O. (enalapril is the only one available in IV form). Many combination products are available.

What is the purpose of echinacea? (A herbal product)

Reduces symptoms of the common cold and recovery time (decreases viral shedding and spread)

Antidiabetic agent administered intravenously (IV) only

Regular Insulin

What is the use of nasal decongestants indicated for? (Relief of..)

Relief of nasal congestion associated with - acute or chronic rhinitis - sinusitis - allergies

How do you prevent nitrate/nitrite tolerance with patches?

Remove the patch at night for 8 hours and apply a new patch in the morning.

Lab values to monitor

Renal labs- BUN (5-25 mg/dL) and creatinine (0.5-1.2 mg/dL). Liver enzymes. WBC (5-10,000/mm3)

What are contraindications to immunosuppressants?

Renal or liver failure hypertension radiation therapy

What are conditions related to long term deficiency of Vitamin D?

Rickets Tetany Osteomalacia

propafenone

Rythmol reduces the fast inward sodium current in Purkinje fibers and less in the myocardial fibers mild beta-blocking effects treating life-threatening ventricular dysrhythmias and atrial fibrillation use with caution in patients with heart failure adverse reaction: dizziness, metallic taste, constipation, and headache contraindicated in hypersensitivity, bradycardia, bronchial asthma, hypotension, HF, cardiogenic shock, and various conduction disorders

SE of osmotic diuretics

SE: headaches, tachycardia, thrombophelibitis, seizures

nonbenzodiazepines: zolpidem (ambien)

SHORT ACTING non benzodiazepine hypnotic. has a short half life, and a lack of active metabolites, contributes to a lower incidence of daytime sleepiness, ambien CR, but has implications of SOMNAMBULATION (sleepwalking)!!

nonbenzodiazepines: zaleplon (sonata)

SHORT ACTING non benzodiazepine hypnotic. it has a very short half life and patients whose sleep difficulties include early arousal can take a dose in the middle of the night just as long as its at least 4 HOURS before the arise.

What does prolonged deficiency in Vitamin C (Ascorbic Acid) result in?

Scurvy

What type of hypothyroidism results from insufficient secretion of thyroid-stimulating hormone (TSH) from the pituitary gland?

Secondary Hypothyroidism

Eplerenon (Inspra)

Selective aldosterone blocker (antagonist). Used for hypertension and heart failure. Well tolerated. Hyperkalemia is the greatest risk. Interacts with drugs that can raise potassium levels, erythromycin, protease inhibitors, verapamil, azole antifungals, lithium, NSAIDs.

Metoprolol (Lopressor, Toprol)

Selective beta 1 blocker (cardio-selective). *Adverse effects:* bradycardia, reduced cardiac output, AV heart block, heart failure., lethargy, fatigue Safer for respiratory and diabetic patients. *Black box warning-* rebound cardiac excitation when abruptly d/c.

Laxatives: Adverse Effects - Emollient

Skin rashes Decreased absorption of vitamins Electrolyte imbalances Lipid pneumonia

How do beta blockers impact angina?

Slows conduction through AV node, SA node rate decreases ---> reduces myocardial contractility--> slows heart rate and treats angina.

Patient teaching for a patient taking antithyroid medication should include the need to avoid which foods?

Soy products and Seafood

Laxatives: Mechanism of Action - Emollient

Stool softeners and lubricants Promote more water and fat in the stools Lubricate the fecal material and intestinal walls Examples: Stool softeners: docusate salts (Colace, Surfak) Lubricants: mineral oil

Anticoagulants

Substances that prevent or delay coagulation of the blood

Antiplatelet drugs

Substances that prevent platelet plugs from forming

What is the mechanism of action of opioid antitussives?

Suppress the cough reflex by direct action on the cough center (medulla oblongata)

What is the mechanism of actin of non-opioid antitussives?

Suppress the cough reflex by numbing stretch receptors in respiratory tract - prevent cough reflex from being stimulated

What is the function of Vitamin K?

Synthesis of blood coagulation factors in the liver

Levothyroxine

Synthroid and Levothroid T4 Thyroid replacement Most commonly used

How is cellular immunity mediated?

T lymphocytes

What is the MofA of immunosuppressant drugs?

T-lymphocytes

Tardive dyskinesia

TD causes stiff, jerky movements of your face and body that you can't control.

What is the purpose of a diuretic?

TO DECREASE EDEMA

This hormone is secreted by the pituitary gland to make the thyroid produce more thyroid hormones

TSH

What are common adverse effects of too much thyroid medication

Tachycardia, nervousness, diarrhea, anxiety, fear, appetite, heat

How do you take singulair (antileukotrine agent)?

Take it PO at bedtime. Chewable.

For oral dosage forms of meds, how should you counsel your patient?

Take meds as orders before meals and with 6 oz of water.

Patient teaching

Take meds exactly as prescribed, never abruptly withdrawal (rebound hypertension). Compliance is key to effective management of hypertension. Stress safety precautions. Wear a medical alert bracelet. Teach how to take blood pressure before taking a BP med. Change positions slowly. Schedule periodic eye exams. Just because you feel good, does not mean you can stop taking the meds. Discuss side effects with provider (sexual dysfunction).

A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal? (Select all that apply.) a. Taking a proton-pump inhibitor b. Nasal congestion c. Hypothyroidism d. Hypertension e. Sinus infections f. Pregnancy

Taking a proton-pump inhibitor Hypertension Pregnancy

flecainide

Tambocor limited to the treatment of documented life-threatening ventricular dysrhythmias better tolerated than quinidine or procainamide negative inotropic effect, depresses LV function dizziness, visual disturbances, and dyspnea contraindicated by hypersenstivity, cardiogenic shock, AV block, and non-life-threatening dysrhythmias

Used to destroy the thyroid gland

Tapazole, PTU, or Radioactive Iodine

atenolol

Tenormin useful in treatment of hypertension and angina contraindicated in bradycardia, heart block, HF, cardiogenic shock, or hypersensitvity

What type of Hyperthyroidism stems from reduced secretion of thyrotropin-releasing hormone from the hypothalamus?

Tertiary Hyperthyroidism

Hemostasis

The arrest of bleeding, either by the physiologic properties of vasoconstriction and coagulation or by mechanical, surgical, or pharmacologic means

Pulmonary embolism

The blockage of a pulmonary artery by forein matter such as fat, air, a tumor, or a thrombus

What effects on the Central Nervous System do amphetamines have?

The effects of Amphetamines on the CNS are: -Mood elevation or euphoria - Increased mental alertness and capacity for work - Decreased fatigue and drowsiness -Prolonged wakefulness ----> that is why you should not give at bed time

Plasmin

The enzymatic protein that breaks down fibrin into fibrin degradation products; it is derived from plasminogen

Deep vein thrombosis (DVT)

The formation of a thrombus in one of the deep veins of the body. (Most common affected deep vein include the iliac and femoral veins)

A patient is scheduled for radioactive isotope study. Upon review of his medications, the scheduling nurse notes that he takes Levothyroxine (Levothroid) daily. Which statement is correct regarding the use of this medication before a radioactive isotope study?

The patient should stop the medication about 4 weeks before the test.

Blood pressure is determined by-

The product of cardiac output (4 to 8 L/min) x systemic vascular resistance (SVR). *Cardiac output* is the amount of blood that is ejected from the left ventricle. *SVR* is the resistance to blood flow that is determined by the diameter of the blood vessel and the vascular musculature.

Fibrin specificity

The property of some thrombolytic drugs of activating the conversion of plasminogen to plasmin only in the presence of established clots having fibrin threads rather than inducing systemic plasminogen activation throughout the body

Coagulation cascade

The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot

Thrombus

The technical term for a blood clot; an aggregation of platelets, finrin, clotting factors, and the cellular elements of the blood that is attached to the interior wall of a vein or artery, sometimes occluding the cessel lumen

Xanthine derivatives: what do they contain? Cardiac affects?

They contain caffeine. Excess CNS stimulation if taken with caffeine. Can cause tachycardia, angina, HTN, palpitations, tremors, nervousness, insomnia.

Anticholinergics: mechanism of action

They oppose the action of acetylcholine (a PNS activator). They prevent bronchoconstriction resulting in airway dilation.

Antileukotrine agents: what do they do?

They prevent leukotrines from attaching to circulating immune cells; this prevents inflammation in the lungs when the immune system is *triggered by an allergen*

When discussing glucocorticoids to a patient, what statement by the nurse is accurate regarding the action of these medications? They are produced in lower amounts during times of stress. They decrease serum sodium and glucose levels. They regulate carbohydrate, fat, and protein metabolism. They stimulate defense mechanisms to produce immunity.

They regulate carbohydrate, fat, and protein metabolism. Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress, increase sodium and glucose levels, and suppress the immune system.

What is the mechanism of action of amphetamines?

They stimulate areas of the brain associated with mental alertness

Vitamin B1

Thiamine

What diuretic has a ceiling effect and can result in hyperglycemia in diabetic patients?

Thiazide diuretic

A patient is taking gabapentin (Neurontin), and the nurse notes that the patient has no history of seizures on his medical record. What is the best possible rationale for this medication order? a. This medication is used for treatment of neuropathic pain. b. The medication is helpful for the treatment of osteoarthritis. c. This medication is used to reduce the symptoms of Parkinson's disease. d. The medical record is missing the correct information about his history of seizures.

This medication is used for treatment of neuropathic pain.

Alteplase (Activase)

Thrombolytic drug. Fibrin specific. Cathflo Activase used to flush clogged IV or arterial line. Tenescteplase (TNKase) is a newer form of alteplasr given by IV push after MI. Route by IV

What is the principal thyroid hormone that influences the metabolic rate?

Thyroxine

dofetilide

Tikosyn newer antidysrhythmic drug can cause serious toxicity need to have continuous ECG monitoring for first 3 days contraindicated in severe renal impairment and those taking other certain drugs, hypokalemia and/or hypomagnesmia adverse effects: torsades de pointes, supraventricular dysrhythmias, headaches, dizziness, and chest pain

What are antitussives used for?

To control coughing - only for dry, NONPRODUCTIVE coughs

What is the overall goal of antianginal drug therapy?

To increase blood flow to ischemic myocardium, decrease myocardial oxygen demand, or both.

What conditions do loop diuretics treat?

Treat edema, CHF, hepatic cirrhosis, renal disease, ascites, HTN

Peripherally Acting Opioid Antagonists

Treatment of constipation related to opioid use and bowel reaction therapy. Block entrance of opioid into bowel. Strict regulations for use. Allow bowel to function normally with continued opioid use: methylnaltexone (Relistor) alvimopan (Entereg)

What is nitroglycerin used for (nitrate)??

Treatment of ischemic heart conditions (angina), prevention of angina, blood pressure control, hypertensive patients perioperatively (ischemic pain, heart failure and pulmonary edema.

Antidepressants important facts/nursing implications:

Tricyclics- may need to be weaned and discontinued before surgery to avoid interactions with anesthetic drugs.Causes Orthostatic hypertension, impotence, sedation. -Encourage patients to ear medication ID badges naming drugs that are being taken -caffeine and cigarettes smoking may decrease effectiveness of medication -instruct patient to avoid tyramine containing foods (can cause hypertension leading to stroke, coma, death.) -assess for suicidal tendencies

What are some antimigrine drugs?

Triptan Drugs -Almotriptan (Axert) -Eletripton (Relpax) -Frovatriptan (Frova) -Naratriptan (Amerge) -Rizatriptan (Maxalt) -Sumatriptan (lmitrex) -Zolmitriptan (Zomig) Ergot Alkaloids -Ergotamine -dihydroergotamine mesylate (D.H.E45)(Migranal) -ergotamine tartrate with caffeine (cafergot)

Causes of Chronic Diarrhea

Tumors Diabetes mellitus Addison's Disease Hyperthyroidism Irritable bowel syndrome AIDS

treatment for DM

Type 1 Insulin therapy Type 2 Lifestyle changes Oral drug therapy Insulin when the above no longer provide glycemic control

The nurse would question the order for epoetin in a patient with which condition? Uncontrolled hypertension Anemia Chronic renal failure HIV/AIDS

Uncontrolled hypertension

Which are known contraindications for use of erythropoiesis stimulation agents in patients? (Select all that apply.) Uncontrolled hypertension Cancer of the neck History of thrombosis Renal failure Hemoglobin level of 15 g/dL

Uncontrolled hypertension Cancer of the neck History of thrombosis Hemoglobin level of 15 g/dL

Anxiety disorder

Unpleasant state of mind characterized by a sense of dread and fear May be based on actual anticipated experiences or past experiences. May be exaggerated responses to imaginary negative situations

Prior to administering an antihistamine to a patient, it is most important for the nurse to assess the patient for a history of which condition?

Urinary retention?

The nurse is caring for a patient who is prescribed epoetin alfa (Epogen). What does the nurse expect as the reason for use of this medication in this patient? To replace blood loss from surgery To replace blood loss from a trauma Treatment of pregnancy associated anemia Use for anemic patient with renal failure

Use for anemic patient with renal failure

Aminophylline: when is it indicated?

Use to treat ACUTE asthma. Give IV for asthma that does not respond to initial therapy (status asthmaticus). ...Think: the body needs increased "amino" acids in a emergency state... use "amino"phylline when you are having an acute, emergency asthma attack

Anticholinergics: what are they mainly used to treat?

Used as a preventative for allergy-induce or exercise-induced asthma.

Serotonin Blockers- ondansetron (Zofran) indications

Used for nausea and vomiting in patients receiving chemotherapy and for postoperative nausea and vomiting hyperemesis gravidarum

ginger indications

Used for nausea and vomiting, including that caused by chemotherapy, morning sickness, and motion sickness

colloids adverse effects

Usually safe May cause altered coagulation, resulting in bleeding Have no clotting factors or oxygen-carrying capacity Rarely, dextran therapy causes anaphylaxis or renal failure

What adverse effects do analeptics cause?

Vagal -Stimulation of gastric secretions, diarrhea, and reflex tachycardia Vasomotor -Flushing, Sweating Respiratory -Elevated respiratory rate Musculoskeletal -muscular tension and tremors

what are adverse effects of triptans

Vasoconstriction Irritation at injection site tingling Flushing

Examples of Calcium Channel Blockers

Verapamil Nifedipine Diltiazem Other: amlodipine, felodipine, nicarpidine

What are examples of calcium channel blockers?

Verapamil, diltiazem, nifedipine, amlodipine, nicardipine.

Which is the suspected toxicity of a patient with generalized peeling of the skin and erythema over several weeks?

Vitamin A

Which vitamin is produced by carotenes?

Vitamin A

What are the types of water soluble vitamins?

Vitamin B complex and Vitamin C

What is the most common deficiency in vegetarians?

Vitamin B12 (cyanocobalamin)

Which vitamin is useful in the treatment of hyperlipidemia?

Vitamin B3 (Niacin)

What is Pellagra?

Vitamin B3 - Niacin deficiency

Which Vitamin is used for the prevention of drug-induced neuritis?

Vitamin B6 (Pyridoxine)

What vitamin is needed for efficient absorption of Calcium?

Vitamin D

Which is the "Sunshine Vitamin"?

Vitamin D

Which vitamin is taken to prevent osteoporosis?

Vitamin D

Which vitamin is given to newborns on arrival to the nursery?

Vitamin K

Hyponatremia causes

Vomiting Diuretics Excessive administration of dextrose and water IVs Burns, wound drainage Excessive water intake SIADH

What lab value is most important to monitor while patients are on an immunosuppressant?

WBC

What is a common interaction with Vitamin K?

Warfarin - pt becomes unresponsive to warfarin for 1 week after Vitamin K administration

Important: hypotonic solutions

Watch out for depleting the circulatory system of fluid since you are trying to push extracellular fluid into the cell to re-hydrate it. Never give hypotonic solutions to patient who are at risk for increased cranial pressure (can cause fluid to shift to brain tissue), extensive burns, trauma (already hypovolemic) etc. because you can deplete their fluid volume.

Define Heart Failure:

When the heart is unable to pump blood in sufficient amounts from the ventricles to meet the body's metabolic needs.

What are food sources of Vitamin B6 (Pyridoxine)?

Whole grain, wheat germ, yeast, fish, organ meats, poultry, meats, eggs, peanuts, nuts, vegetables, bananas

When would you need to d/c osmotic diuretics?

With renal impairment or cardiac impairment.

Which groups of individuals are at highest risk for development of iron deficiency anemia? (Select all that apply.) Women aged 12 to 40 Children Men aged 20 to 40 years Men over age 50 years Pregnant women

Women aged 12 to 40 Children Pregnant women

Phosphodiesterase Inhibitors

Work by inhibiting the enzyme, Phosphodiesterase. ❂Results in: ➤ Positive inotropic response ➤ Vasodilation ❂ Two drugs (inodilators) ➤ Inamrinone and Milrinone

How does Copaxone work?

Works by blocking T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with multiple sclerosis

Xanthine derivatives and the medulla?

Xanthine derivatives also enhance the respiratory drive in the medulla. Think: ...when you are in the woods with the p"ine" trees, you want to take in lots of air, breath deeply and frequently

lidocaine

Xylocaine most effective drug for ventricular dysrhythmias makes it difficult for the ventricles to develop a dysrhythmia CNS toxic effects like twitching, convulsions, and confusion, respiratory depression/arrest, and lowered CV effects

Hypernatremia S/S

You are 'fried' or S.A.L.T. F - Fever (low grade), flushed skin R - Restless (irritable) I - Increased fluid retention and increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth S = Skin flushed A = Agitation L = Low-grade fever T = Thirst

This trace element is essential in metabolic reactions of proteins and carbs

Zinc

This trace element is essential in metabolic reactions of proteins and carbs, and for normal tissue growth and repair

Zinc

examples of analeptics

_Doxapram (dopram) _Methylxanthines, such as aminophylline, theophylline, and caffeine

administration of a hypotonic intravenous fluid would result in which of the following. a. cellular shrinkage b. cellular swelling c. dependent edema d. dehydration

a

which action by the nurse is the most appropriate for the patient receiving an infusion of packed red blood cells? a. flush the IV line with normal saline before the blood is added to the infusion b. flush the IV line with dextrose before the blood is added to the infusion c. check patient vital signs once the infusion is completed d. anticipate the flush skin and fever are expected reaction to a blood transfusion

a

Kayexalate (sodium polystyrene sulfonate)

a medication used to reduce high serum potassium; exchanges sodium for potassium in the intestine

hypertonic solution

a solution that causes a cell to shrink because of osmosis

hypotonic solution

a solution that causes a cell to swell because of osmosis

What is an apolipoprotein??

a specialized lipid carrying protein

The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient will lead the nurse to determine that the patient has an adequate understanding? a. "I will need to take extra care of my teeth and gums while on this medication." b. "I can go out for beer while on this medication." c. "I can skip doses if the adverse effects bother me." d. "I will be able to stop taking this drug once the seizures stop."

a. "I will need to take extra care of my teeth and gums while on this medication.

Patients on corticosteroids: contraindications

a. Cardiac disease (don't want to lower the immune system) b. Glaucoma c. GI disease (don't want to lower the immune system)

Adverse effects of diuretic therapy?

a. Hypokalemia or hyperkalemia b. Orthostatic hypotension c. Dig. Toxicity (it potassium levels are too low. This will happen especially wit Lasix/furosemide) d. Dehydration e. Drowsiness/lethargy f. Muscle cramps/weakness g. Hypotension

Choose all that apply A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.) a. Take the iron tablets with meals. b. Take the iron tablets on an empty stomach 1 hour before meals. c. Take the iron tablets with an antacid to prevent heartburn. d. Drink 8 ounces of milk with each iron dose. e. Taking iron supplements with orange juice enhances iron absorption. f. Stools may become loose and light in color. g. Stools may become black and tarry. h. Tablets may be crushed to enhance iron absorption.

a. Take the iron tablets with meals. e. Taking iron supplements with orange juice enhances iron absorption. g. Stools may become black and tarry.

A patient taking entacapone for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation? a. This is a harmless effect of the drug. b. The patient has taken this drug along with red wine or cheese. c. The patient is having an allergic reaction to the drug. d. The patient has most likely taken extra drug doses.

a. This is a harmless effect of the drug.

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a. diazepam (Valium) b. midazolam (Versed) c. valproic acid (Depakote) d. carbamazepine (Tegretol)

a. diazepam (Valium), status epilepticus is seizures tha tfollow one another without revover of coniousness b/w them

Crystalloids Indications

acute liver failure acute nephrosis adult respiratory distress syndrome burns cardiopulmonary bypass hypoproteinemia renal dialysis reduction of the risk for DVT shock

Anticholinergics- scopolomine interactions

additive drying effects when given with antihistamines and antidepressants block the motility effects of metoclopramide

name the advantage and disadvantages of using crystalloids to replace fluid in patients with dehydration

advantages: -crystaolloids are less expensive than colloids -blood products for replacement of fluids are better for emergency short-term plasma volume expansion. -they also promote urinary flow -they do not carry the risk of transmission of viral diseases or anaphylaxis and do not promote bleeding. disadvantages: -the fluid can leak out of the plasma into the tissue, which can result in edema. -may dilute plasma proteins that may result in lower colloid oncotic pressure and diluted erythrocytes concentration resulting in decreased oxygen tension -large volumes are needed to be effective, but prolonged infusion may worsen acidosis and alkalosis. -effect short-lived compared to colloids

For sublingual forms of meds, how should you counsel your patient?

advise patient to place under the tongue as directed and not to swallow until the drug is completely dissolved. Instruct patients to keep nitrates in their original packaging or container. Exposure to light, plastic cotton filler and moisture should be avoided.

what criteria are used to assess for any adverse reactions?

airway breathing circulation, respiratory assessment, history of smoking, neurologic assessment, questions regarding allergies, use of prescriptions and OTC drugs, herbals and supplements. Alcohol and drug use, weight and height, and electrocardiograms, chest x rays, electrolyte, and renal/ liver function studies

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) a. salmeterol (Serevent) inhaler b. albuterol (Proventil) nebulizer solution c. epinephrine d. montelukast (Singulair) e. fluticasone (Flovent) Rotadisk inhaler f. aminophylline IV infusion

albuterol (Proventil) nebulizer solution epinephrine aminophylline IV infusion Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Aminophylline can be used for mild to moderate cases of acute asthma. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

Antidopaminergics- prochlorperazine (Compazine) interactions

alcohol or other CNS depressants

promethazine (Phenergan) interactions

alcohol or other CNS depressants

What are the interactions with nitrates?

alcohol, beta blockers, calcium channel blockers, phenothiazines, erectile dysfunction drugs.

What are the three categories of Asthma

allergic idiopathic mixed allergic-idiopathic

cytokine release syndrome

allergy like reaction caused by Simulect or Zenapax

what is the purpose of moderate sedation?

allows for the patient to relax with markedly reduced anxiety or none, allows for the patient to maintain his or her own open airway, Benzodiazapine-midazolam with an opioid-fentanyl/morphine have a synergistic affect, and propofol is a common agent used. moderate sedation can be used for procedures like COLONOSCOPY, ENDOSCOPY, X RAY PROCEDURES, AND MINOR SURGERIES. THE PATIENT IS UNCONSCIOUS BUT IS ABLE TO MAINTAIN THEIR OWN AIRWAY. AMNESIA IS COMMON

What are calcium channel blockers used for?

angina, hypertension, supraventricular tachycardia, coronary artery spasms (prinzmetal angina), short term management of atrial fibrillation and flutter.

what would increase bicarbonate levels

anoxia respiratory acidosis metabolic alkalosis

the nurse monitors for which signs of possible transfusion reaction when patient is receiving blood products

apprehension restleness fever chills

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 13 mcg/mL, and the nurse evaluates this level to be a. below the therapeutic level. b. at a therapeutic level. c. above the therapeutic level. d. at a toxic level.

at a therapeutic level Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.

indications for class Ib drug phenytoin

atrial and ventricular tachydysrhythmias caused by digitalis toxicity long QT syndrome

a patient is about to receive a dose of the nonprotein plasma expander dextran. the nurse knows that this product is indicated for which type of blood loss? a. slow loss of 20% or less b. slow loss of 20%-50% c. slow loss of over 50% or acute loss of 20% d. loss of 80% or more

b

a patient is receiving conivaptan (vaprisol) which of these are appropriate actions by the nurse? a. administer the drug by slow IV push over 10 min b. report serum sodium level of 149 mEq/l c. monitor for hyperkalemia d. implement measures to prevent constipation

b

when assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be a. acute liver failure b. heart failure c. severe burns d. fluid volume deficit

b

- A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse's best response? a. "He is taking another antiepileptic drug, so he can go without the medication for a week." b. "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." c. "He should temporarily increase the dosage of his other antiseizure medications." d. "He can probably stop all medication because he has been treated for several years now."

b. "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away."

The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose? a. 30 minutes b. 1 hour c. 6 hours d. 24 hours

b. 1 hour

A patient has been taking carbamazepine (Tegretol) for several months and is worried because the physician has increased the dose twice since the beginning of therapy. What explanation by the nurse is correct? a. The initial dose was not sufficient to prevent seizures. b. A process known as autoinduction results in lower-than-expected drug concentrations. c. The seizures are difficult to manage, and increased doses are needed to control them. d. The patient was forgetting to take the medication as prescribed, which led to a need for increased dosage

b. A process known as autoinduction results in lower-than-expected drug concentrations.

- Amantadine (Symmetrel) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication? a. Dyskinesias, drowsiness b. Dizziness, insomnia, nausea c. Leg edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention

b. Dizziness, insomnia, nausea

14. During drug therapy with epoetin alfa (Epogen), the nurse knows that therapy must be stopped if which laboratory result is noted? a. White blood cell count of 550 cells/mm3 b. Hemoglobin level of 13 g/dL c. Potassium level of 4.2 mEq/L d. Glucose level of 78 mg/dL

b. Hemoglobin level of 13 g/dL

An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient's medical history includes which condition? a. Decreased hemoglobin b. Hemolytic anemia c. Weakness d. Concurrent therapy with erythropoietics

b. Hemolytic anemia

A patient has been taking selegiline, 20 mg per day, for a month and says he understands the "cheese effect" that the doctor explained to him. The nurse verifies that he knows about this effect when he states that the cheese effect results in which condition? a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset

b. Hypertension

During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 18 mcg/mL. What concern should the nurse have, if any? a. The patient is at risk for seizures because the drug level is not at a therapeutic level. b. The patient's seizures should be under control because this is a therapeutic drug level. c. The patient's seizures should be under control if she is also taking a second antiepilepsy drug. d. The drug level is at a toxic level, and the dosage should be reduced.

b. The patient's seizures should be under control because this is a therapeutic drug level. NL= 10-20 mcg/mL -phenytoin contraindications: warfarin,contraception drugs, causes gum problems,causes CNS problems

The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? a. Diarrhea b. Urinary retention c. Risk for infection d. Insomnia

b. Urinary retention Anti-cholinergenic side effects include: urinary retention, dry mouth, blurred vidsion,photophobia, constipation , tachycardia

While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by a. rigid, tense muscles. b. difficulty in performing voluntary movements. c. limp extremities with weak muscle tone. d. confusion and altered mental status.

b. difficulty in performing voluntary movements.

The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a. tiagabine (Gabitril) b. phenobarbital (Solfoton) c. valproic acid (Depakote) d. rabapentin (Neurontin)

b. phenobarbital (Solfoton)

A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response? a. Decreased weight b. Increased activity tolerance c. Decreased palpitations d. Increased appetite

b.Increased activity tolerance

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action will the nurse perform to administer the drug? a. Give the dose as a fast intravenous (IV) bolus. b. Mix the drug with normal saline and give it as an IV piggyback. c. Mix the drug with dextrose (D5W) and give it as an IV piggyback. d. Mix the drug with any available solution as long as the drip rate is correct.

b.Mix the drug with normal saline and give it as an IV piggyback.

What are the indications for Vitamin B1 (thiamine)?

beriberi wernickes encephalopathy peripheral neuritis neuritis of pregnancy metabolic disorders malabsorption poor appetite ulcerative colitis chronic diarrhea cerebellar syndrome oral insect repellent

What are drug interactions with calcium channel blockers?

beta blockers, digoxin (interference with drug elimination), antifungals, statins, cyclosporine.

class II

beta-adrenergic blockers, which are also used as antihypertensives block sympathetic nervous system stimulation to the heart block the transmission of impulses in the heart's conduction system

what are the mechanisms of action with Benzodiazepines?

binds with benzodiazepine receptors in the nerve cells of the brain, these cells also have binding sites for GABA (gamma aminobutyric acid) which is an INHIBITORY NEUROTRANSMITTER

effects of class II drugs

block beta-adrenergic cardiac stimulation reduce SA nodal activity eliminate or reduce atrial ectopic foci stimulation reduce ventricular contraction rate reduce cardiac output and blood pressures

Anticholinergics- scopolomine *primary* mechanism

blocking the binding of ACh to the cholinergic receptors in this region and thereby correcting an imbalance between the two neurotransmitters ACh and norepinephrine

What is nitroglycerin IV used for?

blood pressure control in hypertensive patients perioperatively, for treatment of ischemic pain, heart failure, pulmonary edema associated with acute MI, and in hypertensive emergency situations.

some fluids are known as oxygen carrying resuscitation fluids. which class of fluids is given this designation

blood products

adverse effects of sotalol

bradycardia chest pain palpitations fatigue dizziness lightheadedness weakness dyspnea

adverse effects of lidocaine

bradycardia dysrhythmia hypotension anxiety metallic taste

adverse effects of beta blockers

bradycardia hypotension dizziness fatigue AV block heart failure hyperglycemia hypoglycemia bronchospasm wheezing dry mouth impotence

when preparing and IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be a. diarrhea b. serum sodium level of 145 c. serum potassium level of 5.6 d. dehydration

c

- A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth for surgery in the morning. What will the nurse do about his morning dose of phenytoin? a. Give the same dose intravenously. b. Give him the morning dose with a small sip of water. c. Contact the prescriber for another dosage form of the medication. d. Notify the operating room that the medication has been withheld.

c. Contact the prescriber for another dosage form of the medication.

A patient has been given a prescription for levodopa-carbidopa for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact? a. Levodopa alone cannot cross the blood-brain barrier. b. There is really no difference between the two drugs. c. The combination drug is more efficient in increasing the dopamine level in the brain. d. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.

c. The combination drug is more efficient in increasing the dopamine level in the brain.

A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? a. folic acid b. cyanocobalamin (vitamin B12) c. epoetin alfa (Epogen) d. filgrastim (Neupogen)

c. epoetin alfa (Epogen)

During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient about adverse effects that may occur, such as a. anxiety. b. drowsiness. c. hypertension. d. constipation.

c. hypertension

The regular-release capsule dosage form of topiramate (Topamax) is prescribed for a patient, and the nurse provides information to the patient about the medication. What does the nurse instruct the patient? a. "Do not chew, crush, or break the capsule." b. "Take the medication on an empty stomach." c. "The capsule may be opened and sprinkled on a teaspoon of soft food." d. "If adverse effects are too severe, a dose may be skipped."

c."The capsule may be opened and sprinkled on a teaspoon of soft food."

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? a. Intravenous administration mixed with 5% dextrose b. Intramuscular injection in the upper arm c. Intramuscular injection using the Z-track method d. Subcutaneous injection into the abdomen

c.Intramuscular injection using the Z-track method

A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan? a. Take the iron tablets with milk or antacids. b. Crush the pills as needed to help with swallowing. c. Take the iron tablets with meals if gastrointestinal distress occurs. d. If black tarry stools occur, report it to the doctor immediately.

c.Take the iron tablets with meals if gastrointestinal distress occurs.

What are some substances and situations that can increase heart rate and contractility and thus increase oxygen demand?

caffeine, exercise, stress (stimulates SNS --> increased heart rate and contractility).

What are the forms of Vitamin D?

calcifediol (Calderol) calcitriol (Rocaltrol) dihydrotachysterol (Hytakerol) ergocalciferol (Drisdol)

class IV

calcium channel blockers, also used as antihypertensives and antianginal drugs inhibit the calcium channels reduce the influx of calcium ions durint action potentials

What are the actions of calcium channel blockers?

causes coronary artery vasodilation, causes peripheral arterial vasodilation, decreases systemic vascular resistance, reduces the WORKLOAD of THE HEART---> decreases myocardial oxygen demand. Promotes muscle relaxation.

how would you assess for benzodiazepines and nonbenzodiazepines?

check for disorders or medications that interact with benzos and non benzos, cbc, renal and hepatic function, note history of anemia, suicidal ideation and substance abuse, caution in the young and old because of a decreased metabolism, for pregnant or lactating women or for those who are especially sensitive to these medications. caution with concurrent use of other cns depressants.

What are results of Vitamin B2 (Riboflavin) deficiency?

cheilosis seborrheic dermatitis keratitis

What are AE of muromonab-CD3 (Orthoclone OKT3)?

chest pain pyrexia chills tremors dyspnea wheezing pulmonary edema flulike symptoms fluid retention

what are the indication for albumin

chronic illness liver disease nutrition status

what is the drug-drug interactions with benzodiazepines?

cimetidine, hormonal contraceptives, disulfiram, fluoexitine, isoniazid, ketoconazole, metoprolol, propoxyohene, propranolol, and valproic acid may enhance the effects of sedatives by DECREASING their metabolism. May decrease the efficacy of LEVODOPA which is a drug for Parkinson's. Alternately, rifampin, barbiturates may INCREASE the metabolism of benzos which decreases their effect.

What are natural sources of vitamin C (Ascorbic acid)?

citrus fruits and juices, strawberries, tomatoes, potatoes, broccoli, spinach, brussels sprouts, cabbage, green peppers, liver

what are some adverse effects associated with benzodiazepines?

cns depression causing drowsiness, and lightheadedness, paradoxical effects such as insomnia and excitation, respiratory depression, HYPOtension, constipation/diarrhea, nausea/ vomiting, rash

What does general anesthesia mean (balanced)?

combination of sedatives, opioids, gases and neuromuscular binding drugs

Plasma-Lyte

crystalloid not really used anymore - lactated ringer's much more common

the nurse is preparing an infusion for a patient who has a deficiency in clotting factors. which type of infusion in most appropriate? a. albumin 5% b. Packed RBC c. Whole blood d. fresh frozen plasma

d

when monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? a. bradycardia b. hypotension c. decrease skin turgor d. fluid overload

d

A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, "What is the difference in these drugs?" Which response by the nurse is correct? a. "There is no difference in these two drugs." b. "Aranesp works faster than Epogen to raise your red blood cell count." c. "Aranesp is given by mouth, so you will not need to have injections." d. "Aranesp is a longer-acting form, so you will receive fewer injections."

d. "Aranesp is a longer-acting form, so you will receive fewer injections."

A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Occurrence of adverse effects, such as confusion, anxiety, irritability, and headache d. Improved mental status, as well as improved ability to perform activities of daily living

d. Improved mental status, as well as improved ability to perform activities of daily living

The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms? a. Milk b. Yogurt c. Antacids d. Orange juice

d. Orange juice

3 When teaching a patient about taking a newly prescribed AED at home, the nurse should include which instruction? a. Driving will be allowed after 2 weeks of therapy. b. If seizures recur, take a double dose of the medication. c. Antacids can be taken with the AED to reduce gastrointestinal adverse effects. d. Regular, consistent dosing is important for successful treatment.

d. Regular, consistent dosing is important for successful treatment.

The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true? a. Folic acid is used to treat any type of anemia. b. Folic acid is used to treat iron-deficiency anemia. c. Folic acid is used to treat pernicious anemia. d. The specific cause of the anemia needs to be determined before treatment.

d. The specific cause of the anemia needs to be determined before treatment.

A patient has a new order for a catechol-O-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that an advantage of this drug class is that it a. has a shorter duration of action. b. causes less gastrointestinal distress. c. has a slower onset than traditional Parkinson disease agents. d. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

d. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). Which statement regarding the administration of iron sucrose is correct? a.The medication is given with food to reduce gastric distress. b.Iron sucrose is contraindicated if the patient has renal disease. c.A test dose will be administered before the full dose is given. d.The nurse will monitor the patient for hypotension during the infusion.

d.The nurse will monitor the patient for hypotension during the infusion.

effects of class Ib drugs

decrease myocardial excitability in the ventricles eliminate or reduce ectopic foci stimulation in the ventricles have minimal effect on the SA node and automaticity have minimal effect on the AV node and conduction have minimal anticholinergic activity

When monitoring lab values of a patient who is taking antithyroid drugs, the nurse knows to watch for?

decreased white blood cell counts. (thyroid drugs can cause cytoleukopenia)

effects of class Ia drugs

depress myocardial excitability prolong the effective refractory period eliminate or reduce ectopic foci stimulation decrease inotropic effect have anticholinergic activity

what is the indications for amylase

diagnosing: pancreatitis, pancreatic duct, obstruction, macroamylasemia trauma to pancreas

What is the action of nitrates and nitrites?

dilate all blood vessels, causes vasodilation because of relaxation of smooth muscles, potent dilating effect on coronary arteries---> causes oxygen to ischemic myocardial tissue. Nitrates have a potent dilating effect on the large and small coronary arteries. This causes redistribution of blood and oxygen to previously ischemic myocardial tissue and reduction of anginal symptoms.

phosphorated carbohydrate solution (Emetrol) mechanism

direct local action on the walls of the GI tract, where it reduces cramping caused by excessive smooth muscle contraction.

What are drug interactions with beta blockers?

diuretics, anti-hypertensives, calcium channel blcokers, insulin and oral antidiabetic drugs

adverse effects of flecainide

dizziness visual disturbances dyspnea palpitations nausea vomiting diarrhea weakness

What are the CNS adverse effects of beta blockers?

dizziness, fatigue, depression, lethargy

Neurokinin antagonists- aprepitant (Emend) AE

dizziness, headache, insomnia, and GI discomfort, but these are generally no more common than with other standard antiemetic regimens

What are the contraindications for calcium channel blockers?

drug allergy, acute myocardial infarction, second or third degree AV block (unless patient has a pacemaker), hypotension

Blood products

elements of whole blood such as plasma, platelets, and red blood cells that are used in replacement therapy

Which cells have the greatest requirement for vitamin B12 (cyanocobalamin)? Why?

epithelial cells, bone marrow, myeloid cells - because they divide rapidly

Hyperkalemia

excessive potassium in the blood

excitatory vs. inhibitory transmitters

excitatory- norepinipherine inhibitory- GABA

What are beta blockers used for?

exertional angina (exercise angina), Treatment of Myocardial infarction, hypertension, cardiac dysrhythmias, and essential tremor. Also STAGE FRIGHT

What is the function of B12 (cyanocobalamin)?

fat and carb metabolism, protein synthesis, growth and cell replication, hematopoiesis, nucleoprotein and myelin synthesis

what are the main medications used for epidural anesthesia?

fentanyl and bulpivacaine

what are the main medications used for spinal( conscious sedation)?

fentanyl and propofol are the main ones

What are symptoms of cytokine release syndrome?

fever hypotension tachycardia asthenia HA rash scratchy throat dyspnea Nausea chills

class Ic

flecainide propafenone have a more pronounced effect on the blockade of sodium channels little effect on repolarization or action potential duration

which are common uses of crystalloids?

fluid replacement, promotion of urinary flow, replacement of electrolytes, as maintenance fluids

What are AE of Vitamin B3 (Niacin)

flushing pruritus GI distress

what are some adverse reactions with the use of anesthetics?

for general anesthetics, there are fewer side effects with the newer anesthetic drugs and the use of balanced anesthesia. MALIGNANT HYPERTHERMIA which could cause a potentially fatal reaction. Metabolic reactions tend to be genetic which include a rapid rise in the body temperature, tachycardia, tachypnea, muscular rigidity, cyanosis, irregular heart beats, and unstoppable hypertension. Bad in children and adolescents. Can have skeletal and muscular anomalies; and DANTROLENE is the ONLY MUSCLE RELAXANT TO WORK ON THE SKELETAL MUSCLE DIRECTLY.

a patient with a blood disorder needs a replacement product that contains clotting factors. the nurse expects which product to be given?

fresh frozen plasma

how does insulin work for type 1 DM

functions as a substitute for the endogenous hormones and the effects are the same it restores the Pt ability to metabolize carbohydrate, fats, proteins, stores glucose in the liver, and converts glycogen to fat stores so insulin is derived from porcine source, most is human-derivied, using recombinant DNA. the goal is to have glucose control and to reduce long-term complications.

Describe scurvy symptoms

gingivitis and bleeding gums loss of teeth anemia subQ hemorrhage bone lesions delayed healing of soft tissues and bones

what is the hypnotic effect?

given at bedtime with the purpose of inducing sleep; may be the same drug just at different strengths

Anticholinergics- scopolomine contraindications

glaucoma

Dextran 40, 70, or 75

glucose solutions

What is the function of Vitamin B3 (Niacin)?

glycogenolysis tissue respiration lipid, protein and purine metabolism

What are food sources of magnesium?

green leafy veggies, meats, seafood, milk, cheese, yogurt, bran cereal, nuts

A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? a. guaifenesin (Humibid) b. benzonatate (Tessalon Perles) c. diphenhydramine (Benadryl) d. dextromethorphan (Robitussin DM)

guaifenesin (Humibid) Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect.

adverse effects of dofetilide

headache insomnia ventricular tachycardia chest pain torsades de pointes rash back pain nausea vomiting

paroxysmal supraventricular tachycardia (PSVT)

heart rate of 180-200 beats/min or higher

Hypernatremia

high sodium

Antidopaminergics- prochlorperazine (Compazine) contraindications

hypersensitivity to phenothiazines, those in a coma, and those who have seizures, encephalopathy, or bone marrow suppression

What is the most common side effect of CellCept that happens in 28-77% of patients?

hypertension

what would decrease bicarbonate level

hypocapnia respiratory alkalosis metabolic acidosis

adverse effects of quinidine

hypotension QT prolongation lightheadedness diarrhea bitter taste anorexia blurred vision tinnitus angina

adverse effects of phenytoin

hypotension bradycardia thrombophlebitis hypertrichosis gingival hyperplasia

adverse effects of procainamide

hypotension rash diarrhea nausea vomiting agranulocytosis SLE-like syndrome

What are the adverse effects of calcium channel blockers?

hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, rash, flushing, peripheral edema.

What are the 5 different corticosteroids that help decrease inflammation in the airways of the lungs?

i. AzmaCORT, pulmiCORT ii. AeroBid iii. Advair (beta agonist servent + steroid) iv. Flovent v. Solu-Medrol (IVP)

calcuim indications

identify problems with: parathyroid, neuromuscular functions, diseases that affect the bone, effectiveness of treatments.

Nursing implications therapeutic effectiveness for antipsychotics

improved mood and affect alleviation of psychotic symptoms and episodes decreased paranoia, delusions, inability to cope, garbled speech, and hallucinations.

Nursing implications therapeutic effectiveness for antidepressants

improved sleep patterns increased feelings of self esteem decreased feelings of hopelessness increased interest in self and appearance increase interest in daily activities fewer depressive manifestations or suicidal thoughts or ideations

what are some local anesthetics?

in the spinal, or intraspinal; LIDOCAINE, mepivacaine, procaine, letrcaine. Intrathicals, and Epidurals

what causes a albumin to decrease

inadequate intake liver disease inflammation chronic disease losses from: fistula, hemorrhage, kidney disease, burns overhydration increase catabolism

blood products adverse effects

incompatibility with recipients immune system, crossmatch testing, transfusion reaction, anaphylaxis, transmission of pathogens to recipient (hepatitis, HIV)

What is the Black Box warning for CellCept?

increased risk of congenital malformations and spontaneous abortions when used during pregnancy

What are some peripheral anesthetics?

infiltration(e.g dental surgery or sutures, like a little prick), nerve block and topicals

What is the function of antimetabolites?

inhibit cell proliferation

How do calcineurin inhibitors work?

inhibit the phosphate required for interleukin 2 production

grapefruit juice

inhibits the metabolism of several drugs like amiodarone, disopyramide, and quinidine

what is type 2 diabetes caused by

insulin deficiency and insulin resistance this is either due to either to many resistant cell to insulin: reduce number of insulin receptors, or they are less responsive

Antidopaminergics- prochlorperazine (Compazine) indications

intractable hiccups antipsychotic effects but also prevent nausea and vomiting

promethazine (Phenergan) indications

intractable hiccups antipsychotic effects but also prevent nausea and vomiting

What is required for the oral absorption of vitamin B12 (cyanocobalamin)?

intrinsic factor- glycoprotein secreted from gastric parietal cells

What is amylase?

is made in the pancreas. an enzyme that breaks down carbohydrates to allow the body to absorb it.

general anesthetic: propofol (diprovan)

it is classified as a general anesthetic, onset is 40 seconds, peak is unknown, and duration is 3-5 min. induced perenterally, and needs to be maintained because it has a really short half life, it needs to be administered continuously, and the sedation is for mechanical ventilation in ICU unit. lower doses can be used as a sedative/hypnotic for mild to moderate sedation. This is a LIPID based emulsion.

calcuim does what

it is necessary for neuromuscular process, bone mineralization, and hormonal secretion. the parathyroid gland and vit. D are responsible for calcuim regulation in the body. in the blood about half of the calcuim travels in ion form, the other half is bound to proteins like albumin.

which herbal products do you want to avoid when using benzodiazepines?

kava kave, valerian root, and chamomile because the SYNERGISTICALLY INCREASE SEDATION; EFFECTS THE RESPIRATIONS WHICH APPLIES TO ALL CNS DEPRESSANTS

Tetrahydorcannibinoids- dronabinol (Marinol) contra

known drug allergy

phosphorated carbohydrate solution (Emetrol) contra

known drug allergy

Serotonin Blockers- ondansetron (Zofran) contra

known drug allergy pregnancy category B, there is concern regarding cleft palate development in the fetus when used in the first trimester.

ginger contra

known product allergy. It may worsen cholelithiasis (gallstones). There is anecdotal evidence of abortifacient properties, and some practitioners recommend not using during pregnancy

A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. The nurse's answer considers that one benefit of orally administered decongestants is a. immediate onset. b. a more potent effect. c. lack of rebound congestion. d. shorter duration.

lack of rebound congestion. Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.

What are the AE of azathioprine (Imuran)?

leukopenia thrombocytopenia heptotoxicity

what are the main medications used for local infiltration anesthesia?

lidocaine(xylocaine)

indications for class III drugs amiodarone dronedarone dofetilide ibutilide sotalol

life-threatening ventricular tachycardia or fibrillation atrial fibrillation or flutter resistant to other drug therapy

What is the name for the combination of triglyceride or cholestrol with apolipoprotein??

lipoprotein

What are oral and topical dosage forms of nitroglycerin used for?

long term prophylactic management of angina pectoris.

What does insulin do?

lowers blood glucose levels

What can cause a phosphorus deficiency?

malabsorption extensive diarrhea or vomiting hyperthroidism long-term use of aluminum or calcium antacids hepatic disease

Blood Products Indications

management of acute bleeding, increase clotting factor levels, increase O2 carrying capacity in patients with anemia, can contain plasma proteins to draw fluid back into the blood vessels of surrounding tissues

For beta blockers, how should you counsel your patient?

may be taken with or without food, daily weights need to be measured at same time every day with same clothing. Take measures to reduce incidence of ORTHOSTATIC HYPOTENSION

Non-opioid drugs action that suppresses the cough-reflex center

mechanism of action of antitussives

class I drugs

membrane-stabilizing drugs exert effects on the sodium (fast) channels subclasses are based on the magnitude of the effects each drug has on the action potential duration and the effective refractory period

What can B2 (Riboflavin) treat besides deficiencies?

microcytic anemia ance migraine HA

phosphorated carbohydrate solution (Emetrol) indications

mint-flavored, pleasant-tasting oral solution used to relieve nausea. It can be used to control mild cases of nausea and vomiting. (non-FDA-approved) uses is for treatment of morning sickness during pregnancy. Phosphorated carbohydrate solution is not sufficient for treatment of more severe nausea symptoms such as those associated with cancer chemotherapy.

What is the major AE of cyclosporine and tacrolimus?

nephrotoxicity

What are some drugs that can be administered through inhalation? (General anesthetics)

nitrous oxide( inhaled gas), desflurane, enflurane, halothane, isoflurane, methoxylflurane, sevoflurane (inhaled volatile liquid). Inhaled anesthetics are the weakest, and we have seen lots of problems with halothane and methoxylflurane--> with people coming out of anesthesia, affects the heart.

Tetrahydorcannibinoids- dronabinol (Marinol) interactions

no significant drug interactions

adverse effects of ibutilide

nonsustained ventricular tachycardia ventricular extrasystoles tachycardia hypotension AV block headache nausea

Parenteral infusions of potassium rate

normal hourly rate of 10 mEq/hour

how would you assess someone with barbiturate toxicity, or just in general?

note any complaints of insomnia with attention to onset, duration, frequency, pharmacologic, and nonpharmocologic measures used. note any sleeping disorders, sleep patterns, difficulty sleeping, or frequent awakenings. note the vital signs, with special attention to BLOOD PRESSURE, assessing for orthostatic hypotension which it can cause. pulse rate and rhythm, rr's body temp, and the presence of pain. thorough physical examination for baseline comparison, focus of neurologic changes such as loc, mental status, mood changes, or other mental disorders. remember that the medical history will note any use of alcohol, tobacco, caffeine intake, and current medications.

what are some comorbid condition with type 2 diabetes

obesity coronary artery diease dyslipidemaia hypertension micoralbuminemia (protein in urine) enhance conditions of embolic events (blood clots) collectly they are referred to as metabolic syndrome or insulin resistance syndrome or syndrome X

atrial flutter

often progresses to atrial fibrillation

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for adverse effects associated with the use of xanthine derivatives, such as a. diarrhea. b. palpitations. c. bradycardia. d. drowsiness.

palpitations The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

what would cause a decrease in the level of amylase

pancreatic insufficiency pancreatectomy toxemia of pregnancy cystic fibrosis liver disease

what would cause increased level of amylase

pancreatitis pancreatic cancer pancreatic cyst DKA Peritonitis abdominal trauma duodenal obstruction mumps alcohol use

indications for class IV drugs (calcium channel blockers) diltiazem verapamil

paroxysmal supraventricular tachycardia (PSVT) rate control for atrial fibrillation and flutter

class Ib

phentoin lidocaine block sodium channels accelerate repolarization decrease the action potential duration

A glucocorticoid commonly used for inflammation

prednisone

diphenhydramine (Benadryl) contraindications

pregnancy category B drug, and its use is contraindicated in patients with a known hypersensitivity to it. It is to be used with caution in nursing mothers, neonates, and patients with lower respiratory tract symptoms Its use is not advised in older adults, however, because of the "hangover" effect and increased potential for falls

adverse effects of propafenone

prodysrhythmic effect angina tachycardia syncope AV block dizziness fatigue dyspnea

What is albumin?

protein in blood; maintains the proper amount of water in the blood

albumin

protein in blood; maintains the proper amount of water in the blood

What are symptoms of Pellagra?

psychotic symptoms, neurasthenic syndrome, crusting, erythema, Inflammation of mucous membranes, diarrhea

adverse effects of amiodarone

pulmonary toxicity thyroid disorders bradycardia/hypotension SA node dysfunction AV block QT prlongation vomiting constipation photosensitivity abnormal liver function test/jaundice visual distubrances hyperglycemia/hypoglycemia rash/toxic epidermal necolysis/vasculitis/blue-gray coloring of the skin

class Ia

quinidine procainamide disopyramide block the sodium channels delay repolarization increase action potential duration

signs of diabetic ketoacidosis

rapid deep respirations acetone breath lethargy decreased responsiveness

ventricular tachycardia

rapid heartbeat from impulses originating in the ventricles can be brief or sustained

torsades de pointes

rapid ventricular tachycardia preceded by QT interval prolongation intermediate dysrhythmia that often deteriorates into ventricular fibrillation

atrial fibrillation

rapid, ineffective atrial contractions incompletely pumps blood into the ventricles predisposes the patient to stroke because blood stagnates in the incompletely empited atria and is therefore more likely to clot

ventricular fibrillation

rapid, ineffective ventricular contraction fatal if not reversed requires electrical debfibrillation

What are Fingolimod and glatiramer acetate indicated for?

reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis.

human-based insulin: short-acting

regular insulin (Humulin R, novolin R) onset is 30-60 min the only insulin product that can be given IV bolus, IV infusion, IM

diphenhydramine (Benadryl) indications

relief or prevention of histamine-mediated allergies, motion sickness, the treatment of Parkinson's disease (due to its anticholinergic effects, and the promotion of sleep. It is also used in conjunction with epinephrine in the management of anaphylaxis and in the treatment of acute dystonic reactions.

what are benzodiazepines used for?

remember that not all drugs are appropriate for all uses. antianxiety, hypnotic- inducing sleep, anticonvulsant- because of skeletal muscle relaxation, preoperative sedation, prevent DT's in alcohol withdrawl (diazepam). you can combine these with anesthetics, analgesics, and neuromuscular binding drugs for a balance effect

some fluids are known as oxygen carrying resuscitation fluids. why is their origin a potential problem for recipient

require human donors. reactions due to incompatible, with a immune response

What is muromonab-CD3 (Orthoclone OKT3) indicated for?

reversal and prevention of graft rejection

promethazine (Phenergan) AE

sedation

What are the indications for taking Vitamin B6 (Pyridoxine)?

seizures, morning sickness metabolic disorders, drug induced neuritis

Antihistamines- meclizine (Antivert) contraindications

shock and lactation

What are signs and symptoms of a Vitamin B6 (Pyridoxine) deficiency?

siderblastic anemia, neurologic disturbances, beborrheic dermatitis, cheilosis, glassitis, stomatitis, epileptiform convulsions, hypochromic micreocytic anemia

Where is most of the phosphorus in the body?

skeletal bones

the nurse would anticipate the administration of what with the patient potassium level of 5.9 mEq

sodium polystyrene sulfonate (Kayexalate)

What are symptoms of Vitamin D deficiency r/t Rickets

soft bones causing deformities Nodular enlargement Muscle pain enlarged skull chest deformities spinal curvature Enlarged liver and spleen Profuse sweating Tenderness

Colloids

substances such as large protein molecules that do not readily dissolve into true solutions

indications for class II drugs (beta blockers) atenolol osmolol metaprolol

supraventricular and ventricular dysrhythmias general myocardial depressants

what is the criteria of diabetes mellitus

symptoms of diabetes and casual plasma glucose level less than or equal to 200 mg/dl or fasting plasm glucose higher than or equal to 126 mg/dl or 2-hour postload BGL higher than or equal to 200 mg/dl during an oral glucose tolerance test

Hetastarch

synthetic colloid

What are the contraindications for beta blockers?

systolic heart failure, bronchial asthma, diabetes mellitus, peripheral vascular disease.

To help with insomnia associated with thyroid hormone replacement therapy, the nurse should teach the patient to?

take the dose first thing in the morning.

What are the AE caused by hypermagnesemia?

tendon reflex loss Difficult bowl movements CNS depression Respiratory distress heart block hypothermia

glucose tolerance test (GTT) is

test for initial diagnosis of diabetes mellitus; patient is given dose of glucose; then blood samples are taken at regular intervals to determine patient's ability to use glucose properly

how would a nurse manage an epidural spot for pain?

the catheter is placed in the epidural space to inject a narcotic or oipiod drug, can be used for obserics, surgical procedures. to maintain the pain you would use drugs like OIPIOIDS- MORPHINE, HYDROMORPHONE WHICH IS OUR DILOTIC, FENTANYL, AND MEPERIDINE WHICH WE DON'T USE BECAUSE OF THE DANGEROUS METABOLITES THAT CIRCULATE. LOCAL ANETHETICS WE WOULD USE ARE LIDOCAINE, AND BUPIVACAINE. the catheter may be left in for follow up injections from the physician or patient controlled anesthesia. you want to assess the dermatomes to see if the anesthesia travels too high because it can shut down the RESPIRATORY DRIVE.

Hypotonic solutions are used when

the cell is dehydrated and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia.

The barbiturate: phenobarbital

the clinical classification is an anticonvulsant, hypnotic, most commonly prescribed for STATUS EPILIPICUS, ITS GABA MEDIATED MEANING ITS AN INHIBITOR. 10-40 mcg/ ML and toxicity occurs if you exceed 40 mcg/mL. Signs and symptoms of toxicity include cold clammy skin, respirations less than 10 and other signs of cns depression. IV ADMINISTRATION MUST BE STRICLY FOLLOWED AS RAPID INFUSION CAN CAUSE HYPOTENSION AND MARKED RESPIRATORY DEPRESSION. there is an IV infiltration antidote which is 0.5% PROCAINE which should be injected into the affected area. most often this is used in nonindustrial countries because of low cost. it has a LONG HALF LIFE, phenobartital toxicity you can use activated charcoal to get it out of the system, increase urine pH making it more basic and force diuresis with diuretics

What effects on the Respiratory System do amphetamines have?

the effects of amphetamines on the Respiratory system are: -Relaxation of Bronchial Smooth muscle -Increased Respiration -Dilation of pulmonary arteries

Neuromuscular Blocking agents: Nondepolarizing drug- Pancuronium and Vercuronium

these drugs produce paralysis, does not affect the patients level of consciousness or impact their pain, anxiety or sedation. They block the acetylcholine receptors.

What is the purpose of anesthetics?

they are drugs that reduce or eliminate pain by depressing nerve function in the central or PNS

some fluids are known as oxygen carrying resuscitation fluids. why are these fluids able to carry oxygen

they contain hemoglobin

What is the function of B2 (Riboflavin) in the body?

tissue respiration/normal respiration function Activates B6 (Pyridoxine) Converts tryptophan into niacin Maintains erythrocyte integrity

when would you check the amylase range

to help identify if there is a problem with the pancreas

Isotonic solutions are used:

to increase the EXTRACELLULAR fluid volume due to blood loss, surgery, dehydration, fluid loss that has been loss extracellularly.

Why are antifungals typically given with immunosuppressants?

to prevent/treat oral candidiasis that may occur

When hypertonic solutions are used (very cautiously....most likely to be given in the ICU due

to quickly arising side effects of pulmonary edema/fluid over load). In addition, it is prefered to give hypertonic solutions via a central line due to the hypertonic solution being vesicant on the veins and the risk of infiltration.

Antihistamines- meclizine (Antivert) indications

treat the dizziness, vertigo, and nausea and vomiting associated with motion sickness related to inner ear problems, nonproductive cough, allergy symptoms, sedation

Anticholinergics- scopolomine indications

treatment and prevention of the nausea and vomiting associated with motion sickness to treat postoperative nausea and vomiting

What are nitroglycerin sublinguals used to treat?

treatment of chest pain or angina of acute onset, prevention of angina. (exposure to air and moisture can deactivate this drug...must be stored in original container).

Tetrahydorcannibinoids- dronabinol (Marinol) indications

treatment of nausea and vomiting associated with cancer chemotherapy. It is generally used as a 835second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and chemotherapy patients

Sodium indications

treatment or prevention of sodium depletion when dietary measures are inadequate.

which diabetes is the most common

type 2

for ointment forms of meds, how should you counsel your patient?

use the proper dosing paper suppolied by drug company to apply a thin layer on clean, dry, hairless skin of the upper arms or body. Avoid areas below the knees and elbows. Do not apply ointment with fingers...use gloves. Do not rub ointment into the skin, cover the area with an occlusive dressing if not privded. Rotate application sites and remove all residual from previous dosages with soap and water/pat area dry.

how is bicarbonate level measured

using carbon dioxide levels

When do headaches usually subside with nitrates/nitrites?

usually diminish in intensity and frequency with continued use.

I am used to decrease excessive urination

vasopressin

indications for class Ib drug lidocaine

ventricular dysrhythmias only premature ventricular contractions ventricular tachycardia ventricular fibrillation

indications for class Ic drugs flecainide propafenone

ventricular tachycardia and supraventricular tachycardia dysrhytmias atrial fibrillation and flutter Wolff-Parkinson-White syndrome

Neurokinin antagonists- aprepitant (Emend) interactions

warfarin so INR needs to be checked before each cycle of aprepitant reduce the effectiveness of oral contraceptives giving it together with drugs that are primarily metabolized by cytochrome P-450 enzyme 3A4, including azole antifungals, clarithromycin, diltiazem, nicardipine, protease inhibitors, and verapamil. corticosteroids.

H2 Antagonists: Mechanism of Action

works on the parietal cells -Block histamine at the (H2) receptors of acid-producing parietal cells -Production of hydrogen ions( by parietal cells) is reduced, resulting in decreased production of HCl Drug effect: Suppressed acid secretion in the stomach DURG

What is the only AE of Vitamin B2 (Riboflavin)

yellow/orange urine

Hemoglobin (Hgb)

• Females 12-16 g/dL • Males 14-18 g/dL

Colloids Indications

• Treat a wide variety of conditions: anything that causes a decrease in colloid • Superior to crystalloids in PV expansion, but more expensive

Cardiac Glycosides: Drug Effects (cont'd)

◾ Increased stroke volume ◾ Reduction in heart size during diastole ◾ Decrease in venous BP and vein engorgement ◾ Increase in coronary circulation ◾ Promotion of diuresis due to improved blood circulation. ◾ Decreased exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis.

Cardiac Glycosides

◾ No longer used as first-line treatment. ◾ Originally obtained from Digitalis plant, foxglove. ◾ Digoxin ◾ Used in heart failure and to control ventricular response to atrial fibrillation or flutter.

Cardiac Glycosides: Drug Effects

◾ Positive inotropic effect → Increased force and velocity of myocardial contraction. ◾ Negative chronotropic effect → Reduced heart rate ◾ Negative dromotropic effect → Decreased automaticity at SA node, decreased AV nodal conduction.

Phosphodiesterase Inhibitors: Indications

◾ Short-term management of heart failure. ◾ Given when patient does not respond to treatment with digoxin, diuretics, and/or vasodilators. ◾ AHA and ACC advise against weekly infusions. ➤ No improvement of clinical status.

𝞫-type Natriuretic Peptides: Mechanism of Action

◾ Vasodilating effects on arteries and veins ◾ Indirectly increases cardiac output ◾ Suppresses renin-angiotensin system ◾ Diuresis

Drug Therapy for Heart Failure

☐ ACE inhibitors ☐ Angiotensin II receptor blockers ☐ 𝞫-type natriuretic peptides ☐ Phosphodiesterase inhibitors ☐ Cardiac glycosides

Angiotensin II Receptor Blockers

✰ Potent vasodilators; decrease systemic vascular resistance (afterload). ✰ Examples: Valsartan, Candesartan, Losartan

ACE Inhibitors

✽ Prevent sodium and water resorption by inhibiting aldosterone secretion. ✽ Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart. ✽ Examples: → Lisinopril → Enalapril → Captopril

Cardiac Glycosides: Adverse Effects

❑ Digoxin (Lanoxin) ➤ Very narrow therapeutic range and low TI. ➤ Drug levels must be monitored. → 0.5 to 2 ng/mL ➤ Hypokalemia increases its toxicity. ➤ Electrolyte levels must be monitored.

Digoxin: Adverse Effects

❑ Digoxin (Lanoxin) (cont'd) ➤ CARDIOVASCULAR → Dysrhythmias, including bradycardia or tachycardia. ➤ CENTRAL NERVOUS SYSTEM (CNS) → Headaches, fatigue, malaise, confusion, convulsions.

Digoxin Toxicity

❑ Digoxin immune Fab (Digibind) therapy ➤ Life-threatening digoxin overdose ➤ Life-threatening cardiac dysrhythmias

What are the Mechanism of Action (MOAs) for Cardiac Glycosides?

❑ Increase myocardial contractility ❑ Change electrical conduction properties of the heart ➤ Decrease rate of electrical conduction ➤ Prolong the refractory period → Area between SA node and AV node.

𝞫-type Natriuretic Peptides

❑ Nesiritide (Natrecor) ➤ Used in severe, life-threatening heart failure.

Drug Therapy for Heart Failure do what

❑ Positive inotropic drugs ➤ Increase the force of myocardial contraction ❑ Positive chronotropic drugs ➤ Increase heart rate ❑ Positive dromotropic drugs ➤ Accelerate cardiac conduction ❑ Used to treat heart muscle failure