nurs:final exam study guide

What causes "red man" syndrome?

- IV that may occur with the first dose of vancomycin or when the drug is amdinersted too fasts s/s flushing of the neck, pritus, hypotension

Evaluation (nursing process)

- Progress toward outcomes - Conduct systematic, ongoing, criterion-based evaluation - Include patient and significant others - Use ongoing assessment to revise diagnoses, outcomes, plan - Disseminate results to patient and family

What is the standard medication treatment regimen for H. pylori peptic ulcer? a. __________________ b. __________________ and c. _____________________ for ________ days.

- antibiotc, Ht blocker, proton pump inhibotor - for 7-14 days -omeprazole, amoxicullin + claritromogan for 10 days

ASSESMENT In the nursing process

- as the patient about allergies to food or medications, current health concerns, use of OTC medication and herbal supplements. for all medications take prior to assesment ensue that the patient has been receiving the right dose, right time, and right route. asses kidney,liver and other body system functions

Why glucocorticoid therapy is gradually reduced (tapered)? Explain this to a patient.

- beta blockers slow down heart rate - supresses adrelin, if you take it off right away you go trough whitdrawl and rebound

Special considerations for a patient allergic to penicillin who is prescribed ampicillin?

- dont give it yet because an ampicllin is a penicillin so ask provider

describe the relationship between liver function and dosage of drug

- high dosage of drug an decrease liver function the you would want to decrease that drug because your liver is not going to break it down as well. - adjust when you give it, longer half life so instead of 12 it would take 18 hours so you would spread out and lower the dosage and monitor liver function

what effects does NTG (nitroglyceren exert on)

- mesodilation decrease BP - hedache is common

. A common anticipated gastrointestinal side effect of opiod analgesics (meperidine/morphine) is ______________________. In 2014 the FDA approved ___________________ drug for this side effect?

constipation FDA approved naloxegol(=Treatment of opioid-induced constipation (OIC) in patients with chronic non-cancer pain,) - headche, seating, gastrointestinal performation, diarhea, nausea, hypeternsive, agniodema, opiod withfrawe

Chemotherapy kills ________________ and __________________ rapidly growing cells

cancer and healthy

STD treatment

clomizpne + ziphensime + edimcrozone

Which organ is most responsible for drug metabolism? ____________________ Drug excretion? _____________________________

liver and drug excretion is kidney

calcium channel blockers major effet

lower blood prssure ( decrease heart rate)

nadir

lowest WBC platelt +neutrophill

What is the antidote for bleeding due to heparin? Blood test to assess for therapeutic effect?

portamine sulfate and PPTT

Heparin, Coumadin, Lovenox modify coagulation by what action? a. Prevent formation of new clot b. Dissolve existing clot

prevent formation of new clots heparin: prevent couman( prevent and treat) lovenox (prevent/ treat)

corticosteroids are the #1 treament for long term

propixlis of astham

ataxia

" being drunk"

Dioxin

0.5-2

Adverse effects

A general term for any undesirable effects that are a direct response to one or more drugs.

EPS(extraphyramidal side effects)

Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.

Benzodiazepines s/s

_> furopil hangry: hedache, irrtable slughs drowsiness. confusion. dizziness. trembling. impaired coordination. vision problem

Explain the differences between the following: Know these terms . a. Normal flora b. Superinfection c. Super bug

a. bacterial GI tract (the good bacteria) 2. second infection, antibitoic over use 3. when you stop half way (bacteria did not fully die)

Important teaching for respiratory inhalant includes the following: a. Administer the bronchodilator ________ b. Administer the anti-inflammatory _______ c. Rinse mouth after using the _____________________inhalant d. What is the rationale for rinsing mouth after a corticosteroid anti-inflammatory inhalant?__________________________________________

a. before b. c. steorid.cortioers d. help prevent hoarseness, throat irritation, and infection in the mouth.

Common adverse effects of beta adrenergic agonist bronchodilators include: a. ______Pulse b. ______BP c. ______Mentation

a. increases b. increases c. inceases/decreases it just canges

Explain to a mother why Vitamin K is administered to their newborn?

against bleeding

taper

avoid afrenal, rebound adran weight loss, comting diarha

time frames of inahltion

b-c 5/10 in

Retaplase (Retavase) modifies coagulation by hat action? a. Prevent formation of new clot b. Dissolve existing clot

b. disolve existing clot

synthetic drugs

both have similar effects on body (ex. bytano and Ibprofen work better together

Tamoxifen is used to treat what type of cancer?

breast cancer

kidney

creatin,

What effects do most antipsychotics exert on the BP _______

decrease

fibrolysts

destroyg clots blisters

sympathetic

fight or flight

Which medication is indicated for the treatment of a benzodiazepine overdose? ______________________________.

flumenzonal

Explain the relationship between protein levels and drug levels in the body.

high protein -> high protein bound-> less forms active forms in the blood

utricarial + pritus

itching

Which insulin acts for 24 hours and has no peak action?

lantus (Basaglar, Lantus, Toujeo)

Acetaminophen (Tylenol) can be toxic to which organ? ____________________

liver

lytes

potassium soidum chlroide

Antidote for bleeding due to Coumadin? Blood test to assess for therapeutic effect?

vitamin K PT,IRN

line of defenses

1. inflammatory response 2. immune respons

corner stone treamtent for diabets

1. diet 2. excercise 3. education 4. medicaion digoxin

IMPLEMENTATION nursing

( is when you give the drug) - eliminate potentail distractions during medication adminstration that could result in an error. - identify of each patient using two means (name and birth), use thecorreect procdedres and technieques. calculate med,

A patient receiving Regular insulin at 0730 should have a snack at what time to cover peak action time?

(2-4 hours)

Important patient teaching for NTG: a. Drug action? b. Storage? c. Up to how many tablets may be taken? d. In what specific time frames? e. Should MD be notified if headache develop? Why?

(Ther: antianginal drug pharm: organic nitrate Oldest and most widely used organic nitrate. Can be delivered by a number of different routes. When given sublingually it terminates angina pain in 2-4 min. Chest pain does not resolve within 5 min after a dose of nitroglycerin may ignace MI. Adverse effects can dilate cerebral vessels, headache is common.) a. b. away from heat/cold. keep near yourse c. 3 tables d. -- e. headache common

Rare though serious adverse effects of ibuprofen (Motrin)?

(decreased pain and inflammation) -GI bleeding, renal infection

What are 2 priority teaching points with phenytoin (Dilantin) therapy?

- pregnancy D, fetal rhtmias, hyperglasimia Prototype drug phenytoin ( dilantin, phenytek) Ther: antiseizure drug: antidysrhythmic pharm: hydantoin; sodium influx-suppressing drug Phenytoin acts by desensitizing sodium channels in the CNS, preventing the spread of abnormal electrical charges in the brain that produce seizures. Effective against most type of seizures except absence seizures Pregnancy D Adverse effects dysrhythmias, such bradycardia and ventricular fibrillation, severe hypotension, and hyperglycemia. CNS reactions include: headache, nystagmus,ataxia, confusion and slurred speech, paradoxical nervousness, twitching and insomnia. BLACK BOX: rate of IV dilantin admin exceeds 50 mg/min. In pediatric patients bc of the risk of severe hypertension and cardiac arrhythmias

Narcotics S/S

-> nancasin Reduced rate of breathing. Dyspnea. Low skin temperature. Muscles relaxed. Pinpoint pupils. Very sleepy.

Heparin

-> prpamine irritation, pain, redness, or sores at the injection site. bleeding takes longer to stop

Coumadin side effects

-> vitamine K Bleeding (in stool, vomit, gums, etc), bruising, weakness

Patient teaching for a patient prescribed antibiotics and taking birth control pills?

-you ask them like you should be on other protetice meds if sexually active

The therapeutic level (range) for digoxin (Lanoxin) ___________________.

0.5-2

Lithium therapeutic level?

0.6-1.2

Label the controlled substance schedule I ---------- V from least to highest potential for abuse

1. highest no benefits 2. morphines 3. benzos 4. nonfilusion 5. tylanol

Dilatin ther

1-20 - prevent and control seizures to high toxicity - s/s: dizines, dorwines,fatigue

Which laboratory values should be monitored to best assess for kidney damage?

1. BON= check urine levels - when high Heart failure, dehydration, or a diet high in protein - Liver disease or damage can lower your BUN level. 2. creatnin: breakdown protein in blood ( high protein breakdown means damage in)

. Identify two major adverse effects of aminoglycoside therapy: _______________________ and __________________________.

1. myosins (motor proteins best known for their roles in muscle contraction) 2. Ototoxicity refers to drug or chemical-related damage to the inner ear, resulting in damage to the organs responsible for hearing and balanc

Refer to the Adams text book to list at least 3 of the 11 nurse's responsibilities that includes medication knowledge and understanding besides the 3 medication checks and 5 rights

1. name of the person and read med 2. while prepaing med look at the medcation label and check against MAR 3.recheck the label on the contain before returin to sotrage/ check the labl on the medcation agisnt MAR before openign the apckage at the bedside

What is the major advantage of intravenous drug administration? List 2

1. onset to blood right away 2. passes first-pass effect ( instead through organs)

List the 5 key rights of medication (not including documentation) administration as noted in the required text book, that constitute a correctly written prescription order.

1. patiens 2. med 3. route 4. dose 5. time

Risperidone (Risperdal) an atypical antipsychotic is prescribed for a patient with schizophrenia. The nurse monitors the patient for what favorable outcomes? List 2.

1. reduction extreme parionia 2. +/- w/ draw

Which neurotransmitters are related to mental illness and are key to medication management? (at least 4)

1. semnting 2. nornephinre 3. nephrine 4. dopamine

What is the therapeutic range for Dilantin? _________________ug/ml

10-20

A patient receiving NPH insulin at 0730 should have a snack at what time to cover peak action time?

14:00 (

The therapeutic effects of an antibiotic should be evident within _________ days? _______ should trend downward

2-3 days. WBC should trend downward - if WBC are high means infection

How many medication checks should be done prior to administering a medication? _________ When should they be done?

3 1. pull med out 2. draw it 3. give it again

When should proton pump inhibitors be administered in relation to meals?

30 min before

normal BGL

70-110

Normal glucose parameters _________ __________mg/dl on _____ separate occasions

70-110 on 2 seperate

A patient is at risk for increased digoxin toxicity when level potassium is ___________. Normal potassium level is _______________.

<3.5 and normal potassium level is 3.5-5

Antagonist

A character or force in conflict with the main character

blood test to monitor coumadin

APTF: screeting test help evoutle person abilty to approly from blood cloths ptn/InG-> coumating hepatin+ duenox aPPT

liver:

AST,ALT, althiane phostma, themoslim

What is the first pass effect?

After oral administration, many drugs are absorbed intact from the small intestine and transported first via the portal system to the liver, where they undergo extensive metabolism, therefore usually decreasing the bioavailability of certain oral medications.

idosyncratic reaction

An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.

Why is silver sulfasiazine (Silvadine) used for burn victims? Where will the medication be applied?

Ans: silver sulfasiazine is a topical antibiotic , it is generally available in cream form , it is generally apply in wound infection, second and third degree burn.it should not be used in viral infection like common cold etc, These antibiotic should be work by killing the bacteria or prevent it's growth. It should be softly apply on infected part without friction,after apply it should not be rubbed,it should not be apply on the sensitive part like eye .it should not be taken internally.

S/S hypothyroid ( too little)

CNS decreases heart rate decrease BP decreates

The nurse should monitor which lab results to best assess kidney damage? ________________ and

CR(albumin to creatinine ratio) & GFR(glomerular filtration rate) lab ACR(albumin to creatinine ratio) report indicate how much albumin(a type of protein) should be there in urine, generally 20 mg a day, more than that result into possibility of side effect like kidney damage etc. GFR(glomerular filtration rate) determine what stage of kidney disease you have, generally our muscle tissue produce waste material in your body like creatinine ,how much creatinine available in your body should be used to count glomerular filtration rate. Normal value of GFR is 90 to 120 ml /min/173m2.older people having lower GFR value due to kidney damage

When is a patient receiving insulin at most risk for hypoglycemia?

Common causes of diabetic hypoglycemia include: Taking too much insulin or diabetes medication. ... Increasing exercise or physical activity without eating more or adjusting your medications at peak

NSAIDs are high risk for which adverse effects?

GI bled, stroke, platicl platlet, prayotin

A common gastrointestinal side effect of aspirin is ____________________ and a common side effect of the ears is ____________________.

GI bleeding/ulcer effect the ears in tynits (rining)

Name two drugs in the aminoglycoside family. ______________________and ________________

Gentamicin (generic version is IV only) Amikacin (IV only) Tobramycin. neomicin

major effects of NSAIDs

Gi bleeds

A1C levels

Normal: below 5.7% Prediabetes: 5.7 to 6.4% Diabetes: 6.5% or above : really effects the periodontium and overall health negatively

Schizophrenia

a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions postive: delusion, hallucination, disorganized speech negative:flattened effect, reduced speech, lack of initative

Agonist

a molecule that, by binding to a receptor site, stimulates a response

psychosis

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

Identify patient teaching for a patient prescribed anti-tuberculosis medications... a. How long will I need to take the meds? b. Will I take one medication or several? c. Why can't I drink alcohol while on these med? d. Are there any other drugs I should avoid?

a. 6-12 months b. 2-4 meds c. increase toxicity, and alchol w/liver d. aniasissits

What nursing actions are important in each phase of the nursing process?

a. Assessment b. Diagnosing c. Planning d. Implementation e. Evaluation

How will glucocorticoids affect the following? a. Hair growth? b. Weight? c. Sleep patterns? d. Glucose levels? e. Eyes? f. Blood pressure? g. Fluid balance?

a. gain hair growh b. gain (ex. insullin needs sugar) c. inomnia d. hypoglycemia( blood sugar(glucose level lower then normal e. C__ blurry vision f. hyptenstion contract g. fluid retention

The following drugs can cause what impact on potassium levels? a. Spironolactone (Aldactone) _______ b. Furosemide (Lasix) _______ c. Hydrochlorothiazide (HCTZ________ d. Lupin (Lisinopril) ________

a. hold on potssium-> hyper b. potassium wasing diurecic-hypo - both cause dyrtmias c. decreae potassium d. increase potassium so furosemide and lupin increase and spironlactone and hydrochorthaizes decrease

Bone marrow cells are suppressed during chemotherapy neutropenia anemia

a. neutropenia low WBC, infection, neulogin - neutrophils are suppressed makign the patiet at risk for antibotics b. anemia lower RBC, internal bleeding, B23,iron VItamine E - extreme tired, fatigue, low hemoglobin

What is the rationale for the following assessments for a patient receiving Digoxin (Lanoxin) for the management of heart failure? Hint...you want to see no drug side effects and you want to see symptoms of heart failure resolving. a. Apical pulse b. Peripheral edema c. Lung sounds d. Daily weight e. Appetite

a. slow and trengh beat stroke>60 b. no fluid widing up c. right side near lungs, indicen wrosen d. gain weight e. no anerexia that could be toxic

A patient on transdermal nitroglycerine (NTG) patch asks the nurse: a. "Why do I have to take off the patch at night?" b. "Where should I apply it?"

a. take it of at night becaue we dont want tolerane b. should apply no hair ares, no scare tissue, no bruises

nitrogylcerin

acute ingina-> pain in chest due to blockage in artery, reduce blood flow cause of narrowin artery. nitrogycen oens it up blood cells and allwosblood flow freely

Diagnosing (Nursing Process)

analyzing patient data to identify patient strengths and problems

Diagnosing (Nursing Process)

analyzing patient data to identify patient strengths and problems, assesment data -ex. heart failure already and is on lasix and gaining weight

allergic reactions and treatment for the most deatly reaction

anapylaxiss 1. neurphorin 2. cotricoiteroids 3. benedryl 4. oxygen

. List the early signs/symptoms of digoxin (Lanoxin) toxicity:

anorexia, nausea, vomting, adominal cramping - later on visual

Which insulin is the fastest acting?

aspart(novolog) novolog

Morphine is available in many forms... What is unique about MS Contin? How should it be administered? (regular intervals or prn)

contin is giving longer term acute painkiller should be adminsiterd prn - morhine SNS depression- give it and resptiro is 10 or less you give narcan

Beta blockers and calcium channel blockers ______BP and ______pulse

decrease and decreae -induce muscle - B cell in sympathetic

decrease toxcicy

different dosage, alchol, other hypodreng drug monto liver function ASt/ALT

beta blockers major effects

dizzens and hypo, tremmor decreaste heart rate

"How should I draw up Regular and NPH insulin in the same syringe?"

draw up regular first then NPH

When is a peak and trough drawn for a drug administered at 1200? Peak drawn at __________. Trough drawn at __________.

drawn(= how much still in the blood) at 30 min after is 11:30

Anticholinergic effects

dry mouth constipation photophobia blurred vision Tachycardia

. What are common anticholinergic side effects on? a. Oral mucus membranes b. Urination c. Bowel function d. Heart rate

dry mouth, urinary retention, constopation, dizzines, dry eys, blurred vision cortcoirda,

Flagyl (metronidazole) is often prescribed to prevent antibiotic-induced

flagyl ( prescription meds used to treat the symmptoms of bacterial infections. fagyl is the tablet form. side effects nausea, vomiting, diarhea) -Amebiasis

furosemdie HF edemia HTN

fluid status, nput and out put rations amoutn and lcoation of edema, lung sounds, skin tugor and mcous membrane. montiol blood lasix causes diueis of excess fluid and hence decerse edema, plreu effusion and blood pressure HTN: urine edema: gain weight

Planning (nursing process)

minimize factors that contribute to medication errors: avoid using abbreviations that can be mis udnerstood. questions unclear orders, do not accept verbal orders, and followg spefic facilty polcieis. as the patient to demonstrate an undersating of the goals of therapy - ex. insulin patient does not have breakfast try later when patient has eaten breakfast

What is the most serious allergic reaction?____________________________ (See Chapter 29) Common S/S? ________________________________________________________________________________ Specific Standard Treatments? 1. _____________ 2. _________________ 3. _______________ 4. ______________

most serous allergic reaction is anaphylactic common s/s: high heart rate, low blood pressure, rash and redness, phenogimia standard treamtent 1. benedryl (bronco dilation) 2. epinephrine (anti-histamines) 3. corticosteroids (prostaguage) 4. oxygen

What effect do corticosteroids exert on the body's immune response?

multiple inflamtory modfies, so results in alto of aminosupresion and contour inidcated in infactions

What medication is administered to treat narcotic(opiod) overdose? Generic name? ___________________ Trade name? __________

nalaxan and trade name is narcan

Erectile dysfunction medications can interact adversely with which cardiac medication?

nitrogtisuen

A person receiving antifungal medications is at risk for which organ damage. ________________________. What other drugs/substances can cause damage to this organ? _________________

organ damage is liver damage to organ is alcholc, drugs

What drugs are prescribed for treatment of severe EPS?

prototype chlorpromazine: 1. anticollinergic 2. benzodiazpien 3. beta adrenrgic blockers

Which insulin can be administered IV?

regular

Parasympathetic

rest and digest

What is a typical sign of ototoxicity?

ringing in ears (tintinius)

risperdol

schrizophenai

Phenobarbital (Luminal) is commonly prescribed for ___________________.

seizures

What are common gastrointestinal side effects of cholesterol lowering agents? Pregnancy category for statins?

side effects: headhce, myalgia, drowziness, diziness, neause or voming statins: grapefruit and pregnancy category D

Diet teaching for a person on lithium includes consuming adequate ______________. Why?

sodium -levels. While taking lithium, do not make sudden changes to your salt intake.

enteric coated

special coating on drug that prevents absorption until drug reaches the small bowel - to delay the medication - less iritiable and delay inpect

Common causes of diabetic hypoglycemia include: Taking too much insulin or diabetes medication. ... Increasing exercise or physical activity without eating more or adjusting your medications subjective objectiv

subjective: (hangry) irritable, redensnss, cofusion, hunger, clumpsiness objective: tachycaida, seating, low bloodglucoe (<50)

glucosteroids

supress inflamtion

diaphoressis

sweating

Which medication is most often prescribed to treat syphilis and gonorrhea? Resistant strains will need?

synphillis and gonorrhea are STDS - azithromycin (Zithromax, Zmax) - satniacone

The _____________the half-life the ___________________the intervals between administering the drug. A drug administered every 4 hours has a ____________ half-life than a drug administered every 12 hours

the longer the half life the longer the intervals between adminstering the drug. a drug adminstered every 4 hours has a shorter half-life than a drug adminstered every 12 hours

The nurse should teach the patient to drink a full glass of _________ to enhance oral drug absorption

water,