Pharm HESI Review
acetylchlinesterase inhibitor antidote
atropine pralidoxime
acetylcholinesterase inhibitor antidotes
atropine pralidoxime
physostigmine is used to treat _____ and ______ drug overdoses
atropine anticholinergic
what are the benefits of transdermal medication administration
avoids first pass metabolism sustained administration of medication
when applying ear drops for an child how do you pull the pinna
back and downward
when applying ear drops for an adult how do you pull the pinna
back and upward
beta blockers decrease
heart rate and contractility peripheral vascular resistance renin release
needle size depends on
height and weight of the patient
purpose of Bethanechol
helps activate bowel and bladder smooth muscle/
What is oxybutynin used for?
decrease bladder spasms
What to do before administering beta blockers
assess blood pressure and heart rate look for signs of hypoglycemia
do not give beta blockers to patients with
asthma heart block patients
when should prazosin be administered
at bedtime
physostigmine also is used to
decrease intraocular pressure in glaucoma
Alpha 2 receptor characteristics
decrease sympathetic outflow decrease insulin release decrease lipolysis increase platelet aggregation
max amount of injection for child
1 mL
what size needle do you need for Intramuscular (IM) injection
1-1.5 inches
for eye medication administration what is the process
1. instill drops into conjunctival sac 2. repeat if missed or patient blinks 3. 5 minutes before 2nd medication
Steps for mixing NPH and Regular insulin for injection
1. verify order 2. roll NPH insulin 3. alcohol to multiuse vials 4. inject air into NPH insulin (cloudy) 5. inject air into regular insulin (clear) 6. withdraw regular insulin units 7. withdraw NPH units 8. verify with 2nd nurse 9. discard if error
Max amount of injection for adult
2-5 mL
what size needle do you need for subcutaneous injections
3/8 or 5/8 inch
A client diagnosed with a urinary tract infection is prescribed an ampicillin. Which nursing intervention is most important for the practical nurse to do first before administering the client's medication? A. Obtain a clean-catch urine specimen. B. Assess the urine pH for acidity. C. Insert an indwelling catheter. D. Assess for complaints of dysuria.
A A clean-catch urine specimen is used to determine the causative organism and to evaluate the effectiveness of pharmacological therapy in treating the source of the infection. The initial specimen should be obtained before beginning treatment with an antiinfective agent.
A client diagnosed with bacterial pneumonia is being admitted to the unit from the emergency room. Which intervention should the practical nurse ensure that it has been done prior to the administration of antibiotics? A. Sputum specimen B. Set of vital signs C. Electrocardiogram D. Glucometer check
A A culture and sensitivity of a sputum specimen should be done prior to the initiation of the administration of antibiotics.
A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention? A. Apical heart rate of 60 beats/min B. Sweating across the forehead C. Poor sucking effort D. Respiratory rate of 30 breaths/min
A A heart rate of 60 beats/min for a 6-month-old warrants immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered to be within normal limits.
A client prescribed ephedrine nasal drops 0.5% PRN complains of having difficulty falling asleep to the nurse. What action should the nurse take to minimize the client's insomnia? A. Administer the dose a few hours before bedtime. B. Offer the client a sedative with the bedtime dose. C. Provide warm milk when administering the bedtime dose. D. Reduce environmental stimuli by closing the client's door.
A Administering the dose a few hours before bedtime is effective in minimizing insomnia.
A client prescribed ephedrine nasal drops 0.5% PRN complains of having difficulty falling asleep to the nurse. What action should the nurse take to minimize the client's insomnia? A. Administer the dose a few hours before bedtime. B. Offer the client a sedative with the bedtime dose. C. Provide warm milk when administering the bedtime dose. D.Reduce environmental stimuli by closing the client's door.
A Administering the dose a few hours before bedtime is effective in minimizing insomnia.
Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better. Which explanation should the PN provide? A. "It takes 1 to 4 weeks for antidepressant medications to become effective." B. "The dosage may need to be increased; I will contact your health care provider." C. "Depression is difficult to treat with drugs alone. Therapy sessions would enhance their effectiveness." D. "Based on your child's response to this drug, the health care provider is reviewing your medication regimen."
A Antidepressant medications take 1 to 4 weeks to reach its full therapeutic effect. The family needs to be educated that their child may experience increased anxiety in the first week of administration.
An older client is prescribed gentamicin sulfate. Which question should the practical nurse (PN) ask an older client before beginning treatment? A. "Are you hard of hearing?" B. "Have you ever had cancer?" C. "Do you have diabetes?" D. "Did you ever have anemia?"
A Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining and monitoring the client's hearing before initiation of this medication and as the treatment progresses is important. Peak and trough levels are usually prescribed around the second and third dose.
A client is recovering from a myocardial infarction. The cardiologist prescribes docusate sodium 100 mg PO bid. What therapeutic effect does this medication provide for this client? A. Maintaining soft stools to prevent straining on defecation B. Increasing cardiac blood flow by dilating the coronaries C. Replacing serum potassium lost with diuretic therapy D. Preventing the occurrence of stress ulcers in the duodenum
A Docusate sodium is a stool softener that prevents the use of the Valsalva maneuver (straining) for defecation.
A 59-year-old client is prescribed furosemide 40 mg twice a day for the management of heart failure. The practical nurse (PN) should monitor the client for the development of which complication? A. Hypokalemia B.Hyperchloremia C.Hypercalcemia D. Hypophosphatemia
A Furosemide is a loop diuretic. The action of this medication inhibits the reabsorption of sodium and chloride at the proximal and distal tubule and in the loop of Henle. This medication potentiates the excretion of potassium, causing hypokalemia. Hypokalemia can cause cardiac irregularities.
A 78-year-old client prescribed furosemide 40 mg PO twice daily is demonstrating EKG changes. Which condition should the practical nurse suspect is causing these changes? A. Hypokalemia B.Hyperchloremia C.Hypernatremia D.Hypophosphatemia
A Furosemide potentiates the excretion of potassium causing hypokalemia. Hyperchloremia, hypernatremia, and hypophosphatemia are not related to furosemide administration.
The practical nurse interprets the client's PPD as a positive skin test. Which drug is considered the primary prophylaxis for a client exposed to active tuberculosis? A. Isoniazid B.Rifampin C. Acyclovir D.Griseofulvin
A Isoniazid is highly specific for Mycobacterium tuberculosis and is the primary drug of choice for clients with positive PPD skin tests.
A client diagnosed with asthma is prescribed methylprednisolone 40 mg IV daily. Which laboratory test results should the practical nurse closely monitor for increased values? A. Serum glucose B. Serum calcium C. Red blood cells D. Serum potassium
A Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can increase a client's glucose levels, which can lead to hyperglycemia.
A health care provider (HCP) prescribed an antibiotic for a client. Which of the medications listed should be used with caution when given to a client with a penicillin (PCN) allergy? A.Cephalosporin B.Aminoglycosides C.Erythromycins D.Sulfonamides
A Penicillins (PCN) have a 1% cross allergy with first-generation cephalosporins and lesser rate with second-generation. If a client has a known PCN allergy, then cephalosporin should be given with caution to these clients.
A client is prescribed phenobarbital 100 mg daily for the treatment of seizures. Which statement made by the client indicates an accurate understanding of the medication phenobarbital? A. I will take my medicine at 10 pm before retiring to bed. B. The medication will turn the color of my urine to a pink color. C. I should not eat or drink anything for at least 2 hours before taking my medicine. D. In the event a seizure occurs in the middle of the day, I need to take an extra dose of my medicine.
A Phenobarbital should be taken at the same time every day to maintain blood levels and enhance compliance. Common side effects of the phenobarbital are drowsiness, lethargy, dizziness, and nausea; it is best to take it before bedtime.
The nurse is caring for a client who was newly prescribed insulin aspart 7 units subcutaneously prior to each meal. Which nursing intervention has the highest priority when planning this client's care? A. Ensure that the client's meal will be available within the next 15 minutes before administration of insulin. B. Rotate sites at least once weekly and label the sites used on a diagram. C. Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption. D. Help the client express his/her feelings about the injection.
A Rapid-acting synthetic insulin analogs like insulin aspart have an onset of action of approximately 15 minutes and should be injected 0 to 15 minutes before the meal to prevent or decrease the risk of hypoglycemia.
A client diagnosed with a sinus infection is prescribed ampicillin sodium. The practical nurse (PN) should instruct the client to notify the health care provider immediately if which symptom occurs? A. Rash B.Nausea C. Headache D. Dizziness
A Rash is the most common adverse side effect of all generations of penicillin, indicating an allergy to the medication, which could result in anaphylactic shock, a medical emergency.
Daily dose of alendronate is prescribed for a 54-year-old postmenopausal client. Which instruction should the practical nurse provide to this client regarding taking the prescribed medications? A. Take medication 30 minutes before breakfast and remain in an upright position for 30 minutes after taking the medication. B. The medications should be taken together 2 hours after a meal with a full glass of water. C. Divide the medication over the course of the day and take it in small doses 1 hour after meals and at bedtime. D.The medication may be taken with or without food but should be taken at the same time every day.
A Studies have shown a significant reduction in fractures when clients take the alendronate. It is important to instruct the client to remain in an upright position for at least 30 minutes after administration to prevent esophageal irritation.
A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication? A. The client is experiencing vision and hearing loss. B. The client has an erection lasting longer than 2 hours. C. The client is complaining about nasal congestion. D. The client is complaining about feeling flushed.
A The client should be instructed to discontinue the use of the medication and notify the health care provider immediately if the client is experiencing vision and/or hearing loss or an erection lasting more than 4 hours.
A client prescribed chemotherapy asked the practical nurse (PN), "Why is so much of my hair falling out each day?" Which response by the PN best explains the reason for alopecia? A. "Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant." B. "Alopecia is a common side effect you will experience during long-term steroid therapy." C. "Your hair will grow back completely after your course of chemotherapy is completed." D. "The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss."
A The common adverse effects of chemotherapy (nausea, vomiting, alopecia, bone marrow depression) are results of chemotherapy's effect on the rapidly reproducing cells, both normal and malignant.
While taking a client's history, the practical nurse (PN) discovers that the client, who takes warfarin daily for atrial fibrillation, has added a St. John's wort to their daily regime. What recommendation should the PN provide to this client? A. You need to discontinue the use of the herb and consult with your health care provider. B.Cut your warfarin dose in half, if you notice an increase of bruising or bleeding from the gums. C.You should increase your consumption of dark green leafy vegetables and tomatoes. D.Check your apical pulse daily and withhold the warfarin if your heart rate is below 60 beats/minute.
A Use of natural products should be shared with the health care provider, so possible interactions can be addressed. The St. John's wort may interfere with the effectiveness of the warfarin.
While taking a client's history, the practical nurse (PN) discovers that the client, who takes warfarin daily for atrial fibrillation, has added a St. John's wort to their daily regime. What recommendation should the PN provide to this client? A. You need to discontinue the use of the herb and consult with your health care provider. B. Cut your warfarin dose in half, if you notice an increase of bruising or bleeding from the gums. C. You should increase your consumption of dark green leafy vegetables and tomatoes. D. Check your apical pulse daily and withhold the warfarin if your heart rate is below 60 beats/minute.
A Use of natural products should be shared with the health care provider, so possible interactions can be addressed. The St. John's wort may interfere with the effectiveness of the warfarin.
A client has been prescribed pregabalin. Which outcome(s) should the practical nurse (PN) anticipate a client to experience? (Select all that apply.) A. decrease in joint pain resulting from osteoarthritis B. Elevated mood with improved responsiveness to family C. Decrease of inflammation in all major joints. D. Improved range of motion during physical therapy exercises
A D The precise mechanism of pregabalin is unknown, but it is a gamma-aminobutyric acid (GABA) analogue that binds with calcium channels in the central nervous system (CNS), which reduces neuropathic pain to the spinal cord. When pain relief is achieved, then client's range of motion should improve during physical therapy exercises.
Prazosin drug classification
Alpha-1 receptor blocker
Donepezil is used for treating
Alzheimer's disease
A practical nurse (PN) is reviewing the plan of care for client who is prescribed glucocorticoid methylprednisolone. Which nursing diagnosis is related to this medication? A. ineffective airway clearance B. risk for infection C. deficient fluid volume D. impaired gas exchange
B Corticosteroids depress the immune system, placing the client at risk for infection. The nursing diagnosis for "risk for infection" is directly related to the administration of glucocorticoid methylprednisolone.
The practical nurse administered carbidopa levodopa to a client diagnosed with Parkinson disease. Which outcome by the client would indicate a therapeutic response? A. Decreased blood pressure B. Lessening of tremors C. Increased salivation D. Increased attention span
B Carbidopa-levodopa increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson, such as involuntary movements, resting tremors, and shuffling gait.
Drug classification for Atropine
Anticholinergic
What is ipratropium used for?
Asthma, COPD
The health care provider prescribes morphine sulfate grain 1/8 IM stat. Morphine is available in 8 mg/mL. How many milliliters should the practical nurse (PN) administer? A. 0.5 mL B. 1 mL C. 1.5 mL D. 2 mL
B 1 mL, because 1 gr = 60 to 64 mg. 1 gr:60 mg::1/8:x mg = x = 60 × 1/8 = 7.5 = 8 mg, or 1 gr:64 mg::1/8:x mg = x = 64 × 1/8 = 8 mg. Formula:D/H × Q = (8 mg/8 mg) × 1 mL = 1 mLDimensional analysis formula:mL/8 mg × 64 mg/gr × 1/8 gr/x mL = 1 mL.
A client in the immediate postoperative period is prescribed morphine via a patient-controlled analgesia (PCA) pump. Which finding should the PN consider the highest priority in this client? A.The expiration date of the PCA morphine B. The rate and depth of the client's respirations C. The type of anesthesia used during the surgery D. The client's signs of disorientation
B A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. If the client is going in to respiratory depression, the PCA pump should be stopped and the registered nurse (RN) or health care provider should be notified if the client's respiratory rate falls below 10 breaths/min.
The health care provider (HCP) has prescribed a 74-year-old client to be vaccinated with the influenza vaccine prior to discharge. Which client condition will make the practical nurse not to vaccinate the client and consult with the charge nurse? A. History of congested heart failure B. History of an allergy to eggs C. History of pneumococcal vaccination D. History of end stage renal disease
B According to the CDC website, the flu vaccination is contraindicated if a client has a severe allergy to any part of the vaccine. "Most, but not all, types of flu vaccine contain a small amount of egg protein." The practical nurse needs not to administer the flu vaccination and consult with the charge nurse for further guidance.
A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse (PN) reinforce in this client's teaching? A. "Quit taking the medication if dizziness occurs." B. "Do not get up quickly. Always rise slowly." C. "Take the medication with food only." D. "Increase your intake of potassium-rich foods."
B An anticipated side effect of nitrates is orthostatic hypotension. The PN should instruct the client to rise slowly when rising from a sitting or lying down position in order to prevent orthostatic hypotension
A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse (PN) reinforce in this client's teaching? A. "Quit taking the medication if dizziness occurs." B. "Do not get up quickly. Always rise slowly." C. "Take the medication with food only." D. "Increase your intake of potassium-rich foods."
B An anticipated side effect of nitrates is orthostatic hypotension. The PN should instruct the client to rise slowly when rising from a sitting or lying down position in order to prevent orthostatic hypotension.
A first-day post-operative client vomits 30 minutes after receiving a dose of hydromorphone. What initial intervention is best for the practical nurse (PN) to implement? A. Obtain a prescription for nasogastric intubation. B. Administer a PRN dose of ondansetron (Zofran) IV. C. Reduce the next scheduled dose of hydromorphone. D. Assess the client's abdomen and bowel sounds.
B Because the emesis appears to be directly related to the administration of the opiate analgesic, the first action should be to reduce the client's nausea with the administration of the ondansetron, which is an antiemetic.
An immobile client is prescribed dalteparin subcutaneously and has been receiving the medication for 5 days. Which finding indicates that the PN should hold the prescribed dose? A. Tachypnea B. Guaiac-positive stool C. Dependent pitting edema D. Multiple small abdominal bruises
B Dalteparin is a low-molecular-weight heparin (LMWH) anticoagulant used to prevent DVT in the at-risk client. If the client develops overt signs of bleeding such as guaiac-positive stool while receiving an anticoagulant, the medication should be held and coagulation studies completed.
A client whose seizure disorder has been managed with phenytoin is admitted to the emergency department with status epilepticus. Which drug should the practical nurse (PN) anticipate to be prescribed for administration to treat these seizures? A. phenytoin B. diazepam C. phenobarbital D. carbamazepine
B Diazepam is the drug of choice for the treatment of status epilepticus and is given during a seizure.
A client whose seizure disorder has been managed with phenytoin is admitted to the emergency department with status epilepticus. Which drug should the practical nurse (PN) anticipate to be prescribed for administration to treat these seizures? A.Phenytoin B.Diazepam C.Phenobarbital D.Carbamazepine
B Diazepam is the drug of choice for the treatment of status epilepticus and is given during a seizure.
A 78-year-old client with congestive heart failure (CHF) receives digoxin 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? A. Systolic blood pressure readings range from 120 to 130 mm Hg. B. Clear breath sounds bilaterally. C. Jugular venous distention present with supine positioning D. Radial pulse volume of +4 bilaterally
B Digoxin is a cardiac glycoside, which increases force of the heart contractions and decreases heart rate, which in turn increases cardiac output. Clear breath sounds bilaterally indicates that the medication was effective in increasing the cardiac output thus preventing pulmonary edema.
A practical nurse is getting ready to administer digoxin to a client. Which assessment finding would require the nurse to hold the medication? A. Irregular apical pulse rhythm B. Apical pulse rate of 50 beats/min C. Apical pulse heard best at the pulmonic site D. Presence of a systolic heart murmur
B Digoxin slows the contractions of the heart. Bradycardia is a late sign of toxicity. Therefore, the practical nurse (PN) must always assess the apical pulse for 1 minute to determine that the rate is 60 beats/min or greater. If the apical pulse is less than 60 beats per minute, the PN should not administer the medication and notify the health care provider.
A client is receiving the medication haloperidol. Which client data would indicate to the practical nurse that the medication is therapeutic? A. The client has maintained a consistent weight loss of 2 pounds/week. B. The client has demonstrated a decrease in paranoia behaviors. C. The client's blood pressure has remained within the normal limits. D. The client's fasting blood glucose has remained below 120 mg/dL.
B Haloperidol is an antipsychotic, neuroleptic medication. A therapeutic response would be decrease in emotional excitement, hallucinations, delusions, paranoia, and clear process of thought and speech.
A healthy 68-year-old client asks the practical nurse (PN) should they take the pneumococcal vaccine. Which statement should the PN offer to the client that provides the most accurate information about this vaccine? A. The vaccine is given annually before the flu season to those older than 50 years. B The immunization is recommended for children younger than 2 years old and all adults 65 years or older. C The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection. D The vaccine will prevent the occurrence of pneumococcal pneumonia for up to 5 years.
B It is usually recommended that persons younger than 2 years old and 65 years and older get vaccinated. Those with a history of certain medical conditions may also be recommended to receive the immunization.
The practical nurse administers lactulose to a client. Which client outcome would indicate a therapeutic response? A. An increase in urine output B. Two or three soft stools per day C. Absence of nausea D. Decreased serum potassium
B Lactulose is an ammonia detoxicant (hyperosmotic) laxative which prevents absorption of ammonia in the colon by acidifying the stool. This causes the stool to absorb more water, therefore softening the stool. Two to three stools per day indicate that lactulose is performing as intended.
A 67-year-old client is discharged from the hospital with a prescription for digoxin 0.25 mg daily. Which instruction by the practical nurse (PN) is correct? A. Take the medication in the morning before rising. B. Do not take the medication if the heartbeat is irregular or slow. C. Expect some vision changes due to the medication. D. Increase intake of foods rich in vitamin K.
B Monitoring the pulse rate for 1 minute is very important when taking digoxin. The client should be further instructed to report pulse rates lower than 60, greater than 110 beats/min, or irregular, and to withhold the dosage until consulting with the health care provider in such cases.
The practical nurse (PN) administered 15 units of NPH insulin subcutaneously to a client before they consumed their breakfast at 7:30 am. At what time is the client at an increased risk for a hypoglycemic reaction? A. 8:30 to 11:30 am B. 3:30 to 7:30 pm C. 9:30 pm to midnight D. 1:00 to 5:00 am
B NPH, an intermediate acting insulin, peaks approximately 8 to 12 hours after subcutaneous injection. The most likely time for this client to experience a hypoglycemic reaction is between 3:30 and 7:30 pm.
The practical nurse (PN) administers two newly prescribed medications, isosorbide dinitrate (a nitrate) and hydrochlorothiazide (a diuretic), to a client. What instructions should the PN reinforce with the client in regard to these medications? A. Instruct the client to use soft bristle toothbrush. B. Instruct the client to slowly rise from a sitting or lying down position. C. Instruct the client to elevate their legs above the level of their heart. D. Instruct the client to limit the amount of roughage in their diet.
B The additive effects of the concomitant use of nitrates, such as isosorbide dinitrate, which produce vasodilation, and diuretics, such as hydrochlorothiazide, which reduce blood volume, can cause hypotension, so it is important to instruct the client to slowly change positions when rising from a sitting or lying position. Both of these medications can cause orthostatic hypotension.
A 43-year-old female client status post thyroidectomy for Addison disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the health care provider? A. Tinnitus and dizziness B. Tachycardia and chest pain C. Dry skin and intolerance to cold D. Weight gain and increased appetite
B The signs and symptoms of thyroid replacement hormone toxicity include tachycardia and chest pain.
A client receiving the antibiotic vancomycin is prescribed to have a peak and trough level done with the next dose. What time should the practical nurse obtain the blood specimen for the trough level? A. Sixty minutes after the antibiotic dose is administered B. Immediately before the next antibiotic dose is given C. When the next blood glucose level is to be checked D. Thirty minutes before the next antibiotic dose is given
B Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given. The PN needs to wait for the lab results of the trough level from the lab before administering the scheduled antibiotic. If the trough level is above the recommended levels, the medication needs to be held and the health care provider needs to be notified.
The practical nurse prepares to administer ophthalmic drops to a client before cataract surgery. List the steps in the order they should be implemented from first step to final step. A. drop prescribed number of drops into the conjunctival sac B. Wash hands and apply clean gloves C. place the dominant hand on the client's forehead D. ask the client to close the eye gently
B C A D Washing hands and applying gloves before procedure initiation prevent the spread of infection. Placing the dominant hand on the client's forehead stabilizes the hand, so the nurse can hold the dropper 1 to 2 cm above the conjunctival sac and drop the prescribed number of drops, and asking the client to close the eye gently helps distribute the medication.
What does the acronym B.O.AT.S mean for Anticholinergics
B: Benztropine O: oxybutynin AT: Atropine S: Scopolamine
The health care provider (HCP) recommends the over-the-counter (OTC) expectorant guaifenesin for a client who has a dry, nonproductive cough and congested nasal passages. The client reports that they usually have a glass of wine with dinner nightly. Which information should the practical nurse provide to this client? A. Return to the clinic if they start to cough up thin, watery secretions. B. Frequent use can cause rebound nasal congestion. C. Notify the HCP if the cough persists longer than 7 days. D. Consumption of alcohol will interact with this medication and cause vomiting
C A cough that lasts more than 1 week or is accompanied by a fever, rash, or headache may be an indication of more serious medical condition such as a bacterial infection and should be followed up by the health care provider. Alcohol and CNS depressants, such as guaifenesin, have a cumulative effect when consumed concurrently which can be lethal such as respiratory depression. The client needs to be aware of this and advise that alcohol consumption should not be consumed while taking this medication.
Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer disease has been accomplished? A. Increased muscle strength and tone B. Fewer episodes of urinary incontinence C. Decreased confusion and improved mood D. Reversal of disease process as evidenced by increased functioning
C Aricept is used for those suffering from Alzheimer disease. Its action elevates acetylcholine concentrations by slowing down degradation of acetylcholine released in cholinergic neurons. It does not reverse or cure Alzheimer disease but slows down the deterioration.
A practical nurse (PN) is reviewing teaching with the client and/or significant others about the concurrent use of benztropine and olanzapine to manage psychotic behavior. What information should the PN reinforce? A. Benztropine will reduce the olanzapine's side effect of urinary retention. B. Benztropine potentiates the effect of olanzapine. C. The benztropine is used to control the side effects of olanzapine. D. The combined effect of these drugs will modify psychotic behavior.
C Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with olanzapine use. Caution is required in the dosage of benztropine used in conjunction with olanzapine.
An adolescent client with a seizure disorder is prescribed the anticonvulsant medication carbamazepine. The nurse should notify the health care provider if the client develops which condition? A. Experiences dry mouth B. Experiences dizziness C. Develops a sore throat D. Develops gingival hyperplasia
C Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flu-like symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.
The practical nurse administered cyclobenzaprine to a client. Which outcome would indicate a therapeutic response? A. Elevated mood with improved responsiveness to family B. A decreased amount of inflammation present in the joint C. Improved range of motion during physical therapy exercises D. Fewer absence seizures with lengthened attention span
C Cyclobenzaprine is a central skeletal muscle relaxant used to relieve muscle spasms, so an improved range of motion would indicate a therapeutic response and expected outcome of therapy.
A client who received a prescription for cyclosporine ophthalmic emulsion for dry eyes asks the practical nurse (PN) if it is safe to continue using artificial tears. What information should the PN provide? A. Avoid the use of artificial tears because they decrease the efficacy of cyclosporine. B. Discontinue the use of both products if transient blurring occurs after administration. C. Allow a 15-minute interval between the administration of cyclosporine and artificial tears. D. Discontinue the use of cyclosporine and artificial tears when tear production reaches a normal level.
C Cyclosporine, an ophthalmic emulsion which increases tear production, may be used in conjunction with artificial tears as long as the products are administered 15 minutes apart. Transient blurring after administration is a side effect of cyclosporine and does not necessitate discontinuation of the medication. After tear production is increased, artificial tears may be stopped, but discontinuing cyclosporine will result in a decrease in tear production.
A client who received a prescription for cyclosporine ophthalmic emulsion for dry eyes asks the practical nurse (PN) if it is safe to continue using artificial tears. What information should the PN provide? A. Avoid the use of artificial tears because they decrease the efficacy of cyclosporine. B. Discontinue the use of both products if transient blurring occurs after administration. C. Allow a 15-minute interval between the administration of cyclosporine and artificial tears. D. Discontinue the use of cyclosporine and artificial tears when tear production reaches a normal level.
C Cyclosporine, an ophthalmic emulsion which increases tear production, may be used in conjunction with artificial tears as long as the products are administered 15 minutes apart. Transient blurring after administration is a side effect of cyclosporine and does not necessitate discontinuation of the medication. After tear production is increased, artificial tears may be stopped, but discontinuing cyclosporine will result in a decrease in tear production.
A child is admitted to the emergency department for accidental ingestion of a poison. The practical nurse (PN) should know that inducing vomiting is recommended for which child? A. 8-month-old who ate four to six ibuprofen tablets B. 3-year-old who drank an unknown amount of charcoal lighter fluid C. 16-month-old who drank 2 ounces of acetaminophen elixir D. 2-year-old who ate a handful of automatic dishwasher detergent
C Emesis should be induced for the child who drank the large dose of acetaminophen elixir because this medication is hepatotoxic. Vomiting is contraindicated for children younger than 1 year of age. Inducing vomiting of corrosives such as dishwasher detergents and lighter fluid is contraindicated.
A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond? A. "Glipizide is an oral form of insulin and has the same actions and properties as intermediate insulin." B. "Glipizide is an oral form of insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "Glipizide is not an oral form of insulin and can be used only when some beta cell function is present." D. "Glipizide is not an oral form of insulin, but it is effective for those who are resistant to injectable insulins."
C Glipizide is an oral hypoglycemic agent that enhances pancreatic production of insulin when some beta cell function is present.
The practical nurse is assigned a client on digoxin therapy. Which finding is likely to predispose this client to developing digoxin toxicity? A. Hyponatremia—low serum sodium level B. Hypernatremia—high serum sodium level C. Hypokalemia—low serum potassium level D. Hyperkalemia—high serum potassium level
C Hypokalemia predisposes the client on digoxin to digoxin toxicity and is usually presented as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels and prompt correction of hypokalemia are important interventions for the client taking digoxin.
A client who is prescribed carbamazepine for the treatment of tonic clonic seizures asked why they are required to have weekly blood tests. The practical nurse informs the client that the weekly blood tests are necessary to monitor for which complication? A. kidney damage B. hearing loss C. decreased immune response D. liver damage
C Myelosuppression (bone marrow depression) is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. The lab work scheduled should be: CBC reticulocyte counts every week × 4 weeks, then every 3 to 6 months if on long-term therapy. If myelosuppression occurs, then the medication should be discontinued. Hepatic and renal function may be altered, but these complications do not require weekly blood work for monitoring.
Phenazopyridine is commonly prescribed for clients with urinary tract infections (UTI). Which statement by the practical nurse describes the purpose for the administration of phenazopyridine? A. To change the pH level of the urine B. To decrease the frequency of bladder spasms C. To relieve the symptoms caused by the UTI D. To inhibit bacterial replication and avoid growth of resistant organisms
C Phenazopyridine, a urinary analgesic, is used to relieve pain associated with urinary tract infections such as burning, pain, urgency, and frequent voiding. The administration of phenazopyridine will turn the urine to a bright red orange color. This medication should be taken with food to decrease gastric irritation. Phenazopyridine should only be used for 2 days when taken together with an antibacterial agent, which is typically prescribed for approximately 2 weeks.
The practical nurse (PN) is obtaining the medical history of a client starting a new prescription for conjugated estrogens PO daily. Which medical condition is not treated by this medication? A. Menopausal symptoms B. Prostatic cancer C. Thromboembolic diseases D. Abnormal uterine bleeding
C Premarin is not indicated in the treatment of thromboembolic diseases. The serious side effects of it are thromboembolism, stroke, pulmonary embolism, and MI.
A client diagnosed with a urinary tract infection has been prescribed phenazopyridine. Which data would indicate to the practical nurse that the therapeutic outcome has been achieved? A. White blood cell count is 5000/mm3. B. Urine is a bright yellow and without sediment. C. Client denies pain when voiding. D. Urine culture is negative for bacterial growth
C Pyridium is a urinary analgesic that relieves the symptoms of UTI but does not treat the underlying cause. One of the side effects of pyridium is that it changes the color of the urine to a bright yellow, but that is not a therapeutic effect.
A client diagnosed with vaginal trichomoniasis is prescribed oral metronidazole. What instructions should the practical nurse (PN) review with the client while taking this medication? A. Vinegar or commercial product douches should be done daily. B. Avoid direct sunlight exposure and use sunscreen product with SPF100. C. The client's sexual partner(s) should also be treated. D. Dairy products should be eliminated from the diet during treatment.
C Sexual intercourse is the route of spread for vaginal trichomoniasis and the sexual partner(s) should be treated simultaneously to prevent reinfection.
A female client who started taking an oral sulfonamide for a urinary tract infection the previous day reports to the nurse that the medication is causing slight anorexia. She also states that she continues to experience urinary frequency, so she takes the medication with a glass of cranberry juice and with a snack. What information should the practical nurse provide? A Take the medication with an antacid instead of cranberry juice to reduce the anorexia. B Continue to take the medication with a sip of cranberry juice, restricting fluids until the frequency is controlled. C Continue to drink the cranberry juice, but take medicine on an empty stomach with a full glass of water. D Take the medication with a spoonful of ice cream or applesauce and avoid drinking cranberry juice.
C The PN should emphasize the need to take sulfonamides with a full glass of water to help prevent crystalluria and to take the medicine on an empty stomach, ideally 1 hour before anything is eaten or 2 hours after eating something.
A client diagnosed with a herniated disc is prescribed hydrocodone/acetaminophen 10 mg/300 mg PRN every 4 to 6 hours. As the practical nurse (PN) enters the client's room to administer their requested medication, the client is seen talking and laughing with his visiting family. Which action should the PN implement? A. Hold the pain medication until after the visitors leave. B. Notify the physician of the client's drug-seeking behavior. C. Administer analgesia as requested by the client. D. Inform the client based on their display behavior, the medication is not needed.
C The medication should be administered as per client's request. The client's self-report of pain is the single most reliable indication of the existence, character, and intensity of pain. Analgesics should be administered as soon as pain occurs and before it increases in intensity. The PN should consult with the charge nurse after she administers the medication about the situation.
A client is prescribed an antacid for the treatment of peptic ulcer disease. What is the action of this medication that is effective in treating the client's ulcer? A. Decrease in the production of gastric secretions B. Production of an adherent barrier over the ulcer C. Maintenance of a gastric pH of 3.5 or above D. Decrease in the gastric motor activity
C The objective of antacids is to neutralize gastric acids and keep a pH of 3.5 or above which is necessary for pepsinogen inactivity.
what is Benztropine used for
Parkinson's Disease
A client status post hip replacement 24 hours ago has been prescribed enoxaparin 30 mg IVP bid × 4 doses. Which intervention is most important for the practical nurse (PN) to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Clarify the prescription with the RN and health care provider.
D Enoxaparin is a low-molecular-weight heparin that can only be administered subcutaneously, so the PN should contact and ask the registered nurse (RN) to call the health care provider to clarify the route of administration.
A client diagnosed with essential hypertension is prescribed phenylephrine for nasal congestion as needed every 4 hours. The client is complaining about nasal congestion. Which nursing action should the practical nurse (PN) do next? A. Administer the medication as prescribed. B. Instruct the client to gently blow nose prior to administration of medication. C. Perform nasal irrigation prior to administration. D. Hold the medication and consult with the charge nurse.
D Phenylephrine can cause transient hypertension and should not be taken by a client with hypertension. The PN should hold the medication and consult with the charge nurse about the client's diagnosed hypertension and prescribed medication.
Phenytoin is prescribed for a client who has a seizure disorder. Which statement by the client needs to be clarified by the practical nurse? A. "I should notify the health care provider, if the color of my urine turns pink." B. "I should never stop taking this medication abruptly." C. "I should monitor my glucose levels closely, since I am diabetic." D. "I should take the medicine with antacids if gastric upset occurs."
D Antacids should not be taken within 2 hours of taking medication. Antacids will decrease the effects of phenytoin. Phenytoin can increase glucose levels. Do not discontinue medication abruptly as seizures could occur. Medicine may cause pink discoloration of urine.
A client diagnosed with seizures is prescribed phenytoin. Which medication instruction should the practical nurse (PN) reinforce to this client? A. maintain consistent sodium intake B. use sunscreen when outdoors C. return for monthly urinalysis D. brush and floss teeth daily
D Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.
A client is prescribed clonidine 0.1 mg/24 hour via transdermal patch. Which client outcome would indicate the medication is effective? A. No complaints of recent episodes of angina B. Change in peripheral edema from +3 to +1 C. No complaints of new onset of nausea or vomiting D. Blood pressure changes from 180/120 to 140/70 mm Hg
D Clonidine acts as a centrally acting analgesic and antihypertensive agent. The decrease in the blood pressure indicates a reduction in hypertension.
An 18-month-old toddler with a three-day history of diarrhea was administered loperamide by their parent. What intervention is most important for the PN to implement initially? A. Tell the parent never to give this drug to her toddler. B. Ask if any other siblings have experienced diarrhea. C. Obtain the child's oral and tympanic temperatures. D. Question the parent how many wet diapers has the child had in 24 hours.
D Determining the amount and when the child last voided is most important because urine output is decreased with dehydration. An 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Additionally, loperamide causes an anticholinergic effect of urinary retention. Although the manufacturer states that loperamide should not be given to a child younger than the age of 2 years except under the direction of a health care provider, this information is not the best answer for the question being asked.
The H2 receptor blocker famotidine is prescribed for a client for gastroesophageal reflux disease (GERD). Which client statement indicates to the practical nurse (PN) that teaching was effective regarding concurrent use of these medications? A. "I will take the famotidine first thing in the morning." B. "I will take the famotidine as needed for GI discomfort." C. "I will take the famotidine at bedtime." D. "I will take the famotidine twice a day.
D Famotidine inhibits histamine at the histamine H2-receptor site, thus decreasing gastric secretions. In the treatment of GERD, it should be taken twice a day.
The dosing of heparin intravenous infusion is guided by which laboratory value?The dosing of heparin intravenous infusion is guided by which laboratory value? A. Prothrombin time B. Fibrin split products C. Platelet count D. Partial thromboplastin time
D Heparin therapy is guided by changes in the partial thromboplastin time (PTT).
A client who is taking hydrochlorothiazide is admitted to the hospital and is experiencing muscle weakness and cramps. Which condition should the practical nurse suspect is causing these changes? A.Hypolipidemia B.Hypermagnesemia C.Hyperchloremia D.Hyponatremia
D Hydrochlorothiazide acts on the distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, and potassium. The signs and symptoms of hyponatremia include muscle weakness and cramps.
A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request? A. Determine if a take-home prescription for hydrocodone was provided and, if so, tell him to take one of them. B. Encourage him to wait until he is at home to take a medication that might impair reasoning. C. Give him a tablet from the hospital stock and tell him to wait until he is almost home to take it. D. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10.
D Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. It is possible for the client to take one of the prescriptions provided, but first the nurse should assess the client's level of pain. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.
A client has been prescribed an angiotensin II receptor antagonist losartan. Which change in data indicates to the practical nurse (PN) that the desired effect of this medication has been achieved? A. Dependent edema reduced from +3 to +1. B. Serum HDL increased from 35 to 55 mg/dL. C. Pulse rate reduced from 150 to 90 beats/min. D. Blood pressure reduced from 160/90 to 130/80 mm Hg.
D Losartan is prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.
A client with angina pectoris has been prescribed nitroglycerin tablets PRN for chest pain. Which statement by the client to the practical nurse (PN) clarify with this client? A. Take one tablet every 5 minutes, up to three tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets every 3 to 6 months to maintain freshness. D. Ensure to chew the pill completely before swallowing it.
D Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet should be placed under the tongue (sublingually), not chewed or swallow. One tablet can be taken every 5 minutes, up to three doses. If pain relief not achieved after taking three pills, seek medical attention immediately. Nitroglycerin should be replaced every 3 to 6 months. Nitroglycerin pain relief should occur in 5 minutes and duration should last 30 minutes.
A client has developed oral thrush. Which pharmacological agent should the practical nurse (PN) expect to be prescribed? A. Ampicillin B. Ciprofloxacin C. Neomycin sulfate D. Nystatin
D Nystatin is an antifungal drug that is effective in treating thrush, an oral fungal infection.
Benztropine is prescribed for a client with Parkinson disease. After a few days of therapy, the client complains of a constipation and abdominal distention. What response by the practical nurse would be most appropriate? A. Contact the health care provider and report symptoms, so that a prescription can be obtained to relieve the symptoms. B. Inform the client that the constipation and abdominal distention are unrelated to your use of these drugs. C. Ask the client if they are concerned that these conditions may be symptoms of progression of the Parkinson disease. D. Auscultate for bowel sounds and ask the client when they last had a bowel movement.
D One of the side effects of benztropine is a paralytic ileus. It is important to first assess the client's abdomen, listen for bowel sounds, and determine when they last had a bowel movement. The practical nurse should then consult with the charge nurse and report findings.
A client has been diagnosed with open-angle glaucoma. The health care provider prescribes pilocarpine 1% eye drops. What action of this drug makes it a useful treatment for the client's condition? A. The production of aqueous humor in the eyes is decreased. B. Ciliary muscles are paralyzed to decrease accommodation. C. Bilateral mydriasis with cycloplegia is accomplished. D. The ciliary muscle contracts increasing the outflow of aqueous humor in the eye.
D Pilocarpine, a cholinergic agent, causes pupillary constriction (miosis), which facilitates outflow of aqueous humor, causing a decrease in intraocular pressure.
A client who takes metformin for diabetes mellitus type 2 is NPO for surgery. The practical nurse (PN) anticipates which pre-op prescription for this client's glucose management. A. NPO except for metformin and regular snacks B. NPO except for oral antidiabetic agent C. Novolin-N insulin subcutaneously twice daily D. Regular insulin subcutaneously per sliding scale
D Regular insulin dosing based on the client's blood glucose levels (sliding scale) is the best method to achieve control of the client's blood glucose while the client is NPO.
A client with diagnoses of diabetes mellitus and gastroesophageal reflux disease is newly prescribed propranolol for hypertension. Which information should the nurse provide to this client? A. To remain in an upright position for 30 minutes after taking the propranolol B. To take propranolol either 1 hour before breakfast or 2 hours later C. To hold the dose of propranolol if blood glucose is below 50 mg/dL D. To use glucometer frequently throughout the day
D The client needs to be instructed to monitor blood glucose because propranolol may mask symptoms of hypoglycemia. The propranolol should be taken with 8 ounces (240 mL) of water and food because food enhances bioavailability.
When thinking of acetylcholinesterase inhibitor poisioning rember DUMBBELSS. Which stands for?
D: diarrhea U: urination M: miosis B: bronchospasm B: bradycardia E: emesis L: lacrimation S: salivation S: sweating
want is one important thing to remeber about beta blockers
DO NOT STOP ABRUPTLY
Dalteparin is used to prevent ____ in the at-risk patient
DVT
Iron antidote
Deferoxamine
Benzodiazepine antidote
Flumazenil
What is Scopolamine used for
Motion Sickness
Edrophonium use and classification
Myasthenia gravis indirect cholinomimetics
acetaminophen antidote
N-acetylcysteine
opioid antidote
Naloxone
what are the 6 rights of medication Administration
Right patient Right medication Right dose Right time Right route Right documentation
Warfarin antidote
Vitamin K, fresh frozen plasma
amphetamine antidote
ammonium chloride acidify urine
neostigimine is used to reverse neuromuscular blocking agensts in ____
anesthesia
what would nitrate isosorbide dinitrate be prescribed for
angina
drug classification for Benztropine (Cogentin)
anticholinergic
Drug classification for Dalteparin
anticogulant
what drugs end in -olol
beta blockers
major side effects of Benztropine (cogentin)
blurred vision dry mouth urinary retention tachycardia contipation psychosis
What is Atropine used for
bradycardia increased exocrine secretions smooth muscle spasms
What is methacholine used for
bronchoconstriction
what medication could be prescribed for tonic clonic seizures
carbamazepine
What should the nurse check before administering a medication
check order and patient THREE times check for allergies assess the patient patient education
nursing considerations for transdermal medication administration
clean skin after removal rotate sites of patch apply to dry skin avoid shaved skin avoid heat nitro effects lost after 24 hours
drug classification of pilocarpine
contracts cillary muscle and pupillabry sphincter
Sites of intramuscular medication (IM) administration
deltoid vastus lateralis ventrogluteal
Drug classification for Bethanechol
direct cholinomimetics
Drug classification of Methacholine
direct cholinomimetics
drug classification of carbachol
direct cholinomimetics
cyclosporine ophthalmic emulsion is used for
dry eyes
indications for ear drops
earwax buildup ear infections
indirect cholinomimetics that don't cross the blood brain barrier include:
edrophonium neostigmine pyridostigmine
beta blocker antidote
glucagon
what is Prazosin used for
hypertension benign prostatic hyperplasia (BPH) Nightmares
beta blockers are used for
hypertension heart failure angina pectoris
Beta 1 receptor characteristics
increased heart rate increased contractility increase renin release increased lipolysis
Beta 2 receptor characteristics
increased heart rate increased contractility increased lipolysis increased insulin increased aqueous humor production ciliary muscle relaxation vasodilation bronchodilation decrease uterine tone
risks of intramuscular medication (IM) administration
injury to nerves, bone, and blood vessels
What is Hyoscyamine used for
irritable bowel syndrome
late symptoms of aspirin poisoning
metabolic acidosis coma hyperthermia
pyridostigmine and neostigmine are both used to treat for
mysasthenia gravis
Early symptoms of aspirin poisoning
nause.vomiting tinnitus confusion hyperventilation respiratory alkalosis
If an individual comes in with vaginal trichomoniasis what would the doctor prescribe
oral metronidazole
major side effects of Prazosin
orthostatic hypotension tachycardia priapism/inhibition of ejaculation nasal congestion
lead antidotes
penicillamine dimercaprol CaEDTA succimer
arsenic, goldm and copper antidotes
penicillamine dimercaprol succimer
indirect cholinomimetics that do cross the blood brain barrier include:
physostigmine donepezil
antimuscarinic antidote
physostigmine salicylate
What is Glycopyrrolate used for
reduces airway secretions Ulcer treatment
what is carbachol used for
releases intracoluar pressure
Phenytoin is used for
seizures
tricyclic antidepressants antidote
sodium bicarbonate
major side effects of atropine
tachycardia dry mouth urinary retention
what is the tensilon-test used for?
to test if a person has myasthenia gravis
Alpha 1 receptor increases
vascular smooth muscle contraction pupillary dilator muscle contraction intestinal and bladder sphincter muscle contraction