ati pharm proctored exam

• Transdermal patch

education: rotate the site each time you change the patch

• Synergistic effect

effect of combined drugs greater than either of drugs alone

• Dexamethasone (Decadron

effects on blood glucose: glucocortoid steroids & stress ↑ blood glucose

Prothrombin time

evaluate adequacy of extrinsic system&common pathway in clotting mechanism

The nurse may administer acetylcysteine (Mucomyst) inhalation to:

facilitate mucus expectoration.

A client is receiving amphotericin B intravenously. A nurse observes for what common side effects occurring within the first 1 to 3 hr of initiating the infusion?

fever and chills

• Status epilepticus

given via IV route

• Treatment for constipation in children

glycerine suppositories (↑ osmotic pressure-draws fluid into colon) castor oil-distasteful & ↓ absorption of fat-soluble vitamins;

Metoclopramide (Reglan

has increased sedation when given with Morphine

Clients receiving intravenous gentamicin (Garamycin) should be assessed closely for:

hearing loss.

Insulin

high dose (U-500) is 5 times stronger than U-100—divide dosage ordered by 5

When a client develops tolerance to a drug, the nurse would expect:

higher dose needed to achieve same effect.

Levothryoxine (T4) Indication

hypothyroidism RT dysfxn of hypothalamus, pituitary, or thyroid gland

• Ventricula dysrhythmias

in emergency setting—drug of choice: lidocaine hydrochloride (Xylocaine

• Substance abuse

inappropriate, excessive, self-admin of drug for non-medical purposes

The purpose of a spacer with a metered-dose inhaler is to:

increase the amount of drug delivered to the lungs.

The effects of epinephrine include:

increased pulse and blood pressure.

• Psuedoephedrine (Sudafed)

increases BP, HR, RR; Contraindication: HTN

• Cromolyn sodium (Intal

indication: asthma prophylaxis (mast cell stabilizer→↓ release of histamine, bradykinin, and serotonin that start a cascade of aqllergy symptoms)

• Fluticasone (Flovent

inhaled steroid]—Indic.: decrease inflammation of the bronchi

Phenobarbital [Barbiturates

interventions for anticonvulsant therapy: assess for resp. depression, excess sedation from toxic effects, IV at < 50mg/min, avoid extravasation (alkaline→skin damage)

Route—fastest/most effective:

intravenous

• Mannitol (Osmitrol)

is an osmotic diuretic and is not used in the treatment of HTN

The only drug commonly used both to prevent and to treat tuberculosis is:

isoniazid

IM injection site

locate dorsogluteal site

• Aluminum hydroxide (amphojel)

long term use SE: constipation (antiacids w/Mg alone cause diarrhea; Often Al & Mg are combined to balance their side effects)

When a client is being treated with trimethoprim-sulfamethoxazole (Bactrim) for a urinary tract infection, it is important to:

maintain good hydration.

The best laxative for clients who have chronic constipation and cannot or will not consume adequate dietary fiber is a:

saline cathartic.

A nurse cautions a client with Parkinson's disease who is taking carbidopa/levodopa (Sinemet) against taking any monoamine oxidase (MAO) inhibitors because the drug interaction can cause:

severe hypertension.

An elderly client is prescribed a new drug. Because of the age-related changes in the kidneys and liver, it is most important that the nurse assess for:

signs of drug toxicity.

Two days after abdominal surgery, a client's bowel sounds are hypoactive and the abdomen is distended. The physician orders bethanechol (Urecholine), a cholinergic agonist, which acts to:

stimulate intestinal peristalsis and tone.

An antiulcer drug that forms a gel to coat and protect the ulcer so that healing can occur is:

sucralfate (Carafate).

A client who is taking one daily dose of a thiazide diuretic should be instructed to:

take the medication in morning to avoid nighttime voiding.

• Digoxin [cardiac glycoside]

that ↓ HR. Interv: assess apical HR for 1 min. Contact DR if HR < 60bpm

Narcan [opioid antagonist]:

therapeutic action: improvement of respiratory rate.

• Phenytoin (Dilantin)

therapeutic level: 10-20 mcg/mL

• Theophylline

therapeutic serum level: 10-20mcg/mL

The most serious adverse reaction to oral contraceptives is:

thromboembolism.

Which of the following instructions should be included in the discharge teaching plan for a client taking tetracycline (Tetracyn) to prevent the development of the suprainfection, Candida albicans?

Eat a container of yogurt with active cultures daily.

Synergistic drugs

Effect of giving both drugs > than the drugs individually

A client receives a prescription for calcium channel blockers. The nurse should expect which of the following diagnostic tests to be prescribed to obtain baseline data prior to starting the medication?

Electrocardiogram (ECG)

In a walk-in clinic, clients are often given intramuscular injections. Which drug should be readily available in case a client has an anaphylactic reaction?

Epinephrine

• Proton pump inhibitors for treatment of:

GERD

Prior to giving a client a dose of digoxin, the nurse counts the apical pulse. If the rate is 62 bpm and regular, which is the appropriate nursing action?

Give the drug and document the heart rate.

A client is receiving naproxen (Aleve) 375 mg 3 times/day by mouth. The nurse observes the client's stools are becoming darker with a tarry consistency. Which of the following nursing interventions is most appropriate?

Give the medication with milk or food

A client who has received an injection of regular insulin at 0800 complains of feeling sweaty, weak, hungry, and shaky two hours after the injection. Which drug is indicated for this client?

Glucagon

When reviewing medication teaching with a client, a nurse reinforces that which of the following food and medication interactions can lead to medication toxicity?

Grapefruit juice and nifedipine (Procardia) also a calcium channel blocker

The presence of Helicobacter pylori is confirmed in a client with peptic ulcer disease. The nurse may anticipate the use of multiple antibiotics because:

Helicobacter pylori commonly develop resistance to single drugs.

A client is taking metoprolol (Lopressor) for heart failure. The nurse notes that the client's heart rate is 50 beats/min, and the client has a systolic blood pressure of 90 mm Hg. Which of the following should the nurse do first?

Hold the client's medication.

A nurse is caring for a client with heart failure who is receiving spironolactone. The nurse should monitor for which of the following electrolyte imbalances related to side effects from this aldosterone antagonist?

Hyperkalemia also during Eletrocardio Gram (EKG look for peaked T waves as an indication of increased K+++

The nurse practitioner prescribed anhydrous theophylline (Theo-Dur) for the client with chronic bronchitis. With which disorder would the nurse practitioner reconsider the use of this medication?

Hypertension

A client who has been on furosemide (Lasix) for one year reports weakness in her legs, constipation, palpitations, and lethargy. Her bowel sounds are hypoactive. The nurse should suspect which complication?

Hypokalemia

An older adult client treated for recurring episodes of heart failure has been on long- term thiazide diuretic therapy. Which of the following findings should the nurse report as an adverse effect of these medications?

Hypokalemia

Testosterone IM

If use to correct delayed puberty→assess bone maturation with bi-annual x-rays of hand and wrist; monitor liver fxn (can ↑ hypoglycemia, potentiate sleep apnea, exacerbate heart failure due to fluid retension.

A nurse should recognize that which of the following findings indicates the most serious side effect of vancomycin (Vancocin)?

Impairment of hearing

A nurse is reinforcing teaching for a client who has colorectal cancer and is receiving the platinum compound oxaliplatin (Eloxatin). The client should be taught about which of the following nutritional interventions?

Increase the amount of fiber in the diet, such as whole grains.

A client is admitted to the emergency department by an ambulance for a heroin overdose. The client is currently taking methadone (Methadose) that was prescribed through an outpatient clinic for opioid detoxification. The client is unresponsive and is administered naloxone (Narcan). The nurse evaluates for which of the following desired responses to this medication?

Increased respiratory rate

Allopurinol (Zyloprim)

Ind. Gout; MofA: ↓ serum uric acid levels & urinary uric acid secretion; Precaution: avoid foods that acidify urine such as corn

Acetazolamide (Diamox)

Indic.: edema, epilepsy, acute mountain sickness, glaucoma (↓ intraocular pressure by ↓ amount of aqueous humor in the eye) Contra: allergy to sulfonamides

Chloroquine phosphate (Aralen):

Indic.: malaria prevention; Use: take weekly starting 1 week before departure and continued for 4 weeks after return.

• Antihistamines

Indic: allergy-induced symptoms

Montelukast (Singulair)

Indic: prevent asthma exacerbations;Dose: daily at bedtime; SE: well tolerated

Acetylcysteine (Mucomyst)

Indic: prevent liver damage following acetaminophen (Tylenol) overdose. Most effective if given shortly after ingestion; some protection up to 24 hrs.

Auranofin (Ridaura)

Indic: slows the progression of rheumatoid arthritis; takes 4-6 months of therapy to achieve therapeutic effect; SE: renal toxicity (less toxic through oral route than IM route), severe blood dyscrasias, GI rxns,

Epoetin Alfa (Procrit)

Indic: treat anemia; SE: headache, HTN, seizures RT Hct rises too quickly

• Antitussive

Indic: used to suppress a cough

• Decongestant

Indic: used to treat nasal congestion

• Mucolytic

Indic: ↓ viscosity of mucus plugs making them easier to expel

Cyclosporine (Neoral)

Intervention: Mix w/ orange juice or milk to ↑ palatability; mixed & dispense in a glass container(since drug binds to plastic); grapefruit juice ↑ cyclosporine levels & ↑ risk of toxicity; administer immediately after mixing (can separate & settle)

IV medications

Intervention: assess site for redness/swelling before administration

Why is carbidopa-levodopa preferred over levodopa alone?

It decreases the amount of levodopa needed.

A 12-year-old client is to receive oral cefaclor (Ceclor) for otitis media. A nurse monitors the client for which of the following symptoms that may indicate an allergic reaction to the medication?

Maculopapular rash and pruritus

A client is undergoing general anesthesia administered by inhalation for a cholecystectomy. The nurse in the operating room observes that the client has a temperature of 40° C (104° F) and significant muscle rigidity. The nurse prepares to assist in the care of the client for which of the following medical emergencies?

Malignant hyperthermia

A client with active tuberculosis is started on a regimen of antitubercular medications. Which of the following is important for a nurse to stress to the client?

Medication resistance may develop if dose scheduling is irregular.

Which phase of pharmacokinetics is affected most by abnormal liver function?

Metabolism

• Narcotics

MofA: alter perception of pain at the spinal cord & higher levels in the CNS

• Vecuronium (Norcuron)

MofA: causes relaxation of muscles & total flaccid paralysis, but does not affect CNS, diminish pain, or consciousness

• Ibuprofen (Motrin)—

Most common SE: GI distress

A client is started on haloperidol (Haldol) to control antipsychotic episodes associated with schizophrenia. The nurse should instruct the client to observe for which of the following potential adverse medication effects?

Muscle spasm and parkinsonian symptoms

A male client comes to the clinic requesting sildenafil (Viagra). Viagra should not be combined with which of the following?

Nitroglycerin (Nitrogard) also head ache is a side effect of overdosing

A client is receiving ferrous sulfate orally. Which of the following findings reported by the client indicates that the medication is achieving its desired outcome?

No shortness of breath with exertion

• Dantrolene sodium (Dantrium)

SE: hepatitis (highest risk for women 35yrs or taking lg doses)

Thiazides

SE: hyperuricemia (common SE); assess: uric acid levels

Simvastatin (Zocor)—

SE: muscle weakness/aches; Assess: Creatine Kinase (released w/severe muscle injury)

• Acyclovir (Zovirax)—

SE: nephrotoxicity (crystallization of drug in nephron→renal tubular obstruction)

• Narcotic (opiate) analgesic

SE: papillary constriction, ↓BP, ↓HR, ↓ GI mobility

• Terbutaline (Brethine

SE: tachycardia

Estrogen (premarin)

SE: ↑ risk of Thromboembolism with s/s: SOB, severe headache, vomiting, sudden acute pain in the calves, legs, chest, abdomen.

A nurse is assisting a client in planning a therapeutic diet to enhance the effectiveness of cholestyramine (Questran) and avoid possible adverse effects. Which of the following would be appropriate to incorporate into the plan?

Select from foods that are low in saturated fat and cholesterol.

Which adverse effect is common for a client being treated with the antidepressant fluoxetine (Prozac)?

Sexual dysfunction

Digoxin is started for a client with an atrial arrhythmia. Within three days, the client's heart rate has decreased from 94 to 74. What action of digitalis explains this change?

Slowed impulse conduction

Which group may represent an increased risk for substance abuse?

Socioeconomically advantaged clients

There are many agents that are useful in the treatment of gastric ulcers. Which agent reacts with hydrochloric acid to form a viscous protective barrier over the ulcer?

Sucralfate (Carafate)

A client newly diagnosed with peptic ulcer disease is started on the cytoprotective agent sucralfate (Carafate). What important information should the nurse provide the client regarding potential interactions of this medication?

Sucralfate should be taken on an empty stomach before meals and at bedtime.

Which nursing intervention is specifically important when a client is taking an alpha- blocker, such as doxazosin (Cardura) for hypertension?

Teach the client how to manage orthostatic hypotension.

The use of which class of antibiotics should be avoided in children?

Tetracyclines

A nurse is monitoring a client with a history of bulimia in regards to the use of the stimulant laxative, senna (Senokot). Which of the following client findings supports a suspicion of laxative abuse?

The client has no urge to defecate even though stools are in the rectal vault.

A nurse is administering oral levothyroxine (Levothroid) to an infant with congenital thyroid deficiency. Which of the following findings indicates a therapeutic response to this medication?

The infant's height and weight will be at the 50th percentile by age 2.

A client takes ethinyl estradiol/norgestimate (Ortho Tri-Cyclen) birth control pills. She calls the clinic and relates that she missed her medication yesterday. Which instructions will the nurse give?

"Take two pills today then continue on a daily basis."

Which of the statements by the nurse most accurately describes the effects of declined plasma albumin levels in older adults?

"There is an increased risk for adverse effects."

. A client with Parkinsonʼs disease is taking carbidopa-levodopa (Sinemet) daily. The client reports he is frustrated that he has "good" days with few symptoms and "bad" days where he has poor symptom control.

The nurse understands this phenomenon is seen in clients who need a higher medication dose to control symptoms.

Albuterol (Proventil)

[sympathomimetic/ adrenergic beta-2 agonist] Contraindicated: with MAOIs (can↑ action of albuterol and → HTN crisis); β-blockers can inhibit the therapeutic effects Use: invert canister, shake before use, rinse mouth after use, w/new inhaler perform test spray

• Amitriptyline (Elavil)

[tricyclic antidepressant] SE: orthostatic hypotension, sedation, & confusion

Metoprolol (Lopressor)

[β-blocker] Hold dose for dyspnea (sign of exacerbation of CHF)

A client is admitted to the hospital with exacerbation of asthma and is receiving albuterol (Proventil) nebulizer treatments every 4 hr. If encountered, which central nervous system (CNS) side effect should the nurse attribute to this medication?

mild tremors

TB

multi drug tx: Isoniazid(INH), Rifampin, pyrazinamide, ethambutol—to deal w/ resistant strains

The antagonist for a client who has overdosed on morphine is:

narcan.

Histamine 2 receptor antagonists such as cimetidine (Tagamet) are used to treat peptic ulcers because they:

neutralize hydrochloric acid in the stomach.

A home health client tells the nurse that she is taking triamterene (Dyrenium) for fluid retention. She tells the nurse she is using a salt substitute so she will not retain so much water. What is the most appropriate nursing response?

"Using a salt substitute with this medication could cause you to have too much potassium."

A client whose asthma has been poorly controlled is prescribed cromolyn sodium (Intal) for inhalation. Client teaching should include which statement by the nurse?

"Using this drug regularly will reduce the frequency of acute attacks."

Which statement is made by a client who is experiencing an adverse reaction to levothyroxine (Synthroid)?

"I feel like my heart is pounding."

A client is prescribed estrogen for the reversal of menopause symptoms. The nurse recognizes the need for further teaching when the client states,

"I should immediately report any leg pain or redness, numbness or stiffness, or swelling to my primary care provider."

An adult female client is placed on cyclosporine (Neoral) after receiving a kidney transplant. Which of the following client statements indicates that the nurse's teaching about this medication was effective?

"I will contact my doctor immediately if I have a fever or sore throat."

. A client is prescribed diphenoxylate/atropine (Lomotil) for severe diarrhea. Which of the following statements made by the client indicates a need for further nursing instruction regarding the self- administration of the medication?

"I will continue to take the medication as long as necessary until my diarrhea is resolved."

A nurse has just completed teaching a 71-year-old client about the flu vaccine. Which of the following client statements indicates that the nurse's teaching was effective?

"I will make an appointment for the flu vaccine in late October or early November."

A client is being discharged with a prescription for warfarin (Coumadin) following treatment for deep vein thrombosis (DVT). The nurse recognizes that teaching has been effective when the client states,

"I will not take any aspirin for pain while I am on warfarin. I will take acetaminophen instead."

A client recently diagnosed with peptic ulcer disease (PUD) is prescribed antacids by the primary care provider. The client is being instructed by the nurse on when to take the antacids. Which of the following responses by the client indicates a correct understanding of when to take the antacids?

"I will take my antacid at 1 and 3 hr after each meal and at bedtime."

A client is receiving diuretics as part of the pharmacologic therapy for heart failure. Which of the following client statements indicates the need for further instruction?

"I will take the diuretic if I experience difficulty breathing or chest pressure."

A client who was prescribed oral contraceptives comes to the clinic for her 4 week follow-up visit. After discussing the use of oral contraceptives with the client, the nurse recognizes a need for further client education when the client states,

"If I miss a dose, I should take two pills the next time the dose is due."

A client who has hyperthyroidism (Graves' disease) is taking oral propylthiouracil (PTU). Which of the following client statements indicates effective teaching regarding this medication?

"It may take two to three months for the thyroid levels to stabilize."

A client reports taking large amounts of vitamins because she believes they increase her energy level and will prevent various diseases. Client teaching should include which nursing response?

"Large amounts of fat-soluble vitamins can be toxic."

A client is prescribed intravenous (IV) heparin by a primary care provider. Which of the following client statements shows understanding of the rationale for the IV heparin that was prescribed by the primary care provider?

"My right leg swelled when I got a blood clot after surgery."

When a client is prescribed an aminoglycoside, such as gentamicin (Garamycin), which instruction should be included in the teaching plan?

"Report to your health care provider any ringing in your ears."

Client teaching for the use of sublingual nitroglycerin tablets to relieve angina should include which nursing instruction:

"You can take up to three doses, five minutes apart, if needed."

A client with a diagnosis of gastroesophageal reflux disease (GERD) is prescribed famotidine (Pepcid) 20 mg twice a day. When teaching this client about the proper self- administration schedule for this medication, the nurse should inform the client that famotidine should be taken

1 hr before meals.

At 1130, a nurse administers aspart insulin (NovoLog) to a client with diabetes mellitus. When is the client at greatest risk for hypoglycemia?

1345

A client diagnosed with bipolar disorder and stabilized with lithium is admitted to the hospital through the emergency department. The primary care provider's diagnosis includes accidental overdose of lithium. What is the most important information the nurse can provide the client with about precautions associated with the administration of lithium?

Blood levels must be monitored to keep lethal levels from accumulating.

A nurse should anticipate that the primary care provider may prescribe polystyrene sulfonate (Kayexalate) for a client who has a serum potassium of

5.4 mEq/L and burn injuries.

A nurse working on a gynecological-obstetrics unit is preparing equipment in anticipation for prescriptions from the primary care provider for Pitocin (oxytocin) administration to several of the clients on the unit. For which of the following clients should the nurse anticipate oxytocin administration? (Select all that apply.)

A client admitted for augmentation of labor A client admitted for induction of labor A client with postpartum uterine hemorrhage

Before prescribing a cephalosporin, the nurse practitioner asks if the client is allergic to penicillin. Why is this important to assess?

A client who is allergic to penicillin can have a cross sensitivity to cephalosporins.

A client with a diagnosis of cystic fibrosis is prescribed acetylcysteine (Mucomyst).

A nurse understands that the primary reason for giving this medication to the client is to thin respiratory secretions.

The nurse assesses a client shortly after an intravenous infusion of the osmotic diuretic mannitol is started. Which finding represents an early adverse effect of mannitol?

Bounding pulse

Fluconazole (Diflucan) is prescribed for the client with a fungal infection in the toenails. The nurse should instruct the client to contact the nurse practitioner immediately if which adverse effect occurs?

Bruising or sore throat

Medroxyprogesterone (Provera);

Contra: smoking/tobacco products; Risks: Thromboembolism & Cardiovascular complications; Interventions: use additional contraceptive measures w/antibiotic therapy

. A primary care provider has prescribed enoxaparin (Lovenox), 60 mg subcutaneously. The nurse should select which of the following as the recommended site to administer this medication?

Abdomen at least 1in away from belly button

Mafenide acetate (sulfamylon) Interventions:

Admin PRN analgesics 30 min prior to tx; apply after daily tubbing to remove previous cream; Monitor fluid & electrolyte/acid-base balances; schedule wound care > 1 hr before meals; wear sterile gloves when applying

A client with a history of alcoholism is taking acetaminophen (Tylenol) for headaches. The nurse reviews the client's laboratory report. For which of the following laboratory values should the acetaminophen use be discontinued immediately?

An elevated serum bilirubin

The parents of an adolescent male client question the nurse about the possibility of androgen therapy for their son. The nurse responds appropriately with which of the following statements?

Androgens are useful for male clients when puberty will not take place."

Development of a chronic cough is an adverse effect associated with which class of anti-hypertensive drugs?

Angiotensin converting enzyme (ACE) inhibitors

Antacids should be given one hour apart from most other drugs. Which is the rationale?

Antacids may interfere with absorption of drugs taken at the same time.

Oral diazepam (Valium), a benzodiazepine, has been prescribed for a client who has anxiety and muscle spasms. Which nursing intervention is appropriate for the care of this client?

Assess for incoordination and daytime drowsiness.

Thrombocytopenia

Assess: platelet count

Orders are written for anticholinergic drugs for each of the following clients. Which order should the nurse question?

Atropine combined with opioid analgesics to relieve pain in a 30-year-old client with urinary calculi.

Compared to other beta adrenergic blockers, cardioselective beta adrenergic blockers:

are less likely to cause bronchoconstriction.

Which of the following assessment findings in a client receiving transdermal nitrate therapy for angina indicates an adverse effect?

Dizziness when the client stands up

A client who has a history of thrombophlebitis is taking warfarin to prevent new clot formation. He should be cautioned not to take salicylic acid because:

aspirin increases the effects of warfarin.

• Phenobarbital (Luminal

assess: respiratory depression

A client is receiving the thrombolytic medication streptokinase (Kabikinase). Which of the following findings indicates that the client is experiencing an adverse reaction to the medication that should be reported to the primary care provider?

Bleeding from a previous injection site

• Parkinson's

associated with ↓ of dopamine in the substantia nigra (brain)

Diphenhydramine (Benadryl) Precaution

avoid other CNS depressants such as: alcohol, benzodiazepines, kava kava

A postoperative client has a prescription for oxycodone (OxyContin) to be administered for postoperative pain. In monitoring the client and reviewing the clientʼs chart prior to the first administration of the medication, which of the following should give the nurse the most cause for concern?

Benign prostatic hypertrophy (BPH)

When a client is receiving intravenous fluid with supplementary potassium chloride, it is especially important for the nurse to monitor for which potential adverse effect?

Cardiac dsyrhythmias

Mannitol

Caution with pts with heart disease (can precipitate CHF and pulmonary ededa)

Diphenoxylate & Atropine (Lomotil)

Caution: With Renal impairment ↓ elimination of atropine → ↑ anticholinergic effects of atropine like confusion

When a client is using a sympathomimetic (adrenergic) bronchodilator such as albuterol, the nurse would expect which effect?

Central nervous system stimulation

A client diagnosed with migraine headaches is prescribed sumatriptan (Imitrex). The nurse is reinforcing client teaching regarding side effects of the medication and advises the client to seek immediate medical attention for which of the following symptoms?

Chest discomfort, pressure, and tightness

A medication order is written for ciprofloxacin (Cipro). For which client should the nurse question use of this medication?

Child age 10

After giving a dose of dextromethorphan, an antitussive, which data reflects evaluation of the drug's effectiveness?

Client states that cough has been relieved.

Isotretinoin (Accutane)

Contra: pregnancy w/ 2 forms of birth control due to teratogenic effects

Which statement by the nurse best explains why nausea, vomiting, and bone marrow suppression are common adverse effects of cytotoxic antineoplastic drugs?

Cytotoxic drugs affect the most rapidly dividing cells."

Urofollitropin (Fertinex)

Dosage: admin. IM based on dose in preceding cycles SE: ovarian hyperstimulation syndrome.

• Dopamine (Intropin)—

Dose for cardiac shock: Intermediate doses ↑ CO; other uses: low doses ↑ renal perfusion & urine output; high doses (>10mcg/kg/min) α effects predominate→vasoconstriction & ↑BP

Zidovudine (AZT

Dose: take at the times prescribed to prevent resistance development SE: bone marrow suppression, hepatotoxic, nephrotoxic

A client who experiences motion sickness during airplane flights obtains a prescription for meclizine (Antivert). When is the best time to take the drug?

One hour before the flight

A nurse is administering glucagon intramuscularly to a client. Which of the following actions will help the nurse evaluate the medication's effectiveness?

Performing a blood glucose fingerstick

• Anti-convulsant for infants/children

Phenobarbital (often admin w/ phenytoin)

A client is receiving the thrombopoietic growth factor oprelvekin (Interleukin-11). The nurse recognizes that this medication is being given to correct which abnormal laboratory finding?

Platelet count 22,000/mm 3

The nurse may administer baclofen (Lioresal) for the treatment of which condition?

Protracted muscle spasticity

• Barbiturate overdose

RT: respiratory depression

To prevent oral fungal infections, the nurse should instruct the client who uses a beclomethasone inhaler to take which action?

Rinse the mouth after each use.

Anaphylaxis rxn S/S

S/S: bronchoconstriction, angioedema, hypotension

Hypertensive crisis

S/S: flushed skin, headache, visual changes

• Trimethoprim/Sulfamethoxazole (Bactrim)[sulfonamide antibiotic]

SE: crystalluria that can clog the kidneys; to prevent ↑ fluids to 2-3 liters per day unless contraindicated

ACE Inhib. Lisinopril (Zestril)

SE: dry/persistent cough for 1-2 wks from ↑ bradykinin

A primary care provider has prescribed dextromethorphan (Balminil DM) to a client with a persistent cough.

The nurse recognizes that the antitussive is used to stop or reduce the cough.

A primary care provider has prescribed phenytoin (Dilantin) 200 mg extended release capsule every day by mouth for a client.

The nurse recognizes that the client requires further instruction when the client states the medication can be chewed.

A client is prescribed alprazolam (Xanax) 0.25 mg three times a day.

The nurse should independently hold the evening dose if the client is displaying signs/symptoms of rage.

Baclofen (Lioresal

Therapeutic action: ↓ frequency & severity of muscle spasms

A client who is scheduled for cataract surgery has an order for acetazolamide (Diamox) preoperatively. Is this an appropriate order and, if so, why?

This type of drug is commonly used before ophthalmic surgery to reduce intraocular pressure.

Which findings are most likely in the client who has taken a toxic dose of a salicylate (aspirin)?

Tinnitus and dizziness

Antihyperglycemic agents are prescribed for clients with:

Type 2 diabetes mellitus.

Propanolol

Use. Dysrhythmia, HTN, angina; SE: bronchoconstriction/bronchospasm; can block glyconeogenesis

Collagenase (Santy

Use: Debride ulcers

Interferon

Use: Prevent viral replication

Sulfisoxazole (Gantrisin uses

Use: UTI

Loperamide (Imodium)

Use: anti-diarrheal (poorly absorbed from GI tract; difficulty crossing the blood-brain barrier)

Norgestrel (Ovrette)

Use: contraception; SE: excess progestin →weight gain from ↑ appetite; deficiency of progestin: late breakthrough bleeding, amenorrhea; excess estrogen → edema

Methylphenidate (Concerta)

Use: marcolepsy Precaution: avoid caffeine use

Clopidogrel (Plavix

Use: reduce long-term risk of clotting w/ atherosclerosis and recent MI of CVA

• Bulk-forming laxatives (Metamucil)

Use: take w/lg amounts of water to prevent a gel-like mass to ↑ constipation

• Asthma therapy

Use: use albuterol (sympathomimetic drug) first to open up airways and allow other inhaled drugs to be dispersed further down the bronchial tree

Heparin (anticoagulant)

Use: w/alteplase for acute MI

Sumatriptan (Imitrex):

Use: when migraine symptoms appear and again in 1 hr if symptoms persist

Warfarin (Coumadin)

Use:long-term prophylaxis of thrombosis [antidote—Vit K]

Spironolactone (Aldactone)

[K sparing diuretic]—avoid foods w/ ↑ K such as salt substitutes

• Fluoxetine (Prozac)

[SSRI]—Teach: effects may not be seen for weeks; Dosage starts at 20mg, can be increased after 2 wks gradually up to 80mg/day divided into 2 doses

• Gentamicin (Garamycin)

[aminoglycoside antibiotic]; SE: nephrotoxicity & ototoxicity

Doxepin (Sinequan)

[anticholinergic] SE: urinary retension, constipation, drying of nasal/oral secretons, ↑HR

Hexacholorphene (pHisoHex

[antiseptic solution] Caution: CNS stimulation if sufficient amts are absorbed through skin or mucous membranes; avoid if pregnant/breastfeeding

• Triazolam (Halcion)

[benzo]—use: do not take with alcohol

• Lorazepam (ativan)

[benzodiazepine]: SE: adbrupt cessation can →seizures RT physical addiction

• Prednisone (Deltasone)

[corticosteroid] suppresses endogenous cortisol production, so abrupt stopping of drug can result in acute adrenal insufficiency can occur

• Succinylcholine

[depolarizing NMBA] common SE: muscular pain/stiffness

Furosemide (Lasix

[loop diuretic] Intervention: check BP before giving to determine baseline; can cause ↓ BP by ↓ circulatory volume or by relaxing venous smooth muscle

The nurse would describe a penicillinase to a client receiving this medication as:

a bacterial enzyme that can inactivate many penicillins.

A nurse recognizes that a client is experiencing an adverse reaction to a nebulized dose of ipratropium (Atrovent) if the client reports

a dry, scratchy throat.

A client with Type I diabetes mellitus is given an injection of neutral protamine hagedorn (NPH) insulin at 7:00 a.m. In order to prevent a hypoglycemic reaction, the client should have:

a mid-afternoon snack.

• Triaterene/hydrochlorthiazide (maxzide)—

a thiazide diuretic that is ineffective when ureine output is low or renal dysfnx is present

A client is self-administering 5 units of lispro insulin (Humalog) every morning. The nurse should instruct the client that the best time to administer the lispro insulin is

no sooner than 15 min before breakfast.

"A disease process characterized by the continued use of a specific psychoactive substance despite physical, psychologic, or social harm" is the definition of:

addiction.

If corticosteroids are discontinued abruptly, a problem that may develop is:

adrenal gland shut-down.

Vaccine

adv. of live vs attenuated/killed vaccine: long-lasting active immunity vs partial (passive)

• Oral Iron supplement

adverse SE: gastric irritation→anorexia, nausea, vomiting, constipation

Cephalosporins (Keflex

allergy to cephalosporins is considered a precaution for taking penicillins

• Antidysrhythmic agents—

alter the dysfunction in the electrical system of the heart.

Digoxin (lanoxin)

anti dysrhythmic] SE: blurred/double vision

Nausea tx

antiemetic plus cool, damp cloth to forehead, neck, and wrists.

Alteplase (Activase)

antithrombolytic] Use: Acute MI/CVA (has short half-life)

A client is in a clinic for an annual physical exam. During the medication review the client reports daily use of loratadine (Claritin) and occasional use of diphenhydramine (Benadryl) for allergy relief. The nurse recognizes the potential for medication interactions when the client reports use of

barbiturates for sleep.

• Unconscious type 1 diabetic

best intervention: admin glucagons IM

• Tolerance

body develops natural resistance to drug effects, need to increase dosage

Methylcellulose (Citrucel)

bulk-forming agent with minimal Side Effects (SE)

Psyllium (Metamucil

bulk-forming agent with minimal Side Effects (SE)

To administer eardrops to a child, the nurse should straighten the external ear canal by pulling the auricle:

down and toward the back of the head.

Erythromycin (Erythrocin)

drug class macrolide SE: liver toxicity

• Bipolar

drug of choice: lithium

Vancomycin should not be used to treat minor infections because it:

can cause "red man syndrome", a hypertensive crisis that is almost always fatal.

Guaifenesin

can cause drowsiness

• Corticosteroids

can interfere with effect of a vaccine since they depress the immune system and can interfere with body's ability to produce antibodies

• Liver & kidney disease

causes increase in length of duration of action of medication

• Penicillin allergy may ↑ risk for allergy to

cephalosporins

A client is receiving long-term glucocorticoid therapy for an inflammatory condition. Which of the following findings should be reported to the primary care provider?

chills and fever

A pharmacy supplies a fluticasone (Flovent) inhaler for a client who is hospitalized. The nurse recognizes that this medication will be of the most benefit to the client with

chronic asthma who consistently uses the inhaler every 12 hr.

A client phones the primary care clinic and informs a nurse that he is having a "flare up" of his gout. He tells the nurse he has been prescribed several medications for his gout and questions which medication he should take. When reviewing the clientʼs medical record, the nurse notes the client has a history of migraine headaches. Based on this information, which of the following medications should the nurse anticipate the primary care provider will prescribe?

colchicine

• Metronidazole (Flagyl)

education: avoid alcohol (drug inhibits alcohol metabolism→accumulation)

Thiazide and loop (high ceiling) diuretics are similar in that both:

decrease tubular reabsorption of sodium and water.

Evidence of effective treatment with a nucleoside reverse transcriptase inhibitor (NRTI), such as zidovudine is:

decreased HIV RNA level.

• Eye drop administration:

depress the lower lid and place the medication in the lower conjunctival sac.

When oral iron supplements are prescribed, client teaching should include the fact that:

diarrhea or constipation may occur.

The combination of aluminum and magnesium in many antacids decreases the risk of:

diarrhea or constipation.

The drug of choice to treat a client with status epilepticus is:

diazepam (Valium).

One mechanism by which antihypertensive drugs lower blood pressure is to:

dilate peripheral blood vessels.

Drugs given for a systemic effect by any route must be capable of:

distribution throughout the body.

• Tissue dependence---

occurs when actual changes in cells, secondary to physical addition causes body to need the drug for homeostasis

• Zidovudine (AZT

only anti-retroviral drug that reduces maternal-fetal transmission of HIV virus

• Insulin

oral hypoglycemic agents are contraindicated during pregnancy—use insulin instead

• Levothyroxine (synthroid)—

overdose s/s: those that mimic hyperthyroidism: tremor & wt loss ; undermedicated s/s: cold,dry,scaly skin; depression; slow cognitive ability

Glucocorticoids, such as prednisone (Deltasone), are given cautiously to clients with:

peptic ulcer disease.

• Addiction

physical or psychological need for a drug

Ticlopidine (Ticlid)

prevent coronary artery thombosis; Intervention: check platelet count

A 60-year-old client questions a nurse about her prescribed medication, raloxifene (Evista). Recognizing that this medication is a selective estrogen receptor modulator (SERM), the nurse replies that the medication

prevents postmenopausal osteoporosis.

An immunizing agent that confers active immunity protects by:

providing antibodies obtained from immune humans or animals.

• Diuretics

pt. education: take during the day, report any changes in daily wt.

The most serious adverse reaction to morphine is:

respiratory depression.

• Anti-tussive

treat cough

• Nasal congestion

treat with decongestant

• Tamoxifen citrate (Nolvadex)

type of hormonal antineoplastic agent: anti-estrogen

To administer heparin subcutaneously, the nurse should:

use a 26-gauge, 1⁄2-inch needle to minimize trauma.

• Atropine

use: severe symptomatic bradycardia

• Verapamil (Calan

use: ↓ HR

PRBC (packed red blood cells)

used as blood replacement when fluid overload is a concern

• Diltizem (Cardizem

used for SVT

• Furosemide (lasix)—

used for treatment of HTN in clients with renal dysfunction

• MAOI drugs

used in treatment of depression

• Tricyclic drugs

used in treatment of depression

• Mucolytic

used to decrease the viscosity of mucus plugs making them easier to expel

• Tocainide HCl (Tonocard)

used to prevent ventricular arrhythmias

• Propranolol (Inderal)

used to prevent/control SVT (esp. assoc. w/ excessive catecholamines

• Benztropine mesylate

used to treat extrapyramidal effects w/ use of phenothiazines

• IM site for 18 month old child

vastus lateralis

A client is receiving digoxin (Lanoxin) for heart failure. Which of the following clinical manifestations is an early rather than late sign of medication toxicity?

vommiting