Giant Hesi Study guide

OSTEOPOROSIS

"-*dronate*" Rise-dronate = Actonel Alen-dronate = *Fosa*max *GI Upset* SUNRISE - Take first thing in AM SIP - Take with 6-8 oz water SIT - Remain sitting upright x 30 min STARVE- Avoid food 30 min after taking

*Shock:*

(1) Impaired oxygen delivery and use (2) Impaired Glucose delivery and use leading to decreased tissue perfusion and increased cellular demand and consumption

PT

(Coumadin/Warfarin) 11-12.5 sec (INR and PT TR= 1.5-2 times normal)

Constipation Agents - Colace/Docusate - Sodium biphosphate - Psyllium/Metamucil - Senna - Bisacodyl/Dulcolax

*NO LAXATIVES WITH AB PAIN or FEVER!!!* *GIVEN WITH PAIN MEDS (MORPHINE)* - Monitor F/E - Chronic use --> abuse

*Parkinson's Disease:* Onset: after 40, average 60 Men are 1.5x more likely

*P:* Loss of dopaminergic pigmented neurons in the Substantial Nigra (SN). Degeneration of the Basal Ganglia. Lewy Body formation. (decrease dopamine) *SS:* bradykinesia/akinesia, rigidity (resistance against passive movement), postural abnormalities (stooping) Parkinsonian tremor (tremor that occurs at rest, disappears briefly during voluntary movement then reoccur on rest) *Dx:* (1) Resting Tremor (2) Cogwheel rigidity [palpable jerks accompanied by tremors] (3) akinesia (4) postural instability

*Anphylactic shock:* outcome of a widespread hypersensitivity to an allergen that triggers a reaction known as anaphylaxis.

*SS:* anxiety, difficulty in breathing, GI cramps, edema, hives, sensation of burning of itching of the skin, fever, hemolysis.

Type III: Immune Complex

*ex:* Arthus reaction; Serum Sickness; SLE; Acute Glomerulonephritis. *P:* Inflammation d/t immune complex blockage *C:* Antigen-antibody complexes

*Monocytes: Increased in* Chronic infection Infection in the heart Collagen vascular diseases Inflammatory bowel disease

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Thiazide

- First choice tx: *hypertension* - Careful with *DIG & LITHIUM toxicity * - (caution if renal impairment)

What med is given to control hypertension in pregnancy, assuming pt. needs meds (systolic > 110)

- Methyldopa / Aldomet

Sucralfate (Carafate)

- Monitor for constipation - Alters absorption of other meds: *give 2 hours prior*

What do beta blockers mask? (2)

- Tachycardia in hypovolemia - Hypoglycemia in T1DM

Calcium channel blockers

Anti-hypertension and Anti-dysrhythmic activity (Decreases SA / AV node conduction) - dipine - Calan / Verapamil - Cardizem / Diltiazem

Antigens vs Immunogens

Antigens: react with antibodies or antigen receptors Immunogens: produce immune response and antibodies

Negative symptoms of schizophrenia

Apathy Social withdrawal Blunted affect Poverty of speech Catatonia

Nursing implications for sulfonamide antibiotics

Assess allergies prior to administering, and assess for allergic reaction after administering Assess renal function and blood counts prior to and during therapy Perform thorough skin assessment during drug therapy, monitoring for adverse cutaneous reactions

Nursing implications for Beta-Lactam antibiotics

Assess allergies prior to administration and continue to monitor for hypersensitivity reactions after the assessment phase because immediate reactions may occur within 30 minutes, accelerated reactions occur within 1-72 hours, and delayed responses may occur after 72 hours Administer around the clock to maintain effective blood levels Administer oral penicillins with at least 6 ounces of water (versus juice) because of interaction between the drug's antibacterial action and acidic juices Administer oral cephalosporins with food to decrease gastrointesitnal upset, even though this will delay absorption. Alcohol and alcohol-containing products should be avoided because of the Antabuse-like reactions that are associated with some of the cephalosporins

Assessment for Buspirone

Assess degree and manifestation of anxiety before and periodically during therapy Buspirone does not appear to cause physical or psychological dependence or tolerance

Assessment for anticonvulsants

Assess location, duration, and characteristics or seizure activity Toxicity and overdose: monitor serum drug levels routinely throughout anticonvulsant therapy, especially when adding or discontinuing other agents

Nursing implications for parenteral anticoagulant drugs

Assess partial thromboplastin time and activated partial thromboplastin time (PTT and aPTT) prior to beginning infusion and periodically throughout therapy Use an infusion pump when administering intravenously When administering subcutaneously, do not aspirate and do not massage injection site. The abdomen is the preferred site of administration Monitor the patient for signs of blood loss (petechiae, bleeding, bruises, dark stools, dark urine) and for hematoma formation at injection site Assess therapeutic effectiveness as evidenced by PTT and aPTT 1.5 to 2.5 times the control or normal level and by lack of evidence of clot formation

Nursing implications for Nonsteroidal Antiinflammatory Drugs (NSAIDs)

Assess patient for pain, inflammation, and fever prior to administration of medication, as well as after administration to determine relief of symptoms Administer oral dosage forms with food, milk, or meals Do not crush sustained-release or enteric-coated tablets Be alert to signs of toxicity, such as bleeding, gastric ulcers, and gastric bleeding and report these signs to the health care provider Monitor bowel patterns, stool consistency, and the occurrence of dizziness during the therapy Monitor complete blood count and blood urea nitrogen levels, platelets, bilirubin, serum alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase

Assessment for antiulcer agents

Assess patient routinely for apigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate Assess for heartburn and indigestion as well as the location, duration, character, and precipitating factors of gastric pain for antacids Assess elderly and severely ill patients for confusion routinely when taking Histamin H2 Antagonists When taking misoprostol, assess women of childbearing age for pegnancy

Nursing implications for HMG-CoA Reductase inhibitors

Assess patient's dietary history and any cultural preferences that may affect taking this drug Assess client's lipid profile, liver function tests, and renal function tests Monitor for muscle pain and myoglobinuruia Monitor for cataract formation

What is the normal lab value of serum lipase?

0-110

What are the normal levels of Aspartate aminotransferase (AST)?

0-35 units/L

What is the normal value for the QRS complex?

0.06-0.10

What is the normal value for the PR interval?

0.12-0.20

Assessment for proton-pump inhibitors

Assess swallowing capacity because of the size of some of the oral capsules

B/P medications

Assess the B/P

Nursing implications for Cardiac Glycosides

Assess the patient's serum electrolytes and digoxin level prior to administration Auscultate apical pulse for 1 full minute. Hold dose and notify the health care provider if beats per minute are < 60 or > 120 (or according to institutional policy) administer intravenous dose undiluted at no more than 0.25 mg/min or according to institutional policy Assess for clinical manifestations of toxicity Assess blood pressure, lung sounds, peripheral edema, and energy levels for therapeutic effect

Nursing implications of insulin therapy

Assess the patient's serum glucose levels prior to administration Know the peak, onset, and duration of action of the specific insulin being given Administer rapid-acting insulin within 15 minutes after a meal. Administer short-acting insulin within 45 minutes of a meal to prevent hypoglycemia and obtain optimal control of blood glucose levels Administer only regular insulin intravenously

Spinal cord injuries

1 week to know ultimate prognosis

Cardiac Cycle Phases

1) Atrial Systole - Ventricular Diastole 2) Isovolumetric ventricular contraction 3) Ejection 4) Isovolumetric ventricular contraction 5) Passive ventricular filling

*Brain Death:* Irreversible brain damage is so extensive that the brain has no potential for recovery and no longer can maintain the body's internal homeostasis. Brain is autolyzing itself.

1) Completion of all appropriate and therapeutic procedures with no possibility of brain function recovery 2) Unresponsive coma (absence of motor and reflex) 3) no spontaneous respiration (apnea) 4) no brainstem function 5) Isoelectric (Flat) EEG 6) Persistence of these signs for an appropriate period of time

*Minimally Conscious State (MCS):* Individual demonstrates minimal but defined behavioral evidence of self or environmental awareness

1) Following simple commands 2) Manipulating objects 3) responding with gestural or verbal "yes/no" responses 4) demonstrating intelligible verbalization 5) blinking and smiling that occur in a meaningful relationship to the eliciting stimulus

5 Categories of Neuro function that are critical in the evaluation process:

1) Level of Consciousness 2) Pattern of Breathing 3) Pupillary Changes 4) Oculomotor Responses 5) Motor Responses

Bilirubin New Born

1-12

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol Rationale: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

142.) A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times? 1. At bedtime 2. After lunch 3. With supper 4. Before breakfast

1. At bedtime Rationale: A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa. **recall that ranitidine suppresses secretions of gastric acids**

100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to: 1. Avoid sun exposure. 2. Eat low-calorie foods. 3. Eat foods that are low in fat. 4. Take the medication on an empty stomach.

1. Avoid sun exposure. Rationale: Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. The nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply. 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5 Tossed salad 6. Oatmeal cookies

1. Figs 2. Yogurt 4. Aged cheese Rationale: Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoid taking in foods that are high in tyramine. Use of these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

213.) A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following complaints would indicate aspirin intoxication? 1. Tinnitus 2. Constipation 3. Photosensitivity 4. Abdominal cramps

1. Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production. Options 2, 3, and 4 are incorrect.

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this level is: 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

1. Toxic Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

BUN

10-20

Dilantin TR

10-20

What is the safe range for Dilantin?

10-20

What is the normal lab value for ALT?

10-30

What are the normal levels of Lactic dehydrogenase (LDH)

100-190 units/L

What are the normal lab values for hemaglobin for women?

12-16

Na+

136-145

What is the normal lab value for ammonia?

15-110

Platelets

150-400k

Assessment of tricyclic antidepressants (TCAs)

Associated with serious adverse effects Monitor closely for potential adverse effects Use with the herbal product, St.John's work is not recommended Amitriptyline is not to be used in patients with recent myocardial infarction and is associated with potent anticholinergic properties leading to dry mouth, constipation, blurred vision, urinary retention, and alterations in cardiac rhythm

What population should beta blockers be avoided?

Asthma patients

Eosinophils

Asthma, allergies Drug reactions Inflammation of the skin Parasitic infection

What is the generic name for morphine?

Astramorph PF AVINza Doloral Duramorph PF Embeda Epimorph Infumorph Kadian M-Eslon Morphine H.P. M.O.S.

P Wave

Atrial Depolarization

Administration for morphine sulfate

Available in oral, injectable, and rectal dosage forms Extended release forms include MS Contin, Kadian, and Avinza IM: Onset: rapid Peak: 30-60 min Duration: 6-7 hr Coadministration with nonopioid analgesics may have additive analgesic effects and may permit lower doses Morphine should be discontinued gradually to prevent withdrawal symptoms after long-term use Doses may be administered with food or milk to minimize GI irritation Swallow extended-release tablets whole; do not break, crush, dissolve, or chew

Intermediate stage

2-24 hours post-op

What are the normal values for CVP?

2-6 mm Hg

29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is: 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 16 to 18 hours after administration 4. 18 to 24 hours after administration

2. 4 to 12 hours after administration Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

Patient teaching for thrombolytic drugs

Avoid brushing teeth with a hard-bristled toothbrush, shaving with a straight razor, and engaging in any activity that would increase the risk for tissue injury Report any unusual bleeding immediately

Ca++ channel blockers

Avoid grapefruit juice

133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration. **Recall that this medication is used to treat diabetes insipidus to eliminate weight loss and increased urination.**

51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication? 1. To take the medication before meals 2. To return to the clinic weekly for serum drug-level testing 3. It is not necessary to call the health care provider (HCP) if a skin rash occurs. 4. It is not necessary to restrict alcohol intake with this medication.

2. To return to the clinic weekly for serum drug-level testing Rationale: Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

135.) A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count

2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin? 1. 3 to 5 ng/mL 2. 0.5 to 2 ng/mL 3. 1.2 to 2.8 ng/mL 4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mL Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

Phos

3-4.5

210.) Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for discomfort resulting from spasticity. The nurse tells the client about the importance of follow-up and the need for which blood study? 1. Creatinine level 2. Sedimentation rate 3. Liver function studies 4. White blood cell count

3. Liver function studies Rationale: Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is taking this medication? 1. CD4 cell count 2. Serum albumin 3. Serum creatinine 4. Lymphocyte count

3. Serum creatinine Rationale: Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus these levels are also measured with the same frequency.

80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the client? 1. Pregnancy should be avoided while taking phenytoin (Dilantin). 2. The client may stop taking the phenytoin (Dilantin) if it is causing severe gastrointestinal effects. 3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). 4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin) and birth control pills together.

3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). Rationale: Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

Patient teaching for Hydantoin Antiepileptic drugs

Avoid tasks requiring alertness until a steady state of the drug has been achieved (which takes 4 to 5 half-lives) to help prevent injury Avoid drinking alcohol and smoking Do not abruptly withdraw from an AED; rebound seizure activity could occur Phenytoin may turn urine to pink or red-brown. This color change commonly diminishes over time. Drowsiness commonly decreases after several weeks because tolerance to this particular adverse effect occurs Frequent oral care and dental visits are necessary so as to prevent the adverse effect of gingival hyperplasia Avoid any form of stimulant (caffeine) because there is a higher risk for seizure Therapy is usually lifelong. Resources available include national and local support groups Contact the HCP if any unusual reactions occur, such as glandular swelling, fever, sore throat, tarry stools, back pain, hematuria, easy bruising, lethargy, or mouth ulcers

What is the normal lab value for T4?

4-12 mcg/dL

226.) A client receiving lithium carbonate (Lithobid) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following? 1. 0.7 mEq/L 2. 1.0 mEq/L 3. 1.2 mEq/L 4. 1.7 mEq/L

4. 1.7 mEq/L Rationale: The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.

4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

155.) Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which of the following instructions does the nurse reinforce regarding administration of this medication? 1. Administer following meals. 2. Take the medication with a magnesium-type antacid. 3. Open the capsule and mix with food for administration. 4. Contact the health care provider (HCP) if a sore throat occurs.

4. Contact the health care provider (HCP) if a sore throat occurs. Rationale: Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the HCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs because these are adverse effects of the medication. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore should not be taken with the medication. The medication may be given in combination with corticosteroids and cyclosporine. **neutropenia can occur with this medication**

231.) A client admitted to the hospital gives the nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication? 1. Complaints of hunger 2. Complaints of insomnia 3. A pulse rate less than 60 beats per minute 4. Frequent handwashing with hot, soapy water

4. Frequent handwashing with hot, soapy water Rationale: Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur but is seldom a side effect.

70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4. Restlessness Rationale: Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

232.) A client in the mental health unit is administered haloperidol (Haldol). The nurse would check which of the following to determine medication effectiveness? 1. The client's vital signs 2. The client's nutritional intake 3. The physical safety of other unit clients 4. The client's orientation and delusional status

4. The client's orientation and delusional status Rationale: Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate: 1. The dose of the medication is too low. 2. The client is experiencing toxic effects of the medication. 3. The client has developed inadequacy of thermoregulation. 4. The result of another infection caused by leukopenic effects of the medication.

4. The result of another infection caused by leukopenic effects of the medication. Rationale: Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

What is the normal lab value for RBC for women?

4.2-5.4 million

WBC's

4.5-11k

What is the normal lab value for RBC for men?

4.7-6.1 million

What are the normal lab values for hematocrit for men?

40%-54%

What is the safe range for theophylline?

5-20

What is the normal lab value of Creatine Kinase?

50-325

What is the normal lab value for HDL for women?

55-60

What are the normal values for PAWP?

6-12 mm Hg

What is the normal lab value for BUN?

6-20

What is the normal lab value for Total Protein?

6.4-8.3

What is the normal lab value for LDL?

60-180

What is the normal lab value of AST?

7-40

What are the normal lab values for pH?

7.35-7.45

Glucose

70-100

What is the normal lab value for AST?

8-46

Prostate Cancer

> 40 = Age PSA elevation DRE Mets to spine, hips, legs Elevated PAP (prostate acid phosphatase) TRUS = Transurethral US Post Op...monitor of hemorrhage and cardiovascular complication

What is the toxic level for acetaminophen?

>150 mcg/mL

Stupor

A condition of deep sleep or unresponsiveness, can only be aroused with vigorous and repeated stimulation. Response is often withdrawal or grabbing at stimulus

What drugs interact with insulin therapy?

A decreased hypoglycemic effect of insulin occurs when it is given concurrently with chlorthalidone, corticosteroids, diazoxide, epinephrine, ethacrynic acid, furosemide, phenytoin, thiazides, and thyroid hormones An increased hypoglycemic effect occurs when it is given concurrently with alcohol, anabolic steroids, guanethidine, monoamine oxidase inhibitors (MAOIs), propranolol, and salicylates

- Artan

ARB

Administration of anticonvulsants

Administer around the clock Abrupt discontinuation may precipitate status epilepticus Implement seizure precautions

Administration for antiulcer agents

Administer before meals, preferably in the morning. Capsules should be swallowed whole. May be administered concurrently with antacids Administer Misoprostol with meals and at bedtime to reduce the severity of diarrhea Administer sucralfate on an empty stomach 1 hr before meals and at bedtime. do not crush or chew tablets. Separate administration of antacids and other oral medications by at least 1 hr. Shake liquid preparations well before pouring. Chewable tablets must be chewed thoroughly before swallowing. Administer 1 and 3 hr after meals and at bedtime for maximum antacid effect

Symptoms of serotonin syndrome

Agitation Tachycardia Sweating Muscle tremors (myoclonus) Delirium hyperreflexia Shivering Coarse tremors Extensor plantar muscle (sole of foot) responses Hyperthermia Seizures rhabdomyolysis Renal failure Cardiac dysrhythmias Disseminated intravascular coagulation

ABC's

Airway, Breathing, Circulation

Akathisia

Akathisia is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting.

What are the precautions for pregabalin?

All patients (may increase risk of suicidal thoughts/behaviors) Renal impairment (dose alteration recommended for CCr < 60 mL/min) HF History of drug dependence/drug-seeking behavior use only if maternal benefit outweighs fetal risk May increase risk of male-mediated teratogenicity Safety not established in children

What is the mechanism of action of Hydantoin Antiepileptic drugs?

Although the exact mechanism of action of antiepileptic drugs (AEDs) is not known with certainty, strong evidence shows that they alter the movement of sodium, potassium, calcium, and magnesium ions. The changes in the movement of these ions result in stabilized and less responsive cell membranes The ion theory may explain how AEDs decrease the excitability and responsiveness of brain neurons (nerve cells)

Rebound disinhibition

An elderly patient experiences marked sedation for 1 to 2 hours, followed by marked agitation and confusion for several hours afterward

What does ACE stand for?

Angiotensin-converting enzyme

Isotonic solutions

D5W, NS (0.9% NaCl), Ringers Lactate, NS only with blood products and Dilantin

DIURETICS

DIURETICS

Intra-renal problem

Damage to renal parenchyma

Lesions of Cortex

Decorticate posturing (flexion of elbows, wrists, fingers, straight legs, mummy position)

Evaluation for antiulcer agents

Decrease in GI pain and irritation Prevention of gastric irritation and bleeding Healing of duodenal ulcers

What are the therapeutic effects of Labetalol?

Decreased BP

Agnosia

Defect of pattern recognition Failure to recognize the form and nature of objects (unable to identify a pencil by hand, but able to identify it by sight)

Alcohol withdrawal

Delerium tremens- tachycardia, tachypnea, anxiety, nausea, shakes, hallucinations, paranoia. (DT's start 12-36 hours after last drink)

Exemptions from "Brain Death"

Depressant drugs Alcohol poisoning Neuromuscular blockage Hypothermia

What are the indications for selective serotonin reuptake inhibitors (SSRIs)?

Depression Bipolar disorder, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, PTSD, premenstrual dysphoric disorder, and alcholism

Mydriasis

Dilation of the pupil of the eye

What is the mechanism of action of metronidazole?

Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, trichomonacidal, or amebicidal action Most notable for activity against anaerobic bacteria, including: bacteroides, clostridium Active against: trichomonas vaginalis, entamoeba bistolytica, giardia lamblia, H. pylori, clostridium difficile

BPH - Flomax - Proscar - Cardure

Dizziness Headache Ortho/Hypo May causes *erectile dysfunction* I'm assuming this med induces vasodilation...

What are the therapeutic effects of Levodopa-Carbidopa (Sinemet)?

Dopamine replacement drug Used in the later stages of Parkinson's Helps control the tremors, including muscle rigidity, because of both its dopaminergic and anticholinergic effects

What are the contraindications for Beta-agonist (sympathomimetic) Bronchodilators?

Drug allergy Uncontrolled cardiac arrhythmias High risk for stroke

What are Contraindications for Beta-Lactam Antibiotics?

Drug allergy (Cross-sensitivity is probably the result of structural similarity, so penicillins should be used cautiously in patient's allergic to cephalosporin and vice versa)

Teratogenic effects

Drugs that may disturb the development of the fetus

What are the adverse effects of Nonsteroidal Antiinflammatory drugs (NSAIDs)?

Dyspepsia Heartburn Epigastric distress Nausea and vomiting Gastrointestinal bleeding Mucosal lesions Altered hemostats Acute reversible hepatotoxicity Skin lesions Tinnitus Hearing loss Noncardiogenic pulmonary edema Renal failure

COPD

Emphysema = Pink puffer Chronic Bronchitis = Blue bloater (cyanosis, rt sided heart failure = boating/edema)

NG tube length

End of nose, to ear lobe, to xyphoid (~22-26 inches)

First Degree

Epidermis (superficial partial thickness)

Second Degree

Epidermis and dermis (deep partial thickness)

Third Degree

Epidermis, dermis and SQ (full thickness)

Head injuries

Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP

What drugs interact with ACE inhibitors?

Excessive hypotension may occur with concurrent use of diuretics and other antihypertensives Increased risk of hyperkalemia with concurrent use of potassium supplements, potassium sparing diuretics, or potassium-containing salt substitutes Decreased effects occur with aspirin and NSAIDs Risk for lithium toxicity occurs if administered concurrently with lithium

Pancreas

Exocrine functions: Secretes sodium bicarb to regulate pH in the stomach Pancreatic juices contain enzymes for digesting carbs, fats, and proteins Endocrine functions: Secretes glucagon to raise blood glucose Somatostatin to exert a hypoglycemic effect Islets of Langerhans secrete insulin

RESPIRATORY Glucocorticoids Albuterol/Proventil

Fast acting Monitor for increased HR, tremors *Rinse mouth* *Dry the chamber after each use( Risk for *candidiasis*

Peptic ulcers

Feed a duodenal ulcer (pain is relieved by food) Starve a gastric ulcer

Cardiac catheterization

Flat (HOB no more than 30 degrees), leg straight 4-6 hour, bed rest 6-12 hours

Calcium

Functions in bone formation, nerve impulse transmission, skeletal and cardiac muscle contraction. Aids in blood clotting by converting prothrombin to thrombin.

What are the adverse effects for tricyclic antidepressants (TCAs)?

GI: anorexia, dry mouth, constipation Endo: Gynecomastia, sexual dysfunction, altered blood glucose level GU: urinary retention CNS: agitation, anxiety, ataxia, cognitive impairment, sedation, headache, insomnia CV: orthostatic hypotension, blood dyscrasias ENNT: blurred vision

Brain tumor (remove benign and malignant)

HA more severe on wakening

Hemoglobin and Hematocrit

Hematocrit represents RBC mass and is an important measurement in the identification of anemia or polycythemia.

Acute Care...CVA

Hemorrhagic = bleed Embolic = blockage of blood supply to part of the brain

What are the precautions for metronidazole?

History of blood dyscrasias History of sezures or neurologic problems Severe hepatic impairment ( dose decrease suggested) Although safety not established, has been used to treat trichomoniasis in 2nd and 3rd trimester pregnancy-but not as single-dose regimen Lactation

What are the precautions for rifampin?

History of liver disease Diabetes Concurrent use of other hepatotoxic agents Lactation or pregnancy

What are the contraindications of Esomeprazole?

Hypersensitivity Lactation: not recommended Concurrent use of atazanavir or nelfinavir

What are the contraindications for antianxiety agents?

Hypersensitivity Narrow-angle glaucoma Should not be used in comatose patients or in those with pre-existing CNS depression Should not be used in patients with uncontrolled severe pain Avoid use during pregnancy or lactation

What are the contraindications for antituberculars?

Hypersensitivity Severe liver disease

What are the contraindications for thrombolytic drugs?

Hypersensitivity Allergy to preservatives used in medication active internal bleeding History of stroke Cerebral neoplasms Known bleeding disorders Severe uncontrolled hypertension Intracranial or intraspinal surgery or trauma within the past 2 months

What are contraindications for insulin therapy?

Hypersensitivity Hypoglycemia

What are the contraindications for antiulcer agents?

Hypersensitivity Pregnancy

Vitamin K in neonates

IM Needed bc *gut is sterile* Clotting

Analgesic - Narcotics Codeine Morphine Oxycodone Hydromorphone/Dilaudid -fentanyl (duragesic)

IV - hypotension, *respiratory depression* PO - n/v/c (give with *Colace*) Antidote: Narcan

Robaxin - IV/IM - PO

IV/IM - seizures, bradycardia, hypotension, flushing, anaphylaxis PO - urine may turn brown, green, black (no need to d/c for this) Monitor for dizziness, drowsiness, change positions slowly

Dysphasia

Impairment of comprehension or production of language (semantic processing) *associated with CVAs*

Evaluation for benzodizepines

Improved mental alertness, cognition, and mood Fewer anxiety and panic attacks Improved sleep patterns and appetite

ENDOCRINE Levothyroxine (Synthroid)

Improves hypothyroidism. monitor for s/s hyperthyroidism: insomnia, tachycardia, nervousness, CV collapse (life-threatening) *take for life* *Monitor TSH periodically*

Lipitor (-statins)

In PM only; No grapefruit juice

Antibiotics

Increase and decrease effects of birth control and can cause secondary infections like yeast infection ( assess the mouth for thrush).

Evaluation of Buspirone

Increase in sense of well-being Decrease in subjective feelings of anxiety

What drugs interact with Selective Serotonin Reuptake Inhibitors (SSRIs)?

Increased drug effects occur when SSRIs are given with other strongly protein-bound drugs (warfarin and phenytoin) SSRIs prolong the actions of drugs metabolized by the cytochrome P-450 system (carbamazepine). There is increased risk for toxicity with monoamine oxidase inhibitors and tricyclic antidepressants

What drugs interact with Hydantoin Antiepileptic drugs?

Increased hydantoin levels occur with disulfiram, isoniazid, and valproic acid Increased risk for seizures occurs with tricyclic antidepressants

What are the therapeutic effects for acetaminophen (tylenol)?

Indicated for the treatment of mild to moderate pain and fever The antipyretic (antifever) drug of choice in children and adolescents with flu syndromes, because the use of aspirin in these populations is associated with Reye's syndrome

Burns

Infection = primary concern

Incentive spirometry

Inhale slowly and completely to keep flow at 600-900, hold breath 5 seconds...10 times/hr

Prodromal Period

Initial Ambiguous Symptoms

Incubation Period

Initial exposure Colonization Asymptomatic

What are the adverse effects of Beta-Agonist (Sympathomimetic) Bronchodilators?

Insomnia Restlessness Anorexia Cardiac stimulation Hyperglycemia Tremor Hypotension Hypertension Vascular headache

Long Acting Insulin

Insulin Glargine (Lantus); O: 1.1 hr. P: 14-20 hrs. (Don't Mix)

Intermediate

Insulin isophane suspension (NPH) (cloudy)

Ginkgo Biloba

Interactions with anticoagulants and NSAID's

Pre-renal problem

Interference with renal perfusion

Tracheostomy patients

Keep Kelly clamp and obturator (used to insert into trachea then removed leaving cannula) at bed side

Long acting insulin

Lantus (glargine), Levemir (detimir) (Clear) once daily dose, usually at night

Liver

Largest organ in the body Kupffer cells, remove bacteria in the portal venous blood Removes excess glucose and amino acids Synthesizes glucose, amino acids, and fats Stores Vitamins A, D, and B and iron Bile used to emulsify fats.

Ovarian Cancer

Leading cause of death from gynecological cancer

Orlistat

Leaky fat monitor weight or BMI

Declarative Memory

Learning and remembrance of episodic memories (personal history, events, and experiences) and semantic memories (facts and information)

Enema

Left Sims (flow into sigmoid)

Penia

Less

Signs of Antibiotic Effectiveness

Less growth, Decreased WBC count

What are the adverse effects of Hydantoin Antiepileptic drugs?

Lethargy Abnormal movements Mental confusion Cognitive changes Bone marrow suppression Exfoliative dermatitis Lupus erythematosus Stevens-Johnson syndrome Neuropathies Long-term therapy: gingival hyperplasia, acne, hirsutism, osteoporosis, and hypertrophy of subcutaneous facial tissue resulting in an appearance known as Dilantin facies

PROSTATE CANCER SE (8)

Leuprolide (LUPRON) - *hot flashes* - *dizziness, headache* - *anxiety, insomnia* - *epistaxis, MI, stroke, GI bleed*

Aphasia

Loss of comprehension or production of language

ANTICOAGULANTS Lovenox - as compared to heparin

Low dose - Longer 1/2 life - Less thrombocytopenia

What are the normal levels of Gamma-glutamyl transferase (GGT)?

Male/female 45 years of age and older: 8-38 units/L

What are the indications for Buspirone?

Management of anxiety

What are the indications for Labetalol?

Management of hypertension

Lithium

Manic disorder; 1-1.5 norm.; watch sodium levels don't decrease; Drink lots if fluids; hypo-natremia give drug toxicity

Nursing implications for Selective Serotonin Reuptake Inhibitors (SSRIs)

Monitor the patient's mental status Monitor for postural hypotension Administer with meals to minimize gastrointestinal upset

What are the precautions of barbiturates?

Must be used with caution in elderly patients due to their sedative properties and increased fall risk

Diclofenac (NSAID)

NSAID's cause bleeding check Hct and Hgb

What is the mechanism of action for Nonsteroidal Antiinflammatory Drugs (NSAIDs)?

NSAIDs relieve pain, fever, and inflammation by blocking the chemical activity within arachidonic acid pathway Specifically, the block the enzymes cyclooxygenase (COX; responsible for the synthesis of prostaglandins) or lipoxygenase (responsible for synthesis of leukotrienes)

What are the indications for pregabalin?

Neuropathic pain associated with diabetic peripheral neuropathy Postherpetic neuralgia Fibromyalgia neuropathic pain associated with spinal cord injury Adjunctive therapy of partial-onset seizures in adults

ANTACIDS: Maalox (Al & Mg)

Neutralize gastric acid Space *2 hrs* apart from other meds bc these meds COAT GASTRIC LINING

Potassium

Never give IV bolus or IV push

Long acting

Never mix

Post-renal problem

Obstruction in UT anywhere from tubules to urethral meatus

Breakthrough pain

Occurs between doses of pain medications

Secondary Intention

Occurs when wounds that have tissue loss and require gradual filling in of dead space with connective tissue. Wounds left open

Sex after MI

Okay when able to climb 2 flights of stairs without exertion (take Nitro prophylactically before sex)

Usually 3 phases

Oligouric, diuretic, recovery Monitor body wt, and I&O's

Pyloric stenosis

Olive-shaped mass (epigastric) and projectile vomiting

Large brain tumor resection

On non-operative side

Bladder irrigation

Only isotonic sterile saline to be used

Drugs that cause pinhole pupils

Opiates Barbiturates Pontine Damage

What laboratory tests do opioids interact with?

Opioids can cause an abnormal increase in the serum levels of amylase, alanine aminotransferase, alkaline phosphatase, bilirubin, lipase, creatinine kinase, and lactate dehydraogenase

Cataract Sx

Opposite side, Semi-Fowler

Pyridium (for bladder infection)

Orange/red/pink urine

EYE / EAR AGENTS Cortisporin Opthalmic (eye) / Otic (ear)

Otic (ear) drops are *NOT sterile* so do not mix up the bottle. Both are liquids Administered via dropper!!!!

Arterial Blood Gases (Acidosis vs Alkalosis)

PH 7.35-7.45 CO2 35-45 (respiratory driver) High=Acidosis HCO3 21-28 (metabolic driver) High=Alkalosis O2 80-100 O2Sat 95-100%

What are the routes for Labetalol?

PO: Onset: 20 min-2 hr Peak: 1-4 hr Duration: 8-12 hr IV: Onset: 2-5 min Peak: 5 min Duration: 16-18 hr

Administration of haloperidol

PO: Onset: 2hr Peak: 2-6 hr Duration: 8-12 hr Administer with food or full glass of water or milk to minimize GI irritation IM: Onset: 20-30 min Peak: 30-45 min Duration: 4-8 hr IM (decanoate): Onset: 3-9 days Peak: unknown Duration: 1 mo Avoid skin contact with oral solution (may cause contact dermatitis)

Administration of pregabalin

PO: Onset: unknown Peak: 2-4 wk Duration: unknown PO: may be administered without regard to meals Pregabalin should be discontinued gradually over at least 1 wk. Abrupt discontinuation may cause insomnia, nausea, headache, anxiety, sweating, and diarrhea when used for pain and may cause increase in seizure frequency when treating seizures

Pericarditis

Pericardial friction rub, pain relieved by leaning forward

Oral hypoglycemics - metformin (Glucophage) - glipizide (Glucotrol) - glyburide (Micronase) - Side Effects (4) - Allergies (1) - Monitor (3)

Photosensitivity Hypoglycemia Aplastic Anemia GI adverse effects - diarrhea - bloating Allergies: sulfonamides Monitor - CBC - HgbA1C - LFT: Concern for liver dysfunction

Opiate OD

Pinpoint pupils

Injury above T6

Possible hypotension and bracycardia

Interleukins

Produced by macrophages & lymphocytes Enhances the adaptive immune response

Apneusis

Prolonged inspiratory cramp (a pause at full inspiration) occurs. A common variant of this is a brief end-inspiratory pause of 2 or 3 seconds, often alternating with an end expiratory pause. *C:* hypoglycemia, anoxia, meningitis

Hypokalemia

Prominent U waves, depressed ST segment, flat T waves

Contracture

Proper Positioning and Range of Motion exercises to prevent. Burn wounds especially susceptible.

Interferons

Proteins that primarily protect against viral infection and modulate inflammation (does not kill viruses, protects cells from being infected)

OCD (SSRI's)

Prozac Zoloft

Anaphylaxis

Pruritus Erythema Headaches Vomiting Abdominal Cramps Diarrhea Bronchoconstriction

Alexia

Reading

Signs of Inflammation

Redness Heat Swelling Pain

Nondeclarative Memory (nonconscious)

Reflexive, procedural, or implicit memory, is the memory for actions, behaviors (habits), skills, and outcomes. Motor memory

Short acting Insulin

Regular (human) O: 30-60 min, P: 2-3 hours (IV okay)

Troponins

Regulatory protein found in striated muscle. Elevated in the case of MIs

Evaluation for proton-pump inhibitors

Relief of symptoms associated with peptic ulcer, gastritis, esophagitis, gastric hyperacidity, or hiatal hernia

Staples and sutures

Removed in 7-14 days, deep dry until then

Fractures

Report abnormal assessment findings promptly; compartment syndrome may occur = permanent damage to nerves and vessels

Evaluation of metronidazole

Resolution of signs and symptoms of infection Significant results should be seen within 3 wk of application of topical gel

Posthyperventilation apnea

Respirations stop after hyperventilation has lowered Pco2 levels below normal. Rhythmic breathing returns when the Pco2 levels return to normal.

What are the precautions for opioids?

Respiratory insufficiency Conditions involving ICP Morbid obesity and/or sleep apnea Myasthenia gravis Paralytic ileus (bowel paralysis) Pregnancy

TB

Respiratory isolation

Spinal cord injuries

Respiratory status paramount...C3-C5 innervates diaphram

Renal failure

Restrict protein intake Fluid and electrolyte problems...watch for hyper K+(dizzy, weak, nausea, cramps, arhythmias)

What are the indications for naloxone?

Reversal of CNS depression and respiratory depression because of suspected opioid overdose Opioid-induced pruritus (unlabeled use) Management of refractory circulatory shock (unlabeled use)

what is a possible life-threatening side effect of statins; what should RN assess for?

Rhabdomyolosis (can lead to kidney failure, death) muscle pain (myalgia) dark red, cola colored urine

What is the generic name of rifampin?

Rifadin Rofact

Miller Abbott Tube

Right side for GI advancement into small intestine

Liver biopsy

Right side with pillow/towel against puncture site

What is the generic name for risperidone?

Risperdal Risperdal M-TAB Risperdal Consta

Insulin injection

Rotate injection sites (rotate in 1 region then move to new region)

Harris Tube

Rt/back/Lt - to advance tube in GI

SE of ACE Inhibitors

SE: Cough and *Angioedema* Monitor renal function

Dilantin

Seizure medication; has a narrow therapeutic index

Droplet (Respiratory) Precautions (Wear Mask)

Sepsis, Scarlet fever, Strep, Fifth disease (Parvo B19), Pertussis, Pneumonia, Influenza, Diptheria, Epiglottitis, Rubella, Rubeola, Memingitis, Mycoplasma, Adenovirus, Rhinovirus

AHDH Methylphenidate (Ritalin, Concerta) Side Effects (6) - think mania

Side Effects (think mania) - Hyperactivity, hypertension - tremor, tachycardia - anorexia, insomnia

Smoke inhalation burns

Singed nasal hair and circumoral soot/burns

Aphasia

Speaking

Serum Creatinine

Specific indicator of renal function Increased levels indicate a slowing of GFR

Dysphasia

Speech and verbal comprehension

Decubitus (pressure) ulcer staging

Stage 1 = erythema only Stage 2 = partial thickness Stage 3 = full thickness to SQ Stage 4 = full thickness + involving mm/bone

Clonic Phase

State of alternating contraction and relaxation of muscles

Tonic Phase

State of muscle contraction in which there is excessive muscle tone

ACE inhibitor

Stay in bed for 3 hours after first dose

What drugs interact with barbiturates?

Stimulate the action of enzymes in the liver that are responsible for the metabolism or breakdown of many drugs Additive CNS depression occurs with the coadministration of barbiturates with alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers

Gallbladder

Stores and concentrates bile to put into the stomach

Fibrinolytics

Streptokinase, Tenecteplase (TNKase)

Convalescence

Successful removal of infectious agents Decline of symptoms

What drugs interact with sulfonamide antibiotics?

Sulfonamides can potentiate the hypoglycemic effects of sufonylureas in diabetes, the toxic effects of phenytoin, and the anticoagulant effects of warfarin May inhibit the immunosuppressant effects of cyclosporine in transplant patients and can also increase the likelihood of cyclosporine-induced nephrotoxicity

QRS Complex

Sum of Ventricular Muscle Cell Depolarization 0.06 - 0.10 Seconds

Phlebitis

Supine, elevate involved leg

Dysphagia

Swallowing

Indications for oral hypoglycemics vs. insulin (SQ, IV)

T1DM - SQ Insulin T2DM - PO Hypoglycemic - SQ Insulin Emergency: IV Insulin

Patient teaching for sulfonamide antibiotics

Take as directed, with plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria Take oral dosage forms with food to minimize GI upset Report any of the following signs and symptoms to the health care provider immediately: worsening abdominal cramps, stomach pain, diarrhea, blood in the urine, severe or worsening rash, shortness of breath, and fever

NG tube removal

Take deep breath and hold it

Flu vaccination

Take every year

Patient teaching for B-blockers

Take medication exactly as prescribed. Do not stop abruptly Move and change positions slowly to prevent postural hypotension Report to the HCP any edema of the feet or ankles, weight gain > 2 lbs/day, shortness of breath, dyspnea, excessive fatigue or weakness syncope, or dizziness Monitor BP and HR and understand which parameters to report Avoid caffeine and other central nervous system stimulants while on this medication

Patient teaching for Angiotensin II Receptor Blockers (ARBs)

Take medication exactly as prescribed. Do not stop taking abruptly Report any unusual shortness of breath, dyspnea, weight gain, chest pain, or palpitations to the HCP immediately The drug may cause dizziness, fainting, or light-headedness Rise slowly to a sitting position to minimize orthostatic hypotension Monitor BP and be sure to understand what parameters to report

Patient teaching for Calcium Channel Blockers (Class IV antiarrhythmics)

Take radial pulse before each dose (instructions have been provided). Withhold a dose and notify the HCP according to the parameters provided Move and change positions slowly and with caution to prevent syncope Contact the HCP immediately if experiencing cardiac irregularities, pronounced dizziness, nausea, or dyspnea Monitor daily weights; report a weight gain of 2 pounds in 1 day or 5 pounds or more within 1 week Avoid concurrent use of antacids and the ingestion or grapefruit juice

Patient teaching for Cardiac Glycosides

Take radial pulse before each dose according to instructions. Withhold a dose and notify the HCP according to provided parameters Remember tthe signs and symptoms of digoxin toxicity. Withhold a dose and notify the HCP immediately if they occur Monitor daily weights, reporting a weight gain or 2 pounds in 1 day or 5 pounds or more within 1 wk Do not take within 2 hours of ingesting bran, antacids, or dairy products because they decrease absorption of the drug Know the signs and symptoms of hypokalemia. Maintain a diet high in potassium to prevent toxicity

Hyperkalemia

Tall T waves, prolonged PR interval, wide QRS

Diabetic medication Pt teaching

Teach patient how to give own injections

If chest tube drain stops fluctuating...

The lung has re-inflated (or there is a problem)

Where do penicillins come from?

The penicillins are a very large group of chemically related antibiotics derived from a mold fungus often seen on bread and fruit

Patient teaching for loop diuretics

The signs and symptoms of hypokalemia are leg cramps, weakness, and other cramping Eat potassium-rich foods, such as bananas, oranges, dates, raisins, plums, fresh vegetables, potatoes (white and sweet), meat, fish, apricots, whole-grain cereals, and legumes Change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting (syncope) related to orthostatic hypotension resulting from volume loss secondary to the diuretic therapy Take in the morning to prevent nocturia Weigh yourself daily and report a weight gain of 2 pounds in 1 day or 5 pounds in 1 week

Digoxin - Lab values - Causes of toxicity - S/S toxicity - Administration Assess. - Antidote

Therapeutic: *0.5 - 2 ng*/ml Potassium: If low, incr. chance of Dig toxicity S/S Toxicity: *ab pain, n, v, anorexia, visual disturbances, bradycardia* In reference to bradycardia - Take APICAL HR prior to administration. HOLD if Apical HR < 60 Antidote: Digoxin Immune fab (Digibind)

What is the drug class for pregabalin?

Therapeutic: analgesics, anticonvulsants Pharmacologic: gamma aminobutyric acid (GABA) analogues, nonopioid analgesics

What is the drug class for metronidazole?

Therapeutic: anti-infectives, antiprotozoals, antiulcer agents

What is the drug class for Buspirone?

Therapeutic: antianxiety agents

What is the drug class of naloxone?

Therapeutic: antidotes (for opioids) Pharmacologic: opioid antagonists

What is the classification of Labetalol?

Therapeutic: antihypertensive, antianginal Pharmacologic: alpha1-blocker, nonselective B1- and B2-blocker

What are the therapeutic effects of Sodium Channel Blockers (Class I antiarrhythmics)?

These drugs are useful in the treatment of various atrial and ventricular arrhythmias

What are opioid tolerant patients?

Those who have been taking at least 60 mg of oral morphine daily or at least 30 mg of oral oxycodone daily or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid

What is the mechanism of action for thrombolytic drugs?

Thrombolytic drugs work by activating the conversion of plasminogen to plasmin, a fibrinolytic enzyme that degrades and dissolves fibrin in a clot (thrombus) The presence of a thrombus that interferes significantly with normal blood flow on either the venous or the arterial side of the circulation is an indication for the use of thrombolytic therapy

ST Interval

Time for entire ventricular depolarization

Assessment for Angiotensin II Receptor Blockers (ARBs)

To be used cautiously in elderly patients and in patients with renal dysfunction because of their increased sensitivity to the drug's effects and increased risk for adverse effects

Terbutaline (brethine)

Tocolytic Stop premature contractions Tachycardia, tremors

Management of antianxiety overdose

Treatment of benzodiazepine intoxication is generally symptomatic and supportive Flumazenil is a benzodiazepine receptor blocker that is used to reverse the effects of benzodiazepines

What are the therapeutic effects for antiulcer agents?

Treatment of prophylaxis of peptic ulcer and gastric hypersecretory conditions such as Zollinger-Ellison syndrome Histamine H2-receptor antagonists (blockers) and proton pump inhibitors are also used in the management of gastroesophageal reflux disease (GERD)

TB

Treatment with multidrug regimen for 9 months; Rifampin reduces the effectiveness of OC's and turn pee orange. Isoniazide (INH) increases Dilantin blood levels

Pulmonary air embolism prevention

Trendelenburg (HOB down); place on left side (to trap air in right side of heart)

Cardiac enzymes

Troponin (1hr), CKMB (2-4hrs), Myoglobin (1-4hrs), LDH1 (12-24hrs)

NG tube

Turn off NG suction for 30 minutes after PO meds

Demyelination

Tx with ACTH corticosteroids, Cytoxan and other immunosuppressants

MI (Myocardioinfarction)

Tx: Nitro = Yes, No Digoxin, Betablockers, Atropine

BPH

Tx: TURP (Transurethral Resection of Prostate); some blood for 4 days and burning for 7 days post TURP

Bloody diarrhea

Ulcerative colitis

Thoracocentesis (thoracentesis)

Unaffected side, HOB 30-45 degrees

What are the contraindications for Labetalol?

Uncompensated HF Pulmonary edema Cardiogenic shock Bradycardia of heart block

Succinylcholine

Untraceable, removed quickly from body; Cardiac dysrythmia, body paralysis yet brain is still alert and active.

What are signs of nephrotoxicity?

Urinary casts (visible remnants of destroyed renal cells) Proteinuria Increased blood urea nitrogen (BUN) and serum creatinine levels

Bronchodilators

Use bronchodilators before steroids for asthma; Exhale completely, inhale deeply and hold breath for 10 seconds

Pain medication

Use pain scale to assess for pain 1-10 or the face scale

What drugs interact with morpine?

Use with extreme caution in patients receiving MAO inhibitors within 14 days prior Increased CNS depression with alcohol, sedative/hypnotics, clomipramine, barbiturates, tricyclic antidepressants, and antihistamines Administration of partial-antagonist opioid analgesics may precipitate opioid withdrawal in physically dependent patients Buprenorphine, nalbuphine, butorphanol, or pentazocine may decrease analgesia May increase the anticoagulant effect of warfarin Cimetidine decreases metabolism and may increase effects Concurrent use of kava-kava, valerian, or chamomile can increase CNS depression

Deapkote

Used for bipolar disorder

Neurontin

Used for chronic pain (peripheral neuropathy)

Actonel

Used for osteoporosis; sit up 30 min after taking medication; Give in AM; Drink a full glass of water with this medication

What are the indications for antituberculars?

Used in the treatment and prevention of tuberculosis Combinations are used in the treatment of active disease tuberculosis to rapidly decrease the infectious state and delay or prevent the emergence of resistant strains In selected situations, intermittent regimens may be employed Streptomycin is also used as an antitubercular Rifampin is used in the prevention of meningococcal meningitis and Haemophilus influenzae type b disease

Post-op Monitoring

VS and BP every 15 min the first hour, every 30 min next 2 hours, every hour the next 4 hours, then every 4 hours prn

Trental

Vascular Pain

Inflammation

Vasodilation (Drop in BP) Increased Vascular permeability & leaky capillaries WBC adhesion & diapedesis

Lidocaine

Ventricular Arrhythmias

Dysarthria

Verbal enunciation/articulation

Brain tumor

Vomiting not associated with nausea

What are the therapeutic effects of Oral Anticoagulant drugs?

Warfarin (Coumadin) is indicated for the prevention of blood clots in at-risk patients

Opiate (Heroin, Morphine, etc.) withdrawal

Watery eyes, runny nose, dilated pupils, NVD, cramps

Paraneoplastic Syndrome

When tumor markers such as alpha fetoprotein (AFP) and prostate specific antigens (PSA) cause symptoms

Evaluation of selective serotonin reuptake inhibitors (SSRIs)

When used as antidepressants, SSRIs may take up to 6 weeks to reach full therapeutic effect Improved depression or mental status, improved ability to carry out activities of daily living, less insomnia, and improved mood disorder with minimal adverse effects

Epineprhine

allergies cardiac arrest reversible airway disease (allergies)

Agents in children - doses based on ------ - tetracycline side effect: - why isn't aspirin given to kids?

based on weight tetracycline stains teeth Reye's Syndrome (swelling in liver, brain)

erectile dysfunction meds "*-afil*

cialis, viagra, levitra - headache, flushing - *concurrent use of nitrates --> threatening hypotension*

Hypnotics (2) - Ambien / Zolpidem - Restoril / Temazepam

daytime drowsiness, dizziness physical, psychological dependence, tolerance *use cautiously in elderly* Teach alternative sleep aids - dark, quiet room - avoid caffeine, alcohol, nicotine - avoid exercise before bed

Hold Digoxin

if HR <60

Administration of tricyclic antidepressants (TCAs)

may take up to 4-6 weeks before therapeutic effects are evident Advise to change positions purposely and slowly Weaning must occur when these drugs are to be discontinued Advise the patient to report any of the following: blurred vision, excessive drowsiness, sleepiness, urinary retention, constipation, and cognitive impairment

Plegia

paralysis

Scopolamin

q72h; patch for motion sickness; dry out secretions in hospice

Enyzme linked immunosorbent assay (ELISA) and microparticle enzyme immunosassay

serological tests for specific hepatitis virus markers.

Anabolic Steroids

shrink testicles; effects liver

Paresis

weakness

What is the normal value of BNP?

Below 100 --> indicates no heart failure is present

What is the mechanism of action for Aminoglycoside Antibiotics?

Bind to ribosomes (30S) and thereby prevent protein synthesis in bacteria Misreadings of mRNA lead to cell death

What is the mechanism of action of Esomeprazole?

Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen

What is the mechanism of action for Buspirone?

Binds to serotonin and dopamine receptors in the brain Increases norepinephrine metabolism in the brain Relief of anxiety

What are the adverse effects of oral anticoagulant drugs?

Bleeding Alopecia Urticaria Dermatitis, and nausea

Nasal Inhaler patient teaching

Block one nostril while sniffing in other and vice versa

What is the mechanism of action for Angiotensin II Receptor Blockers (ARBs)?

Block the binding of AII to type 1 AII receptors (AT1 receptors), which blocks vasocontriction and aldosterone-producing effects of AII

Cheyne-Stokes Respirations

Breathing pattern has a smooth increase in rate and depth which peaks and then a smooth decrease in rate and depth of breathing to the point of apnea.

What is the generic name for Buspirone?

BuSpar Bustab

SLE

Butterfly rash...avoid direct sunlight

What are the adverse effects of naloxone?

CV: ventricular arrhythmias, hypertension, hypotension GI: nausea, vomiting

Administration of Levodopa-Carbidopa (Sinemet)

Can be halved once (it is scored) Taken orally Not to be taken with B6 or tricycle antidepressants Take 30 min. before eating proteins Amantadine (Symmetrel) Anti-Parkinson's

What are the indications for barbiturates?ocedures

Can be used as hypnotics, sedatives, and anticonvulsants and also as anesthesia during surgical

PPI ( protonix)

Can give zantac at the same time

Tetracycline

Can stain teeth; don't eat dairy with this drug; Photo-sensativity ;

Antidysrythmic drug

Cardisem; always use cardiac monitor

What are the therapeutic effects for opioid analgesics?

Cause euphoria and sedation Reduction in pain sensation

MS Contin

Chronic pain q12h

How are Sodium Channel Blockers (Class I antiarrhythmics) divided?

Class Ia Class Ib Class Ic

What is the mechanism of action for naloxone?

Competitively blocks the effects of opioids, including CNS and respiratory depression, without producing any agonist (opioid-like) effects Reversal of signs of opioid excess

Acute pancreatitis

Cullen's sign (periumbelical discoloration) and Turner's sign (blue flank)

Intussiception

Current jelly stool (blood and mucus) and sausage-shaped mass in RUQ

GENERAL CANCER SE (10)

Cyclophosphamide (*Cytoxan*) Many caustic side effects: - *pulmonary, myocardial fibrosis* - *anorexia, n/v* - *hemorrhagic cystitis - hematuria - leukopenia, thrombocytopenia* - alopecia

St. Johns Wort Drug Interaction

Cyclosporine

*Virchow's Triad:* Factors that contribute to thrombus formation

(1) Injury to the blood vessel endothelium (2) abnormalities of blood flow (3) hypercoagulability of the blood

APTT

(Heparin) 60-70 sec (INR and PT TR=1.5-2.5 times normal)

Flexeril

*Anti-Cholinergic* effects: - dry mouth, *confusion*, constipation, urinary retention Monitor for dizziness, drowsiness, change positions slowly

Aura and Prodroma

*Aura:* Partial seizure experienced as a peculiar sensation, a feeling of dizziness or numbness, or just a "funny feeling", may be gustatory, visual or auditory *Prodroma:* Malaise, headache or a sense of depression. Both may occur hours or days before a seizure

*Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNKS or just HHS):* Extreme hyperglycemia without acidosis (T2)

*CM:* Glycosuria and polyuria (as much as 19g of glucose per hour), hypovolemia, stupor. *Difference from T2:* Dehydration is severe

Essential Nutrients for Erythropoeisis

*Cobalamin (B12)* *Folate* Vitamin B6 Vitamin B2 Vitamin C Iron Copper

*Lymphocytes: Increased in* Acute viral infections Certain bacterial infections (pertussis, whooping cough, TB) Lymphocytic leukemia Lymphoma

*Decreased in* Autoimmune disorders infections Bone marrow Damage immune deficiency

*Neutrophils: Increased in* Acute bacterial infections Inflammation Tissue death (necrosis by heart attack, burns, trauma) Physiological (stress, reigorous exercise) Chronic Leukemia

*Decreased in:* Severe, overwhelming infection (sepsis) Reaction to drugs Autoimmune disorder Chemotherapy Aplastic Anemia Bone marrow cancer

Anti-Diarrheal Agents

*Imodium* (loperamide) OTC or Rx Drowsiness, dizziness *Small dose given* after each loose stool up to max dose / day

Tegretol & Dilantin

*Monitor CBC* - aplastic anemia - agranulocytosis Therapeutic Levels - T: 6-12 mcg/ml - D: 10-20 mcg/ml Dilantin: - *gingival hyperplasia* - toxicity = nystagmus, ataxia, confusion, nausea, dizziness, dysrhythmias (IV), Steven Johnson

EYE / EAR AGENTS Cerumenex/Debrox

*Non-prescription* removal of earwax

*Cushings Syndrome:* A metabolic disorder characterized by abnormally increased secretion of cortisol, caused by increased amounts of adrenocortictropic hormone (ACTH) secreted by the pituitary gland

*P:* (1) do not have dirunal or circadian secretion patterns of ACTH and cortisol (2) they do not increase ACTh and cortisol secretions in response to a stressor *SS:* Weight gain: Truncal obesity, moon face, buffalo hump, glucose intolerance, protein intolerance

Systemic Lupus Erythematosus (SLE) - Autoimmune

*P:* Autoantibodies against nucleic acids, and other immune cells and cell products. Causes inflammatory lesions in organs (brain, heart, kidneys, etc) *R/F:* Women; Black; 20-40 yrs; Hydralazine *S/S:* Arthralgias; vasculitis; rash; renal disease; anemia

*Huntington's Disease (chorea)* Onset 25-40 usually # of (htt) protein sequences determines onset

*P:* Genetic defect on the short arm of chromosome 4. Abnormally long huntingtin (htt) protein toxic to neurons. Severe degeneration of basal ganglia. Loss of GABA and Glutamate. Excess dopamine action *SS:* involuntary abnormal movements (begins in the face and the arms), emotional lability, dysfunction of cognitive processes (dementia, inability to plan or organize, slow thinking [bradyphrenia])

*Spinal Cord Trauma (SCI)* -80.7% Males -36.5% vehicular 28% Falls 14% Violence -41% Incomplete Quad 18.7% Paraplegia 18% complete paraplegia

*P:* Initial mechanical trauma and immediate tissue destruction. Can cause bone fragments or connective tissues to compress and damage nerve fibers. Result from acceleration, deceleration, or deformation forces at impact. Force causes compression, traction or shearing of tissues. *SS:* Normal spinal cord activity below the level of injury ceases. *Spinal Shock:* complete loss of reflex function, flaccid paralysis, sensory deficit, and loss of bladder and rectal control.

*Amyotrophic Lateral Sclerosis (ALS)* More common in women (4:1) Onset 40s - 50s Death 2-5 years after onset d/t resp failure Mostly sporadic

*P:* Lower and upper motor neuron degeneration. Axonal degeneration and secondary demyelination with glial proliferation and sclerosis (scarring). *SS:* (1) Paresis begins in a single muscle group (2) Corresponding muscle groups are asymmetrically affected in a mottled distribution (3) Gradual involvement occurs in all striated muscles except eyes and heart (4) Urethral and anal sphincter weakness is uncommon

*Cerebrovascular Accidents (CVA):* -87% Ischemic (thrombosis or emboli) 10% intracerebral hemorrhage 3% Subarachnoid hemorrhage -HTN single greatest risk factor, atherosclerosis, DM, Hypercholesteremia, high sodium intake, smoking, obesity

*P:* atherosclerosis and inflammatory disease processes that damage arterial walls causing increased coagulation and thrombus formation. *Transient Ischemic Attacks (TIAs)* episodes of weakness, numbness, sudden confusion, loss of balance, loss of vision, sudden severe headaches *Cerebral Infarction:* Brain loses blood supply r/t vascular occlusion. *Lacuna Stroke:* Microinfarct smaller than 1 cm in diameter in small perforating arteries. Symptoms depend on area of obstruction.

*DI:* Insufficiency of ADH leading to Polyuria, Polydipsia *Classifications:* Neurogenic - organic lesion in the brain (closed head trauma) Nephrogenic - Insensitivity of renal collecting tubules Dipsogenic - Psychological, caused by excess thirst

*P:* inability of the kidney to increase permeability of water. *SS:* Polyuria, Polydipsia, Low Urine Specific Grav, Low Urine Osmolality, continued Diuresis. *Dx:* Water deprivation test (+) = no decrease in urine volume or increased urine osmolality *TX:* Vasopressin Analog Demopressin Acetate (DDAVP) for neurogenic DI.

*Hemorrhagic Stroke* -8-18% Whites 30% Blacks and Asians -Most common cause = Hypertension -Others ruptured aneurysms, arteriovenous malformation and fistula

*P:* significant increase in systolic and diastolic pressure over several years and usually occurs within the brain tissue. Hypertension eventually thickens vessels walls an may even cause necrosis. *SS:* Impending rupture: headache, transient unilateral weakness, numbness, parasthesias, and transient speech disturbances.

*SIADH:* Characterized by high levels of ADH in the absence of normal physiological stimuli for release *R/t:* tumors, pneumonia, asthma, cystic fibrosis, resp failure, encephalitis, meningitis, intracranial hemorrhage. Medication especially in older adults -Transient SIADH common after pituitary surgery.

*P:* water retention r/t ADH action on renal collecting ducts increasing water reabsorption. *SS:* Hypotonic hyponatremia; Hypervolemia; Weight gain. *Hyponatremia @ 130 mEq/L:* Polydipsia, dyspnea on exertion, fatigue, dulled senses *Hyponatremia @ 120:* Severe cramping, vomiting *TX:* FLUID RESTRICTION to 1L/Day, correction of underlying problems, administration of hypotonic saline to fix hyponatremia

*Traumatic Brain Injury (TBI):* Highest risk are children 4 years and younger, 15-19 years, and adults over 65 years. 35% Falls 17% Motor Vehicle Accidents 17% blow or strike to the head (including sports injuries) Closed (blunt) Trauma Open (penetrating Trauma Measured with the Glasgow Coma Scale

*Primary Injury:* is caused by impact and involves neural injury, primary glial injury, vascular responses, and shearing and rotational forces *Ex:* Scalp Lac, Skull fracture, Hemorrhage (hematoma), Concussion *Secondary Injury:* indirect consequence of the primary injury and includes a cascade of cellular and molecular brain events. *Ex:* Hypotension, Hypoxic, Cerebral Ischemia, edema, Oxidative stress, neuronal death *Tertiary Injury:* Days or months after injury, include pneumonia, fever, infections, and immobility

Cough & Cold Preparations - dextromethorphan - Guafenesin - Pseudoephedrine (Sudafed) S/E (4)

*Pt. with hypertensions should consult MD prior to taking cough, cold preparations* Dextro: anti-tussive Guafenesin: expectorant Psu*d*o: *d*econgestant Psuedophedrine: - *HTN Crisis* - Insomnia - Nervousness - Tachycardia

Insulin types - rapid: when to give - regular: peak? - NPH: peak? - long acting: how often to give? - concentrated regular: unacceptable route?

*Rapid: Lispro, Humalog* - Give 15 min PRIOR to eating Regular: Humulin R - Peaks in 2-4 hours NPH: Humulin N - Peaks in 6-12 hours *Long acting: Lantus, Glargine* - Given once daily, lasts 24 hours Concentrated regular: U500 - NEVER GIVEN IV

*Cardiogenic Shock:* persistent hypotension and tissue hypoperfusion caused by cardiac dysfunction in the presence of adequate intravascular volume and left ventricular filling pressure.

*SS:* Chest pain, dyspnea, faintness, feelings of impending doom. Tachycardia, Tachypnea, hypotension, jugular venous distension, dysrthyrmias, low cardiac output. Pulmonary Edema

*Hyperadolsteronism (Conn Disease):* *Primary:* excessive secretion of aldosterone from an abnormality of the adrenal cortex, usually a single benign aldosterone-producing adrenal adenoma. *Secondary:* excessive aldosterone secretion from an extra-adrenal stimulus, most often RAAS.

*SS:* HTN, hypokalemia, renal potassium wasting, and neuromuscular manifestations. Hypokalemic acidosis *TX:* Management of HTN and hypokalemia, as well as correction of any underlying causal abnormalities.

*Hypovolemic shock:* caused by a loss of whole blood, plasma (burns), or interstitial fluids (diaphoresis, DM, DI).

*SS:* High systemic vascular resistance, poor skin turgor, polydipsia, oliguria, tachycardia

*Thyrotoxic Crisis (Thyroid Storm):* Severe hyperthyroidism + excessive stress from: infection, pulmonary or cardiovascular disorders, trauma, burns, seizures, surgery, obstetric complications, emotional distress, or dialysis.

*SS:* Hyperthermia, Tachycardia, Atrial Tachydysrhtymias, High-output HF, agitation or delirium, nausea, vomiting, diarrhea *TX:* (1) Drugs that block TH synthesis (propylthiouracil/methimazole) (2) Beta blockers for cardio control (3) Corticosteroids (4) Iodine (5) Supportive care

*Myxedema coma:* Diminished level of consciousness associated with severe hypothyroidism *R/T:* discontinuation of thyroid supplements, overuse of narcotics or sedatives, or a consequence of an acute illness in individuals who have hypothyroidism.

*SS:* Hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis, and coma. *TX:* TH, Circulatory and ventilatory support, management of hypothermia and hyponatremia.

*Hypothyroidism:* Deficient production of TH by the thyroid gland; More common than hyperthyroidism. *R/T:* Iodine Deficiency (endemic goiter), Autoimmune thyroiditis (Hashimoto's disease| Chronic Lymphocytic thyroiditis). Spontaneous Recovery: Subacute thyroiditis, painless thyroiditis (silent), Postpartum thyroiditis (5.4%)

*SS:* Muscle weakness, fatigue, bradycardia, peripheral edema, puffy face, periorbital edema, coarse brittle hair, loss of hair, cold intolerance, osteoporosis. *DX:* Increased levels of TSH, Decreased T4, T3 *TX:* Hormone therapy (levothyroxine)

*Neurogenic | Vasogenic Shock:* widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle

*SS:* Very low systemic vascular resistance, bradycardia, high ejection fraction, may faint.

*Thyrotoxicosis:* Any condition from any cause of increased amounts of TH (hyperthyroidism). *Primary:* Graves disease, toxic multinodular goiter, toxic adenoma *Central (secondary):* TSH pituitary adenomas.

*SS:* Weight loss, Tachy, Diarrhea, Thin Hair, Exopthalmos, Normal or Enlarged Thyroid, Pretibial myxedema (orange peel), Hyperreflexia *DX:* Elevated T4 and T3 levels. Decreased TSH. Central = Elevation in T4, T3, TSH. *TX:* Antithyroid therapy (Methimazole or propylthiouracil), Radioactive iodine therapy

*Disseminated Intravascular Coagulation:* Widespread activation of coagulation, resulting in the formation of fibrin clots in medium and small vessels throughout the body. *S/T:* Arterial hypotension associated with shock; hypoxemia; acidemia; stasis of capillary blood flow. Eclampsia, Acute liver failure. Sepsis is most commonly associated with DIC. Occurs in about 2/3rds of individuals with a systemic response of trauma.

*SS:* Widespread hemorrhage and vascular lesions, oozing from puncture sites, Acrocyanosis, Gangrene. Subarachnoid hemorrhage, Altered state of consciousness, Hypoxemia, tachypnea, ARDS. *TX:* Eliminating underlying pathology, controlling ongoing thrombosis, and maintaining organ function. Replacement therapy.

*Diabetic Ketoacidosis:* an absolute or relative deficiency of insulin and increase in the levels of insulin counterrgulatory hormones. most common in T1 *R/F:* intercurrent illness (infection, trauma, surgery, MI); older age, diagnostic error, ethnic minority, lack of health insurance, low BMI, delayed treatment.

*SS:* nonspecific, marked deficiency in serum potassium levels, Kussmaul respirations, postural dizziness, CNS depression, ketonuria, anorexia, nausea, abdominal pain. *CM:* Abdominal pain, vomiting, dehydration, acetone odor on the breath, change in sensorium.

*Septic Shock:* begins with systemic inflammatory response syndrome (SIRS), then sepsis, then severe sepsis, and then septic shock.

*SS:* persistant low arterial pressure, low systemic vascular resistance, Tachycardia, hyperthermia or hypothermia

*Addison's Disease:* Primary adrenal insufficiency. -More common in women -Can be caused by infection or bilateral adrenal hemorrhage. *P:* Inadequate corticosteroid and mineralcorticoid synthesis and elevated serum ACTH level.

*SS:* weakness & easy fatigability, hyperpigmentation and vitiligo. Anorexia, nausea, vomiting, and diarrhea. *DX:* Decreased serum and urine levels of Cortisol. Increase in BUN levels. Decreased glucose. Eosinophil and lymphocyte counts elevated.

What are signs that NG is working?

*TINGLING* under the tongue confirms NTG is working Store NTG in a *dark* container NTG *expires q6 months*

HYPERLIPIDEMIAS: cholesterol absorption inhibitors and combination drugs: - name of drug - key lab value - s/s to monitor for

*Vytorin* = Ezetimibe (Zetia) + Simvastatin Monitor *LFTs* Monitor for angioedema (zetia)

Oxybutynin (ditropan) Tolterodine (Detrol) Imipramine (Tofranil) (used for children)

*antispasmoDics* for overactive/ neurogenic bladder -- Diropan -- Detrol nocTurnal emesis -- Tofranil Monitor for drowsiness, fatigue, blurred vision, arrhythmias, hypotension, constipation, dry mouth

Type II: Cytolytic, Cytotoxic

*ex:* ABO incompatibility; Drug-induced hemolytic anemia *P:* Cell lysis d/t complement fixation *C:* IgG; IgM; Complement

Type I: Immediate Anaphylactic

*ex:* Anaphylaxis; Atopic Diseases; Skin Reactions; Food allergies *P:* Histamine and leukotriene production *C:* IgE

Type IV: Cell-mediated, delayed

*ex:* Tuberculosis, Contact dermatitis, Transplant rejection *P:* Lymphokine release *C:* Sensitized T-Cells

Valium

*status epilepticus* - esp. in kids - Stat. ep. --> brain damage

S/S Hypoglycemia

- *Cool, clammy skin* - Confused - Weak - Hungry - Palpitations (*shaky*)

Analgesic - Non-Narcotic Ibuprofen Acetaminophen

- *GI irritation - GI bleeding* - *Renal failure* TYLENOL - *hepatotoxicity*: sweating, anorexia, ab pain, n/v/d Max Dose Tylenol: *4 grams in 24 hrs* Antidote: *activated charcoal*, *mucomyst/acetylcysteine*

Aldactone

- *edema* (holds K, gets rid of Na; water follows Na) - Potassium sparing: monitor for hyperkalemia

DEPRESSION: SSRIs (first line) Celexa Lexapro Paxil Prozac Zoloft

- *insomnia* - drowsiness - *constipation* - nausea - sweating - tremors - *sexual dysfunction*

Indications for Digoxin (3)

- A Fib - A tach (paroxysmal) - CHF

ARB SE

- Angioedema - Renal failure (*incr. K*) - BP - hypotension

ANTIDYSRHYTHMICS

- B - Beta Blockers - C - Calcium Channel blockers - D - Digoxin

S/S Hyperglycemia

- Dry, flushed skin - Polyuria (always peeing) - Polydipsia (always thirsty)

MUSCLE RELAXANTS (2)

- Flexeril (cyclobenzaprine) - Robaxin (methocarbamol) Monitor for dizziness, drowsiness, change positions slowly

Epoetin (epogen) - action - population - se (2)

- Increases RBC production - Used in cancer pt. when chemo wipes out RBC - Monitor for: SEIZURES HYPERTENSION

Filgrastim (neupogen) - action - population - se (1)

- Increases WBC production - Used in cancer pt. when chemo wipes out WBC - Monitor for *bone pain*

Antidote to hypoglycemia:

- PO intake - IV D50 (if unable to take PO) - IM Glucagon

When should SINIMET be given?

- before meals - bedtime

H2 Antagonists - tidine SE (5)

- cimeditine (Tagamet) - ranitidine (Zantac) - famotidine (Pepcid) *increase hydration to avoid contsipation* all are available without Rx. monitor for - arrhythmias - agranulocutosis - aplastic anemia - constipation - confusion

Side effects of Sinimet (6)

- constipation, dry mouth - dizziness, drowsiness, confusion - insomnia

PPI ("*-prazole*")

- dizziness - headache - diarrhea, constipation

Estrogen Replacement therapy - Prempro: (Estrogen, Progesterone) - Premarin: (conj. estrogen) - Raloxifene (Evista)

- incr. risk of breast cancer, cardiac events - Thromboembolism, MI, HTN, Hot flash, leg cramps

ANTI-ANXIETY - Ativan (lorazepam) - Xanax (alprazolam)

- sexual dysfunction - drowsiness, dizziness - impaired memory, coordination, attention Psychological & physical dependence *Abrupt withdrawal --> seizures*

Loop Diuretic

- sulfa allergy - ototoxicity - monitor for hypotension

ANTI-PARKINSON MEDS

- used in *COMBINATION* to yield maximum function, fewest side effects Cogentin (benztropine mesylate) Sinemet (levodopa-carbidopa) Mirapex (pramipexole)

IV's and blood product administration

-18-19 guage needle for blood with filter in tubing -Run blood with NS only and within 30 minutes of hanging -Vitals and Breath sounds before, during and after insusion (15 min after start, then 30 min later, then hourly up to 1 hour after) -Check blood for exp. date, clots, color, air bubbles, leaks -2 RN's must check order, pt , blood product, ask about Hx of blood transfusions -Stay with pt for first 15 min; if there is a transfusion rx stop and KVO with NS -Pre-medicate with Benadryl prn for previous urticaria rxn's

Perioperative Care

-Breathing is taught in advance (before and early in pre-op) -Remove nail polish

Pre-op

-Meds as ordered, NPO x 8 hrs., incentive spirometry & breathing is taught in advance; void, no NSAIDS x 48 hrs. -Increase corticosteriods for surgery (stress)...may need to increase insulin too

Post-op

-Restlessness may = hemorrhage, hypoxia -Wound dehiscence or extravisation...wet sterile dressing + call doctor -Call doctor post-op if...< 30ml/hr urine, Sys BP < 90, T > 100 or <96

Post-op breathing exercises...every 2 hours

-Sit up straight -Breath in deeply thru nose and out slowly thru pursed lips -Hold last breath 3 seconds -Then cough 3 times (unless abd wound; reinforce/splint if cough)

Sexually Transmitted Disease

-Syphilis (Treponema pallidum)...chancre + red painless lesion primary stage = 90 days; Secondary stage = up to 6 mo, rash on palms and soles plus flu-like symptoms; Tertiary stage = neurologic and cardiac destruction (10-30 yrs.), treated with penicillin G IM -Gonorrhea (Neisseria Gonorrhea)...Yellow-green urethral discharge ("the clap") -Chlamydia (Chlamydia Trachomatis)...Mild vaginal discharge or urethritis; Doxycycin, Tetracycline -Trichomoniasis (Trichomonas Vaginalis)...Frothy foul-smelling vaginal discharge; Flagyl -Candidiasis (Candida Albicans)...Yellow, cheesy discharge with itching; Miconazole, Nystatin, Clomitrazole (Gyne-Lotrimin) -Herpes Simplex 2...Acyclovir -HPV (Human Pappilovirus)...Acid, Laser, Cryotherapy -HIV...Cocktails

Post-op positioning

-THR...No adduction past midline, no hip flexion past 90 degrees -Supratentorial Sx...HOB 30-45 degrees (Semi-Fowler) -Infrantentorial Sx...Flat

How can you tell if a drug is a benzodiazepine?

-azepam

How can you tell which drugs are B-blockers?

-lol

How can you tell if a drug is an ACE inhibitors?

-pril ending

How can you tell which drugs are Angiotensin II Receptor Blockers (ARBs)?

-sartan

What is the normal creatinine level for women?

0.5-1.0

Creatinine

0.5-1.2

What is the therapeutic range of Digoxin?

0.5-2.0

What is the safe range for Lithium levels?

0.6-1.2

What is the normal creatinine level for men?

0.6-1.3

What is the normal value of INR?

0.8-1.1 Most therapeutic levels are maintained between 2 and 3

*Persistent Vegetative State (VS):* Complete unawareness of the self or surrounding environment and complete loss of cognitive function

1) periods of eye opening 2) potential for responses to external stimuli (such as tachycardia to pain) 3) Return of so-called vegetative functions (sleep-wake cycles, respiration, digestion) 4) Occasional roving eye movements without visual tracking

Extended stage

1-4 days post-op

Immediate stage

1-4 hours post-op

173.) A nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During data collection, the nurse asks which question to determine medication effectiveness? 1. "Do you have any joint pain?" 2. "Are you having any diarrhea?" 3. "Do you have frequent headaches?" 4. "Are you experiencing heartburn?"

1. "Do you have any joint pain?" Rationale: Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other options are unrelated to medication effectiveness.

127.) The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following? 1. "I can skip a dose once a week." 2. "I need to change my position slowly." 3. "I take the pill after breakfast each day." 4. "If I get a bad headache, I should call my doctor immediately."

1. "I can skip a dose once a week." Rationale: Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds a week, I will call my doctor."

1. "I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

179.) A nurse provides medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy."

1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? 1. "I will use a soft toothbrush to brush my teeth." 2. "It's all right to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1. "I will use a soft toothbrush to brush my teeth." Rationale: Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

220.) A adult client with muscle spasms is taking an oral maintenance dose of baclofen (Lioresal). The nurse reviews the medication record, expecting that which dose should be prescribed? 1. 15 mg four times a day 2. 25 mg four times a day 3. 30 mg four times a day 4. 40 mg four times a day

1. 15 mg four times a day Rationale: Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.

115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse should check the client for a potential hypoglycemic reaction at what time? 1. 5:00 PM 2. 10:00 AM 3. 11:00 AM 4. 11:00 PM

1. 5:00 PM Rationale: NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for: 1. Acne 2. Eczema 3. Hair loss 4. Herpes simplex

1. Acne Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered-dose inhaler. The nurse administers the medication by giving the: 1. Albuterol first and then the beclomethasone dipropionate 2. Beclomethasone dipropionate first and then the albuterol 3. Alternating a single puff of each, beginning with the albuterol 4. Alternating a single puff of each, beginning with the beclomethasone dipropionate

1. Albuterol first and then the beclomethasone dipropionate Rationale: Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

202.) A nurse is collecting data from a client about medications being taken, and the client tells the nurse that he is taking herbal supplements for the treatment of varicose veins. The nurse understands that the client is most likely taking which of the following? 1. Bilberry 2. Ginseng 3. Feverfew 4. Evening primrose

1. Bilberry Rationale: Bilberry is an herbal supplement that has been used to treat varicose veins. This supplement has also been used to treat cataracts, retinopathy, diabetes mellitus, and peripheral vascular disease. Ginseng has been used to improve memory performance and decrease blood glucose levels in type 2 diabetes mellitus. Feverfew is used to prevent migraine headaches and to treat rheumatoid arthritis. Evening primrose is used to treat eczema and skin irritation.

156.) A nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication? 1. Dementia 2. Schizophrenia 3. Seizure disorder 4. Obsessive-compulsive disorder

1. Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and 4 are incorrect.

33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply. 1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).

1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. The nurse tells the client to expect which of the following side effects of this medication? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction

1. Dry mouth Rationale: Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options describe the opposite effects of cholinergic-blocking agents and therefore are incorrect.

193.) Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg wound containing purulent drainage. The nurse is assisting in developing a plan of care for the client and includes which of the following in the plan? 1. Ensure that the solution is freshly prepared before use. 2. Soak a sterile dressing with solution and pack into the wound. 3. Allow the solution to remain in the wound following irrigation. 4. Apply the solution to the wound and on normal skin tissue surrounding the wound.

1. Ensure that the solution is freshly prepared before use. Rationale: Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. Solutions are unstable and the nurse must ensure that the solution has been prepared fresh before use. **Eliminate options 2 and 3 first because they are comparable or alike. It makes sense to ensure that the solution is freshly prepared; therefore, select option 1**

93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Hemoglobin and hematocrit blood levels

1. Gait Rationale: Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.

91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication? 1. Heart rate 2. Temperature 3. Respirations 4. Blood pressure

1. Heart rate Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.

158.) A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. White blood cell count of 6000 cells/mm3 4. Blood urea nitrogen (BUN) level of 15 mg/dL

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic renal failure. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

167.) A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that, if swelling of the lips occurs, this is a normal expected response.

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the plan of care for instructions? 1. Maintain a high fluid intake. 2. Discontinue the medication when feeling better. 3. If the urine turns dark brown, call the health care provider immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

1. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the health care provider.

43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors. H2-receptor antagonists medication names end with -dine. Proton pump inhibitors medication names end with -zole.

109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate medication effectiveness? 1. No rapid heartbeats or anxiety 2. No paranoid thought processes 3. No thought broadcasting or delusions 4. No reports of alcohol withdrawal symptoms

1. No rapid heartbeats or anxiety Rationale: Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action? 1. Notify the registered nurse. 2. Administer pain medication to reduce the discomfort. 3. Apply ice and maintain the infusion rate, as prescribed. 4. Elevate the extremity of the IV site, and slow the infusion.

1. Notify the registered nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.

235.) A tricyclic antidepressant is administered to a client daily. The nurse plans to monitor for the common side effects of the medication and includes which of the following in the plan of care? 1. Offer hard candy or gum periodically. 2. Offer a nutritious snack between meals. 3. Monitor the blood pressure every 2 hours. 4. Review the white blood cell (WBC) count results daily.

1. Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease

1. Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

171.) A nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. The most important laboratory test result for the nurse to check before administering this medication is: 1. Potassium level 2. Creatinine level 3. Cholesterol level 4. Blood urea nitrogen

1. Potassium level Rationale: Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with low electrolyte levels could precipitate ventricular dysrhythmias. Options 2 and 4 reflect renal function. The cholesterol level is unrelated to the administration of this medication.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

152.) Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit? 1. Protamine sulfate 2. Potassium chloride 3. Phytonadione (vitamin K ) 4. Aminocaproic acid (Amicar)

1. Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic acid is the antidote for thrombolytic therapy.

102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply. 1. Rash 2. Hepatotoxicity 3. Hyperglycemia 4. Peripheral neuropathy 5. Reduced bone mineral density

1. Rash 2. Hepatotoxicity Rationale: Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.

72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart. 1. Renal insufficiency 2. Chest x-ray: normal 3. Blood glucose, 102 mg/dL 4. Folic acid (vitamin B6) 0.5 mg, orally daily

1. Renal insufficiency Rationale: Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider? 1. Seizure disorders 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1. Seizure disorders Rationale: Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply. 1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.

92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature upon rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. The nurse determines that: 1. The client should reschedule the appointment. 2. A lower dose of allergen will need to be injected. 3. A higher dose of allergen will need to be injected. 4. The client should have the skin test read a day later than usual.

1. The client should reschedule the appointment. Rationale: Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

221.) A nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms; the health care provider has prescribed 350 mg to be administered four times a day. When preparing to give this medication, the nurse determines that this dosage is: 1. The normal adult dosage 2. A lower than normal dosage 3. A higher than normal dosage 4. A dosage requiring further clarification

1. The normal adult dosage Rationale: The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.

21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply. 1. Tinnitus 2. Ototoxicity 3. Hyperkalemia 4. Hypercalcemia 5. Nephrotoxicity 6. Hypomagnesemia

1. Tinnitus 2. Ototoxicity 5. Nephrotoxicity 6. Hypomagnesemia Rationale: Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin)

1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

239.) Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)? 1. Wearing goggles 2. Wearing a gown 3. Wearing a gown and a mask 4. Handwashing before administration

1. Wearing goggles Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Handwashing is to be performed before and after any child contact.

79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication: 1. With 8 oz of milk 2. In the morning after arising 3. 60 minutes before breakfast 4. At bedtime on an empty stomach

1. With 8 oz of milk Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into the vial

1. Withdraws the NPH insulin first Rationale: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

195.) A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse (AP) immediately before administration. The client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based on this data, which of the following is the appropriate action? 1. Withhold the medication. 2. Notify the registered nurse immediately. 3. Administer the medication as prescribed. 4. Administer half of the prescribed medication.

1. Withhold the medication. Rationale: Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and AP immediately before administration. If the systolic BP is below 90 mm/Hg and the AP is below 60 beats/min, the nurse should withhold the medication and document this action. Although the registered nurse should be informed of the client's vital signs, it is not necessary to do so immediately. The medication should not be administered because the data is outside of the prescribed parameters for this medication. The nurse should not administer half of the medication, or alter any dosages at any point in time.

234.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray will the nurse remove? 1. Yogurt 2. Crackers 3. Tossed salad 4. Oatmeal cookies

1. Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, or figs.

What is the normal range for urine specific gravity?

1.010-1.025

What are the normal lab values for magnesium?

1.6-2.6

6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local pain at the burn site 4.Local rash at the burn site

1.Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

What is the normal lab value for cholesterol?

122-200

What are the normal lab values for sodium?

135-145

What are the normal lab values for hemaglobin for men?

14-18

What is the normal lab value for platelets?

150000-400000

What is the normal lab value of pre-albumin?

17-40

176.) A nurse notes that a client is taking lansoprazole (Prevacid). On data collection, the nurse asks which question to determine medication effectiveness? 1. "Has your appetite increased?" 2. "Are you experiencing any heartburn?" 3. "Do you have any problems with vision?" 4. "Do you experience any leg pain when walking?"

2. "Are you experiencing any heartburn?" Rationale: Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat visual problems, problems with appetite, or leg pain. **NOTE: "-zole" refers to gastric acid pump inhibitors**

183.) A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instructions? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider (HCP) if more than one dose is missed."

2. "I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported immediately to the HCP. The client should also call the HCP if more than one dose is missed. The medication may be taken with meals to minimize nausea.

194.) A nurse provides instructions to a client regarding the use of tretinoin (Retin-A). Which statement by the client indicates the need for further instructions? 1. "Optimal results will be seen after 6 weeks." 2. "I should apply a very thin layer to my skin." 3. "I should wash my hands thoroughly after applying the medication." 4. "I should cleanse my skin thoroughly before applying the medication."

2. "I should apply a very thin layer to my skin." Rationale: Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication.

78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range? 1. 5 to 10 mcg/mL 2. 10 to 20 mcg/mL 3. 20 to 30 mcg/mL 4. 30 to 40 mcg/mL

2. 10 to 20 mcg/mL Rationale: The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL. ** A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.**

215.) A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? 1. 1 g daily 2. 4 g daily 3. 325 mg daily 4. 1000 mg daily

2. 4 g daily Rationale: Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses. **Eliminate options 1 and 4 because they are alike**

64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client? 1. Discontinuation of warfarin sodium (Coumadin) 2. A decrease in the warfarin sodium (Coumadin) dosage 3. An increase in the warfarin sodium (Coumadin) dosage 4. A decrease in the usual dose of nalidixic acid (NegGram)

2. A decrease in the warfarin sodium (Coumadin) dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a decrease in the anticoagulant dosage may be needed.

88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. **Options 1, 3, and 4 are all comparable or alike in that they address CNS suppression and the depression of reflexes. Therefore, eliminate these options.**

74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? 1. Vitamin K 2. Atropine sulfate 3. Protamine sulfate 4. Acetylcysteine (Mucomyst)

2. Atropine sulfate Rationale: The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).

86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).

199.) A nurse is applying a topical glucocorticoid to a client with eczema. The nurse monitors for systemic absorption of the medication if the medication is being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical glucocorticoids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axillae, face, eyelids, neck, perineum, genitalia), and lower from regions where penetrability is poor (back, palms, soles). **Eliminate options 3 and 4 because these body areas are similar in terms of skin characteristics**

123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication? 1. Respiratory rate 2. Blood pressure and heart rate 3. Heart rate and respiratory rate 4. Level of consciousness and blood pressure

2. Blood pressure and heart rate Rationale: Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction. **amlodipine is a calcium channel blocker, and this group of medications decreases the rate and force of cardiac contraction. This in turn lowers the pulse rate and blood pressure.**

224.) Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication would the nurse prepare in anticipation of being prescribed to treat this adverse effect related to the use of chlorpromazine? 1. Protamine sulfate 2. Bromocriptine (Parlodel) 3. Phytonadione (vitamin K) 4. Enalapril maleate (Vasotec)

2. Bromocriptine (Parlodel) Rationale: Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which of the following as a priority action before administering the medication? 1. Listen to the client's lung sounds. 2. Check the client's blood pressure. 3. Check the recent electrolyte levels. 4. Assess the client for muscle weakness.

2. Check the client's blood pressure. Rationale: Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse would check baseline renal and liver function tests. The medication may cause weakness, and the nurse would assist the client with activities if weakness occurs. **Beta-blockers have "-lol" at the end of the medication name**

34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2. Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication? 1. Oranges and pineapple 2. Coffee, cola, and chocolate 3. Oysters, lobster, and shrimp 4. Cottage cheese, cream cheese, and dairy creamers

2. Coffee, cola, and chocolate Rationale: Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply. 1. Call a code blue. 2. Contact the registered nurse. 3. Contact the client's family. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually.

2. Contact the registered nurse. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following? 1. Increased muscle tone 2. Decreased muscle spasms 3. Increased range of motion 4. Decreased local pain and tenderness

2. Decreased muscle spasms Rationale: Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.

209.) A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which of the following would indicate that the client is experiencing a side effect related to this medication? 1. Headache 2. Drowsiness 3. Urinary retention 4. Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.

240.) A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4. Hyperactive bowel sounds

2. Dry mouth Rationale: Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication. **Eliminate options 1 and 4 because they are comparable or alike. Recall that the medication is an anticholinergic, which causes dry mouth**

108.) A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

2. Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

136.) A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease Rationale: PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2. Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

131.) The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to: 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply. 1. Restrict fluid intake. 2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 5. Instruct the client to avoid exposure to the sun. Rationale: Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.

162.) Carbamazepine (Tegretol) is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history, knowing that this medication is contraindicated if which of the following disorders is present? 1. Headaches 2. Liver disease 3. Hypothyroidism 4. Diabetes mellitus

2. Liver disease Rationale: Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options.

89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. **Eliminate options 1 and 3 because these tests both assess kidney function.**

65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

2. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

161.) A nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which of the following would the nurse include in the plan of care while the client is taking this medication? 1. Restrict fluid intake. 2. Monitor bowel activity. 3. Monitor for hypertension. 4. Monitor peripheral pulses.

2. Monitor bowel activity. Rationale: While the client is taking codeine sulfate, an opioid analgesic, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

204.) A client receives a dose of edrophonium (Enlon). The client shows improvement in muscle strength for a period of time following the injection. The nurse interprets that this finding is compatible with: 1. Multiple sclerosis 2. Myasthenia gravis 3. Muscular dystrophy 4. Amyotrophic lateral sclerosis

2. Myasthenia gravis Rationale: Myasthenia gravis can often be diagnosed based on clinical signs and symptoms. The diagnosis can be confirmed by injecting the client with a dose of edrophonium . This medication inhibits the breakdown of an enzyme in the neuromuscular junction, so more acetylcholine binds to receptors. If the muscle is strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of myasthenia gravis. Another medication, neostigmine (Prostigmin), also may be used because its effect lasts for 1 to 2 hours, providing a better analysis. For either medication, atropine sulfate should be available as the antidote.

227.) When teaching a client who is being started on imipramine hydrochloride (Tofranil), the nurse would inform the client that the desired effects of the medication may: 1. Start during the first week of administration 2. Not occur for 2 to 3 weeks of administration 3. Start during the second week of administration 4. Not occur until after a month of administration

2. Not occur for 2 to 3 weeks of administration Rationale: The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. Therefore options 1, 3, and 4 are incorrect.

169.) Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin: 1. 1 hour after each meal 2. Once daily, at the same time each day 3. 15 minutes before breakfast, lunch, and dinner 4. Before each meal, on the basis of the blood glucose level

2. Once daily, at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time each day.

47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peripheral neuritis Rationale: A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

228.) A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse recognizes this complaint as a symptom of: 1. Cardiac dysrhythmias 2. Postural hypotension 3. Psychosomatic symptoms 4. Respiratory insufficiency

2. Postural hypotension Rationale: Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication. Options 1, 3, and 4 are unrelated to the use of this medication.

50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report: 1. Impaired sense of hearing 2. Problems with visual acuity 3. Gastrointestinal (GI) side effects 4. Orange-red discoloration of body secretions

2. Problems with visual acuity Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to: 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

186.) A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it: 1. Releases bicarbonate in exchange for primarily sodium ions 2. Releases sodium ions in exchange for primarily potassium ions 3. Releases potassium ions in exchange for primarily sodium ions 4. Releases sodium ions in exchange for primarily bicarbonate ions

2. Releases sodium ions in exchange for primarily potassium ions Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

2. Relief of epigastric pain Rationale: The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but is not an intended effect. Options 3 and 4 are incorrect.

168.) Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? 1. Myxedema 2. Renal failure 3. Hypothyroidism 4. Diabetes mellitus

2. Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, older clients, and debilitated clients. **Note that options 1, 3, and 4 are all endocrine-related disorders: Myxedema=Hypothyroidism**

48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to: 1. Drink alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge? 1. Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systematically. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage.

2. Rotate the insulin injection sites systematically. Rationale: Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

216.) A nurse is caring for a client with gout who is taking Colcrys (colchicine). The client has been instructed to restrict the diet to low-purine foods. Which of the following foods should the nurse instruct the client to avoid while taking this medication? 1. Spinach 2. Scallops 3. Potatoes 4. Ice cream

2. Scallops Rationale: Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

114.) A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client? 1. Ondansetron (Zofran) 2. Simethicone (Mylicon) 3. Acetaminophen (Tylenol) 4. Magnesium hydroxide (milk of magnesia, MOM)

2. Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

172.) A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item? 1. Grapes 2. Spinach 3. Watermelon 4. Cottage cheese

2. Spinach Rationale: Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green, leafy vegetables, fish, liver, coffee, and tea.

188.) The nurse should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be: 1. Prednisone 2. Sulfisoxazole 3. Furosemide (Lasix) 4. Intravenous immune globulin (IVIG)

2. Sulfisoxazole Rationale: A neurogenic bladder prevents the bladder from completely emptying because of the decrease in muscle tone. The most likely medication to be prescribed to prevent urinary tract infection would be an antibiotic. A common prescribed medication is sulfisoxazole. Prednisone relieves allergic reactions and inflammation rather than preventing infection. Furosemide promotes diuresis and decreases edema caused by congestive heart failure. IVIG assists with antibody production in immunocompromised clients.

147.) A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will: 1. Drink at least 2 L of fluid per day. 2. Take the daily dose at bedtime. 3. Avoid changing brands of the medication without health care provider (HCP) approval. 4. Avoid over-the-counter (OTC) cough and cold medications unless approved by the HCP.

2. Take the daily dose at bedtime. Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the physician before changing brands of the medication. The client also checks with the HCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline and causing dysrhythmias.

45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will: 1. Watch for irritability as a side effect. 2. Take the tablet with a full glass of water. 3. Take an extra dose if the cough is accompanied by fever. 4. Crush the sustained-release tablet if immediate relief is needed.

2. Take the tablet with a full glass of water. Rationale: Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

214.) A health care provider initiates carbidopa/levodopa (Sinemet) therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. The nurse tells the client that: 1. Taking an antiemetic is the best measure to prevent the nausea. 2. Taking the medication with food will help to prevent the nausea. 3. This is an expected side effect of the medication and will decrease over time. 4. The nausea and vomiting will decrease when the dose of levodopa is stabilized.

2. Taking the medication with food will help to prevent the nausea. Rationale: If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. **eliminate options 3 and 4 because they are comparable or alike**

57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication

2. The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention? 1. The medication is administered within 60 minutes before the morning and evening meal. 2. The medication is withheld and the HCP is called to question the prescription for the client. 3. The client is monitored for gastrointestinal side effects after administration of the medication. 4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client. Rationale: Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

165.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to assess: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth and a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth, with a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common signs of side effects of this medication.

126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. 1. Nausea 2. Tinnitus 3. Hypotension 4. Hypokalemia 5. Photosensitivity 6. Increased urinary frequency

2. Tinnitus 3. Hypotension 4. Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6. Increased respiratory rate

2. Tremors 3. Drowsiness 4. Hypotension Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level

2. Uric acid level Rationale: Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.

68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

238.) Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which of the following routes? 1. Orally 2. Via face mask 3. Intravenously 4. Intramuscularly

2. Via face mask Rationale: Ribavirin is an antiviral respiratory medication used mainly in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

What is the normal value of APTT?

20-45 sec

What are the normal lab values for HCO3?

21-28

128.) A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions? 1. "I will never be able to drive a car." 2. "My anticonvulsant medication will clear up my skin." 3. "I can't drink alcohol while I am taking my medication." 4. "If I forget my morning medication, I can take two pills at bedtime."

3. "I can't drink alcohol while I am taking my medication." Rationale: Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the health care provider should be notified.

106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? 1. "I should take the medication with my evening meal." 2. "I should take the medication at noon with an antacid." 3. "I should take the medication in the morning when I first arise." 4. "I should take the medication right before bedtime with a snack."

3. "I should take the medication in the morning when I first arise." Rationale: Fluoxetine hydrochloride is administered in the early morning without consideration to meals. **Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking the medication with an antacid or food.**

197.) Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client indicates an accurate understanding of the use of this medication? 1. "I will apply the ointment once a day and leave it open to the air." 2. "I will apply the ointment twice a day and leave it open to the air." 3. "I will apply the ointment once a day and cover it with a sterile dressing." 4. "I will apply the ointment at bedtime and in the morning and cover it with a sterile dressing."

3. "I will apply the ointment once a day and cover it with a sterile dressing." Rationale: Collagenase is used to promote debridement of dermal lesions and severe burns. It is usually applied once daily and covered with a sterile dressing.

164.) A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further instructions? 1. "My urine may turn brown or green." 2. "This medication is prescribed to help relieve my muscle spasms." 3. "If my vision becomes blurred, I don't need to be concerned about it." 4. "I need to call my doctor if I experience nasal congestion from this medication."

3. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that, if these adverse effects occur, the health care provider needs to be notified. The medication is used to relieve muscle spasms.

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication will permanently stain my skin." 4. "The medication should be applied directly to the wound."

3. "The medication will permanently stain my skin." Rationale: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. **Note the closed-ended word "only" in option 3**

219.) A health care provider instructs a client with rheumatoid arthritis to take ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the normal adult dose for this client is which of the following? 1. 100 mg orally twice a day 2. 200 mg orally twice a day 3. 400 mg orally three times a day 4. 1000 mg orally four times a day

3. 400 mg orally three times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg three or four times daily.

191.) A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which of the following medications first? 1. Oral corticosteroids 2. A leukotriene modifier 3. A β2 agonist 4. A nonsteroidal anti-inflammatory

3. A β2 agonist Rationale: In treating an acute asthma attack, a short acting β2 agonist such as albuterol (Proventil HFA) will be given to produce bronchodilation. Options 1, 2, and 4 are long-term control (preventive) medications.

120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse advises the client to take which of the following products if needed for a headache? 1. Naprosyn (Aleve) 2. Ibuprofen (Advil) 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol) Rationale: Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory drugs (ibuprofen). The client should be advised to take acetaminophen for headache. **Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options 1 and 2 first.**

233.) Diphenhydramine hydrochloride (Benadryl) is used in the treatment of allergic rhinitis for a hospitalized client with a chronic psychotic disorder. The client asks the nurse why the medication is being discontinued before hospital discharge. The nurse responds, knowing that: 1. Allergic symptoms are short in duration. 2. This medication promotes long-term extrapyramidal symptoms. 3. Addictive properties are enhanced in the presence of psychotropic medications. 4. Poor compliance causes this medication to fail to reach its therapeutic blood level.

3. Addictive properties are enhanced in the presence of psychotropic medications. Rationale: The addictive properties of diphenhydramine hydrochloride are enhanced when used with psychotropic medications. Allergic symptoms may not be short term and will occur if allergens are present in the environment. Poor compliance may be a problem with psychotic clients but is not the subject of the question. Diphenhydramine hydrochloride may be used for extrapyramidal symptoms and mild medication-induced movement disorders.

35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

207.) A client is suspected of having myasthenia gravis, and the health care provider administers edrophonium (Enlon) to determine the diagnosis. After administration of this medication, which of the following would indicate the presence of myasthenia gravis? 1. Joint pain 2. A decrease in muscle strength 3. An increase in muscle strength 4. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client

3. An increase in muscle strength Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If no response occurs, another dose is given over the next 2 minutes, and muscle strength is again tested. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore the other options are incorrect.

107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? 1. Reports not going to work for this past week 2. Complains of not being able to "do anything" anymore 3. Arrives at the clinic neat and appropriate in appearance 4. Reports sleeping 12 hours per night and 3 to 4 hours during the day

3. Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

174.) A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness? 1. Lung sounds 2. Blood pressure 3. Blood ammonia level 4. Serum potassium level

3. Blood ammonia level Rationale: Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon.

96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry

3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

153.) A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy? 1. Adventitious breath sounds 2. Temperature of 99.4° F orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths/min

3. Blood pressure of 198/110 mm Hg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the registered nurse before initiating therapy. The findings in options 1, 2, and 4 may be present in the client with pulmonary embolism.

69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3. Bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication: 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3. Confusion Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: 1. To take aspirin (acetylsalicylic acid) as needed for headache 2. Drink beverages containing alcohol in moderate amounts each evening 3. Consult with health care providers (HCPs) before receiving immunizations 4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair

3. Consult with health care providers (HCPs) before receiving immunizations Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.

150.) A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a β-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis? 1. Dyspnea, edema, and palpitations 2. Chest pain, hypotension, and paresthesia 3. Double vision, loss of appetite, and nausea 4. Constipation, dry mouth, and sleep disorder

3. Double vision, loss of appetite, and nausea Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence. **gastrointestinal (GI) and visual disturbances occur with digoxin toxicity**

148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for which of the following side effects of this medication? 1. Diarrhea 2. Excitability 3. Drowsiness 4. Excess salivation

3. Drowsiness Rationale: A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3. Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3. Early morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. **Note the suffix "-sone," and recall that medication names that end with these letters are corticosteroids.**

71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

3. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

244.) A client has a prescription for valproic acid (Depakene) orally once daily. The nurse plans to: 1. Administer the medication with an antacid. 2. Administer the medication with a carbonated beverage. 3. Ensure that the medication is administered at the same time each day. 4. Ensure that the medication is administered 2 hours before breakfast only, when the client's stomach is empty.

3. Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels. **Use general pharmacology guidelines to assist in eliminating options 1 and 2. Eliminate option 4 because of the closed-ended word "only."**

154.) A nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be avoided. Red meats, orange juice, and green leafy vegetables are acceptable to consume.

97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified. **(most aminoglycoside medication names end in the letters -cin)**

60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

130.) The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

3. Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by: 1. Telling the client not to take the medication with food 2. Suggesting that the client taper the dose until taste returns to normal 3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months 4. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor

3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months Rationale: ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval and the medication should never be stopped abruptly.

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site

3. Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect

243.) A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to: 1. Weigh the client daily. 2. Observe for ecchymosis. 3. Institute seizure precautions. 4. Monitor blood glucose levels.

3. Institute seizure precautions. Rationale: Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are not associated with the use of this medication.

230.) A client is placed on chloral hydrate (Somnote) for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication? 1. Monitoring neurological signs every 2 hours 2. Monitoring the blood pressure every 4 hours 3. Instructing the client to call for ambulation assistance 4. Lowering the bed and clearing a path to the bathroom at bedtime

3. Instructing the client to call for ambulation assistance Rationale: Chloral hydrate (a sedative-hypnotic) causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation.

241.) A client with a history of simple partial seizures is taking clorazepate (Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response is based on the understanding that clorazepate: 1. Is not habit forming, either physically or psychologically 2. Leads to physical tolerance, but only after 10 or more years of therapy 3. Leads to physical and psychological dependence with prolonged high-dose therapy 4. Can result in psychological dependence only, because of the nature of the medication

3. Leads to physical and psychological dependence with prolonged high-dose therapy Rationale: Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic (benzodiazepine). One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted. **Eliminate options 2 and 4 first because of the closed-ended word "only"**

52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels Rationale: INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for renal failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

3. Monitor for signs of bleeding. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

151.) A client is being treated for acute congestive heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment? 1. Monitoring weight loss 2. Monitoring temperature 3. Monitoring blood pressure 4. Monitoring potassium level

3. Monitoring blood pressure Rationale: Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The other options also require assessment but are not the priority. **priority ABCs—airway, breathing, and circulation**

201.) A nurse is preparing to administer eardrops to an infant. The nurse plans to: 1. Pull up and back on the ear and direct the solution onto the eardrum. 2. Pull down and back on the ear and direct the solution onto the eardrum. 3. Pull down and back on the ear and direct the solution toward the wall of the canal. 4. Pull up and back on the ear lobe and direct the solution toward the wall of the canal.

3. Pull down and back on the ear and direct the solution toward the wall of the canal. Rationale: When administering eardrops to an infant, the nurse pulls the ear down and straight back. In the adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum.

37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3. Reduction of steatorrhea Rationale: Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin

3. Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

111.) A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? 1. Insomnia 2. Weight gain 3. Seizure activity 4. Orthostatic hypotension

3. Seizure activity Rationale: Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted? 1. Serum protein 2. Blood glucose 3. Serum amylase 4. Serum creatinine

3. Serum amylase Rationale: Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

211.) A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result? 1. Nystagmus 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level

3. Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

187.) A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered? 1. Intramuscularly in the deltoid muscle 2. Subcutaneously in the gluteal muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Intramuscularly in the anterolateral aspect of the thigh

3. Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client: 1. Cut the dose in half. 2. Discontinue the medication. 3. Take the medication with food. 4. Contact the health care provider (HCP).

3. Take the medication with food. Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

245.) A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be: 1. Withheld until the next scheduled dose 2. Withheld and the health care provider is notified immediately 3. Taken as long as it is not immediately before the next dose 4. Withheld until the next scheduled dose, which should then be doubled

3. Taken as long as it is not immediately before the next dose Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the health care provider.

229.) A client who is taking lithium carbonate (Lithobid) is scheduled for surgery. The nurse informs the client that: 1. The medication will be discontinued a week before the surgery and resumed 1 week postoperatively. 2. The medication is to be taken until the day of surgery and resumed by injection immediately postoperatively. 3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. 4. The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period.

3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is prescribed after the surgery. **lithium carbonate is an oral medication and is not given as an injection**

129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial infarction

3. Thrombophlebitis Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. **megestrol acetate is a hormonal antagonist enzyme and that a side effect is thrombotic disorders**

22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany. Rationale: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? 1. Neuralgia 2. Insomnia 3. Use of nitroglycerin 4. Use of multivitamins

3. Use of nitroglycerin Rationale: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1. Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level

3. White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication? 1. Sodium level, 140 mEq/L 2. Uric acid level, 5.0 mg/dL 3. White blood cell count, 3000 cells/mm3 4. Blood urea nitrogen (BUN) level, 15 mg/dL

3. White blood cell count, 3000 cells/mm3 Rationale: Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

What is the normal lab value of albumin?

3.4-5.4

What are the normal lab values for potassium?

3.5-5.0

What is the normal level for alkaline phosphatase (ALP)?

30-120 units/L

What is the normal lab value for triglycerides for women?

35-135

What are the normal lab values for PaCO2?

35-45

What are the normal lab values for hematocrit for women?

37%-47%

What is the normal level of alanine aminotransferase (ALT)?

4-36 units/L Elderly may have slightly higher levels than the adult

What is the normal lab value of CO?

4-8 L/min

118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates that further teaching is necessary? 1. "I rest each afternoon after my walk." 2. "I cough and deep breathe many times during the day." 3. "If I get abdominal cramps and diarrhea, I should call my doctor." 4. "I can change the time of my medication on the mornings that I feel strong."

4. "I can change the time of my medication on the mornings that I feel strong." Rationale: The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. Options 1, 2, and 3 include the necessary information that the client needs to understand to maintain health with this neurological degenerative disease.

54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

218.) A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse provide to the client? 1. "Crush the tablets and mix them with food." 2. "Notify the health care provider for a medication change." 3. "Open the tablet and mix the contents with food." 4. "Swallow the tablets with large amounts of water or milk."

4. "Swallow the tablets with large amounts of water or milk." Rationale: Diflunisal may be given with water, milk, or meals. The tablets should not be crushed or broken open. Taking the medication with a large amount of water or milk should be tried before contacting the health care provider.

198.) Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instructions? 1. "The medication can cause phototoxicity." 2. "The medication has an unpleasant odor." 3. "The medication can stain the skin and hair." 4. "The medication can cause systemic effects."

4. "The medication can cause systemic effects." Rationale: Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur. **The name of the medication will assist in eliminating options 2 and 3**

87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

163.) A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL

4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Enlon) is administered. Which of the following indicates that the client is in cholinergic crisis? 1. No change in the condition 2. Complaints of muscle spasms 3. An improvement of the weakness 4. A temporary worsening of the condition

4. A temporary worsening of the condition Rationale: An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.

181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client to avoid which of the following while taking this medication? 1. Vitamin C 2. Vitamin D 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

4. Acetylsalicylic acid (aspirin) Rationale: Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided.

56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication? 1. Hematocrit level 2. Hemoglobin level 3. Prothrombin time (PT) 4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT) Rationale: The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

242.) A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on the understanding that these symptoms: 1. Usually occur if the client takes the medication with food 2. Are probably the result of an interaction with another medication 3. Indicate that the client is experiencing a severe untoward reaction to the medication 4. Are worse during initial therapy and decrease or disappear with long-term use

4. Are worse during initial therapy and decrease or disappear with long-term use Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. **Eliminate options 2 and 3 first because they are comparable or alike and because of the word "severe" in option 3**

178.) Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which of the following as the important client parameter? 1. Temperature 2. Lochial flow 3. Urine output 4. Blood pressure

4. Blood pressure Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse would check the client's blood pressure before administering the medication and would follow agency protocols regarding withholding of the medication. Options 1, 2, and 3 are items that are checked in the postpartum period, but they are unrelated to the use of this medication.

237.) A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to: 1. Avoid soy sauce, wine, and aged cheese. 2. Have the lithium level checked every week. 3. Take medication only as prescribed because it can become addicting. 4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.

4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting, and, although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: 1. Increase DNA and RNA synthesis. 2. Promote the biosynthesis of nucleic acids. 3. Increase estrogen concentration and estrogen response. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

217.) A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which of the following would indicate to the nurse that the client is experiencing toxicity related to the medication? 1. Joint pain 2. Constipation 3. Ringing in the ears 4. Complaints of a metallic taste in the mouth

4. Complaints of a metallic taste in the mouth Rationale: Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy. Early symptoms of toxicity include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

4. Complete blood count Rationale: A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication? 1. Diarrhea 2. Weakness 3. Headache 4. Constipation

4. Constipation Rationale: Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation. **Focus on the name of the medication. Recalling that oral iron can cause constipation will easily direct you to the correct option.**

157.) A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication? 1. Nausea 2. Diarrhea 3. Anorexia 4. Cough and chest pain

4. Cough and chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray, would indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication. **Eliminate options 1, 2, and 3 because they are similar GI-related side effects. Also, use the ABCs— airway, breathing, and circulation**

132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication? 1. Fever 2. Diarrhea 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects. **keep in mind that the question is asking about a toxic effect and think: ABCs—airway, breathing, and circulation**

117.) A nurse has given the client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client immediately reports: 1. Impaired sense of hearing 2. Distressing gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty discriminating the color red from green

4. Difficulty discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

190.) A child is hospitalized with a diagnosis of lead poisoning. The nurse assisting in caring for the child would prepare to assist in administering which of the following medications? 1. Activated charcoal 2. Sodium bicarbonate 3. Syrup of ipecac syrup 4. Dimercaprol (BAL in Oil)

4. Dimercaprol (BAL in Oil) Rationale: Dimercaprol is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for excretion in the urine. Sodium bicarbonate may be used in salicylate poisoning. Syrup of ipecac is used in the hospital setting in poisonings to induce vomiting. Activated charcoal is used to decrease absorption in certain poisoning situations. Note that dimercaprol is prepared with peanut oil, and hence should be avoided by clients with known or suspected peanut allergy.

203.) A nurse is preparing to give the postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates the understanding that codeine: 1. Is one of the strongest opioid analgesics available 2. Cannot lead to physical or psychological dependence 3. Does not cause gastrointestinal upset or constipation as do other opioids 4. Does not alter respirations or mask neurological signs as do other opioids

4. Does not alter respirations or mask neurological signs as do other opioids Rationale: Codeine sulfate is the opioid analgesic often used for clients after craniotomy. It is frequently combined with a nonopioid analgesic such as acetaminophen for added effect. It does not alter the respiratory rate or mask neurological signs as do other opioids. Side effects of codeine include gastrointestinal upset and constipation. The medication can lead to physical and psychological dependence with chronic use. It is not the strongest opioid analgesic available.

159.) A nurse is caring for a client receiving morphine sulfate subcutaneously for pain. Because morphine sulfate has been prescribed for this client, which nursing action would be included in the plan of care? 1. Encourage fluid intake. 2. Monitor the client's temperature. 3. Maintain the client in a supine position. 4. Encourage the client to cough and deep breathe.

4. Encourage the client to cough and deep breathe. Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. **ABCs—airway, breathing, and circulation**

223.) A client with a psychotic disorder is being treated with haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication? 1. Nausea 2. Hypotension 3. Blurred vision 4. Excessive salivation

4. Excessive salivation Rationale: Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred vision are occasional side effects.

236.) A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is: 1. Prescribing the client a tyramine-free diet 2. Checking the client for anticholinergic effects 3. Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication 4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

196.) A client has been prescribed amikacin (Amikin). Which of the following priority baseline functions should be monitored? 1. Apical pulse 2. Liver function 3. Blood pressure 4. Hearing acuity

4. Hearing acuity Rationale: Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, liver function studies, and blood pressure are not specifically related to the use of this medication.

175.) A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. **Note the letters "-vir" in the trade name for this medication**

192.) A nurse is collecting medication information from a client, and the client states that she is taking garlic as an herbal supplement. The nurse understands that the client is most likely treating which of the following conditions? 1. Eczema 2. Insomnia 3. Migraines 4. Hyperlipidemia

4. Hyperlipidemia Rationale: Garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. An herbal supplement that may be used to treat eczema is evening primrose. Insomnia has been treated with both valerian root and chamomile. Migraines have been treated with feverfew.

73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists? 1. Ataxia 2. Mouth sores 3. Hypotension 4. Hypertension

4. Hypertension Rationale: Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4. Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

212.) Mannitol (Osmitrol) is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which of the following indicates the therapeutic action of this medication? 1. Prevents the filtration of sodium and water through the kidneys 2. Prevents the filtration of sodium and potassium through the kidneys 3. Decreases water loss by promoting the reabsorption of sodium and water in the loop of Henle 4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes

4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

225.) A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication? 1. It is a serotonin reuptake blocker. 2. It inhibits the breakdown of released acetylcholine. 3. It blocks the uptake of norepinephrine and serotonin. 4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.

4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

200.) A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies. Lindane is prescribed, and the nurse is asked to provide instructions to the client regarding the use of the medication. The nurse tells the client to: 1. Apply a thick layer of cream to the entire body. 2. Apply the cream as prescribed for 2 days in a row. 3. Apply to the entire body and scalp, excluding the face. 4. Leave the cream on for 8 to 12 hours and then remove by washing.

4. Leave the cream on for 8 to 12 hours and then remove by washing. Rationale: Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is required.

119.) A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most reliable indicator of hypoglycemia? 1. Sweating 2. Tachycardia 3. Nervousness 4. Low blood glucose level

4. Low blood glucose level Rationale: β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

205.) A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by: 1. Administering the medication subcutaneously in the deltoid muscle 2. Administering the medication by the intramuscular route in the gluteal muscle 3. Administering the medication by the intramuscular route, mixed in 10 mL of normal saline 4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw

4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw Rationale: Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route. **Knowing that the medication is a solution that is also used for nebulization treatments will assist you to select the option that indicates an oral route**

36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: 1. Heartburn 2. Constipation 3. Abdominal pain 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Numbness and tingling in the fingers and toes

4. Numbness and tingling in the fingers and toes Rationale: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice

4. Orange juice Rationale: Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.

15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension

4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

222.) A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room? 1. Giving the client a bedpan 2. Drawing the shades or blinds closed 3. Turning down the volume on the television 4. Per agency policy, putting up the side rails on the bed

4. Per agency policy, putting up the side rails on the bed Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

184.) A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question? 1. Cyclobenzaprine (Flexeril) 2. Alendronate (Fosamax) 3. Allopurinol (Zyloprim) 4. Prednisone

4. Prednisone Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. Alendronate is a bone-resorption inhibitor. Allopurinol is an antigout medication.

189.) Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child asks the nurse why the child needs the medication. The nurse tells the mother that the medication: 1. Prevents hypercyanotic (blue or tet) spells 2. Maintains an adequate hormone level 3. Maintains the position of the great arteries 4. Provides adequate oxygen saturation and maintains cardiac output

4. Provides adequate oxygen saturation and maintains cardiac output Rationale: A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increase blood mixing if systemic and pulmonary mixing are inadequate to maintain adequate cardiac output. Options 1, 2, and 3 are incorrect. In addition, hypercyanotic spells occur in tetralogy of Fallot. **Use the ABCs—airway, breathing, and circulation—to answer the question. The correct option addresses circulation**

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies

4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

144.) A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

4. Regular bowel movements Rationale: Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.

44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

4. Suction equipment Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

166.) Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to: 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client: 1. To take the medication at bedtime 2. To take the medication before meals 3. To discontinue the medication if a headache occurs 4. That a reddish orange discoloration of the urine may occur

4. That a reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

177.) A nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? 1. The magnesium sulfate is effective. 2. The infusion rate needs to be increased. 3. The client is experiencing cerebral edema. 4. The client is experiencing magnesium toxicity.

4. The client is experiencing magnesium toxicity. Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate or maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that: 1. Both are weak potassium-losing diuretics. 2. The combination of these medications prevents renal toxicity. 3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective. 4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.

4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic. Rationale: Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics. **It is especially helpful to remember that hydrochlorothiazide is a potassium-losing diuretic and triamterene is a potassium-sparing diuretic**

160.) Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

4. Urinary retention Rationale: Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

4. When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

180.) A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to: 1. Count the radial and carotid pulses every morning. 2. Check the blood pressure every morning and evening. 3. Stop taking the medication if the pulse is higher than 100 beats per minute. 4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute. Rationale: An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.

185.) Which of the following herbal therapies would be prescribed for its use as an antispasmodic? Select all that apply. 1.Aloe 2.Kava 3.Ginger 4.Chamomile 5.Peppermint oil

4.Chamomile 5.Peppermint oil Rationale: Chamomile has a mild sedative effect and acts as an antispasmodic and anti-inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable bowel syndrome. Topical aloe promotes wound healing. Aloe taken orally acts as a laxative. Kava has an anxiolytic, sedative, and analgesic effect. Ginger is effective in relieving nausea.

What is the normal lab value for triglycerides for men?

40-160

What is the normal lab value of serum amylase?

45-200

What is the normal lab value for HDL for men?

45-50

What is the normal lab value for WBC?

5000-10000

What are the normal lab values for PaO2?

80-100

What are the normal lab values for calcium?

9-10.5

What is the normal range of PT?

9.5-12 sec

What is a normal GFR rate?

90-120

What are the normal lab values for chloride?

98-106

Cyclosporine

A immuno-suppressant; 50% of patients get HTN; interacts with st johns wart; monitor patient B/P

Dawn Phenomenon

A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in clients with DM. *tx:* administering an evening dose of intermediate-acting insulin at 10 pm

What are the therapeutic effects of Cardiac Glycosides?

A positive inotropic effect increases cardiac contractility and cardiac output, making these drugs useful in the treatment of heart failure A negative chronotropic effect (decreased heart rate) and negative dromotropic effect (decreased conductivity) make these drugs useful in the treatment of supraventricular tachydysrhythmias as well

What is the function of Bradykinin?

A potent vasodilator Increased bradykinin leads to increased vasodilation

Somogyi Phenomenon

A rebound phenomenon that occurs in clients with Type 1 DM. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 AM. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia. *Tx:* decreasing the evening dose of intermediate-acting insulin or increasing the bedtime snack

Chvostek's Sign

A sign of hypocalcemia. A spasm of the fascial muscles elicited by tapping the facial nerve just anterior to the ear

Trousseau's Sign

A sign of hypocalcemia. Carpal spasm can be elicited by compressing the brachial artery with a blood pressure cuff for 3 minutes.

Opioid tolerance

A state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects over time

Syncope

A temporary loss of consciousness caused by decreased blood pressure

- pril

ACE Inhibitor ACE Cough - not a reason to withhold medication

What is the rationale for Alkaline phosphatase (ALP) assessment?

ALP is found in many tissues but in highest concentrations in the liver, biliary tract, and bone Detection of this enzyme is important for determining liver and bone disorders Enzyme levels of ALP are increased in both extrahepatic and intrahepatic obstructive biliary disease and cirrhosis and/or other liver abnormalties

Large Intestine

Absorbs water and eliminates waste Intestinal Bacteria play a role in some B vitamins and vitamin K

Med Surg Hypoventilation

Acidosis = too much CO2

What are the indications of rifampin?

Active tuberculosis (with other agents) Elimination of meningococcal carriers Prevention of disease caused by H. influenzae type B in close contacts (unlabeled use) Synergy with other antimicrobial agents for S. aureus infections (unlabeled use)

What are the indications for haloperidol?

Acute and chronic psychotic disorders including: schizophrenia, manic states, drug-induced psychoses Patients with schizoprenia who require long-term parenteral (IM) antipsychotic therapy Useful in managing aggressive or agitated patients Tourette's syndrome Severe behavioral problems in children which may be accompanied by: unprovoked, combative, explosive hyperexcitability, hyperactivity accompanied by conduct disorders Nausea and vomiting from surgery or chemotherapy

What drugs interact with Nonsteroidal Antiinflammatory Drugs (NSAIDs)?

Additive effects occur with alcohol, and increased risk for bleeding occurs with anticoagulants, aspirin and other salicylates, and corticosteroids Decreased effects occur in combination with hypotensive agents and diuretics Transient elevations in liver enzymes may occur NSAID-induced hyperkalemia or hyponatremia may occur

What drugs interact with antipsychotics?

Additive hypotension with acute ingestion of alcohol, antihypertensives, or nitrates Antacids may decrease absorption Phenobarbital may increase metabolism and decrease effectiveness Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, opioid analgesics, or sedative/hypnotics Lithium may decreased blood levels and effectiveness of phenothoazines Potential toxicity of beta blockers Excessive sedation, hypotension when used with opioids Diminished antiparkinson effects when used with levodopa/carbidopa

What drugs interact with antihistamines?

Additive sedation when used with other CNS depressants, including alcohol, antidepressants, opioid analgesics, and sedative/hypnotics MAO inhibitors prolong and intensify the anticholinergic properties of antihistamines

Evaluation for naloxone

Adequate ventilation Alertness without significant pain or withdrawal symptoms

ANTI-INFECTIVES

Adverse effects: - thrush, vaginal yeast infection, enteric colitis - Diarrhea (GI) - Hypotension if Rapid IV - Blood dyscrasias - Rashes, allergic rxn Tips: - Avoid alcohol *- take entire dose - Obtain cultures before starting med!!* Allergies (sulfa, PCN?)

Patient teaching for antituberculars

Advise patient of the importance of continuing therapy even after symptoms have subsided Emphasize the importance of regular follow-up exams to monitor progress and check for side effects Inform patients taking rifampin that saliva, sputum, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored

Patient teaching for Esomeprazole

Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly Advise patient to notify HCP if signs of hypomagnesemia (seizures, dizziness, abnormal or fast heartbeat, jitteriness, jerking movements or shaking, muscle weakness, spasms of the hands and feet, cramps or muscle aches, spasm of the voice box) occur Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding

Patient education for antiulcer agents

Advise patient to avoid alcohol, products containing aspirin, NSAIDs, and foods that may cause an increase in GI irritation Advise patient to report onset of black, tarry stools to health care professional promptly Inform patient that cessation of smoking may help prevent the recurrence of duodenal ulcers Caution patients to consult health care professional before taking antacids for more than 2 wk or if problem is recurring. Advise patient to consul health care professional if relief is not obtained or if symptoms of gastric bleeding Misoprostol may cause spontaneous abortion. Women of childbearing age must be informed of this effect through verbal and written information and must use contraception throughout therapy

Patient teaching for rifampin

Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur Caution patient to avoid the use of alcohol during this therapy (may increase risk of hepatotoxicity) Instruct patient to report the occurrence of flu-like symptoms promptly Rifampin may occasionally cause drowsiness Inform patient that saliva, sputum, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored May decrease the effectiveness of oral contraceptives Wear sunscreen

Patient teaching for haloperidol

Advise patient to take medication as directed Inform patient of possibility of extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome Advise patients to change positions slowly to minimize orthostatic hypotension may cause drowsiness. Caution patient to avoid driving or other activities requring alertness Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication advise patient to use sunscreen and protective clothing when exposed to the sun and avoid temperature extremes Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth

Patient teaching for antipsychotics

Advise patients to avoid hot baths, saunas, and hot climates with antipsychotics because of the risk of further drop in blood pressure ,especially upon standing (postural hypotension). INjury to self may occur due to dizziness or fainting Haloperidol and other antipsychotics must never be stopped abruptly because of the high risk of inducing a withdrawal psychosis Any sore throat, malaise, fever, or bleeding must be reported to the HCP immediately because of the drop in WBC counts with clozapine Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia Advise patient to make position changes slowly to minimize orthostatic hypotension Medication may cause drowsiness Avoid drinking alcohol or other CNS depressants concurrently with this medication Advise patientto use sunscreen and protective clothing when exposured to the sun to prevent photosenstivity reactions. Avoid extremes in temperature (impaired body temperature regulation) Instruct patient to use frequent mouth rinses, good oral hygiene, and surgarless gum or candy to minimize dry mouth

Patient teaching for metronidazole

Advise patients treated for trichomoniasis that sexual partners may be asymptomatic sources of reinfection and should be treated concurrently Caution patient to avoid intake of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment with metronidazole, including vaginal gel May cause dizziness or light-headedness. Caution paitent to avoid driving or other activities requiring alertness until response to medication is known Instruct patient to notify health care professional promptly if rash occurs Inform patient that medication may cause an unpleasant metallic taste Frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth Inform patient that medication may cause urine to turn dark Patients must avoid alcohol for 24 hours before initiation of therapy and for at least 36 hours after last dose

Patient teaching for proton-pump inhibitors

Advise the patient to contact the prescriber immediately if he or she experiences severe or prolonged constipation and/or diarrhea; increase in abdominal pain; abdominal distention; nausea; vomiting; hematemesis; or black, tarry stools

Patient teaching for Levodopa-Carbidopa (Sinemet)

After 5-10 years, the med is ineffective for Parkinson's

What drugs interact with benzodiazepines

Alcohol and CNS depressants, when coadministered, with benzodiazepines, can result in additive CNS depression and even death. More likely to occur in patients with renal and/or hepatic compromise Oral contraceptives, azole antifungals, SSRIs, verapamil, diltiazem, opioids, and valproic acid enhance benzodizepine effects because of impaired hepatic elimination of benzodiazepine Rifampin reduces therapeutic effects and enhances benzodiazepine clearance Theophylline reduces sedative effects phenytoin causes an increased risk for digoxin toxicity and phenytoin toxicity when given with benzodiazepines

What drugs interact with opioid analgesics?

Alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, and other central nervous system depressants can result in additive respiratory-depressant effects Monoamine oxidase inhibitors can result in respiratory depression and hypotension

Clonidine (Catapres)

Alpha 1 blocker, works on smooth muscle. It is CENTRALLY ACTING Patch - change weekly

What is the mechanism of action for haloperidol?

Alters the effects of dopamine in the CNS Has anticholinergic and alpha-adrenergic blocking activity Diminished signs and symptoms of psychoses Improved behavior in children with Tourette's syndrome or other behavioral problems

What are the adverse effects for antianxiety agents?

Amnesia Anorexia Sedation Lethargy Fatigue Confusion Drowsiness Dizziness Ataxia Headache Visual changes Hypotension Weight gain or loss nausea Weakness

Prothrombin time (PT) and International normalized ratio (INR)

Amount of time it takes in seconds for clot formation and is used to monitor response to warfarin sodium (coumadin) therapy or to screen for dysfunction of the extrinsic clotting system.

What is the mechanism of action of opioid drugs?

An agonist binds to an opioid pain receptor in the brain and causes an analgesic response-the reduction of pain sensation An agonist-antagonist, also called a partial agonist or a mixed agonist, binds to a pain receptor and causes a weaker pain response than does a full agonist An antagonist binds to a pain receptor but does not reduce pain signals. It functions as a competitive antagonist because it competes with and reverses the effects of agonist and agonist-angtagonist drugs at the receptor sites Suppress the medullary cough center, which results in cough suppression

BREAST CANCER dex the breast

Anastrazole (Arimi*dex*) Tamoxifen (Nolva*dex*) - weakness - nausea - hot flashes - PE - Stroke

Oncology Leukemia

Anemia (reduced RBC production), immunosuppression (neutropenia and immature WBC's), Hemorrahage and bleeding tendencies (thrombocytopenia) Acute Lymphocytic = most common type, kids, best prognosis

What is the function of Angiotensin II?

Angiotensin II is a potent vasoconstrictor and it stimulates the secretion of aldosterone, which leads to Na+ and H2O resorption

Administration of Esomeprazole

Antacids may be used while taking esomeprazole Administer at least 1 hr before meals. Delayed-release capsules can be placed in applesauce

Beta Blockers (-olol) Inderal / Propranolol Tenormin / Atenolol Lopressor / Metropolol

Anti-hypertension & Anti-dysrhythmic Decreases HR and BP - With vaso-dilation comes *broncho-constriction*: avoid in *asthma* patients - *masking tachycardia* in hypovolemia - *masking hypoglycemia* in T1DM

Neomycin Opthalmic Ointment in neonates

Anti-infective in case of STDs

What are the indications for antianxiety agents?

Antianxiety agents are used in the management of various forms of anxiety, including generalized anxiety disorder (GAD) Some agents are more suitable for intermittent or short-term use (benzodiazepines) while others are more useful long-term (buspirone, doxepin, fluoxetine, paroxetine, sertraline, venlafaxine)

What is the mechanism of action for parenteral anticoagulant drugs?

Anticoagulant drugs inhibit the action of or the formation of clotting factors and therefore prevent clots from forming and extending; they do not lyse existing clots All anticoagulants work in the clotting cascade but do so at different points Unfractionated heparin binds primarily to activated factors II, X, and IX Low molecular weight heparins (enoxaparin and dalteparin) are much more specific for activated factor X (Xa) than for activated factor II and therfore have a more predictable anticoagulant response, negating the necessity for laboratory monitoring The glycosaminoglycans (danaparoid and fondaparinux) prevent fibrin formation by inhibiting clotting factors Xa and IIa. Antithrombin drugs (desirudein, lepirudein, argatroban, bivalirudin, and antithrombin III inhibit the thrombin molecules directly to prevent clot formation

What is the manifestation of action for oral anticoagulant drugs?

Anticoagulant drugs inhibit the action of or the formation of clotting factors and therefore prevent clots from forming or extending; they do not lyse existing clots All anticoagulants work in the clotting cascade but do so at different points Warfarin (Coumadin) works by inhibiting vitamin K synthesis by bacteria in the GI tract. This, in turn, inhibits production of clotting factors II, VII, IX, and X

What are the therapeutic effects for anticonvulsants?

Anticonvulsants are used to decrease the incidence and severity of seizures due various etiologies Some anticonvulsants are used parenterally in the immediate treatment of seizures

What is the mechanism of action for anticonvulsants?

Anticonvulsants include a variety of agents, all capable of depressing abnormal neuronal discharges in the CNS that may result in seizures they may work by preventing the spread of seizure activity, depressing the motor cortex, raising seizure threshold, or altering levels of neurotransmitter, depending on the group

Diflucan

Antifungal: Monitor liver enzymes while on this medication

What is the mechanism of action for antihistamines?

Antinhistamines block the effects of histamine at the H1 receptor They do not block histamine release, antibody production, or antigen-antibody reactions Most antihistamines have anticholinergic properties and may cause constipation, dry eyes, dry mouth, and blurred vision. Many antihistamines cause sedation Some phenothiazines have strong antihistamine properties Circulating histamine molecules bind to histamine receptors on basophils and mast cells. This stimulates further release of histamine stored within these cells Antihistamine drugs work by blocking the histamine receptors on the surfaces of basophils and mast cells, thereby preventing the release and actions of histmaine stored within these cells

Left hemisphere lesion

Aphasia, agraphia, slow, cautious, anxious, memory okay

Patient teaching for naloxone

As medication becomes effective, explain purpose and effects of naloxone to patient

Nursing implications for Aminoglycoside antibiotics

Assess allergies prior to administration and assess for allergic reaction after administration Assess baseline hearing and renal function Monitor for signs and symptoms of nephrotoxicity and ototoxicity Draw a trough blood level at least 18 hr after completing the dose (closer to 24 hr for renally impaired patients). The therapeutic goal is a trough level at or below 1 mcg/mL. Trough levels > 2 mcg/mL are associated with greater risk for ototoxicity and nephrotoxicity Maintain adequate hydration (up to 3000 mL/day) give IM injections deeply and slowly (minimize discomfort) IV over 30-60 min for adults and 60-120 min for infants/children

Assessment for antihistamines

Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically throughout therapy Monitor pulse and blood pressure before initiating and throughout IV therapy Assess lung sounds and character of bronchial secretions Maintain fluid intake of 1500-2000 mL/day to decrease viscosity of secretions assess degree of nausea and frequency and amount of emesis when administering for nausea and vomiting Assess mental status, mood, and behavior when administering for anxiety observe the character, location, and size of affected area when administered for pruritic skin conditions

Assessment for selective serotonin reuptake inhibitors (SSRIs)

Assess and document neuromuscular and gastrointestinal systems Cautious use in the elderly is recommended due to their increased risk for toxicity Contraindications include the use of these drugs within 14 days of use of MAOIs and with some antipsychotic deugs

Nursing implications for Angiotensin II Receptor Blockers (ARBs)

Assess blood pressure and apical pulse prior to administration Know that the dose may have to be reduced if the patient has hypovolemia or hepatic dysfunction Monitor for angioedema and notify the HCP immediately if it occurs Monitor fluid volume status

Nursing implications for B-blockers

Assess blood pressure, apical pulse, and respiratory status prior to administration Hold medication if blood pressure < 100 mmHg or HR is < 60 bpm and notify HCP Monitor daily weights and fluid volume status

Nursing Implications for ACE inhibitors

Assess blood pressure, apical pulse, and respiratory status prior to administration Withhold medication if serum K+> 5 mEq/L and notify HCP Monitor for angioedema and notify HCP immediately if it occurs Monitor sodium and fluid volume status Monitor dietary and fluid intake because ACE inhibitors can cause anorexia secondary to impaired taste Assess serum K+, Na+,and Cl- levels Assess complete blood count before and during therapy

Nursing implications for Hydantoin Antiepileptic drugs

Assess complete blood count, serum chemistry, and drug levels prior to administration. Know that therapeutic drug levels are usually 10-20 mcg/mL Know that 150 mg of fosphenytoin yeild 100 mg of phenytoin and that the concentration and infusion rate of fosphenytoin would be expressed as a phenytoin equivalent (PE) Administer phenytoin no faster than 50 mg/min and fosphenytoin at 150 mg PE/min to avoid hypotension or cardiorespriatory depression Dilute phenytoin only with normal saline solution. Flush intravenous lines with saline before and after administration Monitor the patient for ataxia and dizziness after an infusion Do not confuse fosphenytoin (Cerebyx) with Celebrex Administer oral dosage forms of the drug with food. Instruct the patient not to open, chew, or break capsules; however, the non-sustained-release tablets may be chewed

Nursing implications for loop diuretics

Assess fluid volume status via vital signs, intake and output, daily weights, skin turgor, mucous membranes, and capillary refill Assess serum potassium sodium, chloride, magnesium, calcium, and serum creatinine levels Administer in the morning to prevent nocturia Monitor the patient for signs of hypokalemia Assess therapeutic effectiveness as evidenced by resolution of or reduction in edema, fluid volume overload, heart failure, and hypertension

Assessment of metronidazole

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results Monitor neurologic status during and after IV infusions Monitor intake and output and daily weight, especially for patients on sodium restriction Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia

Nursing implications for Calcium Channel Blockers (Class IV antiarrhythmics)

Assess heart rate, blood pressure, and rhythm before administration. Hold dose and notify the HCP if heart rate is < 60 bpm or systolic blood pressure is < 90 mmHg (or according to institutional policy) Monitor electrocardiogram continuously if intravenous infusion, and initially if oral therapy. Monitor for prolongation of PR interval or AV block. Discontinue medication and notify the HCP if these occur Use an infusion pump when administering intravenously Assess for clinical manifestations of toxicity, such as hypotension, bradycardia, heart failure, and conduction disorders Assess therapeutic effectiveness as evidenced by improved cardiac output and decreased chest discomfort and fatigue; and note improved vital signs, skin color, and urinary output

Assessment of haloperidol

Assess mental status prior to and periodically during therapy Assess positive (hallucination, delusions) and negative (social isolation) symptoms of schizophrenia monitor BP and pulse prior to and frequently during the period of dose adjustment (may cause QT interval changes) Monitor intake and output ratios and daily weight. Assess patients for signs and symptoms of dehydration (decreased thirst, lethargy, hemoconctrration) Monitor patient for onset of akathisia, which may appear within 6 hr of the 1st dose Observe closely for extrapyramidal side effects (parkinsonian) Monitor for tardive dyskinesia Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction) Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension

Nursing implications for Sodium Channel blockers (Class I antiarrhythmics)

Assess patient's heart rate and rhythm before administering. Hold the dose and notify the health care provider if the rate is less than 60 (or according to institutional policy) Monitor electrocardiogram continuously if administering an intravenous infusion and monitor it initially if administering oral therapy. Monitor for lengthening of QT level, PR segment, and QRS. Discontinue medication and notify the health care provider if lengthening occurs Use infusion pump when administering intravenously Assess for clinical manifestations of toxicity

Nursing implications for oral anticoagulant drugs

Assess prothrombin time and internationalized normalized ratio (INR) prior to administration and periodically so as to adjust dosages Monitor patient for signs of blood loss (petechiae, bleeding, bruises, dark stools, dark urine) Evaluate all drugs ordered for potential drug-drug interactions that may necessitate dose changes Administer at the same time each day to maintain constant serum levels If switching from heparin to Coumadin, be away that it may take 4-5 days for a therapeutic response to coumadin to occur; concurrent use of heparin may be needed in the interim Maintain vitamin K on standby in case of overdose Assess therapeutic effectiveness as evidenced by INR of 2-3

Assessment for Esomeprazole

Assess routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis May cause increased serum creatinine, uric acid, total bilirubin, alkaline phosphatase, AST, and ALT May cause hypomagnesemia

Nursing implications for thrombolytic drugs

Assess the patient carefully for contraindications prior to administration Assess any arterial puncture, venous cutdown sites, PICC line sites, and central infusion ports and sites for bleeding Avoid invasive procedures and simultaneous use of anticoagulants or antiplatelet drugs during the use of these medications Report any bleeding from gums or mucous membranes and the occurrence of epitasix and increased pulse (greater than 100 beats per minute) to the health care provider immediately Monitor all vital signs frequently, including cardiac rhythm Monitor for hypotension, restlessness, and decrease in hemoglobin and hematocrit Report any changes to the HCP immediately Monitor INR, aPTT, platelets, and fibrinogen levels Institute safety precautions that help patient to avoid injury and subsequent bleeding

Assessment for morphine sulfate

Assess type, location, and intensity of pain prior to and 1 hr following PO, subcut, IM, and 20 min following IV administration Patients on a continuous infusion should have additional bolus every 15-30 min (breakthrough pain) Assess level of consciousness, BP, pulse, and respiration before and periodically during administration. if respiratory rate is < 10/min, assess level of sedation Prolonged use may lead to physical and psychological dependence and tolerance Assess bowel function routinely. Institute prevention of constipation with increased intake of fluids and bulk with laxatives to minimize constipating effects May increase plasma amylase and lipase levels

Nursing implications for opioid analgesics

Assess vital signs (blood pressure, pulse, respirations, and pain level) prior to administration Withhold medication if respiratory rate is < 12 breaths/min or systolic blood pressure is < 90 Administer oral medications with food to decrease nausea and vomiting Monitor urinary output and bowel status Institute safety precautions (side rail up, call bell in place)

Nursing implications for Beta-Agonist (Sympathomimetic) Bronchodilators

Assess vital signs and breath sounds before and after administration Monitor for adverse effects, includeing tachyarrhythmias, chest pain, restlessness, agitation, nervousness, and insomnia Allow 1 minute in between puffs, and use a spacer if necessary to increase the amount of drug delivered Do not allow crushing or chewing of oral sustained-release tablets. They should be taken with food if gastrointestinal upset occurs Make sure the patient rinses the mouth with water immediately after inhaling the drug so as to prevent oral dryness and irritation

Nursing process

Assessment, Diagnosis (analysis), Planning, Implementation (treatment), Evaluation

PR Interval

Atrial Activation to Ventricular Activation 0.12-0.20 Seconds

Drugs that Dilate Pupils

Atropine Scopolamine Amphetamines Mydriatics Cycloplegics

Patient teaching for parenteral anticoagulant drugs

Avoid anything that may cause an injury that could lead to bleeding (going barefoot, playing contact sports, using a straight razor, using a hard toothbrush) Wear a MedicAlert bracelet Report unusual bleeding, black or bloody stools, dark urine, sore throat, fever, chills, severe headaches, and dizziness Inform your dentist and other health care providers about your anticoagulant therapy

What are the therapeutic effects of B-blockers?

B-blockers are useful in the treatment of angina, coronary artery disease, cardiac arrhythmias, and hypertension Topical B-blockers are effective in treating glaucoma Treatment of MI and essential tremor Treatment of migraine headache (not approved)

What is the mechanism of action of B-blockers?

B-blockers block the sympathetic nervous system's stimulation of the B-adrenergic receptors by competing with endogenous epinephrine and norepinephrine B1-receptors are located primarily on the surface of the heart and B2-receptors are located on the smooth muscles of the bronchioles and blood vessels Cardioselective B-blockers inhibit primarily B1-receptors, decreasing myocardial stimulation which reduces HR, conductivity, and contractility Non-selective B-blockers also block the B2-receptors in the lungs, potentially leading to bronchospasm

What drugs interact with anticonvulsants?

Barbiturates stimulate the metabolism of other drugs that are metabolized by the liver, decrease their effectiveness Hydantoins are highly protein-bound and may displace or be displaced by other highly protein-bound drugs Lamotrigine, tiagabine, and topiramate are capable of interacting with several other anticonvulsants Many drugs are capable of lowering seizure threshold and may decrease the effectiveness of anticonvulsants, including tricyclic antidepressants and phenothiazines

How do you know if a drug is an HMG-CoA Reductase Inhibitor?

Because the generic name of these medications ends in -statin, they are collectively referred to as the statin drugs

What is the mechanism of action for tricyclic antidepressants (TCAs)?

Believed to work by correcting imbalance in the neurotransmitter concentrations of serotonin and norepinephrine at the nerve endings in the CNS. This is accomplished by blocking the presynaptic reuptake of the neurotransmitters, which makes them available for transmission of nerve impulses to adjacent neurons in the brain

What drugs interact with antianxiety agents?

Benzodiazepines: additive CNS depression with alcohol, antihistamines, some antidepressants, opioid analgesics, or phenothiazines may occur Most agents should not be used with MAO inhibitors

What is the mechanism of action for pregabalin?

Binds to calcium channels in CNS tissues which regulate neurotransmitter release Does not bind to opioid receptors Decreased neuropathic or post-herpetic pain Decreased partial-onset seizures

What is the mechanism of action of morphine sulfate?

Binds to opiate receptors in the CNS Alters the perception of an response to painful stimuli while producing generalized CNS depression Decrease in severity of pain Addition of naltrexone in Embeda product is designed to prevent abuse or misuse by altering the formulation naltrexone has no effect unless the capsule is crushed or chewed

What are the adverse effects for parenteral anticoagulant drugs?

Bleeding HIT Hematoma Nausea/vomiting Anemia Fever Edema Insomnia Headache Dizziness Rash Pruritus Constipation Injection site pain Joint pain Asthenia Urinary retention or UTI Dizziness Chest discomfort Chills Shortness of breath Urticaria Heart and kidney failure (with lepirudin, argatroban) Cardiac arrhythmias (with argatroban) Hypotension (with argatroban and bivalirudin)

What is the mechanism of action for antipsychotics?

Block dopamine receptors in the brain, which decreases the dopamine concentration in the CNS Alter dopamine release and turnover Peripheral effects include anticholinergic properties and alpha-adrenergic blockagde

What is the mechanism of action for acetaminophen (tylenol)?

Blocks peripheral pain impulses by inhibition of prostaglandin synthesis lowers febrile body temperatures by acting on the hypothalamus, the structure in the brain that regulates body temperature. Heat is dissipated through vasodilation and increased peripheral blood flow

What is the mechanism of action of Labetalol?

Blocks stimulation of B1 (myocardial) and B2 (pulmonary, vascular, and uterine)-adrenergic receptor sites Also has alpha1-adrenergic blocking activity, which may result in more orthostatic hypotension

Human immunodeficiency virus (HIV)

Blood Borne (blood, vaginal fluids, semen, breast milk) *P:* Retrovirus converts its own RNA to DNA, Decreases in helper T cells. Serologically 4-7 weeks can be up to years. *S/S:* Weight Loss; Annorexia; Kaposi sarcoma; Vesicular and ulcerative lesions perianal; loss of vision

Atropine

Bradycardia Heart Block

What are the adverse effects of B-blockers?

Bradycardia Heart failure Dizziness Depression Bronchospasms Lethargy Nausea Dry mouth Constipation Diarrhea Cramps Ischemia colitis Agranulocytosis Thrombocytopenia Impotence Rash Alopecia Hypotension Atrioventricular block Fatigue hyperglycemia/hypoglycemia Hypolipodemia Wheezing Dyspnea

What are the adverse effects of Cardiac Glycosides?

Bradycardia or tachycardia Anorexia Nausea Vomiting Diarrhea Colored vision (green, yellow, or purple) Haloed vision Flickering lights Headache Fatigue Malaise Confusion Convulsions Hypokalemia increases the risk for toxicity

Cerebral Death (Irreversible coma)

Brain Death with normal homeostasis controls (respiration, heart rate, temperature control, GI)

What drugs interact with Cardiac Glycosides?

Bran may decrease the absorption of oral digitalis drugs Increased risk for toxicity occurs with loop diuretics, adrenergic drugs, laxatives, thiazide diuretics, quinidine, verapamil, amiodarone, succinylcholine, and amphotericin B Increased therapeutic effects occur with anticholinergics, calcium channel blockers, and beta-blockers Decreased therapeutic effects occur with barbiturates, antacids, antidiarrheals, colestipol, cholestyramine, and the herbal supplement hawthorn

RESPIRATORY Glucocorticoids Ipratorium (Atrovent)

Bronchi-dilation: relaxes bronchial smooth muscle Slower acting than albuterol *no tachycardia*

What is the mechanism of action of barbiturates?

CNS depressants that act primarily on the brainstem in an area called the reticular formation Act by reducing the nerve impulses traveling to the area of the brain called the cerebral cortex

What are adverse effects of opioid analgesics?

CNS depression Respiratory depression Hypotension Flushing palpitations Constipation nausea and vomiting Urinary retention Itching Rash Biliary tract spasm

What are the adverse effects for benzodiazepines?

CNS: CNS depression, hyperactivity and aggressive behavior (paradoxical excitement or nervousness), rebound disinhibition, amnesia, sedation, dizziness (vertigo), lethargy, fatigue, confusion, drowsiness, ataxia, headache ENNT: visual changes GI: anorexia, weight gain or loss, nausea MS: Weakness CV: hypotension

What are the adverse effects of barbiturates?

CNS: Drowsiness, lethargy, vertigo CV: vasodilation and hypotension, especially if given too rapidly GI: nausea, vomiting, diarrhea, constipation Hem: Agranulocytosis, thrombocytopenia Resp: respiratory depression, cough Hypersensitivity reactions: urticaria, angioedema, rash, fever, Stevens-Johnson syndrome

What are adverse effects of opioids?

CNS: Sedation, disorientation, euphoria, light-headedness, dysphoria CV: Hypotension, flushing, bradycardia GI: nausea, vomiting, constipation, biliary tract spasm GU: urinary retention Derm: Itching, rash, wheal formation Resp:Respiratory depression and possible aggravation of asthma

What are the adverse effects of rifampin?

CNS: ataxia, confusion, drowsiness, fatigue, headache, weakness Derm: rash, pruritus EENT: red discoloration of tears GI abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, increased liver enzymes, red discoloration of saliva, can cause vision loss in patient with optic neuritis GU: red discoloration of urine, tears, sweat, sputum Hemat: hemolytic anemia, thrombocytopenia MS: arthralgia, muscle weakness, myalgia Flu-like syndrome, hepatitis

What are the adverse effects for morphine sulfate?

CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams EENT: bluured vision, diplopia, miosis Resp: Respiratory depression CV: hypotension, bradycardia GI: constipation, nausea, vomiting GU: urinary retention Derm: flushing, itching, sweating Physical dependence, psychological dependence, tolerance

What are the adverse effects of Angiotensin II Receptor Blockers (ARBs)?

CNS: dizziness, anxiety, depression, fatigue, headache, insomnia, weakness CV: hypotension, chest pain, edema, tachycardia Derm: rashes EENT: nasal congestion, pharyngitis, rhinitis, sinusitis GI: abdominal pain, diarrhea, drug-induced hepatitis, dyspepsia, N/V GU: Impaired renal function MS: Arthralgia, back pain, myalgia Resp: cough, upper respiratory infections, dyspnea Hyperkalemia, angioedema

What are the adverse effects of Buspirone?

CNS: dizziness, drowsiness, excitement, fatigue, headache, insomnia, nervousness, weakness, personality changes, paradoxical anxiety EENT: blurred vision, nasal congestion, sore throat, tinnitus, altered taste or smell, conjunctivitis Resp: chest congestion, hyperventilation, shortness of breath CV: chest pain, palpitations, tachycardia, hypertension, hypotension, syncope GI: nausea, abdominal pain, constipation, diarrhea, dry mouth, vomiting GU: changes in libido, dysuria, urinary frequency, urinary hesitancy Derm: rashes, alopecia, blisters, dry skin, easy bruising, edema, flushing, pruritus Endo: irregular menses MS: myalgia Neuro: incoordination, numbness, paresthesia, tremor Clamminess, sweating, fever

What are the adverse effects of ACE inhibitors?

CNS: dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness, mood changes Resp: Dry nonproductive cough, dyspnea CV: First-dose hypertension, chest pain, edema, tachycardia Endo: hyperuricemia, hyperkalemia GI: taste disturbances, abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting GU: erectile dysfunction, proteinuria, renal dysfunction Derm: flushing, pruritus, rashes Hem: Agranulocytosis, neutropenia, thrombocytosis, anemia MS: back pain, muscle cramps, myalgia Angioedema, fever

What are the adverse effects of antipsychotics?

CNS: drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, and tardive dyskinesia Pseudoparkinsonism (akathisia and acute dystonia) CV: postural hypotension Prolonged QT interval

What are the adverse effects of Labetalol?

CNS: fatigue, weakness, anxiety, depression, drowsiness, insomnia, memory loss, mental status changes, nightmares EENT: blurred vision, dry eyes, intraoperative floppy iris syndrome, nasal stuffiness Resp: bronchospasm, wheezing CV: arrhythmias, bradycardia, CHF, pulmonary edema, orthostatic hypotension GI: constipation, diarrhea, nausea GU: Erectile dysfunction, decreased libido Derm: itching, rashes Endo: hyperglycemia, hypoglycemia MS: arthralgia, back pain, muscle cramps Neuro: paresthesia

What are the adverse effects of Esomeprazole?

CNS: headache GI: pseudomembranous colitis, abdominal pain, constipation, diarrhea, dry mouth, flatulence, nausea F and E: hypomagnesemia (especially if treatment duration > 3 mo) MS: bone fracture

What are the adverse effects of Beta-Lactam Antibiotics?

CNS: lethargy, hallucinations, anxiety, depression, twitching, coma, and convulsions GI: nausea, vomiting, diarrhea, increased levels of aspartate aminotransferase and alanine transaminase, abdominal pain, and colitis Hem: anemia, increased bleeding time, bone marrow depression, and granucolytopenia Metabolic: hyperkalemia, hypokalemia, and alkalosis Taste alterations, soreness in mouth, dark discolored or sore tongue, hives, and rash

What are the adverse effects of risperidone?

CNS: neuroleptic malignant syndrome, suicidal thoughts, aggressive behavior, dizziness, extrapyramidal reactions, headache, increased dreams, increased sleep duration, insomnia, sedation, fatigue, impaired temperature regulation, nervousness, tardive dyskinesia EENT: pharyngitis, rhinitis, visual disturbances Resp: cough, dyspnea CV: arrhythmias, orthostatic hypotension, tachycardia GI: constipation, diarrhea, dry mouth, nausea, weight gain, abdominal pain, anorexia, dyspepsia, polydipsia, increased salivation, vomiting, weight loss GU: decreased libido, dysmenorrhea/menorrhagia, difficulty urinating, polyuria, priapism Derm: itching/skin rash, dry skin, increased pigmentation, sweating, photosensitivity, seborrhea Endo: dyslipidemia, galactorrhea, hyperglycemia Hemat: agranulocytosis, leukopenia, neutropenia MS: arthralgia, back pain, elevated prolactin levels

What are the adverse effects of metronidazole?

CNS: seizures, dizziness, headache, aseptic meningitis (IV), encephalopathy (IV) EENT: optic neuropathy, tearing (topical only), nasal congestion GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Derm: Stevens-Johnson syndrome, rash, urticardia (topical only), burning, mild dryness, skin irritation, transient redness Hemat: leukopenia, reversible neutropenia and thrombocytopenia Local: phlebitis at IV site Neuro: peripheral neuropathy Superinfection

What are the adverse reactions of haloperidol?

CNS: seizures, extrapyramidal reactions, confusion, drowsiness, restlessness, tardive dyskinesia, akisthesia, headache EENT: blurred vision, dry eyes Resp: respiratory depression CV: hypotension, tachycardia, ECG changes (QT prolongation, torsade de pointes), ventricular arrythmias GI: constipation, dry mouth, anorexia drug-induced hepatitis, ileus, weight gain GU: impotence, urinary retention Derm: diaphoresis, photosensitivity, rashes, edema Endo: Amenorrhea, galactorrhea, gynecomastia Hemat: agranulocytosis, anemia, leukopenia, neutropenia Metab: hyperpyrexia Neuroleptic malignant syndrome, hypersensitivity reactions

What are the adverse effects of pregabalin?

CNS: suicidal thoughts, dizziness, drowsiness, impaired attention/concentration/thinking CV: edema EENT: blurred vision GI: dry mouth, abdominal pain, constipation, increased appetite, vomiting Hemat: thrombocytopenia Metab; weight gain Allergic reactions, fever

What drugs interact with antiulcer agents?

Calcium- and magnesium-containing antacids decrease the absorption of tetracycline and fluoroquinolones Cimetidine inhibits the ability of the liver to metabolize several drugs, increases the risk of toxicity from warfarin, tricyclic antidepressants, theophylline, metoprolol, phenytoin, propranolol, and lidocaine Omeprazole decrease metabolism of phenytoin, diazepam, and warfarin All agents that increase gastric pH will decrease the absroption of ketoconazole and some of the protease inhibitors (atazanavir)

What drugs interact with naloxone?

Can precipitate withdrawal in patients physically dependent on opioid analgesics Larger doses may be required to reverse the effects of busprenorphine, butorphanol, nalbuphine, or phentazocine Antagonizes postoperative opioids analgesics

Right hemisphere lesion

Can't recognize faces, loss of depth perception, impulsive behavior, confabulates, poor judgement, constantly smiles, denies illness, loss of tonal hearing

What is the mechanism of action of Cardiac Glycosides?

Cardiac glycosides alter the electrochemical properties of the myocardium, affecting the conduction system and cardiac automaticity

What are the precautions of naloxone?

Cardiovascular disease patients physically dependent on opioids (may precipitate severe withdrawal) May cause acute withdrawal syndrome in mother and fetus if mother is opioid dependent Lactation safety not established May cause acute withdrawal syndrome in neonates of opioid-dependent mothers

Herbal Meds: Precautions

Caution if pt. has - HTN - Renal, Liver disease Drug interactions are many, including *Dilantin, Coumadin*

Where do cephalosporins come from?

Cephalosporins are semisynthetic antibiotic derivatives also derived from mold

Sinemet (antiparkinsons)

Change positions slowly

Anti-coagulants Labs

Check for bleeding; Avoid leafy greens; use electric razor, and soft tooth brush; PT (normal 12-14 sec); I.N.R (0.9-1.1) therapy 2.0-3.0, and check coumadin levels

Restraints

Check restraints every 30 minutes/2 fingers room underneath

what drugs interact with acetaminophen (tylenol)?

Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use Other hepatotoxic drugs need to be avoided

What drugs interact with metronidazole?

Cimetidine may decrease metabolism Phenobarbital and rifampin increase metabolism and may decrease effectiveness Metronidazole increases the effects of phenytoin, lithium, and wafarin Disulfiram-like reaction may occur with alcohol ingestion May cause acute psychosis and confusion with disulfiram Increased risk of leukopenia with fluorouracil or axathioprine Increased risk of lithium toxicity, benzodiazepines, cyclosporine, CCBs, various antidepressants, and warfarin toxicity

What is the mechanism of action for Sodium Channel Blockers (Class I antiarrhythmics)?

Class I antiarrhythmics work to correct abnormal cardiac electrophysiologic function by stabilizing the cardiac membrane and slowing conduction in the atria, atrioventricular node, and ventricles they exert their actions by blocking the sodium (fast) channels there are some slight differences in the actions of the drugs in this class, so there are three subgroups of the drugs, depending on the magnitude of their effects on phase 0, the action potential duration (APD), and the effective refractory period (ERP)

What is the mechanism of action of Calcium Channel Blockers (Class IV antiarrhythmics)?

Class IV antiarrhythmics work specifically by blocking the inward flow of calcium ions into the slow (calcium) channels in cardiac conduction tissue The conduction effects of these drugs are limited to the atria and the atrioventricular (AV) node, where conduction is prolonged and the tissues are made for refractory to stimulation, resulting in negative chronotropic, inotropic, and dromotropic actions

How to mix insulin

Clear before cloudy because you want the cloudy to be injected into the body before the clear.

Patient teaching for insulin therapy

Closely monitor the capillary blood glucose levels Know the signs and symptoms of hyperglycemia and hypoglycemia. proper management of both is important The conditions that lead to altered serum glucose levels include fever, illness, stress, increased activity and exercise, surgery, and emotional distress. Be sure to contact a HCP if these conditions occur

What drugs interact with opioids?

Co-administration of opioids with alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, and other CNS depressants can result in additive respiratory depressant effects

Sucralfate (Pepto)

Coats inside of stomach

Echinacea Intended effect

Cold/ infection; cold sore

GOUT DRUGS - colochine - allopurinol (zyloprim)

Colochine - treat attacks - side effects: diarrhea, n/v - monitor CBC: ~ aplastic anemia ~ agranuloytosis Alloputinol - prophylaxis - rash - flu like symptoms

ANTI-TUBERCULOSOS AGENTS (3)

Combination therapy *12-18 mo.* Iso-Nicotonic Acid (Idoniazid) - B1 (pyridoxine) deficiency. Rx. vitamin Ethambutol (Myambutol) - eye: decreased color vision Rifampin (Rifadin) - red urine, sweat, salive

Bladder infection

Common cause of death (try to keep urine acidic)

IgE

Common in allergic responses Defense against parasites

What are the indications for Benzodiazepines?

Commonly used for sedation, relief of agitation or anxiety, treatment of anxiety-related depression, sleep induction, skeletal muscle relaxation, and treatment of acute seizure disorders Used in the treatment and prevention of the symptoms of alcohol withdrawal, insomnia and muscle spasms, seizure disorders, and adjuncts in anesthesia Commonly used in therapy for depression because depressive and anxious symptoms often occur together

Spinal shock

Complete loss of all reflex, motor, sensory and autonomic activity below the lesion; medical emergency

Locked-in syndrome

Complete paralysis of voluntary muscles with the exception of eye movement. Perception and emotions intact

What drugs interact with pregabalin?

Concurrent use with thiazolidinediones (pioglitazone, rosiglitazone) may increase risk of fluid retention Increased risk of CNS depression with other CNS depressants including opioids, alcohol, benzodiazepines, or other sedatives/hypnotics

S/S Hypoglycemia

Confusion, jittery, shaking, sweaty, CNS related is 1st sign , hungry, weak or tired, headache, Nervous or upset

Administration of ACE inhibitors

Contact HCP immediately if angioedema occurs If drug is discontinued, weaning is recommended to avoid rebound hypertension Serum potassium levels increase as an adverse effect, resulting in hyperkalemia and possible complications Takes several weeks to see full therapeutic effects K+ supplements are not needed with ACE inhibitors because of adverse effect of hyperkalemia

CABG

Coronary Artery Bypass Graft

Skin tastes salty

Cystic fibrosis

What are the precautions for haloperidol?

Debilitated patients (dose decrease needed) Cardiac disease (risk for QT prolongation with high doses) Diabetes Respiratory insufficiency prostatic hyperplasia CNS tumors Intestinal obstruction Seizures

What are the precautions for risperidone?

Debilitated patients, patient with renal or hepatic impairment (initial dose reduction recommended0 Underlying cardiobascular disease (increased risk of arrhythmias and hypotension) History of seizures History of suicide attempt or drug abuse Diabetes or risk factors for diabetes (may worsen glucose control) Patients at risk for aspiration OB, pediactric safety not established

Evaluation of Esomeprazole

Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy Decrease in symptoms of GERD and erosive esophagitis Eradication of H. pylori Decreased incidence of gastric ulcer during continuous NSAID therapy

Evaluation of antihistamines

Decrease in allergic symptoms Prevention or decreased severity of nausea and vomiting Decrease in anxiety Relief of pruritus Sedation when used as a hypnotic

Evaluation of antianxiety agents

Decrease in anxiety level Improved mental alertness, cognition, and mood Fewer anxiety and panic attacks Improved sleep patterns and appetite

Evaluation of antipsychotics

Decrease in excitable, paranoic, or withdrawn behavior Relief of nausea and vomiting Relief of intractable hiccupsa

Evaluation of pregabalin

Decrease in intensity of chronic pain Decrease in the frequency or cessation of seizures

What are the therapeutic effects of HMG-CoA reductase inhibitors?

Decrease in plasma concentration of low-density lipoproteins (LDLs; bad cholesterol) and triglyerides and the increase in plasma concentration of high-density lipoproteins (HDLs; good cholesterol)

Evaluation of morphine sulfate

Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status Decrease in symptoms of pulmonary edema

Evaluation of anticonvulsants

Decrease or cessation of seizures without excessive sedation

What is the mechanism of action for antiulcer agents?

Decreased acid secretion, or protecting the ulcer surface from further damage Histamine H2-receptor antagonists competitively inhibit the action of histamine at the H2-receptor, located primarily in the gastric parietal cells, resulting in inhibition of gastric acid secretion

What are the threapeutic effects of miotics?

Decreased aqueous humor of the eye with resultant decreased intraocular pressure and decreased signs, symptoms, and long-term effects associated with glaucoma beta-adrenergic blockers are therapeutic if there is a resultant decrease in intraocular pressure

What drugs interact with B-blockers?

Decreased effects occur when given with anticholinergic drugs and antacids Increased hypotensive effects occur when given with other antihypertensive drugs and diuretics Decreased hypoglycemic effects occur when used concurrently with oral hypoglycemic drugs Prolonged neuromuscular blockade occurs when given with neuromuscular blocking drugs May antagonize the therapeutic effects of bronchodilators Cimetidine may decrease the metabolism and increase the effects of some B-blockers

Evaluation for rifampin

Decreased fever and night sweats Diminished cough and sputum production negative sputum cultures Increased appetitie Weight gain Reduced fatigue Sense of well-being in patients with tuberculosis prevention of meningococcal meningitis Prevention of H. influenzae type B

What drugs interact with Esomeprazole?

Decreased levels of atazanavir and nelfirnavir (avoid concurrent use with either of these antiretrovirals) May increase levels and risk of toxicity of saquinavir (may need to decrease dose of saquinavir) May decrease absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin, and iron salts may increase risk of bleeding with warfarin Voriconazole may increase levels May decrease the antiplatelet effects of clopidogrel; avoid concurrent use may increase levels of cilostazol Rifampin may decrease levels and may decrease response Hypomagnesemia increases risk of digoxin toxicity May increase levels of tacrolimus and methotrexate St. John's wort may decrease levels and may decrease response

Topamax

Decreases dilantin levels; so check dilantin levels

What is the mechanism of action of miotics?

Direct- and indirect-acting miotics have effects similar to those of acetylcholine, but their actions are more prolonged the direct acting miotics are able to directly stimulate ocular cholinergic receptors and mimic acetylcholine Indirect-acting miotics work by binding to an inactivating the cholinesterases acetylcholinesterase and pseudocholinesterase, the enzymes that break down acetylcholine

What are the adverse effects of loop diuretics?

Dizziness Headache Tinnitus (ototoxicity) Blurred vision Nausea Vomiting diarrhea Bone marrow suppression Hypokalemia Hyperglycemia Hyperuricemia

What are symptoms of ototoxicity?

Dizziness Tinnitus A sense of fullness in the ears Hearing loss

Patient teaching for Nonsteroidal antiinflammatory Drugs (NSAIDs)

Do not crush or chew any sustained-release or enteric-coated aspirin The adverse effects important to report include ringing in the ears, persistent gastrointestinal or abdominal pain, and easy bruising or bleeding there is a difference in the onset of action when treating acute pain as opposed to chronic pain (arthritis) for which a therapeutic effect may take 3-4 weeks Inform your HCP and dentists of NSAID use It is important to take an NSAID with milk, food, or an antacid so as to minimize adverse GI effects

Patient teaching for opioid analgesics

Do not use with alcohol or other depressants of the CNS Take before pain becomes severe Report any dizziness, difficulty in breathing, low blood pressure, or excessive sedation to the health care provider It is important to pay attention to your own safety while taking opioids in the home setting. Be sure to ambulate and perform activities with cuation

Insulin draw

Draw regular (clear) insulin into syringe first when mixing insulins

What are the contraindications for Angiotensin II Receptor Blockers (ARBs)?

Drug allergy 2nd and 3rd trimester pregnancy and lactation Elderly Renal dysfunction

What are contraindications for HMG-CoA reductase inhibitors?

Drug allergy Advanced age Renal dysfunction Hepatic dysfunction

What are the contraindications for ACE inhibitors?

Drug allergy Hyperkalemia Bilateral renal stenosis Pregnancy Laceration (hypovolemia) Lactation Hepatic impairment Hyponatremia Concurrent diuretic therapy

What are contraindications for Nonsteroidal Antiinflammatory Drugs (NSAIDs)?

Drug allergy Rhinitis Vitamin K deficiency Peptic ulcer disease Pregnancy Lactation Severe renal and hepatic disease

What are the contraindications for opioid analgesics?

Drug allergy Severe asthma or other respiratory insufficiency Increased intracranial pressure Myasthenia gravis Paralytic ileus Acute abdominal conditions Pregnancy Lactation

What are the contraindications for B-blockers?

Drug allergy Uncompensated HF Cardiogenic shock Heart block of bradycardia Pregnancy Severe coronary disease Raynaud's phenomenon bronchial asthma Diabetes mellitus (masking of hyperglycemia) Peripheral vascular disease

What are the contraindications for Hydantoin Antiepileptic Drugs?

Drug allergy Pregnancy

What are the contraindications for sulfonamide antibiotics?

Drug allergy to sulfonamides or chemically related drugs, such as sulfonylureas, and thiazide and loop diuretics Allergy to carbonic anhydrase inhibitors Pregnancy at term Infants younger than 2 months of age

HyperK+

Due to cell damage and release of intracellular K+

IV fluids given

Due to fluid shift to interstitial spaces and resultant shock

Angioedema

Dyspnea Facial Swelling

ENDOCRINE

ENDOCRINE

Restlessness and irritability

Early signs of cerebral hypoxia

Lispro

Eat within 15 minutes before

Seborrhea

Eczema

SE of Ca Channel blockers

Edema Hypotension Verapamil - Constipation

ENDOCRINE: Glucocorticoids prednisone (PO) methylprednisone (IV) - Effects (2) - Adv Effects 6) - Instructions to D/C (1)

Effects: - *Anti-inflammatory - Immunosuppressive Effect* Adverse effects to nearly EVERY ORGAN SYSTEM - hyperglycemia - poor wound healing - decr. resistance to infection - *osteoporosis* - *emotional lability* - *Na, H20 retention* (aldoster-one) *TAPER to discontinue*

What are the precautions for antihistamines?

Elderly patients may be more susceptivle to adverse anticholinergic effects of antihistamines use cautiously in patients with pyloric obstruction, prostatic hypertrophy, hyperthyroidism, cardiovascular disease,e or severe liver disease Use cautiously in pregnancy and lactation

QT Interval

Electrical systole of the ventricles 0.4 seconds

Burn autograph

Elevated and Immobile 3-7 days

Blood urea nitrogen

Elevated levels indicate a slowing of GFR Urea is normally freely filtered through the renal gloveruli.

Patient teaching for benzodiazepines

Encourage patients to avoid operating heavy machinery and driving Educate about the development of tolerance to the sedating properties alcohol and other CNS depressants must be avoided Advise patients to carry a medical alert or other identification bracelet/necklace with their diagnoses and a list of their drugs and allergies

Creatine Kinase

Enzyme found in muscle and brain tissue that reflects tissue catabolism resulting from cell trauma. CK-MB is found in cardiac CK-BB is found in brain tissue CK-MM found in skeletal muscle.

What is the mechanism of action for insulin therapy?

Exogenously administered insulin functions as a substitute for the endogenous hormone It serves to replace the insulin that is not made at all or is made defectively in the body of a diabetic patient Exogenously administered insulin restores the diabetic patient's ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen into fat stores

Acute pancreatitis

Fetal position, bluish discoloration of flanks (Turner's sign), bluish discoloration of pericumbelical region (Cullen's sign); Board like abdomen with guarding; self digestion of pancreas by Trypsin

What are the signs and symptoms of superinfection?

Fever Black hairy tongue Stomatitis Loose or foul-smelling stools Vaginal discharge Cough

TNF-alpha effects

Fever Increases proinflammatory proteins by the liver Cachexia (muscle wasting) Shock with gram (-) bacteria

Systemic Signs of inflammation

Fever Leukocytosis Plasma protein synthesis

IgM

First antibody produced during initial or primary response

What are the indications for proton-pump inhibitors?

First-line therapy for erosive esophagitis, symptomatic GERD that is poorly responsive to other medical treatment such as therapy with H2-receptor antagonists, short-term treatment of active duodenal ulcers and active benign gastric ulcers, gastric hypersecretory conditions (Zollinger-Ellison syndrome), nonsteroidal antiinflammatory drug (NSAID)-induced ulcers, and for stress ulcer prophylaxis Can be used in combination with antibiotics to treat patients with H.pylori infections

What is the generic name for metronidazole?

Flagyl Flagyl ER MetroCream MetroGel MetroGel-Vaginal Metro-Lotion MetroIV Nidagel Noritate Novonidazol Trikacide Vandazole

What are the concerns with long-term glucocorticoid therapy?

For adrenal drugs, lifespan considerations include concern about their use during pregnancy and lactation. Growth suppression may occur in children who are receiving long-term adrenal drug therapy (glucocorticoids) if the epiphyseal plates of the long bones have not closed Elderly patients are more prone to adrenal suppression with prolonged adrenal therapy Long-term use can cause adrenal suppression or Addison's disease (fatigue, nausea, vomiting, and hypotension). can turn in to Addison's crisis: drop in extracellular fluid volume, hyponatremia, and hyperkalemia (life-threatening) DO NOT stop abruptly Take glucocorticoids in the morning to help avoid adrenal suppression Cushing's syndrome occurs with prolonged or frequent use of glucocorticoids and is characterized by moon face, obesity of the trunk area, increase in blood glucose, and sodium levels

Assessment for Aminoglycoside antibiotics

For patients requiring a CT scan with contrast who are also on nephrotoxic medication, alert the HCP Complete a neuromuscular assessment because of the potential for drug-related neurotoxicity Assess hydration status

Patient teaching for Beta-Lactam antibiotics

For penicillins: take the drugs exactly as prescribed and for the full duration, with spacing of doses at regularly scheduled intervals. Take then with water. Oral dosage forms should not be taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice because they will inactivate the drug. For cephalosporins: It is important to eat dairy products to minimize superinfections. Avoid OTC liquid cold products that contain alcohol so as to avoid an Antabuse-like reaction (with some of the cephalosporins). Report diarrhea, flui-like symptoms, blistering or peeling of the skin, hearing loss, breathing difficulty, or seizures to the HCP immediately. Report immediately the occurrence of foul-smelling, loose, frequent stools or bloody stools. Consume yogurt, buttermilk, or kefir to help prevent superinfections such as the occurrence of vaginal yeast infections Oral contraceptives interact with the antibiotic, so use other forms of contraception

What is the rationale for aspartate aminotransferase (AST) assessment?

Formerly called serum glutamic-oxalocetic transaminase (SGOT) AST is elevated with hepatocellular diseases With disease or injury of liver cells, the cells lyse and the AST is released and picked up by the blood; the elevation of AST is directly related to the number of cells affected by disease or injury

What is the rationale for alanine aminotransferase (ALT) assessment?

Formerly serum glutamic-pyruvic transaminase (SGPT) ALT is found mainly in the liver and lesser amounts in the kidneys, heart, and skeletal muscle If there is injury or disease to the liver parynchyma (cells), it will cause a release of this liver cellular enzyme into the bloodstream and thus elevate serum ALT levels most ALT elevations are from liver disease. Therefore, if medications are then metabolized by the liver, this metabolic process will be altered and possibly lead to toxic levels of drugs

IgA

Found predominantly in blood Found in normal body secretions, mucus membranes

Administration for benzodiazepines

Frequent monitoring of vital signs with sepcific attention to blood pressure and postural blood pressures Encourage the use of SCDs or compression stockings and to change positions slowly to minimize dizziness and falls

Function, SE of Anti-anginals

Function - lower BP - improve flow to myocardium SE - *headache* - hypotension (change pos. slowly) - rebound tachycardia (due to hypotension)

What are the indications for Esomeprazole

GERD/erosive esophagitis (IV therapy should only be used if PO therapy is not possible/appropriate) Hypersecretory conditions, including Zollinger-Ellison syndrome With amoxicillin and clarithromycin to eradicate Helicobacter pylori in duodenal ulcer disease or history of duodenal ulcer disease Decrease risk of gastric ulcer during continuous NSAID therapy

What is the rational for the gamma-glutamyl transferase (GGT) assessment?

GGT is an enzyme that is present in liver tissue; when there is damage to the liver cells (hepatocytes) that manufacture bile, the enzyme will be released throughout the cell membranes and released into the blood Individuals of African ancestry have normal values that are double the values of those who are white

What are the drug interactions for Labetalol?

General anesthesia and verapamil may cause additive myocardial depression Additive bradycardia may occur with digoxin, varapamil, or diltizem Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates May later the effectiveness of insulin or oral hypoglycemic agents Concurrent NSAIDs may decrease antihypertensive action Effects may be increased by propranolol or cimetidine May decrease the effectiveness of adrenergic bronchodilators and theophylline Labetalol decreases effects of dopamine and dobutamine Labetalol causes unopposed alpha-adrenoceptor stimulation with epinephrine and related drugs

Diabetic coma vs. Insulin shock

Give glucose first - if no help, give insulin

Before dressing changes

Give medications to help with pain

PTU ( hyperThyroid Med)

Give other medications at least 1 hour before or after giving this medication

HYPERLIPIDEMIAS - statins

Given in conjunction with *diet, exercise modifications*

Benzos (Ativan, Lorazepam, etc.)

Good for alcohol withdrawal and status epilepticus

Vitamin A

Good for night vision

*Mild Concussion (Mild TBI):* Grade I: Transient Confusion and disorientation, accompanied by amnesia, no loss of consciousness, return of function in 15 minutes Grade II: Transient Confusion and retrograde amnesia that develops after 5-10 min (memory loss extends several minutes before impact). Symptoms last 15 min.

Grade III: Any loss of consciousness, confusion, and retrograde and anterograde amnesia remains present form impact and lasts several minutes *Classic Cerebral Concussion Grade IV:* any loss of consciousness (can be up to 6hrs) accompanied by retrograde and anterograde amnesia. Transient cessation of respiration and decrease in BP, periods of bradycardia, effects stabilize within a few seconds.

What is the mechanism of action for HMG-CoA reductase Inhibitors?

HMG-CoA reductase inhibitors are the most potent antilipemic drugs available Cholesterol production by the liver requires the action of an enzyme called HMG-CoA reductase. Statins competitively inhibit the actions of this enzyme, thus decreasing the actual synthesis of hepatic cholesterol

What is the generic name for haloperidol?

Haldol Haldol Decanoate

Positive symptoms of schizophrenia

Hallucinations Delusions Conceptual disorganization

Rule of 9's

Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each Front trunk = 18% Back trunk = 18%

*Postconcussive Syndrome:* Effects last weeks or months after concussion resolves.

Headache Nervousness or anxiety Irritability Insomnia Depression Inability to concentrate Forgetfulness Fatigability

What are the adverse effects for sulfonamide antibiotics?

Hem: agranulocytosis, aplastic anemia, hemolytic anemia, and thrombocytopenia GI: nausea and vomiting, pancreatitis, and diarrhea Derm: epidermal necrolysis, exfoliative dermatitis Stevens-Johnson syndrome Convulsions Crystalluria Toxic nephrosis Headache Peripheral neuritis Uriticaria

What is APTT used to monitor?

Heparin therapy

What are the precautions for antianxiety agents?

Hepatic dysfunction Severe renal impairment Severe underlying pulmonary disease (Benzodiazepines only) Patients who may be suicidal or who may have had previous drug addictions

Reed-Sternberg cells

Hodgkin's

Tube feeding

Hold tube feeding if residual >100mL

What are the contraindications for anticonvulsants?

Hypersensitivity

What are the contraindications of naloxone?

Hypersensitivity

What are the contraindications for antihistamines?

Hypersensitivity Angle-closure glaucoma Should not be used in premature or newborn infants

What are the contraindications for rifampin?

Hypersensitivity Concurrent use of atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, or ritonavir-boosted saquinavir Usually safe in pregnancy, but cautioned in elderly, safety not established under 13 yr

What are the contraindications for morphine sulfate?

Hypersensitivity Some products contain tartrazine, bisulfites, or alcohol and should be avoided in patients with known hypersensitivity; Acute, mild, intermittent, or postoperative pain; Significant respiratory depression; acute or severe bronchial asthma; paralytic ileus

What are the contraindications for Calcium Channel Blockers (Class IV antiarrhythmics)?

Hypersensitivity Acute myocardial infarction Pulmonary congestion Wolff-Parkinson-White syndrome Severe hypotension Cardiogenic shock Sick sinus syndrome Second- or third-degree AV block

What are the contraindications for loop diuretics?

Hypersensitivity Allergy to sulfonamide antibiotics Hepatic coma Severe electrolyte loss

What are the contraindications for haloperidol?

Hypersensitivity Angle-closure glaucoma Bone marrow depression CNS depression Parkinsonism Severe liver or cardiovascular disease Some products contain tartrazine, sesame oil, or benzyl alcohol and should be avoided in patients with known intolerance or hypersenitivity

What are the contraindications for antipsychotics?

Hypersensitivity Cross-sensitivity may exist among phenothiazines Angle-closure glaucoma Patients who have CNS depression comatose state Significant CNS depression Brain damage Liver or kidney disease blood dyscrasias Uncontrolled epilepsy

What are the contraindications for metronidazole?

Hypersensitivity Hypersensitivity to parabens (topical only) First trimester pregnancy

What are the contraindications for risperidone?

Hypersensitivity Lactation (discontinue drug or bottle feed)

What are the contraindications for parenteral anticoagulant drugs?

Hypersensitivity Major blood dyscrasias Heparin-induced thrombocytopenia (HIT) Pregnancy (may use heparin if needed) GI obstruction Serious inflammation (colitis) Infection Recent surgery or other invasive medical procedures

What are contraindications for oral Anticoagulant drugs?

Hypersensitivity Major blood dyscrasias Pregnancy (absolute contraindication) GI obstruction Serious inflammation (colitis) Infection Recent surgery or other invasive medical procedure

What are the adverse effects of Sodium Channel Blockers (Class I antiarrhythmics)?

Hypersensitivity Nausea Vomiting Diarrhea Dizziness Headache New arrhythmias (the proarrhythmic effect) Bradycardia Hypotension blood disorders Lupus-like syndrome Respiratory depression Cinchonism (tinnitus, loss of hearing, blurred vision, and GI upset) CNS toxicities (twitching, convulsions, and confusion)

What are the contraindications for Selective Serotonin Reuptake inhibitors (SSRIs)?

Hypersensitivity Renal dysfunction Hepatic dysfunction Pregnancy Lactation

What are the contraindications for Cardiac Glycosides?

Hypersensitivity Second- or third-degree heart block Atrial fibrillation Ventricular tachycardia or fibrillation Heart failure resulting from diastolic dysfunction Subaortic stenosis (obstruction in the left ventricle below the aortic valve)

What are the contraindications for Sodium Channel Blockers (Class I antiarrhythmics)?

Hypersensitivity Second- or third-degree heart block Bundle branch block Cardiogenic shock Sick sinus syndrome Lupus erythematosus Cinchonism

What are the contraindications for Buspirone?

Hypersensitivity Severe hepatic or renal impairment Concurrent use of MAO inhibitors Ingestion of grapefruit juice

What are the adverse effects of insulin therapy?

Hypoglycemia Tachycardia palpitations Headache Lethargy Tremors Weakness Fatigue Delirium Sweating Blurred vision Dry mouth Hunger Nausea Flushing Rash Urticaria Anaphylaxis

Treatment of Low / High K+

Hypokalemia --> Give Potassium (*K-Dur*) supplement; often given with loop diuretics Hyperkalemia --> *Kayexelate* (Sodium Polystyrene Sulfonate)

What are the adverse effects of Calcium Channel Blockers (Class IV antiarrhythmics)?

Hypotension Palpitations Bradycardia Heart failure Constipation Nausea Dermatitis Dyspnea Rash Flushing Peripheral edema Wheezing

Assessment for B-blockers

If asthma or other respiratory problems are present, B-blockers would not be indicated because bronchoconstriction could be exacerbated Assessment for edema is important in patients with cardiac risk factors and a weight gain of 2 lbs or more in 24 hrs or 5 lbs or more in 1 week

NG tube insertion

If cough and gag, back off a little, let calm advance again with pt sipping water from straw

Acid-Base balance

If it comes out of your ass, it's Acidosis Vomiting = Alkalosis

Permanent paralysis

If spinal cord is compressed for 12-24 hours

Administration of proton-pump inhibitors

If the patient has difficulty swallowing capsules, a capsule may be opened and the granules sprinkled over at least a tablespoon of applesauce, which then must be swallowed immediately Omeprazole may be given with antacids, if ordered Always double-check the names and dosages of these drugs to ensure that they are not confused with similarly named drugs

What are the therapeutic effects of Hydantoin Antiepileptic drugs?

Increase the threshold of activity in the area of the brain called the motor cortex, making it more difficult for a nerve to be excited Act to depress or limit the spread of a seizure discharge from its origin Decrease the speed of nerve impulse conduction within a given neuron The major therapeutic indication for AEDs is the prevention or control of seizure activity

Urecholine intended effect

Increase urine output; relax the bladder

Themia

Increased

Elevated ICP

Increased BP, widened pulse pressure, increased Temp

What drugs interact with tricyclic antidepressants (TCAs)?

Increased anticholinergic effects are seen when TCAs are taken with anticholinergics and phenothiazines When MAOIs are taken with TCAs, the result may be increased therapeutic and toxic effects, including hyperpyretic crisis (excessive fever)

What drugs interact with proton-pump inhibitors?

Increased chance of bleeding in patients who are taking both a PPI and warfarin Interference with the absorption of ketoconazole, ampicillin, iron salts, and digoxin When given with clopidogrel, there is some concern of an increased risk of death if the patient has acute coronary syndrome Sucralfate may delay the absorption of PPIs Food may decrease absorption of the PPIs, and it is recommended that they be taken on an empty stomach

What does an increased APTT indicate?

Increased clotting time --> Bleeding tendency

What does an increased PT/INR indicate?

Increased clotting time --> Bleeding tendency

What Drugs do Beta-Lactam Antibiotics interact with?

Increased effects occur when combined with aminoglycosides and other penicillins Prolonged effects occur when combined with NSAIDs Decreased effects occur when combined with neomycin and rifampin (penicillins) Decreased effectiveness of oral contraceptives occurs with penicillins Enahanced anticoagulant effects of warfarin occur when penicillins are given with potassium supplements Increased alcohol intolerance occurs when cephalosporins are given with disulfiram

What drugs interact with oral anticoagulant drugs?

Increased effects occur with acetaminophen (high doses), aspirin, amiodarone, ciprofloxacin, cimetidine, furosemide, erythromycin, Omeprazole, and ketoconazole Increased effects occur with many herbal products, such as capsicum pepper, feverfew, garglic, ginger, ginkgo, and ginseng Decreased effects occur with barbiturates, aminoglutethimide, glutethimide, carbamazepine, rifampin, cholestyramine, and sucralfate Vitamin K antagonizes the effect of warfarin

What drugs interact with parenteral anticoagulant drugs?

Increased effects occur with aspirin, NSAIDs, oral anticoagulants, ethacrynic acid, thrombolytics, and cephalosporins

What drugs interact with Sodium Channel Blockers (Class I antiarrhythmics)?

Increased effects occur with other antiarrhythmic drugs, anticholinergics, cimetidine, macrolide antibiotics, quinolone antibiotics, antipsychotics, and tricyclic antidepressants Decreased effects occur with barbiturates, cholinergics, phenytoin, nifedipine, and rifampin Grapefruit juice may increase serum levels of quinidine

What drugs interact with Calcium Channel Blockers (Class IV antiarrhythmics?

Increased effects occur with other antiarrhythmic drugs, cimetidine, and ranitidine Decreased effects occur with phenytoin and rifampin Grapefruit juice may increase serum levels Possible toxicity occurs when anesthetics, doxorubicin, benzodiazepines, buspirone, carbamazepine, digoxin, statins, steroids, tacrolimus, sirolimus, theophylline, or vincristine are given concurrently

What drugs interact with loop diuretics?

Increased effects occur with thiazide diuretics Decreased effects occur with NSAIDs Increased risk for neurotoxicity occurs with aminoglycosides, vancomycin, capreomycin, and chloroquine Increased risk for digoxin and lithium toxicity occurs when they are given concurrently with loop diuretics Decreased effects of sulfonylureas occur Increased risk for hypokalemia occurs when given with corticosteroids Increased effects occur for serum uric acid, glucose, alanine aminotransferase, and aspartate aminotrasferase

Chronic Inflammation

Increased lymphocyte and macrophage Lasts longer than 2 weeks Presence of giant cells

What drugs interact with thrombolytic drugs?

Increased risk for bleeding occurs with concurrent use of anticoagulant, antiplatelet, or other drugs that affect platelet function Reduction in plasminogen and fibrinogen levels may occur

What drugs interact with Aminoglycoside antibiotics?

Increased risk for nephrotoxicity with concurrent use of other nephrotoxic drugs, such as vancomycin, cyclosporine, and amphotericin B Increased risk of ototoxicity with concurrent use of loop diuretics Aminoglycosides can potentiate warfarin toxicity (reduce amount of vitamin K produced by gut flora) Concurrent use with neuromuscular blocking drugs may produce prolonged duration of action of the neuromuscular blockade

What drugs interact with HMG-CoA Reductase Inhibitors?

Increased risk for rhabdomyolysis with erythromycin, gemfibrozil, niacin, and grapefruit juice Increased risk for bleeding occurs with oral anticoagulants

What drugs interact with rifampin?

Increased risk of hepatotoxicity with ritonavir-boosed saquinavir, concurrent use contraindicated Significantly decrease blood levels of atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir, concurrent use contraindicated Increased risk of hepatotoxicity with other hepatotoxic agents, including alcohol, ketoconazole, isoniazid, pyrazinamide concurrent use with pyrazinamide may result in potentially fatal hepatotoxicity and should be avoided) Significantly decreased blood levels of delavirdine, indinavir, and nelfinavir rifampin stimulates liver enzymes, which may increase metabolism and decrease effectiveness of other drugs, including ritonavir, nevirapine, and efavirenze, ciproflozacin, clarithromycin, corticosteroids, cyclosporine, diazepam, diltiazem, disopyramide, doxycycline, levothyroxine, methadone, nifedipine, quinidine, opioid analgesics, oral hypoglycemic agents, warfarin, estrogens, phenytoin, phenobarbital, tacrolimus, verapamil, fluconazole, ketoconazole, itraconazole, quinidine, theophylline, zidovudine, chloramphenicol, and hormonal contraceptive agents Increases metabolism of P-450 drugs Increases the effect of warfarin (increases bleeding)

ANTICOAGULANTS Warfarin/Coumadin - Indications (5) - Therapeutic Level - Adv Effects (1) - Labs (2) - Antidote (1)

Indications - *Valve replacement* (2.5-3.5) - *AFib* (2-3) - PE - MI - DVT (1.5-2) Therapeutic: *1.5-3.5* Adv. Effects: bleeding Labs: PT / INR Antidote: Vitamin K

What are the therapeutic effects for thrombolytic drugs?

Indications include acute myocardial infarction, arterial thrombosis, deep vein thrombosis, occlusion of shunts or catheters, pulmonary emboli, and acute ischemic stroke

Patient teaching for risperidone

Inform patient of the possibility of extrapyramidal symptoms Advise patient to change positions slowly to minimize orthostatic hypotension May cause drowsiness. Caution paitent to avoid driving or other activities requiring alerrtness Advise patient and family to notify HCP professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety occur Advise patient to use sunscreen and protective clothing when exposed to the sun and avoid extremes in temperature

Patient teaching for antihistamines

Inform patient that drowsiness may occur Caution patient to avoid using concurrent alcohol or CNS depressants Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may help relieve dryness of mouth Instruct patient to contact health care professional if symptoms persist

What is the mechanism of action for rifampin?

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms Bactericidal action against susceptible organisms Broad spectrum notable for activity agaisnt: mycobacterium spp, staphylococcus aureus, H. influenzae, Legionella pneumophila, Neisseria meningitis

What are the adverse effects of Selective Serotonin Reuptake inhibitors (SSRIs)?

Insomnia Weight gain Sexual dysfunction Serotonin syndrome (elevated or diminished blood pressure, palpitations, fever, confusion, mania, and seizures and coma)-usually self-limited with discontinuation of medication

What are the adverse effects for selective serotonin reuptake inhibitors (SSRIs)?

Insomnia (reduced REM) Weight gain Sexual dysfunction Serotonin syndrome

What are the adverse effects for thrombolytic drugs?

Internal, intracranial, and superficial bleeding as well as hypersensitivity Anaphylactoid reactions Nausea Vomiting Hypotension Cardiac reperfusion arrythmias

Invasion Period

Invasion Specific Symptoms

what drugs interact with antituberculars?

Isoniazid inhibits the metabolism of phenytoin Rifampin significantly decreases levels of many drugs

Intermediate Acting Insulin

Isophane Insulin (NPH); O: 1-2 hrs. P: 6-12 hrs.

What are the therapeutic effects of insulin therapy?

It is indicted for use in all patients with type 1 diabetes and in patients with type 2 diabetes that is uncontrolled by oral hypoglycemic drugs

Administration of antipsychotics

Keep patient recumbent for at least 30 min following parenteral administration to minimize hypotensive effects Phenothiazines should be discontinued 48 hr before and not resumed for 24 hr after myelography, as they decrease the seizure threshold PO: administer with food, milk, or a full glass of water to minimize gastric irritation Dilute most concentrations in distilled or acidified tap water or fruit juice just before administration

Post-op (general instructions) Watch for stridor after any neck/throat Sx

Keep trach kit at bed side

Post thyroidectomy

Keep tracheostomy set by the bed with O2, suction and calcium gluconate

What is the mechanism of action for antituberculars?

Kill (tuberculocidal) or inhibit the growth of (tuberculostatic) mycobacteria responsible for causing tuberculosis Combination therapy with two or more agents is required, unless used as prophylaxis

Laxative administration

Know last bowel movement and frequency

What are the contraindications for proton-pump inhibitors?

Known drug allergy

What are the contraindications for benzodiazepines?

Known drug allergy Narrow-angle glaucoma, due to their ability to cause mydriasis Pregnancy, due to sedative properties and risk for teratogenic effects

What are the contraindications for selective serotonin reuptake inhibitors (SSRIs)?

Known drug allergy Use of MAOIs in the previous 14 days Therapy with certain antipsychotic drugs such as thioridazine or mesoridazine A significant history of cardiac disease may be a contraindication due to the uncommon cardiac effects and alterations in seizure threshold

What are the contraindications for barbiturates?

Known drug allergy Pregnancy Significant respiratory difficulties Severe kidney or liver disease

What are contraindications for Aminoglycoside antibiotics?

Known drug allergy Pregnancy (only used in life-threatening infections) Lactation

What are the contraindications for opioids?

Known drug allergy Severe asthma

What are the contraindications for acetaminophen (tylenol)?

Known drug allergy Severe liver disease Glucose-6-phosphate dehydrogenase (G6PD) deficiency

What are the contraindications for tricyclic antidepressants (TCAs)?

Known drug allergy Use of MAOIs within previous 14 days Pregnancy Not recommended in patients with any acute or chronic cardiac problems or history of seizures, because both conditions are associated with a greater likelihood of death upon TCA overdose

What is the rationale for lactic dehydrogenase (LDH) assessment?

LDH is found in cells of many body tissues including the heart, liver, red blood cells, kidneys, skeletal muscles, brain, and lungs Because it is in so many tissues, the total LDH level is not a specific indicator of one disease If there is disease or injury affecting cell containing LDH, the cells lyse and LDH is released from the cells into the bloodstream, thus increasing LDH levels This enzyme is just part of the total picture of altered liver function which, if present, will then decrease the breakdown/metabolism of drugs and other chemical compounds, resulting in elevated levels of drugs

Cervical and Uterine Cancer

Laser, cryotherapy, radiation, conization, hysterectomy, exenteration; Chemotherapy = No help PAP smears should start within 3 years of intercourse or by age 21

Breast Cancer

Leading cause of cancer in women Upper outer quadrant, left > right Monthly SBE Mammography...Baseline @ 35, annually after age 50 Mets to lymph nodes, then lungs, liver, brain, spine Mastectomy...Radical mastectomy = lymph nodes too (but no mm resected) Avoid BP measurements, injections and venipuncture on the surgical side

Septic Shock (Endotoxic Shock)

Leading cause of death in ICUs *C:* gram (-) bacteria, some gram (+) and fungi *S/S:* vasodilation, hypoxia, cardiovascular shock

Watch for CSF leaks from nose and ears

Leakage can lead to meningitis and mask intracranial injury since usual increased ICP symptoms may be absent

What is the mechanism of action for Levodopa-Carbidopa (Sinemet)?

Levodopa is precursor for dopamine and must be given in high doses because it broken down outside CNS Carbidopa prevents breakdown of levodopa in peripheral Causes release of dopamine from storage in presynaptic fibers Blocks reuptake of dopamine

Lethargy

Limited spontaneous movement or speech *Easy arousal with normal speech or touch* May not be oriented time, place, or person

Fast acting insulin

Lispro

Rapid acting Insulins

Lispro (Humalog) and Aspart (Novolog) O: 5-15 minutes P: .75-1.5 hours

what should you check before starting a pt on statins?

Liver Function Tests

Glaucoma

Long term control is eye drops for pressure

Lasix

Loop diuretic; Depletes potassium; eat a banana;

What is the mechanism of action for Loop Diuretics?

Loop diuretics act primarily in the kidneys along the ascending loop of Henle, blocking chloride and sodium resorption They activate renal prostaglandins, resulting in dilation of the blood vessels of the kidneys, the lungs , and the rest of the body These drugs produce a potent diuresis, resulting in decreased fluid volume and reduce blood pressure, reduced pulmonary and systemic vascular resistance, lower central venous pressure, and lower left ventricular end-diastolic pressure The reduced preload and afterload effects make them very useful in the treatment of edema associated with heart failure and hepatic or renal disease, as well as in the control of hypertension

What are the therapeutic effects of loop diuretics?

Loop diuretics are particularly useful when rapid diuresis is needed because of their rapid onset of action, which lasts at least 2 hours. Diuretic action continues even when the creatinine clearance decreases to below 25 ml/min

Dysmnesia

Loss of past memories (retrograde amnesia) coupled with an inability to form new memories (anterograde amnesia)

What is the generic name for pregabalin?

Lyrica

Hgb

M 14-18 F 12-16

RBC's

M 4.7-6.1 F 4.2-5.4

Hct

M 42-52 F 37-47

IG bands on electrophoresis

MS; weakness starts in upper extremities, bowel/bladder affected in 90%

Head trauma and seizures

Maintain airway = primary concern

Haldol

Make a tight jaw, give benadryl

Ventilators

Make sure alarms are on; check every 4 hours minimum

What are the therapeutic effects for ACE inhbitors?

Management of hypertension (lower BP) Diuresis Decreases risk for MI, stroke or death from cardiovascular causes in high-risk patients Cardioprotective effect

What is the mechanism of action for risperidone?

May act by antagonizing dopamine and serotonin in the CNS Decreased symptoms of psychoses, bipolar mania, or autism

Insulin temp

May be kept at room temperature for 28 days

Administration of B-blockers

May be taken with or without food Daily weights Assess BP and apical pulse prior to administration Administer with meals or directly after for absorption If HR < 50 bpm or if arrhythmia occurs, withhold medicine and notify HCP

Patient Teaching for antianxiety agents

May cause daytime drowsiness. Cautions patient to avoid driving and other activities requiring alertness Advise patient to avoid the use of alcohol and other CNS depressants conccurrently with these medications Advise patient to inform HCP is pregnancy is planned or expected Educate about the development of tolerance to the sedating properties of benzodiazepines with chronic use

Patient teaching for Buspirone

May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness Advise patient to avoid concurrent use of alcohol or other CNS depressants Notify HCP of all prescriptions, vitamins, or herbal products being taken Instruct patient to notify HCP if any chronic abnormal movements occur (dystonia, motor restlessness, involuntary movement of facial or cervical muscles) or if pregnancy is suspected

Patient teaching for pregabalin

May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known Advise patient to notify HCP if changes in vision occur Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever. Discontinue therapy if myopathy is diagnosed or suspected or if markedly elevated creatinine kinase levels occur Advise patient and family to notify health care provider if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless Inform patient that pregabalin may cause edema and weight gain. Caution patient to avoid alcohol or other CNS depressants with pregabalin Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding

Patient teaching for morphine sulfate

May cause drowsiness or dizziness Advise patient to change positions slowly to minimize orthostatic hypotension Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication Encourage patients who are immobilized or on prolonged bedrest to turn, cough, and breathe deeply every 2 hr to prevent atelectasis Explain to patient and family how and when to administer morphine and how to care for infusion equipment properly

Patient teaching for anticonvulsants

May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known Advise patient to avoid taking alcohol or other CNS depressants concurrently with these medications Advise patient to carry identification describing disease process and medication regimen at all times

What drugs interact with risperidone?

May decrease the antiparkinsonian effects of levodopa or other dopamine agonists Carbamazepine, phenytoin, rifampin, phenobarbital, and other enzyme inducers increase metabolism and may decrease effectiveness Fluoxetine and paroxetine increase bloood levels and may increase effects Clozapine decrease metabolism and may increase effects of risperidone Increased CNS depression may occur with other CNS depressants, including alcohol, antihistamines, sedative/hypnotics, or opioid analgesics Kava, valerian, or chamomile can increase CNS depression

What drugs interact with haloperidol?

May enhance the QT-prolonging effect of QT-prolonging agents Increase hypotension with antihypertensives, nitrates, or acute ingestion of alcohol Increased anticholinergic effects with drugs having anticholinergic properties, including antihistamines, antidepressants, atropine, phenothiazines, quinidine, and disopyramide Increased CNS depression with other CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics Concurrent use with epinephrine may result in severe hypotension and tachycardia may decrease therapeutic effects of levodopa Acute encephalopathic syndrome may occur when used with lithium Dementia may occur with methyldopa Kava-kava, valerian, or chamomile can increase CNS depression

Hypoparathyroidism

May result in chronic hypocalcemia and hyperphosphatemia

Oral Anti-diabetic drugs

Metformin, glipizide, pioglitazone, repaglinide, stigliptin.

Obtundation

Mild or moderate reduction in arousal (awakeness) with limited response to the environment Falls asleep unless stimulated verbally or tactiley Answers questions with minimum response

What are the adverse effects of HMG-CoA Reductase Inhibitors?

Mild, transient GI disturbances Rash Headache Increase in serum liver enzymes and creatinine kinase levels Rhabdomyolysis (manifested by muscle pain and myoglobinuria)

What is the mechanism of action for ACE inhibitors?

Minimize ACE (responsible for converting angiotensin I (AI) into angiotenin II (AII) prevent vasoconstriction and the retension of sodium and water Prevent the breakdown of bradykinin Decrease preload and afterload Increased plasma renin levels and decrease aldosterone levels

What are the indications for miotics?

Miotics are drugs used to constrict the pupil the direct- and indirect-acting miotics are used for treatment of open-angle glaucoma, angle-closure glaucoma, and convergent strabismus ( a condition in which one eye points toward the other, or "cross-eye") and in ocular surgery Used to reserve the effect of mydriatic (pupil-dilating) drugs after ophthalmic examination

What are the Therapeutic effects of Beta-Lactam Antibiotics?

Modifications of the basic chemical structure have given rise to four generations of cephalosporins. Depending on the generation, these drugs may be active against gram-positive, gram-negative, or anaerobic bacteria.

Assessment for Labetalol

Monitor BP and pulse frequently during dose adjustment and periodically during therapy Orthostatic hypotension assessment Patients receiving labetalol IV must be supine during and for 3 hr after adminsitration Vital signs should be monitored every 5-15 min during and after Monitor intake and output and daily weights

Assessment for antianxiety agents

Monitor blood pressure, pulse and respiratory status frequently throughout IV administration Prolonged high-dose therapy may lead to psychologic or physical dependence Assess degree of anxiety and level of sedation (ataxia, dizziness, slurred speech) before and periodically throughout therapy

Assessment for pregabalin

Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression Diabetic peripheral neuropathy, psttherpetic neuralgia, fibromyalgia, and spinal cord injury pain: assess location, characteristics, and intensity of pain periodically during therapy Seizures: assess location, duration, and characteristics of seizure activity May cause increased creatinine kinase levels may cause decreased platelet count

Birth Control - Loestrin - Norinyl

Monitor for - thrombosis, embolism - hemorrhage AVOID SMOKING to decr. emboli risk If miss 1 tablet: take as soon as you remember If miss 2 tablets: - take 2 tablets/day x 2 days AND - use another form of birth control

MOOD STABILIZER: Lithium (lithobid)** Lamotrigine (lamictal) divalproex (depakote)

Monitor for seizures, arrhythmias LITHIUM - Therapeutic: 0.5-1.5 mEq/L - Toxicity: v/d, drowsy, decreased coordination, muscle weakness - Monitor I/O, Renal, *Na* Low Na = toxic Li High Na = sub-therapeutic Li

Assessment for risperidone

Monitor patient's mental status and mood before and periodically during therapy Assess weight and BMI initially and throughout therapy Monitor BP and pulse before and frequently during initial dose titration. May cause prolonged QT interval, tachycardia, and orthostatic hypotension Monitor for tardive dyskinesia monitor for development of neuroleptic malignant syndrome

Assessment for naloxone

Monitor respiratory rate, rhythm, and depth; pulse, ECG, BP; and level of consciousness frequently for 3-4 hr after the expected peak of blood concentrations Patients who have been receiving opioids for > 1 wk are extremely sensitive to the effects of naloxone (dilute and administer carefully) Assess patient for level of pain after administration when used to treat postoperative respiratory depression Assess patient for signs and symptoms of opioid withdrawal (vomiting, restlessness, abdominal cramps, increased BP, and temperature)

What are the precautions for morphine sulfate?

Morphine has a potentially toxic metabolite known as morphine-6-glucuronide. Accumulation of this metabolite is more likely to occur in patients with renal impairment Head trauma; increased intracranial pressure; severe renal, hepatic, or pulmonary disease; hypothyroidism; seizure disorder; adrenal insufficiency History of substance abuse Undiagnosed abdominal pain Prostatic hyperplasia Patients undergoing procedures that rapidly decrease pain (cordotomy, radiation) Long-acting agents should be discontinued 24 hr before and replaced with short-acting agents geriatric or debilitated patients avoid chronic use in OB or when lactating

What are the indications for mophine sulfate?

Morphine is indicated for severe pain and has a high abuse potential Pulmonary edema Pain associated with MI

IgG

Most abundant Protective against infection

What is the mechanism of action for antianxiety agents?

Most agents cause generalized CNS depression Benzodiazepines may produce tolerance with long-term use and have potential psychological or physical dependence NO analgesic properties

What are the indications for tricyclic antidepressants (TCAs)?

Most commonly used to treat neuropathic pain syndromes and insomnia Use as antidepressants is rare

What are the precautions for antiulcer agents?

Most histamine H2 antagonists require dose reduction in renal impairment and in elderly patients Magnesium-containing antacids should be used cautiously in patients with renal impairment Misoprostol should be used cautiously in women with childbearing potential

Changes in level of responsiveness

Most important indicator of increased ICP

Administration of antituberculars

Most medications can be administered with food if GI irritation occurs

Pregnancy + Meds

Most meds: pregnancy category D, X These are TERATOGENIC EXCRETED IN BREAST MILK

Anthrax

Multi-vector biohazard

Gall bladder or liver disease

Murphy's sign (Rt. costal margin pain on palp with inspiration)

Assessment for antituberculars

Mycobacterial studies and susceptibility tests should be performed prior to an periodically throughout therapy to detect possible resistance Assess lung sounds and character and amount of sputum periodically throughout therapy

What are the contraindications for pregabalin?

Myopathy (known/suspected) Lactation

First IV for DKA

NS, then infuse regular insulin IV as Rx'd

What is the antidote for opioid overdose?

Naloxone (IV)/Narcan Naltrexone (PO)/Revia

What is the generic name of naloxone?

Narcan

Stenosis

Narrowing or Occlusion

In ascending order of delivery potency:

Nasal Cannula, simple face mask, nonrebreather mask, partial rebreather mask, venturi mask

Adverse effects to gentamycin, vancmycin (NO)

Nephrotoxic Ototoxic

What are the adverse effects of Aminoglycoside Antibiotics?

Nephrotoxicity (kidneys) Ototoxicity (ears)-hearing and balance functions Headache Paresthesia Vertigo Skin rash Fever Overgrowth of nonsusceptible organisms Neuromuscular paralysis (very rare and reversible)

Neurontin

Nerve pain gabapentin

O2 Administration

Never more than 6L/min by cannula Must humidify with more than 4L/hr No more than 2L/min with COPD (CO2 Narcosis-a slowing of the O2 drive to breath)

What is the generic name of Esomeprazole?

Nexium

Angina Medication

Nitro

Lifting restrictions

No lifting over 10lbs for 6 weeks

What drugs interact with Beta-Agonist (Sympathomimetic) Bronchodilators?

Non-selective Beta-blockers antagonize bronchodilation Increased risk for hypertension occurs with monoamine oxidase inhibitors (MAOIs) and other sympathomimetics Hypokalemia and changes in electrocardiograms are more likely to occur with concurrent use of diuretics A decreased effectiveness of oral hypoglycemic drugs occurs

What is the drug class for acetaminophen (tylenol)?

Nonopioid analgesic

Vancomycin

Normal level 10-20; Monitor Creatinine level normal 0.6-1.2 mg/dL

What is the generic name for labetalol?

Normodyne or Trandate

What are contraindications for Levodopa-Carbidopa (Sinemet)?

Not to be used with narrow angle glaucoma or any undiagnosed skin problem because it activates malignant melanoma

What are signs of toxicity of Hydantoin Antiepileptic drugs?

Nystagnus Ataxia Dysarthria Encephalopathy

What is the mechanism of action for opioid analgesics?

Opioid analgesics bind to opioid receptors in the brain, blocking the transmission of pain messages and causing a reduction in pain sensation

Patient teaching for Sodium Channel blockers (Class I antiarrhythmics)

Oral doses may be taken with food if GI upset occurs Any chest pain, hypotension, GI distress, dizziness or syncope, blurred vision, change in respiratory status, or edema should be reported to your HCP immediately Monitor daily weights, reporting a weight gain of 2 pounds in 1 day or 5 pounds or more within 1 week Avoid concurrent use of antacids and the ingestion of grapefruit juice

Management of acetaminophen (tylenol) overdose

Overdose can cause hepatic necrosis The standard maximum daily dose of acetaminophen for healthy adults is 4000 mg Acetylcysteine is the recommended antidote for acetaminophen toxicity and works by preventing the hepatotoxic metabolites of acetaminophen from

Administration of Buspirone

PO: Onset: 7-10 days Peak: 3-4 wk Duration: unknown Patients changing from other antianxiety agents should receive gradually decreasing doses. Buspirone will not prevent withdrawal symptoms May be administered with food to minimize gastric irritation. Food lows but does not alter extent of absorption

Administration of metronidazole

PO: Onset: rapid Peak: 1-3 hr Duration: 8 hr Administer on an empty stomach, or may administer with food or milk to minimize GI irritation Tablets may be crushed for those with difficulty swallowing PO-ER: onset: rapid Peak: unknown Duration: up to 24 hr IV: Onset: rapid Peak: end of infusion Duration: 6-8 hr topical Onset: 3 wk Peak: 9 wk Duration: 12 hr Vaginal: Onset; unknown Peak: 6-12 hr Duration: 12 hr

Administration of rifampin

PO: Onset: rapid Peak: 2-4 hr Duration: 12-24 IV: Onset: rapid Peak: end of infusion Duration: 12-24 hr Administer medication on an empty stomach at least 1 hr before or 2 hr after meals with a full glass of water May be administered with food if GI irritation becomes a problem. Capsules may be opened and contents mixed with applesauce Antacids may be taken 1 hr prior to adminstration

Administration for risperidone

PO: Onset: 1-2 wk Peak: unknown Duration: up to 6 wk IM: Onset: 3 wk Peak: 4-6 wk Duration: up to 6 wk

5 P's of neurovascular status (Important with fx's)

Pain, Pallor, Pulse, Paresthesia, Paralysis; Provide age appropriate toys for kids in traction

5 P's of NV functioning

Pain, paresthesia, pulse, pallor, paralysis

Testicular Cancer

Painless lump or swelling testicle...STE in shower > 14yrs; 15-35 = Age

Pill-rolling tremor

Parkinson's (tx with Levodopa, Carbidopa); Fall precautions, rigid, stooped, shuffling

Patient teaching for Beta-Agonist (Sympathomimetic) Bronchodilators

Participate in healthy living, including health checkups, forcing fluids, eating three balanced meals daily, and engaging in consistent exercise as tolerated and as ordered In cases of asthma, bronchitis, or COPD: avoid exposure to conditions and situations that may lead to bronchoconstriction or worsening of the condition, such as allergens, stress, smoking, and air pollutants Avoid excessive fatigue, heat, and extremes of temperature, and avoid consuming caffeinated beverages because they may increase bronchoconstriction Short-acting beta-agonists are known as rescue drugs and are used for acute attacks of asthma or acute exacerbations of bronchospastic diseases The proper method of administering the inhaled forms of these drugs is as demonstrated; return the demonstration. Taking more than the prescribed dose of beta-agonists is strongly discouraged because of the excessive cardiac demands and cardiac and CNS stimulation (hypertension and tachycardia) that may occur

Administration of antianxiety agents

Patients changing to buspirone from other antianxiety agents should receive gradually decreased doses Buspirone will not prevent withdrawal symptoms Frequent monitoring of vital signs with special attention to blood pressure and postural blood pressures Encourage the use of elastic compression stockings and changing positions slowly to minimize dizziness and falls from orthostatic hypotension

What are the precautions for Buspirone?

Patients receiving other antianxiety agents (other agents should be slowly withdrawn to prevent withdrawal or rebound phenomenon) Patients receiving other psychotropics Lactation, OB, Pedi: safety not established

What are the adverse effects for anticonvulsants?

Patients with severe hepatic or renal disease Choose agents carefully in pregnant and lactating women Fetal hydantoin syndrome may occur in offspring of patients who receive phenytoin during pregnancy

What is the mechanism of action for Beta-Lactam Antibiotics?

Penicillin and cephalosporin antibiotics are structurally and pharmacologically simimlar. Both contain a beta-lactam ringe, are bactericidal, work by interfering with bacterial cell wall synthesis, and have a broad spectrum of activity.

What drugs do Beta-Lactam Antibiotics include?

Penicillins and Cephalosporins

Assessment for rifampin

Perform mycobacterial studies and susceptibility tests prior to and periodically during therapy to detect possible resistance Assess lung sounds and character and amount of sputum during therapy Evaluate renal function, CBC, and urinalysis periodically and during therapy Monitor hepatic function at least monthly. May cause increased BUN, AST, ALT, and serum alkaline phosphatase, bilirubin, and uric acid concentrations May interfere with methods for determining serum folate and vitamin b levels and with urine tests based on color reaction

Apraxia

Perform purposeful movements

Postictal state

Period immediately following the cessation of seizure activity

Patient teaching for oral anticoagulant drugs

Periodic blood tests are necessary and it is important to take the medication at same time each day, preferably in the evening, so lab work can be checked first if the dose must be adjusted Avoid actions that might cause injury and bleeding (going barefoot, being involved in contact sports, using a straight razor, using a hard-bristled toothbrush) Wear a MedicAlert bracelet Avoid large mounts of foods high in vitamin K, such as broccoli, Brussels sprouts, collard greens, kale, lettuce, mustard greens, and tomatoes, because these foods interact with the drug and decrease its effectiveness. Consistent daily intake is most important Report unusual bleeding, black or bloody stools, dark urine, sore throat, fever, chills, severe headaches, dizziness, and pregnancy Do not change any medications without consulting a health care provider because doing so may necessitate a change in the dosage of Coumadin

Anti-emetics given with Chemotherapy (Cytoxan, Methotrexate, Interferon, etc.)

Phenergan (promethazine HCl), Compazine (prochlorperazine), Reglan (metocolpramide), Benadryl (diphenydramine), Zofran (ondansteron HCl), Kytril (granisetron)

Adverse effects to Tetracycline (1)

Photosensitivity Avoid sun exposure (tetra = 4; 4 eyes = sunglasses to prevent sun exposure)

Patient teaching for Selective Serotonin Reuptake Inhibitors

Possible adverse effects include GI upset, sexual dysfunction, and weight gain Use caution when driving and performing other activities requiring mental alterness until tolerance to the adverse effect devlops It is important to take SSRIs as ordered and not to discontinue them abruptly, because of possible discontinuation syndrome (dizziness, diarrhea, movement disorders, insomnia, irritability, visual disturbances, lethargy, anorexia, and lowered mood) Notify your HCP immediately if you experience diarrhea, nausea, abdominal cramping, mental status changes, restlessness, diaphoresis, shivering, tremors, ataxia, headaches, or hyperreflexia because they may signify sertononin syndrome Check with your HCP before using any OTC medications

Suctioning

Pre and Post oxygenate with 100% O2, no more than 3 passes, no longer than 15 seconds; Suction on withdrawal with rotation

What are the precautions for antipsychotics?

Pregnancy and lactation Patients with symptomatic cardiac disease Avoid exposure to temperature extremes Use cautiously in severely ill or debilitated patients and patients with respiratory insufficiency, diabetes, prostatic hypertrophy, or intestinal obstruction

Premarin

Premarin - adverse effects • (This is from book) Hypertension, thrombophlebitis, edema, nausea, vomiting, diarrhea, constipation, amenorrhea, breakthrough uterine bleeding, enlarged uterine fibromyomas Chloasma (facial skin discoloration; also called melasma), hirsutism, alopecia, tender breasts, fluid retention, decreased carbohydrate tolerance, headaches • (The rest is from the internet) Premarin increase your risk of developing endometrial hyperplasia, a condition that may lead to cancer of the uterus. Taking progestins while using Premarin may lower this risk. If your uterus has not been removed, your doctor may prescribe a progestin for you to take while you are using Premarin. • Long-term use of Premarin may increase your risk of breast cancer, heart attack, stroke, or blood clot. Talk with your doctor about your individual risks before using conjugated estrogens long term, especially if you smoke or are overweight. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment. • FDA pregnancy category X. Premarin can harm an unborn baby or cause birth defects. Do not use Premarin if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication. Conjugated estrogens can pass into breast milk and may harm a nursing baby. Premarin may also slow breast milk production. Do not use if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without the advice of a doctor.

ANTI-EMETICS - Reglan (metroclopramide) - Tigan (trimethobenzamide) - Compazine (prochlorperazine) - Kytril (greanisetron) - Anzemet (dolasetron)

Prevent or Tx. of N/V, especially during chemo - hr, bp - EPS, NMS, Agranulocytosis - Arrhythmia - seizures

What are the therapeutic effects for sulfonamide antibiotics?

Prevent the growth of microorganisms by inhibiting the production of folic acid in bacterial cells through competition with PABA Sulfonamides have a broad spectrum of antibacterial activity, including both gram-positive and gram-negative organisms Co-trimoxazole (SMX-TMP) is commonly used in the treatment of urinary tract infections and for respiratory tract infections and opportunistic infection prophylaxis and treatment in patients affected by the human immunodeficiency virus

What are the therapeutic effects of Angiotensin II Receptor Blockers (ARBs)?

Primarily affect the vascular smooth muscle and the adrenal gland by selectively blocking the binding of AII to the AT1 receptor, ARBs block vasoconstriction and the secretion of aldosterone do not prevent the breakdown of Bradykinin, thus reducing the risk of nonproductive cough (ACE inhibitors) Antihypertensives due to vasodilating properties Adjunctive drugs for treatment of HF

What drugs interact with Angiotensin II Receptor Blockers (ARBs)?

Promote hyperkalemia, especially when taken concurrently with K+ supplements (less frequently occurs than ACE inhibitors) Risk for lithium toxicity occurs if administered concurrently NSAIDs and selective COX-2 inhibitors blunt the antihypertensive effect and increased risk of renal dysfunctions Increased antihypertensive effects with other antihypertensives and diuretics Decreased effects occur with phenobarbitol and rifampin increased risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren

If chest tube comes disconnected...

Put free end in container of sterile water

Maslow's hierarchy of needs

Pysiologic, Safety, Love and Belonging, Esteem, Self-actualization

Basophils

Rare allergic reactions Inflammation Some Leukemias

What are the adverse effects of acetaminophen (tylenol)?

Rash Nausea vomiting Blood disorders or dyscrasias (anemias) Nephrotoxicities Hepatotoxicity

Erythema marginatum

Rash of Rheumatic fever

182.) A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected as a result of this medication. The temperature also is not associated with the administration of this medication.

134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. **Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.**

206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

Rationale: Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. **Option 3 is most closely associated with a neurological disorder**

Lactulose intended effect

Reduce amonia level in body

Therapeutic effect of Cholesterol Medication (crestor, lipitor) Statin drugs

Reduced cholesterol

short acting

Regular insulin (Humulin R) (Clear)

What are the indications for antihistamines?

Relief of symptoms associated with allergies, including rhinitis, urticaria, and angioedema, and adjunctive therapy in anaphylactic reactions some antihistamines are used to treat motion sickness (dimenhydrinate and meclizine), insomnia (diphenhydramine), parkinson-like reactions (diphenhydramine), and other nonallergic conditions

Patient teaching for Aminoglycoside Antibiotics

Report immediately to the HCP any changes in hearing, ringing of the ears (tinnitus), or full feeling in the ears, nausea/vomiting with motion, ataxia, nystagmus, or dyskinesias Consumption of yogurt or buttermilk may help prevent antibiotic-induced syperinfections Report any signs or symptoms of superinfection (diarrhea, vaginal discharge, stomatitis, or glossitis, as well as black hairy tongue, loose and fowl smelling stools, or cough) Increase fluid intake to up to 3000 mL/day unless contraindicated

Evaluation of antiberculars

Resolution of the signs and symptoms of tuberculosis Negative sputum cultures

ANTICOAGULANTS Heparin - Routes (2) - Indications (4) - Therapeutic Level - Adv Effects (3) - Labs (2) - Antidote (1)

Routes: - IV: 25,000 units in 250 mL - SQ: 5,000 units q8-12h Indications: PE, MI, CVA, DVT to *prevent* clot formation; it does not break up pre-existing clots!!! Therapeutic: *1.5-2.5*x control Adverse effects: - Bleeding - *Thrombocytopenia* - *Anemia* Labs: PTT & *Hct* Antidote: Protamine Sulfate

ANTIANGINALS (*nitrates*) - Routes of admin. (4) - Indications (3)

Routes: - NG tablet - Patch - Paste - IV Indications - ANGINA: 1 tablet SL q 5 min x 3. If no relief after *1*, go to ER - MI (IV) - CHF

Koplik spots

Rubeola (measles)

ALZHEIMERS - Side effects (3) Donepezil (Aricept) Memantine (Namenda) Galantamine (Razadyne)

SE - Dizziness - Headache - GI Upset Namenda/Memantine - has fewest side effects

ANTI-SEIZURE MEDS Depakote, Dilantin, Neurotin, Tegretol, Valium Side effects (3)

SE - confusion - drowsiness - ataxia (balance)

What are the therapeutic effects of Selective Serotonin Reuptake inhibitors (SSRIs)?

SSRIs are the first-line treatment for major depression and are also indicated for the treatment of obsessive-compulsive disorder, anxiety disorders, panic disorders, and compulsive eating disorders such as bulimia nervosa

What is the mechanism of action of Selective Serotonin Reuptake Inhibitors (SSRIs)?

SSRIs inhibit the reuptake of serotonin into presynaptic terminals (nerve endings) and thus increase the levels of serotonin available for neurotransmission at the postsynaptic nerve endings they demonstrate weak inhibition of norepinephrine and dopamine reuptake. Increased levels of neurotransmitters are responsible for the improvement of the symptoms of depression

What are the indications for risperidone?

Schizoprenia in adults and adolescents ages 13-17 yr Short-term treatment of acute manic or mixed episodes associated with Bipolar I Disorder in adults ,and children and adolescents aged 10-17 yr, maintenance treatment of Bipolar I disorder in adults only Can be used with lithium or valproate Irritability associated with autistic disorder in children

DEPRESSION: MAOIs (second line) Nardil Parnate

Seizures HTN Crisis - if consume *tyramine* - chocolate, avocado, wine, beer, cheese, salami, yogurt

Adverse effects to Metronidazole (flagyl)

Seizures (flailing flagyl) Avoid alcohol!! (avoid alc. so you don't need to take the metro)

What are the precautions of Esomeprazole?

Severe hepatic impairment Patients using high-doses for > 1 year (increased risk of hip, wrist, or spine fractures) OB: use only if clearly needed Long-term use can lead to C.diff, osteoporosis, and pneumonia

What are the adverse effects of miotics?

Side effects include blurred vision, drug-induced myopia (nearsightedness), and accommodative spasms Vasodilation of blood vessels supplying the conjunctiva, iris, and ciiary body, which may lead to vascualr congestion and ocular inflammation Prolonged use can result in iris cysts, lens opacities, and rarely, retinal detachment Common ocular effects are transient burning and discomfort, blurred vision, pain, photophobia, lacrimation, blepharitis, keratitis (inflammation of the cornea), and decreased corneal sensitivity

What electrolyte losses are associated with loop diuretics?

Sodium Potassium Calcium

Oxytocin (Pitocin) [also Methergine] Indications (2)

Stimulate uterine contractions Give AFTER placental to *decrease bleeding risk*

What is the mechanism of action for sulfonamide antibiotics?

Sulfonamides inhibit the growth of susceptible bacteria by preventing bacterial synthesis of folic acid Sulfonamides are structural analogs of para-aminobenzoic acid (PABA), a substance required by many microorganisms for the production of folic acid Host cells and microorganisms that require exogenous folic acid (not synthesized by the bacterium itself) are not affected by sufonamide antibiotics

Amputation

Supine, elevate stump for 48 hours

Management of benzodiazepine overdose

Symptoms include: somnolence, confusion, coma, diminished reflexes, and respiratory depression Flumazenil can be used to reverse the sedative effects of benzodiazepines. May cause acute withdrawal syndrome, including seizures in patients taking long-term benzodiazepines or those with a history of substance abuse

Patient teaching for ACE inhibitors

Take medication as prescribed. Do not stop taking abruptly Do not use with K+ supplements or increased dietary intake of K+ Move and change position slowly to prevent postural hypotension This medication may cause an irritating dry cough. Lozenges or hard candy may help, but notify HCP if the cough worsens Impaired taste may be an adverse effect that may last up to 2-3 months after discontinuation of medication Monitor blood pressure and understand which parameters to report

Patient teaching for HMG-CoA Reductase Inhibitors?

Take medication exactly as prescribed. Do not stop taking it abruptly. It may take several weeks for therapeutic effect to occur. Lab tests will be taken for monitoring at 3-6 months Take with at least 6 ounces of water or with food to minimize gastrointestinal upset Limit intake of grapefruit juice to less than 1 quart daily Immediately report signs of toxicity, including muscle soreness, changes in urine color, fever, malaise, nausea, and vomiting Do not neglect follow-up lab work because it is important to monitor for potential hepatic or renal dysfunction Do not neglect ophthalmic examinations prior to and during therapy because of the potential development of adverse visual effects

Ciproflaxin

Teach patient to drink lots of fluid/ minimize sunlight exposure; Tendon rupture especially in elderly

Corticotrophin

Teach pt to avoid salt; causes weight gain

Mysthenis Gravis

Tensilon will increase muscle use

What is the mechanism of action for proton-pump inhibitors?

The action of the hydrogen-potassium-ATPase pump is the final step in the acid-secretory process of the parietal cell Bind irreversibly to the proton pump. This inhibition prevents the movement of hydrogen ions out of the parietal cell into the stomach and thereby blocks all gastric acid secretion

What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

The inhibition of serotonin reuptake is the primary mechanism of action of the SSRIs, although they may also have weak effects on norepinephrine and dopamine reuptake

What is the mechanism of action for Beta-Agonist (Sympathomimetic) Bronchodilators?

The mechanism of action of beta-agonist bronchodilators begins at the specific receptor stimulated and ends with the dilation of the airways, but many reactions must take place at the cellular level for this bronchodilation to occur. When a beta2-adrenergic receptor is stimulated by a beta-agonist, adenylate cyclase (an enzyme needed to make cAMP) is activated. The increased levels of cAMP make available by adenylate cyclase cause bronchial smooth muscles to relax, which results in bronchial dilation and increased airflow into and out of the lungs. Non-selective adrenergic agonist drugs also stimulate alpha-adrenergic receptors, causing constriction within the blood vessels. This vasoconstriction reduces the amount of edema, or swelling, in the mucous membranes and limits the quality of secretions normally secreted by these membranes

Management of TCA (tricyclic antidepressant) overdose

The primary organ systems affects are the CNS and cardiovascular system Death usually results from seizures or dysrhythmias No specific antidote. Management efforts are aimed at reducing drug absorption by administering activated charcoal Administration of sodium bicarbonate speeds up elimination of the TCA by alkalinizing the urine

What are the therapeutic effects of Beta-agonist (sympathomimetic) Bronchodilators?

The primary therapeutic effects are the relief of bronchospasm related to bronchial asthma, bronchitis, and other pulmonary diseases The Beta2-stimulants are thought to stimulate the NaK+-adenosine triphosphatase (ATPase) ion pump contained in the cell membranes. This facilitates a temporary shift of potassium ions from the bloodstream into the cells, resulting in a temporary decrease in serum potassium levels

What is the mechanism of action for Benzodiazepines?

The sedative and hypnotic action of benzodiazepines is related to their ability to depress activity in the CNS GABA is the primary inhibitory neurotransmitter of the brain, and it serves to modulate CNS activity by inhibiting overstimulation. Benzodiazepines are believed to increase the action of GABA Benzodizepines exert their effects by depressing activity in the areas of the brain called the brainstem and the limbic system

What are the therapeutic effects of Aminoglycoside antibiotics?

The toxicity associated with aminoglycosides normally limits their use to treatment of serious gram-negative infections and specific conditions involving gram-positive cocci Used for prophylaxis in procedures involving the GI or GU tract, because such procedures carry a high risk for enterococcal bacteremia Commonly given to surgical patients with a history of valvular heart disease, because diseased heart valves are also more prone to enterococcal infection May be used in neonates for pneumonia, meningitis, or UTIs

What is the drug class for haloperidol?

Therapeutic: antipsychotics Pharmacologic: Butyrophenones

What is the drug class for risperidone?

Therapeutic: antipsychotics, mood stabilizers Pharmacologic: benzisoxazoles

What is the drug class of rifampin?

Therapeutic: antituberculars Pharmacologic: rifamycins

What is the drug class of Esomeprazole?

Therapeutic: antiulcer agents Pharmacologic: proton-pump inhibitors

What are the therapeutic effects of Calcium Channel Blockers (Class IV antiarrhythmics)?

These drugs are used to treat paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation, and atrial flutter but have little effect on ventricular arrhythmias Calcium channel blockers are also effective in the treatment of hypertension and angina because of their ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contraction Subsequent dilation of peripheral arteries decreases afterload, leading to a decrease in blood pressure and a reduction in myocardial workload and oxygen demand Coronary arteries also dilate, increasing blood flow to the myocardium

A-fib and A-flutter

Thrombus formation

Stroke

Tongue points toward side of lesion (paralysis) Uvula deviates away from the side of lesion (paralysis)

What are the indications for antipsychotics?

Treatment of acute and chronic psychoses, particularly when accompanied by increased psychomotor activity Selected agents are also used as antihistamines or antiemetics Schizophrenia

What are the therapeutic effects for metronidazole?

Treatment of the following anaerobic infections: intra-abdominal infections, gynecologic infections, skin and skin structure infections, lower respriatory tract infections, bone and joint infections, CNS infections, depticemia, endocarditis Perioperative prophylactic agent in colorectal surgery amebicide in the management of amebic dysentery, amebic liver abscess, and trichomoniasis: treatment of peptic ulcer disease caused by H. pylori Management of bacterial vaginosis Treatment of giardiasis. Treatment of anti-infective associated pseudomembranous colitis

What are the precautions for antituberculars?

Use cautiously in patients with a history of liver disease or in elderly or debilitated patients Ethanmbutol requires ophthalmologic follow-up Safety in pregnancy and lactation not established, although selected agents have been used without adverse effects on the fetus Compliance is required for optimal response

What are adverse effects of inhaled medications?

Use of inhaled glucocorticoids may lead to fungal infections (candidiasis) of the oral mucosa and oral cavity, larynx, and pharynx (rinse mouth with warm water after use) Inhaled nasal decongestants can lead to rebound congestion

What drugs interact with Buspirone?

Use with MAO inhibitors may result in hypertension and is not recommended Erythromycin, nefazodone, ketoconazole, itraconazole, ritonavir, and other inhibitors of CYP3A4 increase blood levels and effects of buspirone Rifampin, dexamethasone, phenytoin, phenobarbital, carbamazepine, and other inducers of CYP3A4 decrease blood levels and effects of buspirone Avoid concurrent use with alcohol Use of kava-kava, valerian, or chamomile can increase CNS depression Grapefruit juice increases serum levels and effect (ingestion of large amounts of grapefruit juice are not recommended) Can cause serotonin syndrome: not given with MAOIs (14 day clearance period) and careful use with SSRIs

What are the indications for opioids?

Used to alleviate moderate to severe pain Many are used for postoperative pain

Magnesium

Used to determine metabolic activity and renal function Mg is needed in the blood-clotting mechanism and regulates neuromuscular activity of many enzymes.

Activated Partial Thromboplastin Time (aPTT)

Used to screen for deficiencies and inhibitors of all factors, except VII and XII. Used to determine the effectiveness of heparin therapy and screen for coagulation disorders

Mannitol (IV)

Uses: - ICP - Acute renal fx. Monitor for *confusion* (think ICP)

RESPIRATORY Antihistamines Diphenhydramine (Benadryl)

Uses: - Motion Sickness - Allergies: anaphylaxis, skin rash, seasonal - Sleep sedative (mild) SE: - Drowsiness - Dry mouth - Anorexia Ages: - Really young: paradoxical excitation - Really old: *risk for falls*

S. Blakemore tube ( Sengstaken-Blakemore tube)

Usually for esophageal varices; sudden respiratory distress-cut inflation tube and remove

Removing chest tube

Valsalvas, or deep breath and hold

What are PT/INR used to monitor?

Warfarin therapy

Gantanol Adverse Effects

Wheezing, SOB, Itch, Rash

Administration of Aminoglycoside antibiotics

When aminoglycosides are used in combination with B-lactam antibiotics, the B-lactam is given 1st Never used alone to treat gram + infections

What drugs interact with selective serotonin reuptake inhibitors (SSRIs)?

When given with other drugs that are highly protein bound (warfarin and phenytoin) they compete for binding sites on the surface of albumin and this results in more unbound drug and a more pronounced drug effect Some drugs may inhibit cytochrome P-450 enzymes. An enzyme system in the liver that is responsible for the metabolism of several drugs. Inhibition of this enzyme system results in higher levels of these drugs with the potential for toxicity MAOIs

Diabetes and Insulin

When in doubt treat for Hypoglycemia first

Assessment for benzodiazepines

When these drugs are used, the HCP may order lab studies, such as CBCs, serum electrolyte levels, and hepatic/renal function studies Blood pressure readings are important because of drug-related postural hypotension Perform a baseline neurological examination Perform a baseline eye examination

Administration of antihistamines

When used for prophylaxis of motion sickness, administer at least 30 min and preferably 1-2 hr before exposure to conditions that may precipitate motion sickness When administering concurrently with opioid analgesics, supervise ambulation closely to prevent injury secondary to increased sedation

Primary Intention (1st intention)

Wound edges are approximated until healing occurs

Third (tertiary)

Wounds left open intentionally to remove debris and then approximated

Agraphia

Writing

Anti-ulcer medication

Zantac lowers acid

ANTIPSYCHOTICS - Zyprexa (Olanzapine) - Risperidone (Risperdal) - Quetiapine (Seroquel)

Zyprexa - ortho hypo, bipolar Seizures NMS: fever, tremor, elevated HR/BP; potentially fatal EPS - Tardive Dyskinesia: involuntary movements. Give *benadryl* - Parkinsonism: tremor, rigidity, pill-rolling - Akathisia: restlessness

208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium (Enlon). Which of the following would indicate that the client is experiencing a myasthenic crisis? 1. Increasing weakness 2. No change in the condition 3. An increase in muscle spasms 4. A temporary improvement in the condition

auto-define "A client with myasthen..." Rationale: Edrophonium (Enlon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium (Enlon) injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive test. Increasing weakness would occur in cholinergic crisis. Options 2 and 3 would not occur in either crisis.

Regeneration

complete return to normal structure and function

Hypoglycemia

confusion, HA, irritable, nausea, sweating, tremors, hunger, slurring

Patient teaching for selective serotonin reuptake inhibitors (SSRIs)

consumption of fiber supplements must occur at least 2 hours before or after the dosing of medication to avoid interference with drug absorption Any increase in suicidal thought or extreme changes in mood needs to be reported immediately to the HCP Discontinuation of SSRIs and SNRIs requires a tapering period of up to 1-2 months Discontinuation syndrome may occur with or without a tapering period; this includes symptoms of dizziness, diarrhea, movement disorders, insomnia, irritability, visual disturbance, lethargy, anorexia, and lowered mood If transdermal patches are the dosage form used, emphasize the importance of rotating the patch site with each application and to place patch on a nonhairy, healthy, intact area

Oral Hypoglycemics

decrease glucose levels by stimulating insulin production by beta cells of pancreas, increasing insulin sensitivity and decreasing hepatic glucose production; Glyburide, Metformin (Glucophage), Avandia, Actos Acarbose blunts sugar levels after meal

Clonidine side effects?

dizziness, sedation

ANTI-MIGRAINE MEDS (*"-triptan"*) Sumatriptan (Imitrex) Eletriptan (Relpax) Zolmitriptan (Zomig)

dizziness, vertigo parestesia myalgia *chest tightness* With *Sumatriptan/Imitrex, MI can occur*

Administration of inhaled medications

if a second type of inhaled medication is ordered, wait 2-5 minutes between medication inhalations or as prescribed If both a bronchodilator and a corticosteroid inhaled medication are ordered, the bronchodilator needs to be administered first (wait 2-5 min)

Phosphorus

important in bone formation, energy storage and release, urinary acid-base buffering, and carbohydrate metabolism.

What are the adverse effects of proton-pump inhibitors?

increased speed of bone mineral loss Risk of wrist, hip, and spine fractures Pneumonia

Administration of selective serotonin reuptake inhibitors (SSRIs)

may take up to 4-6 weeks before therapeutic effects are evident Advise the patient to take the drugs with food and at least 4-6 oz of fluid Counsel patients about potential sexual dysfunction and provide information about various options (waiting to see if the effect resolves, reducing the current dosage, taking a drug holiday)

Shift to the Left

means that an increased number of immature neutrophils is present in the blood

Shift to the right

means that cells have more than the usual number of nuclear segments; found in liver disease, Down syndrome, and megaloblastic and pernicious anemia.

Assessment of antipsychotics

monitor blood pressure, pulse, and respiratory rate before and frequently during the period of dosage adjustment Monitor patient for onset of akathisia-restlessness or desire to keep moving-and extrapyramidal side effects; parkinsonian-difficulty speaking or swallowing, loss of balance control; and dystonia-muscle spasms, twisting motions, twitching Monitor for tardive dyskinesia-uncontrolled rhythmic movement of mouth, face, and extremities Monitor for development of neuroleptic malignant syndrome-fever, respiratory distress, tachycardia, convulsions

Administration of Angiotensin II Receptor Blockers (ARBs)

often tolerated best with meals A diuretic may be ordered in combination with an ARB for patients who have hypertension with left ventricular hypertrophy

Administration of Aminoglycoside Antibiotics

parenteral dosage forms are the most commonly used Check IM sites for induration Monitor IV sites for heat, swelling, redness, pain, or red streaking (phlebitis)

Repair

replacement of destroyed tissue with scar tissue, not as strong as original tissue

Resolution

returns injured tissues to an approximation of their original structure

NG tube/stomach content

stomach contents pH = < 4 (gastric juices aspirated)

Magnesium Sulfate

stop seizures in pre-eclamptic pt.

Inject insulin

subcut

Administration of naloxone

the effects of naloxone are short-lived and usually last about 1 hour. With long-acting opioids, respiratory depressant effects may reappear, and naloxone may need to be redosed IV: Onset: 1-2 min Peak: unknown Duration: 45 min IM, Subcutaneous: Onset: 2-5 min Peak: unknown Duration: > 45 min

What is the drug class of morphine sulfate?

therapeutic: opioid analgesic Pharmacologic: opioid agonist

Tylenol

toxic to liver

In emergencies, use above meds (epi, atropine, lidocaine) and ------ and transfer to ----- asap.

use OXYGEN transport to EMERGENCY ROOM

Signs of neuroleptic malignant syndrome

very high fever (102-104 F) Irregular pulse, tachycardia Tachypnea Muscle rigidity Altered mental status ANS dysfunction resulting in hypo/hypertension Profuse perspiration (excessive sweating) Liver or kidney failure Abnormally high potassium (hyperkalemia) Major destruction of skeletal muscle tissue (rhabdomyolysis) Blood clots in veins and arteries

Hyperglycemia

weakness, syncope, polydipsia, polyuria, blurred vision, fruity breath

Dehiscence

when an approximated wound pulls apart at the suture line

Patient teaching for tricyclic antidepressants (TCAs)

when the patient is taking a TCA, any blurred vision, agitation, urinary retention, or ataxia needs to be reported to the prescriber immediately encourage wearing of a medical alert necklace or bracelet showing the diagnosis and a list of current drugs

Lithium TR

0.5-1.5

Specific gravity

1.005-1.030

Mg+

1.5-2.5

Albumin

3.5-5

K+

3.5-5

Glycosylated Hemoglobin (Hgb A1c)

4-6% ideal, <7.5% = Ok (120 days)

Ca++

9-10.5

Cl-

96-106

Cholesterol

< 200

Glasgow Coma Scale

< 8 = coma

Post Strep URI diseases and conditions:

Acute glomerulonephritis (triggered by immunologic mechanism), rheumatic fever (valve disease), Scarlet fever

Hyperventilation

Alkalosis = low CO2

Delegation: RN Only

Blood products (2RN's must check) Clotting factors Sterile dressing changes and procedures Assessments that require clinical judgement Ultimately responsible for all delegated duties UAP...non-sterile procedures

Kidney stone

Cholelithiasis Flank pain = stone in kidney or upper ureter Abdominal/scrotal pain = stone in mid/lower ureter bladder

Lesions of Midbrain

Decerebrate posturing (extended elbows, head arched back)

Stimulant withdrawal

Depression, fatigue, anxiety, disturbed sleep

Fruity breath

Diabetic ketoacidosis

Antidotes

Digoxin...Digiband Coumadin...Vitamin K+ (keep PT/[email protected]) Benzodiazapines...Flumzaemil (Tomazicon) Magnesium sulfate...Calcium gloconate Heparin...Proamine sulfate (keep APTT/[email protected] 2.5xnormal) Tylenol...Mucomist (17 doses+loading dose) Opiates (eg. narcotic analgesics, heroin, morphine)...Narcan (Naloxone) Cholinergic meds (eg. Myesthenic Bradycardia)...Atropine Methotrexate...Leucovorin

Phenothiazines (typical antipsychotics)

EPS, Photosensitivity

MAOI's

Hypertensive crisis with Tyramine foods; Nardil, Marplan, Parnate. Need 2 week gap from SSRI's and TCA's to admin MAOI's

Chest tube

If a chest tube becomes disconnected, do not clamp, put end in sterile water. Chest tube drainage system should show bubbling and water level fluctuations (tidal with breathing)

Antabuse for alcohol deterrence

Makes you sick with OH intake

Addison's crisis

Medical emergency-vascular collapse, hypoglycemia, tachycardia, administer IV glucose, corticosteroids; no PO corticosteroids on an empty stomach

Steroid effects

Moon face, hyperglycemia, acne, hirsutism, buffalo hump, mood swings, weight gain-spindle shape, osteoporosis, adrenal suppression (delayed growth in kids), cushing's syndrome symptoms

Mental health & Psychiatry

Most suicides occur after beginning of improvement with increase in energy levels

Hypocalcemia

Muscle spasms, convulsions, cramps/tetany, +Trousseau's (flex at wrist), +Chvostek's (hyperexcitability (tetany). It refers to an abnormal reaction to the stimulation of the facial nerve), prolonged ST interval, prolonged QT segment

RSV

Needs contact precautions too

Phenylalanine

New Born < 2 Adult < 6

Mastectomy

No BP or IV on side of Mastectomy

Peak and Trough

Peak draw 30-60 minutes after drug administration Trough draw ~30 minutes before scheduled administration

PTCA

Percutaneous Transluminal Coronary Angioplasty

In case of fire

RACE (rescue, alarm, contain, extinguish) and PASS (pull pin breaking the plastic seal, aim at the base of the fire, squeeze the handles together, and sweep from side to side

Weird miscellaneous stuff: Rifampin (for TB)

Rust/orange/red urine and body fluids

Lithium (a salt)

Theraputic range = 0.5-1.5

Contact precautions

Universal + goggles; Mask and gown No infection patients with immunosuppressed patients

Precautions & room assignments/Universal precautions...HIV initiated

Wash hands Wear gloves Gown for splashes Mask and eye protection for splashes and droplets Don't recap needles Mouthpiece or ambu-bag for resuscitation Refrain from giving care if you have skin lesions

Potassium sparing diuretic: Aldactone (Spironolactone)

Watch for hyperkalemia with this ACE inhibitor

Gullain-Barre Syndrome

Weakness progresses from legs upward/resp arrest

Myesthenia Gravis: Myesthenic crisis

Weakness with change in vitals (give more meds)

Cholinergic crisis

Weakness with no change in vitals (reduce meds)

Atypical antipsychotics

Work on positive and negative symptoms, less EPS

Urine Output of 30mL/hr

minimal competency of heart and kidney function