NCLEX Pharm: Analgesics, Immune, Integumentary
The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the health care provider before administering?
1) Bumetanide in the patient who has heart failure and hypokalemia 2) Isoniazid in the patient with latent TB with elevated liver enzymes Loop diuretics (eg, bumetanide, furosemide, torsemide) can cause hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]). Elevated liver enzymes in clients receiving the antitubercular drug isoniazid can indicate development of drug-induced hepatitis.
What are the steps for treatment of anaphylactic shock?
1) Ensure patent airway, administer oxygen 2) Remove insect stinger if present 3) IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle (beta 2) and provides vasoconstriction (alpha 1). The IM route (mid anterior lateral thigh) is better than the subcutaneous route. 4) Repeat dose every 5-15 minutes. 5) Place in recumbent position and elevate legs 6) Maintain blood pressure with IV fluids, volume expanders or vasopressors 7) Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small airways and reverse bronchoconstriction 8) Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus 9) Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction 10) Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema
The health care provider has just prescribed tetracycline for an adolescent with acne vulgaris. The client takes oral contraceptive pills. The clinic nurse should educate the teen about which topics?
1) Not taking tetracycline with dairy products 2) Using additional contraceptives 3) Using sunblock - Tetracyclines should be taken 1 hour before or 2 hours after meals with plenty of water. - They should not be taken with dairy products or within 2 hours of taking antacids. - Clients should use sunblock due to photosensitivity and plan to use additional contraceptive techniques.
What are common adverse effects that sulfa drugs have?
Agranulocytosis (leukopenia) - lient should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately Crystalluria Photosensitivity Folic acid insufficiency SJ syndrome
A nurse is caring for a client with a diagnosis of fibromyalgia. During care, the client reports having suicidal thoughts. What currently prescribed medication should the nurse question in regard to this new finding?
Amitriptyline
The home health nurse visits a client with hand osteoarthritis whose health care provider has recommended topical capsaicin for pain relief. Which instruction about capsaicin should the nurse provide the client? ( a local pain relief cream)
Apply cream to hands and wait at least 30 mins before washing them - Local irritation (burning, stinging, erythema) is quite common.
The nurse is preparing medications for the following 4 clients. Which prescription should the nurse clarify with the health care provider before administration?
Azathioprine for a patient with Crohn's disease with leukopenia who is reporting malaise - Leukopenia, a severe adverse effect of azathioprine, should be reported to the health care provider before the medication is administered.
What category of drug is azathioprine and what are its adverse effects?
Azathioprine is an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. - Leukopenia, a severe adverse effect of azathioprine, should be reported to the health care provider before the medication is administered.
What is a severe adverse effect of phenytoin?
Clients taking phenytoin (seizure medication) should discontinue the medication immediately if a rash develops and notify the health care provider. The rash may indicate Stevens-Johnson syndrome, a potentially life-threatening hypersensitivity reaction.
How often are allergy shots given?
Every week. Maintenance doses are given every 3-5 years
The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the client's caregiver?
Give the medication around the clock as scheduled, even if the patient insists they are not having pain - Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. - Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect.
A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug's adverse effects should the nurse include in the teaching plan?
Have an eye exam done every 6 months - Serious adverse drug reactions include retinopathy and visual disturbances; therefore, regular ophthalmologic examination every 6-12 months is required.
What is hydroxychloroquine and what are its adverse effects?
Hydroxychloroquine (Plaquenil) is used to treat the skin and arthritic manifestations of SLE. Taking the medication with food can help alleviate gastrointestinal upset.
The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation?
I am taking an antibiotic for a UTI - Clients with infection should not take tumor necrosis factor (TNF) inhibitors (eg, infliximab, adalimumab, etanercept) as these suppress the immune response. Before starting drug therapy, clients should be tested for tuberculosis and receive the inactivated (injectable) influenza vaccine. Clients taking TNF inhibitors should avoid live vaccines.
The clinic nurse is preparing to administer an allergy immunotherapy injection to a client recently initiated on the therapy. Which statement by the client indicates a need for further teaching?
I can leave right after the shot since I didn't have a reaction last time - A client receiving an allergy shot is at risk for anaphylaxis immediately after the injection, so the client must remain at the facility and be monitored for 30 minutes after the injection.
The nurse provides teaching about methotrexate to a 28-year-old client with rheumatoid arthritis. Which client statement indicates the need for further instruction regarding this drug?
I will have an eye exam every 6 months
What are used for breakthrough pain?
Immediate-release opioids may be required for breakthrough pain.
What is isotretinoin? (Accutane)
Isotretinoin is a teratogenic medication (used for acne) known to cause serious harm to a fetus if taken during pregnancy. .
What is methotrexate and what are its side effects?
Methotrexate is a disease-modifying antirheumatic drug used to treat rheumatoid arthritis and psoriasis. The major adverse effects associated with methotrexate include bone marrow suppression, hepatotoxicity, congenital abnormalities, and fetal death.
What category is ketorlac (Torodol) in?
NSAID
A postoperative client is prescribed IV patient-controlled analgesia (PCA) with morphine. The client tells the nurse, "I am pushing the button, but I'm still having a lot of pain." What is the priority nursing action?
Preform a thorough pain assessment - f the client's attempts are twice the number of doses actually delivered and adequate pain relief is not achieved, the nurse would notify the HCP to request a dose increase or shorter dose interval. However, this is done after the pain assessment.
A client comes to the emergency department following a bee sting. The client has a diffuse rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next?
Repeat IM epi injection - repeat dose Q5-15 mins if symptoms are still present
The nurse administers the prescribed dose of hydromorphone 2 mg to a client who is 2 days postoperative from a colostomy. Which assessment finding is most important for the nurse to follow-up?
The client falls asleep while talking to the nurse - Sedation precedes respiratory depression in narcotic administration. A client (especially if on high doses) should be assessed for sedation level. Level 3 sedation on POSS requires that no additional narcotics be administered to the client.
A client is taking morphine sulfate for acute pain. Which statement will best assist the client worried about nausea and vomiting while taking this medication?
Tolerance develops quickly and persistent nausea is rare - Nausea decreases when patient is lying down in a flat position
A 24-year-old female client is prescribed isotretinoin for severe cystic acne. Which instruction is most important for the nurse to reinforce?
Use two forms of contraception
A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug?
Wearing sunscreen Drinking 8 glasses of water a day Taking folic acid supplements
What is sulfasalazine and what are its adverse effects?
ulfasalazine (Azulfidine) is used for mild to moderate chronic inflammatory RA and inflammatory bowel disease. - Important adverse effects include crystalluria with kidney injury, yellow-orange skin and urine discoloration, folic acid deficiency, and photosensitivity.
