Pharmacology unit 2 IV formulas math problems, dosage calc verifying safe dose
An IV solution of 330 mL at a drip rate of 5 gtt/min using a tubing factor of 20 gtt/ml has been ordered to be initiated at 1800. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
Explenation: 20gt 1 min 1hr 22hr time 330ml x 5 gtt 60 min
• Initial dose:
First dose of a drug given to a patient
A client who has rheumatoid arthritis is taking methotrexate. Which of the following reduces toxicity from this drug?
Folic acid
• Divided dose:
Fractional portions of a total daily dose given at specific intervals
When instructing the client about alendronate, which of the following information shoukd the health care provider include? (Select all that аpply.
Take the drug on an empty stomach. Sit upright for 30 minutes following dosage Take with a full giass of water
The order reads 340 mL over 14 hours. Calculate the infusion rate. (Round your answer to the nearest tenth.)
Explanation: To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 340 mL rate = time 14 hr hr %3D = 24.3 mL
The order reads 660 ml over 14 hours. Calculate the infusion rate, (Round your answer to the nearest tenth.)
Explanation: To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 660 mL ml rate = time 14 hr 47.1 hr
An IV solution of 720 mL at a drip rate of 15 gtt/min using a tubing factor of 10 gtt/mL has been ordered to be initiated at 0715. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
Explanation: time = %3D 720ml = 8hr 10gt 1 min 1hr 15 gt 60 min
An IV solution of 600 mL at a drip rate of 10 gtt/min using a tubing factor of 15 gtt/mL has been ordered to be initiated at 1445. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
15gtt 1min time = 600ml x = 15hr mL 10t 10gtt 60 min
The order reads 580 mL over 3 hours. Calculate the infusion rate. (Round your answer to the nearest tenth.)
193.3 mL/hr To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 580 mL mL rate = = 193.3- time 3 hr hr
An IV solution of 500 mL at a drip rate of 40 gtt/min using a tubing factor of 20 gtt/mL has been ordered to be initiated at 1500. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
20 gtt 1 min 1hr = 4.2hr time = 500ml x mb 40 gtt 60 min
An IV solution of 550 mL at a drip rate of 40 gtt/min using a tubing factor of 20 gtt/mL has been ordered to be initiated at 0045. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
4.6 hr Explanation: 20gti 1min time = 550mlx = 4.6hr 40 gtt 60 min
An IV solution of 990 mL at a drip rate of 35 gtt/min using a tubing factor of 10 gtt/mL has been ordered to be initiated at 1015. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
4.7 hr Explanation: 10 gtt 1min time = 990ml %3D 4.7hr 35 gtt 60 min
The order reads 770 mL over 19 hours. Calculate the infusion rate. (Round your answer to the nearest tenth.)
40.5 ml/hr To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 770 mL mL rate = = 40.5- time 19 hr hr
The order reads 990 mL over 16 hours, Calculate the infusion rate. (Round your answer to the nearest tenth.)
61.9 hr To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 990 mL mL = 61.9- rate = time 16 hr hr
Adverse Drug Reactions SERM
Adverse drug reactions (ADR) of SERM drugs relate primarily to the activation of estrogen receptors. Serious adverse effects of raloxifene are an increased risk of stroke, pulmonary embolism and deep vein thrombosis. Clients may have hot flashes due to blockage of estrogen receptors in other tissue. SAFETY ALERT Women who are pregnant breastfeeding should not take SERMS because they are teratogenic and can damage a developing fetus, SERMS can also pass through breast milk, exposing the infant to the drug.
Single dose:
Dose of medication administered at one time
• Maintenance dose:
Dose required to sustain therapeutic effect
Prototype and Other Drugs calcium supplements.
Drug Classification-Mineral and Electrolyte Supplements You need to know two prototypes in regard to calcium supplements. The first is calcium citrate, also called Citracal, (Drug Classification Mineral and Electrolyte Supplements) which is used primanly for calcium replacement, as a dietary supplement. The second is calcium carbonate (Tums, Os-Cal): Drug Classification-Mineral and Electrolyte Supplements You can also use this as a calcium supplement, but it's primanly on the market as an antacid, under a vanety of different trade names
The health care provider prescribes alendronate (Fosamax) to reduce bone resorption and instructs the client to monitor for which of the following indications of a serious adverse effect of this drug?
Dysphagia Dysphagia (difficulty swallowing) can indicate esophagitis, a rare but serious effect of alendronate. The client must understand that she has to notify the provider of any pain or difficulty swallowing and of worsening heartburn. Alendronate is unlikely to cause deep vein thrombosis. This serious adverse effect is more likely with raloxifene (Evista). Alendronate is more likely to cause musculoskeletal pain than chest pain. Alendronate is unlikely to cause dzziness. Dizziness might accompany bradycardia, a potentially serious adverse effect of neostigmine (Prostigmin) and of parenteral calcium interaction with digoxin (Lanoxin).
The order reads 710 ml over 10 hours. Calculate the drip rate using a tubing factor of 15 gtt/mL. (Round your answer to the nearest whole number.)
Explanation: To calculate the drip rate, multiply the total intusion volume by the tubing factor and then divide by the total infusion time in minutes. total volume x tubing factor 710 mL x 15 gtt/mL 18.9tt gtt drip rate = time 600 min min
An IV solution of 110 mL at a drip rate of 15 gtt/min using a tubing factor of 20 gtt/mL has been ordered to be initiated at 2300. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
Explanation: 20gtt 1min 2.4h time 110ml x 15 gtt 60 min
The order reads 200 mL over 5 hours. Calculate the drip rate using a tubing factor of 20 gtt/mL. (Round your answer to the nearest whole number.)
Explanation: To calculate the drip rate, multiply the total infusion volume by the tubing factor and then divide by the total infusion time in minutes. total volume x tubing factor 200 mL x 20 gtt/mL gtt drip rate = = 13 time 300 min min
An IV solution of 10 mL at a drip rate of 35 gtt/min using a tubing factor of 20 gtt/mL has been ordered to be initiated at 0200. Calculate the infusion time. (Round your answer to the nearest tenth of an hour)
0.1 hr Explanation: 20gtt 1min time = 10m x 0.1 ml 35 gtt 60 min= 0.1 hr
Types of recommended dose, explain
1- standard dose or dosage range( ex. 40 mg TID, or range, 200,000 to 400,000 units recommended for all adult patients). 2. Weight base dose— depends on patients weight ( ex. 10mg/kg) 3. Body surface area based dose— considers height and weight in meters square. ( given per m square, usually burn victims).
An IV solution of 810 mL at a drip rate of 40 gtt/min using a tubing factor of 10 gtt/mL has been ordered to be initiated at 0315. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
10 gt 1 min 1hr = 3.4 hr time = 810ml x 40gtt 60 min
An IV solution of 390 mL at a drip rate of 30 gtt/min using a tubing factor of 10 gtt/mL has been ordered to be initiated at 2230. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
10 gtd 1min time = 390ml 2.2hr 30 gtt 60 min
Client Instructions supplemental calcium
Because clients who take supplemental calcium in some form are at risk for hypercalcemia, stress the importance of reporting them to their provider if they depression. To prevent constipation, encourage clients to eat a diet high in fiber increase water consumption, and take a laxative as necessary. Some clients also find it beneficial to take a fiber supplement or stool softener clients to report flank pain or blood in the urine due to the increased risk of kidney stones. calcium one hour before or one to two hours after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics. after meals and at bedtime. Teach them to chew the tablet swallowing and to not take more than 600 milligrams at one time The body cant Make sure clients know to take supplemental when taking supplemental calcium. Instruct teach them the signs and symptoms, and occur. These include nausea and vomiting, increased urine output, and Instruct clients who take calcsum-based antacids to take them one hour before swallowing, drink a glass of water atter absorb a dose greater than 600 milligrams at one time and will end up excreting it. Tell clients to read the products label about the bioavailability of the calcium. Calcium citrate has a higher bioavailability than other preparations, such as calcium carbonate, because it is highly soluble. Calcium preparations a client can chew also provide a higher bioavailability of the elemental calcium. Make sune they take the amount of elemental calcium per day thath recommended for their age and childbearing status
Interactions SERM
Because of the increased risk for estrogen-supported cancers, concurrent administration with estrogen is not overview of the SERM prototype drug, click the button to access a drug information table.
Adverse Drug Reactions Bisphosphonates
Bisphosphonates such as alendronate have several adverse drug reactions, including gastrointestinal disturbances such as esophagitis, nausea, vomiting, and abdominal pain. Muscle and joint pain can occur in some clients and may even require discontinuing the drug or managing the pain with a mild analgesic. Some clients who resume taking the drug after a brief time off the drug no longer experience pain. While eye pain and vision changes are not common, this might occur in some clients,
A nurse is teaching a client about methotrexate. The nurse should inform the client to monitor for which of the following as an adverse effect of this drug?
Black, tarry stools
A primary care provider prescribes etanercept to treat a client's rheumatoid arthritis. Prior to beginning the treatment, the client requires testing for which of the following?
C Tuberouiosis Primary care providers should test clients for tuberculosis prior to treatment with etanercept. Pulmonary tuberculosis in clents taking etanercept can spread to other organs and pose treatiment chalenges They should also monitor clients for the development of tuberculosis during etanercept therapy
Expected Pharmacologic Action Calcitonin
Calcitonin is expected to decrease bone resorption, It acts similar to the calcitonin that the thyroid gland produces, by inhibiting the action of osteoclasts and increasing excretion of calcium. By increasing excretion of calcium, calcitonin is also valuable in decreasing the serum calcium in clients who are experiencing hypercalcemia.
Expected Pharmacologic Action Calcium supplements
Calcium supplements are expected to provide a non-dietary use vitamin D with a calcium supplement because it enhances absorption of calcium from the intestine neutralizing gastric acid. As mentioned previously, calcium-based antacids can be used as calcium supplements. You can also often source of calcium. Calcium is a basic chemical, so its effective in
Interactions calcitonin
Clients taking lithium may experience a decrease in serum lithium levels if calcitonin is added to their drug regimen. Make sure you monitor serum lithium levels closely in clients that take both lithium and calcitonin. Previous treatment with bisphosphonates such as alendronate, risedronate, etidronate, ibandronate, or pamidronate may decrease the body's response to calcitonin, For an overview of the calcitonin prototype drug, click the button to access the drug information table.
How to verify Safe Dose ?
Compare ORDERED dose with RECOMMENDED DOSE
Contraindications and Precautions calcitonin
Contraindications for calcitonin include clients who are allergic to salmon or other fish protein (as determined by healthcare provider), as it derives from that source.
Contraindications and Precautions bisphosphonates
Contraindications include clients who have esophageal strictures or disorders or have difficulty swallowing. bisphosphonates to clients who are unable to sit or stand for 30 minutes after administration or to clients or hypocalcemia. Take caution when giving bisphosphonates to clients who have other upper gastrointestinal infection, liver disease, or heart failure.
Interactions calcium are several supplements
Glucocorticoids decrease supplement at the same time as thyroid hormones, tetracycline, or quinolone absorption of a calcium supplement; therefore, they should supplements resulting in hypercalcemia may increase the risk of digoxin toxicity when given concurrently. There are several drug and food interactions for you to consider during calcium supplement therapy. Excessive amount of calcium not be given at the same time. On the contrary, if you give a calcium antibiotics, it decreases absorption of all these drugs Clients on thiazide diuretics and a calcium of the calcium. For an overview of the calcium supplements, click the button to access a drug information table. calcium. Be careful giving supplemental calcium close to a meal because foods like cereals, rhubarb, and spinach decrease absorption supplement may be more likely to develop hypercalcemia because of decreased excretion of
A client is about to start taking raloxifene to treat osteoporosis. You advise the client to watch for which of the following adverse effects?
Hot flashes Raloxifene, a selective estrogen receptor modulator that helps reduce the risk of breast cancer, may cause hot flashes, leg cramps, and pulmonary embolism. Bisphosphonates can cause jaw pain and blurred vision
Calcitonin Adverse Drug Reactions
Hypersensitivity reactions and even anaphylaxis can occur in clients with an allergy to salmon protein or gelatin diluent. Because calcitonin increases renal excretion of calcium, hypocalcemia can occur if excretion exceeds intake. Clients taking the nasal form of calcitonin may experience nasal dryness and irntation with therapy as well as headaches and epistaxis. Clients taking calcitonin salmon in the injectable form may experience injection site reactions, nausea and vomiting as well as polyuria. Some clients may experience a decrease in therapeutic effects if they take calcitonin over a long period of time.
Interventions calcitonin
If clients take calcitonin intranasally, assess the nostrils administration for irritation or ulceration. Monitor clients for signs and symptoms of hypocalcemia, such as muscle spasms, tingling of the fingers and toes, and a serum calcium level below the expected reference range of 9.0-10.5 mg/dL. When treating osteoporosis with calcitonin-salmon, provide a diet high in calcium and vitamin D to prevent hypocalcemia from occurring. Also, make sure to perform an intradermal allergy test prior to therapy. SAFETY ALERT Anaphylactic shock can occur in clients allergic to salmon or other fish protein. Performing an allergy test prior to therapy determines if clients are sensitive to calcitonin. The development of erythema within 15 minutes indicates sensitivity. If clients exhibit a sensitivity reaction, withhold the drug. Even if clients do not exhibit an allergic reaction, make antihistamines, oxygen, and epinephrine at a concentration of 1:1000 available during the first few davs of therapy
Calcitonin
Increases the excretion of calcium
• Loading dose:
Initial large dose administered to quickly achieve therapeutic drug levels therapeutic
A nurse is caring for a client taking etanercept. Which of the following adverse effects is most important to mention when educating this client?
Injection site reaction can occur. Injection site reaction occurs in 37% of clients taking etanercept. Teach the client to look for localized reaction signs, such as itching. erythema, swelling, and pain. Elevation of liver enzymes is an adverse effect of the drug leflunomide. Gastrointestinal perforation has been associated with the drug methotrexate. Change in vision is an adverse effect of alendronate
Which of the following information in the client's history causes the health care provider to suspect the client has osteoporosis? (Select all that apply.)
Menopause C , Long-tem corticosteroid use , Loss of height
Selective estrogen receptor modulators
Mimics the effects of estrogen on the bones
A client who is menopausal is taking a calcium supplement to prevent osteoporosis. You instruct the clent to watch for which of the following indications of hypercakcemia?
Nausea, Manifestations of hypercalcemia include anorexia, nausea, vomiting, and constipation. muscle spasms. Vitamin C deficiency can cause bleeding and gingivitis
Can a nurse determine the dose of medication?
No! It is not within the nurse's scope of practice to determine the dose of medication
3 main types of drugs to treat rheumatoid arthritis
Non-steroidal anti-inflammatory drugs(NSAIDs), glucocorticoids, disease modifying anti rheumatic ( DMARDs)
A nurse is teaching a client who has a prescription for calcium citrate about manifestations of hypercalcemia. Which of the following manifestations should the nurse include in the teaching?
O Vomiting
Expected Pharmacologic Action bisphosphonates
O) The expected pharmacologic action of bisphosphonates is to decrease bone resorption by inhibiting activity of osteoclasts.
Where can you find recommend dose?
On package insert or label
SERMs (selective estrogen receptor modulators)
Primary therapeutic use- treatment for postmenopausal osteoporosis. Also for women who are at risk for estrogen dependent or receptor positive cancer or had treatment for estrogen dependent or positive receptor cancer.
A clent is about to start therapy with methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you advise the client to watch for which of the following?
TSore throat
Calcium supplements
Raises calcium levels
Contraindications and Precautions SERMS
Raloxifene and tamoxifen both have teratogenic effects, so contraindications include women who are pregnant and breastfeeding while taking one of these drugs. Clients who have deep vein thrombosis, or a history of deep vein thrombosis, cannot take a SERM. Clients who develop deep vein thrombosis during treatment need to consult their provider about discontinuing the drug. Make sure that clients who have elevated serum lipid levels use SERMS with caution.
Prototype drug for SERMs
Raloxifene, known as Elvista ( classification- bone resorption inhibitor). The first SERM drug was taxoxifen or nolvadex Raloxifene poses less uterine cancer risks
Which of the folowing drugs are effective in disease prevention as well as treatment of osteoporosis? (Select all that apply.)
Raloxitene Alendronate The Selective Estrogen Receptor Modulator (SERM) raloxifene is used in both the prevention and treatment of postmenopausal osteoporosis Alendronate a bisphosphonate, is used in the prevention and treatment of postmenopausal osteoporosis, agerelated osteoporosis in men, and glucocorticoid-related osteoporosis in clients taking glucocorticoids long term. Calcitonin-salmon is used in the treatment, not prevention, of established postmenopausal osteoporosis. NSAIDS treat symptoms of a disease and are not effective in prevention
Which of the following are correct about recommended doses in drug references?
Recommended doses can be based on body surface area. Weight base Written single dose or dosage range CORRECT Recommended doses can be written as a single standard dose, a dosage range, a weight-based dose, or based on body surface area. Recommended doses are provided by the drug manufacturer for all drugs and all ages of patients. The recommended dose is found in a drug reference, the drug insert, or on the drug label.
Bisphosphonates
Reduces the number of osteoclasts
Action SERMS
SERMS exert their pharmacologic action by activating estrogen receptors in some tissue and block receptors in other tissue. This activation decreases both bone resorption and bone loss, thereby maintaining bone mineral density (BMD). Raloxifene blocks acce to estrogen receptors in breast tissue, making them valuable drugs for clients with estrogen-dependent or positive cancer. While SERMS activate receptors in the endometrium, raloxifene does not.
What is SAFE DOSE and EFFECTIVE DOSE?
Safe dose— when the amount of drug is equal or less to recommended drug dose. Recommended dose— when the amount of drug is enough to produce desired therapeutic effect. Safe doses are not always effective.
The health care provider instructs the clent about the mportance of taking the prescribed 1,500 mg/day dosage of cacium carbonate (Tuma). Which of the folowing instructions should the health care provider recommend?
Sel up aimple reminder ystem if the clent's nonadherence is unintentional the health care provider can work with her to devise a reminder system that will workr her such asa calendar, a tablet counter, or a watch alarm routine Clents should take no more than 600 mg of calcium at one time for optimal absorption. Clients should take calcium carbonate that is suppled in a chewable form such as Tums on an empty stomach followed by a fu glass of water. Calcum carbonate is also used as an antacid to neitralze gastrio scid. It is not necessary to take it with mesis to reduce gastric eritation
Drugs that prevent or treat osteoporosis
Selective estrogen receptor modulators(SERMs), bisphophonates, calcitonin, and calcium supplements
LI FLAG A nurse is caring for a client who is taking etanercept for rheumatoid arthritis. The nurse should monitor the client for which of the following indications of a serious adverse reaction to the drug?
Shortness of breath
The drug reference states the following about lenvatinib, when used as treatment for advanced renal cell carcinoma Route/Dosage Renal Cell Carcinoma PO (Adults): 18 mg once daily. The recommended dose of 18 mg once daily for lenvatinib can best be described as a:
Standard dose
Calcium Supplements
Supplements Many clients take a calcium supplement either by itself or in conjunction with one of the other drugs this module discusses Therapeutic uses include hypocalcemia and clients who either have a calcium deficiency. This includes adolescents going through breastfeeding or postmenopausat and men and women at risk for osteoporosis carbonate is also the primary component of several deficiency or are at nisk of experiencing a calcium puberty and experiencing an increase in height women who are pregnant either due to increased age or because they are antacids that treat gastric hyperacidity lactose intolerant Calcium
Client Instructions calcitonin,
Teach clients how to self-administer calcitonin, especially if they are to take it intranasally. Remind clients to prime the pump for each new container prior to the first time using according to the manufacturer's instructions. Instruct them to alternate the nostril they use daily just like you did during administration and to report nasal irritation or bleeding. Also, tell clients to notify their provider Immediately if a rash or itching occurs and if muscle spasms or tingling of the fingers and toes develop. Encourage consumption of a diet high in calcium and vitamin D. Finally, inform clients that calcitonin may lose its effectiveness after a year or more of use, so they need regular bone density studies to evaluate effectiveness.
An IV solution of 590 mL at a drip rate of 5 gtt/min using a tubing factor of 10 gtt/mL has been ordered to be initiated at 1900. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
The correct response was: 19.7 hr. Explanation: 10gtt 1min 1hr = 19.7hm time = 590ml x 5 gtt 60 min
An IV solution of 710 mL at a drip rate of 45 gtt/min using a tubing factor of 15 gtt/mL has been ordered to be initiated at 0530. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
The correct response was: 3.9 hr. Explanation: 15 gtt 1min 1hr time = 710ml x mD 45 gtt 60 min = 3.9hr
The order reads 410 mL over 15 hours. Calculate the drip rate using a tubing factor of 10 gtt/mL. (Round your answer to the nearest whole number.)
The correct response was: 5 gtt/min. Explanation: To calculate the drip rate, multiply the total infusion volume by the tubing factor and then divide by the total infusion time in minutes. total volupne x tubing factor 410 mL x 10 gtt/mL gtt drip rate = time 900 min min
The order reads 30 ml over 30 minutes. Calculate the infusion rate. (Round your answer to the nearest tenth.)
The correct response was: 60 mL/hr. To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 30 mL 60 min mL rate = = 60 time 30 min 1 hr hr
The health care provider explains to the client that there may be a drug interaction between the glucocorticoid and the calcium supplement. Which of the following may occur?
The glucocorticoid may cause reduced absorption of the calcium supplement.
Bisphosphonates
The next type of drug to treat osteoporosis is bisphosphonates. The therapeutic uses of bisphosphonates are for the prevention and treatment of postmenopausal osteoporosis in women, age-related osteoporosis in men, and glucocorticoid-related osteoporosis in clients who were or are on long-term glucocorticoid therapy.
Calcitonin , Prototype and Other Drugs
The prototype and only drug in this classification of drugs is calcitonin-salmon, (Miacalcin, Calcimar): Drug Classification- Hypocalcemic
Prototype and Other Drugs bisphosphonate
The prototype for bisphosphonate drugs is alendronate (Fosamax): Drug Classification- Bone Resorption Inhibitor. Other drugs in this category are risedronate, also called Actonel, and ibandronate, also called Boniva.
Interactions bisphosphonates,
There are two interactions you need to know about when it comes to bisphosphonates. Calcium supplements decrease absorption of bisphosphonates, so do not give them within 30 minutes of administration. For bisphosphonate prototype drug, click the button to access a drug information table.
The order reads 390 mL over 8 hours. Calculate the drip rate using a tubing factor of 15 gtt/mL. (Round your answer to the nearest whole number.)
To calculate the drip rate, multiply the total infusion volume by the tubing factor and then divide by the total infusion time in minutes. total volume x tubing factor 390 mL x 15 gtt/mL gtt 12 drip rate time 480 min min
The order reads 250 mL over 10 hours. Calculate the infusion rate. (Round your answer to the nearest tenth.)
To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 250 mL mL rate = 25 time 10 hr hr
The order reads 270 mL over 17 hours. Calculate the infusion rate. (Round your answer to the nearest tenth.)
To calculate the infusion rate, divide the total infusion volume by the infusion time. total volume 270 mL mL rate = 15.9- time 17 hr hr
Calcitonin
Unlike SERMS, bisphosphonates, and calcium supplements, calcitonin cannot prevent osteoporosis. The therapeutic uses of calcitonin are for treating established postmenopausal osteoporosis, as well as hypercalcemia secondary to hyperparathyroidism, and Pagets disease.
An 85-year-old patient reports she has been taking levothyroxine 0.075 mg daily PO for a long time. The drug reference states the following: Route/Dosage PO (Geriatric Patients and Patients with Increased Sensitivity to Thyroid Hormones): 12.5-25 mcg as a single dose initially; may be increased q.6-8 wk; usual maintenance dose is 75 mcg/day. Which of the following actions by the nurse demonstrates verification of safe dose?
V Convert the metric units in the order and recommended dose so that they are the same, then compare the doses.
Administration bisphosphonate,
When you administer a bisphosphonate, give the drug 30 minutes before other drugs, beverages, or food with a full glass of water to prevent esophagitis. For 30 minutes after taking the drug, place clients in a sitting or standing position, and make sure they avoid eating or drinking anything other than water during that time. Administer a mild analgesic if clients experience muscle and joint pain.
Interventions SERM,
When you care for clients on a SERM, monitor their bone density to determine the effectiveness of the therapy. Observe for signs and symptoms that may indicate the development of thrombo-emboli in either the lower legs or lungs such as leg cramps and difficulty breathing. As raloxifene can cause fluctuations in certain components of the blood such as cholesterol, hormones, and fibrinogen, it is important to obtain routine lab work and monitor results.
Interventions bisphosphonates,
When you care for clients on bisphosphonates, monitor them for decreased bone resorption to determine the effectiveness of the therapy. If clients experience muscle and joint pain, this may require notifying the primary care provider to see if pain may be managed with an analgesic. Also, monitor for changes in vision and watch for signs of esophagitis. SAFETY ALERT Bisphosphonates can cause ulcerative esophagitis if the drug does not pass completely through the esophagus when clients consume the medication. Clients must take the drug with a full glass of water (6-8 oz.) and either sit or stand for 30 minutes to ensure it passes into the stomach and dissolves.
Interventions calcium supplement
When you care for clients taking calcium as either a supplement or antacid, periodically check the client's serum calcium and monitor for signs of decreased gastric and intestinal motility such as nausea, vomiting, and constipation. Also, monitor for urine output in excess of intake, flank pain, or blood in the urine.
Client Instructions bisphosphonate,
When you give the client instructions on how to take a bisphosphonate, the same guidelines and restrictions apply as when you administer the drug. Instruct the clients to take it with a full glass of water, then sit or stand for 30 minutes, avoid eating or drinking anything other than water for 30 minutes, and avoid taking a calcium supplement or antacid. Advise the client to take a mild analgesic for muscle and joint pain and to report pain that persists. Also, make sure the client tells his or her primary care provider about any difficulty in swallowing or changes in vision.
Client Instructions SERMS,
When you provide clients instruction about SERMS, encourage them to do the following: consume adequate amounts of calcium and vitamin D, perform daily weight-bearing exercises such as walking or running, and use contraception to avoid getting pregnant during therapy. If clients are premenopausal and using raloxifene to prevent breast cancer, warn the client that she may experience hot flashes . SAFETY ALERT Clients need to report pain in the lower extremities, particularly in the calves, or chest pain with difficulty breathing to their primary care provider immediately. These findings may indicate that a blood clot has formed in the leg and/or traveled to the lungs.
Adverse Drug Reactions calcium supplement
and depression Hypercalcemia may also result in renal calculi (kidney stones) and hypercalciuria hypercalcemia. Signs and symptoms of hypercalcemia include nausea and vomiting, constipation, increased urine output (polyunia). Clients who take a calcium supplement or antacid on a long-term basis and/or take vitamin D along with it are at risk for
Contraindications and Precautions Calcium supplements
has a blood calcium level above the expected reference range Clients hypercalcemia or a low phosphate level. Calcium can increase to a toxic an even greater decrease if you give them These drugs are also contraindications for clients who have cardiac dysrhythmias history of kidney stones are at increased risk for their supplemental calcium, due to the inverse Give them with caution to clients who have slow gastric motility development if they take calcium supplements. relationship between calcium and phosphorus who have a low phosphate level can experience level if supplemental calcium is given to a client who already Calcium supplements are contraindicated for clients who have in the body. Clients who have a
A primary care provider prescribes calcitonin salmon for a post-menopausal client. Knowing the adverse effects of calcitonin, you instruct the client to
increase calcium and vitamin D intake
Prior to starting alendronate, the nurse should assess which of the folowing in the client? (Select all that apply.)
nurse should assess Ability to swalow Baseine vision
An IV solution of 100 mL at a drip rate of 20 gtt/min using a tubing factor of 15 gtt/ml has been ordered to be initiated at 1430. Calculate the infusion time. (Round your answer to the nearest tenth of an hour)
time = 100mD 15 Imin 1.3 20gtt 60 min
An IV solution of 640 mL at a drip rate of 25 gtt/min using a tubing factor of 15 gtt/mL has been ordered to be initiated at 0300. Calculate the infusion time. (Round your answer to the nearest tenth of an hour)
time = 640mix = 6.4hr 15 gtt 1min 1hr mL 25 gtt 60 min
An IV solution of 730 mL at a drip rate of 5 gtt/min using a tubing factor of 15 gtt/ml has been ordered to be initiated at 0645. Calculate the infusion time. (Round your answer to the nearest tenth of an hour.)
time = 730ml x 15 gtt 1min mD 5 gtt 60 min = 36.5hn
• Total daily dose:
time Total amount of medication to be given in 24 hours
Administration Calcium supplements
to two hours after glucocorticoids, thyroid supplements, Calcium supplements can be given orally or intravenously. after meals, with a full glass of water to increase the solubility of the drug. Administer the same process again at bedtime. and tetracycline and quinolone antibiotics. Give calcium-based antacids one When you administer supplemental calcium, give it one hour before or one
Administration Calcium supplements
to two hours after glucocorticoids, thyroid supplements, Calcium supplements can be given orally or intravenously. hour after meals, with a full glass of water to increase the solubility of the drug. Administer the same process again at bedtime. and tetracycline and quinolone antibiotics. Give calcium-based antacids one When you administer supplemental calcium, give it one hour before or one
