(PN Pharm) A Pathophysiologic Approach Adams - Holland - Urban
Ethnicity and Culture
- Set of beliefs, values, and norms that provide meaning for an individual or group ◦ Cultural Competence - Ability to provide care to people with diverse values, beliefs, and behaviors, including ability to adapt delivery of care to meet needs of these patients
When should calcium supplements be given?
1 hr before or 1 hr after... glucocorticoids (decreases absorption of ca) thyroid supplements (ca decreases absorption of these) Tetracycline and Quinolone antibiotics (ca decreases absorption of these) Thiazide diuretics decrease excretion of ca Give 1 hr after meals
Four Categories of Pharmacokinetic Processes
1. Absorption -Movement from site of administration, across body membranes, to circulating fluids. Primary pharmacokinetic factor determining length of time for drug to produce effect. 2. Distribution - transport of drugs throughout the body. Simplest factor determining distribution is the amount of blood flow to body tissues.Physical properties of drug have great influence. Certain tissues (bone marrow, teeth, eyes, adipose tissue) have a high affinity, or attraction, for certain medications. Many drug molecules form drug protein complexes-binding reversibly to plasma proteins and thus never reach target cells. 3. Metabolism (aka -biotransformation) -Chemically converts drug so it can be easily removed from body. Involves complex biochemical reactions. Liver — primary site. Addition of side chains, known as conjugates, makes drugs more water soluble and more easily excreted by the kidneys. 4. Excretion -how drugs are removed from the body. Rate at which medications are excreted determines the concentration of the drugs in the bloodstream and tissues.
Three Checks of Drug Administration
1. Checking drug with MAR (medical administration record) or medication information system when removing it from storage 2. Checking drug when preparing it 3. Checking drug before administering it to the patient
** Oral Drugs Enter Hepatic Portal Circulation (First-Pass Effect)
1. Drug is absorbed 2. Drug enters hepatic circulation, goes to liver 3. Drug is metabolized to inactive form 4. Drug conjugates and leaves liver 5. Drug is distributed to general circulation 6. Many drugs are rendered inactive by first-pass effect
Drug Label 1. Mycobutin (rifabutin) 2. capsules 3. NDC 0013-5301-17 4. Bar code 5. 150 mg 6. Usual Dosage: Two capsules in a single daily administration. For additional prescribing information read package insert. 7. USP 8. Store at 25 degrees Celsius (77 degree Fahrenheit) excursions permitted to 15-30 degrees Celsius (59-86 Fahrenheit) see USP Controlled Room temperature. 9. expiration date 10. Manufacturer
1. Name of drug: What is trade name of this drug? What is the generic name of this drug? 2.Form of drug:. 3. National Drug Code (NDC) number 4.Bar code: Has the NDC number encoded in it. 5. Dosage Strength:What is the dosage strength of this drug? 6. Dosage recommendations: What is the recommended dosage? 7. USP: This drug meets the standards of the United States Pharmacopeia. 8. Storage directions: Some drugs have to be stored under controlled conditions if they are to retain their effectiveness. How should this drug be stored? 9. Expiration date: The expiration date specifies when the drug should be discarded. What is this drugs expiration date? 10. Manufacturer:
Nursing Diagnoses for Drug Administration
1. Often most challenging part of nursing 2. Focus is on patient's needs, not nurse's 3. Three main areas of concerns - Promoting therapeutic drug effects - Minimizing adverse drug effects and toxicity - Maximizing patient ability for self-care (including knowledge, skills, and resources necessary for safe and effective drug administration)
Nurse Planning Phase
1. Planning - Prioritizes nursing diagnosis - Formulates desired outcomes - Selects nursing interventions that can assist patient to establish an optimum level of wellness. - Create goals/outcomes; be sure goals are SMART!
Four Stages of Approval for Therapeutic and Biologic Drugs
1. Preclinical investigation (1-3 years, average 18months) 2. Clinical investigation (2-10 years; average 5 years) 3. Review of new drug application (NDA) (2 months -7 years, average 24 months) 4. Postmarketing surveillance (adverse reaction reporting; surveys/sampling/testing; inspections)
Excretion of Medications
1. Primary Site of Excretion of Drugs Is Kidneys 2. Free drugs, water-soluble agents, electrolytes, and small molecules are easily filtered 3. Drug-protein complexes and large substances are secreted into distal tubule of nephron 4. Secretion mechanism is less active in infants and older adults
How Drug Reaches and Maintains Therapeutic Range
1. Repeated doses of drug are given 2. Drug accumulates in bloodstream 3. Plateau is reached 4. Amount administered equals amount eliminated
Five Rights of Drug Administration
1. Right patient 2. Right medication 3. Right dose 4. Right route of administration 5. Right time of delivery Right documentation
Assessment of the Patient
1. Systematic collection, organization, validation, and documentation of patient data 2. Health history and physical assessment 3. Baseline data gathered; will be compared to later information from observations 4. Once pharmacotherapy is initiated, assessment focuses on reaction to medication. Watch for: desired response, adverse effects, patient capability of assuming responsibility for self-administration
Common Protocols and Techniques for All Routes of Administration
1. Verify medication order, check allergy history 2. Wash hands and apply gloves, if indicated 3. Use aseptic technique when preparing and administering parenteral medications 4. Identify patient (two forms of ID) 5. Ask patient about known allergies 6. Inform patient about drug 7. Position patient 8. Remove prepackaged drug at bedside 9. Unless instructed to do so, do not leave drugs at bedside 10. Document administration and pertinent patient responses
A nurse is preparing to administer phenobarbital 3mg/kg PO twice a day to a school age child who weighs 44 pounds. Available is phenobarbital elixir 20mg/5ml. How many ML should the nurse plan to minister per dose?
15 mL
U.S. Pharmacopoeia (USP)
1820; 1st comprehensive publication formulary used in the U.S.; drug purity, strength, and directions for synthesis.
USP and National Formulary (NF)
1852-1975, two drug standards in the US by the American Pharmaceutical Association (APhA). 1. USP - all drug products. 2. National Formulary (NF) - pharmaceutical ingredients.
Biologic Control Act
1902 standardized serum and blood-related products
Pure Food and Drug Act
1906 - Established government control (FDA) for labeling medicines
Shirley Amendment
1912 - Prohibited drugs labeled with false therapeutic claims
Food, Drug, and Cosmetic Act (1938) and amendments
1938- Thorough testing of drug; Proof of safety and efficacy of drug
U.S. Pharacopoeia -National Formulary (USP-NF)
1975 merged into a single publication
Dietary Supplement Health and Education Act, 1994
1994-Controls misleading industry claims
26.A nurse is caring for a client who will receive gentamicin (Garamycin) intermittent IV bolus at noon. The infusion will take 30 min. When should the nurse plan to have a peak level of gentamicin drawn by the laboratory?
1:00 pm
A client's blood glucose is 54 mg/dL. The client is lethargic, but arousable. In what order should the nurse perform the following interventions? Recheck blood glucose in 15 min. Give 7 g of protein. Give 15 to 20 g of carbohydrates. Report episode to the provider.
2 Recheck blood glucose in 15 min. 3 Give 7 g of protein. 1 Give 15 to 20 g of carbohydrates. 4 Report episode to the provider. The greatest risk to the client is a lack of glucose for cell metabolism. Therefore, the priority action is to give 15 to 20 g of carbohydrates (4 oz orange juice, 2 oz grape juice, 8 oz milk) to raise the client's serum blood glucose level. Next, the client's blood glucose should be checked in 15 min. If the blood glucose remains below 70 mg/dL, give 15 g more of carbohydrates. Recheck the client's blood glucose in 15 min. Repeat until the client's blood glucose is above 70 mg/dL. Follow with 7 g of protein. Report findings to the client's provider and document actions.
drug
A chemical substance that is taken to cause changes in a person's body or behavior
Dependence
A physiological or psychological need for a substance
Never give epoetin alfa to this pt
A pt with cancer that is NOT on chemotherapy or radiation
medication
A substance that is used to treat or prevent disease or relieve pain.
For which of the following clients is a laxative indicated? (Select all that apply.) A. A young adult female who is postpartum following a vaginal delivery with an episiotomy B. A young adult male who has constipation and periumbilical pain C. A young adult client affected by IBS D. An older adult client who has limited mobility and minor bowel incontinence E. An older adult client preparing for a colonoscopy
A, C, E Laxatives will prevent straining until the episiotomy heals. Bulk-forming laxatives can provide relief of diarrhea for clients who have IBS. Use laxatives for bowel cleansing prior to diagnostic procedures of the gastrointestinal tract. Appendicitis can begin in the periumbilical area before progressing to the right lower quadrant. The older adult may be experiencing fecal impaction and a laxative could cause perforation.
A client's blood glucose level is 232 mg/dL at 1700, and the provider's prescription states to give 8 units Regular insulin (Humulin R) subcutaneously. This client also receives 14 units of insulin glargine (Lantus) subcutaneously at this time. Which of the following methods should the nurse use to draw up and administer the insulin? A. Give two injections by drawing up 8 units of Regular insulin in one syringe and drawing up 14 units of insulin glargine in another syringe. B. Give one injection by drawing up the Regular insulin first, and then drawing up the insulin glargine in the same syringe. C. Give one injection by drawing up the insulin glargine first, and then drawing up the Regular insulin in the same syringe. D. Give only the 8 units of Regular insulin as indicated based on the client's blood glucose.
A. Give two injections by drawing up 8 units of Regular insulin in one syringe and drawing up 14 units of insulin glargine in another syringe. In one insulin syringe, draw up 8 units of Regular insulin. In a separate insulin syringe, draw up 14 units of insulin glargine, and give two separate SC injections. Insulin glargine and Regular insulin are not compatible and cannot be given in the same syringe. The client should receive both the Regular insulin and the routine dose of insulin glargine.
A nurse is reinforcing teaching to a client who is prescribed lovastatin (Mevacor). Which of the following should be included in the teaching? A. Take the medication with the evening meal. B. Change position slowly when rising from a chair. C. Maintain a steady intake of green leafy vegetables. D. Consume no more than 1 L of fluid/day.
A. Take the medication with the evening meal. Instruct the client to take lovastatin with the evening meal to increase absorption. Changing positions slowly may be necessary when taking an antihypertensive. Maintaining a steady intake of green leafy vegetables would be important if taking warfarin. There is no indication for fluid restriction with statins.
peak concentration
Absorption rate equals elimination rate
9.A nurse is caring for a toddler who was just admitted for an acetaminophen overdose. Which of the following medications should the nurse anticipate being administered to this client?
Acetylcysteine (mucomyst)
And nurses caring for a client who has genital herpes. Which of the following medications to the nurse expect administer?
Acyclovir
14.A nurse is caring for a patient with severe pain whose prescription for morphine IV bolus has been changed to Transdermal fentanyl (Duragesic). The nurse should understand which of the following information when administering a fentanyl Transdermal patch?
Administer a short-term opioids for pain for the first 24 hr after patch application
Dopamine (Intropin)
Adrenergic agonists, catecholamines Causes increase cardiac output Uses: Shock, increased perfusion, hypotension Dilation of pupils HR will increase Aches in head GI (N,V,D) Palpitations Angina May cause gangrene with prolonged use
A nurse is caring for a client who is having an acute asthma attack. Which of the following medications should the nurse administer first?
Albuterol
Physical dependence
An altered physical condition caused by the adaptation of the nervous system to repeated drug use.
Erythropoetin (Procrit, Neupogen)
Anemia, replacement of neutrophils and platelets after chemo. Hastening of bone marrow function after transplant. Increase RBC production for chronic renal failure. Hematopoietic growth factors act on bone marrow to increase production of RBC. Produces erythropoietin RBC increased mOnitor BP (Increased HCT=increased BP) Can give with antihypertensives Renal study assessments IV/Sub Q injection Take Iron supplements
Ondansetron (Zofran)
Anti-emetic blocks effects of seratonin. Prevents nausea and vomiting associated with chemo and radiation. diArrhea No pooping (c0nstipation) Take before chemo Interacts with drugs that affect AST/ALT Eye, face, limb involuntary movement notify dr. Monitor AST/ALT
Vancomycin (Vancocin)
Antibiotic-inhibits bacterial wall synthesis Good to give if allergic to penicillin Monitor for red neck syndrome Caution with renal failure Hearing loss and allergies Temperature and blood cultures (CBC) Vitals Allergic to penicillin (give VANCO) Nephrotoxicity Check CBC Ototoxicity
Metformin (Glucophage)
Antidiabetic: Biguanide Type 2 diabetes Decreases hepatic glucose production, increase peripheral insulin uptake and utilization HBa1c 6%-12% Monitor CBC, blood,urine for keytones Elderly caution Take with food Feel like metal in mouth hypOxemia DC (low O2 in blood) Renal function monitor Monitor lactic acidosis Improve insulin sensitivity Not eating (anorexia)
Lidocaine
Antidysrhythmic- decreases cardiac excitability Sodium channel blockers, stabalize cardiac membranes. decrease electrical conduction, decrease automaticity CNS effects Administer dilantin for seizures toxIcity =drowsy No more than 24 hrs Seizure = severe toxicity
promethazine IV (Phenergan)
Antihistamine, anaphylactic reactions, motion sickness Pee, spit, shit (can't do it, anticholinergic) depRession of CNS with alcohol and opioids Observe for hypotension Motion sickness Watch for: Sedation, hypotension, constipation, urinary retention, Dry mouth
Controlled Substances
Are restricted by the Controlled Substances Act of 1970. Have a high potential for addiction or dependence. Have restricted use. Are placed into one of five schedules: Schedule I drugs have the highest abuse potential, Schedule V the lowest
A nurse is monitoring a client who is two hours post operative and has a prescription for opioids analgesics. Which of the following actions provides the nurse with the priority data to determine the clients need for analgesia?
Asked the client to rate her pain level
The Nursing Process
Assessing - Collect data; organize data, validate date, document data Diagnosing -analyze data; identify health problems, risks, and strengths; formulate diagnostic statements Planning - Prioritize problems/diagnoses; formulate goals/desired outcomes; select nursing interventions; write nursing interventions Implementing - Reassess the patient; determine the nurse's need for assistance; implement the nursing interventions; supervise delegated care; document nursing activities. Evaluating - Collect data related to outcome; compare date with outcome; relate nursing actions to patients goals/outcomes; draw conclusions about problem status; continue, modify, or terminate the patient's care plan
20.A nurse is providing teaching to a client who is to start colchicine (Colgout) for acute gouty arthritis. The nurse should advise the client to do which of the following:
Avoid alcohol use Notify the provider of bleeding, bruising, or sore throat Avoid aspirin or products containing salicylates
30.A nurse us reinforcing teaching for a client with a rescription for trimethoprim-sulfamethoxazole (Bactrim). Which of the following precautious should the nurse reinforce to the client in order to minimize an adverse effect of the medication?
Avoid prolonged sun exposure
A nurse is caring for a client who has been prescribed calcitonin-salmon to treat osteoporosis. When evaluating the client's therapy, the nurse should recognize that which of the following serum calcium levels is within the expected range? A. 8.6 mg/dL B. 9.6 mg/dL C. 10.6 mg/dL D. 11.6 mg/dL
B. 9.6 mg/dL The expected reference range for serum calcium is 9.0 to 10.5 mg/dL. The other values represent either hypocalcemia or hypercalcemia.
A nurse is caring for a client who is prescribed daily doses of both digoxin (Lanoxin) and furosemide (Lasix). The client's potassium level is 3.2 mEq/L. For which of the following medication interactions is the client at risk? A. Toxic levels of furosemide B. Toxic levels of digoxin C. Sub-therapeutic levels of furosemide D. Sub-therapeutic levels of digoxin
B. Toxic levels of digoxin If potassium levels are decreased in the client who takes both a loop diuretic and digoxin, there is an increased risk for digoxin toxicity. The other choices are not potential interactions between the two medications when potassium levels are low.
Pharmacologic Classification
Based on the drug's mechanism of action, or how the drug produces its effect
Therapeutic classification of drugs:
Based on what the drug does clinically
A nurse is reviewing a clients medical history before administering hydromorphone for post operative pain. The nurse should notify the provider of which of the following findings before administering this medication?
Benign prostatic hyperplasia
A nurse is reviewing the medical record of a client who has a new prescription for dimenhydrinate To treat motion sickness. Which of the following this order is in the clients medical records should the nurse report to the provider?
Benign prostatic hyperplasia
carvedilol (Coreg)
Beta blocker, hypertension (B1 and B2 blocker) Decrease release of renin, blocks contractility of heart and sympathetic output. SE: Dizzy, hypotension, bradycardia, decrease cardiac output. Monitor: BP and hypotension, HR below 60 BPM hold drug, take pulse before and after drug
27.A nurse is caring for a client with a prescription for erythromycin (E-Mycin) to treat a urethral infection. The client also takes daily prescriptions for furosemide (Lasix) and warfarin (Coumadin). For which of the following manifestations of a drug interaction should the nurse monitor the client?
Bleeding
Teach pt to report these symptoms if on filgrastim (Neupogen)
Bone pain abdominal pain and fullness
Match each of the following types of insulin with the time of its onset: NPH insulin (Humulin N) A. Less than 15 min Insulin glargine (Lantus) B. 0.5 to 1 hr Regular insulin (Humulin R) C. 1 to 2 hr Lispro insulin (Humalog) D. 1 hr
C NPH insulin (Humulin N) A. Less than 15 min D Insulin glargine (Lantus) B. 0.5 to 1 hr B Regular insulin (Humulin R) C. 1 to 2 hr A Lispro insulin (Humalog) D. 1 hr
A nurse is providing teaching to the mother of an infant who is to start taking digoxin (Lanoxin). Which of the following instructions should the nurse include? A. "Do not allow your baby to drink anything after the digoxin is administered." B. "Digoxin speeds the heart rate up to allow the heart to pump out more fluid." C. "It is important to administer the correct amount at regularly scheduled times." D. "If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."
C. "It is important to administer the correct amount at regularly scheduled times." The correct amount of digoxin should be administered at regularly scheduled times to maintain therapeutic blood levels. If the infant has teeth, the dose should be followed by water to prevent tooth decay. Digoxin slows the heart rate. If the infant vomits after the dose, it should not be re-administered because there is no way to know if the infant received any of the medication.
A nurse is reinforcing teaching for a client who has a new prescription for digoxin (Lanoxin). Which of the following medications, which the client reports taking, should the nurse report to the provider because it is contraindicated when taken with digoxin? A. Potassium chloride B. Furosemide (Lasix) C. Quinidine sulfate D. Atorvastatin (Lipitor)
C. Quinidine sulfate Quinidine sulfate and digoxin should not be taken concurrently as the result could be greatly increased digoxin levels and digoxin toxicity. The nurse should notify the provider about the client's report. Potassium chloride and furosemide are frequently taken concurrently with digoxin without adverse interactions. Taking atorvastatin does not cause an interaction with digoxin.
Neutralizes gastric acid
Calcium acetate (Phoslo, Renagel)
A nurse is reinforcing teaching for a client newly diagnosed who has type 2 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) Check blood glucose levels less frequently when feeling ill. Take an extra dose of the oral hypoglycemic agent the next day if a dose is missed. Carry a fast-acting glucose source at all times. Eat a snack prior to planned exercise. Inspect feet surfaces daily.
Carry a fast-acting glucose source at all times. Eat a snack prior to planned exercise. Inspect feet surfaces daily. A client who has diabetes should always carry a fast-acting glucose source to treat unexpected hypoglycemia. Active muscle cells can take in glucose without insulin, and therefore prior to exercising the client should eat a snack to ensure enough glucose is available to prevent hypoglycemia. A client who has diabetes should inspect his feet daily to monitor for skin breakdown and signs of infection. A client who has newly diagnosed diabetes should check blood glucose levels at least before meals and at bedtime, and more frequently when ill as acute illness can lead to hyperglycemia. The client should not take an extra dose of medication if a dose is missed.
Nitroprusside (Nipride, Nitropress)
Centrally acting vasodilator, direct vasodilation of arteries and veins= decrease in BP Dilate vessels = decrease in BP dIzzy Light sensitive solution Administer slowly The ECG and vitals monitored Evaluate cyanide poisoning (Drowsy and headache) Should not be admin with any other meds Cyanide poisoning (drowsy and headache) may lead to cardiac arrest.
Most Drugs have three names
Chemical, Generic, Trade (CHEMICAL: (1/2)-2-(p-isobutylphenyl) propionic acid; GENERIC: ibuprofen; TRADE: Motrin)
A nurse is reinforcing teaching with a client who experiences migraine headaches and has a new prescription for sumatriptan. The nurse should instruct the client to report which of the following manifestations to the provider as a averse effect of this medication?
Chest Tightness
29.A nurse is caring for a group of clients who each have urinary tract infections. The nurse should know that trimethoprim-sulfamethoxazole is contraindicated in clients who have has a hypersensitivity reaction to which of the following medication?
Chlorothiazide (Diuril)
A nurse is collecting data from a client who has bacterial pneumonia and is taking ceftriaxone. Which of the following findings indicates a therapeutic effect of the medication?
Clear, bilateral breath sounds
Drug Plasma Concentration and Therapeutic Response
Concentration of medication at target tissue is often impossible to measure, so it must be measured in plasma
What are some adverse effects of lidocaine (toxicity)?
Confusion, drowsy, paresthesia, restlessness, seizures and respiratory arrest
You have a pt taking oral amiodarone (Cordarone) to treat atrial fibrillation. You should advise the pt to watch and report the following. Select all that apply Cough Blurred vision Dizziness Sore throat Fever
Cough Blurred vision Dizziness Fever
31.A nurse is reinforcing teaching for a client who prescribe nitrofurantoin ( Macrodantin) for a urinary tract infection. Which of the following points should the nurse include in the instructions?
Cough and dyspnea are signs of a hypersensitivity reaction to nitrofurantoin Notify the provider if nosebleeds or brushing easily occur Report numbness or tingling of hands or feet as soon as possible
Which of the following interventions should the nurse implement when preparing to administer filgrastim (Neupogen) for the first time to a client who has just undergone a bone marrow transplant? A. Administer intramuscularly in a large muscle mass to prevent injury. B. Give orally with a meal or snack to prevent severe GI upset. C. Shake vial gently to mix well before withdrawing dose. D. Discard vial after removing one dose of the medication.
D. Discard vial after removing one dose of the medication. Filgrastim is dispensed in a vial meant for single-dose use and any unused portion should be discarded. The medication is administered by subcutaneous and IV routes only, so neither oral nor IM administration is appropriate. The vial should not be shaken before withdrawal because this may damage the medication.
Medication Orders
Date and time are necessary when an order is written. - Many institutions use military time, which is based on a "24 hour clock" that does not use a.m. or p.m.
atorvastin (Lipitor)
Decrease manufacture of LDL cholesterol increase manufacture of HDL (good) cholesterol See LFT (hepatotoxcitity) Take with food Avoid grapefruit Take at bed Increase fluid Notice muscle pain (Rhabdomyosis) Myopthy ->muscle aches ->myostitis ->rhabdomyolysis
12.A nurse is monitoring a client who received regular doses of meperidine (Demerol) for postoperative pain for 36 hr. for which of the following should the nurse monitor the client?
Delirium
A nurse is collecting data from a client who is taking oral amoxicillin to treat a respiratory infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication?
Diarrhea
A nurse is performing the third check before administering hydromorphone To a client. After opening the unit dose pack, the client tells the nurse he does not want to take the medication now. What are the following actions should the nurse take?
Dispose the medication with a second nurse as a witness
A nurse erroneously administered zolpidem to the wrong client. Which of the following actions should the nurse take when documenting the medication error?
Document the notification of the client's provider
A nurse is collecting data from a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings should the nurse identify as an adverse effect of this medication?
Drowsiness
Enterohepatic Recirculation of Drugs
Drugs are excreted in bile. Bile recirculates to liver. Percentage of drug may be recirculated numerous times. Prolongs activity of drug
prescription drugs
Drugs legally available only with a physician's order.
A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse affects of his medication?
Dry cough
A nurse is reinforcing teaching to a client who has heart failure and takes digoxin (Lanoxin). The client tells the nurse that he sometimes forgets to take his medication and asks if he can just take a double dose of digoxin the next morning to make up for the missed dose. What is an appropriate response by the nurse?
Due to the narrow therapeutic range of digoxin and the high risk for toxicity, the client should not take a double dose of the medication the next day to attempt to make up for a missed dose.
Furosemide (IV) (Lasix)
Edema from CHF, hypertension, loop diuretic Monitor electrolytes, decrease in Na, K, Ca, and Mg. Monitor glucose, report change in hearing, vomiting, twitching, tetany (decrease Ca) (Everything is decrease except glucose and uric acid) Dizzy Lizzy Dizzy Ringing ears Decrease K Ototoxicity hypocalcemia
28.A nurse is caring for a client who receives amikacin (Amikin) by intermittent IV bolus for a severe infection. Which of the following laboratory values should the nurse recognize as an adverse effect of amikacin?
Elevated serum creatinine
A nurse is reinforcing teaching to a client who is prescribed digoxin (Lanoxin). Which of the following should the nurse instruct the client to report to the provider? (Select all that apply.) Fatigue Constipation Anorexia Rash Diplopia
Fatigue Anorexia Diplopia Fatigue, anorexia, and diplopia are side effects indicating a possible digoxin toxicity. Constipation and rash are not side effects of digoxin toxicity.
Psychological dependence
Few signs of physical discomfort when drug is withdrawn, but intense compelling desire to continue drug use
Teratogenic Drug Classification
Five categories of risk that a drug poses to a fetus in the case of a pregnant woman taking the drug. A, B, C, D, and X; Class A is the safest, while X poses the most danger to the fetus.
A nurse is reviewing the medication administration record for a client who has a new prescription for tobramycin to treat pulmonary infection. Which of the following medications should the nurse identify as increasing the risk for ototoxicity while taking tobramycin?
Furosemide
A nurse is reviewing the medication administration record of a client who has a history of Stevens-Johnson Syndrome when taking sulfamethoxazole-trimethoprim. Which of the following medications should the nurse identify as contradicted for this client?
Furosemide
18.A nurse is caring for a client who has cancer and is receiving opioids along with prednisone (Deltasone) daily for pain control. While the client is taking prenisone, the nurse should plan to monitor the client for which of the following findings
GI bleeding
What are some side effects of lactulose (Cephulac, Chronulac)?
GI irritation, laxatives with magnesium salts, such as magnesium hydroxide, can lead to accumulation of toxic levels of magnesium, dehydration
17.A nurse is caring for hospital client who has cancer and has a variety of prescribes adjuvant medications which maybe administered along with opioids for pain. When the client describes having "burning pain shooting down my leg" which of the following adjuvant should the nurse administer?
Gabapentin ( Neurontin)
Methylprednisolone Sodium (Solu-medrol) IV
Glucocorticoids Prevent inflammation, suppress sirway mucus production and promote responsiveness of B2 receptors in bronchial tree. Cushing bUffalo hump Sodium sweats Headache, hyperglycemia Increase in BP, HR, and appetite Not healing GI upset Sodium increase Potassium decrease Glucose increase Calcium decrease Cautious in people with fungal infections, peptic ulcer disease, and kidney dysfunction
Pts taking statins should avoid what food
Grapefruit
A nurse is collecting data from a client who has angina and has a new prescription for sub lingual nitroglycerin. Which of the following manifestation should the nurse expect as an adverse affect on this medication?
Headache
Why would a high dose of lactulose (Cephulac, Chronulac) be given?
High dose - Client preparation prior to surgery or diagnostic tests (colonoscopy)
The nurses assisting the admission have a client reports muscle aches and pains associated with construction work. The provider suggest taking acetaminophen. The nurse should identify the provider about which of the following information obtained from the client?
History of hepatitis B
Irebesartan (Avapro)
Hypertension, heart failure, stroke prevention ARBS (angiotensin Receptor blocker) Blocks the action of angiotensin 11 in the body. Results in vasodilation -Excretes Na and water and retention of K -Use of ARBS and NSAIDS increase risk of renal failure Admin with regard to food Renal function tests Blocks vasoconstriction Salt substitute and supplements (AVOID!)
Name some adverse effects of glyburide
Hypoglycemia (can occur if pt has liver of kidney impairment) Nausea Diarrhea
A nurse is assisting with the care of a client who is preterm labor and is receiving magnesium sulfate by continuous IV infusion which of the following findings indicates magnesium toxicity?
Hyporeflexia
A nurse is evaluating a client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicate an adverse reaction to this medication?
Hypotension
24.A nurse is caring for a postoperative client who received spinal anesthesia. For which of the following adverse effects should the nurse monitor the client?
Hypotension Urinary retention Headache
A nurse in the community health clinic is preparing to administer the Varicella vaccine a young adult female client who has not previously had chickenpox or it's vaccine. The nurse should withhold the vaccine and collect additional data when the claim makes which of the following statements?
I am allergic to neomycin
A nurse is reinforcing teaching with a client who has a new prescription for Timolol Eyedrops to treat glaucoma. Which of the following client statements indicate understanding of the teaching?
I will look up when putting the medication into my eyes
A nurse is reinforcing teaching with a client who has a new prescription for a fluticasone inhaler. Which of the following clients statements indicate an understanding of the teaching?
I will rinse my mouth after I use this inhaler
A nurse is caring for a client who has a 10-year history of alcohol use disorder and is experiencing acute alcohol withdrawal. The nurse should identify which of the following interventions as the priority?
Implement seizure precautions
A nurse is caring for a client who has schizophrenia and is to start therapy with risperidone. Which of the following manifestations should the nurse monitor to determine whether the treatment is effective?
Improved social interactions
Drug Administration
In order to prepare and administer drugs, it is imperative that you understand and follow the "Six Rights of Medication Administration" • Right dose - In order to avoid medication errors, always complete three checks when preparing medications 1. When reaching for the container 2. Immediately before preparing the dose 3. When replacing or discarding the container • Right Route -Medications must be administered in the form and via the route specified by the prescriber. Right Time - The prescriber will indicate when and how often a medication should be administered. - Medications can be ordered once a day (daily), twice a day (b.i.d.), three times a day(t.i.d.), or four times a day (q.i.d.). Right Patient - Before administering any medication, it is essential to determine the recipient's identity. At least two identifiers are required by the Joint Commission • the patient identification bracelet information • verbalization of the patient's name by the patient or parent • patient's hospital number or patient's home telephone number. Right Documentation - Always document the name and dosage of the drug, as well as the route and time of administration, on the MAR. - Sign your initials immediately after, but never before, the dose is given and include any relevant information: • patient allergies to medications • heart rate (when giving digoxin) • blood pressure (when giving antihypertensive drugs)
Nurses reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching?
Increase fluid intake
list some pt teaching with lactulose (Cephulac, Chronulac)
Increase fluid to 2-3 L a day. over use can lead to electrolyte imbalances, maintain regular exercise.
21.A nurse is caring for a patient who has severe pain in this right foot. Which of the following laboratory values tell the nurse that the client us having a flare-up of gout?
Increase in uric acid
A nurse is caring for a client who has kidney failure and has been taking epoetin Alfa. Which of the following is a therapeutic affect of this medication?
Increased Hgb
When talking with a pt about self administration of regular insulin (Humulin R) you should include which of the following? shake the vial vigorously Expect the solution to appear cloudy Store unopened vial at room temperature inject it subcutaneously
Inject the insulin subcutaneously Make sure the pt understand how to inject the insulin. Do not shake the vial, rotate it gently, vials should be stored in the fridge. The insulin should not appear cloudy
A nurse is caring for a group of clients who need insulin injections. The nurse should recognize that he can mix which of the following insulins in the same syringe with another insulin? (Select all that apply.) Insulin detemir (Levemir) Insulin lispro (Humalog) Insulin glargine (Lantus) Insulin glulisine (Apidra) Insulin aspart (Novolog)
Insulin lispro (Humalog) Insulin glulisine (Apidra) Insulin aspart (Novolog) Only four types of clear insulin may be mixed in the same syringe with another insulin (usually NPH insulin). These include insulin lispro, regular insulin, insulin glulisine, and insulin aspart. Do not mix insulin detemir and insulin glargine in a syringe with another insulin.
32.A nurse is reinforcing teaching to an adult client about prescription for ciprofloxacin (Cipro). Which of the following adverse reactions shout the nurse tell the client to for?
Jaundice Vaginal yeast infection Achilles tendon pain
10.A nurse is caring for a postoperative client who is prescribed ketorolac (Toradol) for pain management. The nurse should recognize that which of the following is true regarding the administration of ketorolac?
Ketorolac is prescribed postoperatively to lower the dosage of opioids needed
Blocks entry of sodium into the cells of the myocardium
Lidocaine
Anaphylaxis
Life threatening allergic reaction
Rapid acting onset, peak and duration
Lispro (humalog) Onset- less than 15 min Peak- 0.5-1 hr Duration- 3-4 hr
Loading Dose vs. Maintenance Dose
Loading dose-Higher amount of drug given.Plateau reached faster. Quickly produces therapeutic response. Maintenance dose-Keeps plasma-drug concentration in therapeutic range.
Lantus Insulin
Long acting pancreatic hormone Lipodystrophy Absent peak Never mix Take once a day Urtiaria (SE=chronic hives) Somogyi effect
Spironolactone (Aldactone)
Low Na Elevated T waves from increase K Avoid citrus juices K level must be monitored Agranulocytosis with triameterene (K sparing diuretic) Uses: Hypertension (K sparing diuretic). Acts on the distal portion of nephron, blocks aldosterone by decreasing excretion of Na and K and increase excretion of water. Teach: Avoid citrus juice, salt substitutes. SE: Hyperkalemia, nausea, diarrhea, dizzy, headache, photosensitivity, increase K=increased T wave.
Why would a low dose of lactulose (Cephulac, Chronulac) be given?
Low dose - Prevent painful elimination (clients who have episiotomy or hemorrhoids)
A nurse is a provider's office is reviewing the immunization records of a 12-month-old infant who is immunocompromised. Which of the following vaccines should the nurse identify as contraindicated for this client?
MMR (measles, mumps, rubella)
Calcium acetate (Phoslo, RenageL)
Maintenance of normal musculoskeletal, neuro and cardio function. Bone tumors (DON'T GIVE) Observe sedation (increased Ca) Normal level (8.5-10.5) ECG Spinach, rhubarb, bran and whole grains decrease ca absorption. Avoid eating these with ca supplements CA=SEDATIVE
A nurse is reinforcing teaching with a client who has a new prescription for vitamin B 12 intranasal to treat malabsorption syndrome. Which of the following instructions should the nurse include in the teaching?
Massage your nose gently after medication administration
15.A nursing is caring for a client who has back pain and has been prescribed nalbuphine (Nubain). The nurse should know that agonist-antagonist opioids, such as nalbuphine, differ from pure opioids agonists in they:
May cause abstinence syndrome in clients physically dependent to opioids
Therapeutic Index
Measure of a drug's safety margin. The higher the value, the safer the drug.
What should nurses monitor with lactulose (Cephulac, Chronulac)?
Monitor I and O and for signs of dehydration. Avoid lactulose (Cephulac, Chronulac) with renal dysfunction which can lead to toxic levels of magnesium.
List some pt teaching for ARBs irebesartan (Avapro).
Monitor and report CNS effects Take with or without food Do not take if pregnant or breastfeeding
What should be monitored while on epoetin alfa (Procrit)?
Monitor blood pressure administer lowest dose possible Give to cancer pts with hemoglobin levels below 10gm/dm
What should be monitored with taking amiodarone HCL
Monitor changes in vision and light sensitivity Monitor skin color changes Monitor breath sounds
What should you monitor for with a pt on lidocaine?
Monitor for CNS effects (toxicity) and cardiac rhythm
What to monitor for with atorvastin (Lipitor)?
Monitor myopathy Measure CPK if muscle pain occurs Monitor liver function tests
5.When giving a medication that is highly protein-bound to an infant, will there be more or less free medication available? Will medication effects be increased or decreased? Explain
More free medication will be available due to fewer protein-binding sites. Medication effects will be increased with greater potential for toxicity.
A nurse is reinforcing discharge teaching with a client who has type 2 diabetes mellitus and a new prescription for metformin. The nurse should instruct the client to monitor for What should the client monitor for which of the following manifestations as adverse effects of this medication?
Muscle Pain Fatigue Metallic Taste
What are some adverse effects of atorvastin (Lipitor)?
Myopathy (muscle pain) rhabdomylysis (breakdown of muscle protein causing kidney damage) liver toxicity
Intermediate acting onset, peak and duration
NPH (Humulin N) Onset- 1-2 hr Peak- 4-12hr Duration- 18-24 hr
A calcium supplement is prescribed to a post menopausal woman to prevent osteoporosis. What should the pt report as a sign of hypercalcemia? Eye twitching Bleeding gums Tinnitus Nausea
Nausea Hypercalcemia includes anorexia, nausea, vomiting and constipation. Hypocalcemia can cause twitching, tetany and muscle spasms, vitamin C deficiency can cause bleeding gums.
Black Box Warnings
One of the primary alerts for identifying extreme adverse drug reactions discovered during and after the review process; 1997 FDA created "Black Box Warnings"
Insulin Onset, peak, duration
Onset Peak Duration Rapid acting <15 min 0.5-1.5 3-4hr Humalog short acting 30-60 min 2-3 hr 5-7 hr Humulin R Intermediate 1-2 hr 4-12 hr 18-24hr acting NPH Humulin N Long acting 1-1.5 none 20-24hr Lantun Insulin Glargine
Lactulose (Cephulac,Chronulac)
Osmotic laxative draws water into intestine PSE and constipation are indications Orientation (LOC) monitored Output and electrolytes monitored SE: Dehydration Education: Increase fluids and fiber, don't give with fecal impaction, nausea, cramping and abdominal pain.
Pipercillin, Tazobactam (Zosyn)
Penicillin-destroy bacteria by weakening the cell wall Complications-allergy, anaphylaxis to penicillin or cephalosporin Monitor: I and O, WBC, Renal function. Educate: Take 1-2 he before food or 2-3 hours after meal. Increase fluid. If GI upset occurs take with food. Call if rash, fever, chills, diarrhea or bleeding occur.
A nurse is reinforcing teaching with the client who is newly diagnosed with hypertension and is taking metoprolol. The nurse should instruct the client to report which of the following manifestation's to the provider as an adverse effect of this medication?
Peripheral edema
Amiodarone HCL (Codarone, Amio-aqeous,Pacerone)
Potassium channel blocker, severe ventricular tachycardia, ventricular fib not controlled by other meds. Coumadin must be decreased Ordered for vent arrhythmia Resp distress Dig must be decreased Ataxia (loss of control of body movement) and dizzy Risk for bradycardia Ordered for GI No SUN!! Eval with ECG for effectiveness SE: Vomiting, headache, dizzy, report bruising and ataxia
23.A nurse is reinforcing teaching to a client with migraine headaches who has a new prescription for sumatriptan (Imitrex). The nurse should plan to monitor the client for which of the following?
Pressure in the chest
Mannitol (Osmitrol)
Promote na retention and water excretion for hyponatremia and fluid excess. Osmotic diuretic decreases intracranial pressure by increasing serum osmolality and drawing fluid back into vascular and extravascular space. Prevent kidney failure in hypovolemic shock and hypotension. Decreased ICP caused by cerebral edema drawing off fluid from brain an into blood stream. Oligura (little pee) Stops reabsorption of water Monitor electrolytes and reanl function Oh so nauseaus Toxicity for dig increases vIsion blurry (SE) Can't think, blink
Pantaprazole (Protonix)
Proton pump inhibitor Suppresses gastric acid production by inhibiting the enzyme that produces gastric acid. Pass gass UE: GI, headache, dizzy Max 16 weeks for protonix Pooping a lot (diarrhea)
Insulin Lispro (Humalog)
Rapid acting insulin Lipodystrophy (loss of body fat) I (first) draw up first Somogyi effect (rebound hyperglycemia) Prefilled syringes=1 week Rapid action-have food ready Observe for Tired/tachy Flush/fruit breath Irritable/insomnia Lethargic Restless Urine output increased Excess hunger Skin dry diaphoresis/drowsy Hyperventilate (Hypoglycemia) Extreme N and V Drowsy (hyperglycemia)
16.A nurse is caring for a client who has severe pain and has been receiving hydroxyzine (Vistaril) along with each opioids injection. The client asks why she is receiving the medication. The nurse should recognize that use of adjuvant medications in conjunction with an opioids agonist to accomplish which of the following?
Reduce the dosage of the opioid Reduce the side effects of the opioids Increase the analgesic effects
Insulin
Reduces blood sugar levels by increasing glucose transport. Promotes conversion of glucose to glycogen. Moves potassium into cells.
Short acting onset, peak and duration
Regular insulin (Humulin R) Onset- 0.5-1 hr Peak- 2-3 hr Duration- 5-7hr
8.A nurse is caring for an older adult client who is taking large doses of aspirin four times daily for severe rheumatoid arthritis pain. For which of the following should the nurse monitor the client?
Renal impairment
A nurse is caring for a client who is taking disulfiram And consumed alcohol 12 hours ago. Which of the following adverse reactions is the priority finding to report to the provider?
Respiratory depression
A nurse is monitoring a client who has just returned to the unit following surgery. The client received an additional dose of morphine 5MGIV bolus for pain relief. Which of the following adverse a fax to the nurse report immediately to the provider?
Respiratory rate 11/min
Dobutamine HCL (Dobutrex)
Short term mgmt of heart failure due to decrease contractility. Stimulates beta 1 receptors to increase contractility but with relatively minor effects on HR. Falling BP (SE) Angina, arrhythmia (SE) Increase contractility and BP Look for increase in cardiac and urine output Monitor- BP, pulse, resp, ECG
A nurse is collecting data from a client who is taking lithium to treat bipolar disorders. Which of the following findings should the nurse report to the provider?
Slurred Speech
A nurse is preparing to administer sodium phosphate (Fleet Phospho-Soda) liquid osmotic laxative to a client who is undergoing bowel preparation for a colonoscopy. The nurse should understand that sodium phosphate may exacerbate what client condition? (Lactulose)
Sodium laxatives can increase the risk for worsening of heart failure or hypertension. They can create fluid retention caused by increased serum sodium in a client who has an underlying heart condition.
A nurse is preparing to administer sodium phosphate (Fleet Phospho-Soda) liquid osmotic laxative to a client who is undergoing bowel preparation for a colonoscopy. The nurse should understand that sodium phosphate may exacerbate what client condition?
Sodium laxatives can increase the risk for worsening of heart failure or hypertension. They can create fluid retention caused by increased serum sodium in a client who has an underlying heart condition.
The nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil . The nurse should monitor the client for which of the following manifestation's as an adverse effect of this medication?
Sore throat
Glyburide (Diabeta, Euglucon, Glynase, Micronase)
Stimulates insulin release from pancreas GI (N, V, D) Look for headache hYpolycemia Better for elderly sUlfonylureas Renal function Instruct to take with food Diabetes type 2 Evaluate vitals Teach: Avoid alcohol, pregnancy and increase fluid. Monitor: BP, hpoglycemia, hydration and renal function
Pharmacology
Study of medicine; how drugs are administered; where drugs travel in the body, Response that drugs produce.
11.A nurse us collecting data for a client who has arthritis and who hopes to obtain a prescription for celecoxib (celebrex) from his provider to treat chronic joint pain. Which of the following allergies reported by the client is a contraindication to use of celecoxib?
Sulfonamide - client allergic to sulfonamides, an allergic reaction may occur if the clients takes celecoxib used in clients allergic to penicillin, aspirin, or selfish.
The nurse is reinforcing discharge teaching with a client who has a prescription for a metered dose inhaler. Which of the following information should the nurse include in the teaching?
Take a slow, deep breath lasting 3 to 5 seconds after releasing the medication
A nurse is collecting data from a client who recently began taking niacin to treat hyperlipidemia. The client reports experiencing facial flushing after taking that medication. The nurse should expect the provider to make which of the following recommendations?
Take aspirin 30 minutes before taking the medication
A client who has osteoporosis is started on alendronate (Fosamax). The nurse should instruct the client to do which of the following? (Select all that apply.) Take the medication in the morning after arising and before eating. Chew tablets to increase bioavailability. Drink 8 oz of water with each tablet. Take the medication with an antacid if heartburn occurs. Avoid lying down after taking the medication.
Take the medication in the morning after arising and before eating. Drink 8 oz of water with each tablet. Avoid lying down after taking the medication. To prevent esophagitis, the client should take the medication first thing in the morning before eating, swallow the tablet with at least a full 8 oz of water, and avoid lying down after taking the medication. The client should not chew as this can cause esophagitis. To optimize absorption, the client should not ingest anything for 30 min after taking the medication.
3.A nursing responsibility for client receiving an antihypertensive medication is to:
Teach the client to change positions slowly to avoid dizziness or fainting
A nurse is reinforcing teaching about immunizations with a client who is pregnant. Which of the following vaccines should the nurse include in the teaching as save to administer during pregnancy?
Tetanus and diphtheria
Medical Administration Record
The MAR is a form that health care facilities use to document all of the drugs administered to a patient.
A nurse is collecting data from a client who has been taking levodopa/carbiopa. Which of the following findings should indicate to the nurse that the medication is effective?
The client is able to wash his face
A nurse is reinforcing teaching to a client who has been prescribed daily calcium supplements. What foods should the nurse teach the client to avoid at the time she takes her calcium tablets?
The client should avoid taking calcium at the same time as eating spinach, bran, wholegrain breads and cereals, Swiss chard, rhubarb, and beets. These foods decrease the absorption of calcium.
A nurse is reinforcing teaching with a client who has type one diabetes and is learning to self administer NPH insulin. Which of the following clients actions indicate an understanding of the teaching?
The client wipes the cap with alcohol prior to filling the syringe
An older adult client who has terminal cancer reports pain at the level of 5 using a 0 to 10 pain scale. The client has a prescription for morphine 15mg orally every 4 hours. The client's children express concern that the client is receiving too much of the medication. Which of the following responses should the nurse make?
The dose should remain constant to prevent breakthrough pain
7.A nurse is reinforcing discharge teaching for an older adult client who states she has difficulty remembering to take her daily medications. Describe a nursing intervention that could be used to promote medication adherence for this chest.
The nurse could help set up a daily medication calendar or medication containers clearly marked for each day
A nurse is monitoring serum electrolytes for a client prescribed digoxin (Lanoxin). The serum potassium is reported to be 2.8 mEq/L. What action should the nurse take? Why?
The nurse should report the low level of potassium immediately to the provider as hypokalemia can result in fatal dysrhythmias. Digoxin works by binding to and inhibiting the enzyme Na+K+-ATPase. Potassium and digoxin compete for the same binding sites on this enzyme. With hypokalemia, digoxin has more opportunity to bind to Na+K+-ATPase and can lead to cardiotoxicity.
2.A nurse is ready to administer the first dose of a new oral penicillin prescription to a client. The client states she took penicillin 3 years ago and developed a rash. What action should the nurse take?
The nurse should withhold medication and notify the provider of the client's previous reaction.
Addiction
The overwhelming feeling that drives someone to use a drug repeated
Pharmacodynamics
The process by which a medication works on the body.
Pharmacokinetics
The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.
If angioedema occurs and the pt is taking a irebesartan (Avapro) (ARB) what should the nurse do?
The pt needs to discontinue the ARB ASAP.
19.A nurse us reinforcing teaching for a client who has cancer pain and has a new prescription for methylphenidate (Ritalin). What instructions should the nurse give the client regarding administration of the medication?
To prevent problems with insomnia, the client should take his last dose of the day by 4 p.m.
Generic vs. Trade-Name Drugs
Trade name drugs with exclusive rights cost more. When rights end, competing companies offer generic form cheaper
Nitroglycerin NTG (Tridil)
Treat, prevent angina pectoris Dilates vascular smooth muscles, requires less force to expel blood and decrease oxygen need of cardiac tissue. -BP and apical pulse before admin -Continuous ECK for IV administration SE: Dizzy, headache, weak, nausea, hypotension
Digoxin IV (Lanoxin, Digitek)
Treats dysrhtymias- increase cardiac output, increase excretion of water and Na. increase blood flow, decrease vasoconstriciton. Dig level >2 = toxic (low k =toxicity as well) Increases myocardial contractility GI and CNS signs = toxicity Monitor: vomiting can cause hypokalemia, hold if apical pulse below 60 bpm, dig and K levels, report visual disturbances, pulse and hypokalemia.
13.A nurse is caring for a client who has been receiving morphine for postoperative pain for the past few days. For which of the following should the nurse monitor the client?
Urinary retention Orthostatic hypotension Constipation Nausea
6.A nurse us preparing to administer a small amount of liquid oral medication to a toddler. Which of the following interventions should the nurse use in order to prevent medication error?
Verify identity of the child with the child's parents Check dosage calculations with another nurse Administer medication using a plastic needless syringe
A nurse is collecting data from a client who has been taking digoxin for one month. The nurse should identify which of the following findings as a manifestation of digoxin toxicity?
Vomiting
What should be monitored during treatment with filgrastim (Neupogen)?
White cell count (2x a week) bone pain temperature spleen size
A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate food choice?
Yogurt
A nurse is reinforcing teaching about nicotine polacrilex gum with a client who smokes three packs of cigarettes per day. Which of the following statements should the nurse include in the teaching?
You should chew the gum for a whole 30 minutes before discarding
Allergic Reactions
a condition caused by an overreaction of the body's immune system
Agonist
a molecule that, by binding to a receptor site, stimulates a response
pc
after meals, after eating
PM
afternoon
biologics
agents naturally produced in animal cells, in microorganisms, or by the body itself
A potassium channel blocker that widens the QRS complex and decreases contractility
amiodarone HCL
Causes blue discoloration of skin
amiodarone HCL
Used to treat a fib and ventricular tachycardia that is resistant to other drugs.
amiodarone HCL
minimum effective concentration
amount of drug required to produce a therapeutic effect
Medication orders (drug orders, physician's orders)
are directives to the pharmacist for the drugs used in a hospital or other healthcare facility. Orders are written in the sequence: drug name, dose, route, frequency -Written -Verbal -Routine -Standing -PRN -STAT
ad lib
as desired/as directed
Increases HDL and decreases LDL cholesterol by inhibiting HMG CoA- reductase an enzyme which synthesizes cholesterol in the liver.
atorvastin (Lipitor)
PO
by mouth
Over the counter drugs (OTC)
can be purchased without a prescription
cap
capsule
When is lactulose (Cephulac, Chronulac) contraindicated?
clients with fecal impaction and bowel obstruction, nausea, cramping, and abdominal pain.
Antagonist
competes with the agonists for binding at receptor site
What is CAM?
complementary and alternative medicine
Drug Prescriptions
directive to the pharmacist for a drug to be given to a patient
gtt
drop
What drug stimulates the production of red blood cells in the bone marrow?
epoetin alfa (Procrit) Stimulates the production of erythrocytes (RBC)
q12h
every 12 hours
q2h
every 2 hours (even or when first given)
q8h
every 8 hours (even)
Contraindications
factors that prevent the use of a drug or treatment
Which drug is a leukopoetic growth factor that stimulates the bone marrow to increase production of mature neutrophils?
filgrastim (Neupogen)
A sulfonylureas that stimulates the release of insulin from the pancreas.
glyburide (Diabeta, Euglucon, Glynase, Micronase) Must have a functioning pancreas
Teach pt to monitor for these while on epoetin alfa
headaches chest pain weakness numbness changes in vision check bp often
STAT
immediately; at once
IM
intramuscular
IV
intravenous
Which drug blocks angiotensin II receptors
irebesartan (Avapro)
Which drug is an osmotic laxative?
lactulose (Cephulac, Chronulac)
What are some adverse effects of filgrastim (Neupogen)?
leukocytosis (increased white cell count) bone pain fever splenomegaly (enlarged spleen)
Toxic concentration
level of drug that will result in serious adverse effects
AM
morning
no
number
A nurse is collecting data from a client who is taking tobramycin. Which of the following findings should the nurse report to the provider immediately?
oliguria
why should healthcare professionals be concerned about patients taking herbal medicines?
patients could be putting themselves at risk, potential herb-drug interactions
What should be monitored while on calcium acetate?
serum calcium signs of decreased gastric and intestinal motility polyuria flank pain blood in urine (stones)
Which drug excretes sodium and water and retains potassium?
spironolactone (Aldactone)
Rx
take
Drug Compliance
taking a medication in the mannerprescribed by the health care provider
steady-rate concentration
the concentration remains stable when the drug is given repeatedly
Bioavailability
the extent to which the body can absorb and use a nutrient
trough concentration
the point at which the lowest amount of drug is in the serum
bid
twice a day
amiodarone can increase the blood levels of?
warfarin phenytoin digoxin statins
Pts taking this drug with statins are at an increased risk for bleeding
warfarin, increases PT levels
PRN
when needed/necessary
A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply)
white blood cell count serum potassium blood glucose
Evaluation
• Compares the patient's current health status with the desired outcome. - Was plan appropriate - Was it met - Does it need revision - Was the problem resolved • As related to pharmacotherapy, used to determine: - Whether the therapeutic effects of the drug were achieved - Whether adverse effects were prevented or kept to acceptable levels • Begin a new cycle when new assessment data obtained
Obstacles to healthcare
• Inadequate health insurance • Cost of treatment and drugs • Limited medical care in rural areas • Literacy
Implementation Phase
• Involves action on the part of the nurse or patient • As related to pharmacotherapy, involves: - Administering the medication - Continuing to assess the patient & monitoring drug effects - Carrying out the interventions developed in the planning phase to maximize the therapeutic response - Prevent adverse events - Document!
Patient/Caregiver Factors Contributing to Medication Errors
• Taking drugs prescribed by several practitioners • Getting prescriptions filled at more than one pharmacy • Not filling or refilling prescriptions • Taking medications incorrectly •Taking medications that may be left over from a previous illness • Taking medications prescribed for someone else
Sentinel Events
• Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof • Always investigated • Interventions to ensure no repetition • Root cause analysis (RCA) seeks to prevent another occurrence by asking what happened and why, and what can be done to prevent it
Reporting and Documenting Medication Errors
• Utilize and incident report - Documentation in medical record must include specific nursing interventions implemented after the error to protect the patient - Document all individuals notified of error - Give details of what medication was given or omitted in medication - administration record (MAR)
Responsibilities of the Health Care Worker
• What drug is ordered - Name (generic trade) & drug classification - Intended or proposed use - Effects on the body - Contraindications - Special consideration - Side effects • Why the medication has been prescribed for this particular patient • How the medication is supplied by the pharmacy • How the medication is to be administered, including dosage ranges • What nursing process considerations related to the medication apply to this patient
Holistic Approach
◦ Each person: integrated biological, psychosocial, cultural, communicating whole person ◦ If patient believes treatment is important and beneficial, it often is more effective
Examples of Herbal Supplements
◦ Garlic - hypercholesterolemia ◦ Soy ◦ St. John's wort - Depression ◦ Cranberry ◦ Ginseng ◦ Stevia ◦ Horse chestnut seed extract - chronic venous insufficiency ◦ Plant sterols & stanols - hyperlipidemia ◦ Hawthorn - hypertension ◦ Valerian - insomnia ◦ Devil's claw, white willow bark - Low back pain ◦ Ginkgo biloba - memory impairment ◦ Black cohosh, St. John's wort - menopausal symptoms
Herbs
◦ Meaning has changed to refer to any plant product with some useful application either as a food enhancer or a medicine ◦ Documented use for thousands of years
Genetic Influences
◦ Pharmacogenetics = study of genetic variations that give rise to differences in the way patients handle medications
Food, Drug, and Cosmetic Act - Definition of Dietary Supplements
◦ Products intended to enhance or supplement the diet ◦ Botanicals ◦ Vitamins ◦ Minerals ◦ Metabolites
Dietary Supplement Health and Education Act of 1994 (DSHEA)
◦ Regulatory act for dietary supplements ◦ Less rigid than the Food, Drug, and Cosmetic Act (FD&C Act) ◦ Dietary supplements are exempted from FD&C Act standards ◦ Gives Food and Drug Administration power to remove products considered harmful
"Natural" Does Not Always Mean Safer
◦ Some active chemicals are the same as in prescription and OTC medications ◦ Substituting alternative therapy for established medical treatment may prolong condition
Nurse Responsibility on herbal supplements
◦ Watch for herbal products with ingredients that interact with prescription drugs ◦ Ask questions and obtain medical histories ◦ Educate patients ◦ Strengths and weaknesses of CAM ◦ Encourage patients to seek information from reputable sources ◦ Tell pregnant/lactating women never to take supplements without approval from health care provider
A nurse is preparing to administer cefazolon 1g in 100mL 0.9% sodium chloride to infuse over 30 min. The drop factor of the manual IV tubing is 15 gtt/ml. The nurse should set the manual IV infusion to deliver how many gtt/ml?
50 gtt/min
A medication record reads: lispro (Humalog) insulin 15 units subcutaneously at 0800. Which of the following actions should the nurse take when administering this medication? A. Administer the medication when the breakfast tray arrives. B. Administer the medication within 30 min of the scheduled time. C. Check the client's blood glucose immediately after administration. D. Clarify the prescription because the medication is usually given at bedtime.
A. Administer the medication when the breakfast tray arrives. This is a rapid-acting insulin with an onset of less than 15 min. Administering the insulin at the time the breakfast tray arrives will ensure adequate blood glucose at time of peak action. The client's blood glucose level should be checked prior to insulin administration to prevent an episode of hypoglycemia. This medication is given prior to meals, and may be given 2 to 3 times/day.
A nurse is collecting data from a client who is taking exenatide to treat diabetes. For which of the following findings should the nurse withhold the exenatide doses and notify the provider immediately?
Abdominal pain
What are some adverse effects of irebesartan (Avapro)
Angioedema Headache Insomnia Hypotension
A nurse is collecting data prior to administering digoxin to a client. For which of the following findings should the nurse withhold this medication and notify the provider?
Apical pulse 52/min
1.A nurse is obtaining a medication history from a client who is to start a new prescription for warfarin (Coumadin). Which of the following over-the0counter medications should the nurse instruct the client to avoid?
Apirin
filgrastim (Neupogen) is contraindicated in pts with?
Bone marrow cancer respiratory depression Sickle cell disease sensitivity to E Colu derived proteins
Digoxin (Lanoxin) A. Rids body of excess fluid and sodium B. Increases tissue oxygenation C. Improves myocardial contractility D. Reduces afterload
C. Improves myocardial contractility
Which of the following is correct regarding toxicity associated with amiodarone (Cordarone)? A. Visual impairment resolves when the medication is withdrawn. B. Ototoxicity is irreversible. C. Lung damage can persist for months after the medication is discontinued. D. Myopathy is a common manifestation of toxicity.
C. Lung damage can persist for months after the medication is discontinued. impairment can be permanent. Ototoxicity is not a sign of amiodarone toxicity, and myopathy is seen in clients who are receiving statins and fibrates.
Provides a non dietary source of calcium
Calcium acetate (Phoslo, Renagel)
While infusing lidocaine what is important to monitor?
Cardiac rhythm while infusing and report numbness of the lips
What is the mechanism of action for irebesartan (Avapro)
Causes vasodilation Urinary excretion of sodium and water Urinary retention of potassium
22.A nurse is caring for a client, who has migraine headaches and is planning to ask her provider for a prescription for ergotamine (Ergostat), which she heard is helpful for treating migraines. The nurse should be aware that ergotamine is contraindicated for clients who have which of the following conditions?
Coronary artery disease
How do you mix insulin?
Draw up regular insulin then draw up NPH
4.Do drug-drug interactions produce increased or decreased medication effects? Explain
Drug- drug interactions can produce increased or decreased medication effects. These effects can be beneficial or detrimental to the client.
When should glyburide be given?
Give 30 minutes before a meal
What are some adverse effects of calcium acetate?
Hypercalcemia Nausea and vomiting constipation kidney stones polyuria
Some side effects of epoetin alfa (Procrit)
Hypertension Malignancy progression
25.A nurse is reinforcing teaching to a client prescribed tetracycline (Sumycin) to treat a gastrointestinal infection. Which of the following statements by the client indicates a need for further teaching?
I will take the medication with a full glass of milk
Glyburide is contraindicated in?
Impaired renal or hepatic functioning Diabetic keotacidosis Pregnancy, lactation
Long acting onset, peak, and duration
Indulin Glargine (Lantus) Onset- 1hr Peak- None Duration- 10.4-24hr
What insulins should never be mixed?
Insulin glargine and detemir
When given IV this drug controls ventricular dysrhythmias caused by myocardial infarction, cardiac surgery or digoxin toxicity.
Lidocain
partial agonist
Medication that produces a weaker, or less efficacious, response than an agonist.
A nurse On the medical surgical unit is preparing to administer medications to a client. Which of the following questions should the nurse asked the client to verify the clients identity?
What is your name and date of birth?
A nurse is reinforcing teaching with a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?
While using the patch, I will be careful when rising from a chair
Causes pulmonary toxicity
amiodarone HCL
ac
before meals
Therapeutic range
concentration of drug in the blood serum that produces the desired effect without causing toxicity
q4h
every 4 hours (even)
q6h
every 6 hours (even)
qid
four times a day
h or hr
hour
Mechanism of Action
how a drug produces its physiological effect in the body
What are some adverse reactions of insulin?
hypokalemia hypoglycemia lipohypertrophy (accumulation of extra fat at the site of injection)
tab
tablet
tid
three times a day
Complementary and Alternative Medicine (CAM)
◦ Considered outside mainstream health care ◦ Very diverse set of therapies and healing systems ◦ Ingested therapies ◦ Alternate health care systems ◦ Biologic - based therapies ◦ Manual healing ◦ Mind - body interventions ◦ Spiritual ◦ Other therapies
