ATI LSRN Pharm Final

6 yr old client w/ asthma & several prescription meds using metered dose inhalers, pt. getting d/c; which interventions should the nurse include in the plan? -add a spacer to each MDI -instruct the child to inhale more rapidly than usual when using an MDI -request that the provider change the child's meds from inhaled to oral forms -administer oxygen by facemark along w/ the MDI

-add a spacer to each MDI -MDIs are difficult to use correctly- adding a spacer applied to an MDI can make up for lack of hand-lung coordination by inc. amount of med delivered to lungs

iron dextran IV to a pt.-which of the following actions should the nurse plan to take? -administer a small test dose before full dose -infuse the med over 30 seconds -monitor the client closely for HTN -administer cyanocobalamin as an antidote if iron dextran toxicity occurs

-administer a small test dose before full dose -a serious adverse effect is anaphylaxis -a small dose should be administered over 5 min. before full dose

what does taking omeprazole inc. r/f? how long should you take this med? s/e?

-inc. r/f pneumonia -use for 1-2 mo. -inc. r/f fractures and hypomagnesemia

5 adverse effects of theophylline toxicity?

-tachycardia -restlessness and irritability -tremors -seizures -diarrhea

a nurse is administering insulin glulisine 10 units subQ at 0730 to an adolescent client who has type 1 DM. the nurse should anticipate onset of action at which of the following times? -0800 -0745 -0900 -1030

0745 -very SHORT onset of action of 15 min.

NPH insulin onset of action?

1-2 hr

what is normal potassium level?

3.5 to 5.0

regular insulin onset of action?

30-60 min.

TB skin skin positive pt- prescription for isoniazid; teach pt. to monitor which lab? -TSH -AST -potassium -sodium

AST -isoniazid can be toxic to the liver

what class of drug is phenelzine?

MAOI

what is fluticasone?

a glucocorticoid med for long-term prophylaxis of asthma

what is cromolyn?

a mast cell stabilizer w/ anti-inflammatory action designed for prophylaxis of asthma; used on a find schedule

what does naltrexone do for alc. d/o?

decreases cravings

what is echinacea used for?

herb w/ manifestations and duration of colds and flu like illnesses

what is salmeterol?

long acting beta2-adrenergic agonist used for prophylaxis of asthma

what does acamprosate do for alc. d/o?

used to maintain abstinence

diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction- the client has an IV infusion containing a med that is incompatible with diphenhydramine in soln. what should the nurse do? -choose an IV port for IV bolus injection of the diphenhydramine as near as possible to the client's hanging IV bag -flush the IV tubing w/ 2 mL of 0.9% sodium chloride before and after administering diphenhydramine -allow the IV infusion to keep running while administering the diphenhydramine via IV bolus -aspirate to check for IV patency

-aspirate to check for IV patency

pt. has a venous thrombosis and a prescription for warfarin. which of the following instructions should the nurse include in the teaching? -take ibuprofen PRN for HA -carry a medic alert ID card -report to the lab weekly to have blood drawn for aPTT -inc. intake of dark green veggies

-carry a medic alert ID card -at r/f bleeding so if emergency, need ID card

pt. w/ alcohol use d/o and is admitted w/ lower extremity fractures following a motor-vehicle crash- a few hours after admission, a client develops restlessness and tremors;w which med should nurse administer? -acamprosate -naltrexone -chlordiazepoxide -disulifiram

-chlordiazepoxide -long-acting oral benzo -benzo= help w/ alcohol withdrawal

a nurse is administering cipro and phenazopyridine to a client who has a severe UTI. the client asks why both meds are needed- nurse's answer?

-cipro is to treat the infection, phenazopyridine treats pain from UTI

what are manifestation of levothyroxine OD?

-similar to hyperthyroidism effects -tachycardia -heat intolerance -hyperthermia -tremor -anxiety

what kind of s/e does HYDROXYZINE have?

anticholinergic (dry mouth, constipation, dilated pupils, inc. HR)

a nurse is caring for a client who was brought to the emergency dept. by friends who report the client has OD on heroin; which of the following findings should the nurse expect to assess? -temp 39.2 (102.6) -RR 30/min -pinpoint pupils -severe ABD cramping

pinpoint pupils -expected finding in opiod toxicity

nurse providing d/c teaching to a client who has a bleeding duodenal ulcer and is prescribed omeprazole. which of the following statements should the nurse include in the teaching? -you will need to take this med for the next 6 mo. -taking this med will dec. r/f acquiring pneumonia -take this med before breakfast every day -watch out for serious s/e of tachycardia and heart palpitations while taking this med

take this med before breakfast every day -less effective when taken w/ food

how should you d/c clonidine? s/e of the med?

taper- if stopped abruptly could cause HTN crisis -dry mouth, constipation

intranasal calcitonin-salmon med administration? what should you do if nasal bleeding occurs?

-1 nostril daily- rotate nostrils each day -depress the side arms to activate the pump -long-term therapy -d/c med and notify provider

adenosine half life? s/e?

-10 seconds -dyspnea, flushing of the face -warmth

a nurse is planning to administer epoetin alfa to a pt. w/ chronic kidney failure. which of the following data should the nurse plan to review prior to administration of this med? -BP -temp -blood glucose levels -total protein level

-BP -this med causes HTN which can lead to stroke or other CV complications -need concurrent use of HTN med

administration rules for iron dextran?

-IV infusion-infuse the med over 10-15 min -IV bolus-at least 1 min. -give a small test dose to monitor for anaphylaxis -deferoxamine is an antidote for iron toxicity

what is ginger used for?

-a root used to prevent and treat N/V

nurse providing teaching to parents of school-age child who has asthma about meds for bronchospasm- what med relieves an acute asthma attack? -salmeterol -cromolyn -fluticasone -albuterol

-albuterol -acute asthma attack -1 to 2 puffs every 4-6 hr PRN for school aged child

major depressive d/o pt. w/ a prescription for amitriptyline; which statement indicates understanding? -i will take in AM b/c i am likely to have trouble falling asleep if i take it in the evening -i will move slowly when i stand up b/c can cause my BP to dec. -i can drink a glass of beer/wine w/ my evening meal -i will avoid foods high in fiber b/c diarrhea

-i will move slowly when i stand up b/c can cause my BP to dec. -orthostatic hypotension

hospice nurse is caring for a client w/ cancer and is taking naproxen 250 mg 3 times daily PO and gabapentin 1,800 mg 3x daily PO to manage pain. pt. states "I'm having pain that keeps me from doing what I'd like most of the time"- which following addictions should the nurse anticipate to the client's med regiment? -oral meperidine -parenteral naloxone -parenteral diazepam -oral oxycodone

-oral oxycodone

monitor what lab for receiving chemotherapy w/ methotrexate via IV infusion? -BUN 18 -platelets 78,000 -hemoglobin 14.2 -AST 35

-platelets 78,000 -chemotherapy can cause thrombocytopenia and bone marrow suppression and puts client at r/f severe bleeding

pt. w/ alzheimer's disease- lorazepam 1 mg x3 daily for restlessness and anxiety during the past few days- which adverse effect should the nurse assess for? -low-grade fever -sedation -diuresis -tonic-clonic seizures

-sedation -a benzo w/ sedative effects

what are common s/e while taking metformin?

-weight loss -lowers blood glucose -N/V/D

pt. prescribed furosemide 40 mg daily- pt. reports taking extra doses to promote weight loss. which of the following findings should indicate to the nurse the pt. is dehydrated? -urine specific gravity 1.035 -distended neck veins -BUN 18 mg/dL -bounding radial pulses

a urine specific gravity greater than 1.030 is an expected finding of clients who are dehydrated

HTN and oral clonidine- which instruction should nurse include? -d/c med if rash develops -expect inc. salivation during first few weeks of therapy -minimize fiber intake to prevent diarrhea -avoid driving until the client's reaction to the med is known

avoid driving until the client's reaction to the med is known -can cause drowsiness, weakness, sedation, and other CNS effects

terbutaline MOA

beta2 receptors in the uterus which results in dec. frequency of contractions

a nurse is planning d/c teaching for a client who has major depressive d/o and a prescription for phenelzine. which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine? -broiled beer steak -mac and cheese -pepperoni pizza -smoked salmon

broiled beer steak

client w/ CHF taking digoxin- client reports nausea and refuses to eat breakfast. which action should the nurse take first? -encourage the client to eat the toast on the breakfast tray -administer an antiemetic -inform the client's provider -check the client's apical pulse

check the client's apical pulse -N/V, anorexia, fatigue, visual effects and cardiac dysrhythmias often are cause by a slow pulse rate which are possible findings in digoxin toxicity -all other answers are true they just are not the priority

hydrochlorothiazide for HTN- the nurse instructs the client to eat foods rich in potassium- which statement indicates an understanding from pt? -this med will not work unless i have enough potassium -K+ will inc. the therapeutic effect of my BP medication -K+ will lower my BP -this med can cause a loss of K+

this med can cause a loss of K+ -excretion of potassium from kidneys can cause hypokalemia

theophylline for relief of chronic bronchitis- which s/e indicates theophylline toxicity? -constipation -tremors -fatigue -bradycardia

tremors -theophylline is a CNS stimulant -a xanthine derivative bronchodilator

pt. uses several herbal and vit. supplements daily, including saw palmetto. the nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects? -urinary health promotion -immune system stimulation -dec leg pain from arterial disease -prevention of nausea by motion sickness

urinary health promotion -used for BPH and prostatic conditions

a nurse is planning care for a female client w/ irritable bowel syndrome w/ diarrhea (IBS-D) and a prescription for alosetron- which intervention should be included in plan of care? -client must sign an agreement before administering alosetron -client must stop taking alosetron if diarrhea cont. 1 week after beginning the med -client should expect to have a dec. HR -client should should a barrier birth control b/c alosetron interacts w/ oral contraceptives

-client must sign an agreement before administering alosetron -this med has potentially fatal adverse effects associated w/ constipation and bowel obstruction -FDA placed this med on the market only is pt. signs and adheres to a risk management program w/ alosetron

what is ginkgo biloba used for?

-dietary supplement in US for inc. cognitive function in elderly and improve leg pain of intermittent laudation and other peripheral arterial disorders

how often do you need aPTT and INR for warfarin?

-drawn for first 5 days -then, twice weekly for the next 1-2 weeks

a nurse is administering oral hydroxyzine to a client. what s/e should the nurse expect? -diarrhea -anxiety -N/V -dry mouth

-dry mouth

adenosine via IV bolus for a client w/ paroxysmal atrial tachycardia-for which of the following findings should the nurse assess for? -seizures -cinchonism -dyspnea -transient pallor of face

-dyspnea -occurs due to bronchoconstriction

what does disulfiram do for alc d/o?

-helps clients who have alcohol d/o to avoid drinking

d/c teaching to a client who is to begin long-term oral prednisone for asthma. which of the following instructions should the nurse include in the plan? -stop taking the med if a rash occurs -ake the med on an empty stomach to enhance absorption -schedule the med on alternate days to dec. adverse effects -treat SOB w/ an extra dose of the med

-schedule the med on alternate days to dec. adverse effects -long-term glucocorticoid s/e are suppression of adrenal glands which can be avoided by using alternate-day therapy

pt. w/ angina pectoris and a prescription fo verapamil. the client tells the nurse "my brother takes verapamil for HTN. do you think the provider made a mistake?" which response should the nurse make? -used to treat both high BP & angina -talk to your provider to make sure -are you concerned you might have high BP? -prescribed so you won't develop HTN

VERAPAMIL used to treat both high BP & angina -calcium channel blocker that dilates arteries and decreases after load

when is cyanocobalamin administered?

vit. B12 -clients who have megaloblastic anemia

what must occur for a pt. to take alosetron? how long until effects of the med are seen? what can happen to pt. HR while on this med? does this med interact w/ birth control?

-needs to sign an agreement and be enrolled in risk program -1 month to control diarrhea -tachydysrhythmias (should notify provider) -no it does not and has FEW drug interactions

what is spironolactone derived from? what kind of adverse effects can it have? what class of med?

-steroids -adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women -potassium sparing diuretic

how do you do drop factor?

-do not use mg -only use mL -time: min, hr -and gtt/mL (drop factor)

cyclosporin- length of time on med after a transplant? HTN or hypotension? what other specific s/e? why is this med given to transplant pt.s?

-for the rest of the pt. life -HTN -hirsutism (unusual hear growth) -immunosuppression so that the transplanted kidney will not be rejected from pt. body

diltiazem via IV bolus to a client w/ a. fib- when assessing the client, the nurse should recommend which of the following findings is CI to administration of diltiazem? -hypotension -tachycardia -dec. level of consciousness -hx of diuretic use

-hypotension -diltiazem can be a tx for essential HTN bc it LOWERS BP

pt. w/ kidney transplant taking cyclosporine- which of the following statements by the client indicates an understanding of the teaching? -i will be able to stop this med 6 mo after my surgery -i am likely to develop higher BP while taking this med -i am likely to lose my hair -i am taking this med to boost immune system

-i am likely to develop higher BP while taking this med -cyclosporine can inc. BP and may need HTN therapy

d/c teaching about lithium tox to a client who has a prescription for lithium- which of the following statements indicates an understanding of the teaching? -i should take naproxen if i have a HA b/c aspirin can cause lithium toxicity -i can develop if i eat foods w/ lots of sodium -i can develop if i experience N/D -i might need to take a daily diuretic along w/ lithium to prevent lithium toxicity

-i can develop if i experience N/D -nausea and diarrhea can cause electrolyte imbalances -lithium tox is cause by kidneys retaining lithium instead of sodium if sodium is too low

a nurse is providing teaching to a client w/ HTN and DM type 1 w/ a prescription for metoprolol. which statements indicates an understanding of the teaching? -i might have difficulty recognizing when my blood sugar is low -i will have less risk for developing an infection while I take this med -i should be concerned about losing excess weight while i take this med -i could have more problems w/ high blood sugars while taking this med

-i might have difficulty recognizing when my blood sugar is low -this med is used to treat HTN, since it dec. HR, hypoglycemia may be more difficult to recognize -client needs to recognize hypoglycemia by other manifestations such as hunger, nausea, and sweating

nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. which of the following statements by the client indicates an understanding of the teaching? -i will administer a spare into each nostril daily -i should expect nasal bleeding for the first week -i will need to depress the side arms to activate the pump -i should expect to take this med for a short term course of tx

-i will need to depress the side arms to activate the pump

a nurse is providing teaching to a client who has heart failure and is taking spironolactone. which of the following statements by the client indicates an understanding of the teaching? -i will inc. my intake of citrus fruits, bananas, and potatoes -i will use salt substitutes on my food -i will drink as much water as i can while taking this med -i will watch for inc. breast tissue growth while taking this med

-i will watch for inc. breast tissue growth while taking this med

how should the nurse administer oxytocin?

-increase the dose until obtain uterine contraction that occur every 2-3 minutes -goal duration of contraction is 45-60 seconds -BP should be continually monitored -used for cervical ripening/ postpartum bleeding -administed IV infusion for cervical ripening' IM for PP bleeding

client in preterm labor and has prescription for nifedipine-client is concerned b/c her father takes nifedipine for his angina pectoris. what is the MOA of angina pectoris? -dec. incidence of bacterial vaginosis -inhibits uterine contractions by blocking entry of calcium into uterine cells -dec. the activity w/in the CNS, which regulates all smooth m. -beta2 receptors in the uterus which results in dec. frequency of contractions

-inhibits uterine contractions by blocking entry of calcium into uterine cells

client has DMII and a prescription for metformin. which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? -weight gain -myalgia -hypoglycemia -severe constipation

-myalgia -myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis

amitriptyline administration specifics and s/e?

-sedative effects -often prescribed three times daily until a therapeutic dose has been achieved and then the entire dose is prescribed at bedtime to help the client sleep at night and prevent daytime drowsiness -should NOT be taken w/ other CNS depressant such as alc. or sedatives -anticholinergic s/e such as constipation, dry mouth, blurred vision, urinary retention

pt. w/ heart failure taking oral furosemide 40 mg daily. s/e to monitor and notify provider if it occurs? -nasal congestion -tremors -tinnitus -frontal HA

-tinnitus -loop diuretics can cause ototoxicity

pt. has hypothyroidism and takes levothyroxine- what finding should alert the nurse the client is experiencing levothyroxine OD? -bradycardia -cold intolerance -tremor -hypothermia

-tremor -tremor and anxiety are expected findings in acute levothyroxine OD -findings similar to those seen in hyperthyroidism

how should a child use an MDI?

-w/ a spacer -inhale slowly over 3-5 seconds -wash mouth afterwards

how should oral glucocorticoids be taken?

-w/ food or on a full stomach -taper when d/c -take in the AM

digoxin administration? s/e? s/e of digoxin tox?

-weigh pt. daily and record the weight -w/hold digoxin if HR is below 60 -s/e: hypokalemia -pt. should inc. potassium intake -digoxin tox= visual disturbances, HR less than 60