EXAM ONE

erythromycin

prolonged QT intervals hepatotoxicity and otoxicity fever, nausea, vomiting, increased WBC do not give to pt with cardiac probs

bc the pt is allergic to penicillin, which of the folloing antibiotics is appropriate to prescribe for the meningitis?

vancomycin

If you have high PT or INR

you are more susceptible for infection

A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration?

A. Institutional policies regarding routine medication administration times B. Specific characteristics of the medications Rationale: Evidence-based practice indicates that the specific characteristics of the medications be the primary consideration of scheduling administration times. The characteristics of eachmedication, including the indication, onset, durations of action, and potential adverse effects and interactions, primarily determine the schedule of administration. Although an institutional policy may require that all once daily medications be administered at 0800, the nurse should be aware that some classifications of medications should only be given at bedtime, or should only be given with food. Likewise, the client's preferences, as well as the availability of each medication from the pharmacy, play important but smaller roles in determining the schedule of administration. C. Schedule of administration that the client follows at home D. Time at which the medication can be available from the pharmacy

nurse is preparing to administer nalbuphine to a postoperative client who is experiencing pain. The nurse should monitor the client for which of the following potential adverse effects of this medication?

A. Miosis Rationale: Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?

A. Notify the client's provider. B. Check the client's vital signs. Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions. C. Fill out an occurrence form. D. Administer the medication to the correct client.

A nurse arrives for her shift and is preparing to count the controlled substances in the secure cabinet. Which of the following actions should the nurse take?

A. Set aside any controlled substances the nurse plans to give during her shift. B. Verify that the amounts of each medication she counts match the amounts on the inventory record. Rationale: If the amounts available do not match the amounts on the inventory record after subtracting what the nurses administered during the previous shift and adding any medications the nurses added to the cabinet, the nurse must address and reconcile the count. C. Co-sign any notations of wasting controlled substances on the previous shift. D. Discard in the sharps container any partial doses she finds in the cabinet.

A nurse is reviewing the medication administration records of four clients who have a prescription for morphine PRN. Which of the following findings should the nurse identify as a contraindication to this medication?

A. The client is experiencing a myocardial infarction. B. The client who is 24 hr postoperative following hip arthroplasty. C. The client who has bronchitis pleurisy. D. The client has a paralytic ileus. Rationale: Morphine is contraindicated in clients who have a paralytic ileus because morphine suppresses the propulsive contractions of the intestinal tract and inhibits secretion of fluids into the intestinal tract.

A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?

A. The client not been taking the medication properly. B. The client is experiencing episodes of confusion. C. The client has become addicted to the medication. D. The client developed a tolerance to the medication. Rationale: The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.

A client receives a wrong medication. The nurse who made the medication error should take which of the following actions first?

B. Assess the client.

neomycin

no red man syndrome, stops infection, nephro and ototoxicity, INCREASED BUN & CREATINE, muscle aches and cramping

giving oral med

nursing implications: LOC, gag reflux, diet, NPO, 90 degree <

Opioids

phone a dr if respirations are less than 12 breaths per minute ASSESS B4 INTERVENTION

SPORINS

-cillian, amoxacillin, penacillin assessment first, shake before taking it.

active natural immunity

obtained through community

Tamoxifen

DVT Hot flashes are an EXPECTED finding increased Ca level= bone pain vaginal bleeding, endometrial cancer no anticoagulation therapy LABS- Ca blood levels, PT, INR, CBC

to remember NSAIDS, use the neumonic N S A I K

NAPROXEN SALICYLIC ACID ACETYLYSALYTIC ACID IBUPROFEN KETORALAC

phenatopiridine

NORMAL for orange or rred urine or bodily fluids sanitary pads, glasses '

INR

NOT on warfarin: <1sec ON warfarin: 2-3 seconds

first pass effect

tthe first time a drug is metabolized by the liver enzymes- might have to be given IV.

active artificial immunity

vaccination

Creatinine

0.6-1.2 mg/dL

A client is prescribed GENTAMICIN for tx of a resp tract infection, the provido instructs the client to monior and report which of the following adverse effects?

Tinnitus

Metronidazole

Treatment for Trichomonas vaginalis look out for SEIZURE DISORDERS

levofloxacin, ciprofloxacin

-avoid sun, achilles tendon rupture, fall with achilles tendon -avoid INCREASED bun or creatine CIPRO-flush

GOTTA KNOWS FOR ANTIBIOTICS

-encourage finishing the medication and not stopping once you feel better -make client aware that they are more succeptible to accidental pregnancy, and need a second type of birth control -no alcohol -don't take with food, emty stomach witha full glass of water -avoid fun in the sun ((HINT: photosensitivity, and sunblock)) -super toxic kidney and ears + peaks and troughs; ear damage, vertigo, tititus, nephrotoxicity, BUN Creatine

Pt

10-13 seconds

BUN

10-20 mg/dL

AST

10-40 U/L

Plt count

150,000-400,000

Aldasterone

1st prophylatic to subside from nausea

A nurse is preparing to administer a pre-packaged oral medication to a client and complete the final medication check. At which of the following times or places should the nurse perform this final check?

A. At the client's bedside before administration

A nurse is preparing to administer oral medications to a client. Which of the following should the nurse recognize as an acceptable client identifier? (Select all that apply.)

A. Client's full name E. Facility-assigned identification number

thrombocytopenia

a bleeding disorder characterized by an abnormal decrease in the number of platelets in the blood, which impairs the clotting process anything less that 150,000 platelets -use an electric rasor and fall risk ANEMIA: R/t RBC Count , gi discomfort and ulcers

Four processes of pharmacokinetics

absorption, distribution, metabolism, excretion

signs and symptoms of TB

blood in sputum, night sweats, put pt on isolation precautions, negative pressure room and airborne

Methotextrate

bone marrow suppression -RCB= anemia - WBC= Infection -Platelets= bleeding GI BLEEDING = ULCERS avoid NSAIDS & Steroids, avoid empty stomach USE birthcontrol -DO NOT GIVE TO- pregnant pt, do not give vaccines

passive natural immunity

breast milk/placenta

trimpethoprim/sulfamethoxazole

can increase the risk for bleeding

A nurse is caring for a client who has a gyn infection and hx of alcohol use disorder. which drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it?

cefotetan & metronidazole reaction of nausea, severe vomitiing, headache, weakness and hypotension

Nitrofurantoin adverse effects are

cough

clients receieving vanc should be closely monitored for

hearing loss

Signs of DVT

pain or tenderness over area of clot, swelling or tightness of the calf, and skin discoloration localized to one site, warm to touch, redness

Bacterial Meningitis

prescribe third gen cephalosporins

give patients with cancer

protien reich foods first and at room temp

cefotetan IV insertion site is warm, edematous and painful to touch, what should the nurse do?

stop the infusion

Impipenem for bacterialinfection, pain in mouth adverse effect?

superinfection. mouth throat vaginal pain

ciproflaxacin report of dyspepsia, what instructions?

take an antaciid at least 2 hours AFTER takng the drugst

A client is prescribed with itraconzole for tx of systemic mycoses. include what in instructing about admin?

take with food to reduce gastric distress, take with 8oz of acidic liquid liike cola or OJ to increase absorption

A nurse in the emergency department is caring for a client who has acute toxicity from acetaminophen overdose. The nurse should prepare to administer which of the following medications?

B. Acetylcysteine

A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment?

C. Respiratory rate

Metronidazole

CDIFF & STI treatment cephatroxin causes CDIFF Avoid Alcohol during and 3 days after Dark Urine, Metalic taste DEADLY - steven Johnson syndrome, rash peeling of skin

A nurse is teaching a client who takes acetaminophen daily to manage mild knee pain. The nurse should instruct the client to monitor for which of the following adverse reactions to this medication?

D. Jaundice

A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority?

D. Respiratory rate

ATI BASED QUESTIONS:

GET READY! GO

Antimycobacterial

Isoniazid: inhibits growth of bacterial cell growth, latent and active TB COMP: liver fx issues, jaundicie anorexia, fatigue, nausea vomiting, glucose monitoring and neuropathy CONTRA: pt with preexisiting hepatotoxicity NO ALCOHOL, NO TYRAMINE RICH FOODS

a client is prescribed amoxicillin to treat an ear infection. The health care provider instructs the client to monitor and report which of the following?

RASH

interluekins boost

the immune system

Metabolism

the way drugs are metabolized.

30 mL or less

kidneys are in distress

Chloroquine treats

Malaria

antifungals

Nystatin (Mycostatin) acts on fungal cell membrane to cause cell death for yeast infx, thrust, ring worm do a test dosage, monitor K levels contra: prer exisiting liver/kid dysfx infused slowly 2-4 hours

Excretion

Process by which metabolic wastes are eliminated from the body exhalation, urination, defecation, sweating

a client is prescribed oral tetracycline for treatment of acne. when instructing, what info should the provider include?

mouth pain, take 1 hr. before meals, wear sunscreen and protective clothing

MOA of NSAIDS

prostagladin- pop the party with pain

Ciprofloxacin adverse effects

tendon pain

Non-opioids/NSAIDs

these drugs are antipyretic- do not allow for pain/inflammation

Vancomycin causes

treats CDIF MERSARed Man Syndrome!! causeed by a rrapid infusion HYPOtension, puritis, hives, itching, tachy MONITOR BLOOD PRESSURE PEAK and trough levels- under 20

gentamicin monitor alteration of

urine output

oral contraceptive and rifampin therapy for TB

use a non hormonal form of contraception

WBC count

4-11,000

RBC count

4.5-5.5 million

acylovir for tx of herpes- which lab values do you need to monitor?

BUN- drug can cause renal toxicity - INCREASE FLUID

A nurse is administering 1 mg hydromorphone IV to a client. The available dose is 2 mg/1 mL. What should the nurse do with the remaining medication?

D. Waste the medication in the presence of another nurse.

VANC treats

MRSA

Acetaminophen

Reccomended with a child who has the flu Avoid alcohol obtain liver labs : ALT AST

itraconazole

can cause edema whicih can also indicate heart dysfx and needs to be monitored closely

what dos anaphylaxis look like?

hives, angioedema, wheezing

A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse?

"I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it."

Amphotercin B

tx of systemic candidiasis

A nurse is administering an oral medication to an older adult client. The client states, "The pill I always take is green. I do not take an orange pill." which of the following responses should the nurse make?

"I will check your medication order again."

penicillin allergy?

use azithriomycin, clarithromycin and clindamycin

CD4

500-1200 CELLS, BELOW 200=AIDS

A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?

A. UtilitarianismRationale: Utilitarianism refers to actions that are right when they contribute to the greatest good. B. Nonmaleficence Rationale: Nonmaleficence is the duty to do no harm. The ethical mandate of nonmaleficence is that health care workers refrain from intentionally inflicting harm to clients. C. Fidelity Rationale: Fidelity is the duty to keep one's promises or word. It refers to the obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others. D. Veracity Rationale: Veracity is the duty to tell the truth. It means that one does not intentionally deceive or mislead clients.

antiretrovirals

Acyclovir treats herpes only effective when the viral infx is actiive it is NOT CURATIVE for aids or hiv NOR DOES IT NOT decrease spreading to others this is a relief of symptoms

A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available?

B. Naloxone

When reviewing the admitting prescriptions for a client, the nurse notes that the dose of one medication is three times the usual dose of this medication. Which of the following actions should the nurse take?

C. Contact the provider to question the dosage.

. A nurse is preparing medication for a client when another client has an emergency. Which of the following actions should the nurse take?

C. Lock the medication in a room and finish preparing it after returning from the emergency.

IV vanc has been prescribied to treat meningitis. when adminsitering this drug IV, which of the following actions should te health care professional take?

Do not mix with other drugs monitor the IV site for phlebitis monitor vitals during the infusion dilute the drug before admin

what happens if you do a fast push of opioids?

FAST DEATH

N= NOT SAFE FOR? S= STICKY BLOOD A=ASTHMATICS I=INCREASED BLEED RISK D=DYSFX KIDNEYS S= SWELLING OF HEART

N; CHILDREN (REYES SYNDROME S; THROMBUS OR DVT A; USE ACETAMINOPHEN I; EASY BLEEDING, TARRY STOOL, COFFEE GROUND EMISIS D S; HTN CVD

rifampin

RIPE ORANGE urine for inhibition of protein synthesis in conjx with another drug COMP: liver dysfx interatctions!!! WARFARIN. monitor PT/INR- teach non hormonal contraceptive contra- liver conditions and MED COMPLIANCE

Six Rights of Medication Administration

Right patient Right medication Right dose Right route Right time Right documentation

Trimethoprim/Sulfamethoxazole

S- sunburn U - urrine crystals- body is DRY L - LOVE water- 2-3L/d F - folic acid DAILY

A nurse is monitoring a client who took an overdose of acetaminophen 72 hr ago. The nurse should identify which of the following findings as a manifestation of acetaminophen poisoning?

The nurse should expect a client who has acetaminophen poisoning to have early manifestations of nausea, vomiting, abdominal distress, diarrhea, and sweating.

Absorption

The process of how a drug is absorbed- topically, orally ( slowed with the presence of food)

Imipenem should be used with caution in which of the following clients?

a client with seizure disorder

acetyclysteine (Mucomyst)

acetaminophen antidote

complications of vaccinations

allergic reactions- typically to eggs

if a pt has less than 2000 platelets, put them on neutropenic precautions

avoid groups, hand hygiene, and no vaccines

Vancomycin

burns the vein, PIC LINE

Erythromycin adverse effects

cardiac dysrythmias, diiarrhea, hearing loss, fever

because the client is allergic to penicillin, which of the following drugs should be available in case the client has a severe allergic reaction to the antibiotiic that has been prescribed

epinepherine

amphotericin B IV - prevention of adverse effect?

give acetaminiophen and diphenhydramine

what are NSAIDS used for?

gout, arthritits

a nurse is reviewing a clients prescriptiion priior to admiiistering gentamicin, clarify order with the drug of

ETHACRYNIC ACID these are both ototoxic drugs and iincreases risk for hearing loss

Tetracycline

LIVER DSYFX -JAUNDICE, CLAY COLORED STOOLS, ALT AST dangerous for pregnancy, tooth and skin discoloration - give on an empty stomach, sit up for 30 minutes after taking it, avoid Ca and Iron because it decreases absorption

-azole

METRONIADAZOLE -H.Pylori and STIs comp: gi v/d. URINE IS RUSTED -metallic taste- seziurers ataxia numbness of extremities contra: preexisiting CNS disorder DO NOT GIVE TO PREGNANT WOMEN IN THIRD TERM PREGNANCY interacts poorly with Warfarin

passive artificially acquired immunity

immunogoblins

which of the following interventions may prevent a serious adverse reaction to acyclovir?

increase fluid intake to reduce the chances of RENAL TOXICITY

tx of tb with rifampin- DR. prescribes what to prevent possible resistance to rifampin?

isoniazid

adverse effects of isoniazid

jaundce, numbness o fhands, dizziness

a clenint is prescribed rifampin for tx of TB. Monitor for which serious adverse affect?

jaundice!!!

Opioids (narcotics)

low and sloooow morphine codene hyrdromorphone

ALT

7-56 U/L

giving IM injection

90 degree angle, CHILD: vastus lateralis adult: deltoid- only up to 0.1 ml 18-27 mm gauge

A nurse is reviewing the medication administration records from the previous shift. Which of the following findings should indicate to the nurse a need for an incident report?

A. A client received gentamicin intermittent IV bolus over 1 hr. B. A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection. C. A nurse injected Demerol IM into the vastus lateralis site of adult. D. A client received a crushed bupropion XL tablet mixed with applesauce. Rationale: Extended or sustained release medications are intended to release medication levels over a long period of time to sustain therapeutic relief. Crushing, breaking, or chewing an extended release medication releases the medication at once into the bloodstream and could be life-threatening. Mixing this medication in applesauce deviates from standard of care and requires the nurse to complete an incident report.

A nurse manager is presenting to a group of unit nurses the categories regulated under the Controlled Substances Act. Which of the following medication prescriptions should the nurse include under Schedule II?

A. Buprenorphine hydrochloride B. Morphine Rationale: The charge nurse should include in the teaching that morphine is under Schedule II prescription medications, which requires the provider to complete a written prescription with a signature. C. Hydrocodone bitartrate D. Diazepam

A nurse on a medical-surgical unit is reconciling a newly admitted client's medication. The nurse is reviewing the process of medication reconciliation with a newly licensed nurse. The nurse should include which of the following information?

A. The American Hospital Association requires accredited facilities to have protocols in place requiring medication reconciliation. The purpose of medication reconciliation is to prevent adverse medication reactions. Rationale: Medication reconciliation includes reviewing an accurate list of all medications the client is taking and comparing that list to new medications the provider has prescribed. This action decreases the risk of medication interactions and adverse outcomes. C. The nurse who performs medication reconciliation is demonstrating the ethical principal of veracity. D. The International Council of Nurses Code of Ethics stipulates that the nurse performs medication reconciliation when a client is admitted to a facility, is transferred to another facility, and when a client is discharged from a facility.

A nurse is teaching a newly licensed nurse about transcribing prescriptions. Which of the following examples should the nurse include in the instructions?

B. Metformin 500mg,1 tablet, PO, daily

Distribution

There are anatomical barriers to distribute Psychtropic drugs do not allow for passage throught the blood brain barrier blood placental barrier blood testicular barrier

while recieving vanc, a client becomes flushed and warm. which of the following additional adverse reactioins to vanc should be expected

hypotension

antiemetics

reduce nausea and vomiting

atreonam requires cautiion of

renal impairment,

a client is prescribed with trimethoprim/sulfamethoazole for tx of a urinary tract infection. monitor and report which adverse effect?

sore throat. it can cause thrombocytopenia, leukopenia and other blood disorders.

a nurse is teaching a class about medication reconciliation. which of the following information should the nurse include in the teaching

A. Do not include over-the-counter medications in the medication reconciliation report. B. Provide a list of the client's current medications during the change of shift report. C. Do not perform reconciliation for a client at discharge from a health care facility. D. Provide a list of the client's current medications during admission to a health care facility. Rationale: The nurse should create a list of current medications including the name, indication, route, dosage, and dosing interval upon admission to a health care facility. The list consists of all medications, including vitamins, herbal products, and prescription and nonprescription medications.

Doxorubicin

ABX (antibiotic) antitumor IV bone marrow suppression GI alopecia cardiac, elderly HF pt RED Skin & urine

A nurse is teaching a class about safe medication administration. The nurse should include in the teaching that which of the following references are acceptable for safe medication administration? (Select all that apply.)

B. Published journals C. Pharmacists D. Physicians' Desk Reference1

A nurse finds an open vial of morphine lying on top of the cabinet in a client's room. Which of the following actions should the nurse take?

B. Report the discrepancy immediately.

A nurse is teaching a client who has a new prescription for ibuprofen to treat hip pain. Which of the following instructions should the nurse include in the teaching?

B. Take the medication with food.

A nurse is orienting a newly licensed nurse about receiving telephone prescriptions. Which of the following statements by the newly licensed nurse should indicate a need for further teaching?

C. "Telephone prescriptions are transcribed into the nurse's notes."

A nurse is having difficulty reading the provider's writing when transcribing a prescription for a client's medication. Which of the following actions should the nurse take?

D. Contact the provider to clarify the prescription.

A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take?

D. Document that the client refuses the medications.

A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene?

D. Documents medication administration prior to administering it.

The nurse is preparing a medication for a client and observes the date of expiration on the vial occurred 2 months ago. Which of the following actions should the nurse take?

D. Return the medication to the pharmacy.

Aminoglycosides

gentamicin ototoxicity or kidney problems