Pharm exam 4

eat potassium rich foods

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

give 4 ml over 1 to 2 mins

A 64-year-old client in hypertensive crisis is to receive furosemide 40 mg IV. Furosemide comes in 100 mg/10 mL containers. What is the correct action by the nurse when giving the prescribed medication?

you will loose less potassium

A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?

intravenously

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

oral

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

osmotic diuretic

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

hypokalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

furosemide (IV)

A client with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route?

fluid rebound

A client with lower extremity edema from heart failure reports taking a diuretic as prescribed for several weeks. Which situation would the nurse suspect when the edema is still present?

monitoring of serum electrolytes, creatinine, and BUN

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

weigh the client daily

A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client's desired fluid loss?

Spirnolactone

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

administer early in the day

A nurse is preparing a teaching plan for a client with edema who is prescribed a diuretic. Which teaching should the nurse prioritize?

hyperkalimia

A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?

Phenytoin, naproxen, ibuprofen

A nurse notes on assessment of a client receiving furosemide a decrease in urinary output. Which drug(s) should the nurse suspect is affecting the diuretic? Select all that apply.

increased risk of hyperkalemia

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?

increased blood glucose levels

A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus. Which assessment should the nurse prioritize?

"I need to make sure I don't eat too many high potassium foods."

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

Histamine 2 Antagonists

Drug that blocks the H2 receptor sites; used to decrease acid production in the stomach (H2 sites are stimulated to cause the release of acid from parietal cells in response to gastrin or parasympathetic stimulation)

psyllium mucilloid (Metamucil)

If taken with insufficient water, psyllium may swell in the esophagus and cause an obstruction.

complex partial

Name the seizure disorder: •Aura (preceding) •Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion) •Fumbling with or attempting to remove clothing •No response to verbal commands

mannitol

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Spironolactone

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client?

mannitol

The nurse is caring for a client with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client?

Prototype Drug: Diphenoxylate with Atropine (Lomotil)

Therapeutic Class: Antidiarrheal Pharmacologic Class: Opioid Actions and Uses The primary antidiarrheal ingredient in Lomotil is diphenoxylate. Like other opioids, diphenoxylate slows peristalsis, allowing time for additional water reabsorption from the colon and more solid stools. It acts within 45 to 60 minutes. It is effective for moderate to severe diarrhea but is not recommended for infants. The atropine in Lomotil is added not for any therapeutic effect, but to discourage patients from taking too much of the drug. At higher doses, the anticholinergic effects of atropine such as drowsiness, dry mouth, and tachycardia will be experienced. Diphenoxylate is discontinued as soon as the diarrhea symptoms resolve.

the client with increased intracranial pressure secondary to a subarachnoid hemorrhage

To which client should the nurse anticipate administering mannitol?

Prototype Drug: Diphenoxylate with Atropine (Lomotil)

Treatment of Overdose: Overdose with Lomotil may be serious. Narcotic antagonists such as naloxone may be administered parenterally to reverse respiratory depression within minutes.

skin rash, ataxia, difficulty talking, suicidal thoughts

What are the major adverse effects of phenytoin ?

Cholinergics: Acetylcholine

What drugs are used to treat myasthenia gravis?

simple partial

What seizure disorder is this: •Olfactory, auditory, and visual hallucinations •Intense emotions •Twitching of arms, legs, and face

Phenobarbital

What seizure medication changes the action of GABA and is used for controlling seizures? The adverse effects include dependence and drowsiness.

Loop of Henle

When describing where bumetanide acts, what would the nurse include?

it is okay to take with food

Which instruction would be most appropriate for a client who is taking a diuretic?

Prostaglandin

any one of numerous tissue hormones that have local effects on various systems and organs of the body, including vasoconstriction, vasodilation, increased or decreased GI activity, and increased or decreased pancreatic enzyme release

Proton Pump Inhibitors (PPIs)

drug that blocks the H+,K+,-ATPase enzyme system on the secretory surface of the gastric parietal cells, this interfering with the final step of acid production and lowering acid levels in the stomach

gastrointestinal protectant

drug that coats any injured area in the stomach to prevent further injury from acid or pepsin. prototype: sucralfate

antacids

group of inorganic chemicals that neutralize stomach acid

Prototype Drug: Diphenoxylate with Atropine (Lomotil)

has no analgesic properties and has a very low potential for abuse. The drug is well tolerated at normal doses. Some patients experience dizziness or drowsiness, and they should not drive or operate machinery until the effects of the drug are known.

Histamine 2 Antagonists

prototype : cimetidine

Prostaglandins

prototype: misoprostol

Proton Pump Inhibitors (PPIs)

prototype: omeprazole

antacids

sodium bicarbonate

Colase (Docusate)

stool softener

10-20mcg

what is the therapeutic range for phenytoin?

tonic-clonic seizure

•Aura (preceding) •Intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase) •Crying at the beginning as air leaves lungs; loss of bowel/bladder control; shallow breathing with periods of apnea; usually lasting 1-2 minutes •Disorientation and deep sleep after seizure (postictal state)

status epilepticus

•Considered a medical emergency •Continuous seizure activity, which can lead to coma and death

generalized atonic seizure

•Falling or stumbling for no reason •Lasting a few seconds Name the seizure disorder:

myoclonic seizure

•Large jerking movements of a major muscle group, such as an arm •Falling from a sitting position or dropping what is held

absense

•Lasting a few seconds •Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking) •Misdiagnosed often (especially in children) as attention deficit/hyperactivity disorder (A D H D) or daydreaming What is the seizure disorder?

psyllium mucilloid (Metamucil)

•Mechanism of action: swells and increases size of fecal mass •Primary use: to promote passage of stool •Adverse effects: rare; less cramping than stimulant-type laxatives •With insufficient water, may cause obstructions in esophagus or intestine

febrile

•Tonic-clonic activity lasting 1-2 minutes •Rapid return to consciousness •Occurs in children usually between 3 months and 5 years of age