Pharm Final Review
A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response?
"ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."
The home care nurse provides medication instructions to an older hypertensive client who is taking Lisinopril (Prinivil), 20 mg orally daily. Which statement, if made by the client, indicates that further teaching is necessary?
"I can skip a dose once a week"
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?
"I need to stop taking potassium supplements"
A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
"I should take my daily meds with my Questran"
Which of the following client comments demonstrates that teaching has been successful regarding cyclosporine therapy?
"I should take the med on an empty stomach"
A home care nurse provides instructions to a client taking digoxin (Lanoxin) 0.25 mg daily. Which statement by the client indicates a need for further instructions?
"I'll take my antacid if I am nauseated"
A pregnant woman with a history of well controlled chronic hypertension asks the nurse why the obstetrician changed her blood pressure medication from Quinapril (Accupril) to Methyldopa (Aldomet). Her response to the woman is based on the nurse s knowledge that:
"Methyldopa is class B throughout pregnancy, while Quinapril is class C in the first trimester and class D in the second and third trimesters"
Clonidine is prescribed for a hypertensive patient. Which instruction(s) should the nurse give this patient?
"Take frequent sips of water to relieve dryness in your mouth." "Eat plenty of high-fiber foods to help reduce constipation."
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?
"This combination promotes diuresis but decreases the risk of hypokalemia."
What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]?
"Wear sunblock and protective clothing when you are outdoors." "Check your pulse daily and report excessive slowing to your healthcare provider immediately." "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."
When the client with pernicious anemia asked why vitamin B12 injections are necessary, the nurse should provide which of the following responses?
"Your stomach does not produce a substance needed for intestinal absorption of Vitamin B12."
If Phenergan is available in 100 mg/2 mL ampules, which of the following represents the amount is needed in mL to give a dose of 12.5 mg IM?
0.25
How many sublingual nitro doses do patients take before calling 911?
1
4 things nurse should do beyond 6 rights of medication
1) Understand the patient and the disorder being treated 2) Given the disorder, know what medications are appropriate 3) Know drugs that are contraindicated for that patient 4) Know the possible consequences/interaction between the drug and patient
Four major components of Implementation phase of Drug Administration process:
1) drug administration 2)patient education 3)interventions to promote therapeutic effects 4)interventions to minimize adverse effects
Which CA+ Channel blockers cause gingival hyperplasia?
1.Verapamil 2.Cardizem 3.Amlodipine 4.Nefedipine
How would the nurse monitor the patient for fluid volume deficit?
1.Vital signs (pulse and BP) 2.Assess for cap refill and skin turgor 3.Weigh the patient daily 4.Assess for orthostatic hypotension
What are safety measures for nitro patches?
1.Wear Gloves 2.Remove old patch first 3.Dispose of the patch in a safety container- black box 4.At home do not let pets or babies have access to old patches. 5.Be alert to skin irritation and rotate sites.
The nurse is checking on a patient who is getting Acetaminophen 1000 mg IV every 8 hours for surgical pain. What is the daily limit on Acetaminophen ________mg/24 hours. (for surgical pain)
3000 mg/day
1) Therapeutic response 2) adverse reaction/interaction 3) patient's adherence to prescribed drug regimen 4) patient's satisfaction with treatment
4 aspects of evaluation strep in Nursing process
A client who is starting medication therapy with furosemide (Lasix) 20 mg po daily asks the nurse what would be the best time to take the pill. What time schedule should the nurse recommend?
8 AM
Digoxin treats:
A-Fib Atrial flutter CHF
What are the side effects for Dihydropyridine Calcium Channel blockers like amilodipine and nefedapine?
A. hypotension C. headache/flushing D. reflex tachycardia
The nurse is teaching the patient about a complication of LTT cyclosporine (BK virus) select all true statements about this medication.
A.BK virus infections occur in about 75% of patients. B.This infection may cause kidney damage C.This infection may cause the body to reject a transplanted kidney.
The nurse is teaching the patient about an anti organ rejection medication Tacrolimis. Which teaching below is incorrect?
A.Give on an empty stomach -irritating to GI B. Teach client to report fever, sore throat, HA, insomnia, agitation or confusion. C. Avoid NSAIDS and other kidney toxic meds. D. Insomnia and tremors may occur E. The patient should monitor their BP and report hypertension.
The nurse is working in the pregnancy clinic. What two situations would warrant the use of nifedipine a CCB?
A.Maternal Hypertension B.Tocolysis Prevention of preterm labor
What is true of diuretics?
A.With High BP: by lowering blood volume, the stress on end organs is reduced B. In CHF: less volume returning to the heart (preload) reduces the work the pump (heart) has to do, and by lowering the volume the heart has to pump against (afterload), it also reduces the force needed to overcome it. This greatly benefits the heart (along with relieving bothersome symptoms) C. Result: reduced risk of death from CHF, improved exercise tolerance
A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?
ACE inhibitors
T/F •Angiotensin II has negative effects on the heart following myocardial infarctions: it causes pathological changes that lead to hypertrophy and remodeling, and increases the thickness of vessel walls • Aldosterone, like Angiotensin II, promotes cardiac remodeling and fibrosis, and it also causes fibrosis (stiffening) of blood vessels. •ACE inhibitors and ARB's prevent the above •Both improve overall kidney function by lower glomerular filtration pressure • ACE Inhibitors slow the progression of diabetic nephropathy.
ALL TRUE
A nurse is caring for a patient who is receiving verapamil [CCB] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:
AV blockade
Which information is important to teach a patient who is taking corticosteroids?
Abrupt withdraw from med is harmful delayed wound healing
By what process does the primary pharmacokinetic factor determine the length of time it takes a drug to produce its effect?
Absorption
A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving the therapeutic effect based on which of the following results?
Activated partial thromboplastin time of 75 seconds
Compare active/passive immunity
Active immunity: a person develops antibodies after their body is exposed to an antigen either through disease or when getting an immunization. Passive immunity: is where a person is given antibodies to prevent/treat a disease after the body is exposed to an antigen. A mother can give passive immunity to a child through breast milk after birth. Another way passive immunity can take place is medically when patients are given immune globulin products that contain antibodies.
What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy?
Adrenal insufficiency Osteoporosis
What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy?
Adrenal insufficiency Osteoporosis Risk for infectinon
Which Ca+ channel blockers cause reflex tachycardia?
Amlodipine Nefedipine
Sympatholytics
Antagonize effects of adrenaline in SNS
Which of these drugs will NOT be affected by interpatient variability?
Antiseptics applied to skin slow bacterial growth Topical analgesics used to tx local pain Antacids to help with heartburn
Before the nurse administers a dose of digoxin (Lanoxin) to a patient, the nurse should assess:
Apical pulse
The nurse is going to administer a Beta blocker to a patient. Which assessment below would be a contraindication to the medication?
Apical pulse 53
How do you prevent nitro tolerance?
Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night
A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug's side effects. What would be the nurse's priority action?
Ask provider to order plasma drug level
Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication?
Aspirin
When taking a med history the nurse should
Assess whether every med had a current indication
Which of the following is an INCORRECT statement about the nurse's responsibility during the pre-administration assessment phase of medication administration? The nurse's responsibilities include:
Assessment of blood pressure following administration of an anti-hypertensive medication.
The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug?
At least 2 hrs post meal 1+ hr or more before meal
A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child's face is flushed and she is diaphoretic. The mother thinks that the child may have gotten into bethanechol drops. A diagnosis of cholinergic poisoning is made. Which of the following drugs would be administered?
Atropine
A patient is prescribed bethanechol [Urecholine] for urinary retention. If the patient exhibits signs of an overdose, such as increased salivation and sweating, bradycardia, or hypotension, which medication should the nurse administer?
Atropine (AtroPen)
A patient adrenal insufficiency is to be discharged and is given Prednisone as a home medication. The nurse instruct the patient the following, except?
Avoid K+ rich foods -One of the side effects of taking prednisone is hypokalemia so a potassium rich food should be included in the diet.
The client asks about food and drug herbal interactions with cyclosporine. What is the best response by the nurse?
Avoid grapefruit juice Maintain same consumption pattern Avoid St. John's Wart
A client tells the nurse that he has started to take an OTC antihistamine, diphenhydramine. In teaching him about side effects regarding safety, what is most important for the nurse to tell the client?
Avoid operating machinery until stabilized on drug
The nurse is caring for a patient with a kidney transplant in home care. The patient has a T- 101, dark colored urine, complaining of fatigue, muscle pain and weakness. The nurse suspects which ADE listed below:
BK Virus
Two different inhaled drugs (Albuterol, Ipratropium) that act directly on the autonomic nervous system receptors in the lungs are often used to treat asthma and/or chronic obstructive lung disease. What do you know to be true
Because some of the drug may enter the bloodstream, tachycardia and mild tremors are common side effects of albuterol Persons using Ipratropium inhalers may experience dry mouth from contact of the drug with mucous membranes of the mouth. The mechanism of action of albuterol is similar to the effects of adrenaline/epinephrine in the lungs when the fight or flight response is triggered in response to a threat. Use of inhaled albuterol during a mild acute asthma attack is probably a safer choice than use of subcutaneous epinephrine for a person with preexisting heart disease or hypertension. During a severe asthma flare up or COPD exacerbation, Albuterol may not be enough and the client may require stronger drugs. Thus, patients should be taught that if his symptoms are not better after two uses of his Albuterol inhaler, he should contact his Hc provider immediately, and/or come to the ER. Ipratropium bromide is used to stabilize the condition of persons with COPD and to maintain maximum lung function.
Which class of adrenergic receptors are blocked by cardioselective beta blocker drugs?
Beta 1
What is the mechanism of action of ACE inhibitor drugs such as captopril?
Block conversion of Angiotensin I to Angiotensin II to prevent vasoconstriction
Beta Blocker
Blocks B1 & B2 receptors
Which of the following is the most important assessment after administering a newly prescribed ACE inhibitor/ARB?
Blood Pressure
What blood test will be monitored carefully for a patient on a thiazide diuretic and a beta blocker?
Blood sugar
Adverse drug effects of azathioprine
Bone marrow suppression leading to neutropenia & thrombocytopenia
A client is prescribed metoprolol (Lopressor), a beta 1 blocker. Which one of the following symptoms would the nurse expect to encounter if the patient receives TOO HIGH of a dose of this drug?
Bradycardia
A client with a history of mild congestive heart failure (CHF) is receiving diltiazem (Cardizem) for hypertension. The nurse should give priority to which of the following assessments?
Bradycardia/ Pulmonary Edema
Following a bee sting a client who develops shortness of breath and hives on his face and neck receives an epinephrine injection. Which assessment data would indicate that the epinephrine is effective?
Breathing easier
Why do verapamil and diltiazem have less reflex tachycardia than nefedapine?
By having both cardiac depressant and vasodilator actions, these CCB'sare able to reduce arterial pressure without producing the same degree of reflex cardiac stimulation caused by dihydropyridines.
What lab test is monitored in a client receiving azathioprine?
CBC
Which drug class is used to treat both hypertension and dysrhythmias?
Ca+ channel blockers
A patient on long term corticosteroid therapy is on a three week vacation. They had their purse stolen with there medication on day 3. What should the patient do?
Call clinic immediately for refill
A patient has been given an alpha-blocker as treatment for BPH. Which instruction is important to include when the nurse is teaching him about the effects of this medication?
Change to sitting or standing positions slowly to avoid a sudden drop in blood pressure
Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment?
Check apical pulse and BP
Drug is unlikely to lose effectiveness when stored for periods of time.
Chemical Stability
Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching?
Cholestyramine can impair absorption of fat-soluble vitamins.
The client is asking about returning to work as a kindergarten teaching. What is the best response by the nurse?
Client is at risk of infection and needs to avoid others who could carry infection; can she switch to teaching older children? Should NOT receive live-vaccine viruses. .
The nurse is caring for a patient with an organ transplant. The patient is taking cyclosporine as an antirejection medication. Which medication is not contraindicated with this immunosuppressant- Think about ADE.
Codeine
Which response does the nurse expect to see when a patient receives a cholinergic agonist?
Contraction of the detrusor muscle, leading to emptying of the bladder
Which of the following are ACE Inhibitors Adverse Effects
Cough First dose hypotension Hyperkalemia Fetal harm Angioedema
Describe the similarities or differences between the COX-1 and COX-2 pathways and state which (pathologic) physiologic process is mainly responsible for analgesia, antiinflammatory activity, antipyresis, bleeding tendencies, and gastric mucosal damage.
Cyclooxygenase inhibitors are anti-inflammatory, analgesics and antipyretics. However, they have adverse effects such as gastric ulceration, bleeding and renal impairment. COX inhibitors work to inhibit the COX enzyme to prevent it from converting arachidonic acid to prostanoids. COX-1: produces thromboxane & prostaglandins, simulates gastric mucosa, platelet aggregation, and increases kidney perfusion. When COX-1 is inhibited it ades gastric ulceration, bleeding and renal impairment. The benefit of this is protection against MI and stroke. COX-2: produces prostaglandins. When inhibited, it's beneficial because it suppresses inflammation, alleviates pain, reduces fever and protects against colorectal cancer.
Select the expected outcomes associated with the administration of digoxin.
Decreased HR Slowed cardiac conduction speed Strengthen cardiac contractions
Patients taking Statin drugs are at risk for the following:
Diabetes/hyperglycemia Muscle pain/weakness Elevated liver enzymes
Which calcium channel blocker can be used to treat dysrhythmias?
Dilitiazem
Patient education for an individual taking a long term corticosteroid would include?
Do not abruptly stop therapy. Wear a medical alert bracelet. Carry extra dose of glucocorticoid for emergencies (during stress times). Hand hygiene; stay away from those with infection; report fever or sore throat. Report worsening weight gain, edema) Report change in stool (black or tarry).
The nurse comes in to administer the medication. The client states the other nurse did not give me the medication like that. Describe the administration of oral cyclosporine.
Drawn up with a calibrated syringe, mixed in a glass container with milk or juice at room temperature; do not refrigerate.
A client, who is in renal failure, may have a diminished capacity to excrete medications. It is imperative that this client be assessed for what development?
Drug toxicity
What are common complaints of patients taking drugs with anticholinergic effects?
Dry mouth constipation blurry vision difficulty urinating
The nurse knows that drugs that block parasympathetic nerves slow or block the rest and digest function of this system. As a result, the nurse is not surprised that in additon to having less cramping and diarrhea, the client complains of [________] and [___________] when receiving dicyclomine (Bentyl), an antihistamine with anti-cholinergic effects tthat isused to treat Irritable Bowel Syndrome.
Dry mouth, urinary retention
A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time?
During first trimester
Characteristic of a drug that makes it simple to administer, with a schedule that makes adherence with therapy more likely.
Ease of administration
A nurse is administering intravenous dopamine [Intropin] to a patient in the intensive care unit. Which assessment finding would cause the most concern?
Edema at IV site
Drug that elicits the responses for which it is given. Current law requires that this be proven prior to release for marketing.
Effectiveness
The nurse is assessing patients for contraindications to the flu vaccine. An allergy to which substance is a contraindication to the administration of an immunizing drug?
Egg
Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be reabsorbed. This process is known as:
Enterohepatic cycling
Only transmitter that acts on B2 receptors
Epi
The nurse assesses a patient who experienced anaphylaxis from an insect sting. The adrenergic agonist drug of choice to treat this condition is ____________________.
Epi
T/F Clinical pharmacology is defined as the study of drugs and their interactions within living systems.
FALSE
T/F Varicella vaccine has many serious side effects and should be given only to select populations. Monitoring of these patients for 6 hours after vaccination is mandated.
FALSE
T/F Statins lower HDL
FALSE Lower LDL & increase HDL
T/F In pregnant women or women likely to become pregnant and exhibit hyperlipidemia reductase inhibitors (statins) are the agents of choice.
FALSE Category X
What is the most common complaint voiced by clients as they adjust to beta blocker drugs?
Fatigue
The public health department in a local community is planning a campaign to increase compliance with childhood vaccinations to improve herd immunity in the community. Select the THREE subgroups who are MOST likely to benefit from this campaign:
Fetuses of Rubella non-immune pregnant women Cancer patients undergoing chemo Infants who are too young themselves to receive vaccine
What is the main difference between a first generation FGA and a second generation SGA Antihistamines?
First-generation antihistamines cause sedation whereas second generation antihistamines are NON-sedating.
Some drugs may be completely metabolized by the liver circulation before ever reaching the general circulation. This effect is known as:
First-pass effect
Taking the drug in combination with a second drug is unlikely to augment or reduce the effectiveness of either drug.
Freedom from drug Interactions
Which diuretic agent would the nurse expect to produce the greatest volume of diuresis?
Furosemide
Select the drug combinations that are potentially harmful and should trigger a call to the prescriber to clarify the order.
Furosemide & Prednisone Triamterene and Lisinopril Ibuprofen & Hydralazine Digoxin & Verapamil
A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step?
Give a second dose of nitroglycerin in 5 minutes. Call a rapid response
The nurse is discussing drug therapy with cyclosporine (Sandimmune). Which food product inhibits metabolism enzymes and possibly increases the activity of cyclosporine?
Grapefruit juice
Which class doesn't cross the BBB? H1 antihistamine or H2 antihistamine
H2
Vaccinating against which disease prevents occurrence of cervical cancer in women?
HPV
Beta blockers are used to treat which disorders?
HTN Angina Dysrhythmias Migraines
A patient will be taking cyclosporine (Sandimmune) after transplant surgery. Which of these are potential adverse effects of cyclosporine therapy?
HTN Nephrotoxicity Post-transplant diabetes
Adrenergic
Has effects similar to those caused by adrenaline
A nurse gives a client with myasthenia gravis a medication that inhibits the actions of acetylcholinesterase. Because that the nurse knows that inhibiting acetylcholinesterase will slow the breakdown of acetylcholine in the neuronal junctions, the nurse anticipates that the client will:
Have less difficulty chewing/swallowing
A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:
Help relax peripheral arterioles to reduce afterload.
A client is taking epoetin alfa (Epogen) for treatment of anemia related to chronic renal disease, The nurse uses which clinical finding as the best measure of the drug's therapeutic effectiveness?
Hemoglobin & HCT levels rising
Examples of killed virus
Hep A Flu Shot
What vaccines is recommended at birth?
Hep B
What vaccines is recommended for newborns?
Hep B
A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially?
Hold digoxin & diuretic, administer K+ supplement. Notify provider
What kind of side effects will a client who receives atropine, a drug that BLOCKS or ANTAGONIZES acetylcholine receptors in the mouth, skin, salivary glands, gut, heart, bladder and more complain about or experience?
Hot, dry skin Dry mouth Constipation Decreased GI secretions Pupils dilated Urinary retention
Which vasodilator can be used to treat hypertension in pregnant women?
Hydralazine
______________ acts to lower blood pressure by a direct vasodilation activity in arteries.
Hydralazine
The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?
Hyperkalemia
A diabetic patient with phase 2 kidney disease is taking a thiazide diuretic with an ACEI. What ADE below can the patient expect.
Hyperuricemia
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?
Hypokalemia
When caring for a patient taking hydrochlorthiazide, the nurse should monitor the client for:
Hypokalemia
When discussing the major side effects of thiazide diuretics with a patient who has just begun therapy, the nurse should include which possibilities?
Hypokalemia Dehydration Hyperuricemia
Which of the following adverse effects is of greatest concern for the older adult patient taking antihypertensive drugs?
Hypotension
Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)?
I can take this drug to stop acute angina attacks
A home health care nurse is visiting an elderly client at home. Furosemide (Lasix) is prescribed for the client. The nurse teaches the client about medication. Which of the following statements, if made by the client, indicates the need for further teaching?
I need to drink lots of coffee or tea to keep up my energy level
A 5 -year old immunocompromised child comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine [Varivax]; the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child?
IVP & Dtap
A baby is born to a Hepatitis B positive mother. In order to prevent the baby from contracting Hepatitis B the nurse will administer a substance made from others (to the newborn), think the m&ms. Administration of which substance provides passive immunity?
Immunoglobulins
Name two medications that cause gingival hypertrophy:
Immunosuppressant (cyclosporine A) Various Ca+ channel blockers (nifedipine, verapamil, diltiazem)
Why are patients on immunosuppressants are at risk for infection
Immunosuppressant drugs suppress a patient's immune system. A weakened immune system due to taking immunosuppressant drugs puts the patient at higher risk of contracting an infection because their body is not able to fight off infections as well.
What class of meds causes an increase risk for developing cancer?
Immunosuppressants
What does the nurse identify as possible complications of glucocorticoid therapy?
Impaired carbohydrate and glucose tolerance Predisposition to gastrointestinal ulceration
If more acetylcholine is available to triffer the muscles, what will you expect to see in this patient?
Improved ability to walk, dress, bathe and care for self Improved swallowing Increased GI motility/improved bowel function
For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?
Increase serum potassium level
A client is given epinephrine (Adrenaline), an adrenergic agonist (sympathomimetic). The nurse should monitor the client for which condition?
Increased BP
A nurse administers a drug that activates beta1 receptors. Which effect(s) would the nurse expect?
Increased HR Increased force of cardiac contraction
Which electrolyte imbalance is concerning regarding a patient taking an ACE inhibitor?
Increased K+
The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe?
Increased PT/INR levels
Which effect is expected when using a cholinergic agonist?
Increased bladder tone
Prednisone is prescribed for a client with diabetes mellitus type 1 who is using Humulin 70/30 daily. Which of the following prescription changes does the nurse expect during the therapy with the prednisone?
Increased dosage of humalin 70/30
When monitoring patients on immunosuppressants therapy, the nurse must keep in mind that the major risk factor for patients taking these drugs is which condition?
Increased susceptibility to opportunistic infections
What effect would H1 antihistamines potentially have on someone taking a CNS depressant. It _______ (Increases or decreases) CNS depression.
Increases
You are explaining how filgrastim (Neupogen) works to a child who is on chemotherapy and his parents. You understand that which characteristic explains how this medication works?
Increases number of neutrophils produced by bone marrow
The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included?
Increases or supplements dosage of glucocorticoid during times of stress
The nurse is caring for a patient taking an immunosuppressant medication. For nursing diagnosis the patient's highest risk is for _________________.
Infection
The nurse is administering vaccines in the clinic. A pregnant patient is asking about vaccines. Which vaccines are contraindicated in pregnancy.
Inhaled flu MMR
Describe the link between serum insulin and potassium levels, explaining why hyperinsulinism leads to hypokalemia.
It will reduce K+ levels in the serum.
The physician has ordered an IV bolus dose of Solu-Medrol (methylprednisolone sodium succinate), a glucocorticoid, for a client admitted with a spinal cord injury. How will this drug benefit this patient?
It will reduce swelling at the site of injury, which will protect his nerves from further damage.
Which medication should not be prescribed routinely with an ARB or ACEI?
K+ Supplements
Which drug is a centrally acting antihypertensive that blocks both alpha and beta receptors?
Labetalol
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?
Lasix
When monitoring a patient for the most common side effect of oral antihistamines, the nurse would assess the patient's
Level of alertness
Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus?
Lipid-soluble drugs
A teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?
Liver
A patient is taking an HMG-CoA reductase inhibitor. Which of the following tests should be performed at the start of therapy and periodically thereafter?
Liver function test
Expense does not create an undue or considerable burden for the patient.
Low Cost
A nurse is reviewing an older adult patient's chart before giving medications. Which patient information is of most concern?
Low serum albumin
A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he NOT receive?
MMR
Which 3 vaccines are contraindicated in pregnancy?
MMR, Varicella and inhaled flu
A newly married couple is asking the nurse what vaccines to receive before attempting to have a child. Which vaccines are recommended to have before attempting conception? The couple will wait 3 months after the vaccines.
MMR, Varicella, Flu vaccine
The nurse is working in a public health office administering a vaccine clinic. What does she tell patients is TRUE about the MMR vaccine?
Measles, mumps, and rubella virus vaccine (MMR) is a combination product composed of three live virus vaccines. Rare cases cause thrombocytopenia & anaphylactic reactions MMR is contraindicated during pregnancy and should be used with caution in children with a history of either thrombocytopenia or anaphylactic reactions to gelatin, eggs, or neomycin.
What is the most important information for the nurse to teach a client who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)?
Med has fewer sedative effects
The nurse is teaching the patient about corticosteroids. Why should corticosteroids be taken in the morning?
Mimic action of adrenal gland
Physiological responses when adrenaline triggers fight/flight response
Mobilization of glucose reserves by converitng glycogen stored in the liver into glucose to supply energy to muscles. Elevation of the blood pressure in response to contraction of the smooth muscles lining the arteries Increased HR to pump blood to brain and muscles Slowing/stopping of uterine contractions in labor relaxation of muscles lining bronchi to allow increased air flow
The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug?
Monitor ECG
Cyclosporine has a narrow therapeutic effect and increased risk of toxicity. Describe the measures to prevent and monitor for toxicity.
Monitor blood drug levels Monitor CBC Tell client to report fever/other s/s of infection Monitor liver function, BUN & creatinine
The health care provider prescribes sustained-release verapamil [Calan SR] to an 82-year-old patient who takes digoxin [Lanoxin] daily. Which action is most appropriate for the nurse to take?
Monitor the patient's cardiac rhythm continuously. Dig and verapamil decrease conduction through AV node. Increased risk of AV block. Monitor for bradycardia and hypotension.
A nurse provide instructions to a client regarding the administration of the prednisone and instructs the client that the best time to take the medication is during?
Morning
What is MONA?
Morphine Oxygen Nitroglycerin Aspirin
A major difference between acetaminophen and NSAIDs is that:
NSAIDs reduce inflammation
Psedoephedrine (Sudafed) is a beta agonist drug that is used to relieve symptoms of nasal congestion in persons with allergic rhinitis or a common cold. Based on your understanding of beta agonist drugs, please explain why the box has warning against use of this drug in perosns with heart disease, hyperetension, glaucoma, and urinary retention.
Nasal decongestants cause vasoconstriction which leads to a decrease in blood flow. This causes the blood vessels to narrow to reduce swelling in the nose. This can also affect narrowing of other blood vessels which is why it is a problem for those with heart disease, hypertension, glaucoma and urinary retention. The narrowing of these vessels could cause an increase in pressure (glaucoma) or BP (hypertension).
A patient with a liver transplant has been receiving cyclosporine for 6 months. The nurse reviews this patient's laboratory results and notes a s blood urea nitrogen (BUN) of 25 and serum creatinine 1.8. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect?
Nephrotoxicity
The nurse is caring for a patient on Tacrolimus (prograf) immunosuppressant to prevent organ rejection. Which side effect below should the nurse be concerned with?
Neurotoxicity Nephrotoxicity
The physician orders filgrastim (Neupogen) 5 mcg subcutaneously every day for 2 weeks. Which recent lab value is this additional drug based upon?
Neutrophil count 500/mm^3
The nurse admits a patient and is checking orders there is an order for a thiazide diuretic for a patient with a sulfa allergy. What should the nurse do?
Notify provider & hold med
Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication?
Obtain baseline serum thyroid & liver fx studies
A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to:
Order dose proportionately LOWER than adult dose
Corticosteroid therapy is indicated in all of the following conditions except:
Osteoarthritis
Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer?
Papillomavirus (Gardasil)
In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
Paradoxical CNS stimulation.
The nurse is caring for a patient on corrticosteroid therapy, Select from below all teaching that is important for this patient:
Patients with adrenal insufficiency must be given supplemental doses of glucocorticoids at times of stress (e.g., surgery, trauma). Failure to do so may prove fatal. The patient should report illness or stress to the provider. To minimize expression of adrenal insufficiency when glucocorticoids are discontinued, doses should be tapered very gradually. Alternate-day dosing can help minimize the development of adrenal insufficiency. Glucocorticoids should be administered before 9:00 am, because this helps minimize adrenal insufficiency and mimics (sort of) the burst of glucocorticoids released naturally by the adrenals each morning. Concurrent use of NSAIDs & glucocorticoids increases risk of peptic ulcer disease
Why it's important for the nurse to know the expected nature/time course of intended response to drug.
Patients with severe pain need best treatment with the quickest loading dose. Nurse should give med within 30 min to reduce pt pain by 50%. Also monitor adverse side effects
The nurse discovers that the IV infusion of a patient who has been receiving an IV vasopresser has infiltrated. The nurse will expect which drug to be used to reverse the effects of the vasopressor in the infiltrated area?
Phentolamine
Which of these drugs are selective blockers of alpha1 adrenergic receptors?
Phentolamine Prazosin
A term that describes a drug's duration of action in the body is:
Plasma half-life
Which lab value should you play close attention to when a patient is on an ACE inhibitor/ARB?
Potassium; ACE inhibitors/ARBs can cause hyperkalemia
ACE inhibitors are standard therapy for most MI patients with heart failure because they:
Potentiate water loss
Ability to have a reasonable degree of certainty in advance of how most persons who receive a drug will respond to it.
Predictability
What does the nurse identify as possible complications of glucocorticoid therapy?
Predisposition to GI ulcer Impaired carb and glucose tolerance
Abrupt withdrawal of ___________ during drug therapy can lead to cardiovascular collapse
Prednisone
Identify the two most common clinical uses for immunosuppressive drugs?
Prevent rejection of transplanted organ Treatment of autoimmune disorders (RA, systemic lupus - Long term use for life)
Dosing of oral steroids for an acute asthma flare starts out with a higher dose, then is tapered down and discontinued over 5-7 days . This regimen is used to:
Prevent steroid withdrawal syndrome
The nurse is caring for a patient who developed angioedema on captopril (ACE Inhibitor) therapy. Which is the best scenario for this patient?
Pt treated with captopril
Mr. James is a 56-year-old client with chronic renal failure. The nurse should recognize that this client will be at particular risk for which condition?
Rapid development of drug toxicity
A 1-year-old child receives the MMR vaccine. The next day the child's parent calls the nurse to report that the child has a temperature of 102°F. What will the nurse do?
Reassure the parent that fever can occur with the MMR vaccine. The MMR vaccine can have several adverse effects, including fever up to 103°F;
Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class?
Reduce LDLs Elevate HDLs Stabilize plaque in coronary arteries Reduce risk of cardiovascular event
A nurse is conducting a teaching session for a group of clients taking warfarin (Coumadin). The nurse instructs the client that they will need to make which of these dietary adjustments?
Reduce intake of foods such as broccoli & cabbage
The nurse is teaching a nursing student about the medication Acetaminophen (Tylenol). What does the nurse know about Tylenol that is TRUE?
Reduces pain/fever but NOT inflammation Acetaminophen inhibits prostaglandin synthesis in the central nervous system (CNS) but not in the periphery. As a result, acetaminophen differs from the NSAIDs in four ways: it lacks antiinflammatory actions; it does not cause gastric ulceration; it does not suppress platelet aggregation; and it does not impair renal function. Hepatic necrosis from acetaminophen overdose results from the accumulation of a toxic metabolite. Acetaminophen poisoning is treated with PO or intravenous (IV) acetylcysteine, a drug that substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen.
A patient with a BP of 188/110 is receiving a nitroprusside drip to lower his blood pressure. One hour after the infusion is begun, his BP is 135/78, and his heart rate is 124 bpm. The nurse understands that his heart rate has gone up as the body s baroreceptors sense the rapid drop in blood pressure and trigger:
Reflex tachycardia
Which are adverse effects of alpha blockade?
Reflex tachycardia Nasal congestion
A client is to begin immunosuppressant medication. Which of the following conditions would create a contraindication to use of this drug?
Renal disease Hepatic disease Pregnancy
The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication?
Respiratory
Effects of drug can wear off or be reversed.
Reversible Action
A major clinical application of glucocorticoids stem from their ability to suppress immune responses and inflammation which of the non-endocrine disorders listed below can be treated with glucocorticoids?
Rheumatoid arthritis can be given by injection into joint Systemic lupus erythematosus Inflammatory bowel disease-
The nurse should teach the patient on ACE inhibitors/ARBs to:
Rise slowly from a sitting to standing position
A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril), an ACE inhibitor. The nurse tells the client:
Rise slowly from sitting position
Which vaccine preventable disease can cause profuse diarrhea in infants and young children, leading to dehydration and requiring hospital admissions?
Rotavirus
Drug cannot product harmful effects, even if given at high doses for a long time.
Safety
A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following?
See if any drugs can be discontinued Ask pt about OTC meds used Obtain diet hx
A nurse is preparing to give an oral dose of a beta blocker to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking?
Selectivity
Characteristic of a drug that means that it elicits ONLY the response for which it is given.
Selectivity
A hypertensive crisis may occur if the client takes an over-the-counter cold medication containing pseudoephedrine while also taking:
Selegiline, a MAOI
what OPPOSITE effects do you expect to see if we use beta BLOCKER drugs to act as an ANTAGONIST that blocks the action of epinephrine at beta receptor sites?
Slow HR Reduced BP Constriction of smooth muscles of bronchi Increased storage of glucose in liver
ID high-risk patients by reviewing PMH Educate pt about proper drug administration Warn pt of activities that trigger adverse side effects
Steps that nurses can take to minimize adverse drug effects
A client is receiving thrombolytic therapy with a continuous infusion of streptokinase (Streptase). The client suddenly becomes extremely anxious and complains of itching. A nurse hears stridor and on examination of the client notes generalized urticaria and hypotension. Which of the following should be the priority action of the nurse?
Stop infusion, call rapid response
A patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol. He complains that he is having pain in both of his legs. You instruct him to:
Stop taking drug & come to clinic
The patient asks how the medication works to stop the immune system from attacking the new kidney. What is the best response by the nurse
Stops production of interleukin 2
A patient needs emergency endotracheal intubation. Which drug would the nurse expect to administer?
Succinylcholine
A client who recently started taking a daily dose of the drug methyldopa (Aldomet) for hypertension complains of drowsiness and lethargy when the nurse makes a home visit. The nursing intervention would be to:
Suggest that the client take the medication in the evening and reevaluate on the next visit.
One advantage to the use of cyclosporine over other immunosuppressants for the prevention of allograft rejection is that it does NOT:
Suppress bone marrow
T/F Cardiac Output x Peripheral Resistance = Arterial Pressure
TRUE
T/F Gingival hyperplasia is an ADE of cyclosporine
TRUE
T/F HR x Stroke Volume = Cardiac output
TRUE
T/F HepB is one of the safest vaccines. The only contraindication is a previous anaphylactic reaction either to HepB itself or to baker's yeast.
TRUE
T/F Ibuprofen can antagonize the antiplatelet actions of aspirin, thereby reducing the protection against MI and stroke. To minimize this interaction, patients should take aspirin about 2 hours before other NSAIDs.
TRUE
T/F Immunosuppressants put patients at risk for infections
TRUE
T/F Pharmacotherapeutics includes the use of drugs to prevent pregnancy.
TRUE
T/F The more drug bound to protein, the less free drug is available for the desired effect.
TRUE
T/F Varicella vaccine is contraindicated for pregnant women, individuals hypersensitive to neomycin or gelatin, and immunocompromised individuals.
TRUE
The nurse is discussing with the treatment team care of a patient with a new transplant. The nurse asks why Tacrolitmus which is more effective is not the first drug considered. What is the reason that this more effective medication is not given more frequently?
Tacrolitmus is more effective but is more toxic
A woman who is breast-feeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do?
Take med immediately AFTER breast-feeding
The nurse is teaching a client about diphenhydramine (Benadryl). Which are topics to include?
Take med with food to decrease GI upset Avoid alcohol & other CNS depressants Take sugarless candy, gum or ice chips to relive dry mouth Avoid operating machinery/dangerous activities until stabilized on drug
The nurse on the rehab unit is preparing to administer the non-steroidal anti-inflammatory drug ketorolac (Toradol) (IV) to an 83-year-old woman who is 10 days postop after repair of a fractured hip. Of the following symptoms, which would call for withholding the drug and contacting the prescriber?
Tarry black stool
The nurse on the rehab unit is preparing to administer the non-steroidal anti-inflammatory drug ketorolac (Toradol) (IV) to an 83-year-old woman who is 4 days postop after repair of a fractured hip. Of the following symptoms, which would call for withholding the drug and contacting the prescriber?
Tarry black stool
What vaccines are recommended for pregnant women?
Tdap Flu injection
Vaccines safe for pregnant women
Tdap Flu shot
A 60-year-old man is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for this client knows it is essential to include which of the following nursing interventions at this time?
Teach how to care for wound since there is high risk of postoperative infection to develop
A 60-year-old man is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for this client knows it is essential to include which of the following nursing interventions at this time?
Teach the patient how to care for his wound since he is at high risk for developing postoperative infection.
The nurse providing teaching for patients taking immunosuppressnts will include which information?
The mouth and tongue should be inspected carefully for white patches. Pt should avoid crowds to minimize infection risk Pt should report fever, sore throat, chills or joint pain
The "therapeutic range" of a drug is considered to be which of the following?
The plasma drug concentration between the minimum effective concentration and the toxic concentration
The client in hypovolemic shock is prescribed an infusion of lactated Ringer's. What is the purpose for infusing this solution in shock?
The solution will help to replace fluid and promote urine output. The solution will help to maintain vascular volume
Why are first generation antihistamines more sedating
They cross the blood-brain barrier
A patient who is taking corticosteroids says, "My face is getting rounder. Will this go away?" What is the best response?
This is a common side effect and will begin to go away when the therapy stops.
A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect
Tinnitus Hypotension Hypokalemia
Explain why topical form of Epi is applied to control bleeding during nasal surgery.
Topical epinephrine delays the absorption of the anesthetic allowing for mucosal vasoconstriction during nasal surgery.
Alpha agonist
Triggers alpha receptors in sympathetic nervous system
Sympathomimetic
Triggers sympathetic nervous system by mimicking actions of adrenaline in body
After taking high doses of glucocorticoids for several weeks, the client asks the nurse about stopping the drug What is the nurse's best response?
Unsafe to withdraw steroids suddenly
Polypharmacy
Use of multiple meds at once
Which statement accurately describes the current position of U.S. health organizations regarding a link between vaccines and autism?
Vaccines worth risk because research linked to autism was flawed
Examples of Live attenuated/weak virus
Varicella MMR
What is MOA for the Dihydropyridine class of Ca+ Channel Blockers?
Vasodilation
Adrenergic blockade at the alpha-adrenergic receptors leads to which of the following effects?
Vasodilation Decreased BP Pupil constriction
A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition?
Ventricular dysrhythmia
Which Ca+ channel blocker works on the heart directly?
Verapamil
Drug most effective to prevent thrombosis
Warfarin
Explain why a patient on corticosteroids must not suddenly stop their medication and must be weaned off the drug slowly.
When a patient takes a steroid drug it stimulates the adrenal glands to release cortisol. It's important to taper off of steroid drugs to give the kidneys time to adjust back to normal. If a patient stops taking steroids abruptly they can experience withdrawal symptoms (i.e. fatigue, body aches, lightheadedness). In addition, it can cause the adrenal gland to stop working (also known as adrenal insufficiency).
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time?
With evening meal
The nurse notices that the patient seems to be increasingly hard of hearing and is complaining of ringing in the ears. Could this be related to an increase in the lasix dose?
YES
Because a client is taking a high dose of fludrocortisone (Florinef) for treatment of Addison's disease, the nurse should include which of the following in the client's education program?
You will experience a reduced ability to resist infections.
A client is admitted for massive exposure to hepatitis B and hepatitis B immune globulin is prescribed. The patient asks, " How long it will take until I'm protected against hepatitis?" Which one of the following statements would be the best response by the nurse?
You will receive immediate protection with the antibodies given immunity is passive acquired immunity from immunoglobulins and starts immediate but only lasts several weeks and given after an exposure.
A 56-year-old man started anti-hypertensive drug therapy three months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which of the following would be the most appropriate response by the nurse?
Your physician can work with you on lowering the dose or changing to another drug.
The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter?
acetylcholine
A client with clotting disorder has an order to continue Lovenox (enoxaparin) injections after discharge. The nurse should teach the client that Lovenox injections should:
be injected into abdomen
Mrs. Jones has a malignant brain tumor. What property of pharmacokinetics may cause difficulty in treating her tumor?
blood-brain barrier
A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?
canned pears
The nurse is preparing to administer the measles-mumps-rubella vaccine (MMR) to several children in the clinic. Which child CAN safely receive the MMR vaccine?
child with mild URI
Blocking of receptors in the parasympathetic nervous system results in:
constipation urinary retention increased HR
As the last link in the patient's chain of defense against inappropriate drug therapy, the nurse should question use of a drug if the patient has a condition or is using a drug that ___________ the prescribed drug, or if the patient had a serious ____________ to the drug in the past.
contraindicates adverse reaction
A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by:
desensitization of receptor sites d/t continual exposure to drug
Adverse effects of bethanechol
diarrhea abdominal cramps drop in BP reflex tachycardia sweating
Which category of calcium channel blockers may cause reflex tachycardia?
dihydropyridines (i.e. amlodipine)
Effect of concurrent use of nonsteroidal anti-inflammatory agents on the antihypertensive properties of beta-blockers:
diminished antihypertensive effect
Advantage of using cyclosporine for prevention of allograft rejection
does NOT suppress bone marrow
A nurse is caring for a client with a diagnosis of osteoarthritis who is receiving naproxen 500 mg po twice daily. Which finding would indicate to the nurse that the client is experiencing a potentially serious adverse effect of this drug?
epigastric pain
A client has been taking an anti-hypertensive for approximately two months. A home care nurse monitoring the effects of therapy determines that drug tolerance has developed if which of thefollowing are noted in the client?
gradual rise in BP
The nurse obtains information during the admission interview that the client is taking herbal supplements. What implications does this information have for the client's treatment?
herbal products could interact with prescribed meds and affect drug action
A patient is taking drug X and receives a new prescription for drug Y, which is listed as a drug that is capable of inducing cytochrome P450. Which will lower drug X. The nurse caring for this patient understands that this patient may require ______ doses of drug ____.
higher; X
A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:
increase the time the heart is in diastole
A client receiving warfarin (Coumadin) therapy reports use of the herb feverfew. The nurse observes the client for evidence of:
increased bleeding potential
Increased urinary output in a congestive heart failure patient who has been started on digoxin is most likely due to:
increased renal perfusion
A major difference between aspirin and other cyclooxygenase inhibitors is that it:
irreversibly inhibits cyclooxygenase Aspirin is non-selective and irreversibly inhibits both forms (but is weakly more selective for COX-1). ... As platelets have no DNA, they are unable to synthesize newCOX once aspirin has irreversibly inhibited the enzyme, an important difference between aspirin and the reversible inhibitors.
In situations in which it is critical to raise drug plasma levels quickly, the nurse should be prepared to administer:
loading dose
What adverse effects are associated with long-term use of prednisone and other corticosteroids?
mood changes osteoporosis increased infection risk delayed wound healing Hyperglycemia Fluid retention
Which statement is CORRECT? Glucose intolerance following long-term treatment of hypertension with a beta-blocker is:
more likely to develop
A patient is experiencing rejection of a transplanted organ. The nurse expects which drug to be given to manage this?
muromonab-CD3 (Orthoclone OKT3)
A patient has a new prescription for a beta blocker as part of treatment for hypertension. The nurse is reviewing the patient's current medications and notes is concerned regarding reactions to which medication?
oral hypoglycemic for type 2 diabetes mellitus
When tacrolimus is compared with cyclosporine, tacrolimus may be preferred because:
patients on tacrolimus experience fewer episodes of acute transplant rejection.
Which of the following is a side effect of ACE inhibitors that is the main reason for discontinuing the medication?
persistent dry cough
The nurse is teaching a patient on long term corticosteroid therapy about the rationale of not stopping the medication suddenly because of the following:
prevent steroid withdrawal symptoms
A patient is to receive nitroglycerin ointment, 1 inch STAT, for elevated blood pressure. What must the nurse do before giving this drug?
put on gloves
A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to:
reduce intracranial pressure
Mrs. Smith, a 66-year-old client with cirrhosis of the liver, exhibits decreased metabolic activity. This will require what possible change in her drug regime to:
reduction in dose of drugs
A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he NOT receive?
seasonal flu vaccine
A nurse is teaching a client taking cyclosporine (Sandimmune) after renal transplant about his medication. The nurse tells the client to be especially alert for:
signs of infection
Stimulation of the sympathetic nervous system results in
tachycardia
A sublingual drug is administered by placing the drug in what part of the body?
under tongue
When teaching about diuretics, the nurse should instruct the client to:
weigh self daily at same time, call provider if loses more than 2 lb per day
A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include atenolol (Tenormin), digoxin (Lanoxin), and Chlorothiazide (Diuril). A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?
yellow halos around objects, loss of appetite, bradycardia
How to minimize atropine side effects?
•Dry mouth: use gums, sugarless hard candies for dry mouth •Post pupil dilation for eye exams: Use dark glasses, use about walking, driving, etc. caution if vision is impaired •Void BEFORE taking meds preop to decrease urinary retention •Increase fiber & fluids to decrease constipation risk •Avoid vigorous exercise, high temps, saunas because of hyperthermia risk due to impaired ability to sweat
