Pharm Questions

19 year old male with mild concussion after slipping in school parking lot 3 hours prior. No LOC. No appreciable neurological deficits. CT scan normal. Client was preparing for D/C. Now reports a 5/10 headache. Acetaminophen PO ordered. When offered acetaminophen, the client's mother tells the nurse that she would like her son to have something stronger. What is the nurse's best response?

- "Opioids are avoided following a head injury because they may hide a deteriorating condition." Opioids may mask changes in the level of consciousness (LOC) that indicate increased ICP, and shouldn't be given as a first-line drug. Stating that acetaminophen is strong enough ignores the mother's question and isn't appropriate. Aspirin is contraindicated in conditions that include bleeding, and for children or young adults with viral illnesses due to the danger of Reye's syndrome. Stronger medications may not necessarily lead to vomiting, but will sedate the client, thereby masking changes in his LOC.

Naltrexone

- (The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse's best response?) Naltrexone is an opioid antagonist and helps the client stay drug free. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug doesn't decrease the client's memory of the withdrawal experience, and isn't used in place of detoxification with methadone.

Monoamine oxidase inhibitors (MAOIs) have been prescribed for a client with bulimia nervosa. Why is it important to avoid foods with tyramine?

- The ingestion of foods containing tyramines can result in a hypertensive crisis. Water and other fluids may be taken with meals, but can limit the amount of food that can be eaten. Bleeding and bruising is not related to taking MAOIs. Symptoms such as tremors, anxiety, or agitation are also unrelated to taking MAOIs.

The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication?

- To decrease myocardial oxygen demand. Morphine will calm and relax the client and decrease respiratory rate, anxiety, and stress, thus decreasing myocardial oxygen demand. It doesn't have any effect on cardiac output or preload or afterload.

True/False: Lasix and Furosemide are the same drug?

- True.

What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client?

- Nausea and vomiting. Erythromycin is an antibiotic. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and anorexia. It should be given with a full glass of water and after meals, or with food, to lessen gastrointestinal symptoms.

56-year-old client presents with sudden onset of stroke-like symptoms that started 45 minutes prior to admission. Presenting National Institute of Health Stroke Scale (NIHSS) Score = 20. Head CT negative for blood. Past medical history includes hypertension treated with an ACE inhibitor. Alteplase 68 mg IV, given over one hour. At the end of the alteplase infusion, the nurse notes that the client's tongue was swollen. What is the nurse's priority action?

- Administer antihistamines, intravenous corticosteroids, and or epinephrine. The client has orolingual angioedema, a rare allergic reaction to alteplase that is more common in those taking ACE inhibitors. The nurse should prepare to administer antihistamines, intravenous corticosteroids, or epinephrine per provider orders. When caught early, intubation can often be prevented. If the client is in respiratory distress, and swelling is significant, the nurse should prepare for immediate intubation to protect the airway. Arterial blood gases are not needed pre-intubation, as airway obstruction is the immediate concern. Ice chips are contraindicated. A swollen tongue is not a symptom of stroke.

The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function?

- Beta-adrenergic blockers. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, and help reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by reducing contractility and vasodilatation; thus, lowering afterload. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure and systemic vascular resistance.

Atropine is being administered to a child with sinus bradycardia. Which information is most accurate about the administration of this medication?

- Increases heart rate. Atropine blocks vagal impulses to the myocardium and stimulates the cardioinhibitory center in the medulla, which increases heart rate and cardiac output. Atropine is not given to directly increase blood pressure or dilate the bronchial tubes.