pharm quiz #3

What statements by the 54-year-old patient indicates an understanding of the nurse's teaching about how to take sublingual nitroglycerin? A) "A headache means a toxic level has been reached." B) "I can take up to 3 tablets at 5-minute intervals." C) "I can take as much nitroglycerin as I need because it is not habit forming." D) "If I become dizzy after taking the medication, I should stop taking it."

"I can take up to 3 tablets at 5-minute intervals."

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? A. "I should apply a patch every 5 minutes if I Develop chest pain." B. "I will take the patch off right after my evening meal." C. "I will leave the patch off at least 1 day each week." D. "I should discard the used patch by flushing it down the toilet."

"I will take the patch off right after my evening meal."

A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which o the following instruction? A. "Remove the prior dose before applying a new dose. B. "Rub the ointment directly into your skin until it is no longer visible. C. "Cover the applied ointment with a clean gauze pad." D. "Apply the ointment to the same skin area each time.

"Remove the prior dose before applying a new dose.

heparin therapy is prescribed to a patient with deep vien thrombosis. which patient would be at greatest risk of bleeding from this therapy

62 yr old w history of CVA stroke 5 years ago

A nurse is teaching a client who has prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A. Remove the patch each evening. B. Cut each patch in half if angina attacks are under control. C. Take off the nitroglycerin patch for 30 min if a headache occurs. D. Apply a new patch every 48 hr.

A. Remove the patch each evening.

Oxybutynin Category

Anticholinergic

Warfarin (Coumadin) and heparin Category:

Anticoagulant

nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks. "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain? Which of the following responses should the nurse make? A."Take two more sublingual tablets at the same time. B. "Call the emergency response team. C. "Take a sustained-release nitroglycerin capsule." D. "Wait another 5 minutes then take a second sublingual tablet.

B. "Call the emergency response team.

Heparin side effects

BLACK TARRY STOOL bleeding ncrease HR, decreased BP, bruising, petechiae

Nifedipine Labs to monitor:

BP, weight gain, heart rate

Plavix (Clopidogrel) Labs to monitor:

CBC levels, monitor cholesterol

Oxybutynin side effects

Decreased sweating, urinary retention, tachycardia, and changes in GI activity. Drowsiness, dizziness, blurred vision, tachycardia, dry mouth, nausea, urinary hesitancy, decreased sweating.

A nurse is taking a medication history from a client who has angina is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (Select all that apply.) A. Digoxin B. Simvastatin C. Verapamil D. Amlodipine E. Nitroglycerin transdermal patch

Digoxin Simvastatin Verapamil

Cholestyramine Side effects:

Direct GI irritation- nausea constipation, flatulence, exacerbation of hemorrhoids, cramps Increased bleeding times Vitamin A and D deficiencies pg2041 Headache fatigue drowsiness VERTIGO dizziness constipation Rash, anxiety Joint/muscle pain

Spironolactone Side effects

Dizziness, headache, drowsiness, rash, cramping, diarrhea, hyperkalemia, hirsutism, gynecomastia, deepening of the voice, irregular menses.

Hydrochlorothiazide Side effect

Dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, or spasms

Nifedipine Nursing actions:

Do not give it to pt with cardiogenic shock. Tell pt to report SOB or orthopnea (discomfort in breathing when lying down flat) Watch for Ankle EDEMA If reflex tachycardia happens give Beta blocker

Nifedipine Patient teaching:

For angina pectoris and HTN Avoid grapefruit Do NOT crush or chew ER medication

Plavix (Clopidogrel) Side effects

GI Bleeding , thrombocytopenia (low platelet level count)

odinina is discharged from the hospital after an MI. the physician prescribes continuance of the drug clopidogrel at home to help prevent future MI. 5 days after discharge she complains of GI upset and low grade fever. What adverse effect should the nurse monitor for?

GI ulcer and bleeding

The nurse is caring for a patient taking a HMG-CoA inhibitor. What would be an appropriate intervention for this patient? A. Monitor CBC blood tests before and periodically during therapy B. Arrange for periodic ophthalmic examinations C. Administer the drug at breakfast D. Monitor for adverse effects

Monitor CBC blood tests before and periodically during therapy

Atorvastatin Side effects:

NO GRAPEFRUIT JUICE headache, abdominal pain, constipation, nausea. liver damage (report changes in color of urine or stool, extreme fatigue), rhabdomyolysis (report acute muscle pain with fever).

Oxybutynin Administered

Orally, topical gel, dermal patch Relief of symptoms of bladder instability associated with uninhibited neurogenic and reflex neurogenic bladder; treatment of signs and symptoms of overactive bladder. Acts directly to relax smooth muscle in the bladder; inhibits the effects of acetylcholine at muscarinic receptors.

A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? A) Potassium mEq/L B) aPTT times the control C) Hemoglobin g/dL D) Platelets 96,000/mm^3

Platelets 96,000/mm^3

When developing the plan of care for a patient with hyperaldosteronism, the nurse would expect the physician to prescribe which agent?

Spironolactone

Atorvastatin patient teaching:

combined with diet and exercise to be most effective. It should be taken with the evening meal to be most effective.

Hydrochlorothiazide patient teaching:

Take medication first thing in the morning and second dose before 1400 to prevent nocturia - Consume food rich in potassium and fluid intake - If GI upset, take medication with or after meals - If medication is for hypertension, self-monitor BP and weight - Report significant weight loss

Zac is sent home with SQ heparin after a THR. Which symptom = serious drug reaction

Tarry stool

Warfarin (Coumadin) patient teaching:

Teach how to administer (oral); disposable syringe and check for signs of bleeding; avoid foods high in vitamin K

Why are calcium channel blockers used to treat angina?

They work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.

Plavix (Clopidogrel) patient teaching

This medication is used to reduce risk of blood clotting which can lead to stroke. This drug is a substitute for aspirin for patients who cant take aspirin.

What is the antidote for warfarin?

Vitamin K

Hydrochlorothiazide Category:

antihypertensive/ thiazide diuretic

What to monitor with all diuertics

daily weight in and outs (urine) edema

Spironolactone Patient teaching:

expect ^ in volume/frequency of urination. avoid foods high in K+, Avoid alcohol. Avoid tasks that require alertness, motor skills until response to drug is established

ms. schwartz starting on Warfarin therapy. the patient asks why she's not in Heparin therapy any longer. what are the differences of Heparin and Warfarin?

heprarin is administered parentally, while warfain is administered orally

Heparin labs to monitor

less than 100k platelets

A nurse is caring for a client who is prescribed isosorbid mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications shouId the nurse expect to administer? A. Furosemide B. Captopril C. Ranolazine D. Metoprolol

metoprolol

Cholestyramine Nursing actions:

monitor bowel activity, stool softeners/laxatives increase fluids, fiber to prevent constipation monitor for s/s of bleeding/bruising binding w/ vit K take other meds 1 hour before, or 4 hours after diet, exercise, fish oil, flaxseed no ETOH, quit smoking

Plavix (Clopidogrel) Nursing actions:

monitor for GI bleeding

Spironolactone Category:

pottasium sparing diuertic aldosterone antagonist

Heparin Antidote

protamine & avoid aspirin

What is the antidote for heparin?

protamine sulfate

Cholestyramine indication

reduces elevated serum cholesterol in pts with primary hypercholesterolemia, pruritus associated with biliary obstruction

Side effects of mannitol

sudden drop in fluid levels closely monitored for fluid and electrolyte imbalance. Dizziness, headache, hypotension, rash, nausea, anorexia, dry mouth, thirst, diuresis, fluid and electrolyte imbalances

Cholestyramine patient teaching:

take other medications 1 hour before or 4-6 hours after cholestyramine

Nifedipine Side effects

Cough , ventricular dysrhythmias , peripheral edema, hypotension, reflex tachycardia

Atorvastatin (statin) Category

HMG-CoA Reductase Inhibitors (lipid lowering)

The difference between warfarin and heparin

Warfarin is used for long treatment and given ORALLY; Heparin is used for an immediate response and given PARENTALLY