Pharmacology
cyclophosphamide (Cytoxan) [Immunosuppressant]
Category: antineoplastic (alkylating) (1) Adverse: - n/v, loss of appetite - weight loss - abd pain - hair loss - stomatitis - sore throat - fever - red urine (interstitial cystitis) (2) Nursing Considerations: - Pregnancy - Assess lung sounds - Bone marrow suppression - Hepatoxicity - Monitor "Hemorrhagic Cystitis: renal studies (3) Pt Teaching: - Drink plenty (2-3L/day) - Monitor CBC - Report pink/red urine - Use birth control
Bupropion (Wellbutrin)
Antidepressant, smoking cessation
Chlorpromazine:
Antipsychotic (1) Reportable Adverse Effects: - high temperature - decreased LOC - dysrhythmia - Labile BP
Clozapine
Antipsychotic (1) Uses/Treatment: - Schizophrenia - Other antipsychotics have failed - recurrent suicidal behavior (2) Reportable Findings - Deceased WBC <3,000/mm3 [agranulocytosis] - Tardive dyskinesia: bizarre movements of the jaw, mouth, tongue, extremities - tremors - Akathisia: inability to sit still. no pattern to movements - Neuroleptic Malignant Syndrome: tachycardia, seizures, fever, dyspnea, increased/decreased BP, diaphoresis (3) Adverse Effects: - weight gain due to Hyperglycemia Hyperlipidemia
A nurse is providing discharge instructions to a client who has a new prescription for warfarin. Which of the following client statements should the nurse identify as an indication that the client understands the teaching? (A) "I should report a change in the color of my stools." (B) "I can take acetaminophen to treat a headache." (C) "I will take a calcium supplement while taking this medication." (D) "I will return in a month to have my blood tested."
"I should report a change in the color of my stools." [The nurse should inform the client that red, black, or tarry stools can indicate bleeding, an adverse effect of warfarin, and the client should report these findings to the provider] (The nurse should inform the client that taking acetaminophen can increase the risk for bleeding) (The nurse should inform the client that calcium supplements are not indicated while taking warfarin; however, the client should maintain consistent intake of foods containing vitamin K) (daily blood draws for the first 5 days to establish appropriate warfarin dosage)
A nurse is teaching a client who has opioid use disorder about methadone. Which of the following information should the nurse include in the teaching? (A) If you suspect you are pregnant, stop taking this medication (B) "You cannot become physically dependent on this medication." (C) "Sedation is a common adverse effect of this medication." (D) "If you forget a dose, you can double your next dose."
"Sedation is a common adverse effect of this medication." [Sedation and drowsiness are common adverse effects of methadone. Sedation most frequently occurs at the beginning of treatment or during dosage increases] (A client can take methadone to treat opioid withdrawal symptoms during pregnancy)
What is the 12-step program for clients wanting stop addiction such as alcohol, narcotics, and gambling?
(1) Abstinence is necessary for recovery (2) A higher power is needed to assist in recovery (3) Clients are not responsible for their disease but are responsible for their recovery (4) Other people cannot be blamed for the client's addictions, & they must acknowledge their feelings & problems [Encourage the client and family to attend]
What are necessary vitamins for normal functioning of the nervous system? In other words, what does the nervous system depend on, specifically in relation to the vitamins?
(1) B-complex vitamins (2) thiamine (3) niacin (4) V. B6 & B12
Potential side effects of trimethoprim/sulfamethoxazole C. difficile and Steven-Johnson Syndrome. What are the side effect both of the risks, C. difficile & Seven-Johnson Syndrome?
(1) C. difficile - diarrhea - temperature above expected range (2) Steven-Johnson Syndrome - Unexpected Bruising
Medications for alcohol withdrawal:
(1) Diazepam (2) Carbamazepine (3) Clonidine (4) Chlordiazepoxide (5) Phenobarbital (6) Naltrexone
Medications for alcohol abstinence:
(1) Disulfiram (2) Naltrexone (3) Acamprosate
Patient has been receiving chemotherapy, what can you teach in reference to preventing infections?
(1) Don't leave consumable water standing in room temp. for more than 1 hr. - If so, don't drink (2) Clean toothbrush in the dishwasher once a week (3) Take temperature each day to monitor for infection - notify if temp. is >37.8 C (100 F) (4) Walk short distance throughout the day as tolerated to prevent respiratory infections
Safety is the primary focus of nursing care during acute intoxication or withdrawal: What are some nursing interventions?
(1) Maintain a safe environment to prevent falls; implement seizure precautions as necessary (2) Create a low-stimulation environment (3) Orient the client to time, place, & person (4) Provide close observation for withdrawal manifestations, possibly one-on-one supervision
For normal bowel function, how many grams of fiber per day is necessary for females and males?
(1) Males: 38 g/day (2) Females: 25g/day
Opioid Withdrawal:
(1) Methadone substitution (2) clonidine (3) buprenorphine (4) naltrexone (5) levo-alpha-acetylmethadol
What are the 2 comm medications commonly used for treating UTIs?
(1) Sulfamethoxazole/ trimethoprim [Bactrim] (2) Phenazopyridine -local analgesic effect on the urinary tract. It is often used to help with the pain, irritation, or urgency caused by urinary tract infection
Lithium Levels: Therapeutic range
(1) Therapeutic range 0.6-1.2 mEq/L
Medications for nicotine withdrawal from tobacco use:
(1) bupropion (2) nicotine replacement therapy - nicotine gum - nicotine patch (3) varenicline
What is the antidote for benzodiazepines? Also, What are some examples of benzodiazepines?
(1) flumazenil (Romazicon) - ANTIDOTE (2) Examples of benzodiazepines - suffix ending in '-pam' - chlordiazepoxide - alprazolam - clorazepate
What is the antidote for opiate overdose? What are some examples of Opioids?
(1) naloxone (Narcan) - ANTIDOTE (2) Examples of Opioids: - morphine - oxycodone - hydrocodone - methadone - fentanyl
Medications for nicotine abstinence:
(1) varenicline (2) rimonabant
Disulfiram (Antabuse) is prescribed for what reason?
- Disulfiram is used to treat chronic alcoholism (Inhibits aldehyde dehydrogenase and causes an acute attack of flushing, headache, nausea, vomiting etc)
What is the antidote/counteractive for acetaminophen overdose?
Acetylcysteine [Bonus: acetylcysteine is also an antidote for mucomyst]
What is the normal range of Absolute Neutrophil Count for Adults and children? What type of vaccines must be withheld if the child/adult absolute neutrophil count is low?
Adults: 2500-6000 Child: >1500 (1) Live Vaccines: - MMR - Varicella - Rotavirus - Influenza (nasal)
Aripiprazole (Abilify)
Antipsychotic (1) Uses/Treatment: - Schizophrenia - Bipolar - Major depressive disorder - irritability w/ autism (2) Reportable Findings: - Frequent urination & incontinence - Agranulocytosis [WBC <3,000/mm3] - Akathisia - Agitation or has increased - Neuroleptic malignant syndrome: hyperthermia, increased CPK (creatine phosphokinase), altered mental status, muscle rigidity - Tardive dyskinesia: bizarre movements of the jaw, mouth, tongue, & extremities
What is the antidote for neostigmine? (neostigmine is to treat a condition called myasthenia gravis: rare and causes muscle weakness causes by error in how nerve signals transmit to the muscles)
Atropine
A nurse in an emergency department is assessing a client who reports taking methylenedioxymethamphetamine (MDMA). Which of the following findings should the nurse expect? (A) Lethargy (B) Diaphoresis (C) Bradycardia (D) Cough
Diaphoresis [Additionally, the client might experience increased tactile sensitivity, lowered inhibition, chills, muscle cramping, teeth clenching, and mild hallucinogenic effects]
What diet has been proven by research to significantly lower systolic & diastolic blood pressure?
Dietary approaches to stop hypertension [AKA: "DASH"]
What is the antidote for Digoxin Toxicity?
Digoxin immune Fab (Digibind)
A client is receiving lorazepam IV for panic attacks and develops a respiratory rate of 6/min and a blood pressure of 90/44 mm Hg. Which of the following medications should the nurse anticipate administering? (A) Naloxone (B) Flumazenil (C) Acetylcysteine (D) Atropine
Flumazenil (Competitive benzodiazepine receptor antagonist) [In addition, the nurse should continue to support the client's respirations w/ a bag-valve mask]
The nurse is planning to teach the client how to prevent further UTIs from occurring. Which of the following instructions should the nurse plan to include? (A) Gently cleanse the perineum before intercourse (B) Drink orange juice daily (C) Void every 4-6 hr during the day (D) Drink approximately 4 L of fluids daily
Gentle cleanse the perineum before intercourse
A nurse is teaching a client who has a new prescription for estradiol. For which of the following adverse effects of this medication should the nurse instruct the client to monitor and report to the provider? (A) Hypotension (B) Headaches (C) Bruising (D) Oliguria
Headaches [Headaches can be an indication of a thromboembolic stroke because estradiol increases the risk for adverse cardiovascular events]
A nurse is administering cyclophosphamide orally to a school-age child who has neuroblastoma. Which of the following actions should the nurse take when administering this medication? (A) Give an antiemetic 30 min after medication administration. (B) Monitor blood glucose levels. (C) Maintain hydration with liberal fluid intake. (D) Monitor for tumor lysis syndrome.
Maintain hydration with liberal fluid intake. [prevent hemorrhagic cystitis, which is an adverse effect of this medication] (The nurse should administer an antiemetic 30 min before administration of the medication to decrease gastrointestinal effects) (Tumor lysis syndrome can occur in clients who are diagnosed with acute lymphoblastic leukemia, not neuroblastoma)
A nurse is caring for a client who has schizophrenia and began taking a conventional antipsychotic medication yesterday. Which of the following findings indicates the nurse should administer benztropine 2 mg IM? (A) Shuffling gait (B) Hypotension (C) Decreased WBC count (D) Blurred vision
Shuffling gait [Benztropine is used to treat parkinsonism manifestations, such as shuffling gait]
Patient is receiving chemotherapy and his lab result came in. His results from lab demonstrate bone marrow suppressions such as neutropenia, thrombocytopenia, and anemia. Following the urgent vs. nonurgent framework, what 2 lab results require immediate follow up? [ ] Platelet count [ ] WBC count [ ] Hemoglobin
[ ] platelet count [ ] Hemoglobin (Think About: Client is at risk for spontaneous hemorrhage and anemia; therefore, the pt is gonna die before the infection kicks in)
lamotrigine
anticonvulsant/mood stabilizer (1) Reportable findings - Rash (BLACK BOX: Steven-Johnson Syndrome) (2) Adverse effects - Dysmenorrhea
