Exam 1

Which client receiving antibiotic therapy would the nurse identify as being at risk for Achilles tendon rupture? a. Gentamicin b. Ciprofloxin c. Cefazolin D. Tobramycin

b. Ciprofloxin

Which symptom would the nurse include when teaching a client with arthritis who takes large doses of aspirin about the clinical manifestations of aspirin toxicity? a. feelings of drowsiness b. disturbances of hearing c. intermittent constipation d.metallic taste in the mouth

b. disturbances of hearing

Use if which medication would the nurse identify as a potential risk for hearing impairment in a child? a. amoxicillin b. gentamicin c. clindamicin d. ciproflaxin

b. gentamicin

Anticholinergic

blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane)

Which purpose of metoclopramide administered intravenously 30 minutes before initiating chemotherapy for cancer of the colon would the nurse explain to a client? a. to stimulate production of gastrointestinal secretions b. to stimulate peristalsis of the upper GI tract c.to prolong the excretion of the chemotherapeutic medication d. to increase absorption of the chemotherapeutic reaction

b. to stimulate peristalsis of the upper GI tract Prokinetic medications such as metoclopramide stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

Which clinical finding in a client receiving morphine warrants immediate follow-up by the nurse? Select all that apply. a. polyuria b. unconsciousness c. bradycardia d. dilated pupils e. bradypnea

b. unconsciousness c. bradycardia e. bradypnea

Which technique using a metered-dose inhaler (MDI) by a client with obstructive pulmonary disease would cause a nurse to conclude that additional teaching is needed? a.Places the tip of the inhaler just past the lips b. Holds the inspired breath for at least 3 seconds c. Exhales slowly through the mouth with lips pursed slightly d. Inhales rapidly with the lips sealed around the nebulizer opening

d. Inhales rapidly with the lips sealed around the nebulizer opening The client should inhale slowly rather than rapidly when using a metered-dose inhaler (MDI) in order to optimize delivery of the nebulized drug into the lungs. If the client has a dry powder inhaler (DPI), then rapid inhaling would be an important action because the powder is not nebulized. The MDI should be gently held in the mouth just past the lips to deliver the medication into the airway. Holding the inspired breath for at least 3 seconds promotes contact of the medication with the bronchial mucosa. Exhaling slowly through the mouth with lips pursed slightly prolongs and improves delivery of the medication to the respiratory mucosa.

passive diffusion

movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy

Extrapyramid symptoms

muscle tremors, changes in gait, rigidity

superinfection

overgrowth of normal microbiota that is resistant to antibiotics

Before beginning administration of morphine via patient-controlled analgesia (PCA), which assessment would the nurse perform first?

respirations

dynamic equilibrium

the actual concentration that a drug reaches in the body involves the rate of several processes -absorption -distribution biotransformation -excretion

Agonists

drugs that increase the action of a neurotransmitter

partial agonists

drugs that interact with a receptor to stimulate a response but inhibit other responses

Which statement is important for the nurse to teach a client prescribes psyllium 3.5 g twice a day for constipation? 1Urine may be discolored. 2Each dose should be taken with a full glass of water. 3Use only when necessary because it can cause dependence. 4Daily use may inhibit the absorption of some fat-soluble vitamins.

2Each dose should be taken with a full glass of water.

metered-dose inhaler (MDI)

A miniature spray canister used to direct medications through the mouth and into the lungs.

rebound hyperacidity

A side effect of medication causing elevated levels of hydrochloric acid in the stomach after the medication is discontinued.

Orphan drugs

A special category of drugs that have been identified to help treat patients with rare diseases.

Which side effect would the nurse assess for after epinephrine is administered to an infant with severe bronchospasms? A: Tachycardia B: Hypotension C: Respiratory arrest D: Central nervous system depression

A: Tachycardia Epinephrine stimulates beta- and alpha-receptors; its actions include increasing heart rate and blood pressure and inducing bronchodilation. Increased blood pressure, not hypotension, is a potential side effect. Epinephrine relieves respiratory problems; it does not cause respiratory arrest. Epinephrine stimulates, not depresses, the central nervous system.

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes

Category X drugs

Animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant.

Category B drugs

Animal reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women.

Teratogenicity

Any drug that causes harm to the developing fetus or embryo

Kernicterus

Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death

Category C drugs

Either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not available

adverse effects of epinephrine

Hypertensive crisis Dysrhythmias Angina pectoris Necrosis following extravasation Hyperglycemia

The nurse is teaching the parent of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication?

It should be stopped gradually.

receptor sites

Locations on a receptor neuron into which a specific neurotransmitter fits like a key into a lock.

Metoclopramide indications

Nausea, vomiting, GERD

category d drugs

Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit vs risk may warrant use of these drugs in pregnant women.

The Orphan Drug Act of 1983

Provided incentives for the development of orphan drugs for treatment of rare diseases

Metoclopramide

Reglan Antiemetic

factors that influence drug effect

Route of administration, metabolism, tolerance

critical concentration

The amount of a drug that is needed to cause a therapeutic effect

Controlled Substances Act

The federal law giving authority to the Drug Enforcement Administration to regulate the sale and use of drugs.

first pass effect

The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.

Pharmacodynamics

The study of what the drug does to the body

blood dyscrasia

any pathologic condition of the cellular elements of the blood

Psyllium

bulk forming laxative (Metamucil)

Which response would a nurse give to a client prescribed omeprazole for gastroesophageal reflux disease who reports a new occurrence of significant diarrhea? a. "Stop taking your omeprazole." b. "This is a normal side effect of omeprazole." c. "We are going to collect a stool sample for testing." d. Antidiarrheal medication can be used to decrease this."

c. "We are going to collect a stool sample for testing."

competitive agonists

compete with agonists for receptor binding bind irreversibly to receptors equal affinity-receptor occupied by whichever agent is present in the highest concentration

Fluticasone Indications and Use

chronic nasal allergy symptoms

Calculating half-life

divide initial count by two, that counts as one half life. Keep dividing until you get to the final count and see how many half lives you have got

Drug enzyme interaction

drugs can cause their effect by interfering with the enzyme system

Nephrotoxicity symptoms

elevated BUN and creatinine, decreased urine output, fatigue

Hepatoxicity symptoms

fever, malaise, nausea, jaundice, change in color of urine of stool, abdominal pain, elevated liver enzymes

Hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

hepatic enzyme system

intracellular structures of the hepatic cells are lined with enzymes packed together

Hyperglycemia symptoms

lots of eating, peeing, drinking. blurred vision, fatigue, weight loss

What factors affect drug distribution?

membrane permeability, tissue perfusion, protein binding, volume of distribution

Hepatoxocity interventions

notify prescriber discontinue medication provided supportive measures if needed

drug distribution

passage of a drug from the blood to the tissues and organs of the body

absorption processes

passive diffusion, active transport, filtration

antitussives

relieve or suppress coughing by blocking the cough reflex in the medulla of the brain

What are the actions of drugs?

replace or act as substitutes for missing chemicals increase or stimulate certain cellular activities depress or slow cellular activities interfere with the functioning of foreign cells

selective toxicity

selectively finding and destroying pathogens without damaging the host

Where is the most important site for bio transformation?

the liver

Biotransformation

the process in which enzymes convert a drug into a metabolite that is itself active, possibly in ways that are substantially different from the actions of the original substance

Neonates

the term used for newborns

filtration membrane

three barriers through which fluid passes

Loading dose

use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner

Fluoroquinolones

-Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin. -Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids. -Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms. Toxicity: GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias. -Contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage. Some may prolong QT interval. May cause tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone. -Resistance: chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps.

problems related to over the counter drugs use

-Taking these drugs could mask the signs and symptoms of underlying disease, making diagnosis difficult. - Taking these drugs with prescription medications could result in drug interactions and interfere with drug therapy .- Inactive ingredients can cause adverse reactions. - Not taking these drugs as directed could result in serious overdoses.

Which statement by a client with rheumatoid arthritis prescribed ibuprofen 800 mg by mouth three time a day indicates that the nurse's education about the medication's side effects was effective? A. "I need to report any dark tarry stools." B. "I will need to stop taking this medication before any scheduled surgery." C. "I should change positions slowly." D. "I will take the medication on an empty stomach." E. "I need to stop taking low-dose aspirin while I take this medication."

A. "I need to report any dark tarry stools." B. "I will need to stop taking this medication before any scheduled surgery." Ibuprofen increases the risk for bleeding, so clients need to report any signs or symptoms of bleeding such as dark tarry stools. They also will need to stop taking this medication before scheduled surgery to prevent excessive bleeding. Ibuprofen does not cause postural hypotension, so there is no need to change positions slowly. Ibuprofen may cause epigastric distress; it should be taken with meals or milk to reduce this adverse effect. Clients should continue to take low-dose aspirin to reduce myocardial infarction or stroke risk; however, they will need to take this 2 hours before taking ibuprofen because ibuprofen can reduce the antiplatelet effects of aspirin by blocking access of aspirin to COX-1 in platelets.

hyperglycemia interventions

Administer insulin therapy to decrease blood glucose as appropriate, while carefully monitoring glucose levels. Provide support to help the patient deal with signs and symptoms (e.g., provide access to bathroom facilities, control the temperature of the room, decrease stimulation while the patient is in crisis, offer reassurance, provide mouth care—the patient will experience dry mouth and bad breath with the ensuing acidosis, and mouth care will help to make this more tolerable).

Which information would the nurse provide when administering the first dose of prednisone prescribed to a client with an exacerbation of colitis?

Although the medication decreases intestinal inflammation, it will not cure the colitis.

Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? A. Anaphylaxis B. Gastrointestinal (GI) bleeding C. Cardiac dysrhythmia D. Disulfiram reaction

B. Gastrointestinal (GI) bleeding Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage. Cardiac dysrhythmias and anaphylaxis are not typically associated with high-dose or long-term administration of ibuprofen. Disulfiram reactions are associated with alcohol intake, not ibuprofen.

Theophylline

Bronchodilator

Which schedule will the nurse teach a client who presented to the emergency room for an acute asthma attack at the time of discharge who is prescribed theophylline 300 mg orally at 9:00 am? A. With a meal B. Only at bedtime C. At a specific time prescribed D. Until symptoms are gone

C. At a specific time prescribed For theophylline to be effective, therapeutic serum levels must be maintained by taking the medication at the prescribed time. If the medication is not taken at the prescribed time, the level may drop below the therapeutic range. The medication will not be effective if it drops below the therapeutic range. Theophylline should be given after a meal and with a full glass of water to decrease gastric irritability. It should not be taken at night, as it can cause CNS stimulation resulting in insomnia, restlessness, irritability, etc. Theophylline is used for long-term medication therapy.

Gentamicin (Garamycin) adverse effects

Common: N/V/D Others: syncope, vertigo, rash, fever, HA Serious: Neurotoxicity, Nephrotoxicity, Ototoxicity

Which information would the nurse reinforce when teaching a client with gastroesophageal reflux disease (GERD) about antacid therapy? A. Antacids should be taken 1 hour before meals. B. These should be scheduled at 4-hour intervals. C. Antacid tablets are just as fast and effective as the liquid form. D. Antacids commonly interfere with the absorption of other drugs.

D. Antacids commonly interfere with the absorption of other drugs. Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.

active transport

Energy-requiring process that moves material across a cell membrane against a concentration difference

DEA Schedules of Controlled Substances

I: High abuse potential, no accepted medical use (heroin, marijuana, LSD) II: High abuse potential, severe dependence liability (narcotics, amphetamines, and barbiturates) III: Less abuse potential than schedule II, moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics) IV: Less abuse potential than schedule III, limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics) V: Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. Purchaser must be at least 18 years of age and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist.

noncompetitive agonists

Permanently bind with receptor sites and prevent activation by agonist chemicals

Steps of drug evaluation

Preclinical Trials: Chemicals tested in vitro or invivo (animal studies) ■ Phase I Studies: Chemicals tested on human volunteers ■ Phase II Studies: Drug tried on informed patients with the disease ■ Phase III Studies: Drug used in larger sample ofthe population ■ FDA Approval: Studies are evaluated; if approved, may be marketed ■ Phase IV Studies: Continual evaluation of the drug

Hypoglycemia interventions

Restore glucose—orally, if possible, or intravenously. Provide supportive measures (e.g., skin care, environmental control of light and temperature, rest). Institute safety measures to prevent injury or falls. Monitor blood glucose levels to help stabilize the situation. Offer reassurance to help the patient cope with the experience.

Reye's syndrome

Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this.

drug half life

the time required for the amount of drug in the body to decrease by 50%

The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parent asks why the child needs prednisone. Which response by the nurse is correct? a. "It decreases inflammation" b."It suppresses the production of lymphocytes." c."It increases appetite and a sense of well-being." d. "It may decrease skin irritation and edema."

a. "It decreases inflammation" RAT: Prednisone is a synthetic glucocorticoid that exerts an active anti-inflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

Hypoglycemia

abnormally low level of sugar in the blood

Gentamicin (Garamycin)

aminoglycoside antibiotic

After numerous diagnostic tests, a client with jaundice receives the diagnosis of pancreatic cancer. Which rationale explains the cause of the client's jaundice? a. Necrosis of the parenchyma caused by the neoplasm b. excessive serum bilirubin caused by red blood cell destruction c. obstruction of the common bile duct by the pancreatic neoplasm d. impaired liver function, resulting in incomplete bilirubin metabolism

c. obstruction of the common bile duct by the pancreatic neoplasm

Which clinical indicator would be related to a client receiving aspirin therapy? a. urinary calculi b. atrophy of the liver c. prolonged bleeding time d. premature erythrocyte destruction

c. prolonged bleeding time

Which effect may be experienced by a client who reports frequently taking calcium carbonate? a. diarrhea b. water retention c. rebound hyperacidity d. bone mineralization

c. rebound hyperacidity

The nurse understands which medication class may cause kernicterus in neonates? a. salicylates b. tetracyclines c. sulfonamides d. glucocorticoids

c. sulfonamides may cause kernicterus in neonates. Salicylates may cause Reye syndrome. Tetracyclines may cause discoloration of developing teeth. Glucocorticoids may cause growth suppression.

Category A drugs

controlled studies in women fail to show a risk to the fetus and the possibility of fetal harm appears unlikely

A child is prescribed fluticasone after an acute asthma attach. Which instruction would the nurse give family about the administrations of this medication? a. "Fluticasone needs to be taken with food or milk." b. "Fluticasone is primarily used to treat acute asthma attacks." c. "The child should suck on candy to relieve dry mouth." d. "Watch for white patches in the mouth and report to health care provider"

d. "Watch for white patches in the mouth and report to health care provider"

Metoclopramide adverse reactions

may result in CNS depression