Pharm II Exam 2
The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication?
"I feel like my heart is racing."
The nurse has administered a presurgical anticholinergic drug about 30 minutes ago. Which of the following responses would be of concern and should be reported immediately?
"I need to leave. I have important business to do."
What statement indicates that the client understands the purpose of the peak flow meter?
"I should measure my peak flow ever day."
A nurse is reinforcing discharge teaching with a client following an episode of status asthmaticus. The client has a prescription for two inhalations from an albuterol metered-dose inhaler. Which of the following statements by the client indicates an understanding of the teaching?
"I will hold my breath at least 10 seconds after inhaling the medication."
What statement made by the client would be of concern to the nurse?
"I will take this antacid right before I eat."
The nurse has just administered the first dose of omalizumab (Xolair). Which statement by the client alerts the nurse of a life-threatening effect?
"My lips and tongue are swollen."
A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse respond?
"The medication works locally and decreases inflammation."
The drug Advair is a combination of which drug categories?
- Corticosteroids - Long-acting beta2 agonists
The drug Advair is a combination of different medications. What drugs are in this inhaler?
- Fluticasone - Salmeterol
A client with limited health literacy is prescribed an antihistamine for an upper respiratory tract allergy. You want to be sure the client does not used other cold remedies with antihistamines included. What is the best way to relay this information?
- Give the client a list of medicines that include antihistamines. - Show the client where to look on the medicine label for the ingredients. - Make a poster for your clinic with drugs that contain antihistamines for teaching.
A nurse is caring for a client who has asthma. The client asks the nurse how albuterol helps his breathing. Which of the following information should the nurse include in the response?
- The medication will prevent wheezing. - The medication will open the airways. - The medication will decrease coughing episodes.
A client says he is stopping the anticholinergic drug because of dry mouth and constipation. What are some teaching tips the nurse could offer to reduce these adverse reactions?
- add more fiber to diet - swish mouth with water periodically - add a cucumber to drinking water - brush and floss teeth regularly
Harmful drug interactions exist when aminosalicylates are taken with what drugs?
- cardiotonics - oral hypoglycemics - anticoagulants
Which terms describe drugs that block the parasympathetic branch of the ANS?
- parasympatholytic - anticholinergics
Nursing Diagnoses for drugs that affect the respiratory system
- risk of injury - ineffective airway clearance - impaired oral mucous membranes
Match the antacid with the adverse reaction it causes: 1. Constipation 2. Diarrhea A) Milk of magnesia B) Amphojel C) Tums D) Bell/ans
1 = B, C 2 = A, D
The nurse is caring for a client with COPD who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted?
5 mcg/L
impulses traveling along the parasympathetic nerve cannot pass from the nerve ending to the effector organ or structure when the activity of ______ is inhibited?
ACh
Anticholinergic drugs block which transmitters?
Acetylcholine
COPD does not include what conditions?
Acute pneumonia
A nurse is reinforcing teaching to a school-aged child who has asthma. Which of the following medications should the nurse instruct the child to use to abort an ongoing attack?
Albuterol
The nurse has administered prochlorperazine (Compazine) to a client for relief of nausea and vomiting. The nurse should then assess the client for which frequent side or adverse effect of this medication?
Blurred vision
The nurse has administered a dose of docusate. The nurse evaluates that the medication has been effective if the client experiences which finding?
Bowel movement with soft, formed stool.
first generation antihistamines may result in ?
CNS stimulation or depression
adverse reactions to antihistamines?
CNS: drowsiness or sedation; disturbed coordination Anticholinergic effects: dryness of mouth, nose, and throat; thickening of bronchial secretions.
adverse reactions of xanthine derivatives?
CNS: restlessness; nervousness; tachycardia; tremors; headache; palpitations; increased respirations Other: nausea; vomiting; fever; hyperglycemia; flushing; alopecia
adverse reactions of sympathomimetic bronchodilators?
CNS: tachycardia; palpitations; cardiac arrhythmias; nervousness; anxiety; hypertension; insomnia
One of the primary uses of the ______ drugs is the treatment of parkinsonism
Cholinergic blocking
There is a ______ when histamine H2 antagonists are administered with carmustine
Decrease in WBC count
Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution?
Diabetes Mellitus
A client who has been chronically taking acetylsalicylic acid (Aspirin) for arthritis has been given a prescription for misoprostol (Cytotec). The nurse determined that the new medication is effective if the client states relief from which problem?
Epigastric pain
A client has been taking omeprazole (Zegerid) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptoms?
Heartburn
An older client is taking a stimulant laxative for ongoing management of chronic constipation. Which finding should the nurse expect to note when reviewing the client's laboratory results?
Hypokalemia.
First-line treatment for symptoms of allergic rhinitis?
Intranasal steroids (INSs) aka nasal glucocorticoids
interactions of decongestants?
MAOIs; Beta-Adrenergic blocking drugs
A client has an as needed prescription for ondansetron (Zofran). For which condition(s) should the nurse administer this medication?
Nausea and Vomiting
The body reacts to a trigger and stimulates the sympathetic branch of the nervous system causing bronchoconstriction and inflammation. What neurotransmitter is stimulated?
Norepinephrine
A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times?
One hour before meals and at bedtime.
Glycopyrrolate is used for the treatment of
Peptic ulcers
A nurse is collecting data from a client who has respiratory insufficiency. Which of the following findings should the nurse identify as an early sign of inadequate oxygenation?
Restlessness
What is accomplished when using bronchodilators?
Reverse bronchoconstriction
If a client is taking metoclopramide, what behaviors indicate an irreversible condition that should be reported immediately to the PCP?
Rhythmic, involuntary movements of the tongue, face, mouth, or jaw.
What drug is contraindicated during acute bronchospasm.
Salmeterol
What laboratory tests would the nurse expect to be ordered for a client taking Theolair?
Serum theophylline levels
A nurse is reinforcing discharge instructions for a client who has asthma and is about to start taking theophylline. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of the medication?
Tachycardia
How would the nurse correctly administer an antacid to a client taking other oral medication?
Two hours before or after administration of other drugs
Rifampin, when used alone with antihistamines, can reduce its ______.
absorption
antitussives, mucolytics, and expectorants treat...
accompanying cough
What drug would most likely be used to bring up deep mucous plugs in the lungs of a client with a tracheostomy?
acetylcysteine
What medication may smell like "rotten eggs"?
acetylcysteine
salmeterol is contraindicated during?
acute bronchospasm
interactions of sympathomimetic bronchodilators?
adrenergic drugs; MAOIs; beta blockers; methyldopa/tricyclics; theophylline; oxytocic drugs
The nurse administers antidiarrheal drugs _____________.
after each loose bowel movement
Intranasal steroids or antihistamines relieve?
allergy symptoms
A client has an as need prescription for loperamide hydrochloride (Imodium). For which condition should the nurse administer this medication?
an episode of diarrhea.
chewing benzonatate tablets may result in what ?
anesthetic effect
Drugs that neutralize HCl and protect the mucosal lining are called?
antacids
_______ are contraindicated in pts w myasthenia gravis, tachyarrhythmias, myocardial infarction, and congestive heart failure
anticholinergics
What type of drugs may also have antipruritic and antiemetic effects?
antihistamine
The three most common symptoms of ______ are cough, dyspnea, and wheezing.
asthma
atropine should be used with caution in patients with what?
asthma
When is a patient receiving atropine for third-degree heart block placed on a cardiac monitor?
before and after administration of the drug
when explaining how to use transdermal scopolamine, the nurse tells the client to apply the system to ___________.
behind the ear.
A ___________ is a drug used to relieve bronchospasm associated with respiratory disorders.
bronchodilator
Acute ___________ causes severe respiratory distress and wheezing from the forceful expiration of air.
bronchospasm
ipatropium bromide is used for what?
bronchospasm associated w/ COPD, chronic bronchitis, and emphysema in emergent situations
When the SABA drugs are administered to older adults, there is a greater increase risk of ______.
cardiovascular effects
A client receives a prescription for phenylephrine (Neo-Synephrine). The nurse explains that overuse of this drug may ______.
cause rebound nasal congestion
Dryness of the mouth, nose, and throat may be seen as a _______ blocking effect of antihistamine drugs.
cholinergic
what is asthma?
chronic inflammatory disease causing spasmodic constriction of the bronchi. Most common chronic diseases of childhood
decongestants are used to treat?
congestion associated w/ common cold; hay fever; sinusitis; allergic rhinitis;
Because of the effect of cholinergic blocking drugs on intestinal motility, the nurse monitor the client taking these drugs for the development of ________?
constipation
contraindications and precautions of antihistamines?
contraindicated: hypersensitivity; pregnancy and lactation 1st gen: newborns; premature infants; nursing mothers; pts taking MAOIs; glaucoma; peptic ulcers; prostatic hypertrophy; bladder neck obstruction. precautions: bronchial asthma; CV disease; glaucoma; prostatic hypertrophy; hypertension; impaired kidney function; peptic ulcers; urinary retention; pyloroduodenal obstruction; hyperthyroidism.
contraindications and precautions of sympathomimetic bronchodilators?
contraindications: hypersensitivity; cardiac arrhythmias; tachycardia; organic brain damage; cerebral arteriosclerosis; glaucoma; precautions: hypertension; cardiac dysfunction; hyperthyroidism; glaucoma; diabetes; prostatic hypertrophy; hx of seizures; pregnancy and lactation
contraindications and precautions of decongestants?
contraindications: hypersensitivity; pts taking MAOIs precautions: thyroid disease; diabetes; CV disease; prostatic hypertrophy; CAD; PVD; hypertension; glaucoma; pregnancy
_____ refers to paralysis of accommodation or inability to focus the eye.
cycloplegia
Mucolytics are commonly used for what condition?
cystic fibrosis
Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse should determine that this medication is effective if serum diagnostics reveal which finding?
decreased serum ammonia level.
Antitussives are medications that ______.
depress the cough center in the brain
What is the most helpful resource for the nurse assisting the client to determine the best antacid to purchase?
discuss with the clinical pharmacist.
When recording the administration of diphenoxylate for multiple loose stools:
document each dose on the MAR
What points should be included in a teaching plan for a client taking a laxative?
drink more fluid and eat more high-fiber foods
What is the most common adverse reaction the nurse would expect in a client receiving an antiemetic?
drowsiness
A cholinergic blocking drug is administered and the client becomes acutely confused; this is an example of __________.
drug idiosyncrasy
A client taking solifenacin (Vesicare) for an overactive bladder complains of dry mouth. The nurse should ______.
encourage the client to take frequent sips of water.
In gastric hypersecretory conditions, there is what?
excessive gastric secretion of hydrochloric acid
When antihistamines are administered to clients receiving CNS depressants, the nurse monitors the client for ______.
excessive sedation
what do expectorants, mucolytics, and antitussives do?
expectorants: decrease viscosity of the mucus mucolytics: relieve nonproductive cough antitussives: help bring up respiratory secretions
What statement is appropriate for the nurse to include in discharge instructions for a client taking an antitussive?
frequent sips of water may diminish coughing
Cholinergic blocking drugs are contraindicated in clients with ______.
glaucoma
What drug is classified as an expectorant?
guaifenesin
decreased effectiveness of the antipsychotic drug may occur when a cholinergic blocking drug is administered with _______.
haloperidol
When a histamine H2 antagonist drug is prescribed for the treatment of a peptic ulcer, the nurse monitors the client for what adverse effects?
headache, somnolence
The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on the data, the nurse should ask the client about a history of which symptom?
heartburn
The nurse is to administer a mucolytic agent. What nursing action is appropriate to take to promote an effective airway?
increase fluid intake to 2000 mL/day
What adverse effects can occur with the "Benadryl Challenge?"
increased body temperature; tachycardia; confusion; sedation; delirium; hallucinations; blurred vision; dizziness; constipation; urinary retention; possibly death
What interactions would most likely when diphenhydramine is administered with a beta-blocker drug such as propranolol (Inderal)?
increased risk of cardiovascular effects
Common conditions of the upper respiratory system include:
infections; allergic rhinitis; coughs; common cold; congestion
What is the best description of the cause of Crohn disease?
inflammatory response in the colon
In which area of the GI tract is water primarily reabsorbed?
large intestine (colon)
Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication?
liver function tests
antispasmodic drugs used to treat an overactive urinary bladder work as they inhibit the action of the _______ receptors in the parasympathetic nervous system.
muscarinic
Two types of receptors found in the parasympathetic nerve branch are?
muscarinic and nicotinic
Pseudoephedrine may be administered orally to relieve what?
nasal congestion
decongestants reduce...
nasal edema
The nurse correctly administers montelukast (Singulair) ___________.
once daily in the evening
what do sympathomimetic bronchodilators do?
open the bronchi and allow more air into the lungs
The pregnancy category for the antiflatulent drug simethicone is_________.
pregnancy category unknown
The client asks how stool softeners relieve constipation. What would be the best response by the nurse? Stool softeners relieve constipation by ______.
promoting water retention in the fecal mass
contraindications of citirizine?
pts w/ hypersensitivity to hydroxyzine
What adverse reactions would the nurse expect after the administration of atropine as part of a client's preoperative medication regimen?
reduced secretions of the upper respiratory tract
When administering aminophylline, a xanthine derivative bronchodilating drug, the nurse monitors the client for adverse reactions, which include _______.
restlessness and nervousness
The nurse is preparing to administer a dose of naloxone (Narcan) intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed?
resuscitation equipment
Interactions of antihistamines?
rifampin; MAOIs; CNS depressants; beta blockers; aluminum- or magnesium- based antacids
When acetylcholine is blocked in the parasympathetic nervous system, what occurs?
salivary glands secrete less
antihistamines are used for?
seasonal & perennial allergies; allergic & vasomotor rhinitis; allergic conjunctivitis; mild & uncomplicated angioneurotic edema & urticaria; allergic reactions to drugs, blood, or plasma; coughs caused by colds or allergy; adjunctive therapy in anaphylactic shock; treatment of parkinsonism; relief of N/V; relief of motion sickness; sedation; adjuncts to analgesics
Second generation antihistamines are less ...
sedating
What is a common adverse reaction seen when administering an antihistamine?
sedation
xanthine derivatives are used for?
symptomatic relief or prevention of bronchial asthma.
What type of adverse effects may be seen with the use of nasal decongestants?
tachycardia or other cardiac arrhythmias
The use of oral decongestants may result in the what adverse reactions?
tachycardia; cardiac arrhythmias; nervousness; restlessness; insomnia; blurred vision; N/V
A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that she or he will perform which action?
take the tablet with a full glass of water
Anticholinergic drugs are used on pregnant women only when?
the benefits outweigh the risks to the fetus
The patient is taking ____________ may report heartburn because the drug relaxes the lower esophageal sphincter, allowing gastroesophageal reflux.
theophylline
Why is atropine put in an antidiarrheal?
to reduce addictive property
Floxofenadine should not be administered when?
within 2 hours of an antacid