PHARMACOLOGY "A"

The nurse is educating a patient who is taking phenytoin. To make sure phenytoin does not fail, which Over-The-Counter (OTC) medication should the nurse advise the patient not to take at the same time

Calcium Carbonate (tums)

Transfusion Associated Circulatory Overload (TACO)

patients with baseline cardiac and renal disorders

Doxycicline side effects

use a backup method of birth control glossitis, a common side effect of Doxycycline

A nurse is conducting pre-operative teaching to a client who will undergo surgery in 1 week. Which response by the client would prompt the nurse to give additional teaching?

"I should stop Aspirin one day prior to my surgery.

Normal corrective serum digoxin levels range

0.5-2 ng/m

Midazolam is a benzodiazepine

used for acute anxiety attacks. "Rapid Onset" 2 to 5 minutes after IV administration action 3 to 8 hours Flumazenil as an antidote

The calculation of the equianalgesic of oral morphine when compared to IV morphine, which is always used to calculate equianalgesic,

3 to 1 ratio

The nurse is preparing ephedrine nasal spray for a client in the medical ward. The nurse understands that ephedrine is contraindicated in which of the following patients?

A client with pheochromocytoma

You are a nurse in the local childcare facility. You are feeding an infant whose mother has expressed breast milk for feeding, halfway through the food. You notice that the juice you are supplying is not for this child. You have mistakenly picked up the liquid for another woman's child. You should:

A. Inform the parent of the child you are feeding B. Inform the mother of the child whose milk you fed to the child C. Complete an incident report per facility policy D. Inform the providers who are caring for the infants

The nurse is caring for a client that is receiving Aspirin for acute pain. The nurse understands the associated adverse effects of the medication and includes all of the following nursing actions except:

Administering another NSAID (Ibuprofen) when pain relief is inadequate

Which of the following classifications of medications can be used as an adjuvant medication for the pharmacological management of pain?

An antiarrhythmic medication

The nurse has received word that their patient is leaving the postoperative unit and being transferred back up the medical-surgical floor upon arrival. The nurse would be correct if they perform which priority action immediately?

Assess the patient for a patent airway

While reviewing medication-related hematological side effects, the nurse recognizes which of the following as the most severe form of bone marrow toxicity:

Aplastic anemia

HEPARIN Important Nursing Considerations

Biggest side effect to monitor for = bleeding! ○ Hematuria - Pink tinged urine ○ Hematemesis - bloody vomitus ○ Bruising ○ Downtrending Hemato&Hemoglobin

A patient with low blood pressure and tachycardia after a surgical procedure may be experiencing an illness.

Blood loss results in lowered blood pressure, and the heart rate increases to compensate.

Your client, who has chronic pancreatitis and gastroparesis, is complaining of a migraine headache. The doctor has ordered butorphanol orally as needed for pain. What would you do?

Call the doctor and suggest transnasal butorphanol because the client has gastroparesis.

Treatment of heparin-induced thrombocytopenia

Cessation of heparin, including LMW heparin Start non-heparin anticoagulant

A 16-year-old adolescent is brought to the ER following an accident at a skating rink. The adolescent's left knee is bruised and swollen. Upon interview, the nurse finds out that the adolescent has Hemophilia A. Which medication would be most appropriate for the client?

Codeine phosphate

An independent nursing intervention relating to the oral administration of opioid narcotic analgesics is to:

Collect comparative pain assessment data just before and 1 hour after the administration of the opioid narcotic analgesic

heparin Complications - clotting

DVT PE

pain from bone metastases

Dexamethasone or Bisphosphonates

The nurse is administering medications to a 5 year old client diagnosed with pneumonia. The health care provider has ordered a cough suppressant. Which medication does the nurse administer?

Dextromethorphan

A 16-year old male has an appointment with his psychiatrist. He is currently taking haloperidol regularly. The patient complains of dry mouth, weight gain, and muscle stiffness. What adverse effects is this patient experiencing, and what medication will the psychiatrist give?

Extrapyramidal symptoms. benadryl

Adjuvant therapies include

Gabapentin or Duloxetine Neuropathic pain

The nurse is preparing a 3-year-old child for an incision and drainage of large left leg abscess. The nurse understands which of the following types of anesthesia will be administered to the child?

General Anesthesia

Inform the parent of the child you are feeding B. Inform the mother of the child whose milk you fed to the child C. Complete an incident report per facility policy D. Inform the providers who are caring for the infants

Listen and ask him questions about his life is considered to be a regular psychosocial activity for older adults

Which of the following statements about appendicitis are true

McBurney's point tenderness is a sign of appendicitis. Appendicitis is more common among males

Warfarin nursing considerations

Monitor for bleeding Monitor PT and INR PT Normal: 10-13 seconds INR Normal: <1-2 Therapeutic INR: 2-3

You are caring for a 17-year-old patient who has been taking isotretinoin (Accutane) for the past three months. The most critical assessment for this patient is

Mood changes

Patients on a heparin drip have aPTT levels drawn q4-6 hours to titrate the drip.

Normal aPTT: 30-40 seconds Therapeutic aPTT: 1.5-2x normal

Normal saline is the most appropriate intravenous fluid for blood transfusions

Normal saline is an isotonic solution that will not cause blood hemolysis or red blood cell clumping

.The nurse administers bumetanide (Bumex), a loop diuretic, to a client with pulmonary edema. The nurse should watch out for which symptom that indicates a complication to the medication?

Painful leg cramps

Anticonvulsants

Phenytoin (Dilantin) ● Carbamazepine ● Divalproex ● Gabapentin ● Lamotrigine ● Levetiracetam (Keppra)

Your 78-year-old client who has been receiving antibiotics for ten days tells you that he is having frequent watery stools. Which action will you take first?

Place the client on contact precaution

What is the sequence of action when you are mixing two insulins, such as NPH insulin and regular insulin, together in the same syringe? Place these steps in the correct order.

Prep the top of the vials with an alcohol pad Inject an amount of air equal to the ordered dosage of the NPH insulin. Inject an amount of air equal to the regular insulin. Withdraw the ordered dosage of the regular insulin Withdraw the ordered dosage of the NPH insulin.

receiving a blood transfusion. Signs and symptoms of a transfusion reaction include (REACTION)

RASH Elevated temperature Aching Chills Tachycardia Increased pulse Oliguria - low urine output Nausea

One of the most severe side effects of selective serotonin reuptake inhibitors (SSRI) is a serotonin syndrome. While educating a patient who was just initiated on an SSRI, which of the following symptoms of serotonin syndrome should the nurse emphasize to the patient?

Rapid heart beat Muscle twitches

Antianxiety Agents

Short acting ● Midazolam | onset: rapid | duration 1-2 hours - quick on/ quick off Intermediate acting ● Alprazolam | onset: intermediate | duration: 6-12 hours ● Clonazepam | onset: intermediate | duration: 18-50 hours ● Lorazepam | onset: rapid IV, intermediate PO| duration: 2-6 hours - medium on/long off Long acting ● Diazepam| onset: rapid | duration: 20-50 hours - quick on/ long off

Clinical manifestations of heparin complications

Skin lesions at heparin injection sites ○ Chills ○ Fever ○ Dyspnea ○ Chest pain

A A client diagnosed with acute gastroenteritis is prescribed 30mEq of oral potassium chloride twice daily for hypokalemia. The nurse should implement which nursing intervention in administering the medication:

Sprinkle contents of capsule on apple sauce to increase palatability

HEPARIN USES

Strokes Chronic a-fib Post-operatively

HEPARIN ADMINISTRATION

Subcutaneous Intravenous

The nurse is caring for a 2 year old child with hypovolemic shock due to severe dehydration. The child weighs 11 kg. After obtaining appropriate IV access, the nurse prepares to administer 0.9% Normal Saline fluid bolus. Please enter the amount of initial fluid bolus to be administered in milliliters. Enter numerical value only. ____ milliliters.

The child should be given normal saline bolus at a dose of 20 ml/ kilogram over 5 to 15 minutes. IV fluid Bolus to be administered = 20 x 11 = 220 ml over 5 to 15 minutes. Repeat the blouses as necessary.

One of the most common side effects of terbutaline is pulmonary edema

The nurse should monitor the client's breath sounds and assess for respiratory crackles and difficulty of breathing to detect if pulmonary edema is present.

Phenytoin

Therapeutic class: Anticonvulsant Indication: Seizures Action: blocks sustained high frequency repetitive firing of action potentials Nursing Considerations: ● Therapeutic level: 10-20 mcg/mL ● Side effect: gingival hyperplasia ○ Regular dental check-ups ○ Use soft bristle toothbrush ● Antacids can reduce the effect of phenytoin and should be avoided.

Heparin Induced

Thrombocytopenia and Thrombosis (HITT)

Your 75 year old female client complains of pain due to post-herpetic neuralgia. She is taking Naproxen. Which of the following coanalgesics should be added to her pain management regimen?

Topical Lidocaine

The nurse is taking care of a client with neuropathic pain. He is already on Acetaminophen and Gabapentin, but no relief. He rates his pain at six on a numerical pain rating scale of 0 to 10. According to the WHO Three-Step Analgesic Ladder, which of the following is indicated next

Tramadol plus Acetaminophen plus Gabapentin

Complication of Heparin therapy

Usually occurs 5-10 days after Heparin exposure Suspect in any patient on Heparin who has an unexplained platelet drop

Warfarin antidote

Vitamin K

A nurse is caring for a client receiving digoxin. The client's most recent digitalis level was 2.5 ng/mL. The nurse should take which priority action(s)

Withhold the client's scheduled dose Assess the client's heart rate and rhythm.

Your client is receiving a nonsteroidal anti-inflammatory medication (NSAID) in addition to a narcotic analgesic. The client asks why they aregiving an NSAID because the narcotic analgesic is much better than the NSAID. How would you respond to this client's question?

You are getting the NSAID, so the effects of the narcotic analgesic to combat your pain are more effective

A client is about to go for a CT angiogram, which involves the administration of an intravenous radiopaque dye. In preparing the client for the procedure, the nurse's responsibility is to educate him by saying:

You will likely experience flushing of the face

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine and norpinephrine

Aspirin

anti-platelet therapy is usually stopped 5 to 7 days before the scheduled surgery

Tolterodine/detrol

anticholinergic / overactive bladder. decreased urgency and urinary frequency.

Other adjuvant analgesics (coanalgesics) used for pharmacological management of pain include

antidepressants : fluoxetine, duloxetine tricyclics such as amitriptyline, and imipramine corticosteroids, skeletal muscle relaxants: baclofen, carisoprodol, cyclobenzaprine, diazepam anticonvulsants: pregabalin, gabapentin, carbamazepine

Some medications that cause aplastic anemia include

chloramphenicol, phenylbutazone, sulfonamides, anticonvulsants, cimetidine, and NSAIDs.

Dextromethorphan

cough suppressant. It is the ingredient in many over the counter cough medicines such as Delsym, Robitussin, and NyQuil

warfarin actions

disrupts liver synthesis of Vitamin K dependent clotting factors

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid?

grapefruit

Hydrochlorothiazide

increases urinary output while decreasing urinary calcium levels. reduce renal calculi. Low-dose thiazides have been used to reduce the recurrence of calcium-containing kidney stones.

Accutane is a synthetic retinoid that is frequently prescribed for severe acne that does not respond to other topical and oral treatments

mood changes: Depression, irritability, altered sleep patterns, and suicidal ideation

Serotonin syndrome is a medical emergency

persistent rapid heartbeat, muscle twitches or jerking of the muscles are typical symptoms

Warfarin contraindications

pregnancy

Heparin antidote

protamine sulfate

Finasteride

reduces the size of the prostate decreases urinary retention. patients with Benign Prostatic Hypertrophy related urinary retention.

McBurney's point tenderness refers to

right lower quadrant pain

Aplastic anemia leads to pancytopenia

severe decrease in all hematological cell types: red blood cells, white blood cells, and platelets.

Doxycycline is a tetracycline antibiotic that fights bacteria in the body.

such as acne, urinary tract intestinal, respiratory, and eye infections, gonorrhea, chlamydia, syphilis, periodontitis.

Warfarin indications

venous thrombosis, pulmonary embolism, A-fib

Potassium citrate/urocit K

urinary calculi to reduce the recurrence because of its ability to alkalize the urine.

Heparin, HOW IT WORKS?

○ Thrombin → converts fibrinogen to fibrin → Fibrin forms clots! ○ Antithrombin III inhibits Thrombin ○ Heparin ENHANCES antithrombin III ○ This stops thrombin from being activated, which therefore prevents clots from forming. ● This is the intrinsic coagulation pathway

Anticoagulants

● Heparin ● Clopidogrel (Plavix) ● Warfarin ● Enoxaparin (Low-molecular weight heparin)