Pharmy

Timolol Maleate (ophthalmic)

Glaucoma Agent

Magnesium lab value

1.5-2.5

Alanine aminotransferase (ALT)

10-40 units/L

The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test?

Alanine aminotransferase (ALT)/ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis.

Divalproex (Depakote)

Anticonvulsant

Which nursing intervention should the nurse implement when administering a medication through a nasogastric (NG) tube?

Flush the tubing between administering medications

What is the most important goal of care for a client who is receiving warfarin?

Maintain a therapeutic prothrombin time

The nurse is caring for a client who is taking an antipsychotic medication for the treatment of schizophrenia. The nurse is told in report that the client has akathisia, as a side effect of their antipsychotic medication. What symptom should the nurse expect this client to have?

Reports of restlessness.

Divalproex (Depakote)

*class*: Anticonvulsant, vascular headache suppressants *Indication*: seizures, manic episodes, prevention of headache *Action*: increases the level of GABA in CNS *Nursing Considerations*: - may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis - increases risk for bleeding with Warfarin - use caution with MAOIs - monitor liver function tests

A client diagnosed Alzheimer's disease has been prescribed memantine. The nurse is reinforcing education about this medication. What points should the client know about this medication?

1. & 5. Correct: This medication can cause dizziness, so safety precautions should be taught to the caregiver. Extended release caps should not be crushed, chewed, or divided. If the client cannot swallow it whole, it can be opened and sprinkled on a small amount of applesauce.

Donepezil (Aricept)

Alzheimer's

Which medication does the nurse expect will help decrease tremors in a client diagnosed with hyperthyroidism?

Beta blockers / Beta blockers help anxiety and tremors. Beta blockers reduce the effects of adrenaline in the body and help decrease anxiety. In times of stress and emergency the adrenal gland produces adrenaline that acts on various organs in the body to enable us to deal with the situation. For example, the heart beats faster due to adrenaline. In order for adrenaline to be able to do this, various organs have beta receptors to accept the adrenaline and use it to behave differently in times of stress. Beta blockers block these receptors. They stop various organs in the body from accepting adrenaline. Taking them means the heart does less work generally and doesn't get over-worked in times of stress. One of the main symptoms of anxiety is a speeding heart which is part of the fight-or-flight response. In times of danger our body produces adrenaline to stop the heart from beating faster makes us feel calmer. Taking beta blockers for anxiety also makes us feel less shaky. The energy boost to our muscles (from the increased supply of blood and oxygen) which makes us feel 'jittery' and 'on-edge' doesn't happen without a fast heartbeat

A client is taking methylphenidate to treat attention deficit disorder. Which changes are likely to be observed by the nurse when working with this client?

The medication may cause anorexia and subsequent weight loss. The client should be calmer if taking the medication as prescribed. The client's ability to focus on the task at hand should be increased. Insomnia is common

The nurse is caring for a client admitted to rule out myocardial infarction. The nurse has administered sublingual nitroglycerin. What time frame should the nurse expect the earliest onset of effectiveness?

The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered

What instruction should a client know about a newly prescribed salmeterol inhaler?

This inhaler should be used routinely as prescribed even when free of symptoms/ Salmeterol is a maintenance medication. It can prevent asthma attacks and exercise induced bronchospasm. Salmeterol acts as a bronchodilator. It works by relaxing muscles in the airways to improve breathing

A client diagnosed with rheumatoid arthritis has been prescribed dexamethasone orally as part of treatment therapy. What side effects should the nurse inform the client are expected?

These "select all that apply" questions can seem a bit intimidating at first, but the more you practice the basics, the better you will feel when faced with multiple options. Always start with the clues provided in the question. The client is being treated for RA, an auto-immune, inflammatory disease process which damages joints and organs in the body. Because there is no cure, the goal of treatment is to stop, or decrease, the inflammatory response in order to preserve joint and organ function while improving physical mobility. RA clients are treated with combinations of drug categories to achieve possible remission of the disease process. Some of these categories include NSAIDS, like ibuprophen or naproxen, disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate, and short term corticosteroids like methylprednisolone (Medrol). The client in this question has been placed on dexamethasone (Decadron) which falls in the corticosteroid category. Recall what happens to the body when the adrenal glands are over producing glucocorticoids, as in Cushing's disease. The symptoms are the same when a client is taking corticosteroids, regardless of the reason. Steroids are prescribed when inflammation becomes very severe, and, because of the adverse side effects, the treatment is usually short term. But even over a period of a few weeks, the client can develop significant symptoms. Option 1: Good choice! There are many side effects from the use of steroids, and fatigue is one of the chief client complaints because interruption of sleep is common. Many things can contribute to a client's exhaustion, including not sleeping well, constant pain, and systemic response to an auto-immune process. Additionally, the use of steroids increases catabolism in the body, exacerbating all body responses and leaving the client very fatigued. Option 2: Absolutely. Steroids speed up normal body processes, including vital signs, appetite and gastric function. Additionally, corticosteroids wreak havoc on the adrenal glands, which you remember control the "fight and flight" response, making it very difficult for this client to relax and rest properly. The client may have great difficulty getting to sleep or staying asleep, creating an on going cycle of fatigue and even depression. This is why this medication is given early in the day or, in the case of multiple daily doses, the largest dose is given first thing in the morning. Option 3: Not this one. Did you notice it said "hypo", indicating low blood sugar? Recall that the action of excessive corticosteroids on the adrenal glands is the body's inability to regulate all that glucose, and therefore the client would become hyperglycemic. In addition to all the other problems caused by RA, think about what happens to the body when blood sugar is too high. Do you think the nurse might also reinforce client teaching on finger sticks for blood glucose monitoring? Consider all the ways the body could be adversely affected if blood sugar is not controlled. Option 4: Another good selection. Clients with RA will be prescribed systemic corticosteroids in some form intermittently for life, whenever the disease exacerbates. The drugs may be oral, injected, or even by infusion but the body's response is similar to Cushing's disease. Truncal obesity occurs because of redistribution of body fat while very thin extremities develop because of muscle wasting. This client might develop the buffalo hump as well if steroids are used long term. Option 5: Yes! When body processes are accelerated, whether by disease or medications, an increased appetite is the logical response. It is a complicated process, but the basic version is that the corticosteroids stimulate the release of amino acids and breakdown of fats. Remembering your nursing anatomy and physiology, and the gluconeogenesis process, the body's increase in blood sugar levels also increases the appetite for more sugar and starches. Option 6: Nope. We have been describing the acceleration of the body when given corticosteroids, so it is not logical to expect blood pressure to decrease. In fact, high blood pressure is often a problem for clients when taking these medications. Steroids influence the balance of water and sodium in the body, leading to fluid retention and even CHF. Don't forget this client will also be experiencing a weight gain, which will contribute to elevated blood pressure readings.

Proton Pump Inhibitors

decrease the amount of acid produced by the stomach / prazole

Akathisia

restlessness

A client with an ischemic stroke was prescribed warfarin 5 mg daily by mouth 48 hours ago. At 0830 the international normalized ratio (INR) reading was 2.0. What action should the nurse take?

Administer warfarin/The nurse should continue to monitor the client, and administer the warfarin. The normal range for INR is 0.8 - 1.1 for a client not prescribed an anticoagulant. The optimal therapeutic INR range for a client on warfarin should be 2.0 - 3.0

What problem in the client with chronic renal failure would be prevented by receiving epoetin alfa?

Anemia/Yes, the diseased kidney does not produce the hormone necessary for bone marrow stimulation to promote RBCs. Epoetin alfa stimulates erythropoiesis (production of RBC).

The nurse enters the client's room to administer the morning dose of digoxin. Before administration, the nurse checks the client's apical pulse to find the rate to be 70. What should the nurse do?

Give the medication as prescribed / The pulse rate is high enough to give the medication. A pulse rate of less than 60 would warrant holding the medication

The primary healthcare provider prescribed diazepam 12.5 mg IM to a client. The pharmacy dispenses diazepam 5 mg/mL. How many mL will the nurse administer? Round answer using one decimal point

2.5

The nurse has been teaching the client about warfarin for prevention of pulmonary emboli. Which comments by the client indicate understanding of the medication?

1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 3. "I should eat lots of foods containing vitamin K." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider." 1/2/4/5 Do you know what warfarin is? Well you know from the stem that it is prescribed for the prevention of pulmonary emboli. How? Warfarin is an anticoagulant that reduces the formation of blood clots by inhibiting vitamin K dependent coagulation factors. So know you have an idea of what options could be correct. Let's look at them. Option 1. What do you think? True. Too much warfarin can lead to bleeding/hemorrhage. The client needs regular follow up visits to check the INR level. INR is the international normalization ratio and is used for clients taking anticoagulants. Option 2. This is true. What would happen if the client ate too much vitamin K? Vitamin K is the antidote for warfarin. So the client's INR level would not be therapeutic. Can you say pulmonary emboli?! So the client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. Option 3. Well if option 2 is true, can option 3 be true? No! Watch out for opposites. They cannot both be correct. Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage). Option 4. This is a safety issue isn't it? Yes. This is correct. In fact, a list of all medications should be provided to any healthcare providers caring for a client. What about option 5? This is True. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider?

1. Furosemide 20.0 mg p.o. daily. 2. Rosuvastatin 5 mg p.o hs 3. Digoxin 0.125 mg PO every 8 hours for three doses 4. Folic acid 1 mg daily. 5. Heparin 1000 IU subcutaneously daily. When you first read this question, you probably thought, "What medications should not be given to this client?" Right? Yes, that is what I initially thought. But look at the options. Some of these prescriptions are written incorrectly and could cause a medication error if not clarified with the primary healthcare provider. This is a safety issue. So select the options that you would need to clarify with the primary healthcare provider. Option 1: Yes. You better clarify this one! It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen. Option 2: No clarification needed here. This is a statin medication that is written correctly. Option 3: No need to clarify this digoxin prescription. It is written correctly. Option 4: Yes, clarification is needed with this prescription. The folic acid order lacks a route, thus needs clarification. Option 5: Yes, you better clarify this one. The Heparin order should be written as Heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (International units) as this can be mistaken as IV or 10.

The nurse is preparing to administer 0900 medications. Which medications should the nurse include?

1. Heparin 2. Escitalopram 3. Conjugated estrogens 4. Omeprazole 5. Lopressor 6. Magnesium gluconate / 1., 2., 3., & 4. Correct: Heparin was due at 0800 and is now overdue, so the nurse needs to administer this medication now. The other three medications are scheduled for 0900. 5. Incorrect: Lopressor needs to be held based on the prescription to hold the medication for a systolic BP below 90. This clients current BP is 88 systolic. 6. Incorrect: The latest magnesium lab value is within normal limits. Based on the prescription, this medication should be held.

Which medication should the nurse administer first after receiving the morning shift report?

1. Levothyroxine to the client with hypothyroidism and a thyroid stimulating hormone (TSH) level of 2.8 mU/L 2. Amlodipine to the client with hypertension and a blood pressure of 150/86 3. Regular insulin sliding scale dose to the client with diabetes and a 210 blood glucose level. 4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000mm3 /4/This is a priority question, so you have to decide which client needs their medication first. If you look at these option you will see that three are really routine meds given at a set time. Only one is different. Only one is a new medication for a new admit. See it? Option 1 is false. The thyroid medication can be administered within the 30 minute time before and after the scheduled administration time. The TSH is a normal value. Option 2 is false. Although the blood pressure is elevated, the amlodipine is for high blood pressure and should be administered. It is not a priority over the first dose of the IV antibiotic. Option 3 is false. The regular insulin is important to administer but it is not priority over initiating the IV antibiotic therapy. The blood glucose level is elevated but it is not a critical value. Option 4 is true. The first dose of an intravenous antibiotic medication is the priority and should be administered within 1 to 2 hours from when the prescription was placed. This is the priority medication to administer first. The WBC count is elevated

Which signs and symptoms would indicate to the nurse that the client is having an anaphylactic response after receiving penicillin?

1. Reports a scratchy throat 2. Faint expiratory wheeze on auscultation. 3. Client statement, "I feel like something is wrong." 4. Bounding radial pulse rate of 100/min 5. BP 100/70 1., 2. & 3. Correct: Swelling of face, mouth, throat, and a scratchy throat are indicative of an inflammatory response that could obstruct the airway. Wheezes and stridor are indicators of breathing difficulties seen with anaphylactic reaction. A sense that something bad is happening should serve as a warning that something bad is really going on. Suspect anaphylactic response. 4. Incorrect: The pulse rate would be increased, but the client would have a thready, weak pulse, not bounding. The pulse may also be irregular. 5. Incorrect: This blood pressure is not below 90 systolic which could indicate shock. Although on the low side, simply getting this BP reading does not tell you if perfusion is adequate. Once blood pressure decreases, other symptoms may appear such as dizziness, blurred vision and loss of bladder/bowel control.

The nurse is preparing to administer nadolol to a hospitalized client. Which client data would indicate to the nurse that the medication should be held and the primary healthcare provider notified?

Heart rate 56/min/This is a beta blocker. It slows the heart rate. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. Administering a beta blocker to a client who has a heart rate less than 60 could possibly cause the client to develop symptomatic bradycardia and hypotension

A postpartum client is receiving methylergonovine maleate 0.2 mg by mouth three times a day. What is most important for the nurse to monitor with this client?

Hypertension/ Methylergonovine affects smooth muscle of a woman's uterus. It improves muscle tone and strength. It is used after childbirth to help deliver the placenta. Cardiovascular side effects have included palpitations, hypertension, hypotension, acute myocardial infarction, transient chest pains, arterial spasm (coronary and peripheral), bradycardia, and tachycardia. These need to be reported to the primary healthcare provider

While in the emergency department, a 68 year old client being treated for flu symptoms, became symptomatic with an episode of atrial tachycardia which was successfully treated with cardioversion. After stabilization, the client was admitted to the telemetry unit with a diagnosis of the flu, and a history of angina. Primary healthcare provider prescriptions were received. What is most important for the nurse to ensure prior to administering Peramivir?

It is an inhibitor of the influenza virus and is indicated for the treatment of acute influenza in clients over the age of 2 years who have been symptomatic for no more than 2 days. The dose of this medication needs to be decreased if the creatinine clearance of a client is less than 50 mL/min, so the nurse must know the prescribe creatine clearance level of this client prior to administering. Creatinine clearance is greater than 50 mL/min

One hour after administering pyridostigmine, the nurse notes increased salivation, lacrimation, and urination in the client. What initial action should the nurse take?

Notify the primary healthcare provider / Anticholinesterase drugs are aimed at enhancing function of the neuromuscular junction. Acetylcholinesterase is the enzyme that breaks down acetylcholine. Thus inhibition of this enzyme by an anticholinesterase inhibitor will prolong the action of acetylcholine and facilitate transmission of impulses at the neuromuscular junction. Pyridostigmine is the most successful drug of this group in long-term treatment of myasthenia gravis. Cholinergic crisis happens when too much cholinergic medications are taken and, if not treated accordingly, respiratory failure and hypotension might happen. When cholinergic crisis takes place, the muscles cannot react to the inflow of acetylcholine so symptoms usually follow. Symptoms may include salivation, lacrimation, urination, and defecation. Failure of the respiratory system occurs due to the insufficient gas exchange. Flaccid paralysis, too much sweating, bronchial secretions, and miosis develop. While myasthenic crisis requires the application of more anticholesterase drugs, cholinergic crisis must not use these. Atropine is given in order to enhance and maintain respiration.

A female client has used Depo-Provera injections for birth control for several years. For the past 6 months, attempts to become pregnant have been unsuccessful. What information should the nurse provide the client?

Ovulation ceases with Depo-Provera use. It may take 6 to 18 months to reestablish normal ovulation and menstruation.

The nurse is caring for a client on the post surgical unit. What should the nurse know about short term treatment of post op pain?

Pain control following surgery rarely results in addiction

Which side effect of chemo should the nurse immediately report to the primary healthcare provider?

Paresthesia is a side effect of some chemotherapeutic medications and if it occurs, the primary healthcare provider needs to modify the dosage or discontinue

A client is diagnosed with a duodenal ulcer due to Helicobacter pylori (H Pylori). In addition to antibiotic therapy, the nurse anticipates that the client will also receive what class of pharmacologic agent?

Proton pump inhibitor/ Antisecretory agents like proton pump inhibitors are indicated for the treatment of peptic ulcer disease. Antisecretory agents decrease the secretion of gastric acids. Protein pump inhibitors, a combination of antibiotics and bismuth salts are most commonly used for treatment of H Pylori

After discontinuing a peripheral IV line, it is most important for the nurse to record which information?

The length and intactness of the catheter tip / This is the most important information that needs to be documented. This information would be important in determining if a potential safety issue/complication could occur as a result of the IV line being removed or a portion of the catheter tip breaking off before remova

The son of a client diagnosed with Alzheimer's Disease who is listed as a person who has access to the client's health information asks the nurse why his father has been prescribed donepezil. What response should the nurse make?

This medication is used to treat confusion. /Although drug therapy is available for Alzheimer's disease, these drugs do not cure or reverse the progression of the disease. Drugs help many people, but not for very long and not very well. The use of drugs may lead to a modest decrease in the rate of decline of cognitive function. However, the drugs have no effect on overall disease progression. One way Alzheimer's harms the brain is by decreasing levels of acetylcholine, a chemical messenger that's important for alertness, memory, thought and judgment. Cholinesterase inhibitors are a type of drug that boosts the amount of acetylcholine available to nerve cells by preventing its breakdown in the brain. Cholinesterase inhibitors can't reverse Alzheimer's disease, and they don't stop the underlying destruction of nerve cells. Because dwindling brain cells produce less acetylcholine as the disease progresses, these medications eventually lose effectiveness. Donepezil is the only Alzheimer's drug approved to treat all stages of the disease. It's taken once a day as a pill. It's usually well-tolerated, with side effects occurring in about 20 percent of people who take it.

The nurse is reinforcing client education about timolol maleate. What should the client know about the newly prescribed timolol maleate eyedrops for glaucoma?

Timolol maleate is a beta-blocker. Beta-blockers decrease aqueous humor production.

A client with a history of adrenal insufficiency is placed on fludrocortisone. Which value is most important for the nurse to monitor?

Weight / Weight is monitored daily to check for sudden increases which would indicate fluid retention. Fludrocortisone is a man made glococorticoid and is used to treat low gloucocorticoid levels caused by diseases of the adrenal gland. Glucocorticoids are important in maintaining salt and water balance in the body and normalizing blood pressure.

A client has a diagnosis of major depression and began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working. Which reply by the nurse indicates adequate understanding of treatment?

You should reach desired effect in 1-3 weeks.

The nurse is reinforcing client education on zolpidem. Which statement by the client indicates to the nurse that the client understands important points about zolpidem?

Zolpidem is a sedative, also called a hypnotic. It affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia). Zolpidem may impair the client's thinking or reactions. The cleint may still feel sleepy the morning after taking this medicine, especially if taking the extended-release tablet. Wait at least 4 hours or until fully awake before doing anything that requires being awake and alert. Some people using this medicine have engaged in activity such as driving, eating, walking, making phone calls, or having sex and later having no memory of the activity