ATI LSRN Pharm Final

6 yr old client w/ asthma & several prescription meds using metered dose inhalers, pt. getting d/c; which interventions should the nurse include in the plan? -add a spacer to each MDI -instruct the child to inhale more rapidly than usual when using an MDI -request that the provider change the child's meds from inhaled to oral forms -administer oxygen by facemark along w/ the MDI

-add a spacer to each MDI -MDIs are difficult to use correctly- adding a spacer applied to an MDI can make up for lack of hand-lung coordination by inc. amount of med delivered to lungs

iron dextran IV to a pt.-which of the following actions should the nurse plan to take? -administer a small test dose before full dose -infuse the med over 30 seconds -monitor the client closely for HTN -administer cyanocobalamin as an antidote if iron dextran toxicity occurs

-administer a small test dose before full dose -a serious adverse effect is anaphylaxis -a small dose should be administered over 5 min. before full dose

what does taking omeprazole inc. r/f? how long should you take this med? s/e?

-inc. r/f pneumonia -use for 1-2 mo. -inc. r/f fractures and hypomagnesemia

5 adverse effects of theophylline toxicity?

-tachycardia -restlessness and irritability -tremors -seizures -diarrhea

a nurse is administering insulin glulisine 10 units subQ at 0730 to an adolescent client who has type 1 DM. the nurse should anticipate onset of action at which of the following times? -0800 -0745 -0900 -1030

0745 -very SHORT onset of action of 15 min.

NPH insulin onset of action?

1-2 hr

what is normal potassium level?

3.5 to 5.0

regular insulin onset of action?

30-60 min.

TB skin skin positive pt- prescription for isoniazid; teach pt. to monitor which lab? -TSH -AST -potassium -sodium

AST -isoniazid can be toxic to the liver

what class of drug is phenelzine?

MAOI

what is fluticasone?

a glucocorticoid med for long-term prophylaxis of asthma

what is cromolyn?

a mast cell stabilizer w/ anti-inflammatory action designed for prophylaxis of asthma; used on a find schedule

what does naltrexone do for alc. d/o?

decreases cravings

what is echinacea used for?

herb w/ manifestations and duration of colds and flu like illnesses

what is salmeterol?

long acting beta2-adrenergic agonist used for prophylaxis of asthma

what does acamprosate do for alc. d/o?

used to maintain abstinence

diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction- the client has an IV infusion containing a med that is incompatible with diphenhydramine in soln. what should the nurse do? -choose an IV port for IV bolus injection of the diphenhydramine as near as possible to the client's hanging IV bag -flush the IV tubing w/ 2 mL of 0.9% sodium chloride before and after administering diphenhydramine -allow the IV infusion to keep running while administering the diphenhydramine via IV bolus -aspirate to check for IV patency

-aspirate to check for IV patency

pt. has a venous thrombosis and a prescription for warfarin. which of the following instructions should the nurse include in the teaching? -take ibuprofen PRN for HA -carry a medic alert ID card -report to the lab weekly to have blood drawn for aPTT -inc. intake of dark green veggies

-carry a medic alert ID card -at r/f bleeding so if emergency, need ID card

pt. w/ alcohol use d/o and is admitted w/ lower extremity fractures following a motor-vehicle crash- a few hours after admission, a client develops restlessness and tremors;w which med should nurse administer? -acamprosate -naltrexone -chlordiazepoxide -disulifiram

-chlordiazepoxide -long-acting oral benzo -benzo= help w/ alcohol withdrawal

a nurse is administering cipro and phenazopyridine to a client who has a severe UTI. the client asks why both meds are needed- nurse's answer?

-cipro is to treat the infection, phenazopyridine treats pain from UTI

what are manifestation of levothyroxine OD?

-similar to hyperthyroidism effects -tachycardia -heat intolerance -hyperthermia -tremor -anxiety

what kind of s/e does HYDROXYZINE have?

anticholinergic (dry mouth, constipation, dilated pupils, inc. HR)

a nurse is caring for a client who was brought to the emergency dept. by friends who report the client has OD on heroin; which of the following findings should the nurse expect to assess? -temp 39.2 (102.6) -RR 30/min -pinpoint pupils -severe ABD cramping

pinpoint pupils -expected finding in opiod toxicity

nurse providing d/c teaching to a client who has a bleeding duodenal ulcer and is prescribed omeprazole. which of the following statements should the nurse include in the teaching? -you will need to take this med for the next 6 mo. -taking this med will dec. r/f acquiring pneumonia -take this med before breakfast every day -watch out for serious s/e of tachycardia and heart palpitations while taking this med

take this med before breakfast every day -less effective when taken w/ food

how should you d/c clonidine? s/e of the med?

taper- if stopped abruptly could cause HTN crisis -dry mouth, constipation

intranasal calcitonin-salmon med administration? what should you do if nasal bleeding occurs?

-1 nostril daily- rotate nostrils each day -depress the side arms to activate the pump -long-term therapy -d/c med and notify provider

adenosine half life? s/e?

-10 seconds -dyspnea, flushing of the face -warmth

a nurse is planning to administer epoetin alfa to a pt. w/ chronic kidney failure. which of the following data should the nurse plan to review prior to administration of this med? -BP -temp -blood glucose levels -total protein level

-BP -this med causes HTN which can lead to stroke or other CV complications -need concurrent use of HTN med

administration rules for iron dextran?

-IV infusion-infuse the med over 10-15 min -IV bolus-at least 1 min. -give a small test dose to monitor for anaphylaxis -deferoxamine is an antidote for iron toxicity

what is ginger used for?

-a root used to prevent and treat N/V

nurse providing teaching to parents of school-age child who has asthma about meds for bronchospasm- what med relieves an acute asthma attack? -salmeterol -cromolyn -fluticasone -albuterol

-albuterol -acute asthma attack -1 to 2 puffs every 4-6 hr PRN for school aged child

a nurse is planning care for a female client w/ irritable bowel syndrome w/ diarrhea (IBS-D) and a prescription for alosetron- which intervention should be included in plan of care? -client must sign an agreement before administering alosetron -client must stop taking alosetron if diarrhea cont. 1 week after beginning the med -client should expect to have a dec. HR -client should should a barrier birth control b/c alosetron interacts w/ oral contraceptives

-client must sign an agreement before administering alosetron -this med has potentially fatal adverse effects associated w/ constipation and bowel obstruction -FDA placed this med on the market only is pt. signs and adheres to a risk management program w/ alosetron

what is ginkgo biloba used for?

-dietary supplement in US for inc. cognitive function in elderly and improve leg pain of intermittent laudation and other peripheral arterial disorders

how do you do drop factor?

-do not use mg -only use mL -time: min, hr -and gtt/mL (drop factor)

how often do you need aPTT and INR for warfarin?

-drawn for first 5 days -then, twice weekly for the next 1-2 weeks

a nurse is administering oral hydroxyzine to a client. what s/e should the nurse expect? -diarrhea -anxiety -N/V -dry mouth

-dry mouth

adenosine via IV bolus for a client w/ paroxysmal atrial tachycardia-for which of the following findings should the nurse assess for? -seizures -cinchonism -dyspnea -transient pallor of face

-dyspnea -occurs due to bronchoconstriction

cyclosporin- length of time on med after a transplant? HTN or hypotension? what other specific s/e? why is this med given to transplant pt.s?

-for the rest of the pt. life -HTN -hirsutism (unusual hear growth) -immunosuppression so that the transplanted kidney will not be rejected from pt. body

what does disulfiram do for alc d/o?

-helps clients who have alcohol d/o to avoid drinking

diltiazem via IV bolus to a client w/ a. fib- when assessing the client, the nurse should recommend which of the following findings is CI to administration of diltiazem? -hypotension -tachycardia -dec. level of consciousness -hx of diuretic use

-hypotension -diltiazem can be a tx for essential HTN bc it LOWERS BP

pt. w/ kidney transplant taking cyclosporine- which of the following statements by the client indicates an understanding of the teaching? -i will be able to stop this med 6 mo after my surgery -i am likely to develop higher BP while taking this med -i am likely to lose my hair -i am taking this med to boost immune system

-i am likely to develop higher BP while taking this med -cyclosporine can inc. BP and may need HTN therapy

d/c teaching about lithium tox to a client who has a prescription for lithium- which of the following statements indicates an understanding of the teaching? -i should take naproxen if i have a HA b/c aspirin can cause lithium toxicity -i can develop if i eat foods w/ lots of sodium -i can develop if i experience N/D -i might need to take a daily diuretic along w/ lithium to prevent lithium toxicity

-i can develop if i experience N/D -nausea and diarrhea can cause electrolyte imbalances -lithium tox is cause by kidneys retaining lithium instead of sodium if sodium is too low

a nurse is providing teaching to a client w/ HTN and DM type 1 w/ a prescription for metoprolol. which statements indicates an understanding of the teaching? -i might have difficulty recognizing when my blood sugar is low -i will have less risk for developing an infection while I take this med -i should be concerned about losing excess weight while i take this med -i could have more problems w/ high blood sugars while taking this med

-i might have difficulty recognizing when my blood sugar is low -this med is used to treat HTN, since it dec. HR, hypoglycemia may be more difficult to recognize -client needs to recognize hypoglycemia by other manifestations such as hunger, nausea, and sweating

major depressive d/o pt. w/ a prescription for amitriptyline; which statement indicates understanding? -i will take in AM b/c i am likely to have trouble falling asleep if i take it in the evening -i will move slowly when i stand up b/c can cause my BP to dec. -i can drink a glass of beer/wine w/ my evening meal -i will avoid foods high in fiber b/c diarrhea

-i will move slowly when i stand up b/c can cause my BP to dec. -orthostatic hypotension

nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. which of the following statements by the client indicates an understanding of the teaching? -i will administer a spare into each nostril daily -i should expect nasal bleeding for the first week -i will need to depress the side arms to activate the pump -i should expect to take this med for a short term course of tx

-i will need to depress the side arms to activate the pump

a nurse is providing teaching to a client who has heart failure and is taking spironolactone. which of the following statements by the client indicates an understanding of the teaching? -i will inc. my intake of citrus fruits, bananas, and potatoes -i will use salt substitutes on my food -i will drink as much water as i can while taking this med -i will watch for inc. breast tissue growth while taking this med

-i will watch for inc. breast tissue growth while taking this med

how should the nurse administer oxytocin?

-increase the dose until obtain uterine contraction that occur every 2-3 minutes -goal duration of contraction is 45-60 seconds -BP should be continually monitored -used for cervical ripening/ postpartum bleeding -administed IV infusion for cervical ripening' IM for PP bleeding

client in preterm labor and has prescription for nifedipine-client is concerned b/c her father takes nifedipine for his angina pectoris. what is the MOA of angina pectoris? -dec. incidence of bacterial vaginosis -inhibits uterine contractions by blocking entry of calcium into uterine cells -dec. the activity w/in the CNS, which regulates all smooth m. -beta2 receptors in the uterus which results in dec. frequency of contractions

-inhibits uterine contractions by blocking entry of calcium into uterine cells

client has DMII and a prescription for metformin. which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? -weight gain -myalgia -hypoglycemia -severe constipation

-myalgia -myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis

what must occur for a pt. to take alosetron? how long until effects of the med are seen? what can happen to pt. HR while on this med? does this med interact w/ birth control?

-needs to sign an agreement and be enrolled in risk program -1 month to control diarrhea -tachydysrhythmias (should notify provider) -no it does not and has FEW drug interactions

hospice nurse is caring for a client w/ cancer and is taking naproxen 250 mg 3 times daily PO and gabapentin 1,800 mg 3x daily PO to manage pain. pt. states "I'm having pain that keeps me from doing what I'd like most of the time"- which following addictions should the nurse anticipate to the client's med regiment? -oral meperidine -parenteral naloxone -parenteral diazepam -oral oxycodone

-oral oxycodone

monitor what lab for receiving chemotherapy w/ methotrexate via IV infusion? -BUN 18 -platelets 78,000 -hemoglobin 14.2 -AST 35

-platelets 78,000 -chemotherapy can cause thrombocytopenia and bone marrow suppression and puts client at r/f severe bleeding

d/c teaching to a client who is to begin long-term oral prednisone for asthma. which of the following instructions should the nurse include in the plan? -stop taking the med if a rash occurs -ake the med on an empty stomach to enhance absorption -schedule the med on alternate days to dec. adverse effects -treat SOB w/ an extra dose of the med

-schedule the med on alternate days to dec. adverse effects -long-term glucocorticoid s/e are suppression of adrenal glands which can be avoided by using alternate-day therapy

pt. w/ alzheimer's disease- lorazepam 1 mg x3 daily for restlessness and anxiety during the past few days- which adverse effect should the nurse assess for? -low-grade fever -sedation -diuresis -tonic-clonic seizures

-sedation -a benzo w/ sedative effects

amitriptyline administration specifics and s/e?

-sedative effects -often prescribed three times daily until a therapeutic dose has been achieved and then the entire dose is prescribed at bedtime to help the client sleep at night and prevent daytime drowsiness -should NOT be taken w/ other CNS depressant such as alc. or sedatives -anticholinergic s/e such as constipation, dry mouth, blurred vision, urinary retention

what is spironolactone derived from? what kind of adverse effects can it have? what class of med?

-steroids -adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women -potassium sparing diuretic

pt. w/ heart failure taking oral furosemide 40 mg daily. s/e to monitor and notify provider if it occurs? -nasal congestion -tremors -tinnitus -frontal HA

-tinnitus -loop diuretics can cause ototoxicity

pt. has hypothyroidism and takes levothyroxine- what finding should alert the nurse the client is experiencing levothyroxine OD? -bradycardia -cold intolerance -tremor -hypothermia

-tremor -tremor and anxiety are expected findings in acute levothyroxine OD -findings similar to those seen in hyperthyroidism

how should a child use an MDI?

-w/ a spacer -inhale slowly over 3-5 seconds -wash mouth afterwards

how should oral glucocorticoids be taken?

-w/ food or on a full stomach -taper when d/c -take in the AM

digoxin administration? s/e? s/e of digoxin tox?

-weigh pt. daily and record the weight -w/hold digoxin if HR is below 60 -s/e: hypokalemia -pt. should inc. potassium intake -digoxin tox= visual disturbances, HR less than 60

what are common s/e while taking metformin?

-weight loss -lowers blood glucose -N/V/D

pt. w/ angina pectoris and a prescription fo verapamil. the client tells the nurse "my brother takes verapamil for HTN. do you think the provider made a mistake?" which response should the nurse make? -used to treat both high BP & angina -talk to your provider to make sure -are you concerned you might have high BP? -prescribed so you won't develop HTN

VERAPAMIL used to treat both high BP & angina -calcium channel blocker that dilates arteries and decreases after load

pt. prescribed furosemide 40 mg daily- pt. reports taking extra doses to promote weight loss. which of the following findings should indicate to the nurse the pt. is dehydrated? -urine specific gravity 1.035 -distended neck veins -BUN 18 mg/dL -bounding radial pulses

a urine specific gravity greater than 1.030 is an expected finding of clients who are dehydrated

HTN and oral clonidine- which instruction should nurse include? -d/c med if rash develops -expect inc. salivation during first few weeks of therapy -minimize fiber intake to prevent diarrhea -avoid driving until the client's reaction to the med is known

avoid driving until the client's reaction to the med is known -can cause drowsiness, weakness, sedation, and other CNS effects

terbutaline MOA

beta2 receptors in the uterus which results in dec. frequency of contractions

a nurse is planning d/c teaching for a client who has major depressive d/o and a prescription for phenelzine. which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine? -broiled beer steak -mac and cheese -pepperoni pizza -smoked salmon

broiled beer steak

client w/ CHF taking digoxin- client reports nausea and refuses to eat breakfast. which action should the nurse take first? -encourage the client to eat the toast on the breakfast tray -administer an antiemetic -inform the client's provider -check the client's apical pulse

check the client's apical pulse -N/V, anorexia, fatigue, visual effects and cardiac dysrhythmias often are cause by a slow pulse rate which are possible findings in digoxin toxicity -all other answers are true they just are not the priority

hydrochlorothiazide for HTN- the nurse instructs the client to eat foods rich in potassium- which statement indicates an understanding from pt? -this med will not work unless i have enough potassium -K+ will inc. the therapeutic effect of my BP medication -K+ will lower my BP -this med can cause a loss of K+

this med can cause a loss of K+ -excretion of potassium from kidneys can cause hypokalemia

theophylline for relief of chronic bronchitis- which s/e indicates theophylline toxicity? -constipation -tremors -fatigue -bradycardia

tremors -theophylline is a CNS stimulant -a xanthine derivative bronchodilator

pt. uses several herbal and vit. supplements daily, including saw palmetto. the nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects? -urinary health promotion -immune system stimulation -dec leg pain from arterial disease -prevention of nausea by motion sickness

urinary health promotion -used for BPH and prostatic conditions

when is cyanocobalamin administered?

vit. B12 -clients who have megaloblastic anemia