ATI Pharmacology
Oxytocin discontinuation criteria
contractions longer than 60 seconds; 50mmHg or greater; more often than 2-3 minutes; elevated uterine resting tone (over 15-20)
indication of toxic reaction to hydroxychloroquine (Plaquenil)
decreased visual acuity (retinopathy); headache; hematologic effects; abdominal cramps
St. Johns Wort drug interaction
decreases effectiveness of oral contraceptives
Mirtazapine therapeutic use
depression
Tranylcypromine therapeutic use
depression
Pt. teaching for nitroglycerin sublingual tablets
dial 911 if one tablet does not relieve pain and then take up to 2 more 5 min. apart while waiting
______ causes oral medications to pass too quickly through the GI tract to be absorbed.
diarrhea
Expected side effects for oral Erythromycin
diarrhea, epigastric pain, nausea and vomiting
Pt. teaching for methotrexate
do not drink alcoholic beverages; report unexplained bruising to the provider; avoid people who have infections; may take 4-6 weeks to see effects; take folic acid to minimize effects
Cimetidine pt. teaching
do not take this medication if you start taking blood thinning medications
Lithium drug interaction
do not use with NSAIDS (ibuprofen, indomethacin)
Allopurinol pt. teaching
drink at least 3 quarts of water a day; report rash to provider immediately; take after meals; report fever to provider
In CNS adverse effects, if CNS depression is likely, advise the PT not to ____ or participate in other activities that can be _____.
drive, dangerous
A DPI in inhalation med. administration stands for...
dry powdered inhaler
What to evaluate before administering Digoxin
evaluate client for nausea, vomiting and anorexia (may be signs of digoxin toxicity)
_______ is the elimination of medications from the body primarily through the kidneys. It can also take place through the liver, lungs, bowel, and exocrine glands.
excretion
Beta blocker therapy
monitor patient orthostatic blood pressure
Anticholinergic effects are effects that are a result of _____ _____ blockade. Most effects are seen in the eyes, ____ muscle, ____ glands, and the _____.
muscarinic receptor, smooth, exocrine, heart
Cyclosporine adverse effect
nephrotoxicity (monitor for elevated serum creatinine)
When using a DPI, instruct the PT ___ to shake the inhaler. The PT should take a _____ inhalation breath while pressing down on the inhaler. After inhaling, they should hold their breath for __-__ sec. Rinse the inhaler, cap, and spacer ___ per day and dry completely.
not, slow, 5-10, once
Methadone therapeutic use
opioid addiction
Fentanyl
opioid analgesic
Beclomethasone adverse effects
oropharyngeal candidiasis (white patches in mouth or throat)
Serious Adverse Reaction of Ifosfamide (Ifex)
painful urination and hematuria r/t hemorrhagic cystitis
Sumatriptan adverse effects
chest pain secondary to coronary vasospasm resulting in angina
Methods to decrease dry mouth associated with Benadryl therapy
chew on sugarless gum or suck on hard, sour candies
Pseudoparkinsonism
temporary manifestation usually disappearing after discontinuation of medication
Ciprofloxacin contraindication
tendonitis r/t risk for tendon rupture
The _____ _____ is the preferred and expected effect for which the medication is administered to a specific PT.
therapeutic effect
_____ ______ are when medications have specific risks and manifestations of toxicity.
toxic effects
A ____ name is the brand or proprietary name given by the company that manufactures the medication.
trade
Acute alcohol withdrawal delirium
treated with lorazepam (Ativan)
Flumazenil
treats benzodiazepine toxicity/ overdose
_______ substances require monitoring by a provider, but do not pose risk of abuse and/or addiction (e.g. antibiotics).
uncontrolled
Fentanyl adverse effects
urinary retention, constipation, respiratory depression, orthostatic hypotension and cough suppression
Rifampin pt. teaching
urine and other secretions will turn orange take 1 hour before or 2 hr after meals may cause fatigue and drowsiness
Pt. teaching for Warfarin
use electric razor for shaving; avoid aspirin and alcohol
Prophylactic anticoagulant therapy in pt. w/ hip fracture
use heparin
Pilocarpine (Pilocar) therapeutic use
used to great glaucoma
Lactulose
used to reduce serum ammonia levels
Timolol maleate (Timoptic) therapeutic use
used to treat glaucoma
Phenylephrine hydrochloride (AK-Dilate)
used to widely dilate the pupils esp. in preoperative optic pts.
Blood product administration
verify clients ID number, blood group and type, blood unit number
Allopurinol drug interaction
warfarin (increased risk for bleeding)
How to prepare Dilantin suspension
Shake container vigorously
Dantrolene pt. teaching
apply sunscreen when going outside (causes photosensitivity); take medication daily NOT prn; may take a week + to notice improvement in symptoms but muscle strength may decline
PRN stands for ____ ____.
as needed
z track technique
aspirate for 5-10 seconds; insert at 90 degree angle; insert needle quickly and smoothly; pull skin 1 inch to the side
Pt. teaching for chlorpropamide (Diabinese)
avoid alcohol consumption while taking this medication to prevent disulfram reaction
Finasteride (Proscar) use
benign prostatic hypertrophy
Adverse effect of cyclophosphamide therapy
bone marrow suppression (report sore throat, fever or chills immediately)
Appropriate infusion rate for PRBC administration
5ml/min during first 15 minutes to decrease risk for adverse reaction
Beta blocker adverse affects
bradycardia, nasal stuffiness, AV block, BRONCHOSPASM; mask effects of hypoglycemia
Micro tubing (gtt/min)
60 gtt/min
APTT
60-80
Tamoxifen (Nolvadex) use
breast cancer
Methotrexate patient teaching
call doctor if you develop sores in mouth; may take 3-6 weeks to work; should be taken weekly and not daily; may cause drowsiness
Adverse effects of alendronate (Fosamax)
(used to read osteoporosis) jaw pain, blurred vision and dysphagia
Creatinine lab value
0.6-1.2 mg/dL
Digoxin therapeutic levels
0.8-2.0
Hyperkalemia
A nurse is caring for a client who has heart failure and is prescribed enalapril and spironolactone. For which of the following potential side effects should the nurse plan to monitor?
Nurse is caring for client who reports daily use of acetaminophen to manage mild knee pain. Which of the following statements by the client should be of most concern to the nurse
"I take three or four Vicodin ES tablets a day for severe knee and joint pain" (risk for toxicity)
When administering ear medication, hold the dropper about ___ cm above ear.
1
When administering eye medication, hold the dropper about __-__ cm above ______ ____ and drop medication into the centre. Then have the PT close their eye _____.
1-2, conjunctival sac, gently
BUN lab value
10-20
"This medication can cause muscle pain or tenderness."
A nurse is providing teachings for a client who has hypercholesterolemia and has a new prescription for rosuvastatin. Which of the following instructions should the nurse include in the teachings?
Rifampicin Isoniazid
A nurse is reviewing the prescriptions of a client who has tuberculosis. The nurse should recognize that which of the following medications is used to treat TB? (select all apply)
Ibuprofen
A nurse is taking a medication history form a client who has a new prescription for lithium. Which of the following over-the-counter medications should the client discontinue?
"I should sit up for 30 min after taking the risedronate."
A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. Which of the following client statements indicates an understanding of the teaching?
"I will stop using the drops as soon as my vision improves."
A nurse is teaching a client who has a prescription for pilocarpine eye drops. Which of the following client statements should indicate to the nurse a need for additional teaching?
Withhold the medication
A nurse is to administer a new prescription for amoxicillin/clavulanic acid to a client. The client tells the nurse she is allergic to penicillin. Which of the following actions should the nurse take first?
Edema
A nurse working in a provider's office is taking a health history from a client who has been taking prednisone on a long-term basis for rheumatoid arthritis. The nurse should assess the client for which of the following adverse effects of this medication?
Universal blood recipient
AB
Cholinergic crisis reversal agent
ATROPINE
Severe adverse effect of zidovudine
Aplastic anemia
Aspirin Adverse Effects
Bleeding, tinnitus, gastric ulceration, nausea and heartburn
Adverse Reactions to Nalbuphine (Nubain)
Blurred vision, urinary urgency, headache and abdominal cramps
High ceiling loop diuretics
can cause ototoxicity
Dopamine therapeutic use
cariogenic shock
A nurse is reviewing a PT's health record and notes that the PT experiences permanent extrapyramidal effects caused by a previous medication. The nurse recognizes that the medication affects the PT's _____.
CNS
Extrapyramidal symptoms (EPS), which are abnormal body movements, are more often associated with medications affecting the _____.
CNS
Alprazolam (Xanax)
CNS Depressant; can cause sedation, dizziness, lightheadedness and can contribute to falls
Nifedipine, Verapamil, Dilitiazem, Amlodipine
Calcium Channel Blockers
Nitroglycerin transdermal patch pt. teaching
Call the doctor if you experience a headache; apply patch to area that is free of hair; rotate location of patch; check BP 1 hour after applying the patch
Clonidine (Catapress); Methyldopa (Aldomet)
Centrally acting alpha 2 agonists; reduce peripheral vascular resistance, heart rate and BP
CA Channel Blocker Adverse Effects
Constipation, reflex tachycardia, peripheral edema, toxicity
Vasodilator nursing interventions
Continuous ECG and BP monitoring; discard unused fluid after 24hr.; DO NOT MIX nitroprusside
Cross sensitivity for penicillins
cephalosporins (cephalexin)
Cimetidine Adverse Effects
Decreased libido, impotence and CNS effects (lethargy, depression and confusion)
How to give ophthalmic ointment
Discard first bead of ointment each administration
A nurse is caring for a client. The client states, "I don't want to take my medication." What action should the nurse take?
Document that the client refuses the medication (DO NOT ASK WHY)
Administration of timolol (Timoptic)
Drop medication into the conjunctival sac
Centrally acting alpha 2 agonists adverse effects
Dry mouth, drowsiness/sedation, rebound hypertension, LEUKOPENIA, black or sore tongue
Statins
GIVE IN EVENING; monitor liver and kidney functioning
A nurse is to administer subcutaneous short-acting insulin combined with long-acting insulin to the client before he eats breakfast at 8:00 AM. What should the nurse do?
Give the insulin at 7:30AM after checking the blood glucose level results
A nurse is caring for client taking Prednisone and has developed an infection. Nurse should expect the provider will:
Increase the dosage of prednisone to prevent adrenal insufficiency b/c stress increases need for glucocorticoids
Nursing Interventions (Clonidine, Methyldopa)
Monitor CBC, HR, BP, Never skip a dose, take at bedtime, monitor for rebound hypertension. *Do not use in pts. on MAOIs, anticoagulant therapy and hepatic failure
A nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking Propranolol. When the client reports dizziness upon standing the nurse should perform which of the following actions?
Monitor blood pressure lying, sitting and standing
Sucralfate
Most effective when administered with little or no water
Spironolactone (Aldactone)
Potassium sparing diuretic that can cause HYPERKALEMIA and HYPONATREMIA
Nonselective beta blocker (beta 1 and 2)
Propranolol (inderal), labetalol (normodyne)
Heparin Overdose Remedy
Protamine Sulfate
Instilling ear drops in child
Pull auricle down and back
Tamoxifen (Nolvadex) Adverse Effects
Pulmonary embolus, hot flushes, vaginal discharge or bleeding, hypercalcemia, endometrial cancer
Phenytoin adverse effects
Rash -> SJS (report skin rash to provider immediately)
Therapeutic Effect of of H2-Blocker Therapy
Relief of heartburn, indigestion and sour stomach
Amphotericin B Adverse Effects
Renal toxicity
Methotrexate Adverse Effects
Renal toxicity and drowsiness
Suppository insertion positioning
Sims position
Calcium Channel Blocker
Slows calcium influx into smooth muscle = arterial dilation and low BP; avoid grapefruit juice
H2- Recepter Blocker Action
Suppress secretion of gastric acid in ppl with gastric/peptic ulcers and GERD
Action of Expectorants
Treats cough by stimulating secretions
Things to monitor in patient taking Desmopressin
Urine specific gravity; creatinine clearance; serum osmolality
Verapamil/Dilitiazem
Used for A. Fib.; A. Flutter; SVT
Fab Antibody Fragments (Digibind)
Used to treat digoxin toxicity
Therapeutic effect of Liothyronine (Cytomel)
Used to treat hypothyroidism; mood improvement, weight loss, increased appetite, increased body temperature
Ginger root drug interaction
Warfarin (increases risk for bleeding)
When administering transdermal medication, place patch on a ______ area of the skin, and _____ sites to prevent skin irritation. Verify removal of _____ _____ before applying new one.
hairless, rotate, previous patch
Risk for lithium toxicity
hyponatremia
therapeutic effect of dopamine
peripheral vasoconstriction and increased systolic blood pressure; lower pulmonary capillary wedge pressure
Tardive dyskinesia
persistent following discontinuation of an antipsychotic
Reduced responsiveness to a medication administered over time to a client is termed _____ ____.
pharmacodynamic tolerance
_________ refers to how medications travel through the body.
pharmacokinestics
A term used to describe positive medication effects influenced by psychological factors is the _____ ____.
placebo effect
Oral medication administration to infant
position infant in semi upright position to decrease risk of aspiration; wrap infant in blanket; administer medication with an oral syringe; insert medication in buccal cavity
______/______ occur when medications may be contraindicated for a PT who has a specific disease or condition.
precautions/ contraindications
Feverfew herb contraindication
pregnancy
Contraindications of warfarin therapy
pregnant client b/c it can cross the placenta
therapeutic effect of Albuterol (Proventil)
prevents wheezing, opens airways, decreases coughing episodes
Gingko balboa drug interaction
proton pump inhibitors
Appropriate references to ensure safe medication administration
published journals, pharmacists, Physicians Desk Reference
The route of administration affects the _____ and _____ of absorption.
rate, amount
Colace (Docusate) therapeutic effect
regular bowel movements (1-2 soft stools per day)
Theophylline therapeutic effect
relaxation of bronchial smooth muscle (bronchodilation)
Therapeutic use of cyclobenzaprine (Flexeril)
relieve muscle spasms
Adverse effect of calcium supplements
renal stones (increase water intake; report any blood in urine or flank pain)
Action with expired medication
return the medication to the pharmacy
TB medications
rifampicin and isoniazid
What are the 6 rights of safe medication administration?
right PT, right medication, right dose, right time, right route, right documentation
A nurse is reviewing a PT's health record and notes a new prescription by the provider for lisinopril (Zestril) 10mg PO every day. The nurse should recognize this as what type of prescription?
routine prescription
Diphenhydramine side effects
sedation
In CNS adverse effects, if CNS stimulation is to be expected, PTs may be at risk for ______.
seizures
Infliximab therapeutic use
severe Chron's disease and arthritis
Zidovudine adverse effects
severe anemia; nurses should monitor patient hemoglobin levels
Albuterol
short acting beta2 agonist
Hydroxyurea therapeutic use
sickle cell anemia
_____ ______ are usually expected and inevitable outcomes when a medication is given at a therapeutic dose.
side effects
The _______ ______ pathway is when two medications are metabolized by the same pathway, they can interfere with the metabolism of one or both of the medications.
similar metabolic
Absorption with intradermal/tropical medication is _____ and _____. The effects are primarily _____, but _____ as well, especially with lipid soluble medications passing through subcutaneous fatty tissue.
slow, gradual, local, systemic
The rate of absorption in subcutaneous and intramuscular medications is determined by the _____ of medication in water and _____ _____ at the site of injection.
solubility, blood perfusion
The rate of medication absorption determines how _____ the medication will take effect.
soon
A ______ prescription is given only once and it is given immediately.
stat
Glipizide (Glucotrol) method of action
stimulates pancreas to release adequate insulin
Therapeutic use of bethanechol (Urecholine)
stimulates urination in patient with the inability to void
The rate of absorption in_______ and ______ medications is determined by the solubility of medication in water and blood perfusion at the site of injection.
subcutaneous, intramuscular
_______/_______ medications are absorbed quickly systemically through highly vascular mucous membrane.
sublingual/buccal
Early indicator of hypoglycemia
sweating; tachycardia (may be masked by beta blocker)
Doses are usually one to two _____ or one single-dose ____.
tablets, vial
Adverse effects of Albuterol
tachycardia, angina and tremors
Theophylline adverse effects
tachycardia, urinary frequency, diarrhea and insomnia
Nitroglycerin administration
take at first indication of chest pain
Fluoxetine (Prozac) administration
take first thing in the morning to prevent insomnia; take with or without food
Calcium carbonate (antacid) administration
take medication with water
Diphenhydramine (Benadryl) administration
take most of daily dose at bedtime to minimize daytime sedation
Ciprofloxacin pt. teaching
take on empty stomach w/ full glass of water; drink at least 1-2 quarts of fluid each day while taking cipro; may cause photosensitivity (wear protective clothing)
Methotrexate drug administration
take on empty stomach; drink 2-3L of water per day to promote excretion; DO NOT take with NSAIDs
Montelukast (Singulair) pt. teaching
take this medication once a day in the evening
Docusate administration
take with 8 ounces of water
When two medications can compete for the same binding sites, it can result in either _____ or ______ ________.
toxicity, decreased bioavailability
Clozapine therapeutic use
treatment of psychotic findings such as auditory hallucinations
Vitamin K decreases the therapeutic effects of ____ (____) and places the PT s at risk from developing ____ ___.
warfarin, Coumadin, blood clots
Gentamicin cream administration
wash area with soap and water before applying cream; cover area with sterile gauze after applying medication; DO NOT apply cream to large areas to avoid toxicity
Paediatric dosages are based on ____ or ____ _____ __, though some are based on _____ due to a greater risk for decreased skeletal bone growth.
weight, body surface area, age
A ____-____ (___) refers to the period of time needed for the medication to be reduced by 50% in the body.
half-life, t1/2
A nurse is talking with a client about to start taking colestipol (bile acid sequestrant) to lower LDL level. It comes in powder or tablet form. The nurse should inform the patient that if he chooses the tablets:
he will have to take up to 30 tablets per day b/c each tablet contains about 1 g of medication and the therapeutic dosage range is 15-30g/day
Beta blockers adverse cardiac effect
heart failure (decreased cardiac output) monitor for bilateral lung crackles
In general, ______ medication metabolism tends to decline with age.
hepatic
Contraindication to aspirin therapy
history gastric ulcers
Methylphenidate adverse effects
hypertension, linear growth suppression and appetite suppression (weight loss)
Isosorbide mononitrate adverse effect
hypotension
Intravenous medications will have ______ and ______ absorption.
immediate, complete
Blood samples for peak and trough levels for IV gentamycin should be drawn...
immediately prior to and 30-60 minutes after the next dose
Digoxin action
improve stroke volume and cardiac output, slowed conduction rate = increased ventricular filling
A nurse is preparing to administer prednisone (Deltasone) to a client for the treatment of rheumatoid arthritis. Which of the following indicates effective therapy?
improved range of motion (reduction in pain and inflammation)
Primary action of spironolactone
increase sodium excretion (spare potassium)
Trimethoprim/sulfamethoxazole (Bactrim) pt. teaching
increase water intake to 8-10 glasses daily in order to decrease the chance of renal damage from crystalluria
Pegfilgastim therapeutic effect
increased WBC count
Dopamine therapeutic effect
increased blood pressure
Therapeutic use of pancuronium (Pavulon)
induce paralysis and suppress respiratory effort in mechanically ventilated pt.
Medications that are _____ are rapidly absorbed through the alveolar capillary network.
inhaled
Temazepam therapeutic use
insomnia
The amount of medication absorbed determines its ______.
intensity
With ______/______ medications, absorption is slow and gradual. The effects are primarily local, but systemic as well, especially with lipid soluble medications passing through subcutaneous fatty tissue.
intradermal/topical
_______ medications will have immediate and complete absorption.
intravenous
Adverse effect of Doxorubicin (Adriamycin)
irreversible cardiomyopathy
Headache after nitroglycerin therapy...
is expected
Tardive dyskinesia S&S
jerky choreiform movements; lip smacking; neck and back tonic contractions
Contraindication for receiving live attenuated influenza vaccine
just turned 62 (must be between 2-49 yo); pregnancy and immunocompromised
Pt. teaching for insulin therapy
keep open vial of insulin at room temperature; inject subq; DO NOT ASPIRATE
Lantus teaching
lantus is not used on a sliding scale in diabetics
When administering rectal suppositories, position the PT in ____ _____ position and insert just beyond the ____ ___. Instruct the client to retain the medication __-__ min for stimulation of defecation and __ min for stimulation absorption.
left lateral, internal sphincter, 20-30, 60
Spironolactone adverse effect
lethargy
Cyclophosphamide (Cytoxan) use
leukemia, multiple myeloma, lymphomas, head, ovary, great and lung cancer
Medications that are _____ soluble or have a ______ system can cross the blood-brain barrier or the placenta.
lipid, transport
Rectal and vaginal suppositories can be easily absorbed with both ______ and _______ effects.
local, systemic
Ceftriaxone administration to older adult client
locate vastus lateralis injection site (administer in large muscle)
Digoxin administration
measure clients apical pulse
A _____ _____ ____ is how the medication produces the desired therapeutic effect.
mechanisms of action
______ _______ occur when medications interact with each other resulting in desired or undesired effects.
medication interactions
Isotretinoin pt. teaching
medication is teratogenic; pt. should receive pregnancy tests before receiving refills for medication
A half-life (t1/2) refers to the period of time needed for the ______ to be reduced by ____% in the body.
medication, 50
A malnourished client may be deficient in the factors that are necessary to produce specific ______-______ enzymes. Consequently, _____ ______ may be impaired.
medication-metabolizing, medication metabolism
The client has a history of bradycardia.
A client informs the nurse at the primary care provider's office that he received a prescription for timolol to treat glaucoma. Which of the following in the client's history should concern the nurse?
Methadone
A nurse is caring for a client who is receiving treatment for opioid addiction. Which of the following medications should the nurse expect to administer?
Decreased blood pressure
A nurse is caring for a client who is taking atenolol. Which of the following client reports indicates the medication is effective?
Risedronate pt. teaching
"rise after taking" sit up for 30 minutes after taking the medication to avoid esophagitis and dyspepsia
Pt. teaching for Bumetanide (Bumex)
(high ceiling loop diuretic); can cause ototoxicity report changes in hearing
Lithium therapeutic dose
300 mg TID
When administering nose medication, hold the dropper about ___ cm above nose. Afterwards, advise PT not to blow their nose for ___ min.
1.5, 5
In subcutaneous and intramuscular medications, highly soluble medications will be absorbed in ___-___ min. Sites with high blood perfusion at the site of injection will have ______ absorption, while sites with low blood perfusion will have _____ absorption.
10-30, rapid, slow
Hemoglobin
12-16
Normal Platelet Count
150,000-400,000
NPH Duration
18-24hr
therapeutic INR value
2-3
Short Acting Insulin Peak Time
2hr-3hr
Rapid Acting insulin Peak Time
30min - 1 hour
Hematocrit
35-45
It usually takes ____ half-lives to achieve a steady state of _____ concentration (medication intake = medication _______ & _______).
4, serum, metabolism, excretion
NPH Peak Time
4-12 hours after administration
Normal PTT Time
40-75 seconds
When using a MDI, instruct the client to shake the inhaler __-__ times, and to hold it approx. __-__ cm away from front of mouth. The PT should take a slow inhalation breath that lasts about __-__ sec. while pressing down on the inhaler. After inhaling, they should hold their breath for __ sec.
5-6, 2-4, 3-5, 10
wait until you have completed your medication therapy before receiving the vaccinations."
A client diagnosed with acute bronchitis is beginning a short course of prednisone therapy. The client asks the nurse to give him the required vaccinations because he is joining the Peace Corps. The nurse appropriately responds by stating, "You should...
Potassium of 3.1 mEq/L
A client has been prescribed furosemide. Which of the following findings should indicate to the nurse to withhold the medication?
Decrease in intraocular pressure
A client is experiencing acute angle closure glaucoma and IV mannitol 25% is prescribed. Which of the following client findings should the nurse recognize as being the best indication that the medication is achieving its therapeutic effect?
Urinary retention
A client is prescribed amitriptyline. Which of the following adverse effects should the nurse instruct the client to report?
"There is a high risk of fetal malformations while on chemotherapy."
A client is receiving chemotherapy and tells the nurse that she is trying to get pregnant. Which of the following statements by the nurse is the highest priority?
A stool softener should be taken on a daily basis.
A client receiving end-of-life care has been prescribed fentanyl patches topically every 72 hrs. Which of the following instructions regarding adverse effects of fentanyl should the nurse plan to give to the client and family?
Cephalexin
A client tells the nurse that he is allergic to penicillins. The nurse should recognize that the client can have a hypersensitivity to which of the following medications?
Sweating
A client who has diabetes mellitus is receiving insulin lispro and is prescribed metoprolol for hypertension. Which of the following should the nurse observe for in the client as an early indicator of hypoglycemia?
Hypotension
A client who is postoperative has received 2 mg of hydromorphone IV bolus every 2 hrs. The client continues to rate his pain at a 7 on a scale of 0 to 10. Which of the following client findings should the nurse attend to first?
"I have tendonitis, so I haven't been able to exercise."
A nurse at an urgent care clinic is collection a history form a female client who has a UTI. The nurse anticipates a prescription for ciprofloxacin. Which o the following client statements indicates a contraindication for this medication?
Hemoglobin
A nurse in an oncology clinic is reviewing the laboratory values of a client who is receiving chemotherapy for lung cancer and is taking epoetin alfa. Which of the following laboratory tests is used to determine the effectiveness of the medication?
Atropine
A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?
Flumazenil
A nurse in the emergency department is caring for a client whose family reports she has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering?
Increased blood pressure
A nurse is assessing a client who is experiencing cardiogenic shock and is receiving a continuous IV infusion of dopamine. Which of the following findings indicates the medication is effective?
Administer naloxone
A nurse is assessing a client who is receiving morphine for pain via secondary IV infusion. The nurse notes that the client's respirations are 8/min and shallow. After stopping the morphine infusion, what should the nurse plan to do next?
observe the client for behavioral effects of pain.
A nurse is assessing an older adult client who has Alzheimer's disease who is nonverbal and has experienced frequent falls. To determine whether the client is in pain, the nurse should....
Pregnancy test
A nurse is caring for a 20 year old female client who has been prescribed isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests will be required?
300
A nurse is caring for a child who has cystitis. The following order has been prescribed. Ciprofloxacin Elixir 15 mg/kg PO q 12 hr x 10 days. The client weighs 44 lb. How many mg should the nurse administer per dose? (round to nearest whole number)
Hemoglobin 4.2 g/dL Platelets 75,000/mm Neutrophils 1,400/mm
A nurse is caring for a client diagnosed with sickle cell anemia who is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (select all apply)
Hemoglobin
A nurse is caring for a client receiving zidovudine. For which of the following laboratory results should the nurse plan to monitor?
Serum creatinine 2.5 mg/dl
A nurse is caring for a client that has undergone a liver transplant and is taking cyclosporine. Which of the following laboratory findings indicates an adverse effect of the medication
Urine specific gravity Creatine clearance Serum osmolality
A nurse is caring for a client who has a new diagnosis of diabetes insipidus and is to start taking desmopressin. Which of the following should the nurse monitor? (select all apply)
INR of 5
A nurse is caring for a client who has a prescription for 5 mg of warfarin. Which of the following findings should the nurse report to the provider prior to administration
Increased WBC count
A nurse is caring for a client who has cancer and has been receiving pegfilgrastim. which of the following indicates the medication has been effective?
Bilateral crackles in the lungs
A nurse is caring for a client who has had a myocardial infarction and is taking metoprolol. For which of the following should the nurse monitor?
50
A nurse is caring for a client who is postoperative following a cholecysterctomy and is prescribed cefazolin 1 g by intermittent IV bolus Q6H. The amount available is 1 g in 100 mL 0.9% sodium chloride to be delivered in 30 min. The drop factor on the package of IV tubing is 15 gtt/mL. The nurse should set the IV to deliver how many gtt/min? (round to the nearest whole number)
Abdominal distention
A nurse is caring for a client who is prescribed diphenoxylate/atropine. For which of the following adverse effects should the nurse monitor?
Contractions lasting for 2 min each
A nurse is caring for a client who is receiving oxytocin IV for a post-term pregnancy. Which of the following findings indicates the oxytocin should be discontinued?
Notify the primary care provider.
A nurse is caring for a client with chronic back pain who is receiving 650 mg acetaminophen every 4 hr for pain. The primary care provider has prescribed oxycodone/acetaminophen every 4 to 6 hr PRN for breakthrough pain. Which of the following actions should the nurse take?
Maintains age-appropriate weight
A nurse is caring for a school-age child prescribed methylphenidate for ADHD. The nurse has initiated interventions to minimize adverse effects. Which of the following findings indicates a successful intervention?
Recolonizes the intestinal flora
A nurse is caring for client who has been treated for diarrhea and has a prescription for Lactbacillus acidophilus. The nurse should understand that the purpose of this medication is which of the following?
"I cannot take celecoxib because of the rash I developed taking trimethoprim/sufamethoxazole."
A nurse is caring for several clients that report allergies. Which of the following client statements indicates a medication allergy?
Shrimp
A nurse is collecting a history from a client who is scheduled for an intravenous pyelography. Which of the following food allergies places the client at risk for an allergic reaction to the contrast medium?
Warfarin
A nurse is obtaining the medication history of a client who is starting a new prescription for allopurinol. Which of the following medications should the nurse contact the provider regarding a potential interaction?
Move slowly when changing to a standing position.
A nurse is planning teaching for a client who has depression and is to start a new prescription for tranylcypromine. Which of the following should the nurse include in the teaching?
Change position slowly
A nurse is planning teaching for a client who is to start a new prescription for captopril. Which of the following instructions should the nurse include?
Isosorbide mononitrate to a client who has blood pressure 82/60 mm Hg
A nurse is precepting a newly licensed nurse who is caring for four clients. Which of the following actions should be noted in an incident report? The nurse administers
188
A nurse is preparing t administer 0.9% sodium chloride 1,500 mL to infuse over 8 hr to a client who is postoperative. The nurse should set the IV pump to deliver how many mL per hr? (round nearest whole number)
Obtain the client's blood pressure.
A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurionol. Which of the following actions should the nurse take first?
"Repot stools that appear black to the provider."
A nurse is providing discharge teaching for a client who developed a deep vein thrombosis and has a new prescription for warfarin. Which of the following should the nurse include in the teaching?
"I will check my blood pressure before applying the patch."
A nurse is providing teaching about self-administration of transdermal medication for a client who has a new prescription for nitroglycerin. Which of the following statements made by the client indicates a need for additional teaching?
Lethargy
A nurse is providing teaching for a client who has a new prescription for spironolactone. The nurse should instruct the client that which of the following is an adverse effect of this medication?
Massage the site for 10 seconds after injection
A nurse is providing teaching to a client who has a new prescription for a prefilled epinephrine injector. Which of the following should the nurse include in the teaching?
Insert air into the NPH insulin into the syringe. Insert air into the regular insulin into the syringe. Draw up the regular insulin into the syringe. Draw up the NPH insulin into the syringe.
A nurse is providing teaching to a client who has diabetes mellitus and is learning how to administer NPH insulin and regular insulin in a single syringe. The nurse should instruct the client to take the following steps in which order?
Dry cough
A nurse is providing teaching to a client who has hypertension and is to start a new prescription for lisinopril. For which of the following should the nurse instruct the client to monitor and report to the provider?
"I should call my doctor if I develop sores in my mouth."
A nurse is providing teaching to a client who has rheumatoid arthritis and is prescribed methotrexate. Which of the following statements by the client indicates an understanding of the teaching?
Drink 8 to 10 glasses of water daily.
A nurse is providing teaching to a client who is prescribed trimethoprim/sulfamethoxazole. Which of the following instruction should the nurse include in her teaching?
Chest pain
A nurse is providing teaching to a client who is to start taking sumatriptan. For which of the following should the nurse instruct the client to monitor and report to the provider?
Captopril
ACE Inhibitor; hyperkalemia; cough; 1 hr before meals; ANGIOEDEMA
Methylphenidate therapeutic use
ADHD
Therapeutic Effect of Dramamine (dimenhydrinate)
ANTIEMETIC used for motion sickness
Therapeutic effects of Hydroxyzine (Vistaril)
ANTIHISTAMINE controls emesis, diminishes anxiety, reduces amount of narcotics needed for pain relief and drys secretions
Statin Drug Interactions
AVOID GRAPEFRUIT JUICE (no more than 1qt/day) Erythromycin and Ketaconazole increase levels of statins Gemfibrozil, Fenofibrate, and Ezetimibe (Zetia) increase myopathy
Packed Red Blood Cell Administration
Administer PRBCs with 0.9% soda chloride to decrease risk for clotting and hemolysis
Sublingual Nitroglycerin Administration
Administer tablet, recheck pain in 5 minutes, if pain remains administer another tablet (can administer up to 3 tablets)
"I have to turn the volume up on the TV to hear it."
An older adult client who has an infection is prescribed gentamicin. which of the following client statements indicates a side effect of the medication and should be reported to the provider immediately?
Manifestations of digoxin toxicity
Anorexia, vomiting, confusion, headache, and vision changes
Reversal agent for Butorphanol
Naloxone
Adverse Effects of Prednisone
Elevated blood glucose, increased blood pressure, alteration in memory (chronic use); EDEMA r/t sodium and fluid retention
Disulfiram (Antabuse)
Aversion therapy to help maintain abstinence from alcohol. Therapy must not begin until client has abstained for alcohol for at least 12 hr and preferably for 48 hr
Pt. teaching for baclofen (Lioresal) therapy
Avoid driving until drug effects are evident; take with milk or meals; may cause constipation
ACE INHIBITORS Pt. Teaching
Avoid salt substitutes
Vasodilator side effects
HEADACHE; cyanide toxicity; dizziness and profound hypotension
Findings to report in client taking hydroxyurea
Hemoglobin 4.2 g/dL Platelets 75,000/ mm3 Neutrophils 1,400/ mm3
Heparin pt. teaching
Heparin does not dissolve clots; it stops new clots from forming
Statin Adverse Effects
Hepatotoxicity and Myopathy
Beta blocker nursing interventions
Hold if sys. <100 or HR <60 Monitor diabetics for signs of hypoglycemia
How to administer beta2 agonist and a glucocorticoid
Inhale beta2 agonist before inhaling the glucocorticoid
Formoterol and Salmeterol
Inhaled long acting beta2 agonist
How to inject heparin into the deep subcutaneous route.
Inject medication into the abdomen above the level of the iliac crest at least 2 inches from the umbilicus; 25-26 gauge needle; 1/2-5/8 inch needle; apply firm pressure for 1-2 minutes after injection without massage
Levothyroxine overdose signs and symptoms
Insomnia, diarrhea and hyperactive DTRs
Order of Mixing NPH and Regular Insulin
Inspect vials for contaminants; roll NPH vial between palms of hands; inject air into NPH insulin vial; inject air into regular insulin vial; withdraw short acting insulin into syringe; add intermediate insulin to syringe
Medication used for client with prostate cancer
Leuprolide (Lupron)
Enoxaparin (Lovenox)
Low molecular weight heparin that does not require monitoring
Correct administration of biscacodyl (Dulcolax) suppository
Lubricate index finger, LEFT lateral position, don gloves, and insert suppository just beyond the internal sphincter
Tranylcypromine pt. teaching
MAOIs; causes orthostatic hypotension
Warfarin is incompatible with...
Multivitamins
Nurse caring for patient taking naproxen; which comments by the client requires further discussion by the nurse
NSAIDS like Naprosyn can cause serious adverse GI reactions such as bleeding, ulceration and perforations. Warning manifestations such as N/V; GI burning and blood in still should be reported by the client and require further investigation
Vasodilators
Nitroglycerin; hydralazine; nitroprusside and enalaprit *rapid reduction of BP
Universal blood donor
O
Beta Blockers
ON CARDIAC and KIDNEY; decrease myocardial output, excitability, oxygen demand and decrease release of renin in kidney (low BP)
Terbutaline
Oral long acting beta2 agonist (long term control of asthma)
Gentamicin Adverse Effects
Ototoxicity
Alpha Adrenergic Blockers (sympatholytics)
PRAZOSIN AND DOXAZOSIN MESYLATE peripheral arterial and venous dilation & decreased BP
Sumatriptan therapeutic use
SELECTIVE SEROTONIN RECEPTOR used to treat migraine headaches
Sympatholytics
Take at bedtime; No NSAIDs
Client taking oral contraceptive reports that she forgot to take one pill. What instruction should be given?
Take the missed dose along with the next dose
Ibuprofen administration
Take with or immediately after meal to prevent gastric irritation
Oprelvekin
Thrombopoetic factor
________ (or _______) changes medications into less active or inactive forms by the action of enzymes. This occurs primarily in the ______, but also takes place in the ____, lungs, bowels, and _____.
metabolism, bioavailability, liver, kidneys, blood
Diphenoxylate/atropine adverse effects
abdominal distention and dry mouth
______ is the transmission of medications from the location of administration (GI tract, muscle, skin, or subcutaneous tissue) to the bloodstream.
absorption
Epinephrine auto injector pt. teaching
administer IM; store @ room temp. in dark area; should only need one injection; massage site for 10 seconds after injection
Phenytoin medication administraiton
administer a saline solution after injection
Pt. teaching on ferrous iron administration
administer with fruit juice and NOT with milk, meals or yogurt
Priority intervention for client with Wernicke's encephalopathy
administration of thiamine (Vitamin B1)
Adverse effect of rapid discontinuation of Prednisone
adrenocortical insufficiency
The _____ _____ is an undesired, inadvertent, and unexpected dangerous effects of the medication on the body.
adverse effect
The ______ process can also influence medication metabolism but it varies by individual.
aging
Inhalation of medications are rapidly absorbed through _____ ______ network.
alveolar capillary
A nurse is caring for a PT who is taking oral oxycodone (Percolone). The PT also states that is is taking ibuprofen (Advil) in three recommended doses daily. The interactions between these two medications will cause...
an increase in the expected therapeutic effect of both medications
______ reactions is a life-threatening, immediate allergic reaction that causes respiratory distress, severe bronchospasm, and cardiovascular collapse. It can be treated with _____, _____, and ____.
anaphylactic, epinephrine, bronchdilators, antihistamines
An _______ is a medication that can block normal receptor activity regulated by endogenous compounds or receptor activity caused by other medications.
antagonist
An _______ is a medication that can block normal receptor activity regulated by endogenous compounds.
antagonist
Bone marrow depression/suppression is generally associated with _____ medications, and haemorrhagic disorders with _______ and _____.
anticancer, anticoagulants, thrombolytics
Amitriptyline adverse effects
anticholinergic effects such as urinary retention
Ginseng drug interaction
antidiabetic medications (increase hypoglycemia)
Nephrotoxicity may occur with a number of medications, but it is primarily the result of certain _____ agents, and _____.
antimicrobial, NSAIDs
Transdermal Nitroglycerin administration
apply patch in the morning; leave on for minimum of 12hr; apply close to chest area; if patch becomes loose or falls off put another one on a different site; apply a new patch daily
A MDI in inhalation med. administration stands for...
metered dose inhaler
Cardioselective beta blocker (beta 1)
metoprolol (lopressor), atenolol (tenorman) and metoprolol succinate (toprol XL)
Tamoxifen pt. teaching
call the doctor if you notice any unusual menstrual bleeding
Digoxin toxicity
can be caused by HYPOKALEMIA; halos around objects
Side effect of aluminum based antacids
chalky taste and constipation
A medication ______ is how a medication may be organized according to therapeutic effect, pharmacological action, body system, chemical makeup, and safe use during pregnancy.
classification
Aspirin contraindications
client w/ hemmorhagic stroke
Timolol precautions
client with history of bradycardia
Adverse effects of Zileuton (Zyflo)
conjunctivitis, ABDOMINAL PAIN, jaundice (hepatotoxicity), constipation and headache
_______ substances have a potential for abuse and dependence, and are categorized into schedules I-IV. Schedule I has ___ medical use while schedules II-IV have approved _____. Each level has a(n) _____ risk of abuse and dependence.
controlled, no, applications, decreasing
Ipratropium bromide (Atrovent)
could increase intraocular pressure (monitor in pts. with glaucoma) VISUAL CHANGES should be reported
Controlled substance guidelines
count each dose of narcotic in inventory, match number of available doses to record and sign acceptance of narcotic count if correct
When administering vaginal suppositories, position the PT in the ____ _____ position and insert using an _____.
modified lithotomy, applicator
Through the ____ route, medications must pass through the layer of epithelial cells that line the GI tract.
oral
Antihypertensive medications can cause _____ _____.
orthostatic hypotension
High ceiling loop diuretic adverse effect
ototoxicity/tinnitus !!!
Mannitol therapeutic use
decrease intraocular pressure
Colchicine (Colsalide) use
decrease joint inflammation
Therapeutic effect of Levothyroxine (Synthroid)
decreased TSH
Methylphenidate therapeutic effects
decreased activity and increased attention span
Expected finding in pt. taking pancreatic enzymes
decreased fat in stools
Early sign of circulatory overload
dyspnea
S&S of circulatory overload
dyspnea, cough, rales, tachycardia and JVD
Furosemide pt. teaching
eat food w/ plenty of potassium; avoid Aspirin and NSAIDs; take Tylenol instead
When giving sublingual medication, the PT shouldn't ____ or _____ while the tablet is in place.
eat, drink
A nurse is monitoring a client receiving parenteral lipid infusion. Which of the following findings is the HIGHEST priority to report to the provider
elevated temperature because this indicates allergic response or fat overload syndrome
When administering oral or enteral medications, make sure that the PT has an ______ stomach, __ hour(s) before meals and ___ hour(s) after meals.
empty, 1, 2
When administering nasogastric or gastronomy tube medication, do not mix it with _____ _____. To prevent clogging, flush the tubing _____ and ____ each medication with ___ mL of warm sterile water. When the administration of meds. is complete, flush with ___ mL of warm sterile water.
enteral feedings, before, after, 15, 15
The most common routes of administration are _____ (____ ____) and _____ (by ______).
enteral, GI tract, parenteral, injection
Through the oral route, medications must pass through the layer of ______ cells that line the ____ tract.
epithelial, GI
Findings associated with phlebitis
erythema, throbbing, warmth at injection site and streak formation
Lithium pt. teaching
expect control of manic symptoms 7-10 days after starting lithium therapy
Clozapine (Clozaril) adverse effects
fatigue, seizures and orthostatic hypotension
Black Cohosh drug interaction
fertility medications
The ____-____ effect occurs with some oral medications are inactivated on their first pass through the liver and may require a higher dose to achieve a therapeutic effect, or must be given by a nonenteral route.
first-pass
If sublingual/buccal medications are swallowed before being dissolved, _____ _____ may inactivate medication.
gastric pH
A ______ name is the official or nonproprietary name that is given to a medication.
generic
Amoxicillin/Clavulanic acid contraindications
patient with penicillin allergy
